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Bleeding in the upper airway is an important cause of airway-related death, even in young and otherwise healthy individuals. The estimated lifetime incidence of epistaxis is approximately 60%; post-tonsillectomy haemorrhage occurs in 6–15% of tonsillectomy cases; and bleeding following surgery for malignancy in the upper airway is one of the leading causes of requirement of an emergency front of neck airway. Pre-oxygenation may be difficult or impossible. Cornerstone techniques commonly employed to secure the airway, such as direct/videolaryngoscopy and flexible optical laryngoscopy, may be ineffective due to soiling of the hypopharynx – and the equipment – with blood. Supraglottic airway devices may be employed but are typically of limited efficacy due to the increased risk of aspiration and their potential interference with surgical access to the bleeding site in the hypopharynx, glottis and trachea. The clinician may thus be forced to use other, less familiar techniques and modify their approach to airway management, particularly if bleeding is profuse and/or conventional intubation and airway rescue techniques are predicted to be difficult. Cardiovascular compromise from blood loss may further complicate airway management and anaesthesia. We identify techniques and strategies that may be employed in this situation.
Over 2,000 Radcliffe College students, administrators, and alumnae irregularly involved themselves in World War I (WWI) activism. While most matriculating and matriculated Radcliffe members collectively contributed to war work, their individual records illuminate peculiar paradoxes that challenge historical concepts of America's WWI culture. Radcliffe females generally assumed war tasks untethered to their professional experiences and political aspirations. Many undergraduates and graduates contended that they chose, circumscribed and concluded war-connected work at their discretion—not Radcliffe's and/or America's. Moreover, domestic efforts designed to awaken Americans' war patriotism and activity encountered a decidedly dormant and indulgent Cambridge college compound. Not until fall 1918—over a year into U.S. belligerency—did Radcliffe's campus completely mobilize for ‘selfless' war service. Radcliffe's WWI-related chronicles—including its members’ post-hostilities humanitarian activity—suggest that “coercive voluntarism” and “complete citizenship” were not ubiquitous forces in WWI America.
Previous studies using resting-state functional neuroimaging have revealed alterations in whole-brain images, connectome-wide functional connectivity and graph-based metrics in groups of patients with schizophrenia relative to groups of healthy controls. However, it is unclear which of these measures best captures the neural correlates of this disorder at the level of the individual patient.
Here we investigated the relative diagnostic value of these measures. A total of 295 patients with schizophrenia and 452 healthy controls were investigated using resting-state functional Magnetic Resonance Imaging at five research centres. Connectome-wide functional networks were constructed by thresholding correlation matrices of 90 brain regions, and their topological properties were analyzed using graph theory-based methods. Single-subject classification was performed using three machine learning (ML) approaches associated with varying degrees of complexity and abstraction, namely logistic regression, support vector machine and deep learning technology.
Connectome-wide functional connectivity allowed single-subject classification of patients and controls with higher accuracy (average: 81%) than both whole-brain images (average: 53%) and graph-based metrics (average: 69%). Classification based on connectome-wide functional connectivity was driven by a distributed bilateral network including the thalamus and temporal regions.
These results were replicated across the three employed ML approaches. Connectome-wide functional connectivity permits differentiation of patients with schizophrenia from healthy controls at single-subject level with greater accuracy; this pattern of results is consistent with the ‘dysconnectivity hypothesis’ of schizophrenia, which states that the neural basis of the disorder is best understood in terms of system-level functional connectivity alterations.
Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons (MIC). We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.
Cannabis and its main psychoactive ingredient δ-9-tetrahydrocannibidiol (THC) can induce transient psychotic symptoms in healthy individuals and exacerbate them in those with established psychosis. However, not everyone experience these effects, suggesting that certain individuals are particularly susceptible. The neural basis of this sensitivity to the psychotomimetic effects of THC is unclear.
We investigated whether individuals who are sensitive to the psychotomimetic effects of THC (TP) under experimental conditions would show differential hippocampal activation compared with those who are not (NP). We studied 36 healthy males under identical conditions under the influence of placebo or THC (10 mg) given orally, on two separate occasions, in a pseudo-randomized, double-blind, repeated measures, within-subject, cross-over design, using psychopathological assessments and functional MRI while they performed a verbal learning task. They were classified into those who experienced transient psychotic symptoms (TP; n = 14) following THC administration and those who did not (NP; n = 22).
Under placebo conditions, there was significantly greater engagement of the left hippocampus (p < 0.001) in the TP group compared with the NP group during verbal encoding, which survived leave-one-out analysis. The level of hippocampal activation was directly correlated (Spearman's ρ = 0.44, p = 0.008) with the severity of transient psychotic symptoms induced by THC. This difference was not present when we compared two subgroups from the same sample that were defined by sensitivity to anxiogenic effects of THC.
These results suggest that altered hippocampal activation during verbal encoding may serve as a marker of sensitivity to the acute psychotomimetic effects of THC.
Diffusion tensor magnetic resonance imaging studies in schizophrenia to
date have been largely inconsistent. This may reflect variation in
methodology, and the use of small samples with differing illness duration
and medication exposure.
To determine the extent and location of white matter microstructural
changes in schizophrenia, using optimised diffusion tensor imaging in a
large patient sample, and to consider the effects of illness duration and
Scans from 76 patients with schizophrenia and 76 matched controls were
used to compare fractional anisotropy, a measure of white matter
microstructural integrity, between the groups.
We found widespread clusters of reduced fractional anisotropy in
patients, affecting most major white matter tracts. These reductions did
not correlate with illness duration, and there was no difference between
age-matched chronically and briefly medicated patients.
The finding of widespread fractional anisotropy reductions in our larger
sample of patients with schizophrenia may explain some of the
inconsistent findings of previous, smaller studies.
People with prodromal symptoms have a very high risk of developing psychosis.
To use functional magnetic resonance imaging to examine the neurocognitive basis of this vulnerability.
Cross-sectional comparison of regional activation in individuals with an ‘at-risk mental state’ (at-risk group: n=17), patients with first-episode schizophreniform psychosis (psychosis group: n=10) and healthy volunteers (controls: n=15) during an overt verbal fluency task and an N-back working memory task.
A similar pattern of between-group differences in activation was evident across both tasks. Activation in the at-risk group was intermediate relative to that in controls and the psychosis group in the inferior frontal and anterior cingulate cortex during the verbal fluency task and in the inferior frontal, dorsolateral prefrontal and parietal cortex during the N-back task.
The at-risk mental state is associated with abnormalities of regional brain function that are qualitatively similar to, but less severe than, those in patients who have recently presented with psychosis.