tbuckley/cabot-search huggingface dataset:
Selection of Patients With Early-Stage Breast Cancer for Extended Endocrine Therapy
Authors: Laura J. van ’t Veer, Elma Meershoek-Klein Kranenbarg, Marjolijn Duijm-de Carpentier, Cornelis J. H. Van de Velde, Miranda Kleijn, Christa Dreezen, Andrea R. Menicucci, William Audeh, Gerrit-Jan Liefers
Journal: JAMA Network Open (2024)

Importance There is a need for biomarkers that predict late recurrence risk and extended endocrine therapy (EET) benefit among patients with early-stage breast cancer (EBC). MammaPrint, a 70-gene expression risk-of-recurrence assay, has been found to project significant EET benefit in patients with assay-classified low-risk tumors. Objective To determine the test’s utility in identifying which patients with EBC in the IDEAL (Investigation on the Duration of Extended Adjuvant Letrozole) trial could benefit from 5-year vs 2.5-year letrozole treatment. Design, Setting, and Participants This secondary analysis of the IDEAL randomized clinical trial evaluated postmenopausal women with hormone receptor–positive EBC who were assigned to either 2.5 or 5 years of EET, with 10 years of follow-up after randomization. A 70-gene assay was used to classify tumors as high, low, or ultralow risk. Adverse event (AE) frequency and treatment compliance were evaluated. Statistical analyses were performed from April 2022 to September 2024. Interventions After 5 years of endocrine therapy, patients were randomized to 2.5 or 5 years of EET with letrozole. Main Outcomes and Measures Primary end point was distant recurrence (DR). Cox proportional hazard regression models and likelihood ratios tested the interaction between treatment and gene expression assay. Results Among 515 women included (mean [SD] age at randomization, 59.9 [9.5] years), 265 were in the 2.5-year treatment arm and 250 in the 5-year treatment arm. Of these patients, 223 (43.3%) patients with 70-gene assay–classified low-risk tumors had a significant absolute benefit of 10.1% for DR (hazard ratio, 0.32; 95% CI, 0.12-0.87; P = .03). Treatment interaction was not significant for DR. Of patients with either 70-gene assay–classified high-risk tumors (259 [50.3%]) or ultralow risk tumors (33 [6.4%]), 5 years vs 2.5 years of EET was not associated with improved benefit for DR. As expected, rates of AEs and treatment discontinuation were comparable among the different 70-gene assay risk groups in each treatment arm. Conclusions and Relevance This secondary analysis of the IDEAL trial found that the 70-gene assay identified patients with low-risk tumors who could benefit from 5-year vs 2.5-year EET. These findings suggest that this gene expression assay could go beyond guiding neoadjuvant and adjuvant chemotherapy decisions to informing the optimal duration of adjuvant endocrine therapy. Trial Registration EU Clinical Trials Register Eudra CT: 2006-003958-16
Mental Health Disorder Trends in Denmark According to Age, Calendar Period, and Birth Cohort
Authors: Natalie C. Momen, Christoffer Beck, Mette Lise Lousdal, Esben Agerbo, John J. McGrath, Carsten B. Pedersen, Merete Nordentoft, Oleguer Plana-Ripoll
Journal: JAMA Psychiatry (2024)

Importance Research suggests an increase in mental disorder incidence in recent years, but this trend remains unexplained, and there is a lack of large studies based on a representative sample that investigate mental disorders over the full spectrum. Objective To explore sex- and age-specific incidence of any mental disorder and 19 specific disorders according to birth cohort and calendar period. Design, Setting, and Participants This was a population-based cohort study among 5 936 202 individuals aged 1 to 80 years living in Denmark at some point between January 1, 2004, and December 31, 2021. Data were derived from the Danish Civil Registration System and analyzed from February to August 2024. Exposures Birth cohort (8 categories from 1924 to 2011) and calendar period (six 3-year categories from 2004 to 2021). Main Outcomes and Measures Incidence rates of mental disorders from 2004 to 2021 by sex and age, according to birth cohort and calendar period, including the first years of the COVID-19 pandemic, using Danish health register data. Results The population comprised 2 933 857 female individuals and 3 002 345 male individuals, who were followed up for 83.8 million person-years, with median ages at start and end of follow-up of 30.2 and 46.2 years, respectively. There was an overall mental disorder incidence rate of 55.27 every 10 000 person-years. For diagnoses of any mental disorder, higher incidence rates were observed for more recent birth cohorts and calendar periods in the younger ages. Over older ages, incidence rates did not vary so greatly. An increase was observed in rates of most types of mental disorders, especially among young people, and decreases for other types (eg, substance use disorders). Prominent sex differences were also observed. For example, for schizophrenia, a large increase was seen in incidence rates for female individuals in more recent birth cohorts at younger ages, but no change for male individuals, leading to a higher peak incidence for female individuals than for male individuals in the most recent periods. For personality disorders, a large increase was observed in incidence for female individuals over time and a slight decrease for male individuals. Conclusions and Relevance This comprehensive investigation of mental disorders incidence in Denmark indicates sex- and age-specific patterns according to birth cohorts and calendar periods. While trends may partly be explained by increases in incidence, several other factors may contribute, such as diagnostic practices, health sector capacity, and risk factors for mental disorders.
Next-Generation Sequencing for HLA Genotype Screening and Matching to HLA-Restricted Therapies
Authors: Michael V. Gormally, Monica F. Chen, Anne Marie Noronha, Kristalla Panageas, Maggie Reynolds, Kaelyn Kohlasch, Bryan Novak, Tatiana Kee-Velez, Nikeysha Clarke, Michael Eubank, Cynthia Chu, Clare Wilhelm, Amanda Blouin, Chrisann Kyi, Claire Friedman, Charles M. Rudin, Mark G. Kris, Ronak Shah, David Aggen, Sandra D’Angelo, Alexander N. Shoushtari, Michael F. Berger, Chaitanya Bandlamudi, Christopher A. Klebanoff, Alexander Drilon, Adam J. Schoenfeld, Mark T. A. Donoghue
Journal: JAMA Oncology (2024)

This case series evaluates whether human leukocyte antigen (HLA) genotype could be inferred from standard next-generation sequencing, comparing concordance with confirmatory whole-exome sequencing and assessing if this assisted in matching patients to clinical trials.
Issues With the New Liver Allocation System
Authors: Maria Bernadette Majella Doyle, Ola Ahmed, Susan L. Orloff
Journal: JAMA Surgery (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 Surgery 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 Surgery journal
Concerns Regarding the Utility of High-Risk Pancreatic Cancer Surveillance
Authors: Christopher Dasaro, Vinay Prasad
Journal: JAMA Oncology (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 Oncology 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 Oncology journal
Heart Failure: A Ghazal
Authors: Sydney Lea
Journal: JAMA (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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Safety and Efficacy of Deucravacitinib in Moderate to Severe Plaque Psoriasis For Up to 3 Years
Authors: April W. Armstrong, Mark Lebwohl, Richard B. Warren, Howard Sofen, Shinichi Imafuku, Mamitaro Ohtsuki, Lynda Spelman, Thierry Passeron, Kim A. Papp, Renata M. Kisa, John Vaile, Victoria Berger, Eleni Vritzali, Kim Hoyt, Matthew J. Colombo, Julie Scotto, Subhashis Banerjee, Bruce Strober, Diamant Thaçi, Andrew Blauvelt
Journal: JAMA Dermatology (2024)

Safe and effective long-term treatments for moderate to severe plaque psoriasis are needed.
Locoregional Therapies for Hepatocellular Carcinoma
Authors: Krishnan R. Patel, Hari Menon, Roshal R. Patel, Erich P. Huang, Vivek Verma, Freddy E. Escorcia
Journal: JAMA Network Open (2024)

Importance Several locoregional therapies (LRTs) for nonmetastatic hepatocellular carcinoma (HCC) are available; however, a global comparison of the relative efficacy of each is needed. Objective To conduct a systematic review and direct, pairwise meta-analytic comparison of all identified randomized clinical trials evaluating the treatment of nonmetastatic HCC. Data Sources A comprehensive search of PubMed and the proceedings of the American Society of Clinical Oncology and American Society for Radiation Oncology annual meetings from January 1, 2010, to November 1, 2023, was performed. Study Selection Randomized clinical trials using a form of LRT (surgery with or without adjuvant therapy, radiofrequency ablation [RFA], microwave ablation [MWA], radiotherapy [RT], hepatic arterial infusion chemotherapy [HAIC], transarterial bland embolization [TAE], transarterial chemoembolization [TACE], or transarterial radioembolization [TARE]). Data Extraction and Synthesis Study eligibility and data extraction were each reviewed by 2 authors independently. Random-effects meta-analyses were used to compare treatment categories. Main Outcomes and Measures Progression-free survival (PFS) was the primary outcome; overall survival (OS) was the secondary outcome. Results Forty randomized clinical trials reporting on comparative outcomes of 11 576 total patients with localized HCC treated with LRT were included. The median follow-up was 30.0 (IQR, 18.5-40.8) months. Direct pooled comparisons between treatment classes suggested improved outcomes for surgery combined with adjuvant therapy over surgery alone (PFS: hazard ratio [HR], 0.62 [95% CI, 0.51-0.75]; P &amp;amp;lt; .001; OS: HR, 0.61 [95% CI, 0.48-0.78]; P &amp;amp;lt; .001), surgery over RFA (PFS: HR, 0.74 [95% CI, 0.63-0.87]; P &amp;amp;lt; .001; OS: HR, 0.71 [95% CI, 0.54-0.95]; P = .02), RT over TACE (PFS: HR, 0.35 [95% CI, 0.21-0.60]; P &amp;amp;lt; .001; OS: HR, 0.35 [95% CI, 0.13-0.97]; P = .04), and HAIC over TACE (PFS: HR, 0.57 [95% CI, 0.45-0.72]; P &amp;amp;lt; .001; OS: HR, 0.58 [95% CI, 0.45-0.75]; P &amp;amp;lt; .001). No substantial heterogeneity was noted for any pairwise comparison with the exception of RT-based regimens compared with tyrosine kinase inhibitor therapy. Conclusions and Relevance The findings of this systematic review and direct, pairwise meta-analysis suggest that all LRTs are not equivalent for the treatment of localized HCC. The efficacy of LRTs appears hierarchical, with surgery-based management outcomes associated with the best treatment outcomes and embolization-based treatment options associated with the worst treatment outcomes.
Ambulatory Care vs Overnight Hospitalization After Anterior Surgery for Cervical Radiculopathy
Authors: Kimmo Lönnrot, Simo Taimela, Jarno Satopää, Ilkka Saarenpää, Ville Leinonen, Juri Kivelev, Marja Silvasti-Lundell, Johannes Förster, Mikko Pitkänen, Rahul Raj, Mikko Kauppinen, Riitta Westermarck, Behnam Rezai Jahromi, Anniina Koski-Palkén, Matti Seppälä, Leena Kivipelto, Jussi Antinheimo, Miikka Korja, Tomasz Czuba, Teppo L. N. Järvinen
Journal: JAMA Network Open (2024)

Importance During the past decade, spinal surgical procedures have been increasingly performed on an ambulatory basis, a change in clinical practice supported only by observational evidence thus far. There have been no randomized clinical trials (RCTs) comparing ambulatory care with inpatient care after any spinal surgery. Objective To assess whether ambulatory care is noninferior to overnight hospital surveillance in functional outcome, as measured by Neck Disability Index (NDI), in adults after anterior cervical decompression and fusion (ACDF) for cervical radiculopathy. Design, Setting, and Participants This parallel group, noninferiority RCT enrolled patients at 3 tertiary neurosurgical centers in Finland (University Hospitals of Helsinki, Turku, and Oulu) between June 2019 and February 2021, with a final follow-up in October 2021. Patients aged 18 to 62 years who underwent 1-level or 2-level ACDF due to cervical radiculopathy were assessed for eligibility. After surgery, participants were randomly assigned to either ambulatory care or overnight hospital surveillance. Intention-to-treat data analyses were conducted in August 2022. Interventions Patients randomly assigned to ambulatory care were kept under surveillance for 6 to 8 hours after surgery and then discharged. Patients assigned to overnight hospital surveillance were kept in the ward for 24 hours or longer. Main Outcomes and Measures The primary outcome was NDI at 6 months. A minimal important difference of 17.3 percentage points for NDI was set as the margin of noninferiority. Results Among the 105 patients (mean [SD] age, 47.0 [7.9] years; 54 women [50%]) randomly assigned to ambulatory care (n = 52) or overnight hospital surveillance (n = 53), 94 (90%) completed the trial. Four (8%) patients who received ambulatory care crossed over to overnight hospital surveillance. Seventy-nine patients (75%) had a 1-level ACDF and 26 (25%) had a 2-level ACDF. At 6 months after surgery, the mean NDI was 13.3% (95% CI, 9.3%-17.3%) in the ambulatory care group and 12.2% (95% CI, 8.2%-16.2%) in the overnight hospital surveillance group (between-group mean difference, 1.1 [95% CI, −4.6 to 6.8] percentage points). Conclusions and Relevance In this RCT comparing functional outcomes of ambulatory care vs overnight hospital surveillance after ACDF, ambulatory care resulted in noninferior functional outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT03979443
Merkel Cell Carcinoma and Immunosuppression, UV Radiation, and Merkel Cell Polyomavirus
Authors: Jacob T. Tribble, Ruth M. Pfeiffer, Isaac Brownell, Elizabeth K. Cahoon, Michael R. Sargen, Meredith S. Shiels, Qianlai Luo, Colby Cohen, Kate Drezner, Brenda Hernandez, Adrianne Moreno, Karen Pawlish, Brittani Saafir-Callaway, Eric A. Engels, Karena D. Volesky-Avellaneda
Journal: JAMA Dermatology (2024)

Merkel cell carcinoma (MCC) is a rare but aggressive skin cancer. Quantifying the contribution of major potentially modifiable risk factors to the burden of MCC may inform prevention efforts.
Colorectal Cancer Incidence and Mortality After Negative Colonoscopy Screening Results
Authors: Markus Dines Knudsen, Kai Wang, Liang Wang, Georgios Polychronidis, Paula Berstad, Anette Hjartåker, Zhe Fang, Shuji Ogino, Andrew T. Chan, Mingyang Song
Journal: JAMA Oncology (2024)

The current recommendation for a 10-year rescreening interval after a negative colonoscopy screening (NCS) result has been questioned, with some studies showing a persistently lower risk of colorectal cancer (CRC) after NCS results.
Tirzepatide for Weight Reduction in Chinese Adults With Obesity
Authors: Zhao Chen, Wenqiang Li, Zhiping Deng
Journal: JAMA (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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
How Can We Increase the Utilization of Evidence-Based Medication After Myocardial Infarction?
Authors: Matthew A. Cavender, Sidney C. Smith
Journal: JAMA Network Open (2024)

Michelle D. Kelsey, MD; Cassie Ford, PhD; Megan Oakes, MS; Samir Soneji, PhD; Hayden B. Bosworth, PhD; Neha J. Pagidipati, MD, MPH
Dissecting Biological Risk Using Genomic Assays—Implications for Extended Endocrine Therapy and Beyond
Authors: Igor Makhlin
Journal: JAMA Network Open (2024)

Laura J. van 't Veer, PhD; Elma Meershoek-Klein Kranenbarg, MS; Marjolijn Duijm-de Carpentier, BS; Cornelis J. H. Van de Velde, MD; Miranda Kleijn, PhD; Christa Dreezen, MS; Andrea R. Menicucci, PhD; William Audeh, MD; Gerrit-Jan Liefers, MD, PhD
Patient, Caregiver, and Clinician Perspectives on the Time Burdens of Cancer Care
Authors: Arjun Gupta, Whitney V. Johnson, Nicole L. Henderson, Obafemi O. Ogunleye, Preethiya Sekar, Manju George, Allison Breininger, Michael Anne Kyle, Christopher M. Booth, Timothy P. Hanna, Gabrielle B. Rocque, Helen M. Parsons, Rachel I. Vogel, Anne H. Blaes
Journal: JAMA Network Open (2024)

Importance Cancer and its care impose significant time commitments on patients and care partners. The oncology community has only recently conceptualized these commitments and the associated burden as the “time toxicity” of cancer care. As the concept gains traction, there is a critical need to fundamentally understand the perspectives of multiple stakeholders on the time burdens of cancer care. Objectives To explore time-consuming aspects of cancer care that were perceived as burdensome, identify the individuals most affected by time burdens of cancer care, and evaluate the consequences of these time burdens. Design, Setting, and Participants Participants in this qualitative analysis were recruited from a National Cancer Institute–designated cancer center in Minnesota, where semistructured qualitative interviews were conducted from February 1 to October 31, 2023. Purposive and criterion sampling methods were used to recruit patients (adults with advanced stage gastrointestinal cancer receiving systemic cancer-directed treatment), care partners (patient-identified informal [unpaid] partners), and clinicians (physicians, physician assistants, nurse practitioners, nurses, social workers, and schedulers). Data were analyzed from February 2023 to February 2024. Main Outcomes and Measures Thematic analysis was conducted with a hybrid (inductive and deductive methods) approach. Themes, subthemes, and illustrative quotations are presented. Results Interviews included 47 participants (16 patients [8 aged ≤60 years; 12 women (75.0%)], 15 care partners [12 aged ≤60 years; 9 women (60.0%)], and 16 clinicians [11 women (68.7%)]). A total of 31 subthemes were identified that were grouped into 5 themes. Theme 1 captured time burdens due to health care outside the home (eg, travel, parking, and waiting time), while theme 2 identified the often invisible tasks performed at home (eg, handling insurance and medical bills, receiving formal home-based care). Theme 3 explored how care partners are affected alongside patients (eg, burdens extending to the wider network of family, friends, and community) and theme 4 represented the consequences of time burdens (eg, demoralization, seemingly short visits turned into all-day affairs). Finally, theme 5 referenced positive time spent in clinical interactions and hope for change (eg, patients value meaningful care, the “time toxicity” label is a spark for change). Conclusions and Relevance This qualitative analysis identifies key sources and effects of time toxicity, as well as the populations affected. The results of this study will guide the oncology community to map, measure, and address future time burdens.
Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity
Authors: Jeehoon Kang, Jaewook Chung, Kyung Woo Park, Jang-Whan Bae, Huijin Lee, Doyeon Hwang, Han-Mo Yang, Kyoo-Rok Han, Keon-Woong Moon, Ung Kim, Moo-Yong Rhee, Doo-Il Kim, Song-Yi Kim, Sung-Yun Lee, Seung Uk Lee, Sang-Wook Kim, Seok Yeon Kim, Jung-Kyu Han, Eun-Seok Shin, Bon-Kwon Koo, Hyo-Soo Kim
Journal: JAMA Cardiology (2024)

Antiplatelet monotherapy in the chronic maintenance period for patients with high bleeding risk (HBR) and those who have undergone complex percutaneous coronary intervention (PCI) has not yet been explored.
Barriers to Advancement—Unequal Opportunities in Academic Promotion Based on Race, Ethnicity, and Gender
Authors: Shruthi Venkataraman, Mytien Nguyen, Dowin Boatright
Journal: JAMA Network Open (2024)

Lauren Clark, MS; Elena Shergina, PhD; Nathalia Machado, PhD; Taneisha S. Scheuermann, PhD; Nasrin Sultana, MS; Deepika Polineni, MD; Grace H. Shih, MD; Robert D. Simari, MD; Jo A. Wick, PhD; Kimber P. Richter, PhD, MPH