tbuckley/cabot-search huggingface dataset:
Quality of Care in Investor-Owned vs Not-for-Profit HMOs
Authors: David U. Himmelstein
Journal: JAMA (1999)

The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs.To compare quality-of-care measures for investor-owned and not-for-profit HMOs.Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States.Rates for 14 HEDIS quality-of-care indicators.Compared with not-for-profit HMOs, investor-owned plans had lower rates for all 14 quality-of-care indicators. Among patients discharged from the hospital after myocardial infarction, 59.2% of members in investor-owned HMOs vs 70.6% in not-for-profit plans received a beta-blocker (P<.001); 35.1% of patients with diabetes mellitus in investor-owned plans vs 47.9% in not-for-profit plans had annual eye examinations (P<.001). Investor-owned plans had lower rates than not-for-profit plans of immunization (63.9% vs 72.3%; P<.001), mammography (69.4% vs 75.1%; P<.001), Papanicolaou tests (69.2% vs 77.1%; P<.001), and psychiatric hospitalization (70.5% vs 77.1%; P<.001). Quality scores were highest for staff- and group-model HMOs. In multivariate analyses, investor ownership was consistently associated with lower quality after controlling for model type, geographic region, and the method each HMO used to collect data.Investor-owned HMOs deliver lower quality of care than not-for-profit plans.
Vindaloo and you.
Authors: I. Bjarnason, S. Levi, P. Smethurst, I. S. Menzies, A. J. Levi
Journal: BMJ (1988)

Recent developments have led to the introduction of various test substances to assess intestinal permeability, some of which test the barrier function of the small intestinal mucosa.'4Most of the tests are simple, comprising ingestion of a solution containing a poorly metabolised test substance and subsequent collection of urine over 5-24 hours for analysis of the test markers.Such tests have shown abnormal intestinal permeability in several gastrointestinal conditions,'4 and because of their non-invasive nature they can be applied to diagnostic screening and research.5"7Furthermore, close attention to apparent anomalies of intestinal permeability has led to the description of a new enteropathy caused by non-steroidal anti- inflammatory drugs that is not evident using conven- tional techniques.8'0eaten by Permeability tests have not, however, been met with universal success as diagnostic screening tests.In No of particular, the indigenous "normal" populations of subjects east and west Africa," 12 the Middle East,'3 Indonesia, Papua New Guinea, India, and Thailand (I S Menzies, 3 unpublished observations) have such high perme-4
Community institutional care for frail elderly people
Authors: D. Black, C. Bowman
Journal: BMJ (1997)

Responsibility for the medical management of elderly people in community institutional care (residential or nursing) remains poorly defined. It currently rests by default rather than by design on the heavily burdened shoulders of general practitioners. The number of patients in private or voluntary homes in Britain has risen from 18 200 in 1983 to 148 500 in 1994.1 The management of frail elderly people in nursing homes has also been regarded as beyond the scope of the general medical services contract and as a non-core activity.2

To add to this uncertainty, the role of geriatricians has undergone major changes. Increasing responsibilities for acute services have meant less time for continuing care and community care generally. These changes are partly due to the reduction of NHS long term beds, the withdrawal from acute admission duties by some medical specialities, and the lack of understanding and appreciation of geriatric care in the contracting process. The white paper Choice and Opportunity envisages, perhaps optimistically, new entrants into the community care market for health care.3 Generally, the lack of national benchmark standards has contributed to these difficulties. Some aspects of these issues have …
Pleural Effusions: Patterns on Ventilation-Perfusion Lung Scans
Authors: FRANK M. MELE, VICENTE J. CARIDE
Journal: Clinical Nuclear Medicine (1998)

Perfusion and ventilation abnormalities created by pleural effusions can interfere with the interpretation of the lung scan. This retrospective study identified and evaluated the specificity of scintigraphic patterns for pleural effusion. Ninety-two ventilation-perfusion lung scans were analyzed for the following signs of pleural effusion: presence of fissures, straightened or concave lung borders, costophrenic angle blunting, and attenuation of lung activity by interposed fluid. The findings later were correlated with chest radiographs. Of 25 pleural effusions detected by chest radiography, scintigraphy predicted 14 (specificity, 86%). In all of these cases, there was agreement with the chest radiograph (specificity, 100%). The fissure sign and the straight-concave border sign were equally reliable for the prediction of pleural fluid. Costophrenic angle blunting was never seen as the sole indicator of pleural fluid, and attenuation was seen alone in only one case. Another finding observed during this evaluation was absent ventilation at the lung base with preserved perfusion. Scintigraphic patterns may not be reliable in obstructive lung disorders and diseases with altered lung compliance. The recognition of scintigraphic patterns of pleural effusions on ventilation-perfusion scans can improve the clinical value of lung scintigraphy by reducing the number of indeterminate readings.
Physician-Assisted Suicide and Euthanasia in Practice
Authors: Sherwin B. Nuland
Journal: New England Journal of Medicine (2000)

Many readers of the Journal who closely follow the national debate over euthanasia and assisted suicide may find themselves wondering why there has been so little discussion of the actual clinical outcomes of attempts to help patients end lives of intractable anguish. No matter how useful the guidance of tradition, the tenets of religion, the codes of ethicists and professional societies, or even the laws of the state, the critical ingredient of examined experience is all but missing from the debate. In this issue of the Journal, Groenewoud and colleagues describe the Dutch experience with clinical problems in euthanasia and . . .
A NEW MATERIAL FOR SURGICAL SPLINTS AND JACKETS, WITH A METHOD FOR APPLYING IT.Read in the Section on Surgery and Anatomy, at the Forty-fourth Annual Meeting of the American Medical Association.
Authors: EDWARD A. TRACY
Journal: JAMA (1893)

This material, in its crude form, is old as the hills —for the members of the energetic wasp family have used it, time out o' mind, in the construction of their homesteads. I refer to wood pulp. There are many varieties of pulp board on the market, and to give their characteristics in detail would needlessly take up your time; suffice it to say they were tried and found wanting. The needful combination of properties sought for was plasticity, toughness, elasticity and rigidity. It took some experimentation to get the desired product, but my task was lightened by consulting my friend, Mr. Charles H. Fish, of Manchester, N. H., a gentleman familiar with every branch of pulp manufacture. Fig. 1. The experiments made, and the manufacturing processes employed, might form matter for interesting discourse in the laboratory and the mill; I do not propose to claim your attention for them
Processed Pseudogenes Are More Abundant in Human and Mouse X Chromosomes than in Autosomes
Authors: Guy Drouin
Journal: Molecular Biology and Evolution (2006)

Two different hypotheses have been proposed to explain the observation that some genomes contain more processed pseudogenes than others. One predicts that processed pseudogene abundance is inversely proportional to the substrate specificity of the reverse transcriptase that generates processed pseudogenes. The other predicts that the amount of processed pseudogenes found in genomes is proportional to the length of oogenesis. Here, we test the oogenesis hypothesis by analyzing the data from 6 studies that described the number of pseudogenes on different chromosomes of the human and/or mouse genomes. Our results show a significant overabundance of processed pseudogenes in the X chromosomes and a significant underrepresentation of processed pseudogenes in the Y chromosome of the human genome. These observations support the hypothesis that the number of processed pseudogenes is proportional to the length of oogenesis.
Cancer Houses and their Victims
Authors: D. Power
Journal: BMJ (1894)

_zj4 J .IO L (See Fig. 3.) Th'e sore oni the ul)per inner side of the riglht atrimi healed.Appetitte and11 sleep and(l wvalkingr p"oi 'r were aIl improvinig.Thle figures slhowv some of the tranisitionis that occurred up to the date wlien tlhe.piatient recovered.
Core-Shell type lipid/rPAA-Chol polymer hybrid nanoparticles for in vivo siRNA delivery
Authors: Ling-Yan Gao, Xiao-Yan Liu, Cheng-Jun Chen, Jian-Cheng Wang, Qiang Feng, Min-Zhi Yu, Xiao-Fei Ma, Xi-Wei Pei, Yu-Jie Niu, Chong Qiu, Wen-Hao Pang, Qiang Zhang
Journal: Biomaterials (2013)
Lysis of ras oncogene-transformed cells by specific cytotoxic T lymphocytes elicited by primary in vitro immunization with mutated ras peptide.
Authors: D J Peace, J W Smith, W Chen, S G You, W L Cosand, J Blake, M A Cheever
Journal: The Journal of Experimental Medicine (1994)

Ras protooncogenes are activated by characteristic point mutations in a wide variety of malignancies. The expressed p21ras proteins are oncogenic by virtue of single substituted amino acids, usually at position 12 or 61 of the 189-residue p21ras protein. In the current study, the ability of class I major histocompatibility complex (MHC)-restricted T cells to recognize the altered segment of a transforming p21ras protein and to lyse cells transformed by the corresponding ras oncogene was examined. Synthetic ras peptides encompassing the common activating substitution of leucine for glutamine at position 61 were constructed with an amino acid motif appropriate for binding to the H-2Kb murine class I MHC molecule. Cytotoxic T lymphocytes (CTL) specific for bound ras leucine 61 peptide were elicited by in vitro immunization of normal lymphocytes with synthetic peptides. The ras peptide-induced CTL specifically lysed syngeneic fibroblasts transformed by an activated ras gene encoding oncogenic p21ras protein containing the same single amino acid substitution. Thus, in some circumstances, mutated p21ras protein can serve as a tumor-specific antigen.
Neurologic function among termiticide applicators exposed to chlorpyrifos.
Authors: K Steenland, R B Dick, R J Howell, D W Chrislip, C J Hines, T M Reid, E Lehman, P Laber, E F Krieg, C Knott
Journal: Environmental Health Perspectives (2000)

Chlorpyrifos is a moderately toxic organophosphate pesticide. Houses and lawns in the United States receive a total of approximately 20 million annual chlorpyrifos treatments, and 82% of U.S. adults have detectable levels of a chlorpyrifos metabolite (3,5, 6-trichloro-2-pyridinol; TCP) in the urine. The U.S. Environmental Protection Agency has estimated that there are 5,000 yearly reported cases of accidental chlorpyrifos poisoning, and approximately one-fourth of these cases exhibit symptoms. Organophosphates affect the nervous system, but there are few epidemiologic data on chlorpyrifos neurotoxicity. We studied neurologic function in 191 current and former termiticide applicators who had an average of 2.4 years applying chlorpyrifos and 2.5 years applying other pesticides, and we compared them to 189 nonexposed controls. The average urinary TCP level for 65 recently exposed applicators was 629.5 microg/L, as compared to 4.5 microg/L for the general U.S. population. The exposed group did not differ significantly from the nonexposed group for any test in the clinical examination. Few significant differences were found in nerve conduction velocity, arm/hand tremor, vibrotactile sensitivity, vision, smell, visual/motor skills, or neurobehavioral skills. The exposed group did not perform as well as the nonexposed group in pegboard turning tests and some postural sway tests. The exposed subjects also reported significantly more symptoms, including memory problems, emotional states, fatigue, and loss of muscle strength; our more quantitative tests may not have been adequate to detect these symptoms. Eight men who reported past chlorpyrifos poisoning had a pattern of low performance on a number of tests, which is consistent with prior reports of chronic effects of organophosphate poisoning. Overall, the lack of exposure effects on the clinical examination was reassuring. The findings for self-reported symptoms raise some concern, as does the finding of low performance for those reporting prior poisoning. Although this was a relatively large study based on a well-defined target population, the workers we studied may not be representative of all exposed workers, and caution should be exercised in generalizing our results.
Trends in NHS expenditure
Authors: M. G Dunnigan
Journal: BMJ (1997)

Editor–The otherwise informative series of articles on NHS funding from the King's Fund Policy Institute were flawed in several ways.1 2 3 4 They considered only current expenditure in England, they did not discuss the relation between declining capital expenditure and the private finance initiative, and they did not comment on the increased transactional and capital charging costs that have followed the NHS reforms. Most importantly, none of the articles discussed the implications of the government's present plans to squeeze public expenditure, …
Which Answer Do You Read?
Authors: William Dock
Journal: JAMA (1963)

<h3>To the Editor:</h3> —Which answer do you read? On p 550 of the Aug 10 issue ofThe Journal(vol 185), Dr. Robert E. Stone says, "nor are we justified... in burdening and confusing the patient with the term 'cholesterol,' " while only 6 cm down the page, Drs. E. Grey Dimond and Robert B. Voth advise the inquiring physician on diet and drugs for a man with a blood cholesterol level of 457. Does Dr. Stone think we should not measure blood cholesterol? If we do find it very high, how can we treat the patient without clarifying the situation and its significance for him? Dr. Stone's answer can only transmit his own confusion to other physicians. All he needed to say was that no adult, without malabsorption syndrome, needs "large doses" of vitamin D or vitamin A. The effect on the cholesterol, or the blood vessels, is less harmful
Coupling transport and biodegradation of VOCs in surface and subsurface soils.
Authors: J R Hunt, P A Holden, M K Firestone
Journal: Environmental Health Perspectives (1995)

Volatile organic chemicals present at Superfund sites preferentially partition into the soil gas and may be available for microbial degradation. A simple mass transfer model for biodegradation for volatile substrates has been developed for the aerobic decomposition of aromatic and aliphatic hydrocarbons. The mass transfer analysis calculates diffusive fluxes from soil gas through water and membrane films and into the cell. This model predicts an extreme sensitivity of potential biodegradation rates to the air-water partition coefficients of the compounds. Aromatic hydrocarbons are removed rapidly while the aliphatic hydrocarbons are much slower by orders of magnitude. Furthermore, oxygen transfer is likely to limit aromatic hydrocarbon degradation rates. The model presents results that cast doubt on the practicality of using methane or propane for the co-metabolic destruction of trichloroethylene in a gas phase bioreactor. Toluene as a primary substrate has better mass transfer characteristics to achieve more efficient trichloroethylene degradation. Hence, in sites where these contaminants coexist, bioremediation could be improved.
Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome
Authors: T. Kadowaki
Journal: Journal of Clinical Investigation (2006)

Adiponectin is an adipokine that is specifically and abundantly expressed in adipose tissue and directly sensitizes the body to insulin. Hypoadiponectinemia, caused by interactions of genetic factors such as SNPs in the Adiponectin gene and environmental factors causing obesity, appears to play an important causal role in insulin resistance, type 2 diabetes, and the metabolic syndrome, which are linked to obesity. The adiponectin receptors, AdipoR1 and AdipoR2, which mediate the antidiabetic metabolic actions of adiponectin, have been cloned and are downregulated in obesity-linked insulin resistance. Upregulation of adiponectin is a partial cause of the insulin-sensitizing and antidiabetic actions of thiazolidinediones. Therefore, adiponectin and adiponectin receptors represent potential versatile therapeutic targets to combat obesity-linked diseases characterized by insulin resistance. This Review describes the pathophysiology of adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome.
Diffuse Abdominal Uptake of Ga-67 Citrate in Two Cases
Authors: TSUTOMU INAOKA, NORIYUKI SHUKE, WAKAKO YAMAMOTO, KOUKI USUI, KOJI TAKAHASHI, TAMIO ABURANO, KEISUKE SATO, YASUAKI SAIJO
Journal: Clinical Nuclear Medicine (2000)

Diffuse abdominal uptake of Ga-67 citrate is seen relatively rarely in patients with diffuse peritoneal involvement of neoplastic and inflammatory disease. Two cases of intraperitoneal tumor dissemination are presented, both of which showed characteristic diffuse abdominal uptake on Ga-67 citrate scintigraphy. One was in a patient with intraperitoneal dissemination of non-Hodgkin’s lymphoma that originated in the pancreas, and the other was in a patient with disseminated intraperitoneal metastasis of gastric cancer. The scintigraphic features of diffuse peritoneal tumor dissemination on Ga-67 citrate scintigraphy are described in correlation with findings of CT and the pathologic examinations.
THE LIVER AND MEDICAL PROGRESS
Authors: FRANK C. MANN
Journal: JAMA (1941)

It is an essential but almost impossible task for the physician to keep himself sufficiently informed concerning the discoveries in the several sciences that are included in the science of medicine to use intelligently the practical results of these discoveries in his clinical work. From the biologic, chemical and physical laboratories in addition to the research clinic and bedside of the patient there issues a flood of discoveries which is almost overwhelming. If the physician is to render to his patient of today the benefit of the discovery of yesterday, the new accretions to the knowledge and practice of medicine must be evaluated, organized and assimilated within the background of his previous training and experiences. His ability to apply the results of the investigations in the various fields of medicine will depend on his knowledge of the fundamental sciences and the advances made in them as well as on his
Direct Intramuscular Gene Transfer of Naked DNA Encoding Vascular Endothelial Growth Factor Augments Collateral Development and Tissue Perfusion
Authors: Yukio Tsurumi, Satoshi Takeshita, Dongfen Chen, Marianne Kearney, Susan T. Rossow, Jonathan Passeri, Jeffrey R. Horowitz, James F. Symes, Jeffrey M. Isner
Journal: Circulation (1996)

Background Striated muscle has been shown to be capable of taking up and expressing foreign genes transferred in the form of naked plasmid DNA, although typically with a low level of gene expression. In the case of genes that encode secreted proteins, however, low transfection efficiency may not preclude bioactivity of the secreted gene product. Accordingly, we investigated the hypothesis that intramuscular (IM) gene therapy with naked plasmid DNA encoding vascular endothelial growth factor (VEGF) could augment collateral development and tissue perfusion in an animal model of hindlimb ischemia. Methods and Results Ten days after ischemia was induced in one rabbit hindlimb, 500 μg of phVEGF 165 , or the reporter gene LacZ , was injected IM into the ischemic hindlimb muscles. Thirty days later, angiographically recognizable collateral vessels and histologically identifiable capillaries were increased in VEGF transfectants compared with controls. This augmented vascularity improved perfusion to the ischemic limb, documented by a superior calf blood pressure ratio for phVEGF 165 (0.85±0.05) versus controls (0.64±0.05, P &lt;.01), improved blood flow in the ischemic limb (measured with an intra-arterial Doppler wire) at rest (phVEGF 165 =21.3±3.9 mL/min, control=14.6±1.6 mL/min, P &lt;.01) and after a vasodilator (phVEGF 165 =54.2±12.0 mL/min, control=37.3±8.9 mL/min, P &lt;.01) and increased microspheres in the adductor (phVEGF 165 =4.3±1.6 mL·min −1 ·100 g of tissue −1 , control=2.9±1.2 mL·min −1 ·100 g of tissue −1 , P &lt;.05) and gastrocnemius (phVEGF 165 =3.9±1.0 mL·min −1 ·100 g of tissue −1 , control=2.8±1.4 mL·min −1 ·100 g of tissue −1 , P &lt;.05) muscles of the ischemic limb. Conclusions Ischemic skeletal muscle represents a promising target for gene therapy with naked plasmid DNA. IM transfection of genes encoding angiogenic cytokines, particularly those that are naturally secreted by intact cells, may constitute an alternative treatment strategy for patients with extensive peripheral vascular disease in whom the use of intravascular catheter–based gene transfer is compromised and/or prohibited.
Ca2+ signaling in astrocytes from Ip3r2−/− mice in brain slices and during startle responses in vivo
Authors: Rahul Srinivasan, Ben S Huang, Sharmila Venugopal, April D Johnston, Hua Chai, Hongkui Zeng, Peyman Golshani, Baljit S Khakh
Journal: Nature Neuroscience (2015)
Delivering mental health services for a diverse society
Authors: Kamaldeep Bhui, Kwame McKenzie, Paramjit Gill
Journal: BMJ (2004)

We need to marry policy and practice 

T he presentation, management, and outcome of mental disorders differ between ethnic groups.1–3 w1 The most consistent findings are that African-Caribbeans with mental health problems are disproportionately found in forensic, psychiatric, and prison populations and among compulsorily detained patients.2 3 They are more likely to receive antipsychotic medication and less likely to be offered psychotherapy.4–5 w2 Rates of suicide are also higher among some South Asian women and young people of Caribbean origin.6 These disparities have several causes, but it is difficult not to consider the lack of a coordinated and effective response to them as evidence of institutional racism in mental health and allied services.7–8 w3 In response to the disparities and the demands of service users for action,9 the Department of Health recently launched two policy frameworks: Inside Outside , a new strategy for England,10 and a consultation document, Delivering race equality: a framework for action .11 Unfortunately these …