tbuckley/cabot-search huggingface dataset:
Effect of Hospitalist Workload on the Quality and Efficiency of Care
Authors: Daniel J. Elliott, Robert S. Young, Joanne Brice, Ruth Aguiar, Paul Kolm
Journal: JAMA Internal Medicine (2014)

Hospitalist physicians face increasing pressure to maximize productivity, which may undermine the efficiency and quality of care.To determine the association between hospitalist workload and the efficiency and quality of inpatient care.We conducted a retrospective cohort study of 20,241 admissions of inpatients cared for by a private hospitalist group at a large academic community hospital system between February 1, 2008, and January 31, 2011.Daily hospitalist workload as measured by relative value units and patient encounters from the hospitalist billing records.The main outcomes were length of stay (LOS), cost, rapid response team activation, in-hospital mortality, patient satisfaction, and 30-day readmission rates. Key covariates included hospital occupancy and patient-level characteristics.The LOS increased as workload increased, particularly at lower hospital occupancy. For hospital occupancies less than 75%, LOS increased from 5.5 to 7.5 days as workload increased. For occupancies of 75% to 85%, LOS increased exponentially above a daily relative value unit of approximately 25 and a census value of approximately 15. At high occupancy (>85%), LOS was J-shaped, with significant increases at higher ranges of workload. After controlling for LOS, cost increased by $111 for each 1-unit increase in relative value unit and $205 for each 1-unit increase in census across the range of values. Changes in workload were not associated with the remaining outcomes.Increasing hospitalist workload is associated with clinically meaningful increases in LOS and cost. Although our findings should be validated in different clinical settings, our results suggest the need for methods to mitigate the potential negative effects of increased hospitalist workload on the efficiency and cost of care.
Relationships between body mass index and clinical and functional characteristics in childhood asthma: A cross-sectional analysis
Authors: Bruno Mahut, Nicole Beydon, Christophe Delclaux
Journal: European Respiratory Journal (2011)

Background:  Overweight is a risk factor for subsequent asthma in children and obesity in adult represents a unique phenotype of asthma, with more severe disease.   Objectives:  To assess the relationships between body mass index and clinical and functional characteristics of childhood asthma in a cross-sectional design.   Methods:  The z-scores of BMI were evaluated according to the level of control (severe exacerbation and absence of symptom in the past three months), ICS treatment and pulmonary functional tests in asthmatic children. Overweight was defined as a BMI >97th percentile.   Results:  Data from 506 children (178 girls, 10.8±2.6 years, min-max [6-15]) of whom 92 (18%) with overweight were analyzed. The z-scores of BMI were increasing with age (r = 0.11, p = 0.014) and overweight was more frequently observed in girls than in boys (45% vs 33%, p = 0.045). Median of z-score were not significantly different according to atopy (p=0.31), recent exacerbation (p=0.24) or optimal control (p=0.94). There was no correlation between z-score and ICS dose (p=0.76). Z-scores of BMI did not correlate with indices directly obtained from spirometry, but negatively correlated with pre- and post-bronchodilator FRC/TLC and RV/TLC ratios (Rho = - 0.25, p    Conclusions:  This cross-sectional analysis suggests that overweight does not influence asthma control in asthmatic children, but alters lung volumes proportions.
Identification and Clinical Significance of Allergenic Molecules of Cat Origin
Authors: H. Løwenstein, P. Lind, B. Weeke
Journal: Allergy (1985)

Freeze‐dried extracts from cat dander and the corresponding rabbit antibodies were used for establishing the CIE reference pattern for cat dander extracts. Anti‐Cat Ag 1 and anti‐cat albumin were used for identification of the corresponding antigens. CRIE on sera from selected groups of American and Danish cat‐allergic patients demonstrated antigen‐specific IgE binding to 10 of 15 cat dander antigens (Cat Ag 1 being the major allergen). Only minor differences were found between the two groups. Four of these allergens were serum proteins. Variable amounts of many of the 10 allergens were measured by QIE in saliva, serum, urine and three cat pelt extracts. However, extremely wide ranges for content of the serum allergens and the non‐serum allergens were found. This was exemplified by an albumin/cat Ag 1 ratio between 1 and 400, smallest in cat dander. Immunoabsorption using anti‐cat dander, anti‐cat albumin and anti‐Cat Ag 1 indicated that the anti‐cat dander, anti‐cat albumin, and the anti‐Cat Ag 1 absorbed approximately 90%, 25%, and 56%, respectively, of the dander RAST activity, and 87%, 11%, and 45%, respectively, of the saliva RAST activity, confirming the major importance of Ag 1. It is concluded that cat allergenic extracts should contain only modest amounts of serum albumin and other serum‐derived antigens and that any relevant standardization must include quantification of at least Cat Ag 1 and cat albumin.
Smoking Increases Tissue Factor Expression in Atherosclerotic Plaques
Authors: Shlomo Matetzky, Shigemasa Tani, Simon Kangavari, Paul Dimayuga, Juliana Yano, Helen Xu, Kuang-Yuh Chyu, Michael C. Fishbein, Prediman K. Shah, Bojan Cercek
Journal: Circulation (2000)

Smoking increases the risk of atherothrombotic events. To determine whether smoking influences plaque thrombogenicity, we examined the effect of cigarette smoking and aspirin use on tissue factor (TF) expression in atherosclerotic plaques.A total of 23 apoE-/- mice were exposed to cigarette smoke with (n=9) or without (n=14) aspirin treatment. Eleven mice who were exposed to filtered room air served as controls. Aortic root plaques of mice exposed to smoke had higher immunoreactivity for TF (14+/-4% versus 6.4+/-3%; P=0.0005), vascular cell adhesion molecule-1 (15+/-4% versus 5+/-2%; P=0.002), and macrophages (16+/-5% versus 6+/-2%; P=0.002) compared with nonsmoking controls. Aspirin treatment attenuated smoking-induced changes in plaque composition. In human plaques obtained by carotid endarterectomy, TF immunoreactivity (8+/-5% versus 2+/-2%; P=0.0002) and activity (P=0. 03) were higher in the plaques from smokers (n=28) than those from nonsmokers (n=28). Aspirin use was associated with reduced TF expression in smokers (9+/-8% versus 3+/-4%; P=0.0017).Our results suggest increased plaque TF expression and thrombogenicity as a novel mechanism for the increased risk of atherothrombotic events in smokers. Treatment with aspirin may reduce TF expression.
MicroRNA-23b cluster microRNAs regulate transforming growth factor-beta/bone morphogenetic protein signaling and liver stem cell differentiation by targeting Smads
Authors: Charles E. Rogler, Lauretta LeVoci, Tammy Ader, Aldo Massimi, Tatyana Tchaikovskaya, Raquel Norel, Leslie E. Rogler
Journal: Hepatology (2009)

Transforming growth factor-beta / bone morphogenetic protein (TGFbeta/BMP) signaling has a gradient of effects on cell fate choice in the fetal mouse liver. The molecular mechanism to understand why adjacent cells develop into bile ducts or grow actively as hepatocytes in the ubiquitous presence of both TGFbeta ligands and receptors has been unknown. We hypothesized that microRNAs (miRNAs) might play a role in cell fate decisions in the liver. miRNA profiling during late fetal development in the mouse identified miR-23b cluster miRNAs comprising miR-23b, miR-27b, and miR-24-1 and miR-10a, miR-26a, and miR-30a as up-regulated. In situ hybridization of fetal liver at embryonic day 17.5 of gestation revealed miR-23b cluster expression only in fetal hepatocytes. A complementary (c)DNA microarray approach was used to identify genes with a reciprocal expression pattern to that of miR-23b cluster miRNAs. This approach identified Smads (mothers against decapentaplegic homolog), the key TGFbeta signaling molecules, as putative miR-23b cluster targets. Bioinformatic analysis identified multiple candidate target sites in the 3' UTRs (untranslated regions) of Smads 3, 4, and 5. Dual luciferase reporter assays confirmed down-regulation of constructs containing Smad 3, 4, or 5, 3' UTRs by a mixture of miR-23b cluster mimics. Knockdown of miR-23b miRNAs during hepatocytic differentiation of a fetal liver stem cell line, HBC-3, promoted expression of bile duct genes, in addition to Smads, in these cells. In contrast, ectopic expression of miR-23b mimics during bile duct differentiation of HBC-3 cells blocked the process.Our data provide a model in which miR-23b miRNAs repress bile duct gene expression in fetal hepatocytes while promoting their growth by down-regulating Smads and consequently TGFbeta signaling. Concomitantly, low levels of the miR-23b miRNAs are needed in cholangiocytes to allow TGFbeta signaling and bile duct formation.
Histiocytoma cutis: a tumour of dermal dendrocytes (dermal dendrocytoma)
Authors: R. CERIO, J. SPAULL, E.WILSON JONES
Journal: British Journal of Dermatology (2006)

The histogenesis of histiocytoma (dermatofibroma) was investigated using new antibodies that demonstrate factor XIIIa (FXIIIa) positive cells and the monocyte macrophage cell series (MAC 387), in formalin fixed tissue. The distribution of S100 protein, vimentin and Ulex europaeus agglutinin I (UEA-I) were also studied. The antibody against FXIIIa labelled the normal dermal population of fixed connective tissue cells (dermal dendrocytes) emphasizing their dendritic processes; cells that are widely distributed, but are most numerous in the papillary dermis. In contrast, the antibody, MAC 387 against monocyte derived macrophages, did not label this cell population. In 30 histiocytomas, intense labelling for FXIIIa was found peripherally, but labelling was rather weaker in cells situated centrally. Only a few cells labelled for S100 protein and with the monoclonal antibody MAC 387, but vimentin positivity was universal. UEA-I labelled only vessels in histiocytomas. However, FXIIIa labelling was negative in 16 dermatofibrosarcomas, three keloids and several other fibroproliferative lesions. These contrasting results with FXIIIa labelling have practical implications for diagnosis of benign and malignant spindle cell tumours of the skin. We conclude that histiocytomas (dermal dendrocytomas) take their origin from dermal fixed connective tissue cells, (dermal dendrocytes), but other spindle cell tumours may differ in histogenesis.
Vascular Rhythms and Adaptation
Authors: John F. Keaney, David R. Weaver
Journal: Circulation (2009)

T he notion that the clinical manifestations of cardiovas- cular disease do not occur randomly throughout the course of the day has been accepted for Ͼ4 decades.Cohort studies documenting the time of chest pain onset demonstrated a morning predilection for the presentation of myocardial infarction. 1 At the time, however, it was difficult to discern a morning rise in the incidence of myocardial infarction from the simple realization of longstanding nocturnal symptoms on awakening.With the advent of studies to limit myocardial infarct size, it became possible to accurately identify the myocardial infarction onset by the timedependent increase in circulating creatine kinase levels, and these data confirmed a distribution roughly peaking in the hours between 6 AM and noon. 2 It soon became clear that other manifestations of cardiovascular disease, such as sudden cardiac death, stroke, and myocardial ischemia all exhibited similar time-of-day dependence, as reviewed by Muller. 3f one corrects for individual variations in the time of sleep cessation, the preponderance of events occur within the first 3 hours after awakening.
MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA
Authors: M. Barry, MD, C. Roehrborn, MD
Journal: Annual Review of Medicine (1997)

▪ Abstract Benign prostatic hyperplasia (BPH) is a common cause of morbidity among older men. Primary care physicians need to develop expertise in its management. The causes of BPH are unknown; aging and the presence of male androgens are the dominant risk factors. Obtaining a medical history is a key step in assessing whether lower urinary tract symptoms are due to BPH or to some other process. A reliable and valid seven-item questionnaire has been developed to objectively assess symptom severity. A focused physical examination including a digital rectal exam should be performed, as well as a urinalysis and serum creatinine. Optional tests include uroflowmetry, post-void residual urine, and prostate-specific antigen measurements. BPH is treated primarily to improve the quality, rather than increase the quantity, of life. Optimal decisions about treatment are best made by a clinician and an informed patient working together.
Allogeneic stem cell transplantation after reduced-intensity conditioning in patients with myelofibrosis: a prospective, multicenter study of the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation
Authors: Nicolaus Kröger, Ernst Holler, Guido Kobbe, Martin Bornhäuser, Rainer Schwerdtfeger, Herrad Baurmann, Arnon Nagler, Wolfgang Bethge, Matthias Stelljes, Lutz Uharek, Hannes Wandt, Andreas Burchert, Paolo Corradini, Jörg Schubert, Martin Kaufmann, Peter Dreger, Gerald G. Wulf, Hermann Einsele, Tatjana Zabelina, Hans Michael Kvasnicka, Jürgen Thiele, Ronald Brand, Axel R. Zander, Dietger Niederwieser, Theo M. de Witte
Journal: Blood (2009)
Systemic Amyloidosis, Functional Coronary Insufficiency, and Autonomic Impairment
Authors: Robert Capone, Ezra A. Amsterdam, Dean T. Mason, Robert Zelis
Journal: Annals of Internal Medicine (1972)

A patient with orthostatic hypotension and congestive heart failure had primary amyloidosis. Study of autonomic function showed failure of both sympathetic and parasympathetic reflexes. Diffuse myocardial dysfunction was demonstrated by cardiac catheterization. Lactate production was detected despite arteriographically normal coronary arteries at rest and with isoproterenol stimulation. It is suggested that myocardial ischemia may be related to small-vessel infiltration by amyloid, diffusion block at the capillary level by amyloid, or myocardial hypertrophy. The therapeutic implications of balancing the need for an increased blood volume to compensate for the autonomic dysfunction against the need for a decreased preload in treatment of heart failure are discussed.
E2F1 suppresses cardiac neovascularization by down-regulating VEGF and PlGF expression
Authors: Min Wu, Junlan Zhou, Min Cheng, Chan Boriboun, Dauren Biyashev, Hong Wang, Alexander Mackie, Tina Thorne, Jonathan Chou, Yiping Wu, Zhishui Chen, Qinghua Liu, Hongbin Yan, Ya Yang, Chunfa Jie, Yao-Liang Tang, Ting C. Zhao, Robert N. Taylor, Raj Kishore, Douglas W. Losordo, Gangjian Qin
Journal: Cardiovascular Research (2014)

AimsThe E2F transcription factors are best characterized for their roles in cell-cycle regulation, cell growth, and cell death. Here we investigated the potential role of E2F1 in cardiac neovascularization.
CD133+ Glioblastoma Stem-like Cells are Radiosensitive with a Defective DNA Damage Response Compared with Established Cell Lines
Authors: Amy M. McCord, Muhammad Jamal, Eli S. Williams, Kevin Camphausen, Philip J. Tofilon
Journal: Clinical Cancer Research (2009)

Abstract Purpose: CD133+ glioblastoma tumor stem-like cells (TSC) have been defined as radioresistant. However, although previously classified relative to CD133− cells, the radiosensitivity of CD133+ TSCs with respect to the standard glioblastoma model, established glioma cell lines, has not been determined. Therefore, to better understand the radioresponse of this cancer stem cell, we have used established cell lines as a framework for defining their in vitro radioresponse. Experimental Design: The intrinsic radiosensitivity of CD133+ TSC cultures and established glioma cell lines was determined by clonogenic assay. The TSCs and established cell lines were also compared in terms of DNA double-strand break (DSB) repair capacity and cell cycle checkpoint activation. Results: Based on clonogenic analysis, each of the six TSC cultures evaluated was more sensitive to radiation than the established glioma cell lines. Consistent with increased radiosensitivity, the DSB repair capacity as defined by neutral comet assay and γH2AX and Rad51 foci was significantly reduced in TSCs compared with the cell lines. Although G2 checkpoint activation was intact, in contrast to the cell lines, DNA synthesis was not inhibited in TSCs after irradiation, indicating the absence of the intra-S-phase checkpoint. Conclusions: These data indicate that the mechanisms through which CD133+ TSCs respond to radiation are significantly different from those of the traditional glioblastoma in vitro model, established glioma cell lines. If TSCs play a critical role in glioblastoma treatment response, then such differences are likely to be of consequence in the development and testing of radiosensitizing agents. (Clin Cancer Res 2009;15(16):5145–53)
NHS will need to replace half its expensive equipment within three years
Authors: A. O'Dowd
Journal: BMJ (2011)

NHS trusts will have to replace around half of expensive “high value equipment” such as scanners within three years, a report warns.

The report by public spending watchdog the National Audit Office published on 30 March warns that trusts could struggle to find the money to replace equipment such as computed tomography (CT) and magnetic resonance imaging (MRI) scanners and linear accelerator machines (linacs).

Managing high value capital equipment in the NHS in England criticises trusts for not securing value for money when buying and operating this equipment.

Each computed tomography scanner costs around £579 000 (€660 500; $930 000), a MRI scanner costs £895 000 and a linac, £1.4m, says the …
Enhanced Verbal Memory in Nondemented Elderly Women Receiving Hormone-Replacement Therapy
Authors: Pauline M. Maki, Alan B. Zonderman, Susan M. Resnick
Journal: American Journal of Psychiatry (2001)

OBJECTIVE: This study examined the effects of hormone-replacement therapy on memory and other cognitive abilities in cognitively intact older women. METHOD: This prospective observational study in nondemented postmenopausal women aged 50–89 from the Baltimore Longitudinal Study of Aging involved study groups consisting of 103 women who were receiving oral or transdermal estrogen-replacement therapy (44 of whom were receiving adjuvant progesterone) and 81 women who had never received such therapy. Groups were naturally matched on education, health status, depressive symptoms, annual income, and general verbal ability. To restrict the study group to cognitively healthy women, prospective clinical data were used to exclude women who developed dementia up to 5 years after assessment. Data were cross-sectional. Multivariate analysis of variance and follow-up univariate analyses of variance were performed to compare those women who were receiving and those who had never received hormone-replacement therapy on measures of verbal memory, figural memory, mental rotations, attention, and working memory. RESULTS: The women receiving hormone-replacement therapy performed significantly better on measures of verbal learning and memory than did those who had never received hormones, but there were no significant differences in scores on other cognitive tests. Specific aspects of memory performance, including encoding and retrieval, were superior among the women receiving hormone therapy. CONCLUSIONS: These findings, based on groups of women who were receiving and had never received hormone-replacement therapy and who were naturally matched on health and cognitive status, suggest that hormone-replacement therapy may have a selective beneficial effect on verbal memory in older nondemented women.
STUDIES ON THE EFFECT OF THE CARRIER MOLECULE ON ANTIHAPTEN ANTIBODY SYNTHESIS
Authors: William E. Paul, Gregory W. Siskind, Baruj Benacerraf
Journal: The Journal of Experimental Medicine (1966)

Equilibrium measurements of interactions of anti-DNP antibodies, prepared using DNP-PLL and several DNP-proteins for immunization, with DNP(0.6)-PLL(240) and with the univalent hapten, epsilon-DNP-L-lysine, were made utilizing the technique of fluorescence quenching. Carrier specificity of anti-DNP-PLL antibodies was demonstrated by a higher average intrinsic association constant (K(0)) of anti-DNP-PLL antibodies with DNP(0.6)-PLL(240) than with epsilon-DNP-L-lysine. The free energy contribution of the PLL carrier to the interaction of intact anti-DNP-PLL antibodies with DNP(0.6)-PLL(240) was from -0.8 to -2.1 kcal/mole. On the other hand, intact anti-DNP-protein antibodies displayed a lower energy of interaction with DNP(0.6)-PLL(240) than with epsilon-DNP-L-lysine of up to +2.4 kcal/mole. Fab' fragments of both anti-DNP-PLL and anti-DNP-BGG antibodies have K(0)'s with epsilon-DNP-L-lysine identical to the K(0)'s of the intact anti-DNP antibodies from which they were prepared. However, K(0) of interaction of Fab' fragments with DNP(0.6)-PLL(240) (a large proportion of the conjugated PLL molecules in this preparation bear more than one DNP group) is considerably lower than that of the intact antibody. Thus a cooperative effect in the binding of bivalent antibody and bivalent (or greater) antigen exists and is of the order of -1.2 to -2.0 kcal/mole of IgG antibody. Although the direct contribution of the carrier to the interaction of Fab' fragment of anti-DNP-PLL and DNP(0.6)-PLL(240) is -0.4 kcal/mole, the energy of carrier specificity, based upon consideration of cooperative effects and of repulsion of anti-DNP-protein antibodies for portions of the DNP-PLL determinants, is of the order of -3 kcal/mole (approximately 30% of total binding energy).
Migraine and Cardiovascular Disease
Authors: Richard B. Lipton, Marcelo E. Bigal
Journal: JAMA (2006)

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