Sensory testing in leprosy: comparison of ballpoint pen and monofilaments.

The 10 g monofilament has been replaced by the ballpoint pen in routine sensory testing of nerves in leprosy control in Ethiopia. Results of sensory testing between the ballpoint pen and different monofilaments on hands and feet were compared. Ballpoint pen underdiagnosis of loss of sensation was defined to occur when the pen was felt and the monofilament was not. Differences were evaluated both for individual test points (test point level) and for the test points of extremities collectively (extremity level). An extremity (either a hand or a foot) was defined as having sensory nerve function impairment (SNFI) if a supplying nerve had SNFI, which was the case when sensation was absent in two or more test points in the area supplied by that nerve. At test point level, the percentages with ballpoint pen underdiagnosis relative to the 2, 10, 20 and 50 g monofilaments were 40, 21, 9 and 7%, respectively, in the hands, and 47, 30, 15 and 7% in the feet. Ballpoint pen underdiagnosis percentages of SNFI at extremity level were 32, 18, 8 and 9% in the hands, and 37, 26, 14 and 6% in the feet. The risk of ballpoint pen underdiagnosis appears to be higher in extremities without visible damage. In conclusion, substantial levels of underdiagnosis of sensory loss with the ballpoint pen were observed. However, the consequences for the prognosis of treatment with corticosteroids in patients with the more subtle sensation loss noted here need to be established. Development and testing of guidelines is a prerequisite for the use of the ballpoint pen.

The experience of self-care groups with people affected by leprosy: ALERT, Ethiopia.

This paper describes the development of self-care groups in Ethiopia by ALERT, and the successes and failures experienced in the process. The groups were started in 1995 in response to two main problems, the increasing number of people dependent on ALERT to heal their wounds despite years of health education, and the limited financial resources of ALERT for wound healing supplies. By December 1999, there were a total of 72 established groups. Group membership was voluntary. There have been a number of positive outcomes. Group members have taken up responsibility for managing and monitoring their own wounds and supplying their own wound healing materials. More attention is paid to their personal hygiene and personal appearance. They also report increased confidence to participate in society, restored dignity and self-respect, and a sense of belonging within the community. In addition, some members have started to pay more attention to their local environmental hygiene by building pit latrines and waste disposal sites. The ALERT staff involved in this initiative had to change their role from that of a leprosy service provider to a self-care group facilitator, but not all were successful in making this transition. The remaining challenge for the programme is sustainability and further development through the National Tuberculosis and Leprosy Control Programme, The Ethiopian National Association for Ex-Leprosy Patients and possibly other organizations too.

Can people affected by leprosy at risk of developing plantar ulcers be identified? A field study from central Ethiopia.

In the ALERT leprosy control programme, 75 people affected by leprosy, in three different geographical areas, were investigated. Each person was documented as having anaesthesia to the 10 g monofilament. The study sought to determine why some people developed ulcers whilst others did not. According to the records, 43 had an ulcer during the last 5 years but 32 had never had an ulcer. In order to examine protective sensation on the sole of the foot, various sensory modalities were tested and the functional anatomy of the foot was examined. The results showed, as may be expected, that it is not possible to define a specific threshold for protective sensation that could be applied to all cases. Some people with only slightly diminished sensation developed ulcers, while many others with almost complete anaesthesia remained ulcer-free. In these rural communities, being a farmer reduced the risk of developing an ulcer, but no other demographic features were significant. Graded monofilaments were found to be the most appropriate test, with loss of sensation at any of five points tested being a 'positive' result. The 10 g filament was the most sensitive, but only 43% of feet identified by this test actually developed an ulcer. As people with partial loss of sensation were excluded from this study, this figure may be lower under programme conditions. The 50 g and 100 g filaments decrease the number of feet identified as at risk, but increase the percentage which actually develop an ulcer, to 46% and 49%, respectively. An appropriate test for selecting those for special programmes which may have a limited capacity, for example the provision of subsidized footwear or involvement in self-care groups, would be a 100 g filament, which would detect 86% of those feet likely to develop an ulcer, while reducing the number of those selected who are not at great risk. Vibrometry was found to be no better than graded filaments and an examination of functional anatomy did not help in identifying those at risk.

Top 1 in 10,000: a 10-year follow-up of the profoundly gifted.

Adolescents identified before the age of 13 (N = 320) as having exceptional mathematical or verbal reasoning abilities (top 1 in 10,000) were tracked over 10 years. They pursued doctoral degrees at rates over 50 times base-rate expectations, with several participants having created noteworthy literary, scientific, or technical products by their early 20s. Early observed distinctions in intellectual strength (viz., quantitative reasoning ability over verbal reasoning ability, and vice versa) predicted sharp differences in their developmental trajectories and occupational pursuits. This special population strongly preferred educational opportunities tailored to their precocious rate of learning (i.e., appropriate developmental placement), with 95% using some form of acceleration to individualize their education.

Men and women at promise for scientific excellence: similarity not dissimilarity.

U.S. math-science graduate students possessing world-class talent (368 males, 346 females) were assessed on psychological attributes and personal experiences in order to examine how their talents emerged and developed. Comparisons were made, using similar assessments, with mathematically talented students (528 males, 228 females) identified around age 13 and tracked into adulthood by the Study of Mathematically Precocious Youth (SMPY). Well before college, both samples were academically distinguished: however, the graduate students could be identified during adolescence as a subset of mathematically talented youths based on their nonintellectual attributes. Their profiles corresponded to what earlier psychological studies found to characterize distinguished (and exclusively male) scientists: exceptional quantitative reasoning abilities, relatively stronger quantitative than verbal reasoning ability, salient scientific interests and values, and finally, persistence in seeking out opportunities to study scientific topics and develop scientific skills. On these attributes, sex differences were minimal for the graduate students (but notfor the SMPY comparison groups). Developing exceptional scientific expertise apparently requires special educational experiences, but these necessary experiences are similar for the two sexes.

The challenges of integration in health care research.

The team approach in neuroscience patient care results in health care professionals interacting on a daily basis. However, the collaboration of health care disciplines in research is limited. The barrier to research integration among disciplines may be related to the diverse views of the quantitative and qualitative paradigms. Health care research is challenged by both the variety of health professionals and differing research paradigms. Patients will benefit from integrated health care research with a coordinated research agenda and efficient use of resources.

The hand-foot impairment score as a tool for evaluating prevention of disability activities in leprosy: an exploration in patients treated with corticosteroids.

The hand-foot (HF) impairment score in leprosy patients is the sum of the WHO disability grades for hands and feet. This retrospective study explored the possibility of using the HF score for evaluation of the effectiveness of corticosteroid treatment programmes for nerve function impairment (NFI). Changes in the score were compared with changes in sensory testing (ST) and voluntary muscle testing (VMT) for 42 leprosy patients who received corticosteroid treatment. The WHO grade did not change in 30/60 (50%) of extremities gaining, and in 4/10 (40%) extremities losing sensation and/or muscle strength. However, 18/24 (75%) patients with a definite gain in function improved in HF score, while the HF score remained unchanged in 10/11 (91%) patients with no change in nerve function. Five patients with impairment in multiple extremities showed both gain and loss of sensation and/or muscle strength in the same or different extremities. Overall, improvement, deterioration and absence of change in NFI, as indicated by changes in ST and VMT were reflected correctly by the HF score in 28 (76%) of the remaining 37 patients. It was also shown that the HF score does not give appropriate information on the extent of the effect of corticosteroid treatment. This study illustrates that the HF score can not be used to support management of corticosteroid treatment of individual patients, but indicates this score to be a promising device for the evaluation of the effectiveness of corticosteroid treatment programmes. This study used the HF score because information on (changes in) eye impairment was not considered reliable. However, in principle, we consider the EHF score, which is the sum of the WHO disability grades for hands, feet and eyes, preferable for evaluation purposes. We strongly recommend further validation of the EHF score as a tool for evaluation of corticosteroid treatment programmes for patient groups with different distributions of NFI through prospective studies.

Sex differences in mathematical reasoning ability at age 13: their status 20 years later.

Reported is the 20-year follow-up of 1,975 mathematically gifted adolescents (top 1%) whose assessments at age 12 to 14 revealed robust gender differences in mathematical reasoning ability. Both sexes became exceptional achievers and perceived themselves as such; they reported uniformly high levels of degree attainment and satisfaction with both their career direction and their overall success. The earlier sex differences in mathematical reasoning ability did predict differential educational and occupational outcomes. The observed differences also appeared to be a function of sex differences in preferences for (a) inorganic versus organic disciplines and (b) a career-focused versus more-balanced life. Because profile differences in abilities and preferences are longitudinally stable, males probably will remain more represented in some disciplines, whereas females are likely to remain more represented in others. These data have policy implications for higher education and the world of work.

States of excellence.

Research from the individual-differences tradition pertinent to the optimal development of exceptional talent is reviewed, using the theory of work adjustment (TWA) to organize fundings. The authors show how TWA concepts and psychometric methods, when used together, can facilitate positive development among talented youth by aligning learning opportunities with salient aspects of each student's individuality. Longitudinal research and more general theoretical models of (adult) academic and intellectual development support this approach. This analysis also uncovers common threads running through several positive psychological concepts (e.g., effectance motivation, flow, and peak experiences). The authors conclude by underscoring some important ideals from counseling psychology for fostering intellectual development and psychological well-being. These include conducting a multifaceted assessment, focusing on strength, helping people make choices, and providing a developmental context for bridging educational and industrial psychology to facilitate positive psychological growth throughout the life span.

DNA pooling and dense marker maps: a systematic search for genes for cognitive ability.

Pooling DNA from subjects within a group and comparing the pooled DNA across groups for a dense map of DNA markers offers a solution to the conundrum that linkage is systematic but not powerful whereas allelic association is powerful but not systematic. We used DNA pooling to screen 66 markers on chromosome 22 in original and replication samples of children of high general cognitive ability (g) and controls of average g. Although none of these markers survived our three-stage screening design (original pooling, replication pooling, individual genotyping), the results of DNA pooling were largely confirmed by individual genotyping. We can therefore exclude associations of major effect size on chromosome 22 for g, a key variable for cognitive neuroscience research on learning and memory.

DNA pooling identifies QTLs on chromosome 4 for general cognitive ability in children.

General cognitive ability (g), which is related to many aspects of brain functioning, is one of the most heritable traits in neuroscience. Similarly to other heritable quantitatively distributed traits, genetic influence on g is likely to be due to the combined action of many genes of small effect [quantitative trait loci (QTLs)], perhaps several on each chromosome. We used DNA pooling for the first time to search a chromosome systematically with a dense map of DNA markers for allelic associations with g. We screened 147 markers on chromosome 4 such that 85% of the chromosome were estimated to be within 1 cM of a marker. Comparing pooled DNA from 51 children of high g and from 51 controls of average g, 11 significant QTL associations emerged. The association with three of these 11 markers ( D4S2943, MSX1 and D4S1607 ) replicated using DNA pooling in independent samples of 50 children of extremely high g and 50 controls. Furthermore, all three associations were confirmed when each individual was genotyped separately ( D4S2943, P = 0. 00045; MSX1, P = 0.011; D4S1607, P = 0.019). Identifying specific genes responsible for such QTL associations will open new windows in cognitive neuroscience through which to observe pathways between genes and learning and memory.

Dopamine markers and general cognitive ability.

Because general cognitive ability (g) is among the most heritable behavioural traits, it is a reasonable target for a search for quantitative trait loci (QTLs). We used a selected-extremes design to test candidate genes for allelic association with g. Polymorphisms in four genes in the dopamine system (DRD2, DRD3, DRD4, DAT1) were genotyped for 51 high g children with IQ scores > 130 and for 51 average g control children. No significant allelic or genotypic differences were found between the high g and average g groups for these markers of the dopamine system, even though the selected-extremes design provides power to detect QTL associations that involve a relative risk of about 1.5.

No association between general cognitive ability and the A1 allele of the D2 dopamine receptor gene.

Berman and Noble (1995) reported significantly reduced visuospatial performance in children with the TAQI A1 allele of the D2 dopamine receptor (DRD2) gene. Given that visuospatial performance loads highly on an unrotated principal component indexing general cognitive ability, we tested the association between DRD2 and WISC-R IQ comparing 51 high-IQ, 51 average-IQ, and 35 low-IQ children in the IQ Quantitative Trait Loci (QTL) Project. No statistically significant association between the TAQI A DRD2 alleles and IQ was found. Given that a statistically significant portion of genetic variance for specific cognitive abilities is independent of general cognitive ability, it is possible that the TAQI DRD2 association is specific to visuospatial performance and independent of general cognitive ability.

Developmentally advanced EEG alpha power in gifted male and female adolescents.

An electroencephalographic (EEG) study of gifted and average ability male and female adolescents, as well as college students of both sexes, was conducted to investigate further the relative contributions the left and right cerebral hemispheres during an eyes open (baseline) task in all groups. A total of 90 subjects had baseline EEG recorded in three groups with equal numbers of males and females: 30 gifted adolescents, 30 average ability adolescents, and 30 college-age subjects. Overall alpha power (8-12 Hz resting potential) was significantly greater in average ability subjects compared to both college-age subjects. Moreover, there were no significant differences in overall alpha power between college-age and gifted adolescent subjects. However, college-age and gifted adolescent subjects had different RH/LH patterns of activation such that at temporal and parietal locations college-age and gifted adolescent subjects had greater LH alpha power levels whereas gifted adolescents had greater RH alpha power. These findings suggest that gifted adolescents may have a developmentally enhanced state of brain activity, one that more closely resembles that of college-age adults to whom they also resemble in terms of cognitive development.

Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI).

Many long term wheelchair users develop shoulder pain. The purpose of this study was to examine the reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI), an instrument which measures shoulder pain associated with the functional activities of wheelchair users. This 15-item functional index was developed to access shoulder pain during transfers, self care, wheelchair mobility and general activities. To establish test-retest reliability, the index was administered twice in the same day to 16 long term wheelchair users and their scores for the two administrations were compared by intraclass correlation. To establish concurrent validity, the index was administered to 64 long term wheelchair users and index scores were compared to shoulder range of motion measurements. Results showed that intraclass correlation for test-retest reliability of the total index score was 0.99. There were statistically significant negative correlations of total index scores to range of motion measurements of shoulder abduction (r = -0.485), flexion (r = -0.479) and shoulder extension (r = -0.304), indicating that there is a significant relationship of total index score to loss of shoulder range of motion in this sample. The Wheelchair User's Shoulder Pain Index shows high levels of reliability and internal consistency, as well as concurrent validity with loss of shoulder range of motion. As a valid and reliable instrument, this tool may be useful to both clinicians and researchers in documenting baseline shoulder dysfunction and for periodic measurement in longitudinal studies of musculoskeletal complications in wheelchair users.

Development of the Wheelchair User's Shoulder Pain Index (WUSPI).

Chronic shoulder pain is a frequently reported phenomenon in individuals who use wheelchairs as their primary means of mobility. No indices are currently available which detect difficulties in performing daily activities due to shoulder discomfort in a largely independent population of wheelchair users. The Wheelchair User's Shoulder Pain Index (WUSPI) was designed to measure shoulder pain in individuals who use wheelchairs. A pilot index was created to measure shoulder pain and related difficulty during basic and instrumental activities of daily living. The instrument was administered to 64 wheelchair users at an athletic event. Analyses of internal consistency and interitem correlations were used to revise and refine the original instrument. Individual item analysis revealed that the subjects in this study experienced the most shoulder pain when wheeling up an incline or on outdoor surfaces, when lifting an object from an overhead shelf, when trying to sleep, when transferring from tub to wheelchair and when washing their backs. The final 15-item index shows high internal consistency. This instrument is useful for both clinical and research purposes to detect and monitor shoulder pain and accompanying loss of function by wheelchair users.

Stability of vocational interests among the intellectually gifted from adolescence to adulthood: a 15-year longitudinal study.

A sample of 162 intellectually gifted adolescents (top 1%) were administered the Strong-Campbell Interest Inventory at age 13. Fifteen years later, they were administered the Strong again. This study evaluated the intra- and interindividual temporal stability of the 6 RIASEC (Realistic, Investigative, Artistic, Social, Enterprising, Conventional) themes and the Strong's 23 Basic Interest Scales. Over the 15-year test-retest interval, RIASEC's median interindividual correlation for the 6 themes was .46; the median of all 162 intraindividual correlations was .57. Configural analyses of the most dominant theme at age 13 revealed that this theme was significantly more likely than chance to be either dominant or adjacent to the dominant theme at age 28--following RIASEC's hexagonal structure. For intellectually gifted individuals, it appears to be possible to forecast salient features of their adult RIASEC profile by assessing their vocational interests during early adolescence, but some RIASEC themes seem more stable than others.

From top dog to bottom half: social comparison strategies in response to poor performance.

Although the hypothesis that people will alter comparison behavior in response to threat is consistent with the formulation of social comparison theory, the empirical evidence for the natural occurrence of such shifts is weak. Two studies were conducted to examine this hypothesis. In the first study, adolescents' perceptions were assessed before, during, and 6 months after their participation in an academic program for gifted students. Male students who performed poorly, and also worse than they had expected in the program, demonstrated self-protective "strategies" by lowering the amount and level of academic comparison they reported engaging in and by lowering their perception of the importance of academics. Female students, who generally performed as well as expected, reported relatively little change. By follow-up, most of the male students' perceptions had returned to baseline. A second study found that both male and female college students who thought they had performed poorly academically also demonstrated these shifts in comparison. Motivations behind the strategies are discussed.

Concurrent finger-tapping in mathematically gifted males: evidence for enhanced right hemisphere involvement during linguistic processing.

O'Boyle and Benbow (1990) have suggested that enhanced involvement of the right hemisphere (RH) during basic information processing is a neuropsychologic characteristic of the gifted brain. To provide converging evidence for this hypothesis, the present study was conducted using a concurrent finger-tapping paradigm. Specifically, 24 mathematically precocious and 16 average ability adolescent males were required to tap a key as quickly as possible while sitting silently (baseline condition), concurrently reading a paragraph aloud (verbal load), or encoding a random form into memory (spatial load). For average ability subjects, the concurrent verbal load reduced tapping rate for the right but not the left hand, reflecting a division of LH resources between linguistic processing of the paragraph and motor control of the contralateral hand. In contrast, for gifted subjects, both their left- and right-hand tapping rates were significantly reduced, suggesting that both hemispheres were engaged during verbal processing. The concurrent spatial task produced a small but reliable reduction in finger-tapping rate for both the left and right hand in each group. These findings provide additional support for the notion that enhanced reliance on RH functioning is a physiological correlate of mathematical precocity in gifted males.