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Rehabilitation professionals have long used work samples in assessing the ability and functionality of clients requesting rehabilitation services. Although there has been remarkable development in the type and scope of work samples, the incorporation of work samples into assessment has lagged behind that of other measurement systems. One logical reason is the prolonged time required to administer work samples. Despite this time commitment, work samples have usefulness and value for rehabilitation counselling and vocational evaluation. The purpose of this brief report is to provide evidence to indicate the usefulness of work-simulated work samples versus ability-predicted work samples. The authors discussed the advantages and disadvantages of both assessment approaches in demonstrating the benefits in vocational assessment for clients and professionals.

Although a broad range of neuropsychological deficits has been reported in patients with severe sleep disordered breathing (SDB), little is known about the impact of mild SDB on neuropsychological performance. In this study, we compared neuropsychological test performance in two groups of carefully screened volunteers who differed clearly according to the respiratory disturbance index (RDI). Controls (n = 20) were identified on the basis of an RDI < 5; cases (n = 32) had an RDI in the range of 10-30. Cases and controls were well matched with regard to IQ, age, and sex. Cases had significantly more self-reported snorting and apneas and a higher body mass index than controls but did not differ according to sleepiness as measured by either the multiple sleep latency test or the Epworth sleepiness scale. An extensive battery of neuropsychological and performance tests was administered after an overnight sleep study. Cases performed significantly more poorly on a visual vigilance task (perceptual sensitivity, d': 2.24 +/- 0.64 vs. 2.70 +/- 0.53, p = 0.01, for cases and controls, respectively) and a test of working memory, the Wechsler adult intelligence scale-revised digits backwards test (6.12 +/- 2.20 vs. 7.55 +/- 2.22, p = 0.02), than controls. The groups did not differ in their performance on other tests of memory, information processing, and executive functioning. In summary, subjects with mild SDB may manifest a vigilance deficit in the absence of substantial sleepiness. Subjects with a mildly elevated RDI (10-30) without sleepiness do not appear to suffer appreciable deficits in more complex neuropsychological processes (e.g. executive functions).

We conducted a two-year follow-up study of 40 patients with MS in whom we had reported that abnormal eye movements (AEM) were associated with greater general disability. AEM patients (17/40) remained significantly (p < .001) more disabled (median EDSS of 7.0) than those with normal eye movements (median EDSS of 5.0). AEM and great disability were associated with abnormal MRI signals in brainstem or cerebellum, where disease may involve control circuits for eye movements as well as descending motor pathways.

Most legal researchers are familiar with federal sources and materials for their own state. Law librarians, attorneys, and other researchers find state legal research guides are extremely valuable when addressing out-of-state law. These guides, in the form of treatises, periodical articles, or short monographs, also introduce the inexperienced researcher to state legal research. Though several bibliographies of state research guides are available, none provide evaluative annotations for all types of guides. This annotated bibliography is intended to benefit legal researchers of all types as well as collection development librarians in major law libraries.

Aim The clinical nurse leader (CNL®) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice. Background Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources. Method A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region. Results Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model. Conclusions With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs. Implications for nursing management Nursing is in a unique position to address problems that plague the nation’s health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings.

The Monroe County Department of Public Health (MCDPH), in partnership with the Monroe County Medical Society (MCMS), developed a vaccine redistribution model to address the shortage of influenza vaccine during 2004-2005 by assessing the community's need among high-risk patients and establishing a system of redistribution. The target population was high-risk groups defined by the Advisory Committee on Immunization Practices. The main goals were to ensure that only high-risk individuals be vaccinated, to allay public concern, and to eliminate the difficulties associated with public clinics. The MCDPH requested the cancellation of all public and employer clinics, and that vaccine be redirected to physicians who could best determine a patient's need. In addition, the MCDPH asked that private physicians who had excess vaccine make it available. Within 12 weeks, the MCDPH, working in partnership with the MCMS, had redistributed 60,000 doses of influenza vaccine and vaccinated all high-risk patients identified.

Seventeen patients with sleep apnea syndrome [SAS, Respiratory Disturbance Index (RDI) = 12−85] were compared with 16 normal controls (RDI < 7) on neuropsychological tests of executive functions, a domain in which SAS patients have been suggested to have deficits. SAS patients demonstrated greater deficits in the retrieval of information from semantic memory (Controlled Oral Word Association task) and in shifting responses in the face of error (Wisconsin Card Sort Test), but differences in working memory were not observed. Eliciting deficits in cognitive executive functions in SAS may require more sensitive measures than are typically used in neuropsychiatric research.

Equivalent versions of the Complex Figure Test (CFT) are useful for assessing change over time in constructional skills, planning, spatial organization, and visual-spatial memory while minimizing practice effects. To address the need for an equivalent version of the CFT to the Rey, the present study compared copy and 45 min-delayed recall accuracy scores of the Rey and Mack CFTs obtained from 245 adults involved in a study of the neuropsychological correlates of sleep apnea and its treatment. Accuracy scores did not significantly differ between individuals with and without sleep apnea. Also, there was no significant difference between copy or recall accuracy scores obtained on the Rey and Mack CFTs. Similar correlations were found between relevant demographic factors, estimated IQ, and accuracy scores for both CFTs. These data suggest that the Mack figure may be a useful alternative to the Rey CFT.

Sleep-disordered breathing (SDB) has been associated with neuropsychological (NP) deficits. The extent to which such effects are attributable to unmeasured confounders or selection biases, or are manifest across a range of SDB is unclear. The relationship of SDB with a broad range of NP functions was examined in 100 volunteers with a spectrum of SDB and without underlying comorbidity. Factor analysis suggested that the NP tests could be summarized as four constructs: declarative memory, signal discrimination, working memory, and set shifting. These factors plus vigilance were dependent variables. Independent variables were age, the respiratory disturbance index (RDI), a sleepiness score, the arousal index, and sleep-associated hypoxemia. Factors “declarative memory” (measuring 25% of the common variance, � � 0.95), “signal discrimination” (10% variance, � � 0.70), and “working memory” (9% variance, � � 0.52) were each significantly, linearly predicted by hypoxemia and/or the RDI, with no evidence for significant threshold effects. SDB measures accounted for 4‐6% of the variance in NP constructs. In contrast, sleepiness best predicted vigilance. Thus, adverse exposures (hypoxemia or RDI) during sleep may negatively influence NP functions in a dose‐response relationship, and, other than vigilance, these effects may not be directly attributable to sleepiness. Obstructive sleep apnea hypopnea syndrome (OSAHS) is the health condition most commonly associated with disordered breathing during sleep and sleep fragmentation. A major component of the morbidity of the condition is thought to relate to short-term and possible long-term neurocognitive deficits caused by exposure to intermittent hypoxemia, hypercapnia, and arousal, acting independently or synergistically. Deficits have been examined using classic neuropsychological (NP) approaches with administration of test batteries that assess a range of functions (broadly considered to assess different structural areas of the brain). These include executive functions (processes involved in planning, initiation, or self-regulation of goal-oriented behavior), attention (including span of apprehension, sustained attention, vigilance, information processing efficiency, and response times), and learning and memory. Interpretation of such tests requires careful consideration of the noncognitive influences that may confound study findings, including the sensitivity of the tests to the effects of age, alcohol consumption, education level, and motivation, as well as differences in baseline intelligence. Studies that have used these approaches to assess NP function in OSAHS include case series of patients with comparisons with published normative data (1), case‐control and cross-sectional studies (2, 3), pre‐poststudies (4, 5), small randomized control studies (6, 7), and a population-based study (8). A wide range of results that could be attributable to the effects of OSAHS (or to the effects of treatment aimed at reversing OSAHS) has been reported. In general, the largest and broadest range of NP deficits has been demonstrated in studies of patients with severe SDB, as evidenced by pathological levels of sleepiness, severe sleep-associated hypoxemia, and/or with RDIs � 40 (1, 2, 4, 9). Study results suggest that hypoxemia most closely predicts deficits in executive functions and psychomotor skills, whereas sleepiness predicts deficits in attention measures (3, 5). However, it is not clear from these studies if effects were due to unmeasured confounding (from studying subjects with underlying medical or psychological problems) and whether effects persisted across the entire spectrum of SDB. This study is unique in that it includes a large number of subjects with low to intermediate levels of SDB, most of whom were not referred to a Sleep Center, and whom were also screened to be free of underlying neurological or medical problems that might impact NP function. This study assesses the extent to which variations in NP function in a nonreferred sample may be associated with variations in sleepiness, as described by both objective and subjective measures, and by direct measures of SDB, that is, indices of sleep-related hypoxemia, sleep fragmentation, and the RDI.

A 49-year-old right-handed man presented with a severe impairment of motor speech output aphemia. Initially, he could make grunting sounds, but was otherwise mute. There was no disturbance of comprehension, and he preferred to communicate by writing. Writing was agrammatic with lexical errors and misspellings which improved with the speech disturbance. The writing abnormalities of aphemics emphasize the aphasic nature of this speech abnormality.

The aim of this randomized controlled trial was to assess the effects of treatment with continuous positive airway pressure versus conservative therapy (CT) on well-being, mood, and functional status in subjects with mild sleep-disordered breathing (SDB). One hundred and eleven subjects, aged 25 to 65 yr, with a respiratory disturbance index (RDI) of 5 to 30 and without subjective pathologic sleepiness, were randomized to nasal CPAP or to CT. Ninety-seven subjects were followed-up after 8 wk. Treatment response was assessed from changes between baseline and follow-up measures of mood, energy/fatigue, and functional status/general health. Of the 51 subjects randomized to CPAP, 25 (49%) experienced an improved outcome, as compared with 12 of 46 of subjects (26%) randomized to CT (p0.05). The odds of experiencing a treatment response in the CPAP as compared with the CT group were 2.72 (OR: 1.18 to 6.58, 95% CI). A beneficial effect of CPAP over CT was most evident among individuals without sinus problems and among subjects with hypertension or diabetes. Differential treatment responses were not related to degree of baseline sleepiness or SDB. This suggests that middle-aged snorers with relatively low levels of SDB (RDI30) may benefit more from nasal CPAP than from less specific therapy directed at improving breathing during sleep. CPAP therapy may be beneficial to a broader group of subjects than previously appreciated.

One commonly used instrument for evaluating general health and functional status is the medical outcomes survey short form 36 (MOS). Scores obtained from this instrument are known to vary with chronic diseases and depression. However, the degree to which these health dimensions may be influenced by sleep quality or sleepiness is not well understood. A cross-sectional study was performed on the association between general health status, as determined by the MOS, with sleepiness, assessed using a standardized questionnaire [the Epworth sleepiness scale (ESS)] and the multiple sleep latency test (MSLT). One hundred twenty-nine subjects (68 women), aged 25-65 years, without severe chronic medical or psychiatric illnesses, underwent an overnight sleep study, followed by an MSLT (consisting of a series of four attempts at napping at 2-hour intervals), and completed the MOS and the ESS. The mean MSLT score was 11 +/- 2 minutes, (range 2-20) and the mean ESS score was 10 +/- 5 (range 0-24). Scores for the MOS dimensions "general health perceptions", "energy/fatigue", and "role limitations due to emotional problems" were correlated significantly with ESS scores (r = -0.30, -0.41, and -0.30, respectively; p values were all < 0.001). The MSLT was also significantly correlated with "energy/fatigue" (r = -0.19; p < 0.05). After considering the effects of chronic illness and/or body mass index in a multiple hierarchical regression analysis, sleepiness, as assessed by the ESS score, explained 8% of the variance in general health perceptions, 17% of the variance in energy/fatigue, 6% of the variance in the summary measure of well-being, and 3% of the variance in the summary measure of functional status. The variation of MOS scores with sleepiness, unrelated to age or chronic disease, suggests that measures of general health status may be broadly influenced by sleepiness and sleep quality. These data suggest that 1) sleepiness has an important impact on general health and functional status, specifically influencing self-perceptions regarding energy/fatigue; 2) a more specific assessment of sleepiness in general health evaluations may help explain some of the observed variability in these measures across subjects; and 3) general health measures may be useful in the evaluations of patients with sleep disorders.

Knowledge of earlier intellectual functioning can be very helpful in the diagnosis of neurocognitive disorders. The National Adult Reading Test (Nelson, 1982), based on the observation that reading irregularly spelled words remains intact in mild dementia, may be useful for this purpose. A version for speakers of American English (AMNART) was recently published (Grober & Sliwinski, 1991). The present study evaluated the validity of the AMNART with demented and nondemented African-American and White elderly veterans. The average differences between African-American and White participants on the AMNART and WAIS-R were similar. The differences between demented and nondemented patients were greater on the WAIS-R than on the AMNART, as expected. Paradoxically, the AMNART appears to over-estimate IQ among nondemented individuals with lower WAIS-R scores, but underestimate IQ among more impaired demented patients. Using Grober and Sliwinski's (1991) 10-point discrepancy rule between AMNART and WAIS-R VIQ scores, 70% of demented and nondemented veterans were successfully classified. No discontinuation rule for the AMNART could be established because word difficulty order varies across samples.

The recent advent of vector computers has made 3-D seisniic studies feasible, and in many cases, desirable. 2-D forward models simulate the three-dimensional world inaccurately and place unrealistic constraints on the geologic structure. Recent studies show favorable timings for a 2-D elastic forward model implemented using Fouriei techniques on a CDC Cyber 205. These results indicate that it is possible to implement a 3-D elastic forward model on a vector computer and obtain reasonable turn-around times. Differentiation of discrete-valued functions is an important step in forward modeling. The 2-D elastic forward modeling technique developed for the Cyber 205 uses a Fourier method for differentiation. This method does not exhibit the problems associated with conventional finite-difference modeling techniques. In particular, this model can handle geologic structures with strong velocity variations and fluid/solid interfaces. P-waves and S-waves are easily isolated using this method. The major cofisiderations in a 3-D elastic model are those of data motion and memory requirements. This paper outlines an algorithm for the 3-D implementation and presents a FIG. 1. Pressure at T= 500 ms.

We describe a familial disorder consisting of sleep apnea, anosmia, colorblindness, partial complex seizures, and cognitive dysfunction. The phenotypic expression of the syndrome suggests an autosomal dominant inheritance with incomplete penetrance.

The purpose of this study is to assess children's perceptions of the nurse as they are related to children's age, the amount of contact children have had with nurses and children's sex. An oral picture test, consisting of 10 photographs, was administered to 45 children in the Edith Bowen Elementary School at Utah State University. The children were interviewed about their perceptions of the nurses in each photograph and their responses were rated as being positive, negative or neutral. The findings of this study indicate that although significant differences exist in children's perceptions of the nurse in terms of positive, negative and neutral responses, these differences are not due to the effects of the age of the children, the amount of contact they have had with nurses or the sex of the children. The conclusions are that children's perceptions of the nurse are affected by a variable which was not tested in the present study and that children seem to reveal the more positive aspects of their feelings about nurses. The author suggests that children's negative feelings about nurses are too powerful to be verbalized and have been internalized by the children due to the influence of social pressure to conform.