tbuckley/cabot-search huggingface dataset:
Actual versus Perceived Workload for House Officers: Black Cloud Looming?
Authors: Hobart W. Walling
Journal: Annals of Internal Medicine (2004)

Letters18 May 2004Actual versus Perceived Workload for House Officers: Black Cloud Looming?Hobart W. Walling, MD, PhDHobart W. Walling, MD, PhDFrom St. John's Mercy Medical Center, St. Louis, MO 63141.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-10-200405180-00031 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Background: Requisite in residency training is the tendency for house officers to compare, contrast, and commiserate in their shared work experience. A primary rite of passage is the nightly on-call experience, the character of which is largely determined by the number of new admissions. According to time-honored terminology, residents who admit few patients, all with straightforward problems, and encounter few difficulties covering other patients during the night are referred to as white clouds. In contrast, residents who are up all night evaluating complex new admissions and are frequently called to resuscitate unresponsive patients are black clouds, reflecting ...References1. Miele NF. Dissipating the foggy myth of the black cloud. Arch Pediatr Adolesc Med. 1994;148:333. [PMID: 8130877] CrossrefMedlineGoogle Scholar2. Tanz RR, Charrow J. Black clouds. Work load, sleep, and resident reputation. Am J Dis Child. 1993;147:579-84. [PMID: 8488808] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From St. John's Mercy Medical Center, St. Louis, MO 63141. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByCall karma among senior internal medicine residents: a diagnosis of delusionDebunking superstition: Analyzing the cloud phenomenon in apheresis-Results of a 35-month studyJinx or Not?"Black cloud" vs. "white cloud" physicians - Myth or reality in apheresis medicine?A Consult Is Just a Page Away: A Prospective Observational Study on the Impact of Jinxing on Call Karma in NeurosurgeryImpact of Attending Physicians' Comments on Residents' Workloads in the Emergency Department: Results from Two J(^o^)PAN Randomized Controlled TrialsHave the 'black clouds' cleared with new residency programme regulations?Quantification and Perception of On-call Podiatric Surgical Resident Workload 18 May 2004Volume 140, Issue 10Page: 847-848KeywordsCohort studiesPatientsPersonality traitsResidencySleepTriage ePublished: 18 May 2004 Issue Published: 18 May 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Information generation and processing systems that regulate periodontal structure and function
Authors: P. Mark Bartold, Christopher A. McCulloch
Journal: Periodontology 2000 (2013)

Abstract The periodontium is a very dynamic organ that responds rapidly to mechanical and chemical stimuli. It is very complex in that it is composed of two hard tissues (cementum and bone) and two soft connective tissues (periodontal ligament and gingiva). Together these tissues are defined by the molecules expressed by the resident periodontal cells in each compartment and this determines not only the structure and function of the periodontium but also how it responds to infection and inflammation. The biological activity of these molecules is tightly regulated in time and space to preserve tissue homeostasis, influence inflammatory responses and participate in tissue regeneration. In this issue of Periodontology 2000 we explore new experimental approaches and data sets which help to understand the molecules and cells that regulate tissue form and structure in health, disease and regeneration.
Call for case histories of BMT in patients with coincident schizophrenia
Authors: I E Sommer, D W van Bekkum
Journal: Leukemia (2013)

450% reduction in ALC.For each of these cases, however, we did not observe a significant change in the proportionate representation of the mutant SF3B1 allele, indicating that such treatments did not have selective activity or inactivity for subclones with SF3B1 mutations.Taken together, this study reveals subclonal evolution involving cells with SF3B1 mutations in CLL.Our data indicate that the proportionate representation of cells harboring SF3B1 mutations can increase independent of therapy or loss of functional p53.Finally, the data presented here suggest that subclones with SF3B1 mutations do not necessarily have a selective advantage or disadvantage in the setting of effective cytoreductive therapy.Nevertheless, the prevalence of SF3B1 mutations appears higher among patients who already have undergone therapy.This might reflect the fact that treated patients more commonly have had longer disease histories, potentially providing greater time for emergence and subclonal evolution of CLL cells harboring SF3B1 mutations.Further studies with additional cases will be required to address the therapeutic implications of the SF3B1 mutations and subclonal evolution in this disease.
Localized Expression of Aromatase in Human Vascular Tissues
Authors: Nobuhiro Harada, Hironobu Sasano, Hiroshi Murakami, Tsuneo Ohkuma, Hiroshi Nagura, Yasuyuki Takagi
Journal: Circulation Research (1999)

Abstract —The atheroprotective effects of estrogen are well established and the presence of an estrogen receptor in vascular tissues has recently been reported. Therefore, we investigated the localization of the estrogen-producing enzyme aromatase in vascular tissues to assess the possible contribution of endocrine, paracrine, and autocrine modes of action. Aromatase was found in human vascular smooth muscle cells (SMCs) but not in endothelial cells on in situ hybridization. These observations were further supported by quantitative analysis of aromatase mRNA and the activity in 15 human vascular specimens. Only trace levels of expression were detected in the 3 infants examined, whereas 0.0088 to 0.0806 amol/μg RNA of aromatase mRNA and 12.9 to 122.3 fmol · h −1 · mg −1 protein of the activity were detected in 12 of the adult individuals. The switching of tissue-specific exon 1 of the human aromatase gene was also observed in some cases. Aromatase was found to be expressed only in cultured SMCs and not in cultured endothelial cells of human aorta and pulmonary artery and to be regulated through dexamethasone and the signaling pathways of protein kinase A and C. Study results revealed the localized expression of aromatase in vascular SMCs, which indicated a possible direct action of locally produced estrogen in an autocrine or paracrine manner, with possible cross talk between smooth muscle and endothelial cells.
Mechanism of action of gemfibrozil on lipoprotein metabolism.
Authors: K Saku, P S Gartside, B A Hynd, M L Kashyap
Journal: Journal of Clinical Investigation (1985)

Gemfibrozil is a potent lipid regulating drug whose major effects are to increase plasma high density lipoproteins (HDL) and to decrease plasma triglycerides (TG) in a wide variety of primary and secondary dyslipoproteinemias. Its mechanism of action is not clear. Six patients with primary familial endogenous hypertriglyceridemia with fasting chylomicronemia (type V lipoprotein phenotype) with concurrent subnormal HDL cholesterol levels (HDL deficiency) were treated initially by diet and once stabilized, were given gemfibrozil (1,200 mg/d). Each patient was admitted to the Clinical Research Center with metabolic kitchen facilities, for investigation of HDL and TG metabolism immediately before and after 8 wk of gemfibrozil treatment. Gemfibrozil significantly increased plasma HDL cholesterol, apolipoprotein (apo) AI, and apo AII by 36%, 29%, and 38% from base line, respectively. Plasma TG decreased by 54%. Kinetics of apo AI and apo AII metabolism were assessed by analysis of the specific radioactivity decay curves after injection of autologous HDL labeled with 125I. Gemfibrozil increased synthetic rates of apo AI and apo AII by 27% and 34%, respectively, without changing the fractional catabolic rates. Stimulation of apo AI and apo AII synthesis by gemfibrozil was associated with the appearance in plasma of smaller (and heavier) HDL particles as assessed by gradient gel electrophoresis and HDL composition. Postheparin extra-hepatic lipoprotein lipase activity increased significantly by 25% after gemfibrozil, and was associated with the appearance in plasma of smaller very low density lipoprotein particles whose apo CIII:CII ratio was decreased. These data suggest that gemfibrozil increases plasma HDL levels by stimulating their synthesis. Increased transport (turnover) of HDL induced by gemfibrozil may be significant in increasing tissue cholesterol removal in these patients.
Opiate addiction in adult offspring through possible imprinting after obstetric treatment.
Authors: B Jacobson, K Nyberg, L Gronbladh, G Eklund, M Bygdeman, U Rydberg
Journal: BMJ (1990)

OBJECTIVE--To test the hypothesis that opiate addiction in adults might stem partly from an imprinting process during birth when certain drugs are given to the mother. DESIGN--Retrospective study by logistic regression of opiate addicts with siblings as controls. SETTING--Stockholm, Sweden. SUBJECTS--200 Opiate addicts born in Stockholm during 1945-66, comprising 41 identified during interviews of probands for an earlier study; 75 patients whose death from opiate addiction had been confirmed during 1978-88; and 84 accepted for the methadone programme. 262 Siblings (controls) born in Stockholm during the same period, 24 of whom were excluded for drug addiction or being brought up outside the family. Birth records were unavailable for eight, leaving 230 siblings and 139 corresponding probands. MAIN OUTCOME MEASURES--Administration of opiates, barbiturates, and nitrous oxide (for greater than 1 h) to mothers of all subjects during labour within 10 hours before birth as a risk factor for adult opiate addiction. RESULTS--In subjects who had subsequently become addicts a significant proportion of mothers had received opiates or barbiturates, or both, compared with unmatched siblings (25% v 16%, chi 2 = 5.83, df = 1, p = 0.02), and these mothers had received nitrous oxide for longer and more often. After controlling for hospital of birth, order of birth, duration of labour, presentation other than vertex, surgical intervention, asphyxia, meconium stained amniotic fluid, and birth weight the relative risk for offspring subsequently becoming an adult opiate addict increased with the number of administrations of any of the three drugs. When the addicts were matched with their own siblings the estimated relative risk was 4.7 (95% confidence interval 1.8 to 12.4, p for trend = 0.002) for three administrations compared with when no drug was given. CONCLUSIONS--The results are compatible with the imprinting hypothesis. Therefore, for obstetric pain relief methods are preferable that do not permit substantial passage of drugs through the placenta.
Impaired Arteriogenic Response to Acute Hindlimb Ischemia in CD4-Knockout Mice
Authors: Eugenio Stabile, Mary Susan Burnett, Craig Watkins, Timothy Kinnaird, Alessia Bachis, Andrea la Sala, Jonathan M. Miller, Matie Shou, Stephen E. Epstein, Shmuel Fuchs
Journal: Circulation (2003)

T lymphocytes, components of the immune and inflammatory systems, are involved in such normal processes as wound healing and host defense against infection and in such pathological processes as tumor growth and atherosclerotic plaque development. Angiogenesis is a mechanism common to each. Because CD4+ T lymphocytes are active in regulating humoral and cellular responses of the immune system, we determined whether CD4+ cells contribute to collateral vessel development by using the mouse ischemic hindlimb model.One week after ischemia, CD4-/- mice showed reduced collateral flow induction, macrophage number, and vascular endothelial growth factor levels in the ischemic muscle compared with wild-type mice. There was also delayed recovery of hindlimb function and increased muscle atrophy/fibrosis. Spleen-derived purified CD4+ T cells infused into CD4-/- mice selectively localized to the ischemic limb and significantly increased collateral flow as well as macrophage number and vascular endothelial growth factor levels in the ischemic muscle. Muscle function and damage also improved.These results indicate an important role of CD4+ cells in collateral development, as demonstrated by a 25% decrease in blood flow recovery after femoral artery ligation. Our data also suggest that CD4+ T cells control the arteriogenic response to acute hindlimb ischemia, at least in part, by recruiting macrophages to the site of active collateral artery formation, which in turn triggers the development of collaterals through the synthesis of arteriogenic cytokines.
Direct detection of β thalassemic mutations: Use of biotin‐labelled allele specific probes
Authors: J. G. Hendy, M. N. Cauchi
Journal: American Journal of Hematology (1990)

Abstract Mutations at positions βIVSS 1–6 , βIVS 1–110 , and β 39 of the β globin gene are responsible for the three most common thalassemic genes in the Mediterranean population. The polymerase chain reaction (PCR) was employed to amplify a 536 base pair segment surrounding this region. Nonradioactive labelling of an oligonucleotide probe, specific for the βIVS 1–110 mutation, was achieved by incorporation of biotin‐16‐dUTP into a standard 3′‐end labelling procedure. This probe was subsequently hybridized with the PCR amplification product and permitted detection of the mutant gene in a homozygous β thalassemic child by a simple colour detection method using a streptavidin‐alkaline phosphatase conjugate and NBT/BCIP (nitroblue tetrazolium/5‐bromo‐4‐chloro‐3‐indolyl phosphate) substrate. A known cloned mutant gene was similarly detected. Results could be obtained within 48 hr. These findings suggest that such an approach could provide a rapid and specific means for detection of β thalassemic mutations without the need for radioactive probes.
A Whole-Brain Atlas of Inputs to Serotonergic Neurons of the Dorsal and Median Raphe Nuclei
Authors: Iskra Pollak Dorocic, Daniel Fürth, Yang Xuan, Yvonne Johansson, Laura Pozzi, Gilad Silberberg, Marie Carlén, Konstantinos Meletis
Journal: Neuron (2014)
Rate-related electrophysiologic effects of long-term administration of amiodarone on canine ventricular myocardium in vivo.
Authors: K P Anderson, R Walker, T Dustman, R L Lux, P R Ershler, R E Kates, P M Urie
Journal: Circulation (1989)

The electrophysiologic effects of amiodarone were examined in 13 dogs that received 30 g amiodarone orally during 3 weeks and compared with 13 control dogs that did not receive amiodarone. Longitudinal and transverse epicardial conduction velocities were estimated with a square array of 64 closely spaced electrodes and a computer-assisted acquisition and analysis system. Amiodarone caused a rate-dependent decrease in conduction velocity with a slightly greater effect in the longitudinal direction of propagation. Rate-related depression of conduction velocity developed rapidly after abrupt shortening of the pacing cycle length; 67% of the change occurred between the first two beats of the rapid train, and little change occurred after the 10th beat. Recovery from use-dependent depression of conduction velocity was exponential with a mean time constant of 447 +/- 172 msec in the longitudinal direction and 452 +/- 265 msec in the transverse direction. Repolarization intervals, defined as the interval between the activation time and the repolarization time in the unipolar electrograms, correlated highly with refractory period determinations in the absence and presence of amiodarone at each cycle length tested. The increase in repolarization intervals and refractory periods resulting from amiodarone treatment did not vary with cycle length. Amiodarone treatment also resulted in a significant rate-related reduction in systolic blood pressure. The systolic blood pressure in the group that received amiodarone decreased by a mean of 50 +/- 23% between steady-state pacing cycle lengths of 1,000 and 200 msec, whereas the corresponding decrease in the control group was 21 +/- 32% (p less than 0.05). Plasma and myocardial amiodarone and desethylamiodarone levels were comparable to those observed clinically. We conclude that long-term amiodarone administration causes rate-dependent reductions in conduction velocity and blood pressure and causes rate-independent increases in repolarization intervals.
EMBOLISM OF THE PERIPHERAL ARTERIES
Authors: RAYMOND W. BRUST
Journal: JAMA (1934)

Portis and Roth<sup>1</sup>recently reviewed the literature on embolectomy of the peripheral arteries and stated that only 131 cases had been reported. Four months earlier, however, Pearse<sup>2</sup>cited 296 cases which had been reported in the literature to July 1932. All articles on this subject imply that the authors are in agreement with the commonly accepted opinion, that when gangrene results from the occlusion of large vessels, the resulting gangrene, without operation, is fatal. Respect, however, has grown for the collateral circulation, especially in those portions of the body where end arteries have been said to exist. Case 1 is reported to demonstrate the fact that a fatal outcome is not always the result of a peripheral arterial embolism without embolectomy. This statement does not detract from the correctness of the conclusion of Key<sup>3</sup>and others<sup>4</sup>that in all threatening cases operation should be done. It
Modifying risk of developing lung cancer by changing habits of cigarette smoking.
Authors: J H Lubin, W J Blot, F Berrino, R Flamant, C R Gillis, M Kunze, D Schmahl, G Visco
Journal: BMJ (1984)

Data from a hospital based case-control study of lung cancer in Western Europe were used to examine changes in the risk of developing lung cancer after changes in habits of cigarette smoking. Only data for subjects who had smoked regularly at some time in their lives were included. The large size of the study population (7181 patients and 11 006 controls) permitted precise estimates of the effect of giving up smoking. Risks of developing lung cancer for people who had given up smoking 10 or more years before interview were less than half of those for people who continued to smoke. The reduction in risk was seen in men and women and in former smokers of both filter and non-filter cigarettes but varied by duration of smoking habit before giving up. The protective effect of giving up became progressively greater with shorter duration of smoking habit. The risks after not smoking for 10 years for both men and women who had previously smoked for less than 20 years were roughly the same as those for lifelong non-smokers. Reducing the number of cigarettes smoked a day or switching from non-filter to filter cigarettes also lowered the risk of developing lung cancer but not to the extent associated with giving up smoking.
Learning by imitation: A hierarchical approach
Authors: Richard W. Byrne, Anne E. Russon
Journal: Behavioral and Brain Sciences (1998)

To explain social learning without invoking the cognitively complex concept of imitation, many learning mechanisms have been proposed. Borrowing an idea used routinely in cognitive psychology, we argue that most of these alternatives can be subsumed under a single process, priming, in which input increases the activation of stored internal representations. Imitation itself has generally been seen as a “special faculty.” This has diverted much research towards the all-or-none question of whether an animal can imitate, with disappointingly inconclusive results. In the great apes, however, voluntary, learned behaviour is organized hierarchically. This means that imitation can occur at various levels, of which we single out two clearly distinct ones: the “action level,” a rather detailed and linear specification of sequential acts, and the “program level,” a broader description of subroutine structure and the hierarchical layout of a behavioural “program.” Program level imitation is a high-level, constructive mechanism, adapted for the efficient learning of complex skills and thus not evident in the simple manipulations used to test for imitation in the laboratory. As examples, we describe the food-preparation techniques of wild mountain gorillas and the imitative behaviour of orangutans undergoing “rehabilitation” to the wild. Representing and manipulating relations between objects seems to be one basic building block in their hierarchical programs. There is evidence that great apes suffer from a stricter capacity limit than humans in the hierarchical depth of planning. We re-interpret some chimpanzee behaviour previously described as “emulation” and suggest that all great apes may be able to imitate at the program level. Action level imitation is seldom observed in great ape skill learning, and may have a largely social role, even in humans.
Explaining referral variation.
Authors: A Hutchinson
Journal: BMJ (1993)

the condition it addressed.In such cases detailed investigation would lead to no recommendations for change.At the other end of this wide spectrum is the possibility of professional malfeasance (see the paper by Graham Neale on p 14837), and even purposeful harmful acts are not impossible.Unlike the airline pilot, medical professionals do not share the fate of those in their care.Even if the patient dies because the hospital bums down in the middle of the operation this should still not be called an accident because buildings catch fire for reasons.As the issues in the medical case are more complex than in the transport case the reasons for replacing the word accident by a more objective and crisp word are all the more compelling.While some might argue that this is a pedantic quibble to be dismissed by "What's in a name?",I think that the benefits of more precise terminology would be substantial.The central issue is that "accident" conveys a sense that bad outcomes are to be explained in terms of fate and luck rather than a set of understandable, and possibly changeable, antecedents.The opportunities to reduce harm will increase if we keep uppermost in our thinking that "The fault... is not in our stars, but in ourselves.
Sequential Single-Agent Chemotherapy for Metastatic Breast Cancer: Therapeutic Nihilism or Realism?
Authors: Andrew D. Seidman
Journal: Journal of Clinical Oncology (2003)

Article Tools EDITORIALS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2003.10.086 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 12586789 Sequential Single-Agent Chemotherapy for Metastatic Breast Cancer: Therapeutic Nihilism or Realism? Andrew D. SeidmanxAndrew D. SeidmanSearch for articles by this author Show More Memorial Sloan-Kettering Cancer Center, New York, NY https://doi.org/10.1200/JCO.2003.10.086 First Page Full Text PDF Figures and Tables © 2003 by American Society of Clinical Oncology