tbuckley/cabot-search huggingface dataset:
Pharmacologic Management of Acute Pain in Children
Authors: Laura Olejnik, João Pedro Lima, Behnam Sadeghirad, Jason W. Busse, Ivan D. Florez, Samina Ali, James Bunker, Danny Jomaa, Adam Bleik, Mohamed Eltorki
Journal: JAMA Pediatrics (2025)

Importance Several pharmacologic options exist for the management of acute pediatric pain; however, their comparative effectiveness remains uncertain. Objective To assess the relative benefits and harms of pharmacotherapy for acute pediatric pain through a network meta-analysis of randomized clinical trials. Data Sources Cochrane Database of Systematic Reviews, Medline, Embase, CINAHL, Web of Science, and Scopus to October 2023. Study Selection Trials that enrolled children (aged &amp;amp;lt;18 years) with acute pain and randomized them to receive a pharmacologic analgesic vs an alternate analgesic or placebo were included. Data Extraction and Synthesis Pairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. A frequentist random-effects model was used for all meta-analyses, and the certainty of evidence was assessed for treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation approach. Main Outcomes The primary outcomes were pain severity (range, 0-10 cm using a visual analog scale; minimally important difference [MID], 1 cm), need for rescue medication, symptom relief, and adverse drug events. Results A total of 41 trials involving 4935 children were included. High- to moderate-certainty evidence found that compared with placebo, nonsteroidal anti-inflammatory drugs (NSAIDs) (weighted mean difference [WMD], −1.29; 95% CI, −1.89 to −0.70; modeled risk difference [RD] for achieving the MID, 16%), ketamine (WMD, −1.12; 95% CI, −2.09 to −0.14; modeled RD for achieving the MID, 14%), and mid-high potency opioids (WMD, −1.19; 95% CI, −1.83 to −0.55; modeled RD for achieving the MID, 15%) reduced pain. Only NSAIDs reduced the need for rescue medication (relative risk [RR], 0.31; 95% CI, 0.14 to 0.68; modeled RD, 16% fewer patients). Neither NSAIDs (RR, 0.69; 95% CI, 0.31 to 1.55) nor acetaminophen (RR, 0.63; 95% CI, 0.21 to 1.87) increased the risk of short-term gastrointestinal adverse events. All other comparisons showed moderate-certainty evidence of little to no difference from placebo or were supported by low/very low–certainty evidence. Conclusions and Relevance Compared with placebo, NSAIDs, ketamine, and mid- to high-potency opioids are effective in reducing acute pediatric pain. NSAIDs provide the greatest benefits and least harm, suggesting that they should be the first-line therapy for acute painful conditions in children.
Prophylactic Aspirin Dose and Preeclampsia
Authors: Ellen Kupka, Susanne Hesselman, Jóhanna Gunnarsdóttir, Anna-Karin Wikström, Catherine Cluver, Stephen Tong, Roxanne Hastie, Lina Bergman
Journal: JAMA Network Open (2025)

Importance It is unclear whether a higher dose (150-160 mg) or a lower dose (75 mg) of aspirin should be used to prevent preeclampsia. Objectives To compare the risk of preeclampsia and bleeding complications between women using 150 to 160 mg of aspirin and those using 75 mg of aspirin for preeclampsia prevention. Design, Setting, and Participants This nationwide cohort study included 13 828 women giving birth at 22 weeks’ gestation or later in Sweden between January 2017 and December 2020 who used low dose aspirin (75-160 mg) during pregnancy. Data were analyzed from October to November 2023. Exposure The use of 150 to 160 mg or 75 mg of aspirin in pregnancy. Main Outcome and Measures The main outcome was a preeclampsia diagnosis recorded in the maternal birth record at the time of hospital discharge. The main safety outcome was postpartum hemorrhage, defined as bleeding more than 1000 mL after delivery. Relative risks (RRs) and 95% CIs were estimated using a doubly robust inverse probability–weighted regression adjustment model controlling for background characteristics. Results In the total cohort of 13 828 women, the mean (SD) age was 33.0 (5.5) years and 3003 women (21.7%) were nulliparous. Of the women, 4687 (33.9%) were prescribed 150 to 160 mg of aspirin, and 9141 (66.1%) were prescribed 75 mg of aspirin. A total of 10 635 women (76.9%) had at least 2 dispensed prescriptions of low-dose aspirin. Among women using 150 to 160 mg of aspirin, 443 (9.5%) developed preeclampsia compared with 812 (8.9%) of those using 75 mg of aspirin (adjusted RR [aRR], 1.07; 95% CI, 0.93-1.24). Additionally, the risk of postpartum hemorrhage between the groups was similar, with 326 women (6.9%) using 150 to 160 mg of aspirin experiencing a postpartum hemorrhage compared with 581 (6.4%) in the 75-mg group (aRR, 1.08; 95% CI, 0.90-1.30). Conclusions and Relevance In this cohort study of 13 828 women, no difference was found in preeclampsia incidence or bleeding complications between those using 150 to 160 mg of aspirin vs 75 mg of aspirin during pregnancy for preeclampsia prevention. These findings suggest that either dose may be a reasonable choice when using aspirin to prevent preeclampsia. However, large randomized trials investigating aspirin dose in pregnancy are still needed.
Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache
Authors: Holly Elser, Dóra Körmendiné Farkas, Cecilia Hvitfeldt Fuglsang, Sissel Toft Sørensen, Henrik Toft Sørensen
Journal: JAMA Neurology (2025)

Importance Although past research suggests an association between migraine and attempted suicide, there is limited research regarding risk of attempted and completed suicide across headache disorders. Objective To examine the risk of attempted and completed suicide associated with diagnosis of migraine, tension-type headache, posttraumatic headache, and trigeminal autonomic cephalalgia (TAC). Design, Setting, and Participants This was a population-based cohort study of Danish citizens from 1995 to 2020. The setting was in Denmark, with a population of 5.6 million people. Persons 15 years and older who were diagnosed with headache were matched by sex and birth year to persons without headache diagnosis with a ratio of 5:1. Data analysis was conducted from May 2023 to May 2024. Exposures First-time headache diagnoses identified from inpatient hospitalizations, emergency department visits, and outpatient specialty clinic visits using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) codes. Main Outcomes and Measures Diagnostic codes from the ICD-10 were used to identify attempted suicide from the Danish National Patient Registry and the Danish Psychiatric Central Research Register and completed suicides from the Danish Register of Causes of Death. Absolute risks (ARs) and risk differences (RDs) for attempted and completed suicide were calculated using the cumulative incidence function. Hazard ratios (HRs) for attempted and completed suicide associated with headache diagnosis were computed adjusting for age, sex, year, education, income, baseline comorbidities, and accounting for competing risk of death. Results In total, 119 486 persons (83 046 female [69.5%]) diagnosed with headache were identified and matched with 597 430 persons (415 230 female [69.5%]) drawn from the general population. Participants’ median (IQR) age was 40.1 (29.1-51.6) years. The 15-year AR of attempted suicide among persons diagnosed with headache was 0.78% (95% CI, 0.72%-0.85%) vs 0.33% (95% CI, 0.31%-0.35%) in the comparison cohort (RD, 0.45%; 95% CI, 0.39%-0.53%). The 15-year AR of completed suicide among persons diagnosed with headache was 0.21% (95% CI, 0.17%-0.24%) vs 0.15% (95% CI, 0.13%-0.16%) in the comparison cohort (RD, 0.06%; 95% CI, 0.02%-0.10%). The hazards of attempted suicide (HR, 2.04; 95% CI, 1.84-2.27) and completed suicide (HR, 1.40; 95% CI, 1.17-1.68) were elevated among persons with headache vs comparison cohort members. Findings were consistent across headache types, with stronger associations for TACs and posttraumatic headache. Conclusions and Relevance Results of this cohort study revealing the robust and persistent association of headache diagnoses with attempted and completed suicide suggest that behavioral health evaluation and treatment may be important for these patients.
Pediatric Readiness and Trauma Center Access for Children
Authors: Caroline Melhado, Canaan Hancock, Haoyu Wang, Maya M. Eldin, Nicholas George, Jennifer A. Miller, Katherine E. Remick, Bhavin Patel, Brian K. Yorkgitis, Lisa Gray, Michael W. Dingeldein, Hilary A. Hewes, Katie W. Russell, Michael L. Nance, Aaron R. Jensen
Journal: JAMA Pediatrics (2025)

Importance Children initially treated in a timely fashion at trauma centers with high levels of pediatric readiness have been shown to have improved survival, but children historically have had geographically disparate access to pediatric trauma center care. Considerable effort has been invested in improving pediatric readiness nationally, including the implementation of new standards to improve emergency department pediatric readiness at all trauma centers. Objective To assess current access to US pediatric-ready trauma center care and to estimate potential improvement in access if all high-level trauma centers had optimal pediatric readiness. Design, Setting, and Participants This descriptive cross-sectional study collated trauma centers from national organizational lists, state government websites, and online searches. A geospatial analysis was performed of access by pediatric patients (aged ≤18 years) to trauma centers by ground or air ambulance within 60 minutes, stratified by trauma center type and pediatric readiness status. Population density was estimated using 2020 US census data. Weighted pediatric readiness scores (wPRS) were obtained from the 2021 National Pediatric Readiness Project assessment. The data analysis was performed between April 1 and June 30, 2023. Exposure Access times to trauma centers. Main Outcome and Measure The main outcome of interest was access to a pediatric-ready trauma center, defined as a high-level pediatric trauma center (level I-II) or high-level adult trauma center (level I-III) with a wPRS of at least 93 (out of 100). Access times were calculated using previously validated methods and service network model analysis for each trauma center to census block group centroid. Results The analysis included 148 pediatric and 1075 high-level adult trauma centers. A total of 273 adult centers (25%) were pediatric ready. Pediatric trauma center access within 60 minutes by ground or air ambulance was available for 65% of all 74 090 665 children; 73% of children had access to a pediatric-ready trauma center within 60 minutes, and 92% had access to any high-level trauma center within 60 minutes. Conclusion These findings suggest that access to pediatric trauma center care is limited, even with air ambulance transport. Ensuring pediatric readiness at all high-level adult trauma centers may substantially improve access to early high-quality initial resuscitative trauma care for children.
Enhancing Surveillance of Health Care–Associated Infections and Outcomes at the Intersections
Authors: J. Danielle Sharpe
Journal: JAMA Network Open (2025)

Katelin B. Nickel, MPH; Hannah Kinzer, MPH; Anne M. Butler, PhD, MS; Karen E. Joynt Maddox, MD, MPH; Victoria J. Fraser, MD; Jason P. Burnham, MD, MSCI; Jennie H. Kwon, DO, MSCI
Denominator and Composite Calculation Errors in Study of Health System Low-Value Services
Authors: Ishani Ganguli
Journal: JAMA Internal Medicine (2025)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast 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 2025 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Transfusion Strategy for Acute Brain Injury—Reply
Authors: Fabio Silvio Taccone, Jean-Louis Vincent, Elisa Gouvêa Bogossian
Journal: JAMA (2025)

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 2025 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
Age-Related Changes in Brain Structure in Pediatric Chronic Kidney Disease
Authors: Ellen van der Plas, Eric Nelson, Brian Becknell, Anne E. Dawson, Camille S. Wilson, Jeffrey D. Dawson, Joseph L. Alge, Lyndsay A. Harshman
Journal: JAMA Network Open (2025)

Importance Pediatric patients with chronic kidney disease (CKD) exhibit reduced cerebellum volume, which is associated with neurocognitive deficits and a lower estimated glomerular filtration rate (eGFR), even before dialysis or transplantation. These differences have not been examined within the context of age-related brain changes during childhood to early adulthood. Objective To evaluate differences in age-related neurodevelopmental changes in patients with CKD compared with control participants and to investigate associations between regional neuroanatomy, functional outcomes, and disease-related variables. Design, Setting, and Participants Case-control study of individuals aged 6 through 21 years with and without CKD at an academic medical center in Iowa City, Iowa, from September 2016 to August 2024. Exposures Neurocognitive testing; 3-T magnetic resonance imaging. Main Outcomes and Measures Participants completed standardized neurocognitive assessments and quantitative neuroanatomical scans. Brain regions of interest (ROIs) were analyzed for volumetric differences using automated pipelines. Multivariable linear models assessed neurocognitive and neuroanatomical differences between groups, including an age × group interaction for ROI analyses. Results The sample included 124 individuals (mean [SD] age, 12.8 [4.5] years; 74 [59.7%] male), including 87 control participants (44 [50.6%] male) and 37 participants with CKD (30 [81.1%] male). The mean (SD) eGFR was 71.3 [25.5] mL/min/1.73 m 2 for the CKD group. Participants with CKD scored lower than control participants on most neurocognitive measures included in the analyses. The CKD group showed differential age-related changes in cerebellar gray matter (β = −0.10; 95% CI, −0.18 to −0.01; Cohen f = 0.22) and white matter (β = −0.09; 95% CI, −0.19 to −0.00; Cohen f = 0.19). The age × group interaction approached but did not reach significance for amygdala volume (β = 0.09; 95% CI, −0.01 to 0.19; Cohen f = 0.18; P = .06). Volumetric variation in these regions was associated with proxy ratings of executive function in patients with CKD. A significant, positive association between cerebellar gray matter and eGFR was observed in the CKD group (β = 0.04; 95% CI, 0.00 to 0.02; P = .01). Conclusions and Relevance In this case-control study, age-related neurodevelopmental differences were observed in pediatric patients with CKD compared with healthy peers. Reductions in cerebellar volume were associated with cognitive deficits and lower kidney function. These findings underscore the importance of monitoring neurodevelopmental trajectories in children with CKD, as early interventions may be necessary to mitigate cognitive impairments associated with CKD.
Over-the-Counter Naloxone and Nonprescription Syringe Availability in Community Pharmacies
Authors: Lindsey J. Loera, Jennifer E. Lines, Shannon R. Mayberry, Sarah A. Hilzendager, Aaron P. Ferguson, Lucas G. Hill
Journal: JAMA Network Open (2025)

This cross-sectional study evaluates the accessibility of over-the-counter naloxone and nonprescription syringes in community pharmacies in Austin, Texas.
Intersection of Race and Rurality With Health Care–Associated Infections and Subsequent Outcomes
Authors: Katelin B. Nickel, Hannah Kinzer, Anne M. Butler, Karen E. Joynt Maddox, Victoria J. Fraser, Jason P. Burnham, Jennie H. Kwon
Journal: JAMA Network Open (2025)

Importance Health care–associated infections (HAIs) are a major cause of morbidity and mortality, but little is known about whether structural factors impacting race and rurality are associated with HAI and subsequent outcomes. Objective To evaluate the association of race and rurality, which are proxies for structural disadvantage, with HAI and subsequent outcomes. Design, Setting, and Participants This cohort study was conducted at 3 US urban and suburban hospitals. Participants were adults aged 18 years or older admitted for 48 hours or longer from January 1, 2017, to August 31, 2020. Statistical analysis was performed from November 2022 to April 2024. Exposure Patient race and rurality status were defined as the combination of race (Black or White) and residence (urban or rural per patient zip code). Main Outcomes and Measures HAI was defined as a positive culture from a urine, blood, or respiratory specimen obtained 48 hours or longer after admission. To determine the association of race and rurality with HAIs, multivariable generalized estimating equations models were used to account for clustering of admissions by patient. Among patients with HAI admissions, similar models examined post-HAI intensive care unit admission and in-hospital death. Results Among 214 955 patients admitted to the hospital (median [IQR] age, 63 [51-73] years; 108 679 female patients [50.6%]; 72 490 Black patients [33.7%]; 142 465 White patients [66.3%]), recognized HAIs occurred during 6699 (3.1%). Compared with White urban patients, Black urban patients had a decreased risk of HAI (adjusted relative risk [aRR], 0.81; 95% CI, 0.75-0.87), White rural patients had an increased risk of HAI (aRR, 1.12; 95% CI, 1.05-1.20), and Black rural patients (aRR, 1.08; 95% CI, 0.81-1.44) had a similar risk of HAI. Among patients with HAI admissions, Black rural patients had an increased risk of intensive care unit admission (aRR, 1.92; 95% CI, 1.16-3.17) and in-hospital death (aRR, 1.78; 95% CI, 1.26-2.50). White rural and Black urban patients had outcomes similar to those of White urban patients. Conclusions and Relevance This cohort study of hospitalized adults identified inequities related to race and rurality in HAIs and adverse outcomes from HAIs. These findings suggest that factors such as structural racism and disinvestment in rural communities may be associated with individual HAI risk and post-HAI outcomes. Future work to further understand the reasons underpinning these disparities and methods to address structural factors through policy and process changes are critical to eliminate health inequities.
Bioaccumulation of microplastics in decedent human brains
Authors: Alexander J. Nihart, Marcus A. Garcia, Eliane El Hayek, Rui Liu, Marian Olewine, Josiah D. Kingston, Eliseo F. Castillo, Rama R. Gullapalli, Tamara Howard, Barry Bleske, Justin Scott, Jorge Gonzalez-Estrella, Jessica M. Gross, Michael Spilde, Natalie L. Adolphi, Daniel F. Gallego, Heather S. Jarrell, Gabrielle Dvorscak, Maria E. Zuluaga-Ruiz, Andrew B. West, Matthew J. Campen
Journal: Nature Medicine (2025)

Rising global concentrations of environmental microplastics and nanoplastics (MNPs) drive concerns for human exposure and health outcomes. Complementary methods for the robust detection of tissue MNPs, including pyrolysis gas chromatography–mass spectrometry, attenuated total reflectance–Fourier transform infrared spectroscopy and electron microscopy with energy-dispersive spectroscopy, confirm the presence of MNPs in human kidney, liver and brain. MNPs in these organs primarily consist of polyethylene, with lesser but significant concentrations of other polymers. Brain tissues harbor higher proportions of polyethylene compared to the composition of the plastics in liver or kidney, and electron microscopy verified the nature of the isolated brain MNPs, which present largely as nanoscale shard-like fragments. Plastic concentrations in these decedent tissues were not influenced by age, sex, race/ethnicity or cause of death; the time of death (2016 versus 2024) was a significant factor, with increasing MNP concentrations over time in both liver and brain samples (P = 0.01). Finally, even greater accumulation of MNPs was observed in a cohort of decedent brains with documented dementia diagnosis, with notable deposition in cerebrovascular walls and immune cells. These results highlight a critical need to better understand the routes of exposure, uptake and clearance pathways and potential health consequences of plastics in human tissues, particularly in the brain. Pyrolysis gas chromatography–mass spectrometry reveals the presence of microplastics and nanoplastics in human kidney, liver and brain tissue samples from 2016 and 2024, with higher proportions found in the brain.
What do we gain when tolerating loss? The information bottleneck wrings out recombination
Authors: Apurva Narechania, Dean Bobo, Rob DeSalle, Barun Mathema, Barry Kreiswirth, Paul J Planet
Journal: Molecular Biology and Evolution (2025)

Abstract Most microbes have the capacity to acquire genetic material from their environment. Recombination of foreign DNA yields genomes that are, at least in part, incongruent with the vertical history of their species. Dominant approaches for detecting these transfers are phylogenetic, requiring a painstaking series of analyses including alignment and tree reconstruction. But these methods do not scale. Here we propose an unsupervised, alignment-free and tree-free technique based on the sequential information bottleneck (SIB), an optimization procedure designed to extract some portion of relevant information from one random variable conditioned on another. In our case, this joint probability distribution tabulates occurrence counts of k-mers against their genomes of origin with the expectation that recombination will create a strong signal that unifies certain sets of co-occuring k-mers. We conceptualize the technique as a rate-distortion problem, measuring distortion in the relevance information as k-mers are compressed into clusters based on their co-occurrence in the source genomes. The result is fast, model-free, lossy compression of k-mers into learned groups of shared genome sequence, differentiating recombined elements from the vertically inherited core. We show that the technique yields a new recombination measure based purely on information, divorced from any biases and limitations inherent to alignment and phylogeny.