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A comparison of high cell density fed-batch fermentations involving both induced and non-induced recombinant Escherichia coli under well-mixed small-scale and simulated poorly mixed large-scale conditions.

In this work, multi-parameter flow cytometric techniques, coupled with dual colour fluorescent staining, have been used to study the metabolic consequences of inclusion body formation in high cell density fed-batch cultures of the recombinant E. coli strain MSD3735, producing the IPTG inducible model mammalian protein, AP50. Further, we report on the development of the scale-down, two compartment (STR + PFR) experimental simulation model to study, for the first time, the effect of a changing microenvironment with respect to three of the major spatial heterogeneities that may be associated with large-scale bioprocessing (pH, glucose and dissolved oxygen concentration) on a recombinant bacterial system. Using various time points for induction and various scale-down configurations, it has been shown that inclusion body formation is followed immediately by a detrimental progressive change in individual cell physiological state with respect to both cytoplasmic membrane polarisation and permeability, resulting in a lower final biomass yield. However, the extent of this change was found to be dependent on whether the AP50 protein was induced or not, on the time of induction and on which combination of heterogeneities was being simulated. From this and previous work, it is clear that the scale-down two-compartment model can be used to study the impact of genetically modifying an organism to produce inclusion bodies and any range and combination of potential heterogeneities known to exist at the large scale.

Animals↗

Studies on formation and resorption of fish scales. IV. Ultrastructure of developing scales in newly hatched fry of the sheepshead minnow, Cyprinodon variegatus (Atheriniformes: Cyprinodontidae).

Scale formation in Cyprinodon variegatus was found to be initiated at about 26 to 30 days after hatching. Ultrastructural investigation revealed that within 4 to 6 h in the first-formed scales the marginal cells begin to flatten and differentiate into osteogenic cells, which later change to osteoblasts and fibroblasts. These cells are separated from the surrounding epithelial cells by a basal lamina. The osteoid is formed by the marginal and osteogenic cells; the osseous layer by the osteoblasts; and the fibrillary plate by the fibroblasts. The osteoid is formed within 2 to 3 h after the initiation of the scale, and within 20 to 24 h the osseous layer is formed. Hydroxyapatite crystals are deposited in the matrix of the osseous layer without apparent association with collagen fibers. No matrix vesicles or dense bodies are evident at the sites of calcification. The fibrillary plate arises 18 to 20 h after the initiation of the scale. It is also partially calcified, but not before the third week of scale formation. The crystals develop almost exclusively between the collagen fibers at the extreme edge of the calcifying front, but solid calcification of the fibers results with futher growth of the crystals. The fibroblasts appear to participate in calcification of the fibrillary plate.

Animals↗

[Predictive validity of a brief scale to assess subjective prognosis of work capacity (SPE Scale) in a cohort of LVA insured patients with severe back pain or functional complaints relating to internal medicine].

OBJECTIVES: Vocational (dis-)ability is a central concept in social medicine. Beside from medical factors psychological and system factors play a crucial role in determining vocational disability. The development of instruments assessing the prognosis of gainful employment is an important task in rehabilitation research. METHODS: A short scale measuring the subjective prognosis of gainful employment (SPE-scale) was administered to 481 blue collar workers suffering from severe back pain or else functional syndromes. Employment status two or three years following the assessment is known. RESULTS: 11% of the subjects have applied for early retirement; 5% actually have retired. There are statistically significant relations of SPE-scores and subjects employment status. Effect sizes of the SPE-scores equal or even outrank those of other instruments assessing vocational (dis-)ability. The positive predictive power of the scale is low, though. CONCLUSIONS: The SPE scale can be recommended for further use in (rehabilitation) research. The employment of the instrument for medical appraisal has to be viewed with more caution. The percentage of subjects at risk for early retirement is largely overestimated in case of a positive test. Instruments like the SPE-scale can assist but never replace the medical appraisal.

Adult↗

A validity scale for the Sharp consumer satisfaction scales.

Because of the apparently inflated scores commonly reported for consumer satisfaction with mental health services, we developed a 5-item validity scale for the SHARP questionnaire. The scale discriminated significantly (P less than .001) between those former clients who offered suggestions for improvement of services and those who did not (N = 38). In another experiment, the scale significantly improved the ability to predict the 46 clients' true scores from their obtained scores via stepwise regression (p less than .01). Weights were obtained from that sample of former clients, which significantly reduced the deviation of the obtained satisfaction scores from the true scores, with all p less than .05. In two successive experiments (N = 49 and 26), weights were applied to new samples, significantly reducing deviation from the criterion scores for 5 of the 6 scales (p less than .05), and new weights were then derived. A final set of weights was derived from the combined samples of the three experiments, (N = 121) which significantly improved prediction of the criterion and lowered the mean on all scales, with all p less than .05.

Abstracting and Indexing↗

Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale.

The effect of analgesics on pathological pain in a double-blind, complete cross-over design was assessed by means of two rating scales, a verbal rating scale (VRS) and visual analogue scale (VAS). The VRS is widely used, but has several disadvantages as compared to the VAS. The results obtained by means of the VRS showed higher F-ratios (analysis of variance and Kruskall-Wallis H-test) than those obtained by means of the VAS. The VRS, which transfers a continuous feeling into a digital system, seems to augment artificially the measurement of effects produced by analgesics, and the VAS seems to assess more closely what a patient actually experiences with respect to change in pain intensities. The correlation between the two scales was highly significant (r = 0.81, P less than 0.001). The calculated regression line (y=-29.6 + 0.55-x) was not similar to the line of identity and showed much lower values for the VAS, supporting our interpretation. The distribution of the variances of the values obtained by means of both scales was not homogenous. This indicates that the homogeneity of the distribution of variances should always be checked and a Kruskall-Wallis H-test used, if they are inhomogenously distributed.

Adult↗

The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties.

Altogether 553 children (195 first graders, mean age 6.8 years, and 358 third graders, mean age 8.7 years) participated in the development of a self-report measure to assess the intensity of children's pain. The first step was the derivation, from children's drawings of facial expressions of pain, of 5 sets of 7 schematic faces depicting changes in severity of expressed pain from no pain to the most pain possible. With the set of faces that achieved the highest agreement in pain ordering, additional studies were conducted to determine whether the set had the properties of a scale. In one study, children rank-ordered the faces on 2 occasions, separated by 1 week. All 7 faces were correctly ranked by 64% (retest 1 week later, 61%) of grade 1 children and by 86% (retest 89%) of grade 3 children. In a second study, the faces were presented in all possible paired combinations. All 7 faces were correctly placed by 62% (retest 86%) of the younger and by 75% (retest 71%) of the older subjects. A third study asked children to place faces along a scale: a procedure allowing a check on the equality of intervals. The fourth study checked on whether pain was acting as an underlying construct for ordering the faces in memory. We asked whether children perceived the set as a scale by asking if memory for an ordered set of faces was more accurate than for a random set. The final study checked, with 6-year-old children, the test-retest reliability of ratings for recalled experiences of pain. Overall, the faces pain scale incorporates conventions used by children, has achieved strong agreement in the rank ordering of pain, has indications that the intervals are close to equal, and is treated by children as a scale. The test-retest data suggest that it may prove to be a reliable index over time of self-reported pain.

Child↗

The Toddler-Preschooler Postoperative Pain Scale: an observational scale for measuring postoperative pain in children aged 1-5. Preliminary report.

This study evaluates the reliability and validity of the Toddler-Preschooler Postoperative Pain Scale (TPPPS), an observational scale developed to be a clinically useful measure of postoperative pain in children aged 1-5 years. The TPPPS consists of 7 items divided among 3 pain behavior categories: (1) Vocal pain expression; (2) Facial pain expression; and (3) Bodily pain expression. These items were derived from preliminary studies by the authors and from other observational studies of children's pain behavior. Seventy-four children between the ages of 12 and 64 months seen for inguinal hernia or hydrocele repair were the subjects of the study. Subjects were observed postoperatively for six 5-min intervals, commencing with their awakening from anesthesia, using the TPPPS. Two raters independently observed 28 of the children to assess inter-rater reliability. Validity was assessed by relating TPPPS scores to the timing and type of analgesics used, visual analog and numerical scale pain ratings made by parents and nurses, and perioperative vital signs. The TPPPS was found to possess satisfactory internal reliability (Cronbach's alpha = 0.88). Inter-rater reliability was good, with kappas for the pain behavior items ranging from 0.53 to 0.78. Preliminary evidence of the scale's validity is provided by the sensitivity of the scale to analgesic regimen, the convergence between TPPPS scores and nurse and parent ratings of postoperative pain, and the associations found between TPPPS scores and perioperative vital signs.

Analgesia↗

Reliability and validity of screening scales: effect of reducing scale length.

Self-report measures are often useful as the first phase of a multiphase case identification procedure for estimating rates of untreated disorder, but such measures are susceptible to several sources of unreliability. The reliability of respondents' reports can be greatly improved by employing a well-established screening scale composed of multiple replicate items. A practical question that arises is whether interview time can be saved by using only a portion of the original scale. The cost of shortening established scales in terms of the sensitivity and specificity of the screen is modelled statistically, and the robustness of the model is assessed using mental health data obtained on samples of psychiatric patients and community controls. Both the statistical model and the empirical examples suggest that items from highly reliable measures can be dropped without much loss in sensitivity or specificity. Suggestions are made for selecting subsets of items when shortening a screening scale and these are illustrated with screening scales for depression.

Adolescent↗

Rating scale analysis of the Berg Balance Scale.

OBJECTIVES: To examine, using Rasch analysis, the rating scale performance of the Berg Balance Scale (BBS) and to describe the 45/56 cutoff score in functional terms. DESIGN: Retrospective chart review of BBS scores. Rasch rating scale analysis was performed on these data. SETTING: Outpatient Veterans Affairs medical center. PARTICIPANTS: One hundred (99 men, 1 woman) community-dwelling veterans referred for balance deficits (age range, 64-88y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The BBS. RESULTS: Condensing item-rating categories allowed the elimination of underutilized categories and constructed categories that better separated people of differing abilities. Rating pivot points were developed for each item to represent a transition between passing and failing. Following pivot-point development and rating scale rescoring, person and item measures became more evenly distributed across the BBS and resulted in changes in item difficulty order. In our sample, functional indicators of a score of at least 45/56 were a rating of passing the item "tandem stance," as well as passing 2 of the following 3 items: "alternating foot," "standing on one leg," and "look behind." CONCLUSIONS: Our findings provide direction for improving the rating scale structure for each of the items and establish a connection between the BBS cutoff score of 45/56 and functional ability.

Accidental Falls↗

MMPI-2 validity, clinical and content scales, and the Fake Bad Scale for personal injury litigants claiming idiopathic environmental intolerance.

BACKGROUND: Idiopathic environmental intolerance (IEI) is a descriptor for nonspecific complaints that are attributed to environmental exposure. METHODS: The Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was administered to 50 female and 20 male personal injury litigants alleging IEI. RESULTS: The validity scales indicated no overreporting of psychopathology. Half of the cases had elevated scores on validity scales suggesting defensiveness, and a large number had elevations on Fake Bad Scale (FBS) suggesting overreporting of unauthenticated symptoms. The average T-score profile for females was defined by the two-point code type 3-1 (Hysteria-Hypochondriasis), and the average T-score profile for males was defined by the three-point code type 3-1-2 (Hysteria, Hypochondriasis-Depression). On the content scales, Health Concerns (HEA) scale was significantly elevated. CONCLUSION: Idiopathic environmental intolerance litigants (a) are more defensive about expressing psychopathology, (b) express distress through somatization, (c) use a self-serving misrepresentation of exaggerated health concerns, and (d) may exaggerate unauthenticated symptoms suggesting malingering.

Adult↗

Evaluation of reliability, validity, and preference for a pediatric pain intensity scale: the Catalan version of the faces pain scale--revised.

The main objective of this research was to determine the initial psychometric properties of the Faces Pain Scale - Revised (FPS-R) as a measure of pain intensity for use with Catalan children and adolescents. Results of the Catalan version of this scale (FPS-R-C) are similar to those obtained with the original instrument. In order to assess the validity and reliability of the FPS-R-C, two different samples were studied. The first sample contained 124 hospitalized children and adolescents (mean age 10.86; SD 2.5). They were asked to rate their affective state on the Faces Affective Scale (FAS) and the intensity of their pain on the FPS-R-C and the Coloured Analogue Scale (CAS). The pain intensity ratings reported with FPS-R-C and CAS were very similar, correlations ranging from 0.83 to 0.9. The relationship between the intensity of pain experienced and children's affective state was also statistically significant (R = 32, P < 0.01). The second sample contained 247 schoolchildren (mean age 9.43; SD 1.55), who were asked to imagine themselves in eight hypothetical painful situations and rate the degree of pain using the FPS-R-C and the CAS (correlations ranging from 0.83 to 0.96). Test-retest correlations on this questionnaire (Painful Events Inventory) ranged from 0.26 to 0.70. Overall, these results provide preliminary evidence of the reliability, and convergent and criterion-related validity of the FPS-R-C. Moreover, all participating subjects were asked to choose the pain scale they preferred the most. Our data suggest that, regardless of their age and/or gender, the subjects prefer the FPS-R-C to the CAS.

Adolescent↗

[A new patient focused scale for measuring quality of life in schizophrenic patients: the Schizophrenia Quality of Life Scale (SOL)].

UNLABELLED: RATIONALE/OBJECTIVE: Quality of Life (QOL) has been recognized as an important measure of the outcome of patients by clinicians and policy makers in Mental Health. The emerging consensus in the health field that personal values and the patient's preferences are important in monitoring the quality of medical care outcomes makes it even more important to assess the patient's perspectives. Unfortunately, there is little consensus about what constitutes QOL or how to measure it, particularly in psychotic patients. The objective of this study is to report the stages of development and validation of a QOL questionnaire based on issues pertinent to patients with schizophrenia. METHOD: During a first phase, identical pattern were identified among interviews (conducted by psychologists) of schizophrenic patients (DSM IV, n = 100), mental health staff (n = 20) and families (n = 20). The data gathered in the first phase were discussed and organized, by 25 experts, into a structure that made up the skeleton of the scale (133 items, 17 factors). Based on a prospective epidemiological study conducted with 337 French psychiatrists, a validation analysis of structural and psychometric proprieties was performed. Finally reliability of the scale was assessed by a second test/retest (D0, D7) study (n = 100). RESULTS: A total of 686 schizophrenic, schizophreniform or schizoaffective patients (DSM IV) were included. Internal consistency analysis identified 14 factors (74 items), all with a Cronbach's alpha of at least 0.75: professional life (0.95), affective and sexual life (0.92), illness knowledge (0.90), relationship (0.92), life satisfaction, (0.87), coping with drugs (0.79), drugs impact on the body (0.87), daily life (0.83), family relationship (0.81), future (0.88), security feeling (0.84), leisure (0.87), money management (0.76) and autonomy (0.75). Construct validity was confirmed (Pearson test) using established clinical (Brief Psychiatry Rating Scale and Clinical Global Improvement), social (Psychological Aptitude Rating Scale) and generic quality of life (Functional Status questionnaire) measures, correlation coefficient was significant for all factors but 2 in the BPRS (illness knowledge and coping with drugs) and 3 in the CGI (illness knowledge, coping with drugs and life satisfaction). Lastly, test/retest indicated high reliability for each factor (p < 0.001), the lower correlation coefficient (r) was 0.526. CONCLUSIONS: The Schizophrenia Quality Of Life-scale (SOL), based on a patient's point of view approach, is an efficient, multidimensional instrument designed for the measurement of the consequences of schizophrenia on individuals' lives.

Adolescent↗

The development of the Chemotherapy Symptom Assessment Scale (C-SAS): a scale for the routine clinical assessment of the symptom experiences of patients receiving cytotoxic chemotherapy.

The management of symptoms experienced by patients receiving cytotoxic chemotherapy influences quality of life during treatment. Symptom management may be improved through a structured approach to symptom assessment. This paper describes the development of the Chemotherapy Symptom Assessment Scale (C-SAS), a 24-item scale designed for the routine assessment of symptoms experienced by patients receiving cytotoxic chemotherapy. The scale development process focused both upon the psychometric properties and the clinical usefulness of the scale. Patients and health professionals played a significant role in item selection and scale design in order to maximise the clinical utility of the C-SAS.

Antineoplastic Agents↗

Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers.

Simple reaction time, the Berg balance scale, the Activities-specific Balance Confidence (ABC) scale and postural sway were studied in order to determine cut-off scores as well as develop a model used in the prevention of fallers within the elderly community. One hundred and twenty-five subjects, 45 fallers and 80 non-fallers were evaluated throughout the study and results indicated that non-fallers have significantly faster reaction times, have higher scores on the Berg balance scale and the ABC scale as well as sway at slower frequencies when compared to fallers. Furthermore, all risk factors were subsequently entered into a logistic regression analysis and results showed that reaction time, the total Berg score and the total ABC score contributed significantly to the prediction of falls with 89% sensitivity and 96% specificity. A second logistic regression was carried out with the same previous variables as well as all questions of the Berg and ABC scales. Results from the logistic analysis revealed that three variables were associated with fall status with 91% sensitivity and 97% specificity. Results from the following study would seem rather valuable as an assessment tool for health care professionals in the identification and monitoring of potential fallers within nursing homes and throughout the community.

Accidental Falls↗

Construction and psychometric properties of sexuality scales: sex knowledge, experience, and needs scales for people with intellectual disabilities (SexKen-ID), people with physical disabilities (SexKen-PD), and the general population (SexKen-GP).

This study reports on the development and assessment of the psychometric properties of three measures to assess sexual knowledge, experience, feelings, and needs. The first was designed to assess the Sexual Knowledge, Experience, Feelings, and Needs of people with mild intellectual disabilities (SexKen-ID). The two parallel measures were designed to assess the same areas of sexuality among people with physical disabilities (SexKen-PD) and among the general population (SexKen-GP). The areas of sexuality included in the scales were Friendship, Dating and Intimacy, Marriage, Body Part Identification, Sex and Sex Education, Menstruation, Sexual Interaction, Contraception, Pregnancy, Abortion and Child-birth, Sexually Transmitted Diseases, Masturbation, and Homosexuality. Generation of the items in these scales is described in Studies 1-3. Study 4 describes the evaluation of the psychometric properties of the scales. Sixty-six people with intellectual disabilities, 54 people with physical disabilities, and 100 people from the general population completed the scales. Test-retest reliabilities were also calculated with 30 people with intellectual disabilities, 30 people with physical disabilities, and 30 people from the general population. These data demonstrate the good psychometric properties of the scales and so their simitability for assessing the sexual knowledge, experience, feelings, and needs of people with disability.

Adult↗

A new version of the geriatric depression scale for nursing and residential home populations: the geriatric depression scale (residential) (GDS-12R).

The objective was to develop a new short-form Geriatric Depression Scale (GDS-12R) suitable for older people living in nursing and residential care settings, including those persons with significant cognitive impairment. A total of 308 newly admitted residents of 30 nursing and residential homes in northwest England were interviewed using the Geriatric Depression Scale (GDS-15), the Mini-Mental State Examination, and the Affect Balance Scale (ABS). A 12-item version of the GDS was shown to have greater internal reliability than the 15-item version, because of the context-dependent nature of the deleted items. There was close agreement between the GDS-12R items and another indicator of depressed mood (a single item from the ABS). Furthermore, moderate to high levels of cognitive impairment did not affect the performance of the new version of the scale. The GDS-12R provides researchers and clinicians with a brief, easy-to-administer depression scale that is relevant to residential and nursing home populations.

Aged↗

Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity.

OBJECTIVE: To evaluate the reliability of the Ashworth Scale and the Disability Assessment Scale (DAS) in poststroke patients with upper-limb spasticity and functional disability. DESIGN: Single-center trial. SETTING: University medical center. PARTICIPANTS: Nine patients > or = 6 months poststroke with upper-limb spasticity and impairment in the areas of hygiene, dressing, limb posture, or pain were included in the analysis. INTERVENTIONS: Ten experienced medical professionals rated each patient in randomized order twice on the same day (results based on mean of evaluations at times 1 and 2). Elbow, wrist, finger, and thumb flexion tones were assessed by using the Ashworth score (range, 0-4), and functional disability was assessed using the DAS (range, 0-3). MAIN OUTCOME MEASURES: Intra- and interrater reliability of the Ashworth Scale and DAS. RESULTS: For the Ashworth parameters, 38 of 40 evaluations indicated excellent (weighted kappa > or = .75) or good (weighted kappa > or = .4) intrarater reliability. For DAS parameters, 31 of 40 evaluations indicated excellent or good intrarater reliability. The interrater reliability was also good for both the Ashworth Scale (Kendall W=.598-.792) and DAS (Kendall W=.494-.772) with statistically significant agreement found among raters (all P<.001). CONCLUSIONS: In patients with upper-limb spasticity after stroke, the Ashworth Scale and DAS had good intra- and interrater reliability when used by trained medical professions.

Adult↗

Comparison between the Visual Analogue Scale (VAS) and the Category Ratio Scale (CR-10) for the evaluation of leg exertion.

Perceptual ratings given on the Visual Analogue Scale (VAS) and the Category Ratio Scale (CR-10) were compared in 24 healthy male volunteers (18-39 years) subjected to an exercise test using a bicycle ergometer. Ratings of leg exertion were made by means of the CR-10, the VAS and, as a complementary measure, the method of free magnitude estimation (ME). Blood lactate levels (BL) and heart rates (HR) were used as correlates to sensory perception. The correlation between the CR-10 ratings and BL at 180 W were .59 (p less than .01), and between VAS ratings and BL .45 (p less than .05). The corresponding correlations with HR were .64 (p less than 0.01) and .58 (p less than 0.01), respectively. No significant correlation was found for ME. It was concluded that both the CR-10 and the VAS scales were found to be useful for the psychophysical estimation of perceptual intensities. The CR-10 scale appeared to be slightly more efficient than the VAS and both these methods much better than ME. The advantage of the CR-10 scale might be due to a greater ability to discriminate at high intensity levels.

Adolescent↗