The development and validation of the impact of multiple sclerosis scale and the symptoms of multiple sclerosis scale

Objective

To develop and validate the Impact of Multiple Sclerosis Scale (IMSS) and the Symptoms of Multiple Sclerosis Scale (SMSS) using the Extended Disability Status Scale (EDSS) for construct validity.
Design

Panel design involving test-retest over 4 months.
Setting

A mailed survey.
Participants

Volunteers with a diagnosis of multiple sclerosis (MS) recruited from an MS support service in Australia: 193 people (mean age, 39y) and 150 people participated at time 1 and time 2, respectively.
Interventions

Not applicable.
Main Outcome Measures

Principal components analyses, the Cronbach α, and descriptive statistics for the 2 scales; correlations for construct validity with the EDSS and retest; and confirmatory factor analysis to test the stability of IMSS and SMSS components over time.
Results

The IMSS yielded 5 independent and reliable components; the SMSS yielded 3 components; both component structures were stable over time. These scales showed convergent validity with the EDSS.
Conclusions

The IMSS and SMSS are psychometrically sound scales suitable for clinical and research purposes to assess the symptoms and impact of MS.

A randomized comparison of quadruple and triple therapies for helicobacter pylori eradication: The QUADRATE study.

Background &amp; Aims: Direct comparisons of bismuth and proton pump inhibitor (PPI)-based triple and quadruple therapies for Helicobacter pylori eradication are lacking. To address this, a randomized study was conducted.Methods: Infected dyspeptic patients received pantoprazole 40 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, all twice daily, for 7 days (PAC7); or pantoprazole 40 mg twice daily, bismuth subcitrate 108 mg, and tetracycline 500 mg, both 4 times daily, and metronidazole 200 mg 3 times daily and 400 mg at night for 7 days (PBTM7); bismuth subcitrate 108 mg and tetracycline 500 mg, both 4 times daily, and metronidazole 200 mg 3 times daily and 400 mg at night for 14 days (BTM14). Outcome was assessed with ¹³C-urea breath test.Results: Eradication rates (intention to treat [n = 405]/per protocol [n = 320]) were similar for PAC7 (78%/82%) and PBTM7 (82%/88%); the latter significantly superior to BTM14 (69%/74%; P < 0.01). Pretreatment metronidazole resistance (MR) was 53% and clarithromycin resistance was 8%. Eradication rates for primary metronidazole sensitive/resistant isolates were 74%/87% with PAC7 and 80%/81% for PBTM7, compared with 76%/55% (P < 0.02) for BTM14. Noncompliance was greater with BTM14 (15%; P < 0.001) than PAC7 (3%) or PBTM7 (6%). Moderate-severe adverse events were more common with BTM14 (45%; P < 0.001), than PAC7 (23%) or PBTM7 (25%) with more discontinuations (9%, 2%, 3%, respectively).Conclusions: One-week PPI triple therapy is well tolerated and effective. The addition of PPI to bismuth triple therapy allows reduction of treatment duration with improved efficacy and tolerability, despite a high rate of MR. Quadruple therapy appears to overcome pretreatment MR in most cases. Two-week bismuth triple therapy is significantly inferior to quadruple therapy and less well tolerated than both 1-week therapies.

Construct validity of the Chinese version of the disability of the arm, shoulder and hand questionnaire (DASH-HKPWH)

The study evaluated the construct validity of the Chinese Hong Kong version of the disabilities of the arm, shoulder and hand questionnaire (DASH-HKPWH). Three hundred and thirty four patients with a broad range of upper extremity disorders were recruited into the study. Each completed DASH-HKPWH and SF-36 forms and their pain intensity (numeric pain rating scale) and grip strength were also measured. The mean DASH-HKPWH score was 40 (SD = 20). Principal component factor analysis identified a single factor, which accounted for 47% of the total variance. Pearson correlation was applied to assess convergent and divergent validity of the DASH-HKPWH by comparison with the above-mentioned subjective and objective measurements. Our findings were comparable to the DASH of other languages

Beliefs, practices, and expectations of oral teachers of the deaf

This study investigated the beliefs and practices of 28 teachers of the deaf about their practices. The teachers were all working in oral settings either as visiting teachers or teachers in a mainstream school facility supporting groups of students with hearing loss. Teachers who used an Auditory Verbal approach largely adopted a positivist paradigm, whereas those using an Auditory Oral approach were more likely to adopt a constructivist paradigm. Those using a mixed approach (AV/AO) adopted a paradigm that was a mix of both positivist and constructivist. Results suggest that there is a strong relationship between the underlying beliefs of teachers and the model of practice that they adopt, and that professional experience, professional development and the inclusion movement exert an influence on those beliefs and practices.

The mathematical and science skills of students who are deaf or hard of hearing educated in inclusive settings

This study examined the science and mathematics achievements of 16 Year 9 students with hearing loss in an inclusive high-school setting in Western Australia. Results from the Monitoring Standards in Education (MSE) compulsory state tests were compared with state and class averages for students with normal hearing. Data were collected from three cohorts of Year 9 students across a 3-year period (2005‐2007). Results from mathematics MSE9 and the MSE9 science assessments showed that the majority of students with hearing loss performed below the state average (88%). Findings in this study suggest that students with hearing loss demonstrated more mathematical strength in the areas of space and measurement, which use visuo-spatial skills. Results for students with hearing loss in the five sections of the science assessment suggest more consistency across the different areas tested in the MSE. Comparisons with the MSE9 English paper for the 2005 cohort of students with hearing loss suggest a strong relationship between reading and writing skills and performance on mathematics and science assessment. In particular, questions with high language content created difficulty. On the science assessment, questions requiring a written explanation appeared to be particularly challenging. These findings have implications for teaching and learning in these crucial areas for students with hearing loss in inclusive secondary school settings. Greater attention to the interpretation of the language of mathematics and to writing about science concepts may help to improve outcomes for students with hearing loss on statewide assessments

‘Moral luck’ and the question of autonomy, choice, and control in end-of-life decision making

It is commonly assumed that, in the realm of ethical decision making at the end-of-life, ‘luck’ and ‘risk’ do not intrude. Nonetheless ‘moral luck’ (where happenstance makes a moral difference) does intrude and can have an unanticipated impact on the ultimate moral outcomes of end-of-life care. In the interests of upholding the ethical standards of end-of-life care, healthcare providers have increasingly relied on ethical principlism as a rational decision-guiding frame in the sincere belief that such an approach will enable patient selfdetermination and control over treatment decisions when needing end-of-life care. Due to contextual variables and associated uncertainties in end-of-life care, however, the intended moral outcomes of appeals to commonly accepted ethical principles (in particular the principle of autonomy) are not always realized. What is not always appreciated is that whether ‘good’ or ‘bad’ moral outcomes are achieved can be as much a matter of chance as of choice. This essay explores the relevance and possible implications of moral luck in end-of-life decision making and care. A key conclusion of the paper is that the notion of moral luck needs to be taken seriously in end-of-life care contexts since it can have an unanticipated impact on the outcomes of the decisions that are made and thereby on the moral interests of patients facing the end of their lives.

Contribution of objective and subjective attributes to the variation in the whiteness and brightness of commercial mohair sale lots

Colour properties are measured prior to the sale of merino wool as they are of commercial importance when greasy wool is sold and when wool is dyed. With the paucity of knowledge of the colour properties of commercial mohair, this study aimed to identify and quantify the factors affecting the brightness (Y) and yellowness (Y-Z) values of commercial lots of Australian mohair. The research database comprised 520 sale lots (>500,000 kg mohair), which had tristimulus tests, and was sold during the period 2001&ndash;2009. Mohair was subjectively classed and sale lots objectively tested using international standard methods for mean fibre diameter (MFD, μm), fibre diameter coefficient of variation (%), International Wool Testing Organization (IWTO) clean wool base (IWTO yield, %w/w), vegetable matter (VM, %w/w) and the tristimulus values X, Y and Z (T units). The tristimulus values of Australian mohair were affected by the objective measurements of MFD, VM%, the subjective classing of stain, cotting, kemp and length and by the year and selling season. Variation in Y was more easily predicted with 90.5% of variance explained by the best model compared with variation in Y-Z, where the best model explained 51.6% of the total variance. Visually assessed properties of the mohair were very important in separating mohair of different Y properties, accounting for almost 80% of the total variance, but were far less important in accounting for the variance in Y-Z, accounting for about 9&ndash;10% of the total variance. The most important effects on the Y of mohair were associated with subjectively determined fault categories determined before the sale of mohair. In particular, stain fault explained about two-thirds of the variance in brightness of mohair sale lots. Stained mohair had much lower brightness than mohair free of stain but stain fault explained very little of the variation in yellowness of mohair sale lots. The extent of the differences in tristimulus values between seasons and years were not large for Y but were more important for yellowness (Y-Z), and these effects are likely to be of commercial importance. Generally, brightness decreased and yellowness increased as MFD increased up to about 30 μm. Both cotting and kemp fault were associated with reduced brightness and increased yellowness. The effects of VM% on tristimulus values were small. IWTO yield was associated with changes in tristimulus values, but in the best model, IWTO yield was not a significant determinant. This study indicates that commercial Australian fleece (nonfaulted) mohair was essentially white. Faulted mohair on the other hand exhibited poorer colour characteristics. The mohair subjectively identified as stained prior to sale comprised all the mohair which would be regarded as not white, and this investigation indicates that the effect of staining is on the brightness of mohair rather than the Y-Z measurement. Unlike the situation with merino wool, there was little relationship between the naturally occurring contaminants, as measured by the IWTO washing yield, and either Y or Y-Z.