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In an effort to identify bacteria that fail to give the expected Gram reaction, thus leading to misidentification, two nonstaining tests for Gram reaction, vancomycin and colimycin susceptibility testing and the Gram-Sure test (Remel, USA), were employed on 145 strains from 42 gram-negative and gram-positive genera with contradictory Gram stain results. The Gram-Sure test is a commercially available disk that detects the presence of L-alanine-aminopeptidase, an enzyme usually found only in the cell wall of gram-negative bacteria. In this test, aminopeptidase activity is detected using a substrate that can be hydrolyzed to produce a fluorescent compound under long-wave UV light. The commercial disk test and vancomycin plus colimycin susceptibility testing appeared to perform equally well except in the identification of Erysipelothrix and Lactobacillus, for which the commercial disk test was better, and Moraxella, for which vancomycin and colimycin susceptibility testing was more helpful. An advantage of the commercial disk test is that it can be performed in 10 min, whereas vancomycin and colimycin susceptibility testing requires at least 18 h. The commercial disk test is also less expensive than vancomycin and colimycin susceptibility testing. However, since the same results can be obtained with the 5 microg and 30 microg vancomycin disks, it is possible to use only one vancomycin disk, with the cost then being equivalent to that of the commercial disk test. The major inconvenience of the commercial disk test is the requirement of a UV ray. However, this test could be a useful tool for the identification of unusual organisms.
The literature on the mouse sperm morphology test and on other sperm tests in nonhuman mammals was reviewed (a) to evaluate the relationship of these tests to chemically induced spermatogenic dysfunction, germ-cell mutagenicity, and carcinogenicity, and (b) to make an interspecies comparison to chemicals. A total of 71 papers were reviewed. The mouse sperm morphology test was used to assess the effects of 154 of the 182 chemical agents covered. 4 other murine sperm tests were also used: the induction of acrosomal abnormalities (4 agents), reduction in sperm counts, (6 agents), motility (5 agents), and F1 sperm morphology (7 agents)). In addition, sperm tests for the spermatogenic effects of 35 agents were done in 9 nonmurine mammalian species; these included analyses for sperm count, motility, and morphology, using a large variety of study designs. For the mouse sperm morphology test, 41 agents were judged by the reviewing committee to be positive inducers of sperm-head shape abnormalities, 103 were negative, and 10 were inconclusive. To evaluate the relationship between changes in sperm morphology and germ cell mutagenicity, the effects of 41 agents on mouse sperm shape were compared to available data from 3 different mammalian germ-cell mutational tests (specific locus, heritable translocation, and dominant lethal). The mouse sperm morphology test was found to be highly sensitive to germ-cell mutagens; 100% of the known mutagens were correctly identified as positives in the sperm morphology test. Data are insufficient at present to access the rate of false positives. Although it is biologically unclear why one might expect changes in sperm morphology to be related to carcinogenesis, we found that (a) a positive response in the mouse sperm morphology test is highly specific for carcinogenic potential (100% for the agents surveyed), and (b) overall, only 50% of carcinogens were positive in the test (i.e., sensitivity approximately equal to 50%). Since many carcinogens do not produce abnormally shaped sperm even at lethal doses, negative findings with the sperm test cannot be used to classify agents as noncarcinogens. We conclude that the mouse sperm morphology test has potential use for identifying chemicals that induce spermatogenic dysfunction and perhaps heritable mutations. Insufficient numbers of chemicals agents have been studied by the other sperm tests to permit similar comparisons. A comparison of 25 chemicals tested with sperm counts, motility, and morphology in at least 2 species (including man, mouse and 9 other mammals) demonstrated good agreement in response among species. With further study, interspecies comparisons of chemically induced sperm changes may be useful for predicting and evaluating human effects.
Paratuberculosis in cattle is a chronic debilitating infectious disease caused by Mycobacterium paratuberculosis. Control of paratuberculosis is based on tests that principally detect advanced stages of infections: faecal culture and serology. Tests measuring cell-mediated immunity (CMI) could improve control of paratuberculosis if able to diagnose mycobacterial infections earlier, before animals become infectious. A drawback of CMI tests for paratuberculosis has been a reported low specificity. This study re-examined CMI specificity and factors that may affect it. The specificities of the Johnin skin test and its in vitro equivalent, the gamma interferon (IFNgamma) assay, were estimated in 35 uninfected dairy herds. In each herd a random sample of 20 young (6-24 months old) and 20 adult (> or =24 months old) female dairy cattle were tested by both tests simultaneously. Skin test specificity was 93.5% using a skin thickness increase of > or =4mm as the cut-off value. IFNgamma assay specificity when interpreted using a newly developed algorithm was 93.6%. When interpreted according to two alternative algorithms provided by the IFNgamma kit suppliers, the assay had specificities of 66.1 and 67.0%. If the skin test and IFNgamma assay were used in parallel, and only animals positive on both tests were considered as M. paratuberculosis-infected, the specificity was 97.6%. Agreement between skin test and IFNgamma assay on 1631 total animals was fair (kappa=0.41). Antigen batch influenced the specificity of both the skin test, ranging from 92 to 95%, and the IFNgamma assay, ranging from 71 to 99% among batches. Test specificity also varied among herds ranging from 58 to 100% for the skin test and 57 to 100% for the IFNgamma assay. While factors affecting CMI test specificity and agreement need further evaluation, the high specificity and general agreement among these CMI tests, coupled with the excellent results obtained in the control of bovine tuberculosis using CMI tests, support their potential value in the early diagnosis and control of paratuberculosis.
Olfactory threshold and odor identification tasks currently serve as the standard approaches to the clinical assessment of olfactory function. Although these methods can be used effectively with the average patient, they suffer from some limitations when used to evaluate children, people with cognitive impairment, or people from diverse cultural backgrounds. A novel approach to the clinical evaluation of olfactory function, the Sniff Magnitude Test, attempts to minimize the cognitive demands of an olfactory test and thereby overcome some of the limitations of alternative tests. This is achieved by measuring the reflex-like reduction in sniffing that occurs when a malodor is encountered. The reliability and the validity of the Sniff Magnitude Test were assessed by testing people on two occasions using the University of Pennsylvania Smell Identification Test (UPSIT), a butanol threshold task, the Alcohol Sniff Test, and the Sniff Magnitude Test. The test-retest reliability of the Sniff Magnitude Test was r=.80, higher than the butanol thresholds and Alcohol Sniff Test but somewhat lower than the UPSIT. Performance on the Sniff Magnitude Test (the sniff magnitude to a malodor relative to nonodorized air) was correlated between r=-.61 and r=-.66 with the other measures of olfactory function. This range of correlations was comparable to that observed between the butanol threshold, the UPSIT, and the Alcohol Sniff Test. Finally, evidence for the advantages of the Sniff Magnitude Test, as compared to the UPSIT, was provided by a study with young children. It is concluded that the Sniff Magnitude Test has significant potential as a clinical measure of olfactory function, and that further testing and development of this method are warranted.
BACKGROUND: The patch test is an important tool for the diagnosis of contact dermatitis. In the past few years, allergists have shown increased interest in the diagnosis of contact dermatitis and the use of patch testing. OBJECTIVE: The aim of this study was to determine (1) the frequency of usage of the patch test among allergists, (2) the factors that affect the decision to patch test, and (3) the need for training the allergist to perform patch testing. METHOD: A single mailing survey was sent to all the members of the American College of Allergy, Asthma and Immunology (ACAAI). RESULTS: Fifty-seven percent of responding allergists performed patch testing but did so infrequently. Those who were fellowship trained in patch testing or attended a sponsored workshop performed the test more frequently than those with no training. Those who perceived the patch test as useful also were more likely to perform the test. Fellowship-trained members felt more confident than workshop-trained members in performing the test, and both, in turn, were more confident than members with no training. Trained physicians also were more likely to find the test useful compared with those with no training in patch testing. CONCLUSIONS: Education through fellowship training and workshop was associated with greater self-confidence of the allergist in his/her ability to perform patch testing. Education also was associated with increased perception of patch test utility and increased usage of the test.
BACKGROUND: The [13C]urea breath test is a convenient method to estimate Helicobacter pylori colonization non-invasively. As an alternative method, the [15N]urea urine test has been established. It is hypothesized that the urine test could be advantageous under some circumstances. The diagnostic value of the breath test might, for example, be jeopardized owing to fluctuating 13C isotope dilution by endogenous carbon dioxide. METHODS: To compare the reliability and practicability of the two tests, 13C breath tests and 15N urine tests were performed simultaneously in three groups of patients: A) 36 adults under standardized conditions, B) 67 children who were allowed to move around during the test, and C) 18 children once without and once during standardized physical activity. RESULTS: In the 36 adults there was a close correlation of the test results of the two methods (r = 0.88). In contrast, the correlation in the group of 67 children and infants was poor (r = 0.10). In the children with controlled activity the 13C results fluctuated, whereas the 15N results remained unchanged. CONCLUSIONS: Owing to their identical biochemical basis the breath test and the urine test produce the same diagnostic results in the same individuals if standardized pre-test and test conditions are followed. However, factors such as physical activity during the test may provoke fluctuations with a tendency to decreasing 13C values. This could be due to additional isotope dilution by increases in the endogenous production of 12C-carbon dioxide. We conclude that in very active children the 15N urine test might be advantageous and more reliable than the 13C breath test.
PURPOSE: To investigate test-retest variability in glaucoma patients tested with C-20-1 (screening) Frequency Doubling Technology (FDT) perimetry. METHODS: Thirty-one glaucoma patients with a range of visual field defects (17 with mild, 11 with moderate, and 3 with severe defects by AGIS classification) and experienced in standard automated perimetry but not FDT perimetry were prospectively recruited. The C-20-1 screening mode of FDT was consecutively administered three times. Concordance between tests for each patient was measured by presence and severity of defects for each test location. Learning and/or fatigue effects were also evaluated using FDT test scores in which number and severity of defects was graded. RESULTS: Agreement between FDT test locations averaged 88% for any defect, but only 51% for severity of defect. Although the mean test score increased slightly over the three tests, subjects did not demonstrate a statistically significant change in test score across the three testings (P = 0.975). Among 17 patients with early glaucoma (AGIS score 1-5), two returned a normal initial FDT test, and four returned a normal second FDT test. CONCLUSIONS: Using C-20-1 FDT, concordance between tests at a given test location was high for the presence of any defect, which would be important in glaucoma screening, but was only fair for severity of defect. Six of 17 patients with early glaucoma returned normal tests during testing. This group of glaucoma patients with perimetric experience did not demonstrate a significant learning or fatigue effect with FDT screening perimetry.
This is a report on a comparative study of the reactivity of TRUE Test and Finn Chamber patch test techniques. 413 patients attending a contact dermatitis clinic in Singapore were simultaneously patch tested with panels 1 and 2 of the TRUE Test standard series and with corresponding allergens (Hermal, Hamburg) using Finn Chambers. The left/right application of the TRUE Test and Finn Chambers was randomized. The concordance of positive patch test reactions to the 2 test techniques was studied. The number of patient with positive reactions was 38% and 42% for TRUE Test and Finn Chamber techniques, respectively (n.s.). The overall concordance of positive patch test reactions was 64% (209/328). 13% (42/328) of positive reactions appeared on TRUE Test only and 24% (77/328) on Finn Chamber only. When only relevant positive reactions were considered, the concordance rate was 67%; 11.6% of positive reactions appeared on TRUE Test only and 21% on Finn Chamber only. Positive reactions to p-phenylenediamine (PPD) and neomycin were more frequent with the Finn Chamber technique than with TRUE Test, i.e., false negative reactions to PPD and neomycin were more likely to occur with TRUE Test. It appeared that the TRUE Test and Finn Chamber techniques were comparable when used for patch testing. However false negative and false positive patch test reactions can occur when using either technique.
An evaluation was undertaken to determine the optimal method for the in vitro susceptibility testing of 26 Nocardia asteroides complex isolates to the following antimicrobial agents: amikacin, ampicillin, amoxicillin-clavulanate, ceftriaxone, ciprofloxacin, erythromycin, imipenem, minocycline, and trimethoprim-sulfamethoxazole. Five testing methods were studied including the agar dilution, broth microdilution, and disk diffusion methods, the epsilometer test (E-test), and the BACTEC radiometric method. Results for each antimicrobial agent and each testing method were interpreted as indicating susceptibility, intermediate susceptibility, or resistance according to current guidelines of the National Committee for Clinical Laboratory Standards (NCCLS) for bacteria that grow aerobically and were then compared to a "gold standard" susceptibility test result. The gold standard result for each Nocardia isolate was established by a consensus of the results of the majority of testing methods used in the study. When the results were combined for all antimicrobial agents tested against all Nocardia isolates by all methods, the BACTEC radiometric method produced the highest level of agreement (97.9%) with the consensus results and had the fewest very major (n = 1), major (n = 2), and minor (n = 2) errors. In contrast, the results of the agar dilution method were in least agreement (93.2%) with the consensus results, and this method also produced the most very major (n = 8), major (n = 4), and, along with the disk diffusion method, minor (n = 6) errors. For all test methods, interpretive errors were most frequent when testing ampicillin or amoxicillin-clavulanate. Moreover, for all Nocardia nova isolates tested, ampicillin susceptibility results by any of the testing methods were not in agreement with the results of testing for beta-lactamase by the nitrocefin (Cefinase) disk method. We conclude that among the methods evaluated, the BACTEC radiometric method appeared to be the best for determining the in vitro susceptibilities of members of the N. asteroides complex to a panel of nine antimicrobial agents. However, none of the test methods, including the BACTEC method, accurately predicted the ampicillin resistance of the N. nova isolates tested, all of which produced beta-lactamase. Presuming that this beta-lactamase hydrolyzes ampicillin, this disparity may relate to the NCCLS breakpoints that were used, which may require modification for this antimicrobial agent when tested against N. nova isolates.
OBJECTIVE: The purpose of this study was to survey the attitudes of family doctors to the performance of baseline tests and to determine which doctors perform these tests. SETTING: Family physicians in a continuing medical education programme in Tel Aviv, Israel. METHOD: An anonymous questionnaire was distributed focusing on performance of tests by doctors in healthy patients and not as part of a screening programme. RESULTS: Questionnaires were returned by 147 of 165 physicians surveyed (89% response rate). Baseline tests were performed by 98% of respondents: not routinely by 54%, 7% at the patient's request, and 2% did not perform tests. The decision to perform baseline tests was influenced by the presence of other risk factors of disease (86%), patient age (61%), family history (59%), patient request for tests (24%), and patient sex (20%). The tests performed were blood counts, glucose, renal function tests, urinalysis, liver function tests, and electrocardiograms. Baseline tests were useful in case finding of new illnesses for 49% of physicians and 40% said the tests had proved useful during a subsequent illness. The remainder of the physicians found no use for baseline tests. Physicians from the former Soviet Union were more likely to favour baseline tests. CONCLUSION: Almost all of the physicians in this study reported that they perform baseline tests on most of their patients. Evidence based guidelines for these tests and education of physicians are needed.
Advances in molecular biology and genetics have led to the identification of the breast/ovarian cancer susceptibility genes BRCA1 and BRCA2, along with tests to detect mutations in these genes. Although the appropriateness of BRCA1/2 genetic testing for children has been debated in the literature, little is known about the attitudes of individuals who have undergone cancer susceptibility testing. The present study focused on attitudes toward BRCA1 testing for children among 218 adults from a Utah-based kindred who had received BRCA1 test results. Results indicated that approximately one-fourth of the participants would permit BRCA1 testing for children under the age of 18. General attitudes about genetic testing were predictive of attitudes toward the testing of children. In addition, men and individuals without a BRCA1 mutation were more likely to agree that minors should be allowed BRCA1 testing. Individuals whose mother had been affected with breast cancer were less likely to permit testing for minors. Among parents of minor children, less than one-fifth indicated that they would want BRCA1 testing for their own children; carrier status was not predictive of attitudes toward testing their own children. As breast/ovarian cancer susceptibility testing continues to be disseminated into clinical settings, there may be an increase in the number of test requests for minors. The findings of the present study represent an important step in exploring attitudes about genetic testing of children among individuals who have received cancer susceptibility test results.
The purpose of the present study was to develop a new neuro-psychological test for evaluating the severity of dementia based on the newly-developed theory of working memory. In Study I, twelve candidate test items, including experimental tasks used in our previous developmental studies and test items newly developed for this study, were administered to twenty four demented patients. In Study II, the same twelve test items as used in Study I were administered to eighteen normative-aged volunteers to identify the baseline of difficulty of each test item. The normative-aged group, in marked contrast to the demented group, responded correctly to nearly all of these items. These items, therefore, proved to have a discriminating power between dementia patients and normative-aged. After examining thoroughly the result of factor analysis of test scores, the difficulty of the items, and the feasibility and communicability of instructions for each item, the authors finally chose five items to construct the test. Four of these five items were ones originally developed by ourselves. In Study III, the final version of the test composed of the above five items was administered to one hundred demented patients of various etiologies. The test scores were analyzed according to the method of principal factor analysis and the theory of working memory. The results of factor analysis showed the factor pattern of a typical homogeneous test that measures a single dimension of working memory capacity. The authors, therefore, decided to apply to the test scores an item-response theory that postulates test homogeneity as a prerequisite. Based on this theory, parameters of discrimination and difficulty of each item were estimated. In addition, the scale value of each examinee, i.e. working memory capacity, was estimated from his or her response pattern to the items. When the administration of the whole test is difficult in a clinical setting, this theory makes it possible to estimate the scale value of an examinee from even a single item, though inevitably with lower reliability. Owing to the adaptability of this test, its practical utility as a measurement tool was much improved. Further, the test items and their subitems were analyzed in terms of the theory of working memory. The resulting high agreement between item difficulty and working memory demand confirmed the validity of the theoretical analysis. In addition, the result of discriminant analysis with thirty-one subitem scores of five items showed that the test discriminated correctly 79.3% of DAT and VD.
OBJECTIVE: To determine the test-retest reliability of the cough stress test in women who present with complaints of urinary incontinence. METHODS: This prospective observational study involved 50 women between the ages of 28 and 78 years with primary complaints of urinary incontinence. All subjects underwent a pelvic examination, cystometrogram, and a cough stress test. The cough stress test was performed in the standing position at a bladder volume of 300 mL or at maximum cystometric capacity if it was less than 300 mL. The results of the cough stress test were recorded as positive if urine loss occurred with a cough or as negative if no urine loss was seen and the bladder volume was recorded. The women returned in 1-4 weeks for a second cough stress test performed at the same bladder volume as at the initial examination. RESULTS: Of the 50 women studied, 45 (90%) had similar results with both cough stress tests. Thirty-five had a positive cough stress test on the initial examination, and 32 of these patients (91%) also had a positive cough stress test at a repeat visit. Fifteen patients had a negative initial cough stress test, and 13 of these 15 (87%) had a negative cough stress test on repeat examination. All 20 patients diagnosed as having pure genuine stress incontinence had a positive cough stress test on initial and repeat examinations. Of the 15 patients diagnosed with detrusor instability or sensory urge incontinence, 13 (86%) had negative cough stress tests on initial and repeat examinations. Of the 15 patients diagnosed with mixed incontinence, 12 (80%) had positive cough stress tests on initial and repeat examinations. CONCLUSION: The cough stress test appears to be a reliable test. The reliability is more consistent in women with a diagnosis of pure genuine stress incontinence.
It is now well established that prior test experience can alter behavioural baselines and attenuate/abolish the anxiolytic efficacy of benzodiazepines in the elevated plus-maze paradigm. In view of evidence that different models of anxiety measure qualitatively distinct forms of anxiety-like behaviour, it is important to establish whether the effects of prior experience extend to other widely-used tests. The present study assessed the behavioural and pharmacological sequelae of a single undrugged prior exposure to the light/dark exploration (L/D) test in mice, using ethological scoring methods. One group of adult male Swiss-Webster mice was given a single undrugged exposure to the L/D test 24 h prior to drug testing, while another group was completely naïve to the apparatus. On test day, half the animals in each experiential condition were treated with saline and half with an anxiolytic dose (10 mg/kg) of chlordiazepoxide (CDP). When administered to test-naïve animals, CDP induced a clear reduction in anxiety-like behaviour as evidenced by significant increases in exploration of the light compartment (line crossings, % line crossings, and % time) as well as reductions in stretched attend postures (SAPs) and the proportion of SAPs displayed toward the light compartment. The behavioural specificity of these effects was confirmed by the absence of a drug effect on line crossings in the dark compartment, total rearing and grooming. In complete contrast, with the sole exception of a decrease in total SAPs, CDP was without significant behavioural effect in test-experienced mice. As prior test experience did not significantly alter behavioural baselines in the L/D test, a second experiment was designed to investigate the possibility that handling/intraperitoneal injection may have precluded detection of experientially-induced changes in baseline behaviour. Results showed that handling/injection had no effect upon L/D behavioural profiles in either test-naïve or test-experienced subjects, and confirmed that prior experience itself did not modify the primary indices of anxiety in this test. Present data indicate that prior test experience seriously compromises the anxiolytic efficacy of CDP (10 mg/kg) in the mouse L/D test and, together with recent findings in the four-plate test, appear to confirm that an experientially-induced reduction in sensitivity to the anxiolytic effects of benzodiazepines is by no means unique to the elevated plus-maze.