Tag: pubmed

Proc Natl Acad Sci U S A. 2026 Jun 9;123(23):e2518179123. doi: 10.1073/pnas.2518179123. Epub 2026 Jun 1.

ABSTRACT

Childhood stunting is associated with increased mortality, higher risk of chronic disease, impaired cognitive development, lower educational attainment, reduced economic opportunities, and intergenerational transmission of stunting. These risks are likely to intensify as climate change exacerbates key drivers of undernutrition, making it important to understand how rising temperatures affect stunting and the role of socioeconomic inequality in this relationship. We analyze data from 34 African countries from 2004 to 2020 using Demographic and Health Surveys (DHS), combining observed temperature variability from ERA5 reanalysis with anthropogenic temperature anomalies derived from Detection and Attribution Model Intercomparison Project (DAMIP) simulations. Using a mediation framework, we examine pathways linking temperature anomalies, inequality, and child stunting. Results based on observed temperature anomalies show no direct climate effect on stunting or inequality, but a positive and statistically significant association between inequality and stunting. In contrast, anthropogenic temperature anomalies are positively associated with inequality and stunting, with a 1 °C increase linked to a 3.45% rise in child stunting (SE = 1.52, P = 0.023), with no evidence of mediation through inequality. Notably, we find a consistent positive association between inequality and stunting across specifications. These findings suggest that reducing inequality, together with investments in education, sanitation, and household resilience, could substantially lower stunting rates and protect child health in a warming world.

PMID:42224608 | DOI:10.1073/pnas.2518179123

Opt Lett. 2026 Jun 1;51(11):3253-3256. doi: 10.1364/OL.592295.

ABSTRACT

This work investigates the enhancement of channel capacity in photon-starved deep-space optical links by leveraging inter-photon correlations. We analyze an M-ary pulse-position modulation (PPM) photon-counting channel in the presence of Poisson background noise and compare conventional signal sources with recently proposed correlated photonic-dimer sources. In the low-photon-rate regime, the dimer sources in both the Bose-Einstein condensate (BEC) and Bardeen-Cooper-Schrieffer (BCS) limits yield substantial capacity improvements over conventional sources. Specifically, at the operationally relevant PPM order of M = 128, the increase relative to lasers reaches up to ∼37% (BEC) and ∼94% (BCS), respectively. These results underscore photon-statistics and correlation engineering as a promising degree of freedom for maximizing photon information efficiency under stringent power and transceiver constraints.

PMID:42224570 | DOI:10.1364/OL.592295

Toxicol Ind Health. 2026 Jun 1:7482337261453776. doi: 10.1177/07482337261453776. Online ahead of print.

ABSTRACT

The potential of the neonicotinoid insecticide dinotefuran to induce oxidative DNA damage was evaluated in human peripheral blood lymphocyte cultures at three concentrations (0.05, 0.15, and 0.30 µg/mL) using the single-cell gel electrophoresis assay (COMET). Its ability to interact with DNA was further examined through molecular docking analysis. The comet assay results revealed statistically significant increases (p < 0.001) in both the genetic damage index (GDI) and the percentage of heavily damaged cells (DCP) at all tested concentrations compared with the negative control. DNA damage within individual cells caused by genotoxic agents can thus be effectively detected using the comet assay, as demonstrated in our study. Additionally, the optimized molecular structure, total energy, molecular orbital energies, molecular electrostatic potential (MEP) maps, and global reactivity parameters of dinotefuran were obtained using the DFT/B3LYP/6-311G(d,p) method. The fully optimized energy was predicted, and geometric parameters were compared with available single-crystal structure data. Computational studies employing density functional theory (DFT) and MEP analyses provided detailed insights into the geometric and electronic characteristics of dinotefuran, suggesting that the compound possesses significant chemical reactivity and potential for biological activity upon interaction with DNA. Molecular docking studies with the B-DNA dodecamer (PDB ID: 1BNA) yielded a minimum binding energy of -6.24 kcal/mol. Dinotefuran was found to form four conventional hydrogen bonds, two carbon-hydrogen bonds, and one π-donor hydrogen bond with DNA, primarily involving guanosine, cytosine, and thymidine bases. These interactions are consistent with the experimental evidence of genetic-oxidative DNA damage, indicating that dinotefuran can establish strong molecular interactions with DNA.

PMID:42224505 | DOI:10.1177/07482337261453776

Dev Psychol. 2026 Jun 1. doi: 10.1037/dev0002217. Online ahead of print.

ABSTRACT

The goal of this study was to explore the possible moderating and mediating roles of processing speed in children’s interval timing performance. Nine- to 11-year-old children (N = 103; 53% male; 67% White, 4% Black, 5% Asian, 3% Hispanic, 9% biracial/mixed identity, 12% unknown) performed behavioral interval timing, executive functioning, and processing speed tasks, along with a movement skills assessment. We found that processing speed moderated the relation between movement skills and interval timing such that poorer movement skills most strongly predicted more variable interval timing in children with very slow processing speed. Processing speed also statistically mediated the relation between poorer executive functions (working memory and inhibitory control) and more variable interval timing. This suggests that children with movement difficulties who also have very slow processing speed may be most at risk for dysfunctions in timing-based movement skills and that slow processing speed may interfere with efficient operation of executive functions involved in interval timing skills. We discuss the possible role that processing speed may play in understanding individual variation in children’s interval timing skills and how combined difficulties in timing skills, motor ability, and processing speed may represent a particularly at-risk profile for children with neurodevelopmental disorders. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42224002 | DOI:10.1037/dev0002217

Hum Factors. 2026 Jun 1:187208261452147. doi: 10.1177/00187208261452147. Online ahead of print.

ABSTRACT

ObjectiveTo identify eye movement patterns that are correlated with spatial disorientation (SD) events during flights in a flight simulator that induces SD.BackgroundSpatial Disorientation is one of the main causes for aviation mishaps. It can result from illusions caused by misinterpreted vestibular or visual sensory cues, leading to an incorrect perception of an aircraft’s position, attitude, or motion. SD prevention is of great importance, as there is currently no objective tool to identify its occurrence.MethodEye movements of 45 participants (30 aircrew members, 15 cadets) were recorded using Tobii Pro Glasses 2 in a Gyro-IPT SD flight simulator. Illusions were either vestibular or visual. Gaze metrics such as fixations, saccades (rapid gaze shift between two points), and visits were compared between subjects who experienced SD and those who did not. Statistical analyses were conducted to identify significant differences.ResultsAmong 284 flight profiles, 136 SD occurrences were recorded (48%). During visual illusions the participants who more frequently checked the instrument panel had a higher chance of avoiding SD. In contrast, during vestibular illusions, participants who examined the head-up display (HUD) more frequently had a lower probability of SD occurrence.ConclusionMitigating SD requires distinct eye-movement strategies tailored to the illusion type. Our results suggest that to mitigate visual illusions, there is a need for greater instrument panel focus, whereas to mitigate vestibular illusions, increased HUD engagement is needed, as opposed to the current instructions.ApplicationOur findings may inform training programs to enhance performance in high-risk SD flight profiles. Additionally, results support the potential development of a real-time SD alert system for aircraft, aiming to mitigate or prevent SD-related incidents.

PMID:42223995 | DOI:10.1177/00187208261452147

J Craniofac Surg. 2026 Jun 1. doi: 10.1097/SCS.0000000000012978. Online ahead of print.

ABSTRACT

BACKGROUND: Ear anomalies, common in newborns, affect psychosocial development. While otoplasty carries surgical risks, nonsurgical molding within the first weeks of life effectively corrects many deformities using splints like the EarWell system. However, success is time-sensitive, and technique standardization is lacking. This meta-analysis compares commercial systems and custom procedures, evaluating success rates and complications for different auricular anomalies.

METHODS: The authors searched for relevant articles up to October 2025 from PubMed, Scopus, and Web of Science. Two independent reviewers extracted data from the selected studies, including baseline information, outcomes, success rates, complications, and parental satisfaction metrics. All data analyses were performed using R version 4.3.3.

RESULTS: The authors collected 1208 records after excluding 795 duplicates. Thorough screening resulted in the retrieval of 49 entries eligible for inclusion in our review. Our analysis found high success rates across all methods. The EarWell system achieved 93% success, custom methods 91%, and other commercial systems 88%, with no statistically significant differences (P=0.155). Good-to-excellent outcomes occurred in 95% of cases. EarWell was more effective for deformations (96%) than malformations (82%), while custom methods reached 97% for deformations. Parental satisfaction was high overall (89%) but differed significantly by method (P=0.017), with custom methods at the forefront at 96%, followed by EarWell (88%) and other commercial systems (81%). However, meta-regression showed EarWell was associated with 1.6 times higher parental satisfaction odds (OR: 1.593, P=0.024). Complication rates were 13% for EarWell and other commercial systems, and 8% for custom methods (P=0.567). Longer treatment duration slightly reduced overall success odds (OR: 0.996, P=0.023). Device type and age at intervention did not significantly affect outcomes.

CONCLUSION: Nonsurgical ear molding is safe and effective. Since custom splints match commercial devices in efficacy, low-cost methods are viable alternatives.

PMID:42223983 | DOI:10.1097/SCS.0000000000012978

JAMA Intern Med. 2026 Jun 1. doi: 10.1001/jamainternmed.2026.1637. Online ahead of print.

ABSTRACT

IMPORTANCE: Quality metrics with financial incentives are widely used, but their impact on clinical care and patient health remains challenging to isolate.

OBJECTIVE: To evaluate the association of a physician-facing quality metric and financial incentive for hypertension control (blood pressure <140/90 mm Hg) with clinical decisions and health outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This quasi-experimental difference-in-differences study in a large US health system compared changes in outcomes at practices that did vs those that did not adopt the financial incentive before (2021) vs after (2022-2023) adoption. Participants included patients with previously diagnosed hypertension, aged 18 to 85 years, with encounters at eligible primary care practices. Data were analyzed from January 2024 to September 2025.

EXPOSURES: Patient exposure to the financial incentive was determined by which practice delivered their care.

MAIN OUTCOMES AND MEASURES: Initial and final systolic blood pressure at the primary care encounter and number of measurements, antihypertensive prescriptions and dose adjustments, and hospitalizations for incident stroke or acute coronary syndrome (ACS).

RESULTS: The study included 334 364 patients with hypertension (mean [SD] age, 64.9 [12.6] years; 53.3% female) and their 770 907 encounters at 103 primary care practices. In January 2022, the hypertension control financial incentive was introduced in physician contracts for 63 of these practices. In the overall population of patients with hypertension, the financial incentive was associated with an increased probability of blood pressure remeasurement (by 1.9 [95% CI, 0.7-3.1] percentage points [pp]; P = .002) with no statistically significant change in hypertension control, medication outcomes, or cardiovascular hospitalizations. For the subgroup of patients with marginally high blood pressure (defined as initial systolic blood pressure of 140-145 mm Hg), the financial incentive was associated with an increased probability (by 4.1 [95% CI, 2.1-6.0] pp; P < .001) that blood pressure was documented as controlled, subsequent to an increased probability of blood pressure remeasurement (by 5.6 [95% CI, 2.9-8.3] pp; P < .001). The probability of an existing antihypertensive medication dose being increased was reduced (-1.1 [95% CI, -2.0 to -3.0] pp; P = .01), and the 3-month risk of hospitalization for stroke or ACS increased (by 0.25 [95% CI, 0.07-0.44] pp; P = .005), with excess risk growing to 0.52 pp (95% CI, 0.17-0.87 pp; P = .008) pp at 1 year.

CONCLUSIONS AND RELEVANCE: This study’s findings suggest that the addition a quality metric and financial incentive to physicians’ contracts in a large health system had little impact on measured outcomes in the overall population of patients with hypertension. For patients with marginally high blood pressure, the incentive was associated with increased documented hypertension control because of selective remeasurement of blood pressure, decreased medication adjustments, and increased cardiovascular hospitalizations.

PMID:42223964 | DOI:10.1001/jamainternmed.2026.1637

JAMA. 2026 Jun 1. doi: 10.1001/jama.2026.6908. Online ahead of print.

ABSTRACT

IMPORTANCE: Helicobacter pylori infection is the leading cause of gastric cancer, yet the economic value of population-based screening and eradication remains uncertain.

OBJECTIVE: To project the lifetime health benefits and costs of invitation to 1-time H pylori stool antigen testing added to biennial fecal immunochemical test (FIT) screening compared with FIT alone.

DESIGN, SETTING, AND PARTICIPANTS: Lifetime cost-effectiveness analysis conducted using a Markov decision-analytic model to simulate a cohort informed by a pragmatic randomized clinical trial in Changhua County, Taiwan. The model adopted a 30-year time horizon and projected long-term outcomes, including gastric and colorectal cancer mortality, quality-adjusted life-years (QALYs; incorporating both life expectancy and health-related quality of life), and health care expenditures. Costs were evaluated from a societal perspective. One-way and probabilistic sensitivity analyses were performed. Future costs and QALYs were discounted at an annual rate of 3%.

EXPOSURES: Helicobacter pylori stool antigen testing plus FIT or FIT alone.

MAIN OUTCOMES AND MEASURES: Incremental cost-effectiveness ratio of invitation for H pylori stool antigen testing plus FIT vs FIT alone, measured as the additional cost required to gain 1 QALY per person. Secondary outcomes included net monetary benefit and benefit-cost ratio.

RESULTS: Compared with FIT alone, invitation to co-testing was more effective and less expensive (dominant), with a base-case cost-saving incremental cost-effectiveness ratio of $2094 per QALY gained (95% CI, $12 359 saved to $7291 additional cost). This resulted in a positive net monetary benefit, indicating that health benefits exceeded costs, and a benefit-cost ratio of 5.08, indicating an approximately 5-fold return on investment in the Taiwanese population. At a willingness-to-pay threshold of 1 × the Taiwan gross domestic product per QALY ($33 365), invitation to co-testing remained cost-saving in 65.7% of simulations. From a US cost perspective, invitation to co-testing was not cost-saving but remained cost-effective at the trial base-case H pylori prevalence. Sensitivity analyses identified H pylori prevalence as the dominant driver; co-testing exceeded a $100 000-per-QALY threshold when prevalence fell below 21.9%.

CONCLUSIONS AND RELEVANCE: In a pragmatic real-world setting with incomplete adherence, invitation to combined H pylori stool antigen testing and FIT was more cost-effective than FIT alone, improving lifetime outcomes and yielding cost savings in Taiwan while remaining cost-effective in higher-cost settings under moderate H pylori prevalence.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01741363.

PMID:42223961 | DOI:10.1001/jama.2026.6908

JAMA Netw Open. 2026 Jun 1;9(6):e2614764. doi: 10.1001/jamanetworkopen.2026.14764.

ABSTRACT

IMPORTANCE: Antibody-drug conjugates (ADCs), including enfortumab vedotin, disitamab vedotin, and sacituzumab govitecan, are altering the therapeutic landscape for locally advanced or metastatic urothelial carcinoma (la/mUC). Comprehensive comparative evidence evaluating their translation in the clinical setting and modifying clinical covariates is required.

OBJECTIVE: To synthesize multidimensional evidence from interventional and observational settings to evaluate clinical outcomes, define the evolving therapeutic positioning of enfortumab vedotin, disitamab vedotin, and sacituzumab govitecan, and identify drivers of heterogeneity through meta-regression.

DATA SOURCES: PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar were searched from database inception to October 23, 2025.

STUDY SELECTION: Interventional and observational studies of adults with la/mUC treated with enfortumab vedotin, disitamab vedotin, or sacituzumab govitecan.

DATA EXTRACTION AND SYNTHESIS: Independent reviewers extracted data following PRISMA guidelines. A rigorous metadata deduplication algorithm prevented patient double-counting. Random-effects models pooled data. Bayesian network meta-analysis (NMA) used reconstructed individual patient data. Inverse-variance weighted meta-regression assessed clinical covariates.

MAIN OUTCOMES AND MEASURES: Primary outcomes were disease control rate, objective response rate (ORR), and clinical complete response.

RESULTS: Forty independent studies involving 6085 patients were included. For enfortumab vedotin monotherapy, the pooled ORR was 43.9% (95% CI, 40.4%-47.5%) in interventional studies and 44.6% (95% CI, 41.0%-48.2%) in observational cohorts. For enfortumab vedotin plus pembrolizumab, interventional cohorts were associated with a pooled ORR of 67.5% (95% CI, 63.5%-71.3%) overall and 65.4% (95% CI, 60.0%-70.5%) in cisplatin-ineligible patients. Furthermore, disitamab vedotin plus programmed cell death protein 1 (PD-1) inhibitors was associated with an ORR of 74.7% (95% CI, 69.4%-79.4%) in interventional trials and 61.7% (95% CI, 52.6%-70.1%) observationally. Meta-regression identified prior PD-1/L1 exposure (β = -0.071; P = .003) and treatment regimen (β = -0.890; P < .001) as factors associated with primary response. Notably, the pure randomized clinical trial network meta-analysis of first-line treatments for cisplatin-ineligible patients revealed that enfortumab vedotin monotherapy was associated with a statistically significant overall survival advantage over chemotherapy (HR, 0.50; 95% CI, 0.29-0.86; posterior probability >99%).

CONCLUSIONS AND RELEVANCE: In this meta-analysis of ADCs for la/mUC, enfortumab vedotin-based regimens were associated with robust outcomes across clinical settings, and disitamab vedotin combined with immunotherapy was associated with potent clinical activity. Meta-regression indicated that prior immunotherapy exposure and hepatic tumor burden were associated with attenuated treatment responses.

PMID:42223943 | DOI:10.1001/jamanetworkopen.2026.14764

JAMA Netw Open. 2026 Jun 1;9(6):e2615894. doi: 10.1001/jamanetworkopen.2026.15894.

ABSTRACT

IMPORTANCE: Current lung cancer guidelines recommend lymph node sampling (LNS) with the 3 + 1 rule, which recommends station-based sampling with at least 3 N2 (mediastinal) and 1 N1 (hilar) nodal stations. Although there is oncologic benefit to rigorous LNS, potential negative impacts on surgical outcomes have not been well investigated. As adoption of the 3 + 1 rule increases given its formalization as guideline-concordant care, associations with adverse outcomes are crucial to characterize.

OBJECTIVE: To evaluate whether satisfying the 3 + 1 rule is associated with increased postoperative complications.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the Society of Thoracic Surgeons General Thoracic Database, which was queried for patients with clinical stage T1 to T3, N0, M0 non-small cell lung cancer (NSCLC) who underwent surgical resection with known LNS between July 1, 2021, and January 1, 2023. Statistical analysis was performed from March 2024 to March 2025.

EXPOSURE: A propensity match was conducted to compare the postoperative complication rate by 3 + 1 LNS status.

MAIN OUTCOMES AND MEASURES: Data on demographic characteristics were collected and analyzed. Primary outcomes included postoperative complications, such as arrhythmias, pleural effusion requiring drainage, blood transfusion, prolonged air leak, therapeutic bronchoscopy, pneumonia, respiratory failure, bronchopleural fistula, pulmonary embolism, pneumothorax, prolonged ventilatory support, myocardial infarction, and sepsis. Thirty-day mortality and readmission rates were also evaluated.

RESULTS: The cohort included 28 439 patients (median [IQR] age, 69 [66-75] years; 4791 [59.5%] female). There were 18 939 patients (66.6%) who satisfied the 3 + 1 rule. In the unadjusted group, the 3 + 1 cohort had longer median (IQR) operating room duration (224 [178-281] vs 210 [161-273] minutes, P < .001) and rates of pathologic upstaging (2520 [13.3%] vs 922 [9.7%], P < .001). In the postmatch analysis, there were no other significant differences in postoperative complication rates, and the aforementioned associations in the 3 + 1 group were no longer observed.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with NSCLC, the 3 + 1 rule was not associated with increased postoperative complications. This study’s findings suggest support for the continued use of this strategy in terms of overall safety profile.

PMID:42223938 | DOI:10.1001/jamanetworkopen.2026.15894