Use of the Personality Assessment Inventory as an efficacious and cost-effective diagnostic tool for nonepileptic seizures

Video electroencephalographic monitoring (VEEG) is considered the "gold standard" for making the differential diagnosis between epileptic seizures (ES) and nonepileptic seizures (NES), but is a costly, time-consuming procedure and not readily available in all communities. Of the various diagnostic techniques and measures that have been used, the Personality Assessment Inventory (PAI) has shown promise as an effective psychological screening tool to aid in the differential diagnosis of ES/NES. Using VEEG results as the outcome measure, this study examined the diagnostic effectiveness of the PAI in a group of adults with treatment-refractory seizures. Results indicated that, on psychological screening, patients with NES endorse significantly greater functional consequences of their seizure-like episodes than participants with ES. A "NES Indicator" score, calculated from the PAI Somatization subscales, provided a sensitivity of 84% and specificity of 73% for the diagnosis of NES versus ES. The PAI appears to be a useful screening tool prior to hospital admission for VEEG.     

Views of breastfeeding difficulties among drop-in-clinic attendees

Breast-milk is the optimum form of nutrition for the first 6 months of life. However, breastfeeding rates in the UK are low and static compared to other European countries and those in the North-west of England in the UK are even lower. Of the women who initiate breastfeeding, many cease in the first month following the birth for reasons that might be avoided. To try and prevent this, UNICEF Baby Friendly Hospital Initiative (BFHI) 'Ten Steps to Successful Breastfeeding' state that maternity facilities should foster the development of support groups for breastfeeding women. The aim of the present study was to describe breastfeeding difficulties reported by women who attended the infant feeding clinic at a Women's Hospital in the North-west of England. During the study period, the clinic was attended mainly by primiparous mothers who were educated beyond 18 years of age and of higher socio-economic status. They presented with a variety of problems including baby not latching on, concerns about baby's weight gain/loss, sore nipples and advice about expressing milk in preparation for return to work. The women highlighted the importance of meeting other mothers and having someone to talk to who understood what they were going through. Inconsistent information/lack of detailed knowledge from health professionals was cited as contributing to breastfeeding difficulties. A number of women reported that expert hands-on, one-to-one support, was invaluable and many felt they were able to continue breastfeeding but without the support, they may have given up.     

Effects of convenience rice congee supplemented diets on guinea pig whole animal and gut growth, caecal digesta SCFA and in vitro ileal contractility

The aim of the study was to feed convenience baby food brown rice (BC) and white rice (WC) congee diets compared to egg custard (EC) and baked bean (BB) diets to newborn guinea pig pups. Diets were isocaloric and formulated to contain equal macronutrient content of carbohydrate, protein, fat and fibre. Diets were supplemented with essential nutrients, fruit and vegetables and decrementally with standard chow for palatability. We investigated the acceptability of the diets and specifically whether the different natural fibre content of these diets could influence whole animal and small intestinal growth, caecal digesta properties and specifically in vitro ileal contractility. After 8 weeks of feeding, the mean body weight of WC group was significantly lower than the BB group. WC group had lower small intestine weight than both BC group and BB group resulting in lower small intestine density compared to BB group. Caecal digesta pH and total short chain fatty acid (SCFA) concentration were similar. However, butyrate was higher in the BB group compared to the other diets. Contractility studies revealed a small but significantly higher voltage was required to initiate ileal contraction of BC group compared to both the EC and BB groups. All dietary groups responded similarly to acetylcholine, histamine, serotonin, PGE(2), PGF(2alpha), and 8-iso-PGE(2). There were no differences on inhibition of electrically-driven contraction by morphine or epinephrine. The newborn guinea pig model was an effective system for testing, with limitations, supplemented convenience baby foods with variable natural fibre content that demonstrated significant effects on animal growth, caecal digesta SCFA and intestinal contractility.     

CEO's perceptions of hospitalists: diffusion of the strategy

Many hospitals have initiated a strategy to reduce costs and improve quality of care by using physicians as "hospitalists." A hospitalist specializes in inpatient care. This article reports the findings of survey research examining CEO perceptions of the hospitalist model, with particular interest in diffusion of the strategy in rural and low managed care hospital markets. Findings indicate there is less diffusion of the hospitalist model to rural areas because of lack of information about the cost effectiveness of the program and medical staff resistance. Recommendations to increase adoption of the hospitalist strategy include educating about the benefits of the strategy and paying attention to areas of concern by the medical staff.     

Modeling the influence of temporal and spatial factors on the assessment of impacts of pesticides on skylarks

Spatio-temporal factors strongly influence the population dynamics of animals; thus there have been calls to integrate these factors in environmental impact assessment of toxic compounds. To date, methodological difficulties have probably prevented this union. However, new modeling techniques that could help are available. This paper presents the construction and application of an agent-based simulation model of skylarks in agricultural landscapes and its use to assess the impact of pesticides relative to changes in landscape structure and mortality assumptions. Simulations indicated that pesticides had a negative impact on skylark population size. The annual reduction in numbers was variable and depended primarily upon migration mortality and an interaction between weather and pesticides. Altering landscape structure, crop diversity, or migration mortality assumptions resulted in a population change of approximately 37%, compared to a mean of 4% for pesticides. It was concluded that factors other than pesticides are likely to be limiting skylark numbers in most landscapes. This study demonstrates the importance of modeling the interactions between spatio-temporal environmental factors and the study organisms. Agent-based models (ABMs) are able to extract these relationships as emergent properties of their mechanistic nature. Therefore, we recommend the use of ABM models in future regulatory assessment of pesticides.     

Novel CD43 specific phage antibodies react with early stage colorectal tumours

Two panning strategies have been used to isolate phage antibody clones that recognise an intracellular epitope of CD43. Firstly, a naive scFv library was panned against a 15-mer CD43 synthetic peptide (RGGKRNGVVDAWAGP), and secondly the naive library was panned against native CD43, isolated from whole cell lysate of Colo205 cells, followed by selection with the synthetic CD43 peptide. Four phage antibodies (HapE8, F2, G9 and G11) were isolated and used in a preliminary immunohistochemistry study of CD43 expression on frozen colorectal adenoma and carcinoma tissue. The three antibodies HapE8, F2 and G11 showed a similar reactivity pattern, staining all adenomas and Dukes' A carcinomas, but only 2/4 Dukes' B and 1/9 Dukes' C. Antibody HapG9 similarly bound to 5/5 adenomas, but only 1/5 Dukes' A carcinoma and no tumours of a more advanced stage. No reactivity with normal colonic epithelium was observed but cross-reactivity with stromal lymphocytes was seen. These new anti-CD43 antibodies are likely to prove useful as screening tools in the detection of colorectal adenomas.