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PubMed1982

The rapid disability rating scale-2.

A revised version of the Rapid Disability Rating Scale (RDRS-2) is presented. Item definitions have been sharpened and directions expanded to indicate that ratings are based upon the patient's performance in regard to behavior, and that prosthesis normally used by the patient should be included in the assessment. Three items have been added to increase the breadth of the scale. Response items have been changed from three-point to four-point ratings in order to increase group discrimination amd make the scale more sensitive to changes in treatment. The new appraisals of reliability, factor structure, and validity are reported, along with the potential uses of the scale.

Activities of Daily Living↗
PubMed1996

Alcian blue. Now you see it, now you don't.

A brief outline of the history and chemistry of the copper pthalocyanin-based Alcian blue dyes highlights the adverse effects of commercial secrecy and entrepreneurial dishonesty on the use of these valuable histochemical and biochemical reagents in the biological sciences. The acquisition of detailed and validated chemical structures required the avoidable expenditure of much time that otherwise would have been spent on new research. The combination of this chemical knowledge with experiments on isolated polyanions, using critical electrolyte concentration (CEC) techniques, established a molecular recognition paradigm of Alcian blue usage in histochemistry. New reagents (Cuprolinic and Cupromeronic blues) were synthesised to investigate and support the hypothesis that Alcian blue did not intercalate with DNA. They were made with the important additional aim of using them in electron microscopy of polynucleotides (in the case of Cuprolinic blue) and non-nucleotide polyanions, such as sulphated proteoglycans in extracellular matrices (in the case of Cupromeronic blue). The cationic groups of Alcian blue are easily removed in very mild conditions, producing insoluble blue pigment in situ (ingrain dying). This reaction underlies its unique capability to stain in repeated cycles, thus greatly amplifying sensitivity of detection of substrates present in very small amounts in tissues and on electrophoretic strips etc.

Alcian Blue↗
PubMed2001

Radiographic progression in rheumatoid arthritis: does it reflect outcome? Does it reflect treatment?

Although there is clear face validity that structural damage is related to outcome, it is difficult to prove this. Recently, more evidence became available that structural damage, as assessed on plain films, is indeed related to disease activity in clinical trials and therefore can be used to assess the effect of treatment. Also, a relationship between structural damage and outcome, mainly defined as physical disability, was established. Several examples of findings in recent publications are presented which lead to the following conclusions. There is a relation between the response to treatment measured as clinical disease activity and measured as radiographic progression in most clinical therapeutic trials. A strong relation between local inflammation and progression of damage in the individual joint is present. This is robust evidence for the hypothesis that inflammation leads to structural damage. There is a good relation between the damage in small and large joints as assessed on plain films. Damage measured in small joints is a good substitute for overall damage. Disease activity is always strongly correlated with functional disability throughout the disease course. There is an increasing relation between disability and structural damage with increasing disease duration.

Arthritis, Rheumatoid↗
PubMed2000

Emotional and cognitive consequences of head injury in relation to the glasgow outcome scale.

OBJECTIVE: There is current debate over the issue of the best way of assessing outcome after head injury. One criticism of scales of disability and handicap such as the Glasgow outcome scale (GOS) is that they fail to capture the subjective perspective of the person with head injury. The aims of the study were to investigate aspects of the validity of structured interviews for the GOS, and address the issue of the relation between the GOS and subjective reports of health outcome. METHODS: A total of 135 patients with head injury were assessed using the GOS and an extended GOS (GOSE) and other measures of outcome and clinical status at 6 months after injury. RESULTS: There were robust correlations between the GOS and measures of initial injury severity (particularly post-traumatic amnesia) and outcome assessed by disability scales (particularly the disbility rating scale (DRS)); however, associations with cognitive tests were generally modest. There were also strong correlations with self report measures of health outcome: both the GOS and GOSE were related to depression measured by the Beck depression inventory, mental wellbeing assessed by the general health questionnaire, and to all subscales of the short form-36. The GOS scales were also strongly associated with frequency of reported symptoms and problems on the neurobehavioural functioning inventory. CONCLUSIONS: The GOS and GOSE show consistent relations with other outcome measures including subjective reports of health outcome; they thus remain useful overall summary assessments of outcome of head injury.

Adolescent↗
PubMed2000

Familial aggregation of psychotic symptoms in Huntington's disease.

OBJECTIVE: The mutation responsible for Huntington's disease is an elongated and unstable trinucleotide (CAG) repeat on the short arm of chromosome 4. Psychotic symptoms are more common in patients with Huntington's disease than in the general population. This study explored the relationship of psychosis in Huntington's disease patients with the number of CAG repeats and family history of psychosis. METHOD: Forty-four patients with Huntington's disease, 22 with and 22 without psychotic symptoms, were recruited from two university-affiliated medical genetics clinics in Seattle and Vancouver, B.C. Psychiatric assessments of the subjects were made through chart review, and diagnoses were validated by structured interviews in a subset of patients. The demographic and clinical characteristics of the psychotic and nonpsychotic patients were compared. RESULTS: The two groups did not differ in demographic and clinical characteristics, except that subjects with psychosis were significantly more likely than nonpsychotic subjects to have a first-degree relative with psychosis. In eight of nine families in which Huntington's disease probands with psychosis had a first-degree relative with psychosis, the relative's psychosis co-occurred with Huntington's disease. In the Huntington's disease probands with psychosis, the onset of psychosis correlated with the onset of the neurological symptoms of Huntington's disease, and the age at onset of psychosis was lower in probands with a higher number of CAG repeats. CONCLUSIONS: Patients with Huntington's disease and psychotic symptoms may have a familial predisposition to develop psychosis. This finding suggests that other genetic factors may influence susceptibility to a particular phenotype precipitated by CAG expansion in the Huntington's disease gene.

Adolescent↗
PubMed1991

Assessment and diagnosis of borderline personality disorder.

Borderline personality disorder is common in treatment settings and may be so in the general population. In this guide to assessment strategies for diagnosing borderline personality disorder, the authors discuss the reliability and validity of structured interviews and self-report instruments and suggest the use of a self-report questionnaire as a cost-effective screening test. Assessment problems, such as the need for longitudinal observation, are reviewed. Essential features of the recommended diagnostic approach include clarity about the diagnostic concept, consideration of the full range of diagnostic criteria, incorporation of recently developed diagnostic methodologies, care in distinguishing personality disorders from comorbid axis I syndromes, and complete assessment of the full range of axis II disorders.

Borderline Personality Disorder↗
PubMed2000

Production of diagnostic rules from a neurotologic database with decision trees.

A decision tree is an artificial intelligence program that is adaptive and is closely related to a neural network, but can handle missing or nondecisive data in decision-making. Data on patients with Meniere's disease, vestibular schwannoma, traumatic vertigo, sudden deafness, benign paroxysmal positional vertigo, and vestibular neuritis were retrieved from the database of the otoneurologic expert system ONE for the development and testing of the accuracy of decision trees in the diagnostic workup. Decision trees were constructed separately for each disease. The accuracies of the best decision trees were 94%, 95%, 99%, 99%, 100%, and 100% for the respective diseases. The most important questions concerned the presence of vertigo, hearing loss, and tinnitus; duration of vertigo; frequency of vertigo attacks; severity of rotational vertigo; onset and type of hearing loss; and occurrence of head injury in relation to the timing of onset of vertigo. Meniere's disease was the most difficult to classify correctly. The validity and structure of the decision trees are easily comprehended and can be used outside the expert system.

Databases, Factual↗
PubMed1999

Discovering diagnostic rules from a neurotologic database with genetic algorithms.

Data on patients with Meniere's disease, vestibular schwannoma, traumatic vertigo, sudden deafness, benign paroxysmal positional vertigo, or vestibular neuritis were retrieved from the database of otoneurologic expert system ONE for the development and testing of a genetic algorithm (GA). The accuracy of the diagnostic rules in solving the test cases was 81%, 91%, 92%, 95%, 96%, and 98% for the respective diseases. The best rules retrieved from the GA were described by a set of questions with the most likely answers. The most important questions concerned the duration of hearing loss and the occurrence of head injury. The validity and structure of the rules created with a GA can be analyzed in detail. For rare diseases, some other reasoning process can be used, for example, case-based reasoning.

Algorithms↗
PubMed2002

The impact of latitude on the prevalence of seasonal depression.

BACKGROUND: This study sought to determine whether the prevalence of the seasonal subtype of major depression (SAD) in the community varied as a function of latitude. METHODS: Random telephone numbers were generated across 8 degrees of latitude (41.5 degrees N to 49.5 degrees N) for the province of Ontario. Eight strata of 1 degree each were sampled equally throughout a 12-month period. Using a validated and structured diagnostic interview, we interviewed by telephone respondents over 20 years of age who had lived in the region for 3 years or more. We evaluated patterns of symptom change across seasons to establish a diagnosis of SAD according to DSM-IV criteria. RESULTS: Of the 2078 households that were assessed for eligibility, 1605 (77%) completed the interview. The crude prevalence of lifetime SAD was 2.6% (95% CI, 1.9 to 3.5). There was no impact of latitude on prevalence of either major depression or the seasonal subtype across the 8 strata, although the global measure of the severity of seasonal change in mood was significantly negatively correlated with latitude. CONCLUSIONS: SAD is a common subtype of major depression in Ontario, but there is no evidence to support an increase in prevalence with increasing latitude.

Adult↗
PubMed1999

The Rorschach Inkblot Test: a case of overstatement?

In the 1940s, inflated claims were often made regarding the Rorschach Inkblot Test. Over half a century later, overstatements regarding the test are still common. The present article identifies problems with the Rorschach regarding norms, cultural sensitivity, interrater reliability, test-retest reliability, validity, factor structure, and accessibility of supporting studies. Contrary to overstated claims made on behalf of the Rorschach, the test continues to be a highly problematic instrument from a psychometric standpoint.

Adult↗
PubMed1993

The product of the Drosophila segment polarity gene armadillo is part of a multi-protein complex resembling the vertebrate adherens junction.

Sequence similarity between the Drosophila segment polarity protein Armadillo and the vertebrate adherens junction protein beta-catenin raised the possibility that adherens junctions function in transduction of intercellular signals like that mediated by Wingless/Wnt-1. To substantiate the sequence similarity, properties of Armadillo were evaluated for consistency with a junctional role. Armadillo is part of a membrane-associated complex. This complex includes Armadillo, a glycoprotein similar in size to vertebrate cadherins, and the Drosophila homolog of alpha-catenin. Armadillo co-localizes with junctions that resemble vertebrate adherens junctions in morphology and position. These results suggest that Drosophila and vertebrate adherens junctions are structurally similar, validating use of Armadillo and its associated proteins as a model for vertebrate adherens junctions.

Animals↗
PubMed1987

Analysis of individual, intraspecific and interspecific variability in quantitative parameters of caprine tooth enamel structure.

Qualitative and quantitative features of mammalian tooth enamel structure are increasingly being used in taxonomic and phylogenetic analyses, although the variability shown by these traits has not received adequate consideration. This study evaluates the variability displayed by nine quantitative parameters in deep, intermediate, and superficial molar enamel in the closely related bovids Ovis aries and Capra hircus. These parameters are assessed in terms of the absolute and/or relative variability evinced at a given depth within a single individual, among conspecific individuals, and between species samples. The degrees of relative variability expressed at a given depth are comparable among conspecific individuals and between taxonomic samples. Nevertheless, in many instances, there are significant differences in absolute variability amongst individuals. Also, in four parameters for which individual specimen averages could be calculated, the equality of these means among conspecifics can be rejected. Variability is not equivalent at different enamel depths. The null hypothesis of equality of individual, conspecific variances can be rejected most commonly for parameters measured in deep and superficial enamel, and coefficients of variation also tend to be higher for deep and superficial enamel than for enamel of intermediate depth. The greater variability displayed by deep and especially superficial enamel may be related to the initial onset and the terminal phase of ameloblastic secretory activity. Taxonomic and phylogenetic analyses that utilize quantitative data on enamel structure are valid only if comparisons have been made at equivalent enamel depths.

Ameloblasts↗
PubMed2000

Psychiatric epidemiology: selected recent advances and future directions.

Reviewed in this article are selected recent advances and future challenges for psychiatric epidemiology. Major advances in descriptive psychiatric epidemiology in recent years include the development of reliable and valid fully structured diagnostic interviews, the implementation of parallel cross-national surveys of the prevalences and correlates of mental disorders, and the initiation of research in clinical epidemiology. Remaining challenges include the refinement of diagnostic categories and criteria, recognition and evaluation of systematic underreporting bias in surveys of mental disorders, creation and use of accurate assessment tools for studying disorders of children, adolescents, the elderly, and people in less developed countries, and setting up systems to carry out small area estimations for needs assessment and programme planning. Advances in analytical and experimental epidemiology have been more modest. A major challenge is for psychiatric epidemiologists to increase the relevance of their analytical research to their colleagues in preventative psychiatry as well as to social policy analysts. Another challenge is to develop interventions aimed at increasing the proportion of people with mental disorders who receive treatment. Despite encouraging advances, much work still needs to be conducted before psychiatric epidemiology can realize its potential to improve the mental health of populations.

Epidemiology↗
PubMed2001

[Specific aspects of rhinomanometry in children with nasal septum deformity in the region of absorbing part of the nasal valve].

Available are original data on rhinomanometry in children with nasal septum distortion in the anterior part. Nasal patency before and after anemisation of the mucosa was measured in health and disease. Pressure in collapse of the nasal valve in children is higher than in adults, while dynamic range of the valve action in growing flow of the inspired air is more noticeable. In distortion of the nasal septum at the level of the absorbing part of the nasal valve anemisation reduces the air flow while the dynamic range is not detected. It is discussed whether early surgical intervention in children under sparing approach to nasal structures is valid.

Child↗
PubMed1985

[Criterion-oriented measurement in clinical psychology: development of a test on stress management].

Criterion-oriented tests evaluate the performance of the individual in relation to a given criterion which describes abilities and skills (intended competencies). The measuring process decides statistically if the person is "mastering" the criterion or not. The intended competencies should be represented by test items of high content-validity. The structure and application of this method especially to diagnostical issues of clinical psychology and therapeutic control are discussed. Steps are described construing a criterion-oriented test of stress and coping processes related to depressive and fearful behavior. The test is based on a situation-action-model in the theoretical framework of "stress and coping", "self-efficacy", "control" and "learned helplessness". Method and construction of items are shown in order to find some dimensions of coping-behavior-in-situations (appraisals, person-directed and environment-directed actions) and its sequential organisation in stressful episodes.

Adaptation, Psychological↗
PubMed1984

Estimation of individually adapted control parameters for an artificial beta cell.

For optimum long-term glycemic regulation using a miniaturized artificial beta cell it is indispensible to estimate control parameters suited to the individual requirements of each diabetic patient. To solve this problem, a strategy has been developed which is based on engineering optimum-control theory with a model involving glucose and insulin interactions. The model considers physiologically relevant unit processes like endogenous glucose production, insulin-independent glucose uptake from its apparent distribution space, insulin-dependent glucose utilization, glucose-dependent insulin supply, and insulin catabolism. The assumed model structure is validated by results obtained in experimentally diabetic dogs using partition analysis. The individual parameter values of the model are obtained by a digital computer procedure based on a simple test which involves a bolus injection of glucose + insulin when a constant basal insulin dose is being administered in the diabetic in whom normoglycemia was re-established before the test. The method presented is recommended for future use in all cases where an optimized insulin regimen is to be worked out.

Animals↗
PubMed1984

[Noninvasive monitoring with echocardiography. I. Ventricular function following thiopental and positive pressure breathing].

Using continuous M-mode echocardiography for measuring diameters of the left ventricle and calculating variables of left ventricular contractility during induction of anaesthesia the hemodynamic effects of thiopentone and of positive end-expiratory pressure breathing (PEEP) have been noninvasively assessed in 22 patients undergoing minor surgery (series A, n = 4 + 6, thiopentone) or cholecystectomy (series B, n = 12, PEEP). 4 mg X kg-1 i.v. (group I, n = 4) and 2 X 4 mg X kg-1, the second dose injected i.v. 5 min later (group II, n = 6), led in group I to a short lasting and in group II to a prolonged (duration of each experiment 10 min) significant decrease of the ejection fraction (EF), the shortening fraction (FS) and the mean velocity of circumferential fiber shortening (VCF mean). Thus the well known negative inotropic effect of thiopentone has been proven once more this time by noninvasive echocardiography. The influence of PEEP 5 and 10 cm H2O was evaluated in two ways: 1) by finding the incidence and extent of diminishing the "echocardiographic window" due to overexpansion of the lung during PEEP, rendering the sonographic visualization of the cardiac structures less valid, and 2) by assessing potential haemodynamic effects of PEEP. The curves of 3 in 12 cases (25%) have not been able to be evaluated properly because of "window closing"; in the residual 9 patients during PEEP 10 a significant decrease of the above mentioned parameters of contractility in comparison to PEEP 0 has been observed. IPPB without PEEP apparently does not disturb echocardiographic visualization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗