Level of intrateam agreement on candidate scores in a structured interview process.

This study examined the intrateam reliability of a structured interview process used to help select students to a professional education program in physical therapy. Two hundred and twenty academically qualified applicants were interviewed by one of six two-member teams using a standardized format. Each member of a team independently rated the applicant on each of four performance skills using a 5-point ordinal scale; the maximal total score possible was 16 points. A weighted kappa (Kw) statistic was used to estimate intrateam agreement for both 1993 and 1994 on each performance skill and overall interview score. We observed wide variation in intrateam Kw scores for each of the four performance skills between the 1993 and 1994 admission cycles. According to Kw values for overall score agreement, five of the six interview teams either remained the same or increased at least one level between 1993 and 1994. Intrateam variability may be reduced by having team members review specific criteria used to rate a skill before the interview process commences each year.

Stimulus-response compatibility effects in a manual tracking task.

The purpose of this study was to determine whether there are stimulus-response (S-R) compatibility effects in a manual tracking task for male and female subjects of different ages. 20 healthy men and 20 healthy women in each of three different age groups (20 to 39, 40 to 59, and 60 to 79 years) participated (total N = 120). Subjects performed extension and flexion movements of the index finger metacarpophalangeal joint to track a computer-screen cursor along a target sine wave. The hand and forearm were positioned so that the finger movement was either vertical or horizontal, and the computer monitor was positioned so that the voluntary cursor movement was either vertical or horizontal. Each subject performed four different tracking tests corresponding to the four different ensembles of hand-forearm position and monitor position. There were significant differences in tracking performance between test ensembles in both women and men aged 60 to 79 years, and the compatible ensembles showed the superior performance. The results suggest that S-R compatibility effects exist in elderly women and elderly men performing a finger-movement tracking task, and these effects are consistent with impaired information processing in elderly persons. More research is needed on how S-R compatibility affects performance in persons with cerebral lesions.

Finger-movement tracking scores in healthy subjects.

The purpose of this study was to examine the effects of age, sex, and hand preference on precise control of voluntary movement at the index finger metacarpophalangeal joint in able-bodied volunteers. An electrogoniometer was attached to this joint and connected to a computer. The computer screen displayed a sine wave target that each subject attempted to track with careful extension and flexion finger movements. Accuracy index scores were calculated for the extension phases, flexion phases, and the total sine wave. Each subject performed three tracking trials and the average for each of the above scores was computed. The results showed that younger subjects tracked significantly more accurately than older subjects and men tracked significantly more accurately than women. Also, the subjects tracking with the nonpreferred hand (15 right, 105 left) tracked significantly more accurately than those subjects tracking with the preferred hand (112 right, 8 left) in the flexion phases of the test. The data from these able-bodied subjects provide a base for comparison of patients' data, which may be helpful in the early recognition and monitoring of problems with precision in movement control.

Reliability of goniometric measurements and visual estimates of ankle joint active range of motion obtained in a clinical setting.

We examined intratester and intertester reliability for goniometric measurements of ankle dorsiflexion (ADF) and ankle plantar flexion (APF) active range of motion (AROM). Parallel-forms intratester reliability for ankle AROM measurements obtained by the universal goniometer (UG) and by visual estimation (VE) and intertester reliability for VE of ADF and APF were examined. Repeated measurements were obtained on 38 patients with orthopedic problems by 10 physical therapists in a clinical setting. For intratester reliability of measurements obtained with UG, intraclass correlation coefficients (ICC) for all physical therapists were 0.64 to 0.92 (median, 0.825) for ADF and 0.47 to 0.96 (median, 0.865) for APF. Intertester reliability was quantified with use of ICC. ICCs for measurements obtained by UG were 0.28 for ADF and 0.25 for APF; ICC of VE for ADF was 0.34 and was 0.48 for APF. ICC for parallel-forms intratester reliability obtained with UG and VE ranged from 0 to 0.94 (median, 0.58) for ADF and 0 to 0.86 (median, 0.625) for APF. Thus, a physical therapist should use a goniometer when making repeated measurements of ankle joint AROM. Considerable inconsistency exists when two or more physical therapists make repeated goniometric and visual measurements of ankle motion on the same subject. Physical therapists may erroneously conclude that a patient's AROM has changed because of treatment when the change could be attributed to a lack of intertester reliability.

Normal range of motion of the cervical spine: an initial goniometric study.

The purposes of this study were (1) to determine normal values for cervical active range of motion (AROM) obtained with a "cervical-range-of-motion" (CROM) instrument on healthy subjects whose ages spanned 9 decades, (2) to determine whether age and gender affect six cervical AROMs, and (3) to examine the intratester and intertester reliability of measurements obtained. Measurements were made on 337 subjects (171 females and 166 males) whose ages ranged from 11 to 97 years. Measurements were taken by five physical therapists with 7 to 30 years of clinical and teaching experience. Among male and female subjects of the same age, females had a greater AROM than did males for all AROMs except neck flexion. Among both males and females, each of the six cervical AROMs decreased significantly with age. From two pilot studies separate from the acquisition of the normal database, we determined our intratester and intertester reliabilities for making neck AROM measurements with the CROM instrument. We concluded that AROM measurements on the cervical spine with the CROM instrument demonstrated good intratester and intertester reliability, because the intraclass correlation coefficients were generally greater than .80.

A herpes simplex virus ribonucleotide reductase deletion mutant is defective for productive acute and reactivatable latent infections of mice and for replication in mouse cells.

Herpes simplex virus encodes a ribonucleotide reductase that is not essential for virus growth in dividing cells at 37 degrees. This enzyme has been proposed as a target for antiviral drugs; its utility in this regard could depend upon its importance in vivo. To test the requirement of viral ribonucleotide reductase in a mammalian host, we tested a mutant virus, lacking most of the gene encoding the ribonucleotide reductase large subunit, in a mouse eye model of pathogenesis and latency where the wild-type virus establishes reactivatable latent infections in trigeminal ganglia following corneal inoculation. The deletion mutant was severely impaired in its ability to replicate acutely in the eye and in the trigeminal ganglion and failed to establish reactivatable latent infections. In contrast, a recombinant virus in which the deleted sequences were restored was competent for both acute and latent infections. The defects of the deletion mutant in the mouse may be related to its severely impaired growth at 38 degrees in mouse cells relative to its growth in Vero cells. These results indicate that ribonucleotide reductase is critical for productive acute and reactivatable latent infections in mice and replication in mouse cells at 38 degrees and suggest that caution be exercised in extrapolating from studies conducted in mice to human infections when judging the utility of this enzyme as a target for antiviral chemotherapy.

A deletion mutant of the latency-associated transcript of herpes simplex virus type 1 reactivates from the latent state with reduced frequency.

We have generated and characterized a deletion mutant of herpes simplex virus type-1, dlLAT1.8, which lacks the putative promoter region, transcriptional start site, and 1,015 base pairs of the DNA sequences specifying the latency-associated transcripts (LATs). When tested in a CD-1 mouse ocular model, dlLAT1.8 was replication competent in the eye and in ganglia during acute infection but reactivated from explant cultures of ganglia with reduced efficiency (49%) relative to those of wild-type and marker-rescued viruses (94 and 85%, respectively) despite the fact that levels of mutant viral DNA in ganglia during latent infection were comparable to wild-type levels. The neurovirulence of KOS was not significantly altered by the removal of sequences specifying the LATs, as judged by numbers of animals dying on or before 30 days postinfection. Examination of ganglia latently infected with dlLAT1.8 by in situ hybridization revealed no LAT expression. The genotype of reactivated virus was identical to that of input dlLAT1.8 virus as judged by Southern blot analysis. These studies suggest that although the LATs are not essential for the establishment and reactivation of latency in our model, they may play a role in determining the frequency of reactivation of virus from the latent state.

Thymidine kinase-negative herpes simplex virus mutants establish latency in mouse trigeminal ganglia but do not reactivate.

Herpes simplex virus infection of mammalian hosts involves lytic replication at a primary site, such as the cornea, translocation by axonal transport to sensory ganglia and replication, and latent infection at a secondary site, ganglionic neurons. The virus-encoded thymidine kinase, which is a target for antiviral drugs such as acyclovir, is not essential for lytic replication yet evidently is required at the secondary site for replication and some phase of latent infection. To determine the specific stage in viral pathogenesis at which this enzyme is required, we constructed virus deletion mutants that were acyclovir resistant and exhibited no detectable thymidine kinase activity. After corneal inoculation of mice, the mutants replicated to high titers in the eye but were severely impaired for acute replication in trigeminal ganglia and failed to reactivate from ganglia upon cocultivation with permissive cells. Nevertheless, latency-associated transcripts were expressed in neuronal nuclei of ganglia from mutant-infected mice and superinfection of the ganglia with a second virus rescued the latent mutant virus. Thus, contrary to a widely accepted hypothesis, the thymidine kinase-negative mutants established latent infections, implying that neither thymidine kinase activity nor ganglionic replication is necessary for establishment of latency. Rather, thymidine kinase appears to be necessary for reactivation from latency. These results suggest that acyclovir-resistant viruses could establish latent infections in clinical settings and have implications for the use of genetically engineered herpesviruses to deliver foreign genes to neurons.

Immediate-early regulatory gene mutants define different stages in the establishment and reactivation of herpes simplex virus latency.

Using nonsense and deletion mutants of herpes simplex virus type 1, we investigated the roles of three immediate-early proteins (ICP4, ICP27 and ICP0) in the establishment and reactivation of ganglionic latency in a mouse ocular model. DNA hybridization, superinfection-rescue, and cocultivation techniques provided quantitative data that distinguished between the failure of a virus to establish latency in the ganglion and its failure to reactivate. Null mutants with lesions in the genes for ICP4 and ICP27 did not replicate in the eye or in ganglia and failed to establish reactivatable latent infections. Three ICP0 deletion mutants which could replicate in the eye and ganglia varied in their ability to establish and reactivate from the latent state, demonstrating that ICP0 plays a role both in the establishment and the reactivation of latency. The use of viral mutants and a variety of stage-specific assays allowed us to better define the stages in the establishment and reactivation of herpes simplex virus type 1 latency.