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The serotonin (5-HT) hypothesis of anorexia nervosa (AN) posits that individuals predisposed toward or recovered from AN (recAN) have a central nervous hyperserotonergic state and therefore restrict food intake as a means to reduce 5-HT availability (via diminished tryptophan-derived precursor supply) and alleviate associated negative mood states. Importantly, the 5-HT system has also been generally implicated in reward processing, which has also been shown to be altered in AN.
Methods
In this double-blind crossover study, 22 individuals recAN and 25 healthy control participants (HC) underwent functional magnetic resonance imaging (fMRI) while performing an established instrumental reward learning paradigm during acute tryptophan depletion (ATD; a dietary intervention that lowers central nervous 5-HT availability) as well as a sham depletion.
Results
On a behavioral level, the main effects of reward and ATD were evident, but no group differences were found. fMRI analyses revealed a group × ATD × reward level interaction in the ventral anterior insula during reward anticipation as well as in the medial orbitofrontal cortex during reward consumption.
Discussion
The precise pattern of results is suggestive of a ‘normalization’ of reward-related neural responses during ATD in recAN compared to HC. Our results lend further evidence to the 5-HT hypothesis of AN. Decreasing central nervous 5-HT synthesis and availability during ATD and possibly also by dieting may be a means to normalize 5-HT availability and associated brain processes.
In this article I suggest that, although many Jews perished during the wars between the Mamluks and the Franks during the thirteenth century's second half, and others migrated to different Jewish communities in the Middle East and Europe, some Jews migrated to Safed, Jerusalem, and perhaps to Gaza as well. A significant number of the Jews who lived in Safed and Jerusalem during the early decades of the fourteenth century were of a Western European origin but were not newcomers from Europe. I suggest that some of these were Jews who previously lived in Acre and Tyre and migrated to Safed and Jerusalem either shortly before the Latin Kingdom of Jerusalem got its coup de grâce, or afterwards.
Resting state functional magnetic resonance imaging studies have identified functional connectivity patterns associated with acute undernutrition in anorexia nervosa (AN), but few have investigated recovered patients. Thus, a trait connectivity profile characteristic of the disorder remains elusive. Using state-of-the-art graph–theoretic methods in acute AN, the authors previously found abnormal global brain network architecture, possibly driven by local network alterations. To disentangle trait from starvation effects, the present study examines network organization in recovered patients.
Methods
Graph–theoretic metrics were used to assess resting-state network properties in a large sample of female patients recovered from AN (recAN, n = 55) compared with pairwise age-matched healthy controls (HC, n = 55).
Results
Indicative of an altered global network structure, recAN showed increased assortativity and reduced global clustering as well as small-worldness compared with HC, while no group differences at an intermediate or local network level were evident. However, using support-vector classifier on local metrics, recAN and HC could be separated with an accuracy of 70.4%.
Conclusions
This pattern of results suggests that long-term recovered patients have an aberrant global brain network configuration, similar to acutely underweight patients. While the finding of increased assortativity may represent a trait marker of AN, the remaining findings could be seen as a scar following prolonged undernutrition.
Gray matter (GM) ‘pseudoatrophy’ is well-documented in patients with anorexia nervosa (AN), but changes in white matter (WM) are less well understood. Here we investigated the dynamics of microstructural WM brain changes in AN patients during short-term weight restoration in a combined longitudinal and cross-sectional study design.
Methods
Diffusion-weighted images were acquired in young AN patients before (acAN-Tp1, n = 56) and after (acAN-Tp2, n = 44) short-term weight restoration as well as in age-matched healthy controls (HC, n = 60). Images were processed using Tract-Based-Spatial-Statistics to compare fractional anisotropy (FA) across groups and timepoints.
Results
In the cross-sectional comparison, FA was significantly reduced in the callosal body in acAN-Tp1 compared with HC, while no differences were found between acAN-Tp2 and HC. In the longitudinal arm, FA increased with weight gain in acAN-Tp2 relative to acAN-Tp1 in large parts of the callosal body and the fornix, while it decreased in the right corticospinal tract.
Conclusions
Our findings reveal that dynamic, bidirectional changes in WM microstructure in young underweight patients with AN can be reversed with brief weight restoration therapy. These results parallel those previously observed in GM and suggest that alterations in WM in non-chronic AN are also state-dependent and rapidly reversible with successful intervention.
On the twenty-second of August, 1191, the Crusader army led by King Richard Lionheart left Acre. More than two weeks later and about 100 kilometers south of Acre, on the seventh of September, the Crusader and Muslim armies clashed in the Forest of Arsur.
I would like to suggest that the battle was practically inevitable because both sides had good reasons to seek a decisive encounter. The Lionheart could not conquer Jerusalem as long as Saladin's army was in the coastal plain, whereas Saladin wanted to minimize the damage Richard could do and to avoid the conquest of Jerusalem and the establishment of a viable Crusader state. Therefore, the main questions to be addressed hereafter are the “when” and “where”. Why did the battle take place more than two weeks after the Crusader army left Acre and not earlier? Why did it erupt in the Forest of Arsur and not elsewhere? Neither sources nor studies are conclusive on these issues. Therefore, it is crucial to scrutinize additional data: in this case both sides' schedules and the battlefield terrain itself are fairly well known and provide clues as to the choice of this specific battlefield. I will demonstrate that although the two armies marched on parallel roads for nearly 100 kilometers, and theoretically could have clashed anywhere along the way, potential battlefields were few, and after a certain point, it was clear that the battle would take place in the Forest of Arsur.
The latest collection of the most up-to-date research on matters of medieval military history contains a remarkable geographical range, extending from Spain and Britain to the southern steppe lands, by way of Scandinavia, Byzantium, and the Crusader States. At one end of the timescale is a study of population in the later Roman Empire and at the other the Hundred Years War, touching on every century in between. Topics include the hardware of war, the social origins of soldiers, considerations of individual battles, and words for weapons in Old Norse literature. Contributors: Bernard S. Bachrach, Gary Baker, Michael Ehrlich, Nicholas A. Gribit, Nicolaos S. Kanellopoulos,Mollie M. Madden, Kenneth J. McMullen, Craig M. Nakashian, Mamuka Tsurtsumia, Andrew L.J. Villalon.
The goal of an Emergency Medical Services (EMS) system is to prevent needless death or disability from time-sensitive disease processes. Despite growing evidence that these processes contribute significantly to mortality in low- and middle- income countries (LMICs), there has been little focus on the development of EMS systems in poor countries.
Problem
The objective of this study was to understand the utilization pattern of a newly-implemented EMS system in Ruhiira, Uganda.
Methods
An EMS system based on community priorities was implemented in rural Uganda in 2009. Six months of ambulance logs were reviewed. Patient, transfer, and clinical data were extracted and analyzed.
Results
In total, 207 cases were reviewed. Out of all transfers, 66% were for chief complaints that were obstetric related, while 12% were related to malaria. Out of all activations, 77.8% were for female patients. Among men, 34% and 28% were related to malaria and trauma, respectively. The majority of emergency transfers were from district to regional hospitals, including 52% of all obstetric transfers, 65% of malaria transfers, and 62% of all trauma transfers. There was no significant difference in the call to arrival on scene time, the time to scene or the scene to treatment time during the day and night (P > .05). Cost-benefit analysis revealed a cost of $89.95 per life saved with an estimated $0.93/capita to establish the system and $0.09/capita/year to maintain the system.
Conclusion
Contrary to current belief, EMS systems in rural Africa can be affordable and highly utilized, particularly for life-threatening, nontrauma complaints. Construction of a simple but effective EMS system is feasible, acceptable, and an essential component to the primary health care system of LMICs.
Stewart De RamirezS, DollJ, CarleS, AnestT, AriiM, HsiehYH, OkongoM, MoreskyR, SachsSE, MillinM. Emergency Response in Resource-poor Settings: A Review of a Newly-implemented EMS System in Rural Uganda. Prehosp Disaster Med. 2014;29(3):1-6.
Over the centuries, a great deal of poetry has been devoted to warfare and its practitioners. While the majority has tended to celebrate the heroism of men involved in conflict, a not insignificant part has condemned the carnage and futility, a condemnation that reached its height during the First World War in the works of such writers as Wilfred Owens, Siegfried Sassoon, and Robert Service.
During the Middle Ages, martial poetry followed both strains. Much of it emphasized the glory of combat, serving as the supreme tool for recalling honor and assigning shame earned on the battlefield. This was true of the most widely-recited works of the period, the great epics and chanson de geste, including Beowulf, the Song of Roland, the Tales of King Arthur, and the Poema del mio Cid, to name only the most prominent. All centered on human conflict and extolled the heroism of their protagonists. Poets, like the great troubadour, Bertran de Born (c. 1140–c. 1215), could look on war as a spectacle complete with “proud pavilions high … squadrons of armored chivalry … trumpets and tabors, ensigns and pennants.” To Born's mind, participants were expected to spill blood and engage in butchery in their pursuit of “death or victory.”
Byzantine military events in the early fourteenth century have captured the imagination of Western scholars for well over a century, thanks to the participation of Spanish mercenaries in the Catalan Company led by the flamboyant Roger de Flor. The important contribution to this military adventure made by another company of mercenaries composed entirely of Alans has been grossly underestimated when not totally ignored by both Western and Russian historians. Since the Alans were implicated in the disastrous defeat of the Byzantines in Anatolia as well as the first historical success of the Turkish leader Osman, eponymous founder of the Ottoman state, examining the specific role of these warriors may shed light on the military debacle that the Byzantines suffered at the hands of the Turks and Catalans in the first decade of the fourteenth century. Despite its importance, the military effectiveness of this company while contributing to the defense of the empire has never been examined in detail, so that the question remains: why did a Mongol-trained division of considerable military potential fail so spectacularly?
The appearance of the Alans in Byzantine service first attracted attention because scholars in Western Europe, especially Spain, have long been fascinated by the adventures of the Catalan Company, comparing its exploits in the East with those of Cortez and Pizarro in the Americas. Although composed of Aragonese, Calabrians, and Sicilians, it is usually referred to as the Catalan Company since most of the officers and men were from Catalonia.
The comprehensive breadth and scope of the Journal are to the fore in this issue, which ranges widely both geographically and chronologically. The subjects of analysis are equally diverse, with three contributions dealing with the Crusades, four with matters related to the Hundred Years War, two with high-medieval Italy, one with the Alans in the Byzantine-Catalan conflict of the early fourteenth century, and one with the wars of the Duke of Cephalonia in Western Greece and Albania at the turn of the fifteenth century. Topics include military careers, tactics and strategy, the organization of urban defenses, close analysis of chronicle sources, and cultural approaches to the acceptance of gunpowder artillery and the prevalence of military "games" in Italian cities. Contributors: T.S. Asbridge, A. Compton Reeves, Kelly DeVries, Michael Ehrlich, Scott Jessee, Donald Kagay, Savvas Kyriakidis, Randall Moffett, Aldo A. Settia, Charles D. Stanton, Georgios Theotokis, L.J. Andrew Villalon, Anatoly Isaenko.
[“I giochi militari e l'addestramento delle fanterie,” in Aldo A. Settia, Comuni in guerra. Armi ed eserciti nell'Italia delle città (Bologna, 1994), pp. 29–52]
Translated by Valerie Eads
The “Little Battles”
Italian communal armies were, as is well known, largely made up of infantry. Admittedly, the strength of these latter would have resulted more from numbers and determination than from combat experience; still, the term “infantry” properly means “a group of soldiers with a certain level of training and discipline,” two qualities that result only from some form of instruction. And yet, if we wish to develop at least a rough understanding of the military obligations of the mass of the population, of the armament the people had to provide for themselves, and of how it (the population) was mobilized to train for war – with the exception of some late provisions concerning marksmen – the sources as a rule are simply silent concerning training.
One can certainly maintain that economic reasons would have prevented regular exercises for the communal infantry in times of peace, but it is difficult to believe that all training would have taken place on the battlefield or in the course of the socio-political conflicts between milites and pedites. There is, however, a third possibility offered by certain war games – a sort of plebeian rival to the aristocratic tournaments – practiced specifically by those classes that furnished the infantry for the city militia.
In 1966, John R. Hale, following up an earlier essay, which had addressed in general the subject of warfare and public opinion during the fifteenth and sixteenth century, published an article focusing on the question of that same society's acceptance of early gunpowder weaponry. In this article, “Gunpowder and the Renaissance: An Essay in the History of Ideas,” Professor Hale concluded that although there were historical examples of societal acceptance of early guns, on the whole, the people of the fourteenth through the sixteenth centuries had rejected this new military technology. In a time of scholarly protest against the war in Vietnam and a growing concern over the arms race of the Cold War, Hale found some solace in the fact that substantial literary evidence showed that the period of his research also had a large number of intelligentsia who criticized their kingdoms' weapons policies. And while, as he concludes, “by the early seventeenth century, ideals had given ground to the arguments of fact,” yielding to an increased use of and, equally, a growing complacency towards, gunpowder weapons, that period of intellectual fervor known as the Renaissance had at least held out a disdain for the killing power of the new weapons.
Sir John Radcliffe of Attleborough, Norfolk, had an admirable career as a soldier and administrator in the service of the Lancastrian kings of England. His assignments took him into all the dominions of the crown: Ireland, Wales, Normandy, and Gascony. While Sir John's life is of considerable interest in its own right, his career both exemplifies as well as personalizes the English military experience of his lifetime.
Sir John came from a landed family with Lancashire roots. He was the second son of James Radcliffe (d. 1410) and his wife Joan, daughter of Sir John Tempest of Bracewell, Yorkshire. Nothing has come to light on the early years of Sir John, but his career suggests that he was given a firm grounding in military, financial, and administrative matters. The first sure record of John Radcliffe is in a military context helping his king consolidate his hold upon the throne. Many years after the event, in 1429, it was noted that while an esquire (probably in the service of his father, James), John had participated in the battle of Shrewsbury on 21 July 1403. In that battle the first king of the Lancastrian dynasty, Henry IV, defeated a rebel force led by Henry Percy, known as Hotspur, the son of Henry Percy, earl of Northumberland. Six days after the battle, James Radcliffe was one of the men commissioned to gather forces from Lancashire and bring them to the king at Pontefract in Yorkshire.
The purpose of this study is to examine the military schemes of defense that were employed in the town of Southampton during the late medieval period, 1300–1500. In many ways this is the most basic and vital of the varied roles Southampton had as a military entity. If the town was incapable of protecting its own possessions and dependencies, it would be unable to fulfill its other military roles. Moreover, if the town was unable to defend the area it was expected to, that would represent a major vulnerability in the region and ultimately the kingdom. If, on the other hand, the townsmen of Southampton were able to fulfill this responsibility of self-protection, that would not only maintain their day-to-day activities but would also give the kingdom an important defense.
The protection of Southampton was actually a multi-tiered system of various parties and individuals. The townspeople of Southampton managed their own defense in two primary methods. First they created various plans to organize themselves for conflict, second they participated in the gathering and control of information. The town also fitted into a wider defense structure in the kingdom with various groups and individuals supporting it in this endeavor. This organization was at one point the basis of English defense though many questions remain unanswered. How did these defensive schemes develop in Southampton? Were these schemes created in response to or in preparation for dangers posed to the town?