Nevin Manimala

J Am Geriatr Soc. 2026 Aug 6. doi: 10.1111/jgs.70630. Online ahead of print.

ABSTRACT

BACKGROUND: People with Alzheimer’s disease and related dementias (ADRD) are at increased risk of motor vehicle crash (MVC) due to cognitive decline, which often begins years before diagnosis. MVC could serve as an indicator of ADRD-related cognitive impairment and facilitate earlier diagnosis.

METHODS: We conducted a matched cohort study of Medicare beneficiaries in New Jersey aged ≥ 69 years with incident ADRD diagnoses from 2010 to 2017 compared to individuals without ADRD and with four other medical conditions: acute myocardial infarction (AMI), asthma, chronic obstructive pulmonary disease (COPD), and diabetes. Comparison groups were sampled with replacement and matched on sex, age, and calendar quarter of diagnosis or claim (for the non-ADRD group). Crash prevalence at 6 months and 1, 2, and 3 years before diagnosis was compared using chi-square tests, and the monthly prevalence was plotted to examine longitudinal trends in crashes.

RESULTS: We identified 43,115 eligible individuals with incident ADRD diagnosis from 2010 to 2017. MVC crash prevalence was higher in the ADRD group than in non-ADRD and negative control groups at all measured pre-diagnosis time points: 6 months (2.99% vs. 2.31%-2.53%), 1 year (5.26% vs. 4.18%-4.65%), 2 years (9.52% vs. 7.88%-8.67%), and 3 years (13.64% vs. 11.29%-12.37%). The ADRD group was more likely to have multiple crashes in the pre-diagnosis period, but multiple events were rare overall (< 3%). Differences were statistically significant but represented small changes in prevalence. Crash prevalence did not reveal a clear signal of cognitive decline in the years leading up to the index diagnosis.

CONCLUSIONS: Older adults with ADRD had slightly higher prevalence of MVC in the 3 years before diagnosis than matched comparison groups, but absolute differences were small and recurrent crashes were rare. MVC alone is too rare to serve as a signal of incipient ADRD, highlighting the need for more sensitive measures.

PMID:42560687 | DOI:10.1111/jgs.70630

JAMA Oncol. 2026 Aug 6. doi: 10.1001/jamaoncol.2026.2781. Online ahead of print.

ABSTRACT

IMPORTANCE: Adaptive therapy is an evolution-based treatment paradigm that has been shown to delay resistance in prostate cancer through treatment breaks that control, rather than minimize, tumor burden. However, patient responses are highly heterogeneous, and there is a significant unmet clinical need for biomarkers to personalize treatment scheduling.

OBJECTIVE: To develop and retrospectively validate mathematical biomarkers that predict time to progression (TTP), mean daily dose, and overall survival (OS) under adaptive therapy from first-cycle prostate-specific antigen (PSA) dynamics.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective modeling and validation study used longitudinal, nonrandomized clinical trial data from 2 independent cohorts: 40 patients with castrate-sensitive prostate cancer (CSPC) (June 1996 to September 2006) and 13 patients with metastatic castrate-resistant prostate cancer (mCRPC) (April 2015 to January 2022). A 2-population differential equation model was used to describe the overall tumor growth through the competing dynamics of drug-sensitive and drug-resistant cells. The statistical analysis was conducted from January 2025 to May 2026.

EXPOSURES: Patients received either intermittent androgen deprivation therapy (for CSPC) or adaptive abiraterone acetate (for mCRPC). The initial treatment cycle served as the exposure period to extract longitudinal PSA kinetics.

MAIN OUTCOMES AND MEASURES: Mechanism-based mathematical biomarkers (adaptive therapy score, expected TTP, and expected mean daily dose) were derived from first-cycle PSA kinetics. Outcomes included in silico benchmarking experiments and retrospective validation against clinical TTP and OS. Performance was benchmarked against standard phenomenological PSA metrics (eg, PSA nadir, time to nadir, and doubling time).

RESULTS: Overall, data from 53 patients across 2 clinical trials were included. In the CSPC cohort of 40 patients, the adaptive therapy score derived from first-cycle data was highly prognostic for prolonged clinical TTP (univariable hazard ratio [HR], 0.49; 95% CI, 0.31-0.76; P = .002). In the mCRPC cohort of 13 patients, the adaptive therapy score exhibited a strong rank correlation with clinical TTP (Spearman ρ = 0.76; P = .002) and was associated with prolonged TTP (HR, 0.41; 95% CI, 0.16-1.07; P = .07). Analysis of long-term survival data in the mCRPC cohort demonstrated that both the adaptive therapy score and expected TTP were significantly associated with prolonged OS, whereas standard empirical PSA metrics displayed no association with OS.

CONCLUSIONS AND RELEVANCE: In this modeling and validation study, mechanism-based mathematical biomarkers derived from the initial-cycle PSA dynamics accurately predicted patient-specific outcomes and survival, outperforming traditional phenomenological PSA monitoring. These accessible metrics could act as a mathematically informed decision support framework to stratify patients into personalized treatment protocols.

PMID:42560686 | DOI:10.1001/jamaoncol.2026.2781

JAMA Netw Open. 2026 Aug 3;9(8):e2626959. doi: 10.1001/jamanetworkopen.2026.26959.

ABSTRACT

IMPORTANCE: Rural hospital-level surgical quality has been extensively evaluated. However, rural people in the US face growing inequities in care, and quality of surgical care experienced by rural patients nationally remains poorly defined.

OBJECTIVE: To evaluate surgical quality among rural vs nonrural Medicare beneficiaries undergoing common general surgery procedures.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used 100% Medicare inpatient claims linked with the American Hospital Association Annual Survey between 2016 and 2023. The cohort included beneficiaries aged 65 to 99 years who underwent admission for appendectomy, cholecystectomy, colectomy, or incisional hernia repair. This analysis was undertaken between August and October 2025.

EXPOSURE: Rural vs nonrural residence, defined using Rural-Urban Commuting Area codes based on patient home zip code (1-3: nonrural; 4-10: rural).

MAIN OUTCOMES AND MEASURES: Risk-adjusted 30-day mortality, in-hospital mortality, complications, 30-day readmission, discharge disposition, and hospital length of stay. Multivariable logistic regression models adjusted for patient factors, hospital factors, and year of surgery.

RESULTS: Among 2 317 497 beneficiaries (55.5% female; mean [SD] age, 75.2 [7.2] years), 462 358 (19.9%) were rural. Rural patients were more often male (46.4% vs 44.1%) and traveled longer for surgery (median, 45.0 [IQR, 22.0-77.0] minutes vs 20.0 [IQR, 13.0-31.0] minutes). Rural patients had higher adjusted 30-day mortality (6.78% [95% CI, 6.65%-6.90%] vs 5.84% [95% CI, 5.76%-5.93%]; odds ratio [OR], 1.21 [95% CI, 1.18-1.24]; P < .001), in-hospital mortality (3.65% [95% CI, 3.56%-3.74%] vs 3.20% [95% CI, 3.14%-3.25%]; OR, 1.17 [95% CI, 1.14-1.21]; P < .001), and 30-day readmission (14.31% [95% CI, 14.14%-14.48%] vs 13.57% [95% CI, 13.45%-13.69%]; OR, 1.07 [95% CI, 1.05-1.08]; P < .001). Complication rates were higher (29.31% [95% CI, 29.04%-29.57%] vs 28.58% [95% CI, 28.40%-28.76%]; OR, 1.05 [95% CI, 1.03-1.07]; P < .001). Rural patients were less likely to be discharged home (75.56% [95% CI, 75.24%-75.88%] vs 77.61% [95% CI, 77.36%-77.86%]; OR, 0.85 [95% CI, 0.83-0.88]; P < .001) and more likely to be transferred to another facility (1.40% [95% CI, 1.33%-1.47%] vs 0.70% [95% CI, 0.67%-0.73%]; OR, 2.04 [95% CI, 1.92-2.17]; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study of Medicare beneficiaries undergoing common general surgery procedures, rural residence was independently associated with worse clinical outcomes across most measures. These findings identify significant opportunities for quality improvement focused on common rural surgical needs.

PMID:42560677 | DOI:10.1001/jamanetworkopen.2026.26959

JAMA Netw Open. 2026 Aug 3;9(8):e2627595. doi: 10.1001/jamanetworkopen.2026.27595.

ABSTRACT

IMPORTANCE: A previous systematic review reported that general mental health and anxiety symptoms, but not depression or stress, worsened more for females or women than for males or men from before to during the COVID-19 pandemic based on 12 studies published up to August 2021.

OBJECTIVE: To update a systematic review on sex or gender differences in mental health symptom changes from before to during the COVID-19 pandemic.

DATA SOURCES: Medline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints were searched from December 31, 2019, to August 31, 2023.

STUDY SELECTION: Eligible studies included data to calculate changes in general mental health, anxiety symptoms, depression symptoms, or stress from before to during the COVID-19 pandemic by sex or gender.

DATA EXTRACTION AND SYNTHESIS: Standardized mean differences (SMDs) for continuous changes and proportions for dichotomous changes were used. Two independent reviewers extracted data and evaluated risk of bias. Data were pooled via random-effects models on March 21, 2024.

MAIN OUTCOMES AND MEASURES: The main outcome was the differences in SMD changes and proportions between women or females and men or males of mental health symptoms from before the COVID-19 pandemic to during the COVID-19 pandemic.

RESULTS: The study included 27 unique cohorts from 14 countries (n = 102-18 127; 31 155 women or females and 30 737 men or males). Differences in SMD change between men and women were minimal and not statistically significant for continuous outcomes of general mental health (0.01 [95% CI, -0.07 to 0.10 and 95% prediction interval (PI), -0.23 to 0.25]; 8 cohorts; 21 762 participants; heterogeneity [I2] = 81.4%), anxiety (0.09 [95% CI, -0.04 to 0.22 and 95% PI, -0.27 to 0.45]; 7 cohorts; 6039 participants; I2 = 68.7%), depression (0.10 [95% CI, -0.00 to 0.20 and 95% PI, -0.23 to 0.43]; 12 cohorts; 9750 participants; I2 = 65.4%), and stress (-0.08 [95% CI, -0.16 to 0.01 and 95% PI, -0.18 to 0.02]; 8 cohorts; 2994 participants; I2 = 0%). Substantial heterogeneity, high risk of bias, or both were present across analyses. No studies reported changes for gender minority groups (eg, transgender, nonbinary).

CONCLUSION AND RELEVANCE: In this systematic review and meta-analysis of sex or gender differences in mental health changes from before to during the COVID-19 pandemic, no significant differences were found. However, findings should be interpreted cautiously and may not apply in all settings due to heterogeneity and methodological limitations of included studies.

PMID:42560673 | DOI:10.1001/jamanetworkopen.2026.27595

JAMA Netw Open. 2026 Aug 3;9(8):e2627603. doi: 10.1001/jamanetworkopen.2026.27603.

ABSTRACT

IMPORTANCE: Illinois is an abortion hub serving a high volume of patients who travel from midwestern and southern states for abortion care. To sustain access to quality services and reduce health care barriers, research is needed to understand the experiences of abortion travelers.

OBJECTIVES: To explore the experiences of out-of-state individuals who travel to central and southern Illinois to receive abortion care.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used purposeful sampling to recruit 208 participants at 2 abortion clinics between November 2024 and August 2025. Participants completed the study at the time of recruitment.

EXPOSURE: Participants traveled for abortion care based on their state of residence.

MAIN OUTCOMES AND MEASURES: Using reflexive thematic analysis, both the experiences of out-of-state abortion travelers in central and southern Illinois and the need for reduction in access barriers for those traveling for abortion were examined.

RESULTS: In this qualitative study of 208 abortion seekers who successfully traveled to Illinois, 128 (61.54%) self-identified as Black, 50 (24.03%) non-Hispanic White, and 30 (14.42%) as women from additional minoritized racial and ethnic groups. Participants’ age ranged from 18 to 45 years. All lived in midwestern or southern states. Participants were interviewed in a private room at the clinic between November 2024 and August 2025. Participants discussed structural, logistical, and emotional challenges. Yet, they described abortion traveling as necessary because of the abortion ban and misinformation, which contributed to increased medical distrust. Medical distrust was already rooted in some participants’ previous experiences of receiving biased reproductive care, and for Black women, it worsened because of historical mistreatment and discrimination. Increased medical distrust likely drove people to travel for abortion care.

CONCLUSIONS AND RELEVANCE: These findings call for enhanced coordination of care with centralized trusted resources, equitable distribution of funding, mental health support, and attention to reduce biased care for Black women. The results also highlight the need to develop strategies to combat misinformation and increase advocacy efforts to reduce abortion stigma.

PMID:42560672 | DOI:10.1001/jamanetworkopen.2026.27603

J Speech Lang Hear Res. 2026 Aug 6:1-15. doi: 10.1044/2026_JSLHR-26-00145. Online ahead of print.

ABSTRACT

PURPOSE: Depression is prevalent yet frequently underdiagnosed. Although speech-based detection methods show promise, most prior studies have emphasized binary classification in nontonal languages. This study examined whether acoustic features of spontaneous Mandarin speech reflect depression as a categorical condition or a continuous, dimensional construct.

METHOD: A validated emotional Mandarin speech corpus paired with self-reported depression severity scores was analyzed. Acoustic features were extracted using the extended Geneva Minimalistic Acoustic Parameter Set. A multistage analytic framework was applied, including random forest classification to distinguish depressed from nondepressed clips, linear mixed-effects modeling to examine group and severity effects, and unsupervised clustering to examine latent structure in the acoustic feature space.

RESULTS: The random forest classifier achieved an accuracy of 72.3% and an area under the receiver operating characteristic curve of 0.826 on the held-out test set. Model performance favored sensitivity over precision in identifying depressed clips. SHapley Additive exPlanations analysis identified features across multiple acoustic domains, including spectral, pitch-related, voice quality, cepstral, and intensity measures, as important contributors to model predictions. Among the Top 10 features, no acoustic features showed statistically significant group differences. In contrast, median and mean fundamental frequencies were significantly positively associated with depression severity. Clustering analysis revealed overlapping group structures and a continuous distribution of severity scores across clusters.

CONCLUSIONS: These findings provide preliminary support for a dimensional conceptualization of depression in spontaneous Mandarin speech. While classification models can distinguish depressed from nondepressed speech with moderate accuracy, acoustic features appear to vary more consistently with symptom severity than with diagnostic group. Speech-based measures may therefore have potential for continuous monitoring of depression, although this possibility requires further longitudinal verification.

PMID:42560658 | DOI:10.1044/2026_JSLHR-26-00145

Child Dev. 2026 Aug 6:aacag141. doi: 10.1093/chidev/aacag141. Online ahead of print.

ABSTRACT

This systematic review and meta-analysis provides the first comprehensive synthesis of research on emotion regulation (ER) in children and adolescents with developmental language disorder (DLD), based on 16 independent samples (NDLD = 1,616; ages 5-16). Individuals with DLD showed significantly greater ER difficulties than typically developing peers, representing a medium effect size (g = 0.563). This effect remained statistically significant, although reduced to a small-to-medium effect size, in sensitivity analyses excluding studies from the same research group (g = 0.317). Informant discrepancies emerged, with teachers reporting more ER difficulties than parents and children’s self-reports. No clear evidence of publication bias was observed on formal testing; however, converging evidence from small-study effects, risk of bias analyses, and publication year trends suggests that the observed effect size may represent an overestimate of the true effect. These findings underscore the need for more rigorous, theory-driven, multi-method research to accurately estimate the magnitude of ER difficulties in DLD.

PMID:42560654 | DOI:10.1093/chidev/aacag141

Res Health Serv Reg. 2026 Aug 6;5(1):11. doi: 10.1007/s43999-026-00095-3.

ABSTRACT

INTRODUCTION: More than 90% of the highest incidence rates of cervical cancer occur in sub-Saharan Africa region. However, this region has low uptake of cervical cancer screening compared to other World Health Organization (WHO) regions. Therefore, the current study aimed to show the geographical and regional variation and predictors of low uptake of cervical cancer screening among women aged 30-49 years in Tanzania.

METHODS: This study analyzed data from 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS). The uptake of cervical cancer screening was the outcome variable which dichotomized into “Yes” for the women who reported a doctor or other healthcare provider ever tested her for cervical cancer otherwise it was coded “No.” Besides, descriptive and geospatial analysis, the mixed-effect multilevel logistic regression analysis was performed to determine predictors of low uptake of cervical cancer screening.

RESULTS: This study included a total of 6911 women between 30 and 49 years old, with the median age (interquartile range) of 38 (34-43) years. The overall uptake of cervical cancer in Tanzania remain low (12.2%). The geospatial analysis indicates the lowest uptake was observed in Southern (4.7%) and Central (5.9%). The random effect model revealed that the variation in uptake of cervical cancer screening, 26% was attributed to between clusters within regions or geographical zones differences [ICC = 0.26, 95%CI; 0.22-0.31]. Fixed effect model revealed that women with older ages, formal education, health insurance coverage, employed for cash, being in rich household, listen to radio, reading newspapers, magazines, or using the internet had higher odds of uptake cervical cancer screening than their counterparts.

CONCLUSION: For realization of WHO target on elimination of cervical cancer by screening 70% of all eligible women age 30 and above by 2030, more efforts on addressing social determinants of health and provision of health education through mass media should be considered.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42560633 | DOI:10.1007/s43999-026-00095-3

J Robot Surg. 2026 Aug 6;20(1):803. doi: 10.1007/s11701-026-03785-9.

ABSTRACT

Hilar lymph nodes with dense adhesion to the bronchus and pulmonary artery (“doornail” nodes) can be encountered unexpectedly during robot-assisted pulmonary resection. We report our experience managing these nodes and associated factors. This retrospective single-center cohort study included 1,185 patients undergoing robot-assisted pulmonary resection (March 2021-September 2024). Preoperative factors were analyzed using Firth penalized logistic regression in a clinically selected model (age, maximal voluntary ventilation [MVV], and tumor diameter). Operative time and blood loss were compared using robust regression models. Perioperative outcomes were compared descriptively between attempted separate dissection and en bloc stapling. Doornail hilar lymph nodes occurred in 48 of 1,185 patients (4.05%; 95% CI, 3.07-5.33%). Older age remained associated with this finding after adjusting for MVV and tumor diameter (adjusted OR per 10 years, 2.316; 95% CI, 1.533-3.596; P<0.001). Operative time was longer unadjusted (105 vs 92 min; P=0.027) but not after adjustment. Among these 48 patients, 45 (93.8%) received en bloc stapling with no blood loss exceeding 200 mL, transfusion, or prespecified in-hospital complication, whereas all 3 (6.3%) who underwent attempted separate dissection had substantial bleeding (700-2,400 mL), and 2 required transfusion. No conversion to thoracotomy occurred. Doornail hilar lymph nodes occurred in about 4% of patients; older age remained associated with this finding after adjusting for MVV and tumor diameter. Because strategy selection was non-random and groups differed in resection extent, comparative safety cannot be established; en bloc stapling after tissue thinning may be feasible when a node cannot be safely separated.

PMID:42560620 | DOI:10.1007/s11701-026-03785-9

Photochem Photobiol Sci. 2026 Aug 6. doi: 10.1007/s43630-026-00962-5. Online ahead of print.

ABSTRACT

BACKGROUND: The Neodymium-doped Yttrium Aluminum Garnet (Nd: YAG) laser is proposed as an adjunct to scaling and root planing (SRP) to enhance bacterial reduction and healing in periodontitis. This study aims to evaluate the efficacy of Nd: YAG laser therapy (1064 nm) compared with SRP alone in improving clinical periodontal outcomes.

METHODS: This systematic review adhered to PRISMA 2020 guidelines and was prospectively registered with PROSPERO. We included only randomized controlled trials (RCTs) comparing SRP with adjunctive Nd: YAG laser therapy to SRP alone in patients with periodontitis. The primary outcomes were pocket depth (PD), plaque index (PI), bleeding on probing (BOP), and clinical attachment loss (CAL) assessments at baseline and after three months. Secondary outcomes included gingival cervical fluid (GCF) at baseline and after three months. Risk-of-bias assessment (using ROB-2) was performed independently by multiple reviewers. All statistical analyses were performed using R (version 4.4.3). The certainty of evidence for all outcomes was evaluated using the GRADE approach.

RESULTS: The systematic review and meta-analysis included 22 randomized controlled trials published between 2010 and 2025, totaling 776 patients. Meta-analysis demonstrated that adjunctive ND: YAG laser with SRP significantly improved PD reduction compared with SRP alone (MD = – 0.46 mm; 95% CI -0.82 to – 0.10; p = 0.0117), Subgroup analysis showed that split-mouth RCTs had a larger effect (MD = – 0.66 mm) than parallel-group RCTs (MD = – 0.20 mm), but the difference between subgroups was not significant. No statistically significant benefits were observed for PI (MD = – 0.03; 95% CI -0.19 to 0.13; p = 0.63), CAL (MD = – 0.04; 95% CI -0.21 to 0.13; p = 0.61), GCF volume (MD = – 0.20; 95% CI -0.45 to 0.06; p = 0.097), or BOP (MD = – 7.88; 95% CI -19.23 to 3.46; p = 0.17).

CONCLUSION: Adjunctive Nd: YAG laser therapy provides a modest, statistically significant benefit in reducing periodontal pocket depth beyond conventional therapy alone. However, it does not demonstrate superior efficacy in improving clinical attachment levels or plaque control. Consequently, while beneficial for pocket reduction, current evidence does not support its routine universal use as a substitute for standard mechanical debridement.

PMID:42560618 | DOI:10.1007/s43630-026-00962-5