Friedman 2-way ANOVA Research Articles

O.4.1-1 Impact of a pre-pandemic, tele-exercise, fall-prevention intervention on outcomes in older adults

Abstract Purpose This pre-pandemic study used an alternative delivery mode to provide an evidence-based, fall-prevention exercise intervention to older adults. We delivered Tai Ji Quan: Moving for Better Balance® (TJQMBB) via tele-exercise and determined its impact on self-reported and performance-based outcomes in older adults. Methods Five community sites (3 urban, 2 rural) held 6, 1-hour, synchronous TJQMBB classes, over the internet, twice weekly for 16 weeks (32 hours). Baseline and 16-week self-reported data included fear of falling (Falls Efficacy Scale), depression (Geriatric Depression Scale-Short), physical and mental health-related quality of life (HRQOL) (SF-12 PCS and MCS), and total minutes of physical activity per week. Performance-based outcomes included a 5-Meter Walk Test (gait speed), the Timed Up-and-Go Test (mobility), the 4-Square Step Test (balance), and the 5-Times Sit-to-Stand Test (leg strength). Height and weight were used to calculate body mass index (BMI). Paired t-tests and Friedman 2-Way ANOVA tests examined changes in outcomes between baseline and 16 weeks. Results Sixty-three (79.7%) of 79 people were eligible, of which 52 (82.5%) enrolled. Participants were a mean ± SD age of 68.5 ± 7.7 years old, primarily white (96.2%), and female (80.8%). There were no significant improvements in fear of falling (X2r =3.8, p = 0.15), depression (X2r =0.19, p = 0.91), physical (X2r =1.2, p = 0.56) or mental (X2r =0.31, p = 0.86) HRQOL, or physical activity (X2r =3.7, p = 0.16). Gait speed (meters/second) significantly improved from baseline (1.1 ± 0.2) to 16 weeks (1.2 ± 0.2) (p = 0.02). Balance, leg strength, and BMI also improved significantly (balance [seconds]: baseline 10.9 ± 2.4, 16 weeks 10.2 ± 2.5, p = 0.045; strength [seconds]: baseline 14.7 ± 5.7, 16 weeks 12.4 ± 2.9, p = 0.01; BMI [kg/m2]: baseline 30.8 ± 6.3, 16 weeks 30.2 ± 5.6, p < 0.01). There were no changes in mobility (p = 0.16). Conclusions This tele-TJQMBB intervention improved physical function (gait speed, balance, leg strength) and BMI in older adults. Tele-TJQMBB provided an alternative delivery mode that could help overcome the barrier of identifying experienced instructors in rural areas, and could expand TJQMBB’s reach into the older adult population. Future comparative effectiveness studies could establish if outcomes are equivalent between in-person and tele-exercise delivery modes.

Comparison of four cordless gingival displacement systems: A clinical study

Statement of problemAlthough the conventional chemicomechanical cord technique is widely used, packing the cord into the sulcus may cause pain and bleeding. Cordless displacement techniques have been introduced, but a comparison of these systems is lacking. PurposeThe purpose of this clinical study was to evaluate the efficiency and gingival response of 4 cordless gingival displacement systems. Material and methodsOne hundred twenty teeth in 30 participants were allocated to 4 groups according to the material used: Tr (Traxodent; Premier Dental Products Co), Es (Expasyl; Acteon UK), Ez (Expazen; Acteon UK), and Mr (3M Retraction; 3M ESPE). Baseline measurements of periodontal indices and a digital scan were acquired. The cordless displacement pastes were applied according to the manufacturer’s instructions. After removal, a second scan was acquired. Participants were recalled on the 2nd and 14th day to measure periodontal indices and for scans. Screenshots were superimposed to measure changes in the gingiva. Statistical differences among the different materials in achieving lingual and buccal vertical gingival displacement were tested using the related-samples Friedman 2-way ANOVA test by ranks at 3 time points such as immediate, at 2 days, and at 14 days (α=.05). ResultsImmediate gingival displacement varied with the system used. For horizontal displacement, median values ranged between 150 μm (Tr) and 725 μm (Ez) for buccal displacement and between 93 μm (Tr) and 550 μm (Ez) for lingual displacement. Minimum and maximum displacements also varied and followed a similar trend, with Traxodent providing the lowest displacement. The plaque index and attachment level did not statistically differ before and after the treatment. The periodontal parameters were not statistically significant among the groups at all time intervals, except for the gingival index that increased for all the groups after 2 days. ConclusionsSignificant differences were found among the 4 tested systems in both vertical and horizontal gingival displacement. Expasyl, Expazen, and 3M Retraction exceeded the 200-μm requirements for horizontal displacement. Traxodent provided the least displacement in both vertical and horizontal dimensions.

Effect of image sharpening on radiographic image quality

Statement of problemThe image sharpening algorithm, unsharp masking (USM), may cause artifacts that reduce the diagnostic value of digital images. It may create overshoot artifacts that can be misdiagnosed as pathosis or prosthesis misfit. The effect of this image sharpening and the extent of overshoot artifacts on image quality requires investigation. PurposeThe purpose of this in vitro study was to evaluate the effect of USM on digital dental radiographic quality and to demonstrate the extent of overshoot artifacts. Material and methodsThree digital sensors (2 complementary metal-oxide-semiconductors and 1 photostimulable phosphor) were exposed using a digital dental quality assurance imaging phantom to evaluate contrast resolution, spatial resolution, and dynamic range. The 3 sensors were again exposed without the phantom to determine the degree of radiographic noise. Each image was sharpened and then highly sharpened. Overshoot was measured, and images were compared using the Friedman 2-way ANOVA analysis. ResultsImage sharpening significantly affected spatial resolution and noise. Conversely, dynamic range and contrast resolution were not significantly affected by image sharpening. Overshoot artifacts increased with image sharpening. ConclusionsImage sharpening improves visual image quality but significantly increases overshoot artifacts that adversely affect radiographic diagnosis. Data from this study indicate that image sharpening causes artifacts that could negatively affect accurate diagnosis.

Does providing real-time augmented feedback affect the performance of repeated lower limb loading to exhaustion?

IntroductionThis study aimed to determine whether real-time augmented feedback influenced performance of single-leg hopping to volitional exhaustion. MethodsTwenty-seven healthy, male participants performed single-leg hopping (2.2Hz) with (visual and tactile feedback for a target hop height) or without feedback on a force plate. Repeated measures ANOVA were used to determine differences in vertical stiffness (k), duration of flight (tf) and loading (tl) and vertical height displacement during flight (zf) and loading (zl). A Friedman 2-way ANOVA was performed to compare the percentage of trials between conditions that were maintained at 2.2Hz±5%. Correlations were performed to determine if the effects were similar when providing tactile or visual feedback synchronously with the audible cue. ResultsAugmented feedback resulted in maintenance of the tf, zf and zl between the start and end of the trials compared to hopping with no feedback (p<0.01). With or without feedback there was no change in tl and k from start to end. Without feedback, 21 of 27 participants maintained >70% of total hops at 2.2±5% Hz and this was significantly lower (p=0.01) with tactile (13/27) and visual (15/27) feedback. There was a strong correlation between tactile and visual feedback for duration of hopping cycle (Spearman's r=0.74, p≤0.01). ConclusionFeedback was detrimental to being able to maintain hopping cadence in some participants while other participants were able to achieve the cadence and target hop height. This indicates variability in the ability to use real-time augmented feedback effectively.

Periodontal and peri-implant microbiota in patients with healthy and inflamed periodontal and peri-implant tissues.

To compare the prevalence and levels of six bacterial pathogens within the subgingival/submucosal microbiota at teeth versus implants with various clinical conditions. Twenty-two Chinese were included. Four subgingival/submucosal sites were selected for microbiological sampling within each subject, that is, (1) healthy peri-implant tissues; (2) peri-implantitis [PPD ≥ 5mm, presence of bleeding on probing (BOP) and confirmed radiographic bone loss]; (3) healthy gingiva; and (4) periodontitis (PPD ≥4mm). Subgingival/submucosal plaque was sampled using paper points. Quantitative real-time polymerase chain reaction (q-PCR) was used to quantify six pathogens, including Porphyromonas gingivalis (P.g.), Treponema denticola (T.d.), Aggregatibacter actinomycetemcomitans (A.a.), Fusobacterium nucleatum (F.n.), Prevotella intermedia (P.i.), and Staphylococcus aureus (S.a.). Counts were log10-transformed. The most commonly detected species were S. a. and F. n., while A. a. and. P.i. had the lowest detection frequency. The detection frequencies of diseased tooth or implant sites for each of the six target species were either equal to or higher than the respective frequencies at the corresponding healthy sites. There were no statistically significant differences for any of the species or clinical sites (P>0.05, Cochran's Q test). No statistically significant differences in the bacterial loads were found among the four clinical sites; with the exception of F.nucleatum. This was more abundant in periodontitis sites (P=0.023, Friedman's 2-way anova). Both periodontal and peri-implant sites, irrespective of their health status, were revealed to harbor S.aureus cells. The log10-transformed loads of S.aureus were approximately 3.5 within each of the clinical sites (P=0.232). This was the highest of the six species analyzed. Within the same subjects, putative periodontal pathogens were common to both periodontal and peri-implant sites irrespective of health status. The prevalence and levels of P.gingivalis and F.nucleatum were significantly associated with periodontitis, but not with peri-implantitis. A.actinomycetemcomitans was associated with both disease conditions, periodontitis and peri-implantitis, but not with either gingival or mucosal health.

Tasks Matter

Dual-task (DT) performance, the ability to divide one's attention between motor and secondary tasks, is required in daily life. Adults with cognitive impairment (CI) experience more difficulty with DTs than healthy older adults, but it is unclear how the degree of CI relates to DT performance, particularly with tasks of varying levels of difficulty. The purposes of this cross-sectional study were to (1) explore the relationship between cognitive level and DT performance and (2) determine how the difficulty of the combined tasks impacts this relationship. Twenty-three older adults with Mini-Mental State Examination (MMSE) scores ranging from 7 to 30 performed 2 single tasks (ST): the Timed Up and Go (TUG) and a 6-m walk for which self-selected walking speed (SSWS) was calculated. Each ST was repeated under 2 DT conditions: counting forward by 1's (TUG1 and SSWS1) and counting backward by 3's (TUG3 and SSWS3). Dual-task cost (DTC) was calculated for each DT as follows: [(difference between DT and ST motor performance)/ST motor performance] × 100. Spearman rank correlation coefficients were used to determine the relationship between DTC and the MMSE. The Friedman 2-way ANOVA on ranks was used to compare the magnitude of DTC among the 4 DTs. Significant correlations between the MMSE and DTC were found for SSWS3, TUG1, and TUG3 (r = 0.43-0.57). SSWS1 had a weaker and nonsignificant correlation between MMSE and DTC (r = 0.36). The TUG3 was the most difficult DT, while the SSWS1 was the easiest DT. All participants, regardless of MMSE score, were able to engage in all DTs. A linear relationship exists between cognition and DTC in older adults with varying cognitive levels. The strength of this relationship is greater for more challenging tasks. We also suggest that patients with CI may be able to engage in more challenging tasks than might be assumed. The impact of task difficulty has implications in the design of future studies of DT training for individuals both with and without CI.

Microleakage of three different sealants on sound and questionable occlusal surfaces of permanent molars: An in vitro study

This was to evaluate the microleakage of 3 different sealants, applied on sound and questionably carious occlusal surfaces with and without a bonding agent. A total of 120 human molars were selected, photographed with a digital video microscope, and assigned by 3 independent examiners, according to the criteria of ICDAS II, in 2 groups of 60 teeth each. Group A: teeth with deep, clear, sound occlusal surfaces (ICDAS II, code 0). Group B: teeth with questionable occlusal surfaces, having deep, stained pits and fissures with probable incipient, but non-cavitated carious lesions (ICDAS II, codes 1 and 2). Each group was divided into 2 subgroups of 30 teeth each (bonding or no bonding) and then into 3 subgroups of 10 teeth each according to the type of sealant used: one conventional (Conseal) and 2 fluoridated (Conseal F and Teethmate F). After the application of the bonding agent and the sealant to the appropriate teeth, all specimens were subjected to thermal cycling and immersed in a 10% methylene blue dye solution for 4 hours. Average and summed microleakage for each sample were estimated from dye penetration scores on 3 mesiodistal sections of the tooth across the sealed occlusal surface. Non-parametric Friedman's 2-way ANOVA by ranks and Conover-Inman pair wise comparisons were used for differences at the 0.05 level of significance. According to Friedman's 2-way ANOVA by ranks analysis, although there were no significant differences between the different sealants (chi(2) = 0.048, df = 2, P = .976), there were significant differences between the sound and questionably carious occlusal surfaces (chi(2) = 24, df = 3, P = .000). Conover- Inman pair wise comparisons showed no differences between the groups using and not using bonding agents, on sound (SNB-SWB, P = .4561) or questionable occlusal surfaces (QNB-QWB, P = .0842). Sealant microleakage on questionably carious occlusal surfaces was statistically significantly higher than that of sound occlusal surfaces. Using a bonding agent or fluoridated FS did not influence microleakage significantly, either on sound or on questionable fissured surfaces.

Systematic Investigation of the Stability of Food Preferences in Captive Orangutans: Implications for Positive Reinforcement Training

Using preference-assessment tests with humans in conjunction with behavioral modification sessions has been a regular component of almost all operant conditioning programs with mentally challenged humans. This has been very effective in improving the efficiency of behavioral training in these settings and could be similarly effective in zoological and research environments. This study investigated the preferences of 9 captive orangutans for different food items. The study used a pairwise presentation to record each nonhuman animal's preferences for 5 different foods on 6 different occasions over the course of 6 months. Results of a Friedman's 2-way ANOVA indicated that the orangutans showed a clear overall preference for apple. However, there was significant variability among different orangutans in preference ranking for the 5 foods, as shown by a Kendall's tau. In addition, there was variability in preference rankings across time for each orangutan. Because the orangutans' preferences change over time and vary according to individual, regular assessments should identify items to be used as rewards in behavioral husbandry training or as part of feeding enrichment strategies.

Clinical Performance of Viscous Glass Ionomer Cement in Posterior Cavities over Two Years

In this controlled prospective clinical study the highly viscous glass ionomer cement Ketac Molar was clinically assessed in Class I and Class II cavities. Forty-nine subjects (mean age 32.3 years) received 108 restorations placed by six operators in conventional Black I and II type cavities with undercuts after excavating primary lesions or after removing insufficient restorations. At baseline, and after 6, 12, and 24 months, restorations were assessed by two independent investigators according to modified USPHS codes and criteria. Impressions of the restorations were taken and epoxy replicas were made. Between the baseline and the 24-month recall, 51 representative samples were analyzed at 130 × magnification by use of a stereo light microscope (SLM). Recall rates were 83% after 6 months, 50% after 12 months, and 24% after 24 months. Failure rates after 24 months were 8% for Class I and 40% for Class II fillings, mainly due to bulk fracture at occlusally loaded areas (Kaplan Meier survival analysis). Significant changes over time were found for the criteria “surface roughness”, “marginal integrity”, “restoration integrity”, and “overall judgement” (P < .05; Friedman test). SLM analysis revealed statistically significant differences for the following criteria over time (baseline/6 months/12 months (in % of entire evaluable margin length); P < .05; Friedman 2-way ANOVA): perfect margin 37/19/11, negative step formation 26/49/57, gap formation 2/7/9, and overhang 24/11/8. Replicas exhibited mainly negative step formation as main finding due to apparently inferior wear resistance (P < .05). Gap formations were more frequently observed in Class II restorations than in Class I (12% versus 3% after 12 months; P < .05, Mann-Whitney-U test). The evaluated margin lengths were not statistically different (P > .05, Friedman 2-way ANOVA).

Ceramic inlays bonded with two adhesives after 4 years

The aim of the present study was to clinically evaluate the effect of two different adhesive/resin composite combinations for luting of IPS Empress inlays. Ninety-four IPS Empress restorations were placed in 31 patients in a controlled prospective clinical split-mouth study. The restorations were luted with EBS Multi/Compolute (3M Espe) or with Syntac/Variolink II low (Ivoclar Vivadent) without lining. At baseline and after 0.5, 1, 2, and 4 years, the ceramic restorations were examined according to modified USPHS codes and criteria. Two patients including four restorations missed the 4 years recall (drop out). After 4 years of clinical service, four restorations in two patients (three luted with Compolute, one with Variolink II) had to be replaced due to hypersensitivities, 90 inlays and onlays were acceptable (failure rate 4%; Kaplan-Meier survival analysis). Between the five recalls, a statistically significant deterioration was found for the criteria marginal adaptation and inlay fracture (Friedman 2-way ANOVA; p < 0.05). Between the adhesives no statistical difference was found. At baseline, 95% of the restorations revealed luting composite overhangs. After 4 years, 55% of cases had overhangs and 38% showed marginal ditching. No differences were found for surface roughness, color matching, integrity tooth, proximal contact, hypersensitivity, and satisfaction (p > 0.05). For luting of ceramic inlays, no difference between the two luting systems was detectable. The overall failure rate after 4 years was 4%.

Project GLEAN: Evaluation of a School-Based, Gleaned-Food Distribution Project

ABSTRACT Because hunger remains an element of daily life for many Americans, we proposed that a school-based program to distribute gleaned vegetables and fruits, most of which were locally and seasonally grown, would reduce barriers for consuming vegetables and fruits among a low-income school community. In addition to recording the tonnage of food distributed in the project, we collected a series of 3 blood samples from children's parents (n = 17) to assess serum concentrations of vitamin C, folate, and lipid hydroperoxides. Data were analyzed by a Friedman 2-way ANOVA, followed by a post hoc Wilcoxon signed-ranks test. Through this project, we distributed 79,095 pounds of fresh vegetables and fruits. Serum vitamin C (P = 0.02) and serum folate (P = 0.001) increased significantly following program initiation, while serum lipid hydroperoxides dropped numerically (P = 0.07). This food distribution program succeeded in distributing almost 40 tons of produce, with evidence of improvement in parental nutritional status. Given these positive findings, the project is being further investigated as it continues in its second year.

Effect of Computer-Assisted Instruction Versus Traditional Modes of Instruction on Student Learning of Musculoskeletal Special Tests

Background and Purpose. Physical therapist educators strive to maximize the effectiveness and efficiency of instruction by using optimal teaching methods. Most pedagogical research in allied health education has focused on acquisition and retention of cognitive knowledge rather than the development of psychomotor skills. The purpose of this study was to determine the effect of computer-assisted instruction (CAI), live demonstration (LD), and independent textbook instruction (TXT) on acquisition and retention of knowledge and skills related to musculoskeletal special tests. Subjects. Subjects were recruited over 2 consecutive physical therapy classes (2004, n=19, and 2005, n=24). Methods. Using stratified random assignment, subjects were assigned to 1 of 4 intervention groups: CAI, LD, TXT, or control. Pretest written and practical exams measured baseline knowledge and skill in 4 novel musculoskeletal special tests. Students then participated in their group's intervention. Written and practical examinations, identical to pretests, were administered immediately following the prescribed intervention to assess cognitive and psychomotor skill acquisition, and again 3 weeks later to assess retention of learning. Results. Friedman 2-Way ANOVA by Ranks revealed a significant difference in written and practical examination scores across time in each of the 3 intervention groups (P = 0.0001). Nemenyi post-hoc procedure established a significant improvement in each of these groups from pretest to acquisition (P = 0.001). No significant difference existed between acquisition and retention scores, supporting retention of acquired knowledge. Kruskal-Wallis 1-Way ANOVA by Ranks, followed by Dunn's test, revealed significant differences in learning only when the CAI and LD groups were each compared to the control group. Discussion and Conclusion. CAI was as effective as live demonstration and more effective than textbook instruction, particularly in facilitating psychomotor skill acquisition and retention. CAI is an effective and efficient mode of instructional delivery for use in physical therapist education that can be delivered anytime, anywhere.

Clinical performance of bonded leucite-reinforced glass ceramic inlays and onlays after eight years

Objective: Ceramic inlays and onlays are a tooth colored alternative to metallic restorations. Clinical long-term data are scarce though, especially about inlays and onlays having proximal margins in dentin. The present prospective controlled clinical study evaluated the clinical performance of IPS Empress inlays and onlays with cuspal replacements and proximal margins below the cementoenamel junction over eight years. Methods: Ninety six ceramic restorations were placed in 34 patients by six dentists. The restorations were bonded with an enamel/dentin bonding system (Syntac Classic) and four different resin composite systems. The restorations were assessed after placement by two calibrated investigators using modified USPHS codes and criteria at the following time periods: baseline, 1,2,4,6 and 8 years. Results: Eight of the 96 restorations investigated had to be replaced (failure rate 8%; Kaplan–Meier): Six inlays suffered cohesive bulk fractures, two teeth required endodontic treatment. After eight years of clinical service, significant deterioration (Friedman 2-way ANOVA; P<0.05) was found for marginal adaptation of the remaining restorations. 98% of the surviving restorations exhibited marginal deficiencies, independent of the luting composite. Conclusions: IPS Empress inlays and onlays demonstrated to be successful even in large defects. Neither the absence of enamel margins, nor cuspal replacement significantly affected the quality of the restorations.

IPS Empress inlays and onlays after four years — a clinical study

Objective: Ceramic inlays are used as esthetic alternatives to amalgam and other metallic materials for the restoration of badly damaged teeth. However, only limited clinical data are available regarding adhesive inlays and onlays with proximal margins located in dentine. In a prospective, controlled clinical study, the performance of IPS Empress inlays and onlays with cuspal replacements and margins below the amelocemental junction was examined. Materials and methods: Ninety-six IPS Empress fillings were placed in 34 patients by six clinicians. The restorations were luted with four different composite systems. The dentin bonding system Syntac Classic was used in addition to the acid-etch-technique. At baseline and after 6 months, one, two and four years after placement the restorations were assessed by two calibrated investigators using modified USPHS codes and criteria. A representative sample of the restorations was investigated by scanning electron microscopy to evaluate wear. Results: Seven of the 96 restorations investigated had to be replaced (failure rate 7%; Kaplan-Meier). Four inlays had suffered cohesive bulk fractures and three teeth required endodontic treatment. After four years in clinical service, significant deterioration (Friedman 2-way Anova; p<0.05) was found to have occurred in the marginal adaptation of the remaining restorations. Seventy-nine percent of the surviving restorations exhibited marginal deficiencies, independent of the luting composite. Neither the absence of enamel margins, nor cuspal replacement significantly affected the adhesion or marginal quality of the restorations. Conclusion: After four years, extensive IPS Empress inlays and onlays bonded with the dentin bonding system Syntac Classic were found to have a 7% failure rate with 79% of the remaining restorations having marginal deficiencies.

PSYCHOPHYSIOLOGICAL EFFICACY OF A 2% AMINOPHYLLINE-BASED THIGH REDUCING CREAM.

1019 Aminophylline-based creams are marketed as fat reducing agents for the thighs. The purposes of this study were to determine if: 1) a thigh reducing cream would influence body image, 2) product price would influence perception of effectiveness and, 3) the product would decrease thigh size. Serving as their own control, 11 women with thigh cellulite were randomly assigned to a double-blinded, counterbalanced cream treatment with 2% aminophylline (A) on one leg and a placebo (P) on the other (age: 26±7 yrs.; BMI: 23±2 kg/m2; Body Fat (BF): 24±4%; VO2: 39±4 ml/kg/min). They were also randomly assigned into a fictitious expensive (E) or inexpensive (I) cream treatment group. In the lab, subjects massaged 4.5 g of either A or P cream for 1 min into each thigh 5 d/wk for 6 wks. Pre/post testing was done 1 wk prior and immediately after the 6 wk intervention. Dependent measures included thigh girth and skinfolds (distal, mid, proximal to patella) and psychological indices (mood, body image, rating of effectiveness). Results: No significant differences (NSD) were found at baseline between the E vs. I groups for VO2, %BF, or BMI (Independent T's, p>.20). NSD were found for the right vs. left thigh measures at baseline, nor for pre-post measures of VO2, %BF, or BMI (Paired T's, p>.22). NSD were found for skinfold and girth measures between A vs. P-treated thighs (Paired T's, p>.10). Subjects in both the E and I groups reported improved thigh image (Friedman 2-way ANOVA, p=.046), but neither the E nor I group were influenced by product cost (Mann-Whitney U-Wilcoxon Rank Sum Test, p>.17). Conclusions: The 2% A cream was not effective in reducing thigh size, however, the subjects felt more positive about their thighs and overall body build. (Partially supported by FAU Foundation)

Assessment of the emetogenic potential of intrathecal chemotherapy and response to prophylactic treatment with ondansetron.

The purpose of this study was to document the emetogenic potential of intrathecal chemotherapy (IC) in children and to evaluate the efficacy of ondansetron in reducing nausea and vomiting with this chemotherapy treatment. Patients less than 18 years of age with acute lymphoblastic leukemia were eligible to participate in a survey project measuring the emetogenic potential of various chemotherapy treatments. Patients surveyed for 1 or more IC treatments were included in this report. The IC consisted of methotrexate, hydrocortisone and cytarabine, dosed according to patient age. A nausea/vomiting survey instrument was completed by each patient and/or parent following IC treatment. The instrument rated nausea, vomiting and daily activity interference (DAI) on a 4-point scale of 0 = none, 1 = mild, 2 = moderate and 3 = severe, and collected data on the number of vomiting and/or retching episodes in addition to the child's appetite following the chemotherapy treatment. When ondansetron was employed, it was administered in an i.v. infusion at a dose of 0.15 mg/kg before and after chemotherapy or as an oral dose of 4 mg or 8 mg before chemotherapy. Courses of IC without antiemetics were analyzed to determine the emetogenic potential of IC. For patients receiving IC both with and without ondansetron, courses were compared with each patient used as their own control to determine the influence of ondansetron upon survey responses. Statistical analysis consisted of nonparametric Friedman 2-way ANOVA for ordinal variables and a paired t-test for continuous variables. The binomial test was employed to analyze for differences between ondansetron and no antiemetic in the number of patients with complete control of both nausea and vomiting or vomiting alone. A total of 63 children with a mean age of 7.6 +/- 4.2 years were each studied on one or more occasions. Thirty-seven children were surveyed for 87 IC treatments without antiemetics (group I), and 17 children from this group were surveyed for 48 IC courses with i.v. ondansetron (group IA). An additional 18 children were subsequently surveyed for 39 IC courses with i.v. ondansetron (group II). Fifteen patients (7 of whom were members of group I) were surveyed following 33 IC courses with oral ondansetron (group III). The survey scores for group I patients were: nausea severity 1.3 +/- 1.1, vomiting severity 1.2 +/- 1.1, DAI 1.2 +/- 1.0 and mean number of emetic episodes 4.7 +/- 8.4. The mean appetite score was 1.5 +/- 1.1. For patients in group IA, nausea severity (0.8 +/- 0.9), vomiting severity (0.5 +/- 0.8), DAI (0.7 +/- 0.8), and the number of emetic episodes (1.4 +/- 2.8) were all significantly lower than with prior IC treatments without ondansetron. For complete protection, children receiving i.v. ondansetron had greater complete protection rates from both nausea and vomiting or vomiting alone than did patients receiving no antiemetic. Survey responses were also lower for patients receiving oral ondansetron, but insufficient control data did not allow for statistical analysis. IC results in mild to moderate nausea and vomiting in children. The emetogenic potential of IC is significantly reduced by i.v. ondansetron.

Comparison of panic symptom sequences and pathophysiologic models

In an attempt to assess which of the proposed etiologic models best accounts for the symptomatology seen in panic attacks, 21 patients with panic attacks were asked to describe the symptom sequence during an attack. Using the Kolmogorov-Smirnov test, the Runs test, and Friedman's 2-way ANOVA, the degree of agreement between their attacks, and the proposed models was assessed. All three analyses suggest that, at the 0.1, 0.025, and 0.05 levels of significance respectively, the autonomic dysfunction model best accounts for the sequence of symptoms in panic attacks.