Determining patients' readiness for release from the postanesthesia recovery unit.
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Consciousness↗
Biomedical subjects
Michael Lewis
Publications and source records attributed to Michael Lewis.
Adjustment following sexual abuse discovery: the role of shame and attributional style.
This study examined adjustment following sexual abuse as a function of shame and attributional style. One hundred forty-seven participants (83 children and 64 adolescents) were seen at the time of abuse discovery and again 1 year later. Once adjustment at abuse discovery was accounted for, shame and attribution style explained additional variation in subsequent adjustment, whereas abuse severity did not. A pessimistic attribution style at abuse discovery moderated the relation between severity of abuse and subsequent depressive symptoms and self-esteem. The relations between abuse severity and these outcomes were significant only at high levels of pessimistic attribution style. Of note, patterns of change in shame and attribution predicted which children remained at risk or improved in adjustment. In addition, age and gender differences were found in adjustment over time.
Adaptation, Psychological↗
Children's intellectual and emotional-behavioral adjustment at 4 years as a function of cocaine exposure, maternal characteristics, and environmental risk.
The authors examined 223 children at age 4 years for the effects of prenatal cocaine exposure, exposure to other substances, maternal and environmental risk factors, and neonatal medical problems on IQ, externalizing problems, and internalizing problems. Regression analyses showed that maternal verbal IQ and low environmental risk predicted child IQ. Cocaine exposure negatively predicted children's overall IQ and verbal reasoning scores, but only for boys. Cocaine exposure also predicted poorer short-term memory. Maternal harsh discipline, maternal depressive symptoms, and increased environmental risk predicted externalizing problems. In contrast, only maternal depressive symptoms predicted internalizing problems. These findings indicate that early exposure to substances is largely unrelated to subsequent IQ or adjustment, particularly for girls.
Adolescent↗
The colon-selective spasmolytic otilonium bromide inhibits muscarinic M(3) receptor-coupled calcium signals in isolated human colonic crypts.
1. Otilonium bromide (OB) is a smooth muscle relaxant used in the treatment of irritable bowel syndrome. Otilonium bromide has been shown to interfere with the mobilization of calcium in intestinal smooth muscle, but the effects on other intestinal tissues have not been investigated. We identified the muscarinic receptor subtype coupled to calcium signals in colonic crypt derived from the human colonic epithelium and evaluated the inhibitory effects of OB. 2. Calcium signals were monitored by fluorescence imaging of isolated human colonic crypts and Chinese hamster ovary cells stably expressing the cloned human muscarinic M(3) receptor subtype (CHO-M(3)). Colonic crypt receptor expression was investigated by pharmacological and immunohistochemical techniques. 3. The secretagogue acetylcholine (ACh) stimulated calcium mobilization from intracellular calcium stores at the base of human colonic crypts with an EC(50) of 14 micro M. The muscarinic receptor antagonists 4-DAMP, AF-DX 384, pirenzepine and methroctamine inhibited the ACh-induced calcium signal with the following respective IC(50) (pK(b)) values: 0.78 nM (9.1), 69 nM (7.2), 128 nM (7.1), and 2510 nM (5.8). 4. Immunohistochemical analyses of muscarinic receptor expression demonstrated the presence of M(3) receptor subtype expression at the crypt-base. 5. Otilonium bromide inhibited the generation of ACh-induced calcium signals in a dose dependent manner (IC(50)=880 nM). 6. In CHO-M(3) cells, OB inhibited calcium signals induced by ACh, but not ATP. In addition, OB did not inhibit histamine-induced colonic crypt calcium signals. 7. The present studies have demonstrated that OB inhibited M(3) receptor-coupled calcium signals in human colonic crypts and CHO-M(3) cells, but not those induced by stimulation of other endogenous receptor types. We propose that the M(3) receptor-coupled calcium signalling pathway is directly targeted by OB at the level of the colonic epithelium, suggestive of an anti-secretory action in IBS patients suffering with diarrhoea.
Acetylcholine↗
Arterial injury in mice with severe insulin-like growth factor-1 (IGF-1) deficiency.
BACKGROUND: Insulin-like growth factor-1 plays a significant role in wound healing. Injury to the arterial wall is followed by a marked increase in insulin-like growth factor-1 expression and inhibition of insulin-like growth factor-1 action is associated with diminished intimal thickening after injury. METHODS AND RESULTS: The role of insulin-like growth factor-1 in arterial response to cuff injury was investigated in genetically modified mice with severe insulin-like growth factor-1 deficiency ((m/m) mice). Tissue and serum insulin-like growth factor-1 was severely decreased, by 40% to 60% before the injury and by 50% to 60% following the arterial injury in insulin-like growth factor-1 (m/m) mice compared to control mice. Nevertheless, following the cuff induced injury to the carotid arteries, insulin-like growth factor-1 (m/m) mice had a similar number of proliferating medial cells 3 days after injury and similar neointimal thickening (0.019 +/- 0.015 C57BL/6J vs. 0.016 +/- 0.014 mm(2), P = 0.26) 21 days after injury compared to wild type C57BL/6J mice. The phases of the response to injury that are mediated by insulin-like growth factor-1 were studied with recombinant human insulin-like growth factor-1 in rats with balloon-injured femoral arteries. Treatment of rats with recombinant human insulin-like growth factor-1 increased neointimal thickening (0.0265 +/- 0.0099 vs 0.0156 +/- 0.0049 mm(2), P = 0.03), intimal smooth muscle cell numbers (195.6 +/- 40.2 vs 145.3 +/- 27.3; P = 0.03), and the ratio of proliferating intimal to medial smooth muscle cells (10.7 +/- 6.9 vs 3.0 +/- 2.1; P = 0.03) 7 days after injury compared to untreated rats. At 14 days neointimal area was similar in the 2 groups of rats. CONCLUSIONS: The data in insulin-like growth factor-1 deficient mice suggest a relatively low threshold tissue concentration for insulin-like growth factor-1 to exhibit its role in vascular response to injury. The findings in rats treated with recombinant human insulin-like growth factor-1 suggest that insulin-like growth factor-1 is primarily involved in the early phases of neointimal formation.
Animals↗
Facial Expressivity at 4 Months: A Context by Expression Analysis.
The specificity predicted by differential emotions theory (DET) for early facial expressions in response to 5 different eliciting situations was studied in a sample of 4-month-old infants (n = 150). Infants were videotaped during tickle, sour taste, jack-in-the-box, arm restraint, and masked-stranger situations and their expressions were coded second by second. Infants showed a variety of facial expressions in each situation; however, more infants exhibited positive (joy and surprise) than negative expressions (anger, disgust, fear, and sadness) across all situations except sour taste. Consistent with DET-predicted specificity, joy expressions were the most common in response to tickling, and were less common in response to other situations. Surprise expressions were the most common in response to the jack-in-the-box, as predicted, but also were the most common in response to the arm restraint and masked-stranger situations, indicating a lack of specificity. No evidence of predicted specificity was found for anger, disgust, fear, and sadness expressions. Evidence of individual differences in expressivity within situations, as well as stability in the pattern across situations, underscores the need to examine both child and contextual factors in studying emotional development. The results provide little support for the DET postulate of situational specificity and suggest that a synthesis of differential emotions and dynamic systems theories of emotional expression should be considered.
Journal Article↗
Grading the severity of obstruction in the presence of a restrictive ventilatory defect.
STUDY OBJECTIVES: No recommendation currently exists for grading the severity of airway obstruction in the presence of additional restriction. The grading of airway obstruction is currently based on the FEV(1) (American Thoracic Society [ATS] recommendations), while prior recommendations by the Intermountain Thoracic Society (ITS) graded the severity of obstruction based on the FEV(1)/FVC ratio. The objective was to compare the grading of airway obstruction using the percent predicted FEV(1) (ATS) with a confidence interval-based system (ITS), with particular focus on pulmonary functions in patients having both airway obstructions and restrictions. DESIGN: Retrospective analysis. SETTING: Tertiary medical center. PATIENTS: A retrospective analysis of 21,499 patient pulmonary function tests (PFTs) was performed. The predicted values of Crapo and coworkers were used. MEASUREMENTS AND RESULTS: The distribution of the severity of the obstruction was compared using the ATS and ITS methods for PFTs with normal, increased, or decreased total lung capacity (TLC). Analysis was performed using the chi(2) method. Of the 21,499 PFTs that were analyzed, TLC was measured in 28% (5,962 PFTs). In this cohort, 44% (2,619 PFTs) gave evidence of obstruction. Of these, 147 PFTs demonstrated additional restriction. While the ATS criteria graded 133 of these PFTs (90%) as being severe, the ITS criteria graded only 4 PFTs (3%) as severe (the severity distribution between the methods was significantly different [p < 0.01]). CONCLUSIONS: In view of the possible overestimation of the severity of obstruction in PFTs with concurrent restriction using the percentage of predicted FEV(1) values, consideration should be given to grading the severity of obstruction on the basis of the FEV(1)/FVC ratio in this specific subset of PFTs.
Adult↗
sigma-Dative and pi-Backdative Phenyl Cation-Dinitrogen Interactions and Opposing Sign Reaction Constants in Dual Substituent Parameter Relations.
For the overwhelming number of reactions studied with dual substituent parameter treatments, the ratio of the reaction constants rho(R)/rho(F) = lambda is positive and close to unity. Dediazoniations are prominent representatives of the very few unusual reactions for which dual substituent parameter (DSP) relations yield reaction constants of opposing sign. To understand this exceptional behavior, we have studied with ab initio methods the energetic, structural, and electronic relaxations along the unimolecular, linear dediazoniation path of benzenediazonium ions X-1 to form phenyl cation X-2 in detail for the parent system and two important derivatives (X = H, NH(2), NO(2)). The results support the electron density based model that describes CN bonding in X-1 by synergistic sigma-dative N --> C and C --> N pi-backdative bonding. The analysis provides a theoretical basis for the interpretation of the opposing sign DSP relationship and, in addition, furnishes details about the electronic structure that cannot be deduced from physical-organic studies alone. Polarizations in the sigma-frames critically affect structures (Q values) and electronic structures (populations), and consistent explanations of structural and energetic relaxations in the course of the dediazoniation reactions require their explicit consideration. The classical tool of pi-electron pushing does not suffice to provide a correct account of the electronic structures. In particular, the analysis resolves the apparent paradox that the amino group can function as an electron donor even though it is negatively charged. If sigma-polarizations dominate in cases where they counteract pi-effects, it would seem reasonable to assume that they also are of comparable magnitude where sigma- and pi-effects act in concert. In the later case, explanations based on pi-polarizations might therefore seem consistent but they might lack a physical basis.
Journal Article↗
The safety of drugs for OTC use: what evidence is required for an NSAID switch?
In recent years there has been a growing demand for safe and effective over-the-counter (OTC) drugs. The demonstration of the safety of OTC products in actual conditions of use is crucial for their wide distribution, since the circumstances of their use may be different from the prescription-only setting. A group of experts met in Geneva, Switzerland, with the aim of exploring the criteria required to show safety equivalence of OTC medications, with specific reference to low-dose non-steroidal anti-inflammatory drugs (NSAIDs) used for analgesia. It was agreed that an acceptable surrogate marker for safety as the primary endpoint in a study designed to show that a new NSAID was not inferior to a current NSAID would be any adverse event leading the patient to consult a physician. A sample size of 10,000 patients in each arm of a two-arm study would be sufficient to show non-inferiority with acceptable relative risk equal to 1.2 with at least 90% power for an event rate of 5%. An example of a possible pharmacy-based randomized study design to demonstrate safety equivalence of OTC analgesics is given.
Anti-Inflammatory Agents, Non-Steroidal↗
Cortisol response to embarrassment and shame.
This study examined individual differences in 4-year-old children's (N = 60) expression of the self-conscious emotions of embarrassment and shame and their relation to differences in cortisol response to stress. Results indicated the presence of two different types of embarrassment--one that reflected negative evaluation of the self, and the other a nonevaluative type that reflected simply exposure of the self when the individual was the object of attention of others. Results also indicated a relation between a higher cortisol response to stress and the greater expression of the self-conscious emotions of evaluative embarrassment and shame that reflected negative self-evaluation.
Arousal↗
Reactivity and regulation in cortisol and behavioral responses to stress.
This study examined relations between reactivity (i.e., peak response) and regulation (i.e., response dampening) in 6-month-old infants' cortisol and behavioral responses to inoculation (N = 62). Data showed that reactivity and regulation were unrelated for both cortisol and behavior. The independence of reactivity and regulation suggests that measures of both are needed to characterize infant cortisol or behavioral response to stress more completely. For both reactivity and regulation, cortisol and behavior were unrelated, suggesting that measures of both are needed to assess infant stress more adequately. There was considerable variation in the timing of the peak cortisol response, suggesting that obtaining only a single poststressor cortisol sample does not provide a sensitive measure of cortisol reactivity.
Female↗
Development of self-recognition, personal pronoun use, and pretend play during the 2nd year.
This study examined the relation of visual self-recognition to personal pronoun use and pretend play. For a longitudinal sample (N=66) at the ages when self-recognition was emerging (15, 18, and 21 months), self-recognition was related to personal pronoun use and pretend play such that children showing self-recognition used more personal pronouns and demonstrated more advanced pretend play than did children not showing self-recognition. The finding of a relation among these measures provides additional evidence that in the middle of the 2nd year of life a metarepresentation of self emerges in the human child.
Child Language↗
Infant emotional and cortisol responses to goal blockage.
This study examined the relation of infant emotional responses of anger and sadness to cortisol response in 2 goal blockage situations. One goal blockage with 4-month-old infants (N = 56) involved a contingency learning procedure where infants' learned response was no longer effective in reinstating an event. The other goal blockage with 6-month-old infants (N = 84) involved the still face procedure where infants' reactions to their mothers' lack of responsivity were not effective in reestablishing interaction. For both blockages, sadness was related to cortisol response, though anger was not--the greater the sadness, the higher the cortisol response. This differential relation is consistent with other evidence indicating the more positive role of anger as opposed to sadness in overcoming an obstacle.
Affect↗
Early risk, attention, and brain activation in adolescents born preterm.
The relations among early cumulative medical risk, cumulative environmental risk, attentional control, and brain activation were assessed in 15-16-year-old adolescents who were born preterm. Functional magnetic resonance imaging found frontal, temporal, and parietal cortex activation during an attention task with greater activation of the left superior-temporal and left supramarginal gyri associated with better performance. Individual differences in early cumulative risk are related to patterns of brain activation such that medical risk is related to left parietal cortex activation and environmental risk is related to temporal lobe activation. The findings suggest that early risk is related to less mature patterns of brain activation, including reduced efficiency of processing and responding to stimuli.
Adolescent↗