Is it acceptable and feasible to measure prolonged grief disorder symptoms in daily life using experience sampling methodology?

INTRODUCTION: Current grief research is dominated by cross-sectional studies assessing prolonged grief disorder (PGD) symptoms retrospectively. Examining grief in daily life, using Experience Sampling Methodology (ESM), may advance the field. Because of the lack of ESM-research on PGD, we evaluated the acceptability and feasibility of assessing PGD symptoms in daily life of bereaved people. MATERIALS AND METHODS: ESM-items assessing PGD symptoms were developed using cognitive interviewing with five ESM/grief experts. Eighty bereaved adults completed these ESM-items five times a day for two weeks. Before and after this ESM-phase, interviews were administered assessing PGD retrospectively (using the Traumatic Grief Inventory-Clinical Administered). t-tests were performed comparing symptom severity of aggregated moment-to-moment recall (using ESM-items) with retrospective recall (based on interviews) of PGD symptoms. Acceptability of participating in ESM-research (assessed with the Reactions to Research Participation Questionnaire) was examined using descriptive statistics. Feasibility was evaluated by reporting compliance and retention rates. RESULTS: Minor changes were made to the ESM-items based on expert interviews. Average levels of aggregated moment-to-moment recall of the symptoms "yearning" (d = -1.04), "preoccupation with the deceased" (d = -0.91), "marked sense of disbelief" (d = -0.43), and "intense loneliness" (d = -0.28) were lower compared with retrospective recalling these symptoms. On average, bereaved people were neutral about personal benefits gained through participation in this EMS-study. They indicated that participation did not raise emotional reactions. Compliance and retention rates were 60% and 65%, respectively. DISCUSSION: Our findings indicate that whereas compliance and retention is challenging, using ESM to study PGD symptoms in daily life might be useful. Nevertheless, more research is needed.

Citation bias and selective focus on positive findings in the literature on the serotonin transporter gene (5-HTTLPR), life stress and depression.

BACKGROUND: Caspi et al.'s 2003 report that 5-HTTLPR genotype moderates the influence of life stress on depression has been highly influential but remains contentious. We examined whether the evidence base for the 5-HTTLPR-stress interaction has been distorted by citation bias and a selective focus on positive findings. METHOD: A total of 73 primary studies were coded for study outcomes and focus on positive findings in the abstract. Citation rates were compared between studies with positive and negative results, both within this network of primary studies and in Web of Science. In addition, the impact of focus on citation rates was examined. RESULTS: In all, 24 (33%) studies were coded as positive, but these received 48% of within-network and 68% of Web of Science citations. The 38 (52%) negative studies received 42 and 23% of citations, respectively, while the 11 (15%) unclear studies received 10 and 9%. Of the negative studies, the 16 studies without a positive focus (42%) received 47% of within-network citations and 32% of Web of Science citations, while the 13 (34%) studies with a positive focus received 39 and 51%, respectively, and the nine (24%) studies with a partially positive focus received 14 and 17%. CONCLUSIONS: Negative studies received fewer citations than positive studies. Furthermore, over half of the negative studies had a (partially) positive focus, and Web of Science citation rates were higher for these studies. Thus, discussion of the 5-HTTLPR-stress interaction is more positive than warranted. This study exemplifies how evidence-base-distorting mechanisms undermine the authenticity of research findings.

Groundwater contamination in coastal urban areas: Anthropogenic pressure and natural attenuation processes. Example of Recife (PE State, NE Brazil).

In a context of increasing land use pressure (over-exploitation, surface-water contamination) and repeated droughts, identifying the processes affecting groundwater quality in coastal megacities of the tropical and arid countries will condition their long-term social and environmental sustainability. The present study focuses on the Brazilian Recife Metropolitan Region (RMR), which is a highly urbanized area (3,743,854 inhabitants in 2010) on the Atlantic coast located next to an estuarial zone and overlying a multi-layered sedimentary system featured by a variable sediment texture and organic content. It investigates the contamination and redox status patterns conditioning potential attenuation within the shallow aquifers that constitute the interface between the city and the strategic deeper semi-confined aquifers. These latter are increasingly exploited, leading to high drawdown in potenciometric levels of 20-30m and up to 70m in some high well density places, and potentially connected to the surface through leakage. From a multi-tracer approach (major ions, major gases, δ(11)B, δ(18)O-SO4, δ(34)S-SO4) carried out during two field campaigns in September 2012 and March 2013 (sampling of 19 wells and 3 surface waters), it has been possible to assess the contamination sources and the redox processes. The increasing trend for mineralization from inland to coastal and estuarial wells (from 119 to around 10,000µS/cm) is at first attributed to water-rock interactions combined with natural and human-induced potentiometric gradients. Secondly, along with this trend, one finds an environmental pressure gradient related to sewage and/or surface-channel network impacts (typically depleted δ(11)B within the range of 10-15‰) that are purveyors of chloride, nitrate, ammonium and sulfate. Nitrate, ammonium and sulfate (ranging from 0 to 1.70mmol/L, from 0 to 0,65mmol/L, from 0.03 to 3.91mmol/L respectively are also potentially produced or consumed through various redox processes (pyrite oxidation, denitrification, dissimilatory nitrate reduction to ammonium) within the system, as is apparent within a patchwork of biogeochemical reactors. Furthermore, intensive pumping in the coastal area with its high well density punctually leads to temporary well salinization ([Cl] reaching temporarily 79mmol/L). Our results, summarized as a conceptual scheme based on environmental conditions, is a suitable basis for implementing sustainable management in coastal sedimentary hydrosystems influenced by highly urbanized conditions.

Comprehensive DNA barcoding of the herpetofauna of Germany.

We present the first comprehensive DNA barcoding study of German reptiles and amphibians representing likewise the first on the European herpetofauna. A total of 248 barcodes for all native species and subspecies in the country and a few additional taxa were obtained in the framework of the projects 'Barcoding Fauna Bavarica' (BFB) and 'German Barcode of Life' (GBOL). In contrast to many invertebrate groups, the success rate of the identification of mitochondrial lineages representing species via DNA barcode was almost 100% because no cases of Barcode Index Number (BIN) sharing were detected within German native reptiles and amphibians. However, as expected, a reliable identification of the hybridogenetic species complex in the frog genus Pelophylax was not possible. Deep conspecific lineages resulting in the identification of more than one BIN were found in Lissotriton vulgaris, Natrix natrix and the hybridogenetic Pelophylax complex. A high variety of lineages with different BINs was also found in the barcodes of wall lizards (Podarcis muralis), confirming the existence of many introduced lineages and the frequent occurrence of multiple introductions. Besides the reliable species identification of all life stages and even of tissue remains, our study highlights other potential applications of DNA barcoding concerning German amphibians and reptiles, such as the detection of allochthonous lineages, monitoring of gene flow and also noninvasive sampling via environmental DNA. DNA barcoding based on COI has now proven to be a reliable and efficient tool for studying most amphibians and reptiles as it is already for many other organism groups in zoology.

[Outpatient Surgery in German ENT in Teaching Hospitals--Economic Nonsense?]. / Ambulante Operationen in HNO-Ausbildungskliniken - ökonomischer (Un)sinn?

INTRODUCTION: There is an ever-increasing demand to increase efficiency and decrease costs in health care. This leads to an growing number of outpatient surgeries which are less cost effective. Especially in the setting of university teaching hospitals, this may lead to both an undersupply of qualified physicians, as well as to a worsening of clinical training of residents. In order to quantify a possible undersupply and estimate the expense of teaching residents, the time for medical procedures needs to be quantified and compared between board-certified physicians and residents. This was the aim of the current study. MATERIAL AND METHODS: All outpatient adenotomies of children with or without paracentesis or tympanic drainage insertion performed in 2012 in 2 ENT teaching hospitals were analyzed. The length of the surgical procedure as well as the level of training of the surgeon was analyzed. Operating times of residents in training were analyzed stratified by training level and then compared to operation times of board-certified ENT surgeons. RESULTS: 255 procedures were analyzed. Significant differences of the mean operation time could be identified depending on the level of training of residents compared to board-certified ENT surgeons for all investigated training levels. E. g. 1(st) year residents' surgeries required 2.4 times more time than those of board-certified ENT surgeons. CONCLUSION: Based on an analysis of outpatient ENT-surgical procedures it becomes apparent that due to the extended operating times of residents in training outpatient surgery is by far less cost-effective than by board-certified physicians. To cope with the demand of teaching residents for their clinical training, more resources are necessary in the setting of teaching hospitals.

Use of Wisconsin Card Sorting Test short forms with school-age children.

Short forms of the Wisconsin Card Sorting Test (WCST) have been developed and studied in adult populations, however studies addressing their use in children are lacking. This study compared the full WCST to two short forms in a sample of 174 school-age children who were referred for neuropsychological evaluation. Multiple regression was used to predict standard scores (SSs) on the full WCST. Percent scores were obtained, and normative data from the WCST manual was then used to obtain SSs. We found that scores from the short forms were significantly correlated with corresponding scores on the full WCST, however a high proportion of children obtained short form SSs, which differed significantly from the SSs obtained on the full WCST. It is recommended that clinicians use the full WCST with children, unless at least four categories are reached in the first deck.

Evaluation of a WMS-R malingering index in a non-litigating clinical sample.

The purpose of this study was to examine the prevalence of a Wechsler Memory Scale-Revised "malingering index" in a large sample of non-litigating individuals from an inpatient substance abuse program. Past research has demonstrated that experimental-malingerers often obtain substantially lower scores on the Attention/Concentration Index than on the General Memory Index. In the present study, only a small percentage of patients showed large General Memory - Attention/Concentration difference scores. These results provide further support for the validity of this difference score as a marker for non-optimal effort.

Clinical normative data for the WCST-64 following uncomplicated mild head injury.

Clinical norms for the 64-item Wisconsin Card Sorting Test (WCST-64) are presented. The norms were derived from 303 persons presenting for emergency services who met criteria for uncomplicated mild head injury. Most data were obtained within 2 days of injury, and the remaining data were obtained within 10 days of injury. The norms may be used to help determine whether or not a person's scores on the WCST-64 are typical of those seen shortly after sustaining an uncomplicated mild head injury.

Neuropsychological assessment in traumatic brain injury.

The care of patients provided in trauma centers involves many different variables. One of the complicating factors is related to the cognitive and emotional-behavioral consequences of traumatic brain injury. Impairment in attention, memory, communication skills, or planning and problems solving may present significant impediments in the ability of the patient to participate in his or her health care. In addition, the presence of emotional consequences such as anxiety, depression, irritability, and impulsivity may interfere with the ability of the patient to interact successfully with health care personnel. The role of the neuropsychologist is to provide a clinical assessment of the relevant cognitive and emotional problems areas and make suggestions for ways of interacting with and intervening with the brain-injured patient.

Prevalence of abnormal CT-scans following mild head injury.

PRIMARY OBJECTIVE: The purpose of this study was to examine the prevalence of day-of-injury intracranial abnormalities in a large sample of patients with mild head injuries who were admitted to a Trauma Service. METHODS AND PROCEDURES: There were 912 patients who obtained admission Glasgow Coma Scale (GCS) scores of 13-15. MAIN OUTCOMES AND RESULTS: The base rate of complicated mild head injuries (i.e. abnormal CT scans) in this sample was 15.8%. However, nearly 25% of the sample, most of whom had very mild injuries, did not receive CT-scans. Therefore, the actual prevalence is more likely in the range 16-21%. There was a tremendous overlap in injury characteristics between patients with complicated and uncomplicated mild head injuries. None the less, there were modest, yet statistically significant, relationships between the presence of intracranial abnormalities and lower GCS scores, greater frequency of positive loss of consciousness, greater frequency of skull fractures, and lower GOAT scores.

A validity study of the WAIT in closed head injury.

This investigation is a validity study on an instrument designed to assess the cognitive status of CHI patients in the acute phase. The Wolinsky Amnesia Information Test (WAIT) is a questionnaire, orally administered and then scored in a standardized format. Interrater reliability has been previously demonstrated. In this study, the WAIT was compared to the Galveston Orientation and Amnesia Test (GOAT), CT scans, and the Glasgow Coma Scale (GCS). Seventy-five subjects participated in the study, all hospital trauma patients at an urban regional trauma centre, who had been referred to the neuropsychology consult service for cognitive testing. Patients were screened to rule out preexisting developmental, drug, alcohol, or documented prior LOC history. Patients' ages ranged from 18-59, with a mean of 33.45 years. A large majority of the patients (81.3%) were diagnosed with a mild level of CHI. Concurrent, discriminative, and construct validity of the WAIT were investigated, and found satisfactory. The data were submitted to factor analysis in order to uncover underlying constructs. In addition to the 'orientation' and 'amnesia' factors identified through factor analysis, a third factor was found and labelled: 'personal temporal/continuum memory'. Limitations of the study and possible directions for future research are discussed.

Neurobehavioral effects of acute exposure to inorganic mercury vapor.

Mercury has well-established toxic effects on the central nervous system. This article describes comprehensive neuropsychological and emotional functioning of a group of 13 workers exposed to inorganic mercury vapor compared to that of a normal control group. The exposed group was exposed over a 2- to 4-week period and had elevated blood mercury levels. The evaluations were conducted between 10 and 15 months after exposure was terminated. Observed cognitive deficits included impairment in the following domains: motor coordination, speeded processing with and without a motor component, cognitive flexibility, verbal fluency, verbal memory, and visual problem solving and conceptualization. Emotional problems included increased focus on physical functioning, depression, anxiety, and social withdrawal. Cognitive deficits were, for the most part, not significantly associated with the degree of depression present.

Normative comparisons for the controlled oral word association test following acute traumatic brain injury.

The Controlled Oral Word Association Test (COWAT) is widely used in clinical neuropsychology as a measure of verbal fluency. It is important for psychologists to realize that using the recently published normative data will result in different clinical conclusions because the updated normative sample performed better than the original normative sample. The purpose of this study was to compare the original and updated norms in a large sample of patients with acute traumatic brain injuries (N=669). The percentages of patients who scored below the 5th centile in each system varied as a function of brain injury severity. Moreover, a substantially larger number of patients scored in the impaired range according to the updated normative data.

Detecting malingered memory deficits with the Recognition Memory Test.

The purpose of the present study was to examine the efficacy of using the Recognition Memory Test (RMT) as a marker for malingered memory deficits. Data from 60 subjects, including 40 patients seen for neuropsychological evaluation and 20 university undergraduates, are reported. The university students were given experimental instructions to malinger. Students were compared to 20 memory-impaired and 20 memory-nonimpaired patients. The students who were instructed to malinger memory impairment performed more poorly than both groups of patients. Discriminant function analyses using the two scores derived from the RMT as predictors of group membership resulted in a 100% initial correct classification rate and a 96.7% correct classification rate on cross-validation.

Neuropsychological function in restrained versus unrestrained motor vehicle occupants who suffer closed head injury.

It is known that using seatbelts reduces the incidence and severity of closed head injury (CHI) from motor vehicle crashes. One would expect unrestrained occupants in motor vehicle crashes to suffer more severe CHIs than restrained occupants, as reflected by Glasgow Coma Scale (GCS) scores. One might also expect an increased risk of focal injury due to contact forces in unrestrained occupants. The purpose of this study was to test the hypothesis that failure to use seatbelts results in increased severity of neuropsychological sequelae, even with GCS controlled. We also examined the impact of demographic variables on seatbelt use. Subjects included patients admitted to a hospital trauma service who were suspected of having suffered CHI. All patients completed neuropsychological testing, which was entered into a data base along with demographic and clinical information. People who had documented use of seatbelt restraints were compared with those who were unrestrained. Results confirmed that certain demographic variables are associated with the use of seatbelts. Results also suggested that failure to use seatbelt restraints is associated with more severe impairment on tests that are sensitive to frontal lobe dysfunction.

Performance of substance abusers with memory deficits on measures of malingering.

The effects of memory impairment on various malingering indices were assessed in a substance abusing population. Groups were formed by using scores from the Delayed Memory Index of the Wechsler Memory Scale-Revised and selecting individuals from an addictions recovery unit in the top and bottom quintiles. Quintile group differences were found for number correct on free and forced-choice recall on the 21-Item Wordlist; total time for grouped and ungrouped dots on the Rey Dot Counting procedure; and addition errors on the Memorization of 16 Items test. All differences found were in the direction of better performance by subjects with better Delayed Memory Index scores; however, all of the differences were small. With the exception of the free recall index from the 21-Item Wordlist, all subjects had scores on the malingering measures beyond the cutoffs typically used to detect malingering in clinical populations. These findings suggest that, even in memory-impaired populations, memory measures of malingering are valid.

Methods of estimating premorbid functioning.

Clinical neuropsychological assessment frequently requires the comparison of obtained scores against some estimate of premorbid level of functioning, but only recently has significant attention been turned to objective methods to accomplish this objective. Clinical judgment, although useful in some circumstances, is generally insufficient. Other methods of estimating premorbid function include demographic regression formulae, such as the Barona formula, subtest scatter methods, such as that suggested by Lezak, and the use of current scores on tests of presumably spared abilities, such as the National Adult Reading Test (NART). Almost all methods predict to some general level of intellectual functioning rather than to specific neuropsychological skills. This paper reviews the suggested methods in terms of the underlying assumptions and the available empirical evidence. Suggestions for future research include the development of skill specific predictors as well as investigations regarding the relation between predictor accuracy and characteristics of the subject, such as high versus low premorbid functioning in the subject. Additionally, there is a great need for methods to predict premorbid functioning in children.

Neuropsychologists' practice patterns in assessing premorbid intelligence.

The current study surveyed practicing neuropsychologists about the methods they use to estimate premorbid levels of function, and their prior training with these methods. Doctoral level psychologists, who are members of the National Academy of Neuropsychology, were sent a questionnaire developed by the authors to assess these variables. Findings suggest that there is relatively little use of strategies specifically designed to assess premorbid ability. Demographics and training were not associated with methods used. Over one third of the respondents indicated that they believed their formal training had not been adequate in helping them to address this issue.