People with epilepsy and intellectual disability: More than a sum of two conditions

BACKGROUND

Around 25% of people with Intellectual Disability (PwID) have comorbid epilepsy with seizures in up to two-thirds being drug-resistant. Little is known of the general characteristics and prescribing practices to this population.

AIM

Describe and compare characteristics of two cohorts of PwID and epilepsy in two different countries to inform clinical practice better.

METHOD

An explorative, retrospective, case-note review in a specialist ID community service in England and in an expert center for PwID and epilepsy in the Netherlands was conducted. Information on ID severity, medical/behavioral/psychiatric/neurodevelopmental/genetic comorbidities, psychotropic, and antiepileptic drugs (AEDs) for each cohort was collected.

FINDINGS

The English cohort consisted of 167 people (98 males; age range 18-73 years; mild/moderate ID- 35%) and the Dutch cohort of 189 people (111 males; age range 18-85 years; mild/moderate ID - 51%). The two cohorts were comparable in their baseline characteristics. The Dutch had higher rates of physical comorbidity, but less mental or behavioral disorders and were more likely to be on anti-psychotic medication. The mean dosages between three most common AEDs prescribed were similar. The most frequently prescribed drug in both centers is valproate. Three-quarters of the Dutch were on three or more AEDs compared to a third in the English cohort.

CONCLUSIONS

Structured description of the characteristics, differences, and commonalities of PwID, treatment, and services of both countries is presented. This is the first real-world study to reveal unique characteristics of managing epilepsy for a complex ID population. In particular, it highlights the considerable comorbid psychiatric burden and psychotropic prescribing.

Under representation of people with epilepsy and intellectual disability in research

Purpose

One quarter of people with epilepsy have an intellectual disability (ID) and one fifth of people with an ID have epilepsy. Both conditions are associated with higher levels of morbidity, stigma and premature mortality. There have been calls for action to promote more research in this group. We examined if this group are represented adequately in current research.

Methods

The proportion of research output in epilepsy conferences and publications relevant to ID and the proportion in ID conferences and publications on epilepsy for 2015–2016 were identified. As the percentage of children in the population with epilepsy is 17%, research output of this group was compared with the ID group. Recognised material was classified based on whether it applied to general epilepsy/ID research, children with epilepsy or people with epilepsy and ID. Data was analysed to determine the proportion of presented research specifically identifying people with epilepsy and ID.

Results

Fewer than 2% of presentations at epilepsy conferences specifically related to the ID and epilepsy group compared to 15% relating to children with epilepsy. Similarly only 1.4% of the research presented at major ID conferences related to those with people with epilepsy and ID. About 5% of published research in the field of epilepsy related to those with ID as compared with 24% for children with epilepsy. Twelve percent of published research in ID specifically identified epilepsy.

Conclusion

Publications and conference presentations, on the population with epilepsy and comorbid ID is under-represented. Increased research in this area might assist in improving the quality of care for this relatively neglected group.

Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation

INTRODUCTION

Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements.

METHODS

A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system.

RESULTS

The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues. We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows.

DISCUSSION

Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Ambient temperature influences birds' decisions to eat toxic prey

Aposematic prey warn predators of their toxicity using conspicuous signals. However, predators regularly include aposematic prey in their diets, particularly when they are in a poor energetic state and in need of nutrients. We investigated whether or not an environmental factor, ambient temperature, could change the energetic state of predators and lead to an increased intake of prey that they know to contain toxins. We found that European starlings, Sturnus vulgaris, increased their consumption of mealworm, Tenebrio molitor, prey containing quinine (a mild toxin) when the ambient temperature was reduced below their thermoneutral zone from 20 °C to 6 °C. The birds differed in their sensitivity to changes in ambient temperature, with heavier birds increasing the number of toxic prey they ate more rapidly with decreasing temperature compared to birds with lower body mass. This could have been the result of their requiring more nutrients at lower temperatures or being better able to detoxify quinine. Taken together, our results suggest that conspicuous coloration may be more costly at lower temperatures, and that aposematic prey may need to invest more in chemical defences as temperatures decline. Our study also provides novel insights into what factors affect birds' decisions to eat toxic prey, and demonstrates that selection pressures acting on prey defences can vary with changing temperature across days, seasons, climes, and potentially in response to climate change.

•

We investigated the effect of temperature on birds' decisions to eat toxic prey.

•

As it got cooler, birds were more likely to eat prey containing toxins.

•

Heavier birds were more sensitive to changes in temperature.

•

Selection pressures on prey defences will change over days, seasons and climes.

Hepatic activation of irinotecan predicts tumour response in patients with colorectal liver metastases treated with DEBIRI: exploratory findings from a phase II study

PURPOSE

The response of colorectal liver metastases to the cytotoxic agent irinotecan varies widely. Attempts to correlate tumour metabolism with response have been mixed. This study investigated the hepatic metabolism of irinotecan as a potential predictor of tumour response to irinotecan-eluting beads (DEBIRI).

METHODS

Ten patients with colorectal liver metastases were treated with 200 mg irinotecan (as DEBIRI) as part of the PARAGON II study. Hepatic expression of key metabolising enzymes was measured using mass spectrometry-based proteomics. Serum drug concentrations and hepatic irinotecan metabolism were characterised and correlated with tumour response.

RESULTS

Serum concentrations of irinotecan metabolites did not correlate with hepatic metabolism or pathological response. There was a strong correlation between hepatic CES-2 expression and activation of irinotecan (r (2) = 0.96, p < 0.001). Patients with a UGT1A1*28 6/7 SNP showed no difference in drug metabolism or pathological response. Hepatic CES-2 mediated activation of irinotecan clearly correlated with tumour replacement by fibrosis (r (2) = 0.54, p = 0.01).

CONCLUSION

This study provides the first evidence that hepatic activation of irinotecan predicts tumour response. Delivery of liver-targeted irinotecan to normal liver tissue rather than tumour may be a more rational approach to maximise response.

Human pluripotent stem cells for modeling toxicity

The development of xenobiotics, driven by the demand for therapeutic, domestic and industrial uses continues to grow. However, along with this increasing demand is the risk of xenobiotic-induced toxicity. Currently, safety screening of xenobiotics uses a plethora of animal and in vitro model systems which have over the decades proven useful during compound development and for application in mechanistic studies of xenobiotic-induced toxicity. However, these assessments have proven to be animal-intensive and costly. More importantly, the prevalence of xenobiotic-induced toxicity is still significantly high, causing patient morbidity and mortality, and a costly impediment during drug development. This suggests that the current models for drug safety screening are not reliable in toxicity prediction, and the results not easily translatable to the clinic due to insensitive assays that do not recapitulate fully the complex phenotype of a functional cell type in vivo. Recent advances in the field of stem cell research have potentially allowed for a readily available source of metabolically competent cells for toxicity studies, derived using human pluripotent stem cells harnessed from embryos or reprogrammed from mature somatic cells. Pluripotent stem cell-derived cell types also allow for potential disease modeling in vitro for the purposes of drug toxicology and safety pharmacology, making this model possibly more predictive of drug toxicity compared with existing models. This article will review the advances and challenges of using human pluripotent stem cells for modeling metabolism and toxicity, and offer some perspectives as to where its future may lie.

Microsatellite markers for leatherside chubs Lepidomeda aliciae and Lepidomeda copei

We report the isolation and characterization of eight microsatellite markers in a rare desert cyprinid fish, the leatherside chub. This taxon has recently been divided into two species (Lepidomeda aliciae and Lepidomeda copei) based on genetic, ecological and morphological data, and we explore the utility of these microsatellite loci in both species. All eight loci show promise as highly polymorphic markers in L. aliciae, but only three of the markers appear to be useful in L. copei.

The survival of three strains of Arcobacter butzleri in the presence of lemon, orange and bergamot essential oils and their components in vitro and on food

AIMS

To test the effect of oils and vapours of lemon, sweet orange and bergamot and their components against three Arcobacter butzleri strains.

METHODS AND RESULTS

The disc diffusion method was used to screen the oils and vapours against three strains of A. butzleri. In vitro bergamot was the most inhibitory essential oil (EO) and both citral and linalool were effective. On cabbage leaf, the water isolate was the least susceptible to bergamot EO, citral and linalool (1-2 log reduction), with the chicken isolate being the most susceptible (6-8 log reduction). However, the latter appeared not to be susceptible to vapours over 24 h although type strain and water isolate populations reduced by 8 logs. On chicken skin, the effectiveness of the oils was reduced compared with that on cabbage leaf.

CONCLUSIONS

Bergamot was the most effective of the oils tested and linalool the most effective component. All strains tested were less susceptible in food systems than in vitro.

SIGNIFICANCE AND IMPACT OF THE STUDY

Arcobacter isolates vary in their response to EO suggesting that the results of type strain studies should be interpreted with caution. Bergamot EO has the potential for the inhibition of this 'emerging' pathogen.

A robotic testing facility for the measurement of the mechanics of spinal joints

A robotic testing facility for the measurement of joint mechanics was used to determine the significance of tears in the intervertebral disc on the mechanics of the spinal joint. Ten lumbar joints of sheep were dynamically loaded and manipulated. Comparisons were made between the behaviour of the intervertebral disc in flexion and extension at two test speeds. The influence of the posterior elements and of rim lesions was assessed by testing the joint immediately before and after removal of the posterior elements and after the creation of a 4 mm x 10 mm rim lesion in the disc. Stiffness of the spinal joint dropped significantly upon removal of the posterior elements, from 0.81 to 0.23 N m/deg for flexion and from 0.65 to 0.40 N m/deg for extension. Maximum moments dropped 37 per cent for flexion and 63 per cent for extension. The rim lesion caused a further significant stiffness reduction to 0.21 and 0.31 N m/deg respectively. Maximum moments reduced a further 12 per cent and 16 per cent respectively. A higher test speed (2 deg/s instead of 0.5 deg/s) usually did not change these results significantly. The novel six-degrees-of-freedom robotic testing facility used in this study was demonstrated to be an effective system for studying the mechanics of complex biological joints.

Pyrazine odour makes visually conspicuous prey aversive

Unpalatable insects frequently adopt multimodal signals to ward off predators, incorporating sounds and odours into their colourful displays. Pyrazine is an odour commonly used in insect warning displays, and has previously been shown to elicit unlearned biases against common warning colours, e.g. yellow and red in naive predators. We designed two experiments to test for similar effects of pyrazine on the conspicuousness of prey, perhaps the most ubiquitous aspect of aposematic coloration. In the first experiment, we offered predators (Gallus gallus domesticus) a choice between conspicuous crumbs and cryptic crumbs in the presence or absence of pyrazine. In the second experiment, we manipulated the birds' experience of conspicuous prey during an initial training phase. Only in the presence of pyrazine did birds show a bias against conspicuously coloured food, and this occurred whether or not they had previously experienced food that contrasted with the background. This emergent behaviour relied upon the visual and odorous signal components being presented together. These unlearned, yet hidden, responses against conspicuousness demonstrate that there are initial benefits to prey being conspicuous when the multimodal nature of warning signals is accounted for.

Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami

OBJECTIVE

To determine whether regional cerebral blood flow (rCBF) is abnormal in any cerebral structure of women with fibromyalgia (FM), following a report that rCBF is reduced in the thalami and heads of caudate nuclei in FM.

METHODS

Seventeen women with FM and 22 healthy women had a resting single-photon-emission computed tomography (SPECT) brain scan to assess rCBF and a T1-weighted magnetic resonance imaging (MRI) scan to enable precise anatomic localization. Additionally, all participants underwent 2 manual tender point examinations and completed a set of questionnaires evaluating clinical features. SPECT scans were analyzed for differences in rCBF between groups using statistical parametric mapping (SPM) and regions of interest (ROIs) manually drawn on coregistered MRI.

RESULTS

Compared with control subjects, the rCBF in FM patients was significantly reduced in the right thalamus (P = 0.006), but not in the left thalamus or head of either caudate nucleus. SPM analysis indicated a statistically significant reduction in rCBF in the inferior pontine tegmentum (corrected P = 0.006 at the cluster level and corrected P = 0.023 for voxel of maximal significance), with consistent findings from ROI analysis (P = 0.003). SPM also detected a reduction in rCBF on the perimeter of the right lentiform nucleus. No correlations were found with clinical features or indices of pain threshold.

CONCLUSION

Our finding of a reduction in thalamic rCBF is consistent with findings of functional brain imaging studies of other chronic clinical pain syndromes, while our finding of reduced pontine tegmental rCBF is new. The pathophysiologic significance of these changes in FM remains to be elucidated.

Specificity of preformed alloantibodies causing B cell positive flow crossmatch in renal transplantation

The specificity of alloantibodies (alloAb) and their clinical significance in association with T-/B+ flow cytometry crossmatch (FCXM) in kidney transplantation are not clearly defined. This study was undertaken to examine the HLA specificity and clinical relevance of Ab causing B+ FCXM in pre-transplant (final XM) recipients' serum samples. Final FCXM serum samples were analyzed from 457 renal transplant patients followed for 10 months post-transplantation. Two hundred and sixty patients had T-/B+ final FCXM. The control group included 197 recipients with T-/B- FCXM at time of transplantation. Class I/class II PRA and specificity of anti-HLA class I and class II Ab in final FCXM serum samples were analyzed by FlowPRA Class I Screening Test and FlowPRA Class II Screening Test. We found no correlation between graft outcome and pre-transplant T-/B- and T-/B+ FCXM status. Additionally, we observed no clinical relevance of B+ FCXM in retransplant patients. However, MCS > or =200 in B+ FCXM retransplant recipients was associated with anti-class II Ab to previous mismatches in regrafted patients (n = 46). This finding was confirmed by specificity analysis of anti-DR/DQ Ab in patients with high ( > or =15%) class II PRA. In 63% (12 of 19) of retransplants having T-/B+ FCXM, we defined the specificity of alloAb to first graft mismatched class II antigens. In contrast, anti-class II Ab was detected in only 5.7% (2 of 35) of single-graft recipients with different PRA values. Significantly greater MCS (240 +/- 61 vs. 163 +/- 48; p = 0.022) was observed in retransplant patients having short ( < or =5 m) previous graft survival time (PGST) than in those with long PGST ( > or =5 m). Only 2% of retransplant recipients with B + FCXM had non-HLA Ab. In contrast, the overwhelming majority of primary recipients had no detectable alloAbs. No significant difference in class I PRA was found between B- and B+ FCXM recipients. However, class II PRA was significantly higher in patients having B + FCXM (p = 0.028). Collectively, these data show that MCS intensity is not always a reliable criterion for anti-HLA Ab detection because of the presence of non-HLA Ab. These results can be explained by low titers of anti-class II Ab, at which concentration these Ab cannot produce a deleterious effect. FlowPRA and Flow screen beads appeared to be reliable and sensitive methods for detection and specificity analysis of anti-class II alloAb.

Toward a developmental family therapy: the clinical utility of research on adolescence

Tremendous advances have been made in our understanding of the intrapersonal, interpersonal, familial, and contextual characteristics and processes that contribute to adaptive as well as maladaptive developmental outcomes with high-risk and clinically referred adolescents. This empirical knowledge base offers clinically rich opportunities for systematic treatment development. An important step in this process is distinguishing which research findings in basic science areas such as developmental psychology and developmental psychopathology might have clinical relevance. Toward this goal, we review relevant but selective research in areas that are central to clinical work with adolescents (parent-adolescent relationship, biological aspects, and affect and cognition), and we offer examples of how basic research in these areas can inform treatment.

Validation of fully automatic brain SPET to MR co-registration

Fully automatic co-registration of functional to anatomical brain images using information intrinsic to the scans has been validated in a clinical setting for positron emission tomography (PET), but not for single-photon emission tomography (SPET). In this paper we evaluate technetium-99m hexamethylpropylene amine oxime to magnetic resonance (MR) co-registration for five fully automatic methods. We attached six small fiducial markers, visible in both SPET and MR, to the skin of 13 subjects. No increase in the radius of SPET acquisition was necessary. Distortion of the fiducial marker distribution observed in the SPET and MR studies was characterised by a measure independent of registration and three subjects were excluded on the basis of excessive distortion. The location of each fiducial marker was determined in each modality to sub-pixel precision and the inter-modality distance was averaged over all markers to give a fiducial registration error (FRE). The component of FRE excluding the variability inherent in the validation method was estimated by computing the error transformation between the arrays of MR marker locations and registered SPET marker locations. When applied to the fiducial marker locations this yielded the surface registration error (SRE), and when applied to a representative set of locations within the brain it yielded the intrinsic registration error (IRE). For the best method, mean IRE was 1.2 mm, SRE 1.5 mm and FRE 2.4 mm (with corresponding maxima of 3.3, 4.3 and 5.0 mm). All methods yielded a mean IRE <3 mm. The accuracy of the most accurate fully automatic SPET to MR co-registration was comparable with that published for PET to MR. With high standards of calibration and instrumentation, intra-subject cerebral SPET to MR registration accuracy of <2 mm is attainable.

Safety-net health plans: a status report

This paper reports on a national survey of Medicaid managed care plans sponsored by safety-net provider organizations that have a mission of service to low-income populations. We identified ninety-nine safety-net plans and obtained data from eighty of them regarding their sponsorship, age and size, relationships to sponsors, managed care practices, and measures of success. Most plans engage in active managed care and have achieved at least some of their goals. However, 60 percent of plans lost money in 1997, and economic trends have been unfavorable.

Receiver psychology and the evolution of multicomponent signals

Many animals produce and respond to signals made up of multiple components. For example, many avian sexual displays are highly extravagant combinations of visual and acoustic elements, and are described as being 'multicomponent'. One possible reason for the evolution of such complex signals is that they provide more reliable information for receivers. However, receivers also influence signal evolution in another important way, by how they perceive and process signals: signallers will be selected to produce signals that are more easily received. The potential role of receiver psychology in the evolution of multicomponent signals has not previously been considered; in this review I present psychological results that support the notion that two components are better received than one alone. Detection can be improved by producing two components together, thus reducing the reaction time, increasing the probability of detection and lowering the intensity at which detection occurs. Discriminability of multicomponent stimuli is also made easier through better recognition, faster discrimination learning and multidimensional generalization. In addition, multicomponent stimuli also improve associative learning. I show that multicomponency does indeed improve signal reception in receivers, although the benefits of producing components in two sensory modalities (bimodal multicomponent signals) may be larger and more robust than producing them in just one (unimodal multicomponent signals). This highlights the need for consideration of receiver psychology in the evolution of multicomponent signals, and suggests that where signal components do not appear to be informative, they may instead be performing an important psychological function. Copyright 1999 The Association for the Study of Animal Behaviour.

Mental health services in the county jail: a critical partnership?

This study was designed to provide a description of individuals incarcerated in a county jail and referred for mental health services. A standardized intake form was completed for 598 inmates who had contact with the mental health counselor. Analysis of the mental health status of inmates suggests that the presence of a counselor in the jail may serve an important function. Specifically, inmates referred to the counselor were not in acute distress. This suggests they may be better served by an on-site counselor rather than through the traditional method of being transported to the hospital emergency room or community mental health center for evaluation.

Novelty effects in a multimodal warning signal

The warning signals of toxic insects are often 'multimodal', combining bright coloration with sounds or odours (or both). Pyrazine (a common insect warning odour) can elicit an intrinsic avoidance in domestic chicks Gallus gallus domesticus, both against novel coloured food, and also against food colours that are specifically associated with aposematism, namely yellow and red. In three experiments, we investigated the role of novelty in this innate bias against yellow coloured food in the presence of pyrazine. Naive chicks were familiarized either to pyrazine odour or to coloured food before being tested for a bias against yellow (warningly coloured) food as opposed to green (nonwarningly coloured) food. In experiment 1, pyrazine novelty was shown to be vital for eliciting a bias against yellow food. However, experiment 2 suggested that colour novelty was not important: chicks familiarized with coloured crumbs still avoided yellow crumbs when pyrazine was presented. In a third experiment that gave chicks an even greater degree of pre-exposure to coloured crumbs, the bias against yellow food eventually waned, although pyrazine continued to elicit an aversion to yellow even after birds had had experience of up to 24 palatable yellow crumbs. Pyrazine novelty has been an important pressure in the evolution of multimodal warning signals, and can continue to promote the avoidance of warningly coloured food, even when it is relatively familiar. The implications for warning signals are discussed. Copyright 1999 The Association for the Study of Animal Behaviour.

Errors by paediatric residents in calculating drug doses

BACKGROUND

Errors in calculating drug doses in infants and small children can cause morbidity and mortality, especially with agents exhibiting a narrow therapeutic window. A previous study from this institution has detected potential life threatening errors in calculations performed by trainees while writing prescriptions.

OBJECTIVES

To verify whether the true incidence of trainees' errors in prescribing can be explained by impaired calculation skills in written tests.

SETTING

A tertiary paediatric hospital; educational rounds for core paediatric residents.

METHODS

Two anonymous written tests, which included calculations of doses similar to those performed at the paediatric bedside; one was conducted in 1993 and one in 1995.

RESULTS

Thirty four paediatric residents participated in 1993 and 30 in 1995. A substantial number of trainees in both years committed at least one error. In general, there was no correlation between the length of training (0 to 4 years) and likelihood of making a mistake. Three trainees in 1993 and four in 1995 committed 10-fold errors. These seven residents committed significantly more errors than the rest of the group in each of the tests separately. All seven were in their first two years of training, and six were in their first year of residency.

CONCLUSIONS

A substantial proportion of paediatric trainees make mistakes while calculating drug doses under optimal test conditions. Some trainees commit 10-fold errors, which may be life threatening. The results of these anonymous tests suggest that testing of calculations skills should be mandatory, and appropriate remedial steps should follow to prevent paediatric patients receiving wrong drug dosages.

HIV-positive women living in the metropolitan Toronto area: their experiences and perceptions related to HIV testing. The HIV Women's Study Group

Forty HIV-positive women from diverse socioeconomic backgrounds were interviewed. Most (90%) did not perceive themselves to be at risk of HIV infection prior to knowing their HIV-positive status. The majority (61%) were tested because they developed symptoms, or because someone with whom they were intimate, or their child, tested positive for HIV or became ill. The majority (93%) of the women interviewed indicated that they did not receive both pre- and post-test counselling. The findings from this study suggest that encouraging individuals to be tested if they have engaged in "at risk" activities will not be appropriate for individuals who have no perception of risk, and other strategies to encourage appropriate testing may be needed. This research also suggests that continued emphasis needs to be placed on the counselling process, and that consideration may need to be given to multiple counselling sessions to ensure individuals clearly understand the information provided.

HIV-positive women living in the metropolitan Toronto area: their experiences and perceptions related to HIV testing. The HIV Women's Study Group

Forty HIV-positive women from diverse socioeconomic backgrounds were interviewed. Most (90%) did not perceive themselves to be at risk of HIV infection prior to knowing their HIV-positive status. The majority (61%) were tested because they developed symptoms, or because someone with whom they were intimate, or their child, tested positive for HIV or became ill. The majority (93%) of the women interviewed indicated that they did not receive both pre- and post-test counselling. The findings from this study suggest that encouraging individuals to be tested if they have engaged in "at risk" activities will not be appropriate for individuals who have no perception of risk, and other strategies to encourage appropriate testing may be needed. This research also suggests that continued emphasis needs to be placed on the counselling process, and that consideration may need to be given to multiple counselling sessions to ensure individuals clearly understand the information provided.

Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation

The purpose of this study was to investigate the relationship between performance on the shuttle walking test and maximal oxygen uptake (VO2max) during a conventional treadmill test in patients with chronic airflow limitation. Two different techniques were used to measure oxygen consumption, i.e. conventional Douglas bag techniques (treadmill test) and a portable oxygen consumption meter (shuttle test). Initially, 19 patients performed a shuttle walking test (after one practice walk) and a maximal treadmill walking test, in a randomized, balanced design. Subsequently, 10 patients, (after one practice) completed an unencumbered shuttle walking test and one supporting the portable oxygen consumption meter, in random order. The results of the first experiment revealed a strong relationship between performance during the shuttle walking test and VO2max during the treadmill walking test (r = 0.88). The results of the second experiment consistently demonstrated an incremental increase in oxygen consumption and ventilation in response to the increasing intensity of the shuttle walking test. Again, a strong relationship between VO2max and performance on the shuttle test was demonstrated (r = 0.81). We concluded that the shuttle walking test is a valid field exercise test of functional capacity. Performance on the test relates strongly to VO2max, the traditional indicator of cardiorespiratory capacity.

Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation

The purpose of this study was to investigate the relationship between performance on the shuttle walking test and maximal oxygen uptake (VO2max) during a conventional treadmill test in patients with chronic airflow limitation. Two different techniques were used to measure oxygen consumption, i.e. conventional Douglas bag techniques (treadmill test) and a portable oxygen consumption meter (shuttle test). Initially, 19 patients performed a shuttle walking test (after one practice walk) and a maximal treadmill walking test, in a randomized, balanced design. Subsequently, 10 patients, (after one practice) completed an unencumbered shuttle walking test and one supporting the portable oxygen consumption meter, in random order. The results of the first experiment revealed a strong relationship between performance during the shuttle walking test and VO2max during the treadmill walking test (r = 0.88). The results of the second experiment consistently demonstrated an incremental increase in oxygen consumption and ventilation in response to the increasing intensity of the shuttle walking test. Again, a strong relationship between VO2max and performance on the shuttle test was demonstrated (r = 0.81). We concluded that the shuttle walking test is a valid field exercise test of functional capacity. Performance on the test relates strongly to VO2max, the traditional indicator of cardiorespiratory capacity.

Geropsychiatric emergency services: utilization and outcome predictors

Chart data on emergency room visits by elderly patients and a younger control group were examined in an exploratory study of utilization of psychiatric emergency services by the elderly and factors predictive of their subsequent admission to a psychiatric inpatient unit. Elderly patients had lower utilization of psychiatric services than their younger counterparts, but they were significantly more likely to be hospitalized following an emergency room visit. Dementia, the single most frequent diagnosis of the elderly patients, increased the likelihood of hospitalization only if it existed in combination with another psychiatric diagnosis. Medical comorbidity appeared to have no effect on whether the elderly patient was subsequently hospitalized.