Purpose The Patient-Reported Outcomes Measurement Information System (PROMIS®) initiative was developed to advance the methodology of PROs applicable to chronic diseases. Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease associated with poor health. This study was designed to examine the correlation of PROMIS health-related quality of life (HRQOL) scales and clinical measures among COPD patients. Methods A cross-sectional analysis was conducted comparing patients who were stable (n = 100) with those currently experiencing a COPD exacerbation (n=85). All PROMIS measures for adults available at the time of the study (2008), disease-targeted and other HRQOL instruments, health literacy, percent predicted FEV1, and a 6-minute walk distance were assessed when patients were considered clinically stable. Results Stable COPD patients reported significantly (p≤0.05) better health-related quality of life on PROMIS domains than patients experiencing an exacerbation. PROMIS domain scores were significantly (p≤0.01) correlated with each of legacy measures. Six-minute walk scores were most highly correlated with the PROMIS physical function domain scores (r=0.53) followed by the fatigue (r=-0.26), social (r=0.24) and to a lesser extent depression (r=-0.23) and anxiety (r=-0.22) domain scores. Percent predicted FEV1 score was significantly associated with PROMIS physical function scores (r=0.27). Conclusion This study provides support for the validity of the PROMIS measures in COPD patients.

4) Finally, we have certain signs more or less special to drowning which, taken in connection with the signs already referred to, make our diagnosis in many cases positive. Some, perhaps all, of these signs, yet require investigation to thoroughly determine the limits to which their value is confined ; and I shall take the liberty, even in this assemblage of experts, of calling some attention to this part of the subject.(1) Bilateral lacerations of the sterno-cleido mastoidei and pectorales majores. These are mentioned by Paltauf only; more observations are needed.(2) Liquid in the pleural cavities ; lesions to which this might be due being absent. Comparative analysis ought to be made of this fluid, of pleural effusions, and of the liquid that collects in the pleural cavities in consequence of putrefaction.(3) A fine-bubbled, watery, whitish or rosy froth, non-adherent to the walls of the air-passages, in which it is found. Inasmuch as the most eminent authorities are not agreed that this can, by any physical characteristics, be distinguished from the similar froth found in other forms of suffocation and in certain diseases, let us make comparative analyses of all these froths and determine, if we can, any chemical differences that exist between them.(4) The presence of the drowning fluid in the very small bronchi and the alveoli, with or without suspended foreign substances. The question still at issue here is, How deeply can fluids penetrate into the bronchi after death ?(5) An infiltration of the pulmonary parenchyma with fluid. The presence of pleuritic adhesions will enable us to distinguish this conditiou from edema in many cases.(6) Subpleural extravasations of the drowning fluid mixed with a little blood.(7) Increase in the volume of the lungs, associated with increase of absolute weight, increase of specific gravity and a peculiar doughy consistence.(8) Demonstration of hemorrhagic foci where the bronchioles enter the alveoli.(9) Presence of water in the stomach. The very fact that this may enter after death is still contested, and we only know in regard to the conditions necessary for such entrance that it is favored by pressure, for example, by the body being sunk deep in the water.(10) Water in the intestine. Unless great pressure is brought to bear on the body, water will not pass from the stomach to the intestine. How much pressure is required and the influence exerted by putrefaction upon this pressure, we have yet to learn.(11) A special and extreme hydremia of the liver. I cannot believe that it accords with the true scientific spirit to ridicule, as some authors do, the statements of Lacassagne on this point. Careful comparison of the condition in this respect, of livers of persons dead of all sorts of violent deaths would be much more to the point.(12) An actual dilution of the blood with the drowning liquid.In conclusion, gentlemen, I wish to say that I have refrained from enumerating my sources of information, with the object of shortening the time required for the reading of my paper. I sha...

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Notwithstanding the numerous medicaments which have been applied, internally and externally, I do not feel that a résumé of them would add to the report. Perhaps the girl expressed it herself very well when she came to the hospital, saying that she had already been treated with many " salves, powders and other things." Notwithstanding the fact that she has been a patient of nearly every department of the hospital, she has, most of the time, been under my observation, and I have followed her case with a great deal of interest.

day and then frozen that night. The snow was cut with wheel tracks and frozen into a very rough surface.The distance from the door of the police station to the spot where the prisoner fell, as shown by blood on the ice and snow, was about 240 feet, and the grade about 3 feet rise in fOO.