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4 Risk Factor and Biomarker Correlates of FLAIR White Matter Hyperintensities in Former American Football Players
- Monica T Ly, Fatima Tuz-Zahra, Yorghos Tripodis, Charles H Adler, Laura J Balcer, Charles Bernick, Elaine Peskind, Megan L Mariani, Rhoda Au, Sarah J Banks, William B Barr, Jennifer V Wethe, Mark W Bondi, Lisa Delano-Wood, Robert C Cantu, Michael J Coleman, David W Dodick, Michael D McClean, Jesse Mez, Joseph N Palmisano, Brett Martin, Kaitlin Hartlage, Alexander P Lin, Inga K Koerte, Jeffrey L Cummings, Eric M Reiman, Martha E Shenton, Robert A Stern, Sylvain Bouix, Michael L Alosco
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 608-610
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Objective:
White matter hyperintensity (WMH) burden is greater, has a frontal-temporal distribution, and is associated with proxies of exposure to repetitive head impacts (RHI) in former American football players. These findings suggest that in the context of RHI, WMH might have unique etiologies that extend beyond those of vascular risk factors and normal aging processes. The objective of this study was to evaluate the correlates of WMH in former elite American football players. We examined markers of amyloid, tau, neurodegeneration, inflammation, axonal injury, and vascular health and their relationships to WMH. A group of age-matched asymptomatic men without a history of RHI was included to determine the specificity of the relationships observed in the former football players.
Participants and Methods:240 male participants aged 45-74 (60 unexposed asymptomatic men, 60 male former college football players, 120 male former professional football players) underwent semi-structured clinical interviews, magnetic resonance imaging (structural T1, T2 FLAIR, and diffusion tensor imaging), and lumbar puncture to collect cerebrospinal fluid (CSF) biomarkers as part of the DIAGNOSE CTE Research Project. Total WMH lesion volumes (TLV) were estimated using the Lesion Prediction Algorithm from the Lesion Segmentation Toolbox. Structural equation modeling, using Full-Information Maximum Likelihood (FIML) to account for missing values, examined the associations between log-TLV and the following variables: total cortical thickness, whole-brain average fractional anisotropy (FA), CSF amyloid ß42, CSF p-tau181, CSF sTREM2 (a marker of microglial activation), CSF neurofilament light (NfL), and the modified Framingham stroke risk profile (rFSRP). Covariates included age, race, education, APOE z4 carrier status, and evaluation site. Bootstrapped 95% confidence intervals assessed statistical significance. Models were performed separately for football players (college and professional players pooled; n=180) and the unexposed men (n=60). Due to differences in sample size, estimates were compared and were considered different if the percent change in the estimates exceeded 10%.
Results:In the former football players (mean age=57.2, 34% Black, 29% APOE e4 carrier), reduced cortical thickness (B=-0.25, 95% CI [0.45, -0.08]), lower average FA (B=-0.27, 95% CI [-0.41, -.12]), higher p-tau181 (B=0.17, 95% CI [0.02, 0.43]), and higher rFSRP score (B=0.27, 95% CI [0.08, 0.42]) were associated with greater log-TLV. Compared to the unexposed men, substantial differences in estimates were observed for rFSRP (Bcontrol=0.02, Bfootball=0.27, 994% difference), average FA (Bcontrol=-0.03, Bfootball=-0.27, 802% difference), and p-tau181 (Bcontrol=-0.31, Bfootball=0.17, -155% difference). In the former football players, rFSRP showed a stronger positive association and average FA showed a stronger negative association with WMH compared to unexposed men. The effect of WMH on cortical thickness was similar between the two groups (Bcontrol=-0.27, Bfootball=-0.25, 7% difference).
Conclusions:These results suggest that the risk factor and biological correlates of WMH differ between former American football players and asymptomatic individuals unexposed to RHI. In addition to vascular risk factors, white matter integrity on DTI showed a stronger relationship with WMH burden in the former football players. FLAIR WMH serves as a promising measure to further investigate the late multifactorial pathologies of RHI.
Interaction between the FTO gene, body mass index and depression: meta-analysis of 13701 individuals
- Margarita Rivera, Adam E. Locke, Tanguy Corre, Darina Czamara, Christiane Wolf, Ana Ching-Lopez, Yuri Milaneschi, Stefan Kloiber, Sara Cohen-Woods, James Rucker, Katherine J. Aitchison, Sven Bergmann, Dorret I. Boomsma, Nick Craddock, Michael Gill, Florian Holsboer, Jouke-Jan Hottenga, Ania Korszun, Zoltan Kutalik, Susanne Lucae, Wolfgang Maier, Ole Mors, Bertram Müller-Myhsok, Michael J. Owen, Brenda W. J. H. Penninx, Martin Preisig, John Rice, Marcella Rietschel, Federica Tozzi, Rudolf Uher, Peter Vollenweider, Gerard Waeber, Gonneke Willemsen, Ian W. Craig, Anne E. Farmer, Cathryn M. Lewis, Gerome Breen, Peter McGuffin
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- Journal:
- The British Journal of Psychiatry / Volume 211 / Issue 2 / August 2017
- Published online by Cambridge University Press:
- 02 January 2018, pp. 70-76
- Print publication:
- August 2017
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Background
Depression and obesity are highly prevalent, and major impacts on public health frequently co-occur. Recently, we reported that having depression moderates the effect of the FTO gene, suggesting its implication in the association between depression and obesity.
AimsTo confirm these findings by investigating the FTO polymorphism rs9939609 in new cohorts, and subsequently in a meta-analysis.
MethodThe sample consists of 6902 individuals with depression and 6799 controls from three replication cohorts and two original discovery cohorts. Linear regression models were performed to test for association between rs9939609 and body mass index (BMI), and for the interaction between rs9939609 and depression status for an effect on BMI. Fixed and random effects meta-analyses were performed using METASOFT.
ResultsIn the replication cohorts, we observed a significant interaction between FTO, BMI and depression with fixed effects meta-analysis (β=0.12, P = 2.7 × 10−4) and with the Han/Eskin random effects method (P = 1.4 × 10−7) but not with traditional random effects (β = 0.1, P = 0.35). When combined with the discovery cohorts, random effects meta-analysis also supports the interaction (β = 0.12, P = 0.027) being highly significant based on the Han/Eskin model (P = 6.9 × 10−8). On average, carriers of the risk allele who have depression have a 2.2% higher BMI for each risk allele, over and above the main effect of FTO.
ConclusionsThis meta-analysis provides additional support for a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. The findings provide a useful starting point in understanding the biological mechanism involved in the association between obesity and depression.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Structural brain correlates of alcohol and cannabis use in recreational users
- Murat Yücel, Dan I. Lubman, Dennis Velakoulis, Michael T. H. Wong, Stephen J. Wood, Anita Condello, Warrick J. Brewer, Christos Pantelis
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- Journal:
- Acta Neuropsychiatrica / Volume 18 / Issue 5 / October 2006
- Published online by Cambridge University Press:
- 24 June 2014, pp. 226-229
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Background:
Previous studies on substance-dependent populations have shown that age of first use and duration of use are associated with alterations in regional brain volumes. However, it is not clear whether such alterations are factors that predispose young people to use, and so are also present in recreational users, or are a consequence of chronic exposure to substances and/or comorbid psychopathology.
Objective:To investigate relationships between key brain structures and parameters of alcohol and cannabis use, in otherwise healthy male recreational users.
Method:High-resolution magnetic resonance imaging was used to measure hippocampal, amygdala, whole-brain and intracranial cavity (ICC) volumes in 22 young men with a history of both alcohol and cannabis use.
Results:Linear regression analyses with hippocampal, amygdala and whole-brain volumes as the dependent variables and age and ICC as covariates were performed. Findings showed that use of cannabis and alcohol at an earlier age were independently predictive of larger amygdala volumes, whereas longer duration of cannabis use was predictive of smaller hippocampal volumes.
Conclusions:Our findings offer preliminary support for a relationship between patterns of substance use and regional brain volumes in recreational users. It is speculative, but possible that this relationship is an evidence of a neurobiological vulnerability to drug-taking behaviour.
Contributor affiliations
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael Selzer, Stephanie Clarke, Leonardo Cohen, Gert Kwakkel, Robert Miller, Case Western Reserve University, Ohio
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- Book:
- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 May 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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Contributor affiliations
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael E. Selzer, Stephanie Clarke, Leonardo G. Cohen, Gert Kwakkel, Robert H. Miller, Case Western Reserve University, Ohio
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- Book:
- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 June 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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Trajectories of positive aging: observations from the women's health initiative study
- Oleg Zaslavsky, Barbara B. Cochrane, Nancy Fugate Woods, Andrea Z. LaCroix, Jingmin Liu, Jerald R. Herting, Joseph S. Goveas, Karen C. Johnson, Lewis H. Kuller, Lisa W. Martin, Yvonne L. Michael, Jennifer G. Robinson, Marcia Stefanick, Lesley F. Tinker
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- Journal:
- International Psychogeriatrics / Volume 26 / Issue 8 / August 2014
- Published online by Cambridge University Press:
- 17 April 2014, pp. 1351-1362
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Background:
The purpose of this study was to describe the longitudinal trajectories and bidirectional relationships of the physical-social and emotional functioning (EF) dimensions of positive aging and to identify their baseline characteristics.
Methods:Women age 65 and older who enrolled in one or more Women's Health Initiative clinical trials (WHI CTs) and who had positive aging indicators measured at baseline and years 1, 3, 6, and 9 were included in these analyses (N = 2281). Analytic strategies included latent class growth modeling to identify longitudinal trajectories and multinomial logistic regression to examine the effects of baseline predictors on these trajectories.
Results:A five-trajectory model was chosen to best represent the data. For Physical-Social Functioning (PSF), trajectory groups included Low Maintainer (8.3%), Mid-Low Improver (10.4%), Medium Decliner (10.7%), Mid-High Maintainer (31.2%), and High Maintainer (39.4%); for EF, trajectories included Low Maintainer (3%), Mid-Low Improver (9%), Medium Decliner (7.7%), Mid-High Maintainer (22.8%), and High Maintainer (57.5%). Cross-classification of the groups of trajectories demonstrated that the impact of a high and stable EF on PSF might be greater than the reverse. Low depression symptoms, low pain, and high social support were the most consistent predictors of high EF trajectories.
Conclusion:Aging women are heterogeneous in terms of positive aging indicators for up to 9 years of follow-up. Interventions aimed at promoting sustainable EF might have diffused effects on other domains of healthy aging.
21 - Using the public trust doctrine to achieve ocean stewardship
- from Part VII - A rule of law for the oceans
- Edited by Christina Voigt, Universitetet i Oslo
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- Rule of Law for Nature
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- 05 December 2013
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- 21 November 2013, pp 365-379
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- By Gwen Z. Abiola-Oloke, Julie A. Hambrook Berkman, Michael C. Blumm, Klaus Bosselmann, Rebecca M. Bratspies, Edith Brown Weiss, Hans Christian Bugge, Chizoba Chinweze, Larry B. Crowder, Cormac Cullinan, Duncan E. J. Currie, Surya Deva, Kristina M. Gjerde, Tore Henriksen, Chukwuemeka Jideani, Louis J. Kotzé, Jan Laitos, Ryke Longest, Massimiliano Montini, Annika K. Nilsson, Gail Osherenko, Froukje Maria Platjouw, Stephen E. Roady, Nicholas A. Robinson, Raphael D. Sagarin, Peter H. Sand, Linda Sheehan, Anastasia Telesetsky, Mary Turnipseed, Cristina Verones, Christina Voigt, Robin Warner, Gerd Winter, Mary C. Wood
- Edited by Christina Voigt, Universitetet i Oslo
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- Rule of Law for Nature
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- 05 December 2013
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- 21 November 2013, pp x-xii
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- By Matthew C. Beard, Maryna Bodnarchuk, Vladimir Bulovic, Nikolai Gaponik, David S. Ginger, Sjoerd Hoogland, Gerasimos Konstantatos, Maksym V. Kovalenko, Todd D. Krauss, Hyo Joong Lee, Vladimir Lesnyak, Lioz Etgar, Joey M. Luther, Michael Grätzel, Delia J. Milliron, Md. K. Nazeeruddin, Kevin M. Noone, Arthur J. Nozik, Matt Panzer, Jeffrey J. Peterson, Edward H. Sargent, Sang Il Seok, Seth-Coe Sullivan, Jiang Tang, Jeffrey J. Urban, Vanessa Wood
- Edited by Gerasimos Konstantatos, Edward H. Sargent, University of Toronto
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- Colloidal Quantum Dot Optoelectronics and Photovoltaics
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- 05 November 2013
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- 07 November 2013, pp xi-xii
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- By Syed S. Ali, Nathan Allen, John E. Arbo, Elizabeth Arrington, Ani Aydin, Kenneth R. L. Bernard, Amy Caggiula, Nolan Caldwell, Jennifer L. Carey, Jennifer Carnell, Jayaram Chelluri, Michael N. Cocchi, Cristal Cristia, Vishal Demla, Bram Dolcourt, Andrew Eyre, Shawn Fagan, Brandy Ferguson, Sarah Fisher, Jonathan Friedstat, Brian C. Geyer, Brandon Godbout, Jeremy Gonda, Jeremy Goverman, Ashley L. Greiner, Casey Grover, Carla Haack, Abigail Hankin, John W. Hardin, Katrina L. Harper, Gregory Hayward, Stephen Hendriksen, Daniel Herbert-Cohen, Nadine Himelfarb, Calvin E. Hwang, Jacob D. Isserman, Joshua Jauregui, Joshua W. Joseph, Elena Kapilevich, Feras H. Khan, Sarvotham Kini, Karen A. Kinnaman, Ruth Lamm, Calvin Lee, Jarone Lee, Charles Lei, John Lemos, Daniel J. Lepp, Elisabeth Lessenich, Brandon Maughan, Julie Mayglothling, Kevin McConnell, Laura Medford-Davis, Kamal Medlej, Heather Meissen, Payal Modi, Joel Moll, Jolene H. Nakao, Matthew Nicholls, Lindsay Oelze, Carolyn Maher Overman, Viral Patel, Timothy C. Peck, Jeffrey Pepin, Candace Pettigrew, Byron Pitts, Zubaid Rafique, Chanu Rhee, Jonathan C. Roberts, Daniel Rolston, Steven C. Rougas, Benjamin Schnapp, Kathryn A. Seal, Raghu Seethala, Todd A. Seigel, Navdeep Sekhon, Kaushal Shah, Robert L. Sherwin, Kirill Shishlov, Ashley Shreves, Sebastian Siadecki, Jeffrey N. Siegelman, Liza Gonen Smith, Ted Stettner, Marie Carmelle Tabuteau, Joseph E. Tonna, N. Seth Trueger, Chad Van Ginkel, Bina Vasantharam, Graham Walker, Susan Wilcox, Sandra J. Williams, Matthew L. Wong, Nelson Wong, Samantha Wood, John Woodruff, Benjamin Zabar
- Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
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- Practical Emergency Resuscitation and Critical Care
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- 05 November 2013
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- By Christine Alexander, Simon Avery, Michael Baumber, Birgitta Berglund, Dinah Birch, Miriam Elizabeth Burstein, Janis McLarren Caldwell, Edward Chitham, Stephen Colclough, Ann Dinsdale, Bob Duckett, Maria Frawley, Barbara T. Gates, Janet Gezari, Dudley Green, David Jasper, Drew Lamonica Arms, Elizabeth Langland, Alexandra Lewis, Sara J. Lodge, Sue Lonoff, Jill L. Matus, Victor A. Neufeldt, Linda H. Peterson, Stephen Prickett, Lyn Pykett, Herbert Rosengarten, Jane Sellars, Joanne Shattock, Margaret Smith, Patsy Stoneman, Marianne Thormählen, Ian Ward, Stephen Whitehead, T. J. Winnifrith, Steven Wood
- Edited by Marianne Thormählen, Lunds Universitet, Sweden
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- The Brontës in Context
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- 05 December 2012
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- 01 November 2012, pp xi-xvii
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- By Basem Abdelmalak, Linda S. Aglio, Daniel Alam, Maged Argalious, Carlos A. Artime, Rahul G. Baijal, David Beebe, Michael S. Benninger, Carol R. Bradford, Paul C. Bryson, Brian Burkey, Richard M. Cooper, Jacek B. Cywinski, Onur Demirci, D. John Doyle, Thomas Edrich, Louise Ellard, Matthew R. Eng, Nicole M. Fowler, Ursula Galway, John George, Carin A. Hagberg, David W. Healy, Marshal B. Kaplan, Paul Kempen, Ashish Khanna, Alan Kominsky, Tatyana Kopyeva, Biao Lei, Emad B. Mossad, Vladimir Nekhendzy, Edward Noguera, Megan Nolan, Mauricio Perilla, Marc Popovich, Gazanfar Rahmathulla, Gail I. Randel, William H. Rosenblatt, Twain Russell, Mona Sarkiss, Joseph Scharpf, Tracey Straker, David E. Traul, Robert Weil, Sivan Wexler, David T. Wong, Benjamin Wood, Jie Zhou
- Edited by Basem Abdelmalak, John Doyle
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- Anesthesia for Otolaryngologic Surgery
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- 05 November 2012
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- 18 October 2012, pp xi-xiv
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- By Ammar Al-Chalabi, Thomas D. Bird, Vincenzo Bonifati, Alexis Brice, Kate Bushby, John Collinge, David Craufurd, Odile Dubourg, Rosalie E. Ferner, Sonia Gandhi, Mark Gardiner, Michael G. Hanna, John Hardy, Peter S. Harper, Dimitri M. Kullmann, Eric LeGuern, Robert McFarland, Simon Mead, Andrew Schaefer, Christopher E. Shaw, Una-Marie Sheerin, Jemeen Sreedharan, S. H. Subramony, Sarah J. Tabrizi, Robert Taylor, Doug Turnbull, Caroline A. Vance MBioch, Edward J. Wild, Nicholas W. Wood
- Nicholas Wood
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- Neurogenetics
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- 05 May 2012
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- 12 April 2012, pp vi-viii
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- By Graeme J.M. Alexander, Heung Bae Kim, Michael Burch, Andrew J. Butler, Tanveer Butt, Roy Calne, Edward Cantu, Robert B. Colvin, Paul Corris, Charles Crawley, Hiroshi Date, Francis L. Delmonico, Bimalangshu R. Dey, Kate Drummond, John Dunning, John D. Firth, John Forsythe, Simon M. Gabe, Robert S. Gaston, William Gelson, Paul Gibbs, Alex Gimson, Leo C. Ginns, Samuel Goldfarb, Ryoichi Goto, Walter K. Graham, Simon J.F. Harper, Koji Hashimoto, David G. Healy, Hassan N. Ibrahim, David Ip, Fadi G. Issa, Neville V. Jamieson, David P. Jenkins, Dixon B. Kaufman, Kiran K. Khush, Heung Bae Kim, Andrew A. Klein, John Klinck, Camille Nelson Kotton, Vineeta Kumar, Yael B. Kushner, D. Frank. P. Larkin, Clive J. Lewis, Yvonne H. Luo, Richard S. Luskin, Ernest I. Mandel, James F. Markmann, Lorna Marson, Arthur J. Matas, Mandeep R. Mehra, Stephen J. Middleton, Giorgina Mieli-Vergani, Charles Miller, Sharon Mulroy, Faruk Özalp, Can Ozturk, Jayan Parameshwar, J.S. Parmar, Hari K. Parthasarathy, Nick Pritchard, Cristiano Quintini, Axel O. Rahmel, Chris J. Rudge, Stephan V.B. Schueler, Maria Siemionow, Jacob Simmonds, Peter Slinger, Thomas R. Spitzer, Stuart C. Sweet, Nina E. Tolkoff-Rubin, Steven S.L. Tsui, Khashayar Vakili, R.V. Venkateswaran, Hector Vilca-Melendez, Vladimir Vinarsky, Kathryn J. Wood, Heidi Yeh, David W. Zaas, Jonathan G. Zaroff
- Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
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- Organ Transplantation
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- 07 September 2011
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- 11 August 2011, pp vii-x
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- By R. J. Aitken, Gokhan Akkoyunlu, David F. Albertini, Christiani A. Amorim, R. A. Anderson, Baris Ata, Pedro N. Barri, Mohamed A. Bedaiwy, Rosita Bergström, Veronica Bianchi, Montserrat Boada, Paolo Boffetta, Andrea Borini, Karina Braga Ribeiro, Peter R. Brinsden, Ralph L. Brinster, Jason G. Bromer, A. L. Caplan, Chian Ri-Cheng, Ina N. Cholst, A. Ciobanu, Megan Clowse, Ana Cobo, Susannah C. Copland, John K. Critser, B. J. Curry, Giuseppe Del Priore, M. De Vos, Marie-Madeleine Dolmans, Javier Domingo, Jacques Donnez, David H. Edgar, Nanette R. Elster, Carol Fabian, Gregory M. Fahy, Tommaso Falcone, Debra Friedman, Jill P. Ginsberg, Debra A. Gook, Julie R. Gralow, Elizabeth Grill, Sebastien Gouy, Xu Han, Lisa M. Harlan-Williams, Outi Hovatta MD, Wayland Hsiao, Zhongwei Huang, E. Isachenko, V. Isachenko, Roy A. Jensen, I. I. Katkov, S. Samuel Kim, Jennifer Klemp, Larissa A. Korde, R. Kreienberg, Srinivasan Krishnamurthy, Juergen Liebermann, J. Ryan Martin, Elizabeth A. McGee, Marie McLaughlin, P. Mathevet, D. Meirow, Philippe Morice, Steven F. Mullen, Kutluk Oktay, Pasquale Patrizio, Antonio Pellicer, Pinki K. Prasad, Kenny A. Rodriguez-Wallberg, Erin Rohde, Allison B. Rosen, Zev Rosenwaks, María Sánchez, R. Sanchez, Glenn L. Schattman, Peter N. Schlegel, Einat Shalom-Paz, Lonnie D. Shea, Gunapala Shetty, Jill Simmons, Carrie A. Smith, J. Smitz, Miquel Solé, Jean Squifflet, Shane R. Stecklein, Jerome F. Strauss, David J. Tagler, Seang Lin Tan, Evelyn E. Telfer, Sreedhar Thirumala, Michael J. Tucker, Catherine Uzan, Anne Van Langendonckt, Anna Veiga, W. H. B. Wallace, Wenjia Wang, Brent Waters, Dagan Wells, Teresa K. Woodruff, Erik Woods, Christine Wyns
- Edited by Jacques Donnez, Université Catholique de Louvain, Belgium, S. Samuel Kim, University of Kansas
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- Principles and Practice of Fertility Preservation
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- 04 February 2011
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- 03 February 2011, pp x-xiv
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- By Elias Aboujaoude, Tina S. Alster, April Lane Benson, Wolfgang Berner, Donald W. Black, Dana Bodnik, Peer Briken, Raul Caetano, Celal Çalıkuşu, Joan C. Chrisler, Emil F. Coccaro, Pinhas N. Dannon, Helga Dittmar, Sheila Ferguson, Candice Germain, Jon E. Grant, John H. Greist, Andreas Hill, Lorrin M. Koran, Michel Lejoyeux, Laura M. Letson, Timothy Liu, Eileen M. Luna-Firebaugh, Michael S. McCloskey, Duane C. McKay, Christy M. McKinney, Amy McMichael, Drew Miller, Brad Novak, Brian L. Odlaug, Christina S. Pearson, Guy Porter, Marc N. Potenza, Paul Schwartzman, William M. Spice, Vladan Starcevic, Özlem Tecer, Benjamin T. P. Tucker, Michael R. Walther, Rungsima Wanitphakdeedecha, Sven E. Widmalm, Timothy Ivor Williams, Reeta Wolfsohn, Douglas W. Woods
- Edited by Elias Aboujaoude, Stanford University School of Medicine, California, Lorrin M. Koran, Stanford University School of Medicine, California
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- Impulse Control Disorders
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- 06 July 2010
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- 08 February 2010, pp ix-xii
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- By Donald Addington, Jean Addington, Kelly Allott, Amanda Baker, Gregor Berger, Michael Berk, Max Birchwood, Warrick J. Brewer, Peter Burnett, Tyrone Cannon, Andrew Chanen, Philippe Conus, Barbara Cornblatt, Thomas Craig, Alex Fornito, David Fowler, Shona M. Francey, John Gleeson, Susy Harrigan, Meredith Harris, Leanne Hides, Christian G. Huber, Henry J. Jackson, Anthony F. Jorm, Eóin Killackey, Joachim Klosterkötter, Martin Lambert, Tim Lambert, Shon Lewis, Don Linszen, Dan Lubman, Nellie Lucas, Craig Macneil, Ashok K. Malla, Max Marshall, Louise K. McCutcheon, Patrick D. McGorry, Catharine McNab, Maria Michail, Anthony P. Morrison, Merete Nordentoft, Ross M. G. Norman, Keith H. Nuechterlein, Christos Pantelis, Lisa J. Phillips, Richie Poulton, Paddy Power, Jo Robinson, Frauke Schultze-Lutter, Jim van Os, José Luis Vázquez-Barquero, Dennis Velakoulis, Darryl Wade, Daniel Weinberger, Durk Wiersma, Stephen J. Wood, Annemarie Wright, Murat Yücel, Alison R. Yung, Robert B. Zipursky
- Edited by Henry J. Jackson, University of Melbourne, Patrick D. McGorry
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- Book:
- The Recognition and Management of Early Psychosis
- Published online:
- 10 August 2009
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- 19 February 2009, pp xi-xvi
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- By Jeremy Ackerman, Polly Bijur, Hans Bradshaw, Ciaran J. Browne, John H. Burton, Lisa Calder, David Cline, Rita K. Cydulka, Deborah B. Diercks, James Ducharme, Megan L. Fix, Michel Galinski, Ula Hwang, Jonathan S. Ilgen, Andy Jagoda, Samuel Kim, Robert Knopp, Jason B. Lester, Adam Levine, Todd M. Listwa, Frank LoVecchio, Sharon E. Mace, Alan P. Marco, Catherine A. Marco, Chris McEachin, James R. Miner, Kalani Olmsted, Sohan Parekh, Peter Rosen, Michael S. Runyon, Michael T. Schultz, Adam J. Singer, Robert A. Swor, Joshua H. Tamayo-Sarver, Stephen H. Thomas, Michael Turturro, Michael Walta, Benjamin A. White, Beth Wicklund, Susan R. Wilcox, Nathanael Wood, Dale P. Woolridge, Andrew Worster, Janet Simmons Young, Kelly Young
- Edited by Stephen H. Thomas
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- Emergency Department Analgesia
- Published online:
- 18 December 2009
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- 25 September 2008, pp viii-xii
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Consultation outcomes in the emergency department: exploring rates and complexity
- Robert A. Woods, Renee Lee, Maria B. Ospina, Sandra Blitz, Harris Lari, Michael J. Bullard, Brian H. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 10 / Issue 1 / January 2008
- Published online by Cambridge University Press:
- 21 May 2015, pp. 25-31
- Print publication:
- January 2008
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Objective:
Consultation is a common and important aspect of emergency department (ED) care. We prospectively examined the consultation rates, the admission rates of consulted patients, the emergency physician (EP) disposition prediction of consulted patients and the difficult consultations rates in 2 tertiary care hospitals.
Methods:Attending EPs recorded consultations during 5 randomly selected shifts over an 8-week period using standardized forms. Subsequent computer outcome data were extracted for each patient encounter, as well as demographic data from the ED during days in which there was a study shift.
Results:During 105 clinical shifts, 1930 patients were managed by 21 EPs (median 17 patients per shift; interquartile range 14–23). Overall, at least 1 consultation was requested in 38% of patients. More than one-half of the patients (54.3%) who received a consultation were admitted to the hospital. Consultation proportions were similar between males and females (51% v. 49%, p = 0.03). Consultations occurred more frequently for patients who were older, had higher acuity presentations, arrived during daytime hours or arrived by ambulance. The proportion of agreement between the EP's and consultant's opinion on the need for admission was 89% (κ = 0.77, 95% confidence interval 0.72–0.83). Overall, 92% of patents received 1 consultation. Six percent of the consultations were perceived as “difficult” by the EPs (defined as the EP's subjective impression of difficulties with consultation times, accessibility and availability of consultants, and the interaction with consultants or disposition issues).
Conclusion:Consultation is a common process in the ED. It often results in admission and is predictable based on simple patient factors. Because of perceived difficulty with consultations, strategies to improve the EP consultation process in the ED seem warranted.