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Late-life depression (LLD) is characterized by differences in resting state functional connectivity within and between intrinsic functional networks. This study examined whether clinical improvement to antidepressant medications is associated with pre-randomization functional connectivity in intrinsic brain networks.
Methods
Participants were 95 elders aged 60 years or older with major depressive disorder. After clinical assessments and baseline MRI, participants were randomized to escitalopram or placebo with a two-to-one allocation for 8 weeks. Non-remitting participants subsequently entered an 8-week trial of open-label bupropion. The main clinical outcome was depression severity measured by MADRS. Resting state functional connectivity was measured between a priori key seeds in the default mode (DMN), cognitive control, and limbic networks.
Results
In primary analyses of blinded data, lower post-treatment MADRS score was associated with higher resting connectivity between: (a) posterior cingulate cortex (PCC) and left medial prefrontal cortex; (b) PCC and subgenual anterior cingulate cortex (ACC); (c) right medial PFC and subgenual ACC; (d) right orbitofrontal cortex and left hippocampus. Lower post-treatment MADRS was further associated with lower connectivity between: (e) the right orbitofrontal cortex and left amygdala; and (f) left dorsolateral PFC and left dorsal ACC. Secondary analyses associated mood improvement on escitalopram with anterior DMN hub connectivity. Exploratory analyses of the bupropion open-label trial associated improvement with subgenual ACC, frontal, and amygdala connectivity.
Conclusions
Response to antidepressants in LLD is related to connectivity in the DMN, cognitive control and limbic networks. Future work should focus on clinical markers of network connectivity informing prognosis.
On 1 December 2011 the West Antarctic Ice Sheet (WAIS) Divide ice-core project reached its final depth of 3405 m. The WAIS Divide ice core is not only the longest US ice core to date, but is also the highest-quality deep ice core, including ice from the brittle ice zone, that the US has ever recovered. The methods used at WAIS Divide to handle and log the drilled ice, the procedures used to safely retrograde the ice back to the US National Ice Core Laboratory (NICL) and the methods used to process and sample the ice at the NICL are described and discussed.
The state, including its law enforcement and security services, is there to work for the people, to defend their rights, interests and property, not to mention their security and their lives.
Vladimir Putin, 2004
Do Russian law enforcement and security services work for the people and defend their rights? On the eve of his second term, Putin put his finger on what is central to thinking about not just the capacity, but the quality, of state coercive organs. In a civil state with high state quality, the state's monopoly of force is wielded not primarily for the interests of the ruler(s), but for society as a whole.
In the previous two chapters, we focused on the capacity of the Russian power ministries. At the national level, there is some evidence that the capacity of the power ministries increased during Putin's presidency. Violent clashes for sovereign power in the capital were off the table, the fiscal capacity of the state increased, and toward the end of Putin's tenure, there seemed to be some improvement in fighting violent crime and terrorism, although Russia continued to lag comparatively in these areas. The greatest increase in coercive capacity, however, came in the rebuilding of a “regime of repression” that the Kremlin used to help fix elections and repress economic and political rivals. Moreover, private property rights remained insecure, both for oligarchs and for ordinary businesspeople and citizens, as we will see in this chapter.
The group of FSB personnel assigned to work undercover in the government has successfully carried out the first step of their assignment.
Vladimir Putin, December 1999
History has arranged it that the burden of upholding Russian statehood has to a considerable extent fallen on our shoulders.
Viktor Cherkesov, KGB veteran and Putin ally, December 2004
Putin presumably was joking when he made the statement quoted in the epigraph at a reception for secret police personnel on December 20, 1999, less than two weeks before he would become acting president when Boris Yeltsin surprisingly resigned on New Year's Eve 1999. But, as Russians like to say, in every joke there is an element of truth. And if Putin was joking, his close friend Cherkesov was deadly serious, arguing that Russia itself would perish if secret police alumni could not unify their forces.
During Putin's tenure as president, he relied heavily on officials who had made their careers in law enforcement and military agencies. State coercive bodies, referred to in Russia as the power ministries (silovye ministerstva) or power structures (silovye struktury), rose in stature. Russian citizens, for example, believed that Putin represented the interests of the power ministries – more than big business (“the oligarchs”), “ordinary people,” the state bureaucracy, or society as a whole. The increased prominence of personnel from these agencies throughout government led the Russian sociologist Olga Kryshtanovskaya to dub Putin's regime a “militocracy.”
My mission, my historic mission – it sounds pompous, but it is true – is to resolve the situation in the North Caucasus.
Vladimir Putin
The power ministries have been central to state building throughout Russia, but nowhere have their activities been more important than in the North Caucasus. The major reason for this is the war in Chechnya that began in 1994. Further, particularly since 1999, the conflict and political violence has spread to other parts of southern Russia. The North Caucasus, more than any other region in Russia, has been closest to what Guillermo O'Donnell calls a “brown area,” where the state not only does not function properly but is largely absent. Beyond the issues of state capacity and state quality, in the North Caucasus, post-Soviet Russia has faced a threat to state integrity, in which the soundness of its external borders was potentially at risk.
Vladimir Putin's meteoric rise to power was closely tied to the conflict in the North Caucasus. In some ways, a Putin presidency is unthinkable if not for the resumption of war between Russia and Chechnya in 1999. When he declared in early 2000 that resolving the situation in the region was his “historic mission,” he also stated that when he was named prime minister in August 1999, he figured that he only had a few months to “bang away at these bandits,” but that he was willing to sacrifice his political career to “stop the collapse of the country.”
A strong state for a Russian is not an anomaly, not something to fight against, but on the contrary is the source and guarantor of order, the initiator and driving force of any change.
Vladimir Putin, December 1999
From his first days in office as Russia's second president, Vladimir Putin made strengthening the state the primary goal of his rule. Putin's objective responded not only to the wishes of Russian citizens, but arguably to a real and serious problem. By the end of Boris Yeltsin's presidency in 1999, the weakness of the Russian state was being compared to African failed states. A host of pathologies in the 1990s – economic depression culminating in default, the spread of alternative monetary instruments in place of the ruble, demographic crisis evidenced by a rising death rate and declining birth rate, high crime and murder rates, the power of the so-called oligarchs and regional barons – were blamed on state incapacity. Throughout the decade, observers asked, as Matthew Evangelista put it, “will Russia go the way of the Soviet Union?”
By the end of his second term, Putin was proclaiming the rebuilding of the state as one of his most important achievements. This chapter begins the assessment of the capacity and quality of the Russian state, particularly the coercive organs, pursued throughout this book by examining the role of the power ministries at the national level. How should we evaluate Putin's claim to success, one echoed by many Russian and Western observers?
Everyone was saying that the administrative vertical had been destroyed and that it had to be restored.
Vladimir Putin, 2000
Vladimir Putin first became familiar with the details of Russian federalism and regional politics in 1997–1998, when he worked in the presidential administration of Boris Yeltsin in two different positions concerning regional politics and relations with the heads of Russia's eighty-nine subunits (conventionally referred to as “governors”). It was at this time that “everyone was saying” that decentralization had gone too far and federal relations were in crisis, including (or perhaps especially) in the Kremlin. Putin became convinced that Russia did not have a “full-fledged federal state” but a “decentralized state,” and that “regional independence often is treated as permission for state disintegration.” This diagnosis was widely shared, not only in Russia but by many foreign experts.
“Strengthening vertical power” became a key slogan of Putin's presidency, especially in his first term. He was guided by his statist ideology and his belief, as his close ally Viktor Cherkesov put it, that in Russia, it has always been important “to have supreme state control over the activity of local bureaucrats.” It was particularly important to Putin that the central state reassert its control over the power ministries. This control had weakened considerably under Yeltsin, particularly in the law enforcement realm, but there were significant concerns about regionalization of the military as well. Powerful regional governors were seen as amassing substantial political, economic, and even coercive resources, which was of great concern to central authorities.
The Soviet Union has been characterized as “the world's largest-ever police state.” But why is “police state” a pejorative, a synonym for brutal dictatorship? After all, if we expect the state to do anything, policing is surely one of those things. Although policing is a function that can and often is carried out by private actors, all modern states create “an organization authorized by a collectivity to regulate social relations within itself by utilizing, if need be, physical force.” Try living in a community of any significant size that does not have an authorized organization capable of policing it, and one will quickly see the virtues of such a force. Anarchists aside, most citizens in the modern world would rather live with police than without them. But the term “police state” resonates because state power, as Max Weber recognized, ultimately rests on the ability to coerce. The behavior of its coercive organizations, such as the military, the police, and the secret police, tells us much about the character of a state, as the Marenin epigraph emphasizes.
The collapse of “the world's largest-ever police state” introduced a period of remarkable political and economic change in Russia. Although the Soviet collapse is conventionally referred to as peaceful, and by comparative standards perhaps it was, it was not entirely so, with multiple wars and violent conflicts.