tbuckley/cabot-search huggingface dataset:
Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal poorly differentiated neuroendocrine carcinoma: The NORDIC NEC study.
Authors: Halfdan Sorbye, Staffan Welin, Seppo W. Langer, Lene Weber Vestermark, Nanna Holt, Pia J. Osterlund, Svein Dueland, Eva Hofsli, Marianne Gronlie Guren, Katarina Ohrling, Elke Birkemeyer, Espen Thiis-Evensen, Matteo Biagini, Henning Gronbaek, Leena-Maija Soveri, Ingrid Holst Olsen, Birgitte Federspiel, Joerg Assmus, Eva Tiensuu Janson, Ulrich Knigge
Journal: Journal of Clinical Oncology (2012)

4015 Background: Gastrointestinal poorly differentiated neuroendocrine carcinoma (GI-NEC) are aggressive tumors with Ki-67&gt;20% and usually metastatic at diagnosis. Knowledge about GI-NEC is limited. We retrospectively reviewed clinical data to identify predictive and prognostic markers for advanced GI-NEC patients. Methods: Epidemiological, biochemical, histopathological, treatment and survival data were registered for advanced GI-NEC patients diagnosed during 2000-2009 at 12 Nordic university hospitals. Results: 305 patients were included. Palliative chemotherapy was given to 252 patients, median survival was 11 months. Response rate to 1st-line chemotherapy was 31%, 33% had stable disease. Ki-67&lt;55% was by ROC analyses the best cut-off value concerning correlation to response rate. Response rate to platinum-based chemotherapy was lower in patients with Ki-67&lt;55% (14% vs.44%, p&lt;0.001). Response rate for 84 patients given 2nd-line chemotherapy was 18%, whereas 33% achieved SD. The most important negative prognostic factors for survival were poor performance status, primary colorectal tumors, and elevated baseline platelets or lactate dehydrogenase (LDH) levels. Patients with Ki-67&lt;55% had longer median survival (15 months) than patients with Ki-67&gt;55% (10 months) (p&lt;0.001). Survival and response rates did not differ between the different platinum chemotherapy schedules (cisplatin-based vs. carboplatin-based) or morphology subtypes. 53 patients received best supportive care only with a median survival of 1 month. Conclusions: This is, to our knowledge, the largest study reporting patient and tumor characteristics, treatment and survival in advanced GI-NEC. Performance status, location of primary tumor and blood levels of platelets and LDH were the strongest prognostic factors for survival. Patients with Ki-67&lt;55% had significantly longer survival than patients with higher Ki-67, but were less responsive to platinum-based chemotherapy. Our data indicate that to consider all GI-NEC as one single disease entity may not be correct.
A potent hepatitis B surface antigen response in subjects with inactive hepatitis B surface antigen carrier treated with pegylated‐interferon alpha
Authors: Zhenhuan Cao, Yali Liu, Lina Ma, Junfeng Lu, Yi Jin, Shan Ren, Zhimin He, Chengli Shen, Xinyue Chen
Journal: Hepatology (2017)

Hepatitis B surface antigen (HBsAg) clearance represents a clinical cure, although the clearance rate is extremely low. The aim of this study was to evaluate the feasibility and safety profiles of pegylated‐interferon α‐2a (PEG‐IFNα‐2a) as a therapeutic option for inactive HBsAg carriers. There were 144 inactive HBsAg carriers enrolled and divided into a therapeutic group (102 subjects) and a control group (42 subjects). PEG‐IFNα‐2a and PEG‐IFNα‐2a combined with adefovir dipivoxil were used for treatment group subjects with hepatitis B virus DNA &lt;20 IU/mL and 20 IU/mL ≤ hepatitis B virus DNA &lt; 2,000 IU/mL, respectively. Total therapy duration was no more than 96 weeks. HBsAg clearance and seroconversion rates at therapeutic weeks 48 and 96 were used to evaluate the therapeutic efficacy. Per protocol analysis showed that the HBsAg clearance rate and seroconversion rate in the treatment group were 29.8% and 20.2% at week 48 and increased to 44.7% and 38.3% at week 96, respectively. However, the HBsAg clearance rate in the control group was 2.4% at weeks 48 and 96, and no subject achieved seroconversion. The quantitative HBsAg levels and changes during the early period of treatment (at week 12 and week 24) as well as the alanine aminotransferase elevation at week 12 were strong predictors of HBsAg clearance. The adverse events were similar to those with treatment for chronic hepatitis B patients. Conclusion: High rates of HBsAg clearance and seroconversion could be achieved by PEG‐IFNα‐2a‐based treatments and the treatments were relatively safe for inactive HBsAg carriers. (H epatology 2017;66:1058‐1066).
Pembrolizumab in patients with CLL and Richter transformation or with relapsed CLL
Authors: Wei Ding, Betsy R. LaPlant, Timothy G. Call, Sameer A. Parikh, Jose F. Leis, Rong He, Tait D. Shanafelt, Sutapa Sinha, Jennifer Le-Rademacher, Andrew L. Feldman, Thomas M. Habermann, Thomas E. Witzig, Gregory A. Wiseman, Yi Lin, Erik Asmus, Grzegorz S. Nowakowski, Michael J. Conte, Deborah A. Bowen, Casey N. Aitken, Daniel L. Van Dyke, Patricia T. Greipp, Xin Liu, Xiaosheng Wu, Henan Zhang, Charla R. Secreto, Shulan Tian, Esteban Braggio, Linda E. Wellik, Ivana Micallef, David S. Viswanatha, Huihuang Yan, Asher A. Chanan-Khan, Neil E. Kay, Haidong Dong, Stephen M. Ansell
Journal: Blood (2017)
NLR members NLRC4 and NLRP3 mediate sterile inflammasome activation in microglia and astrocytes
Authors: Leslie Freeman, Haitao Guo, Clément N. David, W. June Brickey, Sushmita Jha, Jenny P.-Y. Ting
Journal: The Journal of Experimental Medicine (2017)

Inflammation in the brain accompanies several high-impact neurological diseases including multiple sclerosis (MS), stroke, and Alzheimer's disease. Neuroinflammation is sterile, as damage-associated molecular patterns rather than microbial pathogens elicit the response. The inflammasome, which leads to caspase-1 activation, is implicated in neuroinflammation. In this study, we reveal that lysophosphatidylcholine (LPC), a molecule associated with neurodegeneration and demyelination, elicits NLRP3 and NLRC4 inflammasome activation in microglia and astrocytes, which are central players in neuroinflammation. LPC-activated inflammasome also requires ASC (apoptotic speck containing protein with a CARD), caspase-1, cathepsin-mediated degradation, calcium mobilization, and potassium efflux but not caspase-11. To study the physiological relevance, Nlrc4-/- and Nlrp3-/- mice are studied in the cuprizone model of neuroinflammation and demyelination. Mice lacking both genes show the most pronounced reduction in astrogliosis and microglial accumulation accompanied by decreased expression of the LPC receptor G2A, whereas MS patient samples show increased G2A. These results reveal that NLRC4 and NLRP3, which normally form distinct inflammasomes, activate an LPC-induced inflammasome and are important in astrogliosis and microgliosis.
Safety for the Surgical Patient—What Will “Move the Needle?”
Authors: Dwight W. Burney, David B. Hoyt
Journal: JAMA Surgery (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 Surgery 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 Surgery journal
Emollients and moisturizers for eczema: abridged Cochrane systematic review including<scp>GRADE</scp>assessments
Authors: E.J. Zuuren, Z. Fedorowicz, B.W.M. Arents
Journal: British Journal of Dermatology (2017)

Eczema is a chronic inflammatory skin disorder with considerable impact on quality of life. Emollients or moisturizers are widely recommended, but are these effective and safe? We searched for randomized controlled trials (RCTs) in the Cochrane Skin Group Specialised Skin Register, CENTRAL in The Cochrane Library, MEDLINE, Embase, LILACS, the GREAT database and five trial registers to December 2015. We included 77 RCTs with 6603 participants. Seven studies (9%) were at low risk of bias, 34 (44%) had unclear risk and 36 (47%) were at high risk. The quality of the evidence was mainly low or moderate for the prespecified outcomes. The most important comparison, 'moisturizer vs. no moisturizer', showed improved Scoring Atopic Dermatitis values in the moisturizer group compared with no moisturizer [mean difference -2·42, 95% confidence interval (CI) -4·55 to -0·28], but did not meet the minimal important difference of 8·7. Fewer flares were seen (risk ratio 0·40, 95% CI 0·23-0·70) and the rate of flares was reduced (hazard ratio 3·74, 95% CI 1·86-7·50). The groups applying moisturizer used less topical corticosteroids over 6-8 weeks (mean difference -9·30 g, 95% CI 15·3 to -3·27). Glycyrrhetinic acid-, urea- and glycerol-containing creams worked better than their controls (vehicle, placebo or no moisturizer) according to both participants and physicians. More flares were reported with moisturizer alone than when combined with twice-weekly fluticasone propionate (risk ratio 2·17, 95% CI 1·55-3·11). Adding moisturizers to topical anti-inflammatory treatment was more effective than anti-inflammatory treatment alone and resulted in fewer flares.
Optimizing Radiation Doses for Computed Tomography Across Institutions
Authors: Joshua Demb, Philip Chu, Thomas Nelson, David Hall, Anthony Seibert, Ramit Lamba, John Boone, Mayil Krishnam, Christopher Cagnon, Maryam Bostani, Robert Gould, Diana Miglioretti, Rebecca Smith-Bindman
Journal: JAMA Internal Medicine (2017)

Radiation doses for computed tomography (CT) vary substantially across institutions.To assess the impact of institutional-level audit and collaborative efforts to share best practices on CT radiation doses across 5 University of California (UC) medical centers.In this before/after interventional study, we prospectively collected radiation dose metrics on all diagnostic CT examinations performed between October 1, 2013, and December 31, 2014, at 5 medical centers. Using data from January to March (baseline), we created audit reports detailing the distribution of radiation dose metrics for chest, abdomen, and head CT scans. In April, we shared reports with the medical centers and invited radiology professionals from the centers to a 1.5-day in-person meeting to review reports and share best practices.We calculated changes in mean effective dose 12 weeks before and after the audits and meeting, excluding a 12-week implementation period when medical centers could make changes. We compared proportions of examinations exceeding previously published benchmarks at baseline and following the audit and meeting, and calculated changes in proportion of examinations exceeding benchmarks.Of 158 274 diagnostic CT scans performed in the study period, 29 594 CT scans were performed in the 3 months before and 32 839 CT scans were performed 12 to 24 weeks after the audit and meeting. Reductions in mean effective dose were considerable for chest and abdomen. Mean effective dose for chest CT decreased from 13.2 to 10.7 mSv (18.9% reduction; 95% CI, 18.0%-19.8%). Reductions at individual medical centers ranged from 3.8% to 23.5%. The mean effective dose for abdominal CT decreased from 20.0 to 15.0 mSv (25.0% reduction; 95% CI, 24.3%-25.8%). Reductions at individual medical centers ranged from 10.8% to 34.7%. The number of CT scans that had an effective dose measurement that exceeded benchmarks was reduced considerably by 48% and 54% for chest and abdomen, respectively. After the audit and meeting, head CT doses varied less, although some institutions increased and some decreased mean head CT doses and the proportion above benchmarks.Reviewing institutional doses and sharing dose-optimization best practices resulted in lower radiation doses for chest and abdominal CT and more consistent doses for head CT.
STUDIES ON THE PATHOGENESIS OF FEVER
Authors: Gale W. Rafter, Robert D. Collins, W. Barry Wood
Journal: The Journal of Experimental Medicine (1960)

Study of the chemical properties of the pyrogenic component of rabbit polymorphonuclear leucocytes reveals it to contain an essential, non-dialyzable protein which: (a) is precipitated by perchloric acid, (b) is removed by extraction with phenol, (c) is soluble in 50 per cent methanol and 33 per cent saturated ammonium sulfate, and (d) is destroyed by the proteolytic action of both trypsin and pepsin. By combined chemical and chromatographic techniques the leucocytic pyrogen has been purified approximately 50-fold. The partially purified material contains less than 1 per cent carbohydrate, is resistant to periodate oxidation, is unaffected by extraction with butanol and contains at least two immunologically active components when tested by the Ouchterlony gel-diffusion technique. Its chemical properties distinguish it from other known pyrogenic substances which have been implicated in the pathogenesis of fever.
Transfusion-related transmission of yellow fever vaccine virus - California, 2009.
Authors: E. Lederman, T. Warkentien, M. Bavaro, J. Arnold, D. DeRienzo, J. E. Staples, M. Fischer, J. J. Laven, O. L. Kosoy, R. S. Lanciotti
Journal: MMWR Morbidity and Mortality Weekly Report (2010)
TCTAP C-097 NSTEMI with a CTO Lesion in Left Anterior Descending Artery
Authors: Chun-Yuan Chu, Wen-Hsien Lee, Po-Chao Hsu, Hung-Hao Lee, Cheng-An Chiu, Ho-Ming Su, Tsung-Hsien Lin, Chee-Siong Lee, Heueh-Wei Yen, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu
Journal: Journal of the American College of Cardiology (2017)
Glecaprevir and pibrentasvir yield high response rates in patients with HCV genotype 1–6 without cirrhosis
Authors: Paul Y. Kwo, Fred Poordad, Armen Asatryan, Stanley Wang, David L. Wyles, Tarek Hassanein, Franco Felizarta, Mark S. Sulkowski, Edward Gane, Benedict Maliakkal, J. Scott Overcash, Stuart C. Gordon, Andrew J. Muir, Humberto Aguilar, Kosh Agarwal, Gregory J. Dore, Chih-Wei Lin, Ran Liu, Sandra S. Lovell, Teresa I. Ng, Jens Kort, Federico J. Mensa
Journal: Journal of Hepatology (2017)
Inter-, and Intratumoural Genomic Heterogeneity of Primary Pulmonary Adenocarcinoma in Never Smokers
Authors: Marissa Daniels, Lutz Krause, Jonathan Ellis, Ian A. Yang, Rayleen V. Bowman, Vandana Relan, Kelly Chee, Felicia Goh, Brielle Parris, Leanne Morrison, Maria Martins, Elizabeth Mccaul, Linda Passmore, Deborah Courtney, Edwina Duhig, Rishendran Naidoo, Kwun Fong, Morgan Windsor
Journal: Journal of Thoracic Oncology (2015)
Abstract 291: Fibulin-1 is Required to Prevent Hypoplastic Semilunar Valve Formation
Authors: Keerthi Harikrishnan, Marion A Cooley, Waleed O Twal, Victor M Fresco, Christine B Kern, W. Scott Argraves
Journal: Circulation Research (2013)

Fibulin-1 (Fbln1), an extracellular matrix protein, is prominently expressed during outflow tract (OFT) morphogenesis as a component of both the endocardial cushions and OFT valves. Here we sought to investigate the role of Fbln1 in the process of OFT valvulogenesis. Since Fbln1 null mice die perinatally, we first evaluated the effects of Fbln1 deficiency on OFT valve morphology in hearts of embryos at E17.5. Morphometric analysis of 3D reconstructions revealed that in Fbln1 nulls the volume of the anterior leaflet of the pulmonary valve, and the left and non-coronary leaflets of the aortic valve were significantly reduced as compared to wild type (WT) (30-40% reduction; WT n=6, null n=8; p&lt;0.05). The reduced leaflet size correlated with decreased leaflet cell numbers (45%, 30% and 30% respectively; p&lt;0.05). TUNEL and BrdU analysis showed no difference between E17.5 WT and Fbln1 null OFT valves. To determine when abnormalities of OFT valve leaflet cell numbers first occurs, OFT endocardial cushions and prevalvular mesenchyme from E10.5-14.5 null and WT embryos were analyzed. At E10.5, the proximal OFT cushions of Fbln1 nulls were hypercellular (34% increase; p&lt;0.05; n=5 for each genotype) whereas cellularity of distal cushions was not different from WT (p= 0.49). The fact that the ratio of proximal OFT cushion mesenchymal cells to endothelial cells was increased in E10.5 Fbln1 null cushions suggests that alteration in EMT might contribute to the hypercellularity. At E12.5, cellularity of the proximal OFT cushions was observed to decrease by 35% (p&lt;0.05; WT n=4; null n=4). This was accompanied by a 172% increase in apoptosis, with no alteration in the level of proliferation (p&lt;0.05; WT n=3; null n=4). Decreased cellularity and increased apoptosis persisted in the OFT prevalvular mesenchyme of Fbln1 nulls at E14.5 (p&lt;0.05; WT n=2; null n=2). Taken together, Fbln1 specifically regulates cellularization of the proximal endocardial cushion and prevalvular mesenchyme. Mechanistically, Fbln1 may act as a suppressor of cushion EMT and indirectly or directly as an inhibitor of apoptosis.
Clonal selection and asymmetric distribution of human leukemia in murine xenografts revealed by cellular barcoding
Authors: Mirjam E. Belderbos, Taco Koster, Bertien Ausema, Sabrina Jacobs, Sharlaine Sowdagar, Erik Zwart, Eveline de Bont, Gerald de Haan, Leonid V. Bystrykh
Journal: Blood (2017)
The Threat of Diagnostic Uncertainty in the Medical Management of Uncomplicated Appendicitis
Authors: Richard G. Bachur, Shawn J. Rangel
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
PREDICTING LOWER EXTREMITY INJURY RISK IN SPORT THROUGH MOVEMENT QUALITY SCREENING: A SYSTEMATIC REVIEW
Authors: Jackie Whittaker, Sarah de la Motte, Liz Dennett, Nadine Booysen, Cara Lewis, David Wilson, Carly McKay, Martin Warner, Darin Padua, Carolyn Emery, Maria Stokes
Journal: British Journal of Sports Medicine (2017)

Background The identification of risk factors for lower extremity musculoskeletal (MSK) injury in sport is required to inform primary and secondary injury prevention strategies. Objective To determine whether measures of poor movement quality are associated with lower extremity MSK injury in sport. Design Systematic Review. Methods Five electronic databases (Medline, EMBASE, CINAHL, Sport Discus, SCOPUS) were systematically searched using keywords and Medical Sub-heading terms. Studies selected included: English language; original data; prospective analytic design; a rating of movement compensation, asymmetry, impairment or efficiency through composite batteries and/or individual tests; and participants with lower extremity MSK injury sustained with sport participation. PRISMA guidelines were followed and two independent raters assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Centre of Evidence-Based Medicine model). Results Of 4361 potential relevant studies, 13 were included. The majority (11/13) of the studies were low quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3–14). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen (FMS) was the most common movement quality outcome investigated (11/13 studies). Two studies considered interrelationships between risk factors, five reported diagnostic accuracy and none evaluated an intervention program targeting individuals identified as high-risk. There is inconsistent evidence that poor movement quality is associated with increased risk of lower extremity injury in sport. Conclusions There is insufficient evidence for widespread adoption of movement quality screening programs for predicting lower-extremity injury in sport. Future research should aim to identify the most relevant movement quality outcomes for predicting injury risk through high quality cohort studies. This should be followed by development and evaluation of pre-participation screening and lower extremity injury prevention programs through high quality randomized controlled trials targeting individuals at the greatest risk based on screening tests with validated test properties.
CD200 Is a Marker of LSC Activity in Acute Myeloid Leukemia
Authors: Jenny M. Ho, Stephanie M. Dobson, Jessica McLeod, Liqing Jin, Stanley W.K. Ng, Amanda Mitchell, Liran I. Shlush, Sasan Zandi, Kolja Eppert, Mark D. Minden, John E. Dick, Jean C.Y. Wang
Journal: Blood (2016)
Optimal efficacy of interferon-free HCV retreatment after protease inhibitor failure in real life
Authors: V. Cento, S. Barbaliscia, I. Lenci, T. Ruggiero, C.F. Magni, S. Paolucci, S. Babudieri, M. Siciliano, C. Pasquazzi, A. Ciancio, C.F. Perno, F. Ceccherini-Silberstein, V. Micheli, Y. Troshina, E. Biliotti, M. Milana, M. Melis, E. Teti, L. Lambiase, B. Menzaghi, L.A. Nicolini, S. Marenco, V.C. Di Maio, M. Aragri, A. Pecchioli, A. Bertoli, C. Sarrecchia, M. Macera, N. Coppola, M. Puoti, D. Romagnoli, A. Pellicelli, S. Bonora, S. Novati, F. Baldanti, V. Ghisetti, M. Andreoni, G. Taliani, G. Rizzardini, M. Angelico
Journal: Clinical Microbiology and Infection (2017)
Changes in Rates of Ventilator-Associated Pneumonia
Authors: Martin Wolkewitz, Gerta Rücker, Martin Schumacher
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