tbuckley/cabot-search huggingface dataset:
Efficacy of BIBF 1120 in patients with IPF is dose-dependent: Results from the TOMORROW trial
Authors: Ulrich Costabel, Luca Richeldi, Moises Selman, Dong Soon Kim, Kevin K. Brown, Kevin R. Flaherty, Paul W. Noble, Ganesh Raghu, Michèle Brun, Abhya Gupta, Matthias Klueglich, Nolwenn Juhel, Roland M. du Bois
Journal: European Respiratory Journal (2011)

Background:  BIBF 1120 is an inhibitor of tyrosine kinase receptors involved in lung fibrosis progression.   Methods:  The TOMORROW trial was a 12-month, placebo (PBO)-controlled study to investigate efficacy and safety of BIBF 1120 (50 mg, 100 mg, 200 mg, 300 mg per day) in IPF (∼85 pts per group). Annual rate of decline in forced vital capacity (FVC) was measured.   Results:  FVC decline decreased from 0.17 L/year (50 mg) to -0.06 L/year (300 mg) vs 0.19 L/year in PBO (300 mg vs PBO: p=0.014; closed-testing multiplicity-corrected: p=0.064). Absolute changes from baseline in% pred FVC were -6.00, -4.58, -4.90, -3.15 and -1.04% in PBO and rising dose groups (200 mg: p=0.031; 300 mg: p=0.0002).  Absolute difference of% change in SpO2 was superior vs PBO by 0.44, 0.33, 1.36 and 1.12% for rising doses (200 mg: p=0.005; 300 mg: p=0.021). Incidence of acute exacerbations fell with dose (15.67, 13.03, 12.46, 7.46 and 2.44 per 100 patient years for PBO and rising doses). Gastrointestinal adverse events (AEs) increased with dose (31.8%, 38.4%, 36.0%, 57.0% and 74.1% in PBO and rising doses). AEs leading to discontinuation occurred in 25.9%, 23.3%, 16.3%, 14.0% and 30.6% of pts in PBO and rising dose groups. Fatal AEs (on-treatment) fell with dose (12, 10, 4, 5 and 1 pts for PBO and rising doses).   Conclusion:  Treatment of IPF with BIBF 1120 reduced decline in lung function and incidence of acute exacerbations in a dose-dependent way.
Psychiatry at a crossroad: our role in primary care
Authors: J H Shore
Journal: American Journal of Psychiatry (1996)

The shortage of primary care physicians is seen as an urgent health systems priority and is supported by a national consensus. Psychiatry is at a crossroad and must reevaluate the profession's role in primary care. This article supports the position that psychiatrists need to be able to medically evaluate and to provide basic primary medical care for seriously mentally ill patients who do not have adequate access to general health care. Many of the seriously mentally ill are difficult to treat when they contact a medical care provider. Because of their psychiatric symptoms, they often are unlikely to receive adequate medical care. Psychiatrists frequently are the only physicians with whom they have consistent contact.This article contains a proposal for a new initiative to broaden the role of public psychiatrists to include a primary care role. In addition, new opportunities for dual or triple board certification are reviewed.A new curricular model for primary care training in general psychiatry programs is outlined. The new curriculum would include training for diagnostic and primary care skills to prepare psychiatrists to provide basic primary medical services for the chronically mentally ill.The new curricular proposal would create an elective psychiatry primary care track. This is possible within current accreditation requirements. Psychiatric residents could receive primary care training throughout their residency.
Cuba is first country to eliminate mother to child HIV transmission
Authors: Anne Gulland
Journal: BMJ (2015)

Cuba has become the first country to receive validation from the World Health Organization for having eliminated mother to child transmission of HIV and syphilis.

In 2010 all countries of the Americas, including the United States and Canada, committed to eliminating mother to child transmission of these two diseases by 2020. Cuba has been the first to officially achieve that goal, but another 30 countries in the region are close, said Carissa Etienne, director of the Pan American Health Organization, at a press conference to announce Cuba’s success.

To achieve official recognition Cuba had to show for at least one year that new infections from mother to child transmission of HIV had fallen below 50 cases in 100 000 live births and …
Gastrointestinal Complications of Mycosis Fungoides
Authors: David N Slater, Stanley S Bleehen, Stephen Beck
Journal: Journal of the Royal Society of Medicine (1984)

Mycosis fungoides (MF) is an uncommon T-cell lymphoma which characteristically involves the skin. Two patients with MF are described who developed fatal complications secondary to involvement of the gastrointestinal tract. One developed malabsorption due to small intestinal involvement; the other had a massive haemorrhage from an ulcerated nodule of tumour in the stomach. The potential for extracutaneous spread is discussed, and it is emphasized that bowel infiltration should be considered in any patient with MF who develops gastrointestinal symptoms or complications.
NCCN Task Force Report: Management of Neuropathy in Cancer
Authors: Michael D. Stubblefield, Harold J. Burstein, Allen W. Burton, Christian M. Custodio, Gary E. Deng, Maria Ho, Larry Junck, G. Stephen Morris, Judith A. Paice, Sudhakar Tummala, Jamie H. Von Roenn
Journal: Journal of the National Comprehensive Cancer Network (2009)

Neuropathy is a common, often debilitating complication of cancer and its treatment. Effective management of this disorder depends on early diagnosis and an understanding of its underlying causes in the individual patient. In January 2009, NCCN gathered a multidisciplinary group to review the literature and discuss intervention strategies currently available to patients as well as areas that require research efforts. The task force, which comprised experts in anesthesiology, medical oncology, neurology, neuro-oncology, neurophysiology, nursing, pain management, and rehabilitation, was charged with the goal of outlining recommendations for the possible prevention, diagnosis, and management of neuropathy. This report documents the proceedings of this meeting with a general background on neuropathy and neuropathy in oncology, followed by discussions on challenges and research issues, evaluation criteria, and management of different symptoms associated with this disorder.
Necessity for Inpatient Services in Neurological Practice<sup>1</sup>
Authors: G D Perkin
Journal: Journal of the Royal Society of Medicine (1983)

An analysis has been performed of the case material referred to a single neurologist in one year, including outpatient referrals, ward referrals and those patients admitted directly from other hospitals or from general practitioners. A summary of diagnoses, reasons for admission and duration of stay is included. It is concluded that some 6 inpatient beds sufficed for their investigation and management.
Cross-sectional and Longitudinal Associations Between Objectively Measured Sedentary Time and Metabolic Disease: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Bethany Barone Gibbs, Kelley Pettee Gabriel, Jared P. Reis, John M. Jakicic, Mercedes R. Carnethon, Barbara Sternfeld
Journal: Diabetes Care (2015)

OBJECTIVE Prolonged sedentary time (ST) might be contributing to the diabetes epidemic, but most studies have been cross-sectional and few have objectively measured ST. The purpose of this study was to evaluate cross-sectional and 5-year longitudinal relationships between ST and metabolic parameters and outcomes. RESEARCH DESIGN AND METHODS This was an analysis of 2,027 Coronary Artery Risk Development in Young Adults (CARDIA) study participants (aged 38–50 years, 57% female, and mean BMI of 29.0 ± 7.0 kg/m2) with accelerometry data (≥4 days with ≥10 h/day) measured at the year 20 follow-up exam (2005–2006). Metabolic variables (fasting glucose, fasting insulin, 2-h postchallenge glucose, HOMA of insulin resistance [HOMA-IR], and HbA1c) and outcomes (impaired fasting glucose [IFG], impaired glucose tolerance [IGT], prediabetes by HbA1c, and diabetes) were assessed concurrently and 5 years later. RESULTS Average ST was 8.1 ± 1.7 h/day or 55 ± 10% of wear time. Each additional hour per day of ST was cross-sectionally associated with a 3% higher fasting insulin and HOMA-IR (both P &amp;lt; 0.01) but not 5-year changes in metabolic parameters. Having ≥10 h/day vs. &amp;lt;6 h/day of ST was associated with an odds ratio (OR) = 2.74 (95% CI 1.13, 6.62) for IGT and an OR = 3.80 (95% CI 1.39, 10.35) for diabetes. ST was not associated with prevalent IFG, prevalent prediabetes by HbA1c, or 5-year incidence of any metabolic outcomes (all P &amp;gt; 0.05). CONCLUSIONS ST was independently related to insulin, HOMA-IR, and prevalent diabetes and IGT but did not predict 5-year changes in metabolic parameters or incidence of metabolic outcomes. These results suggest that higher ST may not be a risk factor for future metabolic outcomes, but more research with repeated ST measurement and longer follow-up is needed.
Infectious Complications Associated With Immunomodulating Monoclonal Antibodies Used in the Treatment of Hematologic Malignancy
Authors: Sophia Koo, Lindsey R. Baden
Journal: Journal of the National Comprehensive Cancer Network (2008)

Immunomodulating monoclonal antibodies are a relatively new addition to the armamentarium of cancer therapeutics and have been shown to improve clinical outcomes in patients with various hematologic malignancies. Because of their targeted nature, these agents are often believed to be less immunosuppressive than standard cytotoxic chemotherapeutic agents. A clear causal association between an immunomodulating therapy and its infectious sequelae is often difficult to discern because of the burden of comorbid illness, intrinsic immunosuppression from the underlying malignancy, use in the salvage setting, and prior and concomitant use of immunosuppressive agents in this patient population. This article evaluates better-established and anecdotal infectious complications associated with major immunomodulating therapies used in hematologic malignancy and hematopoietic stem cell transplantation, including rituximab, alemtuzumab, gemtuzumab ozogamicin, infliximab, dacluzimab, and basiliximab.
Increases in the occurrence of asthma and respiratory symptoms in Polish children over the last 21 years
Authors: Grzegorz Brozek, Jan Zejda, Dawid Szumilas, Agnieszka Jarosinska, Agnieszka Idzik, Weronika Bulska, Magdalena Bonk
Journal: European Respiratory Journal (2014)

Background: Recent results suggest that trends in the frequency of asthma and respiratory symptoms depend on the region studied.

Aim: The aim of this study was to analyze temporal trends in the frequency of respiratory symptoms and associated diseases over the past 21 years in school children from Silesia, Poland.

Methods: We compared the results of four population-based surveys performed in the town of Chorzow in 1993, 2002, 2007 and 2014 in children aged 7-10 years. All four studies had the same study protocol, recruitment (cluster, school-based sampling), questionnaire (WHO respiratory health questionnaire), and principal investigator The surveys included 1130 children in 1993, 1421 children in 2002, 1661 children in 2007 and 1698 in 2014.

Results: The results, covering a 21 year span, showed a statistically significant (p<0.05) increase in the prevalence of asthma and spastic bronchitis diagnosed by physician as well as attacks of dyspnea and symptoms induced by exercise (wheeze, dyspnea, cough).

View this table:



Conclusions: Our findings are in line with the concept of a real increase in the occurrence of asthma, in children. The pattern involves not only physician-diagnosed allergic diseases but also occurrence of symptoms related to respiratory disorders.
Reversing hard won victories in the name of human rights: a critique of the General Comment on Article 12 of the UN Convention on the Rights of Persons with Disabilities
Authors: Melvyn Colin Freeman, Kavitha Kolappa, Jose Miguel Caldas de Almeida, Arthur Kleinman, Nino Makhashvili, Sifiso Phakathi, Benedetto Saraceno, Graham Thornicroft
Journal: The Lancet Psychiatry (2015)
Robustness of the 16-gene signature for prediction of recurrence-free interval in localized clear cell renal cell carcinoma.
Authors: Bernard J. Escudier, Serge Koscielny, Tara Maddala, Christer Svedman, Virginie Verkarre, Camelia Radulescu, Yann Neuzillet, Marc Olivier Timsit, Isabelle Hemmerlé, Athanasios C. Tsiatis, Michael Bonham, Dejan Knezevic, Jean-Francois Martini, James Andrew Williams, Thierry Lebret, Audrey D. Goddard, Arnaud Mejean
Journal: Journal of Clinical Oncology (2015)

455 Background: The Renal Cancer assay is a clinically validated RT-PCR assay developed to estimate the risk of recurrence in stage I-III clear cell renal cell carcinoma (ccRCC) patients (pts) treated with nephrectomy. The assay measures expression of 16 genes that are combined to calculate the Recurrence Score result (RS). The RS is associated with recurrence, renal cancer-specific survival and overall survival (all p&lt;0.001) (Escudier, ASCO 2014). The performance of the RS in clinically relevant subgroups, compared to the Leibovich score, and its within-patient variability was examined. Methods: The algorithm, endpoints, methods, and analysis plan were pre-specified prior to merging clinical and molecular data. RT-PCR of RNA from fixed paraffin-embedded ccRCC tissue was performed without knowledge of clinical data. Recurrence-free internval (RFI) was analyzed using Cox regression stratified by stage with data censored at 5 years, and Kaplan-Meier methods. Multivariable models incorporating the Leibovich score were used to assess the additional contribution of the RS to prediction of recurrence. Within- and between-tumor block reproducibility was assessed in an independent study using two separate tumor blocks from 8 pts, where each block was analyzed at 3 depths. Results: RS was generated in 626/645 pts (97%): 398 stage I, 54 stage II, 174 stage III. Median follow up was 5.5 yrs. The RS was significantly associated with risk of recurrence after adjustment for the Leibovich score (HR=4.20, p&lt;0.001). Additionally, the performance of RS was similar across age groups (&lt;60, 60-70 or ≥70), gender, nephrectomy type, tumor size (≤4, 4-7 or &gt;7cm), grade, and presence/absence of invasion (all interaction p&gt;0.29). Within-patient variability in the score (std. dev. of 1.73 and 4.74 RS units for within- and between-tumor block, respectively) was lower than patient-to-patient variability (std. dev. of 15.6 in validation study). Conclusions: The 16-gene signature remains strongly associated with risk of recurrence after adjustment for the Leibovich score and performs consistently across clinically relevant subgroups. Examination of within-patient and between-patient variability indicates that the score is robust to tumor heterogeneity.
For Debate: Setting priorities: can Britain learn from Sweden?
Authors: M. McKee, J. Figueras
Journal: BMJ (1996)

The Swedish government recently published a report on priorities in health care. It was written by a cross party group of politicians and drew extensively on the views of the public, health professionals, experience of earlier local exercises in priority setting, and research based evidence. It laid down an ethical framework for approaching issues of health care rationing. Underpinning the framework are the principles of human dignity, need and solidarity, and cost efficiency. The Swedish approach thus contrasts with the British experience of many local initiatives but an absence of national political guidance. The absence of political consensus on many aspects of social policy in the United Kingdom is a major obstacle to developing an agreed ethical framework within which decision makers in the National Health Service can work.
High-Flow Nasal Oxygen Therapy for Postextubation Acute Hypoxemic Respiratory Failure
Authors: Christophe Girault, Antoine Rabbat
Journal: JAMA (2015)

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More on the Restless Legs Syndrome and Spinal Anesthesia
Authors: Birgit Högl, Claudia Trenkwalder, Werner Poewe
Journal: New England Journal of Medicine (2009)

To the Editor: In their letter about the restless legs syndrome (RLS) and spinal anesthesia (Nov. 20 issue), Crozier et al.1 report that spinal or gen­ eral anesthesia does not induce or exacerbate RLS, in contrast to the 8.7% incidence after spi­ nal anesthesia in our earlier study.2 As an expla­ nation, they suggest that we misdiagnosed RLS. In our study, RLS was diagnosed according to strict clinical criteria involving several personal interviews, whereas Crozier et al. used a ques­ tionnaire in which questions regarding RLS symp­ toms were included in a much longer list of het­ erogeneous items. Their method has not been validated for diagnosing RLS, and Crozier et al. do not detail the exact criteria they used to deter­ mine the presence or absence of RLS. Their as­ sessment did not include measures of the severity of RLS, making it impossible to conclude that “no patients had . . . worsening of preexisting symp­ toms.” In addition, no attempts were made to control for postoperative opioid use. Opioids are a well­established, effective treatment for RLS.3
L1 gene conversion or same-site transposition.
Authors: F H Burton, D D Loeb, M H Edgell, C A Hutchison
Journal: Molecular Biology and Evolution (1991)

DNA sequence analysis of the same chromosomal region from two haplotypes of Mus musculus and from the related species M. caroli and M. pahari reveals the presence of long interspersed sequence one (LINES-1, or L1) elements residing at the same nucleotide position in the two most distantly related of the species (M. musculus and M. pahari). The DNA sequence of each of these L1 elements is more similar to that of other L1 elements from its own species than to the other. Thus, the L1 sequence at each of these sites is recent with respect to the divergence of the species. This could be a result of recent gene conversion of L1 elements inherited from a common ancestor or of two recent independent L1 insertion events at the same nucleotide position in the two species. Such specificity of insertion would be quite different from the apparent randomness of other characterized L1 insertion events, such as those in the beta-globin locus. If the recent L1 sequences arose at this site by gene conversion of an ancestral L1 element, then the absence of an L1 element at this location in the M. caroli chromosome examined could arise either from its precise deletion from M. caroli or from the segregation into M. caroli of a polymorphic chromosome present in the ancestral population which was missing this L1 element.
Health care reform for Americans with severe mental illnesses: report of the National Advisory Mental Health Council
Authors: F. K. Goodwin, D. C. Alfred, J. T. Coyle, J. C. Fox, R. L. Hollings, J. S. Jackson, N. Lagomarsino, J. D. Matarazzo, J. L. McGaugh, D. P. Purpura, D. L. Shumway, G. J. Tucker, B. Healy, R. T. Suchinsky, J. A. Scaramozzino
Journal: American Journal of Psychiatry (1993)

This report was produced in response to a request by the Senate Committee on Appropriations that the National Advisory Mental Health Council prepare and submit a report on the cost of insurance coverage of medical treatment for severe mental illness commensurate with the coverage of other illnesses and an assessment of the efficacy of treatment of severe mental disorders. About 5 million Americans (2.8% of the adult population) experience severe mental disorders in a 1-year period. Treating these disorders now costs the nation an estimated $20 billion a year (with an additional $7 billion a year in nursing home costs). These costs represent 4% of total U.S. direct health care costs. When the social costs are also included, severe mental disorders exact an annual financial toll of $74 billion. This total accounts for the dollar costs of shortened lives and lost productivity, as well as the costs incurred in the criminal justice and social service systems. However, it cannot begin to account in human terms for the enormous emotional cost and pain borne by Americans with severe mental illness and by their families. Many myths and misunderstandings contribute to the stigmatization of persons with mental illness and to their often limited access to needed services. For example, millions of Americans and many policy makers are unaware that the efficacy of an extensive array of treatments for specific mental disorders has been systematically tested in controlled clinical trials; these studies demonstrate that mental disorders can now be diagnosed and treated as precisely and effectively as are other disorders in medicine. The existence of effective treatments is only relevant to those who can obtain them. Far too many Americans with severe mental illness and their families find that appropriate treatment is inaccessible because they lack any insurance coverage or the coverage they have for mental illness is inequitable and inadequate. For example, private health insurance coverage for mental disorders is often limited to 30-60 inpatient days per year, compared with 120 days or unlimited days for physical illnesses. Similarly, the Medicare program requires 50% copayment for outpatient care of mental disorders, compared with 20% copayment for other medical outpatient treatment. These inequities in both the public and private sectors can and should be overcome.(ABSTRACT TRUNCATED AT 400 WORDS)