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Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with broad medical and psychiatric morbidity, and obesity. While BED may be characterized by altered cortical morphometry, no evidence to date examined possible sex-differences in regional gray matter characteristics among those with BED. This is especially important to consider in children, where BED symptoms often emerge coincident with rapid gray matter maturation.
Pre-adolescent, 9–10-year old boys (N = 38) and girls (N = 33) with BED were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development Study. We investigated sex differences in gray matter density (GMD) via voxel-based morphometry. Control sex differences were also assessed in age and body mass index and developmentally matched control children (boys N = 36; girls N = 38). Among children with BED, we additionally assessed the association between dorsolateral prefrontal (dlPFC) GMD and parent-reported behavioral approach and inhibition tendencies.
Girls with BED uniquely demonstrate diffuse clusters of greater GMD (p < 0.05, Threshold Free Cluster Enhancement corrected) in the (i) left dlPFC (p = 0.003), (ii) bilateral dmPFC (p = 0.004), (iii) bilateral primary motor and somatosensory cortex (p = 0.0003) and (iv) bilateral precuneus (p = 0.007). Brain-behavioral associations suggest a unique negative correlation between GMD in the left dlPFC and behavioral approach tendencies among girls with BED.
Early-onset BED may be characterized by regional sex differences in terms of its underlying gray matter morphometry.
Behavioral features of binge eating disorder (BED) suggest abnormalities in reward and inhibitory control. Studies of adult populations suggest functional abnormalities in reward and inhibitory control networks. Despite behavioral markers often developing in children, the neurobiology of pediatric BED remains unstudied.
58 pre-adolescent children (aged 9–10-years) with BED (mBMI = 25.05; s.d. = 5.40) and 66 age, BMI and developmentally matched control children (mBMI = 25.78; s.d. = 0.33) were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in resting-state functional MRI functional connectivity (FC) within and between reward and inhibitory control networks. A seed-based approach was employed to assess nodes in the reward [orbitofrontal cortex (OFC), nucleus accumbens, amygdala] and inhibitory control [dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)] networks via hypothesis-driven seed-to-seed analyses, and secondary seed-to-voxel analyses.
Findings revealed reduced FC between the dlPFC and amygdala, and between the ACC and OFC in pre-adolescent children with BED, relative to controls. These findings indicating aberrant connectivity between nodes of inhibitory control and reward networks were corroborated by the whole-brain FC analyses.
Early-onset BED may be characterized by diffuse abnormalities in the functional synergy between reward and cognitive control networks, without perturbations within reward and inhibitory control networks, respectively. The decreased capacity to regulate a reward-driven pursuit of hedonic foods, which is characteristic of BED, may in part, rest on this dysconnectivity between reward and inhibitory control networks.
Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients.
This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests.
A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use.
PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.
This chapter describes the syndromes of mild cognitive impairment (MCI) and Alzheimer's disease (AD). Many elderly persons exhibit MCI, characterized by memory complaints and mild abnormalities of performance on formal tests, associated with intact general cognition and preserved activities of daily living. The clinical manifestations of AD arise from abnormalities involving brain regions and neural circuits composed of populations of neurons that are essential for memory, learning, and cognitive performance. Early information about the involvement of neurotransmitter-specific circuits damaged by the disease led to the design of early therapies for AD. The genetics of AD are complex, often influencing phenotype in an age-dependent manner. Late onset cases of AD without clear familial association reflect the influences of a variety of risk factors. The chapter emphasizes the need for safe and effective mechanism-based therapies for AD. New treatments will probably require combinatorial approaches.
Transport by groundwater within the Culebra Dolomite, an aquifer above the Waste Isolation Pilot Plant (WIPP), is the most probable mechanism for long-term release of radionuclides to the accessible environment. Radionuclides could be retarded by sorption if the groundwater is exposed to sufficient amounts of fracture-lining clays. In this natural-analog study, distributions of U and trace metals have been examined to constrain the strength of clay/solute interactions within the Culebra.
Uranium solid/liquid distribution ratios, calculated from U concentrations of groundwaters and consanguineous fracture-filling clays, range from ∼80 to 800 mℓ/g and imply retardation factors of 60 to 500 using a fracture-flow model. Retardation factors inferred from uranium-series disequilibria and 14C ages in Culebran groundwaters alone are much lower (∼10), implying that clays may contain a significant unreactive component of U. Such a possibility is corroborated by Rb/Sr ages; these imply long-term stability of the clays, with resetting occurring more than 250 Ma ago. Factor analysis and mass-balance calculations suggest, however, that Mg-rich clays are dissolving in Pleistocene-age groundwaters and/or are converting to Na-rich smectites, and that B and Li are taken up from the water by the clays. Apparently, the solution chemistry reflects gradual equilibration of clays with groundwater, but thus far the bulk of the clays remain structurally intact. Measurements of the distribution of U in the Culebra will be more meaningful if the inert and exchangeable components of the U content of the clays can be quantified.
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