tbuckley/cabot-search huggingface dataset:
Advanced Achievement in Internal Medicine: "The Last Gasp of Voluntarism"?
Authors: EDWIN P. MAYNARD
Journal: Annals of Internal Medicine (1986)

Editorials1 July 1986Advanced Achievement in Internal Medicine: "The Last Gasp of Voluntarism"?EDWIN P. MAYNARD, M.D.EDWIN P. MAYNARD, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-105-1-132_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHow to maintain clinical competence is a central concern of every practicing internist. In a time of rapidly expanding medical information and newer management strategies, it is only too easy to lag behind in one or more areas, thereby compromising one's ability to provide excellent care. Generalists, subspecialists, full-time practitioners, academicians—and most importantly, our patients—will benefit from a program that tests objectively our knowledge base and clinical judgment and identifies areas in need of revitalization.For more than a decade the American Board of Internal Medicine (ABIM) has directed its attention beyond initial certification. In 1974 the Board offered its... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe future of certification and recertificationRecertification in Internal Medicine: A Program of Continuous Professional DevelopmentStephen I. Wasserman, MD, Harry R. Kimball, MD, and F. Daniel Duffy, MD, for the Task Force on Recertification*Advanced achievement in internal medicineAdvanced Achievement in Internal MedicineJOSEPH I. MATTHEWS, M.D.Examinations and the Medical LiteratureMICHAEL A. LACOMBE, M.D. 1 July 1986Volume 105, Issue 1Page: 132-133KeywordsSub-specialty care Issue Published: 1 July 1986 PDF downloadLoading ...
Anatomy of Nerves and Muscles
Authors: Stanley W. Jacob
Journal: JAMA (1997)

New Media Anatomy The age of the multimedia hypertext book has arrived. Anatomy of Nerves and Muscles is an interactive CD-ROM focused on the detailed anatomy of peripheral nerves and muscles. The CD is produced by GREMI, a nonprofit medical research and education unit composed of neurologists and their research team whose purpose is to develop multimedia projects. Anatomy of Nerves and Muscles offers a user-friendly guided tour through 2000 drawings, muscle animations, and text descriptions. It traces nerves from their root origins to their end organs and supplements the muscle illustrations with animated representations of the motions they summon. Several features give Anatomy of Nerves and Muscles the potential to be a more immediately useful learning tool than the traditional textbook: the narration, which points out special details and teaches correct pronunciation, the interactive ability to backtrack along with the narrator (how easily can the student do this in
Remarks on Dr. Chambers's Assertion that Disease is in All Cases a Deficiency of Action
Authors: L. S. Beale
Journal: BMJ (1863)

buted; and in no single morbid action in young life can tlheir influeinec even for one miioment be disre- garded.For, although the forces whiclh are employed in the building uip of the body, and in main- taining it wheii completecd, may be mere different expressionls of the saine power directed in different di- rections, growth, development, and maintenance are so distinct in their several natures, and so uniform in their ends, that it might be excusable if, for a momnent only, we were to regard them as oriminating from indepenident sources, and to be expressions of distinct powers.Daily practice proves to us that the growth of a part may go on in all its complete- ness, wvhilst its development miay be arrested, or pro-
THE PRIMARY IMMUNE RESPONSE IN MICE
Authors: Robert E. Franzl, Philip D. McMaster
Journal: The Journal of Experimental Medicine (1968)

The manner in which a single injection of S. typhosa endotoxin effects the primary hemolysin response to sheep erythrocytes in the mouse has been shown to depend on the dosage, route, and time of administration of the endotoxin, as well as on the route employed for the injection of antigen. The normal production of antibody, following an intravenous or an intraperitoneal injection of red blood cells, is suppressed if the bacterial lipopolysaccharide is given before and by the same route as the antigen. The response to an intraperitoneal injection of sheep red cells is also inhibited if preceded by an intravenous injection of endotoxin. By contrast, hemolysin formation to intravenous antigen is enhanced considerably by a previous intraperitoneal injection of endotoxin, and the response both to intravenous and to intraperitoneal injections of the antigen increases if the endotoxin is given by the same route either simultaneously or shortly after the foreign red cells. These findings are discussed in regard to the physiological action of bacterial endotoxins and the early events in antibody formation.
Arterial glucocorticoid receptors: the binding of tritiated dexamethasone in rabbit aorta
Authors: D. DUVAL, J. W. FUNDER, M.-A. DEVYNCK, P. MEYER
Journal: Cardiovascular Research (1977)

Current concepts of the mechanism of the physiological action of both mineralocorticoids and glucocorticoids include an initial step in interaction between the steroid and specific receptors in the cytoplasm of target tissue cells. Using cells from rabbit aorta as a model system, we have studied the cytoplasmic binding of 3H-dexamethasone and 3H-aldosterone. Aorta cells appear to contain binding sites with a high affinity (Kd 4 degrees C approximately 1.3 X 10(-8) mol) for dexamethasone, and with specificity appropriate for glucocorticoid receptors. Under similar experimental conditions, mineralocorticoid receptors could not be demonstrated.
Bartering old stone tools: When did communicative ability and conceptual structure begin to interact?
Authors: Stephen F. Walker
Journal: Behavioral and Brain Sciences (1995)

Abstract Wilkins &amp; Wakefield are clearly right to separate linguistic capacity from communicative ability, if only because other animal species have one without the other. But I question the abruptness of the demarcation they make between a period when hominids evolved enriched conceptual representation for other reasons entirely, and a subsequent later stage when language use became an adaptation.
Experimental Arterial Disease
Authors: WILLIAM B. WARTMAN, BRYAN HUDSON, ROBERT B. JENNINGS
Journal: Circulation (1951)

Rabbits were injected with saline suspensions of fibers of filter paper and of mixtures of filter paper and human fibrin or filter paper and rabbit whole blood. The emboli became impacted in the pulmonary arteries or adhered to the intima. In one rabbit an embolus adhered to the endocardium of the right ventricle. An acute arteritis resulted which was finally organized leaving a diffuse or eccentric scar on the intima. The filter paper fibers were surrounded by a foreign body granuloma and localized in either the intima or adventitia. Frequently they passed entirely through the wall clausing varying amounts of injury and were found in the adventitia or perivascular lung tissue. This is interpreted as indicating the existence of a mechanism for ridding the circulation of foreign material in the blood.
French doctors are tried for treating children with infected growth hormone
Authors: Brad Spurgeon
Journal: BMJ (2008)

Graduates from some UK medical schools consistently perform better than others in postgraduate medical exams, says a study published this week.The authors say that their finding supports the introduction of a national licensing examination for doctors.The study retrospectively analysed the performance from 2003 to 2005 of 5827 doctors from 19 UK medical schools in one or more of the three examinations required for membership of the Royal College of Physicians.This is an international postgraduate assessment that is important for career progression and is attempted by about 30% of all UK medical graduates.The research group looked at performance in parts 1 and 2 of the written examination, which are multiple choice assessments, and in part 2 of the practical examination of clinical assessment skills (PACES), which uses real and simulated patients to test clinical examination and communication skills.A further analysis involved data on performance in the part 1 examination over a much longer timeframe, from 1989 to 2002.The results showed that graduates from Oxford, Cambridge, and Newcastle upon Tyne performed significantly better than average in part 1 and part 2 of the written examination (BMC Medicine 2008;6:5).Those from Liverpool, Dundee, Belfast, and Aberdeen showed significantly below average performance.Ninety one per cent of Oxford students, 76% from Cambridge, and 67% from Newcastle passed part 1 at their first attempt, whereas the figures were 32% for Liverpool, 38% for Dundee, 37% for Belfast, and 41% for Aberdeen.The overall relation between medical school and exam performance was highly significant (χ 2 =300, df=6, P<0.001).About 60% of the variance between medical schools was explained by differences in pre-admission qualifications (according to number of points gained, but not subjects taken, in A level examinations or in the Scottish highers).However, the remaining portion of the variance was still significant. Doctors from different schools vary in later postgraduate examsUK NEWS BMA advises GPs on longer opening hours, p 351 World NEWS Inquiry finds scientists collaborated with Nazis, p 353 bmj.comCharity is set up to improve adolescents' health care newS
Complications of pregnancy and benign familial joint hyperlaxity.
Authors: J G Thornton, J Hill, H A Bird
Journal: Annals of the Rheumatic Diseases (1988)

A family is described in which four generations were affected by benign familial joint hyperlaxity and, in the two generations for which obstetric data were available, pregnancies were complicated by unexplained mid-trimester vaginal bleeding. This prompted a study to determine whether unexplained antepartum haemorrhage (APH) and premature rupture of the membranes (PROM) both of which might reflect the structure of fetal collagen, were associated with joint hyperlaxity in offspring. The joint hyperlaxity of children born from such pregnancies was slightly greater than that found in age matched children born from uncomplicated pregnancies.
CITY DISPENSARY: ON REDUPLICATION OF THE SOUNDS OF THE HEART, PRINCIPALLY OBSERVED IN CASES OF MALFORMATION OF THE CHEST, ETC.
Authors: J. Cockle
Journal: BMJ (1856)

suferinm from the disease for four years; and attributed he origin of it to having slept in an out-house during one cold night, whilst in a state of intoxication.Soon after this occurrence, he was attacked with rheumatic fever, which confined him to his bed for six weeks; but during his convalescence, fresh inflammation and swelling took place above the condyles, which, in the course of some time, .ded in suppuration.Matter formed, discharging itself through an external opening, the latter sometimes healing, and then breaking out a-fresh.Thus matters went on for the last four years, incapacitating the man from following his ordinary employment.
High-Dose Penicillin
Authors: Robert A. Fishman
Journal: JAMA (1975)

<h3>To the Editor.—</h3> The recent article inThe Journal, "High-Dose Penicillin Therapy and Pneumococcal Pneumonia" by Brewin et al (230:409, 1974), demonstrated clearly that high doses of penicillin G had no advantage in the treatment of their series of severely ill patients. There is one point in the discussion, however, with which exception must be taken. The authors state: Human beings are able to tolerate massive quantities of penicillin. The dosage of penicillin is not limited by direct toxic effects of the drug but by the emergence of pathogenic organisms... where normal flora are usually present. Penicillin toxicity is by no means rare in patients receiving dosages of 20 million units of penicillin G per day. It is more likely to occur in patients with renal insufficiency, but the dosage may be toxic in patients with normal renal function. There is a useful review of the subject by Raichle and
Decreased Muscular Radionuclide Uptake in Tc-99m MIBI Scintigraphy During Paralytic Phase of Thyrotoxic Periodic Paralysis
Authors: Yung-Yee Chang, Min-Yu Lan, Hsiu-Shan Wu, Shu-Hua Huang, Shun-Sheng Chen, Jia-Shou Liu
Journal: Clinical Nuclear Medicine (2008)

The underlying pathophysiology of thyrotoxic periodic paralysis (TPP) is still obscure. From histologic surveys, vacuole formation and abundant mitochondrial abnormalities ranged from swelling, matrical pallor, pleomorphism, and reduced cristae were often disclosed in the muscle fibers during paralytic periods. In a 47-year-old man experiencing 2 episodes of transient paralysis, hyperthyroidism with TPP was diagnosed. During the acute paralytic phase, a significant reduction of radionucleotide uptake in the quadriceps on Tc-99m sestamibi scintigraphy was found, aside from the previous morphologic findings, that it further suggests impaired mitochondrial integrity and cellular viability in TPP.
Myoglobin O2 desaturation during exercise. Evidence of limited O2 transport.
Authors: R S Richardson, E A Noyszewski, K F Kendrick, J S Leigh, P D Wagner
Journal: Journal of Clinical Investigation (1995)

The assumption that cellular oxygen pressure (PO2) is close to zero in maximally exercising muscle is essential for the hypothesis that O2 transport between blood and mitochondria has a finite conductance that determines maximum O2 consumption. The unique combination of isolated human quadriceps exercise, direct measures of arterial, femoral venous PO2, and 1H nuclear magnetic resonance spectroscopy to detect myoglobin desaturation enabled this assumption to be tested in six trained men while breathing room air (normoxic, N) and 12% O2 (hypoxic, H). Within 20 s of exercise onset partial myoglobin desaturation was evident even at 50% of maximum O2 consumption, was significantly greater in H than N, and was then constant at an average of 51 +/- 3% (N) and 60 +/- 3% (H) throughout the incremental exercise protocol to maximum work rate. Assuming a myoglobin PO2 where 50% of myoglobin binding sites are bound with O2 of 3.2 mmHg, myoglobin-associated PO2 averaged 3.1 +/- .3 (N) and 2.1 +/- .2 mmHg (H). At maximal exercise, measurements of arterial PO2 (115 +/- 4 [N] and 46 +/- 1 mmHg [H]) and femoral venous PO2 (22 +/- 1.6 [N] and 17 +/- 1.3 mmHg [H]) resulted in calculated mean capillary PO2 values of 38 +/- 2 (N) and 30 +/- 2 mmHg(H). Thus, for the first time, large differences in PO2 between blood and intracellular tissue have been demonstrated in intact normal human muscle and are found over a wide range of exercise intensities. These data are consistent with an O2 diffusion limitation across the 1-5-microns path-length from red cell to the sarcolemma that plays a role in determining maximal muscle O2 uptake in normal humans.
Nutlin-3a Efficacy in Sarcoma Predicted by Transcriptomic and Epigenetic Profiling
Authors: Kathleen I. Pishas, Susan J. Neuhaus, Mark T. Clayer, Andreas W. Schreiber, David M. Lawrence, Michelle Perugini, Robert J. Whitfield, Gelareh Farshid, Jim Manavis, Steve Chryssidis, Bronwen J. Mayo, Rebecca C. Haycox, Kristen Ho, Michael P. Brown, Richard J. D'Andrea, Andreas Evdokiou, David M. Thomas, Jayesh Desai, David F. Callen, Paul M. Neilsen
Journal: Cancer Research (2013)

Nutlin-3a is a small-molecule antagonist of p53/MDM2 that is being explored as a treatment for sarcoma. In this study, we examined the molecular mechanisms underlying the sensitivity of sarcomas to Nutlin-3a. In an ex vivo tissue explant system, we found that TP53 pathway alterations (TP53 status, MDM2/MDM4 genomic amplification/mRNA overexpression, MDM2 SNP309, and TP53 SNP72) did not confer apoptotic or cytostatic responses in sarcoma tissue biopsies (n = 24). Unexpectedly, MDM2 status did not predict Nutlin-3a sensitivity. RNA sequencing revealed that the global transcriptomic profiles of these sarcomas provided a more robust prediction of apoptotic responses to Nutlin-3a. Expression profiling revealed a subset of TP53 target genes that were transactivated specifically in sarcomas that were highly sensitive to Nutlin-3a. Of these target genes, the GADD45A promoter region was shown to be hypermethylated in 82% of wild-type TP53 sarcomas that did not respond to Nutlin-3a, thereby providing mechanistic insight into the innate ability of sarcomas to resist apoptotic death following Nutlin-3a treatment. Collectively, our findings argue that the existing benchmark biomarker for MDM2 antagonist efficacy (MDM2 amplification) should not be used to predict outcome but rather global gene expression profiles and epigenetic status of sarcomas dictate their sensitivity to p53/MDM2 antagonists.
Family payments: a cautionary tale for policy makers
Authors: P. J Lucas
Journal: BMJ (2008)

Much observational evidence shows that children in wealthier families are healthier and have improved life chances.1 2 3 However, a cautious approach should be taken to adopting conditional payments as a means to increase family wealth and children’s wellbeing.

Ashcroft et al (doi 10.1136/bmj.a1135) rightly call for empirical as well as moral reasoning to be considered when judging the …
Measuring healthcare outcomes--a race to utopia?
Authors: S. Jessani, J. Tomson
Journal: Journal of the Royal Society of Medicine (2006)

JRSM 1 ) overlooks the most salient message of the recent Vioxx matter: authors must take responsibility for the integrity of their work.Integrity is not defined by what an author can get past an editor.It is the indisputable obligation of researchers to include all relevant data in manuscript submissions-especially in research involving drug safety.The VIGOR authors, two of whom were Merck employees, withheld critical data on the cardiovascular toxicity of Merck's drug Vioxx.As soon as we learned that the authors knew of these data well before the article was published, we began preparing our Expression of Concern.By bringing this matter to public attention, we underscored its importance.The tale Smith tells is riddled with distortions and unsubstantiated opinions.These inaccuracies seem designed to serve an agenda he already has put forth: that journals are information-laundering vehicles for industry, a cynical view that we do not share.We stepped forward when we did, exposing ourselves to criticism, for the sake of open and honest discourse between authors and editors.Smith contends that medical journals have been damaged and the NEJM has been embarrassed.To the contrary, we are proud of our actions.We wanted to serve our readers by correcting the record and to affirm with authors the importance of accuracy and completeness.On the second point, we already have seen authors taking greater care to ensure the completeness of their submissions.
Repeats in the kringle IV encoding domains in the Apo(a) gene and serum lipoprotein(a) level do not contribute to the risk for avascular necrosis of the bone (AVN) in pediatric acute lymphoblastic leukemia
Authors: R D van Beek, D D L Bezemer, J P P Meijerink, S M P F de Muinck Keizer-Schrama, O A Haas, L te Winkel, R Pieters, M van den Heuvel-Eibrink
Journal: Leukemia (2006)
Mutations in the guanine nucleotide exchange factor gene IQSEC2 cause nonsyndromic intellectual disability
Authors: Cheryl Shoubridge, Patrick S Tarpey, Fatima Abidi, Sarah L Ramsden, Sinitdhorn Rujirabanjerd, Jessica A Murphy, Jackie Boyle, Marie Shaw, Alison Gardner, Anne Proos, Helen Puusepp, F Lucy Raymond, Charles E Schwartz, Roger E Stevenson, Gill Turner, Michael Field, Randall S Walikonis, Robert J Harvey, Anna Hackett, P Andrew Futreal, Michael R Stratton, Jozef Gécz
Journal: Nature Genetics (2010)
Ultrastructural localisation of fibronectin in human osteoarthritic articular cartilage.
Authors: J A Rees, S Y Ali, R A Brown
Journal: Annals of the Rheumatic Diseases (1987)

A protein A-gold immunolocalisation technique has been used on sections of femoral head articular cartilage to localise fibronectin. Chondroitinase treatment enhanced gold staining, particularly when tissue samples were digested before fixation. The greatest accumulations of fibronectin were seen in the surface zone of osteoarthritic cartilage. Disease free cartilage contained very little fibronectin in this region. Cells which appeared to produce fibronectin were rare in normal specimens but common in the superficial region of osteoarthritic cartilage. These chrondrocytes appeared to release fibronectin as part of an amorphous material which accumulated in the pericellular region. This is the first ultrastructural demonstration of fibronectin synthesis by articular cartilage chondrocytes.
HEREDITY AS A SOCIAL BURDEN.
Authors: A. W. WILMARTH
Journal: JAMA (1896)

It may appear a waste of time to place before you proofs of the existence of heredity as a large factor in the production of those nervous diseases on which I wish to speak briefly to-day. My reason for doing so is two-fold. The existence of heredity as such a factor has been occasionally denied by men of such position that their opinion must carry weight, even though they are opposed by the majority of the thinking men who have given this matter their attention. The existence of heredity appears thoroughly established by statistics which have been most carefully compiled and verified. Moreover, the great number of these defectives, and the vast, ever-increasing expense of their maintenance, as well as their harmful influence on society at large, can only be realized in this way. The three forms of disease which are most liable to make their victims dependent on society
Relationship of Cardiac Problems to Athletic Participation
Authors: Kenneth D. Rose
Journal: JAMA (1969)

A rapid electrocardiographic technique, using a semireclining chair fitted with copper skin electrodes for arms and legs, has been employed in a screening survey of athletes during the routine preseason physical examinations. Mutually perpendicular leads I and aVF were recorded on 1,219 candidates. Following standards set by Dawber and Katz, 1,158 were normal, 51 doubtful, and 10 abnormal. Based on current knowledge, Wolff-Parkinson-White syndrome without history of paroxysmal arrhythmia is acceptable for strenuous sports; acquired bundle-branch block, right or left, should be suspected and thoroughly investigated; nodal rhythm and other second-degree block aggravated by exercise is cause for rejection as is myocardial ischemia and active myocarditis but not isolated T-wave changes. Cardiac contusion should be suspected in injuries of the anterior portion of the chest, and the patient should be permitted to play only when fully recovered.