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PubMed1998

Identifying dissociative identity disorder: a self-report and projective study.

This study compared 21 female adult psychiatric patients diagnosed with dissociative identity disorder (DID) with 21 female adult nondissociative psychiatric patients to determine whether DID patients exhibit a distinguishing set of clinical features, and perceptual, attentional, and cognitive processes. Participants were assessed with the Dissociative Disorders Interview Schedule to assess diagnostic status. Group scores on the Dissociative Experiences Scale, Tellegen Absorption Scale, Childhood Trauma Questionnaire, Brief Symptom Inventory, and the Rorschach test were compared. DID participants reported earlier and more severe childhood trauma, more dissociative symptoms, and a greater propensity for altered states of consciousness. The DID participants also exhibited increased projective and imaginative activity, a diminished ability to integrate mental contents, a complex and driven cognitive style, and a highly unconventional view of reality.

Adult↗
PubMed2005

A pilot project on hospital-based universal newborn hearing screening: lessons learned.

OBJECTIVE: This paper reports the performance of a newly implemented hospital-based universal newborn hearing screening programme and the challenges to the effective implementation. METHODS: Data of 4437 babies screened from April 2003 to February 2004 at Hospital Universiti Kebangsaan Malaysia was analyzed to measure the performance of the newborn hearing screening programme. Quality indicators, which include the coverage rate, initial refer rate, return for follow-up rate, ages of diagnosis and intervention were calculated. Factors contributing to poor compliance for follow-up were examined through questionnaire survey of 341 parents who did not bring their babies for the initial screening follow-up. RESULTS: The findings of this study revealed unsatisfactory performance of the hearing screening programme compared to the Joint committee of Infant Hearing recommendation [Joint Committee on Infant Hearing Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs, Pediatrics 106 (4) (2000) 798-817]. The coverage rate, initial refer rate, and return for follow-up rate were 84.64, 11.97 and 56.97%, respectively. The average age of diagnosis was 3.56 months (S.D. 1.33). Only 1 of the 16 babies identified as having hearing loss through the screening programme has been fitted with hearing aids. Delay in coming to audiological certainty was one of the reasons hampering early intervention of these children. The commonly cited reasons for not returning for screening follow-up reflect the need to create public awareness of the importance of early diagnosis and intervention of hearing loss. CONCLUSIONS: The implementation of the present screening programme needs to be reviewed. Factors contributing to its unsatisfactory performance must be identified and steps must be taken to resolve them so that early identification and intervention of permanent congenital hearing loss can become a reality.

Continuity of Patient Care↗
PubMed2000

Remedial self-fulfilling prophecy: two field experiments to prevent Golem effects among disadvantaged women.

The Pygmalion effect is a self-fulfilling prophecy (SFP) in which raising leader expectations boosts subordinate performance. Although attempts to produce Pygmalion effects have been successful repeatedly among men, attempts to produce Pygmalion effects with female leaders have yielded null results. Also, only 1 experiment has demonstrated the Golem effect (i.e., negative SFP in which low leader expectations impair subordinate performance). In 2 field experiments testing the SFP hypothesis among women leading disadvantaged women, experimental leaders were led to believe that their trainees had higher than usual potential. In reality, the trainees had been assigned randomly. Manipulation checks confirmed that the treatment raised leader expectations toward experimental trainees. Analysis of variance of performance detected the predicted SFP effects in both experiments. These were the first-ever experimental confirmations of SFP among women as leaders.

Adolescent↗
PubMed1992

Why children start smoking cigarettes: predictors of onset.

We review findings from 27 prospective studies of the onset of cigarette smoking conducted since 1980. Almost 300 measures of predictors of smoking onset were examined, and 74% of them provided multivariate support for predictors of onset derived from theory and previous empirical findings. Expected relationships were strongly supported for (a) socioeconomic status, with students with compromised status being more likely to try smoking; (b) social bonding variables, particularly peer and school bonding, with less support for family bonding; (c) social learning variables, especially peer smoking and approval, prevalence estimates, and offers/availability, with less consistent support for parent smoking and approval; (d) refusal skills self efficacy; (e) knowledge, attitudes and intentions, with the expected stronger predictions from intentions than from attitudes than from knowledge; and (f) broad indicators of self-esteem. The few investigators who analyzed their data separately by age, gender, or ethnicity found many differences by these factors, though there were too few of them to detect any pattern with confidence. Though the 27 studies are far from perfect, we believe that they confirm the importance of many well-accepted predictors and raise some questions about others. In particular, family smoking, bonding and approval each received unexpectedly low support. It is not clear whether this lack of support reflects reality as it has always been, is due to a changing reality, reflects developmental changes, either in the age of subjects or the stage of onset, or is due to poor measurement and too few tests. Future prospective studies need to be theory-driven, use measures of known reliability and validity, report analyses of scale properties, and use statistical methods appropriate to the hypotheses or theories under study. Finally, we encourage more investigations of the potentially different predictors of transitions to experimental or regular cigarette smoking. This will require multi-wave studies and careful measurement of changes in smoking behavior.

Adolescent↗
PubMed2004

Reduction of human anti-tetanus toxoid antibody in hu-PBL-SCID mice by immunodominant peptides of tetanus toxoid.

Immunotherapy of murine autoimmune and allergic diseases by administration of peptides corresponding to the dominant T cell epitope is a reality. However, problems remain in applying this therapy to reduce antibody responses in humans. To overcome these difficulties, a preclinical system was developed to test the effect of immunodominant peptides from a common antigen, tetanus toxoid (TT), on the long-term human anti-TT response. Individuals whose T cells proliferated against dominant TT peptides were identified. Peripheral blood leucocytes (PBL) from these donors were injected intraperitoneally (i.p.) into mice with severe combined immunodeficiency (SCID) that had been depleted of murine natural killer (NK) cells (hu-PBL-SCID mice). Peptides or PBS were injected i.p. before a further injection of PBL and immunization with TT. The concentration of human IgG and anti-TT in murine plasma was followed for 10 weeks. The total IgG was similar in both groups. By contrast, there was a statistically significant reduction in IgG anti-TT from eight weeks onwards. It is considered that the hu-PBL-SCID model system may provide a means by which the efficacy of peptide immunotherapy for reduction of pathological antibodies in humans can be examined.

Adult↗
PubMed1994

Measurement of acoustic impedance and reflectance in the human ear canal.

The pressure reflectance R (omega) is the transfer function which may be defined for a linear one-port network by the ratio of the reflected complex pressure divided by the incident complex pressure. The reflectance is a function that is closely related to the impedance of the 1-port. The energy reflectance R (omega) is defined as magnitude of [R]2. It represents the ratio of reflected to incident energy. In the human ear canal the energy reflectance is important because it is a measure of the inefficiency of the middle ear and cochlea, and because of the insight provided by its simple frequency domain interpretation. One may characterize the ear canal impedance by use of the pressure reflectance and its magnitude, sidestepping the difficult problems of (a) the unknown canal length from the measurement point to the eardrum, (b) the complicated geometry of the drum, and (c) the cross-sectional area changes in the canal as a function of distance. Reported here are acoustic impedance measurements, looking into the ear canal, measured on ten young adults with normal hearing (ages 18-24). The measurement point in the canal was approximately 0.85 cm from the entrance of the canal. From these measurements, the pressure reflectance in the canal is computed and impedance and reflectance measurements from 0.1 to 15.0 kHz are compared among ears. The average reflectance and the standard deviation of the reflectance for the ten subjects have been determined. The impedance and reflectance of two common ear simulators, the Brüel & Kjaer 4157 and the Industrial Research Products DB-100 (Zwislocki) coupler are also measured and compared to the average human measurements. All measurements are made using controls that assure a uniform accuracy in the acoustic calibration across subjects. This is done by the use of two standard acoustic resistors whose impedances are known. From the experimental results, it is concluded that there is significant subject variability in the magnitude of the reflectance for the ten ear canals. This variability is believed to be due to cochlear and middle ear impedance differences. An attempt was made at modeling the reflectance but, as discussed in the paper, several problems presently stand in the way of these models. Such models would be useful for acoustic virtual-reality systems and for active noise control earphones.

Acoustic Impedance Tests↗
PubMed2003

Essential hypertension: genes and dreams.

Herein we review all of the data from linkage by genome scanning and from association studies in essential hypertension. Genome scans have yielded loci linked to hypertension on almost every chromosome. We tabulate all of these loci to highlight the striking inconsistency. Similarly, association studies have implicated > 66 genes to date, which we also list, but virtually all have failed to show consistent replication in other settings. Nevertheless, we believe that molecular genetics should eventually find all of the major gene variants for essential hypertension. This will be a great scientific achievement and lead to new treatments. The dream, however, of using this information in clinical genetic testing could turn out to be a nightmare. Thus at present the hype surrounding genes for complex polygenic diseases like hypertension far exceeds the reality.

Genetic Carrier Screening↗
PubMedDate not supplied

Diagnosing schistosomiasis.

The ideal diagnostic method for schistosomiasis detection seems to be still far from available. Paucity of egg output in low prevalence situations, low levels of circulating antigens in individuals with low intensity of infection and inadequate specificity of antibody detection systems outline pieces of a puzzle that challenges scientific efforts. Estimated prevalence, financial resources and operational reality must be taken into account when deciding the diagnostic method to be used. A combination of a screening step, using a fast strip test for antibody detection with a parasitological ratification step such as Kato-Katz repeated stool examination may serve as a diagnostic approach for a previously untreated low level endemic area. However, when eradication is the aim, and high financial investment is available, re-treatment may be based on the association between multiple stool examination and circulating antigen detection. Ethical aspects as well as cost-benefit rates between treatment and diagnosis approaches lead to the conclusion that in spite of the recent advances in simple administered and relatively safe drugs, treatment should only be performed when supported by appropriated diagnosis.

Animals↗
PubMed2000

The use of virtual reality in the assessment of driving performance in persons with brain injury.

In this article, we present the results of a pilot study that examined the driving performance of persons with brain injury using a virtual reality environment, known as the DriVR. Virtual driving performance was examined and compared to on-road, cognitive, visual-perceptual, and driving video test results. The DriVR appeared to be a useful adjunctive screening tool for assessing driving performance. However as with any new assessment tool, will need to undergo further empirical validation.

Automobile Driver Examination↗
PubMed1993

Prenatal diagnosis using fetal cells from the maternal circulation.

All current methods of fetal karyotyping are invasive and carry a definite, albeit small, procedure-related risk. Because of this and testing costs, only women older than 35 years who have a greater risk for fetal aneuploidy are currently offered prenatal testing. But this detects only 20% to 25% of fetuses with Down syndrome. It would be a tremendous advance to find a noninvasive technique for prenatal diagnosis that carries no procedure-related risk and could be offered to all pregnant women. We describe a possible technique for noninvasive prenatal diagnosis that aims to identify fetal cells in the peripheral maternal circulation and successfully garner them for prenatal testing. Early attempts at fetal karyotyping were hampered by inaccurate diagnostic methods and cumbersome cell-counting techniques. Today, improved capabilities of identifying and enriching for fetal cells, coupled with sensitive methods of analysis such as the polymerase chain reaction, bring renewed enthusiasm to this task. Many technical issues, as well as serious questions regarding the test's utility, still exist, however, and must be explored and answered before the capture of fetal cells in the maternal circulation translates into reality for noninvasive prenatal diagnosis.

Antibodies, Monoclonal↗
PubMed1993

Genetic counseling for families with inherited susceptibility to breast and ovarian cancer.

Efforts are under way to isolate a gene (BRCA1) on chromosome 17q12-21. Mutations in this gene predispose women to breast and ovarian cancer. Women with germline mutations in BRCA1 are estimated to have an 85% lifetime risk of developing breast cancer and an increased but as yet undetermined risk of ovarian cancer. It is estimated that one in 200 to 400 American women may be carriers of BRCA1 mutations. We have identified several families that show linkage between breast and/or ovarian cancer and genetic markers that flank BRCA1. It is now possible, within these linked families, to prospectively identify family members likely to be carrying BRCA1 mutations. Because of profound and immediate clinical ramifications, we offered to provide this information to one such extended family. To provide information to this family, we developed a protocol to address the many issues that arise in the delivery of these services. Although testing for BRCA1 mutation carriers is currently limited to very rare families being analyzed for research purposes, this experience presages the complexities of the much larger scale availability of population screening for BRCA1 mutations, which is likely to become a reality in the next few years.

Breast Neoplasms↗
PubMed1997

Protecting the integrity of clinical laboratory test results.

The authors' inspection reports demonstrate that the improper alteration of patient data is not a rare aberration in private commercial clinical laboratories. Although laboratory surveyors could be trained to recognize this problem, the availability of unprotected test systems makes even trained inspectors ineffectual. Both regulatory agencies and professional accrediting agencies should be concerned that their surveyors may be placing a seal of approval on what are, in reality, compromised or even fabricated data. In proposing the regulations discussed in this paper, the FDA sought to "preserve the integrity of the agency's enforcement process." This goal will remain unattainable, however, until a mechanism has been devised to secure the original raw data produced by all of the analytical systems being used not only in clinical laboratories but also in environmental laboratories, pharmaceutical laboratories, etc. Laboratories, as well as regulatory agencies and accrediting bodies, need to be concerned on behalf of the patient, but laboratories may also need to be concerned on their own behalf. In the coming era of unprecedented cost constraints and competitive bidding, unscrupulous testing facilities or groups of such facilities could have a significant edge over their conscientious competitors if the issues raised here continue to be ignored. Although the analytical data management systems provide tremendous benefits, some have serious problems in ensuring the security of their data. However, if regulatory agencies, accrediting bodies, professional organizations, and the analyzer vendors make a united commitment, the problem of securing the integrity of analytical data could eventually be resolved. It is hoped that such a commitment will be made in the near future.

Autoanalysis↗
PubMed2005

Choice of delta: requirements and reality--results of a systematic review.

An essential problem in planning clinical non-inferiority or equivalence studies is the specification of the 'irrelevant difference' (irrelevance margin; delta). This quantifies the amount of non-inferiority or difference, respectively, between a new test therapy and an established standard treatment which is to be considered as tolerable. In the past, most recommendations and guidelines for clinical non-inferiority and equivalence studies contained only general statements and formulations concerning the specification of delta. The current unsatisfactory situation was the reason for performing a systematic review of published clinical non-inferiority and equivalence studies. It was the aim to gain an overview on the irrelevance margins used in such studies, and on reasons for choosing the particular margins. For the sake of comparability, the irrelevance margins were converted into standardized differences and odds ratios. Overall, there were 332 non-inferiority or equivalence trials obtained by means of an extensive literature search. The results of the systematic review show that current requirements on the choice of delta and the reality of recent clinical non-inferiority and equivalence trials differ substantially. In about one half of the trials a difference of 0.5 standard deviations or more was regarded as 'irrelevant' explicitly or implicitly. Estimates of standard-placebo differences formed the basis of the irrelevance margin in less than every tenth trial. Reasons for this very low proportion might be (1) the possibly resulting very small irrelevance margins, and (2) unsolved problems of the requirements themselves. Overall, it seems that a more global definition of 'irrelevance' might be warranted.

Biopharmaceutics↗
PubMed2026

Experiences and Behavior During a Virtual Reality Buffet Simulation: A Secondary Analysis of a Ghrelin-Related Pharmacology Randomized Controlled Trial in People with Alcohol Use Disorder.

BACKGROUND: Virtual reality (VR) can deliver standardized, ecologically valid assessments while capturing nuanced psychological and behavioral outcomes. Sensitivity of VR assessments to pharmacological interventions, however, has seldom been tested. METHODS: We conducted a secondary analysis of a randomized, double-blind, placebo-controlled, crossover study evaluating a growth hormone secretagogue receptor (GHSR, the ghrelin receptor) blocker (PF-5190457) in people (N = 29) with alcohol use disorder. The previously reported primary study results demonstrated that the GHSR blocker did not reduce alcohol cue-elicited craving but did reduce the number of calories selected in a VR buffet food choice assessment. Here, we investigated the impact of the drug on experiences and behavior in the VR buffet. RESULTS: Participants reported higher levels of liking the VR, more typicality, and more satisfaction with their food choices under the GHSR blocker than the placebo. We also found that participants who were given the placebo first took longer to make a decision about the food they should eat and were also more likely to go up for a second serving of food when on the placebo. This was significantly less likely for participants who were given the GHSR blocker. CONCLUSIONS: The present results suggest that the GHSR blocker influenced experiences and behavior in the VR buffet in ways that are conceptually consistent with the known real-world effects of blocking the ghrelin system. These findings support the validity of using VR buffets as proxies for real-world measurements in pharmacology contexts.

alcohol use disorder↗
PubMed2005

Symptoms versus neurocognitive test performance as predictors of psychosocial status in schizophrenia: a 1- and 4-year prospective study.

In recent years, a growing body of literature has highlighted the significance of neurocognitive deficits as markers for subsequent psychosocial deficits in patients with schizophrenia. Relatively few studies, however, have directly compared symptoms and neurocognitive test performance as predictors of psychosocial status in a prospective design. In two studies with schizophrenia patients, we investigated the relationship between symptom dimensions (psychomotor poverty, disorganization, reality distortion) and neurocognitive measures (problem solving, attention, verbal learning and memory) obtained at study entry, and psychosocial status measured at a 1- and 4-year followup. Results from the 1-year followup (n = 70) revealed that psychomotor poverty, symptoms of disorganization, and performance on measures of card-sorting and visual vigilance were related to psychosocial status. Results from the 4-year followup (n = 26) revealed a similar pattern of findings with the exception of verbal learning, which emerged as a predictor of psychosocial status only at the 4-year followup. Stepwise regression revealed that performance on measures of visual vigilance and psychomotor poverty symptoms explained the largest amount of variance in psychosocial status at both followup intervals. The significance of these findings for the development and assessment of novel treatment interventions for schizophrenia is discussed.

Adult↗
PubMed1991

Youth fitness testing: the effect of percentile-based evaluative feedback on intrinsic motivation.

This study was a test of Deci and Ryan's (1985) cognitive evaluation theory in a fitness testing situation. More specifically, it was a test of Proposition 2 of that theory, which posits that external events that increase or decrease perceived competence will increase or decrease intrinsic motivation. Seventh and eighth grade schoolchildren (N = 105) volunteered for an experiment that was ostensibly to collect data on a new youth fitness test (the Illinois Agility Run). After two untimed practice runs, a specially adapted version of the Intrinsic Motivation Inventory (IMI) was administered as a pretest of intrinsic motivation. Two weeks later when subjects ran again, they were apparently electronically timed. In reality, the subjects were given bogus feedback. Subjects in a positive feedback condition were told their scores were above the 80th percentile, while those in a negative feedback condition were told their scores were below the 20th percentile. Those in a control condition received no feedback. The IMI was again administered to the subjects after their runs. Multivariate and subsequent univariate tests were significant for all four subscale dependent variables (perceived interest-enjoyment, competence, effort, and pressure-tension). Positive feedback enhanced all aspects of intrinsic motivation, whereas negative feedback decreased them. In a further test of cognitive evaluation theory, path analysis results supported the prediction that perceived competence would mediate changes in the other IMI subscales. Taken together, these results clearly support cognitive evaluation theory and also may have important implications regarding motivation for those who administer youth fitness tests.

Adolescent↗