tbuckley/cabot-search huggingface dataset:
Improving Geriatrics Training in Internal Medicine Residency Programs: Best Practices and Sustainable Solutions
Authors: David C. Thomas, Rosanne M. Leipzig, Lawrence G. Smith, Kathel Dunn, Gail Sullivan, Eileen Callahan
Journal: Annals of Internal Medicine (2003)

National surveys indicate a need for additional training in geriatrics during internal medicine residencies. This paper describes 1) best practices for integrating geriatrics education into internal medicine residency programs, 2) barriers to implementation of these practices, and 3) possible ways to improve geriatrics training for internal medicine residents. These best practices were determined by a systematic review of the literature and through interviews with leaders of 26 residency and geriatrics programs concerned with geriatrics training for residents. The most successful programs have clinical experiences with 3 key elements: model geriatric care in 1 or more settings (for example, in the hospital or in ambulatory practice), patient care across sites or transitions of care, and interdisciplinary teamwork. Barriers include attitudes, few faculty, need for relationships with nontraditional training sites, and lack of funding. Local solutions include engaging the internal medicine program director to accomplish a mutual goalfor example, by creating a model geriatrics training experience in which residents demonstrate their skill in a new Accreditation Council of Graduate Medical Education competency (such as systems-based practice). National solutions include reaching consensus on the competencies in geriatrics that should be achieved by board-eligible internists. This may mean increasing the number of questions that test geriatrics competency in the certifying and in-training examinations, increasing numbers of faculty members able to teach and model geriatric care, developing effective medical resident teaching courses for nonphysician faculty, and lobbying for improved systems of care.
The Special Article: Political Aspects
Authors: F. J. Ingelfinger
Journal: New England Journal of Medicine (1974)

Last week's editorial on Special Articles1 failed to consider the varieties that contain political elements, either overtly or by implication. These are the kind most apt to arouse readers on the other side of the political fence in question to admonish the editor to "stick to science." The presence of Special Articles in the Journal for 20 years shows, however, that its days as a strictly scientific medical publication are long past. Indeed, in view of the continuing introduction of new specialties, and the unabated development of those that already exist, one may anticipate that articles of strictly scientific content . . .
Hospital Costs of Multiple-Birth and Singleton-Birth Children During the First 5 Years of Life and the Role of Assisted Reproductive Technology
Authors: Georgina M. Chambers, Van Phuong Hoang, Evelyn Lee, Michele Hansen, Elizabeth A. Sullivan, Carol Bower, Michael Chapman
Journal: JAMA Pediatrics (2014)

The unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood.To conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine the contribution of assisted reproductive technology (ART) to the incidence and cost of multiple births.A retrospective population cohort study using individually linked birth, hospital, and death records among 233,850 infants born in Western Australia between October 1993 and September 2003, and followed up to September 2008.Multiple-gestation delivery and ART conception.Odds of stillbirth, prematurity and low birth weight, frequency and length of hospital admissions, the mean costs by plurality, and the independent effect of prematurity on childhood costs.Of 226,624 singleton, 6941 twin, and 285 HOM infants, 1.0% of singletons, 15.4% of twins, and 34.7% of HOM children were conceived following ART. Compared with singletons, twins and HOMs were 3.4 and 9.6 times, respectively, more likely to be stillborn and were 6.4 and 36.7 times, respectively, more likely to die during the neonatal period. Twins and HOMs were 18.7 and 525.1 times, respectively, more likely to be preterm, and 3.6 and 2.8 times, respectively, more likely to be small for gestational age. The mean hospital costs of a singleton, twin, and HOM child to age 5 years were $2730, $8993, and $24,411 (in 2009-2010 US dollars), respectively, with cost differences concentrated in the neonatal period and during the first year of life. Almost 15% of inpatient costs for multiple births could have been avoided if ART twins and HOMs had been born as singletons.Compared with singletons, multiple-birth infants consume significantly more hospital resources, particularly during the neonatal period and first year of life. A significant proportion of the clinical and economic burden associated with multiple births can be prevented through single-embryo transfer. Increasing ART use worldwide and persistently high ART multiple-birth rates in several countries highlight the need for strategies that encourage single-embryo transfer. The costs from this study can be generalized to other settings.
Cellular cardiomyoplasty in large myocardial infarction: Can the beneficial effect be enhanced by ACE‐inhibitor therapy?
Authors: Emerson L. Olivares, Ricardo H. Costa‐e‐Sousa, João P.S. Werneck‐de‐Castro, Vanessa Pinho‐Ribeiro, Márcia G. Silva, Karla C. Ribeiro, Elisabete C. Mattos, Regina C.S. Goldenberg, Antonio C. Campos de Carvalho, Masako Oya Masuda
Journal: European Journal of Heart Failure (2007)
Human acute myelogenous leukemia stem cells are rare and heterogeneous when assayed in NOD/SCID/IL2Rγc-deficient mice
Authors: Jean-Emmanuel Sarry, Kathleen Murphy, Robin Perry, Patricia V. Sanchez, Anthony Secreto, Cathy Keefer, Cezary R. Swider, Anne-Claire Strzelecki, Cindy Cavelier, Christian Récher, Véronique Mansat-De Mas, Eric Delabesse, G. Danet-Desnoyers, Martin Carroll
Journal: Journal of Clinical Investigation (2010)

Human leukemic stem cells, like other cancer stem cells, are hypothesized to be rare, capable of incomplete differentiation, and restricted to a phenotype associated with early hematopoietic progenitors or stem cells. However, recent work in other types of tumors has challenged the cancer stem cell model. Using a robust model of xenotransplantation based on NOD/SCID/IL2Rγc-deficient mice, we confirmed that human leukemic stem cells, functionally defined by us as SCID leukemia-initiating cells (SL-ICs), are rare in acute myelogenous leukemia (AML). In contrast to previous results, SL-ICs were found among cells expressing lineage markers (i.e., among Lin+ cells), CD38, or CD45RA, all markers associated with normal committed progenitors. Remarkably, each engrafting fraction consistently recapitulated the original phenotypic diversity of the primary AML specimen and contained self-renewing leukemic stem cells, as demonstrated by secondary transplants. While SL-ICs were enriched in the Lin-CD38- fraction compared with the other fractions analyzed, SL-ICs in this fraction represented only one-third of all SL-ICs present in the unfractionated specimen. These results indicate that human AML stem cells are rare and enriched but not restricted to the phenotype associated with normal primitive hematopoietic cells. These results suggest a plasticity of the cancer stem cell phenotype that we believe has not been previously described.
Effect of neonatal exposure to estrogenic compounds on development of the excurrent ducts of the rat testis through puberty to adulthood.
Authors: J S Fisher, K J Turner, D Brown, R M Sharpe
Journal: Environmental Health Perspectives (1999)

Neonatal exposure to diethylstilbestrol (DES) can alter the structure of the testicular excurrent ducts in rats. We characterized these changes according to dose and time posttreatment and established whether potent estrogens (ethinyl estradiol), environmental estrogens (genistein, octylphenol, bisphenol A, parabens), and tamoxifen induce such changes. Rats were administered these compounds neonatally and assessed at several time points during (day 10, or day 18 for some treatments) and after (days 18, 25, 35, and 75) the treatment period to detect any changes in testis weight, distension of the rete testis and efferent ducts, epithelial cell height in the efferent ducts, and immunoexpression of the water channel aquaporin-1 (AQP-1). Treatment with DES (10, 1, or 0.1 microg/injection; equivalent to 0.37, 0.037, or 0.0037 mg/kg/day, respectively) induced dose-dependent changes in testis weight and all parameters. These effects were most pronounced at days 18 and 25 and appeared to lessen with time, although some persisted into adulthood. Neonatal treatment with ethinyl estradiol (10 microg/injection; equivalent to 0.37 mg/kg/day) caused changes broadly similar to those induced by 10 mg DES. Administration of tamoxifen (2 mg/kg/day) caused changes at 18 days that were similar to those induced by 1 microg DES. Treatment with genistein (4 mg/kg/day), octylphenol (2 mg/injection; equivalent to 150 mg/kg/day), or bisphenol A (0.5 mg/injection; equivalent to 37 mg/kg/day) caused minor but significant (p<0.05) decreases in epithelial cell height of the efferent ducts at days 18 and/or 25. In animals that were followed through to 35 days and/or adulthood, these changes were no longer obvious; other parameters were either unaffected or were affected only marginally and transiently. Administration of parabens (2 mg/kg/day) had no detectable effect on any parameter at day 18. To establish whether these effects of estrogens were direct or indirect (i.e., resulting from reduced follicle-stimulating hormone/luteinizing hormone secretion), the above end points were assessed in animals in which gonadotropin secretion was suppressed neonatally by administration of a gonadotropin-releasing hormone antagonist. This treatment permanently reduced testis weight, but did not affect any of the other end points, apart from a minor transient reduction in efferent duct epithelial cell height at 18 days. This study suggests that structural and functional (expression of AQP-1) development of the excurrent ducts is susceptible to impairment by neonatal estrogen exposure, probably as a consequence of direct effects. The magnitude and duration of adverse changes induced by treatment with a range of estrogenic compounds was broadly comparable to their estrogenic potencies reported from in vitro assays.
Arachidonic acid protects neonatal rat cardiac myocytes from ischaemic injury through ε protein kinase C
Authors: K Mackay
Journal: Cardiovascular Research (2001)

Objectives: Arachidonic acid is a second messenger which activates protein kinase C (PKC) and is released from the heart during ischaemic preconditioning. The purpose of this study was to examine the effect of arachidonic acid on activation of PKC in cardiac myocytes and the cellular consequences. Methods: Neonatal rat cardiac myocytes were isolated and maintained in culture. Arachidonic acid-induced activation of PKC was examined by cell fractionation and western blot analysis. Contraction frequency was measured by visual inspection under a microscope. Ischaemia was simulated by subjecting cells to an atmosphere of lower than 0.5% oxygen in the absence of glucose and cell damage determined by release of cytosolic lactate dehydrogenase or direct cell viability assay. Results: Arachidonic acid resulted in translocation of δ and ϵPKC but not α, βII, η or ζPKC isozymes, indicating activation of only δ and ϵPKC. Arachidonic acid induced a dose-dependent decrease in spontaneous contraction rate of cardiac myocytes which was blocked by a selective peptide translocation inhibitor of ϵPKC. Pretreatment with arachidonic acid partially protected cardiac myocytes against ischaemia. Down-regulation of PKC with 24 h 4β-phorbol,12-myristate,13-acetate treatment, inhibition of PKC by chelerythrine and selective inhibition of ϵPKC translocation all decreased the protective effect of arachidonic acid. Pretreatment with eicosapentaenoic acid or oleic acid also protected cardiac myocytes against ischaemia. Conclusions: These results demonstrate that arachidonic acid selectively activates δ and ϵPKC in neonatal rat cardiac myocytes, leading to protection from ischaemia. We suggest this is a potential mechanism of PKC activation during PC. In addition, our results suggest that different classes of free fatty acid directly exert cardioprotection from ischaemic injury in cardiac myocytes.
LOWERED FERTILITY IN THE MALE
Authors: DONALD MACOMBER
Journal: JAMA (1925)

[Editorial Note.—This paper and the papers of Drs. Baker and Vecki, which follow it, constitute a symposium on urologic subjects.] It is not the purpose of this paper to discuss the subject of male sterility. The absolute sterilities that follow gonorrheal epididymitis or the orchitis of mumps, or other definite pathologic conditions, are well known and need little amplification. It is not so well known, however, that there are lesser variations in fertility which are more in the nature of functional disorders, and which are therefore more susceptibile of improvement. For some reason or other, physicians have always regarded the fertility of the man as above reproach. It is now beginning to be recognized that the man may be just as much at fault as the woman in accounting for a given sterile marriage; but there still remains the mistaken notion, "Once fertile, always fertile." In other words, there
Microadenomas of the Pituitary and Abnormal Sellar Tomograms in an Unselected Autopsy Series
Authors: Gerard N. Burrow, George Wortzman, Neill B. Rewcastle, Richard C. Holgate, Kalman Kovacs
Journal: New England Journal of Medicine (1981)

PROLACTIN-SECRETING microadenomas of the pituitary gland have been diagnosed on the basis of elevated serum prolactin concentrations and abnormal tomograms of the sella turcica.1 , 2 This diagnosis has been corroborated at the time of transsphenoidal hypophysectomy by removal of a microadenoma that stains for prolactin-secreting cells.3 , 4 The pathogenesis of these prolactinomas has not been defined.5 The reported incidence of pituitary adenomas at autopsy has varied from 2.7 to 23 per cent.6 7 8 Prolactin-cell hyperplasia with nodular or adenomatous changes has been reported in approximately 8 per cent of pituitaries examined at autopsy.9 To study the natural history of microadenomas and of prolactinomas, . . .
Uneasy Truce — New Thoughts on Welfare
Authors: John Lister
Journal: New England Journal of Medicine (1976)

Writing on this New Year's Day, 1976, I find it difficult to look forward with great enthusiasm to the year ahead because the problems both national and international appear so daunting and the medical scene in Britain remains unhappy and confused.The two disputes between the medical profession and the Government are still not satisfactorily resolved, and although it may be said that an uneasy truce has been established, there is little doubt that the recent confrontation has done great damage to the National Health Service (NHS) and some damage to the profession itself.1 The rigid 40-hour working week that . . .
Healthcare giant advertises to children in classrooms
Authors: Ray Moynihan
Journal: BMJ (2007)

The multinational drug and medical device manufacturer Johnson & Johnson has been advertising its products in a resource book used by children in Australian classrooms.

The book, BodyWhys , is sponsored by Johnson & Johnson and contains several advertisements for Johnson & Johnson products, including tampons, sanitary pads, toothbrushes, and pimple cream.

Along with the advertisements , BodyWhys , which was recently distributed to 10 year old children in a state school in Sydney's wealthy eastern suburbs, contains text about personal development.

Johnson & Johnson says it has been sending copies of the book to schools on request for several years. This year …
An Address on STATURE AND POSE: THE PROBLEM OF UNEQUAL LEGS
Authors: E. W. H. Groves
Journal: BMJ (1931)

WhIich of vou, by taking thought, can add one cubit unto his stature?I suppose that if this question was propounded for our answer to-day we should devote ourselves almost entirely to a consideratioin of the possibility of provoking endocrine stimulation of the pituitary gland.A cubit is the distance from the tip of the elbow to the tip of the middle finger, and is about 18 inches in a full-grown adult.The true acromegalic giants, such as Charles Byrne, John Hunter's famous trophy, may be more than two feet taller than anaverage adult, and if we Xknew how to add to the bulk or to increase the activity of a normal pituitary gland such an addition to the (K <> R stature of a growing adult might easily be made.A. B.C. D.F'IG. 1--Shortening of the leg due to infantile paralysis.A. Out- line of the limlbs shoNwing intrinsic shortening of right femutr.B. Alethod of lenigthening femur; step-cut and grafts.C. Method of shortening femnur.D. Shortened femur after impaction. (In the diagraml the peg is iiiade from the lateral half of the femur, whereas in practice it is formed froli the posterior half.)A man's height depends chiefly on the length of the spine, the femora, and tibiae.The length of the spine is made up of the thickness of twenty-four vertebral bodies * An address delivered before the Royal Free Hospital Medical Society.(cervical, dorsa-l, anid lumbar) and of tweinty-three inter- vertebral disks, but the total lenigth of the vertebral column will vary with its curvature.Any marked variation fromi the normal affecting the stature is always JUY4 91 TAUEADPS
THE EFFECT OF PROLONGED APPLICATION OF LARGE DOSES OF FOLLICULAR HORMONE ON THE UTERUS OF RABBITS
Authors: Bernhard Zondek
Journal: The Journal of Experimental Medicine (1936)

Follicular hormone under physiological conditions produced hyperplasia of the muscular wall and proliferation of the mucous membrane of the uterus of rabbits. The following pathological changes were brought about by prolonged application of large doses of the hormone: (a) hyperaemia of the myometrium and the endometrium, with occasional scanty extravasal haemorrhages; (b) glandular-cystic hyperplasia of the endometrium; (c) infarct-like necrosis of the myometrium; (d) aseptic suppuration in the uterine cavity. These four processes can sometimes be found simultaneously in the same uterus, but they occur more frequently in sequence. While follicular hormone, applied in physiological doses, has a stimulating effect, prolonged application of large doses destroys the uterus. The effects described above were only to be observed in the rabbit, not in the rat. This illustrates the fact that hormone reactions may vary in different species.
How Specialized Is a Specialty?
Authors: Donald Munro
Journal: New England Journal of Medicine (1951)

MR. PRESIDENT, fellow-members of the Massachusetts Medical Society, ladies and gentlemen: Permit me, first of all, to thank you for the great honor you have done me by enrolling me among the pre-eminent members of the profession who have previously borne the title of orator. Indeed, I feel myself to be more than usually honored because, as it happens, my father, Dr. John C. Munro, received this same distinction forty-one years ago. It is not often that the son is given the opportunity to follow so exactly in the footsteps of a distinguished father.According to Burrage's history of the . . .
Improved Survival After Transplantation of More Donor Plasmacytoid Dendritic or Naïve T Cells From Unrelated-Donor Marrow Grafts: Results From BMTCTN 0201
Authors: Edmund K. Waller, Brent R. Logan, Wayne A.C. Harris, Steven M. Devine, David L. Porter, Shin Mineishi, John M. McCarty, Corina E. Gonzalez, Thomas R. Spitzer, Oleg I. Krijanovski, Michael L. Linenberger, Ann Woolfrey, Alan Howard, Juan Wu, Dennis L. Confer, Claudio Anasetti
Journal: Journal of Clinical Oncology (2014)

To characterize relationships between specific immune cell subsets in bone marrow (BM) or granulocyte colony-stimulating factor-mobilized peripheral blood (PB) stem cells collected from unrelated donors and clinical outcomes of patients undergoing transplantation in BMTCTN 0201.Fresh aliquots of 161 BM and 147 PB stem-cell allografts from North American donors randomly assigned to donate BM or PB stem cells and numbers of transplanted cells were correlated with overall survival (OS), relapse, and graft-versus-host disease (GvHD).Patients with evaluable grafts were similar to all BMTCTN 0201 patients. The numbers of plasmacytoid dendritic cells (pDCs) and naïve T cells (Tns) in BM allografts were independently associated with OS in multivariable analyses including recipient and donor characteristics, such as human leukocyte antigen mismatch, age, and use of antithymocyte globulin. BM recipients of > median number of pDCs, naïve CD8(+) T cells (CD8Tns), or naïve CD4(+) T cells (CD4Tns) had better 3-year OS (pDCs, 56% v 35%; P = .025; CD8Tns, 56% v 37%; P = .012; CD4Tns, 55% v 37%; P = .009). Transplantation of more BM Tns was associated with less grade 3 to 4 acute GvHD but similar rates of relapse. Transplantation of more BM pDCs was associated with fewer deaths resulting from GvHD or from graft rejection. Analysis of PB grafts did not identify a donor cell subset significantly associated with OS, relapse, or GvHD.Donor immune cells in BM but not PB stem-cell grafts were associated with survival after unrelated-donor allogeneic hematopoietic stem-cell transplantation. The biologic activity of donor immune cells in allogeneic transplantation varied between graft sources. Donor grafts with more BM-derived Tns and pDCs favorably regulated post-transplantation immunity in allogeneic hematopoietic stem-cell transplantation.
Safe Transfer of Civilian Burn Casualties
Authors: John M. Stein
Journal: JAMA (1977)

The advisability of transporting severely burned civilian patients to a definitive burn-care facility during the first hours following injury is discussed and methods providing safe transport for 353 civilian burn patients are described. Feasibility of and methods for transporting patients over various distances are outlined and the problems of jet transportation presented. Adequate communication between referring and receiving physicians is imperative, as are adequate preparation before evacuation and maintenance of intravenous fluid resuscitation, intake and output records, and sterile technique during transport. (<i>JAMA</i>238:489-492, 1977)
Complexity: a simple approach to quality. Are we there yet?
Authors: T. Kemple
Journal: BMJ (2009)

“When I use a word, it means just what I choose it to mean—neither more nor less.” So Lewis Carroll’s Humpty Dumpty understood the words he used. Today’s word is “quality,” and Heath and colleagues’ specific vagueness of the “way forward” to measure quality in primary care suggests we won’t be able agree what we mean for many years.1

“If you don’t know where you are going, any road …