bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coverage and Preventive Screening
Authors: Meeker Daniella , Joyce Geoffrey F. , Malkin Jesse , Teutsch Steven M. , Haddix Anne C. , Goldman Dana P. 
Published: October 2010

Context. Preventive care has been shown as a high‐value health care service. Many employers now offer expanded coverage of preventive care to encourage utilization.Objective. To determine whether expanding coverage is an effective means to encourage utilization.Design. Comparison of screening rates before and after introduction of deductible‐free coverage.Setting. People insured through large corporations between 2002 and 2006.Patients or Other Participants. Preferred Provider Organization (PPO) enrollees from an employer introducing deductible‐free coverage, and a control group enrolled in a PPO from a second employer with no policy change.Main Outcome Measures. Adjusted probability of endoscopy, fecal occult blood test (FOBT), lipid screens, mammography, and Papanicolaou (pap) smears.Intervention. Introduction of first‐dollar coverage (FDC) of preventive services in 2003.Results. After adjusting for demographics and secular trends, there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens (lipid screens, pap smears, mammograms, and FOBT), with no significant changes in the control group or in a service without FDC (endoscopy).Conclusions. FDC improves utilization modestly among healthy individuals, particularly those in lower deductible plans. Compliance with guidelines can be encouraged by lowering out‐of‐pocket costs, but patients' predisposing characteristics merit attention.
Incremental Cost of Postacute Care in Nursing Homes
Authors: Spector William D. , Limcangco Maria Rhona , Ladd Heather , Mukamel Dana 
Published: October 2010

Objectives. To determine whether the case mix index (CMI) based on the 53‐Resource Utilization Groups (RUGs) captures all the cross‐sectional variation in nursing home (NH) costs or whether NHs that have a higher percent of Medicare skilled care days (%SKILLED) have additional costs.Data and Sample. Nine hundred and eighty‐eight NHs in California in 2005. Data are from Medicaid cost reports, the Minimum Data Set, and the Economic Census.Research Design. We estimate hybrid cost functions, which include in addition to outputs, case mix, ownership, wages, and %SKILLED. Two‐stage least‐square (2SLS) analysis was used to deal with the potential endogeneity of %SKILLED and CMI.Results. On average 11 percent of NHs days were due to skilled care. Based on the 2SLS model, %SKILLED is associated with costs even when controlling for CMI. The marginal cost of a one percentage point increase in %SKILLED is estimated at U.S.$70,474 or about 1.2 percent of annual costs for the average cost facility. Subanalyses show that the increase in costs is mainly due to additional expenses for nontherapy ancillaries and rehabilitation.Conclusion. The 53‐RUGs case mix does not account completely for all the variation in actual costs of care for postacute patients in NHs.
Effects of Competition on the Cost and Quality of Inpatient Rehabilitation Care under Prospective Payment
Authors: Colla Carrie Hoverman , Escarce José J. , Buntin Melinda Beeuwkes , Sood Neeraj 
Published: October 2010

Objective. To determine the effect of competition in postacute care (PAC) markets on resource intensity and outcomes of care in inpatient rehabilitation facilities (IRFs) after prospective payment was implemented.Data Sources. Medicare claims, Provider of Services file, Enrollment file, Area Resource file, Minimum Data Set.Study Design. We created an exogenous measure of competition based on patient travel distances and used instrumental variables models to estimate the effect of competition on inpatient rehabilitation costs, length of stay, and death or institutionalization.Data Extraction Methods. A file was constructed linking data for Medicare patients discharged from acute care between 2002 and 2003 and admitted to an IRF with a diagnosis of hip fracture or stroke.Principal Findings. Competition had different effects on treatment intensity and outcomes for hip fracture and stroke patients. In the treatment of hip fracture, competition increased costs and length of stay, while increasing rates of death or institutionalization. In the treatment of stroke, competition decreased costs and length of stay and produced inferior outcomes.Conclusions. The effects of competition in PAC markets may vary by condition. It is important to study the effects of competition by diagnostic condition and to study the effects across populations that vary in severity. Our finding that higher competition under prospective payment led to worse IRF outcomes raises concerns and calls for additional research.
Impact of High‐Deductible Health Plans on Health Care Utilization and Costs
Authors: Waters Teresa M. , Chang Cyril F. , Cecil William T. , Kasteridis Panagiotis , Mirvis David 
Published: October 2010

Background. High‐deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model.Objective. To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer‐based health plans.Data. Claims and member data from a major insurer and zip code‐level census data.Study Design. Retrospective difference‐in‐differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls).Results. In two‐part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronically ill enrollees and those who clearly had a choice of plans were more likely to increase utilization in specific categories after switching to an HDHP plan.Conclusions. Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives.
Counting Uninsurance and Means‐Tested Coverage in the American Community Survey: A Comparison to the Current Population Survey
Authors: Boudreaux Michel , Ziegenfuss Jeanette Y. , Graven Peter , Davern Michael , Blewett Lynn A. 
Published: October 2010

Objective. To compare health insurance coverage estimates from the American Community Survey (ACS) to the Current Population Survey (CPS‐ASEC).Data Sources/Study Setting. The 2008 ACS and CPS‐ASEC, 2009.Study Design. We compare age‐specific national rates for all coverage types and state‐level rates of uninsurance and means‐tested coverage. We assess differences using t‐tests and p‐values, which are reported at <.05, <.01, and <.001. An F‐test determines whether differences significantly varied by state.Principal Findings. Despite substantial design differences, we find only modest differences in coverage estimates between the surveys. National direct purchase and state‐level means‐tested coverage levels for children show the largest differences.Conclusions. We suggest that the ACS is well poised to become a useful tool to health services researchers and policy analysts, but that further study is needed to identify sources of error and to quantify its bias.
The Residential History File: Studying Nursing Home Residents' Long‐Term Care Histories*
Authors: Intrator Orna , Hiris Jeffrey , Berg Katherine , Miller Susan C. , Mor Vince 
Published: October 2010

Objective. To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations, including non‐Medicare‐paid NH stays.Data Sources. Online Survey of Certification and Reporting (OSCAR) data for 202 free‐standing NHs, Medicare Denominator, claims (parts A and B), and MDS assessments for 60,984 people who were present in one of these NHs in 2006.Methods. The algorithm creating the RHF is outlined and the RHF for the study data are used to describe place of death. The identification of residents in NHs is compared with the reports in OSCAR and part B claims.Principal Findings. The RHF correctly identified 84.8 percent of part B claims with place‐of‐service in NH, and it identified 18.3 less residents on average than reported in the OSCAR on the day of the survey. The RHF indicated that 17.5 percent non‐Medicare NH decedents were transferred to the hospital to die versus 45.6 percent skilled nursing facility decedents.Conclusions. The population‐based design of the RHF makes it possible to conduct policy‐relevant research to examine the variation in the rate and type of health care transitions across the United States.
Early Diagnosis and Rescue Pericardiocentesis for Acute Cardiac Tamponade during Radiofrequency Ablation for Arrhythmias. Is Fluoroscopy Enough?
Authors: HUANG XIN‐MIAO , HU JIAN‐QIANG , ZHOU FEI , QIN YONG‐WEN , CAO JIANG , ZHOU BING‐YAN , ZHAO XIAN‐XIAN , ZHENG XING 
Published: October 2010

Background: With the number of complex catheter ablation procedures increasing, procedure‐related acute cardiac tamponade is encountered more frequently in the cardiac catheterization laboratory. Survival depends on prompt recognition and rescue pericardiocentesis.
Objective: The aim of this report was to validate fluoroscopic heart silhouette characteristics associated with cardiac tamponade as a diagnostic method, and evaluate the safety and effectiveness of fluoroscopy‐guided pericardiocentesis during catheter ablation.
Methods: All cases of acute cardiac tamponade that occurred in the cardiac catheterization laboratory during radiofrequency catheter ablation from March 2004 to November 2009 were reviewed retrospectively.
Results: Of 1,832 catheter ablation procedures performed during a 5‐year period, 10 (0.55%) were complicated by cardiac tamponade. Fluoroscopic examination confirmed the diagnosis in all 10 patients and demonstrated effusions before hypotension in four patients. All patients were stabilized by fluoroscopy‐guided pericardiocentesis with placement of an indwelling catheter and autologous transfusion. The time interval between recognition of cardiac tamponade and completion of pericardiocentesis was 6.0 ± 1.8 minutes (range 3–9 minutes). The mean aspirated blood volume was 437 mL (range 110–1,400 mL), and the mean autotransfused blood volume was 425 mL (range 100–1,384 mL). Surgical repair of the cardiac perforation was needed in one patient. No procedure‐related death occurred.
Conclusion: A reduction in the excursion of cardiac silhouette on fluoroscopy is an early diagnostic sign of cardiac tamponade during radiofrequency ablation. Fluoroscopy‐guided pericardiocentesis is a safe and effective management strategy for cardiac tamponade developed in the cardiac catheterization laboratory. (PACE 2011; 9–14)
Advanced Image Fusion to Overlay Coronary Sinus Anatomy with Real‐Time Fluoroscopy to Facilitate Left Ventricular Lead Implantation in CRT
Authors: DUCKETT SIMON G. , GINKS MATTHEW R , KNOWLES BENJAMIN R. , MA YINGLIANG , SHETTY ANOOP , BOSTOCK JULIAN , COOKLIN MICHAEL , GILL JAS S. , CARR‐WHITE GERRY S. , RAZAVI REZA , SCHAEFFTER TOBIAS , RHODE KAWAL S. , RINALDI C. ALDO 
Published: October 2010

Background: Failure rate for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) is up to 12%. The use of segmentation tools, advanced image registration software, and high‐fidelity images from computerized tomography (CT) and cardiac magnetic resonance (CMR) of the coronary sinus (CS) can guide LV lead implantation. We evaluated the feasibility of advanced image registration onto live fluoroscopic images to allow successful LV lead placement.
Methods: Twelve patients (11 male, 59 ± 16.8 years) undergoing CRT had three‐dimensional (3D) whole‐heart imaging (six CT, six CMR). Eight patients had at least one previously failed LV lead implant. Using segmentation software, anatomical models of the cardiac chambers, CS, and its branches were overlaid onto the live fluoroscopy using a prototype version of the Philips EP Navigator software to guide lead implantation.
Results: We achieved high‐fidelity segmentations of cardiac chambers, coronary vein anatomy, and accurate registration between the 3D anatomical models and the live fluoroscopy in all 12 patients confirmed by balloon occlusion angiography. The CS was cannulated successfully in every patient and in 11, an LV lead was implanted successfully. (One patient had no acceptable lead values due to extensive myocardial scar.)
Conclusion: Using overlaid 3D segmentations of the CS and cardiac chambers, it is feasible to guide CRT implantation in real time by fusing advanced imaging and fluoroscopy. This enabled successful CRT in a group of patients with previously failed implants. This technology has the potential to facilitate CRT and improve implant success. (PACE 2011; 34:226–234)
Long‐Term Outcome of Leads and Patients Following Robotic Epicardial Left Ventricular Lead Placement for Cardiac Resynchronization Therapy
Authors: KAMATH GANESH S. , BALARAM SANDHYA , CHOI ANDREW , KUTEYEVA OLGA , GARIKIPATI NAGA VAMSI , STEINBERG JONATHAN S. , MITTAL SUNEET 
Published: October 2010

Introduction: In cardiac resynchronization therapy (CRT), positive clinical response and reverse remodeling have been reported using robotically assisted left ventricular (LV) epicardial lead placement. However, the long‐term performance of epicardial leads and long‐term outcome of patients who undergo CRT via robotic assistance are unknown. In addition, since the LV lead placement is more invasive than a transvenous procedure, it is important to identify patients at higher risk of complications.
Methods: We evaluated 78 consecutive patients (70 ± 11 years, 50 male) who underwent robotic epicardial LV lead placement. The short‐ (<12 months) and long‐term (≥12 months) lead performance was determined through device interrogations. Mortality data were determined by contact with the patient's family and referring physicians and confirmed using the Social Security Death Index.
Results: All patients had successful lead placement and were discharged in stable condition. When compared to the time of implantation, there was a significant increase in pacing threshold (1.0 ± 0.5 vs 2.14 ± 1.2; P < 0.001) and decrease in lead impedance (1010 ± 240 Ω vs 491 ± 209 Ω; P < 0.001) at short‐term follow‐up. The pacing threshold (2.3 ± 1.2 vs 2.14 ± 1.2; P = 0.30) and lead impedance (451 ± 157 Ω vs 491 ± 209 Ω; P = 0.10) remained stable during long‐term follow‐up when compared to short‐term values. At a follow‐up of 44 ± 21 months, there were 20 deaths (26%). These patients were older (77 ± 7 vs 67 ± 11 years; P = 0.001) and had a lower ejection fraction (EF) (13 ± 7% vs 18 ± 9%; P = 0.02) than surviving patients.
Conclusion: Robotically implanted epicardial LV leads for CRT perform well over short‐ and long‐term follow‐up. Older patients with a very low EF are at higher risk of death. The risks and benefits of this procedure should be carefully considered in these patients. (PACE 2011; 34:235–240)
Comparison of the Point‐by‐Point versus Catheter Dragging Technique for Curative Radiofrequency Ablation of Atrial Fibrillation
Authors: YOKOKAWA MIKI , BHANDARI ANIL K. , TADA HIROSHI , SUZUKI ATSUSHI , KAWAMURA MITSUHARU , HO IVAN , CANNOM DAVID S. 
Published: October 2010

Background: The relationship between the applied techniques and clinical outcomes after radiofrequency (RF) ablation of atrial fibrillation (AF) remains unclear. We compared the results of ablation by RF delivered via a point‐by‐point versus catheter dragging technique for the treatment of AF.
Methods: This study included 66 patients with drug‐refractory AF who underwent circumferential pulmonary vein (PV) ablation. A point‐by‐point technique was used in 35 (53%) patients (Group I), and catheter dragging technique in the remaining 31 (47%) patients (Group II). If AF persisted or remained inducible after the PV isolation, additional ablation of complex fractionated atrial electrograms and linear ablation were performed.
Results: Significantly, fewer RF applications were delivered in Group II than in Group I. The total RF energy duration delivered was comparable between the two groups (P = 0.55). However, the total energy of RF deliveries was significantly greater in Group II than in Group I (P = 0.02). Despite a longer fluoroscopic exposure time (P = 0.01), the total procedural duration was significantly shorter in Group II than in Group I (P = 0.005). Within 3 months after a single ablation procedure, 24 patients (69%) in Group I versus 13 patients (42%) in Group II had ≥1 recurrence(s) of atrial tachyarrhythmias (P = 0.03). A multivariate analysis showed that a point‐by‐point ablation was the only independent predictor of early atrial tachyarrhythmia recurrences.
Conclusions: The catheter dragging technique for ablation of AF was associated with a lower early recurrence rate of atrial tachyarrhythmias than the point‐by‐point technique. (PACE 2011; 15–22)
Investigating the relationship between hyposalivation and mucosal wetness
Authors: Osailan S , Pramanik R , Shirodaria S , Challacombe SJ , Proctor GB 
Published: October 2010

Oral Diseases (2010) 17, 109–114Background:  Mucosal wetness (MW) reflects the layer of residual saliva that covers the oral mucosal surfaces.Objectives:  The aim of this study was to determine MW at different oral mucosa sites and to investigate the relationship between MW, unstimulated whole salivary flow rates (UWS) and Clinical Oral Dryness Score (CODS).Method:  A total of 100 dry mouth patients and 50 healthy subjects participated in the study. MW was sampled with filter paper strips at four sites inside the mouth; anterior hard palate (AHP), buccal mucosa (BUC), anterior tongue (AT), lower lip (LL) and measured with a micro‐moisture meter. Reproducibility was assessed by repeated sampling and diurnal variation was examined.Results:  Mucosal wetness in healthy subjects differed according to site and means ± SD were; AHP (11 ± 11.7 μm), BUC (32 ± 14.8 μm), AT (65 ± 17.2 μm), and LL (25 ± 13.5 μm). Dry mouth patients with reduced UWS showed increased CODS. MW at all four sites was significantly reduced (P < 0.05) in dry mouth patients compared with the healthy subjects. Reproducibility of MW measurement using the intra‐class correlation coefficient showed agreement at different visits within subject. MW of the AT showed a positive correlation with UWS (P < 0.05).Conclusion:  Mucosal wetness is a reliable measure of oral dryness and had a positive correlation with UWS.
Lack of modulatory function of coding nucleotide polymorphism S100A2_185G>A in oral squamous cell carcinoma
Authors: Tsai W‐C , Lin Y‐C , Tsai S‐T , Shen W‐H , Chao T‐L , Lee S‐L , Wu L‐W 
Published: October 2010

Oral Diseases (2011) 17, 283–290Objective:  S100A2, a Ca2+ ‐binding protein with two EF‐hands, is a tumor suppressor in oral cancer. Helix III flanking the C‐terminal EF‐hand is implicated to participate in the interaction of S100A2 and its target(s). The aim of this study was to examine if the coding sequence polymorphism S100A2_185G>A, leading to the peptide 62 substitution of asparagine (AAC, A allele) for serine (AGC, G allele) in helix III, had modulation effects on S100A‐mediated tumor suppression.Subjects and Methods:  We sequenced the coding sequence of S100A2 gene in normal oral keratinocytes (NOKs), dysplastic oral keratinocytes (DOKs), eight oral cancer lines, and 54 pairwise oral cancer specimens. We also compared the in vitro anti‐tumor effect of wildtype (G allele) and variant (A allele) S100A2 expression using cell proliferation, migration, invasion, and colony formation assays.Results:  With the exception of CAL27 and SCC‐15 cancer lines being heterozygotes of A and G alleles, the remaining oral cells were homozygotic in G alleles. No alterations of anti‐growth, anti‐migration, anti‐invasion, and anti‐colony formation were observed between variant and wildtype cells. Moreover, no minor S100A2_185A allele was detected in 54‐pairwise clinical specimens.Conclusion:  The coding sequence polymorphism S100A2_185G>A had no regulatory role in S100A2‐mediated tumor suppression in oral cancer.
Shikonin inhibits tumor invasion via down‐regulation of NF‐κB‐mediated MMP‐9 expression in human ACC‐M cells
Authors: Min R , Zun Z , Min Y , Wenhu D , Wenjun Y , Chenping Z 
Published: October 2010

Oral Diseases (2011) 17, 362–369Objective:  The aim of this study was to examine the anti‐invasion effect of Shikonin on human high‐metastatic adenoid cystic carcinoma (ACC‐M) cells and to explain the possible molecular mechanism involved.Methods:  The ACC‐M cells were treated with Shikonin (0, 2.5, 5, 10 μM) for 24 h. The protein levels and gelatinolytic activities of MMP‐2 and MMP‐9 were analyzed using Western blot and Gelatin zymography test, respectively. Matrigel invasion assays were used to investigate tumor invasive potential and electromobility shift assays were used to determine the activity of NF‐κB.Results:  The invasiveness of ACC‐M cells was reduced in a dose dependent manner following 24‐h treatment of up to 10 μM of the Shikonin at which concentration no cytotoxicity occurred. The protein levels and gelatinolytic activities of MMP‐9 were significantly suppressed by increasing Shikonin concentrations. The down‐regulation of MMP‐9 appeared to be via the inactivation of NF‐κB as the treatment with Shikonin suppressed the protein level of phosphate‐IkBa, which was accompanied by a decrease in DNA‐binding level of the factor.Conclusions:  Shikonin inhibits tumor invasion via downregulation of MMP‐9 expression in ACC‐M cells. Pharmacologic inhibition of the NF‐κB‐mediated MMP‐9 expression by Shikonin might be a powerful treatment option for ACC patients in future.
Characterization of aortic aneurysms in cardiovascular disease patients harboring Porphyromonas gingivalis
Authors: Nakano K , Wada K , Nomura R , Nemoto H , Inaba H , Kojima A , Naka S , Hokamura K , Mukai T , Nakajima A , Umemura K , Kamisaki Y , Yoshioka H , Taniguchi K , Amano A , Ooshima T 
Published: October 2010

Oral Diseases (2011) 17, 370–378Objective:  Porphyromonas gingivalis was recently shown to cause intimal hyperplasia in a mouse model by a novel cholesterol‐independent mechanism, suggesting to be a pathogen‐specific feature of cardiovascular diseases. The aim of this study was to characterize the clinical and histopathological features of aortic aneurysms in cardiovascular disease patients harboring oral P. gingivalis.Subject and methods:  Aortic aneurysm specimens were collected from 76 Japanese patients who underwent surgery, of whom dental plaque specimens were also collected from 31 patients. Bacterial DNA was extracted from each specimen to detect P. gingivalis by polymerase chain reaction. Histopathological analyses of the aortic aneurysm specimens, including immunohistochemical staining for embryonic myosin heavy chain isoform (SMemb) and S100 calcium‐binding protein A9 (S100A9), were also performed.Results:  The number of aneurysms occurring in the distal aorta was significantly higher in subjects positive for P. gingivalis in dental plaque compared with those who were negative. The expressions of S100A9 and SMemb were also significantly greater in the subjects positive for P. gingivalis in dental plaque. On the other hand, there were no significant differences in adipocellular accumulation between the groups.Conclusions:  These results suggest that aortic aneurysms in patients harboring oral P. gingivalis have greater expression of S100A9 and proliferative smooth muscle cells, which was different from the present patients without oral P. gingivalis.