tbuckley/cabot-search huggingface dataset:
Trend spotting: fashions in medical education
Authors: J. K Campbell, C. Johnson
Journal: BMJ (1999)

This article explores the nature of fashions in medical education and identifies some of the questions about medical education that such fashions raise. What constitutes a fashion in a professional or academic discipline? What do such “fashions” contribute, both positively and negatively, to the development of medical education? What steps can practitioners and academics in medical education take to change a trend into an important step forward in the development of a discipline?

We define a fashion in medical education as an approach to education that is based primarily on social influences, in contrast to approaches based on established educational principles and theories, critically evaluated experiences, or the results of valid research. An analogy is the distinction between fashion in clothes (colour and style) and the quality and functionality of clothing (material and comfort). We chose multiprofessional learning and multimedia computer aided learning as case studies, and we illustrate why each should currently be characterised as a fashion rather than informed practice. Both have received attention internationally in medical curriculum reform. 1 2

### Summary points

A Medline search was conducted and all available abstracts of articles addressing multimedia computer aided learning (n=258) and multiprofessional learning (n=92) written in 1985-98 were collected. Abstracts were qualitatively analysed to generate categories that could be used to classify each abstract for comparative analysis. Categories included type of publication, relevance of the publication to practice, the presence of and perceived educational rationale informing the publication, and the author's portrayal (as …
Planning and control in action
Authors: Scott Glover
Journal: Behavioral and Brain Sciences (2004)

The views expressed in the commentaries challenge many of the tenets of the planning–control model as espoused in the target article. This response is aimed at addressing the most serious of these challenges as well as clarifying errors of interpretation. It is argued that the majority of the challenges from brain and behavior, although meritorious, can nonetheless be incorporated within the planning–control model. It is concluded that only some minor revision of the model with regard to anatomy is necessary at this time.
Differing Phenotypes between Intraepithelial and Stromal Lymphocytes in Early-Stage Tongue Cancer
Authors: Fuminori Katou, Haruo Ohtani, Yoshiko Watanabe, Takashi Nakayama, Osamu Yoshie, Kenji Hashimoto
Journal: Cancer Research (2007)

The significance of tumor-infiltrating lymphocytes (TIL) has attracted much attention in relation to the prognosis of patients. We herein examined the activation status of the TILs in relation to the tumor microenvironment. By using frozen sections of human early-stage tongue cancers (n = 22), the TILs in the cancer nests and those in the cancer stroma were compared for the expression of PD-1, NKG2A, NKG2D, CD69, and Ki-67. The lymphocytes in oral lichen planus, an active immune response-mediated mucosal disease, were also analyzed for comparison purposes. All of the cancer specimens were abundantly infiltrated by CD8(+) T cells and CD56(+) natural killer (NK) cells in the stroma, as well as in the tumor nest. The tumor nest-infiltrating (intraepithelial) CD8(+) T cells frequently expressed PD-1, an inhibitory receptor, in sharp contrast to those in the stroma or in the lichen planus. Conversely, the intraepithelial CD8(+) T cells only infrequently expressed NKG2D, an activating receptor, in contrast to those in the stroma or in the lichen planus. No intraepithelial CD8(+) T cells expressed Ki-67, a proliferation-associated marker, whereas those in the stroma frequently expressed it. Furthermore, the intraepithelial NK cells expressed NKG2A, an inhibitory receptor, more frequently than those in the stroma or the lichen planus. Collectively, the intraepithelial CD8(+) T cells and NK cells are phenotypically inactivated, whereas stromal counterparts are phenotypically just as active as those in the lichen planus. These results suggest the first-step occurrence of an immune evasion mechanism in the tumor nest of oral squamous cell carcinoma.
Impact of Pramlintide on Glucose Fluctuations and Postprandial Glucose, Glucagon, and Triglyceride Excursions Among Patients With Type 1 Diabetes Intensively Treated With Insulin Pumps
Authors: Claresa Levetan, Laura L. Want, Christian Weyer, Susan A. Strobel, John Crean, Yan Wang, David G. Maggs, Orville G. Kolterman, Manju Chandran, Sunder R. Mudaliar, Robert R. Henry
Journal: Diabetes Care (2003)

OBJECTIVE—To assess the effects of adjunctive treatment with pramlintide, an analog of the β-cell hormone amylin, on 24-h glucose fluctuations and postprandial glucose, glucagon, and triglyceride excursions in patients with type 1 diabetes intensively treated with continuous subcutaneous insulin infusion (CSII). RESEARCH DESIGN AND METHODS—In this study, 18 patients (16 of whom could be evaluated) with type 1 diabetes (age 44 ± 11 years, HbA1c 8.2 ± 1.3% [mean ± SD]) were given mealtime injections of 30 μg pramlintide t.i.d. for 4 weeks in addition to their preexisting CSII regimen (16 lispro, 2 regular insulin). Mealtime insulin boluses were reduced by a minimum of 10% during the first 3 days, and re-adjusted thereafter based on clinical judgment. At weeks 0 (baseline), 4 (on treatment), and 6 (2 weeks off treatment), 24-h interstitial glucose concentrations were measured using a continuous glucose monitoring system (CGMS), and postprandial plasma glucose, glucagon, and triglyceride concentrations were measured in response to a standardized test meal. RESULTS—At baseline, patients had excessive 24-h glucose fluctuations, with 59% of the CGMS measurements &amp;gt;140 mg/dl, 13% &amp;lt;80 mg/dl, and only 28% in the euglycemic range (80–140 mg/dl). After 4 weeks on pramlintide, measurements in the hyperglycemic range declined to 48% and measurements within the euglycemic range increased to 37%. This shift from the hyperglycemic to the euglycemic range occurred with a concomitant 17% reduction in mealtime insulin dosages and without relevant increases in measurements below the euglycemic range (15%) or any severe hypoglycemic events. After 4 weeks on pramlintide, postprandial glucose, glucagon, and triglyceride excursions were reduced by ∼86, ∼87, and ∼72%, respectively (incremental areas under the curve, all P &amp;lt; 0.05 vs. baseline). At week 6 (off treatment), the 24-h glucose profile and postprandial glucose, glucagon, and triglyceride excursions approached pretreatment values. CONCLUSIONS—In this study, the addition of pramlintide to insulin therapy reduced excessive 24-h glucose fluctuations as well as postprandial glucose, glucagon, and triglyceride excursions in patients with type 1 diabetes intensively treated with insulin pumps.
Unusual expression of mRNA typical of Philadelphia positive acute lymphoblastic leukemia detected in chronic myeloid leukemia
Authors: Judy A. Kirk, Jerald Radich, Scott Edmands, Arthur Lee, Donald R. VanDevanter, Jo Anna Reems, Eileen M. Bryant
Journal: American Journal of Hematology (1996)

The Philadelphia chromosome (Ph) is found in both chronic myeloid leukemia (CML) and acute lymphoblastic leukemia (ALL). The Ph translocation, t(9;22)(q34;q11), can disrupt the BCR gene on chromosome 22 in one to two areas called the major (Mbcr1) and minor (mbcr1) breakpoint cluster regions. In CML the breakpoint has been mapped almost exclusively to Mbcr1, whereas in Ph positive ALL both Mbcr1 and the upstream mbcr1 breakpoints have been described. In this communication we describe an unusual patient with typical chronic phase Ph positive CML and evidence of the uncharacteristic mbcr1 breakpoint, predicting expression of the ALL-type p190 fusion protein. Fluorescence in situ hybridization demonstrated BCR gene rearrangement, the reverse transcription polymerase chain reaction detected the BCR-ABL fusion mRNA characteristic of the mbcr1 breakpoint, and failed to detect BCR-ABL mRNA characteristic of the Mbcr1 breakpoint. Southern blot analysis revealed no rearrangement in Mbcr1, and direct sequencing of the PCR product confirmed it to be the ALL-type mbcr1 fusion mRNA with the first exon of the BCR gene fused to ABL exon a2. This case differs from the previously reported cases of “p190” CML in that the patient presented without abnormal hematopoietic features other than those found in typical CML and provides further evidence that the p190 mRNA is not sufficient to cause an acute rather than chronic leukemia. © 1996 Wiley-Liss, Inc.
UPPER GASTRO-INTESTINAL DISEASE ASSOCIATED WITH SYPHILIS
Authors: H. L. BOCKUS
Journal: JAMA (1928)

During the past three years we have studied twenty-three patients with pathologic manifestations at the upper end of the digestive tube in which the possibility of gastro-intestinal syphilis had to be considered. It is the opinion of most students of syphilis that the disease rarely involves the gastro-intestinal tract. Stokes and Brown 1 found gastric syphilis in only 4 per cent of 200 syphilitic patients whose chief complaint was stomach trouble. Symmers, 2 in reviewing 4,880 necropsies at Bellevue, reported only one case of gastric syphilis (Pappenheimer's case). Chiari 3 reports finding two cases of gastric syphilis in a series of 243 autopsies on syphilitic patients. McNeil, 4 in a series of 1,200 persons with syphilis, found ninety-seven complaining of gastric symptoms, which arose from gastric syphilis in only three. Hartwell 5 states that approximately 200 cases are reported in the literature. He is of the opinion that a great
Systemic and intrahepatic interferon-gamma-inducible protein 10 kDa predicts the first-phase decline in hepatitis C virus RNA and overall viral response to therapy in chronic hepatitis C
Authors: Galia Askarieh, Åsa Alsiö, Paolo Pugnale, Francesco Negro, Carlo Ferrari, Avidan U. Neumann, Jean-Michel Pawlotsky, Solko W. Schalm, Stefan Zeuzem, Gunnar Norkrans, Johan Westin, Jonas Söderholm, Kristoffer Hellstrand, Martin Lagging
Journal: Hepatology (2009)

High systemic levels of interferon-gamma-inducible protein 10 kDa (IP-10) at onset of combination therapy for chronic hepatitis C virus (HCV) infection predict poor outcome, but details regarding the impact of IP-10 on the reduction of HCV RNA during therapy remain unclear. In the present study, we correlated pretreatment levels of IP-10 in liver biopsies (n = 73) and plasma (n = 265) with HCV RNA throughout therapy within a phase III treatment trial (DITTO-HCV). Low levels of plasma or intrahepatic IP-10 were strongly associated with a pronounced reduction of HCV RNA during the first 24 hours of treatment in all patients ( P &lt; 0.0001 and P = 0.002, respectively) as well as when patients were grouped as genotype 1 or 4 ( P = 0.0008 and P = 0.01) and 2 or 3 ( P = 0.002, and P = 0.02). Low plasma levels of IP-10 also were predictive of the absolute reduction of HCV RNA ( P &lt; 0.0001) and the maximum reduction of HCV RNA in the first 4 days of treatment ( P &lt; 0.0001) as well as sustained virological response (genotype 1/4; P &lt; 0.0001). To corroborate the relationship between early viral decline and IP-10, pretreatment plasma samples from an independent phase IV trial for HCV genotypes 2/3 (NORDynamIC trial; n = 382) were analyzed. The results confirmed an association between IP-10 and the immediate reduction of HCV RNA in response to therapy ( P = 0.006). In contrast, pretreatment levels of IP-10 in liver or in plasma did not affect the decline of HCV RNA between days 8 and 29, i.e., the second-phase decline, or later time points in any of these cohorts. Conclusion: In patients with chronic hepatitis C, low levels of intrahepatic and systemic IP-10 predict a favorable first-phase decline of HCV RNA during therapy with pegylated interferon and ribavirin for genotypes of HCV. (Hepatology 2010.)
Patient-Level Meta-analysis: Effect of Measurement Timing, Threshold, and Patient Age on Ability of<scp>d</scp>-Dimer Testing to Assess Recurrence Risk After Unprovoked Venous Thromboembolism
Authors: James Douketis, Alberto Tosetto, Maura Marcucci, Trevor Baglin, Mary Cushman, Sabine Eichinger, Gualtiero Palareti, Daniela Poli, R. Campbell Tait, Alfonso Iorio
Journal: Annals of Internal Medicine (2010)

This article has been corrected. The original version (PDF) is appended to this article as a supplement. Background: In patients with a first unprovoked venous thromboembolism (VTE), an elevated d-dimer level after anticoagulation is stopped is a risk factor for recurrent VTE. However, questions remain about the utility of measuring d-dimer in clinical practice. Purpose: To determine whether the timing of testing, patient age, and the cut point used to define a positive or negative result affect the ability of d-dimer testing to distinguish risk for recurrent disease. Data Sources: Comprehensive search of electronic databases (MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials) until July 2010, supplemented by reviewing conference abstracts and contacting content experts. Study Selection: 7 prospective studies that investigated an association between d-dimer, measured after stopping anticoagulation, and disease recurrence in patients with a first unprovoked VTE (proximal deep venous thrombosis, pulmonary embolism, or both). Data Extraction: Patient-level databases were obtained, transferred to a central database, checked, completed with further information provided by study investigators, and pooled into a single database. Data Synthesis: 1818 patients with a first unprovoked VTE were followed for a mean of 26.9 months (SD, 19.1). A study-stratified multivariate Cox regression model, which included patient age, sex, hormone therapy use at the time of the index event, body mass index, timing of postanticoagulation d-dimer testing, and inherited thrombophilia as possible confounders, indicated that the hazard ratio for d-dimer status (positive vs. negative) was 2.59 (95% CI, 1.90 to 3.52). Only male sex had a significant effect on risk for recurrent VTE independent of d-dimer status. The Cox regression model and the log-rank test confirmed that the risk for recurrent VTE was higher in patients with a positive d-dimer result than in those with a negative result, regardless of the timing of postanticoagulation d-dimer testing or patient age. No study- or assay-specific d-dimer effect was found, and reassessing the analysis after recoding data according to specific quantitative d-dimer cut points (500 µg/L and 250 µg/L) did not change the results. Limitations: Unmeasured variables could have affected the risk for recurrent VTE. The study population was predominantly white. Conclusion: In patients with a first unprovoked VTE who have their d-dimer level measured after stopping anticoagulation, the timing of d-dimer testing, patient age, and the assay cut point used do not affect the ability of d-dimer to distinguish patients with a higher or lower risk for recurrent VTE. Primary Funding Source: None.
A "DIVINE HEALER"
Authors: G. E. Learmonth
Journal: JAMA (1923)

<h3>To the Editor:</h3> —Some weeks ago the associate secretary of the Alberta Medical Association wired your secretary for information concerning the Rev. "Dr." C. S. Price, "Divine Healer," who lays claim to California as his place of residence. Your secretary replied that he could give no data regarding him. In some way this man has been able to secure the cooperation of ministers and religious organizations to aid and abet him in his practices. Under the guise of religion, he attempts to cure "the lame, the halt and the blind" as well as those with serious organic diseases, calling to his aid hypnotism pure and unadulterated. I may say that he will not admit that it is hypnotic power, but places the onus on the intervention of the Lord. In many cases, as might be surmised, the results have been disastrous. From official sources in Vancouver, I learn that, following
Effect of nicotinamide on the phototest reaction in polymorphous light eruption
Authors: B. ORTEL, DANIELA WECHDORN, A. TANEW, H. HONIGSMANN
Journal: British Journal of Dermatology (1988)

The effect of nicotinamide on the phototest response was investigated in 14 patients suffering from polymorphous light eruption (PMLE). In contrast to the favourable effect in the prevention of PMLE reported by other groups, oral nicotinamide did not affect the phototesting results in our patients.
Modern Psychiatric Treatment
Authors: H. Keith Fischer
Journal: JAMA (1971)

The authors present their psychiatric regimen. This is applied to all categories of the American Psychiatric Association Diagnostic and Statistical Manual. The approach evolves from a Kraepelinian base, but expands to classify and schematize symptoms seen as manifestations of socioadaptive dysfunction, and of psychobiological dysfunction. In the latter, sleep disturbance is given unique and interesting emphasis. These symptoms, varyingly manifested in all diagnostic categories, are then the focus of treatment efforts. Treatment is outlined with the assistance of excellent tables and charts. "Pharmacotherapy constitutes most of what is modern and effective in contemporary psychiatry, and [since] empathy and common sense— psychotherapy's most essential ingredients—can not in our opinion be conveyed by the printed page, we discuss drug treatment in greater detail. ..." Apparently referring to dynamic psychotherapy and such things as instincts, unconscious, and things freudian (only two references to Freud and these dated 1900), they "avoid speculations about etiology that
Cortisone Treatment of the Low-salt Syndrome
Authors: I. G. Graber, P. Beaconsfield, O. Daniel
Journal: BMJ (1956)

Our incidence of toxaemia was only 6.1 O', compared with their 14.8?%o.We are unable to give a satisfactory explana- tion of this difference.Our stricter criterion with regard to weight gain has not altered the incidence to any appreciable extent, but our wider selection of women booked for delivery may have contributed significantly to the difference.With regard to the close association between toxaemia of pregnancy and essential hypertension, it is interesting to note that Maxwell and Maxwell (1955) found no significant altera- tion in the distribution of the blood groups in the latter condition. SummaryThe distribution of blood groups has been examined in a series of 11,086 pregnant women, 675 of whom developed toxaemia of pregnancy.There was no significant difference in the distribution of ABO blood groups in the toxaemic as compared with the non-toxaemic group of women.We are indebted to Dr.
Well-Being Therapy in School Settings: A Pilot Study
Authors: Chiara Ruini, Carlotta Belaise, Chiara Brombin, Ernesto Caffo, Giovanni A. Fava
Journal: Psychotherapy and Psychosomatics (2006)

&lt;i&gt;Background:&lt;/i&gt; There is increasing interest in the psychobiological mechanisms of resilience and psychological well-being. It is conceivable that activation of such mechanisms in the school setting may entail long-term benefits, both in terms of the developmental process and of prevention of distress. This study wants to apply and test the efficacy of a school-based intervention protocol derived from well-being therapy (WBT) compared to cognitive-behavioral strategies. &lt;i&gt;Methods:&lt;/i&gt; School interventions were performed in a population of 111 students randomly assigned to: (a) a protocol using theories and techniques derived from cognitive-behavioral therapy; (b) a protocol derived from WBT. Assessment before and after interventions was performed using two self-rating scales: Kellner’s Symptom Questionnaire and Ryff’s Psychological Well-Being Scales. &lt;i&gt;Results:&lt;/i&gt; Both school-based interventions resulted in a comparable improvement in symptoms and psychological well-being. &lt;i&gt;Conclusions:&lt;/i&gt; This new well-being-enhancing strategy could play an important role in the prevention of psychological distress in school settings and in promoting optimal human functioning among children.
1191 LOW RATE OF ON-TREATMENT RESISTANCE TO DANOPREVIR BOOSTED BY RITONAVIR (DNVR) COMBINED WITH PEG-IFNa-2A/RIBAVIRIN: 12 WEEK INTERIM ANALYSIS FROM DAUPHINE STUDY
Authors: S. Le Pogam, M. Navarro, L. Bu, A. Voulgari, M. Illnicka, J.M. Yan, K. Klumpp, I. Nájera
Journal: Journal of Hepatology (2012)
Secondary decline of cerebral autoregulation is associated with worse outcome after intracerebral hemorrhage
Authors: Matthias Reinhard, Florian Neunhoeffer, Thomas A. Gerds, Wolf-Dirk Niesen, Klaus-Juergen Buttler, Jens Timmer, Bernhard Schmidt, Marek Czosnyka, Cornelius Weiller, Andreas Hetzel
Journal: Intensive Care Medicine (2009)
Diagnostic accuracy of tumour markers for malignant pleural effusion: a meta-analysis
Authors: Q-L Liang, H-Z Shi, X-J Qin, X-D Liang, J Jiang, H-B Yang
Journal: Thorax (2007)

Background: The role of tumour markers such as carbohydrate antigen (CA) 125, CA 15-3, CA 19-9 and CYFRA 21-1 (a fragment of cytokeratin 19) in differentiating malignant pleural effusions (MPE) from benign effusions is not yet clear. Methods: After a systematic review of English language studies, sensitivity, specificity and other measures of accuracy of pleural concentrations of CA 125, CA 15-3, CA 19-9 and CYFRA 21-1 or their combinations in the diagnosis of MPE were pooled using random effects models. Summary receiver operating characteristic curves were used to summarise overall test performance. Results: Twenty-nine studies met the inclusion criteria for the analysis. The summary estimates of the sensitivity and specificity of these tumour markers were as follows: CA 125, 0.48/0.85; CA 15-3, 0.51/0.96; CA 19-9, 0.25/0.96; CYFRA 21-1, 0.55/0.91 for diagnosing MPE. The estimated summary receiver operating characteristic curves showed that the performance of pleural CA 125 and CA 19-9 measurement in the diagnosis of MPE was limited, whereas that of CA 15-3 and CYFRA 21-1 was better. When two or more of the above four tumour markers were combined, or combined with carcinoembryonic antigen, the sensitivity and specificity were all increased to different extents. Conclusions: The current evidence does not recommend using one tumour marker alone for the diagnosis of MPE, but the combination of two or more tumour markers seems to be more sensitive. The results of tumour marker assays should be interpreted in parallel with clinical findings and the results of conventional tests.
Dose related in vitro effects of ranitidine and cimetidine on basal and ACTH-stimulated steroidogenesis.
Authors: C J Kenyon, R Fraser, G G Birnie, J M Connell, A F Lever
Journal: Gut (1986)

Isolated bovine adrenocortical cells were incubated with and without 3 ng/ml ACTH, with various concentrations (10-1000 micrograms/ml) of either cimetidine or ranitidine. Cortisol, corticosterone, and deoxycorticosterone outputs were measured. Cimetidine and ranitidine at 320 and 1000 micrograms/ml inhibited ACTH-stimulated corticosterone and cortisol synthesis and cimetidine decreased basal cortisol synthesis. The inhibitory effects of cimetidine on cortisol synthesis were approximately 10 times greater than those of ranitidine. Cimetidine (1000 micrograms/ml), but not ranitidine increased deoxycorticosterone synthesis by ACTH-stimulated cells, indicating inhibition of 11 beta-hydroxylation in the adrenal steroidogenic pathway. Although doses of cimetidine and ranitidine which produce these in vitro effects are much greater than plasma concentrations in normal clinical use, they might be important in acutely ill patients given intravenous bolus injections of cimetidine, or if either antagonist were accumulated by the adrenal to produce high intracellular concentrations.