Testing equality of survival functions based on both paired and unpaired censored data.

We introduce two test procedures for comparing two survival distributions on the basis of randomly right-censored data consisting of both paired and unpaired observations. Our procedures are based on generalizations of a pooled rank test statistic previously proposed for uncensored data. One generalization adapts the Prentice-Wilcoxon score, while the other adapts the Akritas score. The use of these particular scoring systems in pooled rank tests with randomly right-censored paired data has been advocated by several researchers. Our test procedures utilize the permutation distributions of the test statistics based on a novel manner of permuting the scores. Permutation versions of tests for right-censored paired data and for two independent right-censored samples that use the proposed scoring systems are obtained as special cases of our test procedures. Simulation results show that our test procedures have high power for detecting scale and location shifts in exponential and log-logistic distributions for the survival times. We also demonstrate the advantages of our test procedures in terms of utilizing randomly occurring unpaired observations that are discarded in test procedures for paired data. The tests are applied to skin graft data previously reported elsewhere.

Enteral glutamine supplementation for very-low-birth-weight infants decreases hospital costs.

BACKGROUND: There is growing evidence that glutamine may be a conditionally essential amino acid for critically ill patients, including preterm infants cared for in neonatal intensive care units (NICUs). In a randomized study of 68 very-low-birth-weight (VLBW) infants, we found evidence of lower morbidity in a group fed glutamine-supplemented preterm infant formula from postnatal day 3 to day 30 than in a group fed a standard formula. We report here the effects of the glutamine supplementation on hospital costs in these infants. METHODS: The costs were analyzed by log-rank tests and Kaplan-Meier plots. RESULTS: The median costs for hospitalization, radiology, pharmacy, laboratory, and the NICU, and the median number of utilization units were reduced with glutamine supplementation. CONCLUSIONS: This study provides the first evidence for decreased hospital costs in VLBW neonates who receive enteral glutamine supplementation.

Enteral glutamine supplementation for very low birth weight infants decreases morbidity.

Glutamine, described as a "conditionally essential" amino acid for critically ill patients, has not been routinely added to parenteral amino acid formulations for critically ill neonates and is provided in only small quantities by the enteral route when enteral intake is low. We conducted a blinded, randomized study of enteral glutamine supplementation in 68 very low birth weight neonates randomly assigned to receive glutamine-supplemented premature formula versus premature formula alone between days 3 and 30 of life. Primary end points consisted of hospital-acquired sepsis, tolerance to subsequent enteral feedings (days with no oral intake), and duration of hospital stay. Hospital acquired sepsis was 30% (control group) and 11% (glutamine group). Logistic regression with birth weight as a covariate showed that: (1) feeding group was significant (p = 0.048) in determining the probability of developing proven sepsis over the course of hospitalization and (2) the estimated odds of developing sepsis were 3.8 times higher for infants in the control group than for those treated with glutamine. Glutamine-supplemented infants had better tolerance to enteral feedings as measured by percent of days on which feedings needed to be withheld (mean percentage of 8.8 vs 23.8, p = 0.007). Analysis of T cells demonstrated a blunting of the rise in HLA-DR+ and CD16 subsets in glutamine-supplemented infants. There were no differences in growth; in serum ammonia, urea, liver transaminase, or prealbumin concentrations; or in mean hospital stay. This study provides evidence for decreased morbidity in very-low-birth-weight neonates who receive enteral glutamine supplementation.

Sensory interaction and descriptions of fabric hand.

82 subjects who viewed and felt fabrics (sensory interaction group) used different categories of terms to describe fabric hand than did 38 subjects who only felt the fabrics. Therefore, the methods used to measure fabric hand that isolate the senses may not accurately assess the way in which subjects describe fabric hand in nonlaboratory settings.

Diaper performance: maintenance of healthy skin.

Skin wetness is proportional to diaper wetness, and with increased skin wetness, the potential for diaper dermatitis is increased. This study evaluated a wide range of infant diaper products. Eighty healthy volunteers wore 2-inch wetted diaper patches on their volar forearm for two hours. An evaporimeter was used to measure excess skin wetness attributed to the patches. The amount of moisture retained in the patch was also calculated. We found that superabsorbent (SA) disposable diapers kept the skin drier and retained more synthetic urine than cloth reusable and conventional disposable brands, and thus have the greatest potential for helping prevent diaper dermatitis. The SA brands evaluated did an equally adequate job in keeping the skin dry and in retaining moisture. Conventional disposable diapers were less able to keep the skin dry than SA diapers and were not superior to cloth products in most instances. Cloth diapers' performance depended on their composition. Those with several layers of the same fabric were less successful in keeping the skin dry than ones that contained middle layers of different nonwoven components.

Clothing fasteners for women with arthritis.

To examine the ability of women with arthritis to manipulate fasteners, 97 women with various forms of arthritis were interviewed and tested using an adjustable bodice-front vest with assorted detachable fastener samples. Since evaluations were performed, in most cases, when the disease was in remission, nearly all of the women were able to manipulate the fasteners presented--sets of zippers, buttons, Velcro, and snaps. The conventional zipper with large teeth and ring pull tab exposed application, and a convex button with a shank used with a vertical buttonhole were manipulated most easily, while fasteners more difficult to manipulate included an invisible zipper, no-sew gripper snaps, and several Velcro samples. Subjects tended to prefer conventional fasteners and methods of application used in ready-to-wear apparel.

Clothing adaptations: the occupational therapist and the clothing designer collaborate.

An occupational therapist and a clothing designer collaborated in solving the dressing problem of a child with multiple amputations. The dressing problems were identified and solutions for clothing adaptations relating to sleeves, closures, fasteners, fit, and design were incorporated into two test garments. Evaluation of the garments was based on ease in dressing and undressing, the effect on movement and mobility, the construction techniques, and their appearance. A description is given of the pattern adjustments, and considerations for clothing adaptations or selection or both are discussed. These clothing adaptations can be generalized to a wider population of handicapped persons.