tbuckley/cabot-search huggingface dataset:
PTU-085 Exploring consultant physicians’ attitudes and beliefs towards barriers to advance care planning and palliative care in end stage liver disease
Authors: L Gelmon, L Macken, L Mason, S Verma
Journal: Gut (2017)

Introduction  Liver disease is a major cause of morbidity and mortality – in the United Kingdom it is the third most common cause of premature death. Mortality rates have increased by over 400% since 1970 and continue to rise. Existing literature suggests that communicating the life-limiting nature of end stage liver disease (ESLD) to patients and subsequent referral to palliative care services is lacking. This study aims to explore the attitudes and beliefs of physicians toward ESLD and consider perceived barriers affecting the provision of palliative care.  Method  An online survey exploring attitudes and beliefs towards ESLD and perceived barriers to palliative care was sent to consultants within Southeast England. The survey consisted of both open and closed responses. Qualitative results were analysed according to iterative themes and Likert-type responses were tabulated.  Results  A total of 16 of 41 (39%) sampled consultants completed the survey, 8 were gastroenterologists; 3 also identified as being hepatologists. Salient themes that emerged included the belief that patients with ESLD are approached differently to those with cancer, physicians feel less confident in managing patients with ESLD compared with other diseases, patients with ESLD do not receive equitable palliative care compared to those with advanced cancer and there is a reluctance amongst physicians to instigate end of life discussions in those with ESLD. Differences in approaches were associated with inadequate understanding of disease progression, lack of disease awareness from both patient and professional perspectives, limited predictability of prognosis, reliance on specialist hepatology teams to initiate prognostic discussions and discomfort with the subject of palliative care in ESLD patients.  Conclusion  This formative study provides evidence that consultants feel confident in recognising ESLD yet are less clear on aspects of prognosis and initiation of advance care planning. Despite the small sample size and low response rate, which limits the generalisability of the findings, themes for further exploration emerged, particularly the incongruity between the identification of those with ESLD and influence on practice in terms of further management and palliative care. Additional themes for further development include raising disease awareness among healthcare professionals and patients, improving identification of patients with or at-risk of developing ESLD as well as earlier discussions regarding prognosis and palliative care involvement. Given the rising prevalence of chronic liver disease nationally, addressing the gaps in management and end of life care for this vulnerable cohort is vital.  Disclosure of Interest  None Declared
Warfarin Use Is Associated With Progressive Coronary Arterial Calcification
Authors: Jordan Andrews, Peter J. Psaltis, Ozgur Bayturan, Mingyuan Shao, Brian Stegman, Mohamed Elshazly, Samir R. Kapadia, E. Murat Tuzcu, Steven E. Nissen, Stephen J. Nicholls, Rishi Puri
Journal: JACC. Cardiovascular imaging (2017)
Experimental Roentgen Injury. I. Effects on the Tissues and Blood of C3H Mice Produced with Single Small Whole-Body Exposures
Authors: Paul S. Henshaw
Journal: JNCI Journal of the National Cancer Institute (1944)

Experimental Roentgen Injury. I. Effects on the Tissues and Blood of C3H Mice Produced with Single Small Whole-Body Exposures Get access Paul S. Henshaw Paul S. Henshaw senior radiobiologist National Cancer Institute, National Institute of Health, United States Public Health Service1 Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 4, Issue 5, April 1944, Pages 477–484, https://doi.org/10.1093/jnci/4.5.477 Published: 01 April 1944
Resilient or reckless? Robust debate on risk and reward in sport
Authors: Jon Patricios
Journal: British Journal of Sports Medicine (2017)

Strong, vigorous, sturdy and rugged are all synonyms applicable to the word ‘robust’.1 A glass of full-bodied South African cabernet sauvignon may also be described by the sommelier as ‘robust’ and I hope that this South African Sports Medicine Association (SASMA) edition of BJSM will linger on your intellectual palate as it highlights key issues around the debate on contact and collision sport.

The infographic ( see page 1165 ) highlights the many benefits of exercise for children. Do these benefits extend to contact and collision sports or are the risks indefensible? The ‘risk-and-reward’ discussion is fascinating as it spans the realms of both scientific and public debate. This can be treacherous territory.

Implementing robust scientific findings into practice is what we strive for, but when does private and public opinion begin to inform ‘scientific’ work? Professor Allyson Pollock and a group of ‘70 academics, doctors and public health professionals’ sent an open letter to the …
Screening Pelvic Examinations—Reply
Authors: David C. Grossman, Kirsten Bibbins-Domingo, Susan J. Curry
Journal: JAMA (2017)

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
The royal free hospital cirrhosis glomerular filtration rate: Validation in a danish cohort
Authors: Julie Steen Pedersen, Nina Kimer, Jens H. Henriksen, Flemming Bendtsen, Søren Møller
Journal: Hepatology (2017)

Potential conflict of interest: Nothing to report. Julie Steen Pedersen has received grants from Novo Nordisk and the Toyota Foundation. Nina Kimer, Flemming Bendtsen, and Søren Møller have received a grant from the Capital Region of Denmark. TO THE EDITOR: Although renal impairment is a frequent complication in cirrhosis, accurate determination of renal function in the decompensated patient remains challenging. Assessment of glomerular filtration rate (GFR) can be performed by 51‐chromium‐ethylene diamine tetraacetic acid (51Cr‐EDTA), which is considered the gold‐standard technique, but is technically challenging and expensive. We read with great interest the article recently published in Hepatology by Kalafateli et al.1 The researchers developed and validated a new algorithm (Royal Free Hospital cirrhosis GFR = RFH cirrhosis GFR) for estimating GFR in the patient with cirrhosis. The investigators found that this algorithm was more accurate in estimating GFR than current equations. In a randomized, controlled trial, we recently measured GFR with use of 51Cr‐EDTA in 54 decompensated patients with cirrhosis (median Model for End‐Stage Liver Disease score, 11; range, 6‐25).2 We therefore found it of interest to validate the RFH cirrhosis GFR algorithm in our cohort comprising a total of 101 51Cr‐EDTA and RFH cirrhosis GFR data sets. GFR was estimated with the proposed RFH cirrhosis GFR equation: GFR = 45.9 × (creatinine−0·836) × (urea−0·229) × (international normalized ratio−0·113) × (age−0.129) × (sodium0·972) × 0.809 (if female) × 0.92 (if moderate/severe ascites). In our patients, GFR was measured twice with a 4‐week interval. If the patient had moderate or severe ascites, a paracentesis was performed the day before 51Cr‐EDTA GFR measurement. Blood samples for measurement of 51Cr‐EDTA were taken at 180, 195, 330, and 240 minutes after injection as described.2 This method may, however, overestimate GFR in patients with ascites with 3.6 mL/min/1.73 m2.3 We found a significant median difference (P = 0.000) between measured 51Cr‐EDTA GFR (median, 74.4 mL/min/1.73 m2; interquartile range [IQR], 57.9‐87.9) and the estimated RFH cirrhosis GFR (median, 65.6; IQR, 52.5‐83.1 mL/min) of 5.9 mL/min (IQR –5.9 to 17.7). A scatter plot (Fig. 1) of 51Cr‐EDTA GFRs and the corresponding RFH cirrhosis GFR resulted in the regression line y = 17.81 + 0.67*x and a strong correlation of 0.76 (P = 0.000).Figure 1: Scatter plot illustrating the corresponding 51Cr‐EDTA GFR (mL/min/1.73 m2) and RFH cirrhosis GFR (mL/min) values.In our hands, validation of the RFH cirrhosis GFR equation showed a slight underestimation (median, 5.9 mL) of GFR by RFH cirrhosis GFR. This result supports that the RFH GFR equation is useful as a screening procedure for renal function. However, it should be brought in mind that underestimation of the GFR may have consequences for patient management such as in the prioritizing for liver transplantation on the waiting list.
Refinement of cytogenetic classification in AML: determination of prognostic significance of rare recurring chromosomal abnormalities amongst patients entered into the UK MRC AML 10 & 12 trials.
Authors: David Grimwade, A Moorman, M P Holt, H Walker, S Chatters, C J Harrison, I Hann, J Rees, R Stevens, D K H Webb, B E Gibson, A H Goldstone, A K Burnett, K Wheatley
Journal: Blood (2002)
Strategies to Improve Private-Well Water Quality: A North Carolina Perspective
Authors: Jacqueline MacDonald Gibson, Kelsey J. Pieper
Journal: Environmental Health Perspectives (2017)

Background: Evidence suggests that the 44.5 million U.S. residents drawing their drinking water from private wells face higher risks of waterborne contaminant exposure than those served by regulated community water supplies. Among U.S. states, North Carolina (N.C.) has the second-largest population relying on private wells, making it a useful microcosm to study challenges to maintaining private-well water quality. Objectives: This paper summarizes recommendations from a two-day summit to identify options to improve drinking-water quality for N.C. residents served by private wells. Methods: The Research Triangle Environmental Health Collaborative invited 111 participants with knowledge of private-well water challenges to attend the Summit. Participants worked in small groups that focused on specific aspects and reconvened in plenary sessions to formulate consensus recommendations. Discussion: Summit participants highlighted four main barriers to ensuring safe water for residents currently relying on private wells: (1) a database of private well locations is unavailable; (2) racial disparities have perpetuated reliance on private wells in some urbanized areas; (3) many private-well users lack information or resources to monitor and maintain their wells; and (4) private-well support programs are fragmented and lack sufficient resources. The Summit produced 10 consensus recommendations for ways to overcome these barriers. Conclusions: The Summit recommendations, if undertaken, could improve the health of North Carolinians facing elevated risks of exposure to waterborne contaminants because of their reliance on inadequately monitored and maintained private wells. Because many of the challenges in N.C. are common nationwide, these recommendations could serve as models for other states. https://doi.org/10.1289/EHP890
Vitamin D Insufficiency Is Associated with an Increased Risk of Early Clinical Failure in Follicular Lymphoma
Authors: Sean I. Tracy, Matthew J Maurer, Thomas E. Witzig, Matthew T. Drake, Stephen Ansell, Grzegorz S. Nowakowski, David James Inwards, Carrie A Thompson, Patrick B. Johnston, Ivana Micallef, Cristine Allmer, William R. Macon, George J Weiner, Susan L. Slager, Thomas M. Habermann, Brian K Link, James R Cerhan
Journal: Blood (2016)
Intelligent oxygen delivery in the acute setting: “Don't think twice, it's all right”
Authors: João Carlos Winck
Journal: European Respiratory Journal (2017)

In 1917 Haldane published "The therapeutic administration of oxygen" and started the era of oxygen therapy [1]. Nowadays, supplemental oxygen is a vital part of pre-hospital and hospital trauma care, the practice of anaesthesia, the management of most forms of respiratory distress and the treatment of many other acute and chronic medical conditions [2]. Automated targeted oxygen therapy improves oxygen titration in the acute setting <http://ow.ly/B2sw30cAalO> This editorial is dedicated to my late father José Guilherme Cruz, who passed away at 99, while I was preparing it.
Association of Hospital Market Concentration With Costs of Complex Hepatopancreaticobiliary Surgery
Authors: Marcelo Cerullo, Sophia Y. Chen, Mary Dillhoff, Carl Schmidt, Joseph K. Canner, Timothy M. Pawlik
Journal: JAMA Surgery (2017)

Trade-offs involved with market competition, overall costs to payers and consumers, and quality of care have not been well defined. Less competition within any given market may enable provider-driven increases in charges.
Intratumoural evolutionary landscape of high-risk prostate cancer: the PROGENY study of genomic and immune parameters
Authors: M. Linch, G. Goh, C. Hiley, Y. Shanmugabavan, N. McGranahan, A. Rowan, Y.N.S. Wong, H. King, A. Furness, A. Freeman, J. Linares, A. Akarca, J. Herrero, R. Rosenthal, N. Harder, G. Schmidt, G.A. Wilson, N.J. Birkbak, R. Mitter, S. Dentro, P. Cathcart, M. Arya, E. Johnston, R. Scott, M. Hung, M. Emberton, G. Attard, Z. Szallasi, S. Punwani, S.A. Quezada, T. Marafioti, M. Gerlinger, H.U. Ahmed, C. Swanton
Journal: Annals of Oncology (2017)

BackgroundIntratumoural heterogeneity (ITH) is well recognised in prostate cancer (PC), but its role in high-risk disease is uncertain. A prospective, single-arm, translational study using targeted multiregion prostate biopsies was carried out to study genomic and T-cell ITH in clinically high-risk PC aiming to identify drivers and potential therapeutic strategies.Patients and methodsForty-nine men with elevated prostate-specific antigen and multiparametric-magnetic resonance imaging detected PC underwent image-guided multiregion transperineal biopsy. Seventy-nine tumour regions from 25 patients with PC underwent sequencing, analysis of mutations, copy number and neoepitopes combined with tumour infiltrating T-cell subset quantification.ResultsWe demonstrated extensive somatic nucleotide variation and somatic copy number alteration heterogeneity in high-risk PC. Overall, the mutational burden was low (0.93/Megabase), but two patients had hypermutation, with loss of mismatch repair (MMR) proteins, MSH2 and MSH6. Somatic copy number alteration burden was higher in patients with metastatic hormone-naive PC (mHNPC) than in those with high-risk localised PC (hrlPC), independent of Gleason grade. Mutations were rarely ubiquitous and mutational frequencies were similar for mHNPC and hrlPC patients. Enrichment of focal 3q26.2 and 3q21.3, regions containing putative metastasis drivers, was seen in mHNPC patients. We found evidence of parallel evolution with three separate clones containing activating mutations of β-catenin in a single patient. We demonstrated extensive intratumoural and intertumoural T-cell heterogeneity and high inflammatory infiltrate in the MMR-deficient (MMRD) patients and the patient with parallel evolution of β-catenin. Analysis of all patients with activating Wnt/β-catenin mutations demonstrated a low CD8+/FOXP3+ ratio, a potential surrogate marker of immune evasion.ConclusionsThe PROGENY (PROstate cancer GENomic heterogeneitY) study provides a diagnostic platform suitable for studying tumour ITH. Genetic aberrations in clinically high-risk PC are associated with altered patterns of immune infiltrate in tumours. Activating mutations of Wnt/β-catenin signalling pathway or MMRD could be considered as potential biomarkers for immunomodulation therapies.Clinical Trials.gov IdentifierNCT02022371
Biochemical, Molecular, and Clinical Characterization of Succinate Dehydrogenase Subunit A Variants of Unknown Significance
Authors: Amber E. Bannon, Jason Kent, Isaac Forquer, Ajia Town, Lillian R. Klug, Kelly McCann, Carol Beadling, Oliver Harismendy, Jason K. Sicklick, Christopher Corless, Ujwal Shinde, Michael C. Heinrich
Journal: Clinical Cancer Research (2017)

Abstract Purpose: Patients who inherit a pathogenic loss-of-function genetic variant involving one of the four succinate dehydrogenase (SDH) subunit genes have up to an 86% chance of developing one or more cancers by the age of 50. If tumors are identified and removed early in these high-risk patients, they have a higher potential for cure. Unfortunately, many alterations identified in these genes are variants of unknown significance (VUS), confounding the identification of high-risk patients. If we could identify misclassified SDH VUS as benign or pathogenic SDH mutations, we could better select patients for cancer screening procedures and remove tumors at earlier stages. Experimental Design: In this study, we combine data from clinical observations, a functional yeast model, and a computational model to determine the pathogenicity of 22 SDHA VUS. We gathered SDHA VUS from two primary sources: The OHSU Knight Diagnostics Laboratory and the literature. We used a yeast model to identify the functional effect of a VUS on mitochondrial function with a variety of biochemical assays. The computational model was used to visualize variants' effect on protein structure. Results: We were able to draw conclusions on functional effects of variants using our three-prong approach to understanding VUS. We determined that 16 (73%) of the alterations are actually pathogenic, causing loss of SDH function, and six (27%) have no effect upon SDH function. Conclusions: We thus report the reclassification of the majority of the VUS tested as pathogenic, and highlight the need for more thorough functional assessment of inherited SDH variants. Clin Cancer Res; 23(21); 6733–43. ©2017 AACR.
Plaque Rupture in Coronary Atherosclerosis Is Associated With Increased Plaque Structural Stress
Authors: Charis Costopoulos, Yuan Huang, Adam J. Brown, Patrick A. Calvert, Stephen P. Hoole, Nick E.J. West, Jonathan H. Gillard, Zhongzhao Teng, Martin R. Bennett
Journal: JACC. Cardiovascular imaging (2017)

The aim of this study was to identify the determinants of plaque structural stress (PSS) and the relationship between PSS and plaques with rupture.Plaque rupture is the most common cause of myocardial infarction, occurring particularly in higher risk lesions such as fibroatheromas. However, prospective intravascular ultrasound-virtual histology studies indicate that <10% higher risk plaques cause clinical events over 3 years, indicating that other factors also determine plaque rupture. Plaque rupture occurs when PSS exceeds its mechanical strength; however, the determinants of PSS and its association with plaques with proven rupture are not known.We analyzed plaque structure and composition in 4,053 virtual histology intravascular ultrasound frames from 32 fibroatheromas with rupture from the intravascular ultrasound-virtual histology in Vulnerable Atherosclerosis study and 32 fibroatheromas without rupture on optical coherence tomography from a stable angina cohort. Mechanical loading in the periluminal region was estimated by calculating maximum principal PSS by finite element analysis.PSS increased with increasing lumen area (r = 0.46; p = 0.001), lumen eccentricity (r = 0.32; p = 0.001), and necrotic core ≥10% (r = 0.12; p = 0.001), but reduced when dense calcium was ≥10% (r = -0.12; p = 0.001). Ruptured fibroatheromas showed higher PSS (133 kPa [quartiles 1 to 3: 90 to 191 kPa] vs. 104 kPa [quartiles 1 to 3: 75 to 142 kPa]; p = 0.002) and variation in PSS (55 kPa [quartiles 1 to 3: 37 to 75 kPa] vs. 43 kPa [quartiles 1 to 3: 34 to 59 kPa]; p = 0.002) than nonruptured fibroatheromas, with rupture primarily occurring either proximal or immediately adjacent to the minimal luminal area (87.5% vs. 12.5%; p = 0.001). PSS was higher in segments proximal to the rupture site (143 kPa [quartiles 1 to 3: 101 to 200 kPa] vs. 120 kPa [quartiles 1 to 3: 78 to 180 kPa]; p = 0.001) versus distal segments, associated with increased necrotic core (19.1% [quartiles 1 to 3: 11% to 29%] vs. 14.3% [quartiles 1 to 3: 8% to 23%]; p = 0.001) but reduced fibrous/fibrofatty tissue (63.6% [quartiles 1 to 3: 46% to 78%] vs. 72.7% [quartiles 1 to 3: 54% to 86%]; p = 0.001). PSS >135 kPa was a good predictor of rupture in higher risk regions.PSS is determined by plaque composition, plaque architecture, and lumen geometry. PSS and PSS variability are increased in plaques with rupture, particularly at proximal segments. Incorporating PSS into plaque assessment may improve identification of rupture-prone plaques.
Comparison of 22C3 PD-L1 Expression between Surgically Resected Specimens and Paired Tissue Microarrays in Non–Small Cell Lung Cancer
Authors: Chao Li, Cheng Huang, Tony S. Mok, Wu Zhuang, Haipeng Xu, Qian Miao, Xirong Fan, Weifeng Zhu, Yunjian Huang, Xiandong Lin, Kan Jiang, Dan Hu, Xiaohui Chen, Peisha Huang, Gen Lin
Journal: Journal of Thoracic Oncology (2017)
<i>Notes from the Field:</i> Cluster of Acute Flaccid Myelitis in Five Pediatric Patients — Maricopa County, Arizona, 2016
Authors: Sally A. Iverson, Scott Ostdiek, Siru Prasai, David M. Engelthaler, Melissa Kretschmer, Nicole Fowle, Harlori K. Tokhie, Janell Routh, James Sejvar, Tracy Ayers, Jolene Bowers, Shane Brady, Shannon Rogers, W. Allan Nix, Ken Komatsu, Rebecca Sunenshine, Tammy Sylvester, Veronica Harrison, Jennifer Heim, Susan Robinson, Gholamabbas A. Ostovar, Kathryn Fitzpatrick
Journal: MMWR Morbidity and Mortality Weekly Report (2017)