tbuckley/cabot-search huggingface dataset:
Human neural dynamics of real-world and imagined navigation
Authors: Martin Seeber, Matthias Stangl, Mauricio Vallejo Martelo, Uros Topalovic, Sonja Hiller, Casey H. Halpern, Jean-Philippe Langevin, Vikram R. Rao, Itzhak Fried, Dawn Eliashiv, Nanthia Suthana
Journal: Nature Human Behaviour (2025)

Abstract The ability to form episodic memories and later imagine them is integral to the human experience, influencing our recollection of the past and envisioning of the future. While rodent studies suggest the medial temporal lobe, especially the hippocampus, is involved in these functions, its role in human imagination remains uncertain. In human participants, imaginations can be explicitly instructed and reported. Here we investigate hippocampal theta oscillations during real-world and imagined navigation using motion capture and intracranial electroencephalographic recordings from individuals with chronically implanted medial temporal lobe electrodes. Our results revealed intermittent theta dynamics, particularly within the hippocampus, encoding spatial information and partitioning navigational routes into linear segments during real-world navigation. During imagined navigation, theta dynamics exhibited similar patterns despite the absence of external cues. A statistical model successfully reconstructed real-world and imagined positions, providing insights into the neural mechanisms underlying human navigation and imagination, with implications for understanding memory in real-world settings.
COVID-19 Pandemic and the Developmental Health of Kindergarteners
Authors: Judith L. Perrigo, Jordan Morales, Nicholas Jackson, Magdalena Janus, Lisa Stanley, Mitchell Wong, Neal Halfon
Journal: JAMA Pediatrics (2025)

Importance Recent studies have associated the COVID-19 pandemic with negative developmental outcomes in children. However, research focused on young children remains limited, with few studies including multiple years of pre- and postpandemic onset data. Objective To examine the impact of the COVID-19 pandemic on US kindergarteners’ developmental health. Design, Setting, and Participants This repeated cross-sectional panel study examined developmental health trends, as measured by the Early Development Instrument (EDI), among a convenience sample US kindergarteners from 2010 to 2023. EDI data were obtained from 390 school districts across 19 states. Data were analyzed from June December 2024. Exposure Kindergarteners’ developmental health was compared between prepandemic (2018 to 2020) and postpandemic (2021 to 2023) onset cohorts. Main Outcomes and Measures Outcomes were EDI scores across time in 5 domains: (1) physical health and well-being, (2) social competence, (3) emotional maturity, (4) language and cognitive development, and (5) communication and general knowledge. The mean (95% CI) EDI scores were assessed. Results In this sample of of 475 740 US kindergarten students, 242 869 were male (51.1%), there were 53 841 African American or Black students (11.4%), 263 037 Hispanic or Latino/a students (55.5%), and 95 258 White students (20.1%), and the mean (SD) age was 6 (0.4) years (range, 4.0-8.0 years). Compared with the immediate prepandemic onset period, the rate of change in EDI scores was significantly lower following the pandemic onset in language and cognitive development (mean change, −0.45; 95% CI, −0.48 to −0.43), social competence (mean change, −0.03; 95% CI, −0.06 to −0.01), and communication and general knowledge (mean change, −0.18; 95% CI, −0.22 to −0.15). EDI scores were significantly higher in emotional maturity (mean change, 0.05; 95% CI, 0.03 to 0.07), and no significant changes were observed in the physical health and well-being domain (mean change, 0; 95% CI, −0.01 to 0.02). Conclusions and Relevance The COVID-19 pandemic was associated with varying developmental health outcomes in kindergarteners. Negative developmental trends existed immediately before the pandemic, with most persisting or slowing postpandemic onset. These results highlight troubling trends in kindergarteners’ development, both before and during the pandemic, and more information is needed to understand why developmental outcomes are worsening over time.
Age Decomposition of Mortality Rates Among Children Younger Than 5 Years in 47 LMICs
Authors: Omar Karlsson, Thomas W. Pullum, Akhil Kumar, Rockli Kim, S. V. Subramanian
Journal: JAMA Pediatrics (2025)

Importance Despite a global decline in the mortality rate of children younger than 5 years (the under-5 mortality rate), neonatal deaths continue to present a substantial challenge. The etiology behind deaths varies between the early and late neonatal periods as well as at later ages. Objective To decompose the under-5 mortality rate in 47 low- and middle-income countries into 8 age intervals, providing a comprehensive understanding of varying vulnerability across age groups. Design, Setting, and Participants This cross-sectional study used nationally representative data from 47 Demographic and Health Surveys conducted between 2014 and 2023 in low- and middle-income countries, including 1.4 million live births. Exposure Age in days, weeks, months, or years. Main Outcomes and Measures The under-5 mortality rate was decomposed by age based on a life table approach, using true cohort probabilities for the early and late neonatal periods and synthetic cohort probabilities for other age intervals, to obtain deaths per 1000 live births (ie, the cohort entering the life table) for each age interval. Results In the pooled sample of 1 448 001 live births, there were 14 576 deaths in the early neonatal period (age 0 to 6 days); 3400 in the late neonatal period (age 7-27 days); 6760 in the early postneonatal period (age 28 days to 5 months); 4912 in the late postneonatal period (age 6-11 months); and 5145, 3990, 2674, and 1640 at ages 1, 2, 3, and 4 years, respectively. The early neonatal mortality rate accounted for 21.3 (95% CI, 20.5-22.1) deaths per 1000 births from a total under-5 mortality rate of 57.7 (95% CI, 56.2-59.3) deaths per 1000 births. The early neonatal mortality rate was significantly higher than mortality at subsequent ages (eg, median [IQR] mortality rates: early neonatal period, 18.8 [14.3-23.2] deaths per 1000 births; late neonatal period, 4.7 [3.1-5.9] deaths per 1000 births) and much higher when considering the average daily mortality rate. The early neonatal mortality rate accounted for the greatest share of under-5 mortality rate in all but 2 countries. In most countries the lowest mortality rates were observed at age 3 or 4 years. The share of deaths occurring in the late postneonatal period and later was greater in countries with greater under-5 mortality rates. Conclusions and Relevance The concentration of mortality in the first week after birth underscores a critical need for enhanced maternal and neonatal health care. Furthermore, early neonatal mortality rates should be routinely reported and included in health targets. In this study, the age of 6 months emerged as an important turning point: high-mortality countries were characterized by a greater concentration of deaths after age 6 months than countries with lower under-5 mortality rate.
Long-Term Outcomes and Determinants of New-Onset Mental Health Conditions After Trauma
Authors: Lai Kin Yaw, Maxine Burrell, Kwok Ming Ho
Journal: JAMA Network Open (2025)

Importance Evidence suggests that trauma-related mortality and morbidities may follow a multiphasic pattern, with outcomes extending beyond hospital discharge. Objectives To determine the incidence of having new mental health conditions after the first (or index) trauma admission and their association with long-term health outcomes. Design, Setting, and Participants This population-based, linked-data cohort study was conducted between January 1994 and September 2020, with data analyzed in April 2024. Participants were adult patients with trauma admitted to 1 of the 5 adult trauma hospitals in Western Australia. All patients with major trauma with an Injury Severity Score (ISS) greater than 15 were included. For each patient with major trauma, 2 patients with trauma with a lower ISS (&amp;amp;lt;16) were randomly selected. Exposure A new mental health condition recorded in either subsequent public or private hospitalizations after trauma admission. Main Outcomes and Measures The primary outcomes were the associations between new mental health conditions after trauma and subsequent risks of trauma readmission, suicide, and all-cause mortality, as determined by Cox proportional hazards regression. Logistic regression was used to determine which factors were associated with developing a new mental health condition after trauma. Results Of 29 191 patients (median [IQR] age, 42 [27-65] years; 19 383 male [66.4%]; median [IQR] ISS, 9 [5-16]; 9405 with ISS &amp;amp;gt;15 and 19 786 with ISS &amp;amp;lt;16) considered, 2233 (7.6%) had a mental health condition before their trauma admissions. The median (IQR) follow-up time after the index trauma admission was 99.8 (61.2-148.5) months. Of 26 958 patients without a prior mental health condition, 3299 (11.3%) developed a mental health condition subsequently, including drug dependence (2391 patients [8.2%], with 419 patients [1.4%] experiencing opioid dependence) and neurotic disorders (1574 patients [5.4%]), including posttraumatic stress disorder. Developing a new mental health condition after trauma was associated with subsequent trauma readmissions (adjusted hazard ratio [aHR], 1.30; 95% CI, 1.23-1.37; P &amp;amp;lt; .001), suicides (aHR, 3.14; 95% CI, 2.00-4.91; P &amp;amp;lt; .001), and all-cause mortality (aHR, 1.24; 95% CI, 1.12-1.38; P &amp;amp;lt; .001). Younger age, unemployment, being single or divorced (vs married), Indigenous ethnicity, and a lower socioeconomic status were all associated with developing a new mental health condition after the first trauma admission. Conclusions and Relevance This cohort study of 29 191 patients with trauma found that mental health conditions after trauma were common and associated with an increased risk of adverse long-term outcomes, indicating that mental health follow-up of patients with trauma, particularly those from vulnerable subgroups, may be warranted.
Error in Figure
Journal: JAMA Network Open (2025)

Alexa Kanbergs, MD-ScM, MS; Alexander Melamed, MD, MPH; David Viveros-Carreño, MD; Chi-Fang Wu, PhD; Roni Nitecki Wilke, MD; Abigail Zamorano, MD, MPHS; Kimeera Paladugu; Laura Havrilesky, MD, MHSc; Jose Alejandro Rauh-Hain, MD, MPH; Nuria Agusti, MD
Universal vs Targeted Chlorhexidine Bathing and Nasal Decolonization in Hospitalized Patients
Authors: Lyndon P. James, Natasha K. Stout, Taliser R. Avery, Sarah Stein, Kenneth E. Sands, Edward J. Septimus, Julia Moody, Eunice J. Blanchard, Russell E. Poland, Richard Platt, Susan S. Huang
Journal: JAMA Network Open (2025)

Importance The ABATE Infection trial investigated the effects of universal bacterial decolonization with chlorhexidine for patients in non–intensive care unit settings to reduce hospital-onset bacteremia and fungemia (HOB) events. Among patients with medical devices (central venous catheters, midline catheters, and lumbar drains), universal decolonization (UD) resulted in a significant and meaningful reduction in bacteremia compared with the standard of care (SOC), but cost-effectiveness is unclear. Objective To examine the cost-effectiveness of universal and targeted bathing strategies compared with SOC in general medical and surgical units. Design, Setting, and Participants A decision analytic model was constructed from June 1, 2021, to May 31, 2024, to simulate the frequency of HOB and costs under 3 strategies: SOC, UD, and targeted decolonization (TD). The model included a simulated cohort representative of the cluster-randomized ABATE Infection trial, which involved more than 500 000 participants across the US. Main Outcomes and Measures In TD, decolonization was administered for patients with medical devices only. Upstream costs of bathing and downstream costs of HOB, under payer and hospital perspectives were included. Parameters were informed by the ABATE Infection Trial and additional literature. Willingness-to-pay per HOB prevented was adopted as $25 000 for payers and $10 000 for hospitals. Sensitivity analyses were tailored to populations with different characteristics. Results The simulated cohort, based on the population from the ABATE trial, included 529 000 adult admissions with a mean (SD) age of 63 (18) years, 54% female, and 13% with a central venous catheter, midline catheter, or lumbar drain. In the base case, the SOC was least effective and most costly. Targeted decolonization was least costly and UD resulted in the fewest HOB events. Targeted decolonization was the cost-effective strategy from payer and hospital perspectives. Compared with TD, UD had an incremental cost-effectiveness ratio of $119 700 per HOB averted from the payer perspective, and $126 600 per HOB averted from the hospital perspective. Depending on willingness-to-pay, UD may be preferred in scenarios with a higher proportion of patients with medical devices, greater reductions in HOB from decolonizing in those with devices, and lower adherence under TD. Conclusions and Relevance In this decision analytic model studying universal and targeted bathing, TD was cost-effective under a broad range of scenarios for both hospital system and payer decision-makers. Universal decolonization was cost-effective in some scenarios, such as in specific units where many patients have medical devices or if it were difficult to implement a targeted approach.
Time From Onset to Diagnosis of Alpha-Gal Syndrome
Authors: Caroline K. Maki, Eleanor F. Saunders, Marissa L. Taylor, Scott P. Commins, Lance A. Waller, Johanna S. Salzer
Journal: JAMA Network Open (2025)

This case series investigates trends in time from onset of alpha-gal syndrome to diagnosis among patients with disease onset from 1977 to 2019.
Emergency Care, Hospitalization Rates, and Floods
Authors: Zachary S. Wettstein, Canada Parrish, Amber K. Sabbatini, Matthew H. Rogers, Edmund Seto, Jeremy J. Hess
Journal: JAMA Network Open (2025)

Importance Flooding is a major environmental hazard, with events increasing in intensity and frequency in the context of climate change. Floods cause significant health and economic impacts, particularly among vulnerable populations, including older adults. However, comprehensive analyses of the health consequences of flooding remain limited. Objective To evaluate the morbidity and health care costs among Medicare beneficiaries associated with flood exposure in the US. Design, Setting, and Participants This retrospective cohort study analyzed emergency department (ED) use and unplanned hospitalization among Medicare beneficiaries 65 years or older living in zip code tabulation areas (ZCTAs) that were exposed to large-scale flood events from January 1, 2008, to December 31, 2017. This analysis was conducted from April 3 to December 15, 2023. Exposure The primary exposure was the presence of a flood as recorded in the Multisourced Flood Inventories, a spatially distributed flood database. Main Outcomes and Measures A conditional fixed-effects regression approach was used to explore the incidence of all-case and cause-specific ED visits and hospitalizations before and after floods. The primary outcomes measured were the incident rate ratios (IRRs) and associated 95% CIs. Attributable risk percentages and estimated attributable excess visits were calculated. Stratified analyses were performed for evaluation of effect modification. Health care costs associated with these events were measured and standardized to 2017 US dollars. Results Among 11 801 527 Medicare beneficiaries 65 years or older (mean [SD] age, 74.4 [7.6] years; 56.3% female), the rate of all-cause ED visits and hospital admissions increased by 4.8% (IRR, 1.05; 95% CI, 1.04-1.05) and 7.4% (IRR, 1.07; 95% CI, 1.07-1.08) after flood exposure, respectively. The mean ZCTA-level cost was $3230 (95% CI, $3198-$3261) per ED visit and $11 310 (95% CI, $11 252-$11 367) for hospitalizations. The national costs to the Medicare system were estimated to be $69 275 429 (95% CI, $63 010 840-$76 315 210) for ED visits and $191 409 579 (95% CI, $172 782 870-$206 181 300) for hospitalizations. Stratified analyses highlighted greater impacts for certain demographic groups, including adults older than 85 years, and specific seasonal patterns. Conclusions and Relevance In this cohort study of Medicare beneficiaries 65 years or older, flood exposure was associated with increased health care use and costs, underscoring the need for targeted public health strategies and improved disaster preparedness, especially for older adults. These findings contribute to a more comprehensive understanding of the health-related costs of flooding and can be used to inform future climate change resilience and health care planning.
Post-<i>Dobbs</i> Decision Changes in Obstetrics and Gynecology Clinical Workforce in States With Abortion Restrictions
Authors: Jane M. Zhu, Aine Huntington, K. John McConnell, Allison M. Whelan, Ruby Aaron, Maria I. Rodriguez
Journal: JAMA Internal Medicine (2025)

This case-control study compares the availability of women’s health care clinicians in states that enacted highly restrictive abortion policy after the Dobbs Supreme Court decision vs states that established abortion legislation before the Dobbs decision.
Prostate Cancer
Authors: Ruben Raychaudhuri, Daniel W. Lin, R. Bruce Montgomery
Journal: JAMA (2025)

Importance Prostate cancer is the most common nonskin cancer in men in the US, with an estimated 299 010 new cases and 35 250 deaths in 2024. Prostate cancer is the second most common cancer in men worldwide, with 1 466 680 new cases and 396 792 deaths in 2022. Observations The most common type of prostate cancer is adenocarcinoma (≥99%), and the median age at diagnosis is 67 years. More than 50% of prostate cancer risk is attributable to genetic factors; older age and Black race (annual incidence rate, 173.0 cases per 100 000 Black men vs 97.1 cases per 100 000 White men) are also strong risk factors. Recent guidelines encourage shared decision-making for prostate-specific antigen (PSA) screening. At diagnosis, approximately 75% of patients have cancer localized to the prostate, which is associated with a 5-year survival rate of nearly 100%. Based on risk stratification that incorporates life expectancy, tumor grade (Gleason score), tumor size, and PSA level, one-third of patients with localized prostate cancer are appropriate for active surveillance with serial PSA measurements, prostate biopsies, or magnetic resonance imaging, and initiation of treatment if the Gleason score or tumor stage increases. For patients with higher-risk disease, radiation therapy or radical prostatectomy are reasonable options; treatment decision-making should include consideration of adverse events and comorbidities. Despite definitive therapy, 2% to 56% of men with localized disease develop distant metastases, depending on tumor risk factors. At presentation, approximately 14% of patients have metastases to regional lymph nodes. An additional 10% of men have distant metastases that are associated with a 5-year survival rate of 37%. Treatment of metastatic prostate cancer primarily relies on androgen deprivation therapy, most commonly through medical castration with gonadotropin-releasing hormone agonists. For patients with newly diagnosed metastatic prostate cancer, the addition of androgen receptor pathway inhibitors (eg, darolutamide, abiraterone) improves survival. Use of abiraterone improved the median overall survival from 36.5 months to 53.3 months (hazard ratio, 0.66 [95% CI, 0.56-0.78]) compared with medical castration alone. Chemotherapy (docetaxel) may be considered, especially for patients with more extensive disease. Conclusions and Relevance Approximately 1.5 million new cases of prostate cancer are diagnosed annually worldwide. Approximately 75% of patients present with cancer localized to the prostate, which is associated with a 5-year survival rate of nearly 100%. Management includes active surveillance, prostatectomy, or radiation therapy, depending on risk of progression. Approximately 10% of patients present with metastatic prostate cancer, which has a 5-year survival rate of 37%. First-line therapies for metastatic prostate cancer include androgen deprivation and novel androgen receptor pathway inhibitors, and chemotherapy for appropriate patients.
Genomic Characterization of RSV in the US by Vaccination Status
Authors: Adam S. Lauring, Connor Edson, Diya Surie, Fatimah S. Dawood, Wesley H. Self, Cynthia Lucero-Obusan, Mark Holodniy, Manjusha Gaglani, Cristie Columbus, Jay S. Steingrub, Nathan I. Shapiro, Abhijit Duggal, Laurence W. Busse, Matthew E. Prekker, Ithan D. Peltan, David N. Hager, Amira Mohamed, Matthew Exline, Akram Khan, Ebaad Haq, Jennifer G. Wilson, Jarrod M. Mosier, Nida Qadir, Adit A. Ginde, Nicholas M. Mohr, Christopher Mallow, Emily T. Martin, Estelle S. Harris, Nicholas J. Johnson, Natasha Halasa, James D. Chappell, Jillian P. Rhoads, Yuwei Zhu, Kevin W. Gibbs, Jennie H. Kwon, Ivana A. Vaughn, Basmah Safdar, Kevin Ma, Katharine A. Yuengling, Emily E. Bendall, Leigh Papalambros
Journal: JAMA (2025)

This study examines respiratory syncytial virus (RSV) genomic surveillance results from 2 large US networks after the introduction of RSV vaccines.
Single-cell multi-stage spatial evolutional map of esophageal carcinogenesis
Authors: Jiang Chang, Junting Lu, Qingyi Liu, Tao Xiang, Shaosen Zhang, Yonglin Yi, Dongxu Li, Tianyuan Liu, Zeyuan Liu, Xinjie Chen, Zhenghao Dong, Cainan Li, HanZhang Yi, Siqi Yu, Luwei Huang, Fangfei Qu, Mengdi Wang, Dehe Wang, Hao Dong, Guoyu Cheng, Liang Zhu, Jiachen Li, Chenying Li, Pujie Wu, Xiaoting Xie, Andrew E Teschendorff, Dongxin Lin, Xiaoqun Wang, Chen Wu
Journal: Cancer Cell (2025)

Cancer development involves the co-evolution of cancer cells and their surrounding microenvironment, yet the dynamics of this interaction within the physical architecture remains poorly understood. Here, we present a spatial transcriptomic map at single-cell resolution, encompassing 127 multi-stage fields of view from 43 patients, to chart the evolutionary trajectories of human esophageal squamous cell carcinoma (ESCC). By analyzing 6.4 million cells, we reveal that ESCC progression is driven by a proliferative epithelial cell subpopulation that acquires dedifferentiated and invasive characteristics. At the late precancerous stage, these cells disrupt the epithelial-stromal interface and recruit normal fibroblasts via JAG1-NOTCH1 signaling, transforming them into cancer-associated fibroblasts (CAFs). This interaction leads to the formation of a "CAF-Epi" (CAF and epithelial cell) niche at the tumor edge that shields the tumor from immune surveillance. The CAF-Epi niche formation is a key indicator of progression in ESCC and other squamous cell carcinomas and patient outcomes.