tbuckley/cabot-search huggingface dataset:
Correcting Mortality for Loss to Follow-Up: A Nomogram Applied to Antiretroviral Treatment Programmes in Sub-Saharan Africa
Authors: Matthias Egger, Ben D. Spycher, John Sidle, Ralf Weigel, Elvin H. Geng, Matthew P. Fox, Patrick MacPhail, Gilles van Cutsem, Eugène Messou, Robin Wood, Denis Nash, Margaret Pascoe, Diana Dickinson, Jean-François Etard, James A. McIntyre, Martin W. G. Brinkhof
Journal: PLoS Medicine (2011)

Background The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. Methods and Findings We developed a nomogram to correct mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting ART in a treatment programme is a weighted average of mortality among patients lost to follow-up and patients remaining in care. The nomogram gives a correction factor based on the percentage of patients lost to follow-up at a given point in time, and the estimated ratio of mortality between patients lost and not lost to follow-up. The mortality observed among patients retained in care is then multiplied by the correction factor to obtain an estimate of programme-level mortality that takes all deaths into account. A web calculator directly calculates the corrected, programme-level mortality with 95% confidence intervals (CIs). We applied the method to 11 ART programmes in sub-Saharan Africa. Patients retained in care had a mortality at 1 year of 1.4% to 12.0%; loss to follow-up ranged from 2.8% to 28.7%; and the correction factor from 1.2 to 8.0. The absolute difference between uncorrected and corrected mortality at 1 year ranged from 1.6% to 9.8%, and was above 5% in four programmes. The largest difference in mortality was in a programme with 28.7% of patients lost to follow-up at 1 year. Conclusions The amount of bias in mortality estimates can be large in ART programmes with substantial loss to follow-up. Programmes should routinely report mortality among patients retained in care and the proportion of patients lost. A simple nomogram can then be used to estimate mortality among all patients who started ART, for a range of plausible mortality rates among patients lost to follow-up. Please see later in the article for the Editors' Summary
Patch testing for Compositae allergy
Authors: None Goulden, None Wilkinson
Journal: British Journal of Dermatology (1998)

Journal Article Patch testing for Compositae allergy Get access V. Goulden, V. Goulden Department of Dermatology, Leeds General Infirmary, Leeds LS1 3EX, U.K. Search for other works by this author on: Oxford Academic Google Scholar S.M. Wilkinson S.M. Wilkinson Department of Dermatology, Leeds General Infirmary, Leeds LS1 3EX, U.K. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 138, Issue 6, 1 June 1998, Pages 1018–1021, https://doi.org/10.1046/j.1365-2133.1998.02270.x Published: 01 June 1998
Antiretroviral Drug Resistance Testing in Adults With HIV Infection
Authors: Martin S. Hirsch, Brian Conway, Richard T. D'Aquila, Victoria A. Johnson, Françoise Brun-Vézinet, Bonaventura Clotet, Lisa M. Demeter, Scott M. Hammer, Donna M. Jacobsen, Daniel R. Kuritzkes, Clive Loveday, John W. Mellors, Stefano Vella, Douglas D. Richman, None for the International AIDS Society–USA Panel
Journal: JAMA (1998)

To review current knowledge of the biology and clinical implications of human immunodeficiency virus (HIV) resistance to antiretroviral drugs, describe assays for measuring resistance, and assess their use in clinical practice.The International AIDS Society-USA assembled a panel of 13 physicians with expertise in basic science, clinical research, and patient care relevant to HIV resistance to antiretroviral drugs.We reviewed available data from published reports and presented at national and international research conferences. Basic science research, clinical trial results, and expert opinions were used to form the basis of this report. Data on methods for and characteristics of specific genotypic and phenotypic assays were obtained from manufacturers and service providers.The panel met regularly between October 1997 and April 1998. Panel subgroups developed and discussed different sections of the report before discussing them with the entire panel. Conclusions and suggested approaches to the use of resistance testing were determined by group consensus.Plasma HIV RNA level and CD4+ cell count are the primary values that should be used to guide the initiation of antiretroviral therapy and subsequent changes in therapy. Possible causes of treatment failure other than development of drug resistance that should be considered are adherence, drug potency, and pharmacokinetic issues. Genotypic and phenotypic testing for HIV resistance to antiretroviral drugs may prove useful for individual patient management. Assays under development need validation, standardization, and a clearer definition of their clinical roles. Possible current roles of resistance testing for choosing an initial regimen or changing antiretroviral therapy, as well as possible implications of the presence or absence of phenotypic resistance and genotypic changes, are discussed.
Reduction in Diabetes-Related Lower-Extremity Amputations in the Netherlands: 1991–2000
Authors: William H. van Houtum, Jan A. Rauwerda, Dirk Ruwaard, Nicolaas C. Schaper, Karel Bakker
Journal: Diabetes Care (2004)

Lower-extremity amputation is a common complication among patients with diabetes throughout the world. However, few data exist on the actual impact of the recent moves to improve the management of diabetic foot ulcers to reduce the incidence of lower-extremity amputations. The aim was to determine the incidence of lower-extremity amputations among diabetic patients from 1991 to 2000 in The Netherlands.A secondary database containing information regarding all hospital admissions in which a lower-extremity amputation occurred for the years 1991-2000 was obtained from the Dutch National Medical Register. Because a patient-unique identifier was included, multiple amputations and hospitalizations for a single individual could be identified. Furthermore, age- and sex-specific diabetes prevalence rates were calculated using a 3-year average for every year, calculating the total diabetic population in the Netherlands at risk for every year.In 1991, a total of 1,687 patients with diabetes had been admitted 1,865 times for 2,409 amputations. In 2000, a total of 1,673 patients with diabetes were admitted 1,932 times for 2,448 amputations. The overall incidence rates of the number of patients who underwent lower-extremity amputation decreased over the years from 55.0 to 36.3 per 10,000 patients with diabetes (P < 0.05). Both in men (71.8 vs. 46.1, P < 0.05) and women (45.0 vs. 28.0, P < 0.05) with diabetes, a significant decrease could be observed. Mean duration of hospitalization decreased from 45.0 days (SD 44.4) in 1991 to 36.2 days (SD 38.4) in 2000; decreases were observed for both men and women.Over the years observed in this study, the incidence rates of diabetes-related lower-extremity amputation in The Netherlands was found to decrease in both men (36%) and women (38%) with diabetes. Furthermore, the duration of hospitalization decreased over time.
Prevalence and Predictors of <i>BRCA1</i> and <i>BRCA2</i> Mutations in a Population-Based Study of Breast Cancer in White and Black American Women Ages 35 to 64 Years
Authors: Kathleen E. Malone, Janet R. Daling, David R. Doody, Li Hsu, Leslie Bernstein, Ralph J. Coates, Polly A. Marchbanks, Michael S. Simon, Jill A. McDonald, Sandra A. Norman, Brian L. Strom, Ronald T. Burkman, Giske Ursin, Dennis Deapen, Linda K. Weiss, Suzanne Folger, Jennifer J. Madeoy, Danielle M. Friedrichsen, Nicola M. Suter, Mariela C. Humphrey, Robert Spirtas, Elaine A. Ostrander
Journal: Cancer Research (2006)

Abstract Although well studied in families at high-risk, the roles of mutations in the BRCA1 and BRCA2 genes are poorly understood in breast cancers in the general population, particularly in Black women and in age groups outside of the very young. We examined the prevalence and predictors of BRCA1 and BRCA2 mutations in 1,628 women with breast cancer and 674 women without breast cancer who participated in a multicenter population-based case-control study of Black and White women, 35 to 64 years of age. Among cases, 2.4% and 2.3% carried deleterious mutations in BRCA1 and BRCA2, respectively. BRCA1 mutations were significantly more common in White (2.9%) versus Black (1.4%) cases and in Jewish (10.2%) versus non-Jewish (2.0%) cases; BRCA2 mutations were slightly more frequent in Black (2.6%) versus White (2.1%) cases. Numerous familial and demographic factors were significantly associated with BRCA1 and, to a lesser extent, BRCA2 carrier status, when examined individually. In models considering all predictors together, early onset ages in cases and in relatives, family history of ovarian cancer, and Jewish ancestry remained strongly and significantly predictive of BRCA1 carrier status, whereas BRCA2 predictors were fewer and more modest in magnitude. Both the combinations of predictors and effect sizes varied across racial/ethnic and age groups. These results provide first-time prevalence estimates for BRCA1/BRCA2 in breast cancer cases among understudied racial and age groups and show key predictors of mutation carrier status for both White and Black women and women of a wide age spectrum with breast cancer in the general population. (Cancer Res 2006; 66(16): 8297-308)
Factors Associated With Closures of Emergency Departments in the United States
Authors: Renee Y. Hsia, Arthur L. Kellermann, Yu-Chu Shen
Journal: JAMA (2011)

<h3>Context</h3>Between 1998 and 2008, the number of hospital-based emergency departments (EDs) in the United States declined, while the number of ED visits increased, particularly visits by patients who were publicly insured and uninsured. Little is known about the hospital, community, and market factors associated with ED closures. Federal law requiring EDs to treat all in need regardless of a patient's ability to pay may make EDs more vulnerable to the market forces that govern US health care.<h3>Objective</h3>To determine hospital, community, and market factors associated with ED closures.<h3>Design</h3>Emergency department and hospital organizational information from 1990 through 2009 was acquired from the American Hospital Association (AHA) Annual Surveys (annual response rates ranging from 84%-92%) and merged with hospital financial and payer mix information available through 2007 from Medicare hospital cost reports. We evaluated 3 sets of risk factors: hospital characteristics (safety net [as defined by hospitals caring for more than double their Medicaid share of discharges compared with other hospitals within a 15-mile radius], ownership, teaching status, system membership, ED size, case mix), county population demographics (race, poverty, uninsurance, elderly), and market factors (ownership mix, profit margin, location in a competitive market, presence of other EDs).<h3>Setting</h3>All general, acute, nonrural, short-stay hospitals in the United States with an operating ED anytime from 1990-2009.<h3>Main Outcome Measure</h3>Closure of an ED during the study period.<h3>Results</h3>From 1990 to 2009, the number of hospitals with EDs in nonrural areas declined from 2446 to 1779, with 1041 EDs closing and 374 hospitals opening EDs. Based on analysis of 2814 urban acute-care hospitals, constituting 36 335 hospital-year observations over an 18-year study interval (1990-2007), for-profit hospitals and those with low profit margins were more likely to close than their counterparts (cumulative hazard rate based on bivariate model, 26% vs 16%; hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.5-2.1, and 36% vs 18%; HR, 1.9; 95% CI, 1.6-2.3, respectively). Hospitals in more competitive markets had a significantly higher risk of closing their EDs (34% vs 17%; HR, 1.3; 95% CI, 1.1-1.6), as did safety-net hospitals (10% vs 6%; HR, 1.4; 95% CI, 1.1-1.7) and those serving a higher share of populations in poverty (37% vs 31%; HR, 1.4; 95% CI, 1.1-1.7).<h3>Conclusion</h3>From 1990 to 2009, the number of hospital EDs in nonrural areas declined by 27%, with for-profit ownership, location in a competitive market, safety-net status, and low profit margin associated with increased risk of ED closure.
Economic contraction and birth outcomes: an integrative review
Authors: C. E. Margerison Zilko
Journal: Human Reproduction Update (2010)

Previous research has demonstrated an association between economic contraction at both the individual and aggregate level, and adverse health outcomes. Proposed mechanisms include increased psychosocial stress and loss of resources. The aim of this review is to assess the quantity, validity and consistency of empirical evidence examining economic contraction and birth outcomes. Empirical, English-language articles examining the effects of economic change at either the aggregate or individual level on birthweight, length of gestation, neonatal mortality and the secondary sex ratio were identified using PubMed and ISI Web of Knowledge. Studies were organized by level of analysis and birth outcome and evaluated for internal and external validity. One individual-level study reported a strong association between individual shift to inadequate employment and decreased birthweight. Of seven aggregate-level studies on birthweight, five exhibited moderate to strong validity but reported inconsistent findings. Similarly, findings from five studies (four with moderate to strong validity) examining rates of neonatal mortality reported inconsistent findings. Three of four moderate to strong studies reported a reduced secondary sex ratio following economic contraction. Associations between economic contraction and birthweight, neonatal mortality and the secondary sex ratio remain speculative. Consensus on methodology is needed to compare findings across studies. Further research on economic contraction and the secondary sex ratio, as well as individual-level birthweight and length of gestation, is warranted.
Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials
Authors: K. K. Varadhan, K. R. Neal, D. N. Lobo
Journal: BMJ (2012)

<b>Objective</b> To compare the safety and efficacy of antibiotic treatment versus appendicectomy for the primary treatment of uncomplicated acute appendicitis. <b>Design</b> Meta-analysis of randomised controlled trials. <b>Population</b> Randomised controlled trials of adult patients presenting with uncomplicated acute appendicitis, diagnosed by haematological and radiological investigations. <b>Interventions</b> Antibiotic treatment versus appendicectomy. <b>Outcome measures</b> The primary outcome measure was complications. The secondary outcome measures were efficacy of treatment, length of stay, and incidence of complicated appendicitis and readmissions. <b>Results</b> Four randomised controlled trials with a total of 900 patients (470 antibiotic treatment, 430 appendicectomy) met the inclusion criteria. Antibiotic treatment was associated with a 63% (277/438) success rate at one year. Meta-analysis of complications showed a relative risk reduction of 31% for antibiotic treatment compared with appendicectomy (risk ratio (Mantel-Haenszel, fixed) 0.69 (95% confidence interval 0.54 to 0.89); I<sup>2</sup>=0%; P=0.004). A secondary analysis, excluding the study with crossover of patients between the two interventions after randomisation, showed a significant relative risk reduction of 39% for antibiotic therapy (risk ratio 0.61 (0.40 to 0.92); I<sup>2</sup>=0%; P=0.02). Of the 65 (20%) patients who had appendicectomy after readmission, nine had perforated appendicitis and four had gangrenous appendicitis. No significant differences were seen for treatment efficacy, length of stay, or risk of developing complicated appendicitis. <b>Conclusion</b> Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis.
Reduced expression of the murine p85α subunit of phosphoinositide 3-kinase improves insulin signaling and ameliorates diabetes
Authors: Franck Mauvais-Jarvis, Kohjiro Ueki, David A. Fruman, Michael F. Hirshman, Kei Sakamoto, Laurie J. Goodyear, Matteo Iannacone, Domenico Accili, Lewis C. Cantley, C. Ronald Kahn
Journal: Journal of Clinical Investigation (2002)

A critical component of insulin action is the enzyme phosphoinositide (PI) 3-kinase. The major regulatory subunits of PI 3-kinase, p85α and its splice variants, are encoded by the Pik3r1 gene. Heterozygous disruption of Pik3r1 improves insulin signaling and glucose homeostasis in normal mice and mice made insulin-resistant by heterozygous deletion of the Insulin receptor and/or insulin receptor substrate-1 (IRS1) genes. Reduced expression of p85 modulates the molecular balance between this protein, the p110 catalytic subunit of PI 3-kinase, and the IRS proteins. Thus, despite the decrease in p85α, PI 3-kinase activation is normal, insulin-stimulated Akt activity is increased, and glucose tolerance and insulin sensitivity are improved. Furthermore, Pik3r1 heterozygosity protects mice with genetic insulin resistance from developing diabetes. These data suggest that regulation of p85α levels may provide a novel therapeutic target for the treatment of type 2 diabetes.
Loss of Bim Allows Precursor B Cell Survival But Not Precursor B Cell Differentiation in the Absence of Interleukin 7
Authors: Paula M. Oliver, Michael Wang, Yanan Zhu, Janice White, John Kappler, Philippa Marrack
Journal: The Journal of Experimental Medicine (2004)

Interleukin (IL)-7 is a stromal cell–derived cytokine required for the survival, proliferation, and differentiation of B cell precursors. Members of the Bcl-2 family of proteins are known to have profound effects on lymphocyte survival, but not lymphocyte differentiation. To distinguish the relative dependence on IL-7 of B cell precursor survival versus B cell differentiation, the combined effects of lack of IL-7 and lack of the proapoptotic Bcl-2 relative, Bim, were studied. Bim is expressed to varying degrees in all B cell precursors and B cells. Lack of Bim compensated for lack of IL-7 in the survival of pro–, pre–, and immature B cells; however, lack of Bim did not substitute for the requirement for IL-7 in B cell precursor differentiation or B cell precursor proliferation. Precursor B cell survival is more dependent on sufficient levels of IL-7 than precursor B cell differentiation because the number of B cells and their precursors were reduced by half in mice heterozygous for IL-7 expression, but were restored to normal numbers in mice also lacking Bim. Hence, Bim and IL-7 work together to control the survival of B cell precursors and the number of B cells that exist in animals.
A SECOND CASE OF GONORRHŒAL SEPTICÆMIA AND ULCERATIVE ENDOCARDITIS WITH OBSERVATIONS UPON THE CARDIAC COMPLICATIONS OF GONORRHŒA
Authors: William Sydney Thayer, Jesse William Lazear
Journal: The Journal of Experimental Medicine (1899)

(1) An acute gonorrhoeal urethritis may be the starting point for a grave general septicaemia with all its possible complications. (2) These infections may be mixed or secondary, due to the entrance into the circulation of organisms other than the gonococcus, or they may be purely gonococcal in nature. (3) Endocarditis is an occasional complication of gonorrhoea. (4) This endocarditis may be transient, disappearing with but few apparent results, or it may leave the patient with a chronic valvular lesion, or it may pursue a rapidly fatal course with the symptoms of acute ulcerative endocarditis. (5) The endocarditis associated with gonorrhoea is commonly due to the direct action of the gonococcus, hut may be the result of a secondary or mixed infection. (6) Pericarditis may also occur as a complication of gonorrhoea, but it is less frequent than endocarditis. It may, as in the case of the latter, be the result either of a pure gonococcal or of a mixed infection. (7) Grave myocardial changes, necroses, purulent infiltration, embolic abscesses are common in the severe gonococcal septicaemias. (8) In instances of gonococcal septicaemia the diagnosis may, in some cases, be made during life by cultures taken from the circulating blood according to proper methods.
Screening for Distress in Lung and Breast Cancer Outpatients: A Randomized Controlled Trial
Authors: Linda E. Carlson, Shannon L. Groff, Olga Maciejewski, Barry D. Bultz
Journal: Journal of Clinical Oncology (2010)

Distress has been recognized as the sixth vital sign in cancer care and several guidelines recommend routine screening. Despite this, screening for distress is rarely conducted and infrequently evaluated.A program of routine online screening for distress was implemented for new patients with breast and lung cancer. Patients were randomly assigned to one of three conditions: (1) minimal screening: the distress thermometer (DT) only plus usual care; (2) full screening: DT, problem checklist, Psychological Screen for Cancer part C measuring anxiety and depression, a personalized report summarizing concerns and the report on the medical file; or (3) triage: full screening plus optional personalized phone triage with referral to resources. Patients in all conditions received an information packet and were reassessed 3 months later with the full screening battery.Five hundred eighty-five patients with breast cancer and 549 patients with lung cancer were assessed at baseline (89% of all patients), and 75.5% retained for follow-up. High prevalence of baseline distress was found across patients. Twenty percent fewer patients with lung cancer in triage continued to have high distress at follow-up compared to those in the other two groups, and patients with breast cancer in the full screening and triage conditions showed lower distress at follow-up than those in minimal screening. The best predictor of decreased anxiety and depression in full screening and triage conditions was receiving a referral to psychosocial services.Routine online screening is feasible in a large cancer center and may help to reduce future distress levels, particularly when coupled with uptake of appropriate resources.
Reassessing the Current TNM Lymph Node Staging for Renal Cell Carcinoma
Authors: Carlo Terrone, C. Cracco, F. Porpiglia, E. Bollito, C. Scoffone, M. Poggio, A. Berruti, F. Ragni, M. Cossu, R.M. Scarpa, S. Rocca Rossetti
Journal: European Urology (2005)