tbuckley/cabot-search huggingface dataset:
Fasting Early Morning Rise in Peripheral Insulin: Evidence of the Dawn Phenomenon in Nondiabetes
Authors: Maria Ines Schmidt, Qi Xiong Lin, John T Gwynne, Steven Jacobs
Journal: Diabetes Care (1984)

The dawn phenomenon, a tendency for glucose to rise between 0500 and 0800 h in subjects with diabetes, is also reflected as an increase in insulin required to maintain normoglycemia during closed-loop insulin infusion. Individuals without diabetes have minimal or absent rises in early morning glucose. To test the hypothesis that the absence of early morning glucose increases in subjects without diabetes is due to an increase in insulin levels, we measured insulin levels from 2400 to 0800 h in four male and two female volunteers. Subjects were on an unrestricted diet with three main meals and one bedtime snack at 2100 h. Blood samples were collected continuously in hourly pools by a constant-rate withdrawal pump. We observed the following: (1) hourly integrated concentration of glucose was stable from 2400 to 0800 h (range of mean plasma values, 94.5–97.3 mg/dl), and (2) hourly integrated concentration of insulin increased from the 0300–0400 (4.6 μU/ml) to the 0700–0800-h pool (6.2 μUμml) (P &amp;lt; 0.05). The observed increase in insulin in the early morning hours despite stable levels of glucose indicates a temporally increased insulin need in nondiabetic individuals similar to that found in individuals with diabetes. The mechanism underlying this increased insulin need may be similar in diabetes and nondiabetes, with the ensuing rise in glucose being dependent on the availability of compensatory insulin.
Dapsone versus topical immunotherapy in alopecia areata
Authors: H.M.J. BAAR, C.J.M. VLEUTEN, P.C.M. KERKHOF
Journal: British Journal of Dermatology (1995)

Twenty-seven patients with severe alopecia areata were treated with dapsone. The results of a mean treatment duration of 10±0.5 months are reported, and compared with the results of long-term topical immunotherapy obtained previously at the same institute. The efficacy of dapsone proved to be markedly inferior to that of topical immunotherapy. The percentage of patients showing regrowth of hair during treatment with dapsone was comparable with the occurrence of spontaneous regrowth of hair reported in the literature.
Good Health! Stories from the Lives of Pioneers in the Health Services
Authors: G. Macpherson
Journal: BMJ (1994)

Jack Gillespie Tabb House, pounds sterling 8.95, pp 256 ISBN 1-873951-00-0

In Good Health! a diverse group of “pioneers in the health services” record in informal conversations their impressions of medicine before and during the NHS. At a time when ministerial interpretations of the government's “back to basics” policy flit daily through the headlines these individual tales remind us that the basic principle of health care is personal and sensitive service to patients.

Readers can see, too, why a state supported health service was so necessary and …
Doctors and patients need to hunt together
Authors: Judith H Harvey
Journal: BMJ (2006)

Editor-The report from the chief medical officer for England has implications for all UK doctors and needs to be considered very carefully. 1Its aim is a system of medical regulation that puts patients' safety first through the early detection, and where possible, remediation, of poor performance.If the report contributes to that aim, and commands public and professional support, it should be welcomed by everyone involved in health care.The Merrison report was the collective effort of Sir William Merrison and the other 14 members of his committee of inquiry, who took both oral and written evidence. 2A different process has been followed in this case.The government, sensibly, has therefore decided on a period of consultation during which the recommendations can be properly debated, tested, and costed.We have already said that we believe that the recommendations to divorce oversight of medical education from the other regulatory functions of standards, registration, and fitness to practise are not in patients' best interests.We will now be consulting widely with our partners before we submit our considered response.It may be another 30 years before there is another opportunity such as this.We must seize it so that future generations of patients can say that we did not fail them.
Changing the Curriculum for Internal Medicine Residency Training
Authors: Gerald S. Levey
Journal: Annals of Internal Medicine (1992)

The academic leadership of internal medicine is considering fundamental changes in the curriculum for internal medicine residency training. The impetus to change the curriculum is derived from various socioeconomic changes during the past 10 years. These changes have resulted in a drastically shortened length of stay of patients in hospitals, an emphasis on outpatient care by reimbursement agencies, and a sharp decline in the numbers of U.S. medical graduates selecting careers in internal medicine. Curriculum change will mandate that we define the roles of general internists and subspecialists in the delivery of primary care and that we re-define how we train these two groups of internists. We must focus attention on the issue of service compared with education and must confront the issue of how best to train foreign medical graduates. Any curriculum change will also have to accommodate residents selecting careers in research in order to ensure an adequate supply of physician-scientists. Before implementing any change in curriculum, we must put into place a rigorous, prospective evaluation system. We must be able to accurately assess both positive and negative outcomes of these changes and make necessary midcourse corrections. The impetus for curriculum change in internal medicine will, it is hoped, ultimately benefit the public, the trainees, and the practice of internal medicine.
Mucoid and Nonmucoid <i>Burkholderia cepacia</i> Complex Bacteria in Cystic Fibrosis Infections
Authors: James E. A. Zlosnik, Paulo S. Costa, Rollin Brant, Paul Y. B. Mori, Trevor J. Hird, Monica C. Fraenkel, Pearce G. Wilcox, A. George F. Davidson, David P. Speert
Journal: American Journal of Respiratory and Critical Care Medicine (2010)

infection with Burkholderia cepacia complex (BCC) bacteria in cystic fibrosis (CF) is associated with an unpredictable rate of pulmonary decline. Some BCC, but not others, elaborate copious mucoid exopolysaccharide, endowing them with a gross mucoid phenotype, the clinical significance of which has not been described.to determine whether there was a correlation between bacterial mucoid phenotype, as assessed in a semiquantitative manner from plate culture, and severity of disease as assessed by the rate of decline in lung function.we performed a retrospective clinical review of 100 patients with CF attending the Vancouver clinics between 1981 and 2007 and analyzed the rate of lung function decline (% predicted FEV(1)).patients infected exclusively with nonmucoid BCC had a more rapid decline in lung function (annual FEV(1) change, -8.51 ± 2.41%) than those infected with mucoid bacteria (-3.01 ± 1.09%; P < 0.05). Linear mixed-effects data modeling revealed a statistically significant inverse association between semiquantitative mucoid exopolysaccharide production and rate of decline of lung function. In vitro incubation of BCC with ceftazidime and ciprofloxacin but not meropenem caused conversion of BCC from mucoid to nonmucoid.our data suggest an inverse correlation between the quantity of mucoid exopolysaccharide production by BCC bacteria and rate of decline in CF lung function. Certain antibiotics may induce a change in bacterial morphology that enhances their virulence. A simple in vitro test of bacterial mucoidy may be useful in predicting the rate of decline of respiratory function in CF.
Becoming Accountable — Opportunities and Obstacles for ACOs
Authors: Harold S. Luft
Journal: New England Journal of Medicine (2010)

The Patient Protection and Accountable Care Act (ACA) requires the secretary of health and human services to establish a program within Medicare in which savings from efficient, high-value care are shared with accountable care organizations (ACOs). No demonstration project, this is the start of an ongoing way of paying for care; the program is to be launched in January 2012. The concept is appealing, but right now ACOs don't exist, and regulations regarding qualification as an ACO have not yet been published. Much needs to be done to make this new approach to payment and delivery a reality.In principle, . . .
Detection of the carrier state in congenital “true” prothrombin deficiency
Authors: Antonio Girolami, Renzo Dal Bo Zanon
Journal: American Journal of Hematology (1988)

We have read with interest the paper by Valls-de-Ruiz et a1 on prothrombin "Mexico City" [l].A few comments seem indicated.At page 238, third paragraph, it is postulated, as a tentative explanation for the peculiar hereditary pattern, that carriers for "true" hypoprothrombinemia might show normal prothrombin activity and antigen levels.On the
Raphael's Portrait of Inghirami
Authors: RICHARD FRANK
Journal: JAMA (1966)

To the Editor:  I was delighted to see the beautiful reproduction of a famous portrait by Raphael on your Oct 3 cover.  The caption states that the original is in the Isabella Stewart Gardner Museum in Boston.  The original painting is actually in the Pitti Palace in Florence, which was the residence of the Medicis. Inghirami was librarian to Pope Leo X, who was a Medici, and therefore the painting is part of the Medici art collection. Mrs. Gardner was a somewhat eccentric lady who freely mixed originals with copies in her collection. She knew that she owned a copy of Raphael's portrait of Inghirami; however, she preferred to declare that she owned the original.
Carotid-Artery Stenting — Case Open or Closed?
Authors: Anthony J. Furlan
Journal: New England Journal of Medicine (2006)

As compared with carotid endarterectomy, carotid-artery stenting has uncertain efficacy and safety in patients at risk for stroke from atherosclerotic stenosis of the internal carotid artery. The benefits of carotid endarterectomy for both symptomatic and asymptomatic patients have been established in several randomized trials comparing surgery with medical therapy. The benefits of surgery in reducing the long-term risk of stroke need to be weighed against the immediate risk of death or stroke as a complication of the surgery. For symptomatic patients with stenosis of the internal carotid artery of 70% or more, carotid endarterectomy is superior to medical therapy alone, . . .
Mammography screening: an incremental cost effectiveness analysis of double versus single reading of mammograms
Authors: J. Brown, S. Bryan, R. Warren
Journal: BMJ (1996)

<h3>Abstract</h3> <b>Objective</b>: To compare mammography reading by one radiologist with independent reading by two radiologists. <b>Design</b>: An observational non-randomised trial at St Margaret9s Hospital, Epping. <b>Subjects</b>: 33734 consecutive attenders for breast screening in the main trial and a sample of 132 attenders for assessment who provided data on private costs. <b>Interventions</b>: Three reporting policies were compared: single reading, consensus double reading, and non-consensus double reading. <b>Main outcome measures</b>: Numbers of cancers detected, recall rates, screening and assessment costs, and cost effectiveness ratios. <b>Results</b>: A policy of double reading followed by consensus detected an additional nine cancers per 10000 women screened (95% confidence interval 5 to 13) compared with single reading. A non-consensus double reading policy detected an additional 10 cancers per 10000 women screened (95% confidence interval 6 to 14). The difference in numbers of cancers detected between the consensus and non-consensus double reading policies was not significant (95% confidence interval -0.2 to 2.2). The proportion of women recalled for assessment after consensus double reading was significantly lower than after single reading (difference 2.7%; 95% confidence interval 2.4% to 3.0%). The recall rate with the non-consensus policy was significantly higher than with single reading (difference 3.0%; 2.5% to 3.5%). Consensus double reading cost less than single reading (saving pounds sterling4853 per 10000 women screened). Non-consensus double reading cost more than single reading (difference pounds sterling19259 per 10000 women screened). <b>Conclusions</b>: In the screening unit studied a consensus double reading policy was more effective and less costly than a single reading policy. <h3>Key messages</h3> Key messages Double reading of screening mammograms detects more cancers than does single reading Double reading with consensus reduces recall rates and has a lower total cost than single reading Breast screening units should consider adopting consensus double reporting for the first screening examination in order to improve efficiency Double reading with consensus is also likely to confer benefits at subsequent screening examinations, though the magnitude and cost effectiveness of these benefits are not known
Sarcoplasmic reticulum Ca2+ leak in heart failure: mere observation or functional relevance?
Authors: C. H. George
Journal: Cardiovascular Research (2007)

Heart failure (HF) is a chronic multi-factorial disease characterized by sarcoplasmic reticulum (SR) dysfunction that manifests as severely reduced contractility and increased risk of arrhythmia. Several lines of evidence have revealed the existence of defective ryanodine receptor (RyR2)-mediated Ca(2+) leak in HF, although its relevance as a causative factor rather than a phenotypic consequence of the disease is questioned. This review will consider the relative contribution of RyR2-mediated Ca(2+) leak to the profound cellular, transcriptional and electrical remodelling associated with HF. In particular, it will focus on our current understanding of the role of defective phosphorylation of RyR2 as a both a chronic mediator of excitation-contraction coupling (ECC) dysfunction and as a potent catalyst of RyR2-dependent arrhythmogenesis. A hypothetical concept that SR Ca(2+) leak fundamentally underlies the increased arrhythmogenic susceptibility in HF, but that it may not directly contribute to contractile dysfunction, which may involve maladaptive perturbations in metabolism and energy utilization, is also discussed.
A new method of testing mitral valve flow characteristics.
Authors: J Wright
Journal: Thorax (1969)

JOHN WRIGHT This has been evolved with a modified pulse duplicator and the use of a hot film probe for measuring velocity, direction, and turbulence.Many of the commercially available mitral valve prostheses are being investigated for their flow characteristics.In addition, efficiency is being examined and some unusual findings point to the possibility of a hydraulic ram effect in the normal mitral valve that allows opening to commence before the end of ventricular systole.TRIAL OF A NEW ANTI-MYXOVIRUS COMPOUND J. E. STARK Two hundred and sixty-four male students
Endocrine Disruptors and Asthma-Associated Chemicals in Consumer Products
Authors: Robin E. Dodson, Marcia Nishioka, Laurel J. Standley, Laura J. Perovich, Julia Green Brody, Ruthann A. Rudel
Journal: Environmental Health Perspectives (2012)

Background: Laboratory and human studies raise concerns about endocrine disruption and asthma resulting from exposure to chemicals in consumer products. Limited labeling or testing information is available to evaluate products as exposure sources.Objectives: We analytically quantified endocrine disruptors and asthma-related chemicals in a range of cosmetics, personal care products, cleaners, sunscreens, and vinyl products. We also evaluated whether product labels provide information that can be used to select products without these chemicals.Methods: We selected 213 commercial products representing 50 product types. We tested 42 composited samples of high-market-share products, and we tested 43 alternative products identified using criteria expected to minimize target compounds. Analytes included parabens, phthalates, bisphenol A (BPA), triclosan, ethanolamines, alkylphenols, fragrances, glycol ethers, cyclosiloxanes, and ultraviolet (UV) filters.Results: We detected 55 compounds, indicating a wide range of exposures from common products. Vinyl products contained &gt; 10% bis(2-ethylhexyl) phthalate (DEHP) and could be an important source of DEHP in homes. In other products, the highest concentrations and numbers of detects were in the fragranced products (e.g., perfume, air fresheners, and dryer sheets) and in sunscreens. Some products that did not contain the well-known endocrine-disrupting phthalates contained other less-studied phthalates (dicyclohexyl phthalate, diisononyl phthalate, and di-n-propyl phthalate; also endocrine-disrupting compounds), suggesting a substitution. Many detected chemicals were not listed on product labels.Conclusions: Common products contain complex mixtures of EDCs and asthma-related compounds. Toxicological studies of these mixtures are needed to understand their biological activity. Regarding epidemiology, our findings raise concern about potential confounding from co-occurring chemicals and misclassification due to variability in product composition. Consumers should be able to avoid some target chemicals—synthetic fragrances, BPA, and regulated active ingredients—using purchasing criteria. More complete product labeling would enable consumers to avoid the rest of the target chemicals.
EFFICIENCY IN NURSING
Authors: W. GILMAN THOMPSON
Journal: JAMA (1913)

This title is intended to describe the much-neglected field of the economic side of ward nursing, especially in the larger hospitals. Recent magazines are filled with articles discussing "efficiency" in laying bricks or handling tools, and "get-together" principles are the order of the day, but one looks in vain for any serious discussion of the importance of efficiency in the nurse's routine or any "getting together" between the architect who plans the clothes closets, pantries and other ward accessories and the nurses who have to walk endless miles between them in the course of their routine work. Mr. Taylor has shown us how many unnecessary motions the bricklayer makes—how often he bends his back and moves his arms to lay a single brick. Does any one know how many unnecessary steps the ward nurse takes or how often she bends her back or lifts heavy weights? What we do know
A single BRCA2 mutation in male and female breast cancer families from Iceland with varied cancer phenotypes
Authors: Steinunn Thorlacius, Gudridur Olafsdottir, Laufey Tryggvadottir, Susan Neuhausen, Jon G. Jonasson, Sean V. Tavtigian, Hrafn Tulinius, Helga M. Ögmundsdottir, Jorunn E. Eyfjörd
Journal: Nature Genetics (1996)
Absence of measles viral genomic sequence in intestinal tissues from Crohn's disease by nested polymerase chain reaction.
Authors: Y Haga, O Funakoshi, K Kuroe, K Kanazawa, H Nakajima, H Saito, Y Murata, A Munakata, Y Yoshida
Journal: Gut (1996)

The aetiology of Crohn9s disease remains unknown, although evidence for a viral cause has long been sought. Recent studies have shown inflammation of the submucosal microvascular endothelium and granulomata, and endothelial cell cytoplasmic inclusions, consistent with paramyxovirus, were identified by electron microscopy suggesting a persistent measles virus infection in Crohn9s disease. Measles, mumps, and rubella viruses were tested for Crohn9s disease by polymerase chain reaction (PCR). RNA was extracted from resected intestinal specimens from 15 patients with Crohn9s disease, 14 with ulcerative colitis, and 14 controls without inflammatory bowel disease. This was used to perform nested PCR after reverse transcription (RT) of the RNA to cDNA with primer pairs directed against two regions in the genome of the measles virus and one region in the mumps and rubella viral genomes. Despite enhanced sensitivity of nested RT-PCR, measles, mumps, and rubella viral genomic sequences were not found in any intestinal specimen.
Trimethylmethoxyphenyl-retinoic acid (Ro 10–1670) inhibits mitogen-induced DNA-synthesis in peripheral blood lymphocytes in vitro
Authors: RALF BAUER, CONSTANTIN E. ORFANOS
Journal: British Journal of Dermatology (1981)

Trimethylmethoxyphenyl-retinoic acid (TMMP-retinoic acid, Ro 10-1670) is the main metabolite of the aromatic retinoid Ro 10-9359 (Tigason, etretinate), which is now in clinical use. Therefore, we selected this metabolite for our in vitro studies on human lymphocytes. The following findings were obtained: TMMP-retinoic acid is practically insoluble in aqueous solution. It remains partly in solution only if bound to protein. Under these conditions it had no influence on DNA-synthesis of human peripheral blood lymphocytes added in vitro without lectins (5--12.5 ng/ml culture medium). However, if human peripheral blood lymphocytes were cultured in vitro with lectins (ConA, PHA-M, PHA-P and PWM) and in the presence of TMMP-retinoic acid (25 microgram/ml culture medium) no induction of DNA-synthesis was seen. The altered lymphocytic response in presence of TMMP-retinoid in vitro was clearly dose-dependent at these levels. Trypan blue exclusion tests showed no evidence of cytotoxicity. Our studies clearly indicate that TMMP-retinoic acid inhibits the biological response of human blood lymphocytes to lectins in vitro, at dosages close to therapeutic levels in vivo. They confirm that retinoids may exert distinct effects on dermal cells in addition to their influence on keratinocytes, and suggest that the therapeutic action of the drug may be also related to the altered lymphocytic response.
Obstructive Uropathy Complicating Anticoagulant Therapy
Authors: William S. Kaden, Eli A. Friedman
Journal: New England Journal of Medicine (1961)

THE varied hemorrhagic complications resulting from the increasing use of anticoagulant drugs are under current study.1 2 3 4 5 6 7 8 Acute medical and surgical diseases may be mimicked by the presence of occult hematoma. In the case presented below, the recognition of a perivesical hematoma as the cause of acute urinary suppression allowed the prompt relief of obstruction and recovery of the patient.Case ReportA 72-year-old widowed, childless woman (P.B.B.H. 4R478) was admitted to the Peter Bent Brigham Hospital for the 1st time, on October 18, 1960, because of shortness of breath of about 4 months' duration. There had been associated exertional dyspnea, . . .