tbuckley/cabot-search huggingface dataset:
Dynamics of People Without Health Insurance
Authors: Katherine Swartz
Journal: JAMA (1994)

IS THE "problem" of people without health insurance really a problem? Opponents of major health care reform argue no. The<i>Wall Street Journal</i>says, "[T]he alleged 37 million uninsured also wilts under analysis.... Studies show that 70 percent of them are uninsured for less than nine months."<sup>1</sup>The Council for Affordable Health Insurance says if everyone were offered a medical savings account, "the numbers [sic] of uninsured could be reduced by as much as 25 million" (from 37 million) because "most (70%) of the uninsured remain without coverage for less than one year."<sup>2</sup>Statistics that describe dynamics—people moving in and out of a particular condition—can mislead even with the best of intentions. When intentions are not the best, the statistics can totally confuse. I write as one of the researchers who estimated the distribution of uninsured spell lengths that yields the findings that the median spell length is
Fake Urine Samples for Drug Analysis: Hot, But Not Hot Enough
Authors: Nils B. Person
Journal: JAMA (1988)

<h3>To the Editor.</h3> —In the recently published survey on drug testing in the workplace, Hoyt et al<sup>1</sup>review the "accuracy and reliability of the various methods commonly used for detection of drugs in urine." Unfortunately, this article does not address the largest source of false results in drug testing: urine sample substitution. The authors assume that witnessing urine specimen collection guarantees sample integrity. According to the Department of Justice, up to 10% of urine samples collected in the military yield false-negative results, and guaranteed drug-free urine can be purchased from a number of commercial sources.<sup>2</sup>In addition, direct observation of urination is not practical for widespread use, may represent an invasion of privacy, and, as recent accounts by professional athletes document, does not ensure that the specimens are genuine. Federal guidelines for drug testing programs require that the temperature of the urine specimen be measured at the time
Regulation of Benzodiazepine Prescription-Reply
Authors: Michael Weintraub
Journal: JAMA (1992)

In Reply.  —All published data, particularly those on controversial issues, should be carefully analyzed and interpreted by the readers. In addition, other investigators should gather data attempting to replicate and verify the hypothesis. Fortunately, both analytical reading and several evaluations of the New York State triplicate prescription regulations for benzodiazepines have been carried out.  The authors of the letters published in this issue of JAMA interpreted the results of our study differently than did my colleagues and I. Publication of their views is a legitimate, important aspect of the research process.  Several other investigators have examined the New York State benzodiazepine regulations. Reidenberg 1 compared benzodiazepine prescribing in New York and Pennsylvania. His conclusion that the full health consequences of the regulations have not yet been clarified mirrors the opinion my colleagues and I articulated in JAMA .  The effects of the regulations have also been examined by Shader et al.
Antibodies to AIDS-Associated Retrovirus Distinguish Between Pediatric Primary and Acquired Immunodeficiency Diseases
Authors: Arthur J. Ammann
Journal: JAMA (1985)

Antibody to acquired immunodeficiency syndrome (AIDS)-associated retroviruses (ARVs) was investigated in 68 pediatric patients with abnormalities of T-cell and/or B-cell immunity. All except seven patients conformed to a specific World Health Organization classification for immunodeficiency disease. These seven patients had polyclonal hypergammaglobulinemia and T-cell immunodeficiency. Six of the seven patients had antibody to ARV and had risk factors associated with AIDS. The one patient without antiviral antibody had no AIDS risk factors. No antibody was detected in 61 patients with other primary immunodeficiency disorders. We conclude that ARV first appeared in our population of immunodeficient pediatric patients prior to 1978, is associated with a distinctive immunologic phenotype consisting of polyclonal hypergammaglobulinemia and T-cell immunodeficiency, and does not appear as an opportunistic infection in other immunodeficiency disorders. Detection of the retrovirus associated with AIDS is of value in identifying infants and children who may have unique medical and social problems that occur with AIDS.
SUICIDE IN CALIFORNIA
Authors: Eva Charlotte Reid
Journal: JAMA (1927)

<h3>To the Editor:</h3> —InThe Journal, July 9, H. A. D. of Buffalo asks the reason for the high suicide rate of cities in California. A partial reply was made by Mr. L. E. Ross of the California State Board of Health. In my opinion the most potent cause is the antiquated laws existing in California in regard to the committment of the mentally sick to state hospitals. The law requires that in order that a patient may receive treatment in a state hospital the complaining witness must make affidavit that the patient is "so far disordered in his mind as to endanger health, person or property." The patient is placed under arrest by police or sheriff; held under observation (in some places in the county jail) for at least twenty-four hours; tried in open court, and if adjudged insane by a judge of the superior court is turned over
Pericardial Fat Burden on ECG-Gated Noncontrast CT in Asymptomatic Patients Who Subsequently Experience Adverse Cardiovascular Events
Authors: Victor Y. Cheng, Damini Dey, Balaji Tamarappoo, Ryo Nakazato, Heidi Gransar, Romalisa Miranda-Peats, Amit Ramesh, Nathan D. Wong, Leslee J. Shaw, Piotr J. Slomka, Daniel S. Berman
Journal: JACC. Cardiovascular imaging (2010)

We aimed to evaluate whether pericardial fat has value in predicting the risk of future adverse cardiovascular outcomes. Pericardial fat volume (PFV) and thoracic fat volume (TFV) can be routinely measured from noncontrast computed tomography (NCT) performed for calculating coronary calcium score (CCS) and may predict major adverse cardiac event (MACE) risk. From a registry of 2,751 asymptomatic patients without known cardiac artery disease and 4-year follow-up for MACE (cardiac death, myocardial infarction, stroke, late revascularization) after NCT, we compared 58 patients with MACE with 174 same-sex, event-free control subjects matched by a propensity score to account for age, risk factors, and CCS. The TFV was automatically calculated, and PFV was calculated with manual assistance in defining the pericardial contour, within which fat voxels were automatically identified. Independent relationships of PFV and TFV to MACE were evaluated using conditional multivariable logistic regression. Patients experiencing MACE had higher mean PFV (101.8 ± 49.2 cm3 vs. 84.9 ± 37.7 cm3, p = 0.007) and TFV (204.7 ± 90.3 cm3 vs. 177 ± 80.3 cm3, p = 0.029) and higher frequencies of PFV >125 cm3 (33% vs. 14%, p = 0.002) and TFV >250 cm3 (31% vs. 17%, p = 0.025). After adjustment for Framingham risk score (FRS), CCS, and body mass index, PFV and TFV were significantly associated with MACE (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.03 to 2.95 for each doubling of PFV; OR: 1.78, 95% CI: 1.01 to 3.14 for TFV). The area under the curve from receiver-operator characteristic analyses showed a trend of improved MACE prediction when PFV was added to FRS and CCS (0.73 vs. 0.68, p = 0.058). Addition of PFV, but not TFV, to FRS and CCS improved estimated specificity (0.72 vs. 0.66, p = 0.008) and overall accuracy (0.70 vs. 0.65, p = 0.009) in predicting MACE. Asymptomatic patients who experience MACE exhibit greater PFV on pre-MACE NCT when they are compared with event-free control subjects with similar cardiovascular risk profiles. Our preliminary findings suggest that PFV may help improve prediction of MACE.
Relation of Left Ventricular Diastolic Properties to Systolic Function in Arterial Hypertension
Authors: Giovanni de Simone, Rosanna Greco, GianFrancesco Mureddu, Carmela Romano, Raffaele Guida, Aldo Celentano, Franco Contaldo
Journal: Circulation (2000)

Background —It is unclear whether impairment of left ventricular (LV) diastolic characteristics is independent of systolic dysfunction. Methods and Results —To address this issue, 159 consecutive hypertensive patients (44±11 years, 78 obese, 96 women) and 165 normotensive subjects (32±11 years, 84 obese, 110 women) were studied with the use of Doppler echocardiography. After adjustment for age, body mass index (BMI), and sex, we found that ejection fraction (EF; M-mode, z -derived) was higher in hypertensive (66.6±5.2%) than in normotensive (63.9±4.4%, P &lt;0.0001) subjects, whereas midwall shortening (MS) was lower (hypertensive patients 16.9±2.0%, normotensive subjects 17.8±2.2%, P &lt;0.02), even after correction for end-systolic wall stress ( P &lt;0.05). Isovolumic relaxation time (IVRT) was greater in hypertensive patients (103±14 ms) than in normotensive subjects (78±19 ms), as was deceleration time of E velocity and peak A velocity (all P &lt;0.0001). In multivariate analysis, IVRT was unrelated to EF, but a negative relation was found with MS ( P &lt;0.001), independent of age, BMI, presence of arterial hypertension, LV geometry, and load (multiple R 2 =0.58). For comparable age, sex distribution, BMI, and blood pressure values, hypertensive patients with lower afterload-adjusted MS exhibited longer IVRT than patients with normal MS ( P &lt;0.005). However, IVRT remained higher than in normotensive control subjects after control for LV geometry and load. Conclusions —Doppler indices of delayed LV relaxation can be detected in the presence of normal or supranormal EF but are independently related to impaired MS. A less severely abnormal relaxation, however, can be also detected in the presence of normal midwall function, independent of LV geometry and load. Thus, diastolic abnormalities may occur before systolic dysfunction even when it is measured at the midwall.
Treatment of Shigellosis: IV. Cefixime Is Ineffective in Shigellosis in Adults
Authors: Mohammed Abdus Salam
Journal: Annals of Internal Medicine (1995)

Objective: To compare the efficacy of cefixime with that of pivamdinocillin in the treatment of adults with acute dysentery caused by Shigella infection. Design: Randomized, double-blind clinical trial. Setting: A diarrhea treatment center in Dhaka, Bangladesh. Patients: 30 men with dysentery lasting 72 hours or less. Interventions: Patients were randomly assigned to receive either 400 mg of cefixime every 24 hours (n = 15) or 400 mg of pivamdinocillin every 6 hours (n = 15) for 5 days. All patients were hospitalized for 6 days. Patients in whom initial drug therapy failed received alternative antimicrobial therapy. Measurements: Physical examinations were done and symptoms were recorded daily, and body temperatures were measured every 6 hours. Stools were counted and examined for consistency and for the presence of blood and mucus. Therapy failed if symptoms of dysentery persisted for more than 72 hours or if, on study day 5, patient had six stools, one watery or bloody-mucoid stool, or an oral temperature higher than 37.8 °C. Bacteriologic failure of therapy occurred if Shigella could be isolated from a stool sample on or after study day 3. Results: Therapy failed in seven (47%) patients given cefixime but in none of the patients given pivamdinocillin (P = 0.006). Patients given cefixime had longer duration of fever (median, 6 hours compared with 0 hours, P = 0.019), longer duration of the period with dysenteric stools (median, 4 days compared with 1 day, P = 0.001), and more stools during the 6 study days (median, 65 compared with 28, P = 0.002) than patients treated with pivamdinocillin. Bacteriologic failure of therapy occurred in 60% of patients (9 of 15) given cefixime and 13% of those (2 of 15) given pivamdinocillin (P = 0.009). Conclusion: Cefixime is ineffective in treating shigellosis in adults when used in the standard recommended dosage.
Disease Prediction Models Aim To Guide Medical Decision Making
Authors: Tom Reynolds
Journal: Annals of Internal Medicine (2001)

Current Clinical Issues16 October 2001Disease Prediction Models Aim To Guide Medical Decision MakingTom ReynoldsTom ReynoldsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-8_Part_1-200110160-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail When performing a history and physical examination on a patient with a disorder such as chest pain, physicians try to gauge the likelihood that each differential diagnosis explains the chief complaint. Determining the likelihood of disease as an estimate of probability has important advantages, and this will become increasingly evident as medical information systems, such as those developed for hand-held personal digital assistants (PDAs), help physicians to estimate probability at the moment of decision making.Clinical prediction rules provide a structured approach to calculating a probability estimate by incorporating the key variables that predict whether a disease is present or ... Author, Article, and Disclosure InformationAuthors: Tom Reynolds PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPEDIS Classification in Diabetic Foot Ulcers PatientsPredicting gastrointestinal infection morbidity based on environmental pollutants: Deep learning versus traditional modelsAn evolutionary deep neural network for predicting morbidity of gastrointestinal infections by food contaminationThe comorbidity of ADHD in children diagnosed with autism spectrum disorderReliability and Validity of the Perfusion, Extent, Depth, Infection and Sensation (PEDIS) Classification System and Score in Patients with Diabetic Foot UlcerValidation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer developmentRisk stratification systems for diabetic foot ulcers: a systematic reviewDo Physicians Attend to Base Rates? Prevalence Data and Statistical Discrimination in the Diagnosis of Coronary Heart DiseaseClinical experience did not reduce the variance in physicians' estimates of pretest probability in a cross-sectional surveyProbabilistic reasoning and clinical decision-making: do doctors overestimate diagnostic probabilities? 16 October 2001Volume 135, Issue 8_Part_1Page: 637-640KeywordsBreast cancerCancer preventionCardiac surgeryDrugsIschemiaMedical risk factorsMuscular dystrophiesMyocardial infarctionStable coronary artery diseaseVascular surgery ePublished: 16 October 2001 Issue Published: 16 October 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The Free Triiodothyronine (T_3) Index
Authors: CLARK T. SAWIN
Journal: Annals of Internal Medicine (1978)

In a large number of normal men (n = 111) and women (n = 110) the free triiodothyronine (T3), index, calculated from serum total T3 and T3-uptake, was highly correlated with free T3, measured by equilibrium dialysis. The correlation was almost as high as that of the free thyroxine (T4) index with free T4. The correlations of the total T3, free T3, and free T3 index with, respectively, the total T4, free T4, and free T4 index were much lower, though still statistically significant. The free T3 index is clinically useful because serum total T3 may sometimes be misleading. Hyperthyroid patients with apparent T4-toxicosis and normal total T3 may have an elevated free T3 index and thus physiologically elevated levels of both thyroid hormones. Calculation of the free T3 index might also make possible the diagnosis of T3-toxicosis in a patient with a normal free T4 index and normal total T3. Total T3 may be elevated without an elevated total T4 in women taking oral contraceptives; thus the free T3 index may prevent a misdiagnosis of T3-toxicosis. The free T3 index seems no better than total T3 in the diagnosis of primary hypothyroidism, but it can confirm the diagnosis of T3-hypothyroidism.
Pop Bottle Explosions: Further Information
Authors: Paul S. Bergeson, Sally A. Sehring, James R. Callison
Journal: JAMA (1978)

<h3>To the Editor.—</h3> Considerable national attention was focused on our article "Pop Bottle Explosions" (238:1048, 1977). Information sent on 14 additional cases allows us to expand our series to 17 and provides opportunity to expand on the problem. Interestingly, 13 explosions occurred in southern or southwestern states. Thirteen of the 16 instances for which information was given happened in the warmer months of May through September. Ambient temperature may, therefore, be of importance in some situations. (Seven previous cases occurred in a tropical climate.) Nevertheless, three cases transpired at Christmas time, and one bottle was refrigerated. All but three bottles were 480 ml or larger. All were soft drinks (no beer). Bottles were dropped in three instances; also, one was knocked over, one was struck against an object, one "rattled," and two exploded while stationary. The remainder were merely grasped, held, or carried. The force of the explosions is evidenced
Molecular Pathology -- Diagnosis of Infectious Disease
Authors: Stephen P. Naber
Journal: New England Journal of Medicine (1994)

The traditional method of identifying a pathogen by culturing it is a key element in forging the causal link between a particular disease and a specific microorganism. However, many kinds of infectious agents, including mycobacteria, fungi, and viruses, either are fastidious and grow slowly or cannot be cultured. In these instances, serologic or histologic methods may identify the infectious agent. Nevertheless, these methods usually yield only circumstantial evidence of infection. Pathologists now have highly sensitive, rapid, and specific molecular methods of identifying infectious agents by the direct detection of DNA or RNA sequences unique to a particular organism. These advances . . .
Multiple Births and Risk of Epithelial Ovarian Cancer
Authors: D. C. Whiteman
Journal: JNCI Journal of the National Cancer Institute (2000)

Prevailing hypotheses about the causes of ovarian carcinogenesis predict that women with a history of multiple births (twins, triplets, etc.) should be at increased risk of epithelial ovarian cancer. However, the scant available evidence suggests that they may actually be at lower risk. To resolve this issue, we pooled data from eight studies involving 2859 parous women with epithelial ovarian cancer (case patients) and 7434 parous women without ovarian cancer (control women). In addition to assessing their history of multiple births (and the sex of the children, where available), we obtained information on age, parity, oral contraceptive use, and other reproductive factors for each woman. Details of tumor histology were available for all case patients. We estimated the relative risks of various histologic types of ovarian cancers associated with multiple births by using multivariable logistic regression analysis, adjusting for matching and confounding variables.Among these parous women, 73 case patients (2. 6%) and 257 control women (3.5%) had a history of multiple births. The adjusted summary odds ratio (OR) for developing all types of epithelial ovarian cancer that are associated with multiple births was 0.81 (95% confidence interval [CI] = 0.61-1.08). We found no evidence that risks associated with multiple births differed among women with borderline or invasive tumors and among women with same-sex and opposite-sex offspring from multiple births. The risk reductions appeared specific for nonmucinous tumors (n = 2453; summary adjusted OR = 0.71 [95% CI = 0.52-0.98]); in contrast, associations with mucinous tumors (n = 406) were heterogeneous across studies.Parous women with nonmucinous ovarian cancer are no more likely to have a history of multiple births than other parous women, counter to the predictions of current hypotheses for causes of ovarian cancer.
Identification of glucocorticoid-inducible cytochromes P-450 in the intestinal mucosa of rats and man.
Authors: P B Watkins, S A Wrighton, E G Schuetz, D T Molowa, P S Guzelian
Journal: Journal of Clinical Investigation (1987)

We used monoclonal antibodies and complementary DNAs (cDNAs) to glucocorticoid-inducible liver cytochromes P-450 in rats (P-450p) and in man (HLp) to search for related cytochromes in intestinal mucosa. In rat enterocytes, we found two dexamethasone-inducible proteins related to the steroid-inducible liver cytochromes P-450. Induction of these proteins in enterocytes was associated with increases in the amount of a P-450p-related messenger RNA and of erythromycin demethylase, an activity highly characteristic of P-450p and HLp. Similar studies on human jejunal enterocytes revealed a microsomal protein indistinguishable from HLp on immunoblots and an abundance of RNA hybridizing with HLp cDNA. In human enterocytes the specific concentration of the HLp-related cytochrome (measured immunochemically or as erythromycin demethylase activity) was similar to that found in human liver and could account for all of the CO-binding hemo-protein detected. We conclude that the intestinal mucosa contains prominent form(s) of cytochromes P-450 similar to liver cytochrome P-450p in their structure, function, and some regulatory characteristics.
Cutaneous Adverse Effects Associated With the Tyrosine-Kinase Inhibitor Cabozantinib
Authors: Rena C. Zuo, Andrea B. Apolo, John J. DiGiovanna, Howard L. Parnes, Corrine M. Keen, Swati Nanda, William L. Dahut, Edward W. Cowen
Journal: JAMA Dermatology (2014)

<h3>Importance</h3> Cabozantinib S-malate is a vascular endothelial growth factor receptor 2, c-MET, and RET multitargeted tyrosine kinase inhibitor that has antiangiogenic and antitumorigenic properties with potential efficacy for the treatment of several cancers. Cutaneous reactions, one of the most frequently observed adverse effects associated with tyrosine kinase inhibitors, can significantly affect patients' quality of life and drug adherence and represent a major therapeutic challenge to maximizing the efficacy of targeted cancer therapy. <h3>Objective</h3> To describe the frequency and spectrum of skin reactions in patients with urothelial carcinoma receiving cabozantinib as monotherapy. <h3>Design, Setting, and Participants</h3> A single-institution study at the Clinical Research Center at the National Institutes of Health included 41 consecutive adults with metastatic, progressive urothelial carcinoma enrolled in a National Cancer Institute open-label, nonrandomized, phase 2 clinical trial. Patients receiving cabozantinib were evaluated for the development of skin reactions at each treatment visit from October 2012 to June 2014 by the primary oncology team and referred for dermatologic evaluation as appropriate. <h3>Main Outcomes and Measures</h3> A detailed history, full-body physical examination, and clinical photographs of cutaneous lesions were obtained. <h3>Results</h3> Of 41 consecutive patients who received cabozantinib, 30 (73%) developed 1 or more cutaneous toxic effects. Adverse events included hand-foot skin reaction (22 [54%]), generalized pigment dilution and/or hair depigmentation (18 [44%]), xerosis (8 [20%]), scrotal erythema/ulceration (6 [15%]), and nail splinter hemorrhages (5 [12%]). Eighteen patients (44%) had 2 or more cutaneous adverse events. Reactions developed in 17 of 30 patients (57%) during the first month of cabozantinib treatment and in 24 of 30 (80%) by the second month. Of patients with skin toxic effects, dose reduction was required for symptom management in 9 of 30 patients (30%), and treatment discontinuation was required in 4 of 30 (13%). <h3>Conclusions and Relevance</h3> Cabozantinib monotherapy is associated with 1 or more cutaneous adverse events in most patients. Early detection and prompt treatment may increase patients' adherence to tyrosine kinase inhibitor therapy. <h3>Trial Registration</h3> clinicaltrials.gov Identifier:NCT01688999