Impulsivity and genetic variants in DRD2 and ANKK1 moderate longitudinal associations between sleep problems and overweight from ages 5 to 11.

OBJECTIVE: Short sleep duration and sleep problems increase risks of overweight and weight gain. Few previous studies have examined sleep and weight repeatedly over development. This study examined the associations between yearly reports of sleep problems and weight status from ages 5 to 11. Although, previous studies have shown that inter-individual differences moderate the effect of short sleep duration on weight, it is not known whether inter-individual differences also moderate the effect of sleep problems on weight. We tested how the longitudinal associations between sleep problems and weight status were moderated by impulsivity and genetic variants in DRD2 and ANKK1. DESIGN: Seven-year longitudinal study. PARTICIPANTS: A total of 567 children from the Child Development Project for the analysis with impulsivity and 363 for the analysis with genetic variants. MEASUREMENTS AND RESULTS: Sleep problems and weight status were measured by mothers' reports yearly. Impulsivity was measured by teachers' reports yearly. Six single-nucleotide polymorphisms located in DRD2 and ANKK1 were genotyped. Data were analyzed using multilevel modeling. Higher average levels of sleep deprivation across years were associated with greater increases in overweight (P=0.0024). Sleep problems and overweight were associated at both within-person across time (P<0.0001) and between-person levels (P<0.0001). Impulsivity and two polymorphisms, rs1799978 and rs4245149 in DRD2, moderated the association between sleep problems and overweight; the association was stronger in children who were more impulsive (P=0.0022), in G allele carriers for rs1799978 (P=0.0007) and in A allele carriers for rs4245149 (P=0.0002). CONCLUSIONS: This study provided incremental evidence for the influence of sleep problems on weight. Findings of DRD2, ANKK1 and impulsivity are novel; they suggest that reward sensitivity and self-regulatory abilities might modulate the influences of sleep on weight gain. The analysis of polymorphisms was restricted to European Americans and hence the results might not generalize to other populations.

Desmoid tumour of the external ear and mastoid following middle-ear surgery.

BACKGROUND: Desmoid tumours (aggressive fibromatosis) are rare, locally invasive, benign tumours. The following case represented a diagnostic challenge, because of the uncommon nature of the lesion. CASE REPORT: A 26-year-old woman, who had previously undergone middle-ear surgery for cholesteatoma, presented with a painful swelling involving the post-auricular area and the conchal bowl. Initially, it was believed to be an infective process related to the surgery or an unusual cholesteatoma recurrence. Following investigations, which involved imaging and histology, the swelling was diagnosed as a desmoid tumour, and the patient received chemotherapy. CONCLUSION: Two incidences of paediatric desmoid tumours affecting the ear have been described in the literature, but there is no previous report of a desmoid tumour related to ear surgery. Desmoid tumours have, however, been reported following trauma, including surgery.

Mechanisms in the cycle of violence.

Two questions concerning the effect of physical abuse in early childhood on the child's development of aggressive behavior are the focus of this article. The first is whether abuse per se has deleterious effects. In earlier studies, in which samples were nonrepresentative and family ecological factors (such as poverty, marital violence, and family instability) and child biological variables (such as early health problems and temperament) were ignored, findings have been ambiguous. Results from a prospective study of a representative sample of 309 children indicated that physical abuse is indeed a risk factor for later aggressive behavior even when the other ecological and biological factors are known. The second question concerns the processes by which antisocial development occurs in abused children. Abused children tended to acquire deviant patterns of processing social information, and these may mediate the development of aggressive behavior.

Reference Determinant Dependence of the Random Phase Approximation in 3d Transition Metal Chemistry.

Without extensive fitting, accurate prediction of transition metal chemistry is a challenge for semilocal and hybrid density funcitonals. The Random Phase Approximation (RPA) has been shown to yield superior results to semilocal functionals for main group thermochemistry, but much less is known about its performance for transition metals. We have therefore analyzed the behavior of reaction energies, barrier heights, and ligand dissociation energies obtained with RPA and compare our results to several semilocal and hybrid functionals. Particular attention is paid to the reference determinant dependence of RPA. We find that typically the results do not vary much between semilocal or hybrid functionals as a reference, as long as the fraction of exact exchange (EXX) mixing in the hybrid functional is small. For large fractions of EXX mixing, however, the Hartree-Fock-like nature of the determinant can severely degrade the performance. Overall, RPA systematically reduces the errors of semilocal functionals and delivers excellent performance from a single reference determinant for inherently multireference reactions. The behavior of dual hybrids that combine RPA correlation with a hybrid exchange energy was also explored, but ultimately did not lead to a systematic improvement compared to traditional RPA for these systems. We rationalize this conclusion by decomposing the contributions to the reaction energies, and briefly discuss the possible implications for double-hybrid functionals based on RPA. The correlation between EXX mixing and spin-symmetry breaking is also discussed.

Horner syndrome in glandular fever: a case report.

OBJECTIVE: This study aimed to present and discuss the case of a patient with known glandular fever who presented with Horner syndrome. CASE REPORT: A 35-year-old patient with known glandular fever developed acute unilateral Horner syndrome, a previously undescribed complication of this common illness. Magnetic resonance imaging and magnetic resonance angiography showed that enlarged intra-carotid sheath lymphoid tissue was likely to be the underlying cause of sympathetic nerve disruption. The case is described, the anatomy of the sympathetic chain is discussed and possible alternative pathophysiological mechanisms are reviewed. CONCLUSION: This is the first report in the worldwide literature of Horner syndrome arising as a result of compression from enlarged lymph nodes in glandular fever.

Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage.

BACKGROUND: Cognitive dysfunction is the most common form of neurologic impairment after subarachnoid hemorrhage (SAH). OBJECTIVE: To evaluate the impact of global and domain-specific cognitive impairment on functional recovery and quality of life (QOL) after SAH. METHODS: One hundred thirteen patients (mean age 49 years; 68% women) were evaluated 3 months after SAH. Three simple tests of global mental status and neuropsychological tests to assess seven specific cognitive domains were administered. Four aspects of outcome (global handicap, disability, emotional status, and QOL) were compared between cognitively impaired and unimpaired patients with analysis-of-covariance models controlling for age, race/ethnicity, and education. Multiple linear regression was used to evaluate the relative contribution of global and domain-specific cognitive status for predicting concurrent modified Rankin Scale (mRS) and Sickness Impact Profile (SIP) scores. RESULTS: Impairment of global mental status on the Telephone Interview of Cognitive Status (TICS) was associated with poor performance in all seven cognitive domains (all p < 0.0005) and was the only cognitive measure associated with poor recovery in all four aspects of outcome (all p < or = 0.005). Cognitive impairment in four specific domains was also associated with functional disability or reduced QOL. After accounting for global cognitive impairment with the TICS, however, neuropsychological testing did not contribute additional predictive value for concurrent mRS or SIP total scores. CONCLUSIONS: Cognitive impairment impacts broadly on functional status, emotional health, and QOL after SAH. The TICS may be a useful alternative to more detailed neuropsychological testing for detecting clinically relevant global cognitive impairment after SAH.

Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus.

BACKGROUND: Although cIV-MDZ has emerged as a popular alternative to barbiturate therapy for refractory status epilepticus (RSE), experience with its use for this indication is limited. OBJECTIVE: - To evaluate the efficacy of continuous intravenous midazolam (cIV-MDZ) for attaining sustained seizure control in patients with RSE. METHODS: The authors reviewed 33 episodes of RSE treated with cIV-MDZ in their neurologic intensive care unit over 6 years. All patients were monitored with continuous EEG (cEEG). MDZ infusion rates were titrated to eliminate clinical and EEG seizure activity; cIV-MDZ was discontinued once patients were seizure-free for 24 hours. Acute treatment failures (seizures 1 to 6 hours after starting cIV-MDZ), breakthrough seizures (after 6 hours of therapy), post-treatment seizures (within 48 hours of discontinuing therapy), and ultimate treatment failure (frequent seizures that led to treatment with pentobarbital or propofol) were identified. RESULTS: All patients were in nonconvulsive SE at the time cIV-MDZ was started; the mean duration of SE before treatment was 3.9 days (range 0 to 17 days). In addition to benzodiazepines, 94% of patients had received at least two antiepileptic drugs (AED) before starting cIV-MDZ. The mean loading dose was 0.19 mg/kg, the mean maximal infusion rate was 0.22 mg/kg/h, and the mean duration of cIV-MDZ therapy was 4.2 days (range 1 to 14 days). Acute treatment failure occurred in 18% (6/33) of episodes, breakthrough seizures in 56% (18/32), post-treatment seizures in 68% (19/28), and ultimate treatment failure in 18% (6/33). Breakthrough seizures were clinically subtle or purely electrographic in 89% (16/18) of cases and were associated with an increased risk of developing post-treatment seizures (p = 0.01). CONCLUSIONS: Although most patients with RSE initially responded to cIV-MDZ, over half developed subsequent breakthrough seizures, which were predictive of post-treatment seizures and were often detectable only with cEEG. Titrating cIV-MDZ to burst suppression, more aggressive treatment with concurrent AED, or a longer period of initial treatment may reduce the high proportion of patients with RSE who relapse after cIV-MDZ is discontinued.

Evaluation of BCDE, a microcomputer program to analyze automated blood counts and differentials.

A microcomputer program (BCDE) has been developed to analyze automated blood cell counts and differentials' similarity to normal values or to 36 disease categories. In 50 normal subjects, the analytic program listed the correct diagnosis as the first diagnosis in 49 cases (the only diagnosis in 44) and second of two diagnoses in one case. In 182 subjects with known hematologic disorders, the correct diagnosis was listed first in 134 and second or third in an additional 40. Subjects with iron deficiency, heterozygous thalassemia, immune thrombocytopenia, anemia of chronic disease, reactive thrombocytosis, acute infection, and chronic leukemia had the disorder identified as the most likely one by the analytic program with both sensitivity greater than 80% and specificity greater than 98%. Subjects with acute leukemia, folate deficiency, sickle cell anemia, cytotoxic chemotherapy, and chronic liver disease had the disorder identified as most likely by the program with a sensitivity less than 80%. In a different 11 cases with known hematologic status, a panel of 37 physicians identified the disorder(s) or normality only 72% of the time, whereas the analytic program listed the correct diagnosis first in 10 of 11 (91%). The analytic program appears useful for both triage of normal from abnormal data and for the initial differential analysis of abnormal data.

The "diff-if". Use of microcomputer analysis to triage blood specimens for microscopic examination.

Increasingly, all automated blood counts are not accompanied by a microscopic white blood cell differential. A popular strategy is to obtain a manual differential if any part of the automated blood count and differential is outside specified limits (the "diff-if" strategy). The authors compared two sets of criteria to triage blood counts for manual differentials: previously recommended numeric values, and the analysis of a microcomputer program. In a population of subjects with a high percentage of hematologic disorders, the microcomputer program and the numeric criteria were equally specific (excluding normal blood smears); the program was more sensitive for bands, immature granulocytes, monocytes, nucleated red blood cells, reticulocytosis, teardrops, red blood cell fragments, and hypersegmented neutrophils. The numeric criteria were more sensitive for eosinophilia (less than 1.0 X 10(9)/L) and mandated fewer manual differentials. In a population of predominantly normal subjects, the program was more sensitive for increased bands and equally sensitive for eosinophilia, the only abnormalities observed on the smear. In a population of subjects with predominantly abnormal blood counts, but excluding most primary hematologic disorders, there were few blood smears with abnormalities beyond eosinophilia or increased bands. In both of these groups, the computer program mandated more manual differentials than did the numeric criteria. The authors conclude that microcomputer analysis by the program tested was more sensitive than numeric criteria to identify specimens with abnormal blood smears. Specificity depended on the patient population. The choice of a triage strategy should be based on the individual laboratory's patient population.

Social information-processing patterns partially mediate the effect of early physical abuse on later conduct problems.

The authors tested the hypothesis that early physical abuse is associated with later externalizing behavior outcomes and that this relation is mediated by the intervening development of biased social information-processing patterns. They assessed 584 randomly selected boys and girls from European American and African American backgrounds for the lifetime experience of physical abuse through clinical interviews with mothers prior to the child's matriculation in kindergarten. Early abuse increased the risk of teacher-rated externalizing outcomes in Grades 3 and 4 by fourfold, and this effect could not be accounted for by confounded ecological or child factors. Abuse was associated with later processing patterns (encoding errors, hostile attributional biases, accessing of aggressive responses, and positive evaluations of aggression), which, in turn, predicted later externalizing outcomes.

Reactive and proactive aggression in school children and psychiatrically impaired chronically assaultive youth.

The authors proposed that reactively aggressive and proactively aggressive types of antisocial youth would differ in developmental histories, concurrent adjustment, and social information-processing patterns. In Study 1, 585 boys and girls classified into groups called reactive aggressive, proactive aggressive, pervasively aggressive (combined type), and nonaggressive revealed distinct profiles. Only the reactive aggressive groups demonstrated histories of physical abuse and early onset of problems, adjustment problems in peer relations, and inadequate encoding and problem-solving processing patterns. Only the proactive aggressive groups demonstrated a processing pattern of anticipating positive outcomes for aggressing. In Study 2, 50 psychiatrically impaired chronically violent boys classified as reactively violent or proactively violent demonstrated differences in age of onset of problem behavior, adjustment problems, and processing problems.

Quality of early family relationships and individual differences in the timing of pubertal maturation in girls: a longitudinal test of an evolutionary model.

In an 8-year prospective study of 173 girls and their families, the authors tested predictions from J. Belsky, L. Steinberg, and P. Draper's (1991) evolutionary model of individual differences in pubertal timing. This model suggests that more negative-coercive (or less positive-harmonious) family relationships in early childhood provoke earlier reproductive development in adolescence. Consistent with the model, fathers' presence in the home, more time spent by fathers in child care, greater supportiveness in the parental dyad, more father-daughter affection, and more mother-daughter affection, as assessed prior to kindergarten, each predicted later pubertal timing by daughters in 7th grade. The positive dimension of family relationships, rather than the negative dimension, accounted for these relations. In total, the quality of fathers' investment in the family emerged as the most important feature of the proximal family environment relative to daughters' pubertal timing.

Daughter and mother report of individual symptoms on the Children's Depression Inventory.

PURPOSE: To examine differences between early adolescent girls' and their mothers' perceptions of girls' depressive symptoms. METHODS: 313 daughter-mother dyads completed the Children's Depression Inventory. RESULTS: Low to modest agreement was found for most symptoms, although higher agreement was found for symptoms relating to school performance. The hypothesis that girls would report more ideational symptoms and mothers more behavioral symptoms of depression was tested; girls generally reported more ideational and behavioral symptoms when differences occurred. However, several specific ideational symptoms (feeling like crying; feeling sad; guilt; worrying) tended to be more frequently endorsed by girls and had particularly poor daughter-mother agreement. Examining third variables associated with daughter-mother agreement, girls scoring high on social desirability tended to have smaller daughter-minus-mother difference scores for ideational, but not for behavioral items; therefore, social desirability may be associated with girls underreporting ideational symptoms. CONCLUSIONS: Mothers appear to be reliable raters of symptoms related to school functioning, but may be less aware of certain covert depressive symptoms in their early adolescent daughters.

Interaction of temperamental resistance to control and restrictive parenting in the development of externalizing behavior.

Child temperament and parental control were studied as interacting predictors of behavior outcomes in 2 longitudinal samples. In Sample 1, data were ratings of resistant temperament and observed restrictive control in infancy-toddlerhood and ratings of externalizing behavior at ages 7 to 10 years; in Sample 2, data were retrospective ratings of temperament in infancy-toddlerhood, observed restrictive control at age 5 years, and ratings of externalizing behavior at ages 7 to 11 years. Resistance more strongly related to externalizing in low-restriction groups than in high-restriction groups. This was true in both samples and for both teacher- and mother-rated outcomes. Several Temperament x Environment interaction effects have been reported previously, but this is one of very few replicated effects.

Adult individual differences as moderators of child effects.

Experimentally varying child behavior stimuli and then assessing the extent to which adult individual differences (especially in cognitions) moderate the effect of the child on the adult is a variation on the usual methods in child effects research. This method allows description of the role of child effects in more complex adult-child systems. Existing literature incorporating this approach is reviewed, with emphasis on the moderating effects of sex, personality, and perceptions. A previously unreported study is described as an example of a multivariate approach to exploring the relationships between adult individual differences and the effects of infant stimuli. The study suggests that experienced caregivers who do not have much liking for infants see themselves as likely to provide appropriate, but minimally social care for an infant. Conversely, the study suggests that inexperienced adults who like infants very much see themselves as providing more extensive and social caregiving, although it would not always be appropriate to the infant's state.

Gender typing of game choices and qualities of boys' play behavior.

Relationships between gender choices and both movement patterns and social behavior were studied in first- and second-grade boys. Three-child, structured play groups were each composed of a boy whose mother saw him as high masculine in play preference on the Games Inventory, one seen as average, and one low masculine. Behaviors rated from videotapes included gender presentation variables, (e.g., leg separation), indicators of dominance and personal comfort (e.g., range of movements), and indicators of social skill and peer response (e.g., interaction initiations). The low masculine boys were found to be the most feminine in their gender presentation, least dominant and aggressive, and the lest socially successful of the boys. The greatest difference was between the low and the high masculine boys. The average masculine boys' scores were generally intermediate, but more similar to the low masculine boys on some variables and more similar to the high masculine boys on others. These conclusions apply to a grou interaction play task, but not to an initial noninteractive play task. A secondary study in which girls played with low and average masculine boys is also reported. Here it was found that low masculine boys were generally intermediate between average boys and girls on gender presentation and dominance variables, but lowest of the groups on social interaction variables.

Early antecedents of childhood impulsivity: the role of parent-child interaction, cognitive competence, and temperament.

This prospective longitudinal investigation examined early mother-child interaction as a predictor of children's later self-control capabilities. Multimethod assessments of mother-child relationships, primarily focused on observed relationship qualities in the home, were conducted during the first 2 years and related to children's later impulse control capabilities. Child cognitive competence and temperament assessed during the 2nd year were also related to later impulsivity. Follow-up assessments of children's impulsivity were conducted at age 6 (N = 79), using a variety of laboratory measures. Findings indicated that responsive, cognitively stimulating parent-toddler interactions in the 2nd year modestly predicted later measures of cognitive nonimpulsivity and ability to delay gratification. Security of mother-infant attachment predicted the same outcomes, but only for boys and not for girls. Child cognitive competence in the 2nd year also consistently predicted children's later impulse control capabilities, although this was not true for measures of child temperament. Overall, the findings support a multidimensional and developmental conceptualization of the early antecedents of childhood impulsivity.

Early developmental precursors of externalizing behavior in middle childhood and adolescence.

This study examined the infancy- and toddler-age precursors of children's later externalizing problem behavior. Risk constructs included suboptimal patterns of observed caregiver-child interaction and the caregiver's perception of child difficultness and resistance to control. In addition, a novel dimension of caregiver-child relationship quality, the caregiver's perception of her toddler's unresponsiveness to her, was examined as a possible precursor of children's externalizing behavior. Externalizing problem outcomes were assessed throughout the school-age period and again at age 17, using multiple informants. As toddlers, children at risk for later externalizing behavior were perceived as difficult and resistant to control, and relationships with their caregivers were relatively low in warmth and affective enjoyment. Finally, the caregiver's perception of her toddler as emotionally unresponsive to her was a consistent predictor of later externalizing behavior, suggesting that negative maternal cognitions associated with child conduct problems may begin in toddlerhood. These predictive patterns were similar for boys and girls, and with minor exceptions, generalized across different subdimensions of externalizing problem behavior. Our findings underscore the importance of the infancy and toddler periods to children's long-term behavioral adjustment, and indicate the desirability of further research into the nature of caregivers' early perceptions of child unresponsiveness.

Human figure drawings of gender-problem and school-problem boys.

In this study 19 boys aged 4 through 13 years referred for gender problems were compared with 35 similar-aged boys referred for school problems on variables derived from sets of human figure drawings. The results indicated that gender-problem boys, relative to school-problem boys, were more likely to draw female figures in response to a Draw-a-Person (DAP) instruction, were more likely to draw figures with good rather than average body proportion, tended to draw more articles of clothing on their figures, and tended to draw their female figures larger than their male figures. There were no differences between the groups in the frequency of emotional disturbance indicators, frequency of age-expected or age-exceptional figure details, and total number of body features. These results are discussed in terms of their implications for the validation of the DAP procedure, their contribution to an understanding of boyhood effeminacy, and their implications for the role of the DAP test as a clinical assessment procedure only in conjunction with other sources of information.

Gender-deviant boys compared with normal and clinical control boys.

The physical movement and social characteristics of effeminate behavior-problem, referred boys (N = 13) were compared with those of normal boys (N = 25) and boys (N = 12) referred for nongender problems. Parent reports, observer ratings, and videotapes were collected in a series of structured tasks. As expected, mothers described gender-problem sons as much more feminine than the other two groups in interests, activities, and mannerisms. Gender-problem sons were also seen as relatively inactive and introverted. Further, they were nonsignificantly lower than the clinical control boys in perceived behavior problems, but both groups had marginally more problems than the normal boys. Gender-problem and clinical control boys both showed more body constriction than normal boys in ratings of a videotaped interview. They also both showed less ideal ball-throw form than normal boys on a set of variables scored with slow-motion video. However, in a set of behaviors directly rated in the various tasks, the gender-problem boys gave a uniquely general impression of uncoordination. The groups did not differ on seven additional variables.