tbuckley/cabot-search huggingface dataset:
Acute Pain Treatment With Opioids
Authors: Bridget Kuehn
Journal: JAMA (2019)

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
Food seeking and food sharing under uncertainty
Authors: Efrat Aharonov-Majar, Ramzi Suleiman
Journal: Behavioral and Brain Sciences (2019)

Abstract We propose an elaboration of Anselme and Güntürkün's research that considers individuals’ foraging behavior as part of group efforts to cope with uncertainty. We discuss different possibilities for the interaction between individual and group mechanisms for risk reduction in uncertain environments, and we raise some open questions for future research.
Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource
Authors: C. Tarrant, A.M. Colman, E. Chattoe-Brown, D.R. Jenkins, S. Mehtar, N. Perera, E.M. Krockow
Journal: Clinical Microbiology and Infection (2019)

BackgroundAntimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterized as a social dilemma. A familiar version describes the situation in which a collective resource (in this case, antibiotic efficacy) is exhausted due to over-exploitation. The dilemma arises because individuals are motivated to maximize individual payoffs, although the collective outcome is worse if all act in this way.ObjectivesWe aim to outline the implications for antimicrobial stewardship of characterizing antibiotic overuse as a social dilemma.SourcesWe conducted a narrative review of the literature on interventions to promote the conservation of resources in social dilemmas.ContentThe social dilemma of antibiotic over-use is complicated by the lack of visibility and imminence of AMR, a loose coupling between individual actions and the outcome of AMR, and the agency relationships inherent in the prescriber role. We identify seven strategies for shifting prescriber behaviour and promoting a focus on the collectively desirable outcome of conservation of antibiotic efficacy: (1) establish clearly defined boundaries and access rights; (2) raise the visibility and imminence of the problem; (3) enable collective choice arrangements; (4) conduct behaviour-based monitoring; (5) use social and reputational incentives and sanctions; (6) address misalignment of goals and incentives; and (7) provide conflict resolution mechanisms.ImplicationsWe conclude that this theoretic analysis of antibiotic stewardship could make the problem of optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.Graphical abstract
Vesicles and Bullae on the Right Cheek, Neck, and Both Hands
Authors: Guannan Zhu, Wenjun Liao
Journal: JAMA Dermatology (2019)

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 Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal
GPs fear patient exodus to Babylon as CCG confirms cuts to extended hours funding
Authors: Gareth Iacobucci
Journal: BMJ (2019)

General practices in west London have warned that they risk a patient exodus to Babylon’s GP at Hand service, after local commissioners approved plans to cut the practices’ own funding for extended opening hours.

Some practices are set to lose two thirds of their extended appointment slots, and they say that they will be forced to lay off staff because they will lose tens of thousands of pounds in practice income.

The BMJ reported last month1 that Hammersmith and Fulham Clinical Commissioning Group, which hosts Babylon’s digital first service at one of its practices, was consulting on plans to drastically cut the number of extended hours appointments available to patients at other practices because of financial pressures. The CCG reported a £2.5m …
It is time to learn from patients like mine
Authors: Saurabh Gombar, Alison Callahan, Robert Califf, Robert Harrington, Nigam H. Shah
Journal: npj Digital Medicine (2019)

Abstract Clinicians are often faced with situations where published treatment guidelines do not provide a clear recommendation. In such situations, evidence generated from similar patients’ data captured in electronic health records (EHRs) can aid decision making. However, challenges in generating and making such evidence available have prevented its on-demand use to inform patient care. We propose that a specialty consultation service staffed by a team of medical and informatics experts can rapidly summarize ‘what happened to patients like mine’ using data from the EHR and other health data sources. By emulating a familiar physician workflow, and keeping experts in the loop, such a service can translate physician inquiries about situations with evidence gaps into actionable reports. The demand for and benefits gained from such a consult service will naturally vary by practice type and data robustness. However, we cannot afford to miss the opportunity to use the patient data captured every day via EHR systems to close the evidence gap between available clinical guidelines and realities of clinical practice. We have begun offering such a service to physicians at our academic medical center and believe that such a service should be core offering by clinical informatics professional throughout the country. Only if we launch such efforts broadly can we systematically study the utility of learning from the record of routine clinical practice.
Gold Clusters Prevent Inflammation-Induced Bone Erosion through Inhibiting the Activation of NF-κB Pathway
Authors: Qing Yuan, Fuping Gao, Yawen Yao, Pengju Cai, Xiangchun Zhang, Jinling Yuan, Kaixiao Hou, Liang Gao, Xiaojun Ren, Xueyun Gao
Journal: Theranostics (2019)

Inflammation-induced bone erosion is a major pathological factor in several chronic inflammatory diseases that often cause severe outcomes, such as rheumatoid arthritis and periodontitis. Plenty of evidences indicated that the inflammatory bone destruction was attributed to an increase in the number of bone-resorbing osteoclasts. However, anti-resorptive therapy alone failed to prevent bone loss in an inflammatory condition. Conventional anti-inflammation treatments are usually intended to suppress inflammation only, but ignore debilitating the subsequent bone destruction. Therefore, inhibition of proinflammatory activation of osteoclastogenesis could be an important strategy for the development of drugs aimed at preventing inflammatory bone destruction. Methods: In this study, we synthesized a peptide coated gold cluster to evaluate its effects on inflammatory osteoclastogenesis in vitro and inflammation-induced bone destruction in vivo. The in vitro anti-inflammation and anti-osteoclastogenesis effects of the cluster were evaluated in LPS-stimulated and receptor activator of nuclear factor κB ligand (RANKL) stimulated macrophages, respectively. The LPS-induced expression of crucial pro-inflammation cytokines and RANKL-induced osteoclastogenesis as well as the activation of NF-κB pathway in both situations were detected. The inflammation-induced RANKL expression and subsequent inflammatory bone destruction in vivo were determined in collagen-immunized mice. Results: The gold cluster strongly suppresses RANKL-induced osteoclast formation via inhibiting the activation of NF-κB pathway in vitro. Moreover, treatment with the clusters at a dose of 5 mg Au/kg.bw significantly reduces the severity of inflammation-induced bone and cartilage destruction in vivo without any significant toxicity effects. Conclusion: Therefore, the gold clusters may offer a novel potent therapeutic stratagem for inhibiting chronic inflammation associated bone destruction.
Abstract P289: The Neighborhood Food Environment and Change in Body Mass Index: A Systematic Review and Meta-Analysis of Longitudinal Studies
Authors: Keon A Maleki-Yazdi, Jose L Peñalvo, Daniel Marsden, Maria V Rompay, Renata Micha, Dariush Mozaffarian
Journal: Circulation (2017)

Introduction: The neighborhood food environment - locations and density of different types of stores and restaurants - is of great interest to reduce obesity. However, prior meta-analyses have focused on cross-sectional studies, for which reverse causation is a major limitation. Meta-analyses restricted to longitudinal study designs evaluating the food environment and change in BMI have yet to be conducted. Hypothesis: We hypothesized that increased exposure to fast food restaurants would be associated with increased change in BMI. Methods: Eleven databases were searched for longitudinal studies evaluating convenience stores, fast food restaurants, grocery stores, or supermarkets and change in BMI. Inclusion criteria consisted of: (1) interventional, quasi-experimental, or cohort studies; (2) adult or children populations; (3) any country; (4) geographic density or distance of food outlets; (5) a multivariable-adjusted change in BMI over time and corresponding uncertainty. Data were extracted independently and in duplicate, and studies pooled using fixed and random-effects models. Heterogeneity was quantified using Cochrane’s Q, and publication bias using funnel plots, Egger’s test, and Begg’s test. Results: 13 studies including 98,268 subjects were identified. In random effects models, no significant association was seen between food environments and change in BMI ( Figure ). A nonsignificant trend was seen toward lower BMI with increasing density of supermarkets; however, a similar nonsignificant trend was also observed between increasing density of fast food restaurants and lower BMI. Evidence for publication bias was not identified. Conclusion: In available longitudinal studies,no significant relationships were identified between food environments and change in BMI. Our novel findings support the need for further longitudinal and especially interventional studies of how the built food environment, including new measures related to cost and accessibility, may influence health and weight.
Association of Ustekinumab vs TNF Inhibitor Therapy With Risk of Atrial Fibrillation and Cardiovascular Events in Patients With Psoriasis or Psoriatic Arthritis
Authors: Moa P. Lee, Rishi J. Desai, Yinzhu Jin, Gregory Brill, Alexis Ogdie, Seoyoung C. Kim
Journal: JAMA Dermatology (2019)

<h3>Importance</h3> Accumulating evidence indicates that there is an increased risk of cardiovascular disease among patients with psoriatic disease. Although an emerging concern that the risk of atrial fibrillation (AF) may also be higher in this patient population adds to the growing support of initiating early interventions to control systemic inflammation, evidence on the comparative cardiovascular safety of current biologic treatments remains limited. <h3>Objective</h3> To evaluate the risk of AF and major adverse cardiovascular events (MACE) associated with use of ustekinumab vs tumor necrosis factor inhibitors (TNFi) in patients with psoriasis or psoriatic arthritis. <h3>Design, Setting, and Participants</h3> This cohort study included data from a nationwide sample of 78 162 commercially insured patients in 2 US commercial insurance databases (Optum and MarketScan) from September 25, 2009, through September 30, 2015. Patients were included if they were 18 years or older, had psoriasis or psoriatic arthritis, and initiated ustekinumab or a TNFi therapy. Exclusion criteria included history of AF or receipt of antiarrhythmic or anticoagulant therapy during the baseline period. <h3>Exposures</h3> Initiation of ustekinumab vs TNFi therapy. <h3>Main Outcomes and Measures</h3> Incident AF and MACE, including myocardial infarction, stroke, or coronary revascularization. <h3>Results</h3> A total of 60 028 patients with psoriasis or psoriatic arthritis (9071 ustekinumab initiators and 50 957 TNFi initiators) were included in the analyses. The mean (SD) age was 46 (13) years in Optum and 47 (13) in MarketScan, and 29 495 (49.1%) were male. Overall crude incidence rates (reported per 1000 person-years) for AF were 5.0 (95% CI, 3.8-6.5) for ustekinumab initiators and 4.7 (95% CI, 4.2-5.2) for TNFi initiators, and for MACE were 6.2 (95% CI, 4.9-7.8) for ustekinumab initiators and 6.1 (95% CI, 5.5-6.7) for TNFi initiators. The combined adjusted hazard ratio for incident AF among ustekinumab initiators was 1.08 (95% CI, 0.76-1.54) and for MACE among ustekinumab initiators was 1.10 (95% CI, 0.80-1.52) compared with TNFi initiators. <h3>Conclusions and Relevance</h3> No substantially different risk of incident AF or MACE after initiation of ustekinumab vs TNFi was observed in this study. This information may be helpful when weighing the risks and benefits of various systemic treatment strategies for psoriatic disease.
Maternal pertussis vaccination and its effects on the immune response of infants aged up to 12 months in the Netherlands: an open-label, parallel, randomised controlled trial
Authors: Daan Barug, Inge Pronk, Marlies A van Houten, Florens G A Versteegh, Mirjam J Knol, Jan van de Kassteele, Guy A M Berbers, Elisabeth A M Sanders, Nynke Y Rots
Journal: The Lancet Infectious Diseases (2019)
Abstract 16784: Participation in Thrill-Seeking Activities for Hypertrophic Cardiomyopathy Patients
Authors: Nikolaos Papoutsidakis, Lisa Salberg, Jodie Ingles, Christopher Semsarian, Meghan Mannello, Iacopo Olivotto, Niccolo Maurizi, Cynthia Waldman, Stephen Heitner, Daniel Jacoby
Journal: Circulation (2018)

Introduction: Hypertrophic Cardiomyopathy (HCM) is the most common inherited cardiomyopathy and an important cause of sudden cardiac death in young. Previous work suggests that adrenergic stimulation during thrill-seeking activities may be dangerous for cardiac patients. Based on this and the Bethesda guidelines many physicians advise against participation. Hypothesis: We hypothesized that many patients would continue to participate in these activities and we sought to examine their characteristics and outcomes. Methods: Patient advocacy organizations (HCMA), social media outlets and collaborating centers invited HCM patients to complete an anonymous online survey, providing information about participation in thrill-seeking activities (Rollercoaster riding, Jet skiing, Rafting, Bungee jumping, Rappelling, Paragliding, Kayaking/canoeing, Motor racing, Snowboarding, BASE jumping, Skydiving) and associated symptoms. Results: Out of 633 responders, (age: 51.3+-14.4 years, 351 F, 272 M), 556 had engaged in thrill-seeking activity, with 331 continuing after HCM diagnosis. The cohort was high-risk for arrhythmias (24.4% daily symptoms, 45% post ICD, 13.8% post ICD shock, 31.4% history VT). Over a total of 7994 participations, 187 subjects (33.6%) experienced minor events consisting of nausea, dizziness, chest pain or palpitations. Nine subjects (0.02%) reported significant events during or within 60 min of participation [8 syncopal events (4 during rollercoaster riding, 4 during other activities), 1 ICD shock (during skiing)] (Figure 1). Conclusions: This is the first study to assess the safety of thrill-seeking activities for HCM patients. A significant number of patients participated in thrill-seeking activities even after HCM diagnosis. These activities are often associated with mild symptoms but rarely lead to significant events (syncope, ICD shock) in this high-risk population of HCM patients.
Automated classification platform for the identification of otitis media using optical coherence tomography
Authors: Guillermo L. Monroy, Jungeun Won, Roshan Dsouza, Paritosh Pande, Malcolm C. Hill, Ryan G. Porter, Michael A. Novak, Darold R. Spillman, Stephen A. Boppart
Journal: npj Digital Medicine (2019)

Abstract The diagnosis and treatment of otitis media (OM), a common childhood infection, is a significant burden on the healthcare system. Diagnosis relies on observer experience via otoscopy, although for non-specialists or inexperienced users, accurate diagnosis can be difficult. In past studies, optical coherence tomography (OCT) has been used to quantitatively characterize disease states of OM, although with the involvement of experts to interpret and correlate image-based indicators of infection with clinical information. In this paper, a flexible and comprehensive framework is presented that automatically extracts features from OCT images, classifies data, and presents clinically relevant results in a user-friendly platform suitable for point-of-care and primary care settings. This framework was used to test the discrimination between OCT images of normal controls, ears with biofilms, and ears with biofilms and middle ear fluid (effusion). Predicted future performance of this classification platform returned promising results (90%+ accuracy) in various initial tests. With integration into patient healthcare workflow, users of all levels of medical experience may be able to collect OCT data and accurately identify the presence of middle ear fluid and/or biofilms.
Abstract 16053: Dynamic Trans Gene Expression Regulation by eQTLs in Complex Disease Traits
Authors: Chen Yao, Roby Joehanes, Tianxiao Huan, Chunyu Liu, Andrew D Johnson, Jane Freedman, Peter J Munson, Daniel Levy
Journal: Circulation (2015)

Genome-wide association studies (GWAS) have been widely used to identify genetic variants associated with complex traits. However, for many of these diseases, it remains unclear how the genetic variants exert their effect on the phenotype, and especially how they affect gene expression of remote genes (trans-eQTL). In a previous study, we found that a large proportion of trans-eQTLs are also cis-eQTLs. Therefore, we hypothesized that some trans-eQTLs influence expression of distant genes through effects on expression levels of a cis-transcript. Using 42,271 SNPs associated with 1,960 complex traits available in public data sets curated in GRASP, we first explored the gene expression associations of trait-associated SNPs in 5,257 individuals from the Framingham Heart Study (FHS) and then we tested mediation effects of cis-transcripts on trans-transcripts when both were associated with the same eQTL. At FDR&lt;0.05, we identified 2,324 trans-eQTLs; 84% of them (1,953) were found to have cis-associated transcripts. Mediation testing suggested that for 797 (41%) of these 1953 trans-eQTLs, the disease-associated SNP may alter expression of the trans-transcript via expression of genes near the eQTL (p&lt;0.0005 for 10,000 permutations). We searched across 7 cardiometabolic traits (BMI, systolic/ diastolic blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, glucose) and identified several cis mediators affecting the expression of multiple downstream genes; the cis mediators include SH2B3, ALDH2, NLRC5, PCSK7 and ALAS2. The expression of each cis mediator gene was significantly associated with one or more CVD phenotype in 5,257 FHS participants. These findings highlight a novel approach to identifying promising drug targets.
CLO19-058: Live Music to Decrease Patient Anxiety During Chemotherapy Treatments
Authors: Crystal Weaver, Mark Varvares, Elaine Ottenlips, Kara Christopher, Andrew Dwiggins
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: Music therapy began in the United States after World War II when community musicians went to veterans’ hospitals to provide live music to those experiencing post-war trauma. Music therapy programs continue to utilize community musicians who provide live music to patients in treatment centers to supplement formal music therapy sessions by credentialed professionals. Little evidence has been gathered regarding the potential ability of these live music performances to decrease the anxiety levels of oncology patients during chemotherapy treatments. Purpose: To determine if listening to live music performed by community musicians decreases oncology patient anxiety levels during chemotherapy treatments in an outpatient infusion center. Method: This quasi-experimental study involved an experimental group who listened to live music by community musicians and a control group who did not listen to live music during a single chemotherapy treatment for 30 minutes. Pre- and post-test measures of blood pressure, pulse, respiration per minute, and responses to the State-Trait Anxiety Inventory (ie, common measures of anxiety) were collected by a registered nurse on all participants. The sample included 60 participants (30 control and 30 experimental). Demographic information for the participants was: (1) 60% were male and 40% were female; (2) 73% were Caucasian and 27% were African American; (3) the mean age was 62 years; and (4) 100% had a cancer diagnosis. Results: Independent sample t-test was conducted to determine if there were differences in the amount of change for dependent variables. Significance was set at P &lt;.05. Results revealed a significantly higher score difference in the experimental group when compared to the control group for pulse, respiration per minute, and systolic blood pressure (Table 1). Conclusion: Listening to live music by community musicians can decrease oncology patient anxiety levels during chemotherapy treatments as evidenced by significant decreases in pulse, respiration per minute, and systolic blood pressure. Additional studies may examine if greater decreases in anxiety levels are achieved by the implementation of formal music therapy sessions by credentialed professionals.