tbuckley/cabot-search huggingface dataset:
Sample size and power
Authors: P. Sedgwick
Journal: BMJ (2011)

Researchers carried out a randomised controlled trial to compare the effectiveness of cryotherapy with that of salicylic acid for treating plantar warts. Participants were eligible if aged 12 years or over. Those randomised to cryotherapy had liquid nitrogen delivered by a healthcare professional, with a maximum of four treatments, each 2-3 weeks apart. Participants randomised to 50% salicylic acid (Verrugon) treated themselves daily for a maximum of eight weeks. The trial was conducted as a superiority study.1

The primary outcome was complete clearance of all plantar warts at 12 weeks. The cure rate for salicylic acid was assumed to be 70% at 12 weeks, and the smallest effect of clinical interest was a difference in cure rates of 15%. To demonstrate the smallest effect of clinical interest with 80% power at the 5% critical level of significance, a sample size of 120 patients in each treatment group was needed, or 133 patients in each group after allowing for 10% attrition (266 patients in total).

The proportion of participants with complete clearance of all plantar warts at 12 weeks was …
HIV/AIDS—Maintaining Momentum, Accelerating Action
Authors: Jeanette M. Smith
Journal: JAMA (2011)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Chronic Kidney Disease in the Elderly — How to Assess Risk
Authors: Lesley A. Stevens, Andrew S. Levey
Journal: New England Journal of Medicine (2005)

Chronic kidney disease is an important problem in the elderly and is associated with a high risk of kidney failure, cardiovascular disease, and death.1,2 The disorder is indicated either by a glomerular filtration rate (GFR) of less than 60 ml per minute per 1.73 m2 of body-surface area or by the presence of kidney damage, assessed most commonly by the finding of albuminuria for three or more consecutive months.3 The severity of chronic kidney disease can be classified according to the level of the GFR, regardless of the cause, as follows: stage 1, kidney damage with a normal or . . .
Oestrogen replacement after oophorectomy.
Authors: J. C. Stevenson, T. C. Hillard, S. I. Whitcroft, M. I. Whitehead
Journal: BMJ (1992)

of people damaged as a result of taking medically prescribed drugs, there has not been one docu- mented case of death due to nutrients and only a relatively small handful of cases reporting serious side effects.The cost to human health of excess salt consumption must be far greater.The most reactionary aspect of the proposed legislation is that American and British journals are publishing a large and growing number of refereed articles reporting the value for human health of vitamin and mineral intake, not only in food form but also in nutrient form.Will the NHS of the future be happy to have nutrients given only through prescribed and costly "drugs"?
Fred Vivian Griffiths
Authors: J. Fricker
Journal: BMJ (2014)

London GP who flew Hurricanes and Spitfires in the second world war



Given the number of close shaves Fred Vivian Griffiths had as a Royal Air Force pilot in the second world war, it is remarkable that he survived unscathed to undergo medical revalidation at the age of 90. Flight Lieutenant Griffiths, known as Vivian, flew 44 sorties in Hurricanes over north west Europe, and then transferred to reconnaissance Spitfires, making 66 sorties over Japanese occupied Burma.

In a half page autobiographical note, Griffiths adopted a gung-ho approach to the “low level operations” across Europe where they “never returned without being shot up.” But his descriptions of his posting to the Burma front, where he joined the 615 Squadron Photographic Reconnaissance Unit, are altogether more taciturn. Here, flying single seater Spitfires out of Calcutta, he photographed the landing grounds for the Chindits Airborne Landing Force in northern Burma.

Griffiths’s oldest son, Charles, said, “Flying eight times over the target on a steady course to get good pictures would have required extremely strong …
Surgery in the Rain Forest
Authors: Christopher P. Coppola
Journal: JAMA (1997)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
The RCGP's new standing group on overdiagnosis
Authors: Margaret McCartney, Julian Treadwell
Journal: BMJ (2014)

Overdiagnosis and overtreatment are close to the hearts of GPs.1 We are frustrated by the limited resources for applying evidence based guidelines, which are often distant from the local population and the reality of multimorbidity. It is a travesty that so many guidelines and invitations (for example, to NHS Health Checks) have been produced with not enough information for patients to be able to make high quality shared decisions.

A recent council meeting of the Royal College of …
Long-Term Metaproterenol Therapy in Asthmatic Children-Reply
Authors: Milan L. Brandon
Journal: JAMA (1976)

I appreciate and understand Dr Carnow's thoughts that criticize my study comparing metaproterenol with placebo rather than with alternative bronchodilators such as ephedrine or isoproterenol. However, the literature of the last 10 to 12 years is replete with studies comparing metaproterenol in various dosage forms with isoproterenol, and doubleblind trials of metaproterenol vs ephedrine have been reported, among others, by Kessler and Weisinger 1 and by Myers and Coltman. 2 Comparative trials with terbutaline sulfate 3 and albuterol (Salbutamol) 4 have also been published. The authors agreed that in these studies, some of them long-term, metaproterenol gave at least as good an account of itself as the reference drugs. Therefore, the essential efficacy of metaproterenol is no longer a matter of dispute among clinicians.  My own study was primarily concerned with the questions of whether children would benefit from longterm treatment with metaproterenol syrup without unduly frequent or
Profession's ideas are ignored
Authors: J Bahrami
Journal: BMJ (1994)

EDITOR, - In his interview with England's chief medical officer Richard Smith raised the question of why the profession was so slow in coming forward with its own ideas.1 In response Dr Calman referred to a document from the National Association of Health Authorities and Trusts and wondered why it had not come from general practice. I wish to point out that almost every recommendation …
Fatty acid distribution in systems modeling the normal and diabetic human circulation. A 13C nuclear magnetic resonance study.
Authors: D P Cistola, D M Small
Journal: Journal of Clinical Investigation (1991)

A nonperturbing 13C nuclear magnetic resonance (NMR) method was used to monitor the equilibrium distribution of carboxyl 13C-enriched fatty acids (FA) between distinct binding sites on human serum albumin, native human lipoproteins, and/or phospholipid model membranes, under conditions that mimic the normal and diabetic human circulation. Two variables pertinent to the diabetic circulation were examined: FA/albumin mole ratio (as elevated in insulin deficiency and/or nephrosis) and pH (as decreased in acidosis). 13C NMR spectra for samples containing carboxyl 13C-enriched palmitate, human serum albumin, and phospholipid vesicles or native lipoproteins (all samples at pH 7.4, 37 degrees C) exhibited up to six carboxyl NMR resonances corresponding to FA bound to distinct binding sites on albumin and nonalbumin components. When the sample FA/albumin mole ratio was 1, three FA carboxyl resonances were observed (182.2, 181.8, and 181.6 ppm; designated peaks beta, gamma, and beta', respectively). These resonances corresponded to FA bound to three distinct high-affinity binding sites on human serum albumin. When the sample mole ratio value exceeded 1, additional carboxyl resonances corresponding to FA bound to phospholipid vesicles (179.0 ppm, peak phi), lipoproteins (180.7 ppm, peak sigma), and lower affinity sites on albumin (183.8 ppm, peak alpha; 181.9 ppm, peak gamma'), were observed. The intensity of peaks phi and sigma increased with increasing mole ratio or decreasing pH. Using Lorentzian lineshape analysis, the relative mole quantities of FA bound to albumin and nonalbumin binding sites were determined. Plots of the fraction of FA associated with nonalbumin components as a function of FA/albumin mole ratio were linear and extrapolated to the abscissa at a mole ratio value of 1. This pattern of FA distribution was observed regardless of the type of nonalbumin acceptor used (phospholipid vesicles, human high- or low-density lipoproteins) or the type of FA used (palmitate, oleate, or stearate), and provided evidence for negative cooperativity for human serum albumin upon binding of 1 mol of FA per mole albumin. These in vitro NMR results suggest that the threshold FA/albumin mole ratio value for alterations in FA distributions in the human circulation may be 1, rather than 3, as previously held. The pathophysiological implications of these findings are discussed.
Preservation of the Chief Medical Residency
Authors: Lawrence Loo
Journal: Annals of Internal Medicine (1998)

Letters15 March 1998Preservation of the Chief Medical ResidencyLawrence Loo, MD and James Couperus, MDLawrence Loo, MDLoma Linda University School of Medicine; Loma Linda, CA 92354Search for more papers by this author and James Couperus, MDLoma Linda University School of Medicine; Loma Linda, CA 92354Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-6-199803150-00034 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We could not agree more with the recent letter by Crausman and Latin [1] on the importance of the chief medical residency position in internal medicine. This position is a unique opportunity for the persons chosen to refine their clinical skills, enhance their teaching abilities, gain insight into the administrative functions of a hospital, and broaden their research interests. According to our past chief residents, the experience has been uniformly positive and is a once-in-a-lifetime learning opportunity.The chief residency position at our teaching institution has been a fourth-year postgraduate position. We were also informed that it ...References1. Crausman RS, Lain R. A serious threat to the medical chief residency [Letter]. Ann Intern Med. 1997; 127:248-9. Google Scholar Author, Article, and Disclosure InformationAuthors: Lawrence Loo, MD; James Couperus, MDAffiliations: Loma Linda University School of Medicine; Loma Linda, CA 92354 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 March 1998Volume 128, Issue 6Page: 511KeywordsGraduate medical educationMedicareResidency ePublished: 15 August 2000 Issue Published: 15 March 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Myocardial lactate metabolism: evidence of lactate release during net chemical extraction in man.
Authors: E W Gertz, J A Wisneski, R Neese, J D Bristow, G L Searle, J T Hanlon
Journal: Circulation (1981)

Myocardial blood flow has been recognized to be heterogeneous in patients with coronary artery disease. Traditional arterial-coronary sinus sampling methods cannot demonstrate comparable heterogeneity of myocardial metabolism. In this study we used a tracer technique to investigate possible heterogeneity of myocardial lactate metabolism. Twenty-one patients with symptoms of ischemic heart disease were studied. We injected 14C-1-lactate intravenously as a constant infusion after a priming dose. Coronary sinus and arterial samples were obtained for chemical and radioisotopic analyses. At rest, myocardial lactate extraction by chemical analysis was 24.6 +/- 8.5% (mean +/- SD). By radioisotopic analysis, the lactate extraction was 41.0 +/- 10.2% (p less than 0.001). Thus, certain areas of the myocardium were releasing lactate despite global net extraction of lactate. In the 12 patients with significant left main or both left anterior descending (LAD) and left circumflex (LCX) lesions, the calculated amount of lactate released at rest was 0.136 +/- 0.045 mumol/ml of blood (mean +/- SD). In contrast, the amount released in the six patients with a significant lesion in only the LAD or LCX was 0.076 +/- 0.019 mumol/ml, and in the three patients without left coronary arterial lesions it was 0.039 +/- 0.004 mumol/ml. Using a tracer method, myocardial lactate metabolism was demonstrated to be heterogeneous at rest in patients with ischemic heart disease. A significant amount of lactate can be released by the myocardium at a time when chemical arterial-coronary sinus analysis indicates global myocardial extraction. The amount of lactate released appears to be related to the severity of the coronary artery disease.
Quantity of sunscreen used by European students
Authors: P. Autier, M. Boniol, G. Severi, J-F. Dore
Journal: British Journal of Dermatology (2001)

Background The ability of sunscreen products to delay sun-induced skin erythema is indicated by the sun protection factor (SPF), which is measured using an internationally agreed sunscreen thickness of 2 mg cm−2. Objectives To determine the thickness of sunscreen used under practical conditions. Methods In two double-blind randomized trials performed in five different places in Europe in 1997 and 1998, 148 18–24-year-old students received either an SPF 10 or an SPF 30 sunscreen to be used during their summer holidays. Results Complete, detailed data on quantities of sunscreen used and skin areas on to which sunscreen was applied were available for 124 students. The median thickness of sunscreen applied was 0·39 mg cm−2. We found no variation in sunscreen thickness according to sex, skin phototype, study place or SPF. Conclusions Our results indicate that most consumers do not benefit from the SPF indicated on sunscreen bottles, and do not support the idea that thickness of sunscreen applied would be greater if these products were cheaper. We suggest that information on ability of a sunscreen product to prevent sunburn should be adapted in order to reflect actual usage patterns.
Cancer Genomics and Inherited Risk
Authors: Zsofia K. Stadler, Kasmintan A. Schrader, Joseph Vijai, Mark E. Robson, Kenneth Offit
Journal: Journal of Clinical Oncology (2014)

Next-generation sequencing (NGS) has enabled whole-exome and whole-genome sequencing of tumors for causative mutations, allowing for more accurate targeting of therapies. In the process of sequencing the tumor, comparisons to the germline genome may identify variants associated with susceptibility to cancer as well as other hereditary diseases. Already, the combination of massively parallel sequencing and selective capture approaches has facilitated efficient simultaneous genetic analysis (multiplex testing) of large numbers of candidate genes. As the field of oncology incorporates NGS approaches into tumor and germline analyses, it has become clear that the ability to achieve high-throughput genotyping surpasses our current ability to interpret and appropriately apply the vast amounts of data generated from such technologies. A review of the current state of knowledge of rare and common genetic variants associated with cancer risk or treatment outcome reveals significant progress, as well as a number of challenges associated with the clinical translation of these discoveries. The combined efforts of oncologists, genetic counselors, and cancer geneticists will be required to drive the paradigm shift toward personalized or precision medicine and to ensure the incorporation of NGS technologies into the practice of preventive oncology.
P949 QUANTITATION AND LOCATION OF THE SEVERITY OF BRAIN EDEMA IN PATIENTS WITH ACUTE ON CHRONIC LIVER FAILURE AND HEPATIC ENCEPHALOPATHY
Authors: N. Weiss, M. Rosselli, S. Mouri, D. Yu, D. Galanaud, B. Agarwal, D. Thabut, R. Jalan
Journal: Journal of Hepatology (2014)
"Small airways disease" in children: no test is best
Authors: L I Landau, C M Mellis, P D Phelan, B Bristowe, L McLennan
Journal: Thorax (1979)

Tests claimed to detect small airway disease were evaluated in children. Fifty-two subjects who were normal, 30 with cystic fibrosis (CF), and 35 with asthma were selected on the basis of normal spirometry, informed consent being obtained from them and their parents. Tests undertaken were measurement of maximum expiratory flow volume curves breathing air and a helium-oxygen gas mixture, single breath nitrogen washout curves, lung volumes, and, except in the normal subjects, measurement of arterial oxygen tension. Closing volumes were normal in most children with CF and asthma, whereas the slope of the alveolar plateau was abnormal in 83%. Maximum expiratory flow rate at 50% of total lung capacity was reduced in 65% and maximum mid-expiratory flow rate in 57%; residual volume increased in 51%, and results of other tests were abnormal in less than 50% of children. There was evidence suggesting that lung disease was more patchy in children with mild CF than in those with interval phase asthma. These tests do not detect specific pathological processes in small airways but reflect the consequences of small airway abnormalities, which may vary in the same disease as well as in different diseases. No one test alone appears most useful. Together they contribute to understanding the functional abnormalities present in each individual.
101. Toxicology and Biodistribution Studies of a Recombinant Adeno-Associated Virus 2 (rAAV2) Alpha-1 Antitrypsin (AAT) Vector
Authors: Amy E. Poirier, Thomas J. Conlon, Lynn A. Combee, Kirsten E. Erger, Terence R. Flotte
Journal: Molecular Therapy (2004)

A series of safety and biodistribution studies were undertaken to support the development of a muscle-based gene therapy system for AAT deficiency. AAT is the primary circulating serum proteinase inhibitor, and its deficiency can result in emphysema. The test article that was used in this toxicology study was rAAV serotype 2 with the CMV/Beta Actin promoter driving expression of the human AAT gene. There were 4 dosing arms in the primary toxicology study (PTS) with sacrifice time points being at 21 days and 90 days post vector administration. In the biodistribution study (BDS), there were 5 dosing arms with duplicate doses given intramuscularly and intravenously. The sacrifice time point for this study was at 60 days post vector administration. The PTS was performed in 48-C57/Bl6 mice (24M/24F) with the primary safety endpoint being the histopathologic examination of organs collected at necropsy. CBC and serum chemistry analyses were also performed. Gene transfer efficiency was evaluated from gDNA isolated from organs and whole blood by real-time PCR. The BDS was performed in 36-C57/Bl6 mice (18M/18F) to determine the potential for vector dissemination following test article administration IV and IM. In the PTS, no abnormalities were noted in the CBC and serum chemistry data among test article and control article study arms. Histopathology results were essentially normal with no vector related findings. Real Time PCR indicated that vector DNA was present in the peripheral blood 24 hours post administration, but decreased to near baseline levels at the time of sacrifice. Vector DNA was not detectable in gonad tissue. Real Time PCR results in the BDS also indicated vector DNA present in peripheral blood at 24 hours post vector administration. At sacrifice, IV injected mice vector levels were higher than IM injected mice. Vector DNA was found in skeletal muscle, lung, heart, liver, diaphragm, kidney and pancreas at the time of necropsy via IM administration at dose dependent levels. No vector DNA was detected in the skeletal muscle following IV administration, but substantial amounts were found in other organs. Gonads were negative for vector DNA with both IM and IV administration indicating that the risk of germline transmission with our gene therapy vector would be relatively low.
Continued Insulin Dependence Despite Normal Range Insulin Sensitivity and Insulin Connecting Peptide Levels in a Kidney/Islet Transplant Patient
Authors: Paul R Atkison, Peter Zucker, Irene Hramiak, Terri L Paul, John Dupre, Margaret T Behme, David W Scharp, Paul E Lacy, Barbera J Olack, Calvin R Stiller
Journal: Diabetes Care (1996)

OBJECTIVE The majority of islet transplant recipients remain insulin-requiring, although many have near-normal connecting peptide (CP) levels. Insulin resistance may be one possible cause of the continuing need for exogenous insulin in islet transplant recipients. To assess this, we have studied the insulin sensitivity index (S1) in one patient with near-normal CP levels after islet transplant who remained insulin-requiring. RESEARCH DESIGN AND METHODS The islet transplant recipient is a 36-year-old woman with no residual CP who received a kidney transplant, followed 7 days later by an islet transplant. The islets were infused into the liver via the umbilical vein. Induction immunosuppression consisted of OKT3, prednisone, cyclosporin A, and azathioprine, with maintenance on the latter three. RESULTS Maximum CP levels after a standardized Sustacal meal were 2.09, 1.18, 0.85, and 0.81 nmol/l at 1,6,18, and 24 months posttransplant, respectively. Insulin requirements at the same times were 0.27, 0.45, 0.49, and 0.62 U·kg−1·d−1, while S1 was 36.3, 53.3, and 13.2 min −1·nmol−1·ml at 6,18, and 24 months, respectively. This compares with S1 values of 43.3 ± 10.0 min−1·nmol−1·ml for normal subjects. CONCLUSIONS This patient had near-normal S1 and CP levels, but she was unable to discontinue insulin therapy, suggesting that other factors are critical. Despite this, she maintained normal or near-normal glycated hemoglobins, indicating metabolic benefit from the islet transplant.