Nevin Manimala

J Nurs Adm. 2026 Mar 1;56(3):148-154. doi: 10.1097/NNA.0000000000001699. Epub 2026 Feb 3.

ABSTRACT

OBJECTIVE: Describe qualitative factors explaining why newly licensed nurses (NLNs) intend to stay or leave clinical practice.

BACKGROUND: One in 3 NLNs will leave nursing within 1 year of entry into practice. Understanding factors related to NLN retention is imperative to address workforce shortages.

METHODS: Descriptive statistical analysis of demographics and qualitative analysis of 3 open-ended survey questions, from a larger study, distributed via email through Listservs for NLNs licensed ≤5 years.

RESULTS: One hundred twenty NLNs responded. Themes for intent to stay are cultural fit, schedule, and being a part of a healthy work environment. Reasons for intent to leave include work environment, current treatment of nurses, and personal well-being.

CONCLUSIONS: Flexibility, appreciation, and healthy work environments are factors valued by NLNs when determining their intent to stay or leave nursing. Younger NLNs place greater emphasis on work-life balance, salary, and support. Nurse administrators play a pivotal role in influencing factors that have been identified to enhance NLN retention.

PMID:41706517 | DOI:10.1097/NNA.0000000000001699

JAMA Psychiatry. 2026 Feb 18. doi: 10.1001/jamapsychiatry.2025.4638. Online ahead of print.

ABSTRACT

IMPORTANCE: Depression most commonly first emerges during adolescence, making early prevention critical. While school-based mindfulness training (SBMT) offers a scalable prevention approach with broad reach, evidence of its effectiveness is mixed, and there is a compelling case for a more personalized approach to prevention.

OBJECTIVE: To develop a data-driven algorithm from baseline characteristics to predict which adolescents are most likely to benefit from SBMT.

DESIGN, SETTING, AND PARTICIPANTS: The My Resilience in Adolescence (MYRIAD) cluster randomized clinical trial was conducted from October 2016 to July 2018. In this secondary analysis, school-level nested cross-validation was used to train and evaluate machine learning models for predicting individualized benefit from SBMT. Participants were students aged 11 to 13 years at baseline from broadly representative secondary schools across England, Scotland, Wales, and Northern Ireland. Data analysis was performed from April 2023 to October 2025.

INTERVENTIONS: SBMT teaching core mindfulness skills through psychoeducation, class discussion, and practices, compared with standard social-emotional learning (teaching as usual).

MAIN OUTCOMES AND MEASURES: Change in depressive symptoms from preintervention to postintervention measured by the Center for Epidemiologic Studies Depression scale. Causal forest (CF) and elastic net regression (ENR) models computed personalized advantage index scores quantifying individual expected benefit from SBMT vs teaching as usual.

RESULTS: Among 8376 adolescents from 84 UK secondary schools, the mean (SD) age at baseline was 12.2 (0.6) years; there were 4509 (54.9%) female participants and 3547 (43.2%) male participants. CF showed acceptable calibration (mean [SE] best linear predictor slope = 0.78 [0.15]), while ENR demonstrated modest predictive performance (r = 0.29; R2 = 0.09; root mean square error = 10.3). Both the CF and ENR models identified a subset of adolescents predicted to benefit from SBMT, but group differences in outcomes were negligible (CF: d = 0.07; 95% CI, 0.02-0.12; P = .007; ENR: d = 0.08; 95% CI, 0.02-0.13; P = .004). Top predictive features from the CF model were symptom severity (eg, low-to-moderate depression and anxiety predicted greater SBMT benefit) and several school factors with nonlinear patterns. ENR emphasized school-level characteristics with minimal differentiation.

CONCLUSIONS AND RELEVANCE: This study found that machine learning identified a subgroup with statistically detectable but clinically trivial differential intervention response. These findings highlight the substantial challenges in achieving clinically useful personalization in universal school-based prevention programs.

TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN86619085.

PMID:41706471 | DOI:10.1001/jamapsychiatry.2025.4638

JAMA Surg. 2026 Feb 18. doi: 10.1001/jamasurg.2025.6741. Online ahead of print.

ABSTRACT

IMPORTANCE: The initial treatment by emergency medical services (EMS) significantly affects the outcomes for severely injured patients. Effective control of hemorrhage, proper administration of blood products, and adherence to traumatic brain injury guidelines can reduce morbidity and mortality after trauma. Additionally, the experience of prehospital clinicians in high-acuity nontrauma conditions is associated with improved outcomes.

OBJECTIVE: To evaluate the association of annual trauma patient volume and outcomes at the individual EMS clinician level.

DESIGN, SETTING, AND PARTICIPANTS: A secondary subset analysis was performed of the Linking Investigations in Trauma and Emergency Services (LITES) Task Order 1 study, a prospective observational cohort from 2017 to 2021. It includes severely injured patients, identified by an Injury Severity Score of 9 or higher, who were transported to a trauma center by 1 air and 1 ground agency. Data were analyzed from February 2023 to June 2024.

EXPOSURES: EMS crew mean 3-year adult trauma volume and 6-hour mortality and several EMS industry quality metrics.

MAIN OUTCOMES AND MEASURES: Patient-level risk-adjusted regression models were constructed to determine the association between EMS crew mean 3-year adult trauma volume and 6-hour mortality and several EMS industry quality metrics. The association of airway success metrics and procedural intubation volume was also assessed.

RESULTS: A total of 6769 patient-clinician interactions involving 359 clinicians and 3649 patients (median [IQR] age, 54 [33-70] years; 2490 male [68.2%]) were included in this study. For every increase of 5 adult trauma patients annually per crew, there was a 10% decrease in 6-hour mortality (adjusted odds ratio [aOR], 0.899; 95% CI, 0.811-0.996) and a 2.6% decrease in in-hospital mortality (aOR, 0.974; 95% CI, 949-0.999). In subgroup analyses including traumatic brain injury (aOR, 0.974; 95% CI, 0.949-0.999) and prehospital shock (aOR, 0.974; 95% CI, 0.949-0.999), volume was associated with reduced 6-hour mortality. Highest trauma volume among treating EMS crew members, nontrauma volume, and years of experience were not significantly associated with differences in mortality. Among EMS industry quality metrics, decreasing scene time (regression coefficient, -0.134; 95% CI, -0.191 to -0.077) was significantly associated with higher clinician volume. Intubation procedural volume was associated with greater odds of success without hypotension or hypoxia (aOR, 1.110; 95% CI, 1.040-1.190).

CONCLUSIONS AND RELEVANCE: Results of this cohort study suggest that higher patient volumes per EMS clinician were associated with lower early mortality rates after trauma. Exploring this association further is essential to optimize staffing, education strategies, and performance benchmarks.

PMID:41706461 | DOI:10.1001/jamasurg.2025.6741

JAMA Psychiatry. 2026 Feb 18. doi: 10.1001/jamapsychiatry.2025.4625. Online ahead of print.

ABSTRACT

IMPORTANCE: The phase 2 data presented here support the development of TSND-201 for posttraumatic stress disorder (PTSD), a disorder for which there is a significant unmet need for rapid-acting and effective treatments. TSND-201 (methylone) is a highly selective, rapid-acting neuroplastogen that releases serotonin, norepinephrine, and dopamine without direct activity at 5-hydroxytryptamine (5-HT) 2A receptors that has shown rapid, robust, and long-lasting benefit for preclinical PTSD-related behaviors and has been well tolerated in phase 1 studies of healthy volunteers.

OBJECTIVE: To evaluate the efficacy and safety of TSND-201 vs placebo in adults with PTSD.

DESIGN, SETTING, PARTICIPANTS: A Study to Assess the Use of Methylone in the Treatment of PTSD (IMPACT-1) part B was a phase 2, multicenter, double-blind, placebo-controlled, 10-week randomized clinical trial of TSND-201 in people with PTSD conducted between November 29, 2023, and February 19, 2025, across 16 sites in the US, UK, and Ireland. Adults aged 18 to 65 years who met DSM-5 criteria for current PTSD and 6 months or more of symptoms (Clinician-Administered PTSD Scales for DSM-5 [CAPS-5] ≥35) were eligible.

INTERVENTIONS: Participants were randomized 1:1 to receive TSND-201 or placebo. There were 4 once-weekly oral dosing sessions (150 mg followed by 100 mg or placebo). No psychotherapy was provided; however, dosing sessions were monitored by mental health professionals using a nondirective approach. Participants were followed up for 6 weeks after the last dose.

MAIN OUTCOMES AND MEASURES: The primary end point was change from baseline to day 64 in the CAPS-5 total severity score. Secondary end points included changes in PTSD Checklist for DSM-5 (PCL-5), Sheehan Disability Scale (SDS), and Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Other measures included response (≥50% improvement from baseline), remission (≤11 total severity score), loss of PTSD diagnosis, changes in CAPS-5 symptom clusters, and incidence of treatment-emergent adverse events (TEAEs). Safety was assessed by monitoring adverse events, vital signs, and Columbia-Suicide Severity Rating Scale.

RESULTS: Among the 65 participants (mean [SD] age, 43.7 [10.5] years; 39 female [60.0%]), TSND-201 demonstrated significantly greater improvement in CAPS-5 total score than placebo (least-squares mean difference, 9.64; 90% CI, -16.48 to -2.80; P = .01). PCL-5 (-28.46 vs -19.47; LS mean treatment difference, -8.99; 90% CI, -17.81 to -0.17), SDS (-8.29 vs -3.57; LS mean treatment difference, -4.72; 90% CI, -8.84 to -0.61), and MADRS (-13.94 vs -7.73; LS mean treatment difference, -6.21; 90% CI, -12.41 to -0.27) scores were also improved. Common TEAEs in the TSND-201 group included headache, decreased appetite, nausea, dizziness, blood pressure increased, dry mouth, insomnia.

CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial reveal that TSND-201 demonstrated statistically significant efficacy and was well tolerated, supporting its potential as a rapid-acting, durable treatment for PTSD.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05741710.

PMID:41706459 | DOI:10.1001/jamapsychiatry.2025.4625

JAMA Netw Open. 2026 Feb 2;9(2):e2559344. doi: 10.1001/jamanetworkopen.2025.59344.

ABSTRACT

IMPORTANCE: Childhood obesity has been independently associated with exposure to gestational diabetes and prenatal depression. Although these conditions frequently co-occur and may share biological pathways, their combined association with childhood obesity remains unknown.

OBJECTIVE: To examine whether exposure to prenatal depression and gestational diabetes is separately and jointly associated with childhood obesity.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study of births from 2011 to 2021 used data from Kaiser Permanente Northern California, an integrated health care system. Individuals receiving prenatal care were universally screened for depression and gestational diabetes and their children’s height and weight were monitored until age 10 years. Data analysis was performed from June 2024 to December 2025.

EXPOSURES: Gestational diabetes diagnosis and prenatal depression diagnosis and severity obtained from medical records.

MAIN OUTCOMES AND MEASURES: The primary outcome was childhood obesity, defined as Centers for Disease Control and Prevention body mass index z scores greater than or equal to the 95th percentile stratified by child age in years. Modified Poisson regression with robust SEs estimated risk ratios (RRs) for prenatal depression and gestational diabetes separately and jointly, adjusting for the birthing parent’s age, race and ethnicity, neighborhood deprivation, parity, and prenatal alcohol and tobacco use. Effect modification was assessed separately by statistical interactions and stratified models.

RESULTS: In this cohort study of 203 333 birthing parent-child pairs (mean [SD] age of birthing parents at the time of delivery, 30.8 [5.3] years; 104 214 male children [51.3%]), rates of childhood obesity increased with child’s age, from 14.6% (29 198 of 199 329 children) at age 2.0 to 4.9 years, to 16.5% (19 155 of 116 398 children) at age 5.0 to 7.9 years, and 21.8% (9798 of 44 894 children) at age 8.0 to 10.0 years. Prenatal depression was minimally associated with obesity (RR, 1.07 [95% CI, 1.04-1.10] for children aged 2.0-4.9 years; RR, 1.08 [95% CI, 1.04-1.12] for children aged 5.0-7.9 years; RR, 1.05 [95% CI, 1.00-1.11] for children aged 8.0-10.0 years). Gestational diabetes demonstrated larger effect estimates (RR, 1.29 [95% CI, 1.25-1.34] for children aged 2.0-4.9 years; RR, 1.45 [95% CI, 1.40-1.51] for children aged 5.0-7.9 years; RR, 1.39 [95% CI, 1.31-1.46] for children aged 8.0-10.0 years). Joint exposure to gestational diabetes and depression conferred the highest RRs compared with having neither exposure (RR, 1.33 [95% CI, 1.23-1.44] for children aged 2.0-4.9 years; RR, 1.54 [95% CI, 1.41-1.69] for children aged 5.0-7.9 years; RR, 1.43 [95% CI, 1.25-1.64] for children aged 8.0-10.0 years), with no evidence of interaction (P for interaction >0.10). After additionally adjusting for prepregnancy body mass index, joint results were attenuated, although the association for the 5.0 to 7.9 years age group remained especially robust.

CONCLUSIONS AND RELEVANCE: In this cohort study, both prenatal depression and gestational diabetes were associated with childhood obesity risk, with larger effect sizes observed for gestational diabetes. Children exposed to both conditions had the greatest risk, although associations appeared additive rather than synergistic. These findings underscore the need for universal prenatal screening and risk stratification, along with targeted interventions for children exposed to these conditions.

PMID:41706453 | DOI:10.1001/jamanetworkopen.2025.59344

Urol Pract. 2026 Feb 18:101097UPJ0000000000000988. doi: 10.1097/UPJ.0000000000000988. Online ahead of print.

ABSTRACT

INTRODUCTION: We share our 10-year experience with transitioning from MRI-fusion transrectal (TR) to MRI-fusion transperineal (TP) prostate biopsy and the increased costs and time associated with this transition, particularly from the pathology perspective.

METHODS: Our prospectively maintained MRI-fusion prostate biopsy database was queried. Demographic and clinical data were captured. The cost difference between processing TR and TP biopsies was calculated. Scenarios to decrease cost and time were explored. R-software was used for statistical analyses.

RESULTS: Over 10 years, 2,370 prostate biopsies were performed (1,719 TR, 651 TP). TP biopsy became the preferred method in 2023. The overall cancer detection rates (CDR) and clinically significant CDR (csCDR) for TR biopsy were 55.4% (952/1,719) and 35.4% (609/1,719), respectively. For TP, it was 62.8% (409/651) and 41.8% (272/651), respectively. This was a significant difference in CDR and csCDR (p<0.01). The estimated increased annual cost for TP biopsy from a pathology processing standpoint was $136,662, and the estimated time increase per year was 1,332.5 hours. We constructed 4 scenarios with cost and time reductions as high as $282,750 and 2730 hours per year, respectively.

CONCLUSION: Transitioning to an MRI-fusion TP prostate biopsy has resulted in higher overall CDR and csCDR rates, but also significantly higher costs and time spent. Possible designs may exist that could yield significant cost and time savings per annum.

PMID:41706435 | DOI:10.1097/UPJ.0000000000000988

J Vector Borne Dis. 2026 Feb 7. doi: 10.4103/jvbd.jvbd_211_24. Online ahead of print.

ABSTRACT

BACKGROUND OBJECTIVES: The aim of this study was to identify the risk factors associated with mortality in patients diagnosed with Crimean-Congo hemorrhagic fever (CCHF) through the application of machine learning models and to evaluate their predictive performance.

METHODS: The study included patients with a definitive diagnosis who were admitted to the Department of Infectious Diseases and Clinical Microbiology of Tokat State Hospital between February 1, 2011 and October 1, 2022 with suspicion of CCHF. Five models, namely XGboost, Logistic regression, Random Forest, LightGBM, and Gradient Boosting Classifier, were constructed using machine learning algorithms to predict mortality in CCHF patients. The performance of these models was subsequently evaluated.

RESULTS: A total of 1,881 cases of suspected CCHF were admitted to the hospital, of which 891 were confirmed, resulting in a fatality rate of 3.3%. In the study, the receiver operating characteristic (ROC) analysis was performed to predict the risk of mortality in CCHF patients with the XGboost, logistic regression, and Gradient Boosting Classifier models. The area under the curve (AUC) results were 0.849, 0.919, and 0.853, respectively. In the evaluation of the relative importance of the features of these models, platelet count, neutrophil-to-lymphocyte ratio (NLR), and neutrophil count were identified as being among the top five.

INTERPRETATION CONCLUSION: Statistically significant predictive models were created using machine learning techniques, specifically XGboost, logistic regression, and Gradient Boosting Classifier. The results of our analysis suggest that platelet count, NLR and neutrophil count are the most effective parameters for predicting mortality.

PMID:41706434 | DOI:10.4103/jvbd.jvbd_211_24

J Vector Borne Dis. 2026 Feb 7. doi: 10.4103/jvbd.jvbd_223_25. Online ahead of print.

ABSTRACT

BACKGROUND OBJECTIVES: CD5L (CD5 antigen-like) is a secreted glycoprotein involved in immune regulation, macrophage polarization, and lipid metabolism. While its role in inflammatory and bacterial diseases has been described, its function in viral infections such as dengue virus (DENV) infection remains unclear. This study aimed to evaluate serum CD5L levels in dengue-infected individuals and investigate its association with serological markers and disease severity. A cross-sectional study involving dengue-positive and dengue-negative individuals was conducted to compare serum CD5L concentrations and assess correlations with NS1, IgM, IgG status, and disease severity.

METHODS: Serum samples were collected from confirmed dengue-positive patients and dengue-negative controls. CD5L concentrations were quantified using enzyme-linked immunosorbent assay (ELISA) and analyzed according to serological profiles (NS1, IgM, and IgG). Two-group comparisons were performed using the Mann-Whitney U test, and multiple groups were analyzed using the Kruskal-Wallis test with Dunn’s post hoc test. A P-value < 0.05 was considered statistically significant.

RESULTS: CD5L levels were significantly elevated in dengue-positive individuals compared to dengue-negative controls (P < 0.05), with the highest levels observed in IgG-positive only individuals (P < 0.01). No significant differences were seen in NS1-positive only or IgM-positive only groups, suggesting that CD5L upregulation is associated with IgG seropositivity rather than acute-phase markers. Similarly, CD5L levels did not significantly differ among individuals with combined serological markers (NS1 & IgM-positive, NS1 & IgG-positive, IgM & IgG-positive). Among IgG-positive only individuals, CD5L levels were significantly higher in non-severe dengue cases compared to severe dengue cases (P < 0.05). No significant differences were observed in CD5L levels between severe and non-severe NS1-positive only or IgM-positive only individuals. These findings suggest a potential association between increased CD5L and later stages of dengue virus infection with less severe outcomes.

INTERPRETATION CONCLUSION: This study highlights CD5L’s potential role in dengue pathogenesis, particularly its association with IgG seropositivity and non-severe disease. Further research is needed to clarify its mechanisms and evaluate its potential as a biomarker or therapeutic target in dengue virus infection.

PMID:41706431 | DOI:10.4103/jvbd.jvbd_223_25

J Vector Borne Dis. 2026 Feb 7. doi: 10.4103/jvbd.jvbd_270_25. Online ahead of print.

ABSTRACT

BACKGROUND OBJECTIVES: Dengue fever remains a major global public health threat, responsible for millions of infections annually across tropical and subtropical regions. Despite extensive modeling efforts, most existing studies focus exclusively on mosquito-mediated transmission and overlook additional non-vectorial pathways that may influence outbreak persistence.

METHODS: This study addresses this gap by developing the first fractional-order dengue transmission model that simultaneously integrates human-to-human, mosquito-to-mosquito, human-to-mosquito, and mosquito-to-human transmission routes. The Caputo fractional derivative is applied to capture memory effects and nonlocal temporal behavior inherent in real epidemic processes.

RESULTS: Analytical results demonstrate that the model exhibits backward bifurcation when the mosquito-to-mosquito reproduction number exceeds unity, implying that dengue may persist even when the basic reproduction number falls below one. Numerical simulations reveal that fractional-order dynamics slow epidemic decay, delay infection peaks, and prolong outbreak duration compared with classical integer-order models. These findings indicate that memory effects significantly influence disease persistence and the effectiveness of control measures.

INTERPRETATION CONCLUSION: By bridging an important gap in dengue modeling, this framework highlights the combined epidemiological impact of multi-route transmission and fractional dynamics. The results provide insight into designing integrated and sustainable dengue control strategies that account for vectorial, non-vectorial, and memory-dependent transmission processes.

PMID:41706429 | DOI:10.4103/jvbd.jvbd_270_25

Dig Dis Sci. 2026 Feb 18. doi: 10.1007/s10620-026-09765-1. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used to treat pancreaticobiliary diseases, but can be technically challenging, leading to occasional unsuccessful attempts. While repeat ERCP is one option in these cases, data on the effectiveness and safety of this practice remain limited. Thus, we conducted a systematic review and meta-analysis to assess outcomes of repeat ERCP after initial unsuccessful attempt.

METHODS: MEDLINE, Embase, and CENTRAL were searched on February 28, 2025. We included randomized trials and observational studies reporting on outcomes of repeat ERCP following an initial unsuccessful attempt, with the primary outcome being technical success of cannulation, and secondary outcomes including adverse events (AEs). Random-effects models were used to pool data, and heterogeneity was assessed through the I² statistic.

RESULTS: A total of 22 studies involving 1514 patients with a median age of 62 years were included. The majority of studies were conducted at a single center (86.4%), where the most common indication for repeat ERCP was choledocholithiasis (41.2%), followed by malignant biliary obstruction (29.0%). The pooled technical success rate of repeat ERCP was 83.6% (95% CI 78.6-88.1%, I² = 76.4%). The pooled AE overall rate was 7.3% (95% CI 5.2-9.6%, I² = 27.5%), with pancreatitis being the most frequent and with this overall AE rate being statistically comparable to that associated with patients’ index ERCPs.

CONCLUSIONS: Our meta-analysis demonstrated encouraging success rates with repeat ERCP after initial failure, with acceptably low AE rates, highlighting its role as a primary option in cases of initial unsuccessful ERCP.

PMID:41706406 | DOI:10.1007/s10620-026-09765-1