tbuckley/cabot-search huggingface dataset:
IMPACT OF A MULTIFACETED EDUCATIONAL INTERVENTION ON ORAL ANTICOAGULATION (OAC) USE IN ATRIAL FIBRILLATION (AF) PATIENTS ACCORDING TO ASPIRIN USE AT BASELINE: INSIGHTS FROM IMPACT-AF TRIAL
Authors: Jie Jiang, Ying Xian, Hussein Al-Khalidi, Maria Bahit, Renato Lopes, Dragos Vinereanu, Denis Xavier, He Pengkang, He Wensheng, Andrea Ciobanu, Deepak Kamanth, Kathleen Fox, Meena Rao, Sean Pokorney, Otavio Berwanger, Carlos Tajer, Pedro G.M. Barros e Silva, Mayme Roettig, Yong Huo, Christopher Granger
Journal: Journal of the American College of Cardiology (2018)
SEX DIFFERENCES IN REVASCULARIZATION AND OUTCOMES OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN ADULTS AGED 60 YEARS OR OVER IN THE UNITED STATES
Authors: Bing Yue, Chayakrit Krittanawong, Xin Wei, Mariam Khandaker, Shuyang Fang, Matthew Tomey
Journal: Journal of the American College of Cardiology (2018)
ARM to debate whether new junior contract disadvantages women
Authors: Abi Rimmer
Journal: BMJ (2016)

Doctors from across the profession are set to discuss whether the proposed new contract for junior doctors in England will disadvantage women, particularly those who train part time or have children.

Delegates at the BMA’s annual representative meeting (ARM) in Belfast will discuss the issues on Thursday 23 June. The motion is one of several that focus on issues related to the new contract. It says, “This meeting is appalled that changes in the junior doctor contract will disadvantage women, particularly those who are training part time, or who are carers or lone parents.”

Doctors previously raised concerns that the new contract discriminated against women when the government published an equality analysis …
AN UNUSUAL CAUSE OF DYSPNEA: CIRRHOTIC CARDIOMYOPATHY WITH CONCOMITANT HEPATOPULMONARY SYNDROME AND PORTOPULMONARY HYPERTENSION
Authors: Aditya Kotecha, Shanchiya Ravindradas, Rajavardhan Bandaru, Rohan Naik, Geetha Krishnamoorthy, Luis Afonso
Journal: Journal of the American College of Cardiology (2018)
Consultants oppose government proposals for contract changes
Authors: Abi Rimmer
Journal: BMJ (2016)

Consultants have opposed the government’s proposals for changes to their contract at a meeting held by the BMA this week.

The association held a consultants contract roadshow event in London on Monday 22 February. Consultants and junior doctors heard about proposed changes to the contract for consultants in England and Northern Ireland.

Chidi Ejimofo, a consultant in emergency medicine who attended the meeting, said that the audience did not support the proposals.1 He said on Twitter, “At end of @TheBMA roadshow audience [was] asked if anyone in favour of DoH #consultantcontract . . . not a single hand …
Sexual violence against children in South Africa: a nationally representative cross-sectional study of prevalence and correlates
Authors: Catherine L Ward, Lillian Artz, Lezanne Leoschut, Reshma Kassanjee, Patrick Burton
Journal: The Lancet Global Health (2018)

We aimed to complete a nationally representative study of sexual violence against children in South Africa, and its correlates, since we could identify no other such study.For this nationally representative, cross-sectional study in South Africa, households were selected by use of a multistage sampling frame, stratified by province, urban or rural setting, and race group, and schools were selected on the basis that they were closest to the area in which households were selected. Interviews and self-administered questionnaires in each location inquired into lifetime and last-year prevalence of sexual abuse, and its correlates among children aged 15-17 years, whose parents gave informed consent and they themselves gave informed assent.The final household sample was 5631 (94·6% participation rate). 9·99% (95% CI 8·65-11·47) of boys and 14·61% (95% CI 12·83-16·56) of girls reported some lifetime sexual victimisation. Physical abuse, emotional abuse, neglect, family violence, and other victimisations were all strongly associated with sexual victimisation. The following were associated with greater risk of sexual abuse (adjusted odds ratio [OR]); school enrolment (OR 2·12, 95% CI 1·29-3·48); rural dwelling (0·59; 0·43-0·80); having a flush toilet (1·43, 1·04-1·96); parental substance misuse (2·37, 1·67-3·36); being disabled (1·42, 1·10-1·82); female (but not male) caregivers' poor knowledge of the child's whereabouts, friends, and activities (1·07, 0·75-1·53) and poor quality of the relationship with the child (ie, poor acceptance; 1·20, 0·55-2·60). The child's own substance misuse (4·72, 3·73-5·98) and high-risk sexual behaviour (3·71, 2·99-4·61) were the behaviours most frequently associated with sexual abuse, with mental health conditions found to be less prevalent than these factors but still strongly associated with sexual victimisation (post-traumatic stress disorder 2·81, 1·65-4·78; depression 3·43, 2·26-5·19; anxiety 2·48, 1·61-3·81).Sexual violence is widespread among both girls and boys, and is associated with serious health problems. Associated factors require multisectoral responses to prevent sexual violence or mitigate consequences.UBS Optimus Foundation.
Adverse respiratory effects of opioids for chronic breathlessness: learning lessons from chronic pain
Authors: Kyle T.S. Pattinson, Matthew J. Rowland, Annabel H. Nickol, Jane Quinlan
Journal: European Respiratory Journal (2018)

Fear of fatal respiratory depression is a major driver limiting opioid prescription for persistent breathlessness in chronic obstructive pulmonary disease (COPD) [1–6], but is this fear warranted? In a recent systematic review and meta-analysis, Verberkt et al. [7] did not detect significant or clinically relevant respiratory adverse events associated with opioid treatment for chronic breathlessness in COPD. Rather, they concluded that "clinicians' fears of respiratory obtundation with low-dose opioids seem to be unfounded". Here, we critically evaluate these conclusions. Chronic breathlessness: beware adverse effects of opioids; no new evidence for safety or efficacy in long-term use <http://ow.ly/vXWv30hVcMS>
CLOSED-LOOP BAROREFLEX NEUROMODULATION MARKEDLY AUGMENTS VOLUME TOLERANCE AND INSTANTLY RESOLVES PULMONARY CONGESTION IN ACUTE HEART FAILURE
Authors: Takeshi Tohyama, Kazuya Hosokawa, Keita Saku, Kenji Sunagawa, Hiroyuki Tsutsui
Journal: Journal of the American College of Cardiology (2018)
ACCURACY OF THE POOLED COHORT EQUATION TO ESTIMATE ATHEROSCLEROTIC CARDIOVASCULAR DISEASE EVENTS BY OBESITY CLASS: A POOLED ASSESSMENT OF FIVE LONGITUDINAL COHORT STUDIES
Authors: Rohan Khera, Ambarish Pandey, Colby Ayers, Mercedes Carnethon, Philip Greenland, Vijay Nambi, Stephen Seliger, Paulo Chaves, Donald Lloyd-Jones, Jarett Berry, James de Lemos, Ian Neeland
Journal: Journal of the American College of Cardiology (2018)
REMOTE INTERPRETATION OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY (CCTA) CAN SAFELY EXPAND ACCESS TO ADVANCED CARDIOVASCULAR IMAGING TO EVALUATE ACUTE CHEST PAIN IN COMMUNITY HOSPITAL SETTING
Authors: Edris Alderwish, Pamela Noack, Jhanna Moore, Moshrik Abd Alamir, Michael Poon
Journal: Journal of the American College of Cardiology (2018)
The Value of Regional Cerebral Blood Flow SPECT and FDG PET in Operculoinsular Epilepsy
Authors: Phillip Fei, Jean-Paul Soucy, Sami Obaid, Olivier Boucher, Alain Bouthillier, Dang Khoa Nguyen
Journal: Clinical Nuclear Medicine (2018)

Operculoinsular epilepsy (OIE) can be challenging to diagnose. While the value of SPECT cerebral blood flow and PET F-FDG studies for presurgical evaluation of patients with medial temporal lobe epilepsy (MTLE) is well established, it remains unclear whether they can help identify an operculoinsular epileptic focus. This study assesses the value of interictal/ictal regional cerebral blood flow (rCBF) SPECT and FDG PET for OIE diagnosis.Eighteen patients with proven OIE who underwent interictal/ictal rCBF SPECT and/or FDG-PET prior to epilepsy surgery were identified from our clinical database and were compared with a group of 18 patients who underwent MTLE surgery. Regional cerebral blood flow SPECT and FDG PET images were reevaluated visually by an expert reader blind to clinical data.Interictal/ictal rCBF SPECT correctly identified an operculoinsular focus in 11 (65%) of 17 OIE patients and was misleading in 3 cases (18%). Secondary activation in areas connected to the insula was often observed. In the MTLE group, the area of maximal increased perfusion was congruent in 12 (75%) of 16 patients and extended to the ipsilateral insula in 1 patient. FDG PET findings were concordant with the epileptic focus in 8 (47%) of 17 OIE patients and were misleading in 4 (24%), whereas they were concordant in all MTLE patients.Interictal/ictal rCBF SPECT can identify a concordant operculoinsular focus in a significant proportion of OIE patients and offers a valuable diagnostic tool in nonlesional cases. By contrast, the value of interictal FDG PET in this population is more equivocal.
Prostate-specific membrane antigen (PSMA) PET-CT imaging in the investigation and management of biochemical recurrence in prostate cancer.
Authors: Fergus Keane, Yasser Ged, Megan Greally, Michael A. Maher, Kieran O'Malley, John McCaffrey
Journal: Journal of Clinical Oncology (2018)

208 Background: It is estimated that within ten years of primary treatment for prostate cancer up to 40% of patients post radical prostatectomy, and up to 50% of patients post radiotherapy will develop disease recurrence. While monitoring of PSA levels is informative of biochemical recurrence, it may precede radiologically detectable recurrence by months to years, and cannot differentiate local/regional recurrence from systemic disease. This represents a management dilemma for treating physicians. The incorporation of PET probes targeting prostate-specific membrane antigen (PSMA) for prostate cancer shows promise for improving the management of patients with prostate cancer, when used alongside existing imaging techniques, like CT, MRI and bone scans. Methods: Retrospective review of all patients referred from our institution for PSMA imaging was carried out. Baseline clinical features were determined and we analyzed impact of PSMA imaging on management outcomes and survival data. Results: 33 patients referred for 68 Ga-PSMA-PET imaging were identified. Median age at diagnosis was 65 years (51 -75). The indication for referral in all patients was biochemical recurrence in the absence of radiological evidence of disease by CT imaging and bone scan. Median PSA at time of referral for PSMA scan was 7.3ug/L (1.4ug/L to 87.7ug/L). 100% of patients (n = 33) were upstaged following PSMA imaging, and 30% (n = 10) had more than one site of metastatic disease identified. Most common sites of metastasis were lymph node and bone. Median number of sites of metastatic disease identified by PSMA imaging was one. These results led to a change in management for 96% patients (n = 32). All patients at the time of this review are alive with a median follow up of 13 months, and median progression-free survival of 11 months. Conclusions: PSMA PET-CT directly led to an alteration in the treatment of the majority of patients in this study. This real world data reflects the growing role of PSMA imaging in influencing clinical decisions for prostate cancer patients with biochemical recurrence. Prospective data from randomized studies are awaited to further validate the role of PSMA PET-CT in this patient cohort.
CARDIOPULMONARY PRESENTATION OF A PATIENT WITH XXXY SYNDROME
Authors: Jad Al Danaf, James Wever-Pinzon, Anwar Tandar, Arvind Hoskoppal, Craig Robison, Ira L. Kraft, Jack Morshedzadeh, Stavros Drakos, James Fang, Jeffrey Turner, Dipayan Chaudhuri
Journal: Journal of the American College of Cardiology (2018)
Trainees are more likely to be undermined than bullied, GMC finds
Authors: Abi Rimmer
Journal: BMJ (2015)

A new report by the General Medical Council has found that doctors in training are more likely to feel undermined than bullied.

The regulator has published a report on research it carried out into instances of undermining and bullying of doctors in training.1 Between September and December last year the GMC visited six departments of surgery and six departments of obstetrics and gynaecology in 12 UK hospitals to gather evidence of undermining and bullying.

Most trainees did not report undermining or bullying behaviour to the GMC, but some did have concerns. These concerns were mostly about undermining, the report said, and there were very few examples of bullying. 

The GMC defines undermining as “behaviour that subverts, weakens or wears away confidence.” It defines bullying as behaviour that hurts or frightens someone who is less powerful, often forcing them to do something they do not want to do.” However, the GMC said that trainees’ perceptions of what constituted both types of behaviour varied widely. It said that undermining and bullying behaviours “unfortunately have a long history in medical education and training” and that some trainees “believe their seniors think humiliation is an acceptable part of medical education.” 

The undermining behaviour identified by trainees in interviews included …
Health department refuses to release correspondence defining seven day working
Authors: Abi Rimmer
Journal: BMJ (2015)

The Department of Health for England has refused a request to see correspondence between itself and the prime minister discussing the definition of seven day services.

The department refused a request from BMJ Careers made under freedom of information legislation on the grounds that the information “relates to the formulation or development of government policy.” It said that officials needed to be able to “discuss policy options without the …
Royal College of Psychiatrists to freeze exam fees in response to surplus
Authors: Helen Jaques
Journal: BMJ (2012)

The Royal College of Psychiatrists has agreed to freeze membership examination fees for 2013 and offer a 15% reduction for registered affiliates and trainees after it was revealed that the college made a surplus of £604 000 on fees for its membership examinations in 2011.

Fees for Membership of the Royal College of Psychiatrists examinations are not set with the intention of generating a profit, said Wendy Burn, dean …
DUAL- VERSUS MONO-ANTIPLATELET THERAPY IN PATIENTS UNDERGOING TAVR: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS AND OBSERVATIONAL STUDIES
Authors: Shadi Al Halabi, Joshua Newman, Michael E. Farkouh, David Fortuin, Ferdinand Leya, John Sweeney, John Webb, John Lopez, Lowell Steen, Bruce Lewis, Amir Darki, Verghese Mathew
Journal: Journal of the American College of Cardiology (2018)
Diagnostic Accuracy of Biomarkers and Imaging for Bone Turnover in Renal Osteodystrophy
Authors: Syazrah Salam, Orla Gallagher, Fatma Gossiel, Margaret Paggiosi, Arif Khwaja, Richard Eastell
Journal: Journal of the American Society of Nephrology (2018)

Background Renal osteodystrophy is common in advanced CKD, but characterization of bone turnover status can only be achieved by histomorphometric analysis of bone biopsy specimens (gold standard test). We tested whether bone biomarkers and high-resolution peripheral computed tomography (HR-pQCT) parameters can predict bone turnover status determined by histomorphometry. Methods We obtained fasting blood samples from 69 patients with CKD stages 4–5, including patients on dialysis, and 68 controls for biomarker analysis (intact parathyroid hormone [iPTH], procollagen type 1 N-terminal propeptide [PINP], bone alkaline phosphatase [bALP], collagen type 1 crosslinked C-telopeptide [CTX], and tartrate-resistant acid phosphatase 5b [TRAP5b]) and scanned the distal radius and tibia of participants by HR-pQCT. We used histomorphometry to evaluate bone biopsy specimens from 43 patients with CKD. Results Levels of all biomarkers tested were significantly higher in CKD samples than control samples. For discriminating low bone turnover, bALP, intact PINP, and TRAP5b had an areas under the receiver operating characteristic curve (AUCs) of 0.82, 0.79, and 0.80, respectively, each significantly better than the iPTH AUC of 0.61. Furthermore, radius HR-pQCT total volumetric bone mineral density and cortical bone volume had AUCs of 0.81 and 0.80, respectively. For discriminating high bone turnover, iPTH had an AUC of 0.76, similar to that of all other biomarkers tested. Conclusions The biomarkers bALP, intact PINP, and TRAP5b and radius HR-pQCT parameters can discriminate low from nonlow bone turnover. Despite poor diagnostic accuracy for low bone turnover, iPTH can discriminate high bone turnover with accuracy similar to that of the other biomarkers, including CTX.
Gender/Sex as a Social Determinant of Cardiovascular Risk
Authors: Adrienne O’Neil, Anna J. Scovelle, Allison J. Milner, Anne Kavanagh
Journal: Circulation (2018)

The social gradient for cardiovascular disease (CVD) onset and outcomes is well established. The American Heart Association's Social Determinants of Risk and Outcomes of Cardiovascular Disease Scientific Statement advocates looking beyond breakthroughs in biological science toward a social determinants approach that focuses on socioeconomic position, race and ethnicity, social support, culture and access to medical care, and residential environments to curb the burden of CVD going forward. Indeed, the benefits of this approach are likely to be far reaching, enhancing the positive effects of advances in CVD related to prevention and treatment while reducing health inequities that contribute to CVD onset and outcomes. It is disappointing that the role of gender has been largely neglected despite being a critical determinant of cardiovascular health. It is clear that trajectories and outcomes of CVD differ by biological sex, yet the tendency for sex and gender to be conflated has contributed to the idea that both are constant or fixed with little room for intervention. Rather, as distinct from biological sex, gender is socially produced. Overlaid on biological sex, gender is a broad term that shapes and interacts with one's cognition to guide norms, roles, behaviors, and social relations. It is a fluid construct that varies across time, place, and life stage. Gender can interact with biological sex and, indeed, other social determinants, such as ethnicity and socioeconomic position, to shape cardiovascular health from conception, through early life when health behaviors and risk factors are shaped, into adolescence and adulthood. This article will illustrate how gender shapes the early adoption of health behaviors in childhood, adolescence, and young adulthood by focusing on physical activity, drinking, and smoking behaviors (including the influence of role modeling). We will also discuss the role of gender in psychosocial stress with a focus on trauma from life events (childhood assault and intimate partner violence) and work, home, and financial stresses. We conclude by exploring potential biological pathways, with a focus on autonomic functioning, which may underpin gender as a social determinant of cardiovascular health. Finally, we discuss implications for cardiovascular treatment and awareness campaigns and consider whether gender equality strategies could reduce the burden of CVD for men and women at the population level.
Integrative analysis of imaging and transcriptomic data of the immune landscape associated with tumor metabolism in lung adenocarcinoma: Clinical and prognostic implications
Authors: Hongyoon Choi, Kwon Joong Na
Journal: Theranostics (2018)

Although metabolic modulation in the tumor microenvironment (TME) is one of the key mechanisms of cancer immune escape, there is a lack of understanding of the comprehensive immune landscape of the TME and its association with tumor metabolism based on clinical evidence.We aimed to investigate the relationship between the immune landscape in the TME and tumor glucose metabolism in lung adenocarcinoma.Methods: Using RNA sequencing and image data, we developed a transcriptome-based tumor metabolism estimation model.The comprehensive TME cell types enrichment scores and overall immune cell enrichment (ImmuneScore) were estimated.Subjects were clustered by cellular heterogeneity in the TME and the clusters were characterized by tumor glucose metabolism and immune cell composition.Moreover, the prognostic value of ImmuneScore, tumor metabolism and the cell type-based clusters was also evaluated.Results: Four clusters were identified based on the cellular heterogeneity in the TME.They showed distinct immune cell composition, different tumor metabolism, and close relationship with overall survival.A cluster with high regulatory T cells showed relative hypermetabolism and poor prognosis.Another cluster with high mast cells and CD4+ central memory T cells showed relative hypometabolism and favorable prognosis.A cluster with high ImmuneScore showed favorable prognosis.Multivariate Cox analysis demonstrated that ImmuneScore was a predictive prognostic factor independent of other clinical features.Conclusions: Our results showed the association between predicted tumor metabolism and immune cell composition in the TME.Our studies also suggest that tumor glucose metabolism and immune cell infiltration in the TME can be clinically applicable for developing a prognostic stratification model.
Replication stress drives constitutive activation of the DNA damage response and consequent radioresistance in glioblastoma cancer stem cells
Authors: Ross Carruthers, Shafiq Ahmed, Shaliny Ramachandran, Ester Hammond, Anthony Chalmers
Journal: Neuro-Oncology (2018)

Glioblastoma (GBM)is a lethal primary brain tumour characterised by treatment resistance and inevitable recurrence, both of which are driven by a subpopulation of glioblastoma cancerstem cells (GSCs) with tumorigenic and self-renewal properties. Radiation resistance of GSCs has been shown to be associated with enhanced DNA double strand break (DSB) repair proficiency caused by preferential activation of the DNA damage response (DDR), however the underlying reasons for activation of DDR in GSCs remains enigmatic. Uncertainty over the origin of GSCs also persists,with the original hypothesis that they derive from neural stem cells remaining unproven. In this study we show that constitutive DDR activation in GSCs is driven by high levels of DNA replication stress (RS). We demonstrate increased RS in GSC compared to non-stem GBM cells in multiple primary cell cultures by DNA fibre assay and show that RS generates DSBs at DNA replication factories in GSCs. From a therapeutic perspective we demonstrate that radioresistance of GSC is reversed by dual inhibition of the key RS and DDR proteins ATR and PARP. Finally we identify increased expression of long neural genes as a likely mechanism for RS in GSC, an observation that correlates closely with recently published studies in neural progenitor cells which demonstrate that DSB arising from replication stress are preferentially located in long neural genes. Several of these genes are overexpressed in our GSC cultures. Together these findings support the controversial hypothesis that GSC derive from neural stem cells. Overall, our observations elucidate the mechanism underlying DDR activation and radioresistance in GSC, shed new light on gliomagenesis and cancer stem cell biology, and identify novel therapeutics with potential to improve clinical outcomes by overcoming the inherent radioresistance of GBM.