tbuckley/cabot-search huggingface dataset:
MD-MBA: A Dual Degree Whose Time Has Come
Authors: John Bernard Henry
Journal: JAMA (1987)

To the Editor.—  As president of an academic health science center, I am confronted with the task of managing an institution buffeted by change in health care delivery and financing. I grapple daily with the business side of medicine while insisting on excellence in patient care as a foundation for teaching and research. While it is true that health-care is a perfect example of an industry in which decisions cannot be made with numbers alone, 1 the numbers cannot be ignored. If physicians are to maintain some control over the health care industry and ensure quality and continuity of care, some of them must be trained in management as well as medicine. Financial decisions must be made within the context of sound medical judgment, lest the bottom line totally dominate decision making.  At the State University of New York Health Science Center at Syracuse, we are collaborating with a sister
Milk intake and bone mineral acquisition in adolescent girls: randomised, controlled intervention trial
Authors: J. Cadogan, R. Eastell, N. Jones, M. E Barker
Journal: BMJ (1997)

<h3>Abstract</h3> <b>Objectives:</b> To investigate the effect of milk supplementation on total body bone mineral acquisition in adolescent girls. <b>Design:</b> 18 month, open randomised intervention trial. <b>Subjects:</b> 82 white girls aged 12.2 (SD 0.3) years, recruited from four secondary schools in Sheffield. <b>Intervention:</b> 568 ml (one pint) of whole or reduced fat milk per day for 18 months. <b>Main outcome measures:</b> Total body bone mineral content and bone mineral density measured by dual energy <i>x</i> ray absorptiometry. Outcome measures to evaluate mechanism included biochemical markers of bone turnover (osteocalcin, bone alkaline phosphatase, deoxypyridinoline, <i>N</i>-telopeptide of type I collagen), and hormones important to skeletal growth (parathyroid hormone, oestradiol, insulin-like growth factor I). <b>Results:</b> 80 subjects completed the trial. Daily milk intake at baseline averaged 150 ml in both groups. The intervention group consumed, on average, an additional 300 ml a day throughout the trial. Compared with the control group, the intervention group had greater increases of bone mineral density (9.6% <i>v</i> 8.5 %, P=0.017; repeated measures analysis of variance) and bone mineral content (27.0% <i>v</i> 24.1 %, P=0.009). No significant differences in increments in height, weight, lean body mass, and fat mass were observed between the groups. Bone turnover was not affected by milk supplementation. Serum concentrations of insulin-like growth factor I increased in the milk group compared with the control group (35% <i>v</i> 25 %, P=0.02). <b>Conclusion:</b> Increased milk consumption significantly enhances bone mineral acquisition in adolescent girls and could favourably modify attainment of peak bone mass. <h3>Key messages</h3> Osteoporosis is a major public health problem; 40% of women will sustain an osteoporotic fracture Maximising peak bone mass at skeletal maturity may be one of the most important protective measures against fracture in later life Adolescence is a critical time for bone mineral acquisition An increase in milk consumption among adolescent girls resulted in significant gains in bone mineral over an 18 month period This simple intervention indicates that increased milk consumption may be associated with higher peak bone mass
Occurrence with bacteriologically positive pulmonary tuberculosis
Authors: M. K. Agarwal
Journal: JAMA (1977)

Fever was unchanged by chemotherapy in ten patients with bacteriologically positive pulmonary tuberculosis. Blood cultures were positive for Gram-positive organisms in six patients and for Gram-negative organisms in four patients. The same organism was present in sputa and blood in six patients and in urine and blood in two patients. Leukocytosis was not found, and roentgenographic findings did not suggest superinfection. Nine of the ten patients survived. Blood cultures must be obtained in patients with pulmonary tuberculosis whose fever is not altered by antituberculous chemotherapy, so that concomitant septicemia is not neglected.
Phase 1–2 study of docetaxel plus aflibercept in patients with recurrent ovarian, primary peritoneal, or fallopian tube cancer
Authors: Robert L Coleman, Linda R Duska, Pedro T Ramirez, John V Heymach, Aparna A Kamat, Susan C Modesitt, Kathleen M Schmeler, Revathy B Iyer, Michael E Garcia, Debbie L Miller, Edward F Jackson, Chaan S Ng, Vikas Kundra, Robert Jaffe, Anil K Sood
Journal: The Lancet Oncology (2011)
Enduring Attributes of Medicine Relevant for the Education of the Physician
Authors: GEORGE L. ENGEL
Journal: Annals of Internal Medicine (1973)

The thesis is advanced that the behavioral sciences basic for the education of the physician may be derived by identifying attributes of medicine that have endured despite changing dogmas, differing social climates, and evolving scientific knowledge. These include the complementarity of a need for help and a desire to provide service, a justification for medicine as a profession; the consistency of the processes involved in the transition from health to illness to patienthood; the interpersonal encounter between the patient and the physician, the keystone of medical care; clinical observation, the basic method of data collection; clinical reasoning, judgment, and decision-making, the analytic procedures of the physician; and the contract between patient and physician, a social and interpersonal bond. The implications for medical education and for the development of effective health care systems are discussed.
The Psychosocial Aspects of Klinefelter's Syndrome
Authors: James N. Kvale
Journal: JAMA (1965)

This is a report of a study done on 12 men with Klinefelter's syndrome, seven of whom were institutionalized. Each expressed feelings of inadequacy and inferiority because of the accompanying gynecomastia and testicular atrophy. All areas of living appear to be affected by these attitudes, but especially sexuality. Further, these feelings appear to have a profound effect on both the behavior patterns and the mental illnesses of these subjects. However, this study was unable to establish a statistical correlation between the degree of disturbance of secondary sexual characteristics and the severity of the concomitant psychopathological disorder.
Long-Term Efficacy and Safety of Biodegradable-Polymer Biolimus-Eluting Stents
Authors: Christoph Kaiser, Soeren Galatius, Raban Jeger, Nicole Gilgen, Jan Skov Jensen, Christoph Naber, Hannes Alber, Maria Wanitschek, Franz Eberli, David J. Kurz, Giovanni Pedrazzini, Tiziano Moccetti, Hans Rickli, Daniel Weilenmann, André Vuillomenet, Martin Steiner, Stefanie Von Felten, Deborah R. Vogt, Kim Wadt Hansen, Peter Rickenbacher, David Conen, Christian Müller, Peter Buser, Andreas Hoffmann, Matthias Pfisterer
Journal: Circulation (2014)

Background— Biodegradable-polymer drug-eluting stents (BP-DES) were developed to be as effective as second-generation durable-polymer drug-eluting stents (DP-DES) and as safe &gt;1 year as bare-metal stents (BMS). Thus, very late stent thrombosis (VLST) attributable to durable polymers should no longer appear. Methods and Results— To address these early and late aspects, 2291 patients presenting with acute or stable coronary disease needing stents ≥3.0 mm in diameter between April 2010 and May 2012 were randomly assigned to biolimus-A9–eluting BP-DES, second-generation everolimus-eluting DP-DES, or thin-strut silicon-carbide–coated BMS in 8 European centers. All patients were treated with aspirin and risk-adjusted doses of prasugrel. The primary end point was combined cardiac death, myocardial infarction, and clinically indicated target-vessel revascularization within 2 years. The combined secondary safety end point was a composite of VLST, myocardial infarction, and cardiac death. The cumulative incidence of the primary end point was 7.6% with BP-DES, 6.8% with DP-DES, and 12.7% with BMS. By intention-to-treat BP-DES were noninferior (predefined margin, 3.80%) compared with DP-DES (absolute risk difference, 0.78%; −1.93% to 3.50%; P for noninferiority 0.042; per protocol P =0.09) and superior to BMS (absolute risk difference, −5.16; −8.32 to −2.01; P =0.0011). The 3 stent groups did not differ in the combined safety end point, with no decrease in events &gt;1 year, particularly VLST with BP-DES. Conclusions— In large vessel stenting, BP-DES appeared barely noninferior compared with DP-DES and more effective than thin-strut BMS, but without evidence for better safety nor lower VLST rates &gt;1 year. Findings challenge the concept that durable polymers are key in VLST formation. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01166685.
Book Review Criticised.
Authors: M. H. Cryer
Journal: JAMA (1902)

Philadelpiiia, Pa., March 1, 1902. <h3>To the Editor:</h3> —The review of my book, "Studies of the Internal Anatomy of the Face," in your issue of January 18, reminds me of the story of a boy who was being paddled by his father for some supposed dereliction. In spite of the fact that the punishment was vigorously applied, the boy kept laughing. The old man, astonished and angry that the thrashing failed to produce its usual effect, yelled out: "What are you laughing about, you young jackanapes?" "I'm laughing at you, Dad; you're dead wrong this time. You're licking the wrong boy. I didn't do it!" Two statements are attributed to me in this review for which no foundation can be found in the book. The first of these is in the second paragraph, which says: "The illustrations are reminders to the student of anatomy that as the author remarks 'owing
Chronic Hyperglycemia Reduces Surface Active Material Flux in Tracheal Fluid of Fetal Lambs
Authors: David Warburton
Journal: Journal of Clinical Investigation (1983)

I tested the hypothesis that chronic hyperglycemia alters fetal lung maturation by continuous infusion of glucose (14+/-2 mg/kg per min, mean+/-SE) from 112 up to 145 d gestation into six chronically catheterized fetal lambs from which tracheal fluid could be collected. Serum glucose levels (32+/-2 mg/dl) and serum insulin levels (38+/-4 muU/ml) in these glucose-treated fetuses were significantly higher than serum glucose levels (18+/-2 mg/dl, P < 0.001) and serum insulin levels (12+/-3 muU/ml, P < 0.001) in six chronically catheterized control fetuses of the same gestational ages. Glucose infusion to the fetuses did not alter maternal serum glucose (60+/-3 mg/dl) or serum insulin levels (35+/-5 muU/ml). Arterial blood gases (pH 7.34+/-0.01, Po(2) 24.3+/-0.5 mmHg, Pco(2) 41.5+/-0.9 mmHg), oxygen saturation (73+/-2%), hematocrit (31+/-1%), and tracheal fluid flow (2.4+/-0.1 ml/g per h) in the glucose-treated fetuses were not significantly different from controls. Among the control fetuses, surface active material (SAM) began to appear in tracheal fluid at 123 d gestation and was present in all six fetuses by 129 d gestation, whereas SAM did not appear at all in tracheal fluid of four of the glucose-treated fetuses, and appeared in two at low levels after 142 d gestation. SAM flux in the glucose-treated fetuses (<1 mug/g per h) was statistically lower than SAM flux in the control fetuses (60+/-9 mug/kg per h, P < 0.001). Between 130 and 140 d gestation, tracheal fluid phospholipid content rose fourfold, mixed lecithin content rose ninefold, disaturated phosphatidylcholine content rose fourfold in the control fetuses, whereas little or no increase in these measurements occurred in the glucose-treated fetuses (all differences significant). I conclude that chronic hyperglycemia with secondary hyperinsulinemia reduces SAM flux in tracheal fluid of fetal lambs. The reduction in SAM flux is attributed to low surface active phospholipid content of the SAM. A similar mechanism may operate in utero to cause respiratory distress in infants of diabetic mothers whose maternal glucose homeostasis is poorly controlled.
RESUSCITATION AFTER ELECTRICAL SHOCK
Authors: WILLS MACLACHLAN
Journal: JAMA (1924)

An old Chinese maxim says, "When you put on your clothes remember the labor of the weaver; when you eat your daily bread, think of the hardships of the husbandman." If written today, it might well have added, "When you turn on the light, remember the work of the lineman and the operator." It is in the interest of these men that I would discuss resuscitation after electrical shock. It is not entirely without reason that the electrical profession and industry look to the medical profession for special consideration and assistance. One need only mention the great boon to physicians the now known electrical helps, such as the roentgen ray, are, to say nothing of the future. In studying the question of electrical shock, certain points stand out. If an electrical current flows from foot to foot, practically no effect will be noticed. If, however, it flows from hand to
Dealing with complaints
Authors: Judith Cave, Jane Dacre
Journal: BMJ (2008)

This article explores why patients complain and outlines some strategies for reducing the rising number of complaints and for dealing appropriately with any that do occur One in 10 patients admitted to hospital in the United Kingdom experience an adverse event, 1 and around half of these events are preventable.The number of complaints from National Health Service (NHS) patients is rising in the UK: the Department of Health's Independent Complaints Advocacy Service dealt with 10 422 complaints in 2003-4 but almost 13 000 complaints in 2004-5. 2 It is essential that healthcare professionals work together with patients and deal constructively with feedback to reduce adverse events.][5] Here we describe how and why patients complain and then suggest some evidence based strategies for reducing complaints and for dealing appropriately and helpfully with any that do occur.
Antibody Response to Preexposure Human Diploid-Cell Rabies Vaccine Given Concurrently with Chloroquine
Authors: Marguerite Pappaioanou, Daniel B. Fishbein, David W. Dreesen, Ira K. Schwartz, Gary H. Campbell, John W. Sumner, Leslie C. Patchen, Walter J. Brown
Journal: New England Journal of Medicine (1986)

We conducted a randomized controlled trial to evaluate the antibody response of freshman veterinary students to intradermal human diploid-cell rabies vaccine administered concurrently with chloroquine, a drug frequently used for chemoprophylaxis against malaria. Fifty-one students who had not been vaccinated against rabies were enrolled: 26 received 300 mg of chloroquine base per week (the recommended dose for malaria prophylaxis); 25 did not receive chloroquine and served as controls. All subjects received 0.1 ml of rabies vaccine intradermally on days 0, 7, and 28. Chloroquine was administered weekly to the treatment group, beginning nine days before the first dose of vaccine and continuing until day 48. The mean rabies-neutralizing antibody titer for the chloroquine group was significantly lower than that for the control group on each day of testing--i.e., day 28 (P = 0.0094), day 49 (P = 0.0008), and day 105 (P = 0.0002)--although both groups had neutralizing antibody titers on days 49 and 105, according to the criteria of the Centers for Disease Control. The blood concentrations of chloroquine and desethylchloroquine (the major metabolite of chloroquine, which also has antimalarial properties) were negatively associated with log antibody titers. These results indicate that chloroquine taken in the dose recommended for malaria prophylaxis can reduce the antibody response to primary immunization with intradermal human diploid-cell rabies vaccine.
AIDS-related <i>Pneumocystis carinii</i> Pneumonia in the Era of Adjunctive Steroids
Authors: ELIE AZOULAY, ANTOINE PARROT, ANTOINE FLAHAULT, DANIELLE CESARI, ISABELLE LECOMTE, PATRICIA ROUX, FAYÇAL SAIDI, MURIEL FARTOUKH, JEAN-FRANÇOIS BERNAUDIN, JACQUES CADRANEL, CHARLES MAYAUD
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

Factors predictive of mortality in patients with AIDS and Pneumocystis carinii pneumonia (PCP) were identified before the introduction of adjunctive steroids, but they have not been reevaluated since. Because PCP still occurs in AIDS, remaining fatal in some cases, we conducted a multivariate analysis of factors predicting mortality in patients with HIV-positive PCP managed from 1990 to 1995, i.e., after the consensus conference on the use of adjunctive steroids. The predictive value of clinical, laboratory, and bronchoalveolar lavage (BAL) data at admission and during the course of PCP was studied retrospectively using multivariate methods, in 144 patients with AIDS. Overall mortality was 21.5%. The univariate analysis identified seven factors predictive of 90-d mortality: Pa(O(2)) on room air < 60 mm Hg, lactate dehydrogenase > 1,000 IU, albuminemia < 30 g/L, BAL neutrophilia > 10%, nosocomial infection, pneumothorax, and a need for mechanical ventilation. Four of these factors were independently associated with 90-d mortality in the multivariate analysis; among them, two were evaluable at admission, namely, Pa(O(2)) < 60 mm Hg on room air and BAL neutrophilia > 10%, and two during hospitalization, namely, the development of pneumothorax and a need for mechanical ventilation. Moreover, BAL neutrophilia was correlated to occurrence of pneumothorax and a need for mechanical ventilation. In the era of adjunctive steroid use, AIDS-related PCP remains fairly common. Two independent factors evaluable at admission, Pa(O(2)) on room air and BAL neutrophilia, are predictive of death.
Running and the Development of Disability with Age
Authors: James F. Fries
Journal: Annals of Internal Medicine (1994)

Objective: To determine, by longitudinal study, whether regular vigorous running activity is associated with accelerated, unchanged, or postponed development of disability with increasing age. Study Design: 8-year prospective, longitudinal study with yearly assessments. Participants: 451 members of a runners' club and 330 community controls who were initially 50 to 72 years old (also characterized as "ever-runners" [n = 534] and "never-runners" [n = 247], respectively). Measurements: The dependent variable was disability as assessed by the Health Assessment Questionnaire and separately validated in these participant cohorts. Covariates included age, sex, body mass index, comorbid conditions, education level, smoking history, alcohol intake, mean blood pressure, initial disability level, family history of arthritis, and radiologic evidence of osteoarthritis of the knee in a subsample. Results: Initially, the runners were leaner, reported joint symptoms less frequently, took fewer medications, had fewer medical problems, and had fewer instances of and less severity of disability, suggesting either that the average previous 12 years of running had improved health or that self-selection bias was present. After 8 years of longitudinal study, the differences in initial disability levels (0.026 compared with 0.079; P < 0.001) had steadily increased to 0.071 for runners compared with 0.242 for controls (P < 0.001). The difference was consistent for men and women. The rate of development of disability was several times lower in the runners' club members than in community controls; this difference persisted after adjusting for age, sex, body mass, baseline disability, smoking history, history of arthritis, or other comorbid conditions (slopes of progression of disability for the years 1984 to 1992, after adjusting for covariates: men in the runners' club, 0.004 (SE, 0.002); community controls, 0.012 (SE, 0.002); women in the runners' club, 0.009 (SE, 0.005); community controls, 0.027 (SE, 0.004); P < 0.002 for both sets of comparisons). In addition to differences in disability, there were significant differences in mortality between the runners' club members (1.49%) and community controls (7.09%) (P < 0.001). These differences remained significant after adjusting for age, sex, body mass, comorbid conditions, education level, smoking history, alcohol intake, and mean blood pressure (P < 0.002, conditional risk ratio for community controls compared with the runners, 4.27; 95% CI, 1.78 to 10.26). Conclusions: Older persons who engage in vigorous running and other aerobic activities have lower mortality and slower development of disability than do members of the general population. This association is probably related to increased aerobic activity, strength, fitness, and increased organ reserve rather than to an effect of postponed osteoarthritis development.
Cycle to work scheme in the NHS
Authors: C. M Jack, M. Edwards, M. Parikh, S. Rajaratnam
Journal: BMJ (2009)

Byberg and colleagues’ study on mortality and physical activity convinces us of the importance of health promotion.1 Making the Department of Transport’s cycle to work scheme available to all NHS employees would yield enormous benefits. The scheme allows a tax exempt loan to purchase a bicycle and associated …
Confocal histopathology of irritant contact dermatitis in vivo and the impact of skin color (black vs white)
Authors: Shari P. Hicks, Kirsty J. Swindells, Maritza A. Middelkamp-Hup, Martine A. Sifakis, Ernesto Gonzlez, Salvador Gonzlez
Journal: Journal of the American Academy of Dermatology (2003)
Azacitidine and donor lymphocyte infusions as first salvage therapy for relapse of AML or MDS after allogeneic stem cell transplantation
Authors: T Schroeder, A Czibere, U Platzbecker, G Bug, L Uharek, T Luft, A Giagounidis, F Zohren, I Bruns, C Wolschke, K Rieger, R Fenk, U Germing, R Haas, N Kröger, G Kobbe
Journal: Leukemia (2013)