tbuckley/cabot-search huggingface dataset:
Weather and the pain in fibromyalgia: are they related?
Authors: E A Fors
Journal: Annals of the Rheumatic Diseases (2002)

To examine the association between fibromyalgic pain and weather to determine the nature of their interrelationship.The daily pain ratings of 55 female patients previously diagnosed with fibromyalgia were recorded on visual analogue scales (VAS) over 28 days. These ratings were then related to the official weather parameters and a composite weather variable using time series methodology. Effect sizes r were calculated from the t values and df.A composite weather variable did not significantly predict changes in pain, either the same day (t=-1.15, df=1483, p=0.25) or on the next day (t=-1.55, df=1483, p=0.12)-that is, the weather was not a factor for changes in the subjective pain of FM. Patients' pain did not predict weather change in this sample, and neither same day (t=-0. 69, df=1483, p<0.49) nor previous day pain (t=-1.31, df=1483, p<0.19) predicted weather changes. A post hoc exploratory analysis showed that those with <10 years of fibromyalgia experienced significantly greater weather sensitivity to pain (t=- 2.73, df=389, p<0.006) than those with longer illness.A statistically significant relationship between fibromyalgic pain and the weather was not found in this sample, although it is possible that a group of patients with less chronic fibromyalgia might be weather sensitive.
Autonomic control of cardiovascular functions during neonatal development and in adult sheep.
Authors: J R Woods, A Dandavino, K Murayama, C R Brinkman, N S Assali
Journal: Circulation Research (1977)

We studied the autonomic control of resting heart rate of systemic and pulmonary vascular blood pressures (BP) in chronically instrumented neonatal lambs 1-8 weeks of age. The maximum response to ganglionic blockade and sympathetic and parasympathetic antagonists was taken as an index of the magnitude of the total neural, adrenergic, and cholinergic tones. The reactivity of the circulatory parameters to adrenergic and cholinergic agonists also was investigated. All findings were compared with those in adult nonpregnant sheep studied concomitantly and with data previously obtained from term fetal lambs. The results of our studies show: (1) resting heart rate declines spontaneously throughout the 8 weeks of neonatal life approaching that of adult sheep; (2) the progressive bradycardia is not related to changes in the parasympathetic or sympathetic tone; (3) resting systemic BP is under strong neurohumoral control during the first two to three weeks of neonatal life; the control decreases progressively, becoming similar to that of adult sheep; (4) resting pulmonary artery pressure of neonatal and adult sheep has no neurohumoral control; (5) the systemic BP response of the neonate to autonomic agonists is greater than that of the term fetus and is similar to that of the adult; (6) in neonatal and adult sheep, compared to the term fetus, the pressor response to norepinephrine is accompanied by a baroreceptor-mediated bradycardia, and acetylcholine-induced systemci hypotension is accompanied by a "paradoxical" tachycardia mediated through beta-adrenergic stimulation; (7) in contrast to our finding for the fetus, the pulmonary vascular pressure of neonatal and adult sheep is unresponsive to autonomic agonists.
The need for needs assessment in continuing medical education
Authors: Geoffrey R Norman, Susan I Shannon, Michael L Marrin
Journal: BMJ (2004)

Maintenance of professional competence is a critical component of professionalism. However, traditional methods, which rely on individual self assessment, are inadequate. Conversely, legislated recertification programmes are difficult to individualise and can be perceived as draconian. What is required are better methods of standardised individual needs assessment. We suggest some possible strategies.

Like all professions medicine is granted professional autonomy by society under the assumption that its practitioners will be deemed competent on entry into practice and will maintain competence for as long as they practise. Traditionally it is the responsibility of the individual practitioner to do whatever is necessary to remain competent.

In the past maintaining one's competence was not problematic because relevant knowledge accreted slowly. Today, however, without a programme of active learning no doctor can hope to remain competent for more than a few years after graduation. One response to this challenge has been for education programmes, particularly problem based ones such as our own, to focus on the development of self assessment skills and self directed learning skills in order to equip graduates to maintain competence. The evidence, however, while not abundant, shows that this was a quixotic quest. The evidence that graduates from problem based learning are better at “keeping up” is weak.1 2 Moreover, many studies have shown that self assessment is far more difficult than we thought.3 Finally, self assessment does not emerge on graduation as a consequence of the demands of changing practice. Sibley et al observed that practitioners tend to pursue education around topics they are already good at while avoiding areas in which they are deficient and where there may be room for improvement.4 The evidence shows therefore that self monitoring programmes such as the maintenance of competence (MOCOMP) programme,5 which leave practitioners to their own devices, …
Letter: Cot deaths.
Authors: S Sivanesan
Journal: BMJ (1974)

Such side effects rule out the use of 5- FC for vulval candidiasis except where this is disabling.Such cases do, however, occur, and the patient described above has been transformed from an anxious, depressed woman to a happy housewife, all her family siharing the benefits.The 5-PC was provided by Dr. J.
Dialysis Dose and Body Mass Index Are Strongly Associated with Survival in Hemodialysis Patients
Authors: Friedrich K. Port, Valarie B. Ashby, Rajnish K. Dhingra, Erik C. Roys, Robert A. Wolfe
Journal: Journal of the American Society of Nephrology (2002)

Low dose of hemodialysis (HD) and small body size are independent risk factors for mortality. Recent changes in clinical practice, toward higher HD doses and use of more high-flux dialyzers, suggest the need to redetermine the dose level above which no benefit from higher dose can be observed. Data were analyzed from 45,967 HD patients starting end-stage renal disease (ESRD) therapy during April 1, 1997, through December 31, 1998. Data from Health Care Financing Administration (HCFA) billing records during months 10 to 15 of ESRD were used to classify each patient into one of five categories of HD dose by urea reduction ratio (URR) ranging from <60% to >75%. Cox regression models were used to calculate relative risk (RR) of mortality after adjustment for demographics, body mass index (BMI), and 18 comorbid conditions. Of the three body-size groups, the lowest BMI group had a 42% higher mortality risk than the highest BMI tertile. In each of three body-size groups by BMI, the RR was 17%, 17%, and 19% lower per 5% higher URR category among groups with small, medium, and large BMI, respectively (P < 0.0001 for each group). Patients treated with URR >75% had a substantially lower RR than patients treated with URR 70 to 75% (P < 0.005 each, for medium and small BMI groups). It is concluded that a higher dialysis dose, substantially above the Dialysis Outcomes Quality Initiative guidelines (URR >65%), is a strong predictor of lower patient mortality for patients in all body-size groups. Further reductions in mortality might be possible with increased HD dose.
Health-related utility values of patients with primary Sjögren's syndrome and its predictors
Authors: Dennis Lendrem, Sheryl Mitchell, Peter McMeekin, Simon Bowman, Elizabeth Price, Colin T Pease, Paul Emery, Jacqueline Andrews, Peter Lanyon, John Hunter, Monica Gupta, Michele Bombardieri, Nurhan Sutcliffe, Costantino Pitzalis, John McLaren, Annie Cooper, Marian Regan, Ian Giles, David Isenberg, Saravanan Vadivelu, David Coady, Bhaskar Dasgupta, Neil McHugh, Steven Young-Min, Robert Moots, Nagui Gendi, Mohammed Akil, Bridget Griffiths, Wan-Fai Ng
Journal: Annals of the Rheumatic Diseases (2013)

EuroQoL-5 dimension (EQ-5D) is a standardised preference-based tool for measurement of health-related quality of life and EQ-5D utility values can be converted to quality-adjusted life years (QALYs) to aid cost-utility analysis. This study aimed to evaluate the EQ-5D utility values of 639 patients with primary Sjögren's syndrome (PSS) in the UK.Prospective data collected using a standardised pro forma were compared with UK normative data. Relationships between utility values and the clinical and laboratory features of PSS were explored.The proportion of patients with PSS reporting any problem in mobility, self-care, usual activities, pain/discomfort and anxiety/depression were 42.2%, 16.7%, 56.6%, 80.6% and 49.4%, respectively, compared with 5.4%, 1.6%, 7.9%, 30.2% and 15.7% for the UK general population. The median EQ-5D utility value was 0.691 (IQR 0.587-0.796, range -0.239 to 1.000) with a bimodal distribution. Bivariate correlation analysis revealed significant correlations between EQ-5D utility values and many clinical features of PSS, but most strongly with pain, depression and fatigue (R values>0.5). After adjusting for age and sex differences, multiple regression analysis identified pain and depression as the two most important predictors of EQ-5D utility values, accounting for 48% of the variability. Anxiety, fatigue and body mass index were other statistically significant predictors, but they accounted for <5% in variability.This is the first report on the EQ-5D utility values of patients with PSS. These patients have significantly impaired utility values compared with the UK general population. EQ-5D utility values are significantly related to pain and depression scores in PSS.
Intestinal Mast Cell Progenitors Require CD49dβ7 (α4β7 Integrin) for Tissue-specific Homing
Authors: Michael F. Gurish, Hong Tao, J. Pablo Abonia, Anu Arya, Daniel S. Friend, Christina M. Parker, K. Frank Austen
Journal: The Journal of Experimental Medicine (2001)

Mast cells (MCs) are centrally important in allergic inflammation of the airways, as well as in the intestinal immune response to helminth infection. A single lineage of bone marrow (BM)-derived progenitors emigrates from the circulation and matures into phenotypically distinct MCs in different tissues. Because the mechanisms of MC progenitor (MCp) homing to peripheral tissues have not been evaluated, we used limiting dilution analysis to measure the concentration of MCp in various tissues of mice deficient for candidate homing molecules. MCp were almost completely absent in the small intestine but were present in the lung, spleen, BM, and large intestine of beta7 integrin-deficient mice (on the C57BL/6 background), indicating that a beta7 integrin is critical for homing of these cells to the small intestine. MCp concentrations were not altered in the tissues of mice deficient in the alphaE integrin (CD103), the beta2 integrin (CD18), or the recombination activating gene (RAG)-2 gene either alone or in combination with the interleukin (IL)-receptor common gamma chain. Therefore, it is the alpha4beta7 integrin and not the alphaEbeta7 integrin that is critical, and lymphocytes and natural killer cells play no role in directing MCp migration under basal conditions. When MCp in BALB/c mice were eliminated with sublethal doses of gamma-radiation and then reconstituted with syngeneic BM, the administration of anti-alpha4beta7 integrin, anti-alpha4 integrin, anti-beta7 integrin, or anti-MAdCAM-1 monoclonal antibodies (mAbs) blocked the recovery of MCp in the small intestine. The blocking mAbs could be administered as late as 4 d after BM reconstitution with optimal inhibition, implying that the MCp must arise first in the BM, circulate in the vasculature, and then translocate into the intestine. Inasmuch as MCp are preserved in the lungs of beta7 integrin-deficient and anti-alpha4beta7 integrin-treated mice but not in the small intestine, alpha4beta7 integrin is critical for tissue specific extravasation for localization of MCp in the small intestine, but not the lungs.
New Insights Into Transmission, Diagnosis, and Drug Treatment of &lt;EMPH TYPE="ITAL"&gt;Pneumocystis carinii&lt;/EMPH&gt; Pneumonia
Authors: Joseph A. Kovacs, Vee J. Gill, Steven Meshnick, Henry Masur
Journal: JAMA (2001)

Pneumocystis carinii has been recognized as a human pathogen for nearly 50 years. We present a case of P carinii infection that typifies clinical presentation in the era of the acquired immunodeficiency syndrome epidemic. The high incidence of P carinii pneumonia in persons infected with human immunodeficiency virus (HIV) has served to focus laboratory and clinical research efforts on better understanding the biology of the organism and on improving diagnosis, treatment, and prevention of this disease. Although inability to culture P carinii has hampered research efforts, molecular and immunologic approaches have led to the recognition that the organism represents a family of fungi with a very restricted host range and have allowed characterization of clinically relevant antigens and enzymes. Molecular epidemiologic studies have identified more than 50 strains of human-derived P carinii and have suggested that recently acquired infection, as opposed to reactivation of latent infection, may account for many cases of clinical disease. Diagnosis has been improved by the development of organism-specific monoclonal antibodies and, more recently, by polymerase chain reaction using multicopy gene targets, together with induced sputum or oral wash samples. Chemotherapeutic prophylaxis is very effective in preventing P carinii pneumonia; the combination of trimethoprim-sulfamethoxazole remains the first-line agent for both therapy and prophylaxis. Prophylaxis needs to be administered only during periods of high risk; in HIV-infected patients responding to effective antiretroviral therapies, prophylaxis no longer needs to be lifelong. Molecular studies have identified mutations in the target of sulfa drugs that appear to represent emerging resistance in P carinii. Resistance to atovaquone, a second-line agent, may also be developing.
Plasma Catecholamine Responses to Hypoglycemia in Children and Adolescents With IDDM
Authors: Robert P Hoffman, Carol Singer-Granick, Allan L Drash, Dorothy J Becker
Journal: Diabetes Care (1991)

Objective The goal of this study was to assess whether children and adolescents with insulin-dependent diabetes mellitus (IDDM) have decreased catecholamine responses to insulin-induced hypoglycemia as has been reported in adults and to explore the pathogenesis of the decreased response in terms of possible relationships to autonomic neuropathy or hyperinsulinism. Research Design and Methods A before-and-after trial on the effects of 3 days of intensive insulin therapy was conducted on 60 subjects with IDDM (age 15.4 ± 2.6 yr, duration of diabetes 7.8 ± 3.5 yr). The control group consisted of 5 children with non-growth hormone-deficient short stature (age 14.8 ± 3.2 yr). Hypoglycemia was induced with an intravenous insulin bolus (0.15–0.75 U/kg) after insulin withdrawal and 3 days of intensive insulin therapy in diabetic subjects on an inpatient basis to assess the role of hyperinsulinism in suppressing the catecholamine response to hypoglycemia. Control subjects were studied once and received an insulin bolus of 0.1 µU/kg. Autonomic neuropathy was assessed by computerized assessment of the basal R-R variation during inspiration and expiration and the pancreatic polypeptide response to hypoglycemia. Results Basal plasma catecholamine levels were lower in diabetic subjects after intensive insulin therapy than in control subjects (P = 0.008). The peak and incremental catecholamine responses after insulin withdrawal and intensive insulin therapy in IDDM subjects were significantly decreased compared with control subjects (P &amp;lt; 0.001). Peak catecholamine responses to hypoglycemia in IDDM were decreased after intensive insulin therapy (P = 0.002). This was particularly true in those with plasma glucose nadir levels of &amp;lt; 2.2 mmol (P &amp;lt; 0.001). The diminished catecholamine responses were primarily due to decreased peak epinephrine responses after intensive insulin therapy compared with insulin withdrawal (P = 0.011). There were no significant correlations between the catecholamine response to hypoglycemia and age, duration of diabetes, pancreatic polypeptide, or R-R interval. Conclusions These results suggest that children and adolescents with IDDM after insulin withdrawal have diminished catecholamine response to hypoglycemia compared with control subjects and indicate that short-term intensive insulin therapy diminishes this response further. Thus, hyperinsulinism may play a role in suppressing the catecholamine response to hypoglycemia. There is no evidence for a clinical or subclinical role of autonomic neuropathy to explain the altered catecholamine responses.
National Case-Control Study of Kaposi's Sarcoma and Pneumocystis carinii Pneumonia in Homosexual Men: Part 1, Epidemiologic Results
Authors: HAROLD W. JAFFE
Journal: Annals of Internal Medicine (1983)

To identify risk factors for the occurrence of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men, we conducted a case-control study in New York City, San Francisco, Los Angeles, and Atlanta. Fifty patients (cases) (39 with Kaposi's sarcoma, 8 with pneumocystis pneumonia, and 3 with both) and 120 matched homosexual male controls (from sexually transmitted disease clinics and private medical practices) participated in the study. The variable most strongly associated with illness was a larger number of male sex partners per year (median, 61 for patients; 27 and 25 for clinic and private practice controls, respectively). Compared with controls, cases were also more likely to have been exposed to feces during sex, have had syphilis and non-B hepatitis, have been treated for enteric parasites, and have used various illicit substances. Certain aspects of a lifestyle shared by a subgroup of the male homosexual population are associated with an increased risk of Kaposi's sarcoma and pneumocystis pneumonia.
Effect of Friend Leukemogenic Virus on Antibody-Forming Cells to a Bacterial Somatic Antigen&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: Shinji Hirano, Walter S. Ceglowski, Jerry L. Allen, Herman Friedman
Journal: JNCI Journal of the National Cancer Institute (1969)

Journal Article Effect of Friend Leukemogenic Virus on Antibody-Forming Cells to a Bacterial Somatic Antigen Get access Shinji Hirano, Shinji Hirano Departments of Microbiology, Albert Einstein Medical Center, and Temple University School of Medicine, Philadelphia, Pennsylvania 19140 Search for other works by this author on: Oxford Academic PubMed Google Scholar Walter S. Ceglowski, Walter S. Ceglowski Departments of Microbiology, Albert Einstein Medical Center, and Temple University School of Medicine, Philadelphia, Pennsylvania 19140 Search for other works by this author on: Oxford Academic PubMed Google Scholar Jerry L. Allen, Jerry L. Allen Departments of Microbiology, Albert Einstein Medical Center, and Temple University School of Medicine, Philadelphia, Pennsylvania 19140 Search for other works by this author on: Oxford Academic PubMed Google Scholar Herman Friedman Herman Friedman Departments of Microbiology, Albert Einstein Medical Center, and Temple University School of Medicine, Philadelphia, Pennsylvania 19140 Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 43, Issue 6, December 1969, Pages 1337–1345, https://doi.org/10.1093/jnci/43.6.1337 Published: 01 December 1969 Article history Received: 24 June 1969 Accepted: 09 September 1969 Published: 01 December 1969
Inhaled Budesonide in Addition to Oral Corticosteroids to Prevent Asthma Relapse Following Discharge From the Emergency Department
Authors: Brian H. Rowe, Gary W. Bota, Lucio Fabris, Sandra A. Therrien, Ruth A. Milner, John Jacono
Journal: JAMA (1999)

STHMA AFFECTS APPROXImately 7% of adults in North America, [1][2][3][4] and patients frequently present to the emergency department (ED) with acute asthma.They often exhibit features that place them at increased risk for complications and even death. 5,6Improved strategies to treat acute asthma and reduce relapses after ED visits are needed to improve patient quality of life 6 and reduce societal costs associated with this disease. 3,7ur understanding of asthma has improved over the past decade 8-10 and there is now general agreement on the primary role of inflammation in the pathophysiology of asthma.2][13] For patients with acute asthma discharged from the ED, the anti-inflammatory agents used most frequently are systemic corticosteroids (CS).There are 7 randomized, placebo-controlled trials 14-20 examining outpatient treatment of asthma with CS that have been summarized in systematic reviews. 21,22These reviews in-
The Feasibility of Detecting Neuropsychologic and Neuroanatomic Effects of Type 1 Diabetes in Young Children
Authors: Tandy Aye, Allan L. Reiss, Shelli Kesler, Sherry Hoang, Jessica Drobny, Yaena Park, Kristin Schleifer, Heidi Baumgartner, Darrell M. Wilson, Bruce A. Buckingham
Journal: Diabetes Care (2011)

To determine if frequent exposures to hypoglycemia and hyperglycemia during early childhood lead to neurocognitive deficits and changes in brain anatomy.In this feasibility, cross-sectional study, young children, aged 3 to 10 years, with type 1 diabetes and age- and sex-matched healthy control (HC) subjects completed neuropsychologic (NP) testing and magnetic resonance imaging (MRI) scans of the brain.NP testing and MRI scanning was successfully completed in 98% of the type 1 diabetic and 93% of the HC children. A significant negative relationship between HbA1c and Wechsler Intelligence Scale for Children (WISC) verbal comprehension was observed. WISC index scores were significantly reduced in type 1 diabetic subjects who had experienced seizures. White matter volume did not show the expected increase with age in children with type 1 diabetes compared with HC children (diagnosis by age interaction, P=0.005). A similar trend was detected for hippocampal volume. Children with type 1 diabetes who had experienced seizures showed significantly reduced gray matter and white matter volumes relative to children with type 1 diabetes who had not experienced seizures.It is feasible to perform MRI and NP testing in young children with type 1 diabetes. Further, early signs of neuroanatomic variation may be present in this population. Larger cross-sectional and longitudinal studies of neurocognitive function and neuroanatomy are needed to define the effect of type 1 diabetes on the developing brain.