tbuckley/cabot-search huggingface dataset:
Hospital Characteristics Associated With Adverse Events and Substandard Care
Authors: Troyen A. Brennan
Journal: JAMA (1991)

To explore the epidemiology of adverse events (AEs), which were defined as injuries due to medical treatment, and that subset of AEs caused by negligence, we studied interhospital variation in these outcomes in a sample of 31,000 medical records drawn from a random selection of 51 hospitals in New York in 1984. We found a substantial variation in both AE rates (0.2% to 7.9%; mean, 3.2%) and the percentage of AEs due to negligence (1% to 60%; mean, 24.9%) among hospitals. Univariate analyses of AEs revealed that primary teaching institutions had significantly higher rates (4.1%) and rural hospitals had significantly lower ones (1.0%). The percentage of AEs due to negligence was lower in primary teaching (10.7%) and for-profit (9.5%) hospitals and was significantly higher in hospitals with predominantly (greater than 80%) minority patients who had been discharged (37%). These findings were corroborated by multivariate analysis. Our results suggest that AEs and negligence are not randomly distributed and that certain types of hospitals have significantly higher rates of injuries due to substandard care. These observations may represent an important improvement on existing measures of quality because they take into account the fact that some hospitals' populations may be at risk of suffering a poor outcome.
Physiological aspects and clinical sequelae of energy deficiency and hypoestrogenism in exercising women
Authors: Mary Jane De Souza, Nancy I. Williams
Journal: Human Reproduction Update (2004)

Amenorrhoea associated with reduced caloric intake and strenuous exercise leads to hypoestrogenism and is associated with clinical manifestations that include disordered eating, stress fractures, osteoporosis, and, as recently reported, a potential increase in the risk of premature cardiovascular disease. Disordered eating, menstrual irregularities and bone loss comprise the clinical condition known as the 'female athlete triad'. The aetiology of the triad is linked to a high prevalence of disordered eating and cognitive restraint. This results in inadequate caloric intake for high exercise energy expenditures that leads to energy deficiency. This in turn stimulates compensatory mechanisms, such as weight loss or energy conservation, subsequently causing a central suppression of reproductive function and concomitant hypoestrogenism. Because the aetiology of menstrual disturbances and the female athlete triad is causally linked to energy deficiency, there is no justification for fears that exercise itself is unhealthy for women. However, improved detection, monitoring, and treatment of all components of the triad in exercising women should be emphasized. This paper critically reviews the physiological aspects and clinical sequelae of energy deficiency and hypoestrogenism associated with the female athlete triad in exercising women.
A Comparison of Amok and Other Homicide in Laos
Authors: JOSEPH WESTERMEYER
Journal: American Journal of Psychiatry (1972)

Past studies of amok have focused on the psychopathology of incarcerated survivors; this study, which compares amok with other forms of homicide in Laos, emphasizes social factors as well. Results indicate that objective criteria can be developed for amok and that certain social variables concerning the homicidal person also distinguish between amok and other homicide. However, psychological characteristics prior to amok did not vary significantly for the two groups.
Multimodal in vivo optical imaging, including confocal microscopy, facilitates presurgical margin mapping for clinically complex lentigo maligna melanoma
Authors: C-S.J. Chen, M. Elias, K. Busam, M. Rajadhyaksha, A.A. Marghoob
Journal: British Journal of Dermatology (2005)

Knowledge of the accurate margins of a lentigo maligna melanoma (LMM) is crucial in the presurgical evaluation of the patient. Towards this end clinicians have utilized the Wood's lamp and dermoscopy to help delineate the borders of the LMM. However, many LMMs arise on photodamaged skin, making it difficult to determine the border of the LMM and separate it from the background lentiginous skin. We present a case of a patient with a recurrent LMM on the scalp that developed in a background of photodamage with diffuse melanocytic atypia and lentigines, making it virtually impossible to determine the precise margins of the LMM by clinical, Wood's lamp or dermoscopic examination. To avoid subjecting the patient to multiple staged excisions we attempted to determine the margins of the LMM by utilizing in vivo confocal laser scanning reflectance microscopy. Using this, it was apparent that there were increased numbers of atypical/dendritic intraepidermal melanocytes in all layers of the epidermis within the LMM. In contrast, skin not involved with the LMM, as viewed under confocal laser examination, had normal honeycomb architecture and no abnormal melanocytes. The confocally determined border was further confirmed by obtaining multiple punch biopsies that were evaluated by haematoxylin and eosin histology and immunohistochemistry. Based on this information, the presurgical margins were marked and the tumour excised accordingly. The excised tissue was examined with multiple-step sections and the margins were determined to be clear. There has been no evidence of tumour recurrence after 1 year. In conclusion, this case illustrates that confocal reflectance microscopy, in conjunction with other in vivo optical instruments, can be utilized to enhance the accuracy for the presurgical margin mapping of LMM.
Immunoglobulin responses to a repeated bout of downhill running
Authors: A J McKune, L L Smith, S J Semple, B Mokethwa, A A Wadee
Journal: British Journal of Sports Medicine (2006)

To examine the effect of downhill running on immunoglobulin responses.Eleven untrained men performed 2 x 60 minute bouts of downhill running (-13.5% gradient), at a speed eliciting 75% of their vO2peak on a level grade. Two runs were spaced 14 days apart. Serum samples were collected before, after, and every hour for 12 hours and every 24 hours for six days. Serum total creatine kinase and immunoglobulin isotypes and subclasses were measured, and results were analysed using a repeated measures analysis of variance (12 hour period, 2 x 14; 24 hour intervals, 2 x 6, p < or = 0.05).There was a significant interaction effect for creatine kinase (activity lower after run 2 than after run 1, 6-24 h) and exercise effect, with the serum concentrations of IgG1, IgG2, IgG4, and IgE lower, and IgM higher, after run 2.Lower concentrations of IgG1, IgG2, and IgE after run 2 may reflect a dampened autoimmune inflammatory response to autoantigens and enhanced autoantigen clearance mediated by the upregulation of IgM.
A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck.
Authors: C Jacobs, G Lyman, E Velez-García, K S Sridhar, W Knight, H Hochster, L T Goodnough, J E Mortimer, L H Einhorn, L Schacter
Journal: Journal of Clinical Oncology (1992)

PURPOSE To determine whether combination chemotherapy is superior to single agents for recurrent/metastatic head and neck cancer, we compared the efficacy and toxicity of cisplatin (CP) and fluorouracil (5-FU), alone and in combination in a phase III trial. PATIENTS AND METHODS Two hundred forty-nine patients with recurrent head and neck cancer were randomized to one of three treatments: CP (100 mg/m2) and 5-FU (1 g/m2 x 4), CP, or 5-FU every 3 weeks. RESULTS The overall response rate to the combination (32%) was superior to that of CP (17%) or 5-FU (13%) (P = .035). Response was associated with good performance status (PS) but not with primary site, site of recurrence, histology, prior irradiation, or relative dose intensity. Median time to progression was less than 2.5 months, and there was no significant difference in median survival (5.7 months) among the groups. By multivariate analysis, patients with better PS and poorly differentiated tumors had superior survival. Hematologic toxicity and alopecia were worse in the combination arm. CONCLUSION Although the response rate to the combination of CP plus 5-FU was superior to that achieved with single agents, survival did not improve.
A Comparison of Estimators of the Population Recombination Rate
Authors: J D Wall
Journal: Molecular Biology and Evolution (2000)

Three new estimators of the population recombination rate C = 4Nr are introduced. These estimators summarize the data using the number of distinct haplotypes and the estimated minimum number of recombination events, then calculate the value of C that maximizes the likelihood of obtaining the summarized data. They are compared with a number of previously proposed estimators of the recombination rate. One of the newly proposed estimators is generally better than the others for the parameter values considered here, while the three programs that calculate maximum-likelihood estimates give conflicting results.
THE CHARACTERISTICS OF THOUGHT DISTURBANCES AS RELATED TO ELECTROENCEPHALOGRAPHIC FINDINGS IN CHILDREN AND ADOLESCENTS
Authors: MARGARET A. KENNARD
Journal: American Journal of Psychiatry (1959)

It may be concluded from the above data which have been accumulated through the multidisciplinary examination of 200 children ages 7-16 who were patients in a mental hospital that organic brain disorders, as shown by history and by behavioral patterns, have a strong positive correlation with EEG abnormality (83%). This, of course, is to be expected since known structural defects of the brain have always been discernible by EEG. In the present cases, however, since the children's disorders were primarily behavioral, and in most instances without organic neurological signs, the high incidences of EEG abnormality is of interest. Thought disturbances, as defined above, when occurring in children with no sign of organic brain disturbance, showed 40% of EEG abnormality as compared to 23% abnormality among children with non-organic, non-thought disturbance syndromes. This fact also fits into previous knowledge, since there has always been a high incidence of EEG abnormality found among young schizophrenics. The EEG abnormality among children with thought disturbances has further been shown to be one of dysrhythmia and instability. This is the result of multiple frequencies occurring during a single recording and from a single area. Theta and beta wave rates as well as irregular frequencies within the alpha band can be seen on frequency analysis. Thus a multiple frequency pattern here replaces the more stable normal single alpha frequency.
Prevalence and Concomitants of Glucose Intolerance in European Obese Children and Adolescents
Authors: Cecilia Invitti, Gabriele Guzzaloni, Luisa Gilardini, Francesco Morabito, Giancarlo Viberti
Journal: Diabetes Care (2003)

The worldwide increase in the prevalence of childhood obesity is reaching epidemic proportions and is associated with a dramatic rise in cases of type 2 diabetes. The prevalence of glucose intolerance and its determinants and the relation of cardiovascular risk factors with levels of glycemia and degree of obesity were studied in grossly obese children of European origin.A total of 710 grossly obese Italian children (SD score [SDS] of BMI 3.8 +/- 0.7) aged 6-18 years, including 345 male subjects, underwent an oral glucose tolerance test. Insulin resistance and insulin secretion were estimated using the homeostasis model assessment for insulin resistance and the insulinogenic index, respectively. Fibrinogen, C-reactive protein, lipids, and uric acid were measured. The 2-h postload glucose and degree of obesity, calculated as the SDS of weight/height(2), were used as dependent variables.The prevalence of glucose intolerance was 4.5%. Insulin resistance (P < 0.0001), impaired insulin secretion (P < 0.0001), and diastolic blood pressure (BP) (P < 0.05) were significantly and independently related to 2-h postload glucose values. The degree of obesity did not relate to insulin resistance but was independently correlated with inflammatory proteins, uric acid, and systolic BP, variables that were often abnormal in this population.In these grossly obese children, both insulin resistance and impaired insulin secretion contribute to the elevation of glycemia, and the degree of obesity is related to cardiovascular risk factors independently of insulin resistance.
Assault Weapons as a Public Health Hazard
Authors: Vincent J. M. Di Maio
Journal: JAMA (1992)

<h3>To the Editor.</h3> —The Council Report entitled "Assault Weapons as a Public Health Hazard in the United States" is seriously enough flawed as to render any of its conclusions questionable.<sup>1</sup>The problems with the article are that the authors do not know what an "assault rifle" is; they are unfamiliar with its wounding characteristics and they misinterpret their statistical data. Thus, in their definition of what constitutes an assault rifle, they omit one of the most important characteristics, as defined by firearms experts, that these weapons are intended to fire ammunition intermediate in power between traditional rifle ammunition and pistol ammunition. Then, there is the statement that "assault rifles are meant to be spray-fired from the hip." This looks good in the movies, but is not what a rifle is designed for. Reference is made to the Uzi implying that it is an assault weapon. The Uzi fires pistol
PTU-107 Comparison Of Mortality Following Hospitalisation For Ulcerative Colitis In Scotland Between 1998–2000 And 2007–2009
Authors: NT Ventham, NA Kennedy, A Duffy, DN Clark, AM Crowe, A Knight, JR Nicholls, J Satsangi
Journal: Gut (2014)

<h3>Introduction</h3> We have previously demonstrated concerningly high 3-year mortality following hospitalisation with ulcerative colitis (UC) between 1998 and 2000 in Scotland.<sup>1</sup> We have extended these studies by examining 3-year mortality following hospitalisation with UC in Scotland between 2007–2009, providing an opportunity for comparison with our earlier results. <h3>Aim</h3> To compare 3-year mortality, and factors related to mortality, in Scottish patients hospitalised with ulcerative colitis (UC) between Period 1 (1998–2000) and Period 2 (2007–2009). <h3>Methods</h3> The Scottish Morbidity Records and linked datasets were used to assess 3-year crude mortality, standardised mortality ratio (SMR) and multivariate analyses of factors associated with 3-year mortality. The 3-year mortality was determined after four admission types: surgery-elective or emergency; medical-elective or emergency. Age-standardised mortality rates (ASR) were used to compare mortality rates between periods. <h3>Results</h3> The admission rate with UC increased from 10.6 per 100,000 of the Scottish population per year in Period 1 to 11.6 in Period 2 (p = 0.046). Among those admitted with UC, the proportion aged &lt;30yrs increased (p = 0.009). Crude and adjusted 3-year mortality fell between time periods (Crude 12.2% [Period 1] to 8.3% [Period 2], adjusted OR 0.59, CI 0.42 to 0.81, p = 0.04). Following emergency medical admission, 3-year mortality was reduced in Period 2 (OR 0.58, p = 0.003). Within the &gt;65 yrs age group crude 3-year mortality fell (38.8% to 28.7%, p = 0.02). The overall SMR in period 1 was 3.04 and 2.96 in Period 2. Directly age standardised mortality decreased from 373 (CI 309–437) to 264 (CI 212–316) per 10,000 person years. On multivariate analysis, older age and co-morbid remained associated with 3-year mortality in Period 2. <h3>Conclusion</h3> Although the mortality associated with admission remains high at 3 years, crude and adjusted rates suggest significant reductions over the last decade. <h3>Reference</h3> Nicholls RJ, Clark DN, Kelso L, <i>et al</i>. Nationwide linkage analysis in Scotland implicates age as the critical overall determinant of mortality in ulcerative colitis. <i>Aliment Pharmacol Ther</i> 2010;31:1310–21 <h3>Disclosure of Interest</h3> N. Ventham: None Declared, N. Kennedy: None Declared, A. Duffy: None Declared, D. Clark: None Declared, A. Crowe: None Declared, A. Knight: None Declared, J. Nicholls Grant/research support from: A grant was obtained from AbbVie Ltd to be administered by the North West London Hospital Trust (NWLHT) on behalf of Prof Nicholls, to allow funding of ISD and Corvus Communications for their work on the project. In the context of the work presented in this manuscript and in consideration of BMJ guidance, none of the authors have any competing or other conflict of interest, J. Satsangi: None Declared.
Flow cytometric identification of proliferative subpopulations within normal human epidermis and the localization of the primary hyperproliferative population in psoriasis.
Authors: Z Bata-Csorgo, C Hammerberg, J J Voorhees, K D Cooper
Journal: The Journal of Experimental Medicine (1993)

In this study we define the proliferative compartments of in vivo human epidermis, using specific antibodies related to cell differentiation (beta 1 and beta 4 integrins and K1/K10 differentiation keratins) and cell cycle (proliferating cell nuclear antigen [PCNA]) in combination with flow cytometric quantitation of the DNA content and optical characteristics of the cells. The beta 1 integrin (CD29) marked both of the potentially proliferative subsets in normal epidermis. One subset of normal epidermis is CD29+ K1/K10-, which was predominantly basal, and found to be comprised of slow cycling, small cells with primitive cytoplasmic organization. The vast majority (95.5%) of these cells were in a quiescent state (G0/early G1) as indicated by their lack of the cyclin, PCNA. The other proliferative subset of normal epidermis was CD29+ K1/K10+, which was suprabasal and occasional basal, highly proliferative, larger in size, and which exhibited a more complex cytoplasmic structure. Because early differentiation (K1/K10 expression) has begun in the CD29+ K1/K10+ subset, it is highly likely that they represent the proliferative population which is capable of transiently amplifying itself before terminal differentiation. Within lesional psoriatic epidermis, similar proliferative cell populations were present as in normal epidermis, and the hyperproliferative defect was localized to the beta 1 and beta 4 integrin+, K1/K10- populations, which in normal epidermis is basally located and quiescent with regard to cell cycle. In psoriatic epidermis, a six- to sevenfold increase in the number of cells in the S/G2+M phase of cell cycle was found among CD29+ K1/K10- cells (p &amp;lt; 0.05). Furthermore, all lesional K1/K10- cells showed high PCNA positivity, indicating that all these cells had been recently induced into cell cycle. By contrast, the proportion of cycling cells among lesional psoriatic CD29+ K1/K10+ keratinocytes was similar to normals. Anti-HLA-DR, CD45, and vimentin antibodies were used to concomitantly track the proliferative states of Langerhans cell, melanocyte, and infiltrating leukocyte populations. In normal epidermis, the cycling fractions (cells in S/G2/M phase) of these cells were similar to the CD29+K1/K10- keratinocytes, whereas in lesional epidermis their cycling pools were increased relative to normal, but not so much as the proliferative fractions of psoriatic CD29+ K1/K10- keratinocytes. These data demonstrate the use of simultaneous analysis of integrin expression, differentiation keratins, cyclin, cell cycle status, and optical characteristics of freshly isolated human epidermal cells. Such analysis allowed the physical identification and quantification of cy cling populations in normal human skin, and has enabled the precise location of the primary epidermal proliferative defect in psoriasis.
The variable response of plaque psoriasis after a single treatment with topical 5-aminolaevulinic acid photodynamic therapy
Authors: P. COLLINS, D.J. ROBINSON, M.R. STRINGER, G.I. STABLES, R.A. SHEEHAN-DARE
Journal: British Journal of Dermatology (1997)

We have investigated the clinical response of 22 patients with plaque psoriasis to photodynamic therapy using topical application of 5-aminolaevulinic acid followed by a single exposure to broad-band visible radiation. Light doses in the range 2-16 J/cm2 delivered at dose of 10-40 mW/ cm2 resulted in a variable clinical response. Seven (35%) patients showed clearing of psoriasis at some treated sites. The intensity of protoporphyrin IX fluorescence was recorded before, during and after treatment. Pre-illumination fluorescence intensity varied considerably between sites on the same patient and between patients. Protoporphyrin IX fluorescence recovered and persisted after treatment for up to 14 days and became higher than preillumination levels at 25% of sites. The rate of protoporphyrin IX photo-oxidation during treatment was proportional to both initial fluorescence intensity and incident light dose rate and was almost complete after 16 J/cm2. We have defined the photodynamic dose as the product of time-dependent protoporphyrin IX concentration and light dose and demonstrated that only in those patients who showed clearance of psoriasis was there a relationship between photodynamic dose and clinical response. Discomfort ranged from stinging through to burning, was significant in some patients and tended to be more severe with increasing photodynamic dose but was not predictable. Efficacy may improve by achieving consistent protoporphyrin IX levels or by using multiple treatments.
Treatment-Resistant Bipolar Depression: A Randomized Controlled Trial of Electroconvulsive Therapy Versus Algorithm-Based Pharmacological Treatment
Authors: Helle K Schoeyen, Ute Kessler, Ole A Andreassen, Bjoern H Auestad, Per Bergsholm, Ulrik F Malt, Gunnar Morken, Ketil J Oedegaard, Arne Vaaler
Journal: American Journal of Psychiatry (2014)

Objective: Electroconvulsive therapy (ECT) is regarded by many clinicians as the most effective treatment for treatment-resistant bipolar depression, but no randomized controlled trials have been conducted, to the authors’ knowledge. They compared efficacy measures of ECT and algorithm-based pharmacological treatment in treatment-resistant bipolar depression. Method: This multicenter, randomized controlled trial was carried out at seven acute-care psychiatric inpatient clinics throughout Norway and included 73 bipolar disorder patients with treatment-resistant depression. The patients were randomly assigned to receive either ECT or algorithm-based pharmacological treatment. ECT included three sessions per week for up to 6 weeks, right unilateral placement of stimulus electrodes, and brief pulse stimulation. Results: Linear mixed-effects modeling analysis revealed that ECT was significantly more effective than algorithm-based pharmacological treatment. The mean scores at the end of the 6-week treatment period were lower for the ECT group than for the pharmacological treatment group: by 6.6 points on the Montgomery-Åsberg Depression Rating Scale (SE=2.05, 95% CI=2.5–10.6), by 9.4 points on the 30-item version of the Inventory of Depressive Symptomatology–Clinician-Rated (SE=2.49, 95% CI=4.6–14.3), and by 0.7 points on the Clinical Global Impression for Bipolar Disorder (SE=0.31, 95% CI=0.13–1.36). The response rate was significantly higher in the ECT group than in the group that received algorithm-based pharmacological treatment (73.9% versus 35.0%), but the remission rate did not differ between the groups (34.8% versus 30.0%). Conclusion: Remission rates remained modest regardless of treatment choice for this challenging clinical condition.