tbuckley/cabot-search huggingface dataset:
Patient mobility in the European Union
Authors: Helena Legido-Quigley, Irene Glinos, Rita Baeten, Martin McKee
Journal: BMJ (2007)

Getting healthcare in another European country should be straightforward, but it often creates problems for both patients and healthcare systems In September 2006 the European Commission launched a consultation on health services, focusing mainly on movement of patients across borders.1 The longstanding view that health care was the preserve of national governments has been rendered untenable by the European Court of Justice. Its judgments place health services firmly on the European agenda, upholding the right of individuals to obtain care abroad paid for by their home health system in specific circumstances (box). We discuss why patients seek care abroad, examine the medical and legal issues that this raises, and outline some possible responses. #### European legal basis for patient mobility The legal basis for patient mobility in Europe was established in 1971 through regulation 1408/712: In 1998 two rulings by the European Court of Justice (the cases of Kohll3 and Decker) relating to spectacles and orthodontic treatment, established that individuals could obtain certain goods and medical service provided outside hospital and be reimbursed by their health funder without getting prior authorisation A series of cases has since expanded the range of care that can be obtained without authorisation and clarified the principles—for example:
The psychological and emotional impact of acne and the effect of treatment with isotretinoin
Authors: None KELLETT, None GAWKRODGER
Journal: British Journal of Dermatology (1999)

Although knowledge concerning the dermatological treatment of chronic acne has grown considerably in recent years, relatively few studies have assessed the impact of effective physical intervention upon the psychoemotional functioning of patients. Hypotheses regarding the psychological impact of acne were developed using concepts drawn from evolutionary psychology. A sample of 34 patients (19 men and 15 women) with chronic acne were assessed for psychological, emotional and dermatological symptomatology using a variety of self-report questionnaires over four time-points during 16 weeks treatment with isotretinoin. Thirty-four patients completed the first assessment, 21 the second, 20 the third and 15 the fourth and final assessment. At the first assessment, prior to isotretinoin treatment, 15 patients (44%) reported clinically significant levels of anxiety, while six patients (18%) reported clinically significant depression. Women with acne were significantly more embarrassed than their male counterparts about their skin disease. Treatment with isotretinoin produced significant improvements across a wide variety of psychological functions, although the emotional status of patients appeared to be more resistant to change. Acne appears to be a condition which has the potential to damage, perhaps even in the long term, the emotional functioning of some patients.
Intraoperative use of tranexamic acid to reduce transfusion rate in patients undergoing radical retropubic prostatectomy: double blind, randomised, placebo controlled trial
Authors: A. Crescenti, G. Borghi, E. Bignami, G. Bertarelli, G. Landoni, G. M. Casiraghi, A. Briganti, F. Montorsi, P. Rigatti, A. Zangrillo
Journal: BMJ (2011)

<b>Objectives</b> To determine the efficacy of intraoperative treatment with low dose tranexamic acid in reducing the rate of perioperative transfusions in patients undergoing radical retropubic prostatectomy. <b>Design</b> Double blind, parallel group, randomised, placebo controlled trial. <b>Setting</b> One university hospital in Milan, Italy. <b>Participants</b> 200 patients older than 18 years and undergoing radical retropubic prostatectomy agreed to participate in the trial. Exclusion criteria were atrial fibrillation, coronary artery disease treated with drug eluting stent, severe chronic renal failure, congenital or acquired thrombophilia, and known or suspected allergy to tranexamic acid. <b>Interventions</b> Intravenous infusion of tranexamic acid or equivalent volume of placebo (saline) according to the following protocol: loading dose of 500 mg tranexamic acid 20 minutes before surgery followed by continuous infusion of tranexamic acid at 250 mg/h during surgery. <b>Main outcome measures</b> Primary outcome: number of patients receiving blood transfusions perioperatively. Secondary outcome: intraoperative blood loss. Six month follow-up to assess long term safety in terms of mortality and thromboembolic events. <b>Results</b> All patients completed treatment and none was lost to follow-up. Patients transfused were 34 (34%) in the tranexamic acid group and 55 (55%) in the control group (absolute reduction in transfusion rate 21% (95% CI 7% to 34%); relative risk of receiving transfusions for patients treated with tranexamic acid 0.62 (0.45 to 0.85); number needed to treat 5 (3 to 14); P=0.004). At follow-up, no patients died and the occurrence of thromboembolic events did not differ between the two groups. <b>Conclusions</b> Intraoperative treatment with low dose tranexamic acid is safe and effective in reducing the rate of perioperative blood transfusions in patients undergoing radical retropubic prostatectomy. <b>Trial registration</b> ClinicalTrials.gov identifier NCT00670345.
Federal Policies and the Poor
Authors: John K. Iglehart
Journal: New England Journal of Medicine (1982)

The federal government's open-ended commitment to finance medical care for the nation's elderly population and eligible poor people has been reduced by wholesale reductions in spending that were incorporated in the $98.3-billion tax-increase bill President Reagan signed into law on September 3. These changes in health policy reflect three important trends: the government's preference for cutting spending by reducing payments for care rather than paring benefits, a stronger congressional commitment to health programs targeted for the poor than administration policies would afford, and overall, a demonstration that health care as a political issue has lost some of its allure as . . .
Social deprivation and health: Money must go where it is most needed
Authors: J. A Main, P. Main
Journal: BMJ (1993)

breathing air-a considerable reduction from normal and one that should correspond with an arterial oxygen pressure of about 8-7 kPa.The boy's thermal injury from steam would probably have been limited to the airway above the larynx by reflex closure of the vocal cords, so any alveolar- arterial oxygen gradient would have been small.Thus the hypoxaemia must have been caused by hypoventilation.The alveolar gas equation, although a crude estimate when a respiratory steady state is improbable, indicates a carbon dioxide pressure of over 8 kPa and therefore appre- ciable hypoventilation.This shows how a pulse oximeter can help assess hypoventilation in such a patient.Endotracheal intubation of patients with upper airway obstruc- tion is seldom easy or free from hazard, and non- invasive pulse oximetry is valuable to confirm the need for such action.
Management of invasive pulmonary aspergillosis in non-neutropenic critically ill patients
Authors: R. J. Trof, A. Beishuizen, Y. J. Debets-Ossenkopp, A. R. J. Girbes, A. B. J. Groeneveld
Journal: Intensive Care Medicine (2007)

During recent years, a rising incidence of invasive pulmonary aspergillosis (IPA) in non-neutropenic critically ill patients has been reported. Critically ill patients are prone to develop disturbances in immunoregulation during their stay in the ICU, which render them more vulnerable for fungal infections. Risk factors such as chronic obstructive pulmonary disease (COPD), prolonged use of steroids, advanced liver disease, chronic renal replacement therapy, near-drowning and diabetes mellitus have been described. Diagnosis of IPA may be difficult and obtaining histo- or cytopathological demonstration of the fungus in order to meet the gold standard for IPA is not always feasible in these patients. Laboratory markers used as a non-invasive diagnostic tool, such as the galactomannan antigen test (GM), 1,3-beta-glucan, and Aspergillus PCR, show varying results. Antifungal therapy might be considered in patients with persistent pulmonary infection who exhibit risk factors together with positive cultures or sequentially positive GM and Aspergillus PCR in serum, in whom voriconazole is the drug of choice. The benefit of combination antifungal therapy lacks sufficient evidence so far, but this treatment might be considered in patients with breakthrough infections or refractory disease.
Erratum: Corrigendum: The ubiquitin-modifying enzyme A20 is required for termination of Toll-like receptor responses
Authors: David L Boone, Emre E Turer, Eric G Lee, Regina-Celeste Ahmad, Matthew T Wheeler, Colleen Tsui, Paula Hurley, Marcia Chien, Sophia Chai, Osamu Hitotsumatsu, Elizabeth McNally, Cecile Pickart, Averil Ma
Journal: Nature Immunology (2004)
Points: McIlroy was here. Or was he?
Authors: C C Smith
Journal: BMJ (1979)

A N Bamji (14 April, p 973) with great interest.We were medical students resident in separate Dublin hospitals in 1966.At this time McIlroy appeared at the casualty department of the Royal City of Dublin Hospital complaining of chest pain.One of us (JRN) was connecting him to an ECG machine which required to be earthed.Unfortunately, this was not done and the patient obviously experienced an electric shock.He leapt from the trolley and, putting his finger over his tracheostomy, confirmed in no uncertain terms that this was the case.He took his own discharge.Later that evening this somewhat ruffled student called at the Adelaide Hospital three kilometres or so away.There CED was found to be examining McIlroy, still complain- ing of chest pain but not referring to his recent experience.When he saw JRN he had the grace to look a little embarrassed.The ECG machine in the Adelaide Hospital evidently caused the patient no further upset-and the tracing showed no abnormality.Nevertheless, he spent a comfortable night in hospital and subsequently took his own discharge.There is no doubt in our minds that this man was McIlroy....
Abstract LB-283: A prospective study of breast cancer risk associated with occupational exposure to potentially endocrine disrupting compounds
Authors: Christine C. Ekenga
Journal: Cancer Research (2014)

Abstract Background: Endocrine disrupting compounds, exogenous substances that interfere with normal endocrine functions, have been suspected to play a role in the etiology of breast cancer. The purpose of this study was to investigate the relationship between occupational exposure to potential endocrine disrupting compounds and breast cancer risk among women enrolled in the Sister Study, a prospective cohort study of US and Puerto Rican women designed to examine the genetic and environmental risk factors for breast cancer. Methods: Over 50,000 women aged 33-74 enrolled in the Sister Study between 2004 and 2009. A comprehensive baseline questionnaire included questions about occupational exposures, including ever use and duration and frequency of use of nine agents containing potential endocrine disrupting compounds: Dyes or Inks, Gasoline or other Petroleum Products, Glues or Adhesives, Lubricating Oils, Metals, Paints, Pesticides, Organic Solvents, and Stains. Cumulative lifetime exposure to each potential endocrine disruptor was estimated and classified into quartiles. Study participants were prospectively followed from baseline until breast cancer diagnosis, death, or end of follow-up. Multivariable Cox proportional hazards regression was used to assess the impact of level of exposure (comparing each quartile of exposure with never exposure) to each of these compounds on breast cancer risk, adjusting for established breast cancer risk factors. Results: Among the 47,755 women in the Sister Study with an occupational history, a total of 1798 cases of invasive breast cancer were diagnosed. Compared to their respective never exposure groups, an elevated risk of estrogen-receptor positive breast cancer was observed for women in the top quartile of occupational exposure to Dyes or Inks (HR: 1.7, 95%CI: 1.1-2.8). Non-significantly elevated risks were observed for women in the top quartile of occupational exposure to Gasoline or other Petroleum Products (HR: 1.7, 95%CI: 1.0-2.9) and Metals (HR: 1.5, 95%CI: 0.9-2.8). Conclusions: Results suggest that exposure to occupational dyes or inks may influence breast cancer risk. Dyes and inks contain compounds with endocrine disrupting properties, including organic compounds and heavy metals. Further studies are necessary to elucidate the role of these potential endocrine disrupting compounds in breast cancer. Citation Format: Christine C. Ekenga. A prospective study of breast cancer risk associated with occupational exposure to potentially endocrine disrupting compounds. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-283. doi:10.1158/1538-7445.AM2014-LB-283
Compound Tests for the Detection of Hitchhiking Under Positive Selection
Authors: Kai Zeng, Suhua Shi, Chung-I Wu
Journal: Molecular Biology and Evolution (2007)

Many statistical tests have been developed for detecting positive selection. Most of these tests draw conclusions based on significant deviations from the patterns of polymorphism predicted by the neutral model. However, many non-equilibrium forces may cause similar deviations, and thus the tests usually have low statistical specificity to positive selection. The main challenge is hence to construct test statistics that are reasonably powerful in detecting positive selection, but are relatively insensitive to other forces. Recently, Zeng et al. (2006) proposed a new test, DH, which is a compound of Tajima's D and Fay and Wu's H, and showed that DH has reasonably high statistical specificity to positive selection. In this report, we expand the idea of a compound test by combining Fay and Wu's H or DH with the Ewens-Watterson (EW) test. We refer to these 2 new tests as HEW and DHEW, respectively. Compared to the DH test, HEW and DHEW are more robust against the presence of recombination, and are also more powerful in detecting positive selection. Furthermore, the DHEW test, similar to DH, is also relatively insensitive to background selection and demography. The HEW test, on the other hand, tends to be somewhat less conservative than DH and DHEW in some cases.
Effectiveness of interferon-alpha therapy in chronic hepatitis C is associated with the amount of interferon-alpha receptor mRNA in the liver
Authors: Ryo Fukuda, Norihisa Ishimura, Yoshinori Kushiyama, Nobuyuki Moriyama, Shunji Ishihara, Sachiko Nagasawa, Tatsuya Miyake, Misa Niigaki, Shuichi Satoh, Shino Sakai, Shuji Akagi, Makoto Watanabe, Shiro Fukumoto
Journal: Journal of Hepatology (1997)
Abstract 2384: A new, highly sensitive IHC test for the detection of HER2 protein in breast cancer (BC) tissue.
Authors: Hans Christian Pedersen, Anni Thomsen, Kristian Jensen, Karen Jakobsen, Bob Wellings, Gillian Dalgliesh, Kerrie Tosh, Chris Harbron, Jill Walker
Journal: Cancer Research (2013)

Abstract HER2 protein over-expression occurs in 15-20% of invasive BC. Trastuzumab and other HER2-targeted agents have mainly been investigated in HER2 over-expressing BC (HercepTest™ 2+/3+). Analysis of clinical study NSABP-31 suggests patients with HER2 non-over-expressed BC (HercepTest™ 0, 1+, 2+ and/or HER2 FISH negative) may benefit from anti-HER2 therapy. Other novel agents are under investigation in HER2 non-over-expressed BC including AZD8931. No IHC assays are optimized for reliable detection of HER2 in the non-over-expressed range. We have therefore developed a highly sensitive, robust HER2 IHC test with a low limit of detection (HER2Low Test). Methods and results: The HER2Low Test uses a novel, high affinity anti-HER2 rabbit monoclonal antibody. Antibody specificity was demonstrated by western blotting using cell lysates expressing HER1, HER2, HER3 or HER4. Analytical sensitivity experiments on BC cell lines showed an ability to differentiate lower levels of HER2 than HercepTest™. Three HER2Low Test staining categories were defined: Low, Medium and High, reflecting differing levels of HER2 expression. A comparative study between HER2Low Test and HercepTest™ on 182 AZD8931 clinical trial BC samples with appropriate ethical approval and consent (Table) showed a redistribution of HercepTest™ scores 0, 1+ and 2+ into HER2Low Test categories Low, Medium and High, demonstrating increased analytical sensitivity of the HER2Low Test. HER2Low Test reproducibility and repeatability studies showed intra-run agreement of 97%, inter-run agreement of 96%, inter-instrument agreement of 87% and observer-to-observer agreement of 89%. Conclusion: Presented here is a novel, reproducible and highly sensitive HER2 IHC assay. This is the first study to demonstrate accurate differentiation across a wide range of HER2 expression levels in non-over-expressed BC. This assay may supplement existing HER2 testing methods for the accurate segmentation of HER2 non-over-expressing BC patients. HER2Low Test score and conventional HercepTest™ (HcT) score in the tested samples from a phase II clinical trial (NCT00900627" locator-type="CLINTRIALGOV"&amp;gt;NCT00900627) HER2Low Test Total Low Medium High HcT 0 11 34 12 57 (31.3%) 1+ 4 24 36 64 (35.2%) 2+ 0 11 50 61 (33.5%) 3+ (not included) 0 0 0 0 (0.0%) Total 15 (8.2%) 69 (37.9%) 98 (53.9%) 182 Citation Format: Hans Christian Pedersen, Anni Thomsen, Kristian Jensen, Karen Jakobsen, Bob Wellings, Gillian Dalgliesh, Kerrie Tosh, Chris Harbron, Jill Walker. A new, highly sensitive IHC test for the detection of HER2 protein in breast cancer (BC) tissue. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2384. doi:10.1158/1538-7445.AM2013-2384
Antagonism between Epidermal Growth Factor and Phorbol Ester Tumor Promoters in Human Breast Cancer Cells
Authors: C. Kent Osborne, Barbara Hamilton, Marianne Nover, Jeanette Ziegler
Journal: Journal of Clinical Investigation (1981)

It has been suggested that the phorbol ester tumor promoters act via the receptor-effector system for epidermal growth factor (EGF), since they interact with the EGF receptor system and mimic many of the effects of EGF in cultured cells. We have studied the interaction of phorbol esters with the EGF-responsive MCF-7 human breast cancer cell line. Similar to other systems, phorbol esters inhibit EGF binding in MCF-7 cells in a manner paralleling their potency as tumor promoters in mice. The effect is specific for EGF since the membrane binding of insulin is unaffected. Like EGF, the potent phorbol ester 12-O-tetradecanoyl-13-phorbol acetate (TPA) stimulates protein synthesis as indicated by a twofold increase in [3H]leucine incorporation into protein after 24 h in TPA. Cell morphology, however, is significantly different with TPA treatment. After 24-48 h in TPA, cells become markedly enlarged with increased cytoplasmic vacuolization and increased membrane microvilli. This is reflected in a fourfold increase in the protein/DNA ratio (control 13.1; TPA 55.9). Furthermore, TPA inhibits cell division in media with or without serum, and prevents growth stimulation by EGF. Low TPA concentrations (1.0 ng/ml) are active, and 10 ng/ml results in maximal inhibition of cell replication. Other phorbol esters inhibit MCF-7 cells relative to their tumor promoting activity in vivo and their ability to inhibit EGF binding in these cells. After 24 h in TPA, incorporation of [3H]thymidine into DNA is markedly reduced and the thymidine labeling index falls (33% to 2%) indicating very few S-phase cells. Growth inhibition is reversible by removing TPA from the medium. Similar inhibitory effects are seen with the two other human breast cancer cell lines studied, ZR75-1 and MDA-MB-231. In conclusion, phorbol esters may interact with the EGF receptor domain in MCF-7 human breast cancer cells, but they have distinct effects on cell morphology and growth suggesting alternative pathways of action. The antineoplastic activity of these compounds needs further investigation.
Berek &amp; Novak’s Gynecology
Authors: Ronald T. Burkman
Journal: JAMA (2012)

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Families and their doctors
Authors: G. Dunea
Journal: BMJ (1987)

The structure of the family has undergone many changes since the tragic night when Mrs N collided with a mammoth in the dark. She had left the cave to pick some strawberries for dessert for what had been a wonderful dinner. Old Mr Neanderthal had been in great form; his numerous children had gulped down the juicy morsels of reptile steak with gusto; and the poor relations had quietly packed away the leftovers into what later would become known as doggie bags. Then the accident happened and as the local medicine man was rushing about with his trephines it was apparent that life would never be the same again. For one thing the family began to shrink in size. It became uneconomical to have quite so many children. They were expensive to maintain, increasingly useless in the fields, and they each insisted on having their own cave. Then the poor relatives stopped coining, preferring to collect welfare cheques to enduring Mr N's sense of humour. In North America the family declined to six members by the end of the eighteenth century; and the trend continued, reversed only temporarily by the baby boom after the second world war, when favourable economic conditions led young people into marrying early and raising large families. By 1970 the family had shrunk to 4*0 and to an average of 3*2 by 1985. Other changes occurred as Mr N let go of the purse strings and stopped ruling with the club. By 1976 the family seemed to be as dead as the mammoth that had attacked Mrs N, thus becoming a convenient election issue in post-Neanderthal politics. Candidate Jimmy Carter, harking back to the nice dinners at the cave, declared that the decline of the family had reached dangerous proportions. Citing statistics showing increased divorce, illegitimacy, teenage pregnancy, crime, and drug use, he pledged to strengthen the American family?as did Gerald Ford. Others also thought that it would look good to worry about the family or sell well to write about it. There was a deluge of publications with appropriate references to Plato and Friedrich Engels. 1976 became the Year of the Family. It culminated in a White House conference where liberals and conservatives glared at each other like Neanderthals and Cro magnons, arguing whether homosexuals and people living in sin could also constitute families. Then they picked up their clubs and walked away without anything being accomplished.