The Predictive Potential of Nutritional and Metabolic Burden: Development of a Novel Validated Metric Predicting Increased Postoperative Complications in Adult Spinal Deformity Surgery

STUDY DESIGN

A retrospective cohort review.

OBJECTIVE

To develop a scoring system for predicting increased risk of postoperative complications in adult spinal deformity (ASD) surgery based on baseline nutritional and metabolic factors.

BACKGROUND

Endocrine and metabolic conditions have been shown to adversely influence patient outcomes and may increase the likelihood of postoperative complications. The impact of these conditions has not been effectively evaluated in patients undergoing ASD surgery.

MATERIALS AND METHODS

ASD patients 18 years or above with baseline and two-year data were included. An internally cross-validated weighted equation using preoperative laboratory and comorbidity data correlating to increased perioperative complications was developed via Poisson regression. Body mass index (BMI) categorization (normal, over/underweight, and obese) and diabetes classification (normal, prediabetic, and diabetic) were used per the Centers for Disease Control and Prevention and the American Diabetes Associates parameters. A novel ASD-specific nutritional and metabolic burden score (ASD-NMBS) was calculated via Beta-Sullivan adjustment, and Conditional Inference Tree determined the score threshold for experiencing ≥1 complication. Cohorts were stratified into low-risk and high-risk groups for comparison. Logistic regression assessed correlations between increasing burden score and complications.

RESULTS

Two hundred one ASD patients were included (mean age: 58.60±15.4, sex: 48% female, BMI: 29.95±14.31, Charlson Comorbidity Index: 3.75±2.40). Significant factors were determined to be age (+1/yr), hypertension (+18), peripheral vascular disease (+37), smoking status (+21), anemia (+1), VitD hydroxyl (+1/ng/mL), BMI (+13/cat), and diabetes (+4/cat) (model: P <0.001, area under the curve: 92.9%). Conditional Inference Tree determined scores above 175 correlated with ≥1 post-op complication ( P <0.001). Furthermore, HIGH patients reported higher rates of postoperative cardiac complications ( P =0.045) and were more likely to require reoperation ( P =0.024) compared with low patients.

CONCLUSIONS

The development of a validated novel nutritional and metabolic burden score (ASD-NMBS) demonstrated that patients with higher scores are at greater risk of increased postoperative complications and course. As such, surgeons should consider the reduction of nutritional and metabolic burden preoperatively to enhance outcomes and reduce complications in ASD patients.

The Impact of Lumbopelvic Realignment Versus Prevention Strategies at the Upper-instrumented Vertebra on the Rates of Junctional Failure Following Adult Spinal Deformity Surgery

STUDY DESIGN/SETTING

Retrospective.

OBJECTIVE

Evaluate the surgical technique that has the greatest influence on the rate of junctional failure following ASD surgery.

SUMMARY OF BACKGROUND DATA

Differing presentations of adult spinal deformity(ASD) may influence the extent of surgical intervention and the use of prophylaxis at the base or the summit of a fusion construct to influence junctional failure rates.

MATERIALS AND METHODS

ASD patients with two-year(2Y) data and at least 5-level fusion to the pelvis were included. Patients were divided based on UIV: [Longer Construct: T1-T4; Shorter Construct: T8-T12]. Parameters assessed included matching in age-adjusted PI-LL or PT, aligning in GAP-relative pelvic version or Lordosis Distribution Index. After assessing all lumbopelvic radiographic parameters, the combination of realigning the two parameters with the greatest minimizing effect of PJF constituted a good base. Good s was defined as having: (1) prophylaxis at UIV (tethers, hooks, cement), (2) no lordotic change(under-contouring) greater than 10° of the UIV, (3) preoperative UIV inclination angle<30°. Multivariable regression analysis assessed the effects of junction characteristics and radiographic correction individually and collectively on the development of PJK and PJF in differing construct lengths, adjusting for confounders.

RESULTS

In all, 261 patients were included. The cohort had lower odds of PJK(OR: 0.5,[0.2-0.9]; P =0.044) and PJF was less likely (OR: 0.1,[0.0-0.7]; P =0.014) in the presence of a good summit. Normalizing pelvic compensation had the greatest radiographic effect on preventing PJF overall (OR: 0.6,[0.3-1.0]; P =0.044). In shorter constructs, realignment had a greater effect on decreasing the odds of PJF(OR: 0.2,[0.02-0.9]; P =0.036). With longer constructs, a good summit lowered the likelihood of PJK(OR: 0.3,[0.1-0.9]; P =0.027). A good base led to zero occurrences of PJF. In patients with severe frailty/osteoporosis, a good summit lowered the incidence of PJK(OR: 0.4,[0.2-0.9]; P =0.041) and PJF (OR: 0.1,[0.01-0.99]; P =0.049).

CONCLUSION

To mitigate junctional failure, our study demonstrated the utility of individualizing surgical approaches to emphasize an optimal basal construct. Achievement of tailored goals at the cranial end of the surgical construct may be equally important, especially for higher-risk patients with longer fusions.

LEVEL OF EVIDENCE

3.

The Importance of Incorporating Proportional Alignment in Adult Cervical Deformity Corrections Relative to Regional and Global Alignment: Steps Toward Development of a Cervical-Specific Score

STUDY DESIGN/SETTING

Retrospective single-center study.

BACKGROUND

The global alignment and proportion score is widely used in adult spinal deformity surgery. However, it is not specific to the parameters used in adult cervical deformity (ACD).

PURPOSE

Create a cervicothoracic alignment and proportion (CAP) score in patients with operative ACD.

METHODS

Patients with ACD with 2-year data were included. Parameters consisted of relative McGregor's Slope [RMGS = (MGS × 1.5)/0.9], relative cervical lordosis [RCL = CL - thoracic kyphosis (TK)], Cervical Lordosis Distribution Index (CLDI = C2 - Apex × 100/C2 - T2), relative pelvic version (RPV = sacral slope - pelvic incidence × 0.59 + 9), and a frailty factor (greater than 0.33). Cutoff points were chosen where the cross-tabulation of parameter subgroups reached a maximal rate of meeting the Optimal Outcome. The optimal outcome was defined as meeting Good Clinical Outcome criteria without the occurrence of distal junctional failure (DJF) or reoperation. CAP was scored between 0 and 13 and categorized accordingly: ≤3 (proportioned), 4-6 (moderately disproportioned), >6 (severely disproportioned). Multivariable logistic regression analysis determined the relationship between CAP categories, overall score, and development of distal junctional kyphosis (DJK), DJF, reoperation, and Optimal Outcome by 2 years.

RESULTS

One hundred five patients with operative ACD were included. Assessment of the 3-month CAP score found a mean of 5.2/13 possible points. 22.7% of patients were proportioned, 49.5% moderately disproportioned, and 27.8% severely disproportioned. DJK occurred in 34.5% and DJF in 8.7%, 20.0% underwent reoperation, and 55.7% achieved Optimal Outcome. Patients severely disproportioned in CAP had higher odds of DJK [OR: 6.0 (2.1-17.7); P =0.001], DJF [OR: 9.7 (1.8-51.8); P =0.008], reoperation [OR: 3.3 (1.9-10.6); P =0.011], and lower odds of meeting the optimal outcome [OR: 0.3 (0.1-0.7); P =0.007] by 2 years, while proportioned patients suffered zero occurrences of DJK or DJF.

CONCLUSION

The regional alignment and proportion score is a method of analyzing the cervical spine relative to global alignment and demonstrates the importance of maintaining horizontal gaze, while also matching overall cervical and thoracolumbar alignment to limit complications and maximize clinical improvement.

Impact of congestive heart failure on patients undergoing lumbar spine fusion for adult spine deformity

Background

With the increasing amount of elective spine fusion patients presenting with cardiac disease and congestive heart failure, it is becoming difficult to assess when it is safe to proceed with surgery. Assessing the severity of heart failure (HF) through ejection fraction may provide insight into patients' short- and long-term risks.

Purpose

The purpose of this study was to assess the severity of HF on perioperative outcomes of spine fusion surgery patients.

Study Design/Setting

This was a retrospective cohort study of the PearlDiver database.

Patient Sample

We enrolled 670,526 patients undergoing spine fusion surgery.

Outcome Measures

Thirty-day and 90-day complication rates, discharge destination, length of stay (LOS), physician reimbursement, and hospital costs.

Methods

Patients undergoing elective spine fusion surgery were isolated and stratified by preoperative HF with preserved ejection fraction (P-EF) or reduced ejection fraction (R-EF) (International Classification of Diseases-9: 428.32 [chronic diastolic HF] and 428.22 [chronic systolic HF]). Means comparison tests (Chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, LOS, 30-day and 90-day complication outcomes, and total hospital charges between those diagnosed with P-EF and those not R-EF. Binary logistic regression assessed the odds of complication associated with HF, controlling for levels fused (odds ratio [OR] [95% confidence interval]). Statistical significance was set at P < 0.05.

Results

Totally 670,526 elective spine fusion patients were included. Four thousand and seventy-seven were diagnosed with P-EF and 2758 R-EF. Overall, P-EF patients presented with higher rates of morbid obesity, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension (all P < 0.001). In relation to No-HF, P-EF patients had higher rates of 30-day major complications including pulmonary embolism, pneumonia, cerebrovascular accident (CVA), myocardial infarctions (MI), sepsis, and death (all P < 0.001). Furthermore, P-EF was associated significantly with increased odds of pneumonia (OR: 2.07 [1.64-2.56], P < 0.001) and sepsis (OR: 2.09 [1.62-2.66], P < 0.001). Relative to No-HF, R-EF was associated with significantly higher odds of MI (OR: 3.66 [2.34-5.47]), CVA (OR: 2.70 [1.67-4.15]), and pneumonia (OR: 1.85 [1.40-2.40]) (all P < 0.001) postoperative within 30 days. Adjusting for prior history of MI, CAD, and the presence of a pacemaker R-EF was a significant predictor of an MI 30 days postoperatively (OR: 2.2 [1.14-4.32], P = 0.021). Further adjusting for history of CABG or stent placement, R-EF was associated with higher odds of CVA (OR: 2.11 [1.09-4.19], P = 0.028) and MI (OR: 2.27 [1.20-4.43], P = 0.013).

Conclusions

When evaluating the severity of HF before spine surgery, R-EF was associated with a higher risk of major complications, especially the occurrence of a myocardial infarction 30 days postoperatively. During preoperative risk assessment, congestive HF should be considered thoroughly when thinking of postoperative outcomes with emphasis on R-EF.

Adult cervical spine deformity: a state-of-the-art review

Adult cervical deformity is a structural malalignment of the cervical spine that may present with variety of significant symptomatology for patients. There are clear and substantial negative impacts of cervical spine deformity, including the increased burden of pain, limited mobility and functionality, and interference with patients' ability to work and perform everyday tasks. Primary cervical deformities develop as the result of a multitude of different etiologies, changing the normal mechanics and structure of the cervical region. In particular, degeneration of the cervical spine, inflammatory arthritides and neuromuscular changes are significant players in the development of disease. Additionally, cervical deformities, sometimes iatrogenically, may present secondary to malalignment or correction of the thoracic, lumbar or sacropelvic spine. Previously, classification systems were developed to help quantify disease burden and influence management of thoracic and lumbar spine deformities. Following up on these works and based on the relationship between the cervical and distal spine, Ames-ISSG developed a framework for a standardized tool for characterizing and quantifying cervical spine deformities. When surgical intervention is required to correct a cervical deformity, there are advantages and disadvantages to both anterior and posterior approaches. A stepwise approach may minimize the drawbacks of either an anterior or posterior approach alone, and patients should have a surgical plan tailored specifically to their cervical deformity based upon symptomatic and radiographic indications. This state-of-the-art review is based upon a comprehensive overview of literature seeking to highlight the normal cervical spine, etiologies of cervical deformity, current classification systems, and key surgical techniques.

No Increased Risk of Cerebrovascular Accident With Beach-Chair Versus Lateral Positioning for Shoulder Arthroscopy

Purpose

To assess the incidence of adverse cerebrovascular events following shoulder arthroscopy in the beach-chair position when compared with the lateral position.

Methods

Records of 5 shoulder surgeons were searched using Current Procedural Technology codes to identify patients who underwent arthroscopic shoulder surgery in both the beach-chair and lateral positions between 2015 and 2020. Using both Current Procedural Technology codes for cerebrovascular accident (CVA) imaging as well as the International Classification of Diseases, Tenth Revision, codes for CVA and late neurologic sequela, patient charts were analyzed in the 30-day postoperative period. The anesthesiology record also was queried for data regarding the blood pressure management intraoperatively, recording mean arterial pressures (MAPs), and vasopressor administration. Patient demographics, comorbidities, and complications were compared between the 2 cohorts using the Student 2-tailed t-test for continuous variables and χ2 analysis for categorical variables. Significance was set at P < .05.

Results

There were 711 patients included in the analysis, with 471 in the beach-chair cohort and 240 in the lateral cohort. Baseline demographics were similar between groups, except for age and American Society of Anesthesiologists physical status classification, with the lateral group being significantly younger (P < .001) and lower American Society of Anesthesiologists physical status classification (P = .001) than the beach-chair group. Mean body mass index, history of CVA, transient ischemic attack, hypertension, and peripheral vascular disease were not significantly different. There were no documented CVAs in either cohort. There was no significant difference in the number of postoperative radiologic scans to evaluate for CVA (P = .77) or neurologic sequelae (P = .48) between groups. The beach-chair cohort had fewer instances of MAP <65 mm Hg, greater mean minimum MAP, but a greater percentage of patients who received blood pressure support.

Conclusions

There were no significant differences identified in the incidence of CVA between patients undergoing arthroscopic shoulder surgery in the beach-chair and lateral positions.

Level of Evidence

Level III, retrospective cohort study.

Impact of Frailty on the Development of Proximal Junctional Failure: Does Frailty Supersede Achieving Optimal Realignment?

BACKGROUND

Patients undergoing surgery for adult spinal deformity (ASD) are often elderly, frail, and at elevated risk of adverse events perioperatively, with proximal junctional failure (PJF) occurring relatively frequently. Currently, the specific role of frailty in potentiating this outcome is poorly defined.

PURPOSE

To determine if the benefits of optimal realignment in ASD, with respect to the development of PJF, can be offset by increasing frailty.

STUDY DESIGN

Retrospective cohort.

MATERIALS AND METHODS

Operative ASD patients (scoliosis >20°, SVA>5 cm, pelvic tilt>25°, or TK>60°) fused to the pelvis or below with available baseline and 2-year (2Y) radiographic and HRQL data were included. The Miller Frailty Index (FI) was used to stratify patients into 2 categories: Not Frail (FI <3) and Frail (>3). Proximal Junctional Failure (PJF) was defined using the Lafage criteria. "Matched" and "unmatched" refers to ideal age-adjusted alignment postoperatively. Multivariable regression determined the impact of frailty on the development of PJF.

RESULTS

Two hundred eighty-four ASD patients met inclusion criteria [62.2yrs±9.9, 81%F, BMI: 27.5 kg/m 2 ±5.3, ASD-FI: 3.4±1.5, Charlson Comorbidity Index (CCI): 1.7±1.6]. Forty-three percent of patients were characterized as Not Frail (NF) and 57% were characterized as Frail (F). PJF development was lower in the NF group compared with the F group (7% vs . 18%; P =0.002). F patients had 3.2 × higher risk of PJF development compared to NF patients (OR: 3.2, 95% CI: 1.3-7.3, P =0.009). Controlling for baseline factors, F unmatched patients had a higher degree of PJF (OR: 1.4, 95% CI:1.02-1.8, P =0.03); however, with prophylaxis, there was no increased risk. Adjusted analysis shows F patients, when matched postoperatively in PI-LL, had no significantly higher risk of PJF.

CONCLUSIONS

An increasingly frail state is significantly associated with the development of PJF after corrective surgery for ASD. Optimal realignment may mitigate the impact of frailty on eventual PJF. Prophylaxis should be considered in frail patients who do not reach ideal alignment goals.

A Hierarchical Approach to Realignment Strategies in Adult Cervical Deformity Surgery

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

Construct an individualized cervical realignment strategy based on patient parameters at the presentation that results in superior 2-year health-related quality of life metrics and decreased rates of junctional failure and reoperation following adult cervical deformity surgery.

SUMMARY OF BACKGROUND DATA

Research has previously focused on adult cervical deformity realignment thresholds for maximizing clinical outcomes while minimizing complications. However, realignment strategies may differ based on patient presentation and clinical characteristics.

METHODS

We included adult cervical deformity patients with 2-year data. The optimal outcome was defined as meeting good clinical outcomes without distal junctional failure or reoperation. Radiographic parameters assessed included C2 Slope, C2-C7, McGregor's slope, TS-CL, cSVA, T1 slope, and preoperative lowest-instrumented vertebra (LIV) inclination angle. Conditional inference trees were used to establish thresholds for each parameter based on achieving the optimal outcome. Analysis of Covariance and multivariable logistic regression analysis, controlling for age, comorbidities, baseline deformity and disability, and surgical factors, assessed outcome rates for the hierarchical approach within each deformity group.

RESULTS

One hundred twenty-seven patients were included. After correction, there was a significant difference in meeting the optimal outcome when correcting the C2 slope below 10 degrees (85% vs. 34%, P <0.001), along with lower rates of distal junctional failure (DJF) (7% vs. 42%, P <0.001). Next, after isolating patients below the C2 slope threshold, the selection of LIV with an inclination between 0 and 40 degrees demonstrated lower rates of distal junctional kyphosis and higher odds of meeting optimal outcome(OR: 4.2, P =0.011). The best third step was the correction of cSVA below 35 mm. This hierarchical approach (11% of the cohort) led to significantly lower rates of DJF (0% vs. 15%, P <0.007), reoperation (8% vs. 28%, P <0.001), and higher rates of meeting optimal outcome (93% vs. 36%, P <0.001) when controlling for age, comorbidities, and baseline deformity and disability.

CONCLUSION

Our results indicate that the correction of C2 slope should be prioritized during cervical deformity surgery, with the selection of a stable LIV and correction of cervical SVA below the idealized threshold. Among the numerous radiographic parameters considered during preoperative planning for cervical deformity correction, our determinations help surgeons prioritize those realignment strategies that maximize the health-related quality of life outcomes and minimize complications.

LEVEL OF EVIDENCE

Level-III.

Anatomic Shoulder Arthroplasty in the Setting of Concurrent or Prior Rotator Cuff Repair: A Systematic Review

Background

Reverse total shoulder arthroplasty (RSA) is the gold standard in management of osteoarthritis (OA) in the setting of rotator cuff pathology. However, there are significant complications associated with the procedure. An alternative option in the setting of a deficient rotator cuff may be to perform a repair prior to or concurrently with an anatomic total shoulder arthroplasty (aTSA).

Methods

A systematic review was performed utilizing Preferred Reporting Items for Systematic Meta-Analyses (PRISMA) guidelines to evaluate outcomes in aTSA with concomitant or prior rotator cuff repair (RCR). Key outcomes were complication rate and subjective outcome scores.

Results

Seven studies were included in the review. One study found a higher rate of total adverse events in the prior repair group (17% vs 7%, P = .01) while others found no significant difference. There was a nonstatistically significant increase in revision rates among patients with larger tears at time of repair. Prior repair groups were associated with a higher rate of re-tear in one study (13% vs 1%, P = .014). Concomitant repair was associated with a higher rate of loosening. In patients with prior repair, there was no statistical difference in strength, range of motion (ROM), simple shoulder test (SST), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and visual analogue scale (VAS). In patients with concurrent repair, one study demonstrated a less drastic improvement in Hospital for Special Surgery (HSS) in "moderate" repairs as opposed to "good" repairs.

Conclusions

Anatomic TSA is an appropriate treatment for glenohumeral OA in patients with a prior successful RCR and in younger patients with concurrent repair of small or medium tears.

Level of Evidence

Level III.

Surgical Repair of Posttraumatic Hallux Valgus Deformity in a Collegiate Football Player: A Case Report

CASE

We report a rare case of posttraumatic hallux valgus in a collegiate football player after an acute medial collateral ligament tear of the first metatarsophalangeal joint. The patient was treated with a modification of the modified McBride technique, using an all-suture anchor for the medial ligamentous complex repair. There was return to sport at 5 months and a Foot and Ankle Outcome Score of 95% at 10 months.

CONCLUSION

A modified McBride procedure further modified with the utilization of an all-suture anchor for the medial ligamentous complex repair can result in correction of deformity, pain-free movement and return to sport.

Post-Traumatic Hallux Valgus: A Modified Surgical Technique

Post-traumatic hallux valgus, a turf toe variant, is a rare, yet limiting injury. According to the literature, the deformity has been associated with acute medial collateral ligament tears, turf toe variant injuries, Lisfranc injury patterns, and first metatarsal fractures. There have been few documented cases of post-traumatic hallux valgus secondary to medial collateral ligament tears, and the treatment has been variable. Some authors have described direct end-to-end repair of the ligament to address the deformity, while others have described a modified McBride bunionectomy involving a Silver bunionectomy, lateral soft tissue release, and medial capsular and ligamentous repair. We propose a modified technique similar to the modified McBride bunionectomy, however, with the use of an all-suture anchor in the medial capsular and ligamentous repair. Our belief is that the all-suture anchor will allow for a stronger repair that will meet the physical demands of everyday ambulation and athletic participation. We used this technique in an individual who had evidence of a medial ligamentous complex injury of the hallux on MRI and failed conservative management. Postoperatively, the patient is immobilized until they can begin working on range of motion, strengthening, and finally to achieve return to full activity and sports.

Supervising dentists' perspectives on the effectiveness of community-based dental education

The Commission on Dental Accreditation recently implemented new predoctoral standards that require dental schools in the United States to provide students with community-based dental education (CBDE) experiences. The objective of this study was to examine the perspectives of supervising dentists (also known as dental preceptors) at rural CBDE sites regarding the University of Nebraska Medical Center program's effectiveness in improving the competencies of dental students. Surveys were sent to all forty-three preceptors in two subsequent years: nineteen responded to all questions in 2012 and sixteen in 2013, for a total of thirty-five participants. These preceptors evaluated the effectiveness of the program based on the American Dental Education Association (ADEA) Competencies for the New General Dentist. Overall, these preceptors rated the CBDE program as effective (excellent or very good) in improving the students' competence in five of the six ADEA domains: Critical Thinking, Professionalism, Communication and Interpersonal Skills, Health Promotion, Patient Care: Assessment, Diagnosis, and Treatment Planning, and Patient Care: Establishment and Maintenance of Oral Health. Practice Management and Informatics was found to be the least effective domain of competence. CBDE provides a unique opportunity to develop a competent dental workforce with an appreciation for the value of community service. Applying a competency-based framework to program evaluation can provide valuable information on program effectiveness to program administrators, educators, and the dental preceptors.

First Report of the Peach Brown Rot Fungus Monilinia fructicola Resistant to Demethylation Inhibitor Fungicides in New Jersey

Reduced sensitivity and resistance of Monilinia fructicola to demethylation inhibitors (DMIs; fungicide group 3) have been previously found in stone fruit orchards in Georgia, South Carolina, Ohio, and New York (2). Resistance development is a major concern because of the importance of DMIs for brown rot management. Eleven single-spore isolates, originally collected during 2006 from separate commercial peach (Prunus persica) orchards in southern New Jersey, were removed from cold storage (5°C) in early 2008 and examined in vitro for resistance to the DMI propiconazole (Orbit 3.6EC; Syngenta Crop Protection, Inc., Greensboro, NC). After 19 months at 5°C, isolate 7 was inhibited 53.4% in growth on potato dextrose agar (PDA) amended at the discretionary dose of 0.3 μg/ml propiconazole; inhibition of the remaining isolates ranged from 81.4 to 100%. Inhibition values were based on two replications of eight colonies per isolate performed after incubation at 25°C for 4 days. Because of the previously reported relationship between duration of cold storage and propiconazole sensitivity, isolate 7 was tentatively deemed resistant (1). To confirm the in vitro results, isolates were grown at 25°C for 7 days on cellophane over PDA. Genomic DNA was isolated from mycelium with the DNeasy Plant Mini Kit (Qiagen, Inc., Valencia, CA). PCR with primers INS65-F and INS65-R was conducted on a GeneAmp thermal cycler (Applied Biosystems, Inc., Foster City, CA) as described previously to amplify a 65-bp region named 'Mona' associated with DMI resistance (2). PCR products were separated via electrophoresis on 0.8% agarose gel. The primers amplified a 376-bp fragment from isolate 7 and a 311-bp fragment from all other isolates, thus indicating the presence of Mona in isolate 7. Restriction fragment length polymorphism analysis using the BsrBI enzyme, specific to a single restriction site within Mona, was conducted on the amplified fragments from all isolates. Electrophoresis results showed digestion of the 376-bp fragment from isolate 7 into 140-bp and 236-bp fragments, thereby confirming the presence of Mona; none of the 311-bp fragments from the remaining isolates were cut by BsrBI. Although economic loss from brown rot has not been reported in New Jersey, these results show that propiconazole-resistant strains have been detected since 2006 and it is most likely that resistant strains of the pathogen are still present in commercial peach orchards. To combat this risk, current brown rot control recommendations are incorporating quinone outside inhibitors (QoIs; fungicide group 11) and carboxamides (fungicide group 7) into control programs as a resistance management strategy. More extensive sampling is planned to ascertain the prevalence and location of resistant strains. References: (1) K. D. Cox et al. Phytopathology 97:448, 2007. (2) C.-X. Luo et al. Plant Dis. 92:1099, 2008.

Influence of factor IX on overall plasma coagulability and fibrinolytic potential as measured by global assay: monitoring in haemophilia B

We sought to determine the influence of factor IX (FIX) deficiency upon overall coagulative and fibrinolytic capacities in plasma using the clot formation and lysis (CloFAL) assay, and to investigate the role of this global assay as an adjunctive monitoring tool in haemophilia B. CloFAL assay parameters were measured in vitro in platelet-poor plasma in relation to FIX activity and antigen (FIX:Ag), and were determined ex vivo among FIX-deficient patients (n = 41) in comparison to healthy individuals (n = 48). Supplementation of FIX-deficient plasma with FIX in vitro demonstrated a non-linear concentration dependence of FIX upon overall plasma coagulability. Ex vivo, coagulability was significantly decreased in FIX-deficient vs. healthy subjects among adults [median coagulation index (CI): 4% vs. 104% respectively; P < 0.001] and children (median CI: 9% vs. 63%; P < 0.001). Fibrinolytic capacity was increased in adult FIX-deficient vs. healthy subjects (median fibrinolytic index: 216% vs. 125%, respectively, P < 0.001), and was supported by a trend in shortened euglobulin lysis time (ELT). Severe haemophilia B patients showed heterogeneity in aberrant CloFAL assay waveforms, influenced partly by FIX:Ag levels. Patients with relatively preserved FIX:Ag (i.e. dysfunctional FIX) exhibited a shorter time to maximal amplitude in clot formation than those with type I deficiency. During patient treatment monitoring, markedly hypocoagulable CloFAL assay waveforms normalized following 100% correction with infused FIX. The CloFAL global assay detects FIX deficiency, demonstrates differences in coagulability between dysfunctional FIX and type I deficiency, and appears useful as an adjunctive test to routine FIX measurement in monitoring haemophilia B treatment.

Influence of factor VIII on overall coagulability and fibrinolytic potential of haemophilic plasma as measured by global assay: monitoring in haemophilia A

The objectives of the present study were to evaluate the analytical sensitivity of the recently developed Clot Formation and Lysis (CloFAL) global assay for factor VIII (FVIII) deficiency, both in vitro and ex vivo, to determine whether this global assay is influenced by FVIII inhibitors, and to investigate the coagulative response to FVIII replacement in haemophilia A patients using the CloFAL assay in comparison with FVIII activity. Among adults and children alike, the CloFAL assay coagulation index (CI) was significantly decreased in FVIII-deficient vs. healthy subjects (adults median CI: 2% vs. 94% respectively; children median CI: 3% vs. 63%; P < 0.001 for each), and correlated significantly with activated partial thromboplastin time-based FVIII activity across all individuals (r = 0.78; P < 0.001). The CloFAL assay was analytically sensitive to deficient FVIII activity and also influenced by the presence of von Willebrand factor. Severe haemophilia A patients without inhibitory antibodies to FVIII showed considerable heterogeneity in CloFAL assay waveforms, despite a uniformly diminished CI of 0-1%. During FVIII infusion half-life studies in patients with severe haemophilia A, the CloFAL assay demonstrated a marked rise in coagulability 30 min following infusion, with progressive decrease in coagulability towards baseline over the ensuing 48-h period. In each case, the profile of coagulative response to FVIII infusion as determined by CloFAL assay CI differed qualitatively from that measured by FVIII activity. These findings indicate that the CloFAL assay may be useful as an adjunctive test to FVIII activity measurements in the therapeutic monitoring of haemophilia A.

Lateralization of speech production using verbal/manual dual tasks: meta-analysis of sex differences and practice effects

The present paper reviews the findings of 30 years of verbal/manual dual task studies, the method most commonly used to assess lateralization of speech production in non-clinical samples. Meta-analysis of 64 results revealed that both the type of manual task used and the nature of practice that is given influence the size of the laterality effect. A meta-analysis of 36 results examining the effect size of sex differences in estimates of lateralization of speech production indicated that males appear to show slightly larger laterality effects than females.

Repeated cocaine administration alters the electrophysiological properties of prefrontal cortical neurons

Recently it has become clear that some of the symptoms of addiction such as relapse to drug-taking behavior arise, in part, from a dysfunction in cognitive and emotional processing. This realization has promoted investigations into the physiology and pathophysiology of forebrain circuits that are both innervated by dopamine and play an important role in cognitive processing, including the prefrontal cortex. In order to study long-term neuroadaptations occurring in the prefrontal cortex of the rat as a consequence of psychostimulant administration, cocaine was repeatedly administered in either a contingent or a non-contingent manner. At least 2 weeks following the last cocaine injection, in vivo intracellular recordings were made from neurons located in the deep layers of the prefrontal cortex. Repeated cocaine administration abolished the presence of membrane bistability normally present in neurons located in the limbic prefrontal cortex. These results indicate that repeated exposure to cocaine produces enduring changes in the basal activity of neurons in the prefrontal cortex that may contribute to previously identify cognitive and emotional dysfunctions in cocaine addicts.

The circuitry mediating cocaine-induced reinstatement of drug-seeking behavior

The role of limbic-striato-pallidal circuitry in cocaine-induced reinstatement was evaluated. The transient inhibition of brain nuclei associated with motor systems [including the ventral tegmental area (VTA), dorsal prefrontal cortex (dPFC), core of the nucleus accumbens (NAcore), and ventral pallidum (VP)] prevented cocaine-induced reinstatement. However, only the VP proved to be necessary for food reinstatement, suggesting that the identified circuit is specific to drug-related reinstatement. Supporting the possibility that the VTA-dPFC-NAcore-VP is a series circuit mediating reinstatement, simultaneous unilateral microinjection of GABA agonists into the dPFC in one hemisphere and into the VP in the contralateral hemisphere abolished cocaine reinstatement. Although dopamine projections from the VTA innervate all three forebrain nuclei, the blockade of dopamine receptors only in the dPFC antagonized cocaine-induced reinstatement. Furthermore, DA administration into the dPFC was sufficient to elicit a reinstatement in drug-related responding. These data demonstrate that dopamine release in the dPFC initiates a dPFC-NAcore-VP series circuit that mediates cocaine-induced drug-seeking behavior.

Post-Traumatic amnesia: consistency-of-recovery and duration-to-recovery following traumatic brain impairment

The aim of this research was to examine the nature and order of recovery of orientation and memory functioning during Post-Traumatic Amnesia (PTA) in relation to injury severity and PTA duration. The Westmead PTA Scale was used across consecutive testing days to assess the recovery of orientation and memory during PTA in 113 patients. Two new indices were examined: a Consistency-of-Recovery and a Duration-to-Recovery index. A predictable order of recovery was observed during PTA: orientation-to-person recovered sooner and more consistently than the following cluster; orientation-to-time, orientation-to-place, and the ability to remember a face and name. However, the type of memory functioning required for the recall face and name task recovered more consistently than that required for memorizing three pictures. An important overall finding was that the "order-of-recovery" of orientation and memory functioning was dependent upon both the elapsed days since injury, and the consistency of recovery. The newly developed indices were shown to be a valuable means of accounting for differences between groups in the elapsed days to recovery of orientation and memory. These indices also clearly increase the clinical utility of the Westmead PTA Scale and supply an objective means of charting (and potentially predicting) patients' recovery on the different components of orientation and memory throughout their period of hospitalization.

Effect of sequential transdermal progesterone cream on endometrium, bleeding pattern, and plasma progesterone and salivary progesterone levels in postmenopausal women

BACKGROUND

Transdermal progesterone is being used in some countries as a purported treatment for menopausal symptoms, either alone or prescribed in conjunction with estrogen, but little information exists regarding the biological activity and effectiveness of this method of delivery of progesterone in protecting the endometrium from excess proliferation. This study was designed to evaluate the use of sequential transdermal progesterone. End-points evaluated included endometrial cellular response and bleeding pattern as well as plasma hormone levels and salivary progesterone estimations.

METHOD

Twenty-seven postmenopausal women were treated with continuous transdermal estrogen (28-day cycle) and a cream containing 16, 32 or 64 mg of progesterone in each 4-cm extrusion from a tube of Pro-Feme administered daily in a sequential (days 15-28 of cycle) regimen. Blood and endometrial samples were analyzed for progesterone response prior to therapy, after the first 14 days of unopposed transdermal estrogen and following 14 days of transdermal progesterone. Saliva samples were taken during the last 14 days of the 84-day study, when the final progesterone cream therapy was being applied.

RESULTS

Hormone assay indicated that physiological levels of estradiol were achieved, but progesterone levels were insufficient to induce any detectable change in the endometrium. Only one patient experienced bleeding during the study period. Levels of salivary progesterone were so variable as to be considered completely unreliable in determining the potential influence on biological activity.

INTERPRETATION

Pro-Feme transdermal progesterone administered in a 16-, 32- or 64-mg daily dose for 14 days in a sequential regimen does not appear to be effective in inducing a secretory change in a proliferative endometrium. Salivary progesterone levels were not of value in managing the therapy of postmenopausal women.

Search for a W' boson via the decay mode W'-->munumu in 1.8 TeV pp collisions

We report the results of a search for a W' boson produced in pp collisions at a center-of-mass energy of 1.8 TeV using a 107 pb-1 data sample recorded by the Collider Detector at Fermilab. We consider the decay channel W'-->&munumu and search for anomalous production of high transverse mass munumu lepton pairs. We observe no excess of events above background and set limits on the rate of W' boson production and decay relative to standard model W boson production and decay using a fit of the transverse mass distribution observed. If we assume standard model strength couplings of the W' boson to quark and lepton pairs, we exclude a W' boson with invariant mass less than 660 GeV/c2 at 95% confidence level.

Cisplatin-based therapy: a neurological and neuropsychological review

The present paper reviews research in the area of the broad-spectrum chemotherapeutic agent cisplatin (cis-diamminedichloro-platinum II) and examines the implications for clinical neuropsychology arising from the neurological disruption associated with cisplatin-based therapy. The paper begins with a brief review of cisplatin treatment in terms other than survival alone, and examines the side-effects and the potential central nervous system (CNS) dysfunction in terms of neurological symptoms and concomitant implications for neuropsychology. Two main implications for clinical neuropsychology arising from cisplatin therapy are identified. First, cisplatin therapy impacts upon the psychological well-being of the patient, particularly during and in the months following treatment. It is suggested that during this time, a primary role for neuropsychology is to focus upon the monitoring and the active enhancement of the patient's social, psychological and spiritual resources. Second, with regard to neurocognitive changes, the review suggests that (1) neurocognitive assessment may not yield stable results within 8 months following treatment and (2) while perceptual, memory, attentional and executive dysfunction may be predicted following cisplatin treatment, little systematic research has been carried out to investigate such a possibility. Future research might profitably address this issue and also specifically examine the effects of low dosage cisplatin-based therapy and the effects of recently developed neuroprotective agents. Finally, there is some evidence to suggest that women may be more susceptible to neurotoxicity during cisplatin therapy, but no gender-related cognitive effects are reported in the cisplatin literature. Future research could usefully investigate gender differences in association with cisplatin chemotherapy.

Micronised transdermal progesterone and endometrial response

Sequential transdermal progesterone administered with continuous transdermal oestrogen was insufficient to increase circulating blood progesterone concentrations or induce a secretory response in proliferating endometrium.

Haloperidol does not attenuate conditioned place preferences or locomotor activation produced by food- or heroin-predictive discriminative cues

The present study examined whether a discriminative cue previously predictive of food or heroin reinforcement could activate and direct behavior in an environment that had never been paired with primary reinforcement. Olfactory cues, predicting the availability (S+) or unavailability (S-) of either heroin (0.1 mg/kg i.v.) or food (45 mg Noyes food pellets) reinforcement in the goal box of a straight-arm runway, were later tested in a separate environment for their ability to elicit locomotion (activate behavior) or induce a conditioned place preference (direct behavior). Presentation of the S+, but not the S-, resulted in a reliable increase in spontaneous locomotor activity that was not blocked by pretreatment with the dopamine receptor antagonist, haloperidol. Similarly, subjects displayed a preference for a novel location in which the S+, but not the S-, was placed. This preference was also unaltered by pretreatment with haloperidol. These data suggest that discriminative cues can profoundly affect behavior, even in environments that have themselves never been associated with primary reinforcement. Additionally, the conditioned motivational quality of these cues is unaltered by treatment with the same dopamine receptor antagonist shown in previous work to attenuate the primary reinforcing properties of heroin and food.

Naloxone blocks reinforcement but not motivation in an operant runway model of heroin-seeking behavior

The present study examined the effects of opiate receptor antagonism on both the motivation to seek heroin and the reinforcing consequences of heroin administration. Subjects were trained to discriminate between olfactory cues predicting either the delivery of intravenous heroin reinforcement (S+) or saline (S-). Subjects were then tested in the presence of the opiate receptor antagonist, naloxone (0.5, 1.0, or 3.0 mg/kg intraperitoneally). Naloxone had no effect on either S+ or S- trials. However, 24 hr later on the first posttreatment trial, subjects that had received heroin in the presence of naloxone (on the previous trial) now traversed the alley more slowly when presented with the S+. These data suggest that although the motivation to seek heroin was not disrupted by naloxone, the reinforcing consequences of heroin administration were.

Haloperidol does not affect motivational processes in an operant runway model of food-seeking behavior

The present experiment examined the effects of dopamine receptor antagonism on subjects' motivation to seek food. Rats were trained to discriminate between 2 olfactory cues predicting either the presence (S+) or absence (S-) of food reinforcement in the goal box of a straight-arm runway. Rats learned to traverse the alley quickly when presented with the S+ and much more slowly when presented with the S-. Haloperidol pretreatment was unable to alter this pattern of behavior (i.e., rats still ran quickly when presented with the scent that predicted food availability). Thus, it seems that the same dopamine antagonist treatments that have been shown to disrupt food reinforcement do not prevent the food-seeking behavior produced by presentation of food-predictive cues.

Haloperidol does not affect motivational processes in an operant runway model of food-seeking behavior

The present experiment examined the effects of dopamine receptor antagonism on subjects' motivation to seek food. Rats were trained to discriminate between 2 olfactory cues predicting either the presence (S+) or absence (S-) of food reinforcement in the goal box of a straight-arm runway. Rats learned to traverse the alley quickly when presented with the S+ and much more slowly when presented with the S-. Haloperidol pretreatment was unable to alter this pattern of behavior (i.e., rats still ran quickly when presented with the scent that predicted food availability). Thus, it seems that the same dopamine antagonist treatments that have been shown to disrupt food reinforcement do not prevent the food-seeking behavior produced by presentation of food-predictive cues.

Anatomy and ultrastructure of the sporophyte of Takakia ceratophylla (Bryophyta)

In this study, morphogenesis and structure of the sporophyte of Takakia ceratophylla are characterized beginning with the late embryo and culminating in the fully dehisced capsule. Information is presented on the development, ultrastructure, and anatomy of the three organographic regions of the sporophyte, namely capsule, seta, and foot. Diagnostic features that identify Takakia as a moss include the gradual elongation of seta, persistence of an apical calyptra, expansion of the capsule after cessation of seta elongation, existence of a columella, monoplastidic meiosis, spore ultrastructure (including a perine layer deposited late in spore wall (development), and the structure of the foot. Commonalities with the capsule of the Andreaeopsida include sporogenous tissue that overarchs a central columella, absence of stomata, and lack of a peristome and operculum. Peculiarities of the genus are seen in the internal structure of the capsule, the disintegration of the columella with spore maturation, and the dehiscence of the capsule along a single, spiralled, longitudinal suture line. Passive spore dispersal through longitudinal splitting of the capsule occurs in andreaeopsid mosses, liverworts, hornworts, and seedless vascular plants. The precise mechanism of dehiscence along a spiralled suture is unparalleled in extant archegoniates but finds counterparts in ancestral land plants such as the pteridophyte Tortilicaulis.

Reinstatement of drug-seeking behavior produced by heroin-predictive environmental stimuli

The current study examined whether stimuli predictive of heroin availability were capable of inducing a relapse of drug-seeking behavior in an operant runway task. Olfactory stimuli (orange and almond food extract) served as discriminative cues about the availability (S+) or unavailability (S-) of heroin reinforcement (a single 0.1 mg/kg IV infusion) in the goal box of a straight arm runway. Following discrimination training, the running response was extinguished in the absence of the olfactory cues. On a single trial, the discriminative stimuli were then tested for their ability to reinstate running behavior prior to presentation of the heroin reinforcer. Subjects presented with the S+ on test day took significantly less time to traverse the alley than they did on the final day of extinction, while those subjects presented with the S- on test day continued to run slowly. These results demonstrate, in an animal model of drug self-administration, that environmental discriminative cues can produce a relapse in drug seeking behavior following a period of abstinence. The response-reinstating properties of the S+ odor were unaltered by pretreatment with any of three doses of haloperidol (0.0, 0.15 or 0.3 mg/kg IP), suggesting that the motivating properties of heroin-predictive stimuli or cues remain intact during dopamine receptor antagonism.

Mild head injury and speed of information processing: a prospective study of professional rugby league players

The sensitivity of several short tests of speed of information processing to the effects of mild head injury in rugby league football was investigated. The measures used were the Symbol Digit Modalities Test, the Digit Symbol Substitution Test, and the Speed of Comprehension Test. Two studies were conducted, the first to examine the effect of practice, the second to determine sensitivity to cognitive impairment immediately following injury. The first study established alternate form equivalence and demonstrated that performance on the Speed of Comprehension and Digit Symbol Substitution tests improved with practice, whereas the Symbol Digit Modalities test remained stable. A second study of 10 players who subsequently sustained mild head injuries showed that measures of speed of information processing were sensitive to impairment in the postacute phase, whereas an untimed task of word recognition (Spot-the-Word) was not. Speed of Comprehension was more sensitive to postinjury impairment than either the Digit Symbol Substitution or Symbol Digit Modalities tests. A repeated baseline assessment before injury using the higher score to reflect a player's potential, allowed measurement of impaired performance on sensitive tests.

Nitrous-oxide use. II. Risks, compliance, and exposure levels among Nebraska dentists and dental assistants

This study measured nitrous oxide (N2O) exposure levels of 70 dentists and their dental assistants, and related these results to minutes of N2O use, compliance with N2O use guidelines, and risk of exposure. Dentists and dental assistants averaged, respectively, 97 and 59 parts per million (ppm) in N2O exposure, much higher than the recommended 25 to 50 ppm. Estimated peaks of exposure averaged 1,415 and 986 respectively for the two groups. Dentists exposure levels were significantly higher than those of dental assistants in both measures. Correlations revealed a significant link between compliance and estimated maximum exposure, and between minutes of use and 40-hour exposure readings. The variables most predictive of 40-hour N2O exposure were: minutes of use, frequency of use, number of operatories equipped, education of staff members on N2O health risks and exposure control, and operation of scavenging systems with the recommended liters/minute. This study established a feasible methodology for long-term, field-based epidemiological studies on N2O exposure, and identified some key variables related to 40-hour exposures and estimated maximum exposure.

Nitrous-oxide use. I. Risk of potential exposure and compliance among Nebraska dentists and dental assistants

Patterns of nitrous-oxide (N,O) use among Nebraska dentists and dental assistants are reported. More than 800 respondents answered questions relating to risk of N,O exposure and compliance with N,O standards in the dental office: 73 percent of these dental practices using N,O have a state-registration permit. Dentists and dental assistants (from registered and unregistered practices) reported risk of exposure differently. Important compliance issues emerged (the average compliance rate was 9 on a scale of 17). Most N,O users have scavenging systems, but they are not properly operated. Few dental practices test for leaks or conduct N,O-monitoring tests. By complying with the recommendations for N,O administration, dental-care workers can minimize their risk of exposure.

Addition of anticholinergic solution prolongs bronchodilator effect of beta 2 agonists in patients with chronic obstructive pulmonary disease

A randomized, double-blind placebo-controlled clinical trial was designed to assess the safety, efficacy, and duration of the bronchodilation resulting from the addition of 500 micrograms of ipratropium bromide (Atrovent; Boehringer Ingelheim, CT) inhalation solution to standard small volume nebulizer treatments with 2.5 mg albuterol inhalation solution. A total of 195 patients (63% men, average age 64 years) with > 10 pack-year smoking histories and stable, moderate-to- severe chronic obstructive pulmonary disease (COPD; forced expiratory volume in 1 second [FEV1] 1.02 liter, 38.8% predicted) from eight university-affiliated chest clinics in seven U.S. cities were enrolled into the study. Asthma, rhinitis, and eosinophilia were exclusions, as was daily use of > 10 mg of prednisone (or 20 mg on alternate days). There was a 2-week stabilization period during which the patients were instructed in the use of the small volume nebulizers, which they used three times daily with albuterol alone. They were asked to keep daily logs of peak flow rates, pulmonary symptoms, and additional medication usage. On their test day 1 the subjects came to the pulmonary function laboratory having been off theophylline for 24 hours and beta 2-agonists for 12 hours and performed a baseline spirometry. They then received their morning small volume nebulizer treatment of albuterol to which was added either 500 micrograms if ipratropium bromide or a saline placebo. Spirometry was repeated at 15, 30, and 60 minutes, and then hourly for 8 hours. Subjects then took home a 2-week supply of albuterol and test drug for thrice daily use in their small volume nebulizer. They were evaluated for pulmonary symptoms and adverse effects every 14 days. The 8-hour spirometry was repeated on test day 43 and finally on test day 85. Primary data evaluated were the peak increase in FEV1 and the area between the FEV1 baseline value and the 8-hour FEV1 curve. Similar calculations were made for forced vital capacity (FVC) and 25-75% forced expiratory flow (FEF25-75%). On test day 1 the peak increase in FEV1 for the ipratropium bromide + albuterol subjects was 26% greater than those on placebo + albuterol (p < 0.003). The area under the 8-hour FEV1 curve was 64% greater in those given ipratropium bromide on test day 1 (p < 0.0002). Similar increases were seen in FVC and FEF25-75%. The peak improvements in FEV1 and FVC with the addition of ipratropium bromide to albuterol were maintained on test days 43 and 85. Considering the safety and efficacy profiles of this combination, the data would suggest that ipratropium bromide inhalation solution should be considered first-line therapy for those patients with COPD requiring small volume nebulizer treatments.

Haloperidol differentially affects reinforcement and motivational processes in rats running an alley for intravenous heroin

The role of drug-paired environmental stimuli in opiate self-administration was investigated by exposing animals to discrete cues that were predictive of the availability or unavailability of heroin reinforcement. Rats were trained to traverse a straight arm runway for a reinforcement consisting of a single 0.1 mg/kg intravenous infusion of heroin delivered upon entrance to the goal box. On each trial, one of two discriminative olfactory stimuli (orange and almond) was used: one which signaled the availability of heroin in the goal box (S+), and one which signaled its absence (S-). The effect of dopamine (DA) receptor antagonism on reinforcement and motivational processes was investigated by pretreating subjects with 0.0, 0.15 or 0.30 mg/kg of the DA receptor antagonist drug, haloperidol. Haloperidol had no effect on operant runway performance (i.e. goal time) in any condition. However, 24 h later, on the first post-treatment trial, those haloperidol animals that received heroin in the goal box on the previous trial (i.e. the S+ condition) ran reliably more slowly than subjects that received vehicle on the previous S+ trial. These results suggest that haloperidol does not affect the motivational properties of stimuli which predict the availability of heroin, while it does diminish the reinforcing effects of actually receiving heroin.

Effects of closed-head injury on attentional processes: generality of Sternberg's additive factor method

The present study examined the generality of Shum, McFarland, Bain, and Humphreys' (1990) findings that closed-head injury (CHI) selectively impairs different processes of attention (operationalized in terms of stages of information processing) depending on the severity of, and the time since, injury. The procedure of Shum et al. was based on Sternberg's additive factor method (AFM), with the mode of information processing involved being a physical-directional matching of visual stimuli. The present study followed a similar procedure except that a name-matching task was used. This task was administered to 16 first-year psychology students and two groups of CHI patients (viz., severe short-term (SS) and severe long-term (SL)) with matched control groups. The results obtained replicated the study by Shum in that the SS group was found to be impaired on the identification and response-selection stages of information processing whereas the SL group was found to be impaired only on the response-selection stage. The present study confirms that the AFM is not limited to one specific mode of information process and strengthens the validity of the conclusions made by Shum et al. regarding the effects of CHI on attention.

Assessment of attention: relationship between psychological testing and information processing approaches

Examined the relationship between the psychological testing and information processing approaches in assessing attention. Eighty-seven subjects (57 females, 30 males) undertook eight psychological tests of attention and a visual-spatial reaction-time task. Using the cognitive-correlate method (Posner & McLeod, 1982), it was found that three components of attention (viz., visual-motor scanning, sustained selective processing, and visual/auditory spanning) derived from the psychological tests could be significantly predicted by specific, yet different, combinations of six indices of information processing (mean reaction time (RT), mean movement time (MT), feature extraction, identification, response selection, and motor adjustment): (a) mean RT and mean MT were found to be the most important indices for predicting performance on visual-motor scanning; (b) the motor-adjustment stage was found to be the most important index for predicting performance on sustained selective processing; (c) the response-selection stage was found to be the most important index for predicting performance on visual/auditory spanning. These relationships are important for supporting the construct-related validity of the psychological tests of attention and for extending the generality and applicability of the RT task.

Hemispheric differences in image generation and use in the haptic modality

Forty adults and 40 children, all right-handed, were presented with either of two series of six nonsense shapes to palpate: Those who were divided into sections by grid lines and thus provided categorical information or those who provided a whole shape and coordinate information that could be processed globally. Subjects were given an Input condition where they formed a mental representation of the shape while palpating the unseen tactual stimulus with either hand, followed by an Evaluation condition in which they attempted to solve the task by generating and using the previously stored image. Evaluation response times showed that the left hemisphere was significantly faster at generating images from categorically stored information. Neither hemisphere had an advantage when generating an image from globally stored information.

Peritoneal dialysis in the neonatal period: outcome data

Scant information exists on the prognosis of infants with renal failure who receive peritoneal dialysis in the first month of life. We reviewed the outcome of 23 such patients 1 year after the onset of renal failure. Diagnoses included acute tubular necrosis (11 infants), renal dysplasia (5), obstructive uropathy (4), polycystic kidney disease (1), renal vein thrombosis (1), and renal artery thrombosis (1). Seven of the eleven patients with acute tubular necrosis had had cardiac surgery. At 1 year, eight (35%) of the patients had died, six (26%) had a full recovery, seven (30%) were receiving long-term dialysis awaiting a transplant, and two (9%) had chronic renal failure. Effective dialysis, characterized by the reversal of metabolic disturbances or attainment of fluid balance, was accomplished in all patients. The mean duration of dialysis was 4.5 months (range, 0.1 to 12 months). The most common complications of dialysis were peritonitis and catheter exit site infection. Despite the provision of supplemental calories via nasogastric tube, the majority of patients receiving long-term dialysis showed impaired growth and mild developmental abnormalities. Peritoneal dialysis is an effective means of renal replacement therapy in the neonatal period; however, the morbidity and mortality rate for this population remains high.

Attentional deficits in head-injured children: an information processing analysis

Attentional problems of closed head-injured (CHI) children were examined using an information processing (IP) approach. Based on Sternberg's (1969) additive factor method (AFM), the study examined attentional processes in terms of four stages and their corresponding task variables. A visual-spatial choice reaction-time task was undertaken with two groups of CHI children (severe and mild to moderate) and corresponding matched control groups. Results indicated that for this task both the CHI and the normal children exhibited a similar mode of linear, sequential information processing. It was found that the severe group was impaired not only in terms of slowed motor execution but also in terms of response selection. This group showed no impairment on the feature extraction, stimulus identification, and motor adjustment stages of processing. No evidence of impairment on any of the stages was found for the mild group. The utility of the AFM and implications of these findings are discussed with reference to CHI children and to neuropsychological assessment and rehabilitation.

A simple dual-task study of laterality, sex-differences and handedness

Nine-hundred and eighty-one right-handed and 55 left-handed subjects were required to tap with a pen for 10 secs between targets 6 cm apart whilst either saying nothing, reciting a tongue-twister or saying la-la. The numbers of dots produced in 10 secs in each condition were analysed. The right-handed group demonstrated the usually found degradation in their right-hand performance whilst reciting the meaningful words, but showed a lesser effect when saying la-la. Their left-handed performance was essentially unaffected. Absolutely no evidence for the presence of a sex difference in lateralization of language was found. The much smaller sample of left-handed subjects presented a complex picture of no significant effects, whether they were the sole left-handers in their family, or had other left-handed close relations.