tbuckley/cabot-search huggingface dataset:
Consensus statements that fail to recognise dissent are flawed by design: a narrative review with 10 suggested improvements
Authors: Ian Shrier
Journal: British Journal of Sports Medicine (2020)

Consensus statements have the potential to be very influential. Recently, such statements in sport and exercise medicine appear more prescriptive, strongly recommending particular approaches to research or treatment. In 2020, a statement on methods for reporting sport injury surveillance studies included an extension to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines; STROBE guidelines are now official requirements for many journals. This suggests that investigators who use methods outside of these guidelines may have difficulty publishing their results. By definition, consensus is not unanimity, and consensus recommendations are sometimes considered flawed at a later date. This is expected as a discipline benefits from new knowledge. However, the consensus methods themselves may also inadvertently suppress contrary—but valid—opinions. I point to a different model for consensus meetings and statements that embraces dissenting opinions and is more transparent than common current methods in sport and exercise medicine. The method, based on how Supreme Courts function in many countries, allows for both majority and one or more minority opinions. I illustrate how a consensus statement might be written using examples from four previous sport and exercise medicine consensus statements. By adopting the ‘Supreme Court’ approach, important disagreements about the strength and interpretation of evidence will be far more visible than is currently the case in most consensus meetings. The benefit of the Supreme Court model is that it will ensure that clinicians, researchers and journals are not inappropriately influenced by recommendations from consensus statements where uncertainty remains.
Continuous Pulse Oximetry Monitoring in Bronchiolitis Patients Not Receiving Oxygen—Reply
Authors: Amanda P. Bettencourt, Amanda C. Schondelmeyer, Christopher P. Bonafide
Journal: JAMA (2020)

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
BRCA1 and PALB2 in a Messy Breakup
Authors: Joonyoung Her, Samuel F. Bunting
Journal: Cancer Research (2020)

Abstract Mutations in the BRCA1 gene cause an extremely high lifetime risk of breast and ovarian cancer, but the exact mechanism by which the BRCA1 protein acts to prevent cancer onset remains unclear. In this edition of Cancer Research, Park and colleagues describe a new mouse model featuring a single amino acid substitution in the coiled-coil motif of BRCA1. This change prevents BRCA1 from interacting with PALB2 (partner and localizer of BRCA2), causing rapid cancer onset and a loss of blood cells similar to Fanconi anemia. See related article by Park et al., p. 4172
Familial Risk of Inflammatory Bowel Disease: A Population-Based Cohort Study in South Korea
Authors: Hyun Jung Kim, Shailja C. Shah, Hoo Jae Hann, Sayada Zartasha Kazmi, Taeuk Kang, Jee Hyun Lee, Kyoung-Beom Kim, Min Ji Kang, Hyeong Sik Ahn
Journal: Clinical Gastroenterology and Hepatology (2020)
Fibroblast growth factor receptor 3 activates a network of profibrotic signaling pathways to promote fibrosis in systemic sclerosis
Authors: Debomita Chakraborty, Honglin Zhu, Astrid Jüngel, Lena Summa, Yi-Nan Li, Alexandru-Emil Matei, Xiang Zhou, Jingang Huang, Thuong Trinh-Minh, Chih-Wei Chen, Robert Lafyatis, Clara Dees, Christina Bergmann, Alina Soare, Hui Luo, Andreas Ramming, Georg Schett, Oliver Distler, Jörg H. W. Distler
Journal: Science Translational Medicine (2020)

Up-regulation of FGFR3 and FGF9 induces profibrotic pathways promoting fibroblast activation and tissue fibrosis in systemic sclerosis.
Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US
Authors: G. Caleb Alexander, Matthew Tajanlangit, James Heyward, Omar Mansour, Dima M. Qato, Randall S. Stafford
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Little is known about the association between the coronavirus disease 2019 (COVID-19) pandemic and the level and content of primary care delivery in the US. <h3>Objective</h3> To quantify national changes in the volume, type, and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based vs telemedicine encounters. <h3>Design, Setting, and Participants</h3> Analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index, a 2-stage, stratified nationally representative audit of outpatient care in the US from the first calendar quarter (Q1) of 2018 to the second calendar quarter (Q2) of 2020. <h3>Main Outcomes and Measures</h3> Visit type (office-based or telemedicine), overall and stratified by patient population and geographic region; assessment of blood pressure or cholesterol measurement; and initiation or continuation of prescription medications. <h3>Results</h3> In the 8 calendar quarters between January 1, 2018, and December 31, 2019, between 122.4 million (95% CI, 117.3-127.5 million) and 130.3 million (95% CI, 124.7-135.9 million) quarterly primary care visits occurred in the US (mean, 125.8 million; 95% CI, 121.7-129.9 million), most of which were office-based (92.9%). In 2020, the total number of encounters decreased to 117.9 million (95% CI, 112.6-123.2 million) in Q1 and 99.3 million (95% CI, 94.9-103.8 million) in Q2, a decrease of 21.4% (27.0 million visits) from the average of Q2 levels during 2018 and 2019. Office-based visits decreased 50.2% (59.1 million visits) in Q2 of 2020 compared with Q2 2018-2019, while telemedicine visits increased from 1.1% of total Q2 2018-2019 visits (1.4 million quarterly visits) to 4.1% in Q1 of 2020 (4.8 million visits) and 35.3% in Q2 of 2020 (35.0 million visits). Decreases occurred in blood pressure level assessment (50.1% decrease, 44.4 million visits) and cholesterol level assessment (36.9% decrease, 10.2 million visits) in Q2 of 2020 compared with Q2 2018-2019 levels, and assessment was less common during telemedicine than during office-based visits (9.6% vs 69.7% for blood pressure;<i>P</i> &lt; .001; 13.5% vs 21.6% for cholesterol;<i>P</i> &lt; .001). New medication visits in Q2 of 2020 decreased by 26.0% (14.1 million visits) from Q2 2018-2019 levels. Telemedicine adoption occurred at similar rates among White individuals and Black individuals (19.3% vs 20.5% of patient visits, respectively, in Q1/Q2 of 2020), varied by region (low of 15.1% of visits [East North Central region], high of 26.8% of visits [Pacific region]), and was not correlated with regional COVID-19 burden. <h3>Conclusions and Relevance</h3> The COVID-19 pandemic has been associated with changes in the structure of primary care delivery, with the content of telemedicine visits differing from that of office-based encounters.
Clinical Utility of Lipoprotein(a) and <i>LPA</i> Genetic Risk Score in Risk Prediction of Incident Atherosclerotic Cardiovascular Disease
Authors: Mark Trinder, Md Mesbah Uddin, Phoebe Finneran, Krishna G. Aragam, Pradeep Natarajan
Journal: JAMA Cardiology (2020)

Lipoprotein(a) is a highly heritable biomarker independently associated with atherosclerotic cardiovascular disease (ASCVD). It is unclear whether measured lipoprotein(a) or genetic factors associated with lipoprotein(a) can provide comparable or additional prognostic information for primary prevention.
Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers
Authors: Benjamin S. Abella, Eliana L. Jolkovsky, Barbara T. Biney, Julie E. Uspal, Matthew C. Hyman, Ian Frank, Scott E. Hensley, Saar Gill, Dan T. Vogl, Ivan Maillard, Daria V. Babushok, Alexander C. Huang, Sunita D. Nasta, Jennifer C. Walsh, E. Paul Wiletyo, Phyllis A. Gimotty, Michael C. Milone, Ravi K. Amaravadi
Journal: JAMA Internal Medicine (2020)

Health care workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) are at risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, to our knowledge, there is no effective pharmacologic prophylaxis for individuals at risk.To evaluate the efficacy of hydroxychloroquine to prevent transmission of SARS-CoV-2 in hospital-based HCWs with exposure to patients with COVID-19 using a pre-exposure prophylaxis strategy.This randomized, double-blind, placebo-controlled clinical trial (the Prevention and Treatment of COVID-19 With Hydroxychloroquine Study) was conducted at 2 tertiary urban hospitals, with enrollment from April 9, 2020, to July 14, 2020; follow-up ended August 4, 2020. The trial randomized 132 full-time, hospital-based HCWs (physicians, nurses, certified nursing assistants, emergency technicians, and respiratory therapists), of whom 125 were initially asymptomatic and had negative results for SARS-CoV-2 by nasopharyngeal swab. The trial was terminated early for futility before reaching a planned enrollment of 200 participants.Hydroxychloroquine, 600 mg, daily, or size-matched placebo taken orally for 8 weeks.The primary outcome was the incidence of SARS-CoV-2 infection as determined by a nasopharyngeal swab during the 8 weeks of treatment. Secondary outcomes included adverse effects, treatment discontinuation, presence of SARS-CoV-2 antibodies, frequency of QTc prolongation, and clinical outcomes for SARS-CoV-2-positive participants.Of the 132 randomized participants (median age, 33 years [range, 20-66 years]; 91 women [69%]), 125 (94.7%) were evaluable for the primary outcome. There was no significant difference in infection rates in participants randomized to receive hydroxychloroquine compared with placebo (4 of 64 [6.3%] vs 4 of 61 [6.6%]; P > .99). Mild adverse events were more common in participants taking hydroxychloroquine compared with placebo (45% vs 26%; P = .04); rates of treatment discontinuation were similar in both arms (19% vs 16%; P = .81). The median change in QTc (baseline to 4-week evaluation) did not differ between arms (hydroxychloroquine: 4 milliseconds; 95% CI, -9 to 17; vs placebo: 3 milliseconds; 95% CI, -5 to 11; P = .98). Of the 8 participants with positive results for SARS-CoV-2 (6.4%), 6 developed viral symptoms; none required hospitalization, and all clinically recovered.In this randomized clinical trial, although limited by early termination, there was no clinical benefit of hydroxychloroquine administered daily for 8 weeks as pre-exposure prophylaxis in hospital-based HCWs exposed to patients with COVID-19.ClinicalTrials.gov Identifier: NCT04329923.
Germ‐Line TP53 Mutation in an Adolescent With CMML/Atypical CML and Familiar Cancer Predisposition
Authors: Silvia Nucera, Grazia Fazio, Rocco Piazza, Silvia Rigamonti, Diletta Fontana, Carlo Gambacorti Passerini, Silvia Maitz, Attilio Rovelli, Andrea Biondi, Giovauni Cazzaniga, Adriana Balduzzi
Journal: HemaSphere (2020)

Supplemental Digital Content is available in the text
Authors’ reply to Kolstoe and Hanna and colleagues
Authors: Helene-Mari van der Westhuizen, Koot Kotze, Sarah Tonkin-Crine, Nina Gobat, Trisha Greenhalgh
Journal: BMJ (2020)

Kolstoe is right that confusion about face coverings is “an important lesson as to what can happen when health messaging is unclear.”1 Hanna and colleagues are right that policies related to face coverings might have negative consequences for some people.2 Mandating face coverings can therefore only be justified if the threat is serious; the benefits of masking are substantial and outweigh harms; and the same benefits cannot be achieved less intrusively. Most global public health organisations and national policy makers consider that these criteria have been met.3456

We have not discounted the negative consequences of population masking but, …
SARS‐CoV‐2 Has Not Been Detected Directly by Electron Microscopy in the Endothelium of Chilblain Lesions: reply from authors
Authors: I. Colmenero, C. Santonja, M. Alonso‐Riaño, D. Andina, J.L. Rodríguez Peralto, L. Requena, A. Torrelo
Journal: British Journal of Dermatology (2020)

Linked Articles: Colmenero et al. Br J Dermatol 2021; 183:729–737. Brealey and Miller. Br J Dermatol 2021; 184:186. Colmenero et al. Br J Dermatol 2021; 183:1170–1171.
Infant Homicides Within the Context of Safe Haven Laws — United States, 2008–2017
Authors: Rebecca F. Wilson, Joanne Klevens, Dionne Williams, Likang Xu
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

Homicide is the 13th leading cause of death among infants (i.e., children aged <1 year) in the United States (1). Infant homicides occurring within the first 24 hours of life (i.e., neonaticide) are primarily perpetrated by the mother, who might be of young age, unmarried, have lower educational attainment, and is most likely associated with concealment of an unintended pregnancy and nonhospital birthing (2). After the first day of life, infant homicides might be associated with other factors (e.g., child abuse and neglect or caregiver frustration) (2). A 2002 study of the age variation in homicide risk in U.S. infants during 1989-1998 found that the overall infant homicide rate was 8.3 per 100,000 person-years, and on the first day of life was 222.2 per 100,000 person-years, a homicide rate at least 10 times greater than that for any other time of life (3). Because of this period of heightened risk, by 2008 all 50 states* and Puerto Rico had enacted Safe Haven Laws. These laws allow a parent† to legally surrender an infant who might otherwise be abandoned or endangered (4). CDC analyzed infant homicides in the United States during 2008-2017 to determine whether rates changed after nationwide implementation of Safe Haven Laws, and to examine the association between infant homicide rates and state-specific Safe Haven age limits. During 2008-2017, the overall infant homicide rate was 7.2 per 100,000 person-years, and on the first day of life was 74.0 per 100,000 person-years, representing a 66.7% decrease from 1989-1998. However, the homicide rate on first day of life was still 5.4 times higher than that for any other time in life. No obvious association was found between infant homicide rates and Safe Haven age limits. States are encouraged to evaluate the effectiveness of their Safe Haven Laws and other prevention strategies to ensure they are achieving the intended benefits of preventing infant homicides. Programs and policies that strengthen economic supports, provide affordable childcare, and enhance and improve skills for young parents might contribute to the prevention of infant homicides.
Urinary Organophosphate Metabolite Concentrations and Pregnancy Outcomes among Women Conceiving through <i>in Vitro</i> Fertilization in Shanghai, China
Authors: Peipei Hu, Angela Vinturache, Hong Li, Ying Tian, Lei Yuan, Chen Cai, Min Lu, Jiuru Zhao, Qianqian Zhang, Yu Gao, Zhiwei Liu, Guodong Ding
Journal: Environmental Health Perspectives (2020)

Background: Animal studies suggest that pesticide exposure elicits endocrine changes, increases embryo implantation failure, and decreases litter size. However, only a few epidemiological studies have evaluated the effects of pesticides on the outcomes of in vitro fertilization (IVF) pregnancies. Objectives: This study examined the associations between preconception organophosphate pesticides (OP) exposure and pregnancy outcomes among women undergoing IVF in a Chinese population. Methods: This study included 522 women with infertility who underwent IVF. Women were recruited from a prospective study, the China National Birth Cohort (CNBC), from Shanghai, China, between July 2017 and December 2018. Demographic and clinical information were collected from medical records and through questionnaires. Preconception exposure to OP was assessed by measuring six nonspecific dialkylphosphate (DAP) metabolites [diethylthiophosphate (DETP), diethylphosphate (DEP), diethyldithiophosphate (DEDTP), dimethylthiophosphate (DMTP), dimethylphosphate (DMP), dimethyldithiophosphate (DMDTP)] in urine samples collected at recruitment. Generalized estimating equation (GEE) models were used to evaluate the associations between OP and pregnancy outcomes. Results: Compared with women in the lowest quartile (Q1) of individual DEP and Σ4DAP (the sum of DMP, DMTP, DEP, and DETP), women in the highest quartile (Q4) had lower odds of successful implantation, clinical pregnancy, and live birth, and most of the negative trends were significant (p-trends<0.05). There were no significant associations between urinary DAP concentrations and early IVF outcomes, including total and mature oocyte counts, best embryo quality, fertilization, E2 trigger levels, and endometrial wall thickness. Conclusion: Preconception OP exposure was inversely associated with successful implantation, clinical pregnancy, and live birth in women who underwent IVF. https://doi.org/10.1289/EHP7076
Dupilumab is effective in type 2‐high asthma patients receiving high‐dose inhaled corticosteroids at baseline
Authors: Arnaud Bourdin, Alberto A. Papi, Jonathan Corren, J. Christian Virchow, Megan S. Rice, Yamo Deniz, Michel Djandji, Paul Rowe, Ian D. Pavord
Journal: Allergy (2020)

Dupilumab blocks the shared receptor component for interleukin (IL)-4/IL-13, key drivers of type 2 inflammation. In phase 2b (NCT01854047) and phase 3 LIBERTY ASTHMA QUEST (NCT02414854), add-on dupilumab 200/300 mg every 2 weeks (q2w) reduced severe exacerbations, improved prebronchodilator (pre-BD) forced expiratory volume in 1 second (FEV1 ) and quality of life measures, and it was generally well tolerated in patients with uncontrolled, persistent (phase 2b), or moderate-to-severe (phase 3) asthma.In patients on high-dose inhaled corticosteroids (ICS) with type 2-high asthma (subgroups including baseline blood eosinophils ≥150/300 cells/µL and/or fractional exhaled nitric oxide [FeNO] ≥25 ppb), annualized severe exacerbation rates over the treatment period, changes from baseline in pre-BD FEV1 and asthma control (5-item asthma control questionnaire [ACQ-5]) were analyzed.In high-dose ICS type 2-high subgroups, dupilumab 200/300 mg q2w vs placebo in the phase 2b (24 weeks) and phase 3 (52 weeks) studies significantly reduced severe exacerbations by 55%-69%/57%-60% (all P<.05) and 53%-69%/48%-66% (all P < .001), respectively, except in patients with ≥ 300 eosinophils/µL in phase 2b study (24%/50% (P = .52/0.15). Across subgroups, pre-BD FEV1 improved by 0.18-0.22 L/0.19-0.24 L (all P < .05) and 0.23-0.36 L/0.15-0.25 L (all P < .01) and ACQ-5 scores were reduced by 0.46-0.55/0.47-0.85 (all P < .05) and 0.38-0.50/0.24-0.30 (all P < .05), respectively, except dupilumab 200 mg q2w in phase 2b in patients with FeNO ≥ 25 ppb (0.41; P = .09). Dupilumab was also effective in patients taking medium-dose ICS.Dupilumab significantly reduced severe exacerbations and improved lung function and asthma control in patients with type 2-high asthma on high-dose ICS at baseline.
Low high-density lipoprotein and increased risk of several cancers: 2 population-based cohort studies including 116,728 individuals
Authors: Kasper Mønsted Pedersen, Yunus Çolak, Stig Egil Bojesen, Børge Grønne Nordestgaard
Journal: Journal of Hematology & Oncology (2020)

Abstract Background Increasing evidence suggests that high-density lipoprotein (HDL) may play a role in cancer development. We tested the hypothesis that low HDL levels are associated with increased risk of cancer. Methods Individuals from two population-based cohorts, the Copenhagen General Population Study (2003–2015, N = 107 341), and the Copenhagen City Heart Study (1991–1994, N = 9387) were followed prospectively until end of 2016 to assess low plasma HDL cholesterol and apolipoprotein A1 as risk factors for cancer using Cox proportional hazard regression. Results During up to 25 years follow-up, we observed 8748 cancers in the Copenhagen General Population Study and 2164 in the Copenhagen City Heart Study. In the Copenhagen General Population Study and compared to individuals with HDL cholesterol ≥ 2.0 mmol/L (≥ 77 mg/dL), multivariable adjusted hazard ratios (HRs) for any cancer were 1.13 (95% confidence interval 1.04–1.22) for individuals with HDL cholesterol of 1.5–1.99 mmol/L (58–77 mg/dL), 1.18 (1.08–1.30) for HDL cholesterol of 1.0–1.49 mmol/L (39–58 mg/dL), and 1.29 (1.12–1.48) for individuals with HDL cholesterol &lt; 1.0 mmol/L (&lt; 39 mg/dL). Correspondingly, compared to individuals with apolipoprotein A1 ≥ 190 mg/dL, HRs for any cancer were 1.06 (0.96–1.17) for individuals with apolipoprotein A1 of 160–189 mg/dL, 1.18 (1.07–1.30) for apolipoprotein A1 of 130–159 mg/dL, and 1.28 (1.13–1.46) for individuals with apolipoprotein A1 &lt; 130 mg/dL. Among 27 cancer types, low HDL cholesterol and/or apolipoprotein A1 were associated with increased risk of multiple myeloma, myeloproliferative neoplasm, non-Hodgkin lymphoma, breast cancer, lung cancer, and nervous system cancer. Results were overall similar in women and men separately, and in the Copenhagen City Heart Study. Conclusions Low HDL levels were associated with increased risk of several cancers. Increased risk was most pronounced for hematological and nervous system cancer, and to a minor extent for breast and respiratory cancer.