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Estimating sexual behaviour parameters in the light of AIDS: a review of recent UK studies of young people.

This paper reviews UK surveys of the sexual behaviour of young people since the advent of AIDS. The studies, which are restricted to those whose samples were intended to be representative of the general population, reveal broadly similar estimates of key sexual behaviours (numbers with sexual experience, numbers of partners, frequency of intercourse, condom use and anal penetration). In spite of these similarities and the usefulness of such information for estimating the potential rate of transmission of HIV a number of methodological issues continue to afflict this kind of research. The paper calls for standardized question formats and a centralized body to monitor changes in these parameters of sexual behaviour.

Acquired Immunodeficiency Syndrome↗

A flexible coefficient smooth transition time series model.

In this paper, we consider a flexible smooth transition autoregressive (STAR) model with multiple regimes and multiple transition variables. This formulation can be interpreted as a time varying linear model where the coefficients are the outputs of a single hidden layer feedforward neural network. This proposal has the major advantage of nesting several nonlinear models, such as, the self-exciting threshold autoregressive (SETAR), the autoregressive neural network (AR-NN), and the logistic STAR models. Furthermore, if the neural network is interpreted as a nonparametric universal approximation to any Borel measurable function, our formulation is directly comparable to the functional coefficient autoregressive (FAR) and the single-index coefficient regression models. A model building procedure is developed based on statistical inference arguments. A Monte Carlo experiment showed that the procedure works in small samples, and its performance improves, as it should, in medium size samples. Several real examples are also addressed.

Algorithms↗

Microbiological collaborative studies for quality control in food laboratories: reference material and evaluation of analyst's errors.

Working groups of the Federal Health Office in Germany and of the International Dairy Federation (IDF) have developed a quality assurance system to assess the analyst performance for colony count methods. The experiment design consists of several dilution series produced from a homogeneous sample suspension. Each series contains a number of twofold dilution steps with parallel plates on each level. The structure of this design permits a detailed analysis of the total variance and identification of analysts' methodological errors as single effects. A computer-based interpretation aid may classify the laboratory as working in correspondence with good laboratory practice ('acceptable') or, otherwise, furnishing 'to good' or 'unacceptable' results. Some examples are given for deviation depending on individual faults. Both, internal quality assurance and collaborative studies demand suitable reference samples. The reference material used has to meet certain requirements concerning homogeneity, contamination level and microbiological stability during a period of storage and transport. A naturally contaminated sample material was prepared, which has been used successfully in microbiological collaborative studies.

Animals↗

Aging-related diagnostic variations: need for diagnostic criteria appropriate for elderly psychiatric patients.

It is commonly thought and taught that most psychiatric disorders other than dementia are much less prevalent among the elderly than among younger adults. This perception is based on a relatively small number of published epidemiologic investigations of the incidence and prevalence of mental illnesses in elderly populations. Most of these studies have had a number of methodologic problems, including improper definitions and diagnostic criteria for older persons. A likely consequence of these misconceptions is that clinically significant and potentially treatable mental illnesses might be overlooked, misdiagnosed, and mistreated in elderly patients. Studies in community samples suggest that many older adults who experience clinically significant psychopathology do not fit easily into our existing nomenclature, and yet are disabled. There is a need to develop aging-appropriate diagnostic criteria for major psychiatric disorders. In this article, we discuss the potential causes of this diagnostic confusion. Four specific classes of disorders-mood (specifically depressive) disorders, schizophrenia (and related psychotic disorders), anxiety disorders, and substance use disorders-are discussed as examples. Finally, we suggest some future steps for clarifying this diagnostic confusion.

Age of Onset↗

Human skin penetration of flufenamic acid: in vivo/in vitro correlation (deeper skin layers) for skin samples from the same subject.

Previously, the interest in in vivo/in vitro correlations in the dermal field of research has increased steadily. Unfortunately, in most cases the skin from different human donors was taken for in vivo and in vitro experiments, which led to problems concerning the interindividual variability of the skin. Therefore, we established a methodology to utilize the same skin for both sets of data. In time dependency, drug amounts in the stratum corneum and the deeper skin layers were determined from eight donors using the same skin area for in vivo and the corresponding in vitro tests. Penetration experiments were carried out with the lipophilic drug flufenamic acid dissolved in wool alcohols ointment as the model formulation, which was administered to the skin under "infinite dose" conditions. At different time points prior to starting the surgery, the drug preparation was applied topically on the edges of the skin area, which was planned for excision using Finn chambers. After anesthetizing the patient and disinfecting the operation area, the incubated skin pieces were cut off first and immediately frozen to limit further drug diffusion. In vitro experiments were performed on the remaining skin flap, using two different test systems, a penetration and a permeation model. At the end of all experiments (in vivo and in vitro) the skin specimens were segmented horizontally and the drug was extracted and quantified. The in vivo and in vitro drug amounts in the stratum corneum and the deeper skin layers, respectively, were compared. The inevitable use of unknown volumes of disinfectant in vivo (medical reasons) might be the reason why a correlation failed for the stratum corneum. Nevertheless, for both in vitro test systems a direct linear correlation was found for the deeper skin layers, which showed slopes of a = 3.2272 +/- 0.3933 (penetration model vs in vivo) and a = 1.7776 +/- 0. 1926 (permeation model vs in vivo). This difference demonstrates the varying influence of the test systems and represents a factor about which in vivo and in vitro data are shifted against each other. As far as the model drug flufenamic acid is concerned, this methodology represents a tool to predict drug penetration into the deeper skin layers in vivo after carrying out corresponding in vitro experiments. Therefore, the potential is given to reduce the number of in vivo experiments, the risk for the volunteers, and the costs for the development of new drug preparations.

Administration, Topical↗

Approximating the distribution of maximally selected McNemar's statistics.

It is common in epidemiologic analyses to summarize continuous outcomes as falling above or below a threshold. With paired data and with a threshold chosen without reference to the outcomes, McNemar's test of marginal homogeneity may be applied to the resulting dichotomous pairs when testing for equality of the marginal distributions of the underlying continuous outcomes. If the threshold is chosen to maximize the test statistic, however, referring the resulting test statistic to the nominal chi 2 distribution is incorrect; instead, the p-value must be adjusted for the multiple comparisons. Here the distribution of a maximally selected McNemar's statistic is derived, and it is shown that an approximation due to Durbin (1985, Journal of Applied Probability 22, 99-122) may be used to estimate approximate p-values. The methodology is illustrated by an application to measurements of insulin-like growth factor-I (IGF-I) in matched prostate cancer cases and controls from the Physicians' Health Study. The results of simulation experiments that assess the accuracy of the approximation in moderate sample sizes are reported.

Case-Control Studies↗

How to design a clinical in cardiology. The main issues.

Accumulated clinical experience, arising from consecutive observation of patients, produces biased evaluations of drug efficacy. Only properly designed clinical trials can minimize bias and evaluate drug efficacy. However, clinical experience can be useful in clinical trial planning. The authors review the main aspects of the methodology of clinical trials in cardiology, namely the different phases of clinical research in humans, definition of the population, how to avoid bias, design and randomization options, determination of sample size, outcome types, and precautions to be taken during follow-up.

Clinical Trials as Topic↗

Carrying on: the experience of premature menopause in women with early stage breast cancer.

BACKGROUND: The survival benefit of adjuvant chemotherapy for breast cancer is established but the experience of organ system toxicity for women, specifically ovarian toxicity, is not fully known. OBJECTIVES: Th e purpose of the study was to develop asubstantive theory that would describe and explain women's responses to chemotherapy-induced premature menopause within the context of breast cancer. METHODS: Qualitative inquiry with Grounded Theory methodology was used to collect, code, and analyze the data. The purposive sample consisted of 27 women with early stage breast cancer who received adjuvant chemotherapy. The majority of women were married, well educated, and employed with a mean age of 41 years. Amenorrhea was reported by 24 women, a peri-menopausal pattern of bleeding was described by two women, and one woman had return of normal menses. Women participated in interviews ranging from 45 minutes to 2 hours and other data sources, such as informal discussions with oncology care providers, and lay women's writings about menopause and midlife women's health were used to increase interpretation of the data. RESULTS: Vulnerability was identified as the basic social psychological problem for women. Carrying On is the basic process that explains how women respond to vulnerability as they attempt to assimilate drug-induced premature menopause into their breast cancer experience. The stages of Carrying On (Being Focused, Facing Uncertainty, Becoming Menopausal, and Balancing) progressed from minimizing the early menopause experience to developing an awareness to balancing the dynamic relationship of menopause and cancer in their lives. CONCLUSIONS: This study described the complexity of the experience of chemotherapy-induced premature menopause in women with early stage breast cancer and identified gaps in knowledge about menopausal symptom distress and factors influencing symptom management and outcomes in this population. Future research is needed to evaluate interventions during and after adjuvant therapy to improve the quality of survival of women who experience ovarian toxicity related to early stage breast cancer treatment.

Adaptation, Psychological↗

Keep moving: patients with myeloma talk about exercise and fatigue.

PURPOSE/OBJECTIVES: To learn about the feelings, beliefs, and experiences of patients with multiple myeloma implementing an exercise program in the context of an aggressive tandem peripheral stem cell transplant protocol. RESEARCH APPROACH: Qualitative naturalistic (constructionist). SETTING: International referral center for the treatment of multiple myeloma. PARTICIPANTS: Purposive nonprobability sample of 12 men and 9 women with multiple myeloma aged 38-70 enrolled in the exercise arm of a randomized trial of epoetin alfa with or without exercise as an intervention to decrease cancer-related fatigue. METHODOLOGIC APPROACH: Verbatim transcripts of tape-recorded, in-depth interviews analyzed for thematic content using content analysis and constant comparison. FINDINGS: Themes included (a) belief systems, which encompassed participants' beliefs about exercise and epoetin alfa, philosophy, and self-concept, (b) social context, which included life before cancer, social environment, and social system congruence, and (c) intersection between belief systems and social context, which were participants' experience appraisals. All participants believed that exercise could be helpful and would recommend exercise to other patients with cancer in a similar situation. Most believed that lack of activity contributed to decreased energy. MAIN RESEARCH VARIABLE: Patients' experience of implementing exercise in the context of treatment for multiple myeloma. CONCLUSIONS: Complex interactions between participants' beliefs and social context and experience appraisal influenced their ability to adhere to an exercise program during aggressive treatment for multiple myeloma. INTERPRETATION: Through careful assessment, clinicians can capitalize on belief and social systems that support adherence to exercise as an intervention to ameliorate fatigue for patients with cancer who are undergoing prolonged aggressive treatment.

Adult↗

[Experiences with the Meyer-Probst encephalopathy questionnaire].

The validity of the questionnaire elaborated by Meyer-Probst for recording the typical behaviour of encephalopaths was checked on a sample comprising 254 high-risk and control children aged 6 to 7 years. The results confirm its value as a diagnostic aid in outpatient work and as methodological tool for research.

Attention Deficit Disorder with Hyperactivity↗

An optimized whole blood method for flow cytometric measurement of ZAP-70 protein expression in chronic lymphocytic leukemia.

BACKGROUND: ZAP-70 protein expression has been proposed as a marker for immunoglobulin heavy chain mutational status, which some studies have correlated with disease course in B-cell chronic lymphocytic leukemia (CLL). Studies published to date measuring levels of expression of ZAP-70 intracellular protein using flow cytometry have demonstrated poor performance, as defined by the difference in signal in known positive and negative lymphocyte populations. METHODS: A recently published method (Chow S, Hedley DW, Grom P, Magari R, Jacobberger JW, Shankey TV, Cytometry A 2005;67:4-17) to measure intracellular phospho-epitopes was optimized using a design of experiments (DOE) approach to provide the best separation of ZAP-70 expression in positive T- or NK-cells as compared to negative B-cells in peripheral blood samples. A number of commercially available anti-ZAP-70 antibody-conjugates were screened using this methodology, and the antibody-conjugate showing the best performance was chosen to develop a four-color, five antibody assays to measure ZAP-70 levels in whole blood specimens. RESULTS: Using the optimized fixation and permeabilization method, improvement in assay performance (signal-to-noise, S/N) was seen in most of the antibodies tested. The custom SBZAP conjugate gave the best S/N when used in conjunction with this optimized fixation /permeabilization method. In conjunction with carefully standardized instrument set-up protocols, we obtained both intra- and interlaboratory reproducibility in the analysis of ZAP-70 expression in whole blood samples from normal and CLL patients. CONCLUSIONS: The development of a sensitive, specific and highly reproducible ZAP-70 assay represents only the first essential step for any clinical assay. The universal implementation of a validated data analysis method and the establishment of methodology-based cutoff points for clinical outcomes must next be established before ZAP-70 protein analysis can be routinely implemented in the clinical laboratory.

Antibodies, Monoclonal↗

Determinants of health policy impact: comparative results of a European policymaker study.

OBJECTIVES: This article will use a new theoretical framework for the analysis of health policy impact introduced by Rütten et al. (2003). In particular, it will report on a comparative European study of policymakers' perception and evaluation of specific determinants of the policy impact, both in terms of output (implemented measures) and outcome (health behaviour change). Policy determinants investigated are goals, resources, obligations and opportunities as related to the policymaking process. METHODS: Theory is applied to a comparative analysis of prevention and health promotion policy in Belgium, Finland, Germany. The Netherlands, Spain and Switzerland. The study is MED2-part of a project that has developed a Methodology for the Analysis of the Rationality and Effectiveness of Prevention and Health Promotion Strategies (MAREPS) within the EU-BIO-program. A mail survey of 719 policymakers on the executive and administrative level selected by a focused sample procedure was conducted. This survey used policymakers' experience and evaluative expertise to analyse determinants of policy output and outcome. RESULTS: Regression analyses reveal differential predictive power of policy goals, resources, obligations, as well as of political, organisational and public opportunities. For instance, whereas resources, concreteness of goals, and public opportunities have significant importance for health outcome of policy, obligations and organisational opportunities significantly predict policy output. CONCLUSIONS: Results are discussed in terms of rationality and effectiveness of health policy. They indicate that six sensitising constructs derived from the theoretical framework represent equivalent structures across nations. They comprise a validated instrument that can be used for further comparative health policy research.

Europe↗

Liquid chromatographic determination of the antibiotic fumagillin in fish meat samples.

A procedure for the determination of fumagillin, an antibiotic of Aspergillus fumigatus in fish meat samples, using reversed-phase high-performance liquid chromatography is described. Liquid chromatography was performed on an octadecylsilane column using acetonitrile-water-phosphoric acid solution as mobile phase, with detection at 350 nm. Two different types of sample preparation were developed, clean-up and enrichment, and the limits of quantification were 100 ng/g and 5 ng/g, respectively, in fish meat. The recovery was 75 +/- 3% in the concentration range 100-500 ng/g. To introduce the methodology and demonstrate its usefulness, a practical experiment was performed. Trouts fed with fumagillin were examined for elimination of fumagillin. After 24 h, the concentration was shown to decrease to below 100 ng/g.

Animals↗

Gender differences in antidepressant and activating drug effects on self-perceptions.

Gender difference in neuropharmacologic responsivity have received surprisingly little attention in clinical research. In view of well-known gender differences in the prevalence of depression, we wondered whether men and women would respond differently to antidepressants or to an activational drug known to predict antidepressant response. Using clorgyline and D-amphetamine in 2 small samples, we illustrated several methodological approaches for examining possible gender-linked differences in the effects of these drugs on self-perceptions. Gender-linked differences in cognitive-perceptual processes may, in turn, be linked to differences in encoding or consolidating information about our experiences into our self-image for later recall.

Adult↗

Simultaneous in situ profiling of DNA lesion endpoints based on image cytometry and a single cell database approach.

Analyzing the integrity of DNA is one of the most frequent used endpoints for risk assessment of chemical and physical agents. In the framework of a radiobiological space experiment, this work aimed at having (1) a histochemical tool for the in situ assessment of DNA damage in as long as 20 days old fixed cell cultures, (2) a comprehensive tool for the quantification of different types of DNA lesions, and (3) a methodology of sampling thousands of nuclei based on confocal microscopy, automated stage scanning and digital image processing. For this purpose several fixatives and permeabilization techniques were tested together with the combinatorial use of terminal dUTP transferase-mediated nick end-labeling (TUNEL) and the DNA polymerase I mediated in situ nick translation. These biochemical tools are useful for scoring DNA single and double breaks, and oxidative lesions. Ltk(-) cells were exposed either to hydrogen peroxide or heavy ion beam irradiation. Combination of paraformaldehyde fixation, sodium citrate permeabilization and heat gave the best staining results. A three-channel fluorescence methodology was established including a DNA counter stain for nucleus identification and normalization of DNA content. Communication between confocal imaging software, image analysis software and a relational database proved to be pivotal for a semi-automated high-end single cell analysis and storage of images. In this way, DNA damage data per nucleus can be traced back to the original image. As much as 2500 cells could be analyzed in situ within a day and correlations drawn between different DNA lesion endpoints.

Animals↗

Determination of solid-state NMR structures of proteins by means of three-dimensional 15N-13C-13C dipolar correlation spectroscopy and chemical shift analysis.

In this paper, a three-dimensional (3D) NMR-based approach for the determination of the fold of moderately sized proteins by solid-state magic-angle spinning (MAS) NMR is presented and applied to the alpha-spectrin SH3 domain. This methodology includes the measurement of multiple (13)C-(13)C distance restraints on biosynthetically site-directed (13)C-enriched samples, obtained by growing bacteria on [2-(13)C]glycerol and [1,3-(13)C]glycerol. 3D (15)N-(13)C-(13)C dipolar correlation experiments were applied to resolve overlap of signals, in particular in the region where backbone carbon-carbon correlations of the C(alpha)-C(alpha), CO-CO, C(alpha)-CO, and CO-C(alpha) type appear. Additional restraints for confining the structure were obtained from phi and psi backbone torsion angles of 29 residues derived from C(alpha), C(beta), CO, NH, and H(alpha) chemical shifts. Using both distance and angular restraints, a refined structure was calculated with a backbone root-mean-square deviation of 0.7 A with respect to the average structure.

Carbon Isotopes↗

"That feeling of not feeling": numbing the pain for substance-dependent African American women.

Using ethnographic methodology, the author uncovered the meanings and expressions of recovery care for substance-dependent African American women residing in an inner-city transitional home for substance abuse. A convenience sample of 12 key and 18 general participants revealed emotional pain associated with negative life experiences, including overt and covert racism, primarily within society but also within their family networks; and physical, sexual, and emotional abuse from parents, siblings, and male relationships. The women described feelings of abandonment associated with the death of loved ones, particularly mothers. They had attempted to numb their emotional pain with alcohol and drugs. As they moved through treatment and recovery, they began to work through past and current painful life experiences without using alcohol and drugs.

Adult↗

[The Menopause Rating Scale (MRS II): methodological standardization in the German population].

The Menopause-Rating-Scale (MRS I) was used in clinical practice since 1992. The physician had to document the severity of 10 important estrogen-related climacteric symptoms. Practical experience and a critical methodological evaluation justified a revision: The MRS I should be converted into a self-administrative rating scale, the wording somewhat optimized, the layout adjusted and one item added. The standardization of the new scale (MRS II) was performed in a representative sample of the German population aged 45-60 years. Three dimensions were extracted from the menopausal symptoms using multivariate statistical techniques: somato-vegetative, psychological, and urogenital complexes of symptoms. A simple evaluation scheme was developed for the MRS II by summing up scoring points. Reference values for the frequency of 4 levels of intensity of complaints in the population were defined and provided for purposes of comparison. The MRS II meets a high methodological standard as an instrument standardized in the population. Moreover, it is convenient to apply this instrument in daily practice in order to quantitate variation of menopausal complaints.

Climacteric↗