Investigation of a Direct Intervention for Improving Attention in Young Children With ADHD

The efficacy of a new set of child-oriented direct intervention materials, Pay Attention! (1994), was investigated in 14 children, ages 7 to 11 years, diagnosed with attention deficit hyperactivity disorder (ADHD). Treatment and control groups were matched for age, sex, and medication status. Both groups completed pre- and posttraining assessment batteries that included psychometric measures of attention, a measure of academic efficiency, and behavioral rating scales completed by parents and teachers. Results indicate that children who received the direct intervention did significantly better on a number of nontrained measures of attention and academic efficiency. Behavioral ratings of inattention-impulsivity and hyperactivity completed by parents did not differ following treatment, although a marginally significant improvement in inattention-impulsivity was noted by school teachers. These results suggest that direct interventions aimed at improving attention may be a valuable treatment option for improving cognitive efficiency in children with ADHD and warrant further investigation.     

Multiplane transesophageal echocardiography: latest evolution in an imaging revolution.

Multiplane imaging with a rotating phased-array transducer from within the esophagus represents the latest development in transesophageal cardiac ultrasound. Transverse, longitudinal, and all possible intermediate oblique planes are easily obtained from the same transducer with minimal probe manipulation. Three-dimensional conceptualization of complex structures and pathologic conditions is facilitated. The major advantages are a simplified examination procedure and much less patient discomfort than monoplane and biplane probe imaging.     

Using routine comparative data to assess the quality of health care: understanding and avoiding common pitfalls

Measuring the quality of health care has become a major concern for funders and providers of health services in recent decades. One of the ways in which quality of care is currently assessed is by taking routinely collected data and analysing them quantitatively. The use of routine data has many advantages but there are also some important pitfalls. Collating numerical data in this way means that comparisons can be made—whether over time, with benchmarks, or with other healthcare providers (at individual or institutional levels of aggregation). Inevitably, such comparisons reveal variations. The natural inclination is then to assume that such variations imply rankings: that the measures reflect quality and that variations in the measures reflect variations in quality. This paper identifies reasons why these assumptions need to be applied with care, and illustrates the pitfalls with examples from recent empirical work. It is intended to guide not only those who wish to interpret comparative quality data, but also those who wish to develop systems for such analyses themselves.     

Quality of life for adolescents: Assessing measurement properties using structural equation modelling

Assessments for quality of life (QOL) of the adolescent have received relatively little attention in the literature. Although there is no consensus on the definition of adolescent QOL and what aspects should be measured, it is generally accepted that QOL is a multidimensional construct. The objective of this study is to determine the measurement properties of the latent factors underlying adolescent QOL based on a second-order confirmatory factor analysis (CFA). A recursive structural equation model (SEM) is then proposed to determine the direction and magnitude of the interdependent effects among the latent factors. The questionnaire used was the Quality of Life Profile-Adolescent Version (QOLPAV). A sample of 363 adolescents was recruited from 20 secondary schools in Perth, Australia. The second-order CFA suggested that adolescent QOL may be measured by five underlying constructs namely social, environment, psychological, health, and opportunities for growth. The interdependent relations among these constructs identified the environment factor as primary, exerting both direct and indirect effects on the other four factors.     

Sensitization of psychomotor stimulation and conditioned reward in mice: differential modulation by contextual learning.

Incentive motivation theory ascribes a critical role to reward-associated stimuli in the generation and maintenance of goal-directed behavior. Repeated psychomotor stimulant treatment, in addition to producing sensitization to the psychomotor-activating effects, can enhance the incentive salience of reward-associated cues and increase their ability to influence behavior. In the present study, we sought to investigate this incentive sensitization effect further by developing a model of conditioned reinforcement (CR) in the mouse and investigating the effects of a sensitizing treatment regimen of amphetamine on CR. Furthermore, we assessed the role of contextual stimuli in amphetamine-induced potentiation of CR. We found that mice responded selectively on a lever resulting in the presentation of a cue previously associated with 30% condensed milk solution, indicating that the cue had attained rewarding properties. Prior treatment with amphetamine (4 x 0.5 mg/kg i.p.) resulted in psychomotor sensitization and enhanced subsequent responding for the CR. Furthermore, this enhancement of responding for the cue occurred independent of the drug-paired context, whereas the sensitized locomotor response was only observed when mice were tested in the same environment as that in which they had received previous amphetamine. These results demonstrate that the CR paradigm previously developed in the rat can be successfully adapted for use in the mouse, and suggest that behavioral sensitization to amphetamine increases the rewarding properties (incentive salience) of reward-paired cues, independent of the drug-paired context.     

Maintenance of foot and mouth disease viruses in buffalo (Syncerus caffer Sparrman, 1779) in southern Africa.

Using age-related infection rates derived from serological data in available deterministic and specially developed stochastic simulation models, it has been possible to establish that the basic reproductive rates for South African Territory (SAT) type foot and mouth disease virus in buffalo (Syncerus caffer) are high. The models predict that there is a periodicity of infection within herds and possibly the population as a whole. Thus, buffalo herds are likely to be more infectious at some times than at others. However, because most infections in buffalo are inapparent, such episodes are difficult to identify. There is wide intratypic variation within the SAT type virus populations circulating in buffalo. This was determined by sequencing part of the 1 D gene of buffalo isolates and establishing antigenic profiles with neutralising monoclonal antibodies and conventional antisera.     

The incidence of antibiotic resistance in aerobic faecal flora in south India.

During a field study in South India in 1989, faecal specimens were collected from residents in villages and the town of Vellore in South India. Examination of the faecal specimens revealed that virtually the whole population carried commensal bacteria resistant to trimethoprim, ampicillin and chloramphenicol. Most specimens contained more than one type of bacterium resistant to each antibiotic. There was less resistance to nalidixic acid, with a higher proportion in the town (33%) than in the villages (13%). Although there was little cross-resistance of the ampicillin-resistant strains to later generation cephalosporins, 50% were resistant to the combination of amoxycillin and clavulanic acid. There was no significant cross-resistance of the nalidixic acid-resistant strains to fluorinated 4-quinolones, despite the free availability of ciprofloxacin and norfloxacin in the area. The probable reason for the high incidence of resistance to first generation antimicrobials is the extensive use of these agents, coupled with continuous exposure to large numbers of faecal micro-organisms.     

Mechanisms involved in potentiation of transient receptor potential vanilloid 1 responses by ethanol

The transient receptor potential vanilloid 1 or TRPV1 is a calcium‐permeable ion channel that is activated by capsaicin, the active component of hot chilli peppers, and is involved in the development of inflammatory and neuropathic hyperalgesias. Ethanol can sensitise TRPV1‐mediated responses, but the pathways contributing to the potentiation of TRPV1 by ethanol have not been clearly defined. Since the μ opioid receptor (MOP) agonist morphine can inhibit TRPV1 responses potentiated by cAMP‐dependent protein kinase A (PKA), and ethanol‐mediated modulation of other ion channels involves activation of PKA, we aimed to assess the contribution of MOP‐sensitive pathways to the potentiation of TRPV1‐mediated capsaicin responses by ethanol. Calcium responses elicited by the TRPV1 agonist capsaicin were potentiated by treatment with ethanol, but morphine was not able to inhibit ethanol‐sensitised capsaicin responses. Indeed, cAMP‐dependent PKA did not appear to contribute to potentiation of TRPV1 responses by ethanol, as the PKA inhibitor Rp‐cAMPS did not inhibit ethanol‐potentiated capsaicin responses. Similarly, treatment with specific PKC and PI3K inhibitors did not affect capsaicin responses in the presence of ethanol. However, treatment with wortmannin at concentrations reported to cause PIP2 depletion limited the ability of ethanol to sensitise TRPV1‐mediated capsaicin responses. Among other plausible mechanisms, such as non‐specific inhibition of kinases including mTOR, DNA‐PK, MLCK, MAPK and polo‐like kinases, this suggests that ethanol may affect the PIP2‐TRPV1 interaction. This was confirmed by inhibition of ethanol‐potentiation by the PLC inhibitor U73122. The results presented here suggest that morphine may be of limited use in inhibiting nociceptive TRPV1 responses that have been sensitised by exposure to ethanol.