tbuckley/cabot-search huggingface dataset:
“Usual Care” for Major Depression in the 1990s: Characteristics and Expert-Estimated Outcomes
Authors: Marcela Horvitz-Lennon, Sharon-Lise T. Normand, Richard G. Frank, Howard H. Goldman
Journal: American Journal of Psychiatry (2003)

Motivated by the public health importance of major depression and calls to study the effectiveness of treatments frequently used in routine practice, the authors characterized the usual outpatient care of acute-phase major depression in a privately insured population as well as the effectiveness of this care.Upon identifying frequent antidepressant interventions from a large administrative database spanning the years 1991-1996, and after completing an exhaustive review of published efficacy evidence, the authors undertook a two-stage elicitation process. A panel of 10 experts estimated probabilities of symptom-based outcomes for 120 combinations of treatment, provider type, and patient characteristics seen in 9,054 depressive episodes. The 10 most frequent treatments, utilized in 90% of the episodes, are reported here.A short course of psychotherapy delivered by specialists to healthy premenopausal women was the most frequent pattern of care. Only two prevalent treatments had adequate evidence. On the basis of expert-estimated rates of remission (Hamilton Depression Rating Scale score <8), response (score <13), and no change (score >/=18), three of the 10 most frequent treatments were highly effective, two were moderately effective, and five were minimally effective.Although experts gave high marks to three commonly used treatments, the expert-estimated effectiveness for this particular system of care was quite modest. More research is needed on the outcomes associated with specific usual care practices as well as the contributors to ineffective care.
Intratumoral pharmacokinetic analysis by 19F-magnetic resonance spectroscopy and cytostatic in vivo activity of gemcitabine (dFdC) in two small cell lung cancer xenografts
Authors: P.E.G. Kristjansen, B. Quistorff, M. Spang-Thomsen, H.H. Hansen
Journal: Annals of Oncology (1993)
Identification and prospective validation of clinically relevant chronic obstructive pulmonary disease (COPD) subtypes
Authors: J. Garcia-Aymerich, F. P. Gomez, M. Benet, E. Farrero, X. Basagana, A. Gayete, C. Pare, X. Freixa, J. Ferrer, A. Ferrer, J. Roca, J. B. Galdiz, J. Sauleda, E. Monso, J. Gea, J. A. Barbera, A. Agusti, J. M. Anto
Journal: Thorax (2010)

<h3>Background</h3> Chronic obstructive pulmonary disease (COPD) is increasingly considered a heterogeneous condition. It was hypothesised that COPD, as currently defined, includes different clinically relevant subtypes. <h3>Methods</h3> To identify and validate COPD subtypes, 342 subjects hospitalised for the first time because of a COPD exacerbation were recruited. Three months after discharge, when clinically stable, symptoms and quality of life, lung function, exercise capacity, nutritional status, biomarkers of systemic and bronchial inflammation, sputum microbiology, CT of the thorax and echocardiography were assessed. COPD groups were identified by partitioning cluster analysis and validated prospectively against cause-specific hospitalisations and all-cause mortality during a 4 year follow-up. <h3>Results</h3> Three COPD groups were identified: group 1 (n=126, 67 years) was characterised by severe airflow limitation (postbronchodilator forced expiratory volume in 1 s (FEV<sub>1</sub>) 38% predicted) and worse performance in most of the respiratory domains of the disease; group 2 (n=125, 69 years) showed milder airflow limitation (FEV<sub>1</sub> 63% predicted); and group 3 (n=91, 67 years) combined a similarly milder airflow limitation (FEV<sub>1</sub> 58% predicted) with a high proportion of obesity, cardiovascular disorders, diabetes and systemic inflammation. During follow-up, group 1 had more frequent hospitalisations due to COPD (HR 3.28, p&lt;0.001) and higher all-cause mortality (HR 2.36, p=0.018) than the other two groups, whereas group 3 had more admissions due to cardiovascular disease (HR 2.87, p=0.014). <h3>Conclusions</h3> In patients with COPD recruited at their first hospitalisation, three different COPD subtypes were identified and prospectively validated: 'severe respiratory COPD', 'moderate respiratory COPD', and 'systemic COPD'.
Is the adjuvant solely to blame?
Authors: T. Tsai, G. D. Giudice, A. Crucitti, J. Weil, V. Narasimhan
Journal: BMJ (2013)

We read with interest Miller and colleagues findings on the association between narcolepsy and the AS03 adjuvanted pandemic A/H1N1 2009 vaccine in England and, in particular, their call for investigations of other A/H1N1 2009 vaccines to ascertain the risk of narcolepsy.1 Risk estimates above 10 are unusual, and in pharmacoepidemiology lead to the suspicion of unknown confounding factors. The English data, confirming previous reports,2 3 considerably lessens the likelihood of confounding. However, the mechanisms by which this vaccine’s components may have contributed to an increased risk for narcolepsy are unclear and may be difficult to dissect, as the still uncertain pathogenesis of Guillain-Barre syndrome after flu vaccination illustrates.

Previous observations suggest that similar vaccines may have subtle differences that manifest themselves in different ways or in different seasonal formulations. Oculorespiratory syndrome has been associated with one split seasonal vaccine product but not with others.4 Perhaps appropriate in the context of narcolepsy cases occurring …
Such stuff as psychoses are made on?
Authors: Armando D'Agostino, Silvio Scarone
Journal: Behavioral and Brain Sciences (2013)

In her target article, Sue Llewellyn concludes that an unconstrained form of consciousness is necessary for the elaboration of meaningful associations. Unlike the author's view that dedifferentiation of memory encoding processes across wakefulness and sleep determines schizophrenia, our proposal suggests this mechanism could reflect a common neurobiological substrate for psychosis across several different diagnostic domains.
The statistical analysis of mitochondrial DNA polymorphisms: chi 2 and the problem of small samples.
Authors: D A Roff, P Bentzen
Journal: Molecular Biology and Evolution (1989)

Significance levels obtained from a chi 2 contingency test are suspect when sample sizes are small. Traditionally this has meant that data must be combined. However, such an approach may obscure heterogeneity and hence potentially reduce the power of the statistical test. In this paper, we present a Monte Carlo solution to this problem: by this method, no lumping of data is required, and the accuracy of the estimate of alpha (i.e., a type 1 error) depends only on the number of randomizations of the original data set. We illustrate this technique with data from mtDNA studies, where numerous genotypes are often observed and sample sizes are relatively small.
Effects of Left Bundle-Branch Block on Cardiac Structure, Function, Perfusion, and Perfusion Reserve
Authors: S.A. Hayat, G. Dwivedi, A. Jacobsen, T.K. Lim, C. Kinsey, R. Senior
Journal: Circulation (2008)

We aimed to investigate the cardiac effects of left bundle-branch block (LBBB) using myocardial contrast echocardiography (MCE) to ascertain the value of MCE for detecting coronary artery disease (CAD) and to uncover the mechanism that affects the accuracy of single-photon emission computed tomography (SPECT) in these patients.Sixty-three symptomatic LBBB patients (group A), 10 left ventricular ejection fraction-matched control subjects without LBBB and no CAD (group B), and 10 normal control subjects (group C) underwent resting echocardiography. Rest and vasodilator MCE and SPECT were undertaken in LBBB patients. Septal (SW) and posterior wall (PW) thickness, thickening, quantitative myocardial blood flow (MBF), and MBF reserve were measured. SW/PW thickness and percentage thickening ratios were lower (P<0.01 and P<0.05, respectively) in group A compared with both groups B and C, but resting SW/PW MBF and MBF reserve ratios were similar in all 3 groups. MBF reserve but not MBF was reduced in groups A and B (2.2+/-0.7 versus 2.2+/-0.2; P=0.98) compared with group C (3.1+/-0.5; P<0.01). SW thickness was an independent predictor (P=0.006) of SPECT perfusion defects in LBBB patients without CAD. MCE (92%) had a sensitivity similar to SPECT (92%); however, the specificity of MCE (95%) was superior (P<0.0001) to SPECT (47%) for the detection of CAD.Despite asymmetrical reduction in SW thickness and function, MBF is preserved and MBF reserve is homogeneously reduced in LBBB patients with left ventricular systolic dysfunction. Because of partial volume effects, the accuracy of SPECT for detecting CAD was significantly compromised compared with MCE in this patient cohort.
The influence of age and gender on the population-based incidence of community-acquired pneumonia caused by different microbial pathogens
Authors: Félix Gutiérrez, Mar Masiá, Carlos Mirete, Bernardo Soldán, J. Carlos Rodríguez, Sergio Padilla, Ildefonso Hernández, Gloria Royo, Alberto Martin-Hidalgo
Journal: Journal of Infection (2006)
Effect of detergent on alveolar particle clearance due to large tidal ventilation.
Authors: J John, P Wollmer, M Dahlback, B Jonson
Journal: Thorax (1994)

BACKGROUND--It has recently been shown that large tidal volume ventilation accelerates the alveolar clearance of insoluble particles and this may be related to accelerated surfactant evacuation from the alveolus into the airway. The aim of this study was to investigate if the effect of large tidal volume ventilation is modified in an experimental model of surfactant dysfunction. METHODS--Fluorescent latex particles of 0.63 microns diameter were administered in aerosol form to 30 rabbits during anaesthesia with thiopentone and mechanical ventilation. Six animals were killed immediately after aerosol administration in order to show the initial deposition of particles. Twenty four animals were divided into two groups and ventilated for three hours with either large tidal volume (mean tidal volume 30 ml/kg) or conventional ventilation (mean tidal volume 12.5 ml/kg). Six rabbits in each of the two groups were administered either the synthetic detergent dioctyl sodium sulphosuccinate in aerosol form or aerosolised vehicle. After the period of experimental ventilation the lungs were removed and dried in the expanded state. Particles in the alveolar region were counted with fluorescent microscopy in sections of the lung. RESULTS--Compared with the baseline group (mean (SD) 24.8 (9.9)) the count of residual alveolar particles was lower after large tidal volume ventilation in the absence of detergent aerosol (13.2 (6.5)). Particle count after large tidal volume ventilation and detergent treatment (23.3 (6.4)) was similar to that in the baseline group and to that in the groups exposed to conventional ventilation. CONCLUSIONS--The increase in alveolar clearance of insoluble particles caused by large tidal volume ventilation is inhibited by detergent aerosol. This might be due to reduced stability of the surfactant film after detergent aerosol.
The Athlete Sleep Screening Questionnaire: a new tool for assessing and managing sleep in elite athletes
Authors: Charles Samuels, Lois James, Doug Lawson, Willem Meeuwisse
Journal: British Journal of Sports Medicine (2015)

Background/aim The purpose of this study was to develop a subjective, self-report, sleep-screening questionnaire for elite athletes. This paper describes the development of the Athlete Sleep Screening Questionnaire (ASSQ). Methods A convenience sample of 60 elite athletes was randomly distributed into two groups; 30 athletes completed a survey composed of current psychometric tools, and 30 athletes completed a revised survey and a sleep specialist structured clinical interview. An item analysis was performed on the revised survey with comparison to clinical decisions regarding appropriate intervention based on a sleep specialist assessment. Results A comparison of existing sleep-screening tools with determination of clinical need from a sleep specialist showed low consistency, indicating that current sleep-screening tools are unsuitable for assessing athlete sleep. A new 15-item tool was developed (ASSQ) by selecting items from existing tools that more closely associated with the sleep specialist's reviews. Based on test-retest percentage agreement and the κ-statistic, we found good internal consistency and reliability of the ASSQ. To date, 349 athletes have been screened, and 46 (13.2%) identified as requiring follow-up consultation with a sleep specialist. Results from the follow-up consultations demonstrated that those athletes identified by the ASSQ as abnormal sleepers have required intervention. Conclusions The research developed a new athlete-specific sleep-screening questionnaire. Our findings suggest that existing sleep-screening tools are unsuitable for assessing sleep in elite athletes. The ASSQ appears to be more accurate in assessing athlete sleep (based on comparison with expert clinical assessment). The ASSQ can be deployed online and provides clinical cut-off scores associated with specific clinical interventions to guide management of athletes’ sleep disturbance. The next phase of the research is to conduct a series of studies comparing results from the ASSQ to blinded clinical reviews and to data from objective sleep monitoring to further establish the validity of the ASSQ as a reliable sleep screening tool for elite athletes.
Can a single equation be used to predict the vital capacity of boys both before and during puberty?
Authors: O Jaeger-Denavit, A Alphonse
Journal: European Respiratory Journal (1990)

Good theoretical values for vital capacity (VCt) can be used to calculate a VC/VCt ratio which remains constant for a given individual subject throughout different growth periods. This longitudinal study on 27 boys was performed in order to determine whether a single equation was accurate throughout the growth of boys. The mean values of VC/VCt were also compared for the beginning and end of the prepubertal period in 57 boys and between the beginning and end of puberty in 40 boys. VCt was calculated from five reference equations using data from boys with average age 8-16 yrs, and from two equations using data specific to children and adolescents. The mean VC/VCt ratio was found to fall between the beginning and end of the prepubertal period and to increase very significantly between the beginning and end of the pubertal period when the reference equation used had been calculated using data from populations containing both pubertal and prepubertal subjects. When the equations established from adolescents were used, VC/VCt fell slightly between the beginning and end of the pubertal period. We conclude that data for children and adolescents should be treated separately when establishing reference values for VC.
Myocardial infarct size is smaller in dogs with pacing-induced heart failure
Authors: D Hoskins
Journal: Cardiovascular Research (1996)

Objective: Determine if ischemic tolerance is reduced in the setting of experimental heart failure (HF). Methods: Dogs were paced for 3 weeks at 240 BPM to induce heart failure which was confirmed with hemodynamic and echocardiographic measurements. The pacemaker was turned off 30 min prior to the ischemia study. Normal (n = 9) and HF dogs (n = 12) were anesthetized with sodium pentobarbital, instrumented for cardiovascular assessment through a left lateral thoracotomy, and myocardial blood flow was measured with radioactive microspheres. The left circumflex (LCX) artery was occluded for 90 min followed by 3 h of reperfusion. Infarct size was determined with triphenyl tetrazolium chloride staining. Results: Two-dimensional echocardiograms were obtained before and after 3 weeks of pacing in the HF group. Ejection fraction was reduced from 67 ± 1 to 32 ± 2% (P < 0.001) and left ventricular end-diastolic volume (LVEDV) increased from 29 ± 4 ml before pacing to 47 ± 5 ml (P < 0.001). HF dogs were characterized by a smaller peak positive dP/dt (1110 ± 72 vs. 2546 ± 411 mmHg/s, P < 0.01), a greater LV end-diastolic pressure (34 ± 3 vs. 9 ± 2 mmHg, P < 0.01), and lower LV end-systolic pressure (99 ±5 vs. 130 ± 5 mmHg, P < 0.05) compared to control dogs. Heart rate was not significantly different between the two groups throughout the experiment. More HF dogs died from ventricular fibrillation (4/12) than control dogs (1/9), but this difference was not statistically significant (P >0.2). The LCX occlusion produced a comparable decrease in blood flow in HF and normal dogs (0.08 ± 0.01 vs. 0.09 ± 0.01 ml/min/g), but infarct size as a percentage of the region at risk was smaller in HF dogs compared to normal dogs (21 ± 4 vs. 45 ± 4%, P < 0.01). Region at risk size was also smaller in HF versus normal dogs (29 ± 3 vs. 40 ± 2%, P < 0.05). Accordingly, a subgroup analysis of 6 HF and 5 control dogs with similar RAR sizes (35 ± 2% vs. 37 ± 2%) was performed and it also demonstrated that infarct size in HF dogs was smaller than in control dogs (19 ± 5 vs. 40 ± 4%, P < 0.01), suggesting that disparities in risk region size did not explain the differences in infarct size. Conclusion: Infarct size produced by a standardized ischemia-reperfusion protocol was smaller in dogs with pacing-induced HF. The reduced extent of infarction could not be attributed to differences in collateral blood flow or the size of the region at risk. Although the hearts in HF dogs were dilated, LV systolic blood pressure and the strength of contraction were lower than controls potentially reducing myocardial oxygen demand and explaining the smaller infarct size in HF dogs. Other mechanisms, however, cannot be discounted. Thus, ischemic tolerance is not reduced and may be augmented in dogs with pacing-induced heart failure.
CD34 <sup>+</sup> and Endothelial Progenitor Cells in Patients With Various Degrees of Congestive Heart Failure
Authors: Marco Valgimigli, Gian Matteo Rigolin, Alessandro Fucili, Matteo Della Porta, Olga Soukhomovskaia, Patrizia Malagutti, Anna Maria Bugli, Letizia Zenone Bragotti, Gloria Francolini, Endri Mauro, Gianluigi Castoldi, Roberto Ferrari
Journal: Circulation (2004)

Background— Peripheral blood CD34 + cells and circulating endothelial progenitor cells (EPCs) increase in myocardial infarction and vascular injuries as a reflection of endothelial damage. Despite the occurrence of endothelial dysfunction in heart failure (HF), no data are available on EPC mobilization in this setting. We investigated the pattern of CD34 + cells and EPC mobilization during HF and their correlation with the severity and origin of the disease. Methods and Results— Peripheral blood CD34 + cells (n=91) and EPCs (n=41), assessed both as CD34 + cells coexpressing AC133 and vascular endothelial growth factor (VEGF) receptor-2 and as endothelial colony-forming units, were studied in HF patients (mean age 67±11 years) and 45 gender- and age-matched controls. Tumor necrosis factor-α (TNF-α) and its receptors (sTNFR-1 and sTNFR-2), VEGF, stromal derived factor-1 (SDF-1), granulocyte-colony stimulating factor (G-CSF), and B-type natriuretic peptide were also measured. CD34 + cells, EPCs, TNF-α and receptors, VEGF, SDF-1, and B-type natriuretic peptide were increased in HF. CD34 + cells and EPCs were inversely related to functional class and to TNF-α, being decreased in New York Heart Association class IV compared with class I and II and controls. No role was found for the origin of the disease. Conclusions— CD34 + cells and EPC mobilization occurs in HF and shows a biphasic response, with elevation and depression in the early and advanced phases, respectively. This could be related to the myelosuppressive role of TNF-α.
A Clinical Lecture ON THE ACTION AND USES OF DIGITALIS IN CARDIAC FAILURE: Delivered at the Hospital for Consumption and Diseases of the Chest, Brompton
Authors: J. M. Bruce
Journal: BMJ (1906)

GENTLEMEN,-It is but seldom that the record of the course of a single case of cardiac disease, or indeed of any disease, for a few weeks furnishes material for a clinical lecture to practical post-graduate medical men like you.it feel that I ought to introduce my subject this afternoon with an apology for such an attempt; and you will forgive me also, I trust, if I speak in a straight, plain, dogmatic fashion, treating you, as it were, like students round a bed.This is the necessary result of our having to con- sider the details of the treatment of an individual patient who has already left the hospital.I have not the patient here, but I have behind me a chart which exhibits ,graphically the course of his disease as far as it concerns us this afternoon, including more particularly the action and*uses of digitalis.I propose to demonstrate to you the observations thus recorded, and to discuss them serially and as a whole.The case itself was full of interest pathologically, but I will not dwell on this aspect of it, except so far as is neces- sary to illustrate certain points in the action and uses of cardiac remedies.The patient was a man of 27, a 'bus conductor, who was under my care in Charing Cross Hos- pital from November, 1903, to February, 1904, suffering from failure of the heart with dropsy in connexion with valvular disease of rlleumatic origin.The valvular lesions were mitral incompetence, mitral stenosis and aortic incompetence, with well-marked physical signs, including the characteristic murmurs, in addition to which a tricuspid systolic murmur was also audible.On admis- sion, November 23rd, the patient was cyanosed and suffered from orthopnoea, praecordial distress, and exten- sive oedema; the pulse was extremely irregular in force and rhythm, 94 beats reaching the wrist per minute; the liver enlarged and pulsating.You will observe that in every respect the case was an ordinary one, and I need only add that the evidence was that the heart had failed in consequence of exposure and -exertion.This was the second occasion on which compensation had broken down within a few years.The patient was at once put on what may be called our routine treatment for cases of the kind.He was in bed, and properly nursed; he had a somewhat dry, solid diet, including fish, chicken, bread and butter, light pudding; and to this was added from lf oz. to 3 oz. of brandy per diem.After an immediate dose of 3 gr. of calomel, followed by white mixture, he was given half a drachm of compound jalap 'powder every morning, and he took 10 minims of tincture of digitalis with potassium .acetate