Discrete-time semi-Markov modeling of human papillomavirus persistence.

Multi-state modeling is often employed to describe the progression of a disease process. In epidemiological studies of certain diseases, the disease state is typically only observed at periodic clinical visits, producing incomplete longitudinal data. In this paper we consider fitting semi-Markov models to estimate the persistence of human papillomavirus (HPV) type-specific infection in studies where the status of HPV type(s) is assessed periodically. Simulation study results are presented indicating that the semi-Markov estimator is more accurate than an estimator currently used in the HPV literature. The methods are illustrated using data from the HIV Epidemiology Research Study.

Epidemiology of periodontal disease in dogs in the UK primary-care veterinary setting.

OBJECTIVES: Periodontal disease is a frequent diagnosis of dogs and can have severe negative impacts on welfare. It was hypothesised that breeds with skull shapes that differ most in conformation from the moderate mesocephalic skull shape have higher odds of periodontal disease. MATERIALS AND METHODS: The cohort study included a random sample of dogs under primary veterinary care in 2016 from the VetCompass Programme database. Risk factor analysis used random effects multivariable logistic regression modelling. RESULTS: The study included a random sample of 22,333 dogs. The 1-year period prevalence for diagnosis with periodontal disease was 12.52% (95% CI: 12.09 to 12.97). Eighteen breeds showed increased odds compared with crossbred dogs. Breeds with the highest odds included Toy Poodle (odds ratio 3.97, 95% confidence intervals 2.21 to 7.13), King Charles Spaniel (odds ratio 2.63, 95% confidence interval 1.50 to 4.61), Greyhound (odds ratio 2.58, 95% confidence interval 1.75 to 3.80) and Cavalier King Charles Spaniel (odds ratio 2.39, 95% confidence interval 1.85 to 3.09). Four breeds showed reduced odds compared with crossbreds. Brachycephalic breeds had 1.25 times the odds (95% confidence interval 1.11 to 1.42) of periodontal disease compared with mesocephalic breeds. Spaniel types had 1.63 times the odds (95% confidence interval 1.42 to 1.87) compared with non-spaniel types. Increasing adult bodyweight was associated with progressively decreasing odds of periodontal disease. CLINICAL SIGNIFICANCE: The high prevalence identified in this study highlights periodontal disease as a priority welfare concern for predisposed breeds. Veterinarians can use this information to promote improved dental care in predisposed dogs, especially as these dogs age.

Separation and characterization of the neoplastic and stromal elements of the R3230AC mammary adenocarcinoma.

The purification of the various types of cells in solid tumors is necessary for study of their biochemical and immunological functions. The R3230AC adenocarcinoma contains both a variety of stromal cells and well-differentiated neoplastic cells that possess many of the biosynthetic capabilities of normal rat mammary cells. Suspensions of cells from tumors weighing less than 1.2 g consisted of 70.4 +/- 7.2% (S.D.) malignant cells by morphology, 6.8 +/- 3.0% lymphocytes, 6.3 +/- 3.2% macrophages, 15.2 +/- 5.2% red blood cells, 0.8 +/- 0.5% granulocytes, and 0.5 +/- 0.6% unidentified cells. Sedimentation of the cells from the R3230AC tumor in a previously described isokinetic gradient resulted in a 5- to 6-fold purification of lymphocytes and macrophages. The modal fraction of malignant cells contained 95.3 +/- 2.9% malignant cells. Detection of alpha-lactalbumin by the direct peroxidase conjugate technique gave vacuolar staining of malignant cells, in contrast to the indirect and peroxidase-antiperoxidase techniques which stained ducts from normal lactating mammary gland and a wide variety of cells without vacuoles in the tumor. The best fixative for frozen sections, paraffin-embedded tissue, and cell suspensions was 50% ethanol-50% acetone. The suspensions of tumor cells contained 14.4 +/- 9.4% cells with histochemically demonstrable alpha-lactalbumin. Squamous metaplasia was commonly observed in tumors than lactating rats.

Effects of plant species richness on invasion dynamics, disease outbreaks, insect abundances and diversity.

Declining biodiversity represents one of the most dramatic and irreversible aspects of anthropogenic global change, yet the ecological implications of this change are poorly understood. Recent studies have shown that biodiversity loss of basal species, such as autotrophs or plants, affects fundamental ecosystem processes such as nutrient dynamics and autotrophic production. Ecological theory predicts that changes induced by the loss of biodiversity at the base of an ecosystem should impact the entire system. Here we show that experimental reductions in grassland plant richness increase ecosystem vulnerability to invasions by plant species, enhance the spread of plant fungal diseases, and alter the richness and structure of insect communities. These results suggest that the loss of basal species may have profound effects on the integrity and functioning of ecosystems.

Binding of polycyclic and nitropolycyclic aromatic hydrocarbons to specific fractions of rat lung chromatin.

Carcinogen-induced damage to nuclear matrix DNA, the site of DNA replication and transcription, could have profound effects on gene regulation and mutation. 1,6-Dinitropyrene (1,6-DNP), 1-nitropyrene (1-NP), 6-nitrobenzo[a]pyrene (6-NBP), benzo[a]pyrene (BP) and benzo[a]pyrene diolepoxide (BPDE) were investigated for their abilities to bind to selected regions of DNA in rat lung cell nuclei. Following in vitro exposure to carcinogen, nuclei were fractionated into active chromatin (AC), nuclear matrix (NM) and bulk (low and high salt) chromatin fractions. At an equivalent molar concentration, the highest binding to unfractionated (total) DNA was obtained with BPDE, followed in order by BP, 1,6-DNP, 6-NBP and 1-NP. BPDE, a direct alkylating compound, was bound approximately 18 times higher than the other compounds. All compounds were bound to AC (mononucleosomal DNA approximately 185 bp) and to NM in greater amounts than to bulk DNA. The binding ratios (AC + NM)/(LS + HS) varied from 2 to 21, depending upon the compound. The selective binding to specific DNA regions did not appear to be significantly related to the structures of the parent compounds or to their inferred metabolites. Thus, it appears that selective binding to specific regions is a general phenomenon that is related to the open state of the chromatin structure.

Chemical carcinogen-induced damage to the c-neu and c-myc protooncogenes in rat lung epithelial cells: possible mechanisms for differential repair in transcriptionally active genes.

N-methyl-N'-nitro-N-nitrosoguanidine (M-NNG)-induced damage to two transcriptionally active genes, c-neu and c-myc, was studied in rat lung epithelial cells in vitro. MNNG, a direct acting alkylating agent that produces alkalilabile sites in DNA, caused damage to both protooncogenes. DNA damage was determined by monitoring the disappearance of specific fragments generated by restriction enzyme digestion in Southern blots. DNA repair in the c-neu and c-myc protooncogenes was examined in confluent cells by measuring the reappearance of these same bands. While the c-neu gene exhibited repair in 24 h, none was detected in the c-myc gene. These results imply that the promutagenic DNA lesions caused by MNNG are differentially repaired in two transcriptionally active genes.

Effect of aryl hydrocarbon hydroxylase induction on the in vivo covalent binding of 1-nitropyrene, benzo[a]pyrene, 2-aminoanthracene, and phenanthridone to mouse lung deoxyribonucleic acid.

The effect of aryl hydrocarbon hydroxylase induction on the covalent binding of 1-nitropyrene (1-NP), benzo[a]pyrene (BaP), 2-aminoanthracene (2-AA), and phenanthridone (PNDO) to mouse lung DNA was investigated. Cytochrome P-450-dependent monooxygenases were induced in mouse lung by intratracheal instillation of BaP, Aroclor-1254, or coal gas condensate (CGC) 24 hr before instillation of [3H]BaP, [3H]-2-AA, [14C]-1-NP, or [14C]PNDO. All inducing agents increased the amount of radioactivity of [3H]BaP, [3H]-2-AA, and [14C]-1-NP or metabolites bound to DNA. However, pretreatment with BaP resulted in the highest amounts of radiolabels covalently bound to DNA. At 4 hr after instillation of radiolabels in BaP-induced mice, the amounts of [3H]BaP, [3H]-2-AA, and [14C]-1-NP bound to DNA were increased 5.4-, 5.2-, and 160-fold above that of control levels; the amount of 1-NP bound to DNA was fifty times higher than the amount bound by BaP. Labeled compounds were still bound to DNA 1 week after administration. [14C]PNDO was not bound to DNA in uninduced or induced mice. Based on the amount of labeled compounds bound to DNA, pretreatment of mice with BaP and CGC induced enzymes with similar specificities; however, enzymes induced by Aroclor were less effective in the metabolism of labeled compounds to DNA-bound products. These data show that specific cytochrome P-450-dependent monooxygenases are inducible in mouse lung and suggest that pre-exposure to inducing agents may be important in the potential toxicity to proximal tissues in direct contact with inhaled xenobiotics.

Metabolism and macromolecular covalent binding of benzo[a]pyrene in cultured Fischer-344 rat lung type II epithelial cells.

Pulmonary biotransformation of many xenobiotics may be important for the mutagenic, carcinogenic and/or toxic response of lung tissue to these compounds. Recently, a lung epithelial cell line (designated LEC), with morphological characteristics suggestive of type II cell origin, was developed in our laboratory. When LEC cells were co-cultivated with Chinese hamster ovary (CHO) cells in a cell-mediated mutagenesis assay, LEC metabolized promutagens to metabolites mutagenic to the CHO cells [A. P. Li, A. L. Brooks, J. M. Benson and F. F. Hahn, Environ. Mutagen. 4, 407 (1982)]. In the present investigation, rates of benzo[a]pyrene (BaP) metabolism in type II lung cells were determined, and the effects of various pollutants on rates of BaP metabolism and covalent binding of BaP to LEC macromolecules were measured. Cultures of LEC cells were incubated for 24 hr with 5 microM [14C]BaP, and the culture medium was analyzed for organic- and water-soluble metabolites. LEC cells metabolized BaP to BaP-7,8-diol and BaP-9,10-diol with total rates of formation of these metabolites measured at 500-600 pmoles per 10(6) cells per 24 hr. BaP-9,10-diol was the major metabolite accounting for about 80% of the total BaP metabolized. Enzyme hydrolysis studies revealed the presence of small quantities (less than 20% of BaP metabolized) of the glucuronide conjugates of BaP-7, 8-diol and 9-hydroxy-BaP. Pretreatment of LEC cells with benz[a]anthracene, coal gas condensate, or diesel exhaust particle extract (DEP) prior to incubation with BaP resulted in a 2- to 5-fold increase in overall rates of BaP metabolism. The largest increase in covalent binding of [14C]BaP equivalents to LEC macromolecules was seen after LEC cells were pretreated with DEP (3-fold). The data suggest that lung epithelial cells may play an important role in the biological fate of inhaled xenobiotics.

Binding of nitropyrenes and benzo[a]pyrene to mouse lung deoxyribonucleic acid after pretreatment with inducing agents.

In assessing the biological effects of exposure to a complex chemical mixture, it is important to determine how the behavior of one compound may be influenced by the presence of other compounds in the mixture. In this study the effect of pre-exposure to an organic extract of diesel exhaust or to selected compounds in diesel exhaust on the binding of diesel exhaust compounds to DNA was determined. The amount of radiolabel covalently bound to mouse lung DNA following intratracheal administration of radiolabeled benzo[a]pyrene (BaP), 1-nitropyrene, 1,3,6-trinitropyrene, or a mixture of dinitropyrene was determined following pretreatment with benzo[a]pyrene, 1-nitropyrene, and diesel exhaust extract. Male CD-1 mice, 15-18 weeks of age, received 10 mg/kg of putative inducing agents by intratracheal instillation and, after 24 hr, 0.03 to 1.2 mg/kg radiolabeled putative DNA binding agents. Lung DNA was extracted, and covalent binding was quantitated by liquid scintillation spectroscopy. 1-Nitropyrene was a potent lung DNA binding agent in the absence of inducing agents [Covalent Binding Index (CBI) = 970] and was extremely potent after benzo[a]pyrene pretreatment (CBI = 21,540, comparable to the CBI for aflatoxin B1). Similar results were obtained for DNA binding of dinitropyrene and trinitropyrene with and without BaP pretreatment. DNA binding of BaP was lower (CBI = 40) and less inducible (BaP-pretreatment CBI = 230). Pretreatment with diesel extract caused an elevation in the binding of benzo[a]pyrene but little or no elevation in the binding of the nitropyrenes. Pretreatment with 1-nitropyrene did not increase significantly DNA binding of any of the agents tested. These results indicate that nitropyrenes bind readily to lung DNA and this binding may be increased in the presence of respirable mixtures, especially those containing inducing agents such as BaP.

Alterations in the K-ras and p53 genes in rat lung tumors.

Activation of the K-ras protooncogene and inactivation of the p53 tumor suppressor gene are events common to many types of human cancers. Molecular epidemiology studies have associated mutational profiles in these genes with specific exposures. The purpose of this paper is to review investigations that have examined the role of the K-ras and p53 genes in lung tumors induced in the F344 rat by mutagenic and nonmutagenic exposures. Mutation profiles within the K-ras and p53 genes, if present in rat lung tumors, would help to define some of the molecular mechanisms underlying cancer induction by various environmental agents. Pulmonary adenocarcinomas or squamous cell carcinomas were induced by tetranitromethane (TNM), 4-methylnitrosamino-1-(3-pyridyl)-1-butanone (NNK), beryllium metal, plutonium-239, X-ray, diesel exhaust, or carbon black. These agents were chosen because the tumors they produced could arise via different types of DNA damage. Mutation of the K-ras gene was determined by approaches that included DNA transfection, direct sequencing, mismatch hybridization, and restriction fragment length polymorphism analysis. The frequency for mutation of the K-ras gene was exposure dependent. Only two agents, TNM and plutonium, led to mutation frequencies of > 10%. In both cases, the transition mutations formed could have been derived from deamination of cytosine. The identification of non-ras transforming genes in rat lung tumors induced by mutagenic and nonmutagenic exposures such as NNK and beryllium would help define some of the mechanisms underlying cancer induction by different types of DNA damage. Alteration in the p53 gene was assessed by immunohistochemical analysis for p53 protein and single-strand conformation polymorphism (SSCP) analysis of exons 4 to 9. None of the 93 adenocarcinomas examined was immunoreactive toward the anti-p53 antibody CM1. In contrast, 14 to 71 squamous cell carcinomas exhibited nuclear p53 immunoreactivity with no correlation to type of exposure. However, SSCP analysis only detected mutations in 2 of 14 squamous cell tumors that were immunoreactive, suggesting that protein stabilization did not stem from mutations within the p53 gene. Thus, the p53 gene does not appear to be involved in the genesis of most rat lung tumors.

The metabolic fate of benzo[a]pyrene in rats after inhalation.

Male Fischer-344 rats were exposed by inhalation to [3H]benzo[a]pyrene (BP) aerosols (100 micrograms/l; activity mass aerodynamic diameter, 1-2 microns) for 30 min. The concentration of organic-soluble, water-soluble and covalently-bound radioactivity was determined in rat lung, liver and kidney at 0.5, 6 and 24 h after exposure. The total amount of [3H] BP decreased rapidly in the lung as a function of time after exposure. At 0.5 h after exposure, the organic-soluble radioactivity accounted for approx. 70% of the total radioactivity in the lung. The organic-soluble radioactivity in the liver and kidney was 24% and 21%, respectively, at 0.5 h after exposure. The organic-soluble radioactivity decreased in the lung to approx. 10% of the total radioactivity by 1 day after exposure; the percent of total lung radioactivity bound to tissue at this time was 80%. Thin-layer chromatography (TLC) of extracts indicated that the organic-soluble radioactivity in the lung at 0.5 h after exposure was comprised primarily of BP, 3-OH-BP, 9-OH-BP and quinones of BP. In contrast, the organic-soluble radioactivity in the liver and kidney at 0.5 h after exposure were primarily polar metabolites, dihydrodiols, and BP. In all organs TLC profiles of the organic-soluble fraction at 6 h and 24 h after exposure were not significantly different from the 0.5 h organic soluble profiles except for the lower amount of BP.

Differential induction of cytochrome P-450 catalyzed activities by polychlorinated biphenyls and benzo [a]pyrene in B6C3F1 mouse liver and lung.

The properties of some constitutive and inducible enzyme activities of liver and lung microsomes were determined in B6C3F1 mice pretreated by either intratracheal (i.t.) administration of benzo[a]pyrene (BaP) or polychlorinated biphenyl (PCBs) mixture (Aroclor 1254), or intraperitoneal (i.p.) administration with Aroclor 1254. After i.p. administration of Aroclor 1254, liver cytochrome P-450 content, aryl hydrocarbon hydroxylase (AHH), benzphetamine N-demethylase and nitroreductase activities were increased 2.8-, 2.0-, 2.2-, and 2.0-fold, respectively. Lung cytochrome P-450 content was also increased (1.9-fold) after i.p. administration of Aroclor 1254; AHH and nitroreductase activities, however, were not affected and benzphetamine N-demethylase activity was decreased. Aroclor 1254 administered i.t. did not affect liver cytochrome P-450 content. However, AHH and benzphetamine N-demethylase activities were decreased 1.4- and 1.2-fold, respectively, and nitroreductase activity was increased 1.6-fold. After i.t. administration of Aroclor 1254, lung cytochrome P-450 content and AHH activity were increased 1.4- and 2.2-fold, respectively. Benzphetamine N-demethylase activity was decreased 2.1-fold and nitroreductase activity was not affected. After i.t. administration of BaP, liver 7-ethoxyresorufin O-deethylase and nitroreductase activities were increased 2.2- and 1.5-fold, respectively, and benzphetamine N-demethylase activity was decreased 1.3-fold. Lung AHH and 7-ethoxyresorufin O-deethylase activities were increased 4.3- and 3.1-fold, respectively, and cytochrome P-450 content, benzphetamine N-demethylase and nitroreductase activities were decreased 1.4-, 1.2- and 1.3-fold, respectively, after BaP administration. These data indicate that different cytochrome P-450 isozymes induced in B6C3F1 mice are responsible for monooxygenase and nitroreductase activities, and that the route of administration of chemicals is important in the expression of cytochrome P-450 catalyzed activities.

Distribution and retention of benzo(A)pyrene in rats after inhalation.

Tritium levels in tissues of rats were determined after inhalation of tritiated benzo(a)pyrene (3H-BaP; 500 micrograms/l; activity mass median diameter, 1-2 micrometers) for 1 h. Significant amounts of radioactivity were found in the nasal turbinates, trachea, larynx, lungs, tracheobronchial lymph nodes, kidneys, and liver immediately after exposure. Lower concentrations of radioactivity were found in the brain, testes, and spleen. Clearance of radioactivity from the respiratory tract occurred in two phases; a rapid phase where 50% of the radioactivity cleared by approx. 2 h, and a slower phase that continued for about 2 days after exposure. Radioactivity in the brain, testes, and spleen remained at about the same level during the first day after exposure and then decreased slightly during the second day. Benzo(a)pyrene inhaled in this particulate form was rapidly solubilized, translocated to internal organs, and excreted primarily in feces.

Damage and repair of mouse lung DNA induced by 1-nitropyrene.

The induction of DNA single-strand breaks (SSB), the repair of SSB, and the role of cell turnover in the removal of SSB were determined in mouse lung following intratracheal instillation of 1-nitropyrene (1-NP). Cellular DNA was prelabeled with [3H]thymidine in neonate and adult mice. 1-NP was administered to labeled neonate mice after they became adults and to the adult mice that were labeled when adults. 1-NP induced a dose-related increase in SSB (10-22 times control rate) as early as 2 h after 1-NP administration. The mice labeled as neonates were more sensitive to SSB induction by 1-NP and had a faster repair rate than mice labeled when adults. By one week after 1-NP administration, the levels of SSB in both groups of mice were similar to controls. The half-lives for DNA turnover in mice prelabeled as neonates and in mice prelabeled when adults were approximately 22 and approximately 9 days, respectively, at the time of 1-NP treatments. These data indicate that both highly proliferative cell populations and populations with lower rates of proliferation are amenable to 1-NP-induced DNA lesions. The rate of cell DNA turnover suggests that active DNA repair processes are involved in the removal of DNA lesions. The slower rate of DNA repair coupled with a relatively high rate of cell division in the rapid proliferative cells suggest that these cells may be involved in the induction of cancer in animals after 1-NP administration.

Preampullary congenital duodenal obstruction in a father and son.

This is the report of an infant seen on June 25, 1960 with preampullary total duodenal obstruction caused by a combined annular pancreas and duodenal stenosis above the ampulla. A gastroduodenostomy was performed. In December 1989, he fathered a 1,700-g boy with preampullary duodenal atresia. A duodeno-duodenostomy was performed successfully by the same pediatric surgeon. Second-generation duodenal obstruction is rare; to our knowledge, there are no other cases.

Factors affecting possible carcinogenicity of inhaled nitropyrene aerosols.

Nitroaromatics in general, and 1-nitropyrene in particular, are potent bacterial mutagens and animal carcinogens. Their importance as possible human carcinogens is difficult to assess because they are usually found in the environment as the products of combustion processes, and so they usually exist with many other compounds associated with airborne particles. The experiments reported here were carried out to determine if the inhalation of particle-associated 1-nitropyrene, or the concomitant exposure to an irritant gas, would alter the tissue distribution of 1-nitropyrene or its metabolites, compared to their distribution after inhalation of pure 1-nitropyrene. These experiments were intended to yield insights into the mechanisms involved in the potential carcinogenicity of particle-associated nitroaromatics as inhaled in the environment from automotive emissions and other sources. Groups of Fischer 344 rats inhaled pure 14C-1-nitropyrene aerosols, with and without coexposure to 5 parts per million sulfur dioxide, or 14C-1-nitropyrene adsorbed onto gallium oxide particles, with and without coexposure to sulfur dioxide, for four weeks. Lung retention of 14C-1-nitropyrene was not prolonged by its association with gallium oxide particles or by coexposure to sulfur dioxide. There was a marked inflammatory and fibrogenic response to the gallium oxide particles. Another set of experiments was carried out in which rats were exposed to 14C-1-nitropyrene either as pure aerosol or adsorbed onto carbon black particles. The amount of 14C in the lung that was bound to carbon black particles steadily decreased with time after exposure, compared to total lung 14C, indicating removal of 14C from the particles. Thirty minutes after exposure, the amount of 14C covalently bound to lung macromolecules, expressed as a percentage of calculated deposited radioactivity, was twofold greater for 1-nitropyrene adsorbed onto carbon black than for 1-nitropyrene alone. The amount of covalently bound 14C increased with time after exposure to 14C-1-nitropyrene adsorbed onto carbon black, reaching a level of approximately 1 percent of deposited radioactivity, 10-fold greater than that seen with pure 14C-1-nitropyrene seven to 30 days after exposure. The level of covalently bound 14C declined steadily after exposure to pure 14C-1-nitropyrene. Carbon black particles associated with adsorbed 1-nitropyrene offer the potential of studying DNA adduct formation in the lung, because DNA modification might be greater after inhalation of 1-nitropyrene adsorbed onto carbon black than after inhalation of pure 1-nitropyrene or 1-nitropyrene associated with metal oxides, such as gallium oxide.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects on rat lung immunity by acute lung exposure to benzo(a)pyrene.

This study describes the effect of intratracheal instillation of benzo(a)pyrene (BaP) on immunological responses in the lung-associated lymph nodes, cervical lymph nodes, and spleen after deposition of 10(8) sheep red blood cells (SRBC) in the lung or peritoneal cavity of rats. An increased number of anti-SRBC antibody-forming cells was observed in the lung-associated lymph nodes when rats were immunized simultaneously with BaP installation. A suppression in the number of anti-SRBC antibody-forming cells occurred when SRBC were given intratracheally 4 or 7 days after BaP. The effects of the BaP appeared to be on the function of the cells in the lung-associated lymph nodes rather than due to changes in the exposed lung. BaP-induced changes in antigen handling or in regulatory populations of immune cells in the lung-associated lymph nodes may be responsible for the immune alterations observed.

Development or restoration of trust in interpersonal relationships during adolescence and beyond.

Individuals low in interpersonal trust have been found to be less confident, less popular with others, and more lonely--all indicators of a need for attitudinal and behavioral change. A student who has reached a point of sufficient discomfort to seek therapeutic assistance can be aided in increasing trust in others through specific tasks cooperatively established by the counselor or other helping professional.

Preparing for vocational choice.

Adolescents are often overwhelmed and disillusioned by the monumental and momentous task and risk of making a career choice. Adults in general and counselors in particular can assist them not only in being more realistic about their career expectations, but can be especially helpful by encouraging them to develop personal attributes and skills.

Capitalizing on formal thought in counseling adolescents on conflicts with parents.

Parent-adolescent conflicts are frequently sufficiently severe to require third-party intervention. Because the adolescent is more likely to be in a setting where counsel is more easily available, the helping person can make use of insight and emotional maturity that is concomitant with the adolescent's acquisition of formal thought.