tbuckley/cabot-search huggingface dataset:
Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis
Authors: Katie L. Druce, Gareth T. Jones, Gary J. Macfarlane, Neil Basu
Journal: Arthritis & Rheumatology (2015)

There is debate as to the role of inflammatory disease activity in the etiology of rheumatoid arthritis (RA)-related fatigue. We undertook this study to determine the relationship of fatigue to disease activity by examining pathways associated with change in fatigue in subjects starting anti-tumor necrosis factor (anti-TNF) therapy for the first time.Participants who had been recruited to the British Society for Rheumatology Biologics Register for RA provided information on fatigue (Short Form 36 [SF-36] vitality scale) and other health status variables at the start of anti-TNF therapy and 6 months later. The Disease Activity Score in 28 joints (DAS28) and inflammation (erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP] level) were also reported. A path analysis model comprising changes in fatigue, pain, disease activity, disability, and mental health, along with effects of sex and a history of depression, was used to examine those with high levels of fatigue at baseline (score of ≤12.5 units on the SF-36 vitality scale). The DAS28 was substituted for ESR/CRP to delineate the specific role of inflammation.With a total of 2,652 participants, we identified a well-fitting model (χ2 = 0.18, P = 0.98) accounting for 40% of the variance in fatigue change. There was no direct pathway from change in inflammation to change in fatigue; instead, significant pathways to change in fatigue were observed from changes in disease activity, pain, mental health, and disability, along with effects of sex and a history of depression. A total of 82% of the effect of change in disease activity was indirect, of which ∼50% was mediated through a change in pain.Improvements in fatigue do not appear to be driven by inflammatory disease activity; instead, they appear to result indirectly from improvements in pain. Additional significant pathways through disability and mental health suggest potentially modifiable factors that could be targeted to improve clinically important levels of fatigue.
Asthma control and quality of life: 6-month follow-up of PRISMA study (PRospectIve Study on asthMA control)
Authors: Luigi Allegra, Giovanni Cremonesi, Giuseppe Girbino, Eleonora Ingrassia, Serafino Marsico, Gabriele Nicolini, Claudio Terzano
Journal: European Respiratory Journal (2011)

Rationale: According to GINA guidelines, asthma control is the goal of the treatment.

Objectives: To estimate the percentage of controlled asthmatic patients and their quality of life.

Methods: Adult asthmatics with not-well controlled asthma (Asthma Control Test score≤19) were involved in a prospective observational study. Asthma control and quality of life were assessed with ACT and EuroQoL-5D, respectively.

Results: 735 patients were evaluated. Figure 1 shows the distribution of asthma control at enrolment visit and after 6 months. As compared to the first visit, 70.1% of uncontrolled and 80.0% of partly controlled reached asthma control.

The mean (SD) of EuroQoL score was 0.72 (0.2) at first visit and 0.84 (0.2) at 6-month follow-up visit. The mean (SD) of VAS was 65.0 (16.1) at first visit and 77.1 (13.6) after 6 months. Figure 2 shows the EuroQoL score and VAS stratified for control level.

![Figure][1] 



Conclusions: Improvements in asthma control and quality of life can be detected in the majority of non-controlled patients after 6-month follow-up in a real life setting.

 [1]: pending:yes
What do excellent psychotherapy supervisors do?
Authors: S B Shanfield, K L Matthews, V Hetherly
Journal: American Journal of Psychiatry (1993)

The author's goal was to discover strategies used by psychotherapy supervisors judged to be excellent teachers.In an earlier study, experienced teachers of psychotherapy rated the level of excellence of 34 different supervisors in 53 videotaped supervision sessions. In this study, the authors examined the transcripts of the nine videotapes assigned the highest ratings as well as three videotapes assigned mid-level ratings and three videotapes assigned low ratings in the previous study. In analyzing these transcripts, the authors drew from their experience with the complete set of videotapes.Supervisors with high ratings allowed the resident's story about the encounter with the patient to develop. They consistently tracked the most immediate aspects of the resident's affectively charged concerns. Most of their comments were directed toward helping the resident further understand the patient and were specific to the material presented in the session. The resident was invited to speculate about the material, and technical words were used sparsely. Discussions about the relationships between resident and patient and between supervisor and resident were in the context of the resident's concerns. Supervisors with mid-level ratings were less disciplined in tracking the resident's concerns and inhibited the development of the resident's story. Supervisors with low ratings paid little or no attention to the resident's issues.The ability to track residents' concerns is at the center of supervisory activities rated as excellent. The resident provides data about what occurred, and new knowledge is constructed in the supervisory interaction. These findings provide an empirical basis for orienting supervisors to supervision.
THE ELECTRENCEPHALOGRAM OF SCHIZOPHRENICS DURING INSULIN TREATMENTS
Authors: Hudson Hoagland, D. Ewen Cameron, Morton A. Rubin
Journal: American Journal of Psychiatry (1937)

1. In 30 out of 35 insulin experiments the post-sugar delta index is considerably less than the pre-insulin delta index. In about this same proportion of cases patients show clinical improvement after treatments. 2. Mean delta indices for 37 normals are 2.1 cm., extremes 0.5-11.0 cm. Thirty-four of these were 3.2 cm. or less, the three higher values were 5.0, 6.0, and 11.0 cm. One normal awake gave a value of 0.5 cm.; asleep 10.9 cm. Twelve chronic alcoholics gave a mean of 2.5, extremes 0.5-6.0 cm. Nine manic depressives gave a mean at 2.8, extremes 1.0 to 5.2. Thirty-one untreated schizophrenics gave a mean of 6.6 cm., extremes 0.5 to 25.2. Twelve of these values were greater than the schizophrenic mean of 6.6 cm. Despite the mean differences the delta index cannot be regarded by itself as a measure of the schizophrenic state owing to overlaps in values between the groups of normals and patients. 3. Eighty-four delta indices taken on seven patients showing high pre-treatment indices, each over some weeks of treatment, exhibit in 88 per cent of the case complete correspondence with independently determined, fluctuating, objective clinical symptoms. With two other patients indices corresponded to symptoms in 60 per cent and 70 per cent of the instances. These two patients were verbally unresponsive and showed little detectable day-to-day change in symptoms to correlate with the indices. Patients who have "low" pre-treatment delta indices, i. e., 4 cm. or less, about 50 per cent of a group of 31, cannot, of course, be analyzed by this method. 4. In schizophrenic patients we have found no special brain waves qualitatively different from those found in normal persons. 5. Transient relapses and remissions of one patient, earlier released after apparently successful insulin therapy, correlated completely with very specific fluctuations in his delta index. 6. In nine instances, with several patients, delta indices have been found to change prior to any other objective change in symptoms. Five of these nine prognostic changes were recorded with one individual.
A multicenter phase II trial of the decitabine alternative 5-day dosing regimen: Analysis of efficacy in various subgroups of patients with myelodysplastic syndromes (MDS)
Authors: D. P. Steensma, M. R. Baer, J. L. Slack, R. Buckstein, L. A. Godley, J. S. Larsen, S. Arora, M. T. Cullen, H. M. Kantarjian
Journal: Journal of Clinical Oncology (2008)

7032 Background: Decitabine is an efficient hypomethylating agent approved by the FDA for the treatment of MDS. In a Phase III trial that studied a 3-day dosing regimen, the overall improvement (IWG 2000: complete response [CR] + partial response [PR] + hematologic improvement [HI]) rate for decitabine was 30% versus 7% in the supportive care arm (Cancer 2006:106:1794); responses were seen in all International Prognostic Scoring System (IPSS) risk groups. A single center Phase II trial in patients (pts) with MDS, examining an alternative outpatient regimen of decitabine administered at 20 mg/m2 IV over 1 hour once daily for 5 days every 4 weeks, resulted in an overall improvement rate (IWG 2006: CR + marrow CR (mCR) + PR + HI) of 72% (Cancer 2007:109:265). The purpose of this trial was to examine the efficacy and safety of this alternative dosing regimen in a multicenter setting. Methods: This Phase II trial enrolled pts with all FAB classifications of MDS and IPSS scores ≥ 0.5 with an ECOG performance status of 0–2. An expert review of responses according to IWG 2006 criteria was performed. Results: Baseline patient characteristics: median age 72 yrs, 11% had secondary MDS, 27% with prior MDS disease-modifying therapy, and 29% had poor risk cytogenetics. The overall improvement rate was similar across IPSS risk groups (Intermediate-1 [n=52]: 50%; Intermediate-2 [n=23]: 61%; High Risk [n=23]: 43%). 82% of pts who experienced clinical improvement did so by cycle 2. The overall improvement rate was 51% for pts with de novo MDS, 45% for secondary MDS, and 44% for pts who received prior disease-modifying agents. The safety profile was consistent with previous studies. Conclusions: This multicenter trial examining the alternative 5-day decitabine dosing schedule compares favorably with that of the 3-day dosing regimen, provides validation and generalizability of the previously published single center trial and confirms that the alternative schedule is safe and effective in pts with MDS including those who have poor prognostic factors. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration MGI Pharma MGI Pharma MGI Pharma MGI Pharma MGI Pharma, Pharmion
Treatment of Blood Cholesterol to Reduce Risk for Atherosclerotic Cardiovascular Disease
Authors: Murray A. Mittleman, William C. Taylor, Gerald Smetana, Risa B. Burns
Journal: Annals of Internal Medicine (2015)

In November 2013, the American College of Cardiology and the American Heart Association released a clinical practice guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease (ASCVD) risk in adults. The recommendation identifies 4 patient groups with strong evidence that the benefits of reduction in ASCVD events from statin therapy exceed adverse events. For these patients, initiating statin therapy of an appropriate intensity to reduce ASCVD risk and minimize adverse effects is recommended. A new risk estimator based on a pooled cohort equation is presented for estimating 10-year ASCVD risk. There is also a recommendation to engage in a clinician–patient discussion before initiating a statin, especially for primary prevention of ASCVD. This paper summarizes a discussion between a cardiologist and an internist about how each clinician would balance these factors and what treatment they would suggest for an individual patient.
Measurement presents technical difficulties
Authors: W A Bartlett, A F Jones
Journal: BMJ (1996)

EDITOR,—In their evaluation of measurement of the prostate specific antigen concentration as a screening test for prostatic cancer Carol Parkes and colleagues advocate the use of values expressed as multiples of the median value in a healthy population matched for age.1 Currently, laboratories report actual numerical values for prostate specific antigen.

The authors do not discuss the technical difficulties in measuring the low prostate specific antigen concentrations seen in healthy men, which …
Choice blindness and the non-unitary nature of the human mind
Authors: Petter Johansson, Lars Hall, Peter Gärdenfors
Journal: Behavioral and Brain Sciences (2011)

Abstract Experiments on choice blindness support von Hippel &amp; Trivers's (VH&amp;T's) conception of the mind as fundamentally divided, but they also highlight a problem for VH&amp;T's idea of non-conscious self-deception: If I try to trick you into believing that I have a certain preference, and the best way is to also trick myself, I might actually end up having that preference, at all levels of processing.
Network therapy for addiction: a model for office practice
Authors: M Galanter
Journal: American Journal of Psychiatry (1993)

Individual therapists in office practice are often considered to have limited effectiveness in treating alcohol and drug dependence. In this article the author describes network therapy, an approach developed to assure greater success in such treatment. It uses psychodynamic and behavioral therapy while engaging the patient in a support network composed of family members and peers. A cognitive-behavioral model of addiction, based on the role of conditioned withdrawal in relapse, is described. Related techniques for securing abstinence are then reviewed; they augment individual psychotherapy to help patients avoid relapse caused by the affective and environmental cues that precipitate drug seeking. The role of social cohesiveness as a vehicle for engaging patients in treatment is outlined next, along with a related technique for enhancing an addicted patient's commitment to the therapy. This is done by using the patient's family and peers as a therapeutic network to join the patient at intervals in therapy sessions. The network is managed by the therapist to provide cohesiveness and support, undermine denial, and promote compliance with treatment. The author presents applications of the network technique designed to sustain abstinence and describes means of stabilizing members' involvement. Applications of network therapy to ambulatory detoxification, disulfiram and naltrexone administration, relapse prevention, and contingency contracting are reviewed.
LV volumes but not filling pressure are determinants of survival in critically ill patients
Authors: David J. Sturgess, Bala Venkatesh, Christopher J. Joyce, Mark Jones, Thomas H. Marwick
Journal: Circulation (2006)

Background: Transthoracic echocardiography (TTE) is able to assess LV volumes as well as LV filling pressure (from the ratio of mitral E velocity/mitral annular tissue velocity [E/e’]). E/e’ predicts outcome after infarction but its prognostic value in critical illness is undefined. The aim of this study was to evaluate the prognostic significance of echocardiographic LV volumes and filling pressure in the critically ill. Methods: A consecutive group of 94 patients (66M, 28F, 61±15 years) who had standard TTE supplemented by measurement of E/e’ in a combined medical and surgical tertiary referral ICU were enrolled. TTE was performed 5±6 days after ICU admission. Severity of critical illness was assessed using APACHE III. Survival analysis was based on 28-day survival from date of echo with patients discharged alive censored at the time of leaving hospital. Results are presented as mean±SD. Results: Mean APACHE III score was 72±25, and length of stay in ICU was 11±11 days and in hospital 32±48 days. Hospital mortality was 33% (n=31); correlates of hospital mortality are summarized in Table 1. Univariate analysis of survival obtained similar results. The independent predictors of survival were APACHE III risk of hospital death (HR 1.3 (95%CI 1.1–1.5), p=0.003), and increased LVESV (HR 2.1 (95%CI 1.2–3.7), p=0.007). Peak E velocity and E/e’ were not predictors of survival. Table 1. Univariate analysis of hospital mortality Conclusion: In this cohort of critically ill patients, LVESV but not E/e’ is a highly significant predictor of survival that adds incremental value to APACHE III derived prediction.
THE PHYSICAL AND MENTAL STATES IN CHRONIC CHOREA
Authors: NICHOLAS J. DYNAN
Journal: American Journal of Psychiatry (1914)

We find then in chronic progressive chorea a varied ancestry, usually of a neurotic type, which shows that the disease has been present and was known in different countries (as for instance the German family shown on the chart) long before Huntington's description of the disease. A careful examination of the personal histories reveals no disease of infantile or adult life to which the condition is ascribable. More accurate history of the ancestry and progeny of choreics is needed. The ratio of choreics to admissions to this hospital is 1 to 696. Physical symptoms were most prominent, including convulsions in five cases. The sense of smell was more impaired than that of taste. Ocular movements of choreic nature occur. Many facial contortions were present. The choreic motions approximate 80 per minute. There was slight impairment of hearing and in a number cutaneous sensibility was impaired. Bulimia was a very marked symptom not previously given sufficient notice. The presence of tuberculosis was frequent. The onset of the disease is at about five-eighths of the age at which the disease manifested itself in the parents. Mental symptoms were noted at the onset oftener than physical symptoms, and homicidal tendencies were more pronounced than suicidal. The emotional conditions were chiefly irritability and indifference, varying to depression. In the stream of thought, food occupied the most prominent place. Only little hallucinosis was manifested and delusions of a vague persecutory type occurred but were poorly upheld. There was some attention, retention and memory impairment as well as impaired judgment and partial disorientation for time, place and persons. Impairment of the intelligence also occurred. There was more or less characteristic defect progressing toward dementia in practically all of the mental functions, leading to the conclusion that chronic progressive chorea has definite characteristic mental states with characteristic behavior, course and termination, while on pathologic examination there is found fairly definite pathology with widespread brain lesions, marked in the third and fourth layers of the cerebral cortex and more definitely marked in the basal ganglia and subthalamic regions. [See table in the PDF file]
ESCMID† and ECMM‡ joint clinical guidelines for the diagnosis and management of mucormycosis 2013
Authors: O.A. Cornely, S. Arikan-Akdagli, E. Dannaoui, A.H. Groll, K. Lagrou, A. Chakrabarti, F. Lanternier, L. Pagano, A. Skiada, M. Akova, M.C. Arendrup, T. Boekhout, A. Chowdhary, M. Cuenca-Estrella, T. Freiberger, J. Guinea, J. Guarro, S. de Hoog, W. Hope, E. Johnson, S. Kathuria, M. Lackner, C. Lass-Flörl, O. Lortholary, J.F. Meis, J. Meletiadis, P. Muñoz, M. Richardson, E. Roilides, A.M. Tortorano, A.J. Ullmann, A. van Diepeningen, P. Verweij, G. Petrikkos
Journal: Clinical Microbiology and Infection (2014)
Effectiveness of tuberculosis contact tracing among migrants and the foreign-born population
Authors: C Mulder, E Klinkenberg, D Manissero
Journal: Eurosurveillance (2009)

A literature review was performed to assess the effectiveness of tuberculosis (TB) contact tracing among migrants and the foreign-born population with emphasis on the European Union. Effectiveness of contact tracing was assessed using the following indicators: coverage, proportion of contacts with TB (TB yield), proportion of contacts with latent tuberculosis infection (LTBI yield) and number of investigated contacts per index case (contacts/index case ratio). The key findings from the literature review were: Among foreign-born contacts, a higher median LTBI yield was found compared with contacts born in the country, when exposed to the same foreign-born index cases. No clear differences were observed between TB and LTBI yield among contacts of foreign-born index cases compared with contacts of index cases from the general population (including the foreign-born) due to the large variation seen between the studies. The included non-European studies screened more contacts per foreign-born index case, used lower cut-off values to define a positive tuberculosis skin test and found higher LTBI yields among contacts. Although the high heterogeneity across the studies made the comparison challenging, several conclusions are made regarding contact tracing among migrants.
Grand Rounds - Hammersmith Hospital: Cardiac arrest and hypertrophic cardiomyopathy
Authors: D C Lefroy
Journal: BMJ (1994)

Hypertrophic cardiomyopathy is a common cause of sudden death in apparently healthy young adults, and antiarrhythmic drugs may not prevent this outcome. Implantable defibrillator technology has progressed sufficiently for these devices to correct malignant cardiac arrhythmias and prevent sudden death in patients with hypertrophic cardiomyopathy. The identification of suitable patients is an important challenge since the non- arrhythmic prognosis of hypertrophic cardiomyopathy is relatively good.

A 35 year old woman collapsed at the wheel of her car after nearly hitting a lorry. Another car driver went to help and found her unconscious, cyanosed, and breathing noisily. Her pulse was initially very rapid and then disappeared. He started cardiopulmonary resuscitation by the roadside, and an ambulance arrived in about seven minutes. Defibrillation immediately ended the ventricular fibrillation and her pulse returned. After admission to hospital, her return to consciousness was slow but computed tomography of the brain showed no abnormality. Apart from some retrograde amnesia of the events leading up to her cardiac arrest, she recovered completely and was transferred to our hospital for further evaluation.

In 1990, she had had a single syncopal episode, and had been admitted to our hospital, where echocardiography had shown hypertrophic cardiomyopathy. At that time tilt testing caused abnormal hypotension associated with marked bradycardia after 34 minutes of tilting the head up 60°. In addition, the signal averaged surface electrocardiogram showed late potentials in the QRS complex, which suggested a predisposition to ventricular tachyarrhythmias. However, no episodes of ventricular tachycardia were observed on 24 hour electrocardiographic monitoring. She was started on amiodarone 200 mg daily and had no further syncopal episodes. She was therefore allowed to retain her driving licence. One year later her amiodarone dose was reduced to 200 mg three times weekly because of photosensitivity. Subsequently, she conceived and gave birth to healthy …