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Schizophrenia is associated with robust hippocampal volume deficits but subregion volume deficits, their associations with cognition, and contributing genes remain to be determined.
Hippocampal formation (HF) subregion volumes were obtained using FreeSurfer 6.0 from individuals with schizophrenia (n = 176, mean age ± s.d. = 39.0 ± 11.5, 132 males) and healthy volunteers (n = 173, mean age ± s.d. = 37.6 ± 11.3, 123 males) with similar mean age, gender, handedness, and race distributions. Relationships between the HF subregion volume with the largest between group difference, neuropsychological performance, and single-nucleotide polymorphisms were assessed.
This study found a significant group by region interaction on hippocampal subregion volumes. Compared to healthy volunteers, individuals with schizophrenia had significantly smaller dentate gyrus (DG) (Cohen's d = −0.57), Cornu Ammonis (CA) 4, molecular layer of the hippocampus, hippocampal tail, and CA 1 volumes, when statistically controlling for intracranial volume; DG (d = −0.43) and CA 4 volumes remained significantly smaller when statistically controlling for mean hippocampal volume. DG volume showed the largest between group difference and significant positive associations with visual memory and speed of processing in the overall sample. Genome-wide association analysis with DG volume as the quantitative phenotype identified rs56055643 (β = 10.8, p < 5 × 10−8, 95% CI 7.0–14.5) on chromosome 3 in high linkage disequilibrium with MOBP. Gene-based analyses identified associations between SLC25A38 and RPSA and DG volume.
This study suggests that DG dysfunction is fundamentally involved in schizophrenia pathophysiology, that it may contribute to cognitive abnormalities in schizophrenia, and that underlying biological mechanisms may involve contributions from MOBP, SLC25A38, and RPSA.
To compare the effects of empiric carbapenems versus cycling cefepime and piperacillin/tazobactam on the rates of vancomycin-resistant Enterococcus (VRE) colonization, bloodstream infections, and outcomes of patients admitted with acute leukemia.
Retrospective clinical study with VRE molecular strain typing and gastrointestinal microbiome comparison.
A regional referral center for acute leukemia.
342 consecutive patients admitted with newly diagnosed acute leukemia.
In September 2015, we changed our empiric antibiotic of choice for neutropenic fever from a carbapenem to the cycling regimen. We studied 214 consecutive patients during the carbapenem period and 128 during the cycling period. Surveillance for VRE stool colonization was conducted weekly. Representative stool samples were analyzed for VRE MLST types and changes in the composition and diversity of the fecal microbiota.
The change in empiric antibiotics was associated with a significant decrease in VRE colonization (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.27–0.66), a switch in the dominant VRE MLST types on the unit, and some modifications in the gastrointestinal microbiome. There were no differences in total gram-positive or gram-negative BSIs. During the carbapenem period, we observed higher absolute numbers of Candida spp and fewer ESBL BSIs, but these did not reach statistical significance. Patients during the carbapenem period had longer lengths of stay and durations of severe neutropenia and 10% higher hospital cost.
Carbapenem-sparing empiric antibiotic regimens may have advantages related to VRE ecology, gastrointestinal dysbiosis, duration of neutropenia, cost and length of stay.
Introduction. The problem discussed in this paper was formulated by T. Harris as follows:
“Consider a rail network connecting two cities by way of a number of intermediate cities, where each link of the network has a number assigned to it representing its capacity. Assuming a steady state condition, find a maximal flow from one given city to the other.”
The theory developed for the study of flows in networks (2; 3; 4; 5; 6; 7) sometimes provides a useful tool for dealing with certain kinds of combinatorial problems, as has been previously indicated in (3; 4; 6; 7). In particular, Hall-type theorems for the existence of systems of distinct representatives which contain a prescribed set of marginal elements (10; 11), or, more generally, whose intersection with each member of a given partition of the fundamental set has a cardinality between prescribed lower and upper bounds (9), can be obtained in this way (7).
The network-flow problem, originally posed by T. Harris of the Rand Corporation, has been discussed from various viewpoints in (1; 2; 7; 16). The problem arises naturally in the study of transportation networks; it may be stated in the following way. One is given a network of directed arcs and nodes with two distinguished nodes, called source and sink, respectively. All other nodes are called intermediate. Each directed arc in the network has associated with it a nonnegative integer, its flow capacity. Source arcs may be assumed to be directed away from the source, sink arcs into the sink. Subject to the conditions that the flow in an arc is in the direction of the arc and does not exceed its capacity, and that the total flow into any intermediate node is equal to the flow out of it, it is desired to find a maximal flow from source to sink in the network, i.e., a flow which maximizes the sum of the flows in source (or sink) arcs.
Thus, if we let P1 be the source, Pn the sink, we are required to find xij (i,j =1, . . . , w) which maximize
We aimed to explore multiple perspectives regarding barriers to and facilitators of advance care planning (ACP) among African Americans to identify similarities or differences that might have clinical implications.
Qualitative study with health disparities experts (n = 5), community members (n = 9), and seriously ill African American patients and caregivers (n = 11). Using template analysis, interviews were coded to identify intrapersonal, interpersonal, and systems-level themes in accordance with a social ecological framework.
Participants identified seven primary factors that influence ACP for African Americans: religion and spirituality; trust and mistrust; family relationships and experiences; patient-clinician relationships; prognostic communication, care preferences, and preparation and control. These influences echo those described in the existing literature; however, our data highlight consistent differences by group in the degree to which these factors positively or negatively affect ACP. Expert participants reinforced common themes from the literature, for example, that African Americans were not interested in prognostic information because of mistrust and religion. Seriously ill patients were more likely to express trust in their clinicians and to desire prognostic communication; they and community members expressed a desire to prepare for and control the end of life. Religious belief did not appear to negate these desires.
Significance of results
The literature on ACP in African Americans may not accurately reflect the experience of seriously ill African Americans. What are commonly understood as barriers to ACP may in fact not be. We propose reframing stereotypical barriers to ACP, such as religion and spirituality, or family, as cultural assets that should be engaged to enhance ACP. Although further research can inform best practices for engaging African American patients in ACP, findings suggest that respectful, rapport-building communication may facilitate ACP. Clinicians are encouraged to engage in early ACP using respectful and rapport building communication practices, including open-ended questions.
Current understanding of climate change impacts, adaptation and vulnerability among Inuit in the Arctic is relatively static, rooted in the community and time that case studies were conducted. This paper captures the dynamism of Inuit–climate relationships by applying a longitudinal approach to assessing vulnerability to climate change among Inuit in Ulukhaktok, Northwest Territories, Canada. Data were collected in 2005 and 2016 following a consistent methodology and analytical framework. Findings from the studies are analysed comparatively together with longitudinal datasets. The data reveal that many of the climatic changes recorded in 2005 that adversely affected hunting activities have been observed to be persisting or progressing, such as decreasing sea ice thickness and extent, and stronger and more consistent summer winds. Inuit are responding by altering travel routes and equipment, taking greater pre-trip precautions, and concentrating their efforts on more efficient and accessible hunts. Increasing living and subsistence costs and time-constraints, changes in the generation and transmission of environmental knowledge and land skills, and the concentration of country food sharing networks were identified as key constraints to adaptation. The findings indicate that the connections between subsistence activities and the wage economy are central to understanding how Inuit experience and respond to climate change.
Schizophrenia (SZ) is a severe neuropsychiatric disorder associated with disrupted connectivity within the thalamic-cortico-cerebellar network. Resting-state functional connectivity studies have reported thalamic hypoconnectivity with the cerebellum and prefrontal cortex as well as thalamic hyperconnectivity with sensory cortical regions in SZ patients compared with healthy comparison participants (HCs). However, fundamental questions remain regarding the clinical significance of these connectivity abnormalities.
Resting state seed-based functional connectivity was used to investigate thalamus to whole brain connectivity using multi-site data including 183 SZ patients and 178 matched HCs. Statistical significance was based on a voxel-level FWE-corrected height threshold of p < 0.001. The relationships between positive and negative symptoms of SZ and regions of the brain demonstrating group differences in thalamic connectivity were examined.
HC and SZ participants both demonstrated widespread positive connectivity between the thalamus and cortical regions. Compared with HCs, SZ patients had reduced thalamic connectivity with bilateral cerebellum and anterior cingulate cortex. In contrast, SZ patients had greater thalamic connectivity with multiple sensory-motor regions, including bilateral pre- and post-central gyrus, middle/inferior occipital gyrus, and middle/superior temporal gyrus. Thalamus to middle temporal gyrus connectivity was positively correlated with hallucinations and delusions, while thalamus to cerebellar connectivity was negatively correlated with delusions and bizarre behavior.
Thalamic hyperconnectivity with sensory regions and hypoconnectivity with cerebellar regions in combination with their relationship to clinical features of SZ suggest that thalamic dysconnectivity may be a core neurobiological feature of SZ that underpins positive symptoms.
Current commercial dairy practice involves the removal of the calf from the dam within the first two days of life. This early separation may result in stress for both cow and calf. However, it may also be that separation occurs before the cow-calf bond is established. The aim of this study was to determine if cows and calves respond to each other's calls after separation and whether they could distinguish their own calf's or dam's calls from another calf's or cow's calls.
We used a sequence of velocity-modulated photographs to find and measure the radial velocities of faint planetary nebulae in the center of M31. The photographs were made with a Velocity Modulating Camera (VMC) which consists of a temperature-tuned 2.1 Å (FWHM) (O III) λ 5007 interference filter, a cooled, two-stage image intensifier, and a calibrating photomultiplier. The camera was mounted at the Cassegrain focus of the Shane 3 m telescope at Lick Observatory. We identified 19 new planetary nebulae, bringing the total number of known planetaries within 250 pc of M31's nucleus to 45. From the plate series, we derived radial velocities and relative brightnesses from 32 of the nebulae and placed radial velocity limits on the remaining nebulae in the field. By applying the method of maximum likelihood to the observed radial velocity distribution, we derive a mean heliocentric velocity of −309 (±25) km s−1 and a velocity dispersion of 155 (±22) km s−1 for the planetary nebulae.
Phased Array Feed (PAF) technology is the next major advancement in radio astronomy in terms of combining high sensitivity and large field of view. The Focal L-band Array for the Green Bank Telescope (FLAG) is one of the most sensitive PAFs developed so far. It consists of 19 dual-polarization elements mounted on a prime focus dewar resulting in seven beams on the sky. Its unprecedented system temperature of ~17 K will lead to a 3 fold increase in pulsar survey speeds as compared to contemporary single pixel feeds. Early science observations were conducted in a recently concluded commissioning phase of the FLAG where we clearly demonstrated its science capabilities. We observed a selection of normal and millisecond pulsars and detected giant pulses from PSR B1937+21.
The global distribution of HI in the Magellanic System is shown in Figure 1. The gas covers some 1500 square degrees of sky and has a mass of 1.8 × 109 M⊙. There are four main components: the LMC, the SMC, the inter-Cloud region and the Magellanic Stream. The integrated HI of the first three components is mapped in Figure 2 with the Parkes 64-m radio telescope which has a resolution of 15 arc min. The previous surveys of McGee and Milton (1966), Hindman (1967), Mathewson et al. (1979) have been combined with a recent survey by Mathewson et al. (1983) of the outer regions of the System to give this large-scale picture of the gas distribution. The last two surveys were made with a velocity resolution of 4.12 km s−1 and a minimum detectable signal of 0.2 K. The long spurs extending from the LMC and SMC and the bridge joining the two galaxies with prominent spurs pointing to the Magellanic Stream are all compelling evidence for tidal interaction between the LMC and SMC (Mathewson 1976a, Murai and Fujimoto 1980). The detailed velocity field of the HI is given in Mathewson et al. (1983). Its large-scale features are shown in Figure 5 of Mathewson et al. (1979) which indicate that the radial velocities of the inter-Cloud region form a velocity continuum with those of the LMC and SMC. This plus the continuity of the general velocity gradient across the entire Magellanic System strongly suggest that the two galaxies are bound.
Optical identifications of 32 X-ray sources in the Magellanic Clouds confirm that they are SNRs. They are separated into four classes: the evolved, the oxygen-rich, the Balmer-dominated and the Crab-like. High velocity HI emission is observed from an extended region near 0525–66.0. It is suggested that this is produced by a possible Type III supernova which occurred out of the plane of the LMC and on the far side of the disk. The cumulative number-diameter relation for the LMC SNRs shows that they have evolved much faster than expected from the Sedov theory. It is suggested that this apparent “free-expansion” up to quite large diameters is due to the gradual conversion of the kinetic energy of the ejecta into thermal energy as they overtake the decelerating blast wave.
While a direct relation between hospital construction and concomitant infection rates has been clearly established, few data are available regarding the environmental decontamination effects of renovation in which surfaces are replaced and regarding subsequent infection incidence.
Retrospective clinical study with vancomycin-resistant Enterococcus (VRE) molecular strain typing and environmental cultures.
A regional referral center for acute leukemia and hematopoietic stem-cell transplantation.
Overall, 536 consecutive hospital admissions for newly diagnosed acute leukemia or a first autologous or allogeneic stem-cell transplantation were reviewed.
During 2009–2010, our unit underwent complete remodeling including replacement of all surfaces. We assessed the effects of this construction on the incidence of hospital-acquired VRE colonization before, during, and after the renovation.
We observed a sharp decrease in VRE colonization rates (hazard ratio, <0.23; 95% confidence interval, 0.18–0.44; P<.0001) during the first year after the renovation, with a return to near baseline rates thereafter. The known risk factors for VRE colonization appeared to be stable over the study interval. Environmental cultures outside of patient rooms revealed several contaminated areas that are commonly touched by unit personnel. Multilocus sequence typing of VRE isolates that were cryopreserved over the study interval showed that dominant strains prior to construction disappeared and were replaced by other strains after the renovation.
Unit reconstruction interrupted endemic transmission of VRE, which resumed with novel strains upon reopening. Contamination of environmental surfaces and shared equipment may play an important role in endemic transmission of VRE.
Although repeatedly associated with white matter microstructural alterations, bipolar disorder (BD) has been relatively unexplored using complex network analysis. This method combines structural and diffusion magnetic resonance imaging (MRI) to model the brain as a network and evaluate its topological properties. A group of highly interconnected high-density structures, termed the ‘rich-club’, represents an important network for integration of brain functioning. This study aimed to assess structural and rich-club connectivity properties in BD through graph theory analyses.
We obtained structural and diffusion MRI scans from 42 euthymic patients with BD type I and 43 age- and gender-matched healthy volunteers. Weighted fractional anisotropy connections mapped between cortical and subcortical structures defined the neuroanatomical networks. Next, we examined between-group differences in features of graph properties and sub-networks.
Patients exhibited significantly reduced clustering coefficient and global efficiency, compared with controls globally and regionally in frontal and occipital regions. Additionally, patients displayed weaker sub-network connectivity in distributed regions. Rich-club analysis revealed subtly reduced density in patients, which did not withstand multiple comparison correction. However, hub identification in most participants indicated differentially affected rich-club membership in the BD group, with two hubs absent when compared with controls, namely the superior frontal gyrus and thalamus.
This graph theory analysis presents a thorough investigation of topological features of connectivity in euthymic BD. Abnormalities of global and local measures and network components provide further neuroanatomically specific evidence for distributed dysconnectivity as a trait feature of BD.
The identification of the factors that influence the persistence of psychiatric disorder may assist practitioners to focus on young people who are particularly prone to poor outcomes, but population-based samples of sufficient size are rare.
This secondary analysis combined data from two large, population-based cross-sectional surveys in Great Britain (1999 and 2004) and their respective follow-ups (2002 and 2007), to study homotypic persistence among the 998 school-age children with psychiatric disorder at baseline. Psychiatric disorder was measured using the Development and Well-Being Assessment applying DSM-IV criteria. Factors relating to the child, family, and the severity and type of psychopathology at baseline were analysed using logistic regression.
Approximately 50% of children with at least one psychiatric disorder were assigned the same diagnostic grouping at 3-year follow-up. Persistent attention-deficit/hyperactivity disorder and anxiety were predicted by poor peer relationship scores. Persistent conduct disorder was predicted by intellectual disability, rented housing, large family size, poor family function and by severer baseline psychopathology scores.
Homotypic persistence was predicted by different factors for different groups of psychiatric disorders. Experimental research in clinical samples should explore whether these factors also influence response to interventions.