tbuckley/cabot-search huggingface dataset:
Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice
Authors: Hallie C. Prescott, Theodore J. Iwashyna, Bronagh Blackwood, Thierry Calandra, Linda L. Chlan, Karen Choong, Bronwen Connolly, Paul Dark, Luigi Ferrucci, Simon Finfer, Timothy D. Girard, Carol Hodgson, Ramona O. Hopkins, Catherine L. Hough, James C. Jackson, Flavia R. Machado, John C. Marshall, Cheryl Misak, Dale M. Needham, Pinaki Panigrahi, Konrad Reinhart, Sachin Yende, Ross Zafonte, Kathryn M. Rowan, Derek C. Angus
Journal: American Journal of Respiratory and Critical Care Medicine (2019)

An estimated 14.1 million patients survive sepsis each year. Many survivors experience poor long-term outcomes, including new or worsened neuropsychological impairment; physical disability; and vulnerability to further health deterioration, including recurrent infection, cardiovascular events, and acute renal failure. However, clinical trials and guidelines have focused on shorter-term survival, so there are few data on promoting longer-term recovery. To address this unmet need, the International Sepsis Forum convened a colloquium in February 2018 titled "Understanding and Enhancing Sepsis Survivorship." The goals were to identify gaps and limitations of current research and shorter- and longer-term priorities for understanding and enhancing sepsis survivorship. Twenty-six experts from eight countries participated. The top short-term priorities identified by nominal group technique culminating in formal voting were to better leverage existing databases for research, develop and disseminate educational resources on postsepsis morbidity, and partner with sepsis survivors to define and achieve research priorities. The top longer-term priorities were to study mechanisms of long-term morbidity through large cohort studies with deep phenotyping, build a harmonized global sepsis registry to facilitate enrollment in cohorts and trials, and complete detailed longitudinal follow-up to characterize the diversity of recovery experiences. This perspective reviews colloquium discussions, the identified priorities, and current initiatives to address them.
Educating Physicians About Marijuana
Authors: Nathaniel P. Morris
Journal: JAMA Internal Medicine (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 Internal Medicine 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 Internal Medicine journal
Measuring Disturbance of the Endocannabinoid System in Psychosis
Authors: Amedeo Minichino, Morwenna Senior, Natascia Brondino, Sam H. Zhang, Beata R. Godlewska, Philip W.J. Burnet, Andrea Cipriani, Belinda R. Lennox
Journal: JAMA Psychiatry (2019)

The endocannabinoid system (ECS) is a lipid-based endogenous signaling system. Its relevance to psychosis is through the association between cannabis use and the onset and course of illness and through the antipsychotic properties of cannabidiol, a potential ECS enhancer.To conduct a systematic review and meta-analysis of the blood and cerebrospinal fluid (CSF) measures of the ECS in psychotic disorders.Web of Science and PubMed were searched from inception through June 13, 2018. The articles identified were reviewed, as were citations to previous publications and the reference lists of retrieved articles.Original articles were included that reported blood or CSF measures of ECS activity in patients with psychotic illnesses and in healthy controls.PRISMA guidelines, independent extraction by multiple observers, and random-effects meta-analysis were used. Heterogeneity was assessed with the I2 index. Sensitivity analyses tested the robustness of the results.The clinical relevance of ECS modifications in psychotic disorders was investigated by (1) a quantitative synthesis of the differences in blood and CSF markers of the ECS between patients and healthy controls, and (2) a qualitative synthesis of the association of these markers with symptom severity, stage of illness, and response to treatment.A total of 18 studies were included. Three individual meta-analyses were performed to identify the differences in ECS markers between people with schizophrenia and healthy controls. Five studies, including 226 patients and 385 controls, reported significantly higher concentrations of anandamide in the CSF of patients than controls (standardized mean difference [SMD], 0.97; 95% CI, 0.67-1.26; P < .001; I2 = 54.8%). In 9 studies, with 344 patients and 411 controls, significantly higher anandamide levels in blood were found in patients, compared with controls (SMD, 0.55; 95% CI, 0.05-1.04; P = .03; I2 = 89.6%). In 3 studies, involving 88 patients and 179 controls, a significantly higher expression of type 1 cannabinoid receptors on peripheral immune cells was reported in patients compared with controls (SMD, 0.57; 95% CI, 0.31-0.84; P < .001; I2 = 0%). Higher ECS tone was found at an early stage of illness in individuals who were antipsychotic naïve or free, and it had an inverse association with symptom severity and was normalized after successful treatment. Moderate to high level of heterogeneity in methods was found between studies.Testing clinically relevant markers of the ECS in the blood and CSF of people with psychotic illness appears possible, and these markers provide useful biomarkers for the psychotic disorder; however, not all studies accounted for important variables, such as cannabis use.PROSPERO identifier: CRD42018099863.
Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population
Authors: Sally McManus, David Gunnell, Claudia Cooper, Paul E Bebbington, Louise M Howard, Traolach Brugha, Rachel Jenkins, Angela Hassiotis, Scott Weich, Louis Appleby
Journal: The Lancet Psychiatry (2019)

BackgroundThe number of people presenting to hospital emergency departments after self-harming has increased in England. However, most people who self-harm do not present to hospitals, so whether this rise reflects an increase in the prevalence of self-harm in the community is unknown. Also unknown is whether the prevalence of non-suicidal self-harm (NSSH) or suicidal self-harm, or both, has increased. We aimed to establish temporal trends in the prevalence of NSSH in England.MethodsWe analysed data from participants in the 2000 (n=7243), 2007 (n=6444), and 2014 (n=6477) Adult Psychiatric Morbidity Surveys of the general population, selecting those aged 16–74 years and living in England. We used weighted data and controlled for complex survey design. We generated temporal trends in lifetime prevalence and methods of, and motivations for, NSSH, and consequent service contact. We used multiple variable logistic regression analyses to investigate factors associated with service contact.FindingsThe prevalence of self-reported lifetime NSSH increased from 2·4% (95% CI 2·0–2·8) in 2000, to 6·4% (5·8–7·2) in 2014. Increases in prevalence were noted in both sexes and across age groups—most notably in women and girls aged 16–24 years, in whom prevalence increased from 6·5% (4·2–10·0) in 2000, to 19·7% (15·7–24·5) in 2014. The proportion of the population reporting NSSH to relieve unpleasant feelings of anger, tension, anxiety, or depression increased from 1·4% (95% CI 1·0–2·0) to 4·0% (3·2–5·0) in men and boys, and from 2·1% (1·6–2·7) to 6·8% (6·0–7·8) in women and girls, between 2000 and 2014. In 2014, 59·4% (95% CI 54·7–63·9) of participants who had engaged in NSSH reported no consequent medical or psychological service contact, compared with 51·2% (42·2–60·0) in 2000 and 51·8% (47·3–56·4) in 2007. Male participants and those aged 16–34 years were less likely to have contact with health services than were female participants and older people.InterpretationThe prevalence of NSSH has increased in England, but resultant service contact remains low. In 2014, about one in five female 16–24-year-olds reported NSSH. There are potential lifelong implications of NSSH, such as an increased frequency of suicide, especially if the behaviours are adopted as a long-term coping strategy. Self-harm needs to be discussed with young people without normalising it. Young people should be offered help by primary care, educational, and other services to find safer ways to deal with emotional stress.FundingNHS Digital, English Department of Health and Social Care, and the National Institute for Health Research.
An Anti-CD3 Antibody, Teplizumab, in Relatives at Risk for Type 1 Diabetes
Authors: Kevan C. Herold, Brian N. Bundy, S. Alice Long, Jeffrey A. Bluestone, Linda A. DiMeglio, Matthew J. Dufort, Stephen E. Gitelman, Peter A. Gottlieb, Jeffrey P. Krischer, Peter S. Linsley, Jennifer B. Marks, Wayne Moore, Antoinette Moran, Henry Rodriguez, William E. Russell, Desmond Schatz, Jay S. Skyler, Eva Tsalikian, Diane K. Wherrett, Anette-Gabriele Ziegler, Carla J. Greenbaum
Journal: New England Journal of Medicine (2019)

Type 1 diabetes is a chronic autoimmune disease that leads to destruction of insulin-producing beta cells and dependence on exogenous insulin for survival. Some interventions have delayed the loss of insulin production in patients with type 1 diabetes, but interventions that might affect clinical progression before diagnosis are needed.We conducted a phase 2, randomized, placebo-controlled, double-blind trial of teplizumab (an Fc receptor-nonbinding anti-CD3 monoclonal antibody) involving relatives of patients with type 1 diabetes who did not have diabetes but were at high risk for development of clinical disease. Patients were randomly assigned to a single 14-day course of teplizumab or placebo, and follow-up for progression to clinical type 1 diabetes was performed with the use of oral glucose-tolerance tests at 6-month intervals.A total of 76 participants (55 [72%] of whom were ≤18 years of age) underwent randomization - 44 to the teplizumab group and 32 to the placebo group. The median time to the diagnosis of type 1 diabetes was 48.4 months in the teplizumab group and 24.4 months in the placebo group; the disease was diagnosed in 19 (43%) of the participants who received teplizumab and in 23 (72%) of those who received placebo. The hazard ratio for the diagnosis of type 1 diabetes (teplizumab vs. placebo) was 0.41 (95% confidence interval, 0.22 to 0.78; P = 0.006 by adjusted Cox proportional-hazards model). The annualized rates of diagnosis of diabetes were 14.9% per year in the teplizumab group and 35.9% per year in the placebo group. There were expected adverse events of rash and transient lymphopenia. KLRG1+TIGIT+CD8+ T cells were more common in the teplizumab group than in the placebo group. Among the participants who were HLA-DR3-negative, HLA-DR4-positive, or anti-zinc transporter 8 antibody-negative, fewer participants in the teplizumab group than in the placebo group had diabetes diagnosed.Teplizumab delayed progression to clinical type 1 diabetes in high-risk participants. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT01030861.).
Fatigue in autoimmune skin diseases
Authors: M. Tarazi, R.G. Gaffney, D. Pearson, C.J. Kushner, V.P. Werth
Journal: British Journal of Dermatology (2019)

People with the disease systemic lupus erythematosus (SLE) often suffer from fatigue, reducing quality of life and contributing to ill health. The authors of this study, based in Pennsylvania and New Jersey, USA, studied whether fatigue was a feature in other autoimmune skin conditions. Autoimmune means when the body's immune system, which usually fights off infection, actually targets healthy cells. They used a 36‐item questionnaire (SF‐36), with a specific vitality scale to measure levels of fatigue in controls (people without SLE) and patients with SLE, and the diseases chronic cutaneous LE, amyopathic dermatomyositis and autoimmune blistering conditions. Levels of fatigue were worst in the patients with SLE, but all the other conditions studied were linked with greater fatigue than the control group. The levels of fatigue were similar in the groups with dermatomyositis and blistering conditions, but less in the patients with cutaneous LE. The authors conclude that fatigue is an important feature of these autoimmune conditions, and is detrimental to quality of life.
Unexpected babesiosis with dramatic morphological features
Authors: Andrew McGregor, John Lambert, Barbara J. Bain, Peter Chiodini
Journal: American Journal of Hematology (2019)

Blood film examination confirmed thrombocytopenia but unexpectedly also showed heavy parasitemia. More than 20% of cells contained small ring trophozoites with a single nuclear dot (Images); some cells contained more than one parasite, with up to four parasites per erythrocyte. There were occasional paired pyriform parasites (top Image) and rare Maltese cross formations. In addition, there were large extracellular aggregates of ring trophozoites (Images). The patient had not traveled to a malaria endemic area and immunological testing for plasmodial LDH was negative. A diagnosis of babesiosis due to Babesia microti infection was made on morphological and geographical grounds. Given the predominance of small rings, B microti infection is easily confused with Plasmodium spp., especially P falciparum. However, in B microti the center of the rings is much paler, almost white. The presence of pyriform pairs and the Maltese cross form is diagnostic of babesia infection. The presence of clusters of extracellular ring trophozoites strongly supports a diagnosis of B microti. Furthermore, unlike malaria parasites, Babesia does not form schizonts, does not produce hemozoin pigment, and does not produce enlargement of the red cell or other red cell abnormalities (Schüffner's dots, James's dots, Maurer's clefts, or Zieman's stippling, depending on the Plasmodium species present). Treatment with specific antibabesia agents was commenced following receipt of the blood film result. Despite intubation, ventilation, and vasopressor support, progressive acidosis occurred. An exchange transfusion was organized but the patient became too unstable for this to be performed and he died shortly afterwards. We postulate that the masses of extracellular parasites caused microvascular obstruction and contributed to the multiorgan failure and fatal outcome. None.
Abstract 19272: Impact of Severe Obesity on Exercise Performance in Heart Failure With Preserved Ejection Fraction (HFpEF)
Authors: Satyam Sarma, Michinari Hieda, Christopher Hearon, Sheryl Livingston, Braden Everding, Mitchel Samels, Michael D Palmer, Benjamin D Levine
Journal: Circulation (2017)

Introduction: Obesity plays an important role in functional impairment, symptom severity and mortality in HFpEF. Prior studies suggest a protective effect of obesity on HFpEF outcomes up to a BMI o...
Complete Regression of Lung Metastases in a Patient With Metastatic Castration-Resistant Prostate Cancer Using 177Lu-PSMA Radioligand Therapy
Authors: Jingjing Zhang, Harshad R. Kulkarni, Aviral Singh, Richard P. Baum
Journal: Clinical Nuclear Medicine (2019)

Patients with metastatic castration-resistant prostate cancer (mCRPC) and visceral (liver or lung) metastases have a poor prognosis and worse outcomes than those with bone disease with or without lymph nodes involvement. The high prostate-specific membrane antigen expression in prostate cancer metastases makes it a promising approach for targeted radionuclide therapy of prostate cancer. Lutetium-177 (Lu)-labeled prostate-specific membrane antigen radioligand therapy (Lu-PRLT) has demonstrated encouraging efficacy in mCRPC. We report here an mCRPC patient with lung, lymph nodes, and extensive bone metastases, who underwent Lu-PRLT and had excellent response to the treatment and complete regression of lung metastases after Lu-PRLT.
Abstract 20: Intraosseous vs. Intravenously Administered Advanced Life Support Drugs in Patients With Out-of-Hospital Cardiac Arrest: Insights From the Resuscitation Outcomes Consortium Continuous Chest Compression Trial
Authors: Purav Mody, Siobhan Brown, Rohan Khera, Ambarish Pandey, Colby Ayers, Peter Kudenchuk, Paul S Chan, James A de Lemos, Karl Kern, Mark Link, Ahamed Idris
Journal: Circulation (2018)

Background: There is an urgent need to identify strategies which improve outcomes for out-of-hospital cardiac arrest (OHCA). Determining the optimal access route to deliver medications during resuscitation from OHCA may be one such strategy. Methods: Using data from the Continuous Chest compression trial between 2011 and 2016, we examined rates of sustained return of spontaneous circulation (ROSC) i.e. ROSC on ER arrival, survival to discharge and survival with favorable neurological function (modified Rankin scale ≤3) among patients with attempted IV and IO access. Results: Among 19,731 patients with available access information, IO or IV access was attempted in 3,068 (15.5%) and 16,663 (84.5%) patients, respectively and was successful in 2,975 (97%) and 15,485 (92%) of these patients. Overall, patients with attempted IO access were younger, more likely female, received less bystander CPR, had lower proportions of shockable and witnessed arrests, marginally faster times to access and to epinephrine administration, and less frequently received therapeutic hypothermia and coronary angiography as compared with patients with IV access ( Table ) . Unadjusted rates of sustained ROSC, discharge survival and survival with favorable neurological function were significantly lower in patients with attempted IO access ( Table) . After adjustment for age, sex, initial rhythm, bystander CPR, public location, witnessed status, EMS response time and trial cluster, attempted IO access was associated with lower sustained ROSC rates (OR 0.79, 95% CI 0.71-0.89, p&lt;0.001) but not with discharge survival (OR 0.88, 95% CI 0.71-1.08, p=0.21) or survival with favorable neurological function (OR 0.86, 95% CI 0.67-1.1, p=0.26). Conclusions: Among patients with OHCA, intraosseous access was attempted in 1 in 7 OHCA patients and associated with worse ROSC rates but no difference in survival. Further studies are necessary to elucidate the optimal access route among OHCA patients.
Estimating Renal Function in Pregnancy—Reply
Authors: Ziv Harel, Joel G. Ray
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 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
Publisher Correction: Neuronal deletion of Gtf2i, associated with Williams syndrome, causes behavioral and myelin alterations rescuable by a remyelinating drug
Authors: Boaz Barak, Zicong Zhang, Yuanyuan Liu, Ariel Nir, Sari S. Trangle, Michaela Ennis, Kirsten M. Levandowski, Dongqing Wang, Kathleen Quast, Gabriella L. Boulting, Yi Li, Dashzeveg Bayarsaihan, Zhigang He, Guoping Feng
Journal: Nature Neuroscience (2019)
Challenges and Opportunities in the Design of Liver-on-Chip Microdevices
Authors: Avner Ehrlich, Daniel Duche, Gladys Ouedraogo, Yaakov Nahmias
Journal: Annual Review of Biomedical Engineering (2019)

The liver is the central hub of xenobiotic metabolism and consequently the organ most prone to cosmetic- and drug-induced toxicity. Failure to detect liver toxicity or to assess compound clearance during product development is a major cause of postmarketing product withdrawal, with disastrous clinical and financial consequences. While small animals are still the preferred model in drug development, the recent ban on animal use in the European Union created a pressing need to develop precise and efficient tools to detect human liver toxicity during cosmetic development. This article includes a brief review of liver development, organization, and function and focuses on the state of the art of long-term cell culture, including hepatocyte cell sources, heterotypic cell–cell interactions, oxygen demands, and culture medium formulation. Finally, the article reviews emerging liver-on-chip devices and discusses the advantages and pitfalls of individual designs. The goal of this review is to provide a framework to design liver-on-chip devices and criteria with which to evaluate this emerging technology.
Validity of a noninvasive estimation of deep body temperature when wearing personal protective equipment during exercise and recovery
Authors: Andrew P. Hunt, Mark J. Buller, Matthew J. Maley, Joseph T. Costello, Ian B. Stewart
Journal: Military Medical Research (2019)

Deep body temperature is a critical indicator of heat strain. However, direct measures are often invasive, costly, and difficult to implement in the field. This study assessed the agreement between deep body temperature estimated from heart rate and that measured directly during repeated work bouts while wearing explosive ordnance disposal (EOD) protective clothing and during recovery. Eight males completed three work and recovery periods across two separate days. Work consisted of treadmill walking on a 1% incline at 2.5, 4.0, or 5.5 km/h, in a random order, wearing EOD protective clothing. Ambient temperature and relative humidity were maintained at 24 °C and 50% [Wet bulb globe temperature (WBGT) (20.9 ± 1.2) °C] or 32 °C and 60% [WBGT (29.0 ± 0.2) °C] on the separate days, respectively. Heart rate and gastrointestinal temperature (TGI) were monitored continuously, and deep body temperature was also estimated from heart rate (ECTemp). The overall systematic bias between TGI and ECTemp was 0.01 °C with 95% limits of agreement (LoA) of ±0.64 °C and a root mean square error of 0.32 °C. The average error statistics among participants showed no significant differences in error between the exercise and recovery periods or the environmental conditions. At TGI levels of (37.0–37.5) °C, (37.5–38.0) °C, (38.0–38.5) °C, and > 38.5 °C, the systematic bias and ± 95% LoA were (0.08 ± 0.58) °C, (− 0.02 ± 0.69) °C, (− 0.07 ± 0.63) °C, and (− 0.32 ± 0.56) °C, respectively. The findings demonstrate acceptable validity of the ECTemp up to 38.5 °C. Conducting work within an ECTemp limit of 38.4 °C, in conditions similar to the present study, would protect the majority of personnel from an excessive elevation in deep body temperature (> 39.0 °C).