tbuckley/cabot-search huggingface dataset:
Male Circumcision Cost-effective Articles Ignore Methodological Problems and Ethical Concerns
Authors: Chris S. Booker
Journal: JAMA Pediatrics (2013)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal
Understanding Rising Health Care Costs: Introducing a Series of Articles
Authors: Harold C. Sox
Journal: Annals of Internal Medicine (2005)

Editorials17 May 2005Understanding Rising Health Care Costs: Introducing a Series of ArticlesHarold C. Sox, MD, EditorHarold C. Sox, MD, EditorSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-10-200505170-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The cost of health care is one of the most serious problems facing the United States. Health care costs are a terrible burden to federal and state governments, to employers, to employees, and to the uninsured. In some cases, the expenditures are buying real gains. The level of disability in older people is lower than it used to be (1), as is the death rate from heart disease (2). But good evidence suggests that the intensity of care varies widely and that more intense care does not substantially improve health (3, 4). Despite growing concern that U.S. health care expenditures ...References1. Manton KG, Gu X. Changes in the prevalence of chronic disability in the United States black and nonblack population above age 65 from 1982 to 1999. Proc Natl Acad Sci U S A. 2001 May 22;98(11):6354-9. Google Scholar2. Rosamond WD, Chambless LE, Folsom AR, Cooper LS, Conwill DE, Clegg L, et al. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. N Engl J Med. 1998;339:861-7. CrossrefMedlineGoogle Scholar3. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003 Feb 18;138(4):273-87. Google Scholar4. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003 Feb 18;138(4):288-98. Google Scholar5. Bodenheimer T. High and rising health care costs. Part 1: seeking an explanation. Ann Intern Med. 2005;142:847-54. LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Harold C. Sox, MD, EditorCorresponding Author: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106-1572. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHigh and Rising Health Care Costs. Part 1: Seeking an Explanation Thomas Bodenheimer Metrics 17 May 2005Volume 142, Issue 10 Page: 865 Keywords Cardiovascular therapy Death rates Disabilities Forecasting Health care Health care policy ePublished: 17 May 2005 Issue Published: 17 May 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
A boy frightened of going to bed and bumps in the night
Authors: C James, A Gupta, D Cheng, S Padley, N Goulden, S Skellett
Journal: BMJ (2009)

An 8 year old boy of Indian origin presented to his local hospital with a three week history of worsening respiratory symptoms. He was previously fit and well, had not been febrile, and his only medical history was a recent visit to his general practitioner because he “found it hard to catch his breath at night.” He was becoming increasingly scared of going to bed at night and his mother was also concerned about some bumps that she could feel on his scalp while stroking his head in bed. A chest radiograph was performed (fig 1⇓). Fig 1 Chest radiograph The decision was made to drain in theatre under general anaesthetic what was assumed to be a right sided pleural effusion. Upon induction, the patient became apnoeic and was difficult to ventilate. He then became asystolic and cardiopulmonary resuscitation was commenced. Emergency bronchoscopy was required to establish an airway and cardiac output was restored after 20 minutes of cardiopulmonary resuscitation. The patient was transferred to his regional paediatric intensive care unit for further investigation and management. Blood tests were undertaken and his initial blood results were as follows (normal ranges in brackets):
Abstract 1122: Lipoic acid analogs induce ROS, leading to potent mitochondrial enzyme inhibition, metabolic dysfunction and cell death in tumor cells
Authors: Shawn D. Stuart, Zuzana Zachar, Sunita Gupta, Robert Rodriguez, Robert Shorr, Paul M. Bingham
Journal: Cancer Research (2012)

Abstract The targeting of tumor cell metabolism has emerged as an attractive candidate for chemotherapeutics. In particular, tumor cell mitochondria are dramatically reprogrammed to generate large amounts of biosynthetic intermediates to fuel cell division. We previously described a novel class of non-redox active lipoic acid analogs (“thioctoids”) which effect dramatic inactivation of the mitochondrial enzyme complex pyruvate dehydrogenase (PDH) (PMID:21769686). We have recently completed a comprehensive metabolomic study indicating that thioctoids down-regulate multiple mitochondria-associated enzymes. Each of these target enzymes are key control points for entry of carbon into the TCA cycle, including the alpha-ketoglutarate dehydrogenase complex and the branch-chain dehydrogenase/amino trasferase complex. In addition we will present data that reactive oxygen species (ROS) play a direct regulatory role in these inactivations and are a major contributor to the resultant cell cycle arrest and multiple cell death pathways which follow. Taken together, our results indicate that thioctoids are potent inhibitors of tumor cell mitochondrial energy metabolism, owing, apparently, to the central regulatory role of lipoic acid in mitochondrial lipoamide dehydrogenase-containing enzyme complexes. We hypothesize that thioctoids are ‘misread’ by these complexes resulting in increased levels of ROS leading to the further shutdown of redox-sensitive metabolic enzymes and ultimately cell death. As a consequence of these novel properties, thioctoids attack tumor-specific metabolism far more broadly and pervasively than other agents directed at individual metabolic steps or activities. Thioctoids are exceptionally well tolerated in animal studies and as a result may have high clinical potential. They are currently in early stage human clinical trials. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1122. doi:1538-7445.AM2012-1122
Human Antitetanus Serum
Authors: L. R. S. MacFarlane
Journal: BMJ (1963)

<b>Background:</b> Unemployment and economic inactivity are associated with poor health. There are social gradients in unemployment and economic inactivity so it was hypothesised that they may contribute to the social gradient in self rated health. <b>Methods:</b> Data on employment status, socio-economic position (SEP), and self-rated heath were obtained for people of working age (25-59) who had ever worked from a 3% sample of the 2001 English census. The age adjusted prevalence differences in not good general health for four separate measures of SEP were compared to the prevalence differences obtained after additional adjustment for employment status. <b>Results:</b> Prevalence differences for not good health were reduced by 50% or over when adjusting for employment status (for men ranging from 57% to 81%, for women 50% to 74%). <b>Discussion:</b> The social gradient in employment status contributes greatly to the social gradient in self-reported health. Understanding why this is the case could be important for tackling social inequalities in health.
Associations of the HDL2 and HDL3 cholesterol subfractions with the development of ischemic heart disease in British men. The Caerphilly and Speedwell Collaborative Heart Disease Studies.
Authors: P M Sweetnam, C H Bolton, J W Yarnell, D Bainton, I A Baker, P C Elwood, N E Miller
Journal: Circulation (1994)

The relative importance of HDL2 and HDL3 cholesterol as risk factors for ischemic heart disease (IHD) is still uncertain. Their associations with the incidence of IHD in the Caerphilly and Speedwell prospective studies are described.The two studies have a common core protocol and are based on a total of 4860 middle-aged men from the general population. The first follow-up was at a nearly constant interval of 5.1 years in Caerphilly and 3.2 years in Speedwell: 251 major IHD events had occurred. Lipid levels were measured on fasting samples. Different laboratories were used by the two studies. Each laboratory used ultracentrifugation to separate HDL2 and HDL3. Both subfractions were inversely associated with risk of IHD. Standardized relative odds of developing major IHD were 0.95 (95% confidence interval [CI], 0.80 to 1.14) for HDL2 cholesterol and 0.83 (95% CI, 0.68 to 1.00) for HDL3 cholesterol in Caerphilly and 0.76 (95% CI, 0.57 to 1.01) for HDL2 and 0.64 (95% CI, 0.49 to 0.83) for HDL3 in Speedwell. The association with incident IHD appeared to be stronger for HDL3 in both areas. No linear combination of the two subfractions was a better predictor of IHD than total HDL cholesterol alone.In British men, both HDL2 and HDL3 cholesterol are inversely associated with the incidence of IHD. However, the prediction of the risk of IHD from total HDL cholesterol alone could not be improved upon by measurement of the two HDL subfractions. The relative value of the two HDL subfractions as predictors of risk is still unresolved. The uncertainty may be due, at least in part, to problems associated with their measurement.
Organotypic culture of fetal lung type II alveolar epithelial cells: applications to pulmonary toxicology.
Authors: S G Shami, J D Aghajanian, R L Sanders
Journal: Environmental Health Perspectives (1984)

Techniques for isolation and culture of fetal Type II alveolar epithelial cells, as well as the morphologic and biochemical characteristics of these histotypic cultures, are described. Type II alveolar epithelial cells can be isolated from fetal rat lungs and grown in an organotypic culture system as described in this review. The fetal Type II cells resemble differentiated rat Type II cells in morphology, biochemistry, and karyotype as they grow in culture for up to 5 weeks. The cells of the mature organotypic cultures form alveolarlike structures while growing on a gelatin sponge matrix. The Type II cells also synthesize and secrete pulmonary surfactant similar in biochemical composition to that produced in vivo. This system has been used to study the effects of hormones on surfactant production and composition. The organotypic model has many potential applications to the study of pulmonary toxicology.
Pharmacologic Management of Renovascular Hypertension
Authors: Mark R. G. Chassin
Journal: JAMA (1974)

To determine the response that might be expected when renovascular hypertension is managed pharmacologically, the records of 24 patients, whose conditions were subsequently cured or improved by surgery, were examined. Mean diastolic pressure fell from 128 to 106 mm Hg, with an average of two antihypertensive agents in patients with fibromuscular hyperplasia, while an average of three agents was required to lower mean diastolic pressure, from 127 to 107 mm Hg, in patients with atherosclerotic lesions. Blood pressure elevation in fibromuscular hyperplasia is more responsive to antihypertensive agents than it is in patients with atherosclerotic lesions causing hypertension of equal severity.
High quality at Scarborough Hospital.
Authors: S Lock
Journal: BMJ (1986)

After two and a half days' listening to debates emphasising the plight of the National Health Service in general and of our hospitals in particular it came as rather a shock to go to an attractive modern hospital with an efficient and happy feel to it. The impression was confirmed by a series of have a go'* demonstrations and invited papers at the impressive new postgraduate centre, which Sir Christopher Booth, the session's chairman, rightly described as of an outstanding standard at one of the half day science sessions on 25 June during the BMA's annual representative meeting. Presumably this quality is one of the arguments in favour of RAWP, yet any notion that Scarborough Hospital was living in luxury was dispelled by hearing that not infrequently some consultants had to sleep in on their duty nights. From experience at Sheffield, Oxford, and Scarborough Dr A N Stanton, a consultant paediatrician, argued cogently for a role for hyperthermia in some unexplained cot deaths. Studies in East Germany had also confirmed that a history of the baby's having excessive clothing and overwrapping (sometimes equivalent to eight blankets) might be obtained and not infrequently a raised rectal temperature was present even when this was taken at necropsy. Other well recognised associations with the sudden infant death syndrome were maternal smoking, poor social factors at home, low birth weight and non-accidental injury, but even if such factors could be eliminated there was probably an irreducible minimum incidence of 0*2 cases per 1000. Discussing advances in bone setting, Mr J G Bradley, an orthopaedic surgeon pointed out that no motor cyclist with a fractured tibia expected to lose his leg these days, a supposition largely confirmed in practice. He compared the traditional closed methods of fracture treatment with the newer ones, including the use of plates and external forces to keep the bone fragments in opposition, pointing out that these led to early mobilisation. He believed that bone glue would provide the optimum means for holding the bones together, but thought that the cost/benefit equation of the new methods still had to be worked out. For instance, in reply to a questioner he conceded that the question of infection (possibly as high as two fifths of cases) remained to be answered and that often the benefit in healing time was only a few weeks.
AN ORTHOPEDIC AND NEUROLOGICAL FOLLOW-UP STUDY OF VERTEBRAL FRACTURES IN SHOCK THERAPY
Authors: PHILLIP POLATIN, LOUIS LINN
Journal: American Journal of Psychiatry (1949)

l. Twenty-four patients with vertebral fractures occurring during the course of convulsive therapy were studied approximately 10 years after the initial lesion. 2. Four patients complain of occasional mild, nondisabling backaches. The rest are symptom-free. 3. In no case is there clinical evidence of orthopedic or neurological sequelæ to the original injury. 4. In 3 cases x-ray findings indicate an increase in the original pathology involving the thoracic vertebræ. 5. Patients with vertebral fractures tolerate subsequent convulsive therapy satisfactorily. 6. No curare was used either in the original or subsequent convulsive therapy.
Antibody deficiency associated with gold treatment: natural history and management in 22 patients.
Authors: N Snowden, D M Dietch, L S Teh, R C Hilton, M R Haeney
Journal: Annals of the Rheumatic Diseases (1996)

OBJECTIVE: To perform a clinical and immunological study of patients with rheumatoid arthritis who develop subnormal serum immunoglobulins on gold treatment; to clarify the nature of the defect in antibody production and determine the natural history of this adverse reaction; to use this information to suggest guidelines for the detection, investigation, and management of this complication. METHODS: 22 patients who developed subnormal levels of one or more immunoglobulin isotypes while receiving gold treatment were recruited over a 10 year period from the practice of a single rheumatologist. Antibody production was assessed by measurement of total immunoglobulins and of specific antibody production against polysaccharide and protein antigens, with test immunisation if necessary. RESULTS: Two broad patterns of antibody deficiency were identified: (1) (n = 11) mild, affecting only one immunoglobulin isotype and with normal specific antibody production. These patients were in general able to continue gold without further deterioration in antibody production. (2) (n = 11) severe, affecting two or three immunoglobulin isotypes, with defective specific antibody production. Six patients developed significant infections and were treated with immunoglobulin. Gold was discontinued in all. Normal antibody production recovered in nine patients, and in all but one followed for more than one year. No relation was seen between duration/dose of gold and antibody deficiency. CONCLUSIONS: Gold-induced antibody deficiency may be more common than usually recognised. A spectrum of deficiency exists, with some patients developing infective complications. Antibody production should be monitored in patients on gold treatment.
Cytokine Manipulation in Animal Models of Asthma
Authors: ROMAIN A. PAUWELS, GUY J. BRUSSELLE, JOHAN C. KIPS
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

We have developed in C57 Black 6 mice an in vivo model of allergic airway inflammation characterized by the presence of IgE antibodies to an inhaled antigen, peribronchial infiltrates with an increased number of eosinophils, and an increased airway responsiveness to nonantigenic bronchoconstrictor stimuli. In this animal model we have investigated the role of different cytokines in the development of IgE antibodies to inhaled antigen, eosinophilic airway inflammation, and airway hyperresponsiveness. The studies were performed by using knockout mice or by exogenous administration of cytokines or cytokine antagonists. Interleukin-4 (IL-4) knockout mice were unable to develop an allergic eosinophilic airway infiltration and did not produce specific IgE antibodies. Chronic aerosol exposure to antigen also did not induce an increase in airway responsiveness. In studies of wild-type mice, pretreatment with the combination of anti-IL5 and anti-IL-5 receptor antibodies, given in an attempt to fully inhibit the effect of endogenously released IL-5, caused a pronounced inhibition of the antigen-induced airway eosinophilia but did not prevent the increase in airway responsiveness. Treatment with IL-12 during the active immunization prevented airway eosinophilia, production of specific IgE antibodies, and the antigen-induced increase in airway responsiveness. In contrast, administration of IL-12 to actively immunized mice during the aerosol exposure abolished airway eosinophilia and airway hyperresponsiveness without affecting the production of specific IgE.
Respectful Treatment: The Human Side of Medical Care
Authors: Charles Kent Smith
Journal: JAMA (1978)

This is a unique book. It fills a niche that is not met by standard texts in major clinical areas, including books on psychiatry and on interviewing techniques. The author states his aims—to provide a handbook on practical psychiatry for nonpsychiatrists. He definitely does this, and he also does more. He provides a fresh perspective on the approach to all patients, not just psychiatric patients. This is done in a straightforward, clinically useful, and, as he says, respectful way. He writes well and clearly and has an original style not generally seen in medical writing. The 15 chapters in the book cover the common psychiatric problems encountered in practice, particularly in a hospital setting, but also in an ambulatory setting. The orientation is not that of classical psychiatric diagnoses and how to treat them, but rather on the problems that the physician encounters in the management of sick people. This
Forgotten, but not gone
Authors: E. Sanchez, S. F. Atabani, J. Kaplanova, P. Griffiths, A. M. Geretti, T. Haque
Journal: BMJ (2010)

A boy born post-term weighing 3.6 kg with normal Apgar scores was noticed to have generalised skin petechiae at birth but no other obvious clinical abnormalities. On investigation, he had thrombocytopenia (platelet count 29×109/l), but other haematological markers were normal. He was discharged after bacterial sepsis and alloimmune thrombocytopenia had been excluded. Unfortunately there was not sufficient blood available to investigate for congenital viral infections. Thrombocytopenia resolved spontaneously at age 16 days (platelet count 176×109/l). 

The infant was readmitted at 10 weeks of age for poor feeding, diarrhoea, and occasional vomiting. On examination he was found to be pale and thin; weight was at the 4th percentile. He had mild hepatosplenomegaly, a soft systolic murmur, mild anaemia (haemoglobin 98 g/l), and slightly abnormal results on liver function tests (aspartarte aminotransferase 75 U/l, alanine aminotransferase 97 U/l, and alkaline phosphatase of 602 U/l). There was no evidence of hepatitis B surface antigen, hepatitis A IgM, hepatitis C IgG, toxoplasma IgA, or IgG antibodies in serum. Cytomegalovirus and parvovirus B19 IgG were detected in serum, suggesting either passive transfer of maternal antibodies or past infection. Interestingly, rubella IgM antibody was strongly positive in serum and rubella IgG was also positive.

The infant’s mother recalled attending hospital at 11 weeks’ gestation with fever, swollen left knee, and a macular rash starting on the face and spreading to the trunk and abdomen, which was considered to be a drug reaction.



### 1 What is your first suspected diagnosis?

#### Short answer

The most likely diagnosis is congenital rubella syndrome.

#### Long answer

Rubella is an acute febrile illness …