Mean MA Research Articles

Assessment of a New Gait Asymmetry Index in Patients After Unilateral Total Hip Arthroplasty.

Background/Objectives: Comparing a given variable between the lower extremities (LEs) usually involves calculating the value of a selected asymmetry index. The aim of this study was to evaluate the mean-dependent asymmetry index for gait variables. Methods: The three-point crutch gait asymmetry between the non-surgical LE (NS) and surgical LE (S) was assessed in 14 patients after unilateral total hip arthroplasty. An eight-camera motion capture system integrated with two force platforms was used. The values of the new gait asymmetry index (MA) were calculated for such variables as stance phase time (ST), knee flexion and extension range of motion (KFE RoM), hip flexion and extension range of motion (HFE RoM), and vertical ground reaction force (VGRF). Results: An analysis related to gait asymmetry showed significantly higher values for all variables for the NS than for the S (the MA ranged from 9.9 to 42.0%; p < 0.001). In the case of comparisons between the MA and other indices, the intraclass correlation coefficient ranged from 0.566 to 0.998 (p < 0.001) with Bland-Altman bias values that ranged from -18.2 to 0.3 %GC (ST), from 0.0 to 0.5° (KFE RoM), from -12.4 to 1.4° (HFE RoM), and from -11.9 to -0.1 %BW (VGRF). Conclusions: The findings revealed a prominent three-point crutch gait asymmetry for all variables, especially a disturbingly large asymmetry for the HFE RoM and VGRF. The comparisons also showed generally excellent or good agreement with the other indices. Furthermore, the mean MA result from n single values was the same as the MA result calculated using the mean values of a given variable. The MA, as an accurate asymmetry index, can be used to objectively assess pathological gait asymmetry.

Evaluation of automatic tube current modulation in a CT scanner using a customised homogeneous phantom

Objective.The introduction of automatic tube current modulation (ATCM) has resulted in complex relationships between scanner parameters, patient body habitus, radiation dose, and image quality. ATCM adjusts tube current based on x-ray attenuation variations in the scan region, and overall patient dose depends on a combination of factors. This work aims to develop mathematical models that predict CT radiation dose and image noise in terms of attenuating diameter and all relevant scanner parameters.Approach.A homogenous phantom, equipped with the features to conduct discrete and continuous adaption tests, was developed to model ATCM in a Philips CT scanner. Scanner parameters were varied based on theoretical dose relationships, and a MATLAB script was developed to extract data from DICOM images. R statistical software was employed for data analysis, plotting, and regression modelling.Main Results.Phantom data provided the following insights: Median tube current decreased by 81% as tube potential varied from 80 kVp to 140 kVp. Doubling the DoseRight Index (DRI) from 12 to 24, at 24 cm diameter, produced a 294% increase in mA and a 46% decrease in noise. Mean mA increased by 53% whilst mean noise increased by 5.7% as helical pitch increased from 0.6 to 0.925. Changing rotation time from 0.33s to 0.75s gave a 56% reduction in mean mA and no change in image noise. Increasing detector collimation (n×T) resulted in higher tube currents and lower output image noise values, asnandTwere varied independently. Interpreting these results to apply transformations relevant to each independent variable produced models for tube current and noise with adjusted R-squared values of 0.965 and 0.912, respectively.Significance.The models developed more accurately predict radiation dose and image quality for specific patients and scanner settings. They provide imaging professionals with a practical tool to optimize scan protocols according to patient diameters and clinical objectives.

Temporal dynamics of in vitro hemostatic function in platelets cryopreserved using a novel approach for rapid issuance.

Current procedures for thawing and issuing of cryopreserved platelets (CPPs) are laborious and have remained challenging in emergency settings such as blood banks and military operations. In this prospective study, a novel processing method designed to facilitate the rapid issuance of CPPs with no postthaw handling required was developed and functionally characterized in parallel with standard CPPs manufactured. Double-dose plateletpheresis units (n = 42) were cryopreserved at -80°C in 5%-6% dimethyl sulfoxide to produce matched pairs thawed successively over a 27-month period for comparison between two processing arms. In contrast to the standard CPPs manufactured as standalone units, platelets were frozen in tandem with resuspending plasma in a distinct partition as a single unit in the novel method, herein referred to as tandem CPPs. Postthaw (PT) CPPs from both arms were assessed at PT0-, 12-, and 24-h to measure platelet recovery, R-time (time to clot initiation; min), and maximum amplitude (MA; clot strength; mm) using thromboelastography. In the overall dataset, mean platelet recovery was higher (p < .0005) for tandem CPPs (83.9%) compared with standard CPPs (73.3%) at PT0; mean R-times were faster (p < .0005) for tandem CPPs (2.5-3.6 min) compared with standard CPPs (3.0-3.8 min); mean MA was higher for tandem CPPs (57.8-59.5 mm) compared with standard CPPs (52.1-55.8 mm) at each postthaw time point (p < .05). Robust temporal dynamics of superior hemostatic functionality were established for tandem CPPs over extended cryopreservation up to 27 months and 24 h of postthaw storage.

Work health promotion (WHP) and salutogenesis: application of soc-13 in a company

Abstract Background Workplace Health Promotion (WHP) is the combined efforts of employers, employees and society to improve the health and well-being of people at work. Sense of Coherence (SOC) is the ability to perceive and manage stressful events. The aims of this study are: to prove the SOC-13 scale sensitivity and, using this tool, to investigate employers' welfare in a company promoting ENWHP model. Methods We selected an Italian company, that, since 2017, is carrying out a WHP project. We sent to all the workers (n = 358) the SOC scale-13 items, which investigates three dimensions: comprehensibility (C), manageability (Ma) and meaningfulness (Me), at T0 (October 2018) and T1 (April 2019). Each item is scored on a 7-point Likert scale, ranging 13-91, with higher score corresponding to a more developed SOC. Total score for C, Ma and Me subscales were calculated. The scores were compared using paired “T” tests. Results The response rate was 29% (n = 104) and 25% (n = 89) at T0 and at T1, respectively. At T1 SOC score and its three dimensions were higher (mean SOC ± SD: T0 =57,23 ± 11,00 vs T1= 61,90 ± 12,03 p = 0,005; mean C ± SD: T0=21,97±4,46 vs T1=23,02±5,16 p = 0,124; mean Ma ± SD: T0=16,64± 4,27 vs T1=17,96±4,36 p = 0,033; mean Me ± SD: T0=18,62 ±5,01 vs T1=20,92±4,89 p = 0,002). Conclusions Our findings suggest that a WHP project can promote healthy workplace environments, enhance workers quality of life and improve the individual capacity to cope successfully with stress. We showed that SOC-13 scale is an easy and appropriate tool to evaluate the employers' wellbeing, thanks to its high sensitivity. Key messages SOC scale-13 can record the quality of workplace health promotion measures and continually improve them. WHP good practices enhance workers’ welfare.

P5348Aspirin versus clopidogrel treatment for refractory migraine with patent foramen oval

Abstract Background The association between migraine with aura (MA+) and persistent foramen ovale (PFO), as well as other right-to-left shunts, is described. Observational studies suggested that when a PFO is closed patients who have MA+ are usually improved. Many observational studies have shown that when PFOs are closed in patients who have had a stroke the patients have a high prevalence of migraine before the procedure and ∼80% report that their migraine symptoms were improved after the closure procedure. Migraine with aura is also improved by medical treatment (aspirin, clopidogrel). Purpose To investigate the MA+ reduction effect with the aspirin or clopidogrel in 90 with MA+ with PFO. Methods MA+ patients were screened for PFO by transcranial sonography and echocardiography. Participants with documented right to left shunt (RLS) and ≥12 monthly MA+ days received aspirin or clopidogrel therapy for 60 days. Those with ≥50% reduction in monthly MA+ days were deemed responders and completed 10 additional treatment months. Results The 90 participants had a mean age of 33.2 years and mean MA+ frequency of 16.4 d/mo. A total of 57/80 were female. A total of 66/80 met criteria for episodic MA+, 14/80 for chronic MA+, 59/80 had a moderate–large RLS. 38 of 80 participants (47%) were responders. MA+ reduction continued through 10 treatment months in all responders. MA+ responder rates were not statistically different in participants with episodic or chronic MA+ or with small/larger RLS shunt magnitude, treatment with aspirin or with clopidogrel. All three (8%) patients had aspirin side effects, without serious adverse events. Conclusion Both medications reduced MA +symptoms and participants seemed to have less MA+ and only small amount had side effects with aspirin. Acknowledgement/Funding None

French Williams syndrome's ability to produce judgments of grammaticality.

This article reports grammatical judgment data from eighteen French Williams syndrome (WS) (mean CA = 21.10; Mean MA = 11.2). Participants had to detect ungrammatical sentences (13 amongst a set of 26 sentences) in telling whether a given sentence was well said or not. Agrammaticality could be due to errors in tense, person agreement, gender agreement, derivational or inflectional morphology, word order and so on. As a group, WS participants scored as seven-year-olds did, far below CA-controls and MA-controls. Scores did not improve with chronological age or mental age but they were related to total IQ and verbal IQ. They showed an important variability, one similar to what was observed in four-year-olds. Although a few WS individuals had good metasyntactic abilities, these abilities generally plateau in our WS group. They were not deviant, however, as the WS's profile of difficulties across items was qualitatively very similar to the one seen in seven-year-olds.

The comparison of bolus tracking and test bolus techniques for computed tomography thoracic angiography in healthy beagles

Computed tomography thoracic angiography studies were performed on five adult beagles using the bolus tracking (BT) technique and the test bolus (TB) technique, which were performed at least two weeks apart. For the BT technique, 2 mL/kg of 300 mgI/mL iodinated contrast agent was injected intravenously. Scans were initiated when the contrast in the aorta reached 150 Hounsfield units (HU). For the TB technique, the dogs received a test dose of 15% of 2 mL/kg of 300 mgI/mL iodinated contrast agent, followed by a series of low dose sequential scans. The full dose of the contrast agent was then administered and the scans were conducted at optimal times as identified from time attenuation curves. Mean attenuation in HU was measured in the aorta (Ao) and right caudal pulmonary artery (rCPA). Additional observations included the study duration, milliAmpere (mA), computed tomography dose index volume (CTDI[vol]) and dose length product (DLP). The attenuation in the Ao (BT = 660 52 HU ± 138 49 HU, TB = 469 82 HU ± 199 52 HU, p = 0.13) and in the rCPA (BT = 606 34 HU ± 143 37 HU, TB = 413 72 HU ± 174.99 HU, p = 0.28) did not differ significantly between the two techniques. The BT technique was conducted in a significantly shorter time period than the TB technique (p = 0.03). The mean mA for the BT technique was significantly lower than the TB technique (p = 0.03), as was the mean CTDI(vol) (p = 0.001). The mean DLP did not differ significantly between the two techniques (p = 0.17). No preference was given to either technique when evaluating the Ao or rCPA but the BT technique was shown to be shorter in duration and resulted in less DLP than the TB technique.

Stochastic Populations, Power Law and Fitness Aggregation in Genetic Algorithms

Natural populations are dynamic in both time and space. In biological populations such as insects, spatial distribution patterns are often studied as the first step to characterize population dynamics. In nature, the spatial distribution patterns of insect populations are considered as the emergent expression property of individual behaviors at population levels and are fine-tuned or optimized by natural selection. This inspiration prompts us to investigate the possibly similar mechanisms in Genetic Algorithms GA populations. In this study, we introduce the mathematical models for the spatial distribution patterns of insect populations to GA with the conjecture that the emulation of biological populations in nature may lead to computational improvement. In particular, we introduce three modeling approaches from the research of spatial distribution patterns of insect populations: i probability distribution modeling approach, ii aggregation index approach, and iii Taylor's 1961, 1977 Power Law, Iwao's 1968, 1976 Mean Crowding Model and Ma's 1991c population aggregation critical density PACD, to characterize populations in GA. With these three approaches, we investigate four mappings from the research field of insect spatial distribution patterns to GA populations in order to search for possible counterpart mechanisms or features in GA. They are: i mapping insect spatial distribution patterns to GA populations or allowing GA populations to be controlled by stochastic distribution models that describe insect spatial distributions; ii mapping insect population distribution to GA population fitness distribution via Power Law and PACD modeling; iii mapping population aggregation dynamics to GA fitness progression across generations or fitness aggregation dynamics in GA via insect population aggregation index; iv mapping insect population sampling model to optimal GA population sizing. With regard to the mapping i, the experiment results show the significant improvements in GA computational efficiency in terms of the reduced fitness evaluations and associated costs. This prompts us to suggest using probability distribution models, or what we call stochastic GA populations, to replace the fixed-size population settings. We also found the counterpart for the second mapping, the wide applicability of Power Law and Mean Crowding model to the fitness distribution in GA populations. The testing of the third and fourth mappings is very preliminary; we use example cases to suggest two further research problems: the potential to use fitness aggregation dynamics for controlling the number of generations iterated in GA searches, and the possibility to use fitness aggregation distribution parameters [obtained in mapping ii] in determining the optimum population size in GA. A third interesting research problem is to investigate the relationship between mapping i and iii, i.e., the controlling of both population sizes and population generations.

1898 Maternal Attachment in Mothers of Under-25 and Over-35 age groups who Have Babies of 1–4 Months Old with Colic Diagnosis

Background and AimsMaternal attachment (MA) is important in terms of mother-infant relationship. The purpose of this study was to investigate the factors that affect MA in mothers of under-25 and...

Evaluation of thrombelastographic platelet‐mapping in healthy cats

Thrombelastography (TEG) permits analysis of clot formation but it is not specific for platelet activity. TEG PlateletMapping (TEG-PM) is a modification of TEG that uses adenosine diphosphate (ADP) and arachidonic acid (AA) as platelet agonists to define the contribution of platelets to clot formation. The objectives of this study were to determine values for TEG-PM in healthy cats and the interassay variation of TEG-PM. TEG-PM analysis was performed on blood specimens collected from 12 healthy cats and was repeated using a second blood specimen collected 2 hours later. Maximum amplitudes generated by thrombin (MA(thrombin)), fibrin (MA(fibrin)), ADP-stimulated platelet activity (MA(ADP)), and AA-stimulated platelet activity (MA(AA)) were recorded. Mean ± SD for MA(thrombin) was 51.1 ± 8.5 mm, for MA(fibrin) was 32.3 ± 17.7 mm, for MA(ADP) was 32.3 ± 15.0 mm, and for MA(AA) was 24.5 ± 12.2 mm. Mean MA(ADP) and MA(fibrin) were not significantly different, whereas mean MA(AA) was significantly lower than mean MA(fibrin). Results from the first and second specimens were not significantly different. Correlation between the first and second specimens was moderate for MA(thrombin), MA(fibrin), and MA(ADP), but was poor for MA(AA). A high degree of variability (coefficient of variation 47.7-60.0%) was observed for MA(fibrin), MA(ADP), and MA(AA). As MA(ADP) and MA(AA) (AA) were the same as or lower than MA(fibrin), a valid baseline to determine platelet-stimulated clot formation could not be established. Considerable interassay variation and wide intervals for MA(fibrin), MA(ADP), and MA(AA) values in this study indicate that TEG-PM should be used cautiously in feline patients. Several preanalytical factors should be examined in further detail.

Evaluation of coagulation status in dogs with naturally occurring canine hyperadrenocorticism

To determine whether or not there are differences in coagulation parameters (eg, thrombelastography [TEG], activated partial thromboplastin time [aPTT], prothrombin time [PT], and fibrinogen) among dogs with naturally occurring hyperadrenocorticism (HAC), dogs with HAC undergoing medical management, and dogs without HAC. Prospective, observational study. Veterinary teaching hospital. Forty-six client-owned dogs undergoing adrenal function testing. None. Nine dogs were diagnosed with HAC de novo, 19 dogs were presented for therapeutic monitoring of previously diagnosed HAC, and 18 dogs did not have HAC. Variables compared between groups were age, body weight, platelet count, mean platelet volume, serum concentrations of cholesterol, triglycerides, antithrombin, PT, aPTT, fibrinogen, and TEG parameters (eg, alpha angle, R, K, and maximum amplitude [MA]). Dogs with HAC and dogs treated for HAC had higher serum cholesterol than dogs without HAC (P < 0.05). All groups had mean MA greater than the institutional reference interval. There was a weak, positive correlation between hematocrit and MA that was independent of diagnosis (r(2) = 0.266, P = 0.004). The results of this study do not support the supposition that a significant difference exists in coagulation tendencies between dogs with HAC prior to treatment, dogs with HAC during treatment, and dogs without HAC. This disagreement with the classically accepted notion that HAC leads to a hypercoagulable state could be due to a couple of possibilities. Namely, the link between HAC and hypercoagulability may be relatively weak, or our findings may be the result of a type II error either as a result of a small sample size or the use of coagulation assays that are insensitive to the effects of HAC on the hemostatic system.

Thromboelastography in healthy horses and horses with inflammatory gastrointestinal disorders and suspected coagulopathies

To evaluate the use of citrated recalcified (nonactivated) thromboelastography (TEG) in healthy horses and horses with colitis and suspected coagulopathies. Prospective, observational study conducted between October 2007 and June 2009. Veterinary Teaching Hospital. Forty-five healthy adult horses and 12 sick adult horses with colitis and prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT). None. Whole blood was collected on admission. Coagulation profile (PT, aPTT, platelet count, and fibrinogen concentration) and citrated recalcified whole blood TEG analysis (R-time [R], K-time [K], angle [α], maximum amplitude [MA], G value [G], lysis at 60 min [LY60]) were evaluated. Mean values (SD) for TEG parameters in healthy horses were: R=10.4 (3.1) minutes; K=3.5 (1.2) minutes; α=46.3 (11.0)°; MA=55.6 (5.1) mm; G=6,429 (1,341) dyn/cm², and LY60=5.1 (2.4)%. Mean coefficients of variation for intra-assay/interindividual variability in healthy horses were: R=4.7%/30.7%, K=4.8%/35.3%, α=4.4%/23.8%, MA=1.4%/9.3%, G=3.4%/20.8%, and LY60=13.1%/47.7%, respectively. Horses with colitis and prolonged PT and/or aPTT had longer mean values for R (P<0.001) and K (P<0.001), narrower mean α (P<0.001), decreased mean MA (P=0.001), and smaller mean G (P=0.02); changes consistent with hypocoagulability. Citrated recalcified (nonactivated) TEG demonstrated changes consistent with hypocoagulability in horses with colitis that had preidentified coagulation abnormalities. This technique has high interindividual variability and low intra-assay variability. TEG may be useful for detecting hypocoagulable states in horses with colitis and suspected coagulopathies.

Navigation versus Radiographic Measurements in the Open-Wedge High Tibial Osteotomy using Computer Assisted Surgery (CAS)

opostoperatively. The mean MA% was 10.2% preoperatively and valgus 64.4% postoperatively. There were positive correlations between the values measured with the navigation system and the radiographs (r＞0.5, p＜0.001). Conclusion: There were significant correlations between the values measured with the navigation system and radiographs in an open wedge high tibial osteotomy using a navigation system. The correction angle from the navigation system is reliable, predictable and controllable during surgery.

Implicit learning differences: a question of developmental level?

A. S. Reber's (1992) proposition that the implicit learning system should demonstrate invariance of intellectual level (IQ) was examined by comparing 20 children with intellectual disability (mean mental age [MA] = approximately 5.8 years) with 20 intellectually gifted children (mean MA = approximately 12.4 years) of similar chronological age (CA; approximately 9.5 years). Implicit learning was assessed using a task involving covariation of 2 incidental cues. Explicit learning was assessed using a task of similar logical structure. Contrary to the IQ-invariance proposition, implicit learning as well as explicit learning varied with intellectual level. A secondary aim was to distinguish the contributions of CA, IQ, and MA to implicit learning. This was done by combining the samples of children in the present study with 2 samples of younger and older children of average ability from a study by M. Maybery, M. Taylor, and A. O'Brien-Malone (1995). Analyses showed that MA is critical to implicit learning.

Evaluation of passive smoking by measuring urinary trans, trans-muconic acid and exhaled carbon monoxide levels.

No method has yet been established to evaluate the exposure to tobacco smoke in passive smoking (PS). We therefore conducted a study on the possibility that the levels of urinary trans, trans-muconic acid (MA) and the exhaled carbon monoxide (CO) could be indices of the passive exposure to tobacco smoke. The moderate correlation was observed between urinary MA levels and the number of consumed cigarettes per day in smokers. The mean urinary MA level of the PS (+) group was significantly higher than that with the PS (-) group. Among the PS (+) group, the mean MA level in the urine obtained in the afternoon was higher than that obtained in the morning. A high correlation was observed between the exhaled CO levels and the number of consumed cigarettes per day in smokers. Like the urinary MA level, the mean exhaled CO level in the PS (+) group, too, gave a significantly higher level than in the PS (-) group. Because the biological half life of MA (7.5 +/- 0.85 h) was longer than that of CO (3.0 +/- 0.36 h), the measurement of urinary MA level is recommended for evaluating the exposure of passive smoking. The measurement of exhaled CO levels is useful only for chain smokers and nonsmokers with PS just before measurement.

SURFACE-WAVE MAGNITUDE CALIBRATION FOR EUROPEAN REGION EARTHQUAKES

This paper is concerned with the calibration of the surface-wave magnitude scale for the European region using the Prague formula. Two issues in particular have been addressed: ˙Does the Prague formula require a correction of the distance dependency term? ˙Is a source depth correction required? The issue of distance dependency has been investigated by examining the distance dependency of residuals from individual station Msmagnitudes and “representative” Ms magnitude values. We find that Ma magnitudes determined for the European region, using the Prague formula show slight dependence on recording station distance. The subsequent distance dependency of the mean Ma magnitude determination is therefore a function of the distance distribution of the recording stations. The question of depth correction has been investigated by examining the regression of Ms magnitudes versus seismic moment as a function of depth. We find that the Ms magnitudes determined by the Prague formula are only valid for crustal events, and require a depth correction for source depths greater than 30 km. As a by-product of these investigations, we find that for the European region there are stable nonlinear relations between surface-wave magnitude (Ms) and the log of seismic moment (logMo) and vice versa. These relationships will provide suitable functions for the correlation between one source size indicator and the other.

Theory of mind and rule use in individuals with Down's syndrome: a test of the uniqueness and specificity claims.

The relationship between Theory of Mind (ToM) and rule use was explored in adults with Down's Syndrome (DS) and in non-handicapped pre-schoolers. Twelve low-functioning individuals with DS (mean mental age = 5.1 years, mean chronological age = 22.7) performed worse than 12 MA-matched non-handicapped children (mean MA = 5.1 years) on several standard ToM tasks and on a color-shape card-sorting task in which subjects were required to switch between two incompatible sets of rules. On the ToM tasks, people with DS tended to focus on a single state of affairs (e.g. the present situation). Likewise, on the card sort, these subjects tended to use a single set of rules on all trials. Performance in the two types of task was positively correlated when MA was partialed out. The results are inconsistent with the slaim that ToM reflects a domain-specific psychological function and the notion that deficits in ToM are unique to individuals with autism.

Benzene Exposure, Assessed by Urinary trans,trans-Muconic Acid, in Urban Children with Elevated Blood Lead Levels

A pilot study was performed to evaluate the feasibility of using trans,trans-muconic acid (MA) as a biomarker of environmental benzene exposure. A secondary aim was to provide data on the extent of exposure to selected toxicants in a unique population consisting of inner-city children who were already overexposed to one urban hazard, lead. Potential sources of benzene were assessed by a questionnaire. Exposure biomarkers included urinary MA and cotinine and blood lead. Mean MA was 176.6 +/- 341.7 ng/mg creatinine in the 79 children who participated. A wide range of values was found with as many as 10.1%, depending on the comparison study, above the highest levels reported in adults not exposed by occupation. Mean MA was increased in children evaluated in the afternoon compared to morning, those at or above the median for time spent playing near the street, and those studied in the first half of the investigation. MA levels were not associated with blood lead or, consistently, with either questionnaire environmental tobacco smoke (ETS) data or cotinine. As expected, the mean blood lead level was elevated (23.6 micrograms/dl). Mean cotinine was also increased at 79.2 ng/mg creatinine. We conclude that the use of MA as a biomarker for environmental benzene exposure is feasible since it was detectable in 72% of subjects with a wide range of values present. In future studies, correlation of MA with personal air sampling in environmental exposure will be essential to fully interpret the significance of these findings. In addition, these inner-city children comprise a high risk group for exposure to environmental toxicants including ETS, lead, and probably benzene, based on questionnaire sources and its presence in ETS.

Contingency Awareness in Infants and Children with Severe and Profound Learning Disabilities

Seven infants and children with severe, profound and multiple learning difficulties (CA 3 months to 4 years, MA 2 months to 12 months, mean MA 4.5 months) were presented with a contingency situation where they could control the onset of a visually and auditorily attractive toy. In this situation their responding increased and some positive emotional effects were seen. When they were subsequently unable to control stimulation, negative effects were seen on a range of emotional, motivational and self‐stimulation measures. These results suggest that from a mental age level of 2 months children are equipped to detect cause and effect relationships and build up a picture of their world based on expectancies about such relationships; and that violations of these expectancies can lead to negative effects.

Increasing severity of illness among patients undergoing phase 1 trials

To determine whether the severity of illness of hospitalized patients participating in Phase 1 trials has changed, a modified APACHE II (MA II) index was used to evaluate retrospectively each Phase 1 patient admitted during September through December 1983 and the same 4-month span in 1987. During the 1983 period, 28 patients were enrolled in 13 Phase 1 protocols. Their average length of stay (LOS) was 12.6 days (+/- 12.3 SD) with a mean MA II of 3.44 (+/- 2.69 SD). During the same 4 months in 1987, there were 37 patients enrolled in 18 Phase 1 trials with a mean LOS of 13.5 days (+/- 13.4 SD) and a mean MA II of 6.08 (+/- 3.33). As indicated by MA II scores, 1987 hospitalized patients enrolled in Phase 1 trials had a higher severity of illness than did 1983 Phase 1 patients (p = 0.01). The implications of an oncology patient population with an increasing severity of illness are examined in relation to nursing staff forecasting, resource allocation, and productivity.