tbuckley/cabot-search huggingface dataset:
Pediatric Intensive Care Unit Mortality Among Latino Children Before and After a Multilevel Health Care Delivery Intervention
Authors: Kanwaljeet J. S. Anand, Robert J. Sepanski, Kimberley Giles, Samir H. Shah, Paul D. Juarez
Journal: JAMA Pediatrics (2015)

Research on health equity has focused on documenting health care disparities or understanding factors leading to disparities, but limited efforts have focused on reducing health care disparities in children. Latino children have increased prevalence of acute and chronic conditions; they have limited access and other barriers to high-quality health care, including intensive care.To determine whether pediatric intensive care unit mortality can be reduced by a multilevel health care delivery intervention.Observational study of factors associated with pediatric intensive care unit mortality at a tertiary care metropolitan children's hospital in Memphis, Tennessee. Participants were children younger than 18 years discharged from the pediatric intensive care unit during the 3-year preintervention period of 2007 to 2009 (n = 3891) and 3-year postintervention period of 2010 to 2012 (n = 4179).Multilevel health care intervention to address the increased odds of mortality among Latino children.The odds of mortality were analyzed over the 3-year preintervention period (2007-2009) using multivariable logistic regressions to control for age, sex, race/ethnicity, severity of illness, major diagnostic categories, diagnosed infections, and insurance status. Data from the postintervention period (2010-2012) were analyzed similarly to measure the effect of changes in health care delivery.Unadjusted mortality rates for white, African American, and Latino children in 2007 to 2009 were 3.3%, 3.3%, and 8.6%, respectively. After controlling for covariates, no differences in the odds of mortality were observed between white children and African American children (odds ratio [OR], 1.0; 95% CI, 0.6-1.7; P = .97), but Latino children had 3.7-fold (95% CI, 1.8-7.5; P < .001) higher odds of mortality. A multilevel and multidisciplinary intervention was launched to address these differences. In the postintervention period, unadjusted mortality rates for white, African American, and Latino children were 3.6%, 3.2%, and 4.0%, respectively, with no differences observed after adjustment for covariates (OR, 0.7; 95% CI, 0.2-2.1; P = .49). The odds of mortality decreased between the preintervention period and postintervention period for Latino children (OR, 0.24; 95% CI, 0.06-0.88; P = .03) but remained unchanged for white and African American children (OR, 1.02; 95% CI, 0.73-1.43; P = .90).Latino children had higher odds of mortality, even after controlling for age, sex, severity of illness, insurance status, and other covariates. These differences disappeared after culturally and linguistically sensitive interventions at multiple levels. Local multilevel interventions can reduce the effect of health care inequities on clinical outcomes, without requiring major changes in health care policy.
Safety and effectiveness of nurse telephone consultation in out of hours primary care: randomised controlled trial
Authors: V. Lattimer, S. George, F. Thompson, E. Thomas, M. Mullee, J. Turnbull, H. Smith, M. Moore, H. Bond, A. Glasper
Journal: BMJ (1998)

<h3>Abstract</h3> <b>Objective</b> To determine the safety and effectiveness of nurse telephone consultation in out of hours primary care by investigating adverse events and the management of calls. <b>Design</b> Block randomised controlled trial over a year of 156 matched pairs of days and weekends in 26 blocks. One of each matched pair was randomised to receive the intervention. <b>Setting</b> One 55 member general practice cooperative serving 97 000 registered patients in Wiltshire. <b>Subjects</b> All patients contacting the out of hours service or about whom contact was made during specified times over the trial year. <b>Intervention</b> A nurse telephone consultation service integrated within a general practice cooperative. The out of hours period was 615 pm to 1115 pm from Monday to Friday, 1100 am to 1115 pm on Saturday, and 800 am to 1115 pm on Sunday. Experienced and specially trained nurses received, assessed, and managed calls from patients or their carers. Management options included telephone advice; referral to the general practitioner on duty (for telephone advice, an appointment at a primary care centre, or a home visit); referral to the emergency service or advice to attend accident and emergency. Calls were managed with the help of decision support software. <b>Main outcome measures</b> Deaths within seven days of a contact with the out of hours service; emergency hospital admissions within 24 hours and within three days of contact; attendance at accident and emergency within three days of a contact; number and management of calls in each arm of the trial. <b>Results</b> 14 492 calls were received during the specified times in the trial year (7308 in the control arm and 7184 in the intervention arm) concerning 10 134 patients (10.4% of the registered population). There were no substantial differences in the age and sex of patients in the intervention and control groups, though male patients were underrepresented overall. Reasons for calling the service were consistent with previous studies. Nurses managed 49.8% of calls during intervention periods without referral to a general practitioner. A 69% reduction in telephone advice from a general practitioner, together with a 38% reduction in patient attendance at primary care centres and a 23% reduction in home visits was observed during intervention periods. Statistical equivalence was observed in the number of deaths within seven days, in the number of emergency hospital admissions, and in the number of attendances at accident and emergency departments. <b>Conclusions</b> Nurse telephone consultation produced substantial changes in call management, reducing overall workload of general practitioners by 50% while allowing callers faster access to health information and advice. It was not associated with an increase in the number of adverse events. This model of out of hours primary care is safe and effective.
Autonomic Nerve Stimulation Reverses Ventricular Repolarization Sequence in Rabbit Hearts
Authors: Rajkumar Mantravadi, Bethann Gabris, Tong Liu, Bum-Rak Choi, William C. de Groat, G. André Ng, Guy Salama
Journal: Circulation Research (2007)

Sympathetic activity and spatial dispersion of repolarization (DOR) have been implicated as mechanisms that promote arrhythmia vulnerability; yet there are no direct measurements of the effects of autonomic nerve stimulation on DOR. Rabbit hearts were perfused in a Langendorff apparatus with full sympathetic and parasympathetic innervation and were optically mapped to measure action potential durations and DOR (apex-base) over the left ventricles. DOR was measured under sinus rhythm, during bilateral sympathetic nerve stimulation (SNS) and right and/or left vagus nerve stimulation and was compared with DOR during isoproterenol (100 nmol/L) or acetylcholine (1 micromol/L) infusion. In sinus rhythm, repolarization started at the apex and systematically progressed toward the base. SNS (10 to 15 Hz) increased DOR by 29% (from Deltaaction potential duration=17+/-0.7 to -22+/-1.6 ms, n=6) and reversed DOR as the direction of repolarization from apex-->base in sinus rhythm shifted to base-->apex in 5 to 15 seconds after SNS. DOR flipped back to its sinus rhythm DOR pattern 115+/-15 seconds after the interruption of SNS. During right or left vagus nerve stimulation, there was no change in the direction of DOR, but bilateral vagus nerve stimulation increased and reversed DOR to base-->apex direction. Infusion of isoproterenol or acetylcholine increased DOR but did not alter the direction of repolarization sequences. These findings demonstrate that bilateral autonomic activity (SNS or vagus nerve stimulation) cause reversible shifts of apex-base DOR and that the spatial heterogeneities of autonomic effects on the ventricles are most likely attributable to a greater innervation at the base than the apex of the heart.
Measurement of parasternal intercostal electromyogram during an infective exacerbation in patients with cystic fibrosis
Authors: Charles C. Reilly, Caroline J. Jolley, Caroline Elston, John Moxham, Gerrard F. Rafferty
Journal: European Respiratory Journal (2012)

The parasternal intercostal muscle electromyogram (sEMGpara) is a measure of neural respiratory drive and reflects lung disease severity in stable cystic fibrosis (CF). The aim of the study was to measure sEMGpara in acute infective exacerbations of CF and compare changes in sEMGpara with those in conventional lung function measures. 12 patients with CF admitted to hospital with an acute chest infection were studied. There was a significant reduction in mean ± SD sEMGpara (ΔsEMGpara -38 ± 19%, p<0.001) between admission and discharge. Spirometery also improved significantly from admission to discharge; Δforced expiratory volume in 1 s % predicted 39 ± 30%, p<0.001 and Δvital capacity % pred 22 ± 18%, p<0.001. sEMGpara has potential value as a nonvolitional measure of change in respiratory function in CF.
Cyclical psoriatic arthritis responding to anti-oestrogen therapy
Authors: H. P. STEVENS, L. S. OSTLERE, C.M. BLACK, H. S. JACOBS, M. H. A. RUSTIN
Journal: British Journal of Dermatology (1993)

We report a patient with severe psoriatic arthritis in whom the severity of both the arthritis and psoriasis fluctuated with the menstrual cycle. These features failed to improve with standard therapy, but there was a prompt response to treatment which suppressed oestrogen secretion. Such treatment should be considered in patients with disabling cyclical changes in psoriatic arthritis.
Cardioprotective Effects of Ramipril and Losartan in Right Ventricular Pressure Overload in the Rabbit
Authors: Jean L. Rouleau, Gaston Kapuku, Stéphane Pelletier, Hugues Gosselin, Albert Adam, Caroline Gagnon, Chantal Lambert, Sylvain Meloche
Journal: Circulation (2001)

The role of kinins in the cardioprotective effects of ACE inhibitors remains controversial.Right ventricular pressure overload in rabbits was produced by pulmonary artery banding for 21 days. Rabbits were untreated, or they received the ACE inhibitor ramipril with or without bradykinin B(1) and B(2) receptor blockers or the angiotensin (Ang) II type I (AT(1)) receptor blocker losartan. Pulmonary artery banding caused right ventricular hypertrophy, depressed papillary muscle contractility, and loss of Ang II contractile effects because of a signaling defect downstream of AT(1) receptors. Paradoxically, AT(1) receptor density and G protein alpha subunits alphaq and alphai1/2 increased. Inotropic responsiveness to the alpha-receptor agonist phenylephrine was normal. Ramipril preserved cardiac contractility, but this effect was attenuated by simultaneous use of kinin receptor blockers. Ramipril also maintained responsiveness to Ang II and prevented AT(1) receptor and G protein upregulation. The simultaneous use of a kinin receptor blocker attenuated but did not prevent upregulation in the AT(1) receptor and G protein. Losartan had no effect on baseline contractility, but it maintained cardiac inotropic responsiveness to Ang II, prevented upregulation of AT(1) receptors, but did not modify G protein upregulation.Pressure overload of the right ventricle decreases contractility, uncouples AT(1) receptors to downstream signaling pathways, and changes the expression of components of the AT(1) receptor signaling pathway. Ramipril attenuates these effects via kinins. Interventions that prevent local increases in Ang II or block AT(1) receptors also prevent decreased responsiveness of the AT(1) receptor in this model.
In vivo switch to IL-10–secreting T regulatory cells in high dose allergen exposure
Authors: Flurina Meiler, Judith Zumkehr, Sven Klunker, Beate Rückert, Cezmi A. Akdis, Mübeccel Akdis
Journal: The Journal of Experimental Medicine (2008)

High dose bee venom exposure in beekeepers by natural bee stings represents a model to understand mechanisms of T cell tolerance to allergens in healthy individuals. Continuous exposure of nonallergic beekeepers to high doses of bee venom antigens induces diminished T cell–related cutaneous late-phase swelling to bee stings in parallel with suppressed allergen-specific T cell proliferation and T helper type 1 (Th1) and Th2 cytokine secretion. After multiple bee stings, venom antigen–specific Th1 and Th2 cells show a switch toward interleukin (IL) 10–secreting type 1 T regulatory (Tr1) cells. T cell regulation continues as long as antigen exposure persists and returns to initial levels within 2 to 3 mo after bee stings. Histamine receptor 2 up-regulated on specific Th2 cells displays a dual effect by directly suppressing allergen-stimulated T cells and increasing IL-10 production. In addition, cytotoxic T lymphocyte–associated antigen 4 and programmed death 1 play roles in allergen-specific T cell suppression. In contrast to its role in mucosal allergen tolerance, transforming growth factor β does not seem to be an essential player in skin-related allergen tolerance. Thus, rapid switch and expansion of IL-10–producing Tr1 cells and the use of multiple suppressive factors represent essential mechanisms in immune tolerance to a high dose of allergens in nonallergic individuals.
Benefits of exercise training in patients receiving haemodialysis: a systematic review and meta-analysis
Authors: Ying Wang, Meg J Jardine
Journal: British Journal of Sports Medicine (2011)

▶ Smart N, Steele M. Exercise training in hemodialysis patients: a systematic review and meta-analysis. Nephrology 2011;16:626–32.[OpenUrl][1][PubMed][2] Patients receiving haemodialysis have poor physical strength,1 muscle metabolism2 and quality of life3 than the general population. Exercise training may improve these parameters for people requiring maintenance haemodialysis. This systematic review with meta-analysis aimed to examine the impact of exercise training on peak VO2, strength, cardiac function, quality of life, adherence, safety and energy intake of patients receiving haemodialysis. Randomised clinical trials of exercise interventions conducted in patients receiving haemodialysis were identified by systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials and CINAHL up to 2010 with no language restriction. The actual search strategy is not included. Search terms may not have included all outcome descriptors (eg, the primary outcome, peak VO2) or all possible terms used to identify patients receiving haemodialysis and, in particular, did not appear to include the terminology of the KDOQI kidney classification4 (eg, 'dialysis', 'end stage kidney/renal disease/failure', 'chronic kidney disease') excluding at least one eligible study.5 Included studies reported the post-training mean and SD of at … [1]: {openurl}?query=rft.jtitle%253DNephrology%2B%2528Carlton%252C%2BVic.%2529%26rft.stitle%253DNephrology%2B%2528Carlton%2529%26rft.aulast%253DSmart%26rft.auinit1%253DN.%26rft.volume%253D16%26rft.issue%253D7%26rft.spage%253D626%26rft.epage%253D632%26rft.atitle%253DExercise%2Btraining%2Bin%2Bhaemodialysis%2Bpatients%253A%2BA%2Bsystematic%2Breview%2Band%2Bmeta-analysis.%26rft_id%253Dinfo%253Apmid%252F21557787%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=21557787&link_type=MED&atom=%2Fbjsports%2F45%2F14%2F1165.atom
Abnormal brain microstructure in patients with chronic pancreatitis
Authors: B. Bonaz
Journal: Gut (2011)

The emergence of brain imaging studies has allowed a better knowledge of pain processing in the central nervous system in both normal and pathological conditions. In particular, abnormal loci of activation have been demonstrated in areas of the ‘pain matrix’ involved in sensory-discriminative (primary sensory and insular cortices), affective (anterior cingulate cortex), cognitive (prefrontal cortex) and limbic (amygdala) components in patients with chronic abdominal pain as observed in irritable bowel syndrome (IBS).1 A widespread aberrant central processing of pain (central sensitisation) is observed in these patients.2 In addition, abnormal structural grey matter integrity in IBS that correlates with individual disease symptoms, duration of IBS or the personality characteristic of pain catastrophising has been reported.3 With the development of magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI), it has been possible to assess changes in white and grey matter microstructure not seen by more conventional imaging techniques.4 DTI has become a popular method to assess white matter integrity and connectivity in the brain, and a DTI-derived value called fractional anisotropy is often examined as a measure of microstructural white matter integrity. Using DTI, white matter abnormalities in the insula, anterior cingulate cortex and other brain areas associated with …
Characterisation of follicular dendritic cells in labial salivary glands of patients with primary Sjogren syndrome: comparison with tonsillar lymphoid follicles
Authors: K. E. Aziz, P. J McCluskey, D. Wakefield
Journal: Annals of the Rheumatic Diseases (1997)

<h3>OBJECTIVE</h3> To localise and characterise follicular dendritic cells (FDC) present in autoimmune lesions of primary Sjogren syndrome. <h3>METHODS</h3> Cryostat sections of labial salivary glands from 15 patients with primary Sjogren syndrome were examined by an indirect immunoperoxidase technique and monoclonal antibodies to a panel of dendritic cell markers. Tonsils from two controls were also examined for the same markers. <h3>RESULTS</h3> FDC were localised in the centre of 75% of lymphoid focal structures in labial salivary gland biopsies. FDC in labial salivary glands of patients with primary Sjogren syndrome expressed CD35, CD11c, and CD106 (VCAM-1) in a pattern similar to FDC in tonsils, but they did not express either CD14 or CD11b. This indicates that they may not be of myeloid origin, while FDC in tonsillar lymphoid follicles strongly expressed both CD14 and CD11b. FDC in labial salivary glands of patients also lacked VLA-2α and VLA-3α, which were expressed by FDC in tonsils. <h3>CONCLUSIONS</h3> The characteristic phenotype and origin of these cells may be of importance in the immune responses involved in Sjogren syndrome and the retention of infiltrating lymphocytes in the glands.
Unsuspected echocardiographic abnormality in the long QT syndrome. Diagnostic, prognostic, and pathogenetic implications.
Authors: F Nador, G Beria, G M De Ferrari, M Stramba-Badiale, E H Locati, A Lotto, P J Schwartz
Journal: Circulation (1991)

BACKGROUND The idiopathic long QT syndrome (LQTS) is characterized by electrocardiographic abnormalities and by a high incidence of lethal arrhythmias. The present case/control study demonstrates the frequent occurrence of unusual and specific ventricular wall motion abnormalities in LQTS and their association with history of syncope or cardiac arrest. These anomalies were present in 23 of 42 LQTS patients (55%) and in two of 42 healthy controls (5%, p less than 0.0001) matched for age, sex, height, and weight. METHODS AND RESULTS Two new measurements were developed to assess quantitatively the abnormalities observed. The first, Th1/2, is an index of the rapidity of the early contraction phase; the second, TSTh, is an index of the presence of a slow movement in the late thickening phase. Th1/2 was smaller in LQTS patients (15.0 +/- 4.1 versus 19.9 +/- 3.9% of the cardiac cycle, p less than 0.001), indicating that they reach half-maximal systolic contraction more rapidly than controls. TSTh was greater in LQTS patients (9.37 +/- 6.82 versus 2.88 +/- 4.46%, p less than 0.001), indicating that they spend more time at a very low thickening rate. A peculiar double peak pattern of late thickening was present in 11 patients and in no controls. These abnormalities were more frequent in symptomatic than in asymptomatic patients (20 of 26, 77%, versus three of 16, 19%, p less than 0.005; relative risk, 2.75). They were not affected by beta-blockade or by left cardiac sympathetic denervation. The same echocardiographic abnormalities were produced by right stellectomy in nine of nine anesthetized dogs, were not dependent on cycle length, and were not modified by subsequent left stellectomy. CONCLUSIONS This study demonstrates a previously unsuspected abnormality in the ventricular contraction pattern of LQTS patients and, for the first time, provides evidence that a noninvasively detected cardiac abnormality is associated with a higher risk for syncope/cardiac arrest. The experimental reproduction of this echocardiographic abnormality by right stellectomy indicates that this newly found clinical characteristic of LQTS does not contradict the "sympathetic imbalance" hypothesis.
Species-restricted interactions between CD8 and the alpha 3 domain of class I influence the magnitude of the xenogeneic response.
Authors: M J Irwin, W R Heath, L A Sherman
Journal: The Journal of Experimental Medicine (1989)

As compared with the vigorous T cell response normally observed against allogeneic MHC molecules, T cells recognize xenogeneic MHC molecules poorly. To define structural features of the MHC molecule important for such species-specific recognition, HLA-A2(A2)-specific murine CTL were examined for their recognition of transfected cell lines expressing the class I molecules A2 or A2/H-2Kb(A2/Kb). A2/Kb is a chimeric molecule consisting of the alpha 1 and alpha 2 domains of A2 and the alpha 3, transmembrane, and cytoplasmic regions of Kb. The majority of CTL clones showed enhanced recognition of transfected cell lines expressing this chimeric molecule. Enhanced recognition was shown to correlate with sensitivity of the CTL clones to inhibition by anti-CD8 antibody. These results suggested that CD8 may interact with class I in a species-specific manner, and that suboptimal CD8 interaction with the alpha 3 domain of xenogeneic molecules may be an important contribution to poor xenoreactivity. This conclusion was supported by the capacity of A2/Kb, but not A2 human cell transfectants, to induce a primary in vitro CTL xenoresponse specific for A2.
cRGD-functionalized, DOX-conjugated, and 64Cu-labeled superparamagnetic iron oxide nanoparticles for targeted anticancer drug delivery and PET/MR imaging
Authors: Xiaoqiang Yang, Hao Hong, Jamison J. Grailer, Ian J. Rowland, Alireza Javadi, Samuel A. Hurley, Yuling Xiao, Yunan Yang, Yin Zhang, Robert J. Nickles, Weibo Cai, Douglas A. Steeber, Shaoqin Gong
Journal: Biomaterials (2011)