tbuckley/cabot-search huggingface dataset:
Surveillance of HIV Infection and Zidovudine Use among Health Care Workers after Occupational Exposure to HIV-Infected Blood
Authors: Jerome I. Tokars
Journal: Annals of Internal Medicine (1993)

Objective: To study the risk for human immunodeficiency virus (HIV) infection and the patterns of use and associated toxicity of zidovudine among health care workers after an occupational exposure to HIV. Design: An ongoing, prospective surveillance project conducted by the Centers for Disease Control and Prevention. Participants: Exposed workers voluntarily reported by 312 U.S. health care facilities from August 1983 to June 1992. Results: Four of 1103 enrolled workers with percutaneous exposure to HIV-infected blood seroconverted (HIV seroconversion rate, 0.36%; upper limit of the 95% CI, 0.83%); no enrolled workers with mucous membrane (n = 75) or skin (n = 67) contact seroconverted. During October 1988 to June 1992, 31% of 848 enrolled workers used zidovudine after exposure; this proportion increased from 5% during October through December 1988 to 43% during January through June 1992. Despite using zidovudine after exposure, one worker became infected with a strain of HIV that was apparently sensitive to zidovudine. Adverse symptoms, most commonly nausea, malaise or fatigue, and headache, were reported by 75% of workers using zidovudine; 31% of workers did not complete planned courses of zidovudine because of adverse events. Conclusions: The risk for HIV seroconversion after percutaneous exposure to HIV-infected blood is 0.36%, which is similar to previous estimates. Zidovudine is used after exposure by a sizable proportion of health care workers enrolled in the project despite frequent, minor, associated symptoms. Documented failures of postexposure zidovudine prophylaxis, including in one worker enrolled in this study, indicate that if zidovudine is protective, any protection afforded is not absolute. Postexposure zidovudine, if used, requires careful consideration of possible risks and benefits.
Survival is worse in renal cancer patients who were denied new drugs, small study indicates
Authors: R. Dobson
Journal: BMJ (2009)

Patients with renal cancer who were denied access to two new drugs, sunitinib and sorafenib, because their NHS trusts would not fund their use had worse survival outcomes than patients who were allowed the drugs, even though they were all treated by the same clinical team, a small study has shown.

The results showed that survival in patients who received the new drugs was better than in those who hadn’t applied for funding for the drugs, even though all had similar prognostic factors (hazard ratio 0.46 (95% confidence interval 0.21 to 1.01; P=0.05)) ( Clinical Oncology doi:10.1016/j.clon.2009.06.007).

“This audit …
Beyond the Hormone: Insulin as an Autoimmune Target in Type 1 Diabetes
Authors: Vedran Brezar, Jean-Claude Carel, Christian Boitard, Roberto Mallone
Journal: Endocrine Reviews (2011)

Insulin is not only the hormone produced by pancreatic β-cells but also a key target antigen of the autoimmune islet destruction leading to type 1 diabetes. Despite cultural biases between the fields of endocrinology and immunology, these two facets should not be regarded separately, but rather harmonized in a unifying picture of diabetes pathogenesis. There is increasing evidence suggesting that metabolic factors (β-cell dysfunction, insulin resistance) and immunological components (inflammation and β-cell-directed adaptive immune responses) may synergize toward islet destruction, with insulin standing at the crossroad of these pathways. This concept further calls for a revision of the classical dichotomy between type 1 and type 2 diabetes because metabolic and immune mechanisms may both contribute to different extents to the development of different forms of diabetes. After providing a background on the mechanisms of β-cell autoimmunity, we will explain the role of insulin and its precursors as target antigens expressed not only by β-cells but also in the thymus. Available knowledge on the autoimmune antibody and T-cell responses against insulin will be summarized. A unifying scheme will be proposed to show how different aspects of insulin biology may lead to β-cell destruction and may be therapeutically exploited. We will argue about possible reasons why insulin remains the mainstay of metabolic control in type 1 diabetes but has so far failed to prevent or halt β-cell autoimmunity as an immune modulatory reagent.
Effect of fluvastatin on renal end points in the Assessment of Lescol in Renal Transplant (ALERT) trial
Authors: Bengt Fellström, Hallvard Holdaas, Alan G. Jardine, Ingar Holme, Gudrun Nyberg, Per Fauchald, Carola Grönhagen-Riska, Søren Madsen, Hans-Hellmut Neumayer, Edward Cole, Bart Maes, Patrice Ambühl, Anders G. Olsson, Anders Hartmann, John O. Logan, Terje R. Pedersen
Journal: Kidney International (2004)
ABC of child abuse. Abuse: the experience.
Authors: S. Fraser
Journal: BMJ (1989)

The book tells a story which is common.For manyyears Sylvia Fraser thought that she was an ordinary person until incestuous memories returned, at which stage shefeared she was a freak.The recognition that sexual abuse within the family is common was, in a strange way, a comfort; she realised that she was still an ordinary person.She makes clear that the denial in herfamily was a reflection of the denial in the society that bred us all-a microcosm of the macrocosm.Today's incest victims are merely shouting the obvious for those who care to hear: "the emperor has no clothes."-RM
Primary care: opportunities and threats Deregulating primary care
Authors: A. Coulter, N. Mays
Journal: BMJ (1997)

Evaluating scientific quality is a notoriously difficult problem which has no standard solution.Ideally, published scientific results should be scrutinised by true experts in the field and given scores for quality and quantity according to established rules.In practice, however, what is called peer review is usually performed by committees with general competence rather than with the specialist's insight that is needed to assess primary research data.Committees tend, therefore, to resort to secondary criteria like crude publication counts, journal prestige, the reputation of authors and institutions, and estimated importance and relevance of the research field, 1 making peer review as much of a lottery as of a rational process. 2 3 On this background, it is hardly surprising that alternative methods for evaluating research are being sought, such as citation rates and journal impact factors, which seem to be quantitative and objective indicators directly related to published science.The citation data are obtained from a database produced by the Institute for Scientific Information (ISI) in Philadelphia, which continuously records scientific citations as represented by the reference lists of articles from a large number of the world's scientific journals.The references are rearranged in the database to show how many times each publication has been cited within a certain period, and by whom, and the results are published as the Science Citation Index (SCI).On the Is the journal impact factor really representative of the individual journal articles? Relation of journal impact factor and citation rate of articleFor the journal's impact factor to be reasonably representative of its articles, the citation rate of individual articles in the journal should show a narrow distribution, preferably a Gaussian distribution, around Summary points• Use of journal impact factors conceals the difference in article citation rates (articles in the most cited half of articles in a journal are cited 10 times as often as the least cited half) • Journals' impact factors are determined by technicalities unrelated to the scientific quality of their articles • Journal impact factors depend on the research field: high impact factors are likely in journals covering large areas of basic research with a rapidly expanding but short lived literature that use many references per article
Sensitization to airborne and food allergens in Reykjavik (Iceland) and Uppsala (Sweden) - a comparative study
Authors: D. Gislason, E. Björnsson, T. Gislason, C. Janson, G. Boman, O. Sjöberg, L. Elfman
Journal: Allergy (1999)

Background: The aim of this study was to compare the prevalence of atopic sensitization and possible risk factors for allergies in two ethnically similar but geographically widely separated urban populations. Methods: Data from two centers of the European Community Respiratory Health Survey, Reykjavík, Iceland, and Uppsala, Sweden, were utilized. This included a structured interview, skin prick tests, and blood samples for total and specific IgE for common aeroallergens. Additional measurements of specific IgE antibodies to common food antigens were performed. Furthermore, data on social environment, lifestyle, air pollution, and meteorologic variables were compared. Results: Skin prick tests were done on 540 individuals in Reykjavík and 527 in Uppsala. The overall prevalence of at least one positive prick test was 20.5% in Reykjavík and 34.2% in Uppsala ( P &lt;0.001). Total and specific IgE were measured in serum from 521 subjects in Reykjavík and 472 in Uppsala. The geometric mean value for total IgE was significantly lower in Reykjavík (13.4 kU/l) than in Uppsala (24.7 kU/l) ( P &lt;0.001). Similarly, the overall prevalence of at least one specific IgE to airborne allergens was 23.6% in Reykjavík and 32.3% in Uppsala ( P &lt;0.01). Specific IgE to a food panel (fx5) was measured in 502 subjects in Reykjavík, and 434 in Uppsala. In Reykjavík, 20 individuals (4.0%) were positive to one or more of the allergens in the food panel compared to 27 (6.0%) in Uppsala. When the single allergens present in the food panel were measured, altogether 16 positive reactions were found in Reykjavík compared to 47 in Uppsala ( P &lt;0.05). Conclusions: The prevalence of sensitization to both airborne and food allergens was lower in Reykjavík than in Uppsala. The difference may be due to environmental and/or dietary differences or to some yet undefined factor.
Contact Lenses and the Physician
Authors: Charles E. Jaeckle
Journal: JAMA (1962)

THE IMPLICATIONS of the use of contact lenses have become a matter of public interest and professional concern. Unlike medications and other therapeutic agents, these lenses have generally been introduced to the patient through promotional material in the public press rather than through a prescription to meet a medical need. "Eight million Americans" are said to "use contact lenses." It is easy to believe that this many have procured contact lenses. Most physicians have patients who have procured, and discarded, contact lenses,<sup>1</sup>sometimes repeating the process 2 or 3 times. Contact lenses are, however, being used not only by people with a need for them, but by a large number of people whose visual needs would be well met by spectacles. Scientific advances may lead to increased use. It is, therefore, appropriate to consider the responsibility of the physician. Many people have been led to believe that the contact
Preadmission Screening of Medicare Patients
Authors: Martha J. Radford
Journal: JAMA (1988)

<h3>To the Editor. —</h3> Imperiale et al<sup>1</sup>studied the clinical effect of preadmission screening and reimbursement denial for Medicare patients. They concluded that "preadmission certification programs can be implemented without major deleterious short-term medical effects." The limitations of their study design do not justify such broad claims for the safety of preadmission screening. This study did not examine the effects of preadmission screening on emergency admissions. Thirty percent to 40% of acute-care hospital admissions are through the emergency department.<sup>2</sup>Because of preadmission screening requirements, how many of these patients were not offered admission, how many had their admission delayed, and how many were admitted only if they agreed to pay for the hospital bill? It is not surprising that no major adverse effects of preadmission screening were found by the authors, since they examined only the low-risk population. This study did not examine the effects on the 28
Multiscale structures of lipids in foods as parameters affecting fatty acid bioavailability and lipid metabolism
Authors: M.C. Michalski, C. Genot, C. Gayet, C. Lopez, F. Fine, F. Joffre, J.L. Vendeuvre, J. Bouvier, J.M. Chardigny, K. Raynal-Ljutovac
Journal: Progress in Lipid Research (2013)
Objective tests exist to aid diagnosis of hand-arm vibration syndrome
Authors: I J Lawson, K L Mcgeoch
Journal: BMJ (1996)

haemophilia data that cannot establish correlation or cause.Duesberg has argued against these data and against mistaking correlation for causality,2 3 but this review fails to mention these arguments and makes no effort to convey the breadth and depth of the reviews collected in the book.Finally, I agree with Derbyshire: Duesberg has been mistreated.What Peter Duesberg has been arguing for-more research on substances known or suspected to be immunosuppressive-should not be controversial, it should be welcomed.Iftrue, then Duesberg should be taken seriously and not, as Derbyshire suggests, placed "peripheral to the mainstream AIDS debate ... as a maverick rather than as a heretic."That debate would be impoverished or non-existent were it not for Duesberg's persistent scientific criticisms over 10 years.Derbyshire cannot have it both ways where a serious critic with something constructive to offer is also marginalised and mistreated by our AIDS leadership.
RIP OR BIND? A RIPPING RESPONSE
Authors: H. M. Rawnsley
Journal: Annals of Internal Medicine (1969)

Letters and Comments1 October 1969RIP OR BIND? A RIPPING RESPONSEH. M. Rawnsley, M.D.H. M. Rawnsley, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-71-4-864 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor:In answer to the question asked inAnnals of Internal Medicine71: 212 (July) 1969, I am a Ripper of the ANNALS....References1. JEGHERS H: New Eng. J. Med. 271: 1297, 1964. CrossrefMedlineGoogle Scholar2. ELKINTON JR: "Where did I see that paper?" Ann. Intern. Med. 67: 459, 1967. LinkGoogle Scholar3. FULLER E (Wintrobe): A system for filing medical literature. Ann. Intern. Med. 68: 684, 1968. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Hospital of the University of Pennsylvania 3400 Spruce St. Philadelphia, Pa. 19104 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEditor Ripped: Rippers TriumphantSTEVE HAAS, M.D.More on Rippers vs BindersVICTOR R. NEUFELD, M.D. F.R.C.P.(C), ANNE LEIBL, M.L.S. 1 October 1969Volume 71, Issue 4Page: 864-864 ePublished: 1 December 2008 Issue Published: 1 October 1969 PDF downloadLoading ...
Unpredictable Fluctuations in Serum Acid Phosphatase Activity in Prostatic Cancer
Authors: Wayne D. Brenckman
Journal: JAMA (1981)

Repeated determinations of the elevated serum acid phosphatase activities in five patients with advanced prostatic cancer were found to be highly variable during 24 to 48 hours of observation. Samples collected every three hours had fluctuations of 44% to 97% around the 24- to 48-hour mean values. These fluctuations appeared to be random, had no apparent circadian rhythm, and were unrelated to concurrent medications or activity. These spontaneous variations indicate the need for caution when using serial serum acid phosphatase determinations as an indicator of the response of prostate cancer to therapy. Elevated serum alkaline phosphatase activities did not show these extreme fluctuations.
Oral Contraception and Liver Damage
Authors: E. T. Tyler
Journal: BMJ (1964)

areas-notably those heavily industrialized and heavily populated-where a hospital- confinement rate higher than 70% is desirable.It is in those areas presumably that the effects of the expected increase in the birth rate will also be more keenly felt and the evil effects of too early discharge most likely to be seen, and, as Sir Andrew warns us, " do not let us therefore imagine that it is the ideal arrangement."From the beginning, those most earnestly advocating this makeshift have been obsessed with only one aspect of its value, and, inasmuch as it is aimed at reducing the risks of labour itself, it obviously serves its purpose.When labour is successfully ended there are two individuals for whose welfare we and our colleagues, the paediatricians, are jointly
Pregnancy and Travel
Authors: Michele Barry
Journal: JAMA (1989)

The special problems of travel during pregnancy have become clinically important as more women are traveling to remote places for business or recreation. Optimal maintenance of fetal and maternal health under these circumstances entails specific considerations for which data, unfortunately, remain incomplete. Nevertheless, questions regarding immunizations, antimalarials, therapy for traveler's diarrhea, and even the risks of high altitude or vigorous exercise for the pregnant woman may be examined clinically. With a few important exceptions, sufficient information is available to ensure relatively safe travel in pregnancy provided precautions are taken and preparations are made.
Bloom and Fawcett: A Textbook of Histology
Authors: Rolla B. Hill
Journal: JAMA (1986)

On Dec 4, 1928, Alexander A. Maximow, professor of anatomy at the University of Chicago, was found dead in bed at age 54 years. A physician, and a member of the Russian aristocracy in St Petersburg, he had emigrated to the United States six years earlier, and at his death he left on his desk manuscripts amounting to about half of a textbook of histology. A junior colleague in the department, William Bloom, undertook the task of finishing the textbook, using the chapters that Professor Maximow had finished, translating fragments in Russian that he found among the Professor's papers, following outlines of unfinished chapters, and enlisting the aid of others. Maximow and Bloom's<i>Textbook of Histology</i>was published by Saunders in 1930. Bloom went on to become professor and chairman of his department in 1941. In 1986, the 11th edition of this distinguished volume appears, still published by WB Saunders
QL-19 * A FOLLOW-UP OF A SURVEY OF ILLNESS-RELATED UNCERTAINTY AND MOOD IN PATIENTS WITH PRIMARY BRAIN TUMORS (PBTs)
Authors: L. Lin, L.-C. Chien, A. Acquaye, E. Vera-Bolanos, M. Gilbert, T. Armstrong
Journal: Neuro-Oncology (2014)

INTRODUCTION: Patients with PBTs face uncertainty related to the treatment outcomes and symptoms. Completing treatment can be stressful to the patients. Our previous study found patients' level of uncertainty during treatment was as high as in newly-diagnosed period and was significantly correlated to negative mood states and symptom severity. This study examined the changes of uncertainty and mood by surveying patients twice in a Brain/Spine clinic. METHODS: 57 patients completed the questionnaires two times; either twice during surveillance appointments or one time during treatment period and the other during follow-up without active treatment. Instruments included a clinical checklist, a demographic data sheet, the Mishel Uncertainty in Illness Scale-Brain Tumor Form (MUIS-BT), and the Profile of Mood States-Short Form (POMS-SF). The paired t-test was used to compare the differences between baseline survey and follow-up survey on uncertainty and mood. RESULTS: Subjects were primarily white(82.5%) males(52.6%) with a mean age of 44.7 ± 12.3 years at the time of the second data collection. For patients whose treatment status changed from ‘on treatment’ to ‘follow-up’(n = 25), their uncertainty was not significantly different in terms of ambiguity/inconsistency of illness-related events; unpredictability of disease prognosis; unpredictability of symptoms; and complexity of the disease process between during treatment and surveillance. However, patients felt significantly less vigorous during the surveillance period(p < .05). Patients ‘not on treatment’ at baseline(n = 32) felt significantly more uncertain about unpredictability of disease prognosis(p < .05) at the second time being surveyed. CONCLUSIONS: The illness trajectory of patients with PBTs is associated with high incidence of uncertainty. Overall uncertainty and mood disturbance such as anxiety and depression remained constant when patients were under only surveillance. Patients may be relieved to finish treatment, but find it difficult not to worry about the disease prognosis and the possibility of recurrence. Patients need psychological support continuously even in the setting of stable disease.
Cost effectiveness of screening for and eradication of Helicobacter pylori in management of dyspeptic patients under 45 years of age
Authors: A H Briggs, M J Sculpher, R P H Logan, J Aldous, M E Ramsay, J H Baron
Journal: BMJ (1996)

To assess the cost effectiveness of screening for and eradicating Helicobacter pylori in patients under 45 years of age presenting with dyspepsia.A decision analytic model composed of a decision tree to represent the epidemiology of dyspepsia and a Markov process to model the outcomes of treatment.Patients under the age of 45 years presenting to their general practitioner with (peptic type) dyspepsia.Conventional empirical treatment with healing and maintenance doses of cimetidine v eradication treatment solely in patients with confirmed peptic ulcer; and conventional empirical treatment for all dyspeptic patients compared with the use of a serology test to identify patients with H pylori, who then receive endoscopy to investigate the presence of peptic ulcer disease and, when disease is found, are given eradication treatment with a breath test to confirm successful eradication.Expected cumulative costs over a period of 10 years. The proportion of time patients spend without a recurrent ulcer.After receiving eradication treatment, patients with confirmed ulcer spend an average of 99% of their time free from recurrent ulcer disease compared with 95% after treatment with cimetidine. Eradication treatment costs less than that with cimetidine. When the initial cost of identifying appropriate patients to receive eradication treatment is added to the analysis, however, these cost savings take almost eight years to accrue.Enthusiasm for introducing testing for and eradication of H pylori for dyspeptic patients in general practice should be tempered by an awareness that cost savings may take many years to realise.
NIH Budget Doubled Since 1998
Authors: Brian Vastag
Journal: JAMA (2002)

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