All of the accuracy in half of the time: Assessing abbreviated versions of the Test of Memory Malingering in the context of verbal and visual memory impairment.

ObjectiveThe Test of Memory Malingering (TOMM) Trial 1 (T1) and errors on the first 10 items of T1 (T1-e10) were developed as briefer versions of the TOMM to minimize evaluation time and burden, although the effect of genuine memory impairment on these indices is not well established. This study examined whether increasing material-specific verbal and visual memory impairment affected T1 and T1-e10 performance and accuracy for detecting invalidity. Method: Data from 155 neuropsychiatric patients administered the TOMM, Rey Auditory Verbal Learning Test (RAVLT), and Brief Visuospatial Memory Test-Revised (BVMT-R) during outpatient evaluation were examined. Valid (N = 125) and invalid (N = 30) groups were established by four independent criterion performance validity tests. Verbal/visual memory impairment was classified as ≥37 T (normal memory); 30 T-36T (mild impairment); and ≤29 T (severe impairment). Results: Overall, T1 had outstanding accuracy, with 77% sensitivity/90% specificity. T1-e10 was less accurate but had excellent discriminability, with 60% sensitivity/87% specificity. T1 maintained excellent accuracy regardless of memory impairment severity, with 77% sensitivity/≥88% specificity and a relatively invariant cut-score even among those with severe verbal/visual memory impairment. T1-e10 had excellent classification accuracy among those with normal memory and mild impairment, but accuracy and sensitivity dropped with severe impairment and the optimal cut-score had to be increased to maintain adequate specificity. Conclusion: TOMM T1 is an effective performance validity test with strong psychometric properties regardless of material-specificity and severity of memory impairment. By contrast, T1-e10 functions relatively well in the context of mild memory impairment but has reduced discriminability with severe memory impairment.

Assessment of differential neurocognitive performance based on the number of performance validity tests failures: A cross-validation study across multiple mixed clinical samples.

Objective: This cross-sectional study examined the effect of number of Performance Validity Test (PVT) failures on neuropsychological test performance among a demographically diverse Veteran (VA) sample (n = 76) and academic medical sample (AMC; n = 128). A secondary goal was to investigate the psychometric implications of including versus excluding those with one PVT failure when cross-validating a series of embedded PVTs. Method: All patients completed the same six criterion PVTs, with the AMC sample completing three additional embedded PVTs. Neurocognitive test performance differences were examined based on number of PVT failures (0, 1, 2+) for both samples, and effect of number of criterion failures on embedded PVT performance was analyzed among the AMC sample. Results: Both groups with 0 or 1 PVT failures performed better than those with ≥2 PVT failures across most cognitive tests. There were nonsignificant differences between those with 0 or 1 PVT failures except for one test in the AMC sample. Receiver operator characteristic curve analyses found no differences in optimal cut score based on number of PVT failures when retaining/excluding one PVT failure. Conclusion: Findings support the use of ≥2 PVT failures as indicative of performance invalidity. These findings strongly support including those with one PVT failure with those with zero PVT failures in diagnostic accuracy studies, given that their inclusion reflects actual clinical practice, does not reduce sample sizes, and does not artificially deflate neurocognitive test results or inflate PVT classification accuracy statistics.

Not so fast! Limitations of processing speed and working memory indices as embedded performance validity tests in a mixed neuropsychiatric sample.

INTRODUCTION: Validity indicators embedded within standard neuropsychological tests have received increasing attention as more efficient measures for sampling performance validity throughout an evaluation. This cross-sectional study examined multiple performance validity tests (PVTs) embedded in the Wechsler Adult Intelligence Scale-IV (WAIS-IV) Working Memory (WMI) and Processing Speed (PSI) Indices for detecting invalid test performance. METHOD: This cross-sectional study examined data from a mixed clinical neuropsychiatric sample of 110 patients referred for outpatient evaluation. The sample was composed of 85 patients with valid neuropsychological performance and 25 with invalid performance based on multiple independent criterion PVTs. Among the patients with valid performance, 54% were cognitively impaired, whereas 46% were cognitively unimpaired. RESULTS: Among the overall sample, performance on WMI, PSI, and 3/4 constituent subtests (i.e., Digit Span, Symbol Search, Coding) was significantly worse among the invalid group compared to the valid group (ηp2 =.06-.16) with areas under the curve (AUCs) of.67-.76 and 24-32% sensitivity (≥88% specificity) for identifying invalid performance at cut-scores that maximized accuracy. When the sample was subdivided by cognitive impairment status, AUCs of.68-.87 and 36-56% sensitivity (≥87% specificity) for detecting invalidity at cut-scores that maximized accuracy were found among those without cognitive impairment. In contrast, for patients with cognitive impairment, Digit Span, Arithmetic, WMI, and Coding were nonsignificant, and AUCs of.66-.67. Further, notably reduced sensitivities of 16-28% (≥91% specificity) were found for the remaining significant indices. CONCLUSION: Overall, results indicated that embedded WAIS-IV WMI and PSI are useful embedded PVTs in conditions in which cognitive impairment is not expected; however, these embedded PVTs demonstrated questionable utility among patients with cognitive impairment due to poor sensitivity, if adequate specificity is maintained, suggesting limited efficacy among patients with cognitive impairment due to risk of false-positive classification.

Saline nasal irrigation for acute upper respiratory tract infections.

BACKGROUND: Acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis, are common afflictions that cause discomfort and debilitation and contribute significantly to workplace absenteeism. Treatment is generally by antipyretic and decongestant drugs and sometimes antibiotics, even though most infections are viral. Nasal irrigation with saline is often employed as an adjunct treatment for URTI symptoms despite a relative lack of evidence for benefit in this clinical setting. This review is an update of the Cochrane review by Kassel et al, which found that saline was probably effective in reducing the severity of some symptoms associated with acute URTIs. OBJECTIVES: To assess the effects of saline nasal irrigation for treating the symptoms of acute URTIs. SEARCH METHODS: We searched CENTRAL (2014, Issue 7), MEDLINE (1966 to July week 5, 2014), EMBASE (1974 to August 2014), CINAHL (1982 to August 2014), AMED (1985 to August 2014) and LILACS (1982 to August 2014). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing topical nasal saline treatment to other interventions in adults and children with clinically diagnosed acute URTIs. DATA COLLECTION AND ANALYSIS: Two review authors (DK, BM) independently assessed trial quality with the Cochrane 'Risk of bias' tool and extracted data. We analysed all data using the Cochrane Review Manager software. Due to the large variability of outcome measures only a small number of outcomes could be pooled for statistical analysis. MAIN RESULTS: We identified five RCTs that randomised 544 children (three studies) and 205 adults (exclusively from two studies). They all compared saline irrigation to routine care or other nose sprays, rather than placebo. We included two new trials in this update, which did not contribute data of sufficient size or quality to materially change the original findings. Most trials were small and we judged them to be of low quality, contributing to an unclear risk of bias. Most outcome measures differed greatly between included studies and therefore could not be pooled. Most results showed no difference between nasal saline treatment and control. However, one larger trial, conducted with children, did show a significant reduction in nasal secretion score (mean difference (MD) -0.31, 95% confidence interval (CI) -0.48 to -0.14) and nasal breathing (obstruction) score (MD -0.33, 95% CI -0.47 to -0.19) in the saline group. However, a MD of -0.33 on a four-point symptom scale may have minimal clinical significance. The trial also showed a significant reduction in the use of decongestant medication by the saline group. Minor nasal discomfort and/or irritation was the only side effect reported by a minority of participants. AUTHORS' CONCLUSIONS: Nasal saline irrigation possibly has benefits for relieving the symptoms of acute URTIs. However, the included trials were generally too small and had a high risk of bias, reducing confidence in the evidence supporting this. Future trials should involve larger numbers of participants and report standardised and clinically meaningful outcome measures.

The short to medium-term risks of intracameral phenylephrine.

PURPOSE: To compare outcomes and complications of patients undergoing phacoemulsification with and without the administration of intracameral phenylephrine. MATERIALS AND METHODS: In this retrospective study, a chart review was performed. Two groups with an equal number of patients who did or did not receive intracameral phenylephrine during phacoemulsification were compared for differences in outcomes, risk factors and complications. The Chi-square test was used for comparison between groups. P<0.05 was statistically significant. RESULTS: The two groups were well matched with regard to preoperative ophthalmic and systemic risk factors for complications and had very similar phacoemulsification power and time profiles. No differences in outcome were detected (P>0.05, all comparisons). CONCLUSION: This retrospective study suggests that intracameral phenylephrine normalizes the intraoperative risk of small pupil cataract surgery and is not associated with an increased risk of systemic or postoperative ophthalmic complications.

Late intraocular pressure rise following intravitreal triamcinolone injection.

Most ophthalmologists are aware of the risk of elevated intraocular pressure developing 1 or 2 months after an intravitreal injection of triamcinolone. However, the two cases reported here demonstrate that such a rise can occur significantly later than this. All patients who have had intravitreal steroid injection should therefore have prolonged intraocular pressure monitoring.

Recycling greenhouse gas fossil fuel emissions into low radiocarbon food products to reduce human genetic damage.

Radiocarbon from nuclear fallout is a known health risk. However, corresponding risks from natural background radiocarbon incorporated directly into human genetic material have not been fully appreciated. Here we show that the average person will experience between 3.4 × 1010 and 3.4 × 1011 lifetime chromosomal damage events from natural background radiocarbon incorporated into DNA and histones, potentially leading to cancer, birth defects, or accelerated aging. This human genetic damage can be significantly reduced using low radiocarbon foods produced by growing plants in CO2 recycled from ordinary industrial greenhouse gas fossil fuel emissions, providing additional incentive for the carbon sequestration.

Persistent fetal vasculature associated with orbital lymphangioma.

Persistent fetal vasculature (PFV), also known as persistent hyperplastic primary vitreous (PHPV), is a failure of regression of the primary vitreous, which usually occurs in isolation. Orbital lymphangiomas present in early life with eyelid swelling or proptosis and are not associated with intraocular abnormalities. We report the case of a male infant with PHPV and ipsilateral orbital lymphangioma.