tbuckley/cabot-search huggingface dataset:
Health maintenance organizations
Authors: W. H. Crosby
Journal: JAMA (1976)

A RETIRED regular Army colonel was asked how he liked civilian life. "I don't know," he said. "All these people running around, and nobody's in charge." Obviously, the colonel, used to doing things the Army way for 30 years, was finding it tough to understand and adapt to a different way of life. And so it is with health maintenance organizations (HMOs). Much is being written, laws have been passed, HMOs are springing up all over, and yet the public, and indeed many physicians and allied professionals, are in large measure uninformed and confused as to what HMOs are all about. This explains, at least in part, the difficulty some HMOs are experiencing in marketing and the resistance of segments of the medical profession in accepting and supporting them. <h3>A Definition</h3> Health maintenance organization, a brief and catchy phrase, proposes a profound change in our health care provision system. Note!
Outdoor, Indoor, and Personal Exposure to VOCs in Children
Authors: John L. Adgate, Timothy R. Church, Andrew D. Ryan, Gurumurthy Ramachandran, Ann L. Fredrickson, Thomas H. Stock, Maria T. Morandi, Ken Sexton
Journal: Environmental Health Perspectives (2004)

We measured volatile organic compound (VOC) exposures in multiple locations for a diverse population of children who attended two inner-city schools in Minneapolis, Minnesota. Fifteen common VOCs were measured at four locations: outdoors (O), indoors at school (S), indoors at home (H), and in personal samples (P). Concentrations of most VOCs followed the general pattern O ≈ S < P ≤ H across the measured microenvironments. The S and O environments had the smallest and H the largest influence on personal exposure to most compounds. A time-weighted model of P exposure using all measured microenvironments and time–activity data provided little additional explanatory power beyond that provided by using the H measurement alone. Although H and P concentrations of most VOCs measured in this study were similar to or lower than levels measured in recent personal monitoring studies of adults and children in the United States, p-dichlorobenzene was the notable exception to this pattern, with upper-bound exposures more than 100 times greater than those found in other studies of children. Median and upper-bound H and P exposures were well above health benchmarks for several compounds, so outdoor measurements likely underestimate long-term health risks from children's exposure to these compounds.
Prospective Multicenter Study of Bone Scintigraphy in Consecutive Patients With Newly Diagnosed Prostate Cancer
Authors: Helle Damgaard Zacho, Tamás Barsi, Jesper C. Mortensen, Maureen K. Mogensen, Henrik Bertelsen, Norah Josephsen, Lars J. Petersen
Journal: Clinical Nuclear Medicine (2013)

International guidelines uniformly suggest no routine staging of bone metastasis in patients with bone scintigraphy (BS) in low-risk prostate cancer (PCa). These recommendations are based on retrospective investigations only. In addition, BS has most often been reported as a definitive investigation with no room for equivocal cases.The objective of this study was to determine the diagnostic value of BS in a large cohort of consecutive patients with newly diagnosed PCa.Over a period of 1.5 years in 2008 to 2009, consecutive patients with newly diagnosed PCa were enrolled in a noninterventional, multicenter, observational study. All patients had a whole-body, planar BS. Clinical history and clinical, pathological, and biochemical data were obtained from electronic patient files and questionnaires.Bone scintigraphy was classified into 4 categories as nonmalignant, equivocal, likely malignant, or multiple metastasis. The primary end point was final imaging, which was a composite end point of BS and additional CT and MRI investigations.A total of 635 eligible patients were recruited. Their median prostate-specific antigen (PSA) was 15 ng/mL, median Gleason was 7, and 80% of patients had local disease (T1 or T2). The proportion of nonmalignant BS was 61%, equivocal scans 26%, and likely or definitive metastasis 13%. A total of 154 patients had additional CT or MRI investigations. The final imaging diagnosis showed a prevalence of bone metastases in 87 (13.7%) of 635 patients. No bone metastases were observed in (1) patients with PSA of less than 10 ng/mL, independently of the clinical Tstage and Gleason score (n = 212) and (2) PSA of less than 20 ng/mL if Tstage is less than T3 and Gleason score is less than 8 (n = 97). Approximately 50% of the patients enrolled in this study met these criteria.This is the first prospective trial to demonstrate that BS can be avoided in patients with low-risk PCa.
Forecasting Physician Workforce Requirements
Authors: Philip E. Veenhuis
Journal: JAMA (1995)

<h3>To the Editor.</h3> —The article by Dr Weiner<sup>1</sup>impels the following comments. Weiner shows in his Table 2 that HMO staffing for psychiatry in the seven Kaiser plans and Kaiser Portland at 3.8 per 100 000 population and 4.8 per 100 000 population, respectively. The same table shows the 1992 US supply of psychiatrists at 12 per 100000 population. This, of course, documents a significant oversupply of psychiatrists. However, it is important to recognize that managed care generally, and HMOs particularly, are thought to significantly underutilize psychiatrists. This is done by limiting utilization of the mental health benefit to "acute conditions." In some areas, this is permitted by state statute. The sickest patients with psychiatric disease and the most expensive to care for have schizophrenia, bipolar disorder, and/or multiple psychiatric diagnoses, including substance abuse and medical comorbidities. These disorders tend to be chronic, intermittent, and/or relapsing. Management of care
MORE PROBLEMS IN BIOMEDICAL MORES
Authors: CLARK MILLIKAN
Journal: Annals of Internal Medicine (1967)

Letters and Comments1 September 1967MORE PROBLEMS IN BIOMEDICAL MORESCLARK MILLIKAN, M.D.CLARK MILLIKAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-67-3-678 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor:At the Annual Session of the College in San Francisco I sat fascinated for 3-plus hours, listening to the excursion into "The Changing Mores of Biomedical Research." Presumably this is to be published, and, certainly, goodly portions of it should reach the printed page. While listening to the various descriptions with some suggestions for possible solution concerning artificial insemination, birth control, infanticide, euthanasia, genetic manipulation, and organ transplantation, I kept waiting for one that never appeared. The items mentioned above are neat, important, andwell-recognizedexamples where ethical, moral, and legal problems exist, and with all of... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: CLARK MILLIKAN, M.D.Affiliations: Sections of Neurology Mayo Clinic Rochester, Minn. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1967Volume 67, Issue 3_Part_1Page: 678-678KeywordsArtificial inseminationEuthanasiaFemale contraceptionGeneticsOrgan transplantation ePublished: 1 December 2008 Issue Published: 1 September 1967 PDF downloadLoading ...
Acceptability of opportunistic screening for occult gastrointestinal blood loss.
Authors: F. D. Hobbs, R. C. Cherry, J. W. Fielding, L. Pike, R. Holder
Journal: BMJ (1992)

OBJECTIVE--To test patient compliance for faecal occult blood testing in suburban and inner city general practice. DESIGN--Prospective opportunistic trial using the Haemoccult test kit. Tests were offered during routine surgery attendance. SETTING--Three group general practices in Birmingham. SUBJECTS--All patients aged 40 years or older on the start date who routinely attended surgery during two years. MAIN OUTCOME MEASURES--Numbers of patients approached for testing and the numbers refusing, accepting, and returning the test kits. RESULTS--Only 26.3% (1230/4677) of the potential target population had been screened within the two years, although 988 (39.3%) of the suburban practice target were screened. However, 55.7% (1230/2207) of patients actually offered a test returned completed kits, with only 6% (133) refusing the kit. 683 (61.6%) patients aged 50-69 returned kits, compared with 343 (54.3%) aged 70 or over and 204 (43.8%) aged 40-49. These differences were significant (p less than 0.001). Patients from the inner city practice were significantly less likely to be offered the test than those in suburban practice (242 (11.2%) v 988 (39.9%), p less than 0.001) and return the samples (242 (38.8%) v 988 (62.4%), p less than 0.001). Patients from the inner city practice were also more likely to refuse the test (78 (12.5%) v 55 (3.5%), p less than 0.001). CONCLUSIONS--Opportunistic testing for occult faecal blood in asymptomatic patients was reasonably acceptable to patients, especially those in a suburban practice. If the test is shown to reduce mortality from colorectal cancer then formal screening would probably achieve acceptable target rates, especially among patients aged 50-69, who represent the prime risk group.
Genitourinary Tumors: Fundamental Principles and Surgical Techniques
Authors: Harry Bergman
Journal: JAMA (1983)

Doctors Johnson and Boileau have edited a comprehensive book on genitourinary tumors. They state that in seven sections it will supply the state of the art of urologic oncology and describe the more common surgical procedures. This they have done very well. Authorities in various fields of urologic cancer give us their expertise in a well-constructed compendium. An "overview" at the beginning of each major chapter briefly traces the history of the respective neoplasms, various classifications describing grading, staging, latest diagnostic procedures, and the newest modalities of therapy. A summation "commentary" at the end of each organ presentation by a well-known expert describes his opinion of the previous chapters and any agreement or disagreement he may have with the contents. Almost all of these are well structured and informative. Cancer of the prostate, well discussed, reveals the present enigmatic state of staging, grading, and treatment. There is definite disagreement between
Response to Letter Regarding Article, “Outcomes of Patients With Acute Type A Aortic Intramural Hematoma”
Authors: Jae-Kwan Song, Ji Hye Yim, Jung-Min Ahn, Dae-Hee Kim, Jong-Min Song, Duk-Hyun Kang, Joon-Won Kang, Tae-Hwan Lim, Taek Yeon Lee, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee
Journal: Circulation (2010)
The Urokinase-Pulmonary Embolism Trial
Authors: Geza de Takats
Journal: JAMA (1974)

<h3>To the Editor.—</h3> Dr. Richard Sautter accuses my recent editorial of a misinterpretation of the findings of a cooperative trial organized to evaluate the thrombolytic activity of urokinase in pulmonary embolism. The report did yield valuable data, and the immense amount of detailed work is admirable. What the editorial objected to can be summed up under two headings. First, thrombolytic agents such as streptokinase and urokinase have long been known to dissolve fresh clots in the vascular system. Dr. Sautter and his associates have notably contributed to this subject, having shown quite recently that the response of the fibrinolytic system to surgical stress varies from patient to patient, a subject in which my associates and I have been involved for a long time. Obviously, the defensive mechanisms of the body depend on many factors, and defective thrombolysis may well be an important factor in the formation and lysis of thromboemboli
Cellular and molecular alterations in the adrenergic system with cardiomyopathy induced by tachycardia
Authors: F. G Spinale, G. E Tempel, R. Mukherjee, D. M Eble, R. Brown, C. A Vacchiano, M. R Zile
Journal: Cardiovascular Research (1994)

The aim was to examine the relationship between changes in myocyte function to changes in protein and mRNA content of components of the beta adrenergic system with tachycardia induced cardiomyopathy.Contractile function and beta adrenergic responsiveness were measured in isolated myocytes from control pigs (n = 6) and in pigs subjected to three weeks of pacing induced supraventricular tachycardia (n = 6). beta Receptor density and affinity, the relative content of the stimulatory (Gs) and inhibitory (Gi) subunits of the G protein complex, and adenylate cyclase activity were determined from sarcolemmal preparations. In order to determine whether these changes were accompanied by alterations in steady state mRNA levels for specific components of the beta adrenergic system, mRNA content for the beta 1 adrenergic receptor and the G alpha s and G alpha i2 subunits of the G protein complex was measured.Chronic supraventricular tachycardia caused a 36% increase in left ventricular end diastolic dimension and a 61% decrease in left ventricular fractional shortening compared to controls. The velocity of isolated myocyte shortening was 50% lower in myocytes from hearts with tachycardia cardiomyopathy than in control myocytes. In the presence of 50 nM isoprenaline or 2 microM forskolin, the velocity of myocyte shortening was 65% lower in the myopathic myocytes than in the controls. With the development of tachycardic cardiomyopathy, beta adrenergic receptor density fell by 25% with no change in affinity, Gs decreased by 35%, and Gi increased by over 50% compared to controls. Basal adenylate cyclase activity and isoprenaline and forskolin stimulated adenylate cyclase activity fell by over 50% with supraventricular tachycardia compared to controls. The relative content of G alpha i2 mRNA increased threefold with the development of tachycardic cardiomyopathy with no change in the relative abundance of mRNA for the beta 1 receptor or G alpha s when compared with controls.The changes in myocyte beta adrenergic responsiveness with the development of tachycardic cardiomyopathy are due to alterations in cellular mechanisms (decreased beta receptor and Gs density, increased Gi) and in molecular mechanisms (increased Gi mRNA content).
Control of diarrhoeal disease in Tonga 1978-83.
Authors: D J Clow
Journal: BMJ (1985)

Tonga, like many developing countries, suffers from a shortage of medical staff and a high morbidity and mortality from paediatric diarrhoeal disease. In 1980 a programme was started to train medical assistants and village administrators in the correct use of oral rehydration salt solution for rehydration. The effect on morbidity, mortality, and admission to hospital over the six years 1978-83 was assessed. After the introduction of the scheme the number of deaths due to diarrhoea fell considerably and the state of hydration in children admitted to hospital with diarrhoea greatly improved. It is recommended that similar programmes be adopted where clinical problems of diarrhoea with dehydration persist. Instruction in the use of oral rehydration fluid was most effectively given by non-medical staff to groups of mothers, rather than by paediatricians in their inevitably brief, although important, explanation given in hospital.
In Vivo Spin Trapping of Glyceryl Trinitrate–Derived Nitric Oxide in Rabbit Blood Vessels and Organs
Authors: Alexander Mülsch, Peter Mordvintcev, Eberhard Bassenge, Frank Jung, Bernd Clement, Rudi Busse
Journal: Circulation (1995)

The objectives of this study were (1) to assess glyceryl trinitrate (GTN)-derived nitric oxide (NO) formation in vascular tissues and organs of anesthetized rabbits in vivo, (2) to establish a correlation between tissue NO levels and a biological response, and (3) to verify biotransformation of GTN to NO by cytochrome P-450.NO was trapped in tissues in vivo as a stable paramagnetic mononitrosyl-iron-diethyldithiocarbamate complex [NOFe(DETC)2]. After removal of the tissues, NO was determined by cryogenic electron spin resonance spectroscopy. NO formation in vitro was assessed by spin trapping and by activation of soluble guanylyl cyclase. The GTN-elicited decrease in coronary perfusion pressure was monitored in isolated, constant-flow perfused rabbit hearts. NO was not detected in control tissues. In GTN-treated rabbits, NO formation was higher in organs than in vascular tissues and higher in venous than in arterial vessels. In isolated hearts, ventricular NO levels and decreases in coronary perfusion pressure achieved by GTN were closely correlated. Purified cytochrome P-450 catalyzed NO formation from GTN in a P-450-NADPH reductase- and NADPH-dependent fashion.Since GTN-derived NO formation in myocardial tissue correlates to the GTN-elicited vasodilator response, we conclude that GTN-derived NO detected in vivo correlates with the systemic effects of GTN. Therefore, the higher rate of NO formation detected in veins compared with arteries explains the preferential venodilator activity of GTN. High NO formation in cytochrome P-450-rich organs in vivo and efficient NO formation from GTN by cytochrome P-450 in vitro highlights the importance of this pathway for NO formation from GTN in the intact organism.
Primary Prevention With Metoprolol in Patients With Hypertension
Authors: Philip Altus
Journal: JAMA (1988)

To the Editor.—  The results of the Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) Study, 1 showing lower mortality with metoprolol use compared with thiazide diuretic therapy, is concordant with many of our beliefs that thiazides are potentially harmful while β-blockers may be cardioprotective. The MAPHY Study, by Wikstrand et al, used neither a placebo group nor actuarial data. As such, three possibilities exist. β-Blockers may be mortality neutral while diuretics have increased mortality, β-blockers may be cardioprotective while diuretics are mortality neutral, or β-blockers are cardioprotective and diuretics have increased mortality. In a previous study by Morgan et al, 2 moderately hypertensive men were treated with either placebo, low-salt diet, high-dose thiazide, or β-blocker. When compared with actuarial data there were twice as many deaths than predicted in the diuretic-treated group and expected numbers of deaths in all other groups. In the study by Wikstrand et al it is clear
The transcription factor Lyl-1 regulates lymphoid specification and the maintenance of early T lineage progenitors
Authors: Fabian Zohren, George P Souroullas, Min Luo, Ulrike Gerdemann, Maria R Imperato, Nicola K Wilson, Berthold Göttgens, Georgi L Lukov, Margaret A Goodell
Journal: Nature Immunology (2012)
TWO CASES OF DUODENAL ULCER TREATED BY GASTRO-ENTEROSTOMY
Authors: F. Eve
Journal: BMJ (1905)

L I I " 4. Large pelvic abscess; operation tenth day.Symptoms of obstruc- tion eight days later; operation sixth day.Multiple adhesions.Old undrained abscess.Death.S. Large pelvic abscess; no operation; considered to have subsided.Symptoms of obstruction after sixteen days; operation on fifth day.Multiple adhesions; pyosalpinx.Two abscesses in connexion with appendix.Operation done in two stages; intestine first drained and the disease removed subsequently.Recovery.6. Gangrenous appendix, advanced peritonitis; operation within thirty-sixhours.Symptoms of obstruction seventeen days later; operation third day.Multiple adhesions.Recovery.
Prevalence of physical symptoms of itch, pain and fatigue in patients with skin diseases in general practice
Authors: E.W.M. Verhoeven, F.W. Kraaimaat, P.C.M. van de Kerkhof, C. van Weel, P. Duller, P.G.M. van der Valk, H.J.M. van den Hoogen, J.H.J. Bor, H.J. Schers, A.W.M. Evers
Journal: British Journal of Dermatology (2007)

Physical symptoms of skin diseases have been shown to negatively affect patients' wellbeing. Although insight into physical symptoms accompanying skin diseases is relevant for the management and treatment of skin diseases, the prevalence of physical symptoms among patients with skin diseases is a rather unexplored territory.The goal of the present study was to examine the prevalence of physical symptoms of itch, pain and fatigue in patients with skin diseases.On the basis of a systematic morbidity registration system in primary care, questionnaires were sent to 826 patients with skin diseases. Eventually, questionnaires from 492 patients were suitable for our analyses.Results indicated that patients with skin diseases particularly experience symptoms of itch and fatigue. Approximately 50% of all patients report experiencing these symptoms and about 25% experience these symptoms as relatively severe. Pain was relatively less frequently reported by 23% of all patients, and was on average somewhat less intense. The physical symptoms showed relatively strong correlations with disease-related quality of life and self-reported disease severity. In contrast, only moderate correlations were found with comorbidity and demographic variables, which suggests that the physical symptoms of itch, pain and fatigue are consequences of the skin diseases.Itch and fatigue and, to a somewhat lesser extent, pain have a high prevalence among patients with skin diseases. Clinicians should be encouraged to carefully assess itch, pain and fatigue in patients with skin diseases, and where appropriate focus treatment to these symptoms.
Liver involvement in a large cohort of patients with hereditary hemorrhagic telangiectasia: Echo-color-Doppler vs multislice computed tomography study
Authors: Paolo Buonamico, Patrizia Suppressa, Gennaro M. Lenato, Giovanna Pasculli, Francesco D’Ovidio, Maurizio Memeo, Arnaldo Scardapane, Carlo Sabbà
Journal: Journal of Hepatology (2008)
Loss of VHL and Hypoxia Provokes PAX2 Up-Regulation in Clear Cell Renal Cell Carcinoma
Authors: Van-Duc Luu, Gunther Boysen, Kirsten Struckmann, Silvia Casagrande, Adriana von Teichman, Peter J. Wild, Tullio Sulser, Peter Schraml, Holger Moch
Journal: Clinical Cancer Research (2009)

The paired box gene 2, PAX2, encodes for a transcription factor that is up-regulated during nephrogenesis and becomes silenced in mature epithelium of the glomeruli, the proximal, and distal tubules. Reactivation of PAX2 has been frequently observed in clear cell renal cell carcinoma (ccRCC), a tumor type characterized by loss of von Hippel-Lindau (VHL) tumor suppressor function. The regulation of PAX2 expression in ccRCC is unknown.We applied reporter gene assays to investigate PAX2 promoter regulation. Furthermore, PAX2 expression was determined in ccRCC cell lines under normoxic and hypoxic condition in a VHL wild-type and mutated background. PAX2 expression was also assessed in 831 human ccRCC and correlated with hypoxia-inducible factor alpha (HIFalpha) and clinical parameters.Here, we show that both loss of VHL protein (pVHL) function and hypoxia leads to strong PAX2 reexpression. Using luciferase reporter gene assays, no induction was obtained in spite of six hypoxia response element motifs identified in the promoter of PAX2. Comprehensive immunohistochemical analyses showed significant correlations between PAX2, HIF1alpha, and HIF2alpha-target CCND1 expression patterns in ccRCC patients. Notably, PAX2 expression was highly associated with early-stage, well-differentiated ccRCC and, consequently, better clinical outcome (P < 0.0001 each). Additional analyses indicated that PAX2 repressor WT1 and cancer-linked hypomethylation are not important for transcriptional regulation of PAX2 in ccRCC.We conclude that in ccRCC, PAX2 reactivation is driven by HIF-dependent mechanisms following pVHL loss.