bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Value of Cervical Screening in Women over 50 Years of Age —Time for a Multicentre Audit
Authors: McKenzie C.A. , Duncan I.D. 
Published: January 2017

This study reviews the cervical smear history of women developing CIN aged over 50 years to consider if they might be discharged sooner from the cervical screening programme in Tayside Region. From the OCCURS database all women over 50 years who developed CIN between 1 Jan 1993 and 30 June 1996 were identified and their smear history obtained. Results show that had women been discharged from the screening programme at age 50 following three consecutive negative smears and a negative exit smear then only two women with CIN3 and one with microinvasive disease would have been missed in the subsequent three and a half years. A wider geographical survey of the incidence of CIN in this older age group is needed to determine whether it is cost beneficial and cost effective to continue cervical screening beyond the age of 50 years.
Early Diagnosis of Hepatocellular Carcinoma in Haemochromatosis Influences Surgical Management
Authors: Pleass H. , Garden O.J. 
Published: January 2017

Using case note review, a retrospective analysis was carried out of all patients referred with haemochromatosis and suspected hepatocelluclar carcinoma between 1988 and 1997 to define the mode of presentation, management and outcome of such patients. All 12 patients were male with a mean age of 67 years. Four patients presented whilst asymptomatic by alpha-fetoprotein screening. Mean time interval between diagnosis of haemochromatosis and heptocellular carcinoma was 6.7 years. One patient underwent right hepatectomy, seven patients were treated by chemoembolisation and the remaining four patients were treated symptomatically. The median survival of the chemoembolised patients was 13 months. Of those patients treated symptomatically, the median survival was four months. Screening for hepatocellular carcinoma is often not undertaken inpatients with haemochromatosis. Survival prospects are poor in patients whose tumour presents symptomatically.
The Formation of Carbonyl Groups during Irradiation of Wool and Its Relevance to Photoyellowing
Authors: Holt L. A. , Milligan B. 
Published: January 2017

The carbonyl contents of wool fabrics have been determined by colorimetric analysis after partial acid hydrolysis. Irradiation of dry wool fabrics with simulated sunlight causes an increase in carbonyl content. The rate of production is approximately the same for unbleached, bleached, and fluorescently whitened fabrics, even though these fabrics yellow at markedly different rates. In contrast, irradiation of the same fabrics in water results in few additional carbonyl groups, although extensive yellowing occurs. Thus it seems unlikely that carbonyl groups are directly responsible for yellowing. However, the observation that hydrothermal yellowing of dry-irradiated wool is accompanied by a loss in carbonyl content leads us to suggest that carbonyl groups could be involved indirectly in yellowing. The keto acids present in partial acid hydrolysates of irradiated wool have been identified by reductive amination with sodium 3H-borohydride in ammonia solution, a reaction which converts keto acids to the corresponding 3H-amino acids. The formation of radiolabeled alanine, glycine, proline, serine, threonine, glutamic acid, and tyrosine provides evidence for the photo-oxidation of a number of amino acid residues during irradiation of wool.
Smoking Habits Amongst House Physicians Working at Jinnah Postgraduate Medical Center, Karachi, Pakistan
Authors: Piryani Rano Mai , Rizvi Nadeem 
Published: January 2017

The objective of this study was to estimate the prevalence of smoking among house physicians working at Jinnah Postgraduate Medical Center, Karachi, Pakistan. Sixty-four (32%) of the 200 house physicians were smokers; 50% (36) had started smoking in their twenties and 44% (28) in their teens. Seventy-five per cent (48) of the smokers were influenced by friends, 20% (13) by cigarette commercials and the remainder by their parents. Ninety-five per cent (61) smoked during duty hours. The frequency of smoking among young doctors was higher than the overall prevalence of smoking in Pakistan.
The Perils of Singleton v. Norris: Ethics and beyond
Authors: Gabos Kelly A. 
Published: January 2017

Nearly 20 years ago, in Ford v. Wainright, the Supreme Court held that it is unconstitutional to execute a legally incompetent inmate. Due to advancements in pharmacological therapy and the ability to make inmates legally competent through medication, various courts since Ford have determined the mechanisms by which competency through medication can be accomplished. Those decisions led to cases involving the legality of forcibly medicating inmates to make them competent to stand trial and to be executed. One recent case involving execution competency is the Eighth Circuit’s decision in Singleton v. Norris.In Singleton, the Eighth Circuit held that execution as an ultimate consequence of administering psychotropic medication to legally incompetent inmates cannot be considered in the determination of whether it was proper to forcibly medicate that inmate. The Eighth Circuit’s decision permitted the execution of Charles Singleton, a schizophrenic who fought against involuntary administration of the medications that rendered him competent to be executed.
Demanding Individually Safe Drugs Today: Overcoming the Cross-Labeling Legal Hurdle to Pharmacogenomics
Authors: Sasjack Scott 
Published: January 2017

If new refrigerators hurt 7% of customers and failed to work for another one-third of them, customers would expect refunds … manufacturers would be strictly liable for the injuries, and there would be implied warranties even if the manufacturer made no guarantees.What if physicians could use genetic tests to tailor prescriptions to their patients’ individual genotypes? Physicians and pharmaceutical companies can use pharmacogenomics to decrease the number of adverse drug reactions, increase drug efficacy, and lower health care costs. Unfortunately, crosslabeling rules serve as both legal and policy hurdles for these advances, hurdles the FDA has the power to remove. Part I explains pharmacogenomics and why it currently has a narrow application. Part II discusses the FDA's regulatory approach to pharmacogenomics. Part III explains the legal and policy hurdles of cross-labeling and how they impede the more widespread use of pharmacogenomics. Part IV examines ways to clear the legal crosslabeling hurdles while Part V examines ways to clear the policy cross-labeling hurdles. Finally, Part VI discusses some of the many other complex legal and policy issues that lawmakers, regulators, and the industry will need to resolve in order to realize the full potential of pharmacogenomics.
… And Health Care for All: Immigrants in the Shadow of the Promise of Universal Health Care
Authors: Ortega Adrianne 
Published: January 2017

President Obama’s ambitious universal health care plan aims to provide affordable and accessible health care for all. The plan to cover the estimated 46.5 million uninsured, however, ignores the over thirty million non-citizens living in the United States. If the United States passes universal health care coverage, Congress should repeal the prohibitions of the Welfare Reform Act, extend Medicaid coverage to non-citizens, and allow non-citizens to purchase employer-based insurance coverage.President Obama’s plan follows the lead of state universal health care legislation by retaining private, employer-sponsored insurance coverage and expanding the eligibility requirements of the Medicaid program. This strategy will not aid uninsured immigrants or overburdened states and hospitals, though, because current law excludes most non-citizens from nonemergency health care services.
The Commercial Speech Doctrine in Health Regulation: The Clash between the Public Interest in a Robust First Amendment and the Public Interest in Effective Protection from Harm
Authors: Orentlicher David 
Published: January 2017

Historically, government has been given more leeway when invoking its interests in safeguarding the public health than when asserting other state interests. Thus, for example, when considering a constitutional challenge to mandatory smallpox immunization in Jacobson v. Massachusetts, the Supreme Court employed its highly deferential, rational basis review rather than the stricter level of scrutiny that it normally employs when individuals assert interests in bodily integrity. Similarly, Congress and the Food and Drug Administration (FDA) have imposed greater restrictions on the speech of pharmaceutical companies than have been considered acceptable for speech in other commercial settings.In recent years, however, it appears that a trend is developing toward applying the same level of constitutional scrutiny to health regulation. In Abigail Alliance, a three-judge panel in the U.S. Court of Appeals for the D.C. Circuit overrode FDA regulations to recognize a constitutional right of access for patients to experimental chemotherapy.
Commercial Speech Law and Tobacco Marketing: A Comparative Discussion of the United States and Canada
Authors: Berman Micah L. 
Published: January 2017

In November 2011, U.S. District Court Judge Richard Leon ruled that the U.S. Food and Drug Administration's (FDA’s) proposed graphic health warnings for cigarette packages violated tobacco companies’ First Amendment rights. In doing so, he pointedly refused to consider the experiences of Canada, the United Kingdom, and the more than thirty other countries that had adopted similar graphic warnings in the past decade. Rather, he swatted away all references to those other countries’ experiences by stating (first at oral argument and then in his decision) that “none of [those countries] afford First Amendment protections like those found in our Constitution.”While it is true that no other country uses the First Amendment per se, many other countries do offer constitutional protection to freedom of speech and/or freedom of expression. Indeed, several other countries apply “strikingly similar” legal tests when reviewing restrictions on speech (and on commercial speech in particular). Thus, the statement that other countries do not “afford First Amendment protections like those found in our Constitution” is an oversimplification.
The Trans-Pacific Partnership Agreement: A Gold-Plated Gift to the Global Tobacco Industry?
Authors: Kelsey Jane 
Published: January 2017

Proponents of the Trans-Pacific Partnership agreement (TPPA) describe it as a twenty-first century agreement that will reach further behind the border than any previous free trade or investment agreement. As the chief executive of Business New Zealand said during the round of TPPA negotiations in Auckland in December 2012:It is true that TPP is more than just a trade negotiation.That's because TPP has the capacity to reach further into domestic economies and domestic policy settings than a conventional trade agreement - as it must if the essential requirements of business are to be addressed and a real difference made, for growth, jobs and community success.More specifically, the TPPA aims to frame how governments make their domestic policy and regulatory decisions as a complement to more extensive rules that constrain the substance of those decisions. These “disciplines” aim to empower commercial players and advance their interests, and to marginalize competing priorities, advocates, and agencies; including democratic political institutions.
The First Amendment and Public Health, at Odds
Authors: Mermin Seth E. , Graff Samantha K. 
Published: January 2017

At the turn of the last century, allies of industry on the Supreme Court deployed a novel constitutional doctrine to thwart government regulations aimed at improving public health and safety. During the Lochner v. New York era, the Supreme Court discovered a right to “freedom of contract” in the Due Process Clause of the Fourteenth Amendment that advanced the “economic liberty” of businesses to conduct their affairs without government oversight. The newfound freedom of contract forbade, for example, public policies aimed at improving factory conditions by setting maximum working hours, forbidding child labor, or setting a minimum wage. The Court later somewhat abashedly changed course, finding that government in fact had great leeway to implement economic regulations protecting and promoting general welfare.Today, seventy-five years after the Supreme Court repudiated the doctrine of economic substantive due process, the Court has backtracked to the notion that the Constitution significantly impedes the government's ability to safeguard public health and safety by regulating commercial activities.
Combating the Prescription Painkiller Epidemic: A National Prescription Drug Reporting Program
Authors: Shepherd Joanna 
Published: January 2017

Prescription painkiller abuse is the fastest growing drug problem in the United States. In the past year, approximately one out of twenty Americans reported misuse or abuse of prescription painkillers. Several factors contribute to the prescription painkiller epidemic. Drug abusers use various methods—such as doctor shopping, paying with cash, and filling prescriptions in different states—to avoid detection and obtain prescription painkillers for illegitimate uses. A few rogue physicians and pharmacists, lured by substantial profits, enable drug abusers by illegally prescribing or supplying controlled substances. Even ethical physicians rarely have adequate training to recognize and address prescription drug abuse, and as a result, prescribe painkillers to patients who are not using them for legitimate medical purposes. Similarly, although the majority of pharmacies have taken steps to combat drug abuse and reduce prescription painkiller dispensing, under current reporting systems, pharmacists lack visibility into several important indicators of drug abuse. As a result, even the most vigilant pharmacists find it extremely difficult to identify and detect drug abuse with certainty.While state governments have established prescription drug monitoring programs (PDMPs) to crack down on prescription drug abuse, these programs have proven to be inadequate. The programs currently suffer from inadequate data collection, ineffective utilization of data, insufficient interstate data sharing, and constraints on sharing data with law enforcement and state agencies. By contrast, third-party prescription payment systems run by pharmacy benefit managers (PBMs) or health insurers have been effective in detecting prescription drug abuse. This paper suggests that a national prescription drug reporting program building on existing PBM networks could be significantly more effective than existing state PDMPs in detecting prescription drug abuse.
Beyond Payment and Delivery Reform: The Individual Mandate's Cost-Control Potential
Authors: Moncrieff Abigail R. , Padi Manisha 
Published: January 2017

In a symposium focused on healthcare cost control, most of our authors have unsurprisingly highlighted and assessed Obamacare’s payment and delivery reforms—the supply-side efforts to decrease costs of medical treatment. But there is another party in healthcare decision-making who is equally or even more important: the patient. The question we will tackle here is whether the individual mandate and its accompanying patient-centered insurance reforms might decrease costs for patients in ways that ought to matter in assessing Obamacare’s cost control provisions.The individual mandate’s cost control potential lies in its reduction or even elimination of patients’ decision costs. The mandate, together with its minimum coverage requirements and a handful of the statute’s substantive insurance reforms, combats demand-side inefficiencies that might arise from patients’ bounded rationality. Decisions about whether to buy commercial insurance, how much insurance to buy, whether to consume preventive care, and how much to pay for that care are all difficult decisions. In order to make optimal choices, patients need a lot of information that is costly to obtain and to evaluate.
State Fiscal Considerations and Research Opportunities Emerging from the Affordable Care Act's Medicaid Expansion
Authors: Sullivan Jean C. , Gershon Rachel 
Published: January 2017

As enacted, the Affordable Care Act (ACA) directed states to provide Medicaid coverage to most nonelderly adults with incomes up to 138% of the Federal Poverty Level (the “Medicaid expansion group”) beginning in 2014. The Medicaid expansion provision of the ACA is an integral component of fulfilling the ACA’s primary objective to achieve near-universal health insurance coverage rates across the United States.Title XIX of the Social Security Act (Title XIX) is Medicaid’s enabling statute. Medicaid is a medical assistance program for certain low-income individuals, jointly funded and administered by federal and state governments. Certain features of the Medicaid program provide a framework within which the ACA and subsequent Supreme Court decision National Federation of Independent Business (NFIB) v. Sebelius can be understood.
Does Dimethicone Increase the Efficacy of Antacids in the Treatment of Reflux Oesophagitis?
Authors: Ogilvie A L , Atkinson Michael 
Published: January 2017

Dimethicone is a common additive to antacids, although its value in the treatment of reflux oesophagitis is unproven. Its efficacy was assessed by comparing the effect of a dimethicone-containing antacid gel (Asilone Gel) with a simple antacid gel in a double-blind trial in 45 patients with reflux oesophagitis. Thirty-eight patients completed the eight-week course of therapy. Antacid therapy alone resulted in a significant improvement of both symptoms and oesophagitis in gastro-oesophageal reflux. The inclusion of dimethicone in the antacid gel preparation did not confer any benefit in terms of symptomatic assessment but did confer a small advantage with regard to objective markers of oesophageal inflammation, suggesting that a dimethicone-containing antacid is of value in the treatment of symptomatic gastro-oesophageal reflux.
The Middle Ear in Cleft Palate Children Pre and Post Palatal Closure
Authors: Dhillon R S 
Published: January 2017

A multicentre prospective trial was commenced in July 1984 to establish the incidence of otitis media with effusion (OME) in children born with a cleft of the palate. Additionally, the data recorded would allow an assessment of the effect of palatal closure on middle ear function. Prior to palatal closure, 97% of ears in a group of 50 patients had otitis media with effusion (OME). The insertion of a long-term ventilation tube provided a means of aeration of one ear with the non-ventilated ear acting as a control. Eighty percent of control ears had persistent OME during a 24-month follow-up period post palatal repair. It would seem that OME is universally present in children with a cleft palate prior to 4 months of age and this incidence is only marginally diminished by palatal surgery. The liaison between plastic surgical and ENT units should be even closer than before in order to manage these patients satisfactorily.
A Rare Complication of Varicose Vein Surgery
Authors: Herman J. , Lovecek M. , Duda M. , Svach I. 
Published: January 2017

Design: Case report. Setting: University Hospital in the Czech Republic. Patients: Patient undergoing surgery for primary varicose veins. Interventions: The patient underwent attempted long saphenous vein stripping by passing a flexible stripper from ankle to groin. The stripper fractured at its upper end and a fragment of stripper became lodged in the internal iliac vein in the pelvis. This was removed at laparotomy. The patient made an uncomplicated recovery. Conclusion: Major complications of varicose vein surgery are rare. This unusual problem was probably caused by material fatigue in the stripper, leading to fracture near the upper end of the stripper.
Risk Factors for Healing and Recurrence of Chronic Venous Leg Ulcers
Authors: Barwell J. R. , Ghauri A. S. K. , Taylor M. , Deacon J. , Wakely C. , Poskitt K. R. , Whyman M. R. 
Published: January 2017

Objective: To identify independent risk factors for delayed healing and increased recurrence of chronic venous leg ulcers. Design: Prospective study. Setting: Community-based leg ulcer service. Patients: Six hundred and thirty-three limbs in 587 consecutive patients with an ankle-brachial pressure index (ABPI) ≥0.85. Method: Potential risk factors were initially assessed in a one-stop clinic incorporating clinical evaluation, ABPI and venous duplex imaging. Limbs were treated within a defined protocol. Twenty-four-week healing and 3-year ulcer recurrence rates were determined. Results: Of 12 potential risk factors age ( p< 0.001), ulcer chronicity ( p< 0.001) and popliteal vein reflux ( p< 0.005) were independent risks for delayed healing. Of 13 potential risk factors rheumatoid arthritis ( p<0.005) and healing time ( p < 0.05) were independent risks for ulcer recurrence. Isolated superficial venous reflux treated by saphenous vein surgery predicted reduced ulcer recurrence ( p< 0.005). Conclusion: Targeting in primary care of ulcer patients with specific characteristics might encourage earlier referral and appropriate resource management. Leg ulcer patients with superficial venous reflux might benefit from surgical correction.
The Prevalence of Venous Disease by Gender and Ethnicity in a Balanced Sample of Four Ethnic Groups in Southern California
Authors: Langer R. D. , Criqui M. H. , Denenberg J. , Fronek A. 
Published: January 2017

Objective: To determine the prevalence of venous disease in a community. Design: Cross-sectional study Setting: Southern California university. Participants: Current and retired university employees and spouses were randomly invited within strata based on gender, ethnicity (Caucasian, Hispanic, Black, Asian) and age. These analyses used a random subsample of 75 participants of each gender and ethnicity. Main outcome measures: Cosmetic and functional venous disease determined by standardised examination including ultrasound and visual inspection. Results: Telangiectases were present in 83% of women and 51% of men. Rates increased with age and were highest in Caucasians and lowest in Blacks. Corresponding rates for varicose veins were 33% and 17% with no ethnic differences. Superficial functional disease was found in 26% of women and 15% of men, without ethnic variation. Deep disease was present in 11% without gender or ethnic effects. Conclusions: Telangiectases varied by gender, ethnicity, and age. Varicose veins varied by gender. All conditions except deep disease were more common in women.
Mercury Strain-Gauge Plethysmography Venous Mode: Non-Invasive Technique of Choice in Vascular Pathology
Authors: Barroy J.P. , Munck D. , Paturiaux E. , Goldstein M. 
Published: January 2017

Mercury strain-gauge plethysmography venous mode is a non-invasive technique for exploration of the haemodynamics of the extremities. The plethysmographic parameters used are: (1) the venous inflow (in ml/100 ml/min); (2) the venous outflow (in ml/100 ml/min); (3) the venous capacity in ml/100ml; (4) the venous distensibility index in ml/100 ml/ mmHg; and (5) the venous pressure measured by ‘hysteresis curve’. This method permits us to analyse the venous haemodynamics of both extremities simultaneously (the normal limb serving as the control), to obtain a precise diagnosis and to appreciate the efficacy of treatment at follow-up. The aetiology of the swollen limb can be precisely identified in 95% of the studied cases: oedema in superficial venous insufficiency, oedema in the deep venous insufficiency, oedema of inflammatory origin, oedema in the arterial insufficiency, oedema of cardiac origin, lymphoedema. During the last 3 years, we have followed up 580 patients with this method.