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Externalizing disorders are known to be partly heritable, but the biological pathways linking genetic risk to the manifestation of these costly behaviors remain under investigation. This study sought to identify neural phenotypes associated with genomic vulnerability for externalizing disorders.
One-hundred fifty-five White, non-Hispanic veterans were genotyped using a genome-wide array and underwent resting-state functional magnetic resonance imaging. Genetic susceptibility was assessed using an independently developed polygenic score (PS) for externalizing, and functional neural networks were identified using graph theory based network analysis. Tasks of inhibitory control and psychiatric diagnosis (alcohol/substance use disorders) were used to measure externalizing phenotypes.
A polygenic externalizing disorder score (PS) predicted connectivity in a brain circuit (10 nodes, nine links) centered on left amygdala that included several cortical [bilateral inferior frontal gyrus (IFG) pars triangularis, left rostral anterior cingulate cortex (rACC)] and subcortical (bilateral amygdala, hippocampus, and striatum) regions. Directional analyses revealed that bilateral amygdala influenced left prefrontal cortex (IFG) in participants scoring higher on the externalizing PS, whereas the opposite direction of influence was observed for those scoring lower on the PS. Polygenic variation was also associated with higher Participation Coefficient for bilateral amygdala and left rACC, suggesting that genes related to externalizing modulated the extent to which these nodes functioned as communication hubs.
Findings suggest that externalizing polygenic risk is associated with disrupted connectivity in a neural network implicated in emotion regulation, impulse control, and reinforcement learning. Results provide evidence that this network represents a genetically associated neurobiological vulnerability for externalizing disorders.
Oesophageal perforation is a rarely reported complication of transoesophageal echocardiography in infants. This case involves a 3.1-kg neonate with Trisomy 21, atrioventricular septal defect, and hypoplastic aortic arch undergoing aortic arch advancement and pulmonary artery banding. A paediatric transoesophageal echocardiography probe was placed intraoperatively causing a contained false passage from the oesophagus below the cricopharyngeus muscle with extension into the left posterior mediastinum. The perforation healed within 2 weeks without permanent sequelae after conservative medical management.
Introduction
Marine protected areas (MPAs) are increasingly used as tools to conserve biodiversity, manage fishing effort, and facilitate recovery of degraded ecosystems (Roberts et al., 2001; Sale, 2002; Hastings and Botsford, 2003; Cinner et al., 2006). Marine protected areas are expected to produce long-lasting local increases in the density, size, diversity, and/or productivity of marine organisms within MPA boundaries (Russ and Alcala 1996; Claudet et al., 2006; Chapter 2), as well as regional increases outside of the MPA via spillover from the MPA to sites that continue to be fished (Chapter 3). Assessment of the actual effects of MPAs relative to these goals is essential for adaptive management and decision-making. Despite a large number of assessments, however, there remains considerable uncertainty about the actual effects of MPAs (e.g., Osenberg et al., 2006).
The central question (and challenge) that underlies the assessment of any MPA is easy to express but difficult to measure: “How does the state of the system (e.g., density or size of a target organism) within the MPA compare to the state that would have existed had the MPA never been established?” The former can be directly observed; however, the latter cannot and must therefore be estimated through indirect means (Stewart-Oaten et al., 1986; Osenberg and Schmitt, 1996; Stewart-Oaten, 1996a, 1996b; Stewart-Oaten and Bence, 2001; Osenberg et al., 2006). Several different approaches have been proposed to estimate this baseline (Box 6.1; see also Osenberg et al., 2006), yet, considerable controversy still exists (Box 6.2).
Two studies have been performed to evaluate the effect of activation tasks on neuroleptic-induced akathisia (NIA). In the first sample (30 patients) we found a consistent increase of symptoms during mental activation while motor activation led to a decrease. In a second study 34 patients with the same diagnosis were evaluated, using slightly different statistical procedures: while the effects of motor activation were corroborated, mental activation did not change NIA. Since mental and motor activation are usually considered to increase tardive dyskinesia and Parkinsonism, these measures might be helpful in differentiating NIA from other antipsychotic-induced movement disorders.
This study provides an evaluation of the effectiveness of methods to increase hand-washing (HW) by nurses working in an intensive care unit. After baseline observations, two interventions were implemented in sequence: three series of classes conducted by the infection control nurse (ICN); and feedback to staff about handwashing errors on the previous day. Staff were aware that handwashing was being observed throughout the study. The educational intervention produced an immediate increase in HW that was followed by a decline to baseline rates over four weeks. Feedback produced an improvement to 97% compliance that was sustained until completion of the study. Improvement in HW compliance following specified critical procedures was also observed following interventions.
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