tbuckley/cabot-search huggingface dataset:
Association of Hospital Participation in a Quality Reporting Program With Surgical Outcomes and Expenditures for Medicare Beneficiaries
Authors: Nicholas H. Osborne, Lauren H. Nicholas, Andrew M. Ryan, Jyothi R. Thumma, Justin B. Dimick
Journal: JAMA (2015)

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) provides feedback to hospitals on risk-adjusted outcomes. It is not known if participation in the program improves outcomes and reduces costs relative to nonparticipating hospitals.To evaluate the association of enrollment and participation in the ACS NSQIP with outcomes and Medicare payments compared with control hospitals that did not participate in the program.Quasi-experimental study using national Medicare data (2003-2012) for a total of 1,226,479 patients undergoing general and vascular surgery at 263 hospitals participating in ACS NSQIP and 526 nonparticipating hospitals. A difference-in-differences analytic approach was used to evaluate whether participation in ACS NSQIP was associated with improved outcomes and reduced Medicare payments compared with nonparticipating hospitals that were otherwise similar. Control hospitals were selected using propensity score matching (2 control hospitals for each ACS NSQIP hospital).Thirty-day mortality, serious complications (eg, pneumonia, myocardial infarction, or acute renal failure and a length of stay >75th percentile), reoperation, and readmission within 30 days. Hospital costs were assessed using price-standardized Medicare payments during hospitalization and 30 days after discharge.After accounting for patient factors and preexisting time trends toward improved outcomes, there were no statistically significant improvements in outcomes at 1, 2, or 3 years after (vs before) enrollment in ACS NSQIP. For example, in analyses comparing outcomes at 3 years after (vs before) enrollment, there were no statistically significant differences in risk-adjusted 30-day mortality (4.3% after enrollment vs 4.5% before enrollment; relative risk [RR], 0.96 [95% CI, 0.89 to 1.03]), serious complications (11.1% after enrollment vs 11.0% before enrollment; RR, 0.96 [95% CI, 0.91 to 1.00]), reoperations (0.49% after enrollment vs 0.45% before enrollment; RR, 0.97 [95% CI, 0.77 to 1.16]), or readmissions (13.3% after enrollment vs 12.8% before enrollment; RR, 0.99 [95% CI, 0.96 to 1.03]). There were also no differences at 3 years after (vs before) enrollment in mean total Medicare payments ($40 [95% CI, -$268 to $348]), or payments for the index admission (-$11 [95% CI, -$278 to $257]), hospital readmission ($245 [95% CI, -$231 to $721]), or outliers (-$86 [95% CI, -$1666 to $1495]).With time, hospitals had progressively better surgical outcomes but enrollment in a national quality reporting program was not associated with the improved outcomes or lower Medicare payments among surgical patients. Feedback on outcomes alone may not be sufficient to improve surgical outcomes.
Early Diagnosis of Cutaneous Melanoma
Authors: Naheed R. Abbasi, Helen M. Shaw, Darrell S. Rigel, Robert J. Friedman, William H. McCarthy, Iman Osman, Alfred W. Kopf, David Polsky
Journal: JAMA (2004)

The incidence of cutaneous melanoma has increased over the past several decades, making its early diagnosis a continuing public health priority. The ABCD (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) acronym for the appraisal of cutaneous pigmented lesions was devised in 1985 and has been widely adopted but requires reexamination in light of recent data regarding the existence of small-diameter (< or =6 mm) melanomas.Cochrane Library and PubMed searches for the period 1980-2004 were conducted using search terms ABCD and melanoma and small-diameter melanoma. Bibliographies of retrieved articles were also used to identify additional relevant information.Available data do not support the utility of lowering the diameter criterion of ABCD from the current greater than 6 mm guideline. However, the data support expansion to ABCDE to emphasize the significance of evolving pigmented lesions in the natural history of melanoma. Physicians and patients with nevi should be attentive to changes (evolving) of size, shape, symptoms (itching, tenderness), surface (especially bleeding), and shades of color.The ABCD criteria for the gross inspection of pigmented skin lesions and early diagnosis of cutaneous melanoma should be expanded to ABCDE (to include "evolving"). No change to the existing diameter criterion is required at this time.
Fucosylation ratio of alpha fetoprotein. Increased accuracy on hepatocellular carcinoma
Authors: J. Peneda, A. Fonseca, F. Calinas, T. Bentes, J. Coimbra, M. Sampaio, R. Godinho, I. Medeiros, C.E. Santo, M. Oliveira
Journal: Journal of Hepatology (1998)
HIV among People Who Inject Drugs in the Middle East and North Africa: Systematic Review and Data Synthesis
Authors: Ghina R. Mumtaz, Helen A. Weiss, Sara L. Thomas, Suzanne Riome, Hamidreza Setayesh, Gabriele Riedner, Iris Semini, Oussama Tawil, Francisca Ayodeji Akala, David Wilson, Laith J. Abu-Raddad
Journal: PLoS Medicine (2014)

Laith Abu-Raddad and colleagues assess the current state of knowledge of the HIV epidemic among people who inject drugs in the Middle East and North Africa. Please see later in the article for the Editors' Summary
Restoring Effects of Vitamin A on Surfactant Synthesis in Nitrofen-induced Congenital Diaphragmatic Hernia in Rats
Authors: BERNARD THÉBAUD, ANNE-MARIE BARLIER-MUR, BERNADETTE CHAILLEY-HEU, ALEXANDRA HENRION-CAUDE, DICK TIBBOEL, ANH-TUAN DINH-XUAN, JACQUES R. BOURBON
Journal: American Journal of Respiratory and Critical Care Medicine (2001)

Congenital diaphragmatic hernia (CDH) is a major cause of refractory respiratory failure in the newborn. Besides pulmonary hypoplasia, the pathophysiology of CDH also includes surfactant deficiency. Vitamin A (vit A) is important for various aspects of lung development. We hypothesized that antenatal treatment with vit A would stimulate lung surfactant synthesis in experimental CDH induced in rats by maternal ingestion of the herbicide nitrofen (2,4-dichloro-phenyl-p-nitrophenyl-ether) on Day 12. Fetuses were assigned to six experimental groups: (1) controls from rats that received olive oil, the vehicle; (2) fetuses from rats that received olive oil on Day 12 and vit A orally (15,000 IU) on Day 14; (3) nitrofen (N)-exposed fetuses without diaphragmatic hernia (N/no DH); (4) N/no DH from rats given vit A on Day 14; (5 ) nitrofen-exposed fetuses with DH (N/ + DH); (6) N/ + DH from rats given vit A on Day 14. Fetuses were delivered by C-section at Day 21. Lung DNA content was lowered in the nitrofen group as compared with the controls group, but increased by subsequent vit A treatment. Lung surfactant disaturated phosphatidylcholine was reduced in the N/ + DH group and restored to control level by vit A. The expression level of surfactant proteins (SP) -A and -C was decreased in vit A–treated control rats and in nitrofen-exposed fetuses with or without DH. Vit A restored SP-A and -C mRNA expression to control levels in N/ + DH. SP-B expression was lowered in N/no DH and increased by vit A in this group. The proportion of type II cells assessed by SP-B immunolabeling was lowered in N/ + DH and restored by vit A treatment. We conclude that antenatal treatment with vit A restores lung maturation in nitrofen-induced hypoplastic lungs with CDH. These findings point out vit A as a potential therapeutical agent for correcting surfactant deficiency in CDH.
The relationship between glial cell mechanosensitivity and foreign body reactions in the central nervous system
Authors: Pouria Moshayedi, Gilbert Ng, Jessica C.F. Kwok, Giles S.H. Yeo, Clare E. Bryant, James W. Fawcett, Kristian Franze, Jochen Guck
Journal: Biomaterials (2014)

Devices implanted into the body become encapsulated due to a foreign body reaction. In the central nervous system (CNS), this can lead to loss of functionality in electrodes used to treat disorders. Around CNS implants, glial cells are activated, undergo gliosis and ultimately encapsulate the electrodes. The primary cause of this reaction is unknown. Here we show that the mechanical mismatch between nervous tissue and electrodes activates glial cells. Both primary rat microglial cells and astrocytes responded to increasing the contact stiffness from physiological values (G' ∼ 100 Pa) to shear moduli G' ≥ 10 kPa by changes in morphology and upregulation of inflammatory genes and proteins. Upon implantation of composite foreign bodies into rat brains, foreign body reactions were significantly enhanced around their stiff portions in vivo. Our results indicate that CNS glial cells respond to mechanical cues, and suggest that adapting the surface stiffness of neural implants to that of nervous tissue could minimize adverse reactions and improve biocompatibility.
Immunological protection against digoxin toxicity
Authors: Donald H. Schmidt, Vincent P. Butler
Journal: Journal of Clinical Investigation (1971)

The lethal dose of digoxin was determined by administering 10 ml of a digoxin-saline solution to 26 nonimmunized rabbits through an ear vein over a 10 min period. Rabbits receiving less than 0.45 mg/kg digoxin showed no toxic effect, whereas all 15 rabbits that received 0.5 mg/kg developed an early arrhythmia and died within 1 hr. Moreover, eight rabbits which had been immunized with antigens unrelated to digoxin or injected with Freund's adjuvant mixture all died after receiving 0.6 mg/kg digoxin. Thus, it was concluded that 0.6 mg/kg digoxin was uniformly lethal in rabbits that had not been immunized or had received antigens unrelated to digoxin. By way of contrast, 17 rabbits immunized with a digoxin-albumin conjugate in complete Freund's adjuvant formed digoxin-specific antibodies and survived doses of digoxin varying between 0.6 and 0.9 mg/kg. In 10 rabbits immunized with digoxin-albumin conjugates, digoxin-specific antibody titers were determined following the administration of digoxin. There was a significant fall in antibody titer. This study indicates that rabbits protected by digoxin-specific antibodies suffer no acute adverse effects from an amount of digoxin which is uniformly lethal in nonimmunized rabbits and in rabbits immunized with other antigens.
Transesophageal Echocardiography in High-Risk Patients with Atrial Fibrillation
Authors: Paul A. Tunick
Journal: Annals of Internal Medicine (1998)

Letters1 November 1998Transesophageal Echocardiography in High-Risk Patients with Atrial FibrillationPaul A. Tunick, MD and Itzhak Kronzon, MDPaul A. Tunick, MDNew York University Medical Center; New York, NY 10016Search for more papers by this author and Itzhak Kronzon, MDNew York University Medical Center; New York, NY 10016Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-9-199811010-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography has made an important contribution to our understanding of embolic risk by including the examination of the thoracic aorta in their patients with atrial fibrillation [1]. Aortic atheromas identified by transesophageal echocardiography have been recognized since 1990 as a source of embolism [2]. The Annals study [1] found exactly the same risk for stroke in patients with aortic atheromas (12% in approximately 1 year) as was found in the two previous prospective studies of risk for stroke in these patients [3]. Perhaps the most important finding of ...References1. Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Ann Intern Med. 1998; 128:639-47. Google Scholar2. Tunick PA, Kronzon I. Protruding atherosclerotic plaque in the aortic arch of patients with systemic embolization: a new finding seen by transesophageal echocardiography. Am Heart J. 1990; 120:658-60. Google Scholar3. Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. The French Study of Aortic Plaques in Stroke Group. N Engl J Med. 1996; 334:1216-21. Google Scholar4. Manning WJ, Douglas PS. Transesophageal echocardiography and atrial fibrillation: added value or expensive toy? [Editorial] Ann Intern Med. 1998; 128:685-7. Google Scholar5. Kronzon I, Tunick PA. Atheromatous disease of the thoracic aorta: pathologic and clinical implications. Ann Intern Med. 1997; 126:629-37. Google Scholar Author, Article, and Disclosure InformationAuthors: Paul A. Tunick, MD; Itzhak Kronzon, MDAffiliations: New York University Medical Center; New York, NY 10016 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1998Volume 129, Issue 9Page: 748KeywordsAortaAtheromasAtrial fibrillationDrugsEchocardiographyMyocardial infarctionProspective studiesStatinsStrokeThrombosis ePublished: 15 August 2000 Issue Published: 1 November 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The Appearance of Cell-Bound IgE in Respiratory-Tract Epithelium after Respiratory-Syncytial-Virus Infection
Authors: Robert C. Welliver, Tej N. Kaul, Pearay L. Ogra
Journal: New England Journal of Medicine (1980)

We studied the appearance of IgE in the respiratory tract in 42 infants and young children with various forms of respiratory illness after infection by respiratory syncytial virus (RSV). IgE was bound to exfoliated nasopharyngeal epithelial cells in most patients with RSV infection during the acute phase of infection, regardless of the form of illness. However, the continued presence of cell-bound IgE was more common in patients with RSV-induced bronchiolitis or asthma than in patients with mild upper-respiratory-tract illness or pneumonia due to RSV. Persistence of IgE was also apparently related to the incidence of previous episodes of wheezing in patients or their families. The production of IgE and the subsequent release of chemical mediators of bronchospasm may contribute to the pathogenesis of acute illness due to RSV; persistence of IgE in the respiratory tract may explain the recurrent episodes of wheezing that occur in many patients after RSV-induced bronchiolitis. (N Engl J Med. 1980; 303:1198–1202.)
Hot melt extrusion: An industrially feasible approach for casting orodispersible film
Authors: Rushiraj Jani, Dasharath Patel
Journal: Asian Journal of Pharmaceutical Sciences (2015)

Over the recent few decades, many groups of formulation scientists are concentrating on rapid release dosage forms in oral cavity. Among all fast release dosage forms, orodispersible films are successful to attract pharmaceutical industry due to ease of formulation and extension patent life. Films are popular in patients too because of quick onset and user friendliness of dosage form. From the beginning, solvent casting has been selected as method of choice for manufacturing of orodispersible films. Solvent casting has been proved as a benchmark technology because of ease in product development, process optimization, process validation and technology transfer to production scale despite of some drawbacks like more number of unit operations involved and consumption of large quantity of solvents with controlled limits of organic volatile impurities in final formulation. The application of hot-melt extrusion (HME) in the pharmaceutical industry is consecutively increasing due to its proven innumerable advantages like solvent free continuous process with fewer unit operations and better content uniformity. Very few development activities has been initiated in the field of hot melt extruded orodispersible films so far. This extensive review covers detailed discussion of heavy duty industrial extruders, selection of downstream equipments, selection of excipients, common problems found in formulations and their remedies. Successive part of review addresses identification of critical quality attributes, quality target profile of product, criticality in selection of process parameters and material for substantial simulation in laboratory scale and production for successful technology transfer.
Allergy markers in adults in relation to the timing of pet exposure: the EGEA* study
Authors: M.‐P. Oryszczyn, I. Annesi‐Maesano, D. Charpin, F. Kauffmann
Journal: Allergy (2003)

Background: Studies suggest that early childhood exposure to pets may protect from the development of atopy, but limited information is available on adults. The association of allergy markers in adulthood with current and childhood exposure to pets was studied considering retrospectively the window of exposure. Methods: Immunoglobulin E (IgE), skin prick tests (SPT), eosinophils were related to exposure to pets in 187 adult asthmatic cases and 243 controls from the Epidemiological Study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy (EGEA) study. Analyses were redone after exclusion of subjects who removed pets or experienced symptoms to animals to take into account selection in that retrospective study. Results: In asthmatic cases, current exposure to pets was unrelated to SPT positivity (+), whereas childhood exposure was significantly related to less SPT+ to any allergen, and to cat in particular, with an association restricted to those exposed before 2 years of age [OR = 0.30 (CI 0.12–0.76)]. Considering the relative timing of exposure in relation to asthma onset showed that the protective effect of exposure to pets occurs for pet exposure starting before asthma onset [OR for SPT+ = 0.19 (CI 0.08–0.48)]. Conclusion: Results support the hypothesis that exposure to pets in early life, and in particular before asthma onset, may protect against allergen sensitization in adulthood.
Epidemiology of allergic diseases
Authors: T. SCHÄFER, J. RING
Journal: Allergy (1997)

Schäfer T, Ring J. Epidemiology of allergic diseases. The escalation of allergic diseases (hay fever, asthma, atopic eczema) over recent decades has been linked to an increase in environmental pollutants. The prevalence of hay fever is associated with genetic predisposition, and some reports show an association with urban areas, socioeconomic status, and combined high allergen and automobile exhaust exposure. In asthma, there is also some evidence for geographical variations in prevalence; exercise challenge tests prove positive more often in urban areas than in rural areas. Although genetic predisposition is the strongest single risk factor for atopic eczema, air pollutants may aggravate the condition by acting as unspecific irritants and immunomodulators, leading to increased immunoglobulin E expression. In a study of 678 pre‐school children, the influence of maternal smoking habits on individual measures of atopy revealed a positive association between smoking during pregnancynactation, and a positive history of atopic eczema. An East‐West German comparative study examining different types and levels of air pollution, i.e. sulphurous (industrial; East) and oxidising (urban; West), showed that the prevalence of atopic eczema was greatest in East Germany. When various direct and indirect parameters of air pollution exposure were measured, the greatest association with atopic eczema was found with NOx exposure (indoor use of gas without a cooker hood), and close proximity to roads with heavy traffic. The increased prevalence of atopic eczema cannot be explained by changes in study methodology over time, or conventional risk factors alone; environmental risk factors may be an important contributing factor.
A Case of Subcutaneous Gammaglobulin Therapy Complicated By MRSA Abscess Requiring Surgical Intervention
Authors: Erin C. Toller-Artis, Yoon M. Kim, Devi Jhaveri, Ali Saad, Jason Casselman, Kathryn Marie Ruda Wessell, Haig Tcheurekdjian, Robert W. Hostoffer
Journal: Journal of Allergy and Clinical Immunology (2015)
Low serum adiponectin level as a predictor of impaired glucose regulation and type 2 diabetes mellitus in a middle-aged Finnish population
Authors: Kirsti Jalovaara, Merja Santaniemi, Markku Timonen, Jari Jokelainen, Y. Antero Kesäniemi, Olavi Ukkola, Sirkka Keinänen-Kiukaanniemi, Ulla Rajala
Journal: Metabolism (2008)
Clinical Usefulness of Cystatin C for the Estimation of Glomerular Filtration Rate in Type 1 Diabetes
Authors: G.D. Tan, A.V. Lewis, T.J. James, P. Altmann, R.P. Taylor, J.C. Levy
Journal: Diabetes Care (2002)

OBJECTIVE—Assessment and follow-up of early renal dysfunction is important in diabetic nephropathy. Plasma creatinine is insensitive for a glomerular filtration rate (GFR) &amp;gt;50 ml/min and creatinine clearance is unwieldy and subject to collection inaccuracies. We aimed to assess the reproducibility, reliability, and accuracy of plasma cystatin C as a measure of GFR ranging from normal to moderate impairment due to type 1 diabetes in the presence of a normal plasma creatinine concentration. RESEARCH DESIGN AND METHODS—A sensitive immunoturbidimetric cystatin C assay was examined in 29 subjects with type 1 diabetes and 11 nondiabetic subjects. Duplicate measurements of the following were collected from each subject, 2 weeks apart: cystatin C, enzymatic plasma creatinine, 24-h creatinine clearance, GFR estimated from plasma creatinine by the Cockcroft-Gault equation, and iohexol clearance as a gold standard. RESULTS—Iohexol clearance ranged from 35 to 132 ml · min−1 · 1.73 m−2. Plasma cystatin C compared well with the other clinically used tests. The reliability of cystatin C, as assessed by the discriminant ratio, was superior to creatinine clearance (3.4 vs. 1.5, P &amp;lt; 0.001) and the correlation of cystatin C with iohexol clearance (Rs −0.80) was similar to that of creatinine clearance (Rs −0.74) and superior to that of plasma creatinine and the Cockcroft-Gault estimate (Rs −0.54 and 0.66, respectively). Duplicate estimations were used to provide an unbiased equation to convert plasma cystatin C to GFR. CONCLUSIONS—Based on this study, cystatin C is a more reliable measure of GFR than creatinine clearance, is more highly correlated with iohexol clearance than plasma creatinine, and is worthy of further investigation as a clinical measure of GFR in type 1 diabetes.
Type 2 diabetes: incremental medical care costs during the 8 years preceding diagnosis.
Authors: G A Nichols, H S Glauber, J B Brown
Journal: Diabetes Care (2000)

OBJECTIVE: To describe and analyze medical care costs for the 8 years preceding a diagnosis of type 2 diabetes. RESEARCH DESIGN AND METHODS: From electronic records of a large group-model health maintenance organization (HMO), we ascertained the medical care costs preceding diagnosis for all members with type 2 diabetes who were newly diagnosed between 1988 and 1995. To isolate incremental costs (costs caused by the future diagnosis of diabetes), we subtracted the costs of individually age- and sex-matched HMO members without impending diabetes from the costs of members who were destined to receive this diagnosis. We also compared these prediagnosis costs with the first 3 years of postdiagnosis costs. RESULTS: An economic burden from impending diabetes is apparent for at least 8 years before diagnosis, beginning with costs for outpatient and pharmacy services. Diabetes-associated incremental costs (costs of type 2 diabetic patients minus matched costs of nondiabetic patients) averaged $1,205 per type 2 diabetic patient per year during the first eight prediagnostic years, including $1,913 each year for the 3 years preceding diagnosis. In the year immediately preceding diagnosis, incremental costs were equivalent to those observed in the second and third years after diagnosis. CONCLUSIONS: Incremental costs of diabetes begin at least 8 years before diagnosis and grow at an accelerating rate as diagnosis approaches and immediately after diagnosis. These incremental costs span the full range of medical services. Furthermore, the majority of these costs are for conditions not normally associated with diabetes or its complications.