tbuckley/cabot-search huggingface dataset:
Health and Economic Implications of a Tobacco-Free Society
Authors: Kenneth E. Warner
Journal: JAMA (1987)

Cigarette smoking causes more premature deaths than do all the following together: acquired immunodeficiency syndrome, cocaine, heroin, alcohol, fire, automobile accidents, homicide, and suicide. Attainment of a tobacco-free society ultimately would produce a national life-expectancy gain comparable with that that would accompany the complete elimination of all cancers not caused by tobacco use. In particular, each year 350000 individuals who would have experienced tobacco-related deaths would realize a life-expectancy gain of 15 years. Reflecting their higher smoking prevalence and rates of smokingrelated diseases, blacks would benefit more than whites. By altering the mix of morbid conditions and fatal diseases, the end of tobacco-related disease would shift the need for particular medical specialties and health care facilities. The tobacco industry implies that the demise of tobacco consumption would wreak havoc with the economy. By contrast, some antitobacco activists suggest that the end of tobacco use would yield a multibillion dollar fiscal dividend. Each argument is fundamentally flawed. The economic impacts of a tobacco-free society would be modest and of far less consequence than the principal implication: a significantly enriched quality and quantity of life. (<i>JAMA</i>1987;258:2080-2086
Toward the Assessment of Scientific and Public Health Impacts of the National Institute of Environmental Health Sciences Extramural Asthma Research Program Using Available Data
Authors: Edward Liebow, Jerry Phelps, Bennett Van Houten, Shyanika Rose, Carlyn Orians, Jennifer Cohen, Philip Monroe, Christina H. Drew
Journal: Environmental Health Perspectives (2009)

BackgroundIn the past 15 years, asthma prevalence has increased and is disproportionately distributed among children, minorities, and low-income persons. The National Institute of Environmental Health Sciences (NIEHS) Division of Extramural Research and Training developed a framework to measure the scientific and health impacts of its extramural asthma research to improve the scientific basis for reducing the health effects of asthma.ObjectivesHere we apply the framework to characterize the NIEHS asthma portfolio’s impact in terms of publications, clinical applications of findings, community interventions, and technology developments.MethodsA logic model was tailored to inputs, outputs, and outcomes of the NIEHS asthma portfolio. Data from existing National Institutes of Health (NIH) databases are used, along with publicly available bibliometric data and structured elicitation of expert judgment.ResultsNIEHS is the third largest source of asthma-related research grant funding within the NIH between 1975 and 2005, after the National Heart, Lung, and Blood Institute and the National Institute of Allergy and Infectious Diseases. Much of NIEHS-funded asthma research focuses on basic research, but results are often published in journals focused on clinical investigation, increasing the likelihood that the work is moved into practice along the “bench to bedside” continuum. NIEHS support has led to key breakthroughs in scientific research concerning susceptibility to asthma, environmental conditions that heighten asthma symptoms, and cellular mechanisms that may be involved in treating asthma.ConclusionsIf gaps and limitations in publicly available data receive adequate attention, further linkages can be demonstrated between research activities and public health improvements. This logic model approach to research impact assessment demonstrates that it is possible to conceptualize program components, mine existing databases, and begin to show longer-term impacts of program results. The next challenges will be to modify current data structures, improve the linkages among relevant databases, incorporate as much electronically available data as possible, and determine how to improve the quality and health impact of the science that we support.
Health risks of overseas travel
Authors: Jonathan S Charlton
Journal: BMJ (2004)

Editor—In his news item Dobson highlights the health risks of overseas travel.1 I find that most of my patients who travel to malarial areas without taking prophylaxis don't do so for the following reasons.

Firstly, they don't believe they are susceptible, having lived in a malarial area for years.

Secondly, they haven't sought advice.

Thirdly, they know they ought to take it but are not willing to pay for it, although the cost of prophylaxis is a fraction of the cost of the holiday.

Fourthly, they believe that they can avoid being bitten.

Finally, very occasionally, they have travelled at very short notice. Adequate prophylaxis at the airport might therefore be helpful 24 hours a day; it could even be a condition of boarding the aeroplane that passengers have adequate and appropriate drug treatment with them.

I suggest that patients returning from abroad with preventable illnesses such as malaria are treated in the NHS only on the production of a receipt proving that they at least bought or were given the appropriate drugs for themselves and all members of their families who travelled with them.
Stroke services could do better
Authors: Paul Dinsdale
Journal: BMJ (2006)

Patients with stroke in England, Wales, and Northern Ireland are still receiving substandard care, despite a large increase in the number of hospitals with a specialist stroke unit, says a major audit of stroke services.

The 2006 national sentinel organisational audit for stroke found that patients with stroke are not being taken to hospital quickly enough and that only 12% of trusts have specific arrangements in place with their local ambulance service for emergency transfer of stroke …
Extracellular Potassium Modulation of Drug Block of I <sub>Kr</sub>
Authors: Tao Yang, Dan M. Roden
Journal: Circulation (1996)

Background Torsade de pointes often occurs with underlying hypokalemia and bradycardia. A common effect of many drugs producing torsade de pointes is block of the rapidly activating component of the cardiac delayed rectifier (I Kr ). In this study, we evaluated the effect of changing extracellular potassium ([K + ] o ) on I Kr block by the nonspecific agent quinidine and by the specific I Kr blocker dofetilide. Methods and Results I Kr was measured in AT-1 cells, where contaminating outward currents are absent. The drug concentration producing 50% inhibition of I Kr tails (IC 50 ) was strikingly [K + ] o -dependent. Elevating [K + ] o from 1 to 8 mmol/L increased the IC 50 for dofetilide block from 2.7±0.9 to 79±32 nmol/L and for quinidine block from 0.4±0.1 to 3.8±1.2 μmol/L. Conclusions (1) The increase in drug block with low [K + ] o provides a mechanism to explain the link between hypokalemia and torsade de pointes. (2) Elevations in [K + ] o occur with myocardial ischemia and with rapid pacing. Possible consequences of blunted drug block with high [K + ] o include loss of drug efficacy with ischemia and with rapid pacing; the latter may contribute to “reverse use-dependent” action potential prolongation. Extracellular potassium is a critical determinant of drug block of I Kr , with substantial clinical implications.
GOVERNMENT AIDS TO PUBLIC HEALTH.Read in the Section of State Medicine, at the Forty-first Annual Meeting of the American Medical Association, at Nashville, Tenn., May, 1890.
Authors: WALTER WYMAN
Journal: JAMA (1890)

At a recent meeting of a sanitary association, its President gave utterance to a sentiment which has often been expressed of late years in public bodies, to the effect that while the Government of the United States is most liberal in its provision for all ordinary, material welfare of its citizens, in matters of public health it is parsimonious and its aid is stinted. This, to my mind, appears unjust and has led me to make an inquiry as to what the Government, in its various branches, actually does for the public health. Without going into greater detail than is necessary, it will be pertinent to mention, first, what has been and is being done to prevent the introduction and spread of epidemic disease; and under this head may be cited the recent establishment, on a broad plan, of the National Quarantine Service, at an expense of more than half
The Care of the Rheumatoid Hand
Authors: Leonard F. Peltier
Journal: JAMA (1975)

This third edition of Dr. Flatt's<i>The Care of the Rheumatoid Hand</i>is even more timely than the first. During the past decade, there has been a growing interest in methods to ameliorate the ravages of rheumatoid arthritis, and a larger number of physicians and surgeons have a special interest and training in the treatment of rheumatoid disease. This book is directed toward this growing constituency. The author has exercised a gardener's skill in pruning old stock to merit new growth. The book has been almost entirely rewritten and has not grown by accretion. Emphasis is given to the normal function of the complex mechanism of the hand. In this way, the disturbances of function introduced by disease of some of the parts can be more easily understood. Rational treatment can only be based on understanding what is wrong. This book presents very well the current state of our knowledge
mTOR-mediated dedifferentiation of the retinal pigment epithelium initiates photoreceptor degeneration in mice
Authors: Chen Zhao, Douglas Yasumura, Xiyan Li, Michael Matthes, Marcia Lloyd, Gregory Nielsen, Kelly Ahern, Michael Snyder, Dean Bok, Joshua L. Dunaief, Matthew M. LaVail, Douglas Vollrath
Journal: Journal of Clinical Investigation (2010)

Retinal pigment epithelial (RPE) cell dysfunction plays a central role in various retinal degenerative diseases, but knowledge is limited regarding the pathways responsible for adult RPE stress responses in vivo. RPE mitochondrial dysfunction has been implicated in the pathogenesis of several forms of retinal degeneration. Here we have shown that postnatal ablation of RPE mitochondrial oxidative phosphorylation in mice triggers gradual epithelium dedifferentiation, typified by reduction of RPE-characteristic proteins and cellular hypertrophy. The electrical response of the retina to light decreased and photoreceptors eventually degenerated. Abnormal RPE cell behavior was associated with increased glycolysis and activation of, and dependence upon, the hepatocyte growth factor/met proto-oncogene pathway. RPE dedifferentiation and hypertrophy arose through stimulation of the AKT/mammalian target of rapamycin (AKT/mTOR) pathway. Administration of an oxidant to wild-type mice also caused RPE dedifferentiation and mTOR activation. Importantly, treatment with the mTOR inhibitor rapamycin blunted key aspects of dedifferentiation and preserved photoreceptor function for both insults. These results reveal an in vivo response of the mature RPE to diverse stressors that prolongs RPE cell survival at the expense of epithelial attributes and photoreceptor function. Our findings provide a rationale for mTOR pathway inhibition as a therapeutic strategy for retinal degenerative diseases involving RPE stress.
Handbook for the Academic Physician
Authors: Kenneth M. Ludmerer
Journal: JAMA (1987)

Academic physicians today have many complex roles—including teacher, researcher, provider of patient care, administrator, and counselor. Yet it is only in clinical work that many academic physicians have been fully trained. This useful volume reviews the entire range of responsibilities of the academic physician and provides practical guidelines for those entering or contemplating an academic career. The book is organized into five sections, each containing several essays: professional responsibilities (which emphasizes the administrative aspects of academic medicine), medical education, clinical research, professional communications (both speaking and writing), and the ethics of teaching and patient care. The book is well organized, and the essays and sections are not redundant. Experienced academic physicians are likely to find much of the discussion superficial, but this is the intent of the editors, who chose comprehensiveness and breadth over depth, and who supplemented the essays with a useful bibliography for more detailed reading. There are
Role of myocardial ischemia during programmed stimulation in survivors of cardiac arrest with coronary artery disease
Authors: Fred Morady, Lorenzo A. DiCarlo, Ryszard B. Krol, Thomas M. Annesley, William W. O’neill, Michael de Buitleir, Jeffrey M. Baerman, William H. Kou
Journal: Journal of the American College of Cardiology (1987)
Proposals to ban abortion in Turkey provoke protests
Authors: E. Green
Journal: BMJ (2012)

Abortion could soon be illegal in Turkey as prime minister Tayyip Erdogan has announced plans to withdraw a woman’s right to terminate her pregnancy.

Erdogan’s two speeches, delivered last month at the International Parliamentarians’ Conference on Population and Development, have provoked a strong reaction. A draft bill outlining what changes to the law will be made, either restricting abortion after 4 weeks’ gestation or banning it completely, is due to be completed and announced next month.

In Istanbul between 3000 and 4000 protesters, mostly women, went on to the streets carrying banners entitled …
Isolated gonococcal pulmonary valve endocarditis: diagnosis by echocardiography.
Authors: B S Dzindzio, L Meyer, R Osterholm, A Hopeman, J Woltjen, A D Forker
Journal: Circulation (1979)

The perplexing clinical course of a 23-year-old black male with isolated gonococcal pulmonary valvular endocarditis is presented. M-mode echocardiography provided the first clue to the presence of pulmonary valvular vegetations and the proper diagnosis. Since Neisseria gonorrhea appears to have a particular affinity for the pulmonary valve, the presence of isolated pulmonary valvular endocarditis should raise the strong possibility that Neisseria gonorrhea is the offending organism. This case report of pulmonary valvular vegetations detected by echocardiography strongly emphasizes that all four cardiac valves must be visualized in order to rule out the presence of echocardiographically detectable valvular vegetations.
Problems Plaguing Public Hospitals: Uninsured Patient Transfers, Tight Funds, Mismanagement, and Misperception
Authors: Emily Friedman
Journal: JAMA (1987)

PUBLIC HOSPITALS today face serious problems. Four types of troubles seem paramount: transfers of uninsured patients from other providers, growing unavailability of working and building capital, the perceived or actual obstacles created by public ownership, and the lingering image problems born in the almshouses of centuries past. <h3>Transfers: "A Strange Symbiosis"</h3> Although the more genteel term is "economic transfers," house staff and public hospital advocates have long called it "dumping"—the practice of sending uninsured (and, in some cases, Medicaid-eligible) patients to public hospitals solely for economic reasons. "Dumping" is defined in many ways: transfer of unstabilized patients; transfer of patients who are stabilized; transfer of patients already admitted, in the middle of a hospital stay, because their insurance coverage has run out or has been found not to exist; or transfer of patients through organized or even formal arrangements. The key ingredient is the patient's lack of public or private
Management and Outcomes of Very Low Birth Weight
Authors: Eric C. Eichenwald, Ann R. Stark
Journal: New England Journal of Medicine (2008)

With increasing numbers of extremely premature infants surviving, the outcome for these infants has generated much interest and controversy. This article reviews recent progress in the management and outcomes of some of the most common conditions affecting infants with very low birth weight (1500 g or less) and extremely low birth weight (1000 g or less).
CCR7 ligands control basal T cell motility within lymph node slices in a phosphoinositide 3–kinase– independent manner
Authors: François Asperti-Boursin, Eliana Real, Georges Bismuth, Alain Trautmann, Emmanuel Donnadieu
Journal: The Journal of Experimental Medicine (2007)

The molecular mechanisms responsible for the sustained basal motility of T cells within lymph nodes (LNs) remain elusive. To study T cell motility in a LN environment, we have developed a new experimental system based on slices of LNs that allows the assessment of T cell trafficking after adoptive transfer or direct addition of T cells to the slice. Using this experimental system, we show that T cell motility is highly sensitive to pertussis toxin and strongly depends on CCR7 and its ligands. Our results also demonstrate that, despite its established role in myeloid cell locomotion, phosphoinositide 3–kinase (PI3K) activity does not contribute to the exploratory behavior of the T lymphocytes within LN slices. Likewise, although PI3K activation is detectable in chemokine-treated T cells, PI3K plays only a minor role in T cell polarization and migration in vitro. Collectively, our results suggest that the common amplification system that, in other cells, facilitates large phosphatidylinositol 3,4,5-trisphosphate increases at the plasma membrane is absent in T cells. We conclude that T cell motility within LNs is not an intrinsic property of T lymphocytes but is driven in a PI3K-independent manner by the lymphoid chemokine-rich environment.
Cost-effectiveness of Mammography Screening
Authors: Rob Boer
Journal: JAMA (1996)

<h3>To the Editor.</h3> —The article by Drs Lindfors and Rosenquist<sup>1</sup>does not meet the standard that has been set by earlier models.<sup>2-4</sup>Five deficiencies of their analysis follow. Two strategies offer additional screenings (under age 50 years) compared with other strategies, but surprisingly these extensions are predicted to gain less years of life. This applies to the sixth strategy compared with the fourth, and the seventh compared with the sixth, as listed in Table 6. This alarming outcome is not mentioned, let alone explained by the authors. Assumptions on effects and costs of screening are taken from various sources without bothering about their consistency. A characteristic example is the assumed 4% breast cancer mortality reduction for biennial screening compared with 23% for annual screening. Normally one would expect that doubling of the screening frequency less than doubles the mortality reduction: of the detected cases in two successive annual
Review: Some TNF inhibitors increase adverse events in patients with rheumatoid arthritis
Authors: Henry S. Sacks
Journal: Annals of Internal Medicine (2015)

Source Citation Michaud TL, Rho YH, Shamliyan T, Kuntz KM, Choi HK. The comparative safety of tumor necrosis factor inhibitors in rheumatoid arthritis: a meta-analysis update of 44 trials. Am J Med. 2014;127:1208-32. 24950486
Foetal Death after Pethidine and Promazine
Authors: A. G. Amias, D. Fairbairn
Journal: BMJ (1963)

Fatal Hypernatraemia after a Saline EmeticHypertonic saline can be used to provoke vomiting in cases of acute poisoning in attempted suicide.'In certain circum- stances this may lead to dangerous side-effects as illustrated by the following report.CASE REPORT A 74-year-old man was admitted to hospital, having taken 60 mg. of perphenazine (" fentazin ") and 750 mg. of imipramine (" tofranil ").This quantity had been intended to represent a ten-day supply.He had been prescribed these tablets by his general practitioner the previous day for what was considered to be mild depression.Apart from having had a transvesical prostatectomy for benign prostatic enlargement in 1957 there was no relevant history of organic disease.On examination he appeared to be well nourished.He could respond to simple questions and obey simple commands, and could hold a tumbler and drink on request.Agitation and a coarse Parkinsonian tremor of the hands were conspicuous.The pulse rate was 84/min., regular, and blood-pressure 115/80 mm.Hg (a recording the previous day by his general practitioner gave 170/90 mm.Hg).Crepitations were present at both lung bases.The pupils reacted sluggishly to direct light; there was no neck stiffness, and Kernig's sign was negative.The patient was able to move-all limbs equally.Tendon jerks in upper and lower limbs were brisk.Clonus was absent but both plantar responses were extensor.An attempt to pass a stomach-tube was unsuccessful because of resistance by the patient.To provoke vomiting a table- spoonful of NaCI (30 g.) in 300 ml. of warm water was given and the patient drank this but no vomiting occurred.The dose was repeated, and only when he lay flat did he vomit, approximately 150 ml.being recovered.There was no retching.The vomit was discarded.An intravenous infusion of NaCl 0.18% in dextrose 4.3% for the purpose of blood lavage,2 and a course of penicillin, were begun.Urethral catheterization was required 10 hours after admission for acute retention of urine.The urine output
Laryngology and Phonosurgery
Authors: Steven M. Zeitels, Gerald B. Healy
Journal: New England Journal of Medicine (2003)

A normal voice is a necessity for effectiveness at work, as well as for psychosocial health. Vocal difficulties are generally obvious during normal conversation, and all physicians should be prepared to initiate proper evaluation and treatment for patients with laryngeal dysfunction or disease. This review of laryngology and phonosurgery considers current advances in the detection and management of conditions that affect the voice.
Toward Less Hazardous Cigarettes
Authors: Kenneth E. Warner
Journal: JAMA (1979)

<h3>To the Editor.—</h3> In a recent issue ofThe Journal, Gio Gori, PhD, and Cornelius Lynch, PhD, report on "[c]ritical levels of selected cigarette smoke constituents... expressed in terms of pre-1960 cigarettes that a smoker may consume without increasing his mortality risk substantially above that of a nonsmoker." These critical levels are translated into equivalent numbers of present-day low tar and nicotine cigarettes in order to provide information to help "the smoker to wean himself to progressively less hazardous cigarettes." While the authors' motivation is beyond reproach, their analysis is predicated on some highly questionable assumptions that, if wrong, challenge the validity of their conclusion. Here I will note only two such assumptions. First, the vast majority of current regular (eg, pack-a-day) smokers inhale. Hence, for a meaningful comparison between present-day low tar and nicotine cigarette smoking and the pre-1960 ingestion of smoke constituents, the latter must be associated with