tbuckley/cabot-search huggingface dataset:
Training More Generalists
Authors: Henry Greenberg
Journal: Annals of Internal Medicine (1994)

Letters1 January 1994Training More GeneralistsHenry Greenberg, MDHenry Greenberg, MDSt. Luke's-Roosevelt Hospital Center; New York, NY 10019Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-1-199401010-00031 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:A reduction in specialists and an increase in generalists is being proclaimed as a way to improve care and to reduce costs. Proposals to alter training content seem to focus on a refurbished, second-best category of physician. Reducing accredited specialty training slots, financially supporting residents who opt for primary practice, enlarging the educational base, and lengthening the training period will impose unwelcome constraints. They are unlikely to attract to primary care a cadre of highly competent, devoted, and committed physicians [1].The prism through which I view all reform efforts is that of excellence. Will the proposed ...References1. Fallon HS. Residency reform: a perspective from the Association of Professors of Medicine. 1992; 116:S1042-S115. Google Scholar2. Barondess JA. The future of generalism. Ann Intern Med. 1993; 119: 153-60. Google Scholar3. Stein JH. Grand cru versus generic: different approaches to altering the ratio of general internists to subspecialists. Ann Intern Med. 1991; 114:79-82. Google Scholar Author, Article, and Disclosure InformationAffiliations: St. Luke's-Roosevelt Hospital Center; New York, NY 10019 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 January 1994Volume 120, Issue 1Page: 92-93 Issue Published: 1 January 1994 CopyrightCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Hypoxia-induced endocytosis of Na,K-ATPase in alveolar epithelial cells is mediated by mitochondrial reactive oxygen species and PKC-ζ
Authors: Laura A. Dada, Navdeep S. Chandel, Karen M. Ridge, Carlos Pedemonte, Alejandro M. Bertorello, Jacob I. Sznajder
Journal: Journal of Clinical Investigation (2003)

During ascent to high altitude and pulmonary edema, the alveolar epithelial cells (AEC) are exposed to hypoxic conditions. Hypoxia inhibits alveolar fluid reabsorption and decreases Na,K-ATPase activity in AEC. We report here that exposure of AEC to hypoxia induced a time-dependent decrease of Na,K-ATPase activity and a parallel decrease in the number of Na,K-ATPase α1 subunits at the basolateral membrane (BLM), without changing its total cell protein abundance. These effects were reversible upon reoxygenation and specific, because the plasma membrane protein GLUT1 did not decrease in response to hypoxia. Hypoxia caused an increase in mitochondrial reactive oxygen species (ROS) levels that was inhibited by antioxidants. Antioxidants prevented the hypoxia-mediated decrease in Na,K-ATPase activity and protein abundance at the BLM. Hypoxia-treated AEC deficient in mitochondrial DNA (ρ0 cells) did not have increased levels of ROS, nor was the Na,K-ATPase activity inhibited. Na,K-ATPase α1 subunit was phosphorylated by PKC in hypoxia-treated AEC. In AEC treated with a PKC-ζ antagonist peptide or with the Na,K-ATPase α1 subunit lacking the PKC phosphorylation site (Ser-18), hypoxia failed to decrease Na,K-ATPase abundance and function. Accordingly, we provide evidence that hypoxia decreases Na,K-ATPase activity in AEC by triggering its endocytosis through mitochondrial ROS and PKC-ζ–mediated phosphorylation of the Na,K-ATPase α1 subunit.
1138 IDIOSYNCRATIC DRUG-INDUCED LIVER INJURY (DILI): FOLLOW-UP IN A COHORT OF PATIENTS IDENTIFIED IN 24 TERTIARY CARE CENTRES IN SPAIN
Authors: Y. Borraz, M.C. Fernández, G. Peláez, M. Romero-Gómez, J.A. Durán, A. Melcón de Dios, R. Planas, J. Costa, J.M. Navarro, H. Hallal, S. Blanco, S. Ávila, J.A. Solís-Herruzo, R. Pérez-Álvarez, M. Bruguera, F. Pons, J. Primo, A. Castiella, J. Salmerón, A. Gila, R. Solá, F.J. Rodríguez, J.L. Montero, M. Berenguer, F. Díaz-García, M.I. Lucena, R.J. Andrade
Journal: Journal of Hepatology (2010)
Anaesthetist is struck off UK register after colleagues found he had been dismissed in Ireland
Authors: C. Dyer
Journal: BMJ (2014)

A Hungarian anaesthetist who concealed his proposed erasure from the medical register of Ireland when applying for locum work in England has been struck off by the Medical Practitioners Tribunal Service.

Laszlo Ruscsak applied to work for UK Specialist Hospitals Limited (UKSH) South West in November 2011, a month after an Irish Medical Council panel recommended his erasure for poor professional performance and professional misconduct. He was hired after answering no to a question that asked whether he had been the subject of any investigation or proceedings by a foreign regulatory body.

But a colleague searched his name on the internet and found …
A high resolution map of a cyanobacterial transcriptome
Authors: Vikram Vijayan, Isha H Jain, Erin K O'Shea
Journal: Genome biology (2011)

Abstract Background Previous molecular and mechanistic studies have identified several principles of prokaryotic transcription, but less is known about the global transcriptional architecture of bacterial genomes. Here we perform a comprehensive study of a cyanobacterial transcriptome, that of Synechococcus elongatus PCC 7942, generated by combining three high-resolution data sets: RNA sequencing, tiling expression microarrays, and RNA polymerase chromatin immunoprecipitation sequencing. Results We report absolute transcript levels, operon identification, and high-resolution mapping of 5' and 3' ends of transcripts. We identify several interesting features at promoters, within transcripts and in terminators relating to transcription initiation, elongation, and termination. Furthermore, we identify many putative non-coding transcripts. Conclusions We provide a global analysis of a cyanobacterial transcriptome. Our results uncover insights that reinforce and extend the current views of bacterial transcription.
Successful CD34+ cell mobilization by intermediate-dose Ara-C in chronic lymphocytic leukemia patients treated with sequential fludarabine and Campath-1H
Authors: M Montillo, A Tedeschi, V Rossi, R Cairoli, E Pungolino, L Intropido, A M Cafro, G D'Avanzo, R Farioli, B Brando, B Scarpati, S Veronese, E Morra
Journal: Leukemia (2003)
Diabetes During Diarrhea-Associated Hemolytic Uremic Syndrome
Authors: Rita S. Suri, William F. Clark, Nick Barrowman, Jeffrey L. Mahon, Heather R. Thiessen-Philbrook, M. Patricia Rosas-Arellano, Kelly Zarnke, Jocelyn S. Garland, Amit X. Garg
Journal: Diabetes Care (2005)

OBJECTIVE—To quantify the incidence of diabetes during the acute phase of diarrhea-associated hemolytic uremic syndrome (D+HUS) and to identify features associated with its development. RESEARCH DESIGN AND METHODS—A systematic review and meta-analysis of articles assessing diabetes during D+HUS was conducted. Relevant citations were identified from Medline, Embase, and Institute for Scientific Information Citation Index databases. Bibliographies of relevant articles were hand searched. All articles were independently reviewed for inclusion and data abstraction by two authors. RESULTS—Twenty-one studies from six countries were included. Only 2 studies reported a standard definition of diabetes; 14 defined diabetes as hyperglycemia requiring insulin. The incidence of diabetes during the acute phase of D+HUS could be quantified in a subset of 1,139 children from 13 studies (1966–1998, age 0.2–16 years) and ranged from 0 to 15%, with a pooled incidence of 3.2% (95% CI 1.3–5.1, random-effects model, significant heterogeneity among studies, P = 0.007). Children who developed diabetes were more likely to have severe disease (e.g., presence of coma or seizures, need for dialysis) and had higher mortality than those without diabetes. Twenty-three percent of those who developed diabetes acutely died, and 38% of survivors required long-term insulin (median follow-up 12 months). Recurrence of diabetes was possible up to 60 months after initial recovery. CONCLUSIONS—Children with D+HUS should be observed for diabetes during their acute illness. Consideration should be given to long-term screening of D+HUS survivors for diabetes.
Heading off teenage personality stunting
Authors: John P. Callan
Journal: JAMA (1979)

Prompt treatment of a thought disorder, especially before there is florid schizophrenic disruption, may keep an affected teenager functioning within a normal social and academic range and prevent what could be lifelong personality stunting. These are the views of William M. Easson, MD, professor and head of the Department of Psychiatry and Behavioral Sciences, Louisiana State University School of Medicine, New Orleans. A thought disorder is an inability to think clearly and put one's thoughts into words that make sense to other people. The potential thought disorder patient often speaks in vague and rambling fashion and has difficulty coming to the point. Males and females are equally affected. Speaking to the 11th Annual Taylor Manor Psychiatric Symposium in Ellicott City, Md, recently, Easson noted that teenagers with an early thought disorder consume much energy in keeping their thinking processes integrated. They find that they have to study harder and that
ISOLATION OF BACILLUS TYPHOSUS FROM UNUSUAL LOCALIZATIONS—CHOLECYSTITIS, MENINGITIS AND A FIVE MONTHS' FETUS.
Authors: O. McDANIEL
Journal: JAMA (1902)

The first case to be reported is that of the isolation of B. typhosus from a case of cholecystitis. The patient, a physician, at the time of the attack was in attendance upon typhoid patients in a mild epidemic which occurred during the fall of 1900 in a mining district in the northern part of the state. Through the kindness of Dr. R. E. Cutts, Minneapolis, it is possible to give the following notes from the history: <h3>Case 1.</h3> —Dr. G. A. C., male, aged 24. Family history is negative; there was no history of previous typhoid infection. Present illness began Sept. 30, 1900, with malaise and evening temperature of 100 F. On the second day the patient attended to his work but had some fever and pain in pit of stomach; no pain or tenderness of bowels. Symptoms continued, the evening temperature reaching 103 on the third day. Patient,
STRESS, DEFENSES AND COPING BEHAVIOR: OBSERVATIONS IN PARENTS OF CHILDREN WITH MALIGNANT DISEASE
Authors: PAUL CHODOFF, STANFORD B. FRIEDMAN, DAVID A. HAMBURG
Journal: American Journal of Psychiatry (1964)

Perhaps for too long a time, psychiatrists have drawn their conclusions about behavior from the study of "patients" or deviants. Research on reactions to stress situations attempts to redress this imbalance by paying attention also to persons who handle life's contingencies well. The present paper reports observations on the adaptional behavior of 46 parents of 27 children under treatment for leukemia or other malignant diseases, carried out over a period of approximately 2 years at the Clinical Center of the NIH. Although each parent reacted to the stresses to which he was exposed in a unique and individual manner, a fairly uniform "natural history" of the sequence of adaptational techniques employed by the group as a whole could be observed and is summarized in the paper. The psychic instrumentalities responsible for the stages in this process are conceptualized as coping strategies which are either aided by personality defenses operating within an optimum range or interfered with by defenses when these are ineffective at one extreme of this range or are symptomatically obtrusive at the other. The various defenses employed are listed and described; the most important of these were isolation of affect, denial, and motor activity, and it is suggested that these may have broad application as "normal" defenses. An important, and even urgent need of the parents was to encompass the tragic events unfolded before them within some broad framework of meaning comprehensible in terms of their experiences and beliefs. This "search for meaning," stemming from an inability to tolerate a world in which leukemia strikes a child without apparent rhyme or reason, took various forms such as seeking out some personal agency who could be blamed for the disease or placing it within the inscrutable significance of a religious scheme of things. The process of anticipatory mourning (Lindemann), the gradual detachment of emotional investment from the child, was noted in most cases in which the course of illness was longer than 3 or 4 months, and resulted in a muting of the grief reaction so that the terminal phase and death of the child was often received with an attitude of "philosophical resignation." However, there appeared to be a reciprocal relationship between this process and unusually strong denial defenses, so that in parents in whom the latter were present, the reaction to the death and to post-mortem mourning was likely to be more distressing.
804 MANGANESE SUPEROXIDE DISMUTASE ALA16VAL AND MYELOPEROXIDASE G463A GENETIC DIMORPHISMS MODULATE THE RISKS OF LIVER IRON OVERLOAD AND HEPATOCELLULAR CARCINOMA OCCURRENCE IN PATIENTS WITH ALCOHOLIC CIRRHOSIS
Authors: P. Nahon, A. Sutton, H. Akouche, P. Rufat, M. Ziol, C. Laguillier, N. Charnaux, J.-C. Trinchet, L. Gattegno, M. Beaugrand
Journal: Journal of Hepatology (2009)
Convulsions Associated With Amoxapine
Authors: James W. Jefferson
Journal: JAMA (1984)

To the Editor.—  The report by Litovitz and Troutman entitled Amoxapine Overdose, Seizures, and Fatalities1prompts me to describe three cases from my practice of seizures associated with the therapeutic use of amoxapine.  Report of Cases.—Case 1.—  A 58-year-old man with major recurrent depression of two years' duration previously refractory to antidepressant drugs and electroconvulsive therapy had responded to a combination of lithium and amoxapine. He had no history of seizures or drug or alcohol abuse. At the time of the seizure, his medications included lithium carbonate, 1,200 mg daily in divided dose, amoxapine, 600 mg daily in divided dose, and liothyronine sodium, 25 μg daily. He had a single witnessed partial motor seizure involving his right upper extremity. The amoxapine dose was reduced to 400 mg/day, the liothyronine therapy was discontinued, and during 18 months of follow-up there have been no further seizures. Anticonvulsant drugs were
Efficiency of referral for suspected glaucoma.
Authors: M W Tuck, R P Crick
Journal: BMJ (1991)

To examine the efficiency of referral for suspected glaucoma to general practitioners and consultants by optometrists.A prospective survey covering 5% of all sight tests performed by optometrists in England and Wales over six months, with analysis of referred patients.241 optometrists' practices in areas representative of England and Wales in socioeconomic terms.Of 275,600 people attending for a sight test, 1505 were referred with suspected glaucoma (0.9% of those aged over 4%). Outcomes were recorded for 1228 patients, 1103 (90%) of whom attended for examination by a consultant ophthalmologist (8% on a private basis). The analysis was confined to the 704 cases in which the information on diagnosis was received directly from a consultant or general practitioner.Diagnoses reported by consultant ophthalmologists. Waiting times before an appointment for examination by a consultant ophthalmologist.Glaucoma was confirmed in 283 of the 704 referred patients, and another 222 patients were considered to require further monitoring. In all, 112 (41%) of 275 confirmed cases of glaucoma were in patients with intraocular pressures greater than or equal to 30 mm Hg. At all levels of intraocular pressure the accuracy of referral was greater when the optometrist also recorded the presence of suspicious optic discs or loss of visual field, or both; but only 331 (47%) out of the 704 referred patients had been tested with a field screener. The median waiting time for an NHS clinic appointment was nine weeks. Almost a 10th of confirmed cases of glaucoma were in people in a high risk category for glaucoma who had to wait at least 14 weeks for an appointment.Closer cooperation, especially at the local level, among consultants, general practitioners, and optometrists is needed to improve testing and referral for suspected glaucoma. Optometrists should be encouraged to perform all the three main tests--ophthalmoscopy, tonometry, and perimetry--in patients before referral and to report precisely on reasons for referral to help prioritisation. The optometrist's referral letter to the general practitioner should always be passed on to the consultant. Similarly, the diagnosis should always be reported back to the optometrist.
Pattern analysis, not simplified algorithms, is the most reliable method for teaching dermoscopy for melanoma diagnosis to residents in dermatology
Authors: P. Carli, E. Quercioli, S. Sestini, M. Stante, L. Ricci, G. Brunasso, V. DE Giorgi
Journal: British Journal of Dermatology (2003)

Simplified algorithms for dermoscopy in melanoma diagnosis were developed in order to facilitate the use of this technique by non-experts. However, little is known about their reliability compared with classic pattern analysis when taught to untrained observers.To investigate the diagnostic performance of three different methods, i.e. classic pattern analysis and two of the most used algorithms (the ABCD rule of dermoscopy and the seven-point check-list) when used by newly trained residents in dermatology to diagnose melanocytic lesions. Methods Five residents in dermatology (University of Florence Medical School) were submitted to a teaching programme in dermoscopy based on both formal lessons and training and self-assessment using a newly developed, interactive CD-ROM on dermoscopy. The performance of the three diagnostic methods was analysed in a series of 200 clinically equivocal melanocytic lesions including 44 early melanomas (median thickness 0.30 mm; 25th-75th percentile 0.00-0.58 mm).Pattern analysis yielded the best mean diagnostic accuracy (68.7%), followed by the ABCD rule (56.1%) and the seven-point check-list (53.4%, P = 0.06). The best sensitivity was associated with the use of the seven-point check-list (91.9%), which, however, provided the worst specificity (35.2%) of the methods tested. The interobserver reproducibility, as shown by kappa statistics, was low for all the methods (range 0.27-0.33) and did not show any statistical difference among them.Pattern analysis, i.e. simultaneous assessment of the diagnostic value of all dermoscopy features shown by the lesion, proved to be the most reliable procedure for melanoma diagnosis to be taught to residents in dermatology.
A Novel Role of the NRF2 Transcription Factor in the Regulation of Arsenite-Mediated Keratin 16 Gene Expression in Human Keratinocytes
Authors: Hitoshi Endo, Yoshihiko Sugioka, Yoshihiko Nakagi, Yasuaki Saijo, Takahiko Yoshida
Journal: Environmental Health Perspectives (2008)

Inorganic sodium arsenite (iAs) is a ubiquitous environmental contaminant and is associated with an increased risk of skin hyperkeratosis and cancer.We investigated the molecular mechanisms underlying the regulation of the keratin 16 (K16) gene by iAs in the human keratinocyte cell line HaCaT.We performed reverse transcriptase polymerase chain reaction, luciferase assays, Western blots, and electrophoretic mobility shift assays to determine the transcriptional regulation of the K16 gene by iAs. We used gene overexpression approaches to elucidate the nuclear factor erythroid-derived 2 related factor 2 (NRF2) involved in the K16 induction.iAs induced the mRNA and protein expression of K16. We also found that the expression of K16 was transcriptionally induced by iAs through activator protein-1-like sites and an antioxidant response element (ARE) in its gene promoter region. Treatment with iAs also enhanced the production and translocation of the NRF2 transcription factor, an ARE-binding protein, into the nucleus without modification of its mRNA expression. In addition, iAs elongated the half-life of the NRF2 protein. When overexpressed in HaCaT cells, NRF2 was also directly involved in not only the up-regulation of the detoxification gene thioredoxin but also K16 gene expression.Our data clearly indicate that the K16 gene is a novel target of NRF2. Furthermore, our findings also suggest that NRF2 has opposing roles in the cell--in the activation of detoxification pathways and in promoting the development of skin disorders.
Incidence and associated premorbid diagnoses of patients with chronic rhinosinusitis
Authors: Bruce K. Tan, Rakesh K. Chandra, Jonathan Pollak, Atsushi Kato, David B. Conley, Anju T. Peters, Leslie C. Grammer, Pedro C. Avila, Robert C. Kern, Walter F. Stewart, Robert P. Schleimer, Brian S. Schwartz
Journal: Journal of Allergy and Clinical Immunology (2013)
Does Taking Vitamins at the Time of Conception Prevent Neural Tube Defects?
Authors: Lewis B. Holmes
Journal: JAMA (1988)

The prevention of birth defects is discussed frequently but achieved rarely. Mulinare et al<sup>1</sup>report, in this issue ofTHE JOURNAL, the exciting possibility that the occurrence of anencephaly and spina bifida may be prevented if the pregnant woman takes a multivitamin preparation around the time of conception. Such a simple solution is almost too good to be true. To their credit, Mulinare et al outline several concerns and reservations about their findings. Most important of all, we need confirmation of this finding from other studies. At this time, spina bifida and anencephaly, the most common of the neural tube defects, occur almost always as a surprise in the children of healthy parents. The defects are present by the fourth week of gestation, which is often before the woman knows she is pregnant. If all women were taking a multivitamin preparation at the time of conception, would this birth
President's Address, Delivered at the Fifty-Second Annual Meeting of the British Medical Association
Authors: J. Cuming
Journal: BMJ (1884)

<h3>Aims:</h3> To compare the non-decanted (standard) 4 mg versus the decanted 20 mg intravitreal triamcinolone acetonide (IVTA) injections and to assess their effect on intraocular pressure (IOP). <h3>Methods:</h3> We retrospectively reviewed the records of 92 consecutive eyes, which received an intravitreal injection of either dose of triamcinolone acetonide, at a single retina centre. The change in IOP (elevation of at least 5 mm Hg from baseline or above 21 mm Hg) was analysed with a multivariate logistic analysis. The mean follow-up period in both groups was 27 weeks. A subgroup analysis comparing vitrectomised to non-vitrectomised eyes in both groups was also performed. <h3>Results:</h3> Of the 92 eyes, 46% (23 of 51) in the 4 mg group versus 30% (12 of 41) in the 20 mg group had an IOP &gt;21 mm of Hg (p = 0.14) after a mean follow-up period of 27 weeks. The vitrectomised eyes (3 of 24) in the 20 mg group had a significantly lower rate of IVTA induced IOP elevation than the non-vitrectomised eyes (9 of 17) (p = 0.013). The IOP elevation occurred significantly earlier in the 4 mg group (vitrectomised eyes 27 (SD 43) days and non-vitrectomised eyes 61 (52) days) than in the 20 mg group (vitrectomised eyes 104 (56) days and non-vitrectomised eyes 119 (82) days), independent of the vitreous status (vitrectomised p = 0.05 and non-vitrectomised p = 0.04). The mean value of initial high IOP in the non-vitrectomised eyes was higher in the 4 mg group than in the corresponding 20 mg group (p = 0.048). <h3>Conclusion:</h3> Decanted 20 mg IVTA may not pose a significantly greater risk of IOP elevation than the 4 mg non-decanted IVTA.
Bacillus Species Pseudosepsis Caused by Contaminated Commercial Blood Culture Media
Authors: Robert C. Noble
Journal: JAMA (1974)

Following Jan 1, 1974, an increased number of positive blood cultures was noted for<i>Bacillus</i>species. Epidemiologic investigation implicated at least two lots of commercially prepared blood culture bottles as the cause of the isolates. (<i>JAMA</i>230:1002-1004, 1974)