Nevin Manimala

Accid Anal Prev. 2026 Jun 28;235:108642. doi: 10.1016/j.aap.2026.108642. Online ahead of print.

ABSTRACT

Due to the perceptual challenges created by obstructed sight lines, drivers in beyond-line-of-sight (BLOS) scenarios often fail to detect hazards until insufficient stopping distance remains, making these situations particularly hazardous for young drivers with limited hazard anticipation capabilities. While vehicle-to-everything (V2X)-based warning systems offer a promising countermeasure, precisely quantifying the system effectiveness remains a challenge, as previous studies often rely on associational methods with limited ability to isolate causal effects or characterize treatment effect heterogeneity. This study aimed to apply a causal machine learning framework to estimate the effect of a V2X-based BLOS warning system on young driver response and explore potential sources of treatment effect heterogeneity in a data-driven manner. Based on data from a randomized within-subject driving simulator experiment for causal identification, double/debiased machine learning (DML) was used to estimate the average treatment effect, with the estimates further examined through robustness analyses. The analysis revealed that the BLOS warning had a positive and statistically significant effect on overall response quality. Among trials with identifiable response initiation, the warning was also associated with shorter reaction times. To explore treatment effect heterogeneity, a causal forest implemented within the DML framework was applied to estimate the conditional average treatment effects. An exploratory analysis utilizing Shapley additive explanations (SHAP) suggested that the estimated treatment effects were highly state-dependent. The heterogeneity patterns were more strongly associated with drivers’ instantaneous vehicle control states than with other variables, such as static driver characteristics. A subgroup analysis further revealed that the warning benefits were statistically reliable primarily for observations characterized by stable longitudinal control and more active steering correction behavior. These findings highlight the value of incorporating real-time vehicle control states into the design of adaptive advanced driver-assistance systems to improve warning system effectiveness.

PMID:42365749 | DOI:10.1016/j.aap.2026.108642

Eur J Radiol. 2026 Mar 15;203:112755. doi: 10.1016/j.ejrad.2026.112755. Online ahead of print.

ABSTRACT

CONTEXT: There is little published population-based information on variations in the anatomical dimensions of lumbar and thoracic intervertebral discs observed in lateral projection.

PURPOSE: To document the simplified anatomy in lateral projection of intervertebral discs and its association with disability or disease in twenty-four male and female European Populations aged over fifty years.

STUDY SETTING: Within the published European Prospective Osteoporosis Study of Vertebral deformities and fractures.

PATIENT SAMPLES: population-based samples of 10,026 men and women aged over fifty years from fourteen European centres.

OUTCOME MEASURES: dimensional and dimension-free measures from lateral radiographs of the anatomical characteristics of three lumbar and six thoracic intervertebral discs per subject, retrieved trigonometrically from previous digitisations of vertebral body heights measured twice per subject (after excluding subjects with interval vertebral fractures). Each subject also completed at recruitment a nurse-supervised questionnaire that included questions about self-assessed health (5-point scale) and activities of daily living (3-level, 12-point scale).

METHODS: Each participant had two interval lateral radiographs of the thoracic and lumbar spine. Six thoracic discs between thoracic vertebra (T) 4 and T9 and three lumbar discs between L1 and L4 were measured. Disc dimensions were adjusted for magnification when tube-film distance was known. Associations were evaluated between anatomical disc characteristics and the self-reported health outcomes quality of life and activities of daily living.

RESULTS: After adjustment for magnification, there were large variations between populations (as well as between participants) in the disc dimensions anterior, mid- and posterior disc height as well as width. The calculated dimension-free disc indices aspect ratio, wedge angle and convexity also varied significantly between countries as well as between subjects. Indices of spine sinuosity (curvature in the AP plane) calculated separately for discs and vertebrae also varied between countries; whereas sex had smaller effects on sinuosity after allowing for differences in body size between men and women. In contrast to vertebral fractures, none of these dimension-free vertebral disc indices was significantly associated with self-assessed quality of life or activities of daily living in men and women, even when restricted to those over 65 years of age.

CONCLUSIONS: These data showed substantial variations across the continent in the geometric characteristics of the inter-vertebral discs that have implications for future study design. These variations associated more with geographic location than with sex or age. Variations in radiological disc anatomy had no significant statistical associations with two widely used health indices in those over (or under) 65 years.

ADVANCES IN KNOWLEDGE: This is the first large scale descriptive population-based multi-centre anatomical study of admittedly simplified European intervertebral disc anatomy. Its main implications are that the dimensional measures studied vary geographically and (within the ranges commonly encountered) are not common determinants of disability in older people. Nevertheless, for future anatomical case-control studies of intervertebral disc disease, it would be wise to recruit controls who are geographically local to cases to avoid statistical confounding.

PMID:42365740 | DOI:10.1016/j.ejrad.2026.112755

Leg Med (Tokyo). 2026 Jun 19;84:102896. doi: 10.1016/j.legalmed.2026.102896. Online ahead of print.

ABSTRACT

This study aims to evaluate suicide statistics from the Turkish Statistical Institute (TURKSTAT) from 2015 to 2024 in terms of demographic and sociocultural characteristics, while also providing a forensic medicine perspective through comparison with the literature. Suicide data were obtained from TURKSTAT’s “Cause of Death Statistics” database and classified according to age group, sex, marital status, educational level, cause, and method of suicide. The annual crude suicide rate in Türkiye ranged between 3.94 and 5.22 per 100,000 population, with males consistently exhibiting a substantially higher mortality risk than females (6.84 vs. 2.14). Across specific age cohorts, sex-specific suicide rates peaked among young adult males aged 25-29 (11.27) and elderly males aged over 75 (11.98), whereas the highest rate among females was observed in the 15-19 age bracket (4.76). Disease-related factors represented the leading category among specified administrative causes (peaking at 1.31), while hanging emerged as the predominant method, accounting for 47.03% of all cumulative cases. By educational attainment, the highest longitudinal suicide rates over the decade were consistently documented among individuals with lower secondary (up to 8.32) and upper secondary education (up to 7.67). These findings suggest that suicide mortality in Türkiye is associated with a complex interplay of systemic health problems, socioeconomic stressors, and distinct sociodemographic vulnerabilities rather than isolated psychiatric conditions. Consequently, integrating macro-level epidemiological insights and sociocultural dimensions into forensic medical evaluations can support the development of targeted public health interventions and evidence-based preventive policies.

PMID:42365733 | DOI:10.1016/j.legalmed.2026.102896

Int J Nurs Stud. 2026 Jun 15;182:105620. doi: 10.1016/j.ijnurstu.2026.105620. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative thirst in the post-anesthesia care unit is a common symptom that can have adverse physiological and psychological effects. Although various cooling and moisturizing interventions have been shown to alleviate postoperative thirst, their relative effectiveness remains unclear.

OBJECTIVE: To compare the effects of cooling and moisturizing interventions on postoperative thirst relief in patients in the post-anesthesia care unit.

DESIGN: A systematic review and network meta-analysis.

INFORMATION SOURCES: PubMed, Web of Science, CINAHL, EMBASE, and Scopus were systematically searched from inception to January 16, 2026.

METHODS: Two reviewers independently conducted study screening, quality assessment, and data extraction. A random-effects network meta-analysis was undertaken to compare the relative effects of oral cooling and moisturizing interventions on postoperative thirst.

RESULTS: A total of eleven RCTs involving 3098 participants and eight oral interventions were included. The network meta-analysis showed that, compared with the nil by mouth (NPO) control group (i.e., no oral intake or oral intervention), the interventions showing the largest reductions in postoperative thirst intensity were menthol ice (MD = -4.84; 95% CI, -6.42 to -3.26), followed by ice (MD = -4.17; 95% CI, -5.82 to -2.51) and water (MD = -4.07; 95% CI, -5.36 to -2.78). In contrast, citric acid spray, aromatic solution spray, water spray, wet gauze, and wet cotton swab did not show statistically significant reductions in postoperative thirst intensity.

CONCLUSIONS: Menthol ice, ice, and water emerged as the most promising options for reducing postoperative thirst intensity. However, the current evidence remains limited, and further high-quality studies with standardized protocols are needed to confirm these findings.

REGISTRATION: https://www.crd.york.ac.uk/prospero/ CRD42024610113, registered 4/11/2024.

PMID:42365725 | DOI:10.1016/j.ijnurstu.2026.105620

Gen Hosp Psychiatry. 2026 Jun 22;101:159-165. doi: 10.1016/j.genhosppsych.2026.06.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the comparative efficacy and safety of quetiapine versus haloperidol for delirium treatment in hospitalized adults.

DATA SOURCES: Systematic search in MEDLINE (via PubMed), Embase, and Cochrane Central Register of Controlled Trials from inception through February 19, 2026.

STUDY SELECTION: RCTs directly comparing quetiapine and haloperidol for delirium treatment in adult inpatients.

DATA EXTRACTION: Two reviewers independently extracted data and assessed risk of bias using the Cochrane RoB 2 tool. Primary outcome was change in delirium severity (DRS-R-98). Secondary outcomes included ICU and hospital length of stay (LOS), mortality, sleep duration, and extrapyramidal symptoms (EPS).

DATA SYNTHESIS: Four RCTs comprising 292 patients were included. No significant difference was found in delirium severity reduction (MD, -1.99; 95% CI, -4.70 to 0.72; p = 0.15; I² = 73.6%), ICU LOS (MD, -0.84 days; 95% CI, -2.30 to 0.62), hospital LOS (MD, -0.06 days; 95% CI, -2.32 to 2.19), or mortality (RR, 0.68; 95% CI, 0.35 to 1.34). Quetiapine showed non-significant trends toward fewer EPS (RR, 0.14; 95% CI, 0.02 to 1.06) and increased sleep duration (MD, 1.59 h; 95% CI, -0.45 to 3.63). TSA indicated the required information size was not reached.

CONCLUSIONS: Quetiapine and haloperidol show no statistically significant differences in efficacy or safety for delirium management. GRADE certainty was very low for all outcomes, and TSA confirmed the evidence is inconclusive due to sparse data and imprecision. The absence of statistical significance should not be interpreted as equivalence. Selection should be individualized based on individual patient risk profiles and adverse-effect susceptibility until adequately powered trials are available.

PMID:42365709 | DOI:10.1016/j.genhosppsych.2026.06.005

Comput Methods Programs Biomed. 2026 Jun 9;285:109508. doi: 10.1016/j.cmpb.2026.109508. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Early identification of carotid atherosclerosis (CAS) is critical for preventing cardio-cerebrovascular diseases. Mainstream screening methods (e.g. ultrasound, CTA) are operator-dependent and high cost. This study aimed to propose a novel non-contact facial imaging photoplethysmography (iPPG) approach for CAS risk assessment.

METHODS: A total of 95 middle-aged and elderly participants were enrolled, with synchronous facial iPPG signals and carotid/lower-extremity ultrasound data collected. A deep learning-based Period-aware Autoencoder (PA-AE) with bidirectional cross-modal attention was developed to reconstruct high-fidelity iPPG signals with periodic peak constraint and full-face reference signal fusion for robust noise suppression. Facial hemodynamic heatmaps were generated via signal-to-spatial mapping, interquartile range-based outlier removal, and spatial proximity repair. We analyzed the association between heatmap patterns and atherosclerosis using Pearson chi-square tests and Odds Ratios (OR).

RESULTS: The PA-AE outperformed traditional wavelet and LSTM-AE methods in signal periodicity preservation and noise reduction. The Type 3 facial iPPG heatmap (characterized by ≤ 20% red area distributed in the facial periphery) was significantly associated with carotid atherosclerosis (P=0.048), whereas no association was observed for lower extremity atherosclerosis (P=0.674). After adjusting for age, BMI, and hypertension in multivariable logistic regression, heatmap Type 3 still showed a positive trend with CAS (adjusted OR=2.29, 95%CI: 0.56-9.41), and robust statistical analyses including stratified analyses (age < 65 and non-hypertensive subgroups), ridge regression, and continuous red-area ratio quantification consistently confirmed this significant association.

CONCLUSIONS: Facial iPPG heatmaps, enhanced by the PA-AE, demonstrate significant potential as a non-invasive tool for identifying CAS risk, offering a promising avenue for accessible community healthcare screening.

PMID:42365708 | DOI:10.1016/j.cmpb.2026.109508

Midwifery. 2026 Jun 23;161:104901. doi: 10.1016/j.midw.2026.104901. Online ahead of print.

ABSTRACT

PROBLEM: Many midwives experience emotional distress, low morale and job dissatisfaction, and are making the decision to leave the profession as a result.

BACKGROUND: There is limited evidence on how resilience shapes midwives’ career experiences, choices, and trajectories, particularly during early exposure to workplace stress and dissatisfaction.

AIM: To conduct a UK based study to explore midwives’ and student midwives’ perceptions, attitudes, and experiences of the influence of resilience in relation to any decisions they make about their careers.

METHODS: A constructivist grounded theory design was used to explore the influence of resilience on midwives’ and student midwives’ career-related decisions. Thirty-six participants recruited from three NHS Trusts in the North of England took part. A purposive and theoretical sampling approach using individual semi-structured interviews between 2019 and 2021 was adopted.

FINDINGS: The influence of resilience in relation to any career-related decisions participants’ made, resulted in the substantive grounded theory (GT), ‘Time to change’. ‘Time to Change’ developed comprising four core concepts: ‘Fitting in’, ‘Being valued,’ ‘Feeling in control’ and ‘Getting the balance right’. Central to the theory was the importance of confidence, experience, and perceived support on fluctuating levels of resilience, and midwives’ subsequent ability to make career-related decisions.

DISCUSSION: Participants’ perceived resilience, alongside a number of other influences, has a significant role in midwives’ career-related decisions.

CONCLUSION: The findings provide novel insight into the influence of resilience in midwifery that has relevance for the profession and the potential to inform midwifery policy, practice, and education for the future.

PMID:42365685 | DOI:10.1016/j.midw.2026.104901

Midwifery. 2026 Jun 19;161:104900. doi: 10.1016/j.midw.2026.104900. Online ahead of print.

ABSTRACT

BACKGROUND: Low paternal self-efficacy in essential newborn care has been associated with reduced father involvement in caregiving and weaker father-infant attachment.

OBJECTIVE: This study aimed to evaluate the effects of essential newborn care training, delivered through different instructional methods, on paternal self-efficacy and father-infant attachment.

DESIGN: A prospective, three-arm randomized controlled trial with a pre-test-post-test design was conducted using a 1:1:1 allocation ratio.

PARTICIPANTS: First-time fathers residing in [xxx Province] were recruited through the obstetrics and gynecology department during the early postnatal (neonatal) period and randomly assigned to one of three groups (n = 25 per group): web-based, face-to-face, or control.

METHODS: This randomized controlled trial included three groups: web-based, face-to-face, and control. Fathers in the intervention groups received essential newborn care training either via an online platform or through in-person sessions, while the control group received routine care. Data were collected at baseline and after the intervention using validated measurement tools assessing paternal self-efficacy and father-infant attachment. Descriptive statistics summarized the data: categorical variables were presented as frequencies and percentages, while continuous variables were expressed as means, standard deviations, and minimum-maximum values. Group homogeneity was evaluated using the Pearson chi-square test or Fisher’s exact test for categorical variables, and one-way ANOVA for continuous variables. The Shapiro-Wilk test assessed normality. Intergroup differences were analyzed using one-way ANOVA. Intragroup changes over time were assessed with repeated measures one-way ANOVA. A two-way repeated measures ANOVA assessed the interaction effects of group and time.

RESULTS: The mean age of the fathers ranged from 30.45 ± 4.80 to 32.04 ± 5.02 years across the groups, with no significant difference between groups (p > 0.05). Data from 73 participants were included in the final analysis. Following the newborn care training, paternal self-efficacy, and father-infant attachment levels significantly increased in both the web-based (p < 0.05) and face-to-face (p < 0.05) intervention groups compared to the control group. Paternal self-efficacy levels in the web-based group were significantly higher than in both the face-to-face and control groups.

CONCLUSION: Web-based newborn care education programs appear to be effective in increasing paternal self-efficacy and father-infant bonding.

PMID:42365684 | DOI:10.1016/j.midw.2026.104900

Environ Int. 2026 Jun 25;214:110383. doi: 10.1016/j.envint.2026.110383. Online ahead of print.

ABSTRACT

BACKGROUND: Gestational exposure to environmental chemicals contributes to adverse neurodevelopmental outcomes in children. We aim to evaluate the joint associations between gestational chemical biomarkers and behavioral functioning in preschool-aged children.

METHODS: We pooled data from 695 mother-child dyads (female, n = 353; male, n = 342) enrolled in the Health Outcomes and Measures of the Environment (HOME) & Maternal-Infant Research on Environmental Chemicals (MIREC) Studies. We assessed concentrations of 29 EDC biomarkers at gestation and assessed the child’s behavior and executive functioning at 3 years using the Behavioral Assessment System for Children (BASC-2) and Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Higher scores on these instruments indicate adverse behavioral outcomes. We applied quantile g-computation to estimate joint associations, adjusting for covariates.

FINDINGS: Every quartile increase in chemical biomarker mixture was associated with a 0.84-point higher behavior symptom index score (95% CI: -0.89, 2.57), 1.38-point higher externalizing behavior score (95% CI: -0.65, 3.41), and 1.34-point higher internalizing behavior score (95%CI: -0.97, 3.65); these associations were imprecise with confidence intervals including null. Although the interaction by child sex remained null (p = 0.69) for internalizing behavior scores, gestational chemical mixture was associated with higher internalizing behavior scores in males (Ψ: 3.59; 95%CI: 0.42, 6.75), but not in females. We found evidence of sex-specific trends for working memory scores (interaction p = 0.02), with an imprecise positive trend in males (Ψ: 3.04; 95%CI: -0.46, 6.55) and a negative trend in females.

INTERPRETATION: Gestational exposure to a mixture of environmental chemicals showed suggestive but imprecise associations with internalizing problems and poorer working memory among preschool-age males, but not females. Associations were more pronounced in the HOME Study, which includes participants with higher concentrations for many chemical biomarkers, than in MIREC, raising the possibility that pooled estimates reflect cohort-specific exposure contexts. Sex-specific patterns, particularly for working memory, need further investigation, and our findings should be interpreted cautiously given the imprecision of subgroup estimates.

PMID:42365676 | DOI:10.1016/j.envint.2026.110383

J Gastrointestin Liver Dis. 2026 Jun 27;35(2):181-188. doi: 10.15403/jgld-6740.

ABSTRACT

BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) case reports provide rich longitudinal insights but have rarely been analyzed using quantitative text-mining approaches. This study applied unsupervised machine learning to PubMed-indexed IBD case reports to identify long-term thematic structures spanning 60 years and evaluate whether major historical milestones in IBD care can be reconstructed from biomedical texts.

METHODS: Case reports indexed under the keyword “inflammatory bowel disease” were retrieved from PubMed (1960-2025). Titles, key words, and abstracts were concatenated and preprocessed before TF-IDF vectorization. Non-negative matrix factorization (NMF) was applied to extract latent topics, followed by KMeans clustering using the optimal topic number selected by silhouette evaluation (2-15 topics). Cluster characteristics were summarized using report counts and term frequency-inverse document frequency (TF-IDF) statistics. Top discriminative key words were used to assign data-driven topic labels. All analyses were performed in Python 3.10.5 (PyCharm 2022.1.3) using pandas, numpy, scikit-learn, matplotlib, and seaborn.

RESULTS: A total of 18,458 case reports were analyzed. Across all time periods, two highly stable clusters consistently emerged, corresponding to Crohn’s disease and ulcerative colitis. Early decades (1960-1989) emphasized pathology and complication-focused descriptions. Reports from the 1990s showed increasing terminology related to diagnosis and emerging therapies. From 2000 onward, infliximab-related and treatment focused terms predominated, paralleling the rise of biology. After 2010, clusters reflected diversified therapeutic strategies, including attention to extraintestinal manifestations and biologic or small-molecule therapies.

CONCLUSIONS: Unsupervised machine learning successfully reconstructed important historical changes in IBD management, demonstrating that a large case report text corpus captures the evolution of clinical concepts and treatment paradigms over 60 years.

PMID:42365648 | DOI:10.15403/jgld-6740