tbuckley/cabot-search huggingface dataset:
Arrhythmias and Cardiac Arrest
Authors: Samuel Berkowitz
Journal: JAMA (1961)

To the Editor:—  In the article, Arrhythmias and Cardiac Arrest Induced by Metaraminol (Aramine) Bitartrate, inThe Journal, Nov. 19, 1960, page 1635, the authors stated that isoproterenol (Isuprel) is a vasodepressor drug which stimulates the myocardium and that methoxamine is a pressor amine with almost purely peripheral action. Both statements are pharmacologically inexact.  Isoproterenol is a vasodepressor (Goodman and Gilman, Pharmacological Basis of Therapeutics , page 533, ed. 2, 1955); it decreases total peripheral vascular resistance as well as vascular resistance in renal, femoral, and mesenteric vascular beds (Kaufman; Iglauer; and Herwitz: Effect of Isuprel [Isopropylepinephrine] on Circulation of Normal Man, Amer J Med  11 :442-447 [Oct.] 1951). Even though isoproterenol is chronotropic and inotropic and usually increases cardiac output and stroke volume, systemic arterial pressure remains essentially unchanged (Dodge; Lord; and Sandler: Cardiovascular Effects of Isoproterenol in Normal Subjects and Subjects with Congestive Heart Failure, Amer Heart J  60
Microscopic Examination of Urine Sediment
Authors: Soo Hwan Pai
Journal: JAMA (1979)

<h3>To the Editor.—</h3> I read the letter from Robert M. Donauer, MD (240:2044, 1978), with much interest. There are two questions I would like to ask the author: Were the urine samples centrifuged before the dipstick tests? What kinds of findings were there among those 12% showing negative chemical screening tests and positive microscopic findings? My own study of roughly 1,000 random urine samples from an active community hospital showed that there is an approximate 6.5% chance that the dipstick will miss the socalled significant microscopic finding. The positive microscopic findings were defined as urine sediment with more than five WBCs per high-power field or more than three RBCs per high-power field or any casts. If I apply the author's criteria to the sample population from this institution, the false-negative rate becomes 3.6%. Dr Donauer may have obtained higher percentages of negative results by dipstick if he used
Management of breast cancer in southeast England
Authors: A M Chouuillett, C M J Bell, J G Hiscox
Journal: BMJ (1994)

<h3>Abstract</h3> <b>Objective</b>: To examine the extent to which management of invasive breast cancer reflected consensus guidelines in the Thames regions in 1990. <b>Design</b>: Population based study of case notes. <b>Setting</b>: Thames Cancer Registry. <b>Subjects</b>: All women with breast cancer diagnosed in early 1990 (417 cases) resident in the four Thames regions. Hospital records were traced for 346 cases, of which 12 were ineligible because of misclassification in initial registration and were excluded from the analysis. 334 cases were analysed. <b>Main outcome measures</b> : Investigations and treatment in the six months after diagnosis, stage of disease. <b>Results</b>: Of the 334 women identified, 86 were aged under 50. Three years after diagnosis, 74 were dead, seven (8%) aged under 50 and 67 (27%) aged 50 or over. Axillary surgery was used to stage cancer in only 155 cases (46%), although this is recommended in the guidelines. Only 79 (24%) case notes had any information recorded on stage. Stage could be determined reliably for only half of the sample. Treatment varied widely within the same age group and stage of disease. In particular, chemotherapy was not routinely given to patients under 50 with stage II disease. Only 17 records showed evidence that the patient was participating in a clinical trial. <b>Conclusions</b> : There was a lack of consensus on the management of breast cancer among clinicians in 1990. More patients should be included in clinical trials.
The forgotten poet laureate
Authors: T. Dalrymple
Journal: BMJ (2009)

<h3>Background</h3> Infliximab is a monoclonal antibody approved for the treatment of inflammatory diseases. The best approach in adjusting the dose of infliximab because of the high interindividual variability in serum concentrations is with a Bayesian approach. <h3>Purpose</h3> Our aim was to estimate the precision and accuracy of five pharmacokinetic models (PopPKmodel) in patients with inflammatory bowel disease. <h3>Material and methods</h3> An observational retrospective study was designed. Patients with ulcerative colitis or Crohn’s disease treated with infliximab during 2014 were included. Trough blood samples for determining infliximab were drawn. Five PopPKmodels were implemented in NONMEM: PopPK in ulcerative colitis and Crohn’s disease. The Infliximab concentrations were estimated from five models at the sample times, through the empirical Bayesian of estimates (EBEs) of the pharmacokinetic parameters. To validate these models, bias of estimated concentrations were calculated as the mean residual predictive error (MRPE) and the precision was calculated as the root mean square predictive error (RMSPE) in our population. <h3>Results</h3> Two hundred and seventy-three serum infliximab concentrations from 160 patients (54% males and 46% females) were included. The mean age was 36 years (CI 95%: 31 to 41), weight 73.1 kg (CI 95%: 71.1 to 75.2) and 3.92 mg/dL (CI 95%: 3.86 to 3.98) baseline serum albumin concentration. 62.5% of patients were diagnosed with Crohn’s disease and 36.3% for ulcerative colitis. The mean trough serum concentration of infliximab was 4.1 mg/L (CI 95%: 3.6 to 4.6). 68.1% of patients were treated with infliximab and 31.9% with biosimilar. Bias of estimated concentrations (MRPE) and precision (RMSPE): <h3>Conclusion</h3> In our study, neither PopPKmodels overestimate infliximab concentrations in the population, although Model 4 was better, (i.e. closer to zero) in terms of bias and accuracy. <h3>Reference and/or Acknowledgements</h3> 1. Fasanmade, et al. 2009: Model 1; 2. Fasanmade, et al. 2011: Model 2; Buurman y col, 2015: Model 3; Dotan y col, 2014: Model 4 and Brandse y col, 2017: Model 5. No conflict of interest
Suicide Prevention Centers: Data From 1970
Authors: David Lester
Journal: JAMA (1974)

To the Editor.—  Recently (225:992, 1973), I reported data from 1968 relevant to the question of whether the introduction of suicide prevention centers to cities in the United States has had an effect on the suicide rates of those cities. The answer was negative. Official statistics for 1969 gave essentially the same answer. 1 Robert Langberg of the National Center forHealth Statistics has recently made available to me data on the suicide rate of the 50 leading metropolitan centers, which permit a further analysis of the effect of suicide prevention centers on the suicide rate.  Eighteen American cities had no suicide prevention center by 1969,thirteen cities are listed as having a suicide prevention center by 1969 but not by 1967, and 16 cities already had suicide prevention centers by 1967. 2,3   The suicide rates of those 47 cities in 1960, 1969, and 1970 are shown in Table 1.
Effects of encainide and its metabolites on energy requirements for defibrillation.
Authors: E S Fain, P Dorian, J M Davy, R E Kates, R A Winkle
Journal: Circulation (1986)

Encainide, a class IC antiarrhythmic agent, has been associated with proarrhythmic responses of ventricular tachycardia and fibrillation requiring defibrillation in patients. We examined the short-term effects of intravenous encainide and its two major metabolites, O-demethyl-encainide (ODE) and 3-methoxy-ODE (MODE), on the energy requirements for successful defibrillation in 25 pentobarbital-anesthetized, open-chest dogs. Truncated exponential (60% tilt) defibrillation shocks were administered through right atrial spring and left ventricular epicardial patch electrodes identical to those used in man with the automatic implantable defibrillator. At baseline multiple shocks of varying energy were applied to construct curves of percent successful defibrillation as a function of energy (DF curves) for each animal. Encainide, ODE, or MODE was then infused in loading and maintenance doses to achieve QRS widening of 20% to 50%. Saline was administered to animals serving as controls. Determination of the DF curve was repeated, after which the infusion was discontinued. After 1 hr washout period, an additional DF curve was constructed. The data were analyzed by logistic regression, and the energies required for 50% successful defibrillation (E50) were compared. No significant differences existed between the four groups in body or heart weight, extent of QRS widening, or baseline E50 values. After administration of encainide and ODE, the E50 increased by 129 +/- 43% (p less than .001) and 76 +/- 34% (p less than .005), respectively. Return of E50 toward baseline was observed after the washout periods in both groups (p less than .025), demonstrating the reversibility of the drugs' effects.(ABSTRACT TRUNCATED AT 250 WORDS)
Evidence for the risk of calcium channel blockers in hypertension was selective
Authors: F. W F Hanna, J. R Peters, J A. Rees
Journal: BMJ (1996)

compared with targets in the Health of the Nation3 a smaller proportion of the fifth of the population in the study that had the highest saturated fat intake smoked cigarettes (14.4% v 20%, the British target for 2000) and this fifth of the population was the only one to derive more than 35% of total food energy from fat (the Brit- ish target for 2005).Mean alcohol consumption was low in all the groups, at below 14 units a week, whereas the Health of the Nation's target for 2005 is to reduce the proportion of adult men drinking 21 units a week to 18% (taking 1 unit as 8.5 g alcohol4).Furthermore, only one group failed to achieve the British target of eating five servings of vegetables and fruit a day.Regardless of the representativeness of the American health professionals, the reported mean serum cholesterol concentration of the groups was remarkably consistent at 5.2-5.3mmol/l.
POSITIVE IDENTIFICATION OF SPHENOID AND ETHMOID SINUSES
Authors: AMEDEE GRANGER
Journal: JAMA (1923)

I admit frankly that if the otolaryngologist had been satisfied with the results obtained from the roentgenographic examinations of the paranasal sinuses, I would never have carried out the experiments which form the basis of this paper. And I feel deeply indebted to my colleagues, the otolaryngologists of New Orleans, for the incentive to undertake this work, and when the experiments were under way, for valuable suggestions and assistance. Later, when the results obtained with dried skulls had to be confirmed on living heads, with and without diseased sinuses, their cooperation and advice became invaluable. I had become thoroughly convinced of the inadequacy and inaccuracy of the findings in roentgenograms intended to show the sphenoid and the ethmoids. I knew of no definite and positive landmarks by which the sphenoid sinus could be identified, and I not only found it difficult and almost impossible when roentgenographing the heads of different
Suppression of Angiotensin-Converting Enzyme Expression and Activity by Shear Stress
Authors: M.J. Rieder, R. Carmona, J.E. Krieger, K.A. Pritchard, A.S. Greene
Journal: Circulation Research (1997)

Shear stress caused by the frictional forces of a fluid moving over a cell monolayer is an important regulator of gene expression. In this study, we investigated the effect of shear stress on angiotensin-converting enzyme (ACE) expression and promoter activity in vitro and on local vascular ACE activity in vivo. ACE activity measured in bovine pulmonary artery endothelial (BPAE) cells was reduced by 49.5% after exposure to a shear stress of 20 dyne/cm 2 for 18 hours. Short-term shearing (2 hours) elevated ACE activity in BPAE cells, whereas long-term shearing produced a time-dependent reduction in ACE activity by 23.3%, 33.5%, and 48.9% at 8, 12, and 18 hours, respectively. Northern blot analysis revealed that shear stress (20 dyne/cm sup 2 for 18 hours) significantly reduced ACE mRNA expression by 82%. To determine the mechanism of ACE activity and message reduction, the effect of shear on transcriptionally related events was determined in a rabbit aortic endothelial cell line (W3LUC) stably transfected with 1.3 kb of a rat ACE promoter/luciferase construct. Different shear stress magnitudes (5 to 20 dyne/cm 2 ) caused suppression of luciferase activity by an average of 40.7%. ACE promoter activity was suppressed by 2 hours of shear stress (24.7%) and was further inhibited at time periods &gt;8 hours. In vivo elevations in shear stress were created by placing a stainless steel clip over a 12-mm region of the rat abdominal aorta. Restriction of vessel diameter increased blood flow velocity and caused reduction in vascular ACE activity by 40%. These studies suggest that elevations in the level of shear stress alter endothelial cell function by suppressing ACE gene and protein expression in vitro and in vivo. (Circ Res. 1997;80:312-319.)
Physicians Tell Washington 'You Want Our Help'
Authors: Charles Marwick
Journal: JAMA (1993)

FACED with inevitable changes in the US health care system, physicians, as the linchpin of all American medical care provision, moved en masse on Washington, DC, late last month to remind the administration and Congress that any reform depends on "the input of medicine." That's what John Lee Clowe, MD, president of the American Medical Association (AMA), told the gathering of more than 1000 physicians, reminding them that a blueprint for change had been put forward by the association 3 years ago. "Health Access America was the first major reform proposal by any national organization," Clowe notes. Raymond Scalettar, MD, chair of the AMA Board of Trustees, characterized the assembled group as "hometown doctors, from every corner of the country, who every day struggle with the unfairness in a system that hinders more than it helps the process of healing." The gathering heard from much of the Washington health care
The Massachusetts Rehabilitation Commission (Medical), Department of Industrial Accidents
Authors: Jacob L. Rudd
Journal: New England Journal of Medicine (1953)

AN explanation of the part that the Massachusetts Rehabilitation Commission plays in the Department of Industrial Accidents requires a brief outline of the workings of the Industrial Accident Board itself.Industrial Accident BoardIn 1911 the General Court of the Commonwealth enacted into law the Massachusetts Workmen's Compensation Act. The Act became effective in 1912 and since then has proved to be one of the most successful legal reforms in Massachusetts.Previously, the victims of industrial accidents found themselves entrapped in a maze of legal entanglements. If they wished to claim damage for their injuries, their only recourse was to . . .
Mentalization: Ontogeny, Assessment, and Application in the Treatment of Borderline Personality Disorder
Authors: Lois W. Choi-Kain, John G. Gunderson
Journal: American Journal of Psychiatry (2008)

This article aims to review the development of the concept of mentalization, its applications in the understanding and treatment of borderline personality disorder, and the issue of its assessment. While conceptually derivative of theory of mind, Fonagy's concept of mentalization concerns more affectively and interpersonally complex understandings of oneself and others, reflecting abilities that enable an individual not only to navigate the social world effectively but also to develop an enriched, stable sense of self. The components of mentalization can be organized around self-/other-oriented, implicit/explicit, and cognitive/affective dimensions. Concepts of mindfulness, psychological mindedness, empathy, and affect consciousness are shown to partially overlap with mentalization within these three dimensions. Mentalization is assessed by the measure of reflective function, a scale to be used adjunctively on semistructured narrative interviews such as the Adult Attachment Interview. Its validity has not been fully tested, and its usage has been hampered by the time and expense it requires. Although the concept of mentalization is a useful heuristic that enables clinicians to adopt a coherent treatment approach, it may be too broad and multifaceted to be operationalized as a marker for specific forms of psychopathology such as borderline personality disorder. Research elucidating the relationship between reflective function, overlapping concepts, and features of borderline psychopathology is needed.
Strongyloides stercoralis hyperinfection associated with cimetidine in an immunosuppressed patient: diagnosis by endoscopic biopsy.
Authors: C C Ainley, D G Clarke, A R Timothy, R P Thompson
Journal: Gut (1986)

Immunosuppression causes Strongyloides stercoralis hyperinfection, but other factors may also be involved. We report a case of S stercoralis hyperinfection in an immunosuppressed patient that followed cimetidine therapy and was diagnosed by endoscopic biopsy.
Propanil Exposure Induces Delayed but Sustained Abrogation of Cell-MediatedImmunity through Direct Interference with Cytotoxic T-LymphocyteEffectors
Authors: James M. Sheil, Marc A. Frankenberry, Todd D. Schell, Kathleen M. Brundage, John B. Barnett
Journal: Environmental Health Perspectives (2006)

The postemergent herbicide propanil (PRN ; also known as 3,4-dichloropropionanilide) is used on rice and wheat crops and has well-known immunotoxic effects on various compartments of the immune system, including T-helper lymphocytes, B lymphocytes, and macrophages. It is unclear, however, whether PRN also adversely affects cytotoxic T lymphocytes (CTLs) , the primary (1 degrees ) effectors of cell-mediated immunity. In this study we examined both the direct and indirect effects of PRN exposure on CTL activation and effector cell function to gauge its likely impact on cell-mediated immunity. Initial experiments addressed whether PRN alters the class I major histocompatibility complex (MHC) pathway for antigen processing and presentation by antigen-presenting cells (APCs) , thereby indirectly affecting effector function. These experiments demonstrated that PRN does not impair the activation of CTLs by PRN-treated APCs. Subsequent experiments addressed whether PRN treatment of CTLs directly inhibits their activation and revealed that 1 degrees alloreactive CTLs exposed to PRN are unimpaired in their proliferative response and only marginally inhibited in their lytic activity. Surprisingly, secondary stimulation of these alloreactive CTL effectors, however, even in the absence of further PRN exposure, resulted in complete abrogation of CTL lytic function and a delayed but significant long-term effect on CTL responsiveness. These findings may have important implications for the diagnosis and clinical management of anomalies of cell-mediated immunity resulting from environmental exposure to various herbicides and other pesticides.
Infection Control in Nursing Homes
Authors: Philip W. Smith
Journal: JAMA (1985)

Approximately 2.1 million infections occur annually in acute care hospitals and 1.5 million occur in nursing homes, according to estimates by the Centers for Disease Control.<sup>1</sup>Several surveys of nursing homes<sup>2-4</sup>and a recent textbook<sup>5</sup>point out that the risk of developing an infection in a nursing home is comparable to the risk of developing a hospital-acquired infection, about 5% to 10% per year. Nursing home beds are categorized as skilled nursing beds or intermediate care beds. Residents in skilled care beds require more intensive nursing, and presumably have a greater risk of developing an institutionally acquired (nosocomial) infection. However, reliable data on comparative infection rates are lacking. Elderly residents of nursing homes are vulnerable to infections because of an age-related waning of immunity, and because of multiple medical problems (eg, cancer, diabetes mellitus, peripheral vascular disease, and incontinence) and therapeutic interventions (eg, urinary catheters and steroid therapy).
Use and Out-of-Pocket Costs of Insulin for Type 2 Diabetes Mellitus From 2000 Through 2010
Authors: Kasia J. Lipska, Joseph S. Ross, Holly K. Van Houten, David Beran, John S. Yudkin, Nilay D. Shah
Journal: JAMA (2014)

Insulin analogs are molecularly altered forms of insulin.Compared with human synthetic and animal insulin for treatment of type 2 diabetes, short-acting analogs may offer flexible dosing and convenience, long-acting analogs less nocturnal hypoglycemia, 1 but both at greater cost. 2 Because insulin analogs have become increasingly popular, 3,4 we examined trends in insulin use, out-of-pocket expenditures, and severe hypoglycemic events among privately insured US adults with type 2 diabetes from 2000 through 2010.
Inhibition of gap junctional conductance by long-chain acylcarnitines and their preferential accumulation in junctional sarcolemma during hypoxia.
Authors: J Wu, J McHowat, J E Saffitz, K A Yamada, P B Corr
Journal: Circulation Research (1993)

Electrophysiological and biochemical sequelae of myocardial ischemia occur within minutes of the onset of myocardial ischemia in vivo. Both conduction delay and conduction block occur rapidly within the same time interval as the accumulation of long-chain acylcarnitines. In the present study, double whole-cell voltage-clamp procedures were used to assess the influence of long-chain acylcarnitines on gap junctional conductance in isolated pairs of canine ventricular myocytes. Long-chain acylcarnitine (5 microM) decreased gap junctional conductance from 153 to 48 nS in a time-dependent and reversible manner. Although the amplitude of junctional current was reduced by 68%, the current continued to demonstrate a linear current-voltage relation. The extent of endogenous accumulation of long-chain acylcarnitines in junctional regions of the sarcolemma was assessed in isolated myocytes in which endogenous free, short-chain, and long-chain acylcarnitine pools had been equilibrated with [3H]carnitine. Under normoxic conditions, long-chain acylcarnitines were not detectable in junctional sarcolemma of myocytes as assessed using electron microscopic autoradiography. Exposure of myocytes to hypoxia (PO2, &lt; 15 mm Hg) for 10 minutes resulted in the preferential accumulation of endogenous long-chain acylcarnitines in junctional sarcolemma (173 +/- 5 x 10(5) molecules/microns 3), a concentration that was sevenfold greater than that found in nonjunctional sarcolemma. Therefore, endogenous long-chain acylcarnitines accumulate preferentially in junctional regions of the sarcolemma during short intervals of hypoxia. Exogenously supplied long-chain acylcarnitines can markedly decrease cellular coupling in a reversible manner, suggesting that this amphiphile may contribute to the marked slowing in conduction velocity in the ischemic heart in vivo, not only by suppressing the rapid Na+ inward current directly, as has been shown previously, but also by decreasing cellular coupling.
Church, Crown and City: changing fortunes in controlling health care
Authors: N. Black
Journal: Journal of the Royal Society of Medicine (2007)

This is the first of four articles, each of which provide the background to one of the walks in a new book, Walking London's Medical History, which aims to tell the story of how health services developed, to help preserve our legacy of buildings and to inform current debates about health care.Walking London's Medical History is available from the RSM Press website: http:// www.rsmpress.co.uk/bkblack2.htmUsually, to enhance our understanding we sit and read books or, nowadays, surf the internet.But it's more fun to go out and literally visit the past, see the buildings where events unfolded and transport yourself back in time.And for the history of health care in England, there is nowhere better to do this than in London.For it was in London that most of the key developments took place: it was here that the key battles were fought over health care policies, where conflicts were resolved and where many innovations occurred.Although some of the important buildings in the history of health care have been destroyed, many remain.