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Radon concentration in soil gas: a comparison of the variability resulting from different methods, spatial heterogeneity and seasonal fluctuations.

From the end of 1996 through March 1999, the spatial and temporal variability of the soil 222Rn concentration was investigated at a 20 m x 20 m test field with porous soil in 0.5 m and 1.0 m depth at nine positions each and at 1 m x 1 m plots at four positions each. For this, soil gas was collected weekly into evacuated scintillation cells and was analysed subsequently for radon activity. In the 20 m x 20 m field the spatial variability was characterized by coefficients of variation (C.V.) of 26% at 0.5 m, and 13% at 1.0 m depth. Within the 1 m x 1 m plots the C.V. values were 4% and 2%, i.e. within the uncertainty of the method. Time series analysis (TSA) of the soil radon data shows seasonal variations with maximum concentrations in the winter months. Radon concentrations ranged from 6 to 50 kBq m(-3) in 0.5 m depth, and from 8 to 34 kBq m(-3) in 1.0 m depth. Mostly, the concentrations were higher in 0.5 depth than in 1.0 m depth. However, seasonal variation of the 0.5 m to the 1.0 m concentration ratio has been verified by TSA. To test the variability resulting from different methods, additional procedures and instruments were investigated at the 20 m x 20 m field and at a second test field with a different soil type. Soil gas sampling into evacuated scintillation cells was selected as the reference procedure. Soil radon concentrations obtained with the different sampling procedures and detection methods at the 20 m x 20 m field essentially agreed within the limits of uncertainty of the methods tested. At the second test field, i.e. in a largely impermeable soil, deviations up to a factor of two related to the reference procedure were observed.

Air Pollutants, Radioactive↗

Assessing educational validity of the Morbidity and Mortality conference: a pilot study.

PURPOSE: To assess inter-rater agreement in perceptions of cases presented during Morbidity & Mortality conference (M&M) and changes associated with initiation of a modified M&M. METHODS: Faculty, residents, fellows, and students at weekly M&M between June 2001 and March 2002 voluntarily completed an anonymous questionnaire after each M&M case presentation, which asked: if the complication was avoidable (yes/no/not sure), if consensus was reached among participants (yes/no/not sure), the primary cause of the complication (diagnostic error, technical error, judgment error, nature of disease, other), when the primary cause occurred (preoperatively, intraoperatively, postoperatively), and which, if any, of 16 listed actions could prevent similar future problems. On September 24, 2001, the conference was lengthened and modified. Data collected before (n = 30 cases) and after M&M modification (n = 46 cases) were compared. RESULTS: A total of 76 cases were evaluated for a total of 860 completed forms. In 57 cases (75%), majority opinion (ie, > or =50% of participants) indicated that the complication resulted from either nature of disease (n = 32, 41%), or error in diagnosis (n = 5, 7%), technique (n = 8, 11%) or judgment (n = 12, 17%). There was no clear majority for the remainder of the cases. Relative to cases presented prior to M&M modification, for those presented post-modification, the majority perceived that consensus was reached more often (96% of cases vs. 70% of cases, p<.01), and that complications were more often avoidable (54% of cases vs. 23% of cases, p <.05), more likely caused during the preoperative period (26% of cases vs. 7% of cases, p <.01) and less likely caused during the postoperative period (28% of cases vs. 67% of cases, p <.01). CONCLUSIONS: The variability in questionnaire responses suggests that an evaluation instrument such as that reported here can be useful in assessing educational needs, quantifying the efficacy of case presentations, and assessing the effects of modifications to conference content and structure. Modifying M&M in accordance with published recommendations appears to improve case analysis and consensus among participants.

Clinical Clerkship↗

Activities of daily living among heart transplant candidates: neuropsychological and cardiac function predictors.

BACKGROUND: The ability of patients to perform day-to-day tasks (e.g., medication management, dietary regulation) is an important concern of transplant teams. METHODS: We studied a clinical series of 75 heart transplant candidates and 38 controls to examine the predictive validity of demographic, neuropsychologic, and cardiac function variables to a performance-based measure of instrumental activities of daily living (IADL) capacity (i.e., Everyday Problems Test, EPT). RESULTS: Multiple regression analyses, controlling for education and race, indicated that neuropsychologic tests accounted for between 34% and 67% of the variance across IADL domains (e.g., cooking, household chores, medication management). The IADL capacity was most consistently predicted by long-standing verbal ability (Shipley Institute of Living Scale-Vocabulary, SILS-VOC) and psychomotor speed and mental flexibility (Trail Making Test-Part B, TMT-B). Similarly, SILS-VOC and TMT-B also tended to show the best operating characteristics (i.e., sensitivity, specificity, positive predictive power, negative predictive power) for detection of dependence across IADL domains. In contrast, cardiac function measures (e.g., cardiac output, mean atrial pressure) were largely unrelated to the patient's performance on the paper-and-pencil EPT task. CONCLUSIONS: Long-standing intellectual ability, and a measure of speeded information processing and mental flexibility are the best predictors of IADL capacity.

Activities of Daily Living↗

A cost-benefit analysis of vision screening methods for preschoolers and school-age children.

INTRODUCTION: The purpose of this study was to determine costs and benefits of visual acuity screening (VAS) or photoscreening (PS) in children. METHODS: A societal-perspective, decision-analytic model compared VAS and PS conducted in three age groups: children 6 to 18 months, 3 to 4 years, and 7 to 8 years old. Literature estimates of sensitivity, specificity, and prevalence were used. Cost estimates and referral rates for surgical treatment were derived from a managed care database and the United States Social Security Administration. RESULTS: All the benefit-to-cost ratios exceeded 1.0, meaning that all screening programs studied had benefits that exceeded the cost of screening. The total net benefit was highest for PS in children of 3 to 4 years of age (19,412 US dollars) and the least for VAS in children 7 to 8 years of age (15,179 US dollars). The benefit-to-cost ratio was highest for the VAS in children 3 to 4 years of age (162 US dollars) and least for PS in infants 6 to 18 month old (140 US dollars). Sensitivity of the PS instrument and VAS charts were the most influential variables in determining the most cost-beneficial program. CONCLUSIONS: Based on the best available data, the net benefit of PS in 3 to 4 year old preschool children is greater than VAS in children 7 to 8 years of age, PS in toddlers, and VAS in children 3 to 4 years of age.

Age Factors↗

[HIV-infected patients' perceived satisfaction with an outpatient pharmaceutical care unit (OPCU)].

INTRODUCTION: Satisfaction measurements attempt to establish patient views regarding health care. In the setting of pharmaceutical care, the measurements of the generically called "h umanistic"variables is scarce, and the number of validated instruments is inadequate. The goal of this study is to present a specifically-developed satisfaction survey regarding outpatient pharmaceutical care units, and to prove its applicability and inner consistency in a HIV-infected patient population on antiretroviral therapy. METHODS: The survey includes 19 questions within four groups - A. The unit's physical space, location, and organization; B. Dispensation; C. Pharmaceutical consultation, and D. Overall satisfaction with the unit. Each question is scored from 1 to 5. The study was carried out by administering 250 surveys to consecutive patients arriving at the OPCU, Castell6n General Hospital. RESULTS: Responses show a high degree of patient satisfaction with questions posed, with mean values oscillating between 3.0 and 4.8. The highest means corresponded to pharmacist valuation, and the lowest values corresponded to questions within the organizational module. All questions considered, the mean score obtained was 3.96 + 0.95 (median of 4). The survey exhibited high internal reproducibility both for each group and all questions. CONCLUSION: The satisfaction survey discussed here is an accessible, easy-to-use instrument that may be rapidly completed and used in pharmaceutical care units with outpatients as a measurement of patient satisfaction. The high scores HIV-infected patients assign to questions included in the survey suggest a benefit from standardized pharmaceutical care.

Acquired Immunodeficiency Syndrome↗

A comparison of two alcohol craving questionnaires.

AIM: To compare two multi-dimensional questionnaires to measure cravings and urges for alcohol: the Alcohol Craving Questionnaire (ACQ: Singleton, Henningfield and Tiffany, 1994a) and the Desires for Alcohol Questionnaire (DAQ: Clark et al., 1996). DESIGN, SETTING, AND PARTICIPANTS: Both questionnaires were administered, in a counterbalanced order, to a total of 380 recreational drinkers. In a further study, a shortened version of the DAQ was administered to a sample of 131 drinkers attending AA or a treatment centre. Exploratory factor analyses were carried out on the data and relationships between questionnaire score and other variables were assessed. FINDINGS: In recreational drinkers both instruments appeared to have a three-factor structure. The DAQ appeared superior to the ACQ in a number of respects: it produced more reliable factors; its structure accounted for a higher proportion of the variance; the factor inter-correlations were somewhat lower; in a combined analysis of both instruments most of the factors retained came from the DAQ; and the DAQ discriminated better between bing and non-binge drinkers and excessive and moderate drinkers. A similar factor structure was found for the DAQ in the alcoholic subjects with addition of a factor of "controllability". CONCLUSIONS: The results support a multifactorial account of alcohol craving, and indicate that the DAQ has some advantages over the ACQ as a research tool.

Adolescent↗

Stressful life events and perimenstrual symptoms.

The purpose of this study was to determine whether the effects of stressful life events on perimenstrual symptoms were due to operational confounding of the instruments used to measure the independent and dependent variables. Women aged 18 to 35 (n = 179) completed the Schedule of Recent Events (SRE) and the Moos Menstrual Distress Questionnaire during a home interview. When variance in PMS scores attributable to age, parity, education, and contraceptive method was controlled using hierarchical multiple regression, total SRE scores were correlated with premenstrual and menstrual negative affect, menstrual water retention, and menstrual performance impairment. When health-related components of the SRE score were controlled in a similar manner, however, the residual SRE scores explain a diminished amount of the variance in premenstrual and menstrual negative affect and menstrual performance impairment. Future investigations are needed to clarify whether the effects of health-related life events on perimenstrual symptoms are simply a matter of operational confounding of measures of the independent and dependent variables, or whether women who recently have experienced personal illness or injury are at greater risk of developing perimenstrual symptoms.

Adolescent↗

Islands of memory: Autobiographical remembering in amnestics.

In amnestics with anterograde amnesia, memories of post-onset autobiographical experiences, if present at all, are typically barren and impoverished. However, there have been sporadic reports of islands of memory--memories that are vivid, detailed, and specific to time and place. The aim of this study was to verify the presence of such memories and examine their incidence rate. Anterograde amnestics were interviewed in their home using a narrative interviewing strategy with a view to describing memory in everyday life. Each autobiographical memory of a post-onset event was coded for quantity-length, and quality-episodicity. In just over half of the amnestics (8 out of 14), a memory that was lengthy, rich in personal details, and localisable was recollected. The quantitative and qualitative aspects of these island memories were significantly different from the other autobiographical memories that the amnestics supplied. These memories were at odds with what would be expected on the basis of their performance on standardised memory instruments. Our findings suggest there is occasionally more variability in remembering of autobiographical experiences in some amnestics than has traditionally been believed.

Adult↗

Functional limitations among home health care users in the National Health Interview Survey Supplement on Aging.

A case-control study compared home health care (HHC) users from the 1984 Supplement on Aging to users of other community services and of no community service, matched on age and gender. Examination of specific activities of daily living (ADLs), instrumental activities of daily living (IADLs), and sociodemographic variables showed that HHC users were significantly more limited than controls in every ADL and IADL. In multivariate analyses, HHC use was significantly associated with three ADLs (dressing, going outside, bathing), two IADLs (shopping, heavy housework), and poor health status.

Activities of Daily Living↗

Instrumentation for the continuous measurement of gas exchange and ventilation of infants during assisted ventilation.

A system of instrumentation for continuous measurement of oxygen consumption (VO2), carbon dioxide production (VCO2) and minute ventilation (V1) in human newborns on assisted ventilation is described. VO2 and VCO2 are measured by open-circuit indirect calorimetry utilizing a Servomex OA 184 differential paramagnetic oxygen analyzer and a Beckman LB 2 infrared CO2 analyzer. Minute volume is measured with a body plethysmograph. Bench performance is described, limitations of the system are defined, and sample clinical data are presented. The instrumentation can measure safely, accurately, and continuously physiologic variables in sick infants on assisted ventilation.

Humans↗

Clinical evaluation of a new, point-of-care hemocytometer.

OBJECTIVE: This study was designed to compare results obtained with a new point-of-care hemocytometer with those of two established (point-of-care and laboratory-based) instruments. DESIGN: To compare CBC values between established laboratory-based and point-of-care instruments, measurements were performed on routinely obtained blood specimens for CBC analysis in our institutional laboratory (phase I) and on specimens from cardiac surgical patients before initiation of cardiopulmonary bypass and after discontinuation of cardiopulmonary bypass in phase II. SETTING: Surgical and hospitalized patients at a tertiary care center. PATIENTS: Measurements were obtained by using blood specimens obtained from 141 hospitalized patients from different services (phase I) or from a consecutive series of 204 patients undergoing cardiac operations (phase II). MEASUREMENTS AND MAIN RESULTS: Hemoglobin (HGB), platelet count (PLT), red blood cell count, and white blood cell count (WBC) were measured with two on-site and one laboratory-based instruments. Hematocrit (HCT) was calculated by using measured variables. Linear regression demonstrated good correlations between Ichor and T540 HGB (r2 = .95), HCT (r2 = .95), PLT (r2 = .94), and WBC (r2 = .95) results (n = 408); similarly, good correlations were observed with Coulter STKS HGB (r2 = .92), HCT (r2 = .91), and PLT (r2 = .94) results (n = 141). The relationship between Ichor and Coulter STKS WBC (r2 = .27) was poor; however, when two Ichor-derived outlier values (>50) were excluded, the relationship was very good (r2 = .99). Bias analysis (mean +/- SD) demonstrated similar results between Ichor and T540 HGB (0.003+/-0.5), HCT (-0.21+/-1.5), WBC (0.79+/-1.3), and PLT values (-9.2+/-16.6) as well as STKS HGB (-0.08+/-0.7), HCT (-0.69+/-2.3), WBC (-0.62+/-5.8), and PLT values (-10.2+/-21.4). CONCLUSIONS: The Ichor hemocytometer provides accurate hematologic results that can facilitate rapid quantitative assessment of CBC variables and thus may be clinically useful, especially in critically ill patients.

Bias↗

Impact of cognitive function on assessments of nursing home residents' pain.

OBJECTIVES: We sought to examine the impact of residents' cognitive function on the quality of Minimum Data Set (MDS) pain data using the latent variable approach. RESEARCH DESIGN: Using the Resident Assessment Instrument (RAI) protocol, nursing home (NH) staff and well-trained study nurses independently assessed 3736 NH residents. MEASURES: Inter-rater agreement of pain ratings between NH staff and study nurses was quantified by weighted kappas and polychoric correlations and compared among groups of residents with no/mild, moderate, and severe cognitive impairment. Probit models were built to examine the effect of residents' cognitive function on thresholds raters used to rate pain. RESULTS: Of 3736 residents, 40.4% had no/mild, 35.9% moderate, and 23.7% severe cognitive impairment. Both NH staff and study nurses recorded less frequent and less severe pain for residents with more severe cognitive impairment. The inter-rater agreement on pain ratings between NH staff and study nurses was good-weighted kappas were greater than 0.5 and polychoric correlations greater than 0.7. The thresholds raters used to record pain were similar for NH staff and study nurses and progressively increased when raters recorded pain for residents with more severe cognitive impairment. CONCLUSIONS: Given the RAI protocols, the quality of MDS pain data collected by NH staff was similar to that of well-trained nurses regardless of residents' cognitive function. Our results strongly support the notion that specialized pain assessment instruments are needed to adequately detect pain for the large proportion of cognitive impaired NH residents.

Aged↗

System for determination of ultrasonic wave speeds and their temperature dependence in liquids and in vitro tissues.

An interferometric technique capable of accurately measuring wave speed in liquids is reported. The hardware is adapted from a design to measure nonlinear responses of biological tissues to pressure changes (pressure derivatives) and temperature changes (temperature derivatives). It is used with the highly sensitive variable frequency pulsed phase-locked loop (VFPPLL) instrument. The system uses well-understood and well-characterized components and systems. The apparatus covers a temperature range from below 5 degrees C to above 45 degrees C. The system with the high-sensitivity VFPPLL is capable of measurement of wave speed to an uncertainty of less than 0.1%, and changes in wave speed to better than 0.001%. The transducer is an undamped temperature-characterized PZT-5A 500-kHz plate, whose output is corrected for off-resonance operation and for diffraction effects. To test the accuracy of the technique, measurement of ultrasonic compressional wave speed in water at temperatures from 10 degrees C to 45 degrees C are reported, with an estimated uncertainty of 0.07% and a temperature uncertainty of 0.15 degrees C. The agreement between mean values and literature values is better than 0.05%.

Acoustics↗

Hypothalamic influences on cardiovascular response of beagles to dynamic exercise.

We studied nine young adult beagles at rest and during four levels of dynamic exercise before and after electrolytic lesions were made in the hypothalamus in the region of the fields of Forel. The beagles were habituated to run freely on a motor-driven treadmill and were instrumented chronically to allow repeated measurement of cardiovascular variables. Variables measured or calculated included O2 consumption, cardiac output, arteriovenous O2 difference, systemic arterial pressure, systemic vascular resistance, heart rate, and mixed venous blood lactate concentration. In addition, regional blood flow was measured with radioactive microspheres in two beagles at rest and during peak exercise (6.4 km/h, 20% grade). After prelesion treadmill studies, the beagles were anesthetized and the tips of stainless steel electrodes were placed bilaterally in the hypothalamus in locations that when stimulated (100-300 microA) evoked increases in cardiovascular and muscle motor function. Lesioning (5 mA; 15 s) abolished the responses evoked by stimulation. By contrast, the cardiovascular variables measured in the beagles at rest and during dynamic exercise were similar pre- and postlesion. Therefore, loss of hypothalamic sites that produce increases in cardiovascular and muscle motor function when stimulated electrically does not appear to comprise the cardiovascular response of awake beagles to dynamic exercise.

Animals↗

Effect of perfusion pressure distal to a coronary stenosis on transmural myocardial blood flow.

We tested the hypothesis that reductions of perfusion pressure distal to a flow-limiting coronary artery stenosis can directly impair perfusion of the subendocardial myocardium. Dogs were instrumented with an electromagnetic flowmeter probe and a variable occluder on the proximal left circumflex coronary artery. Coronary perfusion pressure was measured with a catheter distal to the occluder. Coronary autoregulation was abolished by intraarterial infusion of adenosine to produce maximal coronary vasodilation. The transmural distribution of myocardial blood flow was measured with radioactive microspheres during unimpeded arterial inflow, when the occluder was progressively narrowed to reduce distal coronary pressure to approximately 70%, 50% and 35% of the control coronary perfusion pressure, and during total coronary occlusion. Heart rate, left ventricular diastolic pressure and the fraction of coronary artery flow during systole remained constant throughout the study. Progressive reductions of coronary perfusion pressure were accompanied by direct reductions of the subendocardial/subepicardial blood flow ratio (r = 0.83). Examination of the relationship between myocardial blood flow and coronary perfusion pressure showed that blood flow decreased linearly with perfusion pressure, with flow ceasing at a positive pressure (zero-flow pressure). Blood flow data from four transmural myocardial layers from epicardium to endocardium showed that this zero-flow pressure increased progressively from 10 +/- 2.1 mm Hg in the subepicardium to 18 +/- 2.3 mm Hg in the subendocardium (p less than -.01). Consequently, as coronary pressure was reduced, the zero-flow pressure represented a progressively greater fraction of coronary pressure in the subendocardium than in the subepicardium. This effect appeared to account for the progressive redistribution of blood flow away from the subendocardium that occurred as coronary pressure was decreased. Myocardial vascular resistance did not change as a result of changes in coronary perfusion pressure.

Animals↗

Impact of consumer-operated services on empowerment and recovery of people with psychiatric disabilities.

OBJECTIVE: Although the professional literature is replete with descriptions of consumer-operated services, empirical examination of these services has been relatively limited. In this study, the cross-sectional relationship between participation in consumer-operated services and measures of recovery and empowerment is examined. METHODS: A total of 1,824 people with psychiatric disability indicated whether they had participated in a peer support program (the proxy of consumer-operated services) during the past four months. They also were administered two five-factor measures of recovery and of empowerment. RESULTS: Participation in peer support was associated with nine of ten factors generated by the recovery and empowerment instruments. These associations remained significant when commensurate demographic variables were controlled for. CONCLUSIONS: Participation in peer support showed a significant association with multiple outcome and recovery subscales, but the magnitude of the effect was small. The associative nature of the data precludes stating that peer support caused the observed improvement.

Adolescent↗

Reliability in headache diagnosis.

The reliability of headache diagnosis using the criteria of the International Headache Society (IHS) has not been well studied. One definition of reliability refers to the reproducibility of diagnoses assigned to the same individual at different times. Reproducibility of diagnosis should be assessed using different clinicians at different times, with or without specific diagnostic instruments. A diagnosis may be unreliable because of variability in diagnostic criteria, in the clinical information used to assign diagnoses, or in the interpretation and application of clinical information to a given set of diagnostic criteria. Reliable diagnostic methods are essential to the development of valid diagnostic methods, as well as for the identification of headache risk factors, biological markers, and effective treatments. An approach to studying the reliability of the International Headache Society criteria is outlined, modeled after the extensive studies conducted in the area of psychiatric diagnosis.

Evaluation Studies as Topic↗

A longitudinal study of siblings of children with chronic disabilities.

OBJECTIVE: To examine the unaffected siblings of 2 different groups with chronic disabilities, pervasive developmental disorder (PDD) and Down syndrome (DS), over 3 years, comparing their adjustment with each other and with the siblings of a nondisabled group. METHOD: This study examines 137 siblings of children with PDD, children with DS, and developmentally normal children (control group) initially and 127 siblings at follow-up 3 years later. Their adjustment is measured by the Survey Diagnostic Instrument (SDI), completed by caregivers and teachers. Predictor variables include sibling self-perception, social support, and relationship with sibling, as indicated by siblings; caregiver psychosocial factors such as parental stress, caregiver depression, and marital relationship; family systems characteristics as viewed by both caregiver and sibling; and difficulty that disabled child causes as perceived by the primary caregiver. RESULTS: Significantly more adjustment problems are found in the siblings of PDD children at both times when compared with siblings of DS and control children. Caregivers of PDD children report the highest levels of distress and depression, and this persists over time. Parent distress was found, at both times, to be related to sibling adjustment problems, regardless of study group. CONCLUSION: These results have implications for preventive intervention for the unaffected siblings of PDD children.

Adaptation, Psychological↗