tbuckley/cabot-search huggingface dataset:
A Patient-Designed Do-It-Yourself Mobile Technology System for Diabetes
Authors: Joyce M. Lee, Emily Hirschfeld, James Wedding
Journal: JAMA (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Case 4-2010
Authors: John H. Stone, George N. Papaliodis, Mark R. Dunbar, James R. Stone
Journal: New England Journal of Medicine (2010)

A 53-year-old man was seen in the rheumatology clinic because of arthralgias, oral ulcers, vision loss, and vocal-cord paralysis. He had been well until 19 months earlier, when generalized arthralgias developed. He was treated with corticosteroids, methotrexate, and etanercept. Fever, myalgias, joint swelling, and tinnitus developed, followed by ulcers on the tongue, odynophagia, sudden unilateral visual loss, and vocal-cord paralysis.
The fate of the clinical interview: an observational study
Authors: H L Muslin, R J Thurnblad, G Meschel
Journal: American Journal of Psychiatry (1981)

To highlight differences between data observed in patient interviews conducted by medical students and reports of these data in supervision, the authors compared the number of themes in 26 videotaped interviews with those reported by the students in supervision. They found that 54% of the themes of the videotaped interviews were not reported in supervision; 42% of the themes were reported. Some degree of distortion was present in 14 (54%) of the interviews; 6% (N = 37) of the themes identified were distorted. The authors conclude that the training of students in psychiatry must include careful attention to observation of the manifest details of the actual patient interview conducted by the student.
Case 3-2004
Authors: Donald S. Kaufman, William U. Shipley, W. Scott McDougal, Robert H. Young
Journal: New England Journal of Medicine (2004)

Presentation of CaseA 57-year-old man came to this hospital for bladder-sparing treatment of invasive transitional-cell carcinoma of the bladder.He had had a slight burning sensation on urination for six months, and then he observed gross hematuria. Cystoscopy at another institution revealed a midline, posterior-wall mass, 3.0 by 3.0 by 1.4 cm, that involved the left ureteral orifice and that extended to the left lateral bladder wall. The mass was resected by the transurethral route, and pathological examination revealed transitional-cell carcinoma, grade 3 of 3, with invasion of the muscularis propria (Figure 1). There was invasion of the prostatic . . .
A mesenchymal/stem cell predictor of survival of patients with malignant gliomas.
Authors: E. P. Sulman, M. Guerrero, T. Mikkelsen, V. Bonato, H. S. Phillips, M. S. Berger, P. Collins, B. Broom, K. Do, K. D. Aldape
Journal: Journal of Clinical Oncology (2010)

2049 Background: Identification of the molecular subtypes of diffuse gliomas will guide therapy and risk stratification. Attempts to dissect the biologic diversity of these tumors using array data have been limited to small cohort sizes or to a single histologic subtype. We proposed to overcome these limitations by unifying data from multiple series. Methods: Public and unpublished Affymetrix arrays data were compiled and samples with raw intensity files and clinical annotation were included. Unsupervised clustering was performed to identify major subgroups. Data from 517 tumors were randomly divided into training and validation sets for predictive modeling. Candidate models were evaluated by cross-validation. An independent verification cohort (n = 328) was used for further validation. Stem cell array data were obtained from published sources. Uni/multivariate correlations and survival analyses were performed to published radiation-associated and oncogene-pathway signatures. Results: Two primary molecular subtypes of gliomas, each with distinct survival outcomes, were observed by unsupervised analyses. Genes in the subtype whose expression correlated with poorer survival were associated mesenchymal ontology and characterized the majority of, in contrast to the lower grade tumors. The signature correlated with a glioma stem cells (GSC) profile. Predictive modeling identified a robust prognostic model in both training and primary validation sets (accuracy > 85%) and was validated on an independent data set, including cases from the Cancer Genome Atlas. The mesenchymal signature was correlated with radiation and ras and src oncogene pathway signatures (p < 0.0001) and was an independent predictors of survival. Conclusions: Using the largest reported unified glioma expression profiling dataset we identified a mesenchymal signature associated with poor survival and which correlated to a GSC-specific signature. We used this dataset to develop a robust prognostic marker of patient survival which outperforms existing clinico-pathologic factors, such as age and grade, and which was validated on an independent dataset. Based on its radiation/oncogene association, this predictor may be useful in guiding treatment. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Castle Biosciences, Inc.
Anaphylaxis Preparedness Initiative for Allergen Immunotherapy – Implementation of a Policy for Carrying Autoinjectable Epinephrine
Authors: Ahila Subramanian, Lisanne P. Newton, David M. Lang, Tanya Gobel, Kathleen M. Caruso, Katrina Zell, Xiaofeng F. Wang
Journal: Journal of Allergy and Clinical Immunology (2016)
The Use of Levo-Dromoran Tartrate (Levorphan Tartrate) for Relief of Postoperative Pain
Authors: Robert D. Hunt, Francis F. Foldes
Journal: New England Journal of Medicine (1953)

IT HAS long been recognized that the spatial configuration of optically active compounds can exert an important influence on their pharmacologic action.1 Either the levorotatory or the dextrorotatory form of such compounds may have a greater pharmacodynamic effect on certain tissues than its optical antipode. Usually, the levorotatory isomers are more powerful, but sometimes — for example, with amphetamine2 or acetylmethadol3 — the dextroisomer has greater activity. Occasionally the activity of one of the isomers is negligible.4 In other cases competitive antagonism exists between the two isomers. This has been shown for Neo-Synephrine and Sympatol.2 Recently, a new synthetic, morphine-like . . .
Soundings: Youthful aspirations
Authors: Kevin Barraclough
Journal: BMJ (2002)

On an unexpectedly free afternoon I set off on my bicycle through the unexplored lanes. It was a still, clear day, with a low, watery sun. After several miles I left the lane and entered some woods. Each ride looked the same under the trees and I quickly lost all sense of direction. When I emerged I was looking at a view I had not seen for 20 years. Caught in the horizontal sunlight on the other side of the steep river valley was the Italianate manor where I had spent my school years.

I am not quite sure why I have returned so rarely to the school I left a quarter of a century ago. I do not recall either undue unhappiness, or happiness—only an intensity of experience beside which those of adulthood seem somewhat faded. But I do feel a little shame when measured against all the things I had planned, in those adolescent years, to do with my life.

My aspirations did not seem unreasonable at the time. I think I intended to create the Grand Unified Field theory that had eluded Einstein in his last half century. Fermat's Last Theorem may have come into it, and I certainly wanted to write the definitive novel of the decade. On the other hand I was fairly realistic about some things. I knew I was unlikely to become the second Bill Wyman on bass, and I was never going to get to sleep with Sue Stanway, even if I dealt with my acne. But mostly, anything seemed possible.

My hubris was not peculiar to myself and originated, I suppose, from a general certainty that is characteristic of youth. But there was also a particular spirit of the early 1970s that, I suspect, was not unlike the boundless confidence of those first few decades that sparked the Renaissance. “A man can do all things if he wills,” wrote the archetypal Renaissance man Alberti. It seems an oddly naive belief now, but seemed less so then.

When I got back, weary and muddy from the bike ride, I heard someone on the radio commenting about Bill Wyman reaching 65 and becoming a pensioner. “I thought he was a pensioner years ago,” said one young woman. “He already looks like a scrotum with sunglasses,” said another. “Or a tortoise with a disregard for sun creams.” They broke into peals of irreverent laughter. Have the young no respect?
Cigarette, Cigar, and Marijuana Use Among High School Students — United States, 1997–2013
Authors: Italia V. Rolle, Sara M. Kennedy, Israel Agaku, Sherry Everett Jones, Rebecca Bunnell, Ralph Caraballo, Xin Xu, Gillian Schauer, Tim McAfee
Journal: MMWR Morbidity and Mortality Weekly Report (2015)

What is already known on this topic? Since 2010, the proportion of U.S. 12th grade students who reported using marijuana during the preceding 30 days (21.4%) has surpassed the proportion reporting use of cigarettes during the preceding 30 days (19.2%).What is added by this report? During 1997–2013, the proportion of white, black, and Hispanic high school students overall who were exclusive cigarette or cigar users decreased 64%, from 20.5% to 7.4%. The proportion of white, black, and Hispanic students who were exclusive marijuana users more than doubled from 4.2% to 10.2%, and among cigarette or cigar users, marijuana use increased, with considerable increases identified among black and Hispanic students toward the end of the study period.What are the implications for public health practice? Despite significant declines since 1997, approximately 30% of white, black, and Hispanic U.S. high school students were current users of cigarettes, cigars, or marijuana in 2013. Policy and programmatic efforts might benefit from integrated approaches that focus on reducing the use of tobacco and marijuana among youths.
Patterns of personality disorder comorbidity in early-onset versus late- onset major depression
Authors: M Fava, J E Alpert, J S Borus, A A Nierenberg, J A Pava, J F Rosenbaum
Journal: American Journal of Psychiatry (1996)

This study tested the hypothesis that in a population of adult outpatients with major depression, those with an early onset of depression would have a greater prevalence of personality disorders than those with a late onset of depression.The 404 subjects were patients participating in depression treatment studies at the Massachusetts General Hospital. They were administered the Structured Clinical Interview for DSM-III-R-Patient Version to assess the current presence of major depression and the age at onset of the initial depressive episode. The subjects were then divided into two groups: those with early onset (before 18 years of age) and those with late onset (at age 18 or later). The prevalence of personality disorders was determined through use of the physician-rated Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the patient-rated Personality Diagnostic Questionnaire-Revised (PDQ-R).The patients with early onset of major depression had a significantly higher prevalence of avoidant, histrionic, narcissistic, and borderline personality disorders according to the SCID-II. The PDQ-R scores indicated that avoidant, dependent, passive-aggressive, histrionic, narcissistic, borderline, and antisocial personality disorders were significantly more prevalent among the patients with early onset of major depression.Overall, the results are consistent with the view that early-onset depressive illness is distinguished from late-onset major depression by more frequent association with persistent disturbances in behaviors and attitudes.
Mutation of the Androgen-Receptor Gene in Metastatic Androgen-Independent Prostate Cancer
Authors: Mary-Ellen Taplin, Glenn J. Bubley, Todd D. Shuster, Martha E. Frantz, Amy E. Spooner, George K. Ogata, Harold N. Keer, Steven P. Balk
Journal: New England Journal of Medicine (1995)

Metastatic prostate cancer is a leading cause of cancer-related death in men. The rate of response to androgen ablation is high, but most patients relapse as a result of the outgrowth of androgen-independent tumor cells. The androgen receptor, which binds testosterone and stimulates the transcription of androgen-responsive genes, regulates the growth of prostate cells. We analyzed the androgen-receptor genes from samples of metastatic androgen-independent prostate cancers to determine whether mutations in the gene have a role in androgen independence.
Idiopathic Paroxysmal Myoglobinuria with Acute Renal Failure and Hypercalcemia
Authors: A. S. Tavill, J. M. Evanson, S. B. de C. Baker, Venise Hewitt
Journal: New England Journal of Medicine (1964)

IDIOPATHIC paroxysmal myoglobinuria, variously described as paroxysmal paralytic myoglobinuria, idiopathic recurrent rhabdomyolysis with myoglobinuria and spontaneous myoglobinuria, is a rare disorder of voluntary muscle characterized by episodes of muscle pain and weakness and the passage of myoglobin in the urine. Other rare causes of myoglobinuria such as convulsive attacks, peripheral vascular disease with ischemia, the crush syndrome and electrocution have a visible basis in identifiable muscle damage. Any of these conditions may give rise to renal impairment, and death from acute renal failure may occur.1 2 3 In the case presented below, which was of the idiopathic type and not associated with . . .
Circulating tumor cells (CTC) and circulating endothelial cells (CEC) in patients (pts) receiving adjuvant bevacizumab (B) plus dose-dense (dd) doxorubicin/cyclophosphamide (AC) followed by nab-paclitaxel (nab-P) for early-stage breast cancer (ESBC).
Authors: M. E. Melisko, S. Greenberg, M. N. Dickler, M. M. Moasser, J. H. Scott, A. N. DeLuca, D. H. Moore, C. Hudis, J. W. Park, H. S. Rugo
Journal: Journal of Clinical Oncology (2010)

579 Background: Women with high risk ESBC remain at substantial risk of relapse despite adjuvant chemotherapy (AT). Current testing does not completely stratify individual risk of relapse, or assess response to AT. CTC predict outcome in metastatic BC, and CEC have been associated with response to antiangiogenic therapy. We evaluated CTC and CEC during AT plus the angiogenesis inhibitor B. Methods: In a phase II trial at 2 centers,80 pts with HER2- ESBC were treated with q2 week AC (60/600 mg/m2) × 4 followed by q2wk nab-P (260 mg/m2) × 4 with pegfilgrastin on day 2 plus B for one year (10 mg/kg IV q2wk × 8 with chemotherapy then 15 mg/kg q3wk); radiation and endocrine therapy per standard of care. The primary endpoint was cardiac safety. Blood for CTC and CEC was analyzed at baseline, week 2, 8, 16 and q3 mo for 12 mo. CTC were measured using a 2 step analysis. Cells were enriched using anti-EpCAM coated immunomagnetic beads; CTC were analyzed by multiparametric flow cytometry (FC) and defined as EpCAM+, CD45-, with thioflavin as a nucleic acid marker. CEC were evaluated by FC and defined as CD45-, CD31+ or CD146+ and CD34+ and with low side scatter. Results: 80 pts were enrolled; 16 patients withdrew early due to toxicity. Median FU is 33 mo (range [R] 0.5- 40 mo). 10 pts have relapsed; median TTP is 19.5 mo (R 0.5- 27 mo). Cardiac toxicity data has been presented (Dickler et al, ASCO 2007). Baseline median CTC was 0.28 (R 0 - 96). Baseline median CEC was 11.65 for CD31+ and 2.21 for CD146+. Baseline CTC predicted recurrence; p=0.002 for CTC as a continuous variable and p = 0.03 using a cutpoint of 1 by Wilcoxon log-rank test. CEC at baseline did not predict progression. CTC did not change over time (p = 0.16); CEC decreased - 0.5/week for CD31+ (p < 0.001), and -0.04/wk for CD146+ (p = 0.001). Conclusions: CTC at baseline predicted recurrence, and CEC continuously decreased during dd AC/nab-P combined with B. CTC have the potential to stratify pts at increased risk of recurrence at baseline, and reduction in CEC may be a marker of B effect. Further FU is required to evaluate the prognostic value of serial CTC and CEC. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Genentech Abraxis BioScience, Genentech Abraxis BioScience, Genentech
Use of Mannitol in Exogenous and Endogenous Intoxications
Authors: William J. Cirksena, Robert C. Bastian, John P. Malloy, Kevin G. Barry
Journal: New England Journal of Medicine (1964)

THE use of mannitol for osmotic diuresis has largely been confined to the laboratory and has so far had only limited clinical application. Recently, however, its clinical usefulness in the diagnosis and therapy of oliguric states1 and in the prevention of acute functional renal failure2 , 3 has been emphasized. The effectiveness of mannitol in markedly augmenting urine flow has suggested its application in the treatment of acute intoxications due to endogenous and exogenous substances available for renal excretion.Osmotic diuresis was first applied therapeutically in patients with barbiturate intoxication by Ohlsson4 and subsequently by Mollaret et al.5 with urea. Lassen6 recently . . .
Pharmacokinetic and local tolerability profiles of three potential fentanyl nasal spray formulations developed for breakthrough cancer pain compared with oral transmucosal fentanyl citrate
Authors: D. R. Taylor, A. N. Fisher, A. Smith, M. Watling, A. Knight, N. Y. Gabrail
Journal: Journal of Clinical Oncology (2009)

e20554 Background: The nasal route offers the ability to enhance fentanyl delivery and better match the rapid onset and short duration (30–60 min) of breakthrough cancer pain compared with standard oral delivery. However, conventional nasal fentanyl solutions can be associated with variable, and sometimes supratherapeutic maximum plasma concentrations (C max ). To optimise rapid absorption and delivery, three novel nasal spray formulations have been developed: fentanyl pectin nasal spray (FPNS), fentanyl chitosan nasal spray (FChNS), and fentanyl in chitosan-poloxamer 188 solute (FChP). Methods: This phase I, open-label, crossover study was conducted in 18 healthy adult volunteers to compare the pharmacokinetic profiles of the three new nasal fentanyl formulations with oral transmucosal fentanyl citrate (OTFC). Subjects were dosed on four occasions, separated by a &gt;3-day washout period, under naltrexone blockade, with the nasal sprays (each containing fentanyl citrate 100μg in 100μL) and OTFC 200μg according to a randomized sequence. Venous plasma fentanyl concentrations were measured before and up to 24 hours post-dose. Local nasal tolerability was assessed by a clinician and a reactogenicity questionnaire. Results: Compared with OTFC, mean AUCs ∞ for all three nasal sprays were significantly higher (P&lt;0.05) and bioavailability significantly greater (FPNS 132%; FChNS 154%, FChP 122%). Median t max (FPNS 19.8min; FChNS 10.2min, FChP 15.6min) were significantly (P&lt;0.001) reduced (OTFC 90min) and mean C max significantly increased with all nasal sprays compared with OTFC. Of the three nasal sprays, FPNS had the lowest nasal reactogenicity symptom incidence. Conclusions: Compared with OTFC, all three fentanyl nasal spray formulations demonstrated enhanced pharmacokinetic profiles appropriate for breakthrough cancer pain as evidenced by significantly increased systemic exposure and reduced times to peak plasma values. FPNS exhibited the most favourable tolerability profile. [Table: see text]
Management of Occupational Exposures to Blood-Borne Viruses
Authors: J L Gerberding
Journal: New England Journal of Medicine (1995)

Exposures to blood-borne pathogens pose a serious occupational threat to health care workers. Safer needle devices for performing phlebotomy and other procedures and universal infection-control precautions will not completely eliminate the risk, and prophylactic treatment will remain an important component of prevention efforts. This article will review post-exposure care for the three blood-borne pathogens that are most commonly involved in occupational transmission — hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).Assessment of ExposureOccupational exposures include contact of the eyes, mouth, other mucous membranes, or broken skin and parenteral contact with blood or other . . .
The Effects of Pyromen Administered Intravenously in Subpyrexial Doses to Depressed Patients
Authors: Edna M. J. Fitch, Annette C. Washburne
Journal: New England Journal of Medicine (1951)

PYROMEN is a sterile, nonprotein, nonana-phylactogenic extract of Pseudomonas aemginosa and Proteus vulgaris prepared as a colloidal dispersion in normal saline for intravenous use.1 , 2 Pharmacologically, it is a pyrogen of a high degree of reliability and a low order of toxicity. Chemical analysis has identified it as a complex polysaccharide.1 2 3 4 Study of the histologie and physiologic effects in animals revealed some ACTH-like effects.3 4 5 6 Clinical evaluation was directed toward its efficacy not only as a pyrexial agent but also as a stimulant of the pituitary-adrenal axis in those diseases believed to respond to ACTH.7 8 9 10 11 In certain allergic states it proved beneficial . . .
Case 17-2000
Authors: Craig A. Peters, G. Petur Nielsen
Journal: New England Journal of Medicine (2000)

Presentation of CaseA 21-week-old girl was admitted to the hospital because of fever.The infant had been born by normal spontaneous vaginal delivery to a 37-year-old nulliparous woman after a full-term, uncomplicated pregnancy. The mother had endometritis after delivery. The infant's birth weight was 2840 g. All immunizations were up to date, and growth and development were normal.The infant was well until two weeks before admission (four weeks after having started to attend a day-care program), when fever developed. She was given acetaminophen, but her temperature rose to 38.3°C during the next several days. Ten days before admission . . .