Measuring the ghost in the nursery: an empirical study of the relation between parents' mental representations of childhood experiences and their infants' security of attachment

This paper presents a summary of the Anna Freud Centre-University College London, Parent-Child Project. Its most important finding was that the security of the infants' relationship with both parents at 12 and 18 months could be predicted on the basis of qualitative aspects of the parents' accounts of their own childhoods collected before the birth of the child. This confirmed Selma Fraiberg's observations concerning the reemergence of childhood conflicts at early stages of childbearing. Possible mechanisms mediating this link are explored with particular reference to the role of the parents' accurate mental representations of the infants' mental world.

Maternal attachment representations, maternal sensitivity, and the infant-mother attachment relationship

The role of maternal sensitivity as a mediator accounting for the robust association between maternal attachment representations and the quality of the infant-mother attachment relationship was examined. Sixty mother-infant dyads were observed at home and in the Strange Situation at 13 months, and mothers participated in the Adult Attachment Interview (AAI) within the next 6 months. A strong association was found between AAI and Strange Situation classifications, and autonomous mothers were more sensitive at home than were nonautonomous mothers. Mothers in secure relationships were more sensitive at home than mothers in nonsecure relationships. Likewise, infants in secure relationships were more secure as assessed by the Waters' Attachment Q sort than infants in nonsecure relationships. A test of the mediational model revealed that maternal sensitivity accounted for 17% of the relation between AAI and Strange Situation classifications.

Bacteriology of skin and soft-tissue infections: comparison of infections in intravenous drug users and individuals with no history of intravenous drug use

The bacteriology of cutaneous or subcutaneous abscesses (86 specimens) among intravenous drug users (IVDUs) was compared with the bacteriology of abscesses (74 specimens) in patients with no history of intravenous drug use (non-IVDUs). The IVDU abscesses yielded 173 aerobes and 131 anaerobes. Staphylococcus aureus was the most common aerobe isolated (50% of specimens yielded this isolate), followed by "Streptococcus milleri" (46%). The commonly encountered anaerobes were Fusobacterium nucleatum (17%), pigmented Prevotella species (22%), Peptostreptococcus micros (17%), Actinomyces odontolyticus (15%), and Veillonella species (13%). The non-IVDU isolates included 116 aerobes and 106 anaerobes. S. aureus was isolated from 53% of these specimens, followed by coagulase-negative staphylococci (19%), "S. milleri" (19%), and Streptococcus pyogenes (16%). The main groups of anaerobes were Peptostreptococcus species (35%), Bacteroides species (19%), and gram-positive bacilli (31%). Overall, 67% of the IVDU isolates were of oral origin, compared with 25% of the non-IVDU isolates. Of the specimens from IVDUs and non-IVDUs, 48% and 67%, respectively, yielded only aerobes, and 2% and 4%, respectively, yielded only anaerobes. Sixty-four percent of the patients had one or more beta-lactamase-producing organisms.

Visual, kinaesthetic and cross-modal judgements of length by normal and clumsy children

The ability of normal and clumsy children to match the length of lines within and between the modalities of vision and kinesthesis was studied. The clumsy children showed perceptual impairments, as indicated by their poor performance on the visual, kinaesthetic and cross-modal judgements of length and also by their low scores on spatial subtests of the WISC. Variations in motor skill correlated with performance on the visual perceptual measures, but not with performance on the kinaesthetic or cross-modal tasks. The idea that clumsiness may be caused by an impairment of visual perception is discussed, together with some alternative interpretations of this pattern of results.

The similarity of siblings' attachments to their mother

Do siblings develop similar attachment relationships with their mother? Attachment theory suggests that brothers and sisters growing up in the same family are likely to relate in similar ways to their parents, at least when parental attachment representations and interactive styles remain stable across time. In the current study, sibling attachment data from three research groups (from Pennsylvania State University, Leiden University, and the University of Western Ontario) have been pooled to assemble a sufficiently large sample of observations (N = 138 sibling pairs) for a detailed comparison of sibling attachment relationships. Spacing between the births, differences in maternal sensitivity, and gender of siblings were examined as possible sources of concordance of nonconcordance. Attachment security (including disorganized attachment) of each sibling was assessed with the Strange Situation procedure between 12 and 14 months after birth. Maternal sensitivity was observed with the same rating scale in a laboratory play session in one of the studies and in home observations in the others. Sibling relationships were found to be significantly concordant when classified as secure/nonsecure (62% concordance, p < .01, 1-tailed, intraclass correlation = .23) but not when further subcategorized. Maternal insensitivity to both siblings (shared environment) was associated with concordance of sibling nonsecurity. Siblings of the same gender were more likely to form concordant relationships with their mother (68%; p < .01, 1-tailed, intraclass correlation = .37) than those of opposite gender. Same-sex sibling concordance was comparable to the concordance found for monozygotic twins in earlier studies. Genetic factors may, therefore, play a relatively small role in the development of attachment.

Molecular and phenotypic analysis of Candida dubliniensis: a recently identified species linked with oral candidosis in HIV-infected and AIDS patients

The discovery and characterisation of a novel species of Candida, termed Candida dubliniensis, associated with oral candidosis in HIV-infected individuals is described. These organisms share several phenotypic characteristics in common with Candida albicans and Candida stellatoidea, including the ability to produce germ tubes and chlamydospores. However, in contrast to these latter two species, C. dubliniensis isolates produce abundant chlamydospores, which are often arranged in contiguous pairs, triplets and other multiples suspended from a single suspensor cell. They belong to C. albicans serotype A and exhibit atypical substrate assimilation profiles. Genomic DNA fingerprinting analysis with the C. albicans-specific probe 27A and five different oligonucleotide probes consisting of short repeat sequence-containing motifs, demonstrated that C. dubliniensis has a distinct genomic organisation relative to C. albicans and C. stellatoidea. This was confirmed by karyotype analysis and random amplified polymorphic DNA (RAPD) analysis. Comparison of 500 bp of the V3 variable region of the large ribosomal subunit genes from 14 separate C. dubliniensis isolates and the corresponding sequences from C. albicans, C. stellatoidea, C. tropicalis, C. glabrata, C. parapsilosis, C. kefyr and C. krusei demonstrated that the C. dubliniensis isolates formed a homogenous cluster (100% similarity), representing a discrete taxon within the genus Candida that was significantly different from the other species analysed.

A controlled study of psychoanalytic treatment of brittle diabetes

The study compared two equivalent groups of 11 diabetic children with grossly abnormal blood glucose profiles necessitating repeated admissions to a hospital. Patients in the treatment group were offered an intensive inpatient treatment program including psychoanalytic psychotherapy three to four times a week, which took place on the hospital ward and lasted an average of 15 weeks. The intervention was highly effective in improving the diabetic control of the children, and this was maintained at a 1 year follow-up. Patients in the comparison group, who were offered only inpatient medical intervention, returned to their prehospitalization level of metabolic control within a period of 3 months from discharge.

Visual perceptual deficits in clumsy children

In a previous study clumsy children were found to be impaired in their ability to match the length of successively presented straight lines, and the ability to perform this task correlated with their degree of motor impairment [3]. The present experiments explore two possible explanations for this pattern of results. One possibility is that this earlier result tapped a memory deficit in the clumsy children. The first experiment shows that the clumsy children still experience difficulties in matching the length of a line to a second line which is simultaneously present. This suggests the difficulty is one of perception and not memory. The second experiment explores whether faulty perception of length in the clumsy children is related to eye movement problems. No support for this idea was found; with tachistoscopic presentations at durations which exclude subjects making eye movements the clumsy children are still clearly impaired in judging the length of lines.

Persistence, replacement, and microevolution of Cryptococcus neoformans strains in recurrent meningitis in AIDS patients

Six separate human immunodeficiency virus-positive patients with cryptococcal meningitis were each found to have been infected with a unique strain of Cryptococcus neoformans on the basis of genomic DNA finger-printing analysis with the microsatellite sequence-containing oligonucleotide probe (GGAT)4 and by random amplification of polymorphic DNA. Two patients (A and B) experienced a recurrent episode of infection. Between 12 and 16 single-colony isolates recovered from primary isolation media (> 50% of C. neoformans colonies recovered) from cerebrospinal fluid specimens were fingerprinted from both patients during each episode. The fingerprints of both isolate collections from patient B were very similar, although minor polymorphisms were evident in both sets of profiles. The fingerprints of the isolate collection from the initial episode of infection in patient A were also identical to each other, apart from minor polymorphisms, but they were clearly different from the corresponding profiles of the isolate collection from the recurrent episode, the latter of which were completely identical, apart from minor polymorphisms in a single isolate. Furthermore, prolonged storage and in vitro subculture of the isolates did not alter the fingerprint profiles. These results provided convincing evidence that patients A and B were each infected with a single C. neoformans strain during each episode of infection and that in patient B, the same strain persisted and caused both episodes, while in patient A, a different strain was responsible for each episode. The prevalence of polymorphisms in multiple single-colony isolates from both patients also suggested that C. neoformans populations may undergo microevolution.

Effect of the cyanobacterial (blue-green algal) toxins from Microcystis aeruginosa on isolated enterocytes from the chicken small intestine

Livestock deaths, and clinical reports of human injury, follow the consumption of toxic blue-green algae. The experiments described show that isolated intestinal enterocytes from chicks are both deformed and killed by exposure to Microcystis toxins, in a dose-dependent and time-dependent manner. The enterocytes were protected from toxicity by deoxycholate, bromosulphothalein and rifampicin. It was concluded that the gastroenteritis clinically associated with accidental Microcystis ingestion is likely to reflect enterocyte injury by Microcystis toxins, and that the therapeutic use of bile acids or transport inhibitors may be of value in treatment.

Change in Atypical Maternal Behavior Predicts Change in Attachment Disorganization From 12 to 24 Months in a High-Risk Sample

This longitudinal study examined links between disorganization and atypical maternal behavior at 12 and 24 months in 71 adolescent mother-child dyads. Organized attachment and maternal not disrupted behavior were more stable than disorganization and disrupted behavior, respectively. At both ages, disorganization and maternal disrupted behavior were significantly correlated. Change in atypical maternal behavior predicted change in disorganization across time. The results provide substantial support for extant theories linking anomalous maternal behavior to the development of disorganized attachment. The Interesting-but-Scary paradigm, introduced in this study, promises to be a useful tool for assessing attachment and maternal behavior in toddlerhood.

Predictors of psychosocial adjustment in patients with implantable cardioverter defibrillators

Predictors of psychological distress/adjustment were examined in 25 patients following placement of ICDs. Patients completed a demographic questionnaire and a standardized questionnaire of psychological symptoms (i.e., Symptom Checklist-90 Revised; SCL-90-R). The number of discharges categorized by the patient as inappropriate and appropriate were also ascertained. The number of ICD discharges categorized as inappropriate and diminished levels of physical activity (r = 0.53 and 0.63, P < 0.01, respectively) did significantly relate to overall psychological distress. In addition, after controlling for age and prior psychiatric and physical health status through a stepwise multiple regression analysis, the occurrence of ICD discharges categorized as inappropriate and diminished physical activity continued to significantly predict overall psychological distress (R2 = 0.41, P < 0.01). However, the number of ICD discharges categorized as appropriate did not significantly predict overall psychological distress. The results of this investigation suggest that further refinement of the ICD could reduce the risk of exposure to potential psychological distress, and an analysis of prior and anticipated patient physical activity levels should be a factor when calibrating minimum ICD discharge threshold levels.

Hostility predicts restenosis after percutaneous transluminal coronary angioplasty

OBJECTIVE

To investigate the "toxic" total (potential for) hostility component of the type A behavior pattern (assessed by means of the structured interview) as it relates to prediction of restenosis after percutaneous transluminal coronary angioplasty (PTCA).

DESIGN

Patients with single vessel or multivessel coronary artery disease in whom PTCA had been scheduled or done were administered the structured interview by one trained interviewer prospectively or retrospectively (blinded to angiographic endpoints).

MATERIAL AND METHODS

A total of 41 patients underwent 53 initial balloon dilations on native arteries by 1 of 5 participating cardiologists. Inclusion criteria for this study were a successful initial PTCA and post-PTCA recatheterization if a patient complained of ischemic symptoms possibly related to restenosis.

RESULTS

Of the 41 patients, 15 (36.6%) had restenoses at a total of 18 previous angioplasty sites. Patients with high total (potential for) hostility ratings were almost 2.5 times more likely to have restenosis than those with low total (potential for) hostility scores (95% confidence interval = 1.03 to 5.32). Logistic regression revealed that total (potential for) hostility scores predicted post-PTCA restenosis overall as well as when adjusted for gender and race. Total (potential for) hostility scores were also positively associated with the number of arteries restenosed (P = 0.01).

CONCLUSION

This is the first report of type A total (potential for) hostility behavior conferring an increased risk for restenosis after PTCA. Its modification may be effective in reducing recurrent cardiac events. A coronary-prone behavior modification program for patients with persistent, same-site restenosis after PTCA has been initiated.

Maternal sensitivity and the security of infant-mother attachment: a Q-sort study

40 mothers and their 12-month-old infants were observed twice at home by 2 observers for 2 hours. After the second visit, the observers described the infant using the Waters Attachment Behavior Q-sort and the mother's interactive behavior with the Maternal Behavior Q-sort developed by the present authors and Ainsworth's rating scales. Maternal sensitivity was unrelated to maternal age, income, or SES, but correlated positively with maternal education. Mothers of more difficult children were less sensitive. A strong relation was found between infant attachment and maternal sensitivity as measured by the Maternal Behavior Q-sort and by the Ainsworth scales. Using the Q-sort procedure, mothers of more secure infants were more frequently characterized as noticing their babies' signals and using these signals to guide their behavior; they also were more knowledgeable about their infant and appeared to enjoy them more than mothers of less secure infants.

Maternal attachment representations, maternal sensitivity, and the infant-mother attachment relationship

The role of maternal sensitivity as a mediator accounting for the robust association between maternal attachment representations and the quality of the infant-mother attachment relationship was examined. Sixty mother-infant dyads were observed at home and in the Strange Situation at 13 months, and mothers participated in the Adult Attachment Interview (AAI) within the next 6 months. A strong association was found between AAI and Strange Situation classifications, and autonomous mothers were more sensitive at home than were nonautonomous mothers. Mothers in secure relationships were more sensitive at home than mothers in nonsecure relationships. Likewise, infants in secure relationships were more secure as assessed by the Waters' Attachment Q sort than infants in nonsecure relationships. A test of the mediational model revealed that maternal sensitivity accounted for 17% of the relation between AAI and Strange Situation classifications.

The role of visceral and subcutaneous adipose tissue fatty acid composition in liver pathophysiology associated with NAFLD

Visceral adiposity is associated with type-2-diabetes, inflammation, dyslipidemia and non-alcoholic fatty liver disease (NAFLD), whereas subcutaneous adiposity is not. We hypothesized that the link between visceral adiposity and liver pathophysiology involves inherent or diet-derived differences between visceral and subcutaneous adipose tissue to store and mobilize saturated fatty acids. The goal of the present study was to characterize the fatty acid composition of adipose tissue triglyceride and portal vein fatty acids in relation to indices of liver dysregulation. For 8 weeks rats had free access to control (CON; 12.9% corn/safflower oil; 3.6 Kcal/g), high saturated fat (SAT; 45.2% cocoa butter; 4.5 Kcal/g) or high polyunsaturated fat (PUFA; 45.2% safflower oil; 4.5 Kcal/g) diets. Outcome measures included glucose tolerance, visceral and subcutaneous adipose tissue triglyceride, liver phospholipids and plasma (portal and systemic) free fatty acid composition, indices of inflammation and endoplasmic reticulum stress in the liver and adipose tissue depots and circulating adipo/cytokines. Hepatic triglycerides were significantly increased in both high fat diet groups compared to control and were significantly higher in PUFA compared to SAT. Although glucose tolerance was not different among diet groups, SAT increased markers of inflammation and ER stress in the liver and both adipose tissue depots. Fatty acid composition did not differ among adipose depots or portal blood in any dietary group. Overall, these data suggest that diets enriched in saturated fatty acids are associated with liver inflammation, ER stress and injury, but that any link between visceral adipose tissue and these liver indices does not involve selective changes to fatty acid composition in this depot or the portal vein.

Visual, kinaesthetic and cross-modal development: relationships to motor skill development

The ability of children between the ages of 5 and 10 years to match the length of lines within and between the modalities of vision and kinaesthesis was studied. No evidence was found for specific increases in cross-modal skill which could not be explained in terms of within-modal development. Performance in the perceptual task was related to measures of developing motor skill in the children. Substantial relationships were found between performance on the within-modal tasks and motor skill, but no significant relationships were found between cross-modal measures and motor skill development. It is concluded that the development of cross-modal integration is not a major determinant of motor skill development.

Visual, kinaesthetic and cross-modal judgments of length by clumsy children: a comparison with young normal children

In a previous study, clumsy children, when compared to normal children of the same age, were found to be impaired in their ability to match the length of successively presented straight lines within and between the modalities of vision and kinaesthesis. The present study explores this finding further by comparing the clumsy children's performance with that of a group of younger normal children whose skills of movement are comparable to those of the clumsy children. It was found that the clumsy children's performance on the perceptual measures was equivalent to that of the younger normal children.

Magnetic Resonance Navigation for Targeted Embolization in a Two-Level Bifurcation Phantom

This work combines a particle injection system with our proposed magnetic resonance navigation (MRN) sequence with the intention of validating MRN in a two-bifurcation phantom for endovascular treatment of hepatocellular carcinoma (HCC). A theoretical physical model used to calculate the most appropriate size of the magnetic drug-eluting bead (MDEB, 200 μm) aggregates was proposed. The aggregates were injected into the phantom by a dedicated particle injector while a trigger signal was automatically sent to the MRI to start MRN which consists of interleaved tracking and steering sequences. When the main branch of the phantom was parallel to B₀, the aggregate distribution ratio in the (left-left, left-right, right-left and right-right divisions was obtained with results of 8, 68, 24 and 0% respectively at baseline (no MRN) and increased to 84%, 100, 84 and 92% (p < 0.001, p = 0.004, p < 0.001, p < 0.001) after implementing our MRN protocol. When the main branch was perpendicular to B₀, the right-left branch, having the smallest baseline distribution rate of 0%, reached 80% (p < 0.001) after applying MRN. Moreover, the success rate of MRN was always more than 92% at the 1st bifurcation in the experiments above.