tbuckley/cabot-search huggingface dataset:
Development and Validation of a Novel Acute Myeloid Leukemia–Composite Model to Estimate Risks of Mortality
Authors: Mohamed L. Sorror, Barry E. Storer, Amir T. Fathi, Aaron T. Gerds, Bruno C. Medeiros, Paul Shami, Andrew M. Brunner, Mikkael A. Sekeres, Sudipto Mukherjee, Esteban Peña, Mahmoud Elsawy, Shylo Wardyn, Jennifer Whitten, Rachelle Moore, Pamela S. Becker, Jeannine S. McCune, Frederick R. Appelbaum, Elihu H. Estey
Journal: JAMA Oncology (2017)

To our knowledge, this multicenter analysis is the first to test and validate (1) the prognostic impact of comorbidities on 1-year mortality after initial therapy of acute myeloid leukemia (AML) and (2) a novel, risk-stratifying composite model incorporating comorbidities, age, and cytogenetic and molecular risks.To accurately estimate risks of mortality by developing and validating a composite model that combines the most significant patient-specific and AML-specific features.This is a retrospective cohort study. A series of comorbidities, including those already incorporated into the hematopoietic cell transplantation–comorbidity index (HCT-CI), were evaluated. Patients were randomly divided into a training set (n = 733) and a validation set (n = 367). In the training set, covariates associated with 1-year overall mortality at a significance level of P < .10 constructed a multivariate Cox proportional hazards model in which the impact of each covariate was adjusted for that of all others. Then, the adjusted hazard ratios were used as weights. Performances of models were compared using C statistics for continuous outcomes and area under the curve (AUC) for binary outcomes.Initial therapy for AML.Death within 1 year after initial therapy for AML.A total of 1100 patients, ages 20 to 89 years, were treated for AML between January 1, 2008, and December 31, 2012, at 5 academic institutions specialized in treating AML; 605 (55%) were male, and 495 (45%) were female. In the validation set, the original HCT-CI had better C statistic and AUC estimates compared with the AML comorbidity index for prediction of 1-year mortality. Augmenting the original HCT-CI with 3 independently significant comorbidities, hypoalbuminemia, thrombocytopenia, and high lactate dehydrogenase level, yielded a better C statistic of 0.66 and AUC of 0.69 for 1-year mortality. A composite model comprising augmented HCT-CI, age, and cytogenetic/molecular risks had even better predictive estimates of 0.72 and 0.76, respectively.In this cohort study, comorbidities influenced 1-year survival of patients with AML, and comorbidities are best captured by an augmented HCT-CI. The augmented HCT-CI, age, and cytogenetic/molecular risks could be combined into an AML composite model that could guide treatment decision-making and trial design in AML. Studying physical, cognitive, and social health might further clarify the prognostic role of aging. Targeting comorbidities with interventions alongside specific AML therapy might improve survival.
Gpr158 mediates osteocalcin’s regulation of cognition
Authors: Lori Khrimian, Arnaud Obri, Mariana Ramos-Brossier, Audrey Rousseaud, Stéphanie Moriceau, Anne-Sophie Nicot, Paula Mera, Stylianos Kosmidis, Theodoros Karnavas, Frederic Saudou, Xiao-Bing Gao, Franck Oury, Eric Kandel, Gerard Karsenty
Journal: The Journal of Experimental Medicine (2017)

That osteocalcin (OCN) is necessary for hippocampal-dependent memory and to prevent anxiety-like behaviors raises novel questions. One question is to determine whether OCN is also sufficient to improve these behaviors in wild-type mice, when circulating levels of OCN decline as they do with age. Here we show that the presence of OCN is necessary for the beneficial influence of plasma from young mice when injected into older mice on memory and that peripheral delivery of OCN is sufficient to improve memory and decrease anxiety-like behaviors in 16-mo-old mice. A second question is to identify a receptor transducing OCN signal in neurons. Genetic, electrophysiological, molecular, and behavioral assays identify Gpr158, an orphan G protein-coupled receptor expressed in neurons of the CA3 region of the hippocampus, as transducing OCN's regulation of hippocampal-dependent memory in part through inositol 1,4,5-trisphosphate and brain-derived neurotrophic factor. These results indicate that exogenous OCN can improve hippocampal-dependent memory in mice and identify molecular tools to harness this pathway for therapeutic purposes.
Utilization of electronic tumor board note (ETBN) to improve staging and treatment of cancer patients.
Authors: Marianna Strakhan, Tarek N. Elrafei, Karenza M. Alexis, Louis Juden Reed
Journal: Journal of Clinical Oncology (2014)

e17687 Background: Tumor boards (TB) have long been utilized to provide a forum for multidisciplinary discussion of cancer patients. Formerly, TB recommendations were conveyed informally to providers. The recent initiation of the ETBN at our academic, teaching hospital provided an opportunity to make a comparison between this modality and traditional informal communication. Methods: A retrospective chart review of 140 consecutive ETBN cases for the 2013 calendar year was carried out and compared with 44 unselected TB cases in the pre-ETBN era. The goal of the study was to evaluate the influence of TB discussion on pre-tumor board stage assignment and treatment plan and on the degree of compliance with TB recommendations. Results: In 2013, only 1 case lacked an ETBN and was excluded from analysis. Of 140 cases analyzed, 127 (91%) were presented prospectively and 13 (9%) after the initiation of treatment. TB discussion led to a change in diagnosis in 2 of 140 cases (1.4%) and a change in tumor stage in 23 of 140 cases (16.4%). There was a change in treatment plan in 50 of 140 cases (35.7%). The most common change, development of a definite treatment plan where previously there was none, occurred in 30 of the 50 cases (60%). Compliance with TB recommendations was 85%. Most common reasons for non-compliance were: lost to follow-up (24%), patient refusal (19%), progression of disease/tumor upstage with surgery (POD) (19%), worsening performance status (PS) (19%), patient transfer to another facility (10%), plan changed by consultant (5%), and referral for clinical trial (5%). Of the 44 unselected cases from the pre-ETBN era, the compliance rate with TB recommendations was 66%. The reasons for non-adherence were lack of communication of TB recommendations (40%), POD (27%), patient refusal (13%), worsening PS (13%) and lost to follow-up (7%). Difference in adherence to TB plan between the 2 groups was statistically significant (p=0.005). Conclusions: Tumor boards have long been accepted as beneficial to the staging and treatment of cancer patients. This study documents the importance of ETBN in achieving better communication among all providers and a higher rate of compliance with TB recommendations in the electronic medical record era.
Constitution of the Histochemical Society
Authors: Lillie, R. D.
Journal: JNCI Journal of the National Cancer Institute (1952)

Journal Article Constitution of the Histochemical Society Get access R. D. Lillie, M. D. R. D. Lillie, M. D. Secretary, Histochemical Society National Institutes of Health, Bethesda 14, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 13, Issue 1, August 1952, Pages 213–214, https://doi.org/10.1093/jnci/13.1.213 Published: 01 August 1952
Simultaneous duodenal stenting and endoscopic ultrasound-guided hepaticogastrostomy using a forward-oblique view echoendoscope
Authors: Tanyaporn Chantarojanasiri, Hiroyuki Isayama, Yousuke Nakai, Saburo Matsubara, Suguru Mizuno, Hirofumi Kogure, Kazuhiko Koike
Journal: Endoscopy (2017)

A 65-year old man with advanced pancreatic cancer with a combination of malignant biliary obstruction and gastric outlet obstruction was referred to our hospital. Given the presence of periampullary cancerous lesions, the endoscopic placement of a duodenal stent and endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) were performed simultaneously, using a single convex-array echoendoscope with a forward-oblique view (EG-580T; Fujifilm, Tokyo, Japan; [Fig. 1]). A partially covered metal duodenal stent (Niti-S COMVI; Taewoong Medical, Gimpo, Korea) was placed under fluoroscopic and endoscopic guidance ([Fig. 2], [Video 1]). This was followed, without scope exchange, by EUS-HGS: a long partially covered metal stent (modified GIOBOR, Taewoong Medical) was successfully placed [1] from the B3 intrahepatic duct to the stomach under EUS, endoscopic, and fluoroscopic guidance ([Fig. 3], [Video 2]). The total procedure time was 38 minutes.
微小環境キューに関連した細胞形状表現型を同定するための機械学習ベースの方法論【Powered by NICT】
Authors: Chen Desu, Sarkar Sumona, Candia Julian, J Florczyk Stephen, Bodhak Subhadip, K Driscoll Meghan, G Simon Carl, P Dunkers Joy, Losert Wolfgang
Journal: Biomaterials (2016)
Vision Screening in Very Young Children—Making Sense of an Inexorable Diagnostic Process
Authors: William V. Good
Journal: JAMA Pediatrics (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 Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal
神経保護ペプチドは学習と記憶能力を改善する結合したグラフェン量子ドット【Powered by NICT】
Authors: Xiao Songhua, Zhou Daoyou, Luan Ping, Gu Beibei, Feng Longbao, Fan Shengnuo, Liao Wang, Fang Wenli, Yang Lianhong, Tao Enxiang, Guo Rui, Liu Jun
Journal: Biomaterials (2016)
Abstract P092: Simplified Monolayer Differentiation of Human-Induced Pluripotent Stem Cells to Functional Cardiac Myocytes
Authors: Jennifer K Lang, Stanley Fernandez, Thomas Cimato
Journal: Circulation Research (2011)

Background: Human induced pluripotent stem cells (hiPSCs) are an important model for cardiovascular research, drug discovery, and translational research applications. Commonly used methods to direct iPSCs to cardiac myocytes can be technically demanding. Prior studies have shown that both VEGF and endothelial cells promote differentiation of stem cells to cardiac myocytes. Furthermore, DMEM/F12 with 10% fetal calf serum (DMEM-FCS) has been shown to induce cardiac myocytes in an embryoid body (EB) system. The objective of this study was to determine if differentiation of hiPSCs using conditions that support endothelial cell differentiation would promote cardiac myocyte colony formation. Methods: Two hiPSC lines derived using non-genome integrating methods were maintained on Matrigel-coated surfaces under serum free conditions in mTeSR1 medium. We performed a comparison of monolayer myocyte differentiation efficiency using DMEM-FCS and endothelial cell medium (EC). Cells were maintained in iPSC medium (mTeSR1) as a negative control. The number of beating colonies derived under each growth condition was determined using phase microscopy at 4 weeks. Cardiac myocyte commitment was characterized using an α-MHC-GFP reporter vector and electrophysiologic action potentials on isolated beating colonies. Results: Differentiation of human iPSCs in EC medium induced substantial numbers of beating colonies 4 weeks after differentiation (2.29 ± 0.3 beating colonies/cm2 culture area, n=42). Unlike EB models of myocyte differentiation, no beating clusters were observed in our monolayer system with DMEM-FCS medium (n=14) (p&lt;0.01). As expected, mTESR1 (n=12) did not induce any cardiac myocytes. All beating cell colonies expressed GFP driven by the cardiac specific α-MHC promoter. Electrophysiological studies confirmed the presence of action potentials with ventricular phenotypes. Conclusions: Differentiation of human iPSCs under monolayer conditions that support endothelial cells facilitates efficient induction of functional human cardiac myocytes. Our findings simplify the differentiation of iPSCs to cardiac myocytes, making research with human iPSCs more accessible to a broad range of cardiovascular investigators.
Abstract 17379: Atrial Fibrillation Mutations in β3 Subunits Enhance DIII Voltage Sensing Domain Coupling to Channel Activation Which Inhibits Lidocaine Blockade
Authors: Wandi Zhu, Eric J Hsu, Bicong Li, Angela R Schubert, Zoltan Varga, jonathan R Silva
Journal: Circulation (2015)

Background: Co-assembly of cardiac Na + channels (Na v 1.5) with β subunits modifies channel gating, expression, and post-translational modification. β subunit mutations have been linked to the Brugada and Long QT Syndromes, and atrial fibrillation (AF). Hypothesis: We tested whether β 3 subunits regulate Nav.1.5 ionic current and drug response by modulating the voltage sensing domains (VSDs). Methods: The Na V 1.5 α subunit contains four domains (DI-DIV), each with its own voltage sensing domain (VSD). We previously created four DNA constructs that carried a cysteine within a single VSD. Channels expressed in Xenopus oocytes and these cysteines were labeled with TAMRA-MTS fluorophores. Ionic current and fluorescence emission that tracked VSD conformation were simultaneously recorded using the cut-open configuration with and without β 3 . Results: Steady state inactivation is significantly right shifted by β 3 (V 1/2 = -88.9 ± 1.1 SEM (with, +β 3 ) and -97.8 ± 1.5 (without, -β 3 ), p=0.002, n=4). β 3 also right shifts DIII-VSD activation (V 1/2 = -93.0±2.3 +β 3 , V 1/2 = --114.8±0.8 -β 3 , p=0.001, n=4), while modestly left-shifting channel activation, suggesting enhanced DIII-VSD to pore coupling (V 1/2GV -V 1/2FV =55.0 ± 4.0 +β 3 , V 1/2GV -V 1/2FV =73.6 ± 2.4 -β 3 , n=4). DI and DII were not affected, while DIV was modestly shifted, consistent with DIII/DIV cooperativity. Extracellular domain AF-linked β 3 mutations, R6K and L10P, further enhance DIII-VSD to pore coupling (V 1/2GV -V 1/2FV =34.1 ± 5.8, (R6K), V 1/2GV -V 1/2FV =41.5 ± 4.7 (L10P), n=4). β 3 nearly abolishes stabilization of the DIII-VSD by lidocaine (DIII FV shift by lidocaine: ΔV 1/2 lido=-27.71 ± 12.23 (+β 3 ), ΔV 1/2 lido=-65.44 ± 3.83 (-β 3 ), n=3). The conservative R6K mutation exacerbates this effect, suggesting a cation-pi interaction with Na V 1.5. W1684 is co-localized with the DIII-VSD, and W1684A disrupted β 3 modification of channel gating and the DIII lidocaine interaction. Conclusions: β 3 modifies Nav1.5 gating by increasing DIII-VSD coupling to the pore via interaction with W1684. AF β 3 mutants further enhance DIII-VSD to pore coupling. The differential lidocaine response caused by WT and AF β 3 mutants suggests a molecular mechanism whereby the lidocaine response is patient and heart-chamber specific.
グリコシル‐ホスファチジルイノシトール‐B7‐1蛋白質を,腫よう細胞膜に移行させる 腫よう免疫療法の新しい方法
Authors: Mchugh R S, Nagarajan S, Wang Y‐C, Sell K W, Selvaraj P
Journal: Cancer Research (1999)
Treatment Patterns and Outcomes Following Initial Relapse in Patients with Relapsed Systemic Immunoglobulin Light Chain Amyloidosis
Authors: Nidhi Tandon, Surbhi Sidana, Morie A. Gertz, Angela Dispenzieri, Martha Q. Lacy, Francis K Buadi, David Dingli, Amie Fonder, Miriam Hobbs, Suzanne R. Hayman, Wilson I Gonsalves, Yi L. Hwa, Prashant Kapoor, Robert A. Kyle, Nelson Leung, Ronald S. Go, John A Lust, Stephen J. Russell, Steven R. Zeldenrust, S. Vincent Rajkumar, Shaji Kumar
Journal: Blood (2016)
Interim analysis of survival in a prospective, multi-center registry cohort of cutaneous melanoma tested with a prognostic 31-gene expression profile test
Authors: Eddy C. Hsueh, James R. DeBloom, Jonathan Lee, Jeffrey J. Sussman, Kyle R. Covington, Brooke Middlebrook, Clare Johnson, Robert W. Cook, Craig L. Slingluff, Kelly M. McMasters
Journal: Journal of Hematology & Oncology (2017)

A 31-gene expression profile (GEP) test that provides risk classification of cutaneous melanoma (CM) patients has been validated in several retrospective studies. The objective of the reported study was a prospective evaluation of the GEP performance in patients enrolled in two clinical registries. Three-hundred twenty two CM patients enrolled in the EXPAND (NCT02355587) and INTEGRATE (NCT02355574) registries met the criteria of age ≥ 16 years, successful GEP result and ≥1 follow-up visit for inclusion in this interim analysis. Primary endpoints were recurrence-free (RFS), distant metastasis-free (DMFS), and overall survival (OS). Median follow-up was 1.5 years for event-free patients. Median age for subjects was 58 years (range 18–87) and median Breslow thickness was 1.2 mm (range 0.2–12.0). Eighty-eight percent (282/322) of cases had stage I/II disease and 74% (237/322) had a SLN biopsy. Seventy-seven percent (248/322) had class 1 molecular profiles. 1.5-year RFS, DMFS, and OS rates were 97 vs. 77%, 99 vs. 89%, and 99 vs. 92% for class 1 vs. class 2, respectively (p < 0.0001 for each). Multivariate Cox regression showed Breslow thickness, mitotic rate, and GEP class to significantly predict recurrence (p < 0.01), while tumor thickness was the only significant predictor of distant metastasis and overall survival in this interim analysis. Interim analysis of patient outcomes from a combined prospective cohort supports the 31-gene GEP's ability to stratify early-stage CM patients into two groups with significantly different metastatic risk. RFS outcomes in this real-world cohort are consistent with previously published analyses with retrospective specimens. GEP testing complements current clinicopathologic features and increases identification of high-risk patients. ClinicalTrials.gov, NCT02355574 and NCT02355587
ポリフェノールによるmTORシグナル伝達の標的化:加齢のための新しい治療標的【Powered by NICT】
Authors: Pazoki-Toroudi Hamidreza, Amani Hamed, Ajami Marjan, Nabavi Seyed Fazel, Braidy Nady, Kasi Pandima Devi, Nabavi Seyed Mohammad
Journal: Ageing Research Reviews (2016)
Inhibitory Basal Ganglia Inputs Induce Excitatory Motor Signals in the Thalamus
Authors: Jeongjin Kim, Youngsoo Kim, Ryuichi Nakajima, Anna Shin, Minju Jeong, Ah Hyung Park, Yongcheol Jeong, Seonmi Jo, Seungkyoung Yang, Hosung Park, Sung-Hwan Cho, Kwang-Hyun Cho, Insop Shim, Jae Hoon Chung, Se-Bum Paik, George J. Augustine, Daesoo Kim
Journal: Neuron (2017)
AB1120 Comparison of non-radiographic spondyloarthritis versus ankylosing spondylitis patients undergoing biological therapy
Authors: C Cobilinschi, D Opris-Belinski, R Ionescu
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Axial spondyloarthritis include non-radiographic spondyloarthritis (nr-SpA) and ankylosing spondylitis (AS); they reveal the extent of sacroiliitis assessed by conventional x-ray or MRI (1). The natural history of nr-SpA follows various evolution patterns; smoking, male gender, high levels of inflammatory markers or initial radiographic lesions are among predictor factors of progression to AS (2). <h3>Objectives</h3> The objective of the present study was to compare features related to progression of nr-SpA patients versus AS patients undergoing biological therapy with an anti-TNF agent. <h3>Methods</h3> This was an observational, cross-sectional study including 94 patients with nr-SpA and AS under continuous anti-TNF therapy for at least six months. SPSS 20.0 was used to analyze data with a P value of 0.05. <h3>Results</h3> Out of the selected study group, 69 patients were diagnosed with AS having a mean age of 44.8±10.8, while 25 patients had nr-SpA. Patients with nr-SpA were aged 32.1±6.6 years old and 40% of them were women, a rate significantly than in the AS group (P=0.05). Mean age at disease onset was 30.7 years for the AS subgroup versus only 23.8 years for patients with nr-SpA (P&lt;0.001). AS patients presented a significantly higher value of the BMI compared to nr-SpA (27 versus 24.7 kg/m<sup>2,</sup> P&lt;0.001). 91% of patients had positive HLA B27 and 7.4% had a positive family history of SpA, with no significant differences between the two subgroups. A higher level of CRP was noticed in AS patients (P=0.038).In the study cohort the time interval from symptom onset to establishing a diagnosis was of 39.9±55.6 months, with a mean delay interval of 2.32 years for patients with nr-SpA and higher, of 3.5 for patients with AS (P=0.01). <h3>Conclusions</h3> The nr-SpA group had a considerably higher percentage of females compared to the AS subgroup. AS patients presented higher values of CRP at follow-up visits as opposed to nr-SpA patients. There were no significant differences between nr-SpA and AS patients regarding BASDAI or PtGA scores, smoking status or frequency of uveitis. The presence of HLA B27 did not differ between the two subgroups, thus it might not be a reliable predictive factor of progression. <h3>References</h3> Akgul O, Ozgocmen S. Classification criteria for spondyloarthropathies. World J Orthop. 2011;2(12):107–115. Wendling D, Non-radiographic spondyloarthritis: A theoretical concept or a real entity? Jt Bone Spine 2012;79(6):531–533. doi:10.1016/j.jbspin.2012.06.009. <h3>Disclosure of Interest</h3> None declared
Strengthening infection prevention and control and systematic surveillance of healthcare associated infections in India
Authors: Soumya Swaminathan, Jagdish Prasad, Akshay C Dhariwal, Randeep Guleria, Mahesh C Misra, Rajesh Malhotra, Purva Mathur, Kamini Walia, Sunil Gupta, Aditya Sharma, Vinod Ohri, Sarika Jain, Neil Gupta, Kayla Laserson, Paul Malpiedi, Anoop Velayudhan, Benjamin Park, Padmini Srikantiah
Journal: BMJ (2017)

Establishing and expanding government led networks to strengthen infection prevention and control and healthcare associated infection surveillance are essential to effectively tackle antimicrobial resistance. <b>Soumya Swaminathan and colleagues</b> discuss the progress in India
Eileen P Kane
Authors: Ailbe Beirne, Yvonne Kane
Journal: BMJ (2017)

Originally from County Armagh, Eileen P Kane attended the boarding school Cross and Passion Convent, Ballycastle, Co Antrim. Towards the end of her schooling she decided to pursue a medical career. At that time in Northern Ireland, it was not fashionable for a girl to study science, especially biology. Despite …
The Potential and Challenges of Expanded Germline Testing in Clinical Oncology
Authors: Eliezer M. Van Allen
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