Nevin Manimala

JAMA Netw Open. 2026 Mar 2;9(3):e264024. doi: 10.1001/jamanetworkopen.2026.4024.

ABSTRACT

IMPORTANCE: Mental health morbidity is a proximal factor in suicide. Using the research domain criteria (RDoC) framework to investigate sex and age differences in psychopathology at the time of death may provide better characterization than focusing on clinical diagnosis alone.

OBJECTIVES: To (1) evaluate whether token-based and large language model scoring of RDoC can be successfully applied to law enforcement and coroner or medical examiner death narratives in the US National Violent Death Reporting System (NVDRS), and (2) investigate sex and age differences in clinically relevant scores to illuminate underidentified dimensions of mental health dysfunction proximal to suicide.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study drew on death records in the restricted-access 2020 to 2021 NVDRS. Participants were limited to suicide decedents aged 12 years and older from all 50 states whose death record included a law enforcement and coroner or medical examiner death narrative of 20 words or more. Analyses were conducted between May 2024 and September 2025.

EXPOSURES: Sex and age of decedents.

MAIN OUTCOMES AND MEASURES: RDoC symptom scores; mental health status measures in death records (mental health diagnosis, current depressed mood, and alcohol or drug misuse).

RESULTS: Using both a token-based system and a large language model approach, law enforcement and coroner or medical examiner narratives of 72 585 suicide decedents were scored (mean [SD] age, 46.3 [19.3] years; 57 770 [80.6%] male). Both methods were previously validated with psychiatric electronic health records. To validate this approach, token density and large language model scores were compared with current NVDRS mental health status measures. Both scoring methods correlated with precoded measures and demonstrated levels of neurobehavioral dysfunction at the time of death similar to psychiatric inpatients on admission. Sex- and age-related differences in clinically relevant dysfunction showed the highest levels among female vs male and younger vs older decedents after adjusting for demographic confounding.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of suicide decedents found that information relevant to RDoC domains is encoded in NVDRS death narratives and can be extracted using large language models. The approach used here observed more pervasive neurobehavioral dysfunction among suicide decedents than that captured by currently employed NVDRS measures of mental health.

PMID:41910970 | DOI:10.1001/jamanetworkopen.2026.4024

JAMA Netw Open. 2026 Mar 2;9(3):e264171. doi: 10.1001/jamanetworkopen.2026.4171.

ABSTRACT

IMPORTANCE: A sense of belonging is a fundamental need that predicts mental, physical, social, economic, and behavioral outcomes. Experiencing a sense of belonging at work may be influenced by organizational culture and whether a person feels supported by teammates. There is little evidence of what proportion of physicians feel a strong sense of belonging and teammate support. There exists a gap in literature showing whether these factors are associated with burnout or work intentions, which leaves health care leaders without a valuable tool to improve professional well-being and workforce retention.

OBJECTIVE: To provide health care leaders with a better understanding of how fostering belonging and teammate support can decrease burnout and potentially prevent costly turnover.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from a survey administered to physicians by their organization leaders as part of the organization’s quality improvement efforts through participation in the American Medical Association Organizational Biopsy program. The survey was administered within health care organizations and health systems across the US with more than 50 physicians. The study population comprised physicians working in US-based health care organizations and health systems. Survey responses were collected between November 7, 2023, and November 12, 2024. Analysis was performed from June to August 2025.

MAIN OUTCOMES AND MEASURES: Belonging and teammate support perceptions were measured by asking participants to indicate how much they agree with 2 statements. Burnout was assessed using the single-item Mini Z assessment, and work intentions were indicated by likeliness to reduce clinical hours in the next 12 months or leave practice within the next 2 years. Odds ratios (ORs) and 95% CIs were used.

RESULTS: Of 14 051 physicians, 7315 were male (52.1%), 1978 were Asian (14.1%), 406 were Black or African American (2.9%), 425 were Latinx or Hispanic (3.0%), and 8681 were White (61.8%). Additionally, 4733 (33.7%) had 20 or more posttraining years of clinical practice and 4475 (31.8%) practiced in primary care. A strong sense of belonging was endorsed by 8425 (60.0%) and 11 293 (80.4%) perceived teammate support. Females (odds ratio [OR], 0.91, 95% CI, 0.84-0.98) and physicians with more than 5 years of clinical practice (eg, 6-10 years: OR, 0.76; 95% CI, 0.67-0.85; ≥20 years: OR, 0.87; 95% CI, 0.78-0.96) had lower odds of having strong sense of belonging. A strong sense of belonging was associated with lower odds of burnout (OR, 0.22; 95% CI, 0.21-0.24), lower odds of intent to reduce clinical hours (OR, 0.48; 95% CI, 0.44-0.53), and lower odds of intent to leave the organization (OR, 0.23; 95% CI, 0.21-0.26). Similar patterns were observed for factors associated with teammate support and for the association of teammate support with burnout, intent to reduce hours, and intent to leave the organization.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of physicians in the US, a strong sense of belonging was associated with lower odds of burnout, intent to reduce clinical hours, and intent to leave the organization. These findings suggest that fostering belonging and teammate support can benefit physicians, care teams, patients, and organizations by potentially avoiding physician turnover. Organizations should prioritize belonging and teammate support in their efforts to improve culture, work environment, and physician well-being.

PMID:41910969 | DOI:10.1001/jamanetworkopen.2026.4171

J Autism Dev Disord. 2026 Mar 30. doi: 10.1007/s10803-026-07318-z. Online ahead of print.

NO ABSTRACT

PMID:41910941 | DOI:10.1007/s10803-026-07318-z

Clin Drug Investig. 2026 Mar 30. doi: 10.1007/s40261-026-01547-x. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Carboprost tromethamine is commonly used to prevent or treat postpartum hemorrhage during cesarean section but causes frequent side effects. This study aimed to compare dexmedetomidine and sufentanil for preventing these side effects and assess hemodynamic stability.

METHODS: This is a single-center randomized controlled trial. Parturients undergoing elective cesarean section were randomized to Group D (dexmedetomidine intravenously), Group S (sufentanil intravenously), and Group C (saline intravenously). Carboprost tromethamine 250 µg was intrauterine injected after delivery. The incidence of complications, Ramsay sedation scores, and noninvasive cardiac system-derived hemodynamic parameters were analyzed. The primary endpoint is dexmedetomidine or sufentanil could relieve the nausea and vomiting caused by carboprost tromethamine.

RESULTS: A total of 152 subjects were included in the analysis. Both Groups D and S had significantly fewer intraoperative nausea and vomiting episodes (Group D 16% vs Group S 19.2% vs Group C 76%, P < 0.001) and higher Ramsay scores (P < 0.001) compared with Group C. Group C showed significant increases in mean arterial pressure and respiratory rate (P < 0.05). Heart rate in Group D was significantly lower than in Group C (P < 0.05). The total peripheral resistance was significantly lower in Group S at T2-T5 (from 2 minutes post-carboprost tromethamine until the end of surgery) and in Group D at T2-T4 (2, 5, and 10 minutes post-carboprost tromethamine) compared with Group C (P < 0.05). Cardiac output in Group S was higher at T2-T4 (2, 5, and 10 minutes post-carboprost tromethamine) than in Group C, and at T2-T3 (2 and 5 minutes post-carboprost tromethamine), it was even higher than in Group D (P < 0.05).

CONCLUSIONS: Both dexmedetomidine and sufentanil alleviated carboprost tromethamine-induced side effects while maintaining stable hemodynamics. Sufentanil showed greater efficacy in reducing peripheral vascular resistance.

CLINICAL TRIAL REGISTRATION: ChiCTR2000038350.

PMID:41910933 | DOI:10.1007/s40261-026-01547-x

Int J Implant Dent. 2026 Mar 30. doi: 10.1186/s40729-026-00673-7. Online ahead of print.

ABSTRACT

AIM: To evaluate the efficacy of injectable bone fillers for alveolar ridge preservation (ARP).

MATERIALS AND METHODS: Mandibular premolars (P2, P3, P4) were bilaterally extracted in nine beagle dogs. Each tooth underwent hemisection, with the mesial root devitalized and filled with calcium hydroxide, while the distal roots were extracted. This resulted in six sockets per dog, which were randomly assigned to four injectable test materials (T1-T4), one control (C), and one negative control group (N). Primary wound closure was achieved in all groups except for N. After 12 weeks, tissue blocks were analyzed using micro-computed tomography (micro-CT). The primary outcome was bone volume fraction (BV/TV, %). Secondary outcomes included trabecular thickness (Tb.Th, mm), trabecular separation (Tb.Sp, mm), bone surface to bone volume ratio (BS/BV, mm²/mm³), buccal bone defect volume (BBD, mm³), vertical bone height (VBH, mm), buccal wall thickness (BBW, mm) and lingual wall thickness (LBW, mm). Data were analyzed using the Kruskal-Wallis test.

RESULTS: After 12 weeks of healing, all groups were associated with a similar BC/TV values (64.6%, 68.2%, 69.0%, 66.5%, 76.5% and 79.8% in the T1, T2, T3, T4, C and N groups, respectively; p > 0.05 for all between group comparisons). No statistically significant differences were found among groups for Tb.Th, Tb.Sp, BS/BV, BBD, VBH, BBW and LBW.

CONCLUSIONS: Within its limitations, the present study showed comparable efficacy of injectable bone fillers in maintaining alveolar ridge dimensions compared with the C and N groups.

CLINICAL RELEVANCE: Injectable bone fillers represent a convenient and potentially effective alternative for alveolar ridge preservation procedures.

PMID:41910925 | DOI:10.1186/s40729-026-00673-7

Phys Eng Sci Med. 2026 Mar 30. doi: 10.1007/s13246-026-01734-2. Online ahead of print.

ABSTRACT

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by pain, swelling, stiffness, and loss of joint function, making early diagnosis challenging. The study aims to assess the differences between RA patients (n = 70) and healthy individuals (n = 30) while classifying Ritchie Articular Index (RAI) values (0-3) based on inflammation levels using artificial intelligence algorithms. Metacarpophalangeal (MCP), and proximal-interphalangeal (PIP) joints were analyzed for the degree of inflammation. Static thermal data was collected from individuals at rest in a controlled environment. Then, alcohol was applied to the participants’ hand regions, followed by a 180-second thermal video recording of the same region. In the pre-processing step, background noise cleaning and alignment were performed. Background was eliminated using Snake algorithm. Thermal video recordings were aligned using Scale Invariant Feature Transform (SIFT) algorithm. The Skeletonization algorithm was employed to detect fingers and joint regions in the images. For static thermal analysis, initial temperature ([Formula: see text]) values were extracted from the resting thermogram data. In dynamic thermal analysis, the temperature parameters [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text] were calculated. A statistical analysis of the four temperature parameters across different RAI values revealed that [Formula: see text] (p = 0.025) and [Formula: see text] (p = 0.042) exhibited statistically significant differences among the four RAI levels. Machine learning models were trained using the resting temperature values of patient and healthy groups, and the SVM achieved the highest success rate of 93%. It is believed that the proposed system may help diagnose RA in clinical settings and contribute to determining the severity of inflammation.

PMID:41910922 | DOI:10.1007/s13246-026-01734-2

Prev Sci. 2026 Mar 30. doi: 10.1007/s11121-026-01908-0. Online ahead of print.

ABSTRACT

Research shows that genetic literacy varies as a function of individual-level factors, but these factors may not account for all observed differences in genetic literacy. We tested the hypothesis that neighborhood opportunity-a structural factor-is associated with genetic literacy. We analyzed nationally representative cross-sectional data on a weighted sample of 606 US adults from the 2024 Measurement of Genetic Literacy Survey. The Genetic Literacy and Comprehension measure assessed genetic literacy ( $\alpha$ = 0.87). The Childhood Opportunity Index 3.0 measured overall neighborhood opportunity and three domains (Education, Health and Environment, Social and Economic resources). Unadjusted and adjusted weighted linear regression models quantified the associations between neighborhood opportunity and genetic literacy. Among the weighted sample (mean age = 48, SD = 18), 52% were female, and 61% were as non-Hispanic White. Very low overall neighborhood opportunity was significantly associated with lower genetic literacy (β = – 0.70, 95% CI: – 1.40 to – 0.04, p = 0.037), adjusting for demographic characteristics, health-related factors, and receipt of genetic testing. We observed a similar pattern for exposure to very low social and economic resources (β = – 0.95, 95% CI: – 1.60 to – 0.31, p = 0.004). There was no evidence of a statistically significant association between the Health and Environment domain and genetic literacy in the final model (β = – 0.13, 95% CI: – 0.64 to – 0.38, p = 0.62). Findings indicate that neighborhood opportunity is associated with genetic literacy. These results reinforce the importance of assessing structural factors along with individual-level characteristics in genetic literacy research.

PMID:41910920 | DOI:10.1007/s11121-026-01908-0

Ophthalmic Physiol Opt. 2026 Mar 30. doi: 10.1007/s44402-026-00042-2. Online ahead of print.

ABSTRACT

PURPOSE: Scotland has comprehensive vision screening at age 3.5-5.5 years, with ~85% participation (40,000-50,000 episodes annually). Orthoptists deliver the screening, including presenting vision and tests for binocular vision anomalies (BVAnom). The aims were to investigate (1) changes in the prevalence of BVAnom, 2013-2022 and (2) whether less comprehensive screening of solely presenting vision would detect BVAnom.

METHODS: Data from eight Scottish Health Boards were available for 2013-2014, 2014-2015, 2015-2016, 2020-2021 and 2021-2022. Binocular vision tests included cover test, ocular motility (OM) and additional tests (near point of convergence, 20Δ base out, pass/fail stereopsis). Data were analysed to determine the prevalence of various BVAnom and adequacy of screening if based solely on vision.

RESULTS: From 2013 to 2022, there was a statistically significant increase in prevalence of exotropia (including intermittent; r² = 0.983, p = 0.001) and of any strabismus (including intermittent; r² = 0.887, p = 0.02), with strabismus prevalence ~2% in 2020-2022. Prevalence of OM anomalies remained stable (r² = 0.364, p = 0.28). The prevalence of BVAnom for each year studied, consecutively, was 3.02, 3.78, 3.83, 4.87, 4.89% (r² = 0.930, p = 0.008). If vision screening had been confined to presenting vision, 342-512 cases of BVAnom would have been missed each year, increasing over time (r² = 0.934, p = 0.007).

CONCLUSIONS: In a large population of children in Scotland aged 3.5-5.5 years, the prevalence of BVAnom is increasing, especially exotropia. Many cases of BVAnom would not be detected by solely assessing presenting vision, highlighting the benefits of including binocular vision tests in vision screening. It is recommended that vision screening is repeated during the school years.

PMID:41910916 | DOI:10.1007/s44402-026-00042-2

BioDrugs. 2026 Mar 30. doi: 10.1007/s40259-026-00774-0. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examines the monoclonal antibody innovation landscape through patent activity and market data.

METHODS: A dedicated dataset was constructed by linking multiple sources (Antibody Society, Orange Book, Ark Patent Intelligence, US Patent and Trademark Office, PATSTAT, Purple Book, US Veterans Affairs, US-FDA, and ORBIS), covering patents registered between 1986 and 2019. Data analysis comprised six components: (i) a general description of the dataset, (ii) an examination of monoclonal antibody patents and approval trends, (iii) an analysis of therapeutic indications, (iv) a characterization of patent holders and producers through descriptive and network analyses, (v) an assessment of shareholder influence, including common-ownership patterns, and (vi) an evaluation of monoclonal antibody prices.

RESULTS: The dataset included 63 monoclonal antibodies, 1732 unique patents, 89 active pharmaceutical ingredients, 34 producers, and 214 therapeutic indications, of which 36.5% were single indication, while the average number of secondary indications was 3.78. Roche, Johnson & Johnson, Eli Lilly, Amgen, and Novartis led reference medicine production, while Amgen and Pfizer were notable in biosimilars, with only five companies producing both. Shareholders such as BlackRock, UBS, Vanguard, and JPMorgan exerted strong market influence in monoclonal antibody production. Prices were extremely high, averaging US$127,430 per course or year (s = US$142,509), with 42.1% of monoclonal antibodies priced above US$100,000.

CONCLUSIONS: While monoclonal antibodies have transformed modern medicine and improved safety and effectiveness, their persistently high prices, reinforced by market concentration and financial investor influence, raise serious concerns for equity and social welfare.

PMID:41910914 | DOI:10.1007/s40259-026-00774-0

Clin Rheumatol. 2026 Mar 30. doi: 10.1007/s10067-026-08064-4. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate whether growth differentiation factor-15 (GDF-15) can serve as a potential biomarker for assessing subclinical inflammation during the attack-free (intercritical) period in patients with familial Mediterranean fever (FMF).

METHODS: In a single-center cross-sectional case-control study, 52 FMF patients in the attack-free period were compared with 52 age- and sex-matched healthy controls. ELISA measured serum GDF-15 levels; acute-phase reactants (CRP, ESR, SAA, fibrinogen) and various hematologic inflammation indices were evaluated. Statistical analyses included the Mann-Whitney U, chi-square, Kruskal-Wallis, Spearman correlation, and ROC curve methods.

RESULTS: Serum GDF-15 levels were significantly higher in the FMF group than in controls (p < 0.001). Subclinical inflammation, defined by SAA > 10 mg/L, was detected in 78.8% of FMF patients. GDF-15 correlated positively with CRP and SAA (p < 0.05). GDF-15 levels did not differ across MEFV mutation subgroups or by the presence of the M694V mutation. Patients with subclinical inflammation had significantly higher GDF-15 levels than those without. ROC analysis showed that GDF-15 had a statistically significant ability to distinguish FMF from controls (AUC = 0.78; p < 0.001) and to identify subclinical inflammation (AUC = 0.74; p = 0.014).

CONCLUSION: GDF-15 appears to be a potential biomarker reflecting ongoing subclinical inflammation during the attack-free period in FMF. Elevated GDF-15 levels in patients with SAA-defined subclinical inflammation suggest that GDF-15 may reflect low-grade inflammatory activity. Larger studies are needed to validate these findings. Key Points • Serum GDF-15 was significantly higher in the attack-free FMF patients than in controls, supporting its potential to reflect persistent low-grade (subclinical) inflammation. • GDF-15 showed moderate discriminative performance (AUC 0.783) and may complement conventional acute-phase reactants in assessing inflammatory burden during attack-free periods. • GDF-15 levels did not differ significantly across MEFV mutation subgroups or by M694V status in this cohort.

PMID:41910911 | DOI:10.1007/s10067-026-08064-4