tbuckley/cabot-search huggingface dataset:
Academic medicine: who is it for?
Authors: Sian M Griffiths
Journal: BMJ (2005)

Editor—Much of the correspondence on the future of academic medicine has focused on the clinical specialties.1,2 Many of the problems are common to public health. The recent survey by the Council of Heads of Medical Schools makes it clear that public health medicine faces the most severe problems.3

The first is the overall changes in post since 2000: public health is the most negatively affected of all specialties with a loss of 32%. When this is put alongside the drop in pathology, a loss of 25%, this is particularly harmful for the future of academic health protection.

The second problem is changes by grade since 2000: a 20% loss of professors; a 22% loss of readers or senior lecturers; and a 59% loss of lecturers.

The third problem is that public health medicine has also lost most in funding from outside sources.

These figures speak for themselves in describing the parlous state of academic public health. However, the chief medical officer's report, while voicing general concern about academic medicine failed to make this point. A recent report by the Well-come Foundation highlights the common problems faced by public health.4 Its recommendations are:



An overarching national strategy needs to be developed to secure the future of the public health sciences at a time when the UK health services are being refocused towards the promotion of good health and the prevention of illness


The academic infrastructure for public health sciences at all levels needs to be strengthened through coordinated, long term investment


The partnership between universities and the NHS in the public health field should be re-established, and public health centres could be established to bring together public health science, social science, and public health service delivery


The practical aspects of the regulatory framework need to be streamlined as these processes can act as a strong cumulative dis-incentive to embarking on public health research and may divert resources unnecessarily away from this area


A more informed dialogue between public health scientists, the public, policy makers and the media must be engendered to develop a better understanding of risk in relation to health.






Choosing health gives us an opportunity to do something about this. Let's hope it is taken.
Meeting the challenge of population ageing
Authors: Y. Doyle, M. McKee, B. Rechel, E. Grundy
Journal: BMJ (2009)

Increased longevity poses a challenge to the welfare state, but the problems can be overcome, argue Yvonne Doyle and colleaguesThe welfare state is based on a life course that no longer matches current experience.It assumes that people, or at least men and unmarried women, spend their early years in education and then go on to a long period in work followed by a short period in retirement, when they live off the pension accumulated while in work or, more usually, the tax and pension contributions of those still in work.At a time when many people did not survive to draw their pensions or, if they did, survived for only a few more years, welfare systems coped reasonably well.It is less clear whether they will be able to do so in the future.The scale of the challenge is shown by a single stark statistic.If there is no change in work and retirement patterns, the ratio of workers to older inactive persons in the countries that were European Union member states in May 2004 (the EU25), now at 3:1, is projected to increase to 1:1 in 2050.1 Threat or opportunity?Do ageing populations pose a fundamental threat to the sustainability of welfare states, as many media commentators argue?2 3 Or can we adapt in ways that can accommodate ageing populations without abandoning the social solidarity that has prevailed in the postwar period?Much will depend on whether we can create societies that enable people to remain healthy, employed, and economically secure.4Such societies would embrace the principles set out in the 2002 United Nations International Plan of Action on Ageing, which encourages governments to release the potential of older people by maximising their participation in society.5However, if this is to be achieved, many policies will have to be reassessed. Working longerPeople in almost all industrialised countries live longer after retirement age than ever before.
Importance of left ventricular systolic function in the assessment of left ventricular diastolic function with doppler transmitral flow velocity recording
Authors: Yoshihiro Himura, Toshiaki Kumada, Masashi Kambayashi, Wataru Hayashida, Noboru Ishikawa, Yasuyuki Nakamura, Chuichi Kawai
Journal: Journal of the American College of Cardiology (1991)
Treadmill Stress Tests as Indicators of Presence and Severity of Coronary Artery Disease
Authors: NORA GOLDSCHLAGER
Journal: Annals of Internal Medicine (1976)

The configuration, time of onset, and duration of depressed ST segments during and after treadmill exercise testing were evaluated in 269 patients with angiographically proven coronary artery disease and 141 normal subjects. The test specificity was 93% and sensitivity 64%, the latter being influenced by the type of ST response; false-positive responses were rare with depressed, downsloping STs (1 of 123, 1%), occurred more frequently with horizontal ST depression (9 of 60, 15%), and occurred commonly with slowly upsloping STs (15 of 47, 32%). Depressed downsloping STs, ischemic changes appearing in the first 3 minutes of exercise, and those persisting past 8 minutes in recovery were associated with 91%, 86%, and 90% prevalences of two- to three-vessel or main left coronary disease, respectively. It is concluded that attention to configuration, time of onset, and duration of ischemic ST depression aids both in assessing the validity of exercise responses in diagnosing coronary artery disease and in delineating patients with advanced coronary obstruction.
Monitoring ambulatory blood pressure in general practice.
Authors: C. Silagy, M. Lawrence, D. Ebbs, D. Mant, J. Conway, S. Clark, A. Coats
Journal: BMJ (1992)

death reported by Lim2 is unlikely to have been due to flumazenil,4 while the mechanism of action in the death reported by Burr et al was a withdrawal of the protective action of benzodiazepines in a patient who had taken a multiple drug overdose.3The same mechanism also explains the precipitation of ventricular arrhythmias in the report that Katz and colleagues quote in support of their own case.5Benzodiazepines have a dampening effect on sympathetic nervous system activity,6 and animal studies suggest that they can increase the electrical stability of the heart in patients with acute myo- cardial infarction.7There is little doubt that sympathetic activity in restless, waking, intubated patients is increased.This is primarily the result of irritation due to the endotracheal tube, a response that is augmented in the presence of hypoxia or pain, or both.In this setting reversing sedation with flumazenil unmasks increased sympathetic drive and cardiac electrical instability, thereby precipitating ventricular arrhythmias in an already severely damaged myocardium with compromised left ventricular function.The conclusion can be only that the fatal drug actions in this case are similar to those reported elsewhere.35There is no evidence for any direct cardiac effect of flumazenil.
Invasive and noninvasive assessment of cerebral oxygenation in patients with severe traumatic brain injury
Authors: Santiago R. Leal-Noval, Aurelio Cayuela, Victoria Arellano-Orden, Antonio Marín-Caballos, Vicente Padilla, Carmen Ferrándiz-Millón, Yael Corcia, Claudio García-Alfaro, Rosario Amaya-Villar, Francisco Murillo-Cabezas
Journal: Intensive Care Medicine (2010)
Scintigraphic Findings in a Primary Cerebral Amyloidoma
Authors: Albert J. Moreno, Jerry M. Brown, Tommy J. Brown, Gordon D. Graham, Michael A. Yedinak
Journal: Clinical Nuclear Medicine (1983)

Bone, brain, and gallium scintigrams are presented of a 48-year-old man with biopsy-proven cerebral amyloidosis. Brain scintigraphy revealed a well-circumscribed accumulation of Tc-99m pertechnetate in the amyloidoma. Bone scintigraphy using Tc-99m methylenediphosphonate likewise exhibited increased activity in the same area. Gallium-67 citrate, however, failed to localize within the amyloidoma.
Lung Cancer in a U.S. Population with Low to Moderate Arsenic Exposure
Authors: Julia E. Heck, Angeline S. Andrew, Tracy Onega, James R. Rigas, Brian P. Jackson, Margaret R. Karagas, Eric J. Duell
Journal: Environmental Health Perspectives (2009)

BackgroundLittle is known about the carcinogenic potential of arsenic in areas with low to moderate concentrations of arsenic (< 100 μg/L) in drinking water.ObjectivesWe examined associations between arsenic and lung cancer.MethodsA population-based case–control study of primary incident lung cancer was conducted in 10 counties in two U.S. states, New Hampshire and Vermont. The study included 223 lung cancer cases and 238 controls, each of whom provided toenail clippings for arsenic exposure measurement by inductively coupled–plasma mass spectrometry. We estimated odds ratios (ORs) of the association between arsenic exposure and lung cancer using unconditional logistic regression with adjustment for potential confounders (age, sex, race/ethnicity, smoking pack-years, education, body mass index, fish servings per week, and toenail selenium level).ResultsArsenic exposure was associated with small-cell and squamous-cell carcinoma of the lung [OR = 2.75; 95% confidence interval (CI), 1.00–7.57] for toenail arsenic concentration ≥ 0.114 μg/g, versus < 0.05 μg/g. A history of lung disease (bronchitis, chronic obstructive pulmonary disease, or fibrosis) was positively associated with lung cancer (OR = 2.86; 95% CI, 1.39–5.91). We also observed an elevated risk of lung cancer among participants with a history of lung disease and toenail arsenic ≥ 0.05 μg/g (OR = 4.78; 95% CI, 1.87–12.2) than among individuals with low toenail arsenic and no history of lung disease.ConclusionAlthough this study supports the possibility of an increased risk of specific lung cancer histologic types at lower levels of arsenic exposure, we recommend large-scale population-based studies.
Adolescent Tobacco Use and Physical Activity-Reply
Authors: Luis G. Escobedo
Journal: JAMA (1993)

Prevalence and Odds Ratios for Regular and Heavy Smoking, by Physical Activity Variables, 1990 Youth Risk Behavior Survey Physical Activity Variable Regular Smoking Among Ever Smokers Heavy Smoking Among Current Smokers Sample Size Prevalence, % Odds Ratio (95% CI)* Sample Size Prevalence, % Odds Ratio (95% CI)* Physical education None 6143 Referent 1769 38 Referent No activity 1126 24 1.3(0.9-1.7) 325 36 1.2 (0.9-1.6) Activity 3707 0.9 (0.8-1.1) 970 29 0.8 (0.7-1.0) Unknown 85 21 Community programs, d/mo None 7393 23 Referent 2129 37 Referent 2267 18 0.9 (0.7-1.0) 1.0 (0.7-1.3) 1388 15 0.9 (0.7-1.1) 332 25 0.8 (0.5-1.1) Unknown 13 Vigorous activity, d/mo None 2249 24 Referent 624 Referent 1-2 2329 23 0.9 (0.8-1.0) 687 0.9 (0.7-1.1) 3-5 2428 1.0 (0.8-1.1) 694 34 0.7 (0.5-0.9) 6-8 1290 19 0.8 (0.6-1.0) 0.5 (0.4-0.7) 2742 0.8 (0.6-1.0)† 703 29 0.7 (0.5-0.9)† Unknown 23 *Odds ratios are adjusted for age, race/ethnicity, sex, perceived school
A STUDY OF THE THERAPEUTIC MECHANISM OF ANTI-PNEUMOCOCCIC SERUM ON THE EXPERIMENTAL DERMAL PNEUMOCOCCUS INFECTION IN RABBITS
Authors: Arnold J. Gelarie, Albert B. Sabin
Journal: The Journal of Experimental Medicine (1933)

The purpose of the present investigation was to determine whether or not non-specific agents were capable of exerting any influence on the response of pneumococcus-infected animals to specific serum therapy. It has been demonstrated in these experiments that whereas gold (empirically chosen) by itself had very little effect either on the course or the outcome of the experimental pneumococcus infection, it is nevertheless capable of exerting a definite and marked beneficial effect in rabbits treated with a subeffective dose of the specific antiserum. Of the rabbits treated with the subeffective dose of serum alone, 71 per cent died and only 29 per cent survived; the additional administration of gold reversed this death-survival ratio with the result that of a large group of rabbits which received the combined therapy, 77 per cent survived and only 23 per cent died.
Vitamin K and childhood cancer.
Authors: R. J. Lilford, J. G. Thornton
Journal: BMJ (1992)

Suissa and colleagues raise three issues.Firstly, they suggest that the relative risk of 2-0 for fenoterol explains only a small proportion of the epidemic.Our study was based on prescribed drug treatment rather than that actually taken'; this non-differential information bias would tend to decrease the observed odds ratios towards 1.0.2Secondly, they suggest that the epidemic could have been due to overuse of all inhaled B agonists.A similar error was recently made by Staudinger and Haas.'In fact, sales of all B agonists in New Zealand increased considerably only after 1979, three years after the onset of the epidemic,4 in response to suggestions that B agonists should be used regularly rather than on demand.The large relative risks for all B agonists in the Saskatchewan study emerged only in the questionable multi- variate analysis,5 and probably tell us more about overuse of multivariate analysis than overuse of B agonists.
Mechanism of Synchronization in Isorhythmic Dissociation
Authors: MATTHEW N. LEVY, HARRISON ZIESKE
Journal: Circulation Research (1970)

Third degree heart block was produced in anesthetized dogs by injecting 95% ethanol into the region of the A-V node. When the ventricles were paced artificially at a constant rate near the spontaneous rate of the S-A node, then the atria and ventricles became synchronized. During synchronization, the P wave oscillated rhythmically around the QRS. When the P preceded the QRS, the arterial blood pressure increased, whereas when the P wave followed the QRS, the blood pressure fell. Synchronization depended on such rhythmical fluctuations in blood pressure because (1) when the blood pressure changes were severely attenuated, synchronization ceased, and (2) simulation of the blood pressure changes by means of a servo-controlled pump also produced synchronization. A biological control system operates in such a way that (1) the P-R interval affects blood pressure by virtue of changes in the atrial contribution to ventricular filling; (2) the blood pressure has an inverse effect on atrial frequency through the baroreceptor reflex, and perhaps other mechanisms; and (3) changes in atrial frequency alter the P-R interval, to complete the control loop.
Assisted Ventilation at Home: A Practical Guide
Authors: J M Shneerson
Journal: BMJ (1994)

W J M Kinnear Oxford University Press, £19.50, pp 100 ISBN 0-19-262400-8

Increasing numbers of patients are being cared for with assisted ventilation in their homes, and the trend is likely to continue. Dr Kinnear's concise handbook explaining the essentials of this type of treatment is thus timely.

Clearly written and well illustrated, the book presents a sensible middle of the road approach. Its strength is the description of …
Penile ulceration in Crohn's disease.
Authors: S S Rao, P A Cann, C D Holdsworth
Journal: Gut (1986)

Penile ulceration in Crohn's disease SIR,-We read with interest the well documented cases of penile ulceration by Slaney et al (Gut 1986; 27: 329).We wish to describe a case of pyoderma gangrenosum affecting the penis in a patient with Crohn's disease, which had certain similarities.A 46 year old man presented with a few months history of bloody diarrhoea.A barium enema showed characteristic features of Crohn's disease affecting the transverse and descending colon with skip lesions.A small bowel enema was normal.He was treated with prednisolone and sulphasalazine and made a good recovery.Six months later he developed a discharging punched out ulcer on the skin in the interscapular area.The ulcer had typical features of a pyoderma gangrenosum which was confirmed by histology and responded to a local injection of Triamcinolone.At the same time he developed a rapidly enlarging tender nodular lesion on the dorsum of his penis which was excised.Histology showed granulation tissue and the excision resulted in a large ulcer similar to that shown in Fig. 3 of the article by Slaney et al.There was no serological or cytological evidence for a sexually transmitted di- sease.As the ulcer was discharging seropurulent material, was tender and unresponsive to local antibiotics and topical steroids, a six weeks course of oral prednisolone was given.This resulted in a complete healing of the ulcer.Two months later, however, he developed another nodular lesion at the junction of the glans and the shaft of the penis which was also excised.Histology showed typical features of pyoderma gangrenosum.The excision resulted in an ulcer which once again was refractory to topical treatment.In addition, he developed an indurated area 1 cm distal to the ulcer.These lesions failed to heal over the next four months in spite of treatment with oral prednisolone, supplemented later with azathioprine, but healed completely within six weeks of the injection of 2 mg Triamcinolone between the two lesions.During this period, his colitis was in remission.Eighteen months later he remains well and has had no further recurrence of his penile lesions.Our patient shows some differences from the two reported by Slaney et al, although the clinical presentation was similar to that of case 2. Firstly, the penile lesion was a pyoderma gangrenosum rather than an epithelioid granuloma.Secondly, the ulcer did not respond to topical steroids but initially healed with oral steroids and a recurrence healed only after local injection of a corticosteroid drug.As
Gene therapy experiments put on "clinical hold"
Authors: J. Ciment
Journal: BMJ (2000)

The Food and Drug Administration (FDA) temporarily shut down a series of human gene therapy experiments at the University of Pennsylvania last month following the death of Jesse Gelsinger, an 18 year old man from Arizona who was being treated for a liver disorder.

The order to place the university's entire gene therapy programme on indefinite “clinical hold” came two days after inspectors issued a report noting 18 specific violations of government protocols.

The administration said …
Agranulocytosis and Jaundice during Therapy with Meprobamate and Promazine
Authors: Andrew J. Zweifler
Journal: New England Journal of Medicine (1960)

IT is now well recognized that tranquilizing drugs are capable of producing a variety of untoward reactions, some major and some minor. In an effort to eliminate or at least to minimize such reactions the producers of these drugs have developed an increasing number of analogues, which, they hoped, would be less toxic than the original preparations. More recently, in keeping with the current trend toward proprietary drug combinations,1 mixtures of these drugs have been prepared and tested. One of these mixtures is a combination of meprobamate with promazine.‡ The purpose of this paper is to report 3 cases of . . .
Photodye Herpes Therapy
Authors: Alfred W. Kopf
Journal: JAMA (1978)

<h3>To the Editor.—</h3> We are referring to the recent article "Photodye Herpes Therapy—Cassandra Confirmed?" by Berger and Papa (238:133-134, 1977). A similar patient with multiple papules on the penis, with histologic features of squamous-cell carcinoma in situ, was recently reported by Kopf and Bart.<sup>1</sup>This patient also had photochemotherapy for herpes simplex prior to the development of bowenoid papules of the penis. We will soon publish our experience with 11 young men who have multiple lesions of squamous-cell carcinoma in situ on the penis. Of great importance is the fact that only three of the 11 patients received photodye treatments. Therefore, photochemotherapy is<i>not</i>related to this penile condition in most cases if, indeed, it is in any.
Pathophysiologic Interpretation of Time Activity Curves in Dynamic Bone Imaging
Authors: R W McCULLOUGH, E J GANDSMAN
Journal: Clinical Nuclear Medicine (1988)

Reported here is a theoretical model based on a literature review correlating the 60 sec/25 min time activity curves (TAC) of dynamic bone imaging with the histologic components of bone. Information regarding healing versus nonhealing as well as a histophysiologic description of ongoing disease is obtainable from TACs of paired disease and nondiseased limbs. The TACs reflect the movement of Tc-99m MDP complexes across histologic compartments to reach the amorphous calcium phosphate (ACP) regions. These complexes must exit the bone capillaries, pass through the perivascular space, cross the osteoblastic barrier, enter the bone fluid space, and traverse collagen osteoid to reach ACP. The presence of diseases such as osteomyelitis, cellulitis, and degenerative arthritis and septic arthritis variously affect these spaces to cause typical perturbations in the TACs. The distinction of these patterns were observed in 48 patients, 12 per category. The model that explains how 60 sec/25 min TACs can reflect the histologic status of ongoing bone disease was applied to these disorders.
Guidance on withholding and withdrawing treatment of sick children to be updated
Authors: I. Torjesen
Journal: BMJ (2013)

The Royal College of Paediatrics and Child Health is reviewing its guidance on withholding and withdrawing medical treatment of sick children, amid continuing controversy over a national newspaper story alleging that some sick children have been placed on the Liverpool care pathway.

Simon Newell, the college’s vice president for training and assessment, told the BMJ that he did not expect any radical changes to its existing guidance, which was published in 2004 so is due for updating,1 when it is published in the next few months. But he admitted that the publication is timely, with the Liverpool care pathway and euthanasia having featured recently in the national press.

In November 2012 the Daily Mail ran a front page story entitled, “Now sick babies go on death pathway,” as part of its campaign to expose alleged misuse of the Liverpool care pathway. The story claimed that NHS hospitals were discharging …