Validating an objective video-based dyskinesia severity score in Parkinson's disease patients

Dyskinesia is a common side effect of prolonged dopaminergic therapy in Parkinson's disease patients. Assessing the severity of dyskinesia could help develop better pharmacological and surgical interventions. We have developed a semi-automatic video-based objective dyskinesia quantifying measure called the severity score (SVS) that was evaluated on 35 patient videos. We present a study to evaluate the utility of our severity score and compare its performance to clinical ratings of neurologists. In addition to the Unified Dyskinesia Rating Scale (UDysRS) score for each video, four neurologists provided three sets of time lapsed ratings and rankings of the 35 videos using a specifically developed protocol. The statistical analysis of our data using Kendall's tau-b and intra-class correlations shows that (a) ranking patient videos based on severity is suitable for studying the utility of the SVS, and (b) SVS exhibits moderate utility to quantify dyskinesia severity when compared to manual assessment of dyskinesia by neurologists using the UDysRS. These results support the effective use of SVS as an objective measure to quantify dyskinesia and the rationale for a ranking system that complements traditional rating scales.     

Validating structured DSM-III-R personality disorder assessments with longitudinal data

The authors observed 20 patients over time for mal-adaptive personality traits during hospitalization and made longitudinal diagnoses to validate Structured Clinical Interview for DSM-III-R (SCID) assessments of personality disorders. The SCID assessments identified certain personality disorders better than others.     

Validating an experiential measure of parental style: the use of a twin sample

A study of monozygotic (MZ) and dizygotic (DZ) twins was undertaken to assess further the properties of the Parental Bonding Instrument (PBI), a self-report measure of parental care and overprotection, to examine for associations between PBI and mood (trait anxiety and depression) scores, and to assess the genetic contribution to anxiety and depression scores. Mean correlations on the PBI scales were high and strikingly similar for the MZ and DZ twin pairs, supporting the construct validity of the PBI as a measure of parental characteristics. Higher mood scores were linked with less parental care and greater parental protection, the associations being stronger with anxiety than depression. Finally, methodological limitations in estimating heritability are noted.     

Validating the Adolescent Sleep Wake Scale for use with young adults

ObjectiveThere is a need for examination of sleep across the entire adolescence to young adulthood developmental period (AYA; ages 12–25 years). The Adolescent Sleep Wake Scale (ASWS) is a 28-item measure of overall subjective sleep quality, including five sleep behavior domains (difficulty going to bed, falling asleep, maintaining sleep, reinitiating sleep, and returning to wakefulness), and has been validated to assess overall sleep quality and insomnia symptoms in adolescents (12–18 years). The current study aimed to examine whether the ASWS could be used to assess sleep across the AYA period by investigating the validity of the measure in a national sample of young adults (ages 19–25) using validated adult sleep measures.Materials and methodsA national sample recruited through Amazon's MTurk (N = 332; Mean age = 23.37 (SD = 1.55); 53.8% female; 51.4% Caucasian) completed an online survey including the ASWS, the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Bivariate correlational analyses were performed to explore convergent and discriminant validity.ResultsThe ASWS total score was strongly correlated with both the PSQI total score (r = −0.68) and ISI (r = −0.71) total score. The subscales of the PSQI, including Sleep Latency, Sleep Disturbance, and Daytime Dysfunction were correlated with corresponding ASWS domains. There were weak correlations with other subscales. Internal consistency was good (α = 0.88).ConclusionsOur results suggest that the ASWS measures areas of sleep problems in a manner consistent with the most frequently utilized self-report assessment in adults and supports the use of the ASWS across AYA.     

Validating the Repetitive Behavior Scale-Revised in Young Children with Autism Spectrum Disorder

This study examined the factor structure of the Repetitive Behavior Scale-Revised (RBS-R) in a sample of 287 preschool-aged children with autism spectrum disorder (ASD). A confirmatory factor analysis was used to examine six competing structural models. Spearman’s rank order correlations were calculated to examine the associations between factor scores and variables of interest. The 3- and 5-factor models were selected as preferable on the basis of fit statistics and parsimony. For both models, the strongest correlations were with problem behavior scores on the Child Behavior Checklist and repetitive behavior scores on the ADI-R. Developmental index standard scores were not correlated with factors in either model. The results confirm the utility of the RBS-R as a measure of repetitive behaviors in young children with ASD.     

Patients' Satisfaction with Psychiatric Treatment: Comparison Between an Open and a Closed Ward

The study compared patients' satisfaction with psychiatric inpatient treatment between an open and a closed ward. During a six-month period, all voluntarily participating patients on two wards of a psychiatric University hospital were investigated anonymously at admission and/or before discharge. A self-rating questionnaire (SATQ-98) was used to assess satisfaction with several domains of psychiatric inpatient treatment. In total, 135 questionnaires were received (retrieval rate 49%). The general level of satisfaction with treatment was high. General satisfaction, satisfaction with medication, ward equipment, visiting opportunities, and regulations for going out were significantly lower at discharge on the closed ward. Dissatisfaction with medication was related to low actual mood, and to low satisfaction with the frequency of psychotherapeutic interventions, visiting opportunities, and with the treating doctor. The results thus far strongly support the need for patients' satisfaction with treatment to be taken into account in order to improve psychiatric inpatient services, particularly on closed wards.     

Adapting and Validating the Family Resilience Assessment Scale in an Afrikaans Rural Community in South Africa

A family resilience framework understands families as having the potential to not only face adversities but to overcome them; although its measurement is not always agreed upon. The aim of this study is to explain the processes involved in the adaptation of the 54-item family resilience assessment scale into Afrikaans, and to further examine its psychometric properties. Data were collected via the door-to-door method with the assistance of fieldworkers in two rounds. The pilot sample included 82 participants whilst the larger study included 656 participants. The internal consistency and construct validity was assessed using Cronbach’s alphas and Exploratory Factor Analysis implementing a Principal Component Analysis and Promax rotation, respectively. The factors which were found are similar to those of Sixbey’s, however, a new factor emerged replacing Maintaining a positive outlook which was named Family and community outlook. The processes described in this study facilitated the assessment of the feasibility and efficiency of the full-scale study and reduced the number of unanticipated problems associated with large sample data collection particularly using fieldworkers.     

Validating the Communicative Participation Item Bank (CPIB) for use with people with aphasia: an analysis of differential item function (DIF)

Background: The term “communicative participation” refers to participation in the communication aspects of life roles at home, at work and in social and leisure situations. Participation in life roles is a key element in biopsychosocial frameworks of health, such as the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) and the Aphasia Framework for Outcomes Measurement. The Communicative Participation Item Bank (CPIB) was developed as a patient-reported measure of communicative participation for adults. Initial validation focused on adults with motor speech or voice disorders. No prior studies have conducted quantitative validation analyses for the CPIB for people with aphasia (PWA).

Aims: The primary purpose of this study was to begin validation of the CPIB for PWA by conducting an analysis of differential item functioning (DIF). A DIF analysis was used to identify whether item parameters of the CPIB differed between PWA and the populations used in prior CPIB calibration. Secondary analyses evaluated the level of assistance needed by PWA to complete the CPIB, relationships between the CPIB and a gold-standard patient-reported instrument for PWA—American Speech-Language-Hearing Association Quality of Communication Life Scale (ASHA-QCL) and relationships between PWA and family proxy report on the CPIB.

Methods & Procedures: This study included 110 PWA and 90 proxy raters. PWA completed a battery of patient-reported questionnaires in one face-to-face session. Speech-language pathologists provided communication support. Data on aphasia severity from the Western Aphasia Battery—Revised (WAB-R) and demographic data either existed from prior research or were collected during the session. Proxy raters completed a similar battery of self-report questionnaires.

Outcomes & Results: Results of the DIF analysis suggested statistically significant DIF on two of the 46 items in the CPIB, but the DIF had essentially no impact on CPIB scores. PWA with WAB-R Aphasia Quotient scores above 80 appeared comfortable reading the CPIB items, although required occasional assistance. Most participants who were unable to complete the CPIB had WAB-R Aphasia Quotient scores lower than 50. Correlation between the CPIB and ASHA-QCL was moderate; and correlation between PWA and proxy scores was low.

Conclusions: Most PWA were able to respond to CPIB items, although most required or requested support. Although these results are preliminary due to a small sample size, the data support that the CPIB may be valid for PWA. Caution is warranted regarding proxy report because of low correlation between PWA and proxy ratings.     

Validating the Type D personality construct in Chinese patients with coronary heart disease

Objective

Type D personality predicts poor prognosis in coronary heart disease (CHD) but little is known about Type D in non-Western cultures. We examined the (a) validity of the Type D construct and its assessment with the DS14 scale in the Chinese culture, (b) prevalence of Type D, and (c) gender vs. Type D discrepancies in depression/anxiety, among Chinese patients with CHD.

Method

Patients with CHD (N=326) completed the Chinese version of the DS14. The NEO Five Factor Inventory (NEO-FFI), Hospital Anxiety and Depression Scale (HADS), and Stress Symptom Checklist (SSC) were administered to subsamples to establish construct and discriminant validity.Administration of the DS14, HADS, and SSC was repeated at 1 month after hospital discharge in 66 patients, and stability of the DS14 was examined in another subsample of 100 patients.

Results

The theoretical structure of the Type D construct in the Chinese culture was supported (χ²/df=2.89, root mean square error of approximation=0.08, normal fit index=0.91, non-normal fit index=0.91, comparative fit index=0.93). The Negative Affectivity (NA) and Social Inhibition (SI) subscales of the DS14 in the entire sample were internally consistent (Cronbach's alpha=0.89/0.81), measured stable traits (3-month test-retest ICC=0.76/0.74), and correlated significantly with the neuroticism (NA/neuroticism, r=0.78, P<.001) and extraversion subscales (SI/extraversion, r=−0.64, P<.001) of the NEO-FFI, respectively. The prevalence of Type D personality was 31%. Type D was not related to transient emotional states. However, Chinese patients with a Type D personality were at increased concurrent risk of anxiety (P=.002) and depression (P=.016).

Conclusion

Type D personality is a cross-culturally valid construct, is associated with an increased risk of anxiety and depression, and deserves prompt attention in estimating the prognostic risk of Chinese CHD patients.     

Validating dynamicity in resting state fMRI with activation‐informed temporal segmentation

Confirming the presence (or absence) of dynamic functional connectivity (dFC) states during rest is an important open question in the field of cognitive neuroscience. The prevailing dFC framework aims to identify dynamics directly from connectivity estimates with a sliding window approach, however this method suffers from several drawbacks including sensitivity to window size and poor test–retest reliability. We hypothesize that time‐varying changes in functional connectivity are mirrored by significant temporal changes in functional activation, and that this coupling can be leveraged to study dFC without the need for a predefined sliding window. Here, we introduce a data‐driven dFC framework, which involves informed segmentation of fMRI time series at candidate FC state transition points estimated from changes in whole‐brain functional activation, rather than a fixed‐length sliding window. We show our approach reliably identifies true cognitive state change points when applied on block‐design working memory task data and outperforms the standard sliding window approach in both accuracy and computational efficiency in this context. When applied to data from four resting state fMRI scanning sessions, our method consistently recovers five reliable FC states, and subject‐specific features derived from these states show significant correlation with behavioral phenotypes of interest (cognitive ability, personality). Overall, these results suggest abrupt whole‐brain changes in activation can be used as a marker for changes in connectivity states and provides new evidence for the existence of time‐varying FC in rest.     

Open Trials with Valproate in Epilepsy

Valproic acid (VPA) was first synthesized in the United States (Burton, 1882) and was used worldwide for 80 years as an organic solvent. Its unexpected antiepileptic activity was discovered 20 years ago in Grenoble, France (Meunier et al., 1963; Carraz et al., 1964). The aim of this work is to report the progressive evolution of ideas and the clinical approach to the treatment of epilepsy with sodium valproate (Na VPA) and VPA, according to published open trials and to our own unpublished data.     

Validating cultural adaptations of a school-based social-emotional learning programme for use with Latino immigrant adolescents

Immigrant youth face many challenges as they adapt to a new culture and society. School-based social-emotional learning (SEL) interventions have been proposed to teach these children's coping skills that can help them with such life-changing transitions. A growing body of research supports the need to make adaptations to any evidence-based intervention, including SEL, to ensure the intervention's efficacy and cultural sensitivity. The purpose of this paper is to describe the process of adapting an evidence-based SEL programme for use with a group of Latino immigrant adolescents enrolled in public schools in the USA. The ecology validity framework was adopted for the pilot/feasibility study described in this paper. A group of 40 recent-immigrant Latino adolescents participated in the study. Participants reported favourable social validity and acceptability ratings. The youth also demonstrated an increase in SEL knowledge. The results suggested that developing and implementing cultural adaptations to existing evidence-based interventions in school settings is feasible and socially valid. Implications for culturally responsive school-based interventions are presented.     

Validating the diagnosis of delirium and evaluating its association with deterioration over a one-year period.

The authors probed the associations between clinical diagnoses and independent research measures of cognitive, behavioral, and electroencephalographic (EEG) changes in hospitalized older patients and investigated the contribution of medical illness to deterioration. Patients (N=96; 47 of whom were hospitalized during the course of 1 year; 12 diagnosed with delirium) received tests of cognitive and physical functioning and the Cumulative Illness Rating Scale, specific neuropsychological tests, and a two-channel EEG. Delirium was associated with independent measures of cognitive decline and EEG slowing. Hospitalization was associated with deterioration in functional status during the year, whether or not patients showed delirium. Results suggest that medical illness leading to hospitalization can contribute significantly to deterioration in self-care, and, when it is associated with delirium, to deterioration in cognitive performance and cerebral activity over a period of 1 year.     

Validating mini-mental status, cognitive capacity screening and Hamilton depression scales utilizing subjects with vascular headaches

INTRODUCTION: The Mini-Mental State Examination (MMSE) and Cognitive Capacity Screening Examination (CCSE) are easily and rapidly administered tests for quantifying the general cognitive status of young as well as geriatric subjects. Likewise, the Hamilton Depression Rating Scale (HDRS) is a brief instrument for quantifying depression that may confound cognitive test performances. Testing by means of all three scales concurrently provides useful information for longitudinal research among the elderly. OBJECTIVES: To validate the combined longitudinal use of MMSE, CCSE and HDRS among a specific cohort of normal subjects with vascular headaches characterized by known well-established temporary cognitive decline occurring only during temporary intervals with headache. METHODS: The MMSE, CCSE and HDRS were serially tested at 3-12 monthly intervals among 196 healthy subjects attending our out-patient headache clinic who suffered from migraine or cluster headaches. Stability and specificity of MMSE, CCSE and HDRS were evaluated by comparing consecutive normative scores during headache-free intervals. Sensitivity of MMSE and CCSE for detecting temporary cognitive decline were evaluated by comparing scores during headache and headache-free intervals. RESULTS: CCSE, MMSE and HDRS gave stable headache-free normative values over intervals of 3-10 years among 182 subjects. Among 77 subjects during headache intervals, temporary cognitive decline were confirmed by both CCSE and MMSE (p < 0.0001). When cutoff points for both CCSE and MMSE normal scores were placed at >/= 27, specificity for detecting cognitively normal values for CCSE and MMSE when headache-free were 92.2 and 89.6%, respectively (p > 0.05), while sensitivity for detecting cognitively decline during headache intervals were 83.7 and 49%, respectively (p < 0.001). Compared with scoring by a single rater, reliability estimates for all three rating scales were slightly lower when tested by different raters, but these differences were not significant. CONCLUSIONS: CCSE is reliable and more sensitive than MMSE for detecting cognitive decline.     

Open trial of mirtazapine in patients with fibromyalgia

BACKGROUND: Some positive therapeutic effects in fibromyalgia syndrome (FS) were reported with both tricyclic and new antidepressant drugs as well as serotonergic agents (5HT2 and 5HT3 receptor blockers). METHODS: In the present study, a novel antidepressant drug mirtazapine, 15-30 mg/day, has been used in 29 patients with FS in an open trial. RESULTS: Twenty-six patients completed the six-week study. Ten (38%) were considered responders on account of the reduction of > or =40% on pain, fatigue and sleep disturbances and remission of depressive symptoms at the end of study. Eighteen patients had at least moderate depression before mirtazapine treatment and 8 patients presented mild depressive symptoms. Reduction on main symptoms of FS after 6 weeks of mirtazapine treatment significantly correlated with the reduction in depression. However, the percentage of responders and patients with > or = 40% reduction on main symptoms of fibromyalgia was similar in high and low depression groups. CONCLUSIONS: The results obtained suggest that mirtazapine may be promising method of FS treatment. Further double-blind placebo-controlled studies are required to confirm these results.     

Open trial with levodopa-carbidopa combination to patients with long-standing progressive myoclonus epilepsy

Six adult patients with long-standing progressive myoclonus epilepsy (PME) received levodopa combined with carbidopa in addition to their usual anticonvulsant regimen. During 5 weeks of treatment an improvement in daily activities and a decrease of action myoclonus were observed. The spontaneous EEG did not differ from the recordings prior to the trial, but the provoked EEG showed fewer reactions during provocations in 5 out of 6 patients. The treatment had no effect on psycho-motor reaction time or epileptic seizures. Pre-trial HVA values in the CSF of the PME patients were significantly lower than those of their epileptic controls, but during the trial CSF HVA values in PME patients increased markedly. No untoward side-effects were noted. The results suggest that there could be an alteration of dopaminergic tone in PME.     

Validating the theoretical bases of sleep reactivation during sharp‐wave ripples and their association with emotional valence

Sleep is important for memory consolidation, and an abundant literature suggests that reactivation in the hippocampus during sleep is instrumental to this process. Yet, the current interpretation of activity during sharp‐waves ripples (SWRs), as replay of wake experiences, relies on hypotheses that, while widely accepted, have only recently begun to be tested directly. Moreover, this theory has been mainly studied in the context of pure spatial learning, and it is still not clear how emotional valence can fit into this conceptual framework when considering reward‐ or punishment‐based learning. In this review, we will present recent experimental arguments validating the interpretation of sleep replay as reactivation of awake experiences and examine the evidence showing that the emotional valence is also replayed during sleep in a coordinated fashion with hippocampal SWRs. Finally, we will detail recent experiments showing that brain–computer interfaces can be used to modify the emotional valence associated with sleep replay.     

Resource allocation to brain research in Denmark: an example for other European countries

This study represents a first attempt at estimating Danish resource allocation to brain research including both public and private spending. It appears that private spending is at a reasonable level because a highly developed Danish pharmaceutical industry invests significantly in this branch of science. However, public spending is at a low level compared with several other European countries with a similar economic status. As for other European countries the funding is very low compared with the USA. Dedicated national investigations of the resource allocation to different branches of biomedical research are warranted. Brain research should of course be an important part of such studies. The USA and the European Union have selected brain research as one of their priority areas within health-related research. The present figures indicate that this is highly justified and should be copied in Denmark and in all other European countries.