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.

[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.

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.

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.

Monocyte function is normal in quiescent psoriasis.

We report an investigation of peripheral blood monocytes from untreated patients with mild, quiescent psoriasis. Possible metabolic changes were monitored by the determination of 3 enzymes representing different pathways of glucose metabolism and 2 lysosomal enzymes. Signal processing was evaluated by the measurement of cyclic AMP levels before and after hormonal stimulation. Luminol-amplified chemiluminescence provided an objective approach to assessing phagocytic capacity. Finally, the pattern of maturation of normal and psoriatic monocytes has been compared during culture in vitro. Our results were uniformly and wholly negative; we conclude that the concept of an "intrinsic" abnormality of the psoriatic monocyte may be excluded. Possible reasons for discrepancies in the literature are discussed.

The establishment of clinical cutoffs in measuring caregiver burden in dementia.

Although several scales have been developed to assess burden, their clinical utility has been limited by the absence of relevant cutoff points. Clinical data from 140 primary caregivers seeking a dementia evaluation for a family member were analyzed to establish the psychometric properties of a caregiver burden screen. Results indicate that the cutoff values were both sensitive and specific to negative caregiving outcomes. These findings suggest that use of a burden screen may assist clinicians when assessing the adequacy of caregiving arrangements in dementia.

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.

An interrater reliability study of the Luria-Nebraska Neuropsychological Battery Form-II quantitative scoring system.

This study provides information on the interrater reliability of the quantitative scoring system of the Luria-Nebraska Neuropsychological Battery Form II (LNNB-II). The accuracy of each rater following a training procedure was also evaluated. Six college students served as raters, and participated in a 20-22-hour training procedure. This training procedure utilized a protocol similar to one used in previous interrater reliability studies performed with Form I. Following the training procedure, raters were asked to score two videotaped LNNB-II administrations in which a confederate portrayed test performance that was relatively straightforward to score, as well as more ambiguous test performance. Excellent interrater agreement and accuracy were found on the quantitative scoring on both tapes. Implications for training in administration and scoring are discussed.

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.

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.

The factor structure of the Wechsler Memory Scale-Revised and several brief neuropsychological screening instruments in recently detoxified substance abusers.

The Wechsler Memory Scale-Revised (WMS-R) has attracted a fair amount of research activity since its publication. Much of this activity has centered on the factor structure of the WMS-R. The present study examines the factor structure of the WMS-R, both when the indices are used as variables and when the scale scores themselves are used as variables. Three hundred fifty-two recently detoxified substance abusers were used as subjects. Both sets of analyses included other neuropsychological variables in order to facilitate clear explications of memorial and cognitive functions tapped by the WMS-R. The results indicate support both for use of the indices and for use of the subscale scores. Differences between these results and the results of earlier factor analyses are discussed in terms of sample characteristics.

Application of a forced-choice memory procedure designed to detect experimental malingering.

The detection of dissimulated cognitive deficits is an important issue in many clinical assessment situations. Specific procedures designed to aid in this detection can be useful additions to standard assessment protocols. The present study investigates the potential utility of a modification of the forced-choice, symptom validity paradigm to the assessment of memory deficits. Previous research indicated that the procedure could discriminate between college students instructed to malinger memory impairment and college students instructed to perform at their best ability. The present study administered a forced-choice memory assessment instrument to 60 psychiatric patients, 60 normal community volunteers, and 60 neuropsychological patients. Thirty psychiatric patients and 30 community volunteers were given instructions to malinger. Discriminant function analyses yielded an overall correct group classification rate of 90.6%, with 5% of the nonmalingering subjects and 18.3% of the experimental malingerers incorrectly classified.

Order effects in the administration of the Booklet Category Test and Wisconsin Card Sorting Test.

In order to evaluate the possibility of significant order effects, the Booklet Category Test and Wisconsin Card Sorting Test were administered in counterbalanced order to 20 psychiatric patients, 36 neurological patients, and 30 healthy, elderly individuals. Administering the Booklet Category Test first improved scores on the Wisconsin Card Sorting Test, although not to a statistically significant degree. Unexpectedly administering the Wisconsin Card Sorting Test first resulted in poorer scores on the Booklet Category Test. The results are discussed in terms of future research and clinical implications.

An investigation of the test-retest reliability of the Stroop Color-Word Test across two intervals.

The Stroop Color- Word Test is frequently used in neuropsychological settings. However, there has been no rigorous evaluation of the test-retest reliability of the commercially available version of the Stroop. The present study investigated the test-retest reliability of the Stroop across two different time intervals. In addition, the standard error of prediction and the standard error of differences were computed, and applications of the results to the use of the Stroop to document change in cognitive rehabilitation are discussed.

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.

Impulsivity in suicidal and nonsuicidal adolescents.

Nonsuicidal and suicidal adolescent inpatients were compared to community high school students using behavioral measures of impulsivity. Measures of problem solving ability, hopelessness, and depression were also administered to all groups. The suicidal inpatients were characterized by greater impulsivity, hopelessness, and depression than both nonsuicidal inpatients and community high school students. There were no differences in problem-solving abilities found between the suicidal inpatients and either the nonsuicidal inpatients or the community controls.

Neuropsychological performance and suicidal behavior in adult psychiatric inpatients.

Although various studies have shown that suicidal persons exhibit greater cognitive deficiencies than both normals and other psychiatric patients, researchers as yet have been unable to account for the source(s) of the differences. Some of these differences (e.g., cognitive rigidity and impaired problem solving) hint of possible organic involvement. This study explored the relationship of neuropsychological functioning to suicidal behavior by comparing 20 suicidal and 27 nonsuicidal psychiatric inpatients on several tests of neuropsychological functioning. Although results showed no significant differences between the two groups on most measures, both groups showed evidence of notably high levels of cortical dysfunction relative to test norms. Thirty-five percent of suicidal patients and 44% of nonsuicidal patients scored in the impaired range. Implications of this high frequency of impairment for the treatment of suicidal and nonsuicidal psychiatric patients are discussed.