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.

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.

PREFURROW BEHAVIOR OF THE EQUATORIAL SURFACE IN ARBACIA LIXULA EGGS.

Study of equatorial surface activity occurring immediately before furrowing in Arbacia lixula (=pustulosa) eggs was undertaken to learn more about the establishment of the cleavage mechanism. Behavior of echinochrome granules in the egg surface, observed and recorded with a Nikon AFM camera, was used as the indicator of surface events. An hour after fertilization A. lixula eggs were slightly flattened and periodically photographed until the furrow appeared. By measuring regional changes in the concentration of echinochrome granules, we found that a band of equatorial surface approximately 22 µm wide, which comprises about 32% of the uncleaved egg surface, shrinks about 34% and forms a densely pigmented band averaging 15 µm wide. This contraction in the equatorial zone is accompanied by expansion or stretching in the subequatorial surfaces. The possible relation between these events and formation of the microfilamentous contractile ring is discussed.

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.

Self-monitoring behavior in a case of severe auditory agnosia with aphasia.

This case report describes an unusual combination of speech and language deficits secondary to bilateral infarctions in a 62-year-old woman. The patient was administered an extensive series of speech, language, and audiologic tests and was found to exhibit a fluent aphasia in which reading and writing were extremely well preserved in comparison to auditory comprehension and oral expression, and a severe auditory agnosia. In spite of her auditory processing deficits, the patient exhibited unexpected self-monitoring ability and the capacity to form acoustic images on visual tasks. The manner in which she corrected and attempted to correct her phonemic errors, while ignoring semantic errors, suggests that different mechanisms may underlie the monitoring of these errors.

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.

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.

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.

Division of constricted and urethane-treated sand dollar eggs: a test of the polar stimulation hypothesis.

In spherical cells with a central mitotic apparatus, the centers of the asters are closer to the poles than to the equator. This circumstance is basic to several hypothetical explanations of the way in which the mitotic apparatus establishes the division mechanism. This investigation was designed to determine whether that geometrical relationship is necessary for division. Fertilized, mechanically denuded sand dollar eggs were inserted into glass loops, which reduced the diameter in the constriction plane from the normal 142 to 78-80 microns and partly constricted the cell into equal parts. The mitotic apparatus straddled the constriction, and its length was not significantly changed. The manipulation increased the distance from the astral centers to the poles and decreased the distance from the astral centers to the equator to a degree that reversed the normal distance relations. These cells divided normally. Ethyl urethane (0.06 M) reduces the size of the mitotic apparatus and blocks cleavage in spherical cells. When treated cells are confined in 80-microns i.d. capillaries, they divide. Treated cells also divide when they are constricted by an 80-microns i.d. glass loop if the mitotic apparatus straddles the constriction. An equal degree of constriction in the subfurrow and subpolar areas did not reverse the effect of urethane. The results demonstrate that cleavage does not depend on the normal distance relation between the mitotic apparatus and the poles, and that the urethane effect can be remedied only by reducing the distance between the mitotic apparatus and the equatorial surface. Both findings are inconsistent with the polar stimulation hypothesis.

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.

Acoustic reflex threshold measurement in hearing aid selection.

Aided speech discrimination scores were obtained for 18 patients with sensorineural hearing loss. Monosyllabic word discrimination lists with a competing message of connected discourse at a signal-to-noise ratio of +10 dB were used as the test stimuli, and measurements were made at four hearing aid gain settings for each subject. One of the gain settings was determined by measuring the acoustic reflex threshold for filtered noise in the ear contralateral to the aided ear. Two other settings were at +/- 10 dB relative to the reflex threshold gain setting; the fourth setting was determined with a traditional approach. Mean speech discrimination scores were highest at the reflex threshold gain setting and similar at the other three settings.

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.

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.

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.

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.

The effects of impulsive noise upon human hearing sensitivity (8 to 20 kHz).

The effects of impulsive noise exposure upon hearing sensitivity from 8000 to 20000 Hz were determined for a sample of 23 young military veterans. The subjects' histories consisted primarily of major incidents of weapons fire. Based on audiometric configuration, the subject sample was divided in two groups characterized by predominantly unilateral or bilateral shifts in threshold sensitivity. This division was consistent with history information. The main finding was extensive threshold shifts from 8000 to 20000 Hz which was highly individual-specific and unpredictable. High frequency audiometry frequently revealed extensive changes not evident in the 250 through 8000 Hz range.

An investigation of the validity of high-frequency audition.

In this investigation, a masking experiment was utilized to explore the validity of high-frequency audition. Threshold shifts produced by a narrow-band noise with sharp filter slopes and variable center frequency were determined for pure-tone stimuli from 8000 to 14 000 Hz. Subjects were young adults with normal hearing from 250 through 8000 Hz, and with high-frequency thresholds comparable to those obtained in a previously conducted normative survey. After pure-tone thresholds were obtained for each test frequency, a narrow-band masker was presented ipsilateral to the pure-tone stimulus with center frequency equal to the pure tone. The masker was adjusted to an intensity level necessary to shift the pure-tone threshold approximately 17 dB. The center frequency of the masker was then decreased in discrete steps with the pure-tone threshold re-established at each step. The experimental results, as demonstrated by release-from-masking functions, are consistent with the expectation of increased masker effectiveness as the center frequency of the masker approximates the test frequency. The findings of this investigation suggest that responses to high-frequency auditory stimulation are the result of high-frequency perception, and not the perception of some lower frequency distortion process.