tbuckley/cabot-search huggingface dataset:
Investigational Treatments: Process, Payment, and Priorities
Authors: Reinhard Priester, Dorothy E. Vawter, Karen G. Gervais
Journal: JAMA (1997)

<h3>To the Editor.</h3> —Health plans customarily have excluded coverage for investigational interventions and covered most proven interventions. Although the distinction between investigational and proven has been pivotal, it remains blurry and notoriously unhelpful. The lack of an agreed-on definition of<i>investigational</i>, for example, has been the source of innumerable legal challenges brought—usually successfully—by patients, often of coverage denials for investigational interventions. While Dr Eddy's<sup>1</sup>proposed process is the clearest yet for making defensible judgments about which interventions are investigational, it ultimately may not help health plans make better coverage decisions. The problem goes beyond the term<i>investigational</i>to the distinction itself: even if it could be unambiguously drawn via precise agreed-on definitions and criteria, the investigational vs proven distinction would be an inadequate framework for making coverage decisions. Coverage decisions no longer are, nor should they be, based on a judgment regarding the investigational status of an intervention. Many investigational interventions are
New Thinking on Flame Retardants
Authors: Kellyn S. Betts
Journal: Environmental Health Perspectives (2008)

The most flammable part of a mattress or couch is its plastic polyurethane foam cushioning, he explains.Once a fire gets through a chair or mattress's fabric covering and into this cushioning, it can start a catastrophic reaction that quickly leads to "flashover," in which nearly everything combustible inside a room ignites simultaneously.Until very recently, brominated flame retardants, especially polybrominated diphenyl ethers (PBDEs), were one of the main materials used to reduce the speed with which the plastic components of consumer goods including beds, couches, chairs, and electronics could be consumed by fire.However, growing evidence shows that PBDE compounds are escaping from the products they protect and making their way into the products' users.Moreover, the chemicals may disrupt human thyroid hormone functioning and cause other health effects, prompting many nations to ban or suspend their use in new consumer goods.[For more information on the health effects of PBDEs, see "Unwelcome Guest: PBDEs in Indoor Dust, p. A202 this issue.]Although bromine-and chlorine-containing flame retardants are still used in some products, the need for new alternatives is being driven by a confluence of policy, standards, and pressure from environmental groups.Europe banned the use of two formulations, PBDE pentaBDE and octaBDE, in 2004, the same year they were withdrawn from the North American market.A third compound, decaBDE, was banned 1 April 2008 by the European Court of Justice.Stateside, Maine has banned the use of decaBDE, the only PBDE still on the market in North America, in mattresses and residential upholstered furniture produced and sold in that state, and will extend the ban to electronics in 2010.Washington prohibits the use of decaBDE in mattresses and sets a process for a future ban in furniture and electronics if the state can identify a safer and feasible alternative that meets fire safety standards.Asian countries and other U.S. states have similar legislation in the works."Instead of adding new fire retardant chemicals that ultimately may be shown to cause health problems, we should be asking whether we need to use these chemicals or if there are other ways to achieve equivalent fire safety," contends Arlene Blum, a biophysical chemist and visiting scholar at the University of California, Berkeley."So many of the chemicals we have banned in the past were flame retardants-think about asbestos, polychlorinated biphenyls, polybrominated biphenyls, tris(2,3-dibromopropyl) phosphate, PBDEs-[and] they all ended up in the environment and in people," she points out."We need to think carefully about adding these sorts of chemicals to consumer products before there is adequate health information."
Serotonin Transporter Gene Polymorphism and Myocardial Infarction
Authors: Frédéric Fumeron, Dina Betoulle, Viviane Nicaud, Alun Evans, Frank Kee, Jean-Bernard Ruidavets, Dominique Arveiler, Gérald Luc, François Cambien
Journal: Circulation (2002)

Background — Depression is a risk factor for myocardial infarction (MI). Selective serotonin reuptake inhibitors reduce this risk. The site of action is the serotonin transporter (SLC6A4), which is expressed in brain and blood cells. A functional polymorphism in the promoter region of the SLC6A4 gene has been described. This polymorphism may be associated with the risk of MI. Methods and Results — The SLC6A4 polymorphism has been investigated by polymerase chain reaction in 671 male patients with MI and in 688 controls from the Etude Cas-Témoins de l’Infarctus du Myocarde (ECTIM) multicentric study. Percentages for LL, LS, and SS genotypes were 35.5%, 45.4%, and 19.1%, respectively, for cases versus 28.1%, 49.1%, and 22.8%, respectively, for controls. S allele frequency was 41.8% and 47.4% for cases and controls, respectively. After adjustment for age and center by using multivariable logistic regression, the odds ratio for MI associated with the LL genotype was 1.40 (95% CI 1.11 to 1.76, P =0.0047). Conclusions — The LL genotype of the SLC6A4 polymorphism is associated with a higher risk of MI. This could be attributable to the effect of the polymorphism on serotonin-mediated platelet activation or smooth muscle cell proliferation or on other risk factors, such as depression or response to stress.
False-Positive MIBG Uptake in Pneumonia in a Patient With Stage IV Neuroblastoma
Authors: Tim Schindler, Chris Yu, Monica Rossleigh, John Pereira, Richard Cohn
Journal: Clinical Nuclear Medicine (2010)

A 32-month-old female child with a history of stage IV favorable biology neuroblastoma with a 123-I MIBG (metaiodobenzylguanidine scan) avid adrenal mass, with retroperitoneal nodal extension and bony metastasis, was in complete remission after intense multimodal therapy. Seventeen months after diagnosis a surveillance 123-I MIBG scan showed abnormal tracer uptake in the midzone of the right thorax. Chest x-ray and CT scan confirmed right upper lobe consolidation corresponding to the tracer uptake. Chest x-ray after antibiotics showed resolution of the abnormality. 123-I MIBG scan 3 months later showed no abnormal uptake. False-positive MIBG uptake in pneumonia has not been previously reported.
Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder
Authors: Marco Chiesa, Rachel Sharp, Peter Fonagy
Journal: Psychotherapy and Psychosomatics (2010)

&lt;i&gt;Background:&lt;/i&gt; Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge of DSI as an indicator of severity of psychopathology, as moderator of outcome and with regard to its response to different treatment programs and settings. &lt;i&gt;Methods:&lt;/i&gt; We compare 2 samples of PD with (n = 59) and without (n = 64) DSI in terms of clinical presentation, response to psychosocial treatment and relative outcome when treated with specialist long-term residential and community-based programs. We test the assumption that DSI is an appropriate indicator for long-term inpatient care by contrasting the outcomes (symptom severity and DSI recidivism) of the 2 DSI sub-groups treated in the 2 different approaches. &lt;i&gt;Results:&lt;/i&gt; PD with DSI had greater severity of presentation on a number of variables (early maternal separation, sexual abuse, axis-I comorbidities, suicidality and inpatient episodes) than PD without DSI. With regard to treatment response, we found a significant 3-way interaction between DSI, treatment model and outcome at 24-month follow-up. PD with DSI treated in a community-based program have significantly greater chances of improving on symptom severity and recidivism of self-injurious behaviour compared to PD with DSI treated in a long-term residential program. &lt;i&gt;Conclusions:&lt;/i&gt; Although limitations in the study design invite caution in interpreting the results, the poor outcome of the inpatient DSI group suggests that explicit protocols for the management of DSI in inpatient settings may be beneficial and that the clinical indications for long-term inpatient treatment for severe and non-severe PD may require updating.
Workshop on perinatal exposure to dioxin-like compounds. I. Summary.
Authors: G Lindström, K Hooper, M Petreas, R Stephens, A Gilman
Journal: Environmental Health Perspectives (1995)

An international workshop reviewed 20 ongoing or recently completed studies of the effects of perinatal exposures to dioxins, dibenzofurans, and PCBs on the reproductive, endocrine, neurodevelopmental, and immune systems. Many of the observed effects are consistent with these compounds acting as "environmental hormones" or endocrine disrupters. This report summarizes the conclusions and future directions described at the workshop.
The CORRONA database
Authors: J Kremer
Journal: Annals of the Rheumatic Diseases (2005)

The Consortium of Rheumatology Researchers of North America (CORRONA) was founded by a group of academic rheumatologists. CORRONA was designed to fill a void in North America as, at the time of its founding, there was no database independent of the pharmaceutical industry that collected data in the clinic from both rheumatologists and patients. CORRONA began collecting data in 2002.

There was also a perceived need to develop a database which collected clinical information from all patients with rheumatoid arthritis in a practice. With the introduction of expensive new therapeutic agents, it was apparent that longitudinal, long term, “real world” data would serve the rheumatology community well. There was also the perception that busy physicians would welcome a system that enabled them to treat individuals with chronic diseases associated with complex comorbidities in a smart and efficient manner while reliably tracking standard outcomes, laboratory and imaging data, as well as toxicities. The new agents have the potential for great individual and societal good, as well as the potential for frightening toxicities. It was apparent that reliance on voluntary reporting from post-marketing surveillance to the Food and Drug Administration (FDA), and various long term phase IV studies would not be adequate to inform fully rheumatologists and patients about outcomes in this evolving clinical marketplace.

At the time of this writing, June 2005, the CORRONA database has 8755 patients with rheumatoid arthritis, 955 patients with psoriatic arthritis, and approximately 1000 patients with a primary diagnosis of either osteoarthritis or osteoporosis. There are 83 sites scattered in 33 states in the USA (fig 1), and a total of 200 rheumatologists now participate. Patients with rheumatoid arthritis or psoriatic arthritis are enrolled at the time of a routine visit at a site. They are then followed as often as every three months for rheumatoid …
SUBSTANTIAL INTER-INDIVIDUAL AND GENDER DIFFERENCES IN JUMP FREQUENCY DURING TRAINING AND MATCHES IN YOUNG ELITE VOLLEYBALL PLAYERS – A RISK FACTOR FOR JUMPER'S KNEE?
Authors: MA Bahr, R Bahr
Journal: British Journal of Sports Medicine (2014)

Background Male gender, training volume (# of hours per week) and match exposure (# of games played per week) have been documented as risk factors for jumper's knee among young elite volleyball players (Visnes &amp; Bahr, 2012). However, it is not known whether jump frequency differs between intra-squad players. Objective To examine inter-individual and gender differences in jump frequency during training and matches in young elite volleyball players. Design Observational study. Setting Norwegian elite volleyball boarding school training program. Participants Student-athletes (26 boys and 18 girls, 16–18 yrs). Main outcome measures Individual jump counts were recorded based on video recordings obtained from one week of volleyball training (9 training sessions for boys and 10 for girls, 14.1 h and 17.8 h of training, respectively) and 10 matches (5.9 h for boys (16 sets) and 7.7 h for girls (21 sets). Results A total of 7805 jumps were recorded during training, 4993 among boys and 2812 among girls. As training attendance and jump frequency varied substantially between players, the total exposure in training ranged from 50 to 666 jumps/week among boys and from 11 to 251 jumps/week among girls. On average, this corresponded to 35.7 jumps/h for boys and 13.7 jumps/h for girls (t-test, P=.002). Total jump exposure ranged between 1 to 339 jumps among boys and between 0 to 379 jumps among girls. Player jump frequency averaged 62.2 jumps/h for boys and 41.9 jumps/h for girls (t-test, P&lt;.039). The inter-individual differences seen in jump frequency were substantially more pronounced than any differences observed between player functions. Conclusions Substantial inter-individual and gender differences were observed in jump frequency during training and matches in young elite volleyball players. Thus, jump frequency may represent a more important risk factor for jumper's knee than total training volume and warrants further research attention.
Angiotropic B-cell lymphoma (malignant angioendotheliomatosis): failure of systemic chemotherapy
Authors: R.E.A. WILLIAMS, MORAG M. SEYWRIGHT, ROSEMARY LEVER, N.P. LLUCIE
Journal: British Journal of Dermatology (1990)

A 65-year-old female with angiotropic B-cell lymphoma is reported. Despite the absence of systemic involvement on formal staging and the favourable response of the cutaneous lesions to triple systemic chemotherapy with prednisolone, vincristine and cyclophosphamide, postmortem findings showed that death was due to widespread disease dissemination.
A transcutaneous vaccination system using a hydrogel patch for viral and bacterial infection
Authors: Yumiko Ishii, Tomoko Nakae, Fumiko Sakamoto, Kazuhiko Matsuo, Keisuke Matsuo, Ying-Shu Quan, Fumio Kamiyama, Takuya Fujita, Akira Yamamoto, Shinsaku Nakagawa, Naoki Okada
Journal: Journal of Controlled Release (2008)
Effects of Cardiopulmonary Resuscitation on Predictors of Ventricular Fibrillation Defibrillation Success During Out-of-Hospital Cardiac Arrest
Authors: Trygve Eftestøl, Lars Wik, Kjetil Sunde, Petter Andreas Steen
Journal: Circulation (2004)

Early defibrillation is considered the most important factor for restoring spontaneous circulation in cardiac arrest patients with ventricular fibrillation. Recent studies have shown that, after prolonged ventricular fibrillation, the rates of return of spontaneous circulation (ROSC) and survival are improved if defibrillation is delayed so that CPR can be given first. To examine whether CPR improves myocardial readiness for defibrillation, we analyzed whether CPR causes changes in predictors of defibrillation success calculated from the ventricular fibrillation waveform.ECG recordings were retrieved for 105 patients from an original study of 200 patients receiving CPR or defibrillation first. Altogether, 267 CPR sequences from 77 patients were identified on which the effect of CPR could be evaluated. Five predictors of ROSC (spectral flatness measure, energy, centroid frequency, amplitude spectrum relationship, and estimated probability of ROSC) were determined from a spectral analysis of the ventricular fibrillation waveform immediately before and immediately after each of the 267 sequences. CPR increased spectral flatness measure, centroid frequency, and amplitude spectrum relationship (P<0.05, P<0.001, P<0.01). In an analysis of the effect of the duration of CPR, the probability of ROSC and amplitude spectrum relationship showed a positive change for CPR sequences lasting >3 minutes (P<0.001, P<0.05).During resuscitation from ventricular fibrillation, changes in the predictors calculated from the ventricular fibrillation waveform indicated a positive effect of CPR on the myocardium.
602 Factors associated with the presence of non-alcoholic steatohepatitis (NASH) lesions in patients with hepatitis C
Authors: J.A. Solis-Herruzo, M. Perez-Carreras, C. Garfia, I. Fernandez-Vazquez, E. Bernandos, E. Rivas, F. Colina
Journal: Journal of Hepatology (2004)
158 RELIABILITY OF SERUM CREATININE IN ASSESSING RENAL FUNCTION IS DIMINISHED IN PATIENTS WITH CIRRHOSIS AS COMPARED WITH PATIENTS WITH ORGANIC RENAL DISEASE
Authors: M. Garcovich, E. Tsochatzis, D. Georgadis, G. Germani, G. Fede, A. Davenport, A. Gasbarrini, A.K. Burroughs
Journal: Journal of Hepatology (2011)
The story of an itch
Authors: A. Herxheimer
Journal: BMJ (1995)

Doctors are the focus of the third part of Nanni Moretti's autobiographical film. Earlier episodes have featured his life in the movie business: now he decides to film his last session of intravenous chemotherapy, at home. He looks back at all the prescriptions he has accumulated over the preceding year, all his notes of the encounters with doctors, and the conversations with them. He began to itch on the feet and arms, especially at night. He goes to a famous—and crowded—dermatological institute. The dermatologist examines him, replies to a hesitant question about scabies, “No, that affects other social classes,” and recommends somewhere warm, the seaside. The itching …
Specificity of Tests for Antibody to Hepatitis B Surface Antigen in Patients with Concomitant Antibody and Antigen
Authors: E. Tabor, R.J. Gerety, P.G. Foutch, W.D. Carey
Journal: Annals of Internal Medicine (1984)

Letters and Corrections1 August 1984Specificity of Tests for Antibody to Hepatitis B Surface Antigen in Patients with Concomitant Antibody and AntigenE. TABOR, M.D., R.J. GERETY, M.D., P.G. FOUTCH, D.O., W.D. CAREY, M.D.E. TABOR, M.D.Search for more papers by this author, R.J. GERETY, M.D.Search for more papers by this author, P.G. FOUTCH, D.O.Search for more papers by this author, W.D. CAREY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-101-2-277_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In a recent letter Leibowitz and Vladutiu (1) question whether increased sensitivity of radioimmunoassays for antibody to the hepatitis B surface antigen (anti-HBs) has resulted in the detection of low titers of cross-reacting antibodies that are not specific for the hepatitis B surface antigen (HBsAg). This possibility has led some authors to recommend that low anti-HBs titers (low radioimmunoassay ratios) not be considered indicative of a protective level of anti-HBs, when deciding who should receive the hepatitis B vaccine among persons at high risk for hepatitis B infection (2).In contrast, the anti-HBs detected in the serum...References1. LIEBOWITZVLADUTIU AA. Concomitant hepatitis B surface antigen and antibody [Letter]. Ann Intern Med. 1984;100:615. LinkGoogle Scholar2. TEDDER R. Hepatitis B vaccination policy [Letter]. Lancet. 1983;1:533. MedlineGoogle Scholar3. FOUTCHCAREYTABOR PWE. Concomitant hepatitis B surface antigen and antibody in thirteen patients. Ann Intern Med. 1983;99:460-3. LinkGoogle Scholar4. HOOFNAGLEGERETYSMALLWOODBARKER JRLL. Subtyping of hepatitis B surface antigen and antibody by radioimmunoassay. Gastroenterology. 1977;72:290-6. CrossrefMedlineGoogle Scholar5. TABORGERETYSMALLWOODBARKER ERLL. Coincident hepatitis B surface antigen and antibodies of different subtypes in human serum. J Immunol. 1977;118:369-70. MedlineGoogle Scholar6. TABORGERETYSMALLWOODBARKER ERLL. Induction of antibody to the "y" determinant of HBsAg in a chimpanzee carrier of HBsAg subtype "adw." J Immunol. 1976;117:2038-40. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byClinical significance of concurrent hepatitis B surface antigen and antibody positivity 1 August 1984Volume 101, Issue 2Page: 277-277KeywordsAntigensHepatitis AHepatitis BHepatitis B surface antigenRadioimmunoassaysSpecificityVaccines Issue Published: 1 August 1984 PDF downloadLoading ...
Augmentation of the synthesis of plasminogen activator inhibitor type-1 by precursors of insulin. A potential risk factor for vascular disease.
Authors: T K Nordt, D J Schneider, B E Sobel
Journal: Circulation (1994)

BACKGROUND Both vascular disease and elevated concentrations in plasma of plasminogen activator inhibitor type-1 (PAI-1) are prominent in patients with non-insulin-dependent diabetes mellitus (NIDDM). We and others have hypothesized that the increased PAI-1 may contribute to acceleration of atherosclerosis in this condition and in other states characterized by insulin resistance as well. Surprisingly, however, elevations of PAI-1 decrease when type II diabetic patients are treated with exogenous insulin, as do circulating concentrations of the precursor of insulin, proinsulin, in plasma. Accordingly, the increased PAI-1 in patients with NIDDM may reflect effects of precursors of insulin rather than or in addition to those of insulin itself. To assess this possibility directly, this study was performed to identify potential direct effects of proinsulin and proinsulin split products on synthesis of PAI-1 in liver cells, thought to be the major source of circulating PAI-1 in vivo. METHODS AND RESULTS Hep G2 cells (highly differentiated human hepatoma cells) were exposed to human proinsulin, des(31,32)proinsulin and des(64,65)proinsulin (split products of proinsulin), or C-peptide. Accumulation of PAI-1 in conditioned media increased in a time- and concentration-dependent fashion in response to the two des-intermediates [3.3-fold with des(31,32)proinsulin and 4.5-fold with des(64,65)proinsulin]. C-peptide elicited no increase. Stimulation was transduced at least in part by the insulin receptor as shown by inhibition of stimulation by insulin receptor antibodies, mediated at the level of PAI-1 gene expression as shown by the 2.2- to 2.9-fold increases in steady-state concentrations of PAI-1 mRNA, and indicative of newly synthesized protein as shown by results in metabolic labeling experiments. CONCLUSIONS Our results are consistent with the hypothesis that precursors of insulin (proinsulin and proinsulin split products), known to be present in relatively high concentrations in plasma in patients with NIDDM and conditions characterized by insulin resistance, may directly stimulate PAI-1 synthesis, thereby attenuating fibrinolysis and accelerating atherogenesis.