Judging the Neonatal Abstinence Syndrome Assessment Tools to Guide Future Tool Development: The Use of Clinimetrics as Opposed to Psychometrics

In the face of the current Neonatal Abstinence Syndrome (NAS) epidemic, there is considerable variability in the assessment and management of infants with NAS. In this manuscript, we particularly focus on NAS assessment, with special attention given to the popular Finnegan Neonatal Abstinence Score (FNAS). A major instigator of the problem of variable practices is that multiple modified versions of the FNAS exist and continue to be proposed, including shortened versions. Furthermore, the validity of such assessment tools has been questioned, and as a result, the need for better tools has been suggested. The ultimate purpose of this manuscript, therefore, is to increase researchers\u27 and clinicians\u27 understanding on how to judge the usefulness of NAS assessment tools in order to guide future tool development and to reduce variable practices. In short, we suggest that judgment of NAS assessment tools should be made on a clinimetrics viewpoint as opposed to psychometrically. We provide examples, address multiple issues that must be considered, and discuss future tool development. Furthermore, we urge researchers and clinicians to come together, utilizing their knowledge and experience, to assess the utility and practicality of existing assessment tools and to determine if one or more new or modified tools are needed with the goal of increased agreement on the assessment of NAS in practice

Reliability and validity of a domain-specific last 7-d sedentary time questionnaire

Purpose: The objective of this study is to examine test-retest reliability, criterion validity, and absolute agreement of a self-report, last 7-d sedentary behavior questionnaire (SIT-Q-7d), which assesses total daily sedentary time as an aggregate of sitting/lying down in five domains (meals, transportation, occupation, nonoccupational screen time, and other sedentary time). Dutch (DQ) and English (EQ) versions of the questionnaire were examined. Methods: Fifty-one Flemish adults (ages 39.4 +/- 11.1 yr) wore a thigh accelerometer (activPAL3 (TM)) and simultaneously kept a domain log for 7 d. The DQ was subsequently completed twice (median test-retest interval: 3.3 wk). Thigh-acceleration sedentary time was log annotated to create comparable domain-specific and total sedentary time variables. Four hundred two English adults (ages 49.6 +/- 7.3 yr) wore a combined accelerometer and HR monitor (Actiheart (R)) for 6 d to objectively measure total sedentary time. The EQ was subsequently completed twice (median test-retest interval: 3.4 wk). In both samples, the questionnaire reference frame overlapped with the criterion measure administration period. All participants had five or more valid days of criterion data, including one or more weekend day. Results: Test-retest reliability (intraclass correlation coefficient (95% CI)) was fair to good for total sedentary time (DQ: 0.68 (0.50-0.81); EQ: 0.53 (0.44-0.62)) and poor to excellent for domain-specific sedentary time (DQ: from 0.36 (0.10-0.57) (meals) to 0.66 (0.46-0.79) (occupation); EQ: from 0.45 (0.35-0.54) (other sedentary time) to 0.76 (0.71-0.81) (meals)). For criterion validity (Spearman rho), significant correlations were found for total sedentary time (DQ: 0.52; EQ: 0.22; all P <0.001). Compared with domain-specific criterion variables (DQ), modest-to-strong correlations were found for domain-specific sedentary time (from 0.21 (meals) to 0.76 (P < 0.001) (screen time)). The questionnaire generally overestimated sedentary time compared with criterion measures. Conclusion: The SIT-Q-7d appears to be a useful tool for ranking individuals in large-scale observational studies examining total and domain-specific sitting

Intraindividual Variability in Cortisol: Approaches, Illustrations, and Recommendations

Most of the variance in diurnal cortisol is attributable to intraindividual variability (IIV), defined as relatively short-term, reversible changes. Multiple methods for measuring IIV have been proposed, and some have already been applied to cortisol IIV. In the present review, measurement methods are described and applied to simulated cortisol data with known underlying differences in IIV and to real cortisol data from first-year law students. More slope variance and more residual or net variance were well captured by their individual standard deviations. Explorations of reliability suggested that 10 slopes and 50 residuals result in reliable and stable estimates of the individual standard deviations. A data-analytic plan for cortisol IIV is provided

Correlation of Maximal Inspiratory Pressure to Transdiaphragmatic Twitch Pressure in Intensive Care Unit Patients

Background: Respiratory muscle weakness contributes to respiratory failure in ICU patients. Unfortunately, assessment of weakness is difficult since the most objective test, transdiaphragmatic pressure in response to phrenic nerve stimulation (PdiTw), is difficult to perform. While most clinicians utilize maximum inspiratory pressure (Pimax) to assess strength, the relationship of this index to PdiTw has not been evaluated in a large ICU population. The purpose of the present study was to assess both PdiTw and Pimax in ICU patients to determine how these indices correlate with each other, what factors influence these indices, and how well these indices predict outcomes. Methods: Studies were performed on adult mechanically ventilated patients in the University of Kentucky MICU (n = 60). We assessed PdiTw by measuring transdiaphragmatic pressure (Pdi) in response to bilateral twitch stimulation of the phrenic nerves using dual magnetic stimulators (Magstim 200). Pimax was determined by measuring airway pressure during a 30-second inspiratory occlusion. We also assessed the twitch and maximum force generation for diaphragms excised from control and septic mice. Results: Both Pimax and PdiTw measurements were profoundly reduced for mechanically ventilated MICU patients when compared to normal reference values, e.g., Pimax averaged 56 % of the predicted value for normal subjects. For the ICU population as a whole, PdiTw and Pimax values correlated with each other (r2 = 0.373, p \u3c 0.001), but there was wide scatter and, as a result, PdiTw could not be reliably calculated from Pimax levels for individual subjects. Infection selectively reduced low-frequency force generation more than high-frequency force generation for both our mouse experiments (comparing muscle twitch to 150 Hz tetanic force) and for MICU patients (comparing PdiTw to Pimax). This effect of infection may contribute to scatter in the PdiTw to Pimax relationship. We also found that both PdiTw and Pimax were significantly correlated with both patient survival and the duration of mechanical ventilation, albeit statistically, PdiTw was the better predictor. Conclusions: While more difficult to measure, the PdiTw is a better predictor of outcomes in mechanically ventilated MICU patients than the Pimax. Nevertheless, for some clinical applications, the Pimax determination is a reasonable alternative

Sex Differences in the Subjective Effects of Oral Δ\u3csup\u3e9\u3c/sup\u3e-THC in Cannabis Users

Previous studies suggest that there are sex differences in endocannabinoid function and the response to exogenous cannabinoids, though data from clinical studies comparing acute cannabinoid effects in men and women under controlled laboratory conditions are limited. To further explore these potential differences, data from 30 cannabis users (N=18 M, 12 F) who completed previous Δ9-tetrahydrocannabinol (Δ9-THC) discrimination studies were combined for this retrospective analysis. In each study, subjects learned to discriminate between oral Δ9-THC and placebo and then received a range of Δ9-THC doses (0, 5, 15 and a “high” dose of either 25 or 30 mg). Responses on a drug-discrimination task, subjective effects questionnaire, psychomotor performance tasks, and physiological measures were assessed. Δ9-THC dose-dependently increased drug-appropriate responding, ratings on “positive” visual analog scale (VAS) items (e.g., Good Effects, Like Drug, Take Again), and items related to intoxication (e.g., High, Stoned). Δ9-THC also dose-dependently impaired performance on psychomotor tasks and elevated heart rate. Sex differences on VAS items emerged as a function of dose. Women exhibited significantly greater subjective responses to oral drug administration than men at the 5 mg Δ9-THC dose, whereas men were more sensitive to the subjective effects of the 15 mg dose of Δ9-THC than women. These results demonstrate dose-dependent separation in the subjective response to oral Δ9-THC administration by sex, which might contribute to the differential development of problematic cannabis use

Socioemotional Selectivity and Psychological Health in Amyotrophic Lateral Sclerosis Patients and Caregivers: A Longitudinal, Dyadic Analysis

Objective: Socioemotional selectivity theory predicts that as the end of life approaches, goals and resources that provide immediate, hedonic reward become more important than those that provide delayed rewards. This study tested whether these goal domains differentially affected psychological health in the context of marital dyads in which one partner had been diagnosed with amyotrophic lateral sclerosis (ALS), a life-limiting disease. Design: ALS patients (N = 102) being treated in three multidisciplinary clinics and their spouses (N = 100) reported their loneliness, financial worry and psychological health every 3 months for up to 18 months. Main Outcome Measure: Psychological health composite. Results: In multilevel dyadic models, patients and spouses had similar levels of financial worry and loneliness. Both patients and spouses had worse psychological health with higher loneliness, but only spouses had worse psychological health with higher financial worry. Significant interactions with age and disease severity indicated that older spouses were more affected by loneliness than were younger spouses, and patients with less severe disease were more affected by financial worry than patients with more severe disease. Conclusion: The results provide good support for socioemotional selectivity theory’s implications for psychological health in a strong test of the theory

Flower numbers, pod production, pollen viability, and pistil function are reduced and flower and pod abortion increased in chickpea (Cicer arietinum L.) under terminal drought

Terminal drought during the reproductive stage is a major constraint to yield of chickpea in many regions of the world. Termination of watering (WS) during podding in a small-seeded desi chickpea (Cicer arietinum L.) cultivar, Rupali, and a large-seeded kabuli chickpea cultivar, Almaz, induced a decrease in predawn leaf water potential (LWP), in the rate of photosynthesis, and in stomatal conductance. Compared to well-watered (WW) controls, the WS treatment reduced flower production by about two-thirds. In the WW treatment, about 15% of the flowers aborted and 42% (Rupali) and 67% (Almaz) of the pods aborted, whereas in the WS treatment 37% and 56% of the flowers aborted and 54% and 73% of the pods aborted, resulting in seed yields of 33% and 15% of the yields in WW plants in Rupali and Almaz, respectively. In vitro pollen viability and germination in Rupali decreased by 50% and 89% in the WS treatment, and pollen germination decreased by 80% in vivo when pollen from a WS plant was placed on a stigma of a WW plant. While about 37% of the germinated pollen tubes from WW plants and 22% from the WS plants reached the ovary in the WW plants, less than 3% of pollen grains reached the ovary when pollen from either WS or WW plants was placed on a stigma of a WS plant. It is concluded that, in addition to pod abortion, flower abortion is an important factor limiting yield in chickpea exposed to terminal drought and that water deficit impaired the function of the pistil/style more than the pollen

Impact of Motor Therapy with Dynamic Body-Weight Support on Functional Independence Measures in Traumatic Brain Injury: An Exploratory Study

BACKGROUND: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments. OBJECTIVE: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI. METHODS: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = 6) and who received inpatient rehabilitation without DBWS (SOC, n = 6). The primary outcome measure was the change in Functional Independence Measures (FIM) scores from admission to discharge. RESULTS: There was significant improvement in total FIM scores at discharge compared to admission for both the DBWS (p = 0.001) and SOC (p = 0.005) groups. Overall, the DBWS group had greater improvement in total FIM score and FIM subscales compared to the SOC group. CONCLUSIONS: Our results suggest DBWS has the potential to allow a greater intensity of therapy during inpatient rehabilitation and yield better outcomes compared to SOC in patients with TBI