Examining the role of mother-child interactions and DNA methylation of the oxytocin receptor gene in understanding child controlling attachment behaviors.

This study examined mother-child interactions and DNA methylation of the oxytocin receptor (OXTR) gene in the child, in relation with controlling-attachment behaviors at early preschool age. Maternal interactive behaviors were coded using the Emotional Availability Scales, and child attachment behaviors were assessed with the Separation-Reunion procedure and coded with the Preschool Attachment Rating Scales. DNA methylation data were captured from exon 3 of the OXTR. Results indicated that lower maternal sensitivity was associated with more controlling-caregiving behaviors, and that less maternal structuring was associated with more controlling-punitive behaviors. Hypomethylation of the OXTR gene was associated with greater maternal structuring behaviors, and with more child controlling-caregiving behaviors. The moderating role of the OXTR gene was examined in the association between interactive behaviors and child controlling behaviors, but no interaction effect was found. These results suggest that maternal interactive behaviors and OXTR methylation are independently associated with child controlling attachment.

Novel use of social media to assess and improve coastal flood forecasts and hazard alerts.

Coastal communities and infrastructure need protection from flooding and wave overtopping events. Assessment of hazard prediction methods, used in sea defence design, defence performance inspections and forecasting services, requires observations at the land-sea interface but these are rarely collected. Here we show how a database of hindcast overtopping events, and the conditions that cause them, can be built using qualitative overtopping information obtained from social media. We develop a database for a case study site at Crosby in the Northwest of England, use it to test the standard methods applied in operational flood forecasting services and new defence design, and suggest improvements to these methods. This novel approach will become increasingly important to deliver long-term, cost-effective coastal management solutions as sea-levels rise and coastal populations grow. At sites with limited, or no, monitoring or forecasting services, this approach, especially if combined with citizen science initiatives, could underpin the development of simplified early warning systems.

Birth prevalence of congenital heart disease among newborns in a tertiary hospital in Benin City, Nigeria.

BACKGROUND: Congenital heart disease (CHD) is an important cause of childhood morbidity. The birth prevalence and distribution of CHD among neonates in a tertiary hospital in Nigeria was determined. METHODS: This descriptive, cross-sectional study involved consecutive neonates in the neonatal and postnatal wards of the hospital. Bedside echocardiography was conducted on all neonates. Data entry and analysis was done with IBM-SPSS version 20.0. RESULTS: A total of 2 849 neonates were recruited, consisting of 1 482 (52.0%) males. Forty-one neonates had CHD, giving a birth prevalence of 14.4/1 000 live births. Of the 41 with CHD, 21 (51.2%) were male. Thirty-six (87.8%) neonates had acyanotic CHD, of which the commonest was isolated ventricular septal defect [11 (26.8%)]. Transposition of the great arteries [3 (7.3%)] was the commonest cyanotic CHD. CONCLUSIONS: The birth prevalence of 14.4/1 000 live births in this study is high and buttresses the need for strengthening existing cardiac services in Nigeria.

It's a choice to move forward: women's perceptions about treatment decision making in recurrent ovarian cancer.

OBJECTIVE: This research explores the treatment decision-making (TDM) experiences of women with recurrent ovarian cancer (ROC) with regard to treatment options; their understanding of risks and benefits of various treatment options; the decision-making role they want for themselves and for their oncologist; and the social context of the consultation as it pertains to the decision. METHODS: We conducted semi-structured interviews with 26 women at the time of first recurrence. Through inductive data analysis key themes were identified. RESULTS: Many women describe self-identifying the cancer recurrence fairly quickly due to new symptoms. Many feel that the goal for treating their recurrence is to control versus cure the cancer. They describe the subsequent process of diagnosis and TDM for ROC as quick and straightforward with all women accepting the oncologists' treatment recommendation. They feel that the type and number of treatment options are limited. They have a strong desire for physician continuity in their care. Participants feel that their doctor's recommendations as well as their previous experience with ovarian cancer are strong factors influencing their current TDM process. CONCLUSIONS: Shared decision making is based on a simultaneous participation of both the physician and patient in TDM. When faced with ROC, women feel that their doctor's recommendation and their past experience with treatment and TDM are prominent factors influencing the current TDM process.

Sleep quality is associated with vasopressin methylation in pregnant and postpartum women with a history of psychosocial stress.

BACKGROUND: The relationship between disturbed sleep and stress is well-documented. Sleep disorders and stress are highly prevalent during the perinatal period, and both are known to contribute to a number of adverse maternal and foetal outcomes. Arginine vasopressin (AVP) is a hormone and a neuropeptide that is involved in stress response, social bonding and circadian regulation of the sleep-wake cycle. Whether the AVP system is involved in regulation of stress response and sleep quality in the context of the perinatal mental health is currently unknown. The objective of the present study was to assess the relationship between levels of cumulative and ongoing psychosocial risk, levels of disordered sleep and AVP methylation in a community sample of pregnant and postpartum women. METHODS: A sample of 316 participants completed a battery of questionnaires during the second trimester of pregnancy (PN2, 12-14 weeks gestation), third trimester (PN3, 32-34 weeks gestation), and at 7-9 weeks postpartum (PP). Disordered sleep was measured using the Sleep Symptom Checklist at PN2, PN3 and PP; cumulative psychosocial risk was assessed with the Antenatal Risk Questionnaire (ANRQ) at PN2; salivary DNA was collected at the follow-up (FU, 2.9 years postpartum); and % methylation were calculated for AVP and for two of the three AVP receptor genes (AVPR1a and AVPR1b). Women were separated into high (HighPR) and low (LowPR) psychosocial risk groups, based on their scores on the ANRQ. RESULTS: Women in the HighPR group had significantly worse sleep disturbances during PN2 (p < .001) and PN3 (p < .001), but not at PP (p = .146) than women in the LowPR group. In HighPR participants only, methylation of AVP at intron 1 negatively correlated with sleep disturbances at PN2 (rs=-.390, p = .001), PN3 (rs=-.384, p = .002) and at PP (rs= -.269, p = .032). There was no association between sleep disturbances and AVPR1a or AVPR1b methylation, or between sleep disturbances and any of the AVP methylation for the LowPR group. Lastly, cumulative psychosocial stress was a moderator for the relationship between AVP intron 1 methylation and disordered sleep at PN2 (p < .001, adjusted R2 = .105), PN2 (p < .001, adjusted R2 = .088) and PP (p = .003, adjusted R2 = .064). CONCLUSIONS: Our results suggest that cumulative psychosocial stress exacerbates sleep disorders in pregnant women, and that salivary DNA methylation patterns of the AVP gene may be seen as a marker of biological predisposition to stress and sleep reactivity during the perinatal period. Further research is needed to establish causal links between AVP methylation, sleep and stress.

Comparison of the effects of dopaminergic and serotonergic activity in the CNS on the activity of the immune system.

This work demonstrates that the natural killing function of the innate immune system is affected in psychiatric disorders related primarily to serotonergic pathways in the CNS rather than to psychiatric disorders which involve mainly dopaminergic pathways. Only depressive patients demonstrated low natural killer (NK) cell activity, which is inversely correlated to the intensity of depression and could be reversed by serotonin selective re-uptake inhibitors concomitant with clinical improvement. This phenomenon is absent in Parkinson's and schizophrenic patients, in whom no reduction in NK activity was observed. Also, no effect on NK activity could be demonstrated following the specific respective treatments by dopamine (D2) blockers or agonists.

[Pemphigus vegetans, a rare variant of pemphigus vulgaris].

Pemphigus vegetans is a variant of pemphigus vulgaris with different clinical manifestations. Diagnosis may be difficult because of the varied presentations. A 46-year-old woman with this condition had been treated for Behcet's disease because of oral lesions. On admission, prior to dermatological consultation, she was thought to have an infectious disease. The diagnosis of pemphigus vegetans was confirmed by histological and immunofluorescence studies.

[Cutaneous larva migrans].

Larva migrans is a rare cutaneous parasitic infestation, whose incidence in Israel has increased over the past few years. This is mainly due to the growing number of Israelis traveling to the Far East and to Central and South America. We present 4 such cases. The treatment of choice for this parasite is thiabendazole, an imidazole with anthelminthic properties.

African americans may have to consume more than 12 grams a day of resistant starch to lower their risk for type 2 diabetes.

African Americans have a high prevalence rate of type 2 diabetes mellitus (DM). High-maize 260 (National Starch and Chemical Co., Bridgewater, NJ, USA) resistant starch (RS) is a promising food ingredient to reduce risk factors for type 2 DM. A 14-week, double-blind, crossover design study was conducted with African American male (n = 8) and female (n = 7) subjects at risk for type 2 DM. All subjects consumed bread containing 12 g of added RS or control bread (no added RS) for 6 weeks, separated by a 2-week washout period. There were no significant differences in the subjects' fasting plasma glucose levels due to the consumption of the RS bread versus the control bread. Fructosamine levels were significantly lower after consumption of both RS and control bread than at baseline. However, we found no significant difference in fructosamine levels due to treatment effects, i.e., RS bread intake versus the control bread. There were no significant differences in insulin or C-reactive protein levels due to treatment, gender, or sequence effects. Mean homeostasis model assessment of insulin resistance decreased to normal values (>2.5) at the end of the 14-week study, although there were no significant treatment effects. The results of this study suggest that African Americans may need to consume more than 12 g/day of RS to lower their risk for type 2 DM.

Spatial location in color vision.

Ross argues that the location problem for color-the problem of how it is represented as occupying a particular location in space-constitutes an objection to color subjectivism. There are two ways in which the location problem can be interpreted. First, it can be read as a why-question about the relation of visual experience to the environment represented: Why does visual experience represent a patch of color as located in this part of space rather than that? On this interpretation, the subjectivist can answer Ross's objection by appealing to the physical location of reflectance rather than color. Second, it can be read as a how-question about visual representation itself: How does visual experience put together the experience of a color with the experience of its being located in space? This version makes the location problem a problem about visual experience itself and renders the ontology of color irrelevant to its solution. The location problem is thus no more a problem for the color subjectivist than for the color realist.

A survey of the form of the mental status examination administered by emergency physicians.

The mental status examination (MSE) is an integral and universal tool of medicine. We studied the form and content of the MSE performed by emergency physicians. An 11-item questionnaire was developed to determine the indications, amount of time necessary to evaluate mental status, the content of MSEs utilized, and the ideal characteristics of a short, standardized MSE. A study group of a random sample of 120 of 1,174 American Board of Emergency Medicine-certified emergency physicians and a validation group were surveyed by questionnaire, which was returned by 80% and 62%, respectively. Emergency physicians agreed that there are numerous specific indications to evaluate mental status including head injury (99%), behavioral abnormality (98%), drug ingestion (96%), and psychiatric complaint (95%); however, few would test it in abdominal pain (21%) or extremity injury (17%). Seventy-two percent take less than five minutes to evaluate mental status in the emergency department. Most emergency physicians uniformly test the same set of items selected from the formal MSE, including level of consciousness (95%); orientation to time (87%), place (86%), and person (84%); spontaneous speech (80%); and behavioral observation (72%) to evaluate mental status. Almost all of the physicians (82%) perceived a need for, and would use, a short standardized MSE that would take less than five minutes to perform. Results from the validation group confirmed the accuracy of the survey technique used. Our study demonstrated a perceived need for a short, standardized MSE in emergency medicine.

Infantile seizures caused by voluntary water intoxication.

A case of infantile seizures of unusual etiology and presentation is described. Water intoxication with resultant epilepticus was caused by ingestion of nearly 150 ml/kg of fresh water on the day of presentation. It is unclear why the infant voluntarily consumed so much water, but heat illness is the most probable cause.

A neuron doctrine in the philosophy of neuroscience.

Many neuroscientists and philosophers endorse a view about the explanatory reach of neuroscience (which we will call the neuron doctrine) to the effect that the framework for understanding the mind will be developed by neuroscience; or, as we will put it, that a successful theory of the mind will be solely neuroscientific. It is a consequence of this view that the sciences of the mind that cannot be expressed by means of neuroscientific concepts alone count as indirect sciences that will be discarded as neuroscience matures. This consequence is what makes the doctrine substantive, indeed, radical. We ask, first, what the neuron doctrine means and, second, whether it is true. In answer to the first question, we distinguish two versions of the doctrine. One version, the trivial neuron doctrine, turns out to be uncontroversial but unsubstantive because it fails to have the consequence that the nonneuroscientific sciences of the mind will eventually be discarded. A second version, the radical neuron doctrine, does have this consequence, but, unlike the first doctrine, is highly controversial. We argue that the neuron doctrine appears to be both substantive and uncontroversial only as a result of a conflation of these two versions. We then consider whether the radical doctrine is true. We present and evaluate three arguments for it, based either on general scientific and philosophical considerations or on the details of neuroscience itself, arguing that all three fail. We conclude that the evidence fails to support the radical neuron doctrine.

Development and evaluation of a one-month research track in emergency medicine for medical students.

We present our experience with the development and evaluation of a one-month research track in emergency medicine for medical students. The curriculum includes reading and problem-solving in research methods, biostatistics, and design (80 hours); data collection in one or more of the ongoing studies in the department (usually chart review--40 to 60 hours); one major literature search using Index Medicus and Science Citation Index (20 to 40 hours); and participation in all research-related meetings in the Division, as well as the hospital's Institutional Review Board. Evaluation of the student is done by a pretest and final exam covering the topics of the readings. Pre- and post-testing demonstrated increased understanding of basic research concepts and the use of statistics.