Anthony M. Paolo

Response Rate Comparisons of E-Mail- and Mail-Distributed Student Evaluations

Background: The proliferation of electronic information delivery systems has led to increasing use of e-mail as a rapid method of gathering information. Little research has been conducted on the use of e-mail for collecting curriculum evaluations. Purpose: To compare e-mailed and mailed educational evaluations for 4th-year medical students. Methods: Curriculum evaluations were sent to 4th-year medical students who were randomly assigned to receive the survey either by mail or e-mail. Results: Mailed evaluations yielded a higher return rate, fewer number of students omitting items, and shorter responses to an open-ended question than evaluations completed via e-mail. Conclusions: Although the findings have limited generalizability because of low response rates and small sample sizes, the results suggest caution when using e-mail to collect curriculum evaluations from 4th-year medical students

Action (verb naming) fluency as an executive function measure: convergent and divergent evidence of validity

Numerous studies have demonstrated dissociable neuroanatomic underpinnings for the retrieval of grammatical classes of words such as nouns and verbs. Whereas retrieval of common and proper nouns is primarily mediated by posterior and anterior temporal regions, respectively, verb retrieval is primarily mediated by frontal regions. The majority of studies evaluating verb production have utilized tasks requiring subjects to name a graphically depicted action (i.e. action naming), leaving tests of verb generation in the absence of prompting stimuli (i.e. action fluency) largely unexamined. In a recent study, Piatt, Fields, Paolo, Koller and Tröster (in press) found that an action fluency task discriminated demented Parkinsons disease (PD) patients from non-demented PD patients and healthy control subjects, whereas lexical and categorical fluency tasks did not. These authors suggested that action fluency was sensitive to the fronto-striatal pathophysiology associated with PD dementia, and thus, that action fluency might serve as an indicator of executive functioning. This study was undertaken to evaluate the construct validity of action fluency as an executive function measure in a group of healthy elderly control subjects. Findings revealed modest to moderate relationships between action fluency and several putative executive measures. Action fluency was unrelated to indices of semantic and episodic memory. Results support the construct validity of action fluency as an executive function measure and suggest that this task may provide some unique information not tapped by traditional executive function tasks.

A screening procedure for estimating premorbid intelligence in the elderly

Abstract WAIS-R IQs were estimated using the National Adult Reading Test (NART) in a sample of 126 normal elderly. Linear regression equations to predict WAIS-R IQs from NART error scores were generated for a development sample of 85 subjects. Correlations between reading errors and Verbal, Performance, and Full Scale IQs were -.78, -.56, and -.74, respectively. Cross-validation on 41 elderly subjects yielded significant correlations between earned IQ and the NART that ranged from -.40 to - .83. Mean earned and estimated IQs for the normal elderly cross-validation sample were the same. Additional cross-validation on a sample of 20 neurologically impaired subjects revealed significant overestimation of the actual WAIS-R IQs by the NART estimated IQs. Thus, the NART estimated IQs adequately demonstrated intellectual deterioration in a brain-damaged sample.

The roles of semantic networks and search efficiency in verbal fluency performance in intractable temporal lobe epilepsy

Two competing hypotheses (i.e., disruption of semantic networks vs. search inefficiency) concerning the mechanisms underlying impaired semantic verbal fluency in temporal lobe epilepsy (TLE) were tested within a single paradigm. Reports that semantic verbal fluency is more impaired in left than right TLE groups were confirmed by the findings that the left TLE group produced fewer words on a supermarket fluency task than did the normal control (NC) group, and that the performance of the right TLE group was intermediate to that of the left TLE and NC groups. Because both TLE groups generated fewer words per category of supermarket items sampled, and produced a higher ratio of category labels relative to category exemplars than did the NC group, it can be surmised that TLE disrupts semantic memory networks. The findings did not support the competing hypothesis that reduced semantic verbal fluency in TLE is a manifestation of inefficient search/retrieval strategies, possibly associated with distal frontal lobe pathophysiology. Specifically, the TLE and NC groups did not differ significantly in their mean number of perseverations, intrusions, or search efficiency (operationalized as the ratio of the number of shifts between categories to the number of categories sampled).

SURVEY RESULTS OF WOMEN WHO HAVE BEEN STRANGLED WHILE IN AN ABUSIVE RELATIONSHIP

Few studies attempt to examine individual methods of domestic abuse. The objectives of this study are to evaluate strangulation as a method of domestic violence abuse: to determine the incidence of strangulation occurrence within the cycle of domestic violence, the subjective medical symptoms experienced by victims of intimate partner strangulation, and the elective utilization of health care following a strangulation incident. Sixty-two women were surveyed at two womens shelters in Dallas, Texas and Los Angeles, California and the Parkland Health & Hospital (PHHS) Violence Intervention Prevention (VIP) Center in Dallas, Texas. Each patient was individually interviewed and verbal responses were recorded. Statistics were performed using the SPSS program. Of the 62 surveyed, 42 (68%) had been strangled by their intimate partner who was a husband (23, 55%), boyfriend (13, 31%), or fiancé (2, 5%), by a mother, stranger, or friend (1 each). Strangulation, as a method of domestic violence, is quite common in women seeking medical help or shelter in a large urban city. This study suggests that strangulation occurs late in the abusive relationship; thus, women presenting with complaints consistent with strangulation probably represent women at higher risk for major morbidity or mortality.

Utility of a Wisconsin card sorting test short form in persons with Alzheimer's and Parkinson's disease

The utility of administering only the first deck of 64 cards from the Wisconsin Card Sorting Test (WCST-64) in persons with Alzheimers (AD) and Parkinsons disease (PD) was evaluated. There were 35 elderly subjects matched for gender, age, and education in each of four groups: controls, PD without dementia (PDN), PD with dementia (PDD), and AD. Additionally, the control and PDN subjects were matched for level of cognitive functioning as were the PDD and AD groups. Results revealed that demented persons performed significantly worse than nondemented subjects. The WCST-64 was also sensitive to the subtle executive deficits demonstrated by persons with PD without dementia. The findings support the use of the WCST-64 in elderly persons with AD and PD.

California verbal learning test: Normative data for the elderly

Overlapping age tables were developed, separately for males and females, to provide additional normative information for the California Verbal Learning Test (CVLT) and extend the normative data to persons older than 80 years of age. Participants were 92 males and 120 females with means for age and education of 70.58 years (SD = 6.98) and 14.92 years (SD = 2.56), respectively. Normative information was also provided for additional measures of retention rate and proportion of perseverations and intrusions. The clinical utility of these norms strongly depends on how closely a person matches the demographic characteristics of the normative group.

Differentiation of the Dementias of Alzheimer's and Parkinson's Disease with the Dementia Rating Scale

The Mattis Dementia Rating Scale (DRS) was used to distinguish between 50 dementia of the Alzheimers type (DAT) and 50 Parkinsons disease (PD) subjects matched for age, education, and DRS total score. Despite a similar level of overall cognitive impairment, the DAT group earned significantly lower scores than did the PD group on the Memory subscale, while the PD group displayed lower scores than did the DAT subjects on the Construction subscale. A jackknifed, stepwise, linear discriminant function using the five DRS subscales revealed that the Memory, Construction, and Initiation subtests significantly distinguished the groups. These results suggest qualitative differences in the dementias of DAT and PD patients and reveal that such differences can emerge on brief mental status examinations.

Action verbal fluency normative data for the elderly

An emerging body of literature points to the prominent role of the frontal lobes in the retrieval of verbs, whereas production of common and proper nouns arguably is mediated primarily by posterior and anterior temporal regions, respectively. Although the majority of studies examining the neuroanatomic distinctions between verb and noun retrieval have relied on action naming tasks (naming depicted activities, e.g., running) as indicators of verb retrieval abilities, recent studies have utilized an action (verb) verbal fluency measure, the Action Fluency Test (AFT), to assess verb retrieval. Findings from these studies suggest that action fluency is sensitive to the integrity of fronto-subcortical neural circuitry and that it is a valid measure of executive and language functions. The AFT is an easily administered executive function measure, but no normative data for the AFT or other action fluency tasks has been published. This study was undertaken to provide initial AFT normative data for a sample of 145 healthy elderly subjects. As education is significantly correlated with AFT scores, the normative data are stratified by educational level.

Aligning compensation with education: design and implementation of the Educational Value Unit (EVU) system in an academic internal medicine department.

The authors report the development of a new metric for distributing university funds to support faculty efforts in education in the department of internal medicine at the University of Kansas School of Medicine. In 2003, a committee defined the educational value unit (EVU), which describes and measures the specific types of educational work done by faculty members, such as core education, clinical teaching, and administration of educational programs. The specific work profile of each faculty member was delineated. A dollar value was calculated for each 0.1 EVU. The metric was prospectively applied and a faculty survey was performed to evaluate the faculty’s perception of the metric. Application of the metric resulted in a decrease in university support for 34 faculty and an increase in funding for 23 faculty. Total realignment of funding was US