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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
To better understand clinicians’ rationale for ordering testing for C. difficile infection (CDI) for patients receiving laxatives and the impact of the implementation of a clinical decision support (CDS) intervention.
Design:
A mixed-methods, case series was performed from March 2, 2017 to December 31, 2018.
Setting:
Yale New Haven Hospital, a 1,541 bed tertiary academic medical center.
Participants:
Hospitalized patients ≥ 18 years old, and clinicians who were alerted by the CDS.
Intervention:
CDS was triggered in real-time when a clinician sought to order testing for CDI for a patient who received one or more doses of laxatives within the preceding 24 hours.
Results:
A total of 3,376 CDS alerts were triggered during the 21-month study period from 2,567 unique clinician interactions. Clinicians bypassed the CDS alert 74.5% of the time, more frequent among residents (48.3% bypass vs. 39.9% accept) and advanced practice providers (APPs) (34.9% bypass vs. 30.6% accept) than attendings (11.3% bypass vs. 22.5% accept). Ordering clinicians noted increased stool frequency/output (48%), current antibiotic exposure (34%), and instructions by an attending physician to test (28%) were among the most common reasons for overriding the alert and proceeding with testing for CDI.
Conclusions:
Testing for CDI despite patient laxative use was associated with an increased clinician concern for CDI, patient risk for CDI, and attending physician instruction for testing. Attendings frequently accepted CDS guidance while residents and APPs often reinstated CDI test orders, suggesting a need for greater empowerment and discretion when ordering tests.
Objective: The human gut microbiota has been demonstrated to be associated with a number of host phenotypes, including obesity and a number of obesity-associated phenotypes. This study is aimed at further understanding and describing the relationship between the gut microbiota and obesity-associated measurements obtained from human participants. Subjects/Methods: Here, we utilize genetically informative study designs, including a four-corners design (extremes of genetic risk for BMI and of observed BMI; N = 50) and the BMI monozygotic (MZ) discordant twin pair design (N = 30), in order to help delineate the role of host genetics and the gut microbiota in the development of obesity. Results: Our results highlight a negative association between BMI and alpha diversity of the gut microbiota. The low genetic risk/high BMI group of individuals had a lower gut microbiota alpha diversity when compared to the other three groups. Although the difference in alpha diversity between the lean and heavy groups of the BMI-discordant MZ twin design did not achieve significance, this difference was observed to be in the expected direction, with the heavier participants having a lower average alpha diversity. We have also identified nine OTUs observed to be associated with either a leaner or heavier phenotype, with enrichment for OTUs classified to the Ruminococcaceae and Oxalobacteraceae taxonomic families. Conclusion: Our study presents evidence of a relationship between BMI and alpha diversity of the gut microbiota. In addition to these findings, a number of OTUs were found to be significantly associated with host BMI. These findings may highlight separate subtypes of obesity, one driven by genetic factors, the other more heavily influenced by environmental factors.
Several different types of laterally extensive debris bands occur along the western terminus region of the Matanuska Glacier, Alaska, U.S.A. An ice-bed process, which to our knowledge has not previously been recognized and described, forms the most common and most prominent type of debris band at Matanuska Glacier’s terminus. The debris bands are composed of one or several millimeter-thick laminations of silt-rich ice having much higher sediment content than that of the surrounding ice. Samples of these bands and their surrounding englacial ice have been analyzed for anthropogenic tritium (3H), oxygen-18 (δ18O), and deuterium (δD).We interpreted the laminated, silt-rich debris bands as basal fractures, along which silt-laden, glaciohydraulically supercooled and pressurized waters flowed, healing the fractures by ice growth. This process is analogous to the inward growth of hydrothermal quartz from the sides of an open fracture.
Two rain events at Matanuska Glacier illustrate how subglacial drainage system development and snowpack conditions affect hydrologic response at the terminus. On 21 and 22 September 1995, over 56 mm of rain fell in the basin during a period usually characterized by much drier conditions. This event caused an 8-fold increase in discharge and a 47-fold increase in suspended-sediment concentration. Peak suspended-sediment concentration exceeded 20 kg m —3, suggesting rapid evacuation of stored sediment. While water discharge returned to its pre-storm level nine days after the rain ceased, suspended- sediment concentrations took about 20 days to return to pre-storm levels. These observations suggest that the storm influx late in the melt season probably forced subglacial water into a more distributed system. In addition, subglacially transported sediments were supplemented to an unknown degree by the influx of storm-eroded sediments off hillslopes and from tributary drainage basins.
A storm on 6 and 7 June 1997, dropped 28 mm of rain on the basin demonstrating the effects of meltwater retention in the snowpack and englacial and subglacial storage early in the melt season. Streamflow before the storm event was increasing gradually owing to warming temperatures; however, discharge during the storm and the following week increased only slightly. Suspended-sediment concentrations increased only a small amount, suggesting the drainage system was not yet well developed, and much of the run off occurred across the relatively clean surface of the glacier or through englacial channels.
The stratified-facies ice of the basal zone of Matanuska Glacier, Alaska. U.S.A., contains significant concentrations of anthropogenic tritium, whereas unaltered englacial-zone ice is devoid of tritium. Supercooled water flowing through subglacial conduits during the melt season likewise contains tritium, as does frazil and other platy ice that nucleates and grows within this subglacially flowing water. These initial results demonstrate net accretion of more than 1.4 m of stratified basal-zone ice since initiation of above-ground, thermonuclear bomb testing in 1952. Furthermore, these results support a theory of basal ice formation by ice accretion and debris entrainment from supercooled water within a distributed subglacial drainage system.
Simple theory supports field observations (Lawson and others, 1998 that subGlaciol water flow out of overdeepenings can cause accretion of layered, debris-bearing ice to the bases of glaciers. The large meltwater flux into a temperate glacier at the onset of summer melting can cause rapid water flow through expanded basal cavities or other flow paths. If that flow ascends a sufficiently steep slope out of an overdeepèning, the water will supercool as the pressure-melting point rises, and basal-ice accretion will occur. Diurnal, occasional or annual fluctuations in water discharge will cause variations in accretion rate, debris content of accreted ice or subsequent diagenesis, producing layers. Under appropriate conditions, net accretion of debris-bearing basal ice will allow debris fluxes that are significant in the glacier sediment budget.
Understanding the timing of mountain glacier and paleolake expansion and retraction in the Great Basin region of the western United States has important implications for regional-scale climate change during the last Pleistocene glaciation. The relative timing of mountain glacier maxima and the well-studied Lake Bonneville highstand has been unclear, however, owing to poor chronological limits on glacial deposits. Here, this problem is addressed by applying terrestrial cosmogenic 10Be exposure dating to a classic set of terminal moraines in Little Cottonwood and American Fork Canyons in the western Wasatch Mountains. The exposure ages indicate that the main phase of deglaciation began at 15.7 ± 1.3 ka in both canyons. This update to the glacial chronology of the western Wasatch Mountains can be reconciled with previous stratigraphic observations of glacial and paleolake deposits in this area, and indicates that the start of deglaciation occurred during or at the end of the Lake Bonneville hydrologic maximum. The glacial chronology reported here is consistent with the growing body of data suggesting that mountain glaciers in the western U.S. began retreating as many as 4 ka after the start of northern hemisphere deglaciation (at ca. 19 ka).
In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.
Debris-laden ice accretes to the base of Matanuska Glacier, Alaska, U.S.A., from water that supercools while flowing in a distributed drainage system tip the adverse slope of an overdeepening. Frazil ice grows in the water column and forms aggregates, while other ice grows on the glacier sole or on substrate materials. Sediment is trapped by this growing ice, forming stratified debris-laden basal ice. Growth rates of >0.l ma−1 of debris-rich basal ice are possible. The large sediment fluxes that this mechanism allows may have implications for interpretation of the widespread deposits from ice that flowed through other overdeepenings, including Heinrich events and the till sheets south of the Laurentian Great Lakes.
Objectives: Following pediatric moderate-to-severe traumatic brain injury (msTBI), few predictors have been identified that can reliably identify which individuals are at risk for long-term cognitive difficulties. This study sought to determine the relative contribution of detailed descriptors of injury severity as well as demographic and psychosocial factors to long-term cognitive outcomes after pediatric msTBI. Methods: Participants included 8- to 19-year-olds, 46 with msTBI and 53 uninjured healthy controls (HC). Assessments were conducted in the post-acute and chronic stages of recovery. Medical record review provided details regarding acute injury severity. Parents also completed a measure of premorbid functioning and behavioral problems. The outcome of interest was four neurocognitive measures sensitive to msTBI combined to create an index of cognitive performance. Results: Results indicated that none of the detailed descriptors of acute injury severity predicted cognitive performance. Only the occurrence of injury, parental education, and premorbid academic competence predicted post-acute cognitive functioning. Long-term cognitive outcomes were best predicted by post-acute cognitive functioning. Discussion: The findings suggest that premorbid factors influence cognitive outcomes nearly as much as the occurrence of a msTBI. Furthermore, of youth with msTBI who initially recover to a level of moderate disability or better, a brief cognitive battery administered within several months after injury can best predict which individuals will experience poor long-term cognitive outcomes and require additional services. (JINS, 2016, 22, 1–8)
We analyzed birth order differences in means and variances of height and body mass index (BMI) in monozygotic (MZ) and dizygotic (DZ) twins from infancy to old age. The data were derived from the international CODATwins database. The total number of height and BMI measures from 0.5 to 79.5 years of age was 397,466. As expected, first-born twins had greater birth weight than second-born twins. With respect to height, first-born twins were slightly taller than second-born twins in childhood. After adjusting the results for birth weight, the birth order differences decreased and were no longer statistically significant. First-born twins had greater BMI than the second-born twins over childhood and adolescence. After adjusting the results for birth weight, birth order was still associated with BMI until 12 years of age. No interaction effect between birth order and zygosity was found. Only limited evidence was found that birth order influenced variances of height or BMI. The results were similar among boys and girls and also in MZ and DZ twins. Overall, the differences in height and BMI between first- and second-born twins were modest even in early childhood, while adjustment for birth weight reduced the birth order differences but did not remove them for BMI.
A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m2 in childhood and adolescence and up to 0.2 kg/m2 in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.
For over 100 years, the genetics of human anthropometric traits has attracted scientific interest. In particular, height and body mass index (BMI, calculated as kg/m2) have been under intensive genetic research. However, it is still largely unknown whether and how heritability estimates vary between human populations. Opportunities to address this question have increased recently because of the establishment of many new twin cohorts and the increasing accumulation of data in established twin cohorts. We started a new research project to analyze systematically (1) the variation of heritability estimates of height, BMI and their trajectories over the life course between birth cohorts, ethnicities and countries, and (2) to study the effects of birth-related factors, education and smoking on these anthropometric traits and whether these effects vary between twin cohorts. We identified 67 twin projects, including both monozygotic (MZ) and dizygotic (DZ) twins, using various sources. We asked for individual level data on height and weight including repeated measurements, birth related traits, background variables, education and smoking. By the end of 2014, 48 projects participated. Together, we have 893,458 height and weight measures (52% females) from 434,723 twin individuals, including 201,192 complete twin pairs (40% monozygotic, 40% same-sex dizygotic and 20% opposite-sex dizygotic) representing 22 countries. This project demonstrates that large-scale international twin studies are feasible and can promote the use of existing data for novel research purposes.