OBJECTIVE: Osteoprotegerin (OPG), a regulator of bone resorption, is involved in the pathogenesis of rheumatoid arthritis (RA) and atherosclerosis. OPG is elevated in patients with coronary artery disease, and high OPG levels are associated with cardiac disease severity and mortality in the general population. The purpose of this study was to investigate the relationship of serum OPG levels, traditional coronary risk factors, and RA-related factors to carotid atherosclerosis in RA patients. METHODS: Ninety-one RA patients were studied (85 % women, age 60 ± 10 years). Serum OPG levels were measured by an enzyme-linked immunosorbent assay. The prevalence of carotid plaque was assessed by ultrasonographic imaging in all patients. The relationship between various clinical characteristics, OPG, and carotid plaque was examined. RESULTS: Serum OPG levels were significantly higher in patients with carotid plaque than in those without plaque (median level 1,397 vs. 887 pg/mL, respectively; P = 0.006). There were no significant differences between RA patients with and without carotid plaque with respect to sex, duration of RA, blood pressure, body mass index, smoking, low-density lipoprotein cholesterol, Disease Activity Score-28, van der Heijde-modified Sharp score, and prednisolone dose. After adjusting for age, sex, and C-reactive protein, elevated levels of OPG were still associated with a higher prevalence of carotid plaque in patients with RA (P = 0.038). CONCLUSION: RA patients suffer from accelerated atherosclerosis and also have increased levels of OPG. The serum OPG level is independently associated with carotid plaque.

OBJECTIVES: Prior to oral appliance therapy for snoring and obstructive sleep apnea syndrome (OSAS), patients are screened for jaw symptoms (e.g., pain). However, the presence of jaw symptoms in a large spectrum of OSAS patients remains unknown. This study aimed to assess the distribution of subjective jaw symptoms in patients with symptoms of OSAS. METHODS: Five hundred and eleven consecutive patients (66 female, 445 male; mean age 49.6 ± 12.6 years) with clinical symptoms of OSAS were enrolled for cardiorespiratory evaluation. Self-administered questionnaires were used to assess jaw symptoms, tooth grinding and clenching during sleep, morning oral dryness, morning heartburn sensation, and pain in the neck and back. RESULTS: The mean apnea-hypopnea (AHI) index was 32.5 ± 30.6 per hour of sleep. Nineteen percent of patients (n = 96) reported at least one jaw symptom. The presence of jaw symptoms was more frequently reported by patients with AHI less than 15 (25 %) than those with AHI of 15 and more (15 %, p = 0.012). In the crude analyses, jaw symptoms were associated with tooth grinding, tooth clenching, morning oral dryness, morning heartburn sensation, and neck/back pain. Multiple logistic regression analysis confirmed that jaw symptoms were associated with AHI less than 15 (odds ratio (OR) 1.99, p = 0.009), tooth clenching (OR 1.79, p = 0.006), morning oral dryness (OR 2.17, p = 0.02), and neck/back pain (OR 1.99, p = 0.005). CONCLUSIONS: Jaw symptoms can be found in 19 % of patients with symptoms of OSAS and are more frequently reported in patients with lower AHI, a patient population for whom oral appliances are often prescribed.

Objective: To explore the relationship between parental feedback and the accuracy of children's self-perceptions. Children with ADHD have been demonstrated to overestimate their own competence, a phenomenon known as positive illusory bias (PIB). Method: Participants were families of 56 children (41 male) ages 7 to 10, half of whom had clinical diagnoses of ADHD. PIB was assessed by comparing children's self-ratings of their competence relative to teachers' ratings. Laboratory interactions were observed where parental feedback to children was coded. Results: Parental warmth was associated with lower PIB about social competence in children with ADHD, but greater PIB in comparison children. Parent criticism was positively correlated with greater PIB about social competence in children with ADHD, but the relationship was nonsignificant for comparison children. Parent praise was associated with lower PIB about behavioral conduct in comparison children. Conclusion: Results support the self-protective hypothesis of PIB, and implications for interventions are discussed.(J. of Att. Dis. 2012; XX(X) 1-XX).

We investigated discrepancies between parent- and self-reported social functioning among youth with autism spectrum disorders (ASD). Three distinct samples showed discrepancies indicating that parents viewed their children as performing one standard deviation below a standardization mean, while youth viewed themselves as comparably-skilled relative to peers. Discrepancies predicted lower parental self-efficacy, and lower youth-reported hostile attributions to peers, marginally-lower depression, and decreased post-treatment social anxiety. Discrepancies predicted outcomes better than parent- or youth-report alone. Informant discrepancies may provide valuable additional information regarding child psychopathology, parental perceptions of parenting stress, and youth treatment response. Findings support a model where abnormal self-perceptions in ASD stem from inflated imputation of subjective experiences to others, and provide direction for improving interventions for youth and parents.

Students who do not get along with their peers are at elevated risk for academic disengagement and school failure. Research has predominantly focused on factors within such children that contribute to their peer problems. This study considers whether teacher practices also predict social preference for children in that classroom. Participants were 26 elementary school teachers and 490 students in their classrooms followed for one school year. Results suggested that teachers who favored the most academically talented students in the fall had classrooms where children had lower average social preference in the spring after statistical control of children's fall social preference and externalizing behavior problems. Teachers who demonstrated emotionally supportive relationships with students in the fall had classrooms where children had greater possibility of changing their social preference from fall to spring. Although children with high externalizing behaviors tended to experience declining social preference over the course of the school year, teachers' learner-centered practices attenuated this progression. However, teachers' favoring of the most academically talented accentuated the negative relation between externalizing behaviors and social preference. Implications for school psychology practitioners are discussed.

ABSTRACT: This study investigated whether methylphenidate delivered through a long-acting transdermal system (MTS) would reduce collision rates of young adult drivers with attention-deficit/hyperactivity disorder (ADHD).Seventeen young adults completing the study (mean [SD] age, 20.82 [2.40] years; 14 men and 13 white) met the following inclusion criteria: ADHD diagnoses but not routinely taking ADHD medication, previously responsive to ADHD medication, active drivers with more than 1 collision or citation in the past 2 years, and no significant comorbidities. In this open-labeled, crossover design drivers were randomly assigned either to the no-medication condition for 3 months and then MTS for 3 months or to the reverse sequence. In-car video monitoring of routine driving occurred during these 6 months. At baseline and after each condition, participants completed the Conners Adult ADHD Rating Scale and the Cox Assessment of Risky Driving Scale, and their blood pressure, heart rate, and body weight were monitored.Compared with the no-medication condition, participants in the MTS condition self-reported fewer total ADHD (P < 0.04) and inattentive symptoms (P = 0.014) and a trend for risky driving behaviors (P = 0.059) and had fewer video-recorded collisions (P < 0.005) and other problematic driving events. There were no significant changes in blood pressure, heart rate, or body weight across conditions or any significant skin reactions to the MTS patch.This is the first study demonstrating that long-acting methylphenidate improves activities of daily living among young adults with ADHD. Specifically, methylphenidate improved safety in routine driving while reducing ADHD symptoms with minimal adverse effects.

Student engagement is an important contributor to school success, yet high school students routinely describe themselves as disengaged. Identifying factors that alter (increase) engagement is a key aspect of improving support for student achievement. This study investigated students' perceptions of autonomy, teacher connection, and academic competence as predictors of changes in student engagement within the classroom from the start to the end of a course. Participants were 578 (58% female) diverse (67.8% White, 25.2% African American, 5.1% Hispanic, 1.2% Asian American) high school students from 34 classrooms who provided questionnaire data both at the start and the end of a single course. Novel results from a cross-lagged model demonstrated that students who perceived their classrooms as allowing and encouraging their own autonomy in the first few weeks increased their engagement throughout the course, rather than the typical decline in engagement that was demonstrated by students in other classrooms. This finding is unique in that it extended to both students' perceptions of engagement and observations of student engagement, suggesting a fairly robust pattern. The pertinence of this finding to adolescent developmental needs and its relationship to educational practice is discussed.

OBJECTIVE This study investigated the impact of parental attention-deficit/hyperactivity disorder (ADHD) symptoms on the peer relationships and parent-child interaction outcomes of children with ADHD among families completing a randomized controlled trial of parental friendship coaching (PFC) relative to control families. METHOD Participants were 62 children with ADHD (42 boys and 20 girls, 6 through 10 years old) and their parents. Approximately half of the families received PFC (a 3-month parent training intervention targeting the peer relationships of children with ADHD), and the remainder represented a no-treatment control group. RESULTS Parental inattention predicted equivalent declines in children's peer acceptance in both treatment and control families. However, treatment amplified differences between parents with high versus low ADHD symptoms for some outcomes: Control families declined in functioning regardless of parents' symptom levels. However, high parental inattention predicted increased child peer rejection and high parental inattention and impulsivity predicted decreased parental facilitation among treated families (indicating reduced treatment response). Low parental symptoms among treated families were associated with improved functioning in these areas. For other outcomes, treatment attenuated differences between parents with high versus low ADHD symptoms: Among control parents, high parental impulsivity was associated with increasing criticism over time, whereas all treated parents showed reduced criticism regardless of symptom levels. Follow-up analyses indicated that the parents experiencing poor treatment response are likely those with clinical levels of ADHD symptoms. CONCLUSIONS Results underscore the need to consider parental ADHD in parent training treatments for children with ADHD.

BACKGROUND Routine trichromatic color vision is a characteristic feature of catarrhines (humans, apes and Old World monkeys). This is enabled by L and M opsin genes arrayed on the X chromosome and an autosomal S opsin gene. In non-human catarrhines, genetic variation affecting the color vision phenotype is reported to be absent or rare in both L and M opsin genes, despite the suggestion that gene conversion has homogenized the two genes. However, nucleotide variation of both introns and exons among catarrhines has only been examined in detail for the L opsin gene of humans and chimpanzees. In the present study, we examined the nucleotide variation of gibbon (Catarrhini, Hylobatidae) L and M opsin genes. Specifically, we focused on the 3.6~3.9-kb region that encompasses the centrally located exon 3 through exon 5, which encode the amino acid sites functional for the spectral tuning of the genes. RESULTS Among 152 individuals representing three genera (Hylobates, Nomascus and Symphalangus), all had both L and M opsin genes and no L/M hybrid genes. Among 94 individuals subjected to the detailed DNA sequencing, the nucleotide divergence between L and M opsin genes in the exons was significantly higher than the divergence in introns in each species. The ratio of the inter-LM divergence to the intra-L/M polymorphism was significantly lower in the introns than that in synonymous sites. When we reconstructed the phylogenetic tree using the exon sequences, the L/M gene duplication was placed in the common ancestor of catarrhines, whereas when intron sequences were used, the gene duplications appeared multiple times in different species. Using the GENECONV program, we also detected that tracts of gene conversions between L and M opsin genes occurred mostly within the intron regions. CONCLUSIONS These results indicate the historical accumulation of gene conversions between L and M opsin genes in the introns in gibbons. Our study provides further support for the homogenizing role of gene conversion between the L and M opsin genes and for the purifying selection against such homogenization in the central exons to maintain the spectral difference between L and M opsins in non-human catarrhines.

The aim of this study was to evaluate the efficacy and safety of ramelteon 4, 8, 16 or 32 mg and placebo in Japanese patients with chronic insomnia using a randomized, double-blind, five-period crossover design. A total of 65 Japanese patients with chronic primary insomnia received ramelteon or placebo for two nights each in sleep laboratories. Changes in sleep parameters were assessed objectively by polysomnography and subjectively by postsleep questionnaires. Safety and tolerability was evaluated by assessment of the occurrence of adverse events, next-day residual effects and laboratory and ECG investigations. Ramelteon 8 and 32 mg significantly shortened the mean latency to persistent sleep in comparison with placebo, and there was a statistically significant trend for linear dose-response for this sleep parameter. Overall changes in sleep architecture were modest (<3% changes vs placebo), with increases in stage 1 and decreases in stage 3/4. Ramelteon was well tolerated, the most common adverse effect being somnolence, which was similar to placebo at doses up to 8 mg, but increased with higher doses. Next-day residual effects occurred no more frequently with ramelteon at any dose than with placebo. When compared with sleep latency data from a similarly-designed US study, there was no evidence of any ethnic differences in the efficacy of ramelteon between Japanese and US patients. Overall, ramelteon 8 mg showed the most favorable balance between sleep-promoting effects and tolerability. The unique efficacy profile of ramelteon, promoting sleep initiation without affecting other sleep parameters, may be due to its circadian shifting effect.