Controlling for occasion-specific effects when assessing the test–retest reliability of self-report health questionnaires

OBJECTIVE: This study proposes a method for self-report health questionnaires to adjust test-retest reliability for changes during the test-retest interval based on an external measure, and to distinguish such changes from random response errors. METHODS: In our application, eighty participants completed the Symptoms of Illness Checklist (SIC) on two occasions, two weeks apart, immediately before interviews given on each occasion by one of two physicians in a crossover design. The physician interview scores served as external measures, and structural equation modeling was used to estimate the parameters of a model that corrected for the occasion-specific effect of participants' responses using information from the interviews. RESULTS: Correcting for changes in symptoms during the test-retest interval increased SIC test-retest reliability from .744 to .804 and significantly improved model fit (chi2(diff)(1) = 30.78, p < .001). CONCLUSIONS: The results suggest methods that can improve the evaluation of self-report health questionnaire test-retest reliability by identifying changes using an external measure, and distinguishing these from random response errors; these increased the estimated SIC test-retest reliability and indicated that the SIC was indeed able to measure changes over the studied time interval. This method can be applied across a broad range of questionnaires.     

Origin of impulse initiation in the slowly adapting stretch receptor of the crayfish

Summary Characteristic for the crayfish stretch receptor is a gradual decrease in axon diameter up to a stretch of axon about 350 m away from the soma-axon border. In response to depolarizing currents applied at different positions along the axon this stretch of axon can be localized as the most excitable membrane region. When depolarizing current steps of 10–25 nA intensity are injected into the soma the first impulse is always triggered in the soma (due to sudden rise in the membrane potential) while the second impulse originates at the axon region of highest escitability. As the intensity of the stimulus is increased the site of impulse initiation along the axon shifts nearer to the receptor soma. At a stimulus intensity of 50 nA the second impulse is suppressed and only the membrane potential at the axon hillock increases slightly. An analysis of the conductances for sodium and potassium ions as well as of the leakage current suggests that the molecular basis for the observed variations in excitability resides in a gradual decrease of the sodium conductance between the cell soma and the small-diameter region of the axon. However, the resting potential in this most excitable axon region is only some 3 mV more positive as compared to the receptor soma. A mathematical formulation is presented for the encoder mechanism in a soma-axon region with varying diameter. Using a slightly modified form of the Hodgkin-Huxley equations the experimentally observed changes in membrane potential and in the time course of the ionic currents can be adequately described by applying a nonlinear cable equation to the inhomogeneous axon.     

Heterosynaptic postactivation potentiation in hippocampal CA 3 neurons: Long-term changes of the postsynaptic potentials

Summary CA 3 neurons were excited synaptically by stimulation in the dentate hilus and the stratum radiatum of CA 1 in guinea pig hippocampal slices. Following repetitive stimulation (10–20 c/s, 10 s) of either stimulation site, the amplitudes of orthodromic population spikes or the probability of unitary discharges increased. Changes of the intracellularly recorded potentials were either (a) increased EPSP amplitudes associated with decreased IPSP amplitudes, or (b) increased IPSP amplitudes. A cell showing enhanced IPSPs after repetitive activation could respond with increased EPSP amplitudes and decreased IPSP amplitudes upon further repetitive activation. The potentiation, which was always preceded by a 5–10 min depression, lasted up to 3 h. This potentiation was heterosynaptic, since the responses to the non-stimulated input also changed and since the inputs were found to excite the pyramidal cells through separate synapses in double shock experiments. The heterosynaptic mode of the potentiation as well as the changes of the IPSPs indicate that not only the excitatory pathway but also the inhibitory pathway must be considered in explaining postactivation potentiation in this hippocampal field.     

某地HIV/AIDS者确诊后一年内高危性行为的改变及影响因素研究

目的 了解艾滋病病毒感染者/艾滋病患者（HIV/AIDS）确诊后一年内高危性行为变化情况及其影响因素。方法 从国家艾滋病综合防治数据信息管理系统下载2010年1月1日—2019年12月31日的相关资料,描述性行为发生率的变化趋势,采用广义估计方程（GEE）模型分析HIV/AIDS确诊后一年内高危性行为的相关因素。 结果 2 528例HIV/AIDS中,确诊前性行为发生率60.48%而确诊后一年内在57.09%～60.11%之间,女性（趋势χ2 = 5.417,P = 0.020）和未婚者（趋势χ2 = 6.684,P = 0.010）确诊后一年内的性行为发生率呈下降趋势,男性（趋势χ2 = 4.301,P = 0.038）、已婚（趋势χ2 = 4.061,P = 0.044）和ART者（趋势χ2 = 4.783,P = 0.029）的性行为发生率呈上升趋势。高危性行为发生率由61.61%下降至3.98%（趋势χ2 = 1 606.933,P＜0.001）,多因素结果显示:已婚（OR = 2.374,95%CI:1.478～3.811）和未ART者（OR = 1.837,95%CI:1.431～2.358）更易发生高危性行为。性别和年龄亚组分析显示,已婚和未接受ART治疗与高危性行为的关联方向保持一致。 结论 HIV/AIDS确诊后一年内仍保持性活跃且存在高危性行为,仍具备二代传播、感染其他性传播疾病和不同HIV型别毒株或耐药毒株风险,应提供精准干预,促进HIV/AIDS坚持使用安全套。     

The surgical care practitioner: a dual perspective

The ongoing balance of service delivery and training offset with the European Working Time Directive has resulted in a requirement to review the surgical workforce and new ways of working. The extended surgical team can be utilized to support the delivery of surgical services. Surgical care practitioners are trained to care for surgical patients across the whole patient pathway: in clinics, theatre and on the ward. They are continual members of the surgical team and can support both the service and training due to the flexible nature of the role. This article gives an overview of the role of the surgical care practitioner (SCP) and how the role impacts surgical training.     

强的松对大白鼠心肺肝脾肾影响的病理改变

为了解强的松对心肺肝脾肾影响的病理改变,应用正常Wistar大白鼠28只,分实验组及对照组各14只。实验组给予相当于人2mg/kg.d等效剂量的强的松片剂溶入当日饮水中,对照组饮自来水,共10周,之后解剖光镜见对照组心肺肝脾肾及实验组心肺均无异常。实验组肝肾轻度充血,脾充血明显,且见较多舍铁血黄素沉着,以红髓边缘明显。证实常规剂量的强的松对肝脾肾也有一定不良影响,应用激素时要注意及时调整剂量和给药方式与时间,尽量减少副作用。     

Changes in Locus-of-Control Attitudes about Drug Misuse in a Self-Help Group in a Methadone Maintenance Clinic

Clients of a methadone-maintenance clinic in Brooklyn, New York participating in a clinically-guided self-help (CGSH) program plus standard treatment (methadone maintenance plus individual counseling) demonstrated statistically significant changes in locus-of-control beliefs, from external to internal causation, about personal responsibility for drug misuse. Members of two control groups—one participating in a didactic lecture program plus standard treatment and the other receiving only standard treatment—failed to demonstrate similar changes. This increase in internal locus of control in the CGSH group suggests the potential efficacy of CGSH as a relapse-prevention therapeutic technique.     

Consecutive Cyproterone Acetate and Estradiol Treatment in Late-Pubertal Transgender Female Adolescents

BackgroundCyproterone acetate (CA) is an antiandrogenic progestin commonly used in adult transwomen to suppress endogenous androgens, often in combination with estrogens to induce feminization.AimTo assess the (side) effects and biochemical changes of CA alone and in combination with estrogens in adolescent trans-girls.MethodsThis study was a retrospective analysis of clinical and biochemical data from 27 trans-girls who presented at Tanner stage G4 and were treated with CA monotherapy for at least 6 months (mean = 12 months) and then in combination with incremental doses of estrogens (CA + E; mean = 16 months). Statistical analysis of data included paired or unpaired Student t-test or Wilcoxon signed-ranks or Mann-Whitney U-test as appropriate.OutcomesAnthropometrics, reported beneficial and side effects, safety parameters, and hormone levels.ResultsPhysical changes included decrease of facial and non-facial hair growth. One third showed breast development under CA (Tanner stages B2–B3), which increased to Tanner stages B3 and B4 in 66.7% and 9.5% respectively, during CA + E. Reported side effects during CA and CA + E were breast tenderness, emotionality, fatigue, and flushes. No relevant weight changes were observed. Main safety parameters showed the following changes. Hemoglobin and hematocrit decreased and liver enzymes transiently and modestly increased during CA. Triglycerides and cholesterol levels slightly decreased during CA but returned to baseline during CA + E; glucose metabolism was unaffected. Relevant hormonal changes included a decrease in gonadotropins during CA + E and in total and free testosterone levels throughout treatment. Prolactin levels increased during CA and were restored during CA + E.Clinical ImplicationsCA produced modest feminizing effects in trans-girls and therefore might be a valuable alternative in situations in which gonadotropin-releasing hormone analogues are not the treatment of choice and/or are not reimbursed.Strengths and LimitationsThis is the first study to report on the effects of CA in the treatment of trans-girls and one of the few to report on the use of estrogens in this population. Limitations are the modest sample size and the retrospective nature of this study.ConclusionTreatment with CA in late-pubertal trans-girls overall was safe and well tolerated and induced mild clinical and biochemical feminizing changes. Rapid further feminization was observed with incremental doses of E.Tack LJW, Heyse R, Craen M, et al. Consecutive Cyproterone Acetate and Estradiol Treatment in Late-Pubertal Transgender Female Adolescents. J Sex Med 2017;14:747–757.     

热性惊厥患儿血清离子及微量元素变化与精神运动发育的关系研究

目的研究热性惊厥患儿血清离子及微量元素变化与精神运动发育的相关性。方法 128例热性惊厥患儿,根据惊厥发作次数分为观察组和对照组,各64例。观察组为一次热程度再次和多次热性惊厥发作患儿,对照组为仅发作1次热性惊厥患儿。比较两组患儿两组患儿血清钙离子、铁离子、钠离子、镁离子水平及智力测评评分、行为能力评分。结果观察组钙离子水平(2.02±0.88)μmol/L、铁离子水平(9.76±1.81)μmol/L均高于对照组的(1.55±0.56)、(7.56±1.13)μmol/L,钠离子水平(133.43±10.21)μmol/L低于对照组的(140.23±10.23)μmol/L,差异有统计学意义(P<0.05);两组镁离子水平比较差异无统计学意义(P>0.05)。两组语言智商评分、操作智商评分及总智商评分比较差异无统计学意义(P>0.05)。观察组独立因子评分(54.32±3.56)分、认知因子评分(52.65±5.78)分、社会自制因子评分(60.34±5.93)分及总评分(102.45±10.56)分均低于对照组的(56.23±3.58)、(63.23±5.47)、(68.34±5.82)、(122.56±10.68)分,差异有统计学意义(P<0.05)。结论热性惊厥患儿精神运动发育与其血清离子及微量元素变化有关,病情发作时其血清离子及微量元素出现异常,一次热程度再次和多次热性惊厥发作患儿其精神运动发育迟滞较为明显。