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PubMed2001

Vermont Oxford Network: effective and efficient medical care for the neonate.

The Vermont Oxford Network is a non-profit, voluntary collaboration of health care professionals supported by membership fees and research grants which collects data from 310 intensive care units located in the United States and in many countries around the world. Data are collected on infants between 401-1500 grams and this data is entered into an international database. The information generated by the Vermont Oxford Network can be used for comparisons among hospitals providing similar levels of care. Medical problems can be identified and quality improvement projects implemented. This network also provides an opportunity to participate in randomized clinical trials, serves as an educational tool for the hospital staff, and the information provided helps the physician practice evidence based medicine in an efficient manner. Currently four hospitals in Kentucky are participating in this network and the University of Louisville Hospital has participated in two controlled, randomized studies.

Clinical Trials as Topic↗
PubMed1999

The Vermont Oxford Network: evidence-based quality improvement for neonatology.

The Vermont Oxford Network is a voluntary collaborative group of health professionals committed to improving the effectiveness and efficiency of medical care for newborn infants and their families through a coordinated program of research, education, and quality-improvement projects. In support of these activities, the Network maintains a clinical database of information about very low birth weight infants that now has more than 300 participating neonatal intensive care units (NICUs). We anticipate that these NICUs will submit data for 25 000 infants with birth weights of 401 to 1500 g born in 1998. The research program of the Network includes outcomes research and randomized clinical trials. The goal of Network outcomes research is to identify and explain the variations in clinical practice and patient outcomes that are apparent among NICUs. Network trials are designed to answer practical questions of importance to practitioners and families using pragmatic designs that can be integrated into the daily practice of neonatology. Quality improvement is a major focus of the Network. Members receive confidential quarterly and annual reports based on the Network database that document their performance and compare practices and outcomes at their unit with those at other units within the Network. These reports are intended to assist the members in identifying opportunities for improvement and to help them monitor the success of their improvement efforts. Although information is necessary for improvement to occur, it is not sufficient to foster lasting improvement by itself. Information must be translated into action. The Network is sponsoring an ongoing program of quality initiatives designed to provide members with the knowledge, skills, tools, and resources needed to foster action for improvement. The Network's first formal quality-improvement project, the NIC/Q Project, brought together 10 NICUs to apply the methods of collaborative improvement and benchmarking to neonatal intensive care. Building on the lessons learned in that initial project, the Network now is conducting the Vermont Oxford Network Evidence-Based Quality Improvement Collaborative for Neonatology, known as NIC/Q 2000. This 2-year collaborative will assist multidisciplinary teams from the 34 participating NICUs to develop four key habits for improvement: the habit for change, the habit for practice as a process, the habit for collaborative learning, and the habit for evidence-based practice. During the collaborative, participants will contribute to a knowledge bank of clinical, organizational, and operational change ideas for improving neonatal care. The coordinated program of research, education, and quality improvement described in this article is only possible because of the voluntary efforts of the members. The Network will continue to support these efforts by developing and providing improved tools and resources for the practice of evidence-based neonatology.neonatology, very low birth weight, database, network, quality improvement, evidence-based medicine, randomization, trials, outcomes, mortality, length of stay.

Adrenal Cortex Hormones↗
PubMed2000

Physiology of common map turtles (Graptemys geographica) hibernating in the Lamoille river, Vermont.

Common map turtles (Graptemys geographica) were collected from a natural underwater hibernaculum in Vermont at monthly intervals during the winter of 1997-1998. Blood was sampled by cardiac puncture and analyzed for pH, PCO(2), PO(2), and hematocrit; separated plasma was tested for Na(+), K(+), Cl(-), total [Ca], total [Mg], [lactate], and osmolality (mOsm kg(-1) H(2)O). Control (eupneic; 1 degrees C) values for pH, PO(2), PCO(2), [HCO(3)(-)], and [lactate] were 7.98 +/- 0.03, 47.4 +/- 18.7, 10.1 +/- 0.7 (mm Hg), 36.1 +/- 0.2 (mmol liter(-1)), and 2.1 +/- 0.1 (mmol liter(-1)), respectively. Between November 1997 and March 1998, ice covered the river and the turtles rested on the substratum, fully exposed to the water, and were apneic. Blood PO(2) was maintained at less than 3 mm Hg (range 0.9 +/- 0.2 to 2.1 +/- 0.7 mm Hg), PCO(2) decreased slightly, plasma [lactate] was <5 mmol liter(-1), and plasma [HCO(3)(-)] decreased significantly. In March [lactate] rose to 7.5 +/- 1.5 mmol liter(-l), but there was no acidemia. Map turtles meet most of their metabolic demand for O(2) via aquatic respiration and tolerate prolonged submergence at 1 degrees C with little change in acid-base or ionic status. The adaptive significance of remaining essentially aerobic during winter is to avoid the life-threatening progressive acidosis that results from anaerobic metabolism. J. Exp. Zool. 286:143-148, 2000.

Animals↗
PubMed1985

Presenting conditions of 1539 population-based lung cancer patients by cell type and stage in New Hampshire and Vermont.

The authors identified all newly diagnosed lung cancer cases in New Hampshire and Vermont for the period 1973 through 1976 and abstracted clinical data on presenting symptoms and findings from their hospital records. Microscopy slides were also reviewed, when possible, to confirm cell type. The most frequent presenting symptoms were weight loss (46%) and cough (45%). Other common symptoms were dyspnea (37%), weakness (34%), chest pain (27%), and hemoptysis (27%). The presence of symptoms and findings was in general related to disease stage but bore little relationship to cell type. These results differ from those of previously reported case series that were based on surgical, radiation therapy, or Veterans Hospital groups, but the current data agree closely with those from another population-based series in Finland.

Adenocarcinoma↗
PubMed2004

Quantitative exposure-response for silica dust and lung cancer in Vermont granite workers.

BACKGROUND: Excess lung cancer mortality among the exposed Vermont granite workers has been reported. These studies were based on job and tenure surrogates, with the potential for misclassification and inability to evaluate quantitative exposure-response. METHODS: Industrial hygiene data collected from 1924 to 1977 was analyzed in conjunction with mortality data to examine quantitative exposure-response for silica, lung cancer, and other lung diseases. A person-years analysis was undertaken by cumulative exposure group, including lagged and unlagged tabulations. Poisson models were fitted to untransformed and log transformed exposure. RESULTS: The results indicated a clear relationship of lung cancer, tuberculosis, pneumoconiosis, non-malignant lung disease, and kidney cancer with cumulative exposure. An exposure to 0.05 mg/m(3) from age 20 to 64 was associated with a lifetime excess risk of lung cancer for white males of 27/1,000. CONCLUSIONS: The results of this study of workers exposed almost exclusively to silica and no other major occupational confounding exposures indicate a clear exposure-response for lung cancer.

Adult↗
PubMed1988

Vermont granite workers' mortality study.

A cohort mortality study was carried out in Vermont granite workers who had been employed between the years 1950 and 1982. The cohort included men who had been exposed to high levels of granite dust prior to 1938-1940 (average cutters to 40 million parts/cubic foot), and those employed at dust levels after 1940, which on average were less than 10 million parts/cubic foot. Deaths were coded by a qualified nosologist and standardized mortality ratios were calculated. The results confirm previous studies that show that death rates from silicosis and tuberculosis, the major health threats in the years before 1940, were essentially eliminated after dust controls. However, we found excessive mortality rates from lung cancer in stone shed workers who had been employed prior to 1930, and hence had been exposed to high levels of granite dust. When information was available, 100% of those dying from lung cancer had been smokers.

Adult↗
PubMed1985

The Vermont health risk survey and the design of community wide preventive health programs.

A Vermont health risk survey was performed to gain information on health knowledge and behaviors of the population. Telephone interviews with 1,594 individuals ascertained respondents' demographic characteristics, preventive health behaviors, and health knowledge. Risk prevalence was obtained on five health risks: alcohol (12%), smoking (33%), lack of exercise (70%), overweight (39%), and non-use of seatbelts (86%). Low income, less education, and blue collar occupation status were associated with increased risks of smoking, lack of exercise, and non-use of seatbelts. Increased prevalence of certain risks are associated with the 18-24 year old age group; 32% of those males reported an alcohol risk and 94% reported non-use of seatbelts. Combined risk scores were increased in groups with low income, less education, and blue collar occupations. These variations in health behaviors by social group were not explained by differences in health knowledge. Design of primary prevention activities needs to be community wide, utilize information on the epidemiology of health behaviors, influence diverse community groups and intervene before risk behaviors are established.

Adolescent↗
PubMed2002

Patterns of streamwater acidity in Lye Brook Wilderness, Vermont, USA.

Under the United States Clean Air Act Amendments of 1977, a class I designation safeguards wilderness areas from the negative effects of new sources of air pollution. We monitored streamwater chemistry in the class I Lye Brook Wilderness in southwestern Vermont from May 1994 through August 1995. Stream samples were collected biweekly at nine sampling locations throughout the wilderness and were analyzed for major cations and anions, dissolved organic carbon, pH, and acid-neutralizing capacity. Eight of nine sites sampled had mean annual acid neutralizing capacity values below zero. During the study period, decreases in streamwater acid neutralizing capacity values were caused primarily by SO(4)(2-). At some sites, however, NO(3) (-) and naturally occurring, weak organic acids were seasonally important. During high discharge, the low pH and high concentrations of inorganic monomeric Al were at levels that are toxic to acid-sensitive aquatic species. Watershed mass balances were calculated to determine annual gains or losses for measured ions. These budgets indicate that S inputs and outputs were nearly equal, there was a net loss of base cations, and a net gain in N. How long these watersheds can continue to assimilate additional N inputs is unknown.

Carbon↗
PubMed1994

Characteristics, hospital charges, and effects of road transportation injuries in Vermont.

We studied 470 crash- and noncrash-related road transportation injuries to vehicle occupants, bicyclists, and pedestrians seen at a trauma center in Vermont. Among primary care patients, crash and noncrash groups had similar AIS and average disability at one year. Hospitalized patients had longer disability, but a majority of overall disability days and ongoing disability was found among nonhospitalized patients. Seventy-four percent of hospital bills were paid by insurance, 16% by government, 3% by self, with 7% unpaid. Limiting the sample only to hospitalized patients, or including referred patients, markedly affected--but in different ways--distributions of event type, body area injured, charges, and other characteristics.

Abbreviated Injury Scale↗
PubMed1980

Elective resection for colorectal cancer in Vermont: 1971--1975.

An analysis of 612 patients undergoing elective resection for colon and rectal cancer in Vermont during the period 1971 to 1975 indicates an increasing incidence of cancers of the cecum and ascending colon, an increased number of Duke's A cancers, a synchronous cancer rate of 6 percent, an overall operative mortality of 6.5 percent, a wide variance in postoperative stay and a relatively small experience per operating surgeon. Only one third of colorectal cancers can be visualized through the rigid sigmoidoscope. Better screening techniques that are simple, reliable, inexpensive and safe must be developed to locate proximal lesions before they metastasize to lymph nodes and distant sites. Further trials with stool blood testing are recommended.

Adenocarcinoma↗
PubMed1975

Dust counting. Critical review and presentation of Vermont practice.

Counting respirable dust particles using bright field microscopy has been the classic approach for rapid practical evaluation of the dustiness of workplace atmospheres. The technique has been beset with difficulties arising out of variations in the optical systems and the counting cells used by various laboratories. This papar reviews the history of the technique and some of the problems which have been encountered. It also details the method used by the Vermont Division of Occupational Health for the past 20 years to count dust, describing the easily reproducible optical system and the use of a "thin" hemocytometer cell employed.

Air Pollution↗
PubMed1991

Incidence of nonmelanoma skin cancer in New Hampshire and Vermont.

A survey of skin cancer occurrence between June 1979 and May 1980 among residents of New Hampshire and Vermont identified 277 cases of squamous cell carcinoma and 1761 cases of basal cell carcinoma. The age-adjusted incidence rates for squamous cell carcinoma (32 per 100,000 in men, 8 per 100,000 in women) and for basal cell carcinoma (159 per 100,000 in men, 87 per 100,000 in women) were similar to those reported in other populations in the northern United States. Skin cancer incidence was particularly high among men more than 70 years of age and a large proportion (greater than 30%) of patients 55 years or older had a history of at least one previous skin cancer.

Adolescent↗
PubMed2006

Collaborative environmental planning in river management: an application of multicriteria decision analysis in the White River Watershed in Vermont.

Multicriteria decision analysis (MCDA) provides a well-established family of decision tools to aid stakeholder groups in arriving at collective decisions. MCDA can also function as a framework for the social learning process, serving as an educational aid in decision problems characterized by a high level of public participation. In this paper, the framework and results of a structured decision process using the outranking MCDA methodology preference ranking organization method of enrichment evaluation (PROMETHEE) are presented. PROMETHEE is used to frame multi-stakeholder discussions of river management alternatives for the Upper White River of Central Vermont, in the northeastern United States. Stakeholders met over 10 months to create a shared vision of an ideal river and its services to communities, develop a list of criteria by which to evaluate river management alternatives, and elicit preferences to rank and compare individual and group preferences. The MCDA procedure helped to frame a group process that made stakeholder preferences explicit and substantive discussions about long-term river management possible.

Community Participation↗
PubMed2001

Comparative application of multiple receptor methods to identify aerosol sources in northern Vermont.

This study applies and compares results of four receptor modeling techniques to a common set of speciated fine particle measurement data collected ata remote site in northwestern Vermont between 1988 and 1995. Two multivariate mathematical models, positive matrix factorization and UNMIX, were applied to the measurement data and identified seven "common" sources that had similar compositions and similar fine mass contributions in both models. Two ensemble backward trajectory techniques, potential source contribution function and residence-time analysis, were also applied to evaluate and interpret the mathematical model results. The trajectory techniques indicate a strong regional character to the upwind locations associated with aerosol contributions from most of the sources identified independently by the mathematical models and help in the interpretation of those results. The process of model comparison provides insights on the strengths and limitations of the individual and combined source attribution techniques. Convergent results among the multiple methods provide a degree of confidence that each of the receptor methods may represent useful tools for future air quality management. Divergent or inconsistent results among the models can help identify limitations of the individual models and of the underlying aerosol and meteorological data sets.

Aerosols↗
PubMed1997

A systematic survey of caffeine intake in Vermont.

Detailed data were collected on lifetime caffeine intake from 202 Vermont residents using a random-digit dial telephone survey. The sample appeared representative and test-retest reliability of caffeine intake was high (r = .95). Almost all participants (96%) had ever used and most (83%) presently used one or more caffeinated beverages weekly. The average caffeine intake was 186 mg/day. Many caffeine users (61%) used caffeinated beverages other than coffee. Current caffeine intake was a poor measure of lifetime intake. For example, among ever-users of caffeine, 41% had stopped at least 1 type of caffeinated beverage and 14% had stopped caffeine altogether. Cessation was mostly due to health concerns and unpleasant side effects. It was concluded that simply asking about "usual" coffee use is a poor and biased estimate of lifetime caffeine use. Thus, prior findings that caffeine is not associated with medical or behavioral disorders may represent false-negative results.

Adolescent↗
PubMed2003

Cloud water and throughfall deposition of mercury and trace elements in a high elevation spruce-fir forest at Mt. Mansfield, Vermont.

As part of the Lake Champlain Basin watershed study of mercury (Hg) and pollutant deposition, cloud water and cloud throughfall collections were conducted at the south summit (1204 m) of Mt. Mansfield, Vermont between August 1 and October 31, 1998, for multi-element chemical analysis. A passive Teflon string collector was deployed during non-precipitating events to sample cloud/fog water at timberline, while three sets of paired funnels collected cloud throughfall under the red spruce-balsam fir canopy. Samples were analyzed for concentrations of Hg, major ions, and 10 trace elements. Ultra-clean sampling and analysis techniques were utilized throughout the study. Six events were sampled for cloud water alone and four events were sampled for both cloud water and cloud throughfall. Cloud throughfall chemistry showed substantial modification from incident cloud water. Much higher concentrations of Hg (2.3 x), base cations (Ca2+, K-, Mg2+; 3-18 x) and certain trace elements (Ni, Cu, Mn, Rb, Sr; 2-34 x) were observed in throughfall than in cloud water. These results confirm that cloud water can leach a wide variety of elements from tree foliage and wash off dry deposited elements. Cloud water deposited an average of 0.42 +/- 0.12 mm of water per hour. Estimated cloud water deposition of Hg was 7.4 microg m(-2) for the period August 1-October 31, approximately twice that deposited by rain during this period at a nearby low elevation Hg monitoring site. Our results indicate that cloud water and Hg deposition at Mt. Mansfield are likely to have considerable ecological effects.

Air Pollutants↗
PubMed2001

Major birth defects in very low birth weight infants in the Vermont Oxford Network.

OBJECTIVE: To study the frequency and types of major birth defects in very low birth weight (VLBW) infants and their impact on mortality and resource use. STUDY DESIGN: Analysis of data from the Vermont Oxford Network Database from 1994 and 1995 on infants with birth weights of 501 to 1500 g. Major birth defects were reported from a list of 40 defined major defects or if they were considered lethal or life-threatening. Mortality and length of stay were determined. RESULTS: Major birth defects were present in 823 (4.3%) of 19,228 VLBW infants from 147 hospitals. The most common categories were chromosomal anomalies (20%); named syndromes, sequences, and associations (19%); and gastrointestinal (14%), cardiovascular (11%), and nervous system (10%) anomalies. Infants with major birth defects had a higher mortality rate (58% vs 13%, P <.001) and a higher rate of major surgery (29% vs 5%, P <.001) than infants without such defects. Infants with major birth defects accounted for 16.3% of deaths and 18.9% of major surgical procedures but only for 2.9% of total hospital days. CONCLUSIONS: Major birth defects accounted for 16% of all deaths in VLBW infants. However, they accounted for a low proportion of total hospital days.

Birth Weight↗
PubMed1984

Estimation of long term dust exposures in the Vermont granite sheds.

Analysis of variance models were used to analyze 1153 personal samples of respirable granite dust collected in the Vermont granite sheds in 1970 and 1976. The best fitting model described dust concentrations in terms of job, shed, season, survey year, and included interaction terms between shed, season, and survey. This model explained 46% of the total variability in dust levels, and was used to estimate median annual dust concentrations for every job and shed in the industry. The analysis of variance suggested that dust levels varied more between sheds than between jobs within a shed, and that winter dust levels were significantly higher than summer levels. Dust levels in the 1970s were estimated by the average of the seasonally adjusted levels in the two surveys. Dust estimates in each job and shed were combined with personal work histories, and three procedures for estimating each worker's lifetime exposure were evaluated. The cumulative exposure index with uniform weights for each dust year of exposure was selected as the most physiologically plausible measure of total dose.

Air Pollutants, Occupational↗