tbuckley/cabot-search huggingface dataset:
Abstract 19690: Left Atrial Pressure and the Inotropic State Determine Right Ventricular Pulsatile Vascular Load in the Normal Pulmonary Circulation. A Wave-Intensity Analysis
Authors: Candelas Pérez del Villar, Javier Bermejo, Pablo Martinez-Legazpi, Daniel Rodríguez-Pérez, J. Carlos Antoranz, M. Mar Desco, Enrique Gutierrez, Yolanda Benito, Alicia Barrio, Francisco Fernández-Avilés, Raquel Yotti
Journal: Circulation (2016)

Introduction:  In chronic patients, the relationship between pulmonary vascular resistance (PVR) and pulmonary compliance (C) depends on their pulmonary wedge pressure values. However, whether this is a physiological reflex or a chronic consequence of type-2 pulmonary hypertension remains unknown. The present study characterized the acute determinants of the PVR-C relationship in the healthy pulmonary circulation using wave intensity analysis (WIA).   Methods:  In 22 open-chest pigs we measured high-fidelity pressure and transit-time pulmonary artery flow at baseline, during beta-adrenergic modulation (dobutamine 2.5 ug/Kg/min), acute volume loading, and LV myocardial ischemia. Wave speed was obtained from early P-Q linear relationship and used to compute WIA. Repeated measures within-subjects were analyzed using linear mixed effects models.   Results:  Hemodynamic interventions induced a wide range of left atrial pressures (LAP: 3 to 20 mmHg). PVR and C varied extensively by > 280 and 120%, respectively. Pulmonary C inversely correlated with PVR, and LAP (p   Conclusions:  Beyond PVR, LAP and the inotropic state determine the RV pulsatile vascular load. This is a physiological effect in the healthy subject, and is not consequence of chronic pulmonary vascular or parenchymal remodeling. LAP contributes to RV dysfunction by acutely increasing pulmonary afterload.
Our Shared Humanity—Music as a Means of Facilitating Conversations on End-of-Life Care
Authors: Cynthia S. Peng
Journal: JAMA Oncology (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 Oncology 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 Oncology journal
From Cultural to Structural Competency—Training Psychiatry Residents to Act on Social Determinants of Health and Institutional Racism
Authors: Helena Hansen, Joel Braslow, Robert M. Rohrbaugh
Journal: JAMA Psychiatry (2017)

This Viewpoint presents general principles about developing structural competency curricula from psychiatry residency programs at 3 institutions, including New York University, University of California, Los Angeles, and Yale University.
Motorized spiral colonoscopy: a first single-center feasibility trial
Authors: Torsten Beyna, Markus Schneider, David Pullmann, Christian Gerges, Jennis Kandler, Horst Neuhaus
Journal: Endoscopy (2017)

Cecal intubation rate represents a key procedural quality parameter in diagnostic colonoscopy. However, even experienced investigators report 10 % of all colonoscopies to be difficult and intubation of the cecum is sometimes impossible. A recently developed novel motorized spiral endoscope might potentially overcome some limitations of standard colonoscopy by actively pleating the bowel onto the endoscope. The study aim was to evaluate the feasibility and safety of motorized spiral colonoscopy (MSC) for diagnostic colonoscopy.30 consecutive patients with an indication for diagnostic colonoscopy were enrolled in a proof-of-concept single-center trial.13 men and 17 women (mean age 68.9 years, range 30 - 90) were enrolled; 43.3 % had diverticula. Mean procedure time was 20.8 min (range 11.4 - 55.3). Cecal intubation rate was 96.7 %. One incomplete colonoscopy occurred because of an unexpected postinflammatory stricture. Adenoma detection rate was 46.6 %. No severe adverse events occurred.Results indicate that MSC is safe and effective for diagnostic colonoscopy. It potentially offers advantages in terms of ease and it may facilitate therapeutic interventions.
Sleep disordered breathing does not predict acute severe pain episodes in children with sickle cell anemia
Authors: Shaina M. Willen, Mark Rodeghier, Carol L. Rosen, Michael R. DeBaun
Journal: American Journal of Hematology (2017)

Conflicting evidence has suggested that low mean nocturnal hemoglobin oxygen saturation (SpO2 ) predicts future hospital days for acute severe pain in children with sickle cell anemia (SCA). In an unselected multicenter prospective cohort study, we tested the hypothesis that either low mean nocturnal SpO2 or high obstructive apnea-hypopnea index (OAHI; the number of obstructive apneas and hypopneas with ≥ 3% desaturation or arousal per hour of sleep) or high oxygen desaturation index (ODI; number of ≥ 3% desaturation from baseline saturation per hour of sleep) is associated with increased incidence rates of pain. A total of 140 children with SCA with a median age of 10.8 years (interquartile range 7.2) were followed for a median of 4.9 years (interquartile range 1.8). Overnight polysomnography evaluations at baseline health exam were measured and adjudicated centrally. Multivariable models created in two steps were included. First, all plausible covariates were included in a screening model. Subsequently, covariates meeting level of statistical significance of P < .20 were included in the final model. Contrary to our hypothesis, higher (but not lower) mean nocturnal SpO2 was associated with higher rates of pain episodes (Incidence rate ratio (IRR) 1.10, 95% CI [1.03-1.18], P = .004). Higher log OAHI did not pass screening criteria. Higher log ODI was not significantly associated with higher rates of pain episodes (IRR 0.93, 95% CI [0.82-1.06], P = .28). Neither low nocturnal SpO2, higher OAHI, nor higher ODI were associated with clinically relevant increased incidence rates of acute severe pain episodes.
Scattered Hypopigmented, Atrophic, and Folliculocentric Papules on the Trunk
Authors: Yang Lo, Chien-Ho Chu, Yi-An Chen
Journal: JAMA Dermatology (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 Dermatology 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 Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal
Use Of Central Venous Access Devices (CVAD) And Associated Outcomes In Hereditary Angioedema (HAE) Patients: Findings From A Large United States (US) Claims Database
Authors: Douglas J. Watson, Marc A. Riedl, Aleena Banerji, Michael E. Manning, Earl Burrell, Namita Joshi, Dipen Patel, Thomas Machnig, Ming-Hui Tai
Journal: Journal of Allergy and Clinical Immunology (2018)
Comparison of Tumor Classifications for Cutaneous Squamous Cell Carcinoma of the Head and Neck in the 7th vs 8th Edition of the <i>AJCC Cancer Staging Manual</i>
Authors: Pritesh S. Karia, Frederick C. Morgan, Joseph A. Califano, Chrysalyne D. Schmults
Journal: JAMA Dermatology (2017)

Previous studies have shown that the AJCC Cancer Staging Manual, 7th edition (AJCC 7), tumor classification for cutaneous squamous cell carcinoma (CSCC) failed to accurately stratify disease-related outcomes. The recently released 8th edition (AJCC 8) features a revised tumor classification for only head and neck CSCC (HNCSCC).To compare AJCC 7 and AJCC 8 tumor classifications for HNCSCC and to validate AJCC 8.This was a 10-year retrospective cohort study (2000-2009) at an academic tertiary care center reviewing 680 primary HNCSCC tumors in 459 patients.Primary HNCSCC tumors were reviewed for disease-related outcomes (DROs): local recurrence (LR), nodal metastasis (NM), and disease-specific death (DSD). Tumors were stratified by AJCC 7 and AJCC 8 tumor classification. Distinctiveness (outcome differences between categories), homogeneity (outcome similarity within categories), and monotonicity (outcome worsening with increasing categories) were assessed for both classifications.Most of the 459 patients were white (451 [98.3%]) and male (312 [68.0%]). AJCC 8 high tumor categories (T3/T4) accounted for 121 (17.8%) of total cases but 50 of 71 DROs (70.4%) (22 of 34 of LRs [64.7%], 17 of 24 NMs [70.8%], and 11 of 13 of DSDs [84.6%]). This was a significant improvement over AJCC 7, where only 12 of 71 DROs (16.9%) (4 of 34 LRs [11.8%], 3 of 24 NMs [12.5%], and 5 of 13 DSDs [38.5%]) occurred in T3/T4 categories. However, AJCC 8 T2 and T3 were indistinct, with overlapping 95% CIs for 10-year cumulative incidences of LR, NM, and DSD. The 10-year cumulative incidence of DROs in the 119 AJCC 8 T3 cases were 19.7% (95% CI, 13.0%-29.7%) for LR, 14.1% (95% CI, 9.7%-20.7%) for NM, and 9.3% (95% CI, 6.8%-14.0% for DSD).AJCC 8 demonstrates superior homogeneity and monotonicity compared with AJCC 7. It now may be possible for AJCC 8 HNCSCC T2, T3, and T4 cases to be recorded and tracked by tumor registries because they represented a 23.1% subset in this study, which includes nearly all poor outcomes (85.9%). Further work is needed to validate AJCC 8 with population-level data and to compare AJCC 8 performance against alternative tumor classifications.
Treatment and Prevention of Opioid Use Disorder: Challenges and Opportunities
Authors: Dennis McCarty, Kelsey C. Priest, P. Todd Korthuis
Journal: Annual Review of Public Health (2017)

Treatment for opioid use disorder in the United States evolved in response to changing federal policy and advances in science. Inpatient care began in 1935 with the US Public Health Service Hospitals in Lexington, Kentucky, and Fort Worth, Texas. Outpatient clinics emerged in the 1960s to provide aftercare. Research advances led to opioid agonist and opioid antagonist therapies. When patients complete opioid withdrawal, return to use is often rapid and frequently deadly. US and international authorities recommend opioid agonist therapy (i.e., methadone or buprenorphine). Opioid antagonist therapy (i.e., extended-release naltrexone) may also inhibit return to use. Prevention efforts emphasize public and prescriber education, use of prescription drug monitoring programs, and safe medication disposal options. Overdose education and naloxone distribution promote access to rescue medication and reduce opioid overdose fatalities. Opioid use disorder prevention and treatment must embrace evidence-based care and integrate with physical and mental health care.
Emergency Management of Pediatric Anaphylaxis due to an Unknown Cause: A 5-year follow-up study in Canada
Authors: Michelle Le, Ann Elaine Clarke, Harley Eisman, Judy Morris, Jocelyn Gravel, Edmond S. Chan, Rodrick Lim, Andrew O'Keefe, Greg Shand, Moshe Ben-Shoshan
Journal: Journal of Allergy and Clinical Immunology (2018)
Abstract 18781: Novel Ryanodine Receptor Mutation Associated With Hypertrophic Cardiomyopathy Induces Cardiac Remodeling and Arrhythmia in Mice
Authors: Francisco J Alvarado, Carmen R Valdivia, Zhiguang Yuchi, Cherisse A Marcou, J M Bos, Filip Van Petegem, Michael J Ackerman, Héctor H Valdivia
Journal: Circulation (2016)

Introduction:  Hypertrophic Cardiomyopathy (HCM) is the most common cardiac genetic disease. We identified a novel mutation in the cardiac Ca 2+  release channel/ryanodine receptor, RyR2-P1124L, in a patient with obstructive HCM and positive family history of HCM. The patient showed a mid-ventricular septal thickness of 24 mm, LVOT obstruction and several episodes of ventricular fibrillation. Here, we use a multi-level approach to determine the pathogenic mechanisms associated with RyR2-P1124L, in order to provide new insights into RyR2-mediated HCM.   Results:  Using recombinant RyR2-P1124L channels, we determined the Ca 2+ -dependence of [ 3 H]ryanodine binding, an indirect measure of RyR2 activity. RyR2-P1124L requires higher [Ca 2+ ] for activation (EC 50  = 362.9±74.5 vs. 190.6±9.8 nM,  p  = 0.04) and has lower Bmax than WT (0.44±0.02 vs. 0.60±0.03 pmol/mg of protein,  p   p  = 0.05; and 0.91±0.03 vs. 0.78±0.02 mm,  p  = 0.01, respectively), recapitulating the human phenotype. At 8 months of age, mice do not display cardiac remodeling but are already more susceptible to epinephrine/caffeine-induced arrhythmias, including bidirectional VT (5/7 vs. 0/7,  p   2+  load in the presence of isoproterenol (12.5±0.5 vs. 11.1±0.4 ΔF/F0,  p  = 0.06), which could provide the basis for cellular Ca 2+  mishandling.   Conclusions:  RyR2-P1124L is a loss-of-function mutation that alters RyR2 structure and function. To our knowledge, it is the first to induce ventricular remodeling together with arrhythmia. Therefore, it represents a new paradigm for the emerging field of RyR2-mediated cardiac remodeling and Ca 2+ -dependent HCM.
Successes and Challenges of Pediatric AML: A Report on Survival, Salvage Therapy and Causes of Deaths in the AML-BFM Study Group from 1987 -2012
Authors: Mareike Rasche, Martin Zimmermann, Lisa Kellerstrass, Ursula Creutzig, Jan-Henning Klusmann, Dirk Reinhardt
Journal: Blood (2016)
INDEPENDENT RISK FACTORS FOR BIOPSY-PROVEN CIRRHOSIS IN HEMOCHROMATOSIS: A STUDY OF 110 HFE p.C282Y HOMOZYGOTES WITH GNPAT p.D519G GENOPTYING
Authors: James Barton, Christine McLaren, Wen-Pin Chen, Grant Ramm, Gregory Anderson, Lawrie Powell, V. Nathan Subramaniam, Paul Adams, Pradyumna Phatak, Lyle Gurrin, John D. Phillips, Charles J. Parker, Mary J. Edmond, Gordon McLaren
Journal: American Journal of Hematology (2017)
Epigenetic supersimilarity of monozygotic twin pairs
Authors: Timothy E. Van Baak, Cristian Coarfa, Pierre-Antoine Dugué, Giovanni Fiorito, Eleonora Laritsky, Maria S. Baker, Noah J. Kessler, Jianrong Dong, Jack D. Duryea, Matt J. Silver, Ayden Saffari, Andrew M. Prentice, Sophie E. Moore, Akram Ghantous, Michael N. Routledge, Yun Yun Gong, Zdenko Herceg, Paolo Vineis, Gianluca Severi, John L. Hopper, Melissa C. Southey, Graham G. Giles, Roger L. Milne, Robert A. Waterland
Journal: Genome biology (2018)

Monozygotic twins have long been studied to estimate heritability and explore epigenetic influences on phenotypic variation. The phenotypic and epigenetic similarities of monozygotic twins have been assumed to be largely due to their genetic identity. Here, by analyzing data from a genome-scale study of DNA methylation in monozygotic and dizygotic twins, we identified genomic regions at which the epigenetic similarity of monozygotic twins is substantially greater than can be explained by their genetic identity. This "epigenetic supersimilarity" apparently results from locus-specific establishment of epigenotype prior to embryo cleavage during twinning. Epigenetically supersimilar loci exhibit systemic interindividual epigenetic variation and plasticity to periconceptional environment and are enriched in sub-telomeric regions. In case-control studies nested in a prospective cohort, blood DNA methylation at these loci years before diagnosis is associated with risk of developing several types of cancer. These results establish a link between early embryonic epigenetic development and adult disease. More broadly, epigenetic supersimilarity is a previously unrecognized phenomenon that may contribute to the phenotypic similarity of monozygotic twins.
Effects of Oral Insulin in Relatives of Patients With Type 1 Diabetes
Authors: Jay S Skyler, Jeffrey P Krischer, Joseph Wolfsdorf, Catherine Cowie, Jerry P Palmer, Carla Greenbaum, David Cuthbertson, Lisa E Rafkin-Mervis, H Peter Chase, Ellen Leschek
Journal: Diabetes Care (2005)

OBJECTIVE—This randomized, double-masked, placebo-controlled clinical trial tested whether oral insulin administration could delay or prevent type 1 diabetes in nondiabetic relatives at risk for diabetes. RESEARCH DESIGN AND METHODS—We screened 103,391 first- and second-degree relatives of patients with type 1 diabetes and analyzed 97,273 samples for islet cell antibodies. A total of 3,483 were antibody positive; 2,523 underwent genetic, immunological, and metabolic staging to quantify risk of developing diabetes; 388 had a 5-year risk projection of 26–50%; and 372 (median age 10.25 years) were randomly assigned to oral insulin (7.5 mg/day) or placebo. Oral glucose tolerance tests were performed every 6 months. The median follow-up was 4.3 years, and the primary end point was diagnosis of diabetes. RESULTS—Diabetes was diagnosed in 44 oral insulin and 53 placebo subjects. Annualized rate of diabetes was similar in both groups: 6.4% with oral insulin and 8.2% with placebo (hazard ratio 0.764, P = 0.189). In a hypothesis-generating analysis of a subgroup with insulin autoantibody (IAA) levels confirmed (on two occasions) ≥80 nU/ml (n = 263), there was the suggestion of benefit: annualized diabetes rate 6.2% with oral insulin and 10.4% with placebo (0.566, P = 0.015). CONCLUSIONS—It is possible to identify individuals at high risk for type 1 diabetes and to enroll them in a large, multisite, randomized, controlled clinical trial. However, oral insulin did not delay or prevent type 1 diabetes. Further studies are needed to explore the potential role of oral insulin in delaying diabetes in relatives similar to those in the subgroup with higher IAA levels.
Targeting the Wnt5a-β-catenin pathway in the melanoma microenvironment to augment checkpoint inhibitor immunotherapy.
Authors: Brent Allen Hanks, Fei Zhao, Kathy Evans, Alisha Holtzhausen, Masahito Tsutsui, Douglas Tyler
Journal: Journal of Clinical Oncology (2015)

3054 Background: While checkpoint inhibitor immunotherapy has demonstrated recent success in patients with advanced melanoma, a significant fraction of these patients continue to fail therapy. The β-catenin signaling pathway plays a role in dendritic cell (DC) tolerization and regulatory T cell (Treg) differentiation however the factors responsible for inducing this pathway are unknown. Methods: We utilized a BRAFV600EPTEN-/- autochthonous model of melanoma to identify melanoma-derived factors capable of driving local Treg development and the generation of an immunotolerant microenvironment. Primary human melanoma specimens were examined for expression of these candidate factors by immunohistochemistry while sentinel lymph node-derived DCs were analyzed for expression of downstream mediators of the identified signaling pathway. Based on this data, a small molecule inhibitor of the candidate signaling pathway was tested to augment the anti-tumor immune response of checkpoint inhibitors in a murine melanoma model. Results: We identified the Wnt5a ligand as a critical mediator β-catenin signaling in DCs and of Treg generation in the BRAFV600EPTEN-/-model. We further determined Wnt5a to be associated with expression of the Treg marker, FoxP3, in human melanoma tissues and for Wnt5a expression by primary melanomas to be associated with an improved objective response to anti-CTLA-4 antibody therapy. In addition, our work suggests that activation of the β-catenin signaling pathway in sentinel lymph node derived DCs correlates with higher tumor burden and inferior clinical outcome. Finally, we show that suppressing Wnt ligand secretion and downstream signaling by targeting the Porcn acyl transferase enzyme functions to enhance the anti-melanoma immune response and suppress melanoma growth when administered in combination with anti-CTLA-4 antibody therapy. Conclusions: The Wnt5a-β-catenin signaling pathway represents a novel pharmacological target within the melanoma microenvironment that is worthy of further investigation in combination immunotherapy clinical trials.
Suicide risk in placebo-controlled trials of bipolar disorder - Dr Storosum and colleagues reply
Authors: J. G. Storosum, T. Wohlfarth, C. C. Gispen-de Wied, D. H. Linszen, B. P. R. Gersons, B. J. van Zwieten, W. van den Brink
Journal: American Journal of Psychiatry (2006)
Evidence Required for Drugs Granted Accelerated Approval
Authors: Tetsuya Tanimoto, Kazuhiro Kosugi, Kenji Tsuda
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 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
Azithromycin and Survival After Hematopoietic Stem Cell Transplant
Authors: Shigeo Fuji
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