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Comprehensive proteomic analysis of breast cancer cell membranes reveals unique proteins with potential roles in clinical cancer.

Proteins associated with cancer cell plasma membranes are rich in known drug and antibody targets as well as other proteins known to play key roles in the abnormal signal transduction processes required for carcinogenesis. We describe here a proteomics process that comprehensively annotates the protein content of breast tumor cell membranes and defines the clinical relevance of such proteins. Tumor-derived cell lines were used to ensure an enrichment for cancer cell-specific plasma membrane proteins because it is difficult to purify cancer cells and then obtain good membrane preparations from clinical material. Multiple cell lines with different molecular pathologies were used to represent the clinical heterogeneity of breast cancer. Peptide tandem mass spectra were searched against a comprehensive data base containing known and conceptual proteins derived from many public data bases including the draft human genome sequences. This plasma membrane-enriched proteome analysis created a data base of more than 500 breast cancer cell line proteins, 27% of which were of unknown function. The value of our approach is demonstrated by further detailed analyses of three previously uncharacterized proteins whose clinical relevance has been defined by their unique cancer expression profiles and the identification of protein-binding partners that elucidate potential functionality in cancer.

Amino Acid Sequence↗

Young children's production and comprehension of nonverbal deictic behaviors.

The production of pointing, the understanding of pointing and the comprehension of another's line of regard was investigated in 36 male and female infants 9-, 12-, and 14-months-old. Production of pointing was present in eight out of twelve 12-month-olds and in eleven out of twelve 14-month-olds; only a few of the youngest Ss pointed. For the youngest infants comprehension of pointing was a function of the distance between the person pointing and the object pointed to. All 12-and 14-month-old children comprehended the pointing to a nearby object and most of them also understood the pointing to a distant object. Ten out of twelve 12-month-olds and eleven out of twelve 14-month-olds were able to tell where another person was looking if both the cues of movement and orientation of the head and the eyes were present; their performance was less perfect with only the cue of orientation present or with only the eyes moving. Never more than three out of the twelve youngest Ss succeeded on any of these percept-diagnosis tasks.

Child Development↗

Disturbed children's and adolescents' comprehension of psychological mechanisms of defense.

This study examined the role of Piagetian logical and analytical reasoning in the comprehension of psychological defense mechanisms among 26 emotionally disturbed boys. Participants assigned to one of three Piagetian cognitive stages, listened to vignettes depicting defensive behaviors of various degrees of logical and structural complexity. Results indicated that, although both within- and between-group performances were at variance with theoretical expectations, consistent age trends in the comprehension of defense mechanisms were observed.

Adolescent↗

Factor structure of the Comprehensive Adolescent Severity Inventory (CASI): results of reliability, validity, and generalizability analyses.

This article describes the results of psychometric work conducted on the Comprehensive Adolescent Severity Inventory (CASI) among 205 in-treatment substance-abusing adolescents. Four dimensions, each composed of component subscales, resulted from standard psychometric analyses: Chemical Dependency, Psychosocial Functioning, Delinquency, and Risk Behavior. Each dimension had high internal consistency (alpha coefficients for the component subscales comprising each clinical dimension range from .78 to .96) and test-retest reliability (intraclass correlation coefficients range from .88 to .96 and all are significant at p < .0001.). Concurrent validity and specificity of the CASI dimensions also were found: significant and substantial variance in NIMH Diagnostic Interview Schedule for Children-Revised (DISC-IV) and Brief Symptom Inventory (BSI) scores was associated with relevant CASI dimensions; CASI dimensions that theoretically should show no significant relationship with divergent pathology were not associated. The dimensions forecasted substantial variance in adolescent functioning posttreatment discharge, supporting predictive validity. Finally, the dimensional clinical structure was found to be generalizable over male and female adolescents, younger and older adolescents, and adolescents from different ethnic groups. These results provide further evidence for the CASI's promise in research and practice as an adolescent-specific assessment instrument that comprehensively assesses multidimensional areas of functioning within a developmental context of measurement. Limitations of the study along with future work currently being conducted on the CASI are discussed.

Adolescent↗

A comprehensive new curriculum to teach and assess resident knowledge and diagnostic evaluation of musculoskeletal complaints.

Musculoskeletal complaints are a common reason for primary care visits; however, many essential physical examination, diagnostic and treatment skills are not adequately taught. The objectives of the study were to create and implement a comprehensive clinical skills teaching model, and to evaluate its effects on residents' knowledge and diagnostic skills. A comparison of cohorts who participated and did not participate in a musculoskeletal curriculum was undertaken. Second and third year medical residents participated in comprehensive curricula to teach and evaluate musculoskeletal skills. Sixty-seven attended the first of three lectures on the painful shoulder; 61 attended all three lectures and completed pre- and post-self assessment forms and tests. Three months later 26 of these residents and 10 controls participated in an OSCE examination. Thirty-nine medical residents attended the first of three lectures on the painful knee; 32 attended all three lectures and completed pre- and post-self assessment forms and tests. Seven of these residents and eight controls participated in an OSCE examination three months later. Both the shoulder and knee curricula were associated with a significant improvement in test scores (p < 0.0001), in self-assessment of physical examination, diagnostic and procedural skills (p < 0.0001), and in OSCE results (p < 0.005). It was concluded that the skills required for the diagnosis and treatment of common musculoskeletal complaints can be effectively taught and assessed using inexpensive and simple methods.

Boston↗

Comprehensive analysis of migrates from food-packaging materials: a challenge.

The premise is put forward that present European regulation of food-packaging materials does not provide the assessment for safety corresponding to the opinion of toxicologists that migrants ingested in amounts exceeding a threshold of 1.5 microg day(-1) should be identified and toxicologically evaluated. Many substances that migrate (the large majority of the components migrating from can coatings) are neither starting point materials, nor obvious derivatives therefrom, and are, therefore, not covered by existing systems based on positive lists. Safety presupposes the comprehensive analysis of the migrating substances, ultimately to the limits in terms of concentration and molecular weight considered to he of toxicological concern. This is a new analytical challenge. In this paper, expected problems are discussed, leading to the conclusion that it will be difficult to achieve comprehensive analysis down to the concentrations presently considered safe, but that systematic work should start to define the possibilities and limitations of analytical chemistry for a migrate-oriented coating legislation.

European Union↗

Interpretation and comprehension of linguistic humour by adolescents with head injury: a group analysis.

The aim of the present study was to determine the ability of adolescents with a head injury to interpret and comprehend linguistic humour. Nine adolescents with head injury aged between 12 years 1 month and 15 years 4 months, and nine individually matched adolescents aged between 12 years 1 month and 16 years 1 month were administered a humour test, a standard language battery, the CELF-3, and the Self-Esteem Index. The test of humour abilities required each subject to recognize and select an explanation from a group of three, as to what made each item funny. Items were based on morphological, semantic and syntactic humour elements. Comparison at a group level demonstrated that adolescents with head injury performed significantly poorer in the interpretation and comprehension of linguistic humour than a group of individually matched peers. Contrary to expectations, a relationship between the level of self-esteem and humour comprehension did not exist. The findings of the present study suggest that further research into the effects of head injury on linguistic humour in adolescents is warranted, particularly from a case-by-case perspective.

Adolescent↗

Assessing auditory comprehension in the context of severe physical disability: the PACST.

Existing tests of auditory comprehension are frequently unsuitable for patients with physically disabling conditions as tests require skills such as physical manipulation of materials. A suitable test is required to assess the reliability and validity of responses in patients who can only indicate 'yes' and 'no'. This has implications for enabling patients to participate, for example, in decision making over their care. In the construction of the Putney Auditory Comprehension Screening Test (PACST) 200 normal participants were tested with 258 yes/no questions. From their results a test consisting of 60 unambiguous questions, varying in difficulty, type, syntactic complexity and length were selected. A clinical trial was completed with 112 patients from the Royal Hospital for Neuro-disability. The 60 item test was found to be reliable and valid. Results were also compared with independent ratings by ward managers and speech and language therapists. Effects of demographic variables were as expected. A 60 question test was developed which was shown by the clinical trial to be a useful tool. Questions vary in difficulty, but not enough to establish a difficulty gradient. On the basis of performance on the test, patients can be allocated to three groups: normal, impaired, and chance performance.

Adolescent↗

Medicinal marijuana: a comprehensive review.

Considerable controversy exists regarding the role of marijuana as a therapeutic agent; however, many practitioners are taught very little about existing marijuana data. The authors therefore undertook a comprehensive literature review of the topic. References were identified using textbooks, review and opinion articles, and a primary literature review in MEDLINE. Sources were included in this review based primarily on the quality of the data. Some data exists that lends credence to many of the claims about marijuana's properties. In general, however, the body of literature about marijuana is extremely poor in quality. Marijuana and/or its components may help alleviate suffering in patients with a variety of serious illnesses. Health care providers can best minimize short term adverse consequences and drug interactions for terminally ill patients by having a thorough understanding of the pharmacology of marijuana, potential adverse reactions, infection risks, and drug interactions (along with on-going monitoring of the patient). For chronic conditions, the significance and risk of short and long term adverse effects must be weighed against the desired benefit. Patients who are best suited to medicinal marijuana will be those who will gain substantial benefit to offset these risks, and who have failed a well-documented, compliant and comprehensive approach to standard therapies.

Cannabis↗

Executive control and the comprehension of medical information by elderly retirees.

This study examined the independent contributions of executive control function, general cognition, age, education, and medication usage to the comprehension of medical information. Randomly selected elderly retirees (N = 105) more than 70 years of age completed the Executive Interview (EXIT25), the Mini-Mental State Exam (MMSE), and the Hopkins Competency Assessment Test (HCAT). Cognitive measures were stronger predictors of HCAT scores than age, education, or number of prescribed medications. A discriminant model based on EXIT25 and MMSE scores correctly classified 91% of subjects relative to their HCAT scores. It was concluded that executive impairment is strongly associated with impaired comprehension of medical information. As many as 88% of probable Alzheimer's disease patients, 69% of institutionalized elderly retirees, and 49% of noninstitutionalized retirees may be impaired in their ability to comprehend medical information, even when it has been presented well below their educational level.

Aged↗

Childhood versus adult onset obesity in a comprehensive, multidisciplinary weight reduction program.

The weight loss of 16 obese patients (greater than 130% ideal body weight) who participated for three months in a comprehensive, multidisciplinary weight reduction program was studied. Patients were divided into two groups based on the reported time of onset of their obesity. Childhood-onset obesity was defined in this study as marked weight gain by the age of 11. Adult-onset obesity was defined as weight gain occurring at 18 years of age or later. Each group of patients consisted of two males and six females. The childhood-onset obesity group lost significantly more weight than the adult-onset obesity group during this three-month period (19.45 +/- 3.6% versus 16.17 +/- 2.8%). This preliminary study suggests that patients with childhood-onset obesity tend to lose more weight in a comprehensive multidisciplinary weight reduction program than patients with adult onset obesity.

Adult↗

Reading versus comprehension: implications for patient education and consent in an outpatient oncology clinic.

Written educational materials and consent forms are often given to patients with little regard for their ability to read them. Nationwide sampling and data from the 1990 census suggest that 10% of U.S. adults are functionally illiterate. In this study, 100 adult patients (64 female, 36 male) seen consecutively in an oncology clinic were tested for reading vocabulary (RD-VOCAB) and reading comprehension (RD-COMP) using the Woodcock-Johnson Psychoeducational Battery. The mean grade levels of education (last grade completed), reading vocabulary, and reading comprehension of all participants were 12.5, 11.3, and 10.5, respectively. The discrepancy between the grade level of education and RD-COMP varied by age, the largest discrepancies being found in the 30-39 (three grades) and 60-69 (2 1/2 grades) age groups. After controlling for educational level, it was found that the mean grade level of RD-COMP was statistically lower than educational level. Statistically assuming all subjects to have completed high school, the mean levels of RD-COMP ranged from ninth grade in the 30-39 age group to twelfth grade in the 40-49 age group. This study underscores the fact that the health professional cannot assume that a patient who has completed a certain grade level in school can read at the corresponding level. Consent forms and other health education materials should be written at least three grade levels lower than the average educational level of the target population.

Adolescent↗

Implementation of a comprehensive AIDS education programme for schools in Masaka District, Uganda.

As part of a large IEC (Information, Education and Communication)/STD intervention trial, a 19-lesson, comprehensive school-based AIDS education programme was implemented and evaluated in 50 primary and 16 secondary schools in 12 parishes of Masaka District, Uganda. A series of three teacher-training and evaluation workshops spread over a year was held in each parish, between which teachers implemented the programme in the classroom. One hundred and forty-eight teachers were trained and about 3,500 students were subsequently exposed to the programme. Both teachers and students responded positively, which suggests that this type of programme has much to offer young people who attend school. However, some problems were encountered: language, programme content, community resistance to teaching about condoms, and several practical issues. Proposed solutions include flexibility with the English language policy, alternative approaches to role play activities, targeting influential individuals with information about the need for young people to learn about safer sex, and a parallel community-based IEC programme to facilitate community acceptance of the need for the programme. In addition, implementation may be incomplete unless comprehensive AIDS education is fully incorporated into the curriculum, and properly examined. These findings are placed in the context of other life skills/AIDS education programmes being introduced both in Uganda and elsewhere in Africa.

Acquired Immunodeficiency Syndrome↗

Measuring chronic health condition and disability as distinct concepts in national surveys of school-aged children in Canada: a comprehensive review with recommendations based on the ICD-10 and ICF.

PURPOSE: With the aim of improving the measurement of child health and disability in survey research, this paper reviews the coverage of chronic health conditions and the domains of disability and related environmental factors as they are laid out in the ICD-10 and ICF, respectively, in national surveys of school-aged children conducted in Canada since 1980. Recommendations are made for future survey use and construction. METHODS: Two reviewers independently examined each of the surveys. Coverage of chronic health conditions, the domains of disability, and environmental factors in survey questions was identified by mapping question content onto ICD-10 and ICF codes. The reviewers then compared their findings and came to a final consensus. RESULTS: Surveys vary in the range and depth of coverage of the ICD-10 and ICF chapters. Disability surveys and health surveys for persons aged 12 and over contain the most comprehensive lists of chronic conditions. Coverage of impairments is limited. Coverage of activity limitations and participation restrictions is most limited in the domains of personal care and domestic life. Environmental factors not covered include natural environmental changes, attitudes, and policies. CONCLUSIONS: Development of a comprehensive standard list of chronic health conditions based on the ICD-10 and development of standard survey measures of the domains of disability and environmental factors based on the ICF for use in surveys of school-aged children would facilitate an understanding of children's health and disability in the context of the current international health framework provided by the World Health Organization.

Adolescent↗

Five-year experience with the 'Sheba' model of comprehensive orthogeriatric care for elderly hip fracture patients.

BACKGROUND AND PURPOSE: The Sheba model of orthogerioatric medicine is a unique model of in-hospital care for elderly hip fractured patients, based upon the concept that a hip fracture represents a geriatric, rather than an orthopedic disease. The nature and feasibility of such a comprehensive orthogeriatric unit, taking care of all surgical, medical and rehabilitation needs, in a single geriatric-based setting (rather than orthopedic-based), were questioned. The aim of the study is to describe the results of its operation during a five-year period. METHOD: A retrospective charts analysis of consecutive older patients with hip fractures, admitted from the emergency unit directly to the orthogeriatric unit of a department of geriatric medicine. RESULTS: A total number of 592 patients were admitted. Mean age of patients was 83.2 years, mostly women. A total of 538 (91%) were treated surgically. Delay to surgery was 3.6 +/- 2.9 days. A total of 65.6% were suitable for rehabilitation, and had a mean Functional Independence Measure (FIM) gain of 22.3 +/- 7.9. Mean total hospital length of stay was 29.9 days and 68.7% of patients returned to their previous living residence. Rates of major complications (4.1%) and in-hospital mortality (3.2%, equivalent to 30 days mortality) were low. CONCLUSIONS: Treatment within this unit was associated with low rates of major morbidity and mortality, short stay and acceptable functional outcomes. The data provide clinical evidence supporting the implementation of this model of comprehensive orthogeriatric care, being a practical, applicable and feasible service for elderly hip fractured patients, and covering the various needs of these patients. The present model of organization could also help in skillful use of economic resources, facilitating effective treatment strategies.

Aged↗

Selective preservation of a lexical category in aphasia: dissociations in comprehension of body parts and geographical place names following focal brain lesion.

The selective dissociation of memory for proper names is discussed in the context of a review of dissociations involving broadly defined vs narrowly defined semantic categories in brain damaged adults. Two narrowly defined categories for which dissociations have been reported are body parts (selectively impaired in comprehension) and geographical place names (selectively preserved in comprehension). In this study, 167 aphasic patients were tested for their ability to correctly identify body parts and map locations from spoken names, relative to a baseline for correct responses on general word discrimination (object identification). Wernicke's aphasics and Global aphasics both had significantly more success in pointing to named map locations and significantly worse performance in pointing to named body parts than they had in selecting other objects from multiple choice. Anomic aphasics showed precisely the opposite pattern of results. Other aphasic subgroups (Broca's aphasics, Mixed Nonfluent aphasics, Conduction aphasics, Transcortical Motor and Transcortical Sensory aphasics, and Mixed Fluent aphasics) did not show significant deviations in either direction. We suggest that the selective preservation for place names may be related to their status as proper names.

Adult↗

Pragmatic comprehension in secondary school-aged students with specific developmental language disorder.

This study explores the hypothesis that there may be particular difficulties for secondary school students with specific developmental language disorder (SDLD) in understanding contextual, pragmatic meaning. Sixty-four SDLD students aged 11+ to 14+ years are compared with chronological-age-matched and language-age-matched non-impaired students. New procedures are used to examine comprehension of two types of ambiguity where the context determines speaker intention: inconsistent messages of emotion and multiple meanings in context. These types of ambiguity are evident in a range of communicative intent, e.g. sarcasm, idiomatic expression, deceit and humour. Preliminary study into adolescent language suggests that at this age there is a growing expectation for students to understand these kinds of communication, both in the classroom and socially. The study finds that the SDLD students were less able than both comparison groups to use context to understand implied meanings. Non-impaired children were also more able to rule out literal interpretations when they did not know the non-literal meaning. These findings were statistically significant. The implications for research and practice are discussed, including those of diagnostic assessment, in the light of the literature survey revealing that many currently available do not assess pragmatic meaning comprehension. There is a challenge to the view that disorders in the semantic and pragmatic domains necessarily co-occur, as suggested by the diagnostic category semantic-pragmatic disorder.

Adolescent↗

Consequences of a motor programming deficit for rehearsal and written sentence comprehension.

The role of central motor processes in rehearsal was investigated by studying a brain-damaged patient with a severe articulatory impairment. Evidence is presented that his articulatory impairment is due to a disruption of motor programming rather than to peripheral muscle weakness. Despite his motor programming deficit, the patient showed normal auditory span and evidence of rehearsal for auditorily presented sequences of words. For visual presentation, span was reduced and there was no evidence of rehearsal. Also, the patient showed excellent sentence comprehension for syntactically complex sentences for both auditory and visual presentation. The results imply that central motor processes are not critical for normal short-term memory, at least for auditory presentation, and that reading comprehension does not depend on inner rehearsal.

Articulation Disorders↗