Tag: nevin manimala

JCO Precis Oncol. 2026 Apr;10(4):e2500884. doi: 10.1200/PO-25-00884. Epub 2026 Apr 9.

ABSTRACT

PURPOSE: As treatment options for advanced non-small cell lung cancer (NSCLC) evolve, biomarkers are needed to guide therapy selection while balancing efficacy and toxicity. Although tumor burden is a promising candidate, its prognostic role in guiding epidermal growth factor receptor (EGFR)-targeted kinase inhibitor (TKI) therapies remains understudied in real-world settings.

METHODS: We identified patients with de novo stage IV EGFR-mutant NSCLC treated with first-line EGFR-TKI at Stanford Health Care (2000-2021). Tumor burden metrics were manually annotated from 592 baseline radiology reports, encompassing size, number, and location (1,807 lesions). Multivariable Cox regression evaluated associations between tumor burden metric and overall survival (OS), adjusting for confounders, in the overall cohort and an osimertinib subgroup. A weighted composite tumor burden score was constructed using statistically significant metrics to stratify risk.

RESULTS: Of 312 patients, bone metastasis (hazard ratio (HR)_adjusted, 1.64 [95% CI, 1.23 to 2.19]) and the number of metastatic organs (HR_adjusted, 1.21 [95% CI, 1.10 to 1.32]) were independently associated with worse OS and used to construct the composite score. Patients with low tumor burden (composite-score ≤ median 1.06) experienced better OS than those with high tumor burden, with a 3-year OS of 59.8% versus 41.5% (P = .001). Consistent findings were observed in the osimertinib subgroup, with a 3-year OS of 62.2% versus 44.6% (P = .03) for low versus high tumor burden.

CONCLUSION: Tumor burden may serve as a prognostic biomarker in advanced NSCLC receiving EGFR-TKIs. These findings raise the hypothesis that durable survival in low-burden patients may be achievable with monotherapy, potentially sparing unnecessary toxicity from combination regimens. This warrants prospective validation comparing monotherapy versus combination strategies.

PMID:41955549 | DOI:10.1200/PO-25-00884

JCO Oncol Pract. 2026 Apr 9:OP2501192. doi: 10.1200/OP-25-01192. Online ahead of print.

ABSTRACT

PURPOSE: Approximately three quarters of patients with sarcoma report financial toxicity, defined as the psychosocial and economic burden of cancer care. The Comprehensive Score for Financial Toxicity (COST) is a screening questionnaire validated in patients with cancer. However, its use is not widespread in sarcoma care, likely in part due to its complexity. This study aimed to characterize financial toxicity in patients with sarcoma and evaluate whether shorter screening tools can identify high-risk patients.

METHODS: We conducted a survey and retrospective cohort study of patients treated for sarcoma at a large, academic sarcoma center in 2016-2024. Patients completed the COST questionnaire (11 graded questions, each scored on a five-point Likert scale from 0 to 4) and the shorter, four-question Worry about Affording Healthcare Scale (WAHS). We obtained clinical information from the electronic health record. We used descriptive statistics to summarize responses to COST, Pearson’s correlation coefficient to assess the association between WAHS and COST, and stepwise Spearman correlations to evaluate whether an abbreviated (1-4 question) version of COST correlated highly with total COST score.

RESULTS: Among 205 participants, the mean COST score was 20/44 (standard deviation = 6; lower scores indicate greater financial toxicity). Respondents worried most about job loss (mean COST: 0.99) and family finances (mean COST: 1.11). WAHS was weakly correlated with COST (r = 0.47, P < .01). A four-item abbreviated COST tool was strongly correlated with the total COST (ρ = 0.906, P < .0001) and demonstrated high sensitivity (96%) and moderate specificity (75%).

CONCLUSION: An abbreviated four-item COST tool could act as a clinically feasible, accurate screening tool after external validation. Routine financial toxicity screening could facilitate timely detection and referral to essential financial navigation resources.

PMID:41955544 | DOI:10.1200/OP-25-01192

JMIR Hum Factors. 2026 Apr 9;13:e88122. doi: 10.2196/88122.

ABSTRACT

BACKGROUND: Chronic pain is a widespread condition that impairs quality of life and is often managed primarily with medications. National guidelines now recommend nonpharmacologic, mind-and-body, and behavioral approaches as first-line or complementary treatments. However, access to these evidence-based options remains limited. Digital health technologies offer a scalable way to deliver integrative, self-care interventions that empower patients to live well with pain.

OBJECTIVE: This study examined engagement with and perceived usefulness of a patient- and health care professional-informed mobile app designed to deliver behavioral and educational content to support pain self-management.

METHODS: Adult primary care patients with chronic pain were enrolled in a 12-week feasibility trial. The app included lessons addressing the physical, emotional, and social aspects of pain; tracking and personalized insights; self-screenings; and optional in-app coaching. Participants completed baseline and 3-month surveys assessing usability and satisfaction. Engagement was evaluated through app analytics and milestone completion.

RESULTS: Of 49 patients assigned to the app, 40 (81.6%) activated it. Participants used the app for an average of 27.3 (SD 25.2) unique days and completed an average of 25.5 (SD 22.5) core lessons. Engagement highlights included 42.5% (17/40) completion of the valued living module, 25.0% (10/40) completion of all lessons, and 50.0% (20/40) use of daily check-ins. Usability ratings were high, with 86.7% (26/30) reporting that the app helped them better understand or manage their pain and 90.0% (27/30) recommending it to others.

CONCLUSIONS: Adults with chronic pain engaged with the program and reported high satisfaction with this evidence-informed digital mind-and-body intervention. Findings from this feasibility study suggest the potential for digital tools to support access to nonpharmacologic, integrative pain self-care and complement traditional clinical approaches.

PMID:41955535 | DOI:10.2196/88122

Adv Sci (Weinh). 2026 Apr 9:e22692. doi: 10.1002/advs.202522692. Online ahead of print.

ABSTRACT

Critical-sized bone defects (CSD) remain a major clinical challenge due to three interrelated barriers: inadequate mechanical support, insufficient osteogenic induction, and impaired angiogenesis, all of which hinder effective regeneration. To tackle these, we developed a dual-network bioactive scaffold, ermd bFGF@CB-gel, based on a chondroitin sulfate methacryloyl/bacterial cellulose gel (CB-gel) which synergistically combines three key properties: i) a photocurable biomimetic mineralized scaffold (CB-gel) for in situ bone repair with mechanical support and a bone-ECM-mimicking microenvironment for delivering bone marrow mesenchymal stem cells (BMSCs); ii) a bio-nano carrier (BC) for sustained release of bFGF which enhances the adhesion and proliferation via EGFL/Itga2b pathway, strengthens osteogenic differentiation and mineralization by activating the COMP/PI3K/AKT pathway of rat BMSCs; iii) bFGF released by the dual-network promotes migration and angiogenesis of microvascular endothelial cells by combining FGFR to activate the PI3K/AKT/eNOS pathway. In a rat CSD model, the bFGF@CB-gel achieved a statistically significant increase in new bone volume, as quantified by micro-CT, and enhanced vascular density, evaluated via immunohistochemical staining. These findings highlight the potential of bFGF@CB-gel as an effective local delivery system of BMSCs via linking biomechanics, molecular signaling, and cellular activity, which moves beyond simplistic function stacking to a rational, synergistic design for bone regeneration in CSD, addressing key challenges in reconstructive surgery.

PMID:41955503 | DOI:10.1002/advs.202522692

Int J Epidemiol. 2026 Feb 18;55(2):dyag047. doi: 10.1093/ije/dyag047.

NO ABSTRACT

PMID:41955496 | DOI:10.1093/ije/dyag047

Int J Epidemiol. 2026 Feb 18;55(2):dyag050. doi: 10.1093/ije/dyag050.

NO ABSTRACT

PMID:41955495 | DOI:10.1093/ije/dyag050

Elife. 2026 Apr 9;14:RP108023. doi: 10.7554/eLife.108023.

ABSTRACT

Using temporally delayed linear modeling (TDLM) and magnetoencephalography (MEG), we investigated whether items associated with an underlying graph structure are replayed during a post-learning resting state. In these same data, we previously provided evidence for replay during online (non-rest) memory retrieval. Despite successful decoding of brain activity during a localizer task, and contrary to predictions, we found no evidence for replay during a post-learning resting state. To better understand this, we performed a hybrid simulation analysis in which we inserted synthetic replay events into a control resting state recorded prior to the actual experiment. This simulation revealed that replay detection using our current pipeline requires an extremely high replay density to reach significance (>1 replay sequence per second, with ‘replay’ defined as a sequence of reactivations within a certain time lag). Furthermore, when scaling the number of replay events with a behavioral measure, we were unable to induce a strong correlation between sequenceness and this measure. We infer that even if replay was present at plausible rates in our resting state dataset, we would lack statistical power to detect it with TDLM. Finally, contrasting our novel hybrid simulation to existing purely synthetic simulations indicated that the latter approaches overestimate the sensitivity of TDLM. We discuss approaches that might optimize the analytic methodology, including identifying boundary conditions under which TDLM can be expected to detect replay. We conclude that solving these methodological constraints will be crucial for optimizing the non-invasive measurement of human replay using MEG.

PMID:41954994 | DOI:10.7554/eLife.108023

JAMA Netw Open. 2026 Apr 1;9(4):e265996. doi: 10.1001/jamanetworkopen.2026.5996.

ABSTRACT

IMPORTANCE: Pediatric dental-related emergency department visits have drastically increased in recent years. School-based caries prevention programs (SCPPs) aim to address unmet dental needs, yet it is unclear whether they effectively reach high-risk populations.

OBJECTIVE: To determine whether children with prior dental care utilization are more likely than children without prior utilization to participate in SCPPs.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study, conducted between June 2023 and October 2025, linked 2019 SCPP clinical trial data and 2016 to 2019 Medicaid claims data to examine disparities in sociodemographic characteristics and dental and dental-related medical care utilization prior to SCPP implementation between participants and nonparticipants. SCPPs were implemented in 47 primary schools in New York, New York, primarily in the Bronx, which was deemed to have the highest risk of tooth decay in the city. Participants included children aged 5 to 13 years in 2019 residing in the Bronx and continuously enrolled in Medicaid between 2018 and 2019.

EXPOSURES: Dental and dental-related medical care utilization in 2018, the year prior to SCPP implementation, demographic factors, individual-level clinical dental needs, and health system factors.

MAIN OUTCOMES AND MEASURES: The primary outcome was SCPP participation in 2019. Adjusted logistic regression was used to assess whether prior dental care use was independently associated with participation.

RESULTS: The study included 63 217 children in total (62 187 nonparticipants and 1030 participants), with a mean age of 7.7 years (95% CI, 7.6-7.7 years). There were 30 590 female children (48.4%), 1852 Asian children (2.9%), 13 926 Black children (22.0%), 31 620 Hispanic children (50.0%), and 1988 White children (3.2%). In multivariable analysis, compared with any dental visits, having no dental visits prior to SCPP implementation was associated with 17% lower odds of participating (adjusted odds ratio, 0.83; 95% CI, 0.71-0.96). Compared with having any dental emergencies, having no dental emergencies was associated with 32% increased odds of participating (adjusted odds ratio, 1.32; 95% CI, 1.08-1.62). Mitigating selection from a statewide SCPP rollout was estimated to save up to $2.4 million in nontraumatic dental-related emergency department visits.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of NY Medicaid claims data linked to SCPP participation data, there was evidence that children at high risk of tooth decay who are most in need of dental preventive services have a lower likelihood of participating in school-based prevention programs. More evidence is needed to identify successful strategies for recruitment of high-need children.

PMID:41954936 | DOI:10.1001/jamanetworkopen.2026.5996

JAMA Netw Open. 2026 Apr 1;9(4):e266000. doi: 10.1001/jamanetworkopen.2026.6000.

ABSTRACT

IMPORTANCE: Health-related social needs (HRSNs) may impede colorectal cancer (CRC) screening among US adults, yet population-based evidence on these associations remains limited.

OBJECTIVE: To examine associations between HRSNs and CRC screening uptake overall and by age group among US adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2023 National Health Interview Survey. Participants were US civilian, noninstitutionalized adults aged 45 to 75 years eligible for CRC screening. Age-stratified analyses were conducted for adults aged 45 to 49 years, 50 to 64 years, and 65 to 75 years. Data analysis was performed from April 2025 to February 2026.

EXPOSURES: Self-reported HRSNs, including housing instability, food insecurity, transportation barriers, and number of unmet needs.

MAIN OUTCOMES AND MEASURES: The primary outcome was being up to date with CRC screening according to US Preventive Services Task Force recommendations. Survey-weighted logistic regression models estimated adjusted odds ratios (aORs) and 95% CIs overall and by age group.

RESULTS: The analytic sample included 14 528 adults aged 45 to 75 years, and most participants were aged 50 to 64 years (6940 individuals [52.42%]), female (7788 individuals [51.36%]), insured (13 750 participants [94.07%]), and reported no unmet HRSNs (12 370 participants [85.40%]). Overall, 2158 adults (14.60%) reported at least 1 unmet HRSN. The proportion up to date with CRC screening was 63.91% (9758 adults) overall and increased with age, from 31.01% (586 adults) among adults aged 45 to 49 years to 64.24% (4539 adults) among those aged 50 to 64 years, and 80.85% (4633 adults) among those aged 65 to 75 years. In adjusted models, housing instability (aOR, 0.82; 95% CI, 0.67-0.99) and transportation barriers (aOR, 0.78; 95% CI, 0.64-0.95) were associated with lower odds of being up to date with CRC screening. Screening odds declined with increasing number of unmet HRSNs, including among adults reporting 1 unmet need (aOR, 0.84; 95% CI, 0.72-0.98). Associations were most pronounced among adults aged 50 to 64 years, among whom housing instability (aOR, 0.77; 95% CI, 0.61-0.97), transportation barriers (aOR, 0.71; 95% CI, 0.56-0.91), and reporting 1 HRSN (aOR, 0.80; 95% CI, 0.66-0.97) were associated with lower odds of being up to date with screening.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, unmet HRSNs were associated with lower CRC screening uptake, particularly among adults aged 50 to 64 years. Addressing HRSNs may support age-specific strategies to improve CRC screening.

PMID:41954935 | DOI:10.1001/jamanetworkopen.2026.6000

JAMA Netw Open. 2026 Apr 1;9(4):e266005. doi: 10.1001/jamanetworkopen.2026.6005.

ABSTRACT

IMPORTANCE: Invasive pneumococcal disease (IPD) remains a significant burden despite implementation of pneumococcal conjugate vaccines (PCVs) in childhood immunization programs.

OBJECTIVE: To analyze IPD epidemiology in Canada following 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent PCV (PCV13) introductions and evaluate the potential outcomes associated with newer vaccines, such as PCV15, PCV20, and PCV21.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included IPD isolates from children and adults with IPD across Canada from January 1, 2000, to December 31, 2019. Cases were identified through bacterial isolates sent to national reference laboratories. Data were analyzed from January 2022 to January 2026.

EXPOSURES: Introduction of PCV7 and PCV13.

MAIN OUTCOMES AND MEASURES: IPD incidence rates and proportion analyses were calculated for serotypes belonging to PCV7, PCV13, PCV15, PCV20, and PCV21 using Statistics Canada population estimates. PCV7 and PCV13 impact was assessed using generalized linear piecewise quasi-Poisson regression models.

RESULTS: A total of 37 921 IPD isolates were analyzed. Age data were available for 37 591 isolates (17.9% children aged <18 years; 82.1% adults aged ≥18 years), and sex data for 35 303 isolates (51.5% male; 41.6% female). Following PCV7 introduction, PCV7-specific serotype IPD rates decreased by 98.5%, from an incidence rate (IR) of 20.1 (95% CI, 17.8-22.6) in year 0 to 0.31 (95% CI, 1.0-0.5) in year 7 (P < .001), in children younger than 5 years (direct cohort) and 76.3%, from an IR of 2.2 (95% CI, 1.6-3.0) in year 0 to (0.5; 95% CI, 0.3-0.9) in year 7, in individuals aged 10 years or older (indirect cohort), although the difference was not statistically significant (P = .74). After PCV13 introduction, PCV13-only serotype IPD rates decreased by 90.6% in the direct cohort, from an IR of 10.3 (95% CI, 8.812.1) in year 0 to 1.0 (95% CI, 0.65-1.44) in year 9 (P = .03), and 57.1% in the indirect cohort, from an IR of 3.8 (95% CI, 3.1 to 4.6) in year 0 to 1.6 (95% CI, 1.2 to 2.1) in year 9 (P = .001). Vaccine serotypes 3, 4, and 19F persisted, with increases observed in adults aged 18 to 49 years and 50 to 64 years for serotypes 3 and 4, and in adults aged 65 years and older for serotype 19F. Serotype 19A cases declined after introduction of PCV13, with the highest incidence in adults aged 65 years and older. From 2015 to 2019, the potential serotype coverages by PCV15, PCV20, and PCV21 were estimated at 23% to 29%, 32% to 39%, and 36% to 49%, respectively, while nonvaccine types accounted for 45% to 52%.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of IPD isolates in Canada found that despite initial IPD reductions following PCVs, IPD in Canada increased, driven by emerging nonvaccine types and persistence of some vaccine serotypes. Indirect protection was limited, particularly among older adults, highlighting the need for direct adult vaccination strategies. These findings suggest that while PCV15, PCV20, and PCV21 may improve serotype coverage, continued development of broader-spectrum vaccines is essential to further reduce IPD burden.

PMID:41954934 | DOI:10.1001/jamanetworkopen.2026.6005