tbuckley/cabot-search huggingface dataset:
Contextual Errors and Failures in Individualizing Patient Care
Authors: Saul J. Weiner, Alan Schwartz, Frances Weaver, Julie Goldberg, Rachel Yudkowsky, Gunjan Sharma, Amy Binns-Calvey, Ben Preyss, Marilyn M. Schapira, Stephen D. Persell, Elizabeth Jacobs, Richard I. Abrams
Journal: Annals of Internal Medicine (2010)

This article has been corrected. The original version (PDF) is appended to this article as a supplement. Background: A contextual error occurs when a physician overlooks elements of a patient's environment or behavior that are essential to planning appropriate care. In contrast to biomedical errors, which are not patient-specific, contextual errors represent a failure to individualize care. Objective: To explore the frequency and circumstances under which physicians probe contextual and biomedical red flags and avoid treatment error by incorporating what they learn from these probes. Design: An incomplete randomized block design in which unannounced, standardized patients visited 111 internal medicine attending physicians between April 2007 and April 2009 and presented variants of 4 scenarios. In all scenarios, patients presented both a contextual and a biomedical red flag. Responses to probing about flags varied in whether they revealed an underlying complicating biomedical or contextual factor (or both) that would lead to errors in management if overlooked. Setting: 14 practices, including 2 academic clinics, 2 community-based primary care networks with multiple sites, a core safety net provider, and 3 U.S. Department of Veterans Affairs facilities. Measurements: Primary outcomes were the proportion of visits in which physicians probed for contextual and biomedical factors in response to hints or red flags and the proportion of visits that resulted in error-free treatment plans. Results: Physicians probed fewer contextual red flags (51%) than biomedical red flags (63%). Probing for contextual or biomedical information in response to red flags was usually necessary but not sufficient for an error-free plan of care. Physicians provided error-free care in 73% of the uncomplicated encounters, 38% of the biomedically complicated encounters, 22% of the contextually complicated encounters, and 9% of the combined biomedically and contextually complicated encounters. Limitations: Only 4 case scenarios were used. The study assessed physicians' propensity to make errors when every encounter provided an opportunity to do so and did not measure actual error rates that occur in primary care settings because of inattention to context. Conclusion: Inattention to contextual information, such as a patient's transportation needs, economic situation, or caretaker responsibilities, can lead to contextual error, which is not currently measured in assessments of physician performance. Primary Funding Source: U.S. Department of Veterans Affairs Health Services Research and Development Service.
Endoscopic resection of early oesophageal cancer
Authors: O. Pech, A. May, T. Rabenstein, C. Ell
Journal: Gut (2007)

ndoscopic resection (ER) of early neoplastic lesions has become increasingly important in recent years, both as a diagnostic tool for the staging of oesophageal carcinomas and as a method of carrying out definitive treatment when the cancer meets certain criteria in which the risk of lymph-node metastasis is negligible.Early diagnosis, especially of neoplastic lesions arising in Barrett's oesophagus, has become more frequent as a result of improved endoscopic technology, surveillance programmes, and increasing experience and awareness on the part of endoscopists.For many years, surgery was considered to be the treatment of choice, even in patients with high-grade intraepithelial neoplasia (HGIN) or mucosal carcinoma, but it is associated with a 30-day mortality of between 3 and 10% and with significant morbidity in 40-50% of cases. 1 2 In low-volume centres or with less experienced surgeons, the mortality rate with radical oesophageal resection can rise to more than 20%. 3 4 These alarming data are the reason why local treatment methods such as photodynamic therapy (PDT), argon plasma coagulation (APC), electrocoagulation and ER have been introduced and investigated in several studies on early oesophageal neoplasia.In contrast to ablative treatment methods such as PDT, ER allows histological assessment of the resected specimen in order to assess the depth of infiltration of the tumour and freedom from neoplasia at the lateral and (more importantly) basal margins, imitating the surgical situation. 5][8][9][10][11] Arguments in favour of ER are listed in table 1. TECHNIQUES OF ER c'Endoscopic resection' is the general term for all of the different resection techniques used to treat neoplastic and uncertain lesions in the gastrointestinal tract (table 2).The aim of ER must always be complete resection of the mucosal and submucosal layer down to the lamina muscularis propria.The widely used term 'endoscopic mucosal resection' (EMR) suggests that only the mucosal layer is resected using this technique, sparing the submucosal layer.We therefore believe that the misleading term EMR should no longer be used and should be replaced by ER.
Non-Hodgkin's lymphoma presenting as a primary tumor of the liver: Presentation, diagnosis and outcome in eight patients
Authors: Jean-Yves Scoazec, Claude Degott, Nicole Brousse, Janine Barge, Georges Molas, François Potet, Jean-Pierre Benhamou
Journal: Hepatology (1991)

We report the diagnostic, prognostic and therapeutic features of non-Hodgkin's lymphoma in eight patients in whom the disease was seen as a primary tumor of the liver. This series illustrates the variety of situations in which lymphoma might be diagnosed: (a) abdominal pain and hepatomegaly (three cases), (b) incidental finding at evaluation of a patient with cirrhosis (two cases), (c) secondary neoplasm after treatment for Hodgkin's disease (one case) and (d) complication of AIDS (two cases). In most cases, clinical and/or radiological features were nonspecific. However, the combination of the following features must be considered as suggestive: occurrence of an apparently primary hepatic tumor in an immunocompromised patient, absence of the usual serum tumor markers and increased serum lactic dehydrogenase activity. The final diagnosis was based on histological examination of specimens obtained by ultrasonically guided liver biopsies or at surgery. All cases belonged to unfavorable histological subtypes. Immunohistochemical findings on paraffin-embedded sections demonstrated the B-lymphocyte lineage of the seven tumors available for study. In the three patients without coexisting disease, complete remission was obtained by surgery alone or combined with chemotherapy. In the two patients with coexisting cirrhosis, outcome was rapidly unfavorable, with death occurring less than 3 mo after diagnosis. Among the three immunocompromised patients, two experienced a rapid unfavorable outcome, and the remaining one was in complete remission after surgery and chemotherapy. In conclusion, primary non-Hodgkin's lymphoma of the liver arising in patients without coexisting disease has a slow progression and might be successfully treated by surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Haemoglobin and non-alcoholic fatty liver disease: further evidence from a population-based study
Authors: L. Xu, C.-f. Xu, C.-h. Yu, M. Miao, Y.-m. Li
Journal: Gut (2009)

We read with great interest the article by Trak-Smayra and colleagues1 showing that serum free haemoglobin subunits correlated positively with severity of liver lesions in non-alcoholic fatty liver disease (NAFLD) and may serve as a biomarker for the disease. However, the detail relationship between serum haemoglobin concentrations and NAFLD has not been clearly clarified.

Recently, we conducted a cross-sectional study to analysis the association of serum haemoglobin concentration with NAFLD. We included 8985 employees (6101 men, mean age 45.7 years) of the Zhenhai Refining & Chemical Company Ltd. (Ningbo, China) who were attending their annual health examination …
Sister Studies Aim To Shed Light on Breast Cancer Risk
Authors: S. Jenks
Journal: JNCI Journal of the National Cancer Institute (2012)

later risk of breast cancer. A companion project begun in 2008, the Two Sister Study, focusing only on women younger than 50 years with breast cancer, has already yielded preliminary data on the use of fertility drugs and early-onset breast cancer. However, its fi ndings still await publication. Because the women in the Two Sister Study have been diagnosed with cancer, “we can do case – control analyses” such as this, said Dale Sandler, Ph.D. , principal investigator of the Sister Study and chief of the epidemiology branch at NIEHS. “We looked at fertility drugs fi rst not because we consider this the greatest risk for earlyonset breast cancer but because we had an interest. Fertility drugs convey a big dose of hormones.” Sandler described the two studies as complementary, because the Two Sister Study consists mostly of women with breast cancer who were the sisters of women in the fi rst study. Some 1,400 – 1,600 women are now enrolled in this spin-off effort, meeting researchers ’ target goal. Observations from the cancer cohort then will be tested in the larger group to see whether they hold.
Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer
Authors: Kirsten Vang Nielsen, Jan T. Jørgensen, Andreas Schønau, Anne Øster
Journal: Journal of Clinical Oncology (2007)

TO THE EDITOR: We read with great interest the joint recommendations from the American Society of Clinical Oncology and the College of American Pathologists (ASCO/CAP) concerning human epidermal growth factor receptor 2 (HER-2) testing in breast cancer. The new recommendations are highly appreciated, and the validation, standardization, and accreditation initiatives are very important for increasing accuracy in HER-2 testing. The joint ASCO/CAP guideline is based on a comprehensive review of published data on HER-2 testing, except for the recommendation for changing the cutoff of stained cells from 10% to 30%. Most published data are based on results obtained using a US Food and Drug Administration (FDA) –approved test that defines a positive 3 staining as being uniform, intensive membrane staining of more than 10% of invasive tumor cells. The new guideline recommends a different cutoff of 30% for 3 . It is not clear whether there are data that support this new cutoff, and we recommend the publication of data from clinical trials to do so. As a point of correction, we wish to bring to your attention that Dako (Glostrup, Denmark) has a US FDA–approved assay, the HER2 FISH (fluorescence in situ hybridization) pharmDx Kit (Dako Denmark A/S). This kit is indicated as an aid in the assessment of patients for whom Herceptin treatment is being considered. The cutoff stated in the package inserts of the approved tests will still be the legally valid cutoff, and it will be impossible to change it without presenting the US FDA with valid data that correlate to clinical outcome. We are concerned that the divergence between the recommendations in the package inserts of the approved HER-2 tests and the ASCO/CAP guideline concerning cutoff will generate confusion rather than clarification.
Functional study of a monoclonal antibody to IgE Fc receptor (Fc epsilon R2) of eosinophils, platelets, and macrophages.
Authors: M Capron, T Jouault, L Prin, M Joseph, J C Ameisen, A E Butterworth, J P Papin, J P Kusnierz, A Capron
Journal: The Journal of Experimental Medicine (1986)

An IgM mAb (BB10) was produced by immunization of mice with human eosinophils purified according to their abnormal low density ("hypodense" cells), and previously shown to exhibit increased IgE-dependent antiparasite cytotoxicity. This BB10 antibody, selected for positive fluorescence staining of hypodense blood or lung eosinophils and low or negative staining of normodense eosinophils or neutrophils, could strongly inhibit IgE-dependent cytotoxicity of human eosinophils and platelets. The specificity for the IgE Fc receptor was suggested by the high levels of inhibition of IgE rosettes formed by eosinophils after incubation with the purified IgM fraction of BB10, whereas other receptors (Fc gamma R, CR1) were not affected. On the other hand, BB10, able to inhibit rat eosinophil Fc epsilon R, did not react with the IgE Fc receptor on mast cells or basophils. A technique using radioiodinated BB10 allowed us to quantify the specific binding of BB10 to human eosinophils and platelets. Competition experiments revealed a crossinhibition between the binding of BB10 and IgE, suggesting the specificity of BB10 for the IgE binding site of eosinophil, platelet, and monocyte Fc epsilon R. Three proteins having extrapolated Mr of 32,000, 43,000-45,000, and 97,000 were found in the platelet extract eluted from a BB10 or from an IgE immunosorbent column. These findings confirm the similarities between IgE Fc receptors on human eosinophils, platelets, and macrophages, already observed with polyclonal antibodies directed against the B lymphocyte Fc epsilon receptor. They suggest, moreover, that the mAb BB10 can represent a good reagent for further investigations on the structure and the functions of this IgE Fc receptor (Fc epsilon R2).
Recovery of cognitive and dynamic motor function following concussion
Authors: Tonya M Parker, Louis R Osternig, Paul van Donkelaar, Li-Shan Chou
Journal: British Journal of Sports Medicine (2007)

Objective: Neuropsychological testing has been advocated as an important tool of proper post-concussion management. Although these measures provide information that can be used in the decision of when to return an individual to previous levels of physical activity, they provide little data on motor performance following injury. The purpose of this investigation was to examine the relationship between measures of dynamic motor performance and neuropsychological function following concussion over the course of 28 days. Methods: Participants completed two experimental protocols: gait stability and neuropsychological testing. The gait stability protocol measured whole-body centre of mass motion as subjects walked under conditions of divided and undivided attention. Neuropsychological testing consisted of a computerised battery of tests designed to assess memory, reaction time, processing speed and concussion symptoms. Correlation coefficients were computed between all neuropsychological and gait variables and comparisons of neuropsychological and gait stability post-concussion recovery curves were assessed. Results: Dynamic motor tasks, such as walking under varying conditions of attention, are complex and demanding undertakings, which require a longer recovery time following a concussion than cognitive measures. Little statistical relationship was found between the neuropsychological and gait variables, and the recovery curves of neuropsychological and gait domains were observed to be independent. Conclusions: In order to fully examine the effects of concussion and determine the optimal time for a safe return to activity, a multi-factorial approach, including both cognitive and motor tasks, should be employed.
Aqp2-Expressing Cells Give Rise to Renal Intercalated Cells
Authors: Hongyu Wu, Lihe Chen, Qiaoling Zhou, Xi Zhang, Stefan Berger, Jiong Bi, Dorothy E. Lewis, Yang Xia, Wenzheng Zhang
Journal: Journal of the American Society of Nephrology (2013)

The mammalian collecting duct comprises principal and intercalated cells, which maintain sodium/water and acid/base balance, respectively, but the epigenetic contributors to the differentiation of these cell types remain unknown. Here, we investigated whether the histone H3 K79 methyltransferase Dot1l, which is highly expressed in principal cells, participates in this process. Taking advantage of the distribution of aquaporin 2 (Aqp2), which localizes to principal cells of the collecting duct, we developed mice lacking Dot1l in Aqp2-expressing cells (Dot1lAC) and found that these mice had approximately 20% fewer principal cells and 13%–16% more intercalated cells than control mice. This deletion of Dot1l in principal cells abolished histone H3 K79 methylation in these cells, but unexpectedly, most intercalated cells also had undetectable di-methyl K79, suggesting that Aqp2+ cells give rise to intercalated cells. These Aqp2+ cell-derived intercalated cells were present in both developing and mature kidneys. Furthermore, compared with control mice, Dot1lAC mice had 40% higher urine volume and 18% lower urine osmolarity with relatively normal electrolyte and acid-base homeostasis. In conclusion, these data suggest that Dot1l deletion facilitates the differentiation of some α- and β-intercalated cells from Aqp2-expressing progenitor cells or mature principal cells.
Neoadjuvant Capecitabine and Oxaliplatin Followed by Synchronous Chemoradiation and Total Mesorectal Excision in Magnetic Resonance Imaging–Defined Poor-Risk Rectal Cancer
Authors: Ian Chau, Gina Brown, David Cunningham, Diana Tait, Andrew Wotherspoon, Andrew R. Norman, Niall Tebbutt, Mark Hill, Paul J. Ross, Alison Massey, Jacqueline Oates
Journal: Journal of Clinical Oncology (2006)

To evaluate neoadjuvant capecitabine/oxaliplatin before chemoradiotherapy (CRT) and total mesorectal excision (TME) in newly diagnosed patients with magnetic resonance imaging (MRI) -defined poor-risk rectal cancer.MRI criteria for poor-risk rectal cancer were tumors within 1 mm of mesorectal fascia (ie, circumferential resection margin threatened), T3 tumors at or below levators, tumors extending > or = 5 mm into perirectal fat, T4 tumors, and T1-4N2 tumors. Patients received 12 weeks of neoadjuvant capecitabine/oxaliplatin followed by concomitant capecitabine and radiotherapy. TME was planned 6 weeks after CRT. Postoperatively, patients received another 12 weeks of capecitabine.Between November 2001 and August 2004, 77 eligible patients were recruited. After neoadjuvant capecitabine/oxaliplatin, the radiologic response rate was 88%. In addition, 86% of patients had symptomatic responses in a median of 32 days (ie, just over one cycle of capecitabine/oxaliplatin). After CRT, the tumor response rate was increased to 97%. Three patients remained inoperable. Sixty-seven patients proceeded to TME, and all but one patient had R0 resection. Pathologic complete response was observed in 16 patients (24%; 95% CI, 14% to 36%), and in an additional 32 patients (48%), only microscopic tumor foci were found on surgical specimens. Four deaths occurred during neoadjuvant capecitabine/oxaliplatin therapy as a result of pulmonary embolism, ischemic heart disease, sudden death with history of chest pain, and neutropenic colitis.Capecitabine/oxaliplatin before synchronous CRT and TME results in substantial tumor regression, rapid symptomatic response, and achievement of R0 resection.
Socio-economic status is related to incidence of asthma and respiratory symptoms in adults
Authors: U. Hedlund, K. Eriksson, E. Rönmark
Journal: European Respiratory Journal (2006)

The aim of the present study was to assess the association between socio-economic status and impaired respiratory health in a 10-yr follow-up of a population-based postal survey in Northern Sweden. Multiple logistic regression was used to estimate odds ratios in relation to socio-economic class, using age, sex, a family history of asthma, smoking habits, and occupational exposures to dust, gases and fumes as possible confounders. The study comprised 2,341 males and 2,413 females. Cumulative incidences were generally lowest in professionals, including executives and civil servants at intermediate and higher levels, who were chosen as reference group. Manual workers in industry showed a significantly increased risk of developing asthma, recurrent wheeze, attacks of shortness of breath or a combination of the two, and chronic productive cough. Manual workers in service showed a similar pattern for attacks of shortness of breath, recurrent wheeze, or a combination of the two, and chronic productive cough. The corresponding population attributable risks were ∼10%. Low socio-economic status was a risk factor for the development of asthma, symptoms common in asthma and chronic productive cough.
Behavioral and Neurophysiological Correlates of Autobiographical Memory Deficits in Patients With Depression and Individuals at High Risk for Depression
Authors: Kymberly D. Young, Patrick S. F. Bellgowan, Jerzy Bodurka, Wayne C. Drevets
Journal: JAMA Psychiatry (2013)

Individuals with major depressive disorder (MDD) compared with healthy control subjects (HCs) consistently recall fewer specific and more categorical autobiographical memories (AMs). This effect is most pronounced for positive AMs and persists into remission.To determine whether individuals at high familial risk for developing MDD (HR group) also show an AM overgenerality bias and to use functional magnetic resonance imaging to assess differences in functional correlates of AM recall across HR, currently depressed MDD, and HC groups.While recalling AMs in response to emotionally valenced cue words, study participants underwent functional magnetic resonance imaging. Control tasks involved generating examples from a given category and counting the number of risers in a letter string.Testing was conducted at the Laureate Institute for Brain Research, Tulsa, Oklahoma.Participants included 16 unmedicated patients with MDD, 16 HR participants, and 16 HCs.Percentage of specific and categorical AMs recalled and brain regions in which hemodynamic activity changed during specific and positive AM recall compared with example generation.Both the MDD and HR groups generated fewer specific, more categorical, and fewer positive AMs than the HC group (P ≤ .02 for all). During specific AM recall compared with example generation, neuroimaging results showed between-group differences in the left cuneus (Talairach space coordinates x, y, z = -7, -71, 18; F = 7.55), right medial frontal cortex (x, y, z = 7, 59, 12; F = 8.53), right frontal operculum (x, y, z = 23, 23, 12; F = 8.25), and right and left pregenual anterior cingulate cortex (x, y, z = 9, 37, 10 and x, y, z = -3, 43, 6; F = 6.84 and F = 7.13, respectively).Autobiographic memory deficits exist in HR individuals, suggesting that these impairments constitute traitlike abnormalities in MDD. We also found distinct patterns of hemodynamic activity for each group as they recalled specific AMs. Specifically, the HR and MDD groups showed differential hemodynamic activity from HCs in medial prefrontal and occipital regions, suggesting that these groups may use different self-referential focus during successful retrieval of specific memories.
Multisensory Interplay Reveals Crossmodal Influences on ‘Sensory-Specific’ Brain Regions, Neural Responses, and Judgments
Authors: Jon Driver, Toemme Noesselt
Journal: Neuron (2008)

Although much traditional sensory research has studied each sensory modality in isolation, there has been a recent explosion of interest in causal interplay between different senses. Various techniques have now identified numerous multisensory convergence zones in the brain. Some convergence may arise surprisingly close to low-level sensory-specific cortex, and some direct connections may exist even between primary sensory cortices. A variety of multisensory phenomena have now been reported in which sensory-specific brain responses and perceptual judgments concerning one sense can be affected by relations with other senses. We survey recent progress in this multisensory field, foregrounding human studies against the background of invasive animal work and highlighting possible underlying mechanisms. These include rapid feedforward integration, possible thalamic influences, and/or feedback from multisensory regions to sensory-specific brain areas. Multisensory interplay is more prevalent than classic modular approaches assumed, and new methods are now available to determine the underlying circuits.