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Journal Cover JAMA The Journal of the American Medical Association
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     ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
     Published by American Medical Association Homepage  [11 journals]   [SJR: 4.843]   [H-I: 456]
  • Coronary Artery Calcium Score
    • Authors: Polonsky TS; Blumenthal RS, Greenland P.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Fish Oil Supplements
    • Abstract: Long-chain omega-3 polyunsaturated fatty acids (PUFAs), which are present in cold-water fish such as herring or salmon and are commercially available in capsules (over the counter and by prescription), can decrease fasting triglyceride concentrations 20-50% by reducing hepatic triglyceride production and increasing triglyceride clearance. With long-term intake, they may increase HDL-C.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Clinical Trial Participation After Myocardial Infarction in a National
           Cardiovascular Data Registry
    • Authors: Udell JA; Wang TY, Li S, et al.
      Abstract: Randomized clinical trials of patients with acute myocardial infarction (MI) enroll selected populations, with low enrollment in the United States, raising questions whether findings are generalizable. We evaluated whether participants in cardiovascular trials are representative of contemporary patients with MI.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Management of Persistent Pain in the Older Patient A Clinical Review
    • Authors: Makris UE; Abrams RC, Gurland B, et al.
      Abstract: ImportancePersistent pain is highly prevalent, costly, and frequently disabling in later life.ObjectiveTo describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult.Evidence AcquisitionSearch of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults.FindingsOf the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended—emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician.Conclusions and RelevanceTreatment planning for persistent pain in later life requires a clear understanding of the patient’s treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Association Between Early Administration of High-Dose Erythropoietin in
           Preterm Infants and Brain MRI Abnormality at Term-Equivalent Age
    • Authors: Leuchter R; Gui L, Poncet A, et al.
      Abstract: ImportancePremature infants are at risk of developing encephalopathy of prematurity, which is associated with long-term neurodevelopmental delay. Erythropoietin was shown to be neuroprotective in experimental and retrospective clinical studies.ObjectiveTo determine if there is an association between early high-dose recombinant human erythropoietin treatment in preterm infants and biomarkers of encephalopathy of prematurity on magnetic resonance imaging (MRI) at term-equivalent age.Design, Setting, and ParticipantsA total of 495 infants were included in a randomized, double-blind, placebo-controlled study conducted in Switzerland between 2005 and 2012. In a nonrandomized subset of 165 infants (n=77 erythropoietin; n=88 placebo), brain abnormalities were evaluated on MRI acquired at term-equivalent age.InterventionsParticipants were randomly assigned to receive recombinant human erythropoietin (3000 IU/kg; n=256) or placebo (n=239) intravenously before 3 hours, at 12 to 18 hours, and at 36 to 42 hours after birth.Main Outcomes and MeasuresThe primary outcome of the trial, neurodevelopment at 24 months, has not yet been assessed. The secondary outcome, white matter disease of the preterm infant, was semiquantitatively assessed from MRI at term-equivalent age based on an established scoring method. The resulting white matter injury and gray matter injury scores were categorized as normal or abnormal according to thresholds established in the literature by correlation with neurodevelopmental outcome.ResultsAt term-equivalent age, compared with untreated controls, fewer infants treated with recombinant human erythropoietin had abnormal scores for white matter injury (22% [17/77] vs 36% [32/88]; adjusted risk ratio [RR], 0.58; 95% CI, 0.35-0.96), white matter signal intensity (3% [2/77] vs 11% [10/88]; adjusted RR, 0.20; 95% CI, 0.05-0.90), periventricular white matter loss (18% [14/77] vs 33% [29/88]; adjusted RR, 0.53; 95% CI, 0.30-0.92), and gray matter injury (7% [5/77] vs 19% [17/88]; adjusted RR, 0.34; 95% CI, 0.13-0.89).Conclusions and RelevanceIn an analysis of secondary outcomes of a randomized clinical trial of preterm infants, high-dose erythropoietin treatment within 42 hours after birth was associated with a reduced risk of brain injury on MRI. These findings require assessment in a randomized trial designed primarily to assess this outcome as well as investigation of the association with neurodevelopmental outcomes.Trial Registrationclinicaltrials.gov Identifier: NCT00413946
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Collaborative Care for Adolescents With Depression in Primary Care A
           Randomized Clinical Trial
    • Authors: Richardson LP; Ludman E, McCauley E, et al.
      Abstract: ImportanceUp to 20% of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression.ObjectiveTo determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care.DesignRandomized trial with blinded outcome assessment conducted between April 2010 and April 2013.SettingNine primary care clinics in the Group Health system in Washington State.ParticipantsAdolescents (aged 13-17 years) who screened positive for depression (Patient Health Questionnaire 9-item [PHQ-9] score ≥10) on 2 occasions or who screened positive and met criteria for major depression, spoke English, and had telephone access were recruited. Exclusions included alcohol/drug misuse, suicidal plan or recent attempt, bipolar disorder, developmental delay, and seeing a psychiatrist.InterventionsTwelve-month collaborative care intervention including an initial in-person engagement session and regular follow-up by master’s-level clinicians. Usual care control youth received depression screening results and could access mental health services through Group Health.Main Outcomes and MeasuresThe primary outcome was change in depressive symptoms on a modified version of the Child Depression Rating Scale–Revised (CDRS-R; score range, 14-94) from baseline to 12 months. Secondary outcomes included change in Columbia Impairment Scale score (CIS), depression response (≥50% decrease on the CDRS-R), and remission (PHQ-9 score
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • A Practical and Effective Primary Care Intervention for Treating
           Adolescent Depression
    • Authors: Reeves GM; Riddle MA.
      Abstract: Adolescent depression is a major pediatric public health concern. Approximately 11% of US adolescents experience an episode of depression by age 18 years. The World Health Organization ranks unipolar depression as the leading cause of “illness and disability” for 10- to 19-year-old youth worldwide, above common physical health problems like anemia and asthma. The effects of depression on overall health are widespread and pervasive because of 3 principal concerns: depression is associated with serious mental health problems (eg, suicidality), physical health problems (eg, obesity), and adolescent high-risk behaviors (eg, substance use). Yet best available data indicate that approximately 40% of adolescent depression goes untreated.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Effect of Self-monitoring and Medication Self-titration on Systolic Blood
           Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease
           The TASMIN-SR Randomized Clinical Trial
    • Authors: McManus RJ; Mant J, Haque M, et al.
      Abstract: ImportanceSelf-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.ObjectiveTo determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease.Design, Setting, and PatientsA primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013.InterventionsSelf-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary.Main Outcomes and MeasuresThe primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit.ResultsPrimary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and at 12 months, the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group, with a difference of 8.8 mm Hg (95% CI, 4.9-12.7) for systolic and 3.1 mm Hg (95% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events.Conclusions and RelevanceAmong patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months.Trial Registrationisrctn.org Identifier: ISRCTN87171227
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Extraordinary
    • Authors: Puri S.
      Abstract: In my dreams, Mr Smith always looks the same. He sits at a table with a green-and-white checkered tablecloth, a pale blue hospital gown around his skeletal frame, shadows gathered behind his collarbones. His forearms are a mess of bruises—purple, blue, and a fading yellow-green—though he gestures with them wildly and easily. His amber eyes match the color of the root beer in the glass before him. Arthritic fingers close around the glass, leaving their imprints on its frosted surface. He lifts the glass to chapped lips, taking a big sip.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Self-titration of Antihypertensive Therapy in High-Risk Patients Bringing
           It Home
    • Authors: Nilsson PM; Nystrom FH.
      Abstract: Hypertension is a common cause of premature mortality yet has been amenable to pharmacologic treatment for more than 8 decades. Resting blood pressure fluctuates for various reasons, and individual responses to different classes of antihypertensive drugs vary considerably. In another high-risk common chronic condition, diabetes, glucose levels vary widely due to factors including individual drug response, physical activity, and carbohydrate intake. Patients treated with insulin are generally taught to adjust their insulin dose guided by self-measurement of glucose levels.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Recognizing Worsening Chronic Heart Failure as an Entity and an End Point
           in Clinical Trials
    • Authors: Butler J; Braunwald E, Gheorghiade M.
      Abstract: Heart failure has been considered a progressive and often fatal condition. However, clinical trials conducted during the last 2 decades among outpatients with heart failure and reduced ejection fraction have shown that the negative trajectory of this syndrome can be altered with effective therapies, improving the annual mortality risk from approximately 20% to approximately 5% to 8%. The same success has not been demonstrated for patients with heart failure and preserved ejection fraction as well as for patients hospitalized for worsening symptoms, irrespective of ejection fraction. Patients hospitalized for heart failure are at a particularly high risk for adverse outcomes after discharge.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • New Opportunities in the Changing Landscape of Prevention
    • Authors: Yach D; Calitz C.
      Abstract: The focus of medical research has historically been on curative medicine, yielding better drugs, medical devices, and clinical procedures. Prevention science—the systematic application of scientific methods to the causes and prevention of diseases in populations—has yet to receive the necessary investment and support required to reduce the growing burden of largely preventable noncommunicable diseases (NCDs).
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Engineering a Better Health Care System A Report From the
           President’s Council of Advisors on Science and Technology
    • Authors: Cassel CK; Saunders RS.
      Abstract: Millions of individuals have gained access to the health care system this year due to the Affordable Care Act. With greater access to health care, there is an increased need to ensure care remains high quality, affordable, and centered around the needs of patients and families. One opportunity for addressing these challenges is through systems engineering, which includes a range of tools to improve efficiency and reliability. These tools have produced substantial benefits in other industries, from manufacturing to aviation, and hold similar promise for health care.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Highlights
    • PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • The ACA’s Contraceptive Mandate Religious Freedom, Women’s
           Health, and Corporate Personhood
    • Authors: Gostin LO.
      Abstract: The Supreme Court on June 30, 2014, decided Burwell v Hobby Lobby Stores, Inc—a deeply divisive case. Holding that the federal government cannot lawfully mandate “closely held” for-profit corporations to provide contraceptive coverage, the Court split 5-4 along ideological lines. The Court thus entered a political quagmire at the intersection of religious freedom, women’s health, and corporate personhood.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Bioprosthetic Valves for Transcatheter Aortic Valve Replacement
    • Authors: Barbanti M; Capodanno D, Tamburino C.
      Abstract: To the Editor Dr Abdel-Wahab and colleagues reported a head-to-head comparison between currently available bioprostheses for transcatheter aortic valve replacement (TAVR). In the Comparison of Transcatheter Heart Valves in High Risk Patients With Severe Aortic Stenosis: Medtronic CoreValve vs Edwards SAPIEN XT (CHOICE) trial, a higher rate of device success was obtained with a balloon-expandable prosthesis than with a self-expanding prosthesis. This finding was partly driven by “a lower frequency of residual more-than-mild paravalvular aortic regurgitation. . . .” However, we believe that some limitations hamper this interpretation, particularly with regard to the assessment of postprocedural paravalvular regurgitation.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Bioprosthetic Valves for Transcatheter Aortic Valve Replacement
    • Authors: Reardon MJ.
      Abstract: To the Editor The CHOICE trial is the first randomized trial comparing balloon-expandable and self-expandable valves for TAVR. This trial used the VARC definition of device success as a composite primary end point. It found a higher device success with the balloon-expandable valve, driven largely by a lower frequency of aortic regurgitation. There are several serious flaws in the trial design that call these conclusions into question.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Bioprosthetic Valves for Transcatheter Aortic Valve
           Replacement—Reply
    • Authors: Abdel-Wahab M; Mehilli J, Richardt G.
      Abstract: In Reply We do not share the concerns of Dr Barbanti and colleagues or of Dr Reardon about the use of angiography as the primary tool for assessment of aortic regurgitation after TAVR in the CHOICE trial. Aortic regurgitation after TAVR is commonly paravalvular. These paravalvular jets are usually eccentric with crescentic, irregular orifices and may become entrained along the left ventricular wall, altering their appearance and the perception of severity, particularly with echocardiography.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Patients Affected by Changes to Hypertension Guideline
    • Authors: Margolis KL.
      Abstract: To the Editor A recent study by Dr Navar-Boggan and colleagues used data from the National Health and Nutrition Examination Survey to estimate changes in the proportion of US adults who would be recommended for hypertension treatment based on the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults by Panel Members Appointed to the Eighth Joint National Committee (JNC 8).
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Patients Affected by Changes to Hypertension Guideline—Reply
    • Authors: Navar-Boggan A; Pencina MJ, Peterson ED.
      Abstract: In Reply Dr Margolis raised a few concerns regarding our interpretations of the 2014 blood pressure guideline and our calculations of patients who would be affected by the changes. Specifically, she questioned our use of a cutoff of 150 mm Hg for systolic blood pressure and 90 mm Hg for diastolic blood pressure for initiation of treatment in adults aged 70 years or older with chronic kidney disease and in those aged 60 years or older with diabetes. For both of these issues, the guideline is somewhat vague.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Cost-Related Motivations for Research
    • Authors: Martin DF; Fine SL, Maguire MG.
      Abstract: To the Editor We agree with the authors of the Viewpoint on cost-related motivations for conducting research that patients should be fully informed of the purposes of a clinical trial. We were surprised, however, that the Comparison of Age-Related Macular Degeneration Treatment Trials (CATT) was selected as an example of a clinical trial for which cost was a primary reason for performing the trial and about which patients did not receive an adequate explanation of the purpose of the study.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Cost-Related Motivations for Research—Reply
    • Authors: Nayak RK; Miller FG.
      Abstract: In Reply We argued in our Viewpoint that when the cost of treatment is a factor motivating the design and conduct of a randomized trial, then this should be disclosed in the section of consent documents devoted to describing the purpose of the research.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Additional Information Omitted
    • Abstract: In the Viewpoint entitled “Cost-Related Motivations for Conducting Research: Participation Should Be Informed” published in the April 16, 2014, issue of JAMA (2014;311[15]:1491-1492. doi:10.1001/jama.2014.1821), additional information about the author was omitted. The end matter should have included the following: “Additional Information: Dr Miller was a member of the data and safety monitoring committee for the CATT study.” This article was corrected online.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Data Error in Table
    • Abstract: In the Original Investigation entitled “Proportion of US Adults Potentially Affected by the 2014 Hypertension Guideline” published in the April 9, 2014, issue of JAMA (2014;311[14]:1424-1429. doi:10.1001/jama.2014.2531), a typographical error appeared in Table 1. In the bottom half of the table (Age ≥60 y), in the CKD data, the row headed ≥70 y should have reported “SBP ≥150 or DBP ≥90” in the Above 2014 BP Guideline Goal column (instead of DBP twice). This article was corrected online.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Chikungunya Virus Transmission Found in the United States US Health
           Authorities Brace for Wider Spread
    • Authors: Kuehn BM.
      Abstract: It’s official: the chikungunya virus has arrived in the United States. Public health authorities confirmed the first 2 cases of local transmission in Florida about 6 weeks ago.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Adding Glucocorticoid to Lidocaine Not Helpful for Spinal Stenosis
    • Authors: Slomski A.
      Abstract: Widely used epidural injections of glucocorticoid plus lidocaine offered little or no benefit over epidural injections of lidocaine alone in treating symptoms of lumbar spinal stenosis, according to findings of a randomized controlled trial of 400 people (Friedly J et al. N Engl J Med. 2014;371[1]:11-21).
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Exercise Lowers Type 2 Diabetes Risk After Gestational Diabetes
    • Authors: Slomski A.
      Abstract: Women with a history of gestational diabetes can mitigate their extremely high risk of developing type 2 diabetes mellitus (T2DM) with moderate-intensity exercise, found a prospective cohort study of 4554 women from the Nurses’ Health Study II (Bao W. JAMA Intern Med. 2014;174[7]:1047-1055). The nurses, who were followed up for 16 years, reported their physical activity and sedentary behaviors on questionnaires.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Lifetime Intellectual Enrichment Delays Cognitive Impairment
    • Authors: Slomski A.
      Abstract: People who maintain high levels of intellectual stimulation throughout life may delay the onset of cognitive impairment by more than 8 years, according to a population-based study of 1718 cognitively normal individuals and 277 individuals with mild cognitive impairment aged 70 to 89 years (Vemuri P et al. JAMA Neurol. doi:10.1001/jamaneurol.2014.963 [published online June 23, 2014]). The study examined the protective effect of 2 components of lifetime intellectual enrichment: occupation and number of years of education, and engagement in cognitively stimulating activities (such as reading, crafts, social activities, and games) in mid- to late life.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • MI Survivors Who Quit Using Snuff Add Years to Their Lives
    • Authors: Slomski A.
      Abstract: Individuals younger than 75 years who quit using oral moist snuff after a myocardial infarction (MI) nearly halved their mortality risk compared with those who continued its use after MI, according to a prospective cohort study of 2474 Swedish MI survivors (Arefalk G et al. Circulation. 2014;130[4]:325-332). In Sweden, 20% of men and 3% of women are daily users of snus, the Swedish form of snuff, which has similar levels of nicotine to US moist snuff brands.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Arsenic at Low Levels Linked With Cancer in Rodents
    • Authors: Hampton T.
      Abstract: In a study that attempted to duplicate humans’ exposure to arsenic throughout their entire lifetime, researchers at the National Institute of Environmental Health Sciences found significant increases in lung tumors in mice exposed to very low levels of arsenic, levels similar to those that humans might encounter (Waalkes MP et al. Arch Toxicol. doi:10.1007/s00204-014-1305-8 [published online July 9, 2014]).
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • FDA Alert on Pure Caffeine Powder
    • Authors: Hampton T.
      Abstract: The US Food and Drug Administration (FDA) has issued a warning to consumers about powdered pure caffeine, especially products that are sold in bulk bags over the Internet (http://1.usa.gov/Ugb7Gn).
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Sickle Cell Drug Candidate Under Development
    • Authors: Hampton T.
      Abstract: For the first time, a pharmaceutical company has acquired a drug candidate developed with resources from a National Institutes of Health (NIH) program for rare and neglected diseases (http://1.usa.gov/1kDK7XW).
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Warning System Aims to Detect Emerging Trends in Illegal Drug Use
    • Authors: Hampton T.
      Abstract: A national surveillance system is being developed to use both traditional data collection strategies and scans of social media and web platforms to identify emerging designer synthetic drugs and their metabolites (http://1.usa.gov/1mRw1XJ).
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Shelter Dogs May Offer Clues to Chagas Disease Risk in Humans
    • Abstract: Man’s best friend might also be a harbinger of Chagas disease.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Tobacco’s Continuing Health Threat
    • Abstract: Cigarette smoking has plummeted among US adults in the 50 years since the Surgeon General’s report on the habit’s dangers. But health threats from tobacco products continue, with stagnant rates of cigar and smokeless tobacco use and rapidly increasing electronic cigarette use.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Electronic Health Record Assists in Routine HIV Screening
    • Abstract: Updated programs at health facilities in New York City and New Orleans have used electronic health records to improve their routine HIV screening rates.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Kids Eat Their Fruits and Veggies
    • Abstract: More than three-quarters of US children and teens eat fruit and 9 of 10 consume vegetables, according to a recent analysis.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Woman Walking in an Exotic Forest (Femme se promenant dans une forêt
           exotique) Henri Rousseau
    • Authors: Smith JM.
      Abstract: The impediments encountered on the path to artistic celebrity status for Henri Rousseau (1844-1910) would have deterred anyone of lesser determination, but a painter he wanted to be, and despite poverty, age, and lack of training, he would not be denied. A Rousseau motif came to include a colorful kaleidoscope of tigers, lions, and exotic flora that he brought to life on canvas. A modicum of patience was needed before he saw his dream gain the momentum that occurred around the time of his 1905 exhibition of The Hungry Lion Throws Itself on the Antelope. His jewel-like jungle scenes offer an incomparable excursion for the imagination.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Polio Water
    • Authors: Jones D.
      Abstract: Stagnant and foul, what pooledin oily, iridescent cloudsin puddles, in ditches,in gutters along the curbs,in rain-filled pailsleft outside overnight,was something to be shunned.At school, we’d seenthe suddenly vacant desk,then two, then three, a warningthat something like the windwe couldn’t see exceptby its effects—leaves stumblingin circles, the twisted trunksof trees—could catch usif we played too hardand take our breath away.Under our parents’ frowning,vigilant gaze, we stayedout of the midday sun, tooknaps after school every day.And whenever we found it standing, skinned with pearl,we ran off shrieking“Polio water! Polio water!”—the only name we had for the cold iron seepinginto us, stiffening our legs.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • The Eating of Ices
    • Abstract: There has been some outcry lately against the eating of ices. Hands have been thrown up in astonishment because certain ice cream has been found to contain certain adulterations, and not infrequently the deadly ptomaine. There is no question that many food products are adulterated, but that ice cream is more frequently adulterated than other articles of diet, we disbelieve. A sneer has become habitual with many when speaking of the Americans; and the American fondness for ice water and iced confections has passed into a proverb.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • Testing for “Silent” Coronary Heart Disease
    • Authors: Jin J.
      PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
  • JAMA
    • PubDate: Wed, 27 Aug 2014 00:00:00 GMT
       
 
 
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