tbuckley/cabot-search huggingface dataset:
In Defense of the Personal Statement
Authors: Turi McNamee
Journal: Annals of Internal Medicine (2012)

On Being a Doctor6 November 2012In Defense of the Personal StatementTuri McNamee, MDTuri McNamee, MDFrom Sanford School of Medicine of the University of South Dakota, Sioux Falls, SD 57103.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-9-201211060-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail As the director of an internal medicine residency program, I read hundreds of personal statements every year. I know many program directors who find them irrelevant at best, and I confess I can't blame them. These statements usually follow 1 of 3 scripts: The candidates relay a medical catastrophe that afflicted them or their family. Curiosity is piqued. They indulge their curiosity by poring over endless tomes of biologic sciences and end up in medical school. Or, they know that they've wanted to be a doctor since conception. They were always exceptionally skilled in the sciences but really wanted to ... Author, Article, and Disclosure InformationAffiliations: From Sanford School of Medicine of the University of South Dakota, Sioux Falls, SD 57103.Corresponding Author: Turi McNamee, MD, Sanford School of Medicine, 1400 West 22nd Street, Sioux Falls, SD 57103; e-mail, [email protected]. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByWhat Do Program Directors Value in Personal Statements? A Qualitative AnalysisPreparing for Fellowship in Internal Medicine. Steps for Success with a Focus on Pulmonary and/or Critical Care ProgramsTextual analysis of internal medicine residency personal statements: themes and gender differences 6 November 2012Volume 157, Issue 9Page: 675KeywordsChildrenComputer applicationsDeceptionEmotionsFallsFearOilsResidencySweatSwimming ePublished: 6 November 2012 Issue Published: 6 November 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
NHE4 is critical for the renal handling of ammonia in rodents
Authors: Soline Bourgeois, Leonie Van Meer, Bharath Wootla, May Bloch-Faure, Régine Chambrey, Gary E. Shull, Lara R. Gawenis, Pascal Houillier
Journal: Journal of Clinical Investigation (2010)

Ammonia absorption by the medullary thick ascending limb of Henle's loop (MTALH) is thought to be a critical step in renal ammonia handling and excretion in urine, in which it is the main acid component. Basolateral Na+/H+ exchangers have been proposed to play a role in ammonia efflux out of MTALH cells, which express 2 exchanger isoforms: Na+/H+ exchanger 1 (NHE1) and NHE4. Here, we investigated the role of NHE4 in urinary acid excretion and found that NHE4-/- mice exhibited compensated hyperchloremic metabolic acidosis, together with inappropriate urinary net acid excretion. When challenged with a 7-day HCl load, NHE4-/- mice were unable to increase their urinary ammonium and net acid excretion and displayed reduced ammonium medulla content compared with wild-type littermates. Both pharmacologic inhibition and genetic disruption of NHE4 caused a marked decrease in ammonia absorption by the MTALH. Finally, dietary induction of metabolic acidosis increased NHE4 mRNA expression in mouse MTALH cells and enhanced renal NHE4 activity in rats, as measured by in vitro microperfusion of MTALH. We therefore conclude that ammonia absorption by the MTALH requires the presence of NHE4 and that lack of NHE4 reduces the ability of MTALH epithelial cells to create the cortico-papillary gradient of NH3/NH4+ needed to excrete an acid load, contributing to systemic metabolic acidosis.
Effect of interleukin-28B on treatment outcome in hepatitis C virus G1/4 patients receiving response-guided therapy with pegylated interferon alpha-2a/ribavirin
Authors: Brian L. Pearlman, Carole Ehleben
Journal: Hepatology (2011)

We read with interest that Scherzer et al. demonstrated that slow-responder patients with an interleukin-28B (IL-28B) rs12979860 T allele benefited from therapy extension. The investigators state that to "…(their) knowledge, such clear evidence of an association between relapse and rs12979860 genotype has not been reported previously." 1 However, we published similar findings 3 months before, from a U.S. trial of slow responders to pegylated interferon (Peg-IFN) alpha-2b and ribavirin (RBV). 2, 3 After institutional review board approval, 90 patients participated by providing additional informed consent for genetic testing. These patients represented 89% of our slow-responding patients from our original trial. 2 The findings are shown below. In short, slow-responding patients to Peg-IFN/RBV benefit from treatment extension to 72 weeks, by virtue of diminished rates of relapse, if they harbor any non-CC genotype (i.e., IL-28B major mutation). We believe the investigators were inadvertently unaware of our findings because of nearly concurrent submission times. However, we are writing to inform your readers that the HEPATOLOGY data are confirmatory, which have now been demonstrated, albeit retrospectively, in two disparate slow-responding populations. Brian L. Pearlman M.D., F.A.C.P.* , Carole Ehleben Ed.D. , * Center for Hepatitis C, Atlanta Medical Center, Atlanta GA, Medical College of Georgia, Augusta GA, Emory School of Medicine, Atlanta GA.
Hemodynamic differences between supine and upright exercise in patients with congestive heart failure.
Authors: B Kramer, B Massie, N Topic
Journal: Circulation (1982)

Although the differences in hemodynamic responses to supine and upright exercise have been studied in normal subjects and in patients with angina pectoris, no such comparison has been made in patients with congestive heart failure. Many investigators measure exercise hemodynamics in heart failure patients to assess the effect of vasodilator and inotropic drugs. Both modes of exercise have been used and have often yielded differing results. We compared the hemodynamic response to supine and upright exercise in 14 patients with stable, New York Heart Association class III chronic heart failure. During upright exercise, peak heart rate was higher (124 +/- 15 vs 115 +/- 18 beats/min, p less than 0.025) and peak mean arterial pressure was lower (102 +/- 15 vs 95 +/- 17 mm Hg, p less than 0.25), yielding similar double products. Although the peak left ventricular filling pressure was slightly lower during upright exercise (40 +/- 7 vs 35 +/- 10 mm Hg, p less than 0.05), the maximum cardiac and stroke indexes were not significantly different (3.6 +/- 0.8 vs 3.4 +/- 0.8 l/min/m2 and 30 +/- 8 vs 30 +/- 6 ml/m2, upright vs supine exercise). In contrast to these relatively similar hemodynamic responses, exercise capacity was significantly greater during upright exercise (peak work load 336 +/- 84 vs 293 +/- 73 kpm/min, p less than 0.1; maximum oxygen consumption 12.1 +/- 2.4 vs 9.8 +/- 1.9 ml/min/kg, p less than 0.001). We conclude that either exercise method may be used to assess the hemodynamic effects of drugs, but that exercise capacity should be measured in the upright position.
The Doctor Machine
Authors: Agnes J. Haugen
Journal: JAMA (1974)

<h3>To the Editor.—</h3> Will thousands of unemployed doctors be roaming the streets of America in the near future looking for work—just as thousands of unemployed teachers are doing at the present time and thousands of state employment counselors did before them? Only a few years ago, the Oregon State Employment Service replaced human counselors with machines, and lower-paid clerical workers to explain their use. Then a hue and cry went up about the shortage and the incompetence of classroom teachers. And the Department of Health, Education, and Welfare came to the rescue with the offer of huge sums of federal money to put teaching machines into the schools. As schools began grabbing their share of this federal money, teaching machines were installed in the schools—along with $2-per-hour teachers' aides and other low-paid paraprofessionals to supervise the use of these machines. The jobs of classroom teachers vanished, and thousands of certified
High-Dose Therapy and Autologous Stem-Cell Transplantation in Waldenström Macroglobulinemia: The Lymphoma Working Party of the European Group for Blood and Marrow Transplantation
Authors: Charalampia Kyriakou, Carmen Canals, David Sibon, Jean Yves Cahn, Majid Kazmi, William Arcese, Karin Kolbe, Norbert Claude Gorin, Kristy Thomson, Noel Milpied, Dietger Niederwieser, Karel Indrák, Paolo Corradini, Anna Sureda, Norbert Schmitz
Journal: Journal of Clinical Oncology (2010)

The role of autologous stem-cell transplantation (ASCT) in Waldenström macroglobulinemia (WM) is not defined. The aim of this study was to analyze the results of ASCT in patients with WM and to determine the prognostic factors that have a significant impact on outcome.We analyzed 158 adult patients with WM reported to the European Group for Blood and Marrow Transplantation (EBMT) between January 1991 and December 2005. Median time from diagnosis to ASCT was 1.7 years (range, 0.3 to 20.3 years), 32% of the patients experienced treatment failure with at least three lines of therapy, and 93% had sensitive disease at the time of ASCT. Conditioning regimen was total-body irradiation-based in 45 patients. Median follow-up for surviving patients was 4.2 years (range, 0.5 to 14.8 years).Nonrelapse mortality was 3.8% at 1 year. Ten patients developed a secondary malignancy, with a cumulative incidence of 8.4% at 5 years. Relapse rate was 52.1% at 5 years. Progression-free survival (PFS) and overall survival were 39.7% and 68.5%, respectively, at 5 years and were significantly influenced by number of lines of therapy and chemorefractoriness at ASCT. The achievement of a negative immunofixation after ASCT had a positive impact on PFS after ASCT. When used as consolidation at first response, ASCT provided a PFS of 44% at 5 years.ASCT is a feasible procedure in young patients with advanced WM. ASCT should not be offered to patients with chemoresistant disease and to those who received more than three lines of therapy.
Erasmus Darwin Barlow
Authors: G C Cook
Journal: BMJ (2006)

Former honorary psychiatrist St Thomas's Hospital, London, and businessman (b 1915; q Cambridge/University College Hospital, London, 1941; DPM, FRCPsych), died from renal failure on 2 August 2005.

Erasmus Barlow was a direct descendant of Charles Darwin through his mother, Emma Nora Darwin. He became senior lecturer and honorary consultant in psychological medicine at St Thomas's Hospital Medical School (1951-66). His roles included being vice chairman of the Mental Health Research Fund; chairman of the Bath Institute of Medical Engineering; and secretary of the Zoological Society of London. He had also at various times been chairman, deputy chairman, and director of several companies. He leaves a wife, Brigit, and two children.
The Challenge of Postal Medicine
Authors: Bruce M. Rothschild
Journal: Annals of Internal Medicine (1996)

Letters15 February 1996The Challenge of Postal MedicineBruce M. Rothschild, MD and Cinda ElserBruce M. Rothschild, MDArthritis Center of Northeast Ohio; Youngstown, OH 44512 and Cinda ElserArthritis Center of Northeast Ohio; Youngstown, OH 44512Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-4-199602150-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The tendency of insurance plans to use postal pharmacy services presents challenges that may not have received adequate attention. The effect of extreme temperatures on the stability of medication in transit and the placement of medications in unattended mailboxes (with potential for access by children) are concerns.A 31-year-old woman presented with dry eyes, the Raynaud phenomenon, finger and facial numbness, and “blood clots” on her fingers. She had a history of thrombophlebitis and known protein C and protein S deficiency. Procardia 30XL (Pratt Pharmaceuticals, New York, New York), hypotears, and warfarin (revolving daily doses of 2.5, ... Author, Article, and Disclosure InformationAuthors: Bruce M. Rothschild, MD; Cinda ElserAffiliations: Arthritis Center of Northeast Ohio; Youngstown, OH 44512 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTwo sides of the warfarin issue: diligence versus potency 15 February 1996Volume 124, Issue 4Page: 454-455KeywordsFood and Drug AdministrationHealth care qualityKidneysLiverProtein C deficiencyProtein S deficiencyProthrombin timeResearch laboratoriesTemperatureThrombosis ePublished: 15 August 2000 Issue Published: 15 February 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The Oregon Medicaid Demonstration Project — Will It Provide Adequate Medical Care?
Authors: R Steinbrook, B Lo
Journal: New England Journal of Medicine (1992)

OREGON'S plan to base Medicaid benefits on a prioritized list of health services has attracted national interest as a novel approach to financing medical care for the uninsured.1 2 3 4 5 6 7 8 9 10 11 12 13 The goal is to provide basic health care benefits to substantially more poor people while controlling expenditures by limiting the number of services covered. Recently, the Oregon legislature determined which services on the prioritized list to cover. The plan is now being reviewed by the federal government and may be implemented in 1992.This article analyzes the final Oregon proposal. In presenting this critique of the proposal, our intent is not to . . .
Combining the Antigen Processing Components TAP and Tapasin Elicits Enhanced Tumor-Free Survival
Authors: Yuanmei Lou, Genc Basha, Robyn P. Seipp, Bing Cai, Susan S. Chen, Alexander R. Moise, Andrew P. Jeffries, Ray S. Gopaul, Timothy Z. Vitalis, Wilfred A. Jefferies
Journal: Clinical Cancer Research (2008)

Abstract Purpose: Tpn is a member of the MHC class I loading complex and functions to bridge the TAP peptide transporter to MHC class I molecules. Metastatic human carcinomas often express low levels of the antigen-processing components Tapasin and TAP and display few functional surface MHC class I molecules. As a result, carcinomas are unrecognizable by effector CTLs. The aim of this study is to examine if Tapasin (Tpn) plays a critical role in the escape of tumors from immunologic recognition. Experimental Design: To test our hypothesis, a nonreplicating adenovirus vector encoding human Tpn (AdhTpn) was constructed to restore Tpn expression in vitro and in vivo in a murine lung carcinoma cell line (CMT.64) that is characterized by down-regulation of surface MHC class I due to deficiency in antigen-processing components. Results: Ex vivo, Tpn expression increased surface MHC class I and restored susceptibility of tumor cells to antigen-specific CTL killing, and AdhTpn infection of dendritic cells also significantly increased cross-presentation and cross-priming. Furthermore, tumor-bearing animals inoculated with AdhTpn demonstrated a significant increase in CD8+ and CD4+ T cells and CD11c+ dendritic cells infiltrating the tumors. Provocatively, whereas syngeneic mice bearing tumors that were inoculated with AdhTpn a significant reduction in tumor growth and increased survival compared with vector controls, combining AdhTpn inoculation with AdhTAP1 resulted in a significant augmentation of protection from tumor-induced death than either component alone. Conclusions: This is the first demonstration that Tpn alone can enhance survival and immunity against tumors but additionally suggests that Tpn and TAP should be used together as components of immunotherapeutic vaccine protocols to eradicate tumors.
Lead poisoning in rural Wales.
Authors: E Williams
Journal: BMJ (1972)

the difference in any summary where a diff- erence is stated to be significant in the stat- istical sense?This is not perhaps always possible, because some experiments are planned to tell only whether A is better than B with some predetermined probability, and not how much better.However, when the difference is given in the summnary the skim- ming reader in his bee-like flight can better judge where to pause for the sort of honey he likes.-Iam, etc.,
Nonviral Gene Delivery to the Lateral Ventricles in Rat Brain: Initial Evidence for Widespread Distribution and Expression in the Central Nervous System
Authors: James G Hecker, Leon L Hall, Van R Irion
Journal: Molecular Therapy (2001)

The use of DNA for nonviral gene expression depends on several factors. These include (i) delivery and accessibility to the targeted tissue, (ii) protection from extracellular degradation, (iii) sufficient uptake by cells of interest, and (iv) protection from intracellular degradation to allow translation of adequate levels of intracellular or secreted proteins. As an initial step in demonstrating the feasibility of nonviral, cationic lipid-mediated gene therapy, we present evidence for the successful delivery and expression of heat shock protein Hsp70 and reporter gene enzymes in the central nervous system (CNS) of the rat after injection into the lateral ventricle. Gene delivery is accomplished using optimized formulations of plasmid DNA, which have been complexed with the cationic lipid MLRI. Results from DNA vectors encoding for green fluorescent protein (GFP), luciferase, and Hsp70 are reported. Standard immunofluorescent methods were used to demonstrate widespread expression of the reporter proteins and of Hsp70. Stereology analysis has been completed on three coronal sections, which illustrates the distribution of expression along the longitudinal axis. These initial findings support the further development of nonviral, lipid-mediated gene delivery technology for transient expression of protective, intracellular proteins and represent an important step leading to in vivo studies to identify potential clinical benefits.
PTU-013 Simulation-based Human Factors Training In Endoscopy – Putting The Team In The Spotlight
Authors: S Webster, W Howson, A McKay, G Smith
Journal: Gut (2014)

<h3>Introduction</h3> Human factors play an important role in adverse incidents and complaints in healthcare. Simulation is increasingly recognised as a safe and effective platform for human factors training. We propose that multiprofessional team-based simulation courses could enhance staff training, staff engagement, patient safety and patient experience in the endoscopy unit. <h3>Methods</h3> We designed and delivered four in-situ multiprofessional simulation courses for established endoscopy teams across North West London, using recent clinical incident and complaints data to inform scenario selection and debriefs. We developed learning resources including a faculty information sheet, pre and post course questionnaires, scenario descriptions and an introductory presentation. We procured an OGD and colonoscopy simulator and invited a patient actor to contribute to scenarios and debriefs. Video feedback was used to inform peer-led discussions. We collected quantitative and qualitative pre and post course data including participant demographics, and Likert scores for course enjoyment, usefulness, relevance and realism. Data was analysed descriptively. <h3>Results</h3> A total of 47 endoscopy staff participated in the courses (course size 8–15), including 32 nurse assistants, 11 endoscopists, 3 health care assistants and 1 porter. 70% were female, 55% were aged 35 to 50 and 60% had less than 5 years experience in endoscopy. Post course data analysis showed high Likert scores across all measured domains (1 poor – 5 excellent): 4.74 (enjoyment), 4.81 (usefulness), 4.80 (relevance), 4.33 (realistic). 85% felt that their confidence in managing similar situations in real life had improved. Qualitative data was universally positive, and included: “quality feedback”, “makes you reflect on better practice”, “shared learning”, and “there is a real need for courses such as this”. <h3>Conclusion</h3> Endoscopy teams value simulation based multiprofessional learning platforms for human factors training. We believe that 3 key features enhanced learning and course effectiveness: in-situ delivery of courses with established teams, empowering team members of all professional backgrounds to voice clinical concerns, and active participation with supported feedback. We believe that multiprofessional learning platforms have an important place in healthcare improvement and endoscopy teams are well placed to benefit. <h3>References</h3> Sedlack RE, Kolars JC. Computer simulator training enhances the competency of gastroenterology fellows at colonoscopy: results of a pilot study. <i>Am J Gastroenterol</i>. 99:33–37 Yee B <i>et al</i>. Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education. <i>Anesthesiology</i> 103:241–8 <h3>Disclosure of Interest</h3> None Declared.
OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH CIRRHOSIS
Authors: Dhaval Kolte, Sahil Khera, Nisha Sharma, Wilbert Aronow, Marjan Mujib, Chandrasekar Palaniswamy, Diwakar Jain, Sachin Sule, William Frishman, Ali Ahmed, Gregg Fonarow, Julio Panza
Journal: Journal of the American College of Cardiology (2014)
Correlations among measures of quality in HIV care in the United States: cross sectional study
Authors: Ira B Wilson, Bruce E Landon, Peter V Marsden, Lisa R Hirschhorn, Keith McInnes, Lin Ding, Paul D Cleary
Journal: BMJ (2007)

Objective To determine whether a selected set of indicators can represent a single overall quality construct. Design Cross sectional study of data abstracted during an evaluation of an initiative to improve quality of care for people with HIV. Setting 69 sites in 30 states. Data sources Medical records of 9020 patients. Main outcome measures Adjusted performance rates at site level for eight measures of quality of care specific to HIV and a site level summary performance score (the number of measures for which the site was in the top quarter of the distribution). Results Of 28 site level correlations between measures, two were greater than 0.40, two were between 0.30 and 0.39, four were between 0.20 and 0.29, and the 20 remaining were all less than 0.20. One site was in the top quarter for seven measures, but no sites were in the top quarter for six or eight of the measures. Across the eight quality measures, sites were in the top quarter no more often than predicted by a chance (binomial) distribution. Conclusions The quality suggested by one measured indicator cannot necessarily be generalised to unmeasured indicators, even if this might be expected for clinical or other reasons.