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Zimmerman ME, Hart LJ, Medrano P, Piccone C, Ramirez DM, Huggins LK, Sotres-Alvarez D, Fish LJ, Østbye T, Holliday KM. COVID-19 in the Community: Changes to Women's Mental Health, Financial Security, and Physical Activity. AJPM Focus 2023; 2:100095. [PMID: 37234692 PMCID: PMC10039779 DOI: 10.1016/j.focus.2023.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Introduction This study describes changes in the mental health, financial security, and physical activity levels of women in North Carolina during the COVID-19 pandemic. Methods Data were collected from women aged 20-40 years receiving primary care at 2 health centers in North Carolina during 2020-2022. Surveys (N=127) evaluated changes in mental health, financial security, and physical activity during the COVID-19 pandemic. These outcomes were analyzed both descriptively and for association with sociodemographic factors using logistic regression. A subset of participants (n=46) participated in semistructured interviews. Interview transcripts were reviewed and evaluated for recurring themes by primary and secondary coders using a rapid-coding technique. Analysis was conducted in 2022. Results Women surveyed were 28.4% non-Hispanic White, 38.6% non-Hispanic Black, and 33.1% Hispanic/Latina. Compared with reports before the pandemic, participants reported increased frustration or boredom (69.1%), loneliness (51.6%), anxiety (64.3%), depression (52.4%), and changed sleep patterns (68.3%). Increased alcohol and other recreational substance use were associated with race and ethnicity (p<0.05) after adjustment for other sociodemographic factors. Participants reported difficulty in paying for basic expenses (44.0%). Financial difficulties during COVID-19 were associated with non-Hispanic Black race and ethnicity, less education, and lower prepandemic household income. Data showed pandemic-associated reductions in mild (32.8%), moderate (39.5%), and strenuous (43.3%) exercise, with a correlation between increased depression and reduced mild exercise. Interviews identified themes including reduced activity while working remotely, lack of gym access, and reduced motivation for exercise. Conclusions This mixed-methods study is one of the first to evaluate the mental health, financial security, and physical activity challenges women aged between 20 and 40 years in the southern U.S. faced during the COVID-19 pandemic.
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Affiliation(s)
| | - Lauren J. Hart
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Perla Medrano
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Caitlin Piccone
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Diana M. Ramirez
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Lenique K.L. Huggins
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biology, Trinity College of Arts and Sciences, Duke University, Durham, North Carolina
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura J. Fish
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Truls Østbye
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Katelyn M. Holliday
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
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Zimmerman ME, Batlle JC, Biga C, Blankstein R, Ghoshhajra BB, Rabbat MG, Wesbey GE, Rubin GD. The direct costs of coronary CT angiography relative to contrast-enhanced thoracic CT: Time-driven activity-based costing. J Cardiovasc Comput Tomogr 2021; 15:477-483. [PMID: 34210627 DOI: 10.1016/j.jcct.2021.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) and contrast-enhanced thoracic CT (CECT) are distinctly different diagnostic procedures that involve intravenous contrast-enhanced CT of the chest. The technical component of these procedures is reimbursed at the same rate by the Centers for Medicare and Medicaid Services (CMS). This study tests the hypothesis that the direct costs of performing these exams are significantly different. METHODS Direct costs for both procedures were measured using a time-driven activity-based costing (TDABC) model. The exams were segmented into four phases: preparation, scanning, post-scan monitoring, and image processing. Room occupancy and direct labor times were collected for scans of 54 patients (28 CCTA and 26 CECT studies), in seven medical facilities within the USA and used to impute labor and equipment cost. Contrast material costs were measured directly. Cost differences between the exams were analyzed for significance and variability. RESULTS Mean CCTA duration was 3.2 times longer than CECT (121 and 37 min, respectively. p < 0.01). Mean CCTA direct costs were 3.4 times those of CECT ($189.52 and $55.28, respectively, p < 0.01). Both labor and capital equipment costs for CCTA were significantly more expensive (6.5 and 1.8-fold greater, respectively, p < 0.001). Segmented by procedural phase, CCTA was both longer and more expensive for each (p < 0.01). Mean direct costs for CCTA exceeded the standard CMS technical reimbursement of $182.25 without accounting for indirect or overhead costs. CONCLUSION The direct cost of performing CCTA is significantly higher than CECT, and thus reimbursement schedules that treat these procedures similarly undervalue the resources required to perform CCTA and possibly decrease access to the procedure.
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Affiliation(s)
- Michael E Zimmerman
- Department of Radiology, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Juan C Batlle
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Cathleen Biga
- Cardiovascular Management of Illinois, 900 S. Frontage Road, Suite 325, Woodridge, IL 60517, USA.
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian B Ghoshhajra
- Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, IL, USA
| | - George E Wesbey
- Scripps Clinic Medical Group, Divisions of Cardiovascular Diseases and Radiology, LaJolla, CA, USA
| | - Geoffrey D Rubin
- Department of Radiology, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Group 1670 E Drachman Street, PO Box 245067, Tucson, AZ 85724-5067, USA.
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Zimmerman ME, Meyer AR, Rowe SP, Gorin MA. Imaging of prostate cancer with positron emission tomography. Clin Adv Hematol Oncol 2019; 17:455-463. [PMID: 31449514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prostate cancer is most commonly imaged through a combination of magnetic resonance imaging, x-ray computed tomography, and 99mTc-methylene diphosphonate bone scan. These conventional imaging modalities, however, suffer from limited sensitivity and specificity for the detection of disease. This can lead to disease understaging and the improper selection of treatment. To address this problem, a variety of novel radiotracers for positron emission tomography (PET) imaging have been developed. This includes agents that accumulate on the basis of alterations in cellular metabolism (eg, 11C-choline and 18F-FACBC) as well as those that bind to specific proteins (eg, 68Ga-PSMA-11, 18F-DCFPyL, 68Ga-RM2, and 18F-DHT). In this review, we examine the performance characteristics of these new PET radiotracers for imaging prostate cancer and discuss ways in which PET imaging can offer more precise clinical information to patients and providers.
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Affiliation(s)
| | - Alexa R Meyer
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven P Rowe
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael A Gorin
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Zimmerman ME, Meyer AR, Carter HB, Allaf ME, Gorin MA. In-office Transperineal Prostate Biopsy Using Biplanar Ultrasound Guidance: A Step-by-Step Guide. Urology 2019; 133:247. [PMID: 31374287 DOI: 10.1016/j.urology.2019.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/27/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To provide a step-by-step guide for performing in-office transperineal prostate biopsy using biplanar ultrasound guidance. PATIENTS AND METHODS Biopsies are performed using a freehand technique with the PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD). This disposable needle guide includes 3 components: a rail/clamp subassembly, a needle carriage with 5 aperture holes, and a 15 gauge access needle. The device is clamped to a side-fire biplanar ultrasound probe, ensuring alignment of the biopsy needle with the probe's ultrasound arrays. Once the patient is sufficiently anesthetized using 1% lidocaine, the access needle is engaged into the perineal skin. This allows for multiple passes of the biopsy needle through a common puncture site. A separate puncture is made for each side of the prostate and the aperture hole is chosen based on the overall height of the prostate. Biopsies are taken using a disposable 18 gauge biopsy gun. RESULTS The presented video details our approach for performing transperineal prostate biopsy under local anesthesia. Biopsies are performed in the office setting without the need for periprocedural antibiotics. The PrecisionPoint Transperineal Access System ensures proper alignment of the biopsy needle with the ultrasound probe, while minimizing the number of individual needle sticks to the perineal skin. The use of biplanar ultrasound makes it possible to guide the biopsy needle with excellent precision to virtually any area of the prostate. The descried technique can be used for systematic biopsies as well as for targeted biopsies using cognitive fusion with magnetic resonance imaging. CONCLUSION We provide a step-by-step guide for performing in-office transperineal prostate biopsy. The presented technique minimizes the risk of infectious complications by eliminating the need for biopsy needles to pass through the rectal mucosa. Biopsies are performed without the need for periprocedural antibiotics, thus furthering the goals of antibiotic stewardship.
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Affiliation(s)
- Michael E Zimmerman
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexa R Meyer
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - H Ballentine Carter
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
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Strauss SB, Kim N, Branch CA, Kahn ME, Kim M, Lipton RB, Provataris JM, Scholl HF, Zimmerman ME, Lipton ML. Bidirectional Changes in Anisotropy Are Associated with Outcomes in Mild Traumatic Brain Injury. AJNR Am J Neuroradiol 2016; 37:1983-1991. [PMID: 27282864 DOI: 10.3174/ajnr.a4851] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 04/25/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Mild traumatic brain injury results in a heterogeneous constellation of deficits and symptoms that persist in a subset of patients. This prospective longitudinal study identifies early diffusion tensor imaging biomarkers of mild traumatic brain injury that significantly relate to outcomes at 1 year following injury. MATERIALS AND METHODS DTI was performed on 39 subjects with mild traumatic brain injury within 16 days of injury and 40 controls; 26 subjects with mild traumatic brain injury returned for follow-up at 1 year. We identified subject-specific regions of abnormally high and low fractional anisotropy and calculated mean fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity across all white matter voxels brain-wide and each of several white matter regions. Assessment of cognitive performance and symptom burden was performed at 1 year. RESULTS Significant associations of brain-wide DTI measures and outcomes included the following: mean radial diffusivity and mean diffusivity with memory; and mean fractional anisotropy, radial diffusivity, and mean diffusivity with health-related quality of life. Significant differences in outcomes were found between subjects with and without abnormally high fractional anisotropy for the following white matter regions and outcome measures: left frontal lobe and left temporal lobe with attention at 1 year, left and right cerebelli with somatic postconcussion symptoms at 1 year, and right thalamus with emotional postconcussion symptoms at 1 year. CONCLUSIONS Individualized assessment of DTI abnormalities significantly relates to long-term outcomes in mild traumatic brain injury. Abnormally high fractional anisotropy is significantly associated with better outcomes and might represent an imaging correlate of postinjury compensatory processes.
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Affiliation(s)
- S B Strauss
- From the Department of Radiology (S.B.S., M.L.L.), Montefiore Medical Center, Bronx, New York
| | - N Kim
- Departments of Radiology (N.K., M.L.L.)
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
| | - C A Branch
- Physiology and Biophysics (C.A.B.)
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
| | - M E Kahn
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
| | - M Kim
- Epidemiology and Population Health (M.K., R.B.L.)
| | - R B Lipton
- Epidemiology and Population Health (M.K., R.B.L.)
- The Saul R. Korey Department of Neurology (R.B.L., M.E.Z.)
| | - J M Provataris
- Department of Emergency Medicine (J.M.P.), Jacobi Medical Center, Bronx, New York
| | - H F Scholl
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
| | - M E Zimmerman
- The Saul R. Korey Department of Neurology (R.B.L., M.E.Z.)
| | - M L Lipton
- From the Department of Radiology (S.B.S., M.L.L.), Montefiore Medical Center, Bronx, New York
- Departments of Radiology (N.K., M.L.L.)
- Psychiatry and Behavioral Sciences (M.L.L.)
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
- The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine, Bronx, New York
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Hulkower MB, Poliak DB, Rosenbaum SB, Zimmerman ME, Lipton ML. A decade of DTI in traumatic brain injury: 10 years and 100 articles later. AJNR Am J Neuroradiol 2013; 34:2064-74. [PMID: 23306011 DOI: 10.3174/ajnr.a3395] [Citation(s) in RCA: 303] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY The past decade has seen an increase in the number of articles reporting the use of DTI to detect brain abnormalities in patients with traumatic brain injury. DTI is well-suited to the interrogation of white matter microstructure, the most important location of pathology in TBI. Additionally, studies in animal models have demonstrated the correlation of DTI findings and TBI pathology. One hundred articles met the inclusion criteria for this quantitative literature review. Despite significant variability in sample characteristics, technical aspects of imaging, and analysis approaches, the consensus is that DTI effectively differentiates patients with TBI and controls, regardless of the severity and timeframe following injury. Furthermore, many have established a relationship between DTI measures and TBI outcomes. However, the heterogeneity of specific outcome measures used limits interpretation of the literature. Similarly, few longitudinal studies have been performed, limiting inferences regarding the long-term predictive utility of DTI. Larger longitudinal studies, using standardized imaging, analysis approaches, and outcome measures will help realize the promise of DTI as a prognostic tool in the care of patients with TBI.
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Zimmerman ME, Pan JW, Hetherington HP, Lipton ML, Baigi K, Lipton RB. Hippocampal correlates of pain in healthy elderly adults: a pilot study. Neurology 2009; 73:1567-70. [PMID: 19901248 DOI: 10.1212/wnl.0b013e3181c0d454] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Few neuroimaging investigations of pain in elderly adults have focused on the hippocampus, a brain structure involved in nociceptive processing that is also subject to involution associated with dementing disorders. The goal of this pilot study was to examine MRI- and magnetic resonance spectroscopy (MRS)-derived hippocampal correlates of pain in older adults. METHODS A subset of 20 nondemented older adults was drawn from the Einstein Aging Study, a community-based sample from the Bronx, NY. Pain was measured on 3 time scales: 1) acute pain right now (pain severity); 2) pain over the past 4 weeks (Short Form-36 Bodily Pain); 3) chronic pain over the past 3 months (Total Pain Index). Hippocampal data included volume data normalized to midsagittal area and N-acetylaspartate to creatine ratios (NAA/Cr). RESULTS Smaller hippocampal volume was associated with higher ratings on the Short Form-36 Bodily Pain (r(s) = 0.52, p = 0.02) and a nonsignificant trend was noted for higher ratings of acute pain severity (r(s) = -0.44, p = 0.06). Lower levels of hippocampal NAA/Cr were associated with higher acute pain severity (r(s) = -0.45, p = 0.05). Individuals with chronic pain had a nonsignificant trend for smaller hippocampal volumes (t = 2.00, p = 0.06) and lower levels of hippocampal NAA/Cr (t = 1.71, p = 0.10). CONCLUSIONS Older adults who report more severe acute or chronic pain have smaller hippocampal volumes and lower levels of hippocampal N-acetylaspartate/creatine, a marker of neuronal integrity. Future studies should consider the role of the hippocampus and other brain structures in the development and experience of pain in healthy elderly and individuals with Alzheimer disease.
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Affiliation(s)
- M E Zimmerman
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Zimmerman ME, Pan JW, Hetherington HP, Katz MJ, Verghese J, Buschke H, Derby CA, Lipton RB. Hippocampal neurochemistry, neuromorphometry, and verbal memory in nondemented older adults. Neurology 2008; 70:1594-600. [PMID: 18367703 DOI: 10.1212/01.wnl.0000306314.77311.be] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Characterization of the behavioral correlates of neuromorphometry and neurochemistry in older adults has important implications for an improved understanding of the aging process. The objective of this study was to test the hypothesis that a measure of hippocampal neuronal metabolism was associated with verbal memory in nondemented older adults after controlling for hippocampal volume. METHODS 4-T MRI, proton magnetic resonance spectroscopy ((1)H MRS), and neuropsychological assessment were conducted in 48 older adults (23 women; mean age 81 years). Average hippocampal N-acetyl aspartate/creatine ratios (NAA/Cr) and hippocampal volumes were obtained. Neuropsychological evaluation included tests of verbal memory (Buschke and Grober Free and Cued Selective Reminding Test-Immediate Recall [FCSRT-IR], Wechsler Memory Scale-Revised Logical Memory subtest) and attention and executive function (Trail Making Test Parts A and B). RESULTS Linear regression analysis indicated that after adjusting for age, hippocampal NAA/Cr was a significant predictor of FCSRT-IR performance (beta = 0.38, p = 0.01, R (2) = 0.21). Hippocampal volume was also a significant predictor of FCSRT-IR performance after adjusting for age and midsagittal area (beta = 0.47, p = 0.01, R (2) = 0.24). In a combined model, hippocampal NAA/Cr (beta = 0.33, p = 0.03) and volume (beta = 0.35, p = 0.03) were independent predictors of FCSRT-IR performance, accounting for 30% of the variance in memory. CONCLUSIONS These findings indicate that nondemented older adults with smaller hippocampal volumes and lower levels of hippocampal N-acetyl aspartate/creatine ratio metabolites perform more poorly on a test of verbal memory. The integrity of both the structure and metabolism of the hippocampus may underlie verbal memory function in nondemented elderly.
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Affiliation(s)
- M E Zimmerman
- Albert Einstein College of Medicine, Saul R. Korey Department of Neurology, 1165 Morris Park Ave., Room 343, Bronx, NY 10461, USA.
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Holtzman BK, Kohlstedt DL, Zimmerman ME, Heidelbach F, Hiraga T, Hustoft J. Melt segregation and strain partitioning: implications for seismic anisotropy and mantle flow. Science 2003; 301:1227-30. [PMID: 12947196 DOI: 10.1126/science.1087132] [Citation(s) in RCA: 410] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
One of the principal means of understanding upper mantle dynamics involves inferring mantle flow directions from seismic anisotropy under the assumption that the seismic fast direction (olivine a axis) parallels the regional flow direction. We demonstrate that (i) the presence of melt weakens the alignment of a axes and (ii) when melt segregates and forms networks of weak shear zones, strain partitions between weak and strong zones, resulting in an alignment of a axes 90 degrees from the shear direction in three-dimensional deformation. This orientation of a axes provides a new means of interpreting mantle flow from seismic anisotropy in partially molten deforming regions of Earth.
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Affiliation(s)
- B K Holtzman
- Department of Geology and Geophysics, University of Minnesota, Minneapolis, MN 55455, USA.
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DelBello MP, Soutullo CA, Zimmerman ME, Sax KW, Williams JR, McElroy SL, Strakowski SM. Traumatic brain injury in individuals convicted of sexual offenses with and without bipolar disorder. Psychiatry Res 1999; 89:281-6. [PMID: 10708275 DOI: 10.1016/s0165-1781(99)00112-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors examined the occurrence of traumatic brain injury (TBI) in individuals convicted of sexual offenses with and without bipolar disorder and a comparison group of patients with bipolar disorder without a history of sexual offending behaviors. Individuals convicted of sexual offenses and diagnosed with bipolar disorder had greater rates of brain injury resulting from head trauma than individuals convicted of sexual offenses without bipolar disorder and comparison patients with bipolar disorder. TBI predated the first sexual offense and/or the onset of bipolar disorder in most subjects.
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Affiliation(s)
- M P DelBello
- Department of Psychiatry, University of Cincinnati College of Medicine, OH 45267-0559, USA.
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Wiggins BA, Andrews RW, Conway RA, Corr CL, Dobratz EJ, Dougherty DP, Eppard JR, Knupp SR, Limjoco MC, Mettenburg JM, Rinehardt JM, Sonsino J, Torrijos RL, Zimmerman ME. Use of antibiotic resistance analysis to identify nonpoint sources of fecal pollution. Appl Environ Microbiol 1999; 65:3483-6. [PMID: 10427038 PMCID: PMC91523 DOI: 10.1128/aem.65.8.3483-3486.1999] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/1999] [Accepted: 05/27/1999] [Indexed: 11/20/2022] Open
Abstract
A study was conducted to determine the reliability and repeatability of antibiotic resistance analysis as a method of identifying the sources of fecal pollution in surface water and groundwater. Four large sets of isolates of fecal streptococci (from 2,635 to 5,990 isolates per set) were obtained from 236 samples of human sewage and septage, cattle and poultry feces, and pristine waters. The patterns of resistance of the isolates to each of four concentrations of up to nine antibiotics were analyzed by discriminant analysis. When isolates were classified individually, the average rate of correct classification (ARCC) into four possible types (human, cattle, poultry, and wild) ranged from 64 to 78%. When the resistance patterns of all isolates from each sample were averaged and the resulting sample-level resistance patterns were classified, the ARCCs were much higher (96 to 100%). These data confirm that there are measurable and consistent differences in the antibiotic resistance patterns of fecal streptococci isolated from various sources of fecal pollution and that antibiotic resistance analysis can be used to classify and identify these sources.
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Affiliation(s)
- B A Wiggins
- Department of Biology, James Madison University, Harrisonburg, Virginia 22807, USA.
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Abstract
Since qualitative CT studies have suggested decreased cerebellar size in patients with bipolar disorder, we performed a quantitative analysis of the cerebellum in patients with bipolar disorder to determine whether high-resolution, thin slice magnetic resonance imaging (MRI) morphometry would reveal similar results. Bipolar patients hospitalized for a first manic episode (n = 16), bipolar patients with prior manic episodes hospitalized for a manic episode (n = 14), and normal volunteers (n = 15) matched for age, sex, race, and education were recruited and anatomic brain scans were acquired using a Picker 1.5 Tesla MRI scanner. Right and left cerebellar hemisphere volumes and vermal areas V1 (lobules I-V), V2 (lobules VI-VII), and V3 (lobules VIII-X) were measured. ANCOVA comparing each ROI, adjusting for race, sex, age, total cerebral volume, and substance abuse duration, revealed a significant group effect for vermal V3 area. Specifically, V3 area was significantly smaller in multiple-episode patients than in first-episode patients or healthy volunteers. Number of previous episodes of depression may contribute to this finding. These results suggest that cerebellar vermal atrophy may be a later neurodegenerative event in patients with bipolar disorder who have had multiple affective episodes. The confounding effects of medications are considered.
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Affiliation(s)
- M P DelBello
- Department of Psychiatry, University of Cincinnati College of Medicine, OH 45267-0559, USA
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Strakowski SM, DelBello MP, Sax KW, Zimmerman ME, Shear PK, Hawkins JM, Larson ER. Brain magnetic resonance imaging of structural abnormalities in bipolar disorder. Arch Gen Psychiatry 1999; 56:254-60. [PMID: 10078503 DOI: 10.1001/archpsyc.56.3.254] [Citation(s) in RCA: 370] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The neuropathogenesis of bipolar disorder remains poorly described. Previous work suggests that patients with bipolar disorder may have abnormalities in neural pathways that are hypothesized to modulate human mood states. We examined differences in brain structural volumes associated with these pathways between patients with bipolar disorder hospitalized with mania and healthy community volunteers. METHODS Twenty-four patients with bipolar disorder and mania were recruited from hospital admission records. Twenty-two healthy volunteers were recruited from the community who were similar to the patients in age, sex, race, height, handedness, and education. All subjects were scanned using a 3-dimensional radio-frequency-spoiled Fourier acquired steady state acquisition sequence on a 1.5-T magnetic resonance imaging scanner. Scans were analyzed using commercial software. Prefrontal, thalamic, hippocampal, amygdala, pallidal, and striatal volumetric measurements were compared between the 2 groups. RESULTS Patients with bipolar disorder demonstrated a significant (A = 0.64; F6,37 = 3.4; P = .009) overall difference in structural volumes in these regions compared with controls. In particular, the amygdala was enlarged in the patients. Brain structural volumes were not significantly associated with duration of illness, prior medication exposure, number of previous hospital admissions, or duration of substance abuse. Separating patients into first-episode (n = 12) and multiple-episode (n = 12) subgroups revealed no significant differences in any structure (P>.10). CONCLUSION Patients with bipolar disorder exhibit structural abnormalities in neural pathways thought to modulate human mood.
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Affiliation(s)
- S M Strakowski
- Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559, USA.
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14
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Abstract
OBJECTIVE The authors examined whether Continuous Performance Test scores correlate with frontosubcortical volumes in bipolar disorder. METHOD The subjects were 17 patients hospitalized for an acute manic episode and 12 group-matched comparison subjects. They underwent magnetic resonance imaging and completed the Continuous Performance Test. RESULTS The patients performed worse on the Continuous Performance Test and had smaller prefrontal cortical volumes than the comparison subjects. Within the patient group, Continuous Performance Test performance significantly correlated with prefrontal and hippocampal volumes. CONCLUSIONS These results suggest that certain neuroanatomic structures may be associated with attentional dysfunction in mania.
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Affiliation(s)
- K W Sax
- Department of Psychiatry, University of Cincinnati College of Medicine, OH 45267-0559, USA.
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Zimmerman ME. Survey: hospitals looking for new ways to fund capital projects. Healthc Financ Manage 1991; 45:72, 74. [PMID: 10145385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Abstract
STUDY OBJECTIVE To determine the sensitivity of herpes simplex virus isolates to acyclovir and the importance of resistant isolates in hospitalized patients. DESIGN Retrospective incidence cohort study. SETTING All herpes simplex virus isolates cultured over 1 year from patients followed at a tertiary care center. PATIENTS Consecutive herpes simplex virus isolates were collected from 207 patients, including immunocompetent patients, patients with malignancy, neonates, bone marrow and organ transplant recipients, and patients seropositive for human immunodeficiency virus. MEASUREMENTS AND MAIN RESULTS A rapid nucleic acid hybridization method was used to assess susceptibility to acyclovir. Acyclovir-resistant herpes simplex viruses were recovered from 7 of 148 immunocompromised patients (4.7%) but from none of 59 immunocompetent hosts. Clinical disease was found in all 7 patients with resistant herpes simplex virus and was more severe in pediatric patients. All resistant isolates were from acyclovir-treated patients and had absent or altered thymidine kinase activity by plaque autoradiography. CONCLUSION Herpes simplex virus resistant to acyclovir arises relatively frequently in immunocompromised patients and may cause serious disease. Rapid detection of resistance permits antiviral therapy to be individualized. Antiviral susceptibility testing to monitor viral resistance should be encouraged, especially in tertiary care settings.
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Affiliation(s)
- J A Englund
- University of Minnesota Health Sciences Center, Minneapolis
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Zimmerman ME, Andersson H, Lundell L, Olbe L. Alterations in body composition after gastroplasty for morbid obesity. Scand J Gastroenterol 1990; 25:263-8. [PMID: 2320944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Body compositional changes during rapid weight loss and after weight stabilization were prospectively studied in morbidly obese patients undergoing gastroplasty operations. Body composition was studied preoperatively and 6 and 24 months postoperatively in 23 patients by use of a total body counter (40K) and an isotope dilution technique. The mean fat mass, cell mass, and intracellular water (ICW) decreased during the first 6 months (p less than 0.001) and remained unchanged at the 24-month test. However, the mean liters of extracellular water (ECW) did not change. Consequently, the ECW/ICW ratio, high in states of malnutrition, rose above postoperative levels. A strong correlation was found between decreases in cell mass and increases in the ECW/ICW ratio.
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Affiliation(s)
- M E Zimmerman
- Dept. of Clinical Nutrition, Sahlgren's Hospital, University of Gothenburg, Sweden
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Zimmerman ME, Maier RA. Leasing equipment minimizes capital investment. Healthc Financ Manage 1989; 43:62, 64, 66. [PMID: 10291759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
As consumers continue to demand the most advanced technology at the lowest cost, healthcare organizations are turning to leasing as a way of acquiring equipment with a minimum amount of capital investment. Institutions considering leasing should determine their balance sheet constraints, compare the relative costs of debt financing and leasing, and assess the residual value of the equipment at the end of its use. Comparing potential lessors requires careful analysis of rate structures and the capability of the companies to commit to a contract promptly.
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Zimmerman ME. Quality error. Nurse Educ 1988; 13:40. [PMID: 3357594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Zimmerman ME. Accounting for leases. Hosp Financ Manage 1979; 33:26-9. [PMID: 10242166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Sell GH, Stratford CD, Zimmerman ME, Youdin M, Milner D. Environmental and typewriter control systems for high-level quadriplegic patients: evaluation and prescription. Arch Phys Med Rehabil 1979; 60:246-52. [PMID: 454117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A formal 44-month clinical evaluation was conducted to determine the suitability of selected electronic equipment for use in high-level quadriplegia. A total of 52 traumatic high-level quadriplegic patients (C-2 to C-5,6) participated in the testing of 13 commercial electronic assistive devices including 8 environmental control units, 1 self-contained telephone, and 4 typewriter systems. Most devices were pneumatically ("breath") controlled. Devices were tested in an occupational therapy laboratory, bedside, and homes. Testing yielded data on device reliability, suitability, and acceptance by patients.
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Zimmerman ME. Finding the true cost of a true lease. Hosp Financ Manage 1977; 31:8, 10. [PMID: 10305263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Zimmerman ME. The functional motion test as an evaluation tool for patients with lower motor neuron disturbances. Am J Occup Ther 1969; 23:49-56. [PMID: 5782557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Zimmerman ME. Homemaking training units for rehabilitation centers. Am J Occup Ther 1966; 20:226-35. [PMID: 5975634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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