Family structure and the externalizing behavior of children from economically disadvantaged families.

This study examined the relations among family structure, caregiver relationship history, aspects of environmental adversity, and teacher reports about the externalizing behaviors of 6- and 7-year-old children from economically disadvantaged families. Family structure contrasted intact families, stepfamilies, single-parent families, and cohabiting families. Problem behaviors were more frequent for children from unmarried families than from married families and were more frequent for boys than for girls from cohabiting families. Relationship history reduced the effects for family structure. Children's adjustment varied with both the current status and past stability of caregiver intimate relationships for disadvantaged families.

Emotion knowledge in economically disadvantaged children: self-regulatory antecedents and relations to social difficulties and withdrawal.

We examined the relations of verbal ability and self-regulation in preschool to emotion knowledge in first grade, and concurrent relations between emotion knowledge and indexes of social functioning in 143 children from low-income families. After controlling for children's verbal ability in preschool, teacher reports of attentional control and caregiver reports of behavioral control in preschool predicted children's emotion expression knowledge and emotion situation knowledge 2 years later. After controlling for verbal ability and attentional and behavioral control, children's emotion knowledge predicted concurrent teacher-reported social problems and social withdrawal. Results suggest that low levels of emotion knowledge co-occur with many important aspects of children's early social adaptation.

Emotion knowledge as a predictor of social behavior and academic competence in children at risk.

Following leads from differential emotions theory and empirical research, we evaluated an index of emotion knowledge as a long-term predictor of positive and negative social behavior and academic competence in a sample of children from economically disadvantaged families (N = 72). The index of emotion knowledge represents the child's ability to recognize and label emotion expressions. We administered control and predictor measures when the children were 5 years old and obtained criterion data at age 9. After controlling for verbal ability and temperament, our index of emotion knowledge predicted aggregate indices of positive and negative social behavior and academic competence. Path analysis showed that emotion knowledge mediated the effect of verbal ability on academic competence. We argue that the ability to detect and label emotion cues facilitates positive social interactions and that a deficit in this ability contributes to behavioral and learning problems. Our findings have implications for primary prevention.

Interpersonal problem solving in preschool and first grade: developmental change and ecological validity.

Examined problem-solving strategies, their correlation with multiple-informant ratings of behavior problems and social competence, and developmental change over a 2-year period. Shure's (1999) model targets children's production of alternative solutions to interpersonal problems. Others have found that solution quality correlates more highly with adjustment. Children (N = 208, M age = 60 months) completed the Preschool Interpersonal Problem Solving (PIPS) task in Head Start and again 2 years later. Many children achieved substantial gains in problem-solving skill as measured by PIPS. The prosocial or forceful quality of children's responses correlated with observational, caregiver, and teacher ratings of behavior problems and social competence. Quality of response appeared more important than solution quantity in predicting ecologically valid behaviors, implying that interventions should concentrate on response content more than quantity.

Dysphoria-related bias in maternal ratings of children.

Circumstantial evidence suggests that dysphoria creates a negative bias in caregivers' descriptions of child functioning. Past research has confounded informant and setting, making it unclear whether caregivers are biased or veridically reporting worse behavior in the home. In the present study, 137 low-income mothers watched videotapes of their own child and a control child performing a frustrating task. Mothers then completed 18 items assessing different positive and negative behaviors and emotions. The Beck Depression Inventory, The Differential Emotions Scale--Form IV, and The State-Trait Anxiety Inventory were used to assess maternal dysphoria. Correlations between mothers' dysphoria and descriptions of the control child showed small but significant dysphoria-related bias. Dysphoria provided approximately 10% predictive increment for mothers' ratings of their own children after partialing out independent judges' ratings. Results support an emotion-appraisal model predicting dysphoric bias.

The relations between cluster indexes of risk and promotion and the problem behaviors of 6- and 7-year-old children from economically disadvantaged families.

This study examined the relations between alternative representations of poverty cofactors and promotion processes and teacher reports of the problem behaviors of 6- and 7-year-old children from economically disadvantaged families (N = 159). The results showed that single-index representations of risk and promotion variables predicted child aggressive behaviors but not child anxious/depressed behaviors. An additive model of individual risk indicators performed similarly. Smaller indexes representing clusters of parent adjustment variables and family instability variables, however, differentially predicted aggressive and anxious/depressed behaviors, respectively. The results suggest the importance of promotion processes and of representing environmental adversity at varying levels of specificity for children from economically disadvantaged families.

Family instability and the problem behaviors of children from economically disadvantaged families.

This longitudinal study examined the relation between family instability and the problem behaviors of children from economically disadvantaged families. Family instability was assessed when the children were ages 5 and 7 and included number of residence changes, changes of intimate caregiver relationships, and recent negative life events. The results showed direct concurrent relations between family instability and preschool children's externalizing behavior in the context of other family process variables, relations between subsequent family instability and 1st-grade children's internalizing behavior (i.e., with preschool behavior ratings controlled), and an effect for persistent instability across grade. Moderator effects were also found for child variables, including gender, temperamental adaptability, and prior externalizing scores.

Contextual risk, caregiver emotionality, and the problem behaviors of six- and seven-year-old children from economically disadvantaged families.

This study explored the relations between additive and cumulative representations of contextual risk, caregiver emotionality, child adaptability, and teacher reports of the problem behaviors of 6- and 7-year-old children (N = 155) from economically disadvantaged families. The results showed relations between both risk representations and child problem scores and provided evidence that the relation for cumulative risk may be moderated by caregiver negative emotionality and caregiver positive emotionality and partially mediated by child adaptability. The results suggest the importance of exploring alternative representations of contextual risk and the conditions under which contextual risk influences child behavior.

Children's false memories: a test of the dissociability of cognitive and social processes.

In this reflection on "Fuzzy-Trace Theory and Children's False Memories" by Brainerd and Reyna (1998, this issue), I describe aspects of the historical and theoretical context of fuzzy-trace theory and the usefulness of fuzzy-trace theory in organizing false memory phenomena. I also suggest some limitations of fuzzy-trace theory concerning the representation of child intentionality and of social and affective phenomena.

Disposition of vessel dilator and long-acting natriuretic peptide in healthy humans after a one-hour infusion.

The present investigation was designed to determine half-lives, distribution phases and metabolic clearance of two new cardiac peptide hormones in humans. Long-acting natriuretic peptide (LANP) and vessel dilator were infused at 100 ng/kg of b.wt./min concentrations for 60 min with their respective concentrations measured by specific radioimmunoassays in plasma during and for 3 hr after infusion. The half-life of vessel dilator was 107 min, whereas the half-life of LANP was 28 min. The average time that the respective peptides were retained in the body (mean residence time) was 214 +/- 34 min for vessel dilator and 178 +/- 12 min for LANP, which indicates that they are widely distributed outside the initial space (i.e., circulation). The metabolic clearance normalized to 1.73 m2 body surface area was 241 ml/min for vessel dilator and 249 ml/min for LANP. The total body clearance normalized to 1.73 m2 body surface area was 130 ml/min for vessel dilator and 293 ml/min for LANP. The significantly (P < .001) longer half-lives and slower metabolic clearance of LANP and vessel dilator compared with atrial natriuretic factor (half-life, 2.5 min, metabolic clearance, 582-2,581 ml/min/1.7 m2) explain why these peptides circulate at concentrations 15- to 24-fold higher than atrial natriuretic factor in healthy humans.

The past, present, and future of lung transplantation.

BACKGROUND: The history of lung transplantation from the first human transplant performed in 1963 to the present is reviewed with particular focus on the added challenges because of the contaminated bronchus, exposure of the graft to airborne organisms, the poor blood supply to the bronchus, and the problem of reperfusion pulmonary edema. METHODS: The technical aspects of single and double sequential lung transplantation are reviewed, as are the current indications for single, double sequential, and heart/lung transplantation. Criteria for lung transplant recipients, in addition to their primary disease are noted, as are absolute and relative contraindications. The standard criteria for donor selection are also reviewed. RESULTS: The results of single, double sequential, and heart-lung transplantation over the past 10 years as reported by the International Society for Heart and Lung Transplantation Database are reviewed. In addition, the statistics of the lung and heart-lung transplantation program at the University of Colorado Health Sciences Center are reviewed, including the current immunosuppressive regimens and early and late monitoring for infection and rejection. This experience includes 3 early deaths in the first 53 patients for an operative mortality of 5.6%, with a 1-year actuarial survival of 90%. CONCLUSIONS: During the past decade remarkable improvement in the result of single and double sequential lung transplantation have occurred. As 1-year, actuarial survival is now approaching 90% at some institutions. Living related lobar transplantation, new antirejection agents, chimerism, and xenograft transplantation are areas for continuing and future investigation. The shortage in donor organ supply continues to be a very significant factor in limiting human lung transplantation.

The fluconazole era: management of hematogenously disseminated candidiasis in the nonneutropenic patient.

Hematogenously disseminated candidiasis arising from nosocomial fungal infection is a life-threatening complication in critically ill, nonneutropenic patients. The overall nosocomial fungal infection rate in United States hospitals doubled from 1980-1990. Until recently, amphotericin B was the only agent available for the treatment of life-threatening candidal infections, but its use is plagued by toxicities including nephrotoxicity and infusion-related reactions such as rigors and hypotension. The availability of fluconazole, which is regarded as much less toxic than amphotericin B, prompted a surge in research to determine if it is as efficacious in the management of candidemia and hematogenously disseminated candidiasis. Complicating the interpretation of studies is the broad range of infection severity, from candidemia that may be transient and self-limiting to life-threatening hematogenously disseminated candidiasis. Clinical trials comparing fluconazole and amphotericin B demonstrate the efficacy of fluconazole for catheter-associated candidemia in critically ill patients when the likely pathogen is Candida albicans. Amphotericin B should remain the first-line agent for the management of candidemia and hematogenously disseminated candidiasis in all other patients.

Disturbances of taste and smell induced by drugs.

We reviewed the current literature (1980-1990, 1991-1996) concerning drugs associated with anosmia, hyposmia, dysgeusia, parageusia, and ageusia, and the impact of these adverse effects. Case reports of patients with sudden and delayed onset of one of these disorders with evidence for implication of a drug were included. Disturbances of taste and smell among the elderly and chronically ill, including those with thermal injury, decreases interest in eating and secondarily impairs healing of wounds. Mechanisms involved with these sensory disturbances include deposition of silver sulfate in nerves after use of topical agents containing silver, altered influx of calcium and other ions, chelation or depletion of tissue-bound zinc, disturbed bradykinin catabolism and second messenger synthesis, catabolism, and altered prostaglandin systems. Other mechanisms, particularly prolonged chemosensory disorders after early drug discontinuation, remain unknown.

Induction of a memory retrieval strategy by young children.

This study examines children's modification of their own retrieval processes in a cued recall task. Each experiment had multiple study-test trails with triplets of categorically related words (Horse-Pig-Cow). Category-orienting questions were asked at acquisition, and each trial had different triplet stimuli. The last triplet word was the target, and the retrieval cues were the whole-context cue (Horse-Pig), a part context cue (Horse), or a noncontext associate (Goat). The measure of retrieval induction was recall increases across trials. Experiments 1 and 3 examined retrieval support for induction by 7- to 12-year olds by manipulating cue type. Experiments 2 and 4 manipulated acquisition variables that might effect retrieval induction. The results showed induction of an effective retrieval strategy in the situations of maximum retrieval support even by the 7-year olds, and developmental differences occurred in the situations where the retrieval cues provided few hints about the acquisition encoding operation. The results suggest that monitoring and modification of retrieval processes should be distinguished and that monitoring is necessary but not sufficient for induction of an effective retrieval strategy. The results have implications for understanding children's strategy-utilization deficiencies in memory tasks.

In vitro testing of antibiotics.

To enhance knowledge in the area of in vitro testing of antibiotics and to understand the limitations of available methods for susceptibility testing, we conducted a MEDLINE literature search in the English language to accumulate relevant articles. Headings searched included microbial sensitivity tests; Kirby-Bauer; laboratory tests; antiinfective agents; antibiotics, combined; microbiological techniques; blood bactericidal assay; and pharmacology, clinical. The management of patients with serious life-threatening infections can be complicated by recent changes in organism nomenclature, newly marketed antibiotics, and new isolation and sensitivity testing methods. With the addition of formulary constraints, many problems and controversies arise regarding interpretation of antibiotic sensitivity results. Comprehensive care for infected patients requires assessment of current antibiotic therapy and options for alternative therapy. By applying pharmacodynamic and pharmacokinetic knowledge to known limits of in vitro testing results, the clinician is able to select the most efficient antibiotic or antibiotic combination.

Intravenous ketorolac for pain management in a ventilator-dependent patient with thermal injury.

A patient with a long-standing history of chronic obstructive pulmonary disease suffered a thermal injury over 20% of his total body surface area. He required opiates for pain management and benzodiazepines for anxiety associated with dressing changes. The narcotics compromised his pulmonary function and level of consciousness, and interfered with several attempts to wean him from ventilator support. Intravenous ketorolac instead of narcotics before dressing changes alleviated the respiratory depression and returned his partial pressure of carbon dioxide-mediated respiratory drive to normal. With these changes, including changes in respiratory rate to tidal volume, he was successfully weaned from ventilatory support. In addition, the patient's level of consciousness improved. These changes increased his participation in his daily physical therapy sessions.