tbuckley/cabot-search huggingface dataset:
Plan to halve MRSA cases by 2008 is probably not achievable, memo says
Authors: Michael Day
Journal: BMJ (2007)

Doctors from more than a third of accident and emergency departments in hospitals in England said they were not reaching the government's target of dealing with patients within four hours.The main reason for this finding, from a survey published this week, was a shortage of available hospital beds, making it difficult for patients to be admitted.Only 49% of the nearly 500 members of the British Association for Emergency Medicine-all consultants and middle grade doctors-responding to the survey reported that their departments met the emergency access target for 98% of all patients to be seen, treated, admitted, or discharged within four hours.Although only 49% considered that their department actually met the emergency access target, 67% said that the figures reported by their department indicated that the target had been met.Respondents' comments on what had happened in their departments included, "Middle managers revising figures before being submitted," "Minor injury unit figures used to help achieve department's 96.9% target," and "Patients often 'moved' on the computer tracking but still kept in department to meet targets."Forty one per cent said that their depart- Lack of beds leads to missed government targetsment did not reach this target."Not enough available in-patient beds" was the main reason given for departments not meeting the emergency access target, and 88% of respondents reported it as a major contributory factor.Don MacKechnie, chairman of the BMA's emergency subcommittee and a consultant in emergency medicine at Pennine Acute Hospitals NHS Trust, said that financial problems in the NHS had meant that the availability of hospital beds for patients needing admission from accident and emergency departments was an important problem.He said, "In certain trusts, financial recovery measures have included closing beds previously used as 'safety valves' before, such as beds in rehabilitation wards.This has a knock-on effect to A&E [accident and emergency departments], with recovering patients that might have previously been moved remaining in acute beds."Mr MacKechnie said it was important that emergency access targets were seen as having broader application than simply affecting accident and emergency departments."Sometimes, other specialties forget that this is not just an A&E target.It is an emergency access target, with a responsibility from all specialties in an acute trust to ensure that the four hour target can be met."He said this meant ensuring that sufficient beds were available to admit patients from emergency departments and ensuring that doctors on call in each specialty are free to see patients in accident and emergency departments within the target of one hour after being referred.
Requirement for p56lck tyrosine kinase activation in T cell receptor-mediated thymic selection.
Authors: K Hashimoto, S J Sohn, S D Levin, T Tada, R M Perlmutter, T Nakayama
Journal: The Journal of Experimental Medicine (1996)

The nonreceptor protein tyrosine kinase p56lck (Lck) serves as a fundamental regulator of thymocyte development by delivering signals from the pre-T cell receptor (pre-TCR) that permit subsequent maturation. However, considerable evidence supports the view that Lck also participates in signal transduction from the mature TCR. We have tested this conjecture by expressing a dominant-negative form of Lck under the control of a promoter element (the distal lck promoter) that directs high expression in CD4+CD8+ thymocytes, mature thymocytes, and peripheral T cells, thereby avoiding, complications that result from the well-documented ability of dominant-negative Lck to block very early events in thymocyte maturation. Here we report that expression of the catalytically inactive Lck protein at twice normal concentrations inhibits thymocyte positive selection by as much as 80%, while leaving other aspects of cell maturation intact. This effect was studied in more detail in mice simultaneously bearing the male-specific H-Y alpha/beta TCR transgene and ovalbumin-specific DO10 alpha/beta TCR transgene, where even equimolar expression of the dominant-negative Lck protein substantially vitiated the positive selection process. Although deletion of H-Y alpha/beta thymocytes proceeded normally in male mice despite the presence of catalytically inactive Lck, modest inhibition of superantigen-mediated deletion was in some cases observed. These data further implicate Lck in the propagation of all TCR-derived signals, and indicate that even very modest deficiencies in the representation of functional Lck molecules could in humans, profoundly alter the character of the peripheral TCR repertoire.
Global nursing shortages
Authors: J. Buchan
Journal: BMJ (2002)

In October 2001 government chief nurses and other delegates from 66 countries met to discuss how best to deal with a common challenge—the global growth of nursing shortages.1 Nursing shortages in the United Kingdom and elsewhere have been a repetitive phenomenon, usually due to an increasing demand for nurses outstripping static or a more slowly growing supply.2 This time the situation is more serious. Demand continues to grow, while projections for supply point to actual reductions in the availability of nurses in some developed and developing countries. Some health systems are also coping with the legacy of ill conceived reform projects of the 1990s, which demotivated and disenfranchised nurses and other staff.

Developed countries are facing a demographic double whammy. The United States, United Kingdom, Australia, Canada, and other countries have an ageing nursing workforce, caring for increasing numbers of elderly people.3–5 The challenge is how to replace the many nurses who will retire over the decade. Some countries also have to cope …
Relation Between Hyperinsulinemia and Nonculprit Plaque Characteristics in Nondiabetic Patients With Acute Coronary Syndromes
Authors: Takayuki Mitsuhashi, Kiyoshi Hibi, Masami Kosuge, Satoshi Morita, Naohiro Komura, Ikuyoshi Kusama, Fumiyuki Otsuka, Mitsuaki Endo, Noriaki Iwahashi, Jun Okuda, Kengo Tsukahara, Toshiaki Ebina, Satoshi Umemura, Kazuo Kimura
Journal: JACC. Cardiovascular imaging (2011)
Osteoporosis and Multiple Myeloma
Authors: James R. Mathews
Journal: JAMA (1961)

<h3>To the Editor:—</h3> I was concerned about the answer to "M.D., Illinois" to his question about osteoporosis inThe Journal, March 18, p. 1038. From the letter of inquiry I had the impression that the osteoporosis was limited to, or at least more severe in, the 11th and 12th thoracic vertebrae. Perhaps a more thorough differential diagnosis had already been undertaken and was not elaborated in the the letter; however, I would like to point out that multiple myeloma occasionally appears as a diffuse osteoporosis, particularly in the spine. If it has not already been done, I feel this patient should have several additional studies, including Bence-Jones protein, serum protein electroporesis, serum calcium and inorganic phosphorous, and alkaline and acid phosphatase studies.
Siddig Ahmed Ismail
Authors: K. Elmalik
Journal: BMJ (2010)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following Siddig Ahmed Ismail Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
ON THE RESPONSE OF GENETICALLY RESISTANT AND SUSCEPTIBLE RABBITS TO THE QUANTITATIVE INHALATION OF HUMAN TYPE TUBERCLE BACILLI AND THE NATURE OF RESISTANCE TO TUBERCULOSIS
Authors: Max B. Lurie, Samuel Abramson, A. G. Heppleston
Journal: The Journal of Experimental Medicine (1952)

If genetically resistant and susceptible rabbits inhale a certain number of human type tubercle bacilli, no tuberculosis in the lungs of the resistant animals is seen, as a rule several months after infection, while there is a variable and often extensive disease in the susceptible rabbits. The analogy to the presence or absence of active tuberculosis in man infected with the tubercle bacillus is evident. The inhaled tubercle bacilli multiply for but a short time in the resistant rabbits and are usually rapidly and completely destroyed. In the susceptible rabbits, the bacilli multiply profusely for a much longer time and persist in large numbers even months after inhalation. Whatever be the cause of the more rapid destruction of tubercle bacilli in the resistant animal, the resulting more rapid release of the contained antigens enhances the development of allergic sensitivity and antibodies in these animals. The development of an acquired resistance against tubercle bacilli of the human type is sufficiently rapid to affect the genesis of the initial gross primary pulmonary foci that result from the inhalation of a given number of bacilli. The greater the genetic resistance, the fewer the initial primary foci. Variations in genetic resistance are essentially variations in the rate of development of acquired resistance. It is suggested that variations in genetic resistance to inhaled human type tubercle bacilli may affect the prevalence of alveolar phagocytes capable of acquiring adequate resistance to the growth of the bacilli in their cytoplasm. The prevalence of such cells is subject to hormonal and immunological influences.
Left Ventricular Outflow Destruction—Importance of the Mitral Valve.
Authors: Robert D. Leachman
Journal: Annals of Internal Medicine (1972)

Meeting Abstracts1 May 1972Left Ventricular Outflow Destruction—Importance of the Mitral Valve.Robert D. Leachman, M.D., F.A.C.P., Roberto Lufschanowski, M.D., Paola Angelini, M.D., Denton A. Cooley, M.D.Robert D. Leachman, M.D., F.A.C.P.Search for more papers by this author, Roberto Lufschanowski, M.D.Search for more papers by this author, Paola Angelini, M.D.Search for more papers by this author, Denton A. Cooley, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-76-5-865_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe pressure gradient observed in patients with obstructive cardiomyopathy has been attributed to asymetric hypertrophy of the septum. At the level of the ouflow tract, the anterior leaflet of the mitral valve is in close relation to the septum. Mitral regurgitation of variable degree has been associated with this syndrome. In patients requiring surgical relief of the obstruction, division or resection of the abnormal septum has been performed. During the last 2 years five patients with obstructive cardiomyopathy were treated with replacement of the mitral valve; in all five the complete disappearance of the gradient was observed under basal condition,... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Seattle, Wash. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1972Volume 76, Issue 5Page: 865-865KeywordsCardiomyopathiesMitral insufficiencyMitral valve replacementSurgical resection Issue Published: 1 May 1972 PDF DownloadLoading ...
Further Studies on Segmental Sodium Transport in the Rat Kidney during Expansion of the Extracellular Fluid Volume
Authors: Richard W. Osgood, H. John Reineck, Jay H. Stein
Journal: Journal of Clinical Investigation (1978)

The present studies were designed to further investigate the possibility of heterogeneity of nephron function during Ringer loading in the rat, and to determine the specific nephron segment responsible for this finding. As in previous studies from this laboratory with smaller rats (50-125 g), net addition of sodium between late distal tubule and papillary base (6.9 vs. 10.4% of the filtered load, respectively, P <0.005) was found in more mature rats (170-230 g). In contrast, there was net reabsorption of sodium between these two segments in nonvolume-expanded animals, 1.70 vs. 0.45% of the filtered sodium load, P <0.005. Because nephron heterogeneity of sodium transport during extracellular volume expansion is the most likely explanation for these findings, further studies were performed to determine the specific juxtamedullary nephron segment responsible for the net addition pattern between late distal tubule and papillary base in Ringer-loaded animals. First, a comparison was made of sodium delivery to the late proximal tubule of superficial nephrons vs. the delivery rate to the bend of Henle's loop of juxtamedullary nephrons in both hydropenia and Ringer loading. Fractional sodium delivery was quite comparable between the superficial and juxtamedullary nephrons in both hydropenia and Ringer loading although the absolute level was much greater in both groups of nephrons in the Ringer studies. Chlorothiazide (15 mg/kg loading and 15 mg/kg per h) given during Ringer loading markedly increased late distal sodium delivery, 19% of the filtered load, but did not prevent net addition of sodium at the papillary base. In contrast, furosemide (5 mg/kg loading and 5/mg/kg per h) given during Ringer loading completely reversed the segmental pattern, 35.5 and 28.8% at late distal tubule and papillary base, respectively, P <0.005. These studies demonstrate that the net addition of sodium between late distal tubule and papillary base during Ringer loading is not limited to immature rats and that the segmental pattern does not occur in non-volume-expanded animals. Further, the reversal of the net addition pattern with furosemide, but not chlorothiazide, and the comparable proximal nephron delivery rates in Ringer loading suggest that the loop of Henle of juxtamedullary nephrons reabsorbs less sodium than the same portion of superficial nephrons in this setting. A model is proposed to explain this finding.
Calcium metabolism of brain in acute renal failure. Effects of uremia, hemodialysis, and parathyroid hormone.
Authors: A I Arieff, S G Massry
Journal: Journal of Clinical Investigation (1974)

Studies were carried out to evaluate the changes in content of calcium and magnesium in brain during acute uremia in dogs. Ca content in gray and white matter of brain increased significantly after 3 days of acute uremia and this increment was prevented by thyroparathyroidectomy (TPTX). The administration of parathyroid extract (PTE) to normal dogs and TPTX uremic animals produced a significant rise in brain Ca. These changes were not related to alteration in the concentration of Ca in plasma or cerebrospinal fluid, to changes in calcium-phosphorus product, or to changes in blood pH. Furthermore, the infusion of large amounts of phosphate to vitamin D2-treated animals with suppressed parathyroid gland activity produced marked elevation in calcium-phosphorus product but no significant change in brain Ca. Also, uremia in vitamin D2-treated TPTX dogs failed to increase calcium content in brain despite marked elevation in calcium-phosphorus product. Hemodialysis significantly reduced Ca content of brain but the values were still significantly higher than normal. Mg content increased modestly only in the white matter of uremic dogs with intact parathyroid glands and in normal dogs and TPTX uremic dogs receiving PTE. The results indicate that (a) acute uremia of 3 days is associated with a marked rise of Ca content of brain and modest increment of Mg in certain parts of the brain, and (b) these alterations are not related to uremia, per se, but are dependent on the presence of excess parathyroid hormone. It is suggested that the neurological abnormalities noted in acute uremia may be related in part to the rise in the Ca content of brain.
New conduction abnormalities after TAVI—frequency and causes
Authors: Robert M. van der Boon, Rutger-Jan Nuis, Nicolas M. Van Mieghem, Luc Jordaens, Josep Rodés-Cabau, Ron T. van Domburg, Patrick W. Serruys, Robert H. Anderson, Peter P. T. de Jaegere
Journal: Nature Reviews Cardiology (2012)
PAD2 Overexpression in Transgenic Mice Promotes Spontaneous Skin Neoplasia
Authors: John L. McElwee, Sunish Mohanan, Sachi Horibata, Kelly L. Sams, Lynne J. Anguish, Dalton McLean, Iva Cvitaš, Joseph J. Wakshlag, Scott A. Coonrod
Journal: Cancer Research (2014)

Peptidylarginine deiminase 2 (PAD2/PADI2) has been implicated in various inflammatory diseases and, more recently, cancer. The goal of this study was to test the hypothesis that PAD2 promotes oncogenesis using a transgenic mouse model. We found that about 37% of transgenic mice overexpressing human FLAG-PAD2 downstream of the MMTV-LTR promoter develop spontaneous neoplastic skin lesions. Molecular and histopathologic analyses of the resulting lesions find that they contain increased levels of markers for invasion, inflammation, and epithelial-to-mesenchymal transition (EMT) and that a subset of the lesions progress to invasive squamous cell carcinoma (SCC). We then stably overexpressed FLAG-PAD2 in the human SCC cell line, A431, and found that the PAD2-overexpressing cells were more tumorigenic in vitro and also contained elevated levels of markers for inflammation and EMT. Collectively, these studies provide the first genetic evidence that PAD2 functions as an oncogene and suggest that PAD2 may promote tumor progression by enhancing inflammation within the tumor microenvironment.
A NEW METHOD OF LARYNGEAL AND BRONCHIAL MEDICATION BY MEANS OF A SPRAY AND TUBE DURING THE ACT OF DEEP INSPIRATION.Read in the Section of Laryngology and Otology at the Forty-first Annual Meeting of the American Medical Association, Nashville, Tenn., May, 1890.
Authors: J. MOUNT BLEYER
Journal: JAMA (1890)

I bring before you a novel method and use of the ordinary cold spray. By the extra aid of a hard rubber tube six inches in length and threequarters of an inch in diameter on both sides of its openings, through which a cold spray with tip pointing downwards is passed and held in the mouth between the lips which are clasped over the tube. With this tube, spray, and position of the lips and deep inspirations any desired medicated fluid amounting from a half to one ounce may be forcibly inhaled during the act of ten deep inspirations, and thus reach the deeper portions of the respiratory tract, without coughing, gagging, or immediately expectorating the fluid thus inhaled. The time occupied for re-expectorating the fluid medicament thus inhaled varies in different individuals. Some begin lightly within from five to ten minutes after the inhalation, others again half to
Forensic Psychiatry: Clinical, Legal and Ethical Issues
Authors: P Bowden
Journal: BMJ (1994)

Ed John Gunn, Pamela J Taylor Butterwoth-Heinemann (pounds sterling )125, pp 1151 ISBN 0-7506-0349-6

A series of scandals and notorious cases over the past 20 years has led to positive action to develop forensic psychiatry. The editors of this text-book have benefited more than most from what has been on offer and they have been very influential in the way in which this small branch of psychiatry has expanded. The book is the fruit both of their hard work and of what they have received and it should provide a vision of how the specialty will look in the future. …
What makes a good clinical decision support system
Authors: Gretchen P Purcell
Journal: BMJ (2005)

disease do occur, 10 and if the condition is suspected clinically, biopsy should still be carried out.A possible reason for negative antibody testing is IgA deficiency.This is more common in coeliac disease and since antiendomysial and anti-transglutaminase antibodies are normally measured as immunoglobulin A antibodies they will be absent in patients with IgA deficiency.Therefore in patients with IgA deficiency, IgG anti-endomysial and anti-transglutaminase antibodies need to be checked.Successful diagnosis of coeliac disease depends on a high index of suspicion, careful evaluation of investigations, and, where these are not clear, a willingness to review patients and make the diagnosis later in light of clinical progress and results of re-investigation.
Am I breaking the law again?
Authors: Michael Irwin
Journal: BMJ (2004)

Editor-The Data Protection Act 1998 does not prohibit the processing of personal information for medical research purposes.Indeed, it is clear from section 33 of the act that such processing is expressly permitted.If it were otherwise, then the act would be in direct conflict with the core aims of the laws that underpin it-namely, the Council of Europe Convention of 1981 and the European Union Directive of 1995.These laws seek to facilitate data processing activities, primarily "free flows" of information, rather than suppress data processing.The problems to which Peto et al refer in their editorial on data protection, informed consent, and research are not Data Protection Act problems but, rather, problems caused by ignorance and misunderstanding. 1 With basic training on the key mechanisms of the act the problems of which the authors complain can be easily overcome.Training need not be an expensive task either.Legal compliance can be achieved at comparatively modest cost.There are two additional points of note.Firstly, the Data Protection Act regulates the processing of personal information relating to living individuals.Thus, research following death is not regulated.Secondly, the act and case law make clear that information will not be "personal data" if it does not identify a living person or if it does not have the individual as its focus or is not significantly biographical.So, if medical researchers do not actually need or seek identification information the act should not be engaged.
cAMP regulation of myosin ATPase activity in the maturing rat heart.
Authors: R Horowits, S Winegrad
Journal: Circulation Research (1987)

Calcium-activated myosin adenosine triphosphatase (ATPase) activity has been measured in sections of rat ventricles that were rapidly frozen to preserve the structure and regulatory state of myosin occurring in vivo. These results were related to myosin isozyme composition measured in ventricles by native gel electrophoresis and by quantitative immunocytochemistry. Both total ATPase activity and percent alpha-heavy chain rapidly rise during the first month following birth. However, ATPase activity remains constant at a high level from 1 to 12 months following birth, even though percent alpha-heavy chain declines during this period. The ATPase activity of V1 myosin was specifically determined using sections in which V3 myosin had been completely inhibited by exposure to alkaline pH in the absence of adenosine 5'-triphosphate (ATP). Relative V1 specific activity, taken as the ratio of V1 ATPase activity to percent alpha-heavy chain, doubles in the first 2.0 months after birth and then remains approximately constant at this higher level until at least 4 months after birth. The specific activity of V1 can be further increased by the addition of adenosine-3',5'-cyclic monophosphate (cAMP). This effect of cAMP is age dependent, increasing threefold between 1 and 2 months following birth and then declining as V1 is replaced by V3.
Study shows no difference in bacterial contamination of doctors’ wrists with short or long sleeves
Authors: Susan Mayor
Journal: BMJ (2011)

Doctors wearing long sleeved outfits have no greater risk of bacterial contamination around their wrists than those wearing short sleeves, according to a study of doctors working in a US hospital. The findings question NHS guidelines requiring doctors to be “bare below the elbows.”

The study randomly allocated 50 doctors working at Denver Health—a university hospital in Colorado—to wear freshly laundered, short sleeved uniforms and a further 50 to wear their own long sleeved white coats, which were infrequently laundered. Cultures were taken from the doctors’ wrists, cuffs, and pockets at the end of an eight hour day working in internal medicine departments.

Results showed no significant …