296 research outputs found
The Implications of Insurance Status on Presentation, Surgical Management and Mortality among Non-Metastatic Breast Cancer Patients in Indiana
Background
The National Breast and Cervical Cancer Early Detection Program seeks to reduce health care disparities by providing uninsured and underinsured women access to screening mammograms. The objective of this study is to identify the differences in presentation, surgical management, and mortality among nonmetastatic uninsured patients diagnosed through Indiana's Breast and Cervical Cancer Program compared with patients with private and government (Medicare or Medicaid) insurance.
Methods
Study data were obtained using the Indiana state cancer registry and Indiana's Breast and Cervical Cancer Program. Women aged 50 to 64 with an index diagnosis of stage 0 to III breast cancer from January 1, 2006 to December 31, 2013, were included in the study. Bivariate intergroup analysis was conducted. Kaplan-Meier estimates between insurance types were compared using the log rank test. All-cause mortality was evaluated using a mixed effects model.
Results
The groups differed significantly for sociodemographic and clinical variables. Uninsured Indiana Breast and Cervical Cancer Program patients presented with later disease stage (P < .001) and had the highest overall mortality (hazard ratio 2.2, PâŻ=âŻ.003). Surgical management only differed among stage III patients (PâŻ=âŻ.012).
Conclusion
To improve insurance-based disparities in Indiana, implementation of the Breast and Cervical Cancer Program in conjunction with expansion of insurance coverage to vulnerable low-income populations need to be optimized
Neonatal lupus with left bundle branch block and cardiomyopathy: a case report
Background
Cardiac manifestations of neonatal lupus include an array of structural and conduction abnormalities due to placental transference of maternal anti-SSA/Ro and anti-SSB/La autoantibodies. Late-onset neonatal lupus cardiomyopathies, occurring outside the neonatal period, is an infrequently reported manifestation with unknown pathophysiology and poorly defined treatment regimens. Due to the rarity of this condition, additional studies and case reports are required to better understand and manage late-onset neonatal lupus cardiomyopathies.
Case presentation
A 4-week-old female, born to a mother with known anti-SSA/Ro and anti-SSB/La autoantibodies, presents with classic cutaneous manifestations for neonatal lupus and is found to have left bundle branch block, severely dilated cardiomyopathy with an ejection fraction of 25%, and a thin echogenic dyskinetic ventricular septum. Weekly second trimester and 30-week fetal echocardiograms showed no signs of structural or conduction abnormalities. There were no histologic signs of inflammation on cardiac tissue biopsy. After a complicated hospital course, she was successfully treated with biventricular pacemaker, intravenous immunoglobulin, and plasmapheresis.
Conclusions
We present a case of late-onset neonatal lupus with severe dilated cardiomyopathy, a dyskinetic ventricular septum, and left bundle branch block. To our knowledge, the dyskinetic ventricular septum has never been reported and left bundle branch block is rarely reported in NL. This case further validates the need for long term cardiac follow up for patients born with NL, even if lacking cardiac manifestations in the peripartum period. We characterize a unique presentation of a rare clinical entity, highlighting the diagnostic challenges, and describe a successful treatment course
Dynamical frustration in ANNNI model and annealing
Zero temperature quench in the Axial Next Nearest Neighbour Ising (ANNNI)
model fails to bring it to its ground state for a certain range of values of
the frustration parameter , the ratio of the next nearest neighbour
antiferromagnetic interaction strength to the nearest neighbour one. We apply
several annealing methods, both classical and quantum, and observe that the
behaviour of the residual energy and the order parameter depends on the value
of strongly. Classical or thermal annealing is found to be adequate
for small values of .
However, neither classical nor quantum annealing is effective at values of
close to the fully frustrated point , where the residual
energy shows a very slow algebraic decay with the number of MCS.Comment: 6 pages,10 figures, to be published in Proceedings of " The
International Workshop on Quantum annealing and other Optimization Methods
Mitral Regurgitation Severity and Left Ventricular Systolic Dimension Predict Survival in Young Cavalier King Charles Spaniels
European Society of Veterinary Cardiology screening guidelines for dilated cardiomyopathy in Doberman Pinschers
Nature vs. Nurture: Dynamical Evolution in Disordered Ising Ferromagnets
We study the predictability of zero-temperature Glauber dynamics in various
models of disordered ferromagnets. This is analyzed using two independent
dynamical realizations with the same random initialization (called twins). We
derive, theoretically and numerically, trajectories for the evolution of the
normalized magnetization and twin overlap as the system size tends to infinity.
The systems we treat include mean-field ferromagnets with light-tailed and
heavy-tailed coupling distributions, as well as highly-disordered models with a
variety of other geometries. In the mean-field setting with light-tailed
couplings, the disorder averages out and the limiting trajectories of the
magnetization and twin overlap match those of the homogenous Curie--Weiss
model. On the other hand, when the coupling distribution has heavy tails, or
the geometry changes, the effect of the disorder persists in the thermodynamic
limit. Nonetheless, qualitatively all such random ferromagnets share a similar
time evolution for their twin overlap, wherein the two twins initially
decorrelate, before either partially or fully converging back together due to
the ferromagnetic drift.Comment: 16 pages, 7 figure
Cluster Monte Carlo study of multi-component fluids of the Stillinger-Helfand and Widom-Rowlinson type
Phase transitions of fluid mixtures of the type introduced by Stillinger and
Helfand are studied using a continuum version of the invaded cluster algorithm.
Particles of the same species do not interact, but particles of different types
interact with each other via a repulsive potential. Examples of interactions
include the Gaussian molecule potential and a repulsive step potential.
Accurate values of the critical density, fugacity and magnetic exponent are
found in two and three dimensions for the two-species model. The effect of
varying the number of species and of introducing quenched impurities is also
investigated. In all the cases studied, mixtures of -species are found to
have properties similar to -state Potts models.Comment: 25 pages, 5 figure
Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort
(C) The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved.Financial disclosure: This project was supported by the
National Institute on Aging (R01 AG030611), the National
Center for Research Resources (5UL1RR025741), and the
National Center for Advancing Translational Sciences (Grant
8UL1TR000150). The content is solely the responsibility of the
authors and does not necessarily represent the official views of
the National Institutes of Health. Smith is currently supported
by a Cancer Research UK Fellowship
Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study - A Randomized Clinical Trial
Background: Pimobendan is effective in treatment of dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD). Its effect on dogs before the onset of CHF is unknown. Hypothesis/Objectives: Administration of pimobendan (0.4-0.6 mg/kg/d in divided doses) to dogs with increased heart size secondary to preclinical MMVD, not receiving other cardiovascular medications, will delay the onset of signs of CHF, cardiac-related death, or euthanasia. Animals: 360 client-owned dogs with MMVD with left atrial-to-aortic ratio >= 1.6, normalized left ventricular internal diameter in diastole >= 1.7, and vertebral heart sum >10.5. Methods: Prospective, randomized, placebo-controlled, blinded, multicenter clinical trial. Primary outcome variable was time to a composite of the onset of CHF, cardiac-related death, or euthanasia. Results: Median time to primary endpoint was 1228 days (95% CI: 856-NA) in the pimobendan group and 766 days (95% CI: 667-875) in the placebo group (P = .0038). Hazard ratio for the pimobendan group was 0.64 (95% CI: 0.47-0.87) compared with the placebo group. The benefit persisted after adjustment for other variables. Adverse events were not different between treatment groups. Dogs in the pimobendan group lived longer (median survival time was 1059 days (95% CI: 952-NA) in the pimobendan group and 902 days (95% CI: 747-1061) in the placebo group) (P = .012). Conclusions and Clinical Importance: Administration of pimobendan to dogs with MMVD and echocardiographic and radiographic evidence of cardiomegaly results in prolongation of preclinical period and is safe and well tolerated. Prolongation of preclinical period by approximately 15 months represents substantial clinical benefit
- âŠ