tbuckley/cabot-search huggingface dataset:
Changes in Financial Burdens for Health Care
Authors: Jessica S. Banthin, Didem M. Bernard
Journal: JAMA (2006)

ContextPolicymakers as well as physicians need to understand how rapidly rising health care costs are affecting specific groups of patients.ObjectiveTo estimate the number and characteristics of individuals in the United States faced with very high financial burdens for health care.Design, Setting, and PopulationData from a nationally representative sample of civilian, noninstitutionalized US individuals younger than 65 years from the Medical Expenditure Panel Surveys were used to calculate 2 measures of financial burden as a function of tax-adjusted family income. Total burden included all out-of-pocket expenditures for health care services, including premiums. Health care services burden excluded premiums and, when applied to the insured population, was used to identify the underinsured. We defined the underinsured as insured persons with health care service burdens in excess of 10% of tax-adjusted family income.Main Outcome MeasuresTotal and health care services burdens exceeding 10% and 20% of family income in 1996 and 2003.ResultsIn 2003, there were 48.8 million individuals (19.2%) living in families spending more than 10% of family income on health care, an increase of 11.7 million persons since 1996. Of these individuals, about 18.7 million (7.3%) were spending more than 20% of family income. In 2003, individuals with higher-than-average risk of incurring high total burdens included poor and low-income persons and those with nongroup coverage, aged 55 to 64 years, living in a non–metropolitan statistical area, in fair or poor health, having any type of limitation, or having a chronic medical condition. Applying our definition of underinsured to the insured population, an estimated 17.1 million persons younger than 65 years were underinsured in 2003, including 9.3 million persons with private employment-related insurance, 1.3 million persons with private nongroup policies, and 6.6 million persons with public coverage.ConclusionsOur analysis identifies patients at greatest risk of health-related financial burdens that may adversely affect their access and adherence to recommended treatments. Our study also highlights the high costs associated with nongroup health insurance policies.
The Mini-CEX (Clinical Evaluation Exercise): A Preliminary Investigation
Authors: John J. Norcini
Journal: Annals of Internal Medicine (1995)

Objective: To gather preliminary data on the mini-CEX (clinical evaluation exercise), a device for assessing the clinical skills of residents. Design: Evaluation of residents by faculty members using the mini-CEX. Setting: 5 internal medicine training programs in Pennsylvania. Participants: 388 mini-CEX encounters involving 88 residents and 97 evaluators. Measurements: A mini-CEX encounter consists of a single faculty member observing a resident while that resident conducts a focused history and physical examination in any of several settings. After asking the resident for a diagnosis and treatment plan, the faculty member rates the resident and provides educational feedback. The encounters are intended to be short (about 20 minutes) and to occur as a routine part of training so that each resident can be evaluated on several occasions by different faculty members. Results: The encounters occurred in both inpatient and ambulatory settings and were longer than anticipated (median duration, 25 minutes). Residents saw either new or follow-up patients who collectively presented with a broad range of clinical problems. The median evaluator assessed two residents and was generally satisfied with the mini-CEX format; residents were even more satisfied with the format. The reproducibility of the mini-CEX is higher than that of the traditional CEX, and its measurement characteristics are similar to those of other test formats, such as standardized patients and standardized oral examinations. Conclusions: The mini-CEX assesses residents in a much broader range of clinical situations than the traditional CEX, has better reproducibility, and offers residents greater opportunity for observation and feedback by more than one faculty member and with more than one patient. On the other hand, the mini-CEX may be more difficult to administer because multiple encounters must be scheduled for each resident. Exclusive use of the mini-CEX also prevents residents from being observed while doing a complete history and physical examination. Given the promising results and measurement characteristics of the mini-CEX, however, the American Board of Internal Medicine encourages the use of this method in conjunction with or as an alternative to the traditional CEX.
Prognostic significance of microsatellite instability determined by immunohistochemical staining of MSH2 and MLH1 in sporadic T3N0M0 colon cancer
Authors: Y Parc
Journal: Gut (2004)

Microsatellite instability (MSI) has been identified as a factor with good prognosis and chemosensitivity in stage III C colon cancer. The purpose of this study was to evaluate the routine use of immunohistochemical analysis (immunohistochemical staining of MSH2 and MLH1) to identify T3N0M0 (stage II) colon cancer with MSI and assess the prognostic value of this analysis. The study was conducted in a large cohort of patients in a single institution who had a curatively resected T3N0M0 colon cancer and were not receiving adjuvant therapy.
Sex Differences in Morphology and Outcomes of Mitral Valve Prolapse
Authors: Jean François Avierinos, Jocelyn Inamo, Francesco Grigioni, Bernard Gersh, Clarence Shub, Maurice Enriquez-Sarano
Journal: Annals of Internal Medicine (2008)

Background: Mitral valve prolapse is more common in women than in men, but men more often have surgery for severe regurgitation. Objective: To compare morphology and outcomes of mitral valve prolapse in men and women. Design: Retrospective cohort study. Setting: The Mayo Clinic, Rochester, Minnesota. Patients: 4461 women and 3768 men who received a diagnosis of mitral valve prolapse by echocardiography from 1989 to 1998 (896 Olmsted County residents and 7333 referred patients). Measurements: Mitral prolapse characteristics (localization, leaflet thickening or flail, regurgitation), ventricular and atrial characteristics, cardiac surgery, and mortality. Results: Compared with men, women had less posterior prolapse (22% vs. 31%), less flail (2% vs. 8%), more leaflet thickening (32% vs. 28%), and less frequent severe regurgitation (10% vs. 23%) (P < 0.001 for all comparisons). Regardless of the severity of regurgitation, left ventricular and atrial diameters were smaller in women than in men but were larger in women after normalization to body surface area. Among patients with severe regurgitation, women were less likely than men to undergo cardiac valve surgery (52% vs. 60%; adjusted risk ratio, 0.79 [95% CI, 0.74 to 0.84]). At 15 years, women with no or mild mitral regurgitation had better odds of survival than men (87% vs. 77%; adjusted risk ratio, 0.82 [CI, 0.76 to 0.89]), but those with severe regurgitation had worse survival than men (60% vs. 68%; adjusted risk ratio, 1.13 [CI, 1.01 to 1.26]). The survival rate 10 years after surgery was similar in women and men (77% vs. 79%; P = 0.14). Observations in Olmsted County patients and referred patients were similar. Limitation: Diagnoses were based on echocardiography, and clinical data at initial diagnosis, reason for index echocardiography, and cause of all deaths were lacking. Conclusion: Morphology and severity of mitral valve prolapse differ according to sex. Among patients with severe regurgitation, women have higher mortality and lower surgery rates than men.
618. Hydrodynamic Limb Vein-Delivered Xenogeneic Plasmid DNA Cancer Vaccine Effectively Induces Antitumor Protection
Authors: Zane C. Neal, Mary Kay Bates, Hans Herweijer
Journal: Molecular Therapy (2006)

We recently developed a clinically relevant approach for intravascular hydrodynamic limb vein (HLV) delivery of nucleic acids that results in high-level transgene expression in myofibers. This novel delivery method is a very effective means to induce a high-titer antibody response against expressed transgene antigens following genetic immunization. Here, we examine the utility of HLV as a method to deliver a genetic cancer vaccine in mice. Using the human gp100 (hgp100) xenogeneic DNA cancer vaccine in the murine B16 melanoma model, we show that genetic vaccination of mice by HLV delivery was highly effective at breaking tolerance against the homologous murine gp100 tumor-associated-antigen and induced prophylactic antitumor protection against B16 tumor challenge. Mice were vaccinated by repeated (days 0, 14 and 28) injections of 50 μg of plasmid DNA encoding the hgp100 into a distal site of the hind limb saphenous vein in a volume of 1.0 ml at a rate of 8.0 ml/min. Tolerance was broken in hgp100-vaccinated mice as demonstrated by prophylactic antitumor protection and in vitro cytolytic activity against B16 and hgp100-transfected B16 (B16-hgp100) cells. Tetramer (hgp10025–33/H2Db) analysis of peripheral blood lymphocytes indicated that 3–5% of the CD8+ T cells were gp100-specific following HLV vaccination. Although HLV genetic vaccination elicited an anti-hgp100 antibody response able to recognize and bind appropriately (processed in B16 melanocytic cells) and aberrantly (processed in non-melanosomal COS-7 cells) processed hgp100, adoptive and passive transfer studies demonstrated that protection was cell-mediated. Furthermore, a durable antitumor memory response was evident in HLV vaccinated mice 6 months after tumor challenge. Survivor mice showed delayed tumor progression upon B16 rechallenge, with 3–4% of their CD8+ T cells still exhibiting gp100-specificity. Effective reactivation of antitumor protection was achieved in survivor mice by a single HLV hgp100 boost that resulted in expansion of gp100-specific CD8+ T cells (17%) and protection from tumor rechallenge. Our results indicate that genetic vaccination by HLV delivery is an effective method to break tolerance and induce T cell immunity capable of prophylactic antitumor protection. Most importantly, since HLV gene delivery is equally effective in small and large research animals (mice, rats, rabbits, dogs and monkeys), it represents a clinically promising alternative to existing genetic vaccination strategies.
The Complete Mitochondrial Genome of the Articulate Brachiopod Terebratalia transversa
Authors: Kevin G. Helfenbein, Wesley M. Brown, Jeffrey L. Boore
Journal: Molecular Biology and Evolution (2001)

We sequenced the complete mitochondrial DNA (mtDNA) of the articulate brachiopod Terebratalia transversa. The circular genome is 14,291 bp in size, relatively small compared with other published metazoan mtDNAs. The 37 genes commonly found in animal mtDNA are present; the size decrease is due to the truncation of several tRNA, rRNA, and protein genes, to some nucleotide overlaps, and to a paucity of noncoding nucleotides. Although the gene arrangement differs radically from those reported for other metazoans, some gene junctions are shared with two other articulate brachiopods, Laqueus rubellus and Terebratulina retusa. All genes in the T. transversa mtDNA, unlike those in most metazoan mtDNAs reported, are encoded by the same strand. The A+T content (59.1%) is low for a metazoan mtDNA, and there is a high propensity for homopolymer runs and a strong base-compositional strand bias. The coding strand is quite G+T-rich, a skew that is shared by the confamilial (laqueid) species L. rubellus but is the opposite of that found in T. retusa, a cancellothyridid. These compositional skews are strongly reflected in the codon usage patterns and the amino acid compositions of the mitochondrial proteins, with markedly different usages being observed between T. retusa and the two laqueids. This observation, plus the similarity of the laqueid noncoding regions to the reverse complement of the noncoding region of the cancellothyridid, suggests that an inversion that resulted in a reversal in the direction of first-strand replication has occurred in one of the two lineages. In addition to the presence of one noncoding region in T. transversa that is comparable with those in the other brachiopod mtDNAs, there are two others with the potential to form secondary structures; one or both of these may be involved in the process of transcript cleavage.
Perceptual symbols in language comprehension: Can an empirical case be made?
Authors: Rolf A. Zwaan, Robert A. Stanfield, Carol J. Madden
Journal: Behavioral and Brain Sciences (1999)

Perceptual symbol systems form a theoretically plausible alternative to amodal symbol systems. At this point it is unclear whether there is any truly diagnostic empirical evidence to decide between these systems. We outline some possible avenues of research in the domain of language comprehension that might yield such evidence. Language comprehension will be an important arena for tests of the two types of symbol systems.
Improving Case Definitions for Severe Malaria
Authors: Nicholas M Anstey, Ric N Price
Journal: PLoS Medicine (2007)

The lack of a gold standard definition for severe malaria has been a longstanding problem for both clinicians and researchers. The definitions currently used comprise a set of clinical and laboratory parameters associated with an increased risk of death combined with the presence of Plasmodium falciparum parasitemia. In young children these criteria are predominantly altered consciousness severe anemia and respiratory distress; a broader range of criteria is applicable to adolescents and adults. While these criteria are sensitive in diagnosing severe malaria they are also present in other serious illnesses. Since asymptomatic parasitemia is common in malaria-endemic areas patients fulfilling current World Health Organization (WHO) criteria for severe malaria often have disease attributable to another cause such as bacterial sepsis with incidental parasitemia thereby limiting the specificity of this definition. For a treating clinician a sensitive but less specific definition of severe malaria is entirely appropriate. However for research purposes a sensitive clinical definition may not necessarily be appropriate and the case definition should depend on the research question. (excerpt)
Effect of Work-Hour Regulations on Outcomes
Authors: Leora Horwitz
Journal: Annals of Internal Medicine (2008)

Letters18 March 2008Effect of Work-Hour Regulations on OutcomesLeora Horwitz, MD, MHS, Harlan Krumholz, MD, SM, Zhenqui Lin, PhD, and Mikhail Kosiborod, MDLeora Horwitz, MD, MHSFrom Yale School of Medicine, New Haven, CT 06510; Yale-New Haven Hospital, New Haven, CT 06504; and Mid America Heart Institute, Kansas City, MO 64111.Search for more papers by this author, Harlan Krumholz, MD, SMFrom Yale School of Medicine, New Haven, CT 06510; Yale-New Haven Hospital, New Haven, CT 06504; and Mid America Heart Institute, Kansas City, MO 64111.Search for more papers by this author, Zhenqui Lin, PhDFrom Yale School of Medicine, New Haven, CT 06510; Yale-New Haven Hospital, New Haven, CT 06504; and Mid America Heart Institute, Kansas City, MO 64111.Search for more papers by this author, and Mikhail Kosiborod, MDFrom Yale School of Medicine, New Haven, CT 06510; Yale-New Haven Hospital, New Haven, CT 06504; and Mid America Heart Institute, Kansas City, MO 64111.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-6-200803180-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate Dr. Rifkin's firsthand experience and reactions to our study. Because this was a retrospective, observational study, we could not draw any firm conclusions about causality. Nonetheless, we fully agree with Dr. Rifkin that several factors, including increased supervision by senior residents, fellows, and attending physicians, probably played a role in the outcomes we observed.The fact that the program schedule was revamped after the study period is particularly interesting given that we could not detect any evidence of harm to patients. This illustrates the importance of confirming (or challenging) conventional wisdom with carefully conducted studies.In ... Author, Article, and Disclosure InformationAuthors: Leora Horwitz, MD, MHS; Harlan Krumholz, MD, SM; Zhenqui Lin, PhD; Mikhail Kosiborod, MDAffiliations: From Yale School of Medicine, New Haven, CT 06510; Yale-New Haven Hospital, New Haven, CT 06504; and Mid America Heart Institute, Kansas City, MO 64111.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoChanges in Outcomes for Internal Medicine Inpatients after Work-Hour Regulations Leora I. Horwitz , Mikhail Kosiborod , Zhenqiu Lin , and Harlan M. Krumholz Effect of Work-Hour Regulations on Outcomes Dena E. Rifkin Metrics 18 March 2008Volume 148, Issue 6Page: 483KeywordsConflicts of interestObservational studiesPatients ePublished: 18 March 2008 Issue Published: 18 March 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Activation, exhaustion, and persistent decline of the antimicrobial MR1-restricted MAIT-cell population in chronic HIV-1 infection
Authors: Edwin Leeansyah, Anupama Ganesh, Máire F. Quigley, Anders Sönnerborg, Jan Andersson, Peter W. Hunt, Ma Somsouk, Steven G. Deeks, Jeffrey N. Martin, Markus Moll, Barbara L. Shacklett, Johan K. Sandberg
Journal: Blood (2012)
Telephone vs Face-to-Face Cognitive Behavioral Therapy for Depression—Reply
Authors: David C. Mohr, Joyce Ho, Juned Siddique
Journal: JAMA (2012)

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Abstract 4338: Tumor reversion: From bench to potential clinical applications using sertraline and thioridazine.
Authors: Robert Amson, Salvatore Pece, Pier Paolo Di Fiore, Judith Karp, Jean-Christophe Marine, Adam Telerman
Journal: Cancer Research (2013)

Abstract This presentation aims at summarizing today's knowledge on tumor reversion (ref.1) with recent applications and new findings for potential cancer treatment. In order to study the molecular program of tumor reversion we have provided with a series of biological models. In this approach, we derived revertant cells from tumor cell lines ranging from leukemia to solid tumors such as breast, colon, lung cancer and melanoma. Using differential gene profiling, between the parental tumor cells and the revertants, over 300 genes were identified, as implicated in reversion such as Siah-1, TSAP6, PS1 and most importantly Translationally Controlled Tumor Protein (TPT1/TCTP) (ref. 2). Notably TPT1/TCTP is highly expressed in the tumor cells and almost undetectable in the revertants. Knocking down TPT1/TCTP reorganized breast cancer cells into ductal structures reminiscent of normal breast morphology. More recently, we identified a strong reciprocal repressive feedback loop between TPT1/TCTP and p53 (ref.3). P53 represses the transcription of TPT1/TCTP by binding to the promoter of TPT1/TCTP. Conversely, TPT1/TCTP interacts directly with p53, Numb and MDM2. TPT1/TCTP competes with Numb. Importantly, TPT1/TCTP stabilizes MDM2, promoting hereby MDM2-dependent ubiquitination and proteasomal degradation of p53. Screening of a large cohort of breast cancer patients (508) shows high expression of TPT1/TCTP in the most aggressive G3 tumors, predicting poor prognosis. TPT1/TCTP is also highly expressed in normal and cancer breast stem cells. Decreasing TPT1/TCTP by siRNA in a mammosphere assay significantly reduces the colony forming efficiency. Thus, TPT1/TCTP also regulates the stem cell compartment. We found two drugs, Sertraline and Thioridazine, which bind and inactivate TPT1/TCTP, restoring elevated levels of wild type p53. Pilot studies on ex vivo cells derived from AML-patients indicate that Sertraline and Ara-C act synergistically in reducing the viability of AML cells. The implication of tumor reversion in reprogramming cancer cells and in disclosing new therapeutic targets as well as its potential role in tumor heterogeneity will be discussed. Citation Format: Robert Amson, Salvatore Pece, Pier Paolo Di Fiore, Judith Karp, Jean-Christophe Marine, Adam Telerman. Tumor reversion: From bench to potential clinical applications using sertraline and thioridazine. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4338. doi:10.1158/1538-7445.AM2013-4338
Safety and efficacy of leflunomide in primary Sjogren's syndrome: a phase II pilot study
Authors: J M van Woerkom, A A Kruize, R Geenen, E N van Roon, R Goldschmeding, S M M Verstappen, J A G van Roon, J W J Bijlsma
Journal: Annals of the Rheumatic Diseases (2007)

<b>Background:</b> For invalidating symptoms in primary Sjögren's syndrome (pSS), there is still a need for easy-to-administer, cost-effective and well-tolerated systemic treatment. Leflunomide (LEF) is structurally unrelated to other immunomodulatory drugs and might be efficacious in pSS, given its characteristic immunoregulatory modes of action. <b>Objective:</b> To investigate the safety and efficacy of LEF in pSS in a phase II open-label pilot study. <b>Methods:</b> 15 patients with pSS with early and active disease received LEF 20 mg once daily for 24 weeks. Tolerability, safety and efficacy of LEF were evaluated every 8 weeks. Additional safety visits were performed every fortnight. <b>Results:</b> Mild gastrointestinal discomfort (including diarrhoea) and hair loss were mainly reported. Five patients developed lupus-like skin lesions on the face, arms or trunk, responding well to topical corticosteroids, nevertheless causing the withdrawal of one patient. Two patients with pre-existing hypertension had to increase dosages of anti-hypertensive drugs. Increased levels of alanine aminotransferase normalised after dose reduction in two patients. A decrease in general fatigue and an increase in physical functioning were observed after 24 weeks. Serum IgG levels decreased from 8 weeks onwards. Schirmer test values increased, not reaching statistical significance, whereas sialometry values did not change. In four of five repeated biopsies, the lymphocytic focus score decreased at the rate of 1 focus/4 mm<sup>2</sup>. A remarkable amelioration of leucocytoclastic vasculitis was observed in three patients. <b>Conclusions:</b> Although the safety profile seems fairly acceptable, the observed indications for efficacy were modest and may be doubtful in justifying a randomised controlled trial of LEF in pSS.