Suboptimal Fit Research Articles

70 Risk Scoring Systems for PCI: Need for Geographical Validation and Temporal Calibration

BackgroundRisk scoring is a useful tool for prognostication, decision-making and, increasingly, assessing individual and institutional performance. At the South Yorkshire Cardiothoracic Centre, we have been using the New York risk...

On local micro-architecture analysis of trabecular bone in three dimensions

We read with great interest the article by Djuric et al. [1] on 3D micro-computed tomography (micro-CT) analysis of trabecular bone from femoral neck (Fig. 1 in their paper) of osteoarthritic (OA, n = 9) patients compared with a control group (CTL, n = 13). The excised bone sections show a trend towards increased bone volume fraction (BV/TV), significantly higher connectivity density (Conn.D), lower structure model index (SMI) and reduced degree of anisotropy (DA) in OA compared with CTL. We would like to emphasise the importance of specifying the physical thickness of the bone slice they analysed, which is related to the maximum volume of interest (VOI) available for analysis, and thus to the reported results in 3D. However, there is no such information in their paper, and we can only guess, or infer from 3D images of a similar publication of theirs, that the slices were quite thin, maybe one to three trabecular strut lengths [2]. For accurate analysis, certain 3D parameters—in particular, DA, SMI and Tb.Sp—require a minimum bone volume in order to provide an accurate description in 3D. The reported anisotropy findings were indeed opposite to those of Tassani et al. [3], who found a significant increase in 3D orientation along the z axis and therefore in anisotropy, of the trabecular framework in OA (n = 30) compared with CTL (n = 30). In Tassani et al., the specimen comprised a cylindrical volume of 19.5 mm in height and 9 mm in diameter (main compressive region, femoral head). DA is calculated by dividing the principal axes of an ellipsoid describing the orientation of the trabecular micro-architecture [4], calculated as a regression of mean intercept length (MIL) points in space and based on the assumption of orthotropy. If the selected trabecular VOI is too thin (narrow), or unbalanced in size among the three dimensions (1–2 mm in one direction, capturing maybe two trabeculae, vs. 10–20 mm in another), the ellipsoid might be (misleadingly) squashed because of the choice of the thin VOI, rather than representing the spatial arrangement of the trabeculae in 3D. Moreover, the coefficient of determination of the ellipsoid regression might also be small, revealing a suboptimal fit and hence the possibly an unsuitable MIL analysis over that volume. For instance, the difference in anisotropy findings compared with those by Tassani et al. might also be due to the thin VOI used by Djuric et al. and linked to the thin bone slice used in the 3D examination by Djuric et al. In order to enable better interpretations of the 3D results of Djuric et al.’s study and comparisons with the published literature, we suggest the authors to indicate the dimensions of the bone slice and VOI used, of the MIL values along the three axes used to compute the DA, and possibly of the coefficients of determination (R2) of the fitted ellipsoid. We understand that this last parameter in particular is often ignored and is almost never reported in the scientific literature; however, in cases in which large disproportions in VOI dimensions may exist, and which may impact the DA outcomes, reporting that parameter might also be suggested.

Invited Commentary: Quantifying Salt in Urine--A Complex Solution

Reduction of dietary sodium intake has been identified as a priority to reduce the worldwide burden of hypertension and cardiovascular disease. Dietary sodium intake is most precisely ascertained by using timed urine collection. Casual urine sodium measurements are relatively easy to perform, but their relationship to timed urine sodium measurements is unclear. In this issue of the Journal, Brown et al. (Am J Epidemiol. 2013;177(11):1180-1192) report the development and validation of equations to estimate 24-hour urine sodium excretion from casual urine samples. Their study included a large number of participants on 2 continents, a well-collected gold standard, separate discovery and validation samples, and relevant covariates. The resulting equations represent the best available methods to estimate dietary sodium intake from casual urine samples. However, the study is limited by evidence of a suboptimal model fit, restriction to people 20-59 years of age in North America and Europe, and exclusion and adjustment that further limit external validity. In addition, individual-level correlations of estimated and measured 24-hour urine sodium excretion were modest. Properly applied, the results will facilitate tracking of dietary sodium intake within populations over time and identification of communities for which dietary sodium restriction is most likely to be beneficial. Further work is needed to extend estimation to additional populations and improve individual-level assessment.

Integration of stochastic simulation with multivariate analysis: Short-term facility fit prediction

This article describes a decision-support tool to help pinpoint the potential root causes of sub-optimal short-term facility fit issues in biopharmaceutical facilities. This was achieved by creating a tool that integrated stochastic simulation with advanced multivariate statistical analysis. Process fluctuations in product titers in cell culture, step yields, and chromatography eluate volumes were mimicked using Monte Carlo simulation data derived using a stochastic discrete-event simulation model. The resulting stochastic datasets, with the computed consequences on key metrics such as product mass loss and cost of goods, were examined using advanced multivariate statistical techniques. Principal component analysis combined with clustering algorithms was used to analyze the complex datasets from complete industrial batch processes for biopharmaceuticals. The challenge of visualizing the multidimensional nature of the dataset was addressed using hierarchical and k-means clustering as well as stacked parallel co-ordinate plots to help identify process fingerprints and characteristics of clusters leading to sub-optimal facility fit issues. Industrially-relevant case studies are presented that focus on technology transfer challenges for therapeutic antibodies moving from early phase to late phase clinical trials. The case study details how sub-optimal facility fit can be alleviated by allocating alternative product pool tanks. The impact of this operational change is then assessed by reviewing an updated process fingerprint.

Dimensionality of the Inventory of Parent and Peer Attachment: Evaluation with the Spanish Version

Three studies aimed at developing the Spanish version of the Inventory of Parent and Peer Attachment (IPPA; Armsden & Greenberg, 1987) and at analyzing its factor structure are reported. In Study 1, the Spanish translation of items and their content analysis was carried out via cognitive interviews. In Study 2, the three-factor structure proposed by authors was tested in a sample of 417 adolescents (270 girls and 147 boys) using confirmatory analysis, and indexes showed a suboptimal fit. A principal component analysis yielded one-dimensional structures in father, mother and peer versions, explaining 54.3%, 50.8%, and 50.8% of the variance respectively. On the basis of the factor loadings and of the item-total correlations, a shortened version of the inventory was created. Convergent validity was tested with measures of family climate, parenting socialization and self-esteem. In Study 3, the one-dimension structure was confirmed in a new sample of 604 adolescents (335 girls and 269 boys). Based on all factor analyses and convergent validity indices obtained, we conclude that the Spanish IPPA questionnaire reliably and validly assesses adolescent attachment using only a dimension of attachment security.

The PANAS structure revisited: On the validity of a bifactor model in community and forensic samples.

The Positive and Negative Affect Schedule (PANAS) is a widely used inventory for the assessment of affect in psychology and other applied sciences. Despite its popularity, the structure of the PANAS is still under debate. On the one hand, there is evidence of the traditional 2-factor model with Positive Affect (PA) and Negative Affect (NA) as uncorrelated factors. On the other hand, a more complex structure of the PANAS has been discussed. To shed further light on the core dimensions of the PANAS, 2 studies investigated the structure of the PANAS in 2 German samples (N = 354 and N = 364, respectively) by means of confirmatory factor analysis. The factor analysis results of Study 1 for a traitlike time frame instruction suggested a suboptimal model fit for the uncorrelated 2-factor model and the 3-factor model with PA, Afraid, and Upset as factors, whereas a superior model fit occurred for a bifactor model with traitlike PA, NA, and a general 3rd factor named Affective Polarity. In Study 2, the bifactor model was replicated for a statelike PANAS time frame instruction and evidence of criterion validity was provided for PA, NA, and Affective Polarity factors in 2 sex offender subgroups and in a community sample. With Affective Polarity, we introduce an affect dimension that captures additional variance beyond PA and NA. Because of the adjectives with relevant loadings on Affective Polarity, this general factor represents an individual's orientation toward approach and withdrawal, respectively.

Validation of a French version of the Freiburg Mindfulness Inventory - short version: relationships between mindfulness and stress in an adult population

BackgroundWhereas interest in incorporating mindfulness into interventions in medicine is growing, data on the relationships of mindfulness to stress and coping in management is still scarce. This report first presents a French validation of the Freiburg Mindfulness Inventory-short form (FMI) in a middle-aged working population. Secondly, it investigates the relationship between psychological adjustment and mindfulness.MethodsFive hundred and six non-clinical middle-aged working individuals rated themselves on the self-report French version FMI and completed measures of psychological constructs potentially related to mindfulness levels.ResultsResults were comparable to results of the original short version. Internal consistency of the scale based on the one-factor solution was .74, and test-retest reliability was good. The one-dimensional solution as the alternative to the two-factor structure solution yielded suboptimal fit indices. Correlations also indicated that individuals scoring high on mindfulness are prone to stress tolerance, positive affects and higher self-efficacy. Furthermore, subjects with no reports of stressful events were higher on mindfulness.ConclusionThese data showed that mindfulness can be measured validly and reliably with the proposed French version of the FMI. The data also highlighted the relationship between mindfulness and stress in an adult population. Mindfulness appears to reduce negative appraisals of challenging or threatening events.

Facets of mindfulness – Results of an online study investigating the Freiburg mindfulness inventory

There is an ongoing discussion about the definition of mindfulness including the question whether mindfulness is a one-dimensional or multidimensional construct. Research on the Freiburg mindfulness inventory (FMI) has also reflected this debate. We have investigated the psychometric properties of the FMI-14-item in an online convenience sample of n = 244 individuals (150 female; mean age 28.7 (SD = 8.76)) with ( n = 75) and without ( n = 169) regular meditative training). A simplified version of the beck depression inventory (BDI-V) and the trait subscale of the state-trait-anxiety-inventory (STAI-T) were used for determining criterion validity. A one-dimensional ( α = .83) and an alternative two-dimensional solution ( α F1 = .77; α F2 = .69) of the FMI-14 were tested with a confirmatory factor analysis and yielded suboptimal fit indices. An exploratory analysis resulted in a reduced 8-item version of the two-dimensional solution with better fit indices, but low internal consistency ( α F1 = .71; α F2 = .64). The factors could be identified as “Presence” (F1) and “Acceptance” (F2). Further investigation revealed that the substantial negative relationship between mindfulness and anxiety and depression is completely due to the “Acceptance” factor of mindfulness. This suggests that there may be heuristic value in the two-factorial solution, although for practical purposes it seems sufficient to assess mindfulness as one-dimensional construct.

A βα-barrel built by the combination of fragments from different folds

Combinatorial assembly of protein domains plays an important role in the evolution of proteins. There is also evidence that protein domains have come together from stable subdomains. This concept of modular assembly could be used to construct new well folded proteins from stable protein fragments. Here, we report the construction of a chimeric protein from parts of a (betaalpha)(8)-barrel enzyme from histidine biosynthesis pathway (HisF) and a protein of the (betaalpha)(5)-flavodoxin-like fold (CheY) from Thermotoga maritima that share a high structural similarity. We expected this construct to fold into a full (betaalpha)(8)-barrel. Our results show that the chimeric protein is a stable monomer that unfolds with high cooperativity. Its three-dimensional structure, which was solved to 3.1 A resolution by x-ray crystallography, confirms a barrel-like fold in which the overall structures of the parent proteins are highly conserved. The structure further reveals a ninth strand in the barrel, which is formed by residues from the HisF C terminus and an attached tag. This strand invades between beta-strand 1 and 2 of the CheY part closing a gap in the structure that might be due to a suboptimal fit between the fragments. Thus, by a combination of parts from two different folds and a small arbitrary fragment, we created a well folded and stable protein.

Testing the Construct Validity of Dixon and Johnson's (2007) Gambling Functional Assessment

The Gambling Functional Assessment (GFA; Dixon & Johnson, 2007) is a 20-item self-report inventory identifying four potential consequences maintaining gambling behavior. Exploratory and confirmatory factor analyses are performed for two large, nonclinical samples of university undergraduates. For the exploratory analysis, the optimal model yields two factors: Positive Reinforcement (correlated with GFA Sensory, Attention, and Tangible scores) and Negative Reinforcement (correlated with GFA Escape scores). One GFA item fails to load on either factor adequately. Factor loadings are confirmed using structural equation modeling for the second sample. The resulting model yields a mix of adequate and suboptimal fit indicators. Although the 2-factor model of the GFA has great theoretical utility and shows significant promise, confirmation within clinical samples of gamblers will be necessary to further validate the model. GFA Escape scores are uniquely distributed in the two samples and may represent functions most likely to maintain pathological gambling.

Letter by Bollati et al Regarding Article, “Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery: Differences in Short-Term Outcomes and in Long-Term Mortality and Need for Subsequent Revascularization”

To the Editor: We read with great interest the recent report by Hannan et al1 on the short-term benefits of off-pump coronary artery bypass graft surgery compared with the standard on-pump approach on in-hospital/30-day mortality and perioperative complication rates. The 3-year follow-up proved comparable outcomes, excluding a lower rate of freedom from revascularization for the off-pump surgery group. The topic is certainly extremely interesting, especially nowadays, when less invasive approaches, such as off-pump coronary surgery and percutaneous coronary interventions, are acquiring dominant roles in the treatment of ischemic heart disease.2 However, we believe that this …

Kinetic analysis of butyrylcholinesterase-catalyzed hydrolysis of acetanilides

The aryl-acylamidase (AAA) activity of butyrylcholinesterase (BuChE) has been known for a long time. However, the kinetic mechanism of aryl-acylamide hydrolysis by BuChE has not been investigated. Therefore, the catalytic properties of human BuChE and its peripheral site mutant (D70G) toward neutral and charged aryl-acylamides were determined. Three neutral (o-nitroacetanilide, m-nitroacetanilide, o-nitrophenyltrifluoroacetamide) and one positively charged (3-(acetamido) N,N,N-trimethylanilinium, ATMA) acetanilides were studied. Hydrolysis of ATMA by wild-type and D70G enzymes showed a long transient phase preceding the steady state. The induction phase was characterized by a hysteretic “burst”. This reflects the existence of two enzyme states in slow equilibrium with different catalytic properties. Steady-state parameters for hydrolysis of the three acetanilides were compared to catalytic parameters for hydrolysis of esters giving the same acetyl intermediate. Wild-type BuChE showed substrate activation while D70G displayed a Michaelian behavior with ATMA as with positively charged esters. Owing to the low affinity of BuChE for amide substrates, the hydrolysis kinetics of neutral amides was first order. Acylation was the rate-determining step for hydrolysis of aryl-acetylamide substrates. Slow acylation of the enzyme, relative to that by esters may, in part, be due suboptimal fit of the aryl-acylamides in the active center of BuChE. The hypothesis that AAA and esterase active sites of BuChE are non-identical was tested with mutant BuChE. It was found that mutations on the catalytic serine, S198C and S198D, led to complete loss of both activities. The silent variant (FS117) had neither esterase nor AAA activity. Mutation in the peripheral site (D70G) had the same effect on esterase and AAA activities. Echothiophate inhibited both activities identically. It was concluded that the active sites for esterase and AAA activities are identical, i.e. S198. This excludes any other residue present in the gorge for being the catalytic nucleophile pole.

Compaction Bone-Grafting in Prosthetic Shoulder Arthroplasty

Compaction bone-grafting has been suggested as a means of improving the stability of the humeral component in shoulder arthroplasty, but the clinical and radiographic results of the procedure have not been reported in the literature, to our knowledge. To address this deficit, we report on a series of shoulder arthroplasties performed with compaction bone-grafting to secure humeral component fixation. These prostheses were implanted in shoulders demonstrating a suboptimal interference fit of the humeral component. Fifty-eight shoulders in fifty-three patients were treated with prosthetic shoulder arthroplasty that included compaction bone-grafting. Clinical assessments were performed at regular intervals with use of visual analog scales for pain, shoulder comfort and function, and overall quality of life, and with use of patient self-assessments including the American Shoulder and Elbow Surgeons Score and the validated Simple Shoulder Test. A detailed radiographic analysis was performed by three raters to determine whether radiolucent lines were present immediately postoperatively and at a later follow-up interval. The humeral tilt angle was determined by measuring the angle between the humeral axis and the component. Subsidence was also evaluated. The mean of the raters' measurements was used in the analysis. The mean duration of follow-up was sixty-nine months (range, twenty-six to 148 months). No loose stems were observed, and no humeral component was revised. At the time of follow-up, there was significant improvement in the Simple Shoulder Test scores and all visual analog scores (p < 0.0001 in each instance). Thirty-four stems had no radiolucent line at the time of follow-up, and the mean maximum thickness of the lucent lines was 0.21 mm in the entire group of fifty-eight shoulders. Most lucent lines occurred near the distal stem tip. The mean tilt of the valgus and varus humeral components was 2.2 degrees and 2.6 degrees , respectively, on the immediate postoperative radiographs. No humeral component shifted from varus to valgus or vice versa. The duration of follow-up was not correlated with the maximum thickness of the humeral component lucency, and the presence or absence of a prosthetic glenoid was also unrelated to the maximum thickness of the lucency. Compaction bone-grafting in shoulder arthroplasty can yield stable and durable fixation of the humeral component, as seen clinically and radiographically, without use of cement. Our findings provide evidence that compaction bone-grafting in shoulder arthroplasty is an option to ensure intermediate-term fixation (at a mean of five years) of humeral components that have a suboptimal fit.

Compaction Bone-Grafting in Prosthetic Shoulder Arthroplasty

Background: Compaction bone-grafting has been suggested as a means of improving the stability of the humeral component in shoulder arthroplasty, but the clinical and radiographic results of the procedure have not been reported in the literature, to our knowledge. To address this deficit, we report on a series of shoulder arthroplasties performed with compaction bone-grafting to secure humeral component fixation. These prostheses were implanted in shoulders demonstrating a suboptimal interference fit of the humeral component. Methods: Fifty-eight shoulders in fifty-three patients were treated with prosthetic shoulder arthroplasty that included compaction bone-grafting. Clinical assessments were performed at regular intervals with use of visual analog scales for pain, shoulder comfort and function, and overall quality of life, and with use of patient self-assessments including the American Shoulder and Elbow Surgeons Score and the validated Simple Shoulder Test. A detailed radiographic analysis was performed by three raters to determine whether radiolucent lines were present immediately postoperatively and at a later follow-up interval. The humeral tilt angle was determined by measuring the angle between the humeral axis and the component. Subsidence was also evaluated. The mean of the raters' measurements was used in the analysis. Results: The mean duration of follow-up was sixty-nine months (range, twenty-six to 148 months). No loose stems were observed, and no humeral component was revised. At the time of follow-up, there was significant improvement in the Simple Shoulder Test scores and all visual analog scores (p < 0.0001 in each instance). Thirty-four stems had no radiolucent line at the time of follow-up, and the mean maximum thickness of the lucent lines was 0.21 mm in the entire group of fifty-eight shoulders. Most lucent lines occurred near the distal stem tip. The mean tilt of the valgus and varus humeral components was 2.2° and 2.6°, respectively, on the immediate postoperative radiographs. No humeral component shifted from varus to valgus or vice versa. The duration of follow-up was not correlated with the maximum thickness of the humeral component lucency, and the presence or absence of a prosthetic glenoid was also unrelated to the maximum thickness of the lucency. Conclusions: Compaction bone-grafting in shoulder arthroplasty can yield stable and durable fixation of the humeral component, as seen clinically and radiographically, without use of cement. Our findings provide evidence that compaction bone-grafting in shoulder arthroplasty is an option to ensure intermediate-term fixation (at a mean of five years) of humeral components that have a suboptimal fit. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

The Food Choice Questionnaire: Factorial invariant over western urban populations?

To assess the degree of measurement invariance of the Food Choice Questionnaire (FCQ) across western urban populations, it was filled out by demographically comparable samples in Canada (163 English speaking students, original version), Belgium (Flanders, N = 176, Dutch translation), and Italy ( N = 163, Italian translation). Reliability of the FCQ-scales was moderate to good, but sometimes differed from the normative values. Item analysis pinpointed items with skewed distributions and low item-total correlations. Subsequent confirmatory and exploratory factor analyses revealed a suboptimal fit for the FCQ-model in all samples, with small to considerable divergences from the original configuration. The findings do not support the generalizability of the FCQ’s factor structure, but suggest that its items and underlying constructs may have different connotations across western urban populations. Explanations for the lack of convergence in factor structure and implications for research are discussed.

Liste des Pensées Obsédantes (LPO) en version islandaise : étude des propriétés psychométriques avec une analyse factorielle confirmatoire

The Obsessive Thoughts Checklist (OTC) differs from several other measures of obsessive-compulsive symptoms in its focus on obsessive thoughts instead of compulsive behaviour. The OTC has been used in several studies in France and abroad and support for the discriminant and convergent validity of the instrument has been gathered. The authors of the OTC recently reported 3 underlying factors in this instrument: a perfectionism/verification factor, a contamination factor and a responsibility factor. In an earlier study of the OTC a 2 factor solution was however suggested. It therefore seems important to further elucidate the factorial structure of this instrument using confirmatory factor analysis. In this study data on the Icelandic translation of the OTC from three samples of Icelandic college students were submitted first to an exploratory and then to a confirmatory factor analysis. The total number of subjects was 614 college students, 254 men and 360 women with a mean age of 24.4 (sd = 5.0). The results of the exploratory factor analysis (PCA) submitted to a varimax rotation are presented in table I. The 3 expected factors were reproduced with few cross-loadings. In the confirmatory factor analysis the fit of three models to the data were evaluated: a 1 factor model, the 2 factor model of Bouvard et al. and the 3 factor model of Bouvard et al.. An initial examination of the data led to logarithmic transformation of 18 items to reduce skewness in their distributions. The data was subsequently subjected to a confirmatory factor analysis to compare the three-factor model with the two-factor and one-factor models for the OTC. The factors for the three- and two-factor models were allowed to correlate freely. The data were analysed using the EQS procedure, and the models tested were covariance structure models. Table II presents the goodness of fit indices for all three models. The results show that none of the three models provide an overall appropriate fit for the data. However, the fit indices for the three-factor model were considerably higher than found for the two or one factor models and the RMSEA index for the three-factor model suggested an acceptable fit for that model. Although the three-factor model suggests the best fit of all three models, the fit indices were still unacceptably low. Further examination of the data revealed a pattern of standardized residuals suggesting that this might in part be attributable to three items from the responsibility factor (items 26, 19 and 15) not being well specified within the model. When the residuals for these items were allowed to correlate, the fit of the model was substantially improved (CFI = 0.85; GFI = 0.87; AGFI = 0.85; RMSEA = 0.062). This indicates that a revision of the responsibility scale might be appropriate. Table III provides the means, standard deviations and the alpha coefficients for the 3 subscales of the OTC as well as for the total scale. In one subsample of the study (sample 1, n = 169) the OTC was administered together with the Padua Inventory-Washington State Revision (PI-WSUR) measuring obsessive-compulsive symptoms, the Penn State Worry Questionnaire (PSWQ) and the Community Epidemiological Scale-Depression (CES-D) measuring depression. In order to investigate the convergent validity and divergent of the OTC its correlation with the PI-WSUR was compared with its correlations with PSWQ and CES-D. These correlations shown in table IV support the convergent and divergent validity of the OTC. In another subsample of the study (sample 2, n = 296) the OTC was administered together with the Maudsley Obsessive Compulsive Inventory (MOCI). For samples 1 and 2, zero order and partial correlations were calculated between the subscales of the OTC and the subscales of the other instruments. As shown in table V the strongest correlations between the checking/perfectionism and the contamination subscales of the OTC were with corresponding subscales of the PI-WSUR and the MOCI. It is concluded that the factorial, the convergent and the divergent validities of the Icelandic translation of the OTC are supported in a student population even though the somewhat suboptimal fit of the three-factor model may indicate that a revision of the responsibility factor might be in order. This should however be further studied in a clinical population.

Nuclear morphometry predicts disease-free interval for clinically localized adenocarcinoma of the prostate treated with definitive radiation therapy.

Men treated for prostate cancer often have unexpected outcomes despite predictive models based on stage, grade and prostate-specific antigen (PSA). Previous results have indicated that nuclear morphometry can predict patient outcome in urologic malignancies. Application of this analytical method in prostate cancer treated with radiation therapy is limited. We have evaluated the predictive ability of nuclear morphometry in such patients. Histologic sections from 23 men with clinically localized adenocarcinoma of the prostate treated with radiation therapy were studied. Nuclear morphometric parameters were assessed using a previously described and validated system. Univariate and multivariate logistic regression analyses and a Cox proportional hazards model were used to assess the ability of nuclear morphometric parameters to predict recurrence and disease-free interval. Ten patients had no recurrence with median follow-up of 47. 5 months, while 13 had recurrence. Gleason grade was not predictive of treatment outcome. Pre-treatment PSA data, available for only 11 patients, were predictive of treatment outcome. Several nuclear morphometric parameters predicted recurrence, including upper quartile of suboptimal circle fit and upper quartile of feret-diameter ratio. A prognostic factor score incorporating these 2 parameters was derived, which predicted disease-free interval (p = 0.0014). Int. J. Cancer (Pred. Oncol.) 84:594-597, 1999.

Chinese medicine—New medicine

The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) has been validated in general population samples in many countries. Interest in using this measure in clinical populations is growing, particularly for tertiary prevention and mental health promotion. This paper reports validation of the French WEMWBS in healthy and chronic remitted schizophrenia populations.The French WEMWBS was administered to 319 workers, 75 students and 121 patients. For non-patients, self-reported Trait- and State-Anxiety, Mindfulness, Positive and Negative Affect and the General Health Questionnaire were completed. For patients, the Positive and Negative Syndrome Scale, Clinical Global Impression Severity Scale, Birchwood Insight Scale, Social Adjustment Scale, and Global Assessment of Functioning scale were completed. Test-retest reliability and responsiveness to intervention was assessed at 6 months.Whatever the sample, response frequencies showed normal distributions, and internal consistency was good (Cronbach's α). Scree plots of eigenvalues suggested a single factor in the samples. The one-dimensional solution yielded suboptimal fit indices. Construct validity was confirmed. Significant improvement in scores was observed before and after intervention. Test-retest variation was non-significant.Impairment of insight and cognition in the assessed patients implies that attention must be paid before applying WEMWBS to all patients. Nevertheless, WEMWBS proved valid and reliable in a further European population, suggesting transcultural validity for both monitoring and evaluation of interventions in healthy as well as chronic remitted schizophrenia populations.

Chinese medicine—New medicineedited by Frederick F. Kao and John J. Kao. Neale Watson, New York, 1977. 91 pp. $7.95

The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) has been validated in general population samples in many countries. Interest in using this measure in clinical populations is growing, particularly for tertiary prevention and mental health promotion. This paper reports validation of the French WEMWBS in healthy and chronic remitted schizophrenia populations.The French WEMWBS was administered to 319 workers, 75 students and 121 patients. For non-patients, self-reported Trait- and State-Anxiety, Mindfulness, Positive and Negative Affect and the General Health Questionnaire were completed. For patients, the Positive and Negative Syndrome Scale, Clinical Global Impression Severity Scale, Birchwood Insight Scale, Social Adjustment Scale, and Global Assessment of Functioning scale were completed. Test-retest reliability and responsiveness to intervention was assessed at 6 months.Whatever the sample, response frequencies showed normal distributions, and internal consistency was good (Cronbach's α). Scree plots of eigenvalues suggested a single factor in the samples. The one-dimensional solution yielded suboptimal fit indices. Construct validity was confirmed. Significant improvement in scores was observed before and after intervention. Test-retest variation was non-significant.Impairment of insight and cognition in the assessed patients implies that attention must be paid before applying WEMWBS to all patients. Nevertheless, WEMWBS proved valid and reliable in a further European population, suggesting transcultural validity for both monitoring and evaluation of interventions in healthy as well as chronic remitted schizophrenia populations.