tbuckley/cabot-search huggingface dataset:
Less Expensive, Reliable Blood Glucose Self-Monitoring
Authors: Maximilian Spraul, Gabriele E Sonnenberg, Michael Berger
Journal: Diabetes Care (1987)

We examined the reliability of split test strips for blood glucose self-monitoring. One hundred visual readings were performed with each of the following test strips: original Haemoglukotest 20–800 (HGT 1/1; Boehringer-Mannheim, Mannheim, FRG) and Haemoglukotest 20–800 halved either by a splitting device (HGT 1/2 SP) or by a pair of scissors (HGT 1/2 SC). Within the plasma glucose range of 20–360 mg/dl, there was a close correlation between the results of all three test-strip readings and the values obtained by the reference method (Beckman glucose analyzer): HGT 1/1, r = .950; HGT 1/2 SP, r = .966; and HGT 1/2 SC, r = .966. Absolute deviations from the reference values were 17 ± 2, 17 ± 1, and 17 ± 1 mg/dl (mean ± SE). Analysis of variance did not reveal any significant differences between the values of each of the three procedures compared with the reference method (P = .98). These results indicate that visual reading of split test strips is as reliable as the reading of original test strips. A special splitting device is not necessary. Diabetic patients should be advised to use split test strips for blood glucose self-monitoring to reduce costs.
Human neutrophil gelatinase is a component of specific granules.
Authors: M S Hibbs, D F Bainton
Journal: Journal of Clinical Investigation (1989)

Previous investigators have proposed that gelatinase, a metalloproteinase found in neutrophils, is stored in a novel secretory compartment distinct from the two major granule populations, azurophilic and specific. To locate this proteinase in human neutrophils we reacted the cells for peroxidase and then applied monospecific polyclonal antibodies to human neutrophil gelatinase to immunolabel ultrathin frozen sections using an immunogold technique. Gelatinase was localized in a population of peroxidase-negative granules. Double-labeling experiments using antibodies against lactoferrin, a marker for specific granules, and gelatinase demonstrated colocalization of the two antigens in 80% of the specific granules. However, some granules immunostained with only the lactoferrin or gelatinase antibody. Similar techniques were used to examine precursor cells from bone marrow. In myelocytes both gelatinase and lactoferrin were present in large developing specific granules; however, some mature specific granules contained only lactoferrin. Thus, it is possible that lactoferrin synthesis begins earlier than gelatinase synthesis and that overlapping synthesis and segregation occurs during the myelocyte stage. These findings suggest that the main storage compartment of gelatinase is within the peroxidase-negative specific granules.
Targeting PES1 for restoring the ERα/ERβ ratio in breast cancer
Authors: Christoforos Thomas, Jan-Åke Gustafsson
Journal: Journal of Clinical Investigation (2012)

Alteration of the ERα/ERβ balance is a critical step in breast cancer development and progression, and selective restoration of the activity of estrogen receptors has been proposed as one of the major therapeutic approaches for breast cancer. In this issue of JCI, Cheng et al. show that, by differentially modulating the stability of ERα and ERβ, PES1 increases the ERα/ERβ ratio and triggers breast tumor growth. These findings highlight PES1 as a potential target for the treatment of breast cancer.
Self-referral in Point-of-Service Health Plans
Authors: Christopher B. Forrest, Jonathan P. Weiner, Jinnet Fowles, Christine Vogeli, Kevin D. Frick, Klaus W. Lemke, Barbara Starfield
Journal: JAMA (2001)

Context Most health maintenance organizations offer products with loosened restrictions on patients' access to specialty care. One such product is the point-of-service (POS) plan, which combines "gatekeeping" arrangements with the ability to self-refer at increased out-of-pocket costs. Few data are available from formal evaluations of this new type of plan. Objectives To comprehensively describe the self-referral process in POS plans by quantifying rates of self-referral, identifying patients most likely to self-refer, characterizing patients' reasons for self-referral, and assessing satisfaction with specialty care. Design Retrospective cohort analysis using administrative databases composed of members aged 0 to 64 years who were enrolled in 3 POS health plans in the Midwest (n = 265 843), Northeast (n = 80 292), and mid-Atlantic (n = 39 888) regions for 6 to 12 months in 1996, and a 1997 telephone survey of specialty care users (n = 606) in the midwestern plan. Main Outcome Measures Self-referred service use and charges, reasons for self-referral, and satisfaction with specialty care. Results Overall, 8.8% of enrollees in the midwestern POS plan, 16.7% in the northeastern plan, and 17.3% in the mid-Atlantic plan self-referred for at least 1 physician or nonphysician clinician visit. The proportions of enrollees self-referring to generalists (4.7%-8.5%) were slightly higher than the proportions self-referring to specialists (3.7%-7.2%) across all 3 plans. Nine percent to 16% of total charges were due to self-referral. The chances of self-referral to a specialist were increased for patients with chronic and orthopedic conditions, higher cost sharing for physician-approved services, and less continuity with their regular physician. Patients who self-referred to specialists preferred to access specialty care directly (38%), reported relationship problems with their regular physicians (28%), had an ongoing relationship with a specialist (23%), were confused about insurance rules (8%), and did not have a regular physician (3%). Compared with those referred to specialists by a physician, patients who self-referred were more satisfied with the specialty care they received. Conclusions Having the option to self-refer is enough for most POS plan enrollees; 93% to 96% of enrollees did not exercise their POS option to obtain specialty care via self-referral during a 1-year interval. The potential downside of uncoordinated, self-referred service use in POS health plans is limited and counterbalanced by higher patient satisfaction with specialist services.
Mountain sickness, retinal haemorrhages, and acclimatisation on Mount Everest in 1975.
Authors: C Clarke, J Duff
Journal: BMJ (1976)

During the 1975 British Everest Expedition, which made the first ascent of the south-west face, observations were made in relation to mountain sickness and the appearance of retinal changes. Two Sherpas with cerebral oedema and one Briton with pulmonary oedema were treated. Retinal haemorrhages occurred in four out of six Britons who were newcomers to altitudes over 6000 m (19 685 ft) but in only two out of 14 Britons who had previously visited these altitudes. Intraocular pressures during ascent to 6000 m were within normal limits. The relevance of the ocular findings to acclimatisation in previous years was examined, the results supporting the hypothesis of a "carry-over" effect from previous visits to high altitude.
LYSINE DEFICIENCY AND HOST RESISTANCE TO ANTHRAX
Authors: Irving Gray
Journal: The Journal of Experimental Medicine (1963)

1. Lysine deficiency has been produced in rats by placing the weanling animals on an experimental diet in which gluten replaced the casein of the control diet. Both diets were complete in all other known requirements. 2. The resistance of the deficient animals to a subcutaneous challenge of several concentrations of B. anthracis spores, was decreased. Deaths occurred within 2 days post inoculation. 3. When lysine was added to the gluten diet to bring the total concentration to that of the control diet, the growth rate of the animals was maintained but a decrease in resistance remained, although not as great as on the gluten diet. 4. Changes in the tissues associated with lysine deficiency are reported. 5. It is not unreasonable to state that within the time frame of our experiments, the decreased ability of the RES of the host to clear the invading organism from the tissues and subsequently to break down the organism is a major factor of the decreased resistance of the lysine-deficient rats to anthrax.
Special Commentary: Food and Drug Administration and American Glaucoma Society Co-sponsored Workshop
Authors: Kristen L. Meier, David S. Greenfield, Gene Hilmantel, Malik Y. Kahook, Carol Lin, Eva M. Rorer, Kuldev Singh, Michelle E. Tarver, Robert N. Weinreb, Malvina B. Eydelman, Jeffrey M. Liebmann
Journal: Ophthalmology (2014)
Quantitative study of stiffness in the knee joint.
Authors: C H Such, A Unsworth, V Wright, D Dowson
Journal: Annals of the Rheumatic Diseases (1975)

Data from a knee arthrograph, which imparts a passive sinusoidal motion to the joint and measures the resistive torque and displacement, have been shown to be reproducible. Tests carried out on joints (from 49 males, 21 females) showed that the energy loss per cycle of the joint increased with age for both sexes but the peak to peak torque (elastic stiffness) did not vary with age. Muscle bulk had a large influence on the stiffness (both dissipative and elastic) of the knee as did the size of the joint itself. Women's knee joints exhibited lower values of dissipative energy loss and peak to peak torque than men's for all ages and sizes of joints.
Some Impressions of Teaching Medical Missions of the World Health Organization
Authors: S. Z. Levine
Journal: New England Journal of Medicine (1954)

ON April 7, the World Health Organization (WHO) of the United Nations (UN) celebrated its sixth anniversary, and, in commemoration of the occasion, World Health Day was proclaimed by the President of the United States. The important contribution that this international agency is making to world health impels me to recount some first-hand experiences I have had with one segment of the educational and training programs: the "teaching medical missions," now known as "visiting teams of medical scientists." The name was changed in 1952 to eliminate the patronizing adjective "teaching" and any sectarian implications attached to the term "mission."WHO . . .
Haemophilus influenzae type b: Disease and Immunity in Humans
Authors: JOHN B. ROBBINS
Journal: Annals of Internal Medicine (1973)

Despite an increasing frequency of Haemophilus influenzae type b meningitis in children under 5 years of age, the present age distribution is identical to that at the turn of the century, suggesting that acquisition of immunity has not changed. Immunization of adults and infants with type b capsular polysaccharide has induced formation of serum antibodies estimated to be "protective." Studies of the origin of "natural" immunity to this and other pyogenic organisms have identified enteric bacteria with cross-reacting antigens. Immunization of animals with these organisms induced serum antibodies to the capsular polysaccharides of H. influenzae type b, the meningococcus groups A and C, and pneumococcus types I and III. The heterogenous antiserums had biologic activity similar to that of the antiserum produced by the homologous organism. Haemophilus influenzae type b antibodies were induced in neonatal rabbits by the feeding of Escherichia coli having a cross-reacting antigen. These findings suggest that immunity to several pyogenic organisms may be induced by neonatal feeding of nonpathogenic enteric bacteria possessing cross-reacting antigens.
Related IgA1 and IgG producing cells in blood and diseased mucosa in ulcerative colitis
Authors: V C Thoree, S J C Golby, L Boursier, M Hackett, D K Dunn-Walters, J D Sanderson, J Spencer
Journal: Gut (2002)

<b>Background:</b> Ulcerative colitis (UC) is a chronic inflammatory bowel disease in which the colonic mucosa is infiltrated with plasma cells producing IgG autoantibodies. It is not known whether this represents a local mucosal response which has switched to IgG or a peripheral response which may have been initiated by peripheral antigen which homed to the colonic mucosa. The clonal distribution of IgG secreting cells and isotype switched variants in UC is not known. <b>Aims:</b> To investigate the clonal distribution of mucosal IgG in UC and to search for related IgG and IgA secreting cells in normal and diseased mucosa and blood in UC. To investigate characteristics which may discriminate between the mucosal and peripheral repertoire in the normal mucosa and in UC. <b>Patients:</b> Blood and normal and diseased mucosa from two patients with UC were studied. <b>Methods:</b> Immunoglobulin gene analysis and clone specific polymerase chain reaction were used to study the clonal distribution and characteristics of IgG and related IgA in the mucosa and blood of patients with UC. <b>Results:</b> The IgG response in the mucosa of UC patients included widespread clones of cells that were present in both the diseased mucosa and blood but that were scarce in normal mucosa. Clonally related IgA class switch variants, all IgA1, were detected but also only in the diseased mucosa and blood. This suggests that these clones home preferentially to the diseased mucosa. We showed that J<sub>H</sub>1 usage was characteristic of the peripheral repertoire, and that examples of J<sub>H</sub>1 usage were observed in mucosal IgG in UC. <b>Conclusions:</b> Overall, these data are consistent with a model of UC in which a peripheral response is expressed and expanded in the colonic mucosa.
Cost-Effectiveness of Using Pharmacogenetic Information in Warfarin Dosing for Patients With Nonvalvular Atrial Fibrillation
Authors: Mark H. Eckman
Journal: Annals of Internal Medicine (2009)

Background: Variants in genes involved in warfarin metabolism and sensitivity affect individual warfarin requirements and the risk for bleeding. Testing for these variant alleles might allow more personalized dosing of warfarin during the induction phase. In 2007, the U.S. Food and Drug Administration changed the labeling for warfarin (Coumadin, Bristol-Myers Squibb, Princeton, New Jersey), suggesting that clinicians consider genetic testing before initiating therapy. Objective: To examine the cost-effectiveness of genotype-guided dosing versus standard induction of warfarin therapy for patients with nonvalvular atrial fibrillation. Design: Markov state transition decision model. Data Sources: MEDLINE searches and bibliographies from relevant articles of literature published in English. Target Population: Outpatients or inpatients requiring initiation of warfarin therapy. The base case was a man age 69 years with newly diagnosed nonvalvular atrial fibrillation and no contraindications to warfarin therapy. Time Horizon: Lifetime. Perspective: Societal. Intervention: Genotype-guided dosing consisting of genotyping for CYP2C9*2, CYP2C9*3, and/or VKORC1 versus standard warfarin induction. Outcome Measures: Effectiveness was measured in quality-adjusted life-years (QALYs), and costs were in 2007 U.S. dollars. Results: In the base case, genotype-guided dosing resulted in better outcomes, but at a relatively high cost. Overall, the marginal cost-effectiveness of testing exceeded $170 000 per QALY. On the basis of current data and cost of testing (about $400), there is only a 10% chance that genotype-guided dosing is likely to be cost-effective (that is, <$50 000 per QALY). Sensitivity analyses revealed that for genetic testing to cost less than $50 000 per QALY, it would have to be restricted to patients at high risk for hemorrhage or meet the following optimistic criteria: prevent greater than 32% of major bleeding events, be available within 24 hours, and cost less than $200. Limitation: Few published studies describe the effect of genotype-guided dosing on major bleeding events, and although these studies show a trend toward decreased bleeding, the results are not statistically significant. Conclusion: Warfarin-related genotyping is unlikely to be cost-effective for typical patients with nonvalvular atrial fibrillation, but may be cost-effective in patients at high risk for hemorrhage who are starting warfarin therapy. Funding: The National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; Foundation for Informed Medical Decision Making; National Institutes of Neurological Disorders and Stroke; Deane Institute for Integrative Study of Atrial Fibrillation and Stroke; and American Heart Association.
High Homocysteine Levels Are Independently Related to Isolated Systolic Hypertension in Older Adults
Authors: Kim Sutton-Tyrrell, Andrew Bostom, Jacob Selhub, Charnita Zeigler-Johnson
Journal: Circulation (1997)

Background The association between homocysteine and isolated systolic hypertension in older adults was evaluated using a case-control design, and the relationship between homocysteine and clinical or subclinical atherosclerosis was explored. Methods and Results Cases were 179 adults ≥60 years with a systolic blood pressure of ≥160 mm Hg and diastolic blood pressure &lt;90 mm Hg. One hundred seventy-one control subjects had the same criteria except systolic blood pressures were &lt;160 mm Hg. All had normal creatinine levels. Homocysteine levels were performed on fasting blood samples that had been stored at −70°C. Atherosclerosis was defined as either a history of clinical disease, an internal carotid stenosis of ≥40% by duplex scan, or an ankle/arm pressure ratio of &lt;0.9. The median homocysteine value was 11.5 μmol/L for cases and 9.9 for control subjects ( P &lt;.001). After control for potential confounders, homocysteine remained significantly associated with systolic hypertension ( P =.019). For the hypertensive group, there was no apparent association between level of homocysteine and prevalence of atherosclerosis. However, among the normotensive group, the prevalence of atherosclerosis went from 22% in the lowest quintile of homocysteine values to 53% in the fifth quintile, with an odds ratio of 4.1 (fifth quintile in comparison to the first, P &lt;.05). After adjustment for age, sex, systolic blood pressure, cholesterol, and smoking, this odds ratio increased to 6.4 ( P &lt;.01). Conclusions Elevated levels of homocysteine may be related to the cause of isolated systolic hypertension in some individuals. In normotensive older adults, homocysteine appears to be an independent risk factor for atherosclerosis.
Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine
Authors: J. E. Siegel
Journal: JAMA (1996)

This article, the third in a 3-part series, describes recommendations for the reporting of cost-effective analyses (CEAs) intended to improve the quality and accessibility of CEA reports.The Panel on Cost-Effectiveness in Health and Medicine, a nonfederal panel with expertise in CEA, clinical medicine, ethics, and health outcomes measurement, convened by the US Public Health Service.The panel reviewed the theoretical foundations of CEA, current practices, alternative methods, published critiques of CEAs, and criticisms of general CEA methods and reporting practices.The panel developed recommendations through 2 1/2 years of discussions. Comments on preliminary drafts were solicited from federal government methodologists, health agency officials, and academic methodologists.These recommendations are proposed to enhance the transparency of study methods, assist analysts in providing complete information, and facilitate the presentation of comparable cost-effectiveness results across studies. Adherence to reporting conventions and attention to providing information required to understand and interpret study results will improve the relevance and accessibility of CEAs.
European Union may relax rules on marketing baby milk
Authors: Rory Watson
Journal: BMJ (2004)

Health organisations fear that negotiations now taking place to update European Union legislation on infant formula could dilute existing restrictions on the health and nutritional claims companies may make for their products.

They are also pressing the EU to incorporate fully into European legislation the World Health Organization's International Code of Marketing Breast-milk Substitutes and subsequent resolutions which EU countries have supported at various World Health Assemblies.

   ![][1] 

The final decision on the marketing of infant formula lies with a committee of civil servants from EU countries 

Credit: MARTIN LEE/REX

Adopted in 1981, …

 [1]: /embed/graphic-1.gif
Can We Build a Better Urinary Catheter?
Authors: Calvin M. Kunin
Journal: New England Journal of Medicine (1988)

The urinary catheter is an essential part of medical care. It is widely used to provide temporary relief of anatomical or physiologic obstruction, to facilitate surgical repair of the urethra and surrounding structures, to provide a dry environment for the comatose or incontinent patient, and to permit accurate measurement of urinary output in severely ill patients. Unfortunately, when used inappropriately or left in place too long, it may present a hazard to the very patients it is designed to protect. It is the leading cause of nosocomial urinary infections and the most common predisposing factor for preventable, gram-negative sepsis in . . .
Lipoprotein (a) and coronary heart disease: a prospective case-control study in a general population sample of middle aged men.
Authors: A Rosengren, L Wilhelmsen, E Eriksson, B Risberg, H Wedel
Journal: BMJ (1990)

OBJECTIVE--To examine the association between the serum lipoprotein (a) concentration and subsequent coronary heart disease. DESIGN--Prospective case-control study based on a six year follow up of a general population sample of men aged 50 at baseline in 1983-4. Serum samples were frozen at the time of the baseline examination and kept at -70 degrees C for six years, after which the lipoprotein (a) concentrations in the samples were measured in cases and controls. SETTING--City of Gothenburg, Sweden. SUBJECTS--26 Men, from a general population sample of 776 men, who had sustained a myocardial infarction or died of coronary heart disease during the six years and 109 randomly selected controls from the same sample who had remained free of myocardial infarction. In neither cases nor controls was there a history of myocardial infarction at baseline. MAIN OUTCOME MEASURES--Proportion of myocardial infarction or deaths from coronary heart disease, or both, in relation to the serum lipoprotein (a) concentration. RESULTS--Men who suffered coronary heart disease had significantly higher serum lipoprotein (a) concentrations than controls (mean difference 105 mg/l; 95% confidence interval 18 to 192 mg/l). Men with the highest fifth of serum lipoprotein (a) concentrations (cut off point 365 mg/l) suffered a coronary heart disease rate which was more than twice that of men with the lowest four fifths of concentrations. Logistic regression analysis showed the serum lipoprotein (a) concentration to be significantly associated with coronary heart disease independently of other risk factors. CONCLUSION--The serum lipoprotein (a) concentration in middle aged men is an independent risk factor for subsequent myocardial infarction or death from coronary heart disease.