Distinct developmental origins manifest in the specialized encoding of movement by adult neurons of the external globus pallidus

SummaryTranscriptional codes initiated during brain development are ultimately realized in adulthood as distinct cell types performing specialized roles in behavior. Focusing on the mouse external globus pallidus (GPe), we demonstrate that the potential contributions of two GABAergic GPe cell types to voluntary action are fated from early life to be distinct. Prototypic GPe neurons derive from the medial ganglionic eminence of the embryonic subpallium and express the transcription factor Nkx2-1. These neurons fire at high rates during alert rest, and encode movements through heterogeneous firing rate changes, with many neurons decreasing their activity. In contrast, arkypallidal GPe neurons originate from lateral/caudal ganglionic eminences, express the transcription factor FoxP2, fire at low rates during rest, and encode movements with robust increases in firing. We conclude that developmental diversity positions prototypic and arkypallidal neurons to fulfil distinct roles in behavior via their disparate regulation of GABA release onto different basal ganglia targets

Lumbar puncture in the management of adults with suspected bacterial meningitis--a survey of practice

OBJECTIVES: Assess the use of lumbar puncture (LP) in the management of suspected community acquired bacterial meningitis in adults.METHODS:A questionnaire was sent to secondary care clinicians (excluding junior house officers) in general internal and emergency medicine at three acute NHS healthcare trusts in the south west of England. The questionnaire recorded the experience of the clinician and asked questions related to case scenarios representing common presentations of bacterial meningitis or meningococcal disease.RESULTS:The response rate was 42% (108/260). Nearly all of the respondents (91%) reported regularly managing patients with suspected meningitis. Most respondents considered that (i) brain computerised tomography (CT) was necessary prior to undertaking LP (78%, 60/77), (ii) LP was a useful first line investigation in a patient with meningococcal shock.(80%, 84/105), (iii) LP could be performed safely in a man with a falling level of consciousness if the CT brain was normal (89/106, 84%). Early antibiotic administration was considered important, other management priorities such as oxygen therapy, volume resuscitation, and critical care involvement were not emphasised.CONCLUSIONS:Reported clinical practice in the investigation and management of meningitis in adults is not in line with current published guidance. Efforts to target interventions that promote consensus in practice are needed