tbuckley/cabot-search huggingface dataset:
Medicare Payment for Cognitive vs Procedural Care
Authors: Christine A. Sinsky, David C. Dugdale
Journal: JAMA Internal Medicine (2013)

IMPORTANCE Health care costs in the United States are rising rapidly, and consensus exists that we are not achieving sufficient value for this investment.Historically, US physicians have been paid more for performing costly procedures that drive up spending and less for cognitive services that may conserve costs and promote population health.OBJECTIVE To quantify the Medicare payment gap between representative cognitive and procedural services, each requiring similar amounts of physician time.DESIGN Observational analytical study comparing the hourly revenue generated by a physician performing cognitive services (Current Procedural Terminology [CPT] code 99214) and billing by time with that generated by physicians performing screening colonoscopy (Healthcare Common Procedure Coding System code G0121) or cataract extraction (CPT code 66984) for Medicare beneficiaries.SETTING Outpatient medical practice.PARTICIPANTS Medical care providers of outpatient services.EXPOSURE Work relative-value unit assigned to physician services.MAIN OUTCOME AND MEASURES Payment for physician services. RESULTSThe revenue for physician time spent on 2 common procedures (colonoscopy and cataract extraction) was 368% and 486%, respectively, of the revenue for a similar amount of physician time spent on cognitive care.CONCLUSIONS AND RELEVANCE Our analysis indicates that Medicare reimburses physicians 3 to 5 times more for common procedural care than for cognitive care and illustrates the financial pressures that may contribute to the US health care system's emphasis on procedural care.We demonstrate that 2 common specialty procedures can generate more revenue in 1 to 2 hours of total time than a primary care physician receives for an entire day's work.
The Effective Placement of Miller-Abbott-Tubes under Endoscopic Guidance. Technical improvements
Authors: K. Meissner, W. Weissenhofer
Journal: Endoscopy (1978)

In an earlier publication, the intestinal placement of Miller-Abbott-tubes using routine gastroscopic equipment was proposed for the conservative treatment of intestinal obstruction. In addition to the technical advices presented at this early stage of personal experience, we now recommend to 1. insert the tube primarily through the nostrils, 2. extract the tip through the mouth, 3. grasp the leading ligature of the tube tip extracorporally by means of the biopsy instrument and 4. guide the tube tip to the target area by orogastric approach. This technical improvement excludes difficulties in respect to patient cooperation or other special disadvantages and made 26 intestinal intubations in an uninterrupted series an easy and worthwhile procedure.
Women and Exercise: Physiology and Sports Medicine
Authors: Angela D. Smith
Journal: JAMA (1989)

The editors of this multiauthored volume serve their intended audience of physicians and other health care professionals well by compiling an excellent series of review articles that encompasses all aspects of the exercise physiology and sports medicine concerns of women. Each expert author presents recent data to support appropriate regimens for the prevention and treatment of problems related to exercise and for training as efficiently and safely as possible. Where no satisfactory study data exist to answer a particular exercise question, the authors indicate the methods and recommendations that they have found useful clinically. These experienced scientists and practitioners are well qualified to do so since the basic scientists work extensively with athletes clinically, and the clinicians have strong commitments to research. The editors divide the volume into three sections: exercise physiology, developmental phases, and organ systems. The exercise physiology segment summarizes the basics of exercise testing and fitness maintenance
STUDIES ON THE ANTI-INFLAMMATORY ACTION OF 6-MERCAPTOPURINE
Authors: Eric R. Hurd, Morris Ziff
Journal: The Journal of Experimental Medicine (1968)

The mechanism of action of 6-mercaptopurine (6-MP) on an egg albumin-induced inflammatory lesion in the skin has been studied in rabbits treated with 6-MP in a daily dosage of 18 mg/kg. Relative to control animals, significant decreases in the numbers of large lymphocytes and monocytes in the blood were observed in the 6-MP-treated animals by the 9th day of treatment, without significant decrease in the numbers of polymorphonuclear leukocytes and small and medium lymphocytes. Concurrently, a significant decrease was also seen in the percentage of tissue mononuclear cells in the inflammatory skin lesion. There was a highly significant correlation between the numbers of monocytes in the blood and the per cent of mononuclear cells in the lesion. A mean of 52% of the mononuclear cells in the tissue lesion phagocytosed carbon offering further evidence that the major cell involved was the blood monocyte. In vitro incorporation of (3)H-Tdr by blood mononuclear cells was significantly reduced in the 6-MP-treated animals as determined by scintillation counting and radioautography. The large lymphocyte was the predominant cell type which was labeled in vitro. Small lymphocytes and monocytes were rarely labeled. The data obtained suggest that the anti-inflammatory effect of 6-MP, reflected in these experiments by a decrease in mononuclear cells in a tissue lesion, results from suppression of a bone marrow response to local inflammation, affecting principally proliferating precursors of blood monocytes and large lymphocytes. The possible importance of this action of 6-MP in the treatment of inflammatory and immunologically mediated disease is discussed.
Thunderstorm associated asthma in Atlanta, Georgia
Authors: A Grundstein, S E Sarnat, M Klein, M Shepherd, L Naeher, T Mote, P Tolbert
Journal: Thorax (2008)

causing this disease.Collectively, our findings corroborate those of Jennings and colleagues 1 and support their conclusion that the importance of both viral pneumonia and mixed viral/bacterial pneumonia may be greater than previously realised.
Thinking the unthinkable: selling kidneys
Authors: Kuldip P Anand, Ajit Kashyap, Surekha Kashyap
Journal: BMJ (2006)

EDITOR—Roff's personal view on selling kidneys generated discussion during our morning round in an intensive care unit among 10 doctors, including two nephrologists.1 Only four were against the regulated selling of kidneys for renal transplantation, the nephrologists taking opposing views. We offer several points in favour of the regulated sale of kidneys. …
737–1 Heart Fatty Acid-binding Protein and Myoglobin can Accurately Detect Successful Reperfusion as Early as 15 Minutes After Reperfuslon
Authors: Junnichi Ishii, Masanori Nomura, Toshikazu Ando, Mamoru Kimura, Hiroshi Kurokawa, Takeshi Kondo, Yoshihiko Watanabe, Hitoshi Hishida
Journal: Journal of the American College of Cardiology (1995)
Evaluation of Embolization Effect of Hepatocellular Carcinoma by Hepatic Arterial Flow Study With Tc-99m MAA SPECT
Authors: BYUNG-HEE LEE, HYUNG-SIK YOO, JONG-DOO LEE, JIN-ILL CHUNG, CHANG-YUN PARK, JONG-TAE LEE
Journal: Clinical Nuclear Medicine (1995)

The degree of hepatocellular carcinoma vascularity in eight patients was assessed with Tc-99m MAA radionuclide angiography before and after treatment. For chemoembolization therapy, lipiodol and doxorublcin hydrochloride were administered intraarterially along with Gelfoam particles. The ratio of radioactivity in the hepatocellullar carcinoma compared to that in the surrounding uninvolved tissue before therapy was 6.5–19.0 with a mean of 12.0. After therapy, the ratio dropped to 0.5–1.3. Because survival improved significantly after the therapeutic regimen used in these patients, radionuclide Tc-99m MAA angiography appears to be an accurate method for demonstrating successful embolization of the vascular supply in hepatocellular carcinoma.
Lessons Learned
Authors: Melvina McCabe, Frank Morgan, Melissa Smith, Ella Yazzie, Anthony Spencer, Helen Curley, Rick Begay, Dorothy Gohdes
Journal: Diabetes Care (2003)

Communication about diabetes presents a challenge for indigenous populations experiencing increasing rates of type 2 diabetes. In translating simple terms related to diabetes from English to Navajo and transforming information into acceptable and useful forms for patients from traditional backgrounds, Navajo interpreters are faced with many challenges. The Navajo language was originally unwritten, and like most native languages, the grammatical structures and constructs are very different from those of Latin-based languages.

This commentary highlights the lessons learned during the process of translating information about diabetes into Navajo during the course of the controlled randomized study on the “Effect of Navajo Interpreters on Diabetes Outcomes” and may provide a template of considerations for other ethnic groups when translating terms relating to diabetes. Briefly, four translators initially recorded an oral Navajo translation of the Michigan Diabetes Knowledge Test (1). The taped version was translated back into written English by a Navajo language expert, who then prepared another Navajo version. The revised translation was verified with selected elderly community members and with a committee that included nurses, dieticians, health educators, a traditional medicine practitioner, a community elder, and a patient with diabetes. The original translators and the Navajo language expert together reached a final consensus. While the translators were completing the Navajo translation, they received training about the disease process of diabetes and medical translation. All interpreters passed both Navajo and English proficiency testing.

### Diabetes

Diabetes has usually been translated as the “sugar illness.” The interpreters molded a broader translation that defines diabetes as a process where the pancreas “sends messages” by means of its fluids (insulin). Diabetes means …
Distribution of Liposomes into Brain and Rat Brain Tumor Models by Convection-Enhanced Delivery Monitored with Magnetic Resonance Imaging
Authors: Ryuta Saito, John R. Bringas, Tracy R. McKnight, Michael F. Wendland, Christoph Mamot, Daryl C. Drummond, Dmitri B. Kirpotin, John W. Park, Mitchel S. Berger, Krys S. Bankiewicz
Journal: Cancer Research (2004)

Abstract Although liposomes have been used as a vehicle for delivery of therapeutic agents in oncology, their efficacy in targeting brain tumors has been limited due to poor penetration through the blood-brain barrier. Because convection-enhanced delivery (CED) of liposomes may improve the therapeutic index for targeting brain tumors, we conducted a three-stage study: stage 1 established the feasibility of using in vivo magnetic resonance imaging (MRI) to confirm adequate liposomal distribution within targeted regions in normal rat brain. Liposomes colabeled with gadolinium (Gd) and a fluorescent indicator, 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine-5,5′-disulfonic acid [DiI-DS; formally DiIC18(3)-DS], were administered by CED into striatal regions. The minimum concentration of Gd needed for monitoring, correlation of infused volume with distribution volume, clearance of infused liposome containing Gd and DiI-DS (Lip/Gd/DiI-DS), and potential local toxicity were evaluated. After determination of adequate conditions for MRI detection in normal brain, stage 2 evaluated the feasibility of in vivo MRI monitoring of liposomal distribution in C6 and 9L-2 rat glioma models. In both models, the distribution of Lip/Gd/DiI-DS covering the tumor mass was well defined and monitored with MRI. Stage 3 was designed to develop a clinically relevant treatment strategy in the 9L-2 model by infusing liposome containing Gd (Lip/Gd), prepared in the same size as Lip/Gd/DiI-DS, with Doxil, a liposomal drug of similar size used to treat several cancers. MRI detection of Lip/Gd coadministered with Doxil provided optimum CED parameters for complete coverage of 9L-2 tumors. By permitting in vivo monitoring of therapeutic distribution in brain tumors, this technique optimizes local drug delivery and may provide a basis for clinical applications in the treatment of malignant glioma.
Evaluation of Active Bleeding into Hematomas by Technetium-99m Red Blood Cell Scintigraphy Before Angiography
Authors: MARK W. WILSON, NICHOLAS FIDELMAN, ROBERT J. LULL, SHELLEY R. MARDER, JEANNE M. LABERGE, ROBERT K. KERLAN, ROY L. GORDON
Journal: Clinical Nuclear Medicine (2002)

To evaluate the utility of technetium-99m red blood cell (Tc-99m RBC) scintigraphy in the diagnosis of active hemorrhage into large intra-abdominal hematomas before arteriography.This retrospective case series describes four patients (1 man and 3 women) with large abdominal wall and retroperitoneal hematomas confirmed by computed tomography who underwent Tc-99m RBC scintigraphy before angiography. Arterial transcatheter embolization was performed if active hemorrhage was found.Three of the patients had positive findings on Tc-99m RBC scans, which showed spreading of the labeled erythrocytes into the hematoma space. Positive scintigraphy was diagnostic for active hemorrhage and helped localize the bleeding sites. Angiography confirmed the diagnosis in all patients with positive scintigraphy and ruled out active bleeding in the patient with a negative Tc-99m-labeled RBC scan.Tc-99m RBC scintigraphy appears to be sensitive and accurate in detecting active hemorrhage into intra-abdominal hematomas.
Abstract IA-19: Deconstructing metastasis
Authors: Joan Massagué
Journal: Cancer Research (2009)

Abstract Metastasis is a multi-stage process that selects for circulating cancer cells that can infiltrate, survive in, and colonize distant organs. The cellular origin, oncogenic alterations, tissue affinities, and circulation patterns of tumors markedly influence the sites and temporal course of metastasis. Cancer cell dissemination may be followed by a protracted period of latency before relapse in one or more organs, as in breast cancer, or by a swift colonization of multiple organs, as in lung adenocarcinoma. We have sought to incorporate this varied biology into experimental models to deconstruct metastasis. Searching for mechanisms that prime breast cancer cells for infiltration of different organs, we found few requirements for cancer cell extravasation through fenestrated bone marrow capillaries, certain key requirements (EGFR ligands, COX2, TGFβ-induced angiopoietin-like 4) for infiltration through the non-fenestrated walls of lung and brain capillaries, and additional mediators (sialyl transferase ST6GalNac5) for infiltration though brain capillaries with blood-brain barrier. Searching for mechanisms that allow infiltrated breast cancer cells to survive as latent disease, we found that a hyperactive SRC pathway supports the responsiveness of breast cancer cells to certain survival factors in the marrow microenvironment. Searching for mechanisms that in contrast underlie the rapid metastasis of lung adenocarcinomas to brain and bone, we uncovered an involvement of WNT/TCF signaling through HOXH9 and LEF1. These striking disparities in the natural progression of different cancers bring into focus important questions about the evolution of metastatic traits, the molecular mediators involved, and the treatment opportunities for the prevention of metastasis. Citation Information: Cancer Res 2009;69(23 Suppl):IA-19.
Discontinuation and non-publication of surgical randomised controlled trials: observational study
Authors: S. J. Chapman, B. Shelton, H. Mahmood, J. E. Fitzgerald, E. M. Harrison, A. Bhangu
Journal: BMJ (2014)

<b>Objective</b> To determine the rate of early discontinuation and non-publication of randomised controlled trials involving patients undergoing surgery. <b>Design</b> Cross sectional observational study of registered and published trials. <b>Setting</b> Randomised controlled trials of interventions in patients undergoing a surgical procedure. <b>Data sources</b> The ClinicalTrials.gov database was searched for interventional trials registered between January 2008 and December 2009 using the keyword “surgery”. Recruitment status was extracted from the ClinicalTrials.gov database. A systematic search for studies published in peer reviewed journals was performed; if they were not found, results posted on the ClinicalTrials.gov results database were sought. Email queries were sent to trial investigators of discontinued and unpublished completed trials if no reason for the respective status was disclosed. <b>Main outcome measures</b> Trial discontinuation before completion and non-publication after completion. Logistic regression was used to determine the effect of funding source on publication status, with adjustment for intervention type and trial size. <b>Results</b> Of 818 registered trials found using the keyword “surgery”, 395 met the inclusion criteria. Of these, 21% (81/395) were discontinued early, most commonly owing to poor recruitment (44%, 36/81). The remaining 314 (79%) trials proceeded to completion, with a publication rate of 66% (208/314) at a median time of 4.9 (interquartile range 4.0-6.0) years from study completion to publication search. A further 6% (20/314) of studies presented results on ClinicalTrials.gov without a corresponding peer reviewed publication. Industry funding did not affect the rate of discontinuation (adjusted odds ratio 0.91, 95% confidence interval 0.54 to 1.55) but was associated with a lower odds of publication for completed trials (0.43, 0.26 to 0.72). Investigators’ email addresses for trials with an uncertain fate were identified for 71.4% (10/14) of discontinued trials and 83% (101/122) of unpublished studies. Only 43% (6/14) and 20% (25/122) replies were received. Email responses for completed trials indicated 11 trials in press, five published studies (four in non-indexed peer reviewed journals), and nine trials remaining unpublished. <b>Conclusions</b> One in five surgical randomised controlled trials are discontinued early, one in three completed trials remain unpublished, and investigators of unpublished studies are frequently not contactable. This represents a waste of research resources and raises ethical concerns regarding hidden clinical data and futile participation by patients with its attendant risks. To promote future efficiency and transparency, changes are proposed to research governance frameworks to overcome these concerns.
THE ORIENTATIONS OF LEADERS IN AN URBAN AREA TOWARD PROBLEMS OF MENTAL ILLNESS
Authors: BRUCE P. DOHRENWEND, VIOLA W. BERNARD, LAWRENCE C. KOLB
Journal: American Journal of Psychiatry (1962)

It is necessary to sound a note of caution about these results. They are obtained from interviews with leaders in only one urban area. Viewed as a case study, our findings provide knowledge of the leaders in this area. Viewed as evidence for general contrasts among leaders in different spheres of activity, our work requires replication in other settings. At the very least, however, the differences we have described should provide hypotheses for further research. Our results suggest that orientation towards problems of mental disorder does vary with the individual's order of leadership activity. The differences cannot be accounted for by such factors as educational level, but appear traceable, in large part to the norms governing activities in these orders and serving as major bases for appraising deviant behavior. That these frames of reference dictate orientations varying greatly in the degree to which they are compatible with psychiatric views may well have strong implications for community programs. Leaders are important both as agents of existing social norms and as potential innovators. Their appraisals of problems of mental disorder are thus factors to be reckoned with by agencies planning and coordinating community services for prevention, treatment, and rehabilitation. The leaders' orientations also have implications for the content, methods, and direction of mental health education aimed at more effective communication between the mental health professions and the community. Certain of our findings are especially relevant to programs in both service and mental health education. The political-legal leaders, with strong reputations for influence in the community, showed high tendencies to recognize mental illness in case descriptions of mental disorder, and to advocate help from the mental health professions. Yet it is the educational leaders, low in reputation for influence, who have the orientation most congruent with a psychiatric frame of reference; least congruent with psychiatric views are the orientations of the economic and religious leaders. The former are high in reputation for influence, and the latter are those most likely to be called upon to deal with problems of mental disorder by virtue of their leadership positions.
Use of Tc-99m MAA in Determining the Etiology of Increasing Cyanosis Following SVC-PA Anastomosis for the Hypoplastic Left Heart Syndrom
Authors: TERRI GLASS, SYDNEY HEYMAN, MOHAMED SELIEM, JOHN MURPHY, WILLIAM I. NORWOOD
Journal: Clinical Nuclear Medicine (1991)

The hypoplastic left heart syndrome, which characteristically presents in the first few hours of life with cardiovascular collapse, is treated by reconstructive surgery (Norwood's procedure) beginning in the neonatal period. If untreated, more than 95% of infants with this malformation die within the first month of life. The case described involves the development of increasing cyanosis 7 weeks following bilateral superior vena caval-pulmonary artery (SVC-PA) anastomosis in an infant born with a hypoplastic left heart (including aortic and mitral valve stenosis) and an anatomic variant of bilateral superior vena cavae. The use of Tc-99m MAA proved efficacious in quantitating the differential perfusion to each lung, establishing the site of a postoperative stenosis in an anastomotic channel, and documenting systemic perfusion, thus confirming the right-to-left shunt from the superior vena cava to the systemic circulation that resulted in increasing cyanosis.
Paternal History of Coronary-Heart Disease Reported by Marathon Runners
Authors: Arthur J. Siegel, Charles H. Hennekens, Bernard Rosner, Lynne K. Karlson
Journal: New England Journal of Medicine (1979)

MOST prospective and retrospective epidemiologic studies show an inverse relation between physical activity and coronary-heart disease.1 2 3 4 In the most recently reported prospective study of Harvard alumni, in which leisure activity was assessed by questionnaire, there was a strong relation between decreased risk of coronary-heart disease and increased exercise levels.1 None of these studies resolves, however, the issue of selection versus protection. In other words, it is not known whether those who exercise regularly make up a self-selected group in which the risk of coronary disease is reduced, or whether regular exercise itself exerts a protective effect against this disease.Direct . . .
p16INK4A tumor suppressor gene expression and CD3ϵ deficiency but not pre-TCR deficiency inhibit TAL1-linked T-lineage leukemogenesis
Authors: Magali Fasseu, Peter D. Aplan, Martine Chopin, Nicolas Boissel, Jean-Christophe Bories, Jean Soulier, Harald von Boehmer, François Sigaux, Armelle Regnault
Journal: Blood (2007)