Nevin Manimala

JMIR Form Res. 2026 Jun 16;10:e89820. doi: 10.2196/89820.

ABSTRACT

BACKGROUND: An estimated 5 to 8 million US children live with a parent who uses cannabis, and most cannabis users report smoking cannabis inside their homes, placing children at risk for cannabis secondhand smoke (cSHS) exposure. Indoor air quality (IAQ) monitoring provides real-time feedback on airborne pollutants and has shown promise in reducing in-home tobacco secondhand smoke exposure, suggesting its potential as an effective harm reduction strategy for cSHS.

OBJECTIVE: This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of using low-cost, off-the-shelf IAQ monitors to increase caregivers’ awareness of children’s cSHS exposure risk and to change smoking behavior. Secondary aims were to assess participant engagement, perceived usefulness, and household communication regarding in-home cannabis smoking.

METHODS: Between February 2025 and April 2025, 14 adults who smoked cannabis indoors and lived with at least 1 child aged younger than 16 years were recruited primarily via targeted social media advertisements and completed a 3-week trial. Participants received an Awair Element IAQ monitor, printed health education materials, and text messaging prompts for brief surveys. The IAQ monitor continuously measured PM2.5, VOCs, CO₂, temperature, and humidity. Daily surveys captured self-reported PM2.5 readings and recent cannabis use, while baseline and end-of-study assessments evaluated IAQ perceptions, cSHS risk awareness, and in-home smoking behavior. Survey results were summarized via descriptive statistics, and linear mixed-effects models were used to characterize objective IAQ trends. Six additional adult household members provided parallel end-of-study data.

RESULTS: Reported engagement was high, with 85% (11/13) of participants indicating that they reviewed the monitor at least daily. The average number of days in the previous week that a caregiver reported a child being home while cannabis was smoked declined from 4.5 (SD 2.2) at the trial start to 2.8 (SD 2.9) at the end (6/13, 46% had a reduction; 1/13, 8% reported an increase). Furthermore, 62% (8/13) of participants reported that they reduced (4/13, 31%) or thought about changing (4/13, 31%) their smoking habits. Around 62% (8/13) of participants agreed or strongly agreed that IAQ monitoring helped drive conversations about changing indoor smoking rules, while 100% (13/13) reported no IAQ-driven disagreements among household residents regarding in-home smoking rules. A linear mixed-effects model did not indicate a consistent trend in PM2.5 levels across participants over time (β=-0.28; SE 1.13; P=.81), but there was heterogeneity in trends, and those with the largest reductions in PM2.5 over the trial had the largest reduction in reported children’s cSHS exposure.

CONCLUSIONS: In-home IAQ monitoring was feasible and perceived as useful among caregivers who smoked cannabis indoors. Real-time IAQ feedback supported risk awareness, promoted family dialogue, and coincided with reductions in in-home smoking around children. These findings suggest that IAQ feedback may represent a scalable tool for reducing children’s cSHS exposure and merits further testing in larger, controlled trials.

PMID:42302266 | DOI:10.2196/89820

JMIR Aging. 2026 Jun 16;9:e95286. doi: 10.2196/95286.

ABSTRACT

BACKGROUND: Access to geriatric mental health (GMH) care is limited in rural areas. To meet this need, the Veterans Health Administration provides specialty tele-GMH care for aging rural veterans via regional telehealth hubs.

OBJECTIVE: This study aims to create a roadmap describing key phases and determinants underlying the implementation and sustainment of tele-GMH services as part of a qualitative longitudinal evaluation of tele-GMH teams.

METHODS: Semistructured interviews were conducted with clinicians from all 8 tele-GMH teams (n=25) at 3 time points across a 3-year period (October 2021-September 2024). Interview (n=46) data were summarized into key domains using a templated rapid qualitative approach, guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Further thematic analysis and team discussion elucidated the findings.

RESULTS: We identified key activities and determinants of success in three phases: (1) preimplementation (engaging leaders, securing funding/hiring, and defining services); (2) implementation scale-up and expansion (advertising, addressing challenges, seeking feedback, refining, and growth); and (3) sustainment (maintenance). Activities within each phase were cyclical and iterative (ie, nonlinear). Barriers to implementation included unfamiliarity with local aging resources; facilitators included tailoring strategies and engaging referring clinicians.

CONCLUSIONS: Similar processes emerged across regions in the development and sustainment of tele-GMH services, allowing for the creation of a unified roadmap. Limitations including sampling bias are discussed. Further work could apply and evaluate the utility of the roadmap to guide creation of tele-GMH services in new regions to enhance access to specialty care for aging rural veterans.

PMID:42302264 | DOI:10.2196/95286

JMIR Med Educ. 2026 Jun 16;12:e75516. doi: 10.2196/75516.

ABSTRACT

BACKGROUND: Pretest-posttest designs are widely used to estimate learning gain in studies evaluating educational interventions in medical education. The Weighted Gain Score (WGS) was proposed to reduce bias associated with differences in baseline performance.

OBJECTIVE: This study evaluated the statistical and inferential properties of the WGS by comparing it to Rasch Learning Gain (RLG) across 3 datasets.

METHODS: The WGS implements a weighting coefficient that includes the parameter µ, which linearly rescales the difference between pretest and posttest percentage scores. We examined the effect of varying µ (30, 50, and 70) on learning gain calculations and compared the results with those obtained using RLG. The following three datasets were analyzed: (1) a small illustrative dataset demonstrating the mathematical behavior of the WGS, (2) an empirical dataset from a previous educational evaluation study, and (3) a randomly generated binomial dataset designed to examine the metric under larger sample conditions.

RESULTS: Changing the parameter µ in the WGS affected the magnitude of the calculated learning gains: lower µ-values produced larger gain estimates, whereas higher µ-values produced smaller estimates. Despite these differences in scale, the WGS and RLG correlated strongly in both the empirical dataset (r=0.93; P<.001) and the simulated dataset (r=0.92; P<.001); variation in µ did not alter the inferential results. Both methods identified the same interaction effect in the empirical dataset.

CONCLUSIONS: The WGS produced results highly consistent with those of RLG while requiring substantially lower computational complexity. The metric can be applied to both small and large datasets and allows µ to function as an adjustment coefficient for calibrating learning gain estimates across cohorts without altering inferential conclusions.

PMID:42302261 | DOI:10.2196/75516

J Ultrasound Med. 2026 Jun 16. doi: 10.1002/jum.70337. Online ahead of print.

NO ABSTRACT

PMID:42302255 | DOI:10.1002/jum.70337

JMIR Form Res. 2026 Jun 16;10:e89302. doi: 10.2196/89302.

ABSTRACT

BACKGROUND: Virtual reality (VR) systems are increasingly used in rehabilitation to facilitate motor learning by providing visual feedback. However, few studies have validated the motion tracking accuracy of VR devices compared with gold-standard motion capture systems. In particular, validation evidence for upper-limb reaching with commercially available VR tracking setups remains limited.

OBJECTIVE: This study aimed to evaluate the validity of a custom VR-based rehabilitation system (VRactice) by comparing its motion tracking data with that of a Vicon motion capture system during a goal-directed reaching task in healthy adults.

METHODS: This laboratory-based validation study was conducted at Tokyo Kasei University, Sayama Campus, Japan (August-December 2023). Participants were recruited via posted announcements on campus (convenience sampling) and received a 1000 JPY gift card (US $7.00; JPY 142.79=US $1 as of August 1, 2023). A total of 16 healthy participants (n=6, 37.5% male and n=10, 62.5% female participants; mean age 25.3, SD 4.56 years; all right-handed) performed reaching tasks in a VR environment while being tracked simultaneously by both the VRactice system and a Vicon system. Trackers and reflective markers were attached to the hand and elbow to capture 3D coordinates. Each participant performed 10 reaching trials at a frequency of 1 Hz. Data were upsampled to 100 Hz, synchronized, and normalized to the initial position. Valid cycles were identified, and distance time series from the initial position were extracted for the 500-millisecond interval preceding the peak displacement. For each participant, all valid cycles were pooled, and the coefficient of determination (R2) between VRactice and Vicon trajectories was calculated. Of 160 planned trials (16 participants×10 trials), 4 (2.5%) trials were not recorded; the remaining 156 (97.5%) trials were analyzed without imputation. Statistical significance was evaluated at a 2-sided α level of .05.

RESULTS: Strong agreement between VRactice and Vicon was observed at both the individual and group levels. The R2 ranged from 0.75 to 0.99 across participants, and all comparisons were statistically significant (P<.001). Deviations between the 2 systems remained minimal, confirming that VRactice reliably reproduced the temporal and spatial characteristics of reaching trajectories. At peak displacement, the participant-level mean absolute difference (mean of 10 trials per participant) was 36.5 (SD 29.3) mm (95% CI 20.9-52.1), suggesting spatial agreement that may be acceptable for upper-limb reaching measurements in this experimental context.

CONCLUSIONS: The findings support the validity of VRactice in capturing reaching movements with high spatial accuracy compared with a motion capture system. By providing reliable motion data, VRactice may serve as a useful platform for delivering real-time visual feedback and supporting motor training applications in rehabilitation settings. This study is innovative in that it provides formative validity evidence for a VR-based system that integrates real-time trajectory monitoring with adaptive visual guidance, supporting subsequent clinical implementation and evaluation.

PMID:42302247 | DOI:10.2196/89302

J Chem Inf Model. 2026 Jun 16. doi: 10.1021/acs.jcim.6c00965. Online ahead of print.

ABSTRACT

High-dimensional feature spaces combined with limited sample sizes present substantial challenges for biological prediction tasks. Traditional feature selection methods rely on statistical associations between features and labels, whereas causal feature selection identifies features causally related to the target, improving the interpretability and robustness. Among them, constraint-based methods identify the Markov blanket of the target variable through the conditional independence tests. However, existing constraint-based ensemble strategies are computationally demanding, particularly during the spouse-discovery stage. To address this limitation, we propose EECFS, a novel ensemble causal feature selection algorithm that reduces the computational cost through an efficient spouse discovery strategy. Extensive evaluations on 16 Bayesian network datasets and 17 real-world datasets demonstrate that EECFS achieves improved efficiency while maintaining competitive or superior predictive performance compared with 11 representative methods. Furthermore, we extend causal feature selection to the task of synonymous variant effect prediction and developed CFDPSM. From an initial pool of 23 866 features spanning DNA, RNA, and protein molecular levels, CFDPSM identifies a compact set of 30 Markov blanket features. The experimental results show that it outperforms 13 existing variant effect prediction methods while providing enhanced interpretability.

PMID:42302235 | DOI:10.1021/acs.jcim.6c00965

Cancer Epidemiol Biomarkers Prev. 2026 Jun 16. doi: 10.1158/1055-9965.EPI-25-1949. Online ahead of print.

ABSTRACT

BACKGROUND: We previously reported a significantly increased risk of thyroid cancer due to radioactive iodine-131 (131I) after the 1986 Chernobyl nuclear accident in a cohort of children and adolescents from Belarus. Radiation-related cancer risks were five times higher among those with diffuse goiter, but the relationship between radiation dose and diffuse goiter is not well understood.

METHODS: We used logistic regression to analyze data from 10,278 study participants (mean thyroid dose=0.63 gray (Gy)) who were screened 10-15 years after exposure according to a standardized protocol, which specified thyroid size assessment by both ultrasound and palpation.

RESULTS: Diffuse goiter was identified in 1,811 subjects and was significantly associated with 131I dose (P<0.001). The linear model provided the best fit to the data at doses <0.5 Gy (excess odds ratio per gray (EOR/Gy) = 1.45, 95% confidence interval (CI): 0.70, 2.41) and linear-exponential model at doses <1.5 Gy (odds ratio (OR) at 1 Gy = 1.84). Age at exposure and indicators of iodine deficiency both before the accident (place of residence) and during screening (urinary iodine levels) significantly modified the dose-response (all P-values < 0.01).

CONCLUSIONS: The first systematic evaluation of radiation risks of diffuse goiter after environmental exposure found a strong, statistically significant association with thyroid dose.

IMPACT: Our study shows that radiation exposure is associated with a significantly increased risk of developing diffuse goiter. Future epidemiological studies of iodine-deficient irradiated populations should assess thyroid size.

PMID:42301737 | DOI:10.1158/1055-9965.EPI-25-1949

JAMA Netw Open. 2026 Jun 1;9(6):e2617273. doi: 10.1001/jamanetworkopen.2026.17273.

ABSTRACT

IMPORTANCE: Differences in typical-use contraceptive failure rates between long-acting reversible contraception (LARC; such as intrauterine devices [IUDs] and implants) and shorter-acting methods (depot medroxyprogesterone acetate [DMPA], pills, rings, and male condoms) are often the focus of contraceptive counseling, but assessments of contraceptive counseling have not focused on contraceptive effectiveness over time.

OBJECTIVE: To assess 3-year continuation and typical-use contraceptive failure rates for 7 reversible contraceptive methods provided with access barriers removed.

DESIGN, SETTING, AND PARTICIPANTS: The HER Salt Lake Contraceptive Initiative was a 3-year prospective longitudinal cohort study (September 2015 to March 2017, with follow-up data collected through June 2020). Participants (new contraceptive users 18-45 years who indicated they wanted to avoid pregnancy for at least 1 year) enrolled at 4 family planning clinics in Salt Lake County, Utah, and received person-centered contraception counseling and same-day access to the reversible contraceptive method of their choice. Data were analyzed from June 2024 to February 2026.

EXPOSURE: The exposure was contraceptive method selected at baseline (copper IUD, DMPA, implant hormonal IUD, condoms, pill, or ring).

MAIN OUTCOMES AND MEASURES: The outcome was experiencing a contraceptive failure, defined as an unintended pregnancy (self-reported or identified through electronic medical record) experienced while using a contraceptive method in the previous 4 weeks. Method-specific continuation and failure rates were calculated using a life table analysis.

RESULTS: Among 4275 contraceptive users (1759 [41%] aged 20-24 years), 96 pregnancies resulting from contraceptive failures of methods initiated at baseline were identified. Of all participants, 529 (11%) selected a copper IUD, 558 (13%) selected DMPA, 823 selected an implant (19%), 1025 (24%) selected a hormonal IUD, 52 (<1%) selected condoms, 1065 (25%) selected pills, and 223 (5%) selected the ring. Cumulative continuation at 3 years included 741 hormonal IUD users (72%), 455 implant users (55%), 321 copper IUD users (61%), 186 DMPA users (33%), 75 ring users (34%), 376 pill users (35%), and 8 male condom (15%). Three-year contraceptive failure rates per 100 person-years were 0.7 (95% CI, 0.4-1.1) for hormonal IUD users, 0.8 (95% CI, 0.5-1.3) for implant users, 1.1 (95% CI, 0.6-1.8) for copper IUD users, 1.1 (95% CI, 0.6-2.1) for DMPA users, 1.4 (95% CI, 0.6-3.2) for ring users, 1.6 (95% CI, 1.1-2.3) for pill users, and 2.6 (95% CI, 0.5-10.0) for male condom users.

CONCLUSIONS AND RELEVANCE: In this cohort study of individuals initiating a contraceptive method following person-centered contraceptive counseling and removal of access barriers, low 3-year contraceptive failure rates were observed for all methods, and shorter-acting methods had lower failure rates than previously reported typical use rates. These findings suggest that removing access barriers to preferred contraceptive methods may support access to clinician-dependent LARC methods, like IUDs and implants, and improve the contraceptive effectiveness of user-controlled, shorter-acting methods.

PMID:42301715 | DOI:10.1001/jamanetworkopen.2026.17273

JAMA Netw Open. 2026 Jun 1;9(6):e2618658. doi: 10.1001/jamanetworkopen.2026.18658.

ABSTRACT

IMPORTANCE: Hip fracture is common among older adults and is associated with considerable morbidity and mortality; it is nearly twice as common in those with dementia, who may also experience worse postfracture outcomes. Time spent at home is an important quality-of-life indicator, but this outcome has not been previously examined following hip fracture in older adults with and without dementia.

OBJECTIVE: To compare days at home and survival for the year after hip fracture among older adults with and without dementia and to identify factors associated with fewer days at home among those with dementia.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study used national administrative data from 100% of Medicare beneficiaries from 2012 to 2021 to identify community-dwelling older adults (aged ≥65 years) with and without dementia hospitalized for a hip fracture. Data were analyzed from January 1, 2012, to December 31, 2021.

EXPOSURE: Hip fracture hospitalization.

MAIN OUTCOMES AND MEASURES: Days at home and survival at 30 days, 6 months, and 1 year after hip fracture.

RESULTS: Among 1 756 388 Medicare beneficiaries hospitalized for hip fracture, the mean [SD] age was 82.5 [8.1] years, 1 237 193 (70.4%) were female, 65 889 [3.8%] were Black or African American, 93 362 [5.3%] were Hispanic, 1 547 090 [88.1%] were non-Hispanic White, and 513 698 (29.2%) had dementia. In the year following hip fracture, older adults with dementia died 50.3 days earlier than those without dementia (adjusted mean [SD] days, 264.6 [143.2] vs 314.9 [107.3]). Those with dementia who survived 1 year after fracture had 53.9 fewer days at home compared with those without dementia (adjusted mean [SD] days, 263.8 [129.5] vs 317.7 [72.9]) due to more time in skilled nursing (adjusted mean [SD] days, 38.2 [55.8] vs 24.2 [37.4]) and long-term care facilities (adjusted mean [SD] days, 52.5 [111.5] vs 12.4 [53.7]). Findings were similar at 1 and 6 months. Among individuals with dementia, Medicaid eligibility, rural residence, geographic region, and being aged 85 years or older were associated with the fewest days at home at 1 year.

CONCLUSIONS AND RELEVANCE: In this cohort study, older adults with dementia had shortened survival and more time in skilled nursing or long-term care facilities after hip fracture than those without dementia. Differences in days at home were associated with structural and socioeconomic factors among those with dementia, with implications for health system policy, prognostic counseling, and discussions about long-term care needs in this population.

PMID:42301713 | DOI:10.1001/jamanetworkopen.2026.18658

JAMA Netw Open. 2026 Jun 1;9(6):e2618677. doi: 10.1001/jamanetworkopen.2026.18677.

ABSTRACT

IMPORTANCE: Beneficiaries diagnosed with cancer and enrolled in Medicare Advantage (MA) may face barriers to care due to MA plan network design. Given sizeable growth in MA enrollment, it is important to evaluate how well these plans serve patients with high health care needs.

OBJECTIVE: To examine the association between MA network breadth and changes in coverage among beneficiaries with new cancer diagnoses.

DESIGN, SETTING, AND PARTICIPANTS: This cohort used data from the 2019 to 2020 Surveillance, Epidemiology, and End Results (SEER)-Medicare and 2019 Ideon networks to examine MA plan network inclusion of American College of Surgeons Commission on Cancer-accredited facilities and National Cancer Institute-designated cancer centers. Beneficiaries enrolled in MA who were newly diagnosed with cancer in 2019 were included. Data were analyzed from October 2024 through September 2025.

EXPOSURE: The explanatory variable of interest was network breadth for these hospitals, measured as a continuous variable. Characteristics of patients in narrow networks (those with fewer than 25% of facilities in the network geographic service area that were in network) and nonnarrow networks were compared.

MAIN OUTCOMES AND MEASURES: The main outcome was any plan switch between diagnosis and January 2020, along with the kind of switch (MA to traditional Medicare or new MA plan). Multivariable logistic regression models stratified by plan type (ie, beneficiaries in employer-sponsored and retiree MA plans, plans with premiums, and plans without premiums) were used given potential differences in plan choices for these beneficiary groups. Mean marginal effects were calculated, and coefficients were scaled by 10 percentage points.

RESULTS: Among 24 444 MA beneficiaries, 13 216 individuals had plans with narrow networks (mean [SD] age, 72.2 [7.7] years; 6465 male [48.9%]; 2503 Black [18.9%], 1963 Hispanic [14.9%], and 7563 White [57.2%]) and 11 228 individuals had plans with nonnarrow networks (mean [SD] age, 73.4 [7.7] years; 5638 male [50.2%]; 1613 Black [14.4%], 1346 Hispanic [12.0%], and 7405 White [66.0%]); those in narrow networks were younger and more likely to be Black. A 10-percentage point increase in network breadth was associated with a 4.5-percentage point (95% CI, 5.5 to 3.5 percentage points; P < .001) decrease in the probability of switching to traditional Medicare or a new MA plan for beneficiaries enrolled in a nonemployer plan that charged premiums. It was not associated with enrollment changes among those in employer or retiree plans.

CONCLUSIONS AND RELEVANCE: In this study, increased network breadth was not associated with decreased Medicare plan switching for enrollees in employer plans. This finding suggests that employer subsidization of coverage may outweigh concerns about network breadth for patients newly diagnosed with cancer.

PMID:42301712 | DOI:10.1001/jamanetworkopen.2026.18677