tbuckley/cabot-search huggingface dataset:
The Illusion of Deterministic Rules
Authors: Peter Glassman
Journal: Annals of Internal Medicine (1997)

Letters15 July 1997The Illusion of Deterministic RulesPeter Glassman, MBBS, MSc, John Peabody, MD, PhD, and Karyn Model, PhDPeter Glassman, MBBS, MScWest Los Angeles Veterans Affairs Medical Center; Los Angeles, CA 90073 (Glassman, Peabody)National Economic Research Associates; Los Angeles, CA 90017Search for more papers by this author, John Peabody, MD, PhDWest Los Angeles Veterans Affairs Medical Center; Los Angeles, CA 90073 (Glassman, Peabody)National Economic Research Associates; Los Angeles, CA 90017Search for more papers by this author, and Karyn Model, PhDWest Los Angeles Veterans Affairs Medical Center; Los Angeles, CA 90073 (Glassman, Peabody)National Economic Research Associates; Los Angeles, CA 90017Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-127-2-199707150-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Drs. Asch and Hershey point out two errors, one arithmetic and one conceptual. The arithmetic error, transposing a decimal point (turning 0.25% into 2.5%), does not affect the model. Thus, we focus here on the conceptual error: We added lives saved (by not performing surgery) for patients who were not being considered for intervention in the first place. We concur with the calculations of Asch and Hershey but not concur that our miscalculations understate the persuasiveness of quantitative health policy. When the calculations of Asch and Hershey are used, cost-effectiveness still fails to act as a deterministic decision ...References1. Eddy DM. Clinical decision making: from theory to practice. Benefit language: criteria that will improve quality while reducing costs. JAMA. 1996; 275:650-7. Google Scholar Author, Article, and Disclosure InformationAuthors: Peter Glassman, MBBS, MSc; John Peabody, MD, PhD; Karyn Model, PhDAffiliations: West Los Angeles Veterans Affairs Medical Center; Los Angeles, CA 90073 (Glassman, Peabody)National Economic Research Associates; Los Angeles, CA 90017 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 July 1997Volume 127, Issue 2Page: 166KeywordsDecision makingDiphtheriaHealth careInfectious diseasesMedical servicesMotivationPublic policySurgery ePublished: 15 August 2000 Issue Published: 15 July 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
TREATMENT OF TYPHOID FEVER, WITH REPORT OF TWO CASES, BY WOODBRIDGE METHOD.
Authors: STERLING RUFFIN
Journal: JAMA (1896)

With the exception of pulmonary tuberculosis, there is perhaps no disease about which more has been said and written than typhoid fever. Especially is this true of the last few decades. The literature of the medical world of to-day is filled to overflowing with treatises on the subject, a circumstance at which we do not wonder after a moment's reflection of its frequency, its almost universal distribution and the dangers to which its unfortunate victims are subjected. There is no disease known to us which has contributed with more regularity to the mortality of the world. During the last fifteen years in the cities of Paris, Berlin, New York, Philadelphia, Boston, Chicago and Baltimore it has annually killed upward of five persons out of every 10,000 of their population, and in Liverpool in 1865 it was responsible for 50 deaths to every 10,000 inhabitants. In our own city during the
The Liver-First Approach to the Management of Colorectal Cancer With Synchronous Hepatic Metastases
Authors: Santhalingam Jegatheeswaran, James M. Mason, Helen C. Hancock, Ajith K. Siriwardena
Journal: JAMA Surgery (2013)

To our knowledge, this is the first systematic review of the liver-first approach to the management of patients with colorectal cancer with synchronous liver metastases.To review current evidence for the liver-first approach to the management of patients with colorectal cancer with synchronous liver metastases.PubMed, EMBASE, the Science Citation Index, the Social Sciences Citation Index, Conference Proceedings Citation Index, and the Derwent Innovations Index were searched for the period from January 2000 to May 2012 using terms describing colorectal cancer, liver metastases, and surgery. A predefined protocol for data extraction was used to retrieve data on the design of each study including demographic profile, distribution of primary and hepatic metastatic disease, management of chemotherapy, surgery, the sequence of intervention, disease progression, the numbers completing treatment algorithm, and outcome and survival.The literature search identified 417 articles, of which 4 cohort study reports described the liver-first approach and reported survival data. There was good agreement between studies on the sequence of treatment using the liver-first approach. The preferred algorithm was systemic chemotherapy, followed by liver resection, then chemoradiotherapy for those patients with rectal lesions, and colorectal resection as the last operative step. Two protocols provided further adjuvant chemotherapy after colorectal resection. Of 121 patients starting treatment, 90 (74%) completed the specified treatment protocol. Disease progression during the protocol period occurred in 23 patients (19%). There was wide variation in survival despite apparently similar protocols.The liver-first approach for patients with colorectal cancer with synchronous liver metastases is possible but is associated with a wide range of survival outcomes, despite protocol similarities between studies. There is a need for a well-designed clinical trial comparing this liver-first approach with the classic (bowel-first) approach.
PHYSIOLOGY OF SWEAT
Authors: G. A. Talbert
Journal: JAMA (1926)

To the Editor:  —As a result of collaboration with ten of my students during the last two months, we have been able to demonstrate the following constituents as constant in the sweat of normal individuals: viz., amino-acids, uric acid and sugar. Furthermore, we have discovered that sweating produced by heat has a tendency: (1) to reduce the blood sugar; (2) to increase the red count; (3) to increase the specific gravity of the blood, and (4) to decrease the alkali reserve.
Familial dyslipidemic hypertension. Evidence from 58 Utah families for a syndrome present in approximately 12% of patients with essential hypertension
Authors: R. R. Williams
Journal: JAMA (1988)

Population-based sibships with essential hypertension diagnosed before the age of 60 years are being screened in Utah to find two or more hypertensive siblings with the same biochemical abnormality as a clue to an inherited cause for their specific type of hypertension. Among 131 hypertensive subjects in 58 sibships, concordant abnormalities in fasting serum lipid concentrations were observed in two or more siblings in 48% of the sibships. After adjusting for effects of antihypertensive medications, abnormal values reported in only 10% of the Lipid Research Clinics data were observed in 30% of patients for serum triglycerides, 19% for serum low-density lipoprotein cholesterol, and 39% for high-density lipoprotein cholesterol. More than one lipid level was abnormal in almost all concordant sibships, suggesting an association between hypertension and a syndrome of mixed lipid abnormalities, probably familial combined hyperlipidemia (renamed "familial combined dyslipidemia" because of common low high-density lipoprotein cholesterol levels). We conclude that familial dyslipidemic hypertension may be a specific syndrome with lipid abnormalities more severe than blood pressure elevations.
ROLE OF PASSIVE LEG RAISING TO EVALUATE PRELOAD RESPONSIVENESS IN PATIENTS WITH CARDIOGENIC SHOCK AFTER ST ELEVATION MYOCARDIAL INFARCTION (STEMI) TREATED WITH INOTROPIC THERAPY
Authors: Marco Poli, Paolo Trambaiolo, Valentina Basso, Marina Mustilli, Massimo De Luca, Vjerica Likic, Maurizio Simonetti, Federica Ferraiuolo, Giuseppe Ferraiuolo
Journal: Journal of the American College of Cardiology (2012)
Intravenous Tissue-Type Plasminogen Activator for Treatment of Acute Stroke
Authors: Gregory W. Albers, Vernice E. Bates, Wayne M. Clark, Rodney Bell, Piero Verro, Scott A. Hamilton
Journal: JAMA (2000)

ContextTissue-type plasminogen activator (tPA) is the only therapy for acute ischemic stroke approved by the Food and Drug Administration.ObjectiveTo assess the safety profile and to document clinical outcomes and adverse events in patients treated with intravenous tPA for acute stroke in clinical practice.Design and SettingProspective, multicenter study of consecutive patients enrolled between February 1997 and December 1998 at 57 medical centers in the United States (24 academic and 33 community).InterventionIntravenous tPA (recombinant alteplase).PatientsThree hundred eighty-nine patients with a mean age of 69 years (range, 28-100 years); 55% were men.Main Outcome MeasuresTime intervals between stroke symptom onset, hospital arrival, and treatment with tPA; pretreatment computed tomographic scan results, intracerebral hemorrhage, and major systemic bleeding. The modified Rankin Scale score was used to assess clinical outcomes at 30 days.ResultsMedian time from stroke onset to treatment was 2 hours 44 minutes, and the median baseline National Institutes of Health Stroke Scale score was 13. The 30-day mortality rate was 13%. At 30 days after treatment, 35% of patients had very favorable outcomes (modified Rankin score, 0-1) and 43% were functionally independent (modified Rankin score, 0-2). Thirteen patients (3.3%) experienced symptomatic intracerebral hemorrhage, including 7 who died. Twenty-eight patients (8.2%) had asymptomatic intracerebral hemorrhage within 3 days of treatment with tPA. Protocol violations were reported for 127 patients (32.6%), and included treatment with tPA more than 3 hours after symptom onset in 13.4%, treatment with anticoagulants within 24 hours of tPA administration in 9.3%, and tPA administration despite systolic blood pressure exceeding 185 mm Hg in 6.7%. A multivariate analysis found predictors of favorable outcome to be a less severe baseline National Institutes of Health Stroke Scale score, absence of specific abnormalities (effacement or hypodensity of >33% of the middle cerebral artery territory or a hyperdense middle cerebral artery) on the baseline computed tomographic scan, an age of 85 years or younger, and a lower mean arterial pressure at baseline.ConclusionsThis study, conducted at multiple institutions throughout the United States, suggests that favorable clinical outcomes and low rates of symptomatic intracerebral hemorrhage can be achieved using tPA for stroke treatment.
MYCOSIS FUNGOIDES; WITH REFERENCE TO A CASE.
Authors: JOHN V. SHOEMAKER
Journal: JAMA (1898)

A married woman, 60 years of age, who, upward of a year ago, was for some time under my care, gave the following history: The disease from which she suffered began four years and three months prior to her first visit. The first manifestation occurred in the form of red patches situated upon the back. They were accompanied by intense itching. They were rather bright in color. From the back the lesions gradually spread to the breast, abdomen, neck and limbs, attacking even the soles of the feet. Some, after a certain degree of development, healed. According to her statement, the skin had been more seriously affected than it was at the date of the examination. Itching had throughout been a prominent symptom. The lesions were also the seat of considerable pain. They often bleed when rubbed or scratched. The patient's appetite was poor, she was habitually constipated, and had
Assembly of Therapeutic pRNA-siRNA Nanoparticles Using Bipartite Approach
Authors: Yi Shu, Mathieu Cinier, Sejal R Fox, Nira Ben-Johnathan, Peixuan Guo
Journal: Molecular Therapy (2011)

The 117-nucleotide (nt) RNA, called the packaging RNA (pRNA) of bacteriophage phi29 DNA packaging motor, has been shown to be an efficient vector for the construction of RNA nanoparticles for the delivery of small interfering RNA (siRNA) into specific cancer or viral-infected cells. Currently, chemical synthesis of 117-nt RNA is not feasible commercially. In addition, labeling at specific locations on pRNA requires the understanding of its modular organization. Here, we report multiple approaches for the construction of a functional 117-base pRNA using two synthetic RNA fragments with variable modifications. The resulting bipartite pRNA was fully competent in associating with other interacting pRNAs to form dimers, as demonstrated by the packaging of DNA via the nanomotor and the assembly of phi29 viruses in vitro. The pRNA subunit assembled from bipartite fragments harboring siRNA or receptor-binding ligands were equally competent in assembling into dimers. The subunits carrying different functionalities were able to bind cancer cells specifically, enter the cell, and silence specific genes of interest. The pRNA nanoparticles were subsequently processed by Dicer to release the siRNA embedded within the nanoparticles. The results will pave the way toward the treatment of diseases using synthetic pRNA/siRNA chimeric nanoparticles. The 117-nucleotide (nt) RNA, called the packaging RNA (pRNA) of bacteriophage phi29 DNA packaging motor, has been shown to be an efficient vector for the construction of RNA nanoparticles for the delivery of small interfering RNA (siRNA) into specific cancer or viral-infected cells. Currently, chemical synthesis of 117-nt RNA is not feasible commercially. In addition, labeling at specific locations on pRNA requires the understanding of its modular organization. Here, we report multiple approaches for the construction of a functional 117-base pRNA using two synthetic RNA fragments with variable modifications. The resulting bipartite pRNA was fully competent in associating with other interacting pRNAs to form dimers, as demonstrated by the packaging of DNA via the nanomotor and the assembly of phi29 viruses in vitro. The pRNA subunit assembled from bipartite fragments harboring siRNA or receptor-binding ligands were equally competent in assembling into dimers. The subunits carrying different functionalities were able to bind cancer cells specifically, enter the cell, and silence specific genes of interest. The pRNA nanoparticles were subsequently processed by Dicer to release the siRNA embedded within the nanoparticles. The results will pave the way toward the treatment of diseases using synthetic pRNA/siRNA chimeric nanoparticles.
Antigenic polymorphism of human very late activation protein-2 (platelet glycoprotein Ia-IIa). Platelet alloantigen Hca.
Authors: V L Woods, K D Pischel, E D Avery, H G Bluestein
Journal: Journal of Clinical Investigation (1989)

We have found evidence for a human alloantigenic system on the very late activation protein -2 (VLA-2) heterodimer (platelet GPIa/IIa). Sera from two patients with systemic lupus erythematosus (SLE) contained antibodies that immunoprecipitated surface molecules from platelets and fibroblasts that comigrated on SDS-PAGE and two-dimensional O'Farrell gels with platelet GPIa (VLA-alpha2 chain) and platelet GPIIa (VLA-beta chain). These SLE antibodies were alloreactive as they precipitated VLA molecules from only 5 of 22 normal donors' platelets and did not react with the lupus patients' own platelets, despite the expression of apparently normal amounts of VLA on the donors' cells. Two-dimensional O'Farrell analysis demonstrated no differences in the molecular weight or isoelectric point of GPIa and GPIIa obtained from platelets of alloantibody reactive or unreactive donors. Sequential immunoprecipitation experiments with VLA chain-specific monoclonal antibodies, and the pattern of immunoprecipitation of several different VLA heterodimers demonstrated that the alloantibody-reactive determinant was present on the VLA-2 heterodimer, and not other VLA molecules. Thus, these SLE sera demonstrate a previously unrecognized antigenic polymorphism of the VLA-2 (platelet GPIa/IIa) heterodimer, platelet alloantigen Hca.
Granulocyte-Colony Stimulating Factor Reactivates Human Cytomegalovirus in a Latently Infected Humanized Mouse Model
Authors: M. Shane Smith, Devorah C. Goldman, Alexis S. Bailey, Dana L. Pfaffle, Craig N. Kreklywich, Doran B. Spencer, Florence A. Othieno, Daniel N. Streblow, J. Victor Garcia, William H. Fleming, Jay A. Nelson
Journal: Cell Host & Microbe (2010)
Degenerating Heart Valves
Authors: Konstantinos Charitakis, Craig T. Basson
Journal: Circulation (2007)

The intellect is always fooled by the heart.-La Rochefoucauld M yxoid valvular heart dystrophies are a frequent cause of valvular diseases.They affect approximately 3% of the population and are the most common cause of isolated mitral regurgitations that require surgical repair. 1,2These valvular diseases are a heterogeneous group of disorders and include isolated nonsyndromic valvular diseases, such as idiopathic mitral valve prolapse and the X-linked myxomatous valvular dystrophy (XMVD), and syndromic entities, such as Marfan syndrome.In this issue of Circulation, Kyndt et al 3 report their surprising finding that specific mutations in filamin A (FLNA), a gene previously associated primarily with neurological and skeletal disorders, actually cause XMVD.
A Worrisome Misappropriation of “<i>Mukallaf”</i>in Life-Sustaining Treatment
Authors: Kholoud Alnakshabandi, Autumn Fiester
Journal: The American Journal of Bioethics (2015)

In their target article “Ethical Obligations and Clinical Goals in End-of-Life Care: Deriving a Quality-of-Life Construct Based on the Islamic Concept of Accountability Before God (Taklīf),” Aasim ...
Management of lung cancer in South East Scotland.
Authors: R J Fergusson, A Gregor, R Dodds, G Kerr
Journal: Thorax (1996)

There are few reports which describe the management of unselected groups of patients with lung cancer. This study was undertaken to audit prospectively the presentation, diagnosis, management, and outcome of patients presenting with lung cancer in South East Scotland.Data were recorded on all patients with newly diagnosed lung cancer who presented to a multidisciplinary group of clinicians over a 12 month period. Subsequent follow up data on treatment and survival were collected.Six hundred and twenty two patients were registered, 80% of whom were referred from primary care. There was a considerable variation in the length of history, but the diagnosis was rapidly made after referral (87% within two weeks). In 82% of patients the pathological examination was positive; 70% were treated with palliative intent. Only 36% of patients who underwent surgery had computed tomographic scanning and 55% had sampling of mediastinal nodes. A wide variety of regimens was used for treatment with radiotherapy and chemotherapy, and follow up data were difficult to obtain in these patients. Survival was poor in all patients treated with palliative intent.This audit confirms the importance of previously noted prognostic factors. Significant variation in referral practice, diagnostic and management evaluation has been shown. The data serve as a useful background for the formation of local management guidelines.
Points from Letters: Protection of the Blind
Authors: R. D. Reid
Journal: BMJ (1964)

BRTSw=Hcomings of others-presumably they hope their own virtues will show up better by contrast; but, really, 800 purple hearts a day are too much for any of us to swallow, literally or figuratively.No details have been given, so far as I know, of how many were in the family or how long the tablets were supposed to last, or whether the circum- stances justified the prescribing of purple hearts in any quantity.This statement has been so damaging to the profession in lay eyes and so surprising and shocking to the vast majority of doctors in general practice who never prescribe more than two Drinamyl a day-and these with some diffidence-that the Ministry should justify the statement of the official by supply- ing details to the profession by way of Prescribers' Notes or in the B.M.7.
Reversal of neurochemical changes and pain-related behavior in a model of neuropathic pain using modified lentiviral vectors expressing GDNF
Authors: Sophie Pezet, Agnieszka Krzyzanowska, Liang-Fong Wong, John Grist, Nicholas D. Mazarakis, Biljana Georgievska, Stephen B. McMahon
Journal: Molecular Therapy (2006)

<h2>Abstract</h2> In this study, we evaluated the possible use of lentiviral vectors in the treatment of neuropathic pain. We chose to administer GDNF-expressing vectors because of the known beneficial effect of this trophic factor in alleviation of neuropathic pain in adult rodents. Lentiviral vectors expressing either GDNF or control, green fluorescent protein or β-galactosidase, were injected unilaterally into the spinal dorsal horn 5 weeks before a spinal nerve ligation was induced (or sham surgery for the controls). We observed that intraspinally administered lentiviral vectors resulted in a large and sustained expression of transgenes in both neurons and glial cells. Injection of GDNF-expressing viral vectors induced a significant reduction of ATF-3 up-regulation and IB4 down-regulation in damaged DRG neurons. In addition, it produced a partial but significant reversal of thermal and mechanical hyperalgesia observed following the spinal nerve ligation. In conclusion, our study suggests that lentiviral vectors are efficient tools to induce a marked and sustained expression of trophic factors in specific areas of the CNS and can, even if with some limitations, be efficient in the treatment of neuropathic pain.
Prospective Assessment of Metabolic Control in Diabetes Mellitus: The Complications Question
Authors: Michael P. Stern
Journal: JAMA (1988)

It is widely recognized that prospective studies are superior to cross-sectional or retrospective studies for elucidating the etiology of disease, although the latter are quicker and easier to perform. Despite this, there are remarkably few prospective epidemiologic studies of diabetes. This is quite unlike the situation in cardiovascular disease epidemiology, where there are an almost countless number of such studies. A principal reason for this lack is the much lower rate of occurrence in the general population of diabetes compared with cardiovascular disease. This lower incidence mandates that either very large populations be studied or that very prolonged durations of follow-up be used to achieve statistically meaningful results. These requirements are to varying degrees relaxed when high-risk populations are studied. Thus, among the few prospective studies of diabetes that have been carried out are those in Pima Indians<sup>1</sup>and Micronesians from the South Pacific island of Nauru,<sup>2</sup>both