Amygdala structural and functional abnormalities have been associated to reactive aggression in previous studies. However, the possible linkage of these two types of anomalies has not been examined. We hypothesized that they would coincide in the same localizations, would be correlated in intensity and would be mediated by reactive aggression personality traits. Here violent (n = 25) and non-violent (n = 29) men were recruited on the basis of their reactive aggression. Callous-unemotional (CU) traits were also assessed. Gray matter concentration (gmC) and reactivity to fearful and neutral facial expressions were measured in dorsal and ventral amygdala partitions. The difference between responses to fearful and neutral facial expressions was calculated (F/N-difference). Violent individuals exhibited a smaller F/N-difference and gmC in the left dorsal amygdala, where a significant coincidence was found in a conjunction analysis. Moreover, the left amygdala F/N-difference and gmC were correlated to each other, an effect mediated by reactive aggression but not by CU. The F/N-difference was caused by increased reactivity to neutral faces. This suggests that anatomical anomalies within local circuitry (and not only altered input) may underlie the amygdala hyper-reactivity to social signals which is characteristic of reactive aggression.

This study found different levels of agreement between partners across economic regions of the world when compared with existing global health competencies. By gaining insight into host partners' perceptions of desired competencies, global health education programs in LMICs can be more collaboratively and ethically designed to meet the priorities, needs, and expectations of those stakeholders. This study begins to shift the paradigm of global health education program design by encouraging North-South/East-West shared agenda setting, mutual respect, empowerment, and true collaboration.

BACKGROUND:Obstructive sleep apnea (OSA) is an important cause of morbidity in the elderly population. Limited data are available regarding the healthcare utilization and predisposing conditions related to OSA in the elderly. Our aim was to evaluate the healthcare utilization and the conditions associated with new and chronic diagnosis of OSA in a large cohort of elderly patients in the Veterans Health Administration (VHA).MATERIALS AND METHODS:This retrospective cohort study used inpatient and outpatient VHA data to identify the individuals diagnosed with OSA using ICD-9 codes during the fiscal years 2003-2005. Primary outcomes were emergency department (ED) visits and hospitalizations. Multivariable logistic regression analysis was performed to identify the demographic and clinical characteristics associated with new and chronic diagnosis of OSA.RESULTS:Of 1,867,876 elderly veterans having 2 years of care, 82,178 (4.4%) were diagnosed with OSA. Individuals with OSA were younger and more likely to have chronic diseases than those without OSA. Individuals with chronic OSA were more likely to have diagnoses of congestive heart failure (CHF), pulmonary circulation disorders, COPD, and obesity and less likely to have diagnoses of hypertension, osteoarthritis, and stroke than individuals with newly diagnosed OSA. The proportion of patients with new OSA diagnosis who required at least one ED visit was higher than the proportion of chronic OSA and no OSA patients (37%, 32%, and 15%, respectively; P-value <0.05). The proportion of new OSA patients who required at least one hospitalization was also higher than the proportion of chronic OSA and no OSA patients (24%, 17%, and 7%, respectively; P-value <0.05).CONCLUSION:Patients with OSA had a higher incidence of healthcare utilization compared to patients without OSA. New OSA patients had a higher rate of healthcare utilization in the year of diagnosis compared to chronic patients and patients without OSA. Early OSA recognition may reduce healthcare utilization in these patients.

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Background Thousands of students travel yearly from high-income countries (HICs) to low-income and middleincome countries (LMICs) for short-term experiences in global health, with much less travel by LMIC students to HICs. Little structured research has been done to seek host perspectives, particularly from LMICs, on what they would like to teach learners. By seeking LMIC host perspectives, we aimed to improve global health pedagogy, curriculum design, assessment, and experiential learning, better meeting host goals and expectations. Our additional aim was to improve mutual respect and trust, share power honestly and ethically, and facilitate more genuinely collaborative agenda setting between LMIC and HIC partners. MethodsWe previously did a hybrid quantitative and qualitative web-based survey from Sept 1, 2015, to Dec 31, 2015, exploring global health competencies with particular attention to LMIC hosts supervising and housing trainees in short-term experiences in global health. 274 host perspectives were gleaned from 38 countries speaking 22 languages. In this qualitative study, we analysed open-ended questions and responses not previously covered from the same survey data. 97 of 274 responses were selected for qualitative analysis, conducted via content analysis and coding, ensuring inter-rater reliability, and comparing HIC and LMIC responses. Findings Four core themes emerged in our content analysis regarding desired global health core competencies: most important global health core competencies; biggest mistakes students make; biggest challenges students face; and what students should remember most in experiential global health education.Interpretation Our qualitative study revealed intriguing comparative results addressing core controversies in global health, such as who "does global health" and where one must be to "do global health". Moving forward we hope this initial survey research will facilitate more genuinely collaborative agenda setting between North-South and East-West partners.