tbuckley/cabot-search huggingface dataset:
Preparing for pandemic influenza
Authors: John McConnell, Richard Horton
Journal: The Lancet (2005)

It is almost universally acknowledged that another influenza pandemic is inevitable. Intervals between pandemics have varied from 11 to 42 years with no clear pattern, but since the most recent pandemic was 37 years ago in 1968, the upper limit of past experience is being fast approached. The outbreak of highly pathogenic avian influenza A/H5N1 in domestic birds in parts of Asia, which has recently spread to eastern Europe, has caused at least 135 human cases and 69 deaths,1World Health OrganizationCumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO.http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_12_07/en/index.htmlDate: Dec 7, 2005Google Scholar and raised fears that this virus will mutate into a form capable of causing pandemic influenza. During the influenza pandemic of 1918–19, between 20 and 50 million people died, more than during the preceding World War I. Similarly, the toll of human death and disease during a future pandemic is likely to far outweigh that of recent natural disasters, infectious disease outbreaks such as severe acute respiratory syndrome, or an act of bioterrorism. In addition, because the global economy is now far more interconnected than it has ever been, a future pandemic will have a devastating effect on world trade. In the face of this threat, governments and international agencies are putting considerable effort into pandemic preparation. Yet, despite the influenza virus first being isolated from human beings as long ago as 1933,2Smith W Andrewes C Laidlaw P A virus obtained from influenza patients.Lancet. 1933; 2: 66-68Abstract Scopus (496) Google Scholar, 3The Lancet The virus of influenza.Lancet. 1933; 2: 83Google Scholar and all the advances of the past century in prevention, treatment, and diagnosis of infectious diseases, the world is ill-equipped to prevent the spread of the first wave of a future pandemic. An effective vaccine may not be available for the first 6 months of the pandemic and stocks of antiviral drugs are unlikely to be adequate to treat all those infected. Many questions remain to be answered to prepare adequately for pandemic influenza—eg, what is the role of wild birds and domestic animals besides poultry in transmitting the disease and acting as "mixing vessels" for viral recombination; avian influenza has a high mortality rate in human beings, but will it become less virulent if it mutates into a form capable of human-to-human transmission; and what are the molecular mechanisms that permit human-to-human transmission? These issues, and many others, will be addressed at a conference The Lancet and The Lancet Infectious Diseases are holding in Singapore on May 3–4, 2006. Our objectives for the meeting, at which many of the world's leading experts in influenza have agreed to talk, are to provide clinicians and policymakers with the most up-to-date information to allow them to prepare for the next influenza pandemic, and to identify gaps in pandemic preparations.
A study of headaches and migraine in Sjogren's syndrome and other rheumatic disorders.
Authors: B Pal, C Gibson, J Passmore, I D Griffiths, W C Dick
Journal: Annals of the Rheumatic Diseases (1989)

Migraine occurs with increased frequency in patients with systemic lupus erythematosus and in subjects suffering from Raynaud9s phenomenon without any underlying connective tissue disorders. A possible link between migraine and Raynaud9s phenomenon has been suggested. Two rheumatic conditions where Raynaud9s phenomenon occurs very commonly are scleroderma and primary Sjögren9s syndrome. It is possible that migraine is also common in these disorders but has been unrecognised. Therefore, the prevalence of migraine was assessed by a questionnaire in 191 subjects suffering from various connective tissue disorders and control subjects. Migraine was diagnosed in 16/35 (46%) patients with primary Sjögren9s syndrome, 31/97 (32%) patients with scleroderma, 4/33 (12%) patients with rheumatoid arthritis/Sjögren9s syndrome compared with 3/26 (11%) control subjects. A family history of headaches was more common in the patient groups than controls. There was a significant association between occurrence of Raynaud9s phenomenon and migraine. Small vessel pathology may underlie both migraine and Raynaud9s phenomenon in these connective tissue disorders--as has been suggested in systemic lupus erythematosus. The findings stress the need to ask specifically about complaints of headaches/migraines in patients with scleroderma and primary Sjögren9s syndrome for the appropriate total management of these patients.
Interleukin-8 Secretion and Neutrophil Recruitment Accompanies Induced Sputum Eosinophil Activation in Children with Acute Asthma
Authors: M. Z. NORZILA, KELLIE FAKES, RICHARD L. HENRY, JODIE SIMPSON, PETER G. GIBSON
Journal: American Journal of Respiratory and Critical Care Medicine (2000)

Although airway inflammation is recognized as a key feature of asthma, the characteristics of airway inflammation in children with acute severe asthma are not well defined. The aim of this study was to describe the characteristics of airway inflammation in children with an acute exacerbation of asthma using sputum cell counts and fluid-phase measurements and to examine the changes in these parameters upon resolution of the exacerbation. Children (n = 38) presenting to the Emergency Department with acute asthma underwent successful sputum induction using ultrasonically nebulized normal saline (n = 22), or expectorated sputum spontaneously (n = 16). Sputum induction was repeated at least 2 wk later when the children had recovered (n = 28). Sputum portions were selected, dispersed and total and differential cell counts performed. Neutrophil elastase and EG2-positive eosinophils were assessed and fluid-phase eosinophil cationic protein (ECP), myeloperoxidase (MPO), interleukin-8 (IL-8), and IL-5 were measured. During the acute exacerbation the median (range) total cell count was 8.4 × 106/ml (0.5 to 190.3), and fell significantly at resolution to 1.3 × 106/ml (p < 0.01). The inflammatory cell infiltrate was mixed and included eosinophils (0.8 × 106/ml), neutrophils (3.3 × 106/ml), and mast cells. EG2+ cells were high and correlated with the degree of airflow obstruction (r = − 0.5, p = 0.02). They decreased significantly at resolution as did supernatant ECP (1,078 versus 272 ng/ml), suggesting that eosinophils were activated during the exacerbation. MPO was 220 ng/ ml at exacerbation and fell significantly to 1 ng/ml at resolution. Levels of IL-8 and IL-5 were elevated during the acute exacerbation and IL-8 concentrations decreased at resolution. In conclusion, airway inflammation can be studied in children with acute asthma by sputum induction. Airway inflammation is present during an acute exacerbation of asthma, and is characterized by infiltration and activation of both eosinophils and neutrophils. The heterogeneity of airway inflammation in acute asthma may influence response to corticosteroid therapy. Norzila MZ, Fakes K, Henry RL, Simpson J, Gibson PG. Interleukin-8 secretion and neutrophil recruitment accompanies induced sputum eosinophil activation in children with acute asthma.
Challenge is not crucial
Authors: Y. Karim, Z. Adhya
Journal: BMJ (2009)

<h3>Background</h3> Recent innovations have the potential to disrupt the current paradigm for kidney failure treatment. The US Food and Drug Administration is committed to incorporating valid scientific evidence about how patients weigh the benefits and risks of new devices into their decision making, but to date, premarket submission of patient preference information (PPI) has been limited for kidney devices. With input from stakeholders, we developed a survey intended to yield valid PPI, capturing how patients trade off the potential benefits and risks of wearable dialysis devices and in-center hemodialysis. <h3>Methods</h3> We conducted concept elicitation interviews with individuals receiving dialysis to inform instrument content. After instrument drafting, we conducted two rounds of pretest interviews to evaluate survey face validity, comprehensibility, and perceived relevance. We pilot tested the survey with in-center hemodialysis patients to assess comprehensibility and usability further. Throughout, we used participant input to guide survey refinements. <h3>Results</h3> Thirty-six individuals receiving in-center or home dialysis participated in concept elicitation (<i>N</i>=20) and pretest (<i>N</i>=16) interviews. Participants identified reduced fatigue, lower treatment burden, and enhanced freedom as important benefits of a wearable device, and many expressed concerns about risks related to device disconnection—specifically bleeding and infection. We drafted a survey that included descriptions of the risks of serious bleeding and serious infection and an assessment of respondent willingness to wait for a safer device. Input from pretest interviewees led to various instrument modifications, including treatment descriptions, item wording, and risk-level explanations. Pilot testing of the updated survey among 24 in-center hemodialysis patients demonstrated acceptable survey comprehensibility and usability, although 50% of patients required some assistance. <h3>Conclusions</h3> The final survey is a 54-item web-based instrument that will yield estimates of the maximal acceptable risk for the described wearable device and willingness to wait for wearable devices with lower risk.
An Address on the Importance of Post-Graduate Study: Delivered at the Opening of the Museums of the Medical Graduates College and Polyclinic, July 4th, 1900
Authors: W. Osler
Journal: BMJ (1900)

IF the licence to practise meant the completion of his educa- tion how sad it would be for the doctor, how distressing to his patients!More clearly than any other, the physician should illustrate the truth of Plato's saying-that education is a life- long process.The training of the medical school gives a man his direction, points him the way, and furnishes a chart, fairly incomplete, for the voyage but nothing more.Post-graduation study has always been a characteristic feature of our profes- sion.These three hundred years the schools of Italy, Holland, France, Austria, and Germany have in turn furnished instruc- tion to the young English doctors who believed in the catholicity of medicine, and who felt the sharp sting of the remark which associates homely wits with home-keeping youths.At first it was the grand tour, and many of the masters spent years in foreign-study.In spite of our journals and international societies, and increased facilities for travel, I am not sure that among the teachers in our art, the world over, medicine to-day is any more cosmopolitan than intee seventeenth and eighteenth cen- turies.Men now spend a few months or a year in foreign study, whereas our great-grandfathers thought nothing of two and three years.I have seen the MSS.journal of Dr. John Morgan (a Pennsylvania colonist), the founder of the first medical school in America (University of Pennsylvamia), who, after graduation at Edinburgh, spent three years on the Con- tinent and became thoroughly familiar with Italian, Dutch, and French medicine, reaching such distinction as a student that he took his seat as a corresponding member of the Paris Academy of Surgery, and was elected a Fellow of the Royal Society.Linacre, Caius, and Harvey remain to-day the models for all students in foreign lands, but the pace thev set
Doppler Estimation of Left Ventricular Filling Pressures in Patients With Mitral Valve Disease
Authors: Abhvinav Diwan, Marti McCulloch, Gerald M. Lawrie, Michael J. Reardon, Sherif F. Nagueh
Journal: Circulation (2005)

Background— Conventional Doppler measurements have limitations in the prediction of left atrial pressure (LAP) in patients with mitral valve disease (MVD), given the confounding effect of valve area, left ventricular (LV) relaxation, and stiffness. However, the time interval between the onset of early diastolic mitral inflow velocity (E) and annular early diastolic velocity (Ea) by tissue Doppler imaging (TDI), T E−Ea , which is well related to the time constant of LV relaxation (τ) in canine and clinical studies, is not subject to these variables. We therefore undertook this study to test its usefulness in a patient population. Methods and Results— Two-dimensional Doppler and TDI echocardiography were performed simultaneously with right-heart catheterization in 51 consecutive patients (mean±SD age, 64±11 years) with MVD: 35 with moderately severe to severe mitral regurgitation (MR) and 16 with moderate to severe mitral stenosis (MS). Among several Doppler measurements, only the mitral E/A ratio, isovolumetric relaxation time (IVRT), and pulmonary venous Ar duration had significant relations with mean pulmonary capillary wedge pressure (PCWP). The ratio of IVRT to T E−Ea (for MR, r =−0.92; for MS, r =−0.88; both P &lt;0.001) and the ratio of IVRT to τ (for MR, r =−0.74; for MS, r =−0.85; both P &lt;0.001) had the best correlations with PCWP. In 54 repeat studies, including those performed after MV repair or replacement, these ratios tracked well the changes in PCWP and readily identified changes in mean PCWP by ≥5 mm Hg. A similar correlation was noted in 13 patients with atrial fibrillation ( r =−0.92, P &lt;0.01) and in a prospective group of 14 patients with MR ( r =−0.93, P &lt;0.001). Conclusions— The ratio of IVRT to T E−Ea or to τ can be readily applied for estimating mean PCWP in patients with MVD and can track changes in PCWP after valve surgery.
Toxicology of the Eye: Drugs, Chemicals, Plants, Venoms
Authors: Mary Ellen Kosman
Journal: JAMA (1974)

Twelve years have elapsed since publication of the first edition of this informative and readable book. The second edition, thoroughly updated and expanded, is a worthwhile investment not only for ophthalmologists but for all physicians. The major portion of the book (section 2) is an alphabetically arranged compendium of information on all substances that by direct contact or by the systemic route may have adverse effects on the eyes or produce visual disturbances. The author has done an admirable job of compiling and evaluating the available data and in providing extensive references and many original observations. Drugs, chemicals, cosmetics, plants, and venoms are covered, and the material is presented in a manner that makes the book useful as a quick reference source for diagnosis and treatment. The systemic side effects of ophthalmic drugs are also reviewed. Particular attention has been focused on the effects that systemically administered drugs have on
Preoperative Selection of Patients With Severely Impaired Left Ventricular Function for Coronary Revascularization
Authors: Jean-Louis J. Vanoverschelde, Bernhard L. Gerber, Anne-Marie D'Hondt, Martine De Kock, Robert Dion, William Wijns, Jacques A. Melin
Journal: Circulation (1995)

Background Both thallium imaging and low-dose dobutamine echocardiography have been proposed to predict the reversibility of left ventricular (LV) dysfunction in patients with coronary disease. The present study was designed to evaluate whether the use of these techniques during the preoperative assessment of coronary patients with depressed LV function can improve our ability to identify those likely to have improved LV function after surgery. Methods and Results Forty consecutive patients (age, 60±10 years) with coronary disease and an ejection fraction ≤35% underwent dobutamine echocardiography (10 μg/kg per minute) and exercise-redistribution-reinjection thallium single photon emission computed tomography (SPECT) before coronary revascularization by bypass surgery (n=33) or angioplasty (n=7). Recovery of LV function was evaluated by echocardiography 5.3±2.4 months after revascularization. According to the changes in end-systolic volume and ejection fraction after revascularization, the patients were categorized into groups with (n=19) and without (n=21) postoperative functional improvement, defined as a &gt;5% increase in ejection fraction and &gt;10 mL decrease in end-systolic volume. Before revascularization, patients with improved postoperative function had smaller end-diastolic volume and less wall motion abnormalities than those with persistent dysfunction. They also showed greater improvement of wall motion score with dobutamine (6.1±2.4 versus 1.8±4.2 grades, P &lt;.001) and smaller thallium defect score after exercise (38±12 versus 47±14 grades, P =.04). Discriminant analysis selected the improvement in wall motion score with dobutamine and baseline end-diastolic volume as independent predictors of postoperative recovery. Consideration of both parameters allowed prediction of functional outcome in 84% of the patients with and 81% of those without postoperative improvement. Conclusions Among the parameters commonly available before surgery in coronary patients with depressed LV function, the maintenance of significant inotropic reserve, the severity of LV remodeling, and the magnitude of the perfusion defect after exercise can predict the reversal of LV dysfunction after revascularization.
Challenges of training doctors in the new English NHS
Authors: Linda Hutchinson
Journal: BMJ (2006)

Current health service reforms in England aim to create services that are more patient responsive.Will changes in the design and delivery of services be at the expense of medical education and training?The health service in England is undergoing fundamental changes.Three principles emerge from recent policy documents: patient led culture, mixing of skills, and plurality of providers. 1 2Each of these separately presents a challenge to medical education, and together they present an even greater one.Medical and lay press carry stories of reported threats to doctors' education and training from some of the initiatives. [3]4][5][6] This article examines the challenges. Challenges to current systemThe centralist arrangements of the NHS have allowed universal adoption of changes and improvements to medical training.Although health policy is now devolved to the four UK countries, medical education is mostly considered a UK-wide activity.However, the health service in England is creating a new context, increasingly different from the other three administrations, making common approaches more challenging.Within England, the established framework for education and training of doctors will need to be adapted for the new environment.The box summarises the main initiatives that will affect education.
Creation of an Arteriovenous Fistula for Transfusion
Authors: Harold L. Greenberg, Sanders H. Berk
Journal: New England Journal of Medicine (1971)

The treatment of diseases that require multiple transfusions over a long time is frequently complicated by the lack of an available venous route. The bone marrow has been suggested as an alternate route, but has certain drawbacks.1 Although a subcutaneous arteriovenous fistula has frequently been used in recent years for hemodialysis,2 , 3 this procedure has rarely been used to create new superficial veins for the purpose of transfusions.3 , 4 Case ReportA 59-year-old man with von Willebrand's disease was admitted to the hospital because of melena, shortness of breath and anemia secondary to gastrointestinal bleeding from an occult site. For this problem, . . .
Immunochemical FOBT had higher participation and detection rates than guaiac-based FOBT for colorectal cancer screening
Authors: Robert H. Fletcher
Journal: Annals of Internal Medicine (2010)

Source Citation Hol L, van Leerdam ME, van Ballegooijen M, et al. Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut. 2010;59:62-8. 19671542
Trojan Horse Hypothesis: Inhaled Airborne Particles, Lipid Bullets, and Atherogenesis
Authors: Marcel Twickler, Geesje Dallinga-Thie, Maarten-Jan Cramer
Journal: JAMA (2006)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Clinical diversity in glycogenosis type II. Biosynthesis and in situ localization of acid alpha-glucosidase in mutant fibroblasts.
Authors: A J Reuser, M Kroos, R Willemsen, D Swallow, J M Tager, H Galjaard
Journal: Journal of Clinical Investigation (1987)

The molecular basis of clinical diversity in glycogenosis type II (Pompe's disease) was investigated by comparing the nature of acid alpha-glucosidase deficiency in cultured fibroblasts from 30 patients. Biosynthetic forms of acid alpha-glucosidase with different molecular mass were separated electrophoretically and identified by immunoblotting. Immuno-electron microscopy was employed to determine the intracellular localization of mutant enzyme. Our studies illustrate that maturation of acid alpha-glucosidase is associated with transport to the lysosomes. Deficiency of catalytically active mature enzyme in lysosomes is common to all clinical phenotypes but, in the majority of cases, is more profound in early onset than in late onset forms of the disease. Thus, the results suggest that the clinical course of glycogenosis type II is primarily determined by the amount of functional acid alpha-glucosidase. The role of secondary factors can, however, not be excluded because three adult patients were identified with very low activity and little enzyme in the lysosomes.
The diagnosis of toxoplasmosis.
Authors: G N Dutton
Journal: BMJ (1984)

which after convincing recovery can relapse only one week after six weeks' supervised treatment including high dose parenteral thiamine ?3Many ingrained assumptions concerning the prevalence and supposed lack of pathophysiological importance of thiamine deficiency in alcoholics with liver disease predate or ignore the use of functional assays.These assumptions are not all in the interests of patient survival and merit urgent revision.46We look forward to integrated studies incorporating the systematic prolonged use of thiamine in the supraphysiological dosages that functional tests indicate necessary to raise and maintain tissue transketolase activity.Dr Dancy and others did not (as we requested) give any further dietary history of their alcoholic patients.They did make the point (with which we agree) that "any sick alcoholic merits a trial of thiamine... ." Fr the sake of consistency we invite them to clarify whether or not they think their study provides ground for withholding such treat- ment from ill patients with active liver disease and normal or high blood concentrations of thiamine, its esters, or both.