tbuckley/cabot-search huggingface dataset:
The changing legal landscape of discrimination in medicine
Authors: Peter Taysum
Journal: BMJ (2002)

As the case surrounding Heidi Cox progresses, Peter Taysum discusses the issues and how it could set the precedent for discrimination against disabled students in the future In 1992, Heidi Cox started her undergraduate medical education at St George's Hospital Medical School. Unfortunately, she was seriously injured and damaged her spinal cord, and she became paraplegic. Heidi did not continue her medical studies after this, and she is currently a wheelchair user. She completed a bachelor's degree at Reading and a master's at City University and then decided to return to medicine: she applied and was accepted to Oxford University.



Disabled medical students in the same position as Heidi Cox face being unable to practice medicine



Oxford University contacted the General Medical Council (GMC; the regulatory body for medical education) for advice about how they could support her studies, and about tailoring their course to her different abilities. The council responded that under the Medical Education Act 1983, …
Mechanism of action of posttransplantation cyclophosphamide: more than meets the eye
Authors: Vedran Radojcic, Leo Luznik
Journal: Journal of Clinical Investigation (2019)

For high-risk and refractory hematological malignancies, allogeneic hematopoietic stem cell transplantation (alloHSCT) is the only available curative therapy, with benefits derived from the antigenic disparity between recipient cancer and the incoming immune system. This immunologic mismatch can also lead to lethal graft-versus-host disease (GVHD), and immunosuppression strategies, including high-dose posttransplantation cyclophosphamide (PTCy), have been developed to allow for safe alloHSCT delivery. In this issue of JCI, Wachsmuth et al. present the results of preclinical studies designed to evaluate the mechanisms that underlie efficacy of PTCy after alloHSCT. The results of this study challenge previous reports indicating that alloreactive T cell elimination and thymic clonal deletion are primary mediators of PTCy efficacy and provide strong evidence to support FoxP3+CD4+ Tregs as important effectors of PTCy benefits.
Minerva: February 2002
Authors: Ceri Hughes, Gordon Irvine, R J Skyrme, D Mendonca, B Jenkins
Journal: BMJ (2002)

Alcohol and medical students tend to go together. Despite much effort to educate the public, and even with the current crackdown on drinking and driving, it seems that few of these campaigns have reached medical undergraduates. A survey of medical stu. dents at one school in London found that nothing much has changed in the past 12 years. 28% of students drank more than the safe limit, and a shocking 52% came into the “problem drinker” category, as defined by well recognised assessment tools ( Alcohol and Alcoholism 2001,36:540–3).

The “French paradox”—why people in France have a lower incidence of heart disease than those in Britain despite a diet similar in saturated fats—may be explained by the discovery that the potent polyphenols in red grape skins inhibit production of endothelin.1. This peptide causes vasoconstriction, which is believed to be a key component in the development of coronary arterial disease. White and rose wines do not produce the same effect ( Nature 2001;414:863–4).



A man aged 75 came to hospital with a local recurrence of a carcinoma of the parotid …
Impact of immune work‐up on outcomes and the cost of care in patients with Chronic Rhinosinusitis
Authors: Oral Alpan, Denise Loizou, Ivan Santos, Bernard Ness, Joseph Plandowski
Journal: Allergy (2019)

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Tumor mutational burden is predictive of response to immune checkpoint inhibitors in MSI-high metastatic colorectal cancer
Authors: A.B. Schrock, C. Ouyang, J. Sandhu, E. Sokol, D. Jin, J.S. Ross, V.A. Miller, D. Lim, I. Amanam, J. Chao, D. Catenacci, M. Cho, F. Braiteh, S.J. Klempner, S.M. Ali, M. Fakih
Journal: Annals of Oncology (2019)

Microsatellite instability (MSI) is a biomarker for response to immune checkpoint inhibitors (ICPIs). PD-1 inhibitors in metastatic colorectal carcinoma (mCRC) with MSI-high (MSI-H) have demonstrated a high disease control rate and favorable progression-free survival (PFS); however, reported response rates to pembrolizumab and nivolumab are variable and often <50%, suggesting that additional predictive biomarkers are needed.
Individual Treatment Effect Estimation of 2 Doses of Dabigatran on Stroke and Major Bleeding in Atrial Fibrillation
Authors: Manon C. Stam-Slob, Stuart J. Connolly, Yolanda van der Graaf, Joep van der Leeuw, Jannick A.N. Dorresteijn, John W. Eikelboom, Ron J.G. Peters, Marco Alings, Frank L.J. Visseren
Journal: Circulation (2019)

Background: We aimed to estimate absolute benefit and harm from treatment with dabigatran in individual patients with atrial fibrillation, and to select the optimal dose for each individual. Methods: We derived and validated a prediction model for ischemic stroke/systemic embolism and major bleeding in patients with atrial fibrillation from the 3 treatment arms of the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy With Dabigatran Etexilate) (n=11 955 in derivation cohort, n=6158 in validation cohort). Readily available patient characteristics were included in Fine and Gray competing risk models (sex, age, smoking, antiplatelet drugs, previous vascular disease, diabetes mellitus, blood pressure, estimated glomerular filtration rate, and hemoglobin). Five-year risks for ischemic stroke/systemic embolism and major bleeding were estimated without anticoagulation therapy, and compared with high- and low-dose dabigatran. Results: Model calibration was good, and discrimination was adequate with a c-statistic of 0.65 (95% CI, 0.62–0.70) for ischemic stroke/systemic embolism and 0.69 (95% CI, 0.66–0.71) for major bleeding. The 5-year absolute risk reduction for ischemic stroke/systemic embolism with dabigatran 150 mg twice daily ranged from &lt;10% in 20% of patients to &gt;25% in 14% of patients, and the 5-year absolute risk increase for major bleeding ranged from &lt;5% in 53% of patients to 15% to 20% in 1% of patients. Comparing high-dose to low-dose dabigatran, the net benefit (absolute risk reduction minus absolute risk increase) was positive for 46% of patients. Conclusions: The absolute treatment benefits and harms of dabigatran in atrial fibrillation can be estimated based on readily available patient characteristics. Such treatment effect estimations can be used for shared decision making before starting dabigatran treatment and to determine the optimal dose. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00262600.
Recipe for a doctor
Authors: Lucy Rapp
Journal: BMJ (2007)

A few years ago I started, fresh faced, with a clean, oversized, white coat, in fear of what the consultant would be like on my first clinical placement. Now, with some insight as a penultimate year medical student I have been contemplating the skills I think are needed to make a good doctor.

A doctor needs to be a thinker. And no ordinary thinker, either, but someone who thinks laterally, horizontally, and vertically and especially outside the box.

Doctors also need to be excellent listeners. Taking on board the patient 's ICE their ideas, concerns, and expectations increase the likelihood of a satisfactory doctor-patient relationship. “Listening” to things that aren't said, such as your patients' body language, non-verbal cues, and signs and symptoms, is a skill that must be perfected through experience.

Another essential talent is to be a good detective. Medicine is all about confirming and …
Generative models as parsimonious descriptions of sensorimotor loops
Authors: Manuel Baltieri, Christopher L. Buckley
Journal: Behavioral and Brain Sciences (2019)

The Bayesian brain hypothesis, predictive processing and variational free energy minimisation are typically used to describe perceptual processes based on accurate generative models of the world. However, generative models need not be veridical representations of the environment. We suggest that they can (and should) be used to describe sensorimotor relationships relevant for behaviour rather than precise accounts of the world.
Abstract 15768: Novel Role of Redox-sensitive SUMOylation of Cu Transport Protein Atox1 in Inflammation and Atherosclerosis
Authors: Archita Das, Sudhahar Varadarajan, Bayasgalan Surenkhuu, Junghun Kweon, Jun-ichi Abe, Masuko Ushio-Fukai, Tohru Fukai
Journal: Circulation (2016)

Background: Copper (Cu) is implicated in inflammation and atherosclerosis with unknown mechanism. Cu chaperone Atox1 is recently discovered to function as a Cu-dependent transcription factor for NA...
Analyze Patient Tests for Importance Before Ordering
Authors: Rachna Rawal, Fred R. Buckhold, Jennifer M. Schmidt
Journal: JAMA Internal Medicine (2019)

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 Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Internal Medicine journal
Children in war zones at high risk of suffering emotional disorders
Authors: Kay Seong Ngoo
Journal: BMJ (2002)

Children living in war zones are at a great risk of developing posttraumatic stress and other emotional disorders. Acute distress due to traumatic events in these children can also result in emotional problems that are not commonly recognised.

This observation came from a joint study by researchers from Palestine and Leicester, United Kingdom, who found that, the effects on children during the ongoing armed conflict in the Middle East is devastating ( Lancet 2002; 359:1801-04). The researchers interviewed children aged 9-18 years residing …
One fifth of UK undergraduates drop out
Authors: Helen Barratt
Journal: BMJ (2002)

Almost one in five students who embark on a first degree course in the United Kingdom are expected to abandon higher education before they gain a degree, says a report published by the Higher Education Funding Council for England.1 It also indicates that 8% of school leavers and 16% of mature students drop out before the end of their first year.

The council's third annual report of higher education performance indicators, drawn from data provided by 169 publicly …
Cigarette possession becomes illegal in Nova Scotia for under 19s
Authors: David Spurgeon
Journal: BMJ (2003)

On 1 January it became illegal for people under the age of 19 in the Canadian province of Nova Scotia to possess or smoke cigarettes. Young people caught with cigarettes by police will not be charged or fined, but police will be authorised to confiscate the cigarettes.

The province's Act to Protect Young Persons and …
Rheumatologist turned politician
Authors: Wendy Brown
Journal: BMJ (2001)

Richard Taylor tells Wendy Brown why he stood for parliament in an attempt to stop the downgrading of his local hospital

Have you ever felt appalled by the state of the NHS or the closure or reduction of services in small, local, general hospitals? Well, why not set up your own political party? One man felt just like this and on 7 June Richard Taylor of Health Concern was elected with a majority of nearly 18 000 to be MP of Wyre Forest in Worcestershire. It was one of the best turnouts in the general election (68%).

Dr Richard Taylor, a 66 year old retired rheumatologist left Kidderminster Hospital after 23 years, but since April 1999 he has campaigned on the main issue …
A tall smoker
Authors: Sheraz Younas, Michael Coupe
Journal: BMJ (2004)

A 53 year old man, who was a heavy smoker, was admitted to hospital with shortness of breath at rest and a two week history of a productive cough. His medical history showed that he had never had any serious illness. He led an active life, playing cricket and football. He was slightly reticent when talking about his family. He visited his doctor, who prescribed a course of antibiotics. He failed to complete the course because he had not been sleeping well and felt “on edge.”

He later visited the emergency department and was diagnosed as having lower respiratory tract infection and anxiety attacks. He was treated accordingly. Three days after discharge, he deteriorated and entered the emergency department with acute palpitations, frothy blood tinged sputum, and frank haemoptysis.

Cardiovascular examination found a regular pulse at 108 beats/min, blood pressure of 140/72 mm Hg, and a temperature of 37.3°C. Jugular venous pressure was raised. He had no arterial bruits but a decrescendo diastolic murmur and no ankle swelling or orthopnoea.

Respiratory examination found reduced chest expansion and lung auscultation showed bilateral basal coarse crepitations. Routine biochemistry and arterial blood gases were within normal reference ranges. Both lipid profile and thyroid function tests were normal. Sputum culture found Pseudomonas aeruginosa. His chest x ray on admission is shown (fig 1). Twelve lead electrocardiography was normal.



Fig 1 
Chest X-ray



Imagine you are managing this patient.

1.  What further information should you seek in the history, and what would you do next?

2.  How would you report his chest radiograph?

3.  How would you investigate the signs of his heart failure (raised JVP, upper lobe diversion)?

4.  With this information, what would be the possible differential diagnoses and what is the most likely diagnosis?

5.  What other features may you find in this condition?

6.  How would you manage the …
Abstract 18866: Variation in Early Death and Readmission Following an Acute Myocardial Infarction Hospitalization in Australia and New Zealand
Authors: Clementine Labrosciano, Tracy Air, John F Beltrame, Rosanna Tavella, Dennis Horton, Christopher Zeitz, Isuru Ranasinghe
Journal: Circulation (2017)

Background: An acute myocardial infarction (AMI) may result in death or readmission, however few population-wide studies of early outcomes exist outside of the United States. We assessed 30-day all...
It runs in the family
Authors: Neil Chanchlani
Journal: BMJ (2009)

Whenever I tell people that I am a medical student they usually respond with raised eyebrows and slow paced nod. They almost always follow with the question, “Is anyone else in your family a doctor?” To which I answer, “Yes. Both my older sisters are medics, and my mum’s a general practitioner.” At first I can sense their disbelief, and then they usually mutter, “Makes sense.”

Coming from a family in which being a doctor is the norm used to annoy me. People tend to write you off pretty quickly. “He must have been coerced into it someway.” “He …
PI-3 kinase-PTEN pathway regulates the expression of E- and N-cadherin in melanoma progression
Authors: Tihana Grubac, Vanja Grubac, Andrea De Mendonca, Sujata Persad
Journal: Cancer Research (2007)

3017   Malignant melanoma is the most deadly form of skin cancer, the incidence of which is dramatically increasing in Western countries. Early metastasis is characteristic of melanoma and is associated with poor prognosis as current therapeutic interventions have little influence on survival. Some of the most pertinent molecules involved in the invasion and metastasis of tumors are the cell adhesion molecules (cadherins, catenins, integrins). The expression and interplay among these group of molecules control not only the attachment to ECM and motility on ECM of cells but also regulate numerous signal transduction pathways involved in regulation of cellular functions. While the expression of E-cadherin is inversely associated with melanoma progression to an aggressive phenotype, the expression of N-cadherin is in direct association with this progression. This profile is also observed in epithelial cancers and the loss of expression of E-cadherin is often seen to occur when there is a loss in expression or activity of PTEN resulting in a constitutive activation of PI-3 kinase pathway. In this study we compare the expression of key adhesion molecules in two melanoma cell lines (A375, A2058) to that of primary melanocytes (HEMa-LP). Our results indicate that while there is substantial expression of E-cadherin in melanocytes, there is little to no expression of the protein in the melanoma cell lines. On the other hand, there is a significant expression of N-cadherin in the melanoma lines, especially in the metastatic A2058, with no expression in melanocytes. β-catenin expression is higher in melanoma cell lines with the highest expression being observed in the A2058 line. The A2058 cell line is a PTEN-null cell line exhibiting a constitutively high expression of phospho-Akt. Re-expression of  PTEN-wt into A2058 results in the appearance of E-cadherin expression and an associated disappearance in the expression of N-cadherin. The cellular morphology of the A2058 cells also changes from a fibroblastic/spindle shaped appearance to an epithelial/melanocyte type appearance. Although an alteration in the total cellular expression levels of β-catenin is not observed with introduction of PTEN-wt, immunofluorescence studies showed an alteration in the localization of β-catenin from a primarily nuclear localization in the PTEN-null A2058 cells to a mostly peripheral cell surface localization in the PTEN-expressing A2058 cells. Decreased cellular and nuclear levels of phospho-Akt-Ser-473 in the PTEN expressing A2058 cells, in the absence of any alteration in Akt protein expression, indicates a controlled regulation of a previously constitutely active PI-3 kinase pathway.  Our results suggest that PI-3 kinase pathway is involved in regulating the adhesion molecule phenotype in melanoma and hence is involved in regulating progression to invasive phenotype of this tumor.
Self-reported Symptoms of Depression Among Chinese Rural-to-Urban Migrants and Left-Behind Family Members
Authors: Zlatko Nikoloski, Anwen Zhang, Gareth Hopkin, Elias Mossialos
Journal: JAMA Network Open (2019)

There were an estimated 247 million rural-to-urban migrant workers in China in 2016, yet at a national level, there is scant evidence on the association of migration with mental health among migrants and their left-behind family members.To examine the association of rural-to-urban migration with symptoms of depression among migrants and left-behind family members aged 45 years and older.Using representative cross-sectional data of 14 332 middle-aged and older adults from the 2015 China Health and Retirement Longitudinal Survey, regression analyses were conducted to examine the association of depressive symptoms with rural-to-urban migration status in urban areas and the association of depressive symptoms with left-behind status in rural areas. The statistical analysis was performed from January to August 2018.Migration status (defined as having a rural hukou [household registration record]) in urban areas and left-behind status (defined as having a spouse or child living in another area) in rural areas.Depressive symptoms measured on the 10-item Center for Epidemiological Studies Depression (CES-D-10) scale.A total of 14 332 middle-aged and elderly participants (mean [SD] age, 59.84 [9.51] years; 7394 [51.6%] women) were included, of whom 4404 (30.7%) lived in urban areas and 9928 (69.3%) lived in rural areas. In urban areas, 1607 participants (36.2%) were rural-to-urban migrants, and the remaining 2797 participants (72.8%) were local residents. In rural areas, 3405 participants (34.3%) were left-behind family members, and the remaining 6523 participants (65.7%) were not. Compared with urban residents, rural-to-urban migrants had higher CES-D-10 scores after adjustment for covariates (β = 0.74; 95% CI, 0.08-1.40; P = .03; standard errors clustered at the household level henceforth). Compared with intact-family rural residents, left-behind spouses had higher CES-D-10 scores after adjustment for covariates (β = 0.54; 95% CI, 0.05-1.03; P = .03).Rural-to-urban migration in China was associated with poor mental health for migrants and their left-behind spouses. Short-term policies, such as building community social facilities, may prove effective, but long-term solutions should address issues related to economic and social exclusions and the lack of a social security system in rural China.
SMAD signaling promotes melanoma metastasis independently of phenotype switching
Authors: Eylul Tuncer, Raquel R. Calçada, Daniel Zingg, Sandra Varum, Phil Cheng, Sandra N. Freiberger, Chu-Xia Deng, Ingo Kleiter, Mitchell P. Levesque, Reinhard Dummer, Lukas Sommer
Journal: Journal of Clinical Investigation (2019)

The development of metastatic melanoma is thought to require the dynamic shifting of neoplastic cells between proliferative and invasive phenotypes. Contrary to this conventional "phenotype switching" model, we now show that disease progression can involve malignant melanoma cells simultaneously displaying proliferative and invasive properties. Using a genetic mouse model of melanoma in combination with in vitro analyses of melanoma cell lines, we found that conditional deletion of the downstream signaling molecule Smad4, which abrogates all canonical TGF-β signaling, indeed inhibits both tumor growth and metastasis. Conditional deletion of the inhibitory signaling factor Smad7, however, generated cells that are both highly invasive and proliferative, indicating that invasiveness is compatible with a high proliferation rate. In fact, conditional Smad7 deletion led to sustained melanoma growth and at the same time promoted massive metastasis formation, a result consistent with data indicating that low SMAD7 levels in patient tumors are associated with a poor survival. Our findings reveal that modulation of SMAD7 levels can overcome the need for phenotype switching during tumor progression and may thus represent a novel therapeutic target in metastatic disease.
The meaning of social inclusion
Authors: Reza Kiani
Journal: BMJ (2006)

Driving home after finishing the day's work, I noticed someone familiar walking down the hill. There was nothing unusual about a middle aged man taking a stroll that glowing summer evening. But he was wearing an apron and holding a cup of coffee in his hand that was spilling over his clothes. Although there were people around, no one was paying him any attention. While driving past, I remembered seeing him before in a residential home for people with learning disabilities. I took the next turn, came back up the hill, and approached him after parking the car. Some …