Developmental cascades from early childhood attachment security to adolescent level of personality functioning among high-risk youth.

This study examines associations between early childhood attachment security and adolescent personality functioning in a high-risk sample within a developmental psychopathology framework. Data from 2,268 children (1165 male; 1103 female) and caregivers participating in Future of Families and Child Well-Being Study (FFCWS) were used to examine (1) effects of genetic polymorphisms of the serotonin transporter (5-HTTLPR) and dopamine D4 receptor (DRD4) genes and adverse childhood experiences (ACEs) on attachment security and emotional and behavioral dysregulation in early childhood and (2) longitudinal associations and transactional relationships among attachment security, dysregulation, negative parenting attitudes and behaviors, social competence, and adolescent personality functioning. Results revealed that ACEs predicted attachment security over and above sex or the genetic risk, and gene × environment interactions did not increment prediction. Results of cascade models showed that greater early childhood attachment security predicted higher adolescent level of personality functioning via pathways through intermediary variables. Limitations and future research directions are discussed.

Minimizing Lung Injury During Laparoscopy in Head-Down Tilt: A Physiological Cohort Study.

BACKGROUND: Increased intra-abdominal pressure during laparoscopy induces atelectasis. Positive end-expiratory pressure (PEEP) can alleviate atelectasis but may cause hyperinflation. Cyclic opening of collapsed alveoli and hyperinflation can lead to ventilator-induced lung injury and postoperative pulmonary complications. We aimed to study the effect of PEEP on atelectasis, lung stress, and hyperinflation during laparoscopy in the head-down (Trendelenburg) position. METHODS: An open-label, repeated-measures, interventional, physiological cohort trial was designed. All participants were recruited from a single tertiary Belgian university hospital. Twenty-three nonobese patients scheduled for laparoscopy in the Trendelenburg position were recruited.We applied a decremental PEEP protocol: 15 (high), 10 and 5 (low) cm H 2 O. Atelectasis was studied with the lung ultrasound score, the end-expiratory transpulmonary pressure, the arterial oxygen partial pressure to fraction of inspired oxygen concentration (P ao2 /Fi o2 ) ratio, and the dynamic respiratory system compliance. Global hyperinflation was evaluated by dead space volume, and regional ventilation was evaluated by lung ultrasound. Lung stress was estimated using the transpulmonary driving pressure and dynamic compliance. Data are reported as medians (25th-75th percentile). RESULTS: At 15, 10, and 5 cm H 2 O PEEP, the respective measurements were: lung ultrasound scores (%) 11 (0-22), 27 (11-39), and 53 (42-61) ( P < .001); end-expiratory transpulmonary pressures (cm H 2 O) 0.9 (-0.6 to 1.7), -0.3 (-2.0 to 0.7), and -1.9 (-4.6 to -0.9) ( P < .001); P ao2 /Fi o2 ratios (mm Hg) 471 (435-538), 458 (410-537), and 431 (358-492) ( P < .001); dynamic respiratory system compliances (mL/cm H 2 O) 32 (26-36), 30 (25-34), and 27 (22-30) ( P < .001); driving pressures (cm H 2 O) 8.2 (7.5-9.5), 9.3 (8.5-11.1), and 11.0 (10.3-12.2) ( P < .001); and alveolar dead space ventilation fractions (%) 10 (9-12), 10 (9-12), and 9 (8-12) ( P = .23). The lung ultrasound score was similar between apical and basal lung regions at each PEEP level ( P = .76, .37, and .76, respectively). CONCLUSIONS: Higher PEEP levels during laparoscopy in the head-down position facilitate lung-protective ventilation. Atelectasis and lung stress are reduced in the absence of global alveolar hyperinflation.

The Relationship Between Esophageal Pressure and Diaphragm Thickening Fraction in Spontaneously Breathing Sedated Children: A Feasibility Study.

OBJECTIVES: Diaphragm ultrasound is a novel alternative to esophageal pressure measurements in the evaluation of diaphragm function and activity, but data about its reliability in a pediatric setting are lacking. We aimed to compare the esophageal pressure swing (∆P es , gold standard) with the diaphragmatic thickening fraction (DTF) as a measure of inspiratory effort in sedated children. Additionally, we studied the effect of positive end-expiratory pressure (PEEP) on the end-expiratory thickness of the diaphragm (DT ee ). DESIGN: Prospective open-label non-randomized interventional physiological cohort study. SETTING: Operating room in tertiary academic hospital. PATIENTS: Children 28 days to 13 years old scheduled for elective surgery with general anesthesia, spontaneously breathing through a laryngeal mask airway, were eligible for inclusion. Exclusion criteria were disorders or previous surgery of the diaphragm, anticipated difficult airway or acute cardiopulmonary disease. All measurements were performed prior to surgery. INTERVENTIONS: Patients were subjected to different levels of respiratory load, PEEP and anesthetic depth in a total of seven respiratory conditions. MEASUREMENTS AND MAIN RESULTS: The esophageal pressure and diaphragm thickening fraction were simultaneously recorded for five breaths at each respiratory condition. The relation between ∆P es and DTF was studied in a mixed model. We analyzed 407 breaths in 13 patients. Both DTF ( p = 0.03) and ∆Pes ( p = 0.002) could detect respiratory activity, and ∆P es and DTF were associated across respiratory conditions ( p < 0.001; R2 = 31%). With increasing inspiratory load, ∆P es increased significantly, while DTF did not ( p = 0.08). Additionally, DT ee did not differ significantly between 10, 5, and 0 cm H 2 O PEEP ( p = 0.08). CONCLUSIONS: In spontaneously breathing sedated children and across different respiratory conditions, DTF could differentiate minimal or no inspiratory effort from substantial inspiratory effort and was associated with ∆P es . Increased efforts resulted in higher ∆P es but not larger DTF.

Legal Admissibility of the Rorschach and R-PAS: A Review of Research, Practice, and Case Law.

The special issue editors selected us to form an "adversarial collaboration" because our publications and teaching encompass both supportive and critical attitudes toward the Rorschach and its recently developed system for use, the Rorschach Performance Assessment System (R-PAS). We reviewed the research literature and case law to determine if the Rorschach and specifically R-PAS meet legal standards for admissibility in court. We included evidence on norms, reliability, validity, utility, general acceptance, forensic evaluator use, and response style assessment, as well as United States and selected European case law addressing challenges to mental examination motions, admissibility, and weight. Compared to other psychological tests, the Rorschach is not challenged at unusually high rates. Although the recently introduced R-PAS is not widely referenced in case law, evidence suggests that information from it is likely to be ruled admissible when used by a competent evaluator and selected variables yield scores that are sufficiently reliable and valid to evaluate psychological processes that inform functional psycholegal capacities. We identify effective and ethical but also inappropriate uses (e.g., psychological profiling) of R-PAS in criminal, civil, juvenile, and family court. We recommend specific research to clarify important aspects of R-PAS and advance its utility in forensic mental health assessment.

Reoperation for bleeding after cardiac surgery.

BACKGROUND: Postoperative cardio-surgical haemostatic management is centre-specific and experience-based, which leads to a variability in patient care. This study aimed to identify which postoperative haemostatic interventions may reduce the need for reoperation after cardiac surgery in adults. METHODS: A retrospective case-control study in a tertiary centre. Adult, elective, primary cardiac surgical patients were selected (n = 2098); cases (n = 42) were patients who underwent reoperation within 72 h after the initial surgery. Interventions administered to control surgical bleeding were compared for the need to re-operate using multiple logistic regression. RESULTS: Rate of cardiac surgical reoperation was 2% in the study population. Three variables were found to be associated with cardiac reoperation: preoperative administration of fresh frozen plasma (OR 5.45, CI 2.34-12.35), cumulative volume of chest tube drainage and cumulative count of packed red blood cells transfusion on ICU (OR 1.98, CI 1.56-2.51). CONCLUSION: No significant difference among specific types of postoperative haemostatic interventions was found between patients who needed reoperation and those who did not. Perioperative transfusion of fresh frozen plasma, postoperative transfusion of packed cells and cumulative volume of chest tube drainage were associated with reoperation after cardiac surgery. These variables could help predict the need for reoperation.

Increased protein S-nitrosylation in mitochondria: a key mechanism of exercise-induced cardioprotection.

Endothelial nitric oxide synthase (eNOS) activation in the heart plays a key role in exercise-induced cardioprotection during ischemia-reperfusion, but the underlying mechanisms remain unknown. We hypothesized that the cardioprotective effect of exercise training could be explained by the re-localization of eNOS-dependent nitric oxide (NO)/S-nitrosylation signaling to mitochondria. By comparing exercised (5 days/week for 5 weeks) and sedentary Wistar rats, we found that exercise training increased eNOS level and activation by phosphorylation (at serine 1177) in mitochondria, but not in the cytosolic subfraction of cardiomyocytes. Using confocal microscopy, we confirmed that NO production in mitochondria was increased in response to H2O2 exposure in cardiomyocytes from exercised but not sedentary rats. Moreover, by S-nitrosoproteomic analysis, we identified several key S-nitrosylated proteins involved in mitochondrial function and cardioprotection. In agreement, we also observed that the increase in Ca2+ retention capacity by mitochondria isolated from the heart of exercised rats was abolished by exposure to the NOS inhibitor L-NAME or to the reducing agent ascorbate, known to denitrosylate proteins. Pre-incubation with ascorbate or L-NAME also increased mitochondrial reactive oxygen species production in cardiomyocytes from exercised but not from sedentary animals. We confirmed these results using isolated hearts perfused with L-NAME before ischemia-reperfusion. Altogether, these results strongly support the hypothesis that exercise training increases eNOS/NO/S-nitrosylation signaling in mitochondria, which might represent a key mechanism of exercise-induced cardioprotection.

Many-Body Chaos in the Sachdev-Ye-Kitaev Model.

Many-body chaos has emerged as a powerful framework for understanding thermalization in strongly interacting quantum systems. While recent analytic advances have sharpened our intuition for many-body chaos in certain large N theories, it has proven challenging to develop precise numerical tools capable of exploring this phenomenon in generic Hamiltonians. To this end, we utilize massively parallel, matrix-free Krylov subspace methods to calculate dynamical correlators in the Sachdev-Ye-Kitaev model for up to N=60 Majorana fermions. We begin by showing that numerical results for two-point correlation functions agree at high temperatures with dynamical mean field solutions, while at low temperatures finite-size corrections are quantitatively reproduced by the exactly solvable dynamics of near extremal black holes. Motivated by these results, we develop a novel finite-size rescaling procedure for analyzing the growth of out-of-time-order correlators. Our procedure accurately determines the Lyapunov exponent, λ, across a wide range in temperatures, including in the regime where λ approaches the universal bound, λ=2π/ß.

Narcissism and Reactions to a Self-Esteem Insult: An Experiment Using Predictions from Self-Report and the Rorschach Task.

We used self-reported narcissistic grandiosity and vulnerability and a component derived from 11 potential grandiosity and narcissism variables (GNVs) coded from Rorschach behavior to predict fluctuations in self-esteem and their links to anger and defensive reactions. We assessed state mood, state self-esteem, and performance attributions in 105 college students who underwent a self-esteem manipulation involving success followed by failure on cognitive testing. Self-reported grandiosity predicted the disavowal of effortful ability as a factor in failure, but we did not replicate other previously reported findings for this variable. Self-reported vulnerability predicted oscillations in self-reported mood and self-esteem. The GNV scale predicted spontaneously expressed hostility and externalization following self-esteem insult, and attributions mediated its relationship with anger expressed after failure. We discuss implications of these results and recommend additional replication research.

Does the Rorschach Performance Assessment System (R-PAS) Differ from the Comprehensive System (CS) on Variables Relevant to Interpretation?

We examined the impact of the changes in administration and coding introduced by the Rorschach Performance Assessment System (R-PAS) relative to the Comprehensive System (CS) on the Rorschach response process, as manifested in variables relevant to interpretation. We also examined the efficiency of each system to obtain protocols in an optimal range of responses (R) for interpretation. As hypothesized, when comparing 50 CS and 50 R-PAS nonpatient protocols, R-PAS produced many more protocols in the optimal R range (18-27) than the CS (78% vs. 24%) and it eliminated the need for re-administration, which was required for five CS protocols. As expected, R was less variable with R-PAS, as were two variables derived from it, R8910% and Complexity. In addition, as expected because of different Form Quality tables, R-PAS showed notably fewer and less variable perceptual distortions than the CS, and an increase in more conventional perceptions. The other 58 variables showed no reliable differences in means or standard deviations, though modest power precluded definitive inferences about equivalence. Overall, our results support previous findings about the benefit of R-PAS to obtain protocols in an optimal range for interpretation, while keeping the core manifestations of the response process unchanged.

Artificial sweeteners impair endothelial vascular reactivity: Preliminary results in rodents.

BACKGROUND AND AIMS: Prospective epidemiological studies highlighted recently the link between artificial sweeteners (AS) consumption and the risk of developing cardiometabolic diseases. However, underlying mechanisms remain unknown. Thus, the aim of this preliminary study was to characterize, in a healthy rat population, the effect of chronic AS consumption on body composition and vascular function, an early marker for cardiovascular disease. METHODS AND RESULTS: Healthy Wistar rats followed a 10-week standard diet including the consumption of water sweetened or not with a sucralose/acesulfame potassium solution at different concentrations: for moderate consumption at 1 and 2 mg.kg-1.day-1, respectively or high intake at 15 and 15 mg.kg-1.day-1 for both molecules (acceptable daily intake). Body fat composition has been evaluated and ex vivo aortic vasomotor function has been investigated with a pharmacological approach. CONCLUSION: Both groups of AS-treated rats showed a significant increase in subcutaneous and perirenal adipose tissue mass storage, without changes in total body mass. However, rats that have consumed AS at Acceptable Daily Intake (ADI) concentration revealed a significant vascular endothelial dysfunction compared to other groups. These results are interesting because they will help to better explain the observed increase in cardiometabolic risk.

The Effects of Coding the Location of Individual Objects in a Normative Sample of Rorschach Data.

The locations people use when constructing responses to the Rorschach task demonstrate their style of perceiving the environment. Current systems code location use into three mutually exclusive categories: use of the whole inkblot (W), common detail areas (D), and rare detail areas (Dd). The location of objects within multiobject W responses typically are never classified and those within D areas might or might not be, which could lead to a biased understanding of the visual structure embedded in the task. To better understand this structure, we systematically coded the location of all individual response objects in 145 normative protocols, finding some notable differences relative to conventional coding guidelines. Across cards, from 8% to 71% (M = 40.2%) of W responses had multiple subcomponent objects that typically are never tallied, and multiple unnumbered location areas are used more often than many specific numbered areas. To assess generalizability, we documented correspondence with location frequencies in 4,786 protocols gathered using Rorschach Performance Assessment System guidelines. The results contribute to an improved understanding of the visual structure built into the inkblot stimuli and a method for quantifying exhaustiveness, commonness, and atypicalness as independent dimensions. We discuss implications for coding and interpreting inkblot location use.

The Effect of CS Administration or an R-Optimized Alternative on Potential Projective Material in Rorschach Responses From Six Studies and a Meta-Analysis of Their Findings.

The Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011) introduced R-optimized administration to reduce variability in the number of Responses (R). We provide new data from six studies of participants randomly assigned to receive a version of this method or Comprehensive System (CS; Exner, 2003) administration. We examine how administration methods affect 3 types of codes most likely to contain potential projective material and the frequency of these codes for the 1st, 2nd, 3rd, 4th, or last response to a card (R in Card). In a meta-analytic summary, we found 37% of responses have 1 type of code, 19% have 2 types, and 3% have all 3 types, with stable proportions across responses within cards. Importantly, administration method had no impact on potential projective variable means. Differential skew across samples made variability harder to interpret. Initial results suggesting differences in 3 of the 18 specific Type by R in Card pairs did not follow a coherent pattern and disappeared when using raw counts from all participants. Overall, data do not support concerns that R-optimized administration might alter potential projective processes, or make potentially "signature" last responses to the card any different in R-PAS than the CS.

Contemporary Data on the Location of Response Objects in Rorschach's Inkblots.

Using a diverse sample of 4,786 protocols obtained with the Rorschach Performance Assessment System (Meyer, Viglione, Mihura, Erard, & Erdberg, 2011), we provide a contemporary overview of how people organize Rorschach's inkblots into identifiable regions while formulating responses. After examining how frequently each location was used across all cards in this sample, we examined the consistency of their use by computing parallel information in 17 samples (N = 4,701) obtained using the Comprehensive System (CS; Exner, 2003), including clinical, nonclinical, and adult, child, and adolescent data. Even though the CS data could only record a single location for each response, the average correlation of location use across samples was .96. The results also document continuous dimensionality in use rather than any discontinuities that would demarcate a boundary between common and uncommon locations. Implications of this notable reproducibility and dimensionality are discussed for future conceptualization of location typicality, including location coding considerations and possibilities for improved measures of perceptual fit.

The Effect of CS Administration or an R-Optimized Alternative on R-PAS Variables: A Meta-Analysis of Findings From Six Studies.

Controlling the number of Rorschach responses (R) as a method to reduce variability in the length of records has stimulated controversy among researchers for many years. Recently, the Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011 ) introduced an R-Optimized method to reduce variability in R. Using 4 published and 2 previously unpublished studies (N = 713), we examine the extent to which 51 Comprehensive System-based scores on the R-PAS profile pages are affected as a result of receiving Comprehensive System (CS; Exner, 2003 ) administration versus a version of R-Optimized administration. As hypothesized, R-the intended target of R-Optimized administration-showed reliable weighted average differences across each method of administration. As expected, its mean modestly increased and its standard deviation notably decreased. Also as hypothesized, the next largest effects were decreases in the variability (SD) of 2 variables directly related to R, R8910% and Complexity. No other reliable differences were observed. Therefore, because R-Optimized administration does not notably modify the existing CS-based normative values for other profiled R-PAS variables, the data do not support concerns that R-Optimized administration notably modifies the Rorschach task or that existing CS research data would not generalize to R-PAS. However, because R-Optimized administration reduces variability in R, it allows a single set of norms to apply readily to more people.

Vascular endothelial function masks increased sympathetic vasopressor activity in rats with metabolic syndrome.

Sympathetic hyperactivation, a common feature of obesity and metabolic syndrome, is a key trigger of hypertension. However, some obese subjects with autonomic imbalance present a dissociation between sympathetic activity-mediated vasoconstriction and increased blood pressure. Here, we aimed to determine in a rat model of metabolic syndrome whether the endothelium endothelial nitric oxide (NO) synthase (eNOS)-NO pathway contributes to counteract the vasopressor effect of the sympathetic system. Rats were fed a high-fat and high-sucrose (HFS) diet for 15 wk. Sympathovagal balance was evaluated by spectral analysis of heart rate variability and plasmatic catecholamine measurements. Blood pressure was measured in the presence or absence of N-nitro-l-arginine methyl ester (l-NAME) to inhibit the contribution of eNOS. Vascular reactivity was assessed on isolated aortic rings in response to α1-adrenergic agonist. The HFS diet increased sympathetic tone, which is characterized by a higher low on the high-frequency spectral power ratio and a higher plasmatic concentration of epinephrine. Despite this, no change in blood pressure was observed. Interestingly, HFS rats exhibited vascular hyporeactivity (-23.6%) to α1-adrenergic receptor stimulation that was abolished by endothelial removal or eNOS inhibition (l-NAME). In addition, eNOS phosphorylation (Ser1177) was increased in response to phenylephrine in HFS rats only. Accordingly, eNOS inhibition in vivo revealed higher blood pressure in HFS rats compared with control rats (147 vs. 126 mmHg for mean blood pressure, respectively). Restrain of adrenergic vasopressor action by endothelium eNOS is increased in HFS rats and contributes to maintained blood pressure in the physiological range. NEW & NOTEWORTHY Despite the fact that prohypertensive sympathetic nervous system activity is markedly increased in rats with early metabolic syndrome, they present with normal blood pressure. These observations appear to be explained by increased endothelial nitric oxide synthase response to adrenergic stimulation, which results in vascular hyporeactivity to α-adrenergic stimulation, and therefore blood pressure is preserved in the physiological range. Listen to this article's corresponding podcast at http://www.physiology.org/doi/10.1152/ajpheart.00217.2017 .

Effects of Sugar-Sweetened Beverage Consumption on Microvascular and Macrovascular Function in a Healthy Population.

OBJECTIVE: To assess vascular function during acute hyperglycemia induced by commercial sugar-sweetened beverage (SSB) consumption and its effect on underlying mechanisms of the nitric oxide pathway. APPROACH AND RESULTS: In a randomized, single-blind, crossover trial, 12 healthy male participants consumed 600 mL (20 oz.) of water or a commercial SSB across 2 visits. Endothelial and vascular smooth muscle functions were assessed in the microcirculation using laser speckle contrast imaging coupled with iontophoresis and in the macrocirculation using brachial artery ultrasound with flow- and nitrate-mediated dilation. Compared with water, SSB consumption impaired microvascular and macrovascular endothelial function as indicated by a decrease in the vascular response to acetylcholine iontophoresis (208.3±24.3 versus 144.2±15.7%, P<0.01) and reduced flow-mediated dilation (0.019±0.002 versus 0.014±0.002%/s, P<0.01), respectively. Systemic vascular smooth muscle remained preserved. Similar decreases in endothelial function were observed during acute hyperglycemia in an in vivo rat model. However, function was fully restored by treatment with the antioxidants, N-acetylcysteine and apocynin. In addition, ex vivo experiments revealed that although the production of reactive oxygen species was increased during acute hyperglycemia, the bioavailability of nitric oxide in the endothelium was decreased, despite no change in the activation state of endothelial nitric oxide synthase. CONCLUSIONS: To our knowledge, this is the first study to assess the vascular effects of acute hyperglycemia induced by commercial SSB consumption alone. These findings suggest that SSB-mediated endothelial dysfunction is partly due to increased oxidative stress that decreases nitric oxide bioavailability. CLINICAL TRIAL REGISTRATION: URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366442&isReview=true. Australian New Zealand Clinical Trials Registry Number: ACTRN12614000614695.

The Centrality of the Response Process in Construct Validity: An Illustration via the Rorschach Space Response.

Recently, psychologists have emphasized the response process-that is, the psychological operations and behaviors that lead to test scores-when designing psychological tests, interpreting their results, and refining their validity. To illustrate the centrality of the response process in construct validity and test interpretation, we provide a historical, conceptual, and empirical review of the main uses of the background white space of the Rorschach cards, called space reversal (SR) and space integration (SI) in the Rorschach Performance Assessment System. We show how SR and SI's unique response processes result in different interpretations, and that reviewing their literatures with these distinct interpretations in mind produces the expected patterns of convergent and discriminant validity. That is, SR was uniquely related to measures of oppositionality; SI was uniquely related to measures of cognitive complexity; and both SR and SI were related to measures of creativity. Our review further suggests that the Comprehensive System use of a single space code for all uses of white space likely led to its lack of meta-analytic support as a measure of oppositionality (Mihura, Meyer, Dumitrascu, & Bombel, 2013 ). We close by discussing the use of the response process to improve test interpretation, develop better measures, and advance the design of research.

The Incremental Validity of Self-Report and Performance-Based Methods for Assessing Hostility to Predict Cardiovascular Disease in Physicians.

We evaluated the utility of an integrative, multimethod approach for assessing hostility-related constructs to predict premature cardiovascular disease (CVD) and premature coronary heart disease (CHD) using participants from the Johns Hopkins Precursors Study, which was designed to identify risk factors for heart disease. Participants were assessed at baseline while in medical school from 1946 to 1962 (M age = 24.6) and have been followed annually since then. Baseline assessment included individually administered Rorschach protocols (N = 416) scored for aggressive imagery (i.e., Aggressive Content, Aggressive Past) and self-reports of 3 possible anger responses to stress. Cox regression analyses predicting morbidity or mortality by age 55 revealed a significant interaction effect; high levels of Aggressive Content with high self-reported hostility predicted an increased rate of premature CVD and CHD, and incrementally predicted the rate of these events after controlling for the significant covariates of smoking (CVD and CHD) and cholesterol (CHD) that were also assessed at baseline. The hostility and anger measures, as well as other baseline covariates, were not predictors of CVD risk factors assessed at midlife during follow-up. Overall, this integrative model of hostility illustrates the potential value of multimethod assessment to areas of health psychology and preventive medicine.