Donald Holbert

Use of Oxygen Cannulas in Extremely Low Birthweight Infants is Associated with Mucosal Trauma and Bleeding, and Possibly with Coagulase-negative Staphylococcal Sepsis

OBJECTIVE: We studied the association between the use of oxygen cannulas (OCs) and (1) nasal bleeding and (2) coagulase-negative staphylococcal sepsis (CNSS).STUDY DESIGN: Review of care sheets, with χ 2 or sign-test group comparisons.RESULTS: Infants treated with OCs were suctioned more frequently (2.6 vs 1.3 times per day, p<0.001), and had more bloody nasal secretions (34.6% vs 4.6%, p<0.05) that increased with increasing OC days. By 10 days, 90% of infants had experienced bloody secretions.CNSS occurred less often in infants treated with oxyhoods than those on OC or CPAP (1 of 13, 8%, vs 10 of 44, 23%), but the difference was not significant. Eight of the 10 CNSS episodes clustered within 3 and 7 days of starting CPAP or cannula treatments.CONCLUSION: OC use in extremely low birthweight infants is associated with nasal mucosal injury and bleeding. Studies are needed to see if use of OCs is a risk factor for CNSS.

Modeling survival in colon cancer: a methodological review

The Cox proportional hazards model is the most widely used model for survival analysis because of its simplicity. The fundamental assumption in this model is the proportionality of the hazard function. When this condition is not met, other modifications or other models must be used for analysis of survival data. We illustrate in this review several methodological approaches to deal with the violation of the proportionality assumption, using survival in colon cancer as an illustrative example.

An 18-yr prospective study of pediatric diabetic ketoacidosis: an approach to minimizing the risk of brain herniation during treatment

Background:  During the late 1900s, raised intracranial pressure (ICP) during treatment of pediatric diabetic ketoacidosis (DKA) surfaced as the most important cause of morbidity and mortality in pediatric DKA. The contribution of fluid and electrolyte therapy to neurologic deterioration during treatment remains controversial.

Can within-category naming identify subtle cognitive deficits in the mild traumatic brain-injured patient?

BACKGROUND This investigation examined the effect of a speeded, computer-controlled task on detecting differences in latency and accuracy of within-category name generation in adults having sustained a mild traumatic brain injury (MTBI). METHODS Twenty-four adults in acute recovery and 24 age-matched controls were instructed to view 72 pictures on a computer monitor, and then name another item belonging to the same category as the visual stimulus as quickly as possible. RESULTS The MTBI group demonstrated significantly longer latencies (p < 0.001) and lower accuracy (p < 0.001) than the control group. Both groups displayed similar patterns of response, although the MTBI group produced significantly more perseverative errors (p < 0.001). No significant correlations were found between performance on the Scales of Cognitive Ability for Traumatic Brain Injury and response latency or accuracy. CONCLUSION The MTBI group performed the task significantly slower and less accurately than controls. Reaction time measures may prove more sensitive than traditional assessment measures in detecting subtle difficulties.

Compliance With Food Safety Recommendations Among University Undergraduates: Application of the Health Belief Model

Compliance with food safety recommendations was assessed among 357 university undergraduates, 112 males (31%) and 245 females (69%), in the context of the health belief model. Concerning meats, 87% of the students complied with purchasing, 75% with storage, and 42% with preparation recommendations often/always. Compliance was high with recommended purchasing (96%) and storage (99%) practices for raw eggs, but only 55% of students prepared eggs safely. Overall, the health belief model was a poor predictor of compliance with food-safety recommendations. Findings suggest that college students would benefit from interventions focusing on the causes of microbial food contamination and those that assist them in overcoming perceived barriers to adopting safe food-handling practices. Also, validated instruments are needed to help family and consumer sciences educators identify college students who are noncompliant with food-safety recommendations.

The Effect of an Effortful Swallow on the Normal Adult Esophagus

The effect of an effortful swallow on the healthy adult esophagus was investigated using concurrent oral and esophageal manometry (water perfusion system) on ten normal adults (5 males and 5 females, 20–35 years old) while swallowing 5-ml boluses of water. The effects of gender, swallow condition (effortful versus noneffortful swallows), and sensor site within the oral cavity, esophageal body, and lower esophageal sphincter (LES) were examined relative to amplitude, duration, and velocity of esophageal body contractions, LES residual pressure, and LES relaxation duration. The results of this study provide novel evidence that an effortful oropharyngeal swallow has an effect on the esophageal phase of swallowing. Specifically, effortful swallowing resulted in significantly increased peristaltic amplitudes within the distal smooth muscle region of the esophagus, without affecting the more proximal regions containing striated muscle fibers. The findings pertaining to the LES are inconclusive and require further exploration using methods that permit more reliable measurements of LES function. The results of this study hold tremendous clinical potential for esophageal disorders that result in abnormally low peristaltic pressures in the distal esophageal body, such as achalasia, scleroderma, and ineffective esophageal motility. However, additional studies are necessary to both replicate and extend the present findings, preferably using a solid-state manometric system in conjunction with bolus flow testing on both normal and disordered populations, to fully characterize the effects of an effortful swallow on the esophagus.

Choral reading with filtered speech: effect on stuttering.

This study investigated use of choral reading with filtered components of speech and whispered speech on the frequency of stuttering. Three passages read by a normal adult male were lowpass filtered with kneepoint frequencies at 100 Hz (approximate glottal source), 500 Hz (source and first formant), and 1 kHz (source and the first two formants). Along with a whispered passage, a normal passage, and a control condition, these stimuli were used in a repeated-measures design with 12 adult stutterers as they read passages while listening to one of the stimuli. Frequencies of stuttering in each condition were analyzed. The choral speech, the 500-Hz, the 1-kHz, and the whispered speech conditions all decreased the frequency of stuttering while the 100-Hz stimuli did not. It is suggested that articulatory events, chiefly the encoded speech output from the vocal tract, create effective cues and may induce fluent speech in people who stutter.

The effects of mild traumatic brain injury on confrontation naming in adults

Primary objective: To compare confrontation-naming in adults with MTBI to a group of normal adults under increased processing load conditions. Research design: A randomized block, repeated measures design was used to examine confrontation-naming response latency and accuracy using a computerized experimental program. Methods and procedures: Twenty-four adults having sustained a MTBI (aged 18–53) and 24 age-matched controls named pictures from three levels of vocabulary as quickly and accurately as possible. All MTBI participants were assessed with the Scales of Cognitive Ability for Traumatic Brain Injury(SCATBI) for later comparison. Main outcomes and results: The results revealed a main effect of group ( p ≤ 0.001) for the latency data and a group by vocabulary level interaction ( p = 0.043) for the accuracy data. No significant correlations were found between response latency and accuracy with performance on the SCATBI. Reaction time measures may reveal inefficiencies not tapped by traditional measures.

Personality Traits of Smokeless Tobacco Users and Nonusers: A Comparison

This study investigated the personality characteristics of male university students who were either users or nonusers of smokeless tobacco. The hypotheses attempted to determine any differences in personality characteristics between users and nonusers of smokeless tobacco, and examine differences in personality characteristics according to the amount of smokeless tobacco used. A university sample of 289 males revealed 19% (55) prevalence of smokeless tobacco users. Each subject was administered Cattells Sixteen Personality Factor Questionnaire and a demographic questionnaire. An analysis of variance revealed that smokeless tobacco users exhibited significant differences (p less than .01) in both personality characteristic A (more reserved, less outgoing socially) and personality characteristic I (self-reliant, less sentimental), and significant difference (p less than .05) in personality characteristic Q2 (more conforming, group dependent). No significant differences were noted in personality among persons who used varying amounts of smokeless tobacco.

Prevalence of smokeless tobacco use in Pitt County, North Carolina.

The purpose of this study was to estimate the prevalence of smokeless tobacco use in the largest tobacco-producing county in the United States. A 1-in-100 systematic random telephone sample was taken from the county telephone directory. A total of 280 complete questionnaires were obtained. Results indicate that .40 +/- .042 [p +/- SE(p)] males and .09 +/- .024 of females use smokeless tobacco. The point prevalence for the total population was estimated to be .15.