Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

This paper describes a process to define a comprehensive list of exemplars for seven core Diagnostic and Statistical Manual (DSM) diagnostic criteria for autism spectrum disorder (ASD), and report on interrater reliability in applying these exemplars to determine ASD case classification. Clinicians completed an iterative process to map specific exemplars from the CDC Autism and Developmental Disabilities Monitoring (ADDM) Network criteria for ASD surveillance, DSM-5 text, and diagnostic assessments to each of the core DSM-5 ASD criteria. Clinicians applied the diagnostic exemplars to child behavioral descriptions in existing evaluation records to establish initial reliability standards and then for blinded clinician review in one site (phase 1) and for two ADDM Network surveillance years (phase 2). Interrater reliability for each of the DSM-5 diagnostic categories and overall ASD classification was high (defined as very good .60-.79 to excellent ≥ .80 Kappa values) across sex, race/ethnicity, and cognitive levels for both phases. Classification of DSM-5 ASD by mapping specific exemplars from evaluation records by a diverse group of clinician raters is feasible and reliable. This framework provides confidence in the consistency of prevalence classifications of ASD and may be further applied to improve consistency of ASD diagnoses in clinical settings.

Implementation and evaluation of a transit dosimetry system for treatment verification

PURPOSE

To evaluate a formalism for transit dosimetry using a phantom study and prospectively evaluate the protocol on a patient population undergoing 3D conformal radiotherapy.

METHODS

Amorphous silicon EPIDs were calibrated for dose and used to acquire images of delivered fields. The measured EPID dose map was back-projected using the planning CT images to calculate dose at pre-specified points within the patient using commercially available software, EPIgray (DOSIsoft, France). This software compared computed back-projected dose with treatment planning system dose. A series of tests were performed on solid water phantoms (linearity, field size effects, off-axis effects). 37 patients were enrolled in the prospective study.

RESULTS

The EPID dose response was stable and linear with dose. For all tested field sizes the agreement was good between EPID-derived and treatment planning system dose in the central axis, with performance stability up to a measured depth of 18cm (agreement within -0.5% at 10cm depth on the central axis and within -1.4% at 2cm off-axis). 126 transit images were analysed of 37 3D-conformal patients. Patient results demonstrated the potential of EPIgray with 91% of all delivered fields achieved the initial set tolerance level of ΔD of 0±5-cGy or %ΔD of 0±5%.

CONCLUSIONS

The in vivo dose verification method was simple to implement, with very few commissioning measurements needed. The system required no extra dose to the patient, and importantly was able to detect patient position errors that impacted on dose delivery in two of cases.

Sleep regulation and sex hormones exposure in men and women across adulthood

This review aims to discuss how endogenous and exogenous testosterone exposures in men and estrogens/progesterone exposures in women interact with sleep regulation. In young men, testosterone secretion peaks during sleep and is linked to sleep architecture. Animal and human studies support the notion that sleep loss suppresses testosterone secretion. Testosterone levels decline slowly throughout the aging process, but relatively few studies investigate its impact on age-related sleep modifications. Results suggest that poorer sleep quality is associated with lower testosterone concentrations and that sleep loss may have a more prominent effect on testosterone levels in older individuals. In women, sex steroid levels are characterized by a marked monthly cycle and reproductive milestones such as pregnancy and menopause. Animal models indicate that estrogens and progesterone influence sleep. Most studies do not show any clear effects of the menstrual cycle on sleep, but sample sizes are too low, and research designs often inhibit definitive conclusions. The effects of hormonal contraceptives on sleep are currently unknown. Pregnancy and the postpartum period are associated with increased sleep disturbances, but their relation to the hormonal milieu still needs to be determined. Finally, studies suggest that menopausal transition and the hormonal changes associated with it are linked to lower subjective sleep quality, but results concerning objective sleep measures are less conclusive. More research is necessary to unravel the effects of vasomotor symptoms on sleep. Hormone therapy seems to induce positive effects on sleep, but key concerns are still unresolved, including the long-term effects and efficacy of different hormonal regimens.

Applicability of the MoCA-S test in populations with little education in Colombia

OBJECTIVES

The objectives of this study were to report on the use of the Spanish version of the Montreal Cognitive Assessment (MoCA-S) as cognitive screening tool in a population aged 65 to 74 years in the Andes Mountains of Colombia, assessing the influence of education, and to examine its test-retest reliability.

METHODS

We performed a cross-sectional study of 150 subjects aged 65 to 74 years recruited from older community social centers in Manizales, Colombia. The Leganes Cognitive Test (LCT), a cognitive screening test for populations with low education, was used to exclude those who were likely to have dementia. The associations between the MoCA total score and cognitive domains and education were examined in the total sample and in those likely free of dementia. MoCA-S test-retest reliability was estimated by the intraclass correlation coefficient (ICC) between two measurements taken 7 days apart.

RESULTS

Participants had low levels of formal education (mean years of schooling, 4.8). According to the LCT, the proportion of people screening positive for dementia was 16% (n = 24). The mean MoCA-S scores were 16.1/30 among illiterate subjects, 18.2/30 among those with incomplete primary school, and 20.3/30 among those with complete primary school (p < 0.001). Errors were frequent in the cube and clock drawing, attention-serial subtraction, verbal fluency, and abstraction. Test-retest reliability was high, ICC = 0.86, 95% CI (0.76-0.93).

CONCLUSION

The MoCA-S has high reliability in low-educated older Colombians, but scores were strongly dependent on years of education. Social and cultural factors must be considered when interpreting MoCA-S given the high error rates on items that depend on the ability to read and write and on culture.

Hypernatraemic dehydration in Jamaican breastfed neonates: a 12-year review in a baby-friendly hospital

A 12-year retrospective review of neonates admitted with hypernatraemic dehydration to the neonatal unit of the University Hospital of the West Indies was conducted between 1 January 1990 and 31 December 2001. Twenty-four infants fulfilled the criteria for hypernatraemic dehydration. Nineteen (79%) women were either nulliparous or primiparous with a mean (SD) age of 26.9 (4.4) yrs. Modal length of hospital stay for mothers was 24 hrs. Twenty (83.3%) infants were exclusively breastfed. Mean (SD) age at presentation was 7.4 (3.8) days. Mean (SD) percentage weight loss between birth and presentation was 18.9% (6.3). Mean (SD) serum sodium at presentation was 164.8 (13.9) mmol/L. Babies visited at home by nurses had a lower mean serum sodium, were less dehydrated and were significantly less acidiotic. Their mean (SD) length of hospital stay was also significantly less [4.2 (1.4) days] than those who were not visited [7.9 (3.8) days] (p < 0.05). Complications occurred in 19 (79%) of infants and included renal failure (19, 79%), seizures (3, 13%) and intraventricular haemorrhage (1, 4%), and one died (4%). Hypernatraemic dehydration is an uncommon complication of failure to establish breastfeeding but is associated with severe morbidity and mortality. Education programmes are needed to increase awareness amongst health-care workers and mothers in order to prevent the problem.

Estimating the balance between pasture feed supply and demand of grazing livestock in a farmlet experiment

Data from the Cicerone farmlet study were used to quantify the balance between pasture feed supply and the demand from grazing livestock, in terms of metabolisable energy (ME), on three differently managed farmlets (each of 53 ha) on the Northern Tablelands of New South Wales, Australia. Farmlet A had a high level of pasture renovation and higher soil fertility than the other two farmlets and employed flexible grazing management over eight paddocks. Farmlet B was designed to represent management ‘typical’ of the region and had the same grazing management and number of paddocks as farmlet A but moderate levels of pasture renovation and soil fertility. The third farmlet (C) had the same level of inputs as farmlet B but practised intensive rotational grazing over 37 paddocks. Regular measurements of the feed supply, namely herbage mass and quality, pasture growth and supplement fed and of feed demand were assembled to provide monthly estimates of the balance between feed supply and animal demand of all classes of livestock run on the experiment over its duration of 6.5 years. The significantly greater stocking rate, liveweight and reproductive rate of sheep reached on the higher input system (farmlet A) meant higher levels of ME were required to satisfy the nutritional demands of these animals. As only limited measurements were taken of animal intake, it was assumed that the supply of ME was derived from pasture growth and supplement fed. Using key livestock management dates and measurements of liveweights, the changes in the energy requirements of each class of animal were calculated and aggregated to provide an estimate of overall livestock energy demand over time. Subtracting the energy demand from the estimated energy supply provided a partial net energy balance. Measurements of the rates of change of green herbage during grazing events were found to be highly dependent on stock density with farmlets A, B and C recording rates of change of up to –50, –30 and –200 green DM/ha.day, respectively. Over a series of generally drier-than-average years, the ME supplied in pasture growth and through supplementation was at times inadequate to meet the energy demands of the livestock, resulting in periods during winter when the partial energy balance became negative. Similar feed deficits were observed for all three farmlets, suggesting that they were over-stocked to a similar extent. In spite of the divergence in the stocking rate supported by each farmlet, the similarity of the ME balances between farmlets suggests that no farmlet was subjected to bias because of decisions relating to feed supply and demand. The analyses presented suggest there is considerable potential for practical paddock and grazing management to be improved if more timely and regular assessments can be made of changes in the feed energy supply using satellite images of normalised difference vegetation indices and feed energy demand using calculations of the ME required by grazing livestock.

Is a small muscle mass index really detrimental for insulin sensitivity in postmenopausal women of various body composition status?

OBJECTIVES

We sought to determine if a small muscle mass index (MMI) is actually detrimental for insulin sensitivity when studying a large group of postmenopausal women displaying various body composition statuses and when age and visceral fat mass (VFM) are taken into account.

METHODS

A cross-sectional study was conducted in 99 healthy postmenopausal women with a BMI of 28±4 kg/m(2). Fat mass and total fat-free mass (FFM) were obtained from DXA and VFM and MMI were estimated respectively by the equation of Bertin and by: Total FFM (kg)/height (m)(2). Fasting plasma insulin and glucose were obtained to calculate QUICKI and HOMA as an insulin sensitivity index.

RESULTS

Total MMI and VFM were both significantly inversely correlated with QUICKI and positively with HOMA even when adjusted for VFM. A stepwise linear regression confirmed Total MMI and VFM as independent predictors of HOMA and plasma insulin level.

CONCLUSIONS

A small muscle mass might not be detrimental for the maintenance of insulin sensitivity and could even be beneficial in sedentary postmenopausal women. The impact of muscle mass loss on insulin sensitivity in older adults needs to be further investigated.

Femtosecond laser ablation ICP-MS measurement of otolith Sr:Ca and Ba:Ca composition reveal differential use of freshwater habitats for three amphidromous Sicyopterus (Teleostei: Gobioidei: Sicydiinae) species

The use of freshwater habitats was examined in three amphidromous goby species of the genus Sicyopterus using otolith microchemistry. Two species were endemic to either New Caledonia or Vanuatu whilst the other was widely distributed. Depositional patterns of strontium (Sr) and barium (Ba) in the otolith of adults were analysed with femtosecond laser ablation inductively coupled plasma mass spectrometry (ICP-MS). The Sr:Ca and Ba:Ca results uncovered three different adult behaviours within the freshwater habitat. Some fishes stayed in elevated locations (square profile); others undertook back-and-forth migrations between higher and lower reaches (up-and-down profile), and finally, others stayed in the lower reaches (constant profile). The consequences of these movements to larval survival or competition for food and territory are discussed. This work brings new knowledge on amphidromous behaviour, and it highlights the necessity of multi-elemental analysis to study amphidromy in freshwater systems.

Abstract P5-05-02: Whole Genome In Vivo RNA Interference Screening Identifies the Leukemia Inhibitory Factor Receptor as a Novel Breast Tumor Suppressor

Background: Cancer is caused by mutations in oncogenes and tumor suppressor genes resulting in the deregulation of processes fundamental to the normal behavior of cells. The identification and characterization of oncogenes and tumor suppressors has led to new treatment strategies that have significantly improved cancer outcome. The advent of next generation sequencing has allowed the elucidation of the fine structure of cancer genomes, however, the identification of pathogenic changes is complicated by the inherent genomic instability of cancer cells. Therefore, functional approaches for the identification of novel genes involved in the initiation and development of tumors are critical. Methods: In order to identify functionally important tumor suppressor genes we have conducted the first human whole genome in vivo RNA interference (RNAi) screen. Partially transformed human mammary epithelial cells (HMLEs), which do not form tumors in immunodeficient mice, were infected with the Expression Arrest™ GIPZ lentiviral shRNA library consisting of 62,000 shRNAs targeting the whole human genome, and injected into the mammary fat pad of immunodeficient mice. shRNAs that silenced tumor suppressor genes fully transformed the mammary epithelial cells resulting in tumor formation. Candidate tumor suppressor genes were identified by PCR amplification and sequencing of tumor integrated shRNAs. For validation, candidate tumor suppressor genes were silenced in HMLEs and ectopically expressed in fully transformed breast cancer cells. The effect of modifying gene expression on the transformed phenotype was assessed using soft agar colony formation assays. Clinical significance was determined by comparing expression in normal and cancerous human breast tissue using Oncomine Research. Results and Discussion: Using our novel approach, we identify previously validated tumor suppressor genes including TP53 and MNT, as well as several novel candidate tumor suppressor genes including leukemia inhibitory factor receptor (LIFR). Silencing LIFR expression with multiple shRNA constructs fully transformed human mammary epithelial cells resulting in enhanced colony formation in soft agar (P&lt;0.05). Furthermore, overexpression of LIFR significantly inhibited colony formation in soft agar of fully transformed MDA231 and MCF7 breast cancer cells (P&lt;0.01). In addition, our analysis of clinical data revealed that LIFR expression is significantly decreased in a large percentage of human cancers including breast (P&lt;0.0001), lung (P&lt;0.0001), hepatocellular (P&lt;0.0001) and gastrointestinal tumors (P&lt;0.0001). These results validate LIFR as a previously unidentified highly significant tumor suppressor, and also demonstrate the power of whole genome in vivo RNAi screens as a method for identifying novel genes regulating tumorigenesis.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-05-02.

Measuring indices of lifelong estrogen exposure: self-report reliability

OBJECTIVE

The utility of clinical markers of lifelong estrogen exposure is established in the understanding of breast cancer, osteoporosis and dementia, among others. However, a good number of studies rely on self-reports to ascertain the involvement of certain estrogen exposure indices. The goal of this study is to assess the reliability of self-reported lifelong estrogen exposure indices by measuring correlation between two repeats.

METHODS

A questionnaire assessing lifelong indices of estrogen exposure was developed (revised version included) and completed by 36 healthy postmenopausal women twice within a 4-year interval (age range from 50 to 79 years). Reliability was tested using Pearson's correlation coefficient.

RESULTS

Strong significant correlations were observed for most estrogen exposure indices and an effect of age was revealed. Age at menopause and age at initiation of hormone therapy were the two variables leading to weaker correlations across time of measurements; no relation was found between Time 1 and Time 2 when looking at the group of older women (over 65 years of age).

CONCLUSIONS

Overall, these results support the use of self-reported measures for most of the lifelong estrogen exposure indices, but they also warn us about the pitfalls of the climacteric period. However, the design of the current study did not allow us to test accuracy; thus, the validity of these self-reported variables needs to be addressed in the future.

Stress in Women with Postpartum Obsessive-compulsive Disorder: A Neuroimaging Study

Objective:

Postpartum onset of anxiety disorders, particularly of obsessive-compulsive disorder (OCD) are rarely reported in the literature although frequently observed in the clinical setting. The obsessions and compulsions focus on the newborn and create immense distress. Research on the stress response in postpartum psychiatric populations is limited and the neural and neuroendocrine correlates of postpartum OCD is unclear. Few studies investigated the brain circuitry involved in OCD, very few included women and none in the postpartum period, and none of which focus on the stress reactivity underlying network.

The purpose of this study is to examine neural activation in women with postpartum OCD as compared to healthy postpartum women in response to a stress task using functional magnetic resonance imaging (fMRI).

Method:

Subjects are females diagnosed with postpartum OCD and matched healthy controls. During the stress phase, fMRI is recorded to observe brain activity while subjects complete the Montreal Imaging Stress Task (MIST), a psychological stressor. Saliva samples are obtained before and after the stressor to assess the hormonal stress response along with subjective stress rating.

Results:

To date, 9 postpartum OCD women and 10 controls completed the study. Preliminary analyses show that the majority of the subjects demonstrated an increase in subjective stress rating with postpartum OCD women experiencing the MIST more stressful compared to controls. As previously reported we observed deactivation throughout the limbic system in all subjects but only the postpartum OCD women also recruited the orbitofrontal cortex.

Conclusion:

These preliminary observations are consistent with the literature and point toward a distinct stress brain activation pattern in postpartum OCD women. It is hoped that the results of this study will provide further insight into the nature of neurophysiological and neuroendocrinological involvement in postpartum OCD.

Predictors of survival in very low birth weight infants at the University Hospital of the West Indies, Jamaica

The use of prenatal steroids is an effective, simple clinical intervention that can be implemented in developing countries to help decrease mortality in very low birth weight infants.

Outcome of extremely low birthweight infants at the University Hospital of the West Indies, Jamaica

OBJECTIVE

To describe the early outcome of extremely low birthweight infants delivered at the University Hospital of the West Indies.

METHODS

A two-year retrospective review of the charts of all live, inborn extremely low birthweight infants admitted to the neonatal unit between January 1, 2002 and December 31, 2003 was conducted Differences between survivors and non-survivors were determined using analysis of variance and predictors of outcome were determined using multiple regression models.

RESULTS

During the study period, 47 extremely low birthweight infants were admitted to the neonatal unit. The mean +/- SD birthweight and gestational age of these infants were 780 +/- 137 g and 27 +/- 2 weeks respectively. Twenty (43%) infants survived Babies (19; 58%) of gestational age > or = 27 weeks had increased survival compared to those < 27 weeks, (1; 7%; p = 0.001) and babies weighing > or = 750 g had increased survival (17, 65%) compared to those weighing < 750 g, (3, 14%; p < 0.001). Infants delivered by Caesarean section had improved survival 15 (58%) over those delivered vaginally (5, 24%; p = 0.02). All six (100%) infants whose mothers did not receive prenatal steroids died while 18 (50%) infants whose mothers received prenatal steroids died (p = 0.02). Significant factors associated with outcome were offered and gender was entered into a multiple regression model; gestational age and female gender remained independent predictors of survival.

CONCLUSION

Obstetric measures for the prevention of preterm delivery need to be optimized in order to decrease the morbidity and mortality associated with extremely low birthweight infants.

Dietary animal protein intake: association with muscle mass index in older women

BACKGROUND

Aging is associated with reductions in muscle mass and strength, so-called sarcopenia, and is generally characterized using muscle mass index (MMI = FFM (kg)/height (m)2). It is believed that adequate nutrition especially regarding protein intake, can delay this progression and enhance the quality of life of elders.

OBJECTIVES

We examined whether the predominant source of protein consumed (animal or vegetal) by older women was associated with MMI.

DESIGN

Thirty-eight healthy, normal weight, sedentary women, aged between 57-75 years (mean age: 66 +/- 5 years old), and taking no medication that could influence metabolism were recruited. Body composition was measured by dual-energy X-ray absorptiometry; muscle protein content was measured by the use of creatinine excretion. Physical activity metabolism was obtained by the use of accelerometry, and indirect calorimetry. Finally, protein intake was measured with a 3-day dietary record.

RESULTS

Significant correlations were observed between MMI and body mass index, fat-free mass, muscle protein content, total protein intake, animal protein intake, fat mass, visceral fat and daily energy expenditure. However, a stepwise regression analysis showed animal protein intake to be the only independent predictor of MMI (r2=0.19; p=0.008).

CONCLUSIONS

Our results suggest that protein intake, especially from animal sources, may be associated with a better preservation of MMI. However, more research is needed to confirm our results.

Relationship between antioxidant intakes and class I sarcopenia in elderly men and women

BACKGROUND

The effect of nutritional intake on sarcopenia has been mostly examined in class II sarcopenia, i.e. when muscle mass has sufficiently decreased to induce a loss in physical capacity. Although this provides important information regarding the treatment of sarcopenia, it may not help highlight mechanisms involved at the very beginning of its development.

HYPOTHESIS

We hypothesized that class I sarcopenia is associated with differences in antioxidant intakes (vitamins A, C, E and selenium) and status in healthy, older white men and women when physical activity and protein intake are taken into account.

DESIGN

Fat-free mass and total appendicular skeletal muscle mass was determined by dual-energy X-ray absorptiometry in 50 healthy, older white men (n = 16) and women (n = 34) aged 60-75 yrs. Physical activity energy expenditure (PAEE) was determined using a Caltrac accelerometer over a 3-d period. Dietary protein and antioxidant intakes were estimated from a 3-d food record and serum total antioxidant activity (TAA) was measured by a ferrylmyoglobin- ABTS assay.

RESULTS

The prevalence of class I sarcopenia was 23.5 % in women and 25.0 % in men; 12 participants were thus considered sarcopenic (4 men and 8 women) and 38 participants were considered nonsarcopenic (12 men and 26 women). Our results showed that PAEE, serum albumin concentrations, TAA, and the four antioxidants intake levels were similar between groups. On the other hand, our results showed that total protein intake was significantly higher (P < 0.01) in the non-sarcopenic group than in the sarcopenic group. Also, the number of Recommended Dietary Allowances (RDAs) reached for the antioxidant nutrients and protein intakes by the non-sarcopenic group was significantly higher (P < 0.01) than in the sarcopenic group.

CONCLUSIONS

Although there were no significant differences between the sarcopenic and the non-sarcopenic group when antioxidant intakes were considered individually, we observed that the number of RDAs reached for antioxidant micronutrients and protein in healthy, older white men and women was lower in sarcopenic than nonsarcopenic individuals. Our results also suggest that a higher total dietary protein intake is associated with the preservation of muscle mass loss although both groups displayed values above actual RDAs. Obviously, prospective studies are needed to determine the minimum amount of protein in the diet needed to prevent class I sarcopenia and to examine the utility of antioxidant intake to combat the age-related loss in skeletal muscle mass.

Six months of isoflavone supplement increases fat-free mass in obese-sarcopenic postmenopausal women: a randomized double-blind controlled trial

OBJECTIVE

The aim of this study was to verify if six months of isoflavone supplementation could increase fat-free mass (FFM) and muscle mass index (MMI=appendicular FFM/height(2)) in obese-sarcopenic postmenopausal women.

DESIGN

Double-blind randomized study.

SUBJECT

Eighteen sarcopenic-obese women completed the study (12 on isoflavones and six on placebo). Body composition was measured by dual-energy X-ray absorptiometry. Subjects ingested 70 mg of isoflavones per day (44 mg of diadzein, 16 mg glycitein and 10 mg genestein) or a placebo for 24 weeks.

RESULTS

The isoflavone group increased significantly appendicular (P=0.034), leg (P=0.016) FFM and MMI (P=0.037), but not the placebo group.

CONCLUSION

Six months of isoflavone supplementation increased FFM and MMI in obese-sarcopenic postmenopausal women.

Hippocampal volume is as variable in young as in older adults: implications for the notion of hippocampal atrophy in humans

Previous studies in humans have shown the presence of an age-related reduction of hippocampal (HC) volume, as well as the presence of reduced HC volume in psychiatric populations suffering from schizophrenia, depression or post-traumatic stress disorder. Altogether, these data suggested that aging or psychiatric disease can have neurotoxic effects on the hippocampus, and lead to HC atrophy. However, these two sets of findings imply that HC volume in young healthy adults should present less variability than HC volume in older adults and psychiatric populations. In the present study, we assessed HC volume in 177 healthy men and women aged from 18 to 85 years of age. We show that the dispersion around the mean of HC volume is not different in young and older adults, so that 25% of young healthy adults present HC volume as small as the average participants aged 60 to 75 years. This shows that HC volume is as variable in young as in older adults and suggests that smaller HC volume attributed to the aging process in previous studies could in fact represent HC volume determined early in life. We also report that within similar age groups, the percentage of difference in HC volume between the individuals with the smallest HC volume (smallest quartile) and the group average is greater than the percentage of difference reported to exist between psychiatric populations and normal control in recent meta-analyses. Taken together, these results confront the notion of hippocampal atrophy in humans and raise the possibility that pre-determined inter-individual differences in HC volume in humans may determine the vulnerability for age-related cognitive impairments or psychopathology throughout the lifetime.

A novel nonsense mutation in the EYA1 gene associated with branchio-oto-renal/branchiootic syndrome in an Afrikaner kindred

Branchio-oto-renal (BOR) syndrome is an autosomal dominant disorder characterized by the associations of hearing loss, branchial arch defects and renal anomalies. Branchiootic (BO) syndrome is a related disorder that presents without the highly variable characteristic renal anomalies of BOR syndrome. Dominant mutations in the human homologue of the Drosophila eyes absent gene (EYA1) are frequently the cause of both BOR and BO syndromes. We report a South African family of Afrikaner descent with affected individuals presenting with pre-auricular abnormalities and either hearing loss or bilateral absence of the kidneys. Genetic analysis of the pedigree detected a novel EYA1 heterozygous nonsense mutation in affected family members but not in unaffected family members or a random DNA panel. Through mutational analysis, we conclude that this particular mutation is the cause of BOR/BO syndrome in this family as a result of a truncation of the EYA1 protein that ablates the critical EYA homologous region. To the best of our knowledge, this is the first case of BOR/BO syndrome reported in Africa or in those of the Afrikaner descent.

Perceptions of general environmental problems, willingness to expend federal funds on these problems, and concerns regarding the Los Alamos National Laboratory: Hispanics are more concerned than Whites

Perceptions about general environmental problems, governmental spending for these problems, and major concerns about the US Department of Energy's Los Alamos National Laboratory (LANL) were examined by interviewing 356 people attending a gun show in Albuquerque, New Mexico. The hypothesis that there are differences in these three areas as a function of ethnicity was examined. We predicted that if differences existed, they would exist for all three evaluations (general environmental problems, government spending, and environmental concerns about LANL). However, this was not the case; there were fewer ethnic differences concerning LANL. Hispanics rated most general environmental problems higher than Whites and rated their willingness to expend federal funds higher than Whites, although all groups gave a lower score on willingness than on concern. Further, the congruence between these two types of ratings was higher for Hispanics than for others. In general, the concerns expressed by subjects about LANL showed few ethnic differences, and everyone was most concerned about contamination. These data indicate that Hispanics attending a gun show are equally or more concerned than others about environmental problems generally but are not more concerned about LANL. The data can be useful for developing future research and stewardship plans and for understanding general environmental problems and their relationship to concerns about LANL. More generally, they indicate that the attitudes and perceptions of Hispanics deserve increased study in a general population.

Perceptual indicators of environmental health, future land use, and stewardship

There are important linkages between the health of humans and the environment, restoration of degraded lands, and long-term stewardship of public lands, yet most environmental indicators deal only with assessing the physical and biological aspects of ecosystems. In this article, we examine the ratings of perceptions of several environmental problems for their utility as indicators of environmental quality, and examine perceptions of future land use by people interviewed in Santa Fe, New Mexico, near the Department of Energy's (DOE) Los Alamos National Laboratory (LANL). Overall, people with lower incomes rated environmental problems as more severe than others, were more willing to spend federal funds to solve them, and were consistent in their ratings of severity of environmental problems and their willingness to spend federal funds. Cleaning up LANL and other Department of Energy sites, received the highest rating for expenditure of federal funds. The highest rated future uses for DOE sites were for recreation and for National Environmental Research Parks. People with less education generally gave higher ratings to most future land uses for DOE than did those with more education. However, those with higher education gave higher ratings to nuclear reprocessing, and nuclear material storage. Where there were differences, the people interviewed at Santa Fe rated all environmental problems (except pesticides) as more severe than did those previously interviewed in Albuquerque (located farther from the LANL site), and they were more willing to spend federal funds on these problems. Ratings for all future land uses did not differ between the Santa Fe and Albuquerque respondents. These perception-based indicators show general agreement among people living close and farther away from LANL with respect to cleaning up LANL and the future land uses for the site. These indicators should be considered by regulators, site personnel, and policy makers in future management and land use decisions.

Transmission disequilibrium testing of arginine vasopressin receptor 1A (AVPR1A) polymorphisms in autism

Impairment in social reciprocity is a central component of autism. In preclinical studies, arginine vasopressin (AVP) has been shown to increase a range of social behaviors, including affiliation and attachment, via the V(1a) receptor (AVPR1A) in the brain. Both the behavioral effects of AVP and the neural distribution of the V1a receptor vary greatly across mammalian species. This difference in regional receptor expression as well as differences in social behavior may result from a highly variable repetitive sequence in the 5' flanking region of the V1a gene (AVPR1A). Given this comparative evidence for a role in inter-species variation in social behavior, we explored whether within our own species, variation in the human AVPR1A may contribute to individual variations in social behavior, with autism representing an extreme form of social impairment. We genotyped two microsatellite polymorphisms from the 5' flanking region of AVPR1A for 115 autism trios and found nominally significant transmission disequilibrium between autism and one of the microsatellite markers by Multiallelic Transmission/Disequilibrium test (MTDT) that was not significant after Bonferroni correction. We also screened approximately 2 kb of the 5' flanking region and the coding region and identified 10 single nucleotide polymorphisms.

Transmission disequilibrium mapping at the serotonin transporter gene (SLC6A4) region in autistic disorder

The serotonin transporter gene (SLC6A4, MIM 182138) is a candidate gene in autistic disorder based on neurochemical, neuroendocrine studies and the efficacy of potent serotonin transporter inhibitors in reducing ritualistic behaviors and related aggression. An insertion/deletion polymorphism (5-HTTLPR) in the promoter region and a variable number of tandem repeat polymorphism (VNTR) in the second intron, were previously identified and suggested to modulate transcription. Six previous family-based association studies of SLC6A4 in autistic disorder have been conducted, with four studies showing nominally significant transmission disequilibrium and two studies with no evidence of nominally significant transmission disequilibrium. In the present study, TDT was conducted in 81 new trios. A previous finding of transmission disequilibrium between a haplotype consisting of the 5-HTTLPR and intron 2 VNTR was replicated in this study, but not preferential transmission of 5-HTTLPR as an independent marker. Because of inconsistent transmission of 5-HTTLPR across studies, SLC6A4 and its flanking regions were sequenced in 10 probands, followed by typing of 20 single nucleotide polymorphisms (SNPs) and seven simple sequence repeat (SSR) polymorphisms in 115 autism trios. When individual markers were analyzed by TDT, seven SNP markers and four SSR markers (six SNPs, 5-HTTLPR and the second intron VNTR from promoter 1A through intron 2 of SLC6A4, one SSR from intron 7 of SLC6A4, one SNP from the bleomycin hydrolase gene (BLMH, MIM 602403) and one SSR telomeric to BLMH) showed nominally significant evidence of transmission disequilibrium. Four markers showed stronger evidence of transmission disequilibrium (TDT(max) P = 0.0005) than 5-HTTLPR.

Exposure of South Carolinians to commercial meats and fish within their meat and fish diet

There has been considerable interest in the public's exposure to a variety of contaminants through the consumption of wild fish and game, yet there is little information on consumption of commercial meats and fish, or the relationship between commercial and self-caught fish. We conducted a dietary survey in 1999 to estimate exposure levels of 464 individuals from people attending the Palmetto Sportsmen's Classic. Mean consumption was similar for beef, chicken/turkey, and wild-caught fish, and much lower for pork and store-bought fish, and still lower for restaurant fish. There were no ethnic differences in the consumption of most commercial fish and meats, although the differences for chicken approached significance. There were significant ethnic differences in consumption of wild-caught fish. Women ate significantly less of all meat types, except store-bought fish. People over 45 ate less beef than younger people, and people younger than 32 ate significantly more chicken than others. There were no significant differences in consumption patterns as a function of income, except for chicken and wild-caught fish; people with higher incomes ate more chicken than others, and people with lower incomes ate more wild-caught fish than others. When all wild-caught and commercial fish and meats are considered, there are significant differences only for ethnicity and gender. Blacks consume significantly more fish than Whites, and men consume significantly more than women.

Multisite, double-blind, placebo-controlled trial of porcine secretin in autism

OBJECTIVE

To examine the efficacy of intravenous porcine secretin for the treatment of autistic disorder.

METHOD

Randomized, double-blind, placebo-controlled, crossover design. Fifty-six subjects with autistic disorder received either a secretin or placebo infusion at baseline and the other substance at week 4. Subjects were given the Autism Diagnostic Observation Schedule (ADOS) and other pertinent developmental measures at baseline and at weeks 4 and 8 to assess drug effects.

RESULTS

For the primary efficacy analysis, change of ADOS social-communication total score from week 0 to week 4, no statistically significant difference was obtained between placebo (-0.8 +/- 2.9) and secretin groups (-0.6 +/- 1.4; t54 = 0.346, p < .73). The other measures showed no treatment effect for secretin compared with placebo.

CONCLUSION

There was no evidence for efficacy of secretin in this randomized, placebo-controlled, double-blind trial.

Unusual brain growth patterns in early life in patients with autistic disorder: an MRI study

OBJECTIVE

To quantify developmental abnormalities in cerebral and cerebellar volume in autism.

METHODS

The authors studied 60 autistic and 52 normal boys (age, 2 to 16 years) using MRI. Thirty autistic boys were diagnosed and scanned when 5 years or older. The other 30 were scanned when 2 through 4 years of age and then diagnosed with autism at least 2.5 years later, at an age when the diagnosis of autism is more reliable.

RESULTS

Neonatal head circumferences from clinical records were available for 14 of 15 autistic 2- to 5-year-olds and, on average, were normal (35.1 +/- 1.3 cm versus clinical norms: 34.6 +/- 1.6 cm), indicative of normal overall brain volume at birth; one measure was above the 95th percentile. By ages 2 to 4 years, 90% of autistic boys had a brain volume larger than normal average, and 37% met criteria for developmental macrencephaly. Autistic 2- to 3-year-olds had more cerebral (18%) and cerebellar (39%) white matter, and more cerebral cortical gray matter (12%) than normal, whereas older autistic children and adolescents did not have such enlarged gray and white matter volumes. In the cerebellum, autistic boys had less gray matter, smaller ratio of gray to white matter, and smaller vermis lobules VI-VII than normal controls.

CONCLUSIONS

Abnormal regulation of brain growth in autism results in early overgrowth followed by abnormally slowed growth. Hyperplasia was present in cerebral gray matter and cerebral and cerebellar white matter in early life in patients with autism.

Double-blind, placebo-controlled study of amantadine hydrochloride in the treatment of children with autistic disorder

OBJECTIVE

To test the hypothesis that amantadine hydrochloride is a safe and effective treatment for behavioral disturbances--for example, hyperactivity and irritability--in children with autism.

METHOD

Thirty-nine subjects (intent to treat; 5-19 years old; IQ > 35) had autism diagnosed according to DSM-IV and ICD-10 criteria using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule-Generic. The Aberrant Behavior Checklist-Community Version (ABC-CV) and Clinical Global Impressions (CGI) scale were used as outcome variables. After a 1-week, single-blind placebo run-in, patients received a single daily dose of amantadine (2.5 mg/kg per day) or placebo for the next week, and then bid dosing (5.0 mg/kg per day) for the subsequent 3 weeks.

RESULTS

When assessed on the basis of parent-rated ABC-CV ratings of irritability and hyperactivity, the mean placebo response rate was 37% versus amantadine at 47% (not significant). However, in the amantadine-treated group there were statistically significant improvements in absolute changes in clinician-rated ABC-CVs for hyperactivity (amantadine -6.4 versus placebo -2.1; p = .046) and inappropriate speech (-1.9 versus 0.4; p = .008). CGI scale ratings were higher in the amantadine group: 53% improved versus 25% (p = .076). Amantadine was well tolerated.

CONCLUSIONS

Parents did not report statistically significant behavioral change with amantadine. However, clinician-rated improvements in behavioral ratings following treatment with amantadine suggest that further studies with this or other drugs acting on the glutamatergic system are warranted. The design of these and similar drug trials in children with autistic disorder must take into account the possibility of a large placebo response.

Quantifying the phenotype in autism spectrum disorders

Twin and family studies suggest that familial transmission in autism extends to a spectrum of social and behavioral deficits that characterize individuals who have significant impairments within the autism spectrum, but do not meet formal criteria for autistic disorder. Standardized diagnostic instruments, including the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS-WPS Edition), offer the opportunity to quantify deficits across the autism spectrum, controlling effects of language and cognitive delay, in individuals with significant impairments. It is suggested that quantitative measures of social reciprocity and repetitive behaviors and interests, with separate quantification of expressive language level and nonverbal intelligence, most accurately reflect the range of behavioral phenotypes in autism spectrum disorders.

How much observational data is enough? An empirical test using marital interaction coding

Using three different samples of couples (clinic, nondistressed community, and engaged), we found that 15 minutes was sufficient to witness enough behavior to make reliable (i.e., internally consistent) estimations of most Rapid Marital Interaction Coding System (Heyman & Vivian, 1993) code frequencies. Ten minutes is sufficient for many codes of interest. The ease in which "how much time is necessary" calculations can be made should entice behavioral investigators from a variety of content areas to publish such figures. By empirically investigating a factor that in most fields becomes reified through convention, investigators can conduct observational research that is both maximally efficient and maximally scientifically defensible.

B cell receptor-stimulated mitochondrial phospholipase A2 activation and resultant disruption of mitochondrial membrane potential correlate with the induction of apoptosis in WEHI-231 B cells

Cross-linking of the Ag receptors on the immature B cell lymphoma, WEHI-231, leads to growth arrest and apoptosis. We now show that although commitment to such B cell receptor (BCR)-mediated apoptosis correlates with mitochondrial phospholipase A(2) activation, disruption of mitochondrial function, and ATP depletion, it is executed independently of caspase activation. First, we demonstrate a pivotal role for mitochondrial function in determining B cell fate by showing up-regulation of cytosolic phospholipase A(2) expression, induction of mitochondrial phospholipase A(2) activity, arachidonic acid-mediated collapse of mitochondrial transmembrane inner potential (Delta psi(m)), and depletion of cellular ATP under conditions of apoptotic, but not proliferative, signaling via the BCR. Importantly, disruption of Delta psi(m), ATP depletion, and apoptosis can be prevented by rescue signals via CD40 or by Delta psi(m) stabilizers such as antimycin or oligomycin. Second, we show that commitment and postmitochondrial execution of BCR-mediated apoptosis are not dependent on caspase activation by demonstrating that such apoptotic signaling does not induce release of cytochrome c from the mitochondria or activation of effector caspases, as evidenced by poly(ADP-ribose) polymerase or Bcl-x(L) cleavage. Indeed, apoptotic signaling via the BCR in WEHI-231 B cells does not stimulate the activation of caspase-3 and, consistent with this, BCR-mediated disruption of Delta psi(m) and commitment to apoptosis take place in the presence of caspase inhibitors. In contrast, BCR signaling induces the postmitochondrial activation of cathepsin B, and resultant apoptosis is blocked by the cathepsin B inhibitor, (23,35)trans-epoxysuccinyl-L-leucylamindo-3-methylbutane ethyl ester (EST) suggesting a key role for this executioner protease in Ag receptor-driven apoptosis of WEHI-231 immature B cells.