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Purpose: Little is known about the accuracy of the GAD-7, a self-report anxiety measure, in detecting generalised anxiety disorder (GAD) in people with dissociative seizures (DS). We evaluated the reliability, validity and uniformity of the GAD-7 using a diagnosis of GAD on the Mini-International Neuropsychiatric Interview as a reference.Methods: We assessed 368 adults with DS at the pre-randomisation phase of the CODES trial. Factor analysis for categorical data assessed GAD-7 uniformity. Diagnostic accuracy was assessed by estimating the area under the curve (AUC). We evaluated discriminant validity, reviewed data on convergent validity and calculated internal consistency. We explored correlations between GAD-7 scores and monthly DS frequency, frequency of severe seizures and measures of behavioural and emotional avoidance.Results: Internal consistency of the GAD-7 was high (α = 0.92). Factor analysis elicited one main factor and general measurement invariance. Diagnostic accuracy was fair (AUC = 0.72) but the best balance of sensitivity and specificity occurred at a cut-off of ≥12 and still had a specificity rate of only 68%. Discriminant and convergent validity were good. GAD-7 scores correlated positively with DS frequency, severe seizure frequency, behavioural and emotional avoidance (all p < 0.001).Conclusion: Findings regarding internal consistency and factor structure parallel previous psychometric evaluations of the GAD-7. Correlations between GAD-7 scores and DS occurrence/severity and avoidance are evidence of the concept validity of GAD-7 and provide further support for a fear-avoidance treatment model for DS. However, the utility of the GAD-7 as a diagnostic instrument for generalised anxiety disorder is limited in patients with DS. [ABSTRACT FROM AUTHOR]

To determine whether adult males provide females with a service, in this case anti-predator behaviour, in return for inclusion in a group a free-ranging troop of vervet monkeys, Cercopithecus aethiops, was observed for 9 months. Males were more vigilant than females and the discrepancy increased as the breeding season approached. Higher levels of vigilance by males were associated with their spending a greater proportion of time either isolated or exposed at the tops of trees. Males, however, were not vigilant because they were exposed but moved into such positions in order to scan the surroundings. Despite this, males were no more efficient than females at detecting predators. The top-ranking male was the most vigilant and active against predators. It is argued from these and other data that male vigilance they are not capable of controlling male numbers, and troops, as a consequence, contain a number of supernumerary males who may well be the beneficiaries of the vigilance of others.

Purpose: Most current protocols agree that latex-sensitive patients should be scheduled for elective surgery as the first case of the day with a 12-hour activity-free interval before surgically treating latex-allergic patients. Design: To understand the kinetics of decontamination of airborne particles in the operating room (OR) after a surgical procedure to determine the activity-free interval necessary between surgeries for latex-allergic patients. Methods: This observational study included 12 ORs in four hospitals. Baseline levels of airborne particles were established before surgery. Findings: Mean recovery time of ORs was 18.9 ± 6.5 minutes. To guarantee an efficacy of 99.9%, two standard deviations were added to the maximum time (28 minutes). Total recovery' time: 32 minutes. Conclusions: ORs that complied with the requirements of our study before performing surgery on latex-allergic patients obtained the same environmental conditions as first thing in the morning after thorough cleaning of the OR and a 32-minute activity-free in terval and staff traffic restriction. [ABSTRACT FROM AUTHOR]

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Background: The PHQ-9 is a self-administered depression screening instrument. Little is known about its utility and accuracy in detecting depression in adults with dissociative seizures (DS).Objectives: Using the Mini - International Neuropsychiatric Interview as a reference, we evaluated the diagnostic accuracy of the PHQ-9 in adults with DS, and examined its convergent and discriminant validity and uniformity.Methods: Our sample comprised 368 people with DS who completed the pre-randomisation assessment of the CODES trial. The uniformity of the PHQ-9 was determined using factor analysis for categorical data. Optimal cut-offs were determined using the area under the curve (AUC), Youden Index, and diagnostic odds ratio (DOR). Convergent and discriminant validity were assessed against pre-randomisation measures.Results: Internal consistency of the PHQ-9 was high (α = 0.87). While the diagnostic odds ratio suggested that a cut-off of ≥10 had the best predictive performance (DOR = 14.7), specificity at this cut off was only 0.49. AUC (0.74) and Youden Index (0.48) suggested a ≥ 13 cut-off would yield an optimal sensitivity (0.81) and specificity (0.67) balance. However, a cut-off score of ≥20 would be required to match specificity resulting from a cut-off of ≥13 in other medical conditions. We found good convergent and discriminant validity and one main factor for the PHQ-9.Conclusions: In terms of internal consistency and structure, our findings were consistent with previous validation studies but indicated that a higher cut-off would be required to identify DS patients with depression with similar specificity achieved with PHQ-9 screening in different clinical and non-clinical populations. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To search for biochemical and molecular markers for the diagnosis of patients and carriers with 2-Methyl-3-hydroxybutyryl-CoA dehydrogenase (MHBD) deficiency. Design and methods: Organic acids in urine, MHBD activity in fibroblasts, immunoblotting and molecular studies were performed in seven patients. Seven carriers were also studied. Results: Under low protein diet or poor feeding all the patients showed only a slightly altered organic acid profile. Measurement of 2-methyl-3-hydroxybutyric acid and tiglylglycine after an isoleucine loading test, failed to demonstrate the carrier status of one patient. However, measurement of 2-ethylhydracrylic acid (EHA) was positive in all the carriers tested. MHBD activity was clearly deficient in males and in one female patient. We identified four missense mutations, two of them were novel. Conclusions: Quantification of EHA may be of help for the diagnosis of the heterozygous condition. The carrier females showed the classical biochemical variability of X-linked diseases due to random X-chromosome inactivation. [Copyright &y& Elsevier]