Nevin Manimala

Logoped Phoniatr Vocol. 2026 Jul 28:1-22. doi: 10.1080/14015439.2026.2705822. Online ahead of print.

ABSTRACT

Introduction: Singing-voice therapy by Speech and Language Therapists (SLTs) is the main treatment for singing-voice disorders. Who are the SLTs who treat singing-voice disorders? Who are their patients? What clinical tools do they use? This study answers these three questions through a survey conducted in the French-speaking clinical community.

Method: 112 French-speaking SLTs responded to an open-ended survey. Descriptive and inferential statistical analyses were carried out, together with a comparison with existing voice therapy taxonomies.

Results: Most of the SLTs who work with singers are musicians. They have received cross-disciplinary training from health professionals, singing teachers and voice pedagogues, and teachers of mind-body techniques. Most of them use the term “dysodia” to refer to singing-voice disorders. Semi-occluded vocal tract exercises constitute their primary clinical tool. Indirect therapy is significantly less common than direct therapy. SLTs work significantly less on the musculoskeletal system than on the other systems (respiratory, auditory, somatosensory and vocal function). Their patients are mainly amateur singers of all styles.

Conclusions: This study provides a first structured overview of singing-voice therapy practices among French-speaking SLTs. It highlights clinical practices and tools consistent with recommendations in the literature. It lays the groundwork for future research on these specific therapeutic practices, as well as for the development of clinical guidelines, strengthened interprofessional collaboration, and international standardisation. The issue of therapeutic dosage has yet to be addressed. The predominance of amateur singers among singer-patients confirms the need for prevention.

PMID:42520146 | DOI:10.1080/14015439.2026.2705822

JBJS Rev. 2026 Jul 28;14(7). doi: 10.2106/JBJS.RVW.26.00060. eCollection 2026 Jul 1.

ABSTRACT

BACKGROUND: Aseptic loosening is a leading indication for revision total knee arthroplasty (rTKA). When one component remains well-fixed, surgeons may choose between isolated component revision (ICR) and full component revision (FCR), but the outcomes of these strategies remain uncertain. This systematic review and meta-analysis compared ICR with FCR in aseptic rTKA.

METHODS: Comparative studies of adult patients undergoing aseptic rTKA with ICR vs. FCR were identified. Outcomes included all-cause and cause-specific revision failure, patient-reported outcome measures (PROMs), and range of motion (ROM). The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach for statistically significant meta-analyses. Individual participant data (IPD) were reconstructed from Kaplan-Meier curves and pooled for time-to-event analyses to estimate hazard ratios (HRs). Aggregate data (AD) meta-analyses used random-effects models to calculate pooled odds ratios (ORs) and mean differences (MDs).

RESULTS: Fifteen cohort studies (4,429 patients; 2,893 FCR, 1,536 ICR) were included. Reconstructed IPD from 5 studies (3,187 patients) showed a higher hazard of all cause revision failure after ICR compared with FCR (HR 1.51; 95% CI 1.28-1.78; p < 0.001). The AD meta-analysis of 13 studies showed a similar association (OR 1.58; 95% CI 1.21-2.07; p < 0.001; I2 = 33%). Cause-specific analyses were imprecise and crossed the null for aseptic loosening (OR 1.50; 95% CI 0.75-2.99), infection related failure (OR 0.90; 95% CI 0.41-1.96), and instability-related failure (OR 1.03; 95% CI 0.43-2.46). PROMs did not clearly differ between strategies. ICR was associated with greater postoperative ROM (MD 7.03°; 95% CI 0.21-13.85; p = 0.043).

CONCLUSION: ICR in aseptic rTKA was associated with an increased overall all-cause revision failure rate compared with FCR. While ICR is associated with a higher all-cause revision failure rate, the choice between techniques remains subject to surgeon discretion and patient-specific factors.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:42520142 | DOI:10.2106/JBJS.RVW.26.00060

Gut Microbes. 2026 Dec 31;18(1):2699456. doi: 10.1080/19490976.2026.2699456. Epub 2026 Jul 28.

ABSTRACT

BACKGROUND: Although COVID-19 vaccination has reduced morbidity and mortality, adults aged 65 y old and older are at high risk of complications from COVID-19. The evidence suggests that probiotics may enhance immune responses when co-administered with influenza vaccination. However, few studies have evaluated the potential benefit of probiotic supplementation in this context in this high-risk population.

MATERIAL: This study was a randomized controlled trial recruiting adults between 65 and 89 y of age living in Quebec, Canada, who received an mRNA booster (Pfizer-BioNTech or Moderna). Probiotic supplementation (Lacticaseibacillus rhamnosus Rosell^®-11 and Lacticaseibacillus paracasei Rosell^®-215, 1x 6 x 10⁹CFU per capsule) versus placebo was administered from 15 d pre- to 15 d post-vaccination. Participants provided dried blood spot samples at baseline, at 3- and 6-month post-vaccination. The primary outcome was the proportion of participants without detectable anti-S1-receptor binding domain (anti-S1-RBD) antibodies at 6 months post-vaccination. Secondary outcomes included longitudinal anti-S1-RBD and anti-nucleocapsid (anti-N) antibody responses across the three timepoints.

RESULTS: 592 adults were enrolled. At 6 months post-vaccination, anti-S1-RBD antibodies were comparable between groups, and the percentage of participants with undetectable antibody response in the placebo and probiotic groups (1.2% vs 1.6%) was comparable. Anti-N seropositivity was lower in the probiotic group at 6 months (OR 0.6, 95% CI 0.4-0.9; p = 0.02) and marginally lower at 3 months after adjustment. Self-reported COVID-19 infection incidence was 16.5% overall (19.1% placebo vs 13.9% probiotic; p = 0.134).

CONCLUSION: Probiotic supplementation administered around COVID-19 vaccination did not change the proportion of seronegative participants for anti-S1-RBD antibodies at 6 months. However, in the probiotic group, anti-N antibody levels were lower, while self-reported COVID-19 infections also tended to be reduced, although this difference was not statistically significant. They may be consistent with earlier control of infection and reduced exposure to the nucleocapsid antigen, but this interpretation remains speculative.

TRIAL REGISTRATION NUMBER: #NCT05195151.

PMID:42520140 | DOI:10.1080/19490976.2026.2699456

Public Health Res (Southampt). 2026 Jul;14(19):1-36. doi: 10.3310/GJTB1721.

ABSTRACT

BACKGROUND: Takeaway food outlets (‘takeaways’) sell hot food for consumption off the premises. Takeaway management zones are areas around schools where new takeaways are not allowed to open. They are the most common planning intervention targeting takeaways across local authorities in England to date. We conducted an evaluation of these zones to: model their impact on adult health model their associated economic costs and benefits explore their acceptability and perceived effectiveness among young people investigate support and perceived effectiveness among adults explore barriers to and facilitators of their adoption and implementation among local authority staff.

DATA AND METHODS: We used a forecast of takeaway growth and a statistical model to estimate the impact of zones on diet-related health outcomes, quality-adjusted life-years and healthcare costs to 2040. We did this for adults aged 25-64 years in six different local authorities. We conducted a linked economic analysis to understand the future costs and benefits of zones to local authorities, the National Health Service and national government. We estimated costs when denial of planning permission results in a 3-, 6- or 12-month vacancy before alternative retail uptake. We asked 46 young people about how acceptable they thought the policy was. By conducting ‘go along’ interviews, we gained insights into their everyday food habits within and outside the school gates. We used survey data to understand public acceptability and perceived effectiveness of zones. We also asked whether having fewer takeaways near schools could reduce how often young people consume takeaway food. To evaluate adoption and implementation, we interviewed 29 local authority public health and planning officers about what lessons they had learned.

RESULTS: Compared to no intervention, future reductions in takeaway exposure ranged from 3 outlets/person in Fenland to 28 outlets/person in Manchester. Obesity prevalence was reduced in both sexes in all local authorities, for example, in Manchester, by 2.3 percentage points for males. We observed reductions in disease incidence, for example, in Manchester, by 964 type II diabetes cases/100,000 males. Zones produced a positive net economic impact of, for example, £8.49-12.78M in Manchester. Despite objections on economic grounds, zones are associated with economic benefits for local authorities, the National Health Service and national government. Young people found zones to be acceptable and perceived them to have some positive impacts. But, a wider policy, including other types of outlets selling convenience food, may better limit dietary risk. Out of 3323 adults, 51% supported zone adoption. Almost three-quarters believed that zones would help young people to eat better. Among those aged 16-17 years, 33% agreed that young people would consume takeaway food less often if there were fewer takeaways near schools. Effective working relationships between local authority colleagues were important for adoption and implementation. Some local authorities ensured this by developing cross-departmental roles and policy ‘champions’. A formal implementation process ensured confidence and consistency in implementation.

CONCLUSIONS: Takeaway management zones around schools were forecast to reduce obesity prevalence and disease incidence by 2040, with no net economic costs. The public see zones as acceptable and potentially effective. However, the reality of adopting and implementing zones is challenging, while other aspects of food retail also influence the behaviours of young people.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR130597.

PMID:42518263 | DOI:10.3310/GJTB1721

JAMA Netw Open. 2026 Jul 1;9(7):e2624373. doi: 10.1001/jamanetworkopen.2026.24373.

ABSTRACT

IMPORTANCE: Everyday discrimination, defined as repeated exposure to subtle slights and unfair treatment, has been reported to be associated with adverse health outcomes, but its association with health care use remains incompletely understood.

OBJECTIVE: To examine the association between everyday discrimination and health care use among US adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 27 384 National Health Interview Survey respondents 18 years and older who completed the Everyday Discrimination Scale (EDS) in 2023. Statistical analysis was performed from August to October 2025.

EXPOSURE: Everyday discrimination was measured using the validated 5-item EDS, with composite scores ranging from 0 to 20 (higher scores indicate greater discrimination).

MAIN OUTCOMES AND MEASURES: Four categories of binary, self-reported health care outcomes across multiple timeframes were examined: delayed or forgone care, health care visits, cancer screenings, and vaccinations and other preventive screenings. Adjusted odds ratios (AORs) and 95% CIs were estimated using survey-weighted logistic regression, adjusted for demographic, socioeconomic, geographic, and clinical covariates.

RESULTS: The sample included 27 384 adults (mean [SD] age, 48.1 [18.5] years; 51.2% female [weighted percentage]). The mean (SD) EDS score was 2.48 (3.34). Higher EDS scores were associated with increased odds of cost-related barriers to medical care (AOR per 1-point increase, 1.13; 95% CI, 1.11-1.15) and prescription medications (AOR, 1.14; 95% CI, 1.12-1.16). Higher scores were also associated with greater use of emergency department visits (AOR, 1.05; 95% CI, 1.04-1.06), urgent care (AOR, 1.05; 95% CI, 1.04-1.06) but lower odds of physician visits (AOR, 0.97; 95% CI, 0.96-0.99) and dental visits (AOR, 0.98; 95% CI, 0.97-0.99). Everyday discrimination was associated with lower engagement in cholesterol testing (AOR, 0.96; 95% CI, 0.95-0.97) and diabetes screening (AOR, 0.97; 95% CI, 0.96-0.98).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 27 384 US adults, higher everyday discrimination scores were associated with higher reliance on emergency services and lower engagement with preventive care. Interventions addressing interpersonal and structural forms of discrimination, including culturally responsive care, implicit bias training, patient navigation programs, and expanded primary care access, are essential to reduce discrimination’s impact on health care use and outcomes.

PMID:42518238 | DOI:10.1001/jamanetworkopen.2026.24373

JAMA Netw Open. 2026 Jul 1;9(7):e2625630. doi: 10.1001/jamanetworkopen.2026.25630.

ABSTRACT

IMPORTANCE: Research on the specific experiences of Asian American health care professionals and trainees, who face cultural dilemmas and stereotypes distinct from other minority groups, is limited. Few studies have evaluated interactive theater-based interventions for collective healing from racial trauma and for addressing cultural dilemmas, situations in which individuals navigate internalized stigma, interpersonal bias, and systemic exclusion within professional settings.

OBJECTIVE: To evaluate the acceptability, feasibility, and impacts of Acting Together, a webinar series using interactive theater to promote therapeutic healing and skill-building among Asian American health care professionals and trainees facing cultural dilemmas and biases at individual, interpersonal, and systemic levels.

DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study with a mixed-methods design, Acting Together featured improvisational exercises, interactive skits inspired by Asian American trainees’ lived experiences, and panel discussions with Asian American health care professionals. Skits directly addressed topics of stereotypes, model-minority bias, and cultural expectations. Webinars were conducted via a videoconferencing platform in August and November 2023 and March 2024. Participants were health care trainees recruited nationally through institutional listservs, social media, and word of mouth.

MAIN OUTCOMES AND MEASURES: Prewebinar and postwebinar surveys assessed Likert-scale changes in self-perceived abilities to adapt, communicate, engage, and recognize implicit bias using paired t tests. Acceptability and feasibility were evaluated using summary statistics and Kolmogorov-Smirnov tests. Qualitative data from postwebinar focus groups were analyzed by iterative thematic analysis.

RESULTS: Out of 112 participants, 67 (59.8% response rate) completed paired pre-post surveys (41 [61.2%] female; 34 [50.7%] Asian American), including medical (34 [50.7%]), nursing (7 [10.4%]), and social work (5 [7.5%]) students. Most found the program fit into existing clinical work (63 [94.0%]), was adaptable to training programs (62 [92.5%]), and was recommendable (62 [92.5%]). Significant improvements were noted in pre-post scores for self-perceived wellness (13.8% change; P < .001), communication (13.2% change; P < .001), and confidence (11.2% change; P = .004), and 48 participants (71.6%) reported improved competency to recognize and address implicit biases (P < .001). Qualitative analysis revealed themes of psychological safety, community solidarity, and preparedness to address cultural dilemmas.

CONCLUSIONS AND RELEVANCE: In this mixed-methods study, Acting Together was associated with improved skills and confidence in addressing cultural dilemmas and implicit bias, suggesting interactive theater-based webinars are a promising educational approach to support Asian American health care professionals and trainees.

PMID:42518235 | DOI:10.1001/jamanetworkopen.2026.25630

JAMA Netw Open. 2026 Jul 1;9(7):e2625730. doi: 10.1001/jamanetworkopen.2026.25730.

ABSTRACT

IMPORTANCE: Postoperative delirium (POD) is a frequent and severe complication after cardiac surgery that is associated with increased risk of dementia and adverse outcomes. Early identification of high-risk patients remains challenging.

OBJECTIVE: To examine whether preoperative plasma Alzheimer disease biomarkers are associated with baseline cognition and can independently estimate POD in patients undergoing elective cardiac surgery.

DESIGN, SETTING, AND PARTICIPANTS: This prospective, observational cohort study (FIND Delirium Risk Factors [FINDERI]) included patients 50 years or older undergoing elective cardiac surgery at a comprehensive cardiac surgery center in Germany between February 1, 2021, and October 31, 2022. Statistical analysis was performed from January to December 2025.

EXPOSURES: Preoperative plasma concentrations of amyloid-β 1-40 (Aβ1-40), amyloid-β 42 (Aβ1-42), phosphorylated tau 181 (pTau181), and phosphorylated tau 217 (pTau217) were measured using validated immunoassays between November 1, 2022, and July 31, 2024.

MAIN OUTCOMES AND MEASURES: The primary outcome was POD, assessed daily for 5 days postoperatively using the Confusion Assessment Method algorithm. Baseline cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Risk estimation accuracy was evaluated using receiver operating characteristic analysis and multivariate logistic regression, adjusting for relevant clinical covariates.

RESULTS: Of 504 enrolled patients, 491 completed POD assessment (mean [SD] age, 68.4 [8.3] years; 385 [78.4%] male), of whom 106 (21.6%) developed POD. In multiple linear regression, pTau217 (β = -0.51; 95% CI, -0.89 to -0.12; P = .01) and age (β = -0.12; 95% CI, -0.16 to -0.08; P < .001) remained significant factors associated with lower MoCA scores. Patients who developed POD had higher preoperative Aβ1-40, Aβ1-42, pTau217, and Aβ1-40/Aβ1-42 × pTau217, and lower Aβ1-42/Aβ1-40. Aβ1-40 was the independent biomarker most strongly associated with POD (area under the receiver operating curve [AUC], 0.65; 95% CI, 0.59-0.71; P < .001). Combining biomarkers with clinical factors improved risk estimation (AUC, 0.74; 95% CI, 0.69-0.79; P < .001) compared with clinical factors alone (AUC, 0.73; 95% CI, 0.67-0.78; P < .001). A combined model including MoCA achieved an AUC of 0.77 (95% CI, 0.72-0.82; P < .001), driven primarily by Aβ1-40.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study, preoperative Aβ1-40 showed the strongest association with POD risk among the measured biomarkers. These findings suggest that preoperative plasma Aβ1-40 may contribute to POD risk stratification, but further research is needed to validate these findings and determine clinical utility.

PMID:42518233 | DOI:10.1001/jamanetworkopen.2026.25730

Sleep. 2026 Jul 28:zsag204. doi: 10.1093/sleep/zsag204. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Conventional respiratory-related limb movement (RRLM) metrics rely on event definitions and overlap rules that miss continuous respiratory-motor coupling intensity. We developed the respiration-limb coactivation index (RLCI), an algorithmic continuous biomarker, and evaluated associations with cardiovascular disease (CVD).

METHODS: In Human Sleep Project polysomnography, RLCI was computed in S0001 (N = 20 737) as the interaction between respiratory-flow recovery and phasic leg-EMG envelope. The locked S0001 pipeline, without parameter tuning, was applied to two independent HSP centers (I0004, I0006). Prevalent coronary heart disease (CHD), cerebrovascular disease (CER), and peripheral vascular disease (PVD) associations were assessed by multivariable logistic regression with stage-restricted comparisons against LMI, PLMI, and RRLMI and signal-processing sensitivity analyses.

RESULTS: After covariate adjustment, whole-night RRLMI was not significant for CHD or CER, whereas RLCI metrics, especially in N1 and first-half sleep, remained associated with CER and PVD. RLC N1 showed the strongest CER association (per-1-SD OR 1.11, 95% CI 1.06-1.15), and RLC FirstHalf was associated with PVD (OR 1.07, 95% CI 1.03-1.11). Stage-restricted RRLMI_N1 was significant for all four outcomes, supporting stage-matched benchmarking. Mutual adjustment suggested complementary RLCI information for CER and PVD, while conventional N1 respiratory-related movements better captured CHD. Findings were stable in sensitivity analyses and external validation.

CONCLUSIONS: RLCI associations with CER and PVD suggest respiratory-linked motor coactivation captures autonomic surges distinct from cumulative hypoxia or sleep fragmentation and may complement AHI-based cardiovascular risk stratification.

PMID:42518228 | DOI:10.1093/sleep/zsag204

Tree Physiol. 2026 Jul 28:tpag106. doi: 10.1093/treephys/tpag106. Online ahead of print.

ABSTRACT

Understanding the intra-annual timing of carbon allocation into wood is critical for linking environmental variability to forest carbon sequestration. We quantified the seasonal dynamics of xylem width increase and xylem biomass production in European beech (Fagus sylvatica) in Belgium during two contrasting growing seasons, a year characterized by a severe spring drought and peak summer hot drought (2020) and a mesic year (2021), using high-resolution X-ray micro-computed tomography (XμCT). Point dendrometer and microtomy measurements were used for validation and comparison. Both xylem width increase and cumulated xylem biomass production followed a sigmoidal seasonal trajectory in both years. Contrary to patterns commonly reported for conifers with a clear early- to latewood transition, the temporal lag between xylem width increase and xylem biomass production was minimal (< 3 days) and statistically insignificant, indicating near-synchronous development. XμCT-derived measurements of ring width, wood density, and biomass production broadly matched dendrometer data, as well as independent regional biomass estimates from the literature. Seasonal onset and cessation of xylogenesis shifted between years, with earlier onset and cessation in the dry year, which was aligned to microtomy data. Our results demonstrate that, in semi diffuse- to ring-porous angiosperms like beech, xylem expansion and secondary wall formation are tightly coupled, even under contrasting water availability, and suggest that dendrometer data can serve as a proxy for intra-seasonal wood biomass production at the stand level. XμCT provides a reliable tool for quantifying xylogenesis and carbon allocation, offering new insights into wood formation dynamics under variable environmental conditions.

PMID:42518227 | DOI:10.1093/treephys/tpag106

Lett Appl Microbiol. 2026 Jul 28:ovag065. doi: 10.1093/lambio/ovag065. Online ahead of print.

ABSTRACT

The increasing prevalence of multidrug-resistant Pseudomonas aeruginosa highlights the need for alternative therapeutic strategies. This study evaluated the potential of a commercial bacteriophage cocktail combined with antimicrobial agents and compared two practical methods for screening phage-antimicrobial synergy. A lytic bacteriophage isolated from the PYO phage cocktail was characterized by host range, size, pH and thermal stability, and lytic activity against the reference strain PAO1. Synergy was assessed with nine antimicrobial agents, including conventional antibiotics, efflux pump inhibitors, and essential oil compounds, using agar-based plaque assays and broth microdilution checkerboard assays. Plaque diameter and plaque number were evaluated at sub-MIC concentrations, whereas synergistic interactions were determined by the fractional inhibitory concentration index (FICI). Statistical significance was analyzed using one-way ANOVA followed by Dunnett’s multiple comparison test, and the association between plaque parameters and FICI values was explored using Spearman’s rank correlation. The isolated phage exhibited a burst size of approximately 259 PFU per infected cell and remained stable over a broad pH and temperature range, with significant reductions under highly acidic, highly alkaline, and high-temperature conditions. In agar-based assays, colistin, meropenem, and cinnamaldehyde significantly increased plaque diameter and/or plaque number (p < 0.05-0.001), depending on the bacterial strain tested. Checkerboard analysis identified the same four combinations as synergistic (FICI ≤ 0.5). Spearman’s rank correlation indicated a relationship between plaque parameters and FICI values. Overall, both methods identified the same synergistic combinations, suggesting that agar-based plaque assays may serve as a practical preliminary screening tool for phage-antimicrobial combinations, although further validation is required.

PMID:42518223 | DOI:10.1093/lambio/ovag065