tbuckley/cabot-search huggingface dataset:
Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study
Authors: Eve A. Kerr
Journal: Annals of Internal Medicine (2004)

Background: No studies have compared care in the Department of Veterans Affairs (VA) with that delivered in commercial managed care organizations, nor have studies focused in depth on care comparisons for chronic, outpatient conditions. Objective: To compare the quality of diabetes care between patients in the VA system and those enrolled in commercial managed care organizations by using equivalent sampling and measurement methods. Design: Cross-sectional patient survey with retrospective review of medical records. Setting: 5 VA medical centers and 8 commercial managed care organizations in 5 matched geographic regions. Participants: 8205 diabetic patients: 1285 in the VA system and 6920 in commercial managed care. Measurements: We compared scores on identically specified quality measures for 7 diabetes care processes and 3 diabetes intermediate outcomes and on 4 dimensions of satisfaction. Scores were expressed as the percentage of patients receiving indicated care and were adjusted for patients' demographic and health characteristics. Results: Patients in the VA system had better scores than patients in commercial managed care on all process measures (for example, 93% vs. 83% for annual hemoglobin A1c; P = 0.006; 91% vs. 75% for annual eye examination; P < 0.001). Blood pressure control was poor in both groups (52% to 53% of persons had blood pressure < 140/90 mm Hg), but patients in the VA system had better control of low-density lipoprotein cholesterol and hemoglobin A1c (for example, 86% vs. 72% for low-density lipoprotein cholesterol level < 3.37 mmol/L [<130 mg/dL]; P = 0.002). Satisfaction was similar in the 2 groups. Limitations: Our results may not be generalizable to all regions or health plans, and some of the differences in performance could reflect differences in documentation. Conclusions: Diabetes processes of care and 2 of 3 intermediate outcomes were better for patients in the VA system than for patients in commercial managed care. However, both VA and commercial managed care had room for improvement, especially for blood pressure control.
Association of ambient air pollution with the prevalence and incidence of COPD
Authors: Tamara Schikowski, Martin Adam, Alessandro Marcon, Yutong Cai, Andrea Vierkötter, Anne Elie Carsin, Benedicte Jacquemin, Zaina Al Kanani, Rob Beelen, Matthias Birk, Pierre-Olivier Bridevaux, Bert Brunekeef, Peter Burney, Marta Cirach, Josef Cyrys, Kees de Hoogh, Roberto de Marco, Audrey de Nazelle, Christophe Declercq, Bertil Forsberg, Rebecca Hardy, Joachim Heinrich, Gerard Hoek, Debbie Jarvis, Dirk Keidel, Diane Kuh, Thomas Kuhlbusch, Enrica Migliore, Gioia Mosler, Mark J. Nieuwenhuijsen, Harish Phuleria, Thierry Rochat, Christian Schindler, Simona Villani, Ming-Yi Tsai, Elisabeth Zemp, Anna Hansell, Francine Kauffmann, Jordi Sunyer, Nicole Probst-Hensch, Ursula Krämer, Nino Künzli
Journal: European Respiratory Journal (2014)

The role of air pollution in chronic obstructive pulmonary disease (COPD) remains uncertain. The aim was to assess the impact of chronic exposure to air pollution on COPD in four cohorts using the standardised ESCAPE exposure estimates. Annual average particulate matter (PM), nitrogen oxides (NO x ) and road traffic exposure were assigned to home addresses using land-use regression models. COPD was defined by NHANES reference equation (forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC) less than the lower limit of normal) and the Global Initiative for Chronic Obstructive Lung Disease criterion (FEV 1 /FVC &lt;0.70) and categorised by severity in non-asthmatics. We included 6550 subjects with assigned NO x and 3692 with PM measures. COPD was not associated with NO 2 or PM 10 in any individual cohort. In meta-analyses only NO 2 , NO x , PM 10 and the traffic indicators were positively, although not significantly, associated with COPD. The only statistically significant associations were seen in females (COPD prevalence using GOLD: OR 1.57, 95% CI 1.11–2.23; and incidence: OR 1.79, 95% CI 1.21–2.68). None of the principal results were statistically significant, the weak positive associations of exposure with COPD and the significant subgroup findings need to be evaluated in further well standardised cohorts followed up for longer time, and with time-matched exposure assignments.
Case of OEsophageal Fistula Opening through Thoracic Parietes Laterally
Authors: J. G. S. Coghill
Journal: BMJ (1877)

France where consumption is so prevalent amongst the native popu- lation as at Montpelier and Marseilles.'$Dr. Journ&e's tables upon phthisis in Italy show that the same is the case in that country.Dr. Meryon (Lancet, July i85o) says: " Had I leisure, I could collect facts to prove that there are more natives (not strangers, but born and bred in the place) who die of consumption in Nice than in any town in England of the same amount of population."My colleague Dr. Pollock, who practised for many years in Rome, states that, " in no country is consumption so rapidly fatal as in Genoa, Florence, and Naples" (Medical Gazette, vol.xlvi).Madeira itself, so long the "city of refuge" of our phthisical countrymen, forms no exception.Dr. Mason says that consumption and scrofula are frequent there (Climate and Meteorology of Madeira).The late Sir Ranald Martin, so long distinguished as a surgeon in India, once assured me that, in the East Indies, both native and European residents are often attacked with phthisis.The late Dr. Musgrave of Antigua has often told me that, in the West Indies, many of the native blacks fall victims to consumption.And yet, as in the case of Australia, we send, and wisely so, many of our properly selected consumptive patients to the South of France, Italy, Algiers, etc.As with Australia, however, we must not promise them that they will meet there with anything specific.We can only hope that the rest and change, the milder air permitting more out- door exercise than in England-the variety, in fact, offered to them in their every work and thought--may induce, according to their in- dividual requirements, either some peaceful respite or some healthful ieaction.
Epithelial barrier and oral bacterial infection
Authors: Sabine E. Groeger, Joerg Meyle
Journal: Periodontology 2000 (2015)

Abstract The oral epithelial barrier separates the host from the environment and provides the first line of defense against pathogens, exogenous substances and mechanical stress. It consists of underlying connective tissue and a stratified keratinized epithelium with a basement membrane, whose cells undergo terminal differentiation resulting in the formation of a mechanically resistant surface. Gingival keratinocytes are connected by various transmembrane proteins, such as tight junctions, adherens junctions and gap junctions, each of which has a specialized structure and specific functions. Periodontal pathogens are able to induce inflammatory responses that lead to attachment loss and periodontal destruction. A number of studies have demonstrated that the characteristics of pathogenic oral bacteria influence the expression and structural integrity of different cell–cell junctions. Tissue destruction can be mediated by host cells following stimulation with cytokines and bacterial products. Keratinocytes, the main cell type in gingival epithelial tissues, express a variety of proinflammatory cytokines and chemokines, including interleukin‐1alpha, interleukin‐1beta, interleukin‐6, interleukin‐8 and tumor necrosis factor‐alpha. Furthermore, the inflammatory mediators that may be secreted by oral keratinocytes are vascular endothelial growth factor, prostaglandin E 2 , interleukin‐1 receptor antagonist and chemokine (C‐C motif) ligand 2. The protein family of matrix metalloproteinases is able to degrade all types of extracellular matrix protein, and can process a number of bioactive molecules. Matrix metalloproteinase activities under inflammatory conditions are mostly deregulated and often increased, and those mainly relevant in periodontal disease are matrix metalloproteinases 1, 2, 3, 8, 9, 13 and 24. Viral infection may also influence the epithelial barrier. Studies show that the expression of HIV proteins in the mucosal epithelium is correlated with the disruption of epithelial tight junctions, suggesting a possible enhancement of human papilloma virus infection by HIV‐associated disruption of tight junctions. Altered expression of matrix metalloproteinases was demonstrated in keratinocytes transformed with human papilloma virus‐16 or papilloma virus‐18,. To summarize, the oral epithelium is able to react to a variety of exogenous, possibly noxious influences.
Physical Signs of the Intrinsic Minus Foot
Authors: Richard K. Bernstein
Journal: Diabetes Care (2003)

A recent article in Diabetes Care (1) reminded me that I have never seen in publication a full list of the clinical signs of the so-called “diabetic” or “intrinsic minus foot” that can be discerned on physical examination. It is the purpose of this letter to describe these signs, most of which are present in severe cases.

The term “intrinsic minus foot” was first coined by my long-term teacher and colleague, Heinz I. Lippman, MD, in 1976 (2). The longest motor nerves are those that activate the intrinsic muscles of the foot (lumbricals). Since diabetic neuropathies progress from distal to proximal, the lumbricals are the first muscles to be affected by neuropathy. The characteristics of the intrinsic minus foot that can be discerned on simple physical examination are described below. 

1.  Hammer toes: the lumbricals wrap around the toes in such a fashion …
Elevated Liver Function Enzymes Are Related to the Development of Prediabetes and Type 2 Diabetes in Younger Adults
Authors: Quoc Manh Nguyen, Sathanur R. Srinivasan, Ji-Hua Xu, Wei Chen, Susan Hassig, Janet Rice, Gerald S. Berenson
Journal: Diabetes Care (2011)

OBJECTIVE Elevations in alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT), surrogate markers of liver dysfunction and nonalcoholic fatty liver, are considered as part of metabolic syndrome and related type 2 diabetes. However, information is limited regarding the long-term predictability of ALT and GGT in the development of prediabetes and type 2 diabetes. RESEARCH DESIGN AND METHODS In this retrospective cohort study, normoglycemic (n = 874), prediabetic (n = 101), and diabetic (n = 80) adults aged 26–50 years (average age 41.3 years) were followed over an average period of 16 years since their young adulthood (aged 18–38 years, average age 25.1 years), with measurements of cardiometabolic risk factor variables including ALT and GGT. RESULTS The follow-up prevalence rate of adult diabetes status by quartiles of baseline ALT and GGT levels showed an adverse trend for both prediabetes (P &amp;lt; 0.05) and diabetes (P &amp;lt; 0.01). In a longitudinal multivariate logistic regression analysis that included anthropometric, hemodynamic, and metabolic variables, as well as alcohol consumption and smoking, individuals with elevated baseline ALT and GGT levels (per 1-SD increment) were 1.16 and 1.20 times, respectively, more likely to develop diabetes (P = 0.05 for ALT and P &amp;lt; 0.01 for GGT); no such associations were noted for prediabetes. Regarding the predictive value of ALT and GGT, the area under the receiver operating curve analysis yielded C values ranging from 0.70 to 0.82, with values significantly higher for diabetes compared with prediabetes. CONCLUSIONS These findings in younger adults suggest potential clinical utility of including ALT and GGT as biomarkers in diabetes risk assessment formulations.
EUROCARE-3: survival of cancer patients diagnosed 1990–94—results and commentary
Authors: M. Sant, T. Aareleid, F. Berrino, M. Bielska Lasota, P.M. Carli, J. Faivre, P. Grosclaude, G. Hédelin, T. Matsuda, H. Møller, T. Möller, A. Verdecchia, R. Capocaccia, G. Gatta, A. Micheli, M. Santaquilani, P. Roazzi, D. Lisi
Journal: Annals of Oncology (2003)
F18-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography Screening in Li-Fraumeni Syndrome
Authors: Serena Masciari
Journal: JAMA (2008)

Context Individuals with Li-Fraumeni syndrome (LFS) have an inherited cancer predisposition to a diverse array of malignancies beginning early in life; survivors of one cancer have a markedly elevated risk of additional primary tumors.The underlying genetic defect in the majority of the families is a germline mutation in the TP53 tumor suppressor gene.The diversity of tumors and rarity of families have contributed to the difficulty in devising effective screening recommendations for members of LFS kindreds.Objective To gather preliminary data with which to evaluate F18-fluorodeoxyglucosepositron emission tomography/computed tomography (FDG-PET/CT) imaging as a potential surveillance modality to detect early malignancies in asymptomatic members of LFS kindreds.Design, Setting, and Participants Members of LFS families with documented germline TP53 mutations or obligate carrier status, no history of cancer within 5 years of enrollment, and no symptoms of cancer or ill-health were offered FDG-PET/CT scanning as a screening test in a comprehensive US cancer center from 2006 to 2007.Scans were initially reviewed clinically, then centrally reviewed by an expert radiologist.Main Outcome Measure The primary outcome was the detection of new primary cancers using FDG-PET/CT scanning. ResultsOf 15 individuals, baseline FDG-PET/CT scan identified asymptomatic cancers in 3 (20%).Two individuals had papillary thyroid cancers (stage II and stage III) and one individual had stage II esophageal adenocarcinoma. ConclusionsThese preliminary data provide the first evidence for a potential cancer surveillance strategy that may be worthy of further investigation for patients with LFS.Concerns about radiation exposure and other challenges inherent in screening highrisk patients will require further consideration.
F-BAR family proteins, emerging regulators for cell membrane dynamic changes—from structure to human diseases
Authors: Suxuan Liu, Xinyu Xiong, Xianxian Zhao, Xiaofeng Yang, Hong Wang
Journal: Journal of Hematology & Oncology (2015)

Eukaryotic cell membrane dynamics change in curvature during physiological and pathological processes. In the past ten years, a novel protein family, Fes/CIP4 homology-Bin/Amphiphysin/Rvs (F-BAR) domain proteins, has been identified to be the most important coordinators in membrane curvature regulation. The F-BAR domain family is a member of the Bin/Amphiphysin/Rvs (BAR) domain superfamily that is associated with dynamic changes in cell membrane. However, the molecular basis in membrane structure regulation and the biological functions of F-BAR protein are unclear. The pathophysiological role of F-BAR protein is unknown. This review summarizes the current understanding of structure and function in the BAR domain superfamily, classifies F-BAR family proteins into nine subfamilies based on domain structure, and characterizes F-BAR protein structure, domain interaction, and functional relevance. In general, F-BAR protein binds to cell membrane via F-BAR domain association with membrane phospholipids and initiates membrane curvature and scission via Src homology-3 (SH3) domain interaction with its partner proteins. This process causes membrane dynamic changes and leads to seven important cellular biological functions, which include endocytosis, phagocytosis, filopodium, lamellipodium, cytokinesis, adhesion, and podosome formation, via distinct signaling pathways determined by specific domain-binding partners. These cellular functions play important roles in many physiological and pathophysiological processes. We further summarize F-BAR protein expression and mutation changes observed in various diseases and developmental disorders. Considering the structure feature and functional implication of F-BAR proteins, we anticipate that F-BAR proteins modulate physiological and pathophysiological processes via transferring extracellular materials, regulating cell trafficking and mobility, presenting antigens, mediating extracellular matrix degradation, and transmitting signaling for cell proliferation.
Heat-shock proteins protect cells from monocyte cytotoxicity: possible mechanism of self-protection.
Authors: M Jäättelä, D Wissing
Journal: The Journal of Experimental Medicine (1993)

We have previously shown that major heat-shock protein (hsp 70) protects WEHI-S tumor cells from cytotoxicity mediated by tumor necrosis factor alpha (TNF-alpha) and TNF-beta. In the present study, the effect of altered expression of hsp70 and low molecular weight heat-shock protein, hsp27, on tumor cell sensitivity to monocytes and lymphokine-activated killer (LAK) cells was studied. Constitutive and stable expression of transfected human hsp70 rendered cells almost completely resistant to monocytes. Conversely, inhibition of endogenous hsp70 by expression of antisense hsp70 RNA enhanced the sensitivity of cells to monocyte-mediated killing. Surprisingly, overexpression of human hsp27, which does not protect WEHI-S cells from TNF killing, conferred partial resistance to monocytes. Only approximately 60% of monocyte-mediated killing of WEHI-S cells could be blocked by neutralizing TNF-alpha antibody or immunoglobulin G-TNF receptor chimeric protein, suggesting the presence of both TNF-dependent and TNF-independent lytic mechanisms. As free radicals have been suggested to be mediators of monocyte cytotoxicity, we tested the sensitivity of transfected cells to oxidative stress. Overexpression of either hsp70 or hsp27 rendered cells partially resistant to hydrogen peroxide. No significant changes in the susceptibility of cell lines overexpressing hsp70 or hsp27 to cytotoxicity mediated by LAK cells were observed. Interestingly, monocytes but not LAK cells contained detectable levels of hsp27 and hsp70 in nonstressed conditions. Taken together, these data indicate that hsp70 protects tumor cells from TNF-mediated monocyte cytotoxicity and that both hsp27 and hsp70 confer resistance to TNF-independent, probably free radical-mediated lysis by monocytes. Moreover, hsp27 and hsp70 may provide monocytes with a protective mechanism against their own toxicity.
A Population-Based Cohort Study of Undervaccination in 8 Managed Care Organizations Across the United States
Authors: Jason M. Glanz, Sophia R. Newcomer, Komal J. Narwaney, Simon J. Hambidge, Matthew F. Daley, Nicole M. Wagner, David L. McClure, Stan Xu, Ali Rowhani-Rahbar, Grace M. Lee, Jennifer C. Nelson, James G. Donahue, Allison L. Naleway, James D. Nordin, Marlene M. Lugg, Eric S. Weintraub
Journal: JAMA Pediatrics (2013)

OBJECTIVES To examine patterns and trends of undervaccination in children aged 2 to 24 months and to compare health care utilization rates between undervaccinated and age-appropriately vaccinated children. DESIGN Retrospective matched cohort study. SETTING Eight managed care organizations of the Vaccine Safety Datalink. PARTICIPANTS Children born between 2004 and 2008. MAIN EXPOSURE Immunization records were used to calculate the average number of days undervaccinated. Two matched cohorts were created: 1 with children who were undervaccinated for any reason and 1 with children who were undervaccinated because of parental choice. For both cohorts, undervaccinated children were matched to age-appropriately vaccinated children by birth date, managed care organization, and sex. MAIN OUTCOME MEASURES Rates of undervaccination, specific patterns of undervaccination, and health care utilization rates. RESULTS Of 323 247 children born between 2004 and 2008, 48.7% were undervaccinated for at least 1 day before age 24 months. The prevalence of undervaccination and specific patterns of undervaccination increased over time (P &lt; .001). In a matched cohort analysis, undervaccinated children had lower outpatient visit rates compared with children who were age-appropriately vaccinated (incidence rate ratio [IRR], 0.89; 95% CI, 0.89- 0.90). In contrast, undervaccinated children had increased inpatient admission rates compared with age-appropriately vaccinated children (IRR, 1.21; 95% CI, 1.18-1.23). In a second matched cohort analysis, children who were undervaccinated because of parental choice had lower rates of outpatient visits (IRR, 0.94; 95% CI, 0.93-0.95) and emergency department encounters (IRR, 0.91; 95% CI, 0.88-0.94) than age-appropriately vaccinated children. CONCLUSIONS Undervaccination appears to be an increasing trend. Undervaccinated children appear to have different health care utilization patterns compared with age-appropriately vaccinated children.
Scotland faces GP crisis
Authors: B. Christie
Journal: BMJ (2001)

Doctors have warned of a crisis in general practice in Scotland after a survey of almost two thirds of the country's GPs found widespread levels of dissatisfaction. Only one in four GPs would recommend a career in general practice to today's young people.

Increasing levels of bureaucracy and a lack of involvement in the changes being made to the health service were identified as two of the major …
Treatment of metastatic renal cell carcinoma with constant-rate floxuridine infusion plus recombinant α2b-interferon
Authors: A. Falcone, C. Cianci, E. Pfanner, S. Ricci, M. Lencioni, I. Brunetti, P.C. Giulianotti, L. Vannucci, F. Mosca, P.F. Conte
Journal: Annals of Oncology (1996)
Targeted Temperature Management for Cardiac Arrest—Reply
Authors: Niklas Nielsen, Matt P. Wise, Tobias Cronberg
Journal: JAMA Neurology (2015)

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