tbuckley/cabot-search huggingface dataset:
Academic Medical Centers and Conflicts of Interest
Authors: Kimford J. Meador
Journal: JAMA (2006)

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
Suppression of insulin-induced sympathetic activation and vasodilation by dexamethasone in humans.
Authors: U Scherrer, P Vollenweider, D Randin, E Jéquier, P Nicod, L Tappy
Journal: Circulation (1993)

BACKGROUND Physiological hyperinsulinemia in lean human subjects stimulates sympathetic nerve activity and blood flow in skeletal muscle, but the underlying mechanism is unknown. Potential mechanisms include central neural or peripheral actions of insulin. Glucocorticoids may potentially interfere with both such actions and thereby may attenuate sympathoexcitatory and vasodilatory effects of insulin in skeletal muscle. METHODS AND RESULTS To determine whether insulin-induced sympathetic activation and vasodilation are attenuated by dexamethasone, we measured muscle sympathetic nerve activity and muscle blood flow during euglycemic hyperinsulinemia before and after short-term administration of this pharmacological agent. Insulin concentrations, which normally doubled sympathetic activity and markedly increased blood flow, had no such stimulatory effect after short-term dexamethasone administration. In contrast, responses to two noninsulin sympathetic stimuli, the Valsalva maneuver and immersion of the hand in ice water, and the vasodilatory response to calf vascular occlusion were not altered by dexamethasone. CONCLUSIONS These results demonstrate a dramatic impairment of insulin-induced sympathetic activation and vasodilation by dexamethasone in lean, healthy humans. This study suggests that dexamethasone administration to lean subjects may offer an experimental model to examine underlying mechanisms that regulate the interplay between cardiovascular, sympathetic, and metabolic effects of insulin.
A NEW OPTHALMOSCOPE, COMBINED WITH WHICH THERE IS A PLANE MIRROR FOR RETINOSCOPY; INTENDED AS A POCKET INSTRUMENT FOR OPHTHALMOLOGISTS AND PRACTITIONERS.
Authors: BROWN PUSEY
Journal: JAMA (1901)

This instrument is offered primarily to meet the demand for an ophthalmoscope that can be carried conveniently in one's pocket without a box or case. It consists of a frame with two arms, which swing on a hinge-joint. The arms carry two mirrors, which are so placed that when the instrument is closed, the mirrors lie face to face, and are thus protected from injury and dirt. When the instrument is open one arm acts as a handle for the other. In the joint there is a spring bolt, which fastens the joint tightly when the mirrors lie face to face, and also locks the joint when the instrument is open; this spring bolt is loosened by pressing a little knob. The arms are nickel-plated; on the outside this plating has a high polish, on the inside it has a dull finish, so that this metal part will not reflect
The ShapeLock system adapted to intragastric and transgastric surgery
Authors: P. Swain
Journal: Endoscopy (2007)

Endoluminal and transgastric surgical procedures present challenges for current endoscopes and instruments which, especially when retroflexed, are too flexible and do not permit transmission of adequate force. The USGI TransPort is a multilumen surgical access system designed to enable endosurgical therapy. ShapeLock technology allows the TransPort to have either a flexible or a rigid state. In flexible mode, the TransPort is introduced and steered to a precise location. It is then locked by squeezing a handle, to provide a rigid platform for therapeutic procedures. A new device for tissue grasping and approximation, the g-Prox, has been designed for use with the TransPort, and this new endosurgical system has been tested in a series of intragastric and transgastric procedures in pigs and human cadavers. The experiments demonstrated the potential for using the TransPort platform to improve flexible endoluminal and transluminal procedures, including intragastric and transgastric fundoplication, cholecystectomy, gastric restriction, and gastric full-thickness incision closure.
Quality of care in ISTCs
Authors: Nick Black
Journal: Journal of the Royal Society of Medicine (2009)

I was puzzled by Pollock and Kirkwood's1 claim to have conducted ‘the first independent evaluation’ of Independent Sector Treatment Centres (ISTCs) when they were clearly aware of our earlier study as they cite it.2 Far from showing, as they state, ‘how case-mix in ISTCs differs from the NHS making comparisons of costs and quality difficult’, we demonstrated that when we allowed for case-mix differences, there was little difference in patient reported outcomes between those treated in NHS providers and those treated in ISTCs. If anything, outcomes were slightly better in ISTCs though we speculated that this may reflect the Healthcare Commission's finding that patients in ISTCs reported a better experience of the humanity of care than those in NHS providers.
Effects of Hypoxia on Isometric Force, Intracellular Ca <sup>2+</sup> , pH, and Energetics in Porcine Coronary Artery
Authors: Shunichi Shimizu, Peggy Sue Bowman, George Thorne, Richard J. Paul
Journal: Circulation Research (2000)

Abstract —When exposed to hypoxic conditions, coronary arteries dilate, which is an important protective response. Although vessel sensitivity to oxygen is well documented, the mechanisms are not known with certainty. To further characterize the mechanisms of oxygen sensing in the coronary artery, we tested the major classes of hypotheses by measuring the effects of hypoxia on energetics, [Ca 2+ ] i , K + channel function, and pH i . Hypoxia relaxes porcine coronary arteries stimulated with either KCl or U46619. The extent of relaxation is dependent on both the degree and kind of stimulation. [Ca 2+ ] i was measured in endothelium-denuded arteries using fura 2-AM and ratiometric fluorescent techniques. At lower stimulus levels, hypoxia decreased both force and [Ca 2+ ] i . Inhibitor studies suggest that K Ca and K ATP channels are not involved in the hypoxic relaxation, whereas K V channels may play a minor role, if any. Despite the hypoxia-mediated decrease in force, [Ca 2+ ] i was unchanged or increased at high levels of stimulation. Despite a marked increase in lactate content, pH i (measured with the ratiometric fluorescent dye BCECF) was also little affected by hypoxia. Measurement of the phosphagen and metabolite profile of freeze-clamped arteries with analytical isotachophoresis indicated that hypoxia increased lactate content by 4-fold and decreased phosphocreatine to 60% of control. However, neither ATP nor P i was affected by hypoxia. Interestingly, additional stimulation under hypoxia increased force but not ATP utilization, as estimated from measurements of anaerobic lactate production. Thus, surprisingly, the economy of force maintenance is increased under hypoxia. In porcine coronary artery, both Ca 2+ -dependent and, importantly, Ca 2+ -independent mechanisms are involved in hypoxic vasodilatation. For the latter, mechanisms involving either ATP, [Ca 2+ ] i , pH i , or P i cannot be invoked. This novel oxygen sensing mechanism involves a decreased Ca 2+ sensitivity.
Emergence of Influenza B Viruses With Reduced Sensitivity to Neuraminidase Inhibitors
Authors: Shuji Hatakeyama, Norio Sugaya, Mutsumi Ito, Masahiko Yamazaki, Masataka Ichikawa, Kazuhiro Kimura, Maki Kiso, Hideaki Shimizu, Chiharu Kawakami, Kazuhiko Koike, Keiko Mitamura, Yoshihiro Kawaoka
Journal: JAMA (2007)

Very little is known about the frequency of generation and transmissibility of influenza B viruses with reduced sensitivity to neuraminidase inhibitors. Furthermore, transmission of resistant virus, whether influenza A or B, has not been recognized to date.To assess the prevalence and transmissibility of influenza B viruses with reduced sensitivity to neuraminidase inhibitors.Investigation of the neuraminidase inhibitor sensitivity of influenza B isolates from 74 children before and after oseltamivir therapy and from 348 untreated patients with influenza (including 66 adults) seen at 4 community hospitals in Japan during the 2004-2005 influenza season. Four hundred twenty-two viruses from untreated patients and 74 samples from patients after oseltamivir therapy were analyzed.Sialidase inhibition assay was used to test the drug sensitivities of influenza B viruses. The neuraminidase and hemagglutinin genes of viruses showing reduced sensitivity to neuraminidase inhibitors were sequenced to identify mutations that have the potential to confer reduced sensitivity to these drugs.In 1 (1.4%) of the 74 children who had received oseltamivir, we identified a variant with reduced drug sensitivity possessing a Gly402Ser neuraminidase substitution. We also identified variants with reduced sensitivity carrying an Asp198Asn, Ile222Thr, or Ser250Gly mutation in 7 (1.7%) of the 422 viruses from untreated patients. Review of the clinical and viral genetic information available on these 7 patients indicated that 4 were likely infected in a community setting, while the remaining 3 were probably infected through contact with siblings shedding the mutant viruses.In this population, influenza B viruses with reduced sensitivity to neuraminidase inhibitors do not arise as frequently as resistant influenza A viruses. However, they appear to be transmitted within communities and families, requiring continued close monitoring.
Implementing Accountable Care Organizations
Authors: Sara Singer
Journal: JAMA (2011)

ACHIEVINGTHETRIPLEAIMS—HIGHER-QUALITYPATIENTcenteredcare,improvingpopulationhealth,andmoderating per capita costs—will require fundamental change in the US health care system. Accountable care organizations (ACOs) as outlined in the Affordable Care Act represent an early initiative in restructuring health care. Accountable care organizations accept responsibility for the cost and quality of care for defined patient populations. Under the Medicare shared savings program, ACOs will face expenditure targets based on their previous 3 years of Medicare Part A and Part B experience. Qualifying organizations can choosebetween2riskarrangements.The first involvesupside potential fromsharedsavings in the first2years, addingdownside risk only in the third year of operation. In the second arrangement,organizationsshareagreaterpercentageof thesavingsbutare responsible fordownside risk fromthebeginning. Thesharedsavingsprogramwill requireorganizations toconduct quality improvement initiatives, care coordination, performance measurement, and public reporting. To succeed, organizations contemplating participation in ACOs will need to develop and improve organizational capabilities necessary to meet program requirements. Hospitals and physician organizations will need to forge new relationships and take on new responsibilities. Success will require adaptation and change, learning quickly from mistakes, and developing an ability to transfer knowledge among participating entities. This will require ACOs to become learning organizations that can comprehend and expand what works and move to correct things that do not. In this commentary, we discuss 10 potential mistakes that organizations may experience in becoming ACOs whether with Centers for Medicare & Medicaid Services (CMS) payment or working with private payers.
Agreement of Visual Estimation of Coronary Artery Calcium From Low-Dose CT Attenuation Correction Scans in Hybrid PET/CT and SPECT/CT With Standard Agatston Score
Authors: Andrew J. Einstein, Lynne L. Johnson, Sabahat Bokhari, Jessica Son, Randall C. Thompson, Timothy M. Bateman, Sean W. Hayes, Daniel S. Berman
Journal: Journal of the American College of Cardiology (2010)
Randomized, Controlled Trial of Therapy Interruption in Chronic HIV-1 Infection
Authors: Emmanouil Papasavvas, Jay R Kostman, Karam Mounzer, Robert M Grant, Robert Gross, Cele Gallo, Livio Azzoni, Andrea Foulkes, Brian Thiel, Maxwell Pistilli, Agnieszka Mackiewicz, Jane Shull, Luis J Montaner
Journal: PLoS Medicine (2004)

Approaches to limiting exposure to antiretroviral therapy (ART) drugs are an active area of HIV therapy research. Here we present longitudinal follow-up of a randomized, open-label, single-center study of the immune, viral, and safety outcomes of structured therapy interruptions (TIs) in patients with chronically suppressed HIV-1 infection as compared to equal follow-up of patients on continuous therapy and including a final therapy interruption in both arms.Forty-two chronically HIV-infected patients on suppressive ART with CD4 counts higher than 400 were randomized 1:1 to either (1) three successive fixed TIs of 2, 4, and 6 wk, with intervening resumption of therapy with resuppression for 4 wk before subsequent interruption, or (2) 40 wk of continuous therapy, with a final open-ended TI in both treatment groups. Main outcome was analysis of the time to viral rebound (>5,000 copies/ml) during the open-ended TI. Secondary outcomes included study-defined safety criteria, viral resistance, therapy failure, and retention of immune reconstitution. There was no difference between the groups in time to viral rebound during the open-ended TI (continuous therapy/single TI, median [interquartile range] = 4 [1-8] wk, n = 21; repeated TI, median [interquartile range] = 5 [4-8] wk, n = 21; p = 0.36). No differences in study-related adverse events, viral set point at 12 or 20 wk of open-ended interruption, viral resistance or therapy failure, retention of CD4 T cell numbers on ART, or retention of lymphoproliferative recall antigen responses were noted between groups. Importantly, resistance detected shortly after initial viremia following the open-ended TI did not result in a lack of resuppression to less than 50 copies/ml after reinitiation of the same drug regimen.Cycles of 2- to 6-wk time-fixed TIs in patients with suppressed HIV infection failed to confer a clinically significant benefit with regard to viral suppression off ART. Also, secondary analysis showed no difference between the two strategies in terms of safety, retention of immune reconstitution, and clinical therapy failure. Based on these findings, we suggest that further clinical research on the long-term consequences of TI strategies to decrease drug exposure is warranted.
Hodgkin's Disease Exclusively With Bone Marrow Involvement
Authors: D. Willerson
Journal: JAMA (1970)

<h3>To the Editor.—</h3> During the course of illness lymph node involvement may be detected in almost all patients with Hodgkin's disease.<sup>1</sup>Involvement of other organs such as spleen and liver is also common.<sup>2</sup>This report describes a patient who presented with pancytopenia. Reed-Sternberg cells were found in two bone marrow aspirations before starting chemotherapy and on bone marrow sections taken at autopsy. Neither clinical nor postmortem involvement of lymph nodes or other organs was detected. <h3>Report of a Case.—</h3> A 70-year-old man admitted to the hospital because of pancytopenia had noted only increasing fatigue and dyspnea on exertion during the previous five months. His medications included sulfinpyrazone (Anturane) and diazepam (Valium). Abnormal physical findings included pallor, petechiae over both lower extremities, and flame-shaped hemorrhages in the left fundus. There was no sternal tenderness, hepatosplenomegaly, or lymphadenopathy. Hemoglobin level was 9.8 gm/100 ml, reticulocyte count was 0.9%, mean corpuscular
Receptor-binding residues lie in central regions of Duffy-binding–like domains involved in red cell invasion and cytoadherence by malaria parasites
Authors: Alfredo Mayor, Nivedita Bir, Ritica Sawhney, Shailja Singh, Priyabrata Pattnaik, Saurabh Kumar Singh, Amit Sharma, Chetan E. Chitnis
Journal: Blood (2004)
Chiasma Lesion due to Fall in Epileptic Fit
Authors: R. Klein, P. P. O'Mallie
Journal: BMJ (1948)

ConclusionsNeoantergan conferred no apparent benefit upon 25 specially selected and carefully observed asthmatic patients.Neoantergan was markedly successful in reducing the severity of the symptoms of 15 cases of hay-fever.When working with asthmatic patients an erroneous im- pression of the efficacy of a new preparation is likely to be formed unless a very careful scheme of trial is planned, preferably using a control preparation.
Overcoming Immunoescape Mechanisms of BCL1 Leukemia and Induction of CD8+ T-Cell–Mediated BCL1-Specific Resistance in Mice Cured by Targeted Polymer-Bound Doxorubicin
Authors: Marek Kovar, Jakub Tomala, Helena Chmelova, Lubomir Kovar, Tomas Mrkvan, Radka Joskova, Zuzana Zakostelska, Tomas Etrych, Jiri Strohalm, Karel Ulbrich, Milada Sirova, Blanka Rihova
Journal: Cancer Research (2008)

Abstract BALB/c mice bearing syngeneic BCL1 leukemia, a mouse model of human chronic lymphocytic leukemia, were treated with polymer-bound doxorubicin conjugate targeted with BCL1-specific monoclonal antibody. Such treatment can cure up to 100% of mice and the cured mice show long-lasting resistance to BCL1 leukemia. We show that both CD4+ and CD8+ T cells are required for establishment of the resistance, but only CD8+ T cells are necessary for its maintenance. BCL1 cells express MHC class I and II and also costimulatory molecules CD80 and CD86, which can aid eliciting of antitumor response. On the other hand, BCL1 cells also use several immunoescape mechanisms, such as expression of PD-L1, PD-L2, and interleukin-10. BCL1 cells thus can be recognized by BCL1-specific T cells, but instead of effective priming, such T cells are anergized or deleted by apoptosis. Moreover, BCL1 leukemia progression is accompanied by robust expansion of CD4+CD25+Foxp3+ regulatory T (Treg) cells. Although it has been shown that depletion of Treg cells in tumor-bearing mice can retard tumor growth, direct evidence that expansion of Treg cells can promote tumor growth was lacking. In this study, we provide first direct evidence that expanded Treg cells can indeed promote tumor progression by using mice with selectively expanded Treg cells before inoculation of BCL1 leukemia. Finally, we have also shown that elimination of some immunoescape mechanism (e.g., deletion of Treg) can significantly improve the therapeutic outcome of chemotherapy. [Cancer Res 2008;68(23):9875–83]
Racial Differences in the Response to Drugs — Pointers to Genetic Differences
Authors: Alastair J.J. Wood
Journal: New England Journal of Medicine (2001)

All physicians recognize that individual patients respond differently to medications, so that at so-called standard doses, a drug may have toxic effects in some patients but fail to produce the expected therapeutic effect in others. Our lack of understanding of all the factors determining such variability among individual patients is perplexing to both physicians and their patients and limits physicians' ability to individualize therapy. Consequently, prescribing drugs is an iterative process, in which physicians initially prescribe a standard dose of medication and then adjust the dose or choice of medication in response to the observed toxic or therapeutic response. For . . .
Respiratory Virus Infections in the Glasgow Area
Authors: N. R. Grist, R. G. Sommerville
Journal: BMJ (1959)

The insulin equivalence of aspirin has been determined in 14 diabetics with insulin requirements of 12 to 112 units of insulin zinc suspension daily.Nine patients, who were well controlled with insulin, also had good responses to aspirin.The largest quantity of I.Z.S. replaced completely with aspirin was 48 units; the largest reduction in insulin requirement was 72 units *in the patient receiving 112 units daily.Five patients who were poorly controlled with insulin were not materially improved by aspirin therapy.It was concluded that aspirin was most effective in patients who responded well to insulin, and vice versa.The findings in patients well stabilized with insulin also suggested that the higher the insulin requirement the greater was the amount of hormone that may be replaced by aspirin.These results place salicylate in the class of promising oral antidiabetic substances, and should stimulate investigations to remove its undesirable effects and to find out how it acts.Our thanks are due to Miss M. McCombie, of the dietetic department of the Western Infirmary, for supervision of the diets, and to the staff of the unit for invaluable technical assistance.
Chemoradiotherapy after Surgery Compared with Surgery Alone for Adenocarcinoma of the Stomach or Gastroesophageal Junction
Authors: John S. Macdonald, Stephen R. Smalley, Jacqueline Benedetti, Scott A. Hundahl, Norman C. Estes, Grant N. Stemmermann, Daniel G. Haller, Jaffer A. Ajani, Leonard L. Gunderson, J. Milburn Jessup, James A. Martenson
Journal: New England Journal of Medicine (2001)

Surgical resection of adenocarcinoma of the stomach is curative in less than 40 percent of cases. We investigated the effect of surgery plus postoperative (adjuvant) chemoradiotherapy on the survival of patients with resectable adenocarcinoma of the stomach or gastroesophageal junction.
Henry Evans Robson MB, BS, MRCS, LRCP
Authors: Peter N. Sperryn, Harry Thomason, Dan S. Tunstall Pedoe, John G. P. Williams
Journal: British Journal of Sports Medicine (1992)

It was with great sadness that we heard of the death, on 11 February 1992, of Henry Evans Robson at the age of 69. Henry was synonymous with BASM and there cannot have been a BASM member unfamiliar with Henry's name and huge personality.Schooled in Sunderland, Edinburgh and Dorset, Henry graduated in medicine from Newcastle in 1946, proceeding to house jobs in Sunderland.There followed a busy Casualty Registrarship in Hartlepool and Durham, during which he set up the Hartlepool Casualty Department.He then changed to Anatomy; a Demonstratorship