tbuckley/cabot-search huggingface dataset:
Compensating Physicians for Telephone Calls
Authors: Richard Balon
Journal: JAMA (1995)

<h3>To the Editor.</h3> —In his excellent Commentary, Dr Sorum<sup>1</sup>proposed implementation of financial compensation for the time physicians spend talking with patients by telephone. He stated correctly that "[p]atients and third-party payers are benefiting from physicians' time and expertise." We believe that physicians also should be compensated for telephone calls with third-party payers. Those involved even marginally with managed care are quite familiar with the endless hours on the phone speaking with third-party payers. We have spent an enormous amount of time explaining the obvious, asking for more time for treatment after every third visit, and requesting rejected payments for appropriate services. All free of charge. I am sure that a payment scale for telephone calls with third-party payers would reduce significantly the amount of time we spend on the phone with them. As Sorum says, it is time for payers finally to enter the telephone age. I would
Assessing long-term treatment efficacy in chronic hepatitis B and C: Between evidence and common sense
Authors: Alessio Aghemo, Pietro Lampertico, Massimo Colombo
Journal: Journal of Hepatology (2012)

Chronic infection with the hepatitis B and C virus represents a major health problem worldwide, as it is estimated that roughly 400 and 200 million people respectively, are infected by each virus.By definition, any antiviral therapy that claims to be effective should have as its ultimate efficacy end point an improvement in patients' survival, or at least a reduction in the development rates of liver-related complications.However, this is extremely complicated to prove as the natural course of both viral diseases is extremely slow, requiring decades to evolve in cirrhosis and even more years to lead to liver complications.For this reason, clinicians and health authorities have relied on so called surrogate end points to assess the efficacy of any therapeutic intervention for viral hepatitis.Obviously, this allows for standardization in study designs that ultimately translates into an accelerated time frame for therapeutic drugs as well as healthcare innovations to enter the viral hepatitis clinical practice.However, it also calls for demonstration that surrogate end points in the treatment of patients with chronic hepatitis B or C are good and reliable markers of long-term efficacy.
Preservation of postural control of transient lower oesophageal sphincter relaxations in patients with reflux oesophagitis
Authors: A C Ireland, J Dent, R H Holloway
Journal: Gut (1999)

INTRODUCTION In normal subjects, transient lower oesophageal sphincter relaxations (TLOSRs) and gas reflux during belching are suppressed in the supine position. Supine reflux, however, is a feature of reflux disease. AIMS To investigate whether postural suppression of TLOSRs and gas reflux is impaired in patients with reflux disease. PATIENTS Ten patients with erosive oesophagitis. METHODS Oesophageal manometry was performed during gastric distension with 750 ml carbon dioxide. Measurements were made for 10 minutes before and after distension in both sitting and supine positions. RESULTS In the sitting position gastric distension substantially increased the rate of gas reflux (median (interquartile range)), as evidenced by increases in oesophageal common cavities from 1 (0–1)/10 min to 7 (5–10)/10 min and TLOSRs from 1 (1–1.5)/10 min to 6 (2.5–8)/10 min. However, this effect was suppressed in the supine position in all but one patient (TLOSRs 0 (0)/10 min to 1 (0–4.5)/10 min, common cavities 0 (0)/10 min to 0.5 (0–2)/10 min). CONCLUSIONS Postural suppression of TLOSRs and gas reflux is generally preserved in reflux disease.
The variant fetal hemoglobin F Texas I is abnormally acetylated
Authors: Alan S. Keitt, Richard T. Jones
Journal: American Journal of Hematology (1988)

Abstract Two related infants with indistinct slow‐moving minor hemoglobin bands were detected by electrophoretic cord blood screening. The variant separated into a major and a minor band on isoelectric focusing (IEF), anion exchange chromatography (AEC), and high‐performance liquid chromatography (HPLC). Analysis of the products of tryptic hydrolysis of the abnormal chain revealed a truncated AγT‐l peptide containing a glu→lys substitution at position 5, identifying the variant as Hb F Texas 1. Microsequencing of the major early peak from AEC confirmed the substitution. However, γ chains from the minor peak resisted Edman degradation and were shown to be acetylated by fast atom bombardment mass spectrometry (FABMS). Acetylation of HbF Texas I was nearly three times that of normal HbF measured in the same hemolysate, and this ratio remained constant for over 1 year in the proband. This represents the first demonstration of increased Nα‐acetylation of a variant fetal hemoglobin.
Good News and Bad for Women with Birth Defects
Authors: Jean Golding
Journal: New England Journal of Medicine (1999)

Most parents of a child with a birth defect focus their attention on short-term considerations regarding the child's health. Once these worries abate, parents begin to think about the child's long-term prognosis. Unfortunately, they are unlikely to find much data about the outlook for their child, especially information on fertility and life expectancy. Neither will they find much information on the likelihood of birth defects in the children of their child.The results of a study in Norway by Skjærven et al., reported in this issue of the Journal, provide some of the answers so far as girls are concerned. . . .
581. Development of a Non-Viral DNA Vector Multifunctional Envelop-type Nano Device Modified with Octaarginine Peptide
Authors: Kentaro Kogure, Ikramy A. Khalil, Rumiko Moriguchi, Shiroh Futaki, Hideyoshi Harashima
Journal: Molecular Therapy (2005)

For efficient gene delivery to the nucleus, non-viral vectors need to overcome several barriers such as the plasma membrane, the endosomal membrane and the nuclear membrane. To overcome these obstacles, it is necessary to equip the delivery system with various functional devices [Kamiya H., et al., Drug Discov. Today 21 (2003) 990]. However, it is difficult to package all these functional devices into a single system to exert each of their functions at the appropriate time and at the correct location. Thus, we proposed a new packaging concept, |[ldquo]|Programmed Packaging|[rdquo]|. This concept consists of three components: (1) A program to overcome all barriers. (2) Development of functional devices and their three dimensional assignment. (3) Nano-technology for assembling all devices into a nano-size structure.
Ongoing problems with metal-on-metal hip implants
Authors: C. Heneghan, D. Langton, M. Thompson
Journal: BMJ (2012)

<h3>Background</h3> The association of nursing staffing with patient outcomes has primarily been studied by comparing high to low staffed hospitals, raising concern other factors may account for observed differences. We examine the association of inpatient mortality with patients’ cumulative exposure to shifts with low registered nurse (RN) staffing, low nursing support staffing and high patient turnover. <h3>Methods</h3> Cumulative counts of exposure to shifts with low staffing and high patient turnover were used as time-varying covariates in survival analysis of data from a three-campus US academic medical centre for 2007–2012. Staffing below 75% of annual median unit staffing for each staff category and shift type was characterised as low. High patient turnover per day was defined as admissions, discharges and transfers 1 SD above unit annual daily averages. <h3>Results</h3> Models included cumulative counts of patient exposure to shifts with low RN staffing, low nursing support staffing, both concurrently and high patient turnover. The HR for exposure to shifts with low RN staffing only was 1.027 (95% CI 1.002 to 1.053, p&lt;0.001), low nursing support only, 1.030 (95% CI 1.017 to 1.042, p&lt;0.001) and shifts with both low, 1.025 (95% CI 1.008 to 1.043, p=0.035). For a model examining cumulative exposure over the second to fifth days of an admission, the HR for exposure to shifts with low RN staffing only was 1.048 (95% CI 0.998 to 1.100, p=0.061), low nursing support only, 1.032 (95% CI 1.008 to 1.057, p&lt;0.01) and for shifts with both low,1.136 (95% CI 1.089 to 1.185, p&lt;0.001). No relationship was observed for high patient turnover and mortality. <h3>Conclusion</h3> Low RN and nursing support staffing were associated with increased mortality. The results should encourage hospital leadership to assure both adequate RN and nursing support staffing.
A 37-year-old mechanic with multiple chemical sensitivities.
Authors: H M Kipen, N Fiedler
Journal: Environmental Health Perspectives (2000)

A 37-year-old heating, ventilation, and air-conditioning mechanic developed respiratory, musculoskeletal, and central nervous system symptoms associated with a variety of odorous environmental chemicals. Organic disease was not evident, but the patient was distressed by these symptoms and was at risk for becoming disabled by them. His symptoms fit broadly into the condition recognized as multiple chemical sensitivity. Multiple chemical sensitivity is a diagnostic term for a group of symptoms without demonstrated organic basis. The symptoms are characteristic of dysfunction in multiple organ systems, they increase and decrease according to exposure to low levels of chemical agents in the patient's environment, and they sometimes occur after a distinct environmental change or insult such as an industrial accident or remodeling. Although traditional medical organizations have not agreed on a definition for this syndrome, it is being increasingly recognized and makes up an increasing percentage of the caseload at occupational and environmental medicine clinics. Although there is often dispute about whether the symptoms have a functional or organic basis, an informed approach to evaluation, diagnosis, and management and a careful assessment of impairment, disability, and work relatedness are necessary. Careful exclusion of organic causes is critical, and this should be followed by a judicious approach to coping with symptoms.
Fetal hemorrhage and platelet dysfunction in SLP-76–deficient mice
Authors: James L. Clements, Jong Ran Lee, Barbara Gross, Baoli Yang, John D. Olson, Alexander Sandra, Stephen P. Watson, Steven R. Lentz, Gary A. Koretzky
Journal: Journal of Clinical Investigation (1999)

The adapter protein SLP-76 is expressed in T lymphocytes and hematopoietic cells of the myeloid lineage, and is known to be a substrate of the protein tyrosine kinases that are activated after ligation of the T-cell antigen receptor. Transient overexpression of SLP-76 in a T-cell line potentiates transcriptional activation after T-cell receptor ligation, while loss of SLP-76 expression abrogates several T-cell receptor-dependent signaling pathways. Mutant mice that lack SLP-76 manifest a severe block at an early stage of thymocyte development, implicating SLP-76 in signaling events that promote thymocyte maturation. While it is clear that SLP-76 plays a key role in development and activation of T lymphocytes, relatively little is understood regarding its role in transducing signals initiated after receptor ligation in other hematopoietic cell types. In this report, we describe fetal hemorrhage and perinatal mortality in SLP-76-deficient mice. Although megakaryocyte and platelet development proceeds normally in the absence of SLP-76, collagen-induced platelet aggregation and granule release is markedly impaired. Furthermore, treatment of SLP-76-deficient platelets with collagen fails to elicit tyrosine phosphorylation of phospholipase C-gamma2 (PLC-gamma2), suggesting that SLP-76 functions upstream of PLC-gamma2 activation. These data provide one potential mechanism for the fetal hemorrhage observed in SLP-76-deficient mice and reveal that SLP-76 expression is required for optimal receptor-mediated signal transduction in platelets as well as T lymphocytes.
Kaposi's sarcoma presenting as autoimmune hemolytic anemia
Authors: Denis B. Hammond, Leonard Ellman, Ronald L. Sirota
Journal: American Journal of Hematology (1977)

Abstract A case of Kaposi's sarcoma which presented as a warm type of immune hemolytic anemia is described. The malignancy was discovered at the time of splenectomy, which was required for control of the hemolytic anemia. Three other cases of immune hemolytic anemia in patients with Kaposi's sarcoma have been reported. An association between Kaposi's sarcoma and immune hemolytic anemia is suggested. Careful examination of the skin for Kaposi's sarcoma seems appropriate in cases of immune hemolytic anemia.
The dance of death
Authors: Liam Farrell
Journal: BMJ (2012)

“So,” I asked, “how did it happen?”

“Well,” he said, “I was at a wedding and I got up to dance—that’s when I felt the pain in my chest.”⇑

I was curious; for the third time in a matter of weeks a man in his 50s had had an infarct while at a wedding. The risk factors were obvious: overweight, unfit, suddenly hurled into intense physical activity, but could there be something more going …
A Worthy Use for Discarded Surgical Instruments
Authors: James L. Barton
Journal: JAMA (1913)

To the Editor  —The American Board of Commissioners for Foreign Missions is carrying on extensive medical work in Turkey, India, China, Africa and the islands of the sea. About fifty thoroughly equipped physicians are in charge of this work, and last year nearly 400,000 patients were treated in the hospitals and dispensaries connected with the work. Nearly all the hospitals are so remote from other modern medical facilities that the physicians in charge are compelled to be experts in almost every department of medicine and surgery, and each surgeon must have all the instruments required for the performance of the operations which he undertakes.  As an illustration of the operations performed, the physician in charge of the hospital at Cesarea, Asia Minor, reports 91 abdominal operations and over 800 other operations performed in ten months by himself. According to a report just received from Northern Syria, Turkey, covering a period
Does this patient have sinusitis?
Authors: L. J. Gordon
Journal: JAMA (1994)

To the Editor.  —The review and study by Williams and Simel 1 is an admirable attempt to answer the often-asked question, Does this patient have sinusitis? This is a problem that most primary care physicians should be prepared to deal with and treat appropriately. I have several concerns with the facts as stated in this article. The authors state that sinus aspiration and culture is the gold standard; however, this is not often used because of the difficulty in obtaining a specimen and the difficulty in culturing the anaerobic bacteria responsible for much of chronic sinusitis. They in turn refer to sinus roentgenograms as a readily obtained and pragmatic reference standard.  A four-view sinus series may be useful as an adjunct to the clinical examination in diagnosing acute sinusitis, especially acute frontal sinusitis. However, because of the often-reported discordance between plain films and sinus computed tomography (CT) 2-4 (the accepted
Earlier onset of QRS in anterior precordial ECG leads: precision of time interval measurements.
Authors: M D Danzig, T L Robertson, L S Webber, G Day, D S Dock
Journal: Circulation (1976)

Onset of QRS was compared between simultaneously recorded conventional ECG leads in 84 subjects with clinically normal hearts from a defined population sample. Mean onset of QRS was 6.4 msec earlier in lead V1 and 7.4 msec earlier in V2 than in lead II. These differences were statistically significant. The measuring system was adapted from drafting techniques and took into account variations in paper speed which occurred during recording. Interobserver differences equivalent to greater than 1 msec occurred in 3.9% of timeline measurements, but in in 38% of QRS onset measurements. The lower precision in measuring QRS onset may be attributed to baseline oscillations and to the relatively slow rate of voltage change at the onset of ventricular depolarization.
255 EFFICACY AND SAFETY OF PEGUILATED INTERFERON AND RIBAVIRIN IN HCV-INFECTED PATIENTS WITH ADVANCED CIRRHOSIS AWAITING LIVER TRANSPLANTATION
Authors: A.C.C.A. Feldner, T.C.R. Ribeiro, M.A. Bragagnolo-Jr, J. Seda-Neto, J.D.R. Brito, L.Z. Trindade, E.M.G. Oliveira, E.R. Parise, M. Kondo
Journal: Journal of Hepatology (2010)
Recommended Dietary Allowances for Vitamins-Reply
Authors: Victor Herbert
Journal: JAMA (1988)

<h3>In Reply.—</h3> I could not disagree more with Mr Cerrato. No case can be made for any value of low-dose supplementation among healthy people. I did not dismiss the prosupplement rhetoric out of hand, as Mr Cerrato erroneously alleges, but out of the facts and the logic in the<i>JAMA</i>article I cited.<sup>1</sup>Misrepresented by Mr Cerrato as "Dr Herbert's contention," it in fact was the contention (and conclusion) of the entire group of nutrition professionals and members of the Council on Scientific Affairs who were the authors of the<i>JAMA</i>article<sup>1</sup>indicating that supplements were inappropriate except in the special situations stated. Having served from 1979 through 1985 on the Food and Nutrition Board and its Committee on Dietary Allowances, which is responsible for the RDA, I can state unequivocally that Mr Cerrato misperceives how the RDA are determined. It is as follows: first, the "floor" is
PSYCHIATRIC SERVICES IN GENERAL HOSPITALS
Authors: Leslie A. Osborn
Journal: JAMA (1953)

Grouping patients with similar diseases and then separating these groups from each other has long been useful and effective in medical practice. Sometimes these groupings have been made on wards or services of hospitals, and sometimes there have been specialized hospitals. With increased understanding of illness, it has been shown in many instances that the degree of segregation and specialization once thought necessary is no longer required; in fact, coordination and consultation become increasingly difficult if specialization is carried too far. Increasingly we see the development of general hospitals that are organized so that they can treat the full range of human ailments through well-planned construction and organization of services. A good example of the reduced use of specialized hospitals is in the field of infectious disease. Medical knowledge now makes it possible to handle the problems of infectious diseases without risk to others in a general hospital. This same
Liver disease in adolescents: A cohort study of high-risk individuals
Authors: David Van der Poorten, Dianna T. Kenny, Tony Butler, Jacob George
Journal: Hepatology (2007)

Little is known about the health and behavior of adolescent offenders as they relate to abnormalities of liver biochemistry and hepatitis C virus (HCV) infection. A large study of male juvenile offenders was undertaken that allowed a re-evaluation of the normal limits of alanine aminotransferase (ALT), associations with elevated ALT, and HCV antibody positivity. Young offenders (age 12-19 years) serving community orders participated in a wide-ranging health survey and laboratory assessment between October 2003 and December 2005. Normal ranges for liver biochemistry were calculated from the 95th percentile of males at the lowest risk for liver disease. The final sample comprised 682 males, of whom 439 (64%) gave blood. The calculated upper limit of normal for ALT was 28 IU/L. Seventeen percent of adolescents had an elevated ALT. Strong associations with elevated ALT included HCV antibody positivity [odds ratio (OR) 14.6], overweight and obesity (OR 6.9), and elevated total cholesterol (OR 3.6). More than 90% of adolescents with elevated ALT levels had 1 or more features of the metabolic syndrome. HCV antibody was positive in approximately 3% of the cohort, with the most significant risk factor being injecting drug use (OR 7.8; P < 0.01). The new infection rate was 3.7% per year.New upper limits for ALT provide greater sensitivity for the early diagnosis of liver disease in adolescents. High rates of HCV infection and obesity-related liver disease exist in this group, and targeted interventions are needed to reduce future health-related morbidity.
Rosiglitazone and implications for pharmacovigilance
Authors: Dhruv Kazi
Journal: BMJ (2007)

Postsurveillance data should be systematically collected, timely, and publicly available

On 21 May 2007, the New England Journal of Medicine published a meta-analysis of 42 trials of rosiglitazone (Avandia, GlaxoSmithKline) for treating type 2 diabetes mellitus. It found that the drug was associated with an increased risk of myocardial infarction (odds ratio 1.43; 95% confidence interval 1.03 to 1.98; P=0.03) and death from cardiovascular causes (1.64; 0.98 to 2.74; P=0.06).1

Rosiglitazone, a thiazolidinedione, is an agonist at the peroxisome-proliferator activated receptors in cell nuclei. These receptors modulate the expression of a host of genes, and glycaemic control is achieved primarily through increased insulin sensitivity in peripheral tissues. Rosiglitazone was approved by the US Food and Drug Administration (FDA) in 1999 and by the centralised process of the European Medicines Agency (EMEA) in 2000. Its popularity has increased steadily, with more than one million prescriptions written in the one year period ending March 2006 in England alone—a 22% increase over the previous year.2 However, the recently published meta-analysis raises serious questions about the drug's safety.

Meta-analyses have unique strengths and weaknesses and this one is no exception.3 Its singular strength is the statistical power generated by data on 15 560 patients from published and unpublished trials. However, it includes clinically heterogeneous trials and criteria used …
Embodiment is the foundation, not a level
Authors: Jerome A. Feldman
Journal: Behavioral and Brain Sciences (1997)

Embodiment, the explicit dependence of cognition on the properties of the human body, is the foundation of contemporary cognitive science. Ballard et al.'s target article makes an important contribution to the embodiment story by suggesting how limitations on neural binding ability lead to deictic strategies for many tasks. It also exploits the powerful experimental method of instrumented virtual reality. This commentary suggests some ways in which the target article might be misinterpreted and offers other cautions.
Hereditary Haemorrhagic Telangiectasia with Hepatosplenomegaly and Ascites
Authors: D. W. Ashby, E. Bulmer
Journal: BMJ (1951)

a personal communication, states that hepatomegaly has not been noted in any of the cases of Garland and Anning (1950a, 1950b) and that the splenic enlargement is usually thought to accompany severe anaemia.