Showing papers by "University of Vermont published in 1980"

Evaluation of patients with advanced cancer using the karnofsky performance status

Abstract: The Karnofsky Performance Status Scale (KPS) was designed to measure the level of patient activity and medical care requirements. It is a general measure of patient independence and has been widely used as a general assessment of patients with cancer. Although there is a long history of use of the KPS for judging cancer patients, its reliability and validity have been assumed without formal investigation. The interrater reliability of the KPS was investigated in two ways, both of which gave evidence of moderately high reliability. The patients evaluated in their home were usually assigned a lower KPS score compared with a similar evaluation at the same time done in the outpatient clinic. Construct validity of the KPS was demonstrated by strong correlation with several variables relating to physical function. Onstudy KPS scores accurately predicted early death, but high initial KPS scores did not necessarily predict long survival. Patient deterioration with subsequent death within a few months could be predicted to a limited extent by a rapidly dropping KPS. These results suggest that the KPS has considerable validity as a global indicator of the functional status of patients with cancer and might be helpful for following other patients with chronic disease. Cancer 45:2220-2224, 1980. ITH THE INCREASE in clinical trials designed to W evaluate chemotherapeutic agents in the treatment of cancer, it became evident that some method of quantifying patients’ status relative to degree of independence in carrying out normal activities and selfcare was needed. In 1948, Karnofsky and Burchena15 described a numerical scale for this purpose. This has subsequently become known as the Karnofsky Performance Status Scale (KPS). Although the KPS is widely used for assessment of patients with cancer, its reliability and validity have generally been assumed without formal investigation. In this paper we evaluate the reliability and validity of the KPS and its usefulness as a clinical tool. An earlier study from this institution of patients on chronic hemodialysis demonstrated lower performance scores for patients when seen in the home as compared with the clinic.3 The conclusion was that a more realistic appraisal of activity was possible in the home. Concurrent home and clinic evaluations were planned as a part of this study.

Early and Late Repair of Lateral Ligament of the Ankle

Abstract: Utilizing an apparatus for separately testing the status of the anterior talofibular and the calaneofibular ligaments of the ankle in 25 healthy, 15 to 30-year-old adults, it became apparent that t

Early Diagnosis of Neonatal Sepsis

Abstract: To better define the need for antibiotic therapy, several tests recommended as helpful in diagnosing neonatal sepsis were evaluated in 376 neonates during the first week after birth. The five most useful tests (with definitions of abnormality) were: band/total neutrophils (greater than or equal to 0.2); leukocyte count (less than 5,000/cu mm); latex-C-reactive protein (positive greater than 0.8 mg/100 ml); ESR (greater than or equal to 15 mm for the first hour); and latex haptoglobin (positive greater than 25 mg/100 ml). When these five tests were applied early (at the time infection was suspected and blood culture sent), 28 of 30 cases (93%) subsequently proven to have infection had two or more abnormal tests. This compares with only 24 of 320 babies (8%) with no subsequently documented evidence of infection. Of all babies who had two or more tests positive (n = 71), 39% had proven sepsis, and an additional 23% had "very probable" infection. The combination of leukopenia and an elevated band/total neutrophil ratio seems to be particularly predictive of sepsis (13 of 17 babies with this combination had proven sepsis). When less than two tests were positive, the probability that sepsis was not present was 99%. These simple, rapid tests require no special laboratory facilities and provide a valuable adjunct in the early detection of the neonate with sepsis.

Conditioned fear assessed by freezing and by the suppression of three different baselines

Abstract: Rats received either forward or backward pairings of an auditory CS and shock. They were then tested for conditioned suppression to the CS while barpressing for food, licking a sucrose solution, or being spontaneously active. Behavior was simultaneously observed using a time-sampling method. In each case, forward-conditioned animals exhibited more freezing than controls, and freezing was reliably correlated with suppression of the baseline. These results suggest that the different loss-of-baseline measures of aversive conditioning reflect the amount of defensive behavior evoked by the CS. They also suggest the utility of freezing as an index of conditioning. Freezing assayed by the time-sampling method was comparable to the more conventional indices of conditioning in sensitivity to the effects of conditioning.

Meta-Analysis of the Effects of Stuttering Treatment

Abstract: Despite the many reports of stuttering treatment, there is little consensus either on the long term effectiveness of treatment or on which treatments are the most effective. The literature was searched for treatment outcome studies that reported sufficient data to allow a meta-analysis to be conducted. Forty-two studies covering the treatment of a total of 756 stutterers were located. In these studies the typical client was a 25-year-old severe stutterer who received 80 hours of symptom reduction treatment. Most studies used reliable measures of both stuttering and attitude to assess improvement some six months after treatment had ended. Treatment effects were calculated from 116 pre- and posttreatment pairs of measures. Average effect size was 1.3, which indicates that after treatment the groups of stutterers experienced a 1.3 standard deviation improvement in their pretreatment scores. Clearly, stuttering treatments can be beneficial, and the benefits appear comparable to other treatments in the health sciences. Prolonged speech and gentle onset techniques evidenced better gains in the short term and long term than either attitude or airflow techniques. These four seem preferable to any of the other reported treatments and were certainly better than no treatment.

Noise and hypoxemia in the intensive care nursery.

Abstract: Noise levels in the neonatal intensive care unit (NICU) have received intermittent attention in the pediatric literature.1-4 While risk criteria for the prevention of induced sensorineural hearing loss in adults are well established, little is known about the response of the newborn to environmental noise. The AAP Committee on Environmental Hazards3 has recommended that physicians and hospital personnel be alert to and eliminate unnecessary noise in nurseries. So far, attention has been directed primarily at incubator noise1,5 and that associated with life-support equipment.6 To our knowledge, little has been done to identify other sources of "noise pollution." We wish to report the results of measures taken in one NICU to quantitate and lower the ambient noise levels.

Excessive Handling as a Cause of Hypoxemia

Abstract: Continuous transcutaneous oxygen (TcPo2) monitoring was used to study low-birth-weight infants (15 control, 15 experimental) during their stay in the intensive care nursery (ICN). Twenty hours of continuous recordings were made of heart rate, respiratory rate, and TcPo2 in the first five days after birth. Personnel caring for the control infants were blind to the TcPo2 measurements. Those caring for the experimental group were instructed in the operation of the TcPo2 monitor and used the device to modify the timing and extent of procedures to minimize "undersirable time" (TcPo2 less than 40 or greater than 100 torr). Control group infants had an average of 40 min/20 hr in "undesirable time." When personnel used TcPo2 monitoring to modify care this "undesirable time" was reduced to 6 min/20 hr. This difference was statistically significant (P less than .001). Infants in the control group were handled more frequently, and experienced more hypoxemia. Of the hypoxemic time suffered by the control infants 75% was associated with handling. Only 5% of the hypoxemia or hyperoxemia was detected by blood Pao2 analysis or conventional monitors. Intermittent arterial blood gas sampling is an inadequate method for monitoring arterial oxygenation in low-birth-weight infants since hypoxemia and hyperoxemia are often missed. Continuous TcPo2 monitoring improves care by diminishing "undesirable time."

A major soluble glycoprotein of potato tubers

Abstract: The major soluble glycoprotein of potato tubers was isolated by chromatography on DEAE cellulose and Con A Sepharose. It contained about 5% neutral sugar and 1%hexosamine, exhibited a molecular weight of 45,000 by SDS gel electrophoresis, and consisted of 6–10 ionic forms as revealed by isoelectric focusing. This glycoprotein comprised about 20%of the soluble protein in all of the 31 tested potato cultivars.

Epidemiological Survey of Foot Problems in the Continental United States: 1978–1979∗

Abstract: Questionnaire cards were sent to 45,000 family shoe store customers; 15,000 cards were completed and returned, thereby permitting a broad statistical base in respect to the incidence and types of foot problems encountered in the United States. The incidence of corns, calluses, warts, ingrown toenails, bunions, hallux rigidus, hammer toes, cavus, and pes planus were correlated with age, sex, race, and demographic background, along with the incidence of surgery, conservative treatment, or no treatment. The extrapolated data indicated that 40% of the population have foot problems, of which 12% had surgery and 7% have been untreated.

A typology of child behavior profile patterns: distribution and correlates for disturbed children aged 6–16

Abstract: This article reports the construction of a typology of behavior problem patterns, as scored on the Child Behavior Profile. Hierarchical cluster analysis was used to identify reliable profile patterns that characterize clinically referred boys and girls aged 6–11 and 12–16. Procedures for classifying the profiles of individual children were developed and good agreement was obtained between classifications based on ratings by mothers and a clinician. The distribution of profile patterns was determined for each age and sex group. Children classified by different patterns were found to differ significantly in age, race, school performance, and amount and quality of participation in activities and social relationships. Issues in the application of cluster analysis to behavioral data were analyzed and various options for the classification of individual cases were compared.

Trends in skiing injuries Analysis of a 6-year study (1972 to 1978)

Abstract: The trends in skiing injuries showed a decrease during a study conducted over six seasons, 1972 to 1978, at a Vermont ski resort. Over 11,000 interviews were conducted and nearly 1,000 control skiers were evaluated. The injuries totaled 1,711 in 407,600 skier days. Upper body injuries (pelvis, trunk, neck, head, and upper extremities) totaled 713 (42%) and lower extremity injuries totaled 998 (58%). Eighty percent of the lower extremity injuries were classified as (potentially) equipment related. The overall injury rate decreased 41% (upper body, 25%; lower extremity equipment-related (LEER), 43%; and lower extremity nonequipment-related rate was down 71%). Knee sprains did not decline as rapidly as the tibial fractures and ankle sprains. An increase in the relative frequency of properly functioning equipment is primarily responsible for the decline in LEER injuries. Although the relative frequency of properly adjusted bindings is increasing, more than one-half of the equipment in use is still set higher than recommended. Cooperation between all individuals responsible for equipment design, manufacture, installation, and use must continue, if further improvements in alpine skiing safety are to be realized.

Electrical evidence for different mechanisms of uptake for basic, neutral, and acidic amino acids in oat coleoptiles.

Abstract: The application of neutral or acidic amino acids to oat coleptiles induced transient depolarizations of the membrane potentials. The depolarizations are considered to reflect H(+) -amino acid co-transport, and the spontaneous repolarizations are believed to be caused by subsequent electrogenic H(+) extrusion. The basic amino acids depolarized the cell membrane strongly, but the repolarizations were weak or absent. The depolarizations induced by the basic amino acids were weakly sensitive to manipulations of the extracellular and intracellular pH. The depolarizations induced by the other amino acids, in contrast, were more strongly affected by the pH changes. Several amino acids induced distinct but diminished depolarizations in the presence of 2,4-dinitrophenol or cyanide, but the repolarizations were generally eliminated. These experiments support the co-transport theory but suggest somewhat different mechanisms for the transport of the neutral, acidic, and basic amino acids. We suggest that the neutral amino acids are co-transported with a single H(+) and that accumulation depends upon both the DeltapH and the membrane potential components of the proton motive force. The acidic amino acids appear to be accumulated by a similar mechanism except that the transport of each molecule may be associated with a cation in addition to a single proton. The permanently protonated basic amino acids appear not to be co-transported with an additional proton. Accumulation would depend only on the membrane potential component of the proton motive force.

Ankle instability: evaluation of the lateral ligaments

Abstract: Bilateral ankle stress testing was performed on 25 subjects in a device which controlled position of the foot and the amount of force applied during the examination. Both inversion testing in the anteroposterior plane and anterior drawer testing in the lateral plane were performed in the same group of symptom-free patients. The reproducibility of the test was demonstrated. Previous history of injury, left vs. right handedness, side and anthropometric measurements did not affect the test. There was no difference in the inversion test between ankles tested in neutral and plantar flexion. In functionally normal ankles, the range of inversion "talar tilt" was 0 to 18 degrees while the maximum of anterior displacement on drawer testing was 3 mm. The effective stiffness of the anterior talofibular ligament was thus computed as 65 +/- 34 N/m. Anterior drawer testing appears to evaluate lateral ligamentous integrity of the ankle more critically than the talar tilt test.

Asbestos-induced epithelial changes in organ cultures of hamster trachea: inhibition by retinyl methyl ether

Abstract: The epithelium of the hamster trachea in organ culture undergoes hyperplasia and squamous metaplasia after exposure to the amphibole types of asbestos, crocidolite and amosite. These changes are inhibited when the synthetic vitamin A analog, retinyl methyl ether, is incorporated into the culture medium. These findings suggest a possible use for retinoids in the prevention and treatment of respiratory tract disease associated with environmental exposure to asbestos.

Insect populations respond to fluctuating environments

Abstract: Models of populations inhabiting regularly fluctuating environments suggest that the nature of the population fluctuation is determined by the relative sizes of the characteristic response time of the population, TR, and the period of the environmental variation. For example, May's1 model of a density-regulated population inhabiting a sinusoidally varying environment showed that when the characteristic response time was long relative to the period of environmental fluctuation, Y, the population averaged out environmental fluctuations, whereas for TR short relative to Y, the population tended to track environmental variations. Characteristic response time is a measure of how quickly a system returns to equilibrium following a disturbance, and for the logistic model and its immediate relatives, TR equals the inverse of population growth rate, r. The present study investigated the responses of populations of the flour beetle, Tribolium castaneum, cultured in a series of regularly fluctuating environments. Responses to environmental fluctuations were striking at all periods of environmental fluctuations, but population density declined as environmental period lengthened.

Cyclic loading in knee ligament injuries

Abstract: The effect of cyclic loading on knee ligaments was studied both in vivo and in vitro. The compliance of the medial collateral ligaments of athletes participating in hockey, basketball, soccer, and downhill skiing was determined by using a specially built machine. Tests were conducted before and after participation in the various sports. Most subjects tested showed an increased compliance after their respective sporting activities. This observation was confirmed in the laboratory by imparting cyclic loading to 10 people under controlled conditions. The in vitro studies were conducted on the medial collateral ligaments of rats. These were tested to determine the effect of cyclic loading on the strength and stiffness of the ligaments. Results show a clear relationship between decreased stiffness or softening and a reduction in strength of the ligament. The amount of softening was related to the cyclic stress in the ligament.

Solid-state structure and electronic properties of a mixed-valence two-dimensional metal, potassium copper sulfide (KCu4S3)

Abstract: Abstract : KCu4S3, prepared by the high temperature reaction of copper, potassium carbonate, and sulfur, crystallizes with a unique layered structure. Double layers of tetrahedrally - coordinated (by S) copper ions are separated by layers of potassium ions. Although formally a mixed-valence Cu(I,I,I,II) complex, all copper ions are crystallographically equivalent. Consistent with its Robin and Day Class III designation, KCu4S3 exhibits electrical conductivity characteristic of a metal. Room temperature compaction conductivities of ca. 4000/Ohm/cm increase to ca. 60000/Ohm/cm at 20K. The metallic nature of this two-dimensional material is supported by the temperature independent paramagnetism and the metallic reflectivity through the visible and near ultraviolet region of the spectrum. (Author)

β-adrenergic manipulation in amygdala central n. alters rabbit heart rate conditioning

Abstract: The present study was conducted to assess the effects of beta-adrenergic manipulation within the central nucleus of the amygdala on Pavlovian heart rate conditioning in the rabbit. Administration of the beta-adrenergic antagonist dl-propranolol into the central nucleus impaired the acquisition of conditioned heart rate responding compared to a vehicle injected control group. No significant effects of dl-propranolol on either baseline heart rate or on the heart rate orienting response were observed. The effect of dl-propranolol on conditioning exhibited stereospecificity, and animals receiving combined intracerebral injections of dl-propranolol and the beta-adrenergic agonist 1-isoproterenol did not exhibit comparable conditioning impairments. In addition, dl-propranolol administration dorsal to the central nucleus or into amygdala sites anterior or posterior to the central nucleus was less effective. These results support the interpretation that beta-adrenergic activity within the central nucleus region of the amygdala complex contributes to the acquisition of classically conditioned heart rate responding.

Presumptive tricuspid valve malfunction induced by a pacemaker lead: a case report and review of the literature.

Abstract: A 23-year-old woman developed 3 degrees AV block with syncope. Insertion of a permanent pacemaker lead was followed by the onset of a persistent murmur in late systole preceded by single or multiple clicks. The murmur was best heard at the left sternal edge, grade 3-4/6 with two major frequencies (60-250 Hz), increased with inspiration and on assuming the erect posture. It was considered to be tricuspid in origin and related to interference of the tricuspid valve apparatus by the pacemaker lead resulting in tricuspid regurgitation. No tricuspid valve prolapse or flutter was seen on echocardiography. Withdrawal of the pacemaker lead resulted in immediate disappearance of the new auscultatory findings. Review of the literature suggests that the appearance of such a murmur following pacemaker insertion could be associated with later complications in relation to tricuspid valve dysfunction. It is therefore recommended that, under these circumstances, permanent pacemaker leads should be appropriately repositioned.