Psychometric Properties and Normative Information on the Child and Adolescent Behavior Inventory with Ratings for Spanish Children from Parents and Teachers.

BACKGROUND: Psychometric properties and initial normative information are provided for the sluggish cognitive tempo, attention-deficit/hyperactivity disorder-inattention, attention-deficit/hyperactivity disorder-hyperactivity/impulsivity, oppositional defiant disorder, callous-unemotional behavior (limited prosocial emotions specifier), anxiety, depression, social impairment, and academic impairment scales of the Spanish Child and Adolescent Behavior Inventory. METHOD: Mothers, fathers, and teachers of 2,142 third to sixth grade Spanish children (49.49% girls; ages 8-13) from randomly selected schools on the Balearic Islands completed the Child and Adolescent Behavior Inventory. RESULTS: Scores from the scales demonstrated reliability (internal consistency and inter-rater), structural validity, and convergent/discriminant validity with attention-deficit/hyperactivity disorder and learning disorder diagnoses for boys and girls separately for each source. Normative information (T-scores) is provided for the nine scales separately for boys and girls, with test information functions supporting use of the symptom scales for screening purposes. CONCLUSIONS: Although more comprehensive Spanish norms are still needed, the initial normative information on the scales should be useful to inform the clinical care of individual Spanish children, with the positive psychometric properties of the scores also supporting the use of the scale for research. Copies of the Spanish Child and Adolescent Behavior Inventory and norms are available for free to clinicians and researchers.

A ventricular assist device powered by conditioned skeletal muscle.

BACKGROUND: We are developing and testing a new ventricular assist device (VAD) to be powered by conditioned skeletal muscle. METHODS: To evaluate the VAD hardware and to develop a muscle training regimen, 8 calves have been used in studies in which the right latissimus dorsi muscle was employed. The experiments were carried out to an approximately 4-month duration. RESULTS: There was significant conversion of type II (fast twitch) to type I (slow twitch) muscle fibers. This did not correlate well, however, with device performance. The device stroke volumes ranged from approximately 17 to 90 cc. This variability of outcome occurred despite the fact that identical hardware, surgical procedures, and training regimens were employed. CONCLUSIONS: The results from the first eight studies lead us to speculate that perfusion may be important even when the muscle is working at pressures much lower than systemic blood pressure levels. In an attempt to augment tissue perfusion, we plan to investigate thermally induced angiogenesis as a possible mechanism for increasing blood flow to the tissue.

Hypnosis for the treatment of burn pain.

The clinical utility of hypnosis for controlling pain during burn wound debridement was investigated. Thirty hospitalized burn patients and their nurses submitted visual analog scales (VAS) for pain during 2 consecutive daily wound debridements. On the 1st day, patients and nurses submitted baseline VAS ratings. Before the next day's would debridement, Ss received hypnosis, attention and information, or no treatment. Only hypnotized Ss reported significant pain reductions relative to pretreatment baseline. This result was corroborated by nurse VAS ratings. Findings indicate that hypnosis is a viable adjunct treatment for burn pain. Theoretical and practical implications and future research directions are discussed.

Maudsley Obsessional-Compulsive Inventory: obsessions and compulsions in a nonclinical sample.

Obsessive-compulsive disorder is increasingly being studied in nonclinical samples. The self-report instruments used to select these samples, however, have not been validated with a diagnostic interview. This study thus investigated the predictive validity of the Maudsley Obsessional-Compulsive Inventory (MOCI) using the Anxiety Disorders Interview Schedule (ADIS), a semi-structured interview created according to DSM-III guidelines. Four sections of the ADIS--generalized anxiety disorder, simple phobia, social phobia and obsessive-compulsive disorder--were administered to 11 individuals who scored in the top 2% and 11 individuals who scored in the normal range of the MOCI 6-7 months prior to the interview. High nonclinical MOCI scorers reported more frequent and severe obsessions and compulsions as well as greater disturbance by these symptoms. In addition, the high MOCI group experienced more general worry and interference from worry, and more frequent and severe physiological symptoms when they worry. However, the two groups did not differ in terms of simple and social phobia symptoms. High MOCI scorers thus did not report a broad range of anxiety symptoms or fears, but specific obsessions and compulsions. These results provide further support for the validity of the MOCI in nonclinical samples over a 6-7 month interval.

Obsessions and compulsions: psychometric properties of the Padua Inventory with an American college population.

The psychometric properties of the Padua inventory, a self-report measure of obsessive-compulsive behaviors, were examined in a sample of 678 American college students. Results showed good internal consistency as well as convergent and divergent validity with the subscales of the Symptom Checklist-90 Revised and the Maudsley Obsessional-Compulsive Inventory. A principal components analysis suggested a four factor solution (i.e. 'impaired control of mental activities', 'checking', 'urges and worries of losing control of motor behaviors', and 'being contaminated'). The factor structure was very similar to that found in the original Italian study of the inventory. Suggestions are made for the use of the Padua Inventory in the study of obsessions and compulsions in nonclinical samples.

The utilization of nonpatient samples in the study of obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is increasingly studied in nonpatients, primarily through the selection of individuals who score high on a self-report measure of OCD. The usefulness of this methodology for understanding OCD presupposes that some of the individuals in the high-scoring group meet diagnostic criteria for OCD, that the obsessive-compulsive behaviors in the high-scoring individuals are stable across time to a certain degree, and that the features associated with OCD in patients also are found in the high-scoring nonpatients. Two studies are reported which provide support for these three assumptions. Together the studies suggest that OCD can be productively examined by the selection of individuals who score high on a self-report measure of OCD. Cautions in the use of this methodology for the study of OCD are also noted.

Revision of the Padua Inventory of obsessive compulsive disorder symptoms: distinctions between worry, obsessions, and compulsions.

The Padua Inventory (PI), a self-report measure of obsessive and compulsive symptoms, is increasingly used in obsessive compulsive disorder (OCD) research. Freeston, Ladouceur, Rheaume, Letarte, Gagnon and Thibodeau (1994) [Behaviour Research and Therapy, 32, 29-36], however, recently showed that the PI measures worry in addition to obsessions. In an attempt to solve this measurement problem, this study used a content distinction between obsessions and worry to revise the PI. The revision was constructed to measure five content dimensions relevant to OCD i.e. (1) obsessional thoughts about harm to oneself or others; (2) obsessional impulses to harm oneself or others; (3) contamination obsessions and washing compulsions; (4) checking compulsions; and (5) dressing/grooming compulsions. A total of 5010 individuals participated in the study, 2970 individuals completing the PI and the Penn State Worry Questionnaire (PSWQ) and an additional 2040 individuals completing only the PI. The results provided support for the reliability and validity of the revision. In addition, the revision of the PI was more independent of worry, as measured by the PSWQ, than the original PI. Support was thus found for the validity of the content distinction between obsessions and worry. The importance of this content distinction is also discussed for the evaluation of other hypothesized distinctions between obsessions and worry.

Disruptive behaviors in the classroom: initial standardization data on a new teacher rating scale.

This study presents initial standardization data on the Sutter-Eyberg Student Behavior Inventory (SESBI), a teacher-completed measure of disruptive classroom behaviors. SESBIs were completed on 1116 children in kingergarten through fifth grade in a rural eastern Washington school district. Various analyses (Cronbach's alpha, corrected item-total correlations, average interitem correlations, principal components analyses) indicated that the SESBI provides a homogeneous measure of disruptive behaviors. Support was also found for three factors within the scale (e.g., overt aggression, oppositional behavior, and attentional difficulties). While the child's age did not have a significant effect on the SESBI, the child's gender did have a significant effect on scale scores as well as on most of the items, with males being rated more problematic than females. The SESBI was also able to discriminate between children in treatment for behavioral problems or learning disabilities and children not in treatment.

A confirmatory factor analysis on the DSM-IV ADHD and ODD symptoms: what is the best model for the organization of these symptoms?

Confirmatory factor analysis (CFA) was used to evaluate five different models for the organization of the DSM-IV ADHD and oppositional defiant disorder (ODD) symptoms (Model 1: a single factor model; Model 2: an ADHD and ODD two factor model; Model 3a: an inattention (INA), hyperactivity/impulsivity (HYP/IMP), and ODD three factor model; Model 3b: an INA, HYP/IMP, and ODD three factor model where the three IMP symptoms cross-load on the ODD factor; Model 4: an INA, HYP, IMP, and ODD four factor model). To evaluate these models, maternal ratings of ADHD and ODD symptoms were obtained at outpatient pediatric clinics on 742 children not in treatment and 91 children in treatment for ADHD. Model 3a resulted in a good fit as well as a significantly better fit than Model 2. Model 3a was also equivalent across treatment status, gender, and age groupings for the most part. Though Models 3b and 4 provided a statistically better fit than Model 3a, the improvement in fit was small and other model selection criteria argued against these more complex models.

Internal validity of the disruptive behavior disorder symptoms: implications from parent ratings for a dimensional approach to symptom validity.

A dimensional approach was used to evaluate the internal validity of the DSM-III-R ADHD-inattention, ADHD-hyperactivity/impulsivity, oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms (i.e., whether a symptom has a stronger correlation with its own dimension that the other three). Parents rated 4,019 children between the ages of 2 and 19 on these symptoms. The results showed that 5 of the 6 inattention symptoms, 3 of the 4 hyperactivity symptoms, 1 of the 4 impulsivity symptoms, 6 of the 9 oppositional defiant disorder symptoms, and 8 of the 11 CD symptoms had significant internal validity. Confirmatory factor analysis (CFA) found support for inattention, hyperactivity/impulsivity, oppositional defiant, and conduct disorder dimensions. Multiple-group CFA also found support for factor pattern and loading invariance across gender. The implications of these results as well as the merits of the dimensional approach to symptom validity are discussed in the context of the DSM-IV changes in ADHD, ODD, and CD.

Problem of item overlap between the psychopathy screening device and attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder rating scales.

Content validity requires a clear definition of the construct of interest and the delineation of the construct from similar constructs. Content validity also requires that the items be representative of the construct as well as specific to the construct. An examination of the items on the Psychopathy Screening Device (PSD), a parent- and teacher-rating scale of childhood psychopathy, indicates significant overlap with the symptoms and associated features of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). The failure of the PSD to have unique items results in poor discriminant validity with ADHD, ODD, and CD rating scales. More careful attention to content validation guidelines is required to develop a more useful measure of childhood psychopathy.

The use of an artificial pericardium with a total artificial heart.

Postoperative adhesions following open heart surgery enhance the risks and increase the time of subsequent reoperation. When possible, primary closure of the natural pericardium is recommended, particularly in those cases that are more likely to be reoperated upon. The use of a total artificial heart (TAH) as a bridge to transplantation makes reoperation mandatory. If the pleura is left open to accommodate the ventricles, the risk of adhesion is considerable. To address this question, gluteraldehyde-fixed pericardial allografts were evaluated in calves undergoing TAH replacement. Eight animals were implanted with 3 different types of TAHs and survived from 12 to 108 days (mean 52.8 +/- 14.5). The pericardial substitute was wrapped around the TAH and the vascular grafts and cuffs. Two different surgical techniques were evaluated. At the time of autopsy, the presence of adhesions and gross epicardial reaction was macroscopically characterized and classified according to a standardized scale. Bacterial cultures were taken and tissue submitted for histology. The animals implanted with pericardial allografts for periods greater than 3 weeks were observed to have greater adhesions than those implanted for periods less than 3 weeks (p = 0.006). Pericardial cultures were negative in all cases and neovascularization and fibroplasia of the underlying tissues occurred in all cases. Leukocyte infiltration was minimal in the shorter term implant animals. Degeneration of a portion of the pericardium occurred in only 2 cases after 90 days. Minor calcification of the artificial pericardium was noted, but only in the longer term implant animals. The artificial pericardium reduced adhesion, thus facilitating reoperation in implants lasting up to a month.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of plasma on adhesion of biofilm forming Pseudomonas aeruginosa and Staphylococcus epidermidis to fibrin substrate.

Bacterial adhesion has been identified as the critical initial step in the pathogenesis of foreign body related infection. Recent investigations have shown microbial binding to implanted polymeric materials using specific adhesion of bacteria to immobilized plasma proteins, such as fibrin. These proteins are though to function as bridging molecules to facilitate bacterial colonization of the surface. The authors' results indicated a significant reduction in adhesion of biofilm forming Pseudomonas aeruginosa and coagulase negative Staphylococcus epidermidis to immobilized fibrin strands in the presence of platelet poor plasma (PPP) as compared to studies performed with phosphate buffered saline and Hank's balanced salt solution. A 10-fold decrease in the number of adherent bacteria was noted for samples exposed to PPP as compared to control samples. The effective range of PPP concentrations capable of producing the marked decrease in binding to fibrin strands was determined to be 1-100% for P. aeruginosa and 4-100% for S. epidermidis.

Magnetic field enhancement of antibiotic activity in biofilm forming Pseudomonas aeruginosa.

Device related infection initiated by biofilm bacteria are often difficult to resolve with antimicrobial therapy. Study results indicate that application of static magnetic fields may enhance the activity of gentamicin against biofilm forming Pseudomonas aeruginosa adherent to a polymer substrate. Results indicate a maximal reduction of 86.5 +/- 7.2% (n = 6) in the number of adherent viable bacteria compared with a control for samples exposed to a 5 gauss (G) magnetic field and gentamicin. The effect appears to be limited to magnetic fields between 5 and 20 G. Experiments using glass, Chronoflex (Polymedica, Golden, CO), Biomer (Ethicon, Somerville, NJ), and polystyrene substrate showed that the effect was independent of substrate surface. Autoradiograms from In111 uptake experiments showed that bacteria colonizing the substrate surface were significantly reduced in samples subjected to a magnetic field and gentamicin.

Evidence that bacteria prefer to adhere to thrombus.

This study was undertaken to investigate the possible association between thrombosis and infection using an in vitro test model in which fresh bovine blood was recirculated through test conduits (3.5 mm inner diameter) containing stent-like devices. Anticoagulation was adjusted so that the recirculating blood deposited thrombi on the stent to cause gradual occlusion, thus impeding the flow. Four stent-like devices were placed in separate conduits in each experiment, and blood was recirculated with the help of pneumatically driven ventricles. Flow through these conduits was monitored by ultrasonic flow detection. To quantitate bacterial interaction with thrombi, Staphylococcus epidermidis (15E10(9)) was labeled with 111Indium-oxine and added to the blood. Experiments lasted until the flow in the test conduits dropped to 10% of the starting flow. During this recirculation, as flow gradually decreased, one stent was taken out when flow was still at 100%, the second at 75%, the third at 50%, and the fourth at 10% of the starting flow. The number of bacteria associated with the thrombus was measured by gamma counting. The following observations were made: 1) the amount of thrombus increased with time in all experiments (this was confirmed in separate experiments by using autologous 111Indium labeled platelets); 2) bacterial adhesion showed a concomitant increase as thrombus size increased (this was confirmed by using 111Indium labeled bacteria), and 3) bacterial incorporation into the thrombus occurred regardless of whether they were viable or pretreated with the antibiotic rifampin. These observations suggest that as thrombi develop, they may preferentially attract micro-organisms. This suggests that devices with adherent thrombi may have greater susceptibility for infection.

Quantitative bacterial analysis of porous, fabric, and smooth non-blood contacting implant surfaces and their tissue interfaces in a 169 day pneumatic total artificial heart animal recipient.

All long-term total artificial heart (TAH) survivals are subject to sepsis. Survival can be prolonged, but the source of the infection cannot be eliminated with any known course of antibiotics or treatment regimen. Sambo, a U-100 pTAH calf, survived 169 days. At week 6, he became septic, growing a Pseudomonas species (Ps). Weekly blood cultures were intermittently positive until week 13 when they became continuously positive until his demise, from a ruptured left ventricular pumping diaphragm. Spatially specific porous silicone rubber (SSP) was used for surface modifications on the drive lines and as cuffs around the Dacron TAH graft to large vessel anastomoses. This gave an excellent opportunity to examine two types of porous implants surfaces (Dacron grafts and SSP) to the smooth Biomer ventricular surfaces with their respective adjoining tissue interfaces for bacterial colonization. Nine tissue samples and 13 implant surfaces were processed with Costerton's quantitative bacterial techniques. The largest numbers of bacteria (> 10(6)/cm2 Ps.) were grown from the smooth ventricular surface and in the cul-de-sac where the SSP delaminated from the driveline (two smooth implant surfaces in contact but without tissue apposition). The Dacron grafts were intermediate in bacterial concentrations and SSP surface modified drivelines and tissues were sterile. In this model, the more intimate biointegration found in the porous implants showed improved bacterial resistance in a chronically infected pTAH. The more completely biointegrated and neo-vascularized porosity SSP was the only implant surface and opposing implant tissue interface sampled to remain sterile.

Animal implantation results with the Utah-100 total artificial heart.

The Utah-100 total artificial heart was designed to have increased reliability over the Jarvik-7 total artificial heart, achieve better fit, and minimize device associated thrombus formation, without decreasing the function. The Utah-100 heart was tested in 28 calves and 3 sheep. The smallest animal at the time of implantation weighted 54 kg. Mean survival duration was 78 days (range, 1-331 days), with 14 animals surviving longer than 60 days. Multiple organ function was maintained satisfactorily with the Utah-100 artificial heart, and mean plasma free hemoglobin values in the calves that survived longer than 100 days were less than 10 mg/dl. Hemorrhage was the main cause of death in animals dying within 30 days after implantation (5/13, 38%); infection was another primary cause of death or termination (4/31, 13%). Deaths due to mechanical failure occurred from valve or diaphragm failure in two cases, yielding a 91% reliability at a 90% confidence level for 60 days' support. No animal died because of driver or other technical failure. Utah-100 hearts showed superior antithrombogenicity in the connector and valve-related areas when compared with the results of the Jarvik-7 heart, which was also fabricated and implanted in our laboratory (p less than 0.01). With these test results, the authors anticipate that the Utah-100 heart will be a safe and effective device for interim use as a bridge to heart transplantation.

Anaerobic threshold in total artificial heart animals.

The anaerobic threshold represents an objective measure of functional capacity and is useful in assessment of pulmonary and cardiovascular dysfunction. This study determined the anaerobic threshold in total artificial heart animals and evaluated the performance of the total artificial heart system. Five animals with total artificial hearts were put under incremental exercise testing after exercise training. The intensity of exercise ranged from 2.0 to 4.5 km/hr, with an increment of 0.5 km/hr every 3 min. The anaerobic threshold was 6.72 +/- 0.84 ml/kg/min as detected by the lactate method, and 6.48 +/- 0.79 by the CO2 method. The value of the anaerobic threshold in total artificial heart animals implies that the performance capacity of a total artificial heart is not sufficient to meet the oxygen requirements of vigorously exercising skeletal muscle. The protocol does not allow for driving parameter changes during exercise, and this situation, combined with the manual mode of the control system used, was inadequate to allow the total artificial heart animals to exercise more vigorously. Using an automatic control mode might be helpful, as well as considering the relationship between indices of oxygen metabolism, such as oxygen delivery, oxygen consumption, and oxygen extraction rate, in the control algorithms in total artificial heart control systems.

Oxygen metabolism in animals with total artificial hearts.

The relationship between indices of oxygen metabolism has been widely used in clinical practice to evaluate the adequacy of tissue perfusion, to predict the outcome of the critically ill patient, and to evaluate the effectiveness of therapies. This study quantitated and correlated the relationship between oxygen delivery (DO2), oxygen consumption (VO2), and oxygen extraction rate (EO2) in 14 animals with total artificial hearts (TAH) to investigate the oxygen metabolism in animals with TAH during different physiologic and pathologic conditions. These 14 animals were subdivided into healthy, critical, and exercise groups. There was a physiologic dependence of DO2 to VO2 in animals in the healthy and exercise groups, whereas a pathologic dependence of VO2 to DO2 appeared to occur in animals in the critical group. Reduced or inadequate VO2 leads to organ dysfunction, shock syndrome, multiple organ failure, and finally, mortality. Providing a higher level of DO2 by restoring circulating blood volume, increasing cardiac output, raising hematocrit levels, and improving pulmonary function to achieve a higher level of oxygen extract efficiency and oxygen consumption in animals with TAH that are in a critical condition might be helpful for the treatment of complications and result in decreasing mortality. Using the relationship between indices of oxygen metabolism as a physiologic modifier for TAH control algorithms also might improve the physiologic performance and quality of life of TAH recipients.

Markers of thromboembolization in a bovine ex vivo left ventricular assist device model.

The production of blood microemboli (BME) was studied using an ex vivo exteriorized left ventricular assist device (LVAD) model in calves. Each of eight calves received a series of three LVADs, each operating for 24 hr. Blood microemboli were measured directly by a laser (624 nm and 828 nm) light scattering microemboli detection (LSMD) system through the LVAD outflow cannula and by constant pressure filtration (CPF) of blood samples from the LVAD outflow cannula. Hematologic parameters were also measured. After LVAD removal, perivalvular thrombi were evaluated using polar coordinate mapping. The average LSMD and CPF results correlated. For example, in one series of three calves, one ventricle exhibited significantly greater thrombogenesis than did the other ventricles, as indicated by both the LSMD and CPF results. In a series of five calves, one calf developed an abnormally high activated thromboplastin time (APTT), even in the absence of heparin. For two of the three ventricles tested in that calf, microemboli concentration (CPF), Factor XII activity, level of fibrin degradation products (FDP), and accumulated thrombus were significantly lower than for the other calves. The whole blood viscosity (WBV, at 230 s-1) in this calf also decreased to lower values than were seen with the other calves.