Tag: pubmed

Aesthet Surg J. 2026 Jul 9:sjag142. doi: 10.1093/asj/sjag142. Online ahead of print.

ABSTRACT

BACKGROUND: The décolleté is susceptible to intrinsic aging, photoaging, and mechanical stress (breast movement and weight), resulting in progressive thinning, laxity, and wrinkle formation. Although injectable fillers are increasingly used to improve décolleté appearance, controlled clinical data evaluating effectiveness and effects on breast imaging are limited.

OBJECTIVES: To evaluate the safety and effectiveness of diluted calcium hydroxylapatite carboxymethylcellulose (CaHA-CMC; Radiesse®), prepared at a 1:2 ratio with sterile saline, for treating moderate-to-severe décolleté wrinkles.

METHODS: Eligible females were randomized to immediate or delayed treatment. Patients assigned to immediate treatment received up to three diluted Radiesse sessions, with optional retreatment. Patients assigned to delayed treatment remained untreated through Week 24 (primary endpoint) and subsequently received the same treatment regimen without retreatment. Effectiveness was assessed by blinded evaluators using the Merz Assessment Scale (MAS) Décolleté Wrinkles – At Rest. Safety evaluations included adverse events, patient-reported treatment responses, and retrospective review of post-treatment radiographic breast imaging.

RESULTS: The Week 24 estimated responder rate (≥1-point improvement on the MAS Décolleté Wrinkles – At Rest) was 71.2% [95% CI: 61.4%, 79.4%] among treated patients compared with 6.3% [95% CI: 1.5%, 22.9%] among untreated controls, demonstrating a statistically significant between-group difference. Treatment was well tolerated, with predominantly transient, mild-to-moderate injection-site reactions. No interference attributable to diluted Radiesse was observed on post-treatment breast imaging.

CONCLUSIONS: Diluted Radiesse provided clinically meaningful improvement in décolleté wrinkles with a favorable safety profile and no observed impact on breast imaging, supporting its use as a nonpermanent injectable option for décolleté rejuvenation.

PMID:42424535 | DOI:10.1093/asj/sjag142

Eur J Cardiovasc Nurs. 2026 Jul 9:zvag160. doi: 10.1093/eurjcn/zvag160. Online ahead of print.

ABSTRACT

AIM: Serious games are increasingly used in nursing education as an innovative teaching method. However, evidence regarding the impact of this approach on nursing students’ cardiopulmonary resuscitation knowledge has not yet been reviewed. The aim of this systematic review and meta-analysis was to evaluate the effects of serious games on nursing students’ cardiopulmonary resuscitation knowledge.

METHODS AND RESULTS: This study is of meta-analysis type. In this study, a literature search was conducted in accordance with the PRISMA statement using six databases for studies published up to January 20, 2025. Data were analyzed using CMA statistical software.

RESULTS: Five studies conducted in four different countries with a total of 379 nursing students were included in the analysis. Three of these studies were randomized controlled and two were quasi-experimental. Heterogeneity was observed across studies due to the diversity of serious games, platforms used, and gamification elements.

CONCLUSION: Findings indicate that serious games provide positive effects in improving nursing students’ cardiopulmonary resuscitation knowledge. However, given the methodological limitations of existing studies, further research evaluating the effectiveness of serious games with more robust designs is needed.

REGISTRATION: A protocol was registered on the PROSPERO (CRD420251111467).

PMID:42424523 | DOI:10.1093/eurjcn/zvag160

JMIR Med Educ. 2026 Jul 9;12:e90563. doi: 10.2196/90563.

ABSTRACT

BACKGROUND: Digital educational resources, including asynchronous video-based materials and simulation models, are increasingly used in undergraduate medical education to support procedural skills training. Although both approaches have demonstrated educational value, there is limited qualitative evidence on how the pedagogical integration of these approaches is experienced in real-world clinical training environments, particularly during time-constrained surgical internships.

OBJECTIVE: This study aimed to explore medical students’ and an instructor’s experiences with an integrated suturing skills module combining asynchronous instructional videos and simulation-based practice during a surgical internship.

METHODS: An interpretive qualitative study was conducted with sixth-year medical students during a surgical internship at a medical school in Chile. The intervention consisted of a suturing simulation module supported by asynchronous instructional videos. Data were collected through 2 focus groups with 20 students and a semistructured interview with 1 instructor after completion of the module. All sessions were audio-recorded, transcribed verbatim, and pseudonymized. Data were analyzed using reflexive thematic analysis following an inductive approach. The Technological Pedagogical Content Knowledge framework was used as a sensitizing lens during the interpretive phase. Ethics approval was obtained prior to data collection, and all participants provided informed consent.

RESULTS: Participants described asynchronous videos as facilitating prior preparation by allowing flexible, self-paced review of procedural steps, which supported students’ perceived readiness for hands-on practice. The integration of video-based resources with simulation-based training was perceived as enabling more focused engagement during supervised sessions, shifting attention from procedural recall to technical execution. Participants also reported perceived increases in confidence when approaching early clinical tasks. However, logistical constraints, including limited time for individualized feedback and challenges related to the physical learning environment, were identified. Some participants also expressed ongoing uncertainty regarding specific techniques despite prior video exposure.

CONCLUSIONS: The integration of asynchronous instructional videos with simulation-based practice was perceived as a coherent educational strategy that supported students’ preparation for procedural training within a demanding clinical context. The findings highlight the potential of asynchronous resources to function as preparatory scaffolding that may enable more efficient use of supervised training time. This study contributes to the qualitative understanding of how integrated digital and simulation-based approaches are experienced in surgical internships, supporting their consideration in curriculum design while emphasizing the need for careful implementation and contextual adaptation.

PMID:42424512 | DOI:10.2196/90563

J Med Entomol. 2026 Jul 1;63(4):tjag114. doi: 10.1093/jme/tjag114.

ABSTRACT

Vector-borne diseases represent a growing public health issue nationwide. Nebraska reports a sustained burden of mosquito-borne diseases and expanding tick-borne disease risk. This study aims to assess retrospective surveillance data for vector abundance, vector infection rates, and human vector-borne disease reports to examine the relationship between vector factors and human risk. Vector abundance and pathogen infection rates were mapped alongside the presence and incidence of key vector-borne diseases. Mosquito surveillance and mosquito-borne disease data were available from 2012 to 2024, while tick surveillance and tick-borne disease data were available from 2021 to 2024. Statistical models and comparative tests were used to explore associations between vector factors and disease reports. In the full 2012-2024 dataset, only Culex tarsalis abundance was associated with human WNV case counts. In a contemporary subset (2021-2024), Culex pipiens pooled infection rate showed a significant negative association with human cases, although this relationship was not observed in the full dataset. Tick surveillance indicates established populations of vector tick species in distinct regions of the state, with pathogen detections generally aligning with areas where human cases have been reported. However, there was no positive association between tick infection rates and the presence of human cases. Differences in the level of human case reporting and data availability affected interpretation of long-term trends and limited strong conclusions regarding direct relationships between vector factors and human disease. Continued integration of entomological surveillance with human case information may help clarify patterns of vector-borne disease risk and inform efforts to address current and emerging threats in Nebraska.

PMID:42424506 | DOI:10.1093/jme/tjag114

Eur J Public Health. 2026 Jun 10;36(4):ckag101. doi: 10.1093/eurpub/ckag101.

ABSTRACT

Circadian disruption resulting from night shift work has been associated with cardiometabolic diseases, but the underlying biological pathways remain insufficiently understood. We analyzed data from the EPHOR-NIGHT cohort, including questionnaires, clinical assessments [body mass index (BMI), blood pressure (BP), waist/hip circumference], and plasma metabolites in blood samples (N = 860; day shift workers n = 362, night shift workers = 498) from Sweden, Spain, and Denmark. We applied multivariable linear regression to examine differences in cardiometabolic risk factors and metabolite levels between shift workers and examined associations between metabolites and cardiometabolic risk factors. Night shift work was associated with higher mean systolic BP (β = 1.89, 95%CI 0.00, 3.79 mmHg), higher mean BMI (β = 1.14, 95%CI 0.44, 1.84 kg/m2), and higher odds of hypertension (OR = 1.38, 95%CI 1.00, 1.89) and overweight/obesity (OR = 1.37, 95%CI 1.02, 1.82), compared to day shift work. Associations were stronger among women in sex-stratified analyses. Night shift workers had metabolic alterations, with lower fractions of polyunsaturated fatty acids, higher fractions of mono-unsaturated and saturated fatty acids, and higher levels of amino acids isoleucine, valine, and phenylalanine. These changes remained after multiple adjustments, including diet. Effects were more pronounced for those working more consecutive night shifts, more night shifts per week, and for permanent night schedules versus rotating shifts. The night shift-related metabolites were associated with higher BMI and higher blood pressure. Night shift work was associated with specific metabolic alterations linked to increased cardiometabolic risk. Our results suggest that reducing night shift intensity and consecutive nights may help mitigate these adverse effects.

PMID:42424502 | DOI:10.1093/eurpub/ckag101

JMIR Form Res. 2026 Jul 9;10:e78916. doi: 10.2196/78916.

ABSTRACT

BACKGROUND: Out-of-pocket (OOP) costs pose a significant barrier to participating in cancer clinical trials (CCTs). Financial reimbursement programs (FRPs) that reduce the burden of OOP costs can support participation in CCTs if the information is readily available to participants at the time of enrollment. Prior studies have shown the importance and impact of FRPs, but despite improvements, significant barriers still remain.

OBJECTIVE: This study was designed to explore the feasibility and acceptability of automated texts designed to offer, screen, and enroll CCT participants in an FRP for OOP travel and lodging-related clinical trial costs.

METHODS: This study used a mixed methods approach. Eligible participants were those who consented to participate in a breast, leukemia, or chimeric antigen receptor T cell (CAR-T) trial at the Abramson Cancer Center of the University of Pennsylvania, a National Cancer Institute comprehensive cancer center. Quantitative data were collected through engagement metrics, including text response rates and enrollment rates, as well as patient-reported satisfaction scores. Qualitative data were derived from semistructured interviews. Program enrollment rates were used to determine feasibility, whereas the engagement metrics were used to measure the acceptability of the program. Semistructured interviews were conducted with a subsample of patients who responded to at least one of the FRP texts and agreed to be interviewed to determine the barriers to and facilitators of enrolling in the Improving Patient Access to Cancer Clinical Trials (IMPACT) program via text, perceived advantages and disadvantages of the text messaging program compared to a phone call, and overall feedback on the acceptability of the automated text messaging program.

RESULTS: Quantitative data, including engagement with texts, FRP eligibility screening, and enrollment rates, were collected from all participants who successfully received a text (n=51), and qualitative data were collected from a subsample of participants who agreed to participate in a semistructured interview (n=28) about the text-based program. Participants’ mean age was 58 (SD 12) years, approximately 65% (n=33) of participants were female, 21% (n=11) of participants were Black, and 4% (n=2) of participants were Hispanic or Latino. There was high engagement with texts (n=49, 96.1%) and a high screening rate for FRP eligibility (n=33, 64.7%). Of those who successfully screened, 26 (51%) screened via text. We also saw high overall FRP enrollment rates of those who completed the texts (n=16 of 24 eligible, 66.7%) and high satisfaction (Net Promoter Score=51). The text-based platform streamlined the enrollment process, allowing one-third of patients to complete enrollment independently, without assistance from the FRP coordinator. Reported facilitators for completion of the text conversation included support from the coordinator and introduction of the FRP by CCT teams. Barriers were a lack of communication from CCT teams, patient skepticism about the legitimacy of the texts, and limited program information via text.

CONCLUSIONS: Despite the small sample size and single study site, these findings suggest that automated text messaging can be an effective, low-cost, and scalable strategy to increase awareness and streamline enrollment in FRPs.

PMID:42424491 | DOI:10.2196/78916

Science. 2026 Jul 9;393(6807):eaeb9506. doi: 10.1126/science.aeb9506. Epub 2026 Jul 9.

ABSTRACT

From medicine to marketing to social sciences, the promise of tailoring interventions to individuals is undeniable. However, practical applications force weighing personalization’s potential benefits with its possible increased cost and fragility. We introduce a statistical hypothesis test that evaluates, given historical data, evidence that a personalized intervention policy’s performance will surpass deploying the best single intervention. The test maintains strict Type I error control while achieving asymptotic normality with the minimal possible variance under specified conditions. Results on diverse datasets from job training, depression treatment, education, and recommendation systems demonstrate the test’s versatility and its superior performance over alternatives. This test can support decision-makers throughout the intervention sciences by providing a simple and powerful quantification of the potential benefits of personalization.

PMID:42424443 | DOI:10.1126/science.aeb9506

Cancer. 2026 Jul 15;132(14):e70500. doi: 10.1002/cncr.70500.

ABSTRACT

BACKGROUND: Genomic complexity and small case numbers make statistically robust assessment of mutational patterns in osteosarcoma difficult. The authors analyzed a large cohort of targeted next-generation sequencing data from osteosarcoma cases from young patients submitted for clinical testing to Foundation Medicine.

METHODS: The osteosarcoma cohort included 653 patients: 109 pediatric (males, <13 years old; females, <12 years old), 246 adolescent (males, 13-17 years old; females, 12-17 years old), and 298 young adult (males and females, 18-40 years old). Sequencing from osteosarcoma cases was compared to a pan-cancer cohort comprising 37,947 patients ≤40 years old.

RESULTS: Genes commonly altered and significantly enriched (p < .0001) for alterations in osteosarcoma compared to other cancers were TP53 (55%), RB1 (22%), GID4 (26%), MYC (17%), and CCND3 (16%). Less commonly altered genes also significantly enriched (p < .0001) for alterations in osteosarcoma included AURKB (odds ratio [OR], 28.0), NCOR1 (OR, 8.2), and BCL2L2 (OR, 8.9). Fisher exact tests demonstrated mutual exclusivity between MDM2 amplification and TP53 inactivation and between RB1 inactivation and CDK4 amplification or CDKN2A/B deletion. Chi-square tests and binomial regression revealed statistically significant differences in genomic events by age, including frequent amplification of CDK4 and MDM2 in young adults and MYC, CCND3, and CCNE1 in pediatric and adolescent cases.

CONCLUSIONS: Novel findings from this statistically rigorous analysis of a large patient population include: identifying genes of interest in osteosarcoma that are more often altered when compared to other cancers; identifying MYC and CCND3 amplification as significantly more prevalent in osteosarcoma diagnosed in childhood; and proving mutual exclusivity and co-occurrence with statistical robustness.

PMID:42424099 | DOI:10.1002/cncr.70500

JAMA Netw Open. 2026 Jul 1;9(7):e2622239. doi: 10.1001/jamanetworkopen.2026.22239.

ABSTRACT

IMPORTANCE: Although P2Y purinergic receptor 12 (P2Y12) inhibitors are commonly used in patients with atherosclerotic cardiovascular disease, there are limited data on intracerebral hemorrhage (ICH) associated with use of P2Y12 inhibitors.

OBJECTIVE: To compare stroke severity, in-hospital mortality, and functional outcomes in ICH among patients receiving P2Y12 inhibitor monotherapy, dual antiplatelet therapy (DAPT) with P2Y12 inhibitor plus aspirin, aspirin monotherapy, or no antiplatelet therapy prior to ICH.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study obtained data from the nationwide Get With The Guidelines-Stroke registry, which contains data from participating hospitals. Participants were patients hospitalized with spontaneous ICH between January 2013 to December 2021. The analysis was completed in January 2025.

EXPOSURES: Antiplatelet therapy before ICH, defined as any use within 7 days prior to hospital arrival.

MAIN OUTCOMES AND MEASURES: The primary outcomes were severe stroke at presentation and in-hospital mortality. Severity was assessed using the National Institutes of Health Stroke Scale (NIHSS; range: 0-42, with higher scores indicating greater severity), with a score of 21 or higher indicating severe stroke. Secondary outcomes included in-hospital mortality or discharge to hospice, discharge to home, independent ambulation, and modified Rankin Scale (mRS) score at discharge. An mRS score of 0 to 2 at discharge indicated functional independence.

RESULTS: Of the 252 691 patients included (median [IQR] age, 67 [56-78] years; 134 684 males [53.3%]), 6355 (2.5%) were receiving P2Y12 inhibitor monotherapy, 10 607 (4.2%) were receiving DAPT, 63 299 (25.0%) were receiving aspirin monotherapy, and 172 430 (68.2%) were receiving no antiplatelet agents prior to ICH. Patients taking P2Y12 inhibitors were older and had higher prevalence of cardiovascular risk factors. Overall, 1701 patients (26.8%) receiving P2Y12 monotherapy and 2688 patients (25.3%) receiving DAPT experienced severe ICH (NIHSS score ≥21) compared with 12 952 patients (20.5%) who used aspirin monotherapy and 39 970 (23.2%) patients who received no antiplatelet (P < .001). In-hospital mortality rates were highest in patients using DAPT (24.0%), followed by patients receiving P2Y12 inhibitor monotherapy (23.8%), no antiplatelet (16.8%), and aspirin monotherapy (16.5%) (P < .001). After risk adjustment, patients with prior use of P2Y12 inhibitors were more likely to present with severe stroke (P2Y12 inhibitor monotherapy: adjusted odds ratio [AOR], 1.43 [95% CI, 1.34-1.52]; P < .001; DAPT: AOR, 1.40 [95% CI, 1.33-1.47]; P < .001) and more likely to die in the hospital (P2Y12 inhibitor monotherapy: AOR, 1.55 [95% CI, 1.46-1.66]; P < .001; DAPT: AOR, 1.61 [95% CI, 1.53-1.71]; P < .001) compared with those using aspirin monotherapy. Furthermore, these patients were less likely to be discharged to home, be able to ambulate independently, or have functional independence at discharge. In contrast, there were no statistically significant differences in in-hospital outcomes between aspirin monotherapy and no antiplatelet therapy groups.

CONCLUSIONS AND RELEVANCE: In this registry-based cohort study of patients with ICH not associated with anticoagulation, P2Y12 inhibitors, either as monotherapy or in combination with aspirin, were associated with more severe stroke, in-hospital death, worse clinical outcomes, and reduced functional recovery compared with aspirin monotherapy or no antiplatelet therapy.

PMID:42424082 | DOI:10.1001/jamanetworkopen.2026.22239

JAMA Netw Open. 2026 Jul 1;9(7):e2622676. doi: 10.1001/jamanetworkopen.2026.22676.

ABSTRACT

IMPORTANCE: Adolescent substance use remains a leading preventable cause of morbidity and mortality in the US. Evidence is limited on whether sustained availability of dedicated school-based health coursework is associated with lower substance use prevalence at scale.

OBJECTIVE: To estimate whether sustained availability of a dedicated high school health course was associated with lower student-reported past 30-day substance use prevalence.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included California public high schools that participated in the California Healthy Kids Survey and were linked to annual University of California Office of the President course lists. Participants included high school students in grades 9 and 11 who completed the California Healthy Kids Survey high school between the 2017 to 2018 school year and the 2023 to 2024 school year. Data were analyzed from January to February 2026.

EXPOSURE: School year availability of at least 1 standalone health course that was approved by the University of California Office of the President. Availability was defined as sustained when present for at least 2 consecutive school years.

MAIN OUTCOMES AND MEASURES: Seven binary indicators of any past-30-day substance use: alcohol use, binge drinking, cigarette smoking, drug use, marijuana use, prescription drug misuse, and vaping. Difference-in-differences with 2-way fixed effects and prespecified event-study analyses were used.

RESULTS: The analytic sample included 1 942 640 student survey responses from 915 public high schools across 345 districts and 3499 school years; mean (SD) grade was 10.1 (1.0), and 942 180 responses (48.5%) were from female students. Sustained availability of a dedicated health course was associated with lower school year prevalence of vaping (-1.36 [95% CI, -2.15 to -0.57] percentage points), marijuana use (-1.22 [95% CI, -1.95 to -0.49] percentage points), alcohol use (-1.11 [95% CI, -1.91 to -0.30] percentage points), and binge drinking (-0.70 [95% CI, -1.17 to -0.24] percentage points). Estimates for drug use, prescription drug misuse, and cigarette smoking were smaller and had 95% CIs that included 0.

CONCLUSIONS AND RELEVANCE: In this cohort study of California public high schools, sustained availability of a dedicated health course was associated with modestly lower prevalence in several common forms of adolescent substance use. These findings suggest that sustained, dedicated health coursework may be a scalable component of school-based substance use prevention.

PMID:42424079 | DOI:10.1001/jamanetworkopen.2026.22676