Humiliation: Assessing the Impact of Derision, Degradation, and Debasement

This paper describes the development of a self-report scale to assess the internal experience of humiliation. After defining the construct, an item pool of 149 items was generated, utilizing a five-point Likert scale response format. A sample of 253 individuals ages 15 to 51 (M= 20.66) was used to conduct the item trial. The item pool was evaluated through item and factor analyses. Factor analysis identified two correlated factors accounting for 58% of scale variability. The 20 items loading on factor one were labeled the Fear of Humiliation Subscale and the 12 items loading on factor two were labeled the Cumulative Humiliation Subscale. The full scale of 32 items is called the Humiliation Inventory. Reliability analyses indicate that the subscales and the full scale have high internal consistency. Exploratory analyses of mean scores across six demographic groups indicate significant differences between male and female mean scores on the total scale and the two subscales.     

Treatment in the pediatric emergency department is evidence based: a retrospective analysis

Background  

Our goal was to quantify the evidence that is available to the physicians of a pediatric emergency department (PED) in making treatment decisions. Further, we wished to ascertain what percentage of evidence for treatment provided in the PED comes from pediatric studies.     

Microvascular circulatory changes in the lower extremities after reconstructive vascular surgery for intermittent claudication

We have studied the circulatory changes in the lower extremities after reconstructive vascular surgery in ten patients with intermittent claudication. The following examinations were carried out 3 days before, 3 days, and 28 days after the operation: measurement of ankle systolic blood pressure, calf plethysmography, resting calf muscle blood flow and resting subcutaneous foot blood flow. The vasoconstrictor response (veno-arteriolar reflex) was also assessed. On the night before the operation and on the 28th night after aorto-bifemoral bypass surgery, subcutaneous adipose tissue blood flow in the forefoot was measured during sleep. The ankle systolic blood pressure and the ankle index rose significantly. The former increased from 57 +/- 16.4 mmHg to 93 +/- 24.0 mmHg (mean +/- S.E.M.) and was still elevated on the 28th postoperative day. The total limb blood flow, the muscle blood flow and the blood flow in the subcutaneous tissue of the forefoot during daytime were unchanged. In contrast, the blood flow in the forefoot during sleep increased significantly from 3.5 +/- 1.63 ml x (min x 100 g)-1 to 5.2 +/- 2.14 ml x (min x 100 g)-1 (mean +/- S.E.M.) on the 28th night. The vasoconstrictor response was potentiated, and increased from 27% before the operation to 45% on the third postoperative day. This change was maintained 28 days postoperatively. In conclusion the increase in arterial blood pressure was only reflected in the vasoconstrictor response which had returned to normal by the third postoperative day and nocturnal blood flow in the subcutaneous adipose tissue which did likewise.     

Metabolism of exercising skeletal muscle during beta 1-selective adrenoceptor blockade

Concentrations of glycogen, glucose, glucose-6-phosphate and lactate in the lateral vastus muscle were measured in seven subjects before and after dynamic muscle exercise at a work load of 75% of each subject's maximal working capacity, and with and without intravenous administration of the beta 1-selective beta-adrenoceptor blocking agent, atenolol. Pulmonary oxygen uptake was measured during exercise. Heart rate and arterial blood pressure were measured throughout the study. Arterial concentrations of glucose, lactate and free fatty acids were measured at rest and during exercise. The muscle concentration of glycogen and the extent of glycogen depletion with exercise were not influenced by the beta 1-adrenoceptor blocker. Similarly, there was no change in the muscle concentrations of glucose, glucose-6-phosphate and lactate. Heart rate decreased at rest and during exercise. Arterial blood pressure was not influenced by beta-blockade. Pulmonary oxygen uptake decreased by 6.5%. The exercise induced rise in arterial blood concentration of free fatty acids was abolished by beta 1-selective beta-blockade. It is concluded that the decrease in lactate release from exercising muscles during beta 1-adrenoceptor blockade seen in other studies cannot be explained by an impaired breakdown of muscle glycogen. It may be inferred, however, that a reduced availability of free fatty acids in the exercising muscles during beta 1-selective (and non-selective) beta-blockade may enhance the combustion of pyruvic acid and thereby decrease the production of lactate.     

Children in reviews: Methodological issues in child-relevant evidence syntheses

Background  

The delivery of optimal medical care to children is dependent on the availability of child relevant research. Our objectives were to: i) systematically review and describe how children are handled in reviews of drug interventions published in the Cochrane Database of Systematic Reviews (CDSR); and ii) determine when effect sizes for the same drug interventions differ between children and adults.     

Systematic review data extraction: cross-sectional study showed that experience did not increase accuracy

ObjectiveThis study assessed the impact of systematic review and data extraction experience on the accuracy and efficiency of data extraction in systematic reviews.Study Design and SettingWe conducted a prospective cross-sectional study from October to December 2006. Participants were classified as having minimal, moderate, or substantial experience in systematic reviews and data extraction. Three studies on insomnia treatment were extracted. Our primary outcome was the accuracy of data extraction. Data sets of each experience level were analyzed for errors in data extraction and results of meta-analyses. Additionally, the time required for completion of data extraction was compared.ResultsError rates were similar across the various levels of experience and ranged from 28.3% to 31.2%. Mean rates for errors of omission (11.3–16.4%) were generally lower than those for errors of inaccuracy (13.9–17.9%). There were no significant differences in error rates or accuracy of meta-analysis results between groups. Time required approached significance, with minimally experienced participants requiring the most time.ConclusionOverall, there were high error rates by participants at all experience levels; however, time required for extraction tended to decrease with experience. These results illustrate the need to develop strategies aimed at mastery of data extraction, rather than reliance on previous data extraction experience alone.     

Doctors' requirements for reproducibility of diagnostic information

Two radiologists independently assessed 100 leg vein phlebograms for the presence or absence of deep venous thrombosis. In a subsequent questionnaire, 66 physicians were asked to state the level of agreement they would require to use conventional phlebography in their diagnostic decisions, and whether they would reduce their requirements if the phlebographic technique were made less painful and less expensive. The responses indicated physicians' requirements for reproducibility of a well-known routine diagnostic method may be unrealistic, and that physicians do not consider the inconvenience of an examination to the patient or its cost in setting their requirements for diagnostic precision.     

Effects of dexamethasone on glucose-induced insulin and proinsulin release in low and high insulin responders

We compared the effects of dexamethasone-induced insulin resistance on B-cell secretory performance in 12 low insulin responders (LIR) and in eight high insulin responders (HIR). A hyperglycemic clamp (120 minutes) was performed before and after the subjects had ingested dexamethasone 3 mg x 2 for 2 1/2 days. Fasting levels of blood glucose increased from 4.60 +/- 0.13 to 5.74 +/- 0.23 mmol/L after dexamethasone in LIR and from 4.37 +/- 0.18 to 5.26 +/- 0.13 mmol/L in HIR. Dexamethasone treatment increased fasting levels of total immunoreactive insulin (IRI), C-peptide, and proinsulin, as well as the proinsulin to IRI ratio to a similar degree in LIR and HIR. The amount of glucose infused to uphold hyperglycemia during the clamp decreased by 54% after dexamethasone in LIR and by 46% in HIR. Mean level of stimulated IRI during the clamp increased after dexamethasone by 43% in LIR and by 53% in HIR. Mean level of stimulated C-peptide increased by 11% (not significant) in LIR and by 24% in HIR. Mean level of stimulated proinsulin increased by 86% in LIR and by 93% in HIR. The effects of dexamethasone on insulin secretion varied among individuals, since steroid treatment failed to affect IRI responses to glucose in two LIR and two HIR. The magnitude of dexamethasone effects on secretion was not correlated to pre-dexamethasone insulin sensitivity as assessed by a somatostatin-insulin-glucose infusion test (SIGIT) or by M/I (glucose infused/insulin level) ratios of the control clamp.(ABSTRACT TRUNCATED AT 250 WORDS)