tbuckley/cabot-search huggingface dataset:
Is Primary Care Practice Sustainable?
Authors: Marisa A. Montecalvo
Journal: Annals of Internal Medicine (2016)

Letters19 April 2016Is Primary Care Practice Sustainable?Marisa A. Montecalvo, MDMarisa A. Montecalvo, MDFrom New York Medical College, Valhalla, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-0590 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:I thank Dr. Volpintesta for his comments and agree that we must move beyond voicing our concerns in the pages of our journals; we need physician leadership to champion primary care. Dr. Volpintesta contends that the primary care model, solo practitioner/office manager, is not sustainable.I received letters from many physicians voicing similar concerns, ranging from a physician-in-training who chose a subspecialty to lessen exposure to the “drudgery chores,” to a 95-year-old physician who expressed deep concern over the loss of continuity in medical care. A per-member, per-month payment model to cover the costs of paperwork might be ...References1. Musich S, Klemes A, Kubica MA, Wang S, Hawkins K. Personalized preventive care reduces healthcare expenditures among Medicare Advantage beneficiaries. Am J Manag Care. 2014;20:613-20. [PMID: 25295675] MedlineGoogle Scholar2. Oberlander J, Laugesen MJ. Leap of Faith—Medicare's New Physician Payment System. N Engl J Med. 2015;373:1185-7. [PMID: 26398067] doi:10.1056/NEJMp1509154 CrossrefMedlineGoogle Scholar3. Association of American Medical Colleges. Medical Student Education: Debt, Costs, and Loan Repayment Fact Card. October 2015. Accessed at www.aamc.org/download/447254/data/debtfactcard.pdf on 29 February 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From New York Medical College, Valhalla, New York.Disclosures: Author has disclosed no conflicts of interest. Form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=L15-0590. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIs Primary Care Practice Sustainable? From the Secretary's Desk Marisa A. Montecalvo Is Primary Care Practice Sustainable? Edward Volpintesta Metrics 19 April 2016Volume 164, Issue 8Page: 570KeywordsForecastingGraduate medical educationInsuranceMedicareMotivationNursesNursing educationPrimary carePrimary care physiciansSub-specialty care ePublished: 19 April 2016 Issue Published: 19 April 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Immunologic Reconstitution in Severe Combined Immunodeficiency without Bone-Marrow Chromosomal Chimerism
Authors: E. Richard Stiehm, Glenn J. Lawlor, Michael S. Kaplan, Harris L. Greenwald, Robert C. Neerhout, Dharmendra P.S. Sengar, Paul I. Terasaki
Journal: New England Journal of Medicine (1972)

An 11-month-old male infant with severe combined immunodeficiency was immunologically reconstituted by bone-marrow transplantation from a female sibling whose cells were HL-A compatible on mixed leukocyte culture. The patient's lymphocytes demonstrated multiple extraneous HL-A antigens (up to 10 at one time), some of which were not present in the parents or the four siblings; this typing anomaly delayed bone-marrow donor selection. These additional antigens were nonstimulatory in mixed leukocyte culture, and since they were found in two similar patients, may represent an anomaly peculiar to combined immunodeficiency. After leukocyte transfer factor was given without benefit on two occasions, bone-marrow transplantation was performed. After a severe graft-versus-host reaction subsided, clinical improvement and chimerism ensued as evidenced by an XX (donor) karyotype of cultured peripheral blood lymphocytes and restoration of immunologic functions. Direct chromosome analysis of bone-marrow cells disclosed only XY cells, despite the presence of plasma cells synthesizing IgG-globulin of the donor's genetic type.
Case 40-1999
Authors: Joshua A. Boyce, Eugene J. Mark
Journal: New England Journal of Medicine (1999)

Presentation of CaseA four-month-old girl was admitted to another hospital because of cyanosis.The patient had been well until two months earlier, when she began to require up to 45 minutes for her feedings. Three weeks before admission, acral and perioral cyanosis were noted. During the two weeks before admission, she had a nonblanching papular rash over the left parietal region, which was the side on which she slept.During the week before admission, the infant had episodes of vomiting, with each episode occurring several hours after she had eaten cereal. Her mother noted infrequent episodes of tachypnea, cough, . . .
Outcome analysis of stage II and III cervical carcinoma: Importance of optimal radiation therapy
Authors: J. J. Diaz, Mr B. Thomas, E. Hernandez
Journal: Journal of Clinical Oncology (2009)

e16562 Background: The objective of our study was to conduct an outcome analysis of patients with stage II and III cervical cancer (CC) treated in our institution. We sought to asses the effectiveness and toxicity of carboplatin concomitant with pelvic irradiation and the importance of compliance with treatment. Methods: A retrospective chart review was conducted of all patients with stage II and III CC treated at Temple University Hospital from January 2001 to December 2006. Results: Forty-eight patients with stage II and III CC without radiographic evidence of extra-pelvic disease (IIA = 11, IIB = 15, IIIA = 4, IIIB = 18) were treated during the period under study. Four (8%) patients had adenocarcinoma and 44 (92%) had squamous cell carcinoma. Median age at diagnosis was 48.5 (range, 24–83) years. Median follow-up was 23 (range, 1–74) months. Nonsurgical therapy consisting of radiation (RT) with or without chemotherapy (CT) was offered to all patients. Nine patients (19%) received no CT, whereas 36 (75%) received weekly carboplatin (90 mg/m 2 ) and 3 (6%) received weekly cisplatin (40 mg/m 2 ). Median numbers of CT cycles was 5 (range, 1–7). Optimal dose of RT was defined as a minimal cervical dose exceeding 7000 cGy, point A dose of 8000–9000 cGy and treatment duration not exceeding 56 days. Only 21 (44%) patients received optimal RT. Only 2 patients treated with carboplatin had grade 3 or 4 toxicity. The 5-year progression free survival (PFS) and overall survival (OS) was 41% and 56%, respectively. The pelvic failure (PF) and distal failure (DF) were 38% and 26%, respectively. There were only 4 PF (19%) and 4 DF (19%) in the 21 patients who received optimal RT. The estimate of probability of 5-year pelvic failure rate in patients who received optimal therapy and patients who received suboptimal therapy was 23% vs. 48% (p = 0.2) . On subset analysis patients who received optimal RT had a better 5-year OS (72% versus 45%, p = 0.09). The most important predictor of optimal radiation was compliance with treatment plan. Conclusions: Optimal RT is crucial for successful treatment of advanced CC. Chemo-sensitization with carboplatin is effective and well tolerated. No significant financial relationships to disclose.
Anamorsin Overexpression Leads to Dysregulation of Lipopolysaccharide-Stimulated B Cell Proliferation through Ras Signaling
Authors: Yuri Hamanaka, Hirohiko Shibayama, Akira Tanimura, Takafumi Yokota, Sachiko Ezoe, Michiko Ichii, Norimitsu Saito, Keiko Matsui, Takao Sudo, Tomohiko Ishibashi, Yukiko Doi, Yasuhiro Nagate, Masako Takemoto, Kenji Oritani, Yuzuru Kanakura
Journal: Blood (2014)
15P Change of mTOR, p6, NBR1 and LC3A/B-I/II in A549 cells treated with graphene oxides
Authors: J.W. Shin, S.Y. Kim, K.S. Choi, J.W. Jung, J.C. Choi, J.Y. Kim, I.W. Park, C.S. Park, B.W. Choi
Journal: Journal of Thoracic Oncology (2016)
Remission of the Nephrotic Syndrome in Renal Amyloidosis
Authors: J. Lowenstein, G. Gallo
Journal: New England Journal of Medicine (1970)

Remission of the nephrotic syndrome and disappearance of proteinuria was observed in two patients with histologically documented renal amyloidosis. In one, amyloidosis was secondary to infective endocarditis of the tricuspid valve, with multiple lung abscesses. Proteinuria disappeared and amyloid deposits in the liver regressed completely after treatment of the underlying infection. In the other, amyloidosis was associated with chronic pulmonary tuberculosis and suppurative bronchiectasis. Remission in the nephrotic syndrome with disappearance of proteinuria appeared to be related to antibiotic therapy of purulent bronchiectasis. Amyloid deposits were still present in mesangial areas of glomeruli 27 and six months, respectively, after the disappearance of proteinuria.
Increased Insulin Sensitivity and Insulin Binding to Monocytes after Physical Training
Authors: Vijay R. Soman, Veikko A. Koivisto, David Deibert, Philip Felig, Ralph A. DeFronzo
Journal: New England Journal of Medicine (1979)

We studied the effect of physical training on in vivo tissue sensitivity to insulin and insulin binding to monocytes in six previously untrained healthy adults. Physical training (one hour of cycle-ergometer exercise four times per week for six weeks) failed to alter body weight but resulted in a 20 per cent increase (P<0.02) in maximal aerobic power (V̇O2 max) and a 30 per cent increase (P<0.01) in insulin-mediated glucose uptake (determined by the insulin clamp technique). The increase in insulin sensitivity correlated directly with the rise in V̇O2 max (P<0.05). Binding of [125I]insulin to monocytes also rose by 35 per cent after physical training (P<0.02), primarily because of an increase in the concentration of insulin receptors. Our data indicate that physical training increases tissue sensitivity to insulin in proportion to the improvement in physical fitness. Physical training may have a role in the management of insulin-resistant states, such as obesity and maturity-onset diabetes, that is independent of its effects on body weight. (N Engl J Med 301:1200–1204, 1979)
Early efficacy analysis of the AE37 vaccine in patients with HER2 low-expressing and triple-negative breast cancer.
Authors: Elizabeth Ann Mittendorf, Sonia A. Perez, Diane F. Hale, Timothy J. Vreeland, Alan K. Sears, Guy T. Clifton, Alexandros Ardavanis, Nathan M. Shumway, James L. Murray, Sathibalan Ponniah, Michael Papamichail, George Earl Peoples
Journal: Journal of Clinical Oncology (2012)

109 Background: Peptide vaccines comprised of HLA class II epitopes, which elicit CD4+ T cell responses, play a critical role in potentiating immune responses. We are conducting a randomized phase II trial of AE37, a hybrid peptide created by the addition of the Ii-Key moiety (LRMK) to the HER2 helper epitope, AE36 (HER2 aa776-790). Here, we present efficacy data focusing on outcomes in patients with low HER2 (IHC 1+ or 2+) expression and triple negative breast cancer (TNBC). Methods: The trial is enrolling node positive or high risk node negative breast cancer patients with any degree of HER2 expression (IHC 1+, 2+ or 3+ or FISH &gt; 1.2) rendered disease-free following standard of care therapy. Patients are randomized to receive either AE37+GM-CSF or GM-CSF alone in 6 monthly intradermal inoculations followed by booster inoculations administered every 6 months. Results: The trial has enrolled 254 patients; 105 in the vaccine group (VG) and 149 in the control group (CG). After a median follow-up of 22.3 months, the disease-free survival (DFS) rate in the VG is 90.3% vs 81.1% in the CG (p=.46), a 49% risk reduction. Evaluating patients with low HER2 expression (IHC 1+ or 2+), there are 53 VG patients and 77 CG patients. The groups are well-matched with respect to the percentage of patients with high grade tumors, tumors &gt; 2cm, the rate of node positivity and ER/PR status (all p&gt;.5). The DFS rate in the VG of low HER2 expressers is 89.8% vs 68.2% in the CG (p=.12), a 68% risk reduction. When limiting analyses to patients with TNBC (ER/PR negative, HER2 1+ or 2+), there are 13 VG patients and 23 CG patients. The groups are again well-matched with the exception of control patients having a larger percentage of tumors &gt; 2 cm (70% vs 31%; p=.02). The DFS rate in the VG of TNBC patients is 83.3% vs 47.6% in the CG (p=.23), a 68% risk reduction. Conclusions: Early analyses suggest clinical benefit to vaccination with AE37, particularly in patients with low HER2-expressing tumors. Importantly, the benefit appears to persist in TNBC patients. Patients will continue to be followed per protocol for 5 years; however, these data suggest that a subsequent phase III trial should evaluate the vaccine in patients with low HER2-expressing disease to include TNBC.
The Risk-Adjustment Debate
Authors: Robert Kuttner
Journal: New England Journal of Medicine (1998)

Risk adjustment refers to the adjustment of payments to health plans (or to doctors) to reflect more accurately the actual health status or recent medical experience of patients. Risk adjustment has become an issue because payments by governments, employers, and individuals largely do not take into account differences in the health of patients among (or within) health plans. If plans receive the same unadjusted premium for each subscriber, then the plan with healthier members reaps an unearned windfall, whereas plans with sicker populations of patients face unfair losses.The problem occurs at three distinct levels. First, health plans that receive . . .
The Therapeutic Efficacy of Hemodialysis in Schizophrenia
Authors: William T. Carpenter, John H. Sadler, Paul D. Light, Thomas E. Hanlon, Albert A. Kurland, Manoel W. Penna, William P. Reed, Edwina H. Wilkinson, John J. Bartko
Journal: New England Journal of Medicine (1983)

Prompted by previous reports of substantial clinical improvement in most schizophrenic patients given hemodialysis for their psychiatric condition, we studied the efficacy of hemodialysis in 15 schizophrenic outpatients, under double-blind, controlled conditions. The patients were randomly assigned to either a real–sham or sham–real sequence of dialysis treatment. Results of repeated measurement and other analyses of data on symptoms and behavior that were collected before study treatment, at crossover, and at the end of treatment revealed no difference between the effects of real and sham dialysis. These results provide important experimental evidence of the lack of therapeutic efficacy of hemodialysis in schizophrenia. (N Engl J Med. 1983; 308:669–75.)
Immune Thrombocytopenia Due to a Drug Metabolite
Authors: Eric V. Eisner, Nasrollah T. Shahidi
Journal: New England Journal of Medicine (1972)

Abstract A patient who developed thrombocytopenia while taking analgesics was found to have circulating antibody to a metabolic product of N-acetyl-p-aminophenol (NAPA), but not to the drug itself. The antibody reacted in vitro with an antigen present in the blood of a normal volunteer who had ingested NAPA. The antigenic material was purified from the urine of this volunteer and shown to be the sulfate conjugate of the drug. These findings demonstrate that a drug metabolite may be antigenically active in drug-induced thrombocytopenia when the drug itself is immunologically inert, representing a form of drug-induced thrombocytopenia.
Case 27-1975
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, J. Robert Cassady, Robert T. McCluskey
Journal: New England Journal of Medicine (1975)

Presentation of Case First admission. A 14-year-old girl was admitted to the hospital because of Hodgkin's disease.She was well until five weeks previously, when left axillary swelling developed; it enlarged progressively and became painful. One week before entry a left supraclavicular swelling was noticed, and it also increased in size. An x-ray film of the chest was normal. Six days before admission she entered another hospital, where a biopsy of the left axillary mass revealed Hodgkin's disease. She was referred to this hospital.The patient had experienced interscapular discomfort since the biopsy and had lost 2 kg in . . .
Activating Mutations In Fyn Kinase In Peripheral T-Cell Lymphomas
Authors: Lucile Couronne, Teresa Palomero, Hossein Khiabanian, Mi-Yeon Kim, Alberto Ambesi, Zachary Carpenter, Francesco Abate, Maddalena Allegretta, Izidore S. Lossos, Concha Nicolas, Milagros Balbin, Christian Bastard, Govind Bhagat, Miguel A. Piris, Elias Campo, Olivier A. Bernard, Raul Rabadan, Adolfo A. Ferrando
Journal: Blood (2013)
Conflicts of interest among articles published in the Journal of Clinical Oncology
Authors: B. George, S. Simhan, J. A. Lee, M. A. Mathiason, R. S. Go
Journal: Journal of Clinical Oncology (2007)

6633 Background: The integrity of scientific and clinical research is dependent on the avoidance of conflicts of interest (COI). Hence, the American Society of Clinical Oncology (ASCO) has implemented a COI policy pertaining to articles published in the Journal of Clinical Oncology (JCO). In this study, we examined the prevalence and nature of COI among scientific articles published in JCO. Methods: We reviewed original articles, review articles and ASCO special articles published in JCO from August 2005 to January 2006. COI was categorized into employment/leadership position, consultancy, stock ownership, honoraria, research funding, expert testimonials and other remuneration. Results: Out of a total of 514 articles reviewed, original articles, review articles and ASCO special articles comprised 88.3%, 11.1% and 0.06% respectively. Overall 34.8% of the articles reported at least 1 COI. Among articles with COI, 21.8%, 27.4% and 50.8% reported 1, 2 and 3 or more COI, respectively. Consultancy (64.8%) was the most common COI, followed by honoraria (64.2%), research funds (58.7%), employment/leadership (40.2%), stock ownership (39.7%), testimonials (11.2%) and other remuneration (10.1%). COI was reported in 58.3% of clinical trials compared to 24.6% in other articles (P = 0.001). Out of the total of 4,944 authors, 14.0% reported a COI. Among authors with COI, 47.9%, 38.2% and 13.9% reported 1, 2 and 3 or more COI, respectively. The prevalence of COI among articles originating from North America, Europe and Asia/Australia were 38.2%, 31.8% and 13.8%, respectively (P = 0.020). Conclusions: COI were widely prevalent in articles published in JCO. Clinical trials had a higher prevalence of COI compared to other scientific articles. The prevalence of COI was equally high in articles originating from North America and Europe, but much lower in articles from Asia/Australia. The majority of reported COI were unrelated to research funds. No significant financial relationships to disclose.
Oxygenation and Retrolental Fibroplasia
Authors: Theodore H. Ingalls, Natesaier Purshottam
Journal: New England Journal of Medicine (1954)

The causative factors of disease may be broadly grouped under three headings: those due to injurious agents, those resident in the susceptible host and those deriving from the environment in which host and agent find themselves1; clarification of causation is to be sought along "a broadened front on which the laboratory and the clinic or the field have been brought together for interpretation of a problem."2 These principles guide the search for causes of a noncommunicable illness like retrolental fibroplasia (RLF) no less than that for viruses of infantile paralysis, for example; investigation proceeds in the clinic, field and . . .
Symptom Burden In Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS)
Authors: Patricia S. Ault, Acnp, Hagop M. Kantarjian, Guillermo Garcia-Manero, Alfonso Quintas-Cardama, Gautam Borthakur, Stefan H. Faderl, Elias J. Jabbour, Charles S. Cleeland, Jorge E. Cortes
Journal: Blood (2013)
Case 9-2010
Authors: Misha L. Pless, Yi-Bin Chen, William A. Copen, Matthew P. Frosch
Journal: New England Journal of Medicine (2010)

A 37-year-old right-handed woman was admitted to this hospital because of a 7-month history of intermittent paresthesias, followed by slurred speech, headaches, ataxia, and cognitive difficulties. Treatment with corticosteroids, verapamil, and azathioprine resulted in little improvement. Imaging studies showed lesions in the cerebral and cerebellar white matter. Gait imbalance, unsteadiness, and visual hallucinations developed. A diagnostic procedure was performed.
Intratumor Localization of Monoclonal Antibody in Patients With Melanoma Treated With Antibody to a 250,000-Dalton Melanoma-Associated Antigen&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;&lt;xref ref-type="fn" rid="FN3"&gt;3&lt;/xref&gt;
Authors: R W Schroff, C S Woodhouse, K A Foon, R K Oldham, M M Farrell, R A Klein, A C Morgan
Journal: JNCI Journal of the National Cancer Institute (1985)

Antibody localization at the tumor site was assessed in melanoma patients who received the murine monoclonal antibody 9.2.27. Antibody was administered twice weekly in escalating doses from 1 to 500 mg. Localization was assessed by biopsies of cutaneous and lymph node lesions obtained 24-96 hours following therapy. The percentage of tumor cells that bound the antibody in vivo was dose dependent, with similar findings obtained by either flow cytometry or immunoperoxidase staining techniques. Little or no in vivo binding of the 9.2.27 antibody to tumor cells was found following 1- and 10-mg doses, whereas all specimens demonstrated in vivo binding of the antibody following 200- and 500-mg doses. Fluorescence staining intensity, as quantitated by flow cytometry, was employed to determine the degree of in vivo saturation of antibody binding sites following therapy. The degree of saturation was found to vary substantially among patients: Some patients demonstrated nearly 100% saturation after 200-mg doses of 9.2.27 antibody, whereas others demonstrated only half maximal saturation after doses of 500 mg. Although immunoperoxidase staining provided important qualitative information regarding the distribution of antigen and antibody within the tumor, these studies demonstrated the usefulness of immunofluorescent flow cytometry for quantitative assessment of antibody localization in solid tumors and provided information necessary for the design of further trials of monoclonal antibodies and immunoconjugates.
Sensor Technology in Assessments of Clinical Skill
Authors: Elisabeth Sanchez-Padilla, Matthias Merker, Frauke Jochims, Themba Dlamini, Patricia Kahn, Maryline Bonnet, Stefan Niemann, Drs Sanchez-Padilla, Mr Beckert
Journal: New England Journal of Medicine (2015)

unreliable in Swaziland, since it can miss a substantial percentage of strains that may be resistant to rifampin.