Direct costs and survival of medicare beneficiaries with early and advanced Parkinson's disease.

BACKGROUND: No recent analysis details Parkinson's Disease (PD) costs or survival for Medicare beneficiaries. This study assesses excess direct costs and survival in Medicare beneficiaries with early and advanced PD. METHODS: Patients with ≥ 2 PD diagnoses (ICD-9-CM: 332.0), ≥ age 65, continuously enrolled in Parts A&B during one-year baseline and study periods were selected from the Medicare 5% sample (N = 3.2 million, 1999-2008). Newly diagnosed patients were defined as having no baseline claims for movement disorder, dementia, Alzheimer's, bipolar disorder, psychosis, falls or related injuries, ambulatory assistance device (walker or wheelchair), or skilled nursing facility. Controls without PD were demographically matched 1:1. Costs to Medicare were compared via Wilcoxon rank-sum tests and inverse probability weighted multivariate regression. Survival was assessed via Cox proportional hazards analysis. RESULTS: Costs in the year post-diagnosis were higher for newly diagnosed patients (N = 9,201, $7423) than controls ($5024), resulting in excess PD-associated costs of $2399 (p < 0.001). Cumulative excess costs were $28,422 from the year prior to index quarter to five years following (p < 0.01). PD patients receiving their first claim for an ambulatory assistance device (N = 11,294) had excess cumulative costs of $50,923 (p < 0.001) over the same period; those receiving their first claim for a skilled nursing facility (N = 10,152) had excess costs of $102,750 (p < 0.001). Hazard rates of mortality were higher among newly diagnosed PD (1.43, p < 0.001), ambulatory assistance device (2.37, p < 0.001) and skilled nursing facility (3.34, p < 0.001) cohorts than in corresponding non-PD groups. CONCLUSIONS: Medicare beneficiaries with PD have substantially and progressively higher costs and mortality compared with controls.

Eyeblink conditioning deficits indicate timing and cerebellar abnormalities in schizophrenia.

Accumulating evidence indicates that individuals with schizophrenia manifest abnormalities in structures (cerebellum and basal ganglia) and neurotransmitter systems (dopamine) linked to internal-timing processes. A single-cue tone delay eyeblink conditioning paradigm comprised of 100 learning and 50 extinction trials was used to examine cerebellar timing circuits in 13 medicated patients with schizophrenia and 13 age- and sex-matched controls. Patients with schizophrenia showed impaired learning of the conditioned response compared to controls and also greater within-subject variability in the timing of their responses. These findings are consistent with models of schizophrenia in which timing deficits underlie information-processing abnormalities and clinical features of the disorder.

Auditory event-related potential abnormalities in bipolar disorder and schizophrenia.

Auditory P300 latency prolongation or amplitude reduction has been reported in patients affected by bipolar disorder and in schizophrenia. The purpose of this study was to test whether the auditory P300 and earlier event-related potential (ERP) components elicited during an auditory discrimination task could differentiate between these two disorders. Thirteen patients with manic or mixed bipolar disorder, 12 patients with schizophrenia, and 24 control subjects were evaluated. None of the subjects had a history of alcohol or substance abuse or dependence. ERPs were elicited during an auditory discrimination task in which a subject pressed a key to infrequent 1500 Hz tones interspersed amid a series of 1000 Hz tones. The amplitude and latency of N100 and P200 were measured from ERPs to non-target tones, and N200 and P300 were measured from ERPs to target tones. N100, P200 and N200 amplitudes were reduced in schizophrenia patients, but not in bipolar patients. Both bipolar disorder and schizophrenia patients showed reduced P300 amplitude and prolonged P300 latency. Amplitude reduction in the early ERP components implicates auditory processing deficits in schizophrenia. Both groups showed reductions in P300 amplitude, suggesting a disturbance of the temporal-parietal generators of this component. Prolonged P300 latency is consistent with impaired attentional processing in schizophrenia and symptomatic bipolar disorder patients.

Enhanced intake of ethanol in preweanling rats following interactions with intoxicated siblings.

Recently Hunt, Holloway, & Scordalakes (1999) described a novel procedure for examining how social interactions with an intoxicated sibling can enhance periadolescent rats' voluntary intake of ethanol. In the present series of experiments we extend these findings to preweanlings. In Experiment 1, same-sex sibling 16-day-olds were assigned to be either (a) a demonstrator that was administered 1.5 g/kg ethanol or water control or (b) an observer that was tested for ethanol intake following a brief interaction with the demonstrator. Observers interacting with EtOH demonstrators exhibited increased intake of ethanol relative to observers interacting with water demonstrators. In Experiment 2, subjects were 8, 12, or 16 days of age and at all ages, ethanol intakes increased following exposure to an intoxicated sibling. In Experiment 3, repeated exposures to ethanol demonstrators on days 12, 14, and 16 was found to promote ethanol intake after weaning (on postnatal day 22). Collectively these data indicate that exposure to ethanol cues in the context of home/social cues can lead to modifications in ethanol acceptance, and that repeated exposures to such cues during infancy can impact ethanol ingestion after weaning.

Synthesis of the C1-C13 fragment of leucascandrolide A.

[reaction: see text] The synthesis of the C1-C13 fragment 3 of leucascandrolide A has been completed utilizing a stereoselective and regioselective reductive cleavage of a highly functionalized spiroketal to incorporate the cis-2,6-disubstituted tetrahydropyan. The spiroketal was constructed by addition of a lithiated pyrone 5 to aldehyde 6.

Comparison of the effects of human recombinant insulin-like growth factor I and insulin on plasma amino acid concentrations and leucine kinetics in humans.

We examined the effects of recombinant human insulin-like growth factor I (IGF-I) and insulin on the plasma amino acid (AA) profile and leucine kinetics in eight normal subjects. IGF-I was infused at 52 pmol.kg-1.min-1, in combination with prime-continuous [1-14C] leucine infusion, to obtain steady-state plasma concentrations of total (54 +/- 3 nmol/l) and free (7.3 +/- 1 nmol/l) IGF-I (study 1). In response to IGF-I, plasma AA levels declined by 37 +/- 3% (1975 +/- 198 to 1368 +/- 120 mumol/l) and total branched chain amino acids (BCAA) declined by 34 +/- 3% (390 +/- 21 to 256 +/- 13 mumol/l). This hypoaminoacidaemic effect was associated with a decline in endogenous leucine flux of 17 +/- 2% (1.88 +/- 0.05 to 1.57 +/- 0.04 mumol.kg-1.min-1) and leucine oxidation of 17 +/- 1% (0.31 +/- 0.02 vs 0.26 +/- 0.02 mumol.kg-1.min-1) (both p < 0.01 vs basal). The same subjects underwent a second study (study 2) in which insulin was infused at 6.22 pmol.kg-1.min-1 to obtain a steady-state plasma insulin concentration of 530 +/- 25 pmol/l while maintaining euglycaemia. The infusion rate was designed to match the declines in plasma BCAA levels and leucine turnover observed during IGF-I infusion. The rates of glucose infusion necessary to maintain euglycaemia during IGF-I and insulin infusion were 4.9 +/- 1.0 and 7.8 +/- 0.6 mg.kg-1.min-1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Human immunodeficiency virus infection among members of the reserve components of the US Army: prevalence, incidence, and demographic characteristics. The Walter Reed Retrovirus Research Group.

Since routine testing began, 677,463 members of the Reserve Components of the US Army have been tested for antibody to human immunodeficiency virus (HIV). Of these, 1063 were positive, for a crude prevalence of 1.57/1000 tested. Prevalence varied greatly among different groups as defined by sex, ethnicity, marital status, age, and geographic location. Multivariate analysis indicated that prevalence was higher among men, blacks, and unmarried men and peaked at ages 30-34. The crude incidence density was 0.20/1000 person-years, and multivariate analysis of incidence revealed patterns similar to those for prevalence. Comparison of prevalence and incidence data provides evidence that an increasing proportion of infection is occurring among women and in nonmetropolitan and small urban areas.