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Health care represents approximately 20% of the US economy with $3.5 trillion in spending annually. For many key health-related quality measures, the United States lags behind other developed countries. The intersection of access to health care, quality, and cost is a complex tangle of urgent issues that are vitally important to the health of patients. And a fundamental question—is health care a right or privilege?—remains unanswered. While many in the United States receive exceptional care and about 20 million fewer individuals are uninsured following enactment of the Affordable Care Act (ACA), the number of uninsured is again increasing, now close to an estimated 27.5 million or 8.5% of the US population. Financial support for health and
In this Viewpoint, Anthony Fauci and NIAID colleagues discuss the challenge of managing comorbidities in persons living with HIV with an emphasis on the long-term risk and burden of cardiovascular disease, kidney and hepatic disease, and neurocognitive disorders in an infected population approaching normal longevity while receiving long-term antiretroviral therapy.
In this issue of JAMA, the US Preventive Services Task Force (USPSTF) has updated its previous 2014 recommendations on screening asymptomatic adults for abdominal aortic aneurysm (AAA). In addition, an updated evidence report and systematic review accompanies this report from the USPSTF. These recommendations are not substantially different from the previously published recommendations.
In Reply In our article, we stated that the investigation of US government personnel with potential directional phenomena exposure in Cuba was not undertaken as a research study: "The US Department of State directly referred personnel and family members to the University of Pennsylvania for clinical evaluation and treatment following potential exposure to directional phenomena."
There are many indications in the recent literature of alimentary bacteriology leading to the conclusion that diet can play a significant rôle in determining the bacterial flora of the intestine. The attempts to establish specific types of micro-organisms in the enteric tract by feeding bacterial cultures have not proved successful in the way that the enthusiasts of the Metchnikoff school were led to expect. Despite the positive claims of the manufacturers of such products, the preponderant view at present is against the probability of success in the efforts to implant strains of bacteria in the intestine by feeding cultures of them. On the other hand, there is growing evidence that the flora in the bowel can be profoundly altered by change.
The use of modern additive solutions has allowed blood services to store red blood cells for transfusion for extended periods, commonly up to 42 days. To minimize red blood cell wastage, it is common practice for hospital blood services to issue the oldest compatible red cell unit available for transfusion as part of routine inventory management. During storage, red blood cells and their storage medium undergo numerous structural, biochemical, and metabolic changes, collectively referred to as the storage lesion. These are mostly evident after the second week of storage. Understanding of how red blood cells change during storage continues to evolve.
I. Beside my husband’s ICU bed, I plead my case for waking, hold my palm flat as a bible, place his warm hand on mine. His face inscrutable beneath a bandage wreath, he breathes on his own, his heart pumps, his blood flows, but his brain sleeps. I try to reach him with evidence of our need: sharing handwritten words on well-wishers’ cards, family photos, cassette tapes of our daughter’s toddler chatter, unstopped bottle of Shalimar. To hold him in this world, I read aloud cliff-hanger chapters; play radio news; bring a transistor TV for daytime soaps. Close friends enlisted for strictly timed visits testify to their love, and beg him to resist.
Primary care physicians may one day have a quick and effective tool to triage patients with suspected brain cancer before sending them for costly, time-consuming scans. A newly developed version of a blood test had 83.3% sensitivity and 87% specificity for differentiating patients with and without brain cancer, according to interim results from an ongoing prospective study.
This 2019 Recommendation Statement from the US Preventive Services Task Force recommends 1-time ultrasound screening for abdominal aortic aneurysm (AAA) in men aged 65-75 who have ever smoked (B recommendation), selective screening in men aged 65-75 who have never smoked (C recommendation), against routine screening in women who have never smoked and have no family AAA history (D recommendation), and concludes that current evidence is insufficient to assess the balance of benefits and harms of screening in women aged 65-75 who have ever smoked or have a family AAA history (I statement).

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