tbuckley/cabot-search huggingface dataset:
Tracking Weather-Related Deaths
Journal: JAMA (2014)

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
Massively parallel sequencing identifies a previously unrecognized X-linked disorder resulting in lethality in male infants owing to amino-terminal acetyltransferase deficiency
Authors: Alan F Rope, Kai Wang, Rune Evjenth, Jinchuan Xing, Jennifer J Johnston, Jeffrey J Swensen, Evan W Johnson, Barry Moore, Chad D Huff, Lynne M Bird, John C Carey, John M Opitz, Cathy A Stevens, Christa Schank, Deborah Heidi Fain, Reid Robison, Brian Dalley, Steven Chin, Sarah T South, Theodore J Pysher, Lynn B Jorde, Hakon Hakonarson, Johan R Lillehaug, Leslie G Biesecker, Mark Yandell, Thomas Arnesen, Gholson J Lyon
Journal: Genome biology (2011)
Genetically Engineered V79 Chinese Hamster Cells Metabolically Activate the Cytostatic Drugs Cyclophosphamide and Ifosfamide
Authors: J. Doehmer, A. Seidel, F. Oesch, H. R. Glatt
Journal: Environmental Health Perspectives (1990)

V79 cells, genetically engineered to express active cytochromes P450IIB1 and P450IA1, were used to study the cytotoxicity and mutagenicity of cyclophosphamide and ifosfamide. Cyclophosphamide, tested up to a concentration of 2 mM, was not cytotoxic in V79 nor in the P450IA1-expressing V79-derived cell line XEM2. Pronounced cytotoxicity was, however, observed in the P450IIB1-expressing V79-derived cell line SD1. Induction of gene mutations (acquisition of 6-thioguanine resistance) was observed in SD1 cells as well, but the effects were weak. Ifosfamide was inactive in V79 cells, but was cytotoxic in SD1 cells. Ifosfamide mustard, an active metabolite of ifosfamide, was equally cytotoxic and showed similar mutagenic effects in SD1 and parental V79 cells. The results indicate that cyclophosphamide and ifosfamide are metabolically activated by cytochrome P450IIB1. In contrast, cytochrome P450IA1 was not capable of activating cyclophosphamide. Thus, V79-derived cell lines defined for their expression of a specific form of cytochrome P-450 can be used as diagnostic tools to identify the cytochrome P-450 that is responsible for the metabolic activation of drugs.
Perverted Psychiatry?
Authors: K. R. EISSLER
Journal: American Journal of Psychiatry (1967)

Survivors of Nazi concentration camps who subsequently suffered serious psychiatric disorders have been denied compensation because certain psychiatric experts appointed by the German Consulate have refused to acknowledge a connection between the victims' experiences and later mental illness. The author believes these psychiatrists' adherence to the theory of constitutional etiology and their general approach make it less likely that they would make compensation recommendations in the victims' favor.
Streptococcus mutans Endocarditis
Authors: Lynne I. Neefe
Journal: JAMA (1974)

<i>Streptococcus mutans</i>endocarditis was initially diagnosed as enterococcal endocarditis. The organisms were indistinguishable by testing in two commonly used diagnostic media, Enterococcosel and<i>S faecalis</i>broths. Of 97 additional<i>S viridans</i>cultures isolated, 10% produced false-positive reactions in Enterococcosel broth and 1% in<i>S faecalis</i>broth. The identification of an "enterococcus" that is sensitive to lincomycin by the use of these media should be confirmed by growth in 6.5% sodium chloride broth and on eosin methylene blue agar. (<i>JAMA</i>230:1289-1290, 1974)
California living II: not-the-big-one had no effect on blood pressure
Authors: A. Swislocki
Journal: JAMA (1990)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Leads from the MMWR. Prevention and control of influenza
Journal: JAMA (1986)

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
Minocycline-induced liver injury Departments of Gastroenterology and *Pathology, Royal North Shore Hospital, Sydney, Australia
Journal: Hepatology (1995)

To evaluate the a priori hypotheses that an increased level of glyco and tauro lithocholic acid, perhaps because of a decreased capacity for hepatic sulfation, contributed to the biochemical epidemiology of gallbladder cancer, a case-control study was undertaken at four hospitals in La Paz, Bolivia, and at one hospital in Mexico City, Mexico. Eighty-four cases with newly diagnosed histologically confirmed gallbladder cancer were compared with 264 controls with cholelithiasis or choledocholithiasis in the absence of cancer and with 126 controls with normal biliary tracts. All study subjects were undergoing abdominal surgery. Interview data were collected for all study subjects, as well as blood, bile, and gallstone specimens when feasible. Sera were analyzed for carcinoembryonic antigen, cholesterol concentration, and total bile acids. Bile specimens were analyzed for carcinoembryonic antigen; and for concentration of bile salts; cholesterol; phospholipids; and the glycine and taurine conjugates of cholic, ursodeoxycholic, chenodeoxycholic, deoxycholic, and lithocholates; sulfoglycolithocholate; and sulfotaurolithocholate. Gallstone specimens were analyzed for the percentage of cholesterol content, the percentage of calcium bilirubinate content, and the percentage of calcium carbonate content. Serum bile acids were increased in cases versus the two control groups (median 11.7 nmol/mL vs. 9.3 nmol/mL for stone controls and 8.2 nmol/L for nonstone controls, P < or = .02 for each pairwise comparison). Biliary bile acids were markedly decreased in the cases (median 3.98 micromol/mL vs. 33.09 micromol/mL, and 154.0 micromol/L, respectively, P < or = .0001 for each comparison), even after excluding those with a serum bilirubin higher than 2.0 mg/dL. Bile cholesterol was lower for the cases as well (median 1.70 micromol/mL vs. 4.90 micromol/mL, and 16.81 micromol/ mL, respectively, P < or = .02), as was the concentration of bile phospholipids (median 2.97 micromol/mL vs. 6.26 micromol/mL, and 52.69 micromol/mL, P = .1 and .0004, respectively). Contrary to our a priori hypothesis, there was no difference between the cases and either control group in their bile concentrations of lithocholate, the proportion of bile acids which were sulfated, or the concentration of nonsulfated lithocholate. However, the cases had a higher concentration of ursodeoxycholate (UDC) (P < .004 for both control groups), especially glycoursodeoxycholate (P < .001 for both control groups). A previously published suggestion that gallstone size differed between cases and controls was not confirmed. In conclusion, cases with gallbladder cancer differed from controls with stones and from controls with normal biliary tracts in their serum and bile biochemistries. These findings may be a reflection of the disease process, or may provide useful clues to its pathogenesis. (Hepatology 1996 Jun;23(6):1402-11)
Questions and Answers
Journal: JAMA (1985)

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 Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Can Ambulatory Monitoring Identify High-Risk Patients With Stable Coronary Artery Disease?-Reply
Authors: Arshed A. Quyyumi
Journal: JAMA (1997)

—We, like many other researchers, believed at the initiation of our studies that transient ischemia would be of prognostic significance, but why this was not the case is clearly stated by Drs Deedwania and Carbajal: "Acute ischemic syndromes mostly occur due to fissuring or rupture of atherosclerotic plaque," and "the risk of acute coronary events cannot be reliably predicted based on the evidence and extent of myocardial ischemia." Our findings are confirmed by those of the Multicenter Myoardial Ischemia Research Group and Total Ischemic Burden European Trial (TIBET) studies, conducted in more than 1400 patients.<sup>1,2</sup>If one accepts that transient ischemia per se does not actually cause plaque rupture or fissuring, then it is entirely understandable that acute coronary events (due predominantly to plaque rupture/fissuring) are equally likely to occur in patients with and without ischemia. Unlike previous studies, we had followup angiographic evidence in most cases of nonfatal
BOOK REVIEWS
Authors: VIVIAN R. SHEIDLER
Journal: JNCI Journal of the National Cancer Institute (1990)

BOOK REVIEWS Get access Cancer Pain . Stephen E. Abram , ed. Dordrecht , The Netherlands : Kluwer Academic Publishers , 1989 , 173 pp. $69.95. VIVIAN R. SHEIDLER VIVIAN R. SHEIDLER Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 82, Issue 1, 3 January 1990, Pages 62–63, https://doi.org/10.1093/jnci/82.1.62-a Published: 03 January 1990
Fatal Mycobacterium tuberculosis infection despite adaptive immune response in the absence of MyD88
Authors: Cecile M. Fremond, Vladimir Yeremeev, Delphine M. Nicolle, Muazzam Jacobs, Valerie F. Quesniaux, Bernhard Ryffel
Journal: Journal of Clinical Investigation (2004)

Toll-like receptors (TLRs) such as TLR2 and TLR4 have been implicated in host response to mycobacterial infection. Here, mice deficient in the TLR adaptor molecule myeloid differentiation factor 88 (MyD88) were infected with Mycobacterium tuberculosis (MTB). While primary MyD88–/– macrophages and DCs are defective in TNF, IL-12, and NO production in response to mycobacterial stimulation, the upregulation of costimulatory molecules CD40 and CD86 is unaffected. Aerogenic infection of MyD88–/– mice with MTB is lethal within 4 weeks with 2 log10 higher CFU in the lung; high pulmonary levels of cytokines and chemokines; and acute, necrotic pneumonia, despite a normal T cell response with IFN-γ production to mycobacterial antigens upon ex vivo restimulation. Vaccination with Mycobacterium bovis bacillus Calmette-Guérin conferred a substantial protection in MyD88–/– mice from acute MTB infection. These data demonstrate that MyD88 signaling is dispensable to raise an acquired immune response to MTB. Nonetheless, this acquired immune response is not sufficient to compensate for the profound innate immune defect and the inability of MyD88–/– mice to control MTB infection.
Books Received
Authors: Stian Solem, Åsta S. Husby, Åshild T. Håland, Gunvor Launes, Bjarne Hansen, Patrick A. Vogel, Roger Hagen, Ulrich Voderholzer, Nicola Thiel, Christine Knaevelsrud, Elisabeth Hertenstein, Christoph Nissen, Anne Katrin Külz, Nirmal Herbst, Guido Franzen, Geetha Desai, Santosh K. Chaturvedi, Giovanni A. Fava, Jose de Leon, Enrique Baca-Garcia, Hilario Blasco-Fontecilla, André F. Carvalho, Cristiano A. Köhler, Thomas N. Hyphantis, Brisa S. Fernandes, Michael Berk, André R. Brunoni, Kamilla W. Miskowiak, Nathan Herrmann, Krista L. Lanctôt, João Quevedo, Marieke Wichers, Peter C. Groot, Behzad Chavooshi, Parvaneh Mohammadkhani, Behrouz Dolatshahee, Martin Bürgy, Ulrich Hegerl, Matthias Backenstrass, Hans Kordy, Markus Wolf, Kai Aulich, Johannes Hüsing, Bernd Puschner, Christine Rummel-Kluge, Helmut Vedder, Daniel H. Mathalon, Stuart J. Eisendrath, Erin Gillung, Kevin L. Delucchi, Zindel V. Segal, J. Craig Nelson, L. Alison McInnes, Mitchell D. Feldman, Leonardo Tondo, Falk Leichsenring, Christiane Steinert, Ulrich Jaeger, Oliver Masuhr, Sven Rabung, Andreas Dally, Michael Dümpelmann, Christian Fricke-Neef, Ulrich Streeck, Satz Mengensatzproduktion, Druckerei Stückle, Druckerei Stückle, Psychosystems, ESM Group, EWS Group
Journal: Psychotherapy and Psychosomatics (2016)

The book outlines the cognitive behavioral approach to insomnia in its most diverse manifestations.It is very practical and rich in clinical examples.
Propédeutique et Technique Urologiques.
Journal: JAMA (1923)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
A COMPARISON OF SEVERAL CLINICAL QUANTITATIVE BLOOD SUGAR METHODS
Journal: JAMA (1922)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
BOLERO-2: Health-related quality-of-life (HRQoL) in metastatic breast cancer patients treated with everolimus and exemestane versus exemestane.
Authors: Hope S. Rugo, J. Thaddeus Beck, José Baselga, Shinzaburo Noguchi, Michael Gnant, Fabienne Lebrun, Patrick Neven, Martina Nunzi, Anna Komorowski, Edmond Chouinard, Robyn R. Young, Ian Anderson, Lee Bennett, Jean-Francois Ricci, Gabriel N. Hortobagyi, Tarek Sahmoud, Howard A. Burris
Journal: Journal of Clinical Oncology (2012)

125 Background: BOLERO-2, a phase III study, randomized 724 patients with hormone-receptor–positive metastatic breast cancer, who had recurrence or progression on/after prior nonsteroidal aromatase inhibitor therapy, to everolimus (EVE) + exemestane (EXE) or EXE + placebo. A preplanned 12-mo median time interim analysis demonstrated that EVE + EXE significantly improved progression-free survival (PFS) vs EXE + placebo, but EVE + EXE resulted in a higher rate of grade 3-4 toxicity. Per-protocol patients reported HRQoL data are limited; here we report on additional post hoc analyses of these outcomes. Methods: Using the EORTC QLQ-C30 questionnaire, HRQoL was assessed at baseline and every 6 weeks thereafter until progression. QLQ-C30 consists of 30 items combined into 15 subscales, including a Global Health Status (GHS), where higher scores (range, 0-100) indicate better HRQoL. Analysis included a protocol-specified time to definitive deterioration (TTD) analysis at a 5% decrease in QoL relative to baseline, with no subsequent increase above this threshold. We report additional sensitivity analyses using 10-point minimally important difference (MID) decreases in QLQ-C30 score relative to baseline. Treatment arms were compared using a stratified log-rank test and a Cox proportional hazards model adjusted for trial stratum (visceral metastases and previous hormone sensitivity), age, sex, race, baseline score, ECOG performance status, prognostic risk factors, and treatment history. Results: Baseline QLQ-C30 GHS scores were not statistically significantly different across treatment groups (64.7 vs 65.3; difference –0.7 [95% CI, –4.3-3.0]). Median TTD in HRQoL was 7.0 mo (95% CI, 5.6-8.3) for EVE + EXE vs 5.6 (95% CI, 4.2-7.0) for EXE (p = .0792). Adjusted HR (0.80) approached significance (95% CI, 0.63-1.02). At the 10-point MID, median TTD for EVE + EXE was 9.7 mo (95% CI, 8.3-11.2) vs 8.4 mo (95% CI, 6.3-12.5) for EXE. Adjusted HR was 0.90 (95% CI, 0.69-1.18). Conclusions: These additional analyses from the BOLERO-2 study demonstrate that in addition to significantly improving PFS, EVE + EXE does not compromise HRQoL.
Psychogenic Arthralgia
Authors: H. P. Wright
Journal: Annals of the Rheumatic Diseases (1947)

Today the term " psychosomatic syndrome " needs no introduction or explana- tion to the average intelligent physician.It is generally accepted that disease symptoms mnay be aggravated by emotional disturbance producing pathological changes through the sympathetic or endocrine system, as, for example, in coronary sclerosis.Also, most experienced rheumatologists emphasize the important contributing effect of emotional disturbance in rheumatoid arthritis.This paper, however, is confined to cases in which no organic disease of the joints has been detected.Therefore the term psychogenic arthralgia is suggested, rather than the older one of psychogenic rheumatism.Psychosomatically speaking, such conditions as headache, laughter, tears, flushing, vomiting, heartache (or, if you like, coronary spasm) are frequently manifestations of disturbed psyche-and so it is with changes in the joints.Forty- five years ago my own younger brother avoided church-going on more than one Sunday with a painful knee, which always seemed to clear up while the rest of the family were at church.Early in the world war 1914-18 the classification of the psychoneuroses was confused, and the term " shell shock" was at first generally applied to cover bizarre and unfamiliar clinical entities.But gradually the so-called functional cases were divided into three groups: (1) hysteria; (2) neuras- thenia; (3) malingerers.In the interval between the two world wars, psychiatry became a respectable medical speciality, perhaps partly due to the increasing number of cases in this group and the decreasing number of the more serious epidemio- logical diseases such as smallpox, typhoid fever, etc. Add to this, in our civiliza- tion, the transition from the horse-and-buggy stage to the era of large cities, telephones, automobiles, aeroplanes, and preventive medicine, and the above idea becomes at least suggestive.The power of emotion in the direction of human thought, the impotence of logic to affect the conclusions dictated by passion, prejudice, and fear, and the extent to which man's mind is controlled by psychological processes of which he is himself entirely unconscious, have been so abundantly demonstrated as to become obvious to the most superficial observer.Rationalization allows the mind to regard incompatible facts in such a light that their incompatibility is more or less efficiently cloaked.The man whose commercial morality differs funda- mentally from the code which he practises in his private life persuades himself that the latter code is not properly applicable to business relations-that a man must live and the apparent immorality involved disappears when it is necessary