tbuckley/cabot-search huggingface dataset:
Primary Care Access for New Patients on the Eve of Health Care Reform
Authors: Karin V. Rhodes, Genevieve M. Kenney, Ari B. Friedman, Brendan Saloner, Charlotte C. Lawson, David Chearo, Douglas Wissoker, Daniel Polsky
Journal: JAMA Internal Medicine (2014)

Current measures of access to care have intrinsic limitations and may not accurately reflect the capacity of the primary care system to absorb new patients.To assess primary care appointment availability by state and insurance status.We conducted a simulated patient study. Trained field staff, randomly assigned to private insurance, Medicaid, or uninsured, called primary care offices requesting the first available appointment for either routine care or an urgent health concern. The study included a stratified random sample of primary care practices treating nonelderly adults within each of 10 states (Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas), selected for diversity along numerous dimensions. Collectively, these states comprise almost one-third of the US nonelderly, Medicaid, and currently uninsured populations. Sampling was based on enrollment by insurance type by county. Analyses were weighted to obtain population-based estimates for each state.The ability to schedule an appointment and number of days to the appointment. We also examined cost and payment required at the visit for the uninsured.Between November 13, 2012, and April 4, 2013, we made 12,907 calls to 7788 primary care practices requesting new patient appointments. Across the 10 states, 84.7% (95% CI, 82.6%-86.8%) of privately insured and 57.9% (95% CI, 54.8%-61.0%) of Medicaid callers received an appointment. Appointment rates were 78.8% (95% CI, 75.6%-82.0%) for uninsured patients with full cash payment but only 15.4% (95% CI, 13.2%-17.6%) if payment required at the time of the visit was restricted to $75 or less. Conditional on getting an appointment, median wait times were typically less than 1 week (2 weeks in Massachusetts), with no differences by insurance status or urgency of health concern.Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. Navigator programs are needed, not only to help patients enroll but also to identify practices accepting new patients within each plan's network. Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act.
Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure
Authors: M Confalonieri, P Parigi, A Scartabellati, S Aiolfi, S Scorsetti, S Nava, L Gandola
Journal: European Respiratory Journal (1996)

Noninvasive positive pressure ventilation (NPPV) has been proposed in COPD patients with acute on chronic respiratory failure (ACRF) in order to avoid endotracheal intubation and to improve immediate outcome, but long-term outcome of this therapeutic approach is still undefined. We evaluated short- and long-term (1 year) outcome of early administration of NPPV in 24 patients with ACRF due to exacerbated COPD (Group A) in comparison with 24 matched historical-control patients treated conventionally (Group B). Patients of Group A were initially treated with NPPV via nasal mask in the presence of pH < or = 7.32, and/or Pa,O2 < 7.98 kPa, and/or Pa,CO2 > 7.18 kPa, plus signs of respiratory distress. In-hospital survival rate was not significantly different in Group A vs Group B, but the patients treated with NPPV showed an earlier improvement in blood gases and a better pH and respiratory rate at discharge. Only 2 patients of Group A needed endotracheal intubation as compared with 9 of Group B. Hospital stay was significantly reduced in survivors of Group A vs Group B. Further severe relapses of ACRF in Group A were treated using NPPV. The number and length of further hospitalizations for pulmonary exacerbations were significantly higher in Group B compared with Group A. The survival rate at 12 months was significantly lower in Group B than in Group A (50% vs 71%). In conclusion, NPPV administration in patients with ACRF due to exacerbated COPD improves not only immediate but also long-term outcome.
Eosinophilia — Idiopathic or Not?
Authors: Barbara J. Bain
Journal: New England Journal of Medicine (1999)

In countries where parasitic diseases are prevalent, these infections cause most cases of eosinophilia. Elsewhere, the majority of patients with eosinophilia are found to have atopy or, less often, drug hypersensitivity or a skin disease. There are numerous other causes of eosinophilia, but individually they are all rare.Eosinophilia may be primary or secondary. In patients with secondary eosinophilia, hematopoietic cells are normal and the increased production of eosinophils is a cytokine-driven reactive process. In patients with primary eosinophilia, there is an acquired abnormality of a hematopoietic stem cell. In some cases, differentiation is mainly to cells of the eosinophil . . .
Renal Biopsy in Gout
Authors: D. Greenbaum, J. H. Ross, V. L. Steinberg
Journal: BMJ (1961)

Occasional dilated tub ules with eosinophil casts Atrophy and dilatation with eosino phil casts Atrophy only, marked focally Normal Slight diffuse increase, prob ably normal for juxta medullary cortex Normal Very fine collagen between tubules, probably normal Diffuse slight increase of collagen, more marked focally. No inflammatory cells Slight focal periglomerular and perivascular fibrosis Slight cellular and fine col l?ge nous increase. No inflammatory cells Very slight diffuse increase with fine collagen Slight diffuse cellular and collagenous increase. No inflammatory cells Moderate increase. No in flammatory cells
The diaries of John Knyveton
Authors: G. Hooper
Journal: BMJ (2012)

John Knyveton (1729-1809) was the son of an apothecary in Bromley. His mother died at his birth, and after his father died from an infected scratch sustained while lancing an abscess, he grew up in the village of Hestley in Kent as the adopted child of his surgeon-uncle, George Knyveton. He became an apprentice to his uncle and after further study in London joined the Royal Navy as a surgeon’s mate. Knyveton had an adventurous life at sea during the seven years’ war and then entered practice as a male midwife. After a long successful career in London and a happy marriage, he died at the age of 80. His diaries, discovered in a leather bound journal when a friend …
CONSIDERATIONS IN CIRRHOSIS OF THE LIVER
Authors: LEONARD G. ROWNTREE
Journal: JAMA (1927)

The medical student of two decades ago carried with him on leaving his alma mater a very imperfect knowledge of cirrhosis of the liver. He was altogether inadequately equipped to grapple successfully with the problems of cirrhosis as they are encountered in the practice of medicine. He had acquired a fair conception of Laënnec's<sup>1</sup>cirrhosis. He was familiar with the textbook picture of Hanot's<sup>2</sup>cirrhosis (and is probably still looking for his first case of this disease). He was aware of the existence of hemachromatosis or bronze diabetes. He was taught to be on the qui vive for syphilis of the liver but was quite uncertain as to its clinical manifestations. Since those days considerable progress has been made in the study of the anatomy and physiology of the liver; new diagnostic methods have been introduced, functional tests have been developed, and it would appear that we are
The effects of humoral agents on the myoelectrical activity of the terminal ileum
Authors: W. E. Waterfall, B. H. Brown, H. L. Duthie, G. E. Whittaker
Journal: Gut (1972)

Electrical and motor activities of the terminal ileum have been recorded in 25 patients with a permanent ileostomy. Records made within a week of formation of the ileostomy show an increased motor activity which is significantly reduced after four weeks. Intravenous infusion of gastrin, 1 μg/kg-hr, was accompanied by a significant increase in action potentials and in the percentage motility. Conversely, secretin 1 unit/kg-hr was associated with a decrease in action potentials and in percentage motor activity.
Diversity and Recognition Efficiency of T Cell Responses to Cancer
Authors: Tor B Stuge, Susan P Holmes, Sahdev Saharan, Andrea Tuettenberg, Mario Roederer, Jeffrey S Weber, Peter P Lee
Journal: PLoS Medicine (2004)

Melanoma patients vaccinated with tumor-associated antigens frequently develop measurable peptide-specific CD8+ T cell responses; however, such responses often do not confer clinical benefit. Understanding why vaccine-elicited responses are beneficial in some patients but not in others will be important to improve targeted cancer immunotherapies.We analyzed peptide-specific CD8+ T cell responses in detail, by generating and characterizing over 200 cytotoxic T lymphocyte clones derived from T cell responses to heteroclitic peptide vaccination, and compared these responses to endogenous anti-tumor T cell responses elicited naturally (a heteroclitic peptide is a modification of a native peptide sequence involving substitution of an amino acid at an anchor residue to enhance the immunogenicity of the peptide). We found that vaccine-elicited T cells are diverse in T cell receptor variable chain beta expression and exhibit a different recognition profile for heteroclitic versus native peptide. In particular, vaccine-elicited T cells respond to native peptide with predominantly low recognition efficiency--a measure of the sensitivity of a T cell to different cognate peptide concentrations for stimulation--and, as a result, are inefficient in tumor lysis. In contrast, endogenous tumor-associated-antigen-specific T cells show a predominantly high recognition efficiency for native peptide and efficiently lyse tumor targets.These results suggest that factors that shape the peptide-specific T cell repertoire after vaccination may be different from those that affect the endogenous response. Furthermore, our findings suggest that current heteroclitic peptide vaccination protocols drive expansion of peptide-specific T cells with a diverse range of recognition efficiencies, a significant proportion of which are unable to respond to melanoma cells. Therefore, it is critical that the recognition efficiency of vaccine-elicited T cells be measured, with the goal of advancing those modalities that elicit T cells with the greatest potential of tumor reactivity.
Multiple Sclerosis and Spinal-fluid Gamma-globulin
Authors: J. B. Foster, D. B. Horn
Journal: BMJ (1962)

MEDICAL JOURNAL case, for example, of the skin-sensitizing antibody to ragweed extract (Stavitsky and Arquilla, 1955; Sehon, 1959).Evidence available at the moment, however, does not suggest that circulating antibody to brain plays any fundamental pathogenic part in multiple sclerosis. SummaryBlood serum and spinal fluid from cases of multiple sclerosis in all stages of the disease and from controls (mainly other neurological conditions) failed to fix complement with an alcoholic brain extract when 5 MHD50 of complement was used.The possible causes of discrepant reports in the literature are briefly discussed.
THE YIELD OF RABIES VIRUS IN THE CHICK EMBRYO
Authors: Björn Sigurdsson
Journal: The Journal of Experimental Medicine (1943)

Rabies virus was inoculated intracerebrally in 8 day old chick embryos and the virus activity of pools of embryos titered after incubation at 35-36 degrees C. for different lengths of time. The virus reached a titer of 10(-5.5) to 10(-6.5) in 5 to to 6 days and remained at a rather constant level until the 9th day of the infection. The report by Kligler and Bernkopf that rabies virus will invade the very young embryo after inoculation on the chorioallantoic membrane was confirmed.
A polymorphism in the methylenetetrahydrofolate reductase gene predisposes to colorectal cancers with microsatellite instability
Authors: B Shannon
Journal: Gut (2002)

Background: The enzyme methylenetetrahydrofolate reductase (MTHFR) catalyses the formation of folate intermediates that are vital to methylation reactions. A polymorphic variant (TT) has been linked to reduced levels of plasma folate, aberrant DNA methylation in leucocytes, and increased risk of colorectal cancer (CRC) under conditions of low folate intake. The cystathionine beta-synthase (CBS) enzyme reduces homocysteine levels and thus may protect against CRC. The CBS gene has a variant, 844ins68, that has been linked with increased activity. These variants may be involved in the development of the subgroup of CRC displaying aberrant DNA methylation and frequently associated with microsatellite instability (MSI). Aim: To investigate the frequencies of the TT and 844ins68 genotypes in CRC patients with MSI+ tumours compared with those with MSI− tumours and a control population. Subjects: Patients with CRC (n=501) and healthy control subjects (n=1207) were studied. CRC cases were classified as MSI+ (n=75) or MSI− (n=426) based on deletions within the BAT-26 mononucleotide repeat. Methods: Subjects were genotyped for MTHFR using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and PCR-restriction fragment length polymorphism (PCR-RFLP) techniques, and for CBS using PCR. Results: The MTHFR TT genotype was more frequent in older CRC patients (≥70 y) compared with equivalent aged controls (p=0.03), was associated with a significantly later age of diagnosis in patients with proximal colon tumours (p=0.02), and was almost twice as frequent in MSI+ than in MSI− tumours (p=0.05). Compared with normal controls, the 844ins68 variant of CBS was less frequent in patients with proximal tumours (p=0.02). Conclusions: The TT genotype of MTHFR is associated with an increased risk of CRC in older populations, possibly due to age related disturbances in folate metabolism. The TT genotype appears to predispose to CRC that is MSI+. This may reflect the involvement of aberrant DNA methylation frequently associated with MSI+. The 844ins68 CBS polymorphism may protect against proximal tumours.
Molecular Understanding of Hyperglycemia's Adverse Effects for Diabetic Complications
Authors: Matthew J. Sheetz
Journal: JAMA (2002)

Diabetic complications are the major cause of morbidity and mortality in persons with diabetes. Chronic hyperglycemia is a major initiator of diabetic microvascular complications (eg, retinopathy, neuropathy, nephropathy). Glucose processing uses a variety of diverse metabolic pathways; hence, chronic hyperglycemia can induce multiple cellular changes leading to complications. Several predominant well-researched theories have been proposed to explain how hyperglycemia can produce the neural and vascular derangements that are hallmarks of diabetes. These theories can be separated into those that emphasize the toxic effects of hyperglycemia and its pathophysiological derivatives (such as oxidants, hyperosmolarity, or glycation products) on tissues directly and those that ascribe pathophysiological importance to a sustained alteration in cell signaling pathways (such as changes in phospholipids or kinases) induced by the products of glucose metabolism. This article summarizes these theories and the potential therapeutic interventions that may prevent diabetic complications in the presence of hyperglycemia, control of which is often difficult with current therapeutic options.
More British abortions for Irish women
Authors: D. Payne
Journal: BMJ (1999)

Abortion is illegal in Ireland except when a pregnant woman is judged by physicians to be suicidal. According to early estimates for 1998 soon to be released by Ireland's Office for National Statistics, more than 6000 Irish women are therefore now traveling each year to Britain for induced abortion, the largest number of such women thus far recorded in Ireland. However, Tony O'Brien, head of the Irish Family Planning Association, believes that it is not so much that the abortion rate is rising, but that a larger percentage of women traveling to the UK for abortion are telling people about their journey and abortion. This new liberalism is reflected in an Irish newspaper poll released last week which shows that 59% of Irish adults over age 18 years, and 86% of adults under age 25 years, approve of couples having sex before marriage. Meanwhile, the government of Ireland has yet to publish the report of its working group on abortion, which it promised to do last summer. O'Brien condemns the recent Irish governments for failing to amend or repeal the country's criminal law against abortion.
TUBERCULIN AND SERUM DIAGNOSIS OF PULMONARY AND BRONCHIAL GLAND TUBERCULOSIS
Authors: C. W. BURHANS
Journal: JAMA (1927)

Robert Koch,<sup>1</sup>in his first article on tuberculin, noted the diagnostic possibilities of this substance. He was, however, chiefly interested in its therapeutic aspects, and although he described both the local and the constitutional reactions to injections, the widespread and harmless application of tuberculin as a diagnostic agent was not appreciated until Pirquet,<sup>2</sup>in 1907, brought forth the now familiar skin test. Koch originally prepared tuberculin by concentrating an old glycerin broth culture of tubercle bacilli over steam and filtering it through a porcelain filter. This preparation has always been designated "Koch's old tuberculin" (O. T.). Of the many modifications of old tuberculin that have been proposed, none appear to have any striking points of superiority, and therefore the original product is still almost uniformly the one of choice. Two recent reports, however, should be mentioned. The first is concerning a protein derived from tubercle bacilli. This was
Local arterial vasoconstriction induced by octreotide in patients with cirrhosis
Authors: Rajaa Chatila, Lisa Ferayorni, Tarun Gupta, Roberto J. Groszmann
Journal: Hepatology (2000)

Peripheral vasodilation initiates the hyperdynamic circulation in cirrhosis. Somatostatin and its analogues, such as octreotide, have a vasoconstrictive effect in cirrhotic patients and experimental animals with portal hypertension. The exact mechanism of octreotide-induced vasoconstriction remains unknown. To investigate whether octreotide produces vasoconstriction through suppression of vasodilatory peptides, such as glucagon, or through a local effect, we evaluated the effect of an intra-arterial dose on forearm blood flow (FBF), while measuring systemic glucagon levels. FBF was measured in 10 cirrhotic patients by venous occlusion plethysmography. The brachial artery of the nondominant arm was catheterized, and vasoactive drugs were administered: methacholine 4 μg/min; octreotide 20 μg/h, and octreotide 20 μg/h + methacholine 4 μg/min. Each infusion, lasting 5 minutes, was followed by saline for washout. FBF was measured in both arms during the last minute of each infusion and at the end of washout, with the uninfused arm acting as the control. Nitrates and nitrites, octreotide, and glucagon blood levels were determined at baseline and after each infusion. Percent change in flow (%△) was obtained by comparing the flow during drug administration to that during the preceding saline infusion. Saline infusion did not alter FBF, but octreotide infusion resulted in a 34% ± 7.7 ( P &lt; .005) reduction in FBF in the infused arm. FBF in the control arm was unchanged despite a significant decrease in systemic glucagon levels. Methacholine infusion increased FBF around 300%, which was not altered by the concomitant infusion of octreotide. Octreotide has a local vasoconstrictive effect that seems nitric oxide (NO)-independent. Octreotide probably has a facilitating effect over vasoconstrictors increased in chronic liver diseases.
Local drug delivery of low molecular weight heparin after PTCA: First clinical experience using the porous balloon (PILOT-study)
Authors: Martin Oberhoff, Thomas Hermann, Rita Maier, Anastasios Athanasiadis, Andreas Baumbach, Christian Herdeg, Armin Bohnet, Karl K. Haase, Wolfram Voelker, Karl R. Karsch
Journal: Journal of the American College of Cardiology (1996)
THE ROLE OF OPSONINS IN THE CLEARANCE OF LIVING AND INERT PARTICLES BY CELLS OF THE RETICULOENDOTHELIAL SYSTEM
Authors: Charles R. Jenkin, Derrick Rowley
Journal: The Journal of Experimental Medicine (1961)

An investigation of the clearance of bacteria and colloids from the blood stream of mice has shown that both living and inert particles require serum factors (opsonins) in order that they may be phagocytosed by the macrophages of the reticuloendothelial system. It has been demonstrated that after the injection of a large dose of colloid there is a depletion of these serum opsonins which appears to account for the reduced rate of clearance of a second dose of colloid or living bacteria, since replacement of these factors leads to normal clearance. The significance of these results is discussed and it is suggested that in "blockaded" animals there is a depletion of serum opsonins rather than a saturation of phagocytic cells.
An Atlas of Detailed Normal Pneumoencephalographic Anatomy
Authors: Bernard S. Epstein
Journal: JAMA (1971)

The first edition of this book, which appeared in 1961, was an outstanding example of meticulous pneumoencephalographic detail, beautifully illustrated, and published in a manner befitting the elegance of its preparation. The second edition is basically a reprint of the first. From the reviewer's viewpoint, it is hard to see how it could have been improved. As a matter of fact, all of the original illustrations and text have been retained. However, certain changes have been made, and a few new illustrations added. A particularly interesting one is Fig 182 which shows the intrasellar cistern in beautiful detail. Another change is a reappraisal of the foramina of the fourth ventricle. A nine-page section on axial transverse encephalography has been added, as well as a page of references to other texts dealing with neuroradiology. A running form of legend has been substituted for the double column format. In conformity with the
National Survey of Drug-Resistant Tuberculosis in China
Authors: Yanlin Zhao, Shaofa Xu, Lixia Wang, Daniel P. Chin, Shengfen Wang, Guanglu Jiang, Hui Xia, Yang Zhou, Qiang Li, Xichao Ou, Yu Pang, Yuanyuan Song, Bing Zhao, Hongtao Zhang, Guangxue He, Jing Guo, Yu Wang
Journal: New England Journal of Medicine (2012)

The available information on the epidemic of drug-resistant tuberculosis in China is based on local or regional surveys. In 2007, we carried out a national survey of drug-resistant tuberculosis in China.
Patchy blood testing in central Asia raises risk of HIV infection
Authors: Jane Parry
Journal: BMJ (2008)

The lack of adequate screening of donated blood in countries in central Asia presents a clear and present danger of transmission of HIV and other communicable diseases, says a World Bank report published this month.

Patchy testing is creating a false sense of security, the report states. In some of the region’s health facilities donated blood is not tested at all, and where testing is done it misses blood contaminated with HIV, hepatitis B and C, and syphilis.

The report is based on findings of a 2007 assessment—by the Central Asia Regional Office of the US Centers for Disease Control and Prevention—of blood transfusion services in Kazakhstan, …
Intramucosal Adenocarcinoma of the Appendix
Authors: M. Krüger, J. Behrens, F. Länger, M. P. Manns, P. N. Meier
Journal: Endoscopy (2004)

We read with interest the recent article by Sakamoto et al. [1] on the finding of a small elevated lesion inside the orifice of the appendix. The lesion was removed by polypectomy, and histopathology showed that it was a well-differentiated adenocarcinoma. The patient subsequently underwent laparoscopy-assisted ileocecal resection with lymph-node dissection. We would like to present here a report of a case in which there were similar findings.