tbuckley/cabot-search huggingface dataset:
Controversies in Management: Acyclovir for childhood chickenpox
Authors: M W McKendrick
Journal: BMJ (1995)

Chickenpox is usually a disease of childhood, but it can occur at any age.In Sheffield (population 500 000) about one immunocompetent patient a year requires admission to the intensive care unit for chickenpox pneumonia, and there has been one death in the past 12 years (unpublished observations).Pneumonia is a rare complication in children, in whom the disease is usually mild and uncomplicated.But in immunocompromised patients, including infants acquiring infection perinatally and patients taking steroids, the illness can be severe, and antiviral drugs may be life saving.
Changes in fecal flora and comparative multiple-dose pharmacokinetics of ceftibuten, cefpodoxime proxetil and amoxycillin/clavulanate
Authors: Jörg Hamacher, Jörg Luepke, Bruce E. Reidenberg, Carl Erik Nord, Klaus Borner, Peter Koeppe, David Bristol, Hartmut Lode
Journal: Clinical Microbiology and Infection (1999)
Care of dying patients
Authors: W. G Notcutt
Journal: BMJ (2003)

Editor—How sad it is, that in 2003 the simple messages of palliative care have not reached all parts of the healthcare system. Ellershaw and Ward's paper should be a wake up call to the deans of medical and nursing schools and to the royal colleges.1 No longer is it acceptable to teach surgery and medicine and not include palliative care in the curriculum. The wards of our hospitals are full not only of curably sick people who need care but also of dying people.

All trainees at every level should be able to demonstrate appropriate skills of palliative care in their exams and assessments. Perhaps if the General Medical Council were to drive forward this issue, particularly in training, it would restore some of its credibility and status.

Rabbi Julia Neuberger is wrong when she says that nothing can prepare a young doctor, nurse, or rabbi for facing people whose death is imminent. Training and education can prepare them, while practical experience develops their skills. I reflect on the painful memory of my first breaking of bad news, some 30 years ago. If I had had some basic training it would have been very different.

The goal of all of us should be to ensure that the current and the next generation of healthcare practitioners realise how fundamentally important care of the dying is, at the earliest point in their training.
Mortality of elderly patients with psychiatric disorders
Authors: G S Zubenko, B H Mulsant, R A Sweet, R E Pasternak, X M Tu
Journal: American Journal of Psychiatry (1997)

The goal of this study was to evaluate the impact of common late-life mental disorders on the life expectancy and causes of death of older psychiatric patients.The study population consisted of 809 older psychiatric patients who met DSM-III-R criteria for organic mental disorders, mood disorders, or psychotic disorders and who were discharged after a comprehensive multidisciplinary evaluation and acute inpatient treatment for their behavioral disorders. Dates and causes of death during a 5.75-year follow-up period were provided by the Pennsylvania Department of Health. Univariate and multivariate survival procedures were used to compare the survival rates of the three groups to each other and to a reference population of Pennsylvania residents. Causes of death were also tabulated according to ICD-9-CM and compared across the groups.Age, gender, race, and medical comorbidity made significant independent contributions to survival. When these variables were controlled, the survival of patients with organic mental disorders was less than half of that for patients with mood or psychotic disorders. However, all three groups experienced higher rates of mortality than the reference population, with standardized mortality ratios of 1.5 to 2.5. Deaths occurred from the usual spectrum of natural causes, with the exception that patients with mood disorders were more likely to have died from disorders of the digestive system and suicide.The mental disorders of late life have a significant negative impact on the survival of older psychiatric patients.
Outcomes of Childhood Asthma and Wheezy Bronchitis. A 50-Year Cohort Study
Authors: Nara Tagiyeva, Graham Devereux, Shona Fielding, Stephen Turner, Graham Douglas
Journal: American Journal of Respiratory and Critical Care Medicine (2015)

Cohort studies suggest that airflow obstruction is established early in life, manifests as childhood asthma and wheezy bronchitis, and continues into early adulthood. Although an association between childhood asthma and chronic obstructive pulmonary disease (COPD) in later life has been demonstrated, it is unclear if childhood wheezy bronchitis is associated with COPD.To investigate whether childhood wheezy bronchitis increases the risk of COPD in the seventh decade.A cohort of children recruited in 1964 at age 10 to 15 years, which was followed up in 1989, 1995, and 2001, was followed up again in 2014 when at age 60 to 65 years. Discrete time-to-event and linear mixed effects models were used.FEV1 and FVC were measured. COPD was defined as post-bronchodilator FEV1/FVC <0.7. Childhood wheezing phenotype was related to 1989, 1995, 2001, and 2014 spirometry data. Three hundred thirty subjects, mean age 61 years, were followed up: 38 with childhood asthma; 53 with childhood wheezy bronchitis; and 239 control subjects (of whom 57 developed adulthood-onset wheeze between ages 16 and 46 yr). In adjusted multivariate analyses, childhood asthma was associated with an increased risk of COPD (odds ratio, 6.37; 95% confidence interval, 3.73-10.94), as was childhood wheezy bronchitis (odd ratio 1.81; 95% confidence interval, 1.12-2.91). The COPD risk increased with childhood asthma, and wheezy bronchitis was associated with reduced FEV1 that was evident by the fifth decade and not an accelerated rate of FEV1 decline. In contrast, adulthood-onset wheeze was associated with accelerated FEV1 decline.Childhood wheezy bronchitis and asthma are associated with an increased risk of COPD and reduced ventilatory function.
Fluid-challenge testing to distinguish PAH from pulmonary hypertension secondary to heart failure
Authors: F.P.T. Oosterveer, K.M. Marques, C.P. Allaart, F.S. de Man, H.-J. Bogaard, A.C. van Rossum, N. Westerhof, A. Vonk-Noordegraaf, M.L. Handoko
Journal: European Respiratory Journal (2013)

Pulmonary arterial hypertension (PAH) and pulmonary hypertension secondary to heart failure requires different clinical management. Current guidelines recommend the use of pulmonary capillary wedge pressure (PCWP) to distinguish both conditions. However, within a patient PCWP is quite variable depending on volume-state. Therefore, a patient with a PCWP  Patients (n=17; 2 male, age 65±13yrs, BMI 30±7kg/m2, plasma BNP 359±311pg/ml) referred for analyses of pulmonary hypertension with borderline PCWP between 2010 and 2013 underwent right heart catheterization with standardized fluid-challenge testing (600ml saline in 18 minutes). A PCWP  No complications occurred in any patient tested. Fluid loading resulted in an initial rise in PCWP and leveled after 400ml (Fig.1A). After fluid-challenge, 9 patients had a PCWP>15mmHg. These patients could already be identified using 400ml of fluid loading (Fig.1B).  Fluid-challenge testing is feasible and safe in patients with pulmonary hypertension. Fluid loading of 400ml is sufficient to reveal a differential fluid response.
Prasugrel 5 mg in the Very Elderly Attenuates Platelet Inhibition But Maintains Noninferiority to Prasugrel 10 mg in Nonelderly Patients
Authors: David Erlinge, Paul A. Gurbel, Stefan James, Tomas L. Lindahl, Peter Svensson, Jurrien M. Ten Berg, David P. Foley, Henrik Wagner, Patricia B. Brown, Junxiang Luo, Chunmei Zhou, Brian A. Moser, Joseph A. Jakubowski, David S. Small, Kenneth J. Winters, Dominick J. Angiolillo
Journal: Journal of the American College of Cardiology (2013)
Antecedents, symptom progression, and long-term outcome of the deficit syndrome in schizophrenia
Authors: W S Fenton, T H McGlashan
Journal: American Journal of Psychiatry (1994)

The authors explore the antecedents, symptom progression, and long-term outcome of patients diagnosed as having the deficit syndrome, a putative domain of psychopathology and subtype of schizophrenia defined by Carpenter's group.Patients from the Chestnut Lodge Follow-Up Study were retrospectively rediagnosed as having deficit (N = 46) or nondeficit (N = 141) forms of schizophrenia by using the criteria of Carpenter's group. Patients with deficit and nondeficit forms of schizophrenia were compared in relation to symptom progression between first and index admission, natural history and course of illness, and long-term outcome assessed at follow-up a mean of 19 years after index admission.1) Significantly fewer patients with the deficit form of schizophrenia were married before illness onset, but few other differences between patients with deficit and nondeficit schizophrenia emerged. 2) Illness onset was often insidious for patients with the deficit syndrome; once established, the illness was nearly always continuous with few remissions, and its course appeared unreactive to life events. 3) Negative symptoms among patients with the deficit syndrome were often present at illness onset and progressed in severity over the first 5 years of illness; thought disorder and bizarre behavior also increased in severity over time. 4) Once established, the deficit syndrome was highly stable. 5) The deficit syndrome was associated with a very high risk of poor outcome and long-term disability. 6) None of the patients with the deficit syndrome were known to have committed suicide.The data support the validity of the deficit syndrome as a subtype of schizophrenia with a relatively distinct natural history.
Socioeconomic differentials in the mortality of pets
Authors: G. D. Smith, B. Bonnett
Journal: BMJ (1998)

Papers p 1686

Factors associated with mortality among dogs have not been extensively studied, though recent work has examined age, breed, and sex distributions of mortality.1 There has, however, been little investigation of socioeconomic differentials in pet mortality. The study by Moloo et al in this week's issue (p 1686) is therefore welcome, although the results should be interpreted with caution.2 They show that the probability of reporting the death of a pet in the past year is greater for young people from less favourable socioeconomic backgrounds than for those from more favourable backgrounds.

Pet ownership may have some influence on psychological health,3 but it does not itself seem to influence mortality4 and therefore the dynamics of mortality among pet owners are likely to reflect those of the total population. In this regard the socioeconomic inequalities in mortality—shown in a wide range of populations—will be a key feature. There has been considerable research into explanations of socioeconomic differentials in mortality among humans,5 and similar categories of explanation may account for such differentials in pet mortality.

The “artefact” explanation suggests that socioeconomic differentials in mortality are more apparent than real, resulting from the way data are collected and analysed. In Moloo et al's study a potential artefact is created by the fact …
Clinical risk factors alone are insufficient in decision making
Authors: P. Selby, M. Davies
Journal: BMJ (1996)

40%), moderate (19 to 29) in 28 (22%), and severe (30 and higher) in nine (7%).Half of the carers (64; 51 %) reported three or fewer physical symptoms.Quality of sleep was rated as good by 57 (46%) of carers.Depression was related (non-significantly) to age and female sex.Patient's behavioural distur- bance, assessed by the behaviour and mood dis- turbance scale,1 was the main independent correlate of carer's mood.An interaction of carers' affective state with carers' physical symp- toms and poor quality of sleep was found; in depressed carers the frequency of physical symp- toms and the quality of sleep were not influenced by patients' behavioural disturbance (table 1).In non-depressed carers the high frequency of behavioural disturbances was associated with poor perceived health-that is, more physical symptoms and poor quality of sleep.The two
HPV Serum Antibodies as Predictors of Survival and Disease Progression in Patients with HPV-Positive Squamous Cell Carcinoma of the Oropharynx
Authors: Kristina R. Dahlstrom, Karen S. Anderson, Julia N. Cheng, Diego Chowell, Guojun Li, Marshall Posner, Erich M. Sturgis
Journal: Clinical Cancer Research (2015)

Abstract Purpose: Oropharyngeal carcinoma positive for human papillomavirus type 16 (HPV16) has a significantly better prognosis than oropharyngeal carcinoma unrelated to HPV. Within HPV16-positive oropharyngeal carcinoma, biomarkers of prognosis are urgently needed to individualize care. We hypothesized that serum antibodies specific to HPV16, the major HPV type causing oropharyngeal carcinoma, have biologic relevance and are potential biomarkers for improved prognosis among patients with HPV16-positive oropharyngeal carcinoma. Experimental Design: IgG antibodies to the HPV16 antigens E1, E4-E7, L1, L2, and the N-terminal and C-terminal fragments of E2 (NE2, CE2) were quantified using a custom programmable enzyme-linked immunosorbent assay. Sera were obtained at diagnosis from 209 oropharyngeal carcinoma patients (96 HPV16-positive). The ratios of median fluorescent intensity (MFI) for each antigen to MFI for control GST protein were determined. Kaplan–Meier survival curves and Cox proportional hazards regression were used to determine survival differences between groups. ROC curves were used to determine the best combination of E antibodies to predict disease recurrence. Results: E1, NE2, and E6 antibody positivity were all strongly associated with improved overall and progression-free survival in the entire cohort and in patients with known HPV16-positive tumors (P &amp;lt; 0.05). For both overall and progression-free survival among HPV-positive patients, hazard ratios were 0.2 for NE2, 0.3 for E1, and 0.3 for E6 antibody positivity. Conclusions: We identified three HPV16-specific antibodies that are associated with improved overall and progression-free survival in patients with HPV-related oropharyngeal carcinoma. These results suggest that differential serologic responses in patients may reflect differential biologic processes within the host and tumor and may have prognostic value. Clin Cancer Res; 21(12); 2861–9. ©2015 AACR.
In Vivo Activation of Antigen-Specific CD4 T Cells
Authors: Marc K. Jenkins, Alexander Khoruts, Elizabeth Ingulli, Daniel L. Mueller, Stephen J. McSorley, R. Lee Reinhardt, Andrea Itano, Kathryn A. Pape
Journal: Annual Review of Immunology (2001)

Physical detection of antigen-specific CD4 T cells has revealed features of the in vivo immune response that were not appreciated from in vitro studies. In vivo, antigen is initially presented to naïve CD4 T cells exclusively by dendritic cells within the T cell areas of secondary lymphoid tissues. Anatomic constraints make it likely that these dendritic cells acquire the antigen at the site where it enters the body. Inflammation enhances in vivo T cell activation by stimulating dendritic cells to migrate to the T cell areas and display stable peptide-MHC complexes and costimulatory ligands. Once stimulated by a dendritic cell, antigen-specific CD4 T cells produce IL-2 but proliferate in an IL-2–independent fashion. Inflammatory signals induce chemokine receptors on activated T cells that direct their migration into the B cell areas to interact with antigen-specific B cells. Most of the activated T cells then die within the lymphoid tissues. However, in the presence of inflammation, a population of memory T cells survives. This population is composed of two functional classes. One recirculates through nonlymphoid tissues and is capable of immediate effector lymphokine production. The other recirculates through lymph nodes and quickly acquires the capacity to produce effector lymphokines if stimulated. Therefore, antigenic stimulation in the presence of inflammation produces an increased number of specific T cells capable of producing effector lymphokines throughout the body.
Impaired Intracellular Transport and Cell Surface Expression of Nonpolymorphic HLA-E
Authors: Matthias Ulbrecht, Josef Kellermann, Judith P. Johnson, Elisabeth H. Weiss
Journal: The Journal of Experimental Medicine (1992)

The assembly of the classical, polymorphic major histocompatibility complex class I molecules
in the endoplasmic reticulum requires the presence of peptide ligands and ~2-microglobulin
(~2m). Formation of this trimolecular complex is a prerequisite for e~cient transport to the
cell surface, where presented peptides are scanned by T lymphocytes. The function of the other
class I molecules is in dispute. The human, nonclassical class I gene, HLA-E, was found to be
ubiquitously transcribed, whereas cell surface expression was dif~cult to detect upon transfection.
Pulse chase experiments revealed that the HLA-E heavy chain in transfectants, obtained with
the murine myeloma cell line P3X63-Ag8.653 (X63), displays a significant reduction in
oligosaccharide maturation and intracellular transport compared with HLA-B27 in corresponding
transfectants. The accordingly low HLA-E cell surface expression could be significantly enhanced
by either reducing the culture temperature or by supplementing the medium with human ~2m,
suggesting inefficient binding of endogenous peptides to HLA-E. To analyze whether HLA-E
binds peptides and to identify the corresponding ligands, fractions of acid-extracted material from
HLA-E/X63 transfectants were separated by reverse phase HPLC and were tested for their ability
to enhance HLA-E cell surface expression. Two fractions specifically increased the HLA class
I expression on the HLA-E transfectant clone.
Transmission of respiratory syncytial virus at the paediatric intensive-care unit: a prospective study using real-time PCR
Authors: A.C. van de Pol, J.W.A. Rossen, T.F.W. Wolfs, E.K. Breteler, J.L.L. Kimpen, A.M. van Loon, N.J.G. Jansen
Journal: Clinical Microbiology and Infection (2009)
IOM Public Health Report Urges Massive Change
Authors: Brian Vastag
Journal: JAMA (2002)

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Ribavirin for Chronic Hepatitis E Virus Infection
Authors: Etienne Brochot, Gabriel Choukroun, Gilles Duverlie
Journal: New England Journal of Medicine (2014)

describe the successful use of ribavirin for the treatment of chronic hepatitis E virus (HEV) in-fection in 59 immunosuppressed recipients of solid-organ transplants. One wonders whether the results depended on the type of immunosup -pressive therapy that the patients were receiving. The use of immunosuppressive medications has been proposed as a key factor in the development of chronic HEV infection among organ transplant recipients.
Authors' response
Authors: C. G. Persson, L. Uller
Journal: Thorax (2011)

without a huge expansion of critical care beds that could not be justified without evidence of benefit to patients.It should be noted that most of the studies reported by Dr Challen failed to exclude patients with do not attempt resuscitation orders or with directives not to be admitted to the ICU.Therefore, these percentages and the pooled performance characteristics do not necessarily reflect their 'real life' clinical utility.Expanding on Dr Challen's statement that application of these tools 'should be with caution', we would suggest that severity scores should only be used to predict outcomes for which they have been validated and, as suggested by McGinn, 4 scoring systems should have their impact assessed in clinical studies before being applied to guide clinical decisions.
Randomized clinical trial: Effects of controlled breathing exercises on respiratory muscle in the elderly
Authors: Maria Àngels Cebrià i Iranzo, David Alan Arnall, José Manuel Tomás Miguel, Celedonia Igual Camacho, Juan Carlos Meléndez Moral, Jon Roger Webb
Journal: European Respiratory Journal (2011)

Introduction: Respiratory muscle (RM) strength decreases with aging, and in most cases this decrease is associated with functional impairment and disabilities, particularly in the frail elderly. RM training has been shown to be an effective method to improve RM strength. The purpose of this study was to assess the effect of controlled breathing exercises on RM strength among elderly people with disabilities who are unable to engage in general exercise reconditioning. The hypothesis is that controlled breathing exercises will improve RM strength vs. a control group.

Methods: Forty-eight elderly were randomly assigned to a control group (n=24) or training group (n=24). A supervised training protocol, consisting of controlled Pranayama breathing exercises, was performed 5 times per week for 6 weeks. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were assessed at 4 time points: pre-test, intermediate, post-test and follow-up.

Results: The anthropometrics, pulmonary function and RM function data of participants did not showed significant differences between groups.

ANOVAs revealed significant differences in MIP and MEP between the two groups after the training protocol. For MIP the treatment was effective (F3,138=9,122, p<0,001, η2=0,165). Also for MEP is statistically significant (F3,138=9,102, p<0,001, η2=0,165).

Conclusions: This is the first controlled study in elderly people that reports a significant gain in RM strength due to the Pranayama training program.