tbuckley/cabot-search huggingface dataset:
Smoking by young people
Authors: C. Levy, W. D Novelli
Journal: BMJ (1999)

Developing world needs access to low cost pharmaceutical information from reliable sourcesEditor-Hafeez and Mirza have assessed how seriously (or not) pharmaceutical companies take their responsibility to provide information on request to prescribers in Pakistan. 1 Two of their conclusions are that "providing information on drugs is not a priority for companies in Pakistan" and that "the decision to respond to a request for more information therefore seems to depend on how favourable it might be to the interests of the company."These conclusions are particularly worrying because the biased information from drug companies is often the only type of information that prescribers have access to.The findings are in one respect an indictment of the pharmaceutical industry's approach in the developing world.But in another respect, the fact that most prescribers in the developing world do not have adequate access to reliable generic information is an indictment of the international health community.We cannot and should not expect the pharmaceutical industry to provide consistently unbiased information.What is needed is universal access to free or low cost information from a reliable source.As a basic source of reliable prescribing information, the British National Formulary is arguably the single most useful formulary for prescribers worldwide and is one of the BMJ Publishing Group's best sellers internationally.We applaud the recent decision to make the eBNF available on line. 2 If this facility is free it will be a benefit to some prescribers in developing countries, although the effort required to get information online will always be a barrier, even to those few who do have access.Low cost, printed formularies with a quality and objectivity parallel to those of the British National Formulary should be made affordable to all prescribers.Their value and use should be vigorously promoted, not just by the BMJ Publishing Group but by the international health community at large.
Abstract 1910: Monitoring of Inflammatory Processes By In Vivo 19F Magnetic Resonance Imaging
Authors: Ulrich Flögel, Zhaoping Ding, Hendrik Hardung, Sebastion Jander, Gaby Reichwein, Christoph Jacoby, Rolf Schubert, Jürgen Schrader
Journal: Circulation (2007)

This study was aimed at developing a new approach for in vivo detection of inflammation by 19 F magnetic resonance imaging (MRI) using biochemically inert emulsified perfluorocarbons (PFCs). PFCs have been clinically used as blood substitutes and are known to be phagocytized by the reticuloendothelial system. Local inflammation was provoked in two murine models of acute cardiac and cerebral ischemia, respectively, followed by intravenous injection of PFCs. A typical example of anatomically matching 1 H and 19 F images obtained at 9.4 Tesla 4 days after myocardial infarction is shown below. The 1 H image (left) clearly shows the presence of ventricular dilatation and wall thinning within the infarcted area (I), and in the corresponding 19 F image (middle) a signal pattern matched in shape of the free left ventricular wall. Merging of these images (right) confirms the localization of PFCs within the anterior, lateral, and posterior wall. In all animals (n=8) studied, 19 F signal was also detected in the adjacent chest tissue, where thoracotomy for infarction was performed (T). No background signal from other tissue was observed. Repetitive MRI revealed in both injury models a time-dependent infiltration of injected PFCs into infarcted areas, and histology demonstrated a colocalization of PFCs with cells of the monocyte-macrophage system. Using rhodamine-labelled PFCs, circulating monocytes/macrophages were identified to be the main cell fraction taking up injected PFCs. In conclusion, PFCs can serve as positive contrast agent for detection of inflammatory processes by MRI, permitting high spatial resolution and an excellent degree of specificity due to lack of any 19 F background.
Abstract 14323: Clinical Outcomes in Nonsurgically Managed Patients With Very Severe versus Severe Aortic Stenosis
Authors: Satoshi Honda, Takeshi Kitai, Tomoko Tani, Kite Kim, Natsuhiko Ehara, Atsushi Kobori, Makoto Kinoshita, Shuchiro Kaji, Atsushi Yamamuro, Toru Kita, Yutaka Furukawa
Journal: Circulation (2010)
Abstract 19248: Atrial Fibrillation/Flutter Associated with Rheumatoid Arthritis vs. Osteoarthritis and the use of Etoricoxib vs. Diclofenac: Results from the MEDAL Program
Authors: Payal Kohli, Loren Laine, Amarjot Kaur, Sean Curtis, Christopher P Cannon
Journal: Circulation (2012)

Background: The use of non-steroidal anti-inflammatory drugs (NSAIDs) and rheumatoid arthritis (RA) have been associated with atrial fibrillation/flutter (AF) and adverse cardiovascular outcomes in registry studies. The MEDAL program provides a unique opportunity within the context of large randomized controlled trials to explore this relationship. Methods: MEDAL represents a pooled population from 3 trials; 34,701 patients with osteoarthritis (OA) or RA randomized to receive either a coxib (etoricoxib, 60 or 90 mg daily) or a non-selective NSAID (diclofenac 150 mg daily) had a mean follow up of 18 months. All patients who received at least one dose of study drug were included in the analyses (modified Intent to Treat). AF events occurring on study drug, defined as serious or resulting in drug discontinuation (reported up to 14 days after last date of drug), were counted and unadjusted incidence rates are reported in this post-hoc analysis. Results: Overall, the rates of AF in the study were low (0.5%). More patients with AF were male, ≥65 years, white race, and had ≥2 coronary risk factors (p&lt;0.01 for all). Patients with OA had a slightly higher mean age than those with RA (64.0 vs. 61.2 years) and a somewhat higher proportion of coronary risk factors. In the pooled treatment group (selective plus non-selective NSAIDs), there was a slightly lower rate of AF in patients with RA compared with OA (0.4% vs. 0.6%). When stratified by treatment group and type of arthritis, the highest rate of AF occurred in patients receiving etoricoxib 90 mg and having OA (0.7%) (Figure). Conclusion: Within the MEDAL program, patients with RA did not appear to have a higher unadjusted rate of AF than patients with OA. Furthermore, 90 mg etoricoxib in patients with OA was associated with a higher rate of AF relative to a non-selective NSAID and this relationship may be dose-related. These data suggest greater degrees of COX-2 inhibition may increase the risk of AF, although the absolute risk is small.
Cardiovascular Effects of n-3 Fatty Acids
Authors: O Adam
Journal: New England Journal of Medicine (1988)

N-6 fatty acids comprise linoleic, dihomo-gamma-linolenic and arachidonic acid. Each of these polyunsaturated fatty acids display an individual pattern of cardiovascular effects. Moreover, the supplementation of the diet with one of these n-6 fatty acids results in a concomitant effect on the resorption, distribution and metabolism of the other n-6 fatty acids. While linoleic acid is abundant in our diet, the other n-6 fatty acids are only found in minute amounts. Accordingly, the effects with linoleic acid are less impressive, but more complex (e.g. lowering of plasma cholesterol, inhibition of renin) than with both other n-6 fatty acids. Linoleic acid, being no direct prostaglandin precursor, displays a variety of effects on the prostaglandin cascade, while dihomo-gamma-linolenic acid gives rise to 1-series prostaglandins and arachidonic acid to prostaglandins (eicosanoids) of the 2-series. The quality and quantity of prostaglandins formed, contribute essentially to the cardiovascular effects of the individual n-6 fatty acids.
Mythbusters: Cancer research in jeopardy?
Authors: J. Kennedy, A. Boutte, A. Shaw, C. Hanson, J. Weiss, N. Markham
Journal: Journal of Clinical Oncology (2010)

e19607 Background: In the United States, less than 5% of eligible adult cancer patients participate in clinical trials. Lack of information and commonly held beliefs or myths are among the biggest barriers to enrollment in cancer clinical trials. Additionally, traditional methods of education can be intimidating, frightening or even boring and the most difficult time to educate patients about cancer clinical trials is at the time of diagnosis. Thus, there is a need to develop novel strategies to educate individuals and the community about clinical trials prior to a cancer diagnosis. Methods: The Vanderbilt-Ingram Cancer Center Patient Advocacy Program and the Vanderbilt Postdoctoral Association collaborated to develop and deliver an innovative, interactive pilot program aimed at dispelling myths commonly associated with cancer clinical trials. Patient advocates, researchers, and clinicians scripted and participated in a “Jeopardy” game show format to provide factual information in a relaxed and entertaining environment. For a community audience of 50, a response to each myth was surveyed electronically during the presentation. After the preliminary response of audience members was noted, an expert clarified each myth by presenting factual information. After the presentation of ten myths, a post-test was administered to assess changes in knowledge. Results: We found that audience knowledge was significantly increased by 20%. 96% of audience members indicated that the game show format was an effective method for learning. 87% indicated that they would discuss cancer clinical trials with family, friends or coworkers. Conclusions: We conclude that Mythbusters: Cancer Research in Jeopardy is an effective learning tool and significantly increases community knowledge about cancer clinical trials. The results of this pilot will provide a model for effective community education and may ultimately impact participation in cancer clinical trials. No significant financial relationships to disclose.
Abstract 1878: Improved Detection of Viable Myocardium by a Novel Strain Doppler Measure in Patients with Acute Myocardial Infarction
Authors: Trond Vartdal, Eirik Pettersen, Thomas Helle-Valle, Erik Lyseggen, Hans-Jørgen Smith, Kai Andersen, Otto A Smiseth, Thor Edvardsen
Journal: Circulation (2007)

BACKGROUND: Detection of viable myocardium is vital for treatment strategy during acute myocardial infarction (AMI). The aim was to study if strain Doppler echocardiography (SDE) prior to reperfusion therapy could predict viable myocardium in AMI as determined by cardiac magnetic resonance imaging (CMR). METHODS: Twenty-five patients (58 ± 12 years, 7 women) with AMI who underwent percutaneous coronary intervention (PCI) were examined by SDE immediately prior to PCI. End-systolic longitudinal strain and duration of systolic lengthening was analyzed in 16 left ventricular segments. CMR was performed 11 ± 4 months after reperfusion therapy. Scars exceeding 50% of the segment was considered non-viable. RESULTS: Duration of systolic lengthening in non-viable myocardial segments was 249 ± 135 ms compared to 39 ± 86 ms in viable segments (p&lt;0.0001), with a direct relationship to scar transmurality (r=0.89, p&lt;0.0001). A duration of systolic lengthening longer than 67.3% (~2/3) of systole (Figure ) detected non-viable myocardium by a sensitivity of 90% and a specificity of 93%. Strain demonstrated end-systolic shortening (−15 ± 6%) in viable segments in contrast to lengthening in non-viable segments (3 ± 4%, p&lt;0.0001). End-systolic strain correlated also with the scar transmurality (r=0.71, p&lt;0.0001). CONCLUSION: SDE performed before reperfusion therapy in AMI can identify viable myocardium. Duration of systolic lengthening which is a novel parameter might prove to be a superior measure for predicting recovery of myocardial function.
Abstract 2009: Matching the Transthoracic Defibrillation Vector to the Fibrillation Vector Improves Shock Success
Authors: Leonard A Brooks, Yi Zhang, Raghuveer Dendi, Roger H Anderson, Richard E Kerber
Journal: Circulation (2007)

Background: Depolarization of myocytes requires less energy when electrical current flows along the longitudinal axis compared to the transverse axis of myocytes. Since ventricular fibrillation (VF) amplitude in ECG leads reflects the functional electrical orientation of the majority of myocytes, we hypothesized that a defibrillation shock would be more effective if the shock vector was oriented along the functional electrical axis of the majority of myocytes, and this axis could be determined in real time from the relative amplitudes of the VF signal measured in three orthogonal ECG leads. Methods: In closed-chest, anesthetized, swine (22.0 ± SE0.8 kg, n=9), a new directional defibrillation device was used to simultaneously measure the VF amplitude through three orthogonal pairs of defibrillation electrodes: anterior-posterior, lateral-lateral, and superior-inferior. VF was electrically induced and persisted for 15 seconds. During defibrillation, the device identified the electrode pair that measured the largest or smallest peak amplitudes (+ or −) within the previous 100msec through which to deliver the shock. Defibrillation success for the electrodes measuring the largest or smallest VF amplitude was evaluated by delivering four 50J shocks for VF through each of these electrode pairs (in random order). The electrode pair measuring the largest VF signal amplitude was considered to be most closely aligned with the functional VF vector. Results: Fifty J shocks (n=37) delivered through the electrode pair measuring the largest VF signal amplitude had higher defibrillation success than 50J shocks (n=37) delivered through the electrodes measuring the smallest VF signal amplitude (62 ± 10% vs.19 ± 8%, p&lt;0.05). Impedance and current were not different. Conclusions: By using a directional defibrillation device which instantaneously measures the peak VF signal amplitude in three pairs of orthogonally oriented defibrillation electrodes, it is feasible to determine which set of electrodes is oriented more favorably to the functional VF vector and to direct the shock through that set of electrodes. Matching the defibrillation vector to the fibrillation vector improves shock success.
Recombinant human granulocyte-macrophage colony-stimulating factor after high-dose chemotherapy and autologous bone marrow transplantation with unpurged and purged marrow in non-Hodgkin's lymphoma: a double- blind placebo-controlled trial
Authors: NC Gorin, B Coiffier, M Hayat, L Fouillard, M Kuentz, M Flesch, P Colombat, P Boivin, S Slavin, T Philip
Journal: Blood (1992)
Practical Appraisal of a New Rating Scale (MRSS) for Rehabilitation
Authors: D I Khoosal, A G Oswald, R J Smith
Journal: Journal of the Royal Society of Medicine (1987)

Rating scales are available to assess patients undergoing rehabilitation for chronic psychiatric disorders. Few are universally acceptable because of pitfalls in their structure or administration. This study examines the recently printed Morningside Rehabilitation Status Scale in one rehabilitation network. The MRSS was found to be suitable in discriminating between severely and moderately disabled groups but not between mildly and moderately disabled groups.
Abstract 13368: Reducing Coronary CT Angiography Radiation Exposure: How to Implement Dose Reduction Techniques in a "Real World" Study of 3,333 patients
Authors: Karman Tandon, Christian Hamilton-Craig, Allan J Wesley, Rachael O’Rourke, Mohammad Paymard, Johanne Neil, Kelley R Branch
Journal: Circulation (2014)

Introduction: Coronary CT Angiography (CCTA) use is booming but exposes patients to significant radiation. Between 2009 and 2013, studies suggested prospective gating, decreasing tube voltage (kVp), current modulation and high pitch scanning reduce radiation dose without image quality loss.

Hypothesis: Developing and implementing an optimal CCTA protocol will reduce radiation exposure.

Methods: CCTAs were performed from November 2009 to March 2014 on dual-source and high-pitch scanners. As dose reduction techniques were identified in the literature, a protocol algorithm was developed and imaging staff formally educated in its use. Associations of CCTA settings to radiation dose were tested with linear regression.

Results: 3,333 CCTAs were analyzed. Annual radiation dose decreased from 8.4 mSv (2009), to 5.3, 4.4, 3.7, 2.9, and 2.8 (2014) (p<0.00005). Improvements in protocolling and staff education achieved 52% dose reduction; use of a high-pitch scanner reduced dose 15% further. Lower dose was related to lower kVp, heart rate, and BMI, female gender, current modulation, prospective gating and high-pitch mode (p<0.01).

Conclusion: Significant reduction in radiation exposure is feasible at any CCTA center with no change in infrastructure or cost by consistent use of the educational strategies, review of contributing studies, and the CCTA protocolling algorithm presented here.

   ![][1]    ![][2]    ![][3]  [1]: /embed/graphic-1.gif
 [2]: /embed/graphic-2.gif
 [3]: /embed/graphic-3.gif
The relationship of postdoctoral research training to current research activities of faculty in academic departments of psychiatry
Authors: H A Pincus, M G Haviland, T H Dial, M S Hendryx
Journal: American Journal of Psychiatry (1995)

This report describes the postdoctoral research training of faculty in departments of psychiatry and relates research training characteristics to current involvement in research.Data were taken from a survey of 3,107 doctoral-level faculty in departments of psychiatry at 116 U.S. medical schools. The survey instrument gathered information about faculty members' postdoctoral research training and current research activities and elicited recommendations for research training programs.Of the survey respondents, 34.8% had had some form of postdoctoral research training. Most of those had trained in medical schools or intramural programs of the National Institutes of Health and federal institutes on alcoholism, drug abuse, and mental health. Most funding came from the federal government. Postdoctoral research training was significantly related to greater current research involvement across all degree types--M.D., Ph.D., and M.D.-Ph.D. Length of training was related to level of research involvement for M.D.s and Ph.D.s but not M.D.-Ph.D.s. Although most researchers believed their training programs prepared them for independent research, a smaller proportion of M.D.s than M.D.-Ph.D.s or Ph.D.s responded affirmatively to that question. Researchers were more likely than nonresearchers to consider their training adequate. Respondents rated time with mentor, course work in statistics, and length of training as the most important training program features. Both research training and research activities were concentrated in a relatively few institutions.These data show the critical importance of both federal support of research training and postdoctoral research training for subsequent research involvement of psychiatric faculty.
Abstract 17259: Differential Changes in Plaque Behind the Stent After Bare-Metal and Drug-Eluting Stent Implantation in Humans: Implications for In-Stent Restenosis?
Authors: Ioannis Andreou, Koki Shishido, Antonios P Antoniadis, Saeko Takahashi, Masaya Tsuda, Michail I Papafaklis, Shigeru Saito, Ahmet U Coscun, Charles L Feldman, Peter H Stone
Journal: Circulation (2014)

Background: The natural history and the role of the atherosclerotic plaque located behind the stent (PBS) are still poorly understood. We evaluated the serial changes in PBS following bare-metal (BMS) compared with first-generation drug-eluting stent (DES) implantation and the impact of these changes on in-stent neointimal hyperplasia (NIH). Methods: 3D coronary reconstruction by angiography and intravascular ultrasound were serially performed after intervention and at 6- to 10-month follow-up in 157 Japanese patients treated with BMS (n=90) and DES (n=98; 68 sirolimus-eluting and 30 paclitaxel-eluting stents) included in the PREDICTION Study. Each reconstructed stented coronary artery was divided into consecutive 1.5-mm segments. External elastic lamina, lumen, stent, and PBS area were measured for each segment at both baseline and follow-up. At follow-up NIH area was assessed. Due to the very low rate of events in our population we used significant NIH (defined as NIH area &gt;50% of stent area) as a binary anatomic outcome. Results: Patient, lesion, and stent characteristics were comparable between BMS and DES. There was a significant decrease in PBS area after BMS (median relative change: -7.2%, IQR -19.3 to 5.2%, p&lt;0.001) and a significant increase after DES implantation (median relative change: 6.1%, IQR -5.7 to 20.5%, p&lt;0.001). The decrease in PBS area significantly predicted NIH area at follow-up after controlling for baseline lumen area and baseline PBS area in both BMS (β 0.15, 95% CI 0.1 to 0.2, p&lt;0.001) and DES (β 0.09, 95% CI 0.07 to 0.11, p&lt;0.001). The decrease in PBS area was the most powerful predictor of significant NIH in both BMS (OR 1.13, 95% CI 1.02 to 1.26, p=0.017) and DES (OR 1.65, 95% CI 1.16 to 2.36, p=0.005). Conclusions: The PBS significantly decreased 6 to 10 months after BMS implantation, whereas after DES it increased. The decrease in PBS area was significantly associated with the development of NIH at follow-up in both stent types. These findings raise the possibility of a communication between the lesion within the stent and the underlying native atherosclerotic plaque, and may have important implications regarding the pathobiology of in-stent restenosis.
Abstract 14654: The Relative Roles of Clinic Blood Pressure and Ambulatory Blood Pressure Monitoring in Evaluating Pediatric Hypertension: Dollars and Sense
Authors: Marguerite L Davis, Michael A Ferguson, Justin P Zachariah
Journal: Circulation (2013)

Background: The Affordable Care Act of 2010 mandates population-wide identification of high blood pressure (BP) in children. Given children are prone to white-coat and masked hypertension, inappropriate or inadequate therapy is possible. As screening increases, confirmatory ambulatory blood pressure monitoring (ABPM) utilization may increase which could then increase costs. In our referral cohort, we sought clinic BP (CBP) combinations that predicted ABPM hypertension and to model the cost-efficiency of BP diagnostic strategies. Methods: Clinical and BP data were collected from a consecutive cohort of children referred for elevated BP with a complete ABPM from 2010-2012 (n=170, females= 58, mean age 15.6±3.7 years). Linear regression models were built with ABPM mean 24 hour systolic BP (SBP) or SBP load as continuous outcomes. Holding age, sex, height, and clinic heart rate as covariates in each model, various CBP indices were sequentially replaced as the predictor of interest. Next, significant indices w...
Parents' view
Authors: S Ellis
Journal: BMJ (2006)

When doctors asked us to participate we agreed without hesitation, knowing that it would bring new knowledge to the doctors and patients. When our daughter was first admitted to hospital, we thought she had an infection that could be simply and quickly cured. However, as time went on and all the tests returned negative, it became clear that there was something more sinister and it became increasingly frustrating that doctors could not come up with a definite diagnosis despite numerous investigations.1

As she developed many rare complications associated with this illness, we naturally lost confidence in our attending doctors. Although the diagnosis of adult onset Still's disease was made, we still sought a second medical opinion because of our daughter's deterioration.

Despite her complications, we were reassured and kept regularly informed of her development and progress. Now, we are working together with the doctors for further improvement.
Abstract 3228: Complete Revascularization to the Pedal Arch May Improve the Survival of Patient with Critical Limb Ischemia
Authors: Osamu Iida, Shinsuke Nanto, Masaaki Uematsu, Takakazu Morozumi, Jun-ichi Kotani, Tetsuya Watanabe, Masaki Awata, Toshinari Onishi, Fusako Sera, Hitoshi Minamiguchi, Hirokuni Akahori, Masamichi Yano, Hiroki Yasui, Seiki Nagata
Journal: Circulation (2006)