Broken Mirror Symmetry of Tracer's Trajectories in Turbulence.

Topological properties of physical systems play a crucial role in our understanding of nature, yet their experimental determination remains elusive. We show that the mean helicity, a dynamical invariant in ideal flows, quantitatively affects trajectories of fluid elements: the linking number of Lagrangian trajectories depends on the mean helicity. Thus, a global topological invariant and a topological number of fluid trajectories become related, and we provide an empirical expression linking them. The relation shows the existence of long-term memory in the trajectories: the links can be made of the trajectory up to a given time, with particles positions in the past. This property also allows experimental measurements of mean helicity.

Comparison of multimedia and printed patient education tools for patients with osteoporosis: a 6-month randomized controlled trial.

We conducted a randomized controlled trial to compare the efficacy of adding a video tool to a printed booklet on osteoporosis. Both strategies were effective in increasing knowledge and decreasing decisional conflict. There was no difference in the measured outcomes between the intervention and control groups. Patient preferences and learning styles are key factors in deciding a presentation format when educating patients with osteoporosis. INTRODUCTION: Innovative approaches to patient education about self-management in osteoporosis may improve outcomes. METHODS: We conducted a randomized controlled trial to compare the efficacy of adding a multimedia patient education tool involving video modeling to a printed educational booklet on osteoporosis. Participants were post-menopausal women with osteoporosis. We assessed osteoporosis knowledge, decisional conflict, self-efficacy, and effectiveness in disease management at baseline, immediately post-intervention, and at 3 and 6 months. Linear regression models were used to explore changes in outcomes at 6 months with respect to baseline characteristics. RESULTS: Two hundred and twenty-five women were randomized, 111 to receive the multimedia tool in addition to the booklet and 114 to receive the booklet alone. Knowledge and decisional conflict scores significantly improved in both groups at all post-intervention assessment points, but with no significant differences in score changes between the groups. Self-efficacy and disease management effectiveness showed no significant changes from baseline. In the entire cohort, younger age was associated with better effectiveness in disease management and Hispanic women had greater gains in knowledge at 6 months compared to White women. Women with limited health literacy who had received the multimedia tool in addition to the printed materials had higher decisional conflict than those who received printed materials alone. CONCLUSION: Both multimedia and printed tools increased knowledge and decreased decisional conflict to the same extent, neither of the educational materials proved to be better than the other. For women with limited health literacy, receiving the booklet alone was more effective in reducing decisional conflict after 6 months, than adding the multimedia tool.

Stachydrine in Leonurus cardiaca, Leonurus japonicus, Leonotis leonurus: detection and quantification by instrumental HPTLC and 1H-qNMR analyses.

Stachydrine ((2S)-1,1-dimethylpyrrolidinium-2-carboxylic acid) may be regarded as an essential active principle of the aerial parts of Leonurus japonicus Houtt. (Leonuri herba, yimucao; Chin.Ph., DAB) which are used in TCM and Kampo for the treatment of various gynaecological and cardiovascular disorders. Medically and botanically closely related Lamioideae drugs are the fruits of L. japonicus (Leonuri fructus, chongweizi; Chin.Ph.), the aerial parts of European Leonurus cardiaca L. (Leonuri cardiacae herba; Ph.Eur.) as well as the aerial parts of their South African relative Leonotis leonurus (L.) R.Br. (Leonotis leonuri herba). Regarding L. cardiaca, stachydrine might be an exceptionally interesting constituent as Dragendorff-positive substances like stachydrine were found to be enriched in an antiarrhythmic L. cardiaca refined extract, which was most recently developed via bioassay guided fractionation. The few pharmacological publications on this betaine do indeed describe cardiovascular, hypotensive, and tissue protective effects. However, its pharmacopeial analytics poses a severe difficulty, as it does not contain any chromophoric group suitable for customary HPLC-UV detection. For quality control of yimucao according to Chin.Ph. the entirety of its N-containing compounds is photometrically quantified after Reinecke's complexation. Unfortunately, this method suffers from a relatively low reproducibility. Since no reliable quantification method for stachydrine is available up to now, a highly reproducible instrumental HPTLC method was newly developed, using postchromatographic derivatization by Vágújfalvi reagent, thus changing non absorbing stachydrine into a detectable derivative at 517 nm, and an automatic HPTLC system with scanner and analysis software (winCATS). This method was shown to be precise with respect to concentration and yielded highly reproducible data over numerous inter-day repetitions. Not only did the independent evaluation of the scanned HPTLC sheets for stachydrine peak area and height result in almost identical values for all samples, but also the results of a parallel-developed direct quantitative 1H-NMR procedure using its N-CH3 singlet delta 3.03 ppm in comparison with the singlet of the two vinylic protons of the internal standard maleic acid at delta 6.18 ppm were always within the standard deviation of the HPTLC data. These measurements of 12 drug samples revealed stachydrine contents (w/w) of 0.2 to 1.0% for the L. japonicus aerial parts, 0.6 to 1.5 % for the L. cardiaca aerial parts, 6.7% for the antiarrhythmic refined extract of L. cardiaca, and 0.3% for the aerial parts of Leonotis leonurus, while both L. japonicus and L. cardiaca fruits contained, on average, 0.2 %. Furthermore, stachydrine was found for the first time as a constituent of L. japonicus and L. cardiaca fruits as well as Leonotis leonurus. Methodically, instrumental HPTLC may be a powerful tool for quality assurance for stachydrine containing plants and herbal drugs, especially for industrial routine protocols.

PR39, a peptide regulator of angiogenesis.

Although tissue injury and inflammation are considered essential for the induction of angiogenesis, the molecular controls of this cascade are mostly unknown. Here we show that a macrophage-derived peptide, PR39, inhibited the ubiquitin-proteasome-dependent degradation of hypoxia-inducible factor-1alpha protein, resulting in accelerated formation of vascular structures in vitro and increased myocardial vasculature in mice. For the latter, coronary flow studies demonstrated that PR39-induced angiogenesis resulted in the production of functional blood vessels. These findings show that PR39 and related compounds can be used as potent inductors of angiogenesis, and that selective inhibition of hypoxia-inducible factor-1alpha degradation may underlie the mechanism of inflammation-induced angiogenesis.

Nitrogen-15 Dioxide Uptake and Incorporation by Phaseolus vulgaris (L.).

The sorption rate and metabolic fate of nitrogen dioxide, a major air pollutant, have been determined for Phaseolus vulgaris (L.). Sorption was determined kinetically by chemiluminescent monitoring of (15)NO(2) removal from the test atmosphere and directly by mass spectrometric analysis of nitrogen derived from the plant tissue. Sorptive processes were first order with respect to (15)NO(2) concentration. Virtually all of the (15)NO(2) taken up was metabolized.

A simplified and versatile calibration method for multi-camera optical systems in 3D particle imaging.

This article describes a stereoscopic multi-camera calibration method that does not require any optical model. It is based on a measure of the light propagation within the measurement volume only instead of modeling its entire path up to the sensors. The calibration uses simple plane by plane transformations which allow us to directly link pixel coordinates to light rays. The appeal of the proposed method relies on the combination of its simplicity of implementation (it is particularly easy to apply in any sophisticated optical imaging setup), its versatility (it can easily handle index-of-refraction gradients, as well as complex optical arrangements), and its accuracy {we show that the proposed method gives better accuracy than commonly used techniques, based on Tsai's simple pinhole camera model [R. Tsai, J. Rob. Autom. 3, 323 (1987)], while its numerical implementation remains extremely simple}. Based on ideas that have been available in the fluid mechanics community, this method is a compact turn-key algorithm that can be implemented with open-source routines.

Inhibition of ubiquitin-proteasome pathway-mediated I kappa B alpha degradation by a naturally occurring antibacterial peptide.

Induction of NF-kappaB-dependent gene expression plays an important role in a number of biological processes including inflammation and ischemia-reperfusion injury. However, few attempts aimed at selective regulation of this transcription factor have been successful. We report here that a naturally occurring antibacterial peptide PR39 reversibly binds to the alpha 7 subunit of the 26S proteasome and blocks degradation of NF-kappa B inhibitor I kappa B alpha by the ubiquitin-proteasome pathway without affecting overall proteasome activity. I kappa B alpha phosphorylation and ubiquitination occur normally after PR39 treatment, and binding of valosin-containing proteins is not impaired. The inhibition of I kappa B alpha degradation abolishes induction of NF-kappa B-dependent gene expression in cell culture and in mouse models of acute pancreatitis and myocardial infarction, including upregulation of endothelial adhesion proteins VCAM-1 and ICAM-1. In the latter model, sustained infusion of PR39 peptide resulted in significant reduction of myocardial infarct size. PR39 and related peptides may provide novel means to regulate cellular function and to control of NF-kappa B-dependent gene expression for therapeutic purposes.

Estimating two-point statistics from derivatives of a signal containing noise: Application to auto-correlation functions of turbulent Lagrangian tracks.

This article describes a method for calculating moments and correlation functions of signal derivatives, which were rid of experimental noise without the use of filtering operations. The method is based on the computation of the ensemble-average of different time (or spatial) increments of the signal. The hypotheses are that the noise is white and not correlated with the signal; however, the method is also shown to work with colored noise. The method is first developed, considering white noise, and benchmarked with synthetic trajectories containing noise with variable signal-to-noise ratios. It is then tested on experimental trajectories in the context of Lagrangian tracking of particles in turbulent flows, either containing a short-correlated noise or a colored noise.

Equilibrium position of a rigid sphere in a turbulent jet: A problem of elastic reconfiguration.

The position of floating spheres trapped within an immersed turbulent water jet is investigated. Using the self-similarity properties of the jet velocity profile, the equilibrium problem is formulated in a rescaled space where the sphere is static and deformable. This approach is found to be related to a problem of elastic reconfiguration where elasticity arises here from the geometry of the flow instead of an actual deformation of a body.

Induction, helicity, and alpha effect in a toroidal screw flow of liquid gallium.

We investigate experimentally induction mechanisms in a screw flow of gallium in a toroidal channel. The flow is nonstationary and operated in a spin-down regime: the channel (and fluid) are initially set into solid body rotation; as the channel is stopped the fluid is set into strong helical motion by diverters located inside the channel. In this study, we put a particular emphasis on the induction generated by these helical motions, which are expected to develop over the entire range of turbulent scales. We apply an external magnetic field either perpendicular to the channel axis parallel to it. At large scales the nonlinear induction mechanisms are associated with the Parker stretch and twist effect and with the expulsion due to overall rotation. Induction mechanisms can also originate in the small scale helicity as in the alpha induction effect of mean-field magnetohydrodynamics. Our measurements yield an upper bound for the alpha coefficient, significantly lower than estimates based on dimensional analysis. We discuss the consequences of our observations for the engineering of homogeneous dynamos in the laboratory.

Endostatin: yeast production, mutants, and antitumor effect in renal cell carcinoma.

Endostatin is a Mr 20,000 COOH-terminal fragment of collagen XVIII that inhibits the growth of several primary tumors. We report here the cloning and expression of mouse endostatin in both prokaryotic and eukaryotic expression systems. Soluble recombinant protein expressed in yeast (15-20 mg/L) inhibited the proliferation and migration of endothelial cells in response to stimulation by basic fibroblast growth factor. A rabbit polyclonal antibody was raised that showed positive immunoreactivity to the recombinant protein expressed from both systems. Importantly, the biological activity of the mouse recombinant protein could be neutralized by this antiserum in both endothelial proliferation and chorioallantoic membrane assays. Systemic administration of endostatin at 10 mg/kg suppressed the growth of renal cell cancer in a nude mouse model. The inhibition of tumor growth with soluble yeast-produced protein was comparable to that obtained with non-refolded precipitated protein expressed from bacteria. In addition, two closely related COOH-terminal deletion mutants of endostatin were also tested and showed strikingly differing activity. Collectively, these findings demonstrate the expression of a biologically active form of mouse endostatin in yeast, define a role for the molecule in inhibiting endothelial cell migration, extend its antitumor effects to renal cell carcinoma, and provide a formal proof (via the neutralizing antiserum experiments and the mutant data) that endostatin (and not a possible contaminant) acts as an antiangiogenic agent. Finally, the high level expression of mouse endostatin in yeast serves as an endotoxin free, soluble source of protein for fundamental studies on the mechanisms of tumor growth suppression by angiogenesis inhibitors.

Anti-angiogenic cues from vascular basement membrane collagen.

Vascular basement membrane is an important structural component of blood vessels and has been shown to interact with and modulate vascular endothelial behavior during angiogenesis. During the inductive phase of tumor angiogenesis, this membrane undergoes many degradative and structural changes and reorganizes to a native state around newly formed capillaries in the resolution phase. Such matrix changes are potentially associated with molecular modifications that include expression of matrix gene products coupled with conformational changes, which expose cryptic protein modules for interaction with the vascular endothelium. We speculate that these interactions provide important endogenous angiogenic and anti-angiogenic cues. In this report, we identify an important antiangiogenic vascular basement membrane-associated protein, the 26-kDa NC1 domain of the alpha1 chain of type IV collagen, termed arresten. Arresten was isolated from human placenta and produced as a recombinant molecule in Escherichia coli and 293 embryonic kidney cells. We demonstrate that arresten functions as an anti-angiogenic molecule by inhibiting endothelial cell proliferation, migration, tube formation, and Matrigel neovascularization. Arresten inhibits the growth of two human xenograft tumors in nude mice and the development of tumor metastases. Additionally, we show that the anti-angiogenic activity of arresten is potentially mediated via mechanisms involving cell surface proteoglycans and the alpha1beta1 integrin on endothelial cells. Collectively, our results suggest that arresten is a potent inhibitor of angiogenesis with a potential for therapeutic use.

Stochastic dynamics of particles trapped in turbulent flows.

The long-time dynamics of large particles trapped in two nonhomogeneous turbulent shear flows is studied experimentally. Both flows present a common feature, a shear region that separates two colliding circulations, but with different spatial symmetries and temporal behaviors. Because large particles are less and less sensitive to flow fluctuations as their size increases, we observe the emergence of a slow dynamics corresponding to back-and-forth motions between two attractors, and a super-slow regime synchronized with flow reversals when they exist. Such dynamics is substantially reproduced by a one-dimensional stochastic model of an overdamped particle trapped in a two-well potential, forced by a colored noise. An extended model is also proposed that reproduces observed dynamics and trapping without potential barrier: the key ingredient is the ratio between the time scales of the noise correlation and the particle dynamics. A total agreement with experiments requires the introduction of spatially nonhomogeneous fluctuations and a suited confinement strength.

Nitrate and ammonium uptake by maize: adaptation during relief from nitrogen suppression.

Initial (0-1 h) net rates of nitrate and ammonium uptake from 200 µM NH4 NO3 were progressively increased as 8-d-old maize (Zea mays L.) seedlings, grown on 5 mM nitrate, were exposed to nitrogen-free solutions for up to 48 h. Further nitrogen deprivation to 72 h resulted in a decline in the nitrate uptake rate. Nitrate uptake rates of plants at all stages of nitrogen deprivation increased steadily during an 8 h exposure to 200 µM NH4 NO3 . The pattern of the response of ammonium uptake during the 8 h adaptation period was considerably different. In nitrogen-replete plants the ammonium uptake rate increased steadily, but deprivation of nitrogen for 12 h and longer resulted in complex responses in which the initial rate was followed by a decline, a subsequent increase, and another decline. The responses of the nitrate uptake system are considered to reflect a lifting of the suppressive effects of nitrate and a product of nitrate assimilation during nitrogen deprivation, a concomitant degradation of an induced component of the nitrate uptake system during that time, and reinduction of the uptake system during the adaptation period. The responses of the ammonium uptake system are considered to reflect the interplay of suppression by a product of ammonium assimilation, the accumulation of root ammonium and associated ammonium efflux, and a stimulation by ammonium of its own uptake. As a consequence of the differential responses of the two uptake systems, nitrate and ammonium uptake rates were positively correlated, largely independent, or negatively correlated as the plants progressed through the 8 h adaptation period.

The behavioral risks and life circumstances of adolescent mothers involved with older adult partners.

OBJECTIVE: To investigate behavioral risks and life circumstances of adolescent mothers with older (> or =5 years) adult (> or =20 years old) vs. similar-aged (+/-2 years) male partners at 12 months' postpartum. METHODS: Nine hundred thirty-one adolescent females were interviewed after delivery and were mailed surveys to complete at 12 months' postpartum. Analysis by chi(2) and t test was used to identify differences in behavioral risks (planned repeated pregnancy, substance use, and intimate partner violence) and life circumstances (financial status, school enrollment, and social support) for adolescent mothers with older adult vs similar-aged partners. Additional stratified analyses were conducted to evaluate the extent to which living with an adult authority figure or being with the father of her infant born 12 months previously might alter observed relationships. RESULTS: At 12 months following delivery, 184 adolescent mothers (20%) reported having an older adult partner, whereas 312 (34%) had a similar-aged partner. The remaining adolescent mothers (n = 239) were excluded from further analyses. Adolescent mothers with older adult partners were significantly less likely to be employed or enrolled in school and were more likely to report planned repeated pregnancies. These adolescent mothers also received less social support. No differences were observed in intimate partner violence or the mother's substance use. Adolescent mothers with older adult partners who did not live with an adult authority figure seemed to be at greatest risk. CONCLUSIONS: The negative educational and financial impact of coupling with an older vs. similar-aged partner seems greater for those mothers who no longer reside with an adult authority figure. These adolescent mothers are also at greater risk of planned rapid repeated pregnancy. Given their limited educational attainment and family support, a subsequent pregnancy may place these young women at considerable financial and educational disadvantage.

Cefditoren pivoxil versus cefpodoxime proxetil for community-acquired pneumonia: results of a multicenter, prospective, randomized, double-blind study.

BACKGROUND: According to recently issued treatment guidelines, appropriate empiric choices for ambulatory patients with community-acquired pneumonia (CAP) are a macrolide, doxycycline (for patients aged > or = 8 years), or an oral beta-lactam agent with good activity against pneumococci. OBJECTIVE: This study was designed to compare cefditoren pivoxil, a new beta-lactam, with cefpodoxime proxetil, a beta-lactam with an established role in the treatment of CAP. METHODS: This was a multicenter, prospective, randomized, double-blind study conducted in the United States and South Africa. Ambulatory patients with a diagnosis of CAP were randomized to 14 days of treatment with cefditoren 200 or 400 mg BID or cefpodoxime 200 mg BID. Assessments of clinical cure and pathogen eradication were conducted at 2 visits during treatment, 1 posttreatment visit (s48 hours after completion of treatment), and 1 follow-up visit (7-14 days after completion of treatment). The development of resistant pathogens was assessed at the follow-up visit but not thereafter. The relative cost of treatment was not assessed. RESULTS: The study enrolled 851 patients. Comparable clinical cure rates were observed among evaluable patients in the 3 treatment groups at both the posttreatment and followup visits: at the posttreatment visit, cure rates were 90.5% (162/179) for cefditoren 200 mg, 89.7% (148/165) for cefditoren 400 mg, and 92.2% (153/166) for cefpodoxime 200 mg; at the follow-up visit, they were a respective 88.4% (160/181), 87.2% (143/164), and 90.4% (151/167). Of the 171 strains of Streptococcus pneumoniae isolated before treatment, 22 (12.9%) had reduced susceptibility to penicillin, 5 (2.9%) of them penicillin resistant (minimum inhibitory concentration > or = 2 microg/mL). At the posttreatment visit, the overall eradication rates of pathogens isolated from microbiologically evaluable patients were 88.7% (134/151), 89.9% (134/149), and 95.7% (134/140) in the respective treatment groups (P = 0.031, cefditoren 200 mg vs cefpodoxime). Eradication rates of S pneumoniae were 93.8% (45/48), 95.7% (45/47), and 95.6% (43/ 45) in the respective treatment groups; those of Haemophilus influenzae were 90.2% (46/51), 97.7% (43/44), and 97.4% (37/38). The rates of resolution and/or improvement in clinical signs and symptoms were comparable between groups. The study drugs were well tolerated, with 1.7%, 2.5%, and 1.4% of patients in the respective groups discontinuing study drug prematurely due to a treatment-related adverse event, the majority of these associated with the digestive system. CONCLUSION: The results of this study suggest that cefditoren may have a role in the treatment of CAP in ambulatory patients.

The Alcohol Use Disorders Identification Test (AUDIT) as a screen for at-risk drinking in primary care patients of different racial/ethnic backgrounds.

This study examined the operating characteristics of the Alcohol Use Disorders Identification Test (AUDIT) as a screen for "at-risk" drinking in a multi-ethnic sample of primary care patients, from a family practice center located in the southwestern United States. A probability sample of 1,333 family medicine patients, stratified by gender and racial/ethnic background (white, African-American and Mexican-American) completed the AUDIT, followed by the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS) to determine ICD-10 diagnoses. Indicators of hazardous alcohol use and alcohol-related problems were included as measures of "at-risk" drinking. Despite differences in the spectrum of alcohol problems across patient subgroups, there was no evidence of gender or racial/ethnic bias in the AUDIT as indicated by Receiver Operating Characteristic Curve analysis. Excluding abstainers from the analysis and little impact on screening efficacy. In this population, the AUDIT appears to be an unbiased measure of "at-risk" drinking.

Patient factors influencing variation in the use of preventive interventions for alcohol abuse by primary care physicians.

OBJECTIVE: To identify patient factors associated with primary care physicians asking about alcohol consumption, warning of harmful ethanol effects, and advising modification of alcohol use in their patients. METHOD: A cross-sectional design was used, with a probability sample of 1,333 adult family medicine patients, stratified by sex and racial/ethnic background, drawn from a university-based, family medicine clinic. Patients completed self-report screens for alcohol-related problems (including the CAGE) and questionnaires on their experiences with the primary care provider. RESULTS: Over 64% of male and female patients indicated their physician had asked them at some time about their alcohol consumption. Logistic regression models indicated that male patients were 1.5 times as likely to have been warned about alcohol and three times as likely to have been told to stop or modify their consumption compared to female patients. Patients with lower educational attainment were more likely to have been warned, while the likelihood of ever being told to stop or modify consumption increased with age. These associations were significant after controlling for patient race/ethnicity, cigarette use and CAGE scores. CONCLUSIONS: Patient factors including sex, educational attainment, age, cigarette use and problem alcohol use appear to explain some of the variation in the use of preventive interventions for alcohol abuse by primary care providers. Yet, different patient factors appear to be related to the use of different preventive interventions. The role of patient factors, and in particular sex of patient, in the use of preventive intervention strategies for alcohol abuse by primary care physicians should be further explored.

Teaching outpatient procedures: most common settings, evaluation methods, and training barriers in family practice residencies.

BACKGROUND AND OBJECTIVES: The processes of teaching outpatient procedures in the training of primary care physicians have not been widely studied or standardized. This study identified the most widely used teaching settings, methods of evaluation, and barriers to teaching several key procedures in US family practice residencies. METHODS: A survey was sent to directors of family practice residency programs. Key issues identified in phone survey data of published experts in procedural training were used in developing the survey. RESULTS: Of the 464 residency directors contacted, 342 (73.7%) returned completed surveys. Results showed that the family practice center (FPC) was the most common setting for this teaching. Faculty observation was used as a principal evaluation method in most programs for all procedures. Several barriers to training were identified as "very" or "moderately" important. CONCLUSIONS: While the FPC is the most frequently used setting for training in procedures, significant limitations include problems of low volume, limited methods of evaluation, scheduling difficulties, and lack of faculty interest and skill. Several internal and external strategies may be used to alleviate these problems.

Does the severity of mood and anxiety symptoms predict health care utilization?

BACKGROUND: Traditional diagnostic criteria for depression and anxiety fail to account for symptom severity. We previously evaluated a severity-based classification system of mood and anxiety symptoms. This study examines whether those severity groups are predictive of differences in health care utilization. METHODS: We used a cohort design to compare the health care utilization of 1232 subjects classified into 4 groups according to symptom severity. Health care billing data were evaluated for each subject for a 15-month period around the index visit. Multiple linear regression models were used to examine relative contributions of individual variables to differences in health care utilization. Analysis of variance procedures were used to compare charges among the severity groups after adjusting for demographic and medical comorbidity variables. RESULTS: After adjustment, significant differences in health care utilization between groups were seen in all but 3 of the 15 months studied. Also, after adjustment, the presence of a mood or anxiety disorder influenced utilization for only a 6-month period. At 9 to 12 months, subjects in the high-severity group showed a more than twofold difference in adjusted charges compared with the low-severity group ($225.36 vs $94.37). CONCLUSIONS: Our severity-based classification predicts statistically and clinically significant differences in health care utilization over most of a 15-month period. Differences in utilization persist even after adjustment for medical comorbidity and significant demographic covariates. Our work lends additional evidence that beyond screening for the presence of mood and anxiety disorders, it is important to assess symptom severity in primary care patients. Further study directed toward developing effective methods of identifying patients with high levels of mood and anxiety symptom severity could result in significant cost savings.