Primary follow-up care in a multidisciplinary setting enhances catch-up growth of very-low-birth-weight infants.

OBJECTIVE: To determine the impact of multidisciplinary primary care follow-up, which included the services of a registered dietitian, on growth outcomes of very-low-birth-weight (VLBW) infants. DESIGN: Data were obtained retrospectively from medical records. Forty-two infants receiving follow-up care on an as needed basis from the general pediatric clinic were compared with 33 infants receiving multidisciplinary follow-up care that included routine nutrition intervention from the comprehensive care clinic. Comparisons were made in weight, length, and head circumference measurements; growth rates; and catch-up growth (defined as > or = 5th percentile on growth charts of the National Center for Health Statistics attained by 12 months growth-corrected age). SUBJECTS: VLBW infants (< or = 1,500 g at birth) were selected from both follow-up groups. STATISTICAL ANALYSIS: Chi 2 Analysis compared the proportions of infants in each group who achieved catch-up growth. Unpaired t tests compared group means in weight, length, and head circumference measurements and growth rates. RESULTS: The two groups differed significantly in the number of infants exhibiting catch-up growth for length and head circumference. At 8 months growth-corrected age, 7 (28%) of the general pediatric clinic infants were at the 5th percentile or greater for length compared with 21 (64%) of the comprehensive care clinic infants (P < .01); 15 (60%) of the general pediatric clinic group and 30 (91%) of the comprehensive care clinic group were at the 5th percentile or greater for head circumference (P < .05). At 12 months growth-corrected age, 12 (57%) of the general pediatric clinic infants and 26 (87%) of the comprehensive care clinic infants were at the 5th percentile or greater for length (P < .05); 11 (52%) of the general pediatric clinic infants and 27 (90%) of the comprehensive care clinic infants were at the 5th percentile or greater for head circumference (P < .05). APPLICATIONS: Multidisciplinary primary care follow-up that includes the services of a registered dietitian for nutrition intervention can enhance the catch-up growth of VLBW infants through 12 months growth-corrected age.

Market research to recruit graduate students in dietetics.

In this study we conducted market research to develop a recruitment plan for the master's degree program in nutrition and dietetics at Louisiana Tech University. When individualized experience routes to dietetics registration were eliminated by The American Dietetic Association's Standards of Education in 1988, graduate student enrollment could not be predicted. The steps of the Baron graduate recruitment model were followed to develop and implement a recruitment plan for the master's degree program in nutrition and dietetics. The steps included (a) assessment, (b) developing recruitment and enrollment objectives, (c) developing a recruitment plan and recruitment strategies to meet the objectives, (d) implementing a recruitment program, and (e) monitoring and evaluating the recruitment program. The assessment step involved institutional, student, competitive, and job market analyses. Written questionnaires, telephone surveys, and focus group interviews completed the student analysis. Of the 92 respondents surveyed, 42 were interested in taking graduate classes. Career advancement, specialization, and personal growth were cited as reasons to pursue graduate study. The Baron model provided a useful guide for developing and implementing the graduate recruitment plan.

A process for preparation of 'high-purity' factor VIII by controlled pore glass treatment.

A simple process for large-scale manufacture of 'high-purity' factor VIII is described in detail. A crude concentrate prepared from washed cryo is treated with controlled pore glass (CPG, 500 A pore diameter) in proportion of 20-30 ml of CPG to 1 g input of protein. The slurry is poured into a separation column and the effluent purified concentrate collected. The remaining factor VIII in the void volume is displaced by a wash solution. After passage through a 0.2 micron membrane filter the product is dispensed and lyophilized. Maintaining the operating pH at 6.5-6.7 and adding synthetic amino acids improved the yield and solubility. The current concentrate contains 1 unit of factor VIII per mg protein (10 units mg fibrinogen) with a recovery of 250 units/kg plasma. The CPG stage is non-destructive, yielding more than 90% of the input factor VIII. In 1980-1983, more than 3 X 10(6) units have been used in New South Wales, mostly for massive cover in surgical patients. In collaboration with the Commonwealth Serum Laboratories, it is intended to expand production for use in other Australian States.

Curriculum evaluation: a crucial component of dietetic programs.

The Nominal Group Technique was used to evaluate the existing CUP curriculum at Louisiana Tech University. Forty-five persons involved in the program participated in one of three workshops. The nominal group process successfully generated ranked and weighed "problem" statements to be addressed in program revision. The NGT allowed input from all individuals, leading to the clinical practitioners "owning" the crucial clinical experience component of the coordinated undergraduate program.

Prothrombin times: an evaluation of four thromboplastins and four machines.

The prothrombin times of 63 patients on oral anticoagulant therapy were tested using 4 different thromboplastins; 2 rabbit brains (Simplastin & Ortho), human placenta (Thromborel) and human brain (Australasian Reference Thromboplastin--ART). Four machines measuring the one-stage prothrombin times were compared with the manual method. Each of the machines and thromboplastins showed highly reproducible and predictable results, but there were differences in thromboplastin sensitivities which would pose major therapeutic problems. A system of correcting ratios of different thromboplastins to a reference preparation would overcome these differences in thromboplastin sensitivities. All thromboplastins gave comparable results with the Clotek, MLA 600 and Coag-A-Pet machines and manual method. Cortek gave comparable ratios with the ART but not with any other thromboplastin.

Red cell stroma, a stable standard for assessment of platelet procoagulant release.

Platelet function in vitro may be investigated in various ways. One of the accepted methods involves examination of platelet procoagulant release. Optimal conditions relating to maximal release have not been defined. Red cell stroma phospholipid can substitute for the platelet procoagulant in many in vitro tests (Quick et al., 1954, 1957; Margolis, 1961; Lovric & Margolis, 1964). Using a multiple channel coagulation meter, an assay system was developed for testing both red cell stroma and platelet procoagulants. Maximum procoagulant release was obtained by lysing in alkaline hypotonic solutions or by sonication. The system was tested in a one-stage kaolin-activated platelet-free plasma substrate, obtained from fresh pooled citrated plasma. With this method the amount of available procoagulant could be related to the numbers of red blood cells or platelets. The results indicated that one platelet provided procoagulant equivalent to that derived from 0.7 red cells. Procoagulant release was studied under various conditions and expressed in terms of stable (red cell) standard. Platelets subjected to hypotonic stress or factor 3 release (Hardisty test) were studied quantitatively. The addition of sulphinpyrazone (Anturan) had no observable effect on platelet release in this system.

Preparation of stable intermediate-purity factor VIII concentrate with a note on high-purity factor VIII.

Cryoprecipitate prepared by a rapid thawing technique was pooled in batches of 600--720 donor units and washed with ice-cold Tris-citrate-NaCl solution. After dissolving at 37 degrees C, it was adsorbed with Al(OH)3 and kaolin, and cleared by centrifugation. The supernatant, diluted with 5% dextrose was passed repeatedly through a bed of Celite, filtered through a 293 mm X 0.3 micrometer membrane disc and lyophilized. Typical composition was 15 U . ml-1 factor VII, and 40 mg . ml-1 protein with a yield of 300 U/l of starting plasma. The crude factor VIII concentrate was also a suitable material for preparation of high-purity factor VIII by controlled pore glass chromatography.

CROSS-VALIDATIONAL EVIDENCE ON THE DIMENSIONS OF PROBLEM BEHAVIOR IN THE EARLY GRADES.

One hundred forty-seven children in the first through the third grades were rated by their teachers on a behavior problem inventory employed in previous studies. The data were subjected to a principal axis factor analysis and rotated to an oblique position. Congruence coefficients were computed among the twelve factors resulting from the current analysis, and the eight factors extracted in an earlier study. Six of the factor matches were significant at or beyond the .O1 level. Five of these matches had a sufficient number of salient variables common to the two studies. The five dimensions meeting the consideration of significance of congruence across samples and sufficient common salients were termed, in an earlier study, Hyperactivity, Sluggishness, Paranoid Tendencies, Social Withdrawal, and Acting Out. The evidence of the predictive validity of these was briefly discussed.