Insulin independence following islet transplantation improves long-term metabolic outcomes.

AIMS: Pancreatic islet allotransplantation is an effective therapy for type 1 diabetes mellitus, restoring glycaemic control and hypoglycaemic awareness in patients with recurrent severe hypoglycaemia. Insulin independence following transplant is being increasingly reported; however, this is not a primary endpoint in the UK. Having surpassed 10 years of islet transplantation in Scotland, we aimed to evaluate the impact of insulin independence following transplant on metabolic outcomes and graft survival. METHODS: We conducted a retrospective analysis on data collected prospectively between 2011 and 2022. Patients who underwent islet transplantation in Scotland up to the 31st January 2020 were included. Primary endpoint was graft survival (stimulated C-peptide >50 pmol/L). Secondary endpoints included GOLD score, HbA1c, C-peptide and insulin requirement. Outcomes were compared between patients who achieved insulin independence at any point following transplant versus those who did not. RESULTS: 60 patients were included. 74.5% experienced >50 severe hypoglycaemic episodes in the year preceding transplant. There was a 55.0% decrease in insulin requirement following transplant and 30.0% achieved insulin independence. Mean graft survival time was 9.0 years (95% CI 7.2-10.9) in patients who achieved insulin independence versus 4.4 years (95% CI 3.4-5.3) in patients who did not. Insulin independence was associated with significantly improved graft function, glycaemic control and hypoglycaemic awareness at 1 year. CONCLUSIONS: This is the largest UK single-centre study on islet transplant to date. Our findings demonstrate significantly improved outcomes in patients who achieved insulin independence following islet transplantation.

Islet transplantation from a nationally funded UK centre reaches socially deprived groups and improves metabolic outcomes.

AIMS/HYPOTHESIS: Type 1 diabetes complicated by hypoglycaemia is prevalent in socioeconomically deprived populations. Islet transplantation is of proven efficacy in type 1 diabetes complicated by hypoglycaemia, but it is not known if nationally funded programmes reach the socioeconomically deprived. Our aim was to determine: (1) socioeconomic indices in participants referred to our nationally funded programme; and (2) if metabolic outcomes in our transplant recipients were improved. METHODS: Participants referred (n = 106) and receiving transplants (n = 18; 32 infusions) were examined with respect to socioeconomic status (deprivation category score) and their ability to work and drive. In participants followed for ≥12 months after transplantation, metabolic and anthropometric measurements (n = 14) were recorded pre- and post-transplant (assessed ~1, ~3, ~6 and ~12 months with mixed-meal tolerance tests and 6 day continuous glucose monitoring assessments). Donor data was also examined. RESULTS: There was a greater prevalence of socioeconomic deprivation in referred and transplant recipients than the general population (p < 0.05). Of the transplant recipients, 73% were socioeconomically deprived, 88% did not hold a driver's license and 94% had reduced ability to work (all p < 0.01 vs referred participants). Donors were predominantly obese and included circulatory death donors. At 12 months, 93% of participants who had received transplants had graft function, diminished frequency of hypoglycaemia (10 [4-11] vs 0 [0-2] hypoglycaemic episodes/week), improved awareness of hypoglycaemia (Gold score 7 [5-7] vs 1 [1-2]) and glycaemic control (HbA1c: 7.9% [7.2-8.5%]; 63 [55-69] mmol/mol vs 7.2% [6.8-7.5%]; 55 [51-58] mmol/mol), diminished glycaemic lability and decreased central adiposity (all p < 0.05). CONCLUSIONS/INTERPRETATION: A nationally funded islet transplant programme reaches the socioeconomically deprived and outcomes are significantly improved in this group.

Long-acting muscarinic antagonists (LAMA) added to inhaled corticosteroids (ICS) versus the same dose of ICS alone for adults with asthma.

BACKGROUND: Despite the availability of several evidence-based therapies and non-pharmacological strategies to improve control of symptoms and prevent exacerbations of asthma, patients with asthma continue to be at risk for mortality and morbidity.Previous trials have demonstrated the potentially beneficial effects of the long-acting muscarinic antagonist (LAMA) tiotropium on lung function in patients with asthma; however, a definitive conclusion on the benefit of LAMA in asthma is lacking, as is information on where in the current step-wise management strategy they would be most beneficial. OBJECTIVES: To assess the efficacy and safety of a LAMA added to any dose of an inhaled corticosteroid (ICS) compared with the same dose of ICS alone for adults whose asthma is not well controlled. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register (CAGR) from inception to April 2015, and we imposed no restriction on language of publication. We also searched clinicaltrials.gov, the World Health Organization (WHO) trials portal and drug company registries to identify unpublished studies. SELECTION CRITERIA: We searched for parallel and cross-over randomised controlled trials in which adults whose asthma was not well controlled by ICS alone were randomly assigned to receive LAMA add-on or placebo (both combined with ICS) for at least 12 weeks. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the searches and extracted data from study reports. We used Covidence for duplicate screening, extraction of study characteristics and numerical data and risk of bias ratings. Pre-specified primary outcomes included exacerbations requiring oral corticosteroids, quality of life and all-cause serious adverse events. MAIN RESULTS: We identified five studies that met the inclusion criteria. All studies applied a double-blind, double-dummy design, and the population of all studies totalled 2563 adult participants. Study duration ranged from 12 weeks to 52 weeks, and risk of bias across domains in all studies was low. Trials included more women than men (33% to 47% male), and mean age of participants ranged from 41 to 48 years. Participants generally had a long history of asthma, and mean baseline predicted forced expiratory volume in one second (FEV1) was between 72% and 75% in three studies reporting pre-bronchodilator values.The rate of exacerbations requiring oral corticosteroids (OCS) was lower in patients prescribed an LAMA add-on than in those receiving the same dose of ICS alone (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.46 to 0.93; 2277 participants; four studies; I(2) = 0%; high-quality evidence), meaning that 27 fewer people per 1000 would have an exacerbation over 21 weeks requiring OCS with LAMA compared with ICS alone (95% CI 42 fewer to 6 fewer).All-cause serious adverse events (SAEs) and exacerbations requiring hospital admission were rare and the effects too imprecise to permit firm conclusions, but effects suggested that LAMA add-on may be associated with fewer of both compared with ICS alone (SAEs: OR 0.60, 95% CI 0.23 to 1.57; 2532 participants; four studies; low-quality evidence; exacerbations requiring hospital admission: OR 0.42, 95% CI 0.12 to 1.47; 2562 participants; five studies; moderate-quality evidence). Additional therapy with a LAMA showed no clear benefit in terms of quality of life compared with ICS given alone; high-quality evidence showed only a small mean improvement in quality of life as measured on the Asthma Quality of Life Questionnaire (AQLQ), which was not statistically significant. The same was true for asthma control as measured on the Asthma Control Questionnaire (ACQ), which was based on moderate-quality evidence. LAMA combined with ICS showed consistent benefit in a range of lung function measures compared with the same dose of ICS alone, and LAMA was not associated with significantly higher rates of adverse events than were reported with placebo. AUTHORS' CONCLUSIONS: For adults taking ICS for asthma without a long-acting beta2-agonist (LABA), LAMA given as add-on treatment reduces the likelihood of exacerbations requiring treatment with OCS and improves lung function. The benefits of LAMA combined with ICS for hospital admissions, all-cause serious adverse events, quality of life and asthma control remain unknown.Results of this review, along with findings of related reviews conducted to assess the use of LAMA in other clinical scenarios involving asthma, can help to define the role of LAMA in the management of asthma. Trials of longer duration (up to 52 weeks) would provide a better opportunity to observe rare events such as serious adverse events and exacerbations requiring hospital admission.

Long-acting muscarinic antagonists (LAMA) added to inhaled corticosteroids (ICS) versus higher dose ICS for adults with asthma.

BACKGROUND: Long-acting muscarinic antagonists (LAMA), a class of drugs with proven effectiveness in chronic obstructive pulmonary disease (COPD), are being considered as an add-on option for adults with asthma whose condition is uncontrolled on inhaled corticosteroids (ICS). It is important to assess the safety and efficacy of LAMA add-on as an alternative to the prolonged use of higher doses of ICS, which are known to cause undesirable side effects in some people. OBJECTIVES: To compare the effects of adding a LAMA to any dose of ICS versus increasing the dose of ICS, for uncontrolled asthma in adults. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register (CAGR) from its inception in 1995 to April 2015, imposing no restriction on language of publication. We also handsearched trial registries, reference lists of primary studies and existing reviews, as well as manufacturers' websites. SELECTION CRITERIA: We looked for parallel or cross-over randomised controlled trials lasting at least 12 weeks, in which adults whose asthma was not well controlled on ICS alone were randomised to treatment with LAMA add-on to ICS or with an increased dose of ICS. Trials were excluded if patients were taking long-acting beta2-agonists during the study period. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the searches and extracted data from studies meeting all the inclusion criteria. We used Covidence to manage duplicate screening, data extraction and risk of bias judgements, and to form a consensus where discrepancies arose. We used standard methods expected by The Cochrane Collaboration.The pre-specified primary outcomes were exacerbations requiring a course of oral corticosteroids (OCS), effects on quality of life and serious adverse events. MAIN RESULTS: One cross-over randomised controlled trial met the inclusion criteria. The trial was performed in 210 patients with moderate to severe asthma and compared the use of the LAMA tiotropium bromide with double dose beclomethasone (an ICS) using a cross-over design and 14-week treatment periods.Compared with people taking a double dose of ICS, fewer people taking a LAMA add-on had an exacerbation requiring treatment with OCS (odds ratio (OR) 0.57, 95% confidence interval (CI) 0.22 to 1.43) or an exacerbation resulting in emergency department admission (OR 0.49, 95% CI 0.09 to 2.77), but the confidence intervals for both outcomes did not exclude the possibility that double dose ICS was more effective. Serious adverse events and exacerbations requiring hospitalisation occurred in similarly low numbers of people taking each treatment, but confidence intervals were too wide to suggest that the two treatment options were equivalent.Asthma-related quality of life was similar in both treatment groups (mean difference (MD) in change from baseline 0.10, 95% CI - 0.07 to 0.27). Those taking LAMA add-on scored slightly better on a scale measuring asthma control than those increasing their ICS dose (MD in change from baseline - 0.18, 95% CI - 0.34 to - 0.02), although the difference was clinically small. Evidence was deemed low quality for both quality of life and asthma control.There was moderate-quality evidence that participants' trough forced expiratory volume in one second (FEV1) was 100 mL better when taking LAMA add-on than with increased ICS dose (MD in change from baseline 0.10, 95% CI 0.03 to 0.17). AUTHORS' CONCLUSIONS: Only one randomised trial was found, comparing tiotropium add-on to increased dose beclomethasone. Differences between the treatments were too small or imprecise to understand whether adding a LAMA to ICS is safer or more effective than increasing the dose of ICS, and there is a possibility of carry-over effects due to the study's cross-over design. LAMA add-on may lead to more improvement in lung function (FEV1) than an increased dose of ICS.The results of this review, alongside pending results from related reviews assessing the use of LAMA against other treatments, will help to define the role of these drugs in asthma management, and this review should be updated as results from future trials emerge. Studies assessing the role of LAMA add-on should be longer and include a double-ICS treatment arm so that the results can be interpreted in the context of the guideline-recommended treatment options that are available to physicians.

The high cost of bath salts: a study of the health care burden of illicit synthetic drug use in Duluth, Minnesota.

The Minnesota Department of Health conducted an exploratory epidemiologic investigation into the health care burden of illicit synthetic drug (ISD) use in Duluth, Minnesota. Staff reviewed medical records of 78 patients with suspected ISD use who were treated in emergency departments at two Duluth-area hospitals from January through September 2013. Most (67%) were unemployed, 75% arrived at the hospital by ambulance or police escort and 57% were admitted to the hospital. Use of ISDs has the potential to create a significant burden on the health care system and public services. Therefore, effective prevention and response strategies need to be developed.

Validating cognitive screening in young people with first-episode psychosis: The CogScreen protocol.

AIM: Cognitive impairments are a core feature of first-episode psychosis (FEP) and one of the strongest predictors of long-term psychosocial functioning. Cognition should be assessed and treated as part of routine clinical care for FEP. Cognitive screening offers the opportunity to rapidly identify and triage those in most need of cognitive support. However, there are currently no validated screening measures for young people with FEP. CogScreen is a hybrid effectiveness-implementation study which aims to evaluate the classification accuracy (relative to a neuropsychological assessment as a reference standard), test-retest reliability and acceptability of two cognitive screening tools in young people with FEP. METHODS: Participants will be 350 young people (aged 12-25) attending primary and specialist FEP treatment centres in three large metropolitan cities (Adelaide, Sydney, and Melbourne) in Australia. All participants will complete a cross-sectional assessment over two sessions including two cognitive screening tools (Screen for Cognitive Impairment in Psychiatry and Montreal Cognitive Assessment), a comprehensive neuropsychological assessment battery, psychiatric and neurodevelopmental assessments, and other supplementary clinical measures. To determine the test-retest reliability of the cognitive screening tools, a subset of 120 participants will repeat the screening measures two weeks later. RESULTS: The protocol, rationale, and hypotheses for CogScreen are presented. CONCLUSIONS: CogScreen will provide empirical evidence for the validity and reliability of two cognitive screening tools when compared to a comprehensive neuropsychological assessment. The screening measures may later be incorporated into clinical practice to assist with rapid identification and treatment of cognitive deficits commonly experienced by young people with FEP.

Nanocomposites based on plasticized starch and rectorite clay: structure and properties.

Sodium rectorite clay (REC) was attached to cationic guar gum (CGG) using a cationic-exchange reaction to obtain CGG modified-REC (CREC). It was found that CGG appeared on the surface of REC's layered structure and represented about 30.1% wt. in CREC. REC and CREC were, respectively, used as fillers in a plasticized starch (PS) matrix to prepare PS/REC and PS/CREC composites using the casting process. Rapid Visco Analyser and scanning electron microscopy revealed that an interaction existed between the REC (or CREC) filler and the matrix. Both REC and CREC had obvious reinforcing effects on the matrix. Compared to the neat matrix, REC or CREC improved the thermal stability of the composites. By increasing the filler content from 0 to 10 wt%, water vapor permeability (WVP) values of PS/REC composites obviously decreased, while WVP values of PS/CREC composites decreased slightly.

Optimal Terminology for Services in the United States That Incorporate Horses to Benefit People: A Consensus Document.

Objectives: To recommend (1) the adoption of optimal terminology for referring to services in the United States that incorporate horses and other equines to benefit people, and (2) the discontinuation of especially problematic terminology. Design: A diverse multidisciplinary consortium of individuals, including representatives of relevant national organizations, participated in an inclusive, systematic, and comprehensive 2-year consensus-building process. Results: Twelve specific types of services were identified that relate to one of three broad areas of professional work: therapy, learning, or horsemanship. Related to the area of therapy, five distinct types of therapies were identified: counseling, occupational therapy, physical therapy, psychotherapy, and speech-language pathology. Therapy-first language is recommended that foregrounds the exact therapy (e.g., physical therapy) and adds precise equine-related descriptors as warranted (e.g., physical therapy using equine movement). Related to the area of learning, three distinct types of nontherapy services were identified. The recommended terminology for referring to these services is equine-assisted learning in education, equine-assisted learning in organizations, and equine-assisted learning in personal development. Related to the area of horsemanship, four distinct types of nontherapy services were identified. The recommended terminology for referring to these services is adaptive equestrian sports, adaptive riding or therapeutic riding, driving, and interactive vaulting. The plural term, equine-assisted services, is recommended as a concise shorthand for easily referencing multiple services that differ from each other, yet share the horse as a common thread. Terms recommended for discontinuation include equine therapy, equine-assisted activities and therapies, equine-assisted therapy, equestrian therapy, hippotherapist, hippotherapy clinic (program), horse therapy, horseback riding therapy, and therapy riding. The consensus-building process culminated in extensive but not unanimous endorsements of all terminology recommendations. Conclusions: Terminology recommended for adoption clearly describes and distinguishes 12 distinct types of services. Terminology recommended for discontinuation was found to be ambiguous, misleading, no longer useful, or to have adversely affected stakeholders. It is hoped that all recommendations will prove useful and serve to enhance the professionalism and viability of specific identified services. It is also hoped that improved precision and clarity in terminology for naming specific services will advance their future scientific development and reliable measurement of effectiveness. Not all terminology-related challenges were resolved, however, and new challenges will likely arise as services continue to evolve and diversify. Significant impacts, if any, of the terminology recommendations herein merit ongoing monitoring and the question of optimal terminology merits revisiting in the foreseeable future.

Shape memory histocompatible and biodegradable sponges for subcutaneous defect filling and repair: greatly reducing surgical incision.

Reducing surgical incision for large area subcutaneous defect filling and repair is a great challenge in the biomedical field, especially for plastic surgery. In this study, a novel hydroxyethyl cellulose/soy protein isolate (HEC/SPI) composite sponge (EHSS) with a fluid responsive shape memory property was constructed, whose thickness could be controlled by hot-pressing conditions to reduce the required surgical incision greatly. Effects of the main factors such as pressure, temperature and hot-pressing cycles on the recovery degree of EHSS were investigated systematically. The structure and physical properties of the sponges were characterized by FTIR spectroscopy, XRD, SEM etc. The results showed that EHSS could be pressed into thin disks with much smaller thickness, and the thickness retention ratio and recovery ratio were affected by hot-pressing conditions such as pressure and temperature. Especially, EHSS could be hot-pressed into a dense thin disk (EHSS-PT-130) at 130 °C with the pressure of 30 MPa, which could quickly recover its original shape by soaking in hydrophilic fluids. EHSS-PT-130 also exhibited good hydrophilicity, cytocompatibility, histocompatibility and in vivo biodegradability. Compared with the original EHSS, in vivo shape memory EHSS-PT-130 required much smaller surgical incision to reach the same repair effect and no need of extra sterilization, showing potential application for subcutaneous defect filling and repair.

Accelerated skin wound healing by soy protein isolate-modified hydroxypropyl chitosan composite films.

In this study, a series of hydroxypropyl chitosan (HPCS)/soy protein isolate (SPI) composite films (HCSFs) with different SPI contents were developed via crosslinking, solution casting, and evaporation process. Effects of the SPI content on the structure and physical properties of the HCSFs were characterized by Fourier transform infrared spectroscopy, X-ray diffraction patterns, scanning electron microscopy, swelling kinetics analysis, and mechanical testing. The HCSFs exhibited a lower swelling ratio with an increase in the SPI content. The tensile strength was in a tunable range from 7.88 ±â€¯3.08 to 40.44 ±â€¯2.31 MPa by adjusting the SPI content. Cytocompatibility and hemocompatibility of the HCSFs were evaluated by a series of in vitro assays, including MTT assay, live/dead assay, cell morphology observation, hemolysis ratio testing, and plasma recalcification time measurement. Results showed that the HCSFs support L929 cells attachment and proliferation without obvious hemolysis, indicating good cytocompatibility and hemocompatibility. The potential of resultant HCSFs as the wound dressings was investigated using a full-thickness skin wound model in rats. Results exhibited that the HCSFs with 50% SPI content had the fastest healing speed and the best skin regeneration efficiency and may be a potential candidate as the wound dressing.

Porous cellulose spheres: Preparation, modification and adsorption properties.

Porous cellulose spheres (PCS) were fabricated by precipitating the spheres from a cellulose ionic liquid solution, followed by freezing, solvent exchange, and drying. PCS had low crystallinity and a large surface area that facilitated modification with trisodium trimetaphosphate (STMP) to introduce phosphate ester groups into the porous structure of the heterogeneous system. The STMP-modified PCS (SPCS) were used to remove heavy metal ions from aqueous solution. With increasing STMP dosage, the adsorption capacity of SPCS obviously improved due to chelation between Pb2+ and phosphate ester groups. The kinetic adsorption and isotherm data matched the pseudo-second order model and the Langmuir model well. The maximum adsorption capacity reached 150.6 mg g-1 for SPCS. SPCS were competitive with other absorbents because the phosphate ester groups and porous structure contributed to Pb2+ adsorption. Moreover, SPCS can be regenerated with ethylenediamine tetraacetic acid disodium salt (EDTA) solution for repetitious adsorption of Pb2+.

Epichlorohydrin-Cross-linked Hydroxyethyl Cellulose/Soy Protein Isolate Composite Films as Biocompatible and Biodegradable Implants for Tissue Engineering.

A series of epichlorohydrin-cross-linked hydroxyethyl cellulose/soy protein isolate composite films (EHSF) was fabricated from hydroxyethyl cellulose (HEC) and soy protein isolate (SPI) using a process involving blending, cross-linking, solution casting, and evaporation. The films were characterized with FTIR, solid-state (13)C NMR, UV-vis spectroscopy, and mechanical testing. The results indicated that cross-linking interactions occurred in the inter- and intramolecules of HEC and SPI during the fabrication process. The EHSF films exhibited homogeneous structure and relative high light transmittance, indicating there was a certain degree of miscibility between HEC and SPI. The EHSF films exhibited a relative high mechanical strength in humid state and an adjustable water uptake ratio and moisture absorption ratio. Cytocompatibility, hemocompatibility and biodegradability were evaluated by a series of in vitro and in vivo experiments. These results showed that the EHSF films had good biocompatibility, hemocompatibility, and anticoagulant effect. Furthermore, EHSF films could be degraded in vitro and in vivo, and the degradation rate could be controlled by adjusting the SPI content. Hence, EHSF films might have a great potential for use in the biomedical field.

Modification of porous starch for the adsorption of heavy metal ions from aqueous solution.

Porous starch xanthate (PSX) and porous starch citrate (PSC) were prepared in anticipation of the attached xanthate and carboxylate groups respectively forming chelation and electrostatic interactions with heavy metal ions in the subsequent adsorption process. The lead(II) ion was selected as the model metal and its adsorption by PSX and PSC was characterized. The adsorption capacity was highly dependent on the carbon disulfide/starch and citric acid/starch mole ratios used during preparation. The adsorption behaviors of lead(II) ion on PSXs and PSCs fit both the pseudo-second-order kinetic model and the Langmuir isotherm model. The maximum adsorption capacity from the Langmuir isotherm equation reached 109.1 and 57.6 mg/g for PSX and PSC when preparation conditions were optimized, and the adsorption times were just 20 and 60 min, respectively. PSX and PSC may be used as effective adsorbents for removal of heavy metals from contaminated liquid.

Characterization of magnetic soluble starch-functionalized carbon nanotubes and its application for the adsorption of the dyes.

Soluble starch-functionalized multiwall carbon nanotube composites (MWCNT-starch) were prepared to improve the hydrophilicity and biocompatibility of MWCNTs. Characterization of the MWCNT-starch by Fourier transform infrared (FTIR) spectroscopy, ultraviolet-visible (UV-vis) spectroscopy, X-ray diffraction (XRD), transmission electron microscope (TEM) and thermogravimetric analysis (TG), showed that the starch component (about 14.3 wt%) was covalently grafted onto the surface of MWCNT. MWCNT-starch-iron oxide composites, intended for use as adsorbents for the removal of dyes from aqueous solutions, were prepared by synthesizing iron oxide nanoparticles at the surface of MWCNT-starch. Starch acts as a template for growth of iron oxide nanoparticles which are uniformly dispersed on the surface of the MWCNT-starch. MWCNT-starch-iron oxide exhibits superparamagnetic properties with a saturation magnetization (23.15 emu/g) and better adsorption for anionic methyl orange (MO) and cationic methylene blue (MB) dyes than MWCNT-iron oxide.

Preparation, characterization, and in vitro and in vivo evaluation of cellulose/soy protein isolate composite sponges.

A series of cellulose/soy protein isolate (SPI) sponges was prepared using a freeze-drying process. The effect of the SPI content on the structure of the sponges was characterized by Fourier transform infrared spectrometry (FT-IR), X-ray diffraction analysis (XRD) and scanning electron microscopy (SEM). It showed that the sponges were porous in structure, and that the size of the pores increased and the thickness of the pore walls decreased as the SPI content of the sponges increased. The biocompatibility and biodegradability of the sponges were evaluated in vitro and in vivo. The cell culture experiment and SEM observations showed that L929 fibroblast cells grew and spread well on the surface and cross-section of the composite sponges. The results from MTT (3-[4,5-dimethyl-2-thiazoly1]-2,5-diphenyl-2H-tetrazolium bromide) assay indicated that the cell viability of L929 cultured in extracts from SPI-containing sponges was higher than that from the pure cellulose sponge. The historical analysis and SEM observation revealed that the SPI-containing sponges implanted from 1 to 8 months in rats exhibited better in vivo biocompatibility and biodegradability than the pure cellulose sponge. This was due to the incorporation of SPI into cellulose and to the freeze-drying process which formed large pores and thin pore walls in the composite sponges, promoting the migration of cells and tissue into the sponges, leading to gradual fusing with the implants. The new cellulose/SPI sponges thus have potential applications as biomaterials with good biocompatibility and biodegradability.

Suppressed working memory on the WMS-III as a marker for poor effort.

The purpose of this study was to examine the clinical utility of memory minus Working Memory Index (memory-WMI) discrepancy scores on the WMS-III for detecting poor effort in 145 personal injury litigants (19 poor effort, 126 adequate effort). On average, participants in the poor effort group performed significantly lower on all WMS-III memory indexes and demonstrated larger memory-WMI discrepancy scores compared to participants in the adequate effort group. Discriminant function analyses using memory-WMI discrepancy scores as independent variables revealed poor overall classification rates (60.0% to 63.4%). Based on the prevalence of unusually suppressed attention-concentration ability relative to memory functioning using unidirectional memory-WMI discrepancy scores, high specificity and negative predictive power values were found. However, there was unacceptably low sensitivity and positive predictive power. These results suggest that memory-WMI discrepancy scores on the WMS-III do not provide clinically useful information regarding response set and should be used cautiously as an indicator of poor effort.

Ecological validity of the WMS-III rarely missed index in personal injury litigation.

The purpose of this study was to evaluate the clinical utility of the Rarely Missed Index (RMI) to detect cognitive exaggeration in 78 nonlitigant patients (i.e., Mixed Clinical group) and 158 personal injury litigants (i.e., 20 Suspected Exaggerators, 12 Borderline Exaggerators, 126 Genuine Responders). The base rate for probable malingered neurocognitive dysfunction in the litigant sample was 12.7%. The false positive error rate of the RMI in the Genuine Responder and Mixed Clinical group ranged from 5.4% to 8.6%. Positive RMI scores were found in 25% and 41.7% of the Suspected Exaggerator and Borderline Exaggerator groups respectively. The clinical utility of the RMI to identify Suspected Exaggerators versus individuals in the Genuine Responder and Mixed Clinical groups revealed low sensitivity (sensitivity = .25), very high specificity (range = .91 to .95), moderate positive predictive power (range = .50 to .71), and moderate to high negative predictive power (range = .68 to .83). These results do not support the use of the RMI as a reliable predictor of cognitive exaggeration.