Validation of the Tactual Performance Test as an Organicity Screening Device

Organicity screening devices are those psychometric tests used to detect brain dysfunction during the initial assessment. The characteristics of such tests were listed and ones currently being used were reviewed. The review concentrated on the validity and clinical utility of these organicity tests. From the review it was concluded that the validity has not been thoroughly established, partially because weak criteria have been used. It was also concluded that current screening tests have questionable clinical utility, since an inordinant number of organically impaired people are not detected by the tests. The concept of organicity was discussed, and the Tactual Performance Test was proposed as a new organicity screening test. A validation and cross-validation experiment was done by comparing the Tactual Performance Test with the Halstead-Reitan Battery, a more appropriate criterion. This study investigated the validity and utility of the test. Data from the Tactual Performance Test and the Halstead-Reitan Battery were collected for 200 male veterans; these subjects were randomly selected from the neuropsychology archives at a VA Medical Center. Two groups of 100 subjects each served as the Validation and Cross-validation samples. The groups did not differ significantly in age or education; the mean age was 44.24 years and the mean education level was 10.97 years. To compare the Tactual Performance Test with the Halstead-Reitan Battery, the three test scores, age and education were chosen as independent variables, and the Average Impairment Rating from the battery was chosen as the dependent variable. For the Validation group the the variables were used to create a multiple regression equation which predicted the dependent variable. The independent variables for the Cross-validation group were entered into this equation to check its ability to predict the dependent variable. The validity of the Tactual Performance Test was judged by computing the multiple regression coefficient and the Pearson r for the two groups. The clinical utility of the test was judged by the overall accuracy and the number of Type I and Type II errors. Of the five independent variables, age did not make a significant contribution to the predicted Average Impairment Rating; this variable was found to be a correlate of every other variable. The resultant equation was found very capable of predicting the dependent variable. The correlations for the Validation and Cross-validation groups were .85 and .86 respectively, each significant at the .001 level. The utility of the Tactual Performance Test and education was also impressive; there were 87% correct predictions for the Validation group and 86% correct for the Cross-validation group. In addition very few organically impaired individuals escaped detection by this method. Therefore the Tactual Performance Test is judged a valid and useful organicity screening device. Shortcomings of this study were discussed and a further study incorporating females was proposed

La survie religieuse des communautés protestantes du centre de la France et du Bassin parisien de la Révocation de l’édit de Nantes à l’édit de tolérance (1685-1787)

Le protestantisme du Nord de la France aux XVIIe et XVIIIe siècles se caractérise par sa grande dispersion ainsi que par sa très faible importance numérique. Pourtant, malgré le choc de la Révocation, les conversions et les départs, des communautés vivantes traversent le dernier siècle de l\u27Ancien Régime. Du point de vue religieux, des signes montrent que, tout au long de cette période, les protestants conservent une foi vivante: des assemblées se tiennent dès les premiers mois de l\u27édit de Fontainebleau, des «nouveaux convertis» attaquent le dogme et la discipline de l\u27Église catholique, ou refusent l\u27intervention du curé dans les grands moments de leur vie. Les formes de résistance et les rythmes de persécution sont cependant variables d\u27une communauté, voire d\u27une époque à l\u27autre. Certaines églises, en particulier celles de Picardie, profitent de la proximité de la frontière avec les Pays-Bas autrichiens, ainsi que de la présence des pasteurs qui accompagnent les garnisons de la Barrière. D\u27autres, plus isolées, trouvent dans la capitale un lieu d\u27accueil et leurs membres fréquentent les chapelles d\u27ambassades des pays protestants. Ce n\u27est pourtant que tardivement, et non sans mal, que les structures ecclésiastiques se réorganisent, à partir du milieu des années 1760. L\u27édit de tolérance permet à ces communautés affaiblies démographiquement de reparaître au grand jour, là où elles ont survécu

Les protestants du centre de la France et du Bassin parisien et la Révocation de l’Édit de Nantes

For a long time not has been known of Protestantism in Northern France in the 18th Century, especially in the synodal provinces of Orléanais-Berry and the Ile-de-France-Champagne-Picardie. Some recent studies show that despite a very large diversity in the local situations as well as in their socio-professional composition, the churches of these areas presented numerous common points linked to their particular situation. They are distinguished first of all by their great geographical scattering as well as by their very small numerical importance. Subjected to a strong pressure from the authorities and the Catholic Church in the last years of the Edict of Nantes, the Protestant communities resisted however to attacks to a large extent. The revocation and the dragonnades do caused massive abjurations and departures, but did not lead to the disappearing of Protestantism which survived in several places until the end of the Ancien Régime

Psychological profile and self-administered relaxation in patients with craniofacial pain: a prospective in-office study

Introduction: The objective of this study was to evaluate the psychological profile of craniofacial pain sufferers and the impact of patient subtype classification on the short-time effectiveness of a self-administered relaxation training. Methods: One hundred unselected in-office patients (67% females) suffering from chronic facial pain and/or headache with the presumptive diagnose of temporo-mandibular disorder (TMD) completed a questionnaire battery comprising craniofacial pain perception, somatic complaints, irrational beliefs, and pain behavior and were classified into subtypes using cluster analysis. They underwent a self-administered progressive relaxation training and were re-evaluated for pain perception after 3 months. Results: Pain was mild to moderate in the majority of patients. Symptom domains comprised parafunctional activities, temporo-mandibular pain and dysfunction, fronto-temporal headache, head/neck and neck/back pain. Three patient subtypes were identified regarding symptom/dysfunction level: (i) low burden (mild/moderate), (ii) psychosocial dysfunction (moderate/high), (iii) adaptive coping (moderate/mild). Self-rated adherence to the recommended relaxation training was moderate throughout the sample, but self-rated relief was significantly different between clusters. At follow-up, pain intensity was significantly decreased in all patients, whereas pain-related interference was improved only in dysfunctional and adaptive patients. Improvement of symptom domains varied between clusters and was most comprehensive in adaptive patients. Conclusions: In conclusion, craniofacial pain sufferers can be divided in meaningful subtypes based on their pain perception, irrational beliefs, and pain behaviour. A self-administered relaxation training generally yielded positive effects on pain perception, however the benefit may be greater in patients with more marked symptom impact (both dysfunctional and adaptive).<br

Association of dentoskeletal morphology with incisor inclination in angle class II patients: a retrospective cephalometric study

Introduction: The purpose of this study was to identify possible dentoskeletal parameters associated with variation of anterior tooth inclination in Angle Class II subdivisions. Methods: Pre-treatment lateral radiographs of 144 Class II patients (68 males, 76 females) aged 9 to 17 years were classified for upper incisor inclination into three groups (proclined, normally inclined, retroclined) homogeneous for gender and skeletal jaw relationship. The effect of age on the 22 cephalometric variables was controlled by covariance analysis. Results: Multivariate analysis of the cephalometric parameters indicated significant inter-group differences. Systematic associations with incisor inclination were revealed using rank correlation: Lower incisor proclination, Wits appraisal and gonial angle significantly decreased (0.04 ≥ p ≥ 0.002), while intercisal angle, mandibular total and corpus length and nasolabial angle increased (0.04 ≥ p ≥ 0.001) with decreasing incisor proclination. Conclusions: Clear-cut classification criteria and control of confounding effects may clarify conflicting previous findings on dentoskeletal differences between Class II subdivisions in the mixed dentition. Only minor dentoskeletal differences appear to be associated with incisor inclination. The increased interincisal and nasolabial angle in Class II division 2 subjects are due to reclination of both upper and lower incisors. Jaw positions and chin prominence are not significantly different between the subdivisions. However, Wits appraisal is decreased in Class II division 2. The increased mandibular length observed in Class II division 2 requires further scrutinization.<br

The effect of e-learning on the quality of orthodontic appliances

Purpose: The effect of e-learning on practical skills in medicine has not yet been thoroughly investigated. Today’s multimedia learning environment and access to e-books provide students with more knowledge than ever before. The aim of this study is to evaluate the effect of online demonstrations concerning the quality of orthodontic appliances manufactured by undergraduate dental students. Materials and methods: The study design was a parallel-group randomized clinical trial. Fifty-four participants were randomly assigned to one of the three groups: 1) conventional lectures, 2) conventional lectures plus written online material, and 3) access to resources of groups one and two plus access to online video material. Three orthodontic appliances (Schwarz Plate, U-Bow Activator, and Fränkel Regulator) were manufactured during the course and scored by two independent raters blinded to the participants. A 15-point scale index was used to evaluate the outcome quality of the appliances. Results: In general, no significant differences were found between the groups. Concerning the appliances, the Schwarz Plate obtained the highest scores, whereas the Fränkel Regulator had the lowest scores; however, these results were independent of the groups. Females showed better outcome scores than males in groups two and three, but the difference was insignificant. Age of the participants also had no significant effect. Conclusion: The offer that students could use additional time and course-independent e-learning resources did not increase the outcome quality of the orthodontic appliances. The advantages of e-learning observed in the theoretical fields of medicine were not achieved in the educational procedures for manual skills. Factors other than e-learning may have a higher impact on manual skills, and this should be investigated in further studies

Subanesthetic ketamine infusions for the treatment of children and adolescents with chronic pain: a longitudinal study

Background Chronic pain is common in children and adolescents and is often associated with severe functional disability and mood disorders. The pharmacological treatment of chronic pain in children and adolescents can be challenging, ineffective, and is mostly based on expert opinions and consensus. Ketamine, an N-methyl-D-aspartate receptor antagonist, has been used as an adjuvant for treatment of adult chronic pain and has been shown, in some instances, to improve pain and decrease opioid-requirement. We examined the effects of subanesthetic ketamine infusions on pain intensity and opioid use in children and adolescents with chronic pain syndromes treated in an outpatient setting. Methods Longitudinal cohort study of consecutive pediatric patients treated with subanesthetic ketamine infusions in a tertiary outpatient center. Outcome measurements included self-reported pain scores (numeric rating scale) and morphine-equivalent intake. Results Over a 15-month period, 63 children and adolescents (median age 15, interquartile range 12–17 years) with chronic pain received 277 ketamine infusions. Intravenous administration of subanesthetic doses of ketamine to children and adolescents on an outpatient basis was safe and not associated with psychotropic effects or hemodynamic perturbations. Overall, ketamine significantly reduced pain intensity (p \u3c0.001) and yielded greater pain reduction in patients with complex regional pain syndrome (CRPS) than in patients with other chronic pain syndromes (p = 0.029). Ketamine-associated reductions in pain scores were the largest in postural orthostatic tachycardia syndrome (POTS) and trauma patients and the smallest in patients with chronic headache (p = 0.007). In 37 % of infusions, patients had a greater than 20 % reduction in pain score. Conversely, ketamine infusions did not change overall morphine-equivalent intake (p = 0.3). Conclusions These data suggest that subanesthetic ketamine infusion is feasible in an outpatient setting and may benefit children and adolescents with chronic pain. Further, patients with CRPS, POTS, and

Spine deviations and orthodontic treatment of asymmetric malocclusions in children

Background: The aim of this randomized clinical trial was to assess the effect of early orthodontic treatment for unilateral posterior cross bite in the late deciduous and early mixed dentition using orthopedic parameters. Methods: Early orthodontic treatment was performed by initial maxillary expansion and subsequent activator therapy (Münster treatment concept). The patient sample was initially comprised of 80 patients with unilateral posterior cross bite (mean age 7.3 years, SD 2.1 years). After randomization, 77 children attended the initial examination appointment (therapy = 37, control = 40); 31 children in the therapy group and 35 children in the control group were monitored at the follow-up examination (T2). The mean interval between T1 and T2 was 1.1 years (SD 0.2 years). Rasterstereography was used for back shape analysis at T1 and T2. Using the profile, the kyphotic and lordotic angle, the surface rotation, the lateral deviation, pelvic tilt and pelvic torsion, statistical differences at T1 and T2 between the therapy and control groups were calculated (t-test). Our working hypothesis was, that early orthodontic treatment can induce negative therapeutic changes in body posture through thoracic and lumbar position changes in preadolescents with uniltaral cross bite. Results: No clinically relevant differences between the control and the therapy groups at T1 and T2 were found for the parameters of kyphotic and lordotic angle, the surface rotation, lateral deviation, pelvic tilt, and pelvic torsion. Conclusions: Our working hypothesis was tested to be not correct (within the limitations of this study). This randomized clinical trial demonstrates that in a juvenile population with unilateral posterior cross bite the selected early orthodontic treatment protocol does not affect negatively the postural parameters

Early treatment of posterior crossbite - a randomised clinical trial

Background: The aim of this randomised clinical trial was to assess the effect of early orthodontic treatment in contrast to normal growth effects for functional unilateral posterior crossbite in the late deciduous and early mixed dentition by means of three-dimensional digital model analysis. Methods: This randomised clinical trial was assessed to analyse the orthodontic treatment effects for patients with functional unilateral posterior crossbite in the late deciduous and early mixed dentition using a two-step procedure: initial maxillary expansion followed by a U-bow activator therapy. In the treatment group 31 patients and in the control group 35 patients with a mean age of 7.3 years (SD 2.1) were monitored. The time between the initial assessment (T1) and the follow-up (T2) was one year. The orthodontic analysis was done by a three-dimensional digital model analysis. Using the ‘Digimodel’ software, the orthodontic measurements in the maxilla and mandible and for the midline deviation, the overjet and overbite were recorded. Results: Significant differences between the control and the therapy group at T2 were detected for the anterior, median and posterior transversal dimensions of the maxilla, the palatal depth, the palatal base arch length, the maxillary arch length and inclination, the midline deviation, the overjet and the overbite. Conclusions: Orthodontic treatment of a functional unilateral posterior crossbite with a bonded maxillary expansion device followed by U-bow activator therapy in the late deciduous and early mixed dentition is an effective therapeutic method, as evidenced by the results of this RCT. It leads to three-dimensional therapeutically induced maxillary growth effects. Dental occlusion is significantly improved, and the prognosis for normal craniofacial growth is enhanced

Biological and physical controls in the Southern Ocean on past millennial-scale atmospheric CO2 changes

Millennial-scale climate changes during the last glacial period and deglaciation were accompanied by rapid changes in atmospheric CO2 that remain unexplained. While the role of the Southern Ocean as a 'control valve' on ocean–atmosphere CO2 exchange has been emphasized, the exact nature of this role, in particular the relative contributions of physical (for example, ocean dynamics and air–sea gas exchange) versus biological processes (for example, export productivity), remains poorly constrained. Here we combine reconstructions of bottom-water [O2], export production and 14C ventilation ages in the sub-Antarctic Atlantic, and show that atmospheric CO2 pulses during the last glacial- and deglacial periods were consistently accompanied by decreases in the biological export of carbon and increases in deep-ocean ventilation via southern-sourced water masses. These findings demonstrate how the Southern Ocean's 'organic carbon pump' has exerted a tight control on atmospheric CO2, and thus global climate, specifically via a synergy of both physical and biological processes