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Individuals at risk for bipolar disorder (BD) have a wide range of genetic and non-genetic risk factors, like a positive family history of BD or (sub)threshold affective symptoms. Yet, it is unclear whether these individuals at risk and those diagnosed with BD share similar gray matter brain alterations.
Methods:
In 410 male and female participants aged 17–35 years, we compared gray matter volume (3T MRI) between individuals at risk for BD (as assessed using the EPIbipolar scale; n = 208), patients with a DSM-IV-TR diagnosis of BD (n = 87), and healthy controls (n = 115) using voxel-based morphometry in SPM12/CAT12. We applied conjunction analyses to identify similarities in gray matter volume alterations in individuals at risk and BD patients, relative to healthy controls. We also performed exploratory whole-brain analyses to identify differences in gray matter volume among groups. ComBat was used to harmonize imaging data from seven sites.
Results:
Both individuals at risk and BD patients showed larger volumes in the right putamen than healthy controls. Furthermore, individuals at risk had smaller volumes in the right inferior occipital gyrus, and BD patients had larger volumes in the left precuneus, compared to healthy controls. These findings were independent of course of illness (number of lifetime manic and depressive episodes, number of hospitalizations), comorbid diagnoses (major depressive disorder, attention-deficit hyperactivity disorder, anxiety disorder, eating disorder), familial risk, current disease severity (global functioning, remission status), and current medication intake.
Conclusions:
Our findings indicate that alterations in the right putamen might constitute a vulnerability marker for BD.
The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest.
Methods
The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol.
Results
Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the “4 F” approach: fluid, form, function, filling.
Conclusion
An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.
This book presents a wide range of new research on many aspects of naval strategy in the early modern and modern periods. Among the themes covered are the problems of naval manpower, the nature of naval leadership and naval officers, intelligence, naval training and education, and strategic thinking and planning. The book is notable for giving extensive consideration to navies other than those ofBritain, its empire and the United States. It explores a number of fascinating subjects including how financial difficulties frustrated the attempts by Louis XIV's ministers to build a strong navy; how the absence of centralised power in the Dutch Republic had important consequences for Dutch naval power; how Hitler's relationship with his admirals severely affected German naval strategy during the Second World War; and many more besides. The book is a Festschrift in honour of John B. Hattendorf, for more than thirty years Ernest J. King Professor of Maritime History at the US Naval War College and an influential figure in naval affairs worldwide.
N.A.M. Rodger is Senior Research Fellow at All Souls College, Oxford.
J. Ross Dancy is Assistant Professor of Military History at Sam Houston State University.
Benjamin Darnell is a D.Phil. candidate at New College, Oxford.
Evan Wilson is Caird Senior Research Fellow at the National Maritime Museum, Greenwich.
Contributors: Tim Benbow, Peter John Brobst, Jaap R. Bruijn, Olivier Chaline, J. Ross Dancy, Benjamin Darnell, James Goldrick, Agustín Guimerá, Paul Kennedy, Keizo Kitagawa, Roger Knight, Andrew D. Lambert, George C. Peden, Carla Rahn Phillips, Werner Rahn, Paul M. Ramsey, Duncan Redford, N.A.M. Rodger, Jakob Seerup, Matthew S. Seligmann, Geoffrey Till, Evan Wilson
Edited by
Ian Convery, Professor of Conservation & Forestry, Centre for Wildlife Conservation, University of Cumbria.,Peter Davis, Emeritus Professor of Museology, University of Newcastle
The UK's Wildlife Trusts are unusual in the nature conservation world. A federation of forty-seven Trusts focused on the conservation of wildlife, they are not a centralised, top-down organisation but a movement that draws inspiration from the bottom up. They base their collective strength on diversity and wide local experience, bringing a refreshingly independent view to conservation thinking at a county, regional and national level. This chapter shows the part Wildlife Trusts have played in shaping our understanding and approach to wildlife and its conservation and seeks to situate the Wildlife Trusts better within the wider heritage of nature conservation in Britain (Stamp 1969; Sheail 1976; Adams 1986; Evans 1997; Sheail 1998; Simmons 2001; Marren 2002). It is written at a time of growing academic and public recognition of their past role, particularly since their centenary year in 2012, when a commissioned history was published (Sands 2012a).
The Lincolnshire Wildlife Trust, founded as the Lincolnshire Naturalists Trust in 1948 – and more particularly its Honorary Secretary, Edward (Ted) Smith (1920–2015) – was among the first to recognise the need for a new type of local organisation in response to increasingly obvious harmful developments threatening the countryside and wildlife after World War II. Other local Trusts did exist. The Norfolk Naturalists’ Trust (NNT, formed in 1926) (NNT 1976; Stoddart 2013), the West Wales Field Society (formed 1946) and the Yorkshire Trust (1947) were all actively managing nature reserves, but the Lincolnshire Trust sought to spread its net more widely. From the outset, it campaigned successfully to stop a caravan site being developed in the heart of the first Local Nature Reserve in all of England – Gibraltar Point on the Wash (Sheail 1977). Not only was the Lincolnshire Trust acquiring nature reserves and confronting threats from over-development and agriculture but it was also pioneering educational/visitor projects and collaborating closely with the local authority. The extent of its conservation work and outreach within its community were unique. Smith's view was that if this broader approach was good enough for Lincolnshire, it would fit other counties too (Smith 2007). Each should have an ‘independent organisation devoted primarily to conservation, incorporated to hold property, with some financial resources and, most importantly perhaps, deriving its support from a much wider section of community than the average natural history society’ (Society for the Promotion of Nature Reserves 1954).
Akathisia is a neurological side effect of antipsychotic medications, which are used to treat various psychiatric disorders. Akathisia is characterized by physical restlessness and a subjective urge to move. Although side effects such as akathisia, dystonia, and dyskinesia are common with the use of conventional antipsychotics, they occur in reduced frequency with the use of new-generation antipsychotics. Despite a lowered incidence profile, akathisia and similar conditions continue to affect patients. Neuroleptic-induced akathisia can present as fidgety movements while seated, rocking in place while standing, pacing, inability to sit or stand still for an extended period of time, and an overwhelming urge to move. These symptoms can cause severe distress and an increased risk of suicide for affected patients. First-line treatment of akathisia includes benzodiazepines or β-blockers for patients who do not have symptoms of Parkinson's disease and anticholinergic medications for patients with Parkinson's symptoms. Clinicians should ensure that an accurate diagnosis of akathisia is made and that target symptoms are decreasing due to treatment. At the same time, it must be ensured that the treatment used does not negatively affect the mental health of the patient. This expert roundtable supplement will address the diagnosis, pathophysiology, phenomenology, classification, and history of akathisiaas well as discuss screening tools and treatment options for the condition.
The community treatment order (CTO) is the legal framework by which people in the community are compelled to accept treatment. Both antipsychotic long-acting injections (LAIs) and CTOs are used to address treatment non-adherence.
Aims
To investigate the relationship between CTOs and LAI use in patients with schizophrenia.
Method
Prescribing, demographic and CTO data were collected for patients from four community mental health clinics in Melbourne, Australia, in 1998 and 2002.
Results
Against a background of increasing use of oral second-generation antipsychotic (SGA) medication and decreasing use of LAIs, the rates of CTO implementation doubled from 13% to 26% of patients with schizophrenia between 1998 and 2002. Proportionally more patients with a CTO are prescribed LAIs rather than oral SGAs.
Conclusions
The relationship between receiving an LAI and being subject to a CTO is significant, and reflects the consideration given to enhancing adherence in a community mental health setting.
