Catecholamines in patients with 22q11.2 deletion syndrome and the low-activity COMT polymorphism

Objective:To investigate catecholamine phenotypes and the effects of a tyrosine hydroxylase inhibitor in individuals with the 22q11.2 deletion syndrome and low-activity catechol-O-methyltransferase (COMT).Background:Many persons with the 22q11.2 deletion syndrome suffer severe disability from a characteristic ultrarapid-cycling bipolar disorder and associated “affective storms.” One etiologic hypothesis for this condition is that deletion of theCOMTgene from one chromosome 22 results in increased catecholamine neurotransmission, particularly if the undeleted chromosome 22 encodes a variant of COMT with low activity.Methods:In a preliminary study, plasma, urine, and CSF catecholamines and catecholamine metabolites were measured in four teenage patients with a neuropsychiatric condition associated with 22q11.2 deletion and the low-activity COMT polymorphism on the nondeleted chromosome. In these four patients, and an additional institutionalized adult with the condition, an uncontrolled, open-label trial of metyrosine was administered in an attempt to lower catecholamine production and to alleviate symptoms.Results:Mild elevations of baseline CSF homovanillic acid (HVA) were found in three of four patients and a moderate reduction in CSF HVA after metyrosine treatment in the patient with the highest pretreatment concentration. The course of the five patients during the clinical trial is described.Conclusions:In patients with the 22q11.2 deletion syndrome and low-activity COMT, controlled studies of pharmacologic agents that decrease catecholamine production, block presynaptic catecholamine storage, or enhanceS-adenosylmethionine, the cosubstrate of COMT, are warranted.</jats:p

Uncanny Exchanges: The Possibilities and Failures of ‘Making Change’ with Alternative Monetary Forms

In most standard accounts, modern money depends on its function as the general equivalent. Equivalence, in turn, rotates around a specific numerological metaphysics, including the concept of zero and the algebraic function. Yet, rarely are the mathematics of equivalence subject to critical scrutiny. In this paper I explore contemporary alternative numerologies of money and finance. The alternatives that I consider are a US local scrip currency and transnational Islamic finance experiments. My data come from fieldwork in Ithaca, New York, and from research among Islamic finance specialists devising new financial products. I am interested in how these alternatives make explicit the moral form of the mathematics of the general equivalent

Assessing Patient Attitudes to Computerized Screening in Primary Care: Psychometric Properties of the Computerized Lifestyle Assessment Scale

Background: Computer-based health-risk assessments are electronic surveys which can be completed by patients privately, for example during their waiting time in a clinic, generating a risk report for the clinician and a recommendation sheet for the patient at the point of care. Despite increasing popularity of such computer-based health-risk assessments, patient attitudes toward such tools are rarely evaluated by reliable and valid scales. The lack of psychometric appraisal of appropriate scales is an obstacle to advancing the field. Objective: This study evaluated the psychometric properties of a 14-item Computerized Lifestyle Assessment Scale (CLAS). Methods: Out of 212 female patients receiving the study information at a family practice clinic, 202 completed a paper questionnaire, for a response rate of 97.6%. After 2 weeks, 52 patients completed the scale a second time. Results: Principal component analysis revealed that CLAS is a multidimensional scale consisting of four subscales (factors): (1) Benefits: patient-perceived benefits toward the quality of medical consultation and means of achieving them, (2) Privacy-Barrier: concerns about information privacy, (3) Interaction-Barrier: concerns about potential interference in their interaction with the physician, and (4) Interest: patient interest in computer-assisted health assessments. Each subscale had good internal consistency reliability ranging from .50 (2-item scale) to .85 (6-item scale). The study also provided evidence of scale stability over time with intraclass correlation coefficients of .91, .82, .86, and .67 for the four subscales, respectively. Construct validity was supported by concurrent hypotheses testing. Conclusions: The CLAS is a promising approach for evaluating patients’ attitudes toward computer-based health-risk assessments.The study contributed to doctoral and fellowship training of Farah Ahmad, funded by the Canadian Institutes of Health Research(No. 17744), the Institute of Gender and Health, and Ontario Women’s Health Council. The authors wish to thank Wendy Levinson, thesis/fellowship supervisor, and Donna E. Stewart, thesis advisor, for their conceptual contributions. All in-kind support provided by the Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, is much appreciated