Category: Nevin Manimala

IEEE J Biomed Health Inform. 2026 Apr 23;PP. doi: 10.1109/JBHI.2026.3687164. Online ahead of print.

ABSTRACT

Multi-label Chest X-ray (CXR) classification faces significant challenges from the inherently imperfect nature of clinical data, particularly the complex interplay of co-occurring pathologies, training data with a long-tailed distribution, and high visual similarity between distinct diseases. To address these challenges, we propose a novel framework that synergizes medical prior knowledge with prototype-driven contrastive learning, enabling disentangled and discriminative per-pathology representation learning. In particular, our approach integrates a co-occurrence modulated Label Graph Attention (LGA) module, which leverages semantic prior knowledge from a pre-trained large language model (LLM) and statistical co-occurrence patterns from training data to model inter-pathology relationships. Subsequently, a Label-Aware Decoupling (LAD) decoder is proposed to isolate pathology-specific visual features and mitigate feature suppression by dominant classes. Furthermore, we introduce an Adaptive Proto type Contrastive Learning (APCL) mechanism to enhance the discriminability of visually similar pathologies. Extensive experiments on the NIH ChestX-ray14 and CheXpert datasets demonstrate the framework’s superiority, achieving state-of-the-art mean AUCs of 0.834 and 0.840, respectively. Furthermore, cross-dataset evaluations on the external MIMIC-CXR dataset validate the framework’s exceptional zero-shot and few-shot generalization capabilities, highlighting its strong robustness and potential for real world clinical deployment. The implementation is available at https://github.com/ZengXHYX/Learning-from-Prototypes.

PMID:42024945 | DOI:10.1109/JBHI.2026.3687164

IEEE Trans Neural Netw Learn Syst. 2026 Apr 23;PP. doi: 10.1109/TNNLS.2026.3685617. Online ahead of print.

ABSTRACT

Network motifs, as fundamental functional substructures in gene regulatory networks (GRNs), play a critical role in regulating gene expression. Despite the successful application of graph representation learning in GRN modeling, most existing approaches mainly capture pairwise relationships and overlook higher order regulatory patterns encoded by functional motifs, which limits the accuracy of regulatory inference. To address this limitation, we propose Motif-GRN, a motif-based hypergraph representation learning framework that captures the underlying biological logic in higher order semantic structures. We first identify statistically significant regulatory motifs and construct a multichannel motif-induced hypergraph. We then design a motif-aware hypergraph convolutional network to extract motif-centric semantic features, while a conventional graph convolution module preserves first-order relational information. In addition, we introduce cross-view contrastive learning to align heterogeneous representations and enhance gene embeddings. Building on Motif-GRN, we develop an inductive extension that enables cross-dataset generalization and effective GRN inference with limited labels. Extensive experiments on three ground-truth networks across seven cell types demonstrate that Motif-GRN outperforms state-of-the-art baselines in both transductive and inductive GRN inference tasks, highlighting its potential for higher order regulatory network modeling.

PMID:42024938 | DOI:10.1109/TNNLS.2026.3685617

Indian J Med Res. 2026 Mar;163(3):327-333. doi: 10.25259/IJMR_452_2025.

ABSTRACT

Background and objectives The rise of antibiotic resistance is a global health crisis, and the irrational use of antibiotics is the major contributing factor. Therefore, it is essential to understand the antibiotic usage in the community to estimate the prevalence of antibiotic usage and its association with various co-variates and to evaluate the consumption pattern of antibiotic usage in the catchment areas of the Urban Health Training Centre of a medical college in Ahmedabad City. Methods An observational, community-based cross-sectional study was conducted in 3 phases during May-Aug 2024. Estimated sample size was 315 individuals who were ill anytime in last three months or consumed drugs and were selected from 15 clusters identified by cluster sampling method. Information was gathered on a structured questionnaire, and statistical parameters such as prevalence, prevalence ratios, confidence interval, and chi-square test were calculated in MS Excel. Results The screening of 2278 participants yielded 349 eligible participants as per inclusion criteria and 117 (33.5%) of them consumed 152 antibiotics during the previous three months. Sociodemographic determinates like age, sex and qualification of treatment provider showed significant association with antibiotic usage. Use of antibiotics was higher 55 (42.6%) in children than in adults 62 (28.1%). As per AWaRe classification (WHO), 3/4th of the participants (59.9%) consumed the watch group, more than half (50.4%) consumed the Access group and 2 (1.7%) consumed the Reserve group of antibiotics. Antibiotics are prescription only drugs, still in 37.5% of cases, antibiotics, even those from the Watch group, were obtained without a prescription. Interpretation and Conclusions Overall, a concerning trend of antibiotic use without prescriptions was witnessed, specifically in the ‘Watch’ category of antibiotics. It highlights the need for improved prescribing practices and public education to prevent misuse of antibiotics.

PMID:42024912 | DOI:10.25259/IJMR_452_2025

Indian J Med Res. 2026 Mar;163(3):290-294. doi: 10.25259/IJMR_2226_2025.

ABSTRACT

Background and objectives MicroRNAs (miRNAs) are small, non-coding RNA molecules that regulate gene expression at the post-transcriptional level and play critical roles in tumour development and progression. Bladder cancer requires reliable molecular biomarkers for diagnosis and prognosis; the roles of certain miRNAs remain insufficiently explored. This study aimed to investigate the expression profiles of miR-22-5p and miR-337-5p in bladder cancer and to evaluate their associations with clinicopathological characteristics. Methods Paired tumour and adjacent non-tumorous bladder tissue samples were collected from 50 patients undergoing transurethral resection of bladder tumour. Quantitative PCR was performed using RNA U6 as the reference gene. Expression differences were analysed, and correlations with clinicopathological features were assessed. Results Both miR-22-5p and miR-337-5p were downregulated in tumour tissues compared to normal tissues. miR-22-5p expression showed a marked reduction in bladder cancer, while miR-337-5p downregulation reached borderline statistical significance. Correlation analyses revealed no association between miR-22-5p expression and clinical variables; however, miR-337-5p expression was significantly correlated with patient age and disease duration. Interpretation and conclusions Altered expression of miR-22-5p and miR-337-5p may contribute to bladder cancer pathogenesis. miR-22-5p appears as a potential tumour suppressor, while miR-337-5p expression is influenced by clinical parameters such as age and disease duration, highlighting their potential roles as prognostic and therapeutic biomarkers.

PMID:42024907 | DOI:10.25259/IJMR_2226_2025

J Man Manip Ther. 2026 Apr 23:1-9. doi: 10.1080/10669817.2026.2662609. Online ahead of print.

ABSTRACT

BACKGROUND: Competency-based education (CBE) emphasizes mastery of defined competencies rather than time-based progression. Within orthopedic manual physical therapy (OMPT), the evolving evidence supports person-centered, evidence-informed care, requiring fellowship training standards that reflect this shift. Among the seven proposed domains of competence, Systems-Based Practice (SBP) and Patient Management (PM) are essential. SBP focuses on navigating healthcare systems, interprofessional collaboration, and advocacy, while PM emphasizes delivering comprehensive, value-based care through evidence-informed, person-centered approaches. Consensus on competencies for these domains in OMPT fellowship training remains unclear.

OBJECTIVE: To achieve an international consensus on competencies and graduation milestones for OMPT fellowship training in SBP and PM.

METHODS: A modified three-Round Delphi study was conducted. In Round I, nine content experts drafted competencies and milestones. Rounds II and III invited stakeholders from the International Federation of Manual and Musculoskeletal Physical Therapists (IFOMPT) member organizations via web-based surveys. Consensus was defined a priori as ≥ 80% agreement. Descriptive statistics and composite scores were used to assess the strength of agreement. The reporting in this study follows guidelines from the Accurate Consensus Reporting Document (ACCORD).

RESULTS: Systems-Based Practice (SBP): Five competencies and 19 milestoneswere proposed; four competencies achieved consensus (health screening, healtheducation, healthcare system navigation, health policy and advocacy). PatientManagement (PM): Six competencies and 17 milestones achieved consensus,with the strongest support for evidence-informed treatment implementation,person-centered care, cultural and social sensitivity, and outcomeoptimization. Lesser support was observed for applying the human movementsystem framework.

CONCLUSIONS: Findingsunderscore the importance of competencies that promote leadership, advocacy,and evidence-informed, person-centered care in OMPT fellowship training. Gapsin consensus regarding quality improvement and the application of movementsystems highlight areas for future study or development. These resultscontribute to a global framework for advanced OMPT fellowship-level education.

PMID:42024886 | DOI:10.1080/10669817.2026.2662609

Obstet Gynecol. 2026 Apr 23. doi: 10.1097/AOG.0000000000006298. Online ahead of print.

ABSTRACT

Inequalities in severe maternal morbidity (SMM) and mortality in high-income countries are persistent, socially patterned, and evident across multiple dimensions, including socioeconomic deprivation, race and ethnicity, and migration status. These inequalities are not fully explained by individual clinical risk factors but arise from the interaction of structural disadvantage, intermediate social conditions, and health systems. Many determinants of risk are established before pregnancy; however, variation in access to care, quality of care, and responsiveness to symptoms during pregnancy and childbirth can either mitigate or exacerbate vulnerability. Identifying social and structural determinants, ensuring equitable access to care, providing culturally responsive care, and promoting timely, unbiased clinical decision making are essential components of clinician efforts to reduce inequalities in SMM and mortality.

PMID:42024879 | DOI:10.1097/AOG.0000000000006298

JMIR Aging. 2026 Apr 23;9:e75920. doi: 10.2196/75920.

ABSTRACT

BACKGROUND: Digital exclusion posed a significant challenge, especially in middle-aged and older adults, which affected their health outcomes. However, the evidence regarding the associations of digital exclusion on physical or cognitive function outcomes was controversial, and no systematic review had been performed to synthesize the pooled associations.

OBJECTIVE: This study aimed to explore the relationship between digital exclusion and physical or cognitive function in middle-aged and older adults.

METHODS: We conducted a systematic review and meta-analysis of cohort and cross-sectional studies, including Chinese or English publications retrieved from PubMed, Embase, Web of Science, PsycINFO, Scopus, CNKI, and Wanfang databases up to August 31, 2024. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS). The pooled effect size was calculated based on odds ratios (ORs), hazard ratios, risk ratios, and 95% CIs. This study was registered on PROSPERO (CRD42024585459).

RESULTS: Nineteen studies met the inclusion criteria, including 13 cohort studies and 6 cross-sectional studies, which had moderate-to-low risk of bias. The pooled analysis indicated that digital exclusion had prospective associations with decreased basic activities of daily living (incidence rate ratio 1.35, 95% CI 1.12-1.64, I2=94.7%) and instrumental activities of daily living (incidence rate ratio 1.46, 95% CI 1.13-1.89, I2=96.2%), or cross-sectional association with activities of daily living (OR 1.23, 95% CI 0.41-3.73, I2=91%), with no statistical significance in the prospective association with frailty (OR 1.21, 95% CI 0.92-1.59, I2=95.2%). There were prospective associations between digital exclusion and dementia (hazard ratio 1.78, 95% CI 1.43-2.22, I2=0%), decreased Mini-Mental State Examination scores (OR 1.96, 95% CI 1.39-2.75, I2=0%), as well as cross-sectional associations with Mini-Mental State Examination scores (OR 2.90, 95% CI 2.07-4.07, I2=0%), and no statistical significance in the prospective association with cognitive impairment (risk ratio 2.08, 95% CI 0.98-4.44, I2=78.2%).

CONCLUSIONS: Our findings indicated the negative associations of digital exclusion with physical and cognitive functions. Future research and clinical practice should consider designing digital interventions and services that match the physical and cognitive capacities and preferences of middle-aged and older adults, thereby improving digital engagement and reducing the harms associated with digital exclusion. Policies should focus on expanding access, reducing financial barriers, and improving digital literacy. However, due to the presence of heterogeneity and publication bias, the results should be interpreted cautiously.

PMID:42024876 | DOI:10.2196/75920

J Med Internet Res. 2026 Apr 23;28:e82902. doi: 10.2196/82902.

ABSTRACT

BACKGROUND: The growing number of survivors of cancer in China has created an increasing need for survivorship care as many survivors face ongoing physical, psychological, and social challenges after treatment. Mobile health (mHealth) services, which are delivered through mobile devices and apps, have emerged as potential tools to support self-management, facilitate access to care, and improve quality of life. However, evidence on the prevalence, use patterns, and determinants of mHealth adoption among Chinese survivors of cancer remains limited.

OBJECTIVE: This study aimed to examine the prevalence and patterns of mHealth use among adult survivors of cancer in China and identify sociodemographic and clinical factors associated with adoption.

METHODS: We conducted a multicenter cross-sectional survey study between February 13, 2024, and September 21, 2024, at 4 tertiary cancer care centers in China. Adult survivors of cancer were recruited using convenience sampling. Data were collected through structured face-to-face questionnaires assessing sociodemographic and clinical characteristics, mHealth use, perceived needs, concerns, and user experience. Missing data were limited and handled using complete-case analysis after the Little test supported consistency with missing completely at random. Descriptive analyses summarized participant characteristics and mHealth-related variables. Group differences were examined using chi-square tests and 2-tailed independent-sample t tests. Significant variables in univariate analyses were entered into a multivariable logistic regression model.

RESULTS: Of 1152 participants, 364 (31.6%) reported prior mHealth use. Use was concentrated in practical functions, particularly appointment booking (301/364, 82.7%), online consultation (244/364, 67%), and viewing examination or laboratory reports (215/364, 59.1%), with WeChat-based platforms being the most commonly used access channel (244/364, 67%). Participants reported high demand for clinical guidance (917/1152, 79.6%) and direct communication with health care professionals (901/1152, 78.2%), whereas common concerns included leakage of private information (694/1152, 60.2%) and inaccurate illness judgment (633/1152, 54.9%). In multivariable analysis, mHealth use was significantly associated with younger age, higher educational level, annual household income of at least ¥100,000 (US $14,527.90), widowed or divorced marital status, living alone, and treatment dissatisfaction; cancer type and time since diagnosis were not significant predictors.

CONCLUSIONS: mHealth use among adult survivors of cancer in China is established but uneven, with use concentrated in practical service functions rather than comprehensive survivorship support. Uptake was significantly associated with age, socioeconomic position, social circumstances, and treatment experience but not with clinical characteristics. Survivors reported a strong demand for clinically relevant and communication-oriented functions but also expressed substantial concerns about privacy, accuracy, reimbursement, and physician authenticity. Future survivorship mHealth services should prioritize clinical relevance, trust, integration with formal care, and equitable implementation to achieve broader and more meaningful use.

PMID:42024873 | DOI:10.2196/82902

JMIR Public Health Surveill. 2026 Apr 23;12:e73659. doi: 10.2196/73659.

ABSTRACT

BACKGROUND: Modifiable unhealthy behaviors account for over two-thirds of new cases of noncommunicable diseases. Behavioral risk factor reduction is a potentially cost-effective means to improve long-term health outcomes. Although family serves as a pivotal cornerstone for fostering and maintaining individuals’ health, the associations between family health (FH) and the proactive health risk management index (PHRMI) remain unclear.

OBJECTIVE: This study aimed to construct a comprehensive index to measure the PHRMI and examine the mediating effect of health literacy on the association between FH and the PHRMI, as well as the moderating effect of family communication on the associations among the PHRMI, health literacy, and FH.

METHODS: A cross-sectional questionnaire survey was conducted with 30,044 participants from 34 provinces or regions in China who were recruited using a multistage stratified sampling strategy from June 20, 2023, to August 31, 2023. This study constructed the PHRMI for the general population by encompassing BMI, physical activity (International Physical Activity Questionnaire-Short Form), depression (Patient Health Questionnaire-9), sleep quality (Brief version of the Pittsburgh Sleep Quality Index), smoking behavior, and drinking behavior. Further, we assessed FH (Short Form of the Family Health Scale), health literacy (Short-Form Health Literacy Questionnaire-4), and family communication (Family Communication Scale-Short Form). In addition, we collected the sociodemographic characteristics of the participants. We used model 4 of the IBM SPSS macro PROCESS to verify the mediating effect of health literacy between FH and the PHRMI, while model 7 was adopted to test the moderated mediation of family communication among the PHRMI, health literacy, and FH.

RESULTS: Higher levels of FH were significantly associated with higher PHRMI levels (β=.710, 95% CI 0.669-0.752). Health literacy significantly mediated the association between FH and the PHRMI (β=.207, 95% CI 0.168-0.245), playing a partial mediating role. Family communication significantly moderated the association between FH and health literacy (β=.117, 95% CI 0.105-0.130). The simple slope analysis showed that higher levels of family communication exacerbated the effects of FH on health literacy. Subsequently, we performed a sensitivity analysis, and the main results aligned with the findings of prior studies. Nevertheless, the subgroup analysis revealed that the mediating effect of health literacy was not significant in the group aged >60 years (β=.066, 95% CI -0.024 to 0.157).

CONCLUSIONS: FH can be an important target that appears to be positively linked to proactive health risk management and health literacy. FH promotion for older adults should pay more attention to family or intergenerational communication.

PMID:42024872 | DOI:10.2196/73659

JMIR Public Health Surveill. 2026 Apr 23;12:e75094. doi: 10.2196/75094.

ABSTRACT

BACKGROUND: With the advent of new vaccines, including the COVID-19 vaccines introduced during the recent pandemic, the need for near real-time active surveillance has increased to support timely regulatory decision-making.

OBJECTIVE: This study aimed to assess the feasibility of sequential monitoring for potential adverse events following immunization in Korea, focusing on COVID-19 vaccines.

METHODS: This population-based study used a linked database that combined the COVID-19 registry with national health insurance claims data. Participants included individuals older than 12 years who received either monovalent or bivalent COVID-19 vaccines in Korea between February 2021 and March 2023. Monthly retrospective sequential testing was performed for 3 prespecified outcomes (acute myocardial infarction, myocarditis, and anaphylaxis) as well as a negative control event (colonic diverticulitis). A Poisson-based maximized sequential probability ratio test was applied to compare postvaccination incidence rates with historical background rates, accounting for multiple testing and claims processing delays. Analyses were stratified by age group, vaccine platform, and dose.

RESULTS: This study included over 43 million monovalent and 6.3 million bivalent vaccine recipients. Sequential analyses identified statistical signals for myocarditis following mRNA vaccines in individuals aged 12 to 64 years and protein subunit vaccines in those aged 40 to 64 years. Signals for anaphylaxis were observed following mRNA and nonreplicating viral vector vaccines in individuals older than 18 years. No safety signals were identified for acute myocardial infarction or colonic diverticulitis. Sequential monitoring detected signals for myocarditis and anaphylaxis before regulatory authorities took safety actions, with the earliest signals observed on September 30, 2021, and April 30, 2021, respectively.

CONCLUSIONS: Near real-time sequential testing detected statistical safety signals for myocarditis and anaphylaxis following COVID-19 vaccination. These signals were recognized by the regulatory authority as being associated with the vaccines, demonstrating the potential of this approach to detect signals requiring further causality assessments, particularly for newly introduced vaccines at an early stage.

PMID:42024871 | DOI:10.2196/75094