Response Validity in Forensic Neuropsychology: Exploratory Factor Analytic Evidence of Distinct Cognitive and Psychological Constructs

Forensic neuropsychology studies usually address either cognitive effort or psychological response validity. Whether these are distinct constructs is unclear. In 122 participants evaluated in a compensation-seeking context, the present Exploratory Factor Analysis examined whether forced-choice cognitive effort measures (Victoria Symptom Validity Test, Test of Memory Malingering, Letter Memory Test) and Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) validity scales (L, F, K, FBS, Fp, RBS, Md, Dsr2, S) load on independent factors. Regardless of factor rotation strategy (orthogonal or oblique), four response validity factors emerged by means of both Principal Components Analysis (82.7% total variance) and Principal-Axis Factor Analysis (74.1% total variance). The four factors were designated as follows: Factor I, with large loadings from L, K, and S—underreporting of psychologicalsymptoms; Factor II, with large loadings from FBS, RBS, and Md—overreporting of neurotic symptoms; Factor III, with large loadings from VSVT, TOMM, and LMT—insufficient cognitive effort; and Factor IV, with the largest loadings from F, Fp, and Dsr2—overreporting of psychotic/rarely endorsed symptoms. Results reflect the heterogeneity of response validity in forensic samples referred for neuropsychological evaluation. Administration of both cognitive effort measures and psychological validity scales is imperative to accurate forensic neuropsychological assessment. (JINS, 2007, 13, 440–449.

Use of MMPI-2 to Predict Cognitive Effort: A Hierarchically Optimal Classification Tree Analysis

Neuropsychologists routinely rely on response validity measures to evaluate the authenticity of test performances. However, the relationship between cognitive and psychological response validity measures is not clearly understood. It remains to be seen whether psychological test results can predict the outcome of response validity testing in clinical and civil forensic samples. The present analysis applied a unique statistical approach, classification tree methodology (Optimal Data Analysis: ODA), in a sample of 307 individuals who had completed the MMPI-2 and a variety of cognitive effort measures. One hundred ninety-eight participants were evaluated in a secondary gain context, and 109 had no identifiable secondary gain. Through recurrent dichotomous discriminations, ODA provided optimized linear decision trees to classify either sufficient effort (SE) or insufficient effort (IE) according to various MMPI-2 scale cutoffs. After “pruning” of an initial, complex classification tree, the Response Bias Scale (RBS) took precedence in classifying cognitive effort. After removing RBS from the model, Hy took precedence in classifying IE. The present findings provide MMPI-2 scores that may be associated with SE and IE among civil litigants and claimants, in addition to illustrating the complexity with which MMPI-2 scores and effort test results are associated in the litigation context. (JINS, 2008, 14, 842–852.

Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic

Background: Many people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors. Methods: Consecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Arthritis Self-Efficacy Scale (ASES). Influence of factors on pain level and regularity of analgesic use were investigated using linear regression. Differences in pain between those agreeing and disagreeing with statements regarding analgesic use were assessed using t-tests. Results: 218 patients (85% of attendees) completed the study. Six (2.8%) patients reported no current pain, 26 (12.3%) slight, 100 (47.4%) moderate, 62 (29.4%) severe and 17 (8.1%) extreme pain. In multiple linear regression self efficacy and regularity of analgesic use were significant (p < 0.01) with lower self efficacy and more regular use of analgesics associated with more pain. Low SE was associated with greater pain: 40 (41.7%) people with low SE reported severe pain versus 22 (18.3%) people with high SE, p < 0.001. Patients in greater pain were significantly more likely to take analgesics regularly; 13 (77%) of those in extreme pain reported always taking their analgesics every day, versus 9 (35%) in slight pain. Many patients, including 46% of those in severe pain, adjusted analgesic use to current pain level. In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: higher levels of pain corresponded to more regular analgesic use (p = 0.003). Conclusion: Our study confirms that there is a strong inverse relationship between self-efficacy and pain severity. Analgesics are often used irregularly by people with arthritis, including some reporting severe pain

Gender-dependent differences in plasma matrix metalloproteinase-8 elevated in pulmonary tuberculosis.

Tuberculosis (TB) remains a global health pandemic and greater understanding of underlying pathogenesis is required to develop novel therapeutic and diagnostic approaches. Matrix metalloproteinases (MMPs) are emerging as key effectors of tissue destruction in TB but have not been comprehensively studied in plasma, nor have gender differences been investigated. We measured the plasma concentrations of MMPs in a carefully characterised, prospectively recruited clinical cohort of 380 individuals. The collagenases, MMP-1 and MMP-8, were elevated in plasma of patients with pulmonary TB relative to healthy controls, and MMP-7 (matrilysin) and MMP-9 (gelatinase B) were also increased. MMP-8 was TB-specific (p<0.001), not being elevated in symptomatic controls (symptoms suspicious of TB but active disease excluded). Plasma MMP-8 concentrations inversely correlated with body mass index. Plasma MMP-8 concentration was 1.51-fold higher in males than females with TB (p<0.05) and this difference was not due to greater disease severity in men. Gender-specific analysis of MMPs demonstrated consistent increase in MMP-1 and -8 in TB, but MMP-8 was a better discriminator for TB in men. Plasma collagenases are elevated in pulmonary TB and differ between men and women. Gender must be considered in investigation of TB immunopathology and development of novel diagnostic markers

How Software Matters : Connective Tissue and Self-Driving Cars

Drawing on the example of self-driving and connected cars, this chapter explores how the software that is being integrated into, and transforming, everyday objects might be conceptualised within theories of practice. It argues that although software is an especially dynamic and intangible ‘material’ it can still be accommodated within existing conceptualisations of materiality in practice theories. The automation that software enables can be positioned as part of practice complexes, even when it does not play a direct, constitutive role in any single practice. In addition, through performing varied work in connecting practices and enabling ‘feedback’ over time and space, software can be understood to form part of the connective tissue by which practice complexes hang together and change

The flying buttress construct for posterior spinopelvic fixation: a technical note

<p>Abstract</p> <p>Background</p> <p>Posterior fusion of the spine to the pelvis in paediatric and adult spinal deformity is still challenging. Especially assembling of the posterior rod construct to the iliac screw is considered technically difficult. A variety of spinopelvic fixation techniques have been developed. However, extreme bending of the longitudinal rods or the use of 90-degree lateral offset connectors proved to be difficult, because the angle between the rod and the iliac screw varies from patient to patient.</p> <p>Methods</p> <p>We adopted a new spinopelvic fixation system, in which iliac screws are side-to-side connected to the posterior thoracolumbar rod construct, independent of the angle between the rod and the iliac screw. Open angled parallel connectors are used to connect short iliac rods from the posterior rod construct to the iliac screws at both sides. The construct resembles in form and function an architectural Flying Buttress, or lateral support arches, used in Gothic cathedrals.</p> <p>Results and discussion</p> <p>Three different cases that illustrate the Flying Buttress construct for spinopelvic fixation are reported here with the clinical details, radiographic findings and surgical technique used.</p> <p>Conclusion</p> <p>The Flying Buttress construct may offer an alternative surgical option for spinopelvic fixation in circumstances wherein coronal or sagittal balance cannot be achieved, for example in cases with significant residual pelvic obliquity, or in revision spinal surgery for failed lumbosacral fusion.</p

Defining genes: a computational framework

The precise elucidation of the gene concept has become the subject of intense discussion in light of results from several, large high-throughput surveys of transcriptomes and proteomes. In previous work, we proposed an approach for constructing gene concepts that combines genomic heritability with elements of function. Here, we introduce a definition of the gene within a computational framework of cellular interactions. The definition seeks to satisfy the practical requirements imposed by annotation, capture logical aspects of regulation, and encompass the evolutionary property of homology

Evaluation of models to predict BRCA germline mutations

The selection of candidates for BRCA germline mutation testing is an important clinical issue yet it remains a significant challenge. A number of risk prediction models have been developed to assist in pretest counselling. We have evaluated the performance and the inter-rater reliability of four of these models (BRCAPRO, Manchester, Penn and the Myriad-Frank). The four risk assessment models were applied to 380 pedigrees of families who had undergone BRCA1/2 mutation analysis. Sensitivity, specificity, positive and negative predictive values, likelihood ratios and area under the receiver operator characteristic (ROC) curve were calculated for each model. Using a greater than 10% probability threshold, the likelihood that a BRCA test result was positive in a mutation carrier compared to the likelihood that the same result would be expected in an individual without a BRCA mutation was 2.10 (95% confidence interval (CI) 1.66–2.67) for Penn, 1.74 (95% CI 1.48–2.04) for Myriad, 1.35 (95% CI 1.19–1.53) for Manchester and 1.68 (95% CI 1.39–2.03) for BRCAPRO. Application of these models, therefore, did not rule in BRCA mutation carrier status. Similar trends were observed for separate BRCA1/2 performance measures except BRCA2 assessment in the Penn model where the positive likelihood ratio was 5.93. The area under the ROC curve for each model was close to 0.75. In conclusion, the four models had very little impact on the pre-test probability of disease; there were significant clinical barriers to using some models and risk estimates varied between experts. Use of models for predicting BRCA mutation status is not currently justified for populations such as that evaluated in the current study