Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decision-making.

The Concussion Resolution Index (CRI) is an online assessment tool designed to track resolution of symptoms following sports-related concussion. The CRI is composed of six subtests measuring reaction time, visual recognition, and speed of information processing. Three factors are derived from the subtests: Simple Reaction Time (SRT), Complex Reaction Time (CRT), and Processing Speed (PS). Multiple alternate forms within subtests afford simple, reliable, assessment of change, relative to a baseline test completed by an athlete. The test also assesses self-reported neurophysiological symptoms at the time of injury and tracks resolution of these symptoms. The data demonstrate the CRI is a valid and reliable measure of cognitive performance in a relatively heterogeneous group of athletes aged 13-35. Two methods of statistical analysis for assessing change from baseline were compared to establish a psychometric basis for return-to-play decision-making: the Reliable Change Index (RCI) and multiple regression. Multiple regression was more accurate than the RCI in determining a decline in performance relative to the baseline.     

Promoting healthy lifestyles: Behavior modification and motivational interviewing in the treatment of childhood obesity

Childhood obesity has increased dramatically during the past two decades. The growing incidence of childhood obesity is alarming, given the significant short- and long-term health consequences associated with obesity and the strong tracking of obesity from childhood to adulthood. Lifestyle plays an important role in the development and maintenance of obesity. Behavior modification programs targeting eating, exercise, and diet behaviors continue to be the mainstay for treating obese children. Although family-based behavioral weight management programs have resulted in significant improvements in weight status, maintaining improvements in weight status continues to be a challenge, with many interventions resulting in considerable relapse. Motivational interviewing is one innovative approach, used alone or in conjunction with standard behavioral modification programs, which has been proposed to have the potential to enhance motivation for change and therefore improve long-term treatment outcomes for obese children. A broad literature search using two electronic databases, Medline and PsycINFO, to identify studies that used an intervention with a motivational interviewing component to modify diet and/or physical activity in the prevention or treatment of childhood obesity identified two studies that targeted weight as a primary outcome. The studies reviewed indicate that, although initial findings are encouraging, further research is needed to determine the effectiveness of motivational interviewing for prevention and treatment of childhood obesity. Concerted efforts are clearly needed to elucidate the mechanisms for maintenance of initial treatment gains, as well as the ultimate achievement of more ideal weight once formal treatment ceases.     

A trigeminal conditioned stimulus yields fast acquisition of cerebellum-dependent conditioned eyeblinks

Classical conditioning of the eyeblink response in the rabbit is a form of motor learning whereby the animal learns to respond to an initially irrelevant conditioned stimulus (CS). It is thought that acquired conditioned responses (CRs) are adaptive because they protect the eye in anticipation of potentially harmful events. This protective mechanism is surprisingly inefficient because the acquisition of CRs requires extensive training - a condition that is unlikely to occur in nature. We hypothesized that the rate of conditioning in rabbits could depend on CS modality and that stimulating mystacial vibrissae as the CS could produce CR acquisition faster than the traditional auditory or visual stimulation. We tested this hypothesis by conditioning naïve rabbits in the delay paradigm using a weak airpuff CS (vCS) directed to the ipsilateral mystacial vibrissae. We found that the trigeminal vCS yields significantly faster CR acquisition. We next examined if vCS-evoked CRs are dependent on the intermediate cerebellum in the same fashion as CRs evoked by the traditional auditory CS. We found that vibrissal CRs could be abolished by inactivating the cerebellar interposed nuclei (IN) with muscimol. In addition, injections of picrotoxin in the IN shortened the onset latency of vibrissal CRs. These findings suggest that the tone and vCS-evoked CRs share similar cerebellar dependency.     

The parental attitudes toward psychological services inventory: adaptation and development of an attitude scale

The purpose of this paper is to provide psychometric data on the Parental Attitudes Toward Psychological Services Inventory (PATPSI), which is a revised measure to assess parents' attitudes toward outpatient mental health services. Using a sample of adults (N = 250), Study 1 supported a 3-factor structure (RMSEA = .05, NNFI = .94, and CFI = .94), adequate internal consistency (ranging from .72 to .92), and test-retest reliability (ranging from .66 to .84). Additionally, results indicated that individuals with previous use of mental health services reported more positive views toward child mental health services. Study 2 provided confirming evidence of the 3-factor structure (NNFI = .94, RMSEA = .08, and the CFI = .95) and adequate reliability (ranging from .70 to .90) using a parent-sample (N = 260). Additionally, discriminate validity of the PATPSI was supported. Implications for research and clinical practice are discussed.     

Anxiety and Posttraumatic Stress Disorder in the Context of Human Brain Evolution: A Role for Theory in DSM‐V?

The "hypervigilance, escape, struggle, tonic immobility" evolutionarily hardwired acute peritraumatic response sequence is important for clinicians to understand. Our commentary supplements the useful article on human tonic immobility (TI) by Marx, Forsyth, Gallup, Fusé, and Lexington (2008). A hallmark sign of TI is peritraumatic tachycardia, which others have documented as a major risk factor for subsequent posttraumatic stress disorder (PTSD). TI is evolutionarily highly conserved (uniform across species) and underscores the need for DSM-V planners to consider the inclusion of evolution theory in the reconceptualization of anxiety and PTSD. We discuss the relevance of evolution theory to the DSM-V reconceptualization of acute dissociative-conversion symptoms and of epidemic sociogenic disorder (epidemic "hysteria"). Both are especially in need of attention in light of the increasing threat of terrorism against civilians. We provide other pertinent examples. Finally, evolution theory is not ideology driven (and makes testable predictions regarding etiology in "both directions"). For instance, it predicted the unexpected finding that some disorders conceptualized in DSM-IV-TR as innate phobias are conditioned responses and thus better conceptualized as mild forms of PTSD. Evolution theory may offer a conceptual framework in DSM-V both for treatment and for research on psychopathology.     

Routine large-scale production of monoclonal antibodies in a protein-free culture medium

A defined culture medium and cultivation technique are described which allow the long-term production on a large scale of monoclonal antibodies and myeloma proteins without the use of serum, serum proteins, or protein-containing liposomes. The high initial purity of the culture supernatants obtained with protein-free medium facilitates the purification of the monoclonal antibodies, the immunoglobulin (Ig) purity of which is limited only by the genetic homogeneity of the cells. Successful growth of 8 hybridoma and 2 myeloma lines has been achieved. SDS-PAGE analysis revealed that the levels of Ig production in the protein-free medium were comparable to those achieved with serum-supplemented media and with media supplemented with purified serum proteins. Stability of Ig production during continuous cultivation in the protein-free medium over an extended period was studied for a myeloma and a hybridoma line, both of which produced high levels (50–200 μg/ml) of Ig for periods of 11 and 22 weeks, respectively.     

Etanercept therapy in children with treatment‐resistant uveitis

Objective

To evaluate the safety and efficacy of the tumor necrosis factor fusion protein etanercept in children with treatment‐resistant uveitis.

Methods

Ten children with chronic active uveitis (7 girls and 3 boys, mean age 7.5 years [range 3–12 years]) were enrolled in this prospective study. In 7 children, uveitis was associated with pauciarticular juvenile rheumatoid arthritis. Five children were antinuclear antibody positive. All patients had failed previous therapy with topical steroids and methotrexate and/or cyclosporine. All were treated with etanercept at a dosage of 0.4 mg/kg twice weekly for the first 3 months, and then, if eyes did not improve, with 25 mg twice weekly (mean 1.1 mg/kg) for at least 3 additional months.

Results

At the beginning of the trial, uveitis affected 18 eyes in the 10 children. Within 3 months, 10 of 16 affected eyes (63%; P = 0.017) showed a rapid decrease in anterior chamber cell density, including remission of uveitis in 4 eyes. In children with visual acuity of less than 20/25, 4 of 10 eyes (40%) improved. An exacerbation of uveitis during etanercept therapy occurred in only 1 child (1 of 14 eyes [7%]). Other ocular outcome parameters, such as intraocular pressure, synechia formation, and lens clarity, remained unchanged. Following a dosage increase to an average of 1.1 mg/kg after 3 months in 7 children, no further improvement was noted.

Conclusion

Our data suggest that etanercept injected subcutaneously twice a week has a beneficial effect on treatment‐resistant chronic uveitis in children. Further controlled studies with etanercept in systemic or topical form are necessary to confirm its efficacy and optimal mode of administration.

     

Current concepts of climbing fiber function

This review examines several of the current postulates regarding the function of one of the most intriguing afferent systems in the brain, the climbing fiber system. The fact that these afferents are activated under a variety of conditions has contributed substantially to the diversity of postulates that have been proposed. In part because of the unique anatomical relationship between individual climbing fibers and the dendritic tree of Purkinje cells, these afferents have been proposed as a key input in establishing long-term plastic changes in the cerebellar cortex. This concept is contrasted with other postulates proposing that the heterosynaptic action of this system produces a short-lasting enhancement rather than a long-term depression of Purkinje cell responsiveness. Although a generally accepted view regarding climbing fiber function does not exist, this review emphasizes the extensive functional insights that have been reported and supports the notion that progress toward a complete understanding of these afferents will require an integration of their morphological characteristics with the fundamental physiological properties of their responses assessed in a variety of contexts and conditions. Anat. Rec. (New Anat.) 253:118–126, 1998. © 1998 Wiley-Liss, Inc.