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In this chapter, we address the key psychometric concepts of standardization, reliability, validity, norms, and utility. In doing so, we focus primarily on classical test theory (CTT) – the psychometric framework most commonly used in the clinical assessment literature – which disaggregates a person’s observed score into true score and error components. Given its growing use with psychological instruments, we also present basic information on aspects of item response theory (IRT). In contrast to CTT, IRT assumes that some test items are more relevant than other items for evaluating a person’s true score and that the extent to which an item accurately measures a person’s ability can differ across ability levels. After presenting the central aspects of these two frameworks, we conclude the chapter with a discussion of the need to consider cultural/diversity issues in the development, validation, and use of psychological instruments.
Invalid responding is an important consideration in mental health assessment. Given that most assessment data are gathered from self-report methods, accurate diagnostic and clinical impressions can be compromised by various forms of response bias. In this chapter, we review the ways in which evaluations of psychopathology, neurocognitive symptoms, and medical/somatic presentations can be compromised due to noncredible responding and invalidating test-taking approaches. We cover a variety of strategies and measures that have been developed to assess invalid responding. Further, we discuss evaluation contexts in which invalid responding is most likely to occur. We conclude with some remarks regarding cultural considerations as well as how technology can be incorporated into the assessment of response bias.
Drawing up the balance from the literature, case law, and interviews, one must conclude the communication between courts in the preliminary reference procedure does not represent a dialogue going (much) beyond one side asking questions, while the other side tries to answers them. Procedural mechanisms in the procedure that could enhance cooperation and communication are scarcely used to facilitate co-actorship. There are not only practical reasons for this. The lack of dialogue also partly results from a lack of faith in each other’s competence, reliability, and intentions. CJEU judges sometimes lack faith in the competence and reliability of national highest courts and do not seem to believe in the idea that national highest courts could actually provide an authoritative opinion about the correct interpretation or validity of EU law. Judges from Supreme Administrative Courts, on the other hand, are sometimes frustrated that the CJEU does not seem willing to listen to their explanation of the facts of a case, to their concerns about the potential consequences of preliminary rulings and to their views on how EU law should be interpreted. Few judges, however, seem to feel the need to openly express their discomfort, because it could also make things worse.
Having experienced the Tokyo subway sarin attack in 1995, Japan has established extremely strict rules on handling injured victims before they are sent to a hospital. As a result, it takes a long time before rescue actions are taken. This report aims to propose a reform to change the system that focuses on saving lives.
First, the issues in firefighting on sites that currently present problems in Japan were identified. Then, Japanese guidelines were compared with those that were considered in other countries. Based on this, an ideal way of running rescue operations was examined, and a proposal to save many lives was made. This research was conducted with funding from the Ministry of Health, Labour, and Welfare of Japan (MHLW; Chiyoda, Tokyo, Japan).
In addition to preventing secondary injuries, the temporal aspect of rescuing people early with the clear goal of saving many lives was emphasized. Priority was given to measures against nerve agents to prevent secondary injuries, which put the rescuers’ lives at risk. Possible decontamination methods were pursued before choosing the one that was most appropriate. A linear algorithm was used to determine which decontamination method could be started immediately, and then the gradual use of equipment was recommended. Even if Level A personal protective equipment (PPE) and other dedicated equipment and materials cannot be procured, the possibility of starting rescue activities under certain condition using regular equipment was pointed out. The need for a system for possible victims who would require support, such as foreigners, the handicapped, and elderly people, was also identified. Japan limits the scope of activities that can be undertaken by emergency medical technicians (EMTs) on-site. The way in which on-site medical care can be provided with future legal revisions in mind was also discussed.
There is an urgent need to build a framework in which rescue activities can take place so that the number of deaths would not rise, even if sarin and other poisons are scattered.
The human brain’s motor system, including the motor cortex and corticospinal system, the premotor cortex, basal ganglia, and cerebellum, together with input from sensory and polymodal association cortex, can program almost an infinite number of actions. Therefore, to successfully interact with the environment and ourselves we need the guidance provided by motor programs. There are two major forms of programs, action-intentional (the “when” system) and motor-praxic (the “how” system). The action-intentional system programs when to initiate an action, persist at an action, and terminate an action, or when not to act. The motor-praxic system programs the postures and joint movements required for correct interactions, as well as the speed, force, and sequence of these actions. This chapter describes how different elements of these two major forms of motor programs change with aging as well as the influence of aging on motor learning. The mechanisms that induce the aging-related changes in motor programming, motor skill learning, and motor performance are not fully known; however, in this chapter we discuss the various types of aging-related changes, their possible mechanisms, and how some of the changes can be limited and/or treated.
This chapter provides the reader with a succinct review on the continuum of the systemic inflammatory response syndrome through septic shock. The author provides a review on the pathophysiology of shock in children, the diagnostic criteria, and relevant monitoring considerations. The surgical procedures often required for patients with sepsis as well as the relevant anesthetic considerations are discussed.
Hurricane Dorian’s impact on Eastern North Carolina and the Bahamas islands demonstrate the devastation and public health needs that can be left in the wake of a catastrophic event. The hurricane created a range of public health and healthcare challenges, strained further by the damage to infrastructure on which critical services, including the medical supply chain, depend. The recovery process is long, but offers an opportunity to build back better, more resilient communities that can withstand today’s threats.
To analyse how the auditory brainstem response changes in patients with sudden sensorineural hearing loss.
Data were collected via retrospective medical chart review.
Forty-three patients were included in this study. The mean latency of auditory brainstem response wave 1 was significantly longer for the affected side than for the unaffected side (p = 0.003). The mean latency of auditory brainstem response wave 1 was significantly shorter, and the mean amplitude of auditory brainstem response wave 1 was significantly larger, in the good response group compared to the poor response group. In forward conditional logistic regression analysis, auditory brainstem response wave 1 latency was an independent predictor of a good response (odds ratio = 34.37, 95 per cent confidence interval = 1.56–757.15, p = 0.025).
In patients with sudden sensorineural hearing loss, the latency of wave 1 of the auditory brainstem response was significantly increased and was related to prognosis.
The Federal Emergency Management Agency prescribes a 48-h timeline between the declaration of an emergency and the treatment of the last person with Strategic National Stockpile (SNS) medical countermeasures (MCM). Many states struggle to meet the 48-h window. Issues surrounding adequate staffing, critical to maintaining necessary Points Of Dispensing (POD) throughput, are noted in the literature. The use of public and private partnerships in the health-care sector may improve POD throughput. This study describes a novel strategy for partnering with home health agencies (HHAs) to augment MCM distribution. The HHA In-Home Dispensing Model we propose authorizes HHAs to act as Closed PODs following a head of household model. Here, we evaluate the effectiveness of the model using a case study. First, we provide an overview of the methods used to estimate the duration of in-home nurse dispensing shifts. We then present the results for our case study area. Next, we discuss how the model can be used and its limitations. We conclude that the HHA In-Home SNS Dispensing Model shows promise and should receive further consideration, as it can decrease demand at open PODs and increase the reach of MCMs to vulnerable populations who might otherwise have difficulty receiving them.
The aim of this research was to study the learning process using an objective and computerized task. The performance of 466 schoolchildren aged between 6 and 11 in a category learning task, the Category Learning Test (CLT), was examined. The results showed evidence of category learning throughout the trials for the whole sample, F(7, 469) = 29.979, p <.001. In addition, categorization performance improved with age, H(2) = 48.475, p <.001. However, there were old children that struggled with the task and young children that performed very well. The ability to learn the categories was related to the children’s behavior when trying to solve the task: the response speed (r = –.217, p <.01) and the organization index (r = .247, p <.01). Nevertheless, performance in the task and academic marks were not related. We discuss the impact of these findings on the promotion and improvement of learning in schools: an intervention to promote slowness and organization might help some children to learn.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic kidney disease and is caused by heterozygous germ-line mutations in either PKD1 (85%) or PKD2 (15%). It is characterised by the formation of numerous fluid-filled renal cysts and leads to adult-onset kidney failure in ~50% of patients by 60 years. Kidney cysts in ADPKD are focal and sporadic, arising from the clonal proliferation of collecting-duct principal cells, but in only 1–2% of nephrons for reasons that are not clear. Previous studies have demonstrated that further postnatal reductions in PKD1 (or PKD2) dose are required for kidney cyst formation, but the exact triggering factors are not clear. A growing body of evidence suggests that DNA damage, and activation of the DNA damage response pathway, are altered in ciliopathies. The aims of this review are to: (i) analyse the evidence linking DNA damage and renal cyst formation in ADPKD; (ii) evaluate the advantages and disadvantages of biomarkers to assess DNA damage in ADPKD and finally, (iii) evaluate the potential effects of current clinical treatments on modifying DNA damage in ADPKD. These studies will address the significance of DNA damage and may lead to a new therapeutic approach in ADPKD.
Forty years ago, Colin Leys asked “how far the class that has the greatest interest in surmounting and resolving the problems confronting capitalist development … [has] identified these problems or shown itself able to tackle them?” An examination of the business response in four African countries (Kenya, Uganda, Botswana and South Africa) to two kinds of crises (HIV/AIS and political violence) provides surprising answers: African businesses can be key responders to crisis, on occasion responding well in advance of the state and in welfare-enhancing ways that assist the society more widely to resolve the underlying crisis. Large, home-grown, diversified business groups are prominent in the ranks of the constructive responders to crisis, acting in surprising and counterintuitive ways.
Public responsiveness to policy is contingent on there being a sufficient amount of clear and accurate information about policy available to citizens. It is of some significance then, that there are increasing concerns about limits being placed on media outlets around the world. We examine the impact of these limits on the public’s ability to respond meaningfully to policy by analyzing cross-national variation in the opinion–policy link. Using new measures on spending preferences from Wave 4 of the Comparative Study of Electoral Systems, merged with OECD data on government spending and Freedom House measures of press freedom, we assess the role of mass media in facilitating public responsiveness. We find evidence that when media are weak, so too is public responsiveness to policy. These results highlight the critical role that accurate, unfettered media can play in modern representative democracy.
Mastitis, a major infectious disease in dairy cows, is characterized by an inflammatory response to pathogens such as Escherichia coli and Staphylococcus aureus. To better understand the immune and inflammatory response of the mammary gland, we stimulated bovine mammary gland epithelial cells (BMECs) with E. coli-derived lipopolysaccharide (LPS). Using transcriptomic and proteomic analyses, we identified 1019 differentially expressed genes (DEGs, fold change ≥2 and P-value < 0.05) and 340 differentially expressed proteins (DEPs, fold change ≥1.3 and P-value < 0.05), of which 536 genes and 162 proteins were upregulated and 483 genes and 178 proteins were downregulated following exposure to LPS. These differentially expressed genes were associated with 172 biological processes; 15 Gene Ontology terms associated with response to stimulus, 4 associated with immune processes, and 3 associated with inflammatory processes. The DEPs were associated with 51 biological processes; 2 Gene Ontology terms associated with response to stimulus, 1 associated with immune processes, and 2 associated with inflammatory processes. Meanwhile, several pathways involved in mammary inflammation, such as Toll-like receptor, NF-κB, and NOD-like receptor signaling pathways were also represented. NLRP3 depletion significantly inhibited the expression of IL-1β and PTGS2 by blocking caspase-1 activity in LPS-induced BMECs. These results suggest that NLR signaling pathways works in coordination with TLR4/NF-κB signaling pathways via NLRP3-inflammasome activation and pro-inflammatory cytokine secretion in LPS-induced mastitis. The study highlights the function of NLRP3 in an inflammatory microenvironment, making NLRP3 a promising therapeutic target in Escherichia coli mastitis.
Inhibitory control is a key deficit in patients with schizophrenia. This study aims to test whether emotions can facilitate inhibition in patients with schizophrenia when they increase attention to inhibitory process.
A total of 36 patients with schizophrenia and 36 healthy controls completed an emotional stop-signal task. The task involved selective responses to “Go” stimuli and stopped response when emotional or neutral stop cues occurred.
In all conditions, patients with schizophrenia took longer time to inhibit response compared with healthy controls, indicating an overall impairment in response inhibition. Importantly, patients with schizophrenia and controls acquired similar size of benefit from the negative stop cues, showing as reduced reaction time to negative than neutral stop cues. However, the negative stop cues impaired subsequent Go performance only in patients with schizophrenia, indicating additional cost of the negative stop cues for patients with schizophrenia. In both groups, the positive stop cues did not have any significant influence on response inhibition.
These findings provide novel evidence for the benefit of emotional stop cues on inhibitory control in patients with schizophrenia and reveal different after-effects of emotional enhancement effect in patients and healthy populations. The findings may help develop effective interventions for improving inhibitory control in patients with schizophrenia and other clinical populations.
Plants of Sumatran fleabane [Conyza sumatrensis (Retz.) E. Walker] were identified in a field with an unusual rapid leaf injury herbicide symptom after application of 2,4-D in mixture with glyphosate. The objectives of this study were to confirm the occurrence of resistance to 2,4-D herbicide and to characterize the occurrence of rapid necrosis as the mechanism associated with the herbicide resistance in C. sumatrensis. The performed studies were an initial screening, effect of 2,4-D alone and associated with glyphosate, cross and multiple resistance evaluation, effect of commercial formulation and analytical product, and rate of H2O2 evolution. The accession Marpr9-rn was identified with rapid necrosis symptom and survival to 804 g ae ha-1 of 2,4-D. The resistance factor to the herbicide 2,4-D was 18.6 at 49 days after spraying. The analytical product 2,4-D and the commercial formulation resulted in similar symptoms of rapid necrosis. This symptom did not occur for the six other auxinic herbicides (dicamba, florpyrauxifen-benzyl, fluroxypyr, halauxifen-methyl, picloran and triclopyr) indicating absence of cross-resistance. Multiple resistance was not identified in the Marpr9-rn population to the herbicides paraquat, saflufenacil and ammonium glufosinate. However, survival to the herbicides glyphosate and chlorimuron-ethyl occurred. The evolution of H2O2 began at 15 minutes after application and was less pronounced in low light. These results indicate the first case of resistance to 2,4-D and occurrence of rapid necrosis in C. sumatrensis.
The number of clinical trials in body dysmorphic disorder (BDD) has steadily increased in recent years. As the number of studies grows, it is important to define the most empirically useful definitions for response and remission in order to enhance field-wide consistency and comparisons of treatment outcomes across studies. In this study, we aim to operationally define treatment response and remission in BDD.
We pooled data from three randomized controlled trials of cognitive-behavior therapy (CBT) for BDD (combined n = 153) conducted at four academic sites in Sweden, the USA, and England. Using signal detection methods, we examined the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD–YBOCS) score that most reliably identified patients who responded to CBT and those who achieved remission from BDD symptoms at the end of treatment.
A BDD–YBOCS reduction ⩾30% was most predictive of treatment response as defined by the Clinical Global Impression (CGI) – Improvement scale (sensitivity 0.89, specificity 0.91, 91% correctly classified). At post-treatment, a BDD–YBOCS score ⩽16 was the best predictor of full or partial symptom remission (sensitivity 0.85, specificity 0.99, 97% correctly classified), defined by the CGI – Severity scale.
Based on these results, we propose conceptual and operational definitions of response and full or partial remission in BDD. A consensus regarding these constructs will improve the interpretation and comparison of future clinical trials, as well as improve communication among researchers, clinicians, and patients. Further research is needed, especially regarding definitions of full remission, recovery, and relapse.
The present study was designed to investigate the in vivo biological processes of multivesicular bodies (MVBs) and exosomes in mitochondria-rich cells (MRCs), goblet cells (GCs), and absorptive cells (ACs) in turtle intestines during hibernation. The exosome markers, cluster of differentiation 63 (CD63) and tumor susceptibility gene 101 (TSG101), were positively expressed in intestinal villi during turtle hibernation. The distribution and formation processes of MVBs and exosomes in turtle MRCs, GCs, and ACs were further confirmed by transmission electron microscopy. During hibernation, abundantly secreted early endosomes (ees) were localized in the luminal and basal cytoplasm of the MRCs and ACs, and late endosomes (les) were dispersed with the supranuclear parts of the MRCs and ACs. Many “heterogeneous” MVBs were identified throughout the cytoplasm of the MRCs and ACs. Interestingly, the ees, les, and MVBs were detected in the cytoplasm of the GCs during hibernation; however, they were absent during nonhibernation. Furthermore, the exocytosis pathways of exosomes and autophagic vacuoles were observed in the MRCs, GCs, and ACs during hibernation. In addition, the number of different MVBs with intraluminal vesicles (ILVs) and heterogeneous endosome–MVB–exosome complexes was significantly increased in the MRCs, GCs, and ACs during hibernation. All these findings indicate that intestinal epithelial cells potentially perform a role in the secretion of MVBs and exosomes, which are essential for mucosal immunity, during hibernation.
Comparisons of antipsychotics with placebo can be biased by unblinding due to side effects. Therefore, this meta-analysis compared the efficacy of antipsychotics for acute schizophrenia in trials using barbiturates or benzodiazepines as active placebos.
Randomized controlled trials (RCTs) in acute schizophrenia with at least 3 weeks duration and comparing any antipsychotic with barbiturates or benzodiazepines were eligible. ClinicalTrials.gov, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, WHO-ICTRP as well as previous reviews were searched up to 9 January 2018. Two separate meta-analyses, one for barbiturates and one for benzodiazepines, were conducted using random-effects models. The primary outcome was response to treatment, and mean values of schizophrenia rating scales and dropouts were analyzed as secondary outcomes. This study is registered with PROSPERO (CRD42018086263).
Seven barbiturate-RCTs (number of participants n = 1736), and two benzodiazepine-RCTs (n = 76) were included in the analysis. The studies were published between 1960 and 1968 and involved mainly chronically ill patients. More patients on antipsychotics in comparison to barbiturates achieved a ‘good’ response (36.2% v. 16.8%; RR 2.15; 95% CI 1.36–3.41; I2 = 48.9) and ‘any’ response (57.4% v. 27.8%; RR 2.07; 95% CI 1.35–3.18; I2 = 68.2). In a single small trial (n = 60), there was no difference between antipsychotics and benzodiazepines on ‘any’ response (74.7% v. 65%; RR 1.15; 95% CI 0.82–1.62).
Antipsychotic drugs were more efficacious than barbiturates, based on a large sample size. Response ratios were similar to those observed in placebo-controlled trials. The results on benzodiazepines were inconclusive due to the small number of studies and participants.