Inter-observer reliability of the Spondylitis Functional Index Instrument for assessing spondylarthropathies

OBJECTIVE: To study the Spondylitis Functional Index (SFI) by having two physical therapists observe patients with spondylitis perform various tasks listed on the instrument. The physical therapists' observations were compared with each other and with the self-reported abilities of the patients. METHODS: Subjects (n = 30) were recruited from a cross-section of patients participating in a prospective randomized, multicenter, double-blind, parallel clinical trial of the efficacy of sulfasalazine on ankylosing spondylitis (n = 13), psoriatic arthritis (n = 13), and Reiter's syndrome (n = 4) conducted at the Veterans Affairs Medical Center in Salt Lake City. Percents of agreement and Cohen's kappa analysis were used to assess the reliability of the observations of the therapists and patients. RESULTS: The overall percent of agreement between the observers on the SFI was 93%. The overall percent of agreement between observer 1 and patients on the SFI was 66% and between observer 2 and patients was 67%. The overall inter-observer reliability measured by the Pearson coefficient was 0.91 and by Cohen's kappa was 0.86. Between observer 1 and the patients the Pearson was r = 0.53 and kappa = 0.39. For observer 2 the Pearson was r = 0.52 and kappa 0.39. CONCLUSIONS: We consider the agreement and reliability between observers to be high. The agreement and inter-observer reliability was poor between observers and patients. The SFI, as enhanced for use in this study to assess change in functional ability of patients with spondylitis, demonstrated high reliability when used by trained observers.     

How to manage chest pain in patients with normal coronary angiograms

Sympathetic nerve activity is maintained after high spinal injury through circuits that remain in question. We evaluated patterns of c-fos gene induction as a monitor of spinal neurons responding to high spinal cord transection in the rat. Rats were anesthetized with isofluorane. Lower cervical or upper thoracic spinal segments were exposed, immersed in warm mineral oil and transected. Spinal cords were exposed but not transected in anesthetized controls. After 2.5 h, spinalized and control rats were perfused for immunocytochemistry. Cervical and thoracolumbar spinal segments and dorsal root ganglia were sectioned coronally. Tissues were incubated in primary, polyclonal antisera raised in rabbit or sheep against a peptide sequence unique to the N-terminal domain of Fos, and processed immunocytochemically. Neurons were induced to express Fos-like immunoreactivity (FLI), bilaterally, in the spinal gray, but not in primary sensory ganglia. Spinal cord transection induced neurons to express FLI in thoracic laminae I, IIo (outer substantia gelatinosa), Vre (lateral reticulated division), VII (lamina intermedia) and X, and the intermediolateral cell column. Lamina VIII was also labeled in spinal-injured but not in control animals. Immunolabeled nuclei were prominent in lumbar segments and were concentrated in the medial third of laminae I and IIo, and in laminae VII and X. Few cells were labeled in upper cervical or sacral segments. FLI was sparse in the spinal gray of controls and expressed mainly within the dorsal root entry zone of upper thoracic segments. Patterns of c-fos gene expression were site-specific and correlated with laminae that respond predominantly to noxious stimulation and that contain sympathetic interneurons. Laminae that are responsive to non-noxious stimuli and activated by walking, IIi, nucleus proprius, medial V and layer VI were not induced to express FLI. We conclude that neurons in specific spinal laminae that process high threshold afferents and that harbor neurons with sympathetic nerve-related activity are activated selectively by spinal cord transections. We hypothesize that peripheral afferents processed by spinal-sympathetic circuit neurons may regulate sympathetic discharge in the absence of supraspinal drive.     

Inter-observer and test-retest reliability of the Italian version of the Karolinska Psychodynamic Profile in two groups of psychiatric patients

A total of 64 psychiatric patients were tested with the Italian version of the Karolinska Psychodynamic Profile in order to investigate interobserver and test-retest reliability. The mean inter-observer agreement coefficients (rho) ranged from 0.75 to 0.80 with less experienced psychiatrists, while the mean rho value was higher (0.96) with more experienced raters. Test-retest values were good, ranging from 0.53 to 0.93. Overall, reliability was comparable with that reported in the original Swedish study.     

Low prevalence of coronary artery spasm in patients with normal coronary angiograms and unexplained ventricular fibrillation

AIMS: The aetiology of ventricular fibrillation in patients without identifiable structural heart disease is unknown. Recently, high prevalence of silent ischaemia due to coronary artery spasm has been reported in such patients. However, in at least one report, all patients had non-critical coronary artery lesions. Identification of coronary artery spasm as the underlying aetiology of ventricular fibrillation has important therapeutic implications. METHODS AND RESULTS: We performed ergonovine provocation tests in 18 patients (14 males, and four females; mean age, 36 years) with documented ventricular fibrillation in the absence of identifiable structural heart disease who had undergone aborted sudden death. In group I (n = 7) ergonovine provocation tests were performed at a mean interval of 31 months (range 21-42 months) after the index episode. These patients had already received an implantable cardioverter defibrillator, after failed electrophysiologically guided antiarrhythmic therapy. In group II (n = 11) the ergonovine provocation test was performed prospectively as part of the diagnostic evaluation. All patients were off antiarrhythmic drugs, calcium entry or beta-adrenoceptor blockers at the time of the ergonovine provocation test. Ergonovine was administered intravenously as a bolus injection, beginning with 0.05 mg followed every 3 min by incremental doses up to a cumulative maximum dose of 0.45 mg. Predefined end-points were (1) recording of ischaemic ST segment shifts of > or = 1 mm in at least two corresponding leads of the 12-lead electrocardiogram; (2) induction of ventricular tachycardia or ventricular fibrillation; and (3) administration of a cumulative dose of 0.45 mg. A positive response to ergonovine was seen in only one patient (5%) in group I in whom there developed ST segment elevation without angina and a short burst of rapid ventricular tachycardia. CONCLUSIONS: This study found a low prevalence of coronary artery spasm in patients with aborted sudden death resulting from documented ventricular fibrillation and non-apparent underlying heart disease. All patients had normal coronary angiograms and a negative history for spontaneous episodes of chest pain. The mechanism of arrhythmogenesis in such patients remains largely unknown.     

Angiographic progression in patients with angina pectoris and normal or near normal coronary angiograms who are restudied due to unstable symptoms

In this work we studied the mechanism of nitric oxide (NO) release underlying the vasorelaxant and antiaggregant effect of 3,4-dihydrodiazete 1,2-dioxides (DD). Six derivatives were included in the investigations, namely, 3-bromo- and 3-chloro-3,4,4-trimethyl-DD (1a,b), 3-bromo- and 3-chloro-4-methyl-3,4-hexamethylene-DD (2a,b), 3,3,4,4-tetramethyl-DD (3), and 3-methyl-3,4-hexamethylene-DD (4), and their reactivity toward thiols was analyzed. The 3-bromo- and 3-chloro-DD derivatives were found to react with thiols; this reaction can lead to NO formation, DD 2a being the most reactive compound. 2-(Hydroxyamino)-2-methylbutan-3-one oxime (5a) and 2-hydroxy-2-methylbutan-3-one oxime (6) were the main products isolated from the reaction of 1a with cysteine. Reaction rates of DD with thiols were dependent upon pH and concentration of the reagents. Maximum rates of NO release corresponded to thiol concentrations in the range of 1 mM. Consistent with reaction kinetics data and products isolated, a reaction mechanism was proposed. Addition of 2a to bovine aortic endothelial cells led to strong NO release indicating a reaction with endogenous thiols. In rat mesenterial arteries, the vasorelaxant action of 2a was only slightly influenced by addition of thiol to the incubation medium. For the most reactive DD derivatives, cytotoxic effects were observed at concentrations roughly 2 orders of magnitude higher than those inducing vasorelaxation.     

False-negative angiograms in subarachnoid haemorrhage due to intracranial aneurysms

In occupational epidemiology, the need to consider the age factor properly influences the choice of study design and analytical techniques. In most studies, age is viewed as a potential confounder. Age is strongly associated with end points of interest in occupational epidemiology (diseases, physiological characteristics, doses of xenobiotics, etc), but to measure age as a confounder it must be associated with the exposure under study. When the exposure of interest is time related-for example, duration of employment, time since first exposure, cumulative exposure-a strong intrinsic association with age can be anticipated, and age will behave as a (usually strong) confounder. When occupational exposures without a direct relation with age-for example, job, department, type of exposure-are evaluated, the degree and direction of confounding bias cannot be anticipated. Control of the confounding effect of age can be accomplished in the design phase of a study by way of randomisation, restriction, and matching. Randomisation is seldom viable in occupational settings. Restriction is rarely used in the case of age. Matching is often used in a case-control study as a method to increase the study efficiency, but it must be followed by proper matched or stratified analysis. Options for age adjustment in the analysis phase involve stratification and regression methods. In longitudinal studies the modified life table analysis is used to take into account the fact that subjects cross categories of age as the study proceeds. Stability of relative measures of effect over age strata favoured the greater use of relative risks than risk differences. In the presence of effect modification the influence of age should not be eliminated; its interaction with exposure should be explicitly considered.     

Inter-observer agreement in analysis of basal body temperature graphs from infertile women

In this study, we evaluated the reproducibility of analysis of basal body temperature graphs under optimized conditions for agreement. A total of 160 recordings were selected from spontaneous cycles of infertile women and analysed by three experienced clinicians using uniform criteria. Agreement at the various stages of analysis was assessed by the 'proportions of agreement' with 95% confidence intervals. Agreement in identification of the thermal nadir was clearly superior to that reported in previous publications. Reproducibility of 'ovulatory' graph features (i.e. biphasic graphs and adequate thermal shifts) was excellent. Agreement in classification of monophasic graphs and inadequate thermal shifts, although lower, was still good. Thus, with experienced observers and uniform criteria, a good agreement can be achieved in analysis of the most important parameters of the basal body temperature graph. We believe that an effort should be made to generalize the use of uniform analysis criteria, because only then can results from different institutions be compared and the remaining clinical evaluation of the method be performed.     

Quantifying changes in retinal circulation: the generation of parametric images from fluorescein angiograms

Critical care unit patients show a higher risk of developing a bloodstream infection than ward patients. The urinary tract is the main source of hospital-acquired secondary bloodstream infection. Nosocomial urinary tract infection is promoted by bladder catheterization in the vast majority of cases. Aerobic gram-negative bacilli are the prevalent agents of bloodstream infection secondary to a nosocomial urinary tract infection. Sepsis and septic shock are severe complications of these infections in the critical care patient. Management of patients with a septic process of urinary source calls for the combination of adequate life-supporting care, an appropriate antibiotic therapy, and innovative adjunctive measures. Accurate catheter care is the best measure to adopt for the prevention of urosepsis.     

Caution in the interpretation of MLS

We study the statistical properties of the maximum likelihood score (MLS) test. We show that the criteria for reaching conclusions about linkage are not the same for single point analysis as for multipoint, where the maximization is performed over an additional parameter, the position in the marker interval where the MLS is computed. In addition, this test is shown to be very sensitive to errors in allele frequencies and recombination fraction.     

Vessel enhancement filtering in three-dimensional MR angiograms using long-range signal correlation

Small vessels in three-dimensional MR angiograms have low visibility in maximum-intensity projection images because of their low contrast. In a previous study, we had two nonlinear filters that appeared to give significant improvement in small vessel detail. In this paper, we report on a generalization of this filter that allows a more general modeling of the vessels and a more complete suppression of background. One implementation of the general filter gave a vessel mean contrast-to-noise ratio that is 2.52 and 3.51 times higher than the vessel mean contrast-to-noise ratio obtained using our previously reported maximum-minimum (max-min) filter and cross-section filter, respectively.     

Medical students' and residents' gender bias in the diagnosis, treatment, and interpretation of coronary heart disease symptoms.

Two competing hypotheses explaining gender bias in cardiac care were tested. The first posits that women's coronary heart disease (CHD) symptoms are simply misinterpreted or discounted. The second posits that women's CHD symptoms are misinterpreted when presented in the context of stress. In two studies, medical students and residents randomized to 2 (male vs. female) × 2 (stress vs. nostress) experiments read vignettes of patients with CHD symptoms and indicated their diagnosis, treatment, and symptom origin interpretation. Both studies disconfirmed the first hypothesis and strongly supported the second. Only when stress was added did women receive significantly lower CHD diagnoses and cardiologist referrals than men and did the origin interpretation of women's CHD symptoms (e.g., chest pain) shift from organic to psychogenic. Neither participants' gender nor their attitude toward women influenced assessments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparative analysis of pulmonary perfusion scans with pulmonary angiograms

Pulmonary angiograms and pulmonary lung perfusion scans on 162 patients with pulmonary embolism were comparatively analyzed. Among the expert angiographic panel members who independently evaluated the studies there was consistent agreement on the diagnosis, size of the emboli, and severity. Consistency of agreement among the expert pulmonary lung perfusion scan panelists was considerably less. These data demonstrate that, in addition to the lack of specificity of the lung perfusion scan for the diagnosis of pulmonary thromboemboli, there is a considerable problem of interpretation in this patient population.     

Prospective study of provocative angiograms to localize functional islet cell tumors of the pancreas

BACKGROUND: Controversy exists concerning the use of preoperative imaging studies in patients with islet cell tumors. Since 1993 we have evaluated the use of provocative angiography in patients with insulinoma or Zollinger-Ellison syndrome (ZES). METHODS: Twelve patients with a working diagnosis of insulinoma (n = 4) or ZES (n = 8) were studied. Of the eight patients with ZES, four were known to have multiple endocrine neoplasia type 1. All patients underwent conventional imaging studies followed by provocative angiography. Angiograms were graded based on the ability to detect tumor and regionalize it within the pancreas. RESULTS: Of the three patients with a working diagnosis of ZES but equivocal results of biochemical studies, none had arteriographic imaging of an islet cell tumor or a positive provocative study result (true negative result). Of the nine patients with documented islet cell tumor, seven (78%) underwent arteriographic imaging of the tumor and eight (89%) had correct regional localization by provocative angiography. Sensitivity and specificity for imaging were 78% and 100%, respectively, and for regional localization 89% and 100%, respectively. CONCLUSIONS: Provocative angiography is the localization study of choice for both gastrinoma and insulinoma. Having few false-negative results, it can be used to corroborate the diagnosis and, having few false-positive results, it detects tumor and biochemically confirms localization in nearly every patient.     

Radiographic interpretation in the emergency department

This study examined the concordance of radiographic readings between emergency department (ED) attending physicians and radiologists in a community teaching hospital. In addition, the incidents of misinterpretations leading to an alteration in patient care were also reviewed. All radiographs obtained from January through October 1993 were initially interpreted by ED attending physicians with subsequent final review by attending radiology staff. Misread radiographs were placed into one of three categories. The groupings included overread radiographs with no change in treatment, underread radiographs with no change in treatment, and radiograph misinterpretations with a change in treatment. Of 15,585 radiographs obtained during the study period, there were 120 misreads; 12,099 (77.6%) of the 15,585 radiographs had an initial emergency physician interpretation. Radiographic misinterpretations included 7 (5.78%) overreads, 57 (47.1%) underreads, and 57 (47.51%) misreads requiring follow-up (MR-FU). The five most frequently misread radiographs were: abdominal, 12/247 (4.4%); rib, 3/99 (3.0%); foot, 13/621 (2.1%); hip, 3/152 (1.9%); and ankle 11/758 (1.4%). The most frequently obtained radiographs included: chest, 7,012 (0.33% MR-FU); cervical spine, 1,112 (0.18% MR-FU); ankle, 758 (0.66% MR-FU); knee, 633 (0.32% MR-FU); and foot, 621 (0.97% MR-FU). In this study, 99.0% of all emergency department radiographs were read correctly on initial review by ED attending physicians. Of all misread radiographs, less than half (46%) were deemed clinically significant and required a follow-up intervention.     

Conceptual knowledge in the interpretation of idioms.

The authors examined how people determine the contextual appropriateness of idioms. In Experiment 1, idioms referring to the same temporal stage of a conceptual prototype were judged to be more similar in meaning than idioms referring to different temporal stages. In Experiment 2, idioms in a prototypical temporal sequence were more meaningful than idioms in sentences that violated the temporal sequence. In Experiment 3, idioms referring to the same stage of a conceptual prototype were differentiable on the basis of conceptual information. The conceptual coherence between idioms and contexts facilitated the processing speed of idioms in Experiment 4. Experiment 5 showed that speakers can recover the underlying conceptual metaphors that link an idiom to its figurative meaning. Experiment 6 showed that the metaphoric information reflected in the lexical makeup of idioms also determined the metaphoric appropriateness of idioms in certain contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

网络流行语中哥的语用学释义

随着春哥、犀利哥等称呼在网络上的使用频率越来越高,哥已成为近期的网络流行语之一.哥的网络义是如何演化而来的,表达了说话者怎样的意图,表现了怎样的社会现状.这些问题都令人深思.从语用学角度出发,运用称谓语/称呼语、指示语及礼貌原则等理论,对哥进行了剖析,认为哥在网络上具有嘲讽、彰显个性等作用,体现了网络文化的创造性.