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Impulsive aggressive (IA, or impulsive aggression) behavior describes an aggregate set of maladaptive, aggressive behaviors occurring across multiple neuropsychiatric disorders. IA is reactive, eruptive, sudden, and unplanned; it provides information about the severity, but not the nature, of its associated primary disorder. IA in children and adolescents is of serious clinical concern for patients, families, and physicians, given the detrimental impact pediatric IA can have on development. Currently, the ability to properly identify, monitor, and treat IA behavior across clinical populations is hindered by two major roadblocks: (1) the lack of an assessment tool designed for and sensitive to the set of behaviors comprising IA, and (2) the absence of a treatment indicated for IA symptomatology. In this review, we discuss the clinical gaps in the approach to monitoring and treating IA behavior, and highlight emerging solutions that may improve clinical outcomes in patients with IA.
The dependence of confinement on input power for a tokamak plasma with regions having a stiff temperature profile is explored. The resilience of the confinement of the core energy to increasing power loss by core radiation from impurities in such situations, as it is anticipated will be required in a demonstration fusion reactor (DEMO) design, is examined.
The Square Kilometre Array (SKA) is a planned large radio interferometer designed to operate over a wide range of frequencies, and with an order of magnitude greater sensitivity and survey speed than any current radio telescope. The SKA will address many important topics in astronomy, ranging from planet formation to distant galaxies. However, in this work, we consider the perspective of the SKA as a facility for studying physics. We review four areas in which the SKA is expected to make major contributions to our understanding of fundamental physics: cosmic dawn and reionisation; gravity and gravitational radiation; cosmology and dark energy; and dark matter and astroparticle physics. These discussions demonstrate that the SKA will be a spectacular physics machine, which will provide many new breakthroughs and novel insights on matter, energy, and spacetime.
Shunt-related adverse events are frequent in infants after modified Blalock–Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock–Taussig.
In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock–Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose.
There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2–23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3–71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7–10), p=0.16] was not associated with decrease in these events.
High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock–Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock–Taussig.
Pressure ridges impact the mass, energy and momentum budgets of the sea-ice cover and present an obstacle to transportation through ice-infested waters. Quantifying ridge characteristics is important for understanding total sea-ice mass and for improving the representation of sea-ice dynamics in high-resolution models. Multi-sensor measurements collected during annual Operation IceBridge (OIB) airborne surveys of the Arctic provide new opportunities to assess the sea ice at the end of winter. We present a new methodology to derive ridge sail height from high-resolution OIB Digital Mapping System (DMS) visible imagery. We assess the efficacy of the methodology by mapping the full sail height distribution along 12 pressure ridges in the western and central Arctic. Comparisons against coincident Airborne Topographic Mapper (ATM) elevation anomalies are used to demonstrate the methodology and evaluate DMS-derived sail heights. Sail heights and elevation anomalies were correlated at 0.81 or above. On average mean and maximum sail height agreed with ATM elevation to within 0.11 and 0.49 m, respectively. Of the ridges mapped, mean sail height ranged from 0.99 to 2.16 m, while maximum sail height ranged from 2.1 to 4.8 m. DMS also delivered higher sampling along ridge crests than coincident ATM data.
Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research. The continued leveraging of technology, commitment to data transparency, focus on team-based practice, and recognition of cultural norms and preferences ensure the success of sustainable models of global collaboration.
Correlative microscopy approaches offer synergistic solutions to many research problems. One such combination, that has been studied in limited detail, is the use of atom probe tomography (APT) and transmission Kikuchi diffraction (TKD) on the same tip specimen. By combining these two powerful microscopy techniques, the microstructure of important engineering alloys can be studied in greater detail. For the first time, the accuracy of crystallographic measurements made using APT will be independently verified using TKD. Experimental data from two atom probe tips, one a nanocrystalline Al–0.5Ag alloy specimen collected on a straight flight-path atom probe and the other a high purity Mo specimen collected on a reflectron-fitted instrument, will be compared. We find that the average minimum misorientation angle, calculated from calibrated atom probe reconstructions with two different pole combinations, deviate 0.7° and 1.4°, respectively, from the TKD results. The type of atom probe and experimental conditions appear to have some impact on this accuracy and the reconstruction and measurement procedures are likely to contribute further to degradation in angular resolution. The challenges and implications of this correlative approach will also be discussed.
Hierarchical clustering represents the favoured paradigm for galaxy formation throughout the Universe; due to its proximity, the Magellanic system offers one of the few opportunities for astrophysicists to decompose the full six-dimensional phase-space history of a satellite in the midst of being cannibalised by its host galaxy. The availability of improved observational data for the Magellanic Stream and parallel advances in computational power has led us to revisit the canonical tidal model describing the disruption of the Small Magellanic Cloud and the consequent formation of the Stream. We suggest improvements to the tidal model in light of these recent advances.
The aim of this study was to retrospectively assess the value of whole genome sequencing (WGS) compared to conventional typing methods in the investigation and control of an outbreak of Shigella sonnei in the Orthodox Jewish (OJ) community in the UK. The genome sequence analysis showed that the strains implicated in the outbreak formed three phylogenetically distinct clusters. One cluster represented cases associated with recent exposure to a single strain, whereas the other two clusters represented related but distinct strains of S. sonnei circulating in the OJ community across the UK. The WGS data challenged the conclusions drawn during the initial outbreak investigation and allowed cases of dysentery to be implicated or ruled out of the outbreak that were previously misclassified. This study showed that the resolution achieved using WGS would have clearly defined the outbreak, thus facilitating the promotion of infection control measures within local schools and the dissemination of a stronger public health message to the community.
Studies examining the association of dairy consumption with incident CHD have yielded inconsistent results. The current prospective study examined the association between dairy consumption and CHD in a population-based sample of older community-dwelling adults.
Baseline CHD risk factors were assessed and an FFQ was self-administered. Participants were followed for morbidity and mortality with periodic clinic visits and annual mailed questionnaires for an average of 16·2 years, with a 96 % follow-up rate for fatal and non-fatal CHD.
Participants were 751 men and 1008 women aged 50–93 years who attended a clinic visit in 1984–1987.
At baseline the mean age was 70·6 (sd 9·8) years for men and 70·1 (sd 9·3) years for women. Participants who developed CHD during follow-up were significantly older (P < 0·001), had higher BMI (P = 0·035) and higher total cholesterol (P = 0·050), and were more likely to be male (P < 0·001), diabetic (P = 0·011) and hypertensive (P < 0·001), than those who did not develop CHD. Multivariate regression analyses adjusting for age, BMI, diabetes, hypertension, LDL-cholesterol and oestrogen use (in women) indicated that women who consumed low-fat cheese ‘sometimes/often’ and women who consumed non-fat milk ‘sometimes/often’ had an increased risk of incident CHD (hazard ratio = 2·32; 95 % CI 1·57, 3·41) and CHD (hazard ratio = 1·48; 95 % CI 1·02, 2·16) compared with women who ‘never/rarely’ ate these dairy products.
Woman with higher intake of low-fat cheese and non-fat milk seem to have a higher risk of incident CHD. This needs further investigation considering recent evidence of cardiovascular benefits from certain dairy fat.
The purpose of this study was to describe differences in activity participation between younger and older individuals with stroke to inform transition after stroke. This was a cross-sectional study with individuals six-months poststroke (n = 177). All individuals completed an outcomes assessment battery that included the Stroke Impact Scale, the Reintegration to Normal Living Index and the Activity Card Sort. The sample was divided into two groups: (1) Young — those under the age of 65 (n = 89); and (2) Old — those 65 or older (n = 88). Analysis was completed to examine differences between the groups on the primary outcome measures of the study and to look at differences between the groups on individual questions/items on the specific measures. The results of this study demonstrate: (1) significant differences in both the quantity and nature of activity participation prior to and after stroke between younger and older stroke survivors and (2) total scores and measures of central tendency do not necessarily provide therapists with the information they need to guide treatment. Rehabilitation professionals should focus on providing clients with the tools they will need to be successful in transitioning back to home and community environments once rehabilitation has ended.
It is easy to understand the plausibility of the case that the principal struggle unfolding in Thailand today pits democracy against authoritarianism. The events of the past five years seem to speak for themselves: the 2006 coup against the “pro-poor” Thaksin government, the manipulated pro-military constitutional referendum of 2007, the judicial dissolution of the Thai Rak Thai (2007) and its successor People's Power (2008) parties, and the subsequent military-supported installation of a Democrat-led coalition government in late 2008. Then of course comes the spilling of blood that feeds the democracy-authoritarianism narrative: the bloody crackdown in April–May 2010 against Red Shirt protestors and the imposition of a draconian state of emergency, human rights violations, and the suspension of due process for hundreds of political detainees.
The “democratic versus authoritarian” narrative, connected to the idea of a popular struggle against a rich establishment, has captured international attention. It is also at the heart of the self-presentation of the National United Front for Democracy against Dictatorship (UDD), so brilliantly exemplified by the etching of the word phrai (commoner, bondsman) onto red tee-shirts. There are elements of truth in this formulation. But the same general tension — democracy versus authoritarianism — could just as easily substitute for a short history of human society, with one problem: it explains everything generally, but nothing particularly. In recent times the formulation has led to skewed analysis of Thailand's crisis, and to a cheer-squad mentality that fails to capture intra-class/intra-state conflict and inter-class/inter-state-agency cooperation. It obscures the nature of Thailand's recent past and its likely future trajectory. Moving beyond such a simplistic analysis makes possible a more serious probing of the specific nature of the conflict and of the possibilities for its resolution. Early-twentieth-century Marxist Antonio Gramsci offers the best argument against simplistic representation: “A given socio-historical moment is never homogeneous; on the contrary, it is rich in contradictions.” To understand Thailand's rich contradictions, it is better to drop the catch-all explanation and to come to grips with the specificity of the crisis at hand.
Thailand's political landscape in 2010 was dominated by the ravine-like political division over the rules that define the acceptable exercise of power. Just as yellowshirted protestors of the People's Alliance for Democracy (PAD) had staged a fourmonth “civic uprising” in 2008 against what they claimed was an illegitimate proxy government of the self-exiled Thaksin Shinawatra, so in 2010 red-shirt protestors from the United Front for Democracy Against Dictatorship — Red All Over the Land (UDD) — rebelled against a government they claimed was a puppet of the bureau-aristocratic establishment, what they called the amaat. They occupied major intersections in Bangkok from mid-March to 19 May and called for the army to abandon the government. In 2010, a river of blood ran through the political division. Fatal clashes between red shirts and the Royal Thai Military left over ninety people dead and thousands injured. Previous episodes of mass protest and repression — such as those in 1973, 1976, and 1992 — have come to define new political eras. It remains uncertain as to whether the same may be said of the April-May killings, or if those events are part of a series, as yet unfinished, of increasingly unpredictable political struggle.
The clashes highlighted the deadly trajectory of a contradictory politics that has emerged since the 2006 coup d’état that deposed Thaksin Shinawatra from office. These politics are characterized by antagonistic and hybrid political forces that, in practice, undermine their declared democratic objectives. Since the early 2000s, Thailand's protracted battles over desirable regime form has seen incumbents use state apparatuses in instrumental fashion against political rivals, robbing Thailand of the stability of a loyal opposition that trusts ruling governments to govern within agreed boundaries. Each successive phase sees this approach intensifying as the stakes get higher, space for compromise narrows, positions become irreconcilable, and a combination of intrigue and street politics determines fates of governments and oppositions. For the moment though, predictions of civil war have been proven wrong.
This chapter traces the struggle as it unfolded during 2010. It also touches on humdrum issues of corruption, party politics, and the economy, relating the significance of these developments to the broader politics of regime battles. But first, some comments on the major actors that shaped politics in 2010.
Maternal obesity during pregnancy is often characterized by fetal macrosomia but it can also result in fetal growth restriction in a subset of pregnancies. We hypothesized that mechanisms of this growth restriction may include adverse effects of maternal high fat (HF) intake on placental growth and function. Female rats (100 days old) were time-mated and randomly assigned to either a control (Con) or HF diet ad libitum throughout gestation. At E21, dams were killed; litter size and fetal and placental weights were recorded and maternal and fetal samples collected for further analyses. The HF diet resulted in a 54% increase in maternal body weight gain during gestation. In contrast, male and female fetal weights were reduced in HF pregnancies (P < 0.05), as were the weights of the junctional zone of the placenta (P = 0.013), whereas labyrinth zone weights were unaffected. The HF diet increased maternal and fetal plasma leptin levels (P < 0.05), but maternal and fetal insulin and fetal glucose levels were unaffected. Labyrinthine expression of PPARγ and total VEGFa mRNA, both markers of placental vascular development, were unaffected by consumption of the HF diet in placentas of male and female fetuses. Furthermore, maternal HF nutrition did not alter phosphorylated protein levels of either mammalian target of rapamycin or its downstream signaling factor eIF4E binding protein 1 (4E-BP1). These data show that in the rat, maternal HF nutrition results in fetal and placental junctional zone growth restriction, maternal and fetal hyperleptinemia but did not alter gene expression of markers of placental vascular development.
We previously reported that a maternal high fat (HF) diet resulted in adult offspring with increased adiposity and hyperleptinemia. As leptin has an inhibitory effect on adrenal steroidogenesis and a stimulatory effect on epinephrine synthesis, we hypothesized that key adrenal steroidogenic and catecholaminergic enzymes would be altered in these offspring. Wistar rats were randomized into three groups at weaning: (1) control dams fed a standard control chow diet from weaning and throughout pregnancy and lactation (CON), (2) dams fed a HF diet from weaning and throughout pregnancy and lactation (MHF) and (3) dams fed standard control chow diet throughout life until conception, then fed a HF diet in pregnancy and lactation (PLHF). Dams were mated at day 100 (P100). After birth at P22 (weaning), male offspring were fed a standard control chow (con) or high fat (hf) diet. At P160, plasma samples and adrenal tissues were collected. Postweaning hf diet significantly elevated plasma corticosterone concentrations in PLHF-hf offspring compared to PLHF-con. MHF nutrition increased adrenal adrenocorticotrophic hormone receptor (ACTH-R) mRNA levels compared to CON-con. 3β-hydroxysteroid dehydrogenase (3βHSD) mRNA levels were decreased in MHF compared to PLHF offspring. Phenylethanolamine N-methyltransferase (PNMT) mRNA levels were increased in MHF-hf offspring compared to MHF-con. Plasma homocysteine (HCY) concentrations were significantly elevated in CON-hf and MHF-hf offspring compared to chow-fed offspring, associated with elevated intakes of methionine and reduced intakes of pyridoxine. Immunoreactive leptin receptor (ObRb) and PNMT were colocalized in medullary chromaffin cells. This study suggests that a postweaning HF diet in offspring induced changes in adrenal gene expression levels that are dependent upon the level of maternal nutrition.
A country in Southeast Asia: armed soldiers occupy Buddhist temple compounds protected by sandbags and barbed wire to protect themselves from insurgent attacks. The same security forces use sniffer dogs to search the homes and schools of local Muslims, well knowing that this is deeply offensive. Militants, some say inspired by perverted notions of the Islamic faith, behead victims, seemingly in emulation of so-called “jihadists” elsewhere. There appears to be some mercy though — the beheadings take place after death. Young men, suspected of insurgent activity are released from custody and “disappear”. The whispered talk of the town in the small tea-shops that populate the main strip is whether there will be “an attack tonight”. Welcome to the Malay-speaking “border provinces” of southern Thailand: Pattani, Narathiwat and Yala, where since 2004, over 3,000 people have died in a murky conflict between Malay-Muslim insurgents, criminal networks, and security apparatuses of the Thai state. It feels, in many ways, like another country.
For many outsiders, including myself, the deep south of Thailand has largely been a peripheral concern; studying Thailand has meant studying Buddhist and nationalist Thailand. For the most part, my own work has been motivated by an interest in how nationalism and ideology bind fissiparous social formations. Integrative and almost religious in their combined power, national identity and nationalism (the weapon and the bullet) continue to confound expectations of a post-national age. Thailand seemed to be a good example of this. This interest has led me to pursuing an overly narrow interest in the “success” of Thai nationalism and its various expressions. Events in the south of Thailand, where some form of struggle for national recognition is underway, has brought home just how misplaced such an assumption regarding Thai nation-building can be. More than that, it has introduced to much of the world, including keen observers of Thailand and Thais themselves, a largely misfitting part of that nation-state (as it is currently constituted): the Muslim majority provinces of the deep south.
On my first visit to Pattani in October 2005 I pursued an interest I was then developing in Thailand' Ministry of Culture. I visited its provincial office on the fourth floor of the Sala Jangwat, the large building that brings together in one provincial location most of the offices of the Thai state.