tbuckley/cabot-search huggingface dataset:
Managed Competition That Works
Authors: Philip Caper
Journal: JAMA (1993)

President Clinton has advocated managed competition within a global budget as a long-term strategy for simultaneously controlling health care costs and expanding access to medical care to all Americans. This proposal is intended to show how these two seemingly conflicting goals can be simultaneously accomplished. Managed competition, as it has been conceptualized to date, is primarily a strategy for reforming the system of providing health services. To work, it must be joined with a strategy for reforming our system of financing and paying for those services and of limiting overall system capacity. "Managed Competition That Works" is a proposal that would create a single trust-funded national system of health insurance, implemented through a system of vouchers to individuals. Global budgeting would be accomplished through establishment of the voucher's value each year. The trust fund would pay health plans for all medical care by capitation, but health plans would be free to negotiate a variety of payment arrangements with physicians, hospitals, and other providers. All plans would be required to offer a standard package of benefits, but would have great flexibility in offering benefits beyond the scope of the standard package, if those benefits replace high-cost with lower-cost services or permit the plan to compete more effectively for market share. This proposal would establish firm but acceptable national budget limits; provide universal, comprehensive, and uniform insurance coverage; eliminate cost shifting; encourage competition; reward efficiency-improving innovation; greatly reduce the need for centralized micromanagement of medical care; and retain local determination and a somewhat reduced level of consumer choice. Although this proposal is written as a national plan, trust funds could be implemented at the state level, if problems associated with portability of benefits among states could be solved.
Hospital Mortality in Acute Myocardial Infarction
Authors: Mark S. Blumberg
Journal: JAMA (2010)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Ectopic Splenomegaly in Feltyʼs Syndrome
Authors: RENE P. duCRET, MARK C. ADKINS, ROBERT A. HALVORSEN, CLAUDIA M. ENGELER, CHRISTOPHER C. KUNI, ROBERT J. BOUDREAU
Journal: Clinical Nuclear Medicine (1991)

A 50-year-old woman with Felty's syndrome, who presented with “menopausal” symptoms, was found to have a large pelvic mass on physical exam. Computed tomography of the pelvis led to an incorrect diagnosis of malignancy, while radionuclide imaging using Tc-99m sulfur colloid confirmed the diagnosis of ectopic splenomegaly.
Investigating iron status in microcytic anaemia: Zincprotoporphyrin and soluble transferrin receptor have a role
Authors: Anastasios Koulaouzidis, Shivaram Bhat
Journal: BMJ (2006)

EDITOR—More “sophisticated” tests can be included in Galloway and Smellie's proposed guidelines on iron status in microcytic anaemia.1 Ferritin seems a weak compromise compared with the yield from diagnostic algorithms using soluble transferrin receptors or zincprotoporphyrin.23

High zincprotoporphyrin concentrations detect not only …
Detection of Fibrous Cap in Atherosclerotic Plaque by Intravascular Ultrasound by Use of Color Mapping of Angle-Dependent Echo-Intensity Variation
Authors: Takafumi Hiro, Takashi Fujii, Kyounori Yasumoto, Takashige Murata, Akihiro Murashige, Masunori Matsuzaki
Journal: Circulation (2001)

Background —The thickness of the fibrous cap is a major determinant in the vulnerability of atherosclerotic plaque to rupture. It has been demonstrated that intravascular ultrasound (IVUS) backscatter from fibrous tissue is strongly dependent on the ultrasound beam angle of incidence. This study investigated the feasibility of using a new IVUS color mapping technique representing the angle-dependent echo-intensity variation to determine the thickness of the fibrous cap in atherosclerotic plaque. Methods and Results —Nineteen formalin-fixed noncalcified human atherosclerotic plaques from necropsy were imaged in vitro with a 30-MHz IVUS catheter. The IVUS catheter was moved coaxially relative to the plaque. The images showing maximum and minimum echo intensity of the plaque surface were selected to calculate the angle-dependent echo-intensity variation. A colorized representation of the echo-intensity variation in the plaque was obtained from the 2 IVUS images. A clearly bordered area with large variation in echo intensity was revealed for each plaque surface in the colorized IVUS image. The thickness ( x , mm) of this area correlated significantly with that of fibrous cap ( y , mm) measured from histologically prepared sections as y =1.05 x −0.01 ( r =0.81, P &lt;0.0001). Bland-Altman analysis also supported the reliability of this method (mean difference, 0.00±0.10 mm). Conclusions —This novel technique for color mapping the echo-intensity variation in IVUS provided an accurate representation of the thickness of the fibrous cap in atherosclerotic plaque. This method may be useful in assessing plaque vulnerability to rupture in atherosclerosis.
Off-therapy durability of response to entecavir therapy in hepatitis B e antigen-negative chronic hepatitis B patients
Authors: Wen-Juei Jeng, I-Shyan Sheen, Yi-Cheng Chen, Chao-Wei Hsu, Rong-Nan Chien, Chia-Ming Chu, Yun-Fan Liaw
Journal: Hepatology (2013)

The optimal duration of nucelos(t)ide analog (Nuc) treatment in hepatitis B e antigen (HBeAg)-negative patients with chronic hepatitis B virus (HBV) infection is unknown. The Asian Pacific Association for the Study of the Liver (APASL) guidelines recommend that treatment can be discontinued if undetectable HBV-DNA has been documented on three occasions ≥6 months apart. This study aimed to test this stopping rule in HBeAg-negative chronic hepatitis B (CHB) patients treated with entecavir (ETV). Ninety-five patients (39 cirrhosis) were treated with ETV for a median of 721 (395-1,762) days before stopping therapy and were then monitored with serum HBV DNA and alanine aminotransferase (ALT) at least every 3 months. Within 1 year after stopping ETV therapy, "clinical relapse" (an episode of ALT elevation >2 × upper limit of normal plus HBV-DNA >2,000 IU/mL) occurred in 43 (45.3%) of the 95 patients. Of the 39 cirrhosis patients, 17 (43.6%) relapsed and one (2.6%) developed decompensation. The median duration until relapse was 230 days (74.4% >6 months). Logistic regression analysis showed that baseline HBV-DNA ≤2 × 105 IU/mL was the only significant independent factor for sustained response. The 1-year relapse rate was 29% in patients with a baseline HBV DNA ≤2 × 105 IU/mL versus 53% in those with HBV DNA >2 × 105 IU/mL (P = 0.027). For the latter, consolidation therapy >64 weeks reduced the relapse rate to 33.3% in patients without cirrhosis. Conclusion: With an overall 1-year relapse rate of 45% and 29% in those with a baseline serum HBV DNA ≤2 × 105 IU/mL, the APASL stopping rule for HBeAg-negative CHB patients with proper off-therapy monitoring is adequate even in patients with cirrhosis. Consolidation therapy >64 weeks seems more appropriate for those with higher baseline HBV DNA. (Hepatology 2013; 58:1888–1896)
Conflict of interest: Sometimes consultancies cannot be disclosed
Authors: J Garrow, G Watt, D P Doogan, A House, N Freemantle, P H Millard
Journal: BMJ (1994)

EDITOR, - Richard Smith rightly says that disclosure is a good remedy for conflict of interest. However, academics who choose to advise industry usually have to sign a secrecy agreement to ensure that commercially valuable information is not passed to a competitor. Sometimes the fact that firm A has employed an expert in field B as a consultant is itself commercially sensitive, so the secrecy agreement specifies that the existence of the consultancy should also be kept secret. For obvious reasons I do not know how often this happens, but I have twice had such an approach myself. I think it is important that academics who intend to contribute to the scientific literature as authors, editors, or referees should not accept consultancies which they cannot publicly disclose. 1. 1. Smith R .Conflict of interest and the BMJ.BMJ1994;308: 4–5. (1 January.) [OpenUrl][1][FREE Full Text][2] # Speakers should declare financial support {#article-title-3} EDITOR, - With regard to avoiding potential conflicts of interest,1 I was impressed recently by a procedure used at a satellite meeting of the American Heart Association. The meeting was recognised for the continuing education that American doctors are required to undertake for reaccreditation. At the start of the meeting every participant was given a sheet of paper listing the speakers and any financial support they received that might lead to a conflict of interest. For example, it … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DSmith%26rft.auinit1%253DR%26rft.volume%253D308%26rft.issue%253D6920%26rft.spage%253D4%26rft.epage%253D4%26rft.atitle%253DConflict%2Bof%2Binterest%2Band%2Bthe%2BBMJ%26rft_id%253Dinfo%253Apmid%252F8298354%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=308/6920/4&atom=%2Fbmj%2F308%2F6926%2F471.2.atom
T-cell immunosenescence: lessons learned from mouse models of aging
Authors: Alexander C. Maue, Eric J. Yager, Susan L. Swain, David L. Woodland, Marcia A. Blackman, Laura Haynes
Journal: Trends in Immunology (2009)

It is well established that increasing age is associated with a decreased capacity of the immune system to mediate effective immune responses to vaccination and invading pathogens. Because of the inherent limitations of conducting experiments in humans, much of what we have learned is owed to the utility of experimental mouse models of aging. Recent studies performed in the mouse have demonstrated mechanisms responsible for age-related declines in the function of CD4+ and CD8+ cells. This review describes key findings regarding age-related defects in T-cell function and discusses the impact these defects have on vaccine efficacy and immunity. It is well established that increasing age is associated with a decreased capacity of the immune system to mediate effective immune responses to vaccination and invading pathogens. Because of the inherent limitations of conducting experiments in humans, much of what we have learned is owed to the utility of experimental mouse models of aging. Recent studies performed in the mouse have demonstrated mechanisms responsible for age-related declines in the function of CD4+ and CD8+ cells. This review describes key findings regarding age-related defects in T-cell function and discusses the impact these defects have on vaccine efficacy and immunity.
Age of consent for homosexuals in Britain is cut to 18
Authors: L Dillner
Journal: BMJ (1994)

The age of consent for gay men in Britain was lowered this week from 21 to 18 after a turbulent three hour debate in the House of Commons. Members of parliament voted by 427 to 162 to change the law but rejected moves to reduce the age of consent to 16 by a majority of 27. This is the first time since 1967 that the law on homosexuality has been changed. Protestors for gay rights, who gathered outside parliament in …
β-Adrenergic Sweat Secretion as a Diagnostic Test for Cystic Fibrosis
Authors: Paul Quinton, Laura Molyneux, Wan Ip, Annie Dupuis, Julie Avolio, Elizabeth Tullis, Douglas Conrad, A. K. Shamsuddin, Peter Durie, Tanja Gonska
Journal: American Journal of Respiratory and Critical Care Medicine (2012)

Rationale: β-Adrenergically induced sweat secretion offers an expedient method to assess native cystic fibrosis transmembrane conductance regulator (CFTR) secretory function in vivo.Objectives: To evaluate the sensitivity, specificity, and reliability of a test based on the activity and secretory function of CFTR in the sweat gland.Methods: Primary and validation trials with prospectively ascertained healthy control subjects, obligate heterozygotes, and patients with a CFTR-related disorder and CF (pancreatic sufficient and insufficient).Measurements and Main Results: Diagnostic accuracy and reliability of β-adrenergic sweat secretory rates using an evaporimeter was assessed and compared with sweat chloride concentrations. The cholinergically stimulated mean sweat rate did not differ among groups. The mean maximal β-adrenergically stimulated sweat rate in heterozygotes was about half the rate of healthy control subjects, and completely absent in pancreatic-insufficient patients with CF and pancreatic-sufficient patients with CF (P < 0.0001). Subjects with a CFTR-related disorder showed reduced or absent β-adrenergic sweat secretion. The β-adrenergic secretory response demonstrated high diagnostic accuracy (area under a characteristic receiver-operator curve = 0.99; 95% confidence interval, 0.97–1.00) and reliability (intraclass correlation, 0.90; 95% confidence interval, 0.81–0.95). The diagnostic cutoff level for CF, derived from the primary trial, correctly identified all control subjects, heterozygotes, and patients with CF in the validation cohort, whereas concurrent sweat chloride measurements misclassified one heterozygote and five subjects with CF. The cholinergic and β-adrenergic sweat secretion rates were lower in women compared with men (P < 0.001).Conclusions: β-Adrenergic sweat secretion rate determined by evaporimetry is an accurate and reliable technique to assess different levels of CFTR function and to identify patients with CF.
Intellectual Deficits Associated With Early Onset of Insulin-Dependent Diabetes Mellitus in Children
Authors: Joanne F Rovet, Robert M Ehrlich, Marla Hoppe
Journal: Diabetes Care (1987)

Twenty-seven children with early-onset (&amp;lt; 4 yr) diabetes (EOD), 24 children with late-onset (&amp;gt; 4 yr) diabetes (LOD), and 30 sibling controls were compared in their performance on tests of intellectual functioning and school achievement. The results indicated that children with EOD, particularly girls, scored lower than the other groups of diabetic children and siblings on tests of visuospatial (P &amp;lt; .05) but not verbal ability. Many of the girls with EOD were also having difficulty at school, and several were receiving special education. Children with EOD had more hypoglycemic convulsions than those with LOD. Both convulsions and age of onset were associated with poorer performance on spatial tasks. Girls with EOD had lower spatial test scores regardless of convulsion history, whereas boys with EOD scored lower only if they had had a convulsion.
Fen1 mutations result in autoimmunity, chronic inflammation and cancers
Authors: Li Zheng, Huifang Dai, Mian Zhou, Mei Li, Purnima Singh, Junzhuan Qiu, Walter Tsark, Qin Huang, Kemp Kernstine, Xuemei Zhang, Dongxin Lin, Binghui Shen
Journal: Nature Medicine (2007)
Platelets are essential for leukocyte recruitment in allergic inflammation
Authors: Simon C. Pitchford, Hiroshi Yano, Rebecca Lever, Yanira Riffo-Vasquez, Silvia Ciferri, Mark J. Rose, Silvia Giannini, Stefania Momi, Domenico Spina, Brian O'Connor, Paolo Gresele, Clive P. Page
Journal: Journal of Allergy and Clinical Immunology (2003)
THE USE OF VACCINES IN ACUTE MASTITIS
Authors: T. H. C. Benians
Journal: BMJ (1911)

VACCINES IN ACUTE MABTITIS.LAPRIL 15, 19I1.quantity varied from 5 to 10 millions, and the injections were made on May 15th, May 18th, May 24eh, May 31st, and June 7th.A little pus and blood appeared from time to time in the dis- charge from the bowel, which never became so offensive as it was before the appendicostomy.The temperature, which had oscillated widely between 1020 F. and 980 F., began to show smaller excursions about the beginning of June, and there was no rigor after the operation.The patient left the nursing home on August 15th, but it was not until September 13th that he was abJe to be carried out into his garden, nor until the middle of November that he could stand without support.He then began to increase in weight steadily from 6 st. 4 lb.on October 23rd to 8 st.4j lb. on Decemberl9th, By this time the swelling of his wrists had subsided.On January 11th, 1911, his weight had increased to 8 st. 9 lb., but he had experienced a slight relapse, as his wrists had again become puffy, and there was a return of the discharge from the bowel.The note adds that the patient bad suffered similar relapses on previous occasions, and that they seemed to follow a lew days after any extra effort or mental excitement.
Implications of inflammatory changes on cervical cytology
Authors: M. Griffiths
Journal: BMJ (1990)

We think that their suggestion that general prac- titioners should treat empirically for Chlamvdia trachomatis infection is highly inflammatory.As they admit, this infection has an appreciable morbidity; the correct management of such sexually transmitted infections requires accurate diagnosis, effective treatment, adequate tests of cure, and, very importantly, examination and treatment if necessary of all sexual partners.Suboptimal management, as they suggest, has no doubt contributed to the rising incidence of C trachomatis infection over the past decade.We stand by our recommendations that screening for genital infections be performed in selected women who have had one smear showing in- flammatory changes and in women undergoing colposcopic examination because of repeated smears showing inflammatory changes.Such policies should encourage closer links between departments of genitourinary medicine and colposcopy clinics, which can only be of mutual benefit to patients and staff.
Abstract A61: MDSC phenotypes but not Tregs predict patient survival in unresectable stage IV melanoma independently of the type of treatment applied.
Authors: Henning Zelba, Benjamin Weide, Alexander Martens, Graham Pawelec
Journal: Cancer Research (2013)

Abstract Malignant melanoma is the most aggressive and treatment-resistant form of skin cancer with a steadily increasing incidence. Experimental immunotherapies may result in dramatic tumour regressions but only in a minority of patients. Defining biomarkers allowing identification of those who will survive long-term is crucial to understanding why this is so, and to patient selection. Here, we assessed myeloid-derived suppressor cells (MDSC) and regulatory T cells (Tregs) for their association with survival in late-stage melanoma. We investigated their prognostic value in peripheral blood by polychromatic flow cytometry in a prospective study of 78 patients with unresectable stage IV melanoma treated in a variety of different ways (different peptide vaccinations, ipilimumab, chemotherapy, etc). Thus far, this had only been analyzed in small cohorts and with equivocal results. We investigated four different populations of MDSCs (CD14+CD11b+HLA-DRlo, CD14+CD15+CD11b+, CD14+IL4Ra+ and CD14-CD15+IL4Ra+) that have been associated with poorer outcome in cancers other than melanoma. Tregs were identified as CD4+CD25+FoxP3+ and stratified into CD4+CD45RA+FoxP3lo (resting) and CD4+CD45RA-FoxP3hi (activated) Tregs. We found that the percentages of Tregs in patients were significantly greater than in healthy controls, but differences between patients in their frequencies were not associated with overall survival. In contrast, percentages of the four MDSC populations were not generally different in melanoma patients and controls. However, higher percentages of one population of MSDCs, CD14+CD11b+HLA-DRlo cells, did correlate with shorter survival in Kaplan-Meier analysis and were even superior to the M category in predicting patient survival. These results suggest the importance and potential usefulness of quantifying distinct MDSC populations in the peripheral blood of patients with melanoma for predicting the likelihood of responsiveness to therapy and long-term survival, independently of the nature of their treatment. This is consistent with the notion that anti-tumour immunity plays a crucial role in cancer survivorship, no matter which treatment is applied. Citation Format: Henning Zelba, Benjamin Weide, Alexander Martens, Graham Pawelec. MDSC phenotypes but not Tregs predict patient survival in unresectable stage IV melanoma independently of the type of treatment applied. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology: Multidisciplinary Science Driving Basic and Clinical Advances; Dec 2-5, 2012; Miami, FL. Philadelphia (PA): AACR; Cancer Res 2013;73(1 Suppl):Abstract nr A61.
Animations of Thoracic Viscera
Authors: Stanley W. Jacob
Journal: JAMA (1995)

ABSTRACT The teaching of anatomy has entered a whole new realm since the onset of the computer age and advances in diagnostic imaging. The videodisc-format Animations of Thoracic Viscera, part of the Digital Anatomist Videodisc Series from the University of Washington School of Medicine, represents a medium that is likely to see increasing use because of its three-dimensional accuracy to life, maneuverability for viewing anatomic elements from any angle, and portability.Animations of Thoracic Viscera has created separate computer files for each anatomical structure, reproduced with precise accuracy from a cryoplaned cadaver. This enables the thoracic organs to be reproduced in three-dimensional form. The image quality is superior to usual computer reproductions. All the major thoracic elements—arteries, veins, nerves, bone, muscular tissue, and so on— are differentially colored. This is a helpful identifying technique, although the brightness of the half-dozen colors sometimes gives a surrealistic impression, which detracts from the lifelike