tbuckley/cabot-search huggingface dataset:
Abstract 17328: Novel Oral Anticoagulants in Adult Fontan Patients: A Multi-Site Experience
Authors: Amir Kazerouninia, Payton Kendsersky, Ryan Byrne, Patricia Chu, Yunfei Wang, Justin Georgekutty, Fred H Rodriguez, Benjamin Frischhertz, Dhaval Parekh, Peter Ermis, Wayne J Franklin, Wilson Lam
Journal: Circulation (2018)

Introduction: Adult Fontan patients are typically prescribed antiplatelet or anticoagulant therapy to manage increased risk for thrombotic and embolic complications (TECs). There is a Class III recommendation against the use of novel oral anticoagulants (NOACs) in this population due to a paucity of data. We hypothesized that NOACs are potentially non-inferior to warfarin in adult Fontan patients. Methods: We performed a multi-site retrospective review of adult Fontan patients, evaluated at three major academic medical centers (1995-2018), prescribed NOAC, warfarin, or aspirin therapy. Results: We identified 267 adult Fontan patients: 48 on NOACs, 107 on warfarin, and 180 on aspirin (14.4% to 54.2% cross-over amongst groups). Patients were more likely to have clinically significant bleeds (“bleeds”) if on a NOAC (HR=9.3, CI=3.0-28.4) or warfarin (HR=4.1, CI=1.6-10.5) versus aspirin. Bleed hazard ratio differences between NOAC and warfarin patients were not statistically significant (HR=2.3, CI=0.9-5.9). Patients on NOACs were not more likely to suffer TECs than patients on warfarin (HR=1.7, CI=0.4-6.3) or aspirin (HR=2.8, CI=0.7-10.3). Aspirin patients were younger, healthier, and had more favorable Fontan palliation. The traditional scoring systems to predict bleeds (HAS-BLED) and TECs (CHA 2 DS 2 VASc) were not predictive in this patient population. The only risk factor we identified for bleeds was a history of/predisposition to bleeding (OR=10.2, CI=4.4-23.6). Risk factors we identified for TECs included diabetes mellitus (OR=5.0, CI=2.2-11.4), labile international normalized ratio (OR=3.7, CI=1.1-12.4), and CHF (only in the NOAC/warfarin subgroup, OR=4.4, CI=1.2-16.3). Conclusions: NOACs are a potentially noninferior alternative to warfarin for adult Fontan patients. Our findings have laid the groundwork for a randomized control trial comparing the use of NOACs to warfarin in adult Fontan patients to test noninferiority or equivalence.
NETHERLANDS
Journal: JAMA (1946)

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Allied health education and accreditation
Authors: W. R. Burrows
Journal: JAMA (1988)

<h3>SHARED RESPONSIBILITY AND MUTUAL SUPPORT: THE AMA AND ALLIED HEALTH EDUCATION AND ACCREDITATION</h3> For more than 50 years the American Medical Association (AMA) and its members have recognized the value of actively participating in and promoting quality education for allied health personnel in order to maintain an adequate supply of qualified professionals whose functions include complementing, facilitating, or assisting in the work of physicians and other specialists in the health care system. <h3>Physician Contributions to the Accreditation Review Process</h3> Physician contributions to the accreditation review process, the principal activity through which the AMA promotes quality in education for allied health professionals, have been especially significant in various types of activities now coordinated by the AMA Committee on Allied Health Education and Accreditation (CAHEA). As teachers and medical directors in allied health educational programs, as members of review committees, and as site visitors, physicians make significant contributions to professional standards, to
Therapeutic efficacy of antimalarial drugs targeting DosRS signaling in <i>Mycobacterium abscessus</i>
Authors: Juan Manuel Belardinelli, Deepshikha Verma, Wei Li, Charlotte Avanzi, Crystal J. Wiersma, John T. Williams, Benjamin K. Johnson, Matthew Zimmerman, Nicholas Whittel, Bhanupriya Angala, Han Wang, Victoria Jones, Véronique Dartois, Vinicius C. N. de Moura, Mercedes Gonzalez-Juarrero, Camron Pearce, Alan R. Schenkel, Kenneth C. Malcolm, Jerry A. Nick, Susan A. Charman, Timothy N. C. Wells, Brendan K. Podell, Jonathan L. Vennerstrom, Diane J. Ordway, Robert B. Abramovitch, Mary Jackson
Journal: Science Translational Medicine (2022)

A search for alternative Mycobacterium abscessus treatments led to our interest in the two-component regulator DosRS, which, in Mycobacterium tuberculosis , is required for the bacterium to establish a state of nonreplicating, drug-tolerant persistence in response to a variety of host stresses. We show here that the genetic disruption of dosRS impairs the adaptation of M. abscessus to hypoxia, resulting in decreased bacterial survival after oxygen depletion, reduced tolerance to a number of antibiotics in vitro and in vivo, and the inhibition of biofilm formation. We determined that three antimalarial drugs or drug candidates, artemisinin, OZ277, and OZ439, can target DosS-mediated hypoxic signaling in M. abscessus and recapitulate the phenotypic effects of genetically disrupting dosS . OZ439 displayed bactericidal activity comparable to standard-of-care antibiotics in chronically infected mice, in addition to potentiating the activity of antibiotics used in combination. The identification of antimalarial drugs as potent inhibitors and adjunct inhibitors of M. abscessus in vivo offers repurposing opportunities that could have an immediate impact in the clinic.
Daily symptom monitoring commonly leads to treatment modification in older adults receiving treatment for metastatic prostate cancer (mPC).
Authors: Henriette Breunis, Abirami Sudharshan, Urban Emmenegger, Aaron Richard Hansen, Enrique Soto Perez De Celis, Antonio Finelli, George Tomlinson, Padraig Warde, Monika K. Krzyzanowska, Andrew Matthew, Hance Clarke, Daniel Santa Mina, Martine Puts, Shabbir M.H. Alibhai
Journal: Journal of Clinical Oncology (2022)

82 Background: Treatment options for older adults with mPC expanded significantly in recent years but commonly include chemotherapy with Docetaxel (Chemo), androgen receptor-axis-targeted therapies (ARAT), and Radium-223 (Ra-223). Symptom burden associated with Chemo, ARAT, and Ra-223 is frequently observed and often leads to treatment modification, especially in older men. The objective of this study is to explore how often, and which moderate to severe symptoms during treatment for mPC and triggered follow-up, lead to treatment delay and/or dose reduction. Methods: Men aged 65+ with mPC starting standard dose (n=24) or reduced dose (n=1) Chemo, standard dose (n=41) or reduced dose (n=1) ARATs, or Ra223 (n=12) from two tertiary cancer centres in Toronto, Canada, were enrolled in a prospective cohort study. Participants self-reported symptoms daily using the Edmonton Symptom Assessment Scale (ESAS) for 3-4 weeks either through a web-based interface or phone calls. ESAS scores of &gt;4 were followed by ‘triggered’ detailed questionnaires. The oncology care team was informed of reportable events based on scores of triggered questionnaires and patients were advised to call their care team. Clinical and treatment data were abstracted from electronic patient records and descriptive analysis was used. Results: 52/79 participants (66%) reported 345 moderate to severe symptoms that merited triggered questionnaires (table) with an adherence of 83%. Tiredness (n=74), appetite (n=49), insomnia (n=49), and pain (n=48) were the most frequently reported symptoms. 28 patients reported high scores on triggered questionnaires that led to informing the oncology care team and 79% of these patients were contacted by the care team, or an appointment with the Most Responsible Physician was scheduled. Moderate to severe symptom reporting resulted in treatment modification for 9 patients, Chemo (n=5), ARAT (n=3), and Ra-223 (n=1). Conclusions: Daily monitoring identified clinically relevant symptoms and actionable concerns. Informing care teams of reportable adverse events resulted in contacting patients and ultimately in treatment modification in a considerable number of patients. [Table: see text]
Abstract 275: Arterial Hyperoxia Exposure and Survival Among Resuscitated Patients With Out-of-Hospital Cardiac Arrest. Jaam-ohca Registry in Japan
Authors: Takeyuki Kiguchi, Tetsuhisa Kitamura, Daisuke Kobayashi, Chika Nishiyama, Satoshi Fujimi, Takashi Kawamura, Taku Iwami
Journal: Circulation (2018)

Background: The effect of hyperoxia for outcomes in resuscitated patients with out-of-hospital cardiac arrest (OHCA) is still controversial. Objective: To assess the relationship between the post-ROSC hyperoxia exposure volume (HEV) and survival among resuscitated OHCA patients. Methods: The JAAM-OHCA Registry was a multicenter prospective observation using the OHCA database obtained from 73 critical care medical centers in Japan, and the study period were between June 2014 and December 2015. In this study, patients who sustained a cardiac arrest in a prehospital setting, for whom resuscitation was attempted, and who were then transported to participating institutions were included. Patients receiving extracorporeal cardiopulmonary resuscitation and who was dead in emergency room were excluded. Arterial blood gases were sampled on hospital arrival, ROSC, ICU admission, and at least 24-hours post-ROSC. In addition to the 4 sampling times mentioned above, arterial blood gases were sampled, as and when required. Hyperoxia was defined as a PaO2 value of &gt;=300 mm Hg. Hyperoxia exposure time (HET) was defined as the time of a sustained PaO2 value of &gt;=300 mmHg, and hyperoxia excess level (HEL) was defined as the highest PaO2 level from hospital arrival to 24-hours post-ROSC. HEV was calculated by HET*HEV/2. Primary outcome was one-month survival. Multivariable logistic regression adjusting for age, sex, initial shockable rhythm, bystander witness, bystander CPR, time from call to hospital arrival, tracheal intubation, and targeted temperature management was performed to assess the association between HEV and survival. Results: A total of 1751 patients were included and 414 (23.6%) had hyperoxia. Among the hyperoxia patients, survival gradually decreased from 50.0% to 44.2% as HEV increased. The adjusted odds ratio of minimum HEV groups or maximum HEV groups for one-month survival compared with non-hyperoxia group was 2.50 (95% confidence interval [CI], 1.33-4.70) and 1.16 (95% CI, 0.62-2.18), respectively. Conclusions: Among resuscitated OHCA patients, excessive amounts of HEV was associated with decreased one-month survival.
Inhaled Nitric Oxide Improved Refractory Hypoxemia through Attenuation of Intrapulmonary Shunt
Authors: Yuxian Wang, Ming Zhong
Journal: American Journal of Respiratory and Critical Care Medicine (2022)

"Inhaled Nitric Oxide Improved Refractory Hypoxemia through Attenuation of Intrapulmonary Shunt." American Journal of Respiratory and Critical Care Medicine, 205(9), p. 1114
Long-term cost comparisons of radical cystectomy versus trimodal therapy for muscle-invasive bladder cancer.
Authors: Vishnukamal Golla, Yong Shan, Elias Joseph Farran, Kevin Vu, Courtney A. Stewart, Ali Raza Khaki, Kirk A. Keegan, Ashish M. Kamat, Douglas S. Tyler, Stephen J. Freedland, Stephen B. Williams
Journal: Journal of Clinical Oncology (2022)

455 Background: Earlier studies on the cost of muscle-invasive bladder cancer treatments are limited to short-term periods of cost. Our study objective is to compare the 2- and 5-year costs associated with trimodal therapy (TMT) versus radical cystectomy (RC) benchmarked against costs for patients who received no curative treatment. Methods: This cohort study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Medicare expenditures were summed from inpatient, outpatient, and physician services within 2 and 5 years of diagnosis to determine total costs Total Medicare costs at 2-and 5-years following TMT versus RC were compared using inverse probability of treatment-weighted (IPTW) propensity score models. Results: A total of 2,537 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002 through December 31, 2009. Total median costs for patients that received no definitive/systemic treatments (RC, TMT, radiotherapy alone, or chemotherapy alone) were $73,780 vs. $88,275 at 2-and 5-years respectively. Total median costs were significantly higher for TMT than RC at 2-years ($372,839 vs. $191,363, p&lt;0.001) and 5-years ($424,570 vs. $253,651, p&lt;0.001), respectively. TMT had higher outpatient median costs than RC (2-yr: $318,221 vs. $100,900; 5-yr: $367,092 vs. $146,561) with significantly higher costs largely associated with radiology, medications, pathology/laboratory, and other professional services. Conclusions: TMT vs. RC was associated with higher long-term costs among patients with muscle-invasive bladder cancer largely driven by outpatient expenditures. Reduction in costs associated with radiology, medications, pathology/laboratory, and other professional services may improve the value of TMT.[Table: see text]
TCT-121 First Human Transcatheter Aortic Valve Implantation of the Colibri Heart Valve, A Pre-mounted, Pre-packaged, Low Profile Ready for Use, Dry Valve in a 14 French Delivery System. Six Months Follow up.
Authors: Pedro Urena, Ingrid Valdez, Ramon Almanzar, Erika M. Perez, Gerardo DeLarosa, Yulanka Castro, Eduardo Induni, Lizy M. Paniagua, David E. Paniagua, Richard D. Fish, David Paniagua
Journal: Journal of the American College of Cardiology (2013)
Tuberculosis of the female genital tract.
Authors: Ulf De Faire
Journal: BMJ (1978)

In a recent investigation on 31 male twin pairs cardiovascular reactions during stressful psychiatric interview were studied.5It was found that intrapair variance did not differ between monozygotic and dizygotic pairs at rest either for systolic or for diastolic blood pressure, but during psychological strain the intrapair variances were significantly less within monozygotic than dizygotic pairs for both measures of blood pressure.These data imply that a significant genetic influence on the variability of blood pressure might first be revealed in stressful situations.It was finally stated in your leading article that "clearly the best precaution a newborn baby can take over its arterial blood pressure and therefore its cardiovascular risk in later life is to choose its parents carefully."This hopeful piece of advice could be supplemented with another, more hopeful one: learn to cope with stressful situations.
Dyspareunia.
Authors: M Elstein
Journal: BMJ (1971)

<h3>Abstract</h3> Growth in individual size or biomass is a key demographic component in population models, with wide-ranging applications from quantifying species performance across abiotic or biotic conditions to assessing landscape-level dynamics under global change. In forest ecology, the responses of tree growth to biotic interactions are widely held to be crucial for understanding forest diversity, function, and structure. To date, most studies on plant–plant interactions only examine the additive competitive or facilitative interactions between species pairs; however, there is increasing evidence of non-additive, higher-order interactions (HOIs) impacting species demographic rates. When HOIs are present, the dynamics of a multi-species community cannot be fully understood or accurately predicted solely from pairwise outcomes because of how additional species ‘interfere’ with the direct, pairwise interactions. Such HOIs should be particularly prevalent where species show nonlinear functional responses to resource availability and resource-acquisition traits themselves are density dependent. With this in mind, we used data from a tropical secondary forest—a system that fulfills both of these conditions—to build a ontogenetic diameter-growth model for individuals across ten woody-plant species. We allowed both direct and indirect interactions within communities to influence the species-specific growth parameters in a generalized Lotka–Volterra model. Specifically, indirect interactions entered the model as higher-order quadratic terms, i.e. non-additive effects of conspecific and heterospecific neighbour size on the focal individual’s growth. For the whole community and for four out of ten focal species, the model that included HOIs had more statistical support than the model that included only direct interactions, despite the former containing a far greater number of parameters. HOIs had comparable effect sizes to direct interactions, and tended to further reduce the diameter growth rates of most species beyond what direct interactions had already reduced. In a simulation of successional stand dynamics, the inclusion of HOIs lead to rank swaps in species’ diameter hierarchies, even when community-level size distributions remained qualitatively similar. Our study highlights the implications, and discusses possible mechanisms, of non-additive density dependence in highly diverse and light-competitive tropical forests.
Abstract 17013: Preceding Contraction of Less Distensible Ventricular Compartment Plays a Key Role in the Pathogenesis of Mechanical Dyssynchrony in the Univentricular Heart
Authors: Yohsuke Hayama, Shuji Shimizu, Toru Kawada, Masaru Sugimachi
Journal: Circulation (2018)

Background: Septal flash motion is the key to mechanical dyssynchrony in the left bundle branch block in biventricular physiology. In univentricular Fontan circulations, however, morphological variations of systemic ventricles make it difficult to evaluate the negative impact of asynchronous contraction with widened QRS duration on hemodynamics. Methods: A computational simulation of Fontan circulation using a time-varying elastance chamber model combined with a three-element Windkessel vascular model was performed. Systemic ventricles were divided into two ventricular compartments (Vnt 1 , Vnt 2 ) by large ventricular septal defects (VSD), which had various ratios of end-diastolic volumes (EDV 1 /EDV 2 , α) and contractilities (Emax 1 /Emax 2 , β). We introduced delayed contraction onset of Vnt 2 from Vnt 1 (T dys , ms) and simulated hemodynamic changes. We also studied 44 consecutive postoperative Fontan patients with wide QRS (28 male, 1-37 years; median age 16.2 years) and examined their clinical profiles including the analysis of focal ventricular wall motion with 2D speckle tracking echocardiography, hemodynamic parameters in cardiac catheterization, plasma levels of brain natriuretic peptide (BNP, pg/mL) and exercise capacities (peak VO 2 , mL/kg/min). Results: In silico , compared with the ventricles with α &gt; 1 and β &lt; 1, those with α &lt; 1 and β &gt; 1 exhibited significantly decreased cardiac output as T dys increased, and relatively impaired output reserve when tachycardia developed. These deteriorations were characterized by the increased reverse flow from Vnt 2 to Vnt 1 through VSD during mid-systole. Also in vivo , reverse flow during mid-systole via VSD, flash motion during isovolumic contraction time and lower peak systolic strain of smaller ventricular compartment were associated with higher central venous pressures, elevated BNP levels and decreased peak VO 2 (p &lt; 0.05). Conclusion: Delayed contraction in more distensible ventricular compartment can exacerbate the mechanical dyssynchrony characterized by preceding “flash” contraction and subsequent dyskinetic dilation of less distensible compartment, which contributes to the pathogenesis of heart failure in the univentricular heart.
Correction
Authors: Paul Newacheck, Michelle Pearl, Dana Hughes, Neal Halfon
Journal: JAMA (1999)

clusion based on our quantitative findings as Kaestner misrepresents in his letter.Kaestner states that our multivariate models should have adjusted for additional measures of socioeconomic status.Our models appropriately adjust for differences between the comparison groups in characteristics such as age, family structure, and health status.However, given that our research design incorporates poverty status as an integral component of the comparisons (as discussed above), it would be inappropriate to adjust for additional measures of socioeconomic status, such as education, that are highly correlated with poverty.We addressed limitations of the cross-sectional design under "Methodological Limitations." 1(p1791) In summary, we believe that Kaestner's comments are unfounded.We stand by our analysis and conclusions.
Grading of cervical intraepithelial neoplasia.
Journal: BMJ (1989)

specialised team provides a special seating service for patients referred from a wider area.Our experience has resulted in an acute awareness of many shortfalls of standard issue wheelchairs and, together with the experience of other centres in Scotland, has enabled the Wheelchair Advisory Service, through the auspices of the Central Services Agency who are now responsible for purchasing chairs in Scotland, to address the problems thus identified with a view to improving the overall quality of care.
Sphingosine 1-phosphate modulation and immune cell trafficking in inflammatory bowel disease
Authors: Bram Verstockt, Stefania Vetrano, Azucena Salas, Shadi Nayeri, Marjolijn Duijvestein, Niels Vande Casteele, Silvio Danese, Geert D’Haens, Lars Eckmann, William A. Faubion, Brian G. Feagan, Vipul Jairath, Christopher Ma, Dermot McGovern, Julian Panes, William J. Sandborn, Mark S. Silverberg, Severine Vermeire
Journal: Nature Reviews Gastroenterology & Hepatology (2022)
Hospital management.
Authors: J Wedgwood
Journal: BMJ (1967)

Improving the Psychiatric Services SIR,-Being very interested in and com- mitted to the task of trying to plan and provide suitable hospital services for elderly people, I think that Dr. H. Jacobs's letter (16 December, p. 681) calls for some comment.I refer to the very popular notion of "x weeks in and x weeks out geriatric service."Such service is not necessarily the sort of panacea that many people seek.It is very difficult indeed to keep to any such time- table.One knows that shuttling the elderly from here to there will in itself very often affect them adversely and one had found that at the end of the allocated stay in hospital the patient is much worse than at the time of admission.Although one is keen to help the relatives and benefactors of frail elderly people by giving them respite, and is able to do this in selected cases, I have come after many years to believe that the primary task of the geriatrician is to treat vigorously whichever patients have tractable diseases, tempering such treatment with, one hopes, humanity and common sense.As for day hospitals, I am completely sold on their virtues and efficacy.I am beginning to think that these, paralleled by local authority day centres, might very well reduce dramatically the expense of providing in future for the needs of the elderly.-Iam, etc.,