G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences

Impaired language performance in young children with heavy prenatal alcohol exposure

The aims of this study were to evaluate the language abilities of young children with heavy prenatal alcohol exposure and to determine if these abilities represent a relative strength or weakness for this population. Two matched groups of children (ages 3 to 5) completed the Clinical Evaluation of Language Fundamentals, Preschool version: 25 children with heavy prenatal alcohol exposure (ALC) and 26 non-exposed controls (CON). Consistent with previous research, the CON group had significantly higher full scale IQ (FSIQ) scores than the ALC group. Receptive and expressive language skills of the two groups were compared. The ALC group had significantly poorer language skills than the CON group and both groups had better receptive than expressive abilities. Language performance did not significantly deviate from what would be predicted by FSIQ for either group. These results indicate that receptive and expressive language abilities are impaired in children with heavy prenatal alcohol exposure but not more so than general intellectual functioning. However, these deficits are likely to impact the social interactions and behavioral adjustment of children with prenatal alcohol exposure.

Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial

OBJECTIVE

To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment.

DESIGN

A double-blind, randomized controlled trial.

SETTING

University research laboratory.

PARTICIPANTS

Older adults (N=23) with balance impairment (mean age, 74.8y). They scored 52 or less on the Berg Balance Scale (BBS) and/or walked with a self-selected gait speed of 1.1m/s or less.

INTERVENTIONS

Participants were randomly assigned to 1 of 3 interventions: single-task training, dual-task training with fixed-priority instructions, and dual-task training with variable-priority instructions. Participants received 45-minute individualized training sessions, 3 times a week for 4 weeks.

MAIN OUTCOME MEASURES

Gait speed under single-task and dual-task conditions was obtained at baseline, the second week, the end of training, and the twelfth week after the end of training. Other measures, including the BBS and the Activities-specific Balance Confidence (ABC) Scale, were collected at baseline and after training.

RESULTS

Participants in all groups improved on the BBS (P<.001; effect size [ES]=.72), and walked significantly faster after training (P=.02; ES=.27). When a cognitive task was added, however, only participants who received dual-task training with fixed-priority instructions and dual-task training with variable-priority instructions exhibited significant improvements in gait speed (P<.001, ES=.57; and P<.001, ES=.46, respectively). In addition, only the dual-task training with variable-priority instructions group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up. Only the single-task training group showed a significant increase on the ABC after training (P<.001; ES=.61).

CONCLUSIONS

Dual-task training is effective in improving gait speed under dual-task conditions in elderly participants with balance impairment. Training balance under single-task conditions may not generalize to balance control during dual-task contexts. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect.

Does differential strategy use account for age-related deficits in working-memory performance?

The strategy-deficit hypothesis states that age differences in the use of effective strategies contribute to age-related deficits in working memory span performance. To evaluate this hypothesis, strategy use was measured with set-by-set strategy reports during the Reading Span task (Experiments 1 and 2) and the Operation Span task (Experiment 2). Individual differences in the reported use of effective strategies accounted for substantial variance in span performance. In contrast to the strategy-deficit hypothesis, however, young and older adults reported using the same proportion of normatively effective strategies on both span tasks. Measures of processing speed accounted for a substantial proportion of the age-related variance in span performance. Thus, although use of normatively effective strategies accounts for individual differences in span performance, age differences in effective strategy use cannot explain the age-related variance in that performance.

Psychological distress and cancer mortality

BACKGROUND

Psychological distress, such as ongoing depression and anxiety-related symptomatology, has been associated with a higher risk of incident cancer and poorer survival, although previous studies have not compared prognostic and etiological effects within the same sample. We examined the association between psychological distress and cancer mortality in a sample comprising participants with and without previous cancer admissions.

METHODS

Data were collected from a community-based sample of 15,453 men and women (including 295 people with cancer history) and prospectively linked to a patient-based database of cancer registry and deaths during an average follow-up of 7.0+/-3.3 years. Psychological distress was assessed using the 12-item version of the General Health Questionnaire (GHQ-12).

RESULTS

There were 425 incident cancer deaths. Psychological distress (GHQ-12 > or =4) was associated with increased cancer mortality in participants with cancer history [age, gender, social status, marital status, body mass index, smoking, alcohol, and physical activity; adjusted hazard ratio (HR)=1.97; 95% confidence interval (95% CI)=1.05-3.71; P=.035], but not in participants without cancer history. Among participants without cancer history, there was, however, an association between distress and lung cancer death (age- and gender-adjusted HR=2.04; 95% CI=1.36-3.06; P=.001), although adjustment for covariates attenuated this association.

CONCLUSIONS

Psychological distress was a predictor of cancer mortality, especially in lung cancer. The presence of participants with cancer history in community-based cohorts may overestimate the association between psychological distress and subsequent cancer mortality.

Role of gender in depressive disorder outcome for individual and group cognitive-behavioral treatment

Gender in cognitive-behavioral therapy (CBT) for outcome for depression has been inadequately examined in previous research. Thirty-five men and 55 women diagnosed with a depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) completed individual CBT at an outpatient community mental health clinic and 56 men and 105 women completed group CBT. Depression severity was measured before treatment and at endpoint using the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996) along with secondary outcomes of anxiety (Beck Anxiety Inventory; Beck, Epstein, Brown, & Steer, 1988) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Endicott, Nee, Harrison, & Blumenthal, 1993). Men and women demonstrated equivalent pretreatment and posttreatment illness severity, a comparable gradient of improvement on outcomes, and attainment of clinically meaningful benchmarks.

Evaluation of animal models of neurobehavioral disorders

Animal models play a central role in all areas of biomedical research. The process of animal model building, development and evaluation has rarely been addressed systematically, despite the long history of using animal models in the investigation of neuropsychiatric disorders and behavioral dysfunctions. An iterative, multi-stage trajectory for developing animal models and assessing their quality is proposed. The process starts with defining the purpose(s) of the model, preferentially based on hypotheses about brain-behavior relationships. Then, the model is developed and tested. The evaluation of the model takes scientific and ethical criteria into consideration.Model development requires a multidisciplinary approach. Preclinical and clinical experts should establish a set of scientific criteria, which a model must meet. The scientific evaluation consists of assessing the replicability/reliability, predictive, construct and external validity/generalizability, and relevance of the model. We emphasize the role of (systematic and extended) replications in the course of the validation process. One may apply a multiple-tiered 'replication battery' to estimate the reliability/replicability, validity, and generalizability of result.Compromised welfare is inherent in many deficiency models in animals. Unfortunately, 'animal welfare' is a vaguely defined concept, making it difficult to establish exact evaluation criteria. Weighing the animal's welfare and considerations as to whether action is indicated to reduce the discomfort must accompany the scientific evaluation at any stage of the model building and evaluation process. Animal model building should be discontinued if the model does not meet the preset scientific criteria, or when animal welfare is severely compromised. The application of the evaluation procedure is exemplified using the rat with neonatal hippocampal lesion as a proposed model of schizophrenia.In a manner congruent to that for improving animal models, guided by the procedure expounded upon in this paper, the developmental and evaluation procedure itself may be improved by careful definition of the purpose(s) of a model and by defining better evaluation criteria, based on the proposed use of the model.

Effect of an educational intervention on attitudes toward and implementation of evidence-based practice

PURPOSE

Transitioning to an evidence-based practice (EBP) environment is a new and often overwhelming challenge for many organisations. The most effective strategies to implement EBP have yet to be determined. In this study an accelerated development EBP program, which was administered to nurses from five hospitals was evaluated. At each hospital, nurses were selected as an "EBP champion" whose role would be to help facilitate the transition within that organisation.

AIMS

The purpose of this study was to evaluate the effectiveness of an accelerated educational program on the attitudes toward and implementation of EBP among nurses employed in acute-care facilities.

METHODS

Forty-nine nurses from five acute-care facilities participated in an 8-week program to develop into EBP champions. Participants attended a 2-hour class each week conducted by four faculty members of a local university. Pre- and post-test mean scores of the EBP barriers (EBPB) and EBP implementation (EBPI) scales were compared using paired t tests to determine the effect of the accelerated development program.

RESULTS

Respondents reported higher scores on both the beliefs and implementation scales at the end of the program. Paired t tests indicated a significant difference in means for both the EBPB (p < .01) and EBPI (p < .01).

CONCLUSIONS

Nurses who attend an accelerated educational program have the potential to significantly improve beliefs and attitudes about EBP. Administrative support and collaboration between academia and service are essential for successful intervention.

Facial emotion recognition in patients with bipolar I and bipolar II disorder

OBJECTIVES

The ability to recognize facial emotional expressions is a fundamental skill that is necessary for successful social interaction. Previous studies examining this competency in patients with bipolar disorder have generated mixed results. Since bipolar patients show multiple psychosocial difficulties even after remission, this study was aimed at further elucidating emotion recognition deficits in bipolar patients.

METHODS AND DESIGN

Sixty-two stable bipolar out-patients (37 females; 25 males) and 62 matched healthy controls participated in the study. Explicit facial emotion recognition accuracy was measured with a computerized task.

RESULTS

Analysis of emotion recognition performance revealed no gender effect but a significant group effect, indicating significantly worse accuracy in patients with bipolar I. Patients with bipolar II disorder did not differ significantly from healthy controls. These results were not correlated with either residual symptoms or intellectual impairments.

CONCLUSIONS

Based on our results, patients with bipolar disorder vary not only in diagnosis, but also in social cognitive functions, all of which should be addressed in clinical treatment. Future studies should clarify whether emotion recognition deficits are involved in the development and maintenance of bipolar disorder.

Are plasma VEGF and its soluble receptor sFlt-1 atherogenic risk factors? Cross-sectional data from the SAPHIR study

AIMS

Vascular endothelial growth factor (VEGF) is a potent hypoxia-regulated angiogenic factor. Its soluble receptor soluble (s)Flt-1 binds VEGF with high affinity inhibiting the angiogenic function of VEGF. The role of circulating VEGF in atherosclerosis is unclear.

METHODS AND RESULTS

In 909 healthy subjects (511 male, 398 female) from the Salzburg Atherosclerosis Prevention Program in Subjects at High Individual Risk (SAPHIR) we determined fasting plasma VEGF and sFlt-1 concentration, cardiovascular risk factors and carotid atherosclerosis. VEGF levels were lower and sFlt-1 levels higher in men than in women. VEGF and sFlt-1 showed a positive correlation. In the entire population VEGF correlated positively with age, BMI, insulin resistance, white blood cell and platelet count, C-reactive protein (CRP) and carotid intima media thickness (IMT). After adjustment for age, VEGF showed a weak positive correlation with BMI, liver enzymes, CRP and platelet count in males. In females VEGF correlated negatively with LDL-cholesterol and positively with insulin resistance and platelet count. After adjustment for age, no significant correlation with carotid atherosclerosis could be detected.

CONCLUSION

Plasma VEGF and sFlt-1 are only weakly correlated with cardiovascular risk factors, suggesting that circulating VEGF levels do have only a minor impact on the development of atherosclerosis.

Reduced amygdala-prefrontal coupling in major depression: association with MAOA genotype and illness severity

The amygdala plays a pivotal role in a cortico-limbic circuitry implicated in emotion processing and regulation. In the present study, functional connectivity of the amygdala with prefrontal areas involved in emotion regulation was investigated during a facial expression processing task in a sample of 34 depressed inpatients and 31 healthy controls. All patients were genotyped for a common functional variable number tandem repeat (VNTR) polymorphism in the promoter region of the monoamine oxidase A gene (MAOA u-VNTR) which has been previously associated with major depression as well as reduced cortico-limbic connectivity in healthy subjects. In our control group, we observed tight coupling of the amygdala and dorsal prefrontal areas comprising the dorsolateral prefrontal cortex (DLPFC), dorsal parts of the anterior cingulate cortex (dACC), and lateral orbitofrontal cortex. Amygdala-prefrontal connectivity was significantly reduced in depressed patients and carriers of the higher active MAOA risk alleles (MAOA-H). Hence, depressed MAOA-H carriers showed the weakest amygdala-prefrontal coupling of the investigated subgroups. Furthermore, reduced coupling of this circuitry predicted more than 40% variance of clinical variables characterizing a longer and more severe course of disease. We conclude that genetic variation in the MAOA gene may affect the course of major depression by disrupting cortico-limbic connectivity.

Evaluation of head orientation and neck muscle EMG signals as command inputs to a human-computer interface for individuals with high tetraplegia

We investigated the performance of three user interfaces for restoration of cursor control in individuals with tetraplegia: head orientation, electromyography (EMG) from face and neck muscles, and a standard computer mouse (for comparison). Subjects engaged in a 2-D, center-out, Fitts' Law style task and performance was evaluated using several measures. Overall, head orientation commanded motion resembled mouse commanded cursor motion (smooth, accurate movements to all targets), although with somewhat lower performance. EMG commanded movements exhibited a higher average speed, but other performance measures were lower, particularly for diagonal targets. Compared to head orientation, EMG as a cursor command source was less accurate, was more affected by target direction and was more prone to overshoot the target. In particular, EMG commands for diagonal targets were more sequential, moving first in one direction and then the other rather than moving simultaneous in the two directions. While the relative performance of each user interface differs, each has specific advantages depending on the application.

Vicks VapoRub induces mucin secretion, decreases ciliary beat frequency, and increases tracheal mucus transport in the ferret trachea

BACKGROUND

Vicks VapoRub (VVR) [Proctor and Gamble; Cincinnati, OH] is often used to relieve symptoms of chest congestion. We cared for a toddler in whom severe respiratory distress developed after VVR was applied directly under her nose. We hypothesized that VVR induced inflammation and adversely affected mucociliary function, and tested this hypothesis in an animal model of airway inflammation.

METHODS

[1] Trachea specimens excised from 15 healthy ferrets were incubated in culture plates lined with 200 mg of VVR, and the mucin secretion was compared to those from controls without VVR. Tracheal mucociliary transport velocity (MCTV) was measured by timing the movement of 4 microL of mucus across the trachea. Ciliary beat frequency (CBF) was measured using video microscopy. [2] Anesthetized and intubated ferrets inhaled a placebo or VVR that was placed at the proximal end of the endotracheal tube. We evaluated both healthy ferrets and animals in which we first induced tracheal inflammation with bacterial endotoxin (a lipopolysaccharide [LPS]). Mucin secretion was measured using an enzyme-linked lectin assay, and lung water was measured by wet/dry weight ratios.

RESULTS

[1] Mucin secretion was increased by 63% over the controls in the VVR in vitro group (p < 0.01). CBF was decreased by 35% (p < 0.05) in the VVR group. [2] Neither LPS nor VVR increased lung water, but LPS decreased MCTV in both normal airways (31%) and VVR-exposed airways (30%; p = 0.03), and VVR increased MCTV by 34% in LPS-inflamed airways (p = 0.002).

CONCLUSIONS

VVR stimulates mucin secretion and MCTV in the LPS-inflamed ferret airway. This set of findings is similar to the acute inflammatory stimulation observed with exposure to irritants, and may lead to mucus obstruction of small airways and increased nasal resistance.

Early cortical specialization for face-to-face communication in human infants

This study examined the brain bases of early human social cognitive abilities. Specifically, we investigated whether cortical regions implicated in adults' perception of facial communication signals are functionally active in early human development. Four-month-old infants watched two kinds of dynamic scenarios in which a face either established mutual gaze or averted its gaze, both of which were followed by an eyebrow raise with accompanying smile. Haemodynamic responses were measured by near-infrared spectroscopy, permitting spatial localization of brain activation (experiment 1), and gamma-band oscillatory brain activity was analysed from electroencephalography to provide temporal information about the underlying cortical processes (experiment 2). The results revealed that perceiving facial communication signals activates areas in the infant temporal and prefrontal cortex that correspond to the brain regions implicated in these processes in adults. In addition, mutual gaze itself, and the eyebrow raise with accompanying smile in the context of mutual gaze, produce similar cortical activations. This pattern of results suggests an early specialization of the cortical network involved in the perception of facial communication cues, which is essential for infants' interactions with, and learning from, others.

Alpha power is influenced by performance errors

Error commission evokes changes in event-related potentials, autonomic nervous system activity, and behavior, presumably reflecting the operation of a cognitive control network. Here we test the hypothesis that errors lead to increased cortical arousal, measurable as changes in electroencephalogram (EEG) alpha band power. Participants performed a Stroop task while EEG was recorded. Following correct responses, alpha power increased and then decreased in a quadratic pattern, implying transient mental disengagement during the intertrial interval. This trend was absent following errors, which elicited significantly less alpha power than correct trials. Moreover, post-error alpha power was a better predictor of individual differences in post-error slowing than the error-related negativity (ERN), whereas the ERN was a better predictor of post-error accuracy than alpha power. These findings imply that changes in cortical arousal play a unique role in modulating post-error behavior.

How useful and realistic is the uro trainer for training transurethral prostate and bladder tumor resection procedures?

PURPOSE

We evaluated the face and content validity (novice and expert opinions of realism and usefulness) of the Uro Trainer (Karl Storz GmbH, Tuttlingen, Germany), a simulator for transurethral resection procedures, to ascertain whether it is justifiable to continue the validation process by performing prospective experimental studies.

MATERIALS AND METHODS

Between 2006 and 2008, 104 urologists and urology residents performed a transurethral bladder tumor resection and/or transurethral prostate resection procedure on the Uro Trainer, and rated simulator usefulness and realism on a 10-point scale (1-not at all useful/realistic/poor, 10-very useful/realistic/excellent). Participants were classified as experts (more than 50 procedures performed) or novices (50 or fewer procedures performed). Because the literature offered no guidelines for interpreting our data, we used criteria from other studies to interpret the results.

RESULTS

A total of 161 questionnaires were analyzed from 97 (21% experts, 79% novices) and 64 (30% experts, 70% novices) participants who performed transurethral prostate resection and transurethral bladder tumor resection procedures, respectively. Mean usefulness, realism and overall scores varied from 5.6 to 8.2 (SD 1.4-2.5). Measured by validity criteria from other studies, Uro Trainer face and content validity was unsatisfactory, with ratings on only 3%, 5% and 8% of the parameters interpreted as positive, moderately acceptable and good, respectively.

CONCLUSIONS

Measured against criteria from other validation studies, Uro Trainer face and content validity appears to be unsatisfactory. Modification of the simulator seems advisable before further experimental validation studies are initiated. The lack of general guidelines for establishing face and content validity suggests a need for consensus about appropriate methods for evaluating the validity of simulators.

On sexual dimorphism in immune function

Sexual dimorphism in immune function is a common pattern in vertebrates and also in a number of invertebrates. Most often, females are more 'immunocompetent' than males. The underlying causes are explained by either the role of immunosuppressive substances, such as testosterone, or by fundamental differences in male and female life histories. Here, we investigate some of the main predictions of the immunocompetence handicap hypothesis (ICHH) in a comparative framework using mammals. We focus specifically on the prediction that measures of sexual competition across species explain the observed patterns of variation in sex-specific immunocompetence within species. Our results are not consistent with the ICHH, but we do find that female mammals tend to have higher white blood cell counts (WBC), with some further associations between cell counts and longevity in females. We also document positive covariance between sexual dimorphism in immunity, as measured by a subset of WBC, and dimorphism in the duration of effective breeding. This is consistent with the application of 'Bateman's principle' to immunity, with females maximizing fitness by lengthening lifespan through greater investment in immune defences. Moreover, we present a meta-analysis of insect immunity, as the lack of testosterone in insects provides a means to investigate Bateman's principle for immunity independently of the ICHH. Here, we also find a systematic female bias in the expression of one of the two components of insect immune function that we investigated (phenoloxidase). From these analyses, we conclude that the mechanistic explanations of the ICHH lack empirical support. Instead, fitness-related differences between the sexes are potentially sufficient to explain many natural patterns in immunocompetence.

Evidence-based effect size estimation: an illustration using the case of acupuncture for cancer-related fatigue

Background

Estimating a realistic effect size is an important issue in the planning of clinical studies of complementary and alternative medicine therapies. When a minimally important difference is not available, researchers may estimate effect size using the published literature. This evidence-based effect size estimation may be used to produce a range of empirically-informed effect size and consequent sample size estimates. We provide an illustration of deriving plausible effect size ranges for a study of acupuncture in the relief of post-chemotherapy fatigue in breast cancer patients.

Methods

A PubMed search identified three uncontrolled studies reporting the effect of acupuncture in relieving fatigue. A separate search identified five randomized controlled trials (RCTs) with a wait-list control of breast cancer patients receiving standard care that reported data on fatigue. We use these published data to produce best, average, and worst-case effect size estimates and related sample size estimates for a trial of acupuncture in the relief of cancer-related fatigue relative to a wait-list control receiving standard care.

Results

Use of evidence-based effect size estimation to calculate sample size requirements for a study of acupuncture in relieving fatigue in breast cancer survivors relative to a wait-list control receiving standard care suggests that an adequately-powered phase III randomized controlled trial comprised of two arms would require at least 101 subjects (52 per arm) if a strong effect is assumed for acupuncture and 235 (118 per arm) if a moderate effect is assumed.

Conclusion

Evidence-based effect size estimation helps justify assumptions in light of empirical evidence and can lead to more realistic sample size calculations, an outcome that would be of great benefit for the field of complementary and alternative medicine.

Patients' reasons for electing to undergo total knee arthroplasty impact post-operative pain severity and range of motion

The present study examines the reasons cited by 103 patients for their electing to undergo total knee arthroplastic surgery and the relationship between these reasons and their post-operative pain and range of motion. Results suggest that individuals who describe different reasons for undergoing surgery vary in their post-operative recovery. Specifically, patients who cite pain as the reason they are undergoing surgery report greater levels of pain during the early post-operative period. In contrast, patients who describe goals of regaining mobility or a specific activity as their reason for undergoing surgery achieve a greater range of motion during early post-operative physical therapy. Individuals who express avoidance goals for undergoing total knee arthroplasty report more severe post-operative pain at 1 and 3 months following surgery compared to patients who express approach goals. Interventions targeted towards patients reporting pre-operative pain or avoidance goals may decrease subsequent post-operative pain and increase mobility.

Gene X environment interactions in reading disability and attention-deficit/hyperactivity disorder

This article examines Gene x Environment (G x E) interactions in two comorbid developmental disorders--reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD)--as a window on broader issues on G x E interactions in developmental psychology. The authors first briefly review types of G x E interactions, methods for detecting them, and challenges researchers confront in interpreting such interactions. They then review previous evidence for G x E interactions in RD and ADHD, the directions of which are opposite to each other: bioecological for RD and diathesis stress for ADHD. Given these results, the authors formulate and test predictions about G x E interactions that would be expected at the favorable end of each symptom dimension (e.g., above-average reading or attention). Consistent with their prediction, the authors found initial evidence for a resilience interaction for above-average reading: higher heritability in the presence of lower parental education. However, they did not find a G x E interaction at the favorable end of the ADHD symptom dimension. The authors conclude with implications for future research.

Why do we respond so differently? Reviewing determinants of human salivary cortisol responses to challenge

Stress and stress-related health impairments are major problems in human life and elucidating the biological pathways linking stress and disease is of substantial importance. However, the identification of mechanisms underlying a dysregulation of major components of the stress response system is, particularly in humans, a very challenging task. Salivary cortisol responses to diverse acute challenge paradigms show large intra- and interindividual variability. In order to uncover mechanisms mediating stress-related disorders and to potentially develop new therapeutic strategies, an extensive phenotyping of HPA axis stress responses is essential. Such a research agenda depends on substantial knowledge of moderating and intervening variables that affect cortisol responses to different stressors and stimuli. The aim of this report is, therefore, to provide a comprehensive summary of important determinants of, in particular, human salivary cortisol responses to different kinds of laboratory stimuli including acute psychosocial stress as well as pharmacological provocation procedures. This overview demonstrates the role of age and gender, endogenous and exogenous sex steroid levels, pregnancy, lactation and breast-feeding, smoking, coffee and alcohol consumption as well as dietary energy supply in salivary cortisol responses to acute stress. Furthermore, it briefly summarizes current knowledge of the role of genetic factors and methodological issues in terms of habituation to repeated psychosocial stress exposures and time of testing as well as psychological factors, that have been shown to be associated with salivary cortisol responses like early life experiences, social factors, psychological interventions, personality as well as acute subjective-psychological stress responses and finally states of chronic stress and psychopathology.

Perceptual Load Improves the Expression but not Learning of Relevant Sequence Information

In two experiments, we investigated the hypothesis of Rowland and Shanks (2006a) that sequence learning of relevant information is resistant to variations in perceptual load. Under conditions of increased selection difficulty, participants incidentally learned a sequence of targets presented together with three distractors. Target and distractors were composed of pairs of letters and shared more or less features with each other, rendering perceptual identification of the target either more (high load) or less (low load) attention demanding. The expression of sequence learning improved significantly under high load conditions as compared to low load conditions. This could indicate that the cognitive system promotes the development of response-based sequence learning in order to cope with the attentional demands arising from high perceptual load. However, the learning process proved to be unaffected by perceptual load when tested under baseline conditions without distractors (Experiment 1) or under opposite load conditions as during training (Experiment 2). This demonstrates that sequence learning is not influenced by increasing selection demands and suggests that sequence learning runs independently of input attention.

Internalization of messages from society and perfectionism as predictors of male body image

The purpose of this study was to examine predictors of male body image dissatisfaction, specifically ethnicity, societal factors and a personality variable. A total of 202 college males (37.3% Asian, 27.7% Caucasian, 14.5% Hispanic, and 13.6% African American) completed measures of perfectionism, internalization of societal messages, and a multidimensional measure of male body attitude. The results indicated that an Asian ethnic identity, socially prescribed perfectionism, and internalizing societal messages were predictors of muscle dissatisfaction. Socially prescribed perfectionism and internalization were the only predictors of low body fat dissatisfaction. Ethnicity, perfectionism and internalization were not predictive of height dissatisfaction. Unique aspects of perfectionism appear to predict specific body image dissatisfaction in men.

Adjustment to inflammatory bowel disease: the relative influence of illness perceptions and coping

BACKGROUND

The Common Sense Model (CSM) of illness representations was used in the current study to examine the relative contribution of illness perceptions and coping strategies in explaining adjustment to inflammatory bowel disease (IBD).

METHODS

Participants were 80 adults consecutively attending an outpatients' clinic with a diagnosis of either Crohn's disease or ulcerative colitis. Respondents completed and returned a questionnaire booklet that assessed illness perceptions, coping, and adjustment. Adjustment was measured from the perspectives of psychological distress, quality of life, and functional independence.

RESULTS

Illness perceptions (particularly perception of consequences of IBD) were uniformly the most consistent variables explaining adjustment to IBD. Coping did not significantly add to predicting adjustment once illness perceptions were controlled for and therefore did not mediate the relationship between illness perceptions and adjustment, as proposed in the CSM.

CONCLUSIONS

The results suggest the importance of addressing illness perceptions in developing appropriate psychological interventions for IBD.

No evidence for a cue mismatch in negative priming

An experiment is reported in which the cue mismatch hypothesis of negative priming, an important novel variant of the mismatching hypothesis, was tested. A cue mismatch and a no mismatch condition were contrasted in a visual discrimination task. In the prime display of cue mismatch ignored-repetition trials, the colour of the prime distractor was different from the colour of the cue indicating the selection feature (coloured square). In probe displays, cue and repeated stimulus had the same colour. In the no mismatch condition, the visual cue was neutral in terms of colour (always black), so that there was always no cue mismatch between prime and probe displays. Contrary to the prediction of the cue mismatch hypothesis, the negative priming effect was not larger in the cue mismatch than in the no mismatch condition. The cue mismatch hypothesis must therefore be rejected. In contrast, the episodic retrieval account is consistent with the results.

Decision making preferences in the medical encounter--a factorial survey design

BACKGROUND

Up to now it has not been systematically investigated in which kind of clinical situations a consultation style based on shared decision making (SDM) is preferred by patients and physicians. We suggest the factorial survey design to address this problem.This method, which so far has hardly been used in health service research, allows to vary relevant factors describing clinical situations as variables systematically in an experimental random design and to investigate their importance in large samples.

METHODS/DESIGN

To identify situational factors for the survey we first performed a literature search which was followed by a qualitative interview study with patients, physicians and health care experts. As a result, 7 factors (e.g. "Reason for consultation" and "Number of therapeutic options") with 2 to 3 levels (e.g. "One therapeutic option" and "More than one therapeutic option") will be included in the study. For the survey the factor levels will be randomly combined to short stories describing different treatment situations.A randomized sample of all possible short stories will be given to at least 300 subjects (100 GPs, 100 patients and 100 members of self-help groups) who will be asked to rate how the decision should be made. Main outcome measure is the preference for participation in the decision making process in the given clinical situation.Data analysis will estimate the effects of the factors on the rating and also examine differences between groups.

DISCUSSION

The results will reveal the effects of situational variations on participation preferences. Thus, our findings will contribute to the understanding of normative values in the medical decision making process and will improve future implementation of SDM and decision aids.

Pain intensity during the first 7 days following the application of light and heavy continuous forces

The purpose of the present study was to determine whether a force of 20 cN can be biologically active for tooth movement and to examine the pain intensity during the application of light (20 cN) or heavy (200 cN) continuous forces for 7 days. In the first experiment, a force of 20 cN was applied to eight canines in five volunteers. The mean tooth movement during 10 weeks was 2.4 mm. In the second experiment, two forces of 20 or 200 cN were applied to maxillary premolars in 12 male subjects (aged 24-31 years) to measure pain intensity for 7 days. Spontaneous and biting pain were recorded every 2-4 hours on a 100 mm visual analogue scale (VAS). Wilcoxon signed-rank test was used for statistical analysis. Comparing the VAS score at force initiation with the other time points, there was no significant difference in spontaneous pain for either group, or in biting pain for the light-force group. However, biting pain in the heavy-force group during the time period from 6 to 156 hours was significantly (P < 0.05) greater than that at force initiation. Comparing the VAS scores between the light- and heavy-force group, VAS scores for biting pain in the heavy-force group during the time period from 8 to 100 hours was significantly (P < 0.05) greater than that in the light-force group. A force of 20 cN can move teeth, but pain intensity while biting may be greater approximately 8 hours to 5 days following the application of heavy continuous force compared with light force.

Constitutive immune function responds more slowly to handling stress than corticosterone in a shorebird

Ecological immunologists are interested in how immune function changes during different seasons and under different environmental conditions. However, an obstacle to answering such questions is discerning the effects of biological factors of interest and investigation artifacts such as handling stress. Here we examined handling stress and its effects on constitutive (noninduced) immune function via two protocols on captive red knots (Calidris canutus). We investigated how constitutive immunity responds to handling stress, how quickly these changes take place, and the practical implications for researchers interested in sampling baseline immune levels. We found that Staphylococcus aureus and Candida albicans killing increased with handling stress while total leukocyte and lymphocyte concentrations decreased. However, although corticosterone increased significantly and rapidly in response to handling stress, none of the 10 measures of constitutive immunity that we tested differed significantly from baseline within 20 or 30 min of capture. Thus, researchers interested in baseline immune function should sample animals as soon as possible after capture, but studies in species not easily sampled in less than 3 min (such as red knots) could still yield useful results.

Kv1.1 channel subunits are not necessary for high temporal acuity in behavioral and electrophysiological gap detection

The Kv1.1 potassium channel subunit, encoded by the Kcna1 gene, is heavily expressed in the auditory brainstem and is thought to have a critical role in producing the high temporal precision of action potentials characteristic of the auditory system. Our intent was to determine whether temporal acuity was reduced in Kcna1 null-mutant (-/-) mice, compared to wild-type (+/+) and heterozygotic mice (+/-), as measured by the encoding of gaps in the inferior colliculus by near-field auditory evoked potentials (NFAEP) or behavioral gap detection (BGD) using a prepulse inhibition paradigm. NFAEPs were collected at 40, 60 and 80 dB SPL with gap durations from 0.5 to 64 ms. BGD data were collected using silent gaps in 70 dB noise from 1 to 15 ms in duration. There were no systematic effects of Kcna1 genotype on NFAEP recovery functions, NFAEP latencies, or the time constant for BGD, but there was a small reduction in asymptotic prepulse inhibition for the longest gap stimuli in -/- mice. Gap thresholds were approximately 1-2 ms across genotypes, stimulus conditions, and paradigms. These data suggest that the neural pathways encoding behaviorally relevant, rapid auditory temporal fluctuations are not limited by the absence of Kv1.1 expression.

Bone graft harvest using a new intramedullary system

Obtaining autogenous bone graft from the iliac crest can entail substantial morbidity. Alternatively, bone graft can be harvested from long bones using an intramedullary (IM) harvesting system. We measured bone graft volume obtained from the IM canals of the femur and tibia and documented the complications of the harvesting technique. Donor site pain and the union rate were compared between the IM and the traditional iliac crest bone graft (ICBG) harvest. Forty-one patients (23 male, 18 female) with an average age of 44.9 years (range, 15-78 years) had graft harvested from long bones using an IM harvest system (femoral donor site, 37 patients; tibial donor site, four patients). Forty patients (23 male, 17 female; average age, 46.4 years; range, 15-77 years) underwent anterior ICBG harvest. We administered patient surveys to both groups to determine pain intensity and frequency. IM group reported lower pain scores than the ICBG group during all postoperative periods. Mean graft volume for the IM harvest group was 40.3 mL (range, 25-75 mL) (graft volume was not obtained for the ICBG group). Using an intramedullary system to harvest autogenous bone graft from the long bones is safe provided a meticulous technique is used.

LEVEL OF EVIDENCE

Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.

Desire for control, sense of control and obsessive-compulsive checking: an extension to clinical samples

Research in non-clinical samples has suggested that control beliefs, specifically desire for control and sense of control, may play a role in Obsessive--Compulsive Disorder. The present study extends a previous research design to clinical participants [Moulding, R., Kyrios, M., & Doron, G. (2007). Obsessive-compulsive behaviours in specific situations: The relative influence of appraisals of control, responsibility and threat. Behaviour Research and Therapy, 45, 1693-1702]. In this study, clinical participants with OCD-checking symptoms (n=16), anxiety disorders (n=17) and community controls (n=27) were presented with four hypothetical scenarios. Using a manipulation paradigm, the relationship between control appraisals and other OCD-relevant constructs (threat, responsibility) was examined. As in the non-clinical study, desire for control was moderately affected by responsibility and threat manipulations, while sense of control was not affected by these manipulations. Individuals with OCD recorded higher desire for control and lower sense of control relative to community controls, and a higher desire for control than the anxiety group, suggesting some specificity to OCD. A possible interactive model of control, threat and responsibility is discussed.

Tibio-femoral cartilage defects 3-5 years following arthroscopic partial medial meniscectomy

OBJECTIVE

Arthroscopic partial medial meniscectomy (APMM) is a common procedure to treat a medial meniscal tear. Individuals who undergo APMM have a heightened risk of developing tibio-femoral osteoarthritis (OA). Cartilage defects scored from magnetic resonance imaging (MRI) scans predict cartilage loss over time. It is not known whether cartilage defects in the early years following APMM are more common or of greater severity than in age-matched controls. This study compared the prevalence and severity of tibio-femoral cartilage defects in patients 3-5 years post-APMM with that of age-matched controls.

METHODS

Twenty-five individuals who had undergone APMM in the previous 46.9+/-5.0 months and 24 age-matched controls participated in this study. Sagittal plane knee MRI scans were acquired from the operated knees of patients and from randomly assigned knees of the controls and graded (0-4) for tibio-femoral cartilage defects. Defect prevalence (score of >or=2 for any compartment) and severity of the cartilage from both tibio-femoral compartments were compared between the groups.

RESULTS

The APMM group had greater prevalence (77 vs 42%, P=0.012) and severity (4.1+/-1.9 vs 2.8+/-1.1, P=0.005) of tibio-femoral cartilage defects than controls. Age was positively associated with tibio-femoral cartilage defect severity for APMM, r=0.523, P=0.007, but not for controls, r=0.045, P=0.834.

CONCLUSION

Tibio-femoral joint cartilage defects are more prevalent and of greater severity in individuals who had undergone APMM approximately 44 months earlier than in age-matched controls.

The influence of the cultural climate of the training environment on physicians' self-perception of competence and preparedness for practice

BACKGROUND

In current supervisory practice, the learning environment in which the training of specialist registrars (SpRs) takes place is important. Examples of such learning environments are the hospital settings and/or geographical locations where training occurs. Our objective was to investigate whether the cultural climate of different learning environments influences physicians' perceived level of competence and preparedness for practice.

METHODS

An electronic questionnaire was sent to an equal group of paediatricians who had trained in clinical settings located in Europe and the Caribbean. 30 items (Likert scale 1-4 = totally disagree-totally agree) were used to measure the level of preparedness of the respondents in 7 physician competencies.

RESULTS

42 participants were included for analysis. The distribution of participants in both groups was comparable. The overall perception of preparedness in the Caribbean group was 2.93 (SD = 0.47) and 2.86 (SD = 0.72) in the European group. The European group felt less prepared in the competency as manager 1.81 (SD = 1.06) compared to their Caribbean counterparts 2.72 (SD = 0.66). The difference was significant (p = 0.006).

CONCLUSION

The training in the different environments was perceived as adequate and comparable in effect. The learning environment's cultural climate appeared to influence the physician's perception of their competencies and preparedness for clinical practice.

Human brain white matter atlas: identification and assignment of common anatomical structures in superficial white matter

Structural delineation and assignment are the fundamental steps in understanding the anatomy of the human brain. The white matter has been structurally defined in the past only at its core regions (deep white matter). However, the most peripheral white matter areas, which are interleaved between the cortex and the deep white matter, have lacked clear anatomical definitions and parcellations. We used axonal fiber alignment information from diffusion tensor imaging (DTI) to delineate the peripheral white matter, and investigated its relationship with the cortex and the deep white matter. Using DTI data from 81 healthy subjects, we identified nine common, blade-like anatomical regions, which were further parcellated into 21 subregions based on the cortical anatomy. Four short association fiber tracts connecting adjacent gyri (U-fibers) were also identified reproducibly among the healthy population. We anticipate that this atlas will be useful resource for atlas-based white matter anatomical studies.

Gender and site of injection do not influence intensity of hypertonic saline-induced muscle pain in healthy volunteers

The aim of the study was to determine whether the same stimulus to different muscles results in comparable pain and whether gender has any influence on the pain. We compared the quality and intensity of muscle pain induced by a hypertonic saline injection into the tibialis anterior (leg) muscle to that after an injection into the lumbar erector spinae (back) muscle in both male (n=10) and female (n=10) volunteers. Hypertonic or isotonic saline was injected into the leg and back muscles and pain intensity (visual analogue scale, VAS) and pain quality (McGill Pain Questionnaire) were measured. Pressure pain tolerance around the site of injection and on the contralateral side was measured. Hypertonic saline injection induced significant muscle pain in the back and leg compared to isotonic saline (P<0.05, ANOVA). The site of injection did not influence the quality of pain but there was a gender bias in the descriptive words chosen (chi(2) test, P<0.05) and female subjects were more sensitive to pressure than male subjects. Experimentally induced muscle pain is equivalent in intensity and quality in the leg and back muscle. Gender does not influence muscle pain intensity but does influence sensitivity to pressure and the description of pain.