Measuring the functional impact of fatigue: initial validation of the fatigue impact scale

The fatigue impact scale (FIS) was developed to improve our understanding of the effects of fatigue on quality of life. The FIS examines patients' perceptions of the functional limitations that fatigue has caused over the past month. FIS items reflect perceived impact on cognitive, physical, and psychosocial functioning. This study compared 145 patients referred for investigation of chronic fatigue (ChF) with 105 patients with multiple sclerosis (MS) and 34 patients with mild hypertension (HT). Internal consistency for the FIS and its three subscales was > .87 for all analyses. Fatigue impact was highest for the ChF group although the MS group's reported fatigue also exceeded that of the HT group. Discriminant function analysis correctly classified 80.0% of the ChF group and 78.1% of the MS group when these groups were compared. This initial validation study indicates that the FIS has considerable merit as a measure of patient's attribution of functional limitations to symptoms of fatigue.

Neuroblastoma masquerading as a retroperitoneal Salmonella abscess

Symptomatic Salmonella infections usually manifest as self-limited gastrointestinal distress. Patients with chronic systemic illnesses or those who are immunosuppressed may rarely present with Salmonella infection as distant suppurative abscesses. We present a previously healthy Armenian boy who came to medical attention with abdominal pain, fever, and anemia. Abdominal computed tomography (CT) scan showed a cystic suprarenal mass that was surgically explored and found to be a retroperitoneal Salmonella abscess. Postoperative CT scan showed resolving inflammation. A 6-month follow-up CT showed a large suprarenal tumor, which at exploration was found to be neuroblastoma. To our knowledge, Salmonella has never been reported presenting as a solitary retroperitoneal abscess, and neuroblastoma has not been described presenting as a Salmonella abscess. The patient is also unusual because the abscess contained a species unusual for suppurative salmonellosis.

Inhibition of Molt-4-endothelial adherence by synthetic peptides from the sequence of ICAM-1

Previous studies have shown that inflammatory pathologies are mediated by lymphocyte adhesion to endothelium and subsequent transmigration through the endothelial monolayer. Lymphocyte-endothelial adherence is, in part, caused by the leukocyte integrin LFA-1 binding to ICAM-1, its ligand on endothelial cells. Synthetic peptides based on specific amino acid sequences of human ICAM-1 inhibit the adherence of a lymphocytic cell line, Molt-4, to cytokine-stimulated endothelial cells. A total of 26 peptides spanning the extracellular domains of ICAM-1 were evaluated for their inhibitory activity in two cell adhesion assays. Binding of fluorescently labeled Molt-4 cells to TNF-stimulated human umbilical vein endothelial cells was inhibited reproducibly by peptides ICAM1-20, ICAM26-50, ICAM40-64, ICAM132-146, and ICAM345-375. Three overlapping sequences of the peptide ICAM40-64, KELLLPGNNRKVYELSNVQEDSQPM, were synthesized and tested as well, and the sequence KELLLPGNNRKV showed the greatest inhibition. The inhibitory activity of these peptides was confirmed using a second assay, inhibition of aggregation of the Epstein-Barr virus-transformed B-lymphoblast line JY. Polyclonal antibodies were developed in rabbits by immunization with two of the peptides and characterized for their ability to inhibit lymphocyte-endothelial adherence. These studies predict potential sites for interaction of the integrin receptor, LFA-1, with its ligand, ICAM-1. Thus lymphocyte-endothelial interaction, and resulting inflammation, may be partially mediated by the association of ICAM-1 with LFA-1 at the specific molecular locations identified in this study.

Ear wax removal: a survey of current practice

OBJECTIVE

To determine the methods of removing ear wax used by local general practitioners and the incidence of associated complications.

DESIGN

Postal survey of 312 general practitioners serving a population of about 650,000; supplementary study of ear, nose, and throat outpatients to quantify the improvement in aural acuity after wax removal.

SETTING

Catchment area of the Edinburgh otolaryngological unit.

PARTICIPANTS

289 General practitioners who responded to the survey; 21 outpatients in the ear, nose, and throat department with occlusive wax.

RESULTS

274 General practitioners removed wax by syringing, but only 53 (19%) always performed the procedure themselves; the remainder routinely delegated the task to practice nurses, some of whom had received no instruction. Ears were rarely examined again after the procedure. Complications had been experienced by 105 practitioners (38%) and included perforation, canal lacerations, and failure of wax removal. The removal of occlusive wax improved hearing by a mean of 5 dB over the frequencies analysed.

CONCLUSIONS

About 44,000 ears are syringed each year in the area and complications requiring specialist referral are estimated to occur in 1/1000 ears syringed. The incidence of complications could be reduced by a greater awareness of the potential hazards, increased instruction of personnel, and more careful selection of patients.

Overconfident prediction of future actions and outcomes by self and others

In a follow-up study to Dunning, Griffin, Milojkovic, and L. Ross (1990), which had investigated the phenomenon of overconfidence in social prediction, two samples of first-year undergraduates were invited to make predictions about their own future responses (and, in the case of Sample 2, also those of their roommates) over the months ahead. These predictions were accompanied by confidence estimates and were evaluated in the light of actual responses reported later by the subjects in question. The primary finding was that self-predictions, like social predictions, proved to be consistently overconfident. As in Dunning et al., moreover, overconfidence could be traced to two sources. First, expressions of particularly high confidence rarely proved to be warranted; as confidence increased, the gap between accuracy and confidence widened. Second, predictions that went against relevant base rates yielded very low accuracy in the face of relatively unattenuated confidence levels. The implications of these results are discussed, and one potentially important underlying mechanism--the failure to make adequate inferential allowance for the uncertainties of situational construal--is proposed for further research.

Land use associations and changes in population indices of urban raccoons during a rabies epizootic

Land use associations and changes in population indices were assessed for an urban population of raccoons (Procyon lotor) in Baltimore, Maryland (USA), from January 1984 to December 1987. Records were examined for 1,458 raccoons trapped alive and removed dead from city streets during, and after, the peak of a rabies epizootic. The distribution of raccoons was associated with single-unit residential areas primarily along the northern and western perimeter of the city. Beginning in March 1985 an ending in May 1987, an epizootic of raccoon rabies spread through Baltimore, ultimately resulting in the identification of 95 rabid raccoons. Within the study interval, annual numbers of trapped raccoons remained stable from 1984 to 1986, before showing a marked decline in 1987. The number of raccoons removed as vehicle mortalities (road-kills) varied little from 1984-1985 but declined in the last 2 yr of study. Numbers of other road-killed species did not decrease concurrently, suggesting a specific decrease in the urban raccoon population. The rabies epizootic, in conjunction with the increased city and private control, appears to have contributed to a decline in the number of raccoons in Baltimore.

The overconfidence effect in social prediction

In five studies with overlapping designs and intents, subjects predicted a specific peer's responses to a variety of stimulus situations, each of which offered a pair of mutually exclusive and exhaustive response alternatives. Each prediction was accompanied by a subjective probability estimate reflecting the subjects' confidence in its accuracy--a measure validated in Study 5 by having subjects choose whether to "gamble" on the accuracy of their prediction or on the outcome of a simple aleatory event. Our primary finding was that in social prediction, as in other judgmental domains, subjects consistently proved to be highly overconfident. That is, regardless of the type of prediction item (e.g., responses to hypothetical dilemmas, responses to contrived laboratory situations, or self-reports of everyday behaviors) and regardless of the type of information available about the person whose responses they were predicting (e.g., predictions about roommates or predictions based on prior interviews), the levels of accuracy subjects achieved fell considerably below the levels required to justify their confidence levels. Further analysis revealed two specific sources of overconfidence. First, subjects generally were overconfident to the extent they were highly confident. Second, subjects were most likely to be overconfident when they knowingly or unknowingly made predictions that ran counter to the relevant response base rates and, as a consequence, achieved low accuracy rates that their confidence estimates failed to anticipate. Theoretical and normative implications are discussed and proposals for subsequent research offered.

The overconfidence effect in social prediction

In five studies with overlapping designs and intents, subjects predicted a specific peer's responses to a variety of stimulus situations, each of which offered a pair of mutually exclusive and exhaustive response alternatives. Each prediction was accompanied by a subjective probability estimate reflecting the subjects' confidence in its accuracy--a measure validated in Study 5 by having subjects choose whether to "gamble" on the accuracy of their prediction or on the outcome of a simple aleatory event. Our primary finding was that in social prediction, as in other judgmental domains, subjects consistently proved to be highly overconfident. That is, regardless of the type of prediction item (e.g., responses to hypothetical dilemmas, responses to contrived laboratory situations, or self-reports of everyday behaviors) and regardless of the type of information available about the person whose responses they were predicting (e.g., predictions about roommates or predictions based on prior interviews), the levels of accuracy subjects achieved fell considerably below the levels required to justify their confidence levels. Further analysis revealed two specific sources of overconfidence. First, subjects generally were overconfident to the extent they were highly confident. Second, subjects were most likely to be overconfident when they knowingly or unknowingly made predictions that ran counter to the relevant response base rates and, as a consequence, achieved low accuracy rates that their confidence estimates failed to anticipate. Theoretical and normative implications are discussed and proposals for subsequent research offered.

Decision strategies in neuropsychology I: determination of lateralized cerebral dysfunction

This study addressed the issue concerning neuropsychological assessment and the determination of hemispheric lateralization. Based upon the different processing strategies employed by each hemisphere, several neuropsychological tests were hypothesized to discriminate between left hemisphere and right hemisphere damage. Lesion localization was determined by neurological examination, electroencephalography, and/or neuroradiological procedures for the 111 patients (47 right hemisphere, 64 left hemisphere) who were given a neuropsychological evaluation. Two strategies are presented for lateralizing cerebral impairment, a discriminant analysis and a decision process using one standard deviation as a cut-off point. These two strategies are compared with The Key Approach of Russell, Neuringer, and Goldstein (1970) and Simpson and Vega's WAIS Sign Test. The efficacy of decision strategies used to predict lateralization is discussed.

The role of construal processes in overconfident predictions about the self and others

Overconfident behavioral predictions and trait inferences may occur because people make inadequate allowance for the uncertainties of situational construal. In Studies 1-3, Ss estimated how much time or money they would spend in various hypothetical, incompletely specified situations. Ss then offered associated "confidence limits" under different "construal conditions". In Study 4, Ss made trait inferences about someone they believed had responded "deviantly"--again with situational details unspecified and construal conditions manipulated. In all 4 studies, Ss who made predictions or trait inferences without being able to assume the accuracy of their situational construals offered confidence limits no broader than those of Ss who made their responses contingent on such accuracy. Only in conditions where Ss were obliged to offer alternative construals did they appropriately broaden their confidence limits or weaken their trait inferences.

Overconfident prediction of future actions and outcomes by self and others

In a follow-up study to Dunning, Griffin, Milojkovic, and L. Ross (1990), which had investigated the phenomenon of overconfidence in social prediction, two samples of first-year undergraduates were invited to make predictions about their own future responses (and, in the case of Sample 2, also those of their roommates) over the months ahead. These predictions were accompanied by confidence estimates and were evaluated in the light of actual responses reported later by the subjects in question. The primary finding was that self-predictions, like social predictions, proved to be consistently overconfident. As in Dunning et al., moreover, overconfidence could be traced to two sources. First, expressions of particularly high confidence rarely proved to be warranted; as confidence increased, the gap between accuracy and confidence widened. Second, predictions that went against relevant base rates yielded very low accuracy in the face of relatively unattenuated confidence levels. The implications of these results are discussed, and one potentially important underlying mechanism--the failure to make adequate inferential allowance for the uncertainties of situational construal--is proposed for further research.

Ureterocutaneous fistula: a case report of treatment by subtrigonal injection of polytetrafluoroethylene (Sting procedure)

A ureterocutaneous fistula developed in a patient after nephrectomy for pyohydronephrosis in a kidney with vesicoureteral reflux. Endoscopic injection of polytetrafluoroethylene (Teflon) paste at the ureteral orifice prevented further reflux and cured the ureterocutaneous fistula.

Spinal epidural lipomatosis: a serious complication of iatrogenic Cushing's syndrome

Our experience and review of the literature demonstrate that spinal epidural lipomatosis is a rare but serious neurologic complication of iatrogenic Cushing's syndrome. Most patients develop slowly progressive paraparesis over months, but a subgroup exists which presents with acute, irreversible paraplegia. We consider therapeutic options.

Pathologic changes in the kidneys and other organs of dogs undergoing extracorporeal shock wave lithotripsy with a tubless lithotripter

Extracorporeal shock wave lithotripsy (ESWL) is an accepted method of treatment for renal calculi. Complications are rare, although most patients experience temporary hematuria. Shock waves generated by a spark plug in a tubless lithotripter administered to stones placed into the renal pelves of dogs, resulted in interstitial renal hemorrhage developing acutely, and interstitial fibroblastic reactions chronically. The latter were linear, and were in the cortex and/or medulla. They resulted from organisation of the interstitial hemorrhages. In addition interstitial nephritis was present and this could be the result of the surgery, the stones, preexisting infection or the ESWL. Other organs were intact, with the exception of a hematoma in the large bowel of one dog. Lithotripsy, in this dog model, produced a spectrum of kidney injury.