tbuckley/cabot-search huggingface dataset:
TV: Jamie's School Dinners
Authors: Des Spence
Journal: BMJ (2005)

This series was more terrifying than The Exorcist. Jamie Oliver—loudmouth, Essex boy, school failure, and now celebrity chef—sets out to bring healthy school dinners to a whole London borough. His four part info-doc could have been dismissed as a self serving publicity stunt, but nothing prepared viewers for the real life horror they were to endure—lines of children shuffling along waiting for burgers, chicken nuggets, pizza, and chips, all washed down with carbonated syrup.

We are told it's “what they want” and “it's all that they will eat.” Jamie, however, has a different view and, seasoning his speech with a tasty collection of well chosen expletives, he lets the schools have it. This is junk and should be in a trough. These foods are mechanical reclaimed meat mashed up with fat, sprinkled with fluorescent bread dust, flavoured with 20 different preservatives and colours, then deep fried for extra goodness. Refined sugar is the omnipresent ingredient.​ingredient.




Figure 1





Saving the children: Jamie Oliver (left)

Credit: CHANNEL 4




Jamie's despair is real and powerful. This soon turns to anger when he meets the once mighty dinner ladies, now reduced to little more than food hygiene technicians. They seem fearful of contact with raw ingredients, but they needn't worry—there are none. School dinners were contracted out years ago to the private sector. This now means that 37p is the average cost of each meal. Jamie is lost.

His salvation comes in the guise of a charismatic, Irish dinner lady called Nora who has an even bigger gob than Jamie. These two walking megaphones, fighting back to back, take on the establishment. They “ban the junk,” introduce noodles, veg, pasta, bread, and soups. War breaks out with kids boycotting this healthy “junk.” We even see a child vomiting up a “healthy” meal—fortunately his head doesn't do a 360 degree turn.

It takes time but they do it. Even the most suspicious of children start eating Jamie's dinners. On this healthy diet the schools anecdotally report better conduct and a reduction in the use of asthma drugs. Jamie asserts a widely held view that the explosion in conduct problems is linked to the consumption of processed foods and lack of exercise.

Jamie and Nora are on a roll and meet Charles Clarke (the then education secretary) to promote better school meals. Jamie is offered a dish of junk platitudes, all deep fried in the oil of political expediency as we later learn that “junk food,” obesity, constipation, diabetes, and premature death are to stay on our children's menus.

These programmes are the talk of middle class dinner parties. Hushed voices and furtive looks reflect the shame as even in our suburban wonderland most kids get this same junk food from their parents—“it is just so much easier.”

These programmes were a must-see. Jamie Oliver has done more for the public health of our children than a corduroy army of health promotion workers or a £100m Saatchi & Saatchi campaign. Jamie might be more Dagenham than doctor but I know who I want cooking the nation's school dinners.
PTH-245 Endoscopic removal of buried bumper pegs. outcome of a novel technique from a district general hospital
Authors: H Robertson, S Harding, S McLaughlin
Journal: Gut (2015)

<h3>Introduction</h3> Buried Bumper syndrome is a known complication following PEG tube insertion. Migration of the internal bumper into the gastrostomy tract may lead to tube blockage or abdominal wall infection. Several removal techniques have been described including balloon push or pull traction, needle-knife technique, foreceps pull, snare technique and external traction. We describe the outcome of a case series from our institution using a novel technique described in 2010 by a German group<sup>1</sup>which utilises a metal rod. To our knowledge, outcomes following this procedure have not yet been reported. <h3>Method</h3> We maintain a prospective endoscopy database. Electronic case notes were reviewed. Demographic, procedural, safety and outcome data in all patients were recorded. <h3>Results</h3> 15 procedures of buried bumper PEG removal were undertaken in 12 patients during the period July 2010 to December 2014 by the same endoscopist. Mean age; 67(range 38–90). 10 were male (82%). 11 of 12 (92%) were considered to lack capacity to consent. Indications for initial PEG insertion were: stroke (6), brain injury (3), Huntington’s Chorea (1), Cerebral Palsy (1), Multiple Sclerosis (1). 12 of 15 (80%) buried PEG bumpers were removed using the device. The procedure was unsuccessful in 3 (20%) patients who subsequently underwent a mini-laparotomy. 3 (20%) patients developed aspiration pneumonia following the procedure at a mean of 5 days (range 2–8 day). 1 of these was from the surgical group and 2 from the endoscopically managed group. The 2 in the endoscopy group were successfully managed with antibiotics. In 3 patients (20%) the procedure was performed as a day case. 12 (80%) required inpatient stay following the procedure. Mean length of stay was 7 days. (Range 1–22 days.) 1 patient developed bleeding from the old PEG site post procedure and required endoscopic intervention. 30 day mortality in the group that underwent surgery was 33% (1 patient). Cause of death was aspiration pneumonia. In the endoscopically managed group, the 30 day mortality was 0%. One year mortality was 33% for the surgical group and 8% in the endoscopically managed group. <h3>Conclusion</h3> Our data suggests that this procedure is safe and effective, particularly when compared to the surgical alternative in this high risk group. The success rate of this procedure was high, suggesting that by utilising this technique, surgery can be avoided in the majority of patients with buried bumper syndrome. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Binnebossal M, Klink CD, <i>et al</i>. Endoscopic Removal of Buried Bumper. Department of Surgery. RWTH Aachen University: Endoscopy. 2010:42:E17–18
Locally Advanced, Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline
Authors: Edward P. Balaban, Pamela B. Mangu, Alok A. Khorana, Manish A. Shah, Somnath Mukherjee, Christopher H. Crane, Milind M. Javle, Jennifer R. Eads, Peter Allen, Andrew H. Ko, Anitra Engebretson, Joseph M. Herman, John H. Strickler, Al B. Benson, Susan Urba, Nelson S. Yee
Journal: Journal of Clinical Oncology (2016)

Purpose To provide evidence-based recommendations to oncologists and others for treatment of patients with locally advanced, unresectable pancreatic cancer. Methods American Society of Clinical Oncology convened an Expert Panel of medical oncology, radiation oncology, surgical oncology, gastroenterology, palliative care, and advocacy experts and conducted a systematic review of the literature from January 2002 to June 2015. Outcomes included overall survival, disease-free survival, progression-free survival, and adverse events. Results Twenty-six randomized controlled trials met the systematic review criteria. Recommendations A multiphase computed tomography scan of the chest, abdomen, and pelvis should be performed. Baseline performance status and comorbidity profile should be evaluated. The goals of care, patient preferences, psychological status, support systems, and symptoms should guide decisions for treatments. A palliative care referral should occur at first visit. Initial systemic chemotherapy (6 months) with a combination regimen is recommended for most patients (for some patients radiation therapy may be offered up front) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile. There is no clear evidence to support one regimen over another. The gemcitabine-based combinations and treatments recommended in the metastatic setting (eg, fluorouracil, leucovorin, irinotecan, and oxaliplatin and gemcitabine plus nanoparticle albumin-bound paclitaxel) have not been evaluated in randomized controlled trials involving locally advanced, unresectable pancreatic cancer. If there is local disease progression after induction chemotherapy, without metastasis, then radiation therapy or stereotactic body radiotherapy may be offered also with an Eastern Cooperative Oncology Group performance status ≤ 2 and an adequate comorbidity profile. If there is stable disease after 6 months of induction chemotherapy but unacceptable toxicities, radiation therapy may be offered as an alternative. Patients with disease progression should be offered treatment per the ASCO Metastatic Pancreatic Cancer Treatment Guideline. Follow-up visits every 3 to 4 months are recommended. Additional information is available at www.asco.org/guidelines/LAPC and www.asco.org/guidelines/MetPC and www.asco.org/guidelineswiki .
PWE-233 An organic marine hydrocolloid acts as a stool thickener in patients with diarrhoea and enteric hyperoxaluria due to short bowel syndrome
Authors: CS Rutter, C Tomson, MJ Lockett
Journal: Gut (2015)

<h3>Introduction</h3> Calcium oxalate is the predominant component of most renal stones; they occur in 10% of patients with bile salt and/or fatty acid malabsorption due to enteric hyperoxaluria<sup>1</sup>. Patients who have undergone extensive ileal resection, jejuno-ileal bypass surgery or a Roux-en-Y gastric bypass, whose colon remains in continuity, are at a greater risk of developing enteric hyperoxaluria. It is managed by dietary restriction of oxalate and fat, a high calcium intake, and increasing water intake to ensure a daily urine volume of more than 3 litres. The latter is difficult to achieve in patients with short bowel syndrome. Ox-Absorb<sup>® </sup>is an organic marine hydrocolloid derived from plants and seaweed and was first described in the 1980’s as a promising new treatment for enteric hyperoxaluria. It was also noted that it thickened stools and reduced stool frequency. Ox-Absorb<sup>®</sup>is unlicensed in the UK and imported on a named patient basis from the USA. When it was used by the renal physicians at North Bristol NHS Trust to reduce oxalate stone formation, patients reported beneficial effect on stool frequency and consistency. <h3>Method</h3> We conducted a retrospective case note review of all patients prescribed Ox-Absorb® in North Bristol NHS Trust. Drug history, weight, change in stool consistency and urinary oxalate levels were documented. Net reduction in tablet burden and a cost analysis of the use of Ox-Absorb<sup>®</sup>were calculated. <h3>Results</h3> 8 patients were prescribed Ox-Absorb<sup>®</sup>. 7/8 patients reported thicker stools and reduced stool frequency and there was a reduction in tablet burden (mean 8.6 tablets; range 2 to 22; median 7). Mean net reduction of tablets was 22% (median 29%). There was a cost reduction in 3/8 patients, all of whom were taking higher doses of loperamide, codeine phosphate and Creon<sup>®</sup>(£1.09, £0.57 and £0.15 per day). 3/8 patients had to stop the drug due to supply problems and all noted worsening in diarrhoea symptoms which improved on restarting the drug. Urinary oxalate was reduced in only 2/8 patients. <h3>Conclusion</h3> In this small cohort, patients who were prescribed Ox-Absorb<sup>® </sup>reported thicker stools and were able to reduce their net anti-diarrhoeal tablet burden. This was cost effective in patients taking higher doses of loperamide, codeine and Creon<sup>®</sup>. We believe a larger study of this drug relative to standard treatments is justified. <h3>Disclosure of interest</h3> None Declared.
Atherosclerotic Disease of the Aortic Arch as a Risk Factor for Recurrent Ischemic Stroke
Authors: Pierre Amarenco, A Cohen, M Hommel, T Moulin, D Leys, M-G Bousser
Journal: New England Journal of Medicine (1996)

Atherosclerotic disease of the aortic arch is found in 60 percent of patients 60 years of age or older who have had brain infarction. The aim of this study was to determine whether atherosclerotic plaques in the aortic arch are a risk factor for recurrent brain infarction and for vascular events in general (i.e., brain infarction, myocardial infarction, peripheral embolism, and death from vascular causes).For a period of two to four years, we followed a cohort of 331 patients 60 years of age or older who were consecutively admitted to the hospital with brain infarction (a total of 788 person-years of follow up). All patients underwent transesophageal echocardiography to determine whether atherosclerotic plaques were present in the aortic arch proximal to the ostium of the left subclavian artery. The patients were divided into three groups according to the thickness of the wall of the aortic arch ( < 1 mm, 1 to 3.9 mm, and > or = 4 mm).The incidence of recurrent brain infarction was 11.9 per 100 person-years in patients with an aortic-wall thickness of > or = 4 mm, as compared with 3.5 per 100 person-years in patients with a wall thickness of 1 to 3.9 mm and 2.8 per 100 person-years in patients with a wall thickness of < 1 mm (P < 0.001). The overall incidence of vascular events was 26.0, 9.1, and 5.9 per 100 person-years of follow-up in the respective groups (P < 0.001). After adjustment for the presence of carotid stenosis, atrial fibrillation, peripheral arterial disease, and other risk factors, aortic plaques > or = 4 mm thick (including the thickness of the aortic wall) were found to be independent predictors of recurrent brain infarction (relative risk, 3.8; 95 percent confidence interval, 1.8 to 7.8; P = 0.0012) and of all vascular events (relative risk, 3.5; 95 percent confidence interval, 2.1 to 5.9; P < 0.001).Atherosclerotic plaques > or = 4 mm thick in the aortic arch are significant predictors of recurrent brain infarction and other vascular events.
PTH-107 Geoepidemiology of hepatocellular carcinoma (hcc) in the island of crete. a possible role of pesticides
Authors: D Sifaki-Pistola, A Mantaka, M Koulentaki, D Samonakis, S Karageorgos, S Stratakou, E Digenakis, E Kouroumalis
Journal: Gut (2015)

<h3>Introduction</h3> Geoepidemiological data of HCC are lacking in Greece. The island of Crete has a genetically homogeneous population with minimal immigration and therefore is suitable for such studies attempting to identify a possible contribution of environmental factors in HCC. <h3>Method</h3> We used a data base of HCC patients constructed over the past 20 years in our Unit, the reference centre for liver disease in the island. Similar data bases for chronic HCV and HBV were also used. All patients had a histological confirmation of diagnosis. Recorded data included gender, date and place of birth and place of residence for the last 15 years. The geographic area of the study comprised the four prefectures of the island of Crete. Population statistics from 1980–2010 were obtained from the Hellenic Statistical Authority. 316 HCC patients, 633 HCV and 392 HBV patients were included in the study. Time-spatial methods were applied in Gis – ArcMap 10 software. A spatial statistical test that measures spatial autocorrelation (Moran`s index) was applied at a confidence level of 95%, in order to detect any possible significant difference between the spatial distribution to place of residence. Density maps with the spatial clusters configuring the prevalence of the disease of all provinces in the island were created. Kriging Interpolation method was applied, to produce a prediction map of HCC in Crete. <h3>Results</h3> HCV is present in pockets of high prevalence while HBV is more uniformly distributed. HCC is more prevalent in Eastern Crete. A significant spatial autocorrelation between HCC and either HCV (Moran’ I=0.64, p &lt; 0.001) or HBV (Moran’ I=0.74, p &lt; 0.001) was found as expected. However there is a discrepancy in the South East of Crete, where a higher prevalence of HCC than expected from the dispersion of HCV and HBV was observed. Prediction maps also identified this area as the main source of future HCC cases. This is an area where extensive use of pesticides in large green houses is widely practiced. <h3>Conclusion</h3> 1) HCC is mostly found in Eastern Crete and is broadly associated with the dispersion of chronic HCV and more so with Chronic HBV. 2) In an area with widespread use of pesticides a higher than expected spatial distribution of HCC was detected. <h3>Disclosure of interest</h3> None Declared.
Letter by Pfeiffer et al Regarding Article, “Early Structural Valve Deterioration of Mitroflow Aortic Bioprosthesis: Mode, Incidence, and Impact on Outcome in a Large Cohort of Patients”
Authors: Steffen Pfeiffer, Theodor Fischlein, Giuseppe Santarpino
Journal: Circulation (2015)

We have with interest and thoroughness read the article by Sénage et al 1 reporting a high incidence of structural valve disease (SVD) in the small Mitroflow generation 11, 12, and LX.The article, to our understanding, leaves several unanswered questions, and conclusions cannot be left uncommented.Sénage et al report a cohort 2109 patients, of whom 617 patients (29%) received Mitroflow implants.In the same time period, 1173 Carpentier-Edwards Perimount (56%), 206 Medtronic Mosaic (10%), and 113 miscellaneous (5%) bioprostheses were implanted.What was the authors' rationale for choosing 1 implant over another?As Mitroflow users, we know its advantages very well, especially now that the St. Jude Trifecta, which has similar design features but a metal frame, is on the market.The Mitroflow is mounted on a flexible frame and stent posts, which makes the whole prosthesis very flexible and makes implantation in heavily calcified, narrow, straight, and rigid roots technically much easier than any of the competitors.Especially in older, smaller women with narrow anatomy, this technology avoids the need for root enlargement from this perspective.Severe (<0.65 cm 2 /m 2 ) patient-prosthesis mismatch (PPM) occurred in a very high percentage of patients: 35% of patients receiving 19-mm and 33% of patients receiving 21-mm implants (overall 23.5%).This finding is in contrast to findings of other authors, who found PPM in 4%, 2 0.5%, 3 or even lower percentages.So the question remains whether the group has experienced the same percentage of PPM when using the other implants or whether the Mitroflow group represents a specifically problematic subgroup of patients at risk for early SVD.The authors defined rapid rise of transthoracic echocardiograms as a definition for SVD.Patients experiencing PPM in particular experience less or no left ventricular mass regression at all postoperatively.Therefore, it is imaginable, because reremodeling does not occur in this patient group, that the rise in transprosthetic gradients may reflect an ongoing increase in left ventricular hypertrophy, fibrosis, and stiffening (now called diastolic dysfunction), not necessarily SVD.How could they distinguish between these phenomena?In instances like this at our institution, we do a thorough transesophageal echocardiographic examination to detect abnormal opening patterns, stiffening, or even malopening of the bioleaflets.We also measure effective orifice area by planimetry.If the valve effective orifice area is higher than what would be expected with severe stenosis, we assume "functional" aortic stenosis rather than SVD and consider reoperation with a larger valve as the only curative treatment option.
Fibroids in a Guinea Pig (Family 13) after Partial Castration
Authors: Eli. M. Nadel, M. D.
Journal: JNCI Journal of the National Cancer Institute (1949)

Journal Article Fibroids in a Guinea Pig (Family 13) after Partial Castration Get access Eli. M. Nadel, M. D. Eli. M. Nadel, M. D. National Cancer Institute, National Institutes of Health, Public Health Service, Federal Security Agency Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 9, Issue 4, February 1949, Pages 271–275, https://doi.org/10.1093/jnci/9.4.271 Published: 01 February 1949 Article history Received: 05 August 1948 Published: 01 February 1949
Microsatellite Instability in Colorectal Cancer
Authors: K Heinimann, H Müller, Z Dobbie
Journal: New England Journal of Medicine (2000)

Colorectal cancer (CRC) is a heterogeneous disease that is caused by the interaction of genetic and environmental factors.Although it is one of the most common cancers worldwide, CRC would be one of the most curable cancers if it is detected in the early stages.Molecular changes that occur in colorectal cancer may be categorized into three main groups: 1) Chromosomal Instability (CIN), 2) Microsatellite Instability (MSI), and 3) CpG Island Methylator phenotype (CIMP).Microsatellites, also known as Short Tandem Repeats (STRs) are small (1-6 base pairs) repeating stretches of DNA scattered throughout the entire genome and account for approximately 3 % of the human genome.Due to their repeated structure, microsatellites are prone to high mutation rate.Microsatellite instability (MSI) is a unique molecular alteration and hyper-mutable phenotype, which is the result of a defective DNA mismatch repair (MMR) system, and can be defined as the presence of alternate sized repetitive DNA sequences which are not present in the corresponding germ line DNA.The presence of MSI is found in sporadic colon, gastric, sporadic endometrial and the majority of other cancers.Approximately, 15-20 % of colorectal cancers display MSI.Determination of MSI status in CRC has prognostic and therapeutic implications.As well, detecting MSI is used diagnostically for tumor detection and classification.For these reasons, microsatellite instability analysis is becoming more and more important in colorectal cancer patients.The objective of this review is to provide the comprehensive summary of the update knowledge of colorectal cancer classification and diagnostic features of microsatellite instability.
Increased prevalence of subclinical atherosclerosis in patients with hidradenitis suppurativa (HS)
Authors: Marcos A. González-López, José L. Hernández, Marina Lacalle, Cristina Mata, María López-Escobar, Raquel López-Mejías, Virginia Portilla, Patricia Fuentevilla, Alfonso Corrales, M. Carmen González-Vela, Miguel A. González-Gay, Ricardo Blanco
Journal: Journal of the American Academy of Dermatology (2016)