tbuckley/cabot-search huggingface dataset:
Rationing Resources While Improving Quality
Authors: David M. Eddy
Journal: JAMA (1994)

MY LAST article concluded with a very unpleasant idea— that rationing services, refusing to cover a service from shared resources, is inevitable.<sup>1</sup>Although no one knows the correct proportion of the gross domestic product (GDP) that health care should consume, it is clear that one way or another, sooner or later, the growth must be stabilized. Ideally, we would like to find all the required savings in administrative and operational inefficiencies, without having to touch the content of care. Unfortunately, an analysis of the increases in health care costs over the last 30 years indicates that about two thirds of the excess increase—the portion of the increase that exceeds the general inflation rate and population growth— is caused by increases in the "volume and intensity of services." The other third is caused by medical price inflation that exceeds general price inflation. These two forces exist in large part because
The carriage of Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrhoeic dermatitis and controls
Authors: H. R. ASHBEE, E. INGHAM, K. T. HOLLAND, W. J. CUNLIFFE
Journal: British Journal of Dermatology (1993)

Journal Article The carriage of Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrhoeic dermatitis and controls Get access H. R. ASHBEE, H. R. ASHBEE Department of Microbiology, University of Leeds, Leeds. U.K. Dr H.R.Ashbee, Department of Microbiology, Immunology Research Laboratory, Old Medical School, Thoresby Place. Leeds LS2 9IT. U.K. Search for other works by this author on: Oxford Academic Google Scholar E. INGHAM, E. INGHAM Department of Microbiology, University of Leeds, Leeds. U.K. Search for other works by this author on: Oxford Academic Google Scholar K. T. HOLLAND, K. T. HOLLAND Department of Microbiology, University of Leeds, Leeds. U.K. Search for other works by this author on: Oxford Academic Google Scholar W. J. CUNLIFFE W. J. CUNLIFFE Department of Microbiology Dermatology, University of Leeds, Leeds. U.K. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 129, Issue 5, 1 November 1993, Pages 533–540, https://doi.org/10.1111/j.1365-2133.1993.tb00480.x Published: 01 November 1993 Article history Accepted: 30 April 1993 Published: 01 November 1993
Changes in lung volume and static expiratory pressure-volume diagram after surfactant rescue treatment of neonates with established respiratory distress syndrome.
Authors: L J Björklund, C T Vilstrup, A Larsson, N W Svenningsen, O Werner
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

The effect of natural surfactant on respiratory system mechanics in infants with respiratory distress syndrome (RDS) is incompletely understood, possibly because the analysis has usually been confined to the tidal breath. We studied 11 paralyzed neonates weighing 540 to 1,850 g before and approximately 30 min after surfactant, which was instilled at 4 to 41 h of age. Diagrams relating airway pressure to expired volume were obtained by having the infant exhale passively through a flowmeter, starting at 30 and ending at 0 cm H20 of pressure. An interrupter intermittently stopped the flow so that pressure could be recorded under static conditions. FRC was measured by sulfur hexafluoride washout, and TLC was calculated from FRC and the pressure-volume (P-V) curve. Ventilation homogeneity was assessed from the washout curve as pulmonary clearance delay (PCD). TLC increased by 10% or more in five infants, but it remained unchanged in the others. Median TLC was 19 ml/kg before and 21.5 ml/kg after surfactant (p = 0.39). The P-V curve became markedly steeper at low pressures after surfactant in most infants, the slope of the steepest segment, i.e., maximal compliance, increasing from 0.65 to 1.22 ml/cm H20/kg (medians, p = 0.008). Dynamic compliance (Cdyn) was unchanged at 0.28 ml/cm H20/kg, whereas specific dynamic compliance (Cdyn/FRC) decreased (p = 0.04). There was no significant immediate change in PCD. The findings imply that during the first 30 min surfactant acted mainly by stabilizing already ventilated air spaces.
Correlation Between Clinical and Histological Analyses in Retroocular Connective Tissues and Extraocular Muscles from Patients with Graves' Ophthalmopathy
Authors: Kimble Matos, Vania Nosé, Paulo Gois Manso, Reinaldo Furlane Ho, Edwardo Marback, Celia Nakanami, Deise Nakanami, Luis Pares, Francisco Stamato
Journal: Endocrine Pathology (2000)
Cost-Effectiveness of Screening for Colorectal Cancer
Authors: Mark K. Chelmowski
Journal: Annals of Internal Medicine (2001)

Letters7 August 2001Cost-Effectiveness of Screening for Colorectal CancerMark K. Chelmowski, MDMark K. Chelmowski, MDAdvanced Healthcare; Milwaukee, WI 53209 (Chelmowski)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-3-200108070-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:By using the lowest possible costs for colonoscopy and perhaps an unrealistically high charge for flexible sigmoidoscopy, Sonnenberg and colleagues (1) make screening colonoscopy seem to be more cost-effective than it actually is. Their model is based on Medicare-allowable payments in 2000 and uses combined professional and facility fees for colonoscopy with and without biopsy of $695.95 and $1003.76, respectively. A 50-year-old patient covered by commercial insurance in Milwaukee may be billed $2400 and $2900 (or more) for the same procedures. Furthermore, charges for pathologic examination, laboratory studies, and treatment of colonoscopy-related complications can also be much ...References1. Sonnenberg A, Delcò F, Inadomi J. Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med. 2000;133:573-84. [PMID: 11033584] LinkGoogle Scholar2. Lewis J. Prevention and treatment of colorectal cancer: pay now or pay later [Editorial]. Ann Intern Med. 2000;133:647-9. [PMID: 11033594] LinkGoogle Scholar3. Frazier A, Colditz G, Fuchs C, Kuntz K. Cost-effectiveness of screening for colorectal cancer in the general population. JAMA. 2000;284:1954-61. [PMID: 11035892] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Mark K. Chelmowski, MDAffiliations: Advanced Healthcare; Milwaukee, WI 53209 (Chelmowski) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of Colonoscopy in Screening for Colorectal Cancer Amnon Sonnenberg , Fabiola Delcò , and John M. Inadomi Prevention and Treatment of Colorectal Cancer: Pay Now or Pay Later James D. Lewis Cost-Effectiveness of Screening for Colorectal Cancer Ananya Das Cost-Effectiveness of Screening for Colorectal Cancer Brian Budenholzer and H. Gilbert Welch Cost-Effectiveness of Screening for Colorectal Cancer Amnon Sonnenberg Metrics 7 August 2001Volume 135, Issue 3Page: 218KeywordsCancer screeningColonoscopyColorectal cancerColorectal cancer screeningDeath ratesFlexible sigmoidoscopyHealth maintenance organizationsHematologic testsMedicareResearch laboratories ePublished: 7 August 2001 Issue Published: 7 August 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Protease inhibitors for treatment of genotype 1 hepatitis C virus infection
Authors: I. A. Rowe, D. J. Mutimer
Journal: BMJ (2011)

A 35 year old man is referred for further investigation of abnormal liver function tests. As a teenager, he used intravenous drugs, and now he is found to have genotype 1 hepatitis C virus infection. He is keen to have antiviral treatment but has heard from friends that the results of treatment are disappointing and that the drugs have substantial side effects.

Among people with hepatitis C infection, 70-80% develop chronic hepatitis, which can progress to cirrhosis and liver cancer. In some patients, the infection can be eradicated by treatment of finite duration. The protease inhibitors, telaprevir and boceprevir, are the first directly acting, hepatitis C virus specific antivirals to be licensed for the treatment of chronic hepatitis C virus infection. They are peptidomimetic inhibitors of the hepatitis C virus serine protease.1 This protease is essential for viral replication through cleavage of the viral polyprotein2 and is implicated in viral evasion of the host inflammatory response.3 Targeting the protease inhibits viral replication and may augment the host response to infection.4

Hepatitis C virus exists as multiple species or genotypes, with variation in its protease gene and protein. The efficacy of the protease inhibitors varies according to hepatitis C virus genotype, and telaprevir and boceprevir are principally active against genotype 1.1 In early studies of short term monotherapy, both drugs showed substantial antiviral activity, but with early emergence of viral resistance.5 6 Subsequent studies therefore investigated the efficacy of the drugs in combination with the current standard of care (pegylated interferon and ribavirin) as triple therapy.

Hepatitis C virus infection can be cured by treatment of finite duration with antiviral therapy. Curative treatment is defined by a sustained virological response—that is, undetectable hepatitis C RNA in the plasma, maintained for at least six months after …
End-stage renal disease and diabetes catalyze the formation of a pentose-derived crosslink from aging human collagen.
Authors: D R Sell, V M Monnier
Journal: Journal of Clinical Investigation (1990)

Structure elucidation of a specific fluorophore from the aging extracellular matrix revealed the presence of a protein crosslink formed through nonenzymatic glycosylation of lysine and arginine residues. The unexpected finding that a pentose instead of a hexose is involved in the crosslinking process suggested that the crosslink, named pentosidine, might provide insight into abnormalities of pentose metabolism in aging and disease. This hypothesis was investigated by quantitating pentosidine in hydrolysates of 103 human skin specimens obtained randomly at autopsy. Pentosidine level was found to increase exponentially from 5 to 75 pmol/mg collagen over lifespan (r = 0.86, P less than 0.001). A three- to tenfold increase was noted in insulin-dependent diabetic and nondiabetic subjects with severe end-stage renal disease requiring hemodialysis (P less than 0.001). Moderately elevated levels were also noted in some very old subjects, some subjects with non-insulin dependent diabetes, and two subjects with cystic fibrosis and diabetes. The cause of the abnormal pentose metabolism in these conditions is unknown but may relate to hemolysis, impaired pentose excretion, cellular stress, and accelerated breakdown of ribonucleotides. Thus, pentosidine emerges as a useful tool for assessment of previously unrecognized disorders of pentose metabolism in aging and disease. Its presence in red blood cells and plasma proteins suggests that it might be used as a measure of integrated pentosemia in analogy to glycohemoglobin for the assessment of cumulative glycemia.
THE RISK OF SUDDEN CARDIAC DEATH IN ADULT CONGENITAL HEART DISEASE: IMPLICATIONS FOR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR THERAPY
Authors: Zeliha Koyak, Barbara Mulder, Aeilko Zwinderman, Louise Harris, Erwin Oechslin, Berto Bouma, Candice Silversides, Werner Budts, Isabelle van Gelder, Joris R. de Groot
Journal: Journal of the American College of Cardiology (2013)
Cardiovascular Manifestations of Rheumatologic Diseases
Authors: Mary J. Roman, Jane E. Salmon
Journal: Circulation (2007)

T he prevalence and importance of cardiovascular disease in rheumatologic disorders have increased in the setting of therapeutic advances, resulting in longer life expectancy, a growing understanding of the importance of inflammation and the immune system in the initiation and progression of atherosclerosis, and enhanced disease detection with the use of sophisticated noninvasive cardiac and vascular diagnostic technology.This article will briefly review cardiovascular manifestations of rheumatologic diseases with an emphasis on recent clinical research.Rheumatologic diseases will be discussed individually for ease of reference, although pathophysiology and basis for cardiovascular abnormalities may be common among some of them.When applicable, cardiovascular disease will be categorized as vascular (accelerated atherosclerosis, arterial stiffness, small-vessel disease, aortic disease), myocardial (abnormalities of structure and function), valvular, pericardial, and conduction diseases.Endothelial dysfunction, although reported in some rheumatologic diseases, will not be systematically discussed in view of space limitations and the nonspecific and incompletely characterized nature of this abnormality.Discussion of suggested mechanisms underlying cardiovascular manifestations of rheumatologic diseases is beyond the scope of this review.Rheumatologic diseases with vasculitis as the primary manifestation, such as giant cell arteritis and Takayasu's arteritis, will not be discussed.
The Infected Hand
Authors: John L. Bell
Journal: JAMA (1964)

Americans not familiar with the British surgical literature of the past 15 years will find that this book puts forth concepts on the treatment of the infected hand which are new and practical. The basic principles, clearly stated, differ from older classical teachings mainly in that the timing of surgical intervention and the incisions used to drain abscesses are different. The author emphasizes that there are no standard surgical incisions in surgery of the infected hand. The book is divided into three sections. The first is concerned with general principles of care. In the diffuse stage a hand infection is managed by only rest, elevation, and antibiotic therapy. Heat in any form is not recommended. Drainage is undertaken only when there is evidence of localized abscess. There is a chapter on the technique of local anesthesia which the author believes suffices for drainage of most hand infections. The second section
Risk of first‐generation H<sub>1</sub>‐antihistamines: a GA<sup>2</sup>LEN position paper
Authors: M. K. Church, M. Maurer, F. E. R. Simons, C. Bindslev‐Jensen, P. Van Cauwenberge, J. Bousquet, S. T. Holgate, T. Zuberbier
Journal: Allergy (2010)

First-generation H(1)-antihistamines obtained without prescription are the most frequent form of self-medication for allergic diseases, coughs and colds and insomnia even though they have potentially dangerous unwanted effects which are not recognized by the general public.To increase consumer protection by bringing to the attention of regulatory authorities, physicians and the general public the potential dangers of the indiscriminate use first-generation H(1)-antihistamines purchased over-the counter in the absence of appropriate medical supervision.A GA(2)LEN (Global Allergy and Asthma European Network) task force assessed the unwanted side-effects and potential dangers of first-generation H1-antihistamines by reviewing the literature (Medline and Embase) and performing a media audit of US coverage from 1996 to 2008 of accidents and fatal adverse events in which these drugs were implicated.First-generation H(1)-antihistamines, all of which are sedating, are generally regarded as safe by laypersons and healthcare professionals because of their long-standing use. However, they reduce rapid eye movement (REM)-sleep, impair learning and reduce work efficiency. They are implicated in civil aviation, motor vehicle and boating accidents, deaths as a result of accidental or intentional overdosing in infants and young children and suicide in teenagers and adults. Some exhibit cardiotoxicity in overdose.This review raises the issue of better consumer protection by recommending that older first-generation H(1)-antihistamines should no longer be available over-the-counter as prescription- free drugs for self-medication of allergic and other diseases now that newer second- generation nonsedating H(1)-antihistamines with superior risk/benefit ratios are widely available at competitive prices.
Vessel Imaging by Interferometric Phase-Contrast X-Ray Technique
Authors: Tohoru Takeda, Atsushi Momose, Jin Wu, Quanwen Yu, Tsutomu Zeniya, Thet-Thet- Lwin, Akio Yoneyama, Yuji Itai
Journal: Circulation (2002)

Background— Phase-contrast x-ray imaging using an x-ray interferometer has great potential to reveal the structures inside soft tissues, because the sensitivity of this method to hydrogen, carbon, nitrogen, and oxygen is ≈1000 times higher than that of the absorption-contrast x-ray method. Imaging of vessels is very important to understand the vascular distribution of organs and tumors, so the possibility of selective angiography based on phase contrast is examined with a physiological material composed of low-atomic-number elements. Methods and Results— Phase-contrast x-ray imaging was performed with a synchrotron x-ray source. Differences in refractive index, dδ, of physiological saline, lactated Ringer’s solution, 5% glucose, artificial blood such as pyridoxylated hemoglobin–polyoxyethylene conjugate, and perfluorotributylamine were measured. Because the dδ of physiological saline has highest contrast, it was used for the phase-contrast x-ray imaging of vessel, and this was compared with absorption-contrast x-ray images. Vessels &gt;0.03 mm in diameter of excised liver from rats and a rabbit were revealed clearly in phase-contrast x-ray imaging, whereas the vessel could not be revealed at all by the absorption-contrast x-ray image. Absorption-contrast x-ray images with iodine microspheres depicted only portal veins &gt;0.1 mm in diameter with nearly the same x-ray dose as the present phase-contrast x-ray imaging. Conclusions— Phase-contrast x-ray imaging explored clear depiction of the vessels using physiological saline with small doses of x-rays.
H pylori and Lewis antigens
Authors: B J APPELMELK
Journal: Gut (2000)

See article on page 18 

Lipopolysaccharide (LPS) of many Helicobacter pylori strains expresses Lewis antigens (Lex, Ley, Lea, Leb) which are similar to those expressed by gastric epithelial cells (“molecular mimicry”).1 In addition, H pylori LPS displays phase variation in these antigens—that is, the high frequency, reversible switching of phenotype2; for instance, a strain that expresses Lex may yield variants that express Ley. As yet, no definite role has been assigned to these Lewis antigens, nor to phase variation, in the pathogenesis of gastric disease.

In this issue of Gut (see page 18), Zheng and colleagues3 report that H pylori strains isolated from Asian peptic ulcer patients express two or more Lewis antigens more often than strains from non-ulcer dyspepsia patients (89.6 v 73.2%; p=0.035). What could be the link between H pylori Lewis …
A SMOKER'S PARADOX IN HEART TRANSPLANT RECIPIENTS: FINDINGS FROM THE NATIONWIDE INPATIENT SAMPLE 2003-2010
Authors: Marjan Mujib, Wilbert Aronow, Gregg Lanier, Dhaval Kolte, Sahil Khera, Chandrasekar Palaniswamy, Sachin Sule, Gregg Fonarow, li hmed, William Frishman, Alan Gass, Sumanth Prabhu, Julio Panza
Journal: Journal of the American College of Cardiology (2014)
RENIN PROTEINURIA IN THE RAT
Authors: T. Addis, Evalyn Barrett, Robert I. Boyd, Helen J. Ureen
Journal: The Journal of Experimental Medicine (1949)

In the rat renin induces an intense but transient proteinuria, associated with the excretion of fibrinogen but not accompanied by any evidence of damage to the glomerulus. The inactivation of renin with respect to its pressor effect leads to a loss of its capacity to induce proteinuria. Angiotonin, when given in large amounts, induces proteinuria in the rat. It is concluded that this form of proteinuria is dependent on the pressor action of renin.
Leukocytes and the Risk of Ischemic Diseases
Authors: Edzard Ernst, Dale E. Hammerschmidt, Ulf Bagge, Arpad Matrai, John A. Dormandy
Journal: JAMA (1987)

Predictive indexes for atherosclerotic risk are imperfect, suggesting that there are predictive factors not commonly considered. Such a factor may be the white blood cell (WBC) count. Epidemiologic studies have shown correlations between the WBC count and the risk of myocardial infarction and stroke. The risk of acute myocardial infarction is approximately four times as great in persons with WBC counts high in the normal range (greater than 9000/microL [9 X 10(9)/L]) as in persons with WBC counts low in the normal range (less than 6000/microL [6 X 10(9)/L]); only 50% to 65% of the excess risk of the high-count individuals is explainable by tobacco smoking (which covaries with WBC count). A high WBC count also predicts greater risk of reinfarction and of in-hospital death. Less rigorously studied, the constitutional neutropenia of Yemenite Jews appears to afford protection against atherosclerotic disease. Among WBC types, the strongest epidemiologic association has been with the neutrophil count. Such a predictive value of WBC count is plausible and satisfying, because WBCs make a major contribution to the rheologic properties of blood; alter adhesive properties under stress--including the stress of ischemia, enhancing their rheologic importance; and participate in endothelial injury, both acutely and chronically, by adhering to endothelium and damaging it with toxic oxygen compounds and proteolytic enzymes. Techniques newly developed or under development may allow us to refine the predictive value of the WBC count by combining it with measures of cell activation and/or activatability.
Public Perception of Stroke Warning Signs and Knowledge of Potential Risk Factors
Authors: Arthur M. Pancioli
Journal: JAMA (1998)

Context.—Decreasing the time from stroke onset to hospital arrival and improving control of stroke risk factors depend on public knowledge of stroke warning signs and risk factors.Objective.—To assess current public knowledge of stroke warning signs and risk factors.Design.—A population-based telephone interview survey using random digit dialing conducted in 1995.Setting.—The Greater Cincinnati, Ohio, metropolitan area, the population of which is similar to that of the United States overall in age, sex, percentage of blacks, and economic status.Participants.—Respondents with age, race, and sex that matched the population of patients with acute stroke.Main Outcome Measures.—Knowledge of risk factors for stroke and warning signs of stroke as defined by the National Institute of Neurological Disorders and Stroke.Results.—Telephone calls were made to 17634 households, which yielded 2642 demographically eligible individuals. Interviews were completed by 1880 respondents (response rate, 71.2%). A total of 1066 respondents (57%) correctly listed at least 1 of the 5 established stroke warning signs, and of all respondents, 1274 (68%) correctly listed at least 1 of the established stroke risk factors. Of the respondents, 469 (57%) of 818 respondents with a history of hypertension listed hypertension, 142 (35%) of 402 respondents who were current smokers listed smoking, and 32 (13%) of 255 respondents with diabetes listed diabetes as a risk factor for stroke. Compared with those younger than 75 years, respondents 75 years or older were less likely to correctly list at least 1 stroke warning sign (60% vs 47%, respectively; P&lt;.001) and were less likely to list at least 1 stroke risk factor (72% vs 56%, respectively; P&lt;.001).Conclusion.—Considerable education is needed to increase the public's awareness of the warning signs and risk factors for stroke. Respondents with self-reported risk factors for stroke are largely unaware of their increased risk. The population at greatest risk for stroke, the very elderly, are the least knowledgeable about stroke warning signs and risk factors.