tbuckley/cabot-search huggingface dataset:
Surviving a viva
Authors: I. Fraser
Journal: Journal of the Royal Society of Medicine (2005)

Mr Cascarini and Professor Lowe's advice to viva candidates (October 2004 JRSM1) will have struck a chord with many past examinees and certainly did so in this examiner. Correctly the authors summarize the essentials for a pass— possess a thorough knowledge and convey this to the examiners. For most serious candidates an oral examination comes down to good communication skills in convincing revered examiners of a safe understanding of the subject.

I suspect anxiety or examination nerves substantially degrade the performance of many candidates and steps can reasonably be taken to overcome these. After all, there is a huge difference between dealing with colleagues and relatives and communicating with an examiner who appears to hold all the cards. My advice is to use a modest dose of a beta-blocker such as propranolol. These agents remove the debilitating effects of the adrenalated state without lessening the pressure to perform well. Experience from lecturing in stressful situations has demonstrated that a degree of beta-blockade allows one to handle aggressive questioning with an apparent time advantage in understanding the point of the question and arranging a suitable reply even before the questioner has finished.

Educationalists question the validity of the oral examination process because of variables such as examination nerves. Could anyone object to minimizing this variable by pharmacological means? Is it unfair? I think not. Be careful, however, of pharmacological interactions immediately after the examination when comparing notes in the bar.
A UNIQUE CASE OF VESICAL CALCULUS.
Authors: D. C. HUFFMAN
Journal: JAMA (1902)

James Trimble, Co. D, 63d Pennsylvania, aged 62 years, says he was wounded at the second battle of Bull Run, Aug. 29, 1862, while in a kneeling posture, by a ball which entered the inner side of the left thigh about five inches below the groin. A puckering cicatrix verifies his statement. He says he was treated in the army hospital, where futile efforts were made to locate the ball; that the wound healed uninterruptedly, and that he was soon enjoying his usual good health. During January, 1902, he commenced to have vesical derangement and was troubled more or less until July 30, 1902, when he was admitted to hospital with retention of urine. An attempt to catheterize him was made, but was unsuccessful; the catheter could not be passed beyond the prostatic portion of the urethra, where it met a hard resisting substance. On palpation, a hard tumor about
NCI Trial Hearing Elicits Vow of More Oversight
Authors: Charles Marwick
Journal: JAMA (1994)

A CONTRITE quintet of National Institutes of Health administrators have told Congress that never again will they allow fraudulent data from studies to go uncorrected and unreported in the professional literature—even if they think there is little medical or public health significance. The occasion was a hearing held by Rep John D. Dingell (D, Mich), chair of the Subcommittee on Investigations and Oversight of the House Energy and Commerce Committee. At issue was the failure of the National Cancer Institute (NCI) to adequately disseminate to the scientific community, and especially to the participants, the finding that data regarding some patients in one center of a multicenter study of breast cancer treatment were falsified. The fact that this fabrication did not affect the findings of the study was, hearing participants agreed, no excuse. "It is very clear that the methods used to announce the results of this misconduct were not adequate,
Minocycline in Rheumatoid Arthritis
Authors: Harold W. Clark
Journal: Annals of Internal Medicine (1995)

Letters1 September 1995Minocycline in Rheumatoid ArthritisHarold W. Clark, PhDHarold W. Clark, PhDMycoplasma Research Institute; Beverly Hills, FL 34464-0040Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-5-199509010-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The recent editorial by Dr. Paulus [1], although of great interest, was flawed by inaccurate and missing information.Dr. Paulus stated that in 1968, Sanchez … first reported the use of tetracycline to treat 14 patients with rheumatoid arthritis, with favorable results. Apparently, the author was unaware that Dr. Thomas McPherson Brown started to treat patients with rheumatoid arthritis 20 years earlier, in 1947, with aureomycin when the drug was first available and provided by Lederle Laboratories. Dr. Brown and colleagues first reported the beneficial effects of tetracyclines in 1949 at the Seventh International Congress on Rheumatic ...References1. Paulus HE. Minocycline treatment of rheumatoid arthritis [Editorial]. Ann Intern Med. 1995; 122:147-8. Google Scholar2. Brown TM, Wichelhauser RH, Robinson LB, Merchant WR. The in vivo action of aureomycin on pleuropneumonia-like organisms associated with various rheumatic disease. J Lab Clin Med. 1949; 34:1404-10. Google Scholar3. Brown TM, Wichelhauser RH, Merchant WR, Robinson LB. A study of the antigen-antibody mechanism in rheumatic diseases. Am J Med Sci. 1951; 221:618-24. Google Scholar4. Brown TM, Clark HW, Bailey JS, Gry CW. A Mechanistic approach of rheumatoid-type arthritis naturally occurring in a gorilla. Trans Am Clin Climatol Assoc. 1970; 82:227-47. Google Scholar Author, Article, and Disclosure InformationAffiliations: Mycoplasma Research Institute; Beverly Hills, FL 34464-0040 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCritical data-based re-evaluation of minocycline as a putative specific microglia inhibitor 1 September 1995Volume 123, Issue 5Page: 393KeywordsClinical trialsDoxycyclineDrugsImmunosuppressivesMycoplasmaMycoplasma pneumoniaePneumoniaRheumatoid arthritisSwineTetracyclines Issue Published: 1 September 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Acute management of myocardial infarction with ST-segment elevation: summary of NICE guidance
Authors: S. Carville, M. Harker, R. Henderson, H. Gray
Journal: BMJ (2013)

The incidence of myocardial infarction has been declining in the UK over the past 25 years,1 2 but it varies between regions and still averages more than 600 hospitalised cases of ST-segment elevation myocardial infarction (STEMI) per million people each year.3 4 The case fatality rates after myocardial infarction have also fallen, which has been attributed to improved access to effective treatments.5 The over-riding priority in the management of STEMI is to restore coronary perfusion rapidly and effectively, thereby limiting the extent of damage to myocardium and reducing the likelihood of death or future heart failure. Coronary reperfusion can be achieved by fibrinolysis (with agents such as reteplase and tenecteplase) or by mechanical reopening of the occluded artery by angioplasty and stent insertion (primary percutaneous coronary intervention). This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on the delivery of effective and timely coronary reperfusion treatment for people with STEMI.6 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets. ### Assess eligibility for coronary perfusion therapy
Unfavorable Effects of Resistance Training on Central Arterial Compliance
Authors: Motohiko Miyachi, Hiroshi Kawano, Jun Sugawara, Kouki Takahashi, Kouichiro Hayashi, Ken Yamazaki, Izumi Tabata, Hirofumi Tanaka
Journal: Circulation (2004)

Reductions in the compliance of central arteries exert a number of adverse effects on cardiovascular function and disease risk. Endurance training is efficacious in increasing arterial compliance in healthy adults. We determined the effects of resistance training on carotid arterial compliance using the intervention study design.Twenty-eight healthy men 20 to 38 years old were randomly assigned to the intervention group (n=14) and the control group (n=14). Control subjects were instructed not to alter their normal activity levels throughout the study period. Intervention subjects underwent 3 supervised resistance training sessions per week for 4 months and detraining for a subsequent 4 months. The resistance training increased maximal strength in all muscle groups tested (P<0.001). There were no significant differences in baseline arterial compliance and beta-stiffness index between the intervention and control groups. In the intervention group, carotid arterial compliance decreased 19% (P<0.05), and beta-stiffness index increased 21% (P<0.01) after resistance training. These values returned completely to the baseline levels during the detraining period. Arterial compliance did not change in the control group. In both groups, there were no significant changes in brachial and carotid blood pressure, carotid intima-media thickness, lumen diameter, and femoral arterial compliance. Changes in carotid artery compliance were significantly and negatively related to corresponding changes in left ventricular mass index (r=-0.56, P<0.001) and left ventricular hypertrophy index (r=-0.68, P<0.001).In marked contrast to the beneficial effect of regular aerobic exercise, several months of resistance training "reduces" central arterial compliance in healthy men.
Progress in Medical Genetics
Authors: Walter E. Nance
Journal: JAMA (1968)

Steinberg and Bearn have again succeeded in putting together a diverse and instructive collection of papers on human genetics in the fifth volume of this excellent series. This year's offerings include a brief but provocative essay on the nature-nurture problem by René Dubos and four scholarly reviews of the thalassemias (D. J. Weatherall), the porphyrias (J. Waldenström and Birgitta Haeger-Aronsen), the muscular dystrophies (A. E. H. Emery and J. N. Walton), and the genetic hepatopathies (Sheila Sherlock). Every reader will have his own favorite, but it is hard to imagine a more informative and concise review of such a complex and important field as the thalassemias than Weatherall's 49-page summary. The evidence for clinical and genetic heterogeneity is clearly set forth; however, there is as yet no evidence for the existence of γ thalassemia, as an unfortunate and confusing typographical error may lead the reader to believe. This volume can
MEDICAL AND HYGIENIC EXHIBITS AT THE LOUISIANA PUECHASE EXPOSITION.
Authors: GUY HINSDALE
Journal: JAMA (1904)

<h3>II. FOREIGN EXHIBITS.</h3><h3>GERMANY.</h3> Of the foreign governments Germany makes the most interesting and complete display. It is distributed through several buildings, chiefly in the Palace of Education and Social Economy and the Liberal Arts building. Germany's special building, which is a copy of the Charlottenburg Palace, has no medical exhibit. The German government has spent a million dollars to properly represent Germany at the World's Fair and the result is most admirable and most instructive. The city of Berlin, the Royal Prussian Ministry for Medical Affairs and the Imperial Board of Health have made a most systematic exhibition. Germany shows a model representing her growth in population from 24,833,000 in 1816 to 56,307,000 in 1900; as a nation they are reaping the benefits of an enlightened national board of health and a rigid system of sanitation. The vital statistics of Berlin show that the death rate has fallen steadily,
Calreticulin mediates immune recognition of acute myeloid leukemia cells in vivo
Authors: Xiufen Chen, Dominick Fosco, Douglas E Kline, Justin Kline
Journal: Journal for ImmunoTherapy of Cancer (2013)

Meeting abstracts Calreticulin (CRT) is a chaperone protein which normally resides in the endoplasmic reticulum (ER). However, recent studies have demonstrated that pre-apoptotic cancer cells release internalized CRT to their surface prior to death, and this surface exposure of CRT acts as an ‘
A5.10 Therapeutic education of patients treated for osteoarthritis: Medical advice and assessment of patients knowledge level
Authors: K Nassar, S Janani, W Rachidi, O Mkinsi
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Introduction</h3> Osteoarthritis is the most common and debilitating degenerative arthropathy. Prevention and patient education are part of the international recommendations. A survey was realised between January and July 2012 with 43 medical specialists at the Hospital University of Casablanca, about their point of views on the role of therapeutic education for patients with osteoarthritis of the lower limb. Doctors justified the importance of patient education. <h3>Study purpose</h3> Evaluate of the degree knowledge patients about osteoarthritis in order to establish a learning process and improve their care. <h3>Materials and methods</h3> Survey conducted between December 2012 and March 2013 with 53 patients followed in rheumatology consultation for osteoarthritis. It includes four items. Each item contains an open or a simple choice questionnaires including questions about osteoarthritis, diagnosis, evolution, and finally treatment. <h3>Results</h3> Among 53 patients included in the study, 83% were female. The mean age was 65 years old. 45.71% are treated for osteoarthritis. The origin of osteoarthritis is overweight for 45.7% of patients. The sport can be implicated in osteoarthritis for 74.3%. Duty diet is true for 74.3% of the cases. 42.8% of the cases have no idea about the link between osteoarthritis and osteoporosis, and 34.3% of the link with menopause. For 85.7% of patients, the osteoarthritis progression is worsening whatever treatment. The origin of osteoarthritis pain is the effort for 34.28%. The pain is associated with osteoarthritis for 88.6% of cases. It is a source of aggravation for 85.7%. Osteoarthritis requires a blood test for 54.28%, and necessity X-rays for 85.7%. Osteoarthritis is objectively better by Computer Tomography or Magnetic Resonnance Imaging to 74.28%. 71.4% of patients believe that it is now possible to cure osteoarthritis. 40% said that is necessary to reduce the weight. 62.8% think that they shouldn't do any activity. 45.7% of patients didn't have an idea about the sport choice. 62.8% of patients are using symptomatic treatment for pain. To treat joint, 40% use anti-arthritic, 10 cases local treatment, and the other cases didn't know. 42.85% of patients have no idea about the indication of a prosthesis. 62.85% find no interest to use a cane. All patients received medical education. <h3>Discussion and Conclusion</h3> Our results are consistent with expert opinion. Many data were ignored by patients. While some patients were able to correctly answer questions, others do not know. The osteoarthritis therapeutic patients should be an integral part of our practice, joint savings, and well being of the patient9s autonomy.
Delayed detection of congenital hearing loss in high risk infants.
Authors: N J Wild, S Sheppard, R W Smithells, H Holzel, G Jones
Journal: BMJ (1990)

OBJECTIVE--To examine the methods used to investigate children at high risk of congenital hearing impairment, and to see whether the introduction of evoked response audiometry has reduced the mean age at which hearing loss is identified. DESIGN--Clinicians who notified children to the national congenital rubella surveillance programme were asked retrospectively to complete a questionnaire examining the methods used to identify hearing impairment and the age at testing in two consecutive five year cohorts. The presence or absence of hearing loss was confirmed by obtaining the results of audiometric evaluations and, whenever possible, a recent pure tone audiogram. SETTING--The United Kingdom. PATIENTS--Children notified to the national congenital rubella surveillance programme and born in 1978-87 in whom IgM specific for rubella was detected shortly after birth. MAIN OUTCOME MEASURES--The age at which hearing loss was identified and the degree of loss in decibels at 250, 500, 1000, 2000, and 4000 Hz measured by pure tone audiometry. RESULTS--61 (52%) Of 117 children born in 1978-82 had a hearing impairment of 40 dB or greater in both ears. The mean loss was 93 dB. In the following five years 75 (47%) of 159 children had impaired hearing, their mean loss being 96 dB. The age at which the hearing loss was confirmed decreased from 11.6 to 9.8 months as a result of earlier auditory evoked response testing. Nevertheless, only eight (13%) of the children with hearing impairment born in 1978-82 and 16 (21%) of those born in 1983-7 had these tests performed in the first six months of life. CONCLUSIONS--Unacceptable delays in identifying hearing loss occurred in this high risk group because of failure to arrange auditory evoked response testing in early infancy. Evoked response audiometry is sensitive and specific and should be undertaken within the first few months of life for all infants known to be at risk of sensorineural hearing loss.
An active shooter in our hospital
Authors: Eric Goralnick, Ron Walls
Journal: The Lancet (2015)

On Jan 20, 2015, at about 11 am, a gunman deliberately shot and killed a gifted young cardiac surgeon in our hospital. Michael Davidson, aged 44, director of endovascular cardiac surgery at Brigham and Women's Hospital (Boston, MA, USA), was shot twice by the assailant, who then turned his weapon on himself, with similarly fatal consequences. In the immediacy of the moment, several staff members, without knowing whether the shooter was still at large, tended to their stricken colleague and transported him rapidly to the emergency department, while others systematically secured themselves and patients in various rooms—doors closed and locked, furniture moved to barricade.
Abstract 5591: A homologous recombination assay for classifying BRCA2 missense variants
Authors: Lucia Guidugli, David Goldgar, Vernon S. (Shane) Pankratz, Catherine A. Erding, Fergus J. Couch
Journal: Cancer Research (2011)

Abstract Germline mutations in BRCA2 predispose to breast, ovarian and other cancers. Although most mutations in the gene are known to be pathogenic, there is an increasing number of missense variants for which the contribution to cancer risk is unclear. These missense substitutions are referred to as VUS (variants of uncertain significance). Because loss of BRCA2 HR function leads to defective DNA double-strand break repair and an increased risk of cancer, we evaluated the utility of a cell-based Homologous Recombination (HR) assay for determination of the cancer relevance of BRCA2 VUS. Specifically, we studied VUS localized in the BRCA2 DNA binding domain (DBD) for effects on HR. We transfected full length wild-type and mutant BRCA2 constructs into V-C8 BRCA2 deficient cells along with an I-Sce1-expressing plasmid which induces an unique double strand break in an integrated DR-GFP reporter plasmid. We evaluated the ability of each BRCA2 mutant to repair the induced break by quantifying the GFP positive cells, generated by HR repair of the DNA break, with fluorescent activated cell sorting (FACS). To establish the sensitivity and specificity of the HR assay we evaluated a series of known deleterious and known neutral with the HR assay. These mutations of known effect were identified using a multifactorial likelihood approach, based on available family data, with a prior probability approach based on sequence conservation (A-GVGD) algorithm (http://agvgd.iarc.fr/agvgd_input.php). We calculated the total odds of pathogenicity for co-segregation of variants with the disease in affected carrier families, co-occurrence of VUS (in trans) with deleterious mutations and for family history of cancer of VUS and combined this odds with the A-GVGD based prior probabilities to generate the posterior probability of pathogenicity for each variant. Using this approach we successfully classified 31 VUS as either neutral or deleterious. By comparing these data with results from the HR assay we established that the assay is 100% sensitive (95% CI: 75.3% – 100%) and 100% specific (95% CI: 82.4% – 100%) for deleterious mutations in the BRCA2 DBD domain. In summary we evaluated the sensitivity and specificity of the HR assay for VUS in the DBD relative to a probability model based on family data and A-GVGD algorithm and we showed that the assay was highly sensitive and specific. Based on these results we propose that the HR assay can be used as a classifier of the clinical relevance of the VUS in the absence of direct genetic and family data. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5591. doi:10.1158/1538-7445.AM2011-5591
THE NASAL SEPTUM; A DESCRIPTION OF THE AUTHOR'S PRESENT MANNER OF PERFORMING THE WINDOW-RESECTION FOR DEFLECTIONS.
Authors: OTTO T. FREER
Journal: JAMA (1905)

<h3>TYPES OF DEFLECTION.</h3> The mucous membrane incisions in my method of performing the submucous or window resection vary with the type of deflection and for this reason I precede the details of the operation with a description of deflections as I have seen them, employing for them as much as possible the names in common use and grouping them according to their form. <h3>Angular Deflections.</h3> —The double-angled deflection: This variety of deviation I have found by far the commonest. It possesses a vertical and horizontal angle, joining near the base of the septum and forming a projection on the convex side not unlike the corner of a box. The vertical angle (Fig. 1) occupies the quadrangular cartilage and ascends to a varying degree, sometimes into the perpendicular plate of the ethmoid bone. The vertical angle may jut out so strongly that it presses into the inferior turbinated body. The horizontal
Yersinia arthritis: demonstration of occult enteritis by 111indium leucocyte scanning.
Authors: R M Bernstein, C G Mackworth-Young, S H Saverymutu, S Gupta, J P England, G R Hughes
Journal: Annals of the Rheumatic Diseases (1984)

111Indium-leucocyte scanning demonstrated enteritis in a patient with acute arthritis and diarrhoea when contrast radiology was normal. Infection with Yersinia entercolitica was proved serologically. Leucocyte scanning may be useful in the screening for inflammatory bowel disease in patients with seronegative arthritis.
The Standing-Flexion Position for Auscultation of the Heart
Authors: Abe Ravin
Journal: JAMA (1965)

THERE ARE TIMES when it is an advantage to perform auscultation of the heart with the patient in the prone position. In patients with deep chests, the sound produced by the heart may be very faint when they are in the recumbent position and not well heard when they assume the left lateral position. Occasionally, pericardial rubs may be heard only if the patient is in the prone position. Listening to the heart when the patent is lying on the abdomen with the thorax supported by the elbows puts both the patient and the doctor in an awkward position. We have found that the position shown in Fig 1, which we have called the "standing-flexion" position, is a very satisfactory one for auscultation of the heart in such patients. The patient's chest muscles are relaxed because there is essentially no weight supported by the arms and the listener is in