tbuckley/cabot-search huggingface dataset:
The Potential for Increasing Quality and Reducing Costs
Authors: David M. Eddy
Journal: Annals of Internal Medicine (2011)

Letters18 October 2011The Potential for Increasing Quality and Reducing CostsDavid M. Eddy, MD, PhDDavid M. Eddy, MD, PhDFrom San Francisco, CA 94105.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-8-201110180-00024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We share Dr. Umscheid's concerns about conflicts of interest and took several steps to avoid them. As described in the article, we created a relatively simple cardiovascular risk calculator specifically for this analysis, to transparently illustrate the concept of individualized guidelines—not to promote a particular model. We also stressed that our general conclusions do not depend on any particular model. We are developing methods for more accurately calculating the benefits that individuals can expect from various treatments, and for implementing individualized guidelines in practice settings. However, none of the concepts or methods in the paper is proprietary.We ... Author, Article, and Disclosure InformationAuthors: David M. Eddy, MD, PhDAffiliations: From San Francisco, CA 94105.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0352. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIndividualized Guidelines: The Potential for Increasing Quality and Reducing Costs David M. Eddy , Joshua Adler , Bradley Patterson , Don Lucas , Kurt A. Smith , and Macdonald Morris The Potential for Increasing Quality and Reducing Costs Craig A. Umscheid The Potential for Increasing Quality and Reducing Costs Ravi Varadhan , Carlos O. Weiss , and Cynthia M. Boyd Metrics 18 October 2011Volume 155, Issue 8Page: 564-565KeywordsConflicts of interestFactor analysisInformation storage and retrievalMedical risk factorsTreatment guidelines ePublished: 18 October 2011 Issue Published: 18 October 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Polyandry in nature: a global analysis
Authors: Michelle L. Taylor, Tom A.R. Price, Nina Wedell
Journal: Trends in Ecology & Evolution (2014)

A popular notion in sexual selection is that females are polyandrous and their offspring are commonly sired by more than a single male. We now have large-scale evidence from natural populations to be able to verify this assumption. Although we concur that polyandry is a generally common and ubiquitous phenomenon, we emphasise that it remains variable. In particular, the persistence of single paternity, both within and between populations, requires more careful consideration. We also explore an intriguing relation of polyandry with latitude. Several recent large-scale analyses of the relations between key population fitness variables, such as heterozygosity, effective population size (Ne), and inbreeding coefficients, make it possible to examine the global effects of polyandry on population fitness for the first time.
Reversal of Ouabain-Induced Electrophysiological Effects by Potassium Canrenoate in Canine Purkinje Fibers
Authors: BILLY K. YEH, RALPH LAZZARA
Journal: Circulation Research (1973)

Canrenoate, an aldosterone antagonist, was administered to normal and ouabaintreated Purkinje fibers excised from the hearts of mongrel dogs and perfused with Tyrode's solution at 35-37°C. Intra- and extracellular potentials were recorded with conventional techniques. Potassium canrenoate in concentrations up to 1 x 10 -3 M or sodium canrenoate in concentrations up to 5 x 10 -3 M had inconspicuous electrophysiological effects on untreated Purkinje fibers. The duration of the action potential was slightly shortened. Amplitude of resting and action potentials, rate of rise of action potentials, conduction velocity, membrane responsiveness, automaticity, and excitability were not significantly altered by canrenoate. In contrast, potassium canrenoate in concentrations of 1 x 10 -4 M to 5 x 10 -4 M produced rapid restoration toward normal of fibers moderately or severely affected by ouabain (10 -7 M). Resting and action potentials were augmented, rate of rise of action potentials was increased, excitability was restored, and conduction was enhanced. Also ouabain-induced spontaneous rapid firing could be terminated. Twice equimolar doses of KCI were ineffective. The data suggest that canrenoate might be a specific antagonist to the electrophysiological effects of digitalis.
Clinical Features, Pathophysiology and Relevance of Portal Hypertensive Gastropathy
Authors: H. L. Smart, D. R. Triger
Journal: Endoscopy (1991)

The frequency and importance of gastric mucosal lesions in patients with portal hypertension have been increasingly recognized in recent years. This article describes the clinical and endoscopic features of portal hypertensive gastropathy and reviews the current state of knowledge concerning the pathophysiology and treatment of the disorder.
Dutch government rejects tough measures on genital mutilation
Authors: Tony Sheldon
Journal: BMJ (2005)

Tough proposals to combat female genital mutilation—including examining the sexual organs of all girls up to the age of 14 and doctors being legally obliged to report all cases—have been rejected by the Dutch government. Several medical bodies have agreed with the government that such measures could deter parents and children, damaging school health services that currently reach 95% of the population.

The government has instead announced a £2m ($3.7m; £2.9m) three year campaign geared towards prevention and information among at risk, largely immigrant, populations in the main cities. Pharos, a national organisation for …
Arthur Hill Hassall
Authors: E. F. Laidlaw
Journal: BMJ (1968)

<h3>Abstract</h3> Inflammatory bowel disease (IBD) is mediated by an overexpression of tumor necrosis factor-α (TNF) by mononuclear cells in the intestinal mucosa. Intravenous delivery of neutralizing anti-TNF antibodies can cause systemic immunosuppression and up to one-third of people are non-responsive to treatment. Oral delivery of anti-TNF could reduce adverse effects; however, it is hampered by antibody degradation in the harsh gut environment during transit and poor bioavailability. To overcome these shortcomings, we demonstrate magnetically powered hydrogel particles that roll along mucosal surfaces, provide protection from degradation, and sustain local release of anti-TNF. Iron oxide nanoparticles are embedded into a crosslinked chitosan hydrogel and sieved to produce 100-200 μm particles called milliwheels (m-wheels). Once loaded with anti-TNF, these m-wheels release 10% to 80% of their payload over one week at a rate that depends on crosslinking density and pH. A rotating magnetic field induces a torque on the m-wheels that results in rolling velocities greater than 500 μm/s on glass and mucus-secreting cells. The permeability of TNF challenged gut epithelial cell monolayers was rescued in the presence of anti-TNF carrying m-wheels which both neutralized the TNF and created an impermeable patch over leaky cell junctions. With the ability to translate over mucosal surfaces at high speed, provide sustained release directly to the inflamed epithelium, and provide barrier rescue, m-wheels demonstrate a potential strategy to deliver therapeutic proteins for the treatment of IBD.
Effects of levosimendan on systemic and regional hemodynamics in septic myocardial depression
Authors: Andrea Morelli, Stefano De Castro, Jean-Louis Teboul, Mervyn Singer, Monica Rocco, Giorgio Conti, Leonardo De Luca, Emanuele Di Angelantonio, Alessandra Orecchioni, Natesa G. Pandian, Paolo Pietropaoli
Journal: Intensive Care Medicine (2005)
Is myocardial perfusion spect useful for predicting outcomes between Q wave and non-Q wave myocardial infarction?
Authors: Xingping Kang, Daniel S. Berman, Enrique F. Schisterman, Tali Sharir, Ishac Cohen, Sean W. Hayes, John D. Friedman, Guido Germano
Journal: Journal of the American College of Cardiology (2002)
Commentary: The FDA, politics, and the public. In comment: Rebuttal
Authors: D. C. Goldberg
Journal: JAMA (1975)

THE preceding commentary by Drs. Louis Lasagna and William M. Wardell presents a distorted and unfair representation of hearings held earlier this year by the House Intergovernmental Relations Subcommittee. Lasagna and Wardell state that at hearings in the House of Representatives chaired by Congressman Fountain, "FDA officials have been reprimanded for being 'soft' on industry and too ready to approve new drugs." They cite the hearing on the Food and Drug Administration (FDA) approval of propranolol for the relief of angina pectoris as a case in point, noting that cardiologists have for years accepted and used this drug in the management of severe angina. First, I must state unequivocally that the Subcommittee hearing record does not support in any way the contention that FDA officials were reprimanded for being "soft" on industry. This is untrue. With respect to the approval of propranolol for angina, the Subcommittee was concerned solely and
Pharmacologic Aspects of Adrenocortical Steroids and ACTH in Man
Authors: George W. Thorn, Dalton Jenkins, John C. Laidlaw, Frederick C. Goetz, Joseph F. Dingman, Walter L. Arons, David H. P. Strebten, Brian H. McCracken
Journal: New England Journal of Medicine (1953)

THE importance of the adrenocortical steroids as essential mediators of metabolic processes is well established. In the treatment of adrenocortical insufficiency these hormones are capable of restoring severely ill patients to a state of health that is remarkably near normal. In the wider field of inflammatory diseases their action is no less dramatic, although the indications for their use and their ultimate place in the therapeutic armamentarium are not yet clearly defined. Experience has emphasized the necessity for exercising unusual care in initiating or terminating a therapeutic trial with these agents. Regardless of the extent to which they may eventually . . .
Functional upper airways obstruction: two patients with persistent symptoms.
Authors: C. J. Warburton, R. McL Niven, B. G. Higgins, C. A. Pickering
Journal: Thorax (1996)

Functional upper airways obstruction is caused by vocal cord dysfunction and classically occurs in paroxysms closely resembling acute asthmatic attacks. We present two cases in which the symptoms and signs of the vocal cord dysfunction demonstrate very little variability with time. We suggest that as part of this disorder, a syndrome of chronic unremitting symptoms may occur.
The Cybernetics of Life-mind Unity
Authors: S. Black
Journal: Psychotherapy and Psychosomatics (1970)

The predominance of allergy in psychosomatic disease is noted. It is suggested that any explanation of such phenomena is unlikely without taking into account the nature of life. A life model is deduced from the thermodynamics of the living chemistry and the role of information in molecular biology. According to this model, life derives from information inherent in the improbability of macromolecular form which dictates bodily form. In the proposed life-mind model, the primaeval basis of mind is the informational system which results. It is undue interference with this system at any level of magnitude which evokes the pathology of psychosomatic disease. Some supporting evidence is cited.
Lenalidomide plus Dexamethasone for Relapsed or Refractory Multiple Myeloma
Authors: Meletios Dimopoulos, Andrew Spencer, Michael Attal, H. Miles Prince, Jean-Luc Harousseau, Anna Dmoszynska, Jesus San Miguel, Andrzej Hellmann, Thierry Facon, Robin Foà, Alessandro Corso, Zvenyslava Masliak, Marta Olesnyckyj, Zhinuan Yu, John Patin, Jerome B. Zeldis, Robert D. Knight
Journal: New England Journal of Medicine (2007)

Lenalidomide is a structural analogue of thalidomide with similar but more potent biologic activity. This phase 3, placebo-controlled trial investigated the efficacy of lenalidomide plus dexamethasone in the treatment of relapsed or refractory multiple myeloma.Of 351 patients who had received at least one previous antimyeloma therapy, 176 were randomly assigned to receive 25 mg of oral lenalidomide and 175 to receive placebo on days 1 to 21 of a 28-day cycle. In addition, all patients received 40 mg of oral dexamethasone on days 1 to 4, 9 to 12, and 17 to 20 for the first four cycles and subsequently, after the fourth cycle, only on days 1 to 4. Patients continued in the study until the occurrence of disease progression or unacceptable toxic effects. The primary end point was time to progression.The time to progression was significantly longer in the patients who received lenalidomide plus dexamethasone (lenalidomide group) than in those who received placebo plus dexamethasone (placebo group) (median, 11.3 months vs. 4.7 months; P<0.001). A complete or partial response occurred in 106 patients in the lenalidomide group (60.2%) and in 42 patients in the placebo group (24.0%, P<0.001), with a complete response in 15.9% and 3.4% of patients, respectively (P<0.001). Overall survival was significantly improved in the lenalidomide group (hazard ratio for death, 0.66; P=0.03). Grade 3 or 4 adverse events that occurred in more than 10% of patients in the lenalidomide group were neutropenia (29.5%, vs. 2.3% in the placebo group), thrombocytopenia (11.4% vs. 5.7%), and venous thromboembolism (11.4% vs. 4.6%).Lenalidomide plus dexamethasone is more effective than high-dose dexamethasone alone in relapsed or refractory multiple myeloma. (ClinicalTrials.gov number, NCT00424047 [ClinicalTrials.gov].).
Development of Micrometastases: Earliest Events Detected With Bacterial lacZ Gene-Tagged Tumor Cells
Authors: W.-c. Lin, T. P. Pretlow, T. G. Pretlow, L. A. Culp
Journal: JNCI Journal of the National Cancer Institute (1990)

For the study of micrometastases at their earliest stages, we transfected the lacZ gene, which codes for β-D-gaIac-tosidase in Escherichia coli , into BALB/c 3T3 cells transformed by the Ha-ras oncogene (also known as HRAS1) of a human EJ bladder carcinoma. These cells were subsequently injected into 6-week-old, female athymic NCR-NU nude mice by several routes. With chromogenic detection of the product of the lacZ gene (a heterologous gene not observed in animal cells) by use of 5-bromo-4-chloro-3-indoyl-β-D-galactopy-ranoside, we easily identified tumor cells implanted in the lungs minutes after intravenous injection by the intensely blue staining of the cells harboring the lacZ gene. The number of lung-associated tumor cells remained constant for several hours after intravenous injection but then decreased to a stable level by 24 hours. At most sites of lung invasion, multiple tumor cells, rather than single cells, were identified; this finding suggests that cooperation among multiple cells may be important in the early stages of micrometastasis development. Within several days, a few foci of micrometastases were expanding by proliferation and/or migration of individual tumor cells among host lung cells. These results confirm that the lacZ gene is an ultrasensitive histochemical marker for analyzing both qualitatively and quantitatively the earliest stages of micrometastasis development in the lung and in other organs where micrometastases may ensue. [J Natl Cancer Inst 82:1497–1503, 1990]
Liquor bilirubin levels in rhesus haemolytic disease.
Authors: R P Britt, E G Jonas, M E Downing
Journal: BMJ (1972)

June p.423) have been incompletely understood.Sir Hedley accuses us of misreading the description of his life-table analyses.The original article merely states that life-table analyses were carried out, and displays graphs to show the outcomes of these analyses.As no details of the analyses are given it is difficult to see how we could have misread them.From the criteria suggested by Lionel and Herxheimerl for assessing the reports of therapeutic trials we must conclude that the report of the trial by Sir Hedley and his colleagues is unsatisfactory, as the statistical tests are not described nor are important results of the analyses given.Sir Hedley Atkins also glosses over our criticism of the small numbers on which he and his colleagues based their conclusions.It is well known that the effective sample size in a life-table analysis is greater than the number of patients actually followed up for the maximum length of time,2 but obviously cannot be greater than the total number of paients studied.We clearly pointed out how unsatisfactory the numbers studied by Sir Hedley and colleagues are even if all the 370 patients had been followed up for the full 10 years.
Abstract P3-12-06: Biomarkers of Malignant Potential in Breast Tissue in Relation to Short-Term Breast Cancer Risk
Authors: D Hill, A Nibbe, L Lomo, M Royce, AM Wallace, T. Bocklage
Journal: Cancer Research (2010)

Abstract Background: Biomarkers expressed in benign or normal breast tissue may be important indicators of subsequent risk of malignancy, but investigations identifying such have been few. Limited previous evidence suggests that loss of expression of several breast cancer tumor markers in benign tissue, relative to normal tissue, may contribute to malignant progression. We examined expression of markers implicated in tumorigenesis among women who developed breast cancer shortly after benign biopsy. Material and Methods: We conducted a nested case-control study within a population-based cohort of 15,000 women who received benign breast biopsies between 1996 and 2005 in six New Mexico counties. We identified 95 women who developed breast cancer within 5 years of biopsy, and matched them to 3 similar controls who did not develop cancer. Benign breast as well as adjacent normal tissue was assayed using immunohistochemistry for epithelial and stromal markers plausibly related to risk of cancer development. Logistic regression models were employed to estimate odds ratios and 95% confidence intervals for breast cancer risk after adjustment for age, race/ethnicity, and risk category of benign biopsy. Results: Women who expressed estrogen receptor alpha in their normal tissue (10% or greater staining) had a 2.9-fold increased breast cancer risk (95% confidence interval (CI) 1.0-8.3). Those who expressed Cytokeratin 5/6 (Odds ratio (OR) 3.3; 95% CI 1.2-8.8) or Her2/neu (30% or greater staining) (OR 8.2; 95% CI 0.9-70.6) in normal tissue also appeared to have an elevated breast cancer risk, relative to those with expression below the threshold. In contrast, the presence of these markers in benign tissue was unrelated to subsequent development of breast cancer. Estrogen receptor staining of 10% or greater in normal tissue, but absence of staining in benign tissue, was not a risk factor for progression to breast malignancy (OR 4.9; 95% CI 0.7-34.8) Discussion: Our results suggest that biomarker expression in normal breast tissue may be an important component of risk assessment among women whoreceive benign breast biopsies. Findings such as these aim to identify women at highest risk for breast cancer development, allowing for the implementation of more frequent follow-up and new targeted interventions, while classifying most women as at low risk, providing reassurance and reducing the need for chemoprevention. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-12-06.
Treatment of Malaria — A Continuing Challenge
Authors: Brian Greenwood
Journal: New England Journal of Medicine (2014)

Twenty years ago, malaria was a neglected disease that was responsible for at least 1 million deaths per year; this high mortality was due in part to reliance on chloroquine, a failing drug, for treatment.1 Since then, there has been substantial progress in malaria control, and the number of deaths from malaria has been reduced by about one third. However, the World Health Organization (WHO) estimates that in 2012, malaria caused 627,000 deaths (estimated range, 473,000 to 789,000),2 so there is still much more to be done. An important contributor to recent success in malaria control has been the widespread . . .
The Sounds of the Diseased Heart
Authors: Raymond Harris
Journal: JAMA (1973)

Dr. Luisada knows phonocardiography as a woodsman knows a path he has traced and retraced. His book continues to blaze a trail for the less experienced students of phonocardiography and presents the results of a lifetime of devotion to clinical and laboratory phonocardiographic investigations. This second volume of Dr. Luisada's comprehensive work on auscultation and phonocardiography consists of three parts: part 1 (Systematic Phonocardiography) discusses the abnormal heart sounds and their changes in different clinical situations; part 2 (Clinical Phonocardiography) describes the alterations of sounds and murmurs in various conditions; part 3 (Borderline Conditions) discusses phonocardiographic findings in the straight-back syndrome, the senile heart, the heart in pregnant women, the functional and innocent systolic and diastolic murmurs, unusual sound phenomena, and sounds caused by prosthetic valves or a pacemaker. Particularly noteworthy are the extensive bibliography and profuse, well-reproduced illustrations. On the debit side is the perpetuation of typographical errors that
Three political birds killed with one stone?
Authors: P. Johnston
Journal: BMJ (1986)

The parliamentary written answer is a time honoured vehicle for ferrying information from government departments via the House of Commons to the public at large.Every day hundreds of questions from members are answered.The resulting bumf materialises in the press gallery on to a large table containing a separate tray for the responses of each ministry.Sometimes a diligent reading of the day's Order Paper will alert reporters to a question worth knowing the answer to.More usually, a laborious search through every single reply is a required daily chore; the written answers' tray is a goldmine of information, even of good stories, but it is rare indeed to find the mother lode.Major policy announcements are made by way of an oral statement, on which a minister can be questioned in the House.Members of parliament frown on any attempt to make public an important decision by way of the written answer.For a start, many of them will not know of its existence until they read about it in the papers the next day.There are times, however, when everyone is happy for the written answer to be used to disseminate a govern- ment decision, particularly when it signifies a ministerial volte face.Thus a fortnight ago there was backslapping all round when the Secretary of State for Social Services, Norman Fowler, accepted the inevitable and announced his decision to introduce legislation to remove the crown immunity enjoyed by NHS hospitals.The question which elicited the reply was tabled by Tory backbencher Richard Shepherd, who the next day was to introduce his own private member's bill to do precisely the same thing.His thunder was comprehensively stolen, but he had the satisfaction of knowing he had contributed to a long overdue change of heart by the Department of Health and Social Security.In his answer, Mr Fowler said: "I intend to introduce legislation in the present session to remove crown immunity from hospital catering in respect of the food hygiene regulations by making health authorities subject to the provisions of the Food Act."You could be forgiven for thinking that this is all the Bill would do.That is all Mr Fowler said that it would do.And yet the next day a funny thing happened.The Conservative member for Slough, Mr John Watts, received a reply to a question, totally unsolicited I am sure, asking when the government intended to introduce legislation to bring in the new contract for NHS community pharmacists.This, you may recall, harks back to the legal tangle in which the DHSS found itself last year.Ministers had spent two years negotiating the contract with the pharmacists in