tbuckley/cabot-search huggingface dataset:
Health in South Asia: Future of Kerala depends on its willingness to learn from past
Authors: V Mohanan Nair
Journal: BMJ (2004)

Future of Kerala depends on its willingness to learn from pastEditor-The Kerala model in health, cited by Bhutta et al in the theme issue on health in South Asia as replicable for South Asian countries, 1 is facing serious threats.The state has a triple burden of communicable, non-communicable, and traumatic diseases.Stupendous growth of the private sector has resulted in skyrocketing healthcare costs.Lured by the hi tech sophistication of the private sector, people are abandoning basic principles of primary health care.Even poor people prefer private hospitals, and a major reason for sustaining poverty is healthcare cost. 2 The government is reducing its investments in health and education due to fiscal crises and pressure from funding and lending agencies.The opening up of the medical education sector to private entrepreneurs, lack of guidelines for the private practice of government doctors, and shortage of doctors for rural areas are all disturbing developments.Transfer of healthcare institutions under local self-governments is yet to show the desired benefits.The state is developing a long term plan, "Health Vision Kerala 2025," and a health policy.To equip the primary healthcare workforce to face the emerging challenges, 3 job responsibilities were redefined recently.Factors that determined the successful Kerala model, among others, include historically prevalent social justice, commitment of governments to health and education, land reforms, an organised public distribution system, streamlined primary health care, and an organised labour sector.Deterioration in these determinants is likely to have strong negative impact.Kerala should learn from its past to avoid the sad plight of some other Indian states.
Prematriculation Variables Associated With Suboptimal Outcomes for the 1994-1999 Cohort of US Medical School Matriculants
Authors: Dorothy A. Andriole, Donna B. Jeffe
Journal: JAMA (2010)

<h3>Context</h3>The relationship between increasing numbers and diversity of medical school enrollees and the US physician workforce size and composition has not been described.<h3>Objective</h3>To identify demographic and prematriculation factors associated with medical school matriculants' outcomes.<h3>Design, Setting, and Participants</h3>Retrospective study using deidentified data for the 1994-1999 national cohort of 97 445 matriculants who were followed up through March 2, 2009, and had graduated, had withdrawn, or were dismissed. Data were analyzed using multivariable logistic regression to identify factors associated with suboptimal outcomes.<h3>Main Outcome Measures</h3>Academic withdrawal or dismissal, nonacademic withdrawal or dismissal, and graduation without first-attempt passing scores on the US Medical Licensing Examination Step 1 and/or Step 2 Clinical Knowledge (CK) compared with graduation with first-attempt passing scores on both of the examinations.<h3>Results</h3>Of 84 018 matriculants (86.2%), 74 494 graduated and had first-attempt passing scores on both the Step 1 and Step 2 CK (88.7%), 6743 graduated and did not have first-attempt passing scores on the Step 1 and/or Step 2 CK (8.0%), 1049 withdrew or were dismissed for academic reasons (1.2%), and 1732 withdrew or were dismissed for nonacademic reasons (2.1%). Variables associated with greater likelihood of graduation without first-attempt passing scores on the Step 1 and/or Step 2 CK and of academic withdrawal or dismissal, respectively, were (1) Medical College Admission Test scores (scores of 18-20 [2.9% of sample] vs &gt;29: adjusted odds ratio [AOR], 13.06 [95% confidence interval {CI}, 11.56-14.76] and AOR, 11.08 [95% CI, 8.50-14.45]; scores of 21-23 [5.6% of sample] vs &gt;29: AOR, 7.52 [95% CI, 6.79-8.33] and AOR, 5.97 [95% CI, 4.68-7.62]; and scores of 24-26 [13.9% of sample] vs &gt;29: AOR, 4.27 [95% CI, 3.92-4.65] and AOR, 3.56 [95% CI, 2.88-4.40]), (2) race/ethnicity (Asian or Pacific Islander [18.2% of sample] vs white: AOR, 2.15 [95% CI, 2.00-2.32] and AOR, 1.69 [95% CI, 1.37-2.09]; underrepresented minority [14.9% of sample] vs white: AOR, 2.30 [95% CI, 2.13-2.48] and AOR, 2.96 [95% CI, 2.48-3.54]), and (3) premedical debt (≥$50 000 [1.0% of sample] vs no debt: AOR, 1.68 [95% CI, 1.35-2.08] and AOR, 2.33 [95% CI, 1.57-3.46]).<h3>Conclusions</h3>Lower scores on the Medical College Admission Test, nonwhite race/ethnicity, and premedical debt of at least $50 000 were independently associated with a greater likelihood of academic withdrawal or dismissal and graduation without first-attempt passing scores on the US Medical Licensing Examination Step l and/or Step 2 CK.
Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology
Authors: Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Darren A. DeWalt, Arnold D. Kaluzny, Judith A. Hautala, Oren Grad, Rachel M. Ballard, Worta J. McCaskill-Stevens, Barnett S. Kramer, Steven B. Clauser
Journal: Journal of Clinical Oncology (2015)

Understanding how health care system structures, processes, and available resources facilitate and/or hinder the delivery of quality cancer care is imperative, especially given the rapidly changing health care landscape. The emerging field of cancer care delivery research (CCDR) focuses on how organizational structures and processes, care delivery models, financing and reimbursement, health technologies, and health care provider and patient knowledge, attitudes, and behaviors influence cancer care quality, cost, and access and ultimately the health outcomes and well-being of patients and survivors. In this article, we describe attributes of CCDR, present examples of studies that illustrate those attributes, and discuss the potential impact of CCDR in addressing disparities in care. We conclude by emphasizing the need for collaborative research that links academic and community-based settings and serves simultaneously to accelerate the translation of CCDR results into practice. The National Cancer Institute recently launched its Community Oncology Research Program, which includes a focus on this area of research.
Migraine Intervention With STARFlex Technology Trial
Authors: John D. Carroll
Journal: Circulation (2008)

R ecent epidemiological data suggest that up to 18% of women and 6% of men worldwide have suffered a migraine headache. 1,2Despite its common occurrence, our understanding of both migraine pathophysiology and the optimal means by which to control or abate symptoms remains severely limited. 1 For many years, the care of patients with migraines was left in the capable hands of general practitioners and neurologists.As information surfaced on the potential link between migraines and patent foramen ovale (PFO), however, some cardiologists became involved in the care of patients with migraines and were quickly humbled by the often debilitating nature of the disease process.Personally witnessing such intense suffering, the inconsistent effect of rescue medications, and the subsequent reliance on powerful intravenous narcotic agents to achieve some means of comfort until the storm subsides has been a sobering experience.With the development of implantable devices used to close potentially enabling PFOs, however, came a newfound hope in our ability to help these suffering people.
Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6–7 years: analysis from Phase Three of the ISAAC programme
Authors: Richard Beasley, Tadd Clayton, Julian Crane, Erika von Mutius, Christopher KW Lai, Stephen Montefort, Alistair Stewart
Journal: The Lancet (2008)
apo B gene knockout in mice results in embryonic lethality in homozygotes and neural tube defects, male infertility, and reduced HDL cholesterol ester and apo A-I transport rates in heterozygotes.
Authors: L S Huang, E Voyiaziakis, D F Markenson, K A Sokol, T Hayek, J L Breslow
Journal: Journal of Clinical Investigation (1995)

apo B is a structural constituent of several classes of lipoprotein particles, including chylomicrons, VLDL, and LDL. To better understand the role of apo B in the body, we have used gene targeting in embryonic stem cells to create a null apo B allele in the mouse. Homozygous apo B deficiency led to embryonic lethality, with resorption of all embryos by gestational day 9. Heterozygotes showed an increased tendency to intrauterine death with some fetuses having incomplete neural tube closure and some live-born heterozygotes developing hydrocephalus. The majority of male heterozygotes were sterile, although the genitourinary system and sperm were grossly normal. Viable heterozygotes had normal triglycerides, but total, LDL, and HDL cholesterol levels were decreased by 37, 37, and 39%, respectively. Hepatic and intestinal apo B mRNA levels were decreased in heterozygotes, presumably contributing to the decreased LDL levels through decreased synthesis of apo B-containing lipoproteins. Kinetic studies indicated that heterozygotes had decreased transport rates of HDL cholesterol ester and apo A-I. As liver and intestinal apo A-I mRNA levels were unchanged, the mechanism for decreased apo A-I transport must be posttranscriptional. Heterozygotes also had normal cholesterol absorption and a normal response of the plasma lipoprotein pattern to chronic consumption of a high fat, high cholesterol, Western-type diet. In summary, we report a mouse model for apo B deficiency with several phenotypic features that were unexpected based on clinical studies of apo B-deficient humans, such as embryonic lethality in homozygotes and neural tube closure defects, male infertility, and a major defect in HDL production in heterozygotes. This model presents an opportunity to study the mechanisms underlying these phenotypic changes.
Relationship between clavicle length and scapular resting alignment in healthy subject
Authors: H Toda, K Yamamoto, M Yoshida, M Katayose
Journal: British Journal of Sports Medicine (2011)

Background The scapular resting alignment is one of typical quantitative clinical evaluation of the scapular kinematics. The scapular alignment could be affected by the feature of clavicle morphology, but not studied by previous study. Objective To investigate the correlation between clavicle length and three-dimensional scapular resting alignment. Design Descriptive study. Setting Laboratory setting. Participants 60 shoulders of 30 males without a history of shoulder pathology. Independent variables The clavicle length was normalised by body height (CL/height) and by biacromial arc (CL/biacromial). Two of these normalisation data were used for analysis. Main outcome measurements Three-dimensional scapular resting alignment was measured with 3D motion-capture system. The scapular resting alignment was described by scapular orientation and position relative to the trunk. To describe scapular orientation and position, three of scapular rotation and two clavicular movements were used. Three scapular rotations were external/internal rotation, upward/downward rotation, and posterior/anterior tilt. Two clavicular movements were protraction/retraction and elevation/depression. The correlations of two normalisation data of clavicle length with three scapular rotations and two clavicular movements were calculated by the Pearson's correlation coefficient, with a statistical significance level of p less than 0.05. Results Significant linear correlations were found between the CL/height and posterior tilting (r=0.34, p=0.008), between CL/biacromial and elevation (r=0.31, p=0.018), retraction (r=0.55, p&lt;0.001), upward rotation (r=0.39, p=0.002), posterior tilting (r=0.28, p=0.033) and internal rotation (r=-0.59, p&lt;0.001). Conclusion Our results demonstrated that the normative clavicle length with biacromial arc is more related to the scapular resting alignment than the normative clavicle length with body height.
Who Is at Greatest Risk for Receiving Poor-Quality Health Care?
Authors: Steven M. Asch, Eve A. Kerr, Joan Keesey, John L. Adams, Claude M. Setodji, Shaista Malik, Elizabeth A. McGlynn
Journal: New England Journal of Medicine (2006)

American adults frequently do not receive recommended health care. The extent to which the quality of health care varies among sociodemographic groups is unknown.We used data from medical records and telephone interviews of a random sample of people living in 12 communities to assess the quality of care received by those who had made at least one visit to a health care provider during the previous two years. We constructed aggregate scores from 439 indicators of the quality of care for 30 chronic and acute conditions and for disease prevention. We estimated the rates at which members of different sociodemographic subgroups received recommended care, with adjustment for the number of chronic and acute conditions, use of health care services, and other sociodemographic characteristics.Overall, participants received 54.9 percent of recommended care. Even after adjustment, there was only moderate variation in quality-of-care scores among sociodemographic subgroups. Women had higher overall scores than men (56.6 percent vs. 52.3 percent, P<0.001), and participants below the age of 31 years had higher scores than those over the age of 64 years (57.5 percent vs. 52.1 percent, P<0.001). Blacks (57.6 percent) and Hispanics (57.5 percent) had slightly higher scores than whites (54.1 percent, P<0.001 for both comparisons). Those with annual household incomes over 50,000 dollars had higher scores than those with incomes of less than 15,000 dollars (56.6 percent vs. 53.1 percent, P<0.001).The differences among sociodemographic subgroups in the observed quality of health care are small in comparison with the gap for each subgroup between observed and desirable quality of health care. Quality-improvement programs that focus solely on reducing disparities among sociodemographic subgroups may miss larger opportunities to improve care.
Effects of heart rate on left ventricular filling dynamics: assessment from simultaneous recordings of pulsed Doppler transmitral flow velocity pattern and haemodynamic variables
Authors: K. Yamamoto, T. Masuyama, J. Tanouchi, Y. Doi, H. Kondo, M. Hori, A. Kitabatake, T. Kamada
Journal: Cardiovascular Research (1993)

Objective: The effects of heart rate on transmitral flow velocity pattern are still controversial. The aim of this study was to examine the relations between the changes in Doppler echocardiographic variables and those in haemodynamic variables in association with altering heart rate. Methods: Pulsed Doppler transmitral flow velocity pattern and left atrial and left ventricular pressures were simultaneously recorded at various heart rates (from 80 to 120 beats·min−1) in 14 dogs. Results: As heart rate increased, peak late diastolic filling velocity increased, the time-velocity integral of the early diastolic filling wave decreased, and the decleration time of early diastolic flow shortened without significant changes in mean values of peak early diastolic filling velocity and acceleration time of early diastolic flow. Peak early diastolic filling velocity increased with heart rate, however, in five dogs and decreased in the other nine dogs. The shortening of the time constant of left ventricular isovolumic relaxation was greater in the five dogs in which peak early diastolic filling velocity increased with heart rate than in the other nine dogs. Results of multiple stepwise linear regression analysis showed that the changes in peak early diastolic filling velocity correlated with the changes in the crossover pressure and peak+dP/dt in addition to the time constant, and that diastolic filling period was not selected as an affecting factor. Changes in the other Doppler echocardiographic variables did not correlate solely with changes in heart rate, or diastolic filling period, but correlated in a complex fashion with the combined changes in haemodynamic variables associated with altering heart rate. Conclusions: Although transmitral flow velocity pattern changes with altering heart rate, this change is not considered to be a direct effect of alteration in heart rate, but an indirect one through the associated haemodynamic changes including left atrial pressure and left ventricular relaxation and contractility. Cardiovascular Research 1993;27:935-941
FDG–PET in the assessment of patients with follicular lymphoma treated by ibritumomab tiuxetan Y 90: multicentric study
Authors: E. Lopci, I. Santi, E. Derenzini, C. Fonti, G. Savelli, F. Bertagna, M. Bellò, B. Botto, D. Huglo, F. Morschhauser, P. Zinzani, S. Fanti
Journal: Annals of Oncology (2010)
Heterogeneous Ventricular Repolarization Provides a Substrate for Arrhythmias in a German Shepherd Model of Spontaneous Arrhythmic Death
Authors: Maria N. Obreztchikova, Eugene A. Sosunov, Evgeny P. Anyukhovsky, N. Sydney Moïse, Richard B. Robinson, Michael R. Rosen
Journal: Circulation (2003)

Background— German shepherd dogs with inherited arrhythmias and sudden death appear to be a model for catecholamine-dependent ventricular tachycardias in human subjects. We tested the hypothesis that heterogeneity of left ventricular repolarization creates an arrhythmogenic substrate for pause-dependent ventricular tachycardia in these animals. Methods and Results— We used microelectrode techniques to record action potentials (AP) from midmyocardial sections of anteroseptal, anterobasal, and posterobasal left ventricular (LV) wall of unafflicted and afflicted dogs. There were no differences in AP duration to 90% repolarization (APD) among LV regions in unafflicted dogs. In contrast, in afflicted dogs, there was significant heterogeneity, with the longest APD in anterobasal and shortest in anteroseptal regions. Isoproterenol did not affect repolarization in unafflicted dogs, whereas in afflicted dogs, it shortened APD anterobasally and prolonged APD anteroseptally. We studied the repolarizing currents, I Kr and I Ks , in single anteroseptal and anterobasal LV myocytes with the use of a whole-cell voltage clamp. There were no differences in I Kr and I Ks between anteroseptal and anterobasal regions in unafflicted dogs, whereas in afflicted dogs, I Kr was smaller anterobasally ( P &lt;0.05). Isoproterenol produced a more prominent leftward shift in I Ks voltage-dependent activation in anterobasal regions of afflicted than unafflicted dogs. Conclusions— Spatial heterogeneity in expression and catecholamine responsiveness of I Kr and I Ks results in heterogeneous LV repolarization in afflicted German shepherd dogs, contributing importantly to the arrhythmogenic substrate.
On<i>Trk</i>—The TrkB Signal Transduction Pathway Is an Increasingly Important Target in Cancer Biology
Authors: Carol J. Thiele, Zhijie Li, Amy E. McKee
Journal: Clinical Cancer Research (2009)

Abstract In the beginning, Trk was an oncogene. Yet Neurotrophin-Trk signaling came to preeminence in the field of neurobiology. Now it is appreciated that Trks regulate important processes in nonneuronal cells and, in addition to their impact on tumors of neural origin, may contribute to the pathogenesis of carcinomas, myelomas, and prostate and lymphoid tumors. Although mutations and rearrangements of Trk are seen only sporadically in human cancers, such as medullary thyroid carcinoma, a number of recent studies indicate that expression of TrkB contributes to tumor pathology. In neuroblastoma, TrkA expression marks good prognosis which TrkB and Brain-derived neurotrophic factor (BDNF) expression marks poor prognosis. Activation of the BDNF/TrkB signal transduction pathway also stimulates tumor cell survival and angiogenesis and contributes to resistance to cytotoxic drugs and anoikis, enabling cells to acquire many of the characteristic features required for tumorigenesis. Small molecule inhibitors, such as Cephalon's CEP-701, are in phase 1 and 2 clinical trials, and a series of AstraZeneca Trk inhibitors are poised to enter the clinic. As monotherapy, inhibitors may be effective only in tumors with activating Trk mutations. Important clinical follow-up will be the assessment of Trk inhibitors in combination with standard chemo- or radiotherapy or other signal transduction pathway inhibitors. (Clin Cancer Res 2009;15(19):5962–7)
Cholestatic jaundice caused by D-penicillamine.
Authors: D Barzilai, G Dickstein, R Enat, H Bassan, C Lichtig, B Gellei
Journal: Annals of the Rheumatic Diseases (1978)

D-penicillamine is not generally considered to cause hepatic damage. Cholestatic jaundice developed in a patient with rheumatoid arthritis 4 weeks after penicillamine was added to his regimen, and he died in acute renal failure. The probability that penicillamine caused the cholestasis is discussed.
Automatic nasal continuous positive airway pressure titration in the laboratory: patient outcomes
Authors: J. R. Stradling, C. Barbour, D. J. Pitson, R. J. Davies
Journal: Thorax (1997)

BACKGROUND: Manual titration of nasal continuous positive airway pressure (NCPAP) treatment for obstructive sleep apnoea (OSA) is time consuming and expensive. There are now "intelligent" NCPAP machines that try to find the ideal pressure for a patient by monitoring a combination of apnoeas, hypopnoeas, inspiratory flow limitation, and snoring. Although these machines usually find similar pressures to skilled technicians, it is not clear if their use in the sleep laboratory influences subsequent acceptance by patients. This study addresses this question. METHODS: One hundred and twenty two patients undergoing a trial of NCPAP were randomly allocated to either manual or automatic (Horizon, DeVilbiss) titration of pressure during their first night on NCPAP in a hospital sleep laboratory. The primary outcome (available on 112 patients) was the acceptance of NCPAP or otherwise six weeks following the initial titration night. Baseline indicators of severity were compared between the groups, as were the pressures selected and the subsequent improvement in the sleepiness of the patients. RESULTS: The initial severity of OSA was not significantly different in the two groups and the mean (SD) NCPAP pressures were similar (manual 8.7 (2.5) cm H2O, automatic 8.2 (2.1) cm H2O). The percentage of patients successfully established on CPAP at six weeks was 64% and 73% for the manual and automatic groups, respectively; 13% and 2%, respectively, in the manual and automatic groups had given up completely (p &lt; 0.05), and there were about equal numbers (23% versus 25%) in the two groups who were still undecided. CONCLUSIONS: The substitution of automatic NCPAP titration for manual titration during the first night of NCPAP in patients with OSA does not reduce the number accepting the treatment at six weeks and may slightly improve it. This has important cost saving potential.
Rapamycin induces tumor-specific thrombosis via tissue factor in the presence of VEGF
Authors: Markus Guba, Maksim Yezhelyev, Martin E. Eichhorn, Gerald Schmid, Ivan Ischenko, Armine Papyan, Christian Graeb, Hendrik Seeliger, Edward K. Geissler, Karl-Walter Jauch, Christiane J. Bruns
Journal: Blood (2005)
Experiential effects on mirror systems and social learning: Implications for social intelligence
Authors: Simon M. Reader
Journal: Behavioral and Brain Sciences (2014)

Abstract Investigations of biases and experiential effects on social learning, social information use, and mirror systems can usefully inform one another. Unconstrained learning is predicted to shape mirror systems when the optimal response to an observed act varies, but constraints may emerge when immediate error-free responses are required and evolutionary or developmental history reliably predicts the optimal response. Given the power of associative learning, such constraints may be rare.