tbuckley/cabot-search huggingface dataset:
Insurance Parity and the Use of Outpatient Mental Health Care Following a Psychiatric Hospitalization
Authors: Amal N. Trivedi, Shailender Swaminathan, Vincent Mor
Journal: JAMA (2008)

<h3>Context</h3>Mental health services are typically subject to higher cost sharing than other health services. In 2008, the US Congress enacted legislation requiring parity in insurance coverage for mental health services in group health plans and Medicare Part B.<h3>Objective</h3>To determine the relationship between mental health insurance parity and the use of timely follow-up care after a psychiatric hospitalization.<h3>Design, Setting, and Population</h3>We reviewed cost-sharing requirements for outpatient mental health and general medical services for 302 Medicare health plans from 2001 to 2006. Among 43 892 enrollees in 173 health plans who were hospitalized for a mental illness, we determined the relation between parity in cost sharing and receipt of timely outpatient mental health care after discharge using cross-sectional analyses of all Medicare plans and longitudinal analyses of 10 plans that discontinued parity compared with 10 matched control plans that maintained parity.<h3>Main Outcome Measures</h3>Outpatient mental health visits within 7 and 30 days following a discharge for a psychiatric hospitalization.<h3>Results</h3>More than three-quarters of Medicare plans, representing 79% of Medicare enrollees, required greater cost sharing for mental health care compared with primary or specialty care. The adjusted rate of follow-up within 30 days after a psychiatric hospitalization was 10.9 percentage points greater (95% confidence interval [CI], 4.6-17.3; P &lt; .001) in plans with equivalent cost sharing for mental health and primary care compared with plans with mental health cost sharing greater than primary and specialty care cost sharing. The association of parity with follow-up care was increased for enrollees from areas of low income and less education. Rates of follow-up visits within 30 days decreased by 7.7 percentage points (95% CI, −12.9 to −2.4; P = .004) in plans that discontinued parity and increased by 7.5 percentage points (95% CI, 2.0-12.9; P = .008) among control plans that maintained parity (adjusted difference in difference, 14.2 percentage points; 95% CI, 4.5-23.9; P = .007).<h3>Conclusion</h3>Medicare enrollees in health plans with insurance parity for mental health and primary care have markedly higher use of clinically appropriate mental health services following a psychiatric hospitalization.
Antibiotic Resistance
Authors: Ann R. Punnoose, Cassio Lynm, Robert M. Golub
Journal: JAMA (2012)

Antibiotic ResistanceA ntibiotics are compounds that can kill or interfere with the growth of microorganisms such as bacteria or viruses.Because antibiotics are often used unnecessarily or incorrectly, microorganisms have been able to adapt and survive.This is called antibiotic resistance.One way this happens is genetic mutations, which are random changes in genetic material that can be passed on from one virus or bacterium to successive generations.For example, penicillin is one of the oldest and most commonly used antibiotics.Some bacteria have developed an enzyme or protein that changes the structure of penicillin and prevents it from killing bacteria. CONSEQUENCES OF INCREASING ANTIBIOTIC RESISTANCEAs more microorganisms become resistant, commonly used antimicrobials become ineffective against the diseases these microorganisms cause.In turn, the microorganisms become more virulent (more capable of producing serious illness).Patients may need to be hospitalized to treat infections once considered simple to treat because stronger antibiotics are required or because these diseases are now associated with severe complications.Some examples include • Methicillin-resistant Staphylococcus aureus (MRSA), a strain of bacteria no longer sensitive to different forms of penicillin.It can cause complicated skin infections and pneumonia and requires stronger antibiotics such as vancomycin for treatment.• Multidrug-resistant tuberculosis, which is very difficult to treat because it is caused by microorganisms that are resistant to 2 of the first-choice drugs used to treat tuberculosis.• Extended-spectrum ␤-lactamase bacteria, a group of bacteria that have evolved to produce an enzyme that can interfere with the mechanisms of several newer antibiotics, making these bacteria resistant and difficult to treat.
Management of dyspepsia in primary care
Authors: R. Boutet, M. Buckley, P. Hastier, R. Dumas, J.-P. Delmont, V Stanghellini, G Barbara, B Salvioli, R Corinaldesi, C Tosetti, R D Churchill, P G Hill, G K T Holmes
Journal: BMJ (1998)

Editor—Agreus and Talley’s recommendations for the use of Helicobacter pylori testing in the management of patients with newly appeared dyspepsia1 differ from published guidelines.2,3 They consider eradication therapy an acceptable alternative to endoscopy for patients with a positive test result when access to this investigation is difficult. This alternative option is probably a fait accompli in primary care. 

In June 1995 I sent a questionnaire to all 298 general practitioners in north and east Devon asking how they would use H pylori testing for the management of patients with dyspepsia. After a reminder questionnaire, 271 general practitioners (91%) responded. The table shows the results. 

Only 73 (27%) said they would limit the use of this test to younger patients (under 50 years of age) as recommended by published guidelines at the time.2 Eighty five did not know when to use the test but many of these said how they would manage patients with a positive result. Most general practitioners (73%) would use eradication therapy rather than endoscopy in younger patients with a positive test result. Seventy eight (29%) said they would also attempt eradication therapy in older patients. 

At the time of the survey patients referred for endoscopy had to be placed on a waiting list. General practitioners might have preferred to prescribe antibiotics for dyspeptic patients with a positive H pylori result, which is likely to cure a possible peptic ulcer, rather than wait too long for the diagnosis to be confirmed by endoscopy. 

I thank all general practitioners in north and east Devon district for their cooperation and Dr I Morrel for his help in designing the questionnaire.
Exacerbations of Asthma
Authors: ANNE E. TATTERSFIELD, DIRKJE S. POSTMA, PETER J. BARNES, KLAS SVENSSON, CARL-AXEL BAUER, PAUL M. O'BYRNE, CLAES-GÖRAN LÖFDAHL, ROMAIN A. PAUWELS, ANDERS ULLMAN
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

The identification, prevention, and prompt treatment of exacerbations are major objectives of asthma management. We looked at change in PEF, symptoms, and use of rescue β -agonists during the 425 severe exacerbations that occurred during a 12-mo parallel group study (FACET) in which low and high doses of budesonide with and without formoterol were compared in patients with asthma. Oral corticosteroids were prescribed for severe exacerbations, the main study end point, defined as the need for a course of oral corticosteroids (n = 311) or a reduction in morning PEF of > 30% on two consecutive days. PEF, symptoms, and bronchodilator use over the 14 d before and after the exacerbation were obtained from diary cards. Exacerbations were characterized by a gradual fall in PEF over several days, followed by more rapid changes over 2 to 3 d; an increase in symptoms and rescue β -agonist use occurred in parallel, and both the severity and time course of the changes were similar in all treatment groups. Exacerbations identified by the need for oral corticosteroids were associated with more symptoms and smaller changes in PEF than those identified on the basis of PEF criteria. Female sex was the main patient characteristic associated with an increased risk of having a severe exacerbation. Exacerbations may be characterized predominantly by change in symptoms or change in PEF, but the pattern was not affected by the dose of inhaled corticosteroid or by whether the patient was taking formoterol.
Renin-angiotensin blockade resets podocyte epigenome through Kruppel-like Factor 4 and attenuates proteinuria
Authors: Kaori Hayashi, Hiroyuki Sasamura, Mari Nakamura, Yusuke Sakamaki, Tatsuhiko Azegami, Hideyo Oguchi, Hirobumi Tokuyama, Shu Wakino, Koichi Hayashi, Hiroshi Itoh
Journal: Kidney International (2015)
Follow-up of 17 biologic male transsexuals after sex-reassignment surgery
Authors: D D Hunt, J L Hampson
Journal: American Journal of Psychiatry (1980)

The authors followed up 17 biologic male transsexuals who had received sex-reassignment surgery an average of 8.2 years previously. Information was collected from the transsexuals, their partners, and family members when appropriate; MMPI scores were obtained from 12. No changes in levels of psychopathology and only modest gains overall in economic functioning and interpersonal relationships were found. Larger gains were made in sexual satisfaction and being accepted by family members. None of the 17 transsexuals had doubts about having had the surgery. The authors believe that for a select group surgery is still the best means of coping with transsexualism and that an individual's adjustment before surgery is one of the best indicators of success in coping with the stress of surgery.
Abstract 17483: Healthy Heart Check®: A Large Scale Low-Cost Student Athlete Screening Model Using ECGs and Quick Look Echos Improve Specificity of ECG Screening of Student Athletes
Authors: Kim Bonzheim, Adam deJong, Steven Almany, Nancy Cutler, Justin Trivax, Monique Brand, Susan Koyblarek, Ralph Gentry, Aaron Berman, Barry Franklin, David E Haines
Journal: Circulation (2011)

Introduction: Exertion-related sudden cardiac death (SCD) in a student athlete is a catastrophic and potentially preventable event. Aggressive screening with ECGs may reduce SCD risk, but low specificity and perceived costs limit widespread utilization. Purpose: We developed a rapid, low-cost, scalable cardiovascular screening model using physician volunteers and paid technical staff to effectively screen large numbers of high school students for SCD risk. Methods: Physicians review a parent-completed cardiac risk questionnaire, perform a physical exam and analyze a 12-lead ECG. If higher risk is suspected, a quick-look 2D echo screens for structural disease. Students at increased risk are told to stop exercise and see their physician. Results: Since 2007, 4 hospitals performed 23 free screenings at 12 locations, and screened 5,861 students (age 15.5 ± 1.9 yrs). Average screening time was 10 ± 4 min/student. Abnormal ECGs were found in 740 students (13%), of whom 467 were referred on for a quick look echo. Of these, 418 (90%) were normal. Abnormal echoes were seen in 49 students resulting in a “stop exercise” advisory for 10, or physician follow-up for 35. Of those with normal ECGs, 701 had echoes - 42 (94%) were normal. In the total population, 40 students (0.7%) received “stop exercise” and 527 (9%) physician follow-up advice. Findings included: HCM (1); dilated CM (2); significant LVH (2) and RVH (2); long QT (2); abnormal valve function (4); exertional or frequent syncope (3); tachy- or bradycardias (7); WPW (5); bundle branch block (4); immediate family history SCD (3); possible Marfan's Syndrome (1) and, pericardial effusion (1). Cost analysis of the screening, including staffing and supplies, was $7.84/student. The screening was successfully franchised to three new hospital groups. Conclusions: In conclusion, our screening model provides a low-cost, accessible and sustainable physician-directed option for pre-participation cardiovascular examinations. Addition of a quick look echo reduces false positives generated by ECG screening by 90%. This volunteer-based screening is effective identifying high school students who may be at risk for SCD and other cardiovascular complications. The franchise kit is offered free of charge to other communities.
Assessment of Heart Rate Variability Changes During Dipyridamole Infusion and Dipyridamole-Induced Myocardial Ischemia: A Time Variant Spectral Approach11This report was partially supported by a grant from the Italian Ministry of University (MURST 40%—Special Project on Cardiovascular System).
Authors: ETTORE PETRUCCI, LUCA T. MAINARDI, VRUYR BALIAN, SERGIO GHIRINGHELLI, ANNA M. BIANCHI, MAURIZIO BERTINELLI, MAURO MAINARDI, SERGIO CERUTTI
Journal: Journal of the American College of Cardiology (1996)
The comorbidity of borderline personality disorder and other DSM-III-R axis II personality disorders
Authors: H G Nurnberg, M Raskin, P E Levine, S Pollack, O Siegel, R Prince
Journal: American Journal of Psychiatry (1991)

This study examines the comorbidity of DSM-III-R borderline personality disorder and the other axis II personality disorders. The extent and direction of overlap provides a measure of the clarity of its diagnostic boundaries and descriptive validity.In 110 outpatients without concurrent major axis I conditions, axis II diagnoses were assessed in semistructured format and all DSM-III-R personality disorder criteria were rated. Multiple diagnoses were recorded.Twenty-two patients (20%) met criteria for borderline personality disorder; 18 (82%) had at least one additional personality disorder diagnosis. Using measures of frequencies and intercorrelation coefficients, the authors found that overlap was extensive and not confined to any one of the three designated axis II clusters. Factor analysis revealed 1) a group containing borderline personality disorder with paranoid, histrionic, narcissistic, antisocial, and passive-aggressive personality disorders and 2) another grouping of schizoid, schizotypal, avoidant, obsessive-compulsive, and self-defeating personality disorders.Borderline personality disorder appears to constitute a broad, heterogeneous category with unclear boundaries that embraces a general personality disorder concept. Both further refinement of the borderline personality disorder construct and investigation into alternative models to the DSM-III-R axis II classification system are suggested.
Nuclear factor kappa B–mediated CD47 up‐regulation promotes sorafenib resistance and its blockade synergizes the effect of sorafenib in hepatocellular carcinoma in mice
Authors: Jessica Lo, Eunice Yuen Ting Lau, Rachel Hiu Ha Ching, Bowie Yik Ling Cheng, Mark Kin Fai Ma, Irene Oi Lin Ng, Terence Kin Wah Lee
Journal: Hepatology (2015)

Sorafenib is a new standard treatment for patients with advanced hepatocellular carcinoma (HCC). However, the survival benefit of this treatment is modest, partly owing to drug resistance. Recent evidence has demonstrated the existence of tumor‐initiating cells (T‐ICs) as the culprit for treatment resistance. To examine whether sorafenib resistance was a result of the presence of liver T‐ICs, we developed sorafenib‐resistant HCC cells both in vitro and in vivo through continuous exposure to sorafenib. Using these models, we found that sorafenib‐resistant clones demonstrated enhanced T‐IC properties, including tumorigenicity, self‐renewal, and invasiveness. In addition, several T‐IC markers were found to be up‐regulated, among which CD47 was found to be most significant. Using chromatin immunoprecipitation assays and expression analyses, CD47 expression was found to be regulated by nuclear factor kappa B (NF‐κB) through a specific response element in the promoter of CD47, and the site occupancy and expression were increased and decreased upon stimulation and inhibition of NF‐κB, respectively. Consistently, NF‐κB was activated in sorafenib‐resistant HCC cells, and this finding was confirmed in clinical HCC samples, which showed a positive correlation between NF‐κB and CD47 expression. Functional characterization of CD47 in sorafenib‐resistant HCC cells was evaluated using a lentivirus‐based knockdown approach and showed increased sensitization to sorafenib upon CD47 knockdown. Furthermore, blockade of CD47 using anti‐CD47 antibody (Ab) showed a similar effect. Using a patient‐derived HCC xenograft mouse model, we found that anti‐CD47 Ab (500 μg/mouse) in combination with sorafenib (100 mg/kg, orally) exerted synergistic effects on tumor suppression, as compared with sorafenib and anti‐CD47 Ab alone. Conclusions : NF‐κB‐mediated CD47 up‐regulation promotes sorafenib resistance, and targeting CD47 in combination with sorafenib is an attractive therapeutic regimen for the treatment of HCC patients. (H epatology 2015;62:534–545
Abstract 3106: Longitudinal Changes in NT-proBNP Predict New Onset Heart Failure in Community-Dwelling Older Adults: The Cardiovascular Health Study
Authors: Stephen L Seliger, Robert Christenson, John Gottdiener, Willem J Kop, Christopher deFilippi
Journal: Circulation (2008)

In patients with heart failure (HF), changes in NTproBNP in response to treatment are strong predictors of outcome. In contrast, it is unknown whether there are dynamic changes in NTproBNP in the g...
Sleep-disordered Breathing and Neuropsychological Deficits
Authors: HYON C. KIM, TERRY YOUNG, CHARLES G. MATTHEWS, STEVEN M. WEBER, AUSTIN R. WOODARD, MARI PALTA
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

The relationship of sleep-disordered breathing (SOB) to neuropsychological deficits was investigated with cross-sectional data from the Wisconsin Sleep Cohort Study, a population-based study of the natural history of SDB. A sample of 841 employed men and women ages 30 to 60 yr was studied by overnight polysomnography to assess the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI). Prior to overnight polysomnography, the participants were given a battery of neuropsychological tests for functionally important capacities including motor skills, attention, concentration, information processing, and memory. Principal factor analysis of all the neuro-psychological test data revealed a psychomotor efficiency and a memory factor. Multiple regression analysis showed a significant negative association between logarithmically transformed AHI (LogAHI) and psychomotor efficiency score independent of age, gender, and educational status (p = 0.017). The relationship was not explained by self-reported sleepiness. No significant relationship was seen between LogAHI and memory score. In assessing the clinical significance of mild SDB, we estimate that an AHI of 15 is equivalent to the decrement in psychomotor efficiency associated with 5 additional yr of age, or to 50% of the decrement associated with hypnosedative use.
Abstract 6004: SPIRIT III Japan: Eight-Month IVUS Analysis of Everolimus-Eluting Stent Compared to the US Arm
Authors: Takao Shimohama, Hiromasa Otake, Junya Ako, Masao Yamasaki, Ichizo Tsujino, Katsuhisa Waseda, Takao Hasegawa, Ryota Sakurai, Daisaku Nakatani, Hyeonsoo Chang, Paul G Yock, Yasuhiro Honda, Hajime Kusano, Krishnankutty Sudhir, Shigeru Saito, Gregg W Stone, Peter J Fitzgerald
Journal: Circulation (2008)
Prevalence of viral infection in a cohort with acute respiratory failure
Authors: Mireia Serra Fortuny, Silvia Capilla Rubio, Daniel-Ross Monserrate Mitchell, Miguel Gallego Diaz, Jordi Valles Daunis, Eduard Monsó Molas
Journal: European Respiratory Journal (2013)

OBJECTIVE:  To determine the prevalence of respiratory viral infection in a cohort with acute respiratory failure (ARF) requiring hospitalization.  METHODS:  We conducted a prospective observational study including patients with ARF who required admission from December 2010 to January 2011. Nasopharyngeal swabs were obtained and RT-PCR was performed to detect H1N1 virus and seasonal Influenza. We also froze these samples at -80oC to analyse them afterwards with multiplex RT-PCR nested method described by Coiras et al 1 . This method allows to simultaneously detect the following virus: parainfluenza virus (1,2,3,4), coronavirus, rhinovirus, respiratory syncytial virus, adenovirus and influenza A, B and C.  We excluded patients under 18, nosocomial infection and mild episodes that did not meet the criteria for admission. Demographic data, comorbidities and final diagnosis were analysed.  RESULTS:  50 patients (46% female) were evaluated. Average age was 54,7 ± 18 years. In 49 patients Chest X-ray showed pulmonary infiltrates compatible with pneumonia. Using PSI score, 73% of pneumonias were class IV/V. 21 patients (42%) required ICU admission. Mortality was 12% (6 subjects).  Main comorbidities were Diabetes Mellitus (26%), imunosuppression (24%) and other respiratory diseases (22%). In patients diagnosed with viral infection (40%), H1N1 was the most frequent 70% (14/20).Other viruses isolated were rhinovirus (4 cases) and parainfluenza 4 (2 cases). In 35% of H1N1 subjects, bacterial coinfection was found, whereas in subjects with other viral infection bacterial coinfection was 50%.  CONCLUSIONS:  Prevalence of viral infection was 40%, with H1N1 as the most frequent (70%)  Bibliography  1. J Med Virol 72 : 484-95.
Normality ranges of urine oxidative stress markers (8-OHdG and isoprostane) in Italian people free from respiratory diseases - Preliminary results
Authors: M. Elisabetta Zanolin, Giancarlo Pesce, Paolo Girardi, Paolo Degan, Morena Nicolis, Aneza Jalil, Roberto de Marco
Journal: European Respiratory Journal (2012)

BACKGROUND: The study of oxidative stress (OxS) is becoming increasingly important in respiratory disease research. To our knowledge, the reference ranges of urinary 8-hydroxy-deoxy-guanosine (8-OHdG) and 8-isoprostane (isoprostane), a DNA and a lipid oxidation product respectively, have not yet been determined in subjects without respiratory diseases.  AIM: To assess the reference range of OxS markers in Italian people aged 20-64 free from respiratory diseases (controls).  METHODS: 8-OHdG and isoprostane were measured in spot-urine samples collected in the frame of Gene-Environment Interactions in Respiratory Diseases (GEIRD) study, a nested multi-case control survey. The biomarkers levels were corrected on creatinine concentration. Only controls (n=239) were considered for the aim of this work. The possible effects of potential determinants on OxS-biomarkers were studied before determining the normality range in selected subgroups of controls. Multiple linear regression was fitted to data using the logarithm of 8OHdG or isoprostane as dependent variables and sex, age, season, smoke, body mass index, as covariates. The appropriate percentiles were calculated.  RESULTS: Both 8OHdG and isoprostane concentrations were significantly higher in smokers than in non smokers (p=0.025 and 0.047 respectively), while the other covariates did not influence OxS. The 95% 8OHdG normality range in non smokers varied from 0.26 to 25.94 ng/mg. The 95% isoprostane reference interval was 0.03 -5.42 ng/mg in non smokers.  CONCLUSION: Provisional 95% normality range for urinary 8OHdG and isoprostane were determined in subjects free from respiratory diseases.