tbuckley/cabot-search huggingface dataset:
MD-PhD students in the 1990s: finding a niche for the dual degree
Authors: J. S. Lee
Journal: JAMA (1995)

Given the success of MD-PhD students in the past and the uncertain future of science and clinical medicine, this article has attempted to review the progress of MD-PhD programs and examine the experiences of some of today's MD-PhD students. Most candidates responding to the questionnaire remain committed to research and its applications. Their future plans are in line with the paths their predecessors have chosen, namely, careers devoted to academic medicine. For many of these dual-degree candidates, however, academia encompasses basic research and patient care. There seems to be little doubt that MD-PhD graduates will continue to seed the faculties of leading US medical schools and research institutes. However, some dual-degree recipients will opt for strictly clinical careers, perhaps leaving the laboratory altogether. Indeed, according to the author's survey, 14% of respondents intend to concentrate primarily on patient care. A few of these students seem disenchanted with the benefits conferred by a dual degree. "I don't see the advantages of a combined program that I saw when I was applying," one student explained. "The PhD degree confers no benefit as far as I can tell in how one practices medicine or in how well someone will conduct basic research." Detractors of combined-degree programs have questioned how anyone can succeed in science or medicine if not exclusively dedicated to one program. That achieving this balance was the foremost concern of the students surveyed suggests that doubt lingers for them as well. "I have often wished for more MD-PhD role models," wrote another student. "What have other people done with their combined degree? My career objectives are still vague because I am still not sure of what niche I will fill as an MD-PhD. Perhaps we can fill any niche." Perhaps that was the idea all along.
Extracorporeal Shock Wave Lithotripsy: What Does the Surgeon Do?
Authors: R. G. Schipf
Journal: JAMA (1989)

<h3>To the Editor.—</h3> The advertisement by Dornier Medical Systems, Marietta, Ga, in the September 9 issue of<i>JAMA</i>is of great interest to me. I am happy that "500,000 people have had their kidney stones removed without a scratch" because they did not need "kidney stone surgery" due to the availability of "extracorporeal shock wave lithotripsy." My family physician advised me to have my stones removed so I inquired about lithotripsy. After all, I have read the ads and the stories for some time. I was advised that there is a "surgeon's fee" of $3077 plus the usual fees for anesthesiology and hospital care. I presume that it is not strange to you that there can be a surgeon's fee when no surgery is done. It is clearly to the advantage of the physician with the monopoly here to extract a huge sum for no surgery! It is no wonder
Conflicts of Interest at the NIH — Resolving the Problem
Authors: Robert Steinbrook
Journal: New England Journal of Medicine (2004)

Since December 2003, the National Institutes of Health (NIH) has been battered by accounts of the outside financial arrangements between some of its employees and pharmaceutical companies — and hence by concerns that the NIH ethics program is not working.1,2 Having “reached the conclusion that drastic changes are needed,” Dr. Elias Zerhouni, the NIH director, plans to implement prohibitions and restrictions on many of these payments and new requirements for public disclosure of those that are still allowed. Zerhouni is “working to strike a careful balance.”3 He does not plan to ban all drug-industry payments to institute scientists. A . . .
Surgery of the Liver, Bile Ducts and Pancreas in Children: Edited by E R Howard, M D Stringer, P M Columbani. London: Arnold, 2002, 125, pp 527. ISBN 0-340-76129-6
Authors: D Lloyd
Journal: Gut (2003)

Caution with the use of cyclosporin in pregnancyWe read the article by Alstead and Nelson-Piercy with great interest. 1 We report a case (submitted for publication) of a woman with fulminant ulcerative colitis in the 29th week of pregnancy.Her disease was refractory to steroids, but she refused to have cyclosporin whilst pregnant.She therefore underwent an emergency Caesarean section and was given intravenous cyclosporin post-operatively.After 48 hours of treatment she developed severe hypertension with hypertensive encephalopathy and seizures.Although cyclosporin has been considered to be safe for both mother and foetus, we would like to highlight concerns that it is associated with potentially life threatening side effects.As a result, patients must be counselled thoroughly about the potential morbidity associated with this treatment and monitored closely.We agree with Dr Alstead in that cyclosporin should be used with extreme caution in pregnancy and the postnatal period.
Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide
Authors: N Freemantle, A House, F Song, J M Mason, T A Sheldon
Journal: BMJ (1994)

<b>Objective</b>: To evaluate a policy to reduce the incidence of suicide by means of changing the prescribing of antidepressants from the older tricyclic antidepressants to the routine first line use of selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants. <b>Design</b>: Cost effectiveness analysis with sensitivity analyses using observational data on costs, volume of prescribing, deaths, and toxicity. <b>Setting</b>: United Kingdom primary care. Interventions - Selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants compared with the use of older tricyclics. <b>Main outcome measures</b>: Cost per life saved and cost per life year saved. <b>Results</b>: The potential number of lives which may be saved from a switch to the routine first line use of20selective serotonin reuptake inhibitors is between20300 and 450 each year. The cost per life year gained ranges from pounds sterling 19 000 to pounds sterling 173 000, depending on the assumptions used. The cost per life year gained through the use of the newer tricyclic and related antidepressants is considerably lower. <b>Conclusions</b>: The cost per life year gained through avoiding suicides by the routine first line use20of serotonin reuptake inhibitors is likely to be high. The new tricyclics and related drugs are of similar toxicity to the serotonin reuptake inhibitors but are considerably cheaper and so are more cost effective for this purpose. Further research is required on such prescribing. Because of the great uncertainties the shift to considerably more expensive options must be further investigated.
THE ROLE OF SODIUM IN ADRENAL INSUFFICIENCY
Authors: ROBERT F. LOEB
Journal: JAMA (1935)

Thomas Addison<sup>1</sup>was the first to observe that complete destruction of the adrenal glands results in death. He also suggested that a study of the disease now known by his name might lead to some understanding of the function of these glands. This prophecy has been amply fulfilled. In addition to the clinical approach to the problem, as suggested by Addison, knowledge of the physiologic activities of these structures has been greatly enhanced by two other methods of attack. The first of these, a corollary of the clinical method, is represented by a study of the changes resulting from adrenalectomy in animals and the effects of extracts of various portions of the gland on the disturbances encountered. By the application of this technic, the elementary and fundamental fact that the extract of the cortex is essential for survival has been established. Furthermore, it has been shown that medullary extract
Increased intrahepatic IgG3-bearing cell subpopulations in patients with primary biliary cirrhosis (PBC)
Authors: G. Torgano, M. Vecchi, R. de Franchis, Eliana Arosio, M. Zuin, Manuela Bertolini, P.M. Battezzati, M. Podda
Journal: Journal of Hepatology (1991)
London Teaching Hospitals Committee
Authors: G. Bourne, W. D. Doherty
Journal: BMJ (1943)

CKD associates with systemic inflammation, but the underlying cause is unknown. Here, we investigated the involvement of intestinal microbiota. We report that collagen type 4 <i>α</i>3–deficient mice with Alport syndrome–related progressive CKD displayed systemic inflammation, including increased plasma levels of pentraxin-2 and activated antigen–presenting cells, CD4 and CD8 T cells, and Th17– or IFNγ–producing T cells in the spleen as well as regulatory T cell suppression. CKD–related systemic inflammation in these mice associated with intestinal dysbiosis of proteobacterial blooms, translocation of living bacteria across the intestinal barrier into the liver, and increased serum levels of bacterial endotoxin. Uremia did not affect secretory IgA release into the ileum lumen or mucosal leukocyte subsets. To test for causation between dysbiosis and systemic inflammation in CKD, we eradicated facultative anaerobic microbiota with antibiotics. This eradication prevented bacterial translocation, significantly reduced serum endotoxin levels, and fully reversed all markers of systemic inflammation to the level of nonuremic controls. Therefore, we conclude that uremia associates with intestinal dysbiosis, intestinal barrier dysfunction, and bacterial translocation, which trigger the state of persistent systemic inflammation in CKD. Uremic dysbiosis and intestinal barrier dysfunction may be novel therapeutic targets for intervention to suppress CKD–related systemic inflammation and its consequences.
The electrophysiological properties of normal neonatal and adult canine cardiac Purkinje fibers.
Authors: R F Reder, D S Miura, P Danilo, M R Rosen
Journal: Circulation Research (1981)

To determine the basis for age-related changes that occur in the transmembrane action potentials (AP) of canine cardiac Purkinje fibers (PF), we used standard microelectrode techniques to study PF from normal neonatal and adult beagles. As previously shown, neonatal PF AP have a less negative maximum diastolic potential (MDP), a lower AP amplitude (amp) and maximum upstroke velocity of phase 0 (Vmax), and shorter AP duration measured at 50% and 100% repolarization than have those of adults. Further, the termination of phase 1 and the peak of phase 2 occur at more positive levels of membrane potential in neonatal PF. The less negative MDP in neonatal PF is associated with a lower intracellular potassium activity (aKi) as demonstrated with a K+-sensitive microelectrode. Neonatal PF showed greater depression of AP amp and Vmax during superfusion with the rapid Na+ channel blocker, tetrodotoxin (TTX), than did adult PF. The attainment of more negative voltages at the termination of phase 1 in adult compared to neonatal PF was not attributable to age-related differences in response to changes in drive cycle length, temperature, or external Cl- concentration. However, 4-aminopyridine, a blocker of the early, repolarizing potassium current, altered this variable in adult and not in neonatal PF. The effects of verapamil and AHR-2666, both slow inward current blockers; of TTX, which blocks a background inward Na+ current; and of TEA+, which blocks repolarizing K+ current, were studied on AP repolarization. Adult PF AP were more sensitive to the effects of AHR-2666, verapamil, and TEA+ and less sensitive to the effects of TTX than neonates.
AIDS and Ethics
Authors: Margaret A. Somerville
Journal: JAMA (1993)

This is an excellent book—in fact, even the reviews printed on the dust jacket provide further wisdom. For instance, Freedman's statement that "[e]thics is the immune system of a humane society, and AIDS is challenging that immune system," sums up why this book is so important. In short,<i>AIDS and Ethics</i>will be of much wider interest than just to persons involved in issues raised by the acquired immunodeficiency syndrome or ethical aspects of these issues. <i>AIDS and Ethics</i>is a good combination of review of what are already well-known and important new insights. As such, it will be of use both to persons starting out in ethics and to those with considerable experience, including in relation to AIDS. Reamer's chapter on the relevance of ethics to AIDS provides a good general framework for discussing ethics in health care in general and sounds some well-timed warnings about the promises and
Cross-Sectional Analysis of Renal Function in Black Americans With NIDDM
Authors: Harold E Lebovitz, JoAnne Palmisano
Journal: Diabetes Care (1990)

Our objective was to define glomerular filtration rate (GFR) and renal plasma flow (RPF) in Black Americans with non-insulin-dependent diabetes mellitus (NIDDM). This was a cross-sectional study of 71 Black NIDDM patients with diagnosed diabetes duration from 1 mo to 21 yr. Hyperglycemia was regulated and stabilized before patients were entered into the study. GFR and RPF were determined by the clearance of [l25I]iothalamate and 131I-labeled hippuran, respectively, with a constant-infusion technique and four urine collection periods. Hyperfiltration, as defined by a GFR of &amp;gt;140 ml · min−1 · 1.73 m−2, was found in 7 of 20 patients (35%) with newly diagnosed (&amp;lt;2 yr duration) NIDDM. The percentage of patients with hyperfiltration decreased with increasing duration of diagnosed diabetes. Decreasing GFR and RPF occurred with increasing duration of diagnosed diabetes. In conclusion, renal hemodynamic changes in Black Americans with NIDDM are similar to those known to occur in White populations with IDDM.
Defective Repair of Oxidative DNA Damage in Triple-Negative Breast Cancer Confers Sensitivity to Inhibition of Poly(ADP-Ribose) Polymerase
Authors: Elizabeth Alli, Vandana B. Sharma, Preethi Sunderesakumar, James M. Ford
Journal: Cancer Research (2009)

Subtypes of breast cancer that represent the two major types of epithelial cells in the breast (luminal and basal) carry distinct histopathologic profiles. Breast cancers of the basal-like subtype, which include the majority of hereditary breast cancers due to mutations in the breast cancer susceptibility gene 1 (BRCA1), frequently assume triple-negative status, i.e., they lack expression of estrogen receptor-alpha and progesterone receptor, and lack overexpression or amplification of the HER2/NEU oncogene. Defects in DNA damage response pathways result in genome instability and lead to carcinogenesis, but may also be exploited for therapeutic purposes. We analyzed repair of oxidative DNA damage by the base-excision repair (BER) pathway, which when aberrant leads to genomic instability and breast carcinogenesis, in cell lines that represent the different subtypes of breast cancer and in the presence of BRCA1 deficiency. We found that basal-like and BRCA1-mutated breast cancer cells were defective in BER of oxidative DNA damage, and that this defect conferred sensitivity to inhibition of poly(ADP-ribose) polymerase, a DNA repair enzyme. The defect may be attributed, at least in part, to a novel role for BRCA1 in the BER pathway. Overall, these data offer preventive, prognostic, and therapeutic usefulness.
A NEWLY DEVELOPED RADIO FREQUENCY SIGNAL-BASED INTRAVASCULAR ULTRASOUND TISSUE CHARACTERIZATION: A COMPARISON BETWEEN IMAP AND INTEGRATED BACKSCATTER INTRAVASCULAR ULTRASOUND
Authors: Ryotaro Yamada, Hiroyuki Okura, Yoshinori Miyamoto, Takahiro Kawamoto, Yoji Neishi, Akihiro Hayashida, Tetsuo Tsuchiya, Shintaro Nezuo, Kiyoshi Yoshida
Journal: Journal of the American College of Cardiology (2011)
HIV Testing: AMA Code of Ethics-Reply
Authors: Rebecca Voelker
Journal: JAMA (1994)

In Reply.  —Although Opinion 2.23 was not cited explicitly, the Council on Ethical and Judicial Affairs' sentiment was conveyed in the aforementioned article in the comments of AMA Trustee Nancy Dickey, MD, on page 2531: Whenever possible, communication, if it is explicit consent or education, is  desired part of evaluating patients for possible HIV disease.  While the author appreciates the letter writers' concern for clarifying such vital policy matters, the fact remains that two bodies within the AMA have, in Glasson and Orentlicher's phrase, a divergence of opinion on this extremely sensitive issue.  JAMA recognizes that the Council speaks for the AMA on matters of ethics . —Ed.
Importance of ischemia for myocardial anglogenesis: Effect of basic fibroblast growth factor on well developed collaterals
Authors: Matie Shou, Venugopal Thirumunti, Shamini Rajanayagam, Daisy F. Lazarous, Everett Hodge, Stephen E. Epstein, Ellis F. Unger
Journal: Journal of the American College of Cardiology (1996)
A Psycho-Analytic Dialogue: The Letters of Sigmund Freud and Karl Abraham 1907-1926
Authors: Martin Grotjahn
Journal: JAMA (1966)

The long-awaited correspondence between Sigmund Freud and Karl Abraham is lying before us now. To read it is a delight—a psychoanalytic learning experience, an exciting story of a friendship in its growth and maturation, a monument to the simplicity, sincerity, and honesty of two men, a nostalgic reminder of the times in Vienna and Berlin between 1907 and 1926. From the almost 500 letters that passed between them, 367 are published here, about equally divided between both men. There was an age difference of 21 years between the two men, but this seemed to be forgotten soon. The loyal son and best student became friends and colleagues of equal standing. This "dialogue"—an excellent chosen title—does not reveal great secrets, and any reader driven by primal-scene curiosity will in all probability be disappointed. The facts are more or less known through Ernest Jones's biography or in the recently published<i>Psychoanalytic Pioneers</i>
Offending in psychiatric patients after discharge from medium secure units: prospective national cohort study
Authors: A Maden, F Scott, R Burnett, G H Lewis, P Skapinakis
Journal: BMJ (2004)

Medium secure units admit patients for the assessment and treatment of mental disorder associated with risk.We investigated how many patients offend after discharge. Participants, methods, and resultsWe collected demographic and clinical data on all 959 patients discharged from medium secure units in England and Wales between 1 April 1997 and 31 March 1998 and used the offenders' index to find details of subsequent convictions.A total of 145 patients (15%) were convicted within two years, including 60 (6%) who were convicted of violent offences (table).
Drug Dependency
Authors: ANTHONY KALES
Journal: Annals of Internal Medicine (1969)

The legal and illegal use of psychoactive drugs, including stimulants, hypnotics, tranquilizers, and hallucinogens, is markedly increasing. Lysergic acid diethylamide (LSD) may cause severe acute or chronic symptoms; one cannot predict adverse reactions or relate them to frequency and length of LSD use. Among its effects are acute psychologic changes, including psychosis; and chronic alterations, such as apathy, psychosis, and "flashback." Chlorpromazine is recommended for treatment of symptoms; psychotherapy and education help prevent further LSD use. Chronic amphetamine use may lead to toxic psychosis, confusion, or brain damage; acute withdrawal may lead to depression, with suicidal ideation, and increases in rapid eye movement (REM) sleep with nightmares and insomnia. Chronic use of barbiturates and nonbarbiturate hypnotics may lead to mental impairment, motor incoordination, and depression. Withdrawal produces weakness, irritability, and occasionally convulsions or psychosis. Amphetamines and hypnotics should be withdrawn gradually and patients educated as to possible physiologic alterations, both those patients dependent on large doses and those who have taken therapeutic doses for some months. Withdrawal of these drugs leads to marked increases in REM sleep, nightmares, and insomnia, which may lead to drug dependency. Marijuana may change time sense and visual and auditory perceptions. Chronic use frequently indicates underlying psychologic disturbances needing psychotherapy. Psychoactive drugs differentially affect responses of various autonomic systems. Central nervous system (CNS)-active drugs do not induce only one condition and cannot be simply classified as excitants or depressants. The physiologic alterations produced by psychoactive drugs are basic to drug dependency as are personality factors.
A shadow of doubt
Authors: P J Allan, S Appleton, A S McIntyre
Journal: Gut (2009)

A 69-year-old female patient with a history of ischaemic heart disease and a laparoscopic cholecystectomy 4 years previously was admitted with a 6 month history of fatigue, vague right upper quadrant pain, fevers and night sweats. Initial investigations revealed an erythrocyte sedimentation rate …
One-year follow up of children treated with Chinese medicinal herbs for atopic eczema
Authors: M. P. SHEEHAN, D. J. ATHERTON
Journal: British Journal of Dermatology (1994)

Journal Article One‐year follow up of children treated with Chinese medicinal herbs for atopic eczema Get access M. P. SHEEHAN, M. P. SHEEHAN Department of Dermatology, Hospital for Sick Children, Great Ormond Street, London WCIN 3JH, U.K. Search for other works by this author on: Oxford Academic Google Scholar D. J. ATHERTON D. J. ATHERTON Department of Dermatology, Hospital for Sick Children, Great Ormond Street, London WCIN 3JH, U.K. ; Dr D. J. Atherton. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 130, Issue 4, 1 April 1994, Pages 488–493, https://doi.org/10.1111/j.1365-2133.1994.tb03383.x Published: 01 April 1994 Article history Accepted: 27 September 1993 Published: 01 April 1994
Children's lifestyles pose "unacceptable" cardiovascular risk, warns charity
Authors: M. Limb
Journal: BMJ (2013)

Many children risk developing coronary heart disease in later life unless their “shocking” lifestyles are improved, a charity has warned.

The British Heart Foundation said that inactivity, poor diet, and unhealthy eating habits were storing up cardiovascular problems for the UK’s population. 

The charity published a new compendium of statistics, produced in partnership with the British Heart Foundation Research Group at Oxford University.1 It is the first time that a supplement to the group’s regular statistics on heart disease has focused solely on children and young people.

For the report researchers analysed data from several UK surveys and included commonly measured medical risk factors, such as obesity and diabetes and behavioural risk factors for …