tbuckley/cabot-search huggingface dataset:
People with intellectual disabilities: People registered disabled with learning difficulties tend to fall through the net
Authors: Kiersten L Cornwell
Journal: BMJ (2004)

Incompetent patients may pose a problemEditor-The BMJ ethics committee's revised policy on consent to the publication of patient information is laudable, 1 but an important matter remains overlooked: publishing cases involving incompetent patients.Much can be learnt from these cases; be it highlighting clinical difficulties or drawing attention to neglected moral issues.But the guidelines as written may make it impossible to publish them.Imagine I wished to publish a case involving a traceable adult with learning disability who had requested genetic counselling.Turning to the guidelines, I would be required to obtain her consent before publication.However, obtaining written informed consent from adults with questionable competence could be difficult or exploitative, as they may lack the capacity to understand the implications of consent to publication.Furthermore, the exceptions listed under point 3 do not apply.Merely anonymising her information would be ethically problematic, as could drafting a fictional case "inspired" by the clinical encounter.Until the mental capacity bill becomes law, no one can provide consent on her behalf.How should we balance the value gained from publishing these cases with respecting the interests of the people involved?Rogers and Draper have already addressed this issue in the context of medical ethics research and teaching. 2They argue that using cases with practical obstacles to obtaining consent can often be justified by an appeal to public interest arguments, such as the public's right to know what clinical and ethical dilemmas doctors face.Although more discussion is required, the BMJ ethics committee also needs to develop practical recommendations for the use of case studies where the subject cannot provide full informed consent.
The Discovery of Insulin
Authors: WILLIAM J. STEENROD
Journal: Annals of Internal Medicine (1980)

Letters1 March 1980The Discovery of InsulinWILLIAM J. STEENROD JR., M.D.WILLIAM J. STEENROD JR., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-92-3-443 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In a recent editorial note, Hudson (1), reviewing J. J. R. Macleod's "History of the Researches Leading to the Discovery of Insulin" from the 1978 Bulletin of the History of Medicine, argues that this paper presents a "more favorable picture of Macleod and his contribution than has been drawn before." This is not surprising, since the treatise was written by Macleod. On several points, however, Macleod's version does not square with the evidence.First, was, Dr. Hudson avers, Macleod "leaning over backward in an effort to be fair at a time when it was customary for the...References1. HUDSON R. New light on the insulin controversy. Ann Intern Med. 1979;91:311-2. Editorial. LinkGoogle Scholar2. BANTINGBESTCOLLIPCAMPBELLFLETCHERMACLEODNOBLE FCJWAJE: The effect produced on diabetes by extracts of pancreas. Trans Assoc Am Physicians. 1922;37:337-47. Google Scholar3. MACL J. Insulin. Encyclopaedia Britannica. 14th ed. 1929:451-2. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: The Mason Clinic Seattle, WA 98111 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 March 1980Volume 92, Issue 3Page: 443-443KeywordsHistory of medicineInsulin ePublished: 1 December 2008 Issue Published: 1 March 1980 PDF downloadLoading ...
Suplatast Tosilate Inhibits Late Response and Airway Inflammation in Sensitized Guinea Pigs
Authors: HIDEYA IIJIMA, GEN TAMURA, TZUEN-REN HSIUE, YI LIU, HAJIME TANIGUCHI, KUNIO SHIRATO
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

The effect of suplatast tosilate, which has been proven to inhibit T-cell synthesis of IL-4 and IL-5, on the response to antigen inhalation challenge was investigated in sensitized guinea pigs. The animals were given an oral dose of 30 or 100 mg/kg of suplatast or vehicle (distilled water) daily for 1 wk before antigen challenge. Measurement of pulmonary resistance for 6 h was followed by bronchoalveolar lavage and lung fixation. After antigen challenge, all guinea pigs in the vehicle group displayed dual-phase airway obstruction and accumulation of eosinophils and lymphocytes in the airways. After 1 wk of treatment with the high dose of suplatast, the late asthmatic response and the recruitment of eosinophils and lymphocytes into the airways were significantly inhibited, but the early asthmatic response was not affected. In situ hybridization revealed that challenge-induced increases in IL-5 mRNA-positive cells in lung tissue were significantly inhibited after treatment. Thus, suplatast inhibited airway obstruction in the late phase by specifically inhibiting the inflammatory process after mast cell degranulation.
Tennis Players and Eye Injuries
Authors: Martin Duke
Journal: JAMA (1976)

To the Editor.—  With the number of tennis players, many inexperienced, increasing rapidly, more injuries related to eye-ball contact (no pun intended) can be expected. The article by Seelenfreund and Freilich entitled Rushing the Net and Retinal Detachment (235:2723, 1976) does much to alert physicians to this problem. In addition, a recent book for the tennisplaying public reviews these injuries and the symptoms that should alert a player when to seek medical attention. 1   However, even the expert player can sustain serious trauma to the eye. In 1912, the world-class player William Laurentz, ranked among the top three in France for a decade, was served a ball that glanced off his racket and struck him in the eye. Subsequently, the eye had to be removed. In spite of this handicap, Laurentz continued to enjoy success in the tennis world, playing Davis Cup competition for several years thereafter. 2   It would
Nested sets and base-rate neglect: Two types of reasoning?
Authors: Wim De Neys
Journal: Behavioral and Brain Sciences (2007)

Abstract Barbey &amp; Sloman (B&amp;S) claim that frequency formats and other task manipulations induce people to substitute associative thinking for rule-based thinking about nested sets. My critique focuses on the substitution assumption. B&amp;S demonstrate that nested sets are important to solve base-rate problems but they do not show that thinking about these nested sets relies on a different type of reasoning.
Maternal nutrition and infant birth weight.
Authors: J R Sibert
Journal: BMJ (1978)

<b>1263</b> <h3><b>Objectives:</b></h3> Semantic variant of primary progressive aphasia (SvPPA) is nearly always associated with non-Alzheimer (AD) pathology, such as TDP- 43 pathological aggregates. Very few anatomopathological studies have found the presence of other underlying pathologies, as such AD. The aim of present work is to investigate the brain perfusion SPECT pattern svPPA according to cerebrospinal (CSF) biomarker profile (AD vs. non-AD). We hypothesize that the brain hypoperfusion pattern would be different in SvPPA with CSF profile suggestive of AD, from those of SvPPA having a non-AD profile. <h3><b>Methods:</b></h3> 21 SvPPA patients were classified in two subgroups (SvPPA-AD and SvPPA-nonAD) according to CSF criteria. We compared brain perfusion profiles of subgroups with those of 24 healthy subjects, and 24 amnestic, typical AD patients, on voxel-basis with SPM software. <h3><b>Results:</b></h3> all SvPPA patients had a severe left temporopolar hypoperfusion. In SvPPA-AD (3 out of 21), the hypoperfusion was extended to left parietal associative cortex including the posterior cingulate (p&lt;0.05 corrected). Conversely, SvPPA-nonAD patients had additional hypoperfusion in the anterior cingulate and orbitofrontal cortex (p&lt;0.01). Compared with typical AD, SvPPA-AD showed a deeper perfusion decrease in the left temporal pole, whereas AD had more prominent hypoperfusion in the precuneus (p&lt;0.05 corrected). <h3><b>Conclusion:</b></h3> We observed a specific hypoperfusion pattern in SvPPA with AD CSF profile involving not only the temporal pole but also the left parietal lobe, suggesting that AD can present in atypical way, and that the parietal cortex has critical role in AD pathology, irrespectively of clinical presentation. <b>Research Support:</b> Pitié-Salpêtrière Hospital
Self-Examination Kit
Authors: William B. Bean
Journal: JAMA (1961)

To the Editor:—  My whimsical turn of mind compels me to write a letter to the editor, prompted by the unintentional humor of the Question and Answer section inThe Journal, Feb. 18. Colleague Burt of Milford Center, Ohio, questions you in the cheerful confusion of our do-it-yourself age about the possibility of spreading wholesale across the face of the land a self-examination kit for Papanicolaou-minded women of today. May I call your attention to the interesting sequence of events which was evoked by the paragraph on Penny Cancer Kit in the February, 1955, issue of Today's Health? It was stated hopefully, A home kit costing only a penny offers a promising aid for drastic reduction of deaths from cancer of the cervix, second most common type of female cancer.  This seemingly innocuous, but spectacular, proposal was promptly seized upon by W. B. McCunniff who, to fill up space in
MESENTERIC CYST IN A CHILD
Authors: John A. Nunn
Journal: JAMA (1933)

Our purpose in this paper is to report a case of mesenteric cyst, which, judging from the current literature, is a relatively infrequent condition and, from the textbooks, nonexistent; also to advance a possible explanation for the condition in a case in which the usual pathologic changes did not exist. J. T., a boy, aged 3 years, seen, Aug. 29, 1932, had always been in good health until three months before he came to us. His family and birth histories were negative. He weighed 8½ pounds (3,855 Gm.) at birth; he walked at 9 months; he was breast fed for three months and then fed whole cow's milk formula. His parents had noticed a left sided hernia since he was 1 month old. He had had none of the contagious diseases of childhood. His parents stated that the hernia had been small and reducible until three months before we saw
A 20-year follow-up study on chronic respiratory effects of exposure to cotton dust
Authors: X-R. Wang, H-X. Zhang, B-X. Sun, H-L. Dai, J-Q. Hang, E. A. Eisen, D. H. Wegman, S. A. Olenchock, D. C. Christiani
Journal: European Respiratory Journal (2005)

In order to evaluate chronic effects of long-term exposure to cotton dust on respiratory health, and the role of dust and endotoxin, longitudinal changes in lung function and respiratory symptoms were observed prospectively from 1981 to 2001 in 447 cotton textile workers, along with 472 silk textile controls. The results from five surveys conducted over the 20-yr period are reported, including standardised questionnaires, pre- and post-shift spirometric measurements, work-area inhalable dust sample collections and airborne Gram-bacterial endotoxin analysis. Cotton workers had more persistent respiratory symptoms and greater annual declines in forced expiratory volume in one second (FEV 1 ) and forced vital capacity as compared with silk workers. After exposure cessation, in the final 5-yr period, the rate of FEV 1 decline tended to slow in nonsmoking males, but not in nonsmoking females. Workers who reported byssinotic symptoms more persistently suffered greater declines in FEV 1 . Chronic loss in lung function was more strongly associated with exposure to endotoxin than to dust. In conclusion, the current study suggests that long-term exposure to cotton dust, in which airborne endotoxin appears to play an important role, results in substantial adverse chronic respiratory effects.
DELETERIOUS IMPACT OF MILD ANEMIA ON SURVIVAL OF YOUNG PATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY. DATA FROM TRIESTE CARDIOMYOPATHIES REGISTRY
Authors: Aneta Aleksova, Giulia Barbati, Marco Merlo, Davide Stolfo, Cosimo Carriere, Andrea Di Lenarda, Gianfranco Sinagra
Journal: Journal of the American College of Cardiology (2010)
Sleep and duodenal motor activity in patients with severe non-ulcer dyspepsia.
Authors: D David, H Mertz, L Fefer, B Sytnik, H Raeen, N Niazi, A Kodner, E A Mayer
Journal: Gut (1994)

The prevalence of sleep disturbances was studied in patients with severe non-ulcer dyspepsia. It was also considered if the change in sleep pattern was associated with changes in the rhythmic fasting motor activity of the gastrointestinal tract, and if motor events correlate with the patient9s symptoms. Motor activity in the duodenum was monitored over a 24 hour period under freely ambulatory conditions in 10 healthy controls and in 10 patients with severe non-ulcer dyspepsia using a transnasally placed catheter with six solid state pressure transducers connected to a digital data logging device. Symptoms and sleep disturbance were assessed by questionnaire and diary. Based on their symptoms, the patients were separated into two groups: those with dyspepsia symptoms only (non-ulcer dyspepsia; n = 5) and those with dyspepsia and additional functional symptoms thought to arise from the lower gastrointestinal tract (non-ulcer dyspepsia+irritable bowel syndrome; n = 5). When compared with either the control or the non-ulcer dyspepsia+irritable bowel syndrome group, non-ulcer dyspepsia patients had a considerably decreased number of migrating motor complexes during the nocturnal period (0.7 v 4.6), a decreased percentage of nocturnal phase I (5.2% v 78.0%), and an increased percentage of the nocturnal period in phase II (94% v 15.4%). Patients with non-ulcer dyspepsia+irritable bowel syndrome were not different from normal controls. Four of the non-ulcer dyspepsia patients and all of the non-ulcer dyspepsia+irritable bowel syndrome patients reported difficulties with sleep. Clusters of high amplitude tonic and phasic activity, not accompanied by subjective reports of discomfort were noted in several patients in both groups during the study. In eight of 10 patients, abdominal pain was reported during normal motor activity, while in one patient, pain correlated with phase III of the migrating motor complex. In contrast with previous reports in patients with irritable bowel syndrome, our findings suggest an abnormality of diurnal rhythmicity--shown in changed sleep and changed rhythmic duodenal motor activity--in patients with chronic abdominal pain thought to arise from the upper gastrointestinal tract.
Inflammatory and hyperproliferative skin disease in mice that express elevated levels of the IL-1 receptor (type I) on epidermal keratinocytes. Evidence that IL-1-inducible secondary cytokines produced by keratinocytes in vivo can cause skin disease.
Authors: R W Groves, T Rauschmayr, K Nakamura, S Sarkar, I R Williams, T S Kupper
Journal: Journal of Clinical Investigation (1996)

Interleukin (IL)-1 induces a cascade of secondary cytokines in a large number of cell types in vitro, including monocytes, fibroblasts, synovial cells, and keratinocytes. Although it has been proposed that autocrine or paracrine activation of such cells by IL- 1 in situ could orchestrate a local inflammatory response, formal proof for such an hypothesis has been lacking. In an attempt to lower the threshold for secondary cytokine production in these cells in response to IL-1, we have generated transgenic mice (designated IR10) which overexpress functional type 1 IL-1 receptor in basal layer of epidermis keratinocytes. As predicted, keratinocytes from these animals were substantially more responsive to exogenous IL-1 than nontransgenic keratinocytes when stimulated in vitro. When challenged with known inducers of keratinocyte IL-1 synthesis and release, skin of IR10 mice exhibited an exaggerated inflammatory response, characterized by epidermal hyperplasia and an acute dermal inflammatory cell infiltrate. In this setting, the secondary epidermal cytokines gro-alpha and GM-CSF were strongly induced in transgenic epidermis but not in control skin. To confirm that these changes were indeed related to IL-1 mediated activation pathways, IR10 mice were crossed to a distinct line of transgenic mice that overexpress 17-kD IL-l alpha in basal keratinocytes. Double transgenic mice derived from this cross breeding experiment developed spontaneous inflammation of the skin, similar in appearance to that induced by PMA, both histologically and macroscopically, and distinct from that seen in either parental strain spontaneously. Furthermore, secondary cytokines were more strongly induced in the double transgenic than in either parental strain. These findings conclusively demonstrate the potential for functional autocrine pathways of keratinocyte activation mediated by IL-1 alpha in vivo, and suggest that level of expression of type 1 IL-1 receptor may function as a significant control point in physiologic IL-1 mediated autocrine pathways.
Research and the Community Functions of a Health Department
Authors: Paul M. Densen
Journal: New England Journal of Medicine (1963)

SOME of you will remember the old-style paper-back books we we used to buy at the corner candy store when we were children. Those paperbacks always had double titles such as "From Rags to Riches — or the Rise of Abner Abernathy." This lecture, too, although it is on research and the community functions of a health department, might also be entitled "The Health Department as a Catalyst."The theme I wish to advance is that the modern health department has a major responsibility for exercising leadership in marshaling the total community resources for the attack on today's health problems. . . .
Impact of Physical Activity on Cardiovascular Risk Factors in Children With Type 1 Diabetes
Authors: Antje Herbst, Olga Kordonouri, Karl O. Schwab, Frank Schmidt, Reinhard W. Holl
Journal: Diabetes Care (2007)

Type 1 diabetes is associated with a high risk for early atherosclerotic complications. Patients with type 1 diabetes have a fourfold (in men) to eightfold (in women) excess risk of coronary heart disease compared with that for the general population (1). It has been shown that type 1 diabetic patients aged 20–39 years have a fivefold higher risk of dying from cardio- and cerebrovascular events compared with that for healthy individuals (2). Development of atherosclerotic lesions in healthy subjects begins upon childhood. In children with type 1 diabetes who had died an unnatural death, an asymptomatic increase in the intima-media thickness of the common carotid artery was found (3). Known risk factors for vascular complications are long-standing diabetes, age, poor glycemic control, smoking, hypertension, obesity, and dyslipidemia (4–6). In a recent study, 69% of the pediatric patients with type 1 diabetes were found to have one or more cardiovascular risk factors (7). Thus, there is an urgent need for prevention strategies to reduce these risk factors in childhood and adolescence.

We recently showed that frequency of regular physical activity (RPA) represents an important factor influencing glycohemoglobin and, in girls, BMI (8). The present study focuses on the impact of RPA on further cardiovascular risk factors such as plasma lipids and blood pressure in children with type 1 diabetes.

Data were provided by the Pediatric Quality Initiative (9) and included anonymous longitudinal data of 23,251 patients (3–18 years) with type 1 diabetes from 209 centers in Germany and Austria. The data are continuously generated by the participating centers using the diabetes data acquisition system for prospective surveillance [DPV] software (Diabetes Software for Prospective Documentation) and after anonymization are transmitted to the Pediatric Quality Initiative for …
Spontaneous fibrinolysis in pulmonary embolism
Authors: James E. Wilson, Eugene P. Frenkel, Alan K. Pierce, Robert L. Johnson, Edward R. Winga, George C. Curry, Donald S. Mierzwiak
Journal: Journal of Clinical Investigation (1971)

This study correlated levels of activated fibrinolysis with the presence, extent, and rate of resolution of angiographically documented pulmonary emboli. Pulmonary emboli demonstrable by angiography were associated with detectable fibrin split products in the serum of 24 of 25 patients. In the absence of increased fibrin split products, pulmonary emboli large enough to be demonstrated by angiography were found in only 2 of 25 positive pulmonary angiograms. Spontaneous resolution of pulmonary emboli could not be correlated with the the concentration or persistence of fibrin split products but did correlate well with the presence of a reversible precipitating cause. Thrombophlebitis in the absence of clinical evidence of pulmonary embolism was not associated with increased concentrations of fibrin split products in eight of nine patients. The one patient with increased fibrin split product concentration had evidence on lung scan of silent pulmonary embolism.
TEACHING OF UROLOGY TO INTERNS
Authors: WILLIAM C. QUINBY
Journal: JAMA (1925)

Methods of instruction of the recent graduate in the art of surgery and of the surgical specialties are important, for the problems concerning them affect us all to a greater or less degree. As any special field develops through intensive study and work at the hands of many men, the amount of detailed knowledge in that field is continually increased till a point is reached at which the available knowledge, especially as it concerns diagnostic and therapeutic measures, is of a magnitude so great as to demand a period of months, if not years, of extensive study by him who would become master of it. In such a state is the field of urology today. It is manifestly impossible to acquire proficiency in this branch of surgery during those relatively few months comprised in the usual hospital internship. It is very important, however, that a well balanced surgical instruction should
A NEW MIDDLE EAR, MASTOID AND LACHRYMAL SYRINGE.
Authors: ALFRED HINDE
Journal: JAMA (1896)

In suppurative inflammations of the middle ear, both acute and chronic, and of both atrium and attic and also in the extensions of the same pathologic process into the mastoid antrum the difficulties of removal of exudate, drainage, irrigation and disinfection of the infected parts are almost insuperable. For some years past I have had made and used drawn out and bent glass syringes, not unlike medicine droppers with elongated bent points. These, though exceedingly valuable for the purposes required have now been relegated to the curiosity shelf and the following syringe, modeled on their plan but indestructible and of greater capacity and power has taken their place in my practice and has been found a most useful and satisfactory instrument for the purposes required.  The syringe has four hollow tips, each seven centimeters long; the diameter of the ear end of each tip is one millimeter and that of