Category: Nevin Manimala

Proc Natl Acad Sci U S A. 2026 Feb 24;123(8):e2531783123. doi: 10.1073/pnas.2531783123. Epub 2026 Feb 13.

ABSTRACT

Chen Ning Yang made important contributions to the theory of solvable models in statistical mechanics, including generalizations of the Bethe Ansatz, magnetization in the Ising model, the Lee-Yang circle theorem, and the Yang-Baxter equation. Most famously, Yang made transformative contributions to the current Standard Model of elementary particle interactions. The proposal of Yang and T. D. Lee, that left-right symmetry (parity) is violated in weak particle decays, established that the primary currents involved in weak interactions are left handed. The work of Yang and R. L. Mills gave a framework for force carriers coupling to these currents that are non-Abelian generalizations of the electromagnetic photon, which unlike the electrically neutral photon, carry “charges” to which they self-couple. Two decades of work by others on quantization and mass generation mechanisms then culminated in the Standard Model.

PMID:41686479 | DOI:10.1073/pnas.2531783123

JAMA Health Forum. 2026 Feb 6;7(2):e256800. doi: 10.1001/jamahealthforum.2025.6800.

ABSTRACT

IMPORTANCE: Pediatric hospital care is rapidly consolidating in the US, with some states now depending on neighboring states to supply pediatric inpatient services. The extent and nature of this interstate dependence have not been characterized.

OBJECTIVE: To describe cross-state pediatric hospital utilization patterns and quantify the degree of interstate dependence in the New England region.

DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cross-sectional study of inpatient admissions at all hospitals admitting children (age <15 years) in the New England region and the enclosing border state of New York in 2019. Admissions for mental health, routine newborn care, and pregnancy-related diagnoses were excluded. Data analysis was conducted from July to December 2024.

EXPOSURE: Hospitalization location in state or out of state.

MAIN OUTCOMES AND MEASURES: The source, number, and proportion of out-of-state admissions, bed-days, primary diagnoses, and insurance types in each state in the New England region.

RESULTS: Among 28 631 pediatric admissions, 71.1% occurred in Massachusetts, corresponding to 86.8% of bed-days in the region. Of the total admissions, 16 211 (56.7%) were of male children and slightly more than half (16 336 encounters [57.1%]) were of children older than 4 years. The fraction of residents receiving out-of-state care varied from 2.0% in Massachusetts to 65.8% in New Hampshire (median [IQR], 21.5% [11.3%-28.9%]). Massachusetts hospitals served 578 of the 599 primary diagnoses reported in the region and provided 43.5% (36 731) of all hospital days required by residents of other New England states. In all states, privately insured children were more likely than Medicaid enrollees to be admitted to out-of-state hospitals (median [IQR], 30.5% [17.0%-37.2%] vs 15.6% [6.4%-24.7%]; adjusted odds ratio, 2.21 [95% CI, 2.01-2.44]), often for common conditions.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, pediatric care in New England constituted a de facto regionalized system, with substantial interstate movement of patients and heavy reliance on Massachusetts. These findings highlight an unplanned interdependence that may leave the system vulnerable to disruption. Regional planning and formal coordination among states may be necessary to ensure sustainable access to care. These findings may hold relevance for other regions.

PMID:41686465 | DOI:10.1001/jamahealthforum.2025.6800

JAMA Netw Open. 2026 Feb 2;9(2):e2556937. doi: 10.1001/jamanetworkopen.2025.56937.

ABSTRACT

IMPORTANCE: Experts recommend a shared decision-making (SDM) process before percutaneous left atrial appendage occlusion (pLAAO) in patients with atrial fibrillation, and the Centers for Medicare & Medicaid Services (CMS) require SDM with the use of a patient decision aid (DA) as a condition for reimbursement. However, little is known about how these guidelines and policies have influenced practice.

OBJECTIVE: To describe overall trends in reported SDM and use of DAs for pLAAO and to identify key patient, operator, and institutional factors associated with their use.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from October 1, 2022, to June 30, 2024, from the American College of Cardiology’s National Cardiovascular Data Registry (NCDR) LAAO Registry. Participants included patients who underwent first-time pLAAO.

EXPOSURE: pLAAO implantation.

MAIN OUTCOMES AND MEASURES: The proportion of encounters reporting SDM and DA use (SDM plus DA) overall and each month. Hierarchical logistic regression was used to estimate the odds of reported SDM plus DA, the probability of SDM plus DA, and the variance in SDM plus DA associated with operator and institutional levels.

RESULTS: A total of 147 296 unique patient encounters (86 593 [58.8%] male; mean [SD] age, 76.6 [7.7] years) were included. Of 830 institutions participating in the NCDR LAAO Registry during the study period, 829 (99.9%) reported on SDM and 817 (98.4%) reported on DA use. In the unadjusted analysis, 95 305 encounters (64.7%) reported SDM plus DA had occurred. Unadjusted rates of SDM plus DA rose steadily during the study period from 62.5% in October 2022 to 75.0% in June 2024. The adjusted analysis suggests that the observed variance in SDM plus DA reporting was large and attributable primarily to the institutional level (median odds ratio, 115.64; 95% CI, 79.71-151.56). The range of estimated probability of SDM plus DA by institution was 0.1% to 76.4%, with a mean (SD) of 52.0% (28.6%). There was no statistically significant difference in odds of SDM plus DA for patients with Medicare vs those without (odds ratio, 1.03; 95% CI, 0.98-1.09).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients who underwent pLAAO, SDM plus DA reporting was high, but there was large variation between institutions. Patients with Medicare did not have greater odds of reported SDM plus DA, despite the CMS requirement. These findings exhibit the need for further exploration of institutional barriers and facilitators to SDM and DA use for pLAAO.

PMID:41686441 | DOI:10.1001/jamanetworkopen.2025.56937

JAMA Netw Open. 2026 Feb 2;9(2):e2556945. doi: 10.1001/jamanetworkopen.2025.56945.

ABSTRACT

IMPORTANCE: Prompt antimicrobial therapy is essential in sepsis, but accelerating antimicrobial administration may increase overtreatment.

OBJECTIVES: To examine the extent of and factors associated with physician variation in time from emergency department (ED) presentation to antimicrobial administration (hereinafter termed door-to-antimicrobial time) for sepsis and to assess whether faster practice patterns are associated with overtreatment.

DESIGN, SETTING, AND PARTICIPANTS: This explanatory mixed-methods study linked a quantitative retrospective cohort (July 1, 2013, to January 31, 2017) involving 30-day patient follow-up with prospective qualitative physician interview data (May 17, 2022, to June 28, 2023) at 4 Utah EDs. Participants included ED attending physicians and their patients meeting sepsis criteria (including intravenous antimicrobial administration) before ED departure. Data analysis occurred from 2021 to 2025.

MAIN OUTCOMES AND MEASURES: Assessment for physician door-to-antimicrobial time variation used a likelihood ratio test comparing a linear mixed-effects model incorporating physician-level random intercepts and patient-level covariates with a model without physician random effects. Empirical best linear unbiased predictions of the physician random intercepts (termed physician-predicted mean door-to-antimicrobial times) quantified variation. The primary analysis used a joint mixed-effects shared parameter model to evaluate the association of physicians’ door-to-antimicrobial practice patterns with their overtreatment rate (infection ruled out on final retrospective adjudication). Qualitative analysis of semistructured cognitive task analysis interviews compared ED physicians in the fastest and slowest door-to-antimicrobial time quartiles.

RESULTS: Quantitative analyses included 88 ED physicians (71 [80.7%] male; median age, 39 [IQR, 35-49] years) and 9810 patients with sepsis (median age, 63 [IQR, 48-75] years), of whom 4635 (50.5%) were female and 3540 (38.6%) received antimicrobials more than 3 hours after ED arrival. The median number of patient encounters per physician was 105 (IQR, 75-129). Physicians’ door-to-antimicrobial time varied significantly (likehood ratio test P < .001), with average physician-level estimated mean door-to-antimicrobial time of 184 (95% estimation interval, 146-222) minutes for a typical patient, but was not associated with overtreatment (adjusted odds ratio, 0.98 [95% CI 0.94-1.02] per 10-minute increase in physician estimated mean door-to-antimicrobial time; P = .37). Among 18 physicians interviewed, physicians with faster door-to-antimicrobial times emphasized proactive, parallel task execution and care team coordination, while physicians with slower times described a more reactive and stepwise sepsis evaluation and treatment process.

CONCLUSIONS AND RELEVANCE: In this mixed-methods study, ED physicians’ antimicrobial administration time for sepsis varied significantly, but faster antimicrobial initiation practice patterns were not associated with overtreatment. Physicians with shorter door-to-antimicrobial times described a proactive, parallel processing approach to sepsis care.

PMID:41686440 | DOI:10.1001/jamanetworkopen.2025.56945

JAMA Netw Open. 2026 Feb 2;9(2):e2556951. doi: 10.1001/jamanetworkopen.2025.56951.

ABSTRACT

IMPORTANCE: With advancements in imaging technology and more frequent health evaluations, the incidence and prevalence of pancreatic cysts have gradually increased. Certain types of pancreatic cystic neoplasms are precancerous lesions associated with an increased risk of pancreatic cancer. Hence, identifying risk factors and preventing their occurrence are crucial. Nonetheless, population-based research on modifiable risk factors remains lacking.

OBJECTIVE: To investigate the association of diabetes and related factors with risk of developing pancreatic cysts.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included adults (aged ≥20 years) who underwent health examinations in 2009 through medical institutions designated by the Korean National Health Insurance Service. Participants were followed up until December 31, 2020. Data were analyzed from March 23, 2023, to February 8, 2024.

EXPOSURE: All participants were categorized according to diabetes status as having normoglycemia, impaired fasting glucose, shorter diabetes duration (<5 years), or longer diabetes duration (≥5 years). Demographic characteristics, lifestyle factors, and comorbidities at the time of health examinations were investigated.

MAIN OUTCOMES AND MEASURES: Adjusted hazard ratios (AHRs) for pancreatic cyst occurrence for each diabetes status group were estimated using Cox proportional hazards regression models, adjusting for potential confounders.

RESULTS: Among the entire study population of 3 856 676 adults (mean [SD] age, 47.1 [14.0] years; 54.5% male), 330 138 (8.6%) had diabetes. The median observation period was 10.3 (IQR, 10.1-10.6) years. A total of 31 877 patients (0.8%) developed pancreatic cysts during the observation period. Compared with individuals with normoglycemia, AHRs for the development of pancreatic cysts were 1.06 (95% CI, 1.03-1.08) for those with impaired fasting glucose, 1.23 (1.18-1.28) for those with a shorter diabetes duration, and 1.37 (1.31-1.44) for those with a longer diabetes duration. Subgroup analyses showed higher AHRs for pancreatic cyst occurrence associated with diabetes among individuals younger than 60 years (AHR, 1.34 [95% CI, 1.27-1.40]), males (AHR, 1.32 [95% CI, 1.26-1.38]), and current smokers (AHR, 1.40 [95% CI, 1.30-1.51]) with diabetes compared with patients 60 years or older (AHR, 1.21 [95% CI, 1.16-1.27]), females (AHR, 1.20 [95% CI, 1.15-1.26]), never smokers (AHR, 1.22 [95% CI, 1.18-1.28]), and former smokers (AHR, 1.25 [95% CI, 1.16-1.35]) with diabetes.

CONCLUSIONS AND RELEVANCE: In this cohort study of 3 856 676 Korean adults, longer diabetes duration was associated with an increased risk of pancreatic cysts. The risk of pancreatic cyst occurrence was higher among younger male individuals with diabetes compared with their counterparts. Smoking cessation was associated with a lower risk of pancreatic cysts. Further studies incorporating imaging and longitudinal data are needed to clarify the clinical significance of pancreatic cysts in individuals with diabetes.

PMID:41686439 | DOI:10.1001/jamanetworkopen.2025.56951

JAMA Netw Open. 2026 Feb 2;9(2):e2559471. doi: 10.1001/jamanetworkopen.2025.59471.

ABSTRACT

IMPORTANCE: The impact of late onset in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is still controversial.

OBJECTIVE: To investigate the association of late onset MOGAD with moderate disability and relapse in Korean patients.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide, multicenter, retrospective cohort study included adult patients with a diagnosis of MOGAD according to the 2023 international diagnostic criteria between August 2018 and September 2024 across 28 hospitals in South Korea.

EXPOSURE: Age at onset of MOGAD, categorized into adult-onset MOGAD (AO-MOGAD; 18-49 years) and late-onset MOGAD (LO-MOGAD; ≥50 years).

MAIN OUTCOMES AND MEASURES: The primary outcomes were time to first relapse in patients with a disease duration of 12 or more months and moderate disability, defined as Expanded Disability Status Scale (EDSS) score of 3 or greater at last follow-up.

RESULTS: A total of 350 patients (mean [SD] age at onset, 43.2 [15.0] years; 189 female [54.0%]) with a median (IQR) baseline EDSS of 3.0 (2.0-4.0) were included, with 124 patients (35.4%) with LO-MOGAD and 226 patients (64.6%) with AO-MOGAD. The LO-MOGAD group had less frequent brain involvement than the AO-MOGAD group at onset (26 patients [21.0%] vs 75 patients [33.2%]; P = .02) and during the disease course (28 patients [22.6%] vs 95 patients [42.0%]; P < .001), while optic neuritis or myelitis was comparable between the 2 groups. The LO-MOGAD group showed more frequent monophasic course (55 of 95 patients [57.9%] vs 75 of 188 patients [39.9%]; P = .004), but higher EDSS score at last follow-up (median [IQR], 2.0 [1.0-2.0] vs 1.0 [0.0-2.0]; P < .001) compared with those in the AO-MOGAD group. However, late onset was not significantly associated with the time to first relapse in multivariable analysis (adjusted hazard ratio, 0.72; 95% CI, 0.48-1.08; P = .11), which was consistent after propensity score matching. By contrast, late onset was associated with a significantly higher risk of moderate disability at the last follow-up (adjusted odds ratio, 2.84; 95% CI, 1.39-5.80; P = .004).

CONCLUSIONS AND RELEVANCE: In this cohort study of MOGAD, late onset was not associated with a risk of relapse but with a higher risk of moderate disability at follow-up. Prospective studies with longer follow-up periods are warranted to better understand and manage patients with late-onset disease.

PMID:41686435 | DOI:10.1001/jamanetworkopen.2025.59471

Adv Ther. 2026 Feb 13. doi: 10.1007/s12325-025-03485-0. Online ahead of print.

ABSTRACT

INTRODUCTION: X-linked retinitis pigmentosa (XLRP) is one of the most severe forms of retinitis pigmentosa, representing 5-15% of all cases. There is a notable gap in understanding the health-related quality of life (HRQoL) impact on carers of people with XLRP, essential for holistic health economic evaluations. The objective of the study is to estimate health state utilities of informal carers for a person with XLRP which can be used in economic modelling.

METHOD: Four carer descriptions or “vignettes” were developed for mild, moderate, severe, and completely blind XLRP patient care. The vignettes were based on studies identified in a targeted literature review and validated through qualitative interviews with informal carers and an ophthalmologist. The vignettes were valued using the time trade-off (TTO) method by the general population of Great Britain. Descriptive statistics of the data were analysed.

RESULTS: A total of 220 respondents completed the survey. The mean utility value for providing care to someone with mild XLRP was 0.85, decreasing to 0.76 when caring for someone with moderate XLRP and further decreasing to 0.54 when caring for someone with severe XLRP. The mean carer utility declined to 0.42 for complete blindness.

CONCLUSION: Mean carer utility declined with increased severity of patient XLRP with the most substantial decline calculated when moving from moderate to severe XLRP. This is the first study to generate utility values reflecting HRQoL of carers of patients with XLRP, by different levels of disease severity, and finds that carer utility decreases with increased XLRP severity in patients.

PMID:41686418 | DOI:10.1007/s12325-025-03485-0

Psychiatr Q. 2026 Feb 13. doi: 10.1007/s11126-026-10261-y. Online ahead of print.

NO ABSTRACT

PMID:41686403 | DOI:10.1007/s11126-026-10261-y

J Ultrasound. 2026 Feb 13. doi: 10.1007/s40477-026-01120-4. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatic elastography is a reliable, non-invasive imaging technique for assessing liver stiffness, aiding in the diagnosis of liver fibrosis and cirrhosis. Chronic hepatitis B (CHB) and chronic hepatitis C (CHC) contribute significantly to progressive liver disease and hepatocellular carcinoma (HCC) worldwide. Early detection and continuous monitoring of liver stiffness are crucial for effective disease management. However, data on hepatic elastography findings in Rwanda remain limited. This study aimed to describe hepatic elastography findings in patients with CHB and CHC at King Faisal Hospital; describe elastography findings difference in hepatitis B and C and Assess the correlation between demographic and clinical factors and fibrosis severity.

METHODS: A cross-sectional study was conducted among 149 patients with CHB and CHC. Liver stiffness was assessed using point shear wave elastography (pSWE) on the Siemens Acuson Sequoia ultrasound system. Demographic data, liver function tests, viral loads, and fibrosis staging were collected and analyzed using R and R Studio (v.4.3.3). Descriptive statistics were computed, Fisher’s exact test was used to assess associations, and multinomial logistic regression was applied to identify key contributors to fibrosis severity. Model accuracy, sensitivity, and specificity were also evaluated.

RESULTS: Of the 149 participants, 77 (52%) had CHB and 72 (48%) had CHC. Severe fibrosis (F3-F4) was significantly more prevalent in CHC patients (72%) than in CHB patients (28%) (p = 0.011). Age was a strong predictor of fibrosis severity; patients over 40 years were 10.3 times more likely to have advanced fibrosis (p = 0.002). Other significant predictors included patient with longer infection duration (7-12 years), hepatic steatosis, abnormal viral load, and without on antiviral therapy (p < 0.001). Elevated AST, ALT, and GGT were strongly associated with advanced fibrosis (p < 0.001). Sex was not significantly associated with fibrosis severity. Elastography findings correlated well with biopsy results, with 84% of patients classified as F3-F4 by elastography confirmed to have advanced fibrosis by biopsy.

CONCLUSION: This study confirms that hepatic elastography is a powerful, non-invasive diagnostic tool for assessing liver fibrosis in patients with chronic hepatitis B and C. Advanced fibrosis and cirrhosis were significantly more prevalent among hepatitis C patients. Several clinical and demographic factors including older age, longer infection duration, hepatic steatosis observed on routine abdominal ultrasound, abnormal viral load, and lack of antiviral therapy were strongly associated with increased liver stiffness. Elevated liver enzymes (AST, ALT, GGT) also showed a significant correlation with fibrosis severity. Sex was not found to be a statistically significant predictor of fibrosis stage. These findings reaffirm the clinical reliability of elastography as a practical alternative to biopsy, particularly in resource-limited settings.

PMID:41686400 | DOI:10.1007/s40477-026-01120-4