tbuckley/cabot-search huggingface dataset:
US Graduate Medical Education, 1996-1997
Authors: Marvin R. Dunn
Journal: JAMA (1997)

Workforce planners continue to be concerned that unlimited growth in graduate medical education (GME)-principally fueled by unrestrained federal support-will lead to a physician surplus. Because of this concern, in 1996 six major professional organizations called for a reduction in Medicare support of GME to bring residency training programs into more rational alignment with population needs. As of July 1, 1997, no final action had been taken by Congress to limit GME funding, although extensive discussions are under way. Even without governmental restrictions, the American Medical Association's annual survey of GME programs showed a reduction in the numbers of first-year residents in most major specialties and subspecialties. Minor reductions were initially noticed last year; now, the decreases are significant. Nearly all the specialties that had difficulty placing their graduates for 2 consecutive years also reported at least 10% fewer first-year residents than in 1994. More importantly, disciplines without employment difficulties also reported downsizing. The overall effect of these first-year reductions is easily masked by the addition of programs in new disciplines and some residents staying in the GME system longer. Entry-level reductions appear to be broader and more extensive than can be explained by market forces alone.
<i>Syzygium cumini</i> (L.) Skeels in the Treatment of Type 2 Diabetes
Authors: Claudio Coimbra Teixeira, Letícia Schwerz Weinert, Daniel Cardoso Barbosa, Cristina Ricken, Jorge Freitas Esteves, Flávio Danni Fuchs
Journal: Diabetes Care (2004)

Tea, extracts, solutions, and other preparations from plants with a putative antihyperglycemic effect have a worldwide utilization in the treatment of diabetes (1). Among them, the tea prepared from leaves of jambolan [ Syzygium jambos (L.) Alst or Syzyguium cumini (L.) Skeels] is largely used in our city (2) and elsewhere (3). We demonstrated that the tea and extracts from different parts of the plant had no effect in normal …
Metabolic Alterations After a Two-hour Nocturnal Interruption of a Continuous Subcutaneous Insulin Infusion
Authors: André Scheen, Manuel Castillo, Bernard Jandrain, Georges Krzentowski, Philippe Henrivaux, Alfred S Luyckx, Pierre J Lefèbvre
Journal: Diabetes Care (1984)

In order to evaluate the metabolic consequences of a 2-h nocturnal interruption of continuous subcutaneous insulin infusion (CSII), seven insulin-dependent diabetic patients without residual insulin secretion were investigated. The changes in blood glucose, plasmafree insulin, glucagon, free fatty acids, and 3-hydroxybutyrate (3 OH-B) concentrations have been compared during two randomized tests carried out either during the normal functioning of a Mill-Hill pump from 10 p.m. to 8 a.m. (1.00 ± 0.06 U insulin/h, keeping adequate metabolic control) or during the same conditions but with a deliberate arrest of the pump between 11 p.m. and 1 a.m. Considering the value recorded at 11 p.m. asreference, interruption of the insulin infusion resulted in: (1) a rapid (already significant after 1 h) and sustained (maximal fall: –12.5 ± 2.5 mU/L at 3 a.m.) decrease in plasma free insulin; (2) a delayed (significant after 4 h) and linear rise in blood glucose (maximal increase: + 4.0 ± 1.3 mmol/L at 5 a.m.); (3) an early (significant at midnight) and prolonged rise in plasma free fatty acids (+ 387 ± 148 μumol/L at 3 a.m.); (4) a delayed (significant after 3 h) and sustained increase in plasma 3 OH-B (+ 347 ± 88 μumol/L at 3 a.m.); and (5) no significant changes in plasma glucagon. Thus, a 2-h interruption of CSII in resting nocturnal conditions is sufficient to induce significant, delayed, and sustained metabolic alterations in C-peptide-negative patients despite good baseline blood glucose control. Resetting the pump at its basal rate is insufficient to quicklyrestore adequate circulating insulin levels and effectively counteract the metabolic disturbances. The efficacy of a bolus insulin injection in these conditions should be evaluated.
Doctor, Patient, and Family
Authors: LCDR K. Immerman
Journal: Annals of Internal Medicine (1989)

Letters and Corrections1 March 1989Doctor, Patient, and FamilyLCDR K. Immerman, MC USNRLCDR K. Immerman, MC USNRSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-110-5-412_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor:Hahn and colleagues (1) on the doctor-patient-family relationship are to be commended for acknowledging and discussing the dysfunctional situations that may underlie the behavior of patients. Also important is their recognition of patients' unreasonable demands that place physicians in difficult positions. I would disagree, however, with the authors' suggestions that the primary physician draw in the family and focus on the patient's dysfunctional behavior within the family unit. The primary physician should concentrate on the patient and on the patient's responses to the demands made on him or her. For example, the pregnant diabetic patient who insists...References1. HahnFeinerBellin SJE. The doctor-patient-family relationship: a compensatory alliance. Ann Intern Med. 1988;109:884-9. LinkGoogle Scholar2. Whitfield C. Healing the Child Within. Deerfield Beach: Health Communication, Inc.; 1987:26. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Uniformed Services University of the Health Sciences Bethesda, MD 20892 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 March 1989Volume 110, Issue 5Page: 412-413KeywordsBehaviorPregnancy Issue Published: 1 March 1989 PDF downloadLoading ...
Temporal pattern of Borrelia burgdorferi p21 expression in ticks and the mammalian host.
Authors: S Das, S W Barthold, S S Giles, R R Montgomery, S R Telford, E Fikrig
Journal: Journal of Clinical Investigation (1997)

The temporal synthesis of the P21 protein of Borrelia burgdorferi and the development of the humoral response to this antigen was assessed in infected mice. p21 is a member of the ospE-F gene family and its protein, P21, has been shown to be expressed by B. burgdorferi within infected mice but not by spirochetes cultured in vitro. P21 was not detected on B. burgdorferi in unfed or engorged Ixodes dammini (also known as I. scapularis) ticks, further supporting the postulate that P21 synthesis is specific for the mammalian host. In B. burgdorferi-infected mice, ospE mRNA and OspE antibodies were observed at 7 d, whereas p21 mRNA and P21-specific antibodies were detected at 21-28 d, suggesting that p21 is expressed later than ospE. Moreover, ospA mRNA was not discernible until day 14, indicating that ospA, like p21, is not expressed in the early stages of tick-transmitted murine Lyme borreliosis. Because p21 is expressed during infection in mice, we assessed the human humoral response to P21. 28% (34 of 122) of the patients with either early- or late-stage Lyme disease, and 33% (11 of 33) of the individuals with Lyme arthritis had P21 antibodies, suggesting that a P21 response may serve, at least partially, as a marker of infection. Active immunization with recombinant P21 did not protect C3H mice from tick-borne B. burgdorferi infection, and passive transfer of P21 antiserum to infected mice did not alter the course of disease. These data suggest that the antigenic structure of B. burgdorferi changes during the early stages of murine infection.
Failure of Sulphonamides to Prevent Urinary Infections after Vaginal Surgery
Authors: M. P. Durham, R. A. Shooter, M. P. Curwen
Journal: BMJ (1954)

Among less important factors affecting cure, coccal infections were shown to respond best, those due to Bact. coli and Bact.aerogenes well, whereas infections due to Proteus, Ps. pyocyanea, and paracolon bacilli were more resistant to treatment.There was a clear relationship between the in vitro sensitivity of the organism and the outcome of treatment, and the use of laboratory sensitivity tests is advocated to avoid the prescription of inappropriate drugs.For most species identification only is no longer sufficient.No clear evidence was obtained that any one of the drugs used most often (sulphatriad, sulphadimidine, sulphathiazole, penicillin, streptomycin, and chlortetracycline) was superior to the others.aWe are grateful to our clinical colleagues for permitting us to use the material on which this investigation is based, and particularly to the Medical and Surgical Registrars for their collabora- tion.Among those who have been involved in heavy additional work we wish particularly to thank Miss E. J. Armour for tracing patients' records, and Mr. R.
Highly Sensitive Cardiac Troponin T Assay, Cardiac Disease, and Mortality Risk—Reply
Authors: James A. de Lemos
Journal: JAMA (2011)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Higher Serum 25-Hydroxy Vitamin D<sub>3</sub> Levels at Presentation Are Associated With Improved Survival From Melanoma, But There Is No Evidence That Later Prevailing Levels Are Protective
Authors: Peter E. Hutchinson, Joy E. Osborne, James H. Pringle
Journal: Journal of Clinical Oncology (2010)

We read with interest the article by Newton-Bishop et al, 1 which provides further clinical evidence that vitamin D has an effect on cutaneous melanoma (MM) outcome, as has been suggested by previous studies on vitamin D receptor (VDR) polymorphisms. 2,3][6][7] The authors 1 report two studies: the first, a retrospective study, was described as a pilot study for the second prospective study, though surprisingly, there was a long overlap period between the two.The retrospective study involved patients with at least a 3-year, relapse-free period following initial diagnosis of the MM, and serum for 25hydroxyvitamin D 3 [25(OH)D 3 ] was taken on patients' entry onto the study; the median time after diagnosis was 6.5 to 7.5 years.There was no statistically significant difference in serum 25(OH)D 3 between patients who did or did not experience relapse (P ϭ .3).In the prospective study, serum 25(OH)D 3 was estimated at a time close to presentation of the primary MM, and the serum was found to have a protective effect on Breslow thickness and an independent beneficial effect on relapse and survival.The serum 25(OH)D 3 at presentation is likely to be a reflection of levels before development of the MM and during early development of the MM; therefore, vitamin D appears to inhibit local invasion and micrometastases during early tumor development.This certainly underlines the need to maintain vitamin D levels in the community.The authors go on to state that ". . .patients with melanoma who are avoiding sun exposure should take vitamin D 3 supplements sufficient to ensure normal levels." 1 There are two implications of this: first, the authors believe that the prevailing vitamin D status after excision of the primary MM has an effect on survival in addition to that of the vitamin D status at presentation; and second, vitamin D is still protective during that phase.We would support the first contention, but we believe the second is unjustified.It seems likely that the development of clinical metastases is a function of vitamin D status during early development of the tumor, during local invasion and development of micrometastases, and after presentation, during the phase of growth of micrometastases into clinical metastases.Later vitamin D status was not investigated in the prospective study, but there were limited, relevant data in the retrospective study.In that study, there was no statistically significant difference in serum 25(OH)D 3 between patients who experienced relapse and those who did not, and the levels were apparently lower than those at presentation of the MM in the prospective study.This would suggest that, at
GLUT4 glucose transporter deficiency increases hepatic lipid production and peripheral lipid utilization
Authors: Ko Kotani, Odile D. Peroni, Yasuhiko Minokoshi, Olivier Boss, Barbara B. Kahn
Journal: Journal of Clinical Investigation (2004)

A critical defect in type 2 diabetes is impaired insulin-stimulated glucose transport and metabolism in muscle and adipocytes. To understand the metabolic adaptations this elicits, we generated mice with targeted disruption of the GLUT4 glucose transporter in both adipocytes and muscle (AMG4KO). In contrast to total body GLUT4-null mice, AMG4KO mice exhibit normal growth, development, adipose mass, and longevity. They develop fasting hyperglycemia and glucose intolerance and are at risk for greater insulin resistance than mice lacking GLUT4 in only one tissue. Hyperinsulinemic-euglycemic clamp studies showed a 75% decrease in glucose infusion rate and markedly reduced 2-deoxyglucose uptake into skeletal muscle (85-90%) and white adipose tissue (65%). However, AMG4KO mice adapt by preferentially utilizing lipid fuels, as evidenced by a lower respiratory quotient and increased clearance of lipids from serum after oral lipid gavage. While insulin action on hepatic glucose production and gluconeogenic enzymes is impaired, hepatic glucokinase expression, incorporation of 14C-glucose into lipids, and hepatic VLDL-triglyceride release are increased. The lipogenic activity may be mediated by increased hepatic expression of SREBP-1c and acetyl-CoA carboxylase. Thus, inter-tissue communication results in adaptations to impaired glucose transport in muscle and adipocytes that involve increased hepatic glucose uptake and lipid synthesis, while muscle adapts by preferentially utilizing lipid fuels. Genetic determinants limiting this "metabolic flexibility" may contribute to insulin resistance and type 2 diabetes in humans.
Candidal cystitis. Management by continuous bladder irrigation with amphotericin B
Authors: G. J. Wise
Journal: JAMA (1973)

Ten hospital patients with candidal infection of the urinary bladder were treated with continuous bladder irrigation with amphotericin B (50 mg/1,000 ml of sterile water via a three-way catheter for 24 hours for five days). No evidence of drug toxicity was observed. Infection was eradicated in seven patients. The three failures had clinical and serological evidence of disseminated infection that required systemic therapy.
Socialization in Medical Training: Exploring "Lifelong Curiosity" and a "Community of Support"
Authors: Deborah L. Kasman
Journal: The American Journal of Bioethics (2004)

��� ries of rules, and it suggests that doing so is part of becoming what they had not been. “Think what you will about morality; here is what doctors do.” We in no way wish to deny that the distinctive role of the physician creates distinctive moral challenges. Medical ethics education that gives priority to the development of good ethical deliberation over the imparting of moral truths can, in fact, give medical students and professionals the tools they need to work through many concerns in professionalism. What is called for by many medical educators who have accepted the centrality of professionalism, however, is not this kind of education at all, but instead, the accomplishment of two tasks: introducing students and residents to “professional standards,” and instilling a “professional attitude.” Hoping to create a specialized new curriculum to meet these objectives, however, is for the most part narrow-minded and misguided. “Professional standards” are readily available, and in themselves, rarely motivate (would-be) professionals to serious reoection, while “attitudinal” aspects of professionalism are probably better addressed by making medical schools places in which open, deliberate, and consistent conversation about excellence in medicine among faculty and students is a regular part of life. However, if intelligent reoection on “standards” and “attitudes” is what is desired, then before all else we need our students to be well-trained in being stimu
Influence of somatostatin on splanchnic glucose metabolism in postabsorptive and 60-hour fasted humans.
Authors: J Wahren, S Efendić, R Luft, L Hagenfeldt, O Björkman, P Felig
Journal: Journal of Clinical Investigation (1977)

Cyclic somatostatin was administered intravenously (10 mug/min for 60 min) to 10 healthy overnight fasted (postabsorptive) subjects and to 5 healthy 60-h fasted subjects. In both groups, arterial insulin and glucagon fell 50% and splanchnic release of these hormones was inhibited. In the overnight fasted subjects splanchnic glucose output fell 70%, splanchnic uptake of lactate and pyruvate was unchanged, alanine uptake fell by 25%, and glycerol uptake rose more than twofold in parallel with an increase in arterial glycerol. In the 60-h fasted group splanchnic glucose output was less than 40% of that observed in the overnight fasted subjects. Somatostatin led to a further decrease (--70%) in glucose production. Splanchnic uptake of lactate and pyruvate fell by 30-40%, amino acid uptake was unchanged, while uptake of glycerol rose fivefold. Total uptake of glucose precursors thus exceeded the simultaneous glucose output by more than 200%. Splanchnic uptake of FFA rose fourfold during somatostatin while output of beta-hydroxybutyrate increased by 75%. Estimated hepatic blood flow fell 25-35% and returned to base line as soon as the somatostatin infusion ended. It is concluded that (a) somatostatin-induced hypoglucagonemia results in inhibition of splanchnic glucose output in glycogen-depleted, 60-h fasted subjects as well as in postabsorptive subjects, indicating an effect of glucagon on hepatic gluconeogenesis as well as glycogenolysis; (b) the glucagonsensitive step(s) in gluconeogenesis affected by somatostatin involves primarily intra-hepatic disposal rather than net hepatic uptake of glucose precursors; (c) splanchnic uptake of fatty acids and ketone output are increased in the face of combined insulin and glucagon deficiency; and (d) diminished splanchnic blood flow may contribute to some of the effects of somatostatin on splanchnic metabolism.
Reinventing a broken wheel
Authors: Barbara Landau
Journal: Behavioral and Brain Sciences (1999)

Barsalou is right in arguing that perception has been unduly neglected in theories of concept formation. However, the theory he proposes is a weaker version of the classical empirical hypothesis about the relationship between sensation, perception, and concepts. It is weaker because it provides no principled basis for choosing the elementary components of perception. Furthermore, the proposed mechanism of concept formation, growth and development – simulation – is essentially equivalent to the notion of a concept, frame, or theory, and therefore inherits all the well-known problems inherent in these constructs. The theory of simulation does not provide a clearly better alternative to existing notions.
The District of Columbia's Experiences With the Alcoholic
Authors: Murray Grant
Journal: JAMA (1967)

The landmark decision of the Washington, DC, courts in the Easter case declared the alcoholic to be sick rather than criminal. A variety of rehabilitation programs were initiated, but they are only a beginning in the treatment of Washington's estimated 45,000 alcoholics. Similar decisions affecting many areas of the United States are inevitable and will require the medical profession to take action. Is the profession ready to exercise its leadership role in the development of appropriate treatment facilities?
Laparoscopic Features of Primary Biliary Cirrhosis in AMA-Positive and AMA-Negative Patients
Authors: S. Fujioka, K. Yamamoto, R. Okamoto, M. Miyake, K. Ujike, N. Shimada, R. Terada, Y. Miyake, H. Nakajima, C.-Y. Piao, Y. Iwasaki, M. Tanimizu, T. Tsuji
Journal: Endoscopy (2002)

Background and Study Aims: Antimitochondrial antibody (AMA)-negative primary biliary cirrhosis (PBC) has been difficult to diagnose. Laparoscopic features of AMA-negative PBC were evaluated in comparison with those of AMA-positive PBC and autoimmune hepatitis. Patients and Methods: 71 patients who fulfilled the diagnostic criteria for PBC were enrolled in the study; 48 were AMA-positive and 23 were AMA-negative. As a disease control, 46 autoimmune hepatitis patients were included. Both the frequency and specificity of each laparoscopic finding were evaluated. A laparoscopic scoring system was introduced, which used, common and uncommon laparoscopic findings, and was evaluated for the diagnosis of AMA-negative PBC. Results: The characteristic laparoscopic findings for AMA-positive PBC were yellowish-white marking (92 %), dark-brown discoloration (73 %), gentle undulation (67 %), reddish patch (38 %), and yellowish-white nodules (32 %). On the other hand, laparoscopic findings such as trench-like depression, reddish markings, and wide and small depressions were uncommon in PBC compared with autoimmune hepatitis. The frequencies of characteristic and uncommon laparoscopic findings did not differ statistically between AMA-positive and AMA-negative PBC, but were different between AMA-positive or AMA-negative PBC and autoimmune hepatitis. Scores based on common and uncommon laparoscopic findings were 5.5 ± 1.5 (mean ± SD) in AMA-positive PBC, 5.6 ± 2.0 in AMA-negative PBC, and - 0.30 ± 0.5 in autoimmune hepatitis. Conclusion: The laparoscopic findings in AMA-negative PBC did not differ from those of AMA-positive PBC. A laparoscopic scoring system may be helpful in the diagnosis of AMA-negative PBC.
The Denver II
Authors: Laurel Naversen Geraghty
Journal: JAMA (2010)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal