Ability of the Wisconsin Card-Sorting Test-64 as an embedded measure to identify noncredible neurocognitive performance in mild traumatic brain injury litigants.

OBJECTIVE: To investigate the ability of selective measures on the Wisconsin Card Sorting Test-64 (WCST-64) to predict noncredible neurocognitive dysfunction in a large sample of mild traumatic brain injury (mTBI) litigants. METHOD: Participants included 114 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT). RESULTS: Participants failing PVTs performed worse across all WCST-64 dependent variables of interest compared to participants who passed PVTs. Receiver operating curve analysis revealed that only categories completed was a significant predictors of PVT status. Multivariate logistic regression did not add to classification accuracy. CONCLUSION: Consideration of noncredible executive functioning may be warranted in mild traumatic brain injury (mTBI) litigants who complete ≤ 1 category on the WCST-64.

Detection of noncredible cognitive performance with Wechsler Memory Scale-IV measures in mild traumatic brain injury litigants.

OBJECTIVE: To investigate the operating characteristics of selective measures on the Wechsler Memory Scale-IV (WMS-IV) to predict noncredible neurocognitive dysfunction in a sample of mild traumatic brain injury (mTBI) litigants. METHOD: Participants included 110 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity testing (PVT). RESULTS: Participants failing two stand-alone PVTs exhibited significantly lower scores across all WMS-IV dependent variables of interest compared to participants who passed both PVTs. Participants who failed one PVT were excluded. Bivariate logistic regression revealed that all six dependent variables were significant predictors of PVT status. The best prediction model consisted of three WMS-IV variables including Logical Memory Delayed Recall (LM2), Logical Memory Recognition (LMR), and Visual Reproduction Recognition (VRR). This model demonstrated an accuracy of 90.2%, 0.89 sensitivity, 0.92 specificity, and a Receiver Operating Curve (ROC) of 0.957. CONCLUSION: The current empirically-derived cutscores and logit equation for the WMS-IV may be an additional consideration in analyzing database validity and noncredible performance in mTBI personal injury litigants ages 18-69.

Impact of adjuvant chemotherapy on long-term overall survival in patients with high-risk stage II colon cancer: a nationwide cohort study.

BACKGROUND: This study aimed to investigate the impact of adjuvant chemotherapy on long-term survival in unselected patients with high-risk stage II colon cancer including an analysis of each high-risk feature. MATERIALS AND METHODS: Data from the Danish Colorectal Cancer Group, the National Patient Registry and the Danish Pathology Registry from 2014 to 2018 were merged. Patients surviving > 90 days were included. High-risk features were defined as emergency presentation, including self-expanding metal stents (SEMS)/loop-ostomy as a bridge to resection, grade B or C anastomotic leakage, pT4 tumors, lymph node yield < 12 or signet cell carcinoma. Eligibility criteria for chemotherapy were age < 75 years, proficient MMR gene expression, and performance status ≤ 2. The primary outcome was 5-year overall survival. Secondary outcomes included the proportion of eligible patients allocated for adjuvant chemotherapy and the time to first administration. RESULTS: In total 939 of 3937 patients with stage II colon cancer had high-risk features, of whom 408 were eligible for chemotherapy. 201 (49.3%) patients received adjuvant chemotherapy, with a median time to first administration of 35 days after surgery. The crude 5-year overall survival was 84.9% in patients receiving adjuvant chemotherapy compared with 66.3% in patients not receiving chemotherapy, p < 0.001. This association corresponded to an absolute risk difference of 14%. CONCLUSION: 5-year overall survival was significantly higher in patients with high-risk stage II colon cancer treated with adjuvant chemotherapy compared with no chemotherapy. Adjuvant treatment was given to less than half of the patients who were eligible for it.

Inter-hospital variation in management of patients with small bowel obstruction in Denmark.

INTRODUCTION: Inter-hospital variation in the management of small bowel obstruction (SBO) has been described in other countries, but the extent to which similar variations exist in Denmark remains unknown. This study aimed to compare the management of SBO between hospitals in Denmark and identify potential areas for improvement METHODS. This was a multicentre prospective study performed at six emergency hospitals. Patients aged ≥ 18 years with a diagnosis of SBO were eligible for inclusion. The primary study endpoints were the proportion of patients undergoing operative versus non-operative management, laparoscopic surgery versus open surgery and the success rate of non-operative management. RESULTS: A total of 316 patients were included. No differences were noted in diagnostic pathways or operative versus non-operative management. However, variations were noted in compliance with peri-operative care bundles, ranging from 63.2% to 95.8%. The surgical approach also varied, with the use of laparoscopic surgery ranging from 20.7% to 71.0% (p less-than 0.001). Variations were also noted in duration of surgery (63-124 minutes, p less-than 0.001), time to re-introduction of normal diet and length of hospital stay (3-8.5 days, p less-than 0.001). No differences were observed in 30-day or 90-day mortality rates. CONCLUSION: The management of SBO in Denmark is relatively standardised. Future efforts should focus on improving adherence to multidisciplinary peri-operative protocols, optimising patient selection for laparoscopic surgery and standardising nutritional therapy. FUNDING: None. TRIAL REGISTRATION: NCT04750811.

The Continuous Visual Memory Test: Update and extension on the operating characteristics as an embedded measure of cognitive performance validity.

Objective: To compare and update predictive models comprised of embedded measures from the Continuous Visual Memory Test (CVMT) in their ability to predict performance validity in personal injury litigants. Methods: Ninety-two personal injury litigants underwent a comprehensive neuropsychological examination. Criterion groups were formed, i.e. PVT-Pass and PVT-Fail, based upon their performance on stand-alone measures of performance validity (PVT). Independent-samples t-tests investigated group differences on dependent variables of interest while logistic regression analyses, as well as a decision tree classification procedure, were employed to identify the best predictive model. Results: The PVT-Fail group scored significantly lower on the 20-item Larrabee Index (LI), and three CVMT variables comprising the Henry-Enders Index (HEI) including Hits, Total Score, and Delayed Recall, but significantly higher on False Alarm Errors. Although the Total score was the best single predictor of PVT status, the addition of LI improved sensitivity. The best predictive model was derived via a classification and regression tree analysis which selected LI and CVMT-FA resulting in .91 specificity, .60 sensitivity, and ROC = 0.832. Conclusion: In the current study total CVMT scores < 70, and LI scores < 18 were rare for PI litigants with MTBI and not seen in litigants with moderate and severe brain injury who passed PVTs. Three predictive CVMT models were derived. When failure on one of the models is observed then concerns about the credibility of visual memory performance should be considered with particular attention to other stand-alone and embedded measures of performance validity.

The Pain Disability Index: Effects of performance and symptom validity in mild traumatic brain injury litigants with persistent Post-Concussion pain complaints.

OBJECTIVE: Objectives of the current study were to cross validate the Pain Disability Index (PDI) as a measure of symptom validity in a large sample of mild traumatic brain injury (MTBI) litigants with persistent post-concussive pain complaints, and investigate the effects of performance and symptom validity testing on PDI scores. METHODS: Participants included 91 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT), and the MMPI-2-RF Symptom Validity Scale (FBS-r) as a measure of symptom validity (SVT). RESULTS: Participants who failed PVT and SVT scored significantly higher on the PDI compared to participants who passed both. Failing both was associated with a large effect size. Failing PVT, but passing SVT, was associated with a medium effect on PDI scores, while passing PVT, but failing SVT demonstrated a small effect. A PDI cutscore of 49 was associated with .90 specificity and .47 sensitivity. CONCLUSION: The PDI demonstrates external validity as a self-report measure of symptom validity in MTBI litigants with persistent post-concussive pain complaints. A dose response relationship exists between PVT, SVT and PDI scores. Forensic examiners should include both PVT and SVT to optimize clinical decision making when evaluating MTBI litigants with complaints of pain-related disability years post-incident.

Response time measures on the Word Memory Test do not add incremental validity to accuracy scores in predicting noncredible neurocognitive dysfunction in mild traumatic brain injury litigants.

The objective of the current study was to investigate whether response time measures on the Word Memory Test (WMT) increase predictive validity on determining noncredible neurocognitive dysfunction in a large sample of mild traumatic brain injury (MTBI) litigants. Participants included 203 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT). Participants failing PVTs exhibited significantly slower response times and lower accuracy on the WMT compared to participants who passed PVTs. Response time measures did not add significant incremental validity beyond that afforded by WMT accuracy measures alone. The best predictor of PVT status was the WMT Consistency Score (CNS) which was associated with an extremely large effect size (d = 16.44), followed by Immediate Recognition (IR: d = 10.68) and Delayed Recognition (DR: d = 10.10).

The Modified Somatic Perception Questionnaire: Operating characteristics in non-pain forensic samples.

The objective of the current archival study was to investigate the ability of the Modified Somatic Perception Questionnaire (MSPQ) to discriminate between noncredible and credible neurocognitive dysfunction in a large mixed non-pain forensic sample comprised of personal injury litigants and disability claimants. Participants included 149 adults who underwent comprehensive neuropsychological examination. Criterion groups were formed, i.e., Credible Group (CG), or Noncredible Group (NCG) based upon their performance on stand-alone performance validity tests (PVT) including the Word Memory Test (WMT), and/or Test of Memory Malingering (TOMM), and Victoria Symptom Validity Test (VSVT). After excluding examinees with evidence of somatization participants in the NCG scored significantly higher on the MSPQ compared to participants in the CG. Scores on the MSPQ were not only related to cognitive performance validity but also amplified by the co-existence of somatization. There were no significant effects of gender, age, or race on MSPQ scores. We conclude that the MSPQ demonstrates external validity as a self-report measure of symptom validity that is sensitive to somatic and autonomic complaints in non-pain forensic samples. Future research is needed to develop MSPQ cutscores with external validity pertinent to other non-pain populations.

Posttraumatic stress disorder and noncredible symptom reporting on the Trauma Symptom Inventory-2.

This archival study sought to investigate the ability of raw scores on the Atypical Response scale (ATR) and TRAUMA Factor of the Trauma Symptom Inventory-2 to predict noncredible cognitive performance validity testing (PVTs) in personal injury litigants and disability claimants with posttraumatic stress disorder (PTSD). Participants included 51 adults diagnosed with PTSD who underwent comprehensive neuropsychological examination. Criterion groups were formed based upon passing (Credible Group) or failing (Noncredible Group) cognitive performance validity tests (PVTs). Participants failing PVTs scored significantly higher on the ATR and TRAUMA Factor raw scores compared to those passing PVTs. Bivariate logistic regression analyses revealed that ATR scores ≥7 and TRAUMA Factor scores ≥75 were associated with failure on cognitive performance validity measures at ≥ 90% specificity. We conclude that PTSD in a forensic context is associated with a high rate of exaggerated neurocognitive dysfunction as well as symptom over reporting. The proposed ATR cutoff of ≥15 for forensic contexts in the TSI-2 test manual is methodologically flawed and needs to be adjusted downward. Cutscores for the ATR and TRAUMA Factor are presented at various base rates to assist clinicians examining claims of PTSD in a forensic context.

The relationship of cogniphobia to performance validity and symptom validity in neuropsychological assessment.

OBJECTIVE: Emerging research suggests that fear and avoidance are associated with not only physical symptoms, but also cognitive functioning. The concept of cogniphobia describes the fear and avoidance of cognitively effortful tasks to avoid the onset or worsening of symptoms. Extant studies provide preliminary evidence for associations between cogniphobia and validity testing. However, less is known about the subcomponents of cogniphobia. This study investigated the relationship of cogniphobia subcomponents to validity testing and psychological presentations. METHOD: Participants included 171 adults from an archival database who had completed measures of cogniphobia and psychological symptom reports as part of a larger neuropsychological study. The sample was classified as scoring above or below published cutoffs on performance validity tests (PVTs) and symptom validity tests (SVTs), consistent with current research/recommendations. RESULTS: Confirmatory factor analysis (CFA) supported a two-factor model of cogniphobia, with Avoidance and Dangerousness as subcomponents. Logistic regression analyses identified Avoidance as the strongest predictor of scores falling in the invalid range on PVTs and SVTs, as well as the presence of external incentives. After excluding participants who fell in the invalid range on SVTs, only Avoidance significantly predicted report of somatic complaints. CONCLUSIONS: Cogniphobia, especially the avoidance of cognitive exertion component, is associated with performance in the invalid range on both PVTs and SVTs and is also related to report of somatic concerns when controlling for beliefs that cognitive exertion is dangerous. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Iontophoresis burns: a peculiar cutaneous injury from a diagnostic sweat test for cystic fibrosis.

An 8-month-old child presented after an emergency referral from a paediatric clinic. She had sustained a small burn injury to the left volar wrist during the sweat test for cystic fibrosis. The injury was managed conservatively. There is limited literature on burn injuries sustained during the sweat test, despite it being a known risk and the incidence is reported as very small. We wonder if such events are not being reported because the injury caused is usually minor and so may be more prevalent than previously considered.

Illness Perceptions Predict Cognitive Performance Validity.

OBJECTIVES: The aim of this study was to investigate the relationship of psychological variables to cognitive performance validity test (PVT) results in mixed forensic and nonforensic clinical samples. METHODS: Participants included 183 adults who underwent comprehensive neuropsychological examination. Criterion groups were formed, that is, Credible Group or Noncredible Group, based upon their performance on the Word Memory Test and other stand-alone and embedded PVT measures. RESULTS: Multivariate logistic regression analysis identified three significant predictors of cognitive performance validity. These included two psychological constructs, for example, Cogniphobia (perception that cognitive effort will exacerbate neurological symptoms), and Symptom Identity (perception that current symptoms are the result of illness or injury), and one contextual factor (forensic). While there was no interaction between these factors, elevated scores were most often observed in the forensic sample, suggesting that these independently contributing intrinsic psychological factors are more likely to occur in a forensic environment. CONCLUSIONS: Illness perceptions were significant predictors of cognitive performance validity particularly when they reached very elevated levels. Extreme elevations were more common among participants in the forensic sample, and potential reasons for this pattern are explored. (JINS, 2018, 24, 735-745).

PROGRESSIVE SYRINGOHYDROMYELIA AND DEGENERATIVE AXONOPATHY IN A BOBCAT (LYNX RUFUS) FOLLOWING SURGICAL CORRECTION OF A CHIARI-LIKE MALFORMATION.

A 3-yr-old male captive bobcat (Lynx rufus) presented with chronic ataxia and right-sided head tilt. Magnetic resonance imaging (MRI) revealed cerebellar crowding and compression consistent with Chiari-like malformation. The clinical signs did not improve after surgical occipital craniectomy, and 2 mo postoperatively a second MRI showed hydromyelia and continued cerebellar compression. The bobcat was euthanized, and necropsy showed chronic focal cerebellar herniation and chronic multifocal atlanto-occipital joint osteophyte proliferation. Histology confirmed the presence of a thick fibrous membrane along the caudal aspect of the cerebellar vermis, suggestive of postoperative adhesions, and axonal degeneration of the cervical spinal cord, even in sections without a central canal lesion. These lesions appear to have been complications associated with surgical correction of the Chiari-like malformation.

Formation and dimerization of the phosphodiesterase active site of the Pseudomonas aeruginosa MorA, a bi-functional c-di-GMP regulator.

Diguanylate cyclases (DGC) and phosphodiesterases (PDE), respectively synthesise and hydrolyse the secondary messenger cyclic dimeric GMP (c-di-GMP), and both activities are often found in a single protein. Intracellular c-di-GMP levels in turn regulate bacterial motility, virulence and biofilm formation. We report the first structure of a tandem DGC-PDE fragment, in which the catalytic domains are shown to be active. Two phosphodiesterase states are distinguished by active site formation. The structures, in the presence or absence of c-di-GMP, suggest that dimerisation and binding pocket formation are linked, with dimerisation being required for catalytic activity. An understanding of PDE activation is important, as biofilm dispersal via c-di-GMP hydrolysis has therapeutic effects on chronic infections.

[Formula: see text]evidence of neuropsychological dysfunction in Stevens-Johnson Syndrome and toxic epidermal necrolysis: case report.

Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) is a potentially life-threatening critical illness affecting multiple organ systems including the peripheral and central nervous system. This case report involves a young man who was diagnosed with SJS/TEN at age 16 and underwent neuropsychological assessment at age 21. Results indicate a diffuse pattern of cerebral compromise and represent a decline from premorbid level of functioning. The etiology of the cognitive impairment in this patient is likely multifactorial with possible pathophysiologic mechanisms including hypoxemia, metabolic acid-base perturbations, hyperglycemia, and delirium, as well as sepsis and inflammation.

Use of a novel morphometric method and body fat index system for estimation of body composition in overweight and obese dogs.

OBJECTIVE: To develop morphometric equations for prediction of body composition and create a body fat index (BFI) to estimate body fat percentage in overweight and obese dogs. DESIGN: Prospective evaluation study. ANIMALS: 83 overweight or obese dogs ≥ 1 year of age. PROCEDURES: Body condition score (BCS) was assessed on a 5-point scale, morphometric measurements were made, and visual and palpation-based assessments and dual-energy x-ray absorptiometry (DEXA) were performed. Equations for predicting lean body mass, fat mass, and body fat as a percentage of total body weight (ie, body fat percentage) on the basis of morphometric measurements were generated with best-fit statistical models. Visual and palpation-based descriptors were used to develop a BFI. Predicted values for body composition components were compared with DEXA-measured values. RESULTS: For the study population, the developed morphometric equations accounted for 98% of the variation in lean body mass and fat mass and 82% of the variation in body fat percentage. The proportion of dogs with predicted values within 10% of the DEXA values was 66 of 83 (80%) for lean body mass, 56 of 83 (68%) for fat mass, and 56 of 83 (67%) for body fat percentage. The BFI accurately predicted body fat percentage in 25 of 47 (53%) dogs, whereas the value predicted with BCS was accurate in 6 of 47 (13%) dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Morphometric measurements and the BFI appeared to be more accurate than the 5-point BCS method for estimation of body fat percentage in overweight and obese dogs. Further research is needed to assess the applicability of these findings to other populations of dogs.

Use of a morphometric method and body fat index system for estimation of body composition in overweight and obese cats.

OBJECTIVE: To develop morphometric equations for prediction of body composition and create a body fat index (BFI) system to estimate body fat percentage in overweight and obese cats. DESIGN: Prospective evaluation study. ANIMALS: 76 overweight or obese cats ≥ 1 year of age. PROCEDURES: Body condition score (BCS) was determined with a 5-point scale, morphometric measurements were made, and dual-energy x-ray absorptiometry (DEXA) was performed. Visual and palpation-based evaluation of various body regions was conducted, and results were used for development of the BFI system. Best-fit multiple regression models were used to develop equations for predicting lean body mass and fat mass from morphometric measurements. Predicted values for body composition components were compared with DEXA results. RESULTS: For the study population, prediction equations accounted for 85% of the variation in lean body mass and 98% of the variation in fat mass. Values derived from morphometric equations for fat mass and lean mass were within 10% of DEXA values for 55 of 76 (72%) and 66 of 76 (87%) cats, respectively. Body fat as a percentage of total body weight (ie, body fat percentage) predicted with the BCS and BFI was within 10% of the DEXA value for 5 of 39 (13%) and 22 of 39 (56%) cats, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The BFI system and morphometric equations were considered accurate for estimation of body composition components in overweight and obese cats of the study population and appeared to be more useful than BCS for evaluation of these patients. Further research is needed to validate the use of these methods in other feline populations.