Category: Nevin Manimala

JMIR Aging. 2026 May 18;9:e85074. doi: 10.2196/85074.

ABSTRACT

BACKGROUND: Cognitive decline in older adults is often accompanied by subtle motor alterations. Digital handwriting analysis has emerged as a promising noninvasive approach for detecting these changes, but its usefulness in community-based settings remains unclear.

OBJECTIVE: This study aims to examine the association of handwriting kinematics and physical performance measures with pentagon-copy performance classification in community-dwelling older adults.

METHODS: This cross-sectional study included 174 community-dwelling adults aged 60 years or older (mean age 73.9, SD 6.1 years; 108/174, 62% women). Participants completed 10 digital handwriting tasks and a battery of physical performance tests assessing strength, balance, gait, and cardiorespiratory fitness. Group classification was based on pentagon-copy performance and categorized as normal (93/174, 53% participants) or altered (81/174, 46% participants). Adjusted linear regression models included group as the main predictor and age and sex as covariates. Multiple comparisons were controlled using the Benjamini-Hochberg false discovery rate.

RESULTS: After adjustment for age, sex, and multiple comparisons, selected handwriting variables remained significantly associated with altered pentagon-copy performance, whereas no physical performance variables remained statistically significant. The most consistent differences were observed in cognitive effort and mechanical tasks, where participants with altered pentagon-copy performance showed longer contact time (β=526.8 ms; P<.001) and time on air (β=1111.5 ms; P<.001), together with lower mean writing pressure (β=-2058.8 au; P=.003). Overall, group differences were more consistently detected in handwriting-derived variables than in conventional physical performance outcomes after adjusted analyses.

CONCLUSIONS: Selected digital handwriting variables, particularly temporal measures, were more consistently associated with altered pentagon-copy performance than physical performance outcomes. These findings suggest that digital handwriting analysis may represent a sensitive complementary approach for exploring subtle functional differences in community-based settings.

PMID:42149645 | DOI:10.2196/85074

JMIR Infodemiology. 2026 May 18;6:e72524. doi: 10.2196/72524.

ABSTRACT

BACKGROUND: Public discourse is significantly impacted by the rapid spread of misinformation on social media platforms. Human moderators, while capable of performing well, face many challenges due to scalability. While large language models (LLMs) show great potential across various language tasks, their capacity for cognitive and contextual analysis, in detecting and interpreting misinformation, remains less evaluated.

OBJECTIVE: This study evaluates the effectiveness of LLMs in detecting and interpreting misinformation compared to human annotators, focusing on tasks requiring cognitive analysis and complex judgment. Additionally, we analyze the influence of different prompt engineering strategies on model performance and discuss ethical considerations for using LLMs in content moderation systems.

METHODS: We evaluated 4 OpenAI models against a panel of human annotators using a subset of posts from the MuMiN dataset. Each model and human annotator responded to structured questions on misinformation, following an established cognitive framework. Both human annotators and LLMs also provided scores indicating how confident they were in their responses. Various prompting strategies were used in this research, including: 0-shot, few-shot, and chain-of-thought, with performance evaluated through precision, recall, F₁-score, and accuracy. We used statistical tests, including the McNemar test, to quantitatively assess differences between LLM and human ratings of misinformation.

RESULTS: GPT-4 Turbo with chain-of-thought prompting achieved the highest performance of all LLMs for detecting misinformation, with an accuracy of 67.2% and an F₁-score of 78.3%, but was outperformed by human annotators, who achieved 70.1% accuracy and an F₁-score of 81%. LLMs performed well in tasks involving logical reasoning and straightforward misinformation detection, but struggled with complex judgments, including detecting sarcasm, understanding misinformation, and analyzing user intent. LLM confidence scores positively correlated with accuracy in simpler tasks (r=0.72, P<.01) but were less reliable in subjective and complex contextual evaluations.

CONCLUSIONS: LLMs show significant potential for automating misinformation detection. Their limitations in understanding and interpreting these posts highlight the current necessity of human oversight. A hybrid framework combining LLMs for preliminary screening with human moderators for more complex evaluation presents a promising future direction. Future research could prioritize the fine-tuning of LLMs using datasets that emphasize cognitive and emotional linguistic features, alongside the development of advanced prompting techniques.

PMID:42149639 | DOI:10.2196/72524

Urogynecology (Phila). 2025 Jul 29. doi: 10.1097/SPV.0000000000001729. Online ahead of print.

ABSTRACT

IMPORTANCE: Despite evidence that intraperitoneal local anesthetics can have a positive effect on patients’ postoperative recovery, such use in urogynecology remains underinvestigated.

OBJECTIVE: The purpose of this study was to evaluate the effects of intraperitoneal bupivacaine without epinephrine on postoperative pain control in patients undergoing surgery for pelvic organ prolapse (POP).

STUDY DESIGN: This double-blind randomized controlled trial compared intraperitoneal bupivacaine versus placebo for postoperative pain control in patients undergoing POP surgery. The primary outcome was pain scores based on a 10-point numeric rating scale and visual analog scale (NRS-VAS) at 4 hours after surgery. Secondary outcomes included pain scores based on the NRS-VAS collected at 8, 12, and 24 hours after surgery, postoperative opiate consumption during inpatient stay, time to first narcotic dose, and hospital length of stay.

RESULTS: Ninety-one participants were randomized into treatment (n = 44) or placebo (n= 47) groups. No differences in demographic or baseline characteristics, surgical time, estimated blood loss, or intraoperative complications were observed between groups. The primary outcome, NRS-VAS pain scores at 4 hours after surgery, showed no statistically significant difference between groups. Similarly, no significant differences were found in NRS-VAS scores at 8, 12, or 24 hours after surgery, total postoperative opiate consumption, time to first narcotic dose during inpatient stay, or hospital length of stay.

CONCLUSIONS: No differences in pain scores, opiate consumption, time to first narcotic dose, or hospital length of stay were observed between the treatment and placebo groups. The routine use of intraperitoneal bupivacaine following POP surgery appears to have limited clinical utility.

PMID:42149629 | DOI:10.1097/SPV.0000000000001729

JAMA Netw Open. 2026 May 1;9(5):e2611464. doi: 10.1001/jamanetworkopen.2026.11464.

ABSTRACT

IMPORTANCE: Observational studies have reported associations between pregnancy vitamin D levels and offspring cognition, but no randomized clinical trial (RCT) has investigated the effect of high-dose vitamin D3 supplementation in pregnancy on offspring cognition into middle childhood.

OBJECTIVE: To assess whether high-dose vitamin D3 supplementation during pregnancy is associated with improved offspring cognition at age 10 years.

DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc secondary analysis of the blinded, placebo-controlled Copenhagen Prospective Studies on Asthma in Childhood 2010 RCT conducted from March 4, 2009, to November 17, 2010. The cohort included 700 mother-child pairs from Denmark, of whom 623 were randomized. Exclusion criteria were vitamin D intake above 600 IU/d; endocrine, kidney, or heart disease; and insufficient Danish language proficiency. Cognitive assessments were conducted for the offspring at age 10 years, excluding those born at less than 28 weeks’ gestation and with birth weight less than 1500 g. Participants were unblinded at 3 years of age, while investigators remained unaware of group assignments. The 10-year visits were conducted from February 11, 2019, to December 13, 2021. Statistical analyses were conducted from February to June 2025.

INTERVENTION: High-dose (2800 IU/d) or standard-dose (400 IU/d) vitamin D3 from pregnancy week 24 to 1 week post partum.

MAIN OUTCOME AND MEASURES: The primary outcome was cognitive functioning across 11 functions assessed at age 10 years using a comprehensive neuropsychological test battery as part of the Copenhagen Prospective Study on Neuro-Psychiatric Development (COPSYCH).

RESULTS: The vitamin D3 RCT and the COPSYCH visit were completed by 498 children (mean [SD] age, 10.3 [0.4] years; 258 boys [51.8%]): 247 prenatally exposed to high-dose vitamin D3 and 251 prenatally exposed to standard-dose vitamin D3. Covariate-adjusted analyses of standardized scores (mean [SD], 0 [1]; higher values indicating better performance) showed positive associations of high-dose vitamin D3 with verbal memory (β = 0.17 SD; 95% CI, 0.03-0.32 SD; P = .02), visual memory (β = 0.24 SD; 95% CI, 0.06-0.42 SD; P = .01), and flexibility or set shift (β = 0.19 SD; 95% CI, 0.01-0.37 SD; P = .04); however, high-dose vitamin D3 was no longer associated with flexibility or set shift after multiple test correction.

CONCLUSION AND RELEVANCE: This post hoc analysis of an RCT suggests that high-dose vitamin D3 supplementation in pregnancy is positively associated with visual memory, verbal memory, and flexibility or set shift among offspring measured at age 10 years. These findings strengthen evidence on the association of prenatal vitamin D exposure with childhood cognition.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00856947.

PMID:42149595 | DOI:10.1001/jamanetworkopen.2026.11464

JAMA Netw Open. 2026 May 1;9(5):e2613256. doi: 10.1001/jamanetworkopen.2026.13256.

ABSTRACT

IMPORTANCE: Trauma center designation in the US is determined by state-specific criteria, whereas the optional American College of Surgeons Committee on Trauma (ACS-COT) standards provide a nationally recognized benchmark for optimal trauma care. The number of trauma centers continues to expand, yet access disparities persist. The degree of alignment between state designation criteria and ACS-COT standards as well as its implications for recent patterns of for-profit and nonprofit center expansion remain unexplored.

OBJECTIVE: To quantify the concordance between each state’s trauma center designation criteria and ACS-COT standards, and to evaluate its correlation with expansion of for-profit and nonprofit trauma centers.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Trauma Information Exchange Program database for all designated trauma centers in the 50 states and the District of Columbia from January 1, 2013, to December 31, 2022. Data were analyzed from January to September 2024.

EXPOSURE: State-specific trauma center designation criteria.

MAIN OUTCOMES AND MEASURES: The primary outcome was concordance, defined as the proportion of ACS-COT standards reflected in each state’s trauma center designation criteria. Correlations (Spearman rank [rs]) of concordance with the expansion of for-profit and nonprofit trauma centers from 2013 to 2022 were calculated.

RESULTS: The study cohort comprised 464 trauma centers (389 nonprofit [83.8%] and 75 for-profit [16.2%]) that gained designation between 2013 and 2022. State trauma center designation criteria concordance with ACS-COT standards varied between 31.1% and 100%. Overall mean (SD) concordance was highest for level I trauma centers with the highest resource capacity (92.5% [15.6%]) and lowest for level IV trauma centers with low resource capacity (78.5% [28.2%]). Among the 464 trauma centers, 380 (81.9%) were level III or IV centers with lower resource capacity. States with lower concordance between their designation criteria and ACS-COT standards had a statistically significant correlation with expansion of for-profit trauma centers (rs = -0.39; P = .004) but not with expansion of nonprofit trauma centers.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of state trauma center designation criteria and their alignment with ACS-COT standards, states’ designation criteria and trauma center expansion patterns varied widely. Lower concordance between state designation criteria and ACS-COT standards was correlated with for-profit trauma centers, whereas this pattern was not observed for nonprofit trauma centers. These findings highlight the importance of understanding how regulatory environments may shape trauma system development.

PMID:42149591 | DOI:10.1001/jamanetworkopen.2026.13256

JAMA Netw Open. 2026 May 1;9(5):e2613308. doi: 10.1001/jamanetworkopen.2026.13308.

ABSTRACT

IMPORTANCE: Breastfeeding improves health outcomes in neonates. However, infants’ oral anatomy may alter latch and sucking mechanics, hampering breastfeeding. The role of maxillary frenulum (upper lip-tie) has remained controversial.

OBJECTIVE: To investigate the association between upper lip-tie clinical findings, such as thickness, attachment, and upper lip mobility, and early breastfeeding problems.

DESIGN, SETTING, AND PARTICIPANTS: In this prospective cohort study (Lingual Frenulum in Newborn Infants substudy), consecutive mother-infant dyads were studied from August 2, 2023, to January 31, 2024, in the mother-child unit of Oulu University Hospital, Oulu, Finland. After 6 months, parents were asked about breastfeeding success.

MAIN OUTCOMES AND MEASURES: Main outcomes were the association of various maxillary frenulum clinical findings with breastfeeding problems and possible treatment indications. Study physicians assessed frenulum thickness, tissue type, attachment point, upper lip mobility and skin paleness when stretched, sucking pad, mother’s need to fix the upper lip position, and the need of early tongue-tie treatment. The validated maternal breastfeeding experience scores were recorded. Follow-up information was inquired via emails.

RESULTS: Of the 264 studied mother-infant dyads (151 [57.2%] male infants; mean [SD] gestational age, 39.5 [1.2] weeks), 228 mothers (86.4%) reported early breastfeeding problems in maternal breastfeeding experience scoring. Baseline data were similar between the breastfeeding problem group vs controls. No associations between distinct maxillary frenulum findings and breastfeeding problems were found. Mothers without breastfeeding problems had more often previous breastfeeding experience than mothers who reported breastfeeding problems (28 [77.8%] vs 116 [50.9%], P = .003). Of the mothers with infants treated early for tongue-tie, 17 (43.6%) vs 46 (20.8%) of the nontreated patients’ mothers reported a need to fix the upper lip position during breastfeeding (P = .003). The upper lip-ties of 4 infants (1.5%) had been operated on during the 6-month follow-up period.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study, an isolated, harmful upper lip-tie was rare in newborn infants. Maternal inexperience, rather than infant’s upper lip-tie anatomy, was associated with breastfeeding problems; no operative treatment indications for maxillary frenulum were confirmed.

PMID:42149590 | DOI:10.1001/jamanetworkopen.2026.13308

JAMA Neurol. 2026 May 18. doi: 10.1001/jamaneurol.2026.1232. Online ahead of print.

ABSTRACT

IMPORTANCE: Disruptions in the sleep-wake cycle have been reported in the preclinical period of dementia; whether they contribute to dementia prediction remains unclear.

OBJECTIVE: To examine associations of accelerometer-derived sleep-wake cycle metrics with incident dementia and their contribution to dementia risk prediction in models containing age and known risk factors.

DESIGN, SETTING, AND PARTICIPANTS: This study included 2 prospective UK population-based cohort studies: (1) UK Biobank (derivation study) and (2) Whitehall II (validation study). A UK Biobank accelerometer substudy was undertaken from 2013 to 2015, yielding accelerometer data on 103 278 participants. A Whitehall II accelerometer substudy was undertaken from 2012 to 2013 that provided data on 4267 participants. Analyses were performed between August 2024 and November 2025. Included participants were 60 years and older, without dementia, and with valid accelerometer and covariate data.

EXPOSURES: Thirty-six accelerometer-derived sleep-wake cycle metrics were extracted. A machine learning approach identified and combined metrics predicting dementia risk.

MAIN OUTCOME AND MEASURE: Incident all-cause dementia, ascertained from electronic health records.

RESULTS: Analyses were based on 53 448 UK Biobank participants (mean [SD] age, 67.5 [4.2] years; 28 448 female [54.2%]; mean [SD] follow-up, 7.8 [1.1] years) and 3965 Whitehall II participants (mean [SD] age, 69.4 [5.7] years; 1025 female [25.9%]; mean [SD] follow-up, 10.6 [2.4] years). In UK Biobank, 9 sleep-wake cycle metrics were combined in 2 components. Higher values in component 1 represented shorter durations and less frequent bouts of moderate to vigorous physical activity, more time in low-intensity activity, lower diversity of activity intensities, and higher probabilities to transition from activity to rest during daytime. Higher component 2 corresponded to more extreme sleep durations, longer wake bouts during sleep, lower probabilities to transition from wake to sleep, and earlier waking time. Both components were associated with higher dementia risk (component 1: hazard ratio [HR], 1.43; 95% CI, 1.33-1.54; component 2: HR, 1.10; 95% CI, 1.04-1.17) and improved prediction of a model including sociodemographic, behavioral, and health-related factors (increase in C index = 0.018; 95% CI, 0.011-0.025). Results were confirmed in the Whitehall II cohort study. Compared with an age-only prediction model, adding the components led to an increase in C index equivalent to that for APOE genotype.

CONCLUSIONS AND RELEVANCE: Results of this cohort study show that accelerometer-derived sleep-wake cycle measures were associated with dementia, and made a modest, statistically significant contribution to its prediction. Future studies should evaluate their clinical utility as scalable markers alongside established predictors for early identification of individuals at risk of dementia.

PMID:42149581 | DOI:10.1001/jamaneurol.2026.1232

JAMA Intern Med. 2026 May 18. doi: 10.1001/jamainternmed.2026.1426. Online ahead of print.

ABSTRACT

IMPORTANCE: Most antibiotic prescribing takes place in primary care, driving antimicrobial resistance, a top-10 threat to global public health. There is considerable international interest in whether rapid multiplex microbiological point-of-care testing (RM-POCT) can safely reduce antibiotic prescribing in primary care.

OBJECTIVE: To investigate whether the use of a RM-POCT can safely reduce same-day antibiotic prescribing for children and adults presenting to primary care with respiratory infections.

DESIGN, SETTING, AND PARTICIPANTS: This parallel-group randomized clinical trial was conducted at 16 general practices in Southwest England between December 2022 and April 2024. Patients were eligible if they were aged 12 months or older, presented with any clinician-diagnosed acute (≤21 days) respiratory tract infection, and the patient or clinician believed antibiotic treatment was, or might be, necessary. Participants were randomized (1:1) to RM-POCT or usual care. The research team, including those conducting statistical analyses, were unaware of group allocation. Data were analyzed from November 21, 2024, to March 13, 2025.

INTERVENTION: Patients in the intervention group were tested with RM-POCT to indicate the presence or absence of 19 respiratory viral pathogens and 4 atypical bacteria in approximately 45 minutes.

MAIN OUTCOMES AND MEASURES: The primary outcome was same-day antibiotic prescribing. The safety outcome was patient-reported symptom severity on days 2 to 4.

RESULTS: Among 552 included patients (mean [SD] age, 40.0 [21.2] years; 349 [63%] female), 276 were randomized to the intervention group and 276 to usual care. Primary outcome data were available for all participants, and safety outcome data were available in 216 intervention participants (78%) and 203 usual care participants (74%). Same-day antibiotics were prescribed to 124 participants (45%) in each group (odds ratio [OR], 1.00 [95% CI, 0.71 to 1.41]; P > .99). Prespecified subgroup analyses showed evidence of differentially reduced antibiotic prescribing in participants from whom a virus was detected (OR, 0.35 [95% CI, 0.20 to 0.63]; P for interaction < .001) and those with chronic lung disease (OR, 0.55 [95% CI, 0.28 to 1.09]; P for interaction = .046) but not children younger than 16 years (OR, 1.75 [95% CI, 0.64 to 4.74]; P for interaction = .24), nor where patients and clinicians disagreed on antibiotic necessity (OR, 1.12 [95% CI, 0.63 to 1.98]; P for interaction = .53). There was no difference in symptom severity on days 2 to 4 between groups (difference in means, 0.09 [95% CI, -0.10 to 0.27]; P = .36).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial among patients with respiratory tract infections being considered for antibiotic treatment in primary care, use of an RM-POCT did not reduce same-day antibiotic prescribing or worsen patient outcomes.

TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN16039192.

PMID:42149561 | DOI:10.1001/jamainternmed.2026.1426

J Pers Soc Psychol. 2026 May 18. doi: 10.1037/pspa0000487. Online ahead of print.

ABSTRACT

When thinking about a task or goal feels difficult, people can interpret this as signaling self-relevant value (difficulty-as-importance) and a reminder to stop wasting time on self-irrelevant things (difficulty-as-impossibility). Identity-based motivation theory predicts that both interpretations are available in memory, vary in momentary accessibility, and shape action in part through activating action-relevant judgments. We note that in situations calling for task engagement, action-relevant judgment entails making sense of time, an abstract concept that people reason about metaphorically. We test this novel prediction that difficulty mindsets shape action in part by shaping how people reason metaphorically about time by examining associations (N = 941) and documenting effects of mindset accessibility (using an autobiographical recall task, N = 1,676) on how much people endorse the time-as-limited and time-as-expandable aspects of the time-as-resource metaphor. Indeed, across experiments, people more strongly endorsed time-as-limited, less strongly endorsed time-as-expandable and saw these aspects of the time-as-resource metaphor as more negatively correlated if randomized to the difficulty-as-impossibility (vs. difficulty-as-importance) recall condition. Supporting our novel prediction, the consequence of accessible difficulty mindsets on task engagement (Experiments 2-3) and performance (Experiments 4-5), confidence in goal progress and experienced time to make progress (the length of the line they drew to represent the semester or year, Experiments 6-7) occurred partly through the effect of accessible mindsets on momentary judgments of time-as-limited and time-as-expandable, as revealed in statistical mediation analyses. In situations requiring task engagement and assessing goal certainty, accessible difficulty mindsets matter in part by momentarily shifting judgments about having time. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42149496 | DOI:10.1037/pspa0000487

Psychol Methods. 2026 May 18. doi: 10.1037/met0000834. Online ahead of print.

ABSTRACT

Although previous research has described that intervention effects vary across replication studies, less effort has been devoted to identifying causes of this effect heterogeneity with regard to differences in study implementations. However, knowing in which way study characteristics (such as population, measurement instrument, setting, or treatment implementation) impact the study results may not only help to better infer the impact of research practices but also provide evidence for theory building. Causal effects can be easily identified if all study characteristics but the one under investigation are kept constant across two studies. This is, however, not always possible in practice and unintended differences between the studies to be compared may confound the relationship of the study characteristic of interest and the treatment effect. In this article, we present a statistical approach for identifying effects of study characteristics on study-specific treatment effects from randomized experiments in cases in which unintended differences in study implementation across studies cannot be prevented. We present formal definitions of the causal effects of interest, identification assumptions, and derive respective causal estimands. The assumptions can more likely be fulfilled in prospective replication studies or many-lab studies, where researchers have more control over design and measurement of covariates in both studies. We also provide ways to test the assumptions and illustrate consequences of not meeting the assumptions. The approach is illustrated using an empirical example on the imagined intergroup contact effect in social psychology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42149494 | DOI:10.1037/met0000834