tbuckley/cabot-search huggingface dataset:
Metered-dose inhalers: the specified number of sprays
Authors: A. Bergner
Journal: JAMA (1993)

<h3>To the Editor.</h3> —Asthma morbidity and mortality rates are on the rise and their causes are currently being addressed.<sup>1</sup>The appropriate role and use of β-agonist inhalers are being questioned.<sup>2</sup>We would like to call attention to a problem associated with the use of metered-dose inhalers (MDIs). As is shown in the Table, MDIs contain sufficient medication for a specified number of inhalations.<sup>3</sup> We believe that some of the exacerbations of asthma in our patients occurred when they continued to use their MDIs beyond the specified number of sprays. As an inhaler is used, "the dose emitted by a large number of valves currently used seems to decline as the product is exhausted."<sup>4</sup>When about 15% of the original amount of sus pension remains, the meter chamber does not fill uniformly and subsequent doses fall below acceptable limits.<sup>4</sup>The liquid propellant and decreasing doses of
Fatigue Syndrome
Authors: J. F. Lehrer, L. M. Hover
Journal: JAMA (1988)

<h3>To the Editor.</h3> —We suggest that chronic use of cocaine be added to the possible causes of the "fatigue syndrome" discussed by Dr Straus<sup>1</sup>in his editorial in the May 1,1987, issue of<i>JAMA</i>. Table 1 lists the characteristics of that syndrome as outlined by Jones and Straus.<sup>2</sup>Table 2 lists the characteristics of chronic cocaine abuse as outlined by Gold et al.<sup>3</sup>The similarities are striking. Chronic cocaine use depletes norepinephrine, dopamine, and serotonin supplies.<sup>3</sup>Norepinephrine depletion can be associated with depression<sup>4</sup>and fatigue.<sup>5</sup>Depletion of dopamine or serotonin can be associated with depression.<sup>6</sup>Depletion of serotonin, well known for its effects on sleep induction, may result in the insomnia associated with the fatigue syndrome. The description of those afflicted with the fatigue syndrome as generally well educated, generally affluent, and generally between 20 and 45 years of age, with the majority
Surgical Anatomy for Students.
Journal: JAMA (1892)

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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Malignant Melanomas of the Choroid and Ciliary Body
Journal: JAMA (1963)

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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
ABSTRACTS
Authors: Joseph Ross, Helen Belding, N Maier, Robert Chodos, Roger Crafts, Milo Netou, C Das Gupta, Charles Rath, Washington Solomon Estren, Jean Soulier, Ronald Girdwood, M Su#{225}rez, Timothy Talbot, Oliver Jones, Philip Wagley, Ian Welch, Born Conrad, G James, J Abbott-, H Brooks
Journal: Blood (1954)
Serum ferritin as a predictor of the acute respiratory distress syndrome.
Authors: K G Connelly, M Moss, P E Parsons, E E Moore, F A Moore, P C Giclas, P A Seligman, J E Repine
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

We investigated serum ferritin levels as a predictor of the acute respiratory distress syndrome (ARDS) because: (1) proinflammatory cytokines, which are implicated in ARDS, increase ferritin synthesis; and (2) oxidative stress in patients at risk for ARDS might liberate iron from ferritin, accelerating toxic hydroxyl radical (.OH) formation. Serum ferritin levels measured by radioimmunoassay (RIA) were greater in 75 patients at risk for ARDS (women, p < 0.0001; men, p < 0.0001) and 8 patients with ARDS (women, p = 0.001; men, p = 0.0009) than in healthy control subjects. Serum ferritin levels were also greater in female (p = 0.003) and male (p = 0.003) at-risk patients who developed ARDS than in patients who did not develop ARDS. In women, a value exceeding 270 ng/ml predicted ARDS with an 83% sensitivity, 71% specificity, 67% positive, and 86% negative predictive value. In men, a value exceeding 680 ng/ml predicted ARDS with a 60% sensitivity, 90% specificity, 75% positive, and 82% negative predictive value. Serum ferritin levels did not correlate with C-reactive protein levels, were not different in medical or surgical at-risk patients, and were not accounted for by liver disease. Evaluating serum ferritin levels in at-risk patients may help predict the development of ARDS and thereby improve study and treatment of ARDS. Elevated serum ferritin levels may also regulate the participation of iron in the oxidative responses that contribute to ARDS.
Drug substitution
Authors: K. L. Beers
Journal: JAMA (1979)

<h3>To the Editor.—</h3> This is a report of a clinical failure with substituted tolbutamide. My letter is prompted by the potentially serious situation that was created when one of my diabetic patients permitted substitution without my knowledge of a refill prescription for a specific brand of tolbutamide. <h3>Report of a Case.—</h3> The patient was a 71-year-old woman whose diabetes had been stabilized for seven years with diet and a daily dosage of tolbutamide (Orinase), 500 mg four times a day. The patient's fasting and postprandial blood glucose levels were generally maintained within a range of 100 to 140 mg/dL, and no noteworthy clinical complications associated with blood glucose control had occurred during her relatively long history of diabetes mellitus. During a routine visit to my office, the patient's blood glucose level was found to be 400 mg/dL, and she mentioned that she had not been feeling well. Careful questioning of
Omission in Text
Authors: Richard Klasco, Lewis Glinert
Journal: JAMA (2017)

andthe appearance of quantitation inherent in an alphanumeric rating system may convey the impression of an action that is thoroughly evidence-based and ought to be performed, despite any number of layers of equivocation that might be deployed as a hedge against that impression.To risk a tautology, we advocate that guidelines provide guidance.The National Academy of Medicine (formerly the Institute of Medicine) confronted this issue directly 27 years ago in its initial 1990 report on practice guidelines: "When the evidence is extremely strong and professional judgment is virtually unanimous, the guideline may be treated as a standard of practice permitting few if any exceptions.When the evidence is equivocal, the guideline may only identify currently acceptable practice options." 1 We agree that the use of clinical practice guidelines for inculpatory purposes strays from the intent of the framers.Practice guidelines afford opportunity for extraction of divergent statements that, when used selectively to infer a standard of care in a court of law, may be construed as supporting conclusions that are frankly incorrect.Intermediate-grade recommendations are particularly prone to such interpretations, as they appear to lend support to actions that may only be applicable to a minority of patients.We think that it is best for clinical guidelines to call out uncertainty explicitly when it exists and to deem such recommendations as the purview of the treating physician in the exercise of his or her clinical judgment.Although practice guidelines were conceived to bring rigor to clinical judgment, it would be a mistake to conclude that the current body of scientific knowledge is sufficient to govern clinical practice in areas of sparse or conflicting evidence.
Abstract 239: Transcriptomic Profiling Maps Anatomically Patterned Subpopulations Among Single Embryonic Cardiac Cells
Authors: Guang Li
Journal: Circulation Research (2017)

Embryonic gene expression intricately reflects anatomical context, developmental stage, and cell type. To address whether the precise spatial origins of cardiac cells can be deduced solely from their transcriptional profiles, we established a genomewide expression database from 118, 949, and 1,166 single murine heart cells at embryonic day 8.5 (e8.5), e9.5, and e10.5, respectively. We segregated these cells by type using unsupervised bioinformatics analysis and identified chamber-specific genes. Using a random forest algorithm, we reconstructed the spatial origin of single e9.5 and e10.5 cardiomyocytes with 92.0% ± 3.2% and 91.2% ± 2.8% accuracy, respectively (99.4% ± 1.0% and 99.1% ± 1.1% if a ±1 zone margin is permitted) and predicted the second heart field distribution of Isl-1-lineage descendants. When applied to Nkx2-5/ cardiomyocytes from murine e9.5 hearts, we showed their transcriptional alteration and lack of ventricular phenotype. Our database and zone classification algorithm will enable the discovery of novel mechanisms in early cardiac development and disease.
Bronchial Asthma
Authors: J. J. Robbins
Journal: JAMA (1963)

<h3>To the Editor:</h3> —I should like to present the essential points in my methods of treatment of asthma which have proven uniformly effective: 1.<i>Epinephrine</i>, or one of its related drugs, by nebulization for relief of bronchospasm. This route of administration is favored over injection because of its ready availability to the patient at the onset of symptoms, when it can be expected to be most effective. Also, the much smaller amount of drug required, making for fewer side effects and palatability recommend it. Warnings as to toxic effects have little basis in fact. Recently, it has been demonstrated that alleviation of bronchospasm by nebulization, in fact, was accompanied by fall in blood pressure in hypertensive patients. 2.<i>Use of amynophylline by intravenous route</i>. The fear of this drug in relief of bronchospasm, together with admonitions as to very slow administration, I believe to be a classic example of an
Abstract 105: The Therapeutic Efficacy of Embryonic Stem Cell-Derived Exosomes for Postinfarction Myocardial Repair and Regeneration
Authors: Erin Lambers, Veronica Ramirez, Alex Mackie, Sol Misener, Eneda Hoxha, Prasanna Krishnamurthy, Suresh Verma, Melissa Thal, Raj Gupta, Raj Kishore
Journal: Circulation Research (2012)

Although embryonic stem cells (ESCs) hold great promise for regeneration of the heart post myocardial infarction (MI) due to their pluripotent potential, it is this same potential that poses risk for the formation of teratomas. Lately there have been reports that exosomes, 30-100nm membrane bound vesicles, are not simply used by the cell to exocytose unwanted material, but contain intact protein, mRNA, and miRNA important for intercellular communication. Here we hypothesize that ESC derived exosomes can be used to exploit an already established mechanism to shuttle ESC content intercellularly in a cell free system for physiological and anatomical repair of the myocardium following acute myocardial infarction. To test our hypothesis exosomes were isolated by ultracentrifugation from equal numbers of murine ESCs or primary embryonic fibroblasts (MEFs). ESC exosomes had intact pluripotent transcripts similar to their parent cells in contrast the MEF exosomes. Using a double blinded acute myocardial infarction model, immediately after permanent ligation of the coronary artery, mice were injected with saline, ESC exosomes, or MEF exosomes at 3 locations in the border-zone of the left ventricle (LV). To assess the functional recovery of the LV, echocardiographical analysis was performed at Day 7, 14, and 28 following the AMI. Mice were sacrificed at D28 for histological assessments. LV fractional shortening, ejection fraction, and end systolic diameter measurements demonstrate that mice treated with ESC exosomes have improved LV function compared to mice treated with control MEF exosomes or saline alone (P&lt;.05 for all functional parameters). Mice treated with ESC exosomes show less infarct size and apoptosis, greater capillary density, and greater cycling of both cardiomyocytes and ckit+ stem cells. Taken together, these data demonstrate a novel cell free system in which ESC exosomes can exploit regenerative capabilities of ESCs while bypassing the risk of teratoma formation and hold great promise for cardiovascular regenerative medicine.
Editorial: Pills over the counter.
Journal: BMJ (1975)

A pamphlet published by the Birth Control Trust and followed by a letter in the British Medical Journal has recommended that paramedical personnel be allowed to dispense oral contraceptives if properly supervised. Also, others have recommended that these drugs should be on direct sale to the public. However, because of the multiple risk factors, there is a place for screening before the pills are prescribed. The main objection to freeing the pill from prescription would be the abdication of medical responsibility for supply of potentially dangerous drugs. For an exception to be made for oral contraceptives there should be evidence of a clear benefit to society, which is not believed to be the case. Present contraceptive services would not be improved if the pill went on display on the counters of chemists' shops.
A Critical Analysis of RBRVS
Authors: Ciaran S. Phibbs
Journal: JAMA (1992)

<h3>To the Editor.</h3> —Dr Maloney's article reads more like a thoracic surgeon trying to defend his high income than a scientific critique on the resource-based relative value scale (RBRVS).<sup>1</sup>His assumption that physicians should be paid time and a half after 40 hours of work per week, and double time after 48 hours, sets the analysis up to support his side of the debate. Since when do professionals receive overtime? Many, if not most, professionals with advanced degrees in the United States work quite long hours, with no additional compensation. The effect of overtime is incorporated into the study by adjusting the hours worked per week. Since all of the specialties in this study averaged over 48 hours per week, this assumption doubles the reported 8.6-hour average difference in hours worked per week between surgical and medical specialties. This larger increase in the average hours worked per week for
14. Clinical Results in Lymphoma I
Authors: V Diehl, C Brillant, J Franklin, A Engert, B Pfistner, R Greil, R Herrmann, J Radford, M Cullen, B Hancock, J Walewski, M Sydes, D Ryder, P Smith, S Clawson, S Stenning, P Johnson
Journal: Annals of Oncology (2005)
Bacterial endocarditis and right atrial vegetation. Detection by two-dimensional echocardiography
Authors: E. J. Eichhorn
Journal: JAMA (1981)

PACEMAKER-induced endocarditis has traditionally been diagnosed by clinical suspicion and positive blood cultures. The present case shows that echocardiographic techniques can be used to record right-sided vegetation owing to endocarditis induced by an atrioventricular pacemaker. <h3>Report of a Case</h3> A 62-year-old man with an indwelling pacemaker was hospitalized for cyclic episodes of fever. Eight years previously he had suffered a myocardial infarction, and five years before this admission a permanent transvenous pacemaker electrode had been inserted into the right ventricle. His pacemaker generator was changed 18 months before admission, but had required no further attention. On admission the patient denied dyspnea or chest pain and gave no history of recent dental extractions, skin infections, or instrumentation. He had lost almost 16 kg in the year before admission. His blood pressure was 114/48 mm Hg, his pulse rate was 80 beats per minute, and his temperature was 37 °C. Conjunctivae and
Error in Table 2
Authors: Joshua Geleris, George Shih, Lia Logio
Journal: JAMA Internal Medicine (2019)

All Patients Refined Diagnosis Related Groups (APR-DRG) weight is a measure of expected resource use that can serve as a proxy for illness severity for nonsurgical patients.It is generated from coded diagnoses at the end of a hospitalization.Because it is a measure of resource use, which may include laboratory tests, it is an imperfect measure, but it is the best we had available.We divided the total number of laboratory tests ordered by each resident by the average APR-DRG weight for all of their patients.We found that this adjustment did not change the variability in ordering habits.The ratio of total laboratory orders per unit APR-DRG weight for the top resident compared with the bottom resident was 7.2, which was similar to the unadjusted number.The linear regression equation for APR-DRG weight vs total laboratory tests ordered by each resident is 490.6 × (unit APR-DRG weight) + 4290 (R 2 = 0.007; P = .41).Additional studies should evaluate if there are better available measures of illness severity that might be more meaningfully applied to this data.We strongly agree that more research is needed to better understand the best means to promote high-value care.Ideally, future research would provide a more robust analysis of what influences practice habits, including controlled trials or studies that include a sustained change in provider ordering behavior. 2,3 We believe that understanding variability in practice patterns between individual physicians is the first step toward ensuring higher value care.
CAROTIDYNIA, A DISTINCT SYNDROME
Journal: JAMA (1967)

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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Prioritising resources.
Authors: N Freemantle, T A Sheldon
Journal: BMJ (1993)

Central T-cell tolerance relies on elimination of self-reactive CD4<sup>+</sup> T-cell clones in the thymus by either deletion or conversion to regulatory T cells (tTregs). Developing thymocytes are selected by exposure to tissue-specific antigens (TSAs) expressed by thymic medullary epithelial cells (mTECs) under the control of Autoimmune Regulator (Aire). TSA-derived peptides-MHCII complexes can be presented either directly by mTECs or indirectly by thymic DCs. Dissecting the contributions of these antigen presenting cell (APC) subsets to thymic tolerance has been hindered by the lack of appropriate genetic tools to selectively target presentation by mTECs. To address this, we created a mouse model in which MHCII can be inducibly ablated in Aire-expressing mTECs (iAire-Cre<sup>ERT2</sup>;MHCII<sup>fl/fl</sup>). We show that treatment of these mice with tamoxifen leads to a complete loss of MHCII expression by Aire<sup>+</sup> and post-Aire mTECs without affecting other thymic APCs or perturbing thymic homeostasis. In a TCR-restricted mouse model of negative selection, ablation of MHCII on mTECs led to a failure to delete self-reactive T cells, allowing escape and activation in the periphery. Surprisingly, we also found a defect in conversion of self-reactive CD4<sup>+</sup> T cells to FoxP3<sup>+</sup> tTregs. Similarly, in the diverse repertoire, loss of direct antigen presentation by mTECs resulted in tTreg reduction. In contrast, using CD11c-Cre;MHCII<sup>fl/fl</sup> mice, in which MHCII is absent on thymic DCs but not mTECs, we found no disruption to negative selection or Treg generation. In sum, our data support a distinct and non-redundant role for direct antigen presentation by mTECs in shaping thymic T cell selection.
Indian Health Service
Authors: Thomas W. Milroy
Journal: JAMA (1975)

<h3>To the Editor.—</h3> In reply to O. G. Austin, MD (231:247, 1975), and to other physicians who have written toThe Journalrecently about the dilemma posed for them by excessively high professional liability insurance, I would like to suggest one alternative to "retirement or acceptance of some quasimedical advisory job." In the Public Health Service (PHS), and in particular the Indian Health Service, there are very satisfying opportunities for providing medical care to patients who have great unmet medical needs, and the physician does not have to carry professional malpractice insurance. All federal employees, either Civil Service or Commissioned Corps, are covered by the Federal Tort Claims Act, under which the federal government assumes responsibility for their actions. At the present time, there are positions open for physicians in PHS hospitals and clinics in North and South Dakota, Minnesota, and Nebraska. Although most positions have been filled in the
Long-Term Effects of Inhaled Budesonide on Screening-Detected Lung Nodules
Authors: G. Veronesi, M. Lazzeroni, E. Szabo, P. Brown, A. De Censi, A. Guerrieri-Gonzaga, M. Bellomi, D. Radice, M.C. Grimaldi, L. Spaggiari, B. Bonanni
Journal: Annals of Oncology (2014)