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The Community Placement Scale: an adaptation of the Community Competence Scale for placement of the deinstitutionalized mentally ill.

The Community Placement Scale (CPS), an abbreviated form of the Community Competence Scale (Anderten, 1979) suitable for placement of deinstitutionalized mental patients in the community, was developed in a combined sample of 87 subjects placed in the community in California and Missouri. Although the Community Competence Scale has shown considerable promise as a placement instrument with the deinstitutionalized mentally ill, a briefer measure is needed in order to increase acceptance by both patients and professional staff. Other improvements sought were determining the acceptability of items to placement personnel nationwide, eliminating nondiscriminating items, and heightening internal consistency reliability of subscales. In a series of discriminant analyses, remaining subscales were used to predict community placement with minimal and maximal degrees of structure. From these analyses, a measure that consisted of 5 subscales and 41 items and required approximately 20 minutes to administer was selected. This short form has many similarities to and a few important differences from the previously published short form.

Adult↗

Application of the Unified Parkinson's Disease Rating Scale in progressive supranuclear palsy: factor analysis of the motor scale.

An important criterion in scale validation is the demonstration of a stable factor structure. The Unified Parkinson's Disease Rating Scale (UPDRS) is widely used to assess Parkinson's disease (PD). The reliability and applicability of the motor subscale of the UPDRS (UPDRSm) when applied to patients diagnosed with progressive supranuclear palsy (PSP) is unknown. In a sample of 175 patients with PSP, factor analysis revealed five clinically distinct factors: two independent bradykinesia factors (axial/gait and extremities), one rigidity factor, and two independent tremor factors (rest and action). Two items (posture and rest head tremor) did not reach criteria for factor loadings. There was a high degree of internal consistency. These results suggest that UPDRSm is a reliable and applicable scale for assessing most aspects of PSP function as well as severity measures of five clinical disability domains.

Aged↗

Interspecies scaling of interferon disposition and comparison of allometric scaling with concentration-time transformations.

Interspecies scaling is used to extrapolate pharmacokinetic parameters from animals to humans, through the application of physiologically based models, by empirical allometric procedures, or using concentration-time transformations. The aim of this study was to compare the accuracies of the last two methods for predicting the pharmacokinetic parameters and concentration-time curves in humans. In the first part of this study, interspecies scaling techniques were applied to a hypothetical drug (extracellular distribution and elimination through glomerular filtration), to examine the influence of various laboratory animals (mouse, rat, cynomolgus monkey and dog) on the parameters predicted for man. The same techniques were also applied to interferon-alpha A, using the literature data for various animal species. The kinetic parameters predicted in man were then compared to the values published for man. Our theoretical example showed that, for allometric scaling, each species has a very different influence on the prediction in human. With the approach using concentration-time transformations, however, each animal species potentially makes a similar contribution to the prediction for man. Based on the pharmacokinetic data published for interferon-alpha A in laboratory animals, allometric equations underestimated the observed values of CL and Vdss in man by 2-3-fold, and the prediction of t1/2 was likely to be unreliable, due to a poor correlation. The use of equivalent time, kallynochron, and apolysichron transformations improved the pharmacokinetic predictions for all three parameters in man. In conclusion, concentration-time transformations make more adequate use of the data available in the different species of laboratory animals, to give better predictions of the pharmacokinetic parameters in man.

Adult↗

Metric characteristics of the drug-induced extrapyramidal symptoms scale (DIEPSS): a practical combined rating scale for drug-induced movement disorders.

The metric properties of the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) were examined in 182 subjects treated with antipsychotics. Inter-rater reliability, test-retest reliability, and concurrent validity with other rating scales for EPS were high. Four factors were identified and the optimal diagnostic cut-off scores were obtained. These results suggest that the DIEPSS is a reliable and valid multidimensional rating scale.

Adult↗

Dalhousie dyspnea scales: Pictorial scales to measure dyspnea during induced bronchoconstriction.

The aim of this study was to validate our Dalhousie Dyspnea Scales in children referred for histamine bronchoprovocation challenge. Seventy-four children rated their dyspnea after each FEV(1) measurement following inhalation of doubling histamine concentrations from 0.125 to 8.0 mg/ml by the standard tidal breathing method. Serial FEV(1) and dyspnea rating using the Dalhousie Dyspnea Scales were recorded and Kendall's tau was computed for dyspnea rating versus fall in FEV(1). Subjects were split into those with positive (DeltaFEV(1) >or= 20% with PC(20) <or= 8 mg/ml) or negative histamine challenge test. During histamine inhalation, dyspnea ratings on each of the subscales rose as FEV(1) fell across subjects, whether or not they were histamine-responsive (main effect), and then fell dramatically following relief of induced obstruction by bronchodilator.The Dalhousie Dyspnea Scales are useful and accurate tools to measure dyspnea due to bronchoconstriction in children.

Administration, Inhalation↗

Investigation of Calcium Carbonate Scaling Inhibition and Scale Morphology by AFM.

The calcium carbonate scale inhibition by two inhibitors, polyacrylic acid (PAA) and 2-phosphonobutane-1,2,4-tricarboxylic acid (PBTCA), has been studied in two heat transfer systems: recirculating cooling water and pool boiling systems. It is found that PBTCA has a better inhibition effect than PAA under identical conditions. The inhibition effect increases with increasing fluid velocity for the cooling water system, whereas in the presence of inhibitors, the fluid velocity has less effect on the scaling behavior. When the initial surface temperature increases, the inhibition efficiency decreases. In the presence of inhibitors, the scaling behavior is insensitive to the change of surface temperature. The relationship between the inhibition effect and the fractal dimension has also been investigated. The results show that the fractal dimension is higher in the presence of inhibitors. The better the inhibition effect, the higher the fractal dimension. XRD and FTIR analyses demonstrate that for the CaCO(3) formed in the pool boiling system, the content of vaterite increases with the increase of inhibition effects. The metastable crystal forms of vaterite and aragonite are stabilized kinetically in the presence of inhibitors. The step morphology has been observed by atomic force microscopy. It is shown that the step space on the CaCO(3) surface increases in the presence of inhibitors. Moreover, with the increase in inhibition effect, both the step space and the fractal dimension increase. Step bunching is also found and discussed in this paper. Copyright 2001 Academic Press.

Journal Article↗

DNA-binding proteins of psoriatic scales. II. DNA-Affinity of the three characteristic proteins increased in the water soluble extract of psoriatic scales.

The disc-electrophoretic pattern of a water soluble protein extract of psoriatic scales contains three characteristic proteins. They appear in higher amounts in psoriatic scales compared to normal human stratum corneum. Assuming that these proteins have any functional implication at DNA, their possible correlation to DNA-binding proteins (DBP) of psoriatic scales was examined. The disc-electrophoretic spectrum of DBP was compared with the protein profile of crude extract. However, no protein of DBP fraction correlated with one of the three characteristic proteins present in a water soluble extract. This signifies these proteins to be more a metabolically enriched product than proteins of chromosomal origin.

DNA Helicases↗

Validating the Sedation-Agitation Scale with the Bispectral Index and Visual Analog Scale in adult ICU patients after cardiac surgery.

OBJECTIVE: To validate the Sedation-Agitation Scale (SAS) with the Visual Analog Scale (VAS) and Bispectral Index (BIS) in adult ICU patients after cardiac surgery. DESIGN: Prospective study comparing blinded evaluations of the SAS, VAS and BIS. SETTING: Forty-two-bed multidisciplinary ICU. PATIENTS AND PARTICIPANTS: Convenience sample of 39 adults after cardiac surgery. MEASUREMENTS AND RESULTS: Bispectral Index 3.2 was continuously recorded using the Aspect A-1000 and evaluators were blinded to this value. The bedside nurse and a trained researcher independently rated wakefulness using a 100 mm VAS upon patient arrival on the ICU, at first awakening, when ventilator weaning was started and after extubation; the researcher also evaluated patients using SAS. Upon arrival on the ICU, the median SAS score was 2 (interquartile range = 1-3), the mean VAS was 26+/-30 and the mean BIS was 70+/-16. Twenty-four patients underwent a trial of weaning from mechanical ventilation with a SAS of 4 (IQR = 4), VAS of 86+/-12 and BIS of 87+/-10. SAS correlated well with VAS performed by one researcher (r = 0.91, p < 0.001) or by 19 different bedside nurses (r = 0.43, p < 0.001) and with BIS 3.2 (r = 0.60, p < 0.001). The correlation between SAS and BIS was reduced in patients with above average electromyogram (EMG) power. As a measure of construct validity, significant differences were noted for the BIS, SAS, VAS and EMG between ICU arrival and extubation (all p < 0.001). CONCLUSIONS: Sedation-Agitation Scale and BIS are valid measures of wakefulness after cardiac surgery, but EMG interference may affect the accuracy of BIS for a small percentage of patients not receiving neuromuscular blockade.

Aged↗

Biogas production from crop residues on a farm-scale level in Sweden: scale, choice of substrate and utilisation rate most important parameters for financial feasibility.

Anaerobic digestion would enable the energy potential of agricultural crop residues such as ley crops and sugar beet tops to be harnessed in Sweden. In the present study, the financial prospects of single-stage fed-batch high-solids digestion on three different scales, 51, 67, and 201 kW, were calculated on the basis of experimental results and observations. In addition to scale, the effects of methane yield and fertiliser recovery (compared to green manuring) was investigated by testing different substrate mixtures. The biogas was disposed as heat, combined heat and power, or as vehicle fuel. Besides the positive effect of scale, the results indicate the importance of choosing substrates with a high methane yield and high nitrogen content, and the necessity of fully utilising both the capacity of the equipment installed and the energy carriers produced. Net unit costs of 5.3 and 8.1 ct/kWh were achieved (201 kW), heat and vehicle fuel, respectively.

Anaerobiosis↗

Laboratory-scale chlorination to estimate the levels of halogenated DBPs in full-scale distribution systems.

Occurrence of halogenated disinfection by-products (DBPs) (trihalomethanes -THMs- and haloacetic acids -HAAs-) in the waters of two utilities in Quebec City (Canada) was investigated using two approaches: experimental chlorination studies and full-scale sampling within distribution systems. Experimental studies were designed to reproduce treatment plant and distribution system conditions (chlorine dose, water temperature, pH and water residence time). Differences in halogenated DBPs in the two distribution systems under study were significant and comparable to those observed in experimental laboratory studies. For the waters of both utilities, chlorination studies better reproduced the occurrence of halogenated DBPs in points of the distribution system located near the treatment plant (low residence time of water) than in other points. Multivariate regression models for THMs, HAAs and their species were developed using the data from experimental studies in order to predict halogenated DBP levels measured in the distribution system. Models were all statistically significant, but showed low ability to predict full-scale halogenated DBPs, particularly in points located at distribution system extremities. Specifically, experimental chlorination-based models are not able to simulate the decrease of HAA levels. Results of this research suggest that the use of experimental data to predict halogenated DBP levels in full-scale distribution systems - for operational, regulatory and epidemiological purposes - must be done with caution.

Acetates↗

The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.

Visual analogue scales (VAS) of sensory intensity and affective magnitude were validated as ratio scale measures for both chronic and experimental pain. Chronic pain patients and healthy volunteers made VAS sensory and affective responses to 6 noxious thermal stimuli (43, 45, 47, 48, 49 and 51 degrees C) applied for 5 sec to the forearm by a contact thermode. Sensory VAS and affective VAS responses to these temperatures yielded power functions with exponents 2.1 and 3.8, respectively; these functions were similar for pain patients and for volunteers. The power functions were predictive of estimated ratios of sensation or affect produced by pairs of standard temperatures (e.g. 47 and 49 degrees C), thereby providing direct evidence for ratio scaling properties of VAS. Vas sensory intensity responses to experimental pain, VAS sensory intensity responses to different levels of chronic pain, and direct temperature (experimental pain) matches to 3 levels of chronic pain were all internally consistent, thereby demonstrating the valid use of VAS for the measurement of and comparison between chronic pain and experimental heat pain.

Acupuncture Therapy↗

Evaluation of the MOS SF-36 physical functioning scale (PF-10): I. Unidimensionality and reproducibility of the Rasch item scale.

Indexes developed to measure physical functioning as an essential component of general health status are often based on sets of hierarchically-structured items intended to represent a broad underlying concept. Rasch Item Response Theory (IRT) provides a methodology to examine the hierarchical structure, unidimensionality, and reproducibility of item positions (calibrations) along a scale. Data gathered on the 10-item Physical Functioning Scale (PF-10) from a large sample of Medical Outcomes Study patients (N = 3445) were used to examine the hierarchical order, unidimensionality, and reproducibility of item calibrations. Rasch-IRT analyses generated an empirical item hierarchy, confirmed the unidimensionality of the PF-10 for most patients, and established the reproducibility of item calibrations across patient populations and repeated tests. These findings support the content validity of the PF-10 as a measure of physical functioning and suggest that valid Rasch-IRT summary scores could be generated as an alternative to the current Likert summative scores. Unidimensionality and reproducibility of the item scale are essential prerequisites for the development of Rasch-based person measures of physical functioning that can be used across populations and over repeated tests.

Activities of Daily Living↗

The Neurotoxicity Scale: the validity of a patient-based scale, assessing neurotoxicity.

The validity of a patient-based scale, presumably measuring adverse effects of drugs on cognitive function, was examined in a normal volunteer study. Thirty subjects were randomly assigned to placebo or one of two doses of a benzodiazepine, temazepam (10 mg and 20 mg), in a double-blind placebo-controlled parallel group design. Plasma samples were taken before the scale was completed and up to 8 hours post-dose. After administration of the medication the subjects were asked to maintain their normal daily routine as much as possible (reading, studying, conversations). The inventory was administered twice, at 50 minutes and 2 hours post-dose (peak level). The overall score was different between the three groups, only for the second assessment, 2 h post-dose (ANOVA, P < 0.02). Multiple t-testing between the three groups revealed statistically significant differences between placebo and the 10 mg temazepam group (P = 0.02) and between placebo and the 20 mg temazepam group (P = 0.006). No significant difference was found between the two temazepam groups. Analysis of the separate questions showed least sensitivity for questions related to the domain of 'hyperexcitability' and most sensitivity for 'fatigue' and 'slowing.' The overall score appeared to be sensitive already for the lower toxicity range suggesting an 'all or nothing effect'. The subjective reports, collected by using this scale, may therefore be used for the detection of gross overall changes in cognitive functioning.

Adult↗

The Hospital Anxiety and Depression Scale depression subscale, but not the Beck Depression Inventory-Fast Scale, identifies patients with acute coronary syndrome at elevated risk of 1-year mortality.

OBJECTIVE: The objective of this study was to investigate the use of short-form depression scales in assessing 1-year mortality risk in a national sample of patients with acute coronary syndrome (ACS). METHODS: Patients with ACS (N=598) completed either the Hospital Anxiety and Depression Scale depression subscale (HADS-D) or the Beck Depression Inventory-Fast Scale (BDI-FS). Their mortality status was assessed at 1 year. RESULTS: Cox proportional hazards modeling showed that patients depressed at baseline (combining HADS-D and BDI-FS depressed cases) were more likely to die within 1 year [hazard ratio (HR)=2.8, 95% CI=1.4-5.7, P=.005], even when controlling for major medical and demographic variables (HR=4.1, 95% CI=1.6-10.3, P=.003). Scoring above the threshold on the HADS-D predicted mortality (HR=4.2, 95% CI=1.8-10.0, P=.001), but scoring above the threshold on the BDI-FS did not (HR=1.8, 95% CI=0.6-5.6, P=.291). CONCLUSION: The HADS-D predicted increased risk of 1-year mortality in patients with ACS.

Acute Disease↗

To scale or not to scale: McCarthy and Wood revisited.

We dispute McCarthy and Wood's (1985) claim that some form of scaling should be applied routinely to ERP data before determining differences in scalp distributions between conditions (or groups). Their simulation study involved assumptions about the nature of the variability within each condition, most significantly that the standard deviations are identical at all electrodes, irrespective of the means. Alternative plausible assumptions may be proposed for which scaling is unnecessary. Furthermore, we show that the two main forms of scaling they proposed may distort or even completely eliminate real differences in scalp topography reflecting genuinely different underlying sources.

Electrodes↗

A novel, simple scale for assessing the symptom severity of atrial fibrillation at the bedside: the CCS-SAF scale.

BACKGROUND: The severity of symptoms caused by atrial fibrillation (AF) is extremely variable. Quantifying the effect of AF on patient well-being is important but there is no simple, commonly accepted measure of the effect of AF on quality of life (QoL). Current QoL measures are cumbersome and impractical for clinical use. OBJECTIVE: To create a simple, concise and readily usable AF severity score to facilitate treatment decisions and physician communication. METHODS: The Canadian Cardiovascular Society (CCS) Severity of Atrial Fibrillation (SAF) Scale is analogous to the CCS Angina Functional Class. The CCS-SAF score is determined using three steps: documentation of possible AF-related symptoms (palpitations, dyspnea, dizziness/syncope, chest pain, weakness/fatigue); determination of symptom-rhythm correlation; and assessment of the effect of these symptoms on patient daily function and QoL. CCS-SAF scores range from 0 (asymptomatic) to 4 (severe impact of symptoms on QoL and activities of daily living). Patients are also categorized by type of AF (paroxysmal versus persistent/permanent). The CCS-SAF Scale will be validated using accepted measures of patient-perceived severity of symptoms and impairment of QoL and will require 'field testing' to ensure its applicability and reproducibility in the clinical setting. CONCLUSIONS: This type of symptom severity scale, like the New York Heart Association Functional Class for heart failure symptoms and the CCS Functional Class for angina symptoms, trades precision and comprehensiveness for simplicity and ease of use at the bedside. A common language to quantify AF severity may help to improve patient care.

Atrial Fibrillation↗

A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients.

Visual analogue scales (VAS) and verbal rating scales (VRS) are widely used to assess pain. This paper presents a secondary analysis of a subsection of data collected as part of an evaluation of an intervention to improve nighttime pain. The aims were to describe the relationship between the VAS and VRS; to compare characteristics of the noncompliant groups in terms of age, gender, type of surgery, and analgesics; to explore the reasons for noncompletion of the VAS or VRS; and to determine the noncompliance rates with each assessment scale. Worst and average pain scores were obtained for the second postoperative night for 417 patients. Fifty-nine patients (14.2%) did not complete the VAS. In contrast, two patients did not complete the VRS (0.5%). The scores generated from the VAS and VRS correlated well, although the range of VAS scores corresponding to each VRS category was wide. We conclude that the VRS was more suitable for use in this clinical setting.

Adolescent↗

The development and use of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS) for measuring expectations and satisfaction with community-based psychiatric services in patients, relatives and professionals.

In this paper the global design of a research project aiming at measuring expectations and satisfaction of patients, relatives, and professionals with community-based psychiatric services (CPS) in a multidimensional, sensitive, valid and reliable way is described. Some psychometric properties of two newly developed instruments, partly adapted from the Service Satisfaction Scale (SSS), the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS), are discussed. Three groups were selected for inclusion in the study: all patients living with their families who had more than 18 contacts in the last three years, according to the South-Verona Psychiatric Case Register; the relative who had been mainly caring for the patient; and all professionals working in the South-Verona CPS for at least one year. Data on 75 patients and 76 relatives are presented and show that VECS and VSSS have good content validity and test-retest reliability in both groups. Notwithstanding some differences, patients and relatives expressed similar expectations and were mostly satisfied. The current study is the first to provide a parallel measurement of expectations and satisfaction in all three above-mentioned groups; moreover, it is the first to investigate consumers' satisfaction with a CPS organized according to the principles of the Italian Psychiatric Reform.

Adult↗