tbuckley/cabot-search huggingface dataset:
Ockham's Razor
Authors: Jack Coulehan
Journal: Annals of Internal Medicine (2015)

Ad Libitum3 November 2015Ockham's RazorJack Coulehan, MD, MPHJack Coulehan, MD, MPHFrom Setauket, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1469 Audio Reading - “Ockham's Razor” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Ockham's Razor," by J. Coulehan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Ockham's razor shavesstories to their cores,a stainless blade relievescomplexity—and cures.I want to say zebra,the razor makes it horse.I imagine a plethora,am urged a single course.Simplicity makes sense.Discarding underbrush,the secret of success—a secret, too, of loss.My rogue imaginationcolors, enhances.My ear yearns to listen,my thalamus dances.Now, Ockham's razor sitsno longer trustedin my medicine cabinet,abandoned and rusted. Author, Article, and Disclosure InformationAffiliations: From Setauket, New York.Current Author Address: Jack Coulehan, MD, MPH; e-mail, John.[email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “Ockham's Razor” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Ockham's Razor," by J. Coulehan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 3 November 2015Volume 163, Issue 9Page: 717KeywordsThalamus ePublished: 3 November 2015 Issue Published: 3 November 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Response to Montori et al.
Authors: Jøran Hjelmesæth, Trond Jenssen, Thore Egeland, Monica Hagen, Anders Hartmann
Journal: Diabetes Care (2002)

Montori et al. (1) have performed an extensive and impressive review of the literature addressing the incidence of post-transplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management of the disease. We would like to comment on some aspects of their article.

First, prospective cohort studies are generally accepted to have the most appropriate design to assess the incidence of a disease (2). In the present review, seven randomized clinical trials of immunosuppressive drugs, four case-control studies, and only four cohort studies were included to assess the incidence of PTD. Moreover, only one RCT and one CC study …
Maximally Recommended Doses of Angiotensin-Converting Enzyme (ACE) Inhibitors Do Not Completely Prevent ACE-Mediated Formation of Angiotensin II in Chronic Heart Failure
Authors: Ulrich P. Jorde, Pierre V. Ennezat, Jay Lisker, Vanarani Suryadevara, Jason Infeld, Sonja Cukon, Adam Hammer, Edmund H. Sonnenblick, Thierry H. Le Jemtel
Journal: Circulation (2000)

Background —The added benefits of angiotensin II type I receptor (AT 1 ) blockers (ARBs) to ACE inhibition suggests that recommended doses of ACE inhibitors provide only partial inhibition of ACE in chronic heart failure (CHF). Accordingly, the level of ACE inhibition was assessed by the pressor response to angiotensin (Ang) I in patients who had been treated with recommended doses of ACE inhibitors. Methods and Results —Forty-two patients with CHF receiving 40 mg/d of a long-acting ACE inhibitor or 150 mg of captopril were studied. Radial artery systolic pressure (RASP, mm Hg) was monitored noninvasively. The pressor response to ascending doses of Ang I was evaluated in all patients before and after administration of the ARB valsartan. The pressor response to Ang I before and after valsartan was also reevaluated in 11 patients after the dose of ACE inhibitor was doubled for 1 week. RASP increased linearly with significantly ascending doses of Ang I despite treatment with ACE inhibitors. The pressor response to Ang I was blunted significantly by valsartan. Ang I–induced increase in RASP did not correlate with duration of ACE inhibitor therapy. After the dose of ACE inhibitors was doubled, the pressor response to Ang I was no longer different from that noted after valsartan. Conclusions —Recommended doses of ACE inhibitors do not fully inhibit ACE in CHF. The level of ACE inhibition achieved is not related to duration of ACE inhibitor therapy. Greater ACE inhibition is also achieved at twice the recommended doses of ACE inhibitors.
Acute Myocardial Infarction in Idiopathic Hypertrophic Subaortic Stenosis
Authors: M. R. Sasidharan Nair
Journal: JAMA (1980)

ANGINA pectoris, syncope, sudden death, and ECG changes simulating acute myocardial infarction are all well-recognized features of idiopathic hypertrophic subaortic stenosis (IHSS).<sup>1,2</sup>Acute myocardial infarction associated with coronary artery disease has been described in patients with IHSS.<sup>3</sup>Acute myocardial infarction occurring in young patients with IHSS in the presence of normal coronary arteries, verified by either arteriography or necropsy, has been described only rarely.<sup>4</sup> <h3>Report of a Case</h3> A 19-year-old man was seen in the emergency room of Providence Hospital, Southfield, Mich, complaining of palpitations and severe crushing retrosternal chest pain starting suddenly after shoveling snow on Jan 27, 1978. Idiopathic hypertrophic subaortic stenosis had been diagnosed in this patient in June 1973. An echocardiogram in May 1977 showed asymmetric septal hypertrophy with a septal thickness of 18 to 20 mm and left ventricular wall thickness of 8 mm, giving a ratio of 2.25 to 2.5, and marked systolic
Correlation between levels of DNA antibodies and clinical disease activity in SLE.
Authors: P Davis, J S Percy, A S Russell
Journal: Annals of the Rheumatic Diseases (1977)

Sera were tested from 23 patients with systemic lupus erythematosus followed over a period of 1 to 5 years. Antibodies to native DNA were measured and correlated retrospectively with clinical evidence of disease activity. The overall degree of correlation between the presence of DNA antibodies and evidence of disease activity was good (P less than 0-001). Of 206 sera tested, only 4 had a normal DNA antibody at a time when significant clinical activity was noted. In contrast, 34 sera had mild to moderately raised DNA antibody levels at times of clinical remission. Although DNA antibodies are a useful investigation in the monitoring of disease activity, changes in therapy should not necessarily be made on DNA antibody levels alone.
Freedom, responsibility, and health
Authors: J. P Bunker, S. Stansfeld, J. Potter
Journal: BMJ (1996)

Freedom and responsibility, how much of each and how they are balanced, have profound implications for our personal lives and for our work. The health of a population and its achievement in the workplace are enhanced when individuals have some freedom and some responsibility, but not too much of either, and when civil associations of individuals rather than individuals acting alone are the essential social units. The consistent association of social contacts with health and productivity provides strong support for the premise that intimate relationships are the focus around which people's lives revolve. Membership of a "social network" may be merely conforming to a reigning social norm, and this could mean having to pay an important price in the loss of creativity associated with individualism. But social conformity should not prevent individuals from going their own way, and it should be possible to combine the luxury of individuality with an active life in civic affairs. Less than complete freedom may fall short of existential utopia, but it may be best for our health and wellbeing.
A comparison of parametric and non-parametric statistical tests
Authors: P. Sedgwick
Journal: BMJ (2015)

Researchers investigated the effectiveness of corticosteroids in reducing respiratory disorders in infants born at 34-36 weeks' gestation. A randomised placebo controlled trial was performed. The intervention was treatment with betamethasone, 12 mg intramuscularly daily for two consecutive days at 34-36 weeks of pregnancy. Participants were 320 women at 34-36 weeks of pregnancy who were at risk of imminent premature delivery. Women were randomised to the intervention (n=163) or placebo (n=157).1 The primary outcome was the incidence of neonatal respiratory disorders, including respiratory distress syndrome and transient tachypnoea. Secondary outcomes included perinatal measurements in the infant, including birth weight, plus Apgar score at five minutes. Statistical hypothesis testing used a two sided alternative and a critical level of significance of 0.05 (5%). Distributional assumptions were verified before statistical testing. The rate of respiratory distress syndrome was higher in the intervention group than in the control group (two (1.4%) v one (0.8%)), although the difference was not significant (P=0.54), as was the rate of transient tachypnoea (34 (24%) v 29 (22%); P=0.77). Babies born to mothers in the intervention group had a higher mean birth weight, although the difference was not significant (2640 (standard deviation 445) v 2627 (452) g; Student's t test P=0.80). There was no difference between the intervention and control groups in Apgar scores at five minutes (median 9 (interquartile range 9-10) v 9 (9-10); Mann-Whitney U test P=0.77). The researchers concluded that antenatal treatment with corticosteroids at 34-36 weeks of pregnancy does not reduce the incidence of respiratory disorders in newborn infants. Which of the following statements, if any, are true?
Lipopolysaccharide or Whole Bacteria Block the Conversion of Inflammatory Monocytes into Dendritic Cells In Vivo
Authors: Gianluca Rotta, Emmerson W. Edwards, Sabina Sangaletti, Clare Bennett, Simona Ronzoni, Mario P. Colombo, Ralph M. Steinman, Gwendalyn J. Randolph, Maria Rescigno
Journal: The Journal of Experimental Medicine (2003)

Monocytes can develop into dendritic cells (DCs) that migrate to lymph nodes (LNs) and present antigens to T cells. However, we find that this differentiation is blocked when monocytes accumulate subcutaneously in response to bacteria or lipopolysaccharide (LPS). The inhibition of DC differentiation is mediated by the bacteria and in conjunction with inflammatory cells recruited at the site of injection. Inhibition of migratory DC development was reversed in Toll-like receptor (TLR)4-mutated mice when LPS, but not whole bacteria, was injected, suggesting that TLR4 is one but not the only mediator of the inhibition. The block imposed by bacteria was partly relieved by the absence of interleukin (IL)-12 p40, but not by individual absence of several cytokines involved in DC differentiation or in inflammation, i.e., IL-6, IL-10, IL-12 p35, and interferon γ. Consistent with the inability of monocytes to yield migrating DCs, and the finding that other DCs had limited access to particulate or bacterial antigens, these antigens were weakly presented to T cells in the draining LN. These results illustrate that bacteria-associated signals can have a negative regulatory role on adaptive immunity and that local innate responses for containment of infectious bacteria can at least initially supersede development of adaptive responses.
Platelet-Derived Growth Factor Receptor Inhibition and Chemotherapy for Castration-Resistant Prostate Cancer with Bone Metastases
Authors: Paul Mathew, Peter F. Thall, Corazon D. Bucana, William K. Oh, Michael J. Morris, Donnah M. Jones, Marcella M. Johnson, Sijin Wen, Lance C. Pagliaro, Nizar M. Tannir, Shi-Ming Tu, Anthony A. Meluch, Lon Smith, Lorenzo Cohen, Sun-Jin Kim, Patricia Troncoso, Isaiah J. Fidler, Christopher J. Logothetis
Journal: Clinical Cancer Research (2007)

Abstract Purpose: To further assess preclinical and early clinical evidence that imatinib mesylate, a platelet-derived growth factor receptor (PDGFR) inhibitor, modulates taxane activity in prostate cancer and bone metastases, a randomized study was conducted. Experimental Design: Men with progressive castration-resistant prostate cancer with bone metastases (n = 144) were planned for equal randomization to i.v. 30 mg/m2 docetaxel on days 1, 8, 15, and 22 every 42 days with 600 mg imatinib daily or placebo, for an improvement in median progression-free survival from 4.5 to 7.5 months (two-sided α = 0.05 and β = 0.20). Secondary end points included differential toxicity and bone turnover markers, tumor phosphorylated PDGFR (p-PDGFR) expression, and modulation of p-PDGFR in peripheral blood leukocytes. Results: Accrual was halted early because of adverse gastrointestinal events. Among 116 evaluable men (57 docetaxel + imatinib; 59 docetaxel + placebo), respective median times to progression were 4.2 months (95% confidence interval, 3.1-7.5) and 4.2 months (95% confidence interval, 3.0-6.8; P = 0.58, log-rank test). Excess grade 3 toxicities (n = 23) in the docetaxel + imatinib group were principally fatigue and gastrointestinal. Tumor p-PDGFR expression was observed in 12 of 14 (86%) evaluable bone specimens. In peripheral blood leukocytes, p-PDGFR reduction was more likely in docetaxel + imatinib–treated patients compared with docetaxel + placebo (P &amp;lt; 0.0001), as were reductions in urine N-telopeptides (P = 0.004) but not serum bone-specific alkaline phosphatase (P = 0.099). Conclusions: These clinical and translational results question the value of PDGFR inhibition with taxane chemotherapy in prostate cancer bone metastases and are at variance with the preclinical studies. This discordance requires explanation.
Analysis of rat hemopoietic cells on the fluorescence-activated cell sorter. I. Isolation of pluripotent hemopoietic stem cells and granulocyte-macrophage progenitor cells
Authors: I Goldschneider, D Metcalf, F Battye, T Mandel
Journal: The Journal of Experimental Medicine (1980)

A scheme is presented whereby pluripotent hemopoietic stem cells (PHSC) from rat bone marrow can be enriched 320-fold with the aid of the fluorescence- activated cell sorter. This scheme is based on the observations that PHSC are strongly positive for Thy-1 antigen (upper 10th percentile); have light- scattering properties (size distribution) between those of bone marrow lymphocytes and myeloid progenitor cells; and are relatively resistant to cortisone. It is estimated that PHSC may constitute 80 percent of the cells isolated according to these parameters. Candidate PHSC are described at the light and electron microscopic levels. At least two populations of accessory cells appear to influence the number and/or the nature of the hemopoietic colonies that form in the in vivo spleen colony-forming unit assay. Putative amplifier cells are strongly Thy-1(+) and cortisone sensitive; putative suppressor cells are weakly Thy-1(+) and cortisone resistant. Three subsets of granulocyte (G) -macrophage (M) progenitor cells (in vitro colony-forming cells [CFC]) are identified on the basis of relative fluorescence intensity for Thy-1 antigen: G-CFC are strongly Thy-l(+); M-CFC are weakly Thy-l(+); and cells that produce mixed G and M CFC have intermediate levels of Thy-1. GM-cluster-forming cells and mature G and M are Thy-1(-). The results suggest that G-CFC are bipotential cells that give rise to G and M-CFC; and that the latter produce mature M through a cluster- forming cell intermediate. Thy-1 antigen is also demonstrated on members of the eosinophil, megakaryocyte, erythrocyte, and lymphocyte cell series in rat bone marrow. In each instance, the relative concentration of Thy-1 antigen is inversely related to the state of cellular differentiation.
Swept Away: Use of General Medical and Mental Health Services Among Veterans Displaced By Hurricane Katrina
Authors: Benjamin Druss
Journal: American Journal of Psychiatry (2007)

Objective: This study examined national patterns of outpatient service use by veterans from regions affected by Hurricane Katrina. Methods Analyses tracked use of general medical and mental/substance use services in September and October through December 2005 in New Orleans and Biloxi-Gulfport compared to a cohort receiving care during the same months in the previous 2 years. Results: In adjusted models, veterans from New Orleans and Biloxi-Gulfport were, respectively, 73% and 41% less likely in September 2005 to use any outpatient services as were cohorts from 2003–2004. Particularly in New Orleans, the relative decline in service use was substantially greater for specialty mental health and substance use services than for general medical services. Conclusions: Although many veterans were able to obtain care after Hurricane Katrina, there was a substantial disruption in delivery of Veterans Administration services, with disproportionate declines in mental health and substance use care.
Improving the Accuracy of the Diagnosis of Schizophrenia by Means of Virtual Reality
Authors: Anna Sorkin, Daphna Weinshall, Ilan Modai, Avi Peled
Journal: American Journal of Psychiatry (2006)

OBJECTIVE: The authors' goal was to improve the diagnosis of schizophrenia by using virtual reality technology to build a complex, multimodal environment in which cognitive functions can be studied (and measured) in parallel. METHOD: The authors studied sensory integration within working memory by means of computer navigation through a virtual maze. The simulated journey consisted of a series of rooms, each of which included three doors. Each door was characterized by three features (color, shape, and sound), and a single combination of features—the door-opening rule—was correct. Subjects had to learn the rule and use it. The participants were 39 schizophrenic patients and 21 healthy comparison subjects. RESULTS: Upon completion, each subject was assigned a performance profile, including various error scores, response time, navigation ability, and strategy. A classification procedure based on the subjects' performance profile correctly predicted 85% of the schizophrenic patients (and all of the comparison subjects). Several performance variables showed significant correlations with scores on a standard diagnostic measure (Positive and Negative Syndrome Scale), suggesting potential use of these measurements for the diagnosis of schizophrenia. On the other hand, the patients did not show unusual repetition of response despite stimulus cessation (called "perseveration" in classical studies of schizophrenia), which is a common symptom of the disease. This deficit appeared only when the subjects did not receive proper explanation of the task. CONCLUSIONS: The ability to study multimodal performance simultaneously by using virtual reality technology opens new possibilities for the diagnosis of schizophrenia with objective procedures.
Psoriatic arthritis. Follow-up study.
Authors: M E Roberts, V Wright, A G Hill, A C Mehra
Journal: Annals of the Rheumatic Diseases (1976)

227 patients with psoriasis and various forms of arthritis have been kept under review. Psoriasis and inflammatory arthropathy was present in 168 patients, of whom 94 have been followed up for more than 10 years. An arthritis indistinguishable from rheumatoid disease was present in 78%, distal joint arthritis in 16-6%, and deforming arthritis in 4-8%. There was a female predominance in the sex ratio of patients, although males predominated in the distal joint group (male:female 1-5:1). The peak age of onset was between 36 and 45 years, although in the deforming group the arthritis began before the age of 20 three times as commonly as it did in the indistinguishable group. Onset was acute in nearly half of the patients. At onset the distal joints were affected in one-third of the distal joint group. A synchronous onset of skin and joint changes was uncommon. Skin lesions usually preceded the arthritis but occurred after onset in 16%. Apart from in the deforming group, the arthritis was mild, judged by the number of admissions to hospital for treatment of the joint disease, and the time off work. Deterioration clinically and radiographically occurred in only a small portion of the distal joint and indistinguishable groups. Antimalarial drugs have been used in 7 patients, with deterioration of the skin condition in 4. Uveitis occurred particularly in the men of all three groups, but was most frequent in those with deforming arthritis. A family history of psoriasis was obtained in 26% of first-degree relatives and 13% of second-degree relatives. A history of polyarthritis was most common in patients in the deforming group. The sheep cell agglutination test was negative in the majority, but was positive in 16% of the indistinguishable group, fluctuating in a further 10%. A small number of joints only deteriorated radiographically (10% of the distal and indistinguishable groups). The men in the distal group showed greater radiographic changes and more deterioration in the terminal interphalangeal joints of the fingers than the women. Similarly they showed more deterioration of the metatarsophalangeal joints than the women. 18 patients died, one with gastric haemorrhage resulting from treatment of exfoliative psoriasis with immunosuppressive therapy, and 2 from bronchopneumonia thought to be related to immobility caused by the arthritis.
Flexible Meal-Related Dosing With Repaglinide Facilitates Glycemic Control in Therapy-Naive Type 2 Diabetes
Authors: Robert G. Moses, Ramon Gomis, Kirstine Brown Frandsen, Jean-Louis Schlienger, Ivan Dedov
Journal: Diabetes Care (2001)

OBJECTIVE— This double-blind randomized placebo-controlled parallel group study assessed the efficacy and safety (with particular regard to body weight and hypoglycemia) of repaglinide when used in a flexible mealtime dosing regimen in a situation close to everyday clinical practice. RESEARCH DESIGN AND METHODS— A total of 408 patients with type 2 diabetes considered poorly controlled by diet, but without a history of previous antidiabetic medication, were randomized to receive 0.5 mg repaglinide at mealtimes (increased to 1 mg after 4 weeks depending on blood glucose response) or placebo for 16 weeks. Patients were free to choose a flexible meal pattern, adjusting the dosing schedule from two to four preprandial doses per day in accordance with a “one meal, one dose; no meal, no dose” principle. Additional snacks were not a requirement of the treatment schedule. RESULTS— Treatment with repaglinide significantly improved glycemic control with respect to baseline and placebo, reducing HbAlc by 1.14% from baseline and fasting plasma glucose by 1.8 mmol/l. Improvement in glycemic control was independent of the meal pattern adopted by patients, including those most commonly taking two or four meals daily, with no correlation between meal pattern and risk of hypoglycemia. The improvement in glycemic control was also independent of degree of obesity and age ≤65 or &amp;gt;65 years. There was no significant body weight increase in the repaglinide group. CONCLUSIONS— Mealtime dosing with repaglinide is effective in improving overall glycemic control in type 2 diabetic patients for which control is suboptimal using diet alone. Patients are able to vary their meal pattern from a conventional regimen of three meals daily without compromising control or increasing the risk of adverse events.