tbuckley/cabot-search huggingface dataset:
A defence of the small clinical trial: evaluation of three gastroenterological studies.
Authors: J Powell-Tuck, K D MacRae, M J Healy, J E Lennard-Jones, R A Parkins
Journal: BMJ (1986)

Emphasis has been placed on the importance of 13, the type II error, in clinical trials and the corresponding necessity of including large numbers of subjects in a study.' Large trials are in fashion and small trials-even when they yield statistically significant results-are regarded with suspicion; a small trial which does not show a conventional statistically significant difference is often thought worthless.Interpretation of the small trial has increasingly been recognised to be dangerous, and the argument that lack of a significant difference between two treatments must mean that they have equal efficacy is recognised to be false.The need for large trials is undeniable in diseases such as cancer and cardiovascular problems where earlier trials have excluded large advantages for new treatments and small differences in outcome are still clinically and socially important.The unfortunate consequence of the emphasis on large trials in these settings is that small trials conducted in other diseases where only large differences in outcome are relevant have illogically become unacceptable in many people's minds.With appropriate statistical analysis, including calculation of the confidence limits for the likely "true" difference, small controlled trials can provide clinically useful information.We present three such small clinical trials-none of which show conventional statistically significant results and none of which, given the present
Audit of public education campaign to encourage earlier detection of malignant melanoma.
Authors: R. M. MacKie, D. Hole
Journal: BMJ (1992)

OBJECTIVES--To evaluate a public campaign to encourage earlier referral and treatment of primary cutaneous malignant melanoma and thus reduce mortality related to melanoma. DESIGN--Production and distribution of educational material aimed at adults. Update information sent to general practitioners before campaign. Analysis of data on melanoma before and after campaign in June 1985. SETTING--West of Scotland, population 2.7 million. MAIN OUTCOME MEASURES--Total numbers of referrals per month to melanoma clinic, numbers of melanomas diagnosed, change in distribution of thickness, and mortality before and after introducing the campaign. RESULTS--Referrals to the pigmented lesion clinic increased by 278%, from five a week in June-July 1984 to 19 a week in June-July 1985. Twice as many women as men were referred to the clinic (49% of referrals were of women aged under 65). The numbers of newly diagnosed primary cutaneous melanoma were 63 (12/month) in January-May 1985 and 146 (21/month) in June-December 1985, an increase of 131%. The percentage of tumours detected that were less than 1.5 mm thick rose significantly by 16% (95% confidence interval 11% to 19%), from 38% (328) in 1979-84 to 54% (592) in 1985-9. Mortality began to fall in women from 1988. CONCLUSIONS--The public education campaign succeeded in reducing the absolute number of thick tumours and melanoma related mortality in women.
Declining Stroke Incidence and Improving Survival in US Communities
Authors: Ralph L. Sacco, Chuanhui Dong
Journal: JAMA (2014)

Stroke affects an estimated 795 000 Americans each year, remains the fourth leading cause of death, and is the main cause of adult disability in the United States.1 Worldwide, stroke ranks as the second leading cause of death, responsible for 9.5% of total deaths each year, with a greater burden in developing countries.2 Over the past decade, overall stroke mortality has declined, primarily in western countries. Moreover, several studies have documented a decrease in stroke incidence rates.3- 6 These favorable trends are likely due to better vascular risk factor control and improvements in acute stroke treatment at many institutions, including specialized stroke centers.7 In the United States, however, there are persistent racial, ethnic, sex, and regional disparities in age-adjusted stroke mortality rates,8- 10 and long-term temporal trend data on validated stroke incidence by race and ethnicity are scarce.
REGULATION OF CELL-MEDIATED CYTOTOXICITY
Authors: Edris Sabbadini
Journal: The Journal of Experimental Medicine (1974)

Mice were treated with sublethal and midlethal doses of irradiation (500-700 rads) and injected intravenously with allogeneic or semiallogeneic F(1) hybrid spleen cells. The cytotoxicity developed by their spleen cells was measured with the lysis of (51)Cr-labeled target cells and was found to be stronger (although delayed in time) than the cytotoxic activity of spleen cells from nonirradiated mice. The injection of syngeneic thymus or spleen cells in the irradiated mice after their treatment with allogeneic spleen cells exerted a suppressor activity, i.e., reduced the level of cell-mediated cytotoxicity (CMC). The majority of effector cells involved in the modified CMC response of irradiated mice was shown to be of host origin and lysed specifically target cells of the same genotype as the donor. A small percentage of the cells obtained from the spleens of irradiated recipients of allogeneic spleen cells was composed of donor cells which lysed specifically target cells of the same genotype as the host. These results demonstrate that the precursors of the cytotoxic cells responsible for target cell lysis are relatively radioresistant and suggest that their response is regulated by radiosensitive thymus-dependent cells.
Preoperative Staging of Colorectal Cancer with a Balloon-Sheathed Miniprobe
Authors: L.-J. Tseng, Y. T. F. N. Jao, L.-R. Mo
Journal: Endoscopy (2002)

Conventional endoscopic ultrasonography (EUS) is a valuable modality for staging the depth of invasion of colorectal cancer. However, there are difficulties with this technique in reaching as far as the cecal area, traversing tight strictures, and obtaining clear images of smaller lesions. Due to these factors, mis-staging often occurs. The literature shows that the miniprobe is superior to EUS, because of its easy manipulation and better diagnostic accuracy. We therefore conducted a prospective study using a balloon-sheathed miniprobe for colorectal cancer staging.Eighty-six patients underwent preoperative staging using a miniprobe combined with an outer balloon sheath. Six patients were excluded from lymph-node examination due to local tumor resection. Acoustic coupling was achieved with or without water immersion. The results were compared with the histopathological findings in the resected specimens.The balloon-sheathed miniprobe had an overall accuracy rate of 85 % for T staging, with 100 % in T1; 78 % in T2; 90 % in T3; and 40 % in T4. Lymph-node metastasis was correctly diagnosed in 73 % of cases, with sensitivity and specificity rates of 74 % and 71 %, respectively. It was not possible to obtain clear cross-sectional images using the miniprobe in three patients.The balloon-sheathed miniprobe is a good alternative for evaluating colorectal tumor lesions, since it can usually obtain cross-sectional images even in markedly stenosed lesions, and the examination can be performed easily with endoscopy, with or without water-infusion techniques. One major limitation with the probe is the difficulty in evaluating deeper structures, such as lymph-node groups and contiguous organ involvement.
A New Haemoglobin in a Thai Family. A Case of Haemoglobin Siriraj- Thalassaemia
Authors: S. Tuchinda, D. Beale, H. Lehmann
Journal: BMJ (1965)

Carcinoma of Stomach-Brookes et al.B= 1583 there is difficulty in differentiating between these two conditions clinically, radiologically, and at operation.We wish to express our thanks to Miss J. M. Levi, of the Follow- up Department, for the help she and her
Pharmaceuticals and personal care products in the environment: agents of subtle change?
Authors: C G Daughton, T A Ternes
Journal: Environmental Health Perspectives (1999)

During the last three decades, the impact of chemical pollution has focused almost exclusively on the conventional "priority" pollutants, especially those acutely toxic/carcinogenic pesticides and industrial intermediates displaying persistence in the environment. This spectrum of chemicals, however, is only one piece of the larger puzzle in "holistic" risk assessment. Another diverse group of bioactive chemicals receiving comparatively little attention as potential environmental pollutants includes the pharmaceuticals and active ingredients in personal care products (in this review collectively termed PPCPs), both human and veterinary, including not just prescription drugs and biologics, but also diagnostic agents, "nutraceuticals," fragrances, sun-screen agents, and numerous others. These compounds and their bioactive metabolites can be continually introduced to the aquatic environment as complex mixtures via a number of routes but primarily by both untreated and treated sewage. Aquatic pollution is particularly troublesome because aquatic organisms are captive to continual life-cycle, multigenerational exposure. The possibility for continual but undetectable or unnoticed effects on aquatic organisms is particularly worrisome because effects could accumulate so slowly that major change goes undetected until the cumulative level of these effects finally cascades to irreversible change--change that would otherwise be attributed to natural adaptation or ecologic succession. As opposed to the conventional, persistent priority pollutants, PPCPs need not be persistent if they are continually introduced to surface waters, even at low parts-per-trillion/parts-per-billion concentrations (ng-microg/L). Even though some PPCPs are extremely persistent and introduced to the environment in very high quantities and perhaps have already gained ubiquity worldwide, others could act as if they were persistent, simply because their continual infusion into the aquatic environment serves to sustain perpetual life-cycle exposures for aquatic organisms. This review attempts to synthesize the literature on environmental origin, distribution/occurrence, and effects and to catalyze a more focused discussion in the environmental science community.
P1-075: Combined endoscopic transbronchial and transesophageal ultrasound-guided biopsy of centrally located lung tumours following a nondiagnostic bronchoscopy
Authors: Mark Krasnik, Birgit G. Skov, Peter Vilman, Ralf Eberhardt, Armin Ernst, Felix Herth
Journal: Journal of Thoracic Oncology (2007)
Chemical process safety at a crossroads.
Authors: Carolyn W Merritt
Journal: Environmental Health Perspectives (2004)

will mark the 20th anniversary of the worst industrial accident in history, the chemical plant disaster in Bhopal, India, that killed thousands of people and injured tens of thousands more.Along with other safety professionals from around the world, I will be traveling to India this fall to reflect on what has changed and what we still must do to better protect the lives of workers and the public from chemical accidents.Chi (χ), the 22nd letter of the Greek alphabet, is an ancient symbol of a crossroads.At its center, the intersection point, or chiasm, marks a single event that separates past from future.Bhopal is a chiasm, an event that forever changed the path of the chemical industry and that continues to be felt around the world.Thousands of Bhopal victims suffered permanent, disabling injuries, which they must live with every day.The tragedy has also changed public attitudes toward the chemical industry in lasting ways.The U.S. Congress passed the Emergency Planning and Community Right-to-Know Act (1986), followed by the Clean Air Act Amendments (1990).These laws have established a federal role in overseeing how companies manage the safety of chemical processes on a daily basis.As directed by Congress, the U.S. Occupational Safety and Health Administration (OSHA 1992) and the U.S. Environmental Protection Agency (U.S. EPA 1996) issued regulations requiring companies to analyze the hazards of their processes, preserve safety during process changes, perform preventative maintenance, train workers and contractors, investigate safety incidents, and plan for emergencies.The rules do not require specific safety equipment or
Phylogeny Reconstruction Using Duplicate Genes
Authors: Mark P. Simmons, C. Donovan Bailey, Kevin C. Nixon
Journal: Molecular Biology and Evolution (2000)

In this paper, we propose a new method (uninode coding) for coding duplicate (paralogous) genes to infer species trees. Uninode coding incorporates data from duplicated and unduplicated gene copies in phylogenetic analyses of taxa. Uninode coding utilizes global parsimony through the inclusion of both duplicated and unduplicated gene copies, allows one to code all data sources from a taxon into a single terminal, and overcomes problems of character dependence among duplicated and unduplicated gene copies. We present an example of uninode coding using the phytochrome A and phytochrome C data from a study by Donoghue and Mathews.
Psychosocial and Cognitive Factors Associated with Adherence to Dietary and Fluid Restriction Regimens by People on Chronic Haemodialysis
Authors: Tom Sensky, Christine Leger, Steven Gilmour
Journal: Psychotherapy and Psychosomatics (1996)

Background: Failure by people on chronic haemodialysis to adhere adequately to dietary and fluid restrictions can have serious medical consequences. Numerous psychosocial factors possibly associated with adherence have been investigated in previous research. However, most previous studies have examined one or a few variables in isolation, and have tended to focus on sociodemographic variables not easily amenable to intervention. Much previous work has tended to ignore potential differences in adherence between male and female dialysands. Methods: Sociodemographic and psychosocial factors associated with adherence to dietary and fluid restrictions were investigated in 45 people on haemodialysis attending one renal unit, excluding those with a residual urine volume > 500 ml/day. Multiple regression analyses were used to estimate the contribution to adherence of a range of variables, including gender, age, duration of dialysis, affective disturbance, past psychiatric history, health locus of control, social adjustment and social supports. Results: Adherence to diet (measured by predialysis serum potassium) and to fluid restriction (interdialysis weight gain) were not linked, and had different psychosocial correlates. Regression models of four different aspects of adherence revealed very distinct psychosocial correlates, with contributions to adherence from complex interactions between psychosocial and cognitive variables, notably gender, age, social adjustment, health locus of control, and depression. Conclusions: The findings cast doubt on the results of many previous studies which have used simple models of adherence. Adherence is likely to be influenced in a complex manner by multiple factors including age, gender, locus of control, social adjustment, and past psychiatric history.
THE PATHOLOGY AND TREATMENT OF GUNSHOT WOUNDS OF THE SMALL INTESTINE
Authors: O. Richards
Journal: BMJ (1915)

MKIVAL JOiBuNAL 213 attempt the needle encouiniteredl a free space in the sixthi inter- costal space in.thte posterior axillarv linie.The manometer oscillationis wvere smiall but definitely negative -4, -2, accord-
Calcification of porcine prosthetic heart valves: a radiographic and light microscopy study.
Authors: P R Cipriano, M E Billingham, P E Oyer, L M Kutsche, E B Stinson
Journal: Circulation (1982)

To determine the incidence and extent of calcification of implanted glutaraldehyde-treated porcine prosthetic heart valves, 82 valves explanted from 73 patients were examined for calcium by radiography and light microscopy. At the time of valve implantation, the patients were 2 1/4-76 years old. The included 15 children (patients younger than 15 years of age, mean age at time of valve implantation 8.7 +/- 4.1 years) and 58 adults (patients older than 15 years, mean age at time of valve implantation 53.5 +/- 15.1 years). Valves explanted from children (average time implanted 4.6 +/- 1.7 years) included four aortic, five mitral, as well as six right ventricle-pulmonary artery conduits and one left ventricle-abdominal aorta conduit. Valves explanted from adults (average time implanted 3.2 +/- 2.5 years) included 32 aortic and 32 mitral, as well as one tricuspid valve and one valve from a right ventricle-pulmonary artery conduit. Calcification of explanted valves was graded from 0 to 4+ based on radiographs. All 16 valves from children were calcified, with grade 3+ or 4+ calcification in each of the aortic and mitral valves. In adult patients, calcification was present in 10 of 33 valves (30%) implanted for less than 3 years (average time implanted 1.0 year), in nine of 11 valves (82%) implanted for 3-5 years (average time implanted 3.7 years) and in 21 of 22 valves (96%) implanted for 5 years or longer (average time implanted 6.2 years). Analysis of variance demonstrated that calcification was strongly related to the duration that valves were implanted (p less than 0.001). Age at the time of valve implantation also had a strong effect (p less than 0.001) on the amount of valvular calcium. Valves from children showed the most calcification, and the amount did not change when valves were implanted in patients 30 years of age or older. Patient sex and valve position had no effect on the amount of calcification. Calcification occurred at each right- and left-heart valve position, most frequently at sites of commissural attachments.
Treatment by H 11
Authors: J. H. Thompson
Journal: BMJ (1949)

BRITISH 439 (under five million/ml.), 37cases; group 3, subfertile and border-line, 187 cases; group 4, normally fertile, 44 cases.The age of specimens was as follows: group 1, six specimens produced at laboratory and inspected immediately, six specimens less than 1 hour old, and 12 specimens 1-2 hours old; group 2, 13 specimens produced at laboratory, and 24 specimens 1-2 hours old; groups 3 and 4, 61 specimens produced at laboratory, and 170 specimens 1-2 hours old.These specimens were kept under observation from the time received for periods of 6-24 hours.Specimens showing total azoospermia were mixed with part of others containing spermatozoa and kept under similar observation.No spermatolysis was observed in any of the above 292 cases.In view of this finfding, and in view of the fact that we cannot recall seeing a case suggesting spermatolysis in more than 5,000 previous semen analyses, we conclude that if spermatolysis occurs in this country it must be very uncommon.However, spermatolysis might be a phenomenon confined to other racial or climatic conditions, and it would be of great interest to hear whether Dr. Yildiran's findings have been confirmed elsewhere.-Iam, etc.,
Geriatrics in Internal Medicine
Authors: DENNIS E. HYAMS
Journal: Annals of Internal Medicine (1979)

Letters1 September 1979Geriatrics in Internal MedicineDENNIS E. HYAMS, M.B.DENNIS E. HYAMS, M.B.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-91-3-490_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: As a physician with long experience in geriatric medicine in the United Kingdom, I strongly support the views expressed by Dr. Tamara Harris in her letter (1) in the May issue.Geriatric medicine does not relate only to "nursing home" or other long-stay patients; good geriatric medicine should be seen as good internal medicine practiced on elderly patients to a standard as high as in any other age group. To do this, however, means the application of a coordinated multidisciplinary effort to a degree that is equaled in only a few other specialty situations. This is the...References1. HARRIS T. Geriatric medicine. Ann Intern Med. 1979; 90:851-2. Letter. LinkGoogle Scholar2. BEESON P. Training doctors to care for old people. Ann Intern Med. 1979; 90: 262-3. Editorial. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Merck Sharp & Dohme Research Laboratories Rahway, NJ 07065 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1979Volume 91, Issue 3Page: 490-491KeywordsAge groupsElderlyGeriatricsNursing homes Issue Published: 1 September 1979 PDF downloadLoading ...
Primary Angiosarcoma of the Breast
Authors: R. L. Myerowitz
Journal: JAMA (1978)

<h3>To the Editor.—</h3> Primary angiosarcoma of the breast is a rare neoplasm characterized by its rapid growth, large size, and frequent recurrences with metastasis. Long-term survival is rare.<sup>1-3</sup>In support of recent reports suggesting multimoduality therapy<sup>4,5</sup>(237:2605, 1977) for sarcomas, we wish to relate the clinical and pathologic features of a patient who survived for four years after diagnosis. <h3>Report of a Case.—</h3> In April 1973, at the age of 43 years, the patient came to us with a right breast mass; the biopsy specimen showed angiosarcoma. Therapy consisted of a simple mastectomy followed postoperatively by vincristine and cyclophosphamide chemotherapy. The patient did well until October 1975 when she came for her second admission because of iron deficiency anemia. Her barium enema showed a persistent narrowing of the colon near the hepatic flexure. Selective celiac and superior mesenteric arteriograms showed metastatic angiosarcoma in the distal duodenum. A questionable
The Johns Hopkins Textbook of DyslipidemiaKwiterovichPeter O.Jr MD, ed. The Johns Hopkins Textbook of Dyslipidemia 303 pages. Philadelphia, USA: Lippincott Willams and Wilkins, 2010. $99.95. ISBN 0-7817-8265-4
Authors: D. Paul Nicholls, Ian S. Young
Journal: Circulation (2010)
COMPARISON OF TRENDS IN IN-HOSPITAL AND LONG-TERM OUTCOMES OVER TIME AMONG OLDER PATIENTS WITH NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: INSIGHTS FROM THE CRUSADE QUALITY IMPROVEMENT REGISTRY
Authors: Chee Tang Chin, Tracy Y. Wang, Anita Y. Chen, Robin Mathews, Karen P. Alexander, Matthew T. Roe, Eric D. Peterson
Journal: Journal of the American College of Cardiology (2011)
Limiting the number of oocytes and embryos transferred in GIFT and IVF.
Authors: I Craft, T al-Shawaf
Journal: BMJ (1991)

be screened for evidence of carriage of hepatitis B virus his serum had not been tested for hepatitis B surface antigen and hence his carrier state was not known.Infection with hepatitis B virus is a recognised hazard for health care workers,2 and in future vaccine should be available for all those at risk of infection.This should considerably reduce if not eliminate the risk to staff and patients of nosocomial transmissions.With the current vaccines, however, the failure rate may be as high as 9% and a further 9% will have a low antibody response (<10 mIU).3Some of the non-responders will continue to be at risk and will require hepatitis B immunoglobulin after known exposures.Other non-responders will already be carriers.We suggest that the time has come to identify these non-responders as early as possible after infection so that they can be offered treatment and advice about their career.Treatment has a greater chance of success if given within two years of infection,4 and ideally hepatitis B carriers should be advised to choose a specialty that does not include surgery, obstetrics, or renal medicine.Vaccine should be available for all medical and dental students, and non-responders should be investigated and advised accordingly before firm choices of career have been made.The present policy of redeployment after known transmission to a patient5 could well be challenged in court not only when a surgeon is known to be a hepatitis B carrier but also if the carrier state is not excluded when there is no response to vaccine.