tbuckley/cabot-search huggingface dataset:
The Effect of Longevity on Spending for Acute and Long-Term Care
Authors: Brenda C. Spillman, James Lubitz
Journal: New England Journal of Medicine (2000)

The proportion of the population made up of elderly persons in the United States is projected to increase from 13 percent of the population in 2000 to 20 percent by 2030. The implications for health care expenditures may be profound, because elderly persons use health care services at a greater rate than younger persons. We estimated total expenditures for acute and long-term care from the age of 65 years until death and in the last two years of life.We combined data from Medicare, the National Mortality Followback Survey, and the National Medical Expenditure Survey to estimate total national expenditures for health care according to the age at death. We also simulated expenditures with the use of projected demographic characteristics of two cohorts: people turning 65 in 2000 and those turning 65 in 2015.Total expenditures (in 1996 dollars) from the age of 65 years until death increase substantially with longevity, from $31,181 for persons who die at the age of 65 years to more than $200,000 for those who die at the age of 90, in part because of steep increases in nursing home expenditures for very old persons. Spending in the last two years of life also increases with longevity, but a reduction in Medicare expenditures ($37,000 for persons who die at the age of 75 years and $21,000 for those who die at the age of 95) moderates the effect of the increase in nursing home expenditures ($6,000 for those who die at the age of 75 years and $32,000 for those who die at the age of 95). Health care spending for women is consistently higher than that for men, after adjustment for the increased longevity of women. Simulations show that increased longevity after the age of 65 years has a relatively small effect on the anticipated increase in spending, especially for services covered by Medicare, from 2000 to 2015. The effects of the larger number of people born in 1950 than in 1935 and the larger number of people surviving to the age of 65 years are much more important.In the United States, the effect of longevity on expenditures for acute care differs from its effect on expenditures for long-term care. Acute care expenditures, principally for hospital care and physicians' services, increase at a reduced rate as the age at death increases, whereas expenditures for long-term care increase at an accelerated rate. Increases in longevity after the age of 65 years may result in greater spending for long-term care, but the increase in the number of elderly persons has a more important effect on total spending.
Diagnosis of Orthopedic Infection in Clinical Practice Using Tc-99m Sulesomab (Antigranulocyte Monoclonal Antibody Fragment Fab’2)
Authors: A Garcia Vicente, M Almoguera, J C. Alonso, A Jimenez Heffernan, A Gomez, P I. Contreras, J Martin-Comin
Journal: Clinical Nuclear Medicine (2004)

The aim of the study was to analyze the use of Tc-99m-labeled antigranulocyte monoclonal antibody fragment Fab'2 (SMab, Leukoscan) in the diagnosis of acute osteomyelitis and articular prosthesis infection. One hundred seventeen patients (118 studies) have been included, 92 women and 25 men. Thirty-seven had a suspicion of osteomyelitis and 81 with suspicion of infection of a hip (35 patients) or a knee (45 patients) prosthesis. The mean age was 64 years. A 3-phase bone scan and a SMab scan were obtained in all patients. Antigranulocyte scans were obtained within 3 and 8 hours postinjection of 20 mCi (740 MBq) of Tc-99m-labeled antibody. Diagnosis of infection was based on bone biopsy in 8 cases and on at least 2 positive cultures in the remaining cases. Infection was ruled out with negative cultures or 1-year patient follow up with negative C-reactive protein and normal erythrocyte sedimentation rate.Sensitivity, specificity, accuracy, and negative predictive value of Tc 99m-SMab scintigraphy were: 75%, 95%, 87%, and 92% for long bone osteomyelitis and 80%, 89%, 87%, and 91% for articular prosthesis infection, respectively. Positive predictive values were 83% and 63%, respectively.Tc-99m-antigranulocyte monoclonal antibody fragment Fab'2 scintigraphy seems to be a useful method in the diagnosis of osteoarticular infection.
Abstract 2954: A noncanonical mechanism for BCL-2 inhibition of pro-apoptotic BAX
Authors: Lauren A. Barclay, Susan Lee, Michelle L. Stewart, Craig R. Braun, Gregory H. Bird, Loren D. Walensky
Journal: Cancer Research (2014)

Abstract In response to cellular stress, pro-apoptotic BCL-2 family members such as BAX initiate apoptosis by forming toxic pores in the mitochondrial outer membrane. It is well established that BAX is inhibited by BCL-2 through a sequestering interaction between a surface groove on BCL-2 and the alpha-helical BH3 death domain of BAX. Indeed, BCL-2 overexpression is a cardinal mechanism exploited by cancer cells to resist apoptosis. Novel BCL-2 inhibitors, such as ABT-199, are showing promise as pharmacologic activators of apoptosis in BCL-2-dependent cancers. Emerging data suggest that a distinct interaction between the BH4 domain of BCL-2 and BAX may also account for BCL-2 inhibition of BAX. To dissect this putative interaction mechanism, we generated stabilized alpha-helices of BCL-2 domains (SAHBs) modeled after the BH4 motif of BCL-2 and assessed their capacity to inhibit BAX. We find that distinct BCL-2 BH4 SAHBs directly engage BAX and block BAX-mediated membrane poration. Mutagenesis studies defined key residues for the inhibitory activity of BCL-2 BH4 SAHBs and confirmed the sequence-dependent specificity of action. We extended our findings to full-length BCL-2, demonstrating that point mutagenesis within the BH4 domain disrupts co-immunoprecipitation of expressed BCL-2 and BAX proteins. Taken together, we find that a noncanonical interaction between BCL-2 and BAX contributes to the functional regulation of these critical apoptotic proteins and may serve as a new and complementary target for therapeutic reactivation of cell death in human cancer. Citation Format: Lauren A. Barclay, Susan Lee, Michelle L. Stewart, Craig R. Braun, Gregory H. Bird, Loren D. Walensky. A noncanonical mechanism for BCL-2 inhibition of pro-apoptotic BAX. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2954. doi:10.1158/1538-7445.AM2014-2954
Management in primary care
Authors: E. Roddy, C. D. Mallen
Journal: BMJ (2011)

Although welcome, Cayley’s article focuses exclusively on acute gout and omits several important aspects of diagnosis and management that are particularly relevant to general practice.1 The article rightly points out that hyperuricaemia does not necessarily mean that the patient has gout. However, conversely, serum uric acid concentrations may be normal during an acute …
Estimating Regional Spatial and Temporal Variability of PM <sub>2.5</sub> Concentrations Using Satellite Data, Meteorology, and Land Use Information
Authors: Yang Liu, Christopher J. Paciorek, Petros Koutrakis
Journal: Environmental Health Perspectives (2009)

BackgroundStudies of chronic health effects due to exposures to particulate matter with aerodynamic diameters ≤ 2.5 μm (PM2.5) are often limited by sparse measurements. Satellite aerosol remote sensing data may be used to extend PM2.5 ground networks to cover a much larger area.ObjectivesIn this study we examined the benefits of using aerosol optical depth (AOD) retrieved by the Geostationary Operational Environmental Satellite (GOES) in conjunction with land use and meteorologic information to estimate ground-level PM2.5 concentrations.MethodsWe developed a two-stage generalized additive model (GAM) for U.S. Environmental Protection Agency PM2.5 concentrations in a domain centered in Massachusetts. The AOD model represents conditions when AOD retrieval is successful; the non-AOD model represents conditions when AOD is missing in the domain.ResultsThe AOD model has a higher predicting power judged by adjusted R2 (0.79) than does the non-AOD model (0.48). The predicted PM2.5 concentrations by the AOD model are, on average, 0.8–0.9 μg/m3 higher than the non-AOD model predictions, with a more smooth spatial distribution, higher concentrations in rural areas, and the highest concentrations in areas other than major urban centers. Although AOD is a highly significant predictor of PM2.5, meteorologic parameters are major contributors to the better performance of the AOD model.ConclusionsGOES aerosol/smoke product (GASP) AOD is able to summarize a set of weather and land use conditions that stratify PM2.5 concentrations into two different spatial patterns. Even if land use regression models do not include AOD as a predictor variable, two separate models should be fitted to account for different PM2.5 spatial patterns related to AOD availability.
The doctor's PDA and Smartphone handbook: medical records
Authors: Chris Paton, Mohammad Al-Ubaydli
Journal: Journal of the Royal Society of Medicine (2006)

This is the fifth in a series of extracts from a forthcoming book by M Al-Ubaydli and C Paton. The website [www.rsmpress.co.uk/bkpda.htm] includes video tutorials to accompany this text.
Elitek™–rasburicase: an effective means to prevent and treat hyperuricemia associated with tumor lysis syndrome, a Meeting Report, Dallas, Texas, January 2002
Authors: P M Navolanic, C-H Pui, R A Larson, M R Bishop, T E Pearce, M S Cairo, S C Goldman, S C Jeha, C B Shanholtz, J P Leonard, J A McCubrey
Journal: Leukemia (2003)
Comparison of intravascular ultrasound and angiography in the assessment of myocardial bridging.
Authors: J Ge, R Erbel, H J Rupprecht, L Koch, P Kearney, G Görge, M Haude, J Meyer
Journal: Circulation (1994)

BACKGROUND In autopsy, myocardial bridging is a common finding. With coronary angiography, a systolic compression, mainly of the left anterior descending coronary artery, is observed in 1% to 3% of the patients. Controversy exists concerning the functional importance of this finding. To obtain a functional insight into the myocardial bridging, intravascular ultrasound and intracoronary Doppler were performed. METHODS AND RESULTS Intracoronary ultrasound and Doppler were performed in 14 patients with angiographic evidence of systolic vessel compression ("milking effect") in the left anterior descending coronary artery. The 4.8F, 20-MHz ultrasound catheter could not be advanced through the entire myocardial bridge segment in 6 of the 14 patients studied because the lumen was &lt; 1.6 mm. In these patients, only the proximal parts of the bridge segment were scanned. The changes in cross-sectional shape during the cardiac cycle were determined for both the normal proximal segment and the bridge segment by use of a semiautomatic computer program. Intracoronary Doppler (20 MHz) was performed in 7 patients with a 3F catheter. A highly characteristic systolic eccentric or concentric compression with delayed relaxation in diastole of the myocardial bridging segment was clearly visualized in all patients. The cross-sectional lumen area variation was 40 +/- 25% in the bridging segments and 9 +/- 7% in the normal segments (P &lt; .01). No atherosclerotic lesions were detected in the bridge or the distal segment in the 8 patients in whom the IVUS catheter was successfully advanced through the entire myocardial bridge. However, atherosclerotic plaques were found in the segments proximal to the bridge in 12 of 14 patients (86%). The resting mean flow velocity was 6.4 +/- 1.2 cm/s; the maximal mean flow velocity after intracoronary administration of 10 mg papaverine was 14.1 +/- 3.4 cm/s. The coronary flow velocity reserve was 2.2 +/- 0.7. A highly characteristic pattern showing a prominent peak in coronary velocity in early diastole was observed in 86% of patients, and this pattern was enhanced after injection of intracoronary papaverine. CONCLUSION Intravascular ultrasound demonstrated a characteristic systolic compression of the bridge segments. The delayed compression release may explain the characteristic sharp early diastolic peak in coronary flow velocity found with intracoronary Doppler in vessels with myocardial bridging. Reduced coronary flow reserve may be related to this phenomenon, possibly explaining signs of ischemia detected in some of the patients, but may alternatively be a result of the presence of atherosclerosis in the segment proximal to the bridge in these patients.
Religious Investors Ask Health/Hygiene Products Giant to 'Kleen' Out of the Tobacco Business
Authors: Andrew A. Skolnick
Journal: JAMA (1995)

TWO RELIGIOUS groups that own a large number of shares in Kimberly-Clark Corporation are asking the manufacturer of health, hygiene, and hospital products to get out of the tobacco business. The groups, the Congregation of the Sisters of Charity of the Incarnate Word, in Houston, Tex, and the Redemptorists of St Louis, Mo, are sponsors of a shareholder resolution calling on the company's management to "spin-off all tobacco business." <h3>Tobacco Program Project</h3> In addition to the 70000 company shares owned by the two groups, hundreds of thousands of additional shares are owned by other religious organizations that are members of the Interfaith Center on Corporate Responsibility (ICCR), New York, NY. As part of its Tobacco Program Project, the center has been conducting a "Kleen Out Tobacco From Kimberly-Clark" campaign to persuade the corporation to retire from the tobacco business, says ICCR's executive director Timothy Smith. Well known for its popular
The E3 ubiquitin ligase UBR5 is recurrently mutated in mantle cell lymphoma
Authors: Barbara Meissner, Robert Kridel, Raymond S. Lim, Sanja Rogic, Kane Tse, David W. Scott, Richard Moore, Andy J. Mungall, Marco A. Marra, Joseph M. Connors, Christian Steidl, Randy D. Gascoyne
Journal: Blood (2013)
Fraud and Abuse
Authors: Hyman Da, Williamson Jv
Journal: New England Journal of Medicine (1989)

The ethics of physicians' entrepreneurship have been debated extensively.1 Proponents have pointed to the necessity of entrepreneurial arrangements; critics fear their effect on medical decision making, the quality of care, and the professionalism and reputation of physicians.2 , 3 The resolution of these difficult issues has been left to the consciences of those involved and to ethical codes that seek to prohibit or limit the involvement of physicians in entrepreneurial relationships.4 5 6 Despite these ethical codes, the proponents of entrepreneurship have successfully used antitrust law and the rhetoric of competition to engage in entrepreneurial activities.7 It has been estimated that between 7 and . . .
Peer Review of Papers for Presentation at Meetings
Authors: Anita D. Taylor
Journal: JAMA (1990)

To the Editor. —  At many medical meetings, presentations are evaluated by the participants, who judge their quality and appropriateness. Feedback is then provided to the presenters. There is, however, nothing in the medical, scientific, or even education literature comparing this audience evaluation of an actual presentation with the reviewer's evaluation of the submitted paper. Is peer review worth the effort it takes by both program planners and reviewers?  Study. —  A Call for Papers was sent to 469 family medicine educators in March 1988 for the Eighth Annual Rocky Mountain and Western Regional Meeting of the Society of Teachers of Family Medicine. All who received the Call for Papers were solicited to be reviewers; 26 individuals offered to participate in this capacity. Each paper was reviewed in a blinded fashion by two reviewers who were neither in the same geographic location as each other nor in the same institution
Expression of matrilysin (matrix metalloproteinase-7) in primary cutaneous and metastatic melanoma
Authors: K. Kawasaki, T. Kawakami, H. Watabe, F. Itoh, M. Mizoguchi, Y. Soma
Journal: British Journal of Dermatology (2007)

Matrilysin (MMP-7), a member of the matrix metalloproteinase (MMP) family of proteins, is expressed in various types of malignant tumours. There have been no previous studies of the correlation between matrilysin expression and melanoma.Protein expression of matrilysin was evaluated in human cutaneous melanomas, metastatic melanomas, acquired common melanocytic naevi and Spitz naevi, and the data were corrected with the clinicopathological factors.We retrospectively investigated 18 primary melanomas, 15 metastatic melanomas, 10 common melanocytic naevi and five Spitz naevi samples at our clinic using immunohistochemistry (IHC). Both promatrilysin and active matrilysin were found in the melanoma tissue extracts by Western immunoblotting. In situ hybridization demonstrated that melanoma cells selectively express matrilysin mRNA.Of the melanoma samples, 29 of 33 (87 x 9%) were positive for matrilysin, including 14 of 18 (77 x 8%) primary cutaneous melanomas and 15 of 15 (100%) metastatic melanomas. In contrast, matrilysin was not expressed in common naevi or Spitz naevi. The matrilysin IHC staining score in primary melanomas was associated with the presence of metastases, tumour thickness and TNM staging (P=0 x 001, 0 x 025 and 0 x 021, respectively). The 5-year overall survival was 26.3% for matrilysin-positive cases and 100% for matrilysin-negative cases among melanoma specimen.We found matrilysin expression in primary melanomas and in metastatic melanomas. We further demonstrated that the matrilysin IHC staining score was associated with invasive depth of primary melanoma lesions and metastases. Our observations indicate that matrilysin may be associated with melanoma progression, and may enhance melanoma tumour cell invasion. Therefore, matrilysin may be potentially valuable as a prognostic indicator to predict the clinical behaviour of melanoma.
Metaphyseal Chondrodysplasia
Authors: RAKESH KUMAR, AJAY SOOD, ATUL MARWAH, RAJU SHARMA, AJIT KUMAR PADHY, DENISH MOORTHY
Journal: Clinical Nuclear Medicine (2000)

A 9-year-old girl had a short stature and multiple bony deformities, including widening of the wrists, knee and ankle joints, and chest since the age of 1 month. Despite the administration of calcium and vitamin D, her deformities worsened. Laboratory investigations revealed normal blood biochemical parameters, including serum calcium, phosphorus, and alkaline phosphatase. Plain radiographs showed a fragmented appearance with marked widening and fraying of the metaphyses and of all long bones. The epiphyses of the long tubular bones of both the upper and lower extremities were bulbous. The radiologic results were consistent with metaphyseal chondrodysplasia, and radionuclide imaging reflected these findings.
Radiocontrast Agents and Aspirin
Authors: Arnold E. Postlethwaite
Journal: JAMA (1972)

<h3>To the Editor.—</h3> Iopanoic acid (Telepaque) and other commonly used radiocontrast agents increase the renal clearance of uric acid.<sup>1-3</sup>An abrupt increase in the excretion of uric acid which is produced by these agents could have a potentially detrimental effect on renal function, especially in the oliguric or hyperuricemic patient. Thus, it would be desirable to minimize the uricosuric effect of the radiocontrast agents in such patients. While it has been demonstrated that the antituberculous agent, pyrazinamide, can block the uricosuric effect of both iopanoic acid and ipodate (Oragrafin) calcium,<sup>3</sup>the routine use of pyrazinamide for such purposes may not be justified. In the present communication, we present evidence that a relatively small dose of aspirin effectively diminishes the uricosuric effect of iopanoic acid. The mean change in the serum urate concentration and fractional excretion rate of uric acid after the administration of iopanoic acid (3 gm) to
The "five minute" consultation: effect of time constraint on clinical content and patient satisfaction.
Authors: D C Morrell, M E Evans, R W Morris, M O Roland
Journal: BMJ (1986)

An experiment was carried out in which patients who were seeking appointments for a consultation in a general practice in south London attended consulting sessions booked at 5, 7.5, or 10 minute intervals. The particular session that the patient attended was determined non-systematically. The clinical content of the consultation was recorded on an encounter sheet and on audio-tape. At the end of each consultation patients were invited to complete a questionnaire designed to measure satisfaction with the consultation. The stress engendered in doctors carrying out surgery sessions booked at different intervals of time was also measured. At surgery sessions booked at 5 minute intervals, compared with 7.5 and 10 minute intervals, the doctors spent less time with the patients and identified fewer problems, and the patients were less satisfied with the consultation. Blood pressure was recorded twice as often in surgery sessions that were booked at 10 minute intervals compared with those booked at 5 minute intervals. There was no evidence that patients who attended sessions booked at shorter intervals received more prescriptions, were investigated or referred more often to hospital specialists, or returned more often for further consultations within four weeks. There was no evidence that the doctors experienced more stress in dealing with consultations that were booked at 5 minute intervals than at consultations booked at 7.5 and 10 minute intervals, though they complained of shortage of time more often in surgery sessions that were booked at shorter intervals.
Detection and typing of human papillomavirus in cutaneous warts of patients infected with human immunodeficiency virus type 1
Authors: A.M. Porro, M.M.A. Alchorne, G.R. Mota, N. Michalany, A.C.C. Pignatari, I.E. Souza
Journal: British Journal of Dermatology (2003)

Cutaneous warts are caused by human papillomavirus (HPV). To date, more than 120 different types of HPV are known, of which 80 have been completely characterized. Prevalence studies on types of HPV present in cutaneous warts have been carried out in immunocompetent individuals and immunosuppressed organ allograft recipients, but not in human immunodeficiency virus (HIV)-positive patients.To determine the HPV types present in cutaneous warts of HIV-infected patients.Twenty-five biopsies of cutaneous warts from HIV-infected patients and 14 samples from control non-HIV-infected patients were studied. HPV detection was performed by polymerase chain reaction using two sets of primers: MY09/MY11 and RK91. The type of HPV was determined by restriction fragment length polymorphism analysis and direct sequencing of the amplified products.HPV DNA was detected in 64% of cutaneous warts from HIV-infected patients and in 79% of samples from the control group. The HPV types identified in HIV-infected patients were: HPV 2 (38%), 57 (31%), 27 (12%), 6 (12%) and 7 (6%). HPV 2/27/57 predominated in both groups, being present in 81% of lesions from HIV-infected patients and 82% of samples from non-HIV-infected patients. HPV 6, a genital HPV type rarely found in cutaneous lesions, was detected in two warts from HIV-infected patients and in one lesion of the immunocompetent group. HPV 7, characteristically associated with butcher's warts, and recently detected in oral and perioral lesions of HIV-infected patients, was found for the first time in a non-facial lesion of an HIV-infected patient.This is the first study evaluating the prevalence of HPV types in cutaneous warts of HIV-infected patients and immunocompetent individuals in Brazil.