Emotional experiences and psychological well-being in 51 countries during the COVID-19 pandemic

The COVID-19 pandemic presents challenges to psychological well-being, but how can we predict when people suffer or cope during sustained stress? Here, we test the prediction that specific types of momentary emotional experiences are differently linked to psychological well-being during the pandemic. Study 1 used survey data collected from 24,221 participants in 51 countries during the COVID-19 outbreak. We show that, across countries, well-being is linked to individuals' recent emotional experiences, including calm, hope, anxiety, loneliness, and sadness. Consistent results are found in two age, sex, and ethnicity-representative samples in the United Kingdom (n = 971) and the United States (n = 961) with preregistered analyses (Study 2). A prospective 30-day daily diary study conducted in the United Kingdom (n = 110) confirms the key role of these five emotions and demonstrates that emotional experiences precede changes in well-being (Study 3). Our findings highlight differential relationships between specific types of momentary emotional experiences and well-being and point to the cultivation of calm and hope as candidate routes for well-being interventions during periods of sustained stress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Universal interpretations of vocal music

Despite the variability of music across cultures, some types of human songs share acoustic characteristics. For example, dance songs tend to be loud and rhythmic, and lullabies tend to be quiet and melodious. Human perceptual sensitivity to the behavioral contexts of songs, based on these musical features, suggests that basic properties of music are mutually intelligible, independent of linguistic or cultural content. Whether these effects reflect universal interpretations of vocal music, however, is unclear because prior studies focus almost exclusively on English-speaking participants, a group that is not representative of humans. Here, we report shared intuitions concerning the behavioral contexts of unfamiliar songs produced in unfamiliar languages, in participants living in Internet-connected industrialized societies (n = 5,516 native speakers of 28 languages) or smaller-scale societies with limited access to global media (n = 116 native speakers of three non-English languages). Participants listened to songs randomly selected from a representative sample of human vocal music, originally used in four behavioral contexts, and rated the degree to which they believed the song was used for each context. Listeners in both industrialized and smaller-scale societies inferred the contexts of dance songs, lullabies, and healing songs, but not love songs. Within and across cohorts, inferences were mutually consistent. Further, increased linguistic or geographical proximity between listeners and singers only minimally increased the accuracy of the inferences. These results demonstrate that the behavioral contexts of three common forms of music are mutually intelligible cross-culturally and imply that musical diversity, shaped by cultural evolution, is nonetheless grounded in some universal perceptual phenomena.

Display rules differ between positive emotions: Not all that feels good looks good

People do not always show how they feel; norms often dictate when to display emotions and to whom. Norms about emotional expressions-known as display rules-are weaker for happiness than for negative emotions, suggesting that expressing positive emotions is generally seen as acceptable. But does it follow that all positive emotions can always be shown to everyone? To answer this question, we mapped out context-specific display rules for 8 positive emotions: gratitude, admiration, interest, relief, amusement, feeling moved, sensory pleasure, and triumph. In four studies with participants from five countries (n = 1,181), two consistent findings emerged. First, display rules differed between positive emotions. Weaker display rules were found for gratitude, interest, and amusement, whereas stronger display rules were found for sensory pleasure, feeling moved, and to some degree triumph. Second, contextual features-such as expresser location and perceiver relationship-both substantially influenced display rules for positive emotions, with perceiver relationship having a greater impact on display rules than expresser location. Our findings demonstrate that some positive emotions are less acceptable to express than others and highlight the central role of context in influencing display rules even for emotions that feel good. In so doing, we provide the first map of expression norms for specific positive emotions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Connected Despite Lockdown: The Role of Social Interactions and Social Media Use in Wellbeing

Humans are social beings, but during the COVID-19 pandemic, people around the world were periodically in lockdown and were required to try to physically distance themselves from others. The resultant limitation of face-to-face interactions presented a challenge to wellbeing. During periods of lockdown, people could, however, still connect to others via technology, but it is unknown whether such interactions offer benefits comparable to face-to-face interactions. In the present study, we examined how different ways of interacting with others impacted wellbeing during a period of lockdown in the United Kingdom. In a 30-day diary study conducted in April-June 2020, 110 adults reported the time they spent daily on face-to-face interactions and technology-mediated communication (video, phone, text) with different interaction partners. They also indicated the time they spent on active and passive social media use and their end-of-day wellbeing. Multilevel regressions indicated that more face-to-face interactions both within and outside of one’s household positively predicted wellbeing, while technology-mediated communication had less consistent positive effects. Additionally, more active and less passive social media use predicted better wellbeing. These results highlight the complexity of benefits of different kinds of social interactions during lockdowns in the COVID-19 pandemic and point to the importance of taking into account communication channels, interaction partners, and how people use social media when studying the effects of connecting to others.

How emotions, relationships, and culture constitute each other: advances in social functionalist theory

Social Functionalist Theory (SFT) emerged 20 years ago to orient emotion science to the social nature of emotion. Here we expand upon SFT and make the case for how emotions, relationships, and culture constitute one another. First, we posit that emotions enable the individual to meet six "relational needs" within social interactions: security, commitment, status, trust, fairness, and belongingness. Building upon this new theorising, we detail four principles concerning emotional experience, cognition, expression, and the cultural archiving of emotion. We conclude by considering the bidirectional influences between culture, relationships, and emotion, outlining areas of future inquiry.

Cultural variability in appraisal patterns for nine positive emotions

Emotions result from evaluations of events, referred to as appraisals. Specific configurations of appraisals have been shown to characterize different emotions, with some variation occurring across cultures. However, appraisal research to date has focused primarily on negative emotions, though recent efforts have started to also examine the appraisal profiles of positive emotions. Cross-cultural work on the appraisals of positive emotions has, however, been scarce. Here, we examine the appraisal profiles of nine positive emotions in the US and China. Using 13 commonly employed appraisal dimensions, we investigated the evaluations of events eliciting amusement, awe, compassion, desire, gratitude, interest, love, pride, and relief. Eighty participants from China and the US recalled events from their own life involving each of these emotions and provided Likert-scale appraisal ratings for each emotional event. Consistent with previous research, we find distinct appraisal patters for each positive emotion. We also, for the first time, demonstrate cultural variations in appraisals of positive emotions. Our study extends existing research by highlighting differences in appraisals of positive emotions across cultures.

Voice modulation: from origin and mechanism to social impact

Research on within-individual modulation of vocal cues is surprisingly scarce outside of human speech. Yet, voice modulation serves diverse functions in human and nonhuman nonverbal communication, from dynamically signalling motivation and emotion, to exaggerating physical traits such as body size and masculinity, to enabling song and musicality. The diversity of anatomical, neural, cognitive and behavioural adaptations necessary for the production and perception of voice modulation make it a critical target for research on the origins and functions of acoustic communication. This diversity also implicates voice modulation in numerous disciplines and technological applications. In this two-part theme issue comprising 21 articles from leading and emerging international researchers, we highlight the multidisciplinary nature of the voice sciences. Every article addresses at least two, if not several, critical topics: (i) development and mechanisms driving vocal control and modulation; (ii) cultural and other environmental factors affecting voice modulation; (iii) evolutionary origins and adaptive functions of vocal control including cross-species comparisons; (iv) social functions and real-world consequences of voice modulation; and (v) state-of-the-art in multidisciplinary methodologies and technologies in voice modulation research. With this collection of works, we aim to facilitate cross-talk across disciplines to further stimulate the burgeoning field of voice modulation. This article is part of the theme issue 'Voice modulation: from origin and mechanism to social impact (Part I)'.

Sustained Stress Reduces the Age Advantages in Emotional Experience of Older Adults: Commentary on Carstensen et al. (2020)

Older age is characterized by more positive and less negative emotional experience. Recent work by Carstensen et al. (2020) demonstrated that the age advantages in emotional experience have persisted during the COVID-19 pandemic. In two studies, we replicated and extended this work. In Study 1, we conducted a large-scale test of the robustness of Carstensen and colleagues' findings using data from 23,350 participants in 63 countries. Our results confirm that age advantages in emotions have persisted during the COVID-19 pandemic. In Study 2, we directly compared the age advantages before and during the COVID-19 pandemic in a within-participants study (N = 4,370). We found that the age advantages in emotions decreased during the pandemic. These findings are consistent with theoretical proposals that the age advantages reflect older adults' ability to avoid situations that are likely to cause negative emotions, which is challenging under conditions of sustained unavoidable stress.

The ontogeny of human laughter

Human adult laughter is characterized by vocal bursts produced predominantly during exhalation, yet apes laugh while exhaling and inhaling. The current study investigated our hypothesis that laughter of human infants changes from laughter similar to that of apes to increasingly resemble that of human adults over early development. We further hypothesized that the more laughter is produced on the exhale, the more positively it is perceived. To test these predictions, novice (n = 102) and expert (phonetician, n = 15) listeners judged the extent to which human infant laughter (n = 44) was produced during inhalation or exhalation, and the extent to which they found the laughs pleasant and contagious. Support was found for both hypotheses, which were further confirmed in two pre-registered replication studies. Likely through social learning and the anatomical development of the vocal production system, infants' initial ape-like laughter transforms into laughter similar to that of adult humans over the course of ontogeny.

The rise of affectivism

Research over the past decades has demonstrated the explanatory power of emotions, feelings, motivations, moods, and other affective processes when trying to understand and predict how we think and behave. In this consensus article, we ask: has the increasingly recognized impact of affective phenomena ushered in a new era, the era of affectivism?

What music makes us feel: At least 13 dimensions organize subjective experiences associated with music across different cultures

What is the nature of the feelings evoked by music? We investigated how people represent the subjective experiences associated with Western and Chinese music and the form in which these representational processes are preserved across different cultural groups. US (n = 1,591) and Chinese (n = 1,258) participants listened to 2,168 music samples and reported on the specific feelings (e.g., "angry," "dreamy") or broad affective features (e.g., valence, arousal) that they made individuals feel. Using large-scale statistical tools, we uncovered 13 distinct types of subjective experience associated with music in both cultures. Specific feelings such as "triumphant" were better preserved across the 2 cultures than levels of valence and arousal, contrasting with theoretical claims that valence and arousal are building blocks of subjective experience. This held true even for music selected on the basis of its valence and arousal levels and for traditional Chinese music. Furthermore, the feelings associated with music were found to occupy continuous gradients, contradicting discrete emotion theories. Our findings, visualized within an interactive map (https://www.ocf.berkeley.edu/∼acowen/music.html) reveal a complex, high-dimensional space of subjective experience associated with music in multiple cultures. These findings can inform inquiries ranging from the etiology of affective disorders to the neurological basis of emotion.

How Well Can We Assess Our Ability to Understand Others' Feelings? Beliefs About Taking Others' Perspectives and Actual Understanding of Others' Emotions

People vary in their beliefs about their tendency to engage in perspective taking and to understand other's feelings. Often, however, those beliefs are suggested to be poor indicators of actual skills and thus provide an inaccurate reflection of performance. Few studies, however, have examined whether people's beliefs accurately predict their performance on emotion recognition tasks using dynamic or spontaneous emotional expressions. We report six studies (N ranges from 186 to 315; N total = 1,347) testing whether individuals' report of their engagement in perspective taking, as measured by the Interpersonal Reactivity Index (IRI; Davis, 1983), is associated with accurate emotion recognition. In Studies 1-3, emotion recognition performance was assessed using three standard tests of nonverbal emotion recognition. To provide a more naturalistic test, we then assessed performance with a new emotion recognition test in Studies 4-6, using videos of real targets that share their emotional experiences. Participants' multi-scalar ratings of the targets' emotions were compared with the targets' own emotion ratings. Across all studies, we found a modest, yet significant positive relationship: people who believe that they take the other's perspective also perform better in tests of emotion recognition (r = 0.20, p < 0.001). Beliefs about taking others' perspective thus reflect interpersonal reality, but only partially.

Mapping the Passions: Toward a High-Dimensional Taxonomy of Emotional Experience and Expression

What would a comprehensive atlas of human emotions include? For 50 years, scientists have sought to map emotion-related experience, expression, physiology, and recognition in terms of the "basic six"-anger, disgust, fear, happiness, sadness, and surprise. Claims about the relationships between these six emotions and prototypical facial configurations have provided the basis for a long-standing debate over the diagnostic value of expression (for review and latest installment in this debate, see Barrett et al., p. 1). Building on recent empirical findings and methodologies, we offer an alternative conceptual and methodological approach that reveals a richer taxonomy of emotion. Dozens of distinct varieties of emotion are reliably distinguished by language, evoked in distinct circumstances, and perceived in distinct expressions of the face, body, and voice. Traditional models-both the basic six and affective-circumplex model (valence and arousal)-capture a fraction of the systematic variability in emotional response. In contrast, emotion-related responses (e.g., the smile of embarrassment, triumphant postures, sympathetic vocalizations, blends of distinct expressions) can be explained by richer models of emotion. Given these developments, we discuss why tests of a basic-six model of emotion are not tests of the diagnostic value of facial expression more generally. Determining the full extent of what facial expressions can tell us, marginally and in conjunction with other behavioral and contextual cues, will require mapping the high-dimensional, continuous space of facial, bodily, and vocal signals onto richly multifaceted experiences using large-scale statistical modeling and machine-learning methods.

The neural correlates of the awe experience: Reduced default mode network activity during feelings of awe

In the present fMRI study, we aimed to obtain insight into the key brain networks involved in the experience of awe-a complex emotion that is typically elicited by perceptually vast stimuli. Participants were presented with awe-eliciting, positive and neutral videos, while they were instructed to get fully absorbed in the scenery or to count the number of perspective changes. By using a whole-brain analysis we found that several brain regions that are considered part of the default mode network (DMN), including the frontal pole, the angular gyrus, and the posterior cingulate cortex, were more strongly activated in the absorption condition. But this was less the case when participants were watching awe videos. We suggest that while watching awe videos, participants were deeply immersed in the videos and that levels of self-reflective thought were as much reduced during the awe videos, as during the perspective counting condition. In contrast, key regions of the fronto-parietal network (FPN), including the supramarginal gyrus, the medial frontal gyrus, and the insula, were most strongly activated in the analytical condition when participants were watching awe compared to positive and neutral videos. This finding underlines the captivating, immersive, and attention-grabbing nature of awe stimuli that is considered to be responsible for reductions in self-reflective thought. Together these findings suggest that a key feature of the experience of awe is a reduced engagement in self-referential processing, in line with the subjective self-report measures (i.e., participants perceived their self to be smaller).

What Basic Emotion Theory Really Says for the Twenty-First Century Study of Emotion

Basic emotion theory (BET) has been, perhaps, the central narrative in the science of emotion. As Crivelli and Fridlund (J Nonverbal Behav 125:1-34, 2019, this issue) would have it, however, BET is ready to be put to rest, facing "last stands" and "fatal" empirical failures. Nothing could be further from the truth. Crivelli and Fridlund's outdated treatment of BET, narrow focus on facial expressions of six emotions, inattention to robust empirical literatures, and overreliance on singular "critical tests" of a multifaceted theory, undermine their critique and belie the considerable advances guided by basic emotion theory.

Emotional Expression: Advances in Basic Emotion Theory

In this article, we review recent developments in the study of emotional expression within a basic emotion framework. Dozens of new studies find that upwards of 20 emotions are signaled in multimodal and dynamic patterns of expressive behavior. Moving beyond word to stimulus matching paradigms, new studies are detailing the more nuanced and complex processes involved in emotion recognition and the structure of how people perceive emotional expression. Finally, we consider new studies documenting contextual influences upon emotion recognition. We conclude by extending these recent findings to questions about emotion-related physiology and the mammalian precursors of human emotion.

Pre-verbal infants perceive emotional facial expressions categorically

Adults perceive emotional expressions categorically, with discrimination being faster and more accurate between expressions from different emotion categories (i.e. blends with two different predominant emotions) than between two stimuli from the same category (i.e. blends with the same predominant emotion). The current study sought to test whether facial expressions of happiness and fear are perceived categorically by pre-verbal infants, using a new stimulus set that was shown to yield categorical perception in adult observers (Experiments 1 and 2). These stimuli were then used with 7-month-old infants (N  =  34) using a habituation and visual preference paradigm (Experiment 3). Infants were first habituated to an expression of one emotion, then presented with the same expression paired with a novel expression either from the same emotion category or from a different emotion category. After habituation to fear, infants displayed a novelty preference for pairs of between-category expressions, but not within-category ones, showing categorical perception. However, infants showed no novelty preference when they were habituated to happiness. Our findings provide evidence for categorical perception of emotional expressions in pre-verbal infants, while the asymmetrical effect challenges the notion of a bias towards negative information in this age group.

Do infants discriminate non-linguistic vocal expressions of positive emotions?

Adults are highly proficient in understanding emotional signals from both facial and vocal cues, including when communicating across cultural boundaries. However, the developmental origin of this ability is poorly understood, and in particular, little is known about the ontogeny of differentiation of signals with the same valence. The studies reported here employed a habituation paradigm to test whether preverbal infants discriminate between non-linguistic vocal expressions of relief and triumph. Infants as young as 6 months who had habituated to relief or triumph showed significant discrimination of relief and triumph tokens at test (i.e. greater recovery to the unhabituated stimulus type), when exposed to tokens from a single individual (Study 1). Infants habituated to expressions from multiple individuals showed less consistent discrimination in that consistent discrimination was only found when infants were habituated to relief tokens (Study 2). Further, infants tested with tokens from individuals from different cultures showed dishabituation only when habituated to relief tokens and only at 10-12 months (Study 3). These findings suggest that discrimination between positive emotional expressions develops early and is modulated by learning. Further, infants' categorical representations of emotional expressions, like those of speech sounds, are influenced by speaker-specific information.

Measuring the effects of alexithymia on perception of emotional vocalizations in autistic spectrum disorder and typical development

BACKGROUND

The results from recent studies suggest that alexithymia, a disorder characterized by impairments in understanding personal experiences of emotion, is frequently co-morbid with autism spectrum disorder (ASD). However, the extent that alexithymia is associated with primary deficits in recognizing external emotional cues, characteristic in ASD, has yet to be determined.

METHOD

Twenty high-functioning adults with ASD and 20 age- and intelligence-matched typical controls categorized vocal and verbal expressions of emotion and completed an alexithymia assessment.

RESULTS

Emotion recognition scores in the ASD group were significantly poorer than in the control group and performance was influenced by the severity of alexithymia and the psycho-acoustic complexity of the presented stimuli. For controls, the effect of complexity was significantly smaller than for the ASD group, although the association between total emotion recognition scores and alexithymia was still strong.

CONCLUSIONS

Higher levels of alexithymia in the ASD group accounted for some, but not all, of the group difference in emotion recognition ability. However, alexithymia was insufficient to explain the different sensitivities of the two groups to the effects of psycho-acoustic complexity on performance. The results showing strong associations between emotion recognition and alexithymia scores in controls suggest a potential explanation for variability in emotion recognition in non-clinical populations.

A multimodal approach to emotion recognition ability in autism spectrum disorders

BACKGROUND

Autism spectrum disorders (ASD) are characterised by social and communication difficulties in day-to-day life, including problems in recognising emotions. However, experimental investigations of emotion recognition ability in ASD have been equivocal, hampered by small sample sizes, narrow IQ range and over-focus on the visual modality.

METHODS

We tested 99 adolescents (mean age 15;6 years, mean IQ 85) with an ASD and 57 adolescents without an ASD (mean age 15;6 years, mean IQ 88) on a facial emotion recognition task and two vocal emotion recognition tasks (one verbal; one non-verbal). Recognition of happiness, sadness, fear, anger, surprise and disgust were tested. Using structural equation modelling, we conceptualised emotion recognition ability as a multimodal construct, measured by the three tasks. We examined how the mean levels of recognition of the six emotions differed by group (ASD vs. non-ASD) and IQ (≥ 80 vs. < 80).

RESULTS

We found no evidence of a fundamental emotion recognition deficit in the ASD group and analysis of error patterns suggested that the ASD group were vulnerable to the same pattern of confusions between emotions as the non-ASD group. However, recognition ability was significantly impaired in the ASD group for surprise. IQ had a strong and significant effect on performance for the recognition of all six emotions, with higher IQ adolescents outperforming lower IQ adolescents.

CONCLUSIONS

The findings do not suggest a fundamental difficulty with the recognition of basic emotions in adolescents with ASD.

Receptive prosody in nonfluent primary progressive aphasias

Introduction

Prosody has been little studied in the primary progressive aphasias (PPAs), a group of neurodegenerative disorders presenting with progressive language impairment.

Methods

Here we conducted a systematic investigation of different dimensions of prosody processing (acoustic, linguistic and emotional) in a cohort of 19 patients with nonfluent PPA syndromes (11 with progressive nonfluent aphasia, PNFA; five with progressive logopenic/phonological aphasia, LPA; three with progranulin-associated aphasia, GRN-PPA) compared with a group of healthy older controls. Voxel-based morphometry (VBM) was used to identify neuroanatomical associations of prosodic functions.

Results

Broadly comparable receptive prosodic deficits were exhibited by the PNFA, LPA and GRN-PPA subgroups, for acoustic, linguistic and affective dimensions of prosodic analysis. Discrimination of prosodic contours was significantly more impaired than discrimination of simple acoustic cues, and discrimination of intonation was significantly more impaired than discrimination of stress at phrasal level. Recognition of vocal emotions was more impaired than recognition of facial expressions for the PPA cohort, and recognition of certain emotions (in particular, disgust and fear) was relatively more impaired than others (sadness, surprise). VBM revealed atrophy associated with acoustic and linguistic prosody impairments in a distributed cortical network including areas likely to be involved in perceptual analysis of vocalisations (posterior temporal and inferior parietal cortices) and working memory (fronto-parietal circuitry). Grey matter associations of emotional prosody processing were identified for negative emotions (disgust, fear, sadness) in a broadly overlapping network of frontal, temporal, limbic and parietal areas.

Conclusions

Taken together, the findings show that receptive prosody is impaired in nonfluent PPA syndromes, and suggest a generic early perceptual deficit of prosodic signal analysis with additional relatively specific deficits (recognition of particular vocal emotions).

More Than Happy

Despite great advances in scientific understanding of emotional processes in the last decades, research into the communication of emotions has been constrained by a strong bias toward negative affective states. Typically, studies distinguish between different negative emotions, such as disgust, sadness, anger, and fear. In contrast, most research uses only one category of positive affect, “happiness,” which is assumed to encompass all positive emotional states. This article reviews recent research showing that a number of positive affective states have discrete, recognizable signals. An increased focus on cues other than facial expressions is necessary to understand these positive states and how they are communicated; vocalizations, touch, and postural information offer promising avenues for investigating signals of positive affect. A full scientific understanding of the functions, signals, and mechanisms of emotions requires abandoning the unitary concept of happiness and instead disentangling positive emotions.

The roles of feature-specific task set and bottom-up salience in attentional capture: an ERP study

We investigated the roles of top-down task set and bottom-up stimulus salience for feature-specific attentional capture. Spatially nonpredictive cues preceded search arrays that included a color-defined target. For target-color singleton cues, behavioral spatial cueing effects were accompanied by cue-induced N2pc components, indicative of attentional capture. These effects were only minimally attenuated for nonsingleton target-color cues, underlining the dominance of top-down task set over salience in attentional capture. Nontarget-color singleton cues triggered no N2pc, but instead an anterior N2 component indicative of top-down inhibition. In Experiment 2, inverted behavioral cueing effects of these cues were accompanied by a delayed N2pc to targets at cued locations, suggesting that perceptually salient but task-irrelevant visual events trigger location-specific inhibition mechanisms that can delay subsequent target selection.

New aspects of an anti-tumour drug: sorafenib efficiently inhibits HCV replication

BACKGROUND AND AIMS

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and is associated with significant morbidity and mortality. Since there is evidence for an interaction of NS5A with c-Raf we studied whether the c-Raf inhibitor sorafenib affects HCV replication.

METHODS

HCV replicating HuH7.5 cells were treated with sorafenib and examined for HCV RNA titres by northern blotting or real time polymerase chain reaction (PCR), for core, NS3 and NS5A expression by immunostaining, and for replication by luciferase reporter assays.

RESULTS

Here we demonstrate that in cells replicating infectious HCV particles, NS5A recruits c-Raf to the replicon complex resulting in the activation of c-Raf. Therefore, we studied the effect of inhibition of c-Raf on HCV replication using the anti-tumour drug sorafenib that is known to inhibit c-Raf with high specificity. Sorafenib efficiently blocks HCV replication and viral gene expression. In addition, in HCV-replicating cells sorafenib decreased the hyperphosphorylated form of NS5A and resulted in the formation of additional hypophosphorylated forms. Further, sorafenib caused a rapid dissociation of lipid droplets. We provide evidence that the antiviral effect of sorafenib indeed is caused by inhibition of c-Raf. By contrast, inhibition of targets downstream of c-Raf or inhibition of tyrosine kinases by sunitinib did not affect HCV replication.

CONCLUSION

Our data demonstrate that the well-characterised anti-tumour drug sorafenib efficiently blocks HCV replication in vitro. This novel effect of sorafenib should be further explored as an antiviral strategy for patients with chronic HCV infection.

Developmental phonagnosia: a selective deficit of vocal identity recognition

Phonagnosia, the inability to recognize familiar voices, has been studied in brain-damaged patients but no cases due to developmental problems have been reported. Here we describe the case of KH, a 60-year-old active professional woman who reports that she has always experienced severe voice recognition difficulties. Her hearing abilities are normal, and an MRI scan showed no evidence of brain damage in regions associated with voice or auditory perception. To better understand her condition and to assess models of voice and high-level auditory processing, we tested KH on behavioural tasks measuring voice recognition, recognition of vocal emotions, face recognition, speech perception, and processing of environmental sounds and music. KH was impaired on tasks requiring the recognition of famous voices and the learning and recognition of new voices. In contrast, she performed well on nearly all other tasks. Her case is the first report of developmental phonagnosia, and the results suggest that the recognition of a speaker's vocal identity depends on separable mechanisms from those used to recognize other information from the voice or non-vocal auditory stimuli.

[Nonsymptomatic leukocytosis]

Leukocytosis is a condition often met with in the clinical and ambulatory setting. Although it is usually caused by an increase in the numbers of neutrophilic granulocytes, an increase in other leukocytes populations may also account for leukocytosis. Etiologically, both primary pathological conditions affecting the white blood cells, such as various forms of leukemia and lymphomas, and also rare genetic disorders must be considered. Decidedly more common, however, are reactive changes caused by infections, cigarette smoking, chronic inflammation, necrotic tissue or certain drugs. Although moderate leukocytosis in the absence of a clinical correlate and/or an apparent trigger, requires no diagnostic clarification, it should be kept under observation. If the etiology is uncertain, or a treatment-requiring disorder is suspected, the differential blood count is at the focus of the further diagnostic work-up. Depending upon the findings, this is supplemented by additional laboratory parameters, bone marrow examination, microbiological investigations and imaging procedures. Leukostasis resulting from vasoocclusion in the presence of very high numbers of leukocytes represents an emergency situation, and is an indication for leukapheresis.

Sensor fault diagnosis based on energy balance evaluation: application to a metal processing

This paper deals with the design of a residual generator for fault detection and isolation in the dynamic closed-loop systems based on the balance of energy which "enters" and "leaves" plants. The main contribution of this paper consists in developing a suitable fault detection and isolation technique to detect faults in single-input single-output closed-loop system based on major signals without the requirement of an accurate static or dynamic model. Indeed, in the absence of conventional input-output models, the proposed method involves the on-line energy balance evaluation to detect a sensor fault. The application to the monitoring of a galvanizing line in steel industry shows the effectiveness of the suggested approach when a sensor fault occurs.

Long-term effects of vasopressin on the subcellular localization of ENaC in the renal collecting system

Previous studies revealed that chronic (days) vasopressin treatment stimulates amiloride-sensitive sodium transport in isolated renal cortical collecting ducts and increases the abundance of beta- and gamma-subunits of the epithelial sodium channel (ENaC) in the kidney. The aim of the present work was to investigate in vivo the cellular basis of these effects. The long-term effect of V2 vasopressin agonist (1-deamino-8-D-arginine vasopressin (dDAVP)) on the abundance and subcellular localization of ENaC along the rat renal collecting system was determined by immunohistochemistry and laser confocal microscopy. Moreover, we studied by real-time reverse transcriptase-polymerase chain reaction the effect of vasopressin on proteins implicated in the regulation of ENaC (Nedd4-2, prostasin, Sgk1). After 5 days of administration, dDAVP markedly increased the intracellular pool of the beta- and gamma-ENaC subunits in the principal cells, with an increasing gradient from connecting tubule to the outer medullary collecting duct, but did not increase any subunit at the cell surface. The apical immunostaining of ENaC increased in response to sodium restriction, as expected, but dDAVP did not further enhance this apical labelling. dDAVP increased the gene expression of prostasin in the cortex but not that of Nedd4-2 and Sgk1. These findings suggest that the previously reported increase in sodium transport induced by sustained stimulation of vasopressin V2 receptor is probably mediated by other mechanism than an increase in the apical density of ENaC.

Association between reported use of inhaled triamcinolone and differential short-term responses to aerosolized albuterol in asthmatics in an emergency department setting

Forty-four adult patients with acute asthma were treated with albuterol at a rate of 15 mg/h over 2 h. Analysis of covariance showed a significantly higher baseline adjusted mean for both percent predicted forced expiratory volume in 1 s (PFEV1) (p = 0.045) and percent predicted forced vital capacity (PFVC) (p = 0.022) at 50 and 110 min for the patients who reported triamcinolone use. Although heart rates decreased overall during the first hour of albuterol treatment, a rise in mean heart rate occurred during the second hour of treatment only in patients reporting triamcinolone use (p = 0.005). After accounting for the effects of parenteral corticosteroids, the effect of reported triamcinolone use remained significant. These data suggest that use of inhaled corticosteroids in this context may be associated with enhanced local and systemic beta-responsiveness, and if a causal relationship could be confirmed, this may constitute yet another advantage of early inhaled corticosteroid treatment in asthma. These data also suggest that chronotropic effects of high-dose albuterol should be monitored in patients using inhaled triamcinolone.

Continuous versus intermittent albuterol nebulization in the treatment of acute asthma

STUDY OBJECTIVES

To compare bronchodilation, chronotropic effects, and side effects of the same dose of nebulized albuterol when given by either intermittent or continuous administration.

DESIGN

A randomized assignment of patients to one of the two methods of albuterol nebulization.

SETTING

Adult emergency department in an urban public hospital.

TYPE OF PARTICIPANTS

Adult patients with acute exacerbations of asthma.

INTERVENTIONS

Administration of 30 mg albuterol given over 110 minutes by either continuous or intermittent aerosolization.

MEASUREMENTS

FEV1, forced vital capacity, heart rate, and systolic and diastolic blood pressures were measured immediately before treatment and then hourly for two hours. Side effects, symptoms, subsequent admission, and discharge also were noted.

MAIN RESULTS

An overall significant decrease in heart rate was observed, indicating the lack of significant chronotropic effects with this dose of albuterol. Both treatments resulted in significant spirometric improvement without a significant treatment difference for the entire group. A difference, however, was found in the relative rates of FEV1 improvement with the two treatments depending on whether patients had an initial FEV1 less than or more than 50% predicted (P = .05). A secondary analysis on patients with an initial FEV1 less than percent predicted demonstrated a higher rate of percent predicted FEV1 increase with the continuously nebulized albuterol group (P = .03).

CONCLUSION

This study demonstrates that albuterol can be given safely at this dose by either intermittent or continuous nebulization. Future studies should examine whether continuous nebulization has a reproducible advantage over intermittent nebulization in patients with more severe obstruction.

Acquired traumatic pulmonary arteriovenous fistula: case report

Post-traumatic pulmonary arteriovenous fistula, a rare entity, was treated in a 35-year-old HIV-positive man by transcatheter embolization. When seen 4 months later, the patient had florid Pneumocystis carinii pneumonia. Generally, pulmonary angiography demonstrates such fistulae when they are not visible on chest roentgenograms. This diagnosis should be considered in patients with penetrating chest trauma when suggestive clinical or radiologic signs are present.

Hypersensitivity to common indoor aeroallergens in asthmatic patients

To study whether inhalant allergy to specific allergens is associated with inner city asthma, adult emergency room asthmatic patients (n = 41), and controls (n = 34) were examined for immediate hypersensitivity to six common indoor allergens using both skin tests and serologic tests. A highly significant association was observed between cat epidermis-specific IgE and asthma (P < .01) and this constituted the strongest association for a single allergen. The pooled variable of IgE to cat and/or dog epidermis had an even stronger disease association (P < .001). The presence of IgE to other allergens and the presence of two or more positive IgE tests did not enhance this association. After inclusion of three other significant covariates (elevated serum total IgE, longer duration of residence in the New York City area, and family history of atopic disease) in a logistic prediction model for asthma, skin test-detected IgE to cat and/or dog remained significantly associated with asthma (odds ratio 8.4, P = .019). A higher proportion of asthmatic patients had both IgE to cat and/or dog allergen and ongoing historical exposure to pets and/or rodents compared with controls (P < .005). Skin testing in general distinguished asthmatic patients better than serologic tests. These results suggest that inner city asthma in adults during a nonpeak pollen period is associated with hypersensitivity to specific indoor allergens. The potential to use environmental control to ameliorate disease in such patients may have significant health care implications.

Analysis of eye tracking movements using innovations generated by a Kalman filter

A simple but efficient algorithm has been developed for computer analysis of eye tracking movements. The program separates smooth pursuit and saccadic eye movements. Separation of the two components is achieved using a two-step process of saccade detection. First, an AR model of the velocity of the smooth component is identified and used to determine a Kalman filter. Secondly the innovation sequence generated by this filter allows saccade detection. The precise beginning and end of each saccade are found using a Hinkley algorithm. Examples are given of analysis procedure for eye tracking of a random moving target. The method proved to be highly reliable and could be easily extended to other eye movements such as nystagmus.

Cardiopulmonary arrest following an infusion of calcium 2-amino ethanol phosphate

The intravenous infusion of calcium 2-amino ethanol phosphate was coincidental with cardiopulmonary arrest in a 53-year-old woman with a history of multiple sclerosis. Resuscitation was followed by massive hemolysis, renal failure, adult respiratory distress syndrome, shock liver, and disseminated intravascular coagulation. This agent, in use by at least one practitioner in West Germany for the treatment of inflammatory and autoimmune disorders is not FDA approved for use in the United States, nor is clinical investigation underway. It is currently thought to be in use by about 200 practitioners throughout this country as treatment for multiple sclerosis. It is apparently obtained in West Germany and brought illegally into the United States. This is the first known report of an adverse drug reaction associated with the use of this product.

The New Non-Traditional Student in Nursing

Because different types of new, non-registered nurse students seek baccalaureate nursing education, this study was conducted comparing traditional undergraduate generic students with a group of non-traditional students to dispel myths and to develop policies and educational strategies. Traditional and non-traditional students were differentiated by age, sex, marital status, and experience in higher education. Traditional and non-traditional undergraduate students were compared on demographic variables, educational goals, sources of psychological and financial support, study habits, learning style, and clinical judgment skills. Non-traditional students were found to be an excellent risk for admission, having higher semester grade point averages and being more skilled in making professional judgments. Learning style differentiated traditional and non-traditional students, however, teaching methods were similar. Suggestions for educational planning and policies are made. Let the curriculum of the institution recognize that both educational content and process must be relevant to individual differences and that the curriculum is basically what different individuals do to learn what they need to learn, to fulfill the purposes that brought them to the college (Chickering, 1974).

Methemoglobinemia resulting from smoke inhalation

Methemoglobinemia following fire exposure is largely unrecognized. Fire related morbidity and mortality are customarily attributed to thermal injury, associated trauma, and carbon monoxide poisoning. More recently, cyanide poisoning has been described from the inhalation of hydrogen cyanide liberated from of burning plastics (1). Symptoms of tissue hypoxia and cyanosis resulting from methemoglobinemia may be difficult to diagnose in the presence of thermal injury, cyanide and/or carbon monoxide poisoning. Relatively low levels of methemoglobin could complicate concomitant carbon monoxide poisoning by additive or synergistic effects on oxygen binding and delivery. We report 3 cases of significant methemoglobinemia (levels of 19, 12, and 12%) in survivors of a dwelling fire and review the literature with regard to this phenomenon.

Hematologic aspects of toxicology

Exposure to a number of toxins may result in a variety of hematologic abnormalities. Derangements of the synthesis of cellular elements, a shortened red cell half life, abnormalities of coagulation, and interference in oxygen-carrying capacity are some of the pathologic effects. Pharmacologic agents, heavy metals, and animal and insect venoms are among the toxins implicated in the production of hematologic abnormalities. This article focuses on some of these issues.