tbuckley/cabot-search huggingface dataset:
Do Integrated Medical Groups Provide Higher-Quality Medical Care than Individual Practice Associations?
Authors: Ateev Mehrotra, Arnold M. Epstein, Meredith B. Rosenthal
Journal: Annals of Internal Medicine (2006)

The association between the organizational structure of physician groups and health care quality has never been evaluated empirically.To examine whether integrated medical groups (IMGs) provide higher-quality primary care than individual practice associations (IPAs).Cross-sectional study.PacifiCare, a large health maintenance organization.Approximately 1.7 million enrollees of PacifiCare cared for by 119 California physician groups between July 1999 and June 2000.The percentage of eligible PacifiCare enrollees who received mammography, Papanicolaou smear screening, chlamydia screening, diabetic eye examination, an asthma controller medication, or a beta-blocker after acute myocardial infarction.Physician groups identified as IMGs, compared with those identified as IPAs, had higher rates of mammography (relative risk, 1.15 [95% CI, 1.01 to 1.33]), Papanicolaou smear screening (relative risk, 2.29 [CI, 1.53 to 3.42]), chlamydia screening (relative risk, 2.17 [CI, 1.04 to 4.55]), and diabetic eye screening (relative risk, 1.55 [CI, 1.28 to 1.88]). Leaders of IMGs were more likely to report using EMRs (37% vs. 2%; P < 0.001) and quality improvement strategies, but these characteristics explained little of the quality differences between IMGs and IPAs.Organizational characteristics, including group type, were reported by physician group leaders and not directly assessed. Patient characteristics that could have accounted for some of the observed differences also were not assessed.Patients cared for in IMGs generally received higher-quality primary care than those cared for in IPAs. Having an EMR and implementation of quality improvement strategies did not explain the differences in quality. These findings suggest that physician group type influences health care quality.
Small-Intestinal Histopathology and Mortality Risk in Celiac Disease
Authors: Jonas F. Ludvigsson
Journal: JAMA (2009)

Studies of mortality in celiac disease have not taken small-intestinal pathology into account.To examine mortality in celiac disease according to small-intestinal histopathology.Retrospective cohort study. We collected data from duodenal/jejunal biopsies taken between July 1969 and February 2008 on celiac disease (Marsh stage 3: villous atrophy; n = 29,096 individuals) and inflammation (Marsh stage 1-2; n = 13,306) from all 28 pathology departments in Sweden. A third cohort consisted of individuals with latent celiac disease from 8 university hospitals (n = 3719). Latent celiac disease was defined as positive celiac disease serology in individuals with normal mucosa (Marsh stage 0). Through linkage with the Swedish Total Population Register, we estimated the risk of death through August 31, 2008, compared with age- and sex-matched controls from the general population.All-cause mortality.There were 3049 deaths among patients with celiac disease, 2967 with inflammation, and 183 with latent celiac disease. We found an increased hazard ratio (HR) for death in celiac disease (HR, 1.39; 95% confidence interval [CI], 1.33-1.45; median follow-up, 8.8 years), inflammation (HR, 1.72; 95% CI, 1.64-1.79; median follow-up, 7.2 years), and latent celiac disease (HR, 1.35; 95% CI, 1.14-1.58; median follow-up, 6.7 years). The absolute mortality rate was 10.4 (95% CI, 10.0-10.8) per 1000 person-years in celiac disease, 25.9 (95% CI, 25.0-26.8) in inflammation, and 6.7 (95% CI, 5.7-7.6) in latent celiac disease. Excess mortality was 2.9 per 1000 person-years in celiac disease, 10.8 in inflammation, and 1.7 in latent celiac disease. This risk increase was also seen in children. Excluding the first year of follow-up, HRs decreased somewhat.Risk of death among patients with celiac disease, inflammation, or latent celiac disease is modestly increased.
Immunohistochemical detection and immunochemical analysis of type II collagen degradation in human normal, rheumatoid, and osteoarthritic articular cartilages and in explants of bovine articular cartilage cultured with interleukin 1.
Authors: G R Dodge, A R Poole
Journal: Journal of Clinical Investigation (1989)

Articular cartilage destruction and loss of function in arthritic diseases involves proteolytic degradation of the connective tissue matrix. We have investigated the degradation of cartilage collagen by developing immunochemical methods that permit the identification and analysis of type II collagen degradation in situ. Previously, a technique to specifically identify type II collagen degradation in situ in articular cartilage did not exist. These methods utilize a polyclonal antiserum (R181) that specifically reacts with unwound alpha-chains and CNBr-derived peptides, alpha 1(II)CB11 and alpha 1(II)CB8, of human and bovine type II collagens. The experimental approach is based on the fact that when fibrillar collagens are cleaved the helical collagen molecule unwinds, exposing hidden epitopes. Here we demonstrate the use of R181 in studying type II collagen degradation in bovine articular cartilage that has been cultured with or without IL-1 and in human normal, rheumatoid, and osteoarthritic articular cartilages. Compared to cartilages either freshly isolated or cultured without IL-1, bovine cartilage cultured with IL-1 for 3-5 d showed an increase in both pericellular and intercellular immunohistochemical staining. Extracts of these cartilages contained type II collagen alpha chains that were increased in amount after culture with IL-1 for 11 d. In addition, culture with IL-1 resulted in the appearance of alpha chain fragments of lower molecular weight. All human arthritic tissues examined showed areas of pronounced pericellular and territorial staining for collagen degradation as compared with non-diseased tissues, indicating that chondrocytes are responsible in part for this degradation as compared with non-diseased tissues. In most cases rheumatoid cartilage was stained most intensely at the articular surface and in the deep and mid-zones, whereas osteoarthritic cartilage usually stained more in the superficial and mid-zones, but less intensely. Distinct patterns of sites of collagen degradation reflect differences in collagen destruction in these diseases, suggesting possible different sources of chondrocyte activation. These experiments demonstrate the application of immunological methods to detect collagen degradation and demonstrate an increase of collagen degradation in human arthritides and in IL-1-treated viable bovine cartilage.
d-Tubocurarine Chloride in Electro-Convulsion Therapy
Authors: A. Gillis, D. D. Webster
Journal: BMJ (1947)

The efficacy and dosage of curare preparations are con- sidered, and techniques employing trilene for abdominal cases and cyclopropane for thoracic cases described.Twenty cases with ocular complications are reported.The effect of curare on the blood pressure and on severe laryngeal spasm is also mentioned.An analysis of post-operative results is given and eight deaths after curarization are discussed.My thanks are due to Dr. C. Langton Hewer for his kind permission to publish this paper
Arsenic in the drinking water of the city of Antofagasta: epidemiological and clinical study before and after the installation of a treatment plant.
Authors: J M Borgoño, P Vicent, H Venturino, A Infante
Journal: Environmental Health Perspectives (1977)

This is a second report of epidemiological and clinical investigation, related to the arsenic health problem, unique in the world, occurring in the city of Antofagasta, Chile. The arsenic problem originates in the chronic contamination of water supply in the city during 12 years. This phenomena, investigated clinically and epidemiologically and first reported in 1971, prompted the installation of a water treatment plant. This report aims to evaluate the working efficiency of the plant. The study was carried out through the examination of arsenic content in hair and nail clipping samples of the inhabitants of Antofagasta and the determination of this element in cultivated vegetables and carbonated beverages. Also a clinical study in school children, looking for cutaneous lesions attributed to arsenicism, was made. Results are encouraging. They reveal that contamination persists but in significantly lower levels.
Preclinical Carcinoma of the Cervix Uteri
Authors: Larry McGowan
Journal: JAMA (1968)

Two investigators from Australia, one skilled in colposcopy and clinical gynecology and the other equally knowledgeable in the basic science aspects of regeneration and preneoplastic systems, have written an outstanding text. Colposcopy is clearly and completely detailed as well as related topics such as cervical capillary angioarchitecture, cervical dysplasia, physiological squamous metaplasia, and the early detection and treatment of preclinical squamous cell carcinoma of the cervix. Devoting several chapters to laboratory studies, the authors also include the cell biology of metaplasia and the application of general cancer theory to its process, the search for mutagens, and mutagenesis and cancer. The illustrations, numerous and superior in quality, complement the text at appropriate places, and the references are pertinent and up to date. While they question many of the interpretations placed in cells of cervical tissues studied by the ancillary diagnostic methods of exfoliative cytology and histology, the authors stress that the
Nitric oxide synthesis in the lung. Regulation by oxygen through a kinetic mechanism.
Authors: R A Dweik, D Laskowski, H M Abu-Soud, F Kaneko, R Hutte, D J Stuehr, S C Erzurum
Journal: Journal of Clinical Investigation (1998)

In this study, we show that oxygen regulates nitric oxide (NO) levels through effects on NO synthase (NOS) enzyme kinetics. Initially, NO synthesis in the static lung was measured in bronchiolar gases during an expiratory breath-hold in normal individuals. NO accumulated exponentially to a plateau, indicating balance between NO production and consumption in the lung. Detection of NO2-, NO3-, and S-nitrosothiols in lung epithelial lining fluids confirmed NO consumption by chemical reactions in the lung. Interestingly, alveolar gas NO (estimated from bronchiolar gases at end-expiration) was near zero, suggesting NO in exhaled gases is not derived from circulatory/systemic sources. Dynamic NO levels during tidal breathing in different airway regions (mouth, trachea, bronchus, and bronchiole) were similar. However, in individuals breathing varying levels of inspired oxygen, dynamic NO levels were notably dependent on O2 concentration in the hypoxic range (KmO2 190 microM). Purified NOS type II enzyme activity in vitro was similarly dependent on molecular oxygen levels (KmO2 135 microM), revealing a means by which oxygen concentration affects NO levels in vivo. Based upon these results, we propose that NOS II is a mediator of the vascular response to oxygen in the lung, because its KmO2 allows generation of NO in proportion to the inspired oxygen concentration throughout the physiologic range.
Our New Home
Authors: Adrienne Weiss-Harrison
Journal: JAMA (1987)

<h3>To the Editor.—</h3> After reading "Our New Home"<sup>1</sup>in the A PIECE OF MY MIND column in the Dec 26,1986, issue, I felt compelled to respond. It was surprising to me, after I had read so many fine pieces in this column about touching experiences in the molding of physicians, that you would publish an essay centered on self-pity. It is difficult to believe that Mrs Lovett has been unable to make friends in Denver—unless she hasn't tried. By October of the internship year, she could have joined a mother-toddler group— most major cities have many to choose from, and the cost is minimal; become friendly with other families from the internship program; become friendly with other families from her daughter's preschool; called the pastor of her church and asked him to suggest a church-sponsored group to join; been more persistent in searching for employment, including consulting employment agencies;
Learning from the TGN1412 trial
Authors: Michael Goodyear
Journal: BMJ (2006)

Learning from the TGN1412 trialThis experience should foster an open culture in medical research E arlier this month eight healthy volunteers in a phase I trial received a T cell agonist at Parexel's clinical pharmacology research unit at Northwick Park Hospital, London. 1 The six men who received the active component rapidly developed catastrophic multisystem failure; the remaining two, who received a placebo, were unharmed.At the time of going to press, two remained in a critical condition.This was the first human trial of TeGenero's TGN1412, a new humanised monoclonal superagonist of the CD28 T cell surface receptor, 2 designed to mitigate autoimmune and immunodeficiency disease.This allegedly unprecedented event in clinical research represents a very human tragedy, one which will probably change for ever the face of clinical drug development and testing, and one which gives us the opportunity to learn many valuable lessons.A system based approach to learning is more likely to generate useful outcomes than one that is narrowly explanatory and blame oriented.Yet health care has been learning this lesson slowly and painfully. 3Nobody should be surprised that this disaster happened: even rare events have finite probabilities. 4
Loading Dose and Monitoring of Warfarin Therapy-Reply
Authors: Geoffrey C. Lamb
Journal: JAMA (1997)

The purpose of my article was to make a recommendation regarding the use of a loading dose of warfarin. There was no intent to make any recommendation regarding the frequency of monitoring the INR. The phrase "titrate the daily dose based on the INR" found in the conclusion is not meant to imply that the INR should be measured daily. The letter from Dr Portnoi makes a valid point. The pharmacodynamics of warfarin are such that daily monitoring of the INR is excessive in most cases. In selected patients at risk for bleeding, early measurement of the INR may identify the patient who is very sensitive to the effects of warfarin before the active clotting factors are fully inhibited. In most cases, Portnoi's recommendations make sense for the inpatient setting. In the outpatient setting, daily monitoring is usually impractical, and intervals of 3 to 7 days for initial monitoring may
Clinical and Bacteriological Evaluation of Antibiotic Treatment in Shigellosis
Authors: Myron J. Tong
Journal: JAMA (1970)

Ampicillin trihydrate, administered orally, significantly shortened the duration of diarrhea, abdominal cramps, and fever in 30 adults with shigellosis, when compared to the duration of these symptoms in 30 nontreated controls. Ampicillin also effectively eliminated shigallae from the intestinal tract within 24 to 48 hours of therapy in a majority of cases. In contrast, kanamycin sulfate, given parenterally, was not effective in altering the clinical course, nor in decreasing the number of patients excreting shigellae. Thirty percent (9) of patients treated with ampicillin and 40% (24) in both the kanamycin and control groups continued to shed shigellae 12 days after the start of antibiotic therapy. Although ampicillin therapy effectively shortened the clinical course of shigellosis, further studies are needed to determine whether convalescent excretion of shigellae can be eliminated with either higher doses or a longer course of antibiotic therapy.
Combinatorial effects of interleukin 10 and interleukin 4 determine the progression of hepatic inflammation following murine enteric parasitic infection
Authors: Diana B. Douglas, Daniel P. Beiting, John P. Loftus, Judith A. Appleton, Susan K. Bliss
Journal: Hepatology (2010)

Mice lacking the immunoregulatory cytokine interleukin 10 (IL-10) develop necrotizing hepatitis after infection with Trichinella spiralis , and inflammation is dependent on the migration of intestinally activated CD4+ T cells into the liver. Hepatic production of IL-4 is elevated in these mice, and we hypothesized that it plays a role in the development of hepatic pathology. Wild-type (WT), IL-10 knockout (KO), IL-4 KO, and IL-10/IL-4 KO mice were orally infected, and disease progression was followed by histological examination, alanine aminotransferase assays, and flow cytometric analysis of hepatocellular content. Both IL-10 KO and IL-10/IL-4 KO mice experienced hepatocellular injury, but only IL-10 KO mice advanced to a necrotic phase. Hepatic CD4+ T cells were the major source of IL-4, and IL-10 regulated the number of intestinally-derived CD4+IL-4+ cells. Sequestration of activated neutrophils in the liver required IL-4, and neutrophil depletion prevented progression to overt necrosis. Adoptive transfer of intestinal WT CD4+ T cells inhibited neutrophil accumulation and inflammation, but their regulatory effects did not require IL-10 signaling. Conclusion: The absence of IL-10 led to hepatocyte injury during infection, but IL-4 was necessary for the development of neutrophil-dependent necrosis. These studies provide new insight into the combinatorial role of these cytokines and their targets in the generation and progression of hepatic inflammation. (Hepatology 2010;)
ACE2 and Ang-(1-7) Confer Protection Against Development of Diabetic Retinopathy
Authors: Amrisha Verma, Zhiying Shan, Bo Lei, Lihui Yuan, Xuan Liu, Takahiko Nakagawa, Maria B Grant, Alfred S Lewin, William W Hauswirth, Mohan K Raizada, Qiuhong Li
Journal: Molecular Therapy (2011)

Despite evidence that hyperactivity of the vasodeleterious axis (ACE/angiotensin II (Ang II)/AT1 receptor) of the renin-angiotensin system (RAS) is associated with the pathogenesis of diabetic retinopathy (DR) use of the inhibitors of this axis has met with limited success in the control of this pathophysiology. We investigated the hypothesis that enhancing the local activity of the recently established protective axis of the RAS, ACE2/Ang-(1-7), using adeno-associated virus (AAV)-mediated gene delivery of ACE2 or Ang-(1-7) would confer protection against diabetes-induced retinopathy. Genes expressing ACE2 and Ang-(1-7) were cloned in AAV vector. The effects of ocular AAV-ACE2/Ang-(1-7) gene transfer on DR in diabetic eNOS(-/-) mice and Sprague-Dawley (SD) rats were examined. Diabetes was associated with approximately tenfold and greater than threefold increases in the ratios of ACE/ACE2 and AT1R/Mas mRNA levels in the retina respectively. Intraocular administration of AAV-ACE2/Ang-(1-7) resulted in significant reduction in diabetes-induced retinal vascular leakage, acellular capillaries, infiltrating inflammatory cells and oxidative damage in both diabetic mice and rats. Our results demonstrate that DR is associated with impaired balance of retinal RAS. Increased expression of ACE2/Ang-(1-7) overcomes this imbalance and confers protection against DR. Thus, strategies enhancing the protective ACE2/Ang-(1-7) axis of RAS in the eye could serve as a novel therapeutic target for DR.
Use of SSRIs during pregnancy was not associated with increased risk for stillbirth or neonatal mortality
Authors: Brian Budenholzer
Journal: Annals of Internal Medicine (2013)

ACP Journal Club18 June 2013Use of SSRIs during pregnancy was not associated with increased risk for stillbirth or neonatal mortalityBrian Budenholzer, MDBrian Budenholzer, MDEast Carolina University Brody School of Medicine, Greenville, North Carolina, USA (B.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-12-201306180-02012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationJimenez-Solem E, Andersen JT, Petersen M, et al. SSRI use during pregnancy and risk of stillbirth and neonatal mortality. Am J Psychiatry. 2013;170:299-304. https://pubmed.ncbi.nlm.nih.gov/23361562Clinical Impact RatingsGIM/FP/GP: References1 GlaxoSmithKline. Paroxetine and pregnancy. www.gsk.com/media/paroxetine_pregnancy.htm (accessed 14 Apr 2013). Google Scholar2 Källén BA, Otterblad Olausson P. Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations. Birth Defects Res A Clin Mol Teratol. 2007;79:301-8. [PMID: 17216624] Google Scholar3 ACOG Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111:1001-20. [PMID: 18378767] Google Scholar Author, Article, and Disclosure InformationAuthors: Brian Budenholzer, MDAffiliations: East Carolina University Brody School of Medicine, Greenville, North Carolina, USA (B.B.)This article was published at Annals.org on 4 June 2013. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 June 2013Volume 158, Issue 12Page: JC12KeywordsBirthCohort studiesMortalityObservational studiesPregnancyPreterm birthRandomized trialsSafetySelective serotonin reuptake inhibitorsStillbirths ePublished: 18 June 2013 Issue Published: 18 June 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
SPREADING PROPERTIES OF LEECH EXTRACTS AND THE FORMATION OF LYMPH
Authors: Albert Claude
Journal: The Journal of Experimental Medicine (1937)

1. The injection of leech extracts into the skin increases its permeability, as shown both by the spread of fluid and of foreign particles through the dermis. The spread is followed some hours after the injection by more or less edema of the subcutaneous tissue. 2. A preliminary study of the chemical properties of the leech spreading factor indicates a similarity with the spreading factor prepared from testicle. 3. Attempts to separate the leech spreading and anticoagulating factors showed that the two have practically the same distribution in the leech body, extracts from the separated head being the most active. 4. It is undetermined whether two distinct factors are responsible for the spreading and anticoagulating properties of leech extracts. A chemical similarity is suggested by the fact that agents which affect the activity of one factor have a parallel effect on the other. 5. The mechanism of the spread produced by leech extracts and by other spreading agents is discussed.
Retinaldehyde dehydrogenase 1 regulates a thermogenic program in white adipose tissue
Authors: Florian W Kiefer, Cecile Vernochet, Patrick O'Brien, Steffen Spoerl, Jonathan D Brown, Shriram Nallamshetty, Maximilian Zeyda, Thomas M Stulnig, David E Cohen, C Ronald Kahn, Jorge Plutzky
Journal: Nature Medicine (2012)
Opportunity cost of antidepressant prescribing in England: analysis of routine data
Authors: Sandra Hollinghurst, David Kessler, Tim J Peters, David Gunnell
Journal: BMJ (2005)

Recently, prescribing of antidepressant drugs has increased exceptionally. 1 At the same time, concerns have been raised about the medicalisation of human distress and, more recently, about the safety of antidepressants. 1 Many general practitioners would like to refer patients for psychological treatment, for which there is good evidence of effectiveness, 2 but are constrained by the lack of NHS therapists.We estimated the opportunity cost of the recent rise in antidepressant prescribing by valuing it in terms of an effective alternative treatment-cognitive behaviour therapy.