Nevin Manimala

Am J Speech Lang Pathol. 2025 Jan 29:1-12. doi: 10.1044/2024_AJSLP-24-00284. Online ahead of print.

ABSTRACT

PURPOSE: Cerebral palsy (CP) is the most prevalent motor disability affecting children. Many children with CP have significant speech difficulties and require augmentative and alternative communication (AAC) to participate in communication. Despite demonstrable benefits, the use of AAC systems among children with CP remains constrained, although research in Canada is lacking.

METHOD: Data were collected as part of an exploratory survey of Canadian caregivers and clinicians (N = 60) who shared their perspectives on children’s need for, access to, and use of AAC systems. Quantitative data were summarized using descriptive statistics. Qualitative data were analyzed using inductive content analysis.

RESULTS: Caregivers and clinicians reported high rates of need for AAC systems (> 75%) among children with CP. Both groups reported that access was roughly equivalent to need, although caregiver reports were lower. Despite high rates of need and access, only 38% of children used AAC systems. Children who used AAC primarily used high-tech systems, mostly to make choices, rather than engaging in meaningful reciprocal interactions and conversations.

CONCLUSIONS: Canadian children with CP who required AAC systems generally received them. However, AAC systems were not used to their full potential, suggesting limited participation in social and learning situations. Like reports on other pediatric populations, barriers to obtaining AAC systems related to service, family, and child-specific factors. Although our sample captured the complexity present in the CP population, sample sizes were small and unlikely to be representative of the population of Canada, indicating the need for further research on a national scale.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.28229720.

PMID:39879487 | DOI:10.1044/2024_AJSLP-24-00284

JMIR Med Inform. 2025 Jan 29;13:e63109. doi: 10.2196/63109.

ABSTRACT

BACKGROUND: While expert optometrists tend to rely on a deep understanding of the disease and intuitive pattern recognition, those with less experience may depend more on extensive data, comparisons, and external guidance. Understanding these variations is important for developing artificial intelligence (AI) systems that can effectively support optometrists with varying degrees of experience and minimize decision inconsistencies.

OBJECTIVE: The main objective of this study is to identify and analyze the variations in diagnostic decision-making approaches between novice and expert optometrists. By understanding these variations, we aim to provide guidelines for the development of AI systems that can support optometrists with varying levels of expertise. These guidelines will assist in developing AI systems for glaucoma diagnosis, ultimately enhancing the diagnostic accuracy of optometrists and minimizing inconsistencies in their decisions.

METHODS: We conducted in-depth interviews with 14 optometrists using within-subject design, including both novices and experts, focusing on their approaches to glaucoma diagnosis. The responses were coded and analyzed using a mixed method approach incorporating both qualitative and quantitative analysis. Statistical tests such as Mann-Whitney U and chi-square tests were used to find significance in intergroup variations. These findings were further supported by themes extracted through qualitative analysis, which helped to identify decision-making patterns and understand variations in their approaches.

RESULTS: Both groups showed lower concordance rates with clinical diagnosis, with experts showing almost double (7/35, 20%) concordance rates with limited data in comparison to novices (7/69, 10%), highlighting the impact of experience and data availability on clinical judgment; this rate increased to nearly 40% for both groups (experts: 5/12, 42% and novices: 8/21, 42%) when they had access to complete historical data of the patient. We also found statistically significant intergroup differences between the first visits and subsequent visits with a P value of less than .05 on the Mann-Whitney U test in many assessments. Furthermore, approaches to the exam assessment and decision differed significantly: experts emphasized comprehensive risk assessments and progression analysis, demonstrating cognitive efficiency and intuitive decision-making, while novices relied more on structured, analytical methods and external references. Additionally, significant variations in patient follow-up times were observed, with a P value of <.001 on the chi-square test, showing a stronger influence of experience on follow-up time decisions.

CONCLUSIONS: The study highlights significant variations in the decision-making process of novice and expert optometrists in glaucoma diagnosis, with experience playing a key role in accuracy, approach, and management. These findings demonstrate the critical need for AI systems tailored to varying levels of expertise. They also provide insights for the future design of AI systems aimed at enhancing the diagnostic accuracy of optometrists and consistency across different expertise levels, ultimately improving patient outcomes in optometric practice.

PMID:39879089 | DOI:10.2196/63109

JAMA Cardiol. 2025 Jan 29. doi: 10.1001/jamacardio.2024.5281. Online ahead of print.

ABSTRACT

IMPORTANCE: A comprehensive lipid panel is recommended by guidelines to evaluate atherosclerotic cardiovascular disease risk, but uptake is low.

OBJECTIVE: To evaluate whether direct outreach including bulk orders with and without text messaging increases lipid screening rates.

DESIGN, SETTING, AND PARTICIPANTS: Pragmatic randomized clinical trial conducted from June 6, 2023, to September 6, 2023, at 2 primary care practices at an academic health system among patients aged 20 to 75 years with at least 1 primary care visit in the past 3 years who were overdue for lipid screening. Data analysis was performed from September 2023 to May 2024.

INTERVENTIONS: Eligible patients were randomized in a 1:2:2 ratio to usual care (group 1), direct outreach and bulk orders (group 2), and bulk order outreach with additional text message reminders for scheduling assistance (group 3). In group 3, participants received an initial, follow-up, and reminder text message. Patients with electronic portal accounts were encouraged to schedule through them, while others received laboratory contact information. Any participant inquiries were answered either with automated responses for common questions or with study team support.

MAIN OUTCOMES AND MEASURES: Proportion of patients who completed a lipid panel within 3 months.

RESULTS: Among the 1000 participants, the median (IQR) age was 38 (28-55) years; 470 (47.0%) were female; and 22 (2.3%) were Asian, 38 (3.9%) were Black, 32 (3.2%) were Hispanic or Latino, and 862 (88.6%) were White (race and ethnicity were based on self-reported data). At 3 months, a lipid panel was completed by 12 of 202 patients (5.9%; 95% CI, 3.4% to 10.1%) receiving usual care (group 1) vs 62 of 394 patients (15.7%; 95% CI, 12.5% to 19.7%) receiving direct outreach and bulk order (group 2), a difference of 9.8 percentage points (95% CI, 4.6 to 15.0; P = .001). The panel was completed by 73 of 404 patients (18.1%; 95% CI, 14.6% to 22.1%) receiving outreach, bulk order, and text message reminders (group 3), for a difference of 2.4 percentage points (95% CI, -3.1 to 7.8; P = .43) vs outreach with bulk order alone (group 2). At 6 months, there were no significant differences in lipid screening between either group 1 vs group 2 or group 2 vs group 3.

CONCLUSIONS AND RELEVANCE: Lipid screening among participants receiving bulk orders and outreach letters increased significantly compared with usual care at 3 months. However, there was no difference at 6 months. More than 80% of patients did not follow through with lipid screening despite the intervention, and there was no additional increase in lipid testing at 3 months among participants receiving bulk ordering and supplemental text messaging.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05724615.

PMID:39879069 | DOI:10.1001/jamacardio.2024.5281

Phys Rev Lett. 2024 Dec 31;133(26):260401. doi: 10.1103/PhysRevLett.133.260401.

ABSTRACT

We uncover emergent universality arising in the equilibration dynamics of multimode continuous-variable systems. Specifically, we study the ensemble of pure states supported on a small subsystem of a few modes, generated by Gaussian measurements on the remaining modes of a globally pure bosonic Gaussian state. We find that beginning from highly entangled, complex global states, such as random Gaussian states and product squeezed states coupled via a deep array of linear optical elements, the induced ensemble attains a universal form, independent of the choice of measurement basis: it is composed of unsqueezed coherent states whose displacements are distributed normally and isotropically, with variance depending on only the particle-number density of the system. We further show that the emergence of such a universal form is consistent with a generalized maximum entropy principle, which endows the limiting ensemble, which we call the “Gaussian Scrooge distribution,” with a special quantum information-theoretic property of having minimal accessible information. Our results represent a conceptual generalization of the recently introduced notion of “deep thermalization” in discrete-variable quantum many-body systems-a novel form of equilibration going beyond thermalization of local observables-to the realm of continuous-variable quantum systems. Moreover, it demonstrates how quantum information-theoretic perspectives can unveil new physical phenomena and principles in quantum dynamics and statistical mechanics.

PMID:39879065 | DOI:10.1103/PhysRevLett.133.260401

Phys Rev Lett. 2024 Dec 31;133(26):267302. doi: 10.1103/PhysRevLett.133.267302.

ABSTRACT

We introduce an approach for analyzing the responses of dynamical systems to external perturbations that combines score-based generative modeling with the generalized fluctuation-dissipation theorem. The methodology enables accurate estimation of system responses, including those with non-Gaussian statistics. We numerically validate our approach using time-series data from three different stochastic partial differential equations of increasing complexity: an Ornstein-Uhlenbeck process with spatially correlated noise, a modified stochastic Allen-Cahn equation, and the 2D Navier-Stokes equations. We demonstrate the improved accuracy of the methodology over conventional methods and discuss its potential as a versatile tool for predicting the statistical behavior of complex dynamical systems.

PMID:39879063 | DOI:10.1103/PhysRevLett.133.267302

Phys Rev Lett. 2024 Dec 31;133(26):266704. doi: 10.1103/PhysRevLett.133.266704.

ABSTRACT

The Landau-Lifshitz-Gilbert (LLG) and Landau-Lifshitz (LL) equations play an essential role for describing the dynamics of magnetization in solids. While a quantum analog of the LL dynamics has been proposed in [Phys. Rev. Lett. 110, 147201 (2013)PRLTAO0031-900710.1103/PhysRevLett.110.147201], the corresponding quantum version of LLG remains unknown. Here, we propose such a quantum LLG equation that inherently conserves purity of the quantum state. We examine the quantum LLG dynamics of a dimer consisting of two interacting spin-1/2 particles. Our analysis reveals that, in the case of ferromagnetic coupling, the evolution of initially uncorrelated spins mirrors the classical LLG dynamics. However, in the antiferromagnetic scenario, we observe pronounced deviations from classical behavior, underscoring the unique dynamics of becoming a spinless state, which is nonlocally correlated. Moreover, when considering spins that are initially entangled, our study uncovers an unusual form of revival-type quantum correlation dynamics, which differs significantly from what is typically seen in open quantum systems.

PMID:39879062 | DOI:10.1103/PhysRevLett.133.266704

Phys Rev Lett. 2024 Dec 31;133(26):267102. doi: 10.1103/PhysRevLett.133.267102.

ABSTRACT

We consider many-particle diffusion in one spatial dimension modeled as “random walks in a random environment.” A shared short-range space-time random environment determines the jump distributions that drive the motion of the particles. We determine universal power laws for the environment’s contribution to the variance of the extreme first passage time and extreme location. We show that the prefactors rely upon a single extreme diffusion coefficient that is equal to the ensemble variance of the local drift imposed on particles by the random environment. This coefficient should be contrasted with the Einstein diffusion coefficient, which determines the prefactor in the power law describing the variance of a single diffusing particle and is equal to the jump variance in the ensemble averaged random environment. Thus a measurement of the behavior of extremes in many-particle diffusion yields an otherwise difficult to measure statistical property of the fluctuations of the generally hidden environment in which that diffusion occurs. We verify our theory and the universal behavior numerically over many random walk in a random environment models and system sizes.

PMID:39879054 | DOI:10.1103/PhysRevLett.133.267102

Phys Rev Lett. 2024 Dec 31;133(26):261002. doi: 10.1103/PhysRevLett.133.261002.

ABSTRACT

Using tremendous photon statistics gained with the stray light aperture of the NuSTAR telescope over 11 years of operation, we set strong limits on the emission of close to monochromatic photons from the radiative decays of putative dark matter sterile neutrinos in the Milky Way. In the energy range of 3-20 keV covered by the NuSTAR, the obtained limits reach the bottom edge of theoretical predictions of realistic models where sterile neutrinos are produced in the early Universe. Only a small region is left to explore, if the sterile neutrinos form the entire dark matter component.

PMID:39879052 | DOI:10.1103/PhysRevLett.133.261002

Phys Rev Lett. 2024 Dec 31;133(26):261001. doi: 10.1103/PhysRevLett.133.261001.

ABSTRACT

Joint gravitational-wave and γ-ray burst (GRB) observations are among the best prospects for standard siren cosmology. However, the strong selection effect for the coincident GRB detection, which is possible only for sources with small inclination angles, induces a systematic uncertainty that is currently not accounted for. We show that this severe source of bias can be removed by inferring the a priori unknown electromagnetic detection probability directly from multimessenger data. This leads at the same time to an unbiased measurement of the Hubble constant, to constrain the properties of GRB emission, and to accurately measure the viewing angle of each source. Our inference scheme is applicable to real data already in the small-statistics regime, a scenario that might become reality in the near future. Additionally, we introduce a novel likelihood approximant for gravitational-wave events which treats the dependence on distance and inclination as exact.

PMID:39879018 | DOI:10.1103/PhysRevLett.133.261001

JAMA Netw Open. 2025 Jan 2;8(1):e2456238. doi: 10.1001/jamanetworkopen.2024.56238.

ABSTRACT

IMPORTANCE: Pediatric obesity and hypertension are highly correlated. To mitigate both conditions, provision of counseling on nutrition, lifestyle, and weight to children with high blood pressure (BP) measurements is recommended.

OBJECTIVE: To examine racial and ethnic disparities in receipt of nutrition, lifestyle, and weight counseling among patients with high BP at pediatric primary care visits stratified by patients’ weight status.

DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc secondary analysis of the BP-CATCH study, a matched, stepped-wedge cluster randomized clinical trial investigating the best methods to screen children with high BP measurements and manage their care. Urban, suburban, and rural pediatric primary care practices across the US with a multidisciplinary team of at least 1 physician, 1 nurse and another practice associate, and a hypertension specialist for their practice group submitted baseline data from clinical encounters documented between November 2018 and January 2019. Practices identified the first 17 eligible patients with high BP measurements each month. This analysis was conducted from October 2023 to July 2024.

EXPOSURES: Race and ethnicity (Black, Hispanic, White, and other [Asian, multiracial, other races, and unknown race]) and weight status (with or without obesity).

MAIN OUTCOMES AND MEASURES: Primary outcomes were receipt of counseling on nutrition, lifestyle, and weight during primary care visits. Baseline measures extracted from medical records included demographics, anthropometric measures, and systolic and diastolic BP.

RESULTS: Of 2677 participants from 59 practices, 1516 (56.6%) were male; mean (SD) age was 10.8 (5.2) years. A total of 593 (21.1%) were Black; 414 (15.5%), Hispanic; 1111 (41.5%), White; and 559 (20.9%), other race and ethnicity. The overall crude unadjusted rates of receiving counseling were 63.5% (n = 1564 of 2463) for nutrition, 57.6% (n = 1419 of 2462) for lifestyle, 47.5% (n = 571 of 1202) for weight, and 46.4% (n = 1142 of 2461) for all counseling topics. Compared with the other 3 groups, Hispanic participants received significantly higher adjusted rates of nutrition (78.6%; 95% CI, 73.5%-83.8%), lifestyle (69.3%; 95% CI, 63.6%-74.9%), and all 3 (52.1%; 95% CI, 46.1%-58.2%) counseling topics. There were no significant differences in rates of receiving weight counseling between any pairs of groups. These findings were consistent in general among participants without obesity, and no significant pairwise differences were noted among participants with obesity except that nutrition counseling rates were significantly different between White participants and those reporting other race and ethnicity (68.3% [95% CI, 61.1%-75.4%] vs 81.6% [95% CI, 74.2%-89.1%]; Bonferroni-corrected P = .02).

CONCLUSIONS AND RELEVANCE: This secondary analysis of the BP-CATCH trial found that among children with high BP measurements, racial and ethnic disparities in receiving nutrition, lifestyle, and all 3 counseling topics were significant, although no significant disparities in receipt of weight counseling were noted. Racial disparities in receipt of counseling were not observed in participants with and without obesity.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03783650.

PMID:39878982 | DOI:10.1001/jamanetworkopen.2024.56238