Consensus, controversy, and chaos in the attribution of characteristics to the morally exceptional

OBJECTIVE

What do people see as distinguishing the morally exceptional from others? To handle the problem that people may disagree about who qualifies as morally exceptional, we asked subjects to select and rate their own examples of morally exceptional, morally average, and immoral people.

METHOD

Subjects rated each selected exemplar on several enablers of moral action and several directions of moral action. By applying the logic underlying stimulus sampling in experimental design, we evaluated perceivers' level of agreement about the characteristics of the morally exceptional, even though perceivers rated different targets.

RESULTS

Across three studies, there was strong subjective consensus on who is morally exceptional: those who are empathetic and prone to guilt, those who reflect on moral issues and identify with morality, those who have self-control and actually enact moral behaviors, and those who care about harm, compassion, fairness, and honesty. Deep controversies also existed about the moral directions pursued by those seen as morally exceptional: People evaluated those who pursued similar values and made similar decisions more favorably.

CONCLUSION

Strong consensus suggests characteristics that may push a person to go beyond normal expectations, that the study of moral exceptionality is not overly hindered by disagreement over who is morally exceptional, and that there is some common ground between disagreeing camps.

Borderline personality features are associated with worse perceptions of (but not compliance with) chronic pain treatment

Treating chronic illness requires ongoing patient-provider cooperation, but individual differences in patients' negative perceptions of care can undermine this cooperation. Research suggests people high on borderline personality disorder (BPD) features may react negatively to and comply less with mental health and medical treatment. This might be particularly problematic in chronic pain treatment, where BPD features are over-represented and the dysregulation typifying BPD likely undermines consistent care. In a sample of 147 chronic pain patients, we investigated whether higher levels of BPD features - both in general and by specific facets - predicted worse perceptions of treatment and lower patient-reported compliance with treatment recommendations. Participants higher (vs. lower) on borderline features viewed treatment more negatively but did not report complying less with recommendations. We found evidence that this may reflect the unstable relationships facet of BPD. Our results indicate that, consistent with other treatment settings, BPD features may undermine care for chronic pain. Furthermore, our results highlight the importance of collaborative provider-patient relationships and patient agreement with the treatment of chronic pain, particularly among individuals higher on BPD features.

Truthfulness Predominates in Americans' Conceptualizations of Honesty: A Prototype Analysis

Honesty is a near universally valued trait. However, the term honesty captures a litany of traits and behaviors, obscuring research on social perceptions and trait measurement of honesty and creating philosophical difficulties in accounting for what (if anything) unifies this diversity. We applied a prototype analysis approach to identify the most central elements of lay honesty conceptualizations, identifying elements that come to mind and are explicitly acknowledged as important to honesty. In five studies (N = 1,442), U.S. American participants generated 6,000+ free responses characterizing honesty and indicated which subtraits and behaviors best represent honesty. Truthfulness was most central to lay honesty conceptualizations across all studies and several centrality indices (frequency among responses and participants, agreement across participants, priority in lists, explicit ratings), though several other features were prominent. Findings illuminate social perceptions of honesty, critique popular measurement of trait honesty, and offer empirical foundations for philosophical analysis of honesty.

Investigating corroboration of self-perceived posttraumatic growth among Sri Lankan Tamil survivors of ethnopolitical warfare through trait, domain, and profile agreement approaches

Though research on assessing posttraumatic growth has been severely critiqued, some evidence suggests close others can observe and report changes in individuals following traumatic life events and are sensitive to idiosyncratic ways in which changes manifest. We extended these findings by investigating corroboration of self-perceived posttraumatic growth (PTG) and depreciation (PTD) as measured by the Posttraumatic Growth Inventory-42 (PTGI-42) among Sri Lankan Tamil war survivors (n = 200). Informants slightly corroborated overall levels of PTG and PTD, while a more nuanced profile analysis procedure revealed overall-but not distinctive-profile agreement. This suggests self-other agreement is modest and may partly reflect shared narratives and collective cultural understandings about how people change after trauma. Results demonstrate further that informants were not sensitive to idiosyncratic ways in which target individuals had changed. Together, the lack of validity evidence suggests that the PTGI-42 may be inadequate in some cross-cultural contexts as a measure of nuanced posttraumatic change (i.e., as a measure of specific changes in the five theorized domains of growth and depreciation). Future work should emphasize culture- and context-sensitive measurement of posttraumatic change, particularly focusing on methods other than retrospective self-reports, such as prospective longitudinal designs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Testosterone and cortisol do not predict rejecting harm or maximizing outcomes in sacrificial moral dilemmas: A preregistered analysis

Contemporary moral psychology explores the biological underpinnings of morality, including how neuromodulators influence moral judgment and decision making. Some studies suggest that higher circulating testosterone is associated with increased acceptance of sacrificial harm, such as killing one person to save five lives, consistent with utilitarian ethics and inconsistent with deontological ethics. However, most studies employ conventional analytic techniques that conflate concern about outcomes with reduced concern about sacrificial harm, many are statistically underpowered, and none examine potential regulating effects of cortisol. Therefore, we examined whether salivary concentrations of testosterone and cortisol jointly predict sacrificial dilemma judgments among a large sample of undergraduates (n = 199). We utilized an advanced cognitive modeling technique (process dissociation) to independently assess sensitivity to causing harm and maximizing outcomes, preregistering the prediction that higher testosterone would predict reduced harm-rejection rather than increased concern for outcomes, especially among people low in cortisol. However, neither testosterone, nor cortisol, nor their interaction predicted sacrificial dilemma response tendencies. Such findings raise questions about the robustness of past evidence suggesting links between testosterone and sacrificial dilemma judgments.

APRNs' controlled substance prescribing and readiness following Florida legislative changes

ABSTRACT

Two years after the Florida legislature expanded APRN prescribing to include schedule II-IV drugs in 2017, we studied APRN utilization of this prescriptive authority. Study results reveal that Florida APRNs are meeting the educational requirements to prescribe and apply the use of these drugs in practice, improving patient access to care.

Borderline Personality Disorder Features and Risk for Prescription Opioid Misuse in a Chronic Pain Sample: Roles for Identity Disturbances and Impulsivity

Although borderline personality disorder (BPD) is associated with both chronic pain and substance abuse, little research examines how BPD features in chronic pain patients may constitute a risk factor for misuse of prescription opioids, and no prior research has examined which particular component(s) of BPD might put chronic pain patients at risk-an oversight that undermines prevention and treatment of such problematic opioid use. In a cross-sectional study of patients in treatment for chronic pain (N = 147), BPD features were associated with several measures of prescription opioid misuse, even controlling for pain severity and interference. Specifically, the identity disturbances and self-harmful impulsivity facets of BPD were most consistently associated with opioid misuse, and exploratory analyses suggested that these factors may be interactive in their effects. Together, these results suggest that BPD features-especially unstable identity and self-harmful impulsivity-play a unique role in problematic prescription opioid use in chronic pain settings.

Borderline Personality Disorder Features Are Associated with Concurrent Pain-Related Disability in a Chronic Pain Sample

OBJECTIVE

To determine whether core features of borderline personality disorder are associated with increased rates of being on disability benefits due to chronic pain conditions.

SUBJECTS

A total of 147 patients currently in treatment for chronic pain at a multimodal chronic pain clinic.

METHODS

We tested for a concurrent relationship between borderline personality disorder features and employment status using self-report measures.

RESULTS

Borderline personality disorder features were associated with increased likelihood of currently being on disability due to pain conditions (odds ratio [OR] = 23.13, 95% confidence interval [CI] = 1.68-318.73), on disability due to other conditions (OR = 33.65, 95% CI = 2.15-526.13), and unemployed (OR = 20.14, 95% CI = 1.38-294.93), even while controlling for pain severity and interference, depression, and trait anxiety. A follow-up analysis revealed that these associations were due to the negative relationships facet of borderline personality disorder features.

CONCLUSIONS

Borderline personality disorder features, particularly negative relationships, are associated with increased rates of pain disability, general disability, and unemployment in a chronic pain sample. Future research should examine mechanisms by which the maladaptive interpersonal behaviors and cognitions of borderline personality disorder might result in worse long-term employment outcomes of chronic pain.

Not just bad actions: Affective concern for bad outcomes contributes to moral condemnation of harm in moral dilemmas

Moral dilemmas typically entail directly causing harm (said to violate deontological ethics) to maximize overall outcomes (said to uphold utilitarian ethics). The dual process model suggests harm-rejection judgments derive from affective reactions to harm, whereas harm-acceptance judgments derive from cognitive evaluations of outcomes. Recently, Miller, Hannikainen, and Cushman (2014) argued that harm-rejection judgments primarily reflect self-focused-rather than other-focused-emotional responses, because only action aversion (self-focused reactions to the thought of causing harm), not outcome aversion (other-focused reactions to witnessing suffering), consistently predicted dilemma responses. However, they assessed only conventional relative dilemma judgments that treat harm-rejection and outcome-maximization responses as diametric opposites. Instead, we employed process dissociation to assess these response inclinations independently. In two studies (N = 558), we replicated Miller and colleagues' findings for conventional relative judgments, but process dissociation revealed that outcome aversion positively predicted both deontological and utilitarian inclinations-which canceled out for relative judgments. Additionally, individual differences associated with affective processing-psychopathy and empathic concern-correlated with the deontology but not utilitarian parameter. Together, these findings suggest that genuine other-oriented moralized concern for others' well-being contribute to both utilitarian and deontological response tendencies, but these tendencies nonetheless draw upon different psychological processes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Accounting for the association between BPD features and chronic pain complaints in a pain patient sample: The role of emotion dysregulation factors

Although borderline personality disorder (BPD) features consistently show strong relations with chronic pain, the mechanisms underlying this association remain unclear. BPD is characterized by dysregulated emotion. Given previously observed relationships between emotion dysregulation and pain, we hypothesized that components of this dysregulation-elevated and labile negative affect and emotion sensitivity-would account for the relationship between BPD features and various pain complaints in a chronic pain patient sample. Specifically, we hypothesized that negative affect would indirectly predict pain through higher emotion sensitivity to pain, operationalized as pain anxiety sensitivity. To test these hypotheses, we administered a series of self-report measures to 147 patients at a chronic pain treatment facility. As expected, BPD features predicted pain severity (β = .19, p = .029), activity interference from pain (β = .22, p = .015), and affective interference from pain (β = .41, p < .001). Using path analyses, we found that the associations between BPD features and pain severity and interference were accounted for by serial indirect pathways through affective lability then pain anxiety and, to a lesser extent, through trait anxiety then pain anxiety. This is the first study to demonstrate roles for affective lability and pain anxiety sensitivity in the association between BPD features and chronic pain complaints in a chronic pain sample. We discuss implications for the relationship between dysregulated emotion and pain as well as for psychologically-focused treatment interventions for pain. (PsycINFO Database Record

Chronic obstructive pulmonary disease in Welsh slate miners

BACKGROUND

Exposure to respirable crystalline silica (RCS) causes emphysema, airflow limitation and chronic obstructive pulmonary disease (COPD). Slate miners are exposed to slate dust containing RCS but their COPD risk has not previously been studied.

AIMS

To study the cumulative effect of mining on lung function and risk of COPD in a cohort of Welsh slate miners and whether these were independent of smoking and pneumoconiosis.

METHODS

The study was based on a secondary analysis of Medical Research Council (MRC) survey data. COPD was defined as forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC) ratio <0.7. We created multivariable models to assess the association between mining and lung function after adjusting for age and smoking status. We used linear regression models for FEV₁ and FVC and logistic regression for COPD.

RESULTS

In the original MRC study, 1255 men participated (726 slate miners, 529 unexposed non-miners). COPD was significantly more common in miners (n = 213, 33%) than non-miners (n = 120, 26%), P < 0.05. There was no statistically significant difference in risk of COPD between miners and non-miners when analysis was limited to non-smokers or those without radiographic evidence of pneumoconiosis. After adjustment for smoking, slate mining was associated with a reduction in %predicted FEV₁ [β coefficient = -3.97, 95% confidence interval (CI) -6.65, -1.29] and FVC (β coefficient = -2.32, 95% CI -4.31, -0.33) and increased risk of COPD (odds ratio: 1.38, 95% CI 1.06, 1.81).

CONCLUSIONS

Slate mining may reduce lung function and increase the incidence of COPD independently of smoking and pneumoconiosis.

Immune mechanisms and the impact of the disrupted lung microbiome in chronic bacterial lung infection and bronchiectasis

Recent studies analysing immunogenetics and immune mechanisms controlling susceptibility to chronic bacterial infection in bronchiectasis implicate dysregulated immunity in conjunction with chronic bacterial infection. Bronchiectasis is a structural pathological end-point with many causes and disease associations. In about half of cases it is termed idiopathic, because it is of unknown aetiology. Bronchiectasis is proposed to result from a 'vicious cycle' of chronic bacterial infection and dysregulated inflammation. Paradoxically, both immune deficiency and excess immunity, either in the form of autoimmunity or excessive inflammatory activation, can predispose to disease. It appears to be a part of the spectrum of inflammatory, autoimmune and atopic conditions that have increased in prevalence through the 20th century, attributed variously to the hygiene hypothesis or the 'missing microbiota'. Immunogenetic studies showing a strong association with human leucocyte antigen (HLA)-Cw*03 and HLA-C group 1 homozygosity and combinational analysis of HLA-C and killer immunoglobulin-like receptors (KIR) genes suggests a shift towards activation of natural killer (NK) cells leading to lung damage. The association with HLA-DR1, DQ5 implicates a role for CD4 T cells, possibly operating through influence on susceptibility to specific pathogens. We hypothesize that disruption of the lung microbial ecosystem, by infection, inflammation and/or antibiotic therapy, creates a disturbed, simplified, microbial community ('disrupted microbiota') with downstream consequences for immune function. These events, acting with excessive NK cell activation, create a highly inflammatory lung environment that, in turn, permits the further establishment and maintenance of chronic infection dominated by microbial pathogens. This review discusses the implication of these concepts for the development of therapeutic interventions.

Airways hyper-responsiveness to bradykinin and methacholine: effects of inhaled fluticasone

BACKGROUND

Although inhaled corticosteroids are the most effective anti-inflammatory agents available for the treatment of asthma, they have, at best, only modest effects on airways responsiveness to methacholine. Thus, hyper-responsiveness to methacholine is a relatively insensitive monitor of the effectiveness of glucocorticoids in asthmatic subjects.

OBJECTIVE

The study aimed to determine if airways hyper-responsiveness to bradykinin provides a more sensitive index of glucocorticoid responsiveness in asthmatic subjects than does hyper-responsiveness to methacholine.

METHODS

A double-blind, placebo-controlled, parallel group study comparing the effects of inhaled fluticasone (220 micro g twice daily) on responsiveness to the two stimuli in asthmatic subjects who had never previously received corticosteroid therapy. Drug (n = 13) or placebo (n = 12) were administered for 16 weeks. Responsiveness to bradykinin and methacholine was determined at baseline and at 4 week intervals.

RESULTS

Placebo did not alter responsiveness to either stimulus compared to baseline. Fluticasone treatment significantly reduced responsiveness to bradykinin (P < 0.001 by Friedman anova) and methacholine (P = 0.02), but changes in responsiveness to bradykinin were significantly greater than those in methacholine responsiveness (P = 0.002). Bradykinin responsiveness was decreased at all treatment times compared to baseline, while methacholine responsiveness was not decreased until 8 weeks of therapy. When data were analyzed as changes from baseline (DeltaLog PD20), DeltaLog PD20 for methacholine was not different at any time-point between the two treatment groups. By contrast, DeltaLog PD20 for bradykinin was significantly greater in patients receiving fluticasone compared to those on placebo at all but the 16-week treatment time. Ten of 13 subjects receiving fluticasone failed, on at least one post-treatment visit, to show a 20% fall in forced expiratory volume (FEV1), even at the highest dose of bradykinin.

CONCLUSIONS

Airways responsiveness to bradykinin is more profoundly, and more rapidly, reduced by inhaled glucocorticoids than is responsiveness to methacholine. Airways hyper-responsiveness to bradykinin provides a convenient and sensitive monitor of glucocorticoid responsiveness in asthma.

Airway neural responses to kinins: tachyphylaxis and role of receptor subtypes

To further define the role of neural responses in the hyperreactivity of inflamed human upper airways to bradykinin (BK), we determined if repeated challenges with BK led to tachyphylaxis of neurally mediated responses in subjects with perennial allergic rhinitis. We also tested the hypothesis that enhanced reactivity to kinins in inflamed airways was caused by induction of B1-kinin receptors by comparing the effects of the selective B1-receptor agonist, des-Arg10-lysylbradykinin, and the B2 receptor agonist, BK, in the lower airways of asthmatics and in the upper airways of subjects with perennial allergic rhinitis. Repeated BK challenges led to tachyphylaxis of sneezing and of neurally mediated serous glandular secretion in subjects with perennial allergic rhinitis. Surprisingly, tachyphylaxis of increased local vascular permeability was also observed. By contrast, repeated challenges with BK in normal subjects led to reproducible increases in vascular permeability. Provocation with des-Arg10-lysylbradykinin did not cause bronchoconstriction in asthmatic subjects or increase glandular secretion or vascular permeability in the upper airways of subjects with rhinitis. We conclude that increased reactivity to kinins in inflamed human airways is mediated, at least in part, by neural reflexes, and is not caused by induction of B1-receptors.

Intranasal salmeterol inhibits allergen-induced vascular permeability but not mast cell activation or cellular infiltration

BACKGROUND

Salmeterol is a long-acting beta2-adrenergic agonist that is widely used in the treatment of asthma. It has been suggested that non-bronchodilator actions of salmeterol may contribute to its efficacy.

OBJECTIVE

To further evaluate the potential non-bronchodilator actions of salmeterol in vivo, using a model of nasal challenge with allergen.

METHODS

Twelve asymptomatic subjects with seasonal allergic rhinitis participated in a randomized, double-blind, placebo-controlled crossover trial of the effects of a single dose of 100 microg of salmeterol on the response to allergen challenge. Sneezing and symptom scores, and levels of histamine and albumin in nasal lavages, were measured throughout the protocol. Concentrations of tryptase, prostaglandin D2 and lysozyme were measured during the acute allergic response, while levels of IL-3, IL-5 and IL-8 were measured at later time points. Numbers of eosinophils and of total white blood cells were also recorded.

RESULTS

Salmeterol did not affect sneezing or symptom scores at any point. During the immediate response to allergen challenge, mast cell activation, reflected by concentrations of histamine, tryptase and prostaglandin D2, and serous glandular secretion, assessed by measurements of lysozyme, were unaffected by salmeterol treatment but vascular permeability, reflected by concentrations of albumin in nasal lavages, was significantly reduced. At later time points, salmeterol had no effect on levels of histamine or albumin and did not affect cellular infiltration. Concentrations of IL-3, IL-5 and IL-8 were not increased by allergen challenge in these subjects, so the effects of salmeterol could not be evaluated.

CONCLUSIONS

Treatment with a single dose of salmeterol had no effect on activation of mast cells or cellular infiltration but inhibited vascular permeability. The ability of salmeterol to inhibit antigen-induced vascular permeability may contribute to its therapeutic efficacy in asthma.

Orthographic analogies and developmental dyslexia

Goswami (1986, 1988) has demonstrated that children can use orthographic analogies (particularly at the onset-rime level) between the spelling patterns in words to help to decode new words (e.g. using 'beak' to read 'peak'). This strategy has been shown in children as young as six years old. Since it is known that children with developmental dyslexia find it particularly difficult to read words that they have not been specifically taught (Lovett, Warren-Chaplin, Ransby & Borden, 1990), the present study investigated whether dyslexic children might be unable to use analogies. Employing a design similar to that used by Goswami (1988), it was hypothesized that dyslexics would find it difficult to transfer spontaneously knowledge of a 'clue' word to decode new words that could be read by analogy with the clue word. The results of Expt 1 indicated that the dyslexic readers read significantly fewer of the analogous words than a reading age-matched comparison group of younger children. Furthermore, none of the nine dyslexic children read as many of the analogous words as the lowest scoring control child. In a second experiment, a design similar to that of Muter, Snowling & Taylor (1994) was used with a new and larger sample of dyslexic children. In this experiment, all the children were brought to criterion in reading the clue words before the analogous words were presented. Once again, the dyslexic children read significantly fewer words that were analogous with the clue words than did a reading age-matched comparison group. The number of analogous words that the dyslexic children read was significantly correlated with their performance on a test that is sensitive to the ability to detect rhyme. It is argued that a failure to make analogies may be one of the main causes of the reading impairment experienced by children with developmental dyslexia.

Effects of intranasal administration of endothelin-1 to allergic and nonallergic individuals

Endothelin-1 (ET-1), a 21 amino acid peptide, and its receptors are distributed in the mammalian respiratory tract. To examine the responses of human upper airways to ET-1, we investigated the effects of intranasal administration of ET-1 to nine symptomatic allergic and nine nonallergic volunteers. Paper discs were used to administer ET-1 or diluent to one side of the nasal mucosa, and to collect secretions from the ipsilateral (challenged) and contralateral (opposite) nostrils. ET-1 (0.3-10 micrograms), but not diluent, induced dose-dependent bilateral increases in secretion weights, lysozyme secretion, symptoms of rhinorrhea and itch, and sneezing in both populations. ET-1 did not induce albumin secretion, histamine release, or symptoms of nasal congestion. Compared with the nonallergic subjects, allergic individuals sneezed more and had significantly higher bilateral secretion weights, contralateral lysozyme secretion, and symptoms of rhinorrhea following ET-1 provocation. In summary, ET-1 induced symptoms relevant to inflammatory upper airway diseases in allergic and nonallergic subjects. However, responses of allergic subjects were more pronounced, particularly with respect to symptoms associated with neural reflex responses, such as sneezing and contralateral secretion. Therefore, allergic inflammation enhances responsiveness of the nasal mucosa to ET-1.

Bradykinin effects in guinea pig tracheal epithelial cells are mediated through a B2 kinin receptor and can be inhibited by the selective antagonist Hoe 140

Attempts to evaluate the role of kinins in airway inflammation in humans using the bradykinin receptor antagonist [DArg0-Hyp3-DPhe7]-bradykinin (NPC 567) were unsuccessful, possibly because of the low potency and poor stability of this compound. Recently, [DArg0-Hyp3-Thi5-DTic7-Oic8]-bradykinin (Hoe 140), a novel antagonist that seems to overcome these weaknesses, has been developed. The present study was performed to compare the potency and efficacy of Hoe 140 to those of NPC 567 and another antagonist, [DArg0-Hyp3-DPhe7-Ile8]-bradykinin (B7418), on kinin receptors on guinea pig tracheal epithelial cells. Radioligand binding studies showed the presence of two types of B2 kinin receptors on guinea pig tracheal epithelial cells: a high-affinity site with a Kd of 0.44 nM and Bmax of 12.1 fmol/10(6) cells (4000 sites/cell), and a lower affinity site with a Kd of 10 nM and Bmax of 16 fmol/10(6) cells (9600 sites/cell). Bradykinin-induced prostaglandin E2 production seemed to be associated primarily with the lower affinity site. All three B2 receptor antagonists displaced labeled bradykinin from both classes of binding sites and inhibited bradykinin-induced prostaglandin E2 production, but Hoe 140 was up to 40-fold more potent than NPC 567 and showed an affinity comparable to that of bradykinin for both binding sites. This higher potency of Hoe 140, and its stability against peptidases, suggests that this compound will be useful in evaluating the role of bradykinin in inflammatory diseases of the airways.

The evolution of proteinase substrates with special reference to dipeptidylpeptidase IV

The design and development of specific substrates for proteolytic enzymes is reviewed. Particular attention is given to substrates containing the leaving groups 4-methoxy-2-naphthylamide (MNA) and 7-amino-4-trifluoromethylcoumarin (AFC). The MNA substrates are used for histochemical and cytochemical purposes, and they yield a coloured final reaction product when azo-coupled with a diazonium salt, an osmiophilic product for electron microscopy when coupled with hexazotized Pararosaniline, or a fluorescent final reaction product when coupled with 5-nitrosalicylaldehyde. AFC substrates are considerably more sensitive, and they yield the fluorescent product AFC after enzymatic cleavage of the substrate. AFC is not sufficiently water-insoluble to allow (intra)cellular localization, but AFC substrates are successfully used for incubations in microwells (Immu-Probe technique) and for the demonstration of banding patterns after gel electrophoresis (enzyme-directed overlay membrane technique). The methods are discussed with the example of the elucidation of the role of dipeptidylpeptidase IV in autoimmune diseases.

Tryptase and histamine as markers to evaluate mast cell activation during the responses to nasal challenge with allergen, cold, dry air, and hyperosmolar solutions

We have used assays for histamine and for the specific mast cell enzyme, tryptase, to examine the response of the nasal mucosa to provocation with several different stimuli and to evaluate the reliability of histamine as a marker of mast cell activation. High levels of histamine detected in baseline lavages of some subjects are not associated with any detectable tryptase, suggesting they are not mast cell derived. During pronounced immediate allergic responses, however, mast cell degranulation clearly occurs, and a striking correlation between histamine and tryptase is observed. This correlation is weaker when a more modest allergic response is induced, possibly reflecting differential diffusion of the two mediators across the epithelium. Provocation of susceptible individuals with cold, dry air leads to increased recoveries of both histamine and tryptase, confirming that mast cell degranulation occurs during this reaction. Although hyperosmolarity of the nasal mucosa may contribute to mast cell degranulation induced by cold, dry air, a brief exposure of the nasal cavity to hyperosmolar mannitol was not associated with measurable production of tryptase. The combined use of histamine and tryptase measurements can therefore provide useful evidence regarding the role of mast cell activation in the pathogenesis of inflammatory responses.

A competitive kinin receptor antagonist, [DArg0, Hyp3, DPhe7]-bradykinin, does not affect the response to nasal provocation with bradykinin

1. In two double-blind, placebo controlled studies, we tested the effects of intranasal administration of 500 micrograms of a competitive kinin receptor antagonist, [DArg0, Hyp3, DPhe7]-bradykinin (NPC 567), on the response to nasal provocation with 20 micrograms of bradykinin. Nasal lavage was performed before and after provocation, and subjects recorded symptom scores. Lavages were assayed for albumin and TAME-esterase activity (indicators of vascular permeability). 2. In our initial study, 12 subjects received NPC 567 or placebo 5 min before bradykinin. After placebo, bradykinin challenge resulted in values (mean +/- s.e. mean) for albumin, TAME-esterase activity and total symptom scores of 275 +/- 51 micrograms ml-1, 32.1 +/- 7.2 counts min-1 x 10(-3), and 1.8 +/- 0.5, respectively. After NPC 567, bradykinin challenge resulted in values of 317 +/- 99 micrograms ml-1, 31.4 +/- 6.9 counts min-1 x 10(-3), and 2.6 +/- 0.4 for these parameters. No significant difference was observed between placebo and drug treatment for any parameter. 3. To evaluate if the lack of drug effect was due to its enzymatic degradation prior to bradykinin administration, a second study was performed in which NPC 567 was coadministered with bradykinin (n = 8). After placebo-bradykinin challenge, values of 168 +/- 42 micrograms ml-1, 11.3 +/- 4.0 counts min-1 x 10(-3), and 2.8 +/- 0.6 were recorded for albumin, TAME-esterase activity, and symptom scores, respectively, while following NPC 567-bradykinin challenge, these values were 174 +/- 51 micrograms ml-1, 12.3 +/- 4.1 counts min-1 x 10(-3), and 3.1 +/- 0.7.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacology of nasal provocation with bradykinin: studies of tachyphylaxis, cyclooxygenase inhibition, alpha-adrenergic stimulation, and receptor subtype

We have evaluated mechanisms by which nasal provocation with bradykinin may induce symptoms of rhinitis. Repeated nasal challenges with 100 micrograms of bradykinin led to reproducible increases in symptoms and in vascular permeability. Premedication with aspirin did not alter bradykinin-induced responses. Topical application of the alpha-adrenergic agonist oxymetazoline significantly reduced bradykinin-induced subjective nasal congestion scores, but did not lead to a significant decrease in total symptoms or in vascular permeability. Finally, the B1 kinin receptor agonist des-Arg9-bradykinin (1 mg) was totally ineffective in inducing symptoms or increasing vascular permeability. Thus, nasal provocation with bradykinin leads to induction of symptoms and increased vascular permeability, presumably via stimulation of B2 kinin receptors, and is not dependent on prostanoid generation.

Individualizing the Good Behavior Game across type and frequency of behavior with emotionally disturbed adolescents

The effects of the Good Behavior Game (GBG) individualized across type and frequency of behavior were examined in three classes of severely behaviorally disordered students using a reversal design. The findings showed that the individualized GBG was effective in simultaneously decreasing a variety of inappropriate behaviors exhibited by the three classes, including inappropriate verbalizations, touching, negative comments, cursing, and drumming. Teacher and student satisfaction data indicated that both groups had positive reactions to the individualized GBG. Reasons for the success of the technique are discussed.

Nasal provocation with bradykinin induces symptoms of rhinitis and a sore throat

Kinins are generated in nasal secretions during allergic reactions and during induced rhinovirus colds. To determine if kinins may contribute to the symptomatology of these inflammatory reactions, 8 subjects were challenged with increasing doses of bradykinin or with placebo. Levels of albumin, histamine, and N-alpha-tosyl-L-arginine methyl ester (TAME)-esterase were measured in nasal lavages, and symptom scores were noted. No symptoms or increases in mediators or protein were observed after placebo challenge. Symptom scores increased in a dose-dependent manner, however, in response to bradykinin challenge. Increased symptoms were associated with significant increases in albumin and TAME-esterase activity, but no increases in histamine were observed. Nasal conductance measurements confirmed that bradykinin induces dose-dependent unilateral obstruction in the challenged nostril. Other common symptoms were rhinorrhea and, of particular relevance to rhinovirus infections, a persistent sore throat. We conclude that bradykinin causes increased vascular permeability and rhinitis, which are independent of mast cell mediator release. Kinins may, therefore, contribute to the symptomatology of inflammatory reactions of the upper airways, including the common cold.