Evaluation of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry for Identification of Mycobacterium species, Nocardia species, and Other Aerobic Actinomycetes.

The value of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for the identification of bacteria and yeasts is well documented in the literature. Its utility for the identification of mycobacteria and Nocardia spp. has also been reported in a limited scope. In this work, we report the specificity of MALDI-TOF MS for the identification of 162 Mycobacterium species and subspecies, 53 Nocardia species, and 13 genera (totaling 43 species) of other aerobic actinomycetes using both the MALDI-TOF MS manufacturer's supplied database(s) and a custom database generated in our laboratory. The performance of a simplified processing and extraction procedure was also evaluated, and, similar to the results in an earlier literature report, our viability studies confirmed the ability of this process to inactivate Mycobacterium tuberculosis prior to analysis. Following library construction and the specificity study, the performance of MALDI-TOF MS was directly compared with that of 16S rRNA gene sequencing for the evaluation of 297 mycobacteria isolates, 148 Nocardia species isolates, and 61 other aerobic actinomycetes isolates under routine clinical laboratory working conditions over a 6-month period. MALDI-TOF MS is a valuable tool for the identification of these groups of organisms. Limitations in the databases and in the ability of MALDI-TOF MS to rapidly identify slowly growing mycobacteria are discussed.

The measurement level and trait-specific reliability of 4 scales of shoulder functioning: an empiric investigation.

OBJECTIVE: To evaluate 4 scales of shoulder function with respect to (1) their precision at different levels of shoulder function and (2) the measurement level of their raw scores (interval vs ordinal). DESIGN: Partial credit model calibration. SETTING: Office of private practice orthopedic surgeon with practice limited to the shoulder. PARTICIPANTS: One-hundred ninety-two shoulder patients. INTERVENTIONS: Participants completed the American Shoulder and Elbow Surgeons Patient Self-Evaluation Form (function subscale, modified), the disability subscale of the Shoulder Pain and Disability Index, the Simple Shoulder Test, and the function subscale of the University of Pennsylvania Shoulder Scale. MAIN OUTCOME MEASURES: The patients' responses were calibrated by using a partial credit model. We calculated standard errors of measurement and plotted the 95% confidence interval for different levels of shoulder functioning. We compared scales' raw scores with their equal interval measures obtained in the Rasch calibration. RESULTS: The scales did not measure all levels of shoulder functioning with equal precision, suggesting that commonly used reliability estimates misrepresent scale precision in certain subpopulations. CONCLUSIONS: The scales' raw scores were found to be not of equal interval, calling into question the scoring systems recommended by the developers of these scales and the use of the scores in some statistical procedures.

Altered hormone levels and circadian rhythm of activity in the WKY rat, a putative animal model of depression.

The Wistar Kyoto (WKY) rat is hyperreactive to stress and exhibits depressive-like behavior in several standard behavioral tests. Because patients with depressive disorders often exhibit disruptions in the circadian rhythm of activity, as well as altered secretory patterns of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid hormones, we tested the hypothesis that these phenomena occur in the WKY rat. Plasma ACTH and corticosterone levels remained significantly higher after the diurnal peak for several hours in WKY rats relative to Wistar rats. Also, plasma levels of thyroid-stimulating hormone were significantly higher in WKY relative to Wistar rats across the 24-h period, despite normal or slightly higher levels of 3,5,3'-triiodothyronine. In addition, under constant darkness conditions, WKY rats exhibited a shorter free running period and a decreased response to a phase-delaying light pulse compared with Wistar rats. In several ways these results are similar to those seen in other animal models of depression as well as in depressed humans, suggesting that the WKY rat could be used to investigate the genetic basis for these abnormalities.

Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.

BACKGROUND AND PURPOSE: Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. SUBJECTS: Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. METHODS: Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. CONCLUSION AND DISCUSSION: A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

Emotional expressiveness during peer conflicts: a predictor of social maladjustment among high-risk preschoolers.

Preschool boys' emotional displays during conflicts with mixed-sex peers were related to individual differences in peer sociometric status and teacher ratings of disruptive behavior. Participants were 60 4- to 5-year old boys from low-income families who were videotaped with a small group of classmates in a Head Start preschool classroom. Conflicts were identified and emotional displays were coded from videotape. Results indicated that conflicts were more negative in emotional tone at the end than at the beginning of the year. Furthermore, children tended to mirror each others' emotional displays at the end but not the beginning of the preschool year. In addition, gleeful taunting, a form of emotional aggression, more strongly predicted negative peer nominations and teacher ratings than anger, suggesting that anger may be a more socially accepted form of emotional expression during conflicts among preschool-age children. Implications and directions for future research and interventions are discussed.

Comparison of the University of California-Los Angeles Shoulder Scale and the Simple Shoulder Test with the shoulder pain and disability index: single-administration reliability and validity.

BACKGROUND AND PURPOSE: Shoulder scales are often used to evaluate treatment efficacy, yet little is known about the psychometric properties of these scales. Only one scale has undergone psychometric scrutiny: the Shoulder Pain and Disability Index (SPADI). This study compared 2 shoulder measures-the University of California-Los Angeles (UCLA) Shoulder Scale and the Simple Shoulder Test (SST)-with the SPADI. SUBJECTS: One hundred ninety-two patients with shoulder disorders were recruited from one physician's office to complete the self-report sections of the 3 scales. METHODS: Cronbach alpha values and standard errors of measurement (SEM) were calculated for each of the multi-item subscales. Validity was examined through calculation of correlation coefficients among the 3 scales. Factor analysis was completed to assess the underlying constructs of the SPADI and the SST. RESULTS: Cronbach alpha values ranged from.85 to.95. The SEM values for the multi-item scales ranged from 4.75 to 11.65. Evidence for validity to reflect function was indicated by the correlation between the SST and the SPADI disability subscale. The factor analysis of the SPADI revealed loading on 1 factor, whereas the SST loaded on 2 factors. CONCLUSION AND DISCUSSION: All scales demonstrated good internal consistency, suggesting that all items for each scale measure the same construct. However, the SEMs for all scales were high. Factor loading was inconsistent, suggesting that patients may not distinguish between pain and function.

Early developmental precursors of externalizing behavior in middle childhood and adolescence.

This study examined the infancy- and toddler-age precursors of children's later externalizing problem behavior. Risk constructs included suboptimal patterns of observed caregiver-child interaction and the caregiver's perception of child difficultness and resistance to control. In addition, a novel dimension of caregiver-child relationship quality, the caregiver's perception of her toddler's unresponsiveness to her, was examined as a possible precursor of children's externalizing behavior. Externalizing problem outcomes were assessed throughout the school-age period and again at age 17, using multiple informants. As toddlers, children at risk for later externalizing behavior were perceived as difficult and resistant to control, and relationships with their caregivers were relatively low in warmth and affective enjoyment. Finally, the caregiver's perception of her toddler as emotionally unresponsive to her was a consistent predictor of later externalizing behavior, suggesting that negative maternal cognitions associated with child conduct problems may begin in toddlerhood. These predictive patterns were similar for boys and girls, and with minor exceptions, generalized across different subdimensions of externalizing problem behavior. Our findings underscore the importance of the infancy and toddler periods to children's long-term behavioral adjustment, and indicate the desirability of further research into the nature of caregivers' early perceptions of child unresponsiveness.

Tender point sensitivity, range of motion, and perceived disability in subjects with neck pain.

STUDY DESIGN: Descriptive analysis of impairment and disability measures in subjects with neck pain. OBJECTIVES: To identify discrete tender points and overall pressure sensitivity and assess relationships among palpation tenderness, active cervical range of motion, visual analog scale pain scores, and Sickness Impact Profile disability scores. BACKGROUND: Palpation tenderness and cervical range of motion are used to evaluate patients with neck pain, but their ability to predict patient-perceived pain and disability is unknown. METHODS AND MEASURES: We studied 45 women and 15 men with neck pain (mean age, 35 +/- 7 years). Group 1 included 30 persons who had not sought treatment, and group 2 included 30 persons who had just been referred for treatment. RESULTS: Subjects demonstrated low mean pressure pain thresholds of tender points (2.3 +/- 1.3 kg). Regression analysis showed that only neck flexion predicted pain (R2 = 0.23), with decreased flexion associated with higher pain levels. Sickness Impact Profile total score was predicted by neck rotation (R2 = 0.31), group (R2 = 0.16), tender point pressure pain threshold (R2 = 0.04), and neck retraction (R2 = 0.03). Decreased neck rotation, neck retraction, and pressure pain thresholds were associated with higher disability. CONCLUSIONS: Neither palpation tenderness nor cervical range of motion were strong predictors of pain and disability in subjects with neck pain.

Total head excursion and resting head posture: normal and patient comparisons.

OBJECTIVE: To determine whether significant differences existed between normal and patient groups on three postural measurements: anterior-posterior total head excursion (THE), resting head posture in sitting (RHPsit), and resting head posture in standing (RHPstd). SUBJECTS: Forty-two healthy subjects, 13 men and 29 women between the ages of 20 and 60 years, were matched to 42 patients according to gender and age. DESIGN: Measurements of THE, RHPsit, and RHPstd were taken for each subject. Patients were measured during their initial evaluation and had neck pain as a primary or secondary complaint. RESULTS: A two-way multivariate analysis of variance followed by two-way analyses of variance showed that normal subjects had a significantly (p<.05) greater THE than did the patients and that men (patients and controls) scored significantly higher (p<.05) than women (patients and controls) on both THE and RHPstd. CONCLUSION: Clinical assessment of patients with cervical pain should focus on cervical mobility rather than resting head posture. Head/neck posture is different for males and females and they should not be judged by the same standard.

Measurement of impulsivity: construct coherence, longitudinal stability, and relationship with externalizing problems in middle childhood and adolescence.

This study focused on the assessment of impulsivity in nonreferred school-aged children. Children had been participants since infancy in the Bloomington Longitudinal Study. Individual differences in impulsivity were assessed in the laboratory when children were 6 (44 boys, 36 girls) and 8 (50 boys, 39 girls) years of age. Impulsivity constructs derived from these assessments were related to parent and teacher ratings of externalizing problems across the school-age period (ages 7-10) and to parent and self-ratings of these outcomes across adolescence (ages 14-17). Consistent with prior research, individual measures of impulsivity factor-analyzed into subdimensions reflecting children's executive control capabilities, delay of gratification, and ability or willingness to sustain attention and compliance during work tasks. Children's performance on the main interactive task index, inhibitory control, showed a signficant level of stability between ages 6 and 8. During the school-age years, children who performed impulsively on the laboratory measures were perceived by mothers and by teachers as more impulsive, inattentive, and overactive than others, affirming the external validity of the impulsivity constructs. Finally, impulsive behavior in the laboratory at ages 6 and 8 predicted maternal and self-ratings of externalizing problem behavior across adolescence, supporting the long-term predictive value of the laboratory-derived impulsivity measures.

Physical performance: differences in men and women with and without low back pain.

OBJECTIVE: To determine the extent to which there may be major differences in scores on a battery of physical performance tasks among men with nonspecific, mechanical low back pain (LBP), women with LBP, healthy men, and healthy women. DESIGN: Case series survey. SETTING: A referral-based orthopedic clinic. PATIENTS: Thirty-three men and 46 women with LBP. Control Subjects: Twenty-one men and 25 women healthy controls. INTERVENTION: Completion of six clinician-assessed physical performance tasks and self-report inventories. MAIN OUTCOME MEASURE: Performance scores on distance walked in 5 minutes, 50-foot walk at fastest speed, repeated sit-to-stand, repeated trunk flexion, loaded forward reach, and the Sorensen fatigue tasks. RESULTS: Discriminant function analysis revealed that the four groups of subjects performed the physical tasks significantly different in two major ways: (1) healthy control subjects outperformed LBP patients, irrespective of gender, on tasks involving trunk control, coordination, and stability while withstanding heavy or quickly changing loads on the spine; (2) men outperformed women, irrespective of patient or nonpatient status, on tasks involving anthropometric features of limb length. The findings provide guidance on reasonable performance expectations for men and women patients with LBP. Future studies of treatment effectiveness also will be able to assess physical performance change in terms of the intersection between standards set by the men and women healthy control subjects and those of men and women patients. However, whether a return to nonpatient status is an appropriate treatment goal is left to future research.

Relationships of the extinct moa-nalos, flightless Hawaiian waterfowl, based on ancient DNA.

The extinct moa-nalos were very large, flightless waterfowl from the Hawaiian islands. We extracted, amplified and sequenced mitochondrial DNA from fossil moa-nalo bones to determine their systematic relationships and lend insight into their biogeographical history. The closest living relatives of these massive, goose-like birds are the familiar dabbling ducks (tribe Anatini). Moa-nalos, however, are not closely related to any one extant species, but represent an ancient lineage that colonized the Hawaiian islands and evolved flightlessness long before the emergence of the youngest island, Hawaii, from which they are absent. Ancient DNA yields a novel hypothesis for the relationships of these bizarre birds, whereas the evidence of phylogeny in morphological characters was obscured by the evolutionary transformation of a small, volant duck into a giant, terrestrial herbivore.

Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain.

STUDY DESIGN: The psychometric properties and clinical use of a battery of physical performance measures were tested on 44 patients with low back pain and 48 healthy, pain-free control subjects. OBJECTIVES: Reliability, validity, and clinical use of nine physical performance measures were evaluated. SUMMARY OF BACKGROUND DATA: Although physical performance measures have potential use in evaluation, treatment planning, and determination of treatment outcome, there is sparse systematic investigation of their reliability, validity, and clinical use. METHODS: Forty-four subjects with low back pain and 48 healthy pain-free subjects participated. The following physical performance measures were tested: distance walked in 5 minutes; 50-foot walk at fastest speed; 50-foot walk at preferred speed; 5 repetitions of a sit-to-stand task; 10 repetitions of a repeated trunk flexion task; timed up-and-go task; unloaded forward reach task; loaded forward reach task; and Sorensen fatigue test. Subjects were assessed twice on 2 days. RESULTS: All measures had excellent intertester reliability (intraclass correlation coefficient [ICC]1,1 > 0.95). Test-retest (within session) reliability was adequate for all measures (ICC1,1 > 0.83) except repeated trunk flexion (ICC1,1 > 0.45) in the low back pain group. Test-retest (day-to-day) reliability ranged between 0.59 and 0.88 in the low back pain group and between 0.46 and 0.76 in the control group. Day-to-day reliability improved when the averages of two trials of repeated trunk flexion and sit-to-stand were used (0.76-0.91 low back pain group and 0.62-0.89 control group). Results of a multivariate analysis of variance showed a significant effect of group (F10,65 = 3.52, P = 0.001). Results of univariate analyses showed significant group differences on all measures except the 50-foot walk at preferred speed and unloaded forward reach. Self-report of disability was moderately correlated with the performance tasks (r = 0.400 to -0.603). CONCLUSIONS: The results provide support for the use of these physical performance measures as a complement to patient self-report.

Sequence analysis of the mouse RAG locus intergenic region.

The recombination activating genes RAG-1 and RAG-2 are highly conserved throughout evolution and are necessary and essential for the DNA rearrangement of antigen-receptor gene segments. These convergently transcribed genes are expressed primarily by developing B and T lineage cells. In addition, recent data suggest that the RAG locus can be reactivated in mouse germinal center B cells. Despite these well-defined patterns of expression, little is known about mechanism(s) regulating transcription of the RAG locus. Experiments with a mouse fibroblast line stably transfected with a genomic fragment of the RAG locus suggest that the intergenic region between RAG-1 and RAG-2 may contain information modulating RAG transcription. In order to begin testing this hypothesis, we have sequenced the 7.0-kb RAG intergenic region of the mouse. The sequence did not contain open reading frames larger than 60 amino acids. Analysis with GCG software identified several potential transcription-factor binding sequences within this region. Many of these are associated with transcriptional regulation of the Ig locus.

Bedside musical care: applications in pregnancy, childbirth, and neonatal care.

Although music therapy in health care settings is not new, bringing live music to the bedside is a new way of extending the caring tradition of nursing practice. Bedside musical care is consistent with a philosophy of holistic nursing practice and can be used during pregnancy, childbirth, and in neonatal care. It is defined as live music at the bedside, which is part of a treatment plan to foster integrity, well-being, and health for varied populations across the life span.

The effect of use of a wrist orthosis during functional activities on surface electromyography of the wrist extensors in normal subjects.

Wrist orthoses are advocated for patients with lateral epicondylitis on the assumption that use of the orthosis decreases muscle activity of the wrist extensors during activities. The purpose of this study was to compare the amount of electrical activity, root mean square (RMS) calculated from surface EMG recorded over the wrist extensors, during activities when applying four conditions of wrist orthoses: dorsal; volar; semicircular; and no orthosis. Thirteen normal subjects (mean age 27.7 years) performed three lifting and two gripping tasks, repeated on three consecutive days under four orthotic conditions. Measured were RMS and maximum voluntary grip strength. Repeated measures ANOVA's indicated a significant decrease of RMS using the semicircular design during lifting (p < .0005). Grip strength decreased significantly using all three orthotic designs, but RMS recorded during gripping did not. It was concluded that application of a wrist orthosis reduces electrical activity of the wrist extensors less than anticipated and only during lifting.

Assessment of peer neglect in the preschool years: a short-term longitudinal study.

Examined concurrent and longitudinal relations between different measures of peer neglect in the preschool years. Measures of social competence included peer sociometrics, teacher ratings, and behavioral observations of peer interactions. Participants were sixty 4- to 5-year-old Caucasian boys from low-income family backgrounds. Results indicated that the stability of indicators of peer neglect and social isolation depended on the measure employed. Correlations between different measures suggested heterogeneity in patterns of social adaptation among neglected or isolated preschool children. Results are discussed emphasizing the need to rely on multiple indicators for the assessment of preschool children's social competence.