tbuckley/cabot-search huggingface dataset:
Time to get streetwise: why medical ethics is in need of doctors
Authors: Daniel Sokol
Journal: BMJ (2006)

On my office wall hangs “The Conjurer,” a painting by the 15th century Dutch artist Hieronymus Bosch. On the right side of the canvas, a conjurer holds a small ball between his fingertips. On the other side of the table a gowned spectator, bent over like a hunchback, stares idiotically at the small ball. Behind the spectator, hidden from the stares of the diverted crowd, the conjurer's accomplice is stealing the spectator's purse. 

Like the spectator in Bosch's painting, the modern medical ethicist is at risk of losing something of considerable value. By focusing so closely on the little ball—the purely philosophical aspects of medicine (such as the meanings of autonomy)—the ethicist too easily ignores the broader context in which these issues arise. The combination of abstruse theorising and ignorance of practical medicine alienates the very people the ethicist is trying to help. 

To be of any use to practitioners, armchair bioethics, which tends to tackle issues in a contextual vacuum, must make way for a more streetwise form of bioethics in which conceptual analysis is coupled …
Website of the week: www.doh.gov.uk/indicat/indicat.htm
Authors: D. Carnall
Journal: BMJ (1999)

This week the government launched its scheme to publish “on the issue that really matters to the public”—quality and performance in the NHS. Naturally, part of its strategy is to release the information on the web, although you have to work quite hard to get to grips with it.

The main feature of the site was some fairly hefty PDF (portable …
Myocardial Bridging in Children with Hypertrophic Cardiomyopathy — A Risk Factor for Sudden Death
Authors: Anji T. Yetman, Brian W. McCrindle, Cathy MacDonald, Robert M. Freedom, Robert Gow
Journal: New England Journal of Medicine (1998)

Myocardial bridging may cause compression of a coronary artery, and it has been suggested that myocardial ischemia may result. The clinical significance and prognostic value of myocardial bridging of the left anterior descending coronary artery in children with hypertrophic cardiomyopathy are unknown. We sought to determine the prevalence and clinical effects of myocardial bridging in children with hypertrophic cardiomyopathy who underwent cardiac catheterization.
Scared to Death
Authors: Willard E. Goodwin
Journal: JAMA (1966)

<h3>To the Editor:—</h3> The remarks of George X. Trimble, MD, interested me a great deal (<b>195</b>:952, 1966). I am absolutely convinced that this situation is more common than realized. One of my teachers in medical school, a wise and great surgeon, Dr. John M. T. Finney, said to us "If a patient looks you in the eye, and says, 'Doctor, if you operate on me, I am going to die'... don't operate on him." The danger comes when the patient doesn't look you in the eye, but has made up his or her own mind. We recently had a like tragedy in this community in the case of one of our colleagues, who had a cardiac arrest in connection with a tonsillectomy. He had had strong premonitions. My own experience is unforgettable. Some years ago, I had a patient who was "a bit of a queer duck" but who
Authors' reply to Honeyford and colleagues and Roland
Authors: E. Kontopantelis, D. A. Springate, M. Ashworth, R. T. Webb, I. E. Buchan, T. Doran
Journal: BMJ (2015)

We agree with Honeyford and colleagues that investigation of specific pathways of care is warranted, but we aimed to investigate the association between overall Quality and Outcomes Framework (QOF) performance and mortality.1 2 We did, however, assess outcomes indicators related to deaths from specific conditions, but found no association with mortality. We omitted recorded prevalence from our models because register sizes also depend on “true” community prevalence, which partly depends on survival. …
THE STRESS OF MODERN CIVILIZATION AS A FACTOR IN THE CAUSATION OF INSANITY.
Authors: FREDERIC S. THOMAS
Journal: JAMA (1898)

In presenting a few thoughts upon this subject, I desire not to be exhaustive, but to present points merely for your consideration. The author does not claim the stress of modern civilization to be an exclusive factor in the causation of insanity, yet one which should not be dismissed without consideration. He believes that it is the most intimately associated with the formative period of life; that it is a causative factor in the development of neurotic temperaments. Instead of modern culture making the masses more resistive and better qualified for life's battle, in many instances, by reason of over-stimulation and faulty cerebral development, it tends to weaken the inhibitory qualities of the brain. We are told that man in uncivilized life has but one source of pleasure, viz.: The gratification of his animal desires and passions. In his ultra civilized state, however, we find him possessed of another and
FATALITIES IN PATIENTS RECEIVING CHLORPROMAZINE AND RESERPINE DURING 1956-1957 AT PILGRIM STATE HOSPITAL
Authors: M. ZLOTLOW, A. E. PAGANINI
Journal: American Journal of Psychiatry (1958)

1. Fatalities in the course of treatment with chlorpromazine and reserpine are much lower than with other somatic therapies. 2. Cardio-vascular and respiratory fatalities seen as the main complication with other somatic therapies are not as important complications in the course of treatment with these 2 drugs. 3. In patients with brain damage, asphyxia as the cause of death is due rather to a "masked fit" or "unnoticed convulsion" than to lack of cough reflex or some specific respiratory effect. 4. The development and appearance of ruptered peptic ulcer or a "silent" ulcer in patients receiving ataraxics should be further investigated. 5. The disappearance of the classical syndrome of "psychotic exhaustion" as a cause of death in the years of the use of ataraxics is remarkable and must be reemphasized.
Transonychial water loss: relation to sex, age and nail-plate thickness
Authors: G.B.E JEMEC, T. AGNER, J. SERUP
Journal: British Journal of Dermatology (1989)

The transonychial water loss (TOWL) was measured in 21 healthy volunteers with an evaporimeter, to establish the usefulness of this technique and study the influence of sex, age and nail-plate thickness. The median TOWL was 19.4 g/m2 h-1 and it decreased with increasing age (R = 0.51, P less than 0.018). The median transepidermal water loss (TEWLHAND) from the back of the hand was 16.0 g/m2 h-1 and from the dorsal side of the underarm (TEWLARM) it was 5.6 g/m2 h-1. The TEWLARM was significantly less than from any of the two other points studied (P less than 0.01), while there was no significant difference between the values obtained on the hand and the nail. TEWLARM had a median value of 6.4 g/m2 h-1 in men and 4.3 g/m2 h-1 in women (P less than 0.05) in this study. No significant correlation between nail-plate thickness, as measured by ultrasound 20 MHz A-scan, and TOWL was found. Measurements of TOWL are of interest and should be age-related. Further studies are needed to determine TOWL in various forms of nail pathology.
A Head-Within-A-Head
Authors: ANITA MOALLEM, PERRY S. GERARD, ROBERT LIMANI
Journal: Clinical Nuclear Medicine (1998)

A patient with elevated alkaline phosphatase underwent whole body bone imaging with Tc-99m methylenediphosphonate. Pelvic and lower extremity images showed typical widening and increased density along trabecular and cortical lines typical for Paget's disease. The lateral skull view is remarkable for its "head-within-a-head" appearance. The posterior view, showing greater involvement of the base of the skull, extending posteriorly and laterally, while decreasing toward the parietal area, explains the double contour seen from the lateral perspective.
On the mechanisms of ventricular tachycardia acceleration during programmed electrical stimulation.
Authors: J Brugada, P Brugada, L Boersma, L Mont, C Kirchhof, H J Wellens, M A Allessie
Journal: Circulation (1991)

BACKGROUND The pathophysiological mechanisms leading to acceleration of ventricular tachycardia (VT) are still unclear. METHODS AND RESULTS High-resolution epicardial mapping was used to study the mechanisms of VT acceleration by programmed electrical stimulation (PES) in a model of sustained reentrant VT in Langendorff-perfused rabbit hearts (n = 40). Three different mechanisms responsible for acceleration of VT were identified: 1) induction of double-wave reentry (n = 6), defined as the occurrence of two successive activation waves circulating in the same direction in the same circuit; 2) change to a functionally determined circuit (n = 4), defined as reentry of the impulse around a functional line of block without involvement of a fixed obstacle; and 3) change of the reentrant circuit to reentry within a different, faster anatomic pathway (n = 3). Analysis of 81 episodes of sustained monomorphic VT induced by PES in 74 patients with clinically documented sustained VT in the setting of chronic coronary artery disease showed that in 22 episodes VT was suddenly accelerated by PES (mean cycle length, from 345 +/- 73 to 277 +/- 71 msec, p less than 0.01). CONCLUSIONS With the observations made in the experimental model, the following tentative classification of the mechanisms of VT acceleration of the 22 episodes was made: 1) induction of double-wave reentry in two, 2) change to a functionally determined circuit in four, and 3) change to reentry within a faster anatomic circuit in 16. Simple criteria suggest that these mechanisms may apply in the clinical situation.
ANESTHESIA IN PEDIATRIC UROLOGY
Authors: Stevens J. Martin
Journal: JAMA (1952)

During the past two decades, significant advances have been made in pediatric urology. While many difficulties have been resolved, the problem of a satisfactory and optimum anesthetic management still remains a challenge to some. Thus, published reports on uropediatric anesthesia are meager, limited to a few pediatric centers, and controversial in many respects. 1 In an attempt to clarify this problem, an analysis was made of the pertinent literature and the clinical experiences in the anesthetic management for pediatric urology.  A survey of the progress in anesthesia is of paramount importance to the urologist interested in pediatrics. It reveals several fundamental facts inadequately stressed and not fully appreciated clinically. To begin with, there is no ideal anesthetic agent and/or technique per se. All have their advantages, disadvantages, limitations, contraindications, and complications. Accordingly, for safe and optimum anesthesia, the anesthetic management for each operative procedure must be individualized. Secondly, there is
The secret diary of James Drife, aged 48 1/4
Authors: J. O. Drife
Journal: BMJ (1996)

January 1—Gosh. The first day of my 25th year in the NHS!

Today is a holiday so I watched a film called Reach for the Sky on TV. The best bit was when Kenneth More took over a demoralised unit and telegraphed Whitehall: THIS SQUADRON IS NOT OPERATIONAL, REPEAT NOT OPERATIONAL. The “brass hats” were angry but they gave him equipment. Then his men admired him and became moralised again.

January 2—Today 18 old ladies were sent to our ward from the medical unit. There are no beds on their proper ward. This is nostalgic. When I was a houseman in …
Pleiotrophin produced by multiple myeloma induces transdifferentiation of monocytes into vascular endothelial cells: a novel mechanism of tumor-induced vasculogenesis
Authors: Haiming Chen, Richard A. Campbell, Yunchao Chang, Mingjie Li, Cathy S. Wang, Jennifer Li, Eric Sanchez, Michael Share, Jeffrey Steinberg, Ariana Berenson, Dror Shalitin, Zhaohui Zeng, Dorina Gui, Pablo Perez-Pinera, Ronald J. Berenson, Jonathan Said, Benjamin Bonavida, Thomas F. Deuel, James R. Berenson
Journal: Blood (2008)
Indigenous Chagas' Disease (American Trypanosomiasis) in California
Authors: Robert J. Schiffler
Journal: JAMA (1984)

CHAGAS' disease (American trypanosomiasis) is an infection caused by the protozoan parasite<i>Trypanosoma</i><i>cruzi</i>. Despite the presence of the parasite in<i>Triatoma</i>insects (the vector of T<i>cruzi</i>) and mammals across the southern United States,<sup>1</sup>only two patients with indigenous Chagas' disease have been described<sup>2,3</sup>; both were infants from Texas in 1955. We report herein the first recognized case of indigenous Chagas' disease in California and the first case reported in the United States since 1955. <h3>Report of a Case</h3> In August 1982, a 56-year-old woman from Lake Don Pedro, Calif, 120 miles east of San Francisco, was admitted to the hospital after 16 days of fever. The patient had lived in east-central California for 19 years. She had traveled outside the United States only once, when she visited the California-Mexico border town of Mexicali for an afternoon in 1978. She had never received blood transfusions, nor did
Psychiatric Care and Patient Confidentiality
Authors: Leon Hoffman
Journal: JAMA (1997)

<h3>To the Editor.</h3> —In Resident Forum,<sup>1</sup>Dr Szigethy writes cogently about the problems with the professional identity of psychiatry in the era of managed care. I would like to briefly elaborate on one of her points, the compromise of patient confidentiality when third-party reviewers are involved. The leaders in psychiatry should take the lead in reexamining the casual manner in which patients are asked to waive their rights to privacy and confidentiality. When psychiatric treatment is involved, managed care companies are either uninterested in or unaware of the impact on patients when they are obliged to waive their or their family member's privacy and confidentiality in order to receive psychiatric services, however limited these services may be. More important, the large problem of the loss of privacy and confidentiality in mental health treatment is just the tip of the iceberg. Physicians routinely send medical information, such as operative reports
Gonococci causing disseminated gonococcal infection are resistant to the bactericidal action of normal human sera.
Authors: G K Schoolnik, T M Buchanan, K K Holmes
Journal: Journal of Clinical Investigation (1976)

The susceptibility of strains of Neisseria gonorrhoeae to the bactericidal action of normal human sera was determined for isolates from patients with disseminated gonococcal infection and uncomplicated gonorrhea. Serum susceptibility was correlated with penicillin susceptibility and auxotype. 38 of 39 strains (97%) of N. gonorrhoeae from Seattle patients with disseminated gonococcal infection were resistant to the complement-dependent bactericidal action of normal human sera. 36 of these were inhibited by less than or equal to mug/ml of penicillin G and required arginine, hypoxanthine, and uracil for growth on chemically defined medium (Arg-Hyx-Ura- auxotype). 12 of 43 isolates from patients with uncomplicated gonorrhea were also of the Arg-Hyx-Ura-auxotype, inhibited by less than or equal to 0.030 mug/ml of penicillin G, and serum resistant. Of the 31 remaining strains of other auxotypes isolated from patients with uncomplicated gonorrhea, 18 (58.1%) were sensitive to normal human sera in titers ranging from 2 to 2,048. The bactericidal action of normal human sera may prevent the dissemination of serum-sensitive gonococci. However, since only a small proportion of individuals infected by serum-resistant strains develop disseminated gonococcal infection, serum resistance appears to be a necessary but not a sufficient virulence factor for dissemination. Host factors such as menstruation and pharyngeal gonococcal infection may favor the dissemination of serum-resistant strains. Since serum-resistant Arg-Hyx-Ura strains are far more frequently isolated from patients with disseminated gonococcal infection than serum-resistant strains of other auxotypes, Arg-Hyx-Ura-strains may possess other virulence factors in addition to serum resistance.
Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study
Authors: M. G Dunnigan
Journal: BMJ (2003)

<h3>Abstract</h3> <b>Objectives:</b> To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. <b>Design:</b> Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board9s integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990–1 to 2000-1. <b>Main outcome measures:</b> Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. <b>Results:</b> By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P&lt;0.001). <b>Conclusion:</b> The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995–6 and 2000-1. <h3>What is already known on this topic</h3> The full business cases for the 15 first wave private finance initiative (PFI) hospitals in England and Scotland projected reductions in acute beds of about 30% in the five years before the opening of the new replacement hospitals The new PFI Royal Infirmary of Edinburgh, which will fully open in 2003, is the cornerstone of Lothian Health Board9s healthcare plan for its acute hospitals <h3>What this study adds</h3> Compared with other Scottish NHS hospitals, service delivery has been reduced across Lothian associated with PFI development The planning targets and increase in clinical activity in acute specialties in Lothian hospitals had not been achieved by 2000-1 There is evidence of an independent "PFI effect" on hospital downsizing and bed reductions, which in Lothian has resulted in severe capacity constraints across all acute specialties with a need for immediate expansion in acute and community provision Further hospital and community service downsizing may be required to meet the financial deficit, which is principally due to the high costs of PFI
NADPH oxidase deficiency in X-linked chronic granulomatous disease.
Authors: D C Hohn, R I Lehrer
Journal: Journal of Clinical Investigation (1975)

We measured the cyanide-insensitive pyridine nucleotide oxidase activity of fractionated resting and phagocytic neutrophils from 11 normal donors, 1 patient with hereditary deficiency of myeloperoxidase, and 7 patients with X-linked chronic granulomatous disease (CGD). When measured under optimal conditions (at pH 5.5 and in the presence of 0.5 mM Mn++), NADPH oxidase activity increased fourfold with phagocytosis and was six-fold higher than with NADH. Phagocytic neutrophils from patients with CGD were markedly deficient in NADPH oxidase activity.
Poorer countries will not meet health targets, warns WHO
Authors: Susan Mayor
Journal: BMJ (2005)

Adenylyl cyclases (AC) are important regulators of airway smooth muscle function, because β-adrenergic receptor (AR) agonists stimulate AC activity and increase airway diameter. We assessed expression of AC isoforms in human bronchial smooth muscle cells (hBSMC). Reverse transcriptase-polymerase chain reaction and immunoblot analyses detected expression of AC2, AC4, and AC6. Forskolin-stimulated AC activity in membranes from hBSMC displayed Ca<sup>2+</sup>-inhibited and G<sub>βγ</sub>-stimulated AC activity, consistent with expression of AC6, AC2, and AC4. Isoproterenol-stimulated AC activity was inhibited by Ca<sup>2+</sup> but unaltered by G<sub>βγ</sub>, whereas butaprost-stimulated AC activity was stimulated by G<sub>βγ</sub> but unaffected by Ca<sup>2+</sup> addition. Using sucrose density centrifugation to isolate lipid raft fractions, we found that only AC6 localized in lipid raft fractions, whereas AC2 and AC4 localized in nonraft fractions. Immunoisolation of caveolae using caveolin-1 antibodies yielded Ca<sup>2+</sup>-inhibited AC activity (consistent with AC6 expression), whereas the nonprecipitated material displayed G<sub>βγ</sub>-stimulated AC activity (consistent with expression of AC2 and/or AC4). Overexpression of AC6 enhanced cAMP production in response to isoproterenol and beraprost but did not increase responses to prostaglandin E<sub>2</sub> or butaprost. β<sub>2</sub>AR, but not prostanoid EP<sub>2</sub> or EP<sub>4</sub> receptors, colocalized with AC5/6 in lipid raft fractions. Thus, particular G protein-coupled receptors couple to discreet AC isoforms based, in part, on their colocalization in membrane microdomains. These different cAMP signaling compartments in airway smooth muscle cells are responsive to different hormones and neurotransmitters and can be regulated by different coincident signals such as Ca<sup>2+</sup> and G<sub>βγ</sub>.
THE PRODUCTION OF SKIN NECROSIS BY CERTAIN AUTOLYSATES OF PNEUMOCOCCUS (TYPES I AND II)
Authors: Julia T. Parker
Journal: The Journal of Experimental Medicine (1928)

1. Certain pneumococcus autolysates produce necrosis when injected into the skin of guinea pigs. 2. The necrosis-producing principle can be filtered through a Berkefeld N filter, is extremely thermolabile, and is very sensitive to oxidation. 3. The necrotizing poison can be separated from the pneumococcus hemotoxin by adsorption with red cells. This removes the hemotoxin and leaves the necrosis-producing principle unaffected. 4. The necrotizing substances obtained from Pneumococcus Types I and II are neutralized by the antiserum prepared with Pneumococcus I.