tbuckley/cabot-search huggingface dataset:
Human Papilloma Virus Circulating Cell-Free DNA Kinetics in Cervical Cancer Patients Undergoing Definitive Chemoradiation
Authors: Aaron Seo, Weihong Xiao, Olsi Gjyshi, Kyoko Yoshida-Court, Peng Wei, David Swanson, Tatiana Cisneros Napravnik, Adam Grippin, Aradhana M. Venkatesan, Megan C. Jacobsen, David T. Fuentes, Erica Lynn, Julie Sammouri, Anuja Jhingran, Melissa Joyner, Lilie L. Lin, Lauren E. Colbert, Maura L. Gillison, Ann H. Klopp
Journal: Clinical Cancer Research (2024)

Abstract Purpose: The human papillomavirus (HPV) is a significant cause of cervical cancer. We hypothesized that detecting viral cell-free HPV DNA (cfDNA) before, during, and after chemoradiation (chemoRT) could provide insights into disease extent, clinical staging, and treatment response. Experimental Design: Sixty-six patients with locally advanced cervical cancer were enrolled between 2017 and 2023. 49 received standard-of-care (SOC) treatment and 17 participated in a clinical trial combining a therapeutic HPV vaccine (PDS0101; IMMUNOCERV). Plasma was collected at baseline, weeks 1, 3, and 5 of chemoRT, and 3-4 months after chemoRT. HPV cfDNA was quantified using droplet digital PCR targeting the HPV E6/E7 oncogenes of 13 high-risk types. MRI was performed at baseline and before brachytherapy. Results: The median follow-up was 23 months, with recurrence-free survival (RFS) of 78.4% at 2 years. Baseline nodal disease extent correlated with HPV cfDNA levels. HPV cfDNA levels peaked in week 1 of radiation and decreased through treatment. Patients receiving the PDS0101 vaccine had a higher rate of undetectable HPV type 16 cfDNA compared to SOC. HPV cfDNA clearance correlated with better 2-yr RFS (92.9% vs. 30%, log-rank p=0.0067). The strongest predictor of RFS was HPV cfDNA clearance in follow-up achieving a concordance index (CI) 0.83, which improved when combined with MRI response (CI 0.88). Conclusions: HPV cfDNA levels change dynamically during chemoRT. HPV cfDNA at follow-up predicts RFS. Delivery of therapeutic HPV vaccine with chemoRT was linked to rapid HPV cfDNA decline. Monitoring HPV cfDNA during and after chemoRT may guide tailoring of personalized treatment.
Beyond 1-Way Directionality and 2 Hours Before Sleep
Authors: Qingwei Chen, Taotao Ru, Guofu Zhou
Journal: JAMA Pediatrics (2024)

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 Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast JAMA+ AI Journals 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 2024 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 Pediatrics journal
Conditional and Unconditional Social Transfers, Early-Life Nutrition, and Child Growth
Authors: Jordyn T. Wallenborn, Souliviengkham Sonephet, Somphou Sayasone, Latsamy Siengsounthone, Sengchanh Kounnavong, Günther Fink
Journal: JAMA Pediatrics (2024)

Rates of exclusive breastfeeding are declining despite the numerous benefits to mothers and their children.
Cannabidiol for Scan-Related Anxiety in Women With Advanced Breast Cancer
Authors: Manan M. Nayak, Peter Chai, Paul J. Catalano, William F. Pirl, James A. Tulsky, Stephanie C. Tung, Nancy U. Lin, Nicole Andrade, Sabrina Johns, Clint Vaz, Melissa Hughes, Ilana M. Braun
Journal: JAMA Network Open (2024)

Importance Early evidence from studies outside of oncology has suggested that cannabidiol (CBD) may have anxiolytic effects without neuropsychiatric risks. An understanding of oral CBD in patients with cancer-related anxiety is urgently needed. Objective To determine whether a single 400-mg oral dose of a US Food and Drug Administration–approved CBD improves clinical anxiety in an oncologic population. Design, Setting, and Participants This phase II, double-masked, placebo-controlled, randomized clinical trial was performed at the Dana-Farber Cancer Institute’s Breast Oncology Center from November 2, 2021, through March 1, 2023. Women aged 18 years or older with advanced breast cancer and baseline clinical anxiety were included. Interventions Patients were randomized 1:1 to receive oral CBD, 400 mg, vs placebo within 48 hours before a scan assessing tumor burden. Main Outcomes and Measures The primary end point was a between-arm comparison of change scores on the afraid subscale of the Visual Analog Mood Scale (VAMS) before and 2 to 4 hours after study drug ingestion. The VAMS scores were converted to T-scores to facilitate interpretation of mood change (&amp;amp;gt;20 indicates a reliable change, &amp;amp;gt;30 indicates both a reliable and clinically significant change). Exploratory outcomes included between-arm comparisons of anxiety levels 2 to 4 hours after study drug ingestion, between-arm comparisons of change scores on other VAMS subscales, and safety. Results Among the 50 participants, 25 were randomized to the placebo arm (mean [range] age, 57 [37-81] years) and 25 were randomized to the CBD arm (mean [range] age, 60 [30-79] years). The primary end point of VAMS afraid subscale change score, although numerically greater in the CBD arm, was not significantly different between arms (mean [SD]: CBD, −19.1 [15.4]; placebo, −15.0 [10.9]; P = .37). The secondary outcome directly comparing anxiety levels between arms 2 to 4 hours after study drug ingestion demonstrated significantly lower VAMS afraid T-scores for participants who received CBD compared with those receiving placebo (mean [SD]: CBD, 51.5 [12.8]; placebo, 58.0 [11.6]; P = .02). No grade 3 or 4 toxic effects were reported. Conclusions and Relevance The findings of this randomized clinical trial show that CBD can be used safely in women with advanced breast cancer and clinical anxiety. Although the study did not meet its primary end point comparing preingestion vs postingestion anxiety change scores between study arms, anxiety levels in the CBD arm were significantly lower 2 to 4 hours after ingestion, suggesting a possible anxiolytic effect and warranting further investigation. Trial Registration ClinicalTrials.gov Identifier: NCT04482244
External Validation of Brief Resolved Unexplained Events Prediction Rules for Serious Underlying Diagnosis
Authors: Nassr Nama, Ye Shen, Jeffrey N. Bone, Zerlyn Lee, Kara Picco, Falla Jin, Jessica L. Foulds, Josée Anne Gagnon, Chris Novak, Brigitte Parisien, Matthew Donlan, Ran D. Goldman, Anupam Sehgal, Joanna Holland, Sanjay Mahant, Joel S. Tieder, Peter J. Gill, Polina Kyrychenko, Nardin Kirolos, Ioulia Opotchanova, Émilie Harnois, Elisa Frizon-Peresa, Praveen Rajasegaran, Parnian Hosseini, Melody Wyslobicky, Susan Akbaroghli, Prathiksha Nalan, Marie-Pier Goupil, Shawn Lee, Emy Philibert, Juliette Dufrense, Raman Chawla, Martin Ogwuru
Journal: JAMA Pediatrics (2024)

Importance The American Academy of Pediatrics (AAP) higher-risk criteria for brief resolved unexplained events (BRUE) have a low positive predictive value (4.8%) and misclassify most infants as higher risk (&amp;amp;gt;90%). New BRUE prediction rules from a US cohort of 3283 infants showed improved discrimination; however, these rules have not been validated in an external cohort. Objective To externally validate new BRUE prediction rules and compare them with the AAP higher-risk criteria. Design, Setting, and Participants This was a retrospective multicenter cohort study conducted from 2017 to 2021 and monitored for 90 days after index presentation. The setting included infants younger than 1 year with a BRUE identified through retrospective chart review from 11 Canadian hospitals. Study data were analyzed from March 2022 to March 2024. Exposures The BRUE prediction rules. Main Outcome and Measure The primary outcome was a serious underlying diagnosis, defined as conditions where a delay in diagnosis could lead to increased morbidity or mortality. Results Of 1042 patients (median [IQR] age, 41 [13-84] days; 529 female [50.8%]), 977 (93.8%) were classified as higher risk by the AAP criteria. A total of 79 patients (7.6%) had a serious underlying diagnosis. For this outcome, the AAP criteria demonstrated a sensitivity of 100.0% (95% CI, 95.4%-100.0%), a specificity of 6.7% (95% CI, 5.2%-8.5%), a positive likelihood ratio (LR+) of 1.07 (95% CI, 1.05-1.09), and an AUC of 0.53 (95% CI, 0.53-0.54). The BRUE prediction rule for discerning serious diagnoses displayed an AUC of 0.60 (95% CI, 0.54-0.67; calibration intercept: 0.60), which improved to an AUC of 0.71 (95% CI, 0.65-0.76; P &amp;amp;lt; .001; calibration intercept: 0.00) after model revision. Event recurrence was noted in 163 patients (15.6%). For this outcome, the AAP criteria yielded a sensitivity of 99.4% (95% CI, 96.6%-100.0%), a specificity of 7.3% (95% CI, 5.7%-9.2%), an LR+ of 1.07 (95% CI, 1.05-1.10), and an AUC of 0.58 (95% CI, 0.56-0.58). The AUC of the prediction rule stood at 0.67 (95% CI, 0.62-0.72; calibration intercept: 0.15). Conclusions and Relevance Results of this multicenter cohort study show that the BRUE prediction rules outperformed the AAP higher-risk criteria on external geographical validation, and performance improved after recalibration. These rules provide clinicians and families with a more precise tool to support decision-making, grounded in individual risk tolerance.
Transcutaneous Auricular Vagus Nerve Stimulation for Chronic Insomnia Disorder
Authors: Shuai Zhang, Yanan Zhao, Zongshi Qin, Ying Han, Jiakai He, Bin Zhao, Lei Wang, Yuting Duan, Jin Huo, Tuoran Wang, Yu Wang, Peijing Rong
Journal: JAMA Network Open (2024)

IMPORTANCE Evidence from randomized clinical trials of transcutaneous auricular vagus nerve stimulation (taVNS) for chronic insomnia disorder is lacking. OBJECTIVE To evaluate the efficacy and safety of taVNS for chronic insomnia compared with the sham taVNS. DESIGN, SETTING, and PARTICIPANTS This randomized clinical trial was conducted from October 2021 to December 2022 at a single center in Beijing, China. Patients with chronic insomnia disorder with a Pittsburgh Sleep Quality Index (PSQI) of at least 8 were enrolled. Statistical analysis was performed from June to September 2023. INTERVENTIONS Patients were allocated to the active taVNS group or sham taVNS group with a 1:1 ratio. Both groups received the stimulation for 30 minutes each time, twice a day, 5 consecutive days a week, with an 8-week treatment and a 12-week follow-up. MAIN OUTCOMES AND MEASURES The primary end point was the mean change from baseline through week 8 in PSQI scores. Minimal clinically important difference was 2.5 points. Secondary outcomes included mental health, sleepiness, and fatigue. Safety was also evaluated. RESULTS A total of 72 participants were randomized to either active taVNS group (36 participants; mean [SD] age, 45.2 [14.5] years; 27 [75.0%] female) or the sham taVNS group (36 participants; mean [SD] age, 44.6 [13.9] years; 31 [86.1%] female); 68 participants completed the 8-week intervention. The least-square mean changes from baseline to week 8 in PSQI were −8.2 (95% CI, −9.3 to −7.0) points in the taVNS group and −3.9 (95% CI, −5.1 to −2.7) points in the sham group. Both groups experienced statistically significant improvements from before to after the intervention. However, active taVNS showed a clinically meaningful 4.2-point greater reduction (95% CI, −5.9 to −2.6 points; P &amp;amp;lt; .001; Cohen d effect size, 1.2) in PSQI compared with the sham group (minimal clinically important difference = 2.5 points). Secondary outcomes, including mental health and fatigue, showed similar favorable results. The efficacy of taVNS was sustained throughout the 20-week study period. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, taVNS significantly reduced insomnia severity. Clinically meaningful enhancements in PSQI scores were observed compared with sham stimulation, with the benefits of taVNS sustained over a 20-week period. Future multicenter clinical trials with large sample sizes are needed to validate its effectiveness across diverse populations. Trial Registration Chinese Clinical Trial Registry: ChiCTR2100051319
US FDA Approval of Pediatric Artificial Intelligence and Machine Learning–Enabled Medical Devices
Authors: Ryan C. L. Brewster, Matthew Nagy, Susmitha Wunnava, Florence T. Bourgeois
Journal: JAMA Pediatrics (2024)

This cross-sectional study analyzes the availability of artificial intelligence and machine learning–enabled devices authorized for children by the US Food and Drug Administration (FDA) and assesses reporting of algorithm validation in the pediatric population.
Interpreting Random-Intercept Cross-Lagged Panel Models
Authors: Ross D. Neville
Journal: JAMA Pediatrics (2024)

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 Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast JAMA+ AI Journals 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 2024 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 Pediatrics journal
Beyond 1-Way Directionality and 2 Hours Before Sleep—Reply
Authors: Rachael W. Taylor, Jillian J. Haszard, Bradley Brosnan
Journal: JAMA Pediatrics (2024)

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 Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast JAMA+ AI Journals 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 2024 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 Pediatrics journal
Adverse Obstetric Outcomes in Pregnancies With Major Fetal Congenital Heart Defects
Authors: Gitte Hedermann, Paula L. Hedley, Kasper Gadsbøll, Ida N. Thagaard, Lone Krebs, Mona Aarenstrup Karlsen, Cathrine Vedel, Line Rode, Michael Christiansen, Charlotte K. Ekelund
Journal: JAMA Pediatrics (2024)

Importance Understanding the risk profile of obstetric complications in pregnancies with fetal major congenital heart defects (MCHDs) is crucial for obstetric counseling and care. Objective To investigate the risk of placenta-related adverse obstetric outcomes in pregnancies complicated by fetal MCHDs. Design, Setting, and Participants This cohort study retrieved data from June 1, 2008, to June 1, 2018, from the Danish Fetal Medicine Database, which includes comprehensive data on more than 95% of all pregnancies in Denmark since the database was instituted in 2008. All singleton pregnancies that resulted in a live-born child after 24 weeks’ gestation without chromosomal aberrations were included. A systematic search of the literature was performed in PubMed, Embase, and the Cochrane Library from inception to June 1, 2024, to compile existing knowledge and data on adverse obstetric outcomes among MCHD subtypes. Exposure Fetal MCHDs including 1 of 11 subtypes. Main Outcomes and Measures The primary outcome was a composite adverse obstetric outcome defined as preeclampsia, preterm birth, fetal growth restriction, or placental abruption. Secondary outcomes consisted of each adverse obstetric event. Adjusted odds ratios (AORs) were computed using generalized estimating equations adjusted for maternal body mass index, age, smoking, and year of delivery. Meta-analyses were conducted using random-effects models to pool effect sizes for each MCHD subtype and adverse obstetric outcome. Results A total of 534 170 pregnancies were included in the Danish cohort, including 745 with isolated fetal MCHDs (median [IQR] maternal age, 29.0 [26.0-33.0] years) and 533 425 without MCHDs (median [IQR] maternal age, 30.0 [26.0-33.0] years). Pregnancies with fetal MCHDs exhibited a higher rate of adverse obstetric outcomes at 22.8% compared with 9.0% in pregnancies without fetal MCHDs (AOR, 2.96; 95% CI, 2.49-3.53). Preeclampsia (AOR, 1.83; 95% CI, 1.33-2.51), preterm birth at less than 37 weeks (AOR, 3.84; 95% CI, 3.15-4.71), and fetal growth restriction (AOR, 3.25; 95% CI, 2.42-4.38) occurred significantly more frequently in pregnancies with MCHDs. Except for fetal transposition of the great arteries (AOR, 1.19; 95% CI, 0.66-2.15), all MCHD subtypes carried a greater risk of adverse obstetric outcomes. The meta-analysis included 10 additional studies that supported these results. Conclusions and Relevance These findings suggest that nearly 1 in 4 women expecting a child with an MCHD, except transposition of the great arteries, may be at high risk of adverse obstetric outcomes.
The CMS Sickle Cell Gene Therapy Access Model
Authors: Jeromie Ballreich, Ilina C. Odouard, Mariana P. Socal
Journal: JAMA Pediatrics (2024)

This Viewpoint explores and provides policy recommendations for the Cell and Gene Therapy Access Model recently launched by the US Centers for Medicare &amp;amp;amp; Medicaid Services (CMS), which aims to increase access to Medicaid recipiencts with rare and severe diseases.
Patterns in California Ambulance Patient Offload Times by Local Emergency Medical Services Agency
Authors: Madeline Feldmeier, Karen Patricia Reyes, Crystal Chen, Karl A. Sporer, Zita Konik, Hernando Garzón, Renee Y. Hsia
Journal: JAMA Network Open (2024)

Importance Ambulance offload delays are a timely and crucial issue with implications for patients, emergency medical services (EMS) agencies, hospitals, and communities. Published data on recent patterns in ambulance patient offload times (APOTs) are sparse. Objective To examine patterns in APOT by California local EMS agency and variation between and within local agencies. Design, Setting, and Participants This cohort study used APOT reports from the California EMS Authority and local EMS agencies between January 1, 2021, and June 30, 2023, to examine patterns in ambulance offload times. County-level population data were collected from the US Census Bureau to calculate mean annual offloads per 1000 population. Exposure Ambulance transport to emergency departments. Main Outcomes and Measures Ambulance offload volumes, mean annual offloads per 1000 population, APOT-1 (a reporting metric that includes the 90th percentile ambulance offload time and number of offloads to a specific hospital) weighted means (SDs), and APOT-1 medians (IQRs). Results A total of 5 913 399 offloads across 34 California local EMS agencies were analyzed. The APOT-1 weighted mean (SD) across the state was 42.8 (27.3) minutes, and the median (IQR) monthly hospital-level APOT-1 was 28.9 (14.9-46.3) minutes. Nearly one-half of local EMS agencies (16 of 34 [47.1%], accounting for 79.2% of all offloads) experienced an APOT-1 weighted mean greater than the 30-minute standard set by the state. Moreover, 20 of 33 local EMS agencies (60.6%) reported an annual APOT-1 weighted mean that was worse in 2023 than 2021. Conclusions and Relevance In this cohort study, approximately half of all agencies consistently reported ambulance offload times greater than the 30-minute state standard, and there was significant variation between and within agencies. These findings may spur collaborative efforts between stakeholders to determine the most effective strategies for addressing systemic issues resulting in long APOT across California.
Interpreting Random-Intercept Cross-Lagged Panel Models—Reply
Authors: Caroline Fitzpatrick, Annie Lemieux, Gabrielle Garon-Carrier
Journal: JAMA Pediatrics (2024)

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 Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast JAMA+ AI Journals 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 2024 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 Pediatrics journal