tbuckley/cabot-search huggingface dataset:
The rationing debate: Rationing health care by age: The case for
Authors: A. Williams
Journal: BMJ (1997)

Child mental health: who is responsible?The labelling of all childhood ills as mental health problems diverts doctors into child welfare work that is more properly the province of social services or education, argues child psychiatrist Robert Goodman.The result, he claims, is that many children who could have benefited from medical assessment and treatment for their emotional and behavioural problems do not get that help.We asked another child psychiatrist, an educational psychologist, and a social worker to respond to Dr Goodman's challenge. An overextended remit Robert GoodmanParents and teachers are seriously dissatisfied with the behaviour of many children.Other children experience considerable stress, misery, or anxiety.Epidemiological studies suggest that roughly 20% of all children and teenagers are maladjusted or distressed, 1 with some estimates being substantially higher. 2 In the child psychiatric literature and government strategy documents these maladjusted and distressed children are referred to as having psychiatric disorders or mental health problems. 3 4I believe that this medicalisation of all maladjustment and distress is a serious "own goal" for the health service, generating unrealistic expectations of what child mental health services can deliver and diverting health professionals from their areas of expertise.The medicalisation of maladjustment and distress is enshrined in the contemporary psychiatric classifications of the World Health Organisation and the American Psychiatric Association. 5 6Perhaps both these classifications were overinfluenced by the World Health Organisation's otherworldly definition of health as "a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity" 7 ; falling short of this ideal is then a lack of health, and it is only a small step to define any serious shortfall as a disease.Cynics will also note that the medicalisation of maladjustment and distress generates employment for doctors and persuades health insurers to foot at least some of the bill.An overinclusive notion of child mental health may have encouraged health providers to fill the vacuum as successive funding crises have led social services and education to withdraw from much of their traditional child and family guidance work.Antisocial behaviour in adults is usually seen as a social problem: similar behaviour in children is often categorised as a mental health problem
Aortic Intramural Hematoma
Authors: K M Harris, M Rosenbloom
Journal: New England Journal of Medicine (1997)

A 77-year-old woman with a history of hypertension and an abdominal aortic aneurysm presented with acute upper back discomfort. The physical examination on admission was unremarkable, and a chest film revealed dilatation of a tortuous thoracic aorta. Transesophageal echocardiography (Panel A) showed severe atherosclerosis of a mildly enlarged descending aorta. There was eccentric thickening of one wall of the aorta (arrowhead) that was consistent with thrombus or intramural hematoma. A computed tomographic (CT) scan confirmed these findings. The patient was treated with aggressive blood-pressure control but had recurrent back discomfort, and another CT scan (Panel B) suggested enlargement of the . . .
Steroid Sulfatase: Molecular Biology, Regulation, and Inhibition
Authors: M. J. Reed, A. Purohit, L. W. L. Woo, S. P. Newman, B. V. L. Potter
Journal: Endocrine Reviews (2005)

Steroid sulfatase (STS) is responsible for the hydrolysis of aryl and alkyl steroid sulfates and therefore has a pivotal role in regulating the formation of biologically active steroids. The enzyme is widely distributed throughout the body, and its action is implicated in physiological processes and pathological conditions. The crystal structure of the enzyme has been resolved, but relatively little is known about what regulates its expression or activity. Research into the control and inhibition of this enzyme has been stimulated by its important role in supporting the growth of hormone-dependent tumors of the breast and prostate. STS is responsible for the hydrolysis of estrone sulfate and dehydroepiandrosterone sulfate to estrone and dehydroepiandrosterone, respectively, both of which can be converted to steroids with estrogenic properties (i.e., estradiol and androstenediol) that can stimulate tumor growth. STS expression is increased in breast tumors and has prognostic significance. The role of STS in supporting tumor growth prompted the development of potent STS inhibitors. Several steroidal and nonsteroidal STS inhibitors are now available, with the irreversible type of inhibitor having a phenol sulfamate ester as its active pharmacophore. One such inhibitor, 667 COUMATE, has now entered a phase I trial in postmenopausal women with breast cancer. The skin is also an important site of STS activity, and deficiency of this enzyme is associated with X-linked ichthyosis. STS may also be involved in regulating part of the immune response and some aspects of cognitive function. The development of potent STS inhibitors will allow investigation of the role of this enzyme in physiological and pathological processes.
MRI in predicting curative resection of rectal cancer: Does post-neoadjuvant MRI have a role?
Authors: Durgesh S Raje
Journal: BMJ (2006)

EDITOR—In the MERCURY study, magnetic resonance imaging incorrectly predicted tumour in the margin in 27 patients.1 Twenty one of these had neoadjuvant therapy in the form of chemoradiation.1 This is important, as recently many rectal …
Oligaemia, Renal Failure, and Jaundice Associated with Acute Pustular Psoriasis
Authors: D. J. Warren, R. J. Winney, G. W. Beveridge
Journal: BMJ (1974)

An episode of acute pustular psoriasis in a middle-aged man was associated with cholestatic jaundice and followed by acute tubular necrosis. It is suggested that renal failure was due to oligaemia after the loss of albumin into and from the skin. Fluid balance, central venous pressure, and arterial blood pressure should be monitored in patients with acute pustular psoriasis.
Effects of pioglitazone on metabolic parameters, body fat distribution, and serum adiponectin levels in Japanese male patients with type 2 diabetes
Authors: Hiroshi Hirose, Toshihide Kawai, Yukihiro Yamamoto, Matsuo Taniyama, Motowo Tomita, Koichi Matsubara, Yasunori Okazaki, Tatsuya Ishii, Yuko Oguma, Izumi Takei, Takao Saruta
Journal: Metabolism (2002)
A Theoretical Analysis of Intracavitary Blood Mass Influence on the Heart-Lead Relationship
Authors: DANIEL A. BRODY
Journal: Circulation Research (1956)

As a result of theoretic advances made during the past 10 years, it is now feasible to record scalar and vector electrocardiograms in a manner which is independent of body shape and cardiac location. A similar independence of the body's electric inhomogeneities has not yet been achieved. On the contrary, the evidence presented here shows that inhomogeneity phases in the body, especially the intracavitary blood mass, exert a powerful influence on the heart-lead relationship. The particular effect of the intracavitary phase is to augment the manifest strength of normal components of myocardial doublets, and to reduce the manifest strength of tangential components. This augmentation-reduction effect is quantitatively predictable under conditions of simple idealization, and has been confirmed by experiments on electrocardiograpic models. The net effect of the intracavitary phase is probably to produce quasi-vectorial registration of the electromotive forces of the heart, at least during the normal depolarization phase.
Mediation of hidradenitis suppurativa by androgens.
Authors: P S Mortimer, R P Dawber, M A Gales, R A Moore
Journal: BMJ (1986)

Forty two women with hidradenitis suppurativa were assessed clinically and biochemically for evidence of androgen excess. Thirteen had irregular menses; 22 of 36 experienced exacerbation of hidradenitis suppurativa premenstrually; 19 had or had had acne vulgaris; and seven were hirsute. Comedones (blackheads) were found in apocrine sites in 37, but also in retroauricular sites in 18 and were considered to be an important physical sign for early diagnosis. Eight had evidence of pilonidal (postanal) sinus. The patients had a higher concentration of total testosterone (p less than 0.01) and free androgen index (testosterone to sex hormone binding globulin concentrations) (p less than 0.01) than normal controls. Patients with hidradenitis suppurativa appear to have endocrine abnormalities sufficient to suggest an androgenic basis for the disease.
The Use of the Ophthalmoscope in Detecting the Early Forms of Granular Kidney
Authors: R. P. Oglesby
Journal: BMJ (1877)

Weight of the Body.-Istated at the trial that the emaciation was extreme.Part at least is, I think, to be attributed to tubercular disease.With respect to the remainder, the decision must rest upon the circumstantial evidence.WeiRht of the Solid Viscera.-Mr.Taylor says the solid viscera of the abdomen were shrunk "to little more than half their usual bulk and weight".The kidneys weighed 7Y4 ounces.I find the average of healthy kidneys belonging to adult women dying in hospital from all causes is a little under 8)4 ounces.This estimate excludes cases of renal disease, but includes many cases of heart-disease.Is this -"little more than half"?The spleen weighed 4Y2 ounces; and an average is given of 6.13 ounces ("little more than half", saysTMr.Taylor).I find the average weight of healthy spleens in women, collected as just mentioned, to be about 5 ounces.This includes a range of 2 ounces to IO ounces.So that I adhere to my statement in court, that from the weight of so variable an organ no conclusion can be drawn.The liver was the smallest organ relatively; its weight is given as 34Y4 ounces, while the average given is 53.6 ounces.I esti- mated the average, when asked in court, as 48 to 50 ounces, and was afterwards told this was too high.From the frequency of fatty change, it is very difficult to establish an average.The weight appears to me to be about two-thirds or three-fourths of the average (which Mr.
NOTES ON SOME INTERESTING CASES AT THE NEW YORK MOTHERS' HOME MATERNITY HOSPITAL.
Authors: T. J. McGILLICUDDY
Journal: JAMA (1892)

In May, 1888, the New York Mothers' Home Maternity Hospital began its work in this city. It is located at 531 East 86th St., in a large double house containing thirty rooms. This building has been completely renovated and very particular attention was given to the plumbing, it being entirely renewed. The institution also includes within its grounds 525 E. 86th St., a three story frame house of ten large rooms. These buildings, however, are simply for temporary use, as the erection of a wing to the large new hospital has been started; the size of this wing is 65 by 140 feet, and it will be five stories high. The class of patients received are as a rule the poor and unfortunate, and no discrimination is made in regard to religion, color or nationality. Extreme cleanliness is the rule throughout the whole institution, an important part of which is
Total disc replacement for chronic low back pain
Authors: J. Fairbank
Journal: BMJ (2011)

Current evidence suggests this may be the best surgical solution 

In the linked randomised controlled trial (doi:10.1136/bmj.d2786), Hellum and colleagues compare the efficacy of surgery with disc prosthesis versus intensive rehabilitation for patients with chronic low back pain.1 

Back pain is a common condition that usually improves. Some cases become chronic, however, and mortality can be increased.2 Evidence is accumulating for the efficacy of rehabilitation programmes combined with cognitive behavioural therapy (combined physical and psychological programme; CPP) in patients with chronic disease. The physical element of such programmes usually includes aerobic training, resistance training with the use of gym equipment, and stretching exercises. The psychological content includes cognitive behavioural therapy, counselling, and pain management skills. Programmes place an emphasis on self reliance, coping strategies, goal setting, and problem solving. Treatment is mainly delivered in groups. 

Physical training forms the main part of programmes for chronic low back pain in primary care and secondary care settings.3 4 CPP is recommended by the Department of Health for units delivering spinal care and is supported by guidelines from the National Institute for Health and Clinical Excellence.5

Surgery has been used for many years to treat chronic low back pain. Spinal fusion is based on the concept that the pain …
Cause of Aortic Rupture
Authors: Willard Aronson
Journal: JAMA (1964)

To the Editor:—  Dr. Gueft's suggestion is a very interesting one. However, I believe that my interpretation is more appropriate, for the following reasons:   The patient was studied quite thoroughly several times at a cardiac surgery clinic for evaluation for aortic valve surgery and was diagnosed as having aortic insufficiency, apparently due to rheumatic heart disease.  The appearance of the heart at autopsy, the marked endocarditic scarring of the aortic valve with fusion of the commissures, and the mild scarring of the mitral leaflets are characteristic of the changes seen in rheumatic heart disease.  Neither the physicians at the cardiac clinic nor the men in our department found any features suggestive of Marfan's syndrome.
Abciximab Therapy and Unplanned Coronary Stent Deployment
Authors: Dean J. Kereiakes, A. Michael Lincoff, Dave P. Miller, James E. Tcheng, Catherine F. Cabot, Keaven M. Anderson, Harlan F. Weisman, Robert M. Califf, Eric J. Topol
Journal: Circulation (1998)

Background —The clinical and angiographic demographics of patients requiring unplanned coronary stent deployment and the optimal adjunct pharmacotherapy in this population are not well described. This report details the EPILOG trial experience with unplanned coronary stent deployment and the effect of abciximab platelet glycoprotein IIb/IIIa blockade to improve clinical outcomes during 6 months of follow-up. Methods and Results —After randomization in the EPILOG double-blind, placebo-controlled trial of abciximab therapy during percutaneous coronary intervention, 326 (12%) of 2792 patients required unplanned coronary stent deployment. Although stented patients were not distinguished by clinical variables, they had greater coronary lesion complexity by American Heart Association/American College of Cardiology criteria ( P =.003) and greater incidence of lesion length &gt;10 mm ( P =.002), lesion eccentricity ( P =.027), irregular lesion contour ( P =.001), and bifurcation involvement ( P =.019) than nonstented patients. Unplanned stents were required less often in patients treated with abciximab and low-dose, weight-adjusted heparin than in patients receiving placebo and standard-dose heparin (9.0% versus 13.7%; P =.001). Although adverse clinical outcomes including target-vessel revascularization and bleeding events were more frequent in patients requiring unplanned coronary stent deployment, abciximab therapy reduced adverse outcomes in these patients at 30 days and 6 months to a greater extent than was observed in patients not requiring stent placement. Among stented patients, abciximab therapy did not increase bleeding events. Conclusions —Patients requiring unplanned coronary stent deployment have more complex coronary lesion morphology and a more complicated clinical course after coronary intervention. Abciximab therapy both reduces the need for unplanned stent deployment and confers clinical benefit to patients requiring an unplanned stent, without increasing bleeding complications.
Impact of Point Spread Function Reconstruction on Thoracic Lymph Node Staging With 18F-FDG PET/CT in Non–Small Cell Lung Cancer
Authors: Charline Lasnon, Rodney J. Hicks, Jean-Mathieu Beauregard, Alvin Milner, Maria Paciencia, Anne-Valérie Guizard, Stéphane Bardet, Radj Gervais, Gabriel Lemoel, Gérard Zalcman, Nicolas Aide
Journal: Clinical Nuclear Medicine (2012)

The aim of the present study was to evaluate the impact of point spread function (PSF) reconstruction on quantitative values and diagnostic accuracy of FDG PET/CT for nodal staging in non-small cell lung cancer.Fifty-eight consecutive PET/CT examinations were reconstructed with both ordered subset expectation maximization (OSEM) and PSF algorithms. Two readers independently performed a randomized blinded review of PET/CT examinations and gave a nodal status (N0, N1, N2, or N3) to each PET data set. When discordant, a consensus was reached with a third reader. Sensitivity, specificity, positive and negative predictive values (NPV), and positive and negative likelihood ratios (LRs) were assessed and compared using a McNemar test. All PET data sets were then independently analyzed to extract quantitative PET values in 208 nodes and compare them using Bland-Altman analysis.Bland-Altman analysis showed that, on average, PSF reconstruction increased SUVmax, SUVmean, and node/background ratios by 48%, 28%, and 27%, respectively. This increase was more marked for nodes less than 1 cm than for nodes 1 cm or greater (P < 0.0001 for SUVmax, SUVmean, and node/background ratios). Point spread function PET had higher sensitivity (97%) and NPV (92%) than OSEM PET (78% and 57%, respectively; P = 0.01 and P = 0.04, respectively). Negative LR was 0.04 for PSF PET and 0.31 for OSEM PET.By improving activity recovery, especially for nonenlarged nodes, PSF significantly improves the sensitivity, NPV, and negative LR of FDG-PET for nodal staging in non-small cell lung cancer. These data suggest that preoperative invasive nodal staging may be omitted in the case of a negative PSF FDG-PET/CT.
HHS: Physician-Owned Device Firms a Fraud Risk
Authors: Bridget M. Kuehn
Journal: JAMA (2013)

Physician ownership of companies that sell devices that are subsequently implanted into the owner-physician's patients are a threat to patient safety and pose a high risk of financial fraud, according to a special fraud alert issued March 26 by the Department of Health and Human Services (HHS) Office of Inspector Genera
Assessing Competency for Concealed-Weapons Permits — The Physician's Role
Authors: Adam O. Goldstein, Kathleen K. Barnhouse, Anthony J. Viera, James A. Tulsky, Barak D. Richman
Journal: New England Journal of Medicine (2013)

Many local law-enforcement agencies in the United States ask physicians to assess the physical and mental competence of applicants for concealed-weapons permits. But physicians may have legal and ethical concerns, and we lack standards for making these determinations.
The new out of hours agreement for general practitioners
Authors: B. Hurwitz
Journal: BMJ (1995)

<h3>ABSTRACT</h3> <h3>Objective</h3> Advances in metabolomics now allow high-throughput biomarker profiling of large population studies. We aimed to identify circulating metabolic biomarkers predictive of type 2 diabetes in young adults. <h3>Methods</h3> Nuclear magnetic resonance metabolomics was used to quantify 229 metabolic measures in 11,896 individuals from four Finnish cohorts (mean age 33 years, range 24–45). Associations between baseline metabolites and risk of type 2 diabetes onset during 8–15 years of follow-up (392 incident cases) were assessed by logistic regression adjusted for sex, age, body mass index, and fasting glucose. <h3>Results</h3> Out of 229 metabolic measures, 113 were associated with incident diabetes in meta-analysis of the four cohorts (P&lt;0.0009; odds ratios per 1-SD: 0.59–1.50). Among the strongest predictors of diabetes risk were branched-chained and aromatic amino acids (odds ratios 1.31–1.33), triglyceride fractions within the largest very-low-density lipoprotein particles (VLDL; odds ratios 1.33–1.50)), as well as linoleic omega-6 fatty acids (odds ratio 0.75) and free cholesterol in large high-density lipoprotein particles (HDL; odds ratio 0.59). A biomarker score comprised of phenylalanine, free cholesterol in large HDL, and the ratio of cholesteryl esters to total lipids in large VLDL was predictive of the risk for future diabetes in an independent validation cohort (odds ratio 10.1 [95% confidence intervals 4.2-24.1] comparing individuals in upper <i>vs</i> lower fifth of biomarker score). Adjustment for routine lipids and insulin attenuated the odds ratio to 5.8 [2.2-15.1]. <h3>Conclusions</h3> Metabolic aberrations across multiple molecular pathways are predictive of the long-term risk of type 2 diabetes in young adults. Comprehensive metabolic profiling may potentially help targeting preventive interventions for young asymptomatic individuals at increased risk for type 2 diabetes.
S117 Factors driving the development of chronic respiratory failure in obese patients: Abstract S117 Table 1.
Authors: A Manuel, N Hart, JR Stradling
Journal: Thorax (2013)

<h3>Introduction</h3> Currently, there are limited data reporting the pathophysiology of chronic respiratory failure in obese patients, the so called <i>Obesity Hypoventilation Syndrome</i> (OHS). Although a number of hypotheses have been proposed, there are no comprehensive data that have investigated the imbalance between respiratory muscle load, capacity and drive. We aimed to investigate the factors contributing to early chronic respiratory failure in obese patients including body habitus, upper airways obstruction, lower airflow obstruction and lung volume. <h3>Methods</h3> A cross sectional study was performed in an obese group of subjects (BMI &gt;30kg/m<sup>2</sup>) with and without early chronic respiratory failure. Early chronic respiratory failure was arbitrarily defined for this analysis as an arterial base excess &gt; 2 mmol/l as this is a metabolic respiratory biomarker of 24-hour carbon dioxide levels. Arterial blood gas measurements were undertaken in the morning, after an overnight study to determine the 4% oxygen desaturation index and apnoeas hypopnoea index. An overnight auto titrating continuous positive airway pressure study (S9 ResMed, Oxfordshire, UK) was used as another measure of the severity of upper airways loading. Pulmonary function and the forced oscillation technique (MS-IOS, CareFusion, CA, USA) to measure of airway impedance were performed in the upright and supine position. <h3>Results</h3> 54 patients, aged 51.9 ± 9.08 years, were recruited with BMI of 46.4 ± 9.53. <h3>Conclusion</h3> We are finding considerable heterogeneity in terms of anthropometric and physiological findings within obese subjects with and without early chronic respiratory failure. We have shown that subjects with early chronic respiratory failure, compared to subjects without, have lower lung volumes (upright and supine), a greater airway impedance (seen in FOT at FRC, both upright and supine), and a larger fall in their ERV on lying down. All these differences may be due to the higher BMI, and in particular differences in distribution of fat in subjects with early chronic respiratory failure. However, these obesity differences were not reflected in large differences in the AHI or ODI between the groups.
Cyclosporin cholestasis is worsened by verapamil, a p-glycoprotein (p-GP) inhibitor, in the isolated perfused rat liver (IPRL)
Authors: M. Delle Monache, A. Gigliozzi, F. Fraioli, R. Romeo, A. Benedetti, L. Marucci, A.M. Jezequel, D. Alvaro
Journal: Journal of Hepatology (1998)