tbuckley/cabot-search huggingface dataset:
Family Medicine — Fad or for Real?
Authors: Charles A. Janeway
Journal: New England Journal of Medicine (1974)

Abstract The growing shortage of providers of primary care, with an overabundance of specialists and high costs, owing to emphasis in medical education upon serious illness in the medical center rather than the ordinary health problems in the community, has produced a concerted effort to shift education toward primary care. One such attempt to improve education and research in family medicine has been in operation at Harvard since 1954. There are differences between primary care (first-contact medicine), family practice (primary care by physicians trained specially for the job), family medicine (a discipline affecting all practice by putting "the family into the center of medical-care delivery") and family health care (family-focused health promotion and illness care). In training family physicians, as specialists in people rather than their diseases, education should stress the discipline of family medicine, the predictive use of modern genetics and the potential role of the family physician as health educator. (N Engl J Med 291:337–343, 1974)
Multiple Endocrine Adenoma Syndrome
Authors: W. T. Cooke, D. I. Fowler, R. Gaddie, E. V. Cox, M. J. Meynell, D. Brewer
Journal: Gut (1960)

The case history of a 40-year-old woman with a fatal haemorrhage from a duodenal ulcer, jejunitis, renal lithiasis, hypertrophy of the adrenal glands, multiple adenomas of the pancreas, and three adenomas of both the parathyroid and pituitary glands is reported. Though there was histological evidence, in the bones, of hyperparathyroidism, the serum levels of calcium, phosphorus, and phosphatase and the urinary excretion of calcium were normal. The significance of low calcium and high phosphorus excretion in the urine as an indication of parathyroid disorder is discussed. “Multiple endocrine adenoma syndrome” is suggested as the appropriate designation for the clinical disorders in which adenomas of one or more endocrine glands are associated with disorders of the alimentary tract when patients present with recurrent peptic ulceration, pancreatic dysfunction, or watery diarrhoea.
A mechanism for the induction of immunological tolerance by antigen feeding: antigen-antibody complexes.
Authors: C André, J F Heremans, J P Vaerman, C L Cambiaso
Journal: The Journal of Experimental Medicine (1975)

We have previously reported on the induction, in mice, of a systemic (splenic) immune response with IgA as the dominant antibody, as a result of a short (4 day) intragastric immunization course with foreign erythrocytes. This response was followed by a prolonged period of hyporesponsiveness to similarly administered antigen. Here it is shown that this hyporesponsiveness is also manifested towards antigen given intraperitoneally, and that one is therefore dealing with tolerance, not with failure to absorb antigen from the gut. In contrast, mice primed parenterally and then challenged intragastrically behaved as if never having any previous contact with the antigen, i.e., with a primary-type splenic response of predominant IgA character. This agrees with our former conclusion that splenic responses to enterically absorbed antigen reflect colonization of the spleen by cells sensitized locally in the gut wall, a site not readily primed by the parenteral route. Serum from intragastrically immunized mice contained a very active tolerogen. In vivo, it was capable of conferring tolerance to nonimmune recipient mice. In vitro, it paralyzed the activity of antibody-producing cells. Inhibitory sera has weak antibody activity, restricted to the IgA class, and contained immune complexes reacting with rheumatoid factor but not with C1q. Elimination of these complexes by means by insolubilized rheumatoid factor abolished the tolerogenic effect. In conclusion, the enterically induced tolerogen seems to consist of immune complexes with IgA as the antibody.
RBRVS Gets an Eye Test-Reply
Authors: William C. Hsiao
Journal: JAMA (1992)

<h3>In Reply.</h3> —Dr Tennant's letter contains erroneous reasoning, half-truths, and unsubstantiated charges. They have to be answered. The RBRVS is based on the resource costs required to perform each service. He states that a "fair" test for the RBRVS is whether it produces fees higher than the discounted charges that Medicaid and HMOs pay to physicians. His test is not valid. If a charge for a service is much higher than the resource costs involved, then a discount on that charge would not necessarily produce a charge lower than resource costs. Tennant offers a half-truth when he states that we erred in our initial determination of the ophthalmological RBRVS and that we would only restudy them when the AAO had paid us $250 000. This is not the case. The AAO challenged our original findings on the grounds that some ophthalmological services were highly specialized and most general ophthalmologists sampled
'HeartGuide' food-rating program attracts 114 applications as controversy continues
Authors: M. F. Goldsmith
Journal: JAMA (1989)

EVEN AS jambalaya, crawfish pie, and filé gumbo tempted some 14 000 cardiologists and other health professionals in New Orleans, La, during the American Heart Association's (AHA) 62nd Scientific Sessions, the organization was putting the final touches on a controversial food-rating program designed to make acquiring the family groceries an educational as well as health-enhancing task. "HeartGuide" is the name of this AHA campaign (<i>JAMA</i>. 1989;262:1747, 2785; and<i>JAMA</i>. 1988;260:1192-1193). Its aim, according to Susanna L. Cunningham, PhD, chair of the HeartGuide Public Interest and Oversight Panel, its directing body, is "to fight heart disease, the number one killer of American men and women." Cunningham says 114 products met the November 17 deadline for application to be included in the program's initial phase. (Supermarkets may stock 50 000 or more food products.) The first five categories to be evaluated are frozen dinners and entrées; shelf-stable and frozen vegetables; margarines and
Acts of no mercy
Authors: T. Delamothe
Journal: BMJ (2010)

Painted between 1915 and 1920, this week’s medical classic is free of asylum seekers and demented patients. Instead the main subject matter of “Acts of Mercy” is orphans and convalescent soldiers (doi:10.1136/bmj.c4349). Who should be the proper beneficiaries of our mercy these days? This week’s journal provides some pointers.

Margaret McCartney chronicles the health care provided, or rather not provided, for the 3000 asylum seekers held in the UK’s 11 immigration removal centres (doi:10.1136/bmj.c4106). Only the UK Borders Agency seems to have a good word to say for the services they are providing.

The mental health charity Mind thinks that the centres lack mental healthcare resources and specific guidelines about what they should be providing. One of the 100 or so doctors who work for …
High-dose tumor necrosis factor alpha produces an impairment of hamster diaphragm contractility. Attenuation with a prostaglandin inhibitor.
Authors: P Wilcox, C Milliken, B Bressler
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

We have investigated the influence of the cytokine tumor necrosis factor alpha (TNF alpha), an important mediator of sepsis, on in vitro hamster diaphragm contractility. Costal diaphragm strips were excised and mounted on an experimental apparatus consisting of a force transducer and servomotor. Preparations were randomized to incubation in one of the following solutions: (1) indomethacin 10(-6) M (n = 5); (2) TNF alpha (0.1 ng/ml) (n = 5); (3) TNF alpha (500 ng/ml) (n = 5); and (4) TNF alpha (500 ng/ml) plus indomethacin (10(-6)) (n = 5). Baseline contractile parameters measured at optimal length included twitch and tetanic tension, half relaxation time, time to peak tension, force frequency response (10-80 Hz), and fatigability to response to repetitive stimulation. After 90-min incubation in one of the solutions, an identical stimulation protocol was repeated. Initial twitch and tetanus parameters were similar between groups. Maximal twitch tension and tetanic tension decreased significantly, as did tetanic stimulations at 10-80 Hz in the TNF group (500 ng/ml) (p < 0.05). Coincubation with indomethacin decreased but did not completely abolish changes in diaphragm function caused by the higher dose of TNF. There were no significant changes in twitch or tetanus parameters, or in response to repetitive stimulation after incubation in the lower dose TNF group (0.1 ng/ml). We conclude that TNF causes impairment of in vitro diaphragm contractility at high incubation concentrations of TNF and that this effect can be partially blocked by prostaglandin synthetase inhibition. No significant deleterious effect on in vitro contractility was detected at concentrations of TNF similar to serum levels in human sepsis.
The Principle of Normalization and Its Implications to Psychiatric Services
Authors: WOLF WOLFENSBERGER
Journal: American Journal of Psychiatry (1970)

The "normalization principle" formulated by Scandinavian workers in mental retardation aims at eliciting and maintaining culturally normative behavior and using culturally normative means to this end. The principle is simultaneously simple and comprehensive, and it can constitute a unifying ideology for all human management areas. It provides guidance for decisions from the lowest clinical to the highest systems levels. Some specific implications for psychiatry are discussed.
[692] SEX DIFFERENCES IN HEPATOCYTE-SPECIFIC Pten-DEFICIENT MICE SHOWING STEATOHEPATITIS WITHOUT ETHANOL CHALLENGE
Authors: Y. Anezaki, S. Ohshima, S. Takeuchi, T. Goto, H. Ishii, T. Dhomen, E. Kataoka, W. Sato, K. Yoneyama, T. Shibuya, I. Yamada, M. Iizuka, A. Suzuki, S. Watanabe, Y. Horie
Journal: Journal of Hepatology (2007)
Observations on Urticaria in Childhood
Authors: Isaac Hillson Schwartz
Journal: New England Journal of Medicine (1956)

IT is not uncommon for physicians treating children to be confronted with an eruption consisting of large, red macules with central whealing or swelling of sections of the body, or both. The former corresponds to the usual description of urticaria, and the latter to that of angioneurotic edema. Characteristic is also the shifting, fleeting nature of the individual lesions. It is customary to attribute these manifestations to sensitivity, usually to a hypothetical allergenic food.In reflecting on this phenomenon, I remembered that almost all the cases met with in the course of a general pediatric practice cleared in about three . . .
Technological Imperatives and Paradoxes
Authors: Samuel B. Sheps
Journal: JAMA (1988)

That concepts and techniques for the assessment of diagnostic technologies have been well described since Yerushalmy's article<sup>1</sup>about total body roentgenography<sup>2-4</sup>and that these concepts and techniques seem to have had relatively little influence on the diffusion of diagnostic technology in medicine<sup>5</sup>are paradoxical observations inconsistent with both the scientific basis of medicine and the rhetoric of health care planners and administrators. While science and rhetoric provide a picture of the ideal (which admittedly in the "real" world is rarely achieved) and though the number of decision-makers (each with his or her perspective) influencing the diffusion of health care technology is large, the persistence of this paradox should be of concern. Although one assumes that various decision-makers are well intentioned and seek to promote the use of the best possible health care technology, it must be remembered that behavior rather than intention is of critical importance: "The
Prognostic Value of Very Low Plasma Concentrations of Troponin T in Patients With Stable Chronic Heart Failure
Authors: Roberto Latini, Serge Masson, Inder S. Anand, Emil Missov, Marjorie Carlson, Tarcisio Vago, Laura Angelici, Simona Barlera, Giovanni Parrinello, Aldo P. Maggioni, Gianni Tognoni, Jay N. Cohn
Journal: Circulation (2007)

Circulating cardiac troponin T, a marker of cardiomyocyte injury, predicts adverse outcome in patients with heart failure (HF) but is detectable in only a small fraction of those with chronic stable HF. We assessed the prognostic value of circulating cardiac troponin T in patients with stable chronic HF with a traditional (cTnT) and a new precommercial highly sensitive assay (hsTnT).Plasma troponin T was measured in 4053 patients with chronic HF enrolled in the Valsartan Heart Failure Trial (Val-HeFT). Troponin T was detectable in 10.4% of the population with the cTnT assay (detection limit < or = 0.01 ng/mL) compared with 92.0% with the new hsTnT assay (< or = 0.001 ng/mL). Patients with cTnT elevation or with hsTnT above the median (0.012 ng/mL) had more severe HF and worse outcome. In Cox proportional hazards models adjusting for clinical risk factors, cTnT was associated with death (780 events; hazard ratio=2.08; 95% confidence interval, 1.72 to 2.52; P<0.0001) and first hospitalization for HF (655 events; hazard ratio=1.55; 95% confidence interval, 1.25 to 1.93; P<0.0001). HsTnT was associated with the risk of death in unadjusted analysis for deciles of concentrations and in multivariable models (hazard ratio=1.05; 95% confidence interval, 1.04 to 1.07 for increments of 0.01 ng/mL; P<0.0001). Addition of hsTnT to well-calibrated models adjusted for clinical risk factors, with or without brain natriuretic peptide, significantly improved prognostic discrimination (C-index, P<0.0001 for both outcomes).In this large population of patients with HF, detectable cTnT predicts adverse outcomes in chronic HF. By the highly sensitive assay, troponin T retains a prognostic value at previously undetectable concentrations.
Air pollution and unscheduled hospital outpatient and emergency room visits.
Authors: X Xu, B Li, H Huang
Journal: Environmental Health Perspectives (1995)

We conducted a time-series analysis of daily hospital visits and air pollution data to assess acute effects of air pollution on daily unscheduled outpatient visits to internal medicine, pediatric, and emergency departments in the No. 3 Affiliated Hospital of Beijing Medical University in Beijing, China. Sulfur dioxide was marginally significantly associated with total outpatient visits (beta = 41.5, SE = 24.2) and significantly associated with internal medicine (beta = 14.6, SE = 6.7), pediatric (beta = 12.7, SE = 3.7), and emergency room visits (beta = 6.8, SE = 2.7). Total suspended particulates (TSP) was a significant predictor for total outpatient (beta = 21.1, SE = 7.7) and pediatric visits (beta = 3.4, SE = 1.3) and a marginally significant predictor of internal medicine visits (beta = 4.2, SE = 2.2). In a season-specific analysis, SO2 was a significant predictor for total hospital outpatient visits in summer, although the mean daily SO2 concentration was only 17 micrograms/m3 (maximum = 51 micrograms/m3). In winter, SO2 was significantly associated with internal medicine, pediatric, and emergency room visits, and TSP was associated with total outpatient visits. This study suggests an exposure-response relationship between TSP and SO2 and hospital outpatient visits, both at high air pollution levels and at levels well below air quality standards recommended by the World Health Organization.
Pathogenesis of multiple sclerosis: insights from molecular and metabolic imaging
Authors: Olga Ciccarelli, Frederik Barkhof, Benedetta Bodini, Nicola De Stefano, Xavier Golay, Klaas Nicolay, Daniel Pelletier, Petra J W Pouwels, Seth A Smith, Claudia A M Wheeler-Kingshott, Bruno Stankoff, Tarek Yousry, David H Miller
Journal: The Lancet Neurology (2014)
Election of Branch Representatives
Authors: Chas. E. S. Flemming
Journal: BMJ (1900)

<h3>Background</h3> Hodgkin lymphoma is usually detected in primary care with early signs and symptoms, and is highly treatable with standardised chemotherapy. However, late presentation is associated with poorer outcomes. <h3>Aim</h3> To investigate the relationship between markers of advanced disease, emergency admission, and survival following a diagnosis of classical Hodgkin lymphoma (CHL). <h3>Design &amp; setting</h3> The study was set within a sociodemographically representative UK population-based patient cohort of ~4 million, within which all patients were tracked through their care pathways, and linked to national data obtained from Hospital Episode Statistics (HES) and deaths. <h3>Method</h3> All 971 patients with CHL newly diagnosed between 1 September 2004–31 August 2015 were followed until 18th December 2018. <h3>Results</h3> The median diagnostic age was 41.5 years (range 0–96 years), 55.2% of the patients were male, 31.2% had stage IV disease, 43.0% had a moderate–high or high risk prognostic score, and 18.7% were admitted via the emergency route prior to diagnosis. The relationship between age and emergency admission was U-shaped: more likely in patients aged &lt;25 years and ≥70 years. Compared to patients admitted via other routes, those presenting as an emergency had more advanced disease and poorer 3-year survival (relative survival 68.4% [95% confidence interval {CI} = 60.3 to 75.2] versus 89.8% [95% CI = 87.0 to 92.0], respectively [<i>P</i>&lt;0.01]). However, after adjusting for clinically important prognostic factors, no difference in survival remained. <h3>Conclusion</h3> These findings suggest that CHL survival as a whole could be increased by around 4% if the cancer in patients who presented as an emergency had been detected at the same point as in other patients.
Immunoelectron microscopic observations on the inflammatory infiltrates and HLA antigens in hepatitis B and non-A, Non-B
Authors: Hans P. Dienes, Thomas Hütteroth, Georg Hess, Stefan C. Meuer
Journal: Hepatology (1987)

The present knowledge of the inflammatory reaction occurring in situ during hepatitis B favors a T cell-dependent MHC-restricted immune response. However, the reports in the literature are primarily based on the application of monoclonal antibodies directed at different lymphocyte subsets which discern only lymphocytic phenotypes and do not reflect the actual situation adequately. Therefore, we investigated the liver biopsies of patients with hepatitis B (28 patients) and non-A, non-B (21 patients) by immunoelectron microscopy with monoclonal antibodies directed at lymphocyte subtypes (pan-B, pan-T, T8, T4 and NKH1) and at activation epitopes (IL-2 receptor, TA1 and T11/3) as well, in order to determine the phenotype in association with the activation status of the lymphocytes that are in close contact with hepatocytes; thus, establishing an effector-target cell relationship on the ultrastructural level. We were able to confirm the central role of T8 lymphocytes being the predominant type of lymphocytes in close contact with liver cells in the space of Disse. A certain percentage of these cells expressed “activation” markers as IL-2 receptor, TA1 and T11/3. In acute hepatitis, the NK lymphocytes made up a fifth of all lymphocytes, whereas their number dropped below 10% in the chronic stage. There was a vague correlation between the inflammatory activity of the disease and the expression of HLA antigens (both classes I and II) on inflammatory cells and also on hepatocytes. The results did not show significant differences between hepatitis B and non-A, non-B. Our findings underline the significance of a T lymphocyte-dependent, MHC-restricted immune response in chronic hepatitis B and non-A, non-B as the decisive mechanism which seems to be flanked by NK cell activity in the acute phase. The expression of the T11/3 antigen on many lymphocytes indicates that a certain proportion of the T lymphocytes may be activated by an antigen-independent alternative pathway.
Use of a Mobile Application to Characterize a Remote and Global Population of Acne Patients and to Disseminate Peer-Reviewed Acne-Related Health Education
Authors: Diana K. Cohen, Beatrice Nardone, Martha Cotton, Dennis P. West, Roopal V. Kundu
Journal: JAMA Dermatology (2014)

thase-dependent stimulus was decreased.Quantitatively, these microvascular responses to systemic and localized heat stimuli normalized during nifedipine treatment.Cutaneous vasodilation responses to heating stimuli have been used to assess microvascular function in the forearm skin of humans with varying preclinical vascular disease. 5,6The new, noninvasive LSCI technology presents the opportunity to comfortably and easily examine regional variation in cutaneous perfusion, rendering its clinical application in assessment of cutaneous vascular pathologic conditions.Further research is warranted to determine if an LSCI can predict the occurrence of ulcerations in patients with perniosis.Our data suggest that the LSCI can be used to examine cutaneous blood flow and to assess the efficacy of interventions in dermatology patients.
Low erythrocyte Na/K-pump activity and number in Northeast Thailand adults: Evidence suggesting an acquired disorder
Authors: Piyaratana Tosukhowong, Kriang Tungsanga, Chonticha Kittinantavorakoon, Chuangchan Chaitachawong, Pongsak Pansin, Pote Sriboonlue, Visith Sitprija
Journal: Metabolism (1996)
Evolution of Prokaryotic Two-Component System Signaling Pathways: Gene Fusions and Fissions
Authors: P. J. A. Cock, D. E. Whitworth
Journal: Molecular Biology and Evolution (2007)

Two-component systems (TCSs) are common signal transduction systems, typically comprising paired histidine protein kinase (HK) and response regulator (RR) proteins. In many examples, it appears RR and HK genes have fused, producing a "hybrid kinase " We have characterized a set of prokaryotic genes encoding RRs, HKs, and hybrid kinases, enabling characterization of gene fusion and fission. Primary factors correlating with fusion rates are the presence of transmembrane helices in HKs and the presence of DNA-binding domains in RRs, features that require correct (and separate) spatial location. In the absence of such features, there is a relative abundance of fused genes. The order of paired HK and RR genes and the nucleotide distance between encoded domains also correlate with apparent gene fusion rates. We propose that localization requirements and relative positioning of encoded domains within TCS genes affect the function (and therefore retention) of hybrid kinases resulting from gene fusion.