tbuckley/cabot-search huggingface dataset:
The Decision to Extubate in the Intensive Care Unit
Authors: Arnaud W. Thille, Jean-Christophe M. Richard, Laurent Brochard
Journal: American Journal of Respiratory and Critical Care Medicine (2013)

The day of extubation is a critical time during an intensive care unit (ICU) stay. Extubation is usually decided after a weaning readiness test involving spontaneous breathing on a T-piece or low levels of ventilatory assist. Extubation failure occurs in 10 to 20% of patients and is associated with extremely poor outcomes, including high mortality rates of 25 to 50%. There is some evidence that extubation failure can directly worsen patient outcomes independently of underlying illness severity. Understanding the pathophysiology of weaning tests is essential given their central role in extubation decisions, yet few studies have investigated this point. Because extubation failure is relatively uncommon, randomized controlled trials on weaning are underpowered to address this issue. Moreover, most studies evaluated patients at low risk for extubation failure, whose reintubation rates were about 10 to 15%, whereas several studies identified high-risk patients with extubation failure rates exceeding 25 or 30%. Strategies for identifying patients at high risk for extubation failure are essential to improve the management of weaning and extubation. Two preventive measures may prove beneficial, although their exact role needs confirmation: one is noninvasive ventilation after extubation in high-risk or hypercapnic patients, and the other is steroid administration several hours before extubation. These measures might help to prevent postextubation respiratory distress in selected patient subgroups.
Academic medicine: time for reinvention: Medical education especially needs help
Authors: Y.-S. Chong
Journal: BMJ (2004)

Editor—Clark and Smith's call to revive academic medicine is laudable.1 The form that research into health care as a discipline and industry takes, be it scholarly inquiry or commercial pursuit, will vary and rebalance itself constantly according to environmental pressures. However, medical research, laboratory or clinical, is unlikely to ever become extinct or purely commercial.

I say this because the output of medical research can be easily measured in terms of grants, publications, and patents. So long as these tangible measures are in place, medical research and researchers will be rewarded. The rewards should therefore be made enticing enough for healthcare staff to be drawn to research and for the desired research to be performed.

Unfortunately the same cannot be said of medical education, the other part of academic medicine. Few reliable measures of teaching excellence currently exist, and those that do rely heavily on subjective assessments by superiors, peers, and students or exclusive modes of recognition such as awards that carry scant attraction for clinicians. Indeed, career advancement of clinical academics depends more on research output than teaching.2

The continued production of doctors probably depends more on the quality of students who enter medical training than the quality of the teaching they receive. I wonder whether consumers would accept the same academic “rigour” being applied to the training of airline pilots, or the same quality control in medical education being used for automotive production lines.

Medical research may require revitalisation. Medical education needs a lot more.
Premature Ventricular Depolarization
Authors: CESAR A. CACERES
Journal: Circulation (1961)

Surface "fusion beats", beats with initial and terminal QRS abnormalities, and accompanying secondary ST-T-wave changes appear following intracavitary evidence of premature depolarization. In instances of premature activation of a portion of myocardium, the intracavitary deflection of premature ventricular depolarization may not be apparent in surface leads and, if present, may be reflected in surface leads only by subtle changes in wave configuration that include (1) shortening of the P-R interval, (2) prolongation or amplitude changes or both in the QRS, (3) changes in contour of initial and terminal portion of the QRS, sometimes resembling those of infarction, and (4) secondary ST-T-wave changes. Evidence of electrical asynchronism in a single ventricle and between ventricles is presented.
Exercise metabolism in runners.
Authors: A. E. Hardman, C. Williams
Journal: British Journal of Sports Medicine (1983)

The purpose of this study was to re-examine the commonly accepted association between high maximum oxygen uptake (VO2 max) values and the characteristics of metabolic adaptation to endurance training. The metabolic responses of 9 active males and 8 endurance trained females were observed during one hour of treadmill running at two speeds. One speed was common to both groups (3.58 m s-1. Test 1) whereas the second speed represented approximately 62% VO2 max for each individual (Test 2). The VO2 max values of the males were significantly (p less than 0.01) higher than those of the females but observations of the respiratory exchange ratio and of the changes in the concentrations of metabolites were indicative of greater fat metabolism in the well-trained female group in both Tests. Thus the results of this study suggest that the benefits of endurance training are independent of the absolute values of VO2 max.
John Phillip Partridge
Authors: M. J. Hawkins
Journal: BMJ (2013)

John Phillip Partridge, known to many as JP, was brought up in Devon and educated at Blundell’s School in Tiverton. After qualifying from St Mary’s Hospital he immediately joined the Royal Navy as a surgeon lieutenant, and, despite severe sea sickness, he served on several ships until the end of the war.

After the war …
Xanthine oxidoreductase is present in human synovium.
Authors: R E Allen, J M Outhwaite, C J Morris, D R Blake
Journal: Annals of the Rheumatic Diseases (1987)

It is postulated that the mobile inflamed joint may be subject to cyclical ischaemic reperfusion injury. Xanthine oxidoreductase is an enzyme thought to contribute to oxidative reperfusion injury, and the detection of this activity in human synovium is described. Three normal and five rheumatoid tissues were assayed with a carbon-14 radioassay detecting the conversion of [14C]xanthine to [14C]uric acid. Rheumatoid synovia contained 0.67-305 microU/g tissue (n = 5), while normal synovia contained 1.2-5.0 microU/g tissue (n = 3).
MORTALITY ON THE WAITING LIST FOR TRANSCATHETER AORTIC VALVE IMPLANTATION. A SINGLE CENTER EXPERIENCE FROM VANCOUVER, CANADA
Authors: Edgar Tay, Eve Aymong, Namal Wijesinghe, Fabian Nietlispach, Ronen Gurvitch, DA Wood, Ronald Carere, Jian Ye, Anson Cheung, John Webb
Journal: Journal of the American College of Cardiology (2010)
Inactivation of Penicillins by Carbohydrate Solutions at Alkaline pH
Authors: Michael S. Simberkoff, Lewis Thomas, Dorother McGregor, Isaac Shenkein, Bernard B. Levine
Journal: New England Journal of Medicine (1970)

Penicillin and semisynthetic penicillins are biologically inactivated by carbohydrate solutions at alkaline pH. At 37°C, in the presence of sufficient bicarbonate to elevate the pH above 8.0, 10 per cent sucrose and 5 per cent glucose cause almost complete inactivation of penicillin within a few hours; inactivation occurs more slowly at room temperature. Semisynthetic penicillins are similarly inactivated. Penicilloic acid appears to be the major product of inactivation. Thus, under clinical conditions in which penicillin is administered in solutions containing both carbohydrate and alkaline buffer, there is risk of losing antibiotic activity and forming allergenic derivatives of penicillin.
India's proposed pact with Europe may choke its generic drug exports, health rights activists fear
Authors: G. Mudur
Journal: BMJ (2011)

International aid agencies and patients’ groups from India and several Asian countries have urged the Indian government to reject a free trade agreement it is negotiating with the European Union. The agreement may undermine India’s capacity to produce inexpensive generic drugs, they say.

Indian patients’ groups for people with cancer and HIV and health rights activists from Cambodia, Indonesia, Malaysia, Nepal, and Thailand marched in Delhi and met with Indian government officials this week while Indian and European diplomats negotiated the text of the agreement behind closed doors in Brussels.

The concerns stem from leaked sections of the text showing that the EU wants India to accept a “data exclusivity” provision that would force India’s drug manufacturers to submit their own data on safety and effectiveness to be able to register their generic products. It will oblige manufacturers of generic drugs to repeat clinical trials on products …
Emotional Aspects of Hyperprolactinemia
Authors: L.G. Sobrinho
Journal: Psychotherapy and Psychosomatics (1998)

Patients with hyperprolactinemia often present with emotional difficulties. These occasionally persist even after successful treatment. Insight into the roots of their diseased state makes a difference in the handling of all cases, but becomes crucial in the not-so-rare situations in which the normalization of hormonal levels is not followed by a feeling of cure. This chapter attempts to provide details, discuss and situate in context the following blocks of pertinent information: (1) prolactin acts upon the central nervous system and variations in its concentrations do affect mood, emotions and behavior; (2) most actions of prolactin are directed to metabolical and behavioral adaptation to pregnancy and the care of the young; (3) even in the absence of pregnancy prolactin secretion responds to environmental stimuli under specific conditions. Whether adaptive, as in the case of surrogate maternity, or pathological, as in the case of pseudopregnancy, prolactin responds to a perceived need to take care of a child; (4) the facts that the clinical onset of prolactinomas often follows life-events and that these tumors occur preferentially in women brought up under specific conditions suggest the possibility that psychological factors may predispose to prolactinomas; (5) dealing with individual cases requires the perception that the relations between prolactin, emotions and feelings are circular, i.e., prolactin affects the brain and mood but, on the other hand, personality traits and environmental factors may stimulate the secretion of prolactin and may play a role in the genesis of the disease.
Prophets of Doom? — Or Is There Hope?
Authors: John Lister
Journal: New England Journal of Medicine (1972)

THE increasing dangers of all kinds of pollution and the fear that overpopulation and the continuation of present industrial methods may eventually exhaust the world's natural resources are topics that have received considerable publicity in recent years. Those who foresee the consequences if present trends are allowed to continue unchecked, however, believe that those in authority either have frankly disregarded the evidence because it would be inconvenient to do otherwise or have adopted a completely ostrich-like attitude toward it.Because of this a conservation group called the Movement for Survival came into existence recently with the support of more than . . .
'Health of Nation at Stake' Says Elders
Authors: Charles Marwick
Journal: JAMA (1993)

AS THE Clinton administration moves toward providing some form of adequate health care for all, one of the president's more outspoken nominees for a major post in his administration is on public platforms reminding us:  don't have a real system of health care. We have a lot of economists and health policy people trying to decide how much money it's going to cost to pay for a system that we don't have.  The speaker is Joycelyn Elders, MD, currently state health commissioner for Arkansas and Clinton's Surgeon General—designate of the US Public Health Service. Pending congressional confirmation, Elders is expected to take up her post by July 1. She gave one talk expounding her views during the fifth annual National Managed Health Care Congress, held in Washington, DC.  Elders' observations are of particular interest because it seems apparent that they will serve as an outline of her forthcoming agenda
Effects of maternal gestational diabetes on offspring adiposity at 4-7 years of age.
Authors: B R Vohr, S T McGarvey, R Tucker
Journal: Diabetes Care (1999)

The purpose of this study was to assess the long-term effects of maternal prenatal factors, including gestational diabetes mellitus (GDM), adiposity, and weight gain during pregnancy, on adiposity of offspring from 4 to 7 years of age. A second purpose was to investigate the relationships among childhood adiposity, blood pressure, and 2-h postprandial glucose level.Prospective observational study of four groups of children including large-for-gestational-age (LGA) offspring of mothers with gestational diabetes (OGDM); appropriate-for-gestational-age (AGA) OGDM; LGA control subjects; and AGA control subjects. Anthropometrics including skin-fold measurements, blood pressure measurements, and a 2-h postprandial glucose measurement were obtained at each visit. Repeated measures analysis of variance models were used to detect different patterns of longitudinal change among the groups.LGA OGDM were more likely to be heavier, have larger circumferences and skin-fold measurements, and have a higher BMI than AGA OGDM and control subjects, and these findings increased with increasing age. Blood pressures and postprandial glucose values were similar for OGDM and control subjects at 4-7 years. Multivariable analyses showed that infant BMI and maternal prepregnant BMI predicted 7-year BMI for OGDM, whereas for control subjects, maternal prepregnancy BMI and weight gain during pregnancy were positive predictors with a small negative contribution from birth BMI.We conclude that LGA OGDM have evidence of increasing body size and adiposity with increasing age and that maternal GDM and maternal prepregnant adiposity are significant predictors of their unique growth patterns.
Safety in Scuba Diving
Authors: William C. Patton
Journal: JAMA (1978)

<h3>To the Editor.—</h3> On the cover of the Jan 16, 1978, issue of<i>JAMA</i>, a beautiful picture is presented. In the interest of safety, several things are apparent from this photograph. The scuba divers do not have a pressure gauge on their tanks. They are not wearing buoyancy compensators, and I do not see evidence of a depth gauge. In addition to these safety features that are probably standard in 1978, they probably should have an octopus regulator for safety if one of the buddy team has a malfunctioning primary regulator.
Recovery of prostacyclin production by de-endothelialized rabbit aorta. Critical role of neointimal smooth muscle cells.
Authors: A Eldor, D J Falcone, D P Hajjar, C R Minick, B B Weksler
Journal: Journal of Clinical Investigation (1981)

Prostacyclin (PGI2) synthetic capacity was assayed at the surface of aortas at various intervals after removal of endothelium with a balloon catheter. Results were correlated with morphologic changes in the vessel wall seen by light microscopy, scanning and transmission electron microscopy. To assay PGI2 synthetic capacity, we applied an incubation chamber to the luminal surface of the aortas; after arachidonic acid stimulation we assayed the PGI2 synthesized with a bioassay and radioimmunoassay. PGI2 synthesis in de-endothelialized aortas was determined immediately after balloon-catheter injury and at intervals of 1 h and 2, 4, 15, 35, and 70 d. PGI2 synthesis was low at 1 h and increased over time with levels at 35 and 70 d reaching that of normal artery. Scanning and transmission electron microscopy of de-endothelialized areas showed persistent absence of endothelium with formation of a neointima composed of smooth muscle cells. De-endothelialized aorta was covered with adherent platelets shortly after injury, however several days later only a few platelets adhered to the denuded surface. Results indicated that (a) endothelium is responsible for nearly all PGI2 production at the luminal surface of the normal aorta, (b) de-endothelialized muscular neointima synthesized increasing quantities of PGI2 with time after injury, and (c) increase of PGI2 production at the luminal surface of de-endothelialized aorta correlates with formation of a neointima and with the acquired thromboresistance of the aorta.
A little (body) fat may not hasten death
Authors: Phil Gunby
Journal: JAMA (1980)

Another tradition—that of "desirable" weights and heights for different ages—is being challenged. Internationally known nutrition researcher Ancel Keys, PhD (whose efforts and surname initial are identified with the military "K" rations of World War II), stated his case at the Western Hemisphere Nutrition Congress VI in Los Angeles: "The fact is that the tables of `ideal' or `desirable' weight are armchair concoctions starting with questionable assumptions and ending with three sets of standards for [small, medium, or large] `frame` types that never have been measured or even defined. Unfortunately, those tables have been reprinted by the thousands and are widely accepted as gospel." Robert N. Butler, MD, director of the National Institute on Aging (NIA), Bethesda, Md, had this to say: "An analysis of data from NIA's Baltimore Longitudinal Study of Aging and other sources has raised questions about desirable body weights for middle-aged and elderly adults. The NIA clinical
Reporting System for Violent Deaths and Youth Suicide—Reply
Authors: Jeffrey A. Bridge
Journal: JAMA (2009)

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Octreotide Effect on Growth Hormone and Somatostatin Subtype 2 Receptor mRNAs of the Human Pituitary Somatotroph Adenomas
Authors: Lucia Stefaneanu, Kalman Kovacs, Kamal Thapar, Eva Horvath, Shlomo Melmed, Yona Greenman
Journal: Endocrine Pathology (2000)
Mapping of the X-linked agammaglobulinemia locus by use of restriction fragment-length polymorphism.
Authors: S P Kwan, L Kunkel, G Bruns, R J Wedgwood, S Latt, F S Rosen
Journal: Journal of Clinical Investigation (1986)

A molecular linkage analysis in 11 families with X-linked agammaglobulinemia (XLA) localized the XLA gene to the proximal part of the long arm of the human X chromosome. Significant linkage was detected between XLA and loci defined by two polymorphic DNA probes called 19-2 for the DXS3 locus and S21 for the DXS17 locus. Both localize to the region Xq21.3-Xq22. Most likely recombination distances (theta) and associated logarithm of the odds (lod) scores for the XLA-DXS3 and XLA-DXS17 pairs were theta = 0.04 morgans (lod, 3.65) and theta = 0 (lod, 2.17), respectively. Tight linkage between XLA and the locus DXS43 defined by the X short arm probe D2 (localized to Xp22-Xp21) was strongly excluded and we obtained no evidence for significant linkage between XLA and any other X short arm probe. The probe pair 19-2 and S21 should be informative for molecular linkage-based analysis of XLA segregation in the majority of families afflicted with this disorder.
Natural course and response to interferon of chronic hepatitis B accompanied by antibody to hepatitis B e antigen
Authors: Maurizia Rossana Brunetto, Filippo Oliveri, Giuseppe Rocca, Domenico Criscuolo, Elisabetta Chiaberge, Maria Capalbo, Ezio David, Giorgio Verme, Ferruccio Bonino
Journal: Hepatology (1989)

The course of chronic hepatitis B was studied in 30 patients who had antibody to hepatitis e antigen and hepatitis B virus DNA in the serum and hepatitis B core antigen in the liver. Over a 2-year period, no patient experienced a sustained spontaneous remission of disease, and follow-up liver histology revealed worsening of the disease in four patients. After 2 years of observation, 24 patients were allocated randomly to one of two groups: 12 patients served as untreated controls and 12 received recombinant human α-interferon-2a in a dose of 9 million units intramuscularly three times weekly for 16 weeks. Patients who remained viremic after 16 weeks received 3 million units three times weekly for an additional 8 weeks. Abnormal aminotransferases and serum hepatitis B virus DNA persisted without appreciable changes in all untreated patients. Hepatitis B virus DNA rapidly became undetectable and serum aminotransferases fell to normal in eight treated patients. After the end of treatment, hepatitis B virus DNA became detectable once again in seven patients, in six of whom a peak of aminotransferases (range: 256 to 850 units per liter) ensued; subsequently, hepatitis B virus DNA disappeared, and serum aminotransferases again fell to normal in two of the seven. Overall, hepatitis B virus DNA was no longer detectable in serum and liver histology improved in three treated patients. These results suggest that chronic hepatitis B with anti-HBe in serum differs from chronic hepatitis with HBeAg in both natural history and response to interferon. Peculiar features are the frequency of spontaneous remissions and a high frequency of reactivation after a response to interferon. New and more effective schedules of antiviral treatment are needed for this subset of patients with chronic hepatitis B.
Vaccination Policies and Rates of Exemption from Immunization, 2005–2011
Authors: Saad B. Omer, Jennifer L. Richards, Michelle Ward, Robert A. Bednarczyk
Journal: New England Journal of Medicine (2012)

To the Editor: We computed the annual change in the rates of nonmedical exemptions from school immunization requirements and compared these rates between states that allow philosophical exemptions and states that allow only religious exemptions.We also compared states with respect to how difficult it is to obtain nonmedical exemptions because of certain adminis-