tbuckley/cabot-search huggingface dataset:
Royal colleges' advice on alcohol consumption
Authors: J M. Gaziano, C. Hennekens
Journal: BMJ (1995)

New opportunities in practice nursingRoles matter more than titles Important changes in the education of practice nurses are imminent.Hitherto such nurses have come from widely varying backgrounds and have often had little prior training in practice nursing despite undertaking an increasing range of tasks.New courses are about to define areas of professional responsibility and accountability rather than focusing on isolated areas of competence.' Nurses will be able to attain a qualification equivalent to a first degree to work as a district nurse, health visitor, or general practice nurse from a common core curriculum.Recognition of advanced practice in nursing will be obtained by showing continuous development in clinical, managerial, or academic skills.This concept of advanced practice will include areas of work currently performed by nurses working as nurse practitioners.23What will this new breed of nurses do?Some of the opportunities can be found in the work of nurse practitioners.Nurse practitioners may be the first contact for patients with acute problems or may provide a substantial part ofcontinuing care in chronic illness.They diagnose new problems and make decisions on management.A recent British study suggested that they are popular with patients and work particularly well with singlehanded practitioners.4They may be particularly effective with populations poorly served by general practitioners-for example, homeless people.Whether they are a cost effective alternative to general practitioners is unknown, partly because they spend more time with patients.Most published evaluations of nurse practitioners have been descriptive, with few accounts of outcome in the patientss7; the only controlled trials have been carried out in the United States.8 9 Do practice nurses differ from nurse practitioners?A recent British survey found that 84% of practice nurses advised on acute problems, and that a similar proportion participated in clinics for chronic diseases.'"Most used auriscopes and peak flow meters, and a few also used stethoscopes and ophthalmoscopes.Many practice nurses are clearly already working as "advanced practitioners," with or without formal qualifications.
The ephrin receptor tyrosine kinase A2 is a cellular receptor for Kaposi's sarcoma–associated herpesvirus
Authors: Alexander S Hahn, Johanna K Kaufmann, Effi Wies, Elisabeth Naschberger, Julia Panteleev-Ivlev, Katharina Schmidt, Angela Holzer, Martin Schmidt, Jin Chen, Simone König, Armin Ensser, Jinjong Myoung, Norbert H Brockmeyer, Michael Stürzl, Bernhard Fleckenstein, Frank Neipel
Journal: Nature Medicine (2012)
Anaesthesia for cardioversion.
Authors: S M Lyons, R S Clarke
Journal: BMJ (1971)

An appreciation of prognosis is essential for effective clinical practice, in neurology as in other fields. Predicting risk of a poor outcome in individuals, or at least in well-defined groups of individuals, is necessary to properly inform patients about what the future holds for them, and the likely benefits of treatment. Despite the various pitfalls in the derivation and validation of prognostic models (or scores), there are an increasing number of useful models available to help patients and clinicians in routine neurology practice. This article considers how such models are best derived, and how their reliability should be assessed, drawing on examples from various different neurological disorders.
Recurrent Thrombosis and Survival After a First Venous Thrombosis of the Upper Extremity
Authors: L.E. Flinterman, A. van Hylckama Vlieg, F.R. Rosendaal, C.J.M. Doggen
Journal: Circulation (2008)

Background— Little is known about the consequences of a first venous thrombosis in the upper extremity. We studied the incidence of, survival, and risk factors for recurrence in a follow-up study. Methods and Results— We followed up 224 patients 18 to 70 years of age after a first venous thrombosis of the arm. Information was collected through anticoagulation clinics, the national death registry, discharge letters, and questionnaires. The median follow-up was 3 years, during which time 30 patients experienced a recurrent event, yielding an incidence rate of 43.2 per 1000 person-years. Survival was reduced: 55 of 224 patients died, which was 5.4-fold higher than age- and sex-adjusted population rates (standardized mortality ratio, 5.4; 95% CI, 4.2 to 7.0). The risk of recurrence was 2-fold higher in women than in men (hazard ratio, 1.8; 95% CI, 0.9 to 3.9). A central venous catheter at the time of first thrombosis was associated with a reduced risk of recurrence. A body mass index ≥25 kg/m 2 and a first nonsubclavian thrombosis appeared to increase the risk of a recurrent event. Prothrombotic mutation carriers did not appear to have an increased recurrence risk. Conclusions— The risk of recurrence was high, with women, patients with body mass index ≥25 kg/m 2 , and patients with a first nonsubclavian vein thrombosis having a higher risk of recurrence. Patients with a first venous thrombosis of the arm have a poor vital prognosis.
Early Steps in Hematogenous Metastasis of B16F1 Melanoma Cells in Chick Embryos Studied by High-Resolution Intravital Videomicroscopy
Authors: A. F. Chambers, E. E. Schmidt, I. C. MacDonald, V. L. Morris, A. C. Groom
Journal: JNCI Journal of the National Cancer Institute (1992)

Background : There are few techniques that permit direct observation of tumor metastasis. The ability to observe steps in this process as they occur in experimental animals would complement studies on molecular mechanisms. Purpose : We have developed a novel procedure using highresolution intravital videomicroscopy to permit direct observation of cells as they arrest in the microcirculation, extravasate, and form micrometastases. We used this procedure to study early steps in experimental metastasis in immune-deficient chick embryos, permitting us to develop this technique in a relatively accessible respiratory organ and in the absence of host immune responses. Our goals were to develop techniques applicable to this host and to other hosts and to clarify the process of hematogenous tumor spread in this host. Methods : We injected fluorescently labeled B16F1 melanoma cells into the circulation of 11- to 13-day chick embryos, and using intravital videomicroscopy, we observed the cells in the chorioallantoic membrane over time. Results : The majority of injected cells were trapped initially in orifices to the chorioallantoic membrane capillary plexus or in tapering ends of arterioles leading to the plexus. During the first 2 hours, cells were found only in vessel lumina. After 8 hours, 83% of cells had extravasated, and the rest were in the process of extravasation. Cell shape changes and pseudopodial extensions were seen during extravasation and tumor development. Tumor cell division was seen only after extravasation. Tumors tended to develop near microvessels and were often wrapped around them. Conclusions : Intravital videomicroscopy can provide new information about steps in metastasis. This procedure is applicable to other hosts and can be used in future studies to test hypotheses about molecular mechanisms of tumor spread. [J Natl Cancer Inst 84:797–803, 1992]
Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: A clinical-hemodynamic correlation study
Authors: Vincenzo La Mura, Juan G. Abraldes, Annalisa Berzigotti, Eva Erice, Alexandra Flores-Arroyo, Juan Carlos García-Pagán, Jaime Bosch
Journal: Hepatology (2010)

Hepatic venous pressure gradient (HVPG), the difference between wedge and free hepatic venous pressure, is the preferred method for estimating portal pressure. However, it has been suggested that hepatic atrial pressure gradient (HAPG)—the gradient between wedge hepatic venous pressure and right atrial pressure (RAP)—might better reflect variceal hemodynamics. The aim of this study was to (1) investigate whether HAPG with nonselective beta-blockers correlates with prognosis in cirrhotic patients with portal hypertension at baseline and during treatment; (2) compare the prognostic value of HAPG with that of HVPG; and (3) investigate the agreement between portoatrial gradient (PAG) and portocaval gradient (PCG) in patients with transjugular intrahepatic portosystemic shunt (TIPS). We included 154 cirrhotic patients with varices with a complete hemodynamic study at baseline and on chronic treatment for primary (n = 71) or secondary (n = 83) prophylaxis for bleeding and 99 patients with TIPS. All patients were followed for up to 2 years; portal hypertensive-related bleeding and bleeding-free survival were analyzed. HVPG was equal or lower than HAPG in all patients (−3.2 mm Hg; P &lt; 0.001). Agreement between HAPG and HVPG was modest, especially in patients with increased intra-abdominal pressure. One hundred two patients were HVPG nonresponders and 52 patients were HVPG responders to nonselective beta-blockers, whereas 101 patients were HAPG nonresponders and 53 patients were HAPG responders (k = 0.610). HVPG response revealed an excellent predictive value for bleeding risk and bleeding-free survival; HAPG did not. In our TIPS patients, 20% had a PCG ≤12 mm Hg and a PAG &gt;12 mm Hg, which may have induced unnecessary overdilation of the TIPS. Conclusion: The excellent prognostic information provided by HVPG response to drug therapy is lost if HAPG response is considered. RAP should not be used for the calculation of portal pressure gradient in patients with cirrhosis. Hepatology 2010;51:2108–2116
Antibiotics carried in general practitioners' emergency bags.
Authors: E. L. Ong, E. M. Dunbar
Journal: BMJ (1988)

EDITOR,—S W S Menzies1 highlights an important result in our survey that we were unable to elaborate because of restriction of space2; half of the general practitioners (1329 (50.4%)) still carried co-trimoxazole, and 694 (26.3%) carried ciprofloxacin. There are currently few indications for the first line use of co-trimoxazole (treatment and prophylaxis of Pneumocystis carinii pneumonia being one); even more disturbing is the increase in …
Rapid Induction of Dendritic Spine Morphogenesis by trans-Synaptic EphrinB-EphB Receptor Activation of the Rho-GEF Kalirin
Authors: Peter Penzes, Alexander Beeser, Jonathan Chernoff, Martin R. Schiller, Betty A. Eipper, Richard E. Mains, Richard L. Huganir
Journal: Neuron (2003)
Comprehensive Allelotype Study of Hepatocellular Carcinoma
Authors: Massimo Roncalli M.D., Mauro Borzio, Paolo Bianchi, Luigi Laghi M.D.
Journal: Hepatology (2000)

To the Editor: I read with great interest and more than a little dismay the article by Myers, Gregor, and Marotta 1 on the cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C. While I found the article to be very well written and thorough, I find the premise for the article to be totally unacceptable.Are we to withhold a simple vaccination from our patients, knowing that they run the risk of severe morbidity or death simply because it may not be "cost effective" in a population study?This article calls to mind a story that was recently played out in the courts in the United States.There was once a large automobile manufacturer that produced a vehicle it knew was unsafe.Not only did they know that it was unsafe, they also knew how to fix the problem to render the vehicle safe.However, rather than do the right thing and fix the vehicle (at a cost of $11 per vehicle), they embarked on a course similar to Myers et al.They first calculated the cost of correcting the defect and then compared it with the cost they may incur if the defect was not corrected.They used data from the federal government and that the National Highway Traffic Safety Administration made available to them.They calculated the average damage per person killed by their vehicle.They added medical costs, property damage, insurance administration, legal and court costs, employer losses, victim pain and suffering, and funeral bills as well as "other costs."When they found that this cost would be less than the cost of correcting the defect on the vehicle, they elected to take their chances in court.Their strategy ultimately landed them in court and resulted in one of the largest settlements in the American legal system.The ethics involved in their decision-making process was headline news throughout the nation.The parallels between this story and the conclusions drawn from this article I find to be quite remarkable.I can see myself in the future consoling Mrs. X upon the death of her husband from hepatitis A superimposed on hepatitis C, a disease that could have been prevented by a simple vaccination, by handing her the article and saying, "but as you can see here, clearly it would not have been cost effective for me to have given your husband a simple vaccine."I was surprised that this article did not provoke more editorial comments from the editors of HEPATOLOGY and I certainly hope that the ACIP does not reconsider its stance on vaccinating all patients with hepatitis C with the hepatitis A vaccine.
A novel human primary immunodeficiency syndrome caused by deficiency of the endosomal adaptor protein p14
Authors: Georg Bohn, Anna Allroth, Gudrun Brandes, Jens Thiel, Erik Glocker, Alejandro A Schäffer, Chozhavendan Rathinam, Nicole Taub, David Teis, Cornelia Zeidler, Ricardo A Dewey, Robert Geffers, Jan Buer, Lukas A Huber, Karl Welte, Bodo Grimbacher, Christoph Klein
Journal: Nature Medicine (2006)
Impact of the Spanish Smoking Law on Exposure to Secondhand Smoke in Offices and Hospitality Venues: Before-and-After Study
Authors: Manel Nebot, Maria J. López, Carles Ariza, Mónica Pérez-Ríos, Marcela Fu, Anna Schiaffino, Gloria Muñoz, Esteve Saltó, Esteve Fernández
Journal: Environmental Health Perspectives (2008)

A smoking law was passed by the Spanish Parliament in December 2005 and was enforced by 1 January 2006. The law bans smoking in all indoor workplaces but only in some hospitality venues, because owners are allowed to establish a smoking zone (venues>100 m2) or to allow smoking without restrictions (venues<100 m2). The objective of the study is to assess the impact of the Spanish smoking law on exposure to secondhand smoke (SHS) in enclosed workplaces, including hospitality venues. The study design is a before-and-after evaluation. We studied workplaces and hospitality venues from eight different regions of Spain. We took repeated samples of vapor-phase nicotine concentration in 398 premises, including private offices (162), public administration offices (90), university premises (43), bars and restaurants (79), and discotheques and pubs (24). In the follow-up period, SHS levels were markedly reduced in indoor offices. The median decrease in nicotine concentration ranged from 60.0% in public premises to 97.4% in private areas. Nicotine concentrations were also markedly reduced in bars and restaurants that became smoke-free (96.7%) and in the no-smoking zones of venues with separate spaces for smokers (88.9%). We found no significant changes in smoking zones or in premises allowing smoking, including discotheques and pubs. Overall, this study shows the positive impact of the law on reducing SHS in indoor workplaces. However, SHS was substantially reduced only in bars and restaurants that became smoke-free. Most hospitality workers continue to be exposed to very high levels of SHS. Therefore, a 100% smoke-free policy for all hospitality venues is required.
AVOIDABLE TRAUMATIC ABDOMEN
Authors: JOHN B. DEAVER
Journal: JAMA (1918)

At this time when so much unavoidable injury is occupying the attention of the surgical world, the surgeon in civilian practice is more than ever shocked on being confronted with traumatism that could be avoided. This was forcibly brought home to me recently while operating for symptoms of a severe abdominal lesion: A colored woman, aged 49, had been operated on twelve years previously (operator unknown) for a tumor of the uterus, abscess and appendicitis. After two months at the hospital, she had been dismissed in good condition and had remained perfectly well until her present illness, which had set in with severe abdominal pain six days prior to her coming to the hospital. I was not a little astounded to find the trouble to have been caused by a pair of hemostatic forceps 8 inches long, one half of which was found in the sigmoid and the other half
Abstract 3260: Male pattern baldness increases the risk of aggressive prostate cancer: A prospective analysis of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial
Authors: Cindy K. Zhou, Ruth M. Pfeiffer, Sean D. Cleary, Heather J. Hoffman, Paul H. Levine, Lisa W. Chu, Ann W. Hsing, Michael B. Cook
Journal: Cancer Research (2014)

Abstract Purpose: Androgenic actions are thought to underlie the development of both male pattern baldness and prostate cancer. However, results from previous studies of the relationship between these two phenotypes have been inconsistent. Therefore, we investigated the association of male pattern baldness at age 45 years with overall and aggressive prostate cancer risk in a large, prospective cohort–the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Methods: We included 39,070 men, from the usual care and screening arms of the trial, who were cancer-free at start of follow-up. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) were estimated using Cox proportional hazards regression models with age as the underlying time-scale. Results: During follow-up (median=2.78 years), 1,138 incident prostate cancer cases were diagnosed, 578 of which were aggressive (Gleason score ≥ 7, stage ≥ III, or fatal). Frontal + vertex balding at age 45 years, compared with no balding, was not associated with overall prostate cancer risk (HR=1.19, 95%CI: 0.98, 1.45), but was associated with increased risk of aggressive prostate cancer (HR=1.42, 95%CI: 1.10, 1.83). Adjustment for covariates did not significantly alter these estimates. Other classes of male pattern baldness were not associated with the overall or aggressive prostate cancer. Conclusion: Our analysis indicates that frontal + vertex balding at age 45 years increases the risk for future development of aggressive prostate cancer, and supports the possibility of overlapping pathogenesis. Citation Format: Cindy Ke Zhou, Ruth M. Pfeiffer, Sean D. Cleary, Heather J. Hoffman, Paul H. Levine, Lisa W. Chu, Ann W. Hsing, Michael B. Cook. Male pattern baldness increases the risk of aggressive prostate cancer: A prospective analysis of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3260. doi:10.1158/1538-7445.AM2014-3260
Effects of a Behavioral Weight Loss Program Stressing Calorie Restriction Versus Calorie Plus Fat Restriction in Obese Individuals With NIDDM or a Family History of Diabetes
Authors: Randy W Pascale, Rena R Wing, Betsy A Butler, Monica Mullen, Patricia Bononi
Journal: Diabetes Care (1995)

OBJECTIVE The aim of this randomized trial was to compare the effects of a behavioral intervention focusing on either calorie restriction alone or calorie plus fat restriction on weight loss and changes in lipids and glycemic control in individuals with non-insulin-dependent diabetes mellitus (NIDDM) or a family history of diabetes. RESEARCH DESIGN AND METHODS We recruited 44 obese women with NIDDM and 46 obese women with a family history of NIDDM and randomly assigned these subjects to calorie restriction (CAL) or to calorie plus fat restriction (CAL + FAT). All subjects participated in a 16-week behavioral weight loss program, with training in diet, exercise, and behavior modification. Subjects assigned to the CAL condition were given a 1,000−1,500 kcal/day goal and self-monitored calories consumed. Subjects assigned to the CAL + FAT condition had the same calorie goal, but were also given a fat goal (grams of fat/day), to produce a diet with &amp;lt; 20% of calories from fat; this group monitored both calories and fat grams. RESULTS Among NIDDM subjects, weight loss of the subjects in the CAL+FAT condition was significantly &amp;gt; subjects in the CAL condition (7.7 vs. 4.6 kg) and the CAL+FAT condition group also maintained their weight loss better at the 1-year follow-up (5.2 vs. 1.0 kg). Significant decreases in glucose, high-density lipoprotein (HDL) cholesterol, and total cholesterol were seen after 16 weeks of treatment among NIDDM subjects; these changes were similar in CAL and CAL+FAT groups, but a greater proportion of subjects in CAL condition required oral hypoglycemic medication. At the 1-year follow-up, all parameters had returned to baseline. No significant differences in weight loss or physiological changes were seen between CAL and CAL+FAT conditions in subjects with a family history of diabetes. CONCLUSIONS These results suggest that using the combination of calorie and fat restriction may help promote weight loss in obese NIDDM patients. No other long-term benefits of this regimen were observed.
Brain, emotions, and emotion-cognition relations
Authors: Carroll E. Izard, Christopher J. Trentacosta, Kristen A. King
Journal: Behavioral and Brain Sciences (2005)

Lewis makes a strong case for the interdependence and integration of emotion and cognitive processes. Yet, these processes exhibit considerable independence in early life, as well as in certain psychopathological conditions, suggesting that the capacity for their integration emerges as a function of development. In some circumstances, the concept of highly interactive emotion and cognitive systems seems a viable alternative hypothesis to the idea of systems integration.
Predicting bacterial cause in infectious conjunctivitis: Why say itching counts against bacterial infection in conjunctivitis?
Authors: Richard L Davies
Journal: BMJ (2004)

EDITOR—The development of clinical rules that are easy to use to help discriminate between bacterial and culture negative acute conjunctivitis would be welcomed in primary care, but are the three simple questions proposed by Rietveld et al the right questions?1 One large problem is the use of itching to …
An agitated young man
Authors: F. Mann, A. Sobel
Journal: BMJ (2010)

A 23 year old Afro-Caribbean man was brought to the accident and emergency department by his mother. He had a known diagnosis of schizophrenia, which was managed with 10 mg olanzapine once a day, but he was taking no other drugs, had no allergies, and had no other medical history. His mother said that he was normally fully oriented, independent for activities of daily living, and enjoyed attending his part time IT skills course. He was usually amiable and calm, but she had noticed a change in his behaviour over the past 12 hours. She described him as being confused and agitated. He refused to leave the house the day before and had been reluctant to come to the hospital. She confirmed that he takes his daily drugs but said that he looked “a bit shaky.” 

On examination the patient was disoriented, was able to localise pain (Glasgow coma scale 13/15), and was sweating. He had a fever (38°C), tachycardia (100 beat/min), and a generalised increase in muscle tone. His urine drug screen was negative for all illicit substances and he had no history of alcohol intake. He had a raised white cell count and raised creatinine kinase (2500 IU/l; normal range in men 25-195 IU/l). No clear focus of infection was evident, and he had not recently travelled abroad.



### 1 What “psychiatric emergency” matches this presentation?

#### Short answer

The most likely diagnosis is neuroleptic malignant syndrome. The differential diagnosis should include encephalitis or meningitis, rhabdomyolysis, catatonia, drug toxicity, delirium tremens, serotonergic syndrome, and tetanus.

#### Long answer

The most likely diagnosis is neuroleptic malignant syndrome, which is a rare life threatening idiosyncratic reaction to psychotropic drugs, …