tbuckley/cabot-search huggingface dataset:
Competition on Outcomes and Physician Leadership Are Not Enough to Reform Health Care
Authors: Jennifer Dixon, Cyril Chantler, John Billings
Journal: JAMA (2007)

SOCIETY FLIES BLIND WHEN IT COMES TO HEALTH CARE. The value of treatments to patients, in particular with respect to health gain, is not routinely measured. As a result, reforms focus less on improving health and value to patients and more on cost minimization; consequently, such reforms are led by administrators, not physicians. Physicians are disgruntled and disenfranchised, and perversities result such as, in the United States, cost shifting and other forms of dysfunctional competition. The way forward is for physicians to seize the initiative, take as their goal improved value of care to patients, organize medical practice around medical conditions and care cycles, and measure riskadjusted outcomes and costs, all within a competitive health system. Positive-sum competition for value to patients will result that only physicians can deliver. Tinkering with financial incentives in the system will never be enough. In a reduced form, this is the main argument advanced by Porter and Teisberg for reforming and improving the US health care system. However, there are important similarities in England’s National Health Service (NHS). While reducing overall cost growth is not a problem due to the (relatively) large real-term increases in the global fixed budget over the last 7 years, health reforms in England have been in the main led by politicians and implemented by managers, with the physician community largely on the sidelines, antagonized or marginalized. Measuring risk-adjusted clinical outcomes is not widely implemented, prompted by public outrage (for example, following well-publicized failures in cardiac surgery) as much as by professional leadership. The financial bottom line, rather than health gain, tends to drive local reconfigurations in service. To improve the health care system, physicians should take a firm lead: a large portion of the activities most likely to have an impact on improving outcomes and quality are embedded in the care setting provided by physicians interacting directly with patients. However, it is unlikely that physicians will rise to the leadership needed, at least in the NHS, and some of the “false solutions” rejected by Porter and Teisberg are necessary and worthwhile candidates for future reforms. In this Commentary, we explain why, and describe how some of these “false solutions” are being used to reform the NHS to achieve better value for patients.
F-18 FDG PET/CT Findings of Dedifferentiated Acinic Cell Carcinoma
Authors: Joo Hyun O., Ie Ryung Yoo, Chan-Kwon Jung, Sung Hoon Kim, Soo Kyo Chung
Journal: Clinical Nuclear Medicine (2010)

Dedifferentiated acinic cell carcinoma is a rare variant of acinic cell carcinoma with a poorly differentiated component. Although acinic cell carcinoma is a relatively low grade form of malignant salivary gland tumor, the dedifferentiated variant demonstrates very aggressive behavior. The authors present a case of a 52-year-old man presenting with a palpable infra-auricular mass. F-18 fluorodeoxyglucose positron-emission tomography/computed tomography was performed for initial staging work-up, and intense fluorodeoxyglucose uptake was noted in the parotid gland mass. Dedifferentiated acinic cell carcinoma arising in the parotid gland was confirmed by surgery.
Incidence and trends of heart failure admissions after coronary artery bypass grafting surgery
Authors: Abel E. Moreyra, Yingzi Deng, Alan C. Wilson, Nora M. Cosgrove, William J. Kostis, John B. Kostis
Journal: European Journal of Heart Failure (2012)

Aims Factors related to hospitalization for heart failure (HF) following coronary artery bypass grafting (CABG) surgery were studied. Methods and results Patients ( n = 65 377) undergoing CABG surgery in New Jersey from 1998 to 2007 were identified from the state cardiac surgery database; subsequent hospitalizations for HF were assessed using the Myocardial Infarction Data Acquisition System database . Patients were classified based on pre‐operative ejection fraction (EF). Multivariate models were used to identify factors related to HF admission and mortality. Post‐CABG HF admission rates among patients with pre‐operative EF &lt;35% increased over the 10‐year period ( P = 0.02), but no significant trend was seen among patients with EF ≥35%. Independent factors associated with post‐CABG HF admission within 2 years were: EF, age, female gender, Black race, smoking, diabetes, renal disease, hypertension, and cerebrovascular disease. Pre‐operative use of beta‐blockers increased over the years ( P &lt; 0.0001) and reduced the risk of admission for HF by 13%, with greater benefit in patients with lower EF. Mortality remained unchanged from 1998 to 2007, averaging 1.8% in‐hospital and 5.1% and 7.2% at 1‐year and 2‐year follow‐up, respectively. Conclusions Pre‐operative EF is a strong predictor of HF admission within 2 years after CABG surgery. The use of beta‐blockers decreased HF admission after CABG, especially in patients with EF &lt;35%. Despite the more pronounced benefit and increasing use of beta‐blockers in patients with a low EF, HF admission rates in this group of patients are rising. This suggests that more comprehensive management of factors associated with HF is necessary.
Dichotomous Organization of the External Globus Pallidus
Authors: Nicolas Mallet, Benjamin R. Micklem, Pablo Henny, Matthew T. Brown, Claire Williams, J. Paul Bolam, Kouichi C. Nakamura, Peter J. Magill
Journal: Neuron (2012)

Different striatal projection neurons are the origin of a dual organization essential for basal ganglia function. We have defined an analogous division of labor in the external globus pallidus (GPe) of Parkinsonian rats, showing that the distinct temporal activities of two populations of GPe neuron in vivo are underpinned by distinct molecular profiles and axonal connectivities. A first population of prototypic GABAergic GPe neurons fire antiphase to subthalamic nucleus (STN) neurons, often express parvalbumin, and target downstream basal ganglia nuclei, including STN. In contrast, a second population (arkypallidal neurons) fire in-phase with STN neurons, express preproenkephalin, and only innervate the striatum. This novel cell type provides the largest extrinsic GABAergic innervation of striatum, targeting both projection neurons and interneurons. We conclude that GPe exhibits several core components of a dichotomous organization as fundamental as that in striatum. Thus, two populations of GPe neuron together orchestrate activities across all basal ganglia nuclei in a cell-type-specific manner.
Arginine deprivation using pegylated arginine deiminase has activity against primary acute myeloid leukemia cells in vivo
Authors: Farideh Miraki-Moud, Essam Ghazaly, Linda Ariza-McNaughton, Katharine A. Hodby, Andrew Clear, Fernando Anjos-Afonso, Konstantinos Liapis, Marianne Grantham, Fareeda Sohrabi, Jamie Cavenagh, John S. Bomalaski, John G. Gribben, Peter W. Szlosarek, Dominique Bonnet, David C. Taussig
Journal: Blood (2015)
Heart Rate Response During Exercise and Pregnancy Outcome in Women With Congenital Heart Disease
Authors: George K. Lui, Candice K. Silversides, Paul Khairy, Sue M. Fernandes, Anne Marie Valente, Michelle J. Nickolaus, Michael G. Earing, Jamil A. Aboulhosn, Marlon S. Rosenbaum, Stephen Cook, Joseph D. Kay, Zhezhen Jin, Deborah R. Gersony
Journal: Circulation (2011)

Background— Cardiopulmonary exercise testing is often used to evaluate exercise capacity in adults with congenital heart disease including women who are considering pregnancy. The relationship between cardiopulmonary exercise testing parameters and pregnancy outcome has not been defined. Methods and Results— We conducted a multicenter retrospective observational study of women with congenital heart disease who had undergone cardiopulmonary exercise testing within 2 years of pregnancy or during the first trimester. Cardiopulmonary exercise testing variables included peak oxygen consumption and measures of chronotropic response: peak heart rate, percentage of maximum age predicted heart rate, heart rate reserve (peak heart rate−resting heart rate), and chronotropic index [(peak heart rate−resting heart rate)/(220−age−resting heart rate)]. We identified 89 pregnancies in 83 women. There were 4 spontaneous abortions and 1 termination. One or more adverse cardiac events occurred in 18%; congestive heart failure in 14%, and sustained arrhythmia in 7%. Peak heart rate (odds ratio [OR] 0.71; 95% confidence interval [CI] [0.53, 0.94]; P =0.02), percentage of maximum age predicted heart rate (OR 0.93; 95% CI [0.88, 0.98]; P =0.01), and chronotropic index (OR 0.65; 95% CI [0.47, 0.90]; P =0.01) were associated with a cardiac event. Neonatal events occurred in 20%. Peak heart rate (OR 0.75; 95% CI [0.58, 0.98]; P =0.04), percentage of maximum age predicted heart rate (OR 0.94; 95% CI [0.89, 0.99]; P =0.02), heart rate reserve (OR 0.8; 95% CI [0.64, 0.99]; P =0.04), and chronotropic index (OR 0.73; 95% CI [0.54, 0.98]; P =0.04) correlated with a neonatal event. Peak oxygen consumption was not associated with an adverse pregnancy outcome. Conclusions— Abnormal chronotropic response correlates with adverse pregnancy outcomes in women with congenital heart disease and should be considered in refining risk stratification schemes.
INFLUENCE OF pH AND OF CERTAIN OTHER CONDITIONS ON THE STABILITY OF THE INFECTIVITY AND RED CELL AGGLUTINATING ACTIVITY OF INFLUENZA VIRUS
Authors: Gail Lorenz Miller
Journal: The Journal of Experimental Medicine (1944)

A study has been made of the pH stability of centrifugally purified strains of influenza virus with respect to the biological properties of mouse infectivity and chicken red blood cell agglutinating activity. Observations also were made on the importance of composition of buffer, temperature of storage, and concentration of virus protein to the stability of the virus. When tested for stability at a protein concentration of 0.1 mg. per cc. in phosphate buffer, the infectivity of PR8 virus was found to be most stable at pH 6.5-7; the swine virus, at pH 7-7.9; and the Lee strain, at a pH of 7.9 or higher. The CCA activity of the PR8 virus in phosphate buffer was most stable at pH 7, that of the swine virus at pH 7-8, and that of the Lee virus at a pH greater than 9. Furthermore, the Lee virus was much less stable in dilute solution in phosphate buffer, even under optimum conditions of pH, than either the PR8 or swine strains. The different strains of influenza virus were found to possess certain characteristics in common. They lost infectivity and CCA activity on the acid side of optimum pH conditions much more rapidly than on the alkaline side. Under suitable conditions of buffer and pH, the infectivity decreased while the CCA activity remained unchanged. In general, the rate of loss in infectivity was greater than the rate of loss in CCA activity. When tests of stability were carried out at a protein concentration of 0.1 mg. per cc. in a composite phosphate-glycine-NaCl buffer, the virus strains showed less marked differences and possessed much higher stabilities of CCA activity and infectivity than when stored at the same concentration in phosphate buffer alone. Under the modified conditions, all three viruses possessed maximum stabilities of CCA activity and infectivity at pH 7-8 with the exception of the PR8 virus whose infectivity appeared more stable at pH 7 than at pH 8. In detailed experiments with the Lee virus, it was found that the infectivity and CCA activity of this strain at pH 7 and at a protein concentration of 0.1 mg. per cc. were maintained best in the composite phosphate-glycine-NaCl buffer, less well in a buffer containing glycine and NaCl, and least well in phosphate buffer alone. In tests with PR8 virus, the activity was found to be much more stable at 4 degrees C. than at 23 degrees C. When stored at a concentration of 2 mg. per cc. at 4 degrees C. in phosphate buffer at pH 7, the PR8 and Lee strains were found to be much more stable than when stored at the concentration of 0.1 mg. per cc. At the higher concentration, no significant losses in either infectivity or CCA activity were observed over a period of 2 months.
Abnormalities in CD4 and CD8 Lymphocyte Subpopulations in Patients with Common Variable Immunodeficiency
Authors: Amanda J. Seba, Norma de Paula Motta Rubini, Albertina Varandas Capelo, Eliane Miranda da Silva, Fernando Samuel Sion, Clety Larissa, Angulo Llerena, Carlos Alberto Morais-de-Sá
Journal: Journal of Allergy and Clinical Immunology (2013)
Sepsis and adrenal function
Authors: Lance M. Siegel, Steven K. Grinspoon, Glenda J. Garvey, John P. Bilezikian
Journal: Trends in Endocrinology and Metabolism (1994)

In the setting of sepsis, adrenal function can be difficult to evaluate. Cortisol levels, normally elevated by the stress of sepsis, are occasionally reduced, signifying possible adrenal dysfunction. Even elevated cortisol levels do not assure that adrenal reserve is adequate and may in fact portend a preterminal state. Bilateral adrenal hemorrhage leading to adrenal insufficiency is one complication of the sepsis syndrome. This endocrine rounds illustrates the importance in considering adrenal insufficiency and adrenal hemorrhage in patients with overwhelming sepsis while discussing the pathophysiology, clinical presentation, and therapeutic implications of this dire complication.
Involvement of Adhesion Signaling in GM-CSF-induced Activation of Eosinophils; Evidence of Shp2- Slp76-mediated Cross-talk Between the c Receptor and ICAM-1
Authors: K. Pazdrak, T.W. Young, J. Wiktorowicz, A.R. Brasier, A. Kurosky
Journal: Journal of Allergy and Clinical Immunology (2006)
Expression of cyclin-dependent kinase inhibitor p21 in human liver
Authors: Gretchen S. Crary, Jeffrey H. Albrecht
Journal: Hepatology (1998)

The p21 protein is a universal inhibitor of cyclin-dependent kinases and of cell-cycle progression and is involved in numerous growth-inhibitory pathways in cell culture systems. Recent studies suggest that p21 regulates hepatocyte cell cycle progression in models of liver regeneration. The present study was designed to investigate the possible involvement of p21 in the control of hepatocyte proliferation in human liver diseases. To examine that, the expression of p21 in clinical liver biopsy specimens was determined by immunohistochemistry. This was correlated with hepatocyte Ki-67 immunostaining (a marker of hepatocyte proliferation in vivo ) as well as histologic features. Little p21 or Ki-67 expression was detected in normal human liver or in specimens of nonalcoholic steatohepatitis. In patients with alcoholic hepatitis, increased expression of p21, but not of Ki-67, was observed. In specimens with chronic hepatitis C, hepatocyte p21 expression was significantly correlated with Ki-67 immunostaining, as well as with the degree of inflammation and fibrosis. These results indicate that hepatocyte p21 expression is upregulated in response to hepatic injury and correlates with histologic markers of proliferation and disease activity. This study provides evidence that p21 plays a role in the regulation of hepatocyte proliferation in human liver diseases.
Water and land based rehabilitation for Achilles tendinopathy in an elite female runner
Authors: A G Beneka, P C Malliou, G Benekas
Journal: British Journal of Sports Medicine (2003)

<h3>BACKGROUND</h3> Selective inhibitors of cyclooxygenase (COX)-2 may provoke less gastric damage and platelet inhibition than conventional non-steroidal anti-inflammatory drugs. <h3>AIMS</h3> We compared the biochemical and gastrointestinal effects of nimesulide, a potent and selective COX-2 inhibitor, with naproxen which exhibits no selectivity. <h3>SUBJECTS</h3> Thirty six healthy volunteers were randomised to nimesulide 100 mg or naproxen 500 mg twice daily for two weeks in a double blind, crossover study with a washout between treatments. <h3>METHODS</h3> Gastrointestinal side effects were assessed by endoscopy, and by estimation of small intestinal absorption-permeability and inflammation. Comparisons were made between variables at the end of each treatment phase. <h3>RESULTS</h3> Nimesulide caused significantly less gastric injury using the modified Lanza score (p&lt;0.001) as well as reduced duodenum injury (p=0.039). Nimesulide had lower visual analogue scores (VAS) for haemorrhage and erosive lesions in the stomach (p&lt;0.001) and for mucosal injection in the duodenum (p=0.039). Naproxen increased excretion of calprotectin, a marker of intestinal inflammation (5.5 (1.2) to 12.1 (2.1) mg/l) while nimesulide had no effect (treatment difference p=0.03). Naproxen abolished platelet aggregation to arachidonic acid and suppressed serum thromboxane B<sub>2</sub> (TXB<sub>2</sub>) by 98%, indices of COX-1 activity. In contrast, nimesulide had no significant effect on platelet aggregation, although it reduced serum TXB<sub>2</sub> by 29%. Production of prostaglandin E<sub>2</sub> and prostacyclin by gastric biopsies, also COX-1 dependent, was inhibited by naproxen, but not by nimesulide. COX-2 activity, determined as endotoxin induced prostaglandin E<sub>2</sub> formation in plasma, was markedly suppressed by both treatments. <h3>INTERPRETATION</h3> Nimesulide has preferential selectivity for COX-2 over COX-1 in vivo at full therapeutic doses and induces less gastrointestinal damage than that seen with naproxen in the short term.
Does Radiation Increase Survival in Nonresectable Lung Cancer?
Authors: George G. Spellman
Journal: Annals of Internal Medicine (1992)

Letters15 March 1992Does Radiation Increase Survival in Nonresectable Lung Cancer?George G. Spellman Jr, MDGeorge G. Spellman Jr, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-116-6-524_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: Although Dr. Ihde (1) awaits the end of the beginning in efforts to treat unresectable lung cancer, many clinicians and patients await the beginning of the beginning. Medical research has provided little information on the "no treatment" alternative for patients who are deciding whether to have traditional thoracic radiation, making informed consent difficult.A retrospective chart review of 16 patients with unresectable carcinoma of the lung, who died in the past 4 years after having declined cancer therapy, revealed 1-, 2-, and 5-year survival rates of 50%, 31%, and 13%, respectively. These data support Johnson and colleagues'...References1. Ihde D. Chemotherapy combined with chest irradiation for locally advanced non-small cell lung cancer: the end of the beginning? Ann Intern Med. 1991;115:737-8. LinkGoogle Scholar2. JohnsonEinhornBartolucci DLA. Thoracic radiotherapy does not prolong survival in patients with locally advanced, unresectable non-small cell lung cancer. Ann Intern Med. 1990;113:33-8. LinkGoogle Scholar3. RoswitPatnoRapp BMR. The survival of patients with inoperable lung cancer: a large-scale randomized study of radiation therapy versus placebo. Radiology. 1968;90:688-97. CrossrefMedlineGoogle Scholar1. IhdeMinna DJ. Non-small cell lung cancer. Part II: treatment. Curr Probl Cancer. 1991;15:107-64. Google Scholar2. Zelen M. Keynote address on biostatistics and data retrieval. Cancer Chemother Rep (Part 3). 1973;4:31-42. Google Scholar3. JohnsonEinhornBartolucci DLA. Thoracic radiotherapy does not prolong survival in patients with locally advanced, unresectable non-small cell lung cancer. Ann Intern Med. 1990;113:33-8. LinkGoogle Scholar4. Ihde D. Chemotherapy combined with chest irradiation for locally advanced non-small cell lung cancer: the end of the beginning? Ann Intern Med. 1991;115:737-9. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: George G. SpellmanJr, MDAffiliations: 8551 Center Drive, Suite 300 La Mesa, CA 92042 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 March 1992Volume 116, Issue 6Page: 524-525KeywordsChartsLung and intrathoracic tumorsPatients ePublished: 1 December 2008 Issue Published: 15 March 1992 PDF downloadLoading ...
Regulation of large coronary arteries by increases in myocardial metabolic demands in conscious dogs.
Authors: P Macho, T H Hintze, S F Vatner
Journal: Circulation Research (1981)

In order to assess the effects of increasing myocardial metabolic demand on the large epicardial coronary arteries, we measured left circumflex coronary artery diameter (ultrasonic transit time technique) and blood flow in conscious dogs with chronically implanted transducers. Myocardial oxygen consumption was increased by pacing-induced tachycardia and aortic constriction, and monitored by multiplying left circumflex coronary arterial blood flow by coronary arterio-venous oxygen content difference. Increase of heart rate by 90 beats/min caused myocardial oxygen consumption to increase by 34 +/- 4.3% (1 SEM); coronary blood flow at constant arterial pressure to increase by 32 +/- 6.8%; and coronary diameter to increase by 0.07 +/- 0.01 mm, P less than 0.01. Aortic constriction, producing a 53 +/- 5.1% increase of left ventricular systolic pressure, caused myocardial oxygen consumption to increase by 49 +/- 7.2%, coronary blood flow to increase by 50 +/- 6.0%, and coronary diameter to increase 0.03 mm, P less than 0.01. The increases in coronary artery diameter were gradual, not immediate, in onset and not altered by beta-adrenergic blockade. Thus, increased myocardial metabolic demand dilates large epicardial coronary arteries, but with a slower response time than the rapid dilation of the smaller resistance vessels.