tbuckley/cabot-search huggingface dataset:
Needed Facts on Medical Manpower
Authors: EDWARD J. HUTH
Journal: Annals of Internal Medicine (1978)

Editorials1 March 1978Needed Facts on Medical ManpowerEDWARD J. HUTH, M.D.EDWARD J. HUTH, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-88-3-421 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptToo many americans have to face the consequences of gross maldistributions of medical care (1), maldistributions among specialties and among locales. Can the profession, working through its voluntary associations, rectify these maldistributions? Or are we going to have to be coerced by government? The paper by Tarlov and associates on page 413 of this issue is the first of a series of reports coming from a project that may be a crucial test of what our voluntary associations can do. This project is a direct response by the Association of Professors of Medicine to evidences of need for change. After...Reference1. PETERSDORF R: Health manpower: numbers, distribution, quality. Ann Intern Med 82:694-701, 1975 LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByLymphadenosis Benigna Cutis 1 March 1978Volume 88, Issue 3Page: 421-421 Issue Published: 1 March 1978 PDF DownloadLoading ...
Refugees and Displaced Persons
Authors: Michael J. Toole
Journal: JAMA (1993)

The number of refugees and internally displaced persons in need of protection and assistance has increased from 30 million in 1990 to more than 43 million today. War and civil strife have been largely responsible for this epidemic of mass migration that has affected almost every region of the world, including Europe. Since 1990, crude death rates (CDRs) during the early influx of refugees who crossed international borders have been somewhat lower than CDRs reported earlier among Cambodian and Ethiopian refugees. Nevertheless, CDRs among refugees arriving in Ethiopia, Kenya, Nepal, Malawi, and Zimbabwe since 1990 ranged from five to 12 times the baseline CDRs in the countries of origin. Among internally displaced populations in northern Iraq, Somalia, and Sudan, CDRs were extremely high, ranging from 12 to 25 times the baseline CDRs for the nondisplaced. Among both refugees and internally displaced persons, death rates among children less than 5 years of age were far higher than among older children and adults. In Bangladesh, the death rate in female Rohingya refugees was several times higher than in males. Preventable conditions such as diarrheal disease, measles, and acute respiratory infections, exacerbated often by malnutrition, caused most deaths. Although relief programs for refugees have improved since 1990, the situation among the internally displaced may have worsened. The international community should intervene earlier in the evolution of complex disasters involving civil war, human rights abuses, food shortages, and mass displacement. Relief programs need to be based on sound health and nutrition information and should focus on the provision of adequate shelter, food, water, sanitation, and public health programs that prevent mortality from diarrhea, measles, and other communicable diseases, especially among young children and women. (<i>JAMA</i>. 1993;270:600-605)
Lactic acid removal and heart rate frequencies during recovery after strenuous rowing exercise.
Authors: Y Koutedakis, N C Sharp
Journal: British Journal of Sports Medicine (1985)

Three tests were conducted to assess the effectiveness of three different intensities of exercise both in reducing blood lactic acid (LA) levels and in influencing subjects' heart rate (HR), following a 2000 m race in a rowing boat. In the first and second tests these variables were investigated during a 13 min recovery exercise at 60% and 40% of the preceding maximum rowing speed respectively. In the third test the subjects had a resting recovery. The results include a significant increase (P less than 0.001) in the rate of lactate removal following the 40% recovery compared with the 60% and resting recoveries. The HRs were significantly lower during the last minute of resting recovery compared with 40% and 60% recoveries (P less than 0.001). The same was true when 40% recovery was compared with 60% recovery (P less than 0.001). The present data suggest firstly that 40% of the maximum rowing speed is an appropriate pace for effective LA removal and secondly that, at least for trained rowers, 86% of their maximum HR can be taken as an indication of work of an intensity at or above anaerobic threshold.
Prognostic Value of Cardiac Troponin in Patients With Chronic Kidney Disease Without Suspected Acute Coronary Syndrome
Authors: Erin D. Michos, Lisa M. Wilson, Hsin-Chieh Yeh, Zackary Berger, Catalina Suarez-Cuervo, Sylvie R. Stacy, Eric B. Bass
Journal: Annals of Internal Medicine (2014)

Background: Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS). Purpose: To systematically review the literature on troponin testing in patients with CKD without ACS. Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014. Study Selection: Studies examining elevated versus normal troponin levels in patients with CKD without ACS. Data Extraction: Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE). Meta-analyses were conducted when studies had sufficient homogeneity of key variables. Data Synthesis: Ninety-eight studies met inclusion criteria. Elevated troponin levels were associated with all-cause and cardiovascular mortality among patients receiving dialysis (moderate SOE). Pooled hazard ratios (HRs) for all-cause mortality from studies that adjusted for age and coronary artery disease or a risk equivalent were 3.0 (95% CI, 2.4 to 4.3) for troponin T and 2.7 (CI, 1.9 to 4.6) for troponin I. The pooled adjusted HRs for cardiovascular mortality were 3.3 (CI, 1.8 to 5.4) for troponin T and 4.2 (CI, 2.0 to 9.2) for troponin I. Findings were similar for patients with CKD who were not receiving dialysis, but there were fewer studies. No study tested treatment strategies by troponin cut points. Limitation: Studies were heterogeneous regarding assays, troponin cut points, covariate adjustment, and follow-up. Conclusion: In patients with CKD without suspected ACS, elevated troponin levels were associated with worse prognosis. Future studies should focus on whether this biomarker is more appropriate than clinical models for reclassifying risk of patients with CKD and whether such classification can help guide treatment in those at highest risk for death. Primary Funding Source: Agency for Healthcare Research and Quality.
PTH-093 Chromogranin-a : Can It Predict Radiological Progression In Neuroendocrine Tumours?
Authors: RE Rossi, J Garcia-Hernandez, NG Martin, M Mullan, T Meyer, C Thirlwell, J Watkins, ME Caplin, C Toumpanakis
Journal: Gut (2014)

<h3>Introduction</h3> Chromogranin A (CgA) is considered as the best general marker for the diagnosis and follow-up of neuroendocrine tumours (NETs) and is also of prognostic value. In literature, there are no available studies which analysed the role of CgA as a predictor of radiological disease progression in all NETs. Present study investigates the prognostic value of CgA as a predictor of radiological disease progression in NET patients. <h3>Methods</h3> Patients with metastatic NETs and evidence of Radiological Progression (RP) according to RECIST 1.1 were identified from a NET database. Plasma CgA were measured 6 and 12 months before RP and at the event of RP. CgA was measured with the Supra-regional-Assay-Service radioimmunoassay (Hammersmith Hospital), normal value &lt;60 pmol/L. The tumours were graded according to the 2010 WHO classification, as G1 (Ki67 &lt;2%), G2 (Ki67: 2–20%), G3 (Ki67 &gt;20%). <h3>Results</h3> 152 patients were evaluable including 91 midgut NET and 61 pancreatic NETs (PNETs). Of these, 56 were G1 NETs, 65 G2, 10 G3, 21 of unknown histology. 95.4% of the patients had liver metastases, whereas bone and lung metastases were present in a smaller proportion of patients (27.6 and 9.9%, respectively). Median CgA for all NETs 6 months before RP was 213 pmol/L [Interquartile 1 (Q1)=67 and 3 (Q3)=664.5 pmol/L] compared to 166 pmol/L (Q1 52, Q3 535 pmol/L) one year before RP, T = 598.5, p = 0.07. Significant results were found for PNETs [median CgA 6 months before RP: 100 pmol/L (Q1 53, Q3 286.25 pmol/L) and at 12 months: 52 pmol/L (Q1 36.25, Q3 128 pmol/L), T=52, p = 0.048], but not for midgut NETs [median CgA 6 months before RP: 389.5 pmol/L (Q1 131.5, Q3 791.5 pmol/L) and at 12 months: 319 pmol/L (Q1 158, Q3 753 pmol/L), T=191, p = .39]. Both midgut and PNETs CgA values were significantly higher at RP than 12 months before [267 pmol/L (Q1=66, Q3=777) vs. 166 pmol/L (Q1=52, Q3=535), T= 394.5, p = 0.03]. Overall, G1 tumours had median CgA value at 6 months significantly higher than at 12 months [181(Q1=56.25, Q3=624) vs. 149.5 pmol/L (Q1=44, Q3=247.25), T=70, p = 0.048]. <h3>Conclusion</h3> CgA seems to have predictive value 6 months prior to RP for PNETs and G1 tumours, which may be of value to identify specific subgroups of patients who may benefit from a more aggressive follow-up with possible early intervention in case of increased CgA levels. Further prospective studies are needed to enable more definitive conclusions. <h3>References</h3> 1 Oberg K <i>et al</i>. <i>Pancreas</i> 2011 2 Ter-Minassian M <i>et al</i>. <i>Endocr Relat Cancer</i> 2013 3 Welin S <i>et al</i>. <i>Neuroendocrinology</i> 2009 4 Jensen KH <i>et al</i>. <i>Scand J Gastroenterol</i> 2013 <h3>Disclosure of Interest</h3> None Declared.
Long-Term Exposure to Constituents of Fine Particulate Air Pollution and Mortality: Results from the California Teachers Study
Authors: Bart Ostro, Michael Lipsett, Peggy Reynolds, Debbie Goldberg, Andrew Hertz, Cynthia Garcia, Katherine D. Henderson, Leslie Bernstein
Journal: Environmental Health Perspectives (2009)

Several studies have reported associations between long-term exposure to ambient fine particulate matter (PM) and cardiovascular mortality. However, the health impacts of long-term exposure to specific constituents of PM(2.5) (PM with aerodynamic diameter < or = 2.5 microm) have not been explored.We used data from the California Teachers Study, a prospective cohort of active and former female public school professionals. We developed estimates of long-term exposures to PM(2.5) and several of its constituents, including elemental carbon, organic carbon (OC), sulfates, nitrates, iron, potassium, silicon, and zinc. Monthly averages of exposure were created using pollution data from June 2002 through July 2007. We included participants whose residential addresses were within 8 and 30 km of a monitor collecting PM(2.5) constituent data. Hazard ratios (HRs) were estimated for long-term exposure for mortality from all nontraumatic causes, cardiopulmonary disease, ischemic heart disease (IHD), and pulmonary disease.Approximately 45,000 women with 2,600 deaths lived within 30 km of a monitor. We observed associations of all-cause, cardiopulmonary, and IHD mortality with PM(2.5) mass and each of its measured constituents, and between pulmonary mortality and several constituents. For example, for cardiopulmonary mortality, HRs for interquartile ranges of PM(2.5), OC, and sulfates were 1.55 [95% confidence interval (CI), 1.431.69], 1.80 (95% CI, 1.681.93), and 1.79 (95% CI, 1.582.03), respectively. Subsequent analyses indicated that, of the constituents analyzed, OC and sulfates had the strongest associations with all four outcomes.Long-term exposures to PM(2.5) and several of its constituents were associated with increased risks of all-cause and cardiopulmonary mortality in this cohort. Constituents derived from combustion of fossil fuel (including diesel), as well as those of crustal origin, were associated with some of the greatest risks. These results provide additional evidence that reduction of ambient PM(2.5) may provide significant public health benefits.
Diagnosis of diabetes using the oral glucose tolerance test
Authors: B. Olabi, R. Bhopal
Journal: BMJ (2009)

May be inaccurate in some ethnic groups, and better tests are needed

The prevalence of type 2 diabetes varies greatly by ethnic group within and across countries. The most reliable data on the prevalence of diabetes are based on two hour plasma glucose values after an oral glucose tolerance test,1 which is currently the gold standard epidemiological and clinical diagnostic test for diabetes and impaired glucose tolerance. In Newcastle, England, on the basis of clinical evidence and oral glucose tolerance test results, about 20% of British South Asians had diabetes, compared with only 4% of white Europeans, after age adjustment in a sample of 25-74 year olds.2 Might such observed differences in prevalence, at least in part, be artefacts of the diagnostic method?

In 1965, the World Health Organization expert committee drew attention to the “lack of suitable epidemiological information about glucose tolerance in various populations of various races and cultures in different countries”3 and highlighted the need for research in different populations. The call was repeated in 1980,1 with special reference to the oral glucose tolerance test and the dose of glucose, with 75 g …
Dendritic cell number is related to IL‐4 expression in the airways of atopic asthmatic subjects
Authors: G. Bertorelli, V. Bocchino, X. Zhuo, A. Zanini, M. V. Bernini, R. Damia, V. Di Comite, P. Grima, D. Olivieri
Journal: Allergy (2000)

Background: Airway dendritic cells are essential for stimulating naive T cells in response to inhaled antigen and for the development of allergic sensitization. IL‐4 in vitro can distinguish dendritic cell lines from peripheral blood mononuclear cells. Our study had the following aims: to compare the distribution of CD1a+ dendritic cells and IL‐4+ cells, in the bronchial mucosa of asthmatics and controls to determine the relationship between the numbers of CD1a+ dendritic cells and IL‐4+ cells in the bronchial mucosa of asthmatics to determine whether CD1a+ cells express the IL‐4 receptor. Methods: Twenty atopic asthmatic and eight normal subjects were studied. In each subject, bronchoscopy with bronchial biopsies was performed. CD1a, IL‐4, and IL‐4 receptor expressions were evaluated by immunohistochemistry. Results: The number of CD1a+ and IL‐4+ cells was significantly higher in asthmatics than controls. The number of CD1a+ cells was positively correlated to the number of IL‐4+ cells. Bronchial biopsy serial section studies showed that CD1a+ cells express the receptor for IL‐4. Conclusions: These results suggest that an increased amount of IL‐4 may play a physiopathologic role in maintaining the dendritic cell pool in vivo . Therefore, because of possible IL‐4 activity on antigen‐presenting cells in T‐cell immune responses to allergens, an important new role of IL‐4 in asthma inflammation can be envisaged.
Some effects of motor-car driving on the normal and abnormal heart
Authors: P. Taggart, D. Gibbons, W. Somerville
Journal: BMJ (1969)

Electrocardiograms were recorded in experienced motor-car drivers accustomed to busy city traffic while driving their own cars along familiar routes. The majority with normal hearts or a history of coronary heart disease increased their heart rates; brief periods when the rate exceeded 140/min. were recorded in both groups. ST changes not caused by tachycardia developed in 3 out of 32 normal drivers. Of 24 drivers with coronary heart disease 13 increased their ST and T abnormalities, the changes being gross in six. A further five developed multiple ventricular ectopic beats. Two coronary drivers experienced anginal pain and two left ventricular failure. Healthy motor-racing drivers increased their heart rates to 180/min. in the few minutes before the start of a race and to above 200/min. while racing.Little or no change in the plasma catecholamine levels was noted in three coronary subjects immediately after a city drive compared with resting levels. All the racing drivers showed a considerable increase in noradrenaline, and in one instance adrenaline, immediately after racing.Persons in whom angina is easily provoked when driving or who are in borderline left ventricular failure should be advised not to drive.
Mutations in <i>FOXC2</i> Are Strongly Associated With Primary Valve Failure in Veins of the Lower Limb
Authors: Russell H. Mellor, Glen Brice, Anthony W.B. Stanton, Jane French, Alberto Smith, Steve Jeffery, J. Rodney Levick, Kevin G. Burnand, Peter S. Mortimer
Journal: Circulation (2007)

Background— Mutations in the FOXC2 gene cause lymphedema distichiasis, an inherited primary lymphedema in which a significant number of patients have varicose veins. Because lymphedema distichiasis is believed to be caused by lymphatic valve failure (reflux), and FOXC2 is highly expressed on venous valves in mouse embryos, we tested the hypothesis that FOXC2 mutations may be linked to venous valve failure and reflux. Methods and Results— The venous system of the leg was investigated with Duplex ultrasound. Pathological reflux was recorded by color Duplex ultrasound in all 18 participants with a FOXC2 mutation, including 3 without lymphedema. Every participant with a mutation in FOXC2 showed reflux in the great saphenous vein (n=18), compared with only 1 of 12 referents (including 10 family members; P &lt;0.0001, Fisher exact test). Deep vein reflux was recorded in 14 of 18 participants. Conclusions— FOXC2 is the first gene in which mutations have been strongly associated with primary venous valve failure in both the superficial and deep veins in the lower limb. This gene appears to be important for the normal development and maintenance of venous and lymphatic valves.
NOTES ON RHEUMATOID ARTHRITIS
Authors: E. A. Dent
Journal: BMJ (1918)

RHEUMATOID ARTHRITIS.THU BRmU.general it is impracticable to render these' uniform.. How- ever, the conditions pertaining to a particular service may be maintained sufficiently constant for different patients and at repeated examinations of the same case.It is essential that heart-rates should be regarded broadly, and particular!emphasis is. to .belaid upon consistency of separate readings.-Thus, a patient wlho reports himself as disturbed by a given drill, will usually show ,uniform.high readfings, after that drill if distress is genuine; and, these higlh ,readin,gs wvill be foresha:do:wed by raised rates:after drilU of lpwer grade Equally, importaiis con-; sistency between tliese drill -rates, the-routine wa1rd rates, and the rAte obtained by, tes,t exercises'.P This is, ,common.complaint, but one whicih is given for the most part in the initial .stages of treatment.It consists of transient dizziness or dimness of:vision, and is often described as a cloud before the eyes.Rotation of surrounding objects 'is not ,experienced.Giddiness may be felt' after the patient has stood quietly for some while,1 imme- diately,at the cessation.bfeffort, or onxirising to the upriglht position abruptly.An a prognostic sigin it has littl, value... Faintng.Altho4gh, nearly 3,000 patients sent to ua withdanoses of "'D.A.H." or "'V.D.H."' have now been subniitted; to graded drills, there has been no single accident of conse- quence.Where several hundred men are drilled each day, a fainting attack on drill is less than a monthly.incident.The chief form.ofattack, and one which may always be regarded as genuine,.is that accompanied by a feeble and s0ow lheart action (30-50).It may be preceded by a short initerval of giddiness, by a sense of weakness ,or unsteadi- *ness.Consciousness is lost, and the fall is sudden, but rarely heavy.Pallor and sweating are present.;Involun, tary mnovements are slight, and usually confined to, the face
Textbook of Hypertension
Authors: Donald J. Breslin
Journal: JAMA (1996)

This is a comprehensive and well-balanced presentation of the subject. It is of value as a guide and reference for anyone with a particular interest in systemic hypertension. There are 185 contributors from around the world. Major areas covered include epidemiology, the circulation in hypertension, pathogenesis, target organ damage, special subgroups in the hypertensive population, secondary hypertension, clinical assessment, and treatment. The topic of the hypertensive patient in society includes such problems as compliance, treatment, quality of life, and the economics of therapy. Clinical aspects of hypertension are well integrated with extensive discussions of pathophysiology and molecular biology. When the topics are controversial, references are ample and the discussions are well balanced. The depth, clarity, and detail of approach make this an excellent text.
Adenoviral transduction of mouse hematopoietic stem cells
Authors: Steven B Bradfute, Margaret A Goodell
Journal: Molecular Therapy (2003)

Hematopoietic stem cells (HSC) are quiescent, self-renewing cells that can give rise to all blood cell lineages. HSC are an attractive target for gene therapy, due to their differentiation capacity and the number of diseases that result from abnormal HSC function. While human HSC have been shown to be transduced with adenoviral vectors, the adenoviral transduction of mouse HSC has not been extensively studied. We show here that a population of mouse bone marrow highly enriched for HSC (called side population, or SP, cells) can be transduced with adenovirus type 5 (Ad5) at a low multiplicity of infection. Transduced SP cells showed normal in vitro myeloid differentiation potential compared to mock-transduced SP cells. Transduced SP cells retained substantial but reduced in vivo long-term repopulating activity and contributed to all blood cell lineages. Ad5 transduction of mouse SP cells was dependent on coxsackie and adenovirus receptor (CAR), as an anti-CAR blocking antibody greatly reduced transduction. Therefore, adenoviral transduction of mouse HSC can be achieved without ablation of the hematopoietic repopulating activity.