Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement

Background: In clinical trials, at the group level, results are usually reported as mean and standard deviation of the change in score, which is not meaningful for most readers. Objective: To determine the minimal clinically important improvement (MCII) of pain, patient's global assessment of disease activity, and functional impairment in patients with knee and hip osteoarthritis (OA). Methods: A prospective multicentre 4 week cohort study involving 1362 outpatients with knee or hip OA was carried out. Data on assessment of pain and patient's global assessment, measured on visual analogue scales, and functional impairment, measured on the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) function subscale, were collected at baseline and final visits. Patients assessed their response to treatment on a five point Likert scale at the final visit. An anchoring method based on the patient's opinion was used. The MCII was estimated in a subgroup of 814 patients ( 603 with knee OA, 211 with hip OA). Results: For knee and hip OA, MCII for absolute ( and relative) changes were, respectively, ( a) -19.9 mm (-40.8%) and -15.3 mm (-32.0%) for pain; ( b) -18.3 mm ( - 39.0%) and -15.2 mm ( -32.6%) for patient's global assessment; ( c) -9.1 ( -26.0%) and -7.9 ( -21.1%) for WOMAC function subscale score. The MCII is affected by the initial degree of severity of the symptoms but not by age, disease duration, or sex. Conclusion: Using criteria such as MCII in clinical trials would provide meaningful information which would help in interpreting the results by expressing them as a proportion of improved patients.

Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state

Background: The patient acceptable symptom state ( PASS) is the value beyond which patients can consider themselves well. This concept can help in interpreting results of clinical trials. Objective: To determine the PASS estimate for patients with knee and hip osteoarthritis (OA) by assessing pain, patient's global assessment of disease activity, and functional impairment. Methods: A 4 week prospective multicentre cohort study of 1362 outpatients with knee or hip OA was carried out. Data on assessment of pain and patient's global assessment of disease, measured on visual analogue scales, and functional impairment, measured on the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) function subscale, were collected at baseline and final visits. The patients assessed their satisfaction with their current state at the final visit. An anchoring method based on the patient's opinion was used. Results: For patients with knee and hip OA, the estimates of PASS were, respectively, 32.3 and 35.0 mm for pain, 32.0 and 34.6 mm for patient global assessment of disease activity, and 31.0 and 34.4 points for WOMAC function score. The PASS varied moderately across the tertiles of baseline scores but not across age, disease duration, or sex. Conclusion: The use of PASS in clinical trials would provide more meaningful results expressed as a proportion of patients in an acceptable symptom state.

Variation in Coral Photosynthesis, Respiration and Growth Characteristics in Contrasting Light Microhabitats: An Analogue to Plants in Forest Gaps and Understoreys?

1. The often complex architecture of coral reefs forms a diversity of light microhabitats. Analogous to patterns in forest plants, light variation may drive strategies for efficient light utilization and metabolism in corals. 2. We investigated the spatial distribution of light regimes in a spur-and-groove reef environment and examine the photophysiology of the coral Montipora monasteriata (Forskal 1775), a species with a wide habitat distribution. Specifically, we examined the variation in tissue and skeletal thickness, and photosynthetic and metabolic responses among contrasting light microhabitats. 3. Daily irradiances reaching corals in caves and under overhangs were 1-5 and 30-40% of those in open habitats at similar depth (3-5 m), respectively. Daily rates of net photosynthesis of corals in cave habitats approximated zero, suggesting more than two orders of magnitude variation in scope for growth across habitats. 4. Three mechanisms of photoadaptation or acclimation were observed in cave and overhang habitats: (1) a 20-50% thinner tissue layer and 40-60% thinner skeletal plates, maximizing light interception per unit mass; (2) a two- to threefold higher photosynthetic efficiency per unit biomass; and (3) low rates of dark respiration. 5. Specimens from open and cave habitats displayed a high capacity to acclimate to downshifts or upshifts in irradiance, respectively. However, specimens in caves displayed limited acclimation to further irradiance reduction, indicating that these live near their irradiance limit. 6. Analogous to patterns for some plant species in forest gaps, the morphological plasticity and physiological flexibility of M. monasteriata enable it to occupy light habitats that vary by more than two orders of magnitude.

The cyclic antimicrobial peptide RTD-1 induces stabilized lipid-peptide domains more efficiently than its open-chain analogue

The effects of a mammalian cyclic antimicrobial peptide, rhesus theta defensin 1 (RTD-1) and its open chain analogue (oRTD-1), on the phase behaviour and structure of model membrane systems (dipalmitoyl phosphatidylcholine, DPPC and dipalmitoyl phosphatidylglycerol, DPPG) were studied. The increased selectivity of RTD-1 for anionic DPPG over zwitterionic DPPC was shown by differential scanning calorimetry. RTD-1, at a molar peptide-lipid ratio of 1:100, induced considerable changes in the phase behaviour of DPPG, but not of DPPC. The main transition temperature, T-m, Was unchanged, but additional phase transitions appeared above T-m. oRTD-1 induced similar effects. However, the effects were not observable below a peptide:lipid molar ratio of 1:50, which correlates with the weaker biological activity of oRTD-1. Small-and wide-angle X-ray scattering revealed for DPPG the appearance of additional structural features induced by RTP-1 above T-m, which were interpreted as correlated lamellar structures, with increased order of the fatty acyl side chains of the lipid. It is proposed that after initial electrostatic interaction of the cationic rim of the peptide with the anionic DPPG headgroups, leading to stabilized lipid-peptide clusters, the hydrophobic face of the peptide assists in its interaction with the fatty acyl side chains eventually leading to membrane disruption. (C) 2004 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

Fine mapping of the tomato I-3 gene for fusarium wilt resistance and elimination of a co-segregating resistance gene analogue as a candidate for I-3

The I-3 gene from the wild tomato species Lycopersicon pennellii confers resistance to race 3 of the devastating vascular wilt pathogen Fusarium oxysporum f. sp. lycopersici. As an initial step in a positional cloning strategy for the isolation of I-3, we converted restriction fragment length polymorphism and conserved orthologue set markers, known genes and a resistance gene analogue (RGA) mapping to the I-3 region into PCR-based sequence characterised amplified region (SCAR) and cleaved amplified polymorphic sequence (CAPS) markers. Additional PCR-based markers in the I-3 region were generated using the randomly amplified DNA fingerprinting (RAF) technique. SCAR, CAPS and RAF markers were used for high-resolution mapping around the I-3 locus. The I-3 gene was localised to a 0.3-cM region containing a RAF marker, eO6, and an RGA, RGA332. RGA332 was cloned and found to correspond to a putative pseudogene with at least two loss-of-function mutations. The predicted pseudogene belongs to the Toll interleukin-1 receptor-nucleotide-binding site-leucine-rich-repeat sub-class of plant disease resistance genes. Despite the presence of two RGA332 homologues in L. esculentum, DNA gel blot and PCR analysis suggests that no other homologues are present in lines carrying I-3 that could be alternative candidates for the gene.

Accelerating precursory activity within a class of earthquake analogue automata

A statistical fractal automaton model is described which displays two modes of dynamical behaviour. The first mode, termed recurrent criticality, is characterised by quasi-periodic, characteristic events that are preceded by accelerating precursory activity. The second mode is more reminiscent of SOC automata in which large events are not preceded by an acceleration in activity. Extending upon previous studies of statistical fractal automata, a redistribution law is introduced which incorporates two model parameters: a dissipation factor and a stress transfer ratio. Results from a parameter space investigation indicate that a straight line through parameter space marks a transition from recurrent criticality to unpredictable dynamics. Recurrent criticality only occurs for models within one corner of the parameter space. The location of the transition displays a simple dependence upon the fractal correlation dimension of the cell strength distribution. Analysis of stress field evolution indicates that recurrent criticality occurs in models with significant long-range stress correlations. A constant rate of activity is associated with a decorrelated stress field.

Desire to drink in low- and high-risk social drinkers: An experimental analogue of impaired control

This study used a novel cue exposure paradigm to investigate the differences between high- and low-risk drinkers in their desire to drink during a drinking session. Fifty-three self-selected participants were assigned to high- or low-risk drinking groups based on their self-reported consumption of alcohol, then compared on their desire to drink over a 90 min paced drinking session. High-risk drinkers showed increasing desire over the session, while low-risk drinkers' desire began to decrease after only a short drinking period. The perceived and actual effects of the alcohol did not appear to be able to account for the difference. Results are discussed with reference to issues of impaired control. Suggestions for future research directions are also offered.

On the existence of solutions to boundary value problems on time scales

This work formulates existence theorems for solutions to two-point boundary value problems on time scales. The methods used include maximum principles, a priori bounds and topological degree theory.

A comparison of the Yale-Brown obsessive compulsive scale for "Heavy drinking" with a single item craving measure: Construct validity and clinical utility

The measurement of alcohol craving began with single-item scales. Multifactorial scales developed with the intention to capture more fully the phenomenon of craving. This study examines the construct validity of a multifactorial scale, the Yale-Brown Obsessive Compulsive Scale for heavy drinking (Y-BOCS-hd). The study compares its clinical utility with a single item visual-analogue craving scale. The study includes 212 alcohol dependent subjects (127 males, 75 females) undertaking an outpatient treatment program between 1999-2001. Subjects completed the Y-BOCS-hd and a single item visual-analogue scale, in addition to alcohol consumption and dependence severity measures. The Y-BOCS-hd had strong construct validity. Both the visual-analogue alcohol craving scale and Y-BOCS-hd were weakly associated with pretreatment dependence severity. There was a significant association between pretreatment alcohol consumption and the visual-analogue craving scale. Neither craving measure was able to predict total program abstinence or days abstinent. The relationship between obsessive-compulsive behavior in alcohol dependence and craving remains unclear.

Rainfall variability at decadal and longer time scales: signal or noise?

Rainfall variability occurs over a wide range of temporal scales. Knowledge and understanding of such variability can lead to improved risk management practices in agricultural and other industries. Analyses of temporal patterns in 100 yr of observed monthly global sea surface temperature and sea level pressure data show that the single most important cause of explainable, terrestrial rainfall variability resides within the El Nino-Southern Oscillation (ENSO) frequency domain (2.5-8.0 yr), followed by a slightly weaker but highly significant decadal signal (9-13 yr), with some evidence of lesser but significant rainfall variability at interclecadal time scales (15-18 yr). Most of the rainfall variability significantly linked to frequencies tower than ENSO occurs in the Australasian region, with smaller effects in North and South America, central and southern Africa, and western Europe. While low-frequency (LF) signals at a decadal frequency are dominant, the variability evident was ENSO-like in all the frequency domains considered. The extent to which such LF variability is (i) predictable and (ii) either part of the overall ENSO variability or caused by independent processes remains an as yet unanswered question. Further progress can only be made through mechanistic studies using a variety of models.

A review of the psychometric properties of the Health of the Nation Outcomes Scales (HoNOS) family of measures

BACKGROUND: The Health of the Nation Outcome Scales was developed to routinely measure outcomes for adults with mental illness. Comparable instruments were also developed for children and adolescents (the Health of the Nation Outcome Scales for Children and Adolescents) and older people (the Health of the Nation Outcome Scales 65+). All three are being widely used as outcome measures in the United Kingdom, Australia and New Zealand. There is, however, no comprehensive review of these instruments. This paper fills this gap by reviewing the psychometric properties of each. METHOD: Articles and reports relating to the instruments were retrieved, and their findings synthesised to assess the instruments' validity (content, construct, concurrent, predictive), reliability (test-retest, inter-rater), sensitivity to change, and feasibility/utility. RESULTS: Mostly, the instruments perform adequately or better on most dimensions, although some of their psychometric properties warrant closer examination. CONCLUSION: Collectively, the Health of the Nation Outcome Scales family of measures can assess outcomes for different groups on a range of mental health-related constructs, and can be regarded as appropriate for routinely monitoring outcomes.

Heritability and nineteen-year stability of long and short EPQ-R Neuroticism scales

The heritability and stability over a 19 year period of long (23-item) and short (12-item) versions of Eysenck's Neuroticism scale were compared in a large Australian twin-family sample. Stability over 19 years of the 23-item Neuroticism scale was 0.62 and for the 12-item scale 0.59. Correlations between scores obtained by mailed questionnaire and telephone interview a few weeks apart were 0.87 for the long scale and 0.85 for the short scale; scores obtained by mail were slightly higher, particularly for females. The 12-item scale had slightly reduced power to discriminate both high and low scoring individuals on the full 23-item scale. Mean Neuroticism score for the 12-item scale was atypically low when compared to the distribution of the complete set of scores for all possible combinations (> 1 million) of 12-items drawn from the full 23-item EPQ-R. Mean heritabilities for the lowest and highest 300,000 of these combinations were 43.2% and 42.7%, respectively, somewhat higher than the 41.0% for the actual EPQ-R-S 12-item scale. Heritability for the 23-item scale was 46.5%. We conclude that there is little loss of either stability or heritability in using the short EPQ-R scale, but the choice of which 12-items could have been better. (c) 2005 Elsevier Ltd. All rights reserved.

Conceptual distinctions among Carver and White's (1994) BAS scales: A reward-reactivity versus trait impulsivity perspective

The 'BIS/BAS scales' (Carver & White, 1994) is the most widely cited inventory for assessing Gray's (1982,1991) Reinforcement Sensitivity Theory (RST) of personality. A peculiarity of this instrument is its three-factor representation of Gray's Behavioural Activation System (BAS), which mediates reactions to reward. While the BAS was initially proposed as the causal basis of Impulsivity, recent arguments suggest that Impulsivity is related to but distinct from reward-reactivity. In this paper, two studies examined Carver and White's BAS scales in terms of factor structure, and convergent/divergent validity when predicting proxies of Impulsivity and reward-reactivity. Confirmatory Factor Analysis revealed structural distinctions between the three BAS scales, and multivariate regression suggested that two of the scales (Drive and Reward-Responsiveness) reflect key concepts of the BAS, while the third (Fun-Seeking) has a broader focus, being equally related to reward-reactivity and Impulsivity. (c) 2005 Elsevier Ltd. All rights reserved.

The MMPI-2 Gender-Masculine and Gender-Feminine scales: Gender roles as predictors of psychological health in clinical patients

Previous research measuring various biosocial factors such as age, sex, and marital status has found them to be essentially unrelated to measures of psychological health. Recent empirical studies have revealed that personality constructs may be more significant than demographic variables in the prediction of psychological well-being. The present study assessed the personality constructs of masculinity and femininity and hypothesized that the Gender-Masculine ( GM) scale of the MMPI-2 would be more effective than the Gender-Feminine (GF) scale in predicting psychological well-being. This hypothesis stems from previous research that has indicated the dominance of the masculinity model. It is suggested that previous research supporting androgyny as a primary indicator of well-being was influenced by the masculinity component of this gender orientation. One hundred and seventy-seven psychiatric patients from Australia (N = 107) and Singapore ( N 5 70) completed the MMPI-2. Hierarchical multiple regression revealed significantly stronger masculinity effects, with significance achieved on measures of ego strength and low self-esteem. No significant relationship between psychological well-being and the GF variable was found. Similarly, androgyny did not add any further variance to the model when masculinity was controlled for. Overall, the results are consistent with an interpretation that GM is a better correlate of psychological well-being as compared to the GF scale.