Test–retest reliability of the 10-metre fast walk test and 6-minute walk test in ambulatory school-aged children with cerebral palsy

Short-term test-retest reliability of the 10-metre fast walk test (10mFWT) and 6-minute walk test (6MWT) was evaluated in 31 ambulatory children with cerebral palsy (CP), with subgroup analyses in Gross Motor Function Classification System (GMFCS) Levels I ( n =9), II ( n =8), and III ( n =14). Sixteen females and 15 males participated, mean age 9 years 5 months (SD 3y 7mo, range 4y 3mo-18y 2mo). Twenty had spastic diplegia, while the others had another form of CP. Retest interval varied from 1 to 4 weeks (mean 10.6d [SD 6.4]). Intraclass correlation coefficients (ICCs) estimated reliability. The 10mFWT ICC was 0.81 (95% confidence interval [CI] 0.65–0.90) across participants, and >0.59 in GMFCS subgroups (95% CI lower bound >0.01). The 6MWT ICC was 0.98, and >0.90 in GMFCS subgroups (95% CI lower bound >0.64). Bland-Altman plots indicated bias towards higher 6MWT retest distances in GMFCS Level I. Minimum detectable change (95% CI) was 61.9, 64.0, and 47.4m for the 6MWT within GMFCS Levels I, II, and III respectively. The conclusion is that while the 10mFWT showed inadequate test-retest reliability given its wide 95% CI, the 6MWT demonstrated good to excellent reliability. Investigation of the need for a practice walk when administering the 6MWT with children in GMFCS Level I is recommended to establish their fastest pace.     

Immune monitoring in nonhuman primate transplantation. A review of “Non-human primate transplantation tolerance models: Immune Assays and Analysis Workshop” held in Atlanta, Ga, September 2005

In September 2005, an National Institutes of Health-sponsored workshop was held in Atlanta, Georgia, which focused on non-human primate transplantation tolerance models. The aim of this workshop was an open exchange of techniques and assays applicable to this important translational transplantation model. A major focus of the workshop was the development of assays that are capable of monitoring immune status after transplant. These include mixed lymphocyte reaction assays (using both tritiated thymidine and carboxyfluorescein succinimidyl ester to assess T-cell proliferation), large-scale production of dendritic cells for immune analysis, the molecular analysis of graft rejection and acceptance using single-plex RNA analysis, and multiplex flow cytometric and gene array analysis, as well as sophisticated multi-color flow cytometric profiling of immunocyte subpopulations and cytokine expression patterns. This review will summarize the progress presented at the workshop toward the application of these techniques to immune analysis in non-human primates and discuss their relative contributions to ongoing evaluation of immune tolerance after transplantation.     

Families at high and low risk for depression: a three-generation startle study.

BACKGROUND: Anxiety symptoms might be a vulnerability factor for the development of major depressive disorder (MDD). Because elevated startle magnitude in threatening contexts is a marker for anxiety disorder, the present study investigated the hypothesis that enhanced startle reactivity would also be found in children and grandchildren of individuals with MDD. METHODS: The magnitude of startle was investigated in two tests (anticipation of an unpleasant blast of air and during darkness) in children (second generation) and grandchildren (third generation) of probands with (high risk) or without (low risk) MDD (first generation). RESULTS: Startle discriminated between the low- and high-risk groups. In the probands' children, the high-risk group showed increased startle magnitude throughout the fear-potentiated startle test. In the probands' grandchildren, a gender-specific abnormality was found in the high-risk group with high-risk girls, but not boys, exhibiting elevated startle magnitude throughout the procedure. CONCLUSIONS: Increased startle reactivity in threatening contexts, previously found in patients with anxiety disorder and in children of parents with an anxiety disorder, might also constitute a vulnerability marker for MDD. These findings suggest that there might be common biologic diatheses underlying depression and anxiety.     

Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy.

A hand therapy clinic used a systematic process to select an outcome tool for routine use. After a literature review of available instruments, the choice had been narrowed to two instruments: the Disability of the Arm, Shoulder, and Hand (DASH) and the Patient-Rated Wrist Evaluation (PWRE). The PRWE was modified to attribute to the hand/wrist. A cohort of 60 patients (36 hand problems, 24 wrist problems) completed a DASH and PRWHE at their initial clinic visit and three months later. Standardized response means (SRMs) and effect sizes indicated a large treatment effect. The PRWHE had slightly higher responsiveness than the DASH (SRM=1.51 vs. 1.37). Because this level of responsiveness was obtained with fewer items, it was considered more efficient. A supplementary esthetics question was less responsive than either scale, but was thought to be an important option for selected patients. On completion of the trial period, the therapists unanimously selected the PRWHE with a supplemental esthetics question to be routinely used in measurement of outcomes.     

The Mediating Influence of Refusal Skills in Preventing Adolescent Alcohol Misuse

ABSTRACT: Alcohol is the most frequently used psycho-active substance during adolescence. Adolescents who misuse or overindulge in alcohol are at risk for serious social and psychological consequences. Several preventive approaches can help adolescents deal with peer pressure that contributes to alcohol use experimentation and escalation. One promising approach involves teaching adolescents skills to refuse offers of alcohol and other drugs. Few studies, however, have examined how this approach works; that is, the connection between the prevention effort, refusal skills, and drinking behavior. This paper investigates the relationships among the intervention, refusal skills, and alcohol misuse in the Alcohol Misuse Prevention Study, a randomized, pre/post experimental study. Based on data from sixth through tenth graders (average N per grade = approximately 400), regression analyses indicate that refusal skills are significant mediators of the effect of the intervention on alcohol misuse.     

Inhibition of [Ca2+]i Transients in Rat Adrenal Chromaffin Cells by Neuropeptide Y Role for a cGMP-dependent Protein Kinase-activated K+ Conductance

The effects of neuropeptide Y on the intracellular level of Ca²⁺ ([Ca²⁺]_i) were studied in cultured rat adrenal chromaffin cells loaded with fura-2. A proportion (16%) of cells exhibited spontaneous rhythmic [Ca²⁺]_i oscillations. In silent cells, oscillations could be induced by forskolin and 1,9–dideoxyforskolin. This action of forskolin was not modified by H-89, an inhibitor of protein kinase A. Spontaneous [Ca²⁺_i fluctuations and [Ca²⁺]_i fluctuations induced by forskolin- and 1,9-dideoxyforskolin were inhibited by neuropeptide Y. Increases in [Ca²⁺]_i induced by 10 and 20 mM KCI but not by 50 mM KCI were diminished by neuropeptide Y. However, neuropeptide Y had no effect on [Ca²⁺]_i increases evoked by (-)BAY K8644 and the inhibitory effect of neuropeptide Y on responses induced by 20 mM KCI was not modified by o-conotoxin GVIA, consistent with neither L- nor N-type voltage-sensitive Ca²⁺ channels being affected by neuropeptide Y. Rises in [Ca²⁺]_i provoked by 10 mM tetraethylammonium were not decreased by neuropeptide Y, suggesting that K⁺ channel blockade reduces the effect of neuropeptide Y. However, [Ca²⁺]_i transients induced by 1 mM tetraethylammonium and charybdotoxin were still inhibited by neuropeptide Y, as were those to 20 mM KCI in the presence of apamin. The actions of neuropeptide Y on [Ca²⁺]_i transients provoked by 20 and 50 mM KCI, 1 mM tetraethylammonium, (-)BAY K8644 and charybdotoxin were mimicked by 8–bromo-cGMP. In contrast, 8–bromo-CAMP did not modify responses to 20 mM KCI or 1 mM tetraethylammonium. The inhibitory effects of neuropeptide Y and 8–bromo-cGMP on increases in [Ca²⁺]_i induced by 1 mM tetraethylammonium were abolished by the Rp-8–pCPT-cGMPS, an inhibitor of protein kinase G, but not by H-89. A rapid, transient increase in cGMP level was found in rat adrenal medullary tissues stimulated with 1 μM neuropeptide Y. Rises in [Ca²⁺]_i produced by DMPP, a nicotinic agonist, but not by muscarine, were decreased by neuropeptide Y. Our data suggest that neuropeptide Y activates a K⁺ conductance via a protein kinase G-dependent pathway, thereby opposing the depolarizing action of K⁺ channel blocking agents and the associated rise in [Ca²⁺]_i.