Veterinary technology graduates' perceptions of their education and subsequent employment experiences.

AIMS: To describe the current employment status of Bachelor of Veterinary Technology (BVetTech) graduates in New Zealand, to assess how well they felt that their degree programme had prepared them for practice, and to explore their experiences in their current job roles. METHODS: All 195 individuals who completed the BVetTech degree at Massey University between 2011 and 2018 were invited to participate in a cross-sectional survey regarding their education and employment experiences. Descriptive statistics were provided for all quantitative study variables and thematic analysis was performed on the free-text survey comments. RESULTS: The survey was completed by 125/195 (64.1%) BVetTech graduates. Of these, 96/125 (76.8%) were engaged in full-time or part-time veterinary work. The most common work environments were small animal practice (55/125; 44.0%) and mixed animal practice (19/125; 15.2%). The median reported annual salary was NZ$42,640 (mean $45,817; min $34,515; max $80,000) while the median reported hourly wage was NZ$20.00 (mean $21.01; min $17.70; max $27.00). Most respondents generally agreed with statements that their degree had prepared them well for different aspects of their subsequent work as veterinary technologists with "understanding the scientific rationale behind clinical decisions in practice" and "gaining hands-on practical experience that directly linked with their classroom learning" highlighted as being the best aspects of their education. However, respondents expressed the need for more training in client interactions and veterinary business management. Common themes that emerged when respondents were asked to describe the best things about their work were "forming relationships with animals, clients, and co-workers," "making a meaningful difference through their work," and "having opportunities to use and develop their skills" while the worst things about their job were "underutilisation of their skills," "poor pay in relation to their education and skill," and "compassion fatigue arising from dealing with euthanasia and difficult clients." Another common theme across free-text questions was the lack of employer awareness about the capabilities of a veterinary technologist. CONCLUSIONS AND CLINICAL RELEVANCE: Recent BVetTech graduates were generally satisfied with their educational experience, but perceived that employers underestimated the value of their training and consequently underutilised their skills. This highlights the need for additional research to better estimate the value of veterinary technologists to the New Zealand animal health industries as well as additional extension efforts to increase awareness amongst employers about the scope of responsibilities that veterinary technologists are legally able to perform in practice.

Cross-sectional survey of surgical techniques used to perform dog and cat spays in New Zealand veterinary practice.

Aims: To describe the variation in surgical techniques used by veterinarians to perform routine dog and cat spays in first-opinion veterinary practice in New Zealand, and how these techniques differed with the number of years since the veterinarian graduated.Methods: A cross-sectional survey of veterinarians registered to practice in New Zealand was conducted online between 1 April and 30 May 2018. Respondents were asked their year of graduation and about the procedures, they would use to perform a routine spay of a healthy, 5 kg, young adult, female domestic shorthair cat, and a healthy, 20 kg, young adult, female mixed-breed dog. The number of years since graduation was calculated by subtracting the reported year of graduation from 2018.Results: Overall, 282 respondents provided details about dog spays, and 361 about cat spays, and the median number of years since graduation was 14 (min 0, max 50). Only 54/282 (19.1%) respondents performing dog spays and 43/361 (11.9%) performing cat spays wore a surgical cap, gown, mask, and gloves. For dog spays, 278 (98.6%) respondents used a ventral midline approach and 147 (52.1%) used manual exteriorisation of the uterus. Most used two clamps (168; 59.6%) and used two encircling ligatures (152; 53.9%) for removal of the uterus. For cat spays, 254 (70.4%) respondents used a ventral midline approach and 313 (86.7%) used a spay hook for exteriorising the uterus. Most used two clamps (250; 69.3%) with one encircling ligature (213; 59.0%) for removal of the uterus. Simple interrupted external or intradermal patterns were mostly used for skin closure for both dog and cat spays. For cat spays, the percentage of respondents using the ventral midline approach decreased with increasing years since graduation (p < 0.001). For both dog and cat spays, the percentage of respondents using two encircling ligatures and transfixation ligation of the uterus, and using a simple continuous suture pattern for the closure of the abdomen, decreased with number of years since graduation (p < 0.05).Conclusions and clinical relevance: Veterinarians responding to this survey used a wide range of techniques to perform routine dog and cat spays, some of which were associated with the number of years since graduation. It may be beneficial to provide veterinarians with resources to reflect on their current approaches for performing routine spays. However further research is needed to determine whether any surgical techniques are superior to others.

Experience and confidence of final year veterinary students in performing desexing surgeries.

AIMS: To describe the level of experience and confidence of veterinary students in performing canine and feline desexing procedures at the end of their final clinical year. METHOD: A cross-sectional survey was conducted with veterinary students at Massey University in November 2017 after completion of their final clinical year. The questions included career plans after graduation, number of assisted and unassisted desexing procedures performed, approximate time to complete desexing surgeries, level of confidence with different aspects of desexing surgeries, what aspects of their desexing surgery training were most helpful, and what could be done to improve training in desexing surgical skills in veterinary school. RESULTS: The survey was completed by 70/95 (74%) students in their final clinical year. Among respondents, 55/70 (70%) had performed >2 unassisted feline neuters before graduation. However 38/70 (54%) students had never performed an unassisted feline spay, 31/70 (44%) had never performed an unassisted canine neuter, and 44/70 (63%) students had never performed an unassisted canine spay. The median reported times to complete a feline neuter, feline spay, canine neuter, and canine spay were 9, 40, 30 and 60 minutes, respectively. The median level of confidence for these procedures were 9, 6, 7 and 5 (on a scale from 1=least confident to 10=most confident), respectively. The reported time to complete procedures and the confidence in performing procedures did not change markedly with increasing total number of procedures performed. Students were most concerned about their ability to perform the desexing procedures in a reasonable amount of time and to prevent post-operative bleeding from occurring. Students were least concerned with their ability to manage post-operative pain in patients and to select the appropriate suture material. Free-text comments revealed that 62/70 (89%) students wanted more hands-on surgical experience prior to graduation. CONCLUSION AND CLINICAL RELEVENCE: Many students are currently completing veterinary school with limited experience and low confidence with performing routine canine and feline desexing procedures. Further research is needed to identify the most effective ways for addressing this issue within the constraints of the veterinary curriculum and teaching hospital resources.

The agar microdilution method - a new method for antimicrobial susceptibility testing for essential oils and plant extracts.

AIMS: To develop a new agar microdilution technique suitable for the assessment of the antimicrobial activity of natural plant products such as essential oils or plant extracts as well as to evaluate the antimicrobial effect of several essential oils and plant extracts. METHODS AND RESULTS: The proposed agar microdilution method was evolved on the basis of the CLSI agar dilution method, approved for conventional antimicrobials. However, this new method combines convenience and time/cost effectiveness typical for microtitre methods with the advantages of the agar dilution of hydrophobic or coloured substances. Different concentrations of the tested agents were added to Eppendorf tubes with molten Mueller-Hinton agar, vortexed and dispensed into the 96-well microplate in a small volume of 100 µl per well which allows for rapid, easy and economical preparation of samples as well as providing a uniform and stable dispersion without separation of the oil-water phases which occurs in methods with liquid medium. Next, the agar microdilution plates were inoculated with four reference bacterial strains. The results of our study demonstrated that the minimal inhibitory concentrations (MICs) were successfully determined using the agar microdilution method even with hydrophobic essential oils or strongly coloured plant extracts. CONCLUSIONS: The new agar microdilution method avoids the problems associated with testing of water insoluble, oily or strongly coloured plant natural products. Moreover, it enables the reliable, cheap and easy MIC determination of such agents. SIGNIFICANCE AND IMPACT OF THE STUDY: In the era of increasing antibiotic resistance high hopes are associated with new drugs of plant origin. However, the lack of standardized and reliable testing methods for assessing antibacterial activity of plant natural products causes impediment to research into this area. This study demonstrated that the agar microdilution method can be used successfully for testing oily and coloured substances.

Carbapenemase-producing Enterobacterales in hospital drains in Southern Ontario, Canada.

BACKGROUND: Hospital drains may be an important reservoir for carbapenemase-producing Enterobacterales (CPE). AIM: To determine prevalence of CPE in hospital drains exposed to inpatients with CPE, relatedness of drain and patient CPE, and risk factors for drain contamination. METHODS: Sink and shower drains in patient rooms and communal shower rooms exposed to 310 inpatients with CPE colonization/infection were cultured at 10 hospitals. Using short- and long-read whole-genome sequencing, inpatient and corresponding drain CPE were compared. Risk factors for drain contamination were assessed using multi-level modelling. FINDINGS: Of 1209 exposed patient room and communal shower room drains, 53 (4%) yielded 62 CPE isolates in seven (70%) hospitals. Of 49 CPE isolates in patient room drains, four (8%) were linked to prior room occupants. Linked drain/room occupant pairs included Citrobacter freundii ST18 isolates separated by eight single nucleotide variants (SNVs), related blaKPC-containing IncN3-type plasmids (different species), related blaKPC-3-containing IncN-type plasmids (different species), and related blaOXA-48-containing IncL/M-type plasmids (different species). In one hospital, drain isolates from eight rooms on two units were Enterobacter hormaechei separated by 0-6 SNVs. Shower drains were more likely to be CPE-contaminated than hand hygiene (odds ratio: 3.45; 95% confidence interval: 1.66-7.16) or patient-use (13.0; 4.29-39.1) sink drains. Hand hygiene sink drains were more likely to be CPE-contaminated than patient-use sink drains (3.75; 1.17-12.0). CONCLUSION: Drain contamination was uncommon but widely dispersed. Drain CPE unrelated to patient exposure suggests contamination by undetected colonized patients or retrograde (drain-to-drain) contamination. Drain types had different contamination risks.

MMP-9 in atrial remodeling in patients with atrial fibrillation.

INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. The impact of matrix metalloproteinases (MMPs) on structural atrial remodeling and sustainment of AF in patients with persistent and permanent AF is unresolved. OBJECTIVES: The aim was to evaluate MMP-9 and its tissue inhibitor-1 (TIMP-1) as markers of atrial remodeling in patients with persistent AF (PAF) who underwent electrical cardioversion (ECV) and in patients with permanent AF (continuous AF, CAF). PATIENTS AND METHODS: Plasma levels of MMP-9 and TIMP-1, clinical findings, and echocardiographic parameters were evaluated in 39 patients with AF and in 14 controls with sinus rhythm. RESULTS: The concentrations of MMP-9 were significantly higher in patients with PAF and CAF compared to controls. There was a significant increase of MMP-9 after ECV in the persistent AF group. The values of TIMP-1 were not significantly different between the groups. In patients with AF, MMP-9 levels were positively related to posterior wall thickness of the LV (r=0.356, P=0.049) and body mass index (r=0.367, P=0.046). CONCLUSION: Elevated levels of MMP-9 were related to the occurrence and maintenance of AF. This suggests that MMP-9 can be a marker of atrial remodeling in patients with AF. Regulation of the extracellular collagen matrix might be a potential therapeutic target in AF.

Bilateral partial bronchial obstruction due to broncholithiasis treated with laser therapy.

The previously recognized modes of therapy for symptomatic broncholithiasis are broncholithectomy via surgery or bronchoscopy. A 46-year-old woman with bilateral partial bronchial obstruction was treated with Nd-YAG laser with complete resolution of symptoms and of airway obstruction.

Aging, regional cerebral blood flow, and neuropsychological functioning.

Previous studies found changes in regional cerebral blood flow (rCBF) patterns related to both age and various cognitive tasks. However, no study has yet demonstrated a relationship between rCBF and performance on the Luria-Nebraska Neuropsychological Battery (LNNB) in an elderly group. Seventy-nine elderly volunteers (56-88 years old), both healthy and demented, underwent the 133xenon inhalation rCBF procedure and were given the LNNB. The decrements in the gray-matter blood flow paralleled decrements in performance on the LNNB. Using partial correlations, a significant proportion of shared variance was observed between gray-matter blood flow and the LNNB scales. However, there was much less of a relationship between white-matter blood flow and performance on the LNNB. This study suggests that even within a restricted age sample rCBF is related in a global way to neuropsychological functioning.

Usefulness of automatic measurement of contrast flow intensity: an innovative tool in contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization. A pilot study.

AIM: Contrast-enhanced ultrasound imaging of the carotid arteries (CECU) permits direct, real-time visualization of neovascularization in atherosclerotic plaques and is a confirmed predictor of unstable atheromatous lesions. The aim of the study was the assessment of a new, automatically measured index of intensity in quantitative estimation of the contrast flow through the carotid plaque (till now assessed only visually). METHODS: Forty-four patients (mean age 70.4±11.4) with ultrasound diagnosed significant stenosis of internal carotid artery (ICA), after cerebrovascular or cardiovascular events, qualified for carotid artery stenting (CAS) were examined. The carotid ultrasound examinations with contrast agent Sonovue were performed. RESULTS: Visually in 22 patients (50%) contrast flow through the atherosclerotic plaques was found. In 17 patients (38.6%) massive, calcified atherosclerotic plaques were present. Patients with preserved contrast flow through the plaque more frequently had a history of cerebral stroke (P=0.04). Massive calcifications of atherosclerotic plaques correlated with a previous MI (P=0.03) and the degree of advancement of coronary artery disease (P=0.04), but not with a previous cerebral stroke. Contrast flow through the atherosclerotic plaque positively correlated with values of the index of intensity (r=0.69, P<0.00001). In patients with preserved contrast flow the mean value of the index of intensity was 22.24±3.55 dB as compared with 12.37±7.67 dB - a value present in patients without preserved contrast flow. No significant relation for the degree of calcifications and the value of the index of intensity was found. CONCLUSION: The assessment of the index of intensity is a novel, simple and automatic method to estimate the degree of contrast flow through the carotid plaque. The values of the index of intensity correlate with the contrast flow through the atherosclerotic plaque, but not with its calcification.

Myocardial perfusion and intima-media thickness in patients with subclinical hypothyroidism.

PURPOSE: The data concerning the relation between subclinical hypothyroidism (SH) and the risk of cardiovascular disease are divergent. We aimed to assess myocardial perfusion in contrast-enhanced echocardiography and intima-media thickness (IMT) in patients with SH. MATERIAL/METHODS: Forty females with SH without symptoms of coronary artery disease and 15 healthy female volunteers were examined. Echocardiographic evaluation of the left ventricle function as well as carotid and femoral IMT complex measurements were performed at baseline. Thereafter, dobutamine stress echocardiography with myocardial perfusion assessment at rest and on the peak of stress test was performed. SonoVue® intravenous bolus as a contrast medium was used. The myocardial perfusion was assessed by quantitative method using Q-LAB Philips software (ROI modality). The perfusion index was calculated (a number of left ventricle segments with improved perfusion/a number of all segments). RESULTS: A mean IMT value in the SH group was significantly higher than in the controls (0.7 mm vs. 0.38 mm, p=0.001). Myocardial perfusion at rest and at the peak of stress test was significantly lower in the SH patients as compared to the controls (at rest 120 Db in SH vs. 181 Db in controls, p=0.039 and at the peak of stress 115 Db and 188 Db, p=0.01, respectively). The perfusion index was not significantly worse in the SH group (p=0.6). IMT values negatively correlated with the myocardial perfusion index at the peak of stress (r=-0.54, p=0.014). CONCLUSIONS: In patients with SH contrast-enhanced echocardiographic examination revealed myocardial hypoperfusion and increased IMT. Our results may suggest that the patients with SH are at risk of the development of cardiovascular disease.

Effect of on-pump versus off-pump coronary bypass surgery on cardiac function assessed by intraoperative transesophageal echocardiography.

PURPOSE: To compare cardiac function assessed by intraoperative transesophageal echocardiography in patients undergoing cardiac revascularization with or without cardiopulmonary bypass. MATERIAL AND METHODS: Forty-one patients scheduled for elective, isolated cardiac revascularization (21 on-pump and 20 off-pump) were prospectively analyzed. Patients were matched for demographic (age and gender), anthropometric (BMI), clinical (co-morbidities, EuroScore) and laboratory variables (blood counts, renal function, left ventricular function). Transesophageal echocardiography was performed after induction of anesthesia, protamine sulfate administration, and chest closure. Left ventricular wall motion score index, end-diastolic area, fractional area change, right ventricular area change and end-diastolic area were assessed. Troponin I and C-reactive protein concentrations were measured. RESULTS: Regarding echocardiographic parameters of left and right ventricular function no significant differences between on-pump and off-pump groups at any point-of-time measurements were found. Troponin I and C-reactive protein were higher in on-pump as compared to off-pump group (p=0.001 and p=0.002; p=0.003 and p=0.001, respectively). CONCLUSIONS: In elective patients scheduled for cardiac revascularization there were no difference in cardiac performance assessed by intraoperative echocardiography regardless of surgical method used.

Adiponectin--an independent marker of coronary artery disease occurrence rather than a degree of its advancement in comparison to the IMT values in peripheral arteries.

OBJECTIVE: The aim of the study was to establish whether adiponectin may act as an independent risk factor of coronary artery disease (CAD) and if adiponectin has potential relations with a new marker of cardiovascular risk -intima-media thickness (IMT). METHODS: 165 patients, who had undergone coronary angiography due to symptoms of CAD were enrolled. Selected clinical and biochemical risk factors were assessed, adiponectin concentrations and IMT were measured. RESULTS: A significantly lower adiponectin concentrations in the CAD group, as compared to the controls, were found. Adiponectin concentration did not correlate with a degree of coronary vessels changes advancement. No correlation between adiponectin concentrations and IMT values in the studied peripheral arteries were found. The value of 9.8 ug/ml has been assigned as a cut-off value. Adiponectin concentrations <9.8 µg/ml had the highest positive predictive value (PPV=95.7%) and specificity (90.9), but low sensitivity (30.8). In the multilogistic regression analysis significant variables influencing the appearance of CAD were found: HDL-C (p=0.011, OR=0.88, 95%CI 0.80-0.97), IMT in CCA (p=0.0048, OR=5.25, 95%CI 1.65-16.75), IMT in CFA (p=0.015, OR=1.65, 95%CI 1.10-2.48 ), and adiponectin concentration <9.8 µg/ml (p=0.032, OR=28.95, 95%CI 1.31-641.48). CONCLUSIONS: Adiponectin is an independent risk factor of coronary artery disease occurrence, but not its advancement. No correlation between adiponectin concentration and IMT values in peripheral arteries was shown.

Blood pressure in relation to neurogenic, inflammatory and endothelial dysfunction biomarkers in patients with treated essential arterial hypertension.

PURPOSE: Clinical relevance of relations among blood pressure (BP), inflammation, endothelial dysfunction and sympathetic activation is unknown. Study aimed, whether in patients with diagnosed and treated essential arterial hypertension (HTN) biomarkers of inflammation (hs-C-reactive protein, hs-CRP), endothelial dysfunction (endothelin-1, ET-1), and sympathetic nervous system modulation (epinephrine, E and norepinephrine, NE) could be related to BP values. MATERIAL AND METHODS: In 62 patients with diagnosed and treated HTN (mean time of disease 5±3.2 years), serum hs-CRP and ET-1 as well as plasma E and NE concentrations were measured. 24-hour ambulatory blood pressure measurement device (ABPM) was used to estimate efficacy of treatment. RESULTS: A positive correlation between epinephrine and norepinephrine concentrations was found (r=0.246, p=0.05), however such a statistically significant correlation neither to hs-CRP, nor ET-1 were found. Patients with the highest hs-CRP and NE concentrations had the highest systolic (SBP) and diastolic (DBP) blood pressure values. Similar relation was found in subgroup of patients with suboptimal blood pressure values (SPB l 130mmHg, DBP l 80mmHg). In a group of optimal treated patients, elevated levels of ET-1 and NE related to increased blood pressure values. ROC analysis identified ET-1 as statistically significant to diagnose elevated blood pressure: 0.665 (95% Confidence interval 0.512 to 0.796). CONCLUSIONS: In patients with diagnosed and treated arterial hypertension, there are relations among measurements of hs-CRP, ET-1, NE and blood pressure values in spite of treatment, which may improve understanding of mechanisms involving inflammation, endothelial dysfunction and sympathetic nerve activation and may identify patients with refractory hypertension.

Silent pulmonary embolism in a patient with acute myocardial infarction and type B acute aortic dissection - a case report.

A 69-year-old man while being treated for type B aortic dissection was also found to have acute myocardial infarction. The patient initially was treated conservatively. Prophylactic anticoagulant treatment of potential thrombosis was not given because of aortic dissection. Stent-graft implantation to the thoracic aorta was considered at the time. Unexpectedly, elective computer tomography (CT), revealed 2 large thrombi at the bifurcation of the pulmonary trunk. The patient did not show any symptoms of pulmonary embolism. Heparin therapy was initiated immediately. The patient responded well to the therapy and on transesophageal echocardiography and subsequent CT no embolic material was found. Since that time, the patient is receiving oral anticoagulation. The case we present raises the question of anticoagulation prophylaxis in the presence of aortic dissection in bedridden patients. Failure to use such therapy in our patient could have resulted in an unfavorable clinical outcome.

High-sensitivity C-reactive protein and total antioxidant status in patients with essential arterial hypertension and dyslipidemia.

PURPOSE: To assess low-grade, systemic inflammation and antioxidant status as additional factors contributing to pathophysiology of essential arterial hypertension (HTN) and compare them with traditional risk factors, like abnormal lipids profile, considering their potential diagnostic usefulness. MATERIAL AND METHODS: Serum high-sensitivity C-reactive protein (hs-CRP) concentrations and total antioxidant status (TAS) were measured in 143 subjects - 71 patients with diagnosed HTN and in 72 healthy controls. RESULTS: In hypertensive patients, as compared to healthy control group, the median hs-CRP concentration was higher (2.0 mg/L, 25%; 75% quartile range: 0.1; 27.1 vs 0.4 mg/L, 25%; 75% quartile range: 0.0; 4.6, respectively, p<0.001) and TAS concentration lower (1.4 mmol/L, 25%; 75% quartile range: 1.0; 2.1 vs 1.5 mmol/L, 25%; 75% quartile range: 0.5; 1.8, respectively, p=0.048). Hypertensives had higher low-density lipoprotein cholesterol concentration (LDL-C) as well as triglycerides concentration (TG) and lower high-density lipoprotein cholesterol concentration (HDL-C). Higher diagnostic sensitivity was found for hs-CRP (87%) and for TAS (89%). According to the global linear regression analysis, age, gender, hs-CRP, TAS and HDL-C were the only parameters influencing the occurrence of HTN. ROC analysis identified hs-CRP, HDL-C and TG as statistically significant to diagnose HTN (0.839; 0.816 and 0.855, respectively). Moreover, in ROC analysis there were no differences in hs-CRP and TAS in females and males. CONCLUSIONS: These results indicate that low-grade, systemic inflammation measured by hs-CRP as well as antioxidant status assessed by TAS, in the presence of traditional risk factors, are significant factors contributing to pathophysiology and diagnosis of essential arterial hypertension.

Examination of two decision rules for the global interpretation of the Luria-Nebraska Neuropsychological Battery summary profile.

Rules have been developed to facilitate global interpretive discriminations from the summary profile of the Luria-Nebraska Neuropsychological Battery (LNNB). Two such rules focus on the number of scales above an individual critical level and the range between highest and lowest summary scale t-score. Neither of the criteria have been observed for their relationships with either demographic or treatment variables (e.g., length of hospitalization, type of medication, etc.). The LNNB protocols and demographic and treatment data of 1037 persons were included in this study. The sample included not only brain impaired persons, but also schizophrenic subjects and both medical patients and nonhospitalized normal subjects. A series of analyses indicated that, though the number of scales above critical level and the range may be used in global interpretation of the LNNB profile, the effect of both demographic and treatment variables ought to be taken into account when making an interpretation with an individual patient. More conservative estimates of classification accuracy are reported and several cautions are recommended when applying these decision rules to schizophrenics.

Adaptation of insects to insecticides.

Insects have successfully adapted to most insecticides by becoming resistant to them. This adaptation, of recent origin, has evolved rapidly and independently in a large number of species and is of serious economic and medical importance. The origins of resistance are still obscure, but resistance is assumed to be pre-adaptive, arising through recurrent mutation of existing alleles. However, in at least one well-researched case it probably originated by gene duplication. Resistance can be monofactorial or multifactorial. When several independent mechanisms confer resistance to the same group of insecticides the order in which these mechanisms are selected may reflect their effectiveness in protecting insects from the toxic effects of the different compounds. Our concept of resistance is changing as insects continue to adapt to the insecticide-containing environment. Criteria for defining resistance in both fundamental and practical terms are re-examined here in the light of recent work.

The profile elevation scale and the impairment scale: two new summary scales for the Luria-Nebraska Neuropsychological Battery.

Two new clinical summary scales have been developed for the Luria-Nebraska Neuropsychological Battery. The scales were constructed in a derivation/ crossvalidation design with a sample of 459 mixed brain impaired patients and 135 non-brain impaired persons. Preliminary evidence suggests that the Profile Elevation scale and the Impairment scale are psychometrically viable, produce additional information to what is offered by the current clinical summary scales, and deserve further investigation. Interpretations are suggested for the two new scales and supported by two neurosurgical case examples. The scales are also expected to offer the possibility of quick screening devices.