Assessing the Costs, Benefits, Cost-Effectiveness, and Cost-Benefit of Psychological Assessment: We Should, We Can, and Here's How.

To the extent that assessment improves the effectiveness of treatment, prevention, or other services, it can be said to be effective. If an assessment is as effective as alternatives for improving treatment and less costly, it can be said to be cost effective. If that improvement in the effectiveness of the service is monetary or monetizable, the assessment can be judged beneficial. And, if the sum of monetary and monetizable benefits of assessment exceeds the sum of the costs of treatment, the assessment can be said to be cost-beneficial. An overview of cost-related issues is followed by practical strategies that researchers and administrators can use to measure incremental costs, incremental effectiveness, and incremental benefits of adding psychological assessments to other psychological interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immunolabeling of Mu opioid receptors in the rat nucleus of the solitary tract: extrasynaptic plasmalemmal localization and association with Leu5-enkephalin

Activation of the mu opioid receptor (MOR) by morphine within the caudal nucleus of the solitary tract (NTS) is known to mediate both cardiorespiratory and gastrointestinal responses. Leu5-enkephalin (LE), a potential endogenous ligand for MOR, is also present within neurons in this region. To determine the cellular sites for the visceral effects of MOR ligands, including LE, we used immunogold-silver and immunoperoxidase methods for light and electron microscopic localization of antisera against MOR (carboxyl terminal domain) and LE in the caudal NTS of rat brain. Light microscopy of coronal sections through the NTS at the level of the area postrema showed MOR-like immunoreactivity (MOR-LI) and LE labeling in punctate processes located within the subpostremal, dorsomedial and medial subnuclei. Electron microscopy of sections through the medial NTS at this level showed gold-silver particles identifying MOR-LI prominently distributed to the cytoplasmic side of the plasma membranes of axons and terminals. MOR labeled terminals formed mostly symmetric (inhibitory-type) synapses but sometimes showed multiple asymmetric junctions, characteristic of excitatory visceral afferents. MOR-LI was also present along extrasynaptic plasma membranes of dendrites receiving afferent input from unlabeled and LE-labeled terminals. We conclude that MOR ligands, possibly including LE, can act at extrasynaptic MORs on the plasma membranes of axons and dendrites in the caudal NTS to modulate the presynaptic release and postsynaptic responses of neurons. These are likely to include local inhibitory neurons and both gastric and cardiorespiratory afferents known to terminate in the subnuclei with the most intense MOR-LI.     

A split-mouth placebo-controlled study to determine the effect of amorphous calcium phosphate in the treatment of dentine hypersensitivity

Many treatments for dentine hypersensitivity are formulated to directly or indirectly occlude the open dentinal tubules associated with the condition. Combining solutions of calcium chloride and potassium phosphate can result in the precipitation of amorphous calcium phosphate. Such a system applied to exposed dentine could occlude dentinal tubules and reduce sensitivity. The aims of this study using a placebo control were to assess the therapeutic value of amorphous calcium phosphate in dentine hypersensitivity and provide further information on the apparently natural improvement in the condition frequently observed in clinical trials. 38 subjects with dentine hypersensitivity affecting 1 tooth in each left and right sides of the jaws were recruited into this split mouth, randomised, double-blind study. At baseline, sensitivity was scored by the subjects on a 0-10 visual apologue scale after tactile, cool and cold water and evaporative stimulation of the test teeth. Active and control, water, solutions were then applied by a 2nd clinician. After 24 h, subjects returned for rescoring. On days 7 and 14, subjects were again rescored and the treatments reapplied. Further follow-up appointments for rescoring were on days 21, 28, 56 and 84. Plaque scores also were recorded from test teeth at each visit. Overall sensitivity decreased considerably and to a similar degree in test and control teeth with no consistent significant treatment difference. Plaque scores also decreased through the study period. It is concluded that either the amorphous calcium phosphate was without therapeutic effect or the activity was masked by the placebo response in the control teeth.     

Evidence of a thyrotropin-releasing activity of ovine corticotropin-releasing factor in the domestic fowl (Gallus domesticus)

New tools to prevent malaria morbidity and mortality are needed to improve child survival in sub-Saharan Africa. Insecticide treated bednets (ITBN) have been shown, in one setting (The Gambia, West Africa), to reduce childhood mortality. To assess the impact of ITBN on child survival under different epidemiological and cultural conditions we conducted a community randomized, controlled trial of permethrin treated bednets (0.5 g/m2) among a rural population on the Kenyan Coast. Between 1991 and 1993 continuous community-based demographic surveillance linked to hospital-based in-patient surveillance identified all mortality and severe malaria morbidity events during a 2-year period among a population of over 11000 children under 5 years of age. In July 1993, 28 randomly selected communities were issued ITBN, instructed in their use and the nets re-impregnated every 6 months. The remaining 28 communities served as contemporaneous controls for the following 2 years, during which continuous demographic and hospital surveillance was maintained until the end of July 1995. The introduction of ITBN led to significant reductions in childhood mortality (PE 33%, CI 7-51%) and severe, life-threatening malaria among children aged 1-59 months (PE 44%, CI 19-62). These findings confirm the value of ITBN in improving child survival and provide the first evidence of their specific role in reducing severe morbidity from malaria.     

Examination and anatomy of the hand

In preparation for forthcoming chapters, the reader is offered a clear and thorough discussion of the anatomy of the hand, with important tips for examination and diagnosis.     

Mutational analysis of the A-kinase anchoring protein (AKAP)-binding site on RII. Classification Of side chain determinants for anchoring and isoform selective association with AKAPs

Compartmentalization of the type II cAMP-dependent protein kinase is conferred by interaction of the regulatory subunit (RII) with A-Kinase Anchoring Proteins (AKAPs). The AKAP-binding site involves amino-terminal residues on each RII protomer and is formed through dimerization. A site-directed mutagenesis strategy was utilized to assess the contribution of individual residues in either RII isoform, RIIalpha or RIIbeta, for interaction with various anchoring proteins. Substitution of long-chain or bulky hydrophobic groups (leucines or phenylalanines) for isoleucines at positions 3 and 5 in RIIalpha decreased AKAP-binding up to 24 +/- 3 (n = 8)-fold, whereas introduction of valines had minimal effects. Replacement with hydrophilic residues (serine or asparigine) at both positions abolished AKAP binding. Mutation of proline 6 in RIIalpha reduced binding for four AKAPs (Ht31, MAP2, AKAP79, and AKAP95) from 2.3 to 20-fold (n = 4) whereas introduction of an additional proline at position 6 in RIIbeta increased or conferred binding toward these anchoring proteins. Therefore, we conclude that beta-branched side chains at positions 3 and 5 are favored determinants for AKAP-binding and prolines at positions 6 and 7 increase or stabilize RIIalpha interaction with selected anchoring proteins.     

A new protocol for the integration of voice and data over PRMA

In packet reservation multiple access (PRMA) the receiver in the mobile terminal is required to listen continuously to monitor the acknowledgment messages broadcasted at the end of every time slot. A new scheme for the integration of voice and data based on PRMA is proposed. The voice and the data subsystems are logically separated. The total available bandwidth is divided into three regions-voice information, voice contention, and data regions. The available bandwidth is dynamically partitioned between the above three regions subject to the fulfillment of the quality of service (QoS) requirements of the voice users. The voice subsystem has been modeled as a Markov chain and an exact analytical method used to compute the voice packet dropping probability is described. A nonlinear programming problem is formulated to optimize the bandwidth allocated for the data users. Solutions to this nonlinear programming problem that are very close to optimum have been obtained heuristically. Numerical results indicate that a significant amount of data traffic can be supported without sacrificing the voice capacity of the system     

The treatment of peptic ulcer patients during exacerbation at the day hospital of an industrial enterprise polyclinic

Results are submitted of treatment of 659 patients with exacerbated peptic ulcer at an in-plant day in-patient facility. The basic therapy was hyperbaric oxygenation and ultraviolet irradiation of blood. The relapse rate over the year was 16%. A surgical operation was performed in 1.5% of those cases having completed the course treatment at the day in-patient facility, with 33.3% of patients having been operated on urgently, and 11.28% at a twenty-four-hour department; of these, in 85.62% cases operations were performed in situations of emergency needing prompt action. Duration of temporary disability in patients cared for at the day hospital was 21.3 days, while in those treated at a twenty-four-hour facility-27.8 days. Indications for hospitalization were of social character. Comparison of results of treatment, relapse rates and complications of ulcer disease in hospitalized patients versus those having been treated at a day-care facility gave arguments in favour of reorientation of treatment of major part of those patients experiencing exacerbation of ulcer disease at well equipped day-care in-patient facilities.