tbuckley/cabot-search huggingface dataset:
Interactivity and case learning
Authors: Ed Peile
Journal: BMJ (2006)

The volume of online response to this interactive case report has been disappointing.1 This prompted me to reflect on the nature of interactivity in online learning and in learning in general.

Learners' engagement with, and participation in, educational learning activities is widely accepted to enhance their learning. There is also evidence that in group activities, learning for peers is enhanced by participation of others. So if interactivity is beneficial, how do we encourage this participation, be …
The management of the NHS in England
Authors: C. Ham
Journal: BMJ (2012)

Loss of experienced managers creates a risk that performance will suffer

The shape of the reformed NHS has become much clearer since the recent publication of papers on the role of the NHS Commissioning Board and the sources of support available to clinical commissioning groups.1 2 These papers sound the death knell for strategic health authorities and primary care trusts, which are destined to be abolished in April 2013. Most of the functions of the strategic health authorities and primary care trusts will be taken on by the Commissioning Board and clinical commissioning groups, with the board being organised into four sectors with a total of 50 local offices.

On the surface the proposed arrangements may look similar to the four strategic health authority and 50 primary care trust clusters that exist currently, but in reality the new organisation will be very different. Each sector office and each local office will employ only 50 staff compared with the many more currently employed, so thousands of jobs will be lost. Redundancies among managers will contribute to a 50% reduction in management costs in the new organisation as the government seeks to fulfil its promise to put more resources into front line clinical care.

These changes build on work already done to cut back on the number of managers working in the NHS in anticipation of the controversial Health and Social Care Bill …
Heart transplantation in baboons using α1,3-galactosyltransferase gene-knockout pigs as donors: initial experience
Authors: Kenji Kuwaki, Yau-Lin Tseng, Frank J M F Dor, Akira Shimizu, Stuart L Houser, Todd M Sanderson, Courtney J Lancos, Derek D Prabharasuth, Jane Cheng, Kathleen Moran, Yosuke Hisashi, Nicolas Mueller, Kazuhiko Yamada, Julia L Greenstein, Robert J Hawley, Clive Patience, Michel Awwad, Jay A Fishman, Simon C Robson, Henk-Jan Schuurman, David H Sachs, David K C Cooper
Journal: Nature Medicine (2004)
The Proarrhythmic Potential of Implantable Cardioverter-Defibrillators
Authors: Sergio L. Pinski, Gerard J. Fahy
Journal: Circulation (1995)

Abstract The implantable cardioverter-defibrillator (ICD) is remarkably effective in preventing sudden cardiac death in high-risk patients, but it also has the capacity to provoke or worsen cardiac arrhythmias. Tachyarrhythmias or bradyarrhythmias may result from the delivery of antitachycardia or antibradycardia therapies by tiered-therapy defibrillators. This proarrhythmia, although rarely fatal, increases the morbidity associated with defibrillator therapy. Proarrhythmia is related as much to suboptimal programming as to technical limitations of the device. The proarrhythmic potential of ICD therapy can be minimized by tailoring the “electrical prescription” according to characteristics of the clinical arrhythmia and individual ICD idiosyncrasies.
Effect of topical alkane vapocoolant spray on pain with intravenous cannulation in patients in emergency departments: randomised double blind placebo controlled trial
Authors: R. Hijazi, D. Taylor, J. Richardson
Journal: BMJ (2009)

<b>Objective</b> To assess the efficacy, acceptability, and safety of a topical alkane vapocoolant in reducing pain during intravenous cannulation in adults. <b>Design</b> Randomised double blind placebo controlled trial. <b>Setting</b> Emergency department of a metropolitan teaching hospital. <b>Participants</b> 201 adult patients (54% male), mean (SD) age 58.2 (19.5) years, who required intravenous cannulation. <b>Interventions</b> Less than 15 seconds before cannulation, the skin area was sprayed with either water (control, n=98) or vapocoolant (intervention, n=103), from a distance of 12 cm for 2 seconds. The intervention spray was a blend of propane, butane, and pentane. <b>Main outcome measures</b> Pain with cannulation and discomfort with spray, measured with a 100 mm visual analogue scale. <b>Results</b> Groups did not differ significantly in age, sex, indication for or site of cannulation, cannula size, or who cannulated the patient (P&gt;0.05). Median (interquartile range) pain scores for cannulation in the control and intervention groups were 36 (19-51) and 12 (5-40) mm, respectively (P&lt;0.001), and 59 (60%) and 33 (32%) reported pain scores ≥30 mm (P&lt;0.001). Scores for spray discomfort also differed significantly (P&lt;0.001) because of skewing to the right within the intervention group. The median discomfort scores, however, were 0 mm in both groups. Success rates for first cannulation attempt did not differ between groups (P=0.39). Thirty four (39%) and 62 (62%) patients said they would choose the spray they received for analgesia in the future (P=0.002). At follow-up at five days, two patients in the intervention group reported transient skin redness. <b>Conclusions</b> Topical alkane vapocoolant spray is effective, acceptable, and safe in reducing pain with peripheral intravenous cannulation in adults in the emergency department. <b>Trial registration</b> Australian Clinical Trials ACTRN12607000470493.
ASSOCIATION OF HOME MONITORING WITH INTERSTAGE MORTALITY, READMISSIONS, AND WEIGHT GAIN: A MULTICENTER STUDY FROM THE NATIONAL PEDIATRIC CARDIOLOGY QUALITY IMPROVEMENT COLLABORATIVE
Authors: Matthew Oster, Alexandra Ehrlich, Eileen King, Christopher Petit, Martha Clabby, Sherry Smith, Michelle Glanville, Jeffrey Anderson, Lynn Darbie, Robert Beekman
Journal: Journal of the American College of Cardiology (2014)
Fulminant hepatic failure secondary to hydroxychloroquine.
Authors: A J Makin, J Wendon, S Fitt, B C Portmann, R Williams
Journal: Gut (1994)

Hydroxychloroquine is widely used in rheumatological disease but hepatic side effects have not been reported previously. Two cases are described of fulminant hepatic failure developing after the start of hydroxychloroquine treatment for a chronic rheumatological disorder. In both cases the symptoms of liver disease developed within two weeks of starting hydroxychloroquine and rapidly progressed to fulminant hepatic failure and in neither case was there any pre-existing liver disease. One patient had emergency orthotopic liver transplantation and the other died before a donor organ became available.
Abstract 927: The ligand-gated Cl- channel GABA inhibits colon cancer invasion following activation by pharmacological treatments
Authors: Kristin E. Ceniccola, Carrie D. House, Ryan J. Bateman, Amy Nguyen, Vincent Obias, Susan M. Ceryak, David Mendelowitz, Norman H. Lee
Journal: Cancer Research (2012)

Abstract Gamma-aminobutyric acid (GABA) receptors are ligand-gated ion channels that are essential for neurotransmitter function and neuronal cell homeostasis. Activation of these channels triggers the opening of a chloride-sensitive pore, which causes a hyperpolarization via an influx of chloride ions into the cell. The presence of these channels was recently implicated in several cancers, and the neurotransmitter GABA has been cited as a tumor suppressor. We propose that commercially available pharmacological treatments that manipulate GABA receptor function could be repurposed to target cancer. We have identified functional GABA receptors in a spectrum of colon cancer cell lines and examined the effects of the channels on invasion of the metastatic cell line SW620. Electrophysiological techniques were used to confirm that these channels have functional expression. Treatment with propofol, an agonist which slows the channel closing time, and GABA led to a decrease in invasive potential. Conversely, treatment with the antagonist gabazine, which allosterically blocks GABA from binding in the channel, facilitated invasion by preventing chloride influx. Curiously, treating the cells with bicuculline, which blocks GABA's inhibitory action, led to a decrease in invasion. In some situations bicuculline can also act as a GABA agonist by causing spontaneous gating of homomeric β3 channels. The expression of the β3 subunit was also confirmed through immunocytochemistry. In addition to colon cancer cell lines, β3 expression was detected at higher quantities in colon cancer patient samples compared to matched controls. To further understand how GABA signaling is implicated in cancer, we have looked at the association of GABA with the EGF signaling pathway, which is commonly dysregulated in cancer. The EGF pathway has also been linked with a loss of the glucagon receptor in liver cancer, suggesting that a common pathway may exist between GABA and glutamate that can be exploited for treatment. Altogether, our data suggest that ligand-gated GABA channels inhibit the metastatic potential of cancer cells and can be targeted to treat colon cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 927. doi:1538-7445.AM2012-927
THE PROGNOSIS OF ANGINA PECTORIS AND OF CORONARY THROMBOSIS
Authors: PAUL D. WHITE
Journal: JAMA (1926)

For centuries the prognosis of angina pectoris has in all probability been one of the most important and difficult problems in medicine; it has certainly been such since it received its name 150 years ago. Although a few bold physicians have ventured to discuss the subject at some length, medical writers as a rule have dismissed it with the brief remark that "God alone knows"; and that is the sum and substance of the opinions of most practitioners with whom I have discussed it. This very spirit of fear and ignorance is stimulating. The fact that we know little about the prognosis of angina pectoris now does not mean that we must always remain in the dark. And, although we sometimes make glaring prognostic errors, it is certain that we can make reasonably accurate predictions also. To some these prognoses seem to belong to a hit-or-miss method, but I believe
Peer Review and the Philosophy of Science
Authors: John R. Absher
Journal: JAMA (1990)

<h3>To the Editor.—</h3> Peer review has been acknowledged recently inThe Journalas an important process that needs to be studied carefully. The skills necessary to appraise journal articles are related directly to the peer review process, for it is these skills that are used by reviewers. The final estimation of the value of an article must be left to individual physicians. Education in critical journal appraisal is, therefore, a valuable part of the peer review process. Unfortunately, just as peer review was accepted reluctantly even among journal editors,<sup>1</sup>instruction in the appraisal of journal articles seems to be accepted reluctantly among medical students, despite innovative curricula. <h3>Study. —</h3> An evaluation was completed of computer-aided instruction designed to teach critical journal appraisal skills to medical students. Students who reviewed articles using the computer-aided instruction program were offered $20 to $25. Time requirements were from 4 to 6 hours. A
Dying: Facing the Facts
Authors: Lawrence D. Grouse
Journal: JAMA (1979)

... For many a time I have been half in love with easeful death. "Ode to a Nightingale" Keats The case can no longer be supported that there is insufficient critical attention paid to the cultural, medical, and psychological aspects of death. The opposite may be true. In Muriel Spark's great comic novel,<i>Memento Mori</i>, an unidentified caller torments a group of octogenarians with an annoying telephone message: remember that you must die! A reader of the series of essays entitled<i>Dying: Facing the Facts</i>empathizes with the elderly characters in the novel. I occasionally felt tormented as I read the essays. Many of the sociological and psychological insights that are presented seem too facile and familiar; they belabor the obvious. Still, some critical points came through clearly. One must understand the social context of death to be able to deal with the forces at play. It is necessary for a
Stimulation of the Intracellular Bacterial Sensor NOD2 Programs Dendritic Cells to Promote Interleukin-17 Production in Human Memory T Cells
Authors: Astrid J. van Beelen, Zuzana Zelinkova, Esther W. Taanman-Kueter, Femke J. Muller, Daniel W. Hommes, Sebastian A.J. Zaat, Martien L. Kapsenberg, Esther C. de Jong
Journal: Immunity (2007)
750. Expression Levels of the Amphotropic Receptor May Explain Gestational Age-Dependence of Tissue Transduction in Fetal Sheep
Authors: Ferhat Ozturk, Paul Park, Joe Tellez, Wayne B. Anderson, Maribeth Eiden, Esmail D. Zanjani, Graca Almeida-Porada, Christopher D. Porada
Journal: Molecular Therapy (2005)

We have recently reported that the gestational age of the recipient determines the pattern and level of transgene expression following in utero retroviral gene transfer by direct injection into pre-immune fetal sheep (Molecular Therapy 11(2):284-293, 2005). These studies suggest that the developmental stage of each organ at the time of injection may determine its susceptibility to in utero gene transfer, and that each organ possesses its own unique temporal window during which optimal transduction can be achieved. In the present studies, we sought to determine the mechanism by which the recipient's age was affecting transduction efficiency and subsequent transgene expression. One can envision two mechanisms whereby the age of the tissue could affect its susceptibility to transduction with murine retroviral vectors. The first of these is the proliferative state of the tissue, since these vectors require cell division and nuclear membrane breakdown for genomic integration. To investigate this possibility, we have begun performing analysis of the fetal liver and lung at various gestational ages using BrdU labeling and staining of tissue sections with antibodies to Ki-67 and PH3, both markers of mitosis. Thus far, our results provide evidence that the proliferative state of the various tissues is not the primary mechanism by which transduction efficiency is being limited, since no significant difference was observed in the percentage of cells labeled in each tissue at the various ages studied. The other primary mechanism whereby the age of the tissue could alter its susceptibility to transduction is through age-dependent alterations in the levels of the receptor used for viral attachment and entry, namely, the amphotropic receptor, PiT2. To test this hypothesis, we custom synthesized an antibody to the ovine PiT2 receptor and developed an ELISA to evaluate the various fetal tissues at different gestational ages to determine whether the age of each tissue impacts upon its levels of PiT2 expression. Thus far, our results suggest that peaks in the levels of PiT2 expression occur at different stages of development in different tissues, thereby providing a possible explanation for the observed alterations in transduction efficiency. We are currently conducting real-time RT-PCR assays to confirm these alterations in the levels of PiT2 expression as a function of gestational age. It is hoped that these ongoing studies will enable us to determine the optimal stages for gene delivery to each of the major organs of the developing fetus and delineate the mechanisms that govern the levels of gene transfer that can be obtained.
Differential regulation of protein kinase C and (Na,K)-adenosine triphosphatase activities by elevated glucose levels in retinal capillary endothelial cells.
Authors: T S Lee, L C MacGregor, S J Fluharty, G L King
Journal: Journal of Clinical Investigation (1989)

Elevated cellular sorbitol levels resulting from conversion of increased glucose by aldose reductase might deplete cellular myoinositol content, which could then lower inositol phosphates (InsPs) and diacylglycerol levels, key regulators of protein kinase C (PKC). Secondary to altered PKC activity, other cellular enzymes such as (Na,K)-ATPase could be affected. To test this hypothesis we examined the association between PKC activity, (Na,K)-ATPase activity, and sorbitol, myoinositol, and InsP levels in cultured bovine retinal capillary endothelial cells, a cell type prominently involved in diabetic retinopathy. Elevating glucose concentration in culture media from 100 to 400 mg/dl led to a 100% increase in sorbitol levels, which could be inhibited completely by sorbinil, an aldose reductase inhibitor. In contrast, no changes were observed in myoinositol or InsP levels. Subfractionated PKC activities showed a 100% increase in the membranous pool with a parallel decrease in the cytosolic fraction. Adding sorbinil did not affect PKC activity, whereas the PKC agonist, phorbol myristate acetate (PMA), stimulated translocation of PKC. Ouabain-inhibitable (Na,K)-ATPase activity was decreased 70% by elevated glucose levels. This decrease could be prevented by adding either PMA or sorbinil. Thus, in retinal capillary endothelial cells elevated glucose concentration can affect PKC and (Na,K)-ATPase activities, probably via different mechanisms.
Likelihood ratios for modern screening mammography. Risk of breast cancer based on age and mammographic interpretation
Authors: K. Kerlikowske
Journal: JAMA (1996)

To determine the sensitivity, specificity, and likelihood ratios (LRs) for modern screening mammography by decade of age and mammographic interpretation.Cross-sectional.Nine counties in northern California.A total of 26,057 women aged 30 years and older who underwent a total of 41,747 first and subsequent screening mammographic examinations at the Mobile Mammography Screening Program of the University of California, San Francisco, from April 1985 to September 1991.Breast cancer risk profile, 2 standard mammographic views per breast, and follow-up of abnormal and normal mammograms of contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results tumor registry. False-negative examinations were normal examinations that occurred within 13 months of a diagnosis of invasive breast cancer or ductal carcinoma in situ.The sensitivity of first screening mammography increased with age: 77.3% for ages 30 to 39 years, 86.7% for ages 40 to 49 years, 93.6% for ages 50 to 59 years, 94.1% for ages 60 to 69 years, and 91.2% for ages 70 years and older (P = .04). Specificity was similar for all ages, ranging from 92.6% to 95.2%. Of all abnormal first screening examinations, 92.9% were reported as "additional evaluation needed." The LRs for that category ranged from 5.2 to 8.8 and did not vary with age. Based on the risk of breast cancer before mammography, which increases with age, the risk of breast cancer after mammography associated with these LRs were 0.01 for ages 30 to 39 years, 0.02 for ages 40 to 49 years, 0.05 for ages 50 to 59 years, 0.07 for ages 60 to 69 years, and 0.07 for ages 70 years and older. The LRs for mammography reported as "suspicious for malignancy" ranged from 88 to 144 and did not vary across age groups. These LRs were associated with a risk of breast cancer about 10 times greater than when mammography was reported as "additional evaluation needed."Most abnormal first screening mammography are interpreted as "additional evaluation needed" and are associated with LRs of about 7. Given this low LR, the risk of breast cancer after mammography is primarily influenced by a woman's age-specific risk of breast cancer before mammography. The LRs for screening mammography interpreted as "suspicious for malignancy" are high (about 124) and are associated with a substantial increase in the risk of breast cancer irrespective of age, but these interpretations comprise only a small proportion of abnormal mammography.
Book: Blood and Smoke
Authors: R. M Davis
Journal: BMJ (2000)

Stephen King Hodder and Stoughton Audio Books, £14.99, 3.5 hours ISBN 1 840 32391 4 Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img>![Graphic][4]</img> Blood and Smoke is an audio book written and read engagingly by Stephen King. It comes in a flip-top box resembling a pack of Marlboro cigarettes. The “book” is actually a series of three short stories that take the listener “inside the world of yearning and paranoia, isolation and addiction … the world of the smoker.” In Lunch at the Gotham Café Steve Davis is distraught after his wife leaves him. Two days later, he … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif [4]: /embed/inline-graphic-4.gif
Reply to Emmanuele A. Jannini’s Words of Wisdom re: The Role of Short Frenulum and the Effects of Frenulectomy on Premature Ejaculation [J Sex Med 2010;7:1269–76]. Eur Urol 2010;57:1119–20
Authors: Luigi Gallo, Sisto Perdonà, Antonio Gallo
Journal: European Urology (2010)
Should we use individual cognitive stimulation therapy to improve cognitive function in people with dementia?
Authors: M. Orrell, B. Woods, A. Spector
Journal: BMJ (2012)

Interest is growing in the potential for mental exercises and activities to maintain and improve cognitive function, especially for patients attending memory clinics. However, a recent six week study of online brain training1—using cognitive tasks designed to improve reasoning, memory, planning, visuospatial skills, and attention—found that although specific improvements occurred in each domain, these effects did not transfer to untrained tasks. Psychological therapies targeting cognitive function in dementia have been in widespread use for several decades. These approaches may involve personalised interventions, such as cognitive rehabilitation (which focuses on coping with deficits and enhancing remaining cognitive skills)2 or cognitive training (which aims to enhance cognitive skills such as memory and attention through practice). More generic approaches include reminiscence, reality orientation, and cognitive stimulation therapy (box).3 Reality orientation, which involved re-teaching information related to orientation to everyday life (such as date, location, and current events), has now been superseded by cognitive stimulation, which uses more implicit methods, with activities including categorisation and word association. Group based cognitive stimulation therapy is now a well established, evidence based, and cost effective approach that can improve cognition and quality of life in people with dementia.3 4 #### Description of cognitive stimulation therapy
Utilization of epidermal phospholipase A2 inhibition to monitor topical steroid action
Authors: J. F. B. NORRIS, E. ILDERTON, H. J. YARDLEY, R. SUMMERLY, S. FORSTER
Journal: British Journal of Dermatology (1984)

The effect of several steroid creams on epidermal phospholipase A2 (PLA2) activity in symptomless psoriatic and normal epidermis was studied. The magnitude of PLA2 inhibition produced by the steroids was directly proportional to the initial level of the enzyme activity. This differential inhibition resulted in PLA2 activity approaching or attaining the normal range regardless of its initial level. Clobetasol propionate 0.05% (Dermovate) produced more enzyme inhibition than betamethasone valerate 0.1% (Betnovate) but there was no difference in inhibition between this latter steroid and clobetasone butyrate 0.05% (Eumovate). All were more inhibitory than hydrocortisone I% (Efcortelan).