tbuckley/cabot-search huggingface dataset:
Role of Hospital Connectedness in Brain Metastasis Outcomes
Authors: Lilin Tong, Ruchit V. Patel, Ayal A. Aizer, Amar Dhand, Wenya Linda Bi
Journal: JAMA Network Open (2024)

Importance Although patients with brain metastases receive interdisciplinary and multi-institutional care, the association between neuro-oncologic care networks and patient outcomes remains unknown. As patients often interact with multiple facilities, quantifying this association across a network of hospitals is critical to capture the complexity of the health care journey for patients with brain metastases. Objective To evaluate how statewide health care network metrics are associated with inpatient mortality and hospital length of stay (LOS) for patients with brain metastases. Design, Setting, and Participants This multicenter, statewide cohort study used data from the 2018 to 2019 Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases. Primary analyses were completed by August 2023. Participants included adults with a brain metastases receiving care in Massachusetts. Exposure All inpatient and emergency department visits mapped for patients following the first diagnosis of brain metastasis. Main Outcomes and Measures Inpatient mortality and hospital LOS were the main outcomes assessed. Hospital interdependence in brain metastases care was calculated using a connectedness score (weighted degree: weighted sum of ties to other care facilities). The association between hospital connectedness and clinical outcomes was analyzed using mixed-effects logistic and linear regression models, adjusting for hospital-level features. Results In this cohort study, 4679 patients with brain metastases were identified with inpatient or ED encounters in Massachusetts (from 2018 to 2019). The median (IQR) age was 64 (57-73) years, and 2559 (55%) were female. There was interdependence in brain metastases care, with 993 patients (21%) visiting 2 or more unique hospitals. Highly connected hospitals were heterogeneous, with many being small and one-half lacking subspecialty neuro-oncologic care or teaching status. Increased hospital connectedness was significantly associated with improved inpatient mortality for patients with brain metastases, with the lowest connectedness quartile associated with more than double the risk of mortality compared with the highest quartile (odds ratio, 2.34; 95% CI, 1.33-4.11; P = .003). A stepwise increase in inpatient mortality risk was observed as hospital connectedness decreased, independently of hospital volume. Furthermore, intermediate hospital connectedness was associated with increased hospital LOS (coefficient, 1.08; 95% CI, 0.17-1.95; P = .006). Conclusions and Relevance This study found that hospital-to-hospital interconnectedness was significantly associated with improved clinical outcomes for patients with brain metastases. The salience of network metrics highlights their potential role alongside other patient-level and hospital-level variables to evaluate and improve oncology care delivery.
Early Addition of Selexipag to Double Therapy for Pulmonary Arterial Hypertension
Authors: Charles D. Burger, Wenze Tang, Yuen Tsang, Sumeet Panjabi
Journal: JAMA Network Open (2024)

Importance A subgroup analysis of a randomized clinical trial established the efficacy of selexipag plus background therapy (monotherapy or double oral therapy [DOT]) vs placebo plus background therapy and found that the addition of selexipag within 6 months had an added benefit. However, the timing of selexipag addition to DOT and the incremental benefit in clinical practice is not well studied. Objective To compare triple oral therapy (TOT) consisting of selexipag, endothelin receptor antagonist (ERA), and phosphodiesterase type 5 inhibitor (PDE5i) vs DOT consisting of ERA and PDE5i. Design, Setting, and Participants This comparative effectiveness study was conducted using data from the US Komodo claims database to emulate a randomized trial. Patients aged 18 years or older with pulmonary arterial hypertension (PAH) treated with ERA plus PDE5i with records from July 2015 through June 2022 were duplicated to TOT and DOT and artificially censored when observed treatment deviated from assigned treatment. Hypothetical randomization was emulated using inverse probability of treatment weighting, and the study accounted for censoring-induced selection bias using inverse probability of censoring weighting. A pooled logistic model estimated the per-protocol difference between treatment groups. Data were analyzed from November 2022 through July 2023. Interventions TOT (addition of selexipag within 3, 6, and 12 months of initiating DOT) vs DOT. Main Outcomes and Measures Adjusted risk of all-cause hospitalization, PAH-related hospitalization, and PAH-related disease progression over a 2-year follow-up. Results A total of 2966 patients with PAH (mean [SD] age, 54.3 [14.0] years; 2125 female [71.6%]) met eligibility criteria. Adding selexipag within 6 months of ongoing DOT was associated with a reduction in risk for all-cause hospitalization (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.72-0.94), PAH-related hospitalization (aHR, 0.81; 95% CI, 0.70-0.95), and PAH-related progression (aHR, 0.82; 95% CI, 0.70-0.95) vs DOT alone. There were no associations if selexipag was initiated within 12 months for all-cause hospitalization, PAH-related hospitalization, or PAH-related disease progression. The association remained with a greater decrease in risk for disease progression vs DOT for selexipag initiation within 3 months (aHR, 0.74; 95% CI, 0.61-0.90). Conclusions and Relevance This study found that early selexipag addition to ERA plus PDE5i was associated with a reduction in risk of hospitalization and disease progression. These findings suggest that delays in selexipag initiation likely contribute to suboptimal patient and health system outcomes.
Perceived Chronic Traumatic Encephalopathy and Suicidality in Former Professional Football Players
Authors: Rachel Grashow, Douglas P. Terry, Grant L. Iverson, Heather DiGregorio, Inana Dairi, Cheyenne Brown, Paula S. Atkeson, Alicia J. Whittington, LeRoy Reese, Jonathan H. Kim, Niki Konstantinides, Herman A. Taylor, Frank E. Speizer, Daniel H. Daneshvar, Ross D. Zafonte, Marc G. Weisskopf, Aaron L. Baggish
Journal: JAMA Neurology (2024)

Participation in American-style football (ASF) has been linked to chronic traumatic encephalopathy neuropathological change (CTE-NC), a specific neuropathologic finding that can only be established at autopsy. Despite being a postmortem diagnosis, living former ASF players may perceive themselves to have CTE-NC. At present, the proportion and clinical correlates of living former professional ASF athletes with perceived CTE who report suicidality are unknown.
Influenza Infection During Pregnancy and Risk of Seizures in Offspring
Authors: Yi-Feng Lee, Yi-Hsuan Lin, Ching-Heng Lin, Ming-Chih Lin
Journal: JAMA Network Open (2024)

Importance Seizure is a common neurological problem among infants and children up to age 6 years. Prenatal exposure to maternal influenza infection has been reported to be associated with childhood seizures. Objective To evaluate the association between maternal influenza infection and risk of childhood seizures. Designs, Setting, and Participants This cohort study identified mother-offspring pairs from January 1, 2004, to December 31, 2013, using records in Taiwan’s Maternal and Child Health Database. Mothers who had influenza infection during pregnancy and their first offspring were identified and assigned to the influenza group. Mothers in the control group were those without influenza during pregnancy and were matched 1:4 with mothers in the influenza group by maternal age, offspring sex, and date of delivery. Offspring were followed up until December 31, 2020. Data were analyzed between March 2023 and July 2024. Exposure Diagnosis of influenza infection during pregnancy defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes 487.0, 487.1, and 487.8, or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes J09, J10, and J11. Main Outcomes and Measures The primary outcome was the association between maternal influenza infection during pregnancy and risk of any type of seizures during childhood, including both epilepsy and febrile seizures. Adjusted hazard ratios (AHRs) and 95% CIs were estimated using Cox proportional hazards regression models. Pregnancy-related complications were collected as covariates. Results A total of 1 316 107 mother-offspring pairs were enrolled, of whom 75 835 mothers (predominant maternal age, 25-29 years; 39 324 male offspring [51.9%]) were assigned to the influenza group and 1 240 272 were matched and assigned to the control group (n = 303 340; predominant maternal age, 30-34 years; 157 296 male offspring [51.9%]). In the influenza group, there was a slightly higher prevalence of placenta previa or abruption compared with the control group (1.6% [1241] vs 1.4% [4350]; P &amp;amp;lt; .001). The cumulative risk of seizures was higher among offspring whose mothers had influenza infection. After controlling for potential confounders, the AHRs were 1.09 (95% CI, 1.05-1.14) for seizures, 1.11 (95% CI, 1.06-1.17) for febrile convulsions, and 1.04 (95% CI, 0.97-1.13) for epilepsy. In the subgroup analysis, no statistically significant differences were observed between the trimesters regarding the timing of influenza infection. Conclusions and Relevance Results of this cohort study suggest that maternal influenza infection during pregnancy was associated with an increased risk of childhood seizures, especially febrile seizures, but not epilepsy. Further studies are needed to elucidate the mechanisms underlying childhood neurological development.
Drug Use Patterns in Wastewater and Socioeconomic and Demographic Indicators
Authors: Xiaowei Zhuang, Michael A. Moshi, Oscar Quinones, Rebecca A. Trenholm, Ching-Lan Chang, Dietmar Cordes, Brett J. Vanderford, Van Vo, Daniel Gerrity, Edwin C. Oh
Journal: JAMA Network Open (2024)

Importance Measuring drug use behaviors in individuals and across large communities presents substantial challenges, often complicated by socioeconomic and demographic variables. Objectives To detect spatial and temporal changes in community drug use by analyzing concentrations of analytes in influent wastewater and exploring their associations with area-based socioeconomic and sociodemographic metrics like the area deprivation index (ADI) and rural-urban commuting area (RUCA) codes. Design, Setting, and Participants This longitudinal, cross-sectional wastewater study was performed from May 2022 to April 2023 and included biweekly influent wastewater samples of 39 analytes from 8 sampling locations across 6 wastewater treatment plants in southern Nevada. Statistical analyses were conducted in December 2023. Main Outcomes and Measures It was hypothesized that wastewater monitoring of pharmaceuticals and personal care products (PPCPs) and high-risk substances (HRSs) could reveal true spatial and temporal drug use patterns in near–real time. Data collection of samples for PPCPs and HRSs was performed using mass spectrometry. Both ADI and RUCA scores were utilized to characterize neighborhood contexts in the analysis. The false discovery rate (FDR) method was utilized to correct for multiple comparisons ( P FDR ). Results Over the 12-month wastewater monitoring period, 208 samples for PPCPs and HRSs were collected, and analysis revealed an increase in the consumption of HRSs and the seasonal variation in PPCP use in southern Nevada. There was a significant increase in levels of stimulant-associated analytes, such as cocaine (β = 9.17 × 10 −4 ; SE = 1.29 × 10 −4 ; P FDR = 1.40 × 10 −10 ), and opioids or their metabolites, notably norfentanyl (β = 1.48 × 10 −4 ; SE = 1.88 × 10 −4 ; P FDR = 1.66 × 10 −12 ). In contrast, DEET, an active ingredient in mosquito and tick repellents, demonstrated a seasonal use pattern (β = −4.85 × 10 −4 ; SE = 2.09 × 10 −4 ; P FDR = 4.87 × 10 −2 ). Wastewater from more disadvantaged or rural neighborhoods, as assessed through ADI and RUCA scores, was more likely to show a significant positive correlation with HRSs, such as cocaine (β = 0.075; SE = 0.038; P = .05) and norfentanyl (β = 0.004; SE = 0.001; P = 1.64 × 10 −5 ). Conclusions and Relevance These findings suggest that wastewater monitoring of PPCPs and HRSs offers a complementary method to existing public health tools, providing timely data for tracking substance use behaviors and use of PPCPs at a population level.
Tribal Identity, Pain Interference, and Substance Use Among American Indian and Alaska Native Adolescents
Authors: Ashna Jagtiani, Melvin D. Livingston, Caroline M. Barry, Sierra Talavera-Brown, Hannah LaBounty, Juli R. Skinner, Bethany J. Livingston, Ashley N. Lincoln, Kelli A. Komro
Journal: JAMA Pediatrics (2024)

Substance use is high among American Indian/Alaska Native adolescents. Pain interference is a risk factor for substance use, and identifying potential protective factors, such as Tribal identity, is important to help inform culturally grounded substance use prevention strategies.
Gender Representation of Health Care Professionals in Large Language Model–Generated Stories
Authors: Bradley D. Menz, Nicole M. Kuderer, Benjamin Chin-Yee, Jessica M. Logan, Andrew Rowland, Michael J. Sorich, Ashley M. Hopkins
Journal: JAMA Network Open (2024)

With the growing use of large language models (LLMs) in education and health care settings, it is important to ensure that the information they generate is diverse and equitable, to avoid reinforcing or creating stereotypes that may influence the aspirations of upcoming generations.
Direct-to-Consumer Educational Brochures to Promote Gabapentinoid Deprescribing in Older Adults
Authors: Marc-Alexandre Gingras, Robert Dubé, Jerome Williams, James Shih, Anthony Lieu, Tania Morin, Kristen Moran, Iman Huseen, Todd C. Lee, Emily G. McDonald
Journal: JAMA Internal Medicine (2024)

This study examines gabapentinoid deprescribing using a novel approach of direct-to-consumer educational brochures intended to empower older adults to initiate a discussion on gabapentinoid risks and tapering.
Trends in Location of Death for Individuals With Pediatric Cancer
Authors: Urvish Jain, Angelin Tresa Mathew, Bhav Jain, Erin Jay Garbes Feliciano, Edward Christopher Dee, Leonard H. Wexler, Suzanne L. Wolden
Journal: JAMA Pediatrics (2024)

This cross-sectional study examines trends in location of death among pediatric patients with cancer in the US.
Patient-Directed Education to Promote Deprescribing
Authors: Katie Fitzgerald Jones, Kelly Stolzmann, Jolie Wormwood, Jacquelyn Pendergast, Christopher J. Miller, Michael Still, Barbara G. Bokhour, Joseph Hanlon, Steven R. Simon, Amy K. Rosen, Amy M. Linsky
Journal: JAMA Internal Medicine (2024)

Patient-directed educational materials are a promising implementation strategy to expand deprescribing reach and adoption, but little is known about the impact across medication groups with potentially different perceived risks.
Efficacy of Gamified Digital Mental Health Interventions for Pediatric Mental Health Conditions
Authors: Barry R. Bryant, Morgan R. Sisk, Joseph F. McGuire
Journal: JAMA Pediatrics (2024)

Anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) affect up to 20% of children and adolescents. Despite demonstrated efficacy, evidence-based treatments for these conditions are often inaccessible; innovative solutions are essential to meet the demand for pediatric mental health care.
Four-Repeat Tau Seeding in the Skin of Patients With Progressive Supranuclear Palsy
Authors: Ivan Martinez-Valbuena, M. Carmela Tartaglia, Susan H. Fox, Anthony E. Lang, Gabor G. Kovacs
Journal: JAMA Neurology (2024)

This study discusses 4-repeat tau seeding in the skin of patients with progressive supranuclear palsy.
Alzheimer Dementia Among Individuals With Down Syndrome
Authors: Eric Rubenstein, Salina Tewolde, Amy Michals, Jennifer Weuve, Juan Fortea, Matthew P. Fox, Marcia Pescador Jimenez, Ashley Scott, Yorghos Tripodis, Brian G. Skotko
Journal: JAMA Network Open (2024)

With the advancement in administrative data as a research tool and the reliance on public health insurance for individuals with Down syndrome, population-level trends in Alzheimer dementia in this population are beginning to be understood.
Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018
Authors: Xing Gao, Rachel Morello-Frosch, Amani M. Nuru-Jeter, Jonathan M. Snowden, Suzan L. Carmichael, Mahasin S. Mujahid
Journal: JAMA Network Open (2024)

Historically redlined neighborhoods may experience disinvestment, influencing their likelihood of gentrification, a process of neighborhood (re-)development that unequally distributes harms and benefits by race and class. Understanding the combined outcomes of redlining and gentrification informs how the mutually constitutive systems of structural racism and racial capitalism affect pregnancy outcomes.
Comparing Confirmed Sodium Nitrite Suicide Deaths With Poison Center Surveillance Estimates
Authors: Joshua Bloom, Alexis Sharpe, Seth Nulman, Katrina Monday, Jeanna M. Marraffa, Catherine Stayton, Carla Clark, Michele Slone, Gail Cooper, Mark K. Su
Journal: JAMA Network Open (2024)

Importance Sodium nitrite is a curing agent increasingly used for self-harm and suicide, and multiple locales have reported increasing cases. However, approaches to forensic investigation of these cases are not standardized, and current modes of surveillance in the United States may be inadequate. Objective To define a potential standard approach for identifying sodium nitrite deaths based on forensic confirmation, and compare findings based on this standard to poison center surveillance. Design, Setting, and Participants This retrospective case series of sodium nitrite exposures and deaths was conducted in 2 urban medical examiner jurisdictions in New York State from 2000 to 2022. The population-based sample included individuals from (1) medical examiner reports of decedents where the cause of death was sodium nitrite and (2) poison center reports of intentional exposures to sodium nitrite. Exposure Sodium nitrite as either cause of death (medical examiner reports) or intentional exposure (poison center reports). Main Outcomes and Measures Medical examiner determination of sodium nitrite deaths was considered the criterion standard and relied largely on confirmatory blood nitrite testing. Poison center records were assessed for intentional exposures to sodium nitrite. Results In this case series of 36 decendents, median (range) age was 28 (20-57) years; 23 (63.8%) were male; 6 (16.7%) were African-American, 5 (13.9%) were Chinese, 13 (36.1%) were White, and 4 (11.1%) had unknown race; and 6 (16.7%) were Hispanic. No deaths were found from 2000 to 2018, and yearly increases in deaths from 2019 to 2022; these deaths were largely missed by local poison center surveillance. Most cases (83.3% [n = 30]) had postmortem blood nitrite concentrations available, and multiple decedents had evidence of suicide kit recommendations from internet sources. Conclusions and Relevance In this case series of decedents in 2 New York medical examiner jurisdictions, sodium nitrite deaths increased yearly, and the medical examiners were able to obtain confirmatory nitrite concentrations in most cases. These findings suggest that poison center surveillance underestimates confirmed deaths from sodium nitrite; public health authorities should rely on multiple data sources when analyzing this problem, and forensic analyses should be standardized.
Can Artificial Intelligence Derived Coronary Atherosclerotic Characteristics Using CCTA/CACS Predict The Future Onset Of Atrial Fibrillation?
Authors: Andrew Chiou, Melody Hermel, Christina Rodriguez Ruiz, Alexander van Rosendael, Tim Burton, Francesca Calicchio, Samantha Bagsic, Eric Hu, Elizabeth Epstein, Casey Joye, Shawn Newlander, Michael Salerno, Sanjeev P Bhavnani, Austin Robinson, Jorge Gonzalez, George E Wesbey
Journal:  (2024)
Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents
Authors: Bocheng Jing, Xiaojuan Liu, Laura A. Graham, Chintan V. Dave, Yongmei Li, Kathy Fung, Christine K. Liu, Hoda S. Abdel Magid, Matthew E. Growdon, W. James Deardorff, W. John Boscardin, Sei J. Lee, Michael A. Steinman, Michelle C. Odden
Journal: JAMA Internal Medicine (2024)

Antihypertensive medication deprescribing is common among nursing home residents, yet its association with cognitive decline remains uncertain.
Radiation-Emitting metallic stent for unresectable bismuth type III or IV perihilar cholangiocarcinoma: a multicenter randomized trial
Authors: Qi Chen, Nai-Jian Ge, Yu-Liang Li, Ming Huang, Wen-Hui Li, Dong Lu, Ning Wei, Peng-Hua Lv, Jian-Fei Tu, Cheng-Jian He, Wu-Jie Wang, Rong Ding, Bo Peng, Xue-Jun Wang, Fu-An Wang, Guang-Yu Zhu, Yong Wang, Li Chen, Jie Min, Jin-He Guo, Gao-Jun Teng, Jian Lu
Journal: International Journal of Surgery (2024)

Self-expandable metallic stents (SEMSs) have been recommended for patients with unresectable malignant biliary obstruction while radiation-emitting metallic stents (REMSs) loaded with 125I seeds have recently been approved to provide longer patency and overall survival in malignant biliary tract obstruction. This trial is to evaluate the efficacy and safety of REMS plus hepatic arterial infusion chemotherapy (REMS-HAIC) versus SEMS plus HAIC (SEMS-HAIC) for unresectable perihilar cholangiocarcinoma (pCCA).
National introduction of one-anastomosis gastric bypass in the UK National Bariatric Surgery Registry – a cohort study
Authors: Andrew C Currie, Alan Askari, Chetan Parmar, James Byrne, Ahmed R Ahmed, Chris M Pring, Omar A Khan, Peter K Small, Kamal Mahawar
Journal: International Journal of Surgery (2024)

There is a paucity of evidence regarding the national introduction of newer bariatric metabolic surgery procedures. This study assessed the impact of introducing one-anastomosis gastric bypass (OAGB) in bariatric surgical practice in the UK on 30-day postoperative morbidity and early postoperative weight loss.