Nevin Manimala

Lang Speech Hear Serv Sch. 2026 Aug 5:1-16. doi: 10.1044/2026_LSHSS-25-00193. Online ahead of print.

ABSTRACT

PURPOSE: During the assessment process, speech-language pathologists (SLPs) have the opportunity to account for the involvement, thoughts, and views of children with speech sound disorders (SSDs). This is in alignment with the Convention on the Rights of the Child (CRC; UNICEF, n.d.; United Nations, 1989) including CRC Article 12 (Respect for children’s views), Article 13 (Sharing thoughts freely), and Article 23 (Children with disabilities), which affirms SLPs’ role to facilitate participation and consider perspectives. The International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) offers a holistic framework that can guide assessment practices, including accounting for children’s views of their own speech. While previous research has been limited to theoretical application, the current study provides preliminary data regarding how American SLPs practically utilize the ICF framework in the evaluation of children with SSDs.

METHOD: An online survey was created using REDCap and disseminated to currently practicing SLPs across the United States. A total of 296 surveys were completed, and data were analyzed using descriptive and inferential statistics.

RESULTS: Over 50% of American SLPs were unfamiliar with the ICF, which was reflected in how they selected assessments of Body Functions more than Activities/Participation and Contextual Factors for children with SSDs. Furthermore, under 10% of SLPs included an assessment tool that measures a child’s communicative participation or self-reported attitudes.

CONCLUSIONS: Findings demonstrated a need for greater exposure to holistic assessment of children with SSDs in the United States. Recommendations extend to faculty and researchers to integrate the ICF framework in teaching and research to promote evidence-based assessment practices and patient-reported outcome measures to protect the CRC.

PMID:42554573 | DOI:10.1044/2026_LSHSS-25-00193

JACC CardioOncol. 2026 Jul 30:S2666-0873(26)00277-2. doi: 10.1016/j.jaccao.2026.07.008. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitor (ICI) myocarditis typically develops soon after treatment initiation (<90 days) but may also occur as a delayed complication after discontinuation of ICI therapy. The clinical and histopathologic differences between early- and late-manifestation ICI myocarditis remain unclear.

OBJECTIVES: This study sought to compare the clinical features and myocardial histopathology of early- versus late-manifestation ICI myocarditis.

METHODS: We conducted a retrospective national cohort study of patients diagnosed with myocarditis after ICI initiation who underwent endomyocardial biopsy. Biopsy samples were analyzed for inflammatory cell infiltration, severity of myocardial inflammation, and collagen volume fraction.

RESULTS: Among 35 patients (mean age: 66 ± 13 years; 71.4% male), 26 (74.3%) developed early-manifestation myocarditis (<90 days), whereas 9 (25.7%) had late-manifestation myocarditis (≥90 days). Early-manifestation cases showed significantly more severe myocardial inflammation; higher levels (median [Q1-Q3]) of CD3⁺ T cells (432 [173-1,381] vs 121 [43-400] cells/mm²; P = 0.036), CD8⁺ T cells (289 [73-994] vs 86 [21-168] cells/mm²; P = 0.019), and CD 68⁺ macrophages (307 [116-841] vs 57 [36-200] cells/mm²; P = 0.008); and higher CD4⁺ T-cell levels that did not reach statistical significance (P = 0.054). There were no significant differences in regulatory T cells or collagen volume. Clinically, early-manifestation myocarditis was characterized by higher cardiac biomarker levels and older age, whereas left ventricular ejection fraction was similar between groups. Mortality due to myocarditis occurred in 2 early-manifestation cases and in no late-manifestation cases. Conversely, cancer-related mortality was more frequent in the late-manifestation group (n = 3) than in the early-manifestation group (n = 2). ICI therapy was reinitiated in only 2 patients overall.

CONCLUSIONS: Late-manifestation ICI myocarditis may represent a temporally distinct or partially attenuated inflammatory phase. Despite a milder inflammatory profile, higher cancer-related mortality was observed, suggesting that cautious ICI reinitiation may warrant consideration in selected patients within this subgroup.

PMID:42554546 | DOI:10.1016/j.jaccao.2026.07.008

JACC Heart Fail. 2026 Aug 2:103295. doi: 10.1016/j.jchf.2026.103295. Online ahead of print.

ABSTRACT

BACKGROUND: Despite robust evidence that quadruple guideline-directed medical therapy (GDMT), comprising angiotensin receptor-neprilysin inhibitors (ARNIs), evidence-based beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 (SGLT2) inhibitors, reduces mortality and hospitalizations in heart failure with reduced ejection fraction (HFrEF), implementation in clinical practice remains markedly incomplete.

OBJECTIVES: This study aimed to provide updated national estimates of the eligible untreated HFrEF population and to quantify deaths and hospitalizations preventable with optimal implementation of quadruple GDMT in the United States.

METHODS: The authors performed a population-level decision analytic modeling study using contemporary U.S. epidemiologic data. National HFrEF prevalence estimates were derived from the American Heart Association Heart Disease and Stroke Statistics 2026 report, and annual HFrEF hospitalization counts were derived from the National Inpatient Sample 2022-2023. Eligible untreated populations were estimated after sequential exclusions and therapy-specific contraindication adjustments using primary treatment rates from Epic Cosmos 2023-2025, with sensitivity analyses using alternative treatment-rate sources. Trial-derived numbers needed to treat and relative risk reductions were applied to estimate deaths preventable over 12 months and annual heart failure (HF) hospitalizations prevented.

RESULTS: An estimated 2.76 million U.S. adults with chronic symptomatic HFrEF were eligible for quadruple GDMT, yet only 18.2% received it. Eligible untreated populations included 733,891 for beta-blockers, 1,856,531 for ARNIs, 1,543,967 for MRAs, and 1,717,444 for SGLT2 inhibitors. Class-specific projected deaths preventable over 12 months were 26,210 for beta-blockers, 34,495 for ARNIs, 26,620 for MRAs, and 26,422 for SGLT2 inhibitors; the aggregate estimate across treatment gaps was 113,747 (95% uncertainty interval [UI]: 90,173-149,875). Optimal implementation was also projected to prevent 357,332 HF hospitalizations annually (95% UI: 297,493-425,674).

CONCLUSIONS: Incomplete implementation of quadruple GDMT in HFrEF remains a major modifiable opportunity to reduce preventable deaths and HF hospitalizations in the United States.

PMID:42554537 | DOI:10.1016/j.jchf.2026.103295

Drug Test Anal. 2026 Aug 5. doi: 10.1002/dta.70125. Online ahead of print.

ABSTRACT

Discrimination between endogenous and exogenous Gamma-hydroxybutyrate (GHB) in hair matrix is a major challenge in the forensic context. According to the UNODC, to verify a possible intake, GHB concentration should be compared with the subject’s basal level. Most published studies investigated endogenous GHB on a single hair segment, without considering possible intra-individual variation. The present study aimed to detect endogenous GHB in hair using a newly validated method, with a focus on the relevance of segmental analysis. Two hundred subjects were tested. After the removal of the first 0.5 cm from the proximal end, each hair strand was divided into three segments of 1 cm. A water extraction was performed during the pulverization process, and the extract was injected into a LC-MS/MS system. Data have been statistically analyzed. Overall, endogenous GHB concentration ranged from < LOD (0.1 ng/mg) to 6.6 ng/mg, with 27% of samples having a value < LOD in at least two segments. Within the remaining subjects, neither gender nor age significantly influenced the concentration. On the other hand, results confirmed that hair treatment can modify endogenous GHB concentrations. Intra-individual variability was limited, with the highest percentage of cases showing minimal changes in concentration (0-0.1 ng/mg) between contiguous segments. However, in up to 4% of cases, the variation resulted to be higher than 1 ng/mg between contiguous segments. The present study then confirms the need to perform in forensic cases the segmental analysis, to be sure that any potential increase of GHB depends exclusively on external administration.

PMID:42554518 | DOI:10.1002/dta.70125

J Cachexia Sarcopenia Muscle. 2026 Aug;17(4):e70353. doi: 10.1002/jcsm.70353.

ABSTRACT

BACKGROUND: The Skeletal Muscle Function Deficit (SMFD) score integrates muscle mass, strength, power and quality into a single construct that evaluates the multidimensional status of muscle health. The aim of the study is to investigate the longitudinal associations of systemic inflammation and caloric intake with SMFD-score trajectories in older adults from the InCHIANTI study.

METHODS: Data were obtained from the InCHIANTI population-based longitudinal cohort. A total of 1035 community-dwelling older adults (mean age 74.97 ± 7.39 years; 44.25% men) contributed 3196 repeated observations across four study waves. SMFD-score (range 0-20) was derived from sex-specific quintiles of lower-limb muscle mass, muscle density, grip strength and lower-limb power; participants unable to perform a test received a score of 0 for that component. Interleukin-6 (IL-6) and caloric intake (kcal/day) were assessed at all study waves. Longitudinal associations between time-varying IL-6 tertiles, caloric intake tertiles and SMFD-score trajectories were evaluated using linear mixed-effects models adjusted for baseline age and sex and time-varying multimorbidity and body mass index.

RESULTS: Across follow-up, SMFD-score declined significantly from 9.60 ± 4.20 at baseline to 7.07 ± 4.00 at the last wave (p < 0.001), whereas IL-6 increased from 3.65 ± 2.50 pg/mL to 4.39 ± 3.10 pg/mL (p < 0.001). Mean caloric intake showed a non-significant upward trend (1912.83 ± 562.37 to 1976.00 ± 580.54 kcal/day; p = 0.07). In mixed-effects models, higher IL-6 levels were associated with accelerated SMFD decline over time (IL-6 tertile × time interaction β = -0.31 ± 0.02; p < 0.001). Higher caloric intake was associated with higher SMFD-score and a slower functional decline (caloric intake tertile main effect β = 1.19 ± 0.16; p < 0.001; caloric intake tertile × time interaction β = 0.24 ± 0.03; p < 0.001). In the model including the combined IL-6 × caloric intake × time interaction was statistically significant (β = 0.14 ± 0.04; p < 0.001), indicating that higher caloric intake partially attenuated the negative longitudinal association between IL-6 and SMFD-score.

CONCLUSIONS: SMFD-score captures longitudinal muscle function decline during aging and reflects the opposing influences of inflammation and caloric intake. These findings support the SMFD-score as a clinically relevant construct for identifying potentially modifiable determinants of muscle health and functional decline in older adults.

PMID:42554491 | DOI:10.1002/jcsm.70353

Early Interv Psychiatry. 2026 Aug;20(8):e70244. doi: 10.1111/eip.70244.

ABSTRACT

AIM: Childhood-onset Obsessive-Compulsive Disorder (OCD) has been associated with an increased vulnerability to psychosis, yet no prospective studies have examined this risk in paediatric populations.

METHODS: In this pilot prospective study, 59 adolescents with a primary diagnosis of OCD were assessed at baseline for psychotic vulnerability, measured through Cognitive-Perceptual basic symptoms (COPER) and the high-risk criterion Cognitive Disturbances (COGDIS), as well as for OCD severity and psychosocial functioning. The number of subjects who developed a first episode of psychosis (FEP) during the 18-month follow-up period was evaluated. Logistic regression and moderation analyses were performed.

RESULTS: During the follow-up period, 18.6% of participants presented with a FEP. These patients were older and displayed poorer psychosocial functioning compared with those who did not develop a FEP. Logistic regression identified higher COPER symptoms and lower psychosocial functioning as the only significant predictors of FEP. Although moderation effects were not statistically significant, exploratory simple slopes suggested that both COPER and COGDIS symptoms were more strongly associated with psychosis onset in adolescents with lower psychosocial functioning.

CONCLUSIONS: This study highlights a notable rate of progression to psychosis among adolescents with OCD over an 18-month period. Despite methodological limitations, our findings offer preliminary evidence that COPER symptoms and impaired psychosocial functioning are key risk factors in adolescents with OCD for progression to psychosis.

PMID:42554468 | DOI:10.1111/eip.70244

Neurosurgery. 2026 Aug 5. doi: 10.1227/neu.0000000000004183. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Chronic subdural hematomas (cSDH) are among the most common neurosurgical pathologies. Older adults also often have comorbidities treated with anticoagulant and antiplatelet (ACAP) medications. Managing clinicians frequently must weigh the benefits and risks of stopping and reinitiating such drugs in cSDH. The aim of this retrospective study was to analyze outcomes associated with ACAP use and cSDH, focusing on the need for reoperation, mortality, and neurological function.

METHODS: Between 2011 and 2023, patients requiring surgical management of a cSDH across 5 UK neurosurgical units were identified. Collected variables included patient comorbidities, preoperative and postoperative neurological function, ACAP termination and reinitiation, need for reoperation, and mortality. Statistical analysis included multivariable logistic regression for predictors of key outcomes; reoperation, functional status, and mortality including a Kaplan-Meier analysis for reoperation rates based on different ACAP treatments.

RESULTS: One thousand three hundred fifty-five patients underwent analysis, of which 245 were on anticoagulants, 277 were on antiplatelets, 35 were on dual ACAP medications, and 798 were not on any previous ACAP therapy. The median age was 75 years (IQR = 66-83), and the overall reoperation rate was 10.2% (n = 68 on ACAP and n = 70 on no ACAP treatment). Patients on ACAP had higher crude reoperation rates (12.2% vs 8.8%, P = .049), though this difference was not significant after multivariable adjustment (odds ratio = 1.41, 95% CI, 0.77-2.55, P = .272). Discontinuing ACAP treatment for longer preoperatively and later reinitiation did not significantly affect reoperation rates. ACAP patients were generally more comorbid and had significantly worse functional outcomes (modified Rankin Scale 0-2: 52.4% vs 66.4%, adjusted odds ratio = 0.69, 95% CI, 0.53-0.91, P = .007).

CONCLUSION: Preoperative ACAP use and longer preoperative discontinuation are not independently associated with increased reoperation risk in patients with cSDH. Earlier postoperative ACAP reinitiation is also not significantly associated with reoperation risk. However, more extensive large scale prospective studies are required to support these findings and form clinical recommendations.

PMID:42554463 | DOI:10.1227/neu.0000000000004183

J Clin Ultrasound. 2026 Aug 5. doi: 10.1002/jcu.70363. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate whether maternal dietary calcium intake during early pregnancy is associated with fetal cardiac function at mid-gestation, given the heghtened dependence of the fetal myocardium on extracellular calcium and the lack of previous studies addressing this relationship.

METHODS: This prospective observational study was conducted at Kastamonu Training and Research Hospital between August and November 2025. Pregnant individuals undergoing routine fetal anomaly screening were recruited. Maternal calcium intake over the preceding 3 months was quantified through a calcium-specific food frequency questionnaire. Fetal echocardiography was performed between 18 and 22 weeks of gestation by a single experienced operator. Left and right ventricular myocardial performance indices (MPI), isovolumic intervals, ejection times, E/A ratios, and cardiac morphometrics were measured. Continuous variables were analyzed using Spearman correlation and Mann-Whitney U tests, with significance defined as p < 0.05.

RESULTS: A total of 147 participants were analyzed. Maternal calcium intake showed no significant correlations with any fetal cardiac functional parameter, including LV-IVRT (r = -0.035), LV-IVCT (r = -0.058), LV-ET (r = 0.087), MV-TEI (r = -0.102), RV-TEI (r = 0.000), or ventricular filling indices. Categorization by intake < 800 mg/day versus ≥ 800 mg/day similarly revealed no differences in systolic, diastolic, or global cardiac function (all p > 0.13). Dairy products constituted 68.6% of total calcium intake.

CONCLUSION: No statistically significant association was identified between maternal total calcium intake and fetal cardiac function at mid-gestation in this cohort. However, the study may not have been sufficiently powered to exclude small differences in myocardial performance indices. In addition, the absence of an observed association may reflect physiological placental buffering of maternal calcium homeostasis or a temporal mismatch between the period of calcium exposure assessment and fetal functional evaluation. Future studies involving populations with low habitual calcium intake and incorporating biochemical markers are warranted.

PMID:42554437 | DOI:10.1002/jcu.70363

J Clin Periodontol. 2026 Aug 5. doi: 10.1111/jcpe.70164. Online ahead of print.

ABSTRACT

AIMS: To evaluate wound-healing progression among platelet-rich fibrin (PRF), plasma rich in growth factors (PRGF), a collagen-based wound dressing (CS = collagen substitute) and spontaneous healing (control), assessed by percentage of remaining open wound area and patient-reported pain.

MATERIALS AND METHODS: Twenty participants each received four standardised palatal wounds (6 mm × 3 mm) and were randomly assigned to PRF, PRGF, a collagen substitute or spontaneous healing as control. All dressings were secured with criss-cross sutures. Standardised clinical photographs and pain assessments were obtained at baseline and on postoperative days 2,5,7,9, 12 and 14. Parametric and nonparametric models for longitudinal data were used to compare outcomes, accounting for within-subject correlation of repeated measurements.

RESULTS: Open wound area decreased across all groups throughout the 14-day period. Some defects enlarged transiently at Day 2, and the greatest differences between the groups were observed on Day 7 (35.7%-47.0% of wound remaining). Pain scores decreased significantly over time in all groups, with no statistically significant differences between treatments (p > 0.05). Anterior defects tended to be perceived as more painful than posterior defects.

CONCLUSIONS: Spontaneous healing resulted in slightly faster reduction of remaining open wound area than PRF, PRGF or the collagen substitute, with comparable postoperative pain levels. In standardised defects in healthy individuals, PRF, PRGF and collagen substitutes demonstrate minimal additional benefit for soft-tissue healing. Further studies are warranted to determine whether benefits emerge in larger wounds or in patients with compromised healing.

PMID:42554427 | DOI:10.1111/jcpe.70164

Transl Vis Sci Technol. 2026 Aug 3;15(8):3. doi: 10.1167/tvst.15.8.3.

ABSTRACT

PURPOSE: To assess the within and between-session repeatability of foveal sensitivity measurements using adaptive optics (AO) microperimetry.

METHODS: Five normal-sighted participants underwent AO microperimetry testing (550-nm circular stimulus) at the preferred retinal locus across two sessions (2 months ± 2 weeks). Two psychophysical paradigms were used: quick estimation of threshold (QUEST) and method of constant stimuli (MOCS). Each paradigm employed both 1.05-arcmin2 and 30.4-arcmin2 stimulus sizes; stimuli were not stabilized in real time. Trial-by-trial responses were fit with a logistic psychometric function to obtain thresholds at a criterion of 78% seen. Thresholds were converted to sensitivity. Statistical comparisons were performed using paired-sample t-tests.

RESULTS: Sensitivities measured from QUEST and MOCS procedures were not significantly different (QUEST: 1.05 arcmin2, P = 0.36 for session 1 and P = 0.41 for session 2; MOCS: 30.4 arcmin2, P = 0.14 for session 1 and P = 0.12 for session 2). Data were thus combined across paradigms for tests of repeatability. Sensitivities for data split into two groups within session 1 and separately within session 2 were not significantly different (QUEST: 1.05 arcmin2, P = 0.34 for session 1 and P = 0.51 for session 2; MOCS: 30.4 arcmin2, P = 0.31 for session 1 and P = 0.27 for session 2). Overall, sensitivities across the two sessions were not significantly different (QUEST: 1.05 arcmin2, P = 0.06; MOCS: 30.4 arcmin2, P = 0.81). The coefficients of repeatability across sessions were 1.5 decibels (dB) and 0.4 dB for 1.05 arcmin2 and 30.4 arcmin2, respectively.

CONCLUSIONS: Sensitivity measurements from AO microperimetry were repeatable within and across sessions.

TRANSLATIONAL RELEVANCE: Results of the present study will guide future longitudinal studies of disease progression in detecting sensitivity changes using AO microperimetry.

PMID:42554416 | DOI:10.1167/tvst.15.8.3