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Short term variation of human immunoglobulin levels with an estimation of the day to day physiological variability.

In this work serum Ig levels were determined daily for 14 days in 12 subjects, every two days for 14 days in 19 subjects, every week for 1 month in 11 subjects and fortnightly in 11 subjects for 6 months. The serum IgG, IgM and IgA levels were quantitated by the linear plate method. The day-to-day reproducibility of the technique was checked for a period of one months on seven different samples. The mean coefficient of variation in the reproducibility experiments was found to be 4.8% for IgG, 8.2% for IgM and 5.2% for IgA. Since the observed variation in all groups of subjects was found to be higher than the methodological variation, it appears that physiological variability occurs in the serum Ig levels of an individual. No difference was found between the physiological variances of IgG, IgM and IgA observed in the group with daily analysis and those with determinations every two days. The physiological variations increase when longer periods are considered between consecutive determinations, but the variability of IgG and IgA in the group with fortnightly determinations is less important than that observed in the group with weekly analyses. Some evidence is presented indicating a periodic fluctuation of serum IgG and IgA levels with an amplitude of nearly 20% and with a recurrence rate of two weeks.

Adolescent

Computer-assisted rapid surveys in developing countries.

Health surveys are an important source of population-based data in much of the developing world. Unfortunately, sample surveys often take more time to plan, process, and analyze than is practical, given the information needs of the local decision-makers. Rapid survey methodology (RSM) has been developed to permit health professionals to answer quickly questions about the health status and activities of people at the community level. These answers may be necessary for determining program priorities or for monitoring program activities. Rapid surveys are meant to supplement, rather than replace, information derived from existing sources of vital and health statistics data. RSM combines sample survey methods with contemporary software used in portable, battery-powered microcomputers. The ability to do rapid surveys in developing countries also requires knowledge of how to use appropriate computer hardware and software and how to apply cluster sampling theory in the local environment. RSM was used for the first time in Hlegu Township, Burma, to conduct a health survey of young children. The survey team started the field work on May 4, 1987. Four days later, while still in the field, the data were processed and rapidly analyzed by portable microcomputers for presentation to the local township medical officer and his staff. Within 10 days of starting the field work, we issued a detailed 50-page report of the study findings. This paper provides (a) a description of the components of rapid survey methodology, including the sample survey method, computer hardware, and computer software; (b) the general requirements for portable computer hardware in less developed regions of the world; (c) the procedures for doing a rapid survey; and (d) a summary of our experiences with RSM in Burma.

Developing Countries

Eating in the laboratory: behavioural aspects of the positive energy balance.

A survey is made of a number of experiments conducted in our laboratory over the last six years. Our working hypothesis assumes that positive energy balance, which should not be prematurely defined as the cause of obesity, is itself caused by disturbances in appetite and satiation control which, given certain environmental conditions, can favour the occurrence of obesity. Three points are considered: (1) The hyperphagic reaction as a response to stress. The experimental findings suggest that the hyperphagic reaction is not primarily a biologically determined phenomenon but rather a learned response. The hyperphagic reaction is found more frequently in female and overweight persons. Most children react to stress with a decrease in food consumption. (2) Disturbances of satiation control. The food intake of obese Ss has a linear time function, whilst children and normal weight adults reveal a biological, negatively accelerated satiation curve. (3) Increased responsiveness to external cues. The concept of externality is extended to include the aspect of an internal-external stimulus discrepancy. The findings show that not only manifest obese Ss but also latent obese Ss are characterized by an increased responsiveness to external cues. In three different experiments with the same Ss it could be demonstrated that externality is to a greater or lesser extent independent of the experimental procedure. Finally, methodological aspects are discussed, because in studies on human appetite the possibility exists that experimental procedure, sample composition and laboratory conditions can exert a direct influence on the results.

Adult

The assessment of physical independence handicap: experience in a community disablement survey.

Two approaches to the ascertainment of physical independence handicap have been explored using data from a survey of disablement in the population. The survey used a two-stage methodology with an initial postal shift to ascertain those with selected disabilities, a stratified random sample of whom were followed-up with an in-depth interview. The first approach to handicap was direct ascertainment of the scale categories by means of a question in the interview schedule. The second approach was to synthesize the scale categories from the answers to interview questions about disabilities in activities of daily living and other relevant factors. The final synthesized algorithm gave a 75% match within one scale point with the direct question and 85% agreement with receipt of attendance allowance, a state benefit paid to those meeting certain criteria for dependence on others. The lessons learned from the work have been incorporated in a revised and expanded scale, which is suggested as a starting point for revision of physical independence dimension of handicap.

Activities of Daily Living

[Measurement of the oncotic pressure of blood (methodology and analysis of errors)].

The authors give their practical recommendations on improving the accuracy of the blood plasma colloid osmometry by standardizing the methods for the collection, treatment, and storage of the samples and the oncometry procedure per se. The recommendations are based on literature data and the authors' experience.

Blood Physiological Phenomena

Global vs. restricted negative measure of life change events: methodological inquiry.

The present study replicated a previous investigation that compared a global measure of life change events (the Schedule of Recent Experience) with a restricted negative measure of such events (the Life Experience Survey) in association with self-reported anxiety and depressive symptomatology (N = 84). With appropriate sampling methods and data analysis by gender, the previous finding of the superiority of the negative events measure was not supported. The pattern of inconsistent findings for both measures suggests the need for utilizing semi-structured interviews.

Adult

The natural course of schizophrenia: a review of first-admission studies.

In this article, research on the natural course of illness among first-admission schizophrenic patients is reviewed from an epidemiological perspective. Three types of studies are considered: statistical reports dating primarily from the preneuroleptic era; long-term followback studies; and more recent prospectively designed cohort studies. Although relatively more first-admission patients have a positive course than do multiple admissions patients, the findings confirm the substantial heterogeneity in course and outcome. Methodological improvements in first-admission research are suggested, including separating the analyses of first-episode patients from those with past psychotic experiences; employing longitudinal methods for deriving diagnosis; including patients with drug and alcohol problems where appropriate; enlarging the samples either by multisite or multicenter collaborations or by pooling data across studies; and obtaining better data on treatment experiences in naturalistic research.

Female

Computer-aided self-observation psychological stressors in an ICU.

We have developed a procedure for a computer-aided self-observation method in stressful situations. Staff members of an ICU recorded their experiences on a computer placed in the ICU, immediately after having experienced a stressful event. The computer asked for and stored psychologically relevant information about cognitive, affective and behavioural aspects. An external stress memory of an ICU was established, allowing a personal/institution-orientated stress diagnosis to be made on the basis of 192 episodes. Sixteen nurses in an intensive care unit in a Swiss hospital used this methodology for 12 weeks. One hundred and ninety-two stressful events were recorded (12 episodes per person), forming a good sample of the stressful episodes for the unit. To the same 16 nurses and 31 nurses at the same hospital (N total = 47) the Nursing Stress Scale was administered. The results from both groups showed that problems dealing with death and work load were predominant. Nurse characteristics such as levels of training (unskilled, skilled) and experience (number of years working as a nurse) were analysed by different statistical procedures and related to their stress experience.

Adaptation, Psychological

Isolation of ether-resistant enteroviruses from sewage: methodology.

Experiments were conducted to determine whether polio type 1 (Mahoney and coxsackie A8 viruses adsorb onto cotton fibers of sewer swabs. Negative results were obtained. It has been shown that viruses may exist in sewage as free virus particles or as bound (adsorbed) virus particles. The sewer-swab method of sampling is superior because it filters out the bound virus over several days; when collected, it represents a catch (grab) sample at that particular time which may or may not contain free virus. A simple method for the preparation of sewage inocula for virus isolations is described which samples the bound virus fraction. Only ether-resistant viruses can be isolated, and an ultracentrifuge is not required. By this method, an isolation rate between 60 and 80% of positive sewer swabs can be achieved. Corresponding figures of 84 and 96% were achieved by concentration of sewer-swab eluates with an ultracentrifuge. Quantitative studies showed that the virus concentration in raw sewage can be as high as one infectious particle per 0.5 ml.

Adsorption

Importance of locally derived birth weight nomograms.

Significant differences exist between the published nomograms of birth weight for gestational age. Differences in demographics, altitude above sea level and study methodology have all been implicated. A three-year experience of uncomplicated singleton gestations (N = 14,766) was analyzed for birth weight and gestational age. The mean, 10th percentile and their 95% confidence intervals were compared to Brenner's data and a pooled sample from other studies in this country. The mean birth weights were significantly higher than Brenner's after 32 weeks' gestation and higher than the pooled mean after 35. The 10th percentiles were significantly greater than Brenner's after 36 weeks' gestation. Approximately 66% of neonates at risk, below our 10th percentile, would not be identified with Brenner's criteria. We agree with Goldenberg that uniform criteria for the definition of the normal population are important in identifying aberrant growth. However, birth weight standards should be developed for the specific population in question.

Altitude

Microsphere estimates of blood flow: methodological considerations.

The microsphere technique is a standard method for measuring blood flow in experimental animals. Sporadic reports have appeared outlining the limitations of this method. In this study we have systematically assessed the effect of blood withdrawals for reference sampling, microsphere numbers, and anesthesia on blood flow estimates using radioactive microspheres in dogs. Experiments were performed on 18 conscious and 12 anesthetized dogs. Four blood flow estimates were performed over 120 min using 1 X 10(6) microspheres (15 microns) each time. The effects of excessive numbers of microspheres (13 million), pentobarbital sodium anesthesia (30 mg/kg), and replacement of volume loss for reference samples with dextran 70 were assessed. In both conscious and anesthetized dogs a progressive decrease in gastric mucosal blood flow and cardiac output was observed over 120 min. This was also observed in the pancreas in conscious dogs. The major factor responsible for these changes was the volume loss due to reference sample withdrawals. Replacement of the withdrawn blood with dextran 70 led to stable blood flows to all organs. The injection of excessive numbers of microspheres did not modify hemodynamics to a greater extent than did the injection of 4 million microspheres. Anesthesia exerted no influence on blood flow other than raising coronary flow. We conclude that although blood flow to the gastric mucosa and the pancreas is sensitive to the minor hemodynamic changes associated with the microsphere technique, replacement of volume loss for reference samples ensures stable blood flow to all organs over a 120-min period.

Animals

Estimating sexual behaviour parameters in the light of AIDS: a review of recent UK studies of young people.

This paper reviews UK surveys of the sexual behaviour of young people since the advent of AIDS. The studies, which are restricted to those whose samples were intended to be representative of the general population, reveal broadly similar estimates of key sexual behaviours (numbers with sexual experience, numbers of partners, frequency of intercourse, condom use and anal penetration). In spite of these similarities and the usefulness of such information for estimating the potential rate of transmission of HIV a number of methodological issues continue to afflict this kind of research. The paper calls for standardized question formats and a centralized body to monitor changes in these parameters of sexual behaviour.

Acquired Immunodeficiency Syndrome

[Experiences with the Meyer-Probst encephalopathy questionnaire].

The validity of the questionnaire elaborated by Meyer-Probst for recording the typical behaviour of encephalopaths was checked on a sample comprising 254 high-risk and control children aged 6 to 7 years. The results confirm its value as a diagnostic aid in outpatient work and as methodological tool for research.

Attention Deficit Disorder with Hyperactivity

Bringing social structure back into clinical decision making.

Although research in the past twenty years has resulted in an increasingly sophisticated understanding of clinical decision making processes, the dominant approach in this area of inquiry remains limited. Most studies emphasize normative models of how decisions ought to be made, others attempt to describe physicians' thinking, but few take the social context of decision making systematically into account. Research models typically assume that physicians are autonomous professionals practicing in socially insular clinical settings--an approach that is consistent with classic formulations of the social structure of medical practice, but they ignore 30 years of sociological research on research on patient-physician relationships and major historical changes in the structure of medical practice. Eisenberg's still timely advice to students of clinical decision making--that they need to describe decision making in the context of 'sociologic influences' (including patient, physician and practice setting characteristics)--is expanded in the present discussion. Recent studies are reviewed, highlighting important dimensions of social structure impinging on physicians' decision making. Findings indicate that the process of clinical decision making is likely influenced by patients' age, gender, socioeconomic status, and race, physicians' professional training and experience, as well as by larger structural features of organized clinical settings. Our review of these studies on the social context of clinical decision making, however, reveals major methodological limitations including those inherently imposed by secondary data analysis, normative approaches, written case vignettes, small, non-random samples and the inadequate control of confounding influences. We present a feasible, alternative research strategy, built on a factorial experimental design. Illustrative findings indicate how complex social structural influence on clinical decision making may be disentangled in an unconfounded manner.

Age Factors

How large should my study be so that I can detect an altered sex ratio?

The world literature on manipulations purported to alter the gender of offspring is a quagmire full of reports presenting inadequate data and contradictory conclusions. Many are due to inappropriate statistical design or analysis. The authors present simple, nontechnical reference tables for determination of the minimum sample size necessary to detect a change in sex ratio (1) from a theoretical value, and (2) between two experimental populations. Simple methods for analyzing the results of gender manipulation experiments are described. Technical details are included in a separate section.

Female

The influence of depressive symptomatology on alcoholics' locus of control: a methodological note and a correction.

In a previously published experiment from our laboratory, we reported two findings. First, controls showed the expected negative correlation between internal and external LOC dimensions, while alcoholics did not. Second, a difference score between LOC-internal and LOC-external was correlated significantly and positively with alcoholics' abstracting impairment. Data from two new independent samples of alcoholics and controls confirmed the first finding, but not the second; further, a calculation error was discovered in the previously published data that invalidated the second result. However, in all three studies, depressive symptomatology was found to be correlated negatively with the internal-external LOC difference score in both alcoholics and controls. It is suggested that depressive symptomatology be assessed in any study that investigates LOC.

Adult

Mutagenic activity of disinfection by-products.

Data on raw water quality, disinfection treatment practices, and the resulting mutagenic properties of the treated water were compiled from pilot- and full-scale treatment experiments to evaluate that parameter which might produce variability in the results of a mutagenic study. Analysis of the data and comparison of treatment practices indicated that the measured mutagenic activity is strongly related to the characteristics of the organic matter in the raw water, the methodology used to sample and detect mutagens, the scale of the study both in terms of treatment flow and period of study, and the point at which and the conditions under which oxidants are added during treatment. Conclusions regarding disinfection systems in full-scale water treatment plants include the following: When raw water is pretreated and high concentrations of organics are present in the raw water, both ozonation and chlorination increased mutagenic activity. However, no significant difference in mutagenicity was found between the two oxidants. Both in the case of a nitrified groundwater and a clarified surface water, the mutagenic activity of the water after ozonation was related to its mutagenic activity before ozonation. With ozonation, mutagenic activity decreased after granular activated carbon (GAC) filtration. Thus, when GAC filtration follows ozone disinfection, early addition of oxidants may not be deleterious to the finished water quality. When chlorine or chlorine dioxide is added after GAC filtration, chlorine dioxide was found to produce a less mutagenic water than chlorine. Although these conclusions suggest means of controlling mutagenic activity during treatment, it must be stressed that the measurement of mutagenicity is a presumptive index of contamination level.

Carbon

[Event-related desynchronization and the selection of an alpha-frequency band for quantifying cortical pre- and poststimulus activation].

The amount of event-related decrease of increase in alpha-band power is termed "Event-Related Desynchronization" or ERD. In this study, ERD is used as an index of cortical activation, which not only can be applied to monitor poststimulus but prestimulus processes as well. Usually, ERD is analyzed within a fixed range of alpha-frequency, typically within a range of 8-12 Hz. alpha-frequency, however, shows a considerable between subject variation, even in a sample of subjects with comparable age. The purpose of this study, thus is to show as to how the range of alpha-frequency affects the calculation of ERD. Two different methodological approaches were compared. First, ERD was calculated within a fixed range of 8-12 Hz. Second, ERD was calculated within an individual range, which was adjusted to the individually determined alpha-frequency of each subject. A sample of ten right handed subjects participated in an episodic memory experiment, in which target words, shown in a earlier session of the experiment, were to be identified. A time span of 375 ms preceding and following the presentation of a word was defined as the "pre-" and "poststimulus" interval. EEG-signals were recorded unipolarly from 29 leads. The results show a rather localized increase of ERD in the poststimulus interval. In the prestimulus interval on the other hand, the average magnitude of ERD is much lower and the topographical distribution less localized. Most importantly, however, when comparing the two methods of analyzing ERD, those ERD-values calculated within an individually determined alpha-band, are superior in order to differentiate between the pre- and poststimulus interval.

Adult