tbuckley/cabot-search huggingface dataset:
Witness's Privilege
Authors: W. K. Bernfeld
Journal: BMJ (1970)

<h3>Objectives</h3> The aim of this study was to find information about participation of hospital pharmacists in rational use of medicines at Polish university hospitals. Thus, pharmaceutical services and other tasks performed by hospital pharmacists were determined. <h3>Methods</h3> A simple questionnaire-based survey was applied. All pharmacist team managers of Polish university hospitals were invited to the study. The obtained data considered the present situation and future perspectives of the pharmacists’ role in rational use of medicines at Polish university hospitals. <h3>Results</h3> Each hospital pharmacy arranges hospital supplies of drugs and medical devices. The majority of pharmacists are involved in compounding. Also, pharmacists participate in pharmacotherapy rationalisation and monitoring of adverse drug reactions as well, as they are involved in clinical trials. Clinical activities, like participating in hospital rounds are not common Polish hospitals. <h3>Conclusions</h3> Generally, the role of hospital pharmacists is limited to performing pharmaceutical services at hospital pharmacies, and it should become more patient oriented as is observed in other countries. Similarly, they do not contribute essentially to rational use of medicines. More precise legal regulations, better postgraduate education of pharmacists may be helpful in improving this situation. Hospital pharmacy should become a significant part in medication management in Polish teaching hospitals.
South Asian health: what is to be done?
Authors: Majid Jalil
Journal: BMJ (2004)

South Asian health: what is to be done? Amalgamation of South Asia's medical community will benefit allEditor-The BMJ deserves credit for providing the spark necessary to activate the medical community of the South Asian countries, with their limited resources, unstable governments, and uncommitted politicians pitching in with solutions for public health problems.Amalgamation of South Asia's medical community will ensure benefits to all its constituents.Strength will flow from unity of purpose focused on achievable targets with a structured and pragmatic plan of realistic objectives.The impossible can be made possible.There is a wealth of talent and experience in the South Asian countries in traditional and complementary systems of medicine, which have great potential for providing relief to millions of people at minimal or no cost to the exchequer.Ayurveda, the unani system, homoeopathy, herbal medicine, yoga, and meditation are powerful modalities for providing some remedies to the poor and ailing population of South Asia.Education is the bedrock on which all health practices are based.Knowledge of cleanliness, sanitation, clean potable water, and basic amenities for primary health in every village is an admirable beginning.The public and private sectors have distinctive roles.There must be harmony, cooperation, discipline, and monitoring to ensure optimal use of resources.This needs to be orchestrated by the government agencies designated to run a country's health programmes.
Late abortions and the law
Authors: D. Weeks
Journal: BMJ (1988)

with healthy heterosexuals and antibody negative members of high risk groups.'Asymptomatic people with detectable antigen p24 usually have the highest neopterin levels.3The neopterin data suggest that there is no real latency period for HIV infection.As long as activated T cells are detectable in infected subjects HIV will be reproduced.Failure to detect antigen p24 is due to the limited sensitivity of the tests rather than the absence of HIV expression.
Innervation of the synovium.
Authors: P.I Mapp
Journal: Annals of the Rheumatic Diseases (1995)

This review will describe the normal innervation of the joints, in particular the synovium, and then show how this changes in the rheumatoid arthritis (RA) joint in the human. Substance P will be described in detail, as an example of a particular neuropeptide. The concepts surrounding neuropeptide release and the role of neuropeptides in inflammatory joint disease (neurogenic inflammation) will then be explored. The in vitro and in vivo effects of substance P will be described. The receptors for substance P and the effects of antagonists, peptide and synthetic, for the receptor on inflammatory models will also be discussed. The synovial distribution of the enzyme systems that break down neuropeptides and how this may lead to functional compartmentalisation will be described. Finally, some mechanisms by which pain may arise will be presented.
Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments
Authors: T. V Perneger, F. Giner, M. del Rio, A. Mino
Journal: BMJ (1998)

<h3>Abstract</h3> <b>Objective:</b> To evaluate an experimental heroin maintenance programme. <b>Design:</b> Randomised trial. <b>Setting:</b> Outpatient clinic in Geneva, Switzerland. <b>Subjects:</b> Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments. <b>Intervention:</b> Patients in the experimental programme (n=27) received intravenous heroin and other health and psychosocial services. Control patients (n=24) received any other conventional drug treatment (usually methadone maintenance). <b>Main outcome measures:</b> Self reported drug use, health status (SF-36), and social functioning. <b>Results:</b> 25 experimental patients completed 6 months in the programme, receiving a median of 480 mg of heroin daily. One experimental subject and 10 control subjects still used street heroin daily at follow up (difference 44%; 95% confidence interval 16% to 71%). Health status scores that improved significantly more in experimental subjects were mental health (0.58 SD; 0.07 to 1.10), role limitations due to emotional problems (0.95 SD; 0.11 to 1.79), and social functioning (0.65 SD; 0.03 to 1.26). Experimental subjects also significantly reduced their illegal income and drug expenses and committed fewer drug and property related offences. There were no benefits in terms of work, housing situation, somatic health status, and use of other drugs. Unexpectedly, only nine (38%) control subjects entered the heroin maintenance programme at follow up. <b>Conclusions:</b> A heroin maintenance programme is a feasible and clinically effective treatment for heroin users who fail in conventional drug treatment programmes. Even in this population, however, another attempt at methadone maintenance may be successful and help the patient to stop using injectable opioids.
INTRADERMAL SALT SOLUTION TEST IN LOBAR PNEUMONIA IN CHILDREN
Authors: JEANETTE HARRISON
Journal: JAMA (1925)

McClure and Aldrich<sup>1</sup>found that the elevation produced by intradermal injection of 0.2 c.c. of an 0.8 per cent, aqueous solution of sodium chlorid became impalpable much more quickly in a group of children having edema than in a group of control cases. While in the individual edematous patient the disappearance of the elevation was less rapid in skin areas in which pitting by pressure was not demonstrable than in areas in which palpable edema was present, yet even in the nonpitting areas the disappearance was considerably more rapid than in the control cases. In a later paper 2 they report the results of use of this test in sixteen cases in children characterized by generalized edema with albumin, casts and, in some cases, red blood cells in the urine, with absence of nitrogen retention in the blood and without evidence of cardiovascular disease. They found that in a
Effect of the angiotensin-converting enzyme inhibitor imidapril on reactive hyperemia in patients with essential hypertension: relationship between treatment periods and resistance artery endothelial function
Authors: Yukihito Higashi, Shota Sasaki, Keigo Nakagawa, Hideo Matsuura, Goro Kajiyama, Tetsuya Oshima
Journal: Journal of the American College of Cardiology (2001)
Abstract CT332: Biomarker analysis predicts antitumor activity of Ipilimumab therapy in patients with refractory metastatic melanoma
Authors: Nitin Chakravarti, Isabella C. Glitza, Van A. Trinh, Roland L. Bassett, Wen-Jen Hwu, Victor G. Prieto
Journal: Cancer Research (2014)

Abstract Background: Ipilimumab (Ipi) improves survival of patients (pts) with advanced melanoma. It is unknown which biomarkers predict antitumor activity. Methods: 81 pts with advanced melanoma who had failed to at least one prior systemic treatment were included in the Ipi Expanded Access Program (EAP) (Table 1). All pts received induction therapy with Ipi 10 mg/kg i.v. q 3 weeks x4 doses. At week 24, pts without progressive disease or toxicity received maintenance therapy with Ipi q 12 weeks. Pertinent biomarkers (CTLA-4, PD-1, PD-L1, pAKT, pS6, fas-l, Ki67, and BRAF V600E) were analyzed by immunohistochemistry on pre-treatment tumor specimens and results were correlated with clinical outcomes. Results: Median progression free survival (PFS) and overall survival (OS) were 3.7 and 10.6 mos. Higher stages, ECOG (1 and 2), elevated LDH, and low absolute lymphocyte count (ALC) at baseline were associated with poor survival. Of the 71 pts with progression, 32 received alternative treatment and 39 did not; the OS from the time of disease progression was 17 and 2.6 mos, respectively. Increased CTLA-4 in tumor (p=0.003) and TILs (p=0.02) correlated with poor OS. pS6 expression in TILs (p=0.04), high pAkt in tumor (p=0.03) correlated with poor PFS. Low CTLA-4 (p=0.05) and pAkt (p=0.04) expression in tumor cells correlated with better outcome. High CTLA-4 expression in TILs associated with poor OS (p=0.003) in pts who received alternative treatment post-ipi. Conclusions: High CTLA-4 expression in tumor &amp; TILs as well as activated Akt pathway in tumor cells correlated with poor clinical outcome. High CTLA-4 expression in TILs correlated with poor survival in pts received alternative therapy after Ipi. Analyses of biomarkers predict antitumor activity of Ipi. Table 1.Patient characteristicsVariableLevelNPercentSexMale4960%Female3240%StageIIIc22%M1a67%M1b1114%M1c6277%ECOG04353%12835%21012%Primary Melanoma SiteAcral Lentiginous45%Cutaneous6175%Mucosal79%Uveal22%Unknown primary79%Brain MetastasesNo4454%Before Treatment2328%During Treatment1012%After Treatment45%ResponseCR1114%PR22%SD22%PD6681%Post-Ipi RadiationNo1235%Yes2065%Post-Ipi SurgeryNo1547%Yes1753%Post-Ipi ImmunotherapyNo2991%Yes39%Post-Ipi Targeted TherapyNo1856%Yes1444%Post-Ipi ChemotherapyNo516%Yes2784% Citation Format: Nitin Chakravarti, Isabella C. Glitza, Van A. Trinh, Roland L. Bassett, Wen-Jen Hwu, Victor G. Prieto. Biomarker analysis predicts antitumor activity of Ipilimumab therapy in patients with refractory metastatic melanoma. [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 CT332. doi:10.1158/1538-7445.AM2014-CT332
Adolescent smokers seen in general practice: health, lifestyle, physical measurements, and response to antismoking advice.
Authors: J Townsend, H Wilkes, A Haines, M Jarvis
Journal: BMJ (1991)

OBJECTIVE--To compare physical, lifestyle, and health characteristics of adolescent smokers and non-smokers and their initial response to anti-smoking counselling. DESIGN--Adolescents aged 13, 15, and 17 years were identified from age-sex registers and invited by letter for a general practice health check. SETTING--Three general practices in the MRC general practice research framework. MAIN OUTCOME MEASURES--Blood pressure, body mass index, saliva cotinine concentration, peak flow rate, alcohol consumption, exercise, duration of sleep, and stated persistent health problems. RESULTS--73% of the adolescents (491) attended for the health check. A total of 68 (14%) were regular smokers. By age 17 those who smoked regularly had a significantly lower systolic blood pressure than those who had never smoked regularly (by 6 mm Hg; p = 0.025) despite a significantly higher body mass index (by 1.5; p &lt;0.001) [corrected]. Cotinine concentrations increased with smoking exposure, from 0.7 ng/ml when no family member smoked to 155 ng/ml in active smokers of six or more cigarettes a week. Significantly more regular smokers than never regular smokers drank greater than or equal to 8 g alcohol a day (chi 2 = 15.2 adjusted for age and sex p less than 0.001); regular smokers exercised less (1.0 hrs/week in boys and 0.8 hrs/week in girls v 3.4 hrs/week in boys and 2.2 hrs/week in girls; p less than 0.001) and slept less (8.0 hrs/night v 8.5 hrs/night at age 17; p less than 0.005). Persistent health problems, mostly asthma or allergic symptoms, were reported by 25% (17/68) of the smokers and 16% (60/381) of the non-smokers. Of the smokers given counselling, 60% (26/43) made an agreement with the practice doctor or nurse to give up smoking. CONCLUSION--General practice is an appropriate setting for adolescents to receive advice on healthy lifestyle, which should not focus solely on smoking.
Demonstration of Thyroidal Metastasis From Lung Cancer by F-18 FDG PET Scan
Authors: Richard T. Jackson, Partha Sinha, Gary R. Conrad
Journal: Clinical Nuclear Medicine (2008)

A case is presented of detection of a secondary thyroid cancer arising from a pulmonary adenocarcinoma by fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). The need to investigate thyroidal hypermetabolic foci detected incidentally on PET scans is well established so as not to miss a primary thyroid cancer. However, as our case illustrates, the possibility of metastatic thyroid cancer, even though less common, should be considered.
The great indoors
Authors: B Brunekreef
Journal: Thorax (2004)

Further evidence for the role of indoor pollutants in the development of childhood asthma

The prevalence of asthma (especially childhood asthma) is high, and children in particular spend a lot of time in their homes. In addition, our homes contain many pollutants so, understandably, we’d like to know to what extent pollutants in the home environment cause and/or worsen asthma in our children.

In many children asthma is closely associated with allergy, and many asthmatic children are allergic to dust mite and pet allergens. For them, reduction of exposure is likely to be beneficial. But does this mean that mite and pet exposure causes asthma? This issue is surprisingly complex. Whereas studies suggest that exposure to specific allergens increases sensitisation to those allergens, this does not necessarily mean that such exposures also increase the incidence of asthma.1,2 Some studies even suggest that early life exposure to pets (and other animals) may reduce the incidence of asthma.3–7

Compared with the already complex role of exposure to allergens and other biological contaminants, the evidence with respect to chemicals such as nitrogen oxides, sulfur oxides, and particles produced by combustion appliances, environmental tobacco smoke, and volatile organic compounds (VOCs) is even less clear.

In this issue of Thorax two new studies from Australia attempt to provide further evidence for the role of unvented heating appliances and of VOCs, respectively. Phoa et al 8 retrospectively collected data on unvented heater exposure in a sample of children aged 8–11 …
Impact of Renin-Angiotensin System Blockade Therapy on Outcome in Aortic Stenosis
Authors: M. Adnan Nadir, Li Wei, Douglas H.J. Elder, Renata Libianto, Tiong K. Lim, Maheshwar Pauriah, Stuart D. Pringle, Alex D. Doney, Anna-Maria Choy, Allan D. Struthers, Chim C. Lang
Journal: Journal of the American College of Cardiology (2011)
Stakes and Kidneys: Why Markets in Human Body Parts are Morally Imperative; Kidney for Sale by Owner: Human Organs, Transplantation, and the Market
Authors: Ewen Harrison, Steve McNally, John Forsythe
Journal: BMJ (2005)

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James Stacey Taylor

Ashgate, £16.99, pp 236 ISBN 07546 4110 4 http://www.ashgate.com/

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Mark J Cherry

Georgetown University Press, $26.95, pp 274 ISBN 1 58901 040 X http://www.press.georgetown.edu/

Rating: ![Graphic][7] ![Graphic][8] ![Graphic][9] ![Graphic][10] 

I n a television interview in 2000, the Nobel prize winning economist and libertarian Milton Friedman remarked, “The most important single central fact about a free market is that no exchange takes place unless both parties benefit.” This succinct analysis of free market capitalism is taken to heart in two new volumes that reignite the fraught debate on the ethical issues surrounding the buying and selling of human organs for transplantation.

This is not just armchair ethical discussion. In 2002 a retired London general practitioner was struck off the medical register for revealing to an undercover journalist that a kidney could be obtained from a live donor for a fee ( BMJ 2002;325: 510). Dr Bhagat Singh Makkar told the reporter, posing as the son of a man with end stage renal failure, that there would be “no problem” arranging the procedure in the United Kingdom, India, or Germany. Commentators were united in their condemnation of his actions, a reaction reflecting a deep seated belief held among most concerned parties (including the BMA and the British Transplantation Society) that trading in human organs …

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Neuronal ER Stress Impedes Myeloid-Cell-Induced Vascular Regeneration through IRE1α Degradation of Netrin-1
Authors: François Binet, Gaëlle Mawambo, Nicholas Sitaras, Nicolas Tetreault, Eric Lapalme, Sandra Favret, Agustin Cerani, Dominique Leboeuf, Sophie Tremblay, Flavio Rezende, Aimee M. Juan, Andreas Stahl, Jean-Sebastien Joyal, Éric Milot, Randal J. Kaufman, Martin Guimond, Timothy E. Kennedy, Przemyslaw Sapieha
Journal: Cell Metabolism (2013)
Semiogenesis as a continuous, not a discrete, phenomenon
Authors: Jo Liska
Journal: Behavioral and Brain Sciences (1995)

Abstract This commentary confronts one of the central tenets advanced in Wilkins &amp; Wakefield's target article: “language is unlikely to have evolved directly from communication-based precursors, nor is it likely to have been based on those structures that subserve communication.” By adopting a very narrow perspective on language, the authors have effectively limited discussion of earlier linguistic capabilities thought to be at least facilitative of, if not prerequisite to language defined as a “formal grammatical system.” An alternative conceptualization for describing semiogenesis is offered.
Pre-diabetes as a contributor to stroke
Authors: J. R. Treadwell
Journal: BMJ (2012)

Abstract  Ligand binding sites in proteins are often localized to deeply buried cavities, inaccessible to bulk solvent. Yet, in many cases binding of cognate ligands occurs rapidly. An intriguing system is presented by the L99A cavity mutant of T4 Lysozyme (L99A T4L) that rapidly binds benzene (~106 M−1 s−1). Although the protein has long served as a model system for protein thermodynamics and crystal structures of both free and benzene-bound L99A T4L are available, the kinetic pathways by which benzene reaches its solvent-inaccessible binding cavity remain elusive. The current work, using extensive molecular dynamics simulation, achieves this by capturing the complete process of spontaneous recognition of benzene by L99A T4L at atomistic resolution. A series of multi-microsecond unbiased molecular dynamics simulation trajectories unequivocally reveal how benzene, starting in bulk solvent, diffuses to the protein and spontaneously reaches the solvent inaccessible cavity of L99A T4L. The simulated and high-resolution X-ray derived bound structures are in excellent agreement. A robust four-state Markov model, developed using cumulative 60 µs trajectories, identifies and quantifies multiple ligand binding pathways with low activation barriers. Interestingly, none of these identified binding pathways required large conformational changes for ligand access to the buried cavity. Rather, these involve transient but crucial opening of a channel to the cavity via subtle displacements in the positions of key helices (helix4/helix6, helix7/helix9) leading to rapid binding. Free energy simulations further elucidate that these channel-opening events would have been unfavorable in otherwise ligand-inactive wild type T4L. Taken together, by integrating experiments, these simulations provide unprecedented mechanistic insights into complete ligand recognition process in a buried cavity. By illustrating the power of subtle helix movements in opening up multiple pathways for ligand access, this work offers an alternate view of ligand recognition mechanism in a solvent-inaccessible cavity, contrary to common perception of single dominant pathway for ligand binding.
Antenatal Hiv testing: what now?
Authors: A. Noone, D. Goldberg
Journal: BMJ (1997)

# Despite guidelines, infections remain undetected {#article-title-2}

If a pregnant woman has access to antiretroviral treatment she and her unborn child may benefit greatly from her knowledge of her HIV status early in pregnancy. Zidovudine given during pregnancy and to the infant has been shown to reduce the rate of vertical transmission from 25% to 8%.1 Furthermore, since antiretroviral therapy can produce impressive and sustained reductions in viral load, and low levels of circulating virus are associated with reduced vertical transmission2 as well as slower rates of disease progression,3 there is a strong case for early diagnosis. While mothers should always retain the right to decline an HIV test, every effort should be made to avoid undetected infection in pregnancy. To this end, the departments of health in the United Kingdom have recommended that obstetric units should offer an HIV test to all pregnant women (“universal testing”) in areas of high HIV prevalence4 5 and have provided guidance on how this should be done. Is this policy being implemented effectively?

MacDonagh and colleagues recently reported on the effectiveness …