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SATURDAY, Oct. 12, 2013 (HealthDay News) -- A shot in the neck may curb extreme hot flashes associated with menopause, a small new study suggests.
Injecting a local anesthetic into an area of the neck that communicates with the brain's temperature regulation zone was associated with a 50 percent reduction in hot flashes among women with moderate to severe symptoms, the researchers reported.
Since research over the last decade has suggested that taking hormone replacement therapy to control menopausal symptoms may be associated with increased risk for heart disease and cancer, many women have been searching for a safe and effective non-hormonal means of reducing hot flashes.
The anesthetic treatment isn't designed for everyone with hot flashes. It's intended for those struggling with truly troubling hot flashes that occur regularly, affecting quality of life, said study author Dr. David Walega, chief of the division of pain medicine at Northwestern University Feinberg School of Medicine in Chicago.
"This is for people with multiple drenching sweats, women who can't function in the workplace, who have extreme anxiety preceding the hot flash. And when that happens several times a day, we also see anxiety and depression," explained Walega. Some breast cancer patients stop taking their medication -- tamoxifen -- because it causes hot flashes, he added.
Hot flashes are sudden feelings of heat or warmth starting in the face and extending to the neck and chest area, sometimes accompanied by sweating and flushing of the skin. They are associated with menopause, but can also occur in patients taking estrogen-blocking medications, typically for breast or prostate cancer. Walega estimated that hot flashes affect more than 80 percent of menopausal women.
To deliver the treatment, the physician uses guided imaging to inject a local anesthetic into what is called the stellate ganglion, an area between the thyroid gland (around the "voice box") and the carotid artery. "The patient feels a sense of intense pressure from the physician's finger [guiding the needle], and the pain is moderate," said Walega. "In 30 seconds, we're done."
The researchers got the idea of attacking extreme hot flashes by treating the stellate ganglion from unintended consequences of a pain study published in The Lancet in 2007. "Patients reported their pain was still there, but their hot flashes were gone," Walaga said.
For this study, scheduled for presentation Saturday at the American Society of Anesthesiologists annual meeting in San Francisco, the researchers recruited 40 women between 35 and 65 years old. All were either in natural or surgically induced menopause (when the ovaries are removed).
Half of the women received a stellate ganglion blockade injection of bupivacaine hydrochloride, a local anesthetic. The others were given a placebo, an injection of sterile saline. Participants kept track of their hot flashes for two weeks preceding the injection and six months afterward.
The researchers found that stellate ganglion blockade reduces the incidence of hot flashes by half, especially in women with moderate or severe hot flashes, and the benefits appear to last for at least six months. Subjects also reported experiencing less depression after getting the bupivacaine injections, and they demonstrated improved verbal recall of spoken words.
Walega said the treatment is safe when done by specially trained physicians using X-ray fluoroscopy to guide the injection. The stellate ganglion sits near the carotid artery, the vertebral artery and the spinal cord. "Injecting any of those arteries with anesthetic could cause a seizure and loss of consciousness, and it could do damage to the spinal cord," he explained. As for the risk of radiation exposure from the fluoroscopy, it is equivalent to that of a chest X-ray, he added.
Why might these injections work? Walega said he thinks the ganglion may play a role in turning certain nerves on or off. "It's complex and there's so much else we don't know," Walega said. "We might be resetting the thermostat." Walega now plans to do a larger study with more than 200 participants, he noted.
Dr. Grace Forde, an attending physician and pain management specialist at Syosset Hospital in New York, noted that a large percentage of the patients receiving the placebo also reported an improvement in their hot flashes. "Invasive procedures often have a much stronger placebo effect," she noted.
Walega estimated that the treatment, if proven effective in a larger study, would cost between $750 and $1,000.
Forde, who was not associated with the study, said she thinks the benefits of the treatment probably outweigh the risks. "You can't put a price on quality of life. I personally think it's worth it."
Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.
More information
Learn more about menopause from the U.S. Centers for Disease Control and Prevention.
SOURCES: David Walega, M.D., chief, division of pain medicine and program director, multidisciplinary pain medicine fellowship, department of anesthesiology, Northwestern University Feinberg School of Medicine, Chicago; Grace Forde, M.D., attending physician, pain management specialist, Syosset Hospital, Syosset, N.Y.; Oct. 12, 2013, presentation, American Society of Anesthesiologists annual meeting, San Francisco
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Wednesday night, the four fierce female finalists of American Idol season 12 will face off once again for America's votes, which will be added to all the votes they received last week, when nobody was eliminated. Win or lose, one of the show's past female champs says any one of them can go on to have a fulfilling career -- but it's up to them to take control.
"You know, when you make it through all of those people -- it's thousands and thousands of people -- they are all winners at this point," season-three winner Fantasia tells ABC News Radio. "It's just up to them now where they'll take it. They're the captain of the ship, you see what I'm sayin'? So I'm proud of all of them."
Fantasia, who performed on the results show a couple of weeks ago, wouldn't be pinned down when asked to choose her favorite among the remaining women on the show. "It's really hard because they're all very talented and different," she says, adding, "So, I always say I'm rooting for all of them."
Faced with competition from other viewing choices, including the other TV singing competitions out there now, American Idol has struggled in the ratings this season. While Fantasia remains loyal to Idol , she does admit to doing some cheating with a certain NBC show.
"For me, c'mon, that's my home," Fantasia says of American Idol. "That's where it all started for me. So, it will always be one of my favorites but I do love The Voice ."
However, Fantasia explains that she doesn't love The Voice because she thinks it's better than Idol : she loves it because it's yet another chance for undiscovered talent to hit the big time.
"I love all the shows that are reaching back and helping people, put it like that," she tells ABC News Radio. "'Cause some of these people would never be heard, and they would never be able to share their gifts. So, all of them are great shows but Idol 's my baby. That's my home."
American Idol airs Wednesday and Thursday nights on Fox. Another former champ, David Cook , will perform on this week's results show.
Copyright 2013 ABC News Radio

subset: commoncrawl


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For Immediate Release: June 14, 2010
Thruway Authority Announces the Next Phase for the Redecking of the Tappan Zee Bridge
The New York State Thruway Authority today announced the award of a $148.8 million contract for the next phase of the redecking project on the Tappan Zee Bridge. The contract was awarded to Tutor Perini Corp. from Peekskill, New York.
"This most recent Tappan Zee Bridge deck replacement contract is part of the Authority's ongoing strategic response to maintenance issues related to this heavily-used bridge," said Thruway Authority Executive Director Michael R. Fleischer. "In addition to improving service and ensuring the safety of motorists, the project will also improve mobility and reliability of traffic on the bridge."
This deck replacement project, the second contract to be awarded since August 2006, will replace approximately 28 percent of the total concrete deck area on the Tappan Zee Bridge. When completed, approximately 96 percent of the original deck will have been replaced since the Bridge opened in 1955.
Congressman Eliot Engel (NY-17) said, "This bridge is a vital link for Rockland and Westchester Counties and for a large amount of commercial traffic to and from New England and upstate New York. This work will keep traffic moving and safe, two principles that are essential to the people using it. The Thruway Authority is right to plan the work for the least busy hours so drivers face the least inconvenience."
"My top priority is to push the new bridge project forward as quickly as possible," said Assemblyman Ken Zebrowski, (New City). "However, I am glad the Authority is making the proper investments to ensure the current bridge is safe and secure."
Assemblywoman Sandy Galef (Ossining) said: "This is such an important project for our region. We must make sure we upgrade the Tappan Zee Bridge, even as we plan for its brighter future. I am so pleased that the contract for this redecking has been awarded to a local company. This is good for the company, for the City of Peekskill, and for Westchester County. While we make needed repairs to our infrastructure, we are simultaneously stimulating our local economy."
Similar to other construction projects for the Tappan Zee Bridge and consistent with the goals of the State's competitive bidding statutes, this work will be done under a Project Labor Agreement (PLA) negotiated between the Thruway Authority, contractors and labor organizations. The PLA provides economic and work efficiency benefits including uniform work rules, coordinated work days and work schedules, as well as other productivity benefits. History has demonstrated that not only have PLAs for projects on the Bridge resulted in savings due to the reduction of daily mobilization and demobilization, contracts have been completed more efficiently with less impact on the traveling public.
"Since 1994, nearly $1 billion in work on the Tappan Zee Bridge and related upgrades have been completed without a single hour of lost time due to worker unrest," said Ross J. Pepe, President, Construction Industry Council of Westchester and Hudson Valley. "This is an amazing tribute to the decision of the Thruway Authority and local labor leaders to negotiate a Project Labor Agreement with cost saving features and worker protections. The PLA eliminates disputes and provides flexibility for contractors to work efficiently without disrupting traffic."
Key elements of this deck replacement contract for the Tappan Zee Bridge include:
- Replacement of road surface deck panels
- Replacement of the movable barrier deployed to shift traffic flow during peak hours.
- Safety railings.
As with any project taking place on the heavily-used Tappan Zee Bridge, during construction every effort will be made to minimize traffic disruptions. For example:
- Deck replacement materials will be manufactured off-site, reducing noise on-site.
- Deck replacement work will be conducted primarily during off-peak, overnight shifts, generally from 8 p.m. until 6 a.m.
- The Authority will limit the contractor's day work, permitting single lane closures as needed.
- There are no plans for the regular use of metal plates during the replacement of deck sections.
This deck replacement contract is expected to begin in June 2010; the Authority anticipates the project will be completed in the Winter of 2012.
This contract is the largest single project scheduled to be let by the Authority in 2010. This year the Authority expects to let more than $600 million in projects – the largest one-year letting level in Thruway Authority history.
"Rebuilding and upgrading the Thruway's more-than-50-year-old infrastructure is the principal focus of the Authority's on-going $2.1 billion highway and bridge capital program," Fleischer said.
Tutor Perini Corp. submitted the low bid among six contractors. The high bid was $226.2 million.
The three-mile Tappan Zee Bridge, located about 13 miles north of New York City, carries the New York State Thruway over the Hudson River, between Rockland and Westchester Counties. The structure serves as a lifeline between New York City and Upstate New York. The bridge carries about 140,000 vehicles every day, with volumes as high as 170,000 vehicles daily. The bridge opened in 1955 with a design capacity of 100,000 vehicles per day. In its first year of operation the bridge carried an average of 18,000 vehicles daily.
For more information about the Tappan Zee redecking project please visit the Authority's website at www.thruway.ny.gov click on "Projects and Studies," and then click on "TZB Deck Replacement."


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tizanidine - oral, Zanaflex
GENERIC NAME: TIZANIDINE - ORAL (tye-ZAN-i-deen)
BRAND NAME(S): Zanaflex
Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage
USES: This medication is used to treat muscle spasms caused by certain conditions (such as multiple sclerosis, spinal cord injury). It works by helping to relax the muscles.
HOW TO USE: Take this medication by mouth as directed by your doctor, usually every 6 to 8 hours.The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Do not take more than 36 milligrams a day or more than 3 doses in a 24-hour period.Your body will absorb this medication differently depending on whether you take it as a tablet or capsule, whether you take it with food or on an empty stomach, or if you sprinkle the contents of the capsule on food. Be sure to discuss with your doctor how to take this medication to determine the best way to take your dose, especially when changes to your dose are being considered or if your doctor prescribes a different form of tizanidine (such as tablet or capsule).This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as anxiety, tremor, increased blood pressure/heart rate/muscle tenseness) may occur if you suddenly stop using this medication. Do not stop taking this medication without consulting your doctor. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.Tell your doctor if your condition does not improve or if it worsens.
Medically Reviewed by a Doctor on 4/16/2014
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Need help identifying pills and medications?
Back to Medications Index


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OBJECTIVE: In attempting to explain the familial predisposition to panic disorder, most studies have focused on the heritability of physiologic characteristics (e.g., CO2 sensitivity). A heretofore unexplored possibility is that a psychological characteristic that predisposes to panic—anxiety sensitivity—might be inherited. In this study, the authors examined the heritability of anxiety sensitivity through use of a twin group. METHOD: Scores on the Anxiety Sensitivity Index were examined in a group of 179 monozygotic and 158 dizygotic twin pairs. Biometrical model fitting was conducted through use of standard statistical methods. RESULTS: Broad heritability estimate of the Anxiety Sensitivity Index as a unifactorial construct was 45%. Additive genetic effects and unique environmental effects emerged as the primary influences on anxiety sensitivity. There was no evidence of genetic discontinuity between normal and extreme scores on the Anxiety Sensitivity Index. CONCLUSIONS: This study suggests that one psychological risk factor for the development of panic disorder—anxiety sensitivity—may have a heritable component. As such, anxiety sensitivity should be considered in future research on the heritability of panic disorder.
Anxiety sensitivity is the fear of anxiety-related sensations. It is thought to arise from beliefs that these sensations have harmful consequences (R15602BABBAAJG–R15602BABBBJDG). For example, an individual may fear that the sensation of palpitations indicates a serious, life-threatening condition, such as a heart attack. According to expectancy theory, such an individual may become anxious whenever this symptom is experienced and may tend to avoid activities or places that are believed to bring it on. Anxiety sensitivity theory proposes that some individuals are more prone than others to respond to anxiety symptoms in this fashion. In other words, the higher an individual's level of anxiety sensitivity, the more that individual is likely to experience anxiety symptoms as alarming, dangerous, and threatening.
There is considerable empirical support for the role of anxiety sensitivity in panic disorder (for reviews see references R15602BABBBJDG and R15602BABCEIAB). Anxiety sensitivity, as assessed by the Anxiety Sensitivity Index (R15602BABBDIAF), is higher in people with panic disorder than in healthy comparison subjects and in patients with another anxiety disorder, social phobia (R15602BABDJDCD, R15602BABDAEEE). In normal volunteers, anxiety sensitivity predicts anxious responding to a variety of panic-provoking paradigms such as hyperventilation and CO2 inhalation (R15602BABDCDEE–1R15602BABDBCJD). However, anxiety sensitivity does not seem to predict consistently response to all agents that induce panic, cholecystokinin tetrapeptide being a case in point (R15602BABCAFJJ; see reference R15602BABDCCHJ for review).
Anxiety sensitivity has also been found to be a risk factor for the development of panic disorder. In a prospective study of young adults under stress (i.e., military basic trainees), anxiety sensitivity was found to predict the onset of panic attacks (as well as generalized anxiety and depressive symptoms) over a 5-week period (R15602BABCDEEE). The latter finding, which has since been replicated (cited in reference R15602BABBAJDF), confirms that high anxiety sensitivity at one time point is associated with the development of panic disorder (and perhaps other anxiety or depressive disorders) at a later time point.
Panic disorder runs in families (R15602BABBFAFC–R15602BABCEJAI). Moreover, twin studies clearly demonstrate that the disorder is heritable (R15602BABCAGEH–R15602BABDHAAB). The latter finding has generally been interpreted to mean that patients with panic disorder inherit a physiologic or biological risk factor for panic. Enhanced sensitivity to 35% CO2 among family members of patients with panic disorder has emerged as a promising candidate in this regard (R15602BABBDHGI, R15602BABCJDIF). Surprisingly, though, little attention has been paid to the possibility that the transmission of a psychological construct such as anxiety sensitivity might explain the heritable nature of panic disorder. This is despite the fact that Reiss and McNally originally posited that genetic factors might influence anxiety sensitivity (R15602BABEBHHD) and despite a growing awareness that other complex attitudes and behaviors can have a heritable basis. The purpose of the present study was to 1) estimate the magnitude of genetic and environmental influences on anxiety sensitivity, and 2) determine whether the magnitude of any genetic influence on anxiety sensitivity changes when only cases of extreme anxiety sensitivity (such as would be seen in panic disorder) are examined. Since most authorities agree that anxiety sensitivity is multifactorial (R15602BABBFBGG, R15602BABCAJDA), we examined the heritability of anxiety sensitivity as a unifactorial and multifactorial construct.
The subjects were 337 volunteer urban general population twin pairs recruited from the area of Vancouver, B.C., Canada. The study group included 179 monozygotic twin pairs (mean age=32.13 years, SD=12.11, range=16–79) and 158 dizygotic twin pairs (mean age=31.34, SD=12.04, range=16–66). The monozygotic twin pairs consisted of 45 brother pairs (mean age=31.82, SD=12.94, range=16–71) and 134 sister pairs (mean age=32.23, SD=11.87, range=16–79). The dizygotic twin pairs consisted of 28 brother pairs (mean age=32.50, SD=13.84, range=18–66), 94 sister pairs (mean age=31.48, SD=12.86, range=16–66), and 36 brother-sister pairs (mean age=30.06, SD=13.13, range=18–66).
Twin pairs were recruited through newspaper advertisements, print and radio media stories, and through twin club registries to participate in a study of personality. Zygosity was determined through use of a highly accurate questionnaire (R15602BABBJJGE, R15602BABCBCJJ) and examination of recent color photographs. All subjects gave written informed consent to participate in this study, which was approved by the Human Subjects Committee of the Faculty of Medicine of the University of British Columbia.
Twin pairs completed a packet of questionnaires at home. They were instructed to complete the questionnaires independently of one another in a nondistracting setting. Included in the packet was the Anxiety Sensitivity Index (R15602BABBDIAF), a 16-item self-report questionnaire. Each item is rated on a 5-point Likert-type scale, where respondents indicate the extent to which each item corresponds to their beliefs about the consequences of their anxiety symptoms. Items are rated from 0 to 4 (0=not at all and 4=very much). Total Anxiety Sensitivity Index scores are obtained by summing the responses to each of the 16 items. The Anxiety Sensitivity Index has been shown to have excellent psychometric properties both in clinical and nonclinical samples (R15602BABBDIAF).
Whereas some studies support a single-factor structure for the Anxiety Sensitivity Index (R15602BABBFJGF), others have concluded that it is multifactorial (R15602BABCAJDA). Given the controversy over the factor structure of the Anxiety Sensitivity Index, we conducted an obliquely rotated principal components analysis of the scale's items, which is consistent with extraction and rotational methods used elsewhere (R15602BABCEIAB). We used one randomly selected member of each twin pair for the analyses. A clear three-factor solution emerged (eigenvalues >1.0) with loadings similar to that reported by Stewart et al. (R15602BABBFBGG). The factors were named physical concerns, psychological concerns, and social concerns, and they accounted for 34.3%, 9.9%, and 8.4% of the total variance, respectively. Factor intercorrelations ranged from 0.12 to 0.42 (T1). Factor scores were computed for each factor for all subjects.
A critical assumption of the twin method is that the environments of monozygotic and dizygotic twins are not systematically different from each other, which could influence the degree of twin similarity. No significant differences were detected between monozygotic and dizygotic twins for the number of separations greater than 1 month (t=–1.73, df=333, p=0.08), for number of serious illnesses (t=0.99, df=334, p=0.32), and for two true/false items assessing the similarity of environments for same-sex twins ("We attend the same school" [χ2=3.75, df=1, p=0.05] and "Our parents treat us pretty much the same" [χ2=3.25, df=1, p=0.07]).
Significant monozygotic to dizygotic differences were detected on three true/false items ("We spend most of our time together," "We have the same friends," and "We tend to dress alike" [χ2=18.38–32.39, df=1, p<0.05]), accounting for a small proportion of the variance across Anxiety Sensitivity Index scores (adjusted r2=3.1%–6.4%). Heritability estimates can also be biased by age and gender effects (R15602BABEAJGJ). In the present group these variables accounted for a negligible proportion of the variance in any of the Anxiety Sensitivity Index scores (adjusted r2=0.002–0.01).
Model fitting began with the computation of Pearson r values between co-twins separately for monozygotic and dizygotic twin pairs; the computer program PRELIS 2 (R15602BABDJEFA) was used. In general, larger monozygotic than dizygotic correlations indicate that genetic influences are present because the greater monozygotic similarity is attributed to the twofold greater genetic similarity of monozygotic than dizygotic twins. Biometrical models were fit to the covariance matrices by the method of maximum likelihood, through use of the computer program LISREL 8 (R15602BABBHJCJ).
The first series of models estimated the proportion of variance attributable to additive genetic factors (a); nonadditive genetic variance due to genetic epistasis, primarily due to genetic dominance (d); shared environmental factors (c); and nonshared environmental factors (e). Additive genetic influences represent the extent to which genotypes "breed true" from parent to offspring. Genetic dominance represents genetic effects attributable to the interaction of alleles at the same locus, which results in a character that is not exactly intermediate in expression, as would be expected between pure-breeding (i.e., homozygous) individuals. Genetic dominance effects were estimated only for those items for which these effects were indicated by a monozygotic correlation that was more than twice the magnitude of the dizygotic correlation (R15602BABCJGDB). The shared component of the environment distinguishes the general environment of one family from that of another and influences all children within a family to the same degree (e.g., socioeconomic status). Nonshared environmental factors (R15602BABCJGDB, R15602BABDBBDG) include events that have differential effects on individual family members (e.g., illness, pre- and postnatal traumas, and differential parental treatment). These nonshared, within-family differences extend to the influence of extrafamilial networks, such as differences in peer groups, teachers, or relatives that may cause siblings to differ. It should be noted that nonshared environmental influences are not measured directly but represent the residual variance after the influences of a, d, and c have been removed. Thus, this component of variance also contains measurement error.
The first model fit to the data was the "full model" that specified a, c, and e (or a, d, and e, if appropriate) influences. The full model was systematically modified to test the significance of a, d, c, and e by fitting a series of "reduced" models. These models systematically removed the effects of 1) additive genetic variance (ce model), 2) shared environmental variance or nonadditive genetic effects (ae model), and 3) both additive and nonadditive genetic and shared environmental variance (e only model). The relative fit of each reduced model was assessed by testing the difference in chi-square values between the full and reduced models. The critical value of chi-square to test the chi-square difference is determined by the difference in the number of degrees of freedom between the full and reduced models under consideration. The reduced model was rejected whenever the chi-square difference exceeded the critical value of chi-square. Model fit was also assessed in conjunction with two other criteria: the principle of parsimony and Akaike's information criterion (R15602BABDHFBB) (chi-square minus two degrees of freedom). As such, the best-fitting model is the one that does not significantly increase chi-square, accounts for the variance with the fewest number of parameters, and yields the smallest value of Akaike's information criterion. The parameter estimates obtained from the best-fitting model are squared to yield the familiar proportions (percent) of the variance attributable to each genetic and environmental influence: h2 (additive genetic factors), d2 (when applicable) (nonadditive genetic factors), c2 (shared environmental factors), and e2 (nonshared environmental factors).
A common assumption of heritability studies of psychiatric disorder is that the same etiological mechanisms operate in the normal and extreme (characteristic of psychiatric disorder) ranges of functioning (R15602BABDJFED). This assumption can be addressed by comparing the magnitude of genetic influences on extreme scores (defined by a clinically significant threshold on a quantitative measure) to the magnitude of genetic influences on the entire range of scores (R15602BABCCEAJ). Estimation of the heritability of extreme range scores or "group heritability" is possible by using a quantitative method known as the DF analysis (R15602BABECCII, R15602BABCFBBE). On a single measure, this method uses data from a single sample in which an extreme group has been identified to estimate group heritability and to estimate the heritability of scores throughout the entire response distribution (symbolized as h2). In short, the assumption that scores from the normal and extreme ranges are influenced by common genetic factors is not supported if normal range scores have a significant heritable basis and extreme range scores do not (h2g<h2), and vice versa. However, a finding that the magnitude of genetic influences on extreme and normal range scores is similar (h2g=h2) implicates common genetic factors, although it is possible that qualitatively different etiological factors influence normal and extreme range scores to the same degree.
A multiple regression procedure (R15602BABECCII, R15602BABCFBBE) estimates group heritability from a sample of monozygotic and dizygotic twin pairs in which the score from one member of a pair exceeds a threshold value. The method uses the extent to which the scores from the unaffected monozygotic to dizygotic members of each twin pair differ. Specifically, no genetic influence on the extreme scores is indicated when, despite the twofold greater genetic similarity of monozygotic to dizygotic twins, the mean scores of the unaffected monozygotic to dizygotic co-twins are equal. Genetic influences are suggested when the mean scores of the unaffected monozygotic co-twins exceed the scores of the dizygotic co-twins. A t test of the difference between the unaffected monozygotic and dizygotic co-twin means yields a significance test of genetic influences on the extreme scores. For the Anxiety Sensitivity Index, a score of 25 or greater is typically associated with a clinical condition such as panic disorder (R15602BABDJDCD, R15602BABBFJGF). A series of thresholds (representing scores of 26, 27, 28, and 29) were tested to examine at what level of extremity differential heritable effects (if any) may be observed. For pairs in which both members' scores exceeded the threshold value, one twin was randomly assigned to the co-twin group and the other was assigned to the proband group to control for ascertainment bias.
Twin correlations and model-fitting statistics are presented in T2. A model specifying additive genetic and nonshared environmental effects (AE model) provided the most satisfactory fit to the total Anxiety Sensitivity Index score and the physical and social concern factors. A model specifying shared and nonshared environmental effects (CE model) could account for all of the variance of psychological concerns. T3 presents the parameter estimates, standard errors, and the heritability estimates. Additive genetic factors accounted for 45%, 35%, and 22% of the total variance on the total Anxiety Sensitivity Index score, physical concerns scores, and social concerns scores, respectively. Shared environmental influences accounted for 11% of the total variance on psychological concerns. Nonshared environmental influences (and error) accounted for the greatest proportion of the variance on all scales (range=55% to 89%).
T4 provides the results of the DF analysis. Group heritability, or the heritable basis of the total Anxiety Sensitivity Index scores above the threshold of 25 to 28, ranged from 45% to 63%. The 95% confidence interval around the heritability estimate of the total Anxiety Sensitivity Index score for the total group is 0.33–0.59. The group heritability estimates generally fall within this confidence interval, suggesting that there is no genetic discontinuity between normal and extreme scores on the Anxiety Sensitivity Index.
To the best of our knowledge, this is the first study to examine the heritability of anxiety sensitivity. We found that anxiety sensitivity has a strong heritable component, accounting for nearly half of the variance in total anxiety sensitivity scores. Results of the DF analysis showed that the magnitude of genetic effects across the whole range versus extreme range Anxiety Sensitivity Index scores fell within the same general parameters. These results support the idea that high scores on the Anxiety Sensitivity Index (characteristic of panic disorder) and scores in the subclinical range share the same common genetic factors. We use the word "support" because it is possible that qualitatively different genetic factors influence extreme and normal range scores to the same degree.
Whereas it has generally been hypothesized that the heritable nature of panic disorder reflects the genetic transmission of a physiologic risk factor (e.g., hypersensitivity to CO2) (R15602BABBDHGI, R15602BABCJDIF), this may be too narrow a formulation. In view of our findings, serious consideration should be given to the possibility that an attitudinal or cognitive risk factor (i.e., anxiety sensitivity) is being genetically transmitted. This should not be seen as an unexpected or novel hypothesis (R15602BABEBHHD). As noted by Kendler (R15602BABBHCBJ), considerable evidence now points to the heritability of many complex psychological traits that may themselves serve as risk factors for psychiatric disorders. Certainly, personality traits have a large heritable component (R15602BABCCDEH); hence, it is not surprising that anxiety sensitivity is also heritable. Thus, our findings raise the question of whether anxiety sensitivity is inherited independently from "neuroticism," a question that we hope to address in future studies. Given the empirical support for heritability of a nonspecific neurotic factor in the anxiety disorders (R15602BABCAEJJ, R15602BABCACGF), this must be seriously considered.
Our study has several limitations. Among these are a limited group size and few male twin pairs. Our interpretation of the data is also limited by the relatively restricted range of anxiety sensitivity scores encountered in this group of twins from the general population. We demonstrated that the upper range of anxiety sensitivity scores in our study group (i.e., high 20s) is not inherited differently from lower anxiety sensitivity scores; however, we cannot extrapolate with certainty to state that this will necessarily apply to the much higher anxiety sensitivity scores (i.e., 30 and above) seen in some patients with panic disorder. Thus, although we believe that our findings have relevance to the understanding of the heritability of disorders characterized by pathological levels of anxiety sensitivity (i.e., panic and perhaps other anxiety and depressive disorders) (R15602BABBBJDG), this will require further study.
With these limitations in mind, our findings lead us to tentatively conclude that perhaps what is inherited in panic disorder is a tendency to view anxiety symptoms as frightening. It is expected that anxiety sensitivity, like other cognitive tendencies, will eventually be localized within specific neural networks (R15602BABBBEFG). In order to make further advances in this regard, we would propose that future studies evaluate anxiety sensitivity and other risk factors within this broader context. For example, heritability studies of panic at the level of "disorder" might simultaneously examine anxiety sensitivity heritability at the level of "trait"; and functional neuroimaging studies of anxiety disorders might use neuropsychologically relevant tasks to activate neural structures (e.g., components of the limbic system) that could underlie anxiety sensitivity (R15602BABDHGHA).
When the heritability of the three factors of the Anxiety Sensitivity Index are examined separately, there is some evidence for differential contributions of additive genetic and environmental influences. This must be considered a very tentative finding, given that there are differences among the factors in the number of items with salient loadings (i.e., the psychological and social concerns factors might be less reliable), which may lead to spurious findings in this regard. We found that shared environmental influences accounted for a substantial proportion (11%) of variance in the psychological concerns factor, suggesting that important aspects of this component are influenced by family environment. If this finding is confirmed, then the implication is that interventions directed toward the family milieu might lessen the development of anxiety sensitivity and, hence, might prevent the onset of some forms of psychopathology. Other investigators have similarly hypothesized that specific genetic factors or specific social learning experiences might influence specific factors of anxiety sensitivity (R15602BABCFFFH), leading us to believe that this is an area ripe for further study.
Total Anxiety Sensitivity Index scores and scores on two of the three factors, most notably the physical concerns factor, were best modeled by using a combination of additive genetic and unique environmental influences. Environmental factors account for a large proportion of the variance in Anxiety Sensitivity Index scores, leading us to speculate about the nature of the experiences that may increase anxiety sensitivity and, hence, the risk for panic disorder. The literature suggests that several types of events deserve consideration in this regard. Childhood sexual or physical abuse, a known risk factor for the development of panic disorder (R15602BABCGGIC), could produce feelings of loss of bodily autonomy and concerns related to physiologic hyperarousal. Suffocation experiences (R15602BABCDADC) and other adverse respiratory experiences in childhood, such as asthma (R15602BABBBGBC, R15602BABCHBFD), might sensitize an individual to fear sensations associated with breathlessness. Learning to "catastrophize" about the occurrence of bodily symptoms in general might also lead to higher than normal levels of anxiety sensitivity (R15602BABBEDFB). Thus, although our findings highlight the heritable nature of anxiety sensitivity, they also point to the need to identify experiential factors that influence anxiety sensitivity and to investigate how these factors interact with genetic factors to trigger panic attacks.
Received April 13, 1998;revision received Aug. 14, 1998; accepted Sept. 24, 1998. From the Anxiety and Traumatic Stress Disorders Program, Department of Psychiatry, University of California, San Diego; and the Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada. Address reprint requests to Dr. Stein, Anxiety and Traumatic Stress Disorders Program, Department of Psychiatry (0985), University of California, San Diego, La Jolla, CA 92093-0985; firstname.lastname@example.com (e-mail). Supported in part by a fellowship from the Canadian Psychiatric Research Foundation to Dr. Jang, by grant 181(91-2) from the British Columbia Health Research Foundation, and by grant MA9424 from the Medical Research Council of Canada to Dr. Livesley. The authors thank Steven Taylor, Ph.D., for his input and for his critique of an earlier draft of the manuscript.
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The Winnipeg Jets have signed backup goaltender Al Montoya to a one-year deal worth $601,000.
The 27-year-old spent last season with the New York Islanders, posting a 9-11-5 record, with a 3.10 goals against average and a .893 save percentage.
Montoya has played in 57 career NHL games, between the Islanders and Coyotes, after being drafted by the New York Rangers sixth overall in the 2004 NHL Entry Draft.


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DETROIT (WKZO) -- While water levels in Lakes Huron and Michigan rose two inches last month, levels for all the Great Lakes remain below average. According to the Army Corps of Engineers, all of the lakes are forecasted to remain below average for the next six months, which will impact recreational boating and commercial shipping. Officials are asking federal authorities for money from the Harbor Maintenance Trust Fund so ports throughout the Great Lakes can be dredged.
Jim Bohannon 1:00 AM - 3:00 AM
On Air Now.


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Cross Cut Office Shredders: Ranking a New Category
So I've been trying to get a site to rank for the terms Cross Cut Office Shredders and Cross Cut Office Shredder and I've been having a bit of fun and games with it at the moment. I am therefore going to use this blog to vent some of my thoughts and ideas about what's happening with the rankings there. Continue reading 'Cross Cut Office Shredders: Ranking a New Category' »


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Rustic Charm with urban sophistication is captured in our countrypolitan Tuscan Pillars. Think of vineyards with rows of baby green vines, gently rolling hillsides, dark green cypress trees, and quiet lanes bounded by tall stone walls leading to rust-colored farmhouses, moss-coated castles, creamy-colored villas and topped off with fabulous sunsets.
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Oats and Iron
10 Quick Questions about Met Red Carpet Gala
I have a bunch of questions for anyone who went tonight. Here are the first 10 that I can think of. Sorry they are all very logistical.
Can civilians buy a ticket? Or is it invite-only, for the 805 coolest people?
What happens between the time you walk through the museum doors, and the time you leave? (
I know once you enter, the red carpet goes left - SOUTH - to the Impossible Conversations costume exhibit. What happens after you walk through that?
Were there any after-parties hosted inside of the Museum?
Did they let people go up to the roof?
Was the main reception in the Temple of Dendur?
Was there a dinner? If so, where was that held?
Was anything on the 2nd floor open? I am guessing not.
Did the Museum offer any sort of guided tour of any of the other galleries? For example "See the Steins Collect in 25 minutes or less."
Could you explore the museum, or was the flow of trafic tightly controlled?
What would you change about the experience? Anything to do different next year?
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When I worked the Met and there was a gala event they had dinner in the American Wing courtyard. I was standing guard in the room with the panoramic painting the whole time, which was being used as an opera singer's dressing room.
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Occupational Skills Training (OST)
Frequently Asked Questions for Students
When can I get started?
- Occupational Skills Training is a continuous enrollment program. Students are accepted on a space-available basis. You are encouraged to take a placement test prior to attending one of our OST Information Sessions.
How do I get started?
- The first step is to attend an OST Information Session which is generally offered once a month at either the Jackson or Josephine County campuses. These sessions are open to all interested students, last approximately one hour, and will help you determine whether OST is the right educational path for you. You will learn how the OST program works and some of the typical coursework required. You will also learn about the OST application process, and receive your program application packet. Attendance at an Information Session is mandatory to start the application process.
- Information Session dates can be found at the Individualized Career Training website. If you have questions about the information sessions, please call or e-mail Jennifer Burkes in Grants Pass at 1-541-956-7027 or Peggy Guthmiller in Medford at 1-541-245-7562.
How do I know if OST offers the training I want?
- A list of some of the more popular trainings can be found at the Individualized Career Training website; however it is not an exhaustive list. If your training goal shows an indication of a positive job market and does not overlap with other RCC programs, it may be considered for the OST program. Keep in mind, the popular training goal slots fill up fast. The Information Session will provide you with more information regarding training goals.
What does it cost to attend?
- Each OST student's training plan is individualized. Some students need to take pre-requisites, others don't; some students take more electives than others; some take more internship credits than others. Because of these differences, the cost of your Occupational Skills Training will depend on your individualized OST plan. Once you have applied to the OST program and been accepted, you will meet with a program advisor and design your OST plan.
- The total program credits required for an OST Certificate ranges from 36-62 depending on your training goal, and regular tuition rates apply. Some training will require a criminal background check, drug screen, and immunizations, which will be an additional cost.
Why do I have to take classes when I just want Skills Training?
- Students must be prepared to meet employer standards. Most employers do expect students to have completed a certain level of coursework. The OST Program is a state approved one-year certificate program that requires a combination of academic study and hands-on training.
How long will it take me to get my OST certificate?
- This varies from student to student. Occupational Skills Training is considered a one-year certificate program, but if you enter the program with most of your general education requirements already completed, you could get done in less than a year. If you still have some prerequisites to complete upon entrance into the program, it could take you more than a year.
When will I know if I'm accepted into the program?
- After you submit your OST program application, you will be contacted by an OST faculty advisor, as part of the application process, for a brief phone or in-person interview. After you are accepted into the program an intake appointment is scheduled. At this appointment, you and your advisor will develop your Program Plan, which outlines all of the necessary courses you will need to complete to receive your Occupational Skills Training Certificate. (Note: Depending on faculty workloads, it may take 4-6 weeks to process your application.)
Who can supervise a trainee?
- There should be one primary supervisor for the student who can give assignments, direction, monitoring and feedback. This person can be either line staff or management. They should have the knowledge and skills to train the student on the areas covered in the training goals. The primary supervisor should have the ability to sign off on RCC evaluations.
What classes do I register for?
- Some advice regarding coursework will be given at the Information Session. Most students complete all academic coursework, including electives, before being placed on a worksite. The OST curriculum consists of prerequisites (if necessary), general education requirements, work-based training courses, and approved electives. Required electives will vary depending on your training goal. If you need to register for classes before you have the opportunity to speak to an OST advisor, it is recommended that you follow the Occupational Skills Training Graduation Guide.
What are the benefits of completing the OST program?
- One of the benefits of the OST program is that you learn directly from an employer as you receive hands-on training while earning college credit. Your advisor will consider your long-term goal as you develop your Program Plan together, and advise you on classes and work experience with that long-term goal in mind. Also, the OST Certificate will enable you to be more competitive in the job market, as the majority of employers prefer to hire candidates who have a combination of college and practical experience. In the 2010 – 2011 academic year, 76% of OST graduates found employment as a result of their participation in the OST program.


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- Amily shaw
- Chengdu,chongqing
- China
This conversation is closed.
Can we think without any presumptions?
Questions arised from one of the conversation and a reminiscence of a old lady who said:"nobody is right but me."
Are we free of personal bias when we think?
how reliable it is for us ourselves to judge if we are free of personal bias or not ?
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Bob StiglitzFeb 25 2013: You can't really know your biases unless you have the ability to think about your own thinking and even then science has discovered that most thought is unconscious, see here:
So most people are not capable of accurately thinking about their own thinking because
1) It requires sufficient ability
2) It takes enormous amounts of time, energy, reading, life experience and dedication.
All of which not many people have.
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