Each year approximately 5000 children fall from windows in the US, often sustaining serious injury. Little remains known about modifiable environmental risk factors for preventing these falls. Researchers at the Harborview Injury Prevention and Research Center conducted a pilot study to examine methods for studying factors associated with window design with interest in the presence of a window screen as risk factors. Windows through which children had fallen were matched to control windows in the same home and in the home of an age/gender matched child. Cases were identified when children were treated for window falls in the emergency department; controls were selected from among children treated for injury other than window falls. We measured the presence of a screen as well as the static resistance of these screens. Measurements included the minimum applied force at which the screen failed and the proportion that failed below calculated clinically-relevant thresholds. We obtained data on 18 case windows, 18 in-home control windows and 14 matched out-of-home controls, from April 1 to October 31, 2009. Of the 18 cases, 12 cases had screens that could be tested with 11 in-home control screens. Of the 14 controls, there were 12 screens eligible for testing. Approximately 50% of case screens and in-home matched control screens failed at 22 Newtons or less compared to 16.7% of the community control screens that failed at this level. At 44 N, no significant difference in failure proportion was observed. A case control study of window design and screen factors is possible. Screen presence does not appear to be a risk factor for pediatric window falls, however, screens in case households appear more likely than screens in community control homes to fail at levels of applied pressure comparable to the weight of a child leaning against the mesh.

Rotavirus, which causes severe diarrhea in infants, is thought to be a frequent complication following neonatal intestinal surgery; however, no data exists to corroborate this. Post-surgical neonates are especially vulnerable to the effects of rotavirus-like symptoms, so efficient diagnosis and treatment is important. We sought to measure the actual incidence of post-surgical rotavirus infection in this population. This data could help doctors more quickly distinguish rotavirus from surgical complications or other illnesses in order to diagnose and treat these babies more effectively. A retrospective review was performed of all neonates who underwent abdominal surgery at Seattle Children’s Hospital from 2001-2006. An additional cohort of children with severe intestinal failure managed in the hospital’s Intestinal Failure Program was reviewed. Data collection included admission dates, surgical diagnosis, and the results of all stool samples sent to the microbiology laboratory for rotavirus testing. 183 neonates underwent abdominal surgery during this period, and 81 (44%) had stool samples tested for rotavirus. 18 (9.8%) neonates were positive for rotavirus infection at a median age of 1.4 months. This reflects a rotavirus positive rate of 22% for all infants tested. Of infected patients, 15 (83%) were positive during their initial inpatient stay, and rotavirus infection did not differ by surgical diagnosis. In the group from the Intestinal Failure Program, 34 (61%) children were tested for rotavirus with 7 (20.6%) found to be positive. The incidence of rotavirus infection in these kids was 12.5%. Our results show that while surgical neonates frequently present with symptoms resembling rotavirus infection, only about 10% of these patients are actually infected with the virus during their admission. This leads to the conclusion that rotavirus in surgical neonates is much less common than the high frequency of testing might suggest.

 The purpose of this project is to design a drill guide for use in arthroscopic shoulder surgery. The clinical problem addressed is reattachment of the torn anterior labrum to the glenoid bone of the shoulder joint. An unrepaired torn labrum can lead to shoulder instability with recurrent dislocations. In the current repair method, the surgeon arthroscopically places suture anchors into the glenoid bone and then secures the labrum into near anatomic position with a series of knots. Suture anchors are metal or bioabsorbable screws that secure sutures to bone. Suture anchor use can lead to problems including shoulder weakness, stiffness, instability and/or pain any number of years after surgery. The project develops an alternative surgical method for treatment of labral tears sans suture anchors. A drill guide will be designed to permit accurate drilling of a bone tunnel via which a suture can be passed. The project will first determine the proper diameter and angle in which the hole should be drilled by using a Sawbones® model. Braided, non-absorbable sutures will be passed through the hole drilled into the glenoid bone and through the labrum tissue. The suture will secure the labrum tissue to the glenoid bone. This construct, the labrum sutured to the glenoid bone, will be loaded in compression, tension, and torsion and stiffness of the glenoid rim will be determined. Three different drill guide designs will be fabricated based on the results of stiffness testing and will be drawn and evaluated using Solidworks. The highest ranked tool will be fabricated from stainless steel. The drill guide prototype will be tested using Sawbones and a cadaver model. The labral repair to bone will be loaded biomechanically as described above, and the tool modified as necessary. The final drill guide prototype will be described and surgical protocol recommended.

Despite the pervasiveness of dental caries in children, current technology does not offer an inexpensive, safe, and effective method of early detection. The Scanning Fiber Endoscope (SFE) is an optical device with the potential to efficiently detect early caries. The small size of the SFE would allow it to reach difficult surfaces such as the biting surface of teeth, where caries are common. Unlike many current caries detection devices, the SFE does not use x-rays, but visible light. This study examines the effectiveness of SFE imaging in the early detection of dental maladies, especially caries. The fluorescent, high-resolution, and spectral analysis capabilities of the SFE are tested on extracted teeth to identify the optimal method of identifying dental maladies. Images from the SFE are compared to photographs to determine their diagnostic advantages. Continuing studies will encompass the long-term potential of the SFE as a preventative dental diagnostic tool.

Cisplatin is a platinum-based chemotherapeutic agent that is used in a wide variety of anti-cancer treatments. Unfortunately, one of its side effects is hearing loss due primarily to damage of sensory hair cells in the inner ear. Exactly how cisplatin enters and subsequently affects the hair cells is far from being understood, and knowledge of this is essential for developing methods of preventing hearing loss associated with cisplatin therapies. To study cisplatin uptake and subsequent toxicity, we will use the zebrafish lateral line, which contains hair cells that are quite similar in structure, function, and drug sensitivity, including cisplatin sensitivity, to vertebrate inner ear hair cells. My current work aims to chemically synthesize novel, fluorescently-labeled cisplatin derivatives. The synthesis is a five-step process that uses a chelating diamine to link the platinum complex with fluorescent dyes. Using fluorescent microscopy, these derivatives will then be applied to hair cells to 1) characterize uptake kinetics of the derivatives, 2) identify possible uptake mechanisms by hair cells, and 3) track intracellular movement of cisplatin during cisplatin-induced hair cell death. Successful completion of these experiments will mark an important step towards evaluating and understanding possible entry routes of cisplatin into hair cells, with the goal of preventing cisplatin-induced hair cell death.