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At least 1,423 records · Page 79Linked to original sources
PubMed1999

Cincinnati Prehospital Stroke Scale: reproducibility and validity.

STUDY OBJECTIVE: The Cincinnati Prehospital Stroke Scale (CPSS) is a 3-item scale based on a simplification of the National Institutes of Health (NIH) Stroke Scale. When performed by a physician, it has a high sensitivity and specificity in identifying patients with stroke who are candidates for thrombolysis. The objective of this study was to validate and verify the reproducibility of the CPSS when used by prehospital providers. METHODS: The CPSS was performed and scored by a physician certified in the use of the NIH Stroke Scale (gold standard). Simultaneously, a group of 4 paramedics and EMTs scored the same patient. RESULTS: A total of 860 scales were completed on a convenience sample of 171 patients from the emergency department and neurology inpatient service. Of these patients, 49 had a diagnosis of stroke or transient ischemic attack. High reproducibility was observed among prehospital providers for total score (intraclass correlation coefficient [rI],.89; 95% confidence interval [CI],.87 to.92) and for each scale item: arm weakness, speech, and facial droop (.91,.84, and.75, respectively). There was excellent intraclass correlation between the physician and the prehospital providers for total score (rI,.92; 95% CI,.89 to.93) and for the specific items of the scale (.91,.87, and.78, respectively). Observation by the physician of an abnormality in any 1 of the 3 stroke scale items had a sensitivity of 66% and specificity of 87% in identifying a stroke patient. The sensitivity was 88% for identification of patients with anterior circulation strokes. CONCLUSION: The CPSS has excellent reproducibility among prehospital personnel and physicians. It has good validity in identifying patients with stroke who are candidates for thrombolytic therapy, especially those with anterior circulation stroke.

Aged↗
PubMed2001

Limitations and perspectives about scaling ozone impacts in trees.

We review the need for scaling effects of ozone (O3) from juvenile to mature forest trees, identify the knowledge presently available, and discuss limitations in scaling efforts. Recent findings on O3/soil nutrient and O3/CO2 interactions from controlled experiments suggest consistent scaling patterns for physiological responses of individual leaves to whole-plant growth, carbon allocation, and water use efficiency of juvenile trees. These findings on juvenile trees are used to develop hypotheses that are relevant to scaling O3 effects to mature trees, and these hypotheses are examined with respect to existing research on differences in response to O3 between juvenile and mature trees. Scaling patterns of leaf-level physiological response to O3 have not been consistent in previous comparisons between juvenile and mature trees. We review and synthesize current understanding of factors that may cause such inconsistent scaling patterns, including tree-size related changes in environment, stomatal conductance, O3 uptake and exposure. carbon allocation to defense, repair, and compensation mechanisms, and leaf production phenology. These factors should be considered in efforts to scale O3 responses during tree ontogeny. Free-air O3 fumigation experiments of forest canopies allow direct assessments of O3 impacts on physiological processes of mature trees, and provide the opportunity to test current hypotheses about ontogenetic variation in O3 sensitivity by comparing O3 responses across tree-internal scales and ontogeny.

Air Pollutants↗
PubMed1998

An intrusive impact of anchors in children's faces pain scales.

The numerous pain rating scales using faces depicting varying degrees of distress to elicit reports of pain from children fall into two categories; those with a neutral face as the 'no pain' anchor, and those with a smiling face as the 'no pain' anchor. This study examined the potentially biasing impact of these anchor types on children's self-reports of pain in response to a series of vignettes. Participants were 100 children stratified by age (5-6 years, 7-8 years, 9-12 years) and randomly assigned to one of three groups: (1) neutral scale/sensory instructions; (2) smiling scale/sensory instructions; (3) smiling scale/affective instructions. Children completed a faces scale, a VAS, and emotions ratings in response to four scenarios depicting: (1) no pain/negative emotions; (2) pain/negative emotions; (3) no pain/positive emotions: (4) pain/positive emotions. Results showed that children who used the smiling scale had significantly higher pain scores for no pain and pain/negative emotions vignettes and significantly lower faces scale scores for pain/positive vignettes than children who used the neutral faces scale. Instructions varying in focus on sensory or affective qualities of pain had no effect on children's pain ratings. Group differences in children's ratings with the VAS and emotions measure suggested that rating pain with a smiling faces scale may alter a child's concept of pain. Age differences indicated the younger children rated the negative emotion vignettes as more painful than the older children. These findings suggest that children's pain ratings vary depending on the types of faces scale used, and that faces scales with smiling anchors may confound affective states with pain ratings.

Aging↗
PubMed2002

A comparison of refuse attenuation in laboratory and field scale lysimeters.

For this study, small and middle scale laboratory lysimeters, and a large scale field lysimeter in situ in Shanghai Refuse Landfill, with refuse weights of 187,600 and 10,800,000 kg, respectively, were created. These lysimeters are compared in terms of leachate quality (pH, concentrations of COD, BOD and NH3-N), refuse composition (biodegradable matter and volatile solid) and surface settlement for a monitoring period of 0-300 days. The objectives of this study were to explore both the similarities and disparities between laboratory and field scale lysimeters, and to compare degradation behaviors of refuse at the intensive reaction phase in the different scale lysimeters. Quantitative relationships of leachate quality and refuse composition with placement time show that degradation behaviors of refuse seem to depend heavily on the scales of the lysimeters and the parameters of concern, especially in the starting period of 0-6 months. However, some similarities exist between laboratory and field lysimeters after 4-6 months of placement because COD and BOD concentrations in leachate in the field lysimeter decrease regularly in a parallel pattern with those in the laboratory lysimeters. NH3-N, volatile solid (VS) and biodegradable matter (BDM) also gradually decrease in parallel in this intensive reaction phase for all scale lysimeters as refuse ages. Though the concrete data are different among the different scale lysimeters, it may be considered that laboratory lysimeters with sufficient scale are basically applicable for a rough simulation of a real landfill, especially for illustrating the degradation pattern and mechanism. Settlement of refuse surface is roughly proportional to the initial refuse height.

Biodegradation, Environmental↗
PubMed2004

Children's ratings of the intensity and unpleasantness of post-operative pain using facial expression scales.

This study explored whether global unidimensional self-report pain scales based on facial expression help children separately estimate the sensory and affective magnitude of post-operative pain. Ninety paediatric elective surgery patients (in two age groups: 5-9 and 10-15 years) used each of four scales to estimate pain intensity and pain affect during the first 2 days after surgery. The four scales were: Faces Pain Scale (FPS), Facial Affective Scale (FAS), and the Coloured Analogue Scale (CAS) (one for intensity and one for unpleasantness). As hypothesised, ratings on the FPS correlated more highly with analogue scale ratings for intensity than for unpleasantness, whereas ratings on the FAS correlated more highly with those on the analogue scale for unpleasantness than for intensity. Factor analysis indicated that although all measures loaded on a single dimension of distress, there was an additional weaker factor corresponding to a unique contribution of the FAS. No systematic age effects were observed. It was concluded that the FPS and the FAS may partly measure different aspects of the postoperative pain experience in children, although shared instrument variance may obscure true estimates of covariation in ratings of intensity and affective magnitude. The clinical relevance of the present results remains to be determined.

Adolescent↗
PubMedDate not supplied

[Simplified scale for medication adherence related problems in anti-retroviral therapy].

OBJECTIVE: The purpose is to describe an own-developed scale for medication adherence evaluation of HIV patients under antiretroviral therapy, and to compare it with other previously described methods. METHODS: The six-item scale was compared with a pharmacy record about the delivery of medication. Accordance between scale and a four-item Morisky-type scale (measure 1) and a percentage of doses taken as prescribed during the past two weeks (measure 2) was computed. RESULTS: The own-scale showed 93% sensitivity, 70% specificity, a likelihood ratio of 3.08 and good agreement compared with the pharmacy record (k = 0.62, p < 0.001). Agreement between the scale and measure 1 and measure 2 was very weak (k = 0.12, p = 0.446 and k = 0.10, p = 0.273 respectively). 39.7% of patients was considered as adherent according with the own-scale and was observed correlation between adherence and clinical outcomes. CONCLUSION: The scale appears to be a valid instrument to check and detect adherence related problems compared with the pharmacy medication record. Easiness to use make feasible to consider as an adequate tool to detect non-adherent patients or patients with adherence related problems into the daily clinical practice.

Adult↗
PubMed1989

A framework for the adaptation of psychological questionnaires for epidemiological use: an example of the Bortner Type A scale.

A model for the systematic adaptation of psychological questionnaires for epidemiological use is presented. Application of the model is illustrated using variants of the Bortner Type A scale in a representative age/sex stratified sample of 256 persons. Through the application of the model the Bortner scale was adapted to compare the effects of scale direction, scale format and example position. Overall the Bortner scale was shown to provide robust measurement which was little affected by response rate, age, sex or by the adaptations of the scale. An association was found of sex with response rate. Interaction effects of sex and scale direction on mean Type A scores, and of example position and scale format on both response rate and Type A score variability were also found. In identifying critical aspects of questionnaire performance, and in providing a coherent framework for their interrelationship, the model acts as a guide to the systematic assessment of questionnaire performance. The use of this model will, therefore, facilitate greater confidence in the interpretation of questionnaire data in epidemiological studies.

Adult↗
PubMed2002

Short screening scales to monitor population prevalences and trends in non-specific psychological distress.

BACKGROUND: A 10-question screening scale of psychological distress and a six-question short-form scale embedded within the 10-question scale were developed for the redesigned US National Health Interview Survey (NHIS). METHODS: Initial pilot questions were administered in a US national mail survey (N = 1401). A reduced set of questions was subsequently administered in a US national telephone survey (N = 1574). The 10-question and six-question scales, which we refer to as the K10 and K6, were constructed from the reduced set of questions based on Item Response Theory models. The scales were subsequently validated in a two-stage clinical reappraisal survey (N = 1000 telephone screening interviews in the first stage followed by N = 153 face-to-face clinical interviews in the second stage that oversampled first-stage respondents who screened positive for emotional problems) in a local convenience sample. The second-stage sample was administered the screening scales along with the Structured Clinical Interview for DSM-IV (SCID). The K6 was subsequently included in the 1997 (N = 36116) and 1998 (N = 32440) US National Health Interview Survey, while the K10 was included in the 1997 (N = 10641) Australian National Survey of Mental Health and Well-Being. RESULTS: Both the K10 and K6 have good precision in the 90th-99th percentile range of the population distribution (standard errors of standardized scores in the range 0.20-0.25) as well as consistent psychometric properties across major sociodemographic subsamples. The scales strongly discriminate between community cases and non-cases of DSM-IV/SCID disorders, with areas under the Receiver Operating Characteristic (ROC) curve of 0.87-0.88 for disorders having Global Assessment of Functioning (GAF) scores of 0-70 and 0.95-0.96 for disorders having GAF scores of 0-50. CONCLUSIONS: The brevity, strong psychometric properties, and ability to discriminate DSM-IV cases from non-cases make the K10 and K6 attractive for use in general-purpose health surveys. The scales are already being used in annual government health surveys in the US and Canada as well as in the WHO World Mental Health Surveys. Routine inclusion of either the K10 or K6 in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.

Adult↗
PubMed2003

What pain scales do nurses use in the postanaesthesia care unit?

BACKGROUND AND OBJECTIVE: The visual analogue scale (VAS) is considered as the gold standard method for postoperative pain assessment. Nevertheless, in some clinical situations, this method may not be reliable. We performed an observational study to assess the use of the VAS and other pain scales by nurses in the postanaesthesia care unit. METHODS: We studied the reasons for not using the VAS and asked if it may be less appropriate in certain age groups. RESULTS: Among 600 patients included in the study (16% = 70 yr), nurses used the VAS in 53%, the numerical rating scale in 30%, the verbal rating scale in 12% and the behavioural scale in 5%. In 43% of the assessments, nursed did not use the VAS; the most frequently cited reason was related to their preference for other methods. In 54% of the assessments, the reason for not using the VAS was related to the patients, mainly when they were in too much pain to use it (22%). When the patient was in too much pain, the numerical rating scale was chosen in 54% and the behavioural scale in 27%. There was no difference between young patients and elderly patients. CONCLUSIONS: Although the VAS is the standard method to assess pain, the nurses preferred using the numerical rating scale, both spontaneously or when VAS assessment was not possible.

Adolescent↗
PubMed2006

The correlation between the Richmond agitation-sedation scale and bispectral index during dexmedetomidine sedation.

BACKGROUND AND OBJECTIVES: The primary objective of sedation in the critically ill patient is to achieve security and comfort. The routine use of standardized and validated sedation scales and monitors are needed. The Richmond agitation sedation scale has been used but some patients cannot be evaluated with subjective assessment tools such as the Richmond agitation sedation scale because they lack motor responsiveness due to therapeutic paralysis or because they are receiving deep sedation. We aimed to assess the correlation of bispectral index with Richmond agitation sedation scale during dexmedetomidine sedation and evaluate the use of the bispectral index in monitoring the levels of sedation in intensive care patients. METHODS: This was a single centre, prospective, clinical study. Eleven mechanically-ventilated critically ill patients, aged 17-82 (50.09 +/- 17.76; mean +/- SD) yr, 3 males and 8 females, APACHE II score 12.63 +/- 3.90, SOFA score 3.27 +/- 1.73 were enrolled in the study. Patients received a dexmedetomidine infusion of 1 microg kg-1 over 10 min followed by a maintenance infusion of 0.5 microg kg-1 h-1 for 8 h. Sedation was assessed using the Richmond agitation sedation scale and bispectral index monitoring. Heart rate, blood pressure, respiratory rate and SPO2 were monitored. Wilcoxon signed rank sum test and Spearman's rank correlation analysis were used for statistical analysis. RESULTS: The variation of Richmond agitation sedation scale score was between 0.9 and -1.7 bispectral index varied from 65 to 75. Significant correlations between Richmond agitation sedation scale and bispectral index values were found in this study. (r = 0.900; P = 0.0001) CONCLUSIONS: Richmond agitation sedation scale levels significantly correlated with bispectral index values during dexmedetomidine sedation in critically ill patients requiring mechanical ventilation in the intensive care unit.

Adolescent↗
PubMed2001

Scale invariance in biology: coincidence or footprint of a universal mechanism?

In this article, we present a self-contained review of recent work on complex biological systems which exhibit no characteristic scale. This property can manifest itself with fractals (spatial scale invariance), flicker noise or 1/f-noise where f denotes the frequency of a signal (temporal scale invariance) and power laws (scale invariance in the size and duration of events in the dynamics of the system). A hypothesis recently put forward to explain these scale-free phenomomena is criticality, a notion introduced by physicists while studying phase transitions in materials, where systems spontaneously arrange themselves in an unstable manner similar, for instance, to a row of dominoes. Here, we review in a critical manner work which investigates to what extent this idea can be generalized to biology. More precisely, we start with a brief introduction to the concepts of absence of characteristic scale (power-law distributions, fractals and 1/f-noise) and of critical phenomena. We then review typical mathematical models exhibiting such properties: edge of chaos, cellular automata and self-organized critical models. These notions are then brought together to see to what extent they can account for the scale invariance observed in ecology, evolution of species, type III epidemics and some aspects of the central nervous system. This article also discusses how the notion of scale invariance can give important insights into the workings of biological systems.

Animals↗
PubMedDate not supplied

A systematic approach for scale-down model development and characterization of commercial cell culture processes.

The objective of process characterization is to demonstrate robustness of manufacturing processes by understanding the relationship between key operating parameters and final performance. Technical information from the characterization study is important for subsequent process validation, and this has become a regulatory expectation in recent years. Since performing the study at the manufacturing scale is not practically feasible, development of scale-down models that represent the performance of the commercial process is essential to achieve reliable process characterization. In this study, we describe a systematic approach to develop a bioreactor scale-down model and to characterize a cell culture process for recombinant protein production in CHO cells. First, a scale-down model using 2-L bioreactors was developed on the basis of the 2000-L commercial scale process. Profiles of cell growth, productivity, product quality, culture environments (pH, DO, pCO2), and level of metabolites (glucose, glutamine, lactate, ammonia) were compared between the two scales to qualify the scale-down model. The key operating parameters were then characterized in single-parameter ranging studies and an interaction study using this scale-down model. Appropriate operation ranges and acceptance criteria for certain key parameters were determined to ensure the success of process validation and the process performance consistency. The process worst-case condition was also identified through the interaction study.

Animals↗
PubMed2002

Dissolution of nonuniformly distributed immiscible liquid: intermediate-scale experiments and mathematical modeling.

The purpose of this work is to examine the effect of nonuniform distributions of immiscible organic liquid on dissolution behavior, with a specific focus on the condition dependency of dissolution (i.e., mass transfer) rate coefficients associated with applying mathematical models of differing complexities to measured data. Dissolution experiments were conducted using intermediate-scale flow cells packed with sand in which well-characterized zones of residual trichloroethene (TCE) and 1,2-dichloroethane (DCA) saturation were emplaced. A dual-energy gamma radiation system was used for in-situ measurement of NAPL saturation. Aqueous concentrations of TCE and DCA measured in the flow-cell effluent were significantly less than solubility, due primarily to dilution associated with the nonuniform immiscible-liquid distribution and bypass flow effects associated with physical heterogeneity. A quantitative analysis of flow and transport was conducted using a three-dimensional mathematical model wherein immiscible-liquid distribution, permeability variability, and sampling effects were explicitly considered. Independent values for the initial dissolution rate coefficients were obtained from dissolution experiments conducted using homogeneously packed columns. The independent predictions obtained from the model provided good representations of NAPL dissolution behavior and of total TCE/DCA mass removed, signifying model robustness. This indicates that for the complex three-dimensional model, explicit consideration of the larger scale factors that influenced immiscible-liquid dissolution in the flow cells allowed the use of a dissolution rate coefficient that represents only local-scale mass transfer processes. Conversely, the use of simpler models that did not explicitly consider the nonuniform immiscible-liquid distribution required the use of dissolution rate coefficients that are approximately 3 orders of magnitude smaller than the values obtained from the column experiments. The rate coefficients associated with the simpler models represent composite or lumped coefficients that incorporate the effects of the larger scale dissolution processes associated with the nonuniform immiscible-liquid distribution, which are not explicitly represented in the simpler models, as well as local-scale mass transfer. These results demonstrate that local-scale dissolution rate coefficients, such as those obtained from column experiments, can be used in models to successfully predict dissolution and transport of immiscible-liquid constituents at larger scales when the larger scale factors influencing dissolution behavior are explicitly accounted for in the model.

Ethylene Dichlorides↗
PubMed1999

Characterization of lipophilicity scales using vectors from solvation energy descriptors.

Lipophilicity scales were characterized by an approach using vectors provided from solvation energy descriptors (SED) of solutes such as an excess molar refraction, the dipolarity/polarizability, the hydrogen-bond acidity, the basicity, and the McGowan characteristic volume. The five components of the SED vector were obtained from the coefficients of the five SED terms of the linear solvation energy relationship (LSER) equation for the lipophilicity scales. The analogy between two lipophilicity scales was expressed as the angle between the two SED vectors, while the difference in the contribution of the five independent SEDs to these two lipophilicity scales was quantified by the difference of the unit vectors of the SED vectors. These approaches were applied to several lipophilicity scales measured using microemulsions, micelles, an immobilized artificial membrane column, and an octanol-water system. As a result, the quantitative classification of these scales was successfully carried out, and the difference in the scales was well characterized. In addition, this vector approach was extended to the estimation of the contribution of each constituent of the microemulsions to the lipophilicity scale. Furthermore, some biological parameters such as skin permeability and the distribution between blood and brain could be predicted by the summation of the SED vectors obtained from the chromatographic systems. These results suggest that complex biological systems can be expressed quantitatively by simple chemical models with their SED vectors.

Algorithms↗
PubMed2001

A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore.

Scaling assumptions and validity of the English (UK) and Chinese (HK) short form 36 health survey (SF-36) were assessed in a community-based survey of 5,503 Chinese, Malays and Indians in Singapore using the international quality of life assessment project approach of item and scale level validation. Missing data for SF-36 items and scales occurred in less than 1.0% of subjects. Item level validation of both versions generally supported assumptions underlying Likert scoring and hypothesised item-order clustering. Item level factor analysis supported the eight-scale structure of the SF-36. In scale level validation, SF-36 scale scores showed wide variability and acceptable internal-consistency reliability (Cronbach's alpha > 0.70 for six English and seven Chinese scales), conformed to hypothesised patterns and generally varied according to hypotheses in subjects known to differ in quality of life. Scale level factor analysis of both versions yielded very similar patterns of factor correlation, comparable to that found in Japan, but differing from that seen in Western populations. Taken together, these results support the validity of the English (UK) and Chinese (HK) SF-36 versions in the multi-ethnic Asian socio-cultural context of Singapore.

Adult↗
PubMed1997

The Quality of Well-Being scale in asymptomatic HIV-infected patients. HNRC Group. HIV Neural Behavioral Research Center.

We review applications of the Quality of Well-Being (QWB) scale for use in studies of human immunodeficiency virus (HIV)-infected patients. The QWB scale is a preference-weighted decision theory-based measure that summarizes outcomes in terms of quality-adjusted life years (QALYs). In order to validate the QWB scale for HIV-infected patients, the measure was administered in the University of California, San Diego (UCSD) HIV Neural Behavioral Research Center (HNRC). Data are presented for a cohort of 400 HIV-positive-infected men and 114 HIV-uninfected male controls. The evidence suggests that the QWB scale is a significant prospective predictor of mortality. The QWB scale was concurrently associated with the number of CD4+ lymphocytes and ratings of neurological impairment based upon clinical evaluations. Further, the QWB scale was related to neuropsychological assessments derived from formal tests of cognitive functioning. Neuropsychological impairments may be associated with income loss for affected patients. The QWB scale scores were lower among patients with clinical depression. We conclude that the QWB scale is an appropriate general health outcome measure for use in observational studies and clinical trials for patients with HIV disease.

Case-Control Studies↗
PubMed2002

Can the standard gamble and rating scale be used to measure quality of life in rhinoconjunctivitis? Comparison with the RQLQ and SF-36.

BACKGROUND: With interest in health economics growing, it is important to know whether utilities may be used to measure health-related quality of life in patients with rhinoconjunctivitis. The objective was to compare the validity and measurement properties of disease-specific versions of the standard gamble and rating scale with those of the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and the Short-Form 36 (SF-36). METHODS: One hundred adults with symptomatic rhinoconjunctivitis participated in a 5 week observational study, completing the standard gamble, rating scale, RQLQ and SF-36 at baseline and after 1 and 5 weeks. Symptom diaries were completed for 1 week before each follow-up visit. RESULTS: Reliability was highest for the RQLQ (intraclass correlation coefficient = 0.97), followed by the rating scale (0.75), the SF-36 physical (0.75), the SF-36 mental (0.74) and the standard gamble (0.12). The responsiveness index was highest for the RQLQ (0.76), followed by the rating scale (0.56) and the SF-36 mental (0.28). Both cross-sectional and longitudinal validity were strongest for the RQLQ and the rating scale. CONCLUSIONS: Both the rating scale and the RQLQ have strong evaluative and discriminative properties. The SF-36 has acceptable discriminative properties but its evaluative properties are poor. All measurement properties for the standard gamble are inadequate. Poor correlation between the standard gamble and the rating scale indicates that utilities cannot be derived from rating scale data.

Adolescent↗
PubMed2000

The relationship of symptoms and level of functioning in schizophrenia to general wellbeing and the Quality of Life Scale.

OBJECTIVE: Reports suggesting that quality of life in schizophrenia is more highly related to negative rather than positive symptoms are largely based on use of the Quality of Life Scale which was devised to assess deficit symptoms and does not include an assessment of subjective general wellbeing. In the current paper we examined symptoms, level of community functioning as well as living circumstances as correlates of Quality of Life Scale scores and scores on the General Well-Being Scale. METHOD: One hundred and twenty-eight patients completed the General Well-Being Scale and were rated on the Quality of Life Scale as well as scales assessing positive and negative symptoms. RESULTS: While negative symptoms, level of functioning and positive symptoms all were related to the scores on the Quality of Life Scale, General Well-Being Scale scores were primarily related to positive symptoms, particularly reality distortion. CONCLUSION: The results highlight the importance of recognizing the complex nature of the concept of quality of life. They demonstrate that varying indices of quality of life are likely to have different predictors.

Adolescent↗