Katherine H. Taber

Association of trauma exposure with psychiatric morbidity in military veterans who have served since September 11, 2001

OBJECTIVE This study examined the association of lifetime traumatic stress with psychiatric diagnostic status and symptom severity in veterans serving in the US military after 9/11/01. METHOD Data from 356 US military veterans were analyzed. Measures included a standardized clinical interview measure of psychiatric disorders, and paper-and-pencil assessments of trauma history, demographic variables, intellectual functioning, posttraumatic stress disorder (PTSD) symptoms, depression, alcohol misuse, and global distress. RESULTS Ninety-four percent of respondents reported at least one traumatic stressor meeting DSM-IV criterion A for PTSD (i.e., life threatening event to which the person responded with fear, helplessness or horror), with a mean of four criterion A traumas. Seventy-one percent reported serving in a war-zone, with 50% reporting occurrence of an event meeting criterion A. The rate of current psychiatric disorder in this sample was: 30% PTSD, 20% major depressive disorder, 6% substance abuse or dependence and 10% for the presence of other Axis I psychiatric disorders. After accounting for demographic covariates and combat exposure, childhood physical assault and accident/disasters were most consistently associated with increased likelihood of PTSD. However, PTSD with no comorbid major depressive disorder or substance use disorder was predicted only by combat exposure and adult physical assault. Medical/unexpected-death trauma and adult physical assault were most consistently associated with more severe symptomatology. CONCLUSIONS Particular categories of trauma were differentially associated with the risk of psychiatric diagnosis and current symptom severity. These findings underscore the importance of conducting thorough assessment of multiple trauma exposures when evaluating recently post-deployed veterans.

Taurine in hippocampus: Localization and postsynaptic action

Both immunocytochemical and electrophysiological methods have been employed to determine whether the localization of the taurine synthetic enzyme, cysteine sulfinic acid decarboxylase, (CSAD) and the postsynaptic action of taurine in the CA1 region of rat hippocampus are consistent with the hypothesis that taurine may be used as a neurotransmitter by some hippocampal neurons. At the light microscopic level, CSAD-immunoreactivity (CSAD-IR) was found in the pyramidal basket cells, and around pyramidal cells in stratum pyramidale and stratum radiatum. At the electron microscopic level, CSAD-IR was seen most often in the soma and the dendrites and was rather infrequent in the axon or the nerve terminals. Electrophysiological observations on the in vitro hippocampal slice demonstrated that pyramidal neurons respond to artificially applied taurine with inhibition that depended in large part upon an increased chloride conductance. Although electrophysiological observations are consistent with a neurotransmitter role for taurine, results from immunocytochemical studies suggest a minor role for taurine as a neurotransmitter. In fact, immunocytochemical observations suggested that taurine may be used as a neurotransmitter only by a small number of pyramidal basket interneurons, the vast majority of CSAD-positive neurons may use taurine for other functions.

Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy

Objective To evaluate the cost-effectiveness of routine cystoscopy at the time of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy in terms of cost per ureteral injury identified and treated. Methods Using a hospital-based perspective, a decision-analysis model was constructed to estimate the outcomes and costs of cystoscopy or no cystoscopy at the time of abdominal hysterectomy. A similar model was constructed for vaginal and laparoscopically assisted vaginal hysterectomy to account for the cost of conversion to laparotomy. Cost estimates were based on estimated costs of Duke University Medical Center and from average Medicare reimbursements for similar Diagnostic Related Groups from the Health Care Financing Administration. The incidence of ureteral injury was obtained from a review of the literature. Sensitivity analyses were performed for the following variables: ureteral injury rate, silent ureteral injury rate, cost of cystoscopy, and cost of therapeutic interventions. We assumed a silent renal death rate of 0%. Results Routine cystoscopy at abdominal hysterectomy was cost-saving above a threshold ureteral injury rate of 1.5%. At a ureteral injury rate of 0.2%, the marginal increase in the cost of routine intraoperative cystoscopy was

White matter compromise in veterans exposed to primary blast forces.

108 per abdominal hysterectomy, with an associated cost of

Neuroanatomy of Dopamine: Reward and Addiction

54,000 per ureteral injury identified. In comparison, at a ureteral injury rate of 2%, routine cystoscopy gave a marginal cost savings of

Coronal imaging of the osteomeatal unit: anatomy of 24 variants.

44 per hysterectomy, with a cost savings of

Examining the factor structure of the Connor-Davidson Resilience Scale (CD-RISC) in a post-9/11 U.S. military veteran sample.

2200 per ureteral injury identified intraoperatively. At the baseline ureteral injury rate of 0.5%, routine cystoscopy had a marginally increased cost of

Bio-effects of high magnetic fields: A study using a simple animal model

83 per hysterectomy, with an incremental cost-effectiveness of

The Dynamic Brain: Neuroplasticity and Mental Health

16,600 spent per ureteral injury identified. The model constructed for vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy yielded a threshold ureteral injury rate of 2%, above which routine cystoscopy was cost-saving. In both models, the incidence of ureteral injury and the cost of readmission were the two variables with the greatest influence on cost-effectiveness. Conclusion The cost-effectiveness of routine intraoperative cystoscopy depends on the rate of ureteral injury independent of the route of hysterectomy. If that rate exceeds 1.5% for abdominal hysterectomy and 2% for vaginal or laparoscopically assisted vaginal hysterectomy, then routine cystoscopy is cost-effective.

The effect of postnatal undernourishment on epileptiform kindling of dorsal hippocampus

Objective:Use diffusion tensor imaging to investigate white matter alterations associated with blast exposure with or without acute symptoms of traumatic brain injury (TBI). Participants:Forty-five veterans of the recent military conflicts included 23 exposed to primary blast without TBI symptoms, 6 having primary blast with mild TBI, and 16 unexposed to blast. Design:Cross-sectional case-control study. Main Measures:Neuropsychological testing and diffusion tensor imaging metrics that quantified the number of voxel clusters with altered fractional anisotropy (FA) radial diffusivity, and axial diffusivity, regardless of their spatial location. Results:Significantly lower FA and higher radial diffusivity were observed in veterans exposed to primary blast with and without mild TBI relative to blast-unexposed veterans. Voxel clusters of lower FA were spatially dispersed and heterogeneous across affected individuals. Conclusion:These results suggest that lack of clear TBI symptoms following primary blast exposure may not accurately reflect the extent of brain injury. If confirmed, our findings would argue for supplementing the established approach of making diagnoses based purely on clinical history and observable acute symptoms with novel neuroimaging-based diagnostic criteria that “look below the surface” for pathology.