tbuckley/cabot-search huggingface dataset:
Epidemiology for the uninitiated. Comparing rates.
Authors: G Rose, D J Barker
Journal: BMJ (1978)

Is this disease increasing ?Does it occur with undue frequency in my local community?Does its incidence correlate with some hypothesised cause ?Has the outcome changed since control measures were instituted ?"To answer such questions means setting two sets of rates side by side and making some sense of the comparison.This article will examine some of the problems which may arise. Terminology and classification of diseasesDiagnostic labels and groupings are many and various, and in continual flux: in the interests of communication some standardisation is necessary, even though no single system can meet all requirements. THE ICD SYSTEMThe International Classification of Diseases, Injuries, and Causes of Death, published by the World Health Organisation, assigns a 3-digit numerical code to every major condition.Often a fourth digit is added for more exact specification: for example, ICD 204 is "lymphatic leukaemia," which may additionally be specified as 204.0 "acute" or 204.1 "chronic."Broader group- ings are readily formed-for example, ICD 200-209 consists of all neoplasms of lymphatic and haematopoietic tissue.This system is used for coding death certificates.It determines the presentation of results in the Registrar General's reports, and in the diagnostic registers of most hospitals.Periodically, the system has to be revised to keep pace with medical usage.The new (9th) revision comes into general use in 1979-consequently, some rates published before and after this year will not be directly comparable.In interpreting time trends it is also essential to consider changes in diagnostic standards and clinical terminology.His- torical epidemiology is a dangerous pursuit, but errors are less likely if the analysis deals in broad disease categories.For example, coronary heart disease mortality rates in American men declined between 1968 and 1974 by 220o.One explanation for this might be that deaths formerly attributed to this cause are now being called something else (hypertension, cardio-
Brain Herniation in Toxoplasmosis
Authors: N Singh, K Stempel
Journal: New England Journal of Medicine (1994)

Figure 1. Brain Herniation in Toxoplasmosis. A computed tomographic scan of the head (Panel A) shows subfalcial brain herniation in an outpatient who was seropositive for the human immunodeficiency virus and who had subtle changes in cognitive function but an otherwise normal neurologic examination. A ring-enhancing mass with irregular borders measuring 1.8 by 1.4 cm is present in the left basal ganglia (short arrow), associated with marked edema (arrowhead). The mass effect has caused compression of the left lateral ventricle, with a 0.8-cm ventricular shift toward the right (long arrow) and displacement of the falx cerebri to the right of . . .
A modified technique (using polyester tape) of skin surface biopsy.
Authors: J. M. LACHAPELLE, J. C. GOUVERNEUR, M. BOULET, D. TENNSTEDT
Journal: British Journal of Dermatology (1977)

A technical modification of skin surface biopsy has been introduced by using plastic tape instead of glass as holder, mainly to investigate mycological infections of skin folds. Among various brands of plastic sheets, aa polyester film (Melinex O UCB-SIDAC) has been demonstrated as the most suitable. A direct microscopic comparison has been made between our modified technique and conventional scraping as procedures for collecting material from interdigital spaces in 30 patients with bilateral athlete's foot. It has been shown that the skin surface biopsy gives a slightly greater number of positive results (presence of dermatophytes or Candida species) than the conventional scraping technique, although the difference between both techniques is not statistically significant at the 0.05 level (0.05 < P < 0.10). Some advantages of the modified skin surface biopsy are emphasized.
A case of melanonychia caused by Fusarium solani
Authors: H.J. Lee, B.K. Koh, J.S. Moon, S.O. Kim, S.J. Kim, S.J. Ha, B.K. Cho, J.W.K. Im
Journal: British Journal of Dermatology (2002)

Journal Article A case of melanonychia caused by Fusarium solani Get access H.J. Lee, H.J. Lee Department of Dermatology, College of Medicine, The Catholic University of Korea, St Paul's Hospital, 620–56, Jeon‐nong dong, Dongdaemun‐gu, Seoul, Korea 130–709 Search for other works by this author on: Oxford Academic Google Scholar B.K. Koh, B.K. Koh Department of Dermatology, College of Medicine, The Catholic University of Korea, St Paul's Hospital, 620–56, Jeon‐nong dong, Dongdaemun‐gu, Seoul, Korea 130–709 Search for other works by this author on: Oxford Academic Google Scholar J.S. Moon, J.S. Moon Department of Dermatology, College of Medicine, The Catholic University of Korea, St Paul's Hospital, 620–56, Jeon‐nong dong, Dongdaemun‐gu, Seoul, Korea 130–709 Search for other works by this author on: Oxford Academic Google Scholar S.O. Kim, S.O. Kim Department of Dermatology, College of Medicine, The Catholic University of Korea, St Paul's Hospital, 620–56, Jeon‐nong dong, Dongdaemun‐gu, Seoul, Korea 130–709 Correspondence: Jin‐Wou Kim, MD E‐mail: PAULDERMA@yahoo.co.kr Search for other works by this author on: Oxford Academic Google Scholar S.J. Kim, S.J. Kim Department of Dermatology, College of Medicine, The Catholic University of Korea, St Paul's Hospital, 620–56, Jeon‐nong dong, Dongdaemun‐gu, Seoul, Korea 130–709 Search for other works by this author on: Oxford Academic Google Scholar S.J. Ha, S.J. Ha Department of Dermatology, College of Medicine, The Catholic University of Korea, St Paul's Hospital, 620–56, Jeon‐nong dong, Dongdaemun‐gu, Seoul, Korea 130–709 Search for other works by this author on: Oxford Academic Google Scholar B.K. Cho, B.K. Cho Department of Dermatology, College of Medicine, The Catholic University of Korea, St Paul's Hospital, 620–56, Jeon‐nong dong, Dongdaemun‐gu, Seoul, Korea 130–709 Search for other works by this author on: Oxford Academic Google Scholar J.W.K. Im J.W.K. Im Department of Dermatology, College of Medicine, The Catholic University of Korea, St Paul's Hospital, 620–56, Jeon‐nong dong, Dongdaemun‐gu, Seoul, Korea 130–709 Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 147, Issue 3, 1 September 2002, Pages 607–608, https://doi.org/10.1046/j.1365-2133.2002.48433.x Published: 01 September 2002
UPSTREAM CLOPIDOGREL FOLLOWED BY PRE-PCI PRASUGREL GIVES RAPID PLATELET INHIBITION AND REPRESENTS A FEASIBLE OPTION IN STEMI PATIENTS UNDERGOING PRIMARY PCI
Authors: Sasha Koul, Pontus Andell, Andreas Martinsson, Jan Gustav Smith, Fredrik Scherst&eacute;n, Jan Harnek, Matthias G&ouml;tberg, Eva Norstr&ouml;m, Sven Bj&ouml;rnsson, David Erlinge
Journal: Journal of the American College of Cardiology (2012)
Balancing Incentives
Authors: Lawrence Peter Casalino
Journal: JAMA (1992)

The May 15, 1991,<i>JAMA</i>theme issue presented 14 different proposals for reforming the US medical care system. Though these proposals varied widely, they encompassed only three proposed methods for paying physicians: fee-for-service, salary, and capitation. When examined from a perspective that considers the incentives affecting practicing physicians, each of these methods has serious flaws. I outline these flaws and suggest an alternative method for reimbursing primary care physicians: that of combining capitation and fee-for-service. Specialists would be paid fee-for-service, but the cost of specialty care would be limited by giving each primary care physician a budget for such care. Consistent failure by a physician to stay within the budget would result in ongoing review, but not in direct financial sanctions. This system of reimbursing physicians is intended to balance incentives so that physicians can concentrate on making medical decisions with a minimum of distraction by third parties and by personal financial considerations. (<i>JAMA</i>. 1992;267:403-405)
What do medical students think of flexible training?
Authors: A. Sinha, A. Cook
Journal: BMJ (1997)

Flexible training provides an extremely valuable opportunity for doctors - male or female - who in the face of external pressures wish to continue practising medicine. The most important determinants of career choice among both male and female medical students in an Australian survey,1 seemed to be “the opportunity for part time training, flexible working hours and part time practice.” These factors were more important to women than to men.

Our study examines the attitudes and awareness of medical students towards flexible training opportunities. We distributed a questionnaire to students in the first, third, and fifth years at Birmingham medical school during May and June 1996. Data from the questionnaires were analysed with two computer packages: EpiInfo, and Stats View.

The overall response rate was 61% (328/540). The response rate was 58% (145/249) for men and 63% (183/291) for women. For first year students it was 57% (107/189), third year students 57% (94/166), and fifth year students 73% (121/166). Analysis showed that there were no significant differences between men and women or between the years with regard to ethnic group, age, marital status, and parity.

### Summary points

In all, 54% of students in our study were aware of flexible training before reading our questionnaire. Awareness of flexible training increased with year of medical school …
Support for grouping-by-synchronization, the context-field, and its mechanisms, but doubt in the use of information theory by the cortex
Authors: Reinhard Eckhorn
Journal: Behavioral and Brain Sciences (1997)

Our work supports synchronization for binding within Phillips &amp; Singer's “contextual field” (CF) as well as the type of its lateral interaction they propose. Both firmly agree with our “association field” (AF) and its modulatory influences (Eckhorn et al. 1990). However, the CF connections seem to produce anticorrelation among assemblies representing unrelated structures, whereas experimental evidence indicates decoupling. Finally, it is unclear how the cortex can have access to the logistic function used in the “coherent infomax” approach.
Hyperammonemia in Alzheimer's disease
Authors: M Fisman, B Gordon, V Feleki, E Helmes, J Appell, K Rabheru
Journal: American Journal of Psychiatry (1985)

Postprandial blood ammonia levels were significantly higher in 22 patients with Alzheimer's disease than in 37 control subjects. In the Alzheimer group, fasting blood ammonia levels were significantly higher in patients whose EEGs showed triphasic waves than in patients without this change. The direction of change from fasting to postprandial blood ammonia levels was also significantly different between these two groups.
Prediction of Improvement of Contractile Function in Patients With Ischemic Ventricular Dysfunction After Revascularization by Fluorine-18 Fluorodeoxyglucose Single-Photon Emission Computed Tomography
Authors: Jeroen J. Bax, Jan H. Cornel, Frans C. Visser, Paolo M. Fioretti, Arthur van Lingen, Johannes M. Huitink, Otto Kamp, Francisca Nijland, Jos R.T.C. Roelandt, Cees A. Visser
Journal: Journal of the American College of Cardiology (1997)
398. Extracellular Matrix Identity and Surface Density Alter Transfection by Complexes Delivered from a Cell-Adhesive Substrate
Authors: Zain Bengali, Lonnie D. Shea
Journal: Molecular Therapy (2006)

The application of gene delivery to gene therapy, tissue engineering and functional genomics applications requires efficient delivery systems that overcome significant extracellular and intracellular barriers. Substrate-mediated delivery aims to overcome barriers in localized gene transfer by immobilizing preformed DNA complexes in the cellular microenvironment to reduce the amount of DNA delivered, prevent aggregation and distribute vector to adhered cells. We investigated the cellular quantities and distribution of DNA in the cellular population to identify how influencing the interactions between substrate and vector in substrate-mediated delivery enhances either transgene expression or the number of transfected cells. Relative to non-coated substrates, coating of polystyrene substrates with serum proteins yielded enhancement in transgene expression up to 1500 fold for immobilized polyplexes. Increase in total transgene expression paralleled an increase in association of polyplexes with the cells, however increased quantities of DNA associated with cells did not always result in enhanced expression. Substrate coating also increased the number of transfected cells up to 12-fold with both polyplexes and lipoplexes. Coating the substrate with serum proteins increased the number of cells that internalized polyplexes and lipoplexes, better distributing the DNA in the cell population. The identity and density of the extracellular matrix (ECM) component used for substrate coating significantly affects transgene expression. Collagen IV and fibrinogen yielded polyplex expression levels similar to or less than coating by fetal bovine serum (FBS), however, fibronectin coating enhanced gene expression up to 20-fold over FBS coating. Coating the substrate with 6 μg/cm2 of fibronectin yielded maximal expression and higher or lower amounts of fibronectin on the surface reduced expression. Enhancement in gene expression did not result from differences in the amount of DNA that bound to the substrate or associated with cells, suggesting that fibronectin enhances intracellular trafficking of polyplexes. For bolus transfection, the identity of the ECM component mediating cell adhesion did not influence gene expression. These studies demonstrate that maximal expression will be obtained when substrates are designed to bind DNA complexes with the appropriate affinity and also stimulate intracellular trafficking of complexes. Understanding the mechanisms in substrate-mediated delivery will enhance the application of gene delivery in vitro and in vivo.
Remembrance of conversations past: oral advance statements about medical treatment
Authors: A. Sommerville
Journal: BMJ (1995)

Polls show increasing public interest in advance statements or directives about medical treatment ("living wills") but that few people, apart from Jehovah's Witnesses, carry such documents. Patients' firm, witnessed oral decisions are often sufficient to aid clinical decision making but should still be recorded in medical notes. Without documentation, dilemmas arise when others claim to know patients' views on the basis of past unrecorded conversations and demand withdrawal of treatment when patients are not terminally ill and cannot speak for themselves. Legal and ethical considerations oblige doctors to act in the best interests of an incapacitated patient; these considerations are now formally defined in draft legislation as including consideration of the patient's past wishes. The practicalities of ascertaining the strength and validity of such wishes from conversations reported second hand are complex. The paucity of legal and ethical guidance on reported oral advance statements makes debate imperative and renders the alternative of having designated surrogate decision makers increasingly attractive.
Physiological Origins of Heart Sounds and Murmurs: The Unique Interactive Guide to Cardiac Diagnosis
Authors: Vincent J. Felitti
Journal: JAMA (1997)

Diagnostic recognition of heart sounds has always been a difficult skill to acquire because it requires repeated exposure to patients with appropriately illustrative cardiac lesions. Interpretative understanding of heart sounds is a major additional step, which requires coupling that clinical recognition to a comprehension of complex physiologic processes.  The cardiologist and teacher J. Michael Criley has created an effective teaching tool, which will help those wanting to further their diagnostic ability in both recognizing and understanding heart sounds and murmurs. Whereas many medical CD-ROMs seem designed either to market a skimpy book in a novel format or to inexpensively reproduce multiple color photographs, this one meaningfully exploits the new technology of computer graphics to teach in ways not usually possible.   Physiological Origins of Heart Sounds and Murmurs is an ingenious CD-ROM that takes acoustic recordings of 200 normal and abnormal heart sounds and reproduces them with synchronized depictions of the
Effect of Youth-Onset Type 2 Diabetes Mellitus on Incidence of End-Stage Renal Disease and Mortality in Young and Middle-Aged Pima Indians
Authors: Meda E. Pavkov, Peter H. Bennett, William C. Knowler, Jonathan Krakoff, Maurice L. Sievers, Robert G. Nelson
Journal: JAMA (2006)

The long-term outcome of persons with youth-onset type 2 diabetes mellitus has not been well described.To compare incidence of diabetic end-stage renal disease (ESRD) and mortality in Pima Indians with youth- and older-onset type 2 diabetes mellitus.Longitudinal population-based study conducted between 1965 and 2002 in Pima Indians from the state of Arizona. Participants were divided into 2 groups: (1) youth-onset type 2 diabetes mellitus (onset <20 years of age) and (2) older-onset type 2 diabetes mellitus (onset > or =20 - <55 years of age). Events and person-years of follow-up were stratified in a time-dependent fashion by decades of age. End-stage renal disease was defined as dialysis attributed to diabetic nephropathy or death from diabetic nephropathy.Incidence rate of diabetic ESRD and mortality between 25 and 55 years of age, according to age at onset of type 2 diabetes mellitus.Among the 1856 diabetic participants, 96 had youth-onset type 2 diabetes mellitus. The age-sex-adjusted incidence of diabetic ESRD was 25.0 cases per 1000 person-years (95% confidence interval [CI], 6.7-43.1) in youth-onset diabetes mellitus and 5.4 cases per 1000 person-years (95% CI, 4.4-6.4) in older-onset diabetes mellitus (incidence rate ratio, 4.6; 95% CI, 2.2-9.8). Age-specific incidence rates were higher in participants with youth-onset diabetes mellitus at all ages. Between 25 and 55 years of age, the age-sex-adjusted death rate from natural causes was 15.4 deaths per 1000 person-years (95% CI, 0.2-30.5) in participants with youth-onset diabetes mellitus and 7.3 deaths per 1000 person-years (95% CI, 5.9-8.7) in individuals with older-onset diabetes mellitus (death rate ratio, 2.1; 95% CI, 0.8-5.7). Compared with nondiabetic participants, the death rate was 3.0 times as high in individuals with youth-onset diabetes mellitus (95% CI, 1.1-8.0) and 1.4 times as high in individuals with older-onset diabetes mellitus (95% CI, 1.1-1.8). In a subset of 1386 participants with complete data for all covariates who were observed from the onset of diabetes mellitus, the age at onset of diabetes mellitus was not associated with the incidence of ESRD (hazard ratio, 1.0; 95% CI, 0.9-1.2) after adjusting for sex, mean arterial pressure, body mass index (calculated as weight in kilograms divided by height in meters squared), plasma glucose concentration, smoking, hypoglycemic medicines, and blood pressure medicines in a Cox proportional-hazards model.Early-onset type 2 diabetes mellitus is associated with substantially increased incidence of ESRD and mortality in middle age. The longer duration of diabetes mellitus by middle age in individuals diagnosed younger than age 20 years largely accounts for these outcomes.
Quality Control of Peak Flow Meters for Multicenter Clinical Trials
Authors: CHARLES G. IRVIN, RICHARD J. MARTIN, VERNON M. CHINCHILLI, SUSAN J. KUNSELMAN, REUBEN M. CHERNIACK
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

Although peak expiratory flow (PEF) measurements are recommended for monitoring and assessing treatment of asthmatic patients, and widely employed to assess outcome in clinical trials and epidemiologic studies, information about performance of peak flow meters (PFM) under field conditions is lacking. We describe a simple testing system consisting of a testing chamber, a spirometer, and a calibration syringe to evaluate the relative accuracy or median relative bias (MRB), precision, or interquartile range (IQR) of the mini-Wright PFM. The relative accuracy ranged from − 4.4 to 13.2% (mean, 4.1%) and the precision from 0.06 to 11.5% (mean, 1.2%). Durability of this PFM was assessed during a 26-wk clinical trial in 255 asthmatic subjects at five centers. Seventy-one PFM (19.9%) were identified as having failed to meet acceptance criteria, predominantly because of loss of relative accuracy, by the clinics at follow-up visits (n = 36), and by the Data Coordinating Center on retrospective review of quality control measurements submitted by the clinics (n = 35). This study indicates that a simple device can be used to evaluate the relative accuracy and precision of a given PFM and to ensure the quality of PEF measurements during a clinical trial. To the extent that one can extrapolate these data to other devices, our findings indicate that the failure rate of PFM over time can be high, indicating that quality control of a PFM over time is absolutely essential in clinical trials as well as in routine clinical care.
Future head of German NICE sets out ambitions for health care
Authors: A. Tuffs
Journal: BMJ (2010)

In a country with a powerful drug industry and a medical profession with little experience in evidence based medicine, the thought of introducing it might leave some doctors cold. But Jurgen Windeler, the newly appointed head of Germany’s equivalent to NICE, has grabbed the opportunity with what can only be described as relish.

In one of his first interviews since his appointment, Professor Windeler admitted that the job would be demanding but that the prospect of directly influencing the quality and efficiency of health care in Germany was too much to resist. And his plans are ambitious. With evidence based medicine on his side, he hopes to eliminate unnecessary drugs, medical devices, and procedures while helping to save the country several billions in euros.

On 1 September 2010 the 53 year old medical doctor and professor in biometric methods and clinical epidemiology will become the second director of the German Institute for Quality and Efficiency in Health Care …
A Model for Rheumatic Carditis?
Authors: ANGELO TARANTA
Journal: Annals of Internal Medicine (1967)

Editorial Notes1 February 1967A Model for Rheumatic Carditis?ANGELO TARANTA, M.D.ANGELO TARANTA, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-66-2-445 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptOver the last 10 years Cromartie, Schwab, and their associates have been carrying out an intriguing series of experiments with cell wall fragments of group A (and C) streptococci (1). These preparations injected into the skin of rabbits cause, after a latent period of 2 to 14 days, relapsing nodular lesions of the skin for as long as 80 days after a single injection. The process appears to be not immunologic but rather "toxic" in the wide sense of the word because damage starts after 3 hr only and is not affected by repeated injections. Interestingly, neither whole streptococcal cells...References1. CROMARTIE WJ Reviewed in : Reactions of connective tissue to cellular components of group A streptococci, in The Streptococcus, Rheumatic Fever and Glomerulonephritis, edited by UHR, J. W. The Williams & Wilkins Co., Baltimore, 1964, p. 187. Google Scholar2. CROMARTIECRADDOCK WJJG: Rheumatic-like cardiac lesions in mice. Science 154: 285, 1966. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Department of Medicine and Irvington House Institute New York University Medical School New York, N. Y. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 February 1967Volume 66, Issue 2Page: 445-446KeywordsCell wallsGroup A streptococciLesionsMyocarditisRabbits Issue Published: 1 February 1967 PDF DownloadLoading ...