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PubMed1992

Revising axis V for DSM-IV: a review of measures of social functioning.

OBJECTIVE: Axis V, which uses the Global Assessment of Functioning Scale in the multiaxial system of DSM-III-R, is under review for DSM-IV. This article examines what is known about axis V and selectively reviews the literature on measures of social functioning to identify potential alternatives to the Global Assessment of Functioning Scale. METHOD: About 25 studies on the use, reliability, and validity of axis V in DSM-III and DSM-III-R are reviewed. In addition, nearly 30 measures of social functioning are reviewed and analyzed as potential substitutes for the Global Assessment of Functioning Scale. The analysis focuses on the strengths and weaknesses of each measure for assessing functioning on axis V. RESULTS: Axis V measures are modestly reliable and valid but not widely used. The authors identify and discuss two particular limitations of the Global Assessment of Functioning Scale: 1) the combination of measures of symptoms and measures of social functioning on a single axis and 2) the exclusion of physical impairments from the rating of functioning. CONCLUSIONS: None of the measures of social functioning reviewed is clearly superior to the Global Assessment of Functioning Scale for use on axis V. A modified version of the Global Assessment of Functioning Scale, separating the measures of social and occupational functioning from the measures of symptoms and psychological functioning, is proposed for field testing, along with a new set of instructions permitting the rating of limitations due to both physical and mental impairments.

Persons with Disabilities↗

PubMed1995

Dobutamine echocardiography in predicting improvement in global left ventricular systolic function after coronary bypass or angioplasty in patients with healed myocardial infarcts.

The aim of this study was to determine whether low-dose dobutamine echocardiography (DE) could predict quantitative improvement in global left ventricular (LV) systolic function after coronary revascularization. Low-dose DE was performed in 71 consecutive patients with coronary artery disease and LV dysfunction. Successful coronary bypass surgery or angioplasty was performed in 44 patients, 37 of whom had a resting echocardiogram 1 to 3 months afterward. Group A consisted of 20 patients with contractile reserve during DE, and group B consisted of 17 patients without contractile reserve. As expected, regional wall motion score index (mean +/- SD) improved in group A (1.62 +/- 0.39 to 1.38 +/- 0.31, p < 0.01) but not group B (1.56 +/- 0.42 to 1.57 +/- 0.41, p = NS). In addition, LV ejection fraction (LVEF) improved after bypass surgery or angioplasty in group A (38 +/- 5% to 42 +/- 5%, p < 0.01), but not in group B (38 +/- 7% to 39 +/- 8%, p = NS). In group A, a significant linear correlation was observed between the number of segments with contractile reserve and the improvement in LVEF (r = 0.91, p < 0.0001). A good correlation also existed between the improvement in regional wall motion score index during dobutamine infusion and the improvement in LVEF after bypass surgery or angioplasty (r = 0.90, p < 0.0001). In conclusion, low-dose DE can be used to predict quantitative improvement in global LV systolic function after coronary bypass or angioplasty.

Angioplasty, Balloon, Coronary↗

PubMed2005

The histone chaperone anti-silencing function 1 is a global regulator of transcription independent of passage through S phase.

We investigated the function of the histone H3/H4 chaperones anti-silencing function 1 (Asf1p) and chromatin assembly factor 1 (CAF-1) in global transcriptional regulation in budding yeast. Deletion of ASF1 or CAF-1 components led to global transcriptional misregulation, both activation and repression, of genes scattered throughout the 16 yeast chromosomes. To investigate direct effects on gene regulation, we developed an approach to destabilize Asf1p that results in its rapid degradation within minutes of transcriptional repression. Upon degradation of Asf1p, rapid global changes in gene expression occur without the requirement for passage through S phase or de novo protein synthesis. In particular, we demonstrate that the previously reported influence of Asf1p on histone gene expression is not a direct effect of loss of Asf1p. These data indicate that the histone chaperones CAF-1 and Asf1p regulate the gene expression of a broad array of genes in yeast and, in the case of Asf1p, this is likely to be due to a direct role in chromatin modulation during transcriptional regulation.

Cell Cycle Proteins↗

PubMed1998

Factors associated with outcome in major depression: a 6-month prospective study.

A number of authors have indicated in recent years that the course of depression is not as favourable as previously expected. Research conducted in order to identify predictors of recovery has shown widely different results. In this paper a sample of 90 consecutive patients with non-chronic major depressive disorders (index episode < 6 months) attending four mental health centres in Madrid were followed up prospectively for 6 months, and clinical social and cognitive variables were studied. The patients were treated pharmacologically and controlled. The rate of recovery was measured according to the Hamilton Rating Scale for Depression (HAM-D). Other tools used were: Life Events and Chronic Difficulties, Global Assessment Functioning in the 6 months prior to the onset of episode, Brown Rating Scale for Self-Esteem and Mannheim Interview of Social Support. The results showed that 41 cases recovered (HAM-D score < 8), 29 cases achieved a partial remission, and major depressive disorder persisted in 17 cases (HAM-D score > or = 18). The presence of personality disorders, having suffered a previous episode, GAF score and some aspects of social support were the variables most associated with non full remission in the logistic regression analysis. Personality disorders and the initial HAM-D score were related to non-improvement. Some clinical and cognitive variables maintain a weak relation to outcome and are rejected in logistic regression. This study emphasizes the relationship of personality, and social variables such as social support and previous global functioning, with incomplete recovery in major depression.

Adolescent↗

PubMed2004

Globally uniform semiclassical surface-hopping wave function for nonadiabatic scattering.

A globally uniform time-independent semiclassical wave function for nonadiabatic scattering is presented. This wave function, which takes the form of a surface-hopping expansion, is motivated by the globally uniform semiclassical wave function of Kay and co-workers for the single-surface case. The surface-hopping expansion is similar to a previously presented primitive semiclassical wave function for nonadiabatic problems. This earlier wave function has the important feature that it correctly incorporates all phase terms, allowing for an accurate treatment of quantum interference effects. The globally uniform expression has important numerical advantages over the primitive formulation. The globally uniform wave function does not have caustic singularities, and the globally uniform calculation avoids a root search for trajectories obeying double-ended boundary conditions that is required by the primitive semiclassical calculation.

Journal Article↗

PubMed2006

Emotional distress and medication use in two acute pain populations: jaw and low back.

The present study was undertaken to compare emotional distress and functional ability between two common pain populations--acute jaw pain (JAW; n = 135) and acute low back pain (LB; n = 71). Patient groups were evaluated and compared on a variety of biopsychosocial measures, including the Beck Depression Inventory (BDI), Multidimensional Pain Inventory (MPI), Characteristic Pain Intensity (CPI), and Ways of Coping Questionnaire. Specific diagnoses were assessed using the Structured Clinical Interview of the Diagnostic and Statistical Manual (DSM-IV)--I and II, and rates of Axis I and II diagnoses in these groups were further compared to base rates in the general population. Additionally, medication usage was evaluated to determine group differences. Results revealed that JAW patients had lower BDI and CPI scores, as well as a higher level of functioning on the Global Assessment of Functioning assessed by the DSM-IV. Both acute pain groups also had significantly more Axis I and II disorders than the general population. Additionally, it was found that the JAW group used more benzodiazepines, while the LB group used more schedule II narcotics. A logistic regression model created from these variables found a six-factor model, composed of the CPI, MPI coping style anomalous, Ways of Coping problem-solving, Global Assessment of Functioning, anxiety disorders, and Cluster C personality disorder diagnoses, that differentiated the JAW from the LB group. Overall, these findings suggest that the differences identified between these two groups should be considered in developing tailored treatments for individuals with acute low back and jaw pain.

Activities of Daily Living↗

PubMed2003

Effect of recanalization of chronic total occlusions on global and regional left ventricular function in patients with or without previous myocardial infarction.

Previous studies have demonstrated improvement of regional wall motion and global left ventricular function after successful recanalization of chronic total occlusion in coronary artery. However, the difference of benefits of recanalization between infarct site and noninfarct site is unknown. This study assessed the changes in left ventricular ejection fraction, regional wall motion after successful angioplasty of chronic total occlusions with or without previous myocardial infarction. This study also evaluated the factors that influenced the outcome of left ventricular function. We retrospectively studied 75 patients with a successfully recanalized chronic total occlusion in native coronary artery. Left ventriculograms were obtained at baseline and after 6 months. Global and regional left ventricular function were determined. The patients were divided into two groups. Group 1 comprised patients without previous myocardial infarction in the territories of total occlusion vessel that was recanalized. Group 2 comprised patients with previous myocardial infarction in the territories of total occlusion vessel that was recanalized. Left ventricular ejection fraction increased from 53.2% +/- 16.3% at baseline to 57.3% +/- 20.1% at 6-month follow-up in the whole group (P = 0.001). In group 1 patients, the evolution of left ventricular (LV) ejection fraction increased from 59.5% +/- 13.7% to 67.3% +/- 14.6% (P < 0.001). In group 2 patients, the evolution of LV ejection fraction increased, but not significantly, from 48.9% +/- 16.2% to 50.5% +/- 16.9% (P = NS). The evolution of LV ejection fraction increased from 47.6% +/- 17.4% to 50.8% +/- 17.5% (P < 0.05) in the subgroup of recanalization in infarct-related vessel that had rich collateral circulation and had long-term patency. The regional wall motion all significantly improved in group 1 patients (P < 0.05). The regional wall motion did not change in group 2 patients (P = NS). The influence of recanalization of chronic coronary occlusions on the improvement of left ventricular global function was different between myocardial infarction and nonmyocardial infarction patients. The left ventricular function did not improve in myocardial infarction patient. Regional wall motion improved in patients without previous myocardial infarction. For reliable improvement of left ventricular function after recanalization of chronic total occlusions, evidence (not only by symptom or treadmill test) of viable myocardium in recanalized vessel is important. It is also important to keep patency of infarct-related vessel that has good collateral circulation for improving the left ventricular function.

Aged↗

PubMed1994

Comparison of effects of aprikalim and of hypoxic and ischaemic preconditioning on extracellular potassium accumulation, metabolism, and functional recovery of the globally ischaemic rat heart.

OBJECTIVE: The aim was to compare the effects of a potassium channel opener, aprikalim, and of hypoxic and ischaemic preconditioning on extracellular K+ concentration change, metabolism, and ventricular function in isolated globally ischaemic rat hearts. METHODS: Isovolumetric rat hearts (37 degrees C) were treated with 1 microM (apri 1) or 30 microM (apri 30) aprikalim, or preconditioned with either 10 min of hypoxia (N2PC) or 5 min of ischaemia followed by 5 min of perfusion (IPC5) or 10 min of ischaemia followed by 3 min of perfusion (IPC10). Control hearts received neither treatment nor preconditioning. All hearts received 30 min of sustained ischaemia followed by 25 min of reperfusion. Extracellular K+ concentration was measured with a potassium sensitive electrode inserted into the extracellular space of the left ventricular wall. RESULTS: Recovery of left ventricular developed pressure after 25 min of reperfusion was only 19.20(SEM 5.09)% of the preischaemic level in the control group. No recovery was obtained for the apri 1 group. In contrast, a very good recovery was obtained for the apri 30 group [96.69(10.92)%], the N2PC group [104.92(17.40)%], and the IPC10 group [84.96(9.86)%]. The IPC5 group, however, did not have improved recovery of left ventricular pressure [14.15(5.61)%]; this is likely to be related to differences in the stimulation of anaerobic glycolysis. The protection was also markedly attenuated by pretreatment with 50 microM glibenclamide in the apri 30, N2PC, and IPC10 groups [22.76(9.00), 66.06(6.09), and 46.18(7.06)%, respectively]. Hearts treated with aprikalim before inducing ischaemia showed a concentration dependent increase in [K+]e. Hypoxic (N2PC) and ischaemic preconditioning (IPC5 and IPC10) were also associated with an increase in [K+]e over the 5-10 min period preceding the 30 min of sustained ischaemia. During sustained ischaemia all groups showed a nearly triphasic pattern of extracellular K+ changes with an early rising phase, with the exception of the N2PC group for which the early [K+]e rise was barely detectable. CONCLUSIONS: An increase in [K+]e before sustained ischaemia is one of the mechanisms involved in the conditions affording protection. Although important, this is not sufficient, and further protection may be accomplished by decreased stimulation of anaerobic glycolysis during the sustained ischaemia.

Animals↗

PubMed1999

Electrophysiological abnormalities in age-related macular degeneration.

BACKGROUND: Results from psychophysical tests indicate that in age related macular degeneration (ARMD) retinal function is globally impaired. Observations in single ARMD cases showing abnormalities of the electrooculogram (EOG) and electroretinogram (ERG) encouraged us to systematically examine ARMD patients by means of electrophysiological tests to confirm a global retinal dysfunction in ARMD. METHODS: Sixty-six patients with ARMD were examined clinically and by means of EOG, ERG, triple scotopic ERG, and fluorescein angiography (FA). RESULTS: EOG data were considerably reduced in ARMD. Scotopic a- and b-waves of the ERG were mildly affected. The bright flash response showed reduced b-waves with normal implicit times. The amplitude of the oscillatory potential OP2 was significantly reduced and photopic responses were also pathologic compared with an age-matched control group. Geographic atrophy and pigment epithelium detachment showed specific abnormalities in the ERG, whereas in soft drusen EOG changes were more conspicuous. CONCLUSIONS: In addition to data from psychophysical tests the results from electrophysiological examinations indicated a global reduction of retinal function in ARMD which seemed to be present not only in the macula but also elsewhere in the retina.

Aged↗

PubMed2007

Mechanisms of reduction of mitral regurgitation by cardiac resynchronization therapy.

OBJECTIVES: We sought to investigate the effects of improved left ventricular (LV) synchrony on secondary mitral regurgitation in patients receiving cardiac resynchronization therapy for severe heart failure. METHODS: A total of 22 patients, aged 63 +/- 8 years, were studied during sinus rhythm (unpaced), during LV pacing, and during biventricular pacing. Echocardiography was used to assess LV shape, mitral valve morphology and function, and global systolic and diastolic function. Mechanical ventricular synchrony was calculated from regional systolic timings and velocities, using tissue Doppler. RESULTS: Synchronicity index of LV longitudinal function improved from 36 +/- 19 to 14 +/- 8 milliseconds with LV pacing, and from 31 +/- 17 to 12 +/- 7 milliseconds with biventricular pacing (both P < .01). Heterogeneity of myocardial velocities decreased and mean systolic longitudinal velocity increased. Long-axis and short-axis systolic dimensions decreased, and the LV became less spherical. Apical displacement of coaptation from the plane of the mitral annulus, and annular diameter, were reduced. The severity of mitral regurgitation decreased: vena contracta diameter decreased from 5.3 +/- 1.7 to 4.1 +/- 1.5 mm with LV pacing, and from 5.2 +/- 1.7 to 4.0 +/- 1.7 mm with biventricular pacing (both P < .05), correlating with the increase in mean systolic longitudinal velocity (r = -0.49 for LV pacing and r = -0.67 for biventricular pacing, both P < .05). CONCLUSIONS: Cardiac resynchronization reduces mitral regurgitation by improving LV mechanical synchrony, which leads to an increase in LV longitudinal function and a reduction in subvalvar traction.

Analysis of Variance↗

PubMed2006

The helical ventricular myocardial band: global, three-dimensional, functional architecture of the ventricular myocardium.

We are currently witnessing the advent of new diagnostic tools and therapies for heart diseases, but, without serious scientific consensus on fundamental questions about normal and diseased heart structure and function. During the last decade, three successive, international, multidisciplinary symposia were organized in order to setup fundamental research principles, which would allow us to make a significant step forward in understanding heart structure and function. Helical ventricular myocardial band of Torrent-Guasp is the revolutionary new concept in understanding global, three-dimensional, functional architecture of the ventricular myocardium. This concept defines the principal, cumulative vectors, integrating the tissue architecture (i.e. form) and net forces developed (i.e. function) within the ventricular mass. Here we expose the compendium of Torrent-Guasp's half-century long functional anatomical investigations in the light of ongoing efforts to define the integrative approach, which would lead to new understanding of the ventricular form and function by linking across multiple scales of biological organization, as defined in ongoing Physiome project. Helical ventricular myocardial band of Torrent-Guasp may also, hopefully, allow overcoming some difficulties encountered in contemporary efforts to create a comprehensive mathematical model of the heart.

Animals↗

PubMed1991

A comparison of health-related quality-of-life measures for rheumatoid arthritis research. The Auranofin Cooperating Group.

Twenty-eight instruments measuring pain, clinical, functional, and global characteristics were administered to 303 patients in a six-month randomized clinical trial of auranofin and placebo in the treatment of patients with rheumatoid arthritis. The instruments were compared with respect to their responsiveness in detecting a treatment effect, the time involved in administering the instrument, the need for the presence of an interviewer, and ease of administration. The instruments' ability to detect a treatment effect was the deciding characteristic in the clinical, pain, and global categories in choosing the preferred instrument. The counts of tender and swollen joints were found to be the most responsive clinical measures, the 10-cm pain line was the most responsive and the fastest to administer of the pain instruments, and the categorical self-assessment of arthritis was the most responsive global measure. In the functional ability category, the Health Assessment Questionnaire (HAQ), the Keitel Functional Assessment, and the Quality of Well-Being (QWB) Questionnaire were equally responsive. The HAQ was the shortest and the only self-administered questionnaire. The QWB has had the most extensive validation work but was a complex instrument requiring intensive interviewer training. The Keitel was the most time-consuming instrument, but had the advantage of high interobserver agreement. The design of future trials can be guided by the information obtained in this study on their relative efficiencies and ease of use.

Adult↗

PubMed1997

Dissociation between changes in intramyocardial function and left ventricular volumes in the eight weeks after first anterior myocardial infarction.

OBJECTIVES: We sought to examine the relation between regional changes in intramyocardial function and global left ventricular (LV) remodeling in the first 8 weeks after reperfused first anterior myocardial infarction (MI). BACKGROUND: Because of limitations in imaging methods used to date, this relation has not been thoroughly evaluated. METHODS: We studied 26 patients (21 men, 5 women; mean age 51 years) by magnetic resonance imaging (MRI) on day 5 +/- 2 (mean +/- SD) and week 8 +/- 1 after their first anterior MI. All patients had single-vessel left anterior descending coronary artery disease and although they had received reperfusion therapy, all had regional LV dysfunction and an initial ejection fraction (EF) < or = 50%. Short-axis magnetic resonance tagging was performed spanning the LV. Percent intramyocardial circumferential shortening (%S) on a topographic basis, LV mass index, LV end-diastolic volume index (LVEDVI), LV end-systolic volume index and LV ejection fraction (LVEF) were measured. RESULTS: Left ventricular mass index tended to decrease, whereas the LVEDVI increased from 82 +/- 24 to 96 +/- 27 ml/m2 (p = 0.002). Left ventricular end-systolic volume index remained unchanged, whereas LVEF increased from 39 +/- 12% to 45 +/- 14% (p = 0.002). Apical %S improved from 9 +/- 6% to 13 +/- 5% (p < 0.0001), as it did in the midanterior (6 +/- 6% to 10 +/- 7%, p < 0.02) and midseptal regions (8 +/- 7% to 12 +/- 6%, p < 0.02). Early dysfunction in remote midinferior and basal lateral regions resolved by 8 weeks. By multivariate analysis, the only significant predictor of an increase in LVEDVI over the study period was peak creatine kinase (p = 0.04). CONCLUSIONS: In the first 8 weeks after a large, reperfused anterior MI, %S improved in the apex, midanterior and midseptal regions and normalized in remote noninfarct-related regions, but LV end-diastolic volumes also increased. This increased LVEDVI correlated with infarct size by peak creatine kinase and was not related to changes in global and regional LV function.

Adult↗

PubMed2000

The cognitive correlates of white matter abnormalities in normal aging: a quantitative review.

Cerebral white matter of asymptomatic people frequently exhibits circumscribed areas of hyperintensity on magnetic resonance (MR) images and hypodensity on computed tomography scans. However, behavioral implications of this phenomenon remain unclear. In this meta-analysis, the authors examine cumulative evidence regarding the cognitive sequelae of white matter abnormalities in adults without dementia. The influence of potential moderator variables, such as neuroimaging technique, location of the lesions, rating scale, and demographic characteristics of the sample on the association between the burden of white matter hyperintensities and cognitive performance was also examined. Results indicate that white matter abnormalities observed on MR images are associated with attenuated performance on tasks of processing speed, immediate and delayed memory, executive functions, and indices of global cognitive functioning. There was no significant link between the white matter hyperintensities and psychometric indices of intelligence or fine motor performance.

Adult↗

PubMed2001

Prediction and confirmation of a site critical for effector regulation of RGS domain activity.

A critical challenge of structural genomics is to extract functional information from protein structures. We present an example of how this may be accomplished using the Evolutionary Trace (ET) method in the context of the regulators of G protein signaling (RGS) family. We have previously applied ET to the RGS family and identified a novel, evolutionarily privileged site on the RGS domain as important for regulating RGS activity. Here we confirm through targeted mutagenesis of RGS7 that these ET-identified residues are critical for RGS domain regulation and are likely to function as global determinants of RGS function. We also discuss how the recent structure of the complex of RGS9, Gt/i1alpha-GDP-AlF4- and the effector subunit PDEgamma confirms their contact with the effector-G protein interface, forming a structural pathway that communicates from the effector-contacting surface of the G protein and RGS catalytic core domain to the catalytic interface between Galpha and RGS. These results demonstrate the effectiveness of ET for identifying binding sites and efficiently focusing mutational studies on their key residues, thereby linking raw sequence and structure data to functional information.

Amino Acid Sequence↗

PubMed2004

Investigation of factors related to employment outcome following traumatic brain injury: a critical review and conceptual model.

PURPOSE: The purpose of this article is to critically review the literature to examine factors that are most consistently related to employment outcome following traumatic brain injury (TBI), with a particular focus on metacognitive skills. It also aims to develop a conceptual model of factors related to employment outcome. METHOD: The first stage of the review considered 85 studies published between 1980 and December 2003 which investigated factors associated with employment outcome following TBI. English-language studies were identified through searches of Medline and PsycINFO, as well as manual searches of journals and reference lists. The studies were evaluated and rated by two independent raters (Kappa=0.835) according to the quality of their methodology based upon nine criteria. Fifty studies met the criteria for inclusion in the second stage of the review, which examined the relationship between a broad range of variables and employment outcome. RESULTS: The factors most consistently associated with employment outcome included pre-injury occupational status, functional status at discharge, global cognitive functioning, perceptual ability, executive functioning, involvement in vocational rehabilitation services and emotional status. CONCLUSIONS: A conceptual model is presented which emphasises the importance of metacognitive, emotional and social environment factors for improving employment outcome.

Brain Injuries↗

PubMed1997

Shape-based tracking of left ventricular wall motion.

An approach for tracking and quantifying the nonrigid, nonuniform motion of the left ventricular (LV) endocardial wall from two-dimensional (2-D) cardiac image sequences, on a point-by-point basis over the entire cardiac cycle, is presented. Given a set of boundaries, motion computation involves first matching local segments on one contour to segments on the next contour in the sequence using a shape-based strategy. Results from the match process are incorporated with a smoothness term into an optimization functional. The global minimum of this functional is found, resulting in a smooth flow field that is consistent with the match data. The computation is performed for all pairs of frames in the temporal sequence and equally sampled points on one contour are tracked throughout the sequence, resulting in a composite flow field over the entire sequence. Two perspectives on characterizing the optimization functional are presented which result in a tradeoff resolved by the confidence in the initial boundary segmentation. Experimental results for contours derived from diagnostic image sequences of three different imaging modalities are presented. A comparison of trajectory estimates with trajectories of gold-standard markers implanted in the LV wall are presented for validation. The results of this comparison confirm that although cardiac motion is a three-dimensional (3-D) problem, two-dimensional (2-D) analysis provides a rich testing ground for algorithm development.

Algorithms↗

PubMed2001

Association of estrogen levels with neuropsychological performance in women with schizophrenia.

OBJECTIVE: This study sought to determine the relationship of estrogen levels with psychiatric symptoms and neuropsychological function in female patients with schizophrenia. METHOD: Psychiatric symptoms were assessed and average estrogen and progesterone levels from four consecutive weekly blood samples were measured in 22 female inpatients with schizophrenia who were also administered a neuropsychological battery. RESULTS: There were strong positive correlations between average estrogen level and cognitive function, especially measures of global cognitive function, verbal and spatial declarative memory, and perceptual-motor speed. Correlations of hormone levels with psychiatric symptoms were nonsignificant. CONCLUSIONS: Higher estrogen levels in female patients with schizophrenia are associated with better cognitive ability. These results may have implications for potential treatment of cognitive dysfunction with adjunctive estrogen in female patients with schizophrenia.

Adolescent↗