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PubMed1993

Value and appropriate use of rating scales and apparative measurements in quantification of disability in Parkinson's disease.

Despite widespread use in pharmacotherapeutical trials, in the majority of rating scales used in Parkinson's disease (PD) validity, reliability and appropriate use have never been confirmed by statistical data. For this reason 350 unselected PD-pats. were investigated by an extensive standardized test-battery including registration of basis data, Columbia University Rating Scale (CURS), scale for assessment of functional disability (ADL), SCAG-scale, Hoehn & Jahr-scale (HY), mod. Webster step second-test (WSST), Purdue-pegboard, questionnaire for subjective complaints (SC), WDG, LPS1/2, 3/4, 6, 7, 10, clinical assessment of dementia, v. Zerssen-scale and orthostatic hypotension (60 degrees tilt up). For CURS, SCAG and ADL instrumental reliability was calculated by Cronbach's alpha. For CURS, SCAG, ADL and the total data of complete test battery (CTB) principal component analysis (PCA) was performed for data reduction. CURS, SCAG and ADL showed high internal consistency (alpha approximately > or = 0.9). For CURS 5 factors accounting for 66% total variance could be extracted by PCA. They represent gait, rigidity, tremor, right/left dexterity (eigenvalues > 1). For SCAG 3 factors (61% of total variance) representing dementia, depression and change of personality were extracted. For ADL 3 factors (67% of total variance) could be extracted, representing overall functional disability, handwriting and disability by pain. PCA of the CTB identified 8 interpretable factors (66% of total variance) characterizing at least partially the clinical profile of PD: 1. motor disability (assessment by rating-scales) 2. dementia, 3. motor-disability (assessment by apparative measurements), 4. depression, 5. orthostatic hypotension, 6. WDG, 7. tremor and 8. pain. Our data confirm the suitability of the investigated scales and give a rational base for their appropriate use in a sense of data reduction and economical evaluation.

Aged↗
PubMed2002

The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety.

PURPOSE: To compare three anxiety scales; the anxiety visual analogue scale (VAS), the anxiety component of the Amsterdam preoperative anxiety and information scale (APAIS), and the state portion of the Spielburger state-trait anxiety inventory (STAI), for assessment of preoperative anxiety levels in same day admission patients. METHODS: Patients completed the three anxiety assessment scales both before and after seeing the anesthesiologist preoperatively. The scales used were the STAI, the six-question APAIS, and the VAS. APAIS was further subdivided to assess anxiety about anesthesia (sum A), anxiety about surgery (sum S) and a combined anxiety total (i.e., sum C = sum A + sum S). These scales were compared to one another. Pearson's correlation (pair-wise deletion) was used for validity testing. Cronbach's alpha analysis was used to test internal validity of the various components of the APAIS scale. A correlation co-efficient (r) > or = 0.6 and P < 0.05 were considered significant. RESULTS: Four hundred and sixty three scale sets were completed by 197 patients. There was significant and positive correlation between VAS and STAI r = 0.64, P < 0.001), VAS and APAIS r = 0.6, P < 0.001), sum C and STAI r = 0.63, P < 0.001) and between VAS and sum C r = 0.61, P < 0.001). Sum C and STAI r value were consistent with repeated administration. Cronbach's alpha-levels for the anxiety components of the APAIS (sum C) and desire for information were 0.84 and 0.77 respectively. CONCLUSION: In addition to VAS, the anxiety component of APAIS (sum C) is a promising new practical tool to assess preoperative patient anxiety levels.

Adult↗
PubMed2005

Optimization and scale up of industrial fermentation processes.

To increase product yields and to ensure consistent product quality, key issues of industrial fermentations, process optimization and scale up are aimed at maintaining optimum and homogenous reaction conditions minimizing microbial stress exposure and enhancing metabolic accuracy. For each individual product, process and facility, suitable strategies have to be elaborated by a comprehensive and detailed process characterization, identification of the most relevant process parameters influencing product yield and quality and their establishment as scale-up parameters to be kept constant as far as possible. Physical variables, which can only be restrictedly kept constant as single parameters, may be combined with other pertinent parameters to appropriate mathematical groups or dimensionless terms. Process characterization is preferably based on real-time or near real-time data collected by in situ and on-line measurements and may be facilitated by supportive approaches and tools like neural network based chemometric data analysis and modelling, clarification of the mixing and stream conditions through computational fluid dynamics and scale-down simulations. However, as fermentation facilities usually are not strictly designed according to scale-up criteria and the process conditions in the culture vessels thus may differ significantly and since any strategy and model can only insufficiently consider and reflect the highly complex interdependence and mutual interaction of fermentation parameters, successful scale up in most cases is not the result of a conclusive and straight-lined experimental strategy, but rather will be the outcome of a separate process development and optimization on each scale. This article gives an overview on the problems typically coming along with fermentation process optimization and scale up, and presents currently applied scale-up strategies while considering future technologies, with emphasis on Escherichia coli as one of the most commonly fermented organisms.

Bioreactors↗
PubMed2005

Species-specific allometric scaling under self-thinning: evidence from long-term plots in forest stands.

Experimental plots covering a 120 years' observation period in unthinned, even-aged pure stands of common beech (Fagus sylvatica), Norway spruce (Picea abies), Scots pine (Pinus sylvestris), and common oak (Quercus Petraea) are used to scrutinize Reineke's (1933) empirically derived stand density rule [see text], N=tree number per unit area, [see text]=mean stem diameter), Yoda's (1963) self-thinning law based on Euclidian geometry ([see text] [see text]=mean biomass per tree), and basic assumptions of West, Brown and Enquist's (1997, 1999) fractal scaling rules ([see text] [see text] w=biomass per tree, d=stem diameter). RMA and OLS regression provides observed allometric exponents, which are tested against the exponents, expected by the considered rules. Hope for a consistent scaling law fades away, as observed exponents significantly correspond with the considered rules only in a minority of cases: (1) exponent r of [see text] varies around Reineke's constant -1.605, but is significantly different from r=-2, supposed by Euclidian or fractal scaling, (2) Exponent c of the self-thinning line [see text] roams roughly about the Euclidian scaling constant -3/2, (3) Exponent a of [see text] tends to follow fractal scaling 8/3. The unique dataset's evaluation displays that (4) scaling exponents and their oscillation are species-specific, (5) Euclidian scaling of one relation and fractal scaling of another are coupled, depending on species. Ecological implications of the results in respect to self-tolerance (common oak>Norway spruce>Scots pine>common beech) and efficiency of space occupation (common beech>Scots pine>Norway spruce>common oak) are stressed and severe consequences for assessing, regulating and scheduling stand density are discussed.

Biomass↗
PubMed2005

Density dependence, spatial scale and patterning in sessile biota.

Sessile biota can compete with or facilitate each other, and the interaction of facilitation and competition at different spatial scales is key to developing spatial patchiness and patterning. We examined density and scale dependence in a patterned, soft sediment mussel bed. We followed mussel growth and density at two spatial scales separated by four orders of magnitude. In summer, competition was important at both scales. In winter, there was net facilitation at the small scale with no evidence of density dependence at the large scale. The mechanism for facilitation is probably density dependent protection from wave dislodgement. Intraspecific interactions in soft sediment mussel beds thus vary both temporally and spatially. Our data support the idea that pattern formation in ecological systems arises from competition at large scales and facilitation at smaller scales, so far only shown in vegetation systems. The data, and a simple, heuristic model, also suggest that facilitative interactions in sessile biota are mediated by physical stress, and that interactions change in strength and sign along a spatial or temporal gradient of physical stress.

Analysis of Variance↗
PubMed2005

Use of quantitative assessment scales in cervical spondylotic myelopathy--survey of clinician's attitudes.

BACKGROUND: There is considerable uncertainty regarding the selection criteria of patients and timing of surgery for cervical spondylotic myelopathy (CSM). Attempts have been made to quantify CSM severity using various assessment scales to provide an adjunct to clinical decision-making. The aim of the present study was to determine, by means of a 7-item questionnaire the attitudes of clinicians regarding the importance of quantitative assessment scales in the management of CSM, their actual use in clinical practice and how current scales fall short of the ideal. FINDINGS: Clinical history, examination, radiological imaging and quantitative functional assessment were regarded by 117 clinicians as being almost equally important in the management of CSM. However, only 22 (19%) of clinicians admitted to using an assessment scale in clinical practice and 4 (3%) believed there was a 'gold-standard' assessment scale. These clinicians also considered 'ease of use' to be the most important attribute of an ideal assessment scale, followed by 'reproducibility', 'sensitivity to change' and 'validity'. CONCLUSIONS: The discrepancy between the importance attached to quantitative measurement and its actual use suggests that current scales are under-utilised or unsuitable for clinical practice. A new easy-to use scale may be required that better reflects clinical requirements.

Cervical Vertebrae↗
PubMed2005

Development of a brief scale to measure AIDS-related stigma in South Africa.

Although there has been progress in AIDS stigma research, there are no multi-item AIDS stigma scales that have been shown reliable and valid in Africa. The current research reports the development of the nine-item AIDS-Related Stigma Scale. Research conducted in five South African communities (N = 2306) found the scale internally consistent, alpha = 0.75 and time stable over 3 months, r = 0.67. The scale was also reliable in three different languages (English, Xhosa, and Afrikaans). Correlations showed that the AIDS-Related Stigma Scale was moderately inversely correlated with years of education and AIDS knowledge. In addition, individuals who stated that HIV positive persons should conceal their HIV status had higher AIDS-Related Stigma Scale scores. Also supporting the scale's construct validity, individuals who refused to report whether they had been tested for HIV scored higher on the AIDS-Related Stigma Scale.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Within-plant variation in glucosinolate concentrations of Raphanus sativus across multiple scales.

Variation in chemical defenses remains underexplored. In particular, little is known about patterns of variation at small scales within leaves and spatial variation of induction. I examined variation in glucosinolate concentrations in the leaves of Raphanus sativus at several different spatial scales in two related experiments. I used samples equivalent in area to the amount an intermediate-sized caterpillar might eat in 1 d, a smaller scale than used in most previous studies. I examined variation due to induction and leaf age and small-scale spatial variation within leaves. The mean and variance of glucosinolate concentrations were higher in induced plants, young leaves, and the proximal half of leaves. Higher glucosinolate concentrations in the proximal half of leaves are previously unreported. Small-scale variation was extreme, accounting for 57% of the total random variation, and spatially random. There was no spatial autocorrelation found at scales as small as 1-2 cm. The high degree of small-scale, spatially random variation in glucosinolate concentrations in leaves is previously unreported. This small-scale variation and the variation caused by induction may have significant effects on herbivores and could be an important component of plant defense.

Glucosinolates↗
PubMed2005

Comparison of small- and large-scale expression of selected Pyrococcus furiosus genes as an aid to high-throughput protein production.

As the natural extension of the genomic sequencing projects, the goal of the various world-wide Structural Genomics projects is development of techniques for high throughput (HTP) cloning, protein overexpression, purification and structural determination, with the ultimate goal of determining all possible protein structures. Rapid (small-scale) screening of potential expression clones under different growth conditions is presumed to be possible and a viable way to increase throughput of protein expression. In order to test the utility of screening for soluble, heterologous protein expression, we have compared the production of recombinant proteins on a small scale (1 ml cultures in 96-well plates) in Escherichia coli under two growth conditions [a rich medium and a defined (minimal) medium] using an enzyme-linked immunosorbent assay (ELISA) against the affinity tag, with the amount of recombinant protein produced during the large-scale (500 ml) growth of E. coli. The large-scale expression products were examined after a single step affinity purification by visualization on SDS-PAGE gels. Of the open reading frames that were successfully expressed on the 1 ml scale as judged by immunodetection, 80% of them successfully scaled-up to 500 ml in a rich medium and 81% of them scaled-up in a defined medium. This is significantly higher than would be expected by a randomly selected expression condition and validates the use of small-scale expression as a screening tool for more efficient protein production.

Bacterial Proteins↗
PubMed1985

Reliability and validity of the Orthodontic Locus of Control Scale.

The Orthodontic Locus of Control (OLOC) Scale was developed to assess the ways in which persons perceive and evaluate the events that determine occlusal status and orthodontic treatment. The children's OLOC Scale is a 34-item self-administered inventory with a 6-point response format. The adult measure is a similar, 28-item version of the scale. A 6-item Occlusal Value Scale, was also developed for administration in conjunction with the OLOC Scale. These instruments were given to 51 children and their mothers who applied for treatment at the School of Dental Medicine's Orthodontic Clinic of the State University of New York at Buffalo. For validity studies, children and their mothers completed the Multidimensional Health Locus of Control (HLOC) Scale and the Orthodontic Opinion Poll (OOP) Subscales. The internal consistency estimates for reliability on both the child and parent versions of the OLOC Scales were in the moderate to high-moderate range. Moderate to high-moderate subscale correlations offer promise for the validity and usefulness of the Orthodontic Locus of Control Scale for future research on psychologic and social responses to malocclusion. The implications of the concept of "orthodontic locus of control" for orthodontists and parent-child treatment-related behaviors are discussed.

Adolescent↗
PubMed1994

A rating scale for acute drug-induced akathisia: development, reliability, and validity.

This paper describes the process of developing a new rating scale for acute neuroleptic-induced akathisia. Previously reported clinical characteristics of akathisia were used to construct the initial version of the scale. This was administered to 100 consecutively admitted psychiatric patients treated with neuroleptic medication. The scale was then subjected to a reliability analysis, and the number of items reduced. A factor analysis of the ratings supported the decision to rate subjective and objective items separately. The new version of the scale (The Prince Henry Hospital Akathisia Rating Scale) was further standardized in its administration. A preliminary examination of its construct validity was performed by calculating the correlations with the ratings on the analogue and global scales, as well as those of depression, anxiety, and hyperactivity. The new scale was administered to 50 new subjects to examine its interrater reliability and concurrent validity with respect to the Barnes Akathisia Rating Scale.

Acute Disease↗
PubMed1984

Avian scale development. X. Dermal induction of tissue-specific keratins in extraembryonic ectoderm.

Epidermal-dermal tissue interactions regulate morphogenesis and tissue-specific keratinization of avian skin appendages. The morphogenesis of scutate scales differs from that of reticulate scales, and the keratin polypeptides of their epidermal surfaces are also different. Do the inductive cues which initiate morphogenesis of these scales also establish the tissue-specific keratin patterns of the epidermis, or does the control of tissue-specific keratinization occur at later stages of development? Unlike feathers, scutate and reticulate scales can be easily separated into their epidermal and dermal components late in development when the major events of morphogenesis have been completed and keratinization will begin. Using a common responding tissue (chorionic epithelium) in combination with scutate and reticulate scale dermises, we find that these embryonic dermises, which have completed morphogeneis, can direct tissue-specific stratification and keratinization. In other words, once a scale dermis has acquired its form, through normal morphogenesis, it is no longer able to initiate morphogenesis of that scale, but it can direct tissue-specific stratification and keratinization of a foreign ectodermal epithelium, which itself has not undergone scale morphogenesis.

Animals↗
PubMed1990

The QUALCARE Scale: developing an instrument to measure quality of home care.

In previous research, the theoretical and methodological problems associated with operationalizing elder abuse have been multiple. The QUALCARE Scale was developed in response to the documented problems. The scale is an observational rating scale designed to quantify the quality of family caregiving to home-dwelling elders in six areas: physical, medical management, psychosocial, environmental, human rights and financial. The scale is a 53 item scale in a Likert type format. The QUALCARE Scale is completed by professional nurses after a nursing assessment of the degree to which the caregiver meets the needs of the elder in the six dimensions. The nursing assessment involves both observations and verbal data gathering. In this paper, the development of the scale and the methodological issues associated with scale development are discussed.

Aged↗
PubMed1985

Scaling segmental moments of inertia for individual subjects.

The purpose of this investigation was to validate methods of scaling human segmental moments of inertia for the transverse principal axis. Firstly, two methods of scaling Chandler et al.'s (Pamphlets DOT HS-801 430 and AMRL TR-74-137, Wright Patterson Air Force Base, OH, 1975) mean subject data to estimate the segmental moments of inertia were used. Chandler et al.'s data were scaled using body mass and segment length (formula 1) or body mass and standing height (formula 2). These data were then compared with a procedure of using the cadaver whose anthropometric measurements most closely match those of the subject. The difference between the criterion data (Chandler's subject data) and scaled values were plotted on scatter diagrams with confidence limits of p less than 0.05 at d.f. = 17. For procedure 1, 43% of the scaled values were plotted within the confidence limits using formula (2) (mass and standing height), compared with 26% for formula (1) (mass and segment length). Formula (1) markedly underestimated the tallest and heaviest subjects. In procedure 2, only 16% and 21% of the scaled values, using formula (1) and (2), respectively, fell within the confidence limits. Results suggested that scaling formulae approximate the moment of inertia of body segments with only limited accuracy. However, if scaling was to be adopted then mean moment of inertia data from an appropriate data set, using the formula that incorporates subject mass and standing height, gave results closest to the criterion value.

Anthropometry↗
PubMed1996

Clinical scales for multiple sclerosis.

Many neurological rating scales have been suggested to assess the impact of multiple sclerosis on patients, but none has been universally accepted. The Kurtzke Extended Disability Status Scale has been the most widely used despite its imperfections. It combines disability and impairment, has moderate inter-rater reliability, and its overall score is heavily weighted toward ambulation. The Scripps Neurological Rating Scale attempts to quantify impairment as measured by the traditional neurological examination. However, this and other impairment scales lack direct relevance to patients' functional health status. The Ambulation Index and some of the quantitative upper limb dysfunction assessment methods are sensitive and reproducible, but they only measure limited aspects of the wide range of disabilities encountered in multiple sclerosis. Current scales of disability and activities of daily living, such as the Incapacity Status Scale and the Functional Independent Measure, are not sensitive to the type of change which occurs in multiple sclerosis. The relationship between abnormalities on magnetic resonance images of the brain and disability has been difficult to ascertain. Although recently developed imaging acquisition methods may demonstrate abnormalities which are more closely correlated with disability, the demonstration of prevention, stabilization or recovery from disability using clinical scales will remain the final arbiter of success in clinical trials. We suggest guidelines for an improved disability scale.

Disability Evaluation↗
PubMed1993

Validity and reliability testing of the FAMCARE Scale: measuring family satisfaction with advanced cancer care.

The purpose of the study was to test the validity and reliability of the FAMCARE Scale which was developed to measure family satisfaction with advanced cancer care. The FAMCARE Scale was developed based upon earlier qualitative research which identified indicators of family care satisfaction and a subsequent Q-sort study that reduced those items to the most salient indicators of satisfaction according to a larger, representative sample (N = 210). A pilot test of the FAMCARE Scale using a convenience sample of 30 family members of advanced cancer patients was conducted. The scale achieved internal consistency estimates of 0.93 at two testing times, a test-retest correlation of 0.91, and estimates of criterion validity using the McCusker Scale of 0.80 and 0.77. Cluster analysis of the scale suggested 4 subdimensions. Although the scale requires further testing to establish its reliability and validity, these preliminary results indicate that the scale may be a psychometrically sound instrument useful for measurement of family satisfaction with advanced cancer care.

Adolescent↗
PubMed1984

A study of psychophysical scaling in chronic pain patients.

Chronic pain patients were asked to psychophysically scale two sets of word descriptors (intensity and unpleasantness) using a crossmodality matching procedure with line length and numerical estimates. In 22 patients (group I) descriptor scaling was performed once, in another 20 patients (group II) the procedure was repeated 3 times. 72.7% of patients in group I obtained a correlation of 0.9 or higher when scaling intensity descriptors, but only 18.2% obtained this correlation when scaling unpleasantness words. In group II, an average of 85% of patients reliably scaled intensity words, but only 50% could do so for the unpleasantness descriptors. Patients who reliably judged unpleasantness descriptors generally exhibited a higher level of psychological distress (SCL-90 R). Numerical estimates assigned by patients to individual word descriptors showed a smaller range than obtained from experimental pain studies. There was unequal spacing of values of adjacent descriptors with clustering of words in the low and high ends of the continuum and large gaps in midrange. Results indicate that chronic pain patients in general show a higher incidence of impairment in rendering proportional judgments than a healthy population. In addition, they are more likely to judge pain reliably on an intensity than on an unpleasantness dimension. The difference in performance between scales persists in spite of training and could not be explained by medical history, drug intake, or demographic characteristics. Patients who are unable to render reliable judgments are easily identified. For optimal clinical use words clustering close together should be combined and additional words should be added describing midrange intensities. Conversely, psychophysical scaling techniques may be used to calibrate category or analogue scales of pain.

Adult↗
PubMed1985

Cross-validation of the Back Pain Classification Scale with chronic, intractable pain patients.

The current study investigated the utility of the Back Pain Classification Scale with chronic, intractable low back pain and headache patients. Subjects consisted of 50 chronic low back pain and 50 chronic headache patients referred to a university based Pain Center for evaluation. Data indicated that subjects were a representative sample of severely intractable chronic pain patients typically referred for Pain Center evaluation and treatment. Each was administered the Back Pain Classification Scale as part of a thorough physical and psychological/behavioral evaluation. All subjects were classified by blind review of medical records into one of two categories: (1) presence of psychopathologically based pain complaint with little or no pathophysiological findings and (2) presence of pathophysiologically based pain complaints with little or no psychopathological findings. Subjects were also independently classified from blind review of their scores on the Back Pain Classification Scale into one of these two categories. Findings revealed that the Back Pain Classification Scale accurately predicted the actual classification of 80% of the low back pain patients (i.e., 30% above baseline prediction rate) and only 60% of the chronic headache patients (i.e., only equal to the baseline prediction rate). Furthermore, the scale was found to be most accurate in predicting low back pain patients with primary psychopathologically based pain. It was concluded that the Back Pain Classification Scale was an empirically valid instrument to use with chronic low back pain patients, but not with chronic headache patients. This lack of utility with chronic headache patients was also viewed as support for the construct validity of the scale. Wider use of the scale with chronic low back pain patients was suggested.

Adult↗