Nevin Manimala

Am J Manag Care. 2026 Aug;32(8):464-468. doi: 10.37765/ajmc.2026.90002.

ABSTRACT

OBJECTIVES: Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) poses a risk to patients with chronic kidney disease (CKD), heart failure (HF), and hypertension (HTN). We evaluated changes in NSAID utilization among a large cohort of Virginia patients with CKD, HF, and/or HTN during the COVID-19 pandemic and assessed variation by patient demographic characteristics.

STUDY DESIGN: Quasi-experimental difference-in-differences approach.

METHODS: Using claims from the Virginia All-Payer Claims Database, we identified NSAID prescriptions dispensed to patients with CKD, HF, and/or HTN during the years 2019-2021. We applied Poisson regression to assess the impact of the COVID-19 pandemic (March 1, 2020- December 31, 2021) on NSAID utilization rates, stratifying incidence rate ratios (IRRs) by rurality, sex, and age.

RESULTS: Extrapolated to the statewide population, approximately 3.8 million NSAID prescriptions were dispensed to Virginians with CKD, HF, and/or HTN between 2019 and 2021. Utilization rates declined by 23% during the first 2 years of the pandemic, were greater in rural vs urban areas (IRR, 1.594; 95% CI, 1.408-1.803) and among those aged 40 to 64 years, 65 to 79 years, and 80 years and older vs those aged 18 to 39 years (40-64 years: IRR, 6.366; 95% CI, 5.979-6.778; 65-79 years: IRR, 6.980; 95% CI, 6.568-7.417; ≥ 80 years: IRR, 5.223; 95% CI, 4.772-5.715); and were lower among men than women (IRR, 0.779; 95% CI, 0.758-0.800). The pandemic impacted rural and urban areas and women and men similarly but was associated with lower NSAID utilization among the 3 older age groups vs those aged 18 to 39 years (40-64 years: IRR, 0.869; 95% CI, 0.812-0.931; 65-79 years: IRR, 0.788; 95% CI, 0.733-0.847; ≥ 80 years: IRR, 0.769; 95% CI, 0.709-0.833).

CONCLUSIONS: Despite a modest decline during the first 2 years of the pandemic, NSAID use remains prevalent among patients with CKD, HF, and/or HTN, especially in rural areas and among women. Results highlight the need for tailored deprescribing efforts.

PMID:42663549 | DOI:10.37765/ajmc.2026.90002

Am J Manag Care. 2026 Aug;32(8):456-462. doi: 10.37765/ajmc.2026.90001.

ABSTRACT

OBJECTIVES: Medicare Advantage (MA) Star Ratings influence bonus payments and health plan enrollment. Current approaches to accounting for enrollee social risk may not fully capture differences in beneficiary populations. This study assessed how MA contract performance rankings for statin receipt and adherence change under a social risk-weighted scoring approach.

STUDY DESIGN: Cross-sectional analysis of 2019 MA encounter, prescription drug, and enrollment data for 165 MA contracts.

METHODS: Contract-level statin receipt and adherence scores were calculated for disability and dual-eligibility subgroups and aggregated using empirically derived weights from a constrained optimization framework that equalized each subgroup’s contribution to overall contract performance. Ordered logistic regression assessed associations between contract characteristics and weighted performance.

RESULTS: Social risk-weighted scoring reclassified 24.2% of contracts for statin receipt and 20.6% for adherence relative to unweighted scoring. For statin receipt, 11.5% of contracts moved up, 12.7% moved down, and 75.8% were unchanged; for adherence, 7.3% moved up, 13.3% moved down, and 79.4% were unchanged. Under the weighted approach, higher disability prevalence remained associated with lower performance ratings even after weighting: Each 1-percentage point (PP) increase in disability prevalence corresponded to a 0.7-PP higher probability of receiving 3 or fewer stars for statin receipt and a 1.3-PP higher probability for adherence. Larger contracts also had lower predicted probabilities of receiving 4 stars, decreasing by 3.4 PPs for receipt and 3.8 PPs for adherence per 1-unit increase in log enrollment.

CONCLUSIONS: Social risk weighting rebalanced contract rankings but did not consistently improve ratings for high-risk plans. Remaining variation may reflect differences in quality or unmeasured factors.

PMID:42663548 | DOI:10.37765/ajmc.2026.90001

Am J Manag Care. 2026 Aug;32(8):444-451. doi: 10.37765/ajmc.2026.90000.

ABSTRACT

OBJECTIVE: To assess whether Medicare Advantage (MA) beneficiaries in socially vulnerable counties face more restrictive prior authorization (PA) requirements.

STUDY DESIGN: Cross-sectional analysis of 2945 US counties in 2022.

METHODS: The primary outcome was the mean percentage of Medicare-covered service categories requiring PA across all MA plans in a county, adjusted for service mix and plan enrollment and derived from the CMS MA benefit, landscape, and enrollment files. Secondary outcomes included county-level PA rates for selected service categories, the number of plans with more vs less restrictive PA policies, and mean monthly premiums. The exposure was the county-level Social Vulnerability Index (SVI) subdomains (socioeconomic status, household characteristics, racial/ethnic minority status, housing and transportation), categorized into deciles. Unadjusted linear regression models were used, weighted by county MA enrollment.

RESULTS: Counties in the highest vs lowest SVI decile in the socioeconomic domain had overall PA rates that were 7.2 percentage points (PP) higher ( P < .001), with the largest gap for psychiatric services (16.9 PP; P < .001). Conversely, mean monthly premiums declined across socioeconomic deciles, from $29 in the first decile to $8 in the 10th ( P < .001). Total plan counts were stable across deciles, but the composition differed: The most vulnerable counties offered 5 fewer plans with less restrictive PA policies and 4 more plans with more restrictive policies (both P < .001).

CONCLUSIONS: MA beneficiaries in socially vulnerable counties face more restrictive PA requirements, especially for psychiatric services. These disparities may compound existing structural barriers and warrant consideration in future MA policy reforms.

PMID:42663547 | DOI:10.37765/ajmc.2026.90000

J Vector Borne Dis. 2026 Aug 28. doi: 10.4103/jvbd.jvbd_105_26. Online ahead of print.

ABSTRACT

BACKGROUND OBJECTIVES: Dengue is a major vector-borne disease in tropical and subtropical regions, including Indonesia, where recurrent outbreaks remain a significant public health concern. Understanding the spatial and temporal distribution of dengue transmission is essential for effective surveillance and targeted control strategies. This study aimed to map the spatio-temporal hotspots of dengue transmission in Tasikmalaya City, West Java, Indonesia, using Geographic Information Systems (GIS) and spatial statistical analysis.

METHODS: Village-level spatial analyses were conducted using reported dengue cases from the complete calendar year of 2022 and 279 cases reported between January and September 2023. Of the 279 cases reported in 2023, 275 had valid residential coordinates and were included in the space-time cluster analysis. The space-time analysis was based on symptom onset dates ranging from 27 December 2022 to 30 September 2023. Global Moran’s I, Local Indicators of Spatial Association (LISA), bivariate LISA, and the spatial scan statistic implemented in SaTScan were used to assess the spatial distribution and spatio-temporal clustering of dengue cases.

RESULTS: Spatial clustering of dengue cases was identified in several urban villages, particularly around Cipedes and Tugujaya. Bivariate LISA revealed significant spatial co-occurrence between high dengue incidence and high population density. Spatio-temporal analysis detected three statistically significant clusters during 2023, indicating that dengue transmission was concentrated in specific geographic areas during distinct periods rather than being uniformly distributed over time.

INTERPRETATION CONCLUSION: The findings highlight distinct spatio-temporal hotspots of dengue transmission and emphasize the role of population density and seasonal factors in shaping dengue risk. Spatial mapping and cluster detection can support targeted vector control and public health interventions.

PMID:42663540 | DOI:10.4103/jvbd.jvbd_105_26

Traffic Inj Prev. 2026 Aug 28:1-7. doi: 10.1080/15389588.2026.2709024. Online ahead of print.

ABSTRACT

OBJECTIVE: The Veterinary Abbreviated Injury Scale (V-AIS) was created to mirror the human AIS and address a critical gap in retrospective veterinary trauma analysis. Dogs struck by a vehicle or injured inside a vehicle have the highest mortality rates among cases presenting to Veterinary Trauma Centers (VTC). Improved understanding of injury mechanisms, patterns, and severity in canine vehicular trauma is necessary to inform development of scientifically validated restraint systems and other vehicle safety features for canine occupants.

METHODS: The Veterinary Committee on Trauma (VetCOT) Registry was queried for canine patients injured while inside a vehicle between 2013 and 2024, yielding 268 cases. Descriptive statistics for patient demographics were performed on all registry cases. Available medical records were further abstracted for a subset of 19 cases, in which all injuries were coded using V-AIS v1.0. Case details were extracted when available, noting canine position in the vehicle and crash specifics. Additional descriptive statistics for injury characteristics, anatomic region, severity, and outcome were performed for the subset.

RESULTS: Among 268 registry cases, 91% of dogs (n = 244) survived to hospital discharge, with euthanasia accounting for 83.3% of the 24 non-survivors. Patient weight class was not significantly associated with overall survival (p = 0.48). Non-survivors presented with significantly higher median Animal Trauma Triage (ATT) scores (6.0) compared to survivors (1.0) (p < 0.001). In a 19-case subset coded with V-AIS (63 total injuries), anatomical injury distribution varied significantly by weight class (p < 0.001). Large dogs (>30kg) sustained primarily appendicular trauma (75.8%), medium dogs (10.1-30kg) sustained predominantly central body trauma (61.5%), and small dogs (≤10kg) sustained a mixture of central (47.1%) and axial (47.1%) trauma. Clinically significant injuries (V-AIS Severity ≥3) were exclusively confined to the abdomen (p = 0.02), and all fatalities occurred in dogs with internal organ trauma.

CONCLUSIONS: Application of V-AIS enables detailed characterization of canine injury severity, anatomic distribution, and mechanism of injury in vehicle crashes. Preliminary findings suggest that dog size influences injury pattern, while internal organ injury is strongly associated with adverse outcomes. Expanded application of V-AIS within veterinary trauma registries will provide the automotive industry with actionable, severity-stratified data necessary to support development of evidence-based canine restraint systems and vehicle safety measures, improving injury prevention for canine occupants.

PMID:42663521 | DOI:10.1080/15389588.2026.2709024

Chaos. 2026 Aug 1;36(8):083153. doi: 10.1063/5.0304782.

ABSTRACT

In this work, we focus on different statistical measures to uncover the complexity of extreme events in various nonlinear dynamical systems. Notably, the effectiveness of the variance-based measure, estimated from the mean recurrence time and entropy, reveals a clear distinction between extreme and non-extreme events. Additionally, the variance measure clearly highlights the critical transition point of unforeseen, rare, large-amplitude dynamics. Our investigation involved models from various disciplines, including the Brusselator chemical oscillator, CO2 laser, superconducting quantum interference devices, and a coupled neuron model. Deeper insights into the complexity of extreme events offer significant value for advancing early prediction methods.

PMID:42663518 | DOI:10.1063/5.0304782

Rev Sci Instrum. 2026 Aug 1;97(8):081305. doi: 10.1063/5.0332420.

ABSTRACT

Time-lapse scanning tunneling microscopy (STM) captures how surface structures evolve in real time, but extracting quantitative kinetics from the resulting image series is hampered by drifts and the labor of frame-by-frame processing. We present AutoSPy, a modular software package that automates the conversion of raw time-lapse STM image stacks into analyzable time-series measurements. AutoSPy aligns consecutive frames using scale-invariant feature transform feature matching with RANSAC-based outlier rejection and an affine registration model, correcting not only translational drift but also drift-induced rotation and anisotropic distortion. An adaptive flattening routine combining Sobel gradient detection, Otsu thresholding, region growing, and least-squares plane fitting standardizes background subtraction across large datasets. For analysis, it integrates the Segment Anything Model 2 to segment and track user-selected features across registered frames, yielding trajectories, displacement statistics, and time-dependent area changes for clusters and vacancies with minimal manual input. AutoSPy, thus, provides a generalizable toolkit for quantitative studies of dynamic surface evolution and kinetics under working conditions.

PMID:42663515 | DOI:10.1063/5.0332420

Health Serv Res. 2026 Oct;61(5):e70150. doi: 10.1111/1475-6773.70150.

ABSTRACT

OBJECTIVE: To describe how the characteristics of Medicare Advantage (MA) beneficiaries with end-stage kidney disease (ESKD) changed after the 21st Century Cures Act expanded MA eligibility, and to document accompanying changes in utilization.

STUDY SETTING AND DESIGN: The 2021 Cures Act opened MA to previously diagnosed ESKD patients. Prior to 2021, ESKD patients were ineligible for MA unless diagnosed while enrolled. This cross-sectional descriptive study used 2017-2023 claims to compare enrollee characteristics before and after 2021, using interrupted time-series analysis of monthly hospitalizations, emergency department visits, and outpatient visits.

DATA SOURCES AND ANALYTIC SAMPLE: Optum’s de-identified Clinformatics Data Mart Database (2017-2023) provided data on 216,205 MA beneficiaries with ESKD (359,172 beneficiary-years).

PRINCIPAL FINDINGS: Post-policy, enrollees were younger, had lower comorbidity burden and lower education attainment, and were more likely to report household incomes below $40,000. Hospitalization rates were lower immediately post-policy by 0.013 per beneficiary-month (6% relative decline; 95% CI, -0.022 to -0.003; p < 0.05). ED visits showed no immediate difference but increased over time. Outpatient visits remained largely stable.

CONCLUSIONS: Expanded MA eligibility was associated with a substantial shift in the ESKD MA case mix toward younger, relatively healthier, and more socioeconomically vulnerable beneficiaries. Utilization changes reflect these compositional differences.

PMID:42663502 | DOI:10.1111/1475-6773.70150

Eur J Ophthalmol. 2026 Aug 28:11206721261481272. doi: 10.1177/11206721261481272. Online ahead of print.

ABSTRACT

PurposeTo evaluate the clinical utility of novel systemic inflammatory indices in pediatric allergic conjunctivitis and to examine their relationship with disease severity.MethodsThis prospective, cross-sectional study included 28 patients with vernal keratoconjunctivitis (VKC), 32 with seasonal allergic conjunctivitis (SAC), and 32 healthy controls. Systemic inflammatory indices were calculated using complete blood count (CBC) and albumin data. Clinical symptom and sign scores were recorded in the VKC group. Intergroup comparisons for both CBC values as well as inflammatory biomarkers were investigated.ResultsHemoglobin and platelet counts were significantly higher in VKC patients compared to controls (p = 0.024 and p = 0.012, respectively), while eosinophil counts were elevated in both VKC and SAC groups relative to controls (p = 0.002 and p < 0.001). SII, SIRI, and PIV values were significantly higher in VKC patients than in both SAC and control groups (p < 0.05), whereas NLR, PLR, and HALP did not differ significantly among the groups. No statistically significant correlations were found between inflammatory indices and clinical symptom or sign scores in the VKC group.ConclusionComposite inflammatory indices, particularly SII, SIRI, and PIV, may support the distinction between VKC and SAC at a group level by reflecting differences in systemic immune activation. Although these indices were not associated with clinical severity scores, their elevation in VKC underscores underlying immunological differences between chronic and milder allergic conjunctivitis subtypes and suggests a potential role for systemic inflammatory indices as adjunctive tools to support clinical assessment.

PMID:42663483 | DOI:10.1177/11206721261481272

Strabismus. 2026 Aug 28:1-8. doi: 10.1080/09273972.2026.2719731. Online ahead of print.

ABSTRACT

INTRODUCTION: To evaluate whether subtle facial anthropometric variations may influence the perceived noticeability of exotropia.

METHODS: This was a cross-sectional study of adult participants over the age of 18 years old recruited via social media platforms. Digitally generated facial images were used to create a baseline male face with a constant moderate-angle left exotropia and eight modified images with ±5% changes in palpebral fissure length, intercanthal distance, facial width, and facial height. Participants completed randomized pairwise comparisons, selecting which image demonstrated more noticeable ocular misalignment. Relative noticeability was quantified using Elo rating scores. A Bradley-Terry model was used to estimate odds ratios comparing each modified image with baseline. Subgroup analyses were performed by sex and age. The main outcome measure was perceived noticeability of exotropia based on participant-selected pairwise comparisons.

RESULTS: A total of 201 participants completed the survey (mean age 32.5 ± 11.4 years; 59.2% female). Both decreased palpebral fissure length (Elo score: 1 517.27 ± 16.6) and decreased intercanthal distance (Elo score: 1 512.72 ± 14.1) were ranked as having higher perceived noticeability of exotropia, whereas increased palpebral fissure length (Elo score: 1 485.58 ± 16.4) was ranked as having a lower perceived noticeability. In the Bradley-Terry model, decreased palpebral fissure length (OR 5.87, p < .001), decreased intercanthal distance (OR 3.96, p < .001), and increased intercanthal distance (OR 1.43, p < .05) were associated with higher odds of perceived noticeability relative to baseline, while increased palpebral fissure length (OR 0.41, p < .001) was associated with lower odds. Modifications in facial width and facial height were not statistically significant compared to baseline. Perceived noticeability did not differ by participant sex or age group.

DISCUSSION: Subtle variation in periocular facial anthropometric features may influence the perceived noticeability of exotropia independent of deviation magnitude. Periocular features, particularly palpebral fissure length and intercanthal distance, appear to play a greater role in perception than broader facial dimensions. These findings suggest that facial context may contribute to the cosmetic appearance of strabismus and may help explain variability in perception among patients with similar measured deviations.

PMID:42663454 | DOI:10.1080/09273972.2026.2719731