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Performance discrepancies on the California Verbal Learning Test-Children's Version in the standardization sample.

The standardization data for the California Verbal Learning Test-Children's Version (CVLT-C) were used to evaluate statistically significant discrepancies between key quantitative variables of this instrument, as well as the base rate of specific discrepancies. The results indicated that apparently large discrepancies between the respective standard scores were actually fairly common. However, for 3 of the 4 contrasts, discrepancies that equaled or exceeded 1.5 z-score points in the hypothesized direction were sufficiently unusual to be considered clinically significant. For a 4th contrast, discrepancies that equaled or exceeded 1 z-score point in the hypothesized direction appeared to meet this criterion. It is suggested that the interpretation of clinically obtained CVLT-C profiles should focus primarily on specific quantitative variables, with inclusion of consideration of the presented base rates of discrepancies between the respective z scores.

Adolescent↗

Evaluation of commercially formulated aspartate aminotransferase and alanine aminotransferase activity determinations by the Scandinavian Committee on Enzymes and IFCC methods as modified for use with automated enzyme analysers.

The performance characteristics of the Scandinavian Committee on Enzymes (SCE) methods for the assay of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were determined using six automated enzyme analysers. The reagent formulation did not include pyridoxal phosphate (PLP). An optimal operating mode was defined for each instrument and precision was assessed in greater detail on four instruments. A points rating system was devised to place the instruments in the following order of proficiency: IL Multistat III, LKB-8600, Gilford 3500, ABA 100. In contrast to AST, the ALT activity of patient samples was unstable at -20 degrees C over periods as short as seven days. The performance characteristics of the IFCC methods for assay of AST and ALT activities were determined by using three automated enzyme analyzers in order to assess the effect of PLP upon precision and activity of four quality control sera, and to compare the SCE and IFCC methods. Precision of AST assays did not alter on omission of PLP from the IFCC formulation, while that of ALT assays showed slight deterioration. The decrease in activity on omitting PLP was variable with each instrument. A points-rating system was devised to place the methods in the following order of precision: AST: IFCC (-PLP) 118, IFCC 109, SCE 61; ALT: IFCC 125, IFCC (-PLP) 97, SCE 66. The IFCC methods offer better precision, and the overall change on omitting PLP is minimal.

Alanine Transaminase↗

The Minnesota Living With Heart Failure Questionnaire: sensitivity to differences and responsiveness to intervention intensity in a clinical population.

BACKGROUND: The Minnesota Living With Heart Failure Questionnaire (LHFQ) is a commonly used measure of health-related quality of life in persons with heart failure. Researchers have questioned whether LHFQ is sensitive to subtle differences and sufficiently responsive to clinical interventions because the instrument has demonstrated variable performance in clinical trials. OBJECTIVES: A secondary analysis was conducted to assess the LHFQ for sensitivity to different clinical states and responsiveness to varying intensities of clinical intervention. METHODS: A convenience sample of nine experimental or quasi-experimental studies from eight clinical sites in the United States yielded data from 1,136 patients with heart failure. Data in the studies had been collected at enrollment and one, three, and/or six months later. Data were analyzed using descriptive, univariate, and multivariate techniques. RESULTS: Total and subscale scores on LHFQ were poorer in those with worse New York Heart Association functional class, although there was no difference in LHFQ scores between classes III and IV. No difference in LHFQ scores was found when patients were classified by ejection fraction. Scores improved significantly following hospital discharge, even in those in the control group. Changes in LHFQ scores were greatest in those receiving high intensity interventions. CONCLUSIONS: The LHFQ is sensitive to major differences in symptom severity but may not be sensitive to subtle differences. It is responsive to high intensity interventions. Investigators are cautioned against using this instrument without first maximizing intervention power or without a control group for comparison.

Aged↗

Living with uncertainty: climate change, river flows and water resource management in Scotland.

The recent increased variability of Scotland's hydroclimate poses major problems for water resource managers charged with making informed investment decisions given the likely impact of future climate change. Two strategies are developed in this paper to assist managers faced with this environmental uncertainty. The first involves trend analysis of precipitation and runoff since the 1960s and 1970s viewed against longer-term variability reported from instrumental records. The second strategy is based upon current climate change scenarios coupled with GCMs, and downscaling of precipitation and temperature to provide inputs to rainfall-runoff models. The long-term records of precipitation (back to the 1860s) and runoff (back to the 1930s) reveal the late 1980s and early 1990s as the wettest period on record for the west but not for the east. Over the period 1961-1996 the precipitation gradient has intensified across Scotland: wetter west; relatively dry east. Changes in runoff over the period 1970-1996 are also reported with increases in annual flows at 33 out of 38 stations (significantly at 12 stations) and decreases in low flows at 21 out of 38 stations (significantly at one station). The bulk of these flow increases occurred in the south and west especially in the autumn and spring. In terms of high flows over the period 1970-1996, four out of 44 stations reported a change in magnitude and 15 reported an increase in the frequency of POT events. In terms of future climate change, Hulme and Jenkins (1998) predict annual precipitation increases of 6-16% (Scotland) and 6-14% (Scottish Borders) from the 2020s to the 2080s based on the Hadley Centre model (HadCM2) medium-high scenario. Seasonal changes are concentrated in the autumn (SON) and winter (DJF) with increases as high as 24 and 29% for the autumn by the 2080s. (Arnell NW, et al. Institute of Hydrology Report No. 107, Wallingford, 1996), using an earlier transient Hadley experiment (IS92a), predict a 5-15% increase in annual runoff across Scotland by the 2050s, locally rising to 25%. Simulation flow duration curves for the 2050s generate Q95 values up by 5% or less (Rivers Don, Almond and Nith) and Q5 up by 10-24% (Rivers Don, Almond, Nith and Lyne Water). In terms of water resource planning, these predicted changes should be regarded as first order approximations, as they take no account of natural climatic variability, and could generate different absolute values if other scenarios were used. The predictions are, however, broadly consistent with trends in precipitation and runoff for Scotland since the 1970s. Major issues of concern to water resource managers are identified and commented upon in the light of these predictions.

Climate↗

Proton magnetic resonance spectroscopic imaging of cortical gray and white matter in schizophrenia.

OBJECTIVE: To apply in vivo proton magnetic resonance spectroscopy imaging estimates of N-acetylaspartate (NAA), a neuronal marker, to clarify the relative contribution of neuronal and glial changes to the widespread volume deficit of cortical gray matter seen in patients with schizophrenia with magnetic resonance images. METHODS: Ten male veterans meeting criteria of the DSM-IV, for schizophrenia and 9 healthy age-matched men for comparison were scanned using spectroscopic, anatomical, and field-map sequences. Instrument and collection variables were standardized to allow an estimation of comparable values for NAA, choline, and creatine for all subjects. Metabolite values from each voxel on 3 upper cortical slices were regressed against the gray tissue proportion of that voxel to derive estimates of gray and white matter NAA, creatine, and choline concentrations. RESULTS: The volume of cortical gray matter was reduced in patients with schizophrenia, but NAA signal intensity from a comparable region was normal. In contrast, the volume of cortical white matter was normal in patients with schizophrenia, but NAA signal intensity from a comparable region was reduced. CONCLUSIONS: The lack of reduction in gray matter NAA signal intensity suggests that the cortical gray matter deficit in these patients involved both neuronal and glial compartments rather than a neurodegenerative process in which there is a decrease in the neuronal relative to the glial compartment. Reduced white matter NAA signal intensity without a white matter volume deficit may reflect abnormal axonal connections.

Adult↗

Factor structure of emotional and cognitive behaviors for normals and neurologically impaired patients.

This study examined the factor structure of 68 affective, cognitive, and behavioral symptoms often reported with neurological impairment. The responses of 199 subjects to a behavioral inventory were submitted to an exploratory factor analysis. The results demonstrated that the instrument could be reduced to 16 homogeneous factors, which were able to explain 67% of the instrument's total variability. These factors were entered into a discriminant analysis that examined neurologically impaired patients and normal controls. Eleven of the 16 factors formed a linear composite that discriminated between these two groups with approximately 94% accuracy.

Adolescent↗

Potential of the luminol reaction in the sensitive detection of pesticide residues by flow injection analysis.

This study presents the first analytical application of the luminol chemiluminescence (CL) reaction for the sensitive detection of carbamate residues. Some experiments have been carried out to check the influence of the presence of traces of a N-methylcarbamate (carbaryl) on the CL emission produced from the oxidation of luminol using different oxidants, showing a significant enhancing effect on the CL emission when the oxidation of luminol is produced by potassium permanganate in alkaline medium, this enhancement being proportional to the carbaryl concentration. This fact has permitted the establishment of a sensitive chemiluminescence flow-injection (CL-FIA) method for the direct determination of carbaryl. The optimization of instrumental and chemical variables influencing the CL response has been carried out by applying experimental designs. Under the optimal conditions, the CL intensity was linear for a carbaryl concentration over the range 5-100 ng/mL with a detection limit of 4.9 ng/mL. This luminol-KMnO4-based FIA-CL system in basic medium shows an easy, fast and cheap alternative detection mode for the analysis of carbaryl residues in environmental water samples.

Flow Injection Analysis↗

Flow cytometry and phytoplankton.

Flow cytometry and sorting are now an important technology in aquatic research. Simultaneous measurements of individual particle cell size, fluorescence, and light scatter properties are directly applicable to current topics in aquatic research. Flow sorting may be employed to obtain subsets of cells for analysis by conventional methods. The manner in which rapid, precise measurements of single cells are made is complex, and the application of this technology to aquatic samples is subject to many analytical constraints. Flow cytometric measurements of algal cell size and pigment autofluorescence are relative and are therefore dependent on the optical configuration and variability of the instrument. Specific types of reference materials are used to establish the validity of analyses: 1) instrument standards, 2) fluorescence controls, and 3) internal stain standards. The selection and application of standards and controls are discussed in the context of allometric (cell size versus pigment fluorescence) and ataxonomic (pigment color groups) methods. The widespread acceptance of particular reference materials among research groups will result in comparable data sets describing aquatic particle distributions.

Cell Separation↗

Dimensional changes in acid-demineralized dentin matrices following the use of HEMA-water versus HEMA-alcohol primers.

Although dried acid-etched dentin can be reexpanded by hydroxyethyl methacrylate (HEMA)/water primers, the primed dentin collapses when the water is evaporated. Experimental HEMA/alcohol primers should stiffen the matrix and permit less shrinkage when the solvent is evaporated. The purpose of this study was to test the hypotheses that matrix shrinkage induced by solvent evaporation from HEMA primers is inversely related to solvent-induced matrix stiffness. Dentine discs were prepared from midcoronal dentine of unerupted human third molars. After demineralization in 37% phosphoric acid, the specimens were placed in the well of a linear variable differential transformer instrument, which measures changes in the matrix height and stiffness by load displacement after the application of weights. This was done in their hydrated state after water had been applied, after drying with dry nitrogen gas, and after the application of 35 vol % HEMA-water, HEMA-methanol, HEMA-ethanol, or HEMA-propanol primers. The degree of reexpansion after the application of the primers to the dentine in the dried state was found to be highest using the HEMA-water primer, followed by HEMA-methanol and HEMA-ethanol, with the HEMA-propanol primer producing no expansion. However, when the solvents were evaporated the HEMA-water-treated specimens shrank the most, the HEMA-ethanol-treated specimens shrank an intermediate amount, and the HEMA-methanol-treated specimens shrank the least. The net result of expansion minus shrinkage produced by evaporation determines how much HEMA remains in the hybrid layer just prior to polymerization.

Acids↗

Fusion rate after posterior lumbar interbody fusion with carbon fiber implant: 1-year follow-up of 51 patients.

Problems associated with posterior lumbar interbody fusion (PLIF) have traditionally included the need for donor bone, prolonged healing time of donor bone, the difficulty of cutting precise bony channels, the risk of retropulsion of graft, postoperative collapse of the bone graft, and pseudarthrosis. To avoid these problems a carbon fiber reinforced polymer implant cage has been developed to facilitate interbody fusion. The aim of the present study was to evaluate the technical problems and fusion rate associated with these new device for PLIF. Between April 1991 and December 1993, 65 pairs of these implant cages were sold in Sweden. They were traced to six hospitals, where they had been used in the treatment of 51 patients operated on at a total of 65 levels. All PLIF were supplemented with VSP (Variable Screw Placement) instrumentation. All medical records were evaluated and all patients were examined with plain radiographs taken at least 1 year after surgery. If that investigation did not show a clear fusion they were also evaluated with CT (18 patients, 27 levels). No intraoperative problems with the device have been reported; 44 patients (86%) and 58 levels (89%) achieved successful fusion. All patients bar one maintained their immediately obtained postoperative disc height. CT with 1-mm slices and sagittal reconstruction is most helpful if radiographs are difficult to interpret.

Adult↗

Inhibition of adenosine deaminase and administration of adenosine increase hypoxia induced ventricular ectopy.

Eighteen anesthetized, instrumented beagles (both genders, 10.4 +/- 0.5 kg) were used to investigate the effects of administered adenosine (n = 6), erythro-9-(2-hydroxy, 3-nonyl)adenine (EHNA), a potent inhibitor of endogenous adenosine deaminase (n = 6), and saline (n = 6), on the incidence of ventricular arrhythmias caused by systemic hypoxia (5% O2, 95% N2, PaO2 = 21 +/- 3 mmHg). After dogs were instrumented and monitored variables were in the steady-state, the above compounds were infused continuously into the cannulated left anterior descending (LAD) coronary artery for three minutes before, and throughout a four-minute period of hypoxia. After approximately 4 min of hypoxia the rates of ventricular ectopy [(total beats-normal beats)/total beats x 100 = % ectopy] were 73 +/- 9%, 73 +/- 11%, and 35 +/- 8% for the three groups, respectively. The percent ectopy of the adenosine- and EHNA-treated dogs was significantly greater (p < 0.05) than that for the saline-treated controls. These findings suggest that adenosine contributes to the ventricular arrhythmias of experimental systemic hypoxia.

Adenine↗

Prevalence of abnormal eating behaviours and inappropriate methods of weight control in young women from Brazil: a population-based study.

OBJECTIVE: The aim of this epidemiological investigation was to study the prevalence of abnormal eating behaviours in a community sample of young women from Porto Alegre, RS, Brazil. METHODS: The research team visited 1524 randomly selected households in Porto Alegre and invited all of the women aged 12-29 years to participate in the study: 513 women subsequently completed a socio-economic and demographic questionnaire, the Bulimic Investigatory Test (BITE) and the Eating Attitudes Test (EAT-26). RESULTS: Clinically significant disturbed eating behaviour was revealed in the 16.5% of women who had EAT scores above the cut-off point of 21; 2.9% also had BITE symptom scores of > or = 20. The participants were categorised into three groups on the basis of a new variable combining both instruments: those with abnormal eating behaviours (10.9%), those with unusual eating patterns (23.8%), and those with normal eating behaviours (60.2%). Abnormal eating behaviours were significantly more prevalent in the 16-19 year age range (p = 0.007) and were also more prevalent among overweight/obese women (p = 0.009). Laxative use was reported by 8.5% of the women, followed by fasting (3.1%), use of diuretics (2.8%) and vomiting (1.4%). CONCLUSIONS: Abnormal eating behaviours are fairly common among young women in Brazil. In comparison with other population studies, this survey showed a similar use of laxatives, less self-induced vomiting and a greater use of diet pills (probably because they are less strictly controlled in Brazil). Educational programmes aimed at preventing abnormal eating behaviours and developing healthy weight control practices among children and young adolescents should become public health priorities.

Adolescent↗

[Evaluation of traditional German undergraduate surgical training. An analysis at Heidelberg University].

BACKGROUND: The medical faculty of Heidelberg University implemented a new problem-based clinical curriculum (Heidelberg Curriculum Medicinale, or Heicumed) in 2001. The present study analyses the evaluation data of two student cohorts prior to the introduction of Heicumed. Its aim was to specify problems of the traditional training and to draw conclusions for implementation of a new curriculum. METHODS: The evaluation instrument was the Heidelberg Inventory for the Evaluation of Teaching (HILVE-I). The data were analysed calculating differences in the means between defined groups, with the 13 primary scales of the HILVE I-instrument as dependent variables. RESULTS: Teaching method and subject had no systematic influence on evaluation results. Thus, didactic lecture in orthopedic surgery achieved better results than small group tutorials, while the data on vascular and general surgery showed opposite results. Major factors for success were continuity and didactic training of lecturers and tutors. This is convincingly reflected by the results of the lecture course "Differential diagnosis in general surgery". The good evaluation data on small group tutorials resulted largely from the "participation" and "discussion" scales, which represent interactivity in learning. CONCLUSION: The results of the present study suggest the importance of two major pedagogic ideas: continuity and didactic training of lecturers and tutors. These principles were widely implemented in Heicumed and have contributed to the success of the new curriculum.

Attitude of Health Personnel↗

[Motor signs of depression].

OBJECTIVE: Alterations of motor phenomena are observable clinical phenomena of depressed patients. In addition to cognitive and emotional disturbances, motor dysfunctions are frequent psychopathological features which relate to neurobiological mechanisms of depression. Specific functions of various motor domains, pathophysiological concepts, and relevance of motor functions for diagnosis and prognosis of depression are summarized. METHODS: The contemporary literature regarding clinical and research aspects of differential diagnosis, treatment response and pathophysiology as well as the current knowledge regarding objective measures of motor signs in depression are reviewed. RESULTS: Alterations in motility (gross motor activity), locomotion, gestures, mimic, speech characteristics, and tremor are relevant for diagnosis, therapy and prognosis of depression. A large body of literature exists regarding qualitative, indirect measures of motor phenomena and quantitative analysis of motility. Only few unidimensional studies exist in respect to locomotion, gait and tremor in depression. The low correlation between physiological and clinical features may be due to methodological issues. Whereas most publications investigate motor functions indirectly using different functional coding and classification systems, only few studies report direct, physical, characteristics (kinematics) of motor phenomena in depression. CONCLUSIONS: Existing concepts do not clarify the relation of psychological and somatic components of motor signs. Agitation and retardation should be analyzed as multidimensional and independent variables. New psychometric instruments for documentation of motor phenomena in depression need further evaluation. Application of current technology and quantitative movement analysis may yield further insights in pathophysiological mechanisms and therapeutic strategies and represent important aspects of neurobiological research of depression.

Circadian Rhythm↗

Parental modeling, attachment, and supervision as moderators of adolescent gambling.

Utilizing Jessor's Problem Behavior Theory as a theoretical foundation, 116 male and female students in grades 9-12 (mean age 16.8) from a Midwestern urban high school were surveyed to determine the prevalence and relationship among gambling behavior and parental and peer influences. To measure these variables, the following instruments were used: The SOGS-RA, the Inventory of Parent and Peer Attachment-Parent Scale, and The Alabama Parenting Questionnaire-Parental Monitoring and Supervision Scale. Almost all of the students (91%) reported gambling at least once in their lifetime while 36.2% reported gambling once a week, 19% reported gambling on a daily basis, and 26% were classified as problem gamblers (10% using the "narrow" SOGS-RA criteria). Parental gambling was related to levels of past year gambling as well as increased likelihood of being classified as a problem gambler. Increased parental attachment was also associated with decreased levels of adolescent gambling, while decreased parental trust and communication resulted in increased problem gambling. Measures of parental monitoring and supervision found similar outcomes in that increased monitoring and supervision resulted in lower levels of adolescent gambling. Additionally, when peer influences were moderated by parental influences, there was a moderating effect on gambling behavior. This study illuminates the continued importance parents play in both risk enhancing and risk inhibiting influences on adolescent participation in problem behaviors.

Adolescent↗

Computer control of a modified Langendorff perfusion apparatus for organ preservation using cryoprotective agents.

The construction of an isolated rat heart cryopreservation apparatus which is interfaced to a process-control computer is described. The flexibility of the equipment is demonstrated by the running of simultaneous dual sets of experiments under multiple and variable conditions. The computer-control program allows interactive calibration of the instruments, accurate control of variables and modification of parameters during the experiments. By controlling the speed of the perfusate's peristaltic pump, perfusion pressure was not allowed to exceed a present level. Experiments are reported which allow the storage of hearts at -22 degrees C with the aid of the cryoprotective agents, ethylene glycol.

Animals↗

Enhancement of mitral regurgitation and normal left atrial color Doppler flow signals with peripheral venous injection of a saccharide-based contrast agent.

OBJECTIVES: The saccharide ultrasound contrast agent SHU 508 A was used to test the hypothesis that an intravenous, transpulmonary contrast method can enhance color Doppler flow signals in the left atrium in a clinically useful manner. BACKGROUND: Color Doppler display of mitral regurgitation may be unreliable because of variable signal to noise ratios that are at times poor. Traditional contrast agents enhance color Doppler flow signals in the right heart chambers. This study describes our observation of a recently developed contrast agent, SHU 508 A, capable of pulmonary transit after peripheral venous injection. METHODS: Control subjects (n = 10) and patients with suspected mitral regurgitation (n = 23) were studied by color Doppler flow imaging before and after 3-g intravenous doses of SHU 508 A. Reference grading of mitral regurgitation (0 to 3) was formulated from left ventricular angiography. In the four-chamber view of the left atrium, we selected for analysis the systolic frame with the maximal retrograde jet of mitral regurgitation (aliased/blue) and the diastolic frame with the maximal color coding from anterograde pulmonary venous flow (red) for planimetry and for grading the intensity of the color Doppler signal (0 to 5). RESULTS: The score of the color Doppler signal intensity increased by > or = 2.5 after 3 g of SHU 508 A (p < 0.001). Flow detection improved, as shown by the increased jet area of mitral regurgitation (> or = 170%), after 3 g of SHU 508 A (3 +/- 3 vs. 12 +/- 8 cm2, p < 0.001) and by a > or = 200% increase in normal anterograde flow area (p < 0.001) in both the mitral regurgitation group and the control group. After contrast enhancement, the correlation between angiographic grading and the relation of jet area to the left atrial area increased from r = 0.79 to r = 0.91. CONCLUSIONS: Contrast-mediated increased echogenicity of the left atrial blood pool improves the signal to noise ratio of Doppler images of mitral regurgitation and anterograde atrial flow. The technique is safe and simple and seems to minimize variability due to instrument design and anatomic signal attenuation.

Adult↗

Does stage-of-change predict dropout in a culturally diverse sample of adolescents admitted to inpatient substance-abuse treatment? A test of the Transtheoretical Model.

The Transtheoretical Model (TTM) () proposes that the stages-of-change construct can serve as useful tool for identifying those most at-risk of treatment dropout [Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change (pp. 227-255). Washington: American Psychological Association]. While researchers have found mixed support for this claim in adult samples, studies have not yet tested this issue in adolescent substance-abuse treatment settings. This paper reports findings from a Canadian study of adolescents (n = 130: 80 Caucasians, 50 Aboriginals) admitted to a hospital-based, residential substance-abuse treatment program. Two approaches were used to test the TTM's claim: (1) a hierarchical logistic regression model of dropout was developed using the subscales of the University of Rhode Island Change Assessment instrument (URICA), demographic variables, and subscales of the Addiction Severity Index (ASI); and (2) a chi-square analysis was employed to test the hypothesized relation between stage-of-change and dropout status. The findings demonstrated that the best predictive model of dropout included only the Precontemplation subscale of the URICA (OR: 4.3; 95% CI: 2.0-9.0). In addition, adolescents assigned to the Precontemplation stage manifested significantly higher rates of treatment attrition than individuals in the Contemplation or Preparation/Action stages. This study provides important empirical support for the predictive utility of the stage-of-change construct among a culturally diverse sample of adolescents admitted to an inpatient substance-abuse treatment program.

Adolescent↗