Social anxiety and age are associated with neural response to social evaluation during adolescence.

Adolescence is a sensitive period for the development of adaptive social behaviors and social anxiety, possibly due to aspects of brain development. However, research is needed to examine interactions among age, social anxiety, and social dynamics previously shown to influence neural responding. The current functional magnetic resonance imaging (fMRI) study examines brain function in 8-18 year-olds with varying levels of social anxiety. Interactions are examined among age, social anxiety, and two key task factors: valence and predictability of social interactions. Results demonstrate age, social anxiety severity, and each of the two key task-based factors interact to predict neural response in the caudate, middle and superior temporal gyri. In particular, among adolescents less-than 13 years of age, higher social anxiety predicted greater responding to unpredictable negative evaluations. However, in this same age group, the opposite pattern emerged during receipt of unpredictable positive evaluations, with less neural response in more anxious youth. Adolescents aged 13 and older overall showed less robust effects. We discuss these findings in terms of age- and anxiety-related differences in socioemotional processing.

Discriminant validity, diagnostic utility, and parent-child agreement on the Screen for Child Anxiety Related Emotional Disorders (SCARED) in treatment- and non-treatment-seeking youth.

The Screen for Child Anxiety and Related Emotional Disorder (SCARED) may be differentially sensitive to detecting specific or comorbid anxiety diagnoses in treatment-seeking and non-treatment-seeking youth. We assessed the SCARED's discriminant validity, diagnostic utility, and informant agreement using parent- and self-report from healthy and treatment-seeking anxious youth (Study 1, N=585) and from non-treatment-seeking anxious youth (Study 2, N=331) diagnosed with generalized anxiety disorder (GAD), social anxiety disorder (SAD), or comorbid GAD+SAD. Among treatment-seeking youth, the SCARED showed good diagnostic utility and specificity, differentiating healthy, comorbid, and non-comorbid anxious youth. Child-parent agreement was modest: healthy child self-reports were higher than parent-reports whereas anxious child self-reports were similar or lower than parent-reports. Less consistent results emerged for diagnostic utility, specificity, and informant agreement among non-treatment-seeking youth. Given the number of non-treatment seeking anxious youth (N=33), generalizability of these findings may be limited. Together, results suggest informants may provide distinct information about children's anxiety symptoms.

A modeling and simulation approach to characterize methadone QT prolongation using pooled data from five clinical trials in MMT patients.

Pharmacokinetic (PK)-pharmacodynamic modeling and simulation were used to establish a link between methadone dose, concentrations, and Fridericia rate-corrected QT (QTcF) interval prolongation, and to identify a dose that was associated with increased risk of developing torsade de pointes. A linear relationship between concentration and QTcF described the data from five clinical trials in patients on methadone maintenance treatment (MMT). A previously published population PK model adequately described the concentration-time data, and this model was used for simulation. QTcF was increased by a mean (90% confidence interval (CI)) of 17 (12, 22) ms per 1,000 ng/ml of methadone. Based on this model, doses >120 mg/day would increase the QTcF interval by >20 ms. The model predicts that 1-3% of patients would have ΔQTcF >60 ms, and 0.3-2.0% of patients would have QTcF >500 ms at doses of 160-200 mg/day. Our predictions are consistent with available observational data and support the need for electrocardiogram (ECG) monitoring and arrhythmia risk factor assessment in patients receiving methadone doses >120 mg/day.

Efficacy of 3 commonly used hearing aid circuits: A crossover trial. NIDCD/VA Hearing Aid Clinical Trial Group.

CONTEXT: Numerous studies have demonstrated that hearing aids provide significant benefit for a wide range of sensorineural hearing loss, but no carefully controlled, multicenter clinical trials comparing hearing aid efficacy have been conducted. OBJECTIVE: To compare the benefits provided to patients with sensorineural hearing loss by 3 commonly used hearing aid circuits. DESIGN: Double-blind, 3-period, 3-treatment crossover trial conducted from May 1996 to February 1998. SETTING: Eight audiology laboratories at Department of Veterans Affairs medical centers across the United States. PATIENTS: A sample of 360 patients with bilateral sensorineural hearing loss (mean age, 67.2 years; 57% male; 78.6% white). INTERVENTION: Patients were randomly assigned to 1 of 6 sequences of linear peak clipper (PC), compression limiter (CL), and wide dynamic range compressor (WDRC) hearing aid circuits. All patients wore each of the 3 hearing aids, which were installed in identical casements, for 3 months. MAIN OUTCOME MEASURES: Results of tests of speech recognition, sound quality, and subjective hearing aid benefit, administered at baseline and after each 3-month intervention with and without a hearing aid. At the end of the experiment, patients ranked the 3 hearing aid circuits. RESULTS: Each circuit markedly improved speech recognition, with greater improvement observed for soft and conversationally loud speech (all 52-dB and 62-dB conditions, P

Coping strategies, life style changes, and pessimism after open-heart surgery.

A mail questionnaire was completed by 171 patients two to 20 months after undergoing coronary artery bypass graft surgery (CABG). The post-CABG period was characterized by fewer working hours, a higher level of physical exercise, a reduction in smoking, and more appropriate nutritional habits, compared with the preoperation period. At the same time, the anxiety level of post-CABG patients was higher than that measured in a community sample. Post-CABG high psychological distress (anxiety and mood states) and low functional capacity were associated with high levels of pessimism and ineffective emotion-focused coping strategies. These results may be used by social workers in devising psychological interventions aimed at improving post-CABG patients' quality of life and bolstering their coping strategies.

Plasma endothelin levels as a function of coronary artery manipulation during balloon angioplasty and high-speed rotational atherectomy.

This study was conducted to test the hypothesis that endothelin levels may be related to the coronary artery manipulation during balloon angioplasty (BA) or rotational atherectomy (RA). Blood endothelin levels were measured in 35 patients who underwent BA and in 11 patients who underwent RA followed by adjunctive balloon angioplasty. Arterial and venous levels were measured before, immediately after, and 24 h after the procedure. The levels were then related to the number of balloon inflations, the total inflation time and the maximal pressure in the balloon during inflation. There were no significant differences between groups or time periods. However, 24 h after BA the endothelin plasma levels in venous blood were directly related to the number of balloon inflations (r 3 0.49; P 3 0.03), to the total inflation time (r 3 0.67; P 3 0.005) and to the maximal inflation pressure (r 3 0.71; P 3 0.001). No such correlation was found in venous blood immediately after BA, either in arterial blood or in the RA group. It can be concluded that plasma endothelin levels do not change significantly after balloon angioplasty; however, venous endothelin levels 24 h after BA are related to procedural parameters, reflecting endothelial damage, which may determine the post-angioplasty late results.

Cleavage in conical sand dollar eggs.

Previous experiments have shown that the mitotic apparatus and the surface can interact and produce functional furrows in various unusual geometrical circumstances. The consistent development of the furrow in the plane equidistant from the aster centers has led to conjecture about the need for a special structural configuration of the subsurface in the future cleavage plane. In most experiments involving altered cell geometry, the relation between each aster and nearby surface was symmetrical, and the effect of that symmetry upon the position and orientation of the cleavage mechanism in the cortex has not been systematically analyzed. The normal symmetry of sand dollar eggs can be changed by reshaping them into cones. When the cone and mitotic axes are parallel, the aster center closer to the vertex is also closer to the nearby surface, and the cleavage plane develops on the vertex side of the midpoint between the asters. A mitotic apparatus oriented perpendicular to the cone axis produces in the base of the cone a normal unilateral furrow that advances toward the vertex, and a second contractile band that isolates the vertex region. This event only occurs when the surface is conical and the mitotic apparatus is perpendicular to the cone axis. Furrow formation is not restricted to the plane of the metaphase plate or the midpoint between the aster centers. The orientation of mitotic apparatus-produced contractile bands is not limited to the circumstances in normal cytokinesis, but may vary according to surface contour. These results confirm predictions of the Harris and Gewalt model of contractile ring induction.

Duration of division-related events in cleaving sand dollar eggs.

A minimal mechanism for cytokinesis comprises a stimulus-to-surface contraction, a receptive surface, and a localized surface contractile mechanism. Duration of each is brief and times when they function are predictable. The processes that begin and end the functional period of each component were investigated. Sand dollar blastomeres from the completion of first cleavage to the beginning of fourth cleavage were used. By changing a cell's shape, it was possible to determine whether its capacity to accomplish an activity is restricted to its usual time frame. The first appearance of the furrow was advanced about 5 min by confining the mitotic apparatus in a narrow cytoplasmic cylinder. The period when the mitotic apparatus induces furrowing was prolonged about 18 min by moving the mitotic apparatus in an elongate cell each time the furrow appeared. The period of active furrowing was prolonged to about 21.8 min by pushing the mitotic apparatus close to the cell margin and then stretching the region through which the unilateral furrow must pass. In relation to normal division cycle events, results showed that each event of cytokinesis can operate both before and after its normal active period. Components of the mechanism are capable of functioning for about half the period of the division cycle. Normal timing of events may be determined by geometrical factors and the normal consequences of each activity.

Families of the deceased in the hospital: A multi-disciplinary approach to intervention.

An intervention program for families whose loved ones have died during hospitalization is presented. Collaboration and cooperation among all members of the professional team-doctor, nurse, and medical social worker-provide a systematic primary prevention approach for the surviving family members and helps prevent pathological grief.A model for such multi-disciplinary care-giving has been operating effectively for a number of years within the Department of Cardiothoracic Surgery of Carmel Hospital, Haifa, Israel. Emotional and practical assistance, as well as referrals to community resources, is provided by the team from its first admission meeting with the families of patients. Cases are presented to illustrate the main points of the program.

Multiple sclerosis as a cause of atrial fibrillation and electrocardiographic changes.

We present the case of a young woman with an acute exacerbation of multiple sclerosis associated with paroxysmal atrial fibrillation and electrocardiographic changes characteristic of central nervous system effects on cardiac conduction. The patient presented with ataxia, vertigo, and left facial paresthesia, and was found to have a large demyelinating lesion involving the left middle and inferior cerebellar peduncles with extension rostrally into the brain stem. Profound pulmonary edema, out of proportion with the cardiac abnormalities, also developed. This confirms that demyelinating disease, like other central nervous system abnormalities, can lead to alterations in cardiac conduction, and may induce neurogenic pulmonary edema.

Reliability of evoked responses to high-frequency (8-14 kHz) tone bursts.

Instrumentation to evaluate the auditory brainstem response to high-frequency (8-14 kHz) tone bursts has been developed in the Auditory Research Laboratory, Portland, Oregon VA Medical Center. This system is intended to monitor the audition of patients receiving ototoxic drugs who are unresponsive to behavioral test procedures. The reliability of responses obtained with the high-frequency tone-burst system was studied in 30 normal ears. Intrasubject variability of intersession data from response waves I, III, and V to tone bursts of frequencies 8, 10, 12, and 14 kHz was not significantly different from click response variability. The results of this study demonstrate the reliability of the ABR to these high-frequency tone-burst stimuli. This technique may provide early identification of hearing loss in unresponsive subjects receiving treatment with potentially ototoxic agents, thus allowing alternative treatments to minimize or prevent communicative handicap.

Verification of sleep apnea using a portable sleep apnea screening device.

Sixty-seven patients referred to a sleep laboratory with a tentative diagnosis of obstructive sleep apnea were examined with a device designed for home use as an apnea screening system. Direct comparison was made between data obtained by the portable device and by data acquired simultaneously with standard polysomnographic techniques. The portable recorder measured nasal/oral airflow, chest wall movement, cardiac rhythm, and blood oxygen saturation. There was no significant difference in the number of disordered breathing events (apneas and hypopneas) recorded by the two systems. The portable device was found to have a sensitivity of 95% and a specificity of 96%. Indications and limitations for use of the portable home apnea screening test are reviewed and guidelines for normalcy suggested.

An unusual case of proctalgia.

We report the case of a 21-year-old man with the sudden onset of severe proctalgia followed by headaches and fever. The patient had a lumbar puncture consistent with subarachnoid hemorrhage. After a normal four-vessel cerebral arteriogram, a myelogram and computed tomography scan of the spine were performed and revealed a mass lesion of the L1 level. Pathologic evaluation after resection of the mass resulted in a diagnosis of hemorrhage from a myxopapillary ependymoma. These relatively benign tumors of the cauda equina-filum terminale respond well to treatment. The differential diagnosis of proctalgia is reviewed, and the need for emergency physicians to consider spinal subarachnoid hemorrhage when a patient presents with the acute onset of rectal pain is emphasized.

Evolution of consultation-liaison services in bone marrow transplantation.

Bone marrow transplantation offers new hope for cure in a variety of leukemias, aplastic anemia, and other immunodeficiency and hematologic disorders. But the psychologic circumstances accompanying this procedure are often profoundly stressful. The evolution of consultation--liaison services on a bone marrow transplantation unit are described and illustrated with several clinical vignettes. The results of a survey of 52 other bone marrow transplantation centers report the percentage that provide such services and the extent to which they are performed by a psychiatrist, a nonphysician psychosocial counselor, or both.

Age categorization of high-frequency auditory threshold data.

This article presents high-frequency (8- to 20-kHz) auditory threshold measurements for 157 subjects with normal conventional hearing, ranging in age from 6-30 years. Normative descriptive data are provided in five semidecade age categories. Intra-age category mean and variance values for threshold sensitivity and interaural threshold differences are included. Generally, the data are consistent with the expectation of a gradual diminution of high-frequency sensitivity through the adolescent and early adult years. Several unresolved issues related to high-frequency normative data and clinical applicability of high-frequency threshold measurements are discussed.

A prospective study of high-frequency auditory function in patients receiving oral neomycin.

Orally administered, neomycin is reported to cause ototoxicity rarely. Most reports on hearing loss due to oral neomycin have been case studies. One prospective study of a pediatric sample demonstrated a significant loss of hearing in the frequency range of 2 to 8 kHz in 9 of 17 children. To our knowledge there are no published prospective studies on this type with adult samples and therefore little is known of the true incidence or nature of ototoxicity from oral neomycin. This prospective study presents the results of long-term use of oral neomycin in 30 adult subjects. Hearing sensitivity was serially monitored in the frequency range 250-20,000 Hz. Two of the 30 subjects subsequently revealed ototoxicity. Thus the results of this investigation suggest that clinical use of oral neomycin implies relatively little risk of ototoxicity.