bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of HMOs on the Inpatient Utilization of Medicare Beneficiaries
Authors: Dhanani Nasreen , O'Leary June F. , Keeler Emmett , Bamezai Anil , Melnick Glenn 
Published: August 2004

Objective. To determine the effect of joining HMOs (health maintenance organizations) on the inpatient utilization of Medicare beneficiaries.Data Sources. We linked enrollment data on Medicare beneficiaries to patient discharge data from the California Office of Statewide Health Planning and Development (OSHPD) for 1991–1995.Design and Sample. A quasi‐experimental design comparing inpatient utilization before and after switching from fee‐for‐service (FFS) to Medicare HMOs; with comparison groups of continuous FFS and HMO beneficiaries to adjust for aging and secular trends. The sample consisted of 124,111 Medicare beneficiaries who switched from FFS to HMOs in 1992 and 1993, and random samples of 108,966 continuous FFS beneficiaries and 18,276 continuous HMO enrollees yielding 1,227,105 person‐year observations over five years.Main Outcomes Measure. Total inpatient days per thousand per year.Principal Findings. When beneficiaries joined a group/staff HMO, their total days per year were 18 percent lower (95 percent confidence interval, 15–22 percent) than if the beneficiaries had remained in FFS. Total days per year were reduced less for beneficiaries joining an IPA (independent practice association) HMO (11 percent; 95 percent confidence interval, 4–19 percent). Medicare group/staff and IPA‐model HMO enrollees had roughly 60 percent of the inpatient days per thousand beneficiaries in 1995 as did FFS beneficiaries (976 and 928 versus 1,679 days per thousand, respectively). In the group/staff model HMOs, our analysis suggests that managed care practices accounted for 214 days of this difference, and the remaining 489 days (70 percent) were due to favorable selection. In IPA HMOs, managed care practices appear to account for only 115 days, with 636 days (85 percent) due to selection.Conclusions. Through the mid‐nineties, Medicare HMOs in California were able to reduce inpatient utilization beyond that attributable to the high level of favorable selection, but the reduction varied by type of HMO.
Perfectionists' Appraisal of Daily Hassles and Chronic Headache
Authors: Bottos Shauna , Dewey Deborah 
Published: August 2004

Objective.—To investigate the relationships between daily hassles, perfectionism, and the experience of chronic headache among university students.Background.—Headaches are very common among university students. It has been found that a higher number of hassles reported by students is associated with an increase in headache activity. It has also been suggested that individuals higher in perfectionism appraise more situations as hassles, and that this dispositional characteristic may constitute a risk factor for the experience of chronic headaches.Methods.—A total of 291 university students completed three questionnaires: (1) the Headache Assessment Questionnaire that was utilized to obtain information on headache occurrence and its features, (2) the Brief College Student Hassles Scale, and (3) the Multidimensional Perfectionism Scale.Results.—A total of 18 students (6.2%) met the 2004 IHS criteria for chronic headaches, 179 (61.5%) met the criteria for frequent headaches, and 69 (23.7%) met the criteria for infrequent headaches. Students with chronic headaches reported significantly more stress, as measured by daily hassles. They also exhibited higher levels of perfectionism. The number of hassles reported was a significant predictor of headache frequency, intensity, and duration. Analyses also revealed that perfectionism was a significant predictor of headache frequency and intensity.Conclusions.—The present study indicates that there is a relationship between perfectionism and chronic headache in university students, with those higher in perfectionism experiencing more frequent headaches. This investigation confirmed the relationship between daily hassles and chronic headache in this population. The results also suggest that perfectionists may generate their own stress through their tendency to appraise more situations as hassles. This, in turn, may explain their tendency to experience chronic headaches.
Botulinum Neurotoxin Type A in the Preventive Treatment of Refractory Headache: A Review of 100 Consecutive Cases
Authors: Tepper Stewart J. , Bigal Marcelo E. , Sheftell Fred D. , Rapoport Alan M. 
Published: August 2004

Objectives.—To review the efficacy of botulinum neurotoxin type A (BoNT‐A) in the preventive treatment of refractory headache.Background.—Even after receiving expert care, some patients with refractory headache continue to have high disability and persistent headaches.Methods.—Clinical records and headache calendars of 100 patients fulfilling the following inclusion criteria were reviewed: (1) age from 18 to 65 years; (2) primary headache with previous failure of at least four preventive treatments; and (3) have received BoNT‐A and have been followed for at least 6 months after the BoNT‐A injections. BoNT‐A (100 units) was diluted in 4‐cc normal saline. The muscles injected included some or all of the following: frontalis, temporalis, corrugator, procerus, occipitalis, semispinalis, splenius capitis, trapezius, cervical paraspinalis, and sternocleidomastoid. Migraine‐related disability was assessed using the Migraine Disability Assessment (MIDAS) questionnaire.Results.—There was a statistically significant reduction of the frequency of headache days 1 month after BoNT‐A was administered (14.2 vs 28.2 days at the baseline, P < .001), which was maintained through the 3 months of study; similarly, a significant reduction in the headache index (22.3 vs 40.3, P < .001) and number of severe days with headache per month (2.6 vs 7.4, P < .001) were found at 1 month and maintained through the 3 months of study. MIDAS scores were reduced from 34.5 at baseline to 15.9 at 3 months (P < .001). A similar pattern was found in those overusing versus nonoverusing acute medication, though the response was more dramatic in the nonoverusing subgroup.Conclusion.—BoNT‐A may play a role in the preventive treatment of refractory headache. A significant number of patients showed decrease in clinically important measurements of their headaches as well as reduced headache‐related disability with this treatment. Prospective, controlled studies must be considered for severely disabled, refractory patients.
Mechanism of Action of Botulinum Toxin Type A in Migraine Prevention: A Pilot Study
Authors: Smuts Johan A. , Schultz Donovan , Barnard Adri 
Published: August 2004

Objective.—The main objective of this study is to determine whether change in migraine frequency is correlated with a denervation pattern of the corrugator muscle after local botulinum toxin type A injections.Background.—Recent studies suggest botulinum toxin type A is effective in preventing migraine. Relaxation of the corrugator muscle may be one of multiple targets of botulinum toxin type A in relieving migraine pain.Methods.—The pretreatment amplitude of the compound muscle action potential (CMAP) was obtained in 10 patients with a migraine frequency of two to six attacks per month following stimulation of the temporal branch of the facial nerve. Patients were subsequently injected with 20 units of botulinum toxin type A at predefined sites in the procerus and corrugator muscles. CMAP was obtained on days 7, 30, 60, and 90 after injection. Migraine frequency, as reported in headache diaries, was compared with the amplitudes obtained.Results.—A 50% decrease in CMAP was demonstrated in the total group by day 7. Maximal decline of CMAP was observed by day 30, and was sustained at day 60. Migraine frequency declined by 50% or more in 7 of 10 patients by day 60. Migraine response to botulinum toxin type A treatment did not correlate with the denervation pattern.Conclusion.—Relaxation of the corrugator muscles is not solely responsible for the pain relief in migraine patients treated with botulinum toxin type A.
Tolosa‐Hunt Syndrome Due to Actinomycosis of the Cavernous Sinus: The Infectious Hypothesis Revisited
Authors: Mandrioli Jessica , Frank Giorgio , Sola Patrizia , Ernesta Leone Maria , Guaraldi Giovanni , Guaraldi Pietro , Collina Guido , Roncaroli Federico , Cortelli Pietro 
Published: August 2004

Background.—The Tolosa‐Hunt syndrome is characterized by ophthalmoplegia with unilateral severe retro‐orbital pain associated to a granulomatous inflammatory process occupying the cavernous sinus or the superior orbital fissure. The etiology is unknown and diagnosis is based upon a clinical response to steroid treatment and exclusion of neoplasm, trauma, aneurysms, infectious, and inflammatory diseases.Case description.—A 43‐year‐old man was admitted because of a 1‐week history of acute onset left‐sided retro‐orbital pain, followed by left sixth cranial nerve palsy. Magnetic resonance imaging was normal and Tolosa‐Hunt syndrome was suspected. Steroid treatment controlled pain with recovery of ophthalmoplegia. Four months later, when a good response to treatment was still present, brain magnetic resonance imaging revealed a lesion enlarging the left cavernous sinus, isointense with the gray matter on T1‐weighted sequences, hypointense on T2‐weighted images, and with homogeneous enhancement after gadolinium injection. Two months later, ocular pain and sixth cranial nerve palsy recurred and new brain magnetic resonance imaging showed an extension of the tissue occupying the left cavernous sinus, over the sella, to the right cavernous sinus, making possible an endoscopic transphenoidal biopsy.Results.—Histopathological study revealed a granulomatous aspecific inflammation containing actinomycetes colonies. The patient was treated with intravenous penicillin G followed by amoxicillin per os, with improvement of pain and ophthalmoplegia. A control magnetic resonance imaging 1 month after therapy showed a consistent reduction of the enlarged cavernous sinus, and 3 months later neurological examination and brain magnetic resonance imaging were completely normal.Conclusions.—The present case suggests that the International Classification of Headache Disorders (2nd edition) definition of Tolosa‐Hunt syndrome does not reflect the complexity of the syndrome and that some cases of secondary painful ophthalmoplegias can fit the criteria for the primary form. Since the biopsy can only rarely be performed, we agree with other authors that clinical and radiological follow‐up should be performed for at least 2 years. Moreover, we propose that in patients with painful ophthalmoplegia having transient response to steroid therapy, a trial with antibiotic therapy should be taken into account.
Strategies for improving treatment of bipolar disorder: integration of measurement and management
Authors: Sachs G. S. 
Published: August 2004

Objective:  Bipolar disorder is a common and complex condition associated with high rates of disability and high health care costs. The aim of this article is to provide an overview of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP‐BD).Method:  The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP‐BD) was conceived in response to an NIMH request for proposals to study the effectiveness of treatments for Bipolar Disorder. Aspects of this program have been adapted and enriched for presentation in this paper.Result:  Designed for implementation in routine practice across a variety of settings, STEP‐BD offers a disease management program in which standardized assessments are linked to critical decision points in clinical management pathways.Conclusion:  This paper describes strategies used in STEP‐BD to improve the treatment of Bipolar disorder: a simple conceptual model, which integrates assessments and management, and several specialized elements, used in the STEP‐BD assessment package.
Psychological interventions in bipolar disorder: From wishful thinking to an evidence‐based approach
Authors: Vieta E. , Colom F. 
Published: August 2004

Objective:  We aimed to examine the historical and current relevance of psychosocial approaches to bipolar illness by conducting a systematic review of prospective studies assessing the effectiveness of psychological interventions for bipolar disorder.Method:  A systematic literature search was conducted using EMBASE, MedLine and PsychLIT and reference sections of papers were scrutinized for further relevant reports. Only four trials met the criteria of a prospective study and achieved the necessary methodological standards.Results:  The studies showed benefits for patients in terms of relapse prevention and the reduction of hospitalization rates. Psychoeducation (delivered in groups or as part of a family intervention) and cognitive behavioural therapy were also found to be effective prophylactic treatments for bipolar disorder in medicated patients. Other interventions do not appear to be supported by sufficient evidence.Conclusion:  Psychological approaches, and particularly psychoeducation and cognitive‐behavioural therapies, are evidence‐based prophylactic therapies for bipolar patients receiving pharmacotherapy. They should be used as adjuncts to medication where possible in the prevention of bipolar disorder.
Ceacam1a−/−Mice Are Completely Resistant to Infection by Murine Coronavirus Mouse Hepatitis Virus A59
Authors: Hemmila Erin , Turbide Claire , Olson Melanie , Jothy Serge , Holmes Kathryn V. , Beauchemin Nicole 
Published: August 2004

ABSTRACTCEACAM1a glycoproteins are members of the immunoglobulin (Ig) superfamily and the carcinoembryonic antigen family. Isoforms expressing either two or four alternatively spliced Ig-like domains in mice have been found in a number of epithelial, endothelial, or hematopoietic tissues. CEACAM1a functions as an intercellular adhesion molecule, an angiogenic factor, and a tumor cell growth inhibitor. Moreover, the mouse and human CEACAM1a proteins are targets of viral or bacterial pathogens, respectively, including the murine coronavirus mouse hepatitis virus (MHV),Haemophilus influenzae,Neisseria gonorrhoeae, andNeisseria meningitidis, as well asMoraxella catarrhalisin humans. We have shown that targeted disruption of theCeacam1a(MHVR) gene resulting in a partial ablation of the protein in mice (p/p mice) led to reduced susceptibility to MHV-A59 infection of the modified mice in the BALB/c background. We have now engineered and produced aCeacam1a−/−mouse that exhibits complete ablation of the CEACAM1a protein in every tissue where it is normally expressed. We report that 3-week-oldCeacam1a−/−mice in the C57BL/6 genetic background are fully resistant to MHV-A59 infection by both intranasal and intracerebral routes. Whereas virus-inoculated wild-type +/+ C57BL/6 mice showed profound liver damage and spinal cord demyelination under these conditions,Ceacam1a−/−mice displayed normal livers and spinal cords. Virus was recovered from liver and spinal cord tissues of +/+ mice but not of −/− mice. These results indicate that CEACAM1a is the sole receptor for MHV-A59 in both liver and brain and that its deletion from the mouse renders the mouse completely resistant to infection by this virus.
Human Immunodeficiency Virus Type 1 gp120 Induces Abnormal Maturation and Functional Alterations of Dendritic Cells: a Novel Mechanism for AIDS Pathogenesis
Authors: Fantuzzi Laura , Purificato Cristina , Donato Karim , Belardelli Filippo , Gessani Sandra 
Published: August 2004

ABSTRACTDendritic cells (DCs) play a crucial role in bridging innate and acquired immune responses to pathogens. In human immunodeficiency virus type 1 (HIV-1) infection, immature DCs (iDCs) are also main targets for HIV-1 at the mucosal level. In this study, we evaluated the effects of HIV-1-DC interactions on the maturation and functional activity of these cells. Exposure of human monocyte-derived iDCs to either aldrithiol-2-inactivated HIV-1 or gp120 led to an upmodulation of activation markers indicative of functional maturation. Despite their phenotype, these cells retained antigen uptake capacity and showed an impaired ability to secrete cytokines or chemokines and to induce T-cell proliferation. Although gp120 did not interfere with DC differentiation, the capacity of these cells to produce interleukin-12 (IL-12) upon maturation was markedly reduced. Likewise, iDCs stimulated by classical maturation factors in the presence of gp120 lacked allostimulatory capacity and did not produce IL-12, in spite of their phenotype typical of activated DCs. Exogenous addition of IL-12 restores the allostimulatory capacity of gp120-exposed DCs. The finding that gp120 induces abnormal maturation of DCs linked to profound suppression of their activities unravels a novel mechanism by which HIV can lead to immune dysfunction in AIDS patients.
Herpesvirus Ateles Tio Can Replace Herpesvirus Saimiri StpC and Tip Oncoproteins in Growth Transformation of Monkey and Human T Cells
Authors: Albrecht Jens-Christian , Biesinger Brigitte , Müller-Fleckenstein Ingrid , Lengenfelder Doris , Schmidt Monika , Fleckenstein Bernhard , Ensser Armin 
Published: August 2004

ABSTRACT

Herpesvirus saimiri group C strains are capable of transforming human and simian T-lymphocyte populations to permanent antigen-independent growth. Two viral oncoproteins, StpC and Tip, that are encoded by a single bicistronic mRNA, act in concert to mediate this phenotype. A closely related New World monkey herpesvirus, herpesvirus ateles, transcribes a single spliced mRNA at an equivalent genome locus. The encoded protein, Tio, has sequence homologies to both StpC and Tip. We inserted the
tio
sequence of herpesvirus ateles strain 73 into a recombinant herpesvirus saimiri C488 lacking its own
stpC
/
tip
oncogene. Simian as well as human T lymphocytes were growth transformed by the chimeric Tio-expressing viruses. Thus, a single herpesvirus protein appears to be responsible for the oncogenic effects of herpesvirus ateles.
Fitness Analyses of Vesicular Stomatitis Strains with Rearranged Genomes Reveal Replicative Disadvantages
Authors: Novella Isabel S. , Ball L. Andrew , Wertz Gail W. 
Published: August 2004

ABSTRACT

Gene expression of the nonsegmented negative-strand RNA viruses is determined by the position of each gene relative to that the single 3′ promoter. The general order of genes among all of the viruses of the order
Mononegavirales
is highly conserved. In previous work we generated recombinant viruses in which the order of the three central genes of the prototypical rhabdovirus, vesicular stomatitis virus, was rearranged to all six possible permutations. While some of these viruses replicated less well than the wild type when assayed by single-step growth analyses in BSC-1 cells, others replicated as well or slightly better. In the work reported here, we used competition assays to compare the fitness of the viruses with alternative gene orders to that of the wild-type (wt) virus. We found that the relative fitness of these recombinant viruses depended on the multiplicity of infection (MOI) but not on the population size. However, during competitions at low MOI, when complementation cannot compensate for the defects of the populations with rearranged genomes, the virus with the wt gene order was always the most fit.
Coxsackievirus B4 Infection of Human Fetal Thymus Cells
Authors: Brilot Fabienne , Geenen Vincent , Hober Didier , Stoddart Cheryl A. 
Published: August 2004

ABSTRACTThe infection of human fetal thymus organ cultures (FTOC) with coxsackievirus B4 E2 (CVB4 E2) was investigated. Both positive- and negative-strand viral RNA were detected by real-time quantitative reverse transcription-PCR (RT-PCR) in CVB4 E2-infected FTOC, which supported high yields of virus production (∼10650% tissue culture infective doses/ml), and in flow-sorted thymocyte populations for 7 days after inoculation. Cortical CD4+CD8+thymocytes were found to be the principal targets of infection. Inoculation of human FTOC with CVB4 E2 led to a marked and progressive depletion of immature thymocytes (CD4+CD8+cells) with no enhancement of Annexin V-positive cells. CVB4 E2 replication caused significant major histocompatibility complex (MHC) class I upregulation on these cells. MHC class I upregulation was correlated with positive- and negative-strand RNA quantitative detection and the release of infectious particles. In addition, chloroquine treatment of FTOC and single-thymocyte suspensions suggested that MHC class I upregulation on thymocytes was the result of direct infection rather than caused by production of soluble factors such as alpha interferon. Thus, CVB4 E2 can infect human fetal thymocytes, which subsequently results in quantitative and qualitative abnormalities of these cells.
Major and Minor Capsid Proteins of Human Polyomavirus JC Cooperatively Accumulate to Nuclear Domain 10 for Assembly into Virions
Authors: Shishido-Hara Yukiko , Ichinose Shizuko , Higuchi Kayoko , Hara Yoshinobu , Yasui Kotaro 
Published: August 2004

ABSTRACT
The human polyomavirus JC (JCV) replicates in the nuclei of infected cells. Here we report that JCV virions are efficiently assembled at nuclear domain 10 (ND10), which is also known as promyelocytic leukemia (PML) nuclear bodies. The major capsid protein VP1, the minor capsid proteins VP2 and VP3, and a regulatory protein called agnoprotein were coexpressed from a polycistronic expression vector in COS-7 cells. We found that VP1 accumulated to distinct subnuclear domains in the presence of VP2/VP3 and agnoprotein, while VP1 expressed alone was distributed both in the cytoplasm and in the nucleus. Mutation analysis revealed that discrete intranuclear accumulation of VP1 requires the presence of either VP2 or VP3. However, VP2 or VP3 expressed in the absence of VP1 showed diffuse, not discrete, nuclear localization. The C-terminal sequence of VP2/VP3 contains two basic regions, GPNKKKRRK (cluster 1) and KRRSRSSRS (cluster 2). The deletion of cluster 2 abolished the accumulation of VP1 to distinct subnuclear domains. Deletion of the C-terminal 34 residues of VP2/VP3, including both cluster 1 and cluster 2, caused VP1 to localize both in the cytoplasm and in the nucleus. Using immunoelectron microscopy of cells that coexpressed VP1, VP2/VP3, and agnoprotein, we detected the assembly of virus-like particles in discrete locations along the inner nuclear periphery. Both in oligodendrocytes of the human brain and in transfected cells, discrete nuclear domains for VP1 accumulation were identified as ND10, which contains the PML protein. These results indicate that major and minor capsid proteins cooperatively accumulate in ND10, where they are efficiently assembled into virions.