Tag: nevin manimala

Eur J Health Econ. 2026 May 27. doi: 10.1007/s10198-026-01940-5. Online ahead of print.

ABSTRACT

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological condition predominantly affecting individuals over 65 years of age. Despite its treatability through cerebrospinal fluid (CSF) shunting-with clinical improvement in up to 80% of appropriately selected patients-iNPH remains substantially underdiagnosed, with only approximately 13% of affected individuals in Europe receiving appropriate care. This study evaluates the long-term epidemiological and economic burden of iNPH underdiagnosis in Italy over the decade 2024-2033, quantifying potential savings achievable through systematic diagnosis and surgical treatment.

METHODS: A dual-scenario epidemiological modeling approach was employed using Italian demographic projections from ISTAT for the population aged ≥ 65 years, stratified into two age cohorts (65-79 years and ≥ 80 years). Scenario 1 applied a conservative pooled prevalence of 1.30% derived from an international systematic review; Scenario 2 applied realistic age-stratified rates from a prospective Swedish population-based study (2.1% for ages 65-79; 8.9% for ≥ 80 years). Per-patient annual care costs (€35,866) and surgical intervention costs (€11,803) were modeled with an annual inflation adjustment of 1.78%. The Incremental Cost-Effectiveness Ratio (ICER) was calculated using a reported QALY gain of 1.7 following shunt surgery.

RESULTS: The Italian population aged ≥ 65 years is projected to grow by 16.7% over the study period, reaching 16.77 million by 2033. Estimated iNPH cases range from 186,812 (Scenario 1, conservative) to 611,435 (Scenario 2, realistic) in 2024, increasing to 217,967-707,882 by 2033. Cumulative ten-year costs to the Italian National Health System (INHS) and families without intervention ranged from €145.53 billion (Scenario 1, conservative) to €475.19 billion (Scenario 2, realistic). Systematic shunt surgery could generate cumulative savings ranging from €113.21 billion to €369.74 billion across all four modeled scenarios. The ICER was consistently -€14,166.47/QALY across all scenarios, establishing CSF shunt surgery as an economically dominant intervention.

CONCLUSIONS: iNPH underdiagnosis represents a major and escalating economic and clinical challenge for Italy’s aging healthcare system. Even under the most conservative scenario, the magnitude of avoidable costs is substantial. The consistently negative ICER confirms that CSF shunt surgery simultaneously reduces healthcare expenditure and improves patient outcomes. Urgent investment in standardized screening programs, enhanced clinical awareness among physicians, and integrated care pathways is required to address this preventable burden.

PMID:42201617 | DOI:10.1007/s10198-026-01940-5

J Robot Surg. 2026 May 27;20(1):543. doi: 10.1007/s11701-026-03511-5.

ABSTRACT

Robotic-assisted thoracic surgery (RATS) is increasingly being incorporated into contemporary practice across the United Kingdom (UK) and Republic of Ireland (ROI). However, national data on trainee exposure and preparedness is lacking. This study is the first to evaluate cardiothoracic trainees’ experiences and perceptions of training for RATS nationally. A multicentre, cross-sectional survey study was conducted between June and October 2025 of cardiothoracic trainees (ST1-ST8), post-certificate fellows, and equivalent trust appointed doctors. A 30-item, web-based questionnaire assessed institutional exposure, simulation access, operative console experience, and perceived barriers to RATS training. Quantitative data were analysed using descriptive statistics; while free-text responses underwent inductive thematic analysis. Eighty-two responses were received from all 14 training deaneries. RATS was performed in 71% (58/82) of respondents’ units; however only 16% (9/58) reported a structured training programme in place. Dual console systems were absent or unused in 43% (25/58) of robotic units. Over half (54%, 32/59) of respondents had not fully performed a single RATS procedure. Most respondents (83%, 68/82) agreed that more robotic training is required before the completion of training. Key barriers to training included lack of dual-console utilisation, operative exposure limited to bedside assisting only, and restricted simulation access. Despite widespread adoption of RATS, opportunities for structured training remain inconsistent across the UK and ROI. National standards should be developed to incorporate structured robotic training within the cardiothoracic curriculum, including access to simulation, routine dual-console use, and competency-based progression from bedside assistant to primary operator.

PMID:42201609 | DOI:10.1007/s11701-026-03511-5

Health Care Anal. 2026 May 27. doi: 10.1007/s10728-026-00573-2. Online ahead of print.

ABSTRACT

Investments in public health and education are usually examined independently, but in developing countries, both are relevant to Sustainable Economic Development (SED). Within an integrated policy framework, this study aims to examine the complementary relationship between investments in health and education and their relationship with SED. A mixed-method approach was employed, consisting of 465 questionnaire responses from participants, including government officials, and 96 semi-structured interviews. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), quantitative data were analyzed, and to contextualize the statistical results, qualitative findings were involved. Results indicate that healthcare infrastructure, coupled with investment in health and education, communicable disease reduction, mental health services, and coordinated public investment, is positively and statistically related to SED. Explained variance is (R² = 0.100), showing that there is a moderate but meaningful contribution in the broader institution context. Findings contribute to existing literature by incorporating cross-sectoral modeling with qualitative institutional-level findings. It provides a more holistic understanding of the relation between coordinated human capital investments and developmental outcomes. These insights recommend integrating policies between the health and education sectors to support inclusive and sustainable development in low- and middle-income countries.

PMID:42201595 | DOI:10.1007/s10728-026-00573-2

Hernia. 2026 May 27;30(1):233. doi: 10.1007/s10029-026-03732-5.

ABSTRACT

BACKGROUND: Two-dimensional (2D) laparoscopy provides limited depth perception, which may limit performance during technically demanding operations. Three-dimensional (3D) systems offer stereoscopic vision, improving visualization. We compared 3D versus 2D systems in adults for operative time, visualization, and postoperative complications.

METHODS: PubMed, Scopus, Web of Science, and Cochrane were searched through December 2025. We included randomized controlled trials and observational studies of patients undergoing TAPP repair, comparing 3D with 2D laparoscopy. Total operative time was the primary outcome; visualization and postoperative complications were secondary outcomes. Risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale, and certainty of evidence using GRADE.

RESULTS: Six studies met the inclusion criteria; five were included in the primary meta-analysis (n = 521 patients). Total operative time favored 3D (MD-18.48 min; 95% CI-29.27,-7.69; p = 0.0008), with substantial heterogeneity (I²=94%). Subgroup analysis also favored 3D in RCTs (MD-11.70; 95% CI-17.74,-5.66) and observational studies (MD-26.85; 95% CI-30.55,-23.15). Contrast favored 3D (MD 2.11; 95% CI 0.56, 3.67; p = 0.008), while sharpness was not statistically different (MD 1.49; 95% CI-0.25 to 3.24; p = 0.09). No difference in postoperative complications (MD 1.11; 95% CI 0.75, 1.65; p = 0.59).

CONCLUSION: 3D laparoscopy has been proposed to improve visualization and shorten operative time; however this should be interpreted with caution due to very low certainty of evidence and variability in surgeon experience.

REGISTRATION/FUNDING: PROSPERO CRD420251272842.

PMID:42201585 | DOI:10.1007/s10029-026-03732-5

J Robot Surg. 2026 May 27;20(1):538. doi: 10.1007/s11701-026-03501-7.

ABSTRACT

During early adoption of robotic surgeries, evidence is primarily descriptive, and how such evidence emerges and accumulates over time remains poorly understood. This study introduces a framework for modeling the temporal dynamics of descriptive evidence on device-level utilities and operational issues accumulated during early adoption of the da Vinci system. We employed a three-step approach comprising systematic dataset acquisition, thematic coding of device utilities and operational issues, and quantitative temporal modeling. A PRISMA-guided search of PubMed and Web of Science identified early clinical studies of the da Vinci system from FDA clearance (July 2000) to the first published randomized controlled trial. Two reviewers independently coded descriptive themes, and cumulative occurrence proportions were modeled over time using exponential and logistic regression to characterize the emergence and saturation patterns. Nineteen studies met inclusion criteria, yielding 16 themes (7 utilities, 9 issues) with high inter-rater reliability (agreement rate 93.1%, Cohen’s κ = 0.85). Utilities, particularly instrument dexterity and stereoscopic depth perception, were reported early and reached saturation rapidly, whereas operational issues, including loss of haptic feedback and workflow-related constraints, emerged more gradually and required greater cumulative clinical experience. Time-series modeling demonstrated a clear saturating pattern, with utilities reaching 80% cumulative occurrence at 13.2 months versus 26.0 months for issues. This study presents a framework for modeling how descriptive evidence emerges and matures in early-stage medical device adoption. The observed asymmetry, rapid recognition of utilities versus delayed emergence of operational issues, highlights the importance of structured, continuous synthesis of early clinical evidence.

PMID:42201559 | DOI:10.1007/s11701-026-03501-7

Eur Spine J. 2026 May 27. doi: 10.1007/s00586-026-10038-8. Online ahead of print.

ABSTRACT

OBJECTIVES: Optimal bone quality is essential for spinal surgery, as it mitigates the risk of multiple serious complications. The purpose of this study was to establish a novel, straightforward, and clinically relevant scoring system to assess vertebral bone fragility and investigate its correlation with conventional dual-energy X-ray absorptiometry (DEXA) measurements.

METHODS: A retrospective analysis was conducted on patients who underwent lumbar spine MRI and DEXA scans at our institution for degenerative lumbar diseases between December 2023 and December 2024. Patients were categorized into normal group and osteopenia/osteoporosis group based on DEXA results. Demographic data were collected and imaging parameters, including vertebral bone quality (VBQ), disc signal intensity (DSI), and vertebral bone fragility (VBF), were calculated. Logistic regression analysis was employed to identify risk factors. Pearson correlation analysis was performed between VBF scores and DEXA T-scores. The diagnostic performance of the VBF score in identifying patients with reduced bone mineral density (BMD) was evaluated using receiver operating characteristic(ROC) curve.

RESULTS: Of the 109 patients included in the study, 73 were diagnosed with osteopenia/osteoporosis. Interobserver reliability for DSI and VBF scores was excellent. There were significant differences in age, sex, VBQ, and VBF scores between the two groups. Logistic regression analysis identified a high VBF score (OR 2.870, 95% CI 1.320-6.240) as a significant risk factor for osteopenia/osteoporosis. The area under the curve (AUC) of predicting osteopenia/osteoporosis was 0.829 (p < 0.001) for VBF score, and the best threshold was 3.51 (sensitivity, 64.4%; specificity, 91.7%). VBF score demonstrated a statistically significant correlation with DEXA T-scores (p < 0.001).

CONCLUSIONS: VBF score is a straightforward, reliable, and accurate method for assessing bone fragility in degenerative lumbar diseases, providing additional screening options for preoperative BMD evaluation.

PMID:42201553 | DOI:10.1007/s00586-026-10038-8

Am J Med Genet B Neuropsychiatr Genet. 2026 May 27. doi: 10.1002/ajmg.b.70024. Online ahead of print.

ABSTRACT

Alzheimer’s disease (AD) and Parkinson’s disease (PD) are the most prevalent late-onset neurodegenerative diseases worldwide. Both are influenced in part by genetic factors and are currently incurable. Tobacco and alcohol, the two most common substances used among the general adult population, are potential AD/PD risk factors and are also heritable. Although important progress has been made, most existing research on the genetics of AD and PD has been carried out in individuals of European genetic ancestry. Investigations in a broad range of groups are crucial to understand disease mechanisms. Given the current availability of ancestry-specific tobacco and alcohol use as well as AD and PD genome-wide association study summary statistics, we performed global and local genetic correlation analyses using East Asian datasets. Genes within the correlated genetic regions were subsequently used to identify potentially enriched biological pathways between substance use and neurodegenerative diseases. We identified a global genetic correlation between smoking cessation and PD, which we confirmed in complementary European genetic ancestry data. Gene set enrichment analyses highlighted potentially shared genetic mechanisms between breast cancer and AD, which warrants further exploration. This work aims to promote further analyses across genetic ancestry groups.

PMID:42200344 | DOI:10.1002/ajmg.b.70024

J Phys Chem Lett. 2026 May 27. doi: 10.1021/acs.jpclett.6c00398. Online ahead of print.

ABSTRACT

We present a multitask machine-learning strategy for improving the prediction of molecular dipole moments by simultaneously training on quantum dipole magnitudes and inexpensive Mulliken atomic charges. With dipole magnitudes as the primary target and assuming only scalar dipole values are available without vector components, we examine whether incorporating lower-quality labels that do not quantitatively reproduce the target property can still enhance model accuracy. Mulliken charges were chosen intentionally as an auxiliary task since they lack quantitative accuracy yet encode qualitative physical information about charge distribution. Our results show that including Mulliken charges with a small weight in the loss function yields up to a 30% improvement in the dipole prediction accuracy. This multitask approach enables the model to learn a more physically grounded representation of charge distributions, thereby improving both the accuracy and the consistency of dipole magnitude predictions. These findings highlight that even auxiliary data of limited quantitative reliability can provide valuable qualitative physical insights, ultimately strengthening the predictive power of machine-learning models for molecular properties.

PMID:42200332 | DOI:10.1021/acs.jpclett.6c00398

J Dent Res. 2026 May 27:220345261442125. doi: 10.1177/00220345261442125. Online ahead of print.

ABSTRACT

Preadhesion mineralization and in situ nano-deposition improving dentin bonding durability are currently explained by divergent paradigms: the former is attributed to collagen strengthening and protease fossilization, while the latter is known for the release of interface-confined water. This study challenges this dichotomy by hypothesizing that preadhesion mineralization fundamentally acts as a dehydration strategy. Two bonding strategies were formulated: a polyacrylic acid-stabilized amorphous calcium fluoride (PAA-ACF) preadhesion mineralization and in situ ACF nano-deposition. Cryo-transmission electron microscopy (TEM) revealed collagen binding by ACF nanoparticles within 30 s, whereas scanning electron microscopy, X-ray diffraction, and TEM showed that PAA‑ACF-mediated intrafibrillar mineralization on etched dentin began within 30 min and reached completion by 3 h. The PAA-ACF 3-h mineralization group showed approximately twice the surface roughness and elastic modulus of the phosphoric acid (PA) and ACF 30-s deposition groups, as measured by atomic force microscopy, whereas its gelatinase activity (assessed by zymography) was substantially lower, only about one-fifth and one-third of the levels in the PA and ACF 30-s groups, respectively. Fourier transform infrared spectroscopy, water absorption, and thermogravimetric analysis confirmed that both strategies effectively released the interface-confined water. Notably, both the nano-deposition and mineralization groups displayed similarly low proteolytic activity in resin-dentin interfaces. After 30,000 thermal cycles, the micro-tensile bond strength of the 3-h group was statistically comparable to that of the ACF 30-s group and exceeded that of conventional PA wet-bonding. Pearson correlation analyses revealed that bonding strength correlated not with mechanical properties or protease activity of preadhered dentin but with the extent of dehydration, which facilitated infiltration of the hydrophobic adhesive monomer (Bis-GMA), as validated by Nile red tracing and micro-Raman analysis. In summary, both strategies enhance adhesive infiltration by releasing the interface-confined water, forming a defect-low hybrid layer. This finding unifies the understanding of dentin bond durability improvement under a common dehydration-based mechanism.

PMID:42200302 | DOI:10.1177/00220345261442125

Stroke. 2026 May 27. doi: 10.1161/STROKEAHA.125.053752. Online ahead of print.

ABSTRACT

BACKGROUND: Mobile stroke units (MSUs) aim to expedite acute stroke management when compared with conventional emergency medical services (EMS). Despite the growing body of evidence surrounding MSUs and acute ischemic stroke, experience with intracerebral hemorrhage (ICH) in MSUs has been lacking. We aimed to evaluate the impact of MSU transportation, compared with EMS, on times to diagnosis and goal-directed treatment in patients with ICH.

METHODS: Retrospective analysis of patients with acute ICH triaged by MSU or EMS from January 2018 to December 2022 was performed at 2 tertiary institutions, the Cleveland Clinic (OH) and Stony Brook University (NY). In the EMS cohort, only patients seen between 08:00 and 20:00, corresponding to the operating hours of MSU, were included. Primary outcomes included diagnosis by computed tomography, administration of antihypertensives, and time to goal systolic blood pressure (<160 mm Hg). Analyses included descriptive statistics and multivariable regression modeling of log-transformed time metrics, adjusting for important patient demographic and clinical characteristics.

RESULTS: Among 540 patients screened with ICH, after removing those with exclusion criteria, 218 MSU patients were compared with 192 EMS patients. Cohorts had similar baseline demographics, majority male (53.7% MSU versus 49.5% EMS), mean age 67±14 and 68±16, respectively. MSUs reduced time to diagnosis by 28% (β=0.72 [95% CI, 0.62-0.82]; P<0.001). Antihypertensives were administered to 78% of MSU patients, whereas not routinely given to EMS-transported patients until emergency department arrival. This facilitated a time reduction of 54% in the administration time of antihypertensive medications in MSU compared with EMS transported patients (β, 0.46 [95% CI, 0.36-0.59]; P<0.001). With 87% of MSU patients achieving blood pressure goal within 1 hour from last known well, compared with 60% in EMS (P<0.001).

CONCLUSIONS: MSUs provide faster diagnosis and medical treatment for patients with acute ICH than patients transported by conventional EMS.

PMID:42200292 | DOI:10.1161/STROKEAHA.125.053752