Person-environment assessments in occupational therapy

Occupational therapists have begun to recognize the importance of considering how the environment influences occupational performance. Models of person-environment fit provide a theoretical context within which occupational therapists can consider the influence of the environment on function. The challenge for occupational therapists is to select assessments that incorporate concepts of person-environment fit. However, limited awareness of appropriate environmental assessments that have undergone psychometric testing has limited their introduction into clinical practice. This paper reviews 41 environmental assessments and considers each in terms of its purpose, environmental attribute, environmental application, clinical utility, instrument development, and psychometric testing. A case example illustrates the applicability to the practice of occupational therapy.

Workload measurement: A survey of computerized data collection

The results of a national survey which examined current computer usage and occupational therapist direct entry of Workload Measurement Data is presented. Results indicated an almost equal distribution of departments using computers versus not using computers. A variety of software packages are used for the purposes of collecting workload measurement data, but the majority of departments use customized in-house programmes. The most common method of data entry was a clerk in a central location, however, a number of departments are considering a switch to therapist direct entry. Advantages and disadvantages of both methods were described by survey respondents.

A randomised trial of patient repositioning during radiotherapy using a megavoltage imaging system

Effectiveness of radiotherapy is dependent on the accuracy of beam alignment. Recent developments in megavoltage imaging allow real-time monitoring of beam placement. Maximum gains from this new technology can only be made if the information is utilised to correct patient positioning prospectively before the majority of a treatment fraction is delivered. We have developed and utilised an integrated megavoltage imaging system to perform a randomised trial demonstrating significant improvements in accuracy using treatment intervention techniques for pelvic radiotherapy. The mean field-placement accuracy improved from 4.3 mm to 2 mm and the proportion of treatments given with a field-placement error of > or = 5 mm decreased from 69% to 7%. This improvement in accuracy may enable smaller margins around the target volume to be chosen whilst ensuring complete target coverage at each treatment fraction.

Development of a self-report functional status index for juvenile rheumatoid arthritis

OBJECTIVE

There are few functional indices available for juvenile rheumatoid arthritis (JRA). Our goal was to develop a reliable, valid and responsive self-report physical functional status index for individuals with JRA, ages 8-18 years.

METHODS

Activity (item) generation by interview of children, parents, teachers, clinicians yielded 280 items. Categories of self-care, domestic, mobility, school, and extracurricular were chosen by clinicians. Twelve clinicians sorted the items into categories. Item reduction was by these clinicians who rated items for common problems in JRA, importance of performance, and potential for change.

RESULTS

Ninety-nine items were retained. A separate section was designed for respondents to identify their priority activities. Content validity of the questionnaire, the Juvenile Arthritis Self-Report Index (JASI), was evaluated by 17 different clinicians. One item was added and none eliminated; all rated the index as a credible functional measure for JRA.

CONCLUSION

The JASI has been rigorously developed, and has demonstrated content validity. Index validation is being completed.

Prospective evaluation of prognostic variables from patient-completed questionnaires. North Central Cancer Treatment Group

PURPOSE

This study was developed to determine whether descriptive information from a patient-completed questionnaire could provide prognostic information that was independent from that already obtained by the patient's physician.

PATIENTS AND METHODS

An initial detailed questionnaire was administered to approximately 150 patients with advanced cancer. This questionnaire was subsequently revised and given to a total of 1,115 patients with advanced colorectal or lung cancer. Univariate and multivariate analyses were performed to evaluate the data from these questionnaires.

RESULTS

A total of 36 variables showed statistically significant prognostic information for survival in univariate analyses, even though many of these variables were associated with only a minimal increase in risk. A multivariate analysis demonstrated that there was a high correlation between many variables. Three major groups of variables became apparent as providing strong prognostic information. These included the following: (1) a physician's assessment of performance status (PS); (2) a patient's assessment of their own PS; and (3) a nutritional factor such as appetite, caloric intake, or overall food intake.

CONCLUSION

Data generated by a patient-completed questionnaire can provide important prognostic information independent from that obtained by other physician-determined prognostic factors.

Intratumoral oestrone sulphatase activity as a prognostic marker in human breast carcinoma

Oestrone sulphatase is an important source of local synthesis of biologically active oestrogens in human breast cancer. The oestrone sulphatase enzyme in the particulate fraction of human breast carcinoma was characterised. The Km was 8.91 microM, and the Vmax was 0.022 nmol min-1 mg-1. Oestrone sulphatase activity was detected in 93 of 104 human breast carcinoma samples (89%), and mean activity was 0.041 nmol min-1 mg-1 (range 0-0.399 nmol min-1 mg-1). There was no significant correlation between intratumoral oestrone sulphatase activity and oestrogen receptor status, or with any other prognostic factors. Intratumoral enzyme levels were not associated with time to recurrence or with overall survival time. It thus appears that, although a useful source of intratumoral oestrogens, oestrone sulphatase activity is not of prognostic significance in breast carcinoma.

Apolipoproteins and ischaemic heart disease: implications for screening

Apolipoproteins and lipids are established risk factors of ischaemic heart disease (IHD) but their efficacy as screening tests is not known. We therefore examined the mortality from IHD and serum concentrations of lipids and apolipoproteins in a prospective study of 21,520 men aged 35-64 years. Serum apo B was the apolipoprotein most strongly associated with IHD risk; a decrease in apo B of 10% was associated with 22% lower risk of IHD. However, measurement of apo B alone detected only 17% of all IHD deaths at the cost of a 5% false-positive rate. Combining apo B with apo AI and apo (a) increased the detection rate to 19%. With systolic blood pressure, smoking, and family history of IHD the detection rate increased to 28%. We conclude that screening for IHD by measuring apo B alone or with apo AI and apo (a) is too poor to discriminate between recommending drug therapy or lifestyle change for some and not others. It is not advisable to screen for IHD by measuring any combination of cholesterol, apo B, apo AI, apo (a) and the other risk factors. The primary aim in prevention of ischaemic heart disease should be to lower the risk factors in the population.

Iridoschisis and keratoconus

We report herein a patient with iridoschisis and keratoconus. Since the posterior layers of the cornea and the iris stroma have a common embryological deviation, the combination of these two conditions suggests an inter-related pathogenesis. This case is similar to those of patients with progressive essential iris atrophy and keratoconus described by Cavanagh.

How effective is nicotine replacement therapy in helping people to stop smoking?

OBJECTIVE

To assess the efficacy of nicotine replacement therapy in helping people to stop smoking.

DESIGN

Analysis of the results of 28 randomised trials of nicotine 2 mg chewing gum, six trials of nicotine 4 mg chewing gum, and six trials of nicotine transdermal patch.

SUBJECTS AND SETTING

Subjects were self referred (responding to advertisements or attending anti-smoking clinics) in 20 trials and invited (general practice or hospital patients) in 20. Therapists in self referred trials were generally experienced in helping people stop smoking but not in invited trials.

MAIN OUTCOME MEASURE

Efficacy was defined as difference in percentages of treated and control subjects who had stopped smoking at one year.

RESULTS

Efficacy was highly significant (P < 0.001) for both gum and patch. Nicotine 2 mg chewing gum had an overall efficacy of 6% (95% confidence interval 4% to 8%), greater in self referred subjects than in invited subjects (11% v 3%). Efficacy depended on the extent of dependence on nicotine as assessed by a simple questionnaire; it was 16% (7% to 25%) in "high dependence" smokers, but in "low dependence" smokers there was no significant effect. The 4 mg gum was effective in about one third of "high dependence" smokers. The efficacy of the nicotine patch (9% (6% to 13%) overall) was less strongly related to nicotine dependence, perhaps because the patch cannot deliver a bolus of nicotine to satisfy craving.

CONCLUSIONS

Both gum and patch are effective aids to help nicotine dependent smokers who seek help in stopping. Among the most highly nicotine dependent smokers (those craving a cigarette on waking) the 4 mg gum is the most effective form of replacement therapy; it could enable one third to stop. In less highly dependent smokers the different preparations are comparable in their efficacy but the patch offers greater convenience and minimal need for instruction in its use. Overall, nicotine replacement therapy could enable about 15% of smokers who seek help in stopping smoking to give up the habit.

Caudo-cephalad loading of pedicle screws: mechanisms of loosening and methods of augmentation

The mechanism of failure and the effect of augmentation of single pedicle screws subjected to caudo-cephalad loads applied at the screw head were investigated. In each of 10 lumbar vertebrae, Steffee pedicle screws of appropriate diameter were placed in one pedicle. The cancellous bone of the contralateral pedicle was removed by curettage, a custom fabricated bushing was pressed by hand into the space, and a Steffee screw was inserted through the bushing and into the vertebral body. This arrangement was designed to transfer load directly from the pedicle screw to cortex, bypassing the cancellous bone of the pedicle. In a second experiment, a custom plate was mounted to the posterior surfaces of the articular facets allowing load transfer from the head of the screw directly to cortex. Caudo-cephalad loads were applied by a materials tester and toggle displacement (defined as the total caudo-cephalad movement of the screw under minimal load after loading through a complete cycle) was measured. Under peak loads of +199 N (caudal) and -224 N (cephalad), mean toggle at the screw head was 4.93 mm (standard deviation [SD] = 3.60 mm) for the screw alone and 4.96 mm (SD = 4.42 mm) for the screw augmented by the bushing. Screws without augmentation showed a characteristic pattern of loosening with the base of the pedicle acting as a fulcrum and a butterfly-shape void occurring in the vertebra and the pedicle where cancellous bone had been crushed. Problems with the bushing included poor fit, back-out, and split pedicles.(ABSTRACT TRUNCATED AT 250 WORDS)

Survival, patterns of spread and prognostic factors in uterine sarcoma: a study of 76 patients

We have analysed the medical records and diagnostic imaging of 76 patients presenting to this hospital for treatment of uterine sarcoma between 1970 and 1990. Patients were divided into those presenting before 1980 (n = 22) and after 1980 (n = 54), when sectional imaging (ultrasound, CT scanning) and more modern radiotherapy and chemotherapy were introduced. No survival difference was observed between these two groups. In those patients presenting after 1980, the median age was 54 years (range 18-80), and median survival 22 months from initial diagnosis. Factors associated with a significantly improved survival included low grade (although not histological type) of initial tumour (p = 0.001) and Stage I disease at presentation (p = 0.006). In 17 patients receiving pelvic radiotherapy following initial surgery, both the time to relapse (p = 0.005) and overall survival (p = 0.045) were increased. Adjuvant chemotherapy in 19 patients did not improve outcome. Most diagnoses of relapse were established clinically; they occurred most frequently in the pelvis, followed by lung and abdomen. Pulmonary relapse was accompanied by spontaneous pneumothorax in two cases. Bone and brain metastases were uncommon (< 10%). Following diagnosis of relapse, the median survival was 9 months, with the outcome significantly worse if multiple metastatic sites were involved (p < 0.001). No survival benefit was demonstrated from either local radiotherapy or combination chemotherapy once relapse had occurred. Prognostic factors and current policies for the diagnosis and management of uterine sarcomas are discussed.

Parent compliance with therapeutic interventions for children with cerebral palsy

This paper reports the correspondence between different measures of parental compliance and the relationship of these compliance measures to change in hand function after therapy intervention. 72 children with cerebral palsy, aged 18 months to eight years, participated in a clinical trial of neurodevelopmental therapy (NDT) and upper-limb casting; home programmes were part of each intervention. Measures of parental compliance comprised: self-rating of understanding and skill using a questionnaire, therapist's rating of parental compliance, attendances, mean time of cast wear and number of days completed home-programme log-book. Parent ratings were the only significant predictor of change in hand function. Parent self-rating was the most useful measure, since it correlated moderately with two other compliance measures and was predictive of change in hand function.

Spearheading the fight against infection. The role of the infection control nurse

Prevention of nosocomial and cross-infection is essential, as it has physical and psychosocial implications for patients. The infection control nurse role has evolved over time, with different emphases being placed on the various role components. Specialist roles have been much debated, and it is important that specialist nurses reflect on and evaluate their practice. Further education must be undertaken to prepare ICNs for the diversity of their role.

Prediction of response to endocrine therapy in breast cancer using immunocytochemical assays for pS2, oestrogen receptor and progesterone receptor

Histological sections obtained from 70 patients with breast cancer, all of whom had received endocrine therapy for metastatic or locally advanced disease, were assessed for specific immunocytochemical staining of oestrogen receptor and the oestrogen-induced protein pS2. There was also sufficient material from 25 patients for an assessment of progesterone receptor by immunocytochemistry. We found that, when using a "cut-off" point of 50% for ER and PR, and of 25% for pS2, ER was positive in 22/29 responders and in 12/41 non-responders, and thus was significantly associated with response to endocrine therapy. Similarly, in those subjects in whom PR was measured, PR was positive in 5/14 responders and negative in all 11 non-responders, again being significantly correlated with response. However, pS2 did not relate to response, being only positive in 10/29 responders and negative in 26/41 non-responders. The different response categories varied in their "percentage of positivity" as determined by the 2 tests. Thus, for ER and pS2 we observed: complete response--71% for ER compared with 14% for pS2; partial response--77% compared with 41%; stable disease--36% compared with 64%; and progressive disease--27% compared with 27%. We conclude that at the present time ER appears to be the most reliable indicator for predicting response to endocrine therapy in patients with breast cancer.

Evaluating activities of daily living: directions for the future

Current assessments of simple activities of daily living (ADL) and more complex, instrumental activities of daily living (IADL) could be improved. These assessments are criticized because there are so many different tests for various diagnostic populations, because they rely on self-report rather than observation, because they are based on such varied conceptual frameworks, because they are often cumbersome and lengthy to administer, and because they often rely on outdated or specific cultural perspectives. Improvement of ADL and IADL assessment lies in making them more contextual and client specific, (i.e., by addressing clients' needs in real-life contexts that consider roles, culture, varying environments, and developmental stage.

Prognostic significance of aromatase and estrone sulfatase enzymes in human breast cancer

The aromatase and estrone sulfatase enzymes are important sources of local synthesis of biologically active estrogens in human breast cancer. Significant intratumoral aromatase activity was detected in 91/145 (63%) of tumors and estrone sulfatase was detected in 93/104 (89%) of tumors. There was no relationship between aromatase activity and tumor size, site, nodal status, menopausal status or estrogen receptor status. There was a significant correlation between the aromatase activity and histological grade, with an excess of aromatase-positive in the high grade tumors (P = 0.03). There was a marginally inverse correlation between the aromatase activity and time to relapse (P < 0.1), a significant correlation between aromatase activity and survival after relapse (P < 0.05) but not with overall survival (P > 0.1). Intratumoral estrone sulfatase activity was not significantly correlated to any putative prognostic factors, nor with time to relapse nor overall survival time.

Anticipatory nausea and emesis, and psychological morbidity: assessment of prevalence among out-patients on mild to moderate chemotherapy regimens

The prevalence of nausea and emesis among a series of out-patients (n = 95) receiving mainly mild-to moderately-emetic cytotoxics, was assessed, along with levels of psychological morbidity. Particular focus was given to the rates of psychologically-based (anticipatory) nausea and emesis. Results indicated that 23% of patients experienced anticipatory nausea and the majority reported that this occurred before at least half of the previous treatment cycles. Both emetic challenge of chemotherapy regimen and younger age were linked to this anticipatory effect. The data clearly indicated that nausea and emesis, both post-treatment and in anticipation of treatment, carried a psychological cost with anxiety being highest in those experiencing anticipatory nausea and/or emesis. The role of anxiety in the aetiology of psychologically-based nausea and emesis was not evaluated and it is considered that a prospective study is needed to clarify the exact contribution of psychological factors in the incidence of both post-treatment and anticipatory side-effects.

Adjuvant aminoglutethimide for postmenopausal patients with primary breast cancer: analysis at 8 years

PURPOSE

The study purpose was to evaluate aminoglutethimide (AG) as adjuvant therapy in patients with primary node-positive breast cancer in a randomized double-blind placebo-controlled trial.

PATIENTS AND METHODS

In a multicenter trial, 354 postmenopausal women with early breast cancer and histologically confirmed positive axillary lymph nodes were randomized after surgery to received aminoplac. Patients were prescribed either AG 250 mg four times per day and hydrocortisone 20 mg twice per day or placebos of identical appearance for 2 years.

RESULTS

After a median follow-up of 8.1 years, there has been no overall benefit for AG in terms of either event-free survival or overall survival (OS). However, the results are consistent with interim analyses with a significantly improved event-free survival for patients who received AG for up to 4 years, although this benefit subsequently disappears. Similarly, there is an improved OS for patients who received AG for up to 4 years, but this also subsequently disappears. There was a marginal advantage for estrogen receptor (ER)-positive patients who received AG (n = 74; P = .054). There was no difference in the sites of relapse. There was a significant increase in toxicity for patients who received AG.

CONCLUSION

The lack of survival benefit with long-term follow-up for AG may indicate that aromatase inhibitors have less of an impact on early breast cancer than tamoxifen and may imply different biologic mechanisms of action.

Reliability and construct validity of the Clinical Observations of Motor and Postural Skills

The Clinical Observations of Motor and Postural Skills (COMPS) is a screening tool for children with motor incoordination. A study of reliability (test-retest, interrater, and internal consistency) and construct validity with 132 children, both with and without developmental coordination disorder, is reported here. Test-retest reliability over 2 weeks was high: .92 for a group of 48 children. Interrater reliability for occupational therapists experienced in pediatrics was also excellent: .87 for a group of 72 children. Internal consistency of the COMPS was high, particularly when one of the seven items (Schilder's arm extension) was deleted. The test discriminates well between children with and without motor problems and has many properties of a good screening test.

Prognostic factors in hormone-resistant progressing cancer of the prostate

In 224 consecutive patients with hormone-resistant prostatic cancer referred to 2 European Cancer Centres for palliation of painful bone metastases the one year survival for all patients was 24% (2-year survival: 7%). The median survival was 8 months. In univariate analyses the following prognostic factors were identified: performance status, serum creatinine, alkaline phosphatase, duration of response to primary hormone treatment, degree of bone scan involvement and hemoglobin. Multivariate analyses confirmed the four first parameters to be independent factors. A prognostic model was established (no or one risk factors vs 2 risk factors vs 3 or 4 risk factors) based on performance status, creatinine, alkaline phosphatase and hormone response duration. The median survival of these groups was 10 months, 6 months and 3 months, respectively. This model proved to be discriminative in an external data set of 214 patients with hormone-resistant prostatic cancer entered in two prospective trials. The above differences in outcome between readily and simply defined prognostic groups are greater than the differences one can realistically hope to produce using new treatment strategies. These prognostic factors should be taken into account both in the design and interpretation of clinical studies dealing with the treatment of hormone-resistant progressing prostatic cancer and painful bone metastases.

Mitozantrone and methotrexate chemotherapy with and without mitomycin C in the treatment of advanced breast cancer: a randomised clinical trial

Patients with advanced breast cancer were randomised to 3M (mitozantrone 6.5 mg/m2q 21 days, methotrexate 30 mg/m2q 21 days, mitomycin C 6.5 mg/m2q 42 days) or 2M (as 3M but without mitomycin C). The objective response rates of 30% in 51 evaluable patients receiving 3M and 26% of 54 patients receiving 2M were not significantly different. 4/16 patients not responding to 2M responded to 3M on crossover. Both regimes were well tolerated but there was significantly less haematological toxicity and fewer dose reductions and delays with 2M. We conclude that patients should initially be treated with 2M and that non-responding patients should be crossed to 3M.

1991 Muriel Driver lecture. The environment: a focus for occupational therapy

Individuals in Canada with a disability encounter environmental constraints that limit their active participation in the daily life of our communities. Fundamental inequities in participation and integration continue to exist and there is a need for a concerted effort to eliminate these disabling environments. Several factors, including the built environment, societal production of space, classification of individuals based on norms, the perception of disability as deviance, the power of health disciplines and bureaucracy are examined to determine their contribution to the creation of these disabling environments. Recent modifications to occupational therapy theory and practice, while meaningful, have not fully explored ways in which disabling environments limit occupation. Prevailing ideas about occupation and the environment are examined for their contribution to solving these environmental problems. Principles which can assist occupational therapy intervention directed at changing disabling environments are described. The intent is to define methods of changing disabling environments, based on the desires and active participation of people with disabilities

Neurodevelopmental therapy and upper-extremity inhibitive casting for children with cerebral palsy

The purpose of this research was to study the effect of intensive neurodevelopmental therapy (NDT) and upper-extremity inhibitive casting, separately or in combination, on hand function, quality of upper-extremity movement and range of motion of 73 children with spastic cerebral palsy aged 18 months to eight years. There was no significant difference between intensive or regular therapy and casting or no casting for hand function, between intensive and regular NDT, or between intensive NDT plus casting and the other groups for quality of movement and range of motion. Casting led to increased quality of movement and wrist extension after six months. Casting with NDT improved the quality of upper-extremity movement and range of motion. There appear to be no immediate benefits from intensive therapy alone.

Occupational performance measures: a review based on the guidelines for the client-centred practice of occupational therapy

In 1987, Health and Welfare Canada and the Canadian Association of Occupational Therapists Task Force recommended that work go forward to develop an outcome measure for occupational therapy which reflects the Occupational Performance Model. The first step in this process was to review critically those outcome measures which assess occupational performance and that are currently available in the literature. This paper will present the review process, describe in more detail eight assessments that fulfilled many of the review criteria, discuss the limitations of these measures using the "Guidelines for the Client-centred Practice of Occupational Therapy as the framework, and make recommendations for the development of a new outcome measure for use in occupational therapy.

The Canadian occupational performance measure: an outcome measure for occupational therapy

The Canadian Association of Occupational Therapists, in collaboration with Health and Welfare Canada have developed and published a conceptual model for occupational therapy, the Occupational Performance model. This paper describes the development of an outcome measure, The Canadian Occupational Performance Measure (COPM), which is designed to be used with these guidelines for client-centred clinical practice. The COPM is an outcome measure designed for use by occupational therapists to assess client outcomes in the areas of self-care, productivity and leisure. Using a semi-structured interview, the COPM is a five step process which measures individual, client-identified problem areas in daily function. Two scores, for performance and satisfaction with performance are obtained. This paper describes the rationale and development of the COPM as well as information about its use for therapists.

A critical review of scales of activities of daily living

Occupational therapists routinely perform activities of daily living (ADL) assessments. Although the literature contains many ADL scales, few sources summarize and review the measurement properties of such scales. In this paper, standard criteria are used to review scales of basic self-care. Each scale is critically appraised regarding its purpose, clinical utility, construction, standardization, reliability, and validity. Recommendations are made regarding the ADL scales that are most suitable for describing, predicting, or evaluating ADL function. This review is intended to help therapists in selecting the most appropriate ADL measure to use in their clinical practice.

Criteria mapping: a method of quality assurance

Criteria mapping is a flexible and responsive method of chart audit that allows the simultaneous assessment of both the process and the outcome of care by means of health record abstraction. This method of audit is particularly suited to occupational therapy because it includes branching to reflect the sequential judgments of therapists and does not penalize the clinician for omitting unnecessary procedures. The purpose of this study was to determine the utility and reliability of the criteria mapping process in evaluating the quality of care for a self-care disability in an acute care setting. Three occupational therapists and one independent abstractor evaluated 12 charts twice. Intraobserver reliability calculated with intraclass correlation coefficients was .77 for the therapists and .65 for all observers. Interobserver reliability was .73 for the therapists and .72 for all observers. The criteria map provided comprehensive and relevant information about each chart. This paper discusses the implications of these findings for the ongoing monitoring of the quality of care in occupational therapy.

A study of children with learning disabilities and sensorimotor problems or let's not throw the baby out with the bathwater

The 1986 position statement by the Board of Trustees fo the Council for Learning Disabilities called for a moratorium on the measurement and training of perceptual and perceptual-motor function as a part of services for children with learning disabilities (LD). Estimates in the literature, however, indicate that approximately 13% of children with LD exhibit motor deficits. Such children with motor or perceptual-motor problems are of ten referred to occupational therapy and found to have sensory integrative (SI) dysfunction; subsequently, they are treated with techniques aimed at remediating perceptual or sensorimotor dysfunction. Because the results of research concerned with the efficacy fo sensorimotor therapy are inconclusive and incomplete at this time, the position statement may be premature. Occupational therapists, however, must be aware of the statement and respond appropriately. In order to respond, they must have a better understanding of the nature of this subgroup of children with LD who have motor problems. the purpose fo this study was to assist in the definition of this population. Eighty children with LD between 5 years and 8 years 11 months were examined. They had been referred for occupational therapy at six centres in Southern Ontario. Results indicated that these children were similar to other children with LD in terms of gender and IQ distribution, developmental history, and academic achievement. The study population, however, tended to have less generalized emotional/behavioral disorder than the general population with LD. As expected, these children also had major deficits in gross and fine motor performance. A focus of the paper is on the importance of sensorimotor deficit for learning and self-concept in the child. Implications for both the position statement and practice and research in occupational therapy are discussed.

Joint university-hospital appointments in physical therapy and occupational therapy schools in Canada

A joint appointment is a position agreed to by a health service facility and an educational institution where the appointee holds a position in each affiliated institution and carries out defined responsibilities in each. In light of the growing costs of higher education, financial cut backs, the need to respond to manpower shortages and the expanding need for clinical research, the benefits of joint university-clinical appointments should be considered by academic and clinical institutions in physical therapy (PT) and occupational therapy (OT). To obtain data on existing joint university-clinical positions in Canadian PT and OT schools, mailed survey questionnaires were conducted. The purpose of the survey was to gain information on these appointments so that future faculty-clinical roles in PT and OT could be developed. An initial questionnaire was mailed to the 25 directors of the Canadian PT and OT education programs to obtain information on existing joint appointments and the names of joint appointees holding these positions. A second questionnaire was sent to 104 joint appointees to gather information on their perceptions of these positions. The results of this survey suggest that with continuing manpower shortages, demand for clinical research, increase in student enrollment and insufficient number of faculty members, there is a need to develop these roles further.

A primary genetic linkage map for human chromosome 12

A primary genetic map for human chromosome 12 has been constructed from data on 23 restriction fragment length polymorphic systems collected in 38 normal families with large sibships. Linkage analysis of the genotypic data has ordered 16 loci into a continuous genetic map of 111 cM in males and 258 cM in females. Although most of the genetic map reflects a higher rate of recombination in females relative to males, significantly more frequent recombination was observed in males than in females in intervals between loci on the distal portion of the short arm of the chromosome. The mapping data shown here will serve as a first step toward a high-resolution genetic map for human chromosome 12.

Assignment of the gene for human sphingolipid activator protein-2 (SAP-2) to chromosome 10

Sphingolipid activator protein-2 (SAP-2) has been found to stimulate the enzymatic hydrolysis of glucosylceramide, galactosylceramide, and sphingomyelin. When human skin fibroblast extracts were subjected to sodium dodecylsulfate-polyacrylamide gel electrophoresis followed by electroblotting and immunochemical staining using monospecific antibodies against SAP-2, two or three major bands with estimated mol. wts. of 9,000-10,000 were found. These antibodies did not crossreact with purified SAP-1, another activating protein, or with extracts of CHO-K1 cells. A series of 22 human/Chinese hamster ovary cell hybrids containing different human chromosomes were examined by this method. All eight hybrid clones containing human chromosome 10 were found to have crossreacting protein in this region. Other chromosomes could be excluded by this method. From these results, we conclude that the gene coding for human SAP-2 is located on chromosome 10.

Latent and active plasminogen activator in corneal ulceration

Previous studies of alkali burns have provided evidence for an important role of the plasminogen activator (PA)/plasmin system in corneal ulceration. Current studies have utilized a sensitive, plasminogen-dependent fluorescent assay to demonstrate that PA is present mostly in a latent (trypsin- or plasmin-activatable) form (proactivator) in cultures of rabbit corneal epithelial cells or normal corneas. Cultures of ulcerating corneas demonstrate only active PA early in organ culture, whereas, latent PA levels increase later in culture. Thus, ulceration is correlated with the apparent conversion of latent to active PA. Moreover, profiles of proactivator and latent collagenase and of active PA and active collagenase in vitro, respectively, are similar, suggesting that activator and collagenase are under coordinate control. Cultures of normal epithelial cells and nonulcerating corneas contain PA molecular weight species of 72,000 and 46,000 MW, and ulcer corneas, species of 72,000, 46,000, and 35,000 MW. Double-diffusion analysis indicates that rabbit epithelial cells, fibroblasts, and ulcer corneas produce urokinase (UK)-like PA; and human cornea extracts and tears also contain PA immunoreactive with anti-UK antibodies. The existence of PA in a latent form identifies another level of regulation in the cascades that lead to stromal ulceration.

Post-mortem pink teeth

One hundred coroners' cases were examined for the presence of post-mortem pink teeth. Four cases were found. The pink teeth were subjected to biochemical analysis by means of thin layer chromatography and spectral analysis in an attempt to isolate the compound causing the discoloration. The compound isolated from powdered pink dentine was found to be protoporphyrin. The reason why this phenomenon occurs in some cases and not in others suffering identical forms of violent death remains unsolved at present.

Ulceration is correlated with degradation of fibrin and fibronectin at the corneal surface

Although ulceration of the corneal stroma after alkali burns is known to be correlated with persistent epithelial defects, the relationship between a defect and the mediators thought to contribute to stromal destruction (plasminogen activator, plasmin, collagenase) has not been understood. This report demonstrates that fibrin and fibronectin appear on the stromal surface after an alkali burn, and that those substratum, matrix components disappear in correlation with the appearance of plasminogen activator on the stromal surface, re-surfacing by the epithelium and a persistent epithelial defect. The facts that epithelium releases plasminogen activator and that plasmin, generated from plasminogen by an activator, can degrade both fibrin and fibronectin, as well as the laminin component of the subepithelial basement membrane, would suggest that the plasminogen activator-plasmin system effect degradation of those macromolecules, thus initiating the events that lead to eventual, frank stromal ulceration. It is hypothesized that stromal ulceration is initiated by the chronic secretion from an epithelium with a persistent defect of a protease (plasminogen activator) involved in wound healing.