tbuckley/cabot-search huggingface dataset:
Estimation of Health and Economic Benefits of Commercial Peanut Immunotherapy Products
Authors: Marcus Shaker, Matthew Greenhawt
Journal: JAMA Network Open (2019)

<h3>Importance</h3> Commercial epicutaneous peanut immunotherapy (EPIT) and peanut oral immunotherapy (POIT) may offer significant quality-of-life improvements for patients with peanut allergy, but the cost-effectiveness of commercial peanut immunotherapies is uncharacterized. <h3>Objective</h3> To evaluate critical inputs associated with the cost-effectiveness of EPIT and POIT from a societal perspective. <h3>Design, Setting, and Participants</h3> Economic evaluation in which microsimulations with Markov modeling were performed evaluating virtual children aged 4 years over an 80-year time horizon. The base-case costs included a caregiver-reported willingness to pay of $3839 annually for safe and effective food allergy treatment. Estimates of predictive biomarkers or oral challenges were incorporated after the first year of therapy with additional analyses of immunotherapy risk reduction of anaphylaxis and probability of sustained unresponsiveness (SU) to peanut after 4 years. <h3>Exposures</h3> Children received EPIT, POIT, or no immunotherapy treatment (n = 10 000 per treatment strategy). <h3>Main Outcomes and Measures</h3> Rates of therapy-associated adverse reactions and quality-of-life improvements associated with changes in eliciting or tolerated peanut doses were modeled along with quality-adjusted life-years (QALYs), anaphylaxis, therapy-associated anaphylaxis, and fatalities. <h3>Results</h3> In the base-case analysis without SU to peanut, the EPIT strategy cost less than POIT (mean [SD] cost, $154 662 [$46 716] vs $163 524 [$56 800]) and had fewer total episodes of anaphylaxis (mean [SD], 1.33 [1.55] vs 3.83 [5.02] episodes) and fewer episodes of therapy-associated anaphylaxis (mean [SD], 0.62 [1.30] vs 3.10 [4.94] episodes) but had lower QALY accumulation (mean [SD], 26.932 [2.241] vs 26.945 [2.320] QALYs). The incremental cost-effectiveness ratio was $216 061 for EPIT and $255 431 for POIT. Models were sensitive to therapy cost, SU rates, health state utility, and risk reduction of anaphylaxis. With health state utility sensitivity analyses, the ceiling value-based cost (willingness-to-pay threshold $100 000/QALY) was between $1568 and $6568 for EPIT and between $1235 and $5235 for POIT. If high rates of SU to peanut can be achieved in longer-term models, EPIT and POIT could produce savings in terms of both cost and QALY. <h3>Conclusions and Relevance</h3> In this simulated analysis, findings showed that EPIT and POIT may be cost-effective under some assumptions. Further research is needed to understand the degree of health state utility improvement associated with each therapy, degree of protection against anaphylaxis, and rates of SU.
NKG2D-Deficient Mice Are Defective in Tumor Surveillance in Models of Spontaneous Malignancy
Authors: Nadia Guerra, Ying Xim Tan, Nathalie T. Joncker, Augustine Choy, Fermin Gallardo, Na Xiong, Susan Knoblaugh, Dragana Cado, Norman M. Greenberg, David H. Raulet
Journal: Immunity (2008)
The Medical Profession and Human Rights: Handbook for a Changing Agenda
Authors: Jason O'Neale Roach
Journal: BMJ (2001)

Gross violations of human rights occur in many parts of the world. The nature of the media ensures that many of these are brought to our attention. But the need for equality of rights goes beyond these gross violations. The World Health Organization declared in 1970 that “health is a human right.” Clearly, doctors have a role to play in making this a reality. The BMA's new report on human rights and the medical profession begins to examine the …
Of medical sense and sensitivity
Authors: Sowmya Sivaranjini
Journal: BMJ (2006)

Tears streamed slowly down her cheeks as she unsuccessfully tried to endure the blinding pain in silence. She was in her 60s and had come to the hospital for free treatment from a small distant village, by bus with no one to help her.

The professor demonstrated the clinical examination of a tender, diseased part of her anatomy. Each of my friends then practised examining her. More demonstrations and more practice elicited more painful cries.

She did receive compensation - some free drugs and more time to talk (long enough to clear her doubts) with the doctor. The latter is a rare privilege for patients such as her who come in their thousands to hospitals offering free or minimally charged care.

I chose medicine hoping to acquire the skills to …
Tuition fees about to be imposed in Germany
Authors: Irena Haivas, Katie Reid
Journal: BMJ (2005)

Natarajan et al. and Chen and Savidge comment that comparing the electric field in ketosteroid isomerase’s (KSI’s) active site to zero overestimates the catalytic effect of KSI’s electric field because the reference reaction occurs in water, which itself exerts a sizable electrostatic field. To compensate, Natarajan et al. argue that additional catalytic weight arises from positioning of the general base, whereas Chen and Savidge propose a separate contribution from desolvation of the general base. We note that the former claim is not well supported by published results, and the latter claim is intriguing but lacks experimental basis. We also take the opportunity to clarify some of the more conceptually subtle aspects of electrostatic catalysis.
Abstract 19501: DMGV is Predictive of Future Diabetes, and Modulates Glucose Homeostasis in Zebrafish
Authors: Jordan E Morningstar, Anjali K Nath, John F O'Sullivan, Baohui Zheng, Randall T Peterson, Robert E Gerszten
Journal: Circulation (2017)

Background: Using nontargeted mass spectrometry, we previously identified α-keto-δ-(NGNG-dimethylguanidino)-valeric acid (DMGV) as a novel marker of CT-defined liver fat and incident type 2 DM. DMG...
Anatomy dissection: RIP?
Authors: Mohammad Heetun
Journal: BMJ (2007)

In medical schools throughout the United Kingdom, it wasn't long ago that you could find the next generation of doctors huddled around donated cadavers, learning anatomy through human dissection. Typically, four or five students were dedicated to a body, each dissecting a particular area, sharing and teaching what they saw. The cadavers were fresh and plentiful, kindly donated by ordinary people who wanted to contribute to the future of patient care through education after their death.

Dissection perfectly complemented lectures and bookwork, cementing key concepts such as the location, course, and relationships of structures. Students were left …
Evaluation of a social protection policy on tuberculosis treatment outcomes: A prospective cohort study
Authors: Karen Klein, Maria Paula Bernachea, Sarah Irribarren, Luz Gibbons, Cristina Chirico, Fernando Rubinstein
Journal: PLoS Medicine (2019)

Background Tuberculosis (TB) still represents a major public health problem in Latin America, with low success and high default rates. Poor adherence represents a major threat for TB control and promotes emergence of drug-resistant TB. Expanding social protection programs could have a substantial effect on the global burden of TB; however, there is little evidence to evaluate the outcomes of socioeconomic support interventions. This study evaluated the effect of a conditional cash transfer (CCT) policy on treatment success and default rates in a prospective cohort of socioeconomically disadvantaged patients. Methods and findings Data were collected on adult patients with first diagnosis of pulmonary TB starting treatment in public healthcare facilities (HCFs) from 16 health departments with high TB burden in Buenos Aires who were followed until treatment completion or abandonment. The main exposure of interest was the registration to receive the CCT. Other covariates, such as sociodemographic and clinical variables and HCFs' characteristics usually associated with treatment adherence and outcomes, were also considered in the analysis. We used hierarchical models, propensity score (PS) matching, and inverse probability weighting (IPW) to estimate treatment effects, adjusting for individual and health system confounders. Of 941 patients with known CCT status, 377 registered for the program showed significantly higher success rates (82% versus 69%) and lower default rates (11% versus 20%). After controlling for individual and system characteristics and modality of treatment, odds ratio (OR) for success was 2.9 (95% CI 2, 4.3, P < 0.001) and default was 0.36 (95% CI 0.23, 0.57, P < 0.001). As this is an observational study evaluating an intervention not randomly assigned, there might be some unmeasured residual confounding. Although it is possible that a small number of patients was not registered into the program because they were deemed not eligible, the majority of patients fulfilled the requirements and were not registered because of different reasons. Since the information on the CCT was collected at the end of the study, we do not know the exact timing for when each patient was registered for the program. Conclusions The CCT appears to be a valuable health policy intervention to improve TB treatment outcomes. Incorporating these interventions as established policies may have a considerable effect on the control of TB in similar high-burden areas.
Minerva: November 2002
Authors: Daniel Lawes, Rupan Banga, Martin Clifton, Daniel Lawes, Rupan Banga, Martin Clifton, Princess Alexandra, Alena Salim
Journal: BMJ (2002)

Beds are a great habitat for house dust mites, so anti-allergic mattress covers in carpet free rooms might benefit people who have asthma. A randomised, double blind placebo controlled study of 30 patients with house dust mite allergy found a significant reduction in the concentration of Dermatophagoides pteronyssinus in dust from the covered mattresses after one year. Unfortunately, such allergen avoidance made no difference to the participants symptoms and lung function ( Thorax 2002;57:784-90).

Smokers and childless women are known to go through the menopause at a younger age than other women. Evidence from a British birth cohort suggests that early life influences also play a role in ovarian ageing. Women of low weight at age 2 years had an earlier menopause, and those who had been breast fed had a later menopause ( Human Reproduction 2002,17:2474-9).



The dangers of having a naked flame and, in particular, of smoking, near an oxygen supply are usually fully explained to respiratory patients who must be treated with oxygen at home. The need to explain this to hospital inpatients may not be so obvious. A woman was admitted …
Should doctors apologise for their role in torture?
Authors: Bishoy Morris
Journal: BMJ (2004)

Doctors have been involved in inhumane treatment of people throughout history.1 They have harmed patients by being either obstinate believers in flawed medical theories or instruments of corrupt political regimes. Notorious examples include the inhumane treatment of mentally ill patients in medieval “asylums,”2 torture by Nazi doctors on thousands of prisoners in German concentration camps,3 and the unethical radiation experiments on prisoners conducted by American doctors during the cold war.4 Recently, US military doctors were alleged to be complicit in prisoner abuse in the notorious Abu Ghraib prison in Iraq, collaborating in designing …
A Day in the Life
Authors: Dara Grennan
Journal: JAMA (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 HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
The Nigerian emergency department
Authors: Chibuzo Odigwe, Seye Abimbola
Journal: BMJ (2004)

In the Nigerian emergency department, the expectations of the patients and their relatives are the same as anywhere else. What differs is the manner and extent to which this is met. The facilities and personnel available to handle emergency situations in several emergency rooms vary, depending on the hospital.

The new single storey adult accident and emergency building of the Obafemi Awolowo University Teaching Hospital, Ife, one of the oldest and largest hospitals in Nigeria, has about 20 couches, a number which is well below capacity. Often trolleys and stretchers in cubicles, on the corridor, and sometimes even, the floor supplement the beds. Such is the scene …
Medical students and their faith - being a Christian medic
Authors: Helen Barratt
Journal: BMJ (2002)

I became a Christian at the age of 12. I'd been brought up in a Christian home, and, having investigated the claims of the faith for myself, I decided it was time to trust Jesus Christ with my life. Coming to university in London was the best thing that ever happened to me. I was spoilt for choice when it came to churches and threw myself into life as a Christian at college. It's also been a privilege to go through the ups and downs of the first few years with a group of close Christian friends.

Sadly, Christianity has a poor image in the United Kingdom and is often treated with a contempt that wouldn't be tolerated if it were directed at any other faith group. It saddens me that so many friends and colleagues have such an animosity towards the faith that is central to my life and will often do anything to avoid talking about it with me. But, contrary to popular opinion, most Christians are reasonably well balanced people who don't want to befriend you simply so they can force you to …
Young adults ignore sun exposure risk
Authors: Helen Barratt
Journal: BMJ (2002)

Young adults are continuing to ignore the warnings about the deadly risks associated with sunburn in their pursuit of a perfect tan, according to a study in the American Journal of Preventive Medicine. 1

Researchers found that almost 60% of American adults aged under 30 report having had sunburn in the past year--the worst culprits are young white men. And those most likely to spend too much time …
Evidence based medicine should be taught in medical schools
Authors: Manique Wijesinghe
Journal: BMJ (2005)

With a click of a mouse, medical students can access thousands of research articles of variable credibility about any topic or clinical problem, using resources such as Medline, Ovid, or the Cochrane Library. But sifting through this information and coming up with a coherent, practical, and, above all, effective solution is a big challenge.

Critical appraisal skills are essential to medical students and doctors to make sense of the overwhelming volume of available information. Integrating evidence based medicine-“the judicious application of best current knowledge to the condition and values of the individual patient”1-into clinical practice is more likely to be effective at changing existing behaviour and practice than traditional methods such as workshops and stand alone courses.2

Simply applying the best current knowledge, however, is not enough: you must evaluate the information carefully before doing so. Citing her experiences of making evidence based mistakes, Hilda Bastian, a researcher in Germany, writesthat jumping to conclusions too soon, using a systematic review as a defence, can lead to serious clinical errors.3 “A promising treatment is just the larval stage of a disappointing one,” she opines.

Currently, most teaching of evidence based medicine for undergraduates takes a classroom based format-a teaching method that has been shown to have little effect.2 Information overload is a problem that will only get worse in the future. Thus it is crucial that students are guided in the prudent use of evidence based medicine from early on in their medical careers to facilitate efficient selection, evaluation, and implementation of new research findings, some of which may turn prevailing wisdom on its head.

A good point at which to begin such integrated teaching would be the beginning of a student's clinical years. Clinical medical students could be encouraged, either individually or in small groups, …
Tuberculosis in Romania: a devastating revival of a destructive disease
Authors: Alice Scriven
Journal: BMJ (2003)

Tuberculosis is a major threat to the health of Romania9s people, with an incidence of more than 10 times that of western European countries. In the lead up to World TB Day 2003 on the 24 March, <b>Alice Scriven</b> describes some aspects of the tuberculosis problem in this changing European country
Consumer Warning for Genetic Tests Claiming to Predict Response to Medications: Implications for Psychiatry
Authors: Joshua D. Rosenblat, Joseph F. Goldberg, Roger S. McIntyre
Journal: American Journal of Psychiatry (2019)

for elaborating in detail an interesting signaling mechanism that we briefly referenced in our article, one that could account for the involvement of both opioid and N-methyl-D-aspartate (NMDA) receptors in mediating ketamine's antidepressant effect.We fully agree that our data do not distinguish whether ketamine acts directly at opioid receptors, or indirectly, perhaps via enhanced release of endogenous opioids or by intracellular signaling crosstalk between opioid and NMDA receptors in the manner described by Mr. Wang and Dr. Kaplin.We would stress the importance of testing the key predictions of animal studies in humans.The mechanism described by Mr. Wang and Dr. Kaplin predicts that enhancing mammalian target of rapamycin (mTOR) signaling should also enhance ketamine's antidepressant effect.This prediction has recently been tested in patients with major depression.Abdallah and colleagues (1) pretreated these patients with rapamycin, an mTOR inhibitor, prior to a ketamine infusion.Remarkably, this combination potentiated, rather than blocked, ketamine's antidepressant effect.This result does not at all preclude the possibility of opioid-NMDA receptor crosstalk.Rather, it highlights the need for animal models that recapitulate the mechanistic features of ketamine's antidepressant effect observed in humans.
Possible genetic breakthrough as SARS continues to spread
Authors: Sanjit Bagchi
Journal: BMJ (2003)

As Student BMJ went to press, scientists in the United States were claiming to have identified the genetic sequence of the virus responsible for severe acute respiratory syndrome (SARS).

The World Health Organization said 58 people have died in China, 33 in Hong Kong, 10 in Canada, and nine in Singapore. These areas, along with Hanoi, have been designated the “hot zones,” but suspected or confirmed cases have been reported from other countries including Thailand, Malaysia, Indonesia, the Philippines, the United States, the United Kingdom, Switzerland, France, India, and …
A revolution for nausea
Authors: David Holt
Journal: BMJ (2007)

Postoperative orders are fairly standardised, and hospitals commonly use a checklist to allow doctors to check the needed drugs rapidly. Surgical patients are more or less healthy, and we assume that a checklist will serve most patients well. One category of postoperative drugs is antiemetics, and the most commonly used are those on the checklist, such as dimenhydrinate or diphenhydramine.

In follow-up assessments of patients we are less likely to consider matters already covered by the checklist. We commonly ask about chest pain, shortness of breath, leg swelling, bowel movements, and pain for our postoperative patients-but rarely …
LKB1 and KEAP1/NRF2 Pathways Cooperatively Promote Metabolic Reprogramming with Enhanced Glutamine Dependence in <i>KRAS</i>-Mutant Lung Adenocarcinoma
Authors: Ana Galan-Cobo, Piyada Sitthideatphaiboon, Xiao Qu, Alissa Poteete, Marlese A. Pisegna, Pan Tong, Pei-Hsuan Chen, Lindsey K. Boroughs, Mirna L.M. Rodriguez, Winter Zhang, Francesco Parlati, Jing Wang, Varsha Gandhi, Ferdinandos Skoulidis, Ralph J. DeBerardinis, John D. Minna, John V. Heymach
Journal: Cancer Research (2019)

Abstract In KRAS-mutant lung adenocarcinoma, tumors with LKB1 loss (KL) are highly enriched for concurrent KEAP1 mutations, which activate the KEAP1/NRF2 pathway (KLK). Here, we investigated the biological consequences of these cooccurring alterations and explored whether they conferred specific therapeutic vulnerabilities. Compared with KL tumors, KLK tumors exhibited increased expression of genes involved in glutamine metabolism, the tricarboxylic acid cycle, and the redox homeostasis signature. Using isogenic pairs with knockdown or overexpression of LKB1, KEAP1, and NRF2, we found that LKB1 loss results in increased energetic and redox stress marked by increased levels of intracellular reactive oxygen species and decreased levels of ATP, NADPH/NADP+ ratio, and glutathione. Activation of the KEAP1/NRF2 axis in LKB1-deficient cells enhanced cell survival and played a critical role in the maintenance of energetic and redox homeostasis in a glutamine-dependent manner. LKB1 and the KEAP1/NRF2 pathways cooperatively drove metabolic reprogramming and enhanced sensitivity to the glutaminase inhibitor CB-839 in vitro and in vivo. Overall, these findings elucidate the adaptive advantage provided by KEAP1/NRF2 pathway activation in KL tumors and support clinical testing of glutaminase inhibitor in subsets of KRAS-mutant lung adenocarcinoma. Significance: In KRAS-mutant non–small cell lung cancer, LKB1 loss results in enhanced energetic/redox stress, which is tolerated, in part, through cooccurring KEAP1/NRF2–dependent metabolic adaptations, thus enhancing glutamine dependence and vulnerability to glutaminase inhibition.