tbuckley/cabot-search huggingface dataset:
Decentralisation and equity of healthcare provision in Finland
Authors: M. Koivusalo
Journal: BMJ (1999)

Editorials by Leys and Diderichsen 

Finland has a comparatively sparse population of 5.1 million in an area of 338 145 km2. Although 66% of the population live in towns, a substantial proportion still lives in rural areas.1 The nation is divided into 452 municipalities, which have a long tradition of local democracy and local elections. The population and area of the municipalities varies from a few hundred inhabitants to large cities with over 100 000 inhabitants, the median population being 6000. Municipalities have a mandate to raise taxes and responsibilities for providing services, and they can form federations covering larger populations. Central government has traditionally guided this process through legislation and state subsidies earmarked for specific services (figure). These subsidies were particularly important when basic services were being provided in remoter and poorer areas, where the maintenance of services is expensive and resources are scarce. In 1993 an act of parliament changed the basis of state subsidies from earmarked to block grants, giving municipalities more independence in using resources.



Finance and provision of public health services in Finland excluding care provided by national health insurance and employers. Adapted from Martikainen and Uusilkyla2



#### Summary points

In Finland the provision of health services is decentralised and the responsibility of municipalities

In practice, central government has traditionally supported these responsibilities through specially allocated funding

In the 1990s central government changed to block grants and municipalities have become more independent in providing services

Municipalities have tax powers, but in the 1990s they have been increasingly collecting funds through user fees

In practice local governance as such may not guarantee equitable access to services or the rights of the most vulnerable groups without legal provision, supervision, and subsidies for poorer areas

The Finnish healthcare system has always been comparatively decentralised. Municipalities not only …
THE MODERN TREATMENT OF VARICOSE VEINS: THE HISTORY OF ITS EVOLUTION
Authors: G. H. Colt
Journal: BMJ (1928)

After about the tenth week, when the ulcer improves, the serum calcium returns to normal, usually in about three weeks.If the animals survive much longer, during the remainiing weeks it continues normal or slightly higher.This is in striking contrast with the results obtained after intraperitoneal inoculation.In the latter experimenits the pulmonary-lesioanis were matnly submiliary in character.With subcutaneous inoculation they were always much more extensive, and the weight of the lungs, generally, was over 80 grams (normal 8 grams).They consisted entirely of solid caseous masses, and such extensive dise'ase must inevitably interfere mechanically with pulmonary gas exchanige, and give rise to alterations in the acid-base batance.Evidence exists to suggest that acidosis results in anl increase in the serum calcium.'1How far this mnay be operative during the later stages of my experiments, and thus mask the fall that miiight be expected, remuains for furlher iinvestigation.
Negative regulation of interferon-regulatory factor 3–dependent innate antiviral response by the prolyl isomerase Pin1
Authors: Tatsuya Saitoh, Adrian Tun-Kyi, Akihide Ryo, Masahiro Yamamoto, Greg Finn, Takashi Fujita, Shizuo Akira, Naoki Yamamoto, Kun Ping Lu, Shoji Yamaoka
Journal: Nature Immunology (2006)
Mechanistic studies of sequential injection of cationic liposome and plasmid DNA
Authors: Jing-Shi Zhang, Feng Liu, Christine C. Conwell, Yadi Tan, Leaf Huang
Journal: Molecular Therapy (2005)

We previously reported that sequential injection of cationic liposome and plasmid DNA leads to notably reduced inflammatory toxicity and improved transfection in the lung (Y. Tan et al., 2001, Mol. Ther. 3, 673–682). The purpose of the current study was to explore the mechanism involved in sequential injection. It was observed that sequential injection resulted in dramatically lower DNA uptake by the liver and higher DNA levels in the lung than the lipoplex injection. In vitro experiments with macrophage cells further showed that sequential addition of liposomes and DNA could diminish the cellular uptake of DNA by these cells. The contributions of serum to the enhanced bioactivity and decreased toxicity were examined by injecting mice with samples of premixed liposome with serum and then DNA (LSD sample), and the resulting activities were compared to those obtained with injection of lipoplex–serum mixtures (LDS sample). LSD yielded 80% lower TNF-α levels and over 10-fold higher transfection than lipoplex, which is consistent with the reported findings with sequential injection. In contrast, LDS resulted in the same TNF-α levels and comparable transfection with lipoplex. Thus, the results suggest that the primary interaction of serum with liposome is a critical factor contributing to the superior activity and reduced toxicity of sequential injection. Studies on the interaction between mouse serum, liposomes, and DNA showed that DNA could bind negatively charged liposome–serum complex to form a ternary complex, which has a density similar to that of the ternary complex formed between lipoplex with serum. Further in vitro tests showed that LSD and LDS were similar in particle size and protein content, but different in protein composition as observed by 2-D gel electrophoresis. In addition, DNA in LSD was more readily displaced by dextran sulfate, an anionic polymer, than in LDS. The above findings suggest that the inhibition of opsonin protein binding on the particle surface with the sequential injection may contribute to the reduced macrophage uptake and cytokine induction and that the high ability of DNA release from the particles formed after sequential injection may contribute to the improved lung gene transfection.
Cardiac Sympathetic Denervation in Parkinson Disease
Authors: David S. Goldstein
Journal: Annals of Internal Medicine (2000)

Background: In Parkinson disease, orthostatic hypotension can result from L-dopa treatment or from sympathetic neurocirculatory failure. The latter is detected by abnormal blood pressure responses to the Valsalva maneuver and can be associated with loss of functional cardiac sympathetic nerve terminals. Objective: To determine the frequency of cardiac sympathetic denervation in Parkinson disease, with or without sympathetic neurocirculatory failure, and its association with disease duration, severity, and L-dopa treatment. Design: Intergroup comparisons in resting patients. Setting: National Institutes of Health Clinical Center, Bethesda, Maryland. Patients: 29 patients with Parkinson disease (9 with sympathetic neurocirculatory failure, 10 who had stopped receiving or had never been treated with L-dopa), 24 patients with multiple-system atrophy (17 with sympathetic neurocirculatory failure, 8 receiving L-dopa), 7 patients with pure autonomic failure, 33 controls with episodic or persistent orthostatic intolerance without sympathetic neurocirculatory failure, and 19 normal volunteers. Measurements: Beat-to-beat blood pressure responses to the Valsalva maneuver, interventricular septal 6-[18F]fluorodopamine–derived radioactivity, cardiac extraction fraction of [3H]norepinephrine, appearance rate of norepinephrine in coronary sinus plasma (cardiac norepinephrine spillover) and venous–arterial differences in levels of dihydroxyphenylglycol (DHPG) and endogenous L-dopa. Results: Of the 29 patients with Parkinson disease, 9 with sympathetic neurocirculatory failure and 11 without had low septal 6-[18F]fluorodopamine–derived radioactivity (2861 ± 453 Bq/mL per MBq/kg and 5217 ± 525 Bq/mL per MBq/kg, respectively). All 6 patients with Parkinson disease and decreased 6-[18F]fluorodopamine–derived radioactivity who underwent right-heart catheterization had a decreased cardiac extraction fraction of [3H]norepinephrine and virtually no cardiac norepinephrine spillover or venous–arterial increments in plasma levels of DHPG and L-dopa. Sympathetic neurocirculatory failure and decreased 6-[18F]fluorodopamine–derived radioactivity were unrelated to disease duration, disease severity, or L-dopa treatment. Conclusions: Many patients with Parkinson disease—including all those with sympathetic neurocirculatory failure—have evidence of cardiac sympathetic denervation. This suggests that loss of catecholamine innervation in Parkinson disease occurs in the nigrostriatal system in the brain and in the sympathetic nervous system in the heart.
Pediatric Nutrition: Infant Feedings, Deficiencies, Diseases
Authors: Rita G. Harper
Journal: JAMA (1984)

The editor has assembled 30 monographs from a distinguished group of national and international authors, which focus on current concepts in perinatal and pediatric nutrition and the physiology and management of frequently encountered pediatric nutritional disorders. The authors should be commended for their in-depth coverage of prenatal and postnatal nutritional, vitamin, and mineral requirements and the impact of short-term and long-term undernutrition on the developing fetus and newborn. Neophytes in the field of infant nutrition will find the chapters concerning in utero and perinatal nutrition to be informative and thorough; neonatologists will find these chapters a clear and concise review. If the reader is looking for technical information about a specific regimen or diet, he will not find it in these mongraphs. If he is looking to broaden his base of knowledge in pediatric nutrition, he will not be disappointed. Certain pieces of information, such as the cause of somnolence
Effects of Urotensin II in Human Arteries and Veins of Varying Caliber
Authors: Chris Hillier, Colin Berry, Mark C. Petrie, Patrick J. O’Dwyer, Carlene Hamilton, Amanda Brown, John McMurray
Journal: Circulation (2001)

Background —Urotensin II (UII) is the ligand for the GPR14 receptor and the most potent vasoconstrictor in the cynomolgus monkey. UII also contracts rat thoracic aorta. We studied the effect of human UII (hUII) in human blood vessels Methods and Results —Small subcutaneous resistance arteries, internal mammary arteries, saphenous veins, and small subcutaneous veins were studied using standard techniques. Subcutaneous resistance arteries constricted in response to norepinephrine (maximum tension, 2.84±0.38 mN/mm; the concentration required to produce 50% of the maximum response [EC 50 ], 0.52±0.07 μmol/L) and endothelin-1 (maximum tension, 4.19±0.93 mN/mm; EC 50 , 1.6±0.1 nmol/L). hUII did not contract these arteries, internal mammary arteries, or either type of vein, but it was a potent vasoconstrictor in rat thoracic aorta (maximum tension, 2.36±0.2 mN/mm; EC 50 , 1.13±0.36 nmol/L). Conclusions —hUII has no vasoconstrictor action in human arteries and veins of different sizes and vascular beds. Marked species differences in the actions of UII question its importance in human cardiovascular regulation.
Rape at US Colleges Often Fueled by Alcohol
Authors: Thomas B. Cole
Journal: JAMA (2006)

by psychologists who provide such help, along with general counseling. A study counselor who suspects that anxiety or depression is contributing to the student’s difficulty may refer the individual to the mental health service, staffed by psychiatrists and others who treat psychiatric disorders and also providegeneral collegecounseling.Astudent may ask a residential wellness tutor for advice on eating better, and the tutor may steer the student to a specialist in eating disorders. Dormitorybased peer counselors, who meet weekly with supervisors, also offer aid, usually in the evenings and on weekends. More than 90% of referrals to the campus counseling center come from residential staff members trained to recognize depression symptoms, Barreira said. These individuals, usually graduate students in professional schools or junior faculty who also work as academic advisors, live in the dormitories, providing an adult presence there. Because impulsive behavior is a key concern, each of the psychiatrists, psychologists, and social workers at the mental health service keeps open slots every day for urgent care or triage visits, Barreira said. This strategy enables clinicians to make an immediate connection with troubled students, he noted. Harvard does not mandate treatment nor require students who have been hospitalized to leave, Barreira said. “We prefer to work with the student and often the family to determine what action is in the best interest of the student,” he said. “The student needs to own the decision.”
"ROENTGEN-RAY THERAPY IN THROMBO-ANGIITIS OBLITERANS"
Authors: David Perla
Journal: JAMA (1925)

<h3>To the Editor:</h3> —In their article on this subject (The Journal, May 16), Drs. Philips and Tunick report rather remarkable results with roentgen-ray therapy. They are to be congratulated on their work. Thrombo-angiitis obliterans is an extremely chronic disease, often lasting as long as fifteen or twenty years. More than 80 per cent, of all cases give a history of remissions during which the patient is free from all symptoms. These remissions occur spontaneously at almost any stage of the disease and last from a few months to several years, frequently as long as five, ten and even fifteen years. (These facts are drawn from a study of many cases at Montefiore Hospital, where the patient generally arrives after he has run the course of his diesase for years.) Temporary arrests have been reported as cures, following almost every new therapeutic innovation. In this disease, particularly, a temporary arrest of
INFECTIOUS FIBROMA OF RABBITS
Authors: Richard E. Shope
Journal: The Journal of Experimental Medicine (1936)

In the experiments presented, Virus myxomatosum was observed to produce only a localized fibromatous or myxomatous orchitis when injected into the testicles of cottontail rabbits. This type of disease was quite unlike the acute fatal illness which the virus caused in domestic rabbits. 10 serial passages of Virus myxomatosum through cottontail rabbits, covering a total elapsed time of 140 days, failed to alter its pathogenicity for domestic rabbits. Although it proved impossible to convert the myxoma virus into fibroma virus by serial passage in cottontail rabbits, it was found that these animals, recovered from myxoma, had a solid resistance to infection with the fibroma virus. Furthermore, their sera possessed neutralizing antibodies effective against the fibroma virus as well as Virus myxomatosum. A similar cross-immunological relationship was observed in the cases of domestic rabbits that had survived an attack of infectious myxoma.
Effectiveness of Cloxacillin with and without Gentamicin in Short-Term Therapy for Right-Sided<i>Staphylococcus aureus</i>Endocarditis
Authors: Esteban Ribera
Journal: Annals of Internal Medicine (1996)

Background: It is often difficult to administer extended antibiotic therapy in the hospital for right-sided Staphylococcus aureus endocarditis. Although the effectiveness of single-drug therapy given for 4 to 6 weeks and that of two-drug therapy given for 2 weeks have been shown, no data are available on the effectiveness of short-course single-drug therapy. Objective: To compare the efficacy of cloxacillin alone with that of cloxacillin plus gentamicin for the 2-week treatment of right-sided S. aureus endocarditis in intravenous drug users. Design: Open, randomized study. Setting: An academic tertiary care hospital in Barcelona, Spain. Patients: 90 consecutive intravenous drug users who had isolated tricuspid valve endocarditis caused by methicillin-susceptible S. aureus, had no allergy to study medications, and had no systemic infectious complications that required prolonged therapy. An efficacy subset consisted of 74 of these patients who did not meet an exclusion criterion. Intervention: Cloxacillin (2 g intravenously every 4 hours for 14 days) alone or combined with gentamicin (1 mg/kg of body weight intravenously every 8 hours for 7 days). Measurements: Clinical or microbiological evidence of active infection after 2 weeks of therapy, relapse of staphylococcal infection, or death. Results: In an analysis of the efficacy subset, treatment was successful in 34 of the 38 patients who received cloxacillin alone (89% [95% CI, 75% to 97%]) and 31 of the 36 patients who received cloxacillin plus gentamicin (86% [CI, 71% to 95%]). Three patients died: one in the cloxacillin group and two in the combination therapy group. Of the 37 patients who completed 2-week treatment with cloxacillin, 34 (92%) were cured, and 3 (8%) needed prolonged treatment to cure the infection. Of the 34 patients who completed 2-week treatment with cloxacillin plus gentamicin, 32 (94%) were cured and 2 (6%) required treatment for 4 weeks. One patient in the combination group had relapse. Conclusions: A penicillinase-resistant penicillin used as single-agent therapy for 2 weeks was effective for most patients with isolated tricuspid endocarditis caused by methicillin-susceptible S. aureus. Adding gentamicin did not appear to provide any therapeutic advantages. Additional studies to confirm the therapeutic equivalence of short-course therapy with penicillinase-resistant penicillin alone and therapy with combined regimens are warranted.
Diabetes Mellitus, Lipidus Et... Proteinus!
Authors: Errol B. Marliss, Réjeanne Gougeon
Journal: Diabetes Care (2002)

If there had been a simple early clinical test for urine nitrogen or plasma amino acids, the diseases we know as “diabetes mellitus” might instead have been called “diabetes proteinus.” This is because insufficient insulin action impacts all macronutrients, not just carbohydrate. With our present preoccupations with “glycemic control” and the proven risks associated with hyperglycemia and hyperlipidemia, clinicians may indeed be underestimating the importance of altered protein metabolism and of the quality and quantity of dietary protein. An exception to this is diabetic nephropathy, addressed by Wheeler et al. (1) in this issue of Diabetes Care . Uncontrolled diabetes has been recognized for millennia to cause lean tissue loss. Though anticatabolic and anabolic actions of insulin are accepted as dogma, relatively little clinical research is conducted on them. In the present millennium, publications in the American Diabetes Association (ADA) journals have cited “glucose metabolism” 389 times, “lipid metabolism” 196 times, but “protein metabolism” only 30 times! Protein metabolism is not less than one-tenth as important as glucose. For example, though we use HbA1c as indicator of recent glycemic control, the steady state of glycation of each protein is also a function of the rate of turnover of that protein. The first paper of this millennium in Diabetes Care (2) showed increased whole-body fed-fasted protein turnover in the presence of hyperglycemia; hence, the kinetics of many proteins are increased.

The therapeutic implication of recognizing that protein metabolism is disturbed in diabetes is that dietary protein quality and quantity need to be adapted to individual requirements. Many of the controversies over dietary protein recommendations have been summarized recently by Franz (3). The most recent ADA Clinical Practice Recommendations (4) and corresponding technical papers (5) appeared in Diabetes Care in January 2002. Therein, the level of evidence for establishing recommendations was …
Hematopoietic Stem Cell Biology
Authors: Paulette Mehta
Journal: JAMA (2010)

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Engineered T Cell Receptor-Mimic Antibody, (TCRm) Chimeric Antigen Receptor (CAR) T Cells Against the Intracellular Protein Wilms Tumor-1 (WT1) for Treatment of Hematologic and Solid Cancers
Authors: Sarwish Rafiq, Tao Dao, Cheng Liu, David A. Scheinberg, Renier J Brentjens
Journal: Blood (2014)
Anesthesiology and the Law
Authors: John C. Kruse
Journal: JAMA (1983)

John Naisbitt, in his book<i>Megatrends</i>, points out that in an information society, into which we are growing from an industrial society, "the game is people interacting with people.... This is one basic reason why we are bound to continue to be a litigious intensive society.... The bad news is that there is no end to lawyers and lawyering." The practice of anesthesia is a high-technology business, or should be; frequently there is not enough touch between anesthesiologist and patient. This is a formula for legal action when a bad result of any kind occurs, which makes the publication of<i>Anesthesiology and the Law</i>especially timely. This book is directed at a dual audience, lawyers and anesthesiologists. To that end, there is an extensive review of what are common practices in anesthesia today ("standard of care") and equally extensive exploration of legal doctrines ("elements of negligence," "theories of liability," and
THE VIABILITY OF HEMOLYTIC STREPTOCOCCUS IN CERTAIN SOLUTIONS CONTAINING GELATIN
Authors: Frank L. Meleney, Zung-Dau Zau
Journal: The Journal of Experimental Medicine (1924)

1. The findings of Robertson, Sia, and Woo with regard to the preservative action of 0.1 per cent gelatin in suspending fluids for the pneumococcus have been confirmed for the streptococcus. 2. In gelatin-citrate, gelatin-Locke's, and gelatin-"20:1" solutions, the streptococcus will live for 3 days or longer at room temperature and for 12 hours or longer at incubator temperature in dilutions as high as 100 cocci per cc. 3. The gelatin in 0.1 per cent concentration maintains life at a fairly constant numerical level for from 15 to 24 hours. These fluids may therefore be used for certain quantitative biologic tests. 4. In slightly higher concentrations of gelatin, there is actual growth which suggests that even in 0.1 per cent concentrations the gelatin has a nutrient action. 5. There is also evidence that gelatin affords some protection against the mechanical injury of the dilution process. 6. The toxic action of unbalanced salts, the possible lytic action of water, and the autolytic action of the organisms themselves are all delayed by the presence of gelatin, but eventually these actions take place in the same manner that has been described before by many observers and as here observed for solutions without gelatin. 7. The life of streptococci is maintained in these gelatin solutions through a relatively wide zone of hydrogen ion concentration.