Tag: pubmed

JAMA Health Forum. 2026 Aug 7;7(8):e262503. doi: 10.1001/jamahealthforum.2026.2503.

ABSTRACT

IMPORTANCE: Administrative costs account for nearly one-quarter of US hospital expenditures and are substantially higher than those in other high-income countries. Although mandatory value-based payment programs implemented by the Centers for Medicare & Medicaid Services (CMS) aim to improve quality and efficiency, they may be associated with increased administrative burden.

OBJECTIVE: To evaluate the association between participation in CMS mandatory value-based payment programs and hospital administrative costs.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a synthetic difference-in-differences design to compare hospital administrative costs obtained from the Medicare cost report data from fiscal years 2006 to 2020. The sample included Medicare-certified general acute care hospitals, critical access hospitals, and long-term acute care hospitals. Administrative costs at hospitals participating in mandatory value-based payment programs, including the Hospital Value-Based Purchasing (HVBP) program, Hospital Readmissions Reduction Program (HRRP), and Hospital-Acquired Condition Reduction Program (HACRP), were compared with hospitals not participating in these programs. In addition, hospitals participating in the Comprehensive Care for Joint Replacement (CJR) model were compared with hospitals not participating in this model. Data were analyzed between July 5 and December 25, 2025.

EXPOSURE: Hospital participation in CMS mandatory value-based payment programs initiated under the Affordable Care Act (HVBP, HRRP, and HACRP) or the CJR model.

MAIN OUTCOMES AND MEASURES: The primary outcome was hospital administrative costs, defined as the sum of administrative and general, nursing administration, and medical records costs reported in Medicare cost report data.

RESULTS: A total of 4332 hospitals were included in the sample. Of these hospitals, 2820 (65.1%) participated in the mandatory value-based payment programs (HVBP, HRRP, and HACRP). Nonparticipating hospitals included 42 general acute care hospitals in Maryland (0.9%), 1159 critical access hospitals (26.8%), and 311 long-term acute care hospitals (7.2%). In addition, 357 hospitals participated in the CJR model compared with 2029 that did not participate in the model. Participation in the 3 mandatory value-based programs was associated with annual increases in administrative costs of $1.23 (95% CI, $0.11-$2.36) million per hospital compared with general acute care hospitals in Maryland, $0.93 (95% CI, $0.27-$1.59) million compared with critical access hospitals, and $0.65 (95% CI, $0.01-$1.29) million compared with long-term acute care hospitals. Participation in the CJR model was associated with an annual increase in administrative costs of $1.40 (95% CI, $0.30-$2.49) million per hospital. Aggregated nationally, these increases corresponded to more than $3 billion in additional annual administrative costs.

CONCLUSIONS AND RELEVANCE: In this cohort study, participation in mandatory value-based payment programs was associated with increased hospital administrative costs. These findings suggest that policymakers should consider administrative burden when designing and evaluating payment reforms to ensure that anticipated improvements in cost, quality, and access are not offset by increased complexity.

PMID:42566204 | DOI:10.1001/jamahealthforum.2026.2503

Int J Radiat Biol. 2026 Aug 7:1-12. doi: 10.1080/09553002.2026.2705994. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the dosimetric feasibility of combining stereotactic body radiotherapy (SBRT) for peripheral tumors with conventionally fractionated mediastinal lymph node (MLN) radiotherapy in small cell lung cancer (SCLC), with a focus on tumor-nodal spatial separation and geometry-dependent dose redistribution.

MATERIALS AND METHODS: A retrospective virtual planning study was conducted in 21 patients with peripheral SCLC. Three treatment strategies were generated: (1) SBRT 40 Gy in 5 fractions plus MLN radiotherapy 60 Gy in 30 fractions, (2) SBRT 50 Gy in 5 fractions plus MLN radiotherapy, and (3) conventional thoracic radiotherapy (60 Gy in 30 fractions). Target coverage and dose-volume parameters for organs at risk (OARs) were compared. Biological dose normalization using equivalent dose in 2 Gy fractions (EQD2), based on the linear-quadratic model, and prescription-matched sensitivity analyses were performed.

RESULTS: All strategies achieved adequate target coverage. SBRT-based approaches significantly reduced low-dose lung exposure compared with conventional radiotherapy, particularly in the 40 Gy regimen (lung V5 – 7.34%, V10 – 3.34%, V20 – 2.20%; all p ≤ 0.003), along with a reduction in mean lung dose (-125.74 cGy, p < .001). In exploratory EQD2-normalized analysis, the reduction in mean lung dose remained statistically significant (-0.95 Gy EQD2, p < .001). In prescription-matched analyses, lung V5 remained significantly lower, indicating that differences were not solely attributable to prescription dose. Patients with tumor-nodal spatial separation ≥2 cm exhibited lower doses to multiple OARs, supporting a geometry-dependent reduction in normal tissue exposure.

CONCLUSIONS: Combining SBRT with MLN radiotherapy is dosimetrically feasible in selected patients with SCLC, with feasibility strongly influenced by tumor-nodal spatial separation. Reduced low-dose lung exposure appears to be associated with geometry-dependent dose redistribution. These findings provide a rationale for further investigation of geometry-informed treatment strategies in prospective clinical studies.

PMID:42566199 | DOI:10.1080/09553002.2026.2705994

Carbon Balance Manag. 2026 Jul 27;21(1):104. doi: 10.1186/s13021-026-00488-4.

ABSTRACT

BACKGROUND: Forest carbon mapping is crucial for sustainable forest management, climate mitigation, biodiversity conservation, ecosystem service provision and land-use planning. Carbon stocks have been studied at regional to global scales and across various biomes. However, island-wide studies of carbon stocks and carbon mapping remain limited. Here, we present the first high-resolution (50 m) spatial mapping of forest carbon for the Canary Archipelago. Combining structural field data from the Spanish National Forest Inventory plots with airborne laser scanning, Sentinel-2 multispectral satellite data and fine-scale interpolated climatic variables, we modeled total, aboveground and belowground carbon density of 18 forest types, using machine learning approaches, including Boosted Regression Tree and Random Forest models.

RESULTS: Forests across the Canary Islands store an estimated 10.26 Tg of carbon. Canarian pine forests contain the largest carbon pool (57%) due to their extensive distribution area, whereas mature laurel forests exhibit exceptional carbon densities. In humid laurel forests, average carbon densities reached 413.2 ± 149.5 Mg C ha⁻¹, exceeding previous regional estimates and approaching levels of primary tropical forests. The high spatial heterogeneity of carbon densities across forest types and islands was best explained by structural stand attributes, such as tree canopy cover and volume, and climatic factors with carbon stocks being more strongly associated with moisture than with temperature. Both statistical modelling approaches performed similarly in terms of efficiency, accuracy and error statistics, and the selection of the best model depended on the specific island.

CONCLUSIONS: Our approach integrates field data with advanced remote sensing tools and machine learning algorithms to produce a high-resolution and accurate carbon map of topographically complex oceanic islands. We show that the Canary Islands contain exceptionally high total carbon densities, particularly within the mature, humid laurel forests of La Gomera, and identify structural attributes and water availability as the main drivers of spatial variation in carbon stocks. This assessment provides a baseline for biodiversity conservation, nature-based forest management, ecological restoration and regional climate policy towards carbon neutrality in island ecosystems.

PMID:42566171 | DOI:10.1186/s13021-026-00488-4

Int J Comput Assist Radiol Surg. 2026 Aug 7. doi: 10.1007/s11548-026-03757-2. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate three-dimensional representations of lumbar vertebral anatomy are essential for spinal research and clinical decision-making, particularly biomechanical analyses and the development of patient-specific interventions. However, in many practical settings, only partial information is available, making it difficult to obtain complete vertebral geometries. Statistical Shape Models (SSMs) provide a powerful way to characterize population-level anatomical variability, while Gaussian Process Regression (GPR) enables the reconstruction of full three-dimensional shapes from limited surface information.

OBJECTIVE: To reconstruct complete vertebral geometries from partial anatomical information using SSM and GPR and determine the minimum partial information needed for clinically acceptable reconstruction.

METHODS: Thirteen high-resolution CT datasets of healthy adult lumbar spines were segmented. A two-step registration framework was implemented: rigid registration followed by 3D-3D embedded deformation non-rigid registration. Principal Component Analysis (PCA) was used to generate SSMs of the lumbar spine. GPR was then employed for shape reconstruction from partial input data. Reconstruction performance was assessed with a leave-one-out cross-validation method.

RESULTS: In the full lumbar spine SSM, the first eight principal modes captured 92.7% of total shape variance. GPR enabled accurate reconstruction of full lumbar spines from sparse partial inputs. Shape reconstruction errors remained within the clinically acceptable range, with Average Distance (AD) within 1.23-3.64 mm, depending on input sparsity. Minimum information analysis revealed that as little as 30.67% surface data per vertebra was sufficient for clinically acceptable reconstructions.

CONCLUSION: Combining SSMs with GPR enables accurate, anatomically realistic reconstruction of the lumbar spine from partial data. To the best of our knowledge, this study represents the first integration of SSMs and GPR for vertebral reconstruction. The proposed approach is suitable for future integration with sparse, ultrasound-derived anatomical information and establishes a foundation for radiation-free 3D guidance systems for lumbar facet joint injections and other spine interventions.

PMID:42566161 | DOI:10.1007/s11548-026-03757-2

CNS Drugs. 2026 Aug 7. doi: 10.1007/s40263-026-01326-4. Online ahead of print.

ABSTRACT

BACKGROUND: Psychedelics exert widespread effects on brain activity, but their impact on motor function is unclear. This is clinically relevant given the emerging interest in psychedelic-assisted physical therapy for disorders of motor function. This study examined the feasibility and safety of administering movement tasks following low-to-moderate doses of psilocybin in healthy volunteers.

METHODS: Healthy adult participants were randomly assigned three psilocybin doses consisting of either (1) 5 mg, 10 mg and 15 mg or (2) 10 mg, 15 mg and 20 mg, with at least 1 week between doses. Movement tasks were administered at 1.5 h, 3 h and 4.5 h post-dose. Participants, physiotherapists and statisticians were blinded to the dosing order. Feasibility was assessed by evaluating completion of the de Morton Mobility Index and Functional Movement Exploration (assessing gross motor function). Safety outcomes included vital signs and adverse events. Additional exploratory motor outcomes included the Action Research Arm Test (assessing upper limb functional performance), Box and Block Test (Original and Modified versions) (combining dexterity with motor speed), Digit Symbol Substitution Test (combining motor speed with intellectual functions) and Reaction Time Ruler Drop Test (assessing reaction time). Alterations in conscious states and blinding efficacy were also assessed. Outcomes were summarised descriptively and with post hoc linear mixed-effects modelling performed to explore dose- and time-related effects.

RESULTS: A total of 13 participants (62% male) were enrolled, with a median age of 33 years (range 22-39 years), median height of 177 cm (155-188 cm) and median weight of 74 kg (51-94 kg). One participant was unable to complete several movement tasks at 20 mg. Nausea (n = 8, 62%) and headache (n = 7, 54%) were the most common adverse events. No serious adverse events or adverse events related to movement task administration occurred. Median values [interquartile ranges] remained near-perfect for the de Morton Mobility Index (92.5-100.0 [85.0-100.0]), Functional Movement Exploration (100.0 [96.0-100.0]) and Action Research Arm Test (56.0-57.0 [52.0-57.0]). Baseline Box and Block Test (Original) median scores (65.0 [60.0-67.0]) improved to 79.0 [70.0-83.0] at 5 mg and 4.5 h post-dose (5 mg-4.5 h), and worsened to 57.5 [51.0-64.0] at 20 mg-1.5 h. Baseline Box and Block Test (Modified) median scores (48.0 [47.0-53.0]) worsened to 43.0 [35.0-45.0] at 20 mg-1.5 h. Baseline Digit Symbol Substitution Test median scores (73.0 [66.0-77.0]) improved to 87.0 [81.0-90.0] at 10 mg-4.5 h, and worsened to 62.0 [54.0-86.0] at 20 mg-1.5 h. Reaction Time Ruler Drop Test scores lacked consistent dose-related changes. Alterations in conscious states were greatest at 20 mg. Participants and physiotherapists correctly guessed the administered dose 53% and 50% of the time, respectively.

CONCLUSIONS: Movement tasks were feasible during psilocybin dosing up to 15 mg. No significant safety concerns related to movement task participation during the acute drug effects were observed. At 20 mg, impairments were observed in movement tasks that combined motor and additional cognitive functions. These findings inform future studies utilising psilocybin-assisted physical rehabilitation in clinical populations.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12621000560897. Date registered: 12 May 2021.

PMID:42566154 | DOI:10.1007/s40263-026-01326-4

J Community Health. 2026 Aug 7. doi: 10.1007/s10900-026-01620-8. Online ahead of print.

ABSTRACT

College students remain at increased risk for acquiring human papillomavirus (HPV), yet HPV vaccination coverage remains suboptimal despite the availability of a safe and effective vaccine. This study examined predictors of HPV vaccination and HPV- and HPV vaccine-related knowledge, beliefs, and hesitancy among undergraduate students at a southern United States university. An online cross-sectional survey was administered to undergraduate students aged 18-26 years in November 2024. Descriptive statistics summarized participant characteristics, vaccination status, and HPV-related measures. Multinomial logistic regression models were used to examine factors associated with HPV vaccination status while estimating adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among 1,127 respondents (mean age, 20.1 years), most were female (74.1%), White (74.9%), and insured (90.4%). Overall, 48.4% reported receiving at least one dose of the HPV vaccine, with only 21.7% completion. More than 30% were unsure of their HPV vaccination status. HPV knowledge, HPV vaccine knowledge and beliefs, and vaccine hesitancy were all independently associated with vaccination status (all p < 0.001). Participants with stronger positive HPV vaccine beliefs and lower vaccine hesitancy had significantly greater odds of reporting HPV vaccination. In secondary analyses, both provider and parental recommendation were significantly associated with younger age at initiation. HPV vaccination initiation and completion remain low among college students, with substantial gaps in knowledge, awareness, and confidence. College campuses represent an important setting for interventions that improve HPV-related knowledge, strengthen vaccine confidence, increase awareness of personal vaccination status, and promote vaccination to reduce future HPV-associated cancers.

PMID:42566153 | DOI:10.1007/s10900-026-01620-8

Acta Parasitol. 2026 Aug 7;71(4):185. doi: 10.1007/s11686-026-01348-4.

ABSTRACT

PURPOSE: Psoroptes cuniculi is the most prevalent mite affecting rabbits worldwide. It is the primary cause of otitis in this species and significantly compromises animal welfare, leading to considerable economic losses. In search of alternative control strategies, several plant-derived oils such as olive, cinnamon, oregano, neem, and lemon oils have been evaluated in vitro for their acaricidal potential. In this study, the in vivo efficacy of extra virgin olive oil (EVOO) and linoleic acid (LA) was assessed as alternative treatments against P. cuniculi.

METHODS: Twenty-four rabbits were experimentally infested with 150 mites placed in each auricle. After 139 days, animals were randomly allocated into four treatment groups (n = 6): 60% EVOO (with 0.1% DMSO in distilled water), 150 mg/mL LA, 4 mg/mL ivermectin (IV), and 0.1% DMSO in distilled water. Treatments were applied topically on day 0, and a second dose was administered on day 7. The infested area was quantified in vivo using a transparent grid on days 0, 3, 7, 10, and 14 after the first treatment application.

RESULTS: A marked reduction in infestation area was observed in the LA, EVOO, and IV treated groups, whereas lesion area increased in the negative control group. By day 14, infestation areas were nearly eliminated in rabbits treated with LA, EVOO, and IV. Final infestation areas were significantly lower than those observed in the negative control group (P ≤ 0.0001). Post-mortem evaluation on day 15 revealed no statistically significant differences compared with the in vivo measurements, indicating agreement between both assessment methods. No visible signs of irritation, erythema, or inflammation were observed during treatment.

CONCLUSION: These findings demonstrate that EVOO and LA exhibit substantial acaricidal activity against P. cuniculi under controlled experimental conditions and support their potential as alternative treatments for further investigation.

PMID:42566125 | DOI:10.1007/s11686-026-01348-4

Am J Cardiovasc Drugs. 2026 Aug 7. doi: 10.1007/s40256-026-00818-4. Online ahead of print.

ABSTRACT

BACKGROUND: Short-term studies have demonstrated that single-pill combinations (SPCs) improve adherence, reduce hypertension-related complications, and lower costs; however, long-term benefits remain unclear. This study compared adherence, healthcare resource utilization (HCRU), and costs over 11 years in patients treated with SPCs versus free-pill combinations (FPCs) of antihypertensive drugs in routine Italian practice.

METHODS: We analyzed a large administrative dataset (2010-2022) covering approximately 7 million Italian citizens. Adults initiating perindopril (PER)-based SPC or FPC with amlodipine and/or indapamide were included. PER-based therapies were selected because their SPCs were among the first marketed in Italy, allowing for extended follow-up. Adherence was measured by proportion of days covered (PDC), with high adherence defined as PDC ≥ 80%.

RESULTS: Among 24,476 patients (mean age: 64.6 years; 59.7% male), 92.6% received SPCs, and 6.0% FPCs. High adherence was observed in 75.5% of SPC users compared with 32.0% of FPC users. SPC users had fewer all-cause hospitalizations and outpatient visits (both p < 0.001). Average annual healthcare costs were €242.96 lower for SPC users (95% CI €55.03-€430.89; p < 0.05), with significant reductions in costs related to all-cause and cardiovascular-related hospital admissions (p < 0.001).

CONCLUSIONS: In this long-term, real-world study, SPC use was associated with better adherence, reduced HCRU, and lower healthcare costs compared with FPC regimens. These economic benefits were evident within 1 year and may yield substantial long-term savings for national health systems, given the high prevalence and chronic nature of hypertension.

PMID:42566123 | DOI:10.1007/s40256-026-00818-4

Radiol Phys Technol. 2026 Aug 7. doi: 10.1007/s12194-026-01103-4. Online ahead of print.

ABSTRACT

MRI provides essential insights into tissue microstructure, and high angular resolution diffusion imaging (HARDI) enables detailed assessment of complex white matter architecture through fiber orientation distribution (FOD) analysis. However, HARDI requires high b-values and multiple diffusion directions, leading to reduced signal-to-noise ratio (SNR) and long scan times. Conventional zero-fill interpolation processing (ZIP) is widely used for super-resolution but is limited by edge blurring and artifacts. This study evaluated an AI-based reconstruction method, Precise IQ Engine (PIQE). Specifically, low-resolution diffusion data were reconstructed to standard resolution and compared with standard-resolution acquisitions. Ten healthy volunteers underwent HARDI at 3T, and FOD were estimated using constrained spherical deconvolution. Quantitative comparisons with reference data demonstrated that PIQE exhibited higher distributional similarity (lower Jensen-Shannon divergence) and directional agreement (higher angular correlation coefficient) compared with ZIP+Advanced Intelligent Clear-IQ Engine (AiCE), with statistically significant similarity observed. These findings indicate potential usefulness in advanced diffusion MRI applications.

PMID:42566117 | DOI:10.1007/s12194-026-01103-4

J Mater Sci Mater Med. 2026 Aug 7;37(1):103. doi: 10.1007/s10856-026-07109-z.

ABSTRACT

For centuries, natural extracts such as Aloe vera have been used in wound care due to their soothing, anti-inflammatory, and healing properties. However, their clinical efficacy can be limited by instability, low bioavailability, and restricted antimicrobial potency. Nanotechnology offers promising strategies to enhance and complement the therapeutic benefits of herbal extracts. In this study, we investigated the wound-healing potential of Aloe vera gel combined with ZnO/SWCNT/Ag (zinc oxide-single-walled carbon nanotubes-silver nanoparticles) nanocomposite. Forty full-thickness excisional wounds (15 mm) were created on the dorsum of 20 Sprague Dawley rats and divided into four treatment groups: ZnO/SWCNT/Ag alone (1 mg/mL), Aloe vera gel (30 mg/mL), the combination of Aloe vera gel with the NPs, and control (saline 0.9%). Wound areas were tracked at days 0, 3, 10, 15, and 21 using calibrated imaging, and skin samples were harvested for histopathological analysis. The ZnO/SWCNT/Ag nanocomposite alone accelerated wound closure compared to Aloe vera and saline control, while combining Aloe vera with the nanocomposite improved wound healing compared to Aloe vera alone at day 10 (p < 0.05). Although wound closure was similar across all groups by day 21, nanoparticle-treated wounds showed less variability and more uniform healing. Scar area analysis revealed significant reductions for ZnO/SWCNT/Ag based treatment and the combination compared to Aloe vera (p < 0.05), whereas differences versus saline control were not statistically significant. Additionally, the formulations demonstrated strong antibacterial activity against Escherichia coli and enhanced antioxidant properties. These findings suggest that ZnO/SWCNT/Ag nanoparticles may serve as a supportive platform to enhance the wound-healing behaviour of Aloe vera.

PMID:42566106 | DOI:10.1007/s10856-026-07109-z