tbuckley/cabot-search huggingface dataset:
Cost effectiveness of magnetic resonance imaging in the neurosciences.
Authors: A K Szczepura, J Fletcher, J D Fitz-Patrick
Journal: BMJ (1991)

OBJECTIVES--To measure, in a service setting, the effect of magnetic resonance imaging on diagnosis, diagnostic certainty, and patient management in the neurosciences; to measure the cost per patient scanned; to estimate the marginal cost of imaging and compare this with its diagnostic impact; to measure changes in patients9 quality of life; and to record the diagnostic pathway leading to magnetic resonance imaging. DESIGN--Controlled observational study using questionnaires on diagnosis and patient management before and after imaging. Detailed costing study. Quality of life questionnaires at the time of imaging and six months later. Diagnostic pathways extracted from medical records for a representative sample. SETTING--Regional superconducting 1.5 T magnetic resonance service. SUBJECTS--782 consecutive neuroscience patients referred by consultants for magnetic resonance imaging during June 1988-9; diagnostic pathways recorded for 158 cases. MAIN OUTCOME MEASURES--Costs of magnetic resonance imaging and preliminary investigations; changes in planned management and resulting savings; changes in principal diagnosis and diagnostic certainty; changes in patients9 quality of life. RESULTS--Average cost of magnetic resonance imaging was estimated at 206.20/patient pounds (throughput 2250 patients/year, 1989-90 prices including contrast and upgrading). Before magnetic resonance imaging diagnostic procedures cost 164.40/patient pounds (including inpatient stays). Management changed after imaging in 208 (27%) cases; saving an estimated 80.90/patient pounds. Confidence in planned management increased in a further 226 (29%) referrals. Consultants9 principal diagnosis changed in 159 of 782 (20%) referrals; marginal cost per diagnostic change was 626 pounds. Confidence in diagnosis increased in 236 (30%) referrals. No improvement in patients9 quality of life at six month assessment. CONCLUSIONS--Any improvement in diagnosis with magnetic resonance imaging is achieved at a higher cost. Techniques for monitoring the cost effectiveness of this technology need to be developed.
Meralgia Paresthetica Syringectica
Authors: Marc Auriacombe
Journal: JAMA (1991)

<h3>To the Editor.—</h3> Meralgia paresthetica is characterized by pain, burning, or tingling paresthesias, and decreased touch and pain sensation on the anterolateral aspect of the thigh. It is due to neuropathy of the lateral femoral cutaneous nerve. At least 80 causes for this condition have been reported.<sup>1</sup>We add another. <h3>Report of a Case.—</h3> A 35-year-old, male intravenous drug abuser was admitted to the hospital for cocaine detoxification. He denied injecting cocaine in the legs. Ten years earlier, he underwent a right inguinal herniorrhaphy. There was numbness in the anterolateral aspect of the right thigh of 2 weeks' duration. Examination revealed decreased to absent touch and pain sensation in the anterolateral aspect of the right thigh. There was no reflex or motor deficit indicative of other L2-3 involvement and this was confirmed by electromyogram. Nerve conduction studies showed absence of sensory conduction in the lateral femoral cutaneous nerve on
Intercellular gap junctional communication is required for an optimal metabolic response of the functional units of liver
Authors: J C Saez
Journal: Hepatology (1997)

The gap junction protein connexin32 is expressed in hepatocytes, exocrine pancreatic cells, Schwann's cells, and other cell types. We have inactivated the connexin32 gene by homologous recombination in the mouse genome and have generated homozygous connexin32–deficient mice that were viable and fertile but weighed on the average approximately ≈17% less than wild–type controls. Electrical stimulation of sympathetic nerve in connexin32–deficient liver triggered a 78% lower amount of glucose mobilization from glucose stores, when compared with wild–type liver. Thus, connexin32–containing gap junctions are essential in mouse liver for maximal intercellular propagation of the noradrenaline signal from sympathetic nerve endings, to perivenous (downstream) hepatocytes. In connexin32–defective liver, the amount of connexin26 protein expressed was found to be lower than in wild–type liver and the total area of gap junction plaques was approximately ≈1,000–fold smaller than in wild–type liver. In contrast to patients with connexin32 defects suffering from X chromosome–linked Charcot–Marie–Tooth disease (CMTX) due to demyelination in Schwann cells of peripheral nerves, connexin32–deficient mice did not show neurological abnormalities when analyzed at 3 months of age. It is possible, however, that they may develop neurodegenerative symptoms at an older age.
Increased Interleukin-4 and Decreased Interferon-<b>γ</b> in Exhaled Breath Condensate of Children with Asthma
Authors: Sukhbir K. Shahid, Sergei A. Kharitonov, Nicola M. Wilson, Andrew Bush, Peter J. Barnes
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

Exhaled breath condensate analysis for noninvasive quantification of airway inflammation in asthma is a potentially useful research tool in children. There is an imbalance between T-helper (Th)-2 cells, which secrete interleukin (IL)-4, and Th1 cells, which secrete interferon (IFN)-γ, in asthma. We measured concentrations of IL-4 and IFN-γ in breath condensates of 37 children (11 normal, 12 steroid-naive, and 14 steroid-treated children with asthma). Exhaled IFN-γ was significantly lower in steroid-naive and steroid-treated children with asthma compared with normal control subjects (3.7 ± 0.2 versus 5.1 ± 0.4 pg/ml, p < 0.01 and 4.1 versus 5.1 pg/ml, p < 0.05). By contrast, mean exhaled IL-4 was elevated in asthma (53.7 ± 4.2 pg/ml) compared with normal children (35.7 ± 6.2 pg/ml, p < 0.05) and concentrations were lower with steroid treatment (37.5 ± 5.6 pg/ml, p < 0.05). Exhaled IL-4 was significantly lower in children with asthma on more than 600 μg inhaled steroid/day. The IL-4/IFN-γ ratio was significantly greater in children with asthma compared with control children and the children with asthma on inhaled steroid therapy. We have shown for the first time that IFN-γ and IL-4 can be assayed in exhaled breath condensate and shows an increased ratio of IL-4/IFN-γ, consistent with predominance of Th2 cells in airways of children with asthma. Exhaled breath condensate analysis may have a useful role in studying allergic inflammation in childhood asthma.
Exercise in Insulin-dependent Diabetes Mellitus: The Effect of Continuous Insulin Infusion Using the Subcutaneous, Intravenous, and Intraperitoneal Sites
Authors: Brent R Gooch, Naji N Abumrad, Ronald P Robinson, Mark Petrik, Doug Campbell, Oscar B Crofford
Journal: Diabetes Care (1983)

The metabolic response to exercise in insulin-dependent diabetic (IDD) man was assessed during continuous insulin infusion using the subcutaneous (CSII), intravenous (CIVII),and intraperitoneal (CIPII) routes. During the basal period, plasma glucose levels were higher with CIPII (153 ± 17 mg/dl) than with CSII (117 ± 13 mg/dl) or CIVII (118 ± 17 mg/dl). Basal free insulin concentrations were similar for CSII (12.3 ± 10 μU/ml) and CIVII (12.4 ± 1.4 μU/ml) but lower in CIPII (8.5 ± 1.0 (μU/ml, P &amp;lt; 0.05). Exercise on a stationary bicycle at 75 W for 60 min produced a decline of plasma glucose in each protocol that was significant only during CIVII (55 ± 11 mg/dl, P &amp;lt; 0.01). Insulin levels remained unchanged throughout the study period in all protocols. In normals, insulin values decreased during exercise and remained below basal levels through the recovery period (P &amp;lt; 0.05), while plasma glucose remained unchanged. Plasma glucagon and epinephrine levels were similar in all protocols and remained unchanged with exercise, while plasma norepinephrine tended to be higher than normal in all diabetic subjects. Significant differences between normal and diabetic subjects (P &amp;lt; 0.05) were observed for blood ketone bodies, while blood lactate, glycerol, and plasma FFA were similar. Normalization of intermediarymetabolites occurred only with CIVII. Continuous insulin infusion provides near-normal glycemic and metabolic control before, during and following exercise in IDD man. However, to produce normal blood concentrations of intermediary metabolites during exercise, the insulin infusion rate may be excessive in terms of its hypoglycemic effect. CSII appears tobe a safe, accessible, and adequate method for treating diabetic man during exercise.
Antioxidant Therapy for Idiopathic Pulmonary Fibrosis
Authors: Gary W. Hunninghake
Journal: New England Journal of Medicine (2005)

Idiopathic pulmonary fibrosis (IPF) is a progressive disease characterized by fibrosis and remodeling of the lung parenchyma. The median survival of patients with the disease is about three years after diagnosis or five years after the onset of symptoms. The pathological findings are those of usual interstitial pneumonia.1 In many instances, the diagnosis can be made when typical clinical and radiologic features are present.25 The classic radiologic features are a patchy pattern of peripheral "honeycombing" that is more prominent in the bases of the lungs, traction bronchiectasis, and the absence of prominent ground-glass opacity. When these findings are not . . .
Regulation of the Heart's Functions
Authors: ROBERT F. RUSHMER
Journal: Circulation (1960)

If a regulating system consists of a mechanism for sensing the essential parameters, detecting deviations from a "set" value, and initiating corrective action, then the arterial pressure-regulating mechanism is the only regulating system described for the circulation in any detail. This mechanism appears to be important in maintaining a level of mean arterial pressure within a narrow range. It does not appear, however, to play a dominant role in adjusting the level of the circulation to meet spontaneously changing circulatory demands under many circumstances. During spontaneous activity by intact dogs, an increase in systolic ventricular pressure (and mean arterial pressure) is frequently accompanied by tachycardia as though some other mechanism were overriding the pressoreceptor mechanism. Thus, it appears that the circulatory system as a whole is largely controlled by neural mechanisms, usually initiated by higher levels of the nervous system. Very little is known of the sensory limbs of reflex arcs that can serve to regulate the cardiovascular system as a whole.
Impact of congenital colour vision deficiency
Authors: Barry L Cole
Journal: BMJ (2005)

# Congenital colour vision deficiency does cause problems {#article-title-2} EDITOR—Cumberland et al did not find a significant association between colour vision deficiency and either educational attainment or the occurrence of personal injury.1 They conclude that normal colour vision is not a prerequisite for safe driving or working, saying that their findings challenge the rationale of population screening for colour vision deficiency. ![][1]</img> [1]: /embed/graphic-1.gif
Death from Tuberculosis
Authors: W. M. Macleod
Journal: BMJ (1962)

Tuberculosis Undefeated  is the succinct title used by Professor Crofton for his Marc Daniels Memorial Lecture (Crofton, 1960). Nowhere is this fact more clearly established than in the Registrar-General's report for 1959, which shows the 2,620 men and 854 women died from this disease during the year. That tuberculosis could be eliminaled from Great Britain with available resources may be inferred from Crofton's review and the reports of other workers, such as Thomas et al. (1960) in Birmingham. However, with our present inadequate preventive measures we have to accept continuing infection and so face the three remaining failures of the tuberculosis services. Firstly, late diagnosis of advanced and infectious disease with consequent severe lung damage. Secondly, relapse during or after treatment, often associated with an organism resistant to the standard drugs. Finally, there is death from tuberculosis; sometimes a tragic prelude to its recognition, but more usually following some years after diagnosis. Southampton is a port town and a county borough with a population growing from 177,100 in 1953 to over 200,000 by 1960. During the past 10 years the death rate from tuberculosis has fallen from 35.4 in 1950 to 14.4 per 100,000, but remains hiigher than the general trend for England and Wales (Fig. 1).
Department of Health agrees deal with GSK to cancel part of swine flu vaccine order
Authors: S. Mayor
Journal: BMJ (2010)

The Department of Health in England announced that it has agreed with GlaxoSmithKline (GSK) to cap its order for the company’s swine flu (H1N1) vaccine, saving about one third of the value of the original order that it placed for enough vaccine to protect the entire UK population.

As the numbers infected with H1N1 have declined, the UK government has decided that vaccinating the whole population against the virus—as had originally been planned—is no longer necessary. It had ordered 90 million doses of swine flu vaccine—a higher rate per head than any other country in Europe.

The Department of Health has agreed to cap the order for GSK’s Pandemrix vaccine at 34.8 million doses, including those already received, rather than having to pay for the entire initial order of 60 million doses. An order for a further …
Patients with asthma who do not fill their inhaled corticosteroids: A study of primary nonadherence
Authors: L. Keoki Williams, Christine L. Joseph, Edward L. Peterson, Karen Wells, Mingqun Wang, Vimal K. Chowdhry, Matthew Walsh, Janis Campbell, Cynthia S. Rand, Andrea J. Apter, David E. Lanfear, Kaan Tunceli, Manel Pladevall
Journal: Journal of Allergy and Clinical Immunology (2007)
Survivorship patterns in the posthospital phase of myocardial infarction.
Authors: H T Davis, J DeCamilla, L W Bayer, A J Moss
Journal: Circulation (1979)

A prospective postinfarction follow-up study was used to identify subsets of patients with different survival patterns.Nine hundred forty patients who survived the hospital phase of an acute myocardial infarction were followed for 12-60 months.During the 5-year follow-up, 115 patients died of cardiac causes.Univariate analysis showed that prior myocardial infarction (PMI), left ventricular dysfunction (LVD) in the CCU, one or more ventricular premature depolarizations (VPDs) on a 6-hour Holter recording, and anterior myocardial infarction were significantly (p < 0.01) more frequent in patients who died of cardiac causes than in survivors.Survivorship analyses revealed a variety of survival patterns, depending on the presence or absence of the risk factors PMI, LVD, VPD and anterior infarction, as well as their interactive combinations.A com- bination of anterior infarction with LVD and VPDs identified a high-risk subset that made up 15% of the myocardial infarction population, and this group had 6-month and 3-year survival rates of 85% and 70%, respectively.After we excluded the high-risk subset, PMI, LVD and VPD each had significant yet independent influence on survival, with PMI having a greater effect on mortality than either LVD or VPDs.A low-risk sub- set that made up 24% of the population was identified by the absence of PMI, LVD and VPDs, and this group had a 3-year survival of 94%.PATIENTS WHO SURVIVE an acute myocardial infarction (MI) are at an increased risk of cardiac death and recurrent MI during the subsequent post- hospital years.Poor posthospital prognosis has been associated with older age, ST-segment depression and ventricular conduction defects on the resting ECG, cardiomegaly, advanced New York Heart Association functional class, left ventricular dysfunction (LVD) and frequent and complex ventricular premature depolarizations (VPDs).?-' Although these factors have been used to classify pa- tients in terms of their risk of cardiac death, very little is known about variable interactions as they pertain to the mechanisms influencing mortality.Techniques using multiple variables for modeling survivorship of postinfarction populations are useful in this regard because they utilize the entire experience of all patients, i.e., take into account the length of follow- up.'0 11 However, only limited use has been made of the full power of these techniques.In 1973, a prospective, longitudinal, posthospital follow-up program was initiated in Rochester, New York for patients discharged alive after recovering from acute MI.' The purposes of the present study are twofold: 1) to determine in this population whether clinical univariate risk factors act independently or in combination with each other to influence posthospital
The Unborn Patient
Authors: Irvin M. Cushner
Journal: JAMA (1969)

To  Editor:—  Dr. Warren J. Warwick's editorial,  Unborn Patient ( 209 :1081, 1969), is a thoughtful, sensitive appraisal of one possible impact of  new technology in  care of  fetus. The fundamental question which he raises could be stated as follows: Will accurate diagnosis and effective therapy of fetal disease, earlier in pregnancy than now, make therapeutic abortion for fetal disease inappropriate and unethical?  It has been considered—obstetrically, ethically, vital statistically —that an abortion is distinguished from a birth by whether  pregnancy terminates—or is terminated —when  fetus is viable (ie, capable of survival). This is clearly obvious in  regulations which exist in many, if not most states, requiring  certification of a birth only after a prescribed period of gestation. When Dr. Warwick refers to the time when patient-doctor contract can be made, he refers to  time in pregnancy when  physician attains
Proton beam therapy is effective in highly selected clinical indications
Authors: A. Crellin
Journal: BMJ (2012)

I have little argument with your recent articles,1 2 but the associated headlines and poll fundamentally misunderstood the scope of high energy proton beam therapy planned for the NHS and may mislead readers. The articles focus on the lack of evidence and high cost of using protons for prostate cancer in the US. By contrast, the UK strategy is based …
Serial measurement of integrated ultrasonic backscatter in human cardiac allografts for the recognition of acute rejection.
Authors: T Masuyama, H A Valantine, R Gibbons, I Schnittger, R L Popp
Journal: Circulation (1990)

Cyclic variation of integrated ultrasonic backscatter (IB) was noninvasively measured in the septum and left ventricular posterior wall using a quantitative IB imaging system to assess the alterations in the acoustic properties of myocardium associated with acute cardiac allograft rejection. The study population consisted of 23 cardiac allograft recipients and 18 normal subjects. In each cardiac allograft recipient, one to eight (mean, four) IB studies were performed, each within 24 hours of right ventricular endomyocardial biopsy performed for rejection surveillance. The magnitude of the cyclic variation of IB in the posterior wall was 5.9 +/- 0.9 dB in normal subjects and 6.2 +/- 1.3 dB in the cardiac allograft recipients without previous or current histological evidence of acute rejection (n = 17, p = NS vs. normal subjects). The magnitude of cyclic variation of IB in the septum was 4.8 +/- 1.1 dB in normal subjects and 3.8 +/- 2.0 dB in the cardiac allograft recipients (n = 15, p = NS vs. normal subjects). A significant decrease in the septal IB measure was observed in cardiac allograft recipients with left ventricular hypertrophy (wall thickness of at least 13 mm) (2.6 +/- 1.7 dB, n = 8, p less than 0.05 vs. normal subjects). IB studies were done before and during moderate acute rejection in 11 recipients (14 episodes). During moderate acute cardiac rejection, the magnitude of the cyclic variation in IB decreased from 6.7 +/- 1.3 to 5.1 +/- 1.4 dB in the posterior wall (n = 14, p less than 0.05) and from 4.2 +/- 2.1 dB to 2.9 +/- 1.8 dB in the septum (n = 12, p less than 0.05). These data suggest 1) the magnitude of the cyclic variation in IB of the septum is different in cardiac allografts with cardiac hypertrophy and normal subjects, possibly reflecting regionally depressed myocardial contractile performance and 2) acute cardiac rejection in humans is accompanied by an alteration in the acoustic properties of the myocardium. This change is detectable by serial measurement of the magnitude of the cyclic variation in IB, both in the septum and in the posterior wall.
Assessment of a Universal, School-Based Hepatitis B Vaccination Program
Authors: Simon Dobson
Journal: JAMA (1995)

<h3>Objective.</h3> —To assess a hepatitis B vaccination program offered to all grade 6 students in British Columbia in 1992. <h3>Design.</h3> —Cohort study. <h3>Setting.</h3> —British Columbia, Canada. <h3>Participants.</h3> —All grade 6 students were offered vaccine. Subsets of 454 and 259 students participated in studies of minor adverse events and seroresponse, respectively. <h3>Intervention.</h3> —The vaccine used was Engerix-B, 20 μg, given at intervals of 0, 1, and 6 months. <h3>Main Outcome Measures.</h3> —Province-wide acceptance and series completion rates and reports of severe adverse events. Minor adverse events and immunogenicity in subsamples. <h3>Results.</h3> —A total of 127 922 vaccine doses were administered. Initial enrollment totaled 43358 students or 95.4% of those eligible. The series was completed by 41 594 students (95.6%). Minor adverse events were infrequent in the cohort assessed: no absenteeism or physician visits resulted from vaccination. Sixty-nine reported severe adverse events met surveillance definitions, the major categories being injection site reactions (23% of reports), fainting (20%), and rashes (17%). There was one instance of anaphylaxis. Only 13 of these events resulted in recommendations to discontinue the series. Of students tested following the series, 98% had levels of antibody to hepatitis B surface antigen considered to be protective (≥10 IU/L), the geometric mean titer being 690 IU/L (95% confidence interval, 498 to 957 IU/L). <h3>Conclusion.</h3> —Our experience indicates that school-based programs for universal vaccination of preadolescents can be highly acceptable and efficient. (<i>JAMA</i>. 1995;274:1209-1213)