Nevin Manimala

Minerva Dent Oral Sci. 2026 Mar 11. doi: 10.23736/S2724-6329.25.05196-4. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to compare the orthodontic space closure rate between power chains and nickel-titanium coil springs.

METHODS: In this interventional, split-mouth quasi-experimental study, the participants were allocated into two groups: Space closure by nickel titanium (NiTi) spring and elastomeric chain. The canine retraction rate was measured to the nearest 0.1mm with a Boley’s gauge, using the mesial wing of the premolar bracket and the distal wing of the canine bracket as reference points. Each measurement was taken three times, and the average value was used for analysis to enhance accuracy. Blinded operators conducted measurements. The paired t-test was used to test the hypothesis and evaluate the difference in canine retraction rates between NiTi and Power Chain groups. The p-value was considered to be statistically significant at less than 0.05.

RESULTS: This study included 60 participants (24 females and 36 males). The mean age was 16±2.97 years (12-22 years). The sample consisted of 60 upper first premolar extraction cases on both sides. The mean canine retraction rate over 3-week intervals revealed statistically significant differences between these groups (P=0.026). The rate at 84 days proved to be significantly different (P=0.0001) between the power chain and NiTi group; the rate at 147 days showed a significant difference when the NiTi group was compared with the power chain group (P<0.05).

CONCLUSIONS: At all the follow-ups, the canine retraction was higher using NiTi springs than elastomeric chains.

PMID:41811365 | DOI:10.23736/S2724-6329.25.05196-4

Traffic Inj Prev. 2026 Mar 11:1-10. doi: 10.1080/15389588.2026.2629613. Online ahead of print.

ABSTRACT

OBJECTIVE: With the continuous improvement of transportation infrastructure, tunnels, as an important type of road connecting key traffic nodes, have become increasingly prominent in the transportation system, and traffic accidents are frequent with serious consequences. Therefore, this study explores the key causal factors of tunnel exit safety traffic accident risk from multiple dimensions, including human factors, traffic conditions, environmental factors, road characteristics, and safety facilities, in order to prevent traffic injuries.

METHODS: Based on the analysis of 851 academic literature research since 2000, an improved Apriori algorithm combining subjective and objective methods was used to calculate support, confidence, and lift to mine frequent itemsets and strong association rules. By using the distance function method to fuze and modify the subjective and objective weights, an indicator system consisting of 5 primary indicators and 14 secondary indicators was constructed. A judgment matrix was constructed using expert questionnaires and AHP data to achieve accurate identification and importance ranking of various causal factors of traffic accident risk.

RESULTS: In the current field of tunnel traffic accidents and safety research, human factors account for 28.24% of the total, becoming the primary focus of attention; traffic safety facilities and road factors follow closely behind with a proportion of 20.21% and 19.47%, respectively, with a total proportion of over 65%, highlighting their core position in tunnel safety research. It is worth noting that 52.94% of scholars focus their research on traffic safety facilities when exploring strategies to improve tunnel traffic safety. The correlation between the color, location, and frequency of traffic safety facilities shows a high degree of causality, with a confidence interval of 0.5526 ∼ 1 and a maximum lift reaching 5.2308. By improving the Apriori algorithm, the key influencing factors for tunnel exit safety are more accurately identified as the location, frequency, and vehicle speed of traffic safety facilities, with weights of 0.2607, 0.2241, and 0.1840, respectively.

CONCLUSIONS: Research findings on key influencing factors of tunnel traffic safety revealed that driver-related factors dominated accident causation, followed by traffic facilities and road factors. Statistical analysis demonstrated significant associations among traffic facility parameters (position, frequency, and color). The improved algorithm quantitatively identified facility position, arrangement frequency, and facility color as critical factors influencing tunnel exit safety. These results provided scientifically validated identification of key determinants, establishing an evidence base for tunnel traffic injury prevention and safety enhancement measures.

PMID:41811364 | DOI:10.1080/15389588.2026.2629613

JAMA Psychiatry. 2026 Mar 11. doi: 10.1001/jamapsychiatry.2026.0073. Online ahead of print.

ABSTRACT

IMPORTANCE: Psychiatric classification faces longstanding challenges, including heterogeneous diagnostic categories, high comorbidity rates, limited interrater reliability, and modest clinical utility. Successive revisions of systems such as the DSM since 1980 have done little to resolve these issues. How to move forward?

OBSERVATIONS: This narrative review draws an analogy to biology, which has grappled for centuries with the hard problem of species classification. Following Darwin’s insights that species are not fixed categories, contemporary theorists of classification have moved away from the natural kind view toward understanding species as homeostatic property clusters (HPCs): sets of properties contingently clustered in nature because the presence of some properties favors the presence of others. Probabilistic associations among these properties lead to imperfect aggregations and gray areas between species. This work adapts the HPC view for mental disorders, where probabilistic associations among biopsychosocial mental health properties form statistical aggregations: property clusters. These clusters are just as messy as in biology and usually lack sharp boundaries. Similar to species, diagnostic structures cannot be straightforwardly discovered in this space-they must be superimposed. To advance this view, a research agenda is outlined for mapping out a mental health atlas by identifying properties, their associations, and their dynamics and illustrating this idea using example data.

CONCLUSIONS AND RELEVANCE: The HPC view accounts for many robust phenomena in mental health science, turning classification challenges from isolated anomalies into natural consequences of superimposing structure on the landscape of mental health problems. It aligns with major clinical and research frameworks-including Engel’s biopsychosocial model, network and systems approaches, the Hierarchical Taxonomy of Psychopathology, and the Research Domain Criteria project-highlighting its role as a mental health science meta-framework. Doing so, it helps sidestep unproductive debates over the best universal classification system. Clinicians, researchers, and policymakers have different priorities and constraints, and no single classification system will optimally serve all stakeholders.

PMID:41811340 | DOI:10.1001/jamapsychiatry.2026.0073

Analyst. 2026 Mar 11. doi: 10.1039/d5an01344e. Online ahead of print.

ABSTRACT

To investigate the characteristics of changes in human urinary metabolites of meclofenoxate using metabolomics technology based on an UHPLC-Q Exactive HF Orbitrap mass spectrometer (UHPLC-HRMS) and to search for biomarkers related to drug effects, seventeen healthy college students were selected as experimental subjects, and urine samples were collected from the subjects before and after taking the drug, respectively. The data were subjected to multivariate statistical analysis after format conversion, peak detection, and normalization, and screening of differential metabolites and database search were performed to identify potential biomarkers and conduct metabolic pathway analysis. Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA) demonstrated significant intergroup differences in the metabolites of urine samples before and after the administration of meclofenoxate and further screened for eight major potential biomarkers (VIP > 1 and P < 0.01). The main metabolic pathways involved histidine metabolism, β-alanine metabolism, phenylalanine metabolism, etc. The results of the study can help to provide a theoretical basis for the application and diagnosis of meclofenoxate.

PMID:41811313 | DOI:10.1039/d5an01344e

J Med Econ. 2026 Dec;29(1):799-808. doi: 10.1080/13696998.2026.2640810. Epub 2026 Mar 11.

ABSTRACT

AIM: This retrospective observational cohort study aimed to assess healthcare utilization (HCRU) and costs before and after initiation of treatment with maribavir using a United States (US) administrative claims database to further the understanding of the impact of maribavir in the real world setting.

METHODS: Inovalon Databases were used to identify post-transplant patients with refractory (with or without resistant) CMV treated with maribavir between November 1, 2021 and March 31, 2024 (index = earliest treatment date). HCRU and costs were assessed during variable length periods both prior to and following initiation of maribavir. McNemar’s tests were used to evaluate the statistical significance of differences for categorical variables and paired t-tests were used for continuous variables.

RESULTS: There were 230 patients eligible for analysis. Compared with the pre-maribavir phase, after the initiation of maribavir there was a significant decrease in the utilization of all-cause acute care services, including inpatient hospital admissions (54.3% v. 30.9%; p < 0.001) and emergency room visits (47.0% v. 36.5%; p = 0.014). There was a significant decrease in the number of outpatient office visits per patient per month (PPPM) (2.33 v. 1.47; p < 0.001) as well as a decrease in the number of all outpatient pharmacy prescriptions PPPM (9.64 v. 7.69; p < 0.001). Total medical costs measured PPPM prior to maribavir initiation were $9,986 compared with $5,480 (p < 0.001) after initiation of maribavir.

CONCLUSIONS: In real world practice, initiation of maribavir for the treatment of refractory or drug-resistant post-transplant CMV was associated with decreased acute care service utilization, reduced outpatient visits, and lower healthcare costs, resulting in meaningful benefits for both patients and healthcare systems. These reductions in healthcare utilization highlight maribavir’s role in optimizing treatment strategies and improving the efficiency of CMV management.

PMID:41811308 | DOI:10.1080/13696998.2026.2640810

JAMA Psychiatry. 2026 Mar 11. doi: 10.1001/jamapsychiatry.2026.0044. Online ahead of print.

ABSTRACT

IMPORTANCE: Climate-related disasters are escalating in frequency and severity, yet their population-level mental health impacts-especially in racially and ethnically diverse and geographically isolated settings-remain poorly characterized. The 2023 Maui wildfires, one of the deadliest US wildfires in more than a century, offer a critical opportunity to quantify these effects.

OBJECTIVE: To examine associations between wildfire exposure and symptoms of depression, anxiety, and suicidal ideation and to assess indirect pathways of these associations through housing displacement and income disruption.

DESIGN, SETTING, AND PARTICIPANTS: This multiarm, propensity-weighted cross-sectional study compared adults residing within burn zones and outside burn zones on Maui and unexposed residents from other Hawai’i counties. The analytic sample included wildfire-exposed and unexposed adults enrolled between January 2024 and February 2025 through the Maui Wildfire Exposure Study and the UHERO Rapid Health Survey. Residential addresses at the time of the fires were geocoded and linked to official burn zone perimeters to determine exposure status. Data were analyzed from May to September 2025.

MAIN OUTCOMES AND MEASURES: The primary outcomes were self-reported depression (Center for Epidemiologic Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder scale), and suicidal ideation within the past 30 days, assessed using validated screening instruments.

RESULTS: The analytic sample included 2453 adults (1535 wildfire exposed and 918 unexposed), among whom mean (SD) age was 50.8 (16.3) years and 1502 participants (61.2%) were women. Wildfire exposure was associated with higher risk of depression (risk ratio [RR], 1.53; 95% CI, 1.20-1.94) and anxiety (RR, 1.67; 95% CI, 1.14-2.45) compared with unexposed individuals. Although suicidal ideation was more frequent among burn zone residents (RR, 2.15; 95% CI, 0.72-6.44), this association was not statistically significant. Residents outside burn zones showed significantly higher risk of suicidal ideation (RR, 2.65; 95% CI, 1.21-5.77). Mediation analyses indicated that housing displacement and income loss jointly accounted for more than half of the associations with depression and anxiety.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, wildfire exposure and its socioeconomic consequences were associated with graded increases in psychological distress extending beyond the burn zone. These findings highlight the importance of integrating mental health care, housing stability, and economic recovery as central pillars of disaster response and climate resilience strategies.

PMID:41811306 | DOI:10.1001/jamapsychiatry.2026.0044

Traffic Inj Prev. 2026 Mar 11:1-7. doi: 10.1080/15389588.2026.2628947. Online ahead of print.

ABSTRACT

OBJECTIVES: Road traffic injuries (RTIs) are a major cause of morbidity and mortality among children and adolescents in India. Despite legislative mandates requiring helmet use for all motorized two-wheeler riders aged 4 years and older, adherence remains poor, particularly among children. This study aimed to assess the prevalence and patterns of helmet use among parents and children commuting to school on motorized two-wheelers through direct observation.

METHODS: A cross-sectional observational study was conducted in October 2024 at 4 schools located on roads of differing traffic densities in southern Bangalore. Observations were made during morning drop-off hours recording helmet use among parents and their accompanying children using an online tally counter. Helmet use was categorized as proper helmet, cap helmet, or no helmet. Statistical analysis included chi-square tests for differences between parents and children and across schools, with odds ratios and 95% confidence intervals (CIs) calculated.

RESULTS: A total of 785 parent riders and 966 child pillion riders were observed. Proper helmet use was recorded in 42.0% of parents and only 4.5% of children, while 33.3% of parents and 92.7% of children did not wear any helmet. No child was observed wearing a helmet when their parent did not. Children were 25.3 times less likely to wear a helmet than their parents (95% CI: 19.05-33.6). Significant inter-school variation was observed (p < 0.001), but differences were primarily in the distribution of proper versus cap helmets rather than overall helmet use.

CONCLUSIONS: Helmet use among child pillion riders in Bangalore remains alarmingly low despite legal requirements. The study highlights a large gap between parent and child compliance, reflecting poor awareness, lack of enforcement, and limited availability of child-sized helmets. Strengthening enforcement, improving access to child helmets, and implementing school-based education and parent awareness programs are essential to enhance compliance and reduce preventable head injuries among children in India.

PMID:41811303 | DOI:10.1080/15389588.2026.2628947

Health Promot Chronic Dis Prev Can. 2026 Mar;46(3):92-103. doi: 10.24095/hpcdp.46.3.03.

ABSTRACT

INTRODUCTION: Few studies have analyzed the impact of public investments in indoor and outdoor recreational spaces, and even fewer have assessed this impact longitudinally. This hinders informed decision-making about returns on investments made with limited public budgets. We assessed the impact of a 2008 municipal plan to revitalize existing urban and rural public indoor facilities and outdoor spaces by evaluating changes in usage levels before and after implementation of Phase 1 (2009-2013) of the revitalization plan.

METHODS: A quasi-experimental study involving a telephone survey of 750 participants was conducted before and after Phase 1. A region with similar demographics and public recreational indoor and outdoor infrastructure was used for comparison.

RESULTS: Our analysis found no changes in usage of recreational venues over time whether indoor (e.g. multipurpose recreational facilities, community halls) or outdoor (e.g. golf courses, off-leash dog parks, multiuse trails), in either the intervention or comparison region. Only one rural multipurpose indoor recreational facility showed a statistically significant increase in usage during Phase 1.

CONCLUSION: Strategies targeting only physical infrastructure may not result in increased usage across a municipal population. To address existing inequities in access to publicly funded community resources that support health, both the built and social environments must be considered.

PMID:41811292 | DOI:10.24095/hpcdp.46.3.03

J Hand Surg Am. 2026 Mar 11:S0363-5023(26)00143-7. doi: 10.1016/j.jhsa.2026.01.029. Online ahead of print.

ABSTRACT

PURPOSE: Foveal tears of the triangular fibrocartilage complex (TFCC) are a major cause of distal radioulnar joint instability and often require surgical repair to restore forearm function. Although foveal repair is increasingly performed, postoperative immobilization protocols remain variable and poorly standardized. This systematic review and meta-analysis evaluated the effects of different immobilization methods and durations on clinical outcomes after TFCC foveal repair.

METHODS: Comparative clinical studies assessing postoperative immobilization after TFCC foveal repair were identified through a systematic review of MEDLINE, EMBASE, Web of Science, and the Cochrane Library. Outcomes included pain (visual analog scale), Disabilities of the Arm, Shoulder and Hand scores, wrist range of motion, grip strength, and complications. For quantitative analysis, studies were grouped according to immobilization method: elbow-restricted immobilization versus forearm-restricted immobilization permitting elbow motion. Studies evaluating immobilization duration or timing of motion initiation were analyzed descriptively.

RESULTS: Five comparative studies (288 patients) met the inclusion criteria; four evaluated immobilization methods, and 2 assessed immobilization duration or initiation of forearm rotation. Three studies were included in the meta-analysis. No significant differences were found between elbow-restricted and forearm-restricted immobilization in final pain visual analog scale (mean difference [MD] -0.34; 95% CI, -0.91 to 0.24), Disabilities of the Arm, Shoulder and Hand scores (MD -1.67; 95% CI, -6.71 to 3.38), grip strength (MD +0.38%; 95% CI, -9.69 to 10.45), or wrist range of motion, and complication rates were similarly low across groups. Studies investigating immobilization duration demonstrated that restricting pronation and supination for approximately 4-6 weeks yielded better pain relief and functional recovery than immediate rotation, without causing persistent elbow stiffness.

CONCLUSIONS: Based on currently available comparative studies, postoperative immobilization after TFCC foveal repair may benefit more from restricting forearm rotation than from restricting elbow motion. Additional restriction of elbow flexion and extension has not shown a consistent advantage in reported outcomes, whereas delaying forearm pronation and supination for up to 6 weeks may help protect the repair while still permitting early functional recovery. Further studies are needed to establish standardized guidelines.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

PMID:41811284 | DOI:10.1016/j.jhsa.2026.01.029

JMIR Med Educ. 2026 Feb 2. doi: 10.2196/71455. Online ahead of print.

ABSTRACT

BACKGROUND: Simulation-based training is essential for preparing medical interns to manage high-stakes emergencies. Although virtual reality (VR)-based simulation has been rapidly integrated into medical education, there remains limited evidence directly assessing its effectiveness relative to established high-fidelity simulation (HFS) methodologies.

OBJECTIVE: This study aimed to assess the perceived educational effectiveness of VR and HFS in enhancing novice physicians’ confidence, satisfaction, and perceived preparedness for managing acute oxygen desaturation.

METHODS: A randomized controlled trial was conducted with 168 medical interns from Seoul National University Hospital. Participants were randomly assigned to VR group (n = 81) or HFS group (n = 87). Four participants were excluded due to incomplete surveys, leaving 164 for analysis (VR:79; HFS: 85). Both groups were trained to manage simulated patients with low oxygen saturation. Confidence (10-point Likert scale) and satisfaction (7-point Likert scale) were measured using pre- and post-training surveys. Usability was assessed with the User Experience Questionnaire-Short. Between-group comparisons were conducted using t-tests and chi-square tests, while within-group confidence changes were analyzed using paired t-tests and repeated-measures analysis of variance. To account for correlated data and estimate effect sizes, generalized estimating equations were applied, with statistical significance set at P < .05. Focus group interviews (FGIs) at one- and five-months post-training explored real-world application and behavior transfer. Transcripts were independently reviewed by two researchers and thematically analyzed to identify recurring patterns and insights related to clinical behavior.

RESULTS: Confidence in managing oxygen desaturation significantly improved from a mean [SD] 3.78 [2.12] to 6.20 [2.02] across VR and HFS groups (t(163) = -14.04, P < .001), with no significant difference between groups (F(1,162) = 3.28, P = .07). Satisfaction was high overall (mean [SD] 6.07 [1.02]), but significantly greater in the HFS group than in the VR group (6.23 [0.92] vs. 5.89 [1.10]; t(162) = 2.29, P = .02). HFS participants rated tutor guidance (6.49 [0.86] vs. 6.10 [1.02]; P = .008) and authenticity (6.24 [1.05] vs. 5.77 [1.15]; P = .006) higher, whereas both groups scored usability above 5 on all items. Qualitative analyses revealed complementary strengths. Interns valued VR for its immersive environment, focused repetition, and reduced distractions that facilitated stepwise problem-solving. HFS was praised for palpable realism, hands-on practice with equipment, and immediate feedback that reinforced team communication and role clarity. Across follow-up interviews, interns reported improved recognition of desaturation, more structured initial responses (airway assessment, oxygen delivery adjustments, escalation), and greater willingness to act promptly under pressure-suggesting perceived transfer of learning to clinical practice beyond the simulation lab.

CONCLUSIONS: VR may complement HFS in emergency response training. Both modalities were associated with improvements in interns’ self-reported confidence and perceived preparedness. The scalability and accessibility of VR suggest its potential value in diverse training contexts.

CLINICALTRIAL: ClinicalTrials.gov NCT06295887.

PMID:41811271 | DOI:10.2196/71455