tbuckley/cabot-search huggingface dataset:
PTH-017 Colonoscopy for Abdominal Pain: Is It Worth Performing?
Authors: E Dhesi, K Besherdas
Journal: Gut (2016)

<h3>Introduction</h3> Colonoscopy is accepted as the gold standard imaging modality for colonic symptoms of altered bowel habit, anaemia, rectal bleeding and for the detection of colorectal cancer. Abdominal pain is a common presenting complaint in secondary care, and is generally accepted to be non-specific, with a low predictive value for significant pathology in the absence of other symptoms (altered bowel habit, bleeding). The American Society for Gastrointestinal Endoscopy in their guidelines for appropriate use of colonoscopy advise that this procedure is not indicated in “Chronic, stable, irritable bowel syndrome or chronic abdominal pain”. In observed practice, however, abdominal pain seems to be a common reason for referral for colonoscopy. For an endoscopy unit to be successful and with pressures of waiting times growing it is important not to overburden this with inappropriate referrals. We hypothesise that colonoscopy performed solely for abdominal pain has a low diagnostic yield and should therefore be avoided. <h3>Methods</h3> The aim of the study was to assess abdominal pain as an indication for colonoscopy. A single centre, retrospective analysis of patients undergoing colonoscopy for abdominal pain in a North London NHS Hospital Trust was performed. Patients were identified using the Unisoft Endoscopy reporting software across a 5 year period (March 2010-March 2015 inclusive). Data was scrutinised for procedure findings and result of histology obtained. If abnormal, the patient’s electronic record was scrutinised for documentation of additional symptoms prior to colonoscopy. <h3>Results</h3> A total of 1021 patients underwent colonoscopy for abdominal pain. 38 were diagnostic of Inflammatory Bowel Disease. 7 were diagnostic of adenocarcinoma. All of these patients had at least one other indication (diarrhoea, bleeding, weight loss or anaemia). Adenomatous polyp detection rate in this study was 6%, comparable to asymptomatic individuals. <h3>Conclusion</h3> From this study we can conclude that a large number of colonoscopies are performed for patients with abdominal pain. When pathology is detected it is always with other symptoms. This study suggests that colonoscopy is not a useful investigation in patients presenting solely with abdominal pain, as the diagnostic yield is poor. Avoiding such a procedure in this group of patient would free up space within the endoscopy units and reduce waiting times. Colonoscopy as an investigation for abdominal pain as the sole indication should not be performed. <h3>Disclosure of Interest</h3> None Declared
Aspirin reduces lipopolysaccharide-induced pulmonary inflammation in human models of ARDS
Authors: U Hamid, A Krasnodembskaya, M Fitzgerald, M Shyamsundar, A Kissenpfennig, C Scott, E Lefrancais, M R Looney, R Verghis, J Scott, A J Simpson, J McNamee, D F McAuley, C M O'Kane
Journal: Thorax (2017)

<h3>Rationale</h3> Platelets play an active role in the pathogenesis of acute respiratory distress syndrome (ARDS). Animal and observational studies have shown aspirin9s antiplatelet and immunomodulatory effects may be beneficial in ARDS. <h3>Objective</h3> To test the hypothesis that aspirin reduces inflammation in clinically relevant human models that recapitulate pathophysiological mechanisms implicated in the development of ARDS. <h3>Methods</h3> Healthy volunteers were randomised to receive placebo or aspirin 75 or 1200 mg (1:1:1) for seven days prior to lipopolysaccharide (LPS) inhalation, in a double-blind, placebo-controlled, allocation-concealed study. Bronchoalveolar lavage (BAL) was performed 6 hours after inhaling 50 µg of LPS. The primary outcome measure was BAL IL-8. Secondary outcome measures included markers of alveolar inflammation (BAL neutrophils, cytokines, neutrophil proteases), alveolar epithelial cell injury, systemic inflammation (neutrophils and plasma C-reactive protein (CRP)) and platelet activation (thromboxane B2, TXB2). Human lungs, perfused and ventilated ex vivo (EVLP) were randomised to placebo or 24 mg aspirin and injured with LPS. BAL was carried out 4 hours later. Inflammation was assessed by BAL differential cell counts and histological changes. <h3>Results</h3> In the healthy volunteer (n=33) model, data for the aspirin groups were combined. Aspirin did not reduce BAL IL-8. However, aspirin reduced pulmonary neutrophilia and tissue damaging neutrophil proteases (Matrix Metalloproteinase (MMP)-8/-9), reduced BAL concentrations of tumour necrosis factor α and reduced systemic and pulmonary TXB2. There was no difference between high-dose and low-dose aspirin. In the EVLP model, aspirin reduced BAL neutrophilia and alveolar injury as measured by histological damage. <h3>Conclusions</h3> These are the first prospective human data indicating that aspirin inhibits pulmonary neutrophilic inflammation, at both low and high doses. Further clinical studies are indicated to assess the role of aspirin in the prevention and treatment of ARDS. <h3>Trial registration number</h3> NCT01659307 Results.
Aspects of Ending a Lifelong Dream
Authors: Lawrence J. Hergott
Journal: JAMA (2017)

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
SK Channel Enhancers Attenuate Ca <sup>2+</sup> -Dependent Arrhythmia in Hypertrophic Hearts by Regulating Mito-ROS-Dependent Oxidation and Activity of RyR.
Authors: Tae Yun Kim, Radmila Terentyeva, Karim H.F. Roder, Weiyan Li, Man Liu, Ian Greener, Shanna Hamilton, Iuliia Polina, Kevin R. Murphy, Richard T. Clements, Samuel C. Dudley, Gideon Koren, Bum-Rak Choi, Dmitry Terentyev
Journal: Cardiovascular Research (2017)

Plasmamembrane small conductance Ca2+-activated K+ (SK) channels were implicated in ventricular arrhythmias in infarcted and failing hearts. Recently, SK channels were detected in the inner mitochondria membrane (IMM) (mSK), and their activation protected from acute ischaemia-reperfusion injury by reducing intracellular levels of reactive oxygen species (ROS). We hypothesized that mSK play an important role in regulating mitochondrial function in chronic cardiac diseases. We investigated the role of mSK channels in Ca2+-dependent ventricular arrhythmia using rat model of cardiac hypertrophy induced by banding of the ascending aorta thoracic aortic banding (TAB).Dual Ca2+ and membrane potential optical mapping of whole hearts derived from TAB rats revealed that membrane-permeable SK enhancer NS309 (2 μM) improved aberrant Ca2+ homeostasis and abolished VT/VF induced by β-adrenergic stimulation. Using whole cell patch-clamp and confocal Ca2+ imaging of cardiomyocytes derived from TAB hearts (TCMs) we found that membrane-permeable SK enhancers NS309 and CyPPA (10 μM) attenuated frequency of spontaneous Ca2+ waves and delayed afterdepolarizations. Furthermore, mSK inhibition enhanced (UCL-1684, 1 μM); while activation reduced mitochondrial ROS production in TCMs measured with MitoSOX. Protein oxidation assays demonstrated that increased oxidation of ryanodine receptors (RyRs) in TCMs was reversed by SK enhancers. Experiments in permeabilized TCMs showed that SK enhancers restored SR Ca2+ content, suggestive of substantial improvement in RyR function.These data suggest that enhancement of mSK channels in hypertrophic rat hearts protects from Ca2+-dependent arrhythmia and suggest that the protection is mediated via decreased mitochondrial ROS and subsequent decreased oxidation of reactive cysteines in RyR, which ultimately leads to stabilization of RyR-mediated Ca2+ release.
A Correction to the Research Article Titled: “Frequent and Focal <i>FGFR1</i> Amplification Associates with Therapeutically Tractable FGFR1 Dependency in Squamous Cell Lung Cancer ” by J. Weiss, M. L. Sos, D. Seidel, M. Peifer, T. Zander, J. M. Heuckmann, R. T. Ullrich, R. Menon, S. Maier, A. Soltermann, H. Moch, P. Wagener, F. Fischer, S. Heynck, M. Koker, J. Schöttle, F. Leenders, F. Gabler, I. Dabow, S. Querings, L. C. Heukamp, H. Balke-Want, S. Ansén, D. Rauh, I. Baessmann, J. Altmüller, Z…
Journal: Science Translational Medicine (2011)
Long-Term Efficacy and Safety of Romiplostim for the Treatment of Patients with Chronic Immune Thrombocytopenia (ITP): 5-Year Update From An Open-Label Extension Study.
Authors: James B. Bussel, David J Kuter, Adrian Newland, Joost TM de Wolf, Jeffrey Wasser, Paul Chang, Kun Nie, Dietmar Berger
Journal: Blood (2009)
Partial Restoration of CFTR Function in cftr-Null Mice following Targeted Cell Replacement Therapy
Authors: Pascal Duchesneau, Rickvinder Besla, Mathieu F. Derouet, Li Guo, Golnaz Karoubi, Amanda Silberberg, Amy P. Wong, Thomas K. Waddell
Journal: Molecular Therapy (2017)

Cystic fibrosis (CF) is a fatal recessive genetic disorder caused by a mutation in the gene encoding CF transmembrane conductance regulator (CFTR) protein. Alteration in CFTR leads to thick airway mucus and bacterial infection. Cell therapy has been proposed for CFTR restoration, but efficacy has been limited by low engraftment levels. In our previous studies, we have shown that using a pre-conditioning regimen in combination with optimization of cell number and time of delivery, we could obtain greater bone marrow cell (BMC) retention in the lung. Here, we found that optimized delivery of wild-type (WT) BMC contributed to apical CFTR expression in airway epithelium and restoration of select ceramide species and fatty acids in CFTR−/− mice. Importantly, WT BMC delivery delayed Pseudomonas aeruginosa lung infection and increased survival of CFTR−/− recipients. Only WT BMCs had a beneficial effect beyond 6 months, suggesting a dual mechanism of BMC benefit: a non-specific effect early after cell delivery, possibly due to the recruitment of macrophages and neutrophils, and a late beneficial effect dependent on long-term CFTR expression. Taken together, our results suggest that BMC can improve overall lung function and may have potential therapeutic benefit for the treatment of CF. Cystic fibrosis (CF) is a fatal recessive genetic disorder caused by a mutation in the gene encoding CF transmembrane conductance regulator (CFTR) protein. Alteration in CFTR leads to thick airway mucus and bacterial infection. Cell therapy has been proposed for CFTR restoration, but efficacy has been limited by low engraftment levels. In our previous studies, we have shown that using a pre-conditioning regimen in combination with optimization of cell number and time of delivery, we could obtain greater bone marrow cell (BMC) retention in the lung. Here, we found that optimized delivery of wild-type (WT) BMC contributed to apical CFTR expression in airway epithelium and restoration of select ceramide species and fatty acids in CFTR−/− mice. Importantly, WT BMC delivery delayed Pseudomonas aeruginosa lung infection and increased survival of CFTR−/− recipients. Only WT BMCs had a beneficial effect beyond 6 months, suggesting a dual mechanism of BMC benefit: a non-specific effect early after cell delivery, possibly due to the recruitment of macrophages and neutrophils, and a late beneficial effect dependent on long-term CFTR expression. Taken together, our results suggest that BMC can improve overall lung function and may have potential therapeutic benefit for the treatment of CF.
Targeting of alpha4beta1 Integrin and CD4/CD8 on Human T Cells, in Addition to CD3 and CD28, Induces Maximal Activation, as Assessed by Single-Cell Analysis of MAP Kinase Pathway Activation and Cytokine Production.
Authors: Tae Kon Kim, Matthew J. Billard, Eric D. Wieder, Bradley W. McIntyre, Krishna V. Komanduri
Journal: Blood (2008)
Eculizumab (ECU) in Atypical Hemolytic Uremic Syndrome (aHUS) Patients with Progressing Thrombotic Microangiopathy (TMA): 2-Year Data.
Authors: Larry Greenbaum, Christophe M. Legendre, Sunil Babu, Richard R. Furman, Neil Sheerin, David Cohen, Frank Eitner, Yahsou Delmas, Camille L. Bedrosian, Chantal Loirat
Journal: Blood (2012)
Phase II Study of Sequential Therapy with Cladribine Followed by an Extended Course Rituximab in Patients with Hairy Cell Leukemia
Authors: Farhad Ravandi, Jeffrey Jorgensen, Susan O'Brien, Deborah A Thomas, Stefan Faderl, Sergernne York, Jan A. Burger, Alessandra Ferrajoli, Sherry Pierce, Michael Keating, Hagop Kantarjian
Journal: Blood (2010)
Safety and Immunogenicity of Adenovirus 35 Tuberculosis Vaccine Candidate in Adults with Active or Previous Tuberculosis. A Randomized Trial
Authors: Richard N. van Zyl-Smit, Aliasgar Esmail, Mary E. Bateman, Rodney Dawson, Jonathan Goldin, Eva van Rikxoort, Macaya Douoguih, Maria Grazia Pau, Jerald C. Sadoff, J. Bruce McClain, Margaret Ann Snowden, Jacqueline Benko, David A. Hokey, Kathryn Tucker Rutkowski, Andrew Graves, Barbara Shepherd, Sadritdin Ishmukhamedov, Benjamin M. N. Kagina, Brian Abel, Willem A. Hanekom, Thomas J. Scriba, Eric D. Bateman
Journal: American Journal of Respiratory and Critical Care Medicine (2017)

Administration of tuberculosis (TB) vaccines in participants with previous or current pulmonary TB may have the potential for causing harmful postvaccination immunologic (Koch-type) reactions.To assess the safety and immunogenicity of three dose levels of the AERAS-402 live, replication-deficient adenovirus 35-vectored TB candidate vaccine, containing three mycobacterial antigens, in individuals with current or previous pulmonary TB.We performed a phase II randomized, placebo-controlled, double-blinded dose-escalation study in an HIV-negative adult South African cohort (n = 72) with active pulmonary TB (on treatment for 1-4 mo) or pulmonary TB treated at least 12 months before study entry and considered cured. Safety endpoints included clinical assessment, flow volume curves, diffusing capacity of the lung for carbon monoxide, pulse oximetry, chest radiograph, and high-resolution thoracic computerized tomography scans. Cytokine expression by CD4 and CD8 T cells, after stimulation with Ag85A, Ag85B, and TB10.4 peptide pools, was examined by intracellular cytokine staining.No apparent temporal or dose-related changes in clinical status (specifically acute, Koch phenomenon-like reactions), lung function, or radiology attributable to vaccine were observed. Injection site reactions were mild or moderate. Hematuria (by dipstick only) occurred in 25 (41%) of 61 AERAS-402 recipients and 3 (27%) of 11 placebo recipients, although no gross hematuria was reported. AERAS-402 induced robust CD8+ and moderate CD4+ T-cell responses, mainly to Ag85B in both vaccine groups.Administration of the AERAS-402 candidate TB vaccine to participants with current or previous pulmonary TB induced a robust immune response and is not associated with clinically significant pulmonary complications. Clinical trial registered with www.clinicaltrials.gov (NCT 02414828) and in the South African National Clinical Trials Register ( www.sanctr.gov.za DOH 27-0808-2060).
Glutathione-S-Transferase M1 (GSTM1) and T1 (GSTT1) Single Nucleotide Polymorphisms (SNPs) Predict Regimen-Related Toxicity after Autologous and Allogeneic Blood and Marrow Transplantation (BMT).
Authors: Theresa Hahn, Christine Ambrosone, Minoo Battiwalla, Philip L. McCarthy
Journal: Blood (2006)
Standard step sectioning of skin biopsy specimens diagnosed as superficial basal cell carcinoma frequently yields deeper and more aggressive subtypes
Authors: Kim P. Nguyen, G. Jimmy Knuiman, Piet E.J. van Erp, Willeke A. Blokx, Malou Peppelman, Marie-Jeanne P. Gerritsen
Journal: Journal of the American Academy of Dermatology (2017)
Eradication of hepatitis C virus and non‐liver‐related non–acquired immune deficiency syndrome–related events in human immunodeficiency virus/hepatitis C virus coinfection
Authors: Juan Berenguer, Elena Rodríguez‐Castellano, Ana Carrero, Miguel A. Von Wichmann, Marta Montero, María J. Galindo, Josep Mallolas, Manuel Crespo, María J. Téllez, Carmen Quereda, José Sanz, Carlos Barros, Cristina Tural, Ignacio Santos, Federico Pulido, Josep M. Guardiola, Rafael Rubio, Enrique Ortega, María L. Montes, Juan J. Jusdado, Gabriel Gaspar, Herminia Esteban, José M. Bellón, Juan González‐García
Journal: Hepatology (2017)

We assessed non-liver-related non-acquired immunodeficiency syndrome (AIDS)-related (NLR-NAR) events and mortality in a cohort of human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients treated with interferon (IFN) and ribavirin (RBV), between 2000 and 2008. The censoring date was May 31, 2014. Cox regression analysis was performed to assess the adjusted hazard rate (HR) of overall death in responders and nonresponders. Fine and Gray regression analysis was conducted to determine the adjusted subhazard rate (sHR) of NLR deaths and NLR-NAR events considering death as the competing risk. The NLR-NAR events analyzed included diabetes mellitus, chronic renal failure, cardiovascular events, NLR-NAR cancer, bone events, and non-AIDS-related infections. The variables for adjustment were age, sex, past AIDS, HIV transmission category, nadir CD4+ T-cell count, antiretroviral therapy, HIV RNA, liver fibrosis, HCV genotype, and exposure to specific anti-HIV drugs. Of the 1,625 patients included, 592 (36%) had a sustained viral response (SVR). After a median 5-year follow-up, SVR was found to be associated with a significant decrease in the hazard of diabetes mellitus (sHR, 0.57; 95% confidence interval [CI], 0.35-0.93; P = 0.024) and decline in the hazard of chronic renal failure close to the threshold of significance (sHR, 0.43; 95% CI, 0.17-1.09; P = 0.075).Our data suggest that eradication of HCV in coinfected patients is associated not only with a reduction in the frequency of death, HIV progression, and liver-related events, but also with a reduced hazard of diabetes mellitus and possibly of chronic renal failure. These findings argue for the prescription of HCV therapy in coinfected patients regardless of fibrosis stage. (Hepatology 2017;66:344-356).
Clinical Responses to Oral Vorinostat (Suberoylanilide Hydroxamic Acid, SAHA) Are Associated with Specific Gene Expression Signatures in Patients with Advanced Leukemias: Results of a Phase I Trial.
Authors: Andrey Loboda, Valeria R. Fantin, Carlos E. Bueso-Ramos, Sophia Randolph, James S. Hardwick, Justin L. Ricker, Victoria M. Richon, Jean-Pierre Issa, Hagop M. Kantarjian, Stanley R. Frankel, Guillermo Garcia-Manero
Journal: Blood (2006)
Pralatrexate in Relapsed/Refractory HTLV-1 Associated Adult T-Cell Lymphoma/Leukemia: A New York City Multi-Institutional Experience.
Authors: Matthew A Lunning, Jason Gonsky, Jia Ruan, Adrienne A. Phillips, Melissa Pulitzer, Alison Moskowitz, Christiane Querfeld, Patricia L Myskowski, Ariela Noy, Steven M. Horwitz
Journal: Blood (2012)
Relevance of a One-Year Maintenance Therapy with Interleukin-2 in the Treatment of Childhood Acute Myeloid Leukemia: Results from the French Multicenter, Phase III, Randomized Controlled Sfce Trial, ELAM02
Authors: Arnaud Petit, Stéphane Ducassou, Thierry Leblanc, Marlène Pasquet, Alexandra Rousseau, Christine Ragu, Marine Cachanado, Brigitte Nelken, Yves Bertrand, Gérard Michel, Virginie Gandemer, Wendy Cuccuini, Nicole Dastugue, Odile Fenneteau, Hélène Lapillonne, Anne Auvrignon, André Baruchel, Guy Leverger
Journal: Blood (2014)
Analysis of Beam (Carmustine, Etoposide, Cytosine Arabinoside, Melphalan) Versus High Dose Melphalan (HDM) with Autologous Rescue in Multiple Myeloma(MM).
Authors: Karthikeyan A. Ramasamy, Ruth Branford, Radha Selvaratnam, Aloysius Y.L. Ho, Rafael Duarte, Stephen Devereux, Antonio Pagliuca, Ghulam Mufti
Journal: Blood (2004)
Results of Immunosuppressive Therapy in Children with Severe Aplastic Anaemia (SAA). Report Polish Pediatric Hematology Group (Warszawa, Lublin, Krakow, Wroclaw, Zabrze, Bydgoszcz, Poznan, Lodz, Bialystok, Szczecin, Gdansk).
Authors: Katarzyna Pawelec, Michal Matysiak, Edyta Niewiadomska, Jerzy Kowalczyk, Jolanta Stefaniak, Walentyna Balwierz, Ewa Zaleska-Czepko, Alicja Chybicka, Krzysztof Szmyd, Danuta Sonta-Jakimczyk, Halina Bubala, Mariusz Wysocki, Andrzej Kurylak, Jacek Wachowiak, Malgorzata Kaczmarek-Karnold, Malgorzata Stolarska, Maryna Krawczuk-Rybak, Elzbieta Leszczynska, Tomasz Urasinski, Jaroslaw Peregud-Pogorzelski, Anna Balcerska, Marek Wlazlowski
Journal: Blood (2007)
The Btk Inhibitor Ibrutinib (PCI-32765) in Combination with Rituximab Is Well Tolerated and Displays Profound Activity in High-Risk Chronic Lymphocytic Leukemia (CLL) Patients
Authors: Jan A. Burger, Michael J. Keating, William G. Wierda, Julia Hoellenriegel, Alessandra Ferrajoli, Stefan Faderl, Susan Lerner, Gracy Zacharian, Xuelin Huang, Danelle F. James, Joseph J. Buggy, Hagop M Kantarjian, Susan M. O'Brien
Journal: Blood (2012)
Lymphangiogenesis is a feature of acute GVHD, and VEGFR-3 inhibition protects against experimental GVHD
Authors: Sarah Mertlitz, Yu Shi, Martina Kalupa, Carsten Grötzinger, Jörg Mengwasser, Katarina Riesner, Steffen Cordes, Sefer Elezkurtaj, Olaf Penack
Journal: Blood (2017)
The Effect of Sunlight and Other Factors on the Strength and Color of Cotton Fabrics.
Journal: JAMA (1933)

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