Nevin Manimala

JAMA Netw Open. 2026 Jan 2;9(1):e2552944. doi: 10.1001/jamanetworkopen.2025.52944.

ABSTRACT

IMPORTANCE: General mammography screening guidelines target women at average risk within a specified age range (age based) and do not consider absolute risk of individual women at a given age (risk based).

OBJECTIVE: To compare outcomes of mammography screening strategies that vary by 5-year risk of invasive breast cancer vs age-based strategies.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model used 2 established Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer models and simulated US women born in 1980 who were aged 40 years or older without a prior history of breast cancer. Modeling analyses were conducted from April 2023 to April 2025.

INTERVENTION: Digital breast tomosynthesis delivered via 50 screening strategies (3 age based and 47 risk based) vs a no-screening scenario. Five-year absolute invasive breast cancer risk was based on the validated Breast Cancer Surveillance Consortium, version 3 calculator. Women’s 5-year breast cancer risk was categorized as low, average, intermediate, or high.

MAIN OUTCOMES AND MEASURES: Primary outcomes included lifetime number of breast cancer deaths averted and false-positive screening recalls. Lifetime outcomes were averaged across models and expressed per 1000 women screened.

RESULTS: Nine risk-based screening strategies were associated with a comparable or greater number of deaths averted than biennial age-based screening from ages 40 to 74 years (B40-74) (range across strategies for mean model estimates, 6.8-7.5 per 1000 women vs 6.8 per 1000 women) as well as reduced false-positive recalls by 8% to 23% (1050-1257 per 1000 women for risk-based screening strategies vs 1365 per 1000 women for B40-74). For example, a risk-based approach using a combination of biennial screening (for women at low risk aged 55-74 years, at average risk aged 50-59 years, at intermediate risk aged 45-54 years, and at high risk aged 40-49 years) and annual screening (for women at average risk aged 60-74 years, at intermediate risk aged 55-74 years, and at high risk aged 50-74 years) would be associated with 6% more breast cancer deaths averted than B40-74 (7.2 vs 6.8 per 1000 women) and 13% fewer false-positive recalls (1190 vs 1365 per 1000 women). Results were consistent across the 2 CISNET models, and the relative difference in breast cancer deaths averted between B40-74 and risk-based screening strategies was more pronounced than for life-years gained.

CONCLUSIONS AND RELEVANCE: In this decision analytical modeling study of breast cancer screening, population risk-based screening using 5-year invasive breast cancer risk was associated with similar or greater benefits than age-based screening as well as reduced false-positive recalls. As personalized medicine advances, risk-based screening is poised to become a cornerstone of breast cancer prevention, offering a more nuanced and tailored approach to patient care.

PMID:41557352 | DOI:10.1001/jamanetworkopen.2025.52944

JAMA Netw Open. 2026 Jan 2;9(1):e2554686. doi: 10.1001/jamanetworkopen.2025.54686.

ABSTRACT

IMPORTANCE: Community water fluoridation (CWF) is a widely implemented public health intervention aimed at preventing dental caries. However, concerns have emerged about potential unintended birth outcomes of fluoride exposure, particularly birth weight, which is a widely accepted summary measure of infant health and has been found to be associated with later-life health and human capital.

OBJECTIVE: To evaluate the association between prenatal exposure to CWF and birth outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted using an event-study analysis with a difference-in-differences (DID) approach that exploited the staggered rollout of CWF across US counties from January 1968 to December 1988. The study included birth outcomes from singleton births obtained from the National Vital Statistics System’s Natality Detail Files. The analysis compared within-county changes in birth outcomes before and after the introduction of CWF, using counties that never fluoridated or had not yet fluoridated as the control. Data were analyzed between February 4 and October 28, 2025.

EXPOSURE: County-level CWF.

MAIN OUTCOMES AND MEASURES: The primary outcome was change in mean birth weight, and secondary outcomes were incidence of low birth weight (<2500 g), gestational length (weeks), and incidence of prematurity (gestational age <37 weeks). Community water fluoridation exposure was measured as the population-weighted share of county residents served by fluoridated water based on Centers for Disease Control and Prevention Fluoridation Census data.

RESULTS: The study sample included 11 479 922 singleton births (mean [SD] gestational age, 39.5 [0.8] weeks; 51.2% boys; mean [SD] birth weight, 3337.4 [172.8] g; highest mean [SD] maternal age proportions, 0.36 [0.13] aged 20-24 years and 0.27 [0.12] aged 25-29 years) across 677 counties (408 CWF treated [60.3%] and 269 [39.7%] never treated) over the 21-year period, aggregated to the county-month level. No evidence of an association of CWF with birth weight or other birth outcomes was found (DID estimate, -0.53; 95% CI, -4.75 to 3.70). Event-study estimates showed no discernible pretreatment trends and no significant changes following CWF adoption, with estimates small in magnitude across all posttreatment periods, ranging from -8.44 g (95% CI, -20.41 to 3.53 g) to 7.20 g (95% CI, -5.45 to 19.85 g). Findings were supported by sensitivity analyses incorporating state-specific time trends, alternative exposure thresholds, and tests for compositional changes in births.

CONCLUSIONS AND RELEVANCE: This cohort study of more than 11 million births found no association of CWF with adverse birth outcomes. These findings provide reassurance about the safety of CWF during pregnancy and underscore the value of rigorous causal designs in evaluating potential adverse effects of public health interventions.

PMID:41557351 | DOI:10.1001/jamanetworkopen.2025.54686

JAMA Netw Open. 2026 Jan 2;9(1):e2554797. doi: 10.1001/jamanetworkopen.2025.54797.

ABSTRACT

IMPORTANCE: Socioeconomic disparities in hospice care access are well recognized, but their structural drivers remain underexplored. Low-income patients with cancer often face compounded informational, psychosocial, and financial barriers at the end of life.

OBJECTIVE: To examine how limited cultural capital, disease-related stigma, and class-based disadvantage may be jointly associated with hospice care access among low-income patients with cancer in China.

DESIGN, SETTING, AND PARTICIPANTS: This descriptive qualitative study was conducted at a tertiary hospital in southwestern China from July 2024 to July 2025. Adult patients with advanced cancer receiving government social assistance were purposively sampled.

MAIN OUTCOME AND MEASURES: Semistructured in-depth interviews were conducted, transcribed verbatim, and thematically analyzed using a 6-phase approach. Two researchers independently coded transcripts, with analytic consensus achieved through iterative discussion. NVivo 12 software was used for data management. Analysis occurred from August to October 2025.

RESULTS: Among 16 adults with advanced cancer (median [range] age, 55 years [late 30s to early 70s]; 9 men [56.2%]), 4 themes emerged: (1) Limited cultural capital was associated with cognitive and communicative barriers, including low health literacy, reliance on informal sources, and poor digital navigation. (2) Stigma surrounding cancer and death was associated with moral dilemmas and inhibition of open discussion of hospice. (3) Economic deprivation was associated with restricted care options, reinforced curative treatment priorities, and weakened access to social support. (4) Patients and families used resilience strategies, including peer networks, communication tactics, and value redefinition. These domains interacted synergistically; poverty was associated with reduced access to education and digital literacy, with exacerbated stigma internalization and discouraged care-seeking.

CONCLUSIONS AND RELEVANCE: This study found that cultural capital deficits, stigma, and socioeconomic hardship were jointly associated with a self-reinforcing cycle of hospice exclusion. These outcomes suggest that interventions must address these factors simultaneously by improving health literacy, reducing stigma, and expanding financial and systemic support.

PMID:41557349 | DOI:10.1001/jamanetworkopen.2025.54797

JAMA Pediatr. 2026 Jan 20. doi: 10.1001/jamapediatrics.2025.5866. Online ahead of print.

ABSTRACT

IMPORTANCE: Children born very preterm or with very low birth weight are at higher risk for executive function deficits, affecting attention, self-regulation, and problem-solving. Early developmental interventions have shown potential benefits, but their long-term effect on executive functioning remains uncertain.

OBJECTIVE: To evaluate whether an enhanced developmental intervention (EDI) initiated in the neonatal intensive care unit (NICU) and continued at home through the first 2 years improves executive function at school age in very preterm children.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis assessed school-aged outcomes from a randomized clinical trial of infants born with fewer than 32 weeks of gestation or with birth weight less than 1500 g from January 2016 to February 2019. Follow-up assessments were conducted from July 7, 2023, to August 16, 2024, at a single center in Porto Alegre, Brazil. Data analyses were completed from August to December 2024.

INTERVENTION: EDI compared with usual care.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the scaled scores of Developmental Neuropsychological Assessment, Second Edition, subtests, which measures auditory attention, inhibition, design fluency, and motor persistence. The examiner was masked to group allocation. Medical records identified children with neurodevelopmental conditions that precluded formal assessment. The effect size for the Mann-Whitney U test comparisons was calculated using the rank-biserial correlation. Binary logistic regression was used to compare performance in the primary outcomes. Sensitivity analyses were used for those lost to follow-up.

RESULTS: Of the original randomized clinical trial, 80 children (96% of those eligible) were assessed at a mean (SD) age of 7 (1) years; 34 children (43%) were female. Baseline characteristics were similar between groups. In the primary analysis of median scaled scores, children who received EDI demonstrated significantly better performance across all 4 executive function domains compared to usual care (median scores, 12-14 vs 2-9; r = 0.44-0.77; all P < .001). All results remained significant after Bonferroni correction (P < .0125), indicating medium to large effect sizes. In the secondary analysis of performance classification, EDI was associated with higher odds of expected performance in design fluency (odds ratio, 11.3; 95% CI, 4.08-31.7; P < .001). No statistically significant differences were observed for the remaining 3 domains.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial, early EDI, beginning in the NICU and extending through the first 2 years, contributed to sustained improvements in executive function in very preterm children. These findings support the long-term neurodevelopmental benefits of early intervention, with potential implications for academic and socioemotional outcomes in children from low- and middle-income settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02835612.

PMID:41557341 | DOI:10.1001/jamapediatrics.2025.5866

Phys Rev Lett. 2025 Dec 19;135(25):250802. doi: 10.1103/m8q8-ksrl.

ABSTRACT

Nuclear magnetic resonance (NMR) spectroscopy is widely used in fields ranging from chemistry and materials science to neuroscience. Nanoscale NMR spectroscopy using nitrogen-vacancy (NV) centers in diamond has emerged as a promising platform due to an unprecedented sensitivity down to the single spin level. At the nanoscale, high nuclear spin polarization through spin fluctuations (statistical polarization) far outweighs thermal polarization. However, until now efficient NMR detection using coherent averaging techniques could not be applied to the detection of statistical polarization, leading to long measurement times. Here we present two protocols to enable coherent averaging of stochastic oscillatory signals through rectification. We demonstrate these protocols on an artificial radio frequency signal detected with a single NV center at 2.7 T. The signal-to-noise scaling with number of measurements N increases from N^{0.5} to N^{1}, improving the measurement time significantly. The relevance of rectification for the detection of statistically polarized nuclear spins using ensembles of NV centers is outlined, paving the way for efficient nanoscale NMR spectroscopy.

PMID:41557325 | DOI:10.1103/m8q8-ksrl

Phys Rev Lett. 2025 Dec 19;135(25):250801. doi: 10.1103/1cj2-rxkm.

ABSTRACT

Nuclear magnetic resonance spectroscopy with solid-state spin sensors is a promising pathway for the detection of nuclear spins at the micro- and nanoscale. Although many nanoscale experiments rely on a single sensor spin for the detection of the signal, leveraging spin ensembles can enhance sensitivity, particularly in cases in which the signal merely originates from statistically polarized nuclear spins. In this Letter, we introduce multipoint correlation spectroscopy, which combines the advantages of two well-established methods-correlation spectroscopy and quantum heterodyne detection-to enable temporally efficient measurements of statistically polarized samples at the nanoscale with spin ensembles. We present a theoretical framework for this approach and demonstrate an experimental proof of concept with a nitrogen vacancy center in diamond. We achieve single hertz uncertainty in the estimated signal frequency, highlighting the potential applications of the technique for nanoscale nuclear magnetic resonance.

PMID:41557308 | DOI:10.1103/1cj2-rxkm

Phys Rev Lett. 2025 Dec 19;135(25):250403. doi: 10.1103/jr7l-2cfb.

ABSTRACT

Rydberg atom arrays with van der Waals interactions provide a controllable path to quantum simulate the locally connected transverse-field Ising model (TFIM), a prototypical model in statistical mechanics. Remotely operating the publicly accessible Aquila Rydberg atom array, we experimentally investigate the physics of TFIM far from equilibrium and uncover significant deviations from the theoretical predictions. Rather than the expected ballistic spread of correlations, the Rydberg simulator exhibits a sub-ballistic spread, along with a logarithmic scaling of entanglement entropy in time all while the system mostly retains its initial magnetization. By modeling the atom motion, we trace these effects to an emergent disorder in Rydberg atom arrays, which we characterize with a minimal random spin model. We further experimentally explore the different dynamical regimes hosted in the system by varying the lattice spacing and the Rabi frequency. Our findings highlight the crucial role of atom motion in the many-body dynamics of Rydberg atom arrays at the TFIM limit, and propose simple benchmark measurements to test for its presence in future experiments.

PMID:41557290 | DOI:10.1103/jr7l-2cfb

Phys Rev Lett. 2025 Dec 19;135(25):257401. doi: 10.1103/65jz-81kv.

ABSTRACT

Universal power laws have been scrutinized in physics and beyond, and a long-standing debate exists in econophysics regarding the strict universality of the nonlinear price impact, commonly referred to as the square-root law (SRL). The SRL posits that the average price impact I follows a power law with respect to transaction volume Q, such that I(Q)∝Q^{δ} with δ≈1/2. Some researchers argue that the exponent δ should be system specific, without universality. Conversely, others contend that δ should be exactly 1/2 for all stocks across all countries, implying universality. However, resolving this debate requires high-precision measurements of δ with errors of around 0.1 across hundreds of stocks, which has been extremely challenging due to the scarcity of large microscopic datasets-those that enable tracking the trading behavior of all individual accounts. Here we conclusively support the universality hypothesis of the SRL by a complete survey of all trading accounts for all liquid stocks on the Tokyo Stock Exchange over eight years. Using this comprehensive microscopic dataset, we show that the exponent δ is equal to 1/2 within statistical errors at both the individual stock level and the individual trader level. Additionally, we rejected two prominent models supporting the nonuniversality hypothesis: the Gabaix-Gopikrishnan-Plerou-Stanley and the Farmer-Gerig-Lillo-Waelbroeck models [Gabaix et al., Nature (London) 423, 267 (2003).NATUAS0028-083610.1038/nature01624; Q. J. Econ 121, 461 (2006).10.1162/qjec.2006.121.2.461; Farmer et al., Quant. Finance 13, 1743 (2013)NATUAS0028-083610.1038/nature01624]. Our Letter provides exceptionally high-precision evidence for the universality hypothesis in social science and could prove useful in evaluating the price impact by large investors-an important topic even among practitioners.

PMID:41557288 | DOI:10.1103/65jz-81kv

Phys Rev Lett. 2025 Dec 19;135(25):257101. doi: 10.1103/tgt8-gb13.

ABSTRACT

The XY models with continuous spin orientation play a pivotal role in understanding topological phase transitions and emergent frustration phenomena such as superconducting and superfluid phase transitions. However, the complex energy landscapes arising from frustrated lattice geometries and competing spin interactions make these models computationally intractable. To address this challenge, we designed a programmable photonic spin simulator capable of emulating the XY models with tunable lattice geometries and spin couplings, allowing systematic exploration of their statistical properties. We experimentally observed the Berezinskii-Kosterlitz-Thouless transition in a square-lattice XY model with nearest-neighbor interactions and determined its critical temperature. Expanding to frustrated systems, we implemented the approach in triangular and honeycomb lattices, uncovering sophisticated phase transitions and frustration effects, which were consistent with theoretical predictions. This versatile platform opens avenues for probing unexplored XY model phenomena across diverse geometries and interaction schemes, with potential applications in solving complex optimization and machine learning problems.

PMID:41557271 | DOI:10.1103/tgt8-gb13

Int J Prosthodont. 2026 Jan 20;0(0):1-21. doi: 10.11607/ijp.9668. Online ahead of print.

ABSTRACT

PURPOSE: Restoring severely destructed anterior teeth without a ferrule remains a clinical challenge, and the choice between endocrowns and post-core systems is still debated. This study aimed to compare the fracture strength and failure modes of maxillary central incisors restored with conventional and CAD/CAM post-core systems versus endocrowns fabricated from different materials.

MATERIALS AND METHODS: Fifty endodontically treated maxillary central incisors were decoronated and divided into five groups:Glass-fiber post/composite core (F); CAD/CAM glass-fiber single-piece post-core (CF); CAD/CAM polyetheretherketone (PEEK) single-piece post-core (CP); hybrid ceramic endocrown (HE); lithium disilicate endocrown (LE). Hybrid ceramic crowns were produced on the post-core restorations. After thermocycling, fracture strength (N) was evaluated using a universal testing machine. Then the failure modes were examined under stereomicroscope. Statistical analysis was performed using Kruskal-Wallis and Tukey tests (P= .05).

RESULTS: Group CF exhibited the highest fracture strength (331.624 N) and a 60% repairable failure rate. However, group F exhibited a 100% repairable failure, followed by the group CP, which showed 80% repairable failure. Among the endocrowns, HE demonstrated significantly higher fracture strength (313.9 N) compared with LE (128.9 N, P< .05), although both showed 60% repairable failures.

CONCLUSIONS: CAD/CAM glass-fiber post-cores and hybrid ceramic endocrowns provided superior fracture strength with predominantly repairable failures. In view of their simplified workflow and cost-effectiveness, hybrid ceramic endocrowns may be regarded as a clinically reliable restorative option for anterior teeth lacking a ferrule. In addition, the repairable nature of failures in glass-fiber posts plays a key role in preventing irreversible failures.

PMID:41557270 | DOI:10.11607/ijp.9668