tbuckley/cabot-search huggingface dataset:
Cost-Effectiveness and Population Impact of Statins for Primary Prevention in Adults Aged 75 Years or Older in the United States
Authors: Michelle C. Odden, Mark J. Pletcher, Pamela G. Coxson, Divya Thekkethala, David Guzman, David Heller, Lee Goldman, Kirsten Bibbins-Domingo
Journal: Annals of Internal Medicine (2015)

Background: Evidence to guide primary prevention in adults aged 75 years or older is limited. Objective: To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years or older. Design: Forecasting study using the Cardiovascular Disease Policy Model, a Markov model. Data Sources: Trial, cohort, and nationally representative data sources. Target Population: U.S. adults aged 75 to 94 years. Time Horizon: 10 years. Perspective: Health care system. Intervention: Statins for primary prevention based on low-density lipoprotein cholesterol threshold of 4.91 mmol/L (190 mg/dL), 4.14 mmol/L (160 mg/dL), or 3.36 mmol/L (130 mg/dL); presence of diabetes; or 10-year risk score of at least 7.5%. Outcome Measures: Myocardial infarction (MI), coronary heart disease (CHD) death, disability-adjusted life-years, and costs. Results of Base-Case Analysis: All adults aged 75 years or older in the National Health and Nutrition Examination Survey have a 10-year risk score greater than 7.5%. If statins had no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost-effective. Treatment of all adults aged 75 to 94 years would result in 8 million additional users and prevent 105 000 (4.3%) incident MIs and 68 000 (2.3%) CHD deaths at an incremental cost per disability-adjusted life-year of $25 200. Results of Sensitivity Analysis: An increased relative risk for functional limitation or mild cognitive impairment of 1.10 to 1.29 could offset the cardiovascular benefits. Limitation: Limited trial evidence targeting primary prevention in adults aged 75 years or older. Conclusion: At effectiveness similar to that in trials, statins are projected to be cost-effective for primary prevention; however, even a small increase in geriatric-specific adverse effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to inform decision making. Primary Funding Source: American Heart Association Western States Affiliate, National Institute on Aging, and the National Institute for Diabetes on Digestive and Kidney Diseases.
The Law and Clinical Medicine
Authors: Burton A. Russman
Journal: JAMA (1970)

The practice of law involves the adversary approach, each protagonist stating the facts in the light most favorable to his client and rebutting his opponent by any legal means available. Medicine, on the contrary, is a truth-seeking science, aimed at arriving at the one correct diagnosis and treatment. "And never the twain shall meet." The authors, one a physician well qualified in the medical-legal field, the other a noted trial attorney, have begun each of the book's 15 chapters —called "clinics"—with a case report, much the same way as it is presented in a legal case book or trial brief. After the problem is set forth, it is explored from a legal as well as a medical point of view, finally arriving at a judicial determination of the hypothetical question of law. The involved legal issues are explored and elaborated lucidly and intelligently, combining legal jargon with medical interpretations. This
COCATS 4 Task Force 7: Training in Cardiovascular Computed Tomographic Imaging
Authors: Mario J. Garcia, Ron Blankstein, Matthew J. Budoff, John M. Dent, Douglas E. Drachman, John R. Lesser, Maleah Grover-McKay, Jeffrey M. Schussler, Szilard Voros, L. Samuel Wann
Journal: Journal of the American College of Cardiology (2015)
Past, Present, and Future Directions for Defining Optimal Treatment Outcome in Depression
Authors: Martin B. Keller
Journal: JAMA (2003)

During the past decade, evidence from research on mood disorders has demonstrated that remission is the optimal outcome of treatment. However, there continues to be considerable variability in the specific characteristics that are accepted as indicators of remission. Increasing knowledge of mood disorders and their underlying mechanisms may allow for the development of a new diagnostic and assessment system that no longer is based solely on symptoms and other descriptive phenomena. Continued advances in neuroscience may allow for more knowledge of the underlying neurobiological status and more accurate assessments of the underlying disease state and response to treatment, thus enabling physicians to use treatments that will most effectively bring patients back to euthymia and a truly disease-free healthy state. Until then, remission should continue to be based on the descriptive and experiential phenomena of symptoms and psychosocial functioning.
Transient Acute Myositis in Children
Authors: Joseph B. Rogoff
Journal: JAMA (1977)

<h3>To the Editor.—</h3> Tepperberg (238:27, 1977) describes the clinical and laboratory course in eight boys of an acute illness diagnosed as transient acute myositis on clinical and laboratory grounds. The possibility of Guillain-Barré syndrome was suspected. However, one important differential test, that of electrodiagnosis, was not used. In fact, the differentiation of neuropathy from myopathy is one of the principal aims of an electrodiagnostic evaluation. The tests used include motor and sensory nerve conduction measurement and electromyography. Motor nerve conductions remain entirely within normal limits in the myopathies, although in severe myopathies the responses may be of low amplitude. The sensory nerve conductions and responses are unaffected in the myopathies. In the Guillain-Barré syndrome, motor and sensory conductions should be altered very early in the disease, both in conduction speed and amplitude. Electromyography differs in these two types of involvement principally in the findings on voluntary contraction. The myopathies are
Trends in Mean Waist Circumference and Abdominal Obesity Among US Adults, 1999-2012
Authors: Earl S. Ford, Leah M. Maynard, Chaoyang Li
Journal: JAMA (2014)

Waist circumference is a simple and valuable anthropometric measure of total and intra-abdominal body fat. 1 The clinical guidelines from the National Heart, Lung, and Blood Institute on the identification, evaluation, and treatment of overweight and obesity in adults recommend that clinicians assess waist circumference of their patients. 2Although the prevalence of abdominal obesity has increased in the United States through 2008, 3 its trend in recent years is unknown.Therefore, our objective was to provide recent information about the trends in mean waist circumference and prevalence of abdominal obesity among adults in the United States from 1999 to 2012.Methods | We used data from seven 2-year cycles of the National Health and Nutrition Examination Survey (NHANES) starting with 1999-2000 and concluding with 2011-2012. 4NHANES is a national health survey of the civilian noninstitutionalized US population in which a sample is selected by using a complex, multistage, probability sampling design.The examination re-sponse rates across the survey cycles ranged from 69.5% to 79.6%.The surveys received institutional review board approval and participants provided written informed consent.In the mobile examination center, the waist circumference of participants was measured just above the iliac crest to the nearest 1 mm using a steel measuring tape.Abdominal obesity was defined as a waist circumference greater than 102 cm in men and greater than 88 cm in women. 2 Because the unadjusted and age-adjusted results were similar, we report only the latter.Tests for linear trend were conducted using orthogonal polynomial coefficients.Analyses, which take into account the complex sampling design of the surveys, were conducted using SAS version 9.3 (SAS Institute Inc) and SUDAAN version 11.0.0 (Research Triangle Institute) software.Two-sided P < .05 was considered statistically significant.
Antagonistic control of tumor necrosis factor receptors by protein kinases A and C. Enhancement of TNF receptor synthesis by protein kinase A and transmodulation of receptors by protein kinase C.
Authors: P Scheurich, G Köbrich, K Pfizenmaier
Journal: The Journal of Experimental Medicine (1989)

We have investigated control mechanisms of TNF receptor expression (TNF-R) in various human tumor cells and normal peripheral blood monocytes. Activators of protein kinase A (PKA) signal transduction pathways were found to enhance TNF-R expression up to sevenfold, whereas in the same cells, IFN-alpha and -gamma receptors remained unaffected. Inhibitors of protein kinases downregulate both constitutive and cAMP-enhanced TNF-R expression. Binding studies revealed an increase in TNF-R numbers without a change in receptor affinity. Both, direct activators of PKA and inhibitors of phosphodiesterase, raising intracellular levels of cAMP, were found to be effective. As activation of PKA does not slow down the degradation rate of TNF-Rs, but rather enhances protein synthesis-dependent reexpression of TNF-Rs after transient PKC-mediated transmodulation and after tryptic digestion of TNF-Rs, it is concluded that PKA stimulates TNF-R synthesis. Maximum TNF-Rs enhancement is reached after 24 h of stimulation and is reversible, suggesting that receptor upregulation is not linked to irreversible steps of cellular differentiation. PKA-mediated enhancement of TNF-R expression was predominantly observed in normal peripheral blood monocytes and tumor cell lines of myeloid origin. As in these typical TNF producer cells, the production of TNF is also controlled by PKA and PKC, a regulatory circuit is proposed, by which these two independent signal pathways antagonistically regulate TNF production and, at the receptor level, TNF sensitivity.
Senile Cataract and Glucose Intolerance: The Israel Study of Glucose Intolerance Obesity and Hypertension (The Israel GOH Study)
Authors: Avraham Karasik, Michaela Modan, Hillel Halkin, Giora Treister, Zahava Fuchs, Ayala Lusky
Journal: Diabetes Care (1984)

Association of "senile" cataract (SC) with glucose intolerance (impaired tolerance and diabetes) was assessed by sex and age in a random population sample comprising 930 individuals aged 40-70 yr, who underwent concurrent oral glucose tolerance test and ophthalmoscopy. The eye examination was performed without knowledge of the glucose tolerance status. SC was defined as lens opacification preventing visualization of the eyeground or as surgical aphakia due to SC. To assess the independent effect of hyperglycemia, glycosylated hemoglobin (HbA1) was determined in 769 participants. In men, no association was found between SC, glucose intolerance, and HbA1. In women of all ages, glucose intolerance was associated with an SC risk ratio of 6.1 (95% confidence limits 3.3-11.1; P less than 0.001). Furthermore, SC was associated in women with increased HbA1 independently of the effect of glucose intolerance (P less than 0.01). These findings confirm the reported association of SC with diabetes (although unlike the Framingham and HANES population studies, the association was confined in women), indicate its presence at all degrees of glucose intolerance, and suggest a possible independent role of nonenzymatic glycosylation in its pathogenesis.
Down-Regulation of Estrogen Receptor β and Transcriptional Coregulator SNURF/RNF4 in Testicular Germ Cell Cancer
Authors: Sirpa J Hirvonen-Santti, Antti Rannikko, Henrikki Santti, Saija Savolainen, Marcus Nyberg, Olli A Jänne, Jorma J Palvimo
Journal: European Urology (2003)
Paternal versus maternal transmission of a stimulatory G-protein α subunit knockout produces opposite effects on energy metabolism
Authors: Shuhua Yu, Oksana Gavrilova, Hui Chen, Randy Lee, Jie Liu, Karel Pacak, A.F. Parlow, Michael J. Quon, Marc L. Reitman, Lee S. Weinstein
Journal: Journal of Clinical Investigation (2000)

Heterozygous disruption of Gnas, the gene encoding the stimulatory G-protein α subunit (Gsα), leads to distinct phenotypes depending on whether the maternal (m–/+) or paternal (+/p–) allele is disrupted. Gsα is imprinted, with the maternal allele preferentially expressed in adipose tissue. Hence, expression is decreased in m–/+ mice but normal in +/p– mice. M–/+ mice become obese, with increased lipid per cell in white and brown adipose tissue, whereas +/p– mice are thin, with decreased lipid in adipose tissue. These effects are not due to abnormalities in thyroid hormone status, food intake, or leptin secretion. +/p– mice are hypermetabolic at both ambient temperature (21° C) and thermoneutrality (30° C). In contrast, m–/+ mice are hypometabolic at ambient temperature and eumetabolic at thermoneutrality M–/+ and wild-type mice have similar dose-response curves for metabolic response to a β3-adrenergic agonist, CL316243, indicating normal sensitivity of adipose tissue to sympathetic stimulation. Measurement of urinary catecholamines suggests that +/p– and m–/+ mice have increased and decreased activation of the sympathetic nervous system, respectively. This is to our knowledge the first animal model in which a single genetic defect leads to opposite effects on energy metabolism depending on parental inheritance. This probably results from deficiency of maternal- and paternal-specific Gnas gene products, respectively.
Quality of Medical Care Delivered to Medicare Beneficiaries
Authors: Stephen F. Jencks, Timothy Cuerdon, Dale R. Burwen, Barbara Fleming, Peter M. Houck, Annette E. Kussmaul, David S. Nilasena, Diana L. Ordin, David R. Arday
Journal: JAMA (2000)

Context Despite condition-specific and managed care-specific reports, no systematic program has been developed for monitoring the quality of medical care provided to Medicare beneficiaries.Objective To create a monitoring system for a range of measures of clinical performance that supports quality improvement and provides repeated, reliable estimates at the national and state levels for fee-for-service (FFS) Medicare beneficiaries.Design, Setting, and Participants National study of repeated, cross-sectional observational data collected in 1997-1999 on all Medicare FFS beneficiaries or on a representative sample of beneficiaries with a particular condition.Data were collected using medical record abstraction for inpatient care, analysis of Medicare claims for some ambulatory services, and surveys for immunization rates.Separate samples were drawn for each topic for each state. Main Outcome MeasuresBeneficiary patients' receipt of 24 process-of-care measures related to primary prevention, secondary prevention, or treatment of 6 medical conditions (acute myocardial infarction, breast cancer, diabetes mellitus, heart failure, pneumonia, and stroke) for which there is strong scientific evidence and professional consensus that the process of care either directly improves outcomes or is a necessary step in a chain of care that does so. ResultsAcross all states for all measures, the percentage of patients receiving appropriate care in the median state ranged from a high of 95% (avoidance of sublingual nifedipine for patients with acute stroke) to a low of 11% (patients with pneumonia screened for pneumococcal immunization status before discharge).The median performance on an indicator is 69% (patients discharged with heart failure diagnosis who received angiotensin-converting enzyme inhibitors; diabetic patients having an eye examination in the last 2 years).Some states (particularly less populous states and those in the Northeast) consistently ranked high in relative performance while others (particularly more populous states and those in the Southeast) consistently ranked low. ConclusionsIt is possible to assemble information on a diverse set of clinical performance measures that represent performance on the range of services in a health insurance program.These findings indicate substantial opportunities to improve the care delivered to Medicare beneficiaries and urgently invite a partnership among practitioners, hospitals, health plans, and purchasers to achieve that improvement.
Lower myocardial infarction survival in UK than Sweden blamed on slow uptake of new treatments
Authors: J. Wise
Journal: BMJ (2014)

A comparison of outcomes in patients with acute myocardial infarction shows that 30 day mortality was more than a third higher in the United Kingdom than in Sweden during 2004-10. The researchers concluded that this was because Sweden was much quicker to take up new technologies and to implement evidence based practice.

The study, published in the Lancet , indicated that more than 11 000 lives could have been saved over seven years if UK patients had had the same care as people in Sweden.1 The researchers analysed data from national clinical registries between 2004 and 2010 concerning 391 077 patients from 242 hospitals in the UK and 119 786 patients from 86 …
Hepatitis C Virus and Intravenous Immune Globulin
Authors: Eric Macy
Journal: JAMA (1997)

<h3>To the Editor.</h3> —The diagnosis of common variable immunodeficiency (CVI) is made by demonstrating the lack of the ability to generate new antibody responses or recall antibody responses against protein antigens, such as tetanus and diphtheria, coupled with low serum immunoglobulin levels and recurrent infections. It is interesting that in the cohort described by Dr Bresee and colleagues,<sup>1</sup>26 of 29 immune-deficient patients (the bulk of whom appear to have CVI) who were documented to be positive for hepatitis C virus (HCV) nucleic acid were able to generate an antibody response against HCV proteins. Is there some special feature on the protein constituents of HCV that enables it to overcome the profound immune dysfunction characteristic of CVI?
Adding acupuncture or counselling to usual care hastens improvement in persistent depression
Authors: I. Torjesen
Journal: BMJ (2013)

Patients with depression who received acupuncture or counselling on top of their usual care in primary care experienced greater improvement in their depressive symptoms at three months than patients who received usual care alone, UK researchers have found.

However, after nine months, depressive symptoms were no longer significantly improved in the acupuncture and counselling groups, because depression scores in the usual care group had caught up, found the study.1

The study included 755 patients who in the past five years had consulted in primary …
Reading up on drug companies: there in black and white
Authors: I. Iheanacho
Journal: BMJ (2010)

Say you wanted to keep a casual eye on what the drug industry was up to: where could you look? For the enthusiast, there’s a myriad trade publications, websites, news feeds, and blogs to cater to this need. These, though, may hold little appeal for healthcare professionals, who’d rather remain amateurs in this particular area.

They might try instead general medical journals. But coverage there tends to be tangential and, sometimes, distorting, through its selective focus on individual drugs or conditions. And where the industry, …
Ca2+-Triggered Peptide Secretion in Single Cells Imaged with Green Fluorescent Protein and Evanescent-Wave Microscopy
Authors: Thorsten Lang, Irene Wacker, Jürgen Steyer, Christoph Kaether, Ilse Wunderlich, Thierry Soldati, Hans-Herman Gerdes, Wolfhard Almers
Journal: Neuron (1997)
Allergy to the ornamental indoor green plant Tradescantia 'Albifloxia'
Authors: B. Wüthrich, S. G. O. Johansson
Journal: Allergy (1997)

Wüthrich B, Johansson SGO. Allergy to the ornamental indoor green plant Tradescantia ‘Albifloxia’. We report on a 32‐year‐old atopic female office employee with a moderate tree pollinosis who also suffered from indoor‐related perennial rhinoconjunctivitis. Once when she repotted her two ornamental nonflowering green plants of the genus Tradescantia ‘synonym: Albifloxia ; family Commelinaceae’, she immediately experienced itching of the face, throat, and conjunctiva; swelling of the lips; and dyspnea and wheezing. Skin prick tests with the leaves of Tradescantia ‘T. albifloxia and T. fluminensis ’‘ Ta and Tf ’ were strongly positive as was the specific IgE to Ta leaves extract. On RAST inhibition studies, no cross‐reactivity was found between Ta and Ficus benjamina ‘weeping fig’, a nonflowering green plant, which produces, in its milky sap, an important respiratory allergen. Green plants should be considered potential indoor allergens and tested in plant‐keepers referred for allergologic investigation.
The Membrane-Microfilament Linker Ezrin Is Involved in the Formation of the Immunological Synapse and in T Cell Activation
Authors: Anne Roumier, Jean C Olivo-Marin, Monique Arpin, Frédérique Michel, Marianne Martin, Paul Mangeat, Oreste Acuto, Alice Dautry-Varsat, Andrés Alcover
Journal: Immunity (2001)
Book: The Words of Medicine: Sources, Meanings, and Delights
Authors: J. Aronson
Journal: BMJ (2001)

Robert Fortuine Charles C Thomas, $59.95, pp 424 ISBN 0 398 07133 0 See http://www.ccthomas.com/ for ordering details Rating: ![Graphic][1]</img>![Graphic][2]</img> Why do we call a stamp collector a philatelist? Most collectors are called by the name of the thing they collect plus a suffix. Some are -ists (ex-librists, incunabulists) and some are -ologists (deltiologists, tegestologists); some are -philes (discophiles, notaphiles), -aries (antiquaries, mirabiliaries), -ians (aurelians, Elzevirians), -ers (mossers, pasquinaders), or -os (curiosos, bottle-os); some are just plain -men, like eggmen—perhaps women are not so quirky. When the pursuit becomes fanatical the collector becomes a … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif
Diagnosis and Management of Coeliac Disease in Childhood
Authors: D. Hubble
Journal: BMJ (1963)

Coeliac disease does not occur commonly in childhood.Carter, Sheldon, and Walker (1958-9) calculate its incidence at between 1 in 2,000 and 1 in 6,000 of the population.This incidence may be compared with that of the other common cause of steatorrhoea in children, fibrocystic disease of the pancreas, which Carter (1962) states affects 1 in 2,000 children.Since coeliac disease has to be considered in the differential diagnosis of chronic diarrhoea, of wasting disorders, and of growth failure in children, its diagnosis is a common subject of debate in children's hospitals.Its diagnosis rests oi