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The significance of sieve-retention to the filter validation process.

Current efforts at filter validation involve the need to test under "worst case conditions" the bacterial retentive action of filters utilizing the very drug being processed. These concerns recognize that the adsorptive retentions of organisms vary in their efficiencies, depending upon the filtration conditions and the presence or absence of surfactant. The sieve retention of organisms is independent of such conditions, deriving solely from considerations of organism-size, pore-size relationships. Flow-decay studies, can serve to differentiate between filter actions based on sieve-retentions and adsorptive-retentions. A filter's dependence solely upon sieving effects is demonstrable. What is involved is a plotting of flow rates as a function of time in accordance with established mathematical equations. Appropriate plots would indicate the exclusive sieve retention of organisms, a condition of absolute filter reliability deriving from organism-pore size relationships. The clear demonstration by a filter company that its sterilizing filter retains organisms solely by the sieve retention mechanism would suffice to validate that filter for all pharmaceutical filtrations, eliminating the need for individual user validations. The advantage of this mode of filter validation, one based on structurally-inherent filter pore architecture, is that pharmaceutical manufacturers would be free from the need to validate a given filter for each and every pharmaceutical preparation. This would also simplify the FDA's confirmation of filter validation, since a single inspection of the filter manufacturer's records would suffice for all the filter's users.

Adsorption↗

Issues related to using a short-form of the Center for Epidemiological Studies-Depression Scale.

The study examined the reliability and validity, including the factor structure, of a 10-item abbreviated version of the Center for Epidemiological Studies-Depression (CES-Depression) scale when administered as part of a mail questionnaire. It also examined patterns of nonresponse to items and the effects of imputation of data for missing items on the factor structure of the inventory. A problem of missing data has been reported even with interview administration of the CES-Depression. Researchers have varied considerably in the amount of imputation used to replace missing datapoints. In this study, factor structures varied when items were imputed. In addition, those subjects with complete data were compared with those with up to two imputed datapoints. Those subjects with imputed data were more likely to be female, have lower functional status scores, lower self-reported health status, more advanced age, and a greater number of depressive symptoms than those with no missing data. While the estimate of coefficient alpha of .78 indicated the inventory was reliable, the effects of missing data on construct validity were problematic.

Aged↗

Morphometry demonstrates loss of cortical thickness in cerebral microangiopathy.

OBJECTIVE: To evaluate the role of MR morphometry in the characterization of cerebral microangiopathy (CMA) in relation to clinical and neuropsychological impairment. SUBJECTS AND METHODS: 3D MR images of 27 patients and 27 age-matched controls were morphometrically analysed for regional thickness. The normalized values were related to the patients' clinical and neuropsychological scores. The patients were categorised according to the amount of structural MR signal changes. A ventricle index reflecting internal atrophy was related to MR morphology and cortical thickness as an indicator for external atrophy. RESULTS: Cortical thickness was significantly reduced in the patients group (3.03 mm +/- 0.26 vs. 3.22 mm +/-0.13 in controls, p=0.001). The severest loss of cortical thickness occurred in severe CMA. Internal and external atrophy evolved in parallel and both showed a significant relationship with structural MR-abnormalities (p<0.05; r=-0.7; r=0.67; r=-0.74, respectively). Neuropsychological performance correlated strongly with the loss of cortical thickness. CONCLUSIONS: Cortical thickness was identified as the most sensitive parameter to characterize CMA. A strong correlation was found of morphometric parameters to the severity of CMA based on a score derived from T2-weighted MRI. The degree of cortical atrophy was directly related to the degree of neuropsychological impairment. Our findings suggest that the cortical thickness is a valid marker in the structural and clinical characterization of CMA.

Analysis of Variance↗

Small changes in the polymer structure influence the adsorption behavior of fibrinogen on polymer surfaces: validation of a new rapid screening technique.

Numerous studies conclude that the selective adsorption of plasma proteins on materials contacting blood or tissue affects all subsequent interactions related to the biocompatibility of artificial surfaces. However, there are only a few studies available, which clearly demonstrate that there is a correlation between surface chemistry and selective protein adsorption. Detailed knowledge of such correlations would facilitate the design of biocompatible materials. In this study, a rapid, fluorescence-based, screening technique using a 384-well format for polymer-protein interactions was developed. The screening assay was used to measure the adsorption of human fibrinogen on 46 test polymers (44 polyarylates selected from a combinatorial library of tyrosine-derived polyarylates, and two lactide-based polymers). In this library of polyarylates, structural changes are generated by variations in either the polymer backbone or the polymer pendent chain. Although no overall trend between polymer hydrophobicity and fibrinogen adsorption could be identified using the entire set of test polymers (R(2) = 0.43), fibrinogen adsorption was clearly correlated with variations in the pendent chain structure. Thus, when the test polymers were grouped by backbone composition, increased hydrophobicity of the pendent chain was significantly correlated with reduced fibrinogen adsorption. The following R(2) coefficients within the polymer backbone groups were determined: 0.87 (diglycolates); 0.98 (glutarates); 0.73 (adipates); 0.87 (suberates); 0.67 (3-methyl-adipates). Our results demonstrate that it is possible to screen for protein-material interactions in a cost-effective fashion using a miniaturized immunofluorescence technique. Further, we demonstrate that small changes in chemical composition can significantly influence the adsorption of human fibrinogen on polymer surfaces. The lactide-based polymers were among those polymers exhibiting the highest tendency to adsorb fibrinogen. This information may be useful when polymers have to be selected for specific biomaterial applications.

Adsorption↗

The assessment of anhedonia in clinical and non-clinical populations: further validation of the Snaith-Hamilton Pleasure Scale (SHAPS).

BACKGROUND: Anhedonia, the inability to experience pleasure, is a major endophenotype of depression. In addition to this, it is an important clinical feature of schizophrenia and substance abuse disorders. Valid instruments to measure anhedonia are sparse. METHODS: In the present study, a short, 14-item instrument, the Snaith-Hamilton Pleasure Scale (SHAPS) to measure anhedonia in normal and clinical samples was further validated. Various aspects of the reliability and validity of the SHAPS that have not been addressed before, were examined in three separate studies. First, we assessed the internal consistency, convergent and discriminative validity of the SHAPS in a non-clinical sample. Second, the test-retest reliability of the SHAPS was investigated in another sample. In the third study, the internal consistency, convergent and discriminative validity of the SHAPS was tested by administering the scale in three clinical samples of psychiatric inpatients. RESULTS: The SHAPS was found to be highly reliable in terms of internal consistency and test-retest stability. Further, the SHAPS correlated in a theoretically meaningful way with other measures of affect and personality. Patients with a depression, psychosis or substance dependence scored significantly higher on the SHAPS than non-patient controls. Patients with a depression displayed the highest SHAPS-score. LIMITATIONS: The absence of structured assessment data to validate the clinical diagnoses. CONCLUSIONS: The current study shows that the SHAPS is a reliable and valid questionnaire to assess hedonic tone in patient and non-patient populations. Because it is a brief scale it seems to be a very useful instrument for measuring anhedonia in clinical and research settings.

Adolescent↗

ADHD Rating Scale IV: psychometric properties from a multinational study as a clinician-administered instrument.

The development of rating scales for attention-deficit/hyperactivity disorder (ADHD) has traditionally focused on parent-or teacher-rated scales. However, clinician-based instruments are valuable tools for assessing ADHD symptom severity. The ADHD Rating Scale IV (ADHD RS), clinician administered and scored, has been validated as a useful instrument to assess ADHD symptoms among American children and adolescents. In this study, we assessed the psychometric properties of the scale in a recent clinical trial conducted mainly in Europe with over 600 children and adolescents diagnosed with ADHD. The trial was conducted in 11 European countries plus Australia, Israel, and South Africa. Results based on data in the study indicate that this version of the scale has acceptable psychometric properties including inter-rater reliability, test-retest reliability, internal consistency, factor structure, convergent and divergent validity, discriminant validity, and responsiveness. There were low-to-moderate ceiling and floor effects. The psychometric properties were comparable with other validated scales for assessing ADHD symptom severity. These results were consistent across the 14 countries participating in this trial. Overall, the data from this study support the use of the ADHD RS as a clinician-rated instrument for assessing the severity of ADHD symptoms in children and adolescents in Europe.

Adolescent↗

[Validation of ESCAP-CD as an instrument of measure for the evaluation of the quality of life in prostatic cancer. Part 2a].

UNLABELLED: In order to make a measure of quality of life related to health (QLRH) useful in the investigation, it must fulfill the psychometric properties (validity, reliability and sensibility). The selection of an instrument is a job for the clinic that must choose the most effective for each proposed objective. We set out the objectives to validate the ESCAP-CDV in a multicentric study in Andalusia. We studied 88 patients who were submitted to the instrument presented to validation and two more tests recognized already: the QLQ-C30 from EORTC gold standard in Europe in the valuation of the neoplastic patients' quality of life and the KARNOFSKY the most clinic utility index in neoplastic patients, used to correlate the items. RESULTS: Questionnaire acceptance analysis: The difficulty of understanding was greater for QLQ C30 items (6.81%) than ESCAP items (1.98%). The lapse of time needed to carry out the test was shorter in the ESCAP test (9.84 min) than in the QLQ C30 (13.13), test. Structural analysis or internal validity analysis: The homogeneity index of the items is high (alfa of Cronbach = 0.93). The dimensionality proposed is not accepted, due to the existence of some modifications pund in the factorial analysis. Finally, the established dimensions: Physical and Emotional Capacity (PEC), 5 items; General Symptoms (GS), 4 items; Pain (P), 3 items; Ligh Functional Capcity (LFC), 4 items; Serious Functional Capacity (SFC), 2 items; Economic State (ES), 3 items; Social and Family State (SFE), 5 items; Capacity Sexual (CSX), 2 items; Isolated Variables (IV), 2 items; and Specific Questionnaire (P), 6 items. The ESCAP is a scale with a normal distribution. Approach or external validity analysis: The ESCAP test is well correlated with the other two scales. Reliability test retest: The interclass correlation coefficient is 0.94 in the ESCAP, not so in the KARNOFSKY that is 0.77. CONCLUSIONS: The ESCAP-CDV is a new instrument of valuation of the QLRH composed of a general questionnaire and other specific test of prostate cancer. It has turned out to be a very homogeneous scale due to its internal consistence (alfa of Cronbach of 0.93), showing that it has a normal distribution, that correlates correctly with the scales compared and it is a valid scale to measure the prostate cancer patients' quality of life. The ESCAP-CDV has shown to be a scale with a high reliability (0.94), setting up as an instrument not only useful for investigation, but to clinical use, as well.

Humans↗

Systematic prediction of new inorganic ferroelectrics in point group 4.

The latest release of the Inorganic Crystal Structure Database contains a total of 87 entries corresponding to 70 different materials in point group 4. The structures reported for 11 materials in space group P4 satisfy the criteria for ferroelectricity, as do four in P4(1), one each in P4(2) and P4(3), 12 in I4, including seven that form three families, and another three in I4(1). Three previously known ferroelectrics were also listed in I4 and one in I4(1). In addition, the listing for point group 4 contains 22 entries for nonferroelectric materials and three with misassigned space groups. Among the newly predicted ferroelectrics in point group 4, assuming the validity of the underlying structural reports, are Ce(5)B(2)C(6), modulated NbTe(4), Na(3)Nb(12)O(31)F, Ca(2)FeO(3)Cl, K(4)CuV(5)O(15)Cl, TlBO(2), CrOF(3), PbTeO(3), VO(HPO(3))(H(2)O).3H(2)O, MgB(2)O(OH)(6), beta-tetragonal boron, CuBi(2)O(4), WOBr(4), Na(8)PtO(6), SbF(2)Cl(3), Ba(1.2)Ti(8)O(16), Ni[SC(NH(2))(2)](4)Cl(2), Ca(2)SiO(3)Cl(2), the mineral caratiite, NbAs, beta-NbO(2) and Ag(3)BiO(3).

Journal Article↗

Sequence and secondary structure of mouse 28S rRNA 5'terminal domain. Organisation of the 5.8S-28S rRNA complex.

We present the sequence of the 5' terminal 585 nucleotides of mouse 28S rRNA as inferred from the DNA sequence of a cloned gene fragment. The comparison of mouse 28S rRNA sequence with its yeast homolog, the only known complete sequence of eukaryotic nucleus-encoded large rRNA (see ref. 1, 2) reveals the strong conservation of two large stretches which are interspersed with completely divergent sequences. These two blocks of homology span the two segments which have been recently proposed to participate directly in the 5.8S-large rRNA complex in yeast (see ref. 1) through base-pairing with both termini of 5.8S rRNA. The validity of the proposed structural model for 5.8S-28S rRNA complex in eukaryotes is strongly supported by comparative analysis of mouse and yeast sequences: despite a number of mutations in 28S and 5.8S rRNA sequences in interacting regions, the secondary structure that can be proposed for mouse complex is perfectly identical with yeast's, with all the 41 base-pairings between the two molecules maintained through 11 pairs of compensatory base changes. The other regions of the mouse 28S rRNA 5'terminal domain, which have extensively diverged in primary sequence, can nevertheless be folded in a secondary structure pattern highly reminiscent of their yeast' homolog. A minor revision is proposed for mouse 5.8S rRNA sequence.

Animals↗

A new principle of enzyme catalysis: coupled vibrations facilitate conformational changes.

The coupling between the molecular vibrations in chymotrypsinogen, alpha-chymotrypsin and tosyl-alpha-chymotrypsin, as expressed by the temperature factors of individual amino acid sidechains and by a flexibility parameter calculated from the masses and co-ordinates of the atoms, has been analyzed by calculation of the integral correlation coefficient, the autocorrelation coefficient, the Poincaré projection, the first Liapunov coefficient and the power spectra. The agreement between the results obtained with the temperature factors and the flexibility parameter as well as the correct display by the latter of known structural features support the validity of the approach. The localization and extent of the conformational change in the enzyme following its binding of a specific substrate is detected in the difference plot between the enzyme and the acylenzyme of the distribution of the flexibility parameter over the peptide chain. As many as about 70% of the aminoacids participate in this rearrangement. An attractor of low dimensionality, two, i.e. a limit cycle, is detected both in the total enzyme and in its domain which is mobilized by the specific substrate. A simple model based on a known prominent structural feature, which is common to the trypsin family of serine proteases, two extensive coaxial halfcylinders of beta-sheets, to which previously no mechanistic function could be assigned, is proposed to account for the role of the attractor in the catalytic process: (1) control of the entry of a specific substrate to the catalytic site by co-ordinated disentanglement of the interlocking sidechains; (2) correct positioning of the functional groups in the active site; (3) lowering of the activation energy of the formation of the transition state complex.

Amino Acid Sequence↗

[Validation of the Spanish versions of the Montgomery-Asberg depression and Hamilton anxiety rating scales].

BACKGROUND: Affective and anxiety disorders (AfD & AnD) are the most common psychiatric diseases in the general population. This study's aim was to assess for the first time the psychometric properties of the Spanish translated versions of the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating Scale (HARS), which are widely used both in medical care and clinical research. PATIENTS AND METHOD: A cohort, observational, prospective and multicentre study was conducted in clinically stable or unstable patients with AfD and AnD. The scales were administered at baseline and in a second study visit one week or 2 months later (to stable or unstable patients, respectively). The internal consistency, temporary stability, inter-raters reliability, factorial structure, convergent and discriminant validity, and sensitivity to change were all assessed for both scales. RESULTS: One hundred and eight AfD patients and 106 AnD patients were recruited in 10 psychiatry care centres from a wide geographical distribution. Both scales showed adequate properties in terms of: a) discriminant validity (MADRS/HARS-Clinical Global Impression: p < 0.001); b) convergent validity (MADRS-Hamilton Depression Rating Scale: p < 0.05 and 0.01; MADRS/HARS-EuroQoL 5D: p < 0.05; HARS-State Trait Anxiety Inventory: p < 0.05); c) internal consistency (Cronbach's alpha: MADRS = 0.88; HARS = 0.89); d) test-retest and inter-raters reliability (intraclass correlation coefficient: MADRS = 0.94 and 0.98, respectively; HARS = 0.92 and 0.92), and, e) sensitivity to change (effect size: MADRS = 2.05; HARS = 1.36). CONCLUSIONS: Spanish versions of MADRS and HARS scales showed good psychometric properties, similar to those of the original scales. Therefore, these scales are suitable for use in clinical practice and research in Spain.

Adult↗

Identification of the N-glycosylation sites on glutamate carboxypeptidase II necessary for proteolytic activity.

Glutamate carboxypeptidase II (GCPII) is a membrane peptidase expressed in the prostate, central and peripheral nervous system, kidney, small intestine, and tumor-associated neovasculature. The GCPII form expressed in the central nervous system, termed NAALADase, is responsible for the cleavage of N-acetyl-L-aspartyl-L-glutamate (NAAG) yielding free glutamate in the synaptic cleft, and is implicated in various pathologic conditions associated with glutamate excitotoxicity. The prostate form of GCPII, termed prostate-specific membrane antigen (PSMA), is up-regulated in cancer and used as an effective prostate cancer marker. Little is known about the structure of this important pharmaceutical target. As a type II membrane protein, GCPII is heavily glycosylated. In this paper we show that N-glycosylation is vital for proper folding and subsequent secretion of human GCPII. Analysis of the predicted N-glycosylation sites also provides evidence that these sites are critical for GCPII carboxypeptidase activity. We confirm that all predicted N-glycosylation sites are occupied by an oligosaccharide moiety and show that glycosylation at sites distant from the putative catalytic domain is critical for the NAAG-hydrolyzing activity of GCPII calling the validity of previously described structural models of GCPII into question.

Animals↗

The structure of the molybdenum cofactor. Characterization of di-(carboxamidomethyl)molybdopterin from sulfite oxidase and xanthine oxidase.

A di-(carboxamidomethyl) derivative of molybdopterin, the organic component of the molybdenum cofactor, has been prepared under conditions favoring retention of all of the structural features of the molecule. The specific radioactivity of [1-14C]iodoacetamide incorporated relative to the amount of phosphate indicated two alkylation sites per pterin. Energy-dispersive x-ray analysis of the derivative showed the presence of 2 sulfurs in the derivative. An exact mass corresponding to the molecular formula C14H18N7O5S2 was obtained for the MH+ ion of the alkylated, dephosphorylated compound by fast atom bombardment mass spectroscopy. 1H NMR spectra of the phosphorylated and dephosphorylated forms of alkylated molybdopterin, in conjunction with the other data, have provided strong corroboration of the validity of the proposed structure of molybdopterin (Johnson, J. L., and Rajagopalan, K. V. (1982) Proc. Natl. Acad. Sci. U. S. A. 79, 6856-6860) as a 6-alkylpterin with a 4-carbon side chain containing an enedithiol on C-1' and C-2', a secondary alcohol on C-3', and a phosphorylated primary alcohol on C-4'. As isolated, the di-(carboxamido-methyl)molybdopterin was found to be a 5,6,7,8-tetrahydropterin.

Animals↗

Tripeptides adopt stable structures in water. A combined polarized visible Raman, FTIR, and VCD spectroscopy study.

We have measured the band profile of amide I in the infrared, isotropic, and anisotropic Raman spectra of L-alanyl-D-alanyl-L-alanine, acetyl-L-alanyl-L-alanine, L-vanyl-L-vanyl-L-valine, L-seryl-L-seryl-L-serine, and L-lysyl-L-lysyl-L-lysine at acid, neutral, and alkaline pD. The respective intensity ratios of the two amide I bands depend on the excitonic coupling between the amide I modes of the peptide group. These intensity ratios were obtained from a self-consistent spectral decomposition and then were used to determine the dihedral angles between the two peptide groups by means of a recently developed algorithm (Schweitzer-Stenner, R. Biophys. J. 2002, 83, 523-532). The validity of the obtained structures were checked by measuring and analyzing the vibrational circular dichroism of the two amide I bands. Thus, we found two solutions for all protonation states of trialanine. Assuming a single conformer, one obtains a very extended beta-helix-like structure. Alternatively, the data can be explained by the coexistence of a 3(1)(PII) and a beta-sheet-like structure. Acetyl-L-alanyl-L-alanine exhibits a structure which is very similar to that obtained for trialanine. The tripeptide with the central D-alanine adopts an extended structure with a negative psi and a positive phi angle. Trivaline and triserine adopt single beta(2)-like structures such as that identified in the energy landscape of the alanine dipeptide. Trilysine appears different from the other investigated homopeptides in that it adopts a left-handed helix which at acid pD is in part stabilized by hydrogen bonding between the protonated carboxylate (donor) and the N-terminal peptide carbonyl. Our result provides compelling evidence for the capability of short peptides to adopt stable structures in an aqueous solution, which at least to some extent reflect the intrinsic structural propensity of the respective amino acids in proteins. Furthermore, this paper convincingly demonstrates that the combination of different vibrational spectroscopies provides a powerful tool for the determination of the secondary structure of peptides in solution.

Algorithms↗

Assessing the quality of preparation for posthospital care from the patient's perspective: the care transitions measure.

BACKGROUND: Evidence that both quality and patient safety are jeopardized for patients undergoing transitions across care settings continues to expand. Performance measurement is one potential strategy towards improving the quality of transitional care. A valid and reliable self-report measure of the quality of care transitions is needed that is both consistent with the concept of patient-centeredness and useful for the purpose of performance measurement and quality improvement. OBJECTIVE: We sought to develop and test a self-report measure of the quality of care transitions that captures the patient's perspective and has demonstrated utility for quality improvement. SUBJECTS: Patients aged 18 years and older discharged from one of the 3 hospitals of a vertically integrated health system were included. RESEARCH DESIGN: Cross-sectional assessment of factor structure, dimensionality, and construct validity. RESULTS: The Care Transitions Measure (CTM), a 15-item uni-dimensional measure of the quality of preparation for care transitions, was found to have high internal consistency, reliability, and reflect 4 focus group-derived content domains. The measure was shown to discriminate between patients discharged from the hospital who did and did not have a subsequent emergency department visit or rehospitalization for their index condition. CTM scores were significantly different between health care facilities known to vary in level of system integration. CONCLUSIONS: The CTM not only provides meaningful, patient-centered insight into the quality of care transitions, but because of the association between CTM scores and undesirable utilization outcomes, it also provides information that may be useful to clinicians, hospital administrators, quality improvement entities, and third party payers.

Adult↗

Comparison of energy-minimized crystal structures of 2,3-dilauroyl-D-glycerol, 3-palmitoyl-DL-glycerol-1-phosphorylethanolamine and 1,2-dilauroyl-DL-phosphatidylethanolamine:acetic acid.

Computational procedures have been developed by which the total energy of a lipid multibilayer can be calculated and minimized. The energy is expressed as a sum of non-bonded, electrostatic, hydrogen bonded and torsional energy terms and includes intramolecular and intermolecular components. Calculations were carried out on three lipid crystals for which structural data are available from X-ray diffraction analysis. For each crystal, the energy was minimized as a function of all bond rotations, molecular rotations and translations and the lattice constants. The minimized structures differed by only small amounts from the experimental structures, which confirms the validity of the current set of energy functions and parameters for use with lipids. The intermolecular energy of each crystal is analyzed in terms of lateral interactions, interactions between the two monolayers of the same bilayer and interactions between bilayers. The intermolecular non-bonded energy per CH2 or CH3 group in the acyl chains is also given.

Diglycerides↗

Psychosocial variables, eating behavior, depression, and binge eating in morbidly obese subjects.

OBJECTIVES: Binge eating disorder (BED) is a frequent and significant psychiatric comorbidity among patients seeking treatment for obesity. The purpose of this study was to determine whether morbidly obese subjects with BED differ from those without BED (NBED) in terms of eating behavior, social/environmental variables, and depression. RESEARCH METHODS AND PROCEDURES: Out of 110 morbidly obese (BMI > or = 40 kg/m2) subjects, 88 could be reliably classified as BED (19) or NBED (69). These subjects (age 42.0+/-13.4 years, BMI 47.0+/-5.7 kg/m2) were examined by a semi-structured interview and by validated questionnaires to assess depression and eating behavior. RESULTS: Subjects with BED showed higher scores of disinhibited eating (12.3+/-2.7 vs. 9.1+/-3.6, p<0.05), were more likely to attribute obesity to their eating habits (chi2=8.4, p<0.05), and rated their social environment regarding relationships as less supportive and cohesive (chi2=10.6, p=0.001). In addition, patients with BED experienced an earlier onset of obesity (chi2=6.3, p<0.05). No relationship, however, was found between binge eating disorder and depression. DISCUSSION: Morbidly obese patients with BED exhibit typical psychological features when compared to those without BED. Their recognition by a structured psychological evaluation in conjunction with questionnaires might be necessary to develop appropriate therapeutic strategies to facilitate weight loss.

Adult↗

Outcome measures for urinary incontinence.

UNLABELLED: OBJECTIVES; To discuss the rudiments of data that need to be collected in order to develop validated, reproducible, well-accepted efficacy instruments for assessing treatment outcomes in urinary incontinence (UI). METHODS: Information is presented from two reports issued by the Urodynamics Society: "Definition and Classification of Urinary Incontinence" and "Standards of Efficacy for Evaluation of Treatment Outcomes in Urinary Incontinence." RESULTS: Instruments to assess the efficacy of treatment should be reliable and valid. Such instruments include structured histories, questionnaires, structured physical examinations, urodynamics, voiding diaries, and pad tests. Recommended primary outcome variables include the number of incontinent episodes, volume of urinary loss, and type of incontinence. Secondary measures include patient satisfaction, quality of life, bladder symptoms, uroflow, postvoid residual urine, and other urodynamic variables. General considerations for the development of clinical trials include 1) using a standard lexicon, 2) consistent timing of follow-up, 3) proper outcome assessment at each follow-up, 4) proper data collection, 5) proper data analysis, and 6) formulating conclusions that are supported by the data. CONCLUSIONS: At the present time, there are no validated, reproducible, well-accepted efficacy instruments for assessing treatment outcomes in UI. Further work directed toward the development of such instruments is warranted.

Female↗