Structural atrophy of the right superior frontal gyrus in adolescents with severe irritability.

Severe irritability is common in youths with psychiatric disorders and results in significant dysfunction across domains (academic, social, and familial). Prior structural MRI studies in the pediatric population demonstrated that aberrations of cortical thickness (CT) and gray matter volume (GMV) in the fronto-striatal-temporal regions which have been associated with irritability. However, the directions of the correlations between structural alteration and irritability in the individual indices were not consistent. Thus, we aim to address this by implementing comprehensive assessments of CT, GMV, and local gyrification index (LGI) simultaneously in youths with severe levels of irritability by voxel-based morphometry and surface-based morphometry. One hundred and eight adolescents (46 youths with severe irritability and 62 healthy youths, average age = 14.08 years, standard deviation = 2.36) were scanned with a T1-weighted MRI sequence. The severity of irritability was measured using the affective reactivity index. In youths with severe irritability, there was decreased CT, GMV, and LGI in the right superior frontal gyrus (SFG) compared to healthy youths, and negative correlations between these indices of the SFG and irritability. Our findings suggest that structural deficits in the SFG, potentially related to its role in inhibitory control, may be critical for the neurobiology of irritability.

Strategic Carbon Dioxide Infrastructure to Achieve a Low-Carbon Power Sector in the Midwestern and South-Central United States.

Large-scale carbon capture, utilization, and storage (CCUS) requires development of critical infrastructure to connect capture locations to geological storage sites. Here, we investigate what government policies would be required to make the development of CO2 pipelines and large-scale CCUS in the power sector economically viable. We focus on the transition from conventional coal to non-CO2-emitting natural gas-fired Allam-cycle power with CCUS and study a system in which 156 Allam-cycle power generators representing 100 GW of capacity send their captured CO2 emissions to three geological storage locations in the central United States through 7500 miles of new pipeline. Enabling policies for this system include low-interest government loans of approximately $20 billion for pipeline construction and an extended 20-year Section 45Q tax credit, or similar longer-term carbon price incentive. Additional policy support will be needed to enable initial construction of pipelines and early-mover power generators, such as cost-sharing, governments assuming future demand risk, or increased subsidies to early movers. The proposed system will provide reliable, dispatchable, flexible zero-emission power generation, complementing the intermittent generation by renewables in a decarbonized U.S. power sector. The proposed pipeline network could also connect into future regional infrastructure networks and facilitate large-scale carbon management.

Infrastructure to enable deployment of carbon capture, utilization, and storage in the United States.

In February 2018, the United States enacted significant financial incentives for carbon capture, utilization, and storage (CCUS) that will make capture from the lowest-capture-cost sources economically viable. The largest existing low-capture-cost opportunity is from ethanol fermentation at biorefineries in the Midwest. An impediment to deployment of carbon capture at ethanol biorefineries is that most are not close to enhanced oil recovery (EOR) fields or other suitable geological formations in which the carbon dioxide could be stored. Therefore, we analyze the viability of a pipeline network to transport carbon dioxide from Midwest ethanol biorefineries to the Permian Basin in Texas, which has the greatest current carbon dioxide demand for EOR and large potential for expansion. We estimate capture and transport costs and perform economic analysis for networks under three pipeline financing scenarios representing different combinations of commercial and government finance. Without government finance, we find that a network earning commercial rates of return would not be viable. With 50% government financing for pipelines, 19 million tons of carbon dioxide per year could be captured and transported profitably. Thirty million tons per year could be captured with full government pipeline financing, which would double global anthropogenic carbon capture and increase the United States' carbon dioxide EOR industry by 50%. Such a development would face challenges, including coordination between governments and industries, pressing timelines, and policy uncertainties, but is not unprecedented. This represents an opportunity to considerably increase CCUS in the near-term and develop long-term transport infrastructure facilitating future growth.

Difficulty and help with activities of daily living among older adults living alone with cognitive impairment.

INTRODUCTION: There is limited research on difficulties with activities of daily living (I/ADLs) among older adults living alone with cognitive impairment, including differences by race/ethnicity. METHODS: For U.S. Health and Retirement Study (2000-2014) participants aged 55+ living alone with cognitive impairment (4,666 individuals; 9,091 observations), we evaluated I/ADL difficulty and help. RESULTS: Among 4.3 million adults aged 55+ living alone with cognitive impairment, an estimated 46% reported an I/ADL difficulty; 72% reported not receiving help with an I/ADL. Women reported more difficulty than men. Compared to white women, black women were 22% more likely to report a difficulty without help, and Latina women were 36% more likely to report a difficulty with help. Among men, racial/ethnic differences in outcomes were not significant. Patterns of difficulty without help by race/ethnicity were similar among Medicaid beneficiaries. DISCUSSION: Findings call for targeted efforts to support older adults living alone with cognitive impairment.

Bubble in, bubble out: Lessons for the COVID-19 recovery and future crises from the Pacific.

This note presents three important facts on the COVID-19 pandemic and 22 developing countries, namely those in the Pacific. First, social protection systems are less common in the Pacific than in the rest of the world, meaning the region is not particularly well equipped to deal with the sharp decline in economic activity associated with the disease and standard policy responses (e.g., lockdowns) without plunging a large share of the population into poverty. Second, aggressive travel restrictions and effective domestic policy responses have spared many Pacific countries from the worst impacts of COVID-19. Ten countries have not had a single confirmed case. The experience of the region thus offers helpful lessons for other developing countries in keeping the crisis at bay. Third, the relative success of Australia and New Zealand in managing the virus provides an opportunity to pilot and test in the region what a carefully managed pathway to allow the tourism, migration, and remittances, that many countries depend on, to begin flowing again. Against its relative success, the Pacific has a unique opportunity to show the world how to safely emerge from the current crisis and address underlying vulnerabilities before the next one.

If My Blood Pressure Is High, Do I Take It to Heart? Behavioral Effects of Biomarker Collection in the Health and Retirement Study.

Starting in 2006, respondents in the biennial U.S. Health and Retirement Study were asked to submit biomarkers every other wave and were notified of several results. Rates of undiagnosed high blood pressure and diabetes according to these biomarkers were 1.5 % and 0.7 %, respectively. An intent-to-treat analysis suggests that collection and notification had small effects on the average respondent and may have reduced health care utilization. Among respondents who received notification of potentially dangerous biomarker levels, subsequent rates of new diagnosis and associated pharmaceutical usage increased by 20 to 40 percentage points, an order of magnitude above baseline. High blood glucose A1C was associated with a 2.2 % drop in weight and an increase in exercise among respondents without a previous diagnosis of diabetes. Notifications appear also to have altered health behaviors by spouses, suggesting household responses to health maintenance. Biomarker collection seems to have altered circumstances for an interesting minority of HRS respondents.

Can Switching from Coal to Shale Gas Bring Net Carbon Reductions to China?

To increase energy security and reduce emissions of air pollutants and CO2 from coal use, China is attempting to duplicate the rapid development of shale gas that has taken place in the United States. This work builds a framework to estimate the lifecycle greenhouse gas (GHG) emissions from China's shale gas system and compares them with GHG emissions from coal used in the power, residential, and industrial sectors. We find the mean lifecycle carbon footprint of shale gas is about 30-50% lower than that of coal in all sectors under both 20 year and 100 year global warming potentials (GWP20 and GWP100). However, primarily due to large uncertainties in methane leakage, the upper bound estimate of the lifecycle carbon footprint of shale gas in China could be approximately 15-60% higher than that of coal across sectors under GWP20. To ensure net GHG emission reductions when switching from coal to shale gas, we estimate the breakeven methane leakage rates to be approximately 6.0%, 7.7%, and 4.2% in the power, residential, and industrial sectors, respectively, under GWP20. We find shale gas in China has a good chance of delivering air quality and climate cobenefits, particularly when used in the residential sector, with proper methane leakage control.

Numerical Modeling of Gas and Water Flow in Shale Gas Formations with a Focus on the Fate of Hydraulic Fracturing Fluid.

Hydraulic fracturing in shale gas formations involves the injection of large volumes of aqueous fluid deep underground. Only a small proportion of the injected water volume is typically recovered, raising concerns that the remaining water may migrate upward and potentially contaminate groundwater aquifers. We implement a numerical model of two-phase water and gas flow in a shale gas formation to test the hypothesis that the remaining water is imbibed into the shale rock by capillary forces and retained there indefinitely. The model includes the essential physics of the system and uses the simplest justifiable geometrical structure. We apply the model to simulate wells from a specific well pad in the Horn River Basin, British Columbia, where there is sufficient available data to build and test the model. Our simulations match the water and gas production data from the wells remarkably closely and show that all the injected water can be accounted for within the shale system, with most imbibed into the shale rock matrix and retained there for the long term.

Commentary: U.S. mortality, geography, and the anti-social determinants of health.

Drug-related overdoses appear to be a major factor behind an historic pause or even a reversal in the predominant downward trend over time in U.S. mortality rates, a departure that is especially evident among non-Hispanic white females of middle age. The new geography of accidental poisoning deaths and their covariates suggests that we should reassess traditional policies and perspectives in order to combat this threat to public health.

A Model To Estimate Carbon Dioxide Injectivity and Storage Capacity for Geological Sequestration in Shale Gas Wells.

Recent studies suggest the possibility of CO2 sequestration in depleted shale gas formations, motivated by large storage capacity estimates in these formations. Questions remain regarding the dynamic response and practicality of injection of large amounts of CO2 into shale gas wells. A two-component (CO2 and CH4) model of gas flow in a shale gas formation including adsorption effects provides the basis to investigate the dynamics of CO2 injection. History-matching of gas production data allows for formation parameter estimation. Application to three shale gas-producing regions shows that CO2 can only be injected at low rates into individual wells and that individual well capacity is relatively small, despite significant capacity variation between shale plays. The estimated total capacity of an average Marcellus Shale well in Pennsylvania is 0.5 million metric tonnes (Mt) of CO2, compared with 0.15 Mt in an average Barnett Shale well. Applying the individual well estimates to the total number of existing and permitted planned wells (as of March, 2015) in each play yields a current estimated capacity of 7200-9600 Mt in the Marcellus Shale in Pennsylvania and 2100-3100 Mt in the Barnett Shale.

Agreement among orthodontists experienced with cone-beam computed tomography on the need for follow-up and the clinical impact of craniofacial findings from multiplanar and 3-dimensional reconstructed views.

INTRODUCTION: In this study, we aimed to assess interrater and intrarater agreement among orthodontic clinicians in their assessments of reported incidental findings in regard to both the need for additional follow-up and the impact on future orthodontic treatment in large-field maxillofacial cone-beam computed tomography (CBCT) imaging. METHODS: The study sample consisted of 18 nonrandomly selected large-field maxillofacial CBCT volumes containing a reported total of 88 radiographic findings. All scans were associated with formal radiologic reports. However, the suggestions of further follow-up were removed from the radiologic reports so as to not bias the 3 evaluating orthodontists in their subsequent decision making. The evaluators had on average 7.6 years of CBCT usage and self-interpretation experience. Reliability was determined by quantifying the level of agreement between the evaluators' assessments for both research questions for all 88 findings using a binary response (yes/no) as the outcome measure. The Cohen kappa statistic was calculated to quantify intrarater and interrater agreement globally for both statements. RESULTS: Although interrater agreement was considerable, potential decisions with clinical impact were not consistent. This needs to be considered when interpreting maxillofacial incidental findings. Evaluators demonstrated higher levels of agreement for dentoalveolar findings compared with all other extragnathic regions when assessing clinical significance. CONCLUSIONS: Among the evaluators who were considered experienced in CBCT, "fair-to-good" interrater agreement and "excellent" intrarater agreement were demonstrated in terms of the need for further follow-up and their potential impact on future orthodontic treatment.

Spinning the wheels and rolling the dice: life-cycle risks and benefits of bicycle commuting in the U.S.

OBJECTIVE: To assess the net impact on U.S. longevity of the decision to commute by bicycle rather than automobile. METHODS: We construct fatality rates per distance traveled using official statistics and denominators from the 2009 National Household Travel Survey. We model the life-table impact of switching from auto to bicycle commuting. Key factors are increased risks from road accidents and reduced risks from enhanced cardiovascular health. RESULTS: Bicycling fatality rates in the U.S. are an order of magnitude higher than in Western Europe. Risks punish both young and old, while the health benefits guard against causes of mortality that rise rapidly with age. Although the protective effects of bicycling appear significant, it may be optimal to wait until later ages to initiate regular bicycle commuting in the current U.S. risk environment, especially if individuals discount future life years. CONCLUSIONS: The lifetime health benefits of bicycle commuting appear to outweigh the risks in the U.S., but individuals who sufficiently discount or disbelieve the health benefits may delay or avoid bicycling. Bicycling in middle age avoids much fatality risk while capturing health benefits. Significant cross-state variations in bicycling mortality suggest that improvements in the built environment might spur changes in transit mode.

Acute urinary retention secondary to buprenorphine administration.

Urinary retention is associated with buprenorphine, particularly with epidural/intrathecal delivery. However, it is rare with oral administration. This case report illustrates an occurrence of acute urinary retention after initiation of oral buprenorphine/naloxone.

U.S. War Costs: Two Parts Temporary, One Part Permanent.

Military spending, fatalities, and the destruction of capital, all of which are immediately felt and are often large, are the most overt costs of war. They are also relatively short-lived. But the costs of war borne by combatants and their caretakers, which includes families, communities, and the modern welfare state, tend instead to be lifelong. In this paper I show that a significant component of the budgetary costs associated with U.S. wars is long-lived. One third to one half of the total present value of historical war costs are benefits distributed over the remaining life spans of veterans and their dependents. Even thirty years after the end of hostilities, typically half of all benefits remain to be paid. Estimates of the costs of injuries and deaths suggest that the private burden of war borne by survivors, namely the uncompensated costs of service-related injuries, are also large and long-lived.

Plant synthetic biology as a tool to help eliminate hidden hunger.

Agricultural systems are under increasing pressure from declining environmental conditions, a growing population, and changes in consumer preferences, resulting in widespread malnutrition-related illnesses. Improving plant nutritional content through biotechnology techniques such as synthetic biology is a promising strategy to help combat hidden hunger caused by the lack of affordable and healthy foods in human diets. Production of compounds usually found in animal-rich diets, such as vitamin D or omega-3 fatty acids, has been recently demonstrated in planta. Here, we review recent biotechnological approaches to biofortifying plants with vitamins, minerals, and other metabolites, and summarise synthetic biology advances that offer the opportunity to build on these early biofortification efforts.

Neural Responses to Intranasal Oxytocin in Youths With Severe Irritability.

OBJECTIVE: The authors investigated the neural impact of intranasal oxytocin on emotion processing areas in youths with severe irritability in the context of disruptive mood and behavior disorders. METHODS: Fifty-two participants with severe irritability, as measured by a score ≥4 on the Affective Reactivity Index (ARI), with diagnoses of disruptive behavior disorders (DBDs) and/or disruptive mood dysregulation disorder (DMDD) were randomly assigned to treatment with intranasal oxytocin or placebo daily for 3 weeks. Assessments were conducted at baseline and at the end of the trial; the primary outcomes were measures of irritability on the ARI and ratings on the Clinical Global Impressions severity scale (CGI-S) focusing on DBD and DMDD symptoms, and secondary outcomes included the CGI improvement scale (CGI-I) and ratings of proactive and reactive aggressive behavior on the Reactive-Proactive Aggression Questionnaire. Forty-three participants (22 in the oxytocin group and 21 in the placebo group) completed pre- and posttreatment functional MRI (fMRI) scans with the affective Stroop task. RESULTS: Youths who received oxytocin showed significant improvement in CGI-S and CGI-I ratings compared with those who received placebo. In the fMRI data, blood-oxygen-level-dependent (BOLD) responses to emotional stimuli in the dorsomedial prefrontal cortex and posterior cingulate cortex were significantly reduced after oxytocin compared with placebo. These BOLD response changes were correlated with improvement in clinical severity. CONCLUSIONS: This study provides initial and preliminary evidence that intranasal oxytocin may induce neural-level changes in emotion processing in youths with irritability in the context of DBDs and DMDD. This may lead to symptom and severity changes in irritability.

Nationwide Analysis of Risk Factors Related to Opioid Weaning Following Lumbar Decompression Surgery - A Retrospective Database Study.

BACKGROUND: Opioids are often prescribed for patients who eventually undergo lumbar decompression. Given the potential for opioid-related morbidity and mortality, postoperative weaning is often a goal of surgery. The purpose of this study was to examine the relationship between preoperative opioid use and postoperative complete opioid weaning among lumbar decompression patients. METHODS: We surveyed the IBM Marketscan Databases for patients who underwent lumbar decompression during 2008-2017, had >30 days of opioid use in the year preceding surgery, and consumed a daily average of >0 morphine milligram equivalents in the 3 months preceding surgery. We used multivariable logistic regression and marginal standardization to examine the association between preoperative opioid use duration, average daily dose, and their interactions with complete opioid weaning in the 10-12 months after surgery. RESULTS: Of the 11,114 patients who met inclusion criteria, most (54.7%, n = 6083) had a preoperative average daily dose of 1-20 morphine milligram equivalents. Postoperatively, 6144 patients (55.3%) remained on opioids. For patients with >180 days of preoperative use, the adjusted probability of weaning increased as the preoperative dose decreased. Obesity increased the likelihood of weaning, whereas older age, several comorbidities, female sex, and Medicaid decreased the odds of weaning. CONCLUSIONS: Patients who used opioids for longer preoperatively were less likely to completely wean following surgery. Among patients with >180 days of preoperative use, those with lower preoperative doses were more likely to wean. Weaning was also associated with several clinical and demographic factors. These findings may help shape expectations regarding opioid use following lumbar decompression.

Indices to assess malocclusions in patients with cleft lip and palate.

BACKGROUND: Several indices are now available to assess the severity of the malocclusion in cleft lip and/or palate (CLP) patients; and although it has been quite some time since the introduction of these indices, there is no consensus as to which index should be used for CLP populations. OBJECTIVE: To systematically review the available literature on the indices used to assess the occlusal schemes in dental models of CLP patients, with respect to the most commonly used index and the index that most fulfils the World Health Organization (WHO) criteria. SEARCH METHODS: Ten electronic databases, grey literature, and reference list searches were conducted. SELECTION CRITERIA: The inclusion criteria consisted of studies that aimed to assess a particular malocclusion index on study models of patients with CLP. DATA COLLECTION AND ANALYSIS: Full articles were retrieved from abstracts/titles that appeared to have met the inclusion -exclusion criteria which were subsequently reviewed using more detailed criteria for a final selection decision. The Quality Assessment of Diagnostic Accuracy Studies tool was used to appraise the methodological quality of the finally included studies. Due to the heterogeneity of the data, only a qualitative analysis was performed. RESULTS: A total of 13 studies met the inclusion -exclusion criteria. These studies revealed seven utilized indices, namely the GOSLON Yardstick, Five-Year-Old, Bauru-Bilateral Cleft Lip and Palate Yardstick, Huddart -Bodenham, Modified Huddart -Bodenham, EUROCRAN Yardstick, and GOAL Yardstick. The GOSLON Yardstick was the most commonly used index, and the Modified Huddart -Bodenham performed the best according to the WHO criteria. CONCLUSIONS: Current evidence suggests that the Modified Huddart -Bodenham Index equalled or outperformed the rest of the indices on all the WHO criteria and that the GOSLON Yardstick was the most commonly used index, possibly due to a longer time in use. Therefore, the Modified Huddart -Bodenham could be considered as the standard to measure outcomes of patients with CLP.

Mediating effect of amygdala activity on response to fear vs. happiness in youth with significant levels of irritability and disruptive mood and behavior disorders.

Introduction: Irritability, characterized by a tendency to exhibit increased anger, is a common clinical problem in youth. Irritability is a significant clinical issue in youth with various psychiatric diagnoses, especially disruptive behavior, and mood disorders (Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Disruptive Mood Dysregulation Disorder). Although there have been previous studies focusing on functional alteration in the amygdala related to irritability, there is no comprehensive model between emotional, neuronal, and behavioral characteristics. Methods: Using an functional magnetic resonance imaging (fMRI) procedure, we investigated the relationships between behavioral irritability, selective impairments in processing facial emotions and the amygdala neural response in youth with increased irritability. Fifty-nine youth with disruptive mood and behavior disorder completed a facial expression processing task with an event-related fMRI paradigm. The severity of irritability was evaluated using the Affective Reactivity Index. Results: In the result of behavioral data, irritability, and reaction time (RT) differences between interpreting negative (fear) and positive (happiness) facial expressions were positively correlated. In the fMRI result, youth showed higher activation in the right cingulate gyrus, bilateral cerebellum, right amygdala, right precuneus, right superior frontal gyrus, right middle occipital gyrus, and middle temporal gyrus, during the happiness condition vs. fear condition. No brain region exhibited greater activation in the fear than in the happiness conditions. In the result of the mediator analysis, increased irritability was associated with a longer RT toward positive vs. negative facial expressions. Irritability was also positively associated with the difference in amygdala blood oxygen level-dependent responses between the two emotional conditions (happiness > fear). This difference in amygdala activity mediated the interaction between irritability and the RT difference between negative and positive facial expressions. Discussion: We suggest that impairment in the implicit processing of facial emotional expressions with different valences causes distinct patterns of amygdala response, which correlate with the level of irritability. These results broaden our understanding of the biological mechanism of irritability at the neural level and provide information for the future direction of the study.