tbuckley/cabot-search huggingface dataset:
Hospital Responses to Incentives in Episode-Based Payment for Joint Surgery
Authors: Andrew D. Wilcock, Michael L. Barnett, J. Michael McWilliams, David C. Grabowski, Ateev Mehrotra
Journal: JAMA Internal Medicine (2021)

Medicare's Comprehensive Care for Joint Replacement (CJR) model, initiated in 2016, is a national episode-based payment model for lower-extremity joint replacement (LEJR). Metropolitan statistical areas (MSAs) were randomly assigned to participation. In the third year of the program, Medicare made hospital participation voluntary in half of the MSAs and enabled LEJRs for knees to be performed in the outpatient setting without being subject to episode-based payment. How these changes affected program savings is unclear.
Lyme Disease—United States, 2000
Journal: JAMA (2002)

-LymeDiseaseReport.pdf: PDF of report.                                                                                                   
-LymeDiseaseReport.docx: Microsoft Word document of report.                                                              
-LymeDiseasePresentation.pdf: PDF of the presentation slides.                                                               
-LymeDiseasePresentation.pptx: PowerPoint file of the presentation.
Cell membrane cloaked nanomedicines for bio-imaging and immunotherapy of cancer: Improved pharmacokinetics, cell internalization and anticancer efficacy
Authors: Zahid Hussain, Muhammad Abdur Rahim, Nasrullah Jan, Hassan Shah, Mutasem Rawas-Qalaji, Shahzeb Khan, Mohammad Sohail, Hnin Ei Thu, Nor Amlizan Ramli, Rai Muhammad Sarfraz, Mohammed A.S. Abourehab
Journal: Journal of Controlled Release (2021)
Abstract 15606: The Association Between Health System Integration and Quality and Outcomes After Acute Myocardial Infarction
Authors: Shayne E Dodge, Micah Aaron, Nancy Beaulieu, David Cutler, Mary Beth Landrum, Lauren Gilstrap
Journal: Circulation (2020)

Introduction: Integrated care has long been put forward as a way to both decrease costs and improve the quality and outcomes. To date however, this hypothesis has not been formally evaluated in nationally representative data. In this study, using 100% Medicare data and a novel enhanced database (EDB), we aim to determine the association between integrated inpatient and outpatient care after acute myocardial infarction (AMI) and quality and outcomes. Hypothesis: There will be no difference in quality or outcomes after AMI between integrated and non-integrated inpatient and outpatient care. Methods: Using 100% Medicare data and a novel EDB that combines claims data, tax and financial records and proprietary datasets, we classified all hospitals and providers in the US as: “part of a health system” or “not part of a health system.” We then determined whether AMI patients had “integrated” (hospital and outpatient provider in the same system) or “non-integrated” (hospital and outpatient provider not in the same system) care after AMI. Multivariable linear regression was used to determine the association between care integration between hospital and outpatient provider and quality/outcomes. Results: The differences in quality and outcomes, based on care integration, are displayed below ( Table ). There were no differences in short-term quality or follow up. Integrated care was associated with significantly higher rates of cardiac rehab enrollment. Long-term quality metric performance and outcomes were uniformly better among patients who received integrated care. Conclusions: Integrated inpatient and outpatient care after AMI is associated with higher rates of cardiac rehab enrollment, better long-term quality and improved patient outcomes.
Abstract 17341: Obesity is Associated With Progressive Heart Failure in Hypertrophic Cardiomyopathy
Authors: Aadhavi Sridharan, Martin S Maron, Dou Huang, Craig Cooper, Jennifer Drummond, Barry J Maron, Ethan J Rowin
Journal: Circulation (2020)

Background: The impact of comorbid disease states and lifestyle on the natural history of patients with hypertrophic cardiomyopathy (HCM) remains unknown. Objective: Evaluate the association of non-HCM comorbidities including obesity, hypertension, diabetes, obstructive sleep apnea, kidney disease, tobacco use, alcohol use, and lung disease with disease progression in a large cohort of HCM patients. Methods: 2269 patients evaluated at the Tufts HCM Institute between 2004 to 2019, ≥ 18 years of age (54 ± 15 years; 1392 male), and followed for an average of 4 ± 3.4 years for disease progression including progressive heart failure (HF) symptoms (from NYHA class I/II to NYHA class III/IV), new-onset atrial fibrillation (AF), or sudden death (SD) event (including appropriate defibrillation for ventricular arrhythmias, resuscitated cardiac arrest, or SD). Results: Of 1376 patients with NYHA class I/II symptoms at initial clinical evaluation, 252 (18%) developed progressive HF symptoms to NYHA class III/IV over follow-up (5%/year). Obesity (BMI ≥ 30) was significantly more prevalent in patients who had progressive HF during follow-up (43%) compared to those who remained without HF (34%, p = 0.014). In contrast, other comorbidities were not significantly associated with progressive HF symptoms (p &gt; 0.10 for all other comorbidities). Of the 1823 patients without AF history at initial clinical visit, 198 (11%) developed new-onset AF over follow-up (3%/year). No comorbidities were significantly associated with new-onset AF in HCM (p &gt; 0.10), although obesity was more common in patients who developed new-onset AF (48%) compared to those who had no AF (41%, p = 0.08). Notably, SD events were not associated with non-HCM comorbidities (p &gt; 0.10 for all comorbidities), and patients with SD events were less likely to have comorbidities than patients without SD events. Conclusions: In adult HCM patients, obesity is associated with progressive symptoms and outcomes supporting weight loss as an important modifier in obese HCM patients to potentially help prevent HCM complications. In contrast, other non-HCM comorbidities do not appear to impact disease course, and SD events are not associated with comorbidities in HCM.
Purpuric Edematous Nodules and Plaques in an Immunosuppressed Older Man
Authors: Arianna F. Yanes, Matthew L. Hedberg, Jules B. Lipoff
Journal: JAMA Dermatology (2021)

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
Abstract P195: The Association Of Psychological Stress Measures With Allostatic Load Among African Americans With Hypertension
Authors: Anika L Hines, Ebony Boulware, Sherita H Golden, Joshua J Joseph, Dingfen Han, Patti Ephraim, Lisa A Cooper, Raquel Greer, Deidra Crews
Journal: Circulation (2021)

African Americans experience disproportionate stress over the life course, which has been posited as an explanatory mechanism underlying racial disparities in CVD risk. We studied associations between measures of self-reported psychosocial stress and allostatic load (AL) (elevated or fluctuating endocrine or neural responses resulting from chronic stress) among 74 participants of the Achieving Blood Pressure (BP) Control Together (ACT) study—a randomized control trial to improve BP self-management and control among African Americans. We examined ancillary AL biomarkers (i.e., DHEA-S, cortisol, CRP, IL-6) in addition to ACT study measures (i.e., HbA1c, diabetes status, total cholesterol, HDL-C, triglycerides, hyperlipidemia, urinary microalbumin) collected at 12-months follow-up. We used linear univariable and multivariable regression to estimate correlations between ratings of the Perceived Stress Scale (PSS-10), the Everyday Discrimination Scale, and the Patient Health Questionnaire (PHQ-8) with total AL score (1 point per aforementioned component measure threshold achieved) and its components. Ninety-three percent of the sample reported moderate to severe stress; the mean discrimination score was 14.9 (SD: 7.4) (of a possible 39 points); 22% had moderate to severe depressive symptoms. The mean AL score was 3 of a possible total of 11. Perceived stress was negatively associated with CRP adjusting for other components and patient characteristics. Discrimination was associated with increases in inflammatory factors; however, this association diminished after adjusting for other AL components and patient characteristics. Depressive symptoms were positively associated with inflammatory factors and triglycerides adjusting for other AL components and patient characteristics. In conclusion, the findings from this study of African Americans with hypertension suggest correlations between self-reported psychological stressors and AL components, but not total AL score.
Abstract 15326: Inactivation of Mitochondrial Deacetylase Sirt3 Induces Oxidative Stress, Promotes Vascular Hypertrophy, Increases Aortic Dissections, Exacerbates Hypertension and Mortality
Authors: Anna Dikalova, Sergey Gutor, Vasiliy Polosukhin, Sergey Dikalov
Journal: Circulation (2020)

Introduction: Vascular dysfunction plays a key role in hypertension and cardiovascular disease, which causes one-third of deaths worldwide. Mitochondrial dysfunction contributes to these conditions; however, specific mechanisms are not clear. We showed inactivation of mitochondrial deacetylase Sirt3 in arterioles from patients with essential hypertension associated with superoxide dismutase inactivation, vascular inflammation and oxidative stress. Hypothesis: We hypothesized that the loss of vascular Sirt3 induces oxidative stress, promotes vascular dysfunction and hypertension. Methods: To test this hypothesis, we developed tamoxifen-inducible smooth muscle specific Sirt3 knockout mice (SmcSirt3KO) by crossing the Sirt3flox/flox mice with mice carrying a gene for inducible Cre in the vascular smooth muscle cells. Results and Discussion: Hypertension was modestly increased but considerably increased mortality in angiotensin II-infused SmcSirt3KO mice (35% vs 5% in WT) which was associated with higher rate of aortic dissections (50% vs 10% in WT). The basal superoxide and nitric oxide levels were not affected in SmcSirt3KO mice, however, angiotensin II infusion significantly increased superoxide and nitric oxide inactivation in SmcSirt3KO mice compared with wild-type mice supporting the pathological role of smooth muscle Sirt3 impairment. Post-mortem analysis showed high frequency of abdominal aortic aneurysms in angiotensin II-infused SmcSirt3KO mice suggesting that adverse vascular remodeling contributed to high mortality in these mice. To gain further insight into vascular pathology we performed histological examination using Verhoeff-van Gieson staining. Angiotensin II-infused SmcSirt3KO mice had 5-time higher abdominal aortic dissections rate, increased vascular hypertrophy, and disrupted elastic lamellae. Conclusion: Aortic dissection is a catastrophic disease with high mortality and morbidity characterized by fragmentation of elastin and smooth muscle cell dysfunction. Our data suggest that Sirt3 impairment can contribute to vascular hypertrophy, aortic dissection, end-organ-damage and mortality. It is conceivable that targeting Sirt3 may have therapeutic potential in cardiovascular disease.
Abstract 15140: Older Participant Perspectives on Permanent Study Drug Discontinuation in an Ongoing Primary Prevention Trial of Statins: A Qualitative Study
Authors: Zhen Zhou, Mark R Nelson
Journal: Circulation (2020)

Introduction: Study drug discontinuation is commonplace in clinical trials of older populations and poses a major challenge to trial investigators. Little is known about why older participants discontinue the study drug. This study aimed to understand factors contributing to permanent study drug discontinuation among participants aged ≥70 years within an ongoing primary prevention trial of statins by tapping into their experiences and perceptions. Methods: Trial participants who had permanently discontinued the study drug within 2 years of randomization were purposively sampled based on age (&lt;75 and ≥75 years) and sex to participate in semi-structured phone interviews between March 2019 and February 2020. Interviews were audio-recorded, transcribed and analyzed thematically. Results: Thirty participants took part (21 females; mean age, 77 years) and three themes were identified from the data. Perceived adverse events (AEs) and their impact on daily living (mobility, functional capacity, quality of life, etc.) were identified as the major factors leading to the participants permanently discontinuing their study drug. Muscle symptoms were the most commonly reported AE. Selected participant quotes which describe symptoms and their impact are presented in Table. For some, a challenging life circumstance further lowered their tolerance to the perceived AEs thus making discontinuation more likely. A few discontinuations were attributed to other factors (e.g. concerns about possible side effects, GP advice, unrelated illness). Conclusion: Among healthy older participants enrolled in a statin trial, perceived AEs and their related impact were key factors contributing to the permanent study drug discontinuation. Addressing anticipated participant-reported AEs and their concerns about drug-related side effects at trial entry and offering timely medical assistance and support when AEs occur may be useful to reduce drug discontinuation rates.
A Mutational Survey of Acral Nevi
Authors: Keiran S. M. Smalley, Jamie K. Teer, Y. Ann Chen, Jheng-Yu Wu, Jiqiang Yao, John M. Koomen, Wei-Shen Chen, Paul Rodriguez-Waitkus, Florian A. Karreth, Jane L. Messina
Journal: JAMA Dermatology (2021)

<h3>Importance</h3> Acral skin may develop nevi, but their mutational status and association with acral melanoma is unclear. <h3>Objective</h3> To perform targeted next-generation sequencing on a cohort of acral nevi to determine their mutational spectrum. <h3>Design, Setting, and Participants</h3> Acral nevi specimens (n = 50) that had been obtained for diagnostic purposes were identified from the pathology archives of a tertiary care academic cancer center and a university dermatology clinic. Next-generation sequencing was performed on DNA extracted from the specimens, and mutations called. A subset of samples was stained immunohistochemically for the<i>BRAF</i>V600E mutation. <h3>Results</h3> A total of 50 nevi from 49 patients (19 males and 30 females; median [range] age, 48 [13-85] years) were examined. Analysis of the sequencing data revealed a high prevalence of<i>BRAF</i>mutations (n = 43), with a lower frequency of<i>NRAS</i>mutations (n = 5). Mutations in<i>BRAF</i>and<i>NRAS</i>were mutually exclusive. <h3>Conclusions and Relevance</h3> In this cohort study, nevi arising on mostly sun-protected acral skin showed a rate of<i>BRAF</i>mutation similar to that of acquired nevi on sun-exposed skin but far higher than that of acral melanoma. These findings are in contrast to the well-characterized mutational landscape of acral melanoma.
Abstract 16202: Speckle Tracking Echocardiography for Early Screening for Subclinical Cardiac Sarcoidosis, a Meta-analysis
Authors: Kiro Barssoum, Ahmed M Altibi, Devesh Rai, Adnan Kharsa, Samarthkumar J Thakkar, Ahmed Elkaryoni, Muhammad Waqas Tahir, Mohan Rao, Navin C. Nanda
Journal: Circulation (2020)

Background: Cardiac sarcoidosis (CS) affects 35% of patients with pulmonary sarcoidosis (PS). CS presentation varies from asymptomatic patients to sudden cardiac death. The current screening modalities like EKG and conventional echocardiography lack sensitivity for early detection of CS. Speckle tracking echocardiography (STE) has shown potential for early detection of subclinical myocardial damage in patients with PS. We aimed to investigate the role of STE in early detection of CS. Methods: We queried Medline, EmCare, CINAHL, Cochrane Database and Google Scholar for articles investigating the role of left ventricle global longitudinal strain (LVGLS) in asymptomatic patients with PS versus (vs) controls. Studies that included patients with suspected or proven CS, patients with cardiac symptoms, arrhythmias, coronary artery disease or valvular abnormalities were excluded. The standard mean difference (SMD) in GLS for both groups was pooled using random effects model. Results: Our search yielded a total of 9 studies with a total of 967 patients with PS undergoing screening for CS. In individual studies, the baseline characteristics were not significantly different between both groups. Overall, the studies had more females than males. All patients in our cohort had preserved ejection fraction (EF) and no cardiac symptoms. The LVGLS was significantly decreased in the PS group as compared to controls, SMD: -3.98, (95% CI: -5.32 to -2.64; p-value &lt;0.0001), I 2 = 94.70%, Figure 1. Conclusion: As compared to controls, patients with PS with no clinically suspected or proven CS, and normal EF, have impaired LVGLS. More studies are warranted to investigate the role of LVGLS in CS screening.
Adhesion-mediated mechanosignaling forces mitohormesis
Authors: Kevin M. Tharp, Ryo Higuchi-Sanabria, Greg A. Timblin, Breanna Ford, Carlos Garzon-Coral, Catherine Schneider, Jonathon M. Muncie, Connor Stashko, Joseph R. Daniele, Andrew S. Moore, Phillip A. Frankino, Stefan Homentcovschi, Sagar S. Manoli, Hao Shao, Alicia L. Richards, Kuei-Ho Chen, Johanna ten Hoeve, Gregory M. Ku, Marc Hellerstein, Daniel K. Nomura, Karou Saijo, Jason Gestwicki, Alexander R. Dunn, Nevan J. Krogan, Danielle L. Swaney, Andrew Dillin, Valerie M. Weaver
Journal: Cell Metabolism (2021)
Serial SARS-CoV-2 Receptor-Binding Domain Antibody Responses in Patients Receiving Dialysis
Authors: Shuchi Anand, Maria E. Montez-Rath, Jialin Han, Pablo Garcia, LinaCel Cadden, Patti Hunsader, Russell Kerschmann, Paul Beyer, Scott D. Boyd, Glenn M. Chertow, Julie Parsonnet
Journal: Annals of Internal Medicine (2021)

Assessing the evolution of SARS-CoV-2 immune response among patients receiving dialysis can define its durability in a highly clinically relevant context because patients receiving dialysis share the characteristics of persons most susceptible to SARS-CoV-2 infection.To evaluate the persistence of SARS-CoV-2 receptor-binding domain (RBD) IgG in seroprevalent patients receiving dialysis.Prospective.Nationwide sample from dialysis facilities.2215 patients receiving dialysis who had evidence of SARS-CoV-2 infection as of July 2020.Remainder plasma from routine monthly laboratories was used to measure semiquantitative RBD IgG index value over 6 months.A total of 2063 (93%) seroprevalent patients reached an assay detectable response (IgG index value ≥1). Most (n = 1323, 60%) had responses in July with index values classified as high (IgG ≥10); 1003 (76%) remained within this stratum. Adjusted median index values declined slowly but continuously (July vs. December values were 21 vs. 13; P < 0.001). The trajectory of the response did not vary by age group, sex, race/ethnicity, or diabetes status. Patients without an assay detectable response (n = 137) were more likely to be White and in the younger (18 to 44 years) or older (≥80 years) age groups and less likely to have diabetes and hypoalbuminemia.Lack of data on symptoms or reverse transcriptase polymerase chain reaction diagnosis, cohort of persons who survived infection, and use of a semiquantitative assay.Despite impaired immunity, most seropositive patients receiving dialysis maintained RBD antibody levels over 6 months. A slow and continual decline in median antibody levels over time was seen, but no indication that subgroups with impaired immunity had a shorter-lived humoral response was found.Ascend Clinical Laboratories.
DACH1 as a multifaceted and potentially druggable susceptibility factor for kidney disease
Authors: Sandra Merscher, Christian Faul
Journal: Journal of Clinical Investigation (2021)

Kidney diseases affect more than 15% of adults in the US, yet drug development in the kidney field, when compared with that for other common diseases, has been lagging behind. Modifiers that increase the susceptibility to injury and contribute to the pathogenesis and progression of kidney disease include genetic and environmental factors and epigenetic mechanisms. In this issue of the JCI, Cao et al. and Doke et al. independently report the identification of a susceptibility factor called Dachshund homolog 1 (DACH1). Both groups identify an association of reduced DACH1 expression with kidney disease, using different screening approaches, studying different types of human kidney diseases, and using different experimental models, making the fact that both stumbled over the same protein very compelling. Combined, these studies highlight DACH1 as a key safeguard in the kidney, granting various cell types proper function by modulating several molecular pathways.
Abstract 17394: Measurement of Corrected QT Interval on Apple Watch Series 4 Electrocardiogram Has Moderate to Strong Agreement With 12-lead Electrocardiogram
Authors: Arjun Aggarwal, Nabeel Saghir, Nisha Soneji, Suely Roman Lopez, George Rodgers, MAURICIO HONG, Thomas Kurian
Journal: Circulation (2020)

Introduction: The Apple Watch Series 4 (AW) has native hardware to measure a single-lead ECG (corresponding to Lead I) and detect atrial fibrillation. Wearable technology is an attractive area of research for its screening, monitoring, and diagnostic capabilities. One utility is the convenient ambulatory monitoring of the corrected QT (QTc) for pathophysiologic or pharmacologic reasons. The objective of this study was to compare measurements of the QTc on the AW with Leads I, II, and III of a 12-lead ECG. Methods: AW and 12-lead ECGs were obtained on healthy volunteers age &gt; 18 years at a university hospital. QT intervals and RR intervals were manually measured with calipers to the nearest 0.25 millimeter on standard ECG paper for both devices. Bland-Altman plots were used to assess the level of agreement between QTc measurements on the AW and 12-lead ECGs. Strong and moderate agreement was defined as &lt; 20 and &lt; 40 milliseconds (ms), respectively, away from the mean difference of the sample. Results: Waveforms on the AW ECGs (n=63) and Leads I (n=41), II (n=42), and III (n=39) of the 12-lead ECGs from 20 volunteers (mean age 32 years, 70% female) at a university hospital were analyzed. Six volunteers had sinus bradycardia with mean heart rate (HR) of 55 bpm. No arrhythmias were noted, and none of the volunteers were on antiarrhythmic or QT-prolonging medications. The mean HR was 69 ± 11 bpm on AW and 67 ± 10 bpm on 12-lead ECG. For QTc measurements on AW compared to 12-lead ECG, the mean difference was -13.71 ± 27 ms for Lead I, -11.27 ± 24 ms for Lead II, and -10.38 ± 24 ms for Lead III. Moderate agreement of &lt; 40 ms existed in 56/62 (90%) of QTc measurement comparisons: 18/21 (85.7%) Lead I, 19/21 (90.5%) Lead II, and 19/20 (95%) Lead III. Strong agreement of &lt; 20 ms existed in 32/62 (51.6%) of QTc measurement comparisons: 9/21 (42.9%) Lead I, 13/21 (61.9%) Lead II, and 10/20 (50%) Lead III. Conclusions: Moderate to strong agreement of QTc measurements exists between the AW and Leads I, II and III of a 12-lead ECG.