Cultural accommodations for cutoff scores of embedded performance validity tests in a Spanish college population.

OBJECTIVE: The objective of this study was to identify specific cutoff scores for three commonly used embedded performance validity tests (PVTs) for a Spanish speaking population. Culturally adapted cutoff scores for embedded PVTs were established using an analog study design. In addition, the psychometric properties of these measures when applying culturally adapted scores as compared to non-adapted scores were analyzed. METHOD: Participants (N = 114) were administered three embedded PVTs (Reliable Digit Span, Phonetic Fluency Test, and Animal Semantic Fluency Test) in a randomized order. Following an analog design, control participants were instructed to perform to the best of their abilities and the analog group was instructed to simulate cognitive impairment. RESULTS: In keeping with guidelines for specificity and sensitivity, the most culturally appropriate scores of ≤6, ≤27, and ≤16 were determined for the Reliable Digit Span, Phonetic Fluency Test, and the Semantic Fluency Test, respectively. CONCLUSIONS: This the first study addressing culturally sensitive cutoffs for commonly used embedded validity measures using a European Spanish population. While these findings cannot be generalized to forensic or clinical populations at the present time, they support the claim that specific cutoff scores that are sensitive to cultural variables are necessary in addressing embedded validity measures of the Reliable Digit Span, Phonetic Fluency Test, and Semantic Fluency Test.

Accuracy of influenza vaccination rate estimates in United States nursing home residents.

The US Center for Medicare and Medicaid Services (CMS) requires nursing homes and long-term-care facilities to document residents' vaccination status on the Resident Assessment Instrument (RAI). Vaccinating residents can prevent costly hospital admissions and deaths. CMS and public health officials use RAI data to measure vaccination rates in long-term-care residents and assess the quality of care in nursing homes. We assessed the accuracy of RAI data against medical records in 39 nursing homes in Florida, Georgia, and Wisconsin. We randomly sampled residents in each home during the 2010-2011 and 2011-2012 influenza seasons. We collected data on receipt of influenza vaccination from charts and RAI data. Our final sample included 840 medical charts with matched RAI records. The agreement rate was 0·86. Using the chart as a gold standard, the sensitivity of the RAI with respect to influenza vaccination was 85% and the specificity was 77%. Agreement rates varied within facilities from 55% to 100%. Monitoring vaccination rates in the population is important for gauging the impact of programmes and policies to promote adherence to vaccination recommendations. Use of data from RAIs is a reasonable approach for gauging influenza vaccination rates in nursing-home residents.

Intimate partner violence screening in the emergency department.

BACKGROUND AND AIMS: Every year between 1.5 and 4 million women are abused by a partner in the United States and many abused women turn to the Emergency Department (ED) as their first source of care. Even though the vast majority of patients would feel comfortable disclosing intimate partner violence (IPV) to their physician, identification and referral is inconsistent . AIMS: The aim of this paper was to discuss prevalence statistics of IPV, current screening recommendations and practices in ED settings, and future directions to improve the screening and identifying of victims of IPV that present to the ED. MATERIAL AND METHODS: The authors conducted a Medline search for articles discussing IPV screening in the ED. RESULTS: Intimate partner violence results in approximately 1,300 deaths and 2,000,000 injuries annually among women and up to a third of ED patients have a history of IPV. Despite patients' reported willingness to disclose this information, identification of IPV by healthcare practitioners remains very low, with some estimates ranging between 4-10%. CONCLUSIONS: If we do not identify victims of IPV in the ED, this may result in continuation of the abuse, routine returns to the ED for treatment of injuries, and possibly even death.

Lipid-lowering agents and the risk of hip fracture in a Medicaid population.

CONTEXT: Three recent nested case-control studies conducted in automated databases suggest that users of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have a risk of hip and other osteoporotic fractures half that of non-users of any lipid-lowering drug. However, this comparison may be biased by unmeasured factors associated with treated hyperlipidemias. OBJECTIVE: To compare the risk of hip fracture among users of statins and other lipid-lowering agents, which is less susceptible to bias than the comparisons performed in the previous studies. DESIGN AND SETTING: Retrospective cohort study conducted in the Tennessee Medicaid program between 1 January 1989 through 31 December 1998. SUBJECTS: New users of all lipid-lowering drugs and randomly selected non-user controls who at baseline were at least 50 years of age and did not have life threatening illness, nursing home residence, or diagnosed dementia or osteoporosis. There were 12506 persons with new use of statins, 4798 with new use of other lipid lowering drugs, and 17280 non-user controls. MAIN OUTCOME MEASURE: Fracture of the proximal femur (hip), excluding pathological fractures or those resulting from severe trauma. RESULTS: During 66690 person years of follow up, there were 186 hip fractures (2.8 per 1000). Relative to non-users, the adjusted incidence rate ratios (95% confidence interval) were 0.62 (0.45 to 0.85) for statin users and 0.44 (0.26 to 0.95) for other lipid-lowering drugs. When compared directly with the other drugs, the adjusted incidence rate ratio for statins was 1.42 (0.83-2.43). CONCLUSION: These data provide evidence that the previously observed protective effect of statins may be explained by unmeasured confounding factors.

The Discipline for doing spiritual care: variations on a theme.

This article describes the writers introduction to The Discipline and his decision to utilize selected aspects of it in direct care and in an educational milieu. The first section describes adaptation of the Profile (Concepts of Holy, Meaning, Hope, and Community) in the writer's work with addicted persons on a Recovery Center. The second section presents the employment of this Profile as a way to introduce CPE interns to the art of pastoral assessment.

Sialic acid-dependent binding of baculovirus-expressed recombinant antigens from Plasmodium falciparum EBA-175 to Glycophorin A.

The Plasmodium falciparum Erythrocyte Binding Antigen-175, EBA-175, is a soluble merozoite stage parasite protein which binds to glycophorin A surface receptors on human erythrocytes. We have expressed two conserved cysteine-rich regions, region II and region VI, of this protein as soluble His-tagged polypeptides in insect cell culture, and have tested their function in erythrocyte and glycophorin A binding assays. Recombinant region II polypeptides comprised of the F2 sub-domain or the entire region II (F1 and F2 sub-domains together) bound to erythrocytes and to purified glycophorin A in a manner similar to the binding of native P. falciparum EBA-175 to human red cells. Removal of sialic acid residues from the red cell surface totally abolished recombinant region II binding, while trypsin treatment of the erythrocyte surface reduced but did not eliminate recombinant region II binding. Synthetic peptides from three discontinuous regions of the F2 sub-domain of region II inhibited human erythrocyte cell binding and glycophorin A receptor recognition. Immune sera raised against EBA-175 recombinant proteins recognized native P. falciparum-derived EBA-175, and sera from malaria-immune adults recognized recombinant antigens attesting to both the antigenicity and immunogenicity of proteins. These results suggest that the functionally-active recombinant region II domain of EBA-175 may be an attractive candidate for inclusion in multi-component asexual blood stage vaccines.

Virtual seminars for medical nutrition education: case example.

Nutrition educators are exploring Web-based strategies for delivering course material. This report describes an effort to use computer-mediated communication between medical students and experts. A "virtual seminar" designed to help students apply nutrition knowledge to patient care was added to an existing traditional clinical skills course. There are few models for online nutrition education. Since these efforts are expensive in time, money, or both, it is important to share preliminary findings, including new methods of evaluating participation and effectiveness. Although medical student activity in the seminar was greater than anticipated, the return rate for the online evaluation survey was disappointing.

Analysis of human antibodies to erythrocyte binding antigen 175 of Plasmodium falciparum.

Invasion of human erythrocytes by Plasmodium falciparum merozoites is a multistep process. For many strains of the parasite, part of this process requires that the erythrocyte binding antigen 175 (EBA-175) of the merozoite binds to sialic acid residues of glycophorin A on the erythrocyte surface, a receptor-ligand interaction which represents a potential target for inhibition by antibodies. This study characterizes the reactivity of naturally acquired human antibodies with four recombinant proteins representing parts of EBA-175 (region II, regions III to V, and the dimorphic C and F segment region) in populations in which the organism is endemic. Serum immunoglobulin G (IgG) recognizing the recombinant proteins is predominantly of the IgG1 and IgG3 subclasses, and its prevalence increases with age. In a large population study in The Gambia, serum positivity for IgG or IgG1 and IgG3 subclass antibodies to each of the EBA-175 recombinant antigens was not significantly associated with subsequent protection from clinical malaria. However, there was a trend indicating that individuals with high levels of IgG to region II may have some protection.

Saccharomyces cerevisiae GATA sequences function as TATA elements during nitrogen catabolite repression and when Gln3p is excluded from the nucleus by overproduction of Ure2p.

Saccharomyces cerevisiae selectively uses good nitrogen sources (glutamine) in preference to poor ones (proline) by repressing GATA factor-dependent transcription of the genes needed to transport and catabolize poor nitrogen sources, a physiological process designated nitrogen catabolite repression (NCR). We show that some NCR-sensitive genes (CAN1, DAL5, DUR1,2, and DUR3) produce two transcripts of slightly different sizes. Synthesis of the shorter transcript is NCR-sensitive and that of the longer transcript is not. The longer transcript also predominates in gln3Delta mutants irrespective of the nitrogen source provided. We demonstrate that the longer mRNA species arises through the use of an alternative transcription start site generated by Gln3p-binding sites (GATAAs) being able to act as surrogate TATA elements. The ability of GATAAs to serve as surrogate TATAs, i.e. when synthesis of the shorter, NCR-sensitive transcripts are inhibited, correlates with sequestration of enhanced green fluorescent protein (EGFP)-Gln3p in the cytoplasm in a way that is indistinguishable from that seen with EGFP-Ure2p. However, when the shorter, NCR-sensitive DAL5 transcript predominates, EGFP-Gln3p is nuclear. These data suggest that the mechanism underlying NCR involves the cytoplasmic association of Ure2p with Gln3p, an interaction that prevents Gln3p from reaching it is binding sites upstream of NCR-sensitive genes.

Patient teaching to promote behavioral change.

Nurses are taught that patient teaching is an essential component of their professional role. This article describes the research on which effective patient teaching should be based.

Effects of practice on the ability to perform lumbar stabilization exercises.

STUDY DESIGN: Randomized pretest-posttest control group design. OBJECTIVES: To determine the intratester and intertester reliability of a modified isometric stability test and to use this test to evaluate the effects of practice following a 4-week stabilization exercise program with weekly reinstruction. BACKGROUND: Although "stabilization" exercise programs are commonplace in the clinic, the reliability to a tool capable of measuring changes in the ability to perform increasingly difficult stabilization exercises has not, to our knowledge, been reported. In addition, it is not clear if practice improves the ability to perform stabilization exercises. METHODS AND MEASURES: A convenience sample of 44 asymptomatic subjects was pretested using a pressure transducer placed beneath the lumbar spine to detect motion (+/- 4 mm Hg). A series of 7 exercises was attempted, which required increasing levels of muscular control of the lumbar spine for stability. Subjects received a pass or fail for each exercise level based on the pressure gauge readings and the absence of movement compensations. Subjects were assigned randomly to exercise and nonexercise groups, and posttest measurements were taken after 4 weeks. The control group did not receive additional instruction. RESULTS: The weighted kappa coefficient of 0.61 for intratester and 0.62 for intertester represents good agreement. The median level of exercise attainment increased for the exercise group but not for the nonexercise group. CONCLUSION: These results suggest that the modified isometric stability test was reliable and that a 4-week lumbar stabilization exercise program, with weekly intervals of reinstruction and testing, improves the ability to perform progressively difficult lumbar stabilization exercises.

Overlapping positive and negative GATA factor binding sites mediate inducible DAL7 gene expression in Saccharomyces cerevisiae.

Allantoin pathway gene expression in Saccharomyces cerevisiae responds to two different environmental stimuli. The expression of these genes is induced in the presence of allantoin or its degradative metabolites and repressed when a good nitrogen source (e. g. asparagine or glutamine) is provided. Three types of cis-acting sites and trans-acting factors are required for allantoin pathway gene transcription as follows: (i) UAS(NTR) element associated with the transcriptional activators Gln3p and Gat1p, (ii) URS(GATA) element associated with the repressor Dal80p, and (iii) UIS(ALL) element associated with the Dal82 and Dal81 proteins required for inducer-dependent transcription. Most of the work leading to the above conclusions has employed inducer-independent allantoin pathway genes (e.g. DAL5 and DAL3). The purpose of this work is to extend our understanding of these elements and their roles to inducible allantoin pathway genes using the DAL7 (encoding malate synthase) as a model. We show that eight distinct cis-acting sites participate in the process as follows: a newly identified GC-rich element, two UAS(NTR), two UIS(ALL), and three URS(GATA) elements. The two GATA-containing UAS(NTR) elements are coincident with two of the three GATA sequences that make up the URS(GATA) elements. The remaining URS(GATA) GATA sequence, however, is not a UAS(NTR) element but appears to function only in repression. The data provide insights into how these cis- and trans-acting factors function together to accomplish the regulated expression of the DAL7 gene that is observed in vivo.

Salmonella Thompson associated with improper handling of roast beef at a restaurant in Sioux Falls, South Dakota.

In October 1996, we investigated an outbreak of Salmonella serotype Thompson infections associated with Restaurant A in Sioux Falls, South Dakota, and conducted two cohort studies among persons who ate at luncheons catered by Restaurant A. Fifty-two Salmonella Thompson infections were identified between 29 September and 14 October 1996. Infections occurred among employees and patrons at Restaurant A and among attendees at three luncheons catered by the restaurant on 7 October. Roast beef cooked at Restaurant A was the only food item significantly associated with illness. Cooking times and storage temperatures for roast beef were inadequate to prevent multiplication of Salmonella, and the chefs were unaware of proper cooking and storage temperatures. We conclude that improper handling of roast beef probably caused this outbreak of Salmonella Thompson infections. Better knowledge of food safety practices by the cooking staff at Restaurant A, through required food safety education, might have prevented the outbreak.

Use of nonsteroidal anti-inflammatory drugs and incidence of colorectal cancer: a population-based study.

BACKGROUND: Previous observational studies have provided limited information on the effect of specific nonsteroidal anti-inflammatory drugs (NSAIDs) and different patterns of use (duration and dose) on the incidence of colorectal cancer. OBJECTIVE: To determine how patterns of use (duration, dose, and specific drug) of NSAIDs affect incidence of colorectal cancer. DESIGN: Population-based retrospective cohort study. SETTING: Tennessee Medicaid Program, 1985-1992. SUBJECTS: Enrollees (n = 104217) aged 65 years or older with at least 5 years of enrollment. MAIN OUTCOME MEASURES: Incident histologically confirmed colorectal cancer. RESULTS: Users of nonaspirin NSAIDs for at least 48 months of the previous 5 years had a relative risk (RR) of 0.49 (95% confidence interval [CI], 0.24-1.00) for colon cancer when compared with those with no use of NSAIDs. Among those with more than 12 months of cumulative use, those using NSAIDs in the past year (recent users) had an RR of 0.61 (95% CI, 0.48-0.77), whereas those with no recent use had an RR of 0.76 (95% CI, 0.50-1.15). No specific NSAID offered a unique protective effect and low doses of NSAIDs appeared to be at least as effective as higher doses. Protection was most pronounced for right-sided lesions. The RR among recent users with more than 12 months of cumulative use was 0.81 (95% CI, 0.49-1.32) for rectal cancer, 0.77 (95% CI, 0.55-1.08) for left-sided colon cancer, and 0.48 (95% CI, 0.34-0.68) for right-sided colon cancer. CONCLUSIONS: In this elderly population, long-term use of nonaspirin NSAIDs nearly halved the risk of colon cancer. This study was consistent with previous studies that suggest that duration of use but not daily dose of NSAIDs is an important factor for chemoprevention. Our data also suggest that the protective effect is shared by most NSAIDs, and not confined to a small number of these drugs.

Educating patients on a short stay unit.

Finding time to teach patients on a short stay unit is always a challenge. Involving staff and integrating continuous quality improvement techniques can improve a unit's patient education. Here are time-saving tips.

Evolution of spore release mechanisms in the saprolegniaceae (Oomycetes): evidence from a phylogenetic analysis of internal transcribed spacer sequences

Classical studies on spore release within the Saprolegniaceae (Oomycetes) led to the proposition that different mechanisms of sporangial emptying represent steps in an evolutionary transition series. We have reevaluated this idea in a phylogenetic framework using internal transcribed spacer sequences of four genera. These data were compared with the response to osmotic stress exhibited by each taxon. Saprolegnia emerges as the most basal genus, sister to Achlya, Thraustotheca, and Dictyuchus. Achlya and Thraustotheca are most closely related, while Dictyuchus appears to have evolved along a separate evolutionary lineage. The resulting phylogenetic framework is consistent with the idea that the mechanism of sporangial emptying exhibited by Saprolegnia represents the plesiomorphic condition from which the other mechanisms were derived independently. These alternative mechanisms of spore release may have resulted from a small number of mutations that inhibited axonemal development and altered the temporal and spatial expression of lytic enzymes that degrade the sporangial wall. Copyright 1998 Academic Press.

No association between calcium channel blocker use and confirmed bleeding peptic ulcer disease.

Calcium channel antagonists are commonly used drugs that have recently been reported to be associated with an increased incidence of gastrointestinal hemorrhage. We performed a retrospective cohort study among 105,824 enrollees of the Tennessee Medicaid program 65 years of age or older between 1984 and 1986. Exposure to calcium channel blockers and other medications was determined from pharmacy files. Hospitalization for bleeding peptic ulcers was identified by hospital claims and verified by a review of the medical record. Univariate estimates of relative risk for current users of calcium channel blockers and beta-blocker users were 1.8 (95% confidence interval (CI) 1.2-2.7) and 1.1 (95% CI 0.7-1.6) (reference group was nonuse of either). After adjustment for potential confounders, the relative risks for bleeding peptic ulcer among current users of calcium channel blockers and beta blockers were 1.1 (95% CI 0.7-1.7) and 1.0 (95% CI 0.7-1.6), respectively, when compared with those who used neither drug. In this population, after controlling for important confounders, there was no increased risk for hospitalization with bleeding peptic ulcer among users of calcium channel blockers.

Treatment strategies for premenstrual syndrome.

Premenstrual syndrome (PMS) refers to a group of menstrually related disorders. Premenstrual symptoms sufficient to impair daily activity and relationships are estimated to occur in up to 40 percent of women of reproductive age, with 5 percent of these women having severe impairment. Although no single causative factor has been identified, PMS is related to ovulatory cycles and resolves at menopause. A specific diagnostic test for PMS does not exist. Treatment is based on the symptoms. Oral contraceptive agents, diuretics and antidepressants have been used successfully to relieve symptoms. Cognitive therapy may help the patient develop appropriate ways to cope with the obstacles, frustrations and discomforts of daily life. Although dietary deficiencies may be difficult to demonstrate, nutritional supplementation may result in significant improvement. Various treatments, including progesterone supplementation, vitamin B6 in high doses, alprazolam and gonadotropin-releasing hormone agonists, are generally not recommended. A comprehensive treatment plan that encourages a healthy lifestyle may relieve symptoms in most women.