of histomorphologic diagnoses with special reference to the kappa statistic. APMIS 97: [689][690][691][692][693][694][695][696][697][698] 1989.Systems for classification and grading used in pathology should ideally be biologically meaningful and at least be reproducible from one pathologist to another. A statistical method to evaluate reproducibility (non-chance agreement) for several observers using nominal or ordinal categories has been developed and refined over the past few decadesthe kappa statistic. A high level of observed agreement among different pathologists can either signify a high level of reproducibility, if agreement by chance is low, or express a low level of reproducibility, if agreement by chance is almost as high as the observed agreement. Therefore, the observed agreement says nothing in itself, unless it is low. The kappa value, however, indicates how much better the observers are compared to a throw of the dice, and therefore gives the real credit to the agreement which was found. We have developed a user-friendly computer program for calculating inter-and intra-observer agreement of 2 or more observers. By calculating associations between different categories and different observers, the statistic furthermore obtains a function close to the parameter of accuracy. We recommend the use of the above method before a set of nominal or rank scale parameters are used for deciding prognosis and treatment of patients. By submitting a diskette the computer program will be available at no cost.

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Absiruct: 'The tolerance of paroxetinc (FG 7051). as well as its pharmacokinetics and reduction of 5-HT in blood, has been investigated in man. Three normal, healthy volunteers were administered the single doses 10, 25.50, and 75 mg orally, and three volunteers received 10. 25, and 50 mg per day for seven orfourteen days. No toxic effect on blood. kidney, liver. heart or general condition was found by chemical and physical examinations. The pharmacokinetic studies revealed a dose dependent systemic availability, a rather slow elimination (tl,2=approximately 16 hrs), a good fit to a one compartment open model,and analmost complete metabolism of the substance. 25 mg paroxetine per day gave a maximal reduction of 5-HT in the blood within 2-3 weeks (to approximately 0.03 pg/nil). The 5-HT levels returned to the basic levels during a three to four weeks drug-free period.

Simultaneous records of the pulse waves were obtained from the right common carotid artery and the right femoral artery by means of piezo-electric microphones in 26 per= sons whore ages ranged from 15 to 92 years. The time difference between the foot points of the waves from them two sites was termed Tar.A significant correlation was found between ToS and age, be= tween TOP and the systolic blood pressure and between Top and As described by Miller and White (1) and Geddes and Hoff (2), the pulse wave can be recorded by means of piezo-electric microphones placed externally above the artery. If T is the time difference between the foot points of two pulse waves recorded a t varying distances from the heart and D the length of the segment, the pulse wave velocity = D/T.

No abstract

Workplace discrimination may affect the health of the exposed employees, but it is not known whether workplace discrimination is also associated with an increased risk of long-term sickness absence. The aim of this study was to examine the longitudinal associations of changes in and onset of workplace discrimination with the risk of long-term sickness absence. Data on workplace discrimination were obtained from 29,597 employees participating in survey waves 2004, 2006, 2008 and/or 2010 of the Finnish Public Sector Study. Four-year changes in long-term sickness absence (≥10 days of medically certified absence with a mental or non-mental diagnosis) were assessed. This covered successive study waves in analyses of onset of workplace discrimination as well as fixed effect analyses of change in workplace discrimination (concurrent i.e. during the exposure year and 1-year lagged i.e. within one year following exposure), by using each employee as his/her own control. The risk of long-term sickness absence due to mental disorders was greater for employees with vs. without onset of workplace discrimination throughout the 4-year period, reaching a peak at the year when the onset of discrimination was reported (adjusted risk ratio 2.13; 95% confidence interval (CI) 1.80–2.52). The fixed effects analyses showed that workplace discrimination was associated with higher odds of concurrent, but not 1-year lagged, long-term sickness absence due to mental disorders (adjusted odds ratio 1.61; 95% CI 1.33–1.96 and adjusted odds ratio 1.02; 95% CI 0.83–1.25, respectively). Long-term sickness absence due to non-mental conditions was not associated with workplace discrimination. In conclusion, these findings suggest that workplace discrimination is associated with an elevated risk of long-term sickness absence due to mental disorders. Supporting an acute effect, the excess risk was confined to the year when workplace discrimination occurred.

After introduction of a catheter into the aorta, the pressure wave velocity was measured in 26 subjects whose ages ranged from 9 to 68 years. The first site of registration was approximately 10 cm from the aortic valve, and the second was 50 cm distal to the first. At both sites the time difference was measured between the R‐wave of the electrocardiogram and the foot of the pressure wave (TProx. and TDist.). The time difference T50 (TDist. – TProx.) and the distance between the sites of registration (50 cm) were used for the calculation of the pressure wave velocity (PWV). Four of the 26 subjects were normal; the others had some form of heart disease, including disease of the valves, hypertension and aortic atherosclerosis. Nevertheless, the values found for pressure wave velocity were in agreement with those stated in literature. A significant correlation was found between T50 and age (r = —0.788), between T50 and the proximal systolic blood pressure (r = −0.537), and between T50 and the proximal pulse pressure (r = −0.491), but not between T50 and the cardiac output and peripheral arterial resistance. There was no correlation between the proximal diastolic blood pressure and T50, possibly owing to the fact that all the patients had a diastolic blood pressure below 100 mm Hg. There was no significant difference between the coefficient of correlation for T50 and age (−0.788) and the multiple coefficient of correlation for T50 and age and systolic blood pressure proximal in the aorta (−0.811). Four patients had arteriographic aortic atherosclerosis. Two of these had lower T50 values than would be expected according to the proximal systolic blood pressure and the pulse pressure, but after exercise the values were within the normal range (±2 s.d.) Owing to the dominating influence of age on T50 and the considerable spreading of these values, it is not likely that the determination of pulse wave velocity will be of clinical value, for example, in the diagnosis of atherosclerosis.

Objective: To externally validate recent prognostic models that predict independent gait following stroke. Study Design and Setting: A systematic search identified recent models ( < 10 years) that predicted independent gait in adult stroke patients, using easily obtainable predictors. Predictors from the original models were assigned proxies when required, and model performance was evaluated in the validation cohort (n = 957). Models were updated to determine if performance could be improved.Results: Three prognostic models met our criteria, all with high Risk of Bias. Validation data was only available for the Australian model. This model used National Institute of Health Stroke Scale (NIHSS) and age to predict independent gait, using Motor Assessment Scale (MAS) walking item. For validation, Scandinavian Stroke Scale (SSS) was a proxy for NIHSS, and Functional Independence Measure (FIM) locomotion item was a proxy for MAS. The Area Under the Curve was 0.77 (0.74-0.80) and had good calibration in the validation dataset. Adjustment of the intercept and regression coefficients slightly improved discrimination. By adding paretic leg strength, the model further improved (AUC 0.82). Conclusion:External validation of the Australian model with proxies showed fair discrimination and good calibration. Updating the model by adding paretic leg strength further improved model performance.