Lateral trunk lean gait modification increases the energy cost of treadmill walking in those with knee osteoarthritis.

OBJECTIVE: To compare the energy expenditure of increased lateral trunk lean walking - a suggested method of reducing medial compartment knee joint load - compared to normal walking in a population of older adults with medial knee osteoarthritis (OA). METHOD: Participants completed two randomly-presented treadmill walking conditions: 15 min of normal walking or walking with ten degrees of peak lateral trunk lean. Lateral trunk lean angle was displayed in front of the participant in real-time during treadmill conditions. Energy expenditure (VO2 and METs), heart rate (HR), peak lateral trunk lean angle, knee pain and perceived exertion were measured and differences between conditions were compared using paired t-tests. RESULTS: Twelve participants (five males, mean (standard deviation (SD)) age 64.1 (9.4) years, body mass index (BMI) 28.3 (4.9) kg/m²) participated. All measures were significantly elevated in the lateral trunk lean condition (P < 0.008), except for knee pain (P = 0.22). Oxygen consumption (VO2) was, on average 9.5% (95% CI 4.2-14.7%) higher, and HR was on average 5.3 beats per minute (95% CI 1.7-9.0 bpm) higher during increased lateral trunk lean walking. CONCLUSION: Increased lateral trunk lean walking on a treadmill resulted in significantly higher levels of steady-state energy expenditure, HR, and perceived exertion, but no difference in knee pain. While increased lateral trunk lean has been shown to reduce biomechanical measures of joint loading relevant to OA progression, it should be prescribed with caution given the potential increase in energy expenditure experienced when it is employed.

Blinded vs. unblinded peer review of manuscripts submitted to a dermatology journal: a randomized multi-rater study.

BACKGROUND: Submissions to medical and scientific journals are vetted by peer review, but peer review itself has been poorly studied until recently. One concern has been that manuscript reviews in which the reviewer is unblinded (e.g. knows author identity) may be biased, with an increased likelihood that the evaluation will not be strictly on scientific merits. OBJECTIVES: The purpose of this study was to compare the outcomes of blinded and unblinded reviews of manuscripts submitted to a single dermatology journal via a randomized multi-rater study. MATERIALS AND METHODS: Forty manuscripts submitted to the journal Dermatologic Surgery were assessed by four reviewers, two of whom were randomly selected to be blinded and two unblinded regarding the identities of the manuscripts' authors. The primary outcome measure was the initial score assigned to each manuscript by each reviewer characterized on an ordinal scale of 1-3, with 1 = accept; 2 = revise (i.e. minor or major revisions) and 3 = reject. Subgroup analysis compared the primary outcome measure across manuscripts from U.S. corresponding authors and foreign corresponding authors. The secondary outcome measure was word count of the narrative portion (i.e. comments to editor and comments to authors) of the reviewer forms. RESULTS: There was no significant difference between the scores given to manuscripts by unblinded reviewers and blinded reviewers, both for manuscripts from the U.S. and for foreign submissions. There was also no difference in word count between unblinded and blinded reviews. CONCLUSIONS: It seems, at least in the case of one dermatology journal, that blinding during peer review does not appear to affect the disposition of the manuscript. To the extent that review word count is a proxy for review quality, there appears to be no quality difference associated with blinding.

Accelerated resolution of laser-induced bruising with topical 20% arnica: a rater-blinded randomized controlled trial.

BACKGROUND: Dermatological procedures can result in disfiguring bruises that resolve slowly. OBJECTIVES: To assess the comparative utility of topical formulations in hastening the resolution of skin bruising. METHODS: Healthy volunteers, age range 21-65 years, were enrolled for this double (patient and rater) blinded randomized controlled trial. For each subject, four standard bruises of 7 mm diameter each were created on the bilateral upper inner arms, 5 cm apart, two per arm, using a 595-nm pulsed-dye laser (Vbeam; Candela Corp., Wayland, MA, U.S.A.). Randomization was used to assign one topical agent (5% vitamin K, 1% vitamin K and 0·3% retinol, 20% arnica, or white petrolatum) to exactly one bruise per subject, which was then treated under occlusion twice a day for 2 weeks. A dermatologist not involved with subject assignment rated bruises [visual analogue scale, 0 (least)-10 (most)] in standardized photographs immediately after bruise creation and at week 2. RESULTS: There was significant difference in the change in the rater bruising score associated with the four treatments (anova, P=0·016). Pairwise comparisons indicated that the mean improvement associated with 20% arnica was greater than with white petrolatum (P=0·003), and the improvement with arnica was greater than with the mixture of 1% vitamin K and 0·3% retinol (P=0·01). Improvement with arnica was not greater than with 5% vitamin K cream, however. CONCLUSIONS: Topical 20% arnica ointment may be able to reduce bruising more effectively than placebo and more effectively than low-concentration vitamin K formulations, such as 1% vitamin K with 0·3% retinol.

Teachers' perceptions of the incidence and management of attention-deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) continues to be a common diagnosis of school children, and according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994), it affects approximately 3%-5% of the population. Teachers are often the primary source of information regarding ADHD diagnoses in school children. A previous study by Glass and Wegar (2000) found that teachers were overidentifying children with ADHD and that medication was preferred as the primary treatment for these students. This study further examined teacher perceptions on the causes, incidence, and appropriate treatment methods of ADHD. In addition, this study also examined the prevalence of ADHD as determined by ADHD Rating Scale-IV (School Version; DuPaul et al., 1998) and examined differential identification rates by gender and ethnicity. Results showed that teachers were likely to identify children as having ADHD at rates higher than the expected prevalence rates specified in DSM-IV. Out of 121 rating scales analyzed, 23.97% of students were identified by teachers as meeting criteria for 1 of the 3 types of ADHD. Males had significantly higher scores than females and Whites had significantly higher scores than Hispanics. Class size was also associated with the likelihood that teachers would identify more than 5% of their students as having ADHD. Results suggest that, despite increasing evidence of a connection between biological factors and ADHD, environmental factors (i.e., class size and culture) may still influence teachers' perceptions about what students have the disorder.

Transfer of a male-sterility-inducing cytoplasm from onion to leek ( Allium ampeloprasum).

Two interspecific triploid (AAC) hybrids (84/1-94 and 99/1-94) from crosses between onion [ Allium cepa (2 n=2 x=16, CC)] and leek [ A. ampeloprasum (2 n=4 x=32, AAAA)] were backcrossed to leek in order to transfer a male-sterility-inducing cytoplasm from onion that would enable the production of hybrid leek. GISH evaluations of meiosis in the interspecific hybrids revealed irregularities due to univalent onion chromosomes producing micronuclei from onion chromatin, whereas the pairing of the two sets of leek chromosomes was nearly normal. Attempts to use colchicine to double the chromosome number of the hybrids failed. Backcrosses of 84/1-94 to leek as the pollen parent were not successful. The first backcross of 99/1-94 to tetraploid leek produced 11 BC(1) plants with chromosome numbers between 38 and 41. Identification of parental chromosomes by GISH showed that all eight onion chromosomes and 30-33 leek chromosomes were transmitted to the backcross progenies due to unreduced egg cells. Onion chromosomes were eliminated during the second backcross. Southern hybridization confirmed the transfer of the T-cytoplasm like source of CMS from onion to the BC(2) progenies. After the third backcross to leek, 158 plants were obtained with varying numbers of onion chromosomes and some intergenomic recombinant chromosomes. Alloplasmic leek plants without onion chromatin were selected for further characterization of male sterility and quality traits.

Treatment of tardive dyskinesia with donepezil: a pilot study.

BACKGROUND: Tardive dyskinesia (TD) remains a significant clinical problem for which there is no uniformly effective treatment. Earlier trials with acetylcholine precursors may have been disappointing because of underlying damage to striatal cholinergic neurons in patients with TD. In contrast, new cholinesterase inhibitors, developed for the treatment of dementia, may improve TD by directly increasing cholinergic synaptic transmission. METHOD: We conducted an 8-week open-label trial of donepezil in the treatment of TD. Ten patients with schizophrenia or schizoaffective disorder who received stable doses of antipsychotics and met DSM-IV criteria for TD were treated with donepezil, 5 to 10 mg/day, for 6 weeks after a 2-week baseline period. Changes in total Abnormal Involuntary Movement Scale (AIMS) scores measured every 2 weeks were assessed for significance. Patients were also assessed using the Brief Psychiatric Rating Scale, the Mini-Mental State Examination, the Barnes Akathisia Scale, and the Simpson-Angus Scale. RESULTS: Total AIMS scores decreased significantly (p = .0009), with no changes in other measures. Nine patients showed a positive response. Improvement was greatest in orofacial and upper extremity movements. No significant interactions were noted between the total AIMS scores and age (p > .29), duration of TD (p > .38), or duration of antipsychotic treatment (p > .14). CONCLUSION: Donepezil appeared to be effective in suppressing TD in this pilot study. However, placebo-controlled, double-blind studies are necessary before donepezil can be recommended as a treatment for TD.

Using a 6-minute walk test to predict outcomes in patients with left ventricular dysfunction.

Maximal oxygen consumption (VO2MAX) is an independent variable that predicts outcomes in patients suffering from left ventricular dysfunction (LVD). Determining VO2MAX in a rehabilitation setting is not only costly and time-consuming but it would also be beyond many patients' physical abilities. This study's goal was to show that a simpler and less costly 6-minute walk test can predict mortality in patients with LVD. Sixty-six Phase 1 cardiac rehabilitation patients with LVD performed the 6-minute walk test upon admission and at discharge from a rehabilitation hospital. Upon discharge, the group that was able to walk significantly longer distances upon discharge had a higher survival rate 3 months after discharge. The 6-minute walk test can predict longer survival in patients with LVD and can provide valuable information for determining treatment plans, future prognosis, and home disposition of deconditioned LVD patients in a rehabilitation setting.

Classifying COAs with three variations of the CAST: classification rates, stability, and gender differences.

The Children of Alcoholics Screening Test (CAST) was administered to a sample of young adolescents as sixth graders and again one year later. Psychometric properties of the full CAST and a shortened version (CAST-6) were examined, and three different rules for classifying COAs were analyzed. The CAST was found to demonstrate adequate internal consistency and test-retest reliability. When examined as an entire group, the vast majority of respondents maintained the same classification (COA or NCOA) from the first to the second administration. For boys, however, CAST scores and the proportion who were self-identified as COAs declined significantly. Classification rates based on the full CAST and on the shortened version were similar. The use of two confirmatory items, "Ever think your father (mother) was an alcoholic?" however, substantially reduced the percentage of self-identified COAs. Finally, girls were dramatically more likely than boys to endorse items suggesting parental alcoholism, and they were also more likely to self-identify as COAs.

The relationship of self-perception and stress in adult children of alcoholics and their peers.

Woititz identified thirteen generalizations which she asserts characterize adult children of alcoholics (ACOAs) [1]. Her work, however, was based upon clinical populations and may not be generalizable to a non-clinical population. Using 442 undergraduate students, 2 x 3 multivariate analysis of variance (parental alcoholism by level of childhood stress) on students' perceptions of the applicability of Woititz's variables to them was conducted. No significant effects were found even though ACOAs experienced more childhood stress than their peers. Results do not support the generalization of Woitiz's model to a non-clinical sample.

Variables associated with alcohol abuse among self-identified collegiate COAs and their peers.

In order to investigate the interrelationship among children of alcoholics (COA) status, problem drinking, gender, and several psychosocial variables, a sample of college students completed a questionnaire that measured consequences of drinking, parental drinking habits, family environment, and personality. No relationship was found between COA status and either the likelihood or severity of problem drinking. Furthermore, COAs and non-COAs differed on only 4 of 15 psychosocial variables, suggesting a smaller impact of parental alcohol abuse than is commonly assumed. The variable most consistently related to problem drinking was social nonconformity, a measure of antisocial behavior. Findings suggest the importance of investigating the development and maintenance of antisocial behaviors as etiological factors in problem drinking among college students, rather than COA status per se.

Environmental and personality differences between children of alcoholics and their peers.

Nonclinical, adolescent children of alcoholics (COAs) and their peers from nonalcoholic homes (CONAs) responded to questionnaires of environmental variables, depression, and anxiety. Multivariate (discriminant) analyses revealed several meaningful differences between the two groups. Although the two groups differed on the measures of anxiety and depression, environmental stressors contributed most to the discriminant function that differentiated between the two groups. Also, gender differences were discovered, suggesting that males and females perceive problem drinking differently and that home environments may be different for the two genders. Implications for research and intervention are discussed.

Aphasic and tactile--perceptual deficits of disabled readers.

As part of a psychoeducational battery, 36 children, referred for reading and/or other learning difficulties, were administered the Aphasia Screening Test. the Tactile Finger Recognition Test, and the Finger-tip Number Writing Perception Test from the Halstead-Reitan Neuropsychological Test Battery for Older Children. The children were divided into two groups: 18 determined on the basis of a severe discrepancy to be eligible for learning disabilities services in the area of reading (RD) and 18 determined to be ineligible for such services (NRD). Statistical comparisons of the two groups revealed the RD group to display significantly more impairment on the Aphasia Screening Test and the Finger-tip Number Writing Perception Test.