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PubMed1988

Value of electropharmacologic testing in idiopathic dilated cardiomyopathy and sustained ventricular tachyarrhythmias.

Electrophysiologic studies in 64 patients with idiopathic dilated cardiomyopathy who had sustained ventricular tachycardia or ventricular fibrillation were performed. A sustained ventricular tachyarrhythmia was induced in 43 patients (67%). Electropharmacologic testing predicted an antiarrhythmic drug effective in 15 of 35 patients in whom sustained monomorphic ventricular tachycardia could be induced reproducibly (43% of tested patients, 23% of all patients). During median follow-up of 1.6 years, there were 32 arrhythmia recurrences and 24 cardiac arrests. Multivariate regression analysis identified treatment with a drug predicted to be effective at electropharmacologic testing as the only predictor of freedom from arrhythmia recurrence (p = 0.01); and treatment with a drug predicted to be effective at electropharmacologic testing and lower New York Heart Association functional class as independent predictors of freedom from cardiac arrest (p = 0.03 and p = 0.02, respectively). At median follow-up, the incidences of freedom from arrhythmia recurrence and from cardiac arrest were both 100% during treatment with a drug predicted to be effective at electropharmacologic testing versus 54 +/- 8% and 62 +/- 7%, respectively, during other treatments. These findings indicate that results of electropharmacologic testing accurately predict freedom from arrhythmia recurrence and cardiac arrest in patients with idiopathic dilated cardiomyopathy and sustained ventricular tachyarrhythmias.

Adolescent↗
PubMed2004

Is there a role for chemosensitivity tests in head and neck cancer?

Despite many advances in predictive testing of human malignancies, we are far from using it routinely in clinical practice. Investigating the responsiveness of solid tumors to cytostatic drugs is particularly challenging. Nevertheless, for head and neck cancer, chemosensitivity testing is an increasingly attractive option, since chemotherapy has proven to have curative potential in the therapy of head and neck cancer, in particular in combination with radiation. The significant need for predictive methods to identify patients responsive to therapy, first of all in organ preservation programs, which is an alternative to first-line surgery, had recently renewed the discussion on a possible role of chemosensitivity testing in head and neck cancer. In this review, we discuss the current state of chemosensitivity testing in head and neck cancer. Recent methodological developments, in particular elimination of photochemical artifacts and inclusion of stromal cell response studies, may soon augment the value of ex vivo chemosensitivity testing for the management of head and neck cancer.

Antineoplastic Agents↗
PubMed1996

The social dynamics of genetic testing: the case of Fragile-X.

This article considers a program to screen school children for Fragile-X Syndrome as a way to explore several features of the growing practice of genetic testing in American society. These include the common practice of predictive testing in nonclinical settings; the economic, entrepreneurial, and policy interests that are driving the development of genetic screening programs; and the public support for genetic testing even when there are no effective therapeutic interventions. Drawing from research on popular images of genetics, I argue that cultural beliefs and expectations, widely conveyed through popular narratives, are encouraging the search for diagnostic information and enhancing the appeal of genetic explanations for a growing range of conditions.

Attitude to Health↗
PubMed1995

The utility of three predictors of childhood myopia: a Bayesian analysis.

Any treatment to prevent the onset of juvenile myopia will require predictive tests in order to determine which children should receive treatment. Three risk factors for myopia were evaluated for their ability to predict myopia: (a) refraction at school entry; (b) refraction in infancy; and (c) parental history of myopia. Bayes' theorem was used to estimate these conditional probabilities. Refraction at school entry had twice the power to predict myopia (probability of juvenile myopia given the child is near emmetropia at school entry = 0.53) compared to either infant refraction (0.21-0.28) or parental myopia (0.20-0.25). While a history of any parent having myopia had the highest test sensitivity (probability of a positive family history of myopia given juvenile myopia in the child = 0.90) and refraction at school entry the highest test specificity (probability of more hyperopia than +0.50 D at school entry given no juvenile myopia = 0.91), none of these three factors had high values for both sensitivity and specificity. Further work is required to develop a battery of tests which could predict the onset of juvenile myopia with both adequate sensitivity and specificity.

Age Factors↗
PubMed1989

Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis.

Previous research has suggested that cerebral lesions observed on magnetic resonance imaging (MRI) of MS patients are clinically "silent." We examined the validity of this assertion by correlating neuropsychological test performance with MRI findings in 53 MS patients. We used a semiautomated quantitation system to measure three MRI variables: total lesion area (TLA), ventricular-brain ratio (VBR), and size of the corpus callosum (SCC). Stepwise multiple regression analyses indicated that TLA was a robust predictor of cognitive dysfunction, particularly for measures of recent memory, abstract/conceptual reasoning, language, and visuospatial problem solving. SCC predicted test performance on measures on mental processing speed and rapid problem solving, while VBR did not independently predict cognitive test findings. These findings suggest that cerebral lesions in MS produce cognitive dysfunction and that MRI may be a useful predictor of cognitive dysfunction.

Brain↗
PubMed2006

Fatness at birth predicts adult susceptibility to ovarian suppression: an empirical test of the Predictive Adaptive Response hypothesis.

Poor fetal environments are thought to produce adaptive changes in human developmental trajectories according to the Predictive Adaptive Response hypothesis. Although many studies have demonstrated correlations between indicators of fetal environment and negative adult health outcomes, the adaptive significance of these outcomes is unclear. Our study explicitly tests the adaptive nature of fetal programming in humans. We show that differences in nutritional status at birth are associated with adaptive differences in the sensitivity of adult ovarian function to energetic stress. Women who were born as relatively fat babies do not exhibit ovarian suppression in response to moderate levels of physical activity at adulthood, in contrast to women who were born as skinnier babies. The levels of estradiol in women born in the highest tertile of ponderal index (an indicator of neonatal nutritional status) were 37% and 46% higher, respectively, than levels of estradiol in women born in the low and middle ponderal index tertiles. These findings suggest that fetal programming of reproductive function results in developmentally plastic, but essentially adaptive, shifts in set points of ovarian response to energetic stress, such that women who were gestated under conditions of energetic constraint show greater sensitivity to energetic stress in adulthood. Our results have practical implications in terms of behavioral strategies for reducing the risk of breast cancer. We suggest that the amount of activity necessary to reduce levels of estrogen, which may in turn reduce cancer risk, can depend on a woman's nutritional status at birth.

Adaptation, Physiological↗
PubMed2004

Development of a new measure to assess trunk impairment after stroke (trunk impairment scale): its psychometric properties.

OBJECTIVE: The purpose of this study was to investigate reliability, validity, internal structure, and responsiveness of our newly developed Trunk Impairment Scale (TIS) for patients with stroke. DESIGN: A total of 73 patients with stroke participated in this prospective study. Interrater reliability (weighted kappa statistics), content validity (principal component analysis), concurrent validity (Spearman's rank correlation with the Trunk Control Test), predictive validity (prediction of discharge FIM scores), and responsiveness (standardized response mean values) were examined. Internal consistency and item difficulties were analyzed with Rasch analysis. RESULTS: The weighted kappa of each TIS item ranged from 0.66 to 1.0. Principal component analysis revealed that the TIS measured a domain similar to the Stroke Impairment Assessment Set trunk items but different from the Stroke Impairment Assessment Set motor and visuospatial items. The TIS correlated with the Trunk Control Test (r = 0.91). To predict discharge FIM motor scores, addition of the TIS as one of the predictors to age, time from onset, and admission FIM score increased the adjusted R2 from 0.66 to 0.75. With Rasch analysis, the misfit was acceptable, except for the abdominal muscle strength item. The difficulty patterns were similar at admission and discharge, except for the abdominal muscle strength item. The responsiveness of the TIS was satisfactory and comparable with that of the Trunk Control Test (standardized response mean values, 0.94 and 1.06). CONCLUSIONS: Our newly developed TIS is reliable, valid, and responsive for use in stroke outcome research.

Adult↗
PubMed1994

Ethical issues in genetic testing for Alzheimer's disease: lessons from Huntington's disease.

This article discusses an ethics research project in predictive testing for Huntington's disease (HD) and the relevance of the findings for genetic testing for Alzheimer's disease (AD). Participants were videotaped during their pre- and posttest counseling sessions, as well as when the results were given. Half of these were then interviewed in their homes. Changes that accompanied the receipt of decreased risk suggested that counseling as well as the genetic information led the participants through a rite of passage. The most significant changes seemed to be in relation to other family members. Application to persons at risk for AD needs to be qualified, since persons at risk for AD will not usually have as well developed a sense of "family risk," and are less likely to receive as definite a reduced risk. In diagnostic testing for AD, a substitute decision-maker will often be involved. An unavoidable result is that some of the related substitute decision-makers will receive results which may have, or be mistaken to have, predictive value. Substitute decision-makers must therefore be included in genetic counseling, and the psychosocial effects of their participation must be evaluated.

Adaptation, Psychological↗
PubMed2001

The adenosine triphosphate test: a bedside diagnostic tool for identifying the mechanism of supraventricular tachycardia in patients with palpitations.

OBJECTIVES: This study assesses the value of the "ATP test" (injection of adenosine triphosphate [ATP] during sinus rhythm) for identifying patients with palpitations of unclear etiology who actually have atrioventricular (AV) nodal re-entry tachycardia (AVNRT) or AV re-entry tachycardia (AVRT). BACKGROUND: Because AVNRT and AVRT can be cured with radiofrequency ablation, documentation of spontaneous AVNRT or AVRT usually prompts referral for electrophysiologic (EP) evaluation. However, these paroxysmal arrhythmias may elude clinical diagnosis. We recently showed that administration of ATP during sinus rhythm often reveals dual AV node physiology or a concealed accessory pathway (AP) in patients with documented AVNRT or AVRT. Thus, we postulated that the ATP test could identify patients with palpitations who actually have AVNRT or AVRT and would therefore benefit from EP evaluation. METHODS: One hundred forty-six patients (54 with "palpitations without documented arrhythmias" and 92 with "documentation of arrhythmias of unclear mechanism") underwent a noninvasive ATP test. ATP was injected during sinus rhythm using 10 mg increments. The ATP test was considered positive when prospectively defined signs of dual AV node physiology or concealed AP were disclosed in the electrocardiogram. These findings were correlated with the results of EP evaluation. RESULTS: A positive ATP test predicted induction of AVNRT or AVRT with a positive predictive value of 93% (sensitivity 71%) but a negative predictive value of 37% (specificity 76%). CONCLUSIONS: A bedside ATP test identifies patients with palpitations who are likely to have AVNRT or AVRT (and who are therefore likely to benefit from EP evaluation) with a high positive predictive value.

Adenosine Triphosphate↗
PubMedDate not supplied

Population-based prediction equations for neurobehavioral tests.

Quantitative assessment of neurobehavioral function appraises brain injury from inhaled chemicals. Contemporary predicted values for tests useful in epidemiological studies have been developed with step-wise linear regression. In instances in which age and education do not match those of control groups, these equations assist in the interpretation of results of examinations of individual subjects and pilot studies. In this study, investigators considered brain function tests to be analogous in concept to pulmonary function tests. The authors used the tests to assess 293 adults in three unexposed groups from different areas of the United States. The subjects, who were contacted at random from voter registration rolls, were compensated for their time. The tests included balance, reaction time, strength, hearing, visual performance and cognitive recall, and perceptual motor and memory functions. Regression equations modeled the performance of each test and the influences of demographic factors. The investigators retained all influential factors in the equations. Age was a significant predictor for most tests. Education attainment was not a factor in any of the physiological measures, but it was a determinant in many psychological tests. Prediction equations assist investigators in the quantitative testing of chemically exposed individuals and other brain-injured individuals. The investigators verified the equations against other groups, including additional unexposed populations.

Adolescent↗
PubMed2006

Three-dimensional spatial skill training in a simulated space station: random vs. blocked designs.

BACKGROUND: Astronauts floating inside a spacecraft must be able to recall the direction to surrounding visual landmarks, regardless of their viewing perspective. If 3D orientation skills are taught preflight, should perspective sequences be blocked or randomized? Can standard spatial skill tests predict performance? METHODS: Undergraduates (40 men and 40 women; ages 19-24) learned 3D spatial relationships among landmark pictures in a cubic chamber simulating a space station node. Subjects learned to predict picture directions when told one picture's direction (the one behind them) and the subject's simulated roll orientation, which was changed between trials by rotating pictures. The dependent variable was the proportion of correct predictions. A between group (n=40 per group) independent variable was training type (random vs. blocked sequencing of perspectives). Experiment phase (familiarization, training, transfer, and 2 retention phases) was a within group variable. Subjects also took three standard spatial skill tests: Card Rotation, Cube Comparison, and Group Imbedded Figures. RESULTS: As hypothesized, during training, performance for the random group (0.56) was worse than the blocked group (0.83); during transfer, the random group (0.75) was better than the blocked group (0.56); during retention-i, the random group (0.70) was better than the blocked group (0.55); and during retention-2, the random group (0.76) was better than the blocked group (0.65). Spatial skill tests correlated differently across the two groups, indicating that random sequencing elicits different skills. CONCLUSION: Random presentation enhances 3D spatial skill transfer and retention. Standard spatial tests can predict performance and have the potential to customize training.

Adult↗
PubMed2002

Executive dysfunction and clinical outcome in chronic alcoholics.

BACKGROUND: The purpose of this study was to investigate which of 12 neuropsychological tests predict alcoholic patients' alcohol-specific and/or alcoholic-nonspecific outcome. Our hypothesis was that the ecologically valid neuropsychological tests that measure executive function are better predictors of alcoholics' functional outcome. METHODS: We administered 12 neuropsychological tests to chronic alcoholics. Included in the tests were tasks of Reaction Time, Symbol Digit Modalities, Figure Position, Digit Span, Block Design, Trail Making, and six subtests of a battery called the Behavioral Assessment of the Dysexecutive Syndrome (BADS). Previous investigators have suggested that the BADS has ecological validity. Twenty-two male alcoholics were compared with 15 nonalcoholic control subjects on these neuropsychological measures 7 weeks after detoxification. Two functional outcome indices, i.e., resumption of drinking and occupation, were evaluated 18 months after discharge. RESULTS: The total profile score and the score on three of the six subtests of the BADS were lower in alcoholics than in nonalcoholic controls. Alcoholics' performance on the BADS predicted alcohol-nonspecific outcome (occupation) but not alcohol-specific (drinking) outcome. In contrast, other neuropsychological tests did not predict either of the two outcome indices. CONCLUSIONS: The BADS total profile score is related to alcohol-nonspecific outcome but not to alcohol-specific outcome.

Alcoholism↗
PubMed1992

Selection of a maximal test protocol to validate the Canadian Aerobic Fitness Test.

The purpose of this study was to select a maximal aerobic power test protocol with which to validate a submaximal step test prediction equation. Subjects (N = 129), males and females 15 to 69 years of age, performed one maximal step test and one maximal treadmill test. The maximal treadmill protocol yielded higher peak VO2, ventilation, heart rate, and RER values. An age-predicted maximum heart rate was achieved by 35% of subjects on the step test and 55% on the treadmill. An RER of 1.15 was attained by 22% of the subjects on the step test and 53% on the treadmill. Regression analysis indicated that the submaximal test was more predictive of VO2max when the maximum was attained using the treadmill rather than the maximal step protocol. Peak VO2 values obtained from subjects tested on the treadmill will be used to develop a new prediction equation for the Canadian Aerobic Fitness Test.

Adolescent↗
PubMed1998

Acute irritant reactivity to sodium lauryl sulfate in atopics and non-atopics.

Predictive testing of chemicals to assess their acute skin irritation potential is an important part of the assessment of their toxicological profile. It is possible, where safety and ethical considerations can be met, to do this work in groups of human volunteers. Previously, the relative responsiveness of atopics and non-atopics has been evaluated. The results showed that atopics (defined broadly by high IgE reactivity) were a little more susceptible to skin irritation, but not significantly so. In the present work, the relative reactivity of a skin atopic group versus a non-atopic group was examined in more detail. Sodium lauryl sulfate (SLS) was applied at a range of concentrations and exposure times, such that a fairly constant degree of skin irritation was produced. At various time points, the irritation response was measured by visual assessment, chromametry, laser Doppler flowmetry and transepidermal water loss. Using all of the methods of assessment, the reactions in atopics were similar to or a little less than those seen in non-atopics. The conclusion is that atopics and non-atopics will give similar results in a predictive human test for acute skin irritation. Furthermore, the pattern of response obtained from short duration exposure should be predictive of that following longer durations of (single) exposure.

Acute Disease↗
PubMed2005

Cognitive function predicts first-time stroke and heart disease.

OBJECTIVE: To investigate whether impaired cognitive function is an early manifestation of vascular injury in the brain and therefore predicts risk of subsequent cardiovascular disease. METHODS: The study population consisted of 12,096 middle-aged participants in the Atherosclerosis Risk in Communities (ARIC) Study who had no history of stroke or coronary heart disease (CHD) at the time of cognitive testing. Cognitive function was measured using the Digit-Symbol Substitution Test (DSST), the Word Fluency Test, and the Delayed Word Recall Test. Cognitive test scores were adjusted for demographic factors and then evaluated as predictors of incident cardiovascular events using Cox proportional hazards analysis. RESULTS: Over a median follow-up period of 6.4 years, there were 516 incident cardiovascular events (292 myocardial infarctions, 50 CHD deaths, and 174 strokes), resulting in an average annual incidence rate of 0.7%. Lower adjusted scores on each cognitive test predicted a greater risk of incident cardiovascular events after controlling for established vascular risk factors (highest vs lowest quartile DSST, adjusted hazard ratio 1.56, 95% CI 1.23 to 1.97, p for linear trend by quartile < 0.001). The magnitude of the association was comparable with other commonly used predictors of vascular risk such as left ventricular hypertrophy on EKG and high-density lipoprotein cholesterol level of <35 mg/dL. CONCLUSION: Cognitive test scores below demographic norms predict incident cardiovascular disease in middle-aged subjects independently of established vascular risk factors.

Cognition Disorders↗
PubMed1998

The development of chronic graft-versus-host disease: an analysis of screening studies and the impact of corticosteroid use at 100 days after transplantation.

The value of routine chronic graft-versus-host disease (GVHD) screening studies performed between 70 and 120 days after allogeneic marrow transplantation was retrospectively evaluated among 241 patients. All patients received methotrexate and cyclosporine for GVHD prophylaxis and survived without relapse more than 4 months after transplant. Ninety-one patients (38%) developed clinical extensive chronic GVHD requiring systemic therapy. Data on patients who developed clinical extensive chronic GVHD were compared with those on patients without chronic GVHD to determine which of the following screening tests predicted the subsequent development of clinical extensive chronic GVHD: skin biopsy, oral exam, lip biopsy, Schirmer's test, serum alkaline phosphatase, aspartate transaminase, immunoglobulin level and platelet count. In a univariable analysis, a positive oral examination and a low platelet count were predictive of chronic extensive GVHD development. In a multivariable analysis which adjusted for the contribution of other chronic GVHD risk factors, such as age and a history of acute GVHD none of the screening tests were predictive of chronic GVHD development. The risk factors in this multivariable analysis which had the strongest association with the development of chronic GVHD was a history of acute GVHD and use of corticosteroids at day 100 (RR = 3.9, P = 0.001). The use of corticosteroids for acute GVHD at day 100 had a predictive effect on chronic GVHD development independent of the grade of acute GVHD (RR = 2.1, P = 0.004). Based on these study results, the use of chronic GVHD screening tests may not be of value in predicting who will develop this complication. Patients on corticosteroids at day 100 should be considered for clinical trials to determine the efficacy of new immunosuppressive agents in preventing chronic GVHD.

Adrenal Cortex Hormones↗
PubMed2005

The smoking epidemic in Switzerland--an empirical examination of the theory of diffusion of innovations.

OBJECTIVES: Cultural and sex differences in smoking rates among countries indicate different phases of the smoking epidemic. Their background is summarized in a four-stage model based on the Rogers Theory of Diffusion of Innovations. First, to test predictions of the Rogers theory and, second, to test whether, according to the theory, today's innovative process is smoking cessation, predicted by higher rates of cessation among the more highly educated and among men of all educational levels. METHODS: Data covered respondents older than 24 years from two Swiss Health Surveys (1997 and 2002). Logistic regression models were on lifetime smoking versus never-smoking, and on former smoking versus current smoking. RESULTS: Declining smoking rates in both sexes over time, measured by birth cohorts, indicate that the epidemic has peaked, but women of all educational levels and men of lower education still show high prevalence rates. The gap between higher-educated and lower-educated individuals is widening. CONCLUSION: Smoking prevalence is expected to decline further, particularly among women and little educated men. The incidence of tobacco-related diseases in women is predicted to exceed that of men, owing to their lower cessation rates.

Adult↗
PubMed1993

Comparison of vidas Clostridium difficile toxin-A assay and premier C. difficile toxin-A assay to cytotoxin-B tissue culture assay for the detection of toxins of C. difficile.

Damage to the intestinal mucosa by Clostridium difficile (CD) is toxin mediated. Two enzyme immunoassays (EIAs) for toxin-A detection, the automated Vitek immunodiagnostic assay system CDA (Vidas CDA), and the Premier toxin A (Premier) were tested for their ability to detect toxin A in 301 stool samples and compared with an in-house tissue culture assay for toxin B (TCA). Of these 301 samples, 49 were TCA positive and 252 were TCA negative. Agreement between Vidas CDA and TCA on the initial run was 85% (255 of 301) and increased to 94% (278 of 296) when discordant samples were retested from available frozen specimens. Corresponding levels of agreement for Premier were 91% (272 of 301) and 98% (284 of 288), respectively. If tissue culture positivity at any titer was used as the sole criterion for positivity of the specimen, agreement with positive TCA before and after repeat testing was 57% (26 of 49) and 74% (34 of 46) for Vidas CDA and 65% (32 of 49) and 95% (36 of 38) for Premier. Agreement with negative TCA titers was good: 90% for Vidas CDA and 95% for Premier, and 98% for Vidas CDA and 99% for Premier after repeat testing. Predictive values positive and negative after repeat testing were, respectively, 88% and 96% for Vidas CDA, and 95% and 99% for Premier. Results for the automated and manual EIA methods for detection of C. difficile toxin A were obtained in 2.5 h as compared with 36-48 h for tissue culture.

Bacterial Proteins↗