tbuckley/cabot-search huggingface dataset:
The Inevitable Failure of Cost-Containment Strategies-Reply
Authors: William B. Schwartz
Journal: JAMA (1987)

In Reply.—  I welcome Dr Bader's expansion of my brief mention of the Baumol effect. His fuller treatment provides further insight into the difficulty of controlling hospitals' labor costs.  Dr Albert is incorrect in stating that HMOs use fewer hospital services because they enroll healthier people. My statement that members of HMOs use 30% fewer hospital days than do their fee-for-service counterparts is based on a controlled study in which individuals were randomly assigned to various types of health care providers. 1,2 This study has laid to rest the view that skimming is the primary cause of differences in hospital utilization between HMOs and the fee-for-service sector.  Mr Samuel's letter grossly misrepresents the ideas expressed in my article and also shows no understanding of the cost-containment dilemma that is rapidly approaching. Contrary to his statement, I emphasize the great medical value of new technology. But I also make the point
THE EFFECT OF MILD EXERCISE IN THE SUPINE POSITION ON THE PULMONARY ARTERIAL PRESSURE OF FIVE NORMAL HUMAN SUBJECTS 1
Authors: N. B. Slonim, A. Ravin, O. J. Balchum, S. H. Dressler
Journal: Journal of Clinical Investigation (1954)

In the course of study of a series of patients with cardiopulmonary diseases of various type and de- gree, it was noted that the pulmonary arterial pres- sure rose during supine exercise in all instances.This rise was observed even in individuals with minimal pulmonary involvement and no detectable cardiac abnormality.Inasmuch as it has been stated that the pulmonary arterial pressure does not rise appreciably with mild exercise in subjects with normal cardiorespiratory systems (1-3), it seemed necessary to re-examine this question.It is the purpose of this paper to describe in de- tail the pulmonary arterial pressure rise which oc- curs in normal man during mild, supine exercise, together with certain associated physiological changes. METHODS
205. Quantitative Analysis of Non-Viral Gene Therapy in a Three-Dimensional Liver Bioreactor
Authors: Nathan C. Tedford, Jennifer Fang, Bonnie Huang, Karel Domansky, Linda G. Griffith, Douglas A. Lauffenburger
Journal: Molecular Therapy (2005)

Successful delivery of DNA lies at the heart of gene therapy, and its feasibility in treating a number of diseases depends on the continued development of more effective gene delivery vectors. While vectors based upon recombinant viruses have shown high transfection efficiencies, they may also pose certain health risks to patients and can be difficult to target to individual cell or tissue types of interest. Non-viral vectors look to offer a safer alternative and can be engineered to more effectively treat a specific cell type, tissue, or pathology, but these vectors are still plagued with low transfection levels. Many barriers exist in the successful trafficking of these non-viral complexes to the nucleus. Current evaluations of non-viral gene delivery treatments in more clinical settings often focus on a single barrier at a time, and as a result, may not lead to an overall improvement in gene delivery. Concurrently, more quantitative or systematic in vitro experiments may not correlate well with in vivo data. A scaled up and improved three-dimensional, perfused bioreactor has been designed and built that allows for the long-term culture of primary hepatocytes. Within the microfabricated flow channels of this reactor, cells self assemble over time into tissue structures that more closely mimic hepatic morphology and phenotype than conventional two-dimensional culture systems. By studying non-viral gene delivery in this system, quantitative experiments and experimentally-driven computational models can be developed that may better describe how a vector will perform in vivo. Gene delivery efficiency, kinetics and transgene expression in this system have been directly compared to more conventional culture systems. Methodologies in density gradient electrophoresis (DGE) have been adapted to obtain greater resolution in subcellular fractionation in primary hepatocyte cultures. An experimental scheme has been developed which utilizes a newly constructed DGE device that can attain the separation and collection of the vesicular organelles that play an important role in gene delivery. Combined with quantitative downstream assays for both the DNA plasmid and the polymer carrier, vector dynamics can now potentially be tracked at cell entry, progressive stages of vesicular trafficking and escape, and nuclear import, providing data sets which may in turn lead to more accurate and predictive mathematical models. Through a systematic iteration of quantitative experiments and computational simulations, these models will be fine-tuned for different polymer carriers administered to the hepatic tissue constructs, potentially allowing for optimization of specific vector properties and increased success of non-viral approaches.
Modalities for Tuberculosis Control: Surveillance vs Vaccination
Authors: Lee B. Reichman
Journal: JAMA (1997)

<h3>To the Editor.</h3> —In their model of various tuberculosis (TB) control modalities, Dr Brewer and colleagues<sup>1</sup>suggest that a targeted vaccination strategy using BCG vaccine would be cost effective for TB prevention. The authors state, "In our simulations, eliminating the ability to screen with tuberculin testing among vaccine recipients did not significantly alter BCG's predicted effectiveness,"<sup>1</sup>but they do not comment on what many feel is the most important deterrent to the systematic use of BCG—the loss of surveillance for TB infection in BCG-vaccinated health care workers. To dramatize the significance of this loss of information, we created a scenario<sup>2</sup>that indicated the effect widespread systematic use of BCG had in precluding surveillance. The bottom line is that if BCG had been used widely during the last decade, we would not yet know in 1997 that an epidemic of active, multidrug-resistant pulmonary TB with transmission to health care
8. Appropriateness of Colonoscopy: Hematochezia 1
Authors: J.-J. Gonvers*, V. De Bosset*, F. Froehlich*, R. W. Dubois***, B. Burnand**, J.-P. Vader**
Journal: Endoscopy (1999)

Lower GI bleeding (i. e. bleeding distal to the Treitz ligament) may be acute, chronic or occult. The most common causes cited in the literature vary greatly, in particular according to patient age. In acute bleeding, the large bowel should be investigated by anoscopy and sigmoidoscopy once the patient has been stabilized. If no potential source of bleeding is found, the entire colon should be investigated by colonoscopy. Colonoscopy is not only a diagnostic tool but also allows therapeutic intervention.
IFN-gamma action on pancreatic beta cells causes class I MHC upregulation but not diabetes.
Authors: H E Thomas, J L Parker, R D Schreiber, T W Kay
Journal: Journal of Clinical Investigation (1998)

We have generated transgenic nonobese diabetic (NOD) mice expressing dominant negative mutant IFN-gamma receptors on pancreatic beta cells to investigate whether the direct effects of IFN-gamma on beta cells contribute to autoimmune diabetes. We have also quantitated by flow cytometry the rise in class I MHC on beta cells of NOD mice with increasing age and degree of islet inflammatory infiltrate. Class I MHC expression increases gradually with age in wild-type NOD mice; however, no such increase is observed in the transgenic beta cells. The transgenic mice develop diabetes at a similar rate to that of wild-type animals. This study dissociates class I MHC upregulation from progression to diabetes, shows that the rise in class I MHC is due to local IFN-gamma action, and eliminates beta cells as the targets of IFN-gamma in autoimmune diabetes.
Abstract 1852: Pyruvate dehydrogenase kinase expression and metabolic changes following dichloroacetate exposure in anoxia in human colorectal cancer cells.
Authors: Nelson Ho, Brenda L. Coomber
Journal: Cancer Research (2013)

Abstract Introduction: While glycolysis is a suboptimal metabolic strategy used by cells under hypoxic conditions, many cancer cells preferentially utilize glycolysis for energy production in the presence of abundant oxygen, a phenomenon known as the “Warburg Effect”. Dichloroacetate (DCA) is a small molecule metabolic modulator that shifts cellular metabolism to glucose oxidation by inhibition of pyruvate dehydrogenase kinase (PDK), an enzymatic inhibitor of pyruvate dehydrogenase (PDH). Furthermore, DCA has been shown to induce apoptosis in cancer but not normal cells. Our previous work showed that some human colorectal cancer (CRC) cells are protected from anoxia-induced apoptosis upon exposure to DCA, through as yet unclear mechanisms. Hypothesis: It is hypothesized that differential expression of PDK isoforms will correlate with the ability of different cancer cells to withstand the apoptotic effects of DCA in anoxia. Methods: SW480, LS174T (CRC) and IEC-18 (normal intestinal epithelial) cell lines were exposed to 10 mM DCA in either normoxic (20% O2) or anoxic (&amp;lt; 0.1% O2) conditions for 24 hours. Following treatment, expression of different PDK isoforms was determined through qRT-PCR and western blotting. Phosphorylation of PDH at Ser293 and Ser300 was assessed through western blotting. Glucose consumption and lactate production was determined using a colorimetric-based assay. Changes in mitochondrial function were quantified through Mitotracker staining and subsequent flow cytometry. Cell viability was assessed using the neutral red assay. Results: In all three cell lines: A) PDK isoforms 1 and 3 are highly expressed relative to isoforms 2 and 4, B) DCA and/or anoxic treatment induced a greater effect on PDH phosphorylation at Ser300 than Ser293, and C) DCA had minimal effect on glucose consumption in either normoxia or anoxia. Conclusions: Altered PDK expression and PDH activation may not fully explain the differences in resistance to DCA-induced apoptosis observed in human CRC cells. Investigating the mechanisms by which certain cancer cells are protected from DCA-induced apoptosis will lead to a better understanding of cancer metabolism and thus provide better therapeutic opportunities. Citation Format: Nelson Ho, Brenda L. Coomber. Pyruvate dehydrogenase kinase expression and metabolic changes following dichloroacetate exposure in anoxia in human colorectal cancer cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1852. doi:10.1158/1538-7445.AM2013-1852
Prognosis of subsequent pregnancies after recurrent spontaneous abortion in first trimester.
Authors: H J Carp, V Toder, D M Serr, S Mashiach, L Nebel
Journal: BMJ (1987)

12 Lambert T. Paranoid psychoses after abuse of proprietary cold remedies.BrJ Psyckiaay (in press).Refeeding hypophosphataemia in anorexia nervosa and alcoholism SIR,-The article by Dr Allan D Cumming and colleagues on refeeding hypophosphataemia (22 August, p 490) omits a number of salient points relating to the development of convulsions in alcoholics with complex biochemical disturbances.Several combinations of the abnormalities described might account for the symptoms observed.Magnesium depletion, in particular, is well known to be a common cause of convulsions in such patients.' In addition, magnesium deficiency induces hypokalaemia and hypocalcaemia, as well as hypomagnesaemia.In the alcoholic patient described the potential contributions ofother ionic imbalances, notably hypokalaemia (3-2 mmol/l) and hypomagnesaemia (0-36 mmol/l), are ignored.This is surprising in view of the fact that this patient required "separate infusions of calcium, magnesium, and potassium" before recovery.Though we should not ignore the potential importance of refeeding hypophosphataemia, the contribution of hypophosphataemia itself to the symptoms described remains unclear.
Caffeine Dependence Syndrome-Reply
Authors: Richard M. Glass
Journal: JAMA (1995)

<h3>In Reply.</h3> —Drs Adamson and Roberts imply that the high prevalence of prior substance abuse among the 16 persons with caffeine dependence described by Strain and colleagues<sup>1</sup>invalidates the results. This overlooks the likelihood that the small proportion of regular caffeine users who develop a dependence syndrome would have associated risk factors, such as psychiatric disorders or other substance use disorders. Further research will be necessary to confirm this and to determine whether caffeine dependence is more common among women. My Editorial stressed that the consequences of caffeine dependence appear to be considerably less severe than those of other substance dependencies. The comments of Drs Olekalns and Bardsley are interesting but illustrate the difficulty of using the same terms, with very different meanings, to communicate across disciplines. The notion that addiction is "rational" is preposterous to clinicians who deal with the life-threatening effects of dependence on alcohol, tobacco, or
Effects of chain length on the immunogenicity in rabbits of group B Streptococcus type III oligosaccharide-tetanus toxoid conjugates.
Authors: L C Paoletti, D L Kasper, F Michon, J DiFabio, H J Jennings, T D Tosteson, M R Wessels
Journal: Journal of Clinical Investigation (1992)

One method to improve the immunogenicity of polysaccharide antigens is the covalent coupling of the native polysaccharide or a derivative oligosaccharide to a carrier protein. In general, T cell-dependent properties are enhanced in conjugates of smaller saccharides, but a conformational epitope of the native polysaccharide may be better expressed in conjugates of larger saccharides. We have reported previously the synthesis and immunogenicity in animals of an oligosaccharide-tetanus toxoid conjugate vaccine against type III group B Streptococcus. In this study, we sought to determine the optimal size of group B Streptococcus type III oligosaccharide for use in a conjugate vaccine by evaluating the relative immunogenicity of conjugate vaccines containing oligosaccharides that were twofold smaller (7,000 Mr) or larger (27,000 Mr) than that reported previously (14,500 Mr). All three type III oligosaccharide conjugate vaccines were immunogenic in rabbits, in contrast to native, uncoupled group B Streptococcus type III polysaccharide. However, with respect to eliciting specific antibodies that were protective in vivo, the vaccine containing the intermediate-size oligosaccharide was superior to the smaller or larger conjugate vaccine. Analysis of opsonic activity of vaccine-induced antibodies demonstrated a predominance of IgG antibodies, thought to reflect T cell dependence, in response to shorter chain length conjugates, while the conformational epitope of the native polysaccharide was maximally expressed on longer chain length conjugates. These opposing trends may account for the optimal immunogenicity of an intermediate-size group B Streptococcus type III oligosaccharide conjugate vaccine.
A Critical Examination of the Role of Surgery in the Treatment of Primary Pulmonary Tuberculosis in Children
Authors: J. K. Cameron, J. D. Hay, L. J. Temple
Journal: Thorax (1957)

In recent years surgery has played an increas- TREATMENT ingly large part in the treatment of primaryThe hospital is of an open-air type, situated by tuberculosis of the lungs in children.We have the sea and in a bracing climate.Treatment for been impressed by this increasing frequency, and most atients has been on eneral lines onl also by descriptions of gross pathological changes g yh.r, .. .~~~~~~~~~~beginning with a period of bed-rest, usually short, in mediastinal glands and lung parenchyma found and proceeding to full activity in the absence of at thoracotomy (Thomas, 1952;Huish, 1956).In signs of active disease.The use of antibiotic drugs consequence we have been concerned lest the has been irregular, as our policy has been to con- treatment, or lack of treatment, of our own tinue wherever possible the wishes of the referring patients might be resulting in unnecessary residual consultant.We have initiated antibiotic treatment damage to lung structure, or even in the develop-i '~~~~~~,-in al natune2yar ( ebr 91Td ment in some cases of the adult forms of pul- 19 infan as in a few chilre,most o wo, monary tuecl sis We thref re decde to 1953) and also in a few children, most of whom mnarys tuberclosis.We thereree deided to were being prepared for surgery.Approximately 10 %-of all our cases received antibiotics at some Leasowe Children's Hospital with primary tuber- g W
Preliminary report: Leucine supplementation enhances glutamate dehydrogenase expression and restores glucose-induced insulin secretion in protein-malnourished rats
Authors: Priscilla Muniz Ribeiro da Silva, Claudio Cesar Zoppi, Eliane Filiputti, Leonardo Reis Silveira, Ivan Quesada, Antonio Carlos Boschero, Everardo Magalhães Carneiro
Journal: Metabolism (2009)
Primary Care Sleep Medicine: A Practical Guide
Authors: A. Y. Avidan, R. K. Malhotra
Journal: JAMA (2007)

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
Segmental vascular resistance in isolated perfused rat lungs. Influence of vasomotor tone and cyclooxygenase and lipoxygenase inhibition.
Authors: R Hillyard, J Anderson, J U Raj
Journal: Circulation Research (1991)

We have determined the profile of pressures in isolated perfused lungs of adult rats and investigated the influence of vasomotor tone and cyclooxygenase and lipoxygenase inhibition on total and segmental vascular resistance. We isolated and blood-perfused lungs of 30 rats (480 +/- 21 g). Group 1 (n = 7) was untreated, group 2 (n = 8) was paralyzed with papaverine, group 3 (n = 11) was treated with indomethacin, and group 4 (n = 4) was treated with indomethacin and U60257, a putative lipoxygenase inhibitor. Blood flow was adjusted initially to raise pulmonary artery pressure to approximately 15 cm H2O and then held constant. Airway and left atrial pressures were held constant at 7 and 8 cm H2O, respectively (zone 3 conditions). In all lungs, we measured pressures in subpleural 20-50-microns-diameter arterioles and venules using the micropuncture servonull technique. Thus, the pulmonary circulation was partitioned into three segments: arteries, microvessels, and veins. In group 1 lungs, arteries presented the largest fractional resistance to flow at 46% of total resistance, with microvessels and veins contributing 34% and 20%, respectively. In group 2 lungs that had no vasomotor tone, total vascular resistance was approximately 27% lower than in group 1 lungs, mainly due to a lower resistance in veins. In indomethacin-treated lungs (group 3) and indomethacin and U60257-treated lungs (group 4), total and segmental vascular resistance was not significantly different from untreated lungs (group 1). We conclude that in isolated perfused rat lungs, arteries are the predominant site of resistance to blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)
Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism
Authors: Ravikiran Korabathina, Andrew R. Weintraub, Lori Lyn Price, Navin K. Kapur, Carey D. Kimmelstiel, Mark D. Iafrati, Syed M. Ali Tahir
Journal: Circulation (2013)

Epidemiology data for lower-extremity arterial thromboembolism (LET) are limited and may result from either acute limb ischemia or an acute exacerbation of critical limb ischemia. Given marked changes in both diagnosis and therapy over the last 2 decades, we hypothesized that this time period would have witnessed reductions in both the incidence and in-hospital mortality of LET.Data from 1988 through 2007 from the National Hospital Discharge Survey were analyzed. All admissions for patients with LET were extracted, and the respective International Classification of Diseases, Ninth Revision, Clinical Modification codes were internally validated for both LET and acute limb ischemia. Descriptive statistics were used. The validity of the codes was good for identifying LET cases but poor for identifying acute limb ischemia cases because many of these acute presentations were attributable to critical limb ischemia. Over the 20-year span, there were 1.76 million cases of LET. The incidence of LET decreased significantly from 42.4 per 100 000 persons between 1988 and 1997 to 23.3 per 100 000 persons between 1998 and 2007. The in-hospital mortality for LET decreased significantly from 8.28% between 1988 and 1997 to 6.34% between 1998 and 2007, and male patients achieved greater mortality reduction compared with female patients. Treatments for acute limb ischemia showed decreasing use of surgical bypass and amputation and increasing rates of catheter-based thrombolysis.Over the 20-year study period, there have been significant reductions in both LET incidence and in-hospital mortality. Unfortunately, LET admissions extracted from an administrative database comprise a diverse group of individuals, including those with acute and chronic forms of limb ischemia and iatrogenic arterial injury, limiting the true assessment of ALI incidence.