Feasibility of the neuropsychological spectrum in prediction of outcome following head injury.

This study provided further substantiation of the neuropsychological spectrum conceptualization (Templer, Campodonico, Trent, Spencer, & Hartlage, to appear; Templer, Spencer, & Hartlage, 1993; Templer, Campodonico, Trent, & Spencer, 1991). Two hundred and two traumatic brain injury patients were administered the Wechsler Adult Intelligence Scale-Revised, the Luria-Nebraska Neuropsychological Battery, the Wisconsin Card Sorting Test, the Booklet Category Test, and Trails A and B. The correlations between neuropsychological and intellectual tests were significantly lower than the correlations within intelligence tests and within neuropsychological tests. Neuropsychological tests predicted outcome better than intelligence tests. This was interpreted in terms of outcome for severely brain-damaged patients being more dependent upon basic neuropsychological functioning than on abstract thinking ability.

Analysis of the binding site on intercellular adhesion molecule 3 for the leukocyte integrin lymphocyte function-associated antigen 1.

Intercellular adhesion molecule 3 (ICAM-3, CD50) is a member of the immunoglobulin superfamily and is a constitutively expressed ligand for the leukocyte integrin LFA-1 (CD11a/CD18). ICAM-3 is expressed at high levels by all resting leukocyte populations and antigen presenting cells and is a major ligand for LFA-1 in the resting immune system. ICAM-3 is a signal transducer and may play a key role in initiating immune responses. Mutant ICAM-3 Fc-chimeric proteins were quantitatively analyzed for their ability to bind COS cells expressing human LFA-1. The LFA-1-binding site on ICAM-3 is located in the N-terminal 2 Ig domains. Domains 3-5 do not significantly contribute to adhesion. The binding site has been further resolved by rational targeting of 14 point mutations throughout domains 1 and 2, coupled with modeling studies. Within domain 1 a cluster of residues (Glu37, Leu66, Ser68, and Gln75), that are predicted to lie on the CC'FG face of the Ig fold, play a dominant role in LFA-1 binding.

Mnemonic coding system for clinical data entry into laboratory computers: its effect on quality and efficiency.

A simplified coding method for entering the clinical details found on pathology request cards was developed. The method uses a basic four letter code, derived from the initial character of the first four words in a clinical detail, being expanded to four characters with letters from the final word if the number of words is less than four. Rules were devised to cope with common medical terminology. In excess of 90% of clinical details on request cards are readily input by clerical staff using our coding system, and 8% of clinical details are used intelligently by the computer in scheduling further tests or automatically commenting on results. A carefully designed coding system such as the one outlined above could greatly facilitate input of clinical detail without the penalty of reduced throughput.

Albumin-adjusted calcium concentration in serum increases during normal pregnancy.

Concentrations of total calcium and albumin were measured in serum specimens from 41 women at intervals before, during, and after 42 pregnancies. The albumin concentration decreased but the calcium decreased more slowly, so that the albumin-adjusted calcium concentration increased from conception to term. These findings, taken in conjunction with published observations of hypercalciuria, increased concentrations of 1,25-dihydroxycholecalciferol and calcitonin in serum, and decreased concentrations of intact parathyrin in serum, strongly suggest that maternal ionized calcium increases throughout normal pregnancy.

Effects of workload and analysis time on the cost of out-of-hours investigations.

In the UK, under present Whitley Council Regulations for payment for out-of-hours pathology services, there is a complex relationship between the number of requests received, the time taken to analyse each request, and the number of calls for which payment may be claimed for work done. At a fixed average analysis time, the rate of increase of remuneration slows down as workload increases until at higher workloads remuneration falls. The introduction of methods with a shorter average analysis time to improve the clinical service increases remuneration disproportionately. We suggest that a fixed sessional payment would be a better way of funding the service.

Satisfactory screening for cystic fibrosis with the BM meconium procedure.

The Boehringer Mannheim test (BM test) for cystic fibrosis has been applied to 15 734 neonates. A positive result occurred in 130, seven of whom were subsequently shown to have the disease. To our knowledge no cases have been missed. Tests have been performed centrally by experienced laboratory staff and the false-positive rate of 0.83% is considered acceptable. It is important to follow up weak as well as strongly positive reactions to the BM test strip.

An evaluation of the first production model of the Rank Hilger Chemispek multichannel electrolyte analyser.

The first production model of the Rank Hilger Chemispek multichannel analyser was evaluated. It is a six-channel machine for the analysis of sodium, potassium, chloride, bicarbonate, urea, and creatinine. We chose to run it at 120 samples per hour. The machine was shown to be economical in the volumes of both samples (200 microliters) and regents, flexible, accurate, and precise. It performance was better than that of other machines with a similar capacity and it is considerably cheaper.

Comparison of an all-aqueous automated urine pregnancy oestrogen method with one using organic solvent extraction.

A comparative study between an all-aqueous automated urine pregnancy oestrogen method and a well established one requiring organic solvent extraction showed good agreement (r = 0.992). Advantages offered by the all-aqueous method include a faster rate of sample analysis and elimination of the difficulties of phase separation. The storage of urine for 5 days did not affect the oestrogen concentration measured by the all-aqueous method. Glucose, which reduced the apparent oestrogen concentration, was readily removed by treatment of the urine with borohydride, and treated urines showed good recoveries. The recovery of oestrogen was inadequate when glucose was removed from urine by incubation with yeast, possibly due to the formation of acetaldehyde.

Interpretation of serum calcium in patients with abnormal serum proteins.

Two hundred consecutive specimens received in this laboratory for "liver function tests" showed a wide range of abnormal protein concentrations. Calcium concentration correlated closely with albumin (r = 0.867) but less closely with total protein (r = 0.682). A simple formula for adjusting calcium concentration was derived from the regression equation of calcium on albumin. Adjusted calcium = calcium - albumin + 4.0, where calcium is in mg/100 ml and albumin in g/100 ml.Low calcium concentrations were found in 49 (24.5%) and raised concentrations in six (3%) of the 200 blood specimens taken for liver function tests. After adjustment, the 95% limits of the observed range were identical with the 95% limits of the normal range determined in this laboratory. Unlike adjustments based on total protein or specific gravity, the adjustment on albumin in 39 specimens which showed hypergammaglobulinaemia on electrophoresis gave normal calcium concentrations.

Screening for abnormal haemoglobins: a pilot study.

A pilot study has been made of the implication of screening for abnormal haemoglobins in immigrant schoolchildren. An abnormality was detected by capillary blood haemoglobin electrophoresis in 8.4% of 6,835 children and a haemoglobinopathy outpatient clinic had to be established to deal with the heavy work load which resulted. The clinic was also used to determine the value of investigating the remaining members of the family once an abnormality had been detected in one child.Healthy siblings with normal haemoglobin electrophoretic patterns and normal iron and folate levels were studied to determine a normal range for haemoglobin in relation to age for adequately nourished immigrant children. The lower limit of the normal range was close to the mean value minus 1(1/2) S.D.; by using this definition 10.3% of 280 children were subsequently found to be anaemic.Population screening of this type is desirable, but further pilot studies of patient education, genetic counselling, organization of specimen collection, data processing, and follow-up health care facilities are required before screening is extended more widely in the United Kingdom.