Tag: pubmed

J Synchrotron Radiat. 2026 Sep 1. doi: 10.1107/S1600577526005898. Online ahead of print.

ABSTRACT

Wavefront characterization is essential for diagnosing, interpreting and mitigating performance limitations at X-ray free-electron lasers (XFELs). However, the dramatic increase in thermal load and data throughput at high repetition rates makes established wavefront characterization methods difficult to implement effectively. Here, we demonstrate that X-ray speckle arising from beamline optics can enable fast, robust and sensor-free wavefront metrology at next-generation XFEL facilities. Combining this approach with a statistical formulation of X-ray speckle tracking, we quantify local wavefront fluctuations within pulse trains at the European XFEL. We find that shot-to-shot wavefront fluctuations are predominantly planar phase tilts with distinct statistical signatures across intra- and inter-train timescales. The dominant source of wavefront error is periodic at frequencies consistent with known mechanical oscillation modes of the photon transport optics, while intra-train fluctuations correlate with instabilities in the electron bunch trajectory. Our results establish a practical framework for high-repetition-rate wavefront characterization and diagnostics at next-generation XFELs.

PMID:42455581 | DOI:10.1107/S1600577526005898

JAMA Netw Open. 2026 Jul 1;9(7):e2623089. doi: 10.1001/jamanetworkopen.2026.23089.

ABSTRACT

IMPORTANCE: Childhood cancer is a leading cause of disease-related mortality, with increasing incidence in many high-income countries. Socioeconomic disparities in childhood cancer survival are well documented, but less is known about incidence.

OBJECTIVE: To examine associations between area-based deprivation and childhood cancer incidence in a universal health care system.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study linked data from the population-based Pediatric Oncology Group of Ontario Networked Information System cancer registry with Statistics Canada’s postal code and Ontario Marginalization Index (ON-Marg) databases to identify pediatric cancer cases diagnosed in Ontario from January 1, 1999, to December 31, 2023, among approximately 2.3 million children aged 0 to 14 years living in Ontario, Canada. Data analysis was performed from October 2025 to February 2026.

EXPOSURES: ON-Marg dimensions: material resources (income and educational attainment), households and dwellings (residential instability), age and labor force (dependents and adults not in the labor force), and racialized and newcomer populations.

MAIN OUTCOMES AND MEASURES: Crude and age-standardized incidence rates for each ON-Marg dimension; incidence rate ratios were estimated using multivariable Poisson regression models adjusted for age, sex, and diagnosis period for the overall population and stratified by cancer subtype (ie, leukemia and lymphoma, central nervous system tumors, and other non-central nervous system solid tumors).

RESULTS: Of the 9063 pediatric cancer cases (4981 [55.0%] male; median [IQR] age at diagnosis, 5 [2-10] years), the age-standardized incidence rate was 162.7 cases per million (95% CI, 159.3-166.1). Most cancer cases were found in areas with the greatest concentration of racialized and newcomer populations; however, after accounting for population size, there was no difference in cancer incidence across quintiles. A key finding of this study was that the least marginalized quintiles of material resources (incidence rate ratio, 1.15; 95% CI, 1.07-1.22) and households and dwellings (incidence rate ratio, 1.08; 95% CI, 1.01-1.16) had significantly higher incidence rates compared with the most marginalized quintiles. These findings were driven primarily by hematologic and other solid cancer types.

CONCLUSION AND RELEVANCE: This large population-based cross-sectional study with virtually complete ascertainment of pediatric cancer cases in a Canadian province with a universal health care system found higher cancer incidence among children who lived in affluent and residentially stable neighborhoods. These findings underscore the importance of considering sociodemographic factors when examining pediatric cancer epidemiology; more research is needed to understand the mechanisms driving these differences, their impact on outcomes, and how the findings may inform targeted prevention and intervention strategies.

PMID:42455571 | DOI:10.1001/jamanetworkopen.2026.23089

Stat Med. 2026 Jul;45(15-17):e70651. doi: 10.1002/sim.70651.

ABSTRACT

Recent advances in biotechnology and personalized medicine have driven the development of efficient clinical trial methodologies for assessing treatment efficacy across multiple populations defined by treatment effect modifiers. Within-patient comparison of different treatments is a promising approach for improving study efficiency across multiple populations by eliminating between-patient variability in treatment evaluation. This study provides a framework for evaluating treatment efficacy in multiple populations for $2\times 2$ crossover trials and evaluates the efficacy gain in comparison with the standard parallel-group analysis. Simulation experiments confirm that the crossover analysis consistently outperforms the parallel-group analysis in statistical power, especially when carryover effects are small. An application to a clinical trial in Type 2 diabetes demonstrates the efficiency advantages of the crossover analysis. These numerical results emphasize the potential of the crossover analysis for enhancing the efficiency of clinical development of personalized medicine.

PMID:42455565 | DOI:10.1002/sim.70651

Intern Med J. 2026 Jul 15. doi: 10.1111/imj.70554. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine treatment trends and outcomes over time for patients with ST-elevation myocardial infarction-related cardiogenic shock (STEMI-CS) in a regional centre.

METHOD: This retrospective study analysed data from patients with STEMI and Killip class IV cardiogenic shock at a Victorian regional tertiary hospital over 10 years (2014-2024). Patients treated with percutaneous coronary intervention (PCI) or surgical revascularisation (coronary artery bypass grafting) were identified using state-wide registries. The primary outcome was 30-day mortality with secondary outcomes of door-to-balloon time, mechanical circulatory support (MCS) use, ICU/hospital length of stay and revascularisation technique.

RESULTS: One hundred and seventy-two adult patients (74% male) had STEMI-CS. The number of patients presenting with STEMI-CS increased over the 10-year period; however, 30-day mortality remained unchanged at 49%. In addition, 69% achieved a door-to-balloon time <90 min, and the median door-to-balloon time did not differ significantly over time. However, 19% required MCS, with similar numbers for intra-aortic balloon pump and extra (corporeal membrane oxygenation. The median intensive care unit and hospital length of stay was 5 days (IQR = 2-9) and 8 days (IQR = 3-13) respectively and was unchanged over time. There was a strongly positive and statistically significant trend towards increased use of PCI over the 10-year study period.

CONCLUSION: With timely revascularisation and increasing use of PCI, STEMI-CS patients in regional settings with access to a 24-h catheter lab have outcomes consistent with metropolitan and global trends. Despite medical advancements, outcomes for patients with STEMI-CS are largely unchanged over time, with 30-day mortality rates that remain unacceptably high. There is an urgent need for innovative strategies and system-level improvements to address the increasing burden of STEMI-CS.

PMID:42455523 | DOI:10.1111/imj.70554

J Am Geriatr Soc. 2026 Jul 15. doi: 10.1111/jgs.70552. Online ahead of print.

ABSTRACT

BACKGROUND: Family visits with nursing home residents have been shown to improve residents’ quality of life. However, little is known about the association between in-person family visits and physical (e.g., pain) and behavioral symptoms (e.g., agitation) among residents with cognitive impairment. Using data from a large clinical trial of a palliative care program in Maryland and Indiana, we examined the association between family visits and staff-reported resident symptom burden.

METHODS: Using cross-sectional baseline data from an ongoing multi-state clinical trial involving 194 nursing home residents with cognitive impairment, we conducted bivariate analyses to examine the association between in-person family visits (family involvement) as reported by family members and staff-reported resident symptom burden. Linear regression models assessed the association between symptom burden and family visits in an adjusted framework. The model controlled for other relevant covariates, including resident race, gender, and age, and the care partner’s relationship to the resident. Staff-reported symptom burden was measured using a modified version of the Comfort Assessment in Dying End of Life in Dementia (CAD-EOLD) scale. Family involvement was measured by the average weekly frequency of in-person visits reported by the family over the past month.

RESULTS: On average, spouses visited 5 days per week, children 2 days per week, and other family members 1.5 days a week. In bivariate analyses, there was a weak but statistically significant and positive correlation between family involvement and symptom burden (r = 0.16, p = 0.04). However, in the adjusted model, the association was not statistically significant (b = 0.16, p = 0.09).

CONCLUSION: Bivariate analyses suggest a significant and positive correlation between family visitation and symptom burden. However, this finding was not in the expected direction. Family visitation was associated with residents experiencing greater symptom burden. The association was not statistically significant in the adjusted model.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04520698.

PMID:42455515 | DOI:10.1111/jgs.70552

J Magn Reson Imaging. 2026 Jul 15. doi: 10.1002/jmri.70461. Online ahead of print.

ABSTRACT

BACKGROUND: A previous single-case study has demonstrated that a modified time-spatial labeling inversion pulse (Time-SLIP) technique, specifically Deep Abdominal Breathing-induced CSF Flow Imaging with Time-SLIP (DAB Time-SLIP), successfully visualized dynamic cerebrospinal fluid (CSF) flow during deep breathing with superior contrast compared to conventional Time-SLIP. However, it is unclear whether this occurs consistently across healthy individuals.

PURPOSE: To investigate CSF flow dynamics during deep breathing in healthy volunteers with the DAB Time-SLIP.

STUDY TYPE: Prospective.

POPULATION: 10 healthy participants (7 men; mean age, 29.5 years).

FIELD STRENGTH/SEQUENCE: 1.5-Tesla, Time-SLIP.

ASSESSMENT: Midsagittal Time-SLIP imaging was performed using a 9 s repetition interval. A labeling pulse was applied at four vertebral levels (Th11-L1-L3-L5 or Th12-L2-L4-S1), and images were acquired after a 2 s delay. Separate imaging sessions were conducted during shallow breathing and during a structured 8 s deep abdominal breathing cycle. During deep-abdominal-breathing, an intentional phase shift between the 9 s imaging interval and the 8 s respiratory cycle enabled visualization of CSF movement across the entire cycle within 72 s. This protocol for CSF dynamics during deep-breathing was designated as DAB Time-SLIP. Images acquired under these two breathing conditions were compared with the reference label images obtained during breath-holding, and CSF flow velocity and displacement range were quantified based on the resulting positional changes.

STATISTICAL TESTS: Wilcoxon signed-rank test and simple linear regression analysis. A p < 0.05 was considered significant.

RESULTS: Cranial flow occurred during inhalation, whereas caudal flow was observed during exhalation. Both the magnitude and the displacement range of CSF flow velocity and CSF movement of range progressively decreased toward the caudal direction (rS = -0.9479). Compared with free breathing, the range of CSF movement using DAB Time-SLIP was significantly greater.

DATA CONCLUSION: DAB Time-SLIP demonstrated cranial CSF flow during deep inspiration and caudal CSF flow during deep expiration.

TECHNICAL EFFICACY: Stage 1.

PMID:42455513 | DOI:10.1002/jmri.70461

FASEB J. 2026 Jul 31;40(14):e71920. doi: 10.1096/fj.202502143RRR.

ABSTRACT

Neuroblastoma (NB) remains a challenge due to the lack of robust prognostic biomarkers for risk stratification and treatment guidance. The β3-adrenergic receptor (β3-AR) is implicated in tumor progression and metastasis. The present study evaluates the detection of β3-AR in different tissues and its correlation with survival and clinical characteristics of NB patients. β3-AR expression was analyzed in bone marrow (BM), peripheral blood (PB), circulating tumor cells (CTCs), disseminated tumor cells (DTCs), and tumor biopsies by flow cytometric analysis and immunofluorescence. Receiver Operating Characteristic (ROC) curves, Fisher’s exact test, and Kaplan-Meier curves were used to investigate the validity of β3-AR as a prognostic marker. Statistical analyses were performed by R software and MedCalc. In our cohort of 45 NB patients, β3-AR expression in PB was significantly higher compared to healthy controls (p = 1.839e-07 at diagnosis; p = 0.0006 at follow-up, p < 0.001) and showed strong correlation across tissues (r > 0.72). High β3-AR expression in DTCs at diagnosis (≥ 96.5%) was associated with shorter event-free survival (p = 0.0005). Elevated β3-AR in BM at diagnosis predicted worse overall survival (p = 0.0076). At follow-up, increased β3-AR expression in PB correlated with shorter overall survival (27 months vs. not reached, p = 0.0015). These findings highlight β3-AR as a promising prognostic biomarker for NB risk stratification and disease progression.

PMID:42455511 | DOI:10.1096/fj.202502143RRR

J Obstet Gynaecol Res. 2026 Jul;52(7):e70404. doi: 10.1111/jog.70404.

ABSTRACT

AIM: This study aimed to determine general comfort levels and quality of recovery in women after hysterectomy and to examine the relationship between these variables.

METHODS: A total of 188 women who underwent hysterectomy for benign indications participated in this cross-sectional study. Data were collected using the Descriptive Characteristics Form, the General Comfort Scale (GCS), and the Quality of Recovery-40 Questionnaire (QoR-40). Descriptive statistics, Pearson correlation, and linear regression analyses were performed to evaluate the data.

RESULTS: The mean age of the participants was 50.9 ± 10.5 years, and 41.5% had undergone abdominal hysterectomy. The mean GCS score was 130.66 ± 9.72, and the mean QoR-40 score was 164.16 ± 20.33. A statistically significant moderate positive correlation was found between GCS and QoR-40 scores (r = 0.425, p < 0.001). In addition, higher general comfort scores were significantly associated with higher recovery quality scores (β = 0.403, p < 0.001).

CONCLUSION: Higher levels of general comfort were associated with better postoperative recovery in women undergoing hysterectomy. These findings highlight the importance of assessing and supporting patient comfort as part of postoperative care.

PMID:42455509 | DOI:10.1111/jog.70404

Fam Med. 2026 Jul;58(7):488-494. doi: 10.22454/FamMed.2026.495888.

ABSTRACT

BACKGROUND AND OBJECTIVES: Accelerated 3-year programs (A3YPs) for an MD degree offer a condensed medical education pathway to residency, often with directed pathways in primary care. Many programs aim to address workforce shortages and decrease debt. As these programs expand, assessing whether A3YP graduates are as prepared for residency as their peers from traditional 4 year programs is critical. This study evaluates milestone attainment of A3YP postgraduates in Year 1 (PGY-1s) compared to non-A3YP PGY-1s within family medicine residency programs.

METHODS: We analyzed the Accreditation Council for Graduate Medical Education milestone ratings for family medicine PGY-1s from 2021 to 2023. The study included 109 A3YP graduates across 51 family medicine programs and 1,638 non-A3YP PGY-1s (MD, DO, international medical graduate) in those same programs. PGY-1s were compared across milestone competency domains using mixed-effects regression that accounted for clustering by program and subcompetency.

RESULTS: At midyear, A3YP PGY-1s scored significantly higher in medical knowledge, systems-based practice, and practice-based learning and improvement. Differences were statistically significant but modest. Coefficients ranged from 0.05 for patient care and medical knowledge to 0.10 for practice-based learning and improvement (PBLI; P&lt;0.01). At end-year, A3YP PGY-1s maintained slightly higher scores in medical knowledge, professionalism, PBLI, and communication (coefficients ranged from 0.07 to 0.10; P&lt;0.01).

CONCLUSIONS: A3YP graduates demonstrate equal or minimally higher milestone attainment compared to non-A3YP peers during PGY-1, supporting the viability of accelerated pathways. These findings reassure residency programs of A3YP readiness and highlight their potential to address workforce shortages and reduce student debt without compromising educational outcomes.

PMID:42455502 | DOI:10.22454/FamMed.2026.495888

Obes Surg. 2026 Jul 15. doi: 10.1007/s11695-026-08731-0. Online ahead of print.

ABSTRACT

BACKGROUND: The pharmacokinetics of oral psychotropic drugs can change after metabolic and bariatric surgery (MBS), affecting drug exposure. Given the risk of psychiatric decompensation, patients using psychotropic medications constitute a high-risk group requiring careful post-MBS monitoring. In particular, lithium, tricyclic antidepressants (TCAs), and clozapine are of concern because of their well-established dose-effect relationships, susceptibility to MBS-related exposure changes, and suitability for therapeutic drug monitoring (TDM). This study aimed to examine the prevalence of treatment interventions related to these medications in bariatric patients to prevent drug-related problems such as under- or overexposure requiring dosage adjustments or drug discontinuation.

METHODS: In this retrospective study, patient records from January 2017 to December 2023 were reviewed. Patients who underwent MBS and were using lithium, TCAs (amitriptyline, clomipramine, dosulepin, doxepin, imipramine, maprotiline, nortriptyline), and/or clozapine were included. Baseline characteristics, treatment interventions, and available drug plasma concentrations were collected preoperatively and up to one year postoperatively.

RESULTS: A total of 163 patients were included. Psychotropic drug adjustments were observed in 27 patients (16.6%) within the first year following MBS. Both pre- and postoperative drug plasma concentrations were available for three patients (1.8%). Three patients experienced worsening of psychiatric symptoms that necessitated hospitalization or intensive monitoring. No statistically significant differences in intervention rates were observed among patients with psychiatric disorders or pain.

CONCLUSION: Although only a minority of patients required psychotropic drug treatment interventions, monitoring psychotropic drug treatment is essential for safe and effective treatment post-MBS. Greater attention is needed regarding altered drug exposure, and plasma concentration monitoring may help optimize psychotropic pharmacotherapy in these patients.

PMID:42455492 | DOI:10.1007/s11695-026-08731-0