Nevin Manimala

JAMA Netw Open. 2026 Mar 2;9(3):e264114. doi: 10.1001/jamanetworkopen.2026.4114.

ABSTRACT

IMPORTANCE: Autonomy concerns represent one of many contributors to vaccine hesitancy, yet public health messaging often emphasizes government compliance. It is important to study whether alternative message framing is associated with stated vaccine acceptance among hesitant individuals.

OBJECTIVE: To evaluate whether framing vaccines as freedom enhancing is associated with higher vaccine acceptance among vaccine hesitant adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional online discrete choice experiment was conducted from May 1 to 4, 2024. Each respondent completed 12 choice tasks comparing 2 vaccine options and a no-vaccine option, with vaccines described by 6 attributes, including infection prevention and severe disease protection efficacy, minor and major adverse effects, duration of protection, and additional reason to take (message framing).

EXPOSURES: Three levels for message framing, including government compliance (reference), personal freedom, and protect others.

MAIN OUTCOMES AND MEASURES: Hesitancy was measured using vaccine concerns and the Vaccine Adverse Belief Index (VABI). Main outcomes were vaccine preference shifts and estimated vaccine uptake associated with message framing variations examined using hierarchical bayesian analysis, with vaccine concerns and VABI serving as second-level factors.

RESULTS: A total of 907 adults (mean [SD] age, 69.5 [11.0] years; 454 female [50.3%]) participated in the study. Among respondents with high vaccine concern, freedom framing was associated with a preference shift of 33.8 percentage points (95% credible interval [CrI], 21.5-45.8 percentage points) and an increase in uptake of 6.3 percentage points (95% CrI, 2.9-11.5 percentage points), assuming the most favorable vaccine profile (highest efficacy, lowest adverse effects, longest duration). Among respondents with a high VABI, freedom framing was associated with a preference shift of 27.7 percentage points (95% CrI, 14.5-40.5 percentage points) and an increase in uptake of 4.6 percentage points (95% CrI, 1.8-8.8), respectively. Respondents with low vaccine concern or VABI showed no significant preference shifts associated with framing. In contrast, protect-others framing was associated with positive preference shifts and uptake, with no evidence that these associations differed by vaccine hesitancy.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that compared with government recommendation framing, freedom framing was selectively associated with higher vaccine acceptance among adults who were vaccine hesitant. Protect-others framing was associated with higher vaccine acceptance regardless of hesitancy level. Absolute gains in acceptance were modest. These findings highlight how autonomy-consistent framing may influence stated vaccine preferences among hesitant adults.

PMID:41915389 | DOI:10.1001/jamanetworkopen.2026.4114

Radiol Med. 2026 Mar 31. doi: 10.1007/s11547-026-02203-2. Online ahead of print.

ABSTRACT

PURPOSE: Sarcopenia has already been widely investigated as a potential indicator of negative outcomes in oncology patients. Our aim was to evaluate the potential predictive role of sarcopenia assessed using an Artificial Intelligence-powered software in response to neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC).

MATERIALS AND METHODS: In this single-centre retrospective study, we enrolled patients diagnosed with non-metastatic MIBC who underwent NAC and had available pre-treatment mpMRI of the bladder and baseline CT scan. The follow-up MRI assessment was performed using the NacVI-RADS algorithm to evaluate response to systematic therapy. AI-based software automatically calculated the skeletal muscle index (SMI) from CT images at the L3 vertebral level. Multivariate logistic regression analysis was performed to assess independent predictors of response to NAC, and a receiver operating characteristic (ROC) analysis was subsequently conducted to provide an additional level of statistical validation.

RESULTS: Fifty-five patients were included (mean age: 67.2 years). Sarcopenia was identified in 36.4% of patients. Multivariate logistic regression revealed sarcopenia (OR: 9.08; 95% CI 1.32-61.92; p = 0.024), comorbidities (OR: 14.63; 95% CI 2.12-100.71; p = 0.006), and high NacVI-RADS scores (4-5) (OR = 2.13 95% CI 1.03-4.42; p = 0.042) as independent predictors of poor response to NAC. Receiver operating characteristic (ROC) curve analysis confirmed the high discriminative ability of SMI for predicting treatment response (AUC = 0.952).

CONCLUSION: Sarcopenia, assessed by AI-powered analysis, was negatively associated with tumor response following NAC in patients with MIBC. These findings support the integration of AI-driven sarcopenia evaluation into clinical staging workflows, enabling tailored nutritional interventions and improved patient stratification. Moreover, our study reinforces the prognostic value of the NacVI-RADS scoring system in predicting NAC outcomes.

PMID:41915371 | DOI:10.1007/s11547-026-02203-2

Int J Implant Dent. 2026 Mar 31;12(1):12. doi: 10.1186/s40729-026-00666-6.

ABSTRACT

INTRODUCTION: Accurate implant placement with computer-assisted implant surgery (CAIS) is critical to ensuring long-term success. Dynamic computer-assisted implant surgery (d-CAIS) enhances surgical precision through real-time feedback; however, its accuracy and procedural efficiency when used by novice operators remain insufficiently investigated. This study evaluated how different registration methods in d-CAIS influence implant placement accuracy and procedural time when performed by novice operators.

MATERIALS AND METHODS: In this in vitro study, three registration methods were assessed (surface-based registration: ND, marker-based registration: XC, and pair-point registration: XM groups). Five novice operators, defined as dentists with less than five years of implant experience, placed 25 implants per group (75 total) in partially edentulous maxillary models. Postoperative cone-beam computed tomography scans were used to measure deviations at the implant entry point, apex, vertical depth, and angle. Statistical analyses were performed to compare group differences.

RESULTS: Mean three-dimensional deviations at the implant entry point were 0.97 mm (ND), 0.68 mm (XC), and 0.72 mm (XM); at the apex: 1.33 mm, 0.78 mm, and 0.90 mm, respectively. Vertical depth deviations at the apex were comparable across groups: 0.62 mm (ND), 0.51 mm (XC), and 0.54 mm (XM). Angular deviation was highest in the ND group (3.16°) compared to the XC (1.18°) and XM (0.97°) groups, with significant differences observed between ND and both XC and XM. Average procedural time was longest in the ND group and shortest in the XM group, with statistically significant differences between ND and the other two groups.

CONCLUSIONS: In novice operators, d-CAIS enabled stable control of implant entry point position and insertion depth regardless of the registration method used. In contrast, angular accuracy and procedural efficiency were influenced by registration strategies and system-related characteristics. These findings suggest that selection of appropriate registration methods may play an important role in optimizing accuracy and workflow efficiency during the early learning phase of d-CAIS.

PMID:41915368 | DOI:10.1186/s40729-026-00666-6

Echocardiography. 2026 Apr;43(4):e70437. doi: 10.1111/echo.70437.

ABSTRACT

OBJECTIVE: This study aimed to evaluate right ventricular (RV) function pre and post bone marrow transplantation (BMT) using transthoracic echocardiography (TTE), in order to detect subclinical or clinical RV dysfunction that may occur in the early posttransplant period due to pulmonary vascular changes.

METHODS: A total of 45 patients (aged 18-65 years) who underwent allogeneic or autologous BMT and 45 age- and sex-matched healthy controls were prospectively enrolled. Baseline (pre-BMT) and first-month (post-BMT) data of both groups were compared. Sociodemographic characteristics, laboratory results, and echocardiographic parameters were analyzed.

RESULTS: In the BMT group, RV global longitudinal strain (RVGLS) (-19.24 ± 8.71 vs. -22.33 ± 1.64; p = 0.022) and RV free wall strain (RVFWS) (-25.96 ± 2.83 vs. -28.21 ± 2.10; p < 0.001) were significantly lower than in controls. Four-dimensional echocardiography (4DE) demonstrated lower RV ejection fraction (RVEF) (52.31 ± 2.46 vs. 56.60 ± 5.55; p < 0.001) and RV fractional area change (RVFAC) (46.27 ± 2.57 vs. 51.42 ± 4.56; p < 0.001) in the BMT group compared to controls. Although pulmonary artery stiffness (PAS) (17.09 ± 4.24 vs. 18.56 ± 4.06 Hz/ms; p = 0.098) was higher in the BMT group, the difference did not reach statistical significance.

CONCLUSION: This study indicates that BMT may adversely affect RV systolic and diastolic functions as well as pulmonery artery stiffness (PAS). Advanced echocardiographic assessment in patients at risk of cardiotoxicity during the pre- and posttransplant period may facilitate early detection and implementation of preventive and therapeutic strategies.

PMID:41915363 | DOI:10.1111/echo.70437

J Endocrinol Invest. 2026 Mar 31. doi: 10.1007/s40618-026-02857-9. Online ahead of print.

NO ABSTRACT

PMID:41915358 | DOI:10.1007/s40618-026-02857-9

Clin Rheumatol. 2026 Mar 31. doi: 10.1007/s10067-026-08037-7. Online ahead of print.

ABSTRACT

OBJECTIVES: To systematically evaluate the efficacy and safety of plasma exchange (PE) in adult patients with idiopathic inflammatory myopathies (IIM).

METHODS: A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO. MEDLINE, Embase and Web of Science were searched from inception to 17 January 2025. Studies involving adult patients with IIM treated with PE were included. Baseline demographics, clinical characteristics, treatment outcomes and adverse events were extracted.

RESULTS: Thirty-five studies involving 473 patients were included, of whom 361 received PE. Most studies were observational, and PE was predominantly used as adjunctive or rescue therapy alongside immunosuppressive treatment. Across included studies, PE was reported to be associated with improvements in organ-specific outcomes, including muscle strength, dysphagia, pulmonary manifestations and biochemical markers such as creatine kinase, ferritin, KL-6 and myositis-specific autoantibody titres. A meta-analysis of seven comparative studies did not demonstrate a statistically significant mortality benefit associated with PE in patients with refractory or rapidly progressive interstitial lung disease (RR 0.41, 95% CI 0.16-1.06, I² = 70%). In immune-mediated necrotising myopathy, PE was frequently associated with clinical improvement and reductions in anti-HMGCR antibody titres. Reported adverse events were generally mild to moderate, with no procedure-related mortality.

CONCLUSION: PE has a biologically plausible but clinically selective role in adult IIM and is most commonly used as an adjunctive therapy in severe or refractory disease. Evidence is heterogeneous and largely observational, limiting causal inference. Prospective studies with standardised outcome measures are required to better define the role of PE in IIM.

PMID:41915329 | DOI:10.1007/s10067-026-08037-7

CJEM. 2026 Mar 31. doi: 10.1007/s43678-026-01137-y. Online ahead of print.

ABSTRACT

OBJECTIVES: Medications for alcohol use disorder, or “anti-craving medications”, are effective yet underutilized treatments for alcohol use disorder. This study examined whether a pre-printed prescription embedded in a printable order set could “nudge” clinicians to increase prescribing for medications for alcohol use disorder.

METHODS: We conducted a prescription database review comparing prescribing rates at baseline to those at monthly intervals up to 12 months following implementation of a new provincial pre-printed order set for alcohol withdrawal syndrome in Saskatchewan. Patients were included if they had an alcohol-related emergency department (ED) visit, were discharged home, had a prescription for a medication for alcohol use disorder filled within 3 days of ED discharge, and did not have a previous prescription for a medication for alcohol use disorder filled within a washout window prior to the ED visit. The review captured all provincial prescriptions of naltrexone and acamprosate-the two medications available on the pre-printed prescription-for patients who fit the inclusion criteria.

RESULTS: A total of 5740 pre-implementation and 6021 post-implementation patients met inclusion criteria. Baseline demographics and comorbidities were similar across groups. The rate of ED visits with a filled prescription increased from 1.8% pre-implementation to 3.4% post-implementation. Naltrexone prescribing rose from 1.6 to 2.7%, and acamprosate from 0.2 to 0.7%. Interrupted time-series and logistic regression analyses confirmed a statistically significant increase in prescribing post-implementation (adjusted OR 1.9; 95% CI 1.5-2.5).

CONCLUSIONS: Introducing an order set incorporating pre-printed prescriptions for medications for alcohol use disorder effectively increased prescribing rates for physicians treating patients with alcohol-related ED visits, validating use of a “nudge” to effect behavioural change. While promising, sustaining these gains may require reinforcement. In resource-constrained EDs, nudges offer a feasible strategy to improve alignment with evidence-based treatment for alcohol use disorder.

PMID:41915316 | DOI:10.1007/s43678-026-01137-y

Pharmaceut Med. 2026 Mar 31. doi: 10.1007/s40290-026-00606-0. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Survival benefit constitutes the primary pillar of therapeutic efficacy in oncology. However, the survival benefits observed in registrational trials broadly range from significant to marginal, even for US Food and Drug Administration (FDA)-approved drugs. This study explores the association between survival benefits and the likelihood of FDA approval and estimates the boundary effect size that distinguishes FDA-approved from non-approved drugs.

METHODS: We screened 3463 phase 3 trials initiated between 1990 and 2021 on ClinicalTrials.gov. Eligibility was restricted to randomized phase 3 trials for novel anticancer agents with overall survival (OS) as a primary or co-primary endpoint. Included trials required published results, including the OS hazard ratio (HR) and 95% confidence interval (CI). A total of 189 eligible trials were identified, encompassing 208 arm-pairs and 158,250 participants. Clinical data were extracted from published reports, while regulatory outcomes were adjudicated at the trial-and-indication level using US Prescribing Information on Drugs@FDA database. The association between OS benefit and approval status was modeled using logistic regression, with generalized estimating equations (GEE) to account for trial-level clustering. Publication bias was assessed via funnel plots and the trim-and-fill method.

RESULTS: Of the 208 arm-pairs, 79 (38%) supported FDA approval, and 129 (62%) did not. The dataset spanned 27 cancer types, with a mean sample size of 761 participants. The pooled OS HR was 0.70 (95% CI 0.68-0.73) for approved drugs and 0.95 (95% CI 0.93-0.97) for non-approved drugs. Logistic regression revealed a sharp sensitivity of approval probability to the HR for OS. A boundary was observed ranging from 0.74 to 0.86 in the HR for OS, with a 50% probability of FDA approval at HR 0.80. GEE analysis confirmed the robustness of these estimates against trial-level clustering. While funnel plot asymmetry suggested potential publication bias in the non-approved group, trim-and-fill analysis confirmed that the relative disparity in OS HR between approved and non-approved drugs remained consistent.

CONCLUSION: FDA approval for anticancer drugs is characterized by distinct OS HR patterns. While these findings provide a clear efficacy benchmark for OS-driven trials, they should be interpreted cautiously given the evolving therapeutic landscape and potential publication bias in negative trials. Our results underscore the central role of survival benefit in regulatory decisions and provide a quantitative metric to support oncology drug development.

FUNDING: This study was funded by the Ministry of Education, Culture, Sports, Science and Technology (MEXT): Shunsuke Ono KAKEN-HI: 25K10043.

PMID:41915314 | DOI:10.1007/s40290-026-00606-0

Clin Transplant. 2026 Apr;40(4):e70523. doi: 10.1111/ctr.70523.

ABSTRACT

BACKGROUND: In out-of-sequence (OOS) allocation of deceased donor kidney transplants (DDKTs), providers are allowed to choose recipients irrespective of waitlist priority. Whether candidate obesity affects OOS recipient selection is unknown.

METHODS: We examined access to OOS-DDKT by candidate body mass index (BMI) using kidney offers from Organ Procurement and Transplantation Network data (1/2022-12/2023). We compared characteristics of OOS-DDKT versus being last-skipped candidate at the same center using donor-level conditional logistic regression and multilevel modeling among the top-20 OOS-performing centers.

RESULTS: We identified 4970 OOS-placements and 4588 list-skipped candidates. OOS candidates were older and less likely to be Black. We found a dose-response relationship between weight class and odds of OOS-DDKT. Compared to normal weight candidates, candidates with Class 1, 2, and 3 obesity had 32%, 50%, and 69% lower odds of receiving OOS-DDKT. Mediation analysis suggested candidate BMI partially explained higher access among Asian and Hispanic candidates. There was substantial center-level variation; a 10-unit increase in BMI was associated with >50% lower odds of OOS-DDKT at 3/20 centers, 20%-50% lower odds at 12/20 centers, and comparable odds at 5/20 centers.

CONCLUSIONS: DDKT candidates with obesity have lower access to OOS kidney allocation. However, equitable distribution irrespective of candidate obesity was observed at a small number of top-performing centers.

PMID:41915312 | DOI:10.1111/ctr.70523

J Nurs Manag. 2026;2026(1):e1459619. doi: 10.1155/jonm/1459619.

ABSTRACT

BACKGROUND: Medical staff in Chinese tertiary hospitals experience excessive workloads, increasing burnout vulnerability. Traditional cultural resources may influence their job attitudes, but this area remains unexplored.

PURPOSE: Based on the job demands-resources model, this study investigates how Confucian coping, as a personal culture resource, moderates the relationships among job demands, resources, engagement and burnout in Chinese medical staff.

METHODS: Using an online self-administered survey, we collected data from 1653 medical staff members across 14 tertiary hospitals in China. Structural equation modelling was used to test the hypothesised moderating pathways.

RESULTS: Confucian coping demonstrated a significant positive moderating effect on the job resources-job engagement relationship and a significant negative moderating effect on the job demands-job burnout relationship.

CONCLUSION: Confucian coping serves as a significant personal resource for medical staff, mitigating burnout by buffering job demands and enhancing engagement by amplifying job resources.

ORIGINALITY: By employing empirical analysis with the job demands-resources model, this study unravels how medical staff draw on Confucian coping functions and provides a new theoretical perspective for further study of the influence of cultural and psychological factors.

PMID:41915299 | DOI:10.1155/jonm/1459619