31 results
Co-developed implementation guidelines to maximize acceptability, feasibility, and usability of mobile phone supervision in Kenya
- Noah S. Triplett, Anne Mbwayo, Sharon Kiche, Lucy Liu, Jacinto Silva, Rashed AlRasheed, Clara Johnson, Cyrilla Amanya, Sean Munson, Bryan J. Weiner, Pamela Y. Collins, Shannon Dorsey
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- Journal:
- Cambridge Prisms: Global Mental Health / Volume 10 / 2023
- Published online by Cambridge University Press:
- 23 May 2023, e31
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Opportunities exist to leverage mobile phones to replace or supplement in-person supervision of lay counselors. However, contextual variables, such as network connectivity and provider preferences, must be considered. Using an iterative and mixed methods approach, we co-developed implementation guidelines to support the implementation of mobile phone supervision with lay counselors and supervisors delivering a culturally adapted trauma-focused cognitive behavioral therapy in Western Kenya. Guidelines were shared and discussed with lay counselors in educational outreach visits led by supervisors. We evaluated the impact of guidelines and outreach on the acceptability, feasibility, and usability of mobile phone supervision. Guidelines were associated with significant improvements in acceptability and usability of mobile phone supervision. There was no evidence of a significant difference in feasibility. Qualitative interviews with lay counselors and supervisors contextualized how guidelines impacted acceptability and feasibility – by setting expectations for mobile phone supervision, emphasizing importance, increasing comfort, and sharing strategies to improve mobile phone supervision. Introducing and discussing co-developed implementation guidelines significantly improved the acceptability and usability of mobile phone supervision. This approach may provide a flexible and scalable model to address challenges with implementing evidence-based practices and implementation strategies in lower-resourced areas.
230 The impact of the COVID-19 pandemic on stress, substance use, and teen dating violence among young adult women in Baltimore City
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- Tesha Davilmar, Maria Trent, Leticia Ryan, Sarah J. Flessa, Steven Huettner, Rachel Alinsky, Renee M. Johnson, Pamela A. Matson
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- Journal:
- Journal of Clinical and Translational Science / Volume 7 / Issue s1 / April 2023
- Published online by Cambridge University Press:
- 24 April 2023, p. 70
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OBJECTIVES/GOALS: Social distancing practices during COVID-19 may impact experience of stress, substance use and violence exposure. This study aims to describe the effect of the COVID-19 stay-at-home orders on stress, substance use, and teen dating violence (TDV) among young women living in Baltimore City. METHODS/STUDY POPULATION: Study participants were recruited from an observational study examining TDV before the COVID-19 pandemic, through snowball sampling, pediatric and adolescent primary care clinics, the pediatric emergency department, and a registry for patients interested in participating in COVID-19 research. Participants were between the ages of 16 and 22, identified as female, and lived in Baltimore, Maryland. They were asked to complete a baseline survey. March 16, 2020 (Maryland governor’s stay-at-home order) through June 2022 defined the COVID-19 pandemic period. The survey assessed stress experiences, including isolation, finances, job loss, transportation, school stress, substance use, experiences of violence and adherence to COVID-19 safety measures. We conducted descriptive and bivariate analyses. RESULTS/ANTICIPATED RESULTS: Participants (n=105) had a mean age of 19.4 years (SD 1.73). Preliminary analyses demonstrate that stress associated with isolation, finances, transportation, and school increased during the pandemic compared to pre-pandemic. In addition, the majority of participants who used marijuana, e-cigarettes, and alcohol used about the same amount or more of each substance during the pandemic. For the next steps, we will examine experiences of TDV for young women during the pandemic and examine whether experiences of TDV differ for young women who reported a greater adherence to COVID-19 safety measures compared to participants who adhered less. DISCUSSION/SIGNIFICANCE: Assessing the impact of COVID-19 safety measures on stress, substance use, and TDV is critical to informing and designing future public health interventions. In addition, the information obtained from this study may be used to address the unique challenges faced by disenfranchised populations while curbing the spread of infectious diseases.
How engagement of a diverse set of stakeholders shaped the design, implementation, and dissemination of a multicenter pragmatic trial of stroke transitional care: The COMPASS study
- Sabina B. Gesell, Sylvia W. Coleman, Laurie H. Mettam, Anna M. Johnson, Mysha E. Sissine, Pamela W. Duncan
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- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue 1 / 2021
- Published online by Cambridge University Press:
- 05 November 2020, e60
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Evidence is limited on how to synthesize and incorporate the views of stakeholders into a multisite pragmatic trial and how much academic teams change study design and protocol in response to stakeholder input. This qualitative study describes how stakeholders contributed to the design, conduct, and dissemination of findings of a multisite pragmatic clinical trial, the COMprehensive Post-Acute Stroke Services (COMPASS) Study. We engaged stakeholders as integral research partners by embedding them in study committees and community resource networks that supported local sites. Data stemmed from formal focus groups and continuous participation in working groups. Guided by Grounded Theory, we extracted themes from focus group and meeting notes. These were discussed as a team and with other stakeholder groups for feasibility. A consensus approach was used. Stakeholder input changed many aspects of the study including: the care model that treated stroke as a chronic condition after hospital discharge, training for hospital-based providers who often lacked awareness of the barriers to recovery that patients face, support for caregivers who were essential for stroke patients’ recovery, and for community-based health and social service providers whose services can support recovery yet often go underutilized. Stakeholders brought value to both pragmatic research and health service delivery. Future studies should test the impact of elements of study implementation informed by stakeholders vs those that are not.
Effects of aripiprazole once-monthly on symptoms of schizophrenia in patients switched from oral antipsychotics
- Timothy Peters-Strickland, Cathy Zhao, Pamela P. Perry, Anna Eramo, Phyllis M. Salzman, Robert D. McQuade, Brian R. Johnson, Raymond Sanchez
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- Journal:
- CNS Spectrums / Volume 21 / Issue 6 / December 2016
- Published online by Cambridge University Press:
- 17 August 2016, pp. 460-465
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Objective
To assess the effects of aripiprazole once-monthly 400 mg (AOM 400) on clinical symptoms and global improvement in schizophrenia after switching from an oral antipsychotic.
MethodsIn a multicenter, open-label, mirror-image, naturalistic study in patients with schizophrenia (>1 year, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR] criteria), changes in efficacy measures were assessed during prospective treatment (6 months) with AOM 400 after switching from standard-of-care oral antipsychotics. During prospective treatment, patients were cross-titrated to oral aripiprazole monotherapy (1–4) weeks followed by open-label AOM 400 (24 weeks). Mean change from baseline of the open-label AOM 400 phase in Positive and Negative Syndrome Scale (PANSS) scores (total, positive and negative subscales) and Clinical Global Impression–Severity (CGI-S) scores; mean CGI–Improvement (CGI-I) score; and proportion of responders (≥30% decrease from baseline in PANSS total score or CGI-I score of 1 [very much improved] or 2 [much improved]) were assessed.
ResultsPANSS and CGI-S scores improved from baseline (P<0.0001) and CGI-I demonstrated improvement at all time points. By the end of the study, 49.0% of patients were PANSS or CGI-I responders.
ConclusionsIn a community setting, patients with schizophrenia who were stabilized at baseline and switched to AOM 400 from oral antipsychotics showed clear improvements in clinical symptoms.
Case 44 - Pulmonary artery imaging for pulmonary embolism in patients with Fontan shunt for congenital heart disease
- from Section 5 - Pulmonary arteries
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- By Pamela T. Johnson, Johns Hopkins University School of Medicine
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
- Print publication:
- 21 May 2015, pp 137-140
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Summary
Imaging description
CT imaging for suspected pulmonary embolism is among the most challenging in terms of reproducible high image quality. Even careful timing with bolus tracking does not always guarantee that contrast enhancement levels will be sufficient to image the peripheral pulmonary arteries, as discussed in case 42. In patients with corrected congenital heart disease, the presence of conduits from arteries and veins to cardiac chambers can result in dramatically altered timing of contrast delivery to the right heart, further increasing the complexity of protocol design for imaging of the pulmonary arteries. In the case shown here, the standard timing method of bolus tracking the main pulmonary artery resulted in a non-diagnostic scan because the patient has a Fontan shunt between the inferior vena cava and right pulmonary artery. Markedly dense contrast is seen in the left pulmonary arterial system, with mixing artifact, and complete absence of contrast in the right pulmonary arterial system (Figure 44.1). A longer delay is required to opacify the conduit and pulmonary arterial system (Figure 44.2). Park et al. have reported that the optimal delay to enhance the Fontan conduit and pulmonary arteries is 3 minutes.
An additional pitfall shown in this case is a thrombosed Blalock–Taussig (BT) shunt mimicking acute pulmonary embolism (Figure 44.3). Patients with congenital heart disease may undergo BT shunting in early childhood, followed by other definitive surgical correction, such as a Fontan procedure. Knowledge of their surgical history is critical in recognizing that the thrombosed vessels coursing cranially from the pulmonary arteries are old BT shunts rather than lobar or segmental pulmonary emboli.
Importance
Following surgical repair for congenital heart disease, the standard CT timing for pulmonary artery imaging cannot be used. Timing must be tailored to the altered hemodynamics resulting from indwelling conduits.
Typical clinical scenario
In patients with congenital heart disease, multidetector CT (MDCT) may be requested to image the pulmonary arteries for suspected vascular stenoses or atresia as part of the spectrum of their cardiac anomalies or as a secondary complication that develops over time.
Case 100 - Superior vena cava anatomic variants
- from Section 11 - Veins
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- By Pamela T. Johnson, Johns Hopkins University School of Medicine
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
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- 21 May 2015, pp 312-314
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Summary
Imaging description
Persistent left-sided superior vena cava (SVC) is the most common congenital venous anomaly of the chest. In this variant, the left-sided cava receives blood from the left subclavian and left jugular veins and courses inferiorly in the chest, lateral to the left aortic arch and hilum, and drains directly into the coronary sinus. In the vast majority of cases, a separate right-sided SVC is also present. These vessels communicate via a persistent bridging vein in 35% of patients. On chest radiograph, left-sided SVC appears as superior mediastinal widening and a right-sided venous catheter will cross the mediastinum to enter the heart on the left side. A CT will confirm the presence of left-sided SVC coursing lateral to the aortic arch and terminating in the coronary sinus (Figure 100.1). Duplicated inferior vena cava (IVC) and left-sided IVC are two congenital IVC anomalies where a left-sided IVC will be present in the left para-aortic region.
Importance
Anomalous veins can be mistaken for lymphadenopathy or masses, particularly in studies performed without intravenous contrast. The presence of anomalous veins is also important for planning of central venous access.
Typical clinical scenario
Unless the patient has congenital heart disease, these anomalies are often identified incidentally during imaging. Persistent left-sided SVC is present in 0.3% of people, with a higher incidence (4.3%) in those who have congenital heart anomalies.
Differential diagnosis
The differential diagnosis for a large venous structure coursing lateral to the ascending thoracic aorta is partial anomalous pulmonary venous return (Figure 100.2). Unlike a persistent left SVC, which courses inferiorly into the coronary sinus (Figure 100.1), this venous structure courses into the left hilum and branches into the lung parenchyma, along with the left pulmonary arteries. A central line positioned in PAPVR (partial anomalous pulmonary venous return) will course away from the mediastinum at the level of the hilum (Figure 100.2), unlike one positioned in a duplicated SVC, which extends along the heart border into the coronary sinus (Figure 100.1).
Case 68 - Type II endoleak occult on arterial phase images
- from Section 8 - Post-operative aorta
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- By Pamela T. Johnson, Johns Hopkins University
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
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- 21 May 2015, pp 218-220
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Summary
Imaging description
Following endovascular stent repair of abdominal aortic aneurysms, the most common complication is a type II endoleak. Endoleaks occur when blood continues to flow into the aneurysm sac after the procedure, carrying the risk of continued aneurysm expansion. On CT, endoleaks are identified by the presence of intravenous contrast within the aneurysm sac around the stent, which should normally be completely thrombosed. Five subtypes of endoleaks exist, but only types I–III will show contrast in the aneurysm sac at CT. These endoleaks are classified by the source of blood flow. In type II endoleaks, there is reperfusion of the aneurysm sac by aortic branch vessels. These are typically the inferior mesenteric artery or a lumbar artery branch, and are located anterior or posterior in the aneurysm sac depending on the feeding vessel.
Identification of a type II endoleak hinges on protocol optimization. The literature supports use of multiple acquisitions and narrow reconstruction sections to maximize likelihood of detecting an endoleak. With respect to the relative utility of different phases after contrast infusion, several studies have confirmed that use of delayed acquisition enables identification of more endoleaks than use of only an arterial phase acquisition. While many endoleaks are more conspicuous on the arterial phase, some will be more conspicuous or only visualized on the delayed phase (Figures 68.1and 68.2).
Importance
Studies show that more than half of type II endoleaks will resolve spontaneously, particularly those that do not result in enlargement of the aneurysm sac. However, the risk of a persistent endoleak is expansion of the aneurysm sac, which can result in rupture despite the presence of a stent. Arterial and delayed venous phase acquisitions are recommended for endovascular stent follow-up to avoid missing small type II endoleaks that may only be visible on the delayed phase.
Typical clinical scenario
Type II endoleaks occur in 19–24% of patients who undergo endovascular stent repair of an abdominal aortic aneurysm and account for 40% of endoleaks. These can be identified on the first follow up CT examination, or develop later.
Case 42 - Pitfalls in obtaining optimal vascular contrast for pulmonary embolism examinations
- from Section 5 - Pulmonary arteries
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- By Pamela T. Johnson, Johns Hopkins University School of Medicine
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
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- 21 May 2015, pp 131-133
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Summary
Imaging description
The ability to identify pulmonary emboli depends on the quality of the CT scan. Factors that diminish image quality include low contrast enhancement level, noise, motion artifact, and beam hardening artifact from high-density contrast in the SVC. The level of contrast enhancement achieved depends on the rate of contrast infusion and how the scan is timed. Contrast infusion is currently performed with infusion rates of 4–5 ml/second. Volume can be reduced to 100 ml for an average-sized patient, but for larger patients a higher volume may be necessary to ensure adequate contrast-to-noise ratio.
Optimally, the acquisition timing is tailored to the patient's hemodynamics, often performed with the bolus tracking technique. In this method, a region of interest (ROI) positioned on the main pulmonary artery samples the density as contrast is infused. A preset trigger point is applied, and when the contrast level reaches this density, the scan is initiated.
Performing a well-timed exam requires knowledge of the speed of the scanner being used. The new scanners that can perform studies in a few seconds enable the trigger timing to be delayed, so that the very peak of contrast enhancement is captured. For example, using a 64-slice scanner the study is triggered at 120–150 HU. This usually results in a high level of enhancement in the pulmonary arteries (Figure 42.1), prior to aortic enhancement. With a 128-slice dual-source scanner, the trigger point is delayed to 200 HU (Figure 42.2), and very high-quality imaging can result from high pulmonary artery enhancement and absence of motion artifact.
Despite an understanding of how scanner speed dictates scan timing for bolus tracking timing, pitfalls can occur when bolus tracking is used. One pitfall is malpositioning of the ROI cursor due to patient breathing or movement (Figure 42.3). In some cases, although the ROI cursor is well positioned and scan timed properly, the contrast enhancement level is suboptimal (Figure 42.4).
Case 69 - Elephant trunk graft mimicking aortic dissection
- from Section 8 - Post-operative aorta
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- By Pamela T. Johnson, Johns Hopkins University
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
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- 21 May 2015, pp 221-223
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Summary
Imaging description
Patients who require staged thoracic aneurysm surgery may have an “elephant trunk” prosthesis placed during the first surgery. The proximal graft is sutured into the aortic arch, while the distal edges of the graft are freely mobile within the lumen of the descending thoracic aorta (Figures 69.1 and 69.2). Owing to the configuration, the free edges of the distal end of the graft can simulate an intraluminal dissection on axial CT. Correlation with surgical history and review of 2D MPRs and 3D renderings enables the radiologist to make the correct interpretation of a normal elephant trunk prosthesis. The surgical procedure and typical imaging appearance have been described in detail in the literature.
The free-floating graft serves to protect the descending thoracic aorta prior to the second surgery. It is then incorporated into either a surgical graft or endoluminal stent graft during repair of the descending aorta. Because the graft is positioned in the descending thoracic aorta, the second surgery can be performed at a distance from the first in unaltered anatomic planes; reoperating in the same location carries a high risk of hemorrhage. Patients may alternatively undergo endoluminal stent repair of the descending thoracic aorta. The elephant trunk graft has radiodense markers on the distal end (Figure 69.3), to enable localization during fluoroscopic endovascular stent placement.
It is important to distinguish the normal appearance from potential complications of this type of graft. These include graft entrapment in the patients with a residual dissection; the graft can migrate into one lumen and preferentially supply the blood flow to that lumen. Surgeons will excise the most cranial extent of the dissection to prevent this complication. Additionally, aneurysmal dilatation of the more distal aorta has been reported. Ideally, this graft is a temporary structure that is incorporated into the final repair in a timely fashion to prevent such complication.
Importance
Misdiagnosis of the normal elephant trunk prosthesis as a dissection of the descending thoracic aorta can lead to unnecessary patient anxiety, additional imaging examinations, and potentially inappropriate interventions.
Case 43 - Artifacts mimicking pulmonary embolism
- from Section 5 - Pulmonary arteries
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- By Pamela T. Johnson, Johns Hopkins University School of Medicine
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
- Print publication:
- 21 May 2015, pp 134-136
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Summary
Imaging description
Different artifacts that hamper interpretation during pulmonary artery CT include mixing or flow artifact (also called interrupted contrast enhancement) mimicking a pulmonary embolism, respiratory motion artifact resulting in linear decreased enhancement in segmental arteries that also simulates embolism on axial sections, cardiac motion artifact creating pseudodissection, and beam hardening artifact from dense contrast in the SVC obscuring visualization of the right pulmonary arteries. Owing to poor cardiac output, unopacified and opacified contrast mixed in the main and segmental arteries, mimic pulmonary embolism (Figure 43.1). Contrast enhancement is optimized by using bolus tracking software to tailor the scan timing to the patient's cardiopulmonary status, as described in case 42, and by administering contrast at higher infusion rates. Additionally, a number of studies have reported that hyperventilating the patient and imaging in deep inspiration contribute to flow artifacts that mimic emboli. Expiratory scanning reduces the incidence of focal diminished contrast enhancement and results in higher pulmonary artery enhancement levels.
A more common cause of pseudothrombus is motion artifact (Figure 43.2). Correlation with coronal MPR reveals linear decreased attenuation parallel to the transverse plane secondary to respiratory motion artifact, which underscores the importance of correlating axial findings with MPRs.
Faster scanners (128 slice and beyond) aid in reduction of both cardiac and respiratory motion artifacts. If pulmonary artery dissection is suspected, identification of linear pulsation artifact within other cardiac structures (i.e., aorta) increases confidence that the finding is due to cardiac motion. Finally, the beam-hardening artifact in the superior vena cava, which sends streaks of high density across the right pulmonary arteries, can be reduced by administering a saline chaser after the contrast bolus.
Importance
Interpretation of pulmonary artery CTA requires protocol optimization to maximize contrast enhancement and minimize artifacts. Ideally, protocol design results in a high-quality dataset with excellent pulmonary artery enhancement and absence of these artifacts. In practice, however, image quality is not always perfect.
Case 76 - Splenic artery aneurysm mimicking pancreatic neuroendocrine tumor
- from Section 9 - Mesenteric vascular
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- By Pamela T. Johnson, Johns Hopkins University School of Medicine
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
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- 21 May 2015, pp 241-242
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Summary
Imaging description
Pancreatic neuroendocrine tumors (PNETs) have variable CT appearances, but demonstrate a distinctive CT appearance when they present as small, hypervascular masses within the pancreatic parenchyma. Unlike adenocarcinoma, which is typically hypovascular and most conspicuous on the venous phase, hypervascular PNETs are typically more vascular than the pancreatic parenchyma on the arterial and/or venous phase(s). This appearance can be mimicked by a splenic artery aneurysm that is partially or completely surrounded by pancreatic parenchyma (Figure 76.1). The distinction is made by demonstrating contiguity with the splenic artery on arterial-phase imaging, facilitated by use of 2D multiplanar reconstructions and 3D rendering.
Importance
Distinction of a splenic artery aneurysm from a pancreatic neuroendocrine tumor is essential, for several reasons. Biopsy of a splenic artery aneurysm mistaken for a PNET could result in catastrophic hemorrhage. Resection based on a presumptive CT or MR diagnosis would subject the patient to an unnecessary surgical procedure with significant morbidity rates.
Typical clinical scenario
Splenic artery aneurysms are estimated to occur in 0.1 to 10.4% of the general population. Splenic artery aneurysms have a strong female predominance, with a female to male ratio of 4:1. Splenic artery aneurysms are defined by diameter greater than 1 cm. Splenic artery aneurysms may be mistaken for pancreatic neuroendocrine tumors when proper CT technique is not performed, including high spatial resolution, arterial and venous phase acquisitions, as well as 2D multiplanar reconstructions and 3D rendering. A single venous phase acquisition without narrow reconstruction sections can make the distinction of the two entities challenging.
Differential diagnosis
Differential diagnosis for a vascular lesion in the pancreas includes metastasis from renal cell carcinoma, gastrointestinal stromal tumor, peripancreatic paraganglioma, and intrapancreatic splenule. The presence of calcification would be more common with either a PNET or a splenic artery aneurysm.
Case 54 - Pitfalls in arterial enhancement timing
- from Section 7 - Acute aorta and aortic aneurysms
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- By Pamela T. Johnson, Johns Hopkins University, Spencer T. Lake, University of California
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
- Print publication:
- 21 May 2015, pp 171-175
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Summary
Imaging description
Early arterial phase imaging is critical for high-quality CT angiography examinations; however, accurate imaging can be problematic in patients with large aneurysms or aortic dissections. In some cases, an early arterial acquisition may not allow enough time for complete filling of the aneurysm sac or false lumen with contrast (Figures 54.1–54.3). The incompletely opacified aneurysm sac or false lumen may appear thrombosed, when in actuality it is merely filled with unopacified blood. Swirling of contrast within the aneurysm sac is often present and can be a clue that incomplete contrast filling has occurred (Figure 54.3).
Importance
In the patient with acute pain, large aneurysms must be evaluated for signs of instability or rupture. One of the most critical findings is contrast extravasation reflective of active hemorrhage, which requires immediate repair. The case shown here (Figure 54.1) demonstrates how this important finding could be missed if the arterial timing did not allow for complete aneurysm filling.
Patients with aortic dissection may have very slow flow in the false lumen, resulting in the appearance of pseudothrombosis of both the false lumen and the branches that arise from this lumen. As shown by the second case (Figure 54.2), a longer imaging delay will elucidate that the false lumen, arterial branch and end organ are actually perfused. The distinction is important because in the setting of arterial thrombosis intervention is necessary, whereas uncomplicated type B dissections do not require endovascular or surgical repair.
Although much less common, proper characterization of a coronary artery aneurysm (Figure 54.3) as patent or thrombosed is critical to determine whether repair is indicated to avert rupture.
Typical clinical scenario
Aortic aneurysms and dissections are two of the most common forms of aortic pathology. Patients may present acutely with pain, or may undergo serial imaging to guide management of previously diagnosed aneurysm or partially repaired dissection. Coronary aneurysms are much less common, particularly larger aneurysms. In adults, atherosclerosis is the most common cause, whereas in children it is Kawasaki disease.
Case 65 - Incorrect aneurysm measurement due to aortic tortuosity
- from Section 7 - Acute aorta and aortic aneurysms
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- By Pamela T. Johnson, Johns Hopkins University
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
- Print publication:
- 21 May 2015, pp 210-212
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Summary
Imaging description
In patients with tortuous aortas due to aging or atherosclerotic disease, measurements of aneurysm on axial images can lead to falsely elevated aneurysm diameters. Figure 65.1 shows an axial CT image of the ascending thoracic aorta in a 64-year-old woman, which measured 3.9cm. However, when the aneurysm is evaluated on double oblique, sagittal, and coronal multiplanar reformatted images (MPRs), it becomes apparent that the actual size is 3.5cm. The thoracic aorta has a candycane configuration, which may necessitate measurements using MPRs to accurately determine the cross-sectional diameter. Similarly, Figure 65.2 shows a 64-year-old man with an abdominal aortic aneurysm, the course of which is not entirely perpendicular to the z-axis of the scan. Accordingly, to accurately determine the diameter, the measurements must be made on MPRs tailored to reflect the actual cross-sectional diameter perpendicular to the aortic centerline.
Importance
One of the primary roles of CT in the patient with aortic aneurysm is aneurysm measurement, as the risk of rupture directly correlates with aneurysm size. Surgical thresholds have been defined based on anatomic segment. For the ascending thoracic aorta it is 5.5cm, for descending thoracic aorta 6.5cm, and for abdominal aorta 5.5cm. Serial imaging is critical to evaluate for rate of growth, an additional risk factor that reflects an increased risk of rupture. Aneurysms that grow more than 5–7mm in 6 months or 1cm in one year are considered rapidly enlarging and may warrant repair. Accordingly, accurate methods of measurement are critical to patient management.
As shown in this case, axial CT images should not be relied upon for thoracic aortic and abdominal aortic aneurysm measurements. Tortuosity of the aorta results in a course that is no longer directly perpendicular to the axial plane. In these cases, MPRs or 3D renderings are required to generate accurate bi-dimensional aneurysm measurements orthogonal to the aortic lumen centerline. Either manual double oblique MPRs or short-axis images generated from software-based automated centerline tracking are recommended for the most reliable aneurysm measurement.
Case 62 - Imaging features of aortic aneurysm instability
- from Section 7 - Acute aorta and aortic aneurysms
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- By Pamela T. Johnson, Johns Hopkins University
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
-
- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
- Print publication:
- 21 May 2015, pp 200-203
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Summary
Imaging description
The diagnosis of aortic aneurysm rupture is straightforward on CT. Both precontrast and post-contrast acquisitions will demonstrate disruption of the aneurysm wall with perianeurysm hemorrhage extending into the retroperitoneum and possibly the peritoneal cavity. Prior to frank rupture, certain findings on CT may reflect instability of an intact abdominal aortic aneurysm or contained rupture. Instability indicators include intramural or intrathrombus hemorrhage (“hyperattenuating crescent” sign), perianeurysmal hemorrhage, and disruption of previously continuous aortic wall calcification. The hyperattenuating crescent sign indicates hemorrhage within aneurysm thrombus or the aneurysm wall, and can be recognized by high-attenuation material within the plaque or the wall (Figure 62.1). A small perianeurysm hematoma may be identified prior to frank rupture, suggesting contained rupture (Figure 62.2).
Contained rupture may also manifest as a new focal outpouching of the aortic wall or the “draped aorta” sign (Figures 62.3, 62.4). The latter appears as loss of the fat plane between the posterior wall of the aortic aneurysm and the adjacent vertebral body, and psoas muscle on axial images, and a focal posterior outpouching on sagittal MPRs. Cognizance of these findings is essential so that the interpreting radiologist can alert the vascular surgeon to guide intervention.
Careful assessment for aneurysm enlargement is equally important. A size threshold of 5.5cm has been defined for repair of an abdominal aortic aneurysm. The typical rate of aneurysm enlargement is 1–4mm/year. Rapid aneurysm enlargement is defined as > 6mm in 6 months or >1cm in one year. Measurement should be tailored to the configuration of the aneurysm and performed on current and prior CT examinations for optimal reproducibility. If available, comparison to older studies is recommended, because changes in size may be more apparent than comparison to recent studies alone.
Importance
Imaging signs that suggest a high risk of rupture are important to recognize to prompt treatment before the occurrence of acute aortic rupture, which has a very high mortality rate.
Case 67 - Pseudoendoleak post-endovascular stent graft placement due to calcified material in the aneurysm sac
- from Section 8 - Post-operative aorta
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- By Pamela T. Johnson, Johns Hopkins University
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
-
- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
- Print publication:
- 21 May 2015, pp 216-217
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Summary
Imaging description
CT is the primary imaging modality used to evaluate patients after endoluminal stent placement. The role of CT is to confirm that the aortic pathology (aneurysm and/or dissection) has been excluded, demonstrate that the aortic branches remain patent, and to identify complications, most commonly the presence of an endoleak. An endoleak occurs when blood extends into the aneurysm sac outside of the stent, either by retrograde perfusion from an aortic arterial branch, leak from the proximal or distal end of the stent, or through the stent graft or where adjacent stent grafts overlap. Serial post-treatment CT imaging should demonstrate gradual decrease in the size of the excluded aneurysm sac. In the presence of an endoleak, the sac will stay the same or enlarge.
When performing CT after endoluminal stent placement, a precontrast acquisition is necessary for distinguishing calcification or surgical material within the aneurysm sac from an endoleak, and improves specificity and positive predictive value in identifying endoleaks. As shown in this case, high-attenuation calcification within an aneurysm sac can mimic an endoleak on post-contrast CT, but is definitively characterized as calcification by comparing to a non-contrast acquisition (Figure 67.1).
Importance
Calcification or surgical material within the aneurysm sac may mimic endoleak if only post-contrast images are obtained. Proper protocol design is an integral component to highquality diagnostic interpretation. Knowledge of pitfalls such as this mandates use of a precontrast acquisition following endoluminal stent placement to serve as comparison for the post-contrast sequences. Endoleaks may be followed if small, but can require reintervention. If left untreated, an endoleak can eventually result in rupture of the aneurysm sac.
Typical clinical scenario
Patients typically undergo lifelong serial follow-up imaging after the endovascular stent has been placed. Approximately 25% develop an endoleak, most commonly type II. Delayed endoleaks occur in 10% on average, with reports as high as 30%.
Aripiprazole once-monthly for treatment of schizophrenia: double-blind, randomised, non-inferiority study
- W. Wolfgang Fleischhacker, Raymond Sanchez, Pamela P. Perry, Na Jin, Timothy Peters-Strickland, Brian R. Johnson, Ross A. Baker, Anna Eramo, Robert D. McQuade, William H. Carson, David Walling, John M. Kane
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- Journal:
- The British Journal of Psychiatry / Volume 205 / Issue 2 / August 2014
- Published online by Cambridge University Press:
- 02 January 2018, pp. 135-144
- Print publication:
- August 2014
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Background
Long-acting injectable formulations of antipsychotics are treatment alternatives to oral agents.
AimsTo assess the efficacy of aripiprazole once-monthly compared with oral aripiprazole for maintenance treatment of schizophrenia.
MethodA 38-week, double-blind, active-controlled, non-inferiority study; randomisation (2:2:1) to aripiprazole once-monthly 400 mg, oral aripiprazole (10–30 mg/day) or aripiprazole once-monthly 50mg (a dose below the therapeutic threshold for assay sensitivity). (Trial registration: clinicaltrials.gov, NCT00706654.)
ResultsA total of 1118 patients were screened, and 662 responders to oral aripiprazole were randomised. Kaplan–Meier estimated impending relapse rates at week 26 were 7.12% for aripiprazole once-monthly 400mg and 7.76% for oral aripiprazole. This difference (−0.64%, 95% CI −5.26 to 3.99) excluded the predefined non-inferiority margin of 11.5%. Treatments were superior to aripiprazole once-monthly 50mg (21.80%, P⩽0.001).
ConclusionsAripiprazole once-monthly 400mg was non-inferior to oral aripiprazole, and the reduction in Kaplan–Meier estimated impending relapse rate at week 26 was statistically significant v. aripiprazole once-monthly 50 mg.
Contributors
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- By Kumar Alagappan, Janet G. Alteveer, Kim Askew, Paul S. Auerbach, Katherine Bakes, Kip Benko, Paul D. Biddinger, Victoria Brazil, Anthony FT Brown, Andrew K. Chang, Alice Chiao, Wendy C. Coates, Jamie Collings, Gilbert Abou Dagher, Jonathan E. Davis, Peter DeBlieux, Alessandro Dellai, Emily Doelger, Pamela L. Dyne, Gino Farina, Robert Galli, Gus M. Garmel, Daniel Garza, Laleh Gharahbaghian, Gregory H. Gilbert, Michael A. Gisondi, Steven Go, Jeffrey M. Goodloe, Swaminatha V. Gurudevan, Micelle J. Haydel, Stephen R. Hayden, Corey R. Heitz, Gregory W. Hendey, Mel Herbert, Cherri Hobgood, Michelle Huston, Loretta Jackson-Williams, Anja K. Jaehne, Mary Beth Johnson, H. Brendan Kelleher, Peter G Kumasaka, Melissa J. Lamberson, Mary Lanctot-Herbert, Erik Laurin, Brian Lin, Michelle Lin, Douglas Lowery-North, Sharon E. Mace, S. V. Mahadevan, Thomas M. Mailhot, Diku Mandavia, David E. Manthey, Jorge A. Martinez, Amal Mattu, Lynne McCullough, Steve McLaughlin, Timothy Meyers, Gregory J. Moran, Randall T. Myers, Christopher R.H. Newton, Flavia Nobay, Robert L. Norris, Catherine Oliver, Jennifer A. Oman, Rita Oregon, Phillips Perera, Susan B. Promes, Emanuel P. Rivers, John S. Rose, Carolyn J. Sachs, Jairo I. Santanilla, Rawle A. Seupaul, Fred A. Severyn, Ghazala Q. Sharieff, Lee W. Shockley, Stefanie Simmons, Barry C. Simon, Shannon Sovndal, George Sternbach, Matthew Strehlow, Eustacia (Jo) Su, Stuart P. Swadron, Jeffrey A. Tabas, Sophie Terp, R. Jason Thurman, David A. Wald, Sarah R. Williams, Teresa S. Wu, Ken Zafren
- Edited by S. V. Mahadevan, Stanford University School of Medicine, California, Gus M. Garmel
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- An Introduction to Clinical Emergency Medicine
- Published online:
- 05 May 2012
- Print publication:
- 10 April 2012, pp xi-xvi
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Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Harlan Hahn
- Pamela J. Johnson
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- PS: Political Science & Politics / Volume 41 / Issue 4 / October 2008
- Published online by Cambridge University Press:
- 01 October 2008, pp. 887-888
- Print publication:
- October 2008
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Harlan D. Hahn, activist and leading authority on disability rights, and a faculty member in USC College for 35 years, has died. He was 68.
Personality characteristics of women before and after recovery from an eating disorder
- KELLY L. KLUMP, MICHAEL STROBER, CYNTHIA M. BULIK, LAURA THORNTON, CRAIG JOHNSON, BERNIE DEVLIN, MANFRED M. FICHTER, KATHERINE A. HALMI, ALLAN S. KAPLAN, D. BLAKE WOODSIDE, SCOTT CROW, JAMES MITCHELL, ALESSANDRO ROTONDO, PAMELA K. KEEL, WADE H. BERRETTINI, KATHERINE PLOTNICOV, CHRISTINE POLLICE, LISA R. LILENFELD, WALTER H. KAYE
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- Journal:
- Psychological Medicine / Volume 34 / Issue 8 / November 2004
- Published online by Cambridge University Press:
- 04 November 2004, pp. 1407-1418
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Background. Previous studies of personality characteristics in women with eating disorders primarily have focused on women who are acutely ill. This study compares personality characteristics among women who are ill with eating disorders, recovered from eating disorders, and those without eating or other Axis I disorder pathology.
Method. Female participants were assessed for personality characteristics using the Temperament and Character Inventory (TCI): 122 with anorexia nervosa (AN; 77 ill, 45 recovered), 279 with bulimia nervosa (BN; 194 ill, 85 recovered), 267 with lifetime histories of both anorexia and bulimia nervosa (AN+BN; 194 ill, 73 recovered), 63 with eating disorder not otherwise specified (EDNOS; 31 ill, 32 recovered), and 507 without eating or Axis I disorder pathology.
Results. Women ill with all types of eating disorders exhibited several TCI score differences from control women, particularly in the areas of novelty-seeking, harm avoidance, self-directedness, and cooperativeness. Interestingly, women recovered from eating disorders reported higher levels of harm avoidance and lower self-directedness and cooperativeness scores than did normal control women.
Conclusions. Women with eating disorders in both the ill and recovered state show higher levels of harm avoidance and lower self-directedness and cooperativeness scores than normal control women. Although findings suggest that disturbances may be trait-related and contribute to the disorders' pathogenesis, additional research with more representative community controls, rather than our pre-screened, normal controls, is needed to confirm these impressions.