Radiation dose difference between state of the art myocardial perfusion scintigraphy and computed tomography coronary angiography in patients undergoing evaluation for suspected coronary artery disease.

Minimisation of radiation exposure with cardiac imaging reduces the potential of secondary side effects. Radiation exposure from myocardial perfusion scintigraphy and computed tomography coronary angiography (CTCA) was compared. Overall doses were low with both modalities. Doses were lower in the CTCA group, but by only a small difference of 1.1 mSv. Radiation exposure should not be the primary consideration when choosing between these two modalities.

Replicability of sight word training and phonics training in poor readers: a randomised controlled trial.

Given the importance of effective treatments for children with reading impairment, paired with growing concern about the lack of scientific replication in psychological science, the aim of this study was to replicate a quasi-randomised trial of sight word and phonics training using a randomised controlled trial (RCT) design. One group of poor readers (N = 41) did 8 weeks of phonics training (i.e., phonological decoding) and then 8 weeks of sight word training (i.e., whole-word recognition). A second group did the reverse order of training. Sight word and phonics training each had a large and significant valid treatment effect on trained irregular words and word reading fluency. In addition, combined sight word and phonics training had a moderate and significant valid treatment effect on nonword reading accuracy and fluency. These findings demonstrate the reliability of both phonics and sight word training in treating poor readers in an era where the importance of scientific reliability is under close scrutiny.

Can contrast sensitivity functions in dyslexia be explained by inattention rather than a magnocellular deficit?

We examined whether data demonstrating contrast sensitivity losses in dyslexia that have been interpreted as evidence for loss of magnocellular visual function could be explained by inattention. Computer simulations of observers with poor concentration yielded inflated estimates of threshold that were a constant proportion of the true threshold across spatial frequencies. Data from many, but not all, studies supporting the magnocellular deficit theory are well described by these simulations, which predicted no interaction between observer group and spatial frequency. Some studies have reported significant interactions, but suffer from statistical deficiencies. This compromises some of the evidence for a magnocellular deficit in dyslexia derived from studies of threshold contrast sensitivity.

Lapses of concentration and dyslexic performance on the Ternus task.

Recently, Cestnick and Coltheart (Cognition 71 (1999) 231) have reported evidence of abnormal performance on the Ternus apparent motion task in dyslexics. We demonstrate that some aspects of their data may be accounted for by more frequent lapses of concentration in the dyslexic group than in controls. We then report on a study in which a modification of the Ternus procedure was employed to simplify the task and to control for the effects of inattention. The results suggest that dyslexics do genuinely differ from normal readers in their perceptual processing.

Newborn discharge timing and readmissions: California, 1992-1995.

CONTEXT: Hospital stays for newborns and their mothers after uncomplicated vaginal delivery have decreased from an average of 4 days in 1970 to 1.1 days in 1995. Despite the lack of population-based research on the quality-of-care implications of this trend, federal legislation passed in 1996 mandated coverage for 48-hour hospital stays after uncomplicated vaginal delivery. OBJECTIVE: To assess the impact of very early discharge (defined as discharge on the day of birth) on the risk of infant readmission during the neonatal period in a California healthy newborn population. DESIGN: Retrospective cohort study, based on a linked dataset consisting of the birth certificate, newborn, and maternal hospitalization record, and linked infant readmission records for all healthy, vaginally delivered, and routinely discharged California newborns from 1992 to 1995. OUTCOME MEASURES: Very early discharge and infant readmission during the first 28 days of life. RESULTS: The percentage of infants discharged very early or early (after a 1-night stay) increased from 71% in 1992 to 85% in 1995. The percentage of infants discharged very early increased from 5.0% in 1992 to 5.7% in 1993 and 7.0% in 1994, then decreased to 6.7% in 1995. Characteristics that have been previously associated with suboptimal pregnancy outcomes were found to decrease the likelihood of very early discharge, eg, maternal complications, primiparity, and Hispanic, African American, South East Asian, or other Asian race/ethnicity. The rate of readmission in the neonatal period initially decreased from 27.6 infants per 1000 in 1992 to 25.67 infants per 1000 in 1994, then increased to 30.2 infants per 1000 in 1995. For infants discharged early, no statistically significant increase in the risk of readmission was observed, compared with infants discharged after a 2+-night stay. The adjusted odds ratio (OR) for readmission was statistically significantly higher for infants who were discharged very early, compared with infants discharged early (OR: 1.27), first order births (OR: 1.21), infants born to mothers who experienced complications (OR: 1.11), infants with Medicaid insurance (OR: 1.23), and infants born to mothers who received adequate plus prenatal care (OR: 1.15). The risk was statistically significantly lower for female infants (OR: 0.75). The proportion of infants rehospitalized for dehydration and low-risk infections over the 4 study years combined was statistically significantly higher in infants discharged very early (4.37 per thousand and 10.30 per thousand, respectively), compared with infants discharged early (3.59 per thousand and 8.16 per thousand, respectively) or after a 2+-night stay (2.91 per thousand and 7.95 per thousand, respectively). The proportion of infants rehospitalized for dehydration increased statistically significantly from 2.89 per thousand in 1992 to 4.52 per thousand in 1995. CONCLUSIONS: One-night stays with adequate antenatal and postnatal care outside the hospital do not increase the risk of readmission for healthy, vaginally delivered infants born in California. However, the decision to discharge infants on the day of birth should be applied conservatively because of the increased risk of infant readmission associated with very early discharge.

Effects of smoking during pregnancy. Five meta-analyses.

BACKGROUND: The purpose of this study was to estimate, using meta-analysis, pooled odds ratios for the effects of smoking on five pregnancy complications: placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), and pre-eclampsia. METHODS: Published articles were identified through computer search and literature review. Five criteria were applied to those studies initially identified to determine those eligible for the meta-analysis. A random effects model was applied to derive pooled odds ratios for the eligible studies for each pregnancy complication. Meta-analyses were repeated on subsets of the studies to confirm the overall results. RESULTS: Smoking was found to be strongly associated with an elevated risk or placenta previa, abruptio placenta, ectopic pregnancy, and PPROM, and a decreased risk of pre-eclampsia. All pooled odds ratios were statistically significant. The pooled ratios ranged from 1.58 for placenta previa to 1.77 for ectopic pregnancy. The pooled odds ratio for pre-eclampsia was 0.51 and all subset analyses confirmed this seemingly protective effect. CONCLUSIONS: Smoking during pregnancy is a significant and preventable factor affecting ectopic pregnancy, placental abruption, placenta previa, and PPROM. The findings of smoking's apparently protective effect on pre-eclampsia should be balanced with these harmful effects. In addition, the biological linkage between smoking and pre-eclampsia is not yet well understood. Pregnant women should be advised to stop smoking in order to reduce the overall risk of pregnancy complications as well as any risk of adverse impact on the unborn child.

Varieties of developmental reading disorder: genetic and environmental influences.

There is widespread support for the notion that subgroups of dyslexics can be identified who differ in their reading profiles: Developmental phonological dyslexia is characterized by poor nonword reading, while developmental surface dyslexia is distinguished by a particular difficulty in reading irregular words. However, there is much less agreement about how these subtypes, and particularly the surface dyslexic pattern, are to be accounted for within theoretical models of the reading system. To assist in addressing this issue, the heritability of reading deficits in dyslexic subtypes was examined using a twin sample. Subjects' scores on (a) an exception word reading task and (b) a nonword reading task were used to create a subtype dimension, and surface and phonological dyslexic subgroups were selected from the ends of this distribution. Reading deficits were found to be significantly heritable in both subgroups. However, the genetic contribution to the group reading deficit was much greater in the phonological dyslexics than in the surface dyslexics. The finding of differential genetic etiology across subtypes suggests that there is at least partial independence in the development of the cognitive processes involved in reading exception words and nonwords. Also, the results support accounts of surface dyslexia which emphasize a strong environmental contribution.

Using employer purchasing power to improve the quality of perinatal care.

Large employers have become increasingly involved in helping to set the agenda for quality measurement and improvement. Moreover, they are beginning to hold health care organizations accountable for their performance through marketplace incentives, including the public reporting of comparative quality data and the linkage of reimbursement to performance on quality measures. The Pacific Business Group on Health (PBGH) is an employer coalition that has been prominent in establishing models for collaborative quality measurement and improvement in the California marketplace. PBGH's involvement in quality stems from an environment in which purchasers were faced with high health care costs, yet virtually no information with which to assess the value their employees received from that care. Research indicating widespread variation in performance across health care organizations and seemingly limited oversight for quality of care within the industry has further motivated purchasers' efforts to better understand the quality of care being delivered to their em-ployees. Using the purchasing power of employers representing 2.5-million covered lives, PBGH endeavors to encourage the transition of the health care marketplace from one that competes solely on price to one that competes on price and quality. This entails collaborating with the health care industry to develop and publicly report valid performance data for use by both large employers and consumers of health care services. It also includes communicating to the marketplace purchasers' commitment to making purchasing decisions based on quality as well as cost. PBGH efforts to measure, report, and improve quality have been demonstrated by several undertakings in the perinatal care arena, including research to assess cesarean section rates and newborn readmission rates across California hospitals.employer coalition, purchaser, quality measurement, quality improvement, report cards, perinatal quality of care.

Varieties of developmental dyslexia.

This paper reviews and evaluates the evidence for the existence of distinct varieties of developmental dyslexia, analogous to those found in the acquired dyslexic population. Models of the normal adult reading process and of the development of reading in children are used to provide a framework for considering the issues. Data from a large-sample study of the reading patterns of developmental dyslexics are then reported. The lexical and sublexical reading skills of 56 developmental dyslexics were assessed through close comparison with the skills of 56 normally developing readers. The results indicate that there are at least two varieties of developmental dyslexia, the first of which is characterised by a specific difficulty using the lexical procedure, and the second by a difficulty using the sublexical procedure. These subtypes are apparently not rare, but are relatively prevalent in the developmental dyslexic population. The results of a second experiment, which suggest that neither of these reading patterns can be accounted for in terms of a general language disorder, are then reported.