How we raise young children is one of today's most highly personalized and sharply politicized issues, in part because each of us can claim some level of "expertise." The debate has intensified as discoveries about our development-in the womb and in the first months and years-have reached the popular media. How can we use our burgeoning knowledge to assure the well-being of all young children, for their own sake as well as for the sake of our nation? Drawing from new findings, this book presents important conclusions about nature-versus-nurture, the impact of being born into a working family, the effect of politics on programs for children, the costs and benefits of intervention, and other issues. The committee issues a series of challenges to decision makers regarding the quality of child care, issues of racial and ethnic diversity, the integration of children's cognitive and emotional development, and more. Authoritative yet accessible, From Neurons to Neighborhoods presents the evidence about "brain wiring" and how kids learn to speak, think, and regulate their behavior. It examines the effect of the climate-family, child care, community-within which the child grows.

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From Neurons to Neighborhoods: The Science of Early Childhood Development

Population-based epidemiologic studies have uncovered the high prevalence and wide severity spectrum of undiagnosed obstructive sleep apnea, and have consistently found that even mild obstructive sleep apnea is associated with significant morbidity. Evidence from methodologically strong cohort studies indicates that undiagnosed obstructive sleep apnea, with or without symptoms, is independently associated with increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. Strategies to decrease the high prevalence and associated morbidity of obstructive sleep apnea are critically needed. The reduction or elimination of risk factors through public health initiatives with clinical support holds promise. Potentially modifiable risk factors considered in this review include overweight and obesity, alcohol, smoking, nasal congestion, and estrogen depletion in menopause. Data suggest that obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is weight loss. A focus on weight control is especially important given the expanding epidemic of overweight and obesity in the United States. Primary care providers will be central to clinical approaches for addressing the burden and the development of cost-effective case-finding strategies and feasible treatment for mild obstructive sleep apnea warrants high priority.

Epidemiology of obstructive sleep apnea: a population health perspective.

OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

This paper reviews the literature on the Nl wave of the human auditory evoked potential. It concludes that at least six different cerebral processes can contribute to (he negative wave recorded from the scalp with a peak latency between 50 and 150 ms: a component generated in the auditory-cortex on the supratemporal plane, a component generated in the association cortex on the lateral aspect of the temporal and parietal cortex, a component generated in the motor and premotor cortices, the mismatch negativity, a temporal component of the processing negativity, and a frontal component of the processing negativity, The first three, which can be considered ‘true’ N1 components, are controlled by the physical and temporal aspects of the stimulus and by the general state of the subject. The other three components are not necessarily elicited by a stimulus but depend on the conditions in which the stimulus occurs. They often last much longer than the true N1 components that they overlap.

The N1 wave of the human electric and magnetic response to sound: a review and an analysis of the component structure

Most current models in health psychology assume that stress adversely affects physical health. We re-examined this assumption by reviewing extensive data from the literature and from six samples of our own, in which we collected measures of personality, health and fitness, stress, and current emotional functioning. Results indicate that self-report health measures reflect a pervasive mood disposition of negative affectivity (NA); self-report stress scales also contain a substantial NA component. However, although NA is correlated with health compliant scales, it is not strongly or consistently related to actual, long-term health status, and thus will act as a general nuisance factor in health research. Because self-report measures of stress and health both contain a significant NA component, correlations between such measures likely overestimate the true association between stress and health. Results demonstrate the importance of including different types of health measures in health psychology research.

Health complaints, stress, and distress: exploring the central role of negative affectivity.

Plasma cortisol was measured for seven 24-hr periods using the frequent sampling technique (every 20 min) in 6 normal acclimated subjects. A defined sleep-wake schedule was established over 3–5 consecutive nights with polygraphic definition of their sleep patterns. A mean of 9 secretory episodes (range 7–13) occurred over the 24-hr sampling time, the subjects spending an average of 24% of the time in active secretion. It was estimated that, on the average, 16 mg of cortisol was secreted over the 24 hr, with a mean of 66 min half-life of cortisol decay. Although great variability was found in both the amount of cortisol secreted and the time spent in secretory activity/hr, the secretory rate was quite constant at approximately .05 mg/min. A temporal pattern of episodic secretion was recognized, and the 24-hr sleep-wake cycle could be divided into 4 unequal temporal phases: Phase 1. A 6-hr period of “minimal secretory activity” (4 hr before and 2 hr after lights out); Phase 2. A 3-hr period called ...

Twenty-four Hour Pattern of the Episodic Secretion of Cortisol in Normal Subjects

Two- to threefold variations in sleep length were observed in 12 subjects living on self-selected schedules in an environment free of time cues. The duration of polygraphically recorded sleep episodes was highly correlated with the circadian phase of the body temperature rhythm at bedtime and not with the length of prior wakefulness. Furthermore, the rate of REM (rapid eye movement) sleep accumulation , REM latency, bedtime selection, and self-rated alertness assessments were also correlated with the body temperature rhythm.

https://science.sciencemag.org/content/sci/210/4475/1264.full.pdf

Human sleep: its duration and organization depend on its circadian phase

We describe a new syndrome called "delayed sleep phase insomnia." Thirty of 450 patients seen for a primary insomniac complaint had the following characteristics: (1) chronic inability to fall asleep at a desired clock time; (2) when not on a strict schedule, the patients have a normal sleep pattern and after a sleep of normal length awaken spontaneously and feel refreshed; and (3) a long history of unsuccessful attempts to treat the problem. These patients were younger than the general insomniac population and as a group did not have a specific psychiatric disorder. Six patients' histories are described in detail, including the successful nonpharmacological chronotherapy regimen (resetting the patients' biological clock by progressive phase delay). Delayed sleep phase insomnia is proposed to be a disorder of the circadian sleep-wake rhythm in which the "advance" portion of the phase response curve is small.

Delayed Sleep Phase Syndrome: A Chronobiological Disorder With Sleep-Onset Insomnia

Luteinizing hormone (LH) was measured in plasma every 20 minutes for 24 hours in 14 children and adolescents in different stages of sexual maturation and in five adult men. Polygraphic monitoring of nocturnal sleep was carried out simultaneously to identify sleep onset, wakefulness and sleep stages precisely. Prepubertal children and adult men showed no consistent significant difference between mean LH concentrations with subjects asleep and awake. In all pubertal subjects, an increase in LH secretion was associated with sleep that resulted in significantly higher mean LH concentrations than with the subject awake. By experimental delay in sleep onset, synchronization of this LH secretory "program" with actual sleep was clearly demonstrated. The number of LH secretory episodes during night or day sleep corresponded to the number of sleep cycles of rapid and nonrapid eye movements. This finding of a sleep-associated increase in LH secretory activity provides a biologic index for the identification...

Synchronization of Augmented Luteinizing Hormone Secretion with Sleep during Puberty

Human prolactin was measured in plasma by radioimmunoassay at 20 minute intervals for a 24-hour period in each of six normal adults, whose sleep-wake cycles were monitored polygraphically A marked diurnal variation in plasma concentrations was demonstrated, with highest values during sleep; periods of episodic release occurred throughout the 24 hours

http://science.sciencemag.org/content/sci/177/4055/1205.full.pdf

Elliot D. Weitzman

Papers

Twenty-four Hour Pattern of the Episodic Secretion of Cortisol in Normal Subjects

Human sleep: its duration and organization depend on its circadian phase

Delayed Sleep Phase Syndrome: A Chronobiological Disorder With Sleep-Onset Insomnia

Synchronization of Augmented Luteinizing Hormone Secretion with Sleep during Puberty

Human prolactin - 24-hour pattern with increased release during sleep.