bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decomposing Medicaid Spending During Health System Reform and ACA Expansion
Authors: Renfro Stephanie , Lindner Stephan , McConnell K. John 
Published: May 2018

Background:
Expansion of the Medicaid program is likely to create new budgetary pressures at the state and federal levels, creating a need for greater understanding of how program dollars are allocated and what drives spending growth.

Objective:
To characterize Oregon Medicaid expenditures across diseases and medical conditions, during periods of payment reform and coverage expansion.

Research Design:
Decomposition of changes in Medicaid expenditures using a person-based allocation of spending across 50 diseases/medical conditions. Four indices describe changes in costs per enrolled member, demographic shifts, prevalence of treated disease/condition, and costs per treated member.

Subjects:
Oregon Medicaid beneficiaries during 2011 (N=597,422), 2013 (N=614,858), and 2014 (N=978,237).

Results:
Expenditures on pregnancy/birth and mental conditions accounted for 24% of 2011 spending. Oregon’s 2012 payment reform was associated with reduced spending attributable primarily to decreased prevalence of treated conditions. The 2014 Medicaid expansion was marked by lower pregnancy and mental health expenditures and higher spending on treatment for substance use and heart disease.

Conclusions:
Medicaid spending is concentrated among a small group of medical conditions, not all of which are typically associated with the program. The relative expenditure burdens for some conditions are likely to change with health system reform and enrollment expansions. Decomposition into 4 indices and reporting by disease/condition elucidate variability in drivers of cost growth.
Microbial Metabolism in the Mammalian Gut
Authors: Hall Anne , Versalovic James 
Published: May 2018

ABSTRACTHuman intestinal microbes participate actively at the interface of diet, nutrition, and overall health status. These biodiverse communities of microorganisms have a broader metabolic repertoire compared with their host, and they are able to synthesize and degrade substrates that would be otherwise unavailable. In recent years, we have recognized that healthy microbial communities are important for energy harvest and the regulation of body systems outside the digestive tract. Microbial dysbiosis, however, has been implicated in a number of human disorders, including obesity and inflammation. This dichotomy highlights the need to understand the factors that determine the composition and metabolic output of our resident and transient microbes. Throughout the human lifespan, we know that diet plays a major role in shaping gut microbial communities, as well as directing the types and amounts of metabolites produced. Understanding the factors that affect microbial metabolic output within the host may help identify the roles of microbes in health, as well as new targets for treatment in disease. In this article, we review facets of the assembly and activities of the healthy human intestinal microbiome, as well as ways that the microbiota has been shown to influence the host via metabolism of two dietary macronutrients: carbohydrates and amino acids.
Maltase Has Most Versatile α‐Hydrolytic Activity Among the Mucosal α‐Glucosidases of the Small Intestine
Authors: Lee Byung‐Hoo , Hamaker Bruce R. 
Published: May 2018

ABSTRACTComplete digestion of the glycemic carbohydrates to glucose takes place through the combined action of the 4 mucosal α‐glucosidases (maltase‐glucoamylase and sucrase‐isomaltase) in the small intestine. Maltase digests α‐1,2‐ and α‐1,3‐disaccharides better than the other α‐glucosidases, and has, as well, the capability to effectively hydrolyze α‐1,4 and α‐1,6 linkages that form the major backbone of a starch molecule. This broad hydrolytic activity on α‐linkages makes it an enzyme that has the most versatile α‐hydrolytic activity among the 4mucosal α‐glucosidases. The slowly digestible properties of the unusual linkages from this research suggest the development of new glycemic oligosaccharides which will be hydrolyzed slowly, compared to α‐1,4 linkages, for modulating the postprandial glycemic response. In addition, using mammalian mucosal α‐glucosidases is a better fit to characterize carbohydrate digestion properties, compared to fungal amyloglucosidase which is currently applied in in vitro assays.
Metabolic Impacts of Maltase Deficiencies
Authors: Nichols Buford L. , Baker Susan S. , Quezada‐Calvillo Roberto 
Published: May 2018

ABSTRACTThe mucosal maltase enzymes are characterized by an activity that produces glucose from linear glucose polymers, assayed with the disaccharide maltose. The related enzyme isomaltase produces glucose from branched glucose polymers, assayed with palatinose. Maltase and isomaltase activities are part of the 4 disaccharidases assayed from clinical duodenal biopsy homogenates. The reported maltase activities are more difficult to interpret than lactase or sucrase activities because both the sucrase‐isomaltase and maltase‐glucoamylase proteins have overlapping maltase activities. The early work of Dahlqvist identified 4 maltase activities from human small intestinal mucosa. On one peptide, sucrase (maltase Ib) and isomaltase (maltase Ia) activities shared maltase activities but identified the enzymes as sucrase‐isomaltase. On the other peptide, no distinguishing characteristics of the 2 maltase activities (maltases II and III) were detected and the activities identified as maltase‐glucoamylase. The nutritional/clinical importance of small intestinal maltase and isomaltase activities are due to their crucial role in the digestion of food starches to absorbable free glucose. This review focuses on the interpretation of biopsy maltase activities in the context of reported lactase, sucrase, maltase, and palatinase biopsy assay activity patterns. We present a classification of mucosal maltase deficiencies and novel primary maltase deficiency (Ib, II, III) and provide a clarification of the role of maltase activity assayed from clinically obtained duodenal biopsies, as a path toward future clinical and molecular genomic investigations.
The History of Maltose‐active Disaccharidases
Authors: Lentze Michael J. 
Published: May 2018

ABSTRACTThe history of maltose‐active disaccharidases is closely related to the history of the sugar and starch industry. It began in the 19th century, when a shortage of cane sugar occurred in continental Europe, because Napoleon Bonaparte decreed that no goods could be imported from England to the countries he occupied. Other sugar sources had to be found, and it led to the identification of sugar beets as alternative source of sugar by Marggraf in 1774, to the detection of starch hydrolysis by diluted sulfuric acid by Kirchhoff in 1812, and to the starch digestion enzyme, α‐amylase, by Payen in 1833. In the 20th century, Borkström's group in Sweden investigated the absorption of nutrients in human adults by transintubation techniques and found that the luminal concentration of invertase was small compared to that of α‐amylase. They speculated that the major locus of this enzyme activity must be in the intestinal cells. Borkström's coworker, Dahlqvist, investigated the maltose‐active enzymes in pig intestine, and a second group around Semenza studied the maltase‐active enzymes in rabbit intestine. After the first descriptions of congenital sucrase‐isomaltase deficiency in 1960 and 1961, the research on disaccharidases increased. Dahlqvist published the first quantitative method to measure these enzymes. Consecutive research led to the discovery of 4 maltases, which were later identified as 2 complex enzymes: the sucrase‐isomaltase complex and the maltase‐glucoamylase complex. The homology of the 2 enzyme complexes was later determined when the cDNA sequences of the 2 complexes in human intestine were identified.
Clinical Characteristics of Disaccharidase Deficiencies Among Children Undergoing Upper Endoscopy
Authors: Cohen Stanley A. , Oloyede Hannah , Gold Benjamin D. , Mohammed Aminu , Elser Heather E. 
Published: May 2018

ABSTRACTObjectives:The epidemiology and clinical significance of disaccharidase deficiencies have not been thoroughly characterized. Recent work suggests at least genetic sucrase‐isomaltase deficiency is more prevalent than previously believed. Because lactase deficiency (LD) is well described, the present study focuses on the clinical characteristics of children with disaccharidase deficiencies determined by esophagogastroduodenoscopy.Methods:Endoscopic records were reviewed from patients undergoing esophagogastroduodenoscopies with biopsies assayed for disaccharidase activity performed by 13 pediatric gastroenterologists during 5 years (2010–2014). Presenting symptoms, clinical and histological diagnosis, treatment, disaccharidase results, and demographic variables were obtained from medical and endoscopic records of those with maltase and sucrase deficiency (SD).Results:Among 963 patients undergoing intestinal disaccharidase testing, 73 (7.6%) had SD on biopsy (enzyme activity <25 μmol · min−1 · g−1). Thirty‐four (34/73; 47%) had normal duodenal histology and are the focus of this report. Four patients had SD without LD. Pan‐disaccharidase deficiency was observed in 24 patients when maltase and palatinase assays were obtained (n = 646), and 11 had SD + LD when just those 2 enzymes were analyzed (n = 317). Those with SD without LD were younger 4.6 ± 6.1 versus 14.1 ± 3.6 years and uniformly presented with diarrhea. Patients with pan‐disaccharidase deficiency or SD + LD primarily reported abdominal pain (33/35; 94%), diarrhea (16/35; 46%), nausea (14/35; 40%); and poor weight gain/weight loss (10/35; 29%); constipation, flatulence, and bloating were also noted. Maltase deficiency is less common (8/963; 0.8%), presenting with similar symptoms.Conclusions:Genetic sucrase‐isomaltase deficiency often occurs together with lactase or pan‐disaccharide deficiency. Disaccharidase deficiency should be considered a potential cause of abdominal pain and/or diarrhea in children and adolescents.
Starch Consumption Patterns in Infants and Young Children
Authors: Quann Erin , Carvalho Ryan 
Published: May 2018

ABSTRACTBackground:The introduction of starch into an infant's diet is an important milestone in the feeding journey. Intestinal maturity and the presence of digestive enzymes are necessary for the physiologic breakdown of starch and other complementary foods. However, little is known about the consumption patterns of starch containing foods during complementary feeding.Method:The 2008 Feeding Infants and Toddlers Study (FITS) is a cross‐sectional 24‐hour dietary intake survey of a nationally representative sample of infants, toddlers, and preschoolers from birth to 48 months of age. We looked at the age‐based prevalence of consumption of starch‐containing foods during complementary feeding.Results:We found that about 90% of infants were consuming starch by 6 and 8.9 months, with less than half of infants being exposed to complementary foods from multiple food groups under 6 months. The most common food source of starch was iron‐fortified infant cereals, followed by vegetables and fruits. Rice and oats were the most prevalent cereal types, while sweet potatoes, peas and squash were the most commonly consumed starch‐containing vegetables. Bananas were the leading starch‐containing fruit that was consumed. Around 9 and 11 months, the prevalence of iron‐fortified cereals declined and were replaced with lower iron‐containing ready‐to‐eat cereals. There was also a drop in the prevalence of fruit and vegetable consumption once the infant became a toddler. Most bread products consumed by toddlers were not whole grain, but their cereal choices were often whole grain. Other sources of starch were mixed dishes, which contained grains like bread or pasta combined with other types of foods.Conclusions:Starch enters the infant's diet around the time of complementary feeding, though earlier exposure may occur from certain carbohydrate components of infant formula. Most infants are exposed to starch from grains, followed by vegetables and fruits.
Structure and Digestion of Common Complementary Food Starches
Authors: Lin Amy Hui‐Mei 
Published: May 2018

ABSTRACTStarch is the major source of dietary glucose for rapid development of children. Starches from various crops naturally differ in molecular structures and properties. Cooking, processing, and storage may change their molecular properties and affect their digestibility and functionality. Starch digestion is affected by its susceptibility to α‐amylase and α‐glucosidase (maltase), and the susceptibility is determined by starch granule architecture and glucan structures, as well as the interaction between starch and other food components. Starch is given as a complementary feeding to young children in many cultures, and starch or modified starch, is used in special formulae of infant foods or supplements. Although indigestible starch does not provide much energy, it can benefit colonic health.
Feasibility of a Cognitive-Behavioral and Environmental Intervention for Sleep-Wake Difficulties in Community-Dwelling Cancer Patients Receiving Palliative Care
Authors: Bernatchez Marie Solange , Savard Josée , Savard Marie-Hélène , Aubin Michèle 
Published: May 2018

Background
High rates of sleep-wake difficulties have been found in patients with cancer receiving palliative care. Pharmacotherapy is the most frequently used treatment option to manage these difficulties despite numerous adverse effects and the absence of empirical evidence of its efficacy and innocuity in palliative care.

Objective
This pilot study aimed to assess the feasibility and acceptability of a cognitive-behavioral and environmental intervention (CBT-E) to improve insomnia and hypersomnolence in patients with a poor functioning level and to collect preliminary data on its effects.

Methods
Six patients with cancer receiving palliative care (Eastern Cooperative Oncology Group score 2–3), who had insomnia and/or hypersomnolence, received 1 CBT-E individual session at home. They applied the strategies for 3 weeks. Patients completed the Insomnia Severity Index, the Epworth Sleepiness Scale, a daily sleep diary, and a 24-hour actigraphic recording (7 days) at pretreatment and posttreatment, in addition to a semistructured interview (posttreatment).

Results
Participants found strategies easy to apply most of the time, and none was rated as impossible to use because of their health condition. However, their adherence and satisfaction toward CBT-E were highly variable. Results on the effects of CBT-E were heterogeneous, but improvements were observed in patients with a persistent insomnia disorder.

Conclusions
The CBT-E protocol tested among this highly selected sample was fairly well received and suggested positive outcomes in some patients, particularly those with an insomnia complaint alone.

Implications
Efforts should be pursued to adapt CBT-E and develop other nonpharmacological interventions, in order to provide an alternative to pharmacotherapy for sleep-wake difficulties in this population.
Human Immunodeficiency Virus Serodiscordance and Dual Contraceptive Method Use Among Human Immunodeficiency Virus-infected Men and Women in Lilongwe, Malawi
Authors: Gausi Blessings , Chagomerana Maganizo B. , Tang Jennifer H. , Hosseinipour Mina C. , Haddad Lisa B. , Hannock Tweya , Phiri Sam 
Published: May 2018

Background
Some human immunodeficiency virus (HIV) serodiscordant couples are faced with the dual challenge of preventing HIV transmission to the uninfected partner and avoiding unintended pregnancy. Therefore, we hypothesized that serodiscordance is associated with dual method use at last sex.

Methods
We analyzed data from a cross-sectional survey of HIV-infected men and women attending 2 ante-retroviral therapy clinics in Lilongwe, Malawi. We used Fisher exact test and Wilcoxon rank sum to assess for associations between serodiscordance, covariates, and dual method use. Multivariable logistic regression was used to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) of dual method use at last sex, comparing serodiscordant to seroconcordant relationships. Separate analyses were conducted for men and women.

Results
We surveyed 253 HIV-infected men, of which 44 (17.4%) were in a known serodiscordant relationship and 63 (24.9%) were using dual methods at last sex. Likewise, among 302 HIV-infected women surveyed, 57 (18.9%) were in a known serodiscordant relationship, and 80 (26.5%) were using dual method at last sex. Serodiscordance was not significantly associated with dual method use at last sex for among HIV-infected men (aOR, 0.62; 95% CI, 0.27–1.44) or women (aOR, 1.21; 95% CI, 0.59–2.47).

Conclusion
Dual method use was low among all HIV-infected individuals, irrespective of their partner's HIV status. Given these findings, we recommend greater efforts to encourage HIV providers to counsel their patients about the importance of dual method use to prevent both unintended pregnancy and sexually transmitted infections.
Reduced intraepidermal nerve fibre density, glial activation, and sensory changes in HIV type-1 Tat-expressing female mice: involvement of Tat during early stages of HIV-associated painful sensory neuropathy
Authors: Wodarski Rachel , Bagdas Deniz , Paris Jason J. , Pheby Tim , Toma Wisam , Xu Ruqiang , Damaj M. Imad , Knapp Pamela E. , Rice Andrew S.C. , Hauser Kurt F. 
Published: May 2018

Abstract

Introduction:
HIV infection is associated with chronic pain states, including sensory neuropathy, which affects greater than 40% of patients.

Objectives and Methods:
To determine the impact of HIV-Tat induction on nociceptive behaviour in female mice conditionally expressing HIV Tat1-86 protein through a doxycycline (DOX)-driven glial fibrillary acidic protein promoter, intraepidermal nerve fibre density and immune cell activation in the dorsal root ganglion (DRG) and spinal cord were assessed by immunohistochemistry. Mice were assessed for mechanical and thermal sensitivity for 9 weeks using von-Frey and Hargreaves tests.

Results:
Intraepidermal nerve fibre density was significantly reduced after 6 weeks of Tat induction, similar to sensory neuropathy seen in clinical HIV infection. Tat induction through DOX caused a significant reduction in paw withdrawal thresholds in a time-dependent manner starting the 4th week after Tat induction. No changes in paw withdrawal latencies were seen in Tat(−) control mice lacking the tat transgene. Although reductions in paw withdrawal thresholds increased throughout the study, no significant change in spontaneous motor activity was observed. Spinal cord (cervical and lumbar), DRG, and hind paw skin were collected at 8 days and 6 weeks after Tat induction. HIV-Tat mRNA expression was significantly increased in lumbar DRG and skin samples 8 days after DOX treatment. Tat induced a significant increase in the number of Iba-1 positive cells at 6 weeks, but not after 8 days, of exposure. No differences in glial fibrillary acidic protein immunoreactivity were observed.

Conclusion:
These results suggest that Tat protein contributes to painful HIV-related sensory neuropathy during the initial stages of the pathogenesis.
Computed Tomography Perfusion Measurements in Renal Lesions Obtained by Bayesian Estimation, Advanced Singular-Value Decomposition Deconvolution, Maximum Slope, and Patlak Models
Authors: Deniffel Dominik , Boutelier Timothé , Labani Aissam , Ohana Mickael , Pfeiffer Daniela , Roy Catherine 
Published: May 2018

Objectives
The aims of this study were to evaluate the agreement of computed tomography (CT)-perfusion parameter values of the normal renal cortex and various renal tumors, which were obtained by different mathematical models, and to evaluate their diagnostic accuracy.

Materials and Methods
Perfusion imaging was performed prospectively in 35 patients to analyze 144 regions of interest of the normal renal cortex and 144 regions of interest of renal tumors, including 21 clear-cell renal cell carcinomas (RCC), 6 papillary RCCs, 5 oncocytomas, 1 chromophobe RCC, 1 angiomyolipoma with minimal fat, and 1 tubulocystic RCC. Identical source data were postprocessed and analyzed on 2 commercial software applications with the following implemented mathematical models: maximum slope, Patlak plot, standard singular-value decomposition (SVD), block-circulant SVD, oscillation-limited block-circulant SVD, and Bayesian estimation technique. Results for blood flow (BF), blood volume (BV), and mean transit time (MTT) were recorded. Agreement and correlation between pairs of models and perfusion parameters were assessed. Diagnostic accuracy was evaluated by receiver operating characteristic (ROC) analysis.

Results
Significant differences and poor agreement of BF, BV, and MTT values were noted for most of model comparisons in both the normal renal cortex and different renal tumors. The correlations between most model pairs and perfusion parameters ranged between good and perfect (Spearman ρ = 0.79–1.00), except for BV values obtained by Patlak method (ρ = 0.61–0.72). All mathematical models computed BF and BV values, which differed significantly between clear cell RCCs, papillary RCCs, and oncocytomas, which introduces them as useful diagnostic tests to differentiate between different histologic subgroups (areas under ROC curve, 0.83–0.99). The diagnostic accuracy to discriminate between clear-cell RCCs and the renal cortex was the lowest based on the Patlak plot model (area under ROC curve, 0.76); BF and BV values obtained by other algorithms did not differ significantly in their diagnostic accuracy.

Conclusions
Quantitative perfusion parameters obtained from different mathematical models cannot be used interchangeably. Based on BF and BV estimates, all models are a useful tool in the differential diagnosis of kidney tumors, with the Patlak plot model yielding a significantly lower diagnostic accuracy.
Adrenal Histoplasmosis
Authors: Sanders Vanessa , Donald Joseph , Siegel Barry A. 
Published: May 2018

Abstract
An 89-year-old woman presented with seizure and hyponatremia. CT and MRI demonstrated mass-like enlargement of the adrenal glands and multiple pulmonary nodules. PET/CT performed to evaluate for metastatic disease demonstrated intense 18F-FDG uptake within enlarged adrenal glands. Given mild uptake in the pulmonary nodules, the differential diagnosis for the adrenal uptake included lymphoma, granulomatous infection, and less likely, metastatic lung cancer.
“Hepatic Superscan” in a Patient With Hepatosplenic Alphabeta T-cell Lymphoma
Authors: Liu Entao , Wang Siyun , Lai Peilong , Lian Zhouyang , Wang Shuxia 
Published: May 2018

Abstract
A 36-year-old woman with a 2-week history of fever and markedly elevated lactate dehydrogenase levels. Nonenhanced CT and contrast-enhanced CT showed hepatosplenomegaly, diffusely decreased attenuation of the liver, and homogeneous enhancement in the hepatic and splenic parenchyma. 18F-FDG PET/CT revealed diffuse intense heterogeneous uptake by the liver (like superscan in bone scintigraphy). A liver needle biopsy confirmed the diagnosis of hepatosplenic alphabeta T-cell lymphoma. Subsequently, she received chemotherapy. The follow-up 18F-FDG PET/CT showed decreased 18F-FDG uptake in the liver and spleen.
BRCA2 Mutation as a Possible Cause of Poor Response to 177Lu-PSMA Therapy
Authors: Ahmadzadehfar Hojjat , Gaertner Florian , Lossin Philipp S. , Schwarz Bettina , Essler Markus 
Published: May 2018

Abstract
We present the case of a 66-year-old man with castration-resistant prostate cancer, with an increasing prostate-specific antigen level, and a progressive disease during 177Lu-PSMA radionuclide therapy. Because the patient had a BRCA2 mutation, poly-ADP ribose polymerase inhibitor therapy was started. The patient showed a dramatic subjective and biological response to this therapy with a progression-free survival of 5 months.