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PubMed2025

Genome-wide association meta-regression identifies stem cell lineage orchestration as a key driver of acne risk.

Over 85% of the population experience acne at some point in their lives, with its severity spanning a quantitative spectrum, from mild, transient outbreaks to more persistent, severe forms of the condition. Moderate to severe disease poses a substantial global burden arising from both the physical and psychological impacts of this highly visible condition. The analytical approach taken in this study aimed to address the impact of variation in the dichotomisation of acne case control status, driven by ascertainment and study design, on effect size estimates across independent genetic association studies of acne. Through a fixed intercept meta-regression framework, we combined evidence genome-wide for association with acne across studies in which case-control status had been ascertained in different settings, allowing for different severity threshold definitions. Across a combined sample of 73,997 cases and 1,103,940 controls of European, South Asian and African American ancestry we identify genetic variation at 165 genomic loci that influence acne risk. There is evidence for both shared and ancestry specific components to the genetic susceptibility to acne and for sex differences in the magnitude of effect of risk alleles at three loci. We observe that common genetic variation explains 13.4% of acne heritability on the liability scale. Consistent with the hypothesis that genetic risk primarily operates at the level of individual pilosebaceous units, a polygenic score derived from this case-control study of acne susceptibility is associated with both self-reported and clinically assessed acne severity in adolescence, further strengthening the link between genetic risk and disease severity. Prioritisation of causal genes at the identified acne risk loci, provides genetic validation of the targets of established and emerging acne therapies, including retinoid treatments. The identified acne risk loci are enriched for genes encoding downstream effectors of RXRA signalling, including SOX9 and components of the WNT and p53 pathways. Illustrating that the control of stem cell lineage plasticity and cellular fate are important mechanisms through which genetic variation influences acne susceptibility within the pilosebaceous unit.

Journal Article↗
PubMed1998

Validation of the quality of life scale: living with HIV.

A grounded theory of Salvaging Quality of Life provided the conceptual framework for the development of the Living with HIV scale which was validated in this study. The HIV + convenience sample (n = 187) was 66% male, with a mean age of 40.6 years, 69% African-American, and with an average CD4 count of 229 mm3. A principal components factor analysis with varimax rotation was conducted on the final 32-item scale and nine factors with Eigenvalues > 1 explained 60% of the variance. A second order factor analysis of these nine factors resulted in a two factor solution (HIV Struggles and HIV Reverence) which explained 49.4% of the variance. Cronbach alpha reliability coefficient for the total scale was 0.84. Differences between gender, ethnicity, education and presence of an AIDS diagnosis, and quality of life, were explored. Females had higher total scores which suggested they had a more positive quality of life than males. The Living with HIV scale can be used as a method of obtaining input from patients for care planning and for evaluating the effectiveness of nursing care intervention using quality of life as an outcome of care.

Adult↗
PubMed2004

Changing investment in activities and interests in elders' lives: theory and measurement.

Socioemotional selectivity and gerotranscendence, newer theories with roots in the disengagement theory of aging, provided the theoretical framework for a new measure of perceived change in investment in a variety of pursuits. The 30-item Change in Activity and Interest Index (CAII) was given to a sample of 327 outpatients aged 65-94. Items with at least 30% decreased investment responses included Entertaining in my home, Concern with others' opinions, Shopping and buying things, and Attending social events with new people. Principal Components Analysis of the index with dichotomous recoding (less vs. more or same investment) resulted in four factors: Active Instrumental (AI), Social Intellectual (SI), Spiritual Concerns (SC), and Transcendence (TR). Support for socioemotional selectivity and gerotranscendence is evident in the reported increase of importance of SI pursuits, with concurrent decrease in importance of AI activities among these respondents. Zero-order correlations of component scores with study variables suggest that AI and SI are more clearly related to older age, functional impairment, and negative affect than are SC and TR. The CAII appears to tap several dimensions of change in interests; the index gives geriatric mental health practitioners and researchers a tool to measure an aspect of social development that has been neglected in gerontology.

Activities of Daily Living↗
PubMed1995

A model and diagnostic measures for response time series on tests of concentration: historical background, conceptual framework, and some applications.

Based upon classical hypotheses about accumulating mental fatigue and distraction and its effect on response times, put forward in late 19th and early 20th century papers, a mathematical model is proposed for response times on tests of speed and concentration. The model assumes the random occurrence of very short distractions during information processing. It explains fluctuation and the increasing trend in response times on successive equivalent task units and leads to some simple diagnostic RT measures of speed and concentration as alternatives to the mean RT. A review is given of several experimental applications of the model, with subjects with and without concentration problems, using cancellation and digit addition tasks. The results demonstrate the potential usefulness of the model and the diagnostic measures derived from it. As predicted by the model, prolonged task performance yields an increasing trend in RT mean and variance that can be strongly reduced by giving very short resting periods very frequently, and to a lesser extent also by task alternation, but not by simply motivating the subjects to concentrate. Some practical implications for the administration and scoring of tests of speed and concentration are discussed, as well as limitations of the present results and the complementary relation of our approach to popular ones such as "stage analysis."

Adult↗
PubMed2006

An empirical test of signal detection theory as it applies to Batesian mimicry.

Signal detection theory (SDT) has been repeatedly invoked to understand how palatable prey might gain an advantage by resembling unpalatable prey. Here we developed an experimental test of the theory in which we sequentially presented computer-generated Mimics (profitable to attack) and Models (unprofitable to attack) to human volunteers, and asked them to forage in a way that maximized their personal scores. Both the Mimics and Models exhibited normally distributed variation in a single stimulus dimension. When we varied the mean similarity of Mimics to Models, and the proportion of all prey items that were Mimics, our human predators made foraging decisions that were close to those predicted by SDT, including the adoption of a threshold in appearance beyond which prey items were unlikely to be attacked. The fit of predictions to observations was marginally closer when including the time taken to handle the two types of prey. When Mimics and Models were allowed to evolve in appearance subject to selection, the evolutionary trajectory fitted the predictions of SDT closely. While our system was not appropriate to test all predictions of recent SDT theory, it provides strong support for the SDT framework as it applies to Batesian mimicry.

Adaptation, Biological↗
PubMed1996

Transformational leadership of clinical nutrition managers.

OBJECTIVE: To identify leadership qualities of clinical nutrition managers and associate these leadership qualities with selected demographic variables (eg, training/degree, length of time in management, number of people supervised, income, and participation in advanced practice activities). DESIGN: The theory of transformational leadership, that is, leadership that incorporates specific interpersonal behaviors of the leader and his or her actions within the organization, provided the framework for the study. Specific transformational leadership qualities--leader behavior, leader personal characteristics, and the effect of the leader on organizational functioning and culture--were measured using the Leadership Behavior Questionnaire (LBQ). The reliability and validity of the LBQ have been reported previously. Other data were obtained using two demographic surveys. SAMPLE: Demographic surveys were mailed to 1,599 members of the Clinical Nutrition Management dietetic practice group. From the 951 (59.8%) respondents, a study sample of 150 clinical nutrition managers and their subordinates was selected to receive the LBQ; 116 (77.3%) instrument sets were used for analysis. STATISTICAL ANALYSIS: Descriptive statistics were used to analyze the demographic surveys. A specified mixed linear model repeated measures Statistical Analysis System procedure was used to compare the clinical manager and subordinate LBQ scores. Association of the selected demographic variables with leadership qualities was measured by lambda, a predictive value measure, using the BMDP 4F program. RESULTS: Clinical nutrition managers exhibited transformational leadership qualities as rated by the LBQ, rating lowest on the communication leadership score and highest on the respectful leadership score. Most of the clinical nutrition manager self LBQ scores were significantly higher than the clinical nutrition manager LBQ scores rated by subordinates. The selected demographic variables appeared to have the strongest predictive effect for the visionary culture building subscore of the LBQ. The visionary culture building subscore is a measure of how well the leader interacts with and affects the functioning of an organization. APPLICATIONS/CONCLUSIONS: More research is needed to define leadership in dietetics: this study can serve as a possible model. One way clinical nutrition managers may be able to enhance their leadership behaviors is to strengthen their skills in communicating their vision. Programs are needed to help clinical nutrition managers shape their organizations to foster leadership development in their subordinates.

Dietetics↗
PubMed1999

In-hospital cardiopulmonary resuscitation. 5 years' incidence and survival according to the Utstein template.

BACKGROUND: Direct comparison of survival rates from in-hospital cardiopulmonary resuscitation (CPR) remains difficult. The objective of this study was to report outcome according to the Utstein template for in-hospital cardiac arrest and to evaluate the Utstein template itself as applied to a retrospective material. METHODS: The hospital (900 beds, 37,000 annual admissions) has no established do-not-resuscitate (DNR) order policy. CPR outside the Intensive- or Coronary Care Units (ICU/CCU) is performed by an emergency medical team consisting of an anaesthesiologist, a medical resident and a nurse anaesthetist. CPR attempts during 5 years (1990-1994) were analysed retrospectively. Patient survival, cerebral and overall performance category (CPC/OPC) score of the survivors was determined. The Utstein template was evaluated in terms of clinical relevance and data availability. RESULTS: During 5 years, 4927 patients died as in-patients. CPR outside the CCU/ICU was attempted 244 times. CPR was primarily successful on 83 occasions (34%), and 42 patients (17%) were finally discharged with CPC 1 or 2. Survival from primary ventricular fibrillation (VF) or ventricular tachycardia was 40%, pulseless electrical activity 3%, asystole 11% and of rhythm undetermined 6%. Age or sex effects were not observed. CONCLUSION: More than 90% of in-hospital deaths in this hospital are handled without CPR being initiated. Overall survival was 17%, and almost all survivors made a favourable outcome. The Utstein template for in-hospital cardiac arrest performed acceptably as a framework for reporting outcome in this retrospective study.

Adolescent↗
PubMed2006

Study design, baseline patient characteristics and intervention in a cross-cultural framework: results from the ADORE study.

OBJECTIVE: To describe the methodology and to present the baseline findings of the Attention-deficit/hyperactivity Disorder Observational Research in Europe (ADORE) study, the primary objective of which is to describe the relationship between treatment regimen prescribed and quality of life of children with ADHD in actual practice. METHODS: In this 2-year prospective observational study, data on diagnosis, prescribed treatment and outcomes of ADHD were collected at seven time points by paediatricians and child psychiatrists on 1,573 children recruited in 10 European countries. The data presented here from the 1,478 patients included in the analyses describe the baseline condition, initial treatment regimen prescribed and quality of life of families with children with ADHD. RESULTS: Patients had a mean age of 9.0 years (SD 2.5) and 84% were male. Physicians diagnoses were made using DSM-IV (43%), ICD-10 (32%) and both DSM-IV and ICD-10 (12%). Mean age of awareness of a problem was 5.1 years, suggesting an average delay of approximately 4 years between awareness and diagnosis of ADHD. Baseline ADHD rating scale scores (physician-rated) indicated moderate to severe ADHD. Parent-rated SDQ scores were in agreement and suggested significant levels of co-existing problems. CGI-S, CGAS and CHIP-CE scores also indicated significant impairment. Patients were offered the following treatments after the initial assessment: pharmacotherapy (25%), psychotherapy (19%), combination of pharmacotherapy and psychotherapy (25%), other therapy (10%) and no treatment (21%). CONCLUSION: The ADORE study shows that ADHD is similarly recognised across 10 European countries and that the children are significantly impaired across a wide range of domains. In this respect, they resemble children described in previous ADHD samples.

Adolescent↗
PubMed2004

Recalculation of cardiovascular risk score as a surrogate marker of change in clinical care of diabetes patients: the Alphabet POEM project (Practice Of Evidence-based Medicine).

AIMS: To assess the impact of evidence-based strategies on the care of subjects with diabetes, in particular on their coronary heart disease (CHD) risk, using the Alphabet Strategy template and coronary heart disease (CHD) risk calculators as novel audit tools. METHODS: Diabetes and cardiovascular parameters were collected on 400 consecutive type 2 diabetes patients attending the outpatient clinic. The subjects were men and women aged 21-75 years with necessary follow-up data from referral or first chronological available letter in the notes (T(0)) to the most recent follow-up visit (T(fu)). The disease risk scores: a significant reduction in average follow-up period was 5 years. Absolute CHD risk was calculated using the Framingham risk function and the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. The results were analysed using Student's paired t-test and chi-squared test. RESULTS: (T(0) vs. T(fu)): Advice: smoking status improved 18.3 vs. 15.5%: p = 0.3. Blood pressure: systolic blood pressure improved 145.8 +/- 21.1 vs. 140.1 +/- 20.5mmHg: p < 0.0001. Diastolic blood pressure improved 82.0 +/- 12.2 vs. 76.5 +/- 11.0mmHg: p < 0.0001. Cholesterol: total cholesterol improved 5.8 +/- 1.6 vs. 4.9 +/- 1.0 mmol/L: p < 0.0001; high density lipoprotein (HDL) cholesterol improved 1.05 vs. 1.26 mmol/L: p < 0.001. Diabetes control: glycated haemoglobin (HbA1c)% worsened 7.9 +/- 1.8 vs. 8.1 +/- 1.5: p < 0.0001. However, when adjusted for duration of diabetes, this improved non-significantly by 12% overall. Eye examination: improved 86.5 vs. 97.5%: p < 0.001. Feet examination: improved 69.8 vs. 83.5%: p < 0.001. Guardian drugs: significantly more patients were on aspirin (29.0 vs. 83.5%: p < 0.001), angiotensin converting enzyme (ACE) inhibitors (32.0 vs. 64.5%: p < 0.001), and lipid lowering therapy (16.8 vs. 55.0%: p < 0.001). Heart Framingham 10-year absolute cardiac risk was achieved (20.6 +/- 10.04% vs. 16.7 +/- 9.1%: p = 0.001). Using the UKPDS risk engine, there was a non-significant reduction in absolute CHD risk over the follow-up period (23.8 +/- 14.8% vs. 23.7 +/- 15.5: p = NS). There were significant improvements between age-adjusted risk score (T(adj)) and follow-up values (T(fu)) (Framingham: 23.67% (T(adj)) vs. 16.7% (T(fu)); UKPDS 31.2% (T(adj)) vs. 23.7% (T(fu))). For UKPDS stroke risk, a significant improvement was seen from T(adj) to T(fu) (19.0% (T(adj)) vs. 16.4% (T(fu)): p < 0.001), with a significant deterioration noted between T(0) and T(fu) (11.5% (T(0)) vs. 16.4% (T(fu)): p < 0.0001). CONCLUSIONS: The Alphabet Strategy is a novel evidence-based approach to clinical diabetes care, which produced a statistically significant improvement in most of the assessed parameters. The Alphabet Practice Of Evidence-based Medicine (POEM) template is a useful clinical tool for diabetes care and audit. It includes most of the components of diabetes audit required by the National Service Framework (NSF) and the United Kingdom GP contract.

Adult↗
PubMed2000

Depressive symptoms among African American women with HIV disease.

Depressive symptoms are a common response to HIV disease and evidence suggests that women may be at particular risk. Very little of the research on depressive symptoms within the context of HIV disease has included women, however, and even fewer studies have targeted African American women. In a beginning effort to address this gap, the authors performed a secondary analysis of data collected from 1992-1995 in a sample of 264 HIV+ women. The purpose of the secondary analysis was to describe the levels of depressive symptoms for a subsample of 152 African American subjects and to identify significant covariates. The original analysis was based on a stress and coping framework and was designed to provide a description of stressors, resistance factors, and adaptational outcomes of HIV+ women. It included various measures of psychological distress and quality of life. Depressive symptoms were not examined in the original analysis as an outcome of HIV disease, however. In the secondary analysis, depressive symptoms were operationalized using a depression subscale of the Brief Symptom Inventory (BSI) (Deragotis, 1993). Major categories of correlates examined included person resources, environmental resources, coping responses, and disease-related stressors. The data used in the analysis were collected during the fourth and fifth interviews of the longitudinal study, with 152 of the African American women having completed both interviews. Variance in depressive symptoms was analyzed using ANOVA, zero-order correlations, and multiple regression analysis. The mean depressive symptoms score for the subsample of African American women was considerably higher than published means for female and male normative samples, respectively. The regression model accounted for over half of the variance in depressive symptoms (R2 = .515). Significant correlates included self-esteem, family cohesion, HIV symptoms and quality of life. The findings support personal and social resources and disease-related factors as important correlates of HIV+ African American women's depressive symptoms and suggest the need for interventions to address such factors.

Adaptation, Psychological↗
PubMed2003

Readiness for behavioral changes in patients with heart failure.

BACKGROUND: Successful self-care in heart failure often requires lifestyle changes such as avoiding sodium, excess fluid intake, alcohol, and tobacco; exercising regularly; and losing weight. The Transtheoretical Model, a framework for making behavioral changes, proposes that change requires a series of stages. OBJECTIVES: To identify the stage of readiness for change in 6 lifestyle behaviors important in heart failure and to determine differences in signs and symptoms of heart failure, self-reported knowledge of the disease, and self-reported behavior between patients who have taken action and patients who have not. METHOD: A mail survey of 250 patients with heart failure. RESULTS: Most respondents reported consistent avoidance of tobacco (90.6%), alcohol (87.9%), sodium (81%), and excess fluid (72.6%) and regular participation in exercise (67.1%) and trying to lose weight (64.7%). Yet only 38.7% had a regular exercise program, and 94.2% had eaten high-sodium foods in the preceding 24 hours. Knowledge of heart failure was low (mean score, 67.4%) and did not differ by stage of change. Only 30.4% of the respondents were at their desired weight, and most overweight subjects had been trying to lose weight for more than 6 months. CONCLUSIONS: Although respondents thought they were consistently adhering to recommended guidelines for changes in lifestyle, actual reported behaviors did not always support this evaluation. Use of the stage of change tool to assess stage of readiness to make lifestyle changes may not work well in patients with heart failure, perhaps because of the number and complexity of the changes needed.

Adult↗
PubMed2006

Pediatric highly active antiretroviral therapy in Mozambique: an integrated model of care.

AIM: To test the impact of a public health model to implement HIV pediatric care in Limited Resource Settings. METHODS: A retrospective study on the clinical files of 679 Mozambican children (mean age 4.4 years; SD 3.2), has been carried out. The pediatric patients received HAART (Highly Active Anti-Retroviral Therapy) in the framework of DREAM, a nationwide public health program offering an integrated model of care to HIV patients including free-of-charge HAART and monitoring, nutritional assessment and supplementation, peer-to-peer education, active tracing of the dropped out patients. RESULTS: HAART was started in 297 subjects out of 679. The median time of treatment was 286 (IQ 25-75:125-465). Mortality rate was lower in the sub-sample receiving HAART (8.4%; CI 95%: 5.2-11.6 vs 13.1%; CI 95%: 9.7-16.5). After 6 months of treatment the percentage of viral load lower than 400 copies/mL rose from 4.9% to 46.3%. The percentage of patients with less than 15% of CD4 cells out of the total lymphocyte count and the percentage of patients below the 2 z-score decreased from 56.4% and 58.1% to 8.8% and 38.1% respectively. CONCLUSIONS: Pediatric HAART in limited resource settings often face difficulties to handle complex treatment schemes, but the implemented model seems to be an effective tool to reduce mortality rate in HIV positive pediatric population.

Antiretroviral Therapy, Highly Active↗
PubMed2003

Age identification in the framework of successful aging. A study of older Finnish people.

A person-oriented approach was used in a study of age identification among community-dwelling older people. The study was based on 8-year follow-up data; 843 persons aged 65-84 were involved in the first phase of the study, and 426 persons aged 73-92, in the second phase. Loosely, on the basis of the distinction between successful, usual, and pathological aging (Rowe & Kahn, 1987, 1997), participants were grouped according to their self-ratings of cognitive and physical functioning as "Positive," "Negative," and "Others." Participants possessing at least 4 out of the 5 criteria used as indicators of successful aging in the study (no illness or injury presenting problems in daily life, no health problems imposing limitations on hobbies, self-rated cognitive functioning better than satisfactory, age-comparative functional capacity as good, and no signs of depression) were assigned to the "Positive" group. The results showed these individuals typically to have a more youthful age identity, indicated by a lower feel age and thus a lower subjective age-perception score, lower mental, physical, and look ages, and a less frequently reported sense of age weighing on them. Moreover, this group reported a higher ideal age and had a chronological age satisfaction score closer to 0, suggesting higher satisfaction with chronological age. Also a tendency to set the onset of old age later and a willingness to live to 100 years of age were features that were more characteristic of the "Positive" than the other groups. The findings, supported by multivariate analyses, were in line with those of previous variable-oriented studies on age identification, suggesting that an association exists between perceptions of personal aging and physical and psychological well-being.

Adaptation, Psychological↗
PubMed2006

Phylogeny of Eunicida (Annelida) and exploring data congruence using a partition addition bootstrap alteration (PABA) approach.

Even though relationships within Annelida are poorly understood, Eunicida is one of only a few major annelid lineages well supported by morphology. The seven recognized eunicid families possess sclerotized jaws that include mandibles and a maxillary apparatus. The maxillary apparatuses vary in shape and number of elements, and three main types are recognized in extant taxa: ctenognath, labidognath, and prionognath. Ctenognath jaws are usually considered to represent the plesiomorphic state of Eunicida, whereas taxa with labidognath and prionognath are thought to form a derived monophyletic assemblage. However, this hypothesis has never been tested in a statistical framework even though it holds considerable importance for understanding annelid phylogeny and possibly lophotrochozoan evolution because Eunicida has the best annelid fossil record. Therefore, we used maximum likelihood and Bayesian inference approaches to reconstruct Eunicida phylogeny using sequence data from nuclear 18S and 28S rDNA genes and mitochondrial 16S rDNA and cytochrome c oxidase subunit I genes. Additionally, we conducted three different tests to investigate suitability of combining data sets. Incongruence length difference (ILD) and Shimodaira-Hasegawa (SH) test comparisons of resultant trees under different data partitions have been widely used previously but do not give a good indication as to which nodes may be causing the conflict. Thus, we developed a partition addition bootstrap alteration (PABA) approach that evaluates congruence or conflict for any given node by determining how bootstrap scores are altered when different data partitions are added. PABA shows the contribution of each partition to the phylogeny obtained in the combined analysis. Generally, the ILD test performed worse than the other approaches in detecting incongruence. Both PABA and the SH approach indicated the 28S and COI data sets add conflicting signal, but PABA is more informative for elucidating which data partition may be misleading at a given node. All our analyses indicate that the monophyly of the labidognath/prionognath taxa and even a labidognath clade (i.e., a "Eunicidae"/Onuphidae/Lumbrineridae clade) is significantly rejected. We show that the definition of both the labidognath and ctenognath jaw type does not address adequately the variation within Eunicida and thus misleads our current evolutionary understanding. Based on the presented results a symmetric maxillary apparatus with a carrier and four to six maxillae is most likely the plesiomorphic condition for Eunicida. [COI; conflicting data; fossil record; ILD; Jaw Evolution; molecular phylogeny; rDNA; SH test.].

Animals↗
PubMed2003

How does schema theory apply to real versus virtual memories?

Schemas are cognitive frameworks that guide memory, aide in the interpretation of events, and influence how we retrieve stored memories. The purpose of this study was to explore how schemas operate in a well-known environment and to examine whether or not schemas operate differently in real versus virtual environments. Twenty-four undergraduate students from a small liberal arts college in the northeast participated for course credit. Two identical offices (a real office and a virtual office) were created and filled with eight consistent and eight inconsistent items. Each participant explored either the real office or the virtual office for 20 seconds without any knowledge that their memory would be tested. After leaving the office, participants completed a recognition task and a short demographic questionnaire. Overall sensitivity and higher confidence in recognition memory scores was found for inconsistent compared to consistent items. Greater support for the consistency effect was observed in this study and interpreted in terms of the dynamic memory model and the schema-plus-correction model. The results also demonstrate that virtual reality paradigms may produce similar outcomes compared to the real world in terms of some memory processes, but additional design factors must be considered if the researcher's goal is to create equivalent paradigms.

Adolescent↗
PubMed1994

Further improvement in methods of group-to-group sequence alignment with generalized profile operations.

It has previously been shown that rigorous optimization of alignment between two groups of sequences in the sense of minimal sum of pairs (SP) score with a linear gap-weighting function can be achieved by an extended version of the dynamic programming algorithm. The major drawback of this algorithm was that the computation time grows in proportion to the product of the numbers (M and N) of sequences comprising the two groups. A new algorithm presented in this paper achieves the same rigorous alignment in a time complexity much less dependent on the sizes of the groups. Examinations with many groups of sequences indicated that the new algorithm runs faster than the earlier one when M x N > 6-10, approximately 10 times faster when M x N approximately 200, and > 100 times faster when M x N > 2500. This computational acceleration facilitates application of the algorithm to alignment of large groups, especially in the framework of iterative refinement strategies.

Algorithms↗
PubMed2000

The Israel National Skin Bank: Quality Assurance and Graft Performance of Stored Tissues.

The Israel National Skin Bank (INSB) was founded jointly by the Israel Defense Forces (IDF) Medical Corps and the Ministry of Health in 1986. The prime purpose of the Skin Bank is to treat burn victims incurred at war or during mass casualty incidences. The INSB Protocol is comprised of international skin bank protocols and our previous and present research results. They provide the framework for selecting optimal guidelines for procurement, processing, preservation, storage and evaluation of transplantation performance of viable skin grafts. For evaluation and direct comparison of graft performance of glycerolized or cryopreserved skin stored for long periods, we have applied a mouse recipient model developed by us. This model assesses graft performance before the rejection process takes place. The in vivo design has inherent clinical relevance, which is especially appealing. Cryopreserved skin performed better than glycerolized skin (p > 0.027), but fresh skin performed significantly better than cryopreserved skin (p > 0.003), as analyzed by the Mann-Whitney non-parametric test. Then graft performance of skin specimens were cryopreserved by programmed or stepwise freezing and stored at -80 degrees C or in liquid nitrogen for 1 and 6-10 months was evaluated. The average score of skin preserved by programmed freezing and stored in liquid nitrogen is the highest for both storage periods. This method has a highly significant advantage (p < 0.007) over the others for 6-10 months storage, evaluated by graft adherence. Several interaction factors determine the quality of cryopreserved skin. Highly significant is the interaction factor/'combined effect' of sample variability with the method of cryopreservation or with the storage period. Finally, the results of paired comparison of selected histology criteria of cryopreserved to fresh skin indicated that storage of skin for up to 5 years did not impair significantly its performance compared to fresh skin, whereas, after six years of storage, there was a highly significant (p < 0.001) impairment in skin quality. We offer a simplified in vivo model and analysis for cryopreserved skin graft performance, suggesting that the evaluation procedures, which are issues of great interest in skin banking, may help future skin banks to make informed choices and decisions regarding quality issues.

Journal Article↗
PubMed2003

Generalizability Theory II: Application to perceptual scaling of speech naturalness in adults who stutter.

Generalizability theory has been recommended as the most comprehensive method for assessing the reliability of observational data. It provides a framework for calculating the various sources of measurement error and allows further design of measurements for a particular purpose. This paper gives a practical illustration of how this method may be used in the analysis of observational data. We use the ratings of 15 unsophisticated raters using the 9-point speech naturalness scale of R. R. Martin, S. K. Haroldson, and K. A. Triden (1984) to evaluate the speech of adults before and after treatment for stuttering. We calculate various sources of measurement error and use these to estimate the minimum number of raters and ratings per rater for a reliable result. For posttreatment data, the average of three independent raters, and for pretreatment data, the average of five independent raters should give a result within one scale point of the hypothetical true score for the speaker in at least 80% of samples. The example illustrates the advantages of using this method of analysis.

Adult↗