CINXE.COM
Commenting Policy | JAMA Network
<!DOCTYPE html> <html id="doc" lang="en" class="page-sspage"> <head id="Head1"> <!-- charset must appear in the first 1024 bytes of the document --> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /><meta name="viewport" content="width=device-width, initial-scale=1" /><meta name="format-detection" content="telephone=no" /><link rel="shortcut icon" href="//cdn.jamanetwork.com/UI/app/img/favicons/umb/favicon.ico"> <link rel="icon" type="image/png" href="//cdn.jamanetwork.com/UI/app/img/favicons/umb/favicon-192x192.png" sizes="192x192"> <link rel="apple-touch-icon" sizes="180x180" href="//cdn.jamanetwork.com/UI/app/img/favicons/umb/apple-touch-icon-180x180.png"> <meta http-equiv="X-UA-Compatible" content="IE=Edge" /> <link rel="stylesheet" href="//cdn.jamanetwork.com/UI/app/dist/app.min.css?v=638677764476993385"> <link rel="canonical" href="https://jamanetwork.com/pages/commenting-policy" /> <title>Commenting Policy | JAMA Network</title> <link rel="canonical" href="https://jamanetwork.com/pages/commenting-policy" /> <meta name="description" content="Commenting Policy | JAMA Network Online Commenting Policy The JAMA Network welcomes online comments that contribute to meaningful conversations about the articles we publish. Editors may lightly edit submitted comments for format, spelling, punctuation, grammar, and readability. We do not publish every submitted comment. We may reject comments because they Duplicate what others have already..."> <script src="//cdn.jamanetwork.com/UI/app/dist/head.min.js?v=638677764511843155"></script> <script src="https://r451.jamanetwork.com/script.js" defer></script> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_HeaderScript"> <meta class="SCM-SharedWidgets-AsyncHeaderAdLoader" data-url="/AMA/AdTag/AMA_AdTag_HeaderScript" data-params="{"parameters":{"siteName":null,"siteId":11,"journalId":0,"adDisplay":0,"adSection":"pages","adPosition":"","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"> </div> </head> <body data-sitename="jamanetwork" class="pg_sspage suppress-ads " data-thm="umb"> <script> var App = App || {}; App.suppressAds = App.suppressAds || !!document.getElementsByClassName('suppress-ads').length; App.suppressGtm = App.suppressGtm || !!document.getElementsByClassName('suppress-gtm').length; </script> <a class="accessible js-skip-to-navigation" href="#skip-to-navigation">[Skip to Navigation]</a> <!-- Google Tag Manager --><noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-WNKSNP" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-WNKSNP');</script><!-- End Google Tag Manager --> <span class="hide tagmanagervalue" data-attribute="productName" data-value="JAMA Network" data-type="string"></span> <form method="post" action="./commenting-policy" id="webform" class="m0"> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="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" /> </div> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="E492ED35" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="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" /> </div> <input id="hdnSiteID" type="hidden" value="11" /> <input id="hdnDomain" type="hidden" value=".jamanetwork.com" /> <section class="master-header"> <script type='text/javascript'> var App = App || {}; App.LoginUserInfo = { isInstLoggedIn: [0], currentSessionId: 'sevcpbg1wfz254thegeiymsh' }; </script> <input name="ctl00$ctl00$BodyContent$Header$hfGlobalSearchSiteURL" type="hidden" id="hfGlobalSearchSiteURL" value="https://jamanetwork.com/" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsPaidUser" type="hidden" id="hfAppIsPaidUser" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsMember" type="hidden" id="hfAppIsMember" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppSubscribedTo" type="hidden" id="hfAppSubscribedTo" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsIndividual" type="hidden" id="hfAppIsIndividual" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppHasAccess" type="hidden" id="hfAppHasAccess" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsReferredFromGoogle" type="hidden" id="hfAppIsReferredFromGoogle" value="False" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrAutoSuggestMinimumCharactersLength" type="hidden" id="hfSolrAutoSuggestMinimumCharactersLength" value="2" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalName" type="hidden" id="hfSolrJournalName" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalID" type="hidden" id="hfSolrJournalID" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsLucy" type="hidden" id="hfAppIsLucy" value="false" /> <div class="header-wrap"> <header class="header"> <div class="widget-GdprCookieBanner widget-instance-GdprCookieBanner"> <div class="gdpr-cookie-wrapper js-gdpr-banner"> <div class="gdpr-cookie-body"> Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our <a href="https://jamanetwork.com/pages/privacy-policy#cookies">Cookie Policy</a> <span class="pipe">|</span> <a href="javascript:;" class="js-gdpr-cookie-acceptLink at-acceptgdpr">Continue</a> </div> <input id="hdnDomain" type="hidden" value=".jamanetwork.com" /> <input id="hdnDomainGdpr" type="hidden" value=".jamanetwork.com" /> <input id="hdnClientIdGdpr" type="hidden" value="3" /> </div> </div> <div class="network-bar"> <a class="jama-network" href="/" title="JAMA Network Home"> <img alt="JAMA Network Home" class="title-image" width="443" height="52" src="//cdn.jamanetwork.com/UI/app/svg/Jama_Network_Logo.svg"> </a> </div> <a class="nav-toggler" href="#nav"> <div class="nav-toggler-indicator"> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> </div> <div class="nav-toggler-site"> <span id="BodyContent_Header_siteFullNamenav" class="nav-toggler-microsite"><span class='network'>JAMA</span> Network</span> </div> </a> <nav id="nav" class="nav hide" > <div class="nav-journal-level sb-nav-journal-level"> <a href="/pages/for-authors" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_0" class="for-authors">For Authors</a><a href="/pages/audio" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_1" class="podcasts">Podcasts</a><a href="/pages/video" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_2" class="video">Video</a><a href="https://edhub.ama-assn.org/jn-learning" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_3" target="_blank" class="cme">CME</a> </div> <div class="nav-journals"> <div class="widget-SelfServeContent widget-instance-HamburgerPublicationMenu"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="HamburgerPublicationMenu" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .nav-journals {margin-bottom: 1em;} .nav-heading {color: #B9B9B9;border-bottom: 0;border-top: 1px solid #242424;font-size: 1.15em;font-weight: 400;margin: 0;padding: .7em .75em .25em;text-transform: uppercase;} a.no-bullet:before {content:none !important;} .nav-heading {font-size: 1.15em;margin-bottom:0;padding-left: 38px;} /* .nav-journals a.theme-jama {background-color: #242424;border-bottom: 1px solid #fff;border-top: 1px solid #fff;color: #fff;font-size: 1.15em;margin-bottom: 8px;padding: 11px 0 9px 37px;} .nav-journals a.theme-jama::before {background: unset;content: "\e91b";display: none;font-family: ama_icons !important;font-size: 1.25em;line-height: 1;} .nav-journals a.theme-jama-network-open {border-bottom:0;} */ .nav .widget-instance-HamburgerPublicationMenu a {padding-left: 36px;} .fake-ribbon {border-left: 8px solid #BE1E32;} .fake-ribbon a:before {content:none;} .nav .widget-instance-HamburgerPublicationMenu .fake-ribbon a {padding-left:30px;} .nav-journals a.theme-plus:before {background:#d71635;} .nav-journals a.theme-jama-network-open {border-bottom:0;} </style> <h2 class="nav-heading">JAMA+</h2> <a href="/channels/ai" class="theme-plus">AI</a> <h2 class="nav-heading">Journals</h2> <a href="/journals/jama" class="theme-jama">JAMA</a> <a href="/journals/jamanetworkopen" class="theme-jama-network-open">JAMA Network Open</a> <a href="/journals/jamacardiology" class="theme-jama-cardiology">JAMA Cardiology</a> <a href="/journals/jamadermatology" class="theme-jama-dermatology">JAMA Dermatology</a> <a href="/journals/jama-health-forum" class="theme-jama-health-forum">JAMA Health Forum</a> <a href="/journals/jamainternalmedicine" class="theme-jama-internal-medicine">JAMA Internal Medicine</a> <a href="/journals/jamaneurology" class="theme-jama-neurology">JAMA Neurology</a> <a href="/journals/jamaoncology" class="theme-jama-oncology">JAMA Oncology</a> <a href="/journals/jamaophthalmology" class="theme-jama-ophthalmology">JAMA Ophthalmology </a> <a href="/journals/jamaotolaryngology" class="theme-jama-otolaryngology-head-neck-surgery">JAMA Otolaryngology–Head & Neck Surgery</a> <a href="/journals/jamapediatrics" class="theme-jama-pediatrics">JAMA Pediatrics</a> <a href="/journals/jamapsychiatry" class="theme-jama-psychiatry">JAMA Psychiatry</a> <a href="/journals/jamasurgery" class="theme-jama-surgery">JAMA Surgery</a> <a href="/journals/archneurpsyc" class="theme-archives-of-neurology-psychiatry-1919-1959-">Archives of Neurology & Psychiatry (1919-1959)</a> </div> </div> </div> <div class="nav-network-other"> <a href="https://edhub.ama-assn.org/jn-learning" id="BodyContent_Header_rptOtherResources_aItemResourceList_0" class="is-b link-jn-learning-cme" target="_blank">JN Learning / CME</a><a href="https://store.jamanetwork.com" id="BodyContent_Header_rptOtherResources_aItemResourceList_1" class="is-b link-subscribe" target="_blank">Subscribe</a><a href="https://careers.jamanetwork.com/" id="BodyContent_Header_rptOtherResources_aItemResourceList_2" class="is-b link-jobs" target="_blank">Jobs</a><a href="https://jamanetwork.com/pages/resources-for-librarians" id="BodyContent_Header_rptOtherResources_aItemResourceList_3" class="is-b link-institutions-librarians">Institutions / Librarians</a><a href="https://jamanetwork.com/pages/reprints-and-permissions" id="BodyContent_Header_rptOtherResources_aItemResourceList_4" class="is-b link-reprints-permissions" rel="nofollow">Reprints & Permissions</a> </div> <div class="white text-xxs"> <div class="p05 ml4 mr3 mb1 mt10 flex hamburger-menu-legal"> <a href="/pages/conditions-of-use" class="p0" rel="nofollow">Terms of Use</a> <span class="pl1 pr1">| </span> <a href="/pages/privacy-policy" class="p0" rel="nofollow">Privacy Policy</a> <span class="pl1 pr1">| </span> <a href="/pages/accessibility-statement" class="p0" rel="nofollow">Accessibility Statement</a> </div> <div class="ta-c"> <span class="pb1">2024 American Medical Association. All Rights Reserved</span> </div> </div> </nav> <a class="toolbar-search-trigger is-b" data-mobile-tog-target=".site-search"></a> <div id="site-search" role="search" class="site-search"> <div class="site-search-bar"> <div role="search"> <select name="ctl00$ctl00$BodyContent$Header$ddlForSearch" id="BodyContent_Header_ddlForSearch" Name="dropDownList" class="cs-select cs-skin-border" title="Search Site Selector" role="options" aria-labelledby="searchLabel"> <option value="J*">Search All</option> <option value="3">JAMA</option> <option value="214">JAMA Network Open</option> <option value="192">JAMA Cardiology</option> <option value="12">JAMA Dermatology</option> <option value="261">JAMA Forum Archive</option> <option value="193">JAMA Health Forum</option> <option value="15">JAMA Internal Medicine</option> <option value="16">JAMA Neurology</option> <option value="159">JAMA Oncology</option> <option value="17">JAMA Ophthalmology</option> <option value="18">JAMA Otolaryngology–Head & Neck Surgery</option> <option value="19">JAMA Pediatrics</option> <option value="14">JAMA Psychiatry</option> <option value="20">JAMA Surgery</option> <option value="23">Archives of Neurology & Psychiatry</option> </select> </div> <div class="search-input-container"> <input type="search" name="textbox" autocomplete="off" role="textbox" id="search-term" aria-labelledby="searchLabel" class="search-term at-microsite-search-term" placeholder="Enter Search Term" maxlength="255" title="Enter Search Term"> <ul id="umbrellaSiteAutoCompleteResults" class="term-list hidden"></ul> <label style="display:none" for="umbrellaSiteSearchInputHint" id="searchLabel">Input Search Term</label> <input class="searchTerm search-input" name="textbox" role="textbox" type="text" id="umbrellaSiteSearchInputHint" aria-labelledby="searchLabel" title="Input Search Term" autocomplete="off"> </div> <!-- /.search-input-container --> <a name="button" role="button" class="search-button is-b js-search-button" alt="search button" href="/searchresults"></a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_auth" class="auth"> <a class="auth--trigger is-b is-a" href="javascript:;"> <span id="BodyContent_Header_GlobalSignIn_spnUserFullName" class="user-full-name">Sign In</span> </a> <div class="auth--dropdown js-signIn-dropdown"> <div class="auth--option auth--ind"> <div id="BodyContent_Header_GlobalSignIn_divUserFullName" class="auth--ind-user"></div> <div id="BodyContent_Header_GlobalSignIn_divIndSignIn" class="auth--ind-auth"> <div class="auth--title">Individual Sign In</div> <a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fpages%2fcommenting-policy" id="BodyContent_Header_GlobalSignIn_oauthSignInLink" rel="nofollow" class="auth--ind-sign-in">Sign in</a><a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fpages%2fcommenting-policy" id="BodyContent_Header_GlobalSignIn_oauthSignUpLink" rel="nofollow" class="auth--ind-create">Create an Account</a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_divInstSignIn" class="auth--option auth--inst"> <div class="auth--inst-auth"> <div class="auth--title">Access through your institution</div> <a href="/signinshibboleth?returnUrl=https%3a%2f%2fjamanetwork.com%2fpages%2fcommenting-policy" id="BodyContent_Header_GlobalSignIn_institutionSignIn" rel="nofollow" class="auth--shib">Sign In</a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_divPurchaseOptions" class="auth--option auth--purchase"> <div class="auth--title">Purchase Options:</div> <a id="BodyContent_Header_GlobalSignIn_lnkSubscribeJournal" class="auth--subscribe" rel="nofollow" href="https://store.jamanetwork.com">Subscriptions and More</a> </div> </div> </div> </header> </div> <div class="editors-choice-header"> </div> <div id="BodyContent_Header_divAds" class="header-ad-wrap sb-background-primary-dark"> <div class="leader-ad desktop-only"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_LeaderboardAd"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_LeaderboardAd" data-params="{"parameters":{"siteName":null,"siteId":11,"journalId":0,"adDisplay":1,"adSection":"pages","adPosition":"atf","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> </div> <!-- /.header-ad-wrap --> </section> <section class="master-main"> <div id="mainContent" class="ss-content"> <a id="skip-to-navigation" href="#" tabindex="-1"></a> <div class="widget-SelfServeContent widget-instance-AMA_SelfServe_MainContent"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="commenting-policy" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <link rel="stylesheet" href="https://cdn.jamanetwork.com/data/CSSUploads/jamanetwork-selfserve.css?versionId=77023"> <div class="content jn-ss"> <div class="self-serve"> <div class="row"> <div class="col-12"> <h1 class="id-offset" id="top">Online Commenting Policy</h1> </div> </div> <div class="row"> <div class="col-8"> <p>The JAMA Network welcomes online comments that contribute to meaningful conversations about the articles we publish.</p> <p>Editors may lightly edit submitted comments for format, spelling, punctuation, grammar, and readability.</p> <p>We do not publish every submitted comment. We may reject comments because they</p> <ul> <li> Duplicate what others have already said, or what the commenter has already said in one or more previously published comments </li> <li> Are off-topic, defamatory, insulting, difficult to understand, or potentially compromised by conflicts of interest </li> <li> Reveal personal health information </li> <li> Omit or obscure disclosure of identity, academic or professional affiliations, or conflicts of interest, or mislead about the same </li> <li> Are submitted a long time after article publication </li> <li> Make a limited contribution to meaningful or substantive conversation about the paper </li> </ul> <p>or for other reasons.</p> <p>We aim to publish comments within 2 business days. Due to sheer volume we cannot notify users about the status of their submitted comment or request author replies.</p> <p>To comment on an article click the Comment link on the article page.</p> <!-- <p class="jn-ss-back-to-top"> <a href="#top">Back to top</a> </p> --> </div> <div class="col-4 full-width-tablet"> <div class="ss-box sugar-cookie"> <h4 class="underlined-header"><span>Quick Links</span></h4> <ul class="list-style-1" style="list-style-type: none;"> <li><a href="/pages/accessibility-statement">Accessibility Statement</a></li> <li><a href="/pages/conditions-of-use">Conditions of Use</a></li> <li><a href="/pages/privacy-policy">Privacy Policy</a></li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> </section> <section id="secFooterControl" class="master-footer"> <script> var App = App || {}; function scmByClass(className) { return document.getElementsByClassName(className); } function scmById(id) { return document.getElementById(id); } function scmquery(selector) { return document.querySelector(selector); } function queryAll(selector) { return document.querySelectorAll(selector); } function isTrueString(string) { if (typeof string === 'string') { return string.toLowerCase() === 'true'; } return undefined; } function updateViewportDimensions() { var w = window, d = document, e = d.documentElement, g = d.getElementsByTagName('body')[0], x = w.innerWidth || e.clientWidth || g.clientWidth, y = w.innerHeight || e.clientHeight || g.clientHeight; return { width: x, height: y }; } var viewport = updateViewportDimensions(); var debounce = function (func, wait, immediate) { var timeout; return function () { var context = this, args = arguments; var later = function () { timeout = null; if (!immediate) func.apply(context, args); }; var callNow = immediate && !timeout; clearTimeout(timeout); timeout = setTimeout(later, wait); if (callNow) func.apply(context, args); }; }; (function (App) { App.mobileUpperBreakpoint = 767; App.mobileAltBreakpoint = 640; App.mobileMinBreakpoint = 547; App.tabletUpperBreakpoint = 1023; function setVariables() { viewport = updateViewportDimensions(); App.isMobile = (viewport.width <= App.mobileUpperBreakpoint); App.isMobileAlt = (viewport.width <= App.mobileAltBreakpoint); App.isTablet = (viewport.width > App.mobileUpperBreakpoint && viewport.width <= App.tabletUpperBreakpoint); App.isTabletDown = (viewport.width <= App.tabletUpperBreakpoint); App.isDesktop = (viewport.width > App.tabletUpperBreakpoint); App.activeViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large'; } setVariables(); App.cachedViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large'; App.isAnyArticle = !!(scmByClass('widget-ArticleFullView').length || scmByClass('pg_abstract').length || scmByClass('widget-MagazineView').length || scmByClass('widget-ChannelsMagazineView').length); App.isSplitScreen = !!scmByClass('widget-ArticleFullView').length; App.isArticleRedesign = !!scmByClass('widget-ArticleWrapper').length; App.isAbstract = !!scmByClass('pg_abstract').length; App.isMag = !!(scmByClass('widget-MagazineView').length); App.isChannel = !!(scmByClass('channel-site').length); App.isChannelMag = !!(scmByClass('widget-ChannelsMagazineView').length); App.isFreeArticle = !!(scmquery('.widget-ArticleTopInfo .free-access') || scmquery('.widget-ArticleTopInfo .open-access') || scmquery('.widget-ArticleTopInfo .icon-free') || scmquery('.widget-ChannelsMagazineView .free-access')); App.isTollFreeAccess = false; App.isIssue = !!scmByClass('pg_issue').length || !!scmByClass('pg_newonline').length || !!scmByClass('pg_currentissue').length || !!scmByClass('pg_pastissues').length; App.isNewOnline = !!scmByClass('pg_newonline').length; App.isCurrentIssue = !!scmByClass('pg_currentissue').length; App.isPastIssues = !!scmByClass('pg_pastissues').length; App.isJournal = !!scmByClass('pg_journal').length; App.isNetworkHome = !!scmByClass('pg_index').length; App.isSearch = !!scmByClass('pg_searchresults').length; App.isAdvancedSearch = !!scmByClass('pg_advancedsearch').length; App.isPlayer= !!scmByClass('pg_multimediaplayer').length; App.isSelfServe = !!scmByClass('pg_sspage').length; App.isCmsPage = !!scmByClass('pg_cmspage').length; App.isMyAccount = !!scmByClass('pg_myaccount').length; App.supportsFlexbox = !!scmByClass('flexbox').length; App.isCollection = !!scmByClass('pg_collection').length; App.isPaidUser = isTrueString(scmById('hfAppIsPaidUser').getAttribute('value')); App.isMember = isTrueString(scmById('hfAppIsMember').getAttribute('value')); App.isIndividual = isTrueString(scmById('hfAppIsIndividual').getAttribute('value')); App.hasAccess = isTrueString(scmById('hfAppHasAccess').getAttribute('value')); App.isReferredFromGoogle = isTrueString(scmById('hfAppIsReferredFromGoogle').getAttribute('value')); var subscribedTo = scmById('hfAppSubscribedTo').getAttribute('value'); App.userSubscribedTo = subscribedTo ? subscribedTo.split(',') : undefined; App.isLucy = isTrueString(scmById('hfAppIsLucy').getAttribute('value')); App.currentJournalCount = 27; App.isChannelPage = !!(scmByClass('channels-page')); App.updateAppVariables = debounce(function () { setVariables(); }, 50, false); })(App); </script> <div class="footer-ad-wrapper"> <div id="BodyContent_Footer_divAds" class="footer-ad desktop-only"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_AnchorboardAd_btf"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_AnchorboardAd_btf" data-params="{"parameters":{"siteName":null,"siteId":11,"journalId":0,"adDisplay":11,"adSection":"pages","adPosition":"btf","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> </div> <div class="ad-riser-wrap desktop-only"> <div class="ad-riser--dismiss t-c">X</div> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_Riser"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_Riser" data-params="{"parameters":{"siteName":null,"siteId":11,"journalId":0,"adDisplay":12,"adSection":"pages","adPosition":"Riser","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div class="footer-wrap"> <footer class="footer" id="footer"> <div id="footer-microsite" class="footer-microsite"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Left" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .footer-microsite-contents {margin-bottom:1em;} .footer-network-other .link-apps:before {width: 23px;} .footer-network-other .link-institutions-librarians:before {width: 23px;} .jn-ss-footer-border-top {border-top:1px solid #555;padding-top:15px;} .jn-ss-footer-border-bottom {border-bottom:1px solid #555;padding-bottom:10px;} .jn-ss-footer-button-gray {background: grey !important;} .jn-ss-footer-button-gray:hover {background: #fff !important;} .widget-instance-AMAv2_EmailListSignUp_Footer .email-signup--submit {background: grey !important;} .widget-instance-AMAv2_EmailListSignUp_Footer .email-signup--submit:hover {background: #fff !important;} </style> <div class="footer-heading-wrap"> <h3 id="BodyContent_Footer_h3SiteName" class="footer-heading is-b footer-microsite-heading" data-mobile-tog-target=".footer-microsite-links-wrap">JAMA Network</h3> </div> <div class="footer-microsite-links-wrap"> <div class="footer-microsite-contents"> <h4 id="BodyContent_Footer_ContentHeader" class="footer-subheading">Content</h4> <a href="/">Home</a> <a href="/pages/audio" target="_blank">Podcasts</a> <a href="/pages/video" target="_blank">Video</a> <a href="https://sites.jamanetwork.com/" target="_blank">Featured Content</a> </div> <div class="footer-network-other jn-ss-footer-border-top jn-ss-footer-border-bottom"> <a href="https://edhub.ama-assn.org/jn-learning" class="link-network-other is-b link-learning">JN Learning / CME</a> <a href="https://store.jamanetwork.com" class="link-network-other is-b link-store" target="_blank">Store</a> <a href="https://careers.jamanetwork.com/" class="link-network-other is-b link-jobs" target="_blank">Jobs</a> <a href="/pages/resources-for-librarians" class="link-network-other is-b link-institutions-librarians" target="_blank">Institutions</a> <a href="/pages/reprints-and-permissions" class="link-network-other is-b link-reprints-permissions" target="_blank">Reprints & Permissions</a> </div> <div id="BodyContent_Footer_divSubscribe" class="footer-microsite-subscribe"> <div class="subscribe-meta"> <h4 class="subscribe-heading footer-subheading">Subscribe</h4> <a href="https://store.jamanetwork.com/" class="subscribe-submit btn jn-ss-footer-button-gray">Go</a> </div> </div> </div> </div> <div id="footer-network" class="footer-network"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Middle" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .footer-network-sites {width: 62.85542%;} .footer-network-info {width: 35.93976%} .jn-ss-subheading-mt {margin-top: 1.5em;} .jn-registered:after {content: "\00AE";font-size: 50%;vertical-align: top;} .jn-trademark:after {content: "\2122";font-size: 50%;vertical-align: top;} .nav-logo-cme-signin-container .nav-logo .site-logo img { min-width:50px;} </style> <div class="footer-heading-wrap"> <h3 class="footer-heading is-b jn-registered" data-mobile-tog-target=".footer-network-links-wrap"><strong>JAMA</strong> Network</h3> </div> <div class="footer-network-links-wrap"> <div class="footer-network-sites"> <div class="internal"> <h4 id="BodyContent_Footer_JournalHeader" class="footer-subheading">Publications</h4> <a href="/journals/jama">JAMA</a> <a href="/journals/jamanetworkopen" target="_blank">JAMA Network Open</a> <a href="/journals/jamacardiology">JAMA Cardiology</a> <a href="/journals/jamadermatology">JAMA Dermatology</a> <a href="/journals/jama-health-forum">JAMA Health Forum</a> <a href="/journals/jamainternalmedicine">JAMA Internal Medicine</a> <a href="/journals/jamaneurology">JAMA Neurology</a> <a href="/journals/jamaoncology">JAMA Oncology</a> <a href="/journals/jamaophthalmology">JAMA Ophthalmology</a> <a href="/journals/jamaotolaryngology">JAMA Otolaryngology–Head & Neck Surgery</a> <a href="/journals/jamapediatrics">JAMA Pediatrics</a> <a href="/journals/jamapsychiatry">JAMA Psychiatry</a> <a href="/journals/jamasurgery">JAMA Surgery</a> <a href="/journals/archneurpsyc">Archives of Neurology & Psychiatry (1919-1959)</a> </div> <div class="external"> <h4 class="footer-subheading">Sites</h4> <div id="BodyContent_Footer_ssFooterSiteMenu"> <div class="selfServe"> <a target="_blank" href="https://sites.jamanetwork.com/art-and-images-in-psychiatry/">Art and Images in Psychiatry</a> <a target="_blank" href="/journals/jama/pages/2023-most-viewed-jama">Best of the JAMA Network</a> <a target="_blank" href="/channels/caring-for-the-critically-ill-patient">Caring for the Critically Ill Patient</a> <a target="_blank" href="/journals/jama/pages/crosswords">Clinical Crosswords from JAMA</a> <a target="_blank" href="/journals/jama/pages/coronavirus-alert">Coronavirus Resource Center</a> <a target="_blank" href="https://ebm.jamanetwork.com/index.html">Evidence-Based Medicine: An Oral History</a> <a target="_blank" href="/pages/fishbein-fellowship">Fishbein Fellowship</a> <a target="_blank" href="/channels/genomics/">Genomics and Precision Health</a> <a target="_blank" href="/pages/health-and-the-2024-us-election">Health and the 2024 US Election</a> <a target="_blank" href="/channels/hypertension">Hypertension</a> <a target="_blank" href="/channels/health-forum/archive">JAMA Forum Archive</a> <a target="_blank" href="https://sites.jamanetwork.com/audio">JAMA Network Audio</a> <a target="_blank" href="/pages/video">JAMA Network Video</a> <a target="_blank" href="/pages/conferences">JAMA Network Conferences </a> <a target="_blank" href="/channels/ai">JAMA+ AI</a> <a target="_blank" href="/pages/jama-summit">JAMA Summit </a> <a target="_blank" href="/journals/jamasurgery/pages/statistics-and-methods">JAMA Surgery Guide to Statistics and Methods</a> <a target="_blank" href="/channels/medical-news">Medical News</a> <a target="_blank" href="/channels/monkeypox">Mpox (Monkeypox)</a> <a target="_blank" href="https://sites.jamanetwork.com/research-ethics/">Research Ethics</a> <a target="_blank" href="/pages/collections">Topics and Collections</a> <a target="_blank" href="/pages/visual-abstracts">Visual Abstracts</a> <a target="_blank" href="/channels/war">War and Health</a> <a target="_blank" href="/channels/womens-health">Women's Health</a> <h4 class="footer-subheading jn-ss-subheading-mt">Featured Articles</h4> <a href="/journals/jama/fullarticle/2781397">CONSERVE 2021 Guidelines for Reporting Trials Modified for the COVID-19 Pandemic</a> <a href="/journals/jama/fullarticle/2808296">Creation and Adoption of Large Language Models in Medicine</a> <a href="/journals/jamaoncology/fullarticle/2787350">Global Burden of Cancer, 2010-2019</a> <a href="/journals/jama/fullarticle/2797443">Global Burden of Long COVID</a> <a href="/journals/jamadermatology/fullarticle/2790344">Global Burden of Melanoma</a> <a href="/journals/jamadermatology/fullarticle/2787350">Global Burden of Skin Diseases, 1990-2017</a> <a href="/journals/jamaneurology/fullarticle/2793874">Global Disparities in Parkinson Disease</a> <a href="/journals/jama/fullarticle/2799547">Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension</a> <a href="/journals/jamapsychiatry/fullarticle/2799486">Mass Violence and the Complex Spectrum of Mental Illness and Mental Functioning</a> <a href="/journals/jamapsychiatry/fullarticle/2793903">Neuropsychiatry Sequelae of COVID-19</a> <a href="/journals/jamaneurology/fullarticle/2810313">A New Framework for Dementia Nomenclature</a> <a href="/journals/jama/fullarticle/2800656">Organization and Performance of US Health Systems</a> <a href="/journals/jama-health-forum/fullarticle/2791195">Pharmacy Benefit Managers: History, Business Practices, Economics, and Policy</a> <a href="/journals/jama-health-forum/fullarticle/2791195">Promoting EDI in Genetics Research</a> <a href="/journals/jamacardiology/fullarticle/2781972">PTSD and Cardiovascular Disease</a> <a href="/journals/jama/fullarticle/2810754">Red Blood Cell Transfusion: 2023 AABB International Guidelines</a> <a href="/journals/jamapediatrics/fullarticle/2797600">Reimagining Children’s Rights in the US</a> <a href="/journals/jama/fullarticle/2794049">Spirituality in Serious Illness and Health</a> <a href="/journals/jama/fullarticle/2796374">The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity</a> <h4 class="footer-subheading jn-ss-subheading-mt">USPSTF Recommendation Statements</h4> <a href="/journals/jama/fullarticle/2779985">Screening for Colorectal Cancer</a> <a href="/journals/jama/fullarticle/2779190">Screening for Hypertension</a> <a href="/journals/jama/fullarticle/2777244">Screening for Lung Cancer</a> <a href="/journals/jama/fullarticle/2796244">Screening for Prediabetes and Type 2 Diabetes In Children</a> <a href="/journals/jama/fullarticle/2783414">Screening for Prediabetes and Type 2 Diabetes In Adults</a> <a href="/journals/jama/fullarticle/2795521">Statins for Primary Prevention of Cardiovascular Disease</a> <a href="/journals/jama/fullarticle/2793446">Vitamin and Mineral Supplements for Primary Prevention of of Cardiovascular Disease and Cancer</a> <h4 class="footer-subheading jn-ss-subheading-mt">Blogs</h4> <a target="_blank" href="https://amastyleinsider.com/">AMA Style Insider</a> </div> </div> </div> </div> <div id="footer-network-info" class="footer-network-info"> <div class="information-for-links"> <h4 id="BodyContent_Footer_InfoHeader" class="footer-subheading">Information</h4> <a href="/pages/for-authors">For Authors</a> <a href="/pages/resources-for-librarians">For Institutions & Librarians</a> <a href="/pages/advertisers">For Advertisers</a> <a href="/pages/subscription-agents">For Subscription Agents</a> <a href="https://careers.jamanetwork.com/" target="_blank">For Employers & Job Seekers</a> <a href="https://media.jamanetwork.com" rel="nofollow" target="_blank">For the Media</a> <a href="/pages/equity-diversity-inclusion">Equity, Diversity, Inclusion</a> <a href="/pages/commenting-policy">Online Commenting Policy</a> <a href="/pages/access-at-jama-network">Public Access and Open Access Policy</a> <a href="/pages/offensive-content-statement">Statement on Potentially Offensive Content</a> </div> <div class="services-links"> <h4 id="BodyContent_Footer_JAMANetworkProductsHeader" class="footer-subheading">JAMA Network Products</h4> <a href="http://www.amamanualofstyle.com/" class="footer-service-link" target="_blank">AMA Manual of Style</a> <a href="https://jamaevidence.mhmedical.com/" class="footer-service-link" target="_blank"><span class="jn-registered">JAMAevidence</span></a> <a href="http://www.peerreviewcongress.org/" class="footer-service-link" target="_blank">Peer Review Congress</a> </div> <div class="learning-links"> <h4 id="BodyContent_Footer_LearningHeader" class="footer-subheading">JN Learning</h4> <a href="https://edhub.ama-assn.org/jn-learning">Home</a> <a href="https://edhub.ama-assn.org/jn-learning/state-cme">State CME</a> <a href="https://edhub.ama-assn.org/jn-learning/pages/clinical-challenge-courses">Clinical Challenge CME</a> <a href="https://edhub.ama-assn.org/jn-learning/course/288 ">Atrial Fibrillation Course</a> <a href="https://edhub.ama-assn.org/jn-learning/course/294 ">Women's Health Course</a> <a target="_blank" href="https://edhub.ama-assn.org/pages/auto-credit-reporting">CME / MOC Reporting Preferences</a> <a href="https://edhub.ama-assn.org/jn-learning/pages/about-cme">About CME & MOC</a> </div> </div> </div> </div> <div id="footer-resources-wrap" class="footer-resources-wrap"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Right" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .footer-resources-wrap .footer-subheading {color: grey;display:block !important;font-size: 1.17647em;font-weight: 400;text-transform: uppercase;} </style> <div class="footer-heading-wrap"> <h3 class="footer-heading is-b footer-resources-heading" data-mobile-tog-target=".footer-resources">Help</h3> </div> <div class="footer-resources"> <a href="https://store.jamanetwork.com" class="footer-service-link" target="_blank">Subscriptions & Renewals</a> <a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-alerts" class="footer-service-link" rel="nofollow">Manage Emails</a> <a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-profile" class="footer-service-link" rel="nofollow">Update My Address</a> <a href="https://support.jamanetwork.com/hc/en-us" class="footer-service-link">Support Center</a> <a href="/myaccount " class="footer-service-link">My Account</a> <h4 class="footer-subheading jn-ss-subheading-mt">JAMA Career Center</h4> <a href="https://careers.jamanetwork.com/" class="footer-service-link" target="_blank">Physician Job Listings</a> </div> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Socials" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .widget-instance-AMAv2_Network_Sidebar_Socials .iconsocial {display: inline-block !important;width: 34px;height: 34px;min-width: unset !important;margin: 0 2px !important;background-color: #fff;border-radius: 20px;border: 1px solid #191919;vertical-align: middle;} .widget-instance-AMAv2_Network_Sidebar_Socials .iconsocial.instagram {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);background-position: 7px 7px;background-repeat: no-repeat;background-size: 18px;} .widget-instance-AMAv2_Network_Sidebar_Socials .iconsocial.instagram:hover, .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram:focus {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png);border-color: #C13584;} .footer-resources-wrap .iconsocial {display: inline-block !important;width: 32px;height: 32px;min-width: unset !important;margin: 0 2px 0 3px !important;background-color: #fff;border-radius: 20px;border: 1px solid #191919;vertical-align: middle;} .footer-resources-wrap .iconsocial.instagram {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);background-position: 6px 6px;background-repeat: no-repeat;background-size: 18px;} .footer-resources-wrap .iconsocial.instagram:hover, .footer-resources-wrap .iconsocial.instagram:focus {background-color: #C13584;border-color: #191919;} #load-instagram-image { background: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png) no-repeat -9999px -9999px; } </style> <div id="BodyContent_Footer_divSocial" class="social-links footer-social-links"> <a target="_blank" rel="nofollow" data-emailid="06953c37-785c-4408-b2cd-4b9f89d3b8f1" href="https://www.facebook.com/JAMANetwork/" class="social-link is-b facebook"></a> <a target="_blank" rel="nofollow" data-emailid="06953c37-785c-4408-b2cd-4b9f89d3b8f1" href="https://twitter.com/JAMANetwork" class="social-link is-b twitter"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.instagram.com/jamanetwork/?hl=en" class="iconsocial instagram"></a> <a target="_blank" rel="nofollow" data-emailid="06953c37-785c-4408-b2cd-4b9f89d3b8f1" href="https://www.linkedin.com/company/jamanetwork/" class="social-link is-b linked-in"></a> <a target="_blank" rel="nofollow" data-emailid="06953c37-785c-4408-b2cd-4b9f89d3b8f1" href="https://www.youtube.com/jamanetwork" class="social-link is-b you-tube"></a> <a target="_blank" rel="nofollow" data-emailid="06953c37-785c-4408-b2cd-4b9f89d3b8f1" href="https://www.pinterest.com/jamanetwork/" class="social-link is-b pinterest"></a> <a target="_blank" rel="nofollow" data-emailid="06953c37-785c-4408-b2cd-4b9f89d3b8f1" href="/pages/rss/" class="social-link is-b rss"></a> <a target="_blank" rel="nofollow" data-emailid="06953c37-785c-4408-b2cd-4b9f89d3b8f1" href="https://sites.jamanetwork.com/audio/" class="social-link is-b podcast"></a> <div id="load-instagram-image"> </div> </div> <div id="BodyContent_Footer_divEmailUpdate" class="footer-email-updates"> <div class="widget-EmailListSignUp widget-instance-AMAv2_EmailListSignUp_Footer"> <div class="email-signup"> <div class="email-signup--text sb-pc">Get the latest from JAMA Network</div> <div class="email-signup--input-wrap is-b"> <input type="text" name="email" class="email-signup--input" placeholder="Email address" title="Email address" /> <a rel="nofollow" href="javascript:;" class="email-signup--submit sb-sc btn">Sign Up</a> </div> <div class="email-signup--link"> <a class="email-signup--privacy" href="/pages/privacy-policy">Privacy Policy</a> | <a class="email-signup--terms" href="/pages/terms-of-use">Terms of Use</a></div> <div class="email-signup--user-message"></div> </div> </div> </div> </div> <div class="footer-bar" itemscope itemtype="https://schema.org/Organization"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Bottom_Bar" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .network-bar .auth--inst {color:#B8B8B8;} .multimedia-caption-container div.video-caption {color: #262626;font-size: 15px;font-weight: 700;line-height: 1.5;} .nav-journals a.theme-jama-health-forum:before {background: #133763;} .jn-bottom-bar {color: #fff; float: left;font-size: 10px;padding: 13px 20px;width: 33.33%;} .jn-bottom-bar p {line-height: 2;} @media (max-width: 900px) {.jn-bottom-bar {float: none;width: 100%;}} .jn-footer-copyright {font-size:12px;line-height:1.5;margin-bottom:10px;} .jn-footer-pipe {margin:0 10px;} .footer-bar-jn-logo img {width: 230px;} @media (max-width: 900px) {.footer-bar-jn-logo img {width: 200px;}} [data-thm=umb] .jobs-ad--text h6 {color: #d71635 !important;} [data-thm=jama] .jobs-ad--text h6 {color: #d71635 !important;} [data-thm=jaman] .jobs-ad--text h6 {color: #ed0973 !important;} [data-thm=cardi] .jobs-ad--text h6 {color: #be1e32 !important;} [data-thm=derm] .jobs-ad--text h6 {color: #006f3b !important;} [data-thm=faci] .jobs-ad--text h6 {color: #ed1c24 !important;} [data-thm=jama-] .jobs-ad--text h6 {color: #fb5252 !important;} [data-thm=intem] .jobs-ad--text h6 {color: #006e96 !important;} [data-thm=neur] .jobs-ad--text h6 {color: #981b1e !important;} [data-thm=oncol] .jobs-ad--text h6 {color: #3b923f !important;} [data-thm=ophth] .jobs-ad--text h6 {color: #66bc29 !important;} [data-thm=otol] .jobs-ad--text h6 {color: #34b6e4 !important;} [data-thm=peds] .jobs-ad--text h6 {color: #0084c0 !important;} [data-thm=psych] .jobs-ad--text h6 {color: #005276 !important;} [data-thm=surg] .jobs-ad--text h6 {color: #f47920 !important;} .blockquote .para {margin: 0 0 1em 1em;} .jn-footer-copyright {display: block;} .inline-block {display: inline-block;} </style> <a class="footer-bar-jn-logo d-b no-mw mb1" href="/" title="JAMA Network Home"><img class="mw-100" src="https://cdn.jamanetwork.com/ImageLibrary/global/jn-signature-reversed-r.svg?versionId=82308" alt="Jama Network Logo"></a> <div class="jn-bottom-bar"> <p> <span class="jn-footer-copyright">© 2024 American Medical Association. <span class="inline-block">All rights reserved,</span> including those for text and data mining, AI training, <span class="inline-block">and similar technologies.</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/terms-use" rel="nofollow" class="p0">Terms of Use</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/privacy-policy" rel="nofollow" class="p0">Privacy Policy</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/accessibility-statement" rel="nofollow" class="p0">Accessibility Statement</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a onclick="OneTrust.ToggleInfoDisplay()" rel="nofollow" class="p0" id="CookieFooter">Cookie Settings</a></span> </p> </div> <!-- #selfserve-maintenance {display:block;margin:20px 0;max-height:none !important;min-height:200px;visibility:visible;} #selfserve-maintenance {display:block;margin:20px 0;max-height:none !important;min-height:200px;visibility:visible;} --> <a class="footer-bar-sis no-mw relative nudge-down" href="https://www.silverchair.com" target="_blank"><img class="footer-bar-sis-img mt05 mw-100" width="600" height="70" src="//cdn.jamanetwork.com/UI/app/img/powered.png" alt="Silverchair Logo" /></a> </div> </footer> </div> <div class="ss-ui-only"> <div class="widget-SelfServeContent widget-instance-AMA_SS_UI_Only"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SsUiOnly" /> <input type="hidden" class="SelfServeVersionId" value="0" /> . </div> </div> </div> </section> <div class="widget-UserContentAccessWrite widget-instance-AMA_UserContentAccessWrite_Site"> <div class="SCM-SharedWidgets-LocalStorage-UserContentAccessWrite" data-values='{"id":"0","type":"Site","date":"11/24/2024 1:08:32 AM"}'></div> </div> <div id="revealModal" class="reveal-modal" data-reveal> <div id="revealContent"></div> <a class="close-reveal-modal icon-close"></a> </div> <div class="artmet-modal" id="MetricsModal"> <div class="artmet-modal-contents"> <a class="artmet-close-modal">×</a> </div> </div> <div class="widget-SigninModals widget-instance-AMA_SigninModals"> <div class="js-modal-no-access-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Access your subscriptions</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fpages%2fcommenting-policy"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_NoAccess_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr /> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"><div class="text-truncate">Create a free personal account</div></button> <div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_CreateAccount</div>--> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_PurchaseOptions_NoAccessAndPaidPDF"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_NoAccessAndPaidPDF" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr> <button class="modal--btn js-btn-subscribe-journal" type="button" role="button"> <div class="text-truncate">Subscribe to journal</div> </button> <div class="modal--btn-desc">Get full journal access for 1 year</div> <button class="modal--btn js-btn-purchase-article" type="button" role="button"> <div class="text-truncate">Buy article</div> </button> <div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br> <em>Sign in or create a free account</em></div> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_PurchaseOptions_NoAccessAndPaidPDF</div>--> </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-paid-pdf-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Access your subscriptions</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fpages%2fcommenting-policy"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_PaidPdf_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr /> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"><div class="text-truncate">Create a free personal account</div></button> <div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_CreateAccount</div>--> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_PurchaseOptions_NoAccessAndPaidPDF"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_NoAccessAndPaidPDF" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr> <button class="modal--btn js-btn-subscribe-journal" type="button" role="button"> <div class="text-truncate">Subscribe to journal</div> </button> <div class="modal--btn-desc">Get full journal access for 1 year</div> <button class="modal--btn js-btn-purchase-article" type="button" role="button"> <div class="text-truncate">Buy article</div> </button> <div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br> <em>Sign in or create a free account</em></div> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_PurchaseOptions_NoAccessAndPaidPDF</div>--> </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-free-pdf-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Sign in to access free PDF</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fpages%2fcommenting-policy"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_FreePdf_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_FreePdf_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr /> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"><div class="text-truncate">Create a free personal account</div></button> <div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_CreateAccount</div>--> </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-save-search-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Save your search</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fpages%2fcommenting-policy"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_SaveSearch_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr /> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"><div class="text-truncate">Create a free personal account</div></button> <div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_CreateAccount</div>--> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_SaveSearch"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_SaveSearch" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr /> <button class="modal--btn js-btn-subscribe-now">Subscribe now</button> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_PurchaseOptions_SaveSearch</div>--> </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-follow-collection-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Customize your interests</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fpages%2fcommenting-policy"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_FollowCollection_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr /> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"><div class="text-truncate">Create a free personal account</div></button> <div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_CreateAccount</div>--> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_FollowCollection"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_FollowCollection" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--sub-title">Create a personal account or sign in to:</div> <ul> <li>Register for email alerts with links to free full-text articles</li> <li>Access PDFs of free articles</li> <li>Manage your interests</li> <li>Save searches and receive search alerts</li> <ul> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_PurchaseOptions_FollowCollection</div>--> </div> </div> <div class="modal--link-wrap"> <a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-user-comment-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Make a comment</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fpages%2fcommenting-policy"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_UserComment_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr /> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"><div class="text-truncate">Create a free personal account</div></button> <div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_CreateAccount</div>--> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_UserComment"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_UserComment" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--sub-title">Create a personal account or sign in to:</div> <ul> <li>Register for email alerts with links to free full-text articles</li> <li>Access PDFs of free articles</li> <li>Manage your interests</li> <li>Save searches and receive search alerts</li> <ul> <!--<div class="jn-selfServe-modal-label">JAMA Network|SigninModal_PurchaseOptions_UserComment</div>--> </div> </div> <div class="modal--link-wrap"> <a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="hidden-true js-modal-page-data" data-store-url="https://store.jamanetwork.com" data-store-purchase-url="https://jamanetwork.com/oauthsignin?return_url=https://store.jamanetwork.com" data-store-subscribe-url="https://store.jamanetwork.com"> </div> </div> <script src="//cdn.jamanetwork.com/UI/app/vendor/jquery-2.2.4.min.js?v=638654734634555810"></script> <script>window.jQuery || document.write('<script src="/UI/app/vendor/jquery-2.2.4.min.js">\x3C/script>')</script> <script src="//cdn.jamanetwork.com/UI/app/dist/app.min.js?v=638677764559592887" defer></script> </form> <link rel="stylesheet" href="//cdn.jamanetwork.com/UI/app/scss/modules/_trendMD.css"> <div class="widget-CustomJSScript widget-instance-"> <script src="//cdn.jamanetwork.com/ama/ama.proxylogging.js" async></script> </div> </body> </html>