Cardiac magnetic resonance assessment of left ventricular dilatation in chronic severe left-sided regurgitations: comparison with standard echocardiography.

PURPOSE: The purpose of this study was to investigate the potential additional value of cardiac magnetic resonance (CMR) in the assessment of left ventricular (LV) dilatation and dysfunction by comparison to standard echocardiography in patients with chronic left-sided valvular regurgitation. MATERIALS AND METHODS: We prospectively enrolled patients with chronic severe mitral regurgitation (MR) or aortic regurgitation (AR). They underwent standard echocardiography and CMR using aortic flow and LV-function sequences. LV dilatation or dysfunction was assessed with each technique, based on thresholds used for surgery indication. Reference regurgitation severity was defined following previously reported CMR-based regurgitant volume thresholds. RESULTS: A total of 71 patients with chronic severe MR (n=44) or severe AR (n=27) were prospectively included. There were 60 men and 11 women with a mean age of 61±14 (SD) years (range: 18-83 years). CMR-based regurgitation severity was significantly greater in the LV dysfunction group when assessed with CMR (MR, P=0.011; AR, P=0.006) whereas it was not different when LV dysfunction was assessed using standard echocardiography. Among standard echocardiography and CMR volumetric indices, CMR-derived end-diastolic volume showed the best ability to predict regurgitation severity (area under the curve [AUC]=0.78 for MR; AUC=0.91 for AR). Diagnostic thresholds identified on receiver operating characteristics-curve analysis were lower than those of current European recommendations and closer to North-American guidelines. CONCLUSION: CMR assessment of LV end-diastolic volume in chronic severe left-sided regurgitations is more reliably associated with CMR-based regurgitant volume by comparison with standard echocardiography diameter. CMR may provide useful evaluation before surgery decision for severe asymptomatic regurgitations.

Sphere-Tubule Superstructures through Supramolecular and Supracolloidal Assembly Pathways.

While colloids have been widely employed as models for atoms and molecules, the current study proposes to extend their use as building blocks for supracolloidal frameworks. Hereby, the self-assembly between highly anisotropic supramolecular microtubules and soft spherical fluorescent microgels is explored using confocal laser scanning microscopy. The influence of the particle size and charge with respect to the catanionic tubule composition, which consists of two oppositely charged bile salt derivatives, is investigated. Under certain conditions, microgel particles are found to specifically interact with the extremities of the tubular aggregates and hierarchically self-assemble into various superstructures varying from virus-like assemblies to supracolloidal networks. The reported approach is envisioned to open new self-assembly routes toward ordered hybrid superstructures where the spherical colloids act as responsive linkers of tubular structures.

[Atypical left ventricular hypertrophy revealing a rare cause of heart failure in a man from the Comoros Islands]. / Hypertrophie ventriculaire gauche atypique révélatrice d'une cause rare d'insuffisance cardiaque chez un Comorien.

In Africa, hypertension is a major public health problem, and hypertensive heart disease is a leading cause of heart failure. Left ventricular hypertrophy is a common consequence of hypertension. We present a case illustrating an unusual cause of such hypertrophy in a 73-year-old patient with heart failure living in the Comoros Islands, in whom we diagnosed cardiac amyloidosis. This disease has not previously been reported in the Comoros Islands and remains associated with a poor prognosis.

The development of a stress survey schedule for persons with autism and other developmental disabilities.

The Stress Survey Schedule is an instrument for measuring stress in the lives of persons with autism and other developmental disabilities. Development of the survey and analysis of the underlying measurement structure of the instrument is reported in three studies. Through the use of exploratory and confirmatory analysis procedures, eight dimensions of stress were identified: Anticipation/Uncertainty, Changes and Threats, Unpleasant Events, Pleasant Events, Sensory/Personal Contact, Food Related Activity, Social/Environmental Interactions, and Ritual Related Stress. These stress dimensions are highly relevant to the problems of autism and have not been addressed by other stress surveys. The information obtained from the Stress Survey can be used to plan for strategies to reduce the stress before it occurs or results in maladaptive behavior.

A comparison of Italian, Japanese and American students' responses to the Adolescent Reinforcement Survey Schedule.

The Italian form of the Adolescent Reinforcement Survey Schedule (ARSS-I) was administered to (N = 648) high school boys and girls from northern and central Italy. Their responses were factor analyzed using a principal component. VARIMAX rotation procedure (SAS Institute, Inc., 1990). The 10 interpretable factors from the Italian data were compared and contrasted to factor analytic results from Holmes (1991, 1994) studies using American and Japanese students. Additionally, the Italian data analyses includes an examination by gender using t tests for each of the ARSS-I items and an ANOVA for age and age-gender effects on responses to the ARSS-I.

Adolescent reinforcement survey schedule: summary of research and future directions.

Three completed studies with the Adolescent Reinforcement Survey Schedule are reviewed and further studies are discussed.

Japanese high school and college students' responses to the Adolescent Reinforcement Survey Schedule.

Factor-analyzed correlations among items of the Japanese Adolescent Reinforcement Survey Schedule by Japanese high school students (N = 939) and college students (N = 500) were compared to investigate the changes in reinforcers between mid- and late adolescence, gender differences, and the specific groupings of reinforcers which suggest certain interventions for either or both groups of adolescents. The factor analysis yielded ten interpretable factors in both groups. These factors were similar and did not suggest a dramatic shift in reinforcers between mid- and late adolescence. Items related to heterosexual activities and antisocial behaviors were rated as more pleasurable by males and items related to interpersonal relationships and academic activities were rated as more pleasurable by females. Since both groups of students attach high reinforcement value to interpersonal interaction with peers and family members, interventions focusing on social skills development might be popular and well attended.

The use of the anxiety meter to reduce anxiety.

The use of the Anxiety Meter (AM) is taught to clients to reduce anxiety. At first the AM is used as part of the self-control triad. It is then used alone to reduce anxiety. A rationale for the use of the AM is presented together with a description of the procedure. The AM is a self-control strategy for use in treating agoraphobia and panic reaction. A case example is also presented.

Insight in behavior therapy.

Behavior therapists make frequent use of insight, but avoid the term because dynamic therapists have formulated it in terms of the unconscious. Insight does not necessarily imply belief in the existence of the "unconscious mind." Behavioral insight consists of making the client aware of the antecedents and consequences of target behavior. Case studies are presented in which behavioral insight was involved in therapeutic change. Implications of behavioral insight for behavior therapy are discussed.

Comparison of factor-analyzed Adolescent Reinforcement Survey Schedule (ARSS) responses from Japanese and American adolescents.

The Adolescent Reinforcement Survey Schedule (ARSS) was administered to a sample of male and female late adolescent college students from Japan (N = 500). The responses to the ARSS are factor analyzed using a principal component method. The results of the factor-analyzed ARSS from the Japanese sample are compared and contrasted with the results from a previous study (Holmes et al., 1987) in which ARSS was administered to a sample of American male and female college students (N = 231). Both the American and Japanese samples produced 10 interpretable factors. A recommendation is made to replicate the present study with groups of early and mid-adolescents in each culture in order to study shifts in reinforcers during different periods of adolescent development.

Behavior analysis, cognitive therapy, and covert conditioning.

Branch (The Behavior Therapist 10, 79-84, 1987) and others have expressed interest in extending the behavior analytic framework into the realm of behavior therapy and private events. We point out that several imagery-based behavior therapy procedures such as systematic desensitization, implosive therapy, and covert conditioning were designed to be employed according to learning principles and that covert conditioning is specifically based on principles of operant conditioning. Since the covert conditioning model already combines the advantages of behavior analysis, behavior therapy, and imagery, covert conditioning, rather than cognitive therapy, should be considered by behavior analysts seeking ways to study and modify both private and public events.

Procedures to increase social interaction among adolescents with autism: a multiple baseline analysis.

Isolate behavior, impaired social relationships and lack of conversational skills are behaviors which characterize persons described as autistic. These deficits interfere with their effective integration into school and social environments. This study of three subjects investigates the use of imagery procedures, specifically, covert reinforcement, to increase peer verbal initiations in adolescents who are labeled "autistic" and concomitantly looks at the demand characteristics of therapist "request". A multiple baseline analysis was used to assess the effects of individual training sessions on peer verbal initiations. The results demonstrate that verbal initiations can be changed in socially deficient adolescents labeled "autistic".

Factor analysis of the Adolescent Reinforcement Survey Schedule (ARSS) with college freshmen.

A factor analysis of the Adolescent Reinforcement Survey Schedule (ARSS) with a male and female college freshman (N = 231) population yielded 10 interpretable factors: Heterosexual Dating, Peer Interaction, Sibling/Family Interaction, Sexual Pleasure, Anti-School/Work, Leisure/Work Activity, Drugs/Acting Out, Entertainment/Social Activity, Home Avoidance, and Romantic Fantasy Activity. The first three factors are similar to a Positive Social interaction factor identified in a study that used the adult form of the Reinforcement Survey Schedule with a male and female college population. Suggestions are made from the ARSS responses of the college freshmen re interventions to facilitate social skill competency and the relationship aspects of sexual activity. A recommendation is made to replicate the current study with groups of early and mid-adolescents in order to study reinforces during different periods of adolescent development.

General level of reinforcement.

A concept of General Level of Reinforcement (GLR) is introduced. This concept is defined as the number, quality and duration of reinforcements per unit time. The assumptions of this theory are discussed. A crucial assumption is that the theory is related to psychological and physiological well-being. Ways to measure general level of reinforcement are described, and clinical implications presented. Methods to increase the level of reinforcement, such as covert reinforcement and the Self-Control Triad, are specified. Finally, suggestions for research are provided.