tbuckley/cabot-search huggingface dataset:
Evaluation of total purchasing pilots in England and Scotland and implications for primary care groups in England: personal interviews and analysis of routine data
Authors: N. Goodwin, N. Mays, H. McLeod, G. Malbon, J. Raftery
Journal: BMJ (1998)

Objectives : To evaluate the reported achievements of the 52 first wave total purchasing pilot schemes in 1996-7 and the factors associated with these; and to consider the implications of these findings for the development of the proposed primary care groups. Design : Face to face interviews with lead general practitioners, project managers, and health authority representatives responsible for each pilot; and analysis of hospital episode statistics. Setting : England and Scotland for evaluation of pilots; England only for consideration of implications for primary care groups. Main outcome measures : The ability of total purchasers to achieve their own objectives and their ability specifically to achieve objectives in the service areas beyond fundholding included in total purchasing. Results : The level of achievement between pilots varied widely. Achievement was more likely to be reported in primary than in secondary care. Reported achievements in reducing length of stay and emergency admissions were corroborated by analysis of hospital episode statistics. Single practice and small multipractice pilots were more likely than large multipractice projects to report achieving their objectives. Achievements were also associated with higher direct management costs per head and the ability to undertake independent contracting. Large multipractice pilots required considerable organisational development before progress could be made. Conclusion : The ability to create effective commissioning organisations the size of the proposed primary care groups should not be underestimated. To be effective commissioners, these care groups will need to invest heavily in their organisational development and in the short term are likely to need an additional development budget rather than the reduction in spending on NHS management that is planned by the government.
The effects of lipid-lowering and antioxidant vitamin therapies on flow-mediated vasodilation of the brachial artery in older adults with hypercholesterolemia
Authors: James H Stein, Cynthia M Carlsson, Kristi Papcke-Benson, Susan E Aeschlimann, Apple Bodemer, Molly Carnes, Patrick E McBride
Journal: Journal of the American College of Cardiology (2001)
THEORY AND PRACTICE OF PARENTERAL FLUID ADMINISTRATION
Authors: ALEXIS F. HARTMANN
Journal: JAMA (1934)

In the early stages of undue loss of water from the body, regardless of the cause of such loss, the composition of the blood in respect to its water content and electrolyte pattern tends to remain unaltered because of the stabilizing or buffering effect of the intercellular fluid of the body. This portion of the body may be looked on as a reservoir which may shrink appreciably in order that changes in the blood and perhaps also in the fixed tissue cells may be kept at a minimum. When, however, the intercellular fluid becomes exhausted, changes do appear in the blood indicative of this exhaustion, and probably also in the fixed tissues themselves. The nature of the changes is largely dependent on the manner in which fluid is lost; sometimes acidosis may accompany dehydration, at other times alkalosis, while occasionally a tendency toward one such change may be almost exactly
Iron homeostasis in the brain: complete iron regulatory protein 2 deficiency without symptomatic neurodegeneration in the mouse
Authors: Bruno Galy, Sabine M Hölter, Thomas Klopstock, Dunja Ferring, Lore Becker, Sylvia Kaden, Wolfgang Wurst, Hermann-Josef Gröne, Matthias W Hentze
Journal: Nature Genetics (2006)
Twenty four hour care in inner cities: two years' out of hours workload in east London general practice.
Authors: A. E. Livingstone, J. A. Jewell, J. Robson
Journal: BMJ (1989)

Two inner city general practices in east London jointly provide care outside normal working hours without using deputising services for about 14,000 patients. The statistics on workload were reviewed for 1987 and 1988. An overall rate of face to face consultations of 4.1 per patient per year was recorded, there being 115,965 consultations over two years for a mean list size of 14,174 patients. Four per cent (4737) of such consultations were outside normal working hours. The annual rate of visiting outside normal hours was 128.1 per 1000 patients in 1987 (1793 visits) and 131.5 per 1000 in 1988 (1888 visits). The rates of night visiting were 18.8 (262 visits) and 18.9 (271 visits) per 1000 patients in 1987 and 1988 respectively. Only 24% of all the requests for medical help out of hours (1483/6220) were dealt with by advice given on the telephone. The high rates of consultation outside normal working hours with only a small proportion being dealt with on the telephone alone may be explained by indices of deprivation. Local rotas for out of hours work are a good compromise between meeting the needs of patients and doctors in deprived areas, but there are financial implications for inner cities.
The hepatitis B virus X protein induces paracrine activation of human hepatic stellate cells
Authors: Samuel Martín-Vílchez, Paloma Sanz-Cameno, Yolanda Rodríguez-Muñoz, Pedro L. Majano, Francisca Molina-Jiménez, Manuel López-Cabrera, Ricardo Moreno-Otero, Enrique Lara-Pezzi
Journal: Hepatology (2008)

Chronic hepatitis B virus (HBV) infection is a major cause of liver fibrosis, eventually leading to cirrhosis and hepatocellular carcinoma. Although the involvement of the X protein of HBV (HBx) in viral replication and tumor development has been extensively studied, little is known about its possible role in the development of fibrosis. In this work we show that expression of HBx in hepatocytes results in paracrine activation and proliferation of hepatic stellate cells (HSCs), the main producers of extracellular matrix proteins in the fibrotic liver. Both human primary HSCs and rat HSCs exposed to conditioned medium from HBx-expressing hepatocytes showed increased expression of collagen I, connective tissue growth factor, α smooth muscle actin, matrix metalloproteinase-2, and transforming growth factor-β (TGF-β), together with an enhanced proliferation rate. We found that HBx induced TGF-β secretion in hepatocytes and that the activation of HSCs by conditioned medium from HBx-expressing hepatocytes was prevented by a neutralizing anti-TGF-β antibody, indicating the involvement of this profibrotic factor in the process. Conclusion: Our results propose a direct role for HBx in the development of liver fibrosis by the paracrine activation of stellate cells and reinforce the indication of antiviral treatment in patients with advanced HBV-related chronic liver disease and persistent liver replication.
Medical Colleges and their Graduates.
Authors: Ephraim Ingals
Journal: JAMA (1893)

<h3>To the Editor:</h3> —In your issue of July 1, J. J. Mulheron, M. D., in an article favoring the divorce of the medical licensing from the teaching power, gives copious extracts "from papers submitted by students who were graduated from a so-called medical college in good standing in the Association of American Medical Colleges, and whose announcement would lead you to believe that it is devoted to the cause of the higher medical education." It is painfully humiliating to know that any one is legally permitted to practice medicine who is the subject of such an appalling degree of ignorance as these quotations disclose. It should bring blushes to the lowest member of a class in an institution for the feeble minded. The illustrations are conclusive against the propriety of admitting to practice any physician on a college diploma alone, without the added safeguard to the public of a re-examination
Microbial resistance: Novel screens for a contemporary problem
Authors: Prabhavathi B. Fernandes, Rolf Menzel, Dwight J. Hardy, Yuk-Ching Tse-Dinh, Alicia Warren, David A. Elsemore
Journal: Medicinal Research Reviews (1999)

Historically, natural products have been the source of a large variety of antibacterial agents. In the 1980s, no additional useful antibacterial agents were discovered, leading to the belief that most useful chemotypes from natural product sources had already been discovered. At this time, advances in biotechnology made it feasible to produce sufficient enzyme to set up cell-free screens. Chemical compound libraries and combinatorial synthesis became the source of chemical diversity for the screens. In spite of these efforts, very few new antibacterial agents have been discovered in the last decade. At Small Molecule Therapeutics, Inc., we have developed phenotype-based screens that take advantage of the natural physiology and biochemistry of the target enzymes. We have developed a screen to identify bacterial DNA gyrase and topoisomerase IV poisons. The "hits" identified in this screen are being characterized further. A second screen has also been developed against bacterial topoisomerase 1 in which compounds that cause DNA damage through their interaction with bacterial topoisomerase 1 have been identified. Three of the compounds identified in the screen inhibit DNA relaxation mediated by bacterial topoisomerase 1, induce DNA cleavage, are noncytotoxic at >10 microM, and have MICs of 4.0 microg/mL against Staphylococcus aureus.
High Beryllium-stimulated TNF- α Is Associated with the − 308 TNF- α Promoter Polymorphism and with Clinical Severity in Chronic Beryllium Disease
Authors: LISA A. MAIER, RICHARD T. SAWYER, ROSLYN A. BAUER, LORI A. KITTLE, PENNY LYMPANY, DEIRDRE McGRATH, ROLAND DUBOIS, ELAINE DANILOFF, CECILE S. ROSE, LEE S. NEWMAN
Journal: American Journal of Respiratory and Critical Care Medicine (2001)

Beryllium (Be)-antigen stimulates tumor necrosis factor-alpha (TNF- α ) from bronchoalveolar lavage (BAL) cells in chronic beryllium disease (CBD). This study tested the hypothesis that high concentrations of Be-stimulated TNF- α are related to polymorphisms in the TNF- α promoter and clinical markers of disease severity in CBD. Demographic and clinical information was obtained from patients with CBD (n = 20). TNF- α concentrations were measured in BAL cell culture supernatant by ELISA. A priori, we categorized CBD subjects as either high or low TNF- α producers using a cutoff of 1,500 pg/ml. The TNF- α promoter sequence, + 64 to − 1045, was determined by direct sequencing. Human leukocyte-associated antigen (HLA)-DPB1 and -DRB1 genotyping was determined by polymerase chain reaction (PCR). High Be-stimulated TNF- α was associated with TNF2 alleles, Hispanic ethnicity, presence of HLA-DPB1 Glu69, and absence of HLA-DR4. Be-stimulated TNF- α concentrations correlated with markers of disease severity, including chest radiograph, beryllium lymphocyte proliferation, and spirometry. We found no novel TNF- α promoter polymorphisms. These data suggest that the TNF2 A allele at − 308 in the TNF- α promoter region is a functional polymorphism, associated with a high level of Be-antigen-stimulated TNF- α and that these high TNF- α levels indicate disease severity in CBD.
The Postmenopausal Estrogen/Progestin Interventions Trial
Authors: F. R. Abrams
Journal: JAMA (1995)

To the Editor.  —With all due respect to the numerous institutions and conscientious physicians who participated in the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial research project,1there is a serious shortcoming that must be addressed. Those of us who practiced medicine in the 1970s and 1980s became unhappily aware of the incidence of premalignant and malignant endometrial lesions induced by unopposed estrogen. This was amply confirmed by the literature, and the entire enterprise of estrogen replacement fell into disrepute until concomitant progestin therapy was added.2-5  In the face of this knowledge, the addition of an unopposed estrogen arm to the PEPI project needlessly exposed patients to a foreseeable harm that, in fact, the published outcome demonstrated to have occurred. Despite the precaution of periodic endometrial biopsies, major surgical interventions became necessary.  Minimal risks may be accepted by an informed subject, but only if there is no other way to
Acoustic method to estimate the longitudinal area profile of endotracheal tubes.
Authors: C Van Surell, B Louis, F Lofaso, L Beydon, L Brochard, A Harf, J Fredberg, D Isabey
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

A problem in mechanical ventilation is the accumulation of mucus secretions in the endotracheal tube (ETT), which tends to reduce the patent cross-sectional area. Here we characterized the extent and locus of the ETT obstruction using an acoustic reflection method recently modified to be applied at bedside. Experiments were conducted both in vivo in 10 intubated patients and in vitro in ETT with or without known constrictions of 1 to 3 mm over 5 cm, located at various distances from the ETT entry: 5, 10, 15, and 20 cm. Acoustic results were compared with the results obtained by an hydraulic reference method, which was the only method available to measure ETT obstruction in mechanically ventilated patients. In vivo acoustic results showed that area reductions were maximal near the tracheal extremity of the ETT, with a range from 2 to 36% (mean value 13 +/- 10%), when estimated relative to the area measured in an unused ETT of the same inner diameter (7 to 9 mm). Statistical analysis of the differences between acoustic reflection data and hydraulic data showed that the two methods did not differ significantly. In vitro acoustic results obtained in constricted ETT showed a highly significant correlation with the actual area (r = 0.97, p = 0.0001). Thus, reductions in ETT area may be detected, quantified, and located by the present acoustic reflection method, which therefore provides a means to avoid emergency extubation because of ETT obstruction.
Roquin Paralogs 1 and 2 Redundantly Repress the Icos and Ox40 Costimulator mRNAs and Control Follicular Helper T Cell Differentiation
Authors: Katharina U. Vogel, Stephanie L. Edelmann, Katharina M. Jeltsch, Arianna Bertossi, Klaus Heger, Gitta A. Heinz, Jessica Zöller, Sebastian C. Warth, Kai P. Hoefig, Claudia Lohs, Frauke Neff, Elisabeth Kremmer, Joel Schick, Dirk Repsilber, Arie Geerlof, Helmut Blum, Wolfgang Wurst, Mathias Heikenwälder, Marc Schmidt-Supprian, Vigo Heissmeyer
Journal: Immunity (2013)
Alcohol and the Driver
Authors: B. Hjelle
Journal: JAMA (1986)

To the Editor.—  I read with interest the COUNCIL REPORT, Alcohol and the Driver,1 which advocated the lowering of the per se legal blood alcohol concentration (BAC) from 0.1% to 0.05%. I was struck by the apparent discrepancy between the recommendation of the Council and the evidence presented, which indicates that there would be little or no benefit to lowering the minimum legal BAC.  The authors repeatedly cite studies demonstrating a high incidence of BACs greater than 0.05% among crash victims nationwide, yet they do not break down these statistics into groups, so one cannot determine the number of accidents caused by drivers with BACs less than the current (typical) per se limit of 0.1%. More importantly, the relevant statistic for policymakers is the probability of causing an accident (per man-hour behind the wheel) for an individual with a BAC between 0.05% and 0.1% compared with controls with a BAC
The Story of Medicine in America
Authors: Frederick Stenn
Journal: JAMA (1974)

The history of American medicine is recorded in many books, each one of which possesses individual distinctiveness. Francis Packard's<i>The Story of Medicine in the United States</i>(1901) presented accurate detail up to the days of Crawford Long, and with special emphasis on the colonial period. In 1958, Felix Marti-Ibanez offered a symposium,<i>History of American Medicine</i>, consisting of expert studies on specific epochs and movements. In 1966, Richard Shryock brought together in his<i>Medicine in America</i>separate essays of merit that interlace several disciplines and stress social movements. Now Marks, a lay science-writer, and Beatty, a medical bibliographer and librarian, have written a popular book beginning with Jamestown and moving rapidly over 350 years down to the health maintenance organization of today. The presentation has abundant biographic detail with good descriptions of leaders like Cotton Mather, James Thatcher, Daniel Drake, Joseph Goldberger, Alexis Carrel, and George Hevesy. The accounts
DNA Extraction Protocol for Biological Ingredient Analysis of Liuwei Dihuang Wan
Authors: Xinwei Cheng, Xiaohua Chen, Xiaoquan Su, Huanxin Zhao, Maozhen Han, Cunpei Bo, Jian Xu, Hong Bai, Kang Ning
Journal: Genomics Proteomics & Bioinformatics (2014)

Abstract Traditional Chinese medicine (TCM) preparations are widely used for healthcare and clinical practice. So far, the methods commonly used for quality evaluation of TCM preparations mainly focused on chemical ingredients. The biological ingredient analysis of TCM preparations is also important because TCM preparations usually contain both plant and animal ingredients, which often include some mis-identified herbal materials, adulterants or even some biological contaminants. For biological ingredient analysis, the efficiency of DNA extraction is an important factor which might affect the accuracy and reliability of identification. The component complexity in TCM preparations is high, and DNA might be destroyed or degraded in different degrees after a series of processing procedures. Therefore, it is necessary to establish an effective protocol for DNA extraction from TCM preparations. In this study, we chose a classical TCM preparation, Liuwei Dihuang Wan (LDW), as an example to develop a TCM-specific DNA extraction method. An optimized cetyl trimethyl ammonium bromide (CTAB) method (TCM-CTAB) and three commonly-used extraction kits were tested for extraction of DNA from LDW samples. Experimental results indicated that DNA with the highest purity and concentration was obtained by using TCM-CTAB. To further evaluate the different extraction methods, amplification of the second internal transcribed spacer (ITS2) and the chloroplast genome trnL intron was carried out. The results have shown that PCR amplification was successful only with template of DNA extracted by using TCM-CTAB. Moreover, we performed high-throughput 454 sequencing using DNA extracted by TCM-CTAB. Data analysis showed that 3–4 out of 6 prescribed species were detected from LDW samples, while up to 5 contaminating species were detected, suggesting TCM-CTAB method could facilitate follow-up DNA-based examination of TCM preparations.
Ankle Edema of Tropical Climes
Authors: Ronald F. Buchan
Journal: JAMA (1971)

<h3>To the Editor.—</h3> A question in the QUESTION AND ANSWER section (<b>217</b>:833, 1971) seeks the reason for "Ankle Edema After Week at sea in Small Yacht." Mentioned geographically is "the area of the Bahamas and Virgin Islands." Fairbairn of the Mayo Clinic responded to the query with appropriate remarks. While in medical attendance at many business conferences in Florida and the Caribbean, I have, over the years, seen numerous such cases, which I have come to call "tropical ankle." The victims are usually from the North, men and women alike, on their first expedition to the southern climes, with onset within 48 hours of arrival. None of these I have seen have obvious history or current symptoms of the spectrum of etiological factors one would ordinarily consider. Common to all is the rather abrupt onset, and usually spontaneous and prompt resolution without attempts at therapy or change in activity.
Inhibitory effects of procainamide on sympathetic nerve activity in humans.
Authors: R F Rea, M Hamdan, S J Schomer, D R Geraets
Journal: Circulation Research (1991)

In experimental animals, procainamide causes hypotension and reductions in efferent vasoconstrictor sympathetic outflow that may result from ganglionic blockade or central nervous system sympathetic inhibition. To test the hypothesis that procainamide decreases sympathetic nerve activity (SNA) in humans, we recorded postganglionic SNA in seven normal subjects in the baseline state and during infusions of procainamide HCl at 50 mg/min (loading) and 8 mg/min (maintenance). At the end of the loading infusion, mean arterial pressure (MAP) had decreased from 88.5 +/- 2.4 (mean +/- SEM) to 81.5 +/- 3.2 mm Hg (p less than 0.05), central venous pressure from 6.7 +/- 0.7 to 5.4 +/- 0.9 mm Hg (p less than 0.05), forearm vascular resistance (FVR) from 28 +/- 4.8 to 22.3 +/- 5.1 resistance units (p less than 0.05), and SNA from 259 +/- 47 to 94 +/- 26 units/min (p less than 0.05). These changes persisted during the maintenance infusion. Increased levels of SNA, FVR, and MAP provoked by the cold pressor test were reduced significantly by intravenous procainamide. In eight other subjects, intravenous procainamide HCl (15 mg/kg at 50 mg/min) caused dose-dependent inhibition of SNA that reversed as blood concentrations fell during drug washout. To determine if procainamide causes direct vasodilation, in nine subjects, graded infusions were delivered into the brachial artery at doses that produced no systemic effect. Ipsilateral FVR tended to increase during local intra-arterial infusion of procainamide. These data show that intravenous procainamide causes hypotension, vasodilation, and sympathetic withdrawal. Vasodilation does not result from a direct vasorelaxant effect of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)
The Public Interest and Drug Recall
Authors: S. H. Kraines
Journal: JAMA (1964)

<h3>To the Editor:—</h3> Many of us in the private practice of medicine were surprised and shocked by the sudden order on Feb 24, 1964, of the Food and Drug Administration recalling tranylcypromine (Parnate) sulfate from public use. The problem raised by this action involves much more than this particular edict. Several questions arise. What is the actual incidence of side reactions with tranylcypromine? The occurrence of about 50 cases which resulted in cerebrovascular accidents and of 15 cases terminating in death is significant only in terms of incidence. Among the 3.5 million patients who have used this drug, there would thus be an incidence of one death in 230,000 patients and one case of cerebrovascular accident in 70,000 patients. Since many aging persons were taking this drug, the question arises as to whether the reported side effects were consequential to or coincidental with the use of tranylcypromine. Is
IgE and IgG4 Epitope Mapping by Peptide Microarray Immunoassay for the Identification of Patients with Symptomatic Peanut Allergy
Authors: J. Lin, F.M. Bruni, Z. Fu, J. Maloney, L. Bardina, G. Gimenez, A.L. Boner, H.A. Sampson
Journal: Journal of Allergy and Clinical Immunology (2011)
Assessment of left ventricular remodeling after myocardial infarction by B-type natriuretic peptide secreted form the infarct and noninfarct segment
Authors: A. Hirayama, H. Fuji, H. Yamamoto, Y. Sakata, M. Asakura, F. Ishikura, K. Kodama
Journal: Journal of the American College of Cardiology (1998)
Pulmonary Emboli Masquerading as Asthma
Authors: Francisco Olazábal, Luis A. Román-Irizarry, Jorge D. Oms, Lillian Conde, Ernesto J. Marchand
Journal: New England Journal of Medicine (1968)

BRONCHOCONSTRICTION is a nearly constant sequela to acute pulmonary embolism,1 and wheezing was recently reported as occurring in some patients suspected of having this disease.2 , 3 To our knowledge, however, there are no clinical reports establishing angiographically the diagnosis of pulmonary embolism in patients presenting apparent bronchial asthma. During the last four months we have proved this diagnosis in three patients initially treated for bronchial asthma.Case ReportsCase 1. A 46-year-old nurse reported to the Employees' Clinic at the San Juan Municipal Hospital on August 25, 1967, with a recurrent episode of "asthma." She was found to have generalized wheezing . . .