tbuckley/cabot-search huggingface dataset:
Unscientific Administration Protested
Authors: C. H. Lowery
Journal: JAMA (1984)

To the Editor.—  The longing expressed for a scientific method of decision making for societal change 1 is admirable but, unfortunately, unrealistic. It does, however, reflect an attitude characteristic of the physician. From the day we enter medical school we are taught to analyze critically the work of anyone who advocates a change in our clinical behavior. No prudent physician would change his method of practice on the basis of a reported case history. Information obtained from these reportings is for interest only and is tucked back into one's cerebrum for possible use in the future. It is, therefore, difficult for physicians to understand why they should change their behavior in dealing with patients to reduce their liability to malpractice loss as a result of legal decisions being made on the basis of a single case. It is natural for a physician to want to see data to support a
Cost-effectiveness of Screening Women at Moderate Risk for Genital Infections Caused by Chlamydia trachomatis
Authors: Mary D. Nettleman
Journal: JAMA (1988)

We evaluated the cost-effectiveness of screening women at moderate (prevalence, 7.9%) risk for urogenital infections with Chlamydia trachomatis. The characteristics of culture and direct antigen tests were based on published values. Those of serology were based on a comparative study in 434 college women. Three serological tests were evaluated: microimmunofluorescence, an indirect fluorescent antibody assay, and an enzyme-linked immunoassay. Their sensitivities and specificities were 97% and 64%, 87% and 64%, and 84% and 51%, respectively, compared with culture. Screening all patients with a direct antigen test costing less than $12 was more cost-effective than neither testing nor treating patients, although only 53% of patients with positive test results would actually be infected. The use of culture alone or as a confirmatory test was less cost-effective but had high positive predictive values. Seropositivity was not highly predictive of active infection. Chlamydial screening can be cost-effective in moderate-risk women.
The Independent Physician — Going, Going . . .
Authors: Stephen L. Isaacs, Paul S. Jellinek, Walker L. Ray
Journal: New England Journal of Medicine (2009)

Despite the current focus on expanding health insurance coverage, relatively little attention has been paid to the future of the physicians who provide care for the insured and uninsured alike — specifically, to their ongoing migration from independent solo or small-group practices to larger-group practices, where they are often employees. This trend and its consequences for the care of patients and the practice of medicine have scarcely been explored.The percentage of U.S. physicians who own their own practice has been declining at an annual rate of approximately 2% for at least the past 25 years. Although the decline is . . .
The Evolution of Editorial Peer Review
Authors: John C. Burnham
Journal: JAMA (1990)

Practically no historical accounts of the evolution of peer review exist. Biomedical journals appeared in the 19th century as personal organs, following the model of more general journalism. Journal editors viewed themselves primarily as educators. The practice of editorial peer reviewing did not become general until sometime after World War II. Contrary to common assumption, editorial peer review did not grow out of or interact with grant peer review. Editorial peer review procedures did not spread in an orderly way; they were not developed from editorial boards and passed on from journal to journal. Instead, casual referring out of articles on an individual basis may have occurred at any time, beginning in the early to mid-19th century. Institutionalization of the process, however, took place mostly in the 20th century, either to handle new problems in the numbers of articles submitted or to meet the demands for expert authority and objectivity in an increasingly specialized world.
Psychological Treatment for Anorexia Nervosa: A Meta-Analysis of Standardized Mean Change
Authors: Armin Hartmann, Stefanie Weber, Stephan Herpertz, Almut Zeeck
Journal: Psychotherapy and Psychosomatics (2011)

For the German treatment guidelines for eating disorders, the literature on psychological treatment of anorexia nervosa (AN) was reviewed systematically. As a common meta-analysis of randomized clinical trials proved to be impossible, a review of all available clinical trials was conducted, statistically integrating standardized mean change scores. Research questions comprised differential effects of therapeutic techniques and settings as well as determining which weight gains could be expected.After an extensive literature search, studies were selected, rated by 3 independent raters. Weight gain as the main outcome criterion was transformed into standardized mean change scores. Effect sizes were checked for homogeneity.57 studies containing 84 treatment arms and 2,273 patients could be integrated. Studies differed considerably in quality. The strongest bias identified was reporting selectively on completers or failures, versus intention-to-treat samples. No significant differences between effect sizes could be identified concerning treatment setting, technique or patient characteristics. If treatment time is taken into account, inpatient treatment produced a faster weight gain than outpatient treatment.The study describes weight gains which can be reached in outpatient and inpatient settings. It yielded no salient results speaking for a certain therapy technique, setting or procedure. Treatment guidelines for psychological treatment of AN still have to rely on lower level evidence.
Clinical Interpretation of Laboratory Tests
Authors: Lester S. King
Journal: JAMA (1964)

While clinical pathologists and clinicians use the same technical language, they do not always communicate appropriately. Goodale's<i>Clinical Interpretation of Laboratory Tests</i>has tried to bring together the laboratory man and the clinician. And when a book reaches its fifth edition we may safely conclude that it does satisfy a need. However, regardless of the number of editions, the critical reviewer can raise the question, "How well is the need satisfied?" The volume is in two parts, of which the first deals with various body fluids, discussing certain physiological aspects, the normal values, the significance of abnormal values, together with selected areas of microbiology, allergy, and toxicology. The second part considers diseases by body systems, and the laboratory tests that might be useful in diagnosis. Unfortunately, the intended audience has not been kept clearly in mind. Much of the book seems directed at the laboratory technician, who needs only a
The Role of Baderial Proteases in the Pathogenesis of Cystic Fibrosis
Authors: Susanne Suter
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

Among the roles of mediators damaging the respiratory epithelium in patients with cystic fibrosis (CF) during the course of chronic, purulent bronchitis, that of neutrophil proteases is well established. The role of bacterial proteases is less well known. Among all pathogens colonizing the airways in CF, Pseudomonas aeruginosa is quantitatively the dominant pathogen; Staphylococcus aureus and Haemophilus influenzae are present in lower numbers. Anaerobic bacteria may be detected in numbers exceeding those of Staphylococcus aureus and Haemophilus influenzae. Among all enzymes secreted by these bacterial strains, Pseudomonas elastase and alkaline protease were shown to be secreted in vivo over prolonged periods in the airways. These enzymes, mainly elastase, have proteolytic activity on many proteins involved in host defense mechanisms, often the same as those hydrolyzed by neutrophil proteases. Pseudomonas elastase has damaging effects on the respiratory epithelium; it has recently also been shown to augment the permeability of the respiratory epithelium cultured in vitro by proteolytic attack of tight junctions. The potential role of proteases and other enzymes secreted by anaerobic bacteria has not been studied in this disease. In conclusion, bacterial proteases secreted in vivo may play a role in the pathogenesis of the airway disease in CF; their relative importance to the role of host proteases is, however, often difficult to determine.
Longevity of alveolar macrophages allow sustained in vivo expression of the human 1-antitrypsin gene and amelioration of emphysema
Authors: T. Jordan
Journal: Thorax (2010)

This study describes the transduction of mouse pulmonary alveolar macrophages using an intratracheally instilled lentiviral vector. The transferred genes were expressed in vivo for the duration of the lifespan of the mouse. Labelling studies using bromodeoxyuridine (BrdU) revealed continued expression of the transgenes by alveolar macrophages present in the …
The effect of RAFT-derived cationic block copolymer structure on gene silencing efficiency
Authors: Tracey M. Hinton, Carlos Guerrero-Sanchez, Janease E. Graham, Tam Le, Benjamin W. Muir, Shuning Shi, Mark L.V. Tizard, Pathiraja A. Gunatillake, Keith M. McLean, San H. Thang
Journal: Biomaterials (2012)
Spinal or General Anesthesia for Inguinal Hernia Repair?
Authors: Karl F. Urbach, William R. Lee, Lowry L. Sheely, Frederick L. Lang, Richard P. Sharp
Journal: JAMA (1964)

In 514 patients scheduled for inguinal hernia repair, either spinal or general anesthesia was chosen at random. Postoperatively, the incidence of urinary retention and catheterization, gastrointestinal disturbances, nonspecific and postspinal headaches, back complaints, and respiratory complications was recorded. The complications occurring in 236 patients after spinal anesthesia were compared with the occurrence of identical complications in 278 patients who received general anesthesia. Vomiting but not nausea was significantly greater in the general anesthesia group. All other complications, except postspinal headaches, occurred with approximately the same frequency in both groups. Unexpectedly, spinal anesthesia was followed by a relatively high incidence of nausea. Two patients developed atelectasis, both after spinal anesthesia.
The sunburn cell in mouse skin: preliminary quantitative studies on its production
Authors: A. WOODCOCK, I.A. MAGNUS
Journal: British Journal of Dermatology (1976)

Journal Article The sunburn cell in mouse skin: preliminary quantitative studies on its production Get access A. WOODCOCK, A. WOODCOCK Department of Photobiology, Institute of Dermatology, Homerton Grove, London E9 6BX Search for other works by this author on: Oxford Academic Google Scholar I.A. MAGNUS I.A. MAGNUS Department of Photobiology, Institute of Dermatology, Homerton Grove, London E9 6BX Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 95, Issue 5, 1 November 1976, Pages 459–468, https://doi.org/10.1111/j.1365-2133.1976.tb00854.x Published: 01 November 1976
Spontaneous Fracture of a Biliary Self-Expanding Metal Stent
Authors: P. V. Sriram, A. Ramakrishnan, G. V. Rao, D. Nageshwar Reddy
Journal: Endoscopy (2004)

The endoscopic placement of a self-expanding metallic stent (SEMS) is an established treatment for inoperable malignant biliary obstruction, providing relatively prolonged palliation with acceptably low failure and complication rates [1]. Complications related to SEMSs include entrapment of the stent delivery system in small or nondilated intrahepatic ducts, malpositioning of the stent, stent occlusion due to tumor ingrowth or biliary epithelial hyperplasia, proximal or distal migration, and trauma to the duodenal wall opposite the papilla, resulting in bleeding or perforation. Although SEMS are generally not removable, successful endoscopic retrieval of such stents for the treatment of late complications has been reported. Fracture of a SEMS is a rare complication and has only occasionally been reported in the biliary system, caused by thermal overstrain during the application of laser or electrocautery [2] [3] [4] [5].
ACUTE APPENDICITIS AND INTESTINAL OBSTRUCTION
Authors: H. H. Rayner
Journal: BMJ (1924)

ACUTE APPENDICITIS AND INTESTITAL OB3TRUCTION.ttMts CLL JRux 8S5 _~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~1NPIA Miss D., aged two or three vears over 70. had sclerosed arteries and a mitral and aortic systolic murmur.She was having recurring headache, attacks of disordered vision which made her temporarily unable to read, and passing attacks of aphasia and of uinilateral disturbances of sensation.The pulse resistance measured from 200 to 210 and 220 mm.By means of rest, car-eful dieting, and suitable medicinal management, aided by the understanding watchfulness of the lady's local doctor and lher own intelligent co-operation, the pulse resistance was stabilized to round about 170 mm.But it took ten months to effect this.Mr. S., aged 68, came to me in Novenmber last saying that he had "high blood pressure."He complained of listlessness and somno- lence so great that whenever he began to read he fell asleep.The arteries were scierosed and tortuous, anid the pulse resistance to the armlet 210 mm.The heart apex was one and a half inches beyond the mammary line.The aortic second sound was accen- tuated.The urine was normal.He had always been of costive habit and took a daily laxative.He was not a big eater, but he drank burgunldy, and suffered somewhat from gastric hyper- acidity.Wine was stopped, the acidity was checked, and the laxa- tive modified.The resuilt was that the somnolence passed off, mental activity returned and he felt quite well, and the pulse resistance fell to 180 mm.He has continued to follow out instructions and the arterial condition remains stable.It will be noted that in these three cases a stable pressure of 160 to 170 to 180 respectivelv-which was a lowerinig of 50 to 30 mm.-removed synmptoms, and the patient kept well so long as instr-uctions were followed.The arteries being sclerosed no attempt was made to lower the pressures further.Treatment was directed to removing and checking the hypertonia.The structuial resistance of the thickened arterial wall could not be removed.The for-egoing cases illustrate the limitations of treatment wheni dealing with sclerosed vessels.The following case illustrates the progressive character of sclerosis when its early manifestations are not understood.Mr. B. was seen by me in 1913 for digestive disorders.He was then 44 years of age.His pulse resistance to the armlet was 170 mm., the artery was thickened, the heart and urine normal.I did not see him or hear of him again until the end of February, 1924, when he was again sent to me.He was by this time 54 years of age.He complained of apathy and drowsiness; he could not remember what he had read in the morning newspaper half an lhour after lie had iead it.The radial artery was small and calcareous.The pulse wave was moderate.The brachial artery wvas hard and tortuous, the pulse resistance was 240 mm.The sounds of the heart were faint.There was a trace of albumin in the urine.Such was the advance of the arterial changes, with their accompanimiients, in the ten years between the ages of 44 and 54.The immediate prognosis, of course, was very bad.CONCLUSION.
Intermittent Therapy With Metronidazole for Relapse of Pseudomembranous Colitis
Authors: William R. Gaver
Journal: JAMA (1984)

<h3>To the Editor.—</h3> Serendipity and the often-martyred guinea pig brought us the solution to both cause and treatment of postantibiotic diarrhea from the benches of three superb laboratories.<sup>1</sup>Unfortunately, serendipity neither obeys Sutton's Law nor guarantees its work, since 14% to 20% of patients who dutifully swallow from $180 to $460 worth of vancomycin hydrochloride oral solution (with or without cholestyramine chaser) have a microbiologic and clinical relapse of pseudomembranous colitis.<sup>2</sup>Unfortunately, the encouraging clinical and economic success of metronidazole ($90 per ten days) as a cheap and effective alternative has been marred by a similar 15% relapse rate.<sup>3</sup>The speculation that this relapse is related to suboptimal gut levels of antibiotics is certainly not borne out in the case of nonabsorbable vancomycin hydrochloride but is still controversial with the rapid small intestinal absorption of metronidazole. The minimal inhibitory concentration of the organisms isolated in relapse is
Analysis and Reproducibility of 3′-Deoxy-3′-[18F]Fluorothymidine Positron Emission Tomography Imaging in Patients with Non–Small Cell Lung Cancer
Authors: Anthony F. Shields, Jawana M. Lawhorn-Crews, David A. Briston, Sajad Zalzala, Shirish Gadgeel, Kirk A. Douglas, Thomas J. Mangner, Lance K. Heilbrun, Otto Muzik
Journal: Clinical Cancer Research (2008)

Abstract Purpose: Imaging tumor proliferation with 3′-deoxy-3′-[18F]fluorothymidine (FLT) and positron emission tomography is being developed with the goal of monitoring antineoplastic therapy. This study assessed the methods to measure FLT retention in patients with non-small cell lung cancer (NSCLC) to measure the reproducibility of this approach. Experimental Design: Nine patients with NSCLC who were untreated or had progressed after previous therapy were imaged twice using FLT and positron emission tomography within 2 to 7 days. Reproducibility (that is, error) was measured as the percent difference between the two patient scans. Dynamic imaging was obtained during the first 60 min after injection. Activity in the blood was assessed from aortic images and the fraction of unmetabolized FLT was measured. Regions of interest were drawn on the plane with the highest activity and the adjacent planes to measure standardized uptake value (SUVmean) and kinetic variables of FLT flux. Results: We found that the SUVmean obtained from 30 to 60 min had a mean error of 3.6% (range, 0.6-6.9%; SD, 2.3%) and the first and second scans were highly correlated (r2 = 0.99; P &amp;lt; 0.0001). Using shorter imaging times from 25 to 30 min or from 55 to 60 min postinjection also resulted in small error rates; SUVmean mean errors were 8.4% and 5.7%, respectively. Compartmental and graphical kinetic analyses were also fairly reproducible (r2 = 0.59; P = 0.0152 and r2 = 0.58; P = 0.0175 respectively). Conclusion: FLT imaging of patients with NSCLC was quite reproducible with a worst case SUVmean error of 21% when using a short imaging time.
Community treatment of severe psychiatric illness.
Authors: D R Davies
Journal: BMJ (1993)

kinase advocated by Eamshaw and Beard.23 Their conclusion that "intraoperative thrombolysis . .has considerable advantages" is surprising given the paucity of experience with the technique.We suggest that surgeons interested in the technique should first discuss it with a vascular radiologist and perhaps carry out thrombolysis in the angiographic suite before surgery if required.
Continuing Medical Education Training in Medical Cost Management
Authors: Bernard J. Schuman
Journal: JAMA (1984)

<h3>To the Editor.—</h3> It is generally agreed that physicians are largely responsible for determining the type and quality of medical care that their patients receive and the mechanisms through which that care is provided. According to a recent report to the secretary of Health and Human Services by the General Accounting Office (GAO), "Health expenditures increased from $42.0 billion in 1965 (6.1 percent of the gross national product) to an estimated $278.5 billion in 1981,"<sup>1</sup>and "it has been estimated that 70 percent of all expenditures for health care are directly influenced, if not controlled, by the decisions of physicians."<sup>2</sup> The GAO report cites studies showing that increased emphasis on training physicians in cost-containment techniques is likely to produce lower medical costs. Although physicians should avoid being seduced into supporting cost-containment programs for their cost savings alone unless they are consistent with their fundamental ethical concerns and responsibility
A CASE ILLUSTRATING THE VALUE OF SYMPHYSIOTOMY WHEN A TUMOR OBSTRUCTS THE PARTURIENT CANAL.
Authors: H. W. ROVER
Journal: JAMA (1898)

<h3>PART I.—BY DR. ROVER.</h3><h3>INTRODUCTION.</h3> Based on two cases of symphysiotomy which occurred in my private practice (one operated on by Dr. Gustav Zinke of Cincinnati, and the other by Dr. T. M. Burns of Denver), and both of them successful to mother and child, I desire to give expression and emphasis to the benefits derived from said operation. The operation, though a feasible one, does not suggest itself to every medical mind interested in any particular case. The patient was seen repeatedly by three physicians during the latter part of her pregnancy and no unanimity of opinion could be reached; not even after she was taken in labor did the various counsel agree. One favored a Porro, the second a craniotomy, I pleaded for a symphysiotomy. Why this discrepancy of opinion? Simply because the respective indications, benefits and limitations for either of these operations are not definitely fixed. It
Circulatory Control in Idiopathic Orthostatic Hypotension (Shy-Drager Syndrome)
Authors: JAMES T. BOTTICELLI, MICHAEL H. KEELAN, FRANCIS F. ROSENBAUM, RAMON L. LANGE
Journal: Circulation (1968)

Of three patients with Shy-Drager syndrome, two presented with syncope related to exercise and, in all three, exercise stress clearly defined the element of orthostatic hypotension. Autonomic cardiovascular regulatory function was absent in two, but some residual autonomic function was present in the form of heart rate response in one patient who had milder postural hypotension. Hemodynamic studies were carried out with subjects supine and tilted 45° before and after exercise, following plasma volume expansion, and during the effects of isoproterenol and atropine. Despite disordered venoconstrictor responses demonstrated during exercise, hyperventilation, and after the Valsalva maneuver, decrease in central blood volume and right atrial pressure were not excessive with tilt, and total systemic vascular resistance remained essentially unchanged as did heart rate. Cardiac index may have decreased excessively (–24%), suggesting a cardiac component in production of hypotension. Absence of sympathetic cardiac effects, both chronotropic and inotropic, may play a significant role in orthostatic hypotension by limiting heart rate and preventing shift of the Frank-Starling curve to the left. Amelioration of postural effects by plasma volume expansion was noted along with increased cardiac output, stroke volume, and pulse pressure indicating that myocardial heterometric regulation was operative. Atropine had little effect, eliminating the possibility that parasympathetic depressor effects were responsible for postural hypotension. Exercise, by decreasing systemic vascular resistance even though venous return was adequate, produced hypotension even in recumbency and aggravated postural effects. Similarly, isoproterenol caused marked hypotension in supine subjects. Exercise, by reducing systemic vascular resistance, has a deleterious effect despite increased venous return and may precipitate postural symptoms. Exercise stress is of value in the evaluation of patients with syncope or cerebral ischemia secondary to autonomic dysfunction where orthostatic hypotension is of doubtful significance at rest.
Imatinib-Sensitive Tyrosine Kinases Regulate Mycobacterial Pathogenesis and Represent Therapeutic Targets against Tuberculosis
Authors: Ruth J. Napier, Wasiulla Rafi, Mani Cheruvu, Kimberly R. Powell, M. Analise Zaunbrecher, William Bornmann, Padmini Salgame, Thomas M. Shinnick, Daniel Kalman
Journal: Cell Host & Microbe (2011)