Nevin Manimala

Environ Int. 2026 May 15;212:110306. doi: 10.1016/j.envint.2026.110306. Online ahead of print.

ABSTRACT

p-Phenylenediamines (PPDs) are widely used as antioxidants in tire formulations and are released to the environment via tire wear, where they can be transformed into more toxic p-phenylenediamine-derived quinones (PPD-Qs). Despite growing recognition of their environmental importance, information on the occurrence and behavior of these compounds in farmland soils remains limited. In this study, 122 surface soil samples were collected from agricultural regions across China to quantify six PPDs and five PPD-Qs and to examine their spatial patterns, sources, transformation drivers, and potential risks. The PPD and PPD-Q compounds were detected in all samples, with national mean concentrations of 1.02 and 0.28 ng/g, respectively. Spatially, the ΣPPD concentrations were 0.19‒4.93 ng/g in southern China and 0.13‒4.13 ng/g in northern China, while the ΣPPD-Q concentrations were 0.06‒1.37 ng/g in southern China and 0.03‒1.48 ng/g in northern China. 6PPD and 6PPD-Q were the dominant congeners, indicating strong inheritance from parent compounds to transformation products. Source apportionment implicates both direct inputs from agricultural rubber materials and indirect inputs via atmospheric transport of industrial rubber-derived emissions. Conventional statistical approaches together with non-linear dependence analyses identified sunshine duration and soil total organic carbon (TOC) as key factors influencing their composition and transformation. Risk assessment showed that current non-carcinogenic human and ecological risks were within acceptable limits. These findings advance understanding of the environmental occurrence and transformation of PPDs and PPD-Qs in agricultural soils and highlight key factors relevant to their management and risk control.

PMID:42172717 | DOI:10.1016/j.envint.2026.110306

Vaccine. 2026 May 22;86:128737. doi: 10.1016/j.vaccine.2026.128737. Online ahead of print.

ABSTRACT

BACKGROUND: Pregnant and lactating women face heightened risk of mortality due to Ebola disease during outbreaks, yet have historically been excluded from vaccine trials and emergency vaccination campaigns. This study assessed willingness to receive an Ebola vaccine and identified associated factors among pregnant and lactating women in Kampala-Uganda, in the aftermath of the 2022 Sudan ebolavirus outbreak and amid the COVID-19 pandemic.

METHODS: A cross-sectional survey was conducted in 2023 among pregnant/lactating women receiving antenatal/postnatal services at Kawempe National Referral Hospital. Data were collected using a structured questionnaire adapted from the WHO SAGE Working Group on Vaccine Hesitancy and included additional items on Ebola vaccine attitudes, socio-demographics, prior vaccination experiences, vaccine preferences (oral vs injectable) and health status, including chronic illness. The primary outcome was willingness to receive an Ebola vaccine. Modified Poisson regression was done using STATA version 15 and a p-value <0.05 was considered statistically significant.

RESULTS: Among 424 participants (212 pregnant, 212 lactating), 252(59.4%) expressed willingness to receive an Ebola vaccine. In multivariable analysis, willingness was significantly associated with previous COVID-19 vaccination (adjusted Prevalence Ratio [aPR] = 1.32; 95%CI:1.02-1.70) and a preference for injectable vaccines only, compared to those open to oral or injectable modes (aPR = 1.54; 95%CI:1.18-2.00). Among those who were unwilling or unsure (n = 172), the most cited reasons for hesitancy were fear of side effects (22.1%) and lack of awareness about Ebola vaccines (20.3%).

CONCLUSION: While just over half of the pregnant and lactating women in this study were willing to receive an Ebola vaccine, concerns about safety and limited awareness remain important barriers. Prior COVID-19 vaccination and preference for injectable vaccines were positively associated with willingness, suggesting that trust and familiarity with vaccination influence acceptance. Tailored risk communication and community engagement, and inclusion in vaccine planning are essential to ensuring equitable protection during EVD outbreaks.

PMID:42172692 | DOI:10.1016/j.vaccine.2026.128737

JMIR Form Res. 2026 May 22;10:e83918. doi: 10.2196/83918.

ABSTRACT

BACKGROUND: Unplanned hospital readmissions represent a critical operational and financial challenge for health care systems in the United States, with 3.8 million 30-day all-cause readmissions in 2018 at an average cost of US $15,200 each, totaling US $58 billion in costs. Many published prediction models rely on comprehensive information (eg, full billing abstractions, discharge summaries, laboratory tests, and vitals) that becomes available only late in the encounter, limiting usefulness for real-time, in-hospital intervention. This creates a timeliness-accuracy trade-off: models that are most accurate retrospectively may arrive too late to act upon.

OBJECTIVE: This study tests whether a clinically meaningful predictive signal for 30-day all-cause readmission is present within a limited set of structured clinical codes recorded during the patient’s hospital stay. This approach evaluates whether predictive signals are retained when using a restricted set of structured clinical codes.

METHODS: We conducted a retrospective comparative modeling study using a large, deidentified electronic health record dataset of 50,000 inpatient encounters from the 2019 New York State Emergency Department Database. Two feature sets were constructed: (1) a limited set consisting of the first 5 ICD-10 (International Classification of Diseases, 10th Revision) diagnosis codes, the first 5 Current Procedural Terminology (CPT) codes, and Charlson Comorbidity Index (CCI; 11 input features); and (2) a rich set using all available ICD-10 and CPT codes plus CCI (up to 135 input features). We trained 4 models: random forest, CatBoost, multilayer perceptron, and DistilBERT (a distilled Bidirectional Encoder Representations from Transformers [BERT] model; structured codes mapped to text and tokenized with DistilBERT-base-uncased). Evaluation used an untouched hold-out set of 10,000 encounters, preserving the natural 21.1% readmission prevalence. Primary metrics were area under the receiver operating characteristic curve (AUROC), F1-score, and accuracy. To address class imbalance, the training split only was balanced via undersampling of the majority class and bootstrap oversampling of the minority class; validation/test distributions were left unchanged.

RESULTS: Models trained on the limited feature set achieved AUROC values ranging from 0.5369 to 0.5596 and F1-scores from 0.2555 to 0.3434. Across 3 of 4 architectures, models trained on the limited feature set matched or exceeded the discrimination of their rich counterparts. The best model (random forest, limited) achieved an area under the curve AUROC 0.5596 (95% CI 0.5440-0.5739) compared to the best performing rich model (DistilBERT) at 0.5703 (95% CI 0.5565-0.5842), an absolute difference of 0.0107. The highest F1-score (0.3434) was achieved by DistilBERT on the limited feature set. Differences across architectures were small in absolute terms, with threshold-dependent metrics (eg, F1-score) being comparable.

CONCLUSIONS: The findings suggest that models using a limited set of structured clinical codes can achieve performance comparable to those using more comprehensive coding information.

PMID:42172660 | DOI:10.2196/83918

J Trauma Acute Care Surg. 2026 Jun 1;100(6):915-921. doi: 10.1097/TA.0000000000004941. Epub 2026 May 22.

ABSTRACT

OBJECTIVES: Pediatric thoracolumbar spinal injuries (TLSIs) are rare and uncommonly require intervention. In adults, plain x-ray is not adequate to screen for spinal injury. In children, plain film utilization for screening is variable and supportive evidence is lacking. Liberal CT screening for TLSI in children results in significant unnecessary radiation exposure. We investigated the utility of plain x-rays and physical exam (PE) to screen children for TLSI.

METHODS: Children aged 1 to 18 years with MRI or CT-confirmed TLSI presenting to one of five Level 1 pediatric trauma centers between 2017 and 2022, who had a plain film involving the injured spine, were identified. ICD10 codes for injuries, imaging types, intervention (surgery or bracing), age, mechanism, BMI, fracture type (thoracic, lumbar, both), comorbidities, PE findings, and type of radiograph (spine, chest, abdomen) were identified and compared.

RESULTS: Two hundred thirty-two children with MRI or CT-confirmed TLSI and plain x-rays were identified (46% thoracic, 34.9% lumbar, 18.1% both). 57.3% (n=133) of patients underwent dedicated spine radiographs, while the others had only chest (n=87, 37.5%) or only abdominal (n=10, 4.3%) radiographs. In total, 13.79% of patients underwent surgery, 43.9% required bracing, and the remaining had no intervention. Of the patients with dedicated spine films, x-rays alone were 82.7% sensitive for injury and 100% sensitive for injury needing surgery. Patients with lumbar spine injuries who had positive spine x-rays and suspicious PE findings were significantly more likely to require intervention (p<0.0001). No child with a normal spinal x-ray in the lumbar region required intervention, regardless of PE findings.

CONCLUSIONS: In this retrospective study, dedicated spinal x-rays combined with PE reliably excluded >99% of all injuries and 100% of injuries requiring intervention. These findings suggest children can be effectively screened for TLSI with PE and spinal x-rays, reserving cross-sectional imaging for positive x-ray findings and persistent PE findings on repeat exam. (J Trauma Acute Care Surg. 2026;100:915-921.

LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III.

PMID:42172649 | DOI:10.1097/TA.0000000000004941

JMIR Hum Factors. 2026 May 22;13:e81377. doi: 10.2196/81377.

ABSTRACT

BACKGROUND: The usability of electronic health records influences patient safety, clinical efficiency, and the sustainable digital transformation of health care. While tools such as the System Usability Scale exist, few are based on structured software quality models or align with local regulatory frameworks, particularly in low- and middle-income countries.

OBJECTIVE: This study aims to develop and psychometrically validate an instrument to assess electronic health record usability, based on the ISO 25010 (International Organization for Standardization) quality model, and in accordance with the Peruvian Technical Health Standard (Norma Técnica de Salud [NTS]).

METHODS: A 3-stage methodological study was conducted following COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) guidelines. First, a 23-item instrument was developed, grouped into 7 usability dimensions based on ISO 25010. Second, content validity was assessed using a modified Delphi method with 10 experts, using Aiken’s V coefficient. Third, structural validity and reliability were evaluated in 115 participants (physicians, nurses, and administrative staff) using confirmatory factor analysis and Cronbach α. Additionally, the module’s functional compliance with the NTS was verified.

RESULTS: The instrument demonstrated excellent psychometric properties among 115 participants (53 physicians, 48 nurses, and 14 administrative staff); high content validity (Aiken’s V=0.95; 95% CI 0.84-0.98), excellent internal consistency (α=.968), and optimal factor fit (Comparative Fit Index=1.000; Tucker-Lewis Index=1.001). Overall usability was perceived as very high by 94 of 115 users (81.7%), and high by 21 of 115 users (18.3%), with no perceptions at lower levels. The module met 28 of 35 requirements (80%) of the Peruvian Technical Health Standard. Administrative staff reported higher satisfaction (13/14, 93% rated it as very high) compared with clinical professionals (81/101, 80% rated it as very high), particularly in the dimensions of error protection and operability.

CONCLUSIONS: This study provides the first fully psychometrically validated instrument in Spanish based on ISO 25010, System Usability Scale, and other theoretical foundations for evaluating the usability of information systems. The results highlight the importance of considering both international standards and local regulatory requirements (NTS) in the design of digital health systems. The instrument is applicable in Spanish-speaking contexts and can serve as a reference for future usability evaluations in the region as well as in low- and middle-income countries.

PMID:42172648 | DOI:10.2196/81377

Medwave. 2026 May 22;26(4):e3085. doi: 10.5867/medwave.2026.04.3085.

ABSTRACT

OBJECTIVE: Plantar fasciitis is common and impairs people’s ability to move. Manual therapy is frequently used to treat plantar fasciitis. However, its effects are inconclusive. For this reason, the purpose of this systematic review is to determine the effect of manual therapy on plantar fasciitis.

METHODS: A systematic review of the literature was conducted, following the PRISMA checklist. Five databases (CINAHL, Scopus, PubMed, Web of Science, and OVID) were searched, along with a review of the gray literature and a manual search. Randomized clinical trials from 2014 to 2024 were selected that examined the efficacy of manual therapy in reducing pain intensity and improving function in patients aged 18 to 60 years with a clinical diagnosis of plantar fasciitis. Methodological quality (PEDro scale) and risk of bias (risk of bias scale) were assessed.

RESULTS: Four randomized clinical trials (n = 224) were included, reporting controversial statistical differences in pain and function. In addition, two studies reported clinically relevant changes favoring manual therapy. PEDro scale scores ranged from 4 to 6, and three studies presented a high risk of bias.

CONCLUSIONS: The effects of manual therapy on pain and function in patients with plantar fasciitis are uncertain. The evidence is limited, heterogeneous, and lacking in methodological rigor. A larger number of randomized clinical trials with more consistent, replicable protocols are needed to determine the contributions of manual therapy to improving pain and function in patients with plantar fasciitis. Similarly, the inconsistency and limited evidence on indicators of clinical significance in the selected studies preclude an assessment of the clinical impact of this intervention.

PROSPERO REGISTRATION: CRD42024501550.

PMID:42172644 | DOI:10.5867/medwave.2026.04.3085

JMIR Public Health Surveill. 2026 May 22;12:e80359. doi: 10.2196/80359.

ABSTRACT

BACKGROUND: Sudden death due to cardiorespiratory arrest has a high mortality rate and often occurs outside hospital settings. Prompt initiation of cardiopulmonary resuscitation (CPR) by bystanders, along with the use of an automated external defibrillator (AED), has been shown to double survival rates. Given the challenges of ensuring timely emergency response in rural areas, implementing basic CPR training programs can help improve survival outcomes.

OBJECTIVE: This study aimed to evaluate the effectiveness of online CPR-AED training delivered to participants from a rural area of Camp de Tarragona.

METHODS: This quasi-experimental study consisted of 2 phases: phase 1, evaluation of the effectiveness of online training on CPR-AED knowledge (with pretest and posttest assessments), and phase 2, evaluation of the effectiveness of online training on CPR-AED maneuvers through simulation at 1 month and 6 months after online training. The sample of the study comprised residents in a rural area of Tarragona, Spain. A descriptive statistical analysis of the study population was conducted. For quantitative data with a nonnormal distribution, the median and IQR were presented. Categorical data were described as frequencies and percentages. A bivariate analysis was performed to compare the pretraining and posttraining quantitative variables using the Student 2-tailed t test.

RESULTS: In total, 55 participants were included in the study. Of these, 74.5% (n=55) were women, the mean age was 41.5 (SD 9.1) years, and 94.5% (n=55) were employed. Overall, 52 participants completed the online training. The median time required to complete the course was 261.5 (IQR 935; range 125-327) minutes. In total, 51 participants took part in the first practical simulation, which was conducted 1 month after the theoretical training. The mean score obtained in this first simulation was 7.5 out of 10. Six months after the theoretical training, 46 participants completed a second simulation.

CONCLUSIONS: Online CPR-AED training is effective in improving CPR-AED knowledge and skills in a rural population in the short and medium term.

PMID:42172642 | DOI:10.2196/80359

JMIR Mhealth Uhealth. 2026 May 22;14:e79002. doi: 10.2196/79002.

ABSTRACT

BACKGROUND: Parental oral health education is critical for preventing early childhood caries. However, few interventions are theoretically grounded or use digital approaches.

OBJECTIVE: The objective of this study was to evaluate the effects of a health belief model-based digital intervention on maternal oral health behaviors.

METHODS: This quasi-experimental study enrolled 648 mother-child dyads from 19 community health care centers (CHCs) in Beijing, China. CHCs were allocated to intervention or control groups depending on their voluntary adoption of the dental referral system. Ten CHCs (n=332, 52.6%) were assigned to the intervention group, where mothers received oral health education materials and had access to a dental referral system. The remaining 9 CHCs (n=316, 47.4%) served as the control group, in which mothers continued to receive standard child health care services. The primary outcome was parent-assisted toothbrushing, and the secondary outcome included other oral health behaviors, including night feeding practices, sugar intake, and dental visits. To evaluate the intervention effects on behavioral outcomes, generalized linear mixed models were used, accounting for repeated measures and potential confounding factors.

RESULTS: Compared with the control group, the intervention group demonstrated a significant increase in parent-assisted toothbrushing, with an absolute difference of 10.3 (95% CI 3.0 to 17.6; P=.006) percentage points at 6 months and 1.5 (95% CI -7.2 to 10.1; P=.74) percentage points at 12 months. Additionally, dental visit rates were significantly higher in the intervention group at 12 months (odds ratio 4.65, 95% CI 1.30 to 16.70; P=.02). However, no statistically significant differences were observed between groups in nighttime feeding cessation or sugar intake control at either the 6- or 12-month follow-ups.

CONCLUSIONS: The health belief model-based digital intervention was effective in the short term for enhancing parent-assisted toothbrushing in young children, but its long-term effectiveness remains unproven. Future research should therefore prioritize exploring sustainability strategies.

PMID:42172639 | DOI:10.2196/79002

Int J STD AIDS. 2026 May 22:9564624261449133. doi: 10.1177/09564624261449133. Online ahead of print.

ABSTRACT

BackgroundReports on bladder cancer among people living with HIV (PLWH) are very limited. In this case series, we investigated the clinical characteristics, pathology, treatments, adjuvant therapy, and survival of bladder cancer in PLWH.MethodsThis case series identified all PLWH treated for bladder cancer at our institution between 2013 and 2023 through review of medical records. Clinical data were presented as descriptive statistics. We estimated median and 1-, 3-, and 5-years cancer-specific survival using the Kaplan-Meier method and conducted univariate Cox analyses to evaluate variables associated with cancer-specific survival.ResultsTwenty PLWH underwent treatment for bladder cancer during the study period. All patients were male with a median age of 56 years. Radical cystectomy was performed in four patients (20%) and transurethral resection of bladder tumor in sixteen (80%). Adjuvant immunotherapy (tislelizumab) combined with chemotherapy (gemcitabine and cisplatin) was used in six patients after radical cystectomy. In the Kaplan-Meier analysis, the 1-, 3-, and 5-years cancer-specific survival rates of the cohort were 85%, 65%, and 60%, respectively. In univariate analysis, higher tumor stage (stage >T1 vs T1) was significantly associated with cancer-specific survival.ConclusionsGiven the relatively young age and aggressive pathological features observed in this case series, further research is warranted to determine whether targeted screening in PLWH could be beneficial. Limited data preliminarily suggest that intravesical chemotherapy with pirarubicin and adjuvant immunotherapy combined with chemotherapy may be safe and effective options for PLWH with bladder cancer; however, these observations require validation in larger studies. PLWH with muscle-invasive bladder cancer appear to have poorer cancer-specific survival.

PMID:42172635 | DOI:10.1177/09564624261449133

J Med Internet Res. 2026 May 22;28:e83087. doi: 10.2196/83087.

ABSTRACT

Using a crowdsource model, we developed CycleTrack, a web-based platform that tracks and aggregates medical school application data in real-time. From May 2022 to January 2026, 34,763 users registered on the platform, of whom 20,354 tracked a cumulative 415,837 doctor of medicine (MD), MD-doctor of philosophy (PhD), doctor of osteopathic medicine (DO), and DO-PhD applications. The volume of applications tracked per program strongly correlated with the total number of applications reported in official data from the Association of American Medical Colleges and American Association of Colleges of Osteopathic Medicine (Spearman ρ≥0.91; P<.001); however, statistically significant differences in demographics, grade point average, and Medical College Admission Test (MCAT) scores were observed between CycleTrack users and national averages. Despite this, the CycleTrack database accurately captured the cadence of interview invitations from the Northwestern University and University of Michigan MD programs. Aggregated data from the CycleTrack database offered a glimpse into application cycle dynamics, such as demonstrating the relatively longer DO interview cycle compared to MD and MD-PhD programs. Use data from CycleTrack suggest demand for open and transparent information about statistics and timing of admissions decisions among medical school applicants.

PMID:42172634 | DOI:10.2196/83087