Variable but not random: temporal pattern coding in a songbird brain area necessary for song modification

Practice of a complex motor gesture involves motor exploration to attain a better match to target, but little is known about the neural code for such exploration. We examine spiking in a premotor area of the songbird brain critical for song modification and quantify correlations between spiking and time in the motor sequence. While isolated spikes code for time in song during performance of song to a female bird, extended strings of spiking and silence, particularly bursts, code for time in song during undirected (solo) singing, or "practice." Bursts code for particular times in song with more information than individual spikes, and this spike-spike synergy is significantly higher during undirected singing. The observed pattern information cannot be accounted for by a Poisson model with a matched time-varying rate, indicating that the precise timing of spikes in both bursts in undirected singing and isolated spikes in directed singing code for song with a temporal code. Temporal coding during practice supports the hypothesis that lateral magnocellular nucleus of the anterior nidopallium neurons actively guide song modification at local instances in time.NEW & NOTEWORTHY This paper shows that bursts of spikes in the songbird brain during practice carry information about the output motor pattern. The brain's code for song changes with social context, in performance versus practice. Synergistic combinations of spiking and silence code for time in the bird's song. This is one of the first uses of information theory to quantify neural information about a motor output. This activity may guide changes to the song.

Acupuncture for the Treatment of Animal Pain

Acupuncture is recognized to induce multifactorial changes in the neuroregulatory aspects of pain physiology. Many aspects overlap with known receptor interactions of commonly used analgesic drugs, and acupuncture can increase the efficacy or replace the use of these pharmacologic pain treatments. This article discusses the currently recognized components of the pain pathways that are modified by acupuncture. It introduces the role of fibroblasts and fascia in mechanotransduction and discusses the ways in which this provides a link between the acupuncture needle and the nervous system and is a conduit for extracellular fluid movement, lymphatics, and the immune system.

An evaluation of apnea or spontaneous ventilation in early recovery following mechanical ventilation in the anesthetized horse

OBJECTIVE

To compare arterial oxygen and carbon dioxide tensions in apneic and spontaneously ventilating horses recovering from anesthesia.

STUDY DESIGN

Randomized clinical trial.

ANIMAL POPULATION

Forty-two healthy horses averaging 466 ± 106 kg and 6 ± 5 years of age.

METHODS

Anesthetized horses undergoing a variety of surgical procedures and receiving positive pressure ventilation (IPPV) were divided into two equal groups. One group was allowed to return to spontaneous ventilation prior to disconnection from the anesthetic circuit (weaned). The other group remained apneic during transport to a recovery stall. Arterial blood gas data were collected at five time points: 20 minutes before moving to a recovery stall (t = - 20); at the time the anesthetic circuit was disconncted (t = 0); at 3 and 5 minutes post-disconnection (t = 3 and t = 5) and at the time of the first spontaneous breath (t = sv). The data were analyzed using an anova method for repeated measures and paired, two-tailed t-tests. Significance was assumed when p < 0.05.

RESULTS

The apneic group took a mean of 5 minutes 18 seconds (± 135 seconds) before starting spontaneous ventilation. This group maintained significantly higher PaO₂ levels at intermediate time points (t = 0 and t = 3) but no difference was noted after 5 minutes. PaCO₂ levels were higher in the weaned group at time 0 minutes, returning to a comparable level to the apneic group at t = 3 minutes.

CONCLUSIONS AND CLINICAL RELEVANCE

Horses can survive a short period of apnea during transport from the surgery suite to recovery stall and may benefit from a reduced incidence of transient hypoxemia compared with spontaneously ventilating horses. This information has practical implications for the anesthetist evaluating the options for discontinuing IPPV when horses are moved to a recovery stall.

Validation of the English version of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in cats

Background

A scale validated in one language is not automatically valid in another language or culture. The purpose of this study was to validate the English version of the UNESP-Botucatu multidimensional composite pain scale (MCPS) to assess postoperative pain in cats. The English version was developed using translation, back-translation, and review by individuals with expertise in feline pain management. In sequence, validity and reliability tests were performed.

Results

Of the three domains identified by factor analysis, the internal consistency was excellent for ‘pain expression’ and ‘psychomotor change’ (0.86 and 0.87) but not for ‘physiological variables’ (0.28). Relevant changes in pain scores at clinically distinct time points (e.g., post-surgery, post-analgesic therapy), confirmed the construct validity and responsiveness (Wilcoxon test, p < 0.001). Favorable correlation with the IVAS scores (p < 0.001) and moderate to very good agreement between blinded observers and ‘gold standard’ evaluations, supported criterion validity. The cut-off point for rescue analgesia was > 7 (range 0–30 points) with 96.5% sensitivity and 99.5% specificity.

Conclusions

The English version of the UNESP-Botucatu-MCPS is a valid, reliable and responsive instrument for assessing acute pain in cats undergoing ovariohysterectomy, when used by anesthesiologists or anesthesia technicians. The cut-off point for rescue analgesia provides an additional tool for guiding analgesic therapy.

A multimodal approach to management of suspected neuropathic pain in a prairie falcon (Falco mexicanus)

An adult male prairie falcon (Falco mexicanus) was presented for evaluation and treatment of self-inflicted wounds along the right proximal patagium. The bird had started self-traumatizing approximately 1 month after fracturing the right metacarpus, although the fracture had stabilized, surface wounds had healed completely, and treatment with a nonsteroidal antiinflammatory drug had been administered. The bird was treated with gabapentin (11 mg/kg p.o. q12h), ketamine (0.5 mg/kg i.m. q24h), and low level laser therapy (LLLT) (<5 mW, 630-680 nm, 5-second application per site) for 3 weeks, but, despite initial improvement, new self-inflicted wounds appeared at the same site. Approximately 1.5 months later, a radial and medianoulnar nerve block was performed by using bupivacaine (2 mg/kg) and medetomidine (0.5 microg/kg). In addition, the dosing interval of ketamine was increased to q12h, and the dose of gabapentin was increased 7.5-fold. A higher energy and wavelength of LLLT (1040 mW, 830 nm, 2 J/cm2) was applied once to the injured region and fracture site, then the original LLLT protocol was applied once daily. After 2.5 months, the wounds healed completely and no further mutilation took place. Once deemed ready for release, the falcon was returned to the wild after 181 days in captivity. This is the first reported application of successful multimodal analgesia in a raptor with uncontrolled neuropathic pain.

Heterotopic implantation of a porcine bioprosthetic heart valve in a dog with aortic valve endocarditis

CASE DESCRIPTION

A 5-year-old male German Shepherd Dog was evaluated because of a 5-month history of progressive lethargy, weight loss, and heart failure.

CLINICAL FINDINGS

On physical examination, bounding femoral pulses and systolic and diastolic murmurs were detected. Echocardiography revealed severe aortic valve insufficiency (AVI) and a large vegetative lesion on the aortic valve consistent with aortic valve endocarditis. The AVI velocity profile half-time was 130 milliseconds; the calculated peak systolic pressure gradient across the aortic valve was 64 mm Hg. Left ventricular diameter during diastole was 63.6 mm (predicted range, 40.2 to 42 mm) and during systole was 42.9 mm (predicted range, 25.4 to 27 mm). Systolic, diastolic, and mean arterial blood pressures were 120, 43, and 65 mm Hg, respectively.

TREATMENT AND OUTCOME

To palliate severe AVI, the descending aorta was occluded (duration, 16.75 minutes) and heterotopic implantation of a porcine bioprosthetic heart valve in that vessel was performed. After surgery, systolic, diastolic, and mean arterial blood pressures were 115, 30, and 61 mm Hg, respectively, in the forelimb and 110, 62, and 77 mm Hg, respectively, in the hind limb. Within 6 months, the AVI velocity profile half-time had increased to 210 milliseconds, indicating diminished severity of AVI. After 24 months, the dog was able to engage in vigorous exercise; no pulmonary edema had developed since surgery.

CLINICAL RELEVANCE

Heterotopic bioprosthetic heart valve implantation into the descending aorta during brief aortic occlusion appears feasible in dogs and may provide substantial palliation for dogs with severe AVI.

Pharmacokinetics and anesthetic and cardiopulmonary effects of propofol in red-tailed hawks (Buteo jamaicensis) and great horned owls (Bubo virginianus)

OBJECTIVE

To determine induction doses, anesthetic constant rate infusions (CRI), and cardiopulmonary effects of propofol in red-tailed hawks and great horned owls and propofol pharmacokinetics in the owls during CRI.

ANIMALS

6 red-tailed hawks and 6 great horned owls.

PROCEDURE

The CRI dose necessary for a loss of withdrawal reflex was determined via specific stimuli. Anesthesia was induced by IV administration of propofol (1 mg/kg/min) and maintained by CRI at the predetermined dose for 30 minutes. Heart and respiratory rates, arterial blood pressures, and blood gas tensions were obtained in awake birds and at various times after induction. End-tidal CO2 (ETCO2) concentration and esophageal temperature were obtained after induction. Propofol plasma concentrations were obtained after induction and after completion of the CRI in the owls. Recovery times were recorded.

RESULTS

Mean +/- SD doses for induction and CRI were 4.48 +/- 1.09 mg/kg and 0.48 +/- 0.06 mg/kg/min, respectively, for hawks and 3.36 +/- 0.71 mg/kg and 0.56 +/- 0.15 mg/kg/min, respectively, for owls. Significant increases in PaCO2, HCO3, and ETCO2 in hawks and owls and significant decreases in arterial pH in hawks were detected. A 2-compartment model best described the owl pharmacodynamic data. Recovery times after infusion were prolonged and varied widely. Central nervous system excitatory signs were observed during recovery.

CONCLUSIONS AND CLINICAL RELEVANCE

Effects on blood pressure were minimal, but effective ventilation was reduced, suggesting the need for careful monitoring during anesthesia. Prolonged recovery periods with moderate-to-severe excitatory CNS signs may occur in these species at these doses.

Clinical pain management techniques for cats

Although pain management is an emerging and popular topic in veterinary medicine, use of analgesics in cats has received little attention relative to their canine counterparts. Some of the difficulty lies in assessment of whether or not a cat is in pain. Simple observation of a cat in a cage relies upon overt expression of pain, and is often inaccurate. Pain scales have been developed that allow a semiquantitative evaluation of the degree of pain an animal may be experiencing. However, treating pain based upon observation of the painful state is less effective than anticipating and preemptively treating pain. This article reviews specific methods for preemptively treating and alleviating pain in the cat. The traditional approach to pain management involves drug administration. Specific categories of agents used in cats include opioids, nonsteroidal anti-inflammatories, or alpha-2 agonists. Other modalities of pain management, which are also reviewed, include use of local anesthetic drugs for local and regional analgesia, as well as acupuncture.

Rasch models overview

This overview of Rasch measurement models begins with a conceptualization of our continuous experiences that are often captured as discrete observations. It goes on to discuss the properties that are require of measures if they are to transcend the occasion in which they were collected, and concludes with a discussion the spiral of inferential development. This is followed by a discussion of the mathematical properties of the Rasch family of models that allow the transformation of discrete deterministic counts into continuous probabilistic abstractions on which science is based. The overview concludes with a discussion of six of the family of Rasch models, Binomial Trials, Poisson Counts, Rating Scale, Partial Credit, and Ranks and the types of data for which these models are appropriate.

Overexpression of HER2/neu in solid tumours: an immunohistochemical survey

AIMS

Using a standardized immunohistochemical assay we have evaluated 575 primary neoplasms of different histogenesis to determine the incidence of HER2 overexpression in some of the most common categories of human solid neoplasms. This study addresses the variable incidence of HER2 overexpression previously published for some tumour types.

METHODS AND RESULTS

The immunohistochemical staining was performed on paraffin sections of surgical specimens and a well-defined scoring system based upon numbers of HER2 receptors expressed on the cell surface was applied. Overexpression of HER2 as defined as a HER2 score of equal or greater than 2 was seen in breast cancer (22%), pulmonary adenocarcinoma (28%), colorectal adenocarcinomas (17%), pulmonary squamous (11%) and gastric adenocarcinomas (11%). As expected, the proportion of cases with a HER2 score of 3 was highest in breast cancer. Contrary to published results prostate and pancreas adenocarcinomas showed a very low incidence of HER2 overexpression.

CONCLUSIONS

Overexpression of HER2 is detected immunohistochemically in a proportion of epithelial neoplasms of diverse histogenesis in addition to ductal breast cancer. The standardized format of the assay will allow comparative analyses of studies performed at different institutions.

Detecting unexpected variables in the MMPI 2 Social Introversion scale

The standard scoring structure of the revised Minnesota Multiphasic Personality Inventory (MMPI-2) Social Introversion (Si) scale was reexamined with Rasch Measurement. The 69-item Si scale split into two distinct dimensions when their standardized residuals were factor analyzed. Items keyed "true" to Si defined one dimension and items keyed "false" defined another. Relationships between Lexile values (an index of reading difficulty and comprehension) and item difficulties were also explored. The article shows how to use Rasch Measurement to understand and improve personality assessment.

A new look at the Western Ontario and McMaster Universities Osteoarthritis Index using Rasch analysis

OBJECTIVE

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a valid and widely used instrument for the assessment of osteoarthritis patients. We examined whether applying Rasch analysis, a new item-response theory, supports its metric properties.

METHODS

The metric properties were examined in a cohort of patients with osteoarthritis of the hip or knee. In an exploratory approach, a validated German version of the WOMAC was analyzed using Rasch analysis for its unidimensionality and construct definition.

RESULTS

One hundred fifty-eight patients were included in the study. The 3 WOMAC domains--pain, stiffness, and physical function--were unidimensional when examined separately. In an analysis including all items, the stiffness items did not fit the model. This indicates that they are distinct from the pain and function items. Item difficulty analyses revealed redundancy between corresponding pain and function items addressing the same task (e.g., "pain while standing upright" and "difficulty while standing").

CONCLUSION

Applying Rasch analysis to the 3 WOMAC domains confirms their unidimensionality. However, the pain and function items seem to represent the same construct. Thus, it may be possible to simplify these domains to avoid redundancy. The impact of reducing items must nevertheless be examined.

FIZZ1, a novel cysteine-rich secreted protein associated with pulmonary inflammation, defines a new gene family

Bronchoalveolar lavage fluid from mice with experimentally induced allergic pulmonary inflammation contains a novel 9.4 kDa cysteine-rich secreted protein, FIZZ1 (found in inflammatory zone). Murine (m) FIZZ1 is the founding member of a new gene family including two other murine genes expressed, respectively, in intestinal crypt epithelium and white adipose tissue, and two related human genes. In control mice, FIZZ1 mRNA and protein expression occur at low levels in a subset of bronchial epithelial cells and in non-neuronal cells adjacent to neurovascular bundles in the peribronchial stroma, and in the wall of the large and small bowel. During allergic pulmonary inflammation, mFIZZ1 expression markedly increases in hypertrophic, hyperplastic bronchial epithelium and appears in type II alveolar pneumocytes. In vitro, recombinant mFIZZ1 inhibits the nerve growth factor (NGF)-mediated survival of rat embryonic day 14 dorsal root ganglion (DRG) neurons and NGF-induced CGRP gene expression in adult rat DRG neurons. In vivo, FIZZ1 may modulate the function of neurons innervating the bronchial tree, thereby altering the local tissue response to allergic pulmonary inflammation.

Mapping variables

This paper describes Mapping Variables, the principal technique for planning and constructing a test or rating instrument. A variable map is also useful for interpreting results. Modest reference is made to the history of mapping leading to its importance in psychometrics. Several maps are given to show the importance and value of mapping a variable by person and item data. The need for a critical appraisal of maps is also stressed.

A new look at the Western Ontario and McMaster Universities Osteoarthritis Index using Rasch analysis

OBJECTIVE

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a valid and widely used instrument for the assessment of osteoarthritis patients. We examined whether applying Rasch analysis, a new item-response theory, supports its metric properties.

METHODS

The metric properties were examined in a cohort of patients with osteoarthritis of the hip or knee. In an exploratory approach, a validated German version of the WOMAC was analyzed using Rasch analysis for its unidimensionality and construct definition.

RESULTS

One hundred fifty-eight patients were included in the study. The 3 WOMAC domains--pain, stiffness, and physical function--were unidimensional when examined separately. In an analysis including all items, the stiffness items did not fit the model. This indicates that they are distinct from the pain and function items. Item difficulty analyses revealed redundancy between corresponding pain and function items addressing the same task (e.g., "pain while standing upright" and "difficulty while standing").

CONCLUSION

Applying Rasch analysis to the 3 WOMAC domains confirms their unidimensionality. However, the pain and function items seem to represent the same construct. Thus, it may be possible to simplify these domains to avoid redundancy. The impact of reducing items must nevertheless be examined.

VEGF is required for growth and survival in neonatal mice

We employed two independent approaches to inactivate the angiogenic protein VEGF in newborn mice: inducible, Cre-loxP- mediated gene targeting, or administration of mFlt(1–3)-IgG, a soluble VEGF receptor chimeric protein. Partial inhibition of VEGF achieved by inducible gene targeting resulted in increased mortality, stunted body growth and impaired organ development, most notably of the liver. Administration of mFlt(1–3)-IgG, which achieves a higher degree of VEGF inhibition, resulted in nearly complete growth arrest and lethality. Ultrastructural analysis documented alterations in endothelial and other cell types. Histological and biochemical changes consistent with liver and renal failure were observed. Endothelial cells isolated from the liver of mFlt(1–3)-IgG-treated neonates demonstrated an increased apoptotic index, indicating that VEGF is required not only for proliferation but also for survival of endothelial cells. However, such treatment resulted in less significant alterations as the animal matured, and the dependence on VEGF was eventually lost some time after the fourth postnatal week. Administration of mFlt(1–3)-IgG to juvenile mice failed to induce apoptosis in liver endothelial cells. Thus, VEGF is essential for growth and survival in early postnatal life. However, in the fully developed animal, VEGF is likely to be involved primarily in active angiogenesis processes such as corpus luteum development.

Rasch measurement for reducing the items of the Nottingham Health Profile

The present study aimed to develop a short form of the Spanish version of the Nottingham Health Profile (NHP) by means of Rasch analysis. Data from several Spanish studies that included the NHP since 1987 were collected in a common database. Forty-five different studies were included, covering a total of 9,419 subjects both from the general population and with different clinical pathologies. The overall questionnaire (38 items) was simultaneously analyzed using the dichotomous response model. Parameter estimates, model-data fit and separation statistics were computed. The items of the NHP were additionally regrouped into two different scales: Physical (19 items) and Psychological (19 items). Separated Physical and Psychological parameter estimates were produced using the simultaneous item calibrations as anchor values. Misfitting items were deleted, resulting in a 22 item final short form (NHP22)-11 Physical and 11 Psychological-. The evaluation of the item hierarchies confirmed the construct validity of the new questionnaire. To demonstrate the invariance of the NHP22 item calibrations, Rasch analyses were performed separately for each study included in the sample and for several sociodemographic and health status variables. Results confirmed the validity of using the NHP22 item calibrations to measure different groups of people categorized by gender, clinical and health status.

FIM measurement properties and Rasch model details

To summarize, we take issue with the criticisms of Dickson & Köhler for two main reasons: 1. Rasch analysis provides a model from which to approach the analysis of the FIM, an ordinal scale, as an interval scale. The existence of examples of items or individuals which do not fit the model does not disprove the overall efficacy of the model; and 2. the principal components analysis of FIM motor items as presented by Dickson & Köhler tends to undermine rather than support their argument. Their own analyses produce a single major factor explaining between 58.5 and 67.1% of the variance, depending upon the sample, with secondary factors explaining much less variance. Finally, analysis of item response, or latent trait, is a powerful method for understanding the meaning of a measure. However, it presumes that item scores are accurate. Another concern is that Dickson & Köhler do not address the issue of reliability of scoring the FIM items on which they report, a critical point in comparing results. The Uniform Data System for Medical Rehabilitation (UDSMRSM) expends extensive effort in the training of clinicians of subscribing facilities to score items accurately. This is followed up with a credentialing process. Phase 1 involves the testing of individual clinicians who are submitting data to determine if they have achieved mastery over the use of the FIM instrument. Phase 2 involves examining the data for outlying values. When Dickson & Köhler investigate more carefully the application of the Rasch model to their FIM data, they will discover that the results presented in their paper support rather than contradict their application of the Rasch model! This paper is typical of supposed refutations of Rasch model applications. Dickson & Köhler will find that idiosyncrasies in their data and misunderstandings of the Rasch model are the only basis for a claim to have disproven the relevance of the model to FIM data. The Rasch model is a mathematical theorem (like Pythagoras') and so cannot be disproven by empirical data once it has been deduced on theoretical grounds. Sometimes empirical data are not suitable for construction of a measure. When this happens, the routine fit statistics indicate the unsuitable segments of the data. Most FIM data do conform closely enough to the Rasch model to support generalizable linear measures. Science can advance!

Improving detection of violence among pregnant adolescents

PURPOSE

The purpose of this study was to determine whether a systematic assessment protocol could increase reporting of violence among pregnant adolescents compared with a routine prenatal assessment. This study also sought to examine issues related to violence assessment among maternity care coordinators.

METHODS

The Maternity Care Coordination (MCC) program in a health department prenatal clinic in North Carolina routinely screened all clients for violence at their first visit. This assessment was not standardized. In 1994, the MCC program implemented a systematic violence assessment protocol for all adolescents (n = 117). The protocol assessed violence at three points during pregnancy by asking one direct question: "Have you been hit, slapped, kicked, or hurt during this pregnancy?" To examine the effectiveness of the system, we retrospectively reviewed the 1993 MCC records in which the coordinators routinely screened clients for violence (n = 129). To examine issues related to screening, we conducted in-depth interviews with the maternity care coordinators.

RESULTS

The routine pre-intervention assessment indicated that 5.4% of adolescents 12-19 years of age reported prenatal violence. The systematic assessment protocol resulted in a significant increase in reported violence from 5.4% to 16.2% (odds ratio = 2.9, 95% confidence interval = 1.6, 5.6, adjusted for race). Maternity care coordinators identified five factors related to increased reporting using the standardized protocol: (a) written protocol and data collection form; (b) asking direct, specific questions; (c) not labeling the victim; (d) not naming the perpetrator; and (e) conducting multiple assessments.

CONCLUSIONS

Multiple, direct, systematic assessments throughout prenatal care resulted in increased reporting of prenatal violence among adolescents compared to single, routine, nonstructured assessments.

Assessing for violence during pregnancy using a systematic approach

OBJECTIVES

The purpose of this study was to determine whether a systematic, multiple assessment protocol could increase reporting of prenatal violence compared with a one-time routine assessment.

METHOD

In 1994, the Maternity Care Coordination (MCC) program in a health department prenatal clinic in North Carolina implemented a concise, systematic assessment protocol on all 384 women who enrolled in the program from April 1994 to April 1995. The protocol assessed for violence at three times during pregnancy using the direct question, "Have you been hit, slapped, kicked, or hurt during this pregnancy?" To determine the effectiveness of the system, we retrospectively examined the 1991-1993 MCC records (n = 1056) in which the care coordinators routinely screened all clients for violence at their first visit only.

RESULTS

Compared with the routine assessment approach, the new systematic assessment protocol increased reporting of prenatal violence at the initial prenatal visit from 6.3% to 10.9% (relative risk = 1.7, 95% confidence interval = 1.2, 2.5), and the multiple assessments increased reporting of prenatal violence to 14.1% (relative risk = 2.2, 95% confidence interval = 1.6, 3.1).

CONCLUSIONS

Our study suggests that a concise and systematic screening technique using direct questions combined with multiple assessments increased reporting of prenatal violence compared with a single routine assessment.

Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury

OBJECTIVE

The increasing use of disability measures requires that the validity of these instruments be adequately demonstrated. This study sought to evaluate the concurrent validity of one disability measure, the Functional Independence Measure (FIMSM) using minutes of care reported by nursing staff.

STUDY DESIGN

Correlational, cohort design.

SETTING

Eight inpatient medical rehabilitation hospitals that subscribe to the Uniform Data System for Medical Rehabilitation.

PATIENTS OR OTHER PARTICIPANTS

129 patients with traumatic brain injury (TBI) and 53 patients with traumatic spinal cord injury (SCI).

INTERVENTIONS

Routine rehabilitation care.

MAIN OUTCOME MEASURES

Patient-nurse contact times were recorded with a stop watch for a 24-hour period during the first and last weeks of inpatient rehabilitation. The FIM was also completed during the first and last weeks of rehabilitation.

RESULTS

Contact times declined from the first to last weeks of rehabilitation, concurrent with improving scores on motor and cognitive measures derived from the FIM. Statistically significant correlations between contact times and FIM measures were observed for medication dispensing, treatment provision, and teaching/activities of daily living at admission and discharge. Smaller and usually nonsignificant correlations were observed in activities that did not involve direct patient contact. Contact times increased exponentially as disability increased.

CONCLUSIONS

These results support the construct validity of the FIM by demonstrating strong relationships (r values in the range of .40 to .60) between burden of care and a measure of disability.

Impact of the loop electrosurgical excision procedure on future fertility

OBJECTIVE

The loop electrosurgical excision procedure (LEEP) is a popular and effective method of conservatively treating premalignant lesions of the cervix in reproductive-age women. While the safety and effectiveness of LEEP has been documented, few data have been collected on the long-term effect of LEEP of the cervix on subsequent fertility. The purpose of this study was to determine that effect.

STUDY DESIGN

A retrospective, cohort study with chart review and telephone or mail-in survey. One hundred fifty-eight women seen in the colposcopy clinic at New Hanover Regional Medical Center for abnormal cervical cytologic smears from January 1991 through December 1992 were surveyed concerning their reproductive history since undergoing colposcopy. The study group consisted of 79 women who had been treated with LEEP after demonstrating abnormalities on colposcopically directed cervical biopsy. The control group consisted of 79 women who underwent colposcopy and cervical biopsy without subsequent LEEP of the cervix.

RESULTS

One hundred eleven women responded to the survey. In this study group, 11 of the 12 women who desired pregnancy actually became pregnant in the in interval between treatment and completion of the survey. All 17 patients in the control group who desired pregnancy became pregnant.

CONCLUSION

In our patient population there appeared to be no significant detrimental effect of LEEP on future fertility. These preliminary findings are reassuring, however, due to the small sample size, the study lacked sufficient power for us to draw definitive conclusions.

Effect of MgSO4 on heart rate monitoring in the preterm fetus

OBJECTIVE

To evaluate in a controlled, blind fashion, using both subjective and objective criteria, whether MgSO4 is associated with clinically significant changes in fetal heart rate monitoring.

STUDY DESIGN

Fetal heart rate tracings were prospectively collected before and after MgSO4 loading in 50 preterm labor patients. Three obstetricians, blind to treatment status, graded the tracings using both subjective and objective criteria.

RESULTS

The baseline fetal heart rate declined slightly after therapy. Subjective, but not objective, evaluation demonstrated a greater likelihood of decreased variability after MgSO4 loading. There was no difference in periodic changes after MgSO4 loading. Multiple regression analysis showed a greater likelihood of decreased variability at earlier gestational ages but no relationship to the serum magnesium level.

CONCLUSION

Magnesium sulfate tocolysis is associated with a subjective decrease in fetal heart rate variability in the preterm fetus.

Rasch analysis of Visual Analog Scale measurements before and after treatment of Patellofemoral Pain Syndrome in women

The Visual Analog Scale (VAS) can be used to record subjectively experienced pain in different situations (items). By a mathematical method, the Rasch analysis, the original VAS recordings can be converted to an interval scale. Forty women with Patellofemoral Pain Syndrome (PFPS) reported their pain on the VAS from 12 different situations (items) before and after 12 weeks of rehabilitation. The items recorded pain during the last 3 months, during provocation tests, and during activities such as walking up stairs, jumping and strength testing. It was concluded that the items used for the patients with PFPS were hierarchically ordered in a statistically equivalent manner before and after rehabilitation. Subjectively reported pain after 12 weeks of rehabilitation was significantly alleviated for 23 (58%) of the 40 patients, compared with before rehabilitation. The patients with PFPS did not use the VAS as a linear scale over the full range. Rasch analysis of recordings made with the VAS gave a more detailed pain assessment.

Functional status and therapeutic intensity during inpatient rehabilitation

The objective of this study was to describe the relationships between functional status at discharge and intensity of therapies received during inpatient medical rehabilitation. The sample was comprised of 140 patients with traumatic brain injury and 106 patients with spinal cord injury at eight hospitals that subscribe to the Uniform Data System for Medical Rehabilitation. Data included linear measures of motor and cognitive ability derived from the Functional Independence Measure at admission to and discharge from rehabilitation. Multiple regression was used to predict intensity of therapies, discharge motor and cognitive function, the extent to which potential functional gains were achieved, and the efficiency of gains. Intensities of occupational, physical, and speech therapies were not significant predictors of outcomes for either group, controlling linearly for admission function, psychology intensity, length of stay, onset to admission interval, age, and interrupted stays. Only intensity of psychology services seemed to have any relation to functional gain (in cognition for patients with traumatic brain injury). The apparent lack of benefit related to intensity of therapies may be due to factors such as spontaneous recovery, goals not measured by the Functional Independence Measure, limited modulation of therapy intensity according to likely patient responsiveness, or therapies focused on impairment or other goals rather than disability. We suggest that efficiently staged rehabilitation should vary the intensity and nature of services according to patients' functional status, impairments, comorbid conditions, and other clinical factors.

Factors affecting number of prenatal care visits during second pregnancy among adolescents having rapid repeat births

PURPOSE

To examine factors associated with the number of prenatal care visits during second pregnancy for adolescents having a short interval between pregnancies.

METHODS

The sample includes all adolescents aged 13 to 17 years whose first pregnancy resulted in a birth at a regional medical center in southeastern North Carolina from January 1983 to December 1989 and who had a repeat pregnancy within 24 months which resulted in a birth. We abstracted data from medical records and birth certificates. We fit a negative binomial regression model to determine the effects of various factors on the number of prenatal care visits during second pregnancy.

RESULTS

The number of prenatal care visits during the first pregnancy, poor first birth outcome, interval between first and second pregnancy, and care provided by health department staff during first pregnancy were all positively associated with number of prenatal care visits during second pregnancy when controlling for gestation age of second birth. Other independent variables in the model included maternal age, education, black race, and being unmarried at the time of second birth.

CONCLUSIONS

Because prenatal care is important for healthy mothers and babies, adolescents should be encouraged to seek prenatal care early in the first pregnancy. This could be an important time to implement interventions aimed at increasing prenatal care utilization in this and subsequent pregnancies.

Septic abortion with intact fetal membranes caused by Campylobacter fetus subsp. fetus

We report a case of septic abortion with intact fetal membranes caused by Campylobacter fetus subsp. fetus in an 18-year-old woman who was 9 1/2 weeks pregnant.

The structure and stability of the Functional Independence Measure

The Functional Independence Measure (FIM) records the severity of disability of rehabilitation patients. The necessarily curvilinear relationship between the finite range of recorded FIM raw scores and the conceptually infinite range of additive disability measures is resolved through Rasch analysis. The analysis of admission and discharge FIM ratings of 14,799 patients shows that the 18 FIM items define two statistically and clinically different indicators. Thirteen items define disability in motor functions. Five items define disability in cognitive functions. Additive measures for each indicator have the same characteristics at admission and discharge, so that these measures can be used to assess change in patient status.

Prediction of rehabilitation outcomes with disability measures

This study evaluated the extent to which rehabilitation outcomes and resource use can be predicted by functional status measures. Linear measures of motor and cognitive function were derived from the Functional Independence Measure for a sample of 27,699 patients undergoing initial rehabilitation. Admission functional status was consistently related to discharge function and length of stay, though the strength of these associations varied with impairment. Motor function was a stronger predictor of length of stay than was cognitive function for all impairments. However, the unique contribution of cognitive function was apparent for specific impairment groups. The predicted variance at discharge in motor function averaged 55%, 70% in cognitive function, and 20% in length of stay. These results support the use of functional status measures in the development of rehabilitation resource use models. Recommendations for future research are proposed.

Roles of kinesin and kinesin-like proteins in sea urchin embryonic cell division: evaluation using antibody microinjection

Previous studies suggest that kinesin heavy chain (KHC) is associated with ER-derived membranes that accumulate in the mitotic apparatus in cells of early sea urchin embryos (Wright, B. D., J. H. Henson, K. P. Wedaman, P. J. Willy, J. N. Morand, and J. M. Scholey. 1991. J. Cell Biol. 113:817-833). Here, we report that the microinjection of KHC-specific antibodies into these cells has no effect on mitosis or ER membrane organization, even though one such antibody, SUK4, blocks kinesin-driven motility in vitro and in mammalian cells. Microinjected SUK4 was localized to early mitotic figures, suggesting that it is able to access kinesin in spindles. In contrast to KHC-specific antibodies, two antibodies that react with kinesin-like proteins (KLPs), namely CHO1 and HD, disrupted mitosis and prevented subsequent cell division. CHO1 is thought to exert this effect by blocking the activity of a 110-kD KLP. The relevant target of HD, which was raised against the KHC motor domain, is unknown; HD may disrupt mitosis by interfering with an essential spindle KLP but not with KHC itself, as preabsorption of HD with KHC did not alter its ability to block mitosis. These data indicate that some KLPs have essential mitotic functions in early sea urchin embryos but KHC itself does not.

Relationships between impairment and physical disability as measured by the functional independence measure

This study was conducted to scale the Functional Independence Measure (FIM) with Rasch Analysis and to determine the similarity of scaled measures across impairment groups. The results show that the FIM contains two fundamental subsets of items: one measures motor and the second measures cognitive function. Rasch analysis of the Uniform Data System for Medical Rehabilitation patient sample yielded interval measures of motor and cognitive functions. The validity of the FIM was supported by the patterns of item difficulties across impairment groups. Adequate clinical precision of the FIM was demonstrated, though suggestions for improvement emerged. The frequency of misfit between patients and the performance scales varied across impairment groups, but was acceptable. The results of this project will enable clinicians and researchers to plan cost-effective treatment by providing a valid measure of disability.

Performance profiles of the functional independence measure

The functional independence measure (FIM) is used to determine the degree of disability that patients experience and the progress that they make through programs of medical rehabilitation. Rasch analysis is a statistical technique for constructing interval measures from ordinal data that was applied to derive FIM measures. The major factors that are taken into account to produce FIM measures are the relative difficulty in performance of FIM items and the ability of the persons tested. Our analyses showed the relative difficulties that patients experienced in performing items in the FIM. There were two dominant patterns of difficulty, one for motor FIM items and the other for cognitive FIM items. The patterns were consistent across impairment groups, although not identical. Of the motor items, eating and grooming were easiest whereas stair climbing, tub/shower transfers and locomotion were most difficult. Of the cognitive items, expression and comprehension were easiest and problem solving was the most difficult. The patterns of difficulty in performing FIM items are illustrated by analysis of the following impairment groups: for motor items, orthopedic conditions, stroke with left hemiparesis and spinal cord dysfunction; for cognitive items, orthopedic conditions, brain dysfunction, stroke with right hemiparesis and spinal cord dysfunction. By understanding patterns of difficulty in performing FIM items according to types of impairment and levels of function, clinicians may more precisely design treatment programs, use services and predict outcomes of medical rehabilitation.

Immunolocalization of kinesin in sea urchin coelomocytes. Association of kinesin with intracellular organelles

We have recently used domain-specific monoclonal antibodies (mAbs) to immunofluorescently localize kinesin to vesicle-like structures in the cytoplasm of sea urchin coelomocytes. In order to characterize further these localization patterns we have examined the distribution of kinesin with respect to the arrangement of microtubules (MTs) and various organelles. In double-label experiments involving the immunofluorescent staining of kinesin (using a mixture of the mAbs SUK2, 4 and 5), MTs were labeled with an antiserum against sea urchin tubulin, the endoplasmic reticulum (ER) was labeled with an antiserum against a luminal calsequestrin-like protein, the Golgi apparatus was labeled with rhodamine-wheat germ agglutinin (WGA) or NBD-ceramide, mitochondria were labeled with rhodamine 123, endosomes were labeled with Texas Red-ovalbumin, and lysosomes were labeled with Lucifer yellow or acridine orange. Kinesin-labeled vesicle-like structures were found in the same regions of the cells as MTs and the ER, being widely distributed in motile cells, but restricted to the perinuclear regions of stationary cells. There also appeared to be a correlation between the distribution of endosomes and kinesin staining in a subpopulation of cells. The kinesin binding structures were found occasionally to align in linear arrays, consistent with the idea that kinesin may transport ER and endosomes along linear MT tracks. No clear correlations were observed between the kinesin staining and the distribution of mitochondria, the Golgi apparatus or lysosomes, suggesting that kinesin may specifically associate with only a subclass of organelles in coelomocytes.

Exacerbation of akinetic seizures by atropine eye drops

A case is reported where atropine sulphate eye drops increased the frequency of fits in a child suffering regular akinetic seizures. This increase was marked and observed during two separate courses of eye drops. This is discussed with reference to previous reports of central nervous toxicity after the use of topical atropine sulphate.

Microtubule motors in the early sea urchin embryo

Sea urchin gametes and early embryos have proven to be a useful system for studying the roles of microtubule (MT)-associated motors in axonemal motility and cytoplasmic MT-based movements in dividing cells. In this brief article, known and potential sea urchin MT motors are listed and their possible biological functions are discussed.

Subcellular localization and sequence of sea urchin kinesin heavy chain: evidence for its association with membranes in the mitotic apparatus and interphase cytoplasm

Kinesin was previously immunolocalized to mitotic apparatuses (MAs) of early sea urchin blastomeres (Scholey, J.M., M.E. Porter, P.M. Grissom, and J.R. McIntosh. 1985. Nature [Lond.]. 318:483-486). Here we report evidence that this MA-associated motor protein is a conventional membrane-bound kinesin, rather than a kinesin-like protein. Our evidence includes the observation that the deduced amino acid sequence of this sea urchin kinesin heavy chain is characteristic of a conventional kinesin. In addition, immunolocalizations using antibodies that distinguish kinesin from kinesin-like proteins confirm that conventional kinesin is concentrated in MAs. Finally, our immunocytochemical data further suggest that conventional kinesin is associated with membranes which accumulate in MAs and interphase asters of early sea urchin embryos, and with vesicles that are distributed in the perinuclear region of coelomocytes. Thus kinesin may function as a microtubule-based vesicle motor in some MAs, as well as in the interphase cytoplasm.

Observations are always ordinal; measurements, however, must be interval

Quantitative observations are based on counting observed events or levels of performance. Meaningful measurement is based on the arithmetical properties of interval scales. The Rasch measurement model provides the necessary and sufficient means to transform ordinal counts into linear measures. Imperfect unidimensionality and other threats to linear measurement can be assessed by means of fit statistics. The Rasch model is being successfully applied to rating scales.

A hydroponic system for microgravity plant experiments

The construction of a permanently manned space station will provide the opportunity to grow plants for weeks or months in orbit for experiments or food production. With this opportunity comes the need for a method to provide plants with a continuous supply of water and nutrients in microgravity. The Capillary Effect Root Environment System (CERES) uses capillary forces to maintain control of circulating plant nutrient solution in the weightless environment of an orbiting spacecraft. The nutrient solution is maintained at a pressure slightly less than the ambient air pressure while it flows on one side of a porous membrane. The root, on the other side of the membrane, is surrounded by a thin film of nutrient solution where it contacts the moist surface of the membrane. The root is provided with water, nutrients and air simultaneously. Air bubbles in the nutrient solution are removed using a hydrophobic/hydrophilic membrane system. A model scaled to the size necessary for flight hardware to test CERES in the space shuttle was constructed.

Effects of the volatile anesthetic halothane on fertilization and early development in the sea urchin Lytechinus variegatus: evidence that abnormal development is due to polyspermy

The volatile anesthetic halothane, when present at fertilization, dose-dependently increases the incidence of abnormally developing sea urchin embryos at the first cell division. Microscopic examinations of eggs stained with aceto-orcein or the DNA fluorochrome bisbenzimide and direct observations on isolated sperm aster complexes show that halothane induces polyspermy (multiple sperm entry) when present at fertilization. Experimental evidence suggests that anesthetic-induced polyspermy involves impairment of both the fast (electrically mediated) and slow (morphological) blocks to multiple sperm entry. These observations clearly show that relatively brief exposures to halothane at fertilization cause polyspermy and that this effect is almost certainly responsible for the ensuing abnormal development observed at the first cell division.