Kent H. Rehfeldt, MD

  • Consultant
  • Assistant Professor of Anesthesiology
  • Department of Anesthesiology
  • Mayo Clinic
  • Rochester, Minnesota

Working memory can be evaluated by assessing digit span treatment for dogs ear mites generic ciprofloksacin 750 mg overnight delivery, having the patient spell a word backwards bacteria 02 micron 250mg ciprofloksacin overnight delivery, or having the patient continue specific patterns infection after tooth extraction order 750mg ciprofloksacin visa. Patients with lesions affecting the dorsolateral prefrontal cortex demonstrate impaired attention and working memory bacteria in urinalysis discount ciprofloksacin 1000 mg without a prescription. Lesions of the medial frontal lobes can produce akinetic mutism virus 68 symptoms cheap ciprofloksacin 250mg without a prescription, which is a syndrome of psychomotor retardation resembling severe depression antimicrobial lock solutions discount ciprofloksacin 500mg line. Lesions of the orbitofrontal cortex produce disinhibited behaviors that may transgress accepted social norms antibiotics for acne doryx ciprofloksacin 1000 mg with mastercard. Declarative memory relies upon the integrity of the Papez circuit in the mesial temporal lobes and diencephalon best antibiotics for sinus infection mayo clinic cheap ciprofloksacin 250 mg on line, including entorhinal cortex, the hippocampus, the fornix, the mammillary bodies, the mammillothalamic tract, the anterior nucleus of the thalamus, and the cingulate cortex. Diseases that affect these structures produce anterograde amnesia, with impaired ability to recall newly encoded information. This network is typically represented in the left hemisphere, but there may be bilateral or right hemispheric representation in some individuals. Homologous areas in the right hemisphere contribute to the generation and processing of music as well as prosody of language. The evaluation of language function includes an assessment of fluency, naming, repetition, comprehension, reading, and writing. Lesions in the language networks produce aphasia, which may be characterized as receptive, expressive, conductive, or global based upon the predominant abnormalities on examination. Lesions that disrupt right parietal areas and their networks may produce the clinical syndrome of hemispatial neglect. Higher-order visual processing also relies on a "ventral stream," which includes inferior temporal areas specialized for processing visual features of an object, a face, or a scene. These regions contribute to consciously experienced emotions but also have strong connections with functions unconsciously carried out by the autonomic nervous system. Pathology of the limbic system can have complex cognitive and behavioral manifestations that blur the distinction between neurologic and psychiatric disease. The cases in this section illustrate principles regarding the localization, diagnosis, and management of conditions that impair arousal or other cognitive functions. His past medical history included hypertension, diabetes mellitus, and prostate cancer. Six months later, his wife observed a progressive loss of interest in his previous hobbies and increasing apathy. Twelve months after symptom onset, the patient began having trouble finding his way home when driving. At the same time, his wife observed a personality change, describing her husband as "childlike," and said he began to follow her wherever she went. A year later, the patient developed difficulties with reading and spelling and became unable to plan ahead. His memory for events deteriorated and he had difficulty recognizing familiar faces. His difficulties in spatial orientation progressed until he ultimately got lost in the home he had lived in for 10 years. Prior to presentation, he began making sexually inappropriate comments that contrasted with his concurrent loss of libido. The neuropsychological evaluation upon admission revealed a severe amnestic syndrome, difficulties in naming and verbal comprehension, visuospatial impairment, a cognitive and behavioral prefrontal syndrome, and multimodal visual agnosia including prosopagnosia. Laboratory tests assess the most frequent endocrine and metabolic disorders (thyroid, parathyroid, B12, thiamine, folate and niacin deficiencies, hypoglycemia, hepatic encephalopathy, renal failure). Depending on the results of the abovementioned studies and the clinical context, the evaluation could also include testing for Lyme disease, Whipple disease, subacute sclerosing panencephalitis, progressive multifocal leukoencephalopathy, sarcoidosis, Hashimoto encephalopathy, paraneoplastic encephalopathy, and heavy metal poisoning. Metabolic studies can assess for leukodystrophies, encephalopathies, and porphyria. If the evaluation remains inconclusive, degenerative etiologies should be considered. When pyramidal, cerebellar, or choreiform movements are observed, a genetic study for Huntington disease or spinocerebellar ataxia should be performed. Motor impairment or a concurrent movement disorder suggests subcortical causes of dementia such as Parkinson disease dementia, progressive supranuclear palsy, and corticobasal degeneration. Finally, global (Alzheimer disease) or lobar predominant (frontotemporal lobe degeneration) cortical dementias need to be considered. If the pattern of atrophy is not suggestive of a specific type of degenerative disease, metabolic imaging can be performed (brain perfusion imaging) to further differentiate between the cortical dementias. For a long time, prosopagnosia was considered the main and earliest clinical feature of the syndrome. Affected patients exhibit progressive difficulties in recognizing and identifying the faces of familiar persons due to the multimodal loss of person-based knowledge. Another common symptom is topographic disorientation (getting lost) in familiar places (65%). Some additional symptoms are less frequently observed but are suggestive in this context: hyper-religiosity (15%), complex visual hallucinations (10%), and difficulties in performing calculations (5%). Neurologists need to be aware of the clinical characteristics of this entity, which have recently been described, in order to avoid misdiagnosis and potentially deleterious interventions. International Classification of Diseases and Health Related Problems, 10th Revision. Frequency and clinical characteristics of early-onset dementia in consecutive patients in a memory clinic. On the day prior to presentation, the patient began having memory difficulties and was noted by her husband to have completely forgotten many events and details of the previous days. She presented to an outside hospital where a comprehensive neurologic examination disclosed a nonfluent expressive aphasia but was otherwise unremarkable. Basic laboratory tests including electrolytes, complete blood count, and liver function tests had normal results. What is the differential diagnosis for subacute memory disturbances and confusion in this patient Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. Seizures with postictal confusion or exposure to psychoactive medications or drugs of abuse could produce the changes described. Stroke or cerebral hemorrhage must be considered, but the purely cognitive abnormalities without associated motor or sensory changes on examination would by atypical. Finally, transient global amnesia is a consideration, but is a diagnosis of exclusion. The initial workup would include intracranial imaging to assess for mass lesion, stroke, or hemorrhage. Lumbar puncture and systemic infectious workup should be considered given the recent fevers, upper respiratory symptoms, and changes in cognition. Infectious workup was notable for a rapid influenza swab that was positive for influenza A. What is the differential diagnosis of subacute altered mental status and seizures in association with mesial temporal lobe changes Seizure activity itself can lead to transient T2 hyperintensities in the medial temporal lobes. Other considerations in this patient would be a paraneoplastic or autoimmune encephalitis, but the acute onset and rapid decompensation is atypical. Lumbar puncture showed total protein of 443 mg/dL, glucose of 98 mg/dL, with 4 leukocytes and 11 erythrocytes per mm3. The patient became progressively more somnolent, requiring transfer to an intensive care unit, and she was transferred to our hospital for further evaluation and management. Her cranial nerves were normal, and she was able to localize to noxious stimuli in all extremities. Reflexes were brisk, measuring 3/4 in all 4 extremities, and the patient had positive Hoffman signs, flexor plantar response on the right, and equivocal response with fanning of the toes on the left. Acyclovir was continued, and the patient was empirically treated for bacterial meningitis with vancomycin and ceftriaxone. Repeat lumbar puncture showed total protein of 794 mg/dL, glucose of 84 mg/dL, with 4 leukocytes and 19 erythrocytes per mm3. Chest X-ray demonstrated a left lower lobe opacity, and the patient was treated with a 7-day course of ceftriaxone and azithromycin for pneumonia. She was enrolled in a clinical trial comparing oseltamivir to zanamivir for treatment of influenza. However, her condition continued to deteriorate despite antiviral therapy, and she required intubation for airway protection. Over the next several days, her examination results worsened such that she no longer spontaneously moved her extremities and only demonstrated stereotyped movements in response to noxious stimuli. She demonstrated some purposeful movements on hospital day 9 and was extubated on hospital day 11. Her condition slowly improved over the next week, and she was discharged to a rehabilitation facility on hospital day 21. On discharge, she was alert, was able to speak in 2-word sentences, could follow simple commands, and was able to walk with assistance. On follow-up 8 months later, the patient was fully ambulatory without residual aphasia, but had significant persistent deficits in anterograde and retrograde memory. McCray cared for the patient presented, wrote the text, and helped to assemble the figures. Deborah Forst cared for the patient presented, helped edit the text, and helped to assemble the figures. Neurological complications of pandemic influenza A H1N1 2009 infection: European case series and review. H1N1 encephalitis with malignant edema and review of neurologic complications from influenza. Grinspan, Division of Pediatric Neurology, Harkness Pavilion, 5th Floor, 180 Fort Washington Ave. She presented to the obstetrical service fully dilated after 2 days of leaking vaginal fluid, and delivered a healthy baby girl. She had had a febrile seizure at age 4, and several brief convulsions as a teenager. She recalled 2 of 3 words at 5 minutes, but had no memory for recent events, including her delivery. She could not describe cocktail ingredients, despite working as a bartender, but correctly recited old addresses. Encephalopathy suggests a process affecting large areas of the brain bilaterally due to metabolic derangements or diffuse structural injury to gray and/or white matter. Focal insults to structures responsible for memory or attention, such as the thalamus, hippocampus, and medial temporal lobe, may present similarly. Linking encephalopathy with the focal upper motor neuron sign of right leg hyperreflexia suggests a multifocal process. The differential diagnosis includes emergent peripartum conditions, such as dural sinus thrombosis, metastatic choriocarcinoma, and postpartum angiopathy, a form of reversible cerebral vasoconstriction syndrome. Subacute processes, such as demyelinating diseases and paraneoplastic processes, should also be considered. A complete blood count showed an elevated white blood cell count (14,000 per mm3). Lumbar puncture revealed a protein of 121 mg/dL, normal glucose, 3 white blood cells/mm3, and 23 red blood cells/mm3. Neurology 73 October 13, 2009 13 e75 agulation, endocrine, cardiac, lipid, and immunologic studies were unrevealing. Many lesions were hypointense on T1-weighted imaging and some demonstrated restricted diffusion. There were multiple lesions in the corpus callosum, many with a rim of T2 hyperintensity around a center of T1 hypointensity (figure 1). Magnetic resonance angiography showed caliber changes in the distal branches of both middle cerebral arteries. Optic neuritis worsens over hours to days, and lasts days to weeks, rather than 30 minutes. Susac syndrome is a microvasculopathy due to endothelial damage, which links encephalopathy, hearing loss, and visual changes. Digital subtraction angiography found generalized small caliber arteries intracranially, but no morphologic changes consistent with a large vessel vasculopathy as would be expected in postpartum angiopathy. To evaluate for Susac syndrome, ophthalmologic and audiologic evaluations were performed. Bedside dilated funduscopic examination revealed bilateral branch retinal artery occlusions with retinal infarcts. Fluorescein angiography found bilateral retinal infarcts, retinal artery branch occlusions, and arteriolar hyperfluorescence, suggesting a retinal vasculopathic process (figure 2). Muscle biopsy and additional serum tests to look for evidence of endothelial damage were obtained. We diagnosed Susac syndrome, or retinocochleocerebral vasculopathy, based on the pathognomonic triad of encephalopathy, branch retinal artery occlusions, and hearing loss. Only after an unrevealing evaluation for stroke did we learn of the visual and hearing loss. Also of note, initial bedside funduscopic examination found 16 e78 Neurology 73 October 13, 2009 sharp disc margins, but missed the retinal infarcts. Once we considered the rare diagnosis of Susac syndrome, ophthalmologic examination confirmed the branch retinal artery occlusions. This case underscores the importance of the history in an encephalopathic patient and the utility of a broad differential diagnosis. Months to years may separate the initial symptom from the development of the others. The characteristic callosal lesions in Susac syndrome are frequently misdiagnosed as demyelinating disease. Branch retinal artery occlusions present as flashes of light, black spots, scintillating scotoma, or occasionally monocular amaurosis fugax. Low frequencies are typically lost first, as the apex of the cochlea, which transduces lower frequencies, is more susceptible to infarction. Two developed symptoms during pregnancy, in 1 symptoms abated with pregnancy, and 3 had recurrent encephalopathy postpartum. Mycophenolate mofetil was added after a week, as she had not significantly improved, and the disease severity warranted additional immunosuppression. On discharge, 3 weeks postpartum, she demonstrated right visual field deficits, brisk reflexes, and clonus at both ankles, right more than left. Seven months postpartum, she continues to take mycophenolate mofetil, and is slowly tapering prednisone. She still complains of short-term memory problems, right eye visual problems, and poor hearing in her left ear. Postpartum cerebral angiopathy: reversible vasoconstriction assessed by transcranial Doppler ultrasounds. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome: a prospective series of 67 patients. Two weeks later, he experienced a severe headache of sudden onset without associated nausea, vomiting, or focal neurologic symptoms. This lasted for a few hours, abating after several doses of ibuprofen and acetaminophen. He continued to drive normally, but had a befuddled facial expression and did not respond to questions from his wife. He also developed recurrent, sudden, severe headaches that occurred several times per day. These episodes occurred more frequently when lying in bed than when he was standing or sitting, and were associated with nausea. He was admitted to another hospital for evaluation of these symptoms and transferred to our facility after a 1-hour spell of "unresponsiveness," which resolved spontaneously, while there. His wife described him as "vacant" and "not as active and happy-go-lucky" as usual. He developed a slowly progressive, mild dysarthria; difficulty walking due to frequent "buckling" of the right knee; and numbness in the right medial forearm and little finger. He also described difficulty in using his hands to perform tasks such as putting toothpaste on a toothbrush, which he described as being like "putting two magnets together. In addition to the childhood seizures, his past medical history was notable for a fungal infection of the lung in 1997 for which he had been admitted to an intensive care unit. The details of this illness were not known beyond the fact that he was treated for several months with an antibiotic. What features of the history are most useful in narrowing the differential diagnosis In this case, the history has two main components: spells of altered consciousness and episodes of severe headache. The spells of altered consciousness are most consistent with complex partial seizures. Migraine is unlikely in light of the sudden onset, postural variations, and associated intermittent confusion. Episodic intracranial hypertension from a mass lesion, hydrocephalus, meningitis, or some combination of these diagnoses is an important consideration given the positional nature of the headaches. Equally crucial to formulating a neurologic differential diagnosis is to begin to localize the disease process within the nervous system from the history. While the long duration of the event and the postictal period suggests a temporal lobe focus, it is impossible to precisely localize the seizure focus in this case solely from the history.

Dietary silicon affects acid and alkaline phosphatase and 45calcium uptake in bone of rats antibiotics depression discount 500mg ciprofloksacin overnight delivery. Arsenic mediates cell proliferation and gene expression in the bladder epithelium: Association with activating protein-1 transactivation antibiotics wiki 250mg ciprofloksacin mastercard. Marked increase in bladder and lung cancer mortality in a region of Northern Chile due to arsenic in drinking water antibiotics gave me diarrhea 250 mg ciprofloksacin for sale. Bioavailability of nickel in man: Effects of foods and chemically-defined dietary constituents on the absorption of inorganic nickel bacteria zinc discount ciprofloksacin 250mg. Community Health Associated with Arsenic in Drinking Water in Millard County safe antibiotics for sinus infection while pregnant safe ciprofloksacin 250mg, Utah antibiotics for acne for sale buy ciprofloksacin 1000 mg low cost. Effect of prolonged dietary administration of vanadate on blood pressure in the rat antibiotics for acne oily skin cheap ciprofloksacin 500mg on-line. Acute nickel toxicity in electroplating workers who accidently ingested a solution of nickel sulfate and nickel chloride antibiotic resistance lab report discount ciprofloksacin 750mg visa. Effects and dose-response relationships of skin cancer and blackfoot disease with arsenic. Tsuda T, Babazono A, Yamanoto E, Kurumatani N, Mino Y, Ogawa T, Kishi Y, Aoyama H. Ingested arsenic and internal cancer: A historical cohort study followed for 33 years. Diethyl maleate, an in vivo chemical depletor of glutathione, affects the response of male and female rats to arsenic deprivation. Effect of vanadium, iodine and their interaction on growth, blood variables, liver trace elements and thyroid status indices in rats. Deliberations and evaluations of the approaches, endpoints and paradigms for dietary recommendations of the other trace elements. In vivo percutaneous absorption of boron as boric acid, borax, and disodium octaborate tetrahydrate in humans: A summary. Cancer induction by an organic arsenic compound, dimethylarsinic acid (cacodylic acid), in F344/DuCrj rats after pretreatment with five carcinogens. A semiparametric transformation approach to estimating usual daily intake distributions. Feinleib M, Rifkind B, Sempos C, Johnson C, Bachorik P, Lippel K, Carroll M, Ingster-Moore L, Murphy R. In order to understand the phenomenon of same-sex sexual relations, we must first explore what the research shows about the origins of such attractions. One is that a homosexual orientation is essentially dictated by genetic and or biological factors-put simply, that people are "born gay. In the public square, the latter theory has appeared to be in decline and the former gaining favor in recent decades. Three of these in particular-a study of brain structure by Simon LeVay, a study of twins by J. Hamer-attracted considerable media attention and are largely responsible for the popular belief that a "gay gene" has already been found. The Brain Studies of Simon LeVay Some researchers have theorized that the sexual preferences and behavior of homosexuals may be dictated by the structure of the brain-particularly if the brains of homosexual men, for example, can be shown to resemble those of heterosexual women more than they resemble those of heterosexual men. One highly publicized study that purported to demonstrate this was conducted in 1991 by former Salk Institute researcher Simon LeVay. LeVay studied the brains of cadavers, including 18 men known to have been homosexual and one known to have been bisexual. He compared them with the brains of another 16 men and six women whom he presumed to have been heterosexual. It was also, however, more than twice as large in the heterosexual men as in the homosexual men. LeVay made questionable assumptions regarding the orientation of the "heterosexual" cadavers. On the other hand, three of the homosexuals had larger clusters than the mean size for "heterosexuals. Other Brain Studies Theories concerning the anterior commissure Since LeVay, researchers have examined other areas of the brain to see if there are differences between homosexuals and heterosexuals. Petito, and William Byne, "A Lack of Dimorphism of Sex or Sexual Orientation in the Human Anterior Commissure," Brain Research,936(2002):95. Such speculation is premature as the 23 studies that have sought sexual dimorphism [i. Furthermore, while some researchers did replicate the finding of a more bulbous splenium in women, others found it more bulbous in men and still others found no sex difference. As described by Byne, some of the negative studies have been unfortunately misinterpreted as successful replications. Pillardclaimtohavefoundahigherrateofhomosexuality among identical ("monozygotic") and fraternal ("dizygotic") twins than among adoptive siblings. In particular, although all recruiting advertisements stated that [subjects] were desired regardless of the sexual orientation of their relatives, there is no guarantee that volunteers heeded this request. Furthermore,thefactthattheconcordance rates were similar for nontwin biologic brothers (9. This is because dizygotic twins and full biologic siblings share the same proportion of genetic material. Thus, any difference in the true concordance rates would be attributable to environmental rather than genetic factors. While the study claimed to find "significant genetic effects" for the sexual orientationofwomen,nosucheffectswerefoundformen:"Formen,no significant genetic effects were found for number of opposite- and same-sex sexual encounters, nor for sexual orientation. Hershberger, "A Twin Registry Study of Male and Female Sexual Orientation," the Journal of Sex Research,34(2):212(1997). They found a strong familial resemblance, but had insufficient power to determine whether that correlation was due to genetic or environmental factors or both. The large proportion of discordant pairs underscores our ignorance of the factors that are involved, and the manner in which they interact, in the emergence of sexual orientation. Hamer, however, never claimed to have found a gene that inevitably determines that a person will be homosexual. Rather, he claimed to have located a genetic component to some instances of male homosexuality. The goal of our work was to determine whether or not male sexual orientation is genetically influenced. After studying 40 pairs of brothers who were homosexual, Hamer hypothesized that a certain genetic marker on the X chromosome was at least partially responsible for their homosexuality. Since men have an X and a Y chromosome, and they inherit their X chromosome from their mothers, Hamer theorized that the mother may be the carrier of the gene determining homosexuality in their sons. However, to date linkage studies have not found genes that code for complex behaviors. This could be explained if some instances of homosexuality were male-limited and maternally inherited whereas others were either sporadic, not sex-limited, or not maternally transmitted. Sib-pairs that are discordant at Xq28 should provide a useful resource for identifying additional genes or environmental, experiential, or cultural factors (or some combination of these) that influence the development of male sexual orientation. Support for this hypothesis was initially furnished by segregation patterns consistent with X linked transmission and reports of linkage to chromosomal region Xq2728. In some studies the statistical support for these findings far exceeded the significance levels reported by Hamer et al. Moreover, the evidence from twin and adoption studies for a genetic component in manic depressive illness was far more compelling than that for homosexuality. Unfortunately, non-replication of the linkage findings by other investigators, as well as extension and reevaluation of the original data, has resulted in diminished support for this hypothesis. This outcome underscores the uncertainties in linkage studies of complex behavioural traits. Most would agree that male homosexual orientation is not a simple Mendelian trait. This is important to consider, given the irreproducibility of many linkage reports for complex behavioral traits. Nonetheless, our data do not support the presence of a gene of large effect influencing sexual orientation at position Xq28. Also, from an evolutionary perspective, genetically determined homosexuality would have become extinct long ago because of reduced reproduction. Thus the purported linkage stands in apparent contradiction to the flimsy genetic and epidemiological evidence. Whether or not this sample is truly representative of familial homosexuality is an open question. Although these speculations have been faulted on theoretical, metatheoretical, and empirical grounds (Futuyma & Risch, 1983/84), a more basic problem with such arguments is their circularity. As Bleier has noted about similar accounts, this logic makes a premise of the genetic basis of behaviors, then cites a certain animal or human behavior, constructs a speculative story to explain how the behavior (if it were genetically based) could have served or could serve to maximize the reproductive success of the individual, and this conjecture then becomes evidence for the premise that the behavior was genetically determined. Theories that Hormone Levels Influence Sexual Orientation the theory that homosexuality was the result of a deficiency of male sex hormones in male homosexuals and, conversely, excessive levels of testosterone in lesbians, was repeatedly raised from the 1940s through the late 1970s. Prenatal hormone levels When research data failed to support this theory, attention turned from adult hormonal levels to the levels of hormones in the womb. However, other researchers questioned comparing hormonal levels in rats with humans. Motivated sexual behaviors in humans are unlikely to be under such rigid endocrine control. It is difficult to imagine that the gamut and plasticity of human sexual behavior can be reduced to factors as simple" as the way in which a female rat responds to a male. Genetic Characteristics May Play an Indirect Role in Sexual Orientation To date, all theories regarding the existence a "gay gene" remain unsubstantiated. However, some researchers suggest that genetics may play an indirect role through the presence of certain temperamental traits that increase the likelihood that certain individuals will experience same-sex attractions or come to identify themselves as homosexual. That is, given any heritability estimate, there are a variety of possible developmental mechanisms. For instance, these data are consistent with heritable variation in prenatal brain development or in some aspect of physical appearance that, by way of differential parental treatment, leads to differences in sexual orientation. Because such traits may be heritable or developmentally influenced by hormones, the model predicts an apparent nonzero heritability for homosexuality without requiring that either genes or hormones directly influence sexual orientation per se. Unfortunately, the caveat vanishes completely as word of the latest discovery moves from Science to Newsweek. The public can be forgiven for believing that research is but one government grant away from pinpointing the [sexual] preference gene. Do Upbringing, Experience, and the Social Environment Contribute to the Development of Homosexuality The result was not a conclusion based on an approximation of the scientific truth as dictated by reason, but was instead an action demanded by the ideological temper of the times. Prior to 1973 an extensive literature existed on the role of upbringing and experience in the development of homosexuality. In the remainder of this chapter we will examine parts of that large body of work showing the key developmental influences, as well as looking at more recent research supporting developmental theories of homosexuality. What happens after the child is born is complicated by many factors; there are not only inner biological and emotional factors, parental and familial surroundings, social and cultural circumstances; but the various pressures and expectations shift as the child grows and hardens as he establishes his ways into his eventual adult character structure. Gundlach,"ChildhoodParentalRelationshipsandtheEstablishmentofGenderRoles of Homosexuals," Journal of Consulting and Clinical Psychology,33(April1969):137. In fact, the current trend may be to underrate the explanatory power of extant psychosocial models. In1936,TermanandMilesfoundthemothersof homosexuals to be especially demonstrative, affectionate, and emotional, while the fathers were typically unsympathetic, autocratic, or frequently away from home. In this same publication, West presents his own study in England of 50 homosexual males and 50 matched control (nonhomosexual) males. His findings clearly show that male homosexuals are much more likely to come from a family constellation involving an overintense mother and unsatisfactory father relationship. The Work of Irving Bieber A study conducted by a team of researchers headed by Irving Bieber, published as a book in 1962, is still considered a landmark in the field. From our statistical analysis, the chances appear to be high that any son exposed to this parental combination will become homosexual or develop severe homosexual problems. In 1964 a British psychiatrist compared his patients who were either homosexuals or neurotic heterosexuals, and reported that "approximately 70 percent of the homosexuals (62 percent plus one-third of 28 percent) were either over-attached to their mother or did not get on well with their father. Whereas the percent of close-binding-intimate mothers was 55 for the Homosexuals, the corresponding percent for the Controls was only 20. We had 42 percent detached fathers for the Homosexuals and 24 percent for the Controls. The present authors feel that the function of the detached father in the psychogenesis of male homosexuality deserves a more important place than hitherto it has been given. AirForce,"therewastheopportunitytointerviewandtest approximately 40 male airmen in whom predominant or exclusive homosexuality was the major problem. In more than 30 of these cases, the mother-son and father-son relationship conformed to the family pattern described above. Not one of these airmen had a close, warm, affectionate attachment to his father or a father-substitute in childhood. Brown,"HomosexualityandFamilyDynamics,"Bulletin of the Menninger Clinic 27 (5): 229(Sept. In addition, Hooker herself has been criticized for recruiting research subjects from radical homosexual groups and others with an obvious agenda to promote (see Thomas Landess, "The Evelyn Hooker Study and the NormalizationofHomosexuality,"[FamilyResearchCouncil,1995]). Meanwhile, other research drawn from subjects in the general population confirmed the work of Bieber and others. Evans of the Loma Linda University School of Medicine was published in the Journal of Consulting and Clinical Psychology. Evans of the Loma Linda University School of Medicine concluded: "The present results were remarkably similar to those of Bieber et al. The results strongly suggested poor parental relationships during childhood for the homosexual men, at least as seen in retrospect. In my view, Evans is overly cautious in his assertion that his findings neither confirm nor refute the etiological role of parent-child relations as one set of many variables influencing or causing homosexuality in adult life. Beginning with the penetrating clinicalinsightsofFreud50yearsago,thesystematicinvestigation byTermanandMilessome30yearsago,theindependentfindingsof a number of clinical and research workers, and the recent noteworthy contributions of West and Bieber, there is now strong evidence and considerable agreement as to family dynamics in the development of male homosexuality. It is surprising there has not been greater recognition of this relationship among the various disciplines that are concerned with children. There would seem to be no justification for waiting another 25 or 50 years to bring this information to the attention of those who deal with children. And there is no excuse for professional workers in the behavioral sciences to continue avoiding their responsibility to disseminate this knowledge and understanding as widely as possible. Brown,"HomosexualityandFamilyDynamics,"Bulletin of the Menninger Clinic 27 (5): 232(Sept. The "exotic becomes erotic" theory Another more recent theory regarding the development of same-sex attraction is offered by Daryl Bem of Cornell University. These preferences lead children to feel different from opposite or same-sex peers-to perceive them as dissimilar, unfamiliar, and exotic. This, in turn, produces heightened nonspecific autonomic arousal that subsequently gets eroticized to that same class of dissimilar peers: Exotic becomes erotic. The theory claims to accommodate both the empirical evidence of the biological essentialists and the cultural relativism of the social constructionists. At first this produces strong negative arousal, but with repeated encounters over time, the fear and anger habituate and the opponent process becomes the conditioned, dominant affect. He thus emerges into late childhood or adolescence experiencing positive affective arousal to males, an arousal ready to be eroticized. Such a mechanism would allow for multiple developmental pathways leading to homosexuality and would account for the high concordance rate for homosexuality among identical twins reared together, as well as for the failures of various psychosocial theories that have focused exclusively either on personality traits of individuals or on various environmental factors, but not on the interaction of the two.

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Managing Treatment Failure Both voriconazole and posaconazole have been used successfully in a small number of refractory cases in adults antibiotic resistant kennel cough cheap ciprofloksacin 500 mg fast delivery. Discontinuing Secondary Prophylaxis Discontinuation of secondary prophylaxis (suppressive therapy) has not been examined in children antibiotic resistance the last resort purchase ciprofloksacin 1000mg without prescription. Histoplasmosis in pregnancy: case series and report of transplacental transmission antibiotics make me sick ciprofloksacin 750mg with amex. A human immunodeficiency virus-positive infant with probable congenital histoplasmosis in a nonendemic area infection heart buy generic ciprofloksacin 500mg on-line. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America virus 01 april purchase ciprofloksacin 1000 mg without prescription. Disseminated histoplasmosis as the acquired immunodeficiency syndrome-defining illness in an infant antibiotic resistance questions and answers generic ciprofloksacin 750 mg on line. Disseminated histoplasmosis in a human immunodeficiency virus-infected African child antibiotic jaundice ciprofloksacin 250mg generic. Antigen detection virus 912 500 mg ciprofloksacin fast delivery, serology, and molecular diagnosis of invasive mycoses in the immunocompromised host. Histoplasma, Blastomyces, Coccidioides, and other dimorphic fungi causing systemic mycoses. Urine polymerase chain reaction is not as sensitive as urine antigen for the diagnosis of disseminated histoplasmosis. Disseminated histoplasmosis: a comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals. Improved detection of Histoplasma antigenemia following dissociation of immune complexes. Emergence of resistance to fluconazole as a cause of failure during treatment of histoplasmosis in patients with acquired immunodeficiency disease syndrome. Increased incidence of disseminated histoplasmosis following highly active antiretroviral therapy initiation. Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy. Children also commonly present with lymphatic involvement (30% to 64%), a particularly aggressive form of the disease, and as many as 10% to 18% of these children may not have skin lesions. Intraoral lesions may be seen in 21% to 41%, occasionally (4%) without skin lesions. Multicentric Castleman disease presents with generalized adenopathy and fever and may progress to multiorgan failure. Primary effusion lymphoma presents with symptoms related to fluid accumulation in the pleural or pericardial space or with abdominal distention. Serologic tests range in sensitivity from 80% to 90% and interassay agreement is poor. Although these tests have high levels of sensitivity, their specificity and reproducibility are highly variable. The available studies were retrospective, had relatively small sample sizes, and were performed in sub-Saharan Africa. It is unclear, however, if localized disease (stage T0) can be treated effectively without systemic chemotherapy. Data are insufficient on which to base a recommendation for a particular chemotherapy regimen, and various regimens have been used in different settings. Patient clinical presentation and available therapies in the practice setting should be considered, in consultation with an oncologist. Risk factors for human herpesvirus 8 infection among adults in the United States and evidence for sexual transmission. Blood-borne and sexual transmission of human herpesvirus 8 in women with or at risk for human immunodeficiency virus infection. Human herpesvirus 8: seroepidemiology among women and detection in the genital tract of seropositive women. Geographical differences in human herpesvirus 8 seroepidemiology: a survey of 1,201 individuals in Asia. Frequent and asymptomatic oropharyngeal shedding of human herpesvirus 8 among immunocompetent men. Human herpesvirus 8 infection in children and adults in a population-based study in rural Uganda. Human herpesvirus 8 primary infection occurs during childhood in Cameroon, Central Africa. Human herpesvirus 8 transmission from mother to child and between siblings in an endemic population. Transmission of Kaposi sarcoma-associated herpesvirus between mothers and children in a South African population. Human herpes virus type 8-associated Kaposi sarcoma in a pediatric liver transplant recipient. Extensive gingival and respiratory tract Kaposi sarcoma in a child after allogenic hematopoietic stem cell transplantation. Human herpesvirus 8-encoded thymidine kinase and phosphotransferase homologues confer sensitivity to ganciclovir. Bone marrow failure associated with human herpesvirus 8 infection after transplantation. Human herpesvirus 8-associated hemophagocytic lymphohistiocytosis in human immunodeficiency virus-infected patients. Treatment of Kaposi sarcoma in human immunodeficiency virus-1-infected Mozambican children with antiretroviral drugs and chemotherapy. Human herpesvirus 8-associated neoplasms: the roles of viral replication and antiviral treatment. Successful secondary prophylaxis for primary effusion lymphoma with human herpesvirus 8 therapy. Predictors of immune reconstitution inflammatory syndrome-associated with kaposi sarcoma in mozambique: a prospective study. Reduced human herpesvirus-8 oropharyngeal shedding associated with protease inhibitor-based antiretroviral therapy. The bivalent and quadrivalent vaccines are approved for females and the quadrivalent vaccine is approved for males. The estimated prevalence of skin warts in immunocompetent children varies by population from approximately 5% to 50%. Together, these data show that while oral and genital perinatal transmission can occur, persistence is unusual when infection is acquired (whether through vertical or horizontal transmission). The observational study also noted that 23 cases of condyloma were reported in those younger than age 13. Warts can be single or present with multiple lesions and often appear as papules, flat, smooth or pedunculated lesions. Cancers are often asymptomatic but also can be associated with bleeding, pain or a palpable mass. Diagnosis Genital, Anal, Oral and Skin Warts Most cutaneous and anogenital warts can be diagnosed by visual inspection. A speculum examination may be required for cervical and vaginal lesions and anoscopy for intra-anal lesions. If the lesions do not respond to standard therapy or the warts are pigmented, indurated, fixed, or ulcerated, biopsy may be needed. In sexually active individuals, the entire genitalia and anal canal should be inspected carefully for visual signs of warts, intraepithelial neoplasia or invasive cancers. Vaginal, vulvar, and anal cancers often can be palpated by digital examination of the vaginal, vulvar, and intra-anal regions. Quadrivalent vaccine also offers protection against the two most common types that cause genital warts. The second dose should be administered 1 to 2 months after the first dose, and the third dose should be administered 6 months after the first dose. If Pap smear results are abnormal, care should be provided according to the Guidelines for Management of Women with Abnormal Cervical Cancer Screening Tests by American Society for Colposcopy and Cervical Pathology. Cryotherapy (application of liquid nitrogen or dry ice) must be applied until each lesion is thoroughly frozen. Lesions can be removed surgically by tangential scissor, tangential shave excision, curettage, or electrosurgery. The major toxicity of podofilox, imiquimod, and sinecatechin ointment is inflammation at the application site. The major toxicities of surgical treatment for genital warts are local pain, bleeding, and secondary infection. The major toxicities associated with acid cauterization are local pain and irritation or ulceration of adjacent normal skin. Topical cidofovir may result in systemic absorption and be associated with renal toxicity. Recalcitrant warts should be managed by experienced clinicians and referred for excisional therapy. Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Warts in primary schoolchildren: prevalence and relation with environmental factors. Transmission of human genital papillomavirus disease: comparison of data from adults and children. Pediatric anogenital warts: a 7-year review of children referred to a tertiary-care hospital in Montreal, Canada. Anogenital and respiratory tract human papillomavirus infections among children: age, gender, and potential transmission through sexual abuse. Epidemiology of adult sexually transmitted disease agents in children being evaluated for sexual abuse. Vertical transmission of the human papillomavirus: a systematic quantitative review. Relationship of pregnancy to human papillomavirus among human immunodeficiency virus-infected women. Condyloma in pregnancy is strongly predictive of juvenileonset recurrent respiratory papillomatosis. Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Incidence, duration, and determinants of cervical human papillomavirus infection in a cohort of Colombian women with normal cytological results. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Epidemiology of human papillomavirus infection and abnormal cytologic test results in an urban adolescent population. A longitudinal study of genital human papillomavirus infection in a cohort of closely followed adolescent women. Risk of female human papillomavirus acquisition associated with first male sex partner. Prevalence of and risks for cervical human papillomavirus infection and squamous intraepithelial lesions in adolescent girls: impact of infection with human immunodeficiency virus. The role of sexual behavior and human papillomavirus persistence in predicting repeated infections with new human papillomavirus types. Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. The human papillomavirus infection in men study: human papillomavirus prevalence and type distribution among men residing in Brazil, Mexico, and the United States. Prevalence of and risk factors for anal human papillomavirus infection in men who have sex with women: a cross-national study. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. The significance of squamous metaplasia in the development of low grade squamous intraepithelial lesions in young women. Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial. Consistent condom use is associated with lower prevalence of human papillomavirus infection in men. Use-effectiveness of the female versus male condom in preventing sexually transmitted disease in women. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in Orange Farm, South Africa. The highly protective effect of newborn circumcision against invasive penile cancer. Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. Male circumcision and serologically determined human papillomavirus infection in a birth cohort. External genital warts: report of the American Medical Association Consensus Conference. Cervical intraepithelial neoplasia in women infected with human immunodeficiency virus: prevalence, risk factors, and validity of Papanicolaou smears. Infrared coagulator: a useful tool for treating anal squamous intraepithelial lesions. Human papillomavirus-associated oral warts among human immunodeficiency virus-seropositive patients in the era of highly active antiretroviral therapy: an emerging infection. Multiple recurrences of cervical intraepithelial neoplasia in women with the human immunodeficiency virus. N/A Adequate topical anesthetics to the genital area should be given before caustic modalities are applied. Treatment is directed at maintaining the airway, rather than removing all disease. Abnormal Pap smear cytology should be referred to colposcopy for diagnosis and management. Epidemiology Influenza viruses are spread directly from person to person across distances up to 6 feet via large or small droplets generated by coughing or sneezing, or indirectly from contaminated surfaces to hands to mucosal membranes. Influenza A viruses are further subdivided based on surface glycoproteins: hemagglutinin (H) and neuraminidase (N). Influenza A viruses circulate primarily among aquatic birds, but also among humans and other animals, including pigs, horses, and seals. Two influenza A subtypes (one H1N1 and one H3N2); and one influenza B strain for trivalent vaccine formulations, or two influenza B strains for quadrivalent vaccine formulations are included in current seasonal influenza vaccines. In the United States, influenza viruses cause annual outbreaks lasting from winter through spring. Prevention Recommendations Preventing Exposure Basic personal hygiene, including hand hygiene and proper cough etiquette, are mainstays of influenza prevention. Individuals should avoid touching their eyes, nose, and mouth and avoid contact with sick individuals. Hands should be washed often with soap and water or, if soap and water are unavailable, with an alcohol-based hand rub containing at least 60% alcohol. Proper hand washing technique involves wetting hands with clean running water, applying soap, and rubbing and scrubbing all hand surfaces and under the fingernails for at least 20 seconds. When using alcohol-based hand rub, the hand rub should be applied to one hand, and the hands (including all hand surfaces and fingers) should be rubbed together until dry. Cough etiquette directs that individuals cough or sneeze into a tissue rather than into their hands. Measures used by public health authorities during influenza pandemics include recommendations to reduce crowding, to maintain a few feet of distance from others, to avoid shaking hands or hugging at gatherings, and to avoid gatherings altogether (see Preventing the Flu: Good Health Habits Can Help Stop Germs and Handwashing: Clean Hands Save Lives). Prolonged influenza viral replication in immunocompromised patients has implications for spread of influenza in the health care setting, as well as in the community. Immunocompromised patients with prolonged viral replication in the respiratory tract could potentially serve as a reservoir for spread of influenza in the hospital and the community. In addition, prolonged viral replication increases the risk for emergence of antiviral resistance if antiviral exposure occurs. Strategies to prevent the spread of influenza in health care facilities include use of standard and droplet precautions by health care workers, as well as caution when performing aerosol-generating procedures according to Healthcare Infection Control Practices Advisory Committee guidelines. Household members may be vaccinated with any medically appropriate vaccine formulation. Preventing First Episode of Disease Annual influenza vaccination is a cornerstone of influenza prevention at both the individual and community level. Persons who report having had egg-associated reactions involving symptoms other than hives. Preexposure prophylaxis should rarely be used, except in persons who are severely immunocompromised and therefore at very high risk for influenza virus-associated morbidity and mortality during periods of greatly increased risk for influenza exposure. Post-exposure antiviral chemoprophylaxis should be started within 48 hours of exposure to a contact with confirmed or suspected influenza. Oseltamivir and zanamivir, which are members of the antiviral class of medications called neuraminidase inhibitors, are approved and are recommended for chemoprophylaxis against influenza A and B viruses in children.

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Providing harmony and stability Notice that in addition to providing food antibiotics guide ciprofloksacin 1000 mg cheap, shelter antibiotic x-206 buy ciprofloksacin 750mg lowest price, and clothing antibiotics zomboid buy 500 mg ciprofloksacin, families are responsible for helping the child learn infection rates in hospitals order ciprofloksacin 500 mg amex, relate to others antibiotics and beer order 1000 mg ciprofloksacin visa, and have a confident sense of self bacteria bugs generic ciprofloksacin 500mg. Hopefully antibiotics for dogs wounds trusted 500 mg ciprofloksacin, the family will provide a harmonious and stable environment for living antibiotics lyme purchase 1000mg ciprofloksacin visa. Sometimes families emphasize physical needs but ignore cognitive or emotional needs. The tasks of families listed above are functions that can be fulfilled in a variety of family types-not just intact, two-parent households. Parenting Styles: As discussed in the previous chapter, parenting styles affect the relationship parents have with their children. The authoritative style, which 200 incorporates reason and engaging in joint decision-making whenever possible may be the most effective approach (Berk, 2007). However, Asian-American, African-American, and MexicanAmerican parents are more likely than European-Americans to use an authoritarian style of parenting. This authoritarian style of parenting that uses strict discipline and focuses on obedience is also tempered with acceptance and warmth on the part of the parents. Children raised in this manner tend to be confident, successful and happy (Chao, 2001; Stewart & Bond, 2002). Living Arrangements: Certainly, the living arrangements of children have changed significantly over the years. In 1960, 92% of children resided with married parents, while only 5% had parents who were divorced or separated and 1% resided with parents who had never been married. By 2008, 70% of children resided with married parents, 15% had parent who were divorced or separated, and 14% resided with parents who had never married (Pew Research Center, 2010). In 2017, only 65% of children lived with two married parents, while 32% (24 million children younger than 18) lived with an unmarried parent (Livingston, 2018). Most children in unmarried parent households in 2017 were living with a solo mother (21%), but a growing share were living with cohabiting parents (7%) or a sole father (4%) (see Figure 5. The increase in children living with solo or cohabiting parents was thought to be due to the overall declines in marriage, as well as increases in divorce. Specifically, 30% of solo mothers, 17% of solo fathers, and 16% of families with a cohabitating couple lived in poverty. In contrast, only 8% of married couples lived below the poverty line (Livingston, 2018). Patterson (2013) reviewed more than 25 years of social science research on the development of children raised by lesbian and gay parents and found no evidence of detrimental effects. In fact, research has demonstrated that children of lesbian and gay parents are as well-adjusted overall as those of heterosexual parents. Specifically, research comparing children based on parental sexual orientation has not shown any differences in the development of gender identity, Source gender role development, or sexual orientation. Additionally, there were no differences between the children of lesbian or gay parents and those of heterosexual parents in separation-individuation, behavior problems, self-concept, locus of control, moral judgment, school adjustment, intelligence, victimization, and substance use. Further, research has consistently found that children and adolescents of gay and lesbian parents report normal social relationships with family members, peers, and other adults. Patterson concluded that there is no evidence to support legal discrimination or policy bias against lesbian and gay parents. These problems were evident immediately after the separation and also in early and middle adolescence. An analysis of divorce factors indicated that children exhibited more externalizing behaviors if the family had fewer financial resources before the separation. It was hypothesized that the lower income and lack of educational and community resources contributed to the stress involved in the divorce. Additional concerns include that the child will grieve the loss of the parent they no longer see as frequently. The child may also grieve about other family members that are no longer available. Very often, divorce means a change in the amount of money coming into the household. Custodial mothers experience a 25% to 50% drop in their family income, and even five years after the divorce they have reached only 94% of their pre-divorce family income (Anderson, 2018). School-aged children, especially, may notice that they can no longer have toys, 202 clothing or other items to which they have grown accustomed. Or it may mean that there is less eating out or being able to afford participation in extracurricular activities. The custodial parent may experience stress at not being able to rely on child support payments or having the same level of income as before. This can affect decisions regarding healthcare, vacations, rents, mortgages and other expenditures, and the stress can result in less happiness and relaxation in the home. The parent who has to take on more work may also be less available to the children. Relationships of adult children of divorce are identified as more problematic than those adults from intact homes. For 25 years, Hetherington and Kelly (2002) followed children of divorce and those whose parents stayed together. The results indicated that 25% of adults whose parents had divorced experienced social, emotional, or psychological problems compared with only 10% of those whose parents remained married. For example, children of divorce have more difficulty forming and sustaining intimate relationships as young adults, are more dissatisfied with their marriage, and consequently more likely to get divorced themselves (Arkowitz & Lilienfeld, 2013). One of the most commonly cited long-term effects of divorce is that children of divorce may have lower levels of education or occupational status (Richter & Lemola, 2017). This may be a consequence of lower income and resources for funding education rather than to divorce per se. In those households where, economic hardship does not occur, there may be no impact on long-term economic status (Drexler, 2005). According to Arkowitz and Lilienfeld (2013), long-term harm from parental divorce is not inevitable, however, and children can navigate the experience successfully. For example, children manage better when parents limit conflict, and provide warmth, emotional support and appropriate discipline. Further, children cope better when they reside with a well-functioning parent and have access to social support from peers and other adults. Those at a higher socioeconomic status may fare better because some of the negative consequences of divorce are a result of financial hardship rather than divorce per se (Anderson, 2014; Drexler, 2005). It is important when considering the research findings on the consequences of divorce for children to consider all the factors that can influence the outcome, as some of the negative consequences associated with divorce are due to preexisting problems (Anderson, 2014). Although they may experience more problems than children from non-divorced families, most children of divorce lead happy, well-adjusted lives and develop strong, positive relationships with their custodial parent (Seccombe & Warner, 2004). Children from single-parent families talk to their mothers more often than children of two-parent families (McLanahan & Sandefur, 1994). In a study of college-age respondents, Arditti (1999) found that increasing closeness and a movement toward more democratic parenting styles was experienced. Others have also found that relationships between mothers and children become closer and stronger (Guttman, 1993) and suggest that greater equality and less rigid parenting is beneficial after divorce (Steward, Copeland, Chester, Malley, & Barenbaum, 1997). Specifically, children with an easygoing temperament, who problem-solve well, and seek social support manage better after divorce. A further protective factor for children is intelligence (Weaver & Schofield, 2015). Children may be given more opportunity to discover their own abilities and gain independence that fosters self-esteem. Overall, not all children of divorce suffer negative consequences (Hetherington & Kelly, 2002). Furstenberg and Cherlin (1991) believe that the primary factor influencing the way that children adjust to divorce is the way the custodial parent adjusts to the divorce. The remarriage of a parent may be a more difficult adjustment for a child than the divorce of a parent (Seccombe & Warner, 2004). Parents and children typically have different ideas of how the stepparent should act. A more democratic style of parenting may become more authoritarian after a parent remarries. Biological parents are more likely to continue to be involved with their children jointly when neither parent has remarried. They are least likely to jointly be involved if the father has remarried and the mother has not. Cohabitation can be difficult for children to adjust to because cohabiting relationships in the United States tend to be short-lived. Even in long-term cohabiting relationships, once it is over, continued contact with the child is rare. In contrast, children of Asian descent are more likely to be living with two married parents, often in their first marriage. In the 1700-1800s there were many blended families, but they were created because someone died and remarried. Most blended families today are a result of divorce and remarriage, and such origins lead to new considerations. Blended Source families are different from intact families and more complex in a number of ways that can pose unique challenges to those who seek to form successful blended family relationships (Visher & Visher, 1985). Children may be a part of two households, each with different rules that can be confusing. For example, stepparents expect more gratitude and acknowledgment from the stepchild than they would with a biological child. Stepchildren experience more uncertainty/insecurity in their relationship with the parent and fear the parents will see them as sources of tension. This occurs especially if there has not been time for the relationship to develop. Computerized working memory training: Can lead to gains in cognitive skills in students Rethinking relationships between divorced mothers and their children: Capitalizing on family strengths. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. A method of measuring the development of the intelligence of young children (3rd ed. Child obesity cut-offs as derived from parental perceptions: Cross-sectional questionnaire. Construct validation of the Sternberg Triarchic Abilities Test: Comment and reanalysis. Union transitions among cohabitors: the significance of relationship assessments and expectations. Rethinking environmental contributions to child and adolescent psychopathology: A meta-analysis of shared environmental influences. Extending research on the consequences of parenting styles for Chinese Americans and European Americans. From censure to reinforcement: Developmental changes in the association between aggression and social status. Friendship expectations and the evaluation of present friendships in middle childhood and early adolescence. The contributions of domain-general and numerical factors to third-grade arithmetic skills and mathematical learning disability. Do impaired memory and body weight regulation originate in childhood with diet-induced hippocampal dysfunction Inter-relationships among diet, obesity, and hippocampal-dependent cognitive function. The scientific study of expert levels of performance: General implications for optimal learning and creativity. The development of secondary discourse ability and metalinguistic awareness in second language learners. Mainstream science on intelligence: An editorial with 52 signatories, history and bibliography. Credulity and gullibility in people with developmental disorders: A framework for future research. The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Savings in the relearning of second language vocabulary: the effects of time and proficiency. Moments of social inclusion and exclusion: Race, class, and cultural capital in family-school relationships. Three children, two languages, and strategic reading: Case studies in bilingual/monolingual reading. Learning together and alone: Cooperative, competitive, and individualistic learning, (5th ed. A role for the X chromosome in sex differences in variability in general intelligence Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents. Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: A review of current evidence. Study of mathematically precocious youth after 35 years: Uncovering antecedents for the development of math-science expertise. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: A randomised, double-blinded, placebo-controlled trial. The association of sports specialization and history of lower extremity injury in high school athletes. Stability and change in peer-rejected status: the role of child behavior, parenting, and family ecology. Gender stereotype endorsement and achievement-related outcomes: the role of competence beliefs and task values. Working memory capacity in preschool children contributes to the acquisition of school relevant precursor skills. Growing up with a single mother and life satisfaction in adulthood: A test of mediating and moderating factors. Peer victimization during middle childhood as a lead indicator of internalizing problems and diagnostic outcomes in late adolescence. The social context of career success and course for 2,026 scientists and inventors. Practical intelligence: the nature and role of tacit knowledge in work and at school. Etiologic subtypes of attention-deficit/hyperactivity disorder: brain imaging, molecular genetic and environmental factors and the dopamine hypothesis. Parameters of cortical interactions in subjects with high and low levels of verbal creativity. Developmental changes in attention tests norms: Implications for the structure of attention. Cognitive psychophysiology: A window to cognitive development and brain maturation. Effects of modafinil on dopamine and dopamine transporters in the male human brain: Clinical implications. Creativity: Understanding innovation in problem solving, science, invention, and the arts. Does the treatment of Attention-deficit/hyperactivity disorder with stimulants contribute to use/abuse Peer relationships are important sources of support, but companionship during adolescence can also promote problem behaviors. Identity formation occurs as adolescents explore and commit to different roles and ideological positions. Because so much is happening in these years, psychologists have focused a great deal of attention on the period of adolescence. Girls begin puberty at around ten years of age and boys begin approximately two years later. The overall physical growth spurt results in 10-11 inches of added height and 50 to 75 pounds of increased weight. The head begins to grow sometime after the feet have gone through their period of growth. The difference in these patterns of growth result in adolescents appearing awkward and out-of-proportion. From approximately age ten to fourteen, the average girl is taller, but not heavier, than the average boy. After that, the average boy becomes 215 both taller and heavier, although individual differences are certainly noted. As adolescents physically mature, weight differences are more noteworthy than height differences. At eighteen years of age, those that are heaviest weigh almost twice as much as the lightest, but the tallest teens are only about 10% taller than the shortest (Seifert, 2012). Most modern societies, and the teenagers in them, tend to favor relatively short women and tall men, as well as a somewhat thin body build, especially for girls and women. Yet, neither socially preferred height nor thinness is the destiny for many individuals. Being overweight, in particular, has become a common, serious problem in modern society due to the prevalence of diets high in fat and lifestyles low in activity (Tartamella, Herscher, & Woolston, 2004). The educational system has, unfortunately, contributed to the problem as well by gradually restricting the number of physical education courses and classes in the past two decades.

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For instance antibiotics h pylori discount ciprofloksacin 750mg, a developmental psychologist might watch children on a playground and 24 describe what they say to each other antibiotics zone of inhibition order ciprofloksacin 750 mg mastercard. However antibiotics cvs ciprofloksacin 1000 mg on-line, naturalistic observations do not allow the researcher to have any control over the environment antibiotic resistance funding quality ciprofloksacin 250 mg. Laboratory observation antibiotics for acne when pregnant cheap 1000mg ciprofloksacin free shipping, unlike the naturalistic observation antibiotic guide hopkins ciprofloksacin 500mg cheap, is conducted in a setting created by the researcher antibiotic vs antiviral purchase 250mg ciprofloksacin with amex. One example of laboratory observation involves a systematic procedure known as the strange situation test antibiotics for uti e coli cheap 250 mg ciprofloksacin otc, which you will learn about in chapter three. Concerns regarding laboratory observations are that the participants are aware that they are being watched, and there is no guarantee that the behavior demonstrated in the laboratory will generalize to the real world. Survey: In other cases, the data from descriptive research projects come in the form of a survey, which is a measure administered through either a verbal or written questionnaire to get a picture of the beliefs or behaviors of a sample of people of interest. The people chosen to participate in the research, known as the sample, are selected to be representative of all the people that the researcher wishes to know about called the population. A representative sample would include the same percentages of males, females, age groups, ethnic groups, and socio-economic groups as the larger population. Source Surveys gather information from many individuals in a short period of time, which is the greatest benefit for surveys. However, surveys typically yield surface information on a wide variety of factors but may not allow for in-depth understanding of human behavior. Another problem is that respondents may lie because they want to present themselves in the most favorable light, known as social desirability. They also may be embarrassed to answer truthfully or are worried that their results will not be kept confidential. Interviews: Rather than surveying participants, they can be interviewed which means they are directly questioned by a researcher. Interviewing participants on their behaviors or beliefs can solve the problem of misinterpreting the questions posed on surveys. The examiner can explain the questions and further probe responses for greater clarity and understanding. Although this can yield more accurate results, interviews take longer and are more expensive to administer than surveys. Participants can also demonstrate social desirability, which will affect the accuracy of the responses. Psychophysiological Assessment: Researchers may also record psychophysiological data, such as measures of heart rate, hormone levels, or brain activity to help explain development. These measures may be recorded by themselves or in combination with behavioral data to better understand the bidirectional relations between biology and behavior. Special equipment has been developed to allow researchers to record the brain activity of very young and very small research 25 subjects. These electrodes record tiny electrical currents on the scalp of the participant in response to the presentation of stimuli, such as a picture or a sound. Webb, Dawson, Bernier, and Panagiotides (2006) examined face and object processing in children with autism spectrum disorders, those with developmental delays, and those who were typically developing. The children wore electrode caps and had their brain activity recorded as they watched still photographs of faces of their mother or of a stranger, and objects, including those that were familiar or unfamiliar to them. The researchers examined differences in face and object processing by group by observing a component of the brainwaves. Findings suggest that children with autism are in some way processing faces differently than typically developing children and those with more general developmental delays. Source Secondary/Content Analysis involves analyzing information that has already been collected or examining documents or media to uncover attitudes, practices or preferences. There are a number of data sets available to those who wish to conduct this type of research. Census Data is available and widely used to look at trends and changes taking place in the United States. The researcher conducting secondary analysis does not have to recruit subjects, but does need to know the quality of the information collected in the original study. Correlational Research In contrast to descriptive research, which is designed primarily to provide static pictures, correlational research involves the measurement of two or more relevant variables and an assessment of the relationship between or among those variables. For instance, the variables of height and weight are systematically related (correlated) because taller people generally weigh more than shorter people. The Pearson Correlation Coefficient, symbolized by the letter r, is the most common statistical measure of the strength of linear relationships among variables. The strength of the linear relationship is indexed by the distance of the correlation coefficient from zero (its absolute value). The direction of the linear relationship is indicated by the sign of the correlation coefficient. When the straight line indicates that individuals who have high values for one Figure 1. Examples of positive correlations include those between education and income, and between age and mathematical abilities in children. In each case people who score higher on one of the variables also tend to score higher on the other variable. Negative correlations, in contrast, as shown in part (b), occur when high values for one variable tend to be associated with low Some examples of relationships between two variables as shown in scatter plots. Examples of negative correlations include those between the age of a child and the number of diapers the child uses, and between practice and errors made on a learning task. In these cases, people who score higher on one of the variables tend to score lower on the other variable. An important limitation of correlational research designs is that they cannot be used to draw conclusions about the causal relationships among the measured variables. Consider, for instance, a researcher who has hypothesized that viewing violent behavior will cause increased aggressive play in children. He has collected, from a sample of fourth-grade children, a measure of how much violent television each child views during the week, as well as a measure of how aggressively each child plays. The researcher discovers a positive correlation between the two measured variables. Although this positive correlation appears to support the hypothesis, it cannot be taken to indicate that viewing violent television causes aggressive behavior as there are other possible explanations. One alternative is that children who behaved aggressively at school want to watch violent television shows. Still another possible explanation for the observed correlation is that it has been produced by the presence of a third variable. A third variable is a variable that is not part of the research hypothesis but produces the observed correlation between them. Parents who use a harsh and punitive discipline style may produce children who both like to watch violent television and who behave aggressively in comparison to children whose parents use less harsh discipline. It is important that when you read about correlational research projects, you keep in mind the possibility of third variables. Strengths and limitations: Correlational research can be used when experimental research is not possible because the variables cannot be manipulated or it would be unethical to use an experiment. Correlational designs also have the advantage of allowing the researcher to study behavior as it occurs in everyday life. For instance, we can predict from the scores on a battery of tests the success of job trainees during a training session. However, we cannot use such correlational information to determine whether one variable caused another variable. Experimental Research the goal of the experimental method is to provide more definitive conclusions about the causal relationships among the variables in a research hypothesis than what is available from correlational research. Experiments are designed to test hypotheses, or specific statements about the relationship between variables. Experiments are conducted in a controlled setting in an effort to explain how certain factors or events produce outcomes. In the experimental research design, the variables of interest are called the independent variable and the dependent variable. The independent variable in an experiment is the causing variable that is created or manipulated by the experimenter. The dependent variable in an experiment is a measured variable that is expected to be influenced by the experimental manipulation. A good experiment randomly assigns participants to at least two groups that are compared. The experimental group receives the treatment under investigation, while the control group does not receive the treatment the experimenter is studying as a comparison. Additionally, experimental designs control for extraneous variables, or variables that are not part of the experiment that could inadvertently affect either the experimental or control group, thus distorting the results. One is that they are often conducted in laboratory situations rather than in the everyday lives of people. Therefore, we do not know whether results that we find in a laboratory setting will necessarily hold up in everyday life. Second, and more important, is that some of the most interesting and key social variables cannot be experimentally manipulated because of ethical concerns. Characteristics of descriptive, correlational, and experimental research designs can be found in Table 1. Allows testing of expected relationships between and among variables and the making of predictions. Cannot be used to draw inferences about the causal relationships between and among the variables. Correlational To assess the relationships between and among two or more variables Experimental To assess the causal impact of one or more experimental manipulations on a dependent variable Cannot experimentally manipulate many important variables. Research Involving Time-Spans Cross-sectional research compares samples that represent a cross-section of the population who vary in age. Participants might be asked to complete a survey or take a test of some physical or cognitive skill. In cross-sectional research, respondents are measured only once, and consequently this method is not expensive or time consuming. In addition, because participants are only tested at one point in time, practice effects are not an issue as children do not have the opportunity to become better at the task over time. There is also no need to keep in contact with, or follow-up with, participants over time. For example, those born during the depression have very different views about and experiences with the internet than 29 those born in the last twenty years. Longitudinal research involves studying a group of people who are the same age, and measuring them repeatedly over a period-of-time. This type of design allows researchers to study individual differences in development. Longitudinal studies may be conducted over the short term, such as a span of months, or over much longer durations including years or decades. For these reasons, longitudinal research designs are optimal for studying stability and change over time. Researchers must maintain continued contact with participants over time, and these studies necessitate that scientists have funding to conduct their work over extended durations. Participants may move, change their phone numbers, or simply become disinterested in participating over time. Researchers should account for the possibility of attrition by enrolling a larger sample into their study initially, as some participants will likely drop out over time. Even with a large sample size, the experimenter never knows if there was something different about the individuals who dropped out versus those that remained in the study. The results from longitudinal studies may also be impacted by repeated assessments. Consider how well you would do on a math test if you were given the exact same exam every day for a week. Your performance would likely improve over time not necessarily because you developed better math abilities, but because you were continuously practicing the same math problems. Practice effects occur when participants become better at a task over time because they have done it again and again; not due to natural psychological development. Sequential research includes elements of both longitudinal and cross-sectional research designs. Similar to longitudinal designs, sequential research features participants who are followed over time; similar to cross-sectional designs, sequential work includes participants of different ages. This research design is also distinct from those that have been discussed previously in that individuals of different ages are enrolled into a study at various points in time 30 to examine age-related changes, development within the same individuals as they age, and account for the possibility of cohort effects. Children in Group A would be enrolled when they are 2 years old and would be tested again when they are 4 and 6 years old. Children in Group B would also be enrolled when they are 2 years old, but this would occur two years later when Group A is now 4 years old. Finally, children in Group C would be enrolled when they are 2 years old and Group A is now 6 and Group B is now 4. At this time, the children would represent a cross-sectional design (2, 4, and 6 years of age). Further, along the diagonal children of the same age can be compared to determine if cohort effects are evident. Sequential designs are appealing because they allow researchers to learn a lot about development in a relatively short amount of time. Because they include elements of longitudinal and cross-sectional designs, sequential research has many of the same strengths and limitations as these other approaches. For example, sequential work may require less time and effort than longitudinal research, but more time and effort than cross-sectional research. Although practice effects may be an issue if participants are asked to complete the same tasks or assessments over time, attrition may be less problematic than what is commonly experienced in longitudinal research since participants may not have to remain involved in the study for such a long period-of-time. Research in psychology may cause some stress, harm, or inconvenience for the people who participate in that research. Psychologists may induce stress, anxiety, or negative moods in their participants, expose them to weak electrical shocks, or convince them to behave in ways that violate their moral standards. Additionally, researchers may sometimes use animals, potentially harming them in the process. Decisions about whether research is ethical are made using established ethical codes developed by scientific organizations, such as the American Psychological Association, and federal governments. In the United States, the Department of Health and Human Services provides the guidelines for ethical standards in research. Informed Consent: Researchers must obtain informed consent, which explains as much as possible about the true nature of the study, particularly everything that might be 32 expected to influence willingness to participate. Infants and young children cannot verbally indicate their willingness to participate, much less understand the balance of potential risks and benefits. As such, researchers are oftentimes required to obtain written informed consent from the parent or legal guardian of the child participant. Children are not asked to indicate whether they would like to be involved in a study until they are approximately seven years old. Because infants and young children also cannot easily indicate if they would like to discontinue their participation in a study, researchers must be sensitive to changes in the state of the participant, such as determining whether a child is too tired or upset to continue, as well as to what the parent desires. In some cases, parents might want to discontinue their involvement in the research. As in adult studies, researchers must always strive to protect the rights and wellbeing of the minor participants and their parents when conducting developmental research. Deception: Deception occurs whenever research participants are not completely and fully informed about the nature of the research project before participating in it. Deception may occur when the researcher tells the participants that a study is about one thing when in fact it is about something else, or when participants are not told about the hypothesis. Debriefing: At the end of a study debriefing, which is a procedure designed to fully explain the purposes and procedures of the research and remove any harmful aftereffects of participation, must occur. Theoretical propositions of life span developmental psychology: On the dynamics between growth and decline. We will look at what happens genetically during conception, and describe some known genetic and chromosomal disorders. Next, we will consider what happens during prenatal development, including the impact of teratogens. We will also discuss the impact that both the mother and father have on the developing fetus. Lastly, we will present the birth process and some of the complications that can occur during delivery. Before going into these topics, however, it is important to understand how genes and chromosomes affect development. However, the cells used in sexual reproduction, called the gametes (sperm or ova), are formed in a process called meiosis. Thus, each sperm and egg possesses only 23 chromosomes and combine to produce the normal 46. Given the 35 amount of genes present and the unpredictability of the meiosis process, the likelihood of having offspring that are genetically identical (and not twins) is one in trillions (Gould & Keeton, 1997). Of the 23 pairs of chromosomes created at conception, 22 pairs are similar in length. Meiosis Genotypes and Phenotypes the word genotype refers to the sum total of all the genes a person inherits. Because genes are inherited in pairs on the chromosomes, we may receive either the same version of a gene from our mother and father, that is, be homozygous for that characteristic the gene influences. If we receive a different version of the gene from each parent, that is referred to as heterozygous. It is in the heterozygous condition that it becomes clear that not all genes are created equal. Some genes are dominant, meaning they express themselves in the phenotype even when paired with a different version of the gene, while their silent partner is called recessive. Some dominant traits include having facial dimples, curly hair, normal vision, and dark hair. Most characteristics are not the result of a single gene; they are polygenic, meaning they are the result of several genes.

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