Conduction Properties Of Decellularized Nerve Biomaterials.

The purpose of this study is to optimize poly(3,4,-ethylenedioxythiophene) (PEDOT) polymerization into decellular nerve scaffolding for interfacing to peripheral nerves. Our ultimate aim is to permanently implant highly conductive peripheral nerve interfaces between amputee, stump, nerve fascicles and prosthetic electronics. Decellular nerve (DN) scaffolds are an FDA approved biomaterial (Axogen ) with the flexible tensile properties needed for successful permanent coaptation to peripheral nerves. Biocompatible, electroconductive, PEDOT facilitates electrical conduction through PEDOT coated acellular muscle. New electrochemical methods were used to polymerize various PEDOT concentrations into DN scaffolds without the need for a final dehydration step. DN scaffolds were then tested for electrical impedance and charge density. PEDOT coated DN scaffold materials were also implanted as 15-20mm peripheral nerve grafts. Measurement of in-situ nerve conduction immediately followed grafting. DN showed significant improvements in impedance for dehydrated and hydrated, DN, polymerized with moderate and low PEDOT concentrations when they were compared with DN alone (a ≤ 0.05). These measurements were equivalent to those for DN with maximal PEDOT concentrations. In-situ, nerve conduction measurements demonstrated that DN alone is a poor electro-conductor while the addition of PEDOT allows DN scaffold grafts to compare favorably with the "gold standard", autograft (Table 1). Surgical handling characteristics for conductive hydrated PEDOT DN scaffolds were rated 3 (pliable) while the dehydrated models were rated 1 (very stiff) when compared with autograft ratings of 4 (normal). Low concentrations of PEDOT on DN scaffolds provided significant increases in electro active properties which were comparable to the densest PEDOT coatings. DN pliability was closely maintained by continued hydration during PEDOT electrochemical polymerization without compromising electroconductivity.

Central diabetes insipidus: a rare perioperative cause of severe hypernatraemia.

In this case report we describe the management of severe hypernatraemia following inadvertent water restriction. A 21-year-old woman with no reported medical history presented on transfer from an outside hospital with a complex volar upper extremity injury. Management both operatively and postoperatively involved a prolonged period of fasting which limited her access to drinking water Collateral history revealed that she had previously drunk copious amounts of water during the course of any given day and this had served to alleviate the dramatic symptoms of hypernatraemia that were rapidly manifest when her normal intake was curtailed. We outline the fluid management, administration of desmopressin and her subsequent recovery. A literature review of the management of central diabetes insipidus is also covered.

Associations among maternal depressive symptomatology, state of mind and parent and child behaviors: implications for attachment-based interventions.

Associations among maternal depressive symptomatology, maternal state of mind with regard to attachment, and mother and child behaviors were examined in the treatment groups of an attachment-oriented intervention for primiparous women at high risk for parenting difficulties. The Adult Attachment Interview (AAI) was completed by 48 intervention and 62 control subjects when their children were 19 months old and the Center for Epidemiologic Studies-Depression Inventory (CES-D) and parent-child laboratory tasks were completed by the same subjects when their children were 24 months old. In the control group, preoccupied tendencies were repeatedly associated with poor outcome; in the intervention group coherence of mind was associated with positive outcome. Maternal depression tended to be associated with hostility in the intervention group. Results suggest that maternal state of mind may exert powerful effects on parenting behavior and that an attachment-oriented intervention may influence these associations, particularly among preoccupied subjects. Results also demonstrated potential benefits of using AAI scales in addition to the traditional categories.

Depressive symptomatology in childhood and adolescence.

Antecedents of depressive symptomatology in childhood and adolescence were examined in a prospective longitudinal study of at-risk youth (n = 168) from families of lower socioeconomic status. Relations between family context factors, maternal depressive symptoms, and depressive symptoms in childhood and adolescence were examined, with a focus on early family relationship factors rarely available for analysis in longitudinal data sets. Results suggest the possibility of etiological differences between depressive symptoms in childhood and in adolescence. Depressive symptomatology in childhood was predicted by the overall family context. Cumulative effects of maternal depressive symptomatology, early care lacking in emotional supportiveness, abuse, and family stressors were observed. Depressive symptomatology in adolescence, on the other hand, was specifically associated with maternal depression and early care lacking in emotional supportiveness. Moreover, an intriguing sex difference emerged: maternal depressive symptomatology was strongly associated with depressive symptomatology in adolescence for females, but for males supportive early care appeared more relevant.

Attachment from infancy to early adulthood in a high-risk sample: continuity, discontinuity, and their correlates.

This study explores the stability of attachment security and representations from infancy to early adulthood in a sample chosen originally for poverty and high risk for poor developmental outcomes. Participants for this study were 57 young adults who are part of an ongoing prospective study of development and adaptation in a high-risk sample. Attachment was assessed during infancy by using the Ainsworth Strange Situation (Ainsworth & Wittig) and at age 19 by using the Berkeley Adult Attachment Interview (George, Kaplan, & Main). Possible correlates of continuity and discontinuity in attachment were drawn from assessments of the participants and their mothers over the course of the study. Results provided no evidence for significant continuity between infant and adult attachment in this sample, with many participants transitioning to insecurity. The evidence, however, indicated that there might be lawful discontinuity. Analyses of correlates of continuity and discontinuity in attachment classification from infancy to adulthood indicated that the continuous and discontinuous groups were differentiated on the basis of child maltreatment, maternal depression, and family functioning in early adolescence. These results provide evidence that although attachment has been found to be stable over time in other samples, attachment representations are vulnerable to difficult and chaotic life experiences.

Distinguishing the early-onset/persistent and adolescence-onset antisocial behavior types: from birth to 16 years.

Moffitt's theory regarding two types of adolescent antisocial behavior was investigated using a prospective, longitudinal study of normal and abnormal development in a primarily low socioeconomic status, ethnically diverse sample. Results supported the presence of an early-onset/persistent (EOP) group and an adolescence-onset (AO) group. Groups were most reliably and significantly distinguished by indices of socioemotional history within the first 3 years, but no significant differences were found on early measures of temperament or neuropsychological functioning. EOPs scored significantly lower than other groups on measures of neuropsychological functioning only during late childhood and adolescence, suggesting that the declines in verbal functioning that have been so reliably found in this and other samples of early-starting antisocial adolescents are progressive and consequent to adverse experience. In adolescence, AOs were significantly more likely to report high levels of internalizing symptoms and life stress, suggesting that AO antisocial behavior is not a benign phenomenon. Implications of these findings for etiologic theories of adolescent antisocial behavior are discussed.

Predicting parenting behaviors from Antisocial Practices content scale scores of the MMPI-2 administered during pregnancy.

This article examines the relation between scores on the Antisocial Practices (ASP) content scale of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and parenting behaviors in a sample of low-income women. During pregnancy, 141 women were administered the MMPI-2 and then placed into 1 of 3 groups: an antisocial, nonclinical, or clinical control group. When their children were 13 and 24 months old, antisocial mothers were observed to be less understanding and more hostile and harsh in their parenting styles than mothers in the other groups. The nonclinical and clinical control groups did not differ on any measures. Other MMPI-2 measures of antisocial behavior were not predictive of harsh parenting styles. These findings support the predictive and construct validity of the ASP content scale of the MMPI-2.

Implications of attachment theory for developmental psychopathology.

Bowlby's attachment theory is a theory of psychopathology as well as a theory of normal development. It contains clear and specific propositions regarding the role of early experience in developmental psychopathology, the importance of ongoing context, and the nature of the developmental process underlying pathology. In particular, Bowlby argued that adaptation is always the joint product of developmental history and current circumstances (never either alone). Early experience does not cause later pathology in a linear way; yet, it has special significance due to the complex, systemic, transactional nature of development. Prior history is part of current context, playing a role in selection, engagement, and interpretation of subsequent experience and in the use of available environmental supports. Finally, except in very extreme cases, early anxious attachment is not viewed as psychopathology itself or as a direct cause of psychopathology but as an initiator of pathways probabilistically associated with later pathology.

Child and adolescent anxiety disorders and early attachment.

OBJECTIVE: The major aim of this research is to determine whether infants who were anxiously/resistantly attached in infancy develop more anxiety disorders during childhood and adolescence than infants who were securely attached. To test different theories of anxiety disorders, newborn temperament and maternal anxiety were included in multiple regression analyses. METHOD: Infants participated in Ainsworth's Strange Situation Procedure at 12 months of age. The Schedule for Affective Disorders and Schizophrenia for School-Age Children was administered to the 172 children when they reached 17.5 years of age. Maternal anxiety and infant temperament were assessed near the time of birth. RESULTS: The hypothesized relation between anxious/resistant attachment and later anxiety disorders was confirmed. No relations with maternal anxiety and the variables indexing temperament were discovered, except for a composite score of nurses' ratings designed to access "high reactivity," and the Neonatal Behavioral Assessment Scale clusters of newborn range of state and inability to habituate to stimuli. Anxious/resistant attachment continued to significantly predict child/adolescent anxiety disorders, even when entered last, after maternal anxiety and temperament, in multiple regression analyses. CONCLUSION: The attachment relationship appears to play an important role in the development of anxiety disorders. Newborn temperament may also contribute.

Development and the fragmented self: longitudinal study of dissociative symptomatology in a nonclinical sample.

Dissociative behaviors and their relation to both the self and self-organization were examined using the developmental psychopathology perspective in a prospective longitudinal study of high-risk children. Participants were 168 young adults (n = 79 females, n = 89 males, age = 18-19 years) considered high-risk for poor developmental outcomes at birth due to poverty. The present study investigated whether trauma, sense of self, quality of early mother-child relationship, temperament, and intelligence were related to dissociative symptomatology measured at four times across 19 years. Findings were (a) age of onset, chronicity and severity of trauma were highly correlated and predicted level of dissociation; (b) both the avoidant and disorganized patterns of attachment were strong predictors of dissociation; (c) dissociation in childhood may be a more normative response to disruption and stress, while dissociation in adolescence and young adulthood may be more indicative of psychopathology; (d) preliminary support was found for a model proposed by G. Liotti that links disorganized attachment, later trauma, and dissociation in adulthood; and (e) strong support was found for N. Waller, F. W. Putnam, and E. B. Carlson's contention that psychopathological dissociation should not be viewed as the top end of a continuum of dissociative symptomatology, but as a separate taxon that represents an extreme deviation from normal development.

Dissociation as a mediator of child abuse across generations.

To test the hypothesis that dissociative process is the mechanism that accounts for the transmission of maltreatment across generations, a group of mothers who were abused and maltreated their children were compared to a group of mothers who broke the cycle of abuse. Mothers who were abused and are abusing their children were rated higher on idealization, inconsistency, and escapism in their description of their childhood and they scored higher on the Dissociative Experience Scale compared to mothers who broke the cycle. Mothers who were abused and abused their children recalled the care they received as children in a fragmented and disconnected fashion whereas those who broke the cycle integrated their abusive experience into a more coherent view of self. Even after partialing out the effects of IQ, large differences were found indicating that dissociative process plays a part in the transmission of maltreatment across generations. Possible reasons why some maltreated individuals coped with the trauma by dissociating and others integrate the experience were discussed.

Adult attachment classification and self-reported psychiatric symptomatology as assessed by the Minnesota Multiphasic Personality Inventory--2.

This study examined differences in self-reported psychiatric symptomatology on the Minnesota Multiphasic Personality Inventory-2 according to adult attachment status on the Adult Attachment Interview in first-time mothers from a high-risk poverty sample. Participants reported fairly high levels of symptomatology regardless of attachment status. The dismissing adult attachment group reported comparatively little psychiatric distress, emphasized independence, and scored the lowest on self-reported anxiety. The preoccupied group was highest on a range of indices of psychiatric symptoms indicative of self-perceived distress and relationship problems. The autonomous group's scores ranged between the scores of the other 2 groups on most scales. These different symptom patterns are consistent with adult attachment status as an index of self-representation and as a set of strategies for processing emotions and thoughts related to distress and to attachment relationships.

The long-term consequences of infant day-care and mother-infant attachment.

The aim of this study was to explore the within-group effects of mother-infant attachment and day-care on children's social and emotional adaptation at 42 months and in the early school years. For this high-risk sample, the effects of day-care depended on the quality of mother-infant attachment. Day-care appeared to have a negative effect for secure children but had a positive influence for insecure children. For the secure group, children in day-care were more negative and avoidant at 42 months, and they were more externalizing and aggressive in kindergarten compared to the home-reared group. In contrast, day-care children who were insecurely attached were less withdrawn and more agentic. Overall, day-care children were rated higher on externalizing behavior in kindergarten than home-reared children, but no differences were found in the later school years. The sequelae of attachment indicated that security of attachment during infancy differentially predicted later adaptation for day-care and home-reared children. Attachment was related to later adaptation for home-reared children but did not predict later adaptation for day-care children.

Relation between depressive symptoms and stressful life events in a sample of disadvantaged mothers.

The bidirectional relation between life events and self-reported depression was examined across a 1-year period. With Time 1 depression controlled, Time 2 stress accounted for an additional 10% of Time 2 depressive symptoms. Health-related stress, family violence, and financial stress at Time 2 predicted Time 2 depression after control for Time 1 depression. With Time 1 stress controlled, Time 2 depression accounted for 8% of the variance in Time 2 stress. Time 2 depression predicted Time 2 health-related stress, financial stress, household changes, spouse-partner stress, family violence stress, and substance abuse stress, controlling for each of these stressors at Time 1. The results describe a complex relation between stress and depression and suggest that the relation between stress and depression is moderated by the type of stress.

MMPI-2 profiles of women at risk for child abuse.

This study addresses the utility of the MMPI-2 in assessing personality characteristics of women who have a high potential for abusing their children. A sample of 154 women was identified on the basis of demographic characteristics as high risk for child abuse and other care-taking problems. They were evaluated (with the MMPI-2-AX form) during their pregnancy and are being followed up as part of the evaluation of a prevention/intervention program. This preliminary study compares the MMPI-2 personality characteristics of 146 of these women with several control samples: 1,462 women from the MMPI restandardization sample, 466 low education women from the restandardization sample, 84 pregnant women from the restandardization sample, and 167 women military recruits who are about the same age as the experimental group. The results show that, on the MMPI-2 clinical scales, women from the high-risk sample closely resemble child-abusing parents described in the previous MMPI literature. Moreover, these women differed significantly from all of the comparison groups on a number of MMPI-2 clinical and content scales. The clinical implications of these differences are discussed.

The fate of early experience following developmental change: longitudinal approaches to individual adaptation in childhood.

2 strategies were used to investigate the continued impact of early experience and adaptation given subsequent experience and/or developmental change in a poverty sample (N = 190). Groups were defined whose adaptation was similar during the preschool years but consistently different earlier; then these 2 groups were compared in elementary school. In addition, a series of regression analyses was performed in which variance accounted for by near-in or contemporary predictors of adaptation in middle childhood was removed before adding earlier adaptation in subsequent steps. Children showing positive adaptation in the infant/toddler period showed greater rebound in the elementary school years, despite poor functioning in the preschool period. Regression analyses revealed some incremental power of early predictors with intermediate predictors removed. The results were interpreted as supporting Bowlby's thesis that adaptation is always a product of both developmental history and current circumstances. While this research cannot resolve such a complicated issue, it does point to the need for complex formulations to guide research on individual development.

Preschool behavior problems: stability and factors accounting for change.

From a sample of high risk children, groups of acting out, withdrawn, and normal preschool children were identified and followed through first, second, and third grade. A high degree of stability of developmental adaptation was found for each group. Examination of the exceptions to predicted outcomes indicated that discontinuity of development was accounted for by level and change in maternal depressive symptomatology, life circumstances, stressful life events experienced by the family, and quality of the home environment. Level of maternal depression appeared to directly affect the quality of care she provided her child, and indirectly affected the quality and organization of the home environment.

Early childhood antecedents of aggression and passive-withdrawal in early elementary school.

Early childhood antecedents of elementary school aggression and passive-withdrawal were evaluated in a large longitudinal study (N = 191). With teacher ratings as outcome measures, a variety of predictor variables were selected from a comprehensive data base. Predictors were selected to represent several major factors: (a) a developmental history of insecure attachment and poor adjustment; (b) inadequate or hostile parental care; and (c) stressful or chaotic life circumstances. Support was found for the prediction of these behavior problems from early childhood measures (up to one third of the variance), with results varying with sex and outcome measure. Results were stronger for boys than girls, and stronger for aggression than for passive-withdrawal. Boys' outcome was strongly related to attachment classification at 18 months. It is suggested that these findings support Bowlby's view that early acquired "working models" of self and other affect later interpersonal functioning.

Continuity and discontinuity in maternal sensitivity at 6, 24, and 42 months in a high-risk sample.

Continuity and discontinuity in maternal sensitivity from 6 and 24 months to 42 months were examined in a sample of 135 disadvantaged mothers and their firstborn children. Sensitivity at 6 and 24 months accounted for 18% of the variance in 42-month maternal sensitivity for boys, 14% for girls. Discontinuity was examined using residual scores. Less maternal sensitivity than predicted was related to stressful environmental and child characteristics for both boys and girls, while greater sensitivity than predicted was related to mothers' experiences of emotional support, girls' positive individual characteristics, and boys who were seen as unengaged.

Breaking the cycle of abuse.

The aim of this study was to identify variables that distinguish mothers who broke the cycle of abuse from mothers who were abused as children and who also abused their own children. Based on maternal interviews and questionnaires completed over a 64-month period, measures of mothers' past and current relationship experiences, stressful life events, and personality characteristics were obtained. Abused mothers who were able to break the abusive cycle were significantly more likely to have received emotional support from a nonabusive adult during childhood, participated in therapy during any period of their lives, and to have had a nonabusive and more stable, emotionally supportive, and satisfying relationship with a mate. Abused mothers who reenacted their maltreatment with their own children experienced significantly more life stress and were more anxious, dependent, immature, and depressed.