tbuckley/cabot-search huggingface dataset:
The Dilemmas of Mothers Who Are Physicians and of Physicians Who Are Mothers
Authors: Joyce A. Korvick
Journal: JAMA (1986)

To the Editor.—  I read Equal, Not Really1 when I, too, was facing the problem of integrating mothering and a career as a physician and found no encouragement there. The article is timely, since there are an ever-increasing number of female physicians and physician couples facing the problem of child rearing. However, the article illustrates that, although society supports women professionals in general, when conflicts arise this support vanishes!  As I read Anonymous' article, I heard the pain of a mother exacerbated by society's traditional expectations of a mother's role. Because of her love for her son she was vulnerable to the guilt so readily laid at her feet by school officials. Then, she became sapped of her emotional strength, which, in turn, eroded her confidence and effectiveness as a mother and physician.  In critically approaching the educators'  evaluation of her son's speech problem, I raise two objections. First, could
Site-Level Variation in and Practices Associated With Dabigatran Adherence
Authors: Supriya Shore, P. Michael Ho, Anne Lambert-Kerzner, Thomas J. Glorioso, Evan P. Carey, Fran Cunningham, Lisa Longo, Cynthia Jackevicius, Adam Rose, Mintu P. Turakhia
Journal: JAMA (2015)

Unlike warfarin, which requires routine laboratory testing and dose adjustment, target-specific oral anticoagulants like dabigatran do not. However, optimal follow-up infrastructure and modifiable site-level factors associated with improved adherence to dabigatran are unknown.To assess site-level variation in dabigatran adherence and to identify site-level practices associated with higher dabigatran adherence.Mixed-methods study involving retrospective quantitative and cross-sectional qualitative data. A total of 67 Veterans Health Administration sites with 20 or more patients filling dabigatran prescriptions between 2010 and 2012 for nonvalvular atrial fibrillation were sampled (4863 total patients; median, 51 patients per site). Forty-seven pharmacists from 41 eligible sites participated in the qualitative inquiry.Site-level practices identified included appropriate patient selection, pharmacist-driven patient education, and pharmacist-led adverse event and adherence monitoring.Dabigatran adherence (intensity of drug use during therapy) defined by proportion of days covered (ratio of days supplied by prescription to follow-up duration) of 80% or more.The median proportion of patients adherent to dabigatran was 74% (interquartile range [IQR], 66%-80%). After multivariable adjustment, dabigatran adherence across sites varied by a median odds ratio of 1.57. Review of practices across participating sites showed that appropriate patient selection was performed at 31 sites, pharmacist-led education was provided at 30 sites, and pharmacist-led monitoring at 28 sites. The proportion of adherent patients was higher at sites performing appropriate selection (75% vs 69%), education (76% vs 66%), and monitoring (77% vs 65%). Following multivariable adjustment, association between pharmacist-led education and dabigatran adherence was not statistically significant (relative risk [RR], 0.94; 95% CI, 0.83-1.06). Appropriate patient selection (RR, 1.14; 95% CI, 1.05-1.25), and provision of pharmacist-led monitoring (RR, 1.25; 95% CI, 1.11-1.41) were associated with better patient adherence. Additionally, longer duration of monitoring and providing more intensive care to nonadherent patients in collaboration with the clinician improved adherence.Among nonvalvular atrial fibrillation patients treated with dabigatran, there was variability in patient medication adherence across Veterans Health Administration sites. Specific pharmacist-based activities were associated with greater patient adherence to dabigatran.
Junk Mail Quantitated
Authors: Joe D. Hull
Journal: JAMA (1972)

<h3>To the Editor.—</h3> From July 1, 1971 to Jan 1, 1972, I saved all unsolicited mail received as a medical resident: Judging from the mailboxes of colleagues, this was average, and the 67,384 interns and residents in this country (<b>218</b>:1232, 1971), receive 8,456,692 lb advertising mail annually. Physicians in practice undoubtedly receive much more. This burden for the postal system, secretaries, mail deliveries, and trash collectors is probably 95% unread. Seventeen average-sized trees produce one ton of paper.<sup>1</sup>Thus, house officers receive 4,228.35 tons of junk mail per year, accounting for the disappearance of 71,882 trees. Reasons for eliminating "give-away journals" have been stated by Greenwald.<sup>2</sup>Physicians concerned about reducing the amount of unwanted mail they receive could follow the suggestion of Heyde and request that their names be put on the "no promotional mail list" at the AMA Central Office. His mail was reduced by 75%.
Distribution of di(2-ethylhexyl) phthalate and products in blood and blood components.
Authors: G Rock, R S Labow, M Tocchi
Journal: Environmental Health Perspectives (1986)

In order to impart flexibility, plastic medical devices incorporate liquid plasticizers into their structure. Data from several laboratories, including ours, have shown that these compounds leach from blood bags and tubing during collection of blood, storage of various blood components and during kidney dialysis and cell and plasma apheresis procedures. After the plasticizer di(2-ethylhexyl) phthalate leaches from poly(vinyl chloride) blood packs, it is converted by a plasma enzyme to a more toxic metabolite, mono(2-ethylhexyl) phthalate. Blood fractionation products from outdated plasma contain mono(2-ethylhexyl) phthalate, the highest level being found in normal serum albumin. Recently, we have reported that di(2-ethylhexyl) phthalate actually binds to the red blood cell membrane and reduces its osmotic fragility. Current methods of red cells storage, which permit utilization up to 35 days after collection, are not possible without this membrane stabilization. Platelets are now stored for 5 days in the Fenwal PL 732 polyolefin bag. Although stated to be essentially free of liquid plasticizers, a significant level of leaching from this bag into the extracts of stored platelet concentrates was observed.
Validation of the Prague C&amp;M classification of Barrett's esophagus in clinical practice
Authors: Lorenza Alvarez Herrero, Wouter Curvers, Frederike van Vilsteren, Herbert Wolfsen, Krish Ragunath, Louis-Michel Wong Kee Song, Rosalie Mallant-Hent, Arnoud van Oijen, Pieter Scholten, Erik Schoon, Ed Schenk, Bas Weusten, Jacques Bergman
Journal: Endoscopy (2013)

<b>Background and study aims: </b>The Prague C&M classification for Barrett's esophagus has found widespread acceptance but has only been validated by Barrett's experts scoring video sequences. To date, validation has been lacking for its application in routine practice during real-time endoscopy. The aim of this study was to evaluate agreement between Barrett's experts and community hospital endoscopists when using this classification to describe Barrett's esophagus and hiatal hernia length during real-time endoscopy. <b>Patients and methods:</b> Patients underwent two consecutive endoscopies performed by different endoscopists. The study was performed in two cohorts: one cohort was seen by Barrett's experts and the other cohort by community hospital endoscopists. Landmarks were recorded according to the Prague classification. Outcomes were interobserver agreement (assessed with intraclass correlation coefficient [ICC]), absolute agreement, and relative agreement. <b>Results:</b> A total of 187 patients were included, with median extent of C3M5 (IQR C1 – 7 M4 – 9) for Barrett's esophagus and 3 cm (IQR 2 – 5) for hiatal hernia length. ICC was 0.91 (95 % confidence interval [CI] 0.88 – 0.93) for maximum length, 0.92 (95 %CI 0.90 – 0.94) for circumferential extent, and 0.59 (95 %CI 0.49 – 0.68) for hiatal hernia length. Absolute agreement within ≤ 1 cm was 74 % (95 %CI 68 – 80) for circumference, 68 % (95 %CI 62 – 75) for length, and 63 % (95 %CI 56 – 70) for hiatal hernia length. Relative agreement was 91 % for Barrett's esophagus and 80 % for hiatal hernia length. Barrett's experts and community hospital endoscopists showed no differences in agreement. Shorter Barrett's segments (≤ 5 cm) had lower agreement compared with longer segments (> 5 cm). <b>Conclusions: </b>Agreement was good for Barrett's esophagus and reasonable for hiatal hernia length. These findings strengthen the value of the Prague C&M classification to describe Barrett's esophagus and hiatal hernia length. Although absolute agreement during real-time endoscopy was high, one should anticipate that Barrett's values may vary by 1 – 2 cm between two endoscopies.
Incidence of functional intestinal disorders and postinfectious irritable bowel syndrome following a waterborne viral gastroenteritis outbreak
Authors: B. Zanini, F. Caselani, A. Magni, A. M. La Roga, F. Bandera, C. Ricci, C. Cassarino, M. Romanini, D. Cecchi, F. Vassallo, C. Scarcella, A. Lanzini
Journal: Gut (2011)

<h3>Introduction</h3> Postinfectious irritable bowel syndrome (PI-IBS) may develop in 4–30% of patients following bacterial gastroenteritis (GE), but limited information is available on outcome of viral GE. On summer 2009 a massive community outbreak of Norovirus and Enterovirus GE occurred in San Felice (Lake Garda, Italy) due to contamination of municipal drinking water.1 In order to investigate the natural history of a community outbreak of viral gastroenteritis and to assess the incidence of functional gastrointestinal disorders and PI-IBS, we carried out a prospective population-based cohort study with control group. <h3>Methods</h3> Baseline questionnaires were administered to residents within 1 month of the outbreak. Follow-up questionnaires of the Italian version of Gastrointestinal Symptom Rating Scale (GSRS, a 15 item survey scored according to a 7-point Likert scale) were mailed to patients responding to baseline questionnaire at 3 and 6 months and to a cohort of unaffected controls, living in the same area, at 6 months after the outbreak. GSRS item were grouped into five dimensions: abdominal pain, reflux, indigestion, diarrhoea and constipation. At month 12 all patients and controls were interviewed by an health assistant in order to verify Rome III criteria of IBS. T test and χ<sup>2</sup> or fisher9s exact test were used as appropriate. <h3>Results</h3> Baseline questionnaires were returned by 348 patients: mean age ± SD 45 ± 22 years, 53% female. At outbreak nausea (score ≥4), vomiting and diarrhoea lasting 2–3 days or more were reported by 66%, 60% and 77% of patients, respectively. Fifty per cent reported fever and 19% referred weight loss (mean 3 kg). Follow-up surveys were returned at month 6 by 185 patients and 168 controls: mean of GSRS score for each dimension is reported in the figure. At month 12 we identified 40 patients with a new diagnosis of IBS (Rome III criteria), in comparison with 3 subjects in the control cohort (p&lt;0.0001; OR 11.40, 3.44 to 37.82, 95%CI). The 40 cases of PI-IBS were subtyped according to the predominant stool pattern,2 as follows: 4 IBS with constipation, 7 IBS with diarrhoea, 16 with mixed IBS and 13 with unsubtyped IBS (figure 1). <h3>Conclusion</h3> Our study provides evidence that mixed Norovirus and Enterovirus GE leads to postinfectious gastrointestinal disorders which persist for at least 12 month after infection. PI-IBS following viral infections develops in a substantial proportion of patients (22%) similar to that reported after bacterial GE.
Medical End-of-Life Practices under the Euthanasia Law in Belgium
Authors: Johan Bilsen, Joachim Cohen, Kenneth Chambaere, Geert Pousset, Bregje D Onwuteaka-Philipsen, Freddy Mortier, Luc Deliens
Journal: New England Journal of Medicine (2009)

appears to overcome the poor prognosis conferred by chromosome 13 deletion in phase 2
Modulation of angiogenesis with siRNA inhibitors for novel therapeutics
Authors: Patrick Y. Lu, Frank Y. Xie, Martin C. Woodle
Journal: Trends in Molecular Medicine (2005)

Cancer and many other serious diseases are characterized by the uncontrolled growth of new blood vessels. Recently, RNA interference (RNAi) has reinvigorated the therapeutic prospects for inhibiting gene expression and promises many advantages over binding inhibitors, including high specificity, which is essential for targeted therapeutics. This article describes the latest developments using small-interfering RNA (siRNA) inhibitors to downregulate various angiogenic and tumor-associated factors, both in cell-culture assays and in animal disease models. The majority of research efforts are currently focused on understanding gene function, as well as proof-of-concept for siRNA-mediated anti-angiogenesis. The prospects for siRNA therapeutics, both advantages and looming hurdles, are evaluated. Cancer and many other serious diseases are characterized by the uncontrolled growth of new blood vessels. Recently, RNA interference (RNAi) has reinvigorated the therapeutic prospects for inhibiting gene expression and promises many advantages over binding inhibitors, including high specificity, which is essential for targeted therapeutics. This article describes the latest developments using small-interfering RNA (siRNA) inhibitors to downregulate various angiogenic and tumor-associated factors, both in cell-culture assays and in animal disease models. The majority of research efforts are currently focused on understanding gene function, as well as proof-of-concept for siRNA-mediated anti-angiogenesis. The prospects for siRNA therapeutics, both advantages and looming hurdles, are evaluated.
Low Cholesterol Level as Risk Factor for Noncoronary Death in Middle-aged Men
Authors: Bo Peterson
Journal: JAMA (1981)

Eighty-six deaths occurred zero to five years (mean, 2.5 years) after the screening investigation in 10,000 middle-aged men in Malmö, Sweden. The men were 47 to 50 years old at the time of the screening and represented 75% of their total birth-year cohorts in Malmö. The mortality showed two peaks, one at the higher end of the cholesterol distribution and the other and more pronounced one at the lower end of the cholesterol distribution. The first peak corresponded to the cardiovascular deaths while the second peak corresponded to the noncoronary death causes, including alcohol-related deaths.
Regulation of Toll-like receptor-2 expression in chronic hepatitis B by the precore protein
Authors: Kumar Visvanathan, Narelle A. Skinner, Alex J.V. Thompson, Stephen M. Riordan, Vitini Sozzi, Roslyn Edwards, Sally Rodgers, Jelica Kurtovic, Judy Chang, Sharon Lewin, Paul Desmond, Stephen Locarnini
Journal: Hepatology (2006)

Toll-like receptors (TLRs) play a key role in the innate immune response. The aim of this study was to examine the expression of TLR2 and TLR4 in chronic hepatitis B (CHB). The TLR2 and TLR4 expression on hepatocytes and Kupffer cells from fresh liver biopsies was measured from 21 patients with untreated hepatitis B e antigen (HBeAg)-positive and HBeAg-negative CHB. Parallel studies were also undertaken on monocytes from their peripheral blood. Expression of TLR2 on hepatocytes, Kupffer cells, and peripheral monocytes was significantly reduced in patients with HBeAg-positive CHB in comparison with HBeAg-negative CHB and controls, whereas it was significantly increased in HBeAg-negative CHB compared with controls. The level of TLR4 expression did not differ significantly between the groups. These results were confirmed in vitro using hepatic cell lines transduced with recombinant HBV baculovirus expressing wild-type HBV (HBeAg-positive), precore stop codon (G1896A) mutant HBV (HBeAg-negative). The functional relevance of these findings was established by the demonstration of significantly reduced cytokine production (TNF-alpha) and phospho-p38 kinase expression in the presence of the HBeAg. In the absence of HBeAg, HBV replication was associated with up-regulation of the TLR2 pathway leading to increased TNF-alpha production.This study demonstrates a potentially important interaction between HBeAg, HBV, and the innate immune response.
Trends in disease modifying antirheumatic drug prescription in early rheumatoid arthritis are influenced more by hospital setting than patient or disease characteristics
Authors: C Carli, A G C Ehlin, L Klareskog, S Lindblad, S M Montgomery
Journal: Annals of the Rheumatic Diseases (2005)

<b>Objective:</b> To characterise temporal trends and factors associated with the prescription of disease modifying antirheumatic drugs (DMARDs) at the initial consultation in early rheumatoid arthritis (RA). <b>Methods:</b> Data from 2584 patients with early RA at 19 hospitals were extracted from the Swedish Rheumatoid Arthritis Register for the period 1997–2001. Disease characteristics and DMARD prescription at first consultation with the rheumatologist were investigated using cross tabulation and logistic regression. <b>Results:</b> DMARD prescriptions, particularly for methotrexate, increased from 1997 to 2001 independently of patient characteristics. Stratification by hospital type showed that patients in district hospitals were less likely to be prescribed DMARDs than those in university hospitals (adjusted odds ratio (OR) = 0.53 (95% confidence interval (CI) 0.40 to 0.69), p&lt;0.001), independently of confounding factors. Association of the DAS28 with the likelihood of DMARD prescription was greater among patients attending district hospitals (OR = 1.65 (1.34 to 2.02), p&lt;0.001) than those at university hospitals (OR = 1.23 (1.07 to 1.41), p = 0.003) and county hospitals (OR = 1.34 (1.01 to 1.63), p = 0.003). Interaction testing indicated that the difference was significant (p = 0.007). <b>Conclusions:</b> Temporal trends in DMARD prescription indicate an increasingly aggressive approach to disease management among Swedish rheumatologists. However, the association of hospital type with DMARD prescription suggests that the adoption of research findings in clinical care varies considerably.
A reassessment of soluble urokinase-type plasminogen activator receptor in glomerular disease
Authors: Joann M. Spinale, Laura H. Mariani, Shiv Kapoor, Jidong Zhang, Robert Weyant, Peter X. Song, Hetty N. Wong, Jonathan P. Troost, Crystal A. Gadegbeku, Debbie S. Gipson, Matthias Kretzler, Deepak Nihalani, Lawrence B. Holzman
Journal: Kidney International (2014)
US Congress considers new tracking system for medical devices after excessive recalls
Authors: K. Epstein
Journal: BMJ (2012)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following US Congress considers new tracking system for medical devices after excessive recalls Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
FDA advisers to assess drug for low sexual desire in women
Authors: R. Moynihan
Journal: BMJ (2010)

Advisers to the US Food and Drug Administration will meet on 18 June to assess the drug flibanserin as a potential treatment for women said to have low sexual desire, or “hypoactive sexual desire disorder.”

Flibanserin was originally developed as an anti-depressant, but was not found to be effective and was never approved as one. Its German manufacturer Boehringer Ingelheim has recently released abstracts of unpublished randomised trials testing the drug’s potential sexual benefits in women.

According to the abstracts, the company’s trials of flibanserin in Europe failed to show any statistically significant benefit compared with placebo on the primary outcome measure: the number of “satisfying sexual events.” A satisfying sexual event can …
Differences in Genome Size Between Closely Related Species: The Drosophila melanogaster Species Subgroup
Authors: Matthieu Boulesteix, Michèle Weiss, Christian Biémont
Journal: Molecular Biology and Evolution (2005)

Genome size varies considerably among organisms due to differences in the amplification, deletion, and divergence of various kinds of repetitive sequences, including the transposable elements, which constitute a large fraction of the genome. However, while the changes in genome size observed at a wide taxonomic level have been thoroughly investigated, we still know little about the process involved in closely related species. We estimated genome sizes and the reverse transcriptase–related sequence (RTRS) content in the nine species of the Drosophila melanogaster species subgroup. We showed that the species differ with regard to their genome size and that the RTRS content is correlated with genome size for all species except Drosophila orena. The genome of D. orena, which is 1.6-fold as big as that of D. melanogaster, has in fact not undergone any major increase in its RTRS content.
Outcome of Coronary Bypass Surgery Versus Coronary Angioplasty in Diabetic Patients With Multivessel Coronary Artery Disease
Authors: William S Weintraub, Bernardo Stein, Andrzej Kosinski, John S Douglas, Ziyad M.B Ghazzal, Ellis L Jones, Douglas C Morris, Robert A Guyton, Joseph M Craver, Spencer B King
Journal: Journal of the American College of Cardiology (1998)
Effect of Interferon-<b>γ</b>on Allergic Airway Responses in Interferon-<b>γ</b>–deficient Mice
Authors: Makoto Yoshida, Richard Leigh, Koichiro Matsumoto, Jennifer Wattie, Russ Ellis, Paul M. O'Byrne, Mark D. Inman
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

Interferon (IFN)-γ reduces airway responses after allergen challenge in mice. The mechanisms of this effect are not clear. These studies investigate whether IFN-γ can reverse prolonged airway responses after allergen challenge in IFN-γ–deficient (IFN-γKO) mice. Sensitized mice (IFN-γKO and wild-type [WT]) were challenged with ovalbumin. Airway responsiveness, eosinophils in bronchoalveolar lavage fluid, and lung lymphocyte subsets (CD4+ and CD8+) were measured 24 hours and 8 weeks after challenge. In further experiments, we treated IFN-γKO mice with recombinant IFN-γ starting 4 weeks after the challenge for 1 week or 4 weeks. Airway responsiveness, bronchoalveolar lavage eosinophils, and lung CD4+ cells were increased 8 weeks after challenge in IFN-γKO but not WT mice. IFN-γ treatment returned lung CD4+ cell numbers to values obtained in unchallenged mice. One week of IFN-γ treatment also returned airway responsiveness to baseline levels; however, 4-week treatment with IFN-γ failed to decrease airway responsiveness below levels observed in untreated animals. This suggests that IFN-γ plays an essential role in reversing allergen-induced airway inflammation and hyperresponsiveness and that it may have dual actions on the latter. Observations that IFN-γ reverses airway responses, even when administered after challenge, suggests that IFN-γ treatment could control allergic disease, including asthma.
Uniform Size and Card Index for Reprints and Advertisers
Authors: F. W. Starr
Journal: JAMA (1910)

<h3>To the Editor:—</h3> I wish to suggest thatThe Journaluse its influence to get some uniformity in the size of folio to be used in reprints of various sorts whether put out by authors or (other?) advertisers. If an index card of uniform size were adopted at the same time by advertisers and publishers and sent out with their articles a great deal that goes into the doctor's waste-paper basket would be preserved, indexed and used. I am by no means the originator of this idea but think it worth being called to the attention of the A. M. A. again.