Changing patterns of neuropsychological functioning in children living at high altitude above and below 4000 m: a report from the Bolivian Children Living at Altitude (BoCLA) study

The brain is highly sensitive to environmental hypoxia. Little is known, however, about the neuropsychological effects of high altitude residence in the developing brain. We recently described only minor changes in processing speed in native Bolivian children and adolescents living at approximately 3700 m. However, evidence for loss of cerebral autoregulation above this altitude (4000 m) suggests a potential threshold of hypoxia severity over which neuropsychological functioning may be compromised. We conducted physiological and neuropsychological assessments in 62 Bolivian children and adolescents living at La Paz (～3700 m) and El Alto (～4100 m) in order to address this issue. Groups were equivalent in terms of age, gender, social class, schooling, parental education and genetic admixture. Apart from percentage of hemoglobin saturated with oxygen in arterial blood (%SpO(2)), participants did not differ in their basal cardiac and cerebrovascular performance as explored by heart rate, mean arterial pressure, end-tidal carbon dioxide, and cerebral blood flow velocity at the basilar, anterior, middle and posterior cerebral arteries. A comprehensive neuropsychological assessment was administered, including tests of executive functions, attention, memory and psychomotor performance. Participants living at extreme altitude showed lower levels of performance in all executive tests (Cohen effect size = -0.91), whereas all other domains remained unaffected by altitude of residence. These results are compatible with earlier physiological evidence of a transitional zone for cerebral autoregulation at an altitude of 4000 m. We now show that above this threshold, the developing brain is apparently increasingly vulnerable to neuropsychological deficit.     

Development of aptitude at altitude

Millions of people currently live at altitudes in excess of 2500 metres, where oxygen supply is limited, but very little is known about the development of brain and behavioural function under such hypoxic conditions. We describe the physiological, cognitive and behavioural profile of a large cohort of infants (6–12 months), children (6–10 years) and adolescents (13–16 years) who were born and are living at three altitude locations in Bolivia (～500 m, ～2500 m and ～3700 m). Level of haemoglobin oxygen saturation and end‐tidal carbon dioxide were significantly lower in all age groups living above 2500 metres, confirming the presence of hypoxia and hypocapnia, but without any detectable detriment to health. Infant measures of neurodevelopment and behaviour yielded comparable results across altitude groups. Neuropsychological assessment in children and adolescent groups indicated a minor reduction in psychomotor speed with increasing altitude, with no effect of age. This may result from slowing of underlying brain activity in parallel with reduced cerebral metabolism and blood flow, evidenced here by reduced cerebral blood flow velocity, particularly in the basilar artery, in children and adolescents. The proportion of European, Native American and African genetic admixture was comparable across altitude groups, suggesting that adaptation to high altitude in these children occurred in response to chronic hypoxic exposure irrespective of ethnic origin. Thus, psychomotor slowing is proposed to be an adaptive rather than a deficient trait, perhaps enabling accuracy of mental activity in hypoxic conditions.     

Risk Orientation,Risk Exposure,and Policy Opinions: The Case of Free Trade

This research offers a general framework for thinking about how individual disposition towards risk influences public policy opinions. Affinity for or aversion to risk is, in part, a stable personality characteristic that interacts with risk and reward messages in complex policy debates. We examine the implications of this for public opinions about free trade with extensions to immigration policy. We argue and find that opinions about policy depend jointly upon one's exposure to potential gains or losses and one's risk orientation. The findings have implications for crafting and framing public policies because they highlight how individual characteristics are likely to shape the public response to policy proposals. Our findings suggest that there may be limits, in the aggregate, to the degree to which elites can alter the level of support for policies through framing or through offering risk‐mitigating policy provisions.     

Horizontal and vertical pseudoneglect in peri- and extrapersonal space

The present study investigates the influence of depth on pseudoneglect in healthy young participants (n = 18) within three-dimensional virtual space, by presenting a variation of the greyscales task and a landmark task, which were specifically matched for stimulus–response compatibility, as well as perceptual factors within and across the tasks. Tasks were presented in different depth locations (peripersonal, extrapersonal) and different orientations (horizontal, vertical) within three-dimensional virtual space, using virtual reality technique. A horizontal leftward bias (pseudoneglect) for both tasks was found, which was stronger in peripersonal than in extrapersonal space. For the vertical condition, an upward bias was observed in the greyscales task, but not in the landmark task. These results support the hypotheses of right hemispheric dominance for visual spatial attention and our study is the first to examine horizontal and vertical orienting biases with the greyscales task in peri- and extrapersonal space. Furthermore, the differences in attentional asymmetries with respect to depth suggest dissociable neural mechanisms for visual attentional processing in near and far space and the lack of significant correlations implies independence of horizontal and vertical stimulus processing.     

Loewald's approach to psychoanalytic theory

The author suggests that part of the legacy of Hans Loewald is the nature of his approach to psychoanalytic theory. Loewald carefully considered and selectively utilized the work of theorists from a number of psychoanalytic schools of thought: id psychology, object relations theory, ego psychology, self psychology, and the interpersonal tradition. In addition, he helped pave the way for the current widespread interest in intersubjectivity, and also positioned himself in relation to those who embraced hermeneutics. Through all of this, he maintained a skeptical attitude, embodied in his belief in the complexity of the phenomena to be explored and his commitment to the perspective that psychoanalytic ideas should be open to revision.     

Aging and input processing in dual-task situations

The psychological refractory period (PRP) paradigm was used to test whether older participants suffer from input interference in dual-task situations. Young (24 years) and older (57 years) adults gave speeded responses to 2 successively presented stimuli. The results showed increased susceptibility of older participants to input interference. Further experiments revealed that this input interference is related to the salience of the 2nd stimulus and that it is specific to older participants. Our findings indicate that parallel processing at the input stages of dual-task performance requires cognitive control. An age-related decline in the control of input processes should be considered as one source of age effects in dual-task performance.     

The importance of gesture in children's spatial reasoning

On average, men outperform women on mental rotation tasks. Even boys as young as 4 1/2 perform better than girls on simplified spatial transformation tasks. The goal of our study was to explore ways of improving 5-year-olds' performance on a spatial transformation task and to examine the strategies children use to solve this task. We found that boys performed better than girls before training and that both boys and girls improved with training, whether they were given explicit instruction or just practice. Regardless of training condition, the more children gestured about moving the pieces when asked to explain how they solved the spatial transformation task, the better they performed on the task, with boys gesturing about movement significantly more (and performing better) than girls. Gesture thus provides useful information about children's spatial strategies, raising the possibility that gesture training may be particularly effective in improving children's mental rotation skills.     

Being a candidate: its impact on analytic process

Despite its crucial importance to psychoanalytic training, the control analysis has received surprisingly little scrutiny by psychoanalytic writers. How the candidate's training influences analytic process--a critical feature of the control analysis--is examined. In keeping with previous contributions, it is found that the candidate's training experience does indeed influence analytic process. It is argued, however, that focusing on the influence of training itself, as some authors have done, moves discussion away from the meanings of training for each candidate and from how these meanings bear on the interplay of transference and countertransference in the control analysis. Detailed case examples illustrate how one candidate's experience of training was drawn into his control analyses in the form of enactments, supporting the conclusion that attention to the particular ways in which training influences each candidate's analytic work is critical to the candidate's psychoanalytic education.     

Taoism and psychotherapy

An attempt is made in this paper to apply the principals of Taoism to the practice of psychotherapy. The Eastern approach to the nature of experience is described in order for the therapist to become more present for himself as well as for the patient. The relationship of insight to the process of change is explored, contrasting Eastern notions of transcendent liberation to the traditional psychoanalytic model of personal transformation, which has been viewed as curing the patient. Taoist precepts are described, comparing the Eastern view of the enlightened teacher to an ideal therapist. Finally, fifteen Zen tenets are described, as outlined by Holmes and Horioka, with an effort made to relate each tenet to the experience of being a therapist.