Nevin Manimala

Am J Public Health. 2026 May;116(S2):S70-S74. doi: 10.2105/AJPH.2026.308503.

ABSTRACT

Individuals with intellectual and developmental disabilities (IDD) face significant barriers to health care access. Special Olympics Healthy Athletes addresses this through health screenings and care coordination. From 2023 to 2025, 580 individuals received multidisciplinary referral support. Coordinators provided no-cost benefits navigation, transportation, and provider connections. Common barriers included difficulty locating in-network providers, financial constraints, and limited insurance coverage for specialty services. This highlights the impact of dedicated referral coordination in overcoming systemic barriers and improving care access for individuals with IDD. (Am J Public Health. 2026; 116(S2):S70-S74. https://doi.org/10.2105/AJPH.2026.308503).

PMID:42018944 | DOI:10.2105/AJPH.2026.308503

J Am Acad Orthop Surg Glob Res Rev. 2026 Apr 22;10(4). doi: 10.5435/JAAOSGlobal-D-26-00056. eCollection 2026 Apr 1.

ABSTRACT

INTRODUCTION: Patient insurance type influences treatment timelines in meniscal injuries. This study assessed differences in time to presentation, time to treatment, and clinical outcomes of meniscal injuries in young patients with Medicaid versus commercial insurance. It was hypothesized that patients with Medicaid would have greater delays in time to presentation and treatment and inferior clinical outcomes.

METHODS: This retrospective cohort investigation included patients ages 21 years and younger who underwent meniscal repair by a single sports medicine surgeon. Demographics, injury specifications, and treatment timelines were analyzed. Preoperative, 3-, 6-, and 12-month postoperative pain, International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores were compared.

RESULTS: Time to presentation (163 vs 62 days, P = 0.008) and time from injury to surgery (228 vs 111 days, P = 0.006) were markedly increased in the Medicaid group. Pain (0.5 vs 0.3, P = 0.803), IKDC (89.3 vs 93.1, P = 0.060), Lysholm (94.9 vs 95.1, P = 0.576), and Tegner (7.3 vs 7.3, P = 0.977) scores of Medicaid vs commercial patients were similar at 12 months postoperative. Tegner score of the Medicaid group at 12 months postoperative (7.3) was markedly lower than the preinjury average (8.2) (P = 0.024). The 12-month postoperative IKDC score of Medicaid vs commercial patients with ACL and meniscus tears were markedly different (91.8 vs 97.4, P = 0.044).

CONCLUSION: Young patients with Medicaid insurance undergo meniscal repair nearly 3 months later than those with commercial insurance, return to preinjury activity levels less frequently, and have lower 12-month IKDC scores with combined ACL and meniscus injury. Once established with an orthopaedic surgeon, patients have similar timelines for surgery. The discrepancy in time from injury to surgery is an inequality that deserves to be addressed.

PMID:42018934 | DOI:10.5435/JAAOSGlobal-D-26-00056

Neurol Res. 2026 Apr 22:1-36. doi: 10.1080/01616412.2026.2661743. Online ahead of print.

ABSTRACT

OBJECTIVES: Schizophrenia is a neuropsychiatric disorder that affects emotional, behavioral, and brain functions that can be tracked using electroencephalography (EEG). This research conducts a comparative evaluation of deep learning models utilizing EEG time-frequency and spectral analysis methods to automate schizophrenia detection.

METHODS: Two compatible EEG datasets were merged, yielding a total of 934 EEG samples from 237 subjects (121 schizophrenia patients and 116 controls). Independent Component Analysis (ICA) was applied for signal decomposition. By deriving time-frequency representations using Continuous Wavelet Transform (CWT) and Fast Fourier Transform (FFT), scalogram and spectral inputs for deep learning models were obtained. Six architectures, including CNN variants, CNN-FFT, CNN-ELM, CNN-LSTM, ResNet Transfer, and a Transformer-based model, were evaluated with data augmentation and class balancing to improve robustness.

RESULTS: While variations in numerical performance were observed across models, statistical analysis indicated that these differences were not significant.

DISCUSSION: The study presents results that underscore the benefits of combining time-frequency analysis with deep learning for EEG-based schizophrenia diagnosis, especially via spectral feature extraction in CNN architectures. Furthermore, it provides insights consistent with known neurophysiological patterns in schizophrenia, emphasizing the significance of model interpretability for clinical translation. Future research will focus on the integration of multimodal neuroimaging and the enhancement of explainability frameworks to augment diagnostic reliability.

PMID:42018932 | DOI:10.1080/01616412.2026.2661743

J Am Acad Orthop Surg Glob Res Rev. 2026 Apr 22;10(4). doi: 10.5435/JAAOSGlobal-D-25-00238. eCollection 2026 Apr 1.

ABSTRACT

INTRODUCTION: Sociodemographic differences markedly affect postoperative outcomes in lumbar fusion surgery, often leading to higher infection rates, readmissions, emergency department (ED) visits, and prolonged hospital stays. This study examines the associations between sociodemographic factors and clinical outcomes after elective lumbar fusion surgery.

METHODS: We retrospectively analyzed medical records of patients aged ≥18 years who underwent lumbar or lumbosacral fusion for degenerative conditions from 2018 to 2022 at a single academic institution. ED returns and readmissions within 3 months were also recorded. Statistical analysis was conducted using chi-square tests, t-tests, ANOVA, and multivariate logistic regression models.

RESULTS: A total of 484 patients (54.1% male) were included. Most patients were White (80.4%) and non-Hispanic (91.5%). Men exhibited lower ED utilization (16% versus 23%) and readmission (11.5% versus 19.8%) rates than women. Men were more frequently discharged home (87%) compared with women (79.3%), with fewer discharges to skilled nursing or rehab facilities. No significant differences in length of stay, readmission, ED return, or discharge disposition were observed across racial groups. The private insurance group had shorter hospital stays (3.1 ± 1.7 days) than Medicare/Medicaid patients (3.8 ± 2.6 days) and other groups (4.7 ± 3.3 days, P = 0.005). Medicare/Medicaid patients had higher ED return and readmission rates and were less likely to be discharged home (P < 0.001). Multivariate models revealed that sex and payer status significantly affected readmissions and discharge dispositions.

CONCLUSION: Women and Medicare/Medicaid patients experience poorer postoperative outcomes, with increased ED visits and readmissions after lumbar fusion surgery. Race did not significantly affect outcomes, although small sample sizes may have limited this analysis.

PMID:42018931 | DOI:10.5435/JAAOSGlobal-D-25-00238

An Acad Bras Cienc. 2026 Apr 20;98(1):e20240983. doi: 10.1590/0001-3765202620240983. eCollection 2026.

ABSTRACT

The COVID-19 pandemic’s enforced social isolation significantly disrupted numerous economic activities, notably road transport. This period, dubbed “anthropause,” provided a unique moment to study its effects on wildlife, specifically mammal roadkill patterns on Brazil’s BR-101/North-RJ highway. This research assessed whether reduced vehicle traffic during the pandemic’s first year impacted mammal roadkill rates. Monitoring was conducted monthly from March 2019 to February 2021, spanning pre-pandemic and pandemic periods, across four 10-km highway sections. Findings indicated a 45% decrease in mammal roadkills during the pandemic, especially in the third quadrimester (November-2020 to February-2021) of the pandemic period (W = 77; p = 0.027). Of the nine taxa examined, Didelphis aurita and Coendou spinosus experienced the most significant reductions in roadkill rate. No link was found between climatic conditions and roadkill frequency, yet a noteworthy correlation emerged between vehicle traffic volume and roadkill rates (r = 0.281; p = 0.005). Despite a temporary decline in traffic, varying roadkill rates across highway segments pointed to diverse responses from environmental and traffic variations. The study emphasizes that even modest reductions in traffic can significantly lower roadkill rates, supporting the idea that the anthropause positively influenced the reduction of road-induced mortality among Neotropical mammals.

PMID:42018921 | DOI:10.1590/0001-3765202620240983

JAMA Netw Open. 2026 Apr 1;9(4):e267416. doi: 10.1001/jamanetworkopen.2026.7416.

ABSTRACT

IMPORTANCE: The lack of a comprehensive population-level study evaluating the association of marginalization markers with concussion presentation limits opportunities for health care system improvements.

OBJECTIVE: To describe the association of socioeconomic measures of disparity with location of concussion presentation and follow-up rates.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used linked administrative databases to assess patients with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) concussion diagnosis codes at emergency department (ED) or outpatient clinics in Ontario, Canada, from April 1, 2010, to March 31, 2023. Data analysis was performed from March 1, 2025, to February 8, 2026.

EXPOSURES: Patient-level exposures were age, sex, immigrant status, presence of family physician, and rurality. Neighborhood-level exposures were income quintile, Ontario Marginalization (ON-Marg) Material Resource Index (access to basic material needs, such as percentage of unemployment), Household and Dwelling Index (accommodation type, such as percentage living alone), and Racialized and Newcomer Populations Index (such as percentage of recent immigrants or those who identify as a visible minority group) within 4 different age groups (<18, 18-39, 40-64, and ≥65 years).

MAIN OUTCOMES AND MEASURES: Location of initial visit (ED vs outpatient, including urgent care, walk-in, primary care, and specialty clinic) and presence of outpatient follow-up visit at 30 days or less.

RESULTS: Overall, 674 629 patients were evaluated (356 842 [52.9%] female; mean [SD] age, 32.8 [22.0] years). Marginalization measures were higher for patients first presenting to EDs vs outpatient via the ON-Marg Material Resources Index (57 043 [20.4%] vs 56 856 [14.4%]; difference, 6.2 [95% CI, 6.0-6.3] percentage points), rurality (47 356 [16.9%] vs 35 521 [9.0%]; difference, 7.9 [95% CI, 7.8-8.1] percentage points), and presence of a family physician (264 179 [94.4%] vs 388 346 [98.3%]; difference, -3.9 [95% CI, -3.8 to -4.0] percentage points). In modeling, having a family physician was associated with first seeking care in EDs (18-39 years: odds ratio [OR], 4.71; 95% CI, 4.41-5.03), as was living in rural areas (18-39 years: OR, 1.56; 95% CI, 1.51-1.62). Follow-up rates at 30 days or earlier were lower for patients first seen in EDs (24 307 [8.7%]) vs outpatient (110 821 [28.1%]). In regression analysis assessing variables associated with follow-up, first being seen in EDs (aged 65 years: OR, 0.21; 95% CI, 0.19-0.22), not possessing a family physician (aged ≥65 years: OR, 0.29; 95% CI, 0.19-0.46), and being in the most marginalized quintile for ON-Marg Material Resources (aged ≥65 years: OR, 0.74; 95% CI, 0.65-0.84) were all significantly associated with not completing a follow-up visit.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with concussion treated in Ontario, Canada, those with higher marginalization markers were more likely to first seek care in EDs and have lower follow-up rates. These findings emphasize the importance of expanding health care system-wide resources, including primary care access and telemedicine, and enhancing resources for ED clinicians to optimize concussion care.

PMID:42018325 | DOI:10.1001/jamanetworkopen.2026.7416

JAMA Psychiatry. 2026 Apr 22. doi: 10.1001/jamapsychiatry.2026.0428. Online ahead of print.

ABSTRACT

IMPORTANCE: LB-102 (N-methyl amisulpride) is a novel benzamide under investigation for the treatment of schizophrenia.

OBJECTIVE: To evaluate the efficacy and safety of LB-102 in acute schizophrenia.

DESIGN, SETTING, AND PARTICIPANTS: This US-based, multicenter, double-blind, placebo-controlled, phase 2 randomized clinical trial (NOVA1) conducted from December 2023 to August 2024 comprised an inpatient screening period (≤14 days), 28-day inpatient treatment period, 5-day inpatient stabilization period, and outpatient safety follow-up visit approximately 2 weeks after the treatment period end. Eligible participants were adults (aged 18-55 years) with schizophrenia who required hospitalization or continued hospitalization for an acute exacerbation of psychotic symptoms and had a Positive and Negative Syndrome Scale (PANSS) total score of 80 to 120, PANSS Positive Symptoms subscale item score of 4 or greater on 2 or more key items, and a Clinical Global Impressions-Severity of Illness scale (CGI-S) score of 4 or greater at screening and baseline.

INTERVENTIONS: Participants were randomized (3:3:3:1) to oral once-daily placebo, LB-102 50 mg, 75 mg, or 100 mg.

MAIN OUTCOMES AND MEASURES: The primary end point was change from baseline to week 4 in PANSS total score (Hochberg multiplicity correction for LB-102 50 mg and 75 mg vs placebo). Secondary efficacy end points included changes from baseline to week 4 in CGI-S score, CGI-S response, PANSS subscale scores, PANSS Marder factor scores, and 20% or greater PANSS response. Safety and tolerability end points included treatment-emergent adverse effects (TEAEs).

RESULTS: A total of 359 participants (mean [SD] age, 39.1 [9.3] years; 290 male [80.8%]; mean baseline PANSS total score = approximately 94 across groups) were randomized and included in the safety and intention-to-treat populations (placebo, n = 108; 50 mg, n = 107; 75 mg, n = 108; 100 mg, n = 36). The trial met the primary end point: LB-102 50 mg and 75 mg, were statistically superior to placebo in change from baseline to week 4 in PANSS total score (mean [SE], placebo, -9.3 [1.08]; 50 mg, -14.3 [1.10], P < .001; Hedges g = 0.61; 75 mg, -14.0 [1.11], P = .002; Hedges g = 0.41); LB-102 100 mg, also showed significance (mean [SE], -16.1 [1.91]; nominal P = .002; Hedges g = 0.83). TEAEs were reported in 60 participants (56%) in the placebo group, 74 (69%) in the group receiving 50 mg, 62 (57%) in the group receiving 75 mg, and 27 (75%) in the group receiving 100 mg. Ten participants reported TEAEs leading to withdrawal (placebo, n = 2; 50 mg, n = 2; 75 mg, n = 3; 100 mg, n = 3) with 5 serious TEAEs (placebo, n = 2 [including 1 death]; each LB-102 arm, n = 1).

CONCLUSIONS AND RELEVANCE: This randomized clinical trial provided rigorous evidence demonstrating the efficacy and safety of LB-102 for the treatment of adults with acute schizophrenia.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06179108.

PMID:42018313 | DOI:10.1001/jamapsychiatry.2026.0428

JAMA. 2026 Apr 22. doi: 10.1001/jama.2026.5157. Online ahead of print.

NO ABSTRACT

PMID:42018312 | DOI:10.1001/jama.2026.5157

J Phys Chem A. 2026 Apr 22. doi: 10.1021/acs.jpca.5c07760. Online ahead of print.

ABSTRACT

Analyzing the conformational dynamics of short peptides from molecular dynamics (MD) simulations remains challenging. The high dimensionality of torsional space and the periodic nature of dihedral angles complicate statistical analysis and dimensionality reduction. This work presents an integrated computational workflow that combines all-atom MD simulations with a multistage analytical framework to characterize torsional reorganization patterns. Our approach introduces an angular-displacement representation χ that resolves periodic discontinuities by focusing on frame-to-frame torsional changes rather than absolute configurations. This transformation yields variables suitable for linear analysis and acts as a high-pass filter, emphasizing rapid reorganization events over slow conformational drift. We analyze these transformed coordinates using spatiotemporal principal component analysis (PCA) to identify collective torsional patterns. To evaluate how different coordinate choices preserve dynamical information, we quantitatively compare raw dihedral angles, sine-cosine embedding, and the displacement representation χ using the VAMP score. This comparison reveals their complementary nature: sine-cosine coordinates capture slow conformational variability, while χ highlights rapid torsional reorganizations. Subspace convergence analysis confirms the stability of the reduced PCA representation within the simulation time scale. We apply the methodology to the DENV-2 peptide (CGYGLC) as a representative short system. Our approach identifies hierarchical patterns of torsional flexibility─characterized by a flexible central core and region-specific dynamics─and reconstructs short-term structural evolution with angular errors below 25% and RMSD values of 1.0-2.1 Å. The main contributions are (i) a geometry-aware angular-displacement representation that respects the periodic nature of torsional variables; (ii) a spectral characterization of the displacement transformation; (iii) a quantitative comparison of observable representations using the VAMP score; and (iv) a demonstration of short-horizon structural prediction from reduced dynamical subspaces. The workflow provides a computationally efficient framework for analyzing torsional reorganization dynamics in peptide simulations.

PMID:42018286 | DOI:10.1021/acs.jpca.5c07760

Lang Speech Hear Serv Sch. 2026 Apr 22:1-11. doi: 10.1044/2026_LSHSS-25-00167. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate how speech-language pathologists (SLPs) implement language comprehension curriculums (LCCs) in elementary school settings, particularly for students with language and literacy difficulties. It addressed questions related to current usage, perceived barriers, misconceptions, and factors influencing adoption of LCCs, with the goal of informing future strategies for improving language and reading comprehension outcomes.

METHOD: A survey study was conducted with 83 participants, including 77 certified SLPs and six clinical fellows, recruited through professional networks and online platforms. The survey, administered via Qualtrics, included both quantitative and qualitative items assessing awareness, usage, barriers, and attitudes toward LCCs. Content analysis and descriptive statistics were used to analyze responses, and data were visualized using R.

RESULTS: Findings revealed limited awareness and use of LCCs among SLPs, with significant barriers including lack of training, time constraints, and systemic challenges. SLPs’ misconceptions and their role in implementation were also identified. Despite these challenges, participants expressed interest in future research and recognized the potential benefits of LCCs for managing caseloads and supporting students with language and literacy difficulties.

CONCLUSIONS: The study highlights a critical gap in the implementation of LCCs by SLPs and underscores the need for future quantitative studies and targeted professional development and systemic support in this area. Results support the need for further research that investigates the effectiveness of SLPs using LCCs in individualized and small-group settings, particularly for students with suspected, or diagnosed, language and literacy disabilities.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.31975221.

PMID:42018276 | DOI:10.1044/2026_LSHSS-25-00167