The Behavior Problems Inventory-Short Form for individuals with intellectual disabilities: part II: reliability and validity.

BACKGROUND: The Behavior Problems Inventory-01 (BPI-01) is an informant-based behaviour rating instrument for intellectual disabilities (ID) with 49 items and three sub-scales: Self-injurious Behavior, Stereotyped Behavior and Aggressive/Destructive Behavior. The Behavior Problems Inventory-Short Form (BPI-S) is a BPI-01 spin-off with 30 items. METHODS: The psychometric properties of these two versions of the scale were computed using aggregated archival data from nine different sites in the USA, Wales, England, the Netherlands and Romania with a total of 1122 cases with a BPI-01 total score >0. RESULTS: The internal consistency of the BPI-01 and the BPI-S ranged from fair to excellent with the BPI-01 showing slightly stronger reliability. Construct validity (confirmatory and discriminant) was computed by comparing BPI sub-scale scores with the scores of four other behaviour rating scales (the Aberrant Behavior Checklist, the Diagnostic Assessment for the Severely Handicapped-II, the Nisonger Child Behavior Rating Form and the Inventory for Client and Agency Planning). Strong evidence for confirmatory and discriminant validity was found for both the BPI-01 and the BPI-S. Confirmatory fit indices for the BPI and the BPI-S were comparable and suggesting that the factor structures fit the data well. CONCLUSION: In summary, both BPI versions were found to be equally sound psychometrically and can be endorsed for future use. However, independent future studies are needed to replicate the psychometrics of the BPI-S with new data.

The Behavior Problems Inventory-Short Form for individuals with intellectual disabilities: part I: development and provisional clinical reference data.

BACKGROUND: The Behavior Problems Inventory-01 (BPI-01) is an informant-based behaviour rating instrument that was designed to assess maladaptive behaviours in individuals with intellectual disabilities (ID). Its items fall into one of three sub-scales: Self-injurious Behavior (14 items), Stereotyped Behavior (24 items), and Aggressive/Destructive Behavior (11 items). Each item is rated on a frequency scale (0 = never to 4 = hourly), and a severity scale (0 = no problem to 3 = severe problem). The BPI-01 has been successfully used in several studies and has shown acceptable to very good psychometric properties. One concern raised by some investigators was the large number of items on the BPI-01, which has reduced its user friendliness for certain applications. Furthermore, researchers and clinicians were often uncertain how to interpret their BPI-01 data without norms or a frame of reference. METHODS: The Behavior Problems Inventory-Short Form (BPI-S) was empirically developed, based on an aggregated archival data set of BPI-01 data from individuals with ID from nine locations in the USA, Wales, England, the Netherlands, and Romania (n = 1122). The BPI-S uses the same rating system and the same three sub-scales as the BPI-01, but has fewer items: Self-injurious Behavior (8 items), Stereotyped Behavior (12 items), and Aggressive/Destructive Behavior (10 items). Rating anchors for the severity scales of the Self-injurious Behavior and the Aggressive/Destructive Behavior sub-scales were added in an effort to enhance the objectivity of the ratings. RESULTS: The sensitivity of the BPI-S compared with the BPI-01 was high (0.92 to 0.99), and so were the correlations between the analogous BPI-01 and the BPI-S sub-scales (0.96 to 0.99). Means and standard deviations were generated for both BPI versions in a Sex-by-age matrix, and in a Sex-by-ID Level matrix. Combined sex ranges are also provided by age and level of ID. CONCLUSION: In summary, the BPI-S is a very useful alternative to the BPI-01, especially for research and evaluation purposes involving groups of individuals.

Dental Services and Health Outcomes in the New York State Medicaid Program.

Previous reports suggest that periodontal treatment is associated with improved health care outcomes and reduced costs. Using data from the New York State Medicaid program, rates of emergency department (ED) use and inpatient admissions (IPs), as well as costs for ED, IPs, pharmacy, and total health care, were studied to determine the association of preventive dental care to health care outcomes. Utilization of dental services in the first 2 y (July 2012-June 2014) was compared to health care outcomes in the final year (July 2014-June 2015). Costs and utilization for members who did not receive dental services (No Dental) were compared to those who received any dental care (Any Dental), any preventive dental care (PDC), PDC without an extraction and/or endodontic treatment (PDC without Ext/Endo), PDC with an Ext/Endo (PDC with Ext/Endo), or Ext/Endo without PDC (Ext/Endo without PDC). Propensity scores were used to adjust for potential confounders. After adjustment, ED rate ratios were significantly lower for PDC and PDC without Ext/Endo but higher for the Any Dental and Ext/Endo without PDC. IP ratios were lower for all treatment groups except Ext/Endo without PDC. ED costs differed little compared to the No Dental group except for Ext/Endo without PDC. For IPs, costs per member were significantly lower for all groups (-$262.91 [95% confidence interval (CI), -325.40 to -200.42] to -$379.82 [95% CI, -451.27 to -308.37]) except for Ext/Endo without PDC. For total health care costs, Ext/Endo without PDC had a significantly greater total health care cost ($530.50 [95% CI, 156.99-904.01]). Each additional PDC visit was associated with a 3% reduction in the relative risk for ED and 9% reduction for IPs. Costs also decreased for total health care (-$235.64 [95% CI, -299.95 to -171.33]) and IP (-$181.39 [95% CI, -208.73 to -154.05]). In conclusion, an association between PDC and improved health care outcomes was observed, with the opposite association for Ext/Endo without PDC.

Reconfigurable infrared hyperbolic metasurfaces using phase change materials.

Metasurfaces control light propagation at the nanoscale for applications in both free-space and surface-confined geometries. However, dynamically changing the properties of metasurfaces can be a major challenge. Here we demonstrate a reconfigurable hyperbolic metasurface comprised of a heterostructure of isotopically enriched hexagonal boron nitride (hBN) in direct contact with the phase-change material (PCM) single-crystal vanadium dioxide (VO2). Metallic and dielectric domains in VO2 provide spatially localized changes in the local dielectric environment, enabling launching, reflection, and transmission of hyperbolic phonon polaritons (HPhPs) at the PCM domain boundaries, and tuning the wavelength of HPhPs propagating in hBN over these domains by a factor of 1.6. We show that this system supports in-plane HPhP refraction, thus providing a prototype for a class of planar refractive optics. This approach offers reconfigurable control of in-plane HPhP propagation and exemplifies a generalizable framework based on combining hyperbolic media and PCMs to design optical functionality.

Examining cross-cultural differences in autism spectrum disorder: A multinational comparison from Greece, Italy, Japan, Poland, and the United States.

Autism spectrum disorder (ASD) is characterized by social and communication impairments as well as restricted, repetitive behavior patterns. Despite the fact that ASD is reported worldwide, very little research exists examining ASD characteristics on a multinational scale. Cross-cultural comparisons are especially important for ASD, since cultural differences may impact the perception of symptoms. Identifying behaviors that are similarly reported as problematic across cultures as well as identifying behaviors in which there is cultural variation could aid in the development and refinement of more universally effective measures. The present study sought to examine similarities and differences in caregiver endorsement of symptom severity through scores on the Baby Infant Screen for Children with aUtIsm Traits (BISCUIT). The BISCUIT was utilized to examine ASD core symptomology in 250 toddlers diagnosed with ASD from Greece, Italy, Japan, Poland, and the United States. Significant differences in overall ASD symptom severity and endorsement were found between multinational groups. Implications of the results are discussed.

Bioavailability and therapeutic activity of alicaforsen (ISIS 2302) administered as a rectal retention enema to subjects with active ulcerative colitis.

BACKGROUND: Alicaforsen is a phosphorothioate-modified antisense oligodeoxynucleotide designed to sequence-specifically reduce intercellular adhesion molecule 1 messenger RNA levels. AIMS: To determine the systemic and local bioavailability of alicaforsen, and its activity when administered as a once daily enema in subjects with active ulcerative colitis. METHODS An open-label study was conducted to assess the relative absorption (local and systemic pharmacokinetics) and pharmacologic activity of alicaforsen enema in subjects with active ulcerative colitis. Fifteen subjects received nightly enemas of alicaforsen (240 mg) for a treatment period of 6 weeks. Alicaforsen concentrations in plasma and colonic tissue biopsies were determined. Disease activity index and multiple measurements including endoscopy were used to assess alicaforsen activity in these subjects. RESULTS: Plasma concentrations of parent alicaforsen represented < 0.6% mean bioavailability when compared with historical intravenous area under the plasma concentration-time curves. Concentrations of the intact oligonucleotide in mucosal colonic tissue biopsies were orders of magnitude higher than those observed in plasma. A 46% reduction in mean Disease Activity Index and 33% rate of remission as defined by complete mucosal healing were observed at the end of treatment. Conclusion These data confirm that alicaforsen enema provides local treatment for a local disease with little meaningful systemic exposure.

Extracorporeal blood treatment (EBT) methods in SIRS/Sepsis.

BACKGROUND: Extracorporeal blood purification treatment (EBT) methods have been used in the treatment of experimental and human SIRS/Sepsis in a variety of settings and with variable reports of efficacy and safety. Their role in the management of SIRS/Sepsis remains controversial. OBJECTIVES: To develop consensus statements regarding important aspects of research, practice and technical management concerning EBT. METHODS: Systematic review of published study. Evidence-based grading of information available. Consensus development regarding fundamental questions about EBT. RESULTS: Consensus was achieved on all questions posed during the conference. It was agreed that there is currently a clear biological rational for EBT in SIRS and Sepsis. It was agreed that conventional CVVH has sufficiently been shown not to be effective in SIRS/Sepsis in the absence of concomitant ARF and that other therapies such as plasmapheresis or high-volume hemofiltration or coupled plasma filtration adsorption appear more promising and should be tested in multicentre randomized controlled trials. Patients with ARF and SIRS/Sepsis should be treated differently from those with ARF alone even though current practice in this field is not well known. Patients with refractory septic shock should be considered for EBT. Appropriate end points for clinical trials can be defined and chosen according to the goals of the trial. Different technologies exist for EBT and better understanding of the merits and safety of each is needed as well as better standardization of methodology and dose. CONCLUSIONS: Broad consensus can be achieved on several aspects of EBT and can be used to inform clinical practice and to help guide the establishment of a future research agenda.

Assessment of depression in mentally retarded adults.

Depression and psychopathology were assessed in 110 adult patients (ages 18-71 years) classified as borderline, mildly, moderately, or severely mentally retarded. Patients completed modified versions of the Beck Depression Inventory, the Zung Self-Rating Depression Scale, the MMPI depression scale, the Thematic Apperception Test, and the Psychopathology Instrument for Mentally Retarded Adults. Clinicians and ward personnel rated the patients on the Hamilton Rating Scale for Depression and an informant version of the Psychopathology Instrument for Mentally Retarded Adults. The measures correlated significantly with each other and were consistently related to the diagnosis of depression.

Effects of thioridazine and withdrawal dyskinesias on workshop performance of mentally retarded young adults.

The authors conducted a two-part study of the effects of thioridazine and withdrawal dyskinesias on the workshop performance of mentally retarded young adults. In part 1, 80 mentally retarded subjects were divided into five groups of 16 according to administration, discontinuation, or nonadministration of thioridazine. The major finding was that thioridazine can impair the workshop performance of mentally retarded individuals. In part 2, 28 subjects were divided into four matched groups of 7 subjects each whose thioridazine dose was abruptly or gradually discontinued and who did or did not have withdrawal dyskinesias. Workshop performance declined with the onset of the dyskinesias and improved as the dyskinesias subsided.

Delayed detection of coarctation in infancy: implications for timing of newborn follow-up.

During a recent 5-year period, 74 patients younger than 6 months of age were diagnosed with coarctation of the aorta. Coarctation was correctly diagnosed in only 22% of patients prior to referral despite readily apparent femoral pulse abnormalities in 86%. Infants whose symptoms were detected between 5 and 14 days of age were significantly more ill than infants outside this age range and had a high mortality rate (25%). The number of associated cardiac defects was not related to the severity of clinical illness in this group, suggesting that closure of the ductus arteriosus is the primary determinate of disease severity. Observations in two patients suggested that a detectable pulse discrepancy occurs between 3 and 5 days postnatally. Upper extremity hypertension was found commonly in infants after 5 days of age despite the presence of congestive heart failure. Earlier detection of coarctation in the newborn requires a diligent cardiovascular and peripheral pulse examination between 3 and 7 days of life, upper extremity and lower extremity blood pressure measurement, and a high index of suspicion.

Diphenylhydantoin-induced hypersensitivity reaction with interstitial nephritis.

A 10-year-old black girl had an episode of diphenylhydantoin(DPH)-induced exfoliative dermatitis, lymphadenopathy, hepatitis, peripheral eosinophilia, and transient renal failure. The findings of specific lymphocyte sensitization of DPH, a clinically typical delayed hypersensitivity reaction, multinucleated histiocytes in the renal interstitium, and negative renal immunofluorescence studies for immune reactants indicate that the child's renal injury was at least partially cell-mediated.

Theories of dual diagnosis in mental retardation.

Dual diagnosis, defined in this instance as the co-occurrence of mental health disorders with mental retardation, has become a major area of clinical practice and research in the past 10 years. Whereas areas such as differential diagnosis, assessment, and prevalence have been major focuses of research, etiologies of dual diagnosis have received less attention. Current etiological theories have practical implications for the treatment and prevention of dual diagnoses and suggest important directions for future research. This article provides a historical review of theory development in the field of dual diagnosis. Current status of etiological theories and future directions are discussed with an aim toward encouraging further study.

Assignment of the 13C-nmr spectrum of Hippurin, a novel furospirostane: observation of both ends of the axis of anisotropic reorientation through the measurement of spin-lattice relaxation times.

Anisotropic reorientation of 3 alpha-substituted steroids has been well documented. Assignment of the 13C-nmr spectrum of Hippurin, a novel furospirostane and the measurement of the spin-lattice (T1) relaxation times has established both points in the molecule through which the axis of anisotropic reorientation passes, specifically the 3- and 24-positions.

Comparison of psychotic and autistic children using behavioral observation.

The purpose of this study was to assess the relationship between autism and childhood psychosis. Fifteen children with psychotic symptoms were compared to 15 children with autism, using two observational measures, the Ritvo-Freeman Real Life Rating Scale (RLRS) and the Childhood Autism Rating Scale (CARS), which rate subjects on behaviors pathognomic to autism. In comparison to autistic persons, psychotic individuals were judged to have better language and social skills. In addition, autistic persons were also rated as having more difficulty adapting to new situations and appeared more "autistic-like." Overall scores on the CARS and RLRS were significantly different between the two groups, indicating that these two assessment instruments may be useful in differential diagnosis. However, 20% of the psychotic subjects received pervasive developmental disorder diagnoses, indicating that there may be a relationship between those two disorders.

A comparison of social skills in adults with autistic disorder, pervasive developmental disorder not otherwise specified, and mental retardation.

We examined the social skills of adults with autism, PDDNOS, and mental retardation. All participants were diagnosed with profound mental retardation. Participants in the autism and PDDNOS groups had been previously diagnosed using the Childhood Autism Rating Scale (CARS) and record review. These diagnoses were confirmed by readministering the CARS by one author and an independent rater. Social skills were assessed by using the Vineland Adaptive Behavior Scales and the Matson Evaluation of Social Skills in the Severely Retarded. Significant differences between the autism and mental retardation groups were found on both measures. The PDDNOS group demonstrated better positive nonverbal social skills than the autism group but not the mental retardation group. Special treatment needs of institutionalized adults with autism appear warranted along with a need to clarify further the differences between PDDNOS and mental retardation.

Training nonverbal and verbal play skills to mentally retarded and autistic children.

Two mentally retarded boys with autism and one mentally retarded girl with Down syndrome were taught to initiate and play a ball game with an adult confederate. The program targeted both nonverbal responses related to the actual execution of the ball game as well as verbal responses for play initiation and providing compliments for the confederate's behavior. Training sessions provided ample practice in all aspects of the game from initiation to termination through use of brief play cycles. Instruction was provided using a combination of physical and verbal prompts as well as reinforcement and time-out. All three children learned the game and by the study's completion executed multiple play cycles each session. The implications of combining play and social skills training in programming for developmentally handicapped children are discussed.

Validity of the Autism/Pervasive Developmental Disorder subscale of the Diagnostic Assessment for the Severely Handicapped-II.

This study was designed to establish the empirical validity of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) to screen for the presence of autism in severely and profoundly mentally retarded adults. Participants included 51 individuals residing in a large developmental center in Central Louisiana. The Autism/Pervasive Developmental Disorder subscale of the DASH-II was internally consistent. Additionally, the DASH-II was just as likely as the Childhood Autism Rating Scale (CARS) to classify autistic and control individuals. Specific items on the subscale were examined to identify those items most associated with a diagnosis of autism.

The Behavior Problems Inventory: an instrument for the assessment of self-injury, stereotyped behavior, and aggression/destruction in individuals with developmental disabilities.

The Behavior Problems Inventory (BPI-01) is a 52-item respondent-based behavior rating instrument for self-injurious, stereotypic, and aggressive/destructive behavior in mental retardation and other developmental disabilities. Items are rated on a frequency scale and a severity scale. The BPI-01 was administered by interviewing direct care staff of 432 randomly selected residents from a developmental center between the ages of 14 to 91 years. For 73% of those selected, at least one problem was endorsed on the BPI-01. A total of 43% showed self-injury, 54% stereotyped behavior, and 38% aggressive/destructive behavior. Confirmatory factor analysis and item-total correlations supported the three a priori factors. Analyses of variance (ANOVA) showed that of the variables age, sex, and level of mental retardation, only the latter had a significant effect on the BPI-01 total score, the SIB subscale score, and the Stereotyped Behavior subscale score. Aggression/destruction was not significantly related to any of the three variables. Individuals with a diagnosis of pervasive developmental disorder had higher scores on all three subscales than those without, whereas residents with a diagnosis of stereotyped movement disorder had higher Stereotyped Behavior scale scores than those without. The BPI-01 was found to be a reliable (retest reliability, internal consistency, and between-interviewer-agreement) and valid (factor and criterion validity) behavior rating instrument for problem behaviors in mental retardation and developmental disabilities with a variety of potentially useful applications. Strengths and limitations of the instrument are discussed.

A comparison and evaluation of three commonly used autism scales.

Reliability and validity of three commonly used autism scales, the Autism Behavior Checklist (Krug, Arick, & Almond, 1980), the Real Life Rating Scale (Freeman, Ritvo, Yokota, & Ritvo, 1986), and the Childhood Autism Rating Scale (Schopler, Reichler, & Renner, 1988), were investigated. Data analyses were based on completed protocols for 24 children or adolescents who met DSM-III-R criteria for pervasive developmental disorders. First, to replicate previous findings, interrater reliability of each of the two direct observational scales was assessed. Second, correlations between pairs of the three scales were calculated. Third, diagnostic classifications based on autism scale cutoff scores were compared to classifications based on DSM-III-R criteria. Fourth, relationships between autism scale scores and adaptive behavior scores were investigated. Results and implications for the use of these scales in the assessment of autistic behaviors are discussed.

Empirically derived subtypes of pervasive developmental disorders: a cluster analytic study.

A cluster analytic study was conducted to empirically derive behaviorally homogeneous subtypes of pervasive developmental disorders (PDD). Subjects were clustered based on a broad range of behavioral symptoms which characterize autism. Behavioral variables were measured using several of the standardized psychometric instruments most commonly employed in assessing autistic individuals. The cluster solution indicated the presence of four distinct groups. Validity checks generally confirmed significant between-group differences on independent measures of social, language, and stereotyped behaviors. In addition, the four-group cluster solution was compared to previously developed typological systems of PDD (i.e., subcategories based on IQ early onset, styles of social interaction, and DSM-III-R diagnosis). Results generally supported both the behavioral homogeneity of the four subgroups and also several important between-group differences. The potential utility of using cluster analyses to explore subtypes of PDD is discussed.