A team of mathematicians used whimsical “silly sprinklers” to solve a physics mystery that has puzzled scientists for decades. Their experiments showed that the rotation of both normal and reverse sprinklers is driven by the momentum of flowing water, not by the outside water flow or other long-standing theories. The results finally provide a clear answer to Feynman’s famous sprinkler problem. They could also help engineers design more efficient fluid-powered machines.
Cancer Med. 2026 Jul;15(7):e72025. doi: 10.1002/cam4.72025.
ABSTRACT
BACKGROUND: Clinical and epidemiological evidence has suggested a potential association between kidney dysfunction and bladder cancer (BC). One hypothesis for this comorbidity is the presence of a common genetic etiology. However, little is known about the shared genetics and causality of this association. Thus, we aimed to investigate shared genetic architecture and the causal link between kidney dysfunction and bladder cancer.
METHODS: Leveraging summary statistics from large-scale genome-wide association studies (GWASs) conducted on European-ancestry populations on eGFRcrea (N = 1,004,040), eGFRcys (N = 460,826), BUN (N = 852,678), UACR (N = 288,649), urate (N = 547,361) and BC (N cases = 3357, N controls = 628,027), we conducted a large-scale genome-wide cross-trait study to determine genetic overlap, to identify shared loci, and to infer causal relationships. We evaluated genetic correlation through linkage disequilibrium score regression (LDSC). Integration of single-trait GWAS was accomplished by multi-trait analysis of GWAS (MTAG), which enabled cross-trait meta-analysis to unveil overlapping genetic loci between five kidney function traits and BC. Shared genes were further validated through colocalization analysis and transcriptome-wide association analysis. Bidirectional Mendelian Randomization (MR) was conducted to determine causal inference of kidney function traits on BC.
RESULTS: We found positive correlations between both BUN and urate and BC at the genome-wide level. A total of 157 significant overlapping genetic loci (range 7 to 72) were identified across five kidney function traits and BC. Among them, PSCA was prioritized as the strongest shared gene with support from MTAG, colocalization, and TWAS, whereas ZFHX3, TTC33, and ATP2A1 were considered candidates supported only by MTAG and TWAS. MR provided the most consistent support for a potential positive causal effect of BUN on BC, limited support for UACR, and exploratory evidence for urate.
CONCLUSIONS: Our cross-trait analysis demonstrated a shared genetic basis underlying kidney function and BC, providing novel insights into the biological functions and molecular mechanisms underlying these complex traits.
PMID:42470241 | DOI:10.1002/cam4.72025
Aust J Rural Health. 2026 Aug;34(4):e70234. doi: 10.1111/ajr.70234.
ABSTRACT
OBJECTIVE: To provide the first national analysis of the distribution and professional composition of PhD-qualified health professionals across metropolitan, regional, rural and remote Australia.
DESIGN: Cross-sectional analysis of 2021 Australian Census data.
SETTING: Australia, classified by Modified Monash Model (MM) remoteness categories.
PARTICIPANTS: Health professionals reporting a doctoral-level qualification (PhD).
MAIN OUTCOME MEASURES: Counts and proportions of PhD-qualified health professionals by MM category and occupation group; association between remoteness and PhD representation.
METHODS: Occupations were grouped into medicine, allied health, and nursing. Residential locations were mapped to MM categories. Descriptive statistics and linear regression examined distribution patterns.
RESULTS: Of 21 510 PhD-qualified health professionals, 85% lived in metropolitan areas (MM1), with 3027 (14%) in regional, rural and remote communities and only 12 (< 1%) in very remote areas (MM7). Medical practitioners comprised 61%, allied health 36% (predominantly psychology) and nursing 3%. Increasing remoteness was associated with reduced PhD representation (β = -0.0041, p = 0.011).
CONCLUSIONS: Research capacity is concentrated in metropolitan areas, yet a substantial base of PhD-qualified professionals exists in RRR communities. Targeted investment in funding, infrastructure and support could leverage this workforce to build sustainable rural health research capacity.
PMID:42470212 | DOI:10.1111/ajr.70234
Cancer Med. 2026 Jul;15(7):e72075. doi: 10.1002/cam4.72075.
ABSTRACT
BACKGROUND: Clinical guidelines recommend risk-management care for women with ≥ 20% lifetime risk of breast cancer (BC). Yet, guideline-concordant care-including conversations about BC risk with specialists-is low, and driving factors are not well understood. This study examined (a) associations between the material, psychosocial, and behavioral domains of financial constraint and BC risk conversations with genetics specialists and cancer/breast care specialists, and (b) whether competing resource demands are associated with the specialist BC conversations when controlling for insurance status (to disentangle the role of behavioral factors from material and psychological ones).
METHODS: Non-Hispanic Black or white women aged 18-74 years, with no history of cancer and ≥ 20% lifetime BC risk were recruited from online research volunteer databases, social media, and clinics. Participants completed an online survey about personal/family history, decision-making factors, and risk-management behavior. We used descriptive statistics to calculate proportions and both adjusted and unadjusted logistic regression to estimate odds ratios and 95% confidence intervals.
RESULTS: A total of 662 Black (34%) and white (66%) high-risk women comprised the analytic sample for this paper. Overall rates of specialist BC risk conversations were low: 43% had discussed their BC risk with any specialist (genetics specialist, breast specialist, and/or cancer specialist). In multivariate logistic regressions adjusted for race and age, perceived financial hardship was associated with lower odds of BC risk conversations with genetics (OR = 0.42 [95% CI: 0.25, 0.70]) and breast/cancer specialists (OR = 0.39 [95% CI: 0.24, 0.65]). Similar associations were observed for the relationships between disrupted insurance or single motherhood and specialist risk conversations.
CONCLUSIONS: Limited financial and other resources are associated with lower rates of BC risk conversations with specialists, which are critical to risk management in high-risk women. Future work should further investigate the complexities of resource limitations in BC risk management and develop mitigation strategies.
PMID:42470205 | DOI:10.1002/cam4.72075
JMIR Med Inform. 2026 Jul 17;14:e82924. doi: 10.2196/82924.
ABSTRACT
BACKGROUND: Electronic health records offer vast clinical data for health care research, but interoperability challenges often hinder comprehensive analysis. The Health Level Seven Fast Healthcare Interoperability Resources (FHIR) standard addresses these challenges, although its nested and interconnected resource format can be complex for analytics. Several tools have emerged to facilitate analytical access, either by querying FHIR servers via representational state transfer (REST) APIs or encoding resources in relational formats. However, the performance implications of these methods remain largely unexplored.
OBJECTIVE: This study aimed to benchmark the performance characteristics of different FHIR-based analytical approaches comparing REST API queries against SQL- and Spark-based big data frameworks operating on FHIR-encoded data.
METHODS: We benchmarked the FHIR-PYrate library, which interfaces with a FHIR server’s REST API, against Pathling, a library built for analytics based on Apache Spark, and Trino, a general-purpose SQL query engine. We defined and implemented multiple queries in each engine using 3 common analytics scenarios-data aggregation, counting, and extraction. Execution times were measured across Synthea-generated datasets of increasing size.
RESULTS: On the largest dataset, containing 71,285,064 FHIR resources, Trino completed the aggregate query more than 12,000 times faster, and Pathling did so approximately 500 times faster than FHIR-PYrate. On average across all queries, Trino outperformed FHIR-PYrate, executing extraction queries 33 times faster and count queries 1.8 times faster. Pathling achieved a 2.6-time speedup for extraction queries, but FHIR-PYrate was approximately 13 times faster for count queries.
CONCLUSIONS: While the REST-based FHIR search API is useful for standard queries and retrieving specific patient records and can outperform alternatives for some count queries, it generally lacks the performance and expressiveness needed for complex analytics. In contrast, alternative engines such as Trino and Pathling demonstrated substantial performance advantages for these scenarios.
PMID:42470189 | DOI:10.2196/82924
JMIR Rehabil Assist Technol. 2026 Jul 17;13:e88808. doi: 10.2196/88808.
ABSTRACT
BACKGROUND: Stroke is a leading cause of disability and death, resulting in a clinical, social, and economic burden upon families and the health system worldwide.
OBJECTIVE: This study aimed to introduce nurse-led rehabilitation services for patients after stroke to improve functional independence for self-care management.
METHODS: A pilot, open-label, 2-arm (1:1), randomized controlled trial was conducted at the National Institute of Neuroscience & Hospital in Bangladesh between March and August 2025. A total of 64 patients with stroke were enrolled using simple randomization. In the intervention group (IG), patients received rehabilitation education and assistive devices to improve activities of daily living. The control group (CG) received usual hospital care for stroke. Data were collected through a structured questionnaire. After discharge from the hospital, study nurses enrolled patients after stroke after a face-to-face assessment and provided rehabilitation education at the hospital and monthly rehabilitative education at home for 3 months. The study outcomes were improvement of functional independence, self-efficacy, social participation and reduction of caregivers’ burden.
RESULTS: Among 64 participants, 47 (73%) completed the study. Results depict an increase in self-care capacity, self-efficacy, social involvement and a decrease in care burden in both groups from baseline to end line; nevertheless, there was no statistically significant difference between IG and CG (F2, 44=0.113; P=.74). Functional Independence Measure mean scores (IG: mean 78.4, SD 37.6; CG: mean 74.3, SD 35.4; P=.70; 95% CI -25.16 to 18.14), self-efficacy (IG: mean 27.0, SD 6.9; CG: mean 26.6, SD 7.1; P=.83; 95% CI -3.6 to 4.6), social participation (IG: mean 30.4, SD 21.4; CG: mean 28.2, SD 17.2; P=.61; 95% CI -9.33 to 13.61), and care burden (IG: mean 24.9, SD 13.6; CG: mean 25.2, SD 12.6; P=.83; 95% CI -8 to 7). In qualitative analysis, we noticed enhanced self-care capacities of patients with poststroke disabilities after rehabilitative intervention, as indicated by participants’ perceptions.
CONCLUSIONS: In this study, patients’ self-care capability was improved after the intervention from baseline, and improvements were noted by using assistive devices based on patients’ perceptions and responses. The study findings demonstrated the importance of early self-care management for patients with poststroke disabilities. Future research should focus on long-term, community-integrated strategies that involve primary care, enhanced technological support, and caregiver-focused disability adjustment programs to achieve better outcomes.
TRIAL REGISTRATION: ClinicalTrials.gov NCT06786559; https://clinicaltrials.gov/search?id=NCT06786559.
PMID:42470187 | DOI:10.2196/88808
JMIR Res Protoc. 2026 Jul 17;15:e93012. doi: 10.2196/93012.
ABSTRACT
BACKGROUND: African American and Black women are among the least physically active demographic groups in the United States and experience disproportionate burdens of chronic disease that may be reduced through regular physical activity (PA). Mixed methods research is increasingly used to examine the behavioral, social, and contextual factors that influence PA in this population.
OBJECTIVE: This study aims to identify, examine, and describe the mixed methods designs used in research on PA practices among African American and Black women in the United States; compare methodological approaches; identify gaps in the literature; and provide recommendations for future research.
METHODS: This scoping review will follow Joanna Briggs Institute methodology. A 3-step search strategy was developed and peer reviewed using the Peer Review of Electronic Search Strategies guideline. Seven databases will be searched: Academic Search Ultimate, Agricultural and Environmental Science Database, APA PsycINFO, CINAHL Ultimate, PubMed, SocINDEX, and SPORTDiscus. Eligible studies will be primary mixed methods investigations involving non-Hispanic African American or Black women aged ≥18 years residing in the United States. Studies must include both quantitative and qualitative components with evidence of integration. Records will be deduplicated and screened in Rayyan according to population, concept, and context eligibility criteria. Data will be summarized using descriptive statistics, tables, and an evidence map. The review will be limited to English-language studies published from February 1, 2011, through February 18, 2026.
RESULTS: The protocol was registered with the Open Science Framework. The search strategy was piloted, refined, and finalized on February 18, 2026. Database searching has been completed, records have been imported and deduplicated, and screening is currently ongoing. Data extraction and synthesis have not yet commenced. Completion of study selection, data charting, and synthesis is anticipated by August 2026, with submission of the completed scoping review planned thereafter.
CONCLUSIONS: This review will provide a methodological map of mixed methods studies examining PA among African American and Black women, including design types, integration strategies, timing, prioritization, use of joint displays, and reporting practices. Findings will inform future mixed methods research and support the development of more rigorous and transparent investigations in this field.
TRIAL REGISTRATION: Open Science Framework 10.17605/OSF.IO/NA9ME; https://osf.io/na9me/overview.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/93012.
PMID:42470183 | DOI:10.2196/93012
J Neuroendocrinol. 2026 Jul;38(7):e70235. doi: 10.1111/jne.70235.
ABSTRACT
Hyperthyroidism is associated with cognitive impairment and neuropsychiatric symptoms, yet its effects on white matter architecture and neuromolecular organization remain poorly understood. We examined how hyperthyroidism alters white matter wiring architecture and the neuromodulatory systems underlying these disturbances. Diffusion MRI-derived structural connectomes were analyzed in 30 patients with hyperthyroidism (HT) and 28 matched healthy controls (HC). Structural connections were classified into short-, medium-, and long-range pathways, and global and nodal network topology was quantified using graph theoretical analysis. Molecular associations were examined using nine PET-derived neurotransmitter receptor density maps through spatial correlation, multiple regression, and dominance analysis. Associations with thyroid hormone levels, clinical measures, and cognitive scores were evaluated using permutation-based statistical testing. Neurotransmitter-weighted network measures were computed by linking normative neurotransmitter density with graph theoretical metrics. Spatial autocorrelation was controlled using spin permutation testing, with results additionally corrected for multiple comparisons using false discovery rate (FDR) correction. Hyperthyroid patients exhibited significantly increased medium-range (p = .002) and long-range connectivity (p = .02), reduced modularity (p = .009), and increased characteristic path length (p = .032) as compared to controls, indicating disrupted segregation and efficiency. Nodal alterations were predominantly right-lateralized, involving cortical, subcortical, and cerebellar regions. Clinically, BMI predicted modularity (p = .01), while free thyroxine levels predicted characteristic path length (p = .04) and long-range connectivity strength (p = .03). The Nahor-Benson score was associated with increased medium-range connectivity (p = .02) and nodal degree (p = .03) in right cerebellar lobule IV-V. Neurotransmitter receptor distributions explained substantial variance in network topology (adjusted R2 = 0.45 in controls; 0.38 in hyperthyroidism), with dominant contributions from 5-HT1A (33%) and dopamine transporter (17%). Furthermore, 5-HTT-weighted within module degree z-score predicted thyroid-stimulating hormone (TSH) levels in hyperthyroidism (p = .03), linking hormonal dysregulation to molecular connectomic reorganization. Our findings suggest that excess thyroid hormone drives right-lateralized connectomic reorganization and increased metabolic demand, mediated by serotonergic and dopaminergic receptor architecture, linking endocrine dysfunction to large-scale brain network vulnerability. These insights inform mechanistic models and biomarkers for clinical translation.
PMID:42470173 | DOI:10.1111/jne.70235
Nurs Open. 2026 Jul;13(7):e70659. doi: 10.1002/nop2.70659.
ABSTRACT
AIM: This study aimed to explore latent categories of nursing and medical students’ knowledge, attitude and practice intentions regarding advance care planning (ACP), and to identify the factors influencing these categories. It sought to provide an evidence base for developing personalized, precision-targeted advance care planning educational interventions.
METHODS: From October to December 2023, a stratified cluster random sampling method was employed to select a sample of 1006 undergraduate students in clinical medicine and nursing (Years 1-4) from a medical university in eastern China. A total of 935 valid questionnaires were recovered. Research instruments included a self-developed demographic questionnaire, the advance care planning knowledge, attitude and practice intentions Questionnaire, the Death Attitude Profile-Revised, and the Meaning in Life Questionnaire. Latent profile analysis determined the optimal number of categories; logistic regression identified factors influencing different advance care planning knowledge, attitude and practice intentions categories; a nomogram was constructed using R software, and predictive performance was evaluated using area under the curve (AUC), Hosmer-Lemeshow test, and 1000-bootstrap calibration curves.
RESULTS: Latent profile analysis identified two latent categories: a “collaborative” group (33.6% of the sample) and a “lagging” group (66.4% of the sample). The collaborative group scored higher than the lagging group across all dimensions of advance care planning knowledge, attitude and practice intentions questionnaire. Logistic regression analysis indicated: palliative care training (OR = 1.5, 1.028-2.190), resuscitation experience (OR = 0.64, 0.424-0.966), clinical medicine student (OR = 0.537, 0.376-0.766), urban student (OR = 0.626, 0.419-0.935), high death escape scores, low natural acceptance scores, and low meaning in life questionnaire scores were more likely to be classified as “lagging type”. Senior students (OR = 7.217, 4.089-12.737) and those with positive major attitude (OR = 3.572, 1.228-10.386) were more likely to be classified as “collaborative type”. The nomogram demonstrated good discriminatory ability (AUC = 0.864; 95% CI 0.841-0.887; Brier score = 0.14) and high calibration (χ2 = 13.845, p = 0.086; calibration slope = 0.97).
CONCLUSIONS: The established nomogram model identified the influencing factors of the knowledge, attitude and practice Intentions level of advance care planning among medical undergraduates, providing empirical evidence for the educational intervention of advance care planning for nursing and medical undergraduates. Universities needed to carry out refined advance care planning education in a targeted manner based on the different characteristics of students.
REPORTING METHOD: To strengthen the validity of the research, it was planned, conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.
PATIENT OR PUBLIC CONTRIBUTION: All participants contributed to the conducting of this study by completing self-reported questionnaires.
PMID:42470172 | DOI:10.1002/nop2.70659
Health Serv Res. 2026 Aug;61(4):e70151. doi: 10.1111/1475-6773.70151.
ABSTRACT
OBJECTIVE: To evaluate whether centralized appointment scheduling and same-day virtual clinician evaluation improved appointment timeliness and follow-up after nurse triage. We also assessed whether these changes were associated with differences in downstream utilization, costs, reach, and Veteran experience.
STUDY SETTING AND DESIGN: Retrospective quasi-experimental evaluation of Veteran Administration Health Connect (VAHC) modernization across 18 regions between October 1, 2018, and September 30, 2024. Staggered rollout enabled difference-in-differences and event-study analyses comparing outcomes before and after modernization.
DATA SOURCES AND ANALYTIC SAMPLE: Data were drawn from the Veterans Administration Corporate Data Warehouse, Telecare Record Manager, and Customer Relationship Management platforms, and VSignals Veteran experience surveys. The analytic sample comprised 11,118,916 encounters (4,560,677 pre-modernization; 6,558,239 post-modernization).
PRINCIPAL FINDINGS: Centralized scheduling was associated with modest and mixed improvements in appointment access. Same-day scheduling increased by 14.3 percentage points (95% CI, 10.1 to 18.5). Time from call to scheduled appointment decreased by 0.37 days (95% CI, -0.49 to -0.26), while time to completed appointment increased by 2.9 days (95% CI, 0.2 to 5.7). Following modernization, time from nurse triage to any subsequent care decreased by 0.28 days (95% CI, -0.45 to -0.11), and the proportion of callers receiving no follow-up care within 7 days declined by 2.3 points (95% CI, -4.0 to -0.5). Modernization was not associated with changes in the proportion of all emergency department (ED) visits preceded by a nurse triage call or in total ED visit volume. Seven-day ED visits, admissions, and total costs did not change meaningfully. Veteran satisfaction was high for post-modernization virtual encounters.
CONCLUSIONS: VAHC modernization improved appointment access and follow-up after nurse triage but was not associated with short-term changes in ED use or costs, highlighting gains in navigation and experience without immediate shifts in downstream utilization.
PMID:42470152 | DOI:10.1111/1475-6773.70151