Category: Nevin Manimala

Traffic Inj Prev. 2026 Jul 2:1-11. doi: 10.1080/15389588.2026.2688459. Online ahead of print.

ABSTRACT

OBJECTIVE: Crest vertical curves are frequently employed in long mountainous freeway tunnels to facilitate drainage and ventilation, yet the mechanisms by which specific grades and grade changes within these curves influence driving behavior and traffic safety at tunnel portals remain insufficiently understood. This study aims to explore the effects of crest vertical grade designs, specifically entrance grades, exit grades, and grade changes, on driving behavior at the portals of long mountainous freeway tunnels.

METHODS: Based on a survey of alignment design indicators of over 100 tunnels in Guangdong Province, this study identified that most long tunnels adopt a crest vertical grade design and their typical alignment indicators. Based on the investigation, a 26-km-long freeway model comprising 10 tunnels with distinct vertical profile was constructed. Subsequently, a driving simulation experiment was conducted with 32 recruited participants. Driving behavior data were collected within 100-meter zones inside and outside each portal. Eight key behavioral indicators, including mean and standard deviation of speed, time headway, lane departure, and acceleration, were extracted. Repeated-measures one-way analysis of variance (ANOVA) was then used to identify significant differences across various design conditions. Subsequently, indicators exhibiting statistical significance were integrated into a Fuzzy Comprehensive Evaluation (FCE) model, combining with entropy weight methods to objectively quantify the overall safety performance of each design scheme.

RESULTS: ANOVA results indicated that five specific indicators showed significant variations under different grade designs: mean and standard deviation of speed, mean and standard deviation of time headway, and mean acceleration. Lane departure and standard deviation of acceleration were not significantly affected by grade designs. The Fuzzy Comprehensive Evaluation revealed distinct optimal conditions for portal safety. At tunnel entrances, uphill grades yielded significantly higher safety scores compared to flat or downhill sections, with the 1.5% uphill grade achieving the highest comprehensive score. Conversely, flat (0%) entrances resulted in the lowest safety ratings. At tunnel exits, safety scores generally decreased as the exit grade became less steep; the 1.5% exit grade produced the optimal safety outcome. Regarding internal grade changes, a moderate change of 3% resulted in the highest safety scores, whereas larger changes led to increased speed dispersion and reduced time headways, lowering the overall safety evaluation.

CONCLUSIONS: This study confirms that vertical alignment design critically influences driver performance and safety at portals of long tunnels. These findings provide quantitative guidance for updating freeway tunnel design specifications, recommending that designers prioritize uphill approaches and moderate grade transitions. Furthermore, the results offer a scientific basis for traffic authorities to implement targeted safety management measures, thereby mitigating crash risks in critical tunnel portal zones.

PMID:42391531 | DOI:10.1080/15389588.2026.2688459

Mol Biol Evol. 2026 Jul 2:msag157. doi: 10.1093/molbev/msag157. Online ahead of print.

ABSTRACT

Reconstructing ancient population size history is essential for understanding the evolutionary origin of Homo sapiens. We recently developed the fast infinitesimal time coalescent process (FitCoal) and detected a severe population bottleneck occurring approximately 930 thousand years ago. However, two recent studies compared FitCoal and mushi and concluded that the severe bottleneck is a statistical artifact. In this study, we compared the two methods against a benchmark of ten billion msprime coalescent simulations. We demonstrate that FitCoal achieves both superior speed and accuracy in expected site frequency spectrum (SFS) estimation. Analyses of simulated datasets confirmed that FitCoal reliably recovers the bottleneck, whereas mushi fails under identical conditions. Independent fossil and paleoclimate evidence is consistent with the timing and evolutionary impact of this bottleneck, including associations with hominin dispersals, speciation events, and a subsequent increase in brain size. These findings refine the demographic history of Homo during the Pleistocene and highlight the importance of high-precision SFS computation for revealing critical evolutionary transitions that shaped modern human ancestry.

PMID:42391510 | DOI:10.1093/molbev/msag157

Jpn J Clin Oncol. 2026 Jul 2:hyag102. doi: 10.1093/jjco/hyag102. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with schizophrenia spectrum disorders (SSD) experience higher cancer mortality, partly because of later-stage diagnosis and lower rates of recommended treatments. While treatment disparities have been reported across several cancer types, no study has specifically examined stage-appropriate treatment for gastric cancer among patients with SSD.

METHODS: We conducted a retrospective cohort study using a nationwide Hospital-Based Cancer Registry linked to administrative data in Japan. Patients who received initial treatment for gastric cancer between 2018 and 2021 were included. Multivariable logistic regression models examined the association between SSD and the receipt of stage-appropriate cancer treatments, adjusting for age, sex, clinical stage, Charlson Comorbidity Index, and Barthel Index.

RESULTS: Among 189 447 patients from 709 hospitals, 1312 had SSD. Patients with SSD were more likely to be diagnosed at advanced stages. In crude analysis, SSD was associated with lower rates of surgical or endoscopic treatment; however, this association was not statistically significant after adjustment (adjusted odds ratio [aOR], 0.90; 95% confidence interval [CI], 0.75-1.08). In contrast, SSD was independently associated with lower rates of postoperative adjuvant chemotherapy for pathological stage II/III disease (aOR, 0.64; 95% CI, 0.45-0.91) and systemic therapy for stage IV disease (aOR, 0.36; 95% CI, 0.28-0.47).

CONCLUSIONS: Among patients with gastric cancer, SSD was associated with reduced receipt of systemic therapy but not surgical or endoscopic treatment. Efforts to improve early detection among patients with SSD may be important for reducing treatment disparities, alongside strengthened support for systemic therapy to ensure equitable access to guideline-recommended gastric cancer care.

PMID:42391504 | DOI:10.1093/jjco/hyag102

JMIR Nurs. 2026 Jul 2;9:e94450. doi: 10.2196/94450.

ABSTRACT

BACKGROUND: Inequitable and time-consuming shift scheduling contributes to nurse burnout, dissatisfaction, and turnover. In Taiwan, annual nurse turnover reaches 11.6%, with rigid 3-shift systems and unfair workload distribution frequently cited as key drivers. Although artificial intelligence (AI) scheduling tools exist, most lack transparency and do not formally address algorithmic bias, limiting clinical adoption.

OBJECTIVE: This study aimed to design, deploy, and evaluate a transparent, fairness-audited, explainable AI-enabled nurse scheduling decision support system (XAI-NSDSS) to reduce administrative burden, eliminate experience-based algorithmic bias, and enhance staff acceptance in a real-world hospital setting.

METHODS: A pragmatic before-after implementation study was conducted at a 671-bed teaching hospital in Taiwan (January-December 2023), involving 8 departments and 156 nurses (42 novice, 78 midlevel, and 36 experienced). A 6-month manual scheduling baseline (January-June 2023) was compared with a 6-month AI-assisted period (July-December 2023). The XAI-NSDSS integrates a random forest workload prediction model (R²=0.887), Shapley Additive Explanations-based explainability, a hybrid integer programming and binary differential evolution (IP+ BDE) optimizer, and a multidimensional fairness monitoring dashboard. A formal weight sensitivity analysis (WSA) was conducted across 7 prespecified weight configurations using full-factorial repeated-measures ANOVA to assess outcome robustness. Primary outcomes were scheduling time, error rate, and user satisfaction. Statistical analyses used linear mixed effects models (LMMs) and generalized estimating equations (GEE) with department as a random effect.

RESULTS: Monthly scheduling time decreased by 81.2% (mean 32.0, SD 8.0-mean 6.0, SD 2.0) hours; P<.001; Cohen d=4.33) and error rate decreased by 73.8% (mean 18.3, SD 4.3%-mean 4.8, SD 1.2%; P<.001; Cohen d=4.12). Nurse satisfaction improved from a mean of 3.2 (SD 0.8) to a mean of 4.4 (SD 0.6; P<.001), with 148 out of 156 nurses (94.9%) adopting the system by Month 3. Preexisting experience-based bias was fully eliminated: workload coefficient of variation (CV) decreased 50% (0.18-0.09; P<.001), disparate impact ratios normalized from 1.35-1.56 to 1.01-1.04, and preference satisfaction equity was achieved across experience tiers (ANOVA P=.38). Among 156 nurses, 82 (52.6%) regularly engaged with Shapley Additive Explanations; this engagement was positively associated with satisfaction (Pearson r=0.456; P<.001). The WSA across 7 configurations confirmed that the consensus-derived default weights achieved the highest composite quality score (mean 82.1, SD 3.2) and that disparate impact ratios remained within the 0.80-1.25 fairness threshold across all configurations (P=.12), demonstrating structural robustness of the fairness-auditing module.

CONCLUSIONS: This study presents the first longitudinally validated explainable AI implementation framework for nurse scheduling with formal algorithmic fairness auditing and WSA. The XAI-NSDSS framework is replicable, scalable, and provides a practical blueprint for responsible AI adoption in health care workforce governance, with fairness guarantees that are robust to institutional customization of optimization priorities.

PMID:42391503 | DOI:10.2196/94450

Int Braz J Urol. 2026 Sep-Oct;52(5):e20260166. doi: 10.1590/S1677-5538.IBJU.2026.0166.

ABSTRACT

PURPOSE: To critically evaluate the clinical presentation, imaging performance and surgical findings of malleable penile prosthesis (MPP) fractures in a high-volume tertiary center.

MATERIALS AND METHODS: Medical reports of men who underwent revision surgery with intraoperative confirmation of MPP fracture between January 2008 and January 2025 were reviewed. MPP from a single manufacturer (Promedon®, Cordoba, Argentina) were inserted, and no comparisons were possible. Demographic data, presenting symptoms, imaging findings, and fracture location were analyzed. Diagnostic performance of physical examination and imaging modalities was descriptively compared.

RESULTS: Among 741 penile prosthetic procedures, 98 were revisions and 52 (53.1%) were due to MPP fracture. Median time from implantation to fracture was 59 months (IQR 24.8-84.0). Penile instability was the most common symptom (96.1%), while pain was reported in 21.1%. Physical examination correctly identified fractures in 88.5% of cases, outperforming radiography and magnetic resonance imaging. Bilateral fractures occurred in 51.9% of revisions, most commonly in the proximal segment. Recurrent fractures occurred in 28.2% of patients.

CONCLUSIONS: MPP fractures are more prevalent than expected and a clinically relevant complication in high-volume centers. Diagnosis relies primarily on clinical assessment, with physical examination outperforming imaging modalities. Increased awareness of typical presentation patterns may support earlier recognition and more efficient management. Prospective studies are needed to identify modifiable risk factors, improve device design and quality, and advise patients on use to potentially improve prosthesis lifetime.

PMID:42391489 | DOI:10.1590/S1677-5538.IBJU.2026.0166

Prostate. 2026 Jul 2. doi: 10.1002/pros.70209. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to investigate the effects of holmium laser enucleation of the prostate (HoLEP) with proactive preservation of one lateral lobe (PLL-HoLEP) on urinary function and sexual function in patients with benign prostatic hyperplasia (BPH).

METHODS: From April 2024 to April 2025, 71 patients who underwent PLL-HoLEP (Group A) were studied based on inclusion and exclusion criteria. Meanwhile, 140 patients who underwent traditional HoLEP from September 2022 to March 2024 were selected as the control group (Group B). After propensity score matching (PSM) was performed, the baseline characteristics of the two groups were balanced. Subsequently, differences in clinical outcomes between the groups were compared. We compared preoperative and postoperative complications, international prostate symptom score (IPSS), quality of life (QoL), maximum urine flow rate (Q_max), postvoid residual urine (PVR), International Index of Erectile Function (IIEF-5), QMSHQ EjF, and QMSHQ EjS between the two groups, and conducted follow-up evaluations of surgical outcomes and sexual function.

RESULTS: Fifty-four pairs of patients were successfully matched by PSM. Operative time, resected prostate weight, hemoglobin decrease, and incidence of transient incontinence and retrograde ejaculation in Group A were lower than those in Group B. There were significant differences in IPSS, QoL, Q_max, and PVR between preoperative and 1 month postoperative periods in two groups (p < 0.05). However, there were no statistically significant differences in IPSS, QoL, Q_max, and PVR between the two groups at one and 6 months postoperatively (p > 0.05). Significant differences in IIEF-5, QMSHQ EjF, and QMSHQ EjS scores were observed between the two groups during the 6-month postoperative follow-up of sexual function (p < 0.05), with Group A showing better outcomes.

CONCLUSION: For patients who satisfy the inclusion and exclusion criteria, PLL-HoLEP can reduce the incidence of transient urinary incontinence and retrograde ejaculation and more effectively preserve the sexual function of patients with BPH.

PMID:42391476 | DOI:10.1002/pros.70209

JMIR Form Res. 2026 Jul 2;10:e92442. doi: 10.2196/92442.

ABSTRACT

BACKGROUND: Postoperative pain and anxiety remain common concerns after minimally invasive gynecologic surgery despite advances in surgical techniques and analgesic strategies. Virtual reality (VR) has been investigated as a potential nonpharmacological intervention for pain management; however, evidence in gynecologic postoperative settings is limited.

OBJECTIVE: This study aims to evaluate the efficacy and safety of VR technology compared with standard postoperative analgesia for pain and anxiety management in patients undergoing minimally invasive gynecologic surgery.

METHODS: This randomized controlled trial was conducted at Sun Yat-sen Memorial Hospital of Sun Yat-sen University in China. A total of 131 patients undergoing laparoscopy or combined hysteroscopy for benign gynecologic diseases were randomly assigned in a 1:1 ratio to either a VR group (n=68) or a control group (n=63). All patients received a standardized general anesthesia protocol intraoperatively. The control group received conventional analgesic therapy after surgery, and the VR group received a 20-minute VR intervention 6 hours postoperatively. The pain and anxiety levels were evaluated using a visual analog scale at 6 and 7 hours postoperatively. The primary outcome was the change in pain scores between 6 and 7 hours. Secondary outcomes included maximum pain score, anxiety score changes, length of hospital stay, hospitalization costs, and occurrence of adverse events. Analyses were performed according to the intention-to-treat principle.

RESULTS: There was no statistically significant difference in the primary outcome between the VR and control groups (mean difference 0.169, 95% CI -0.271 to 0.608; P=.45). Similarly, no significant differences were observed in the maximum pain score (mean difference 0.839, 95% CI -0.101 to 1.779; P=.08), and no improvement was observed in the anxiety score (mean difference 0.042, 95% CI -0.365 to 0.449; P=.84). No significant differences were found in length of hospital stay, hospitalization costs, or incidence of adverse events, including dizziness, nausea, and vomiting (all P>.05).

CONCLUSIONS: A single 20-minute VR intervention did not provide additional analgesic or anxiolytic benefit compared with standard postoperative care after minimally invasive gynecologic surgery. VR was well tolerated, and its role in postoperative recovery requires further investigation.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400091244; https://tinyurl.com/4b92a9td.

PMID:42390916 | DOI:10.2196/92442

J Med Internet Res. 2026 Jul 2;28:e92132. doi: 10.2196/92132.

ABSTRACT

The value of a meta-analysis is based on its methodological and statistical rigor, yet many published systematic reviews and meta-analyses contain statistical shortcomings that limit their utility for clinical practice and public health. This can make it challenging to aggregate data for treatment choices for patients as well as limit the extent to which policymakers can promote social change and improve public health. This challenge is compounded by the traditionally slow and resource-intensive nature of systematic reviews, which delays the translation of vital evidence. In this tutorial, we address both challenges. We first provide a primer on essential statistical techniques to help authors produce more robust and reliable meta-analyses. We then briefly discuss the growing role of artificial intelligence (AI) in automating tasks in systematic literature reviews and meta-analyses. Ethical use and disclosure of AI in supporting these essential tasks are also important considerations. This guide is intended to help authors enhance the rigor of their work and use new technologies to ensure their findings are both trustworthy and timely.

PMID:42390911 | DOI:10.2196/92132

Microsc Microanal. 2026 Jul 1;32(4):ozag046. doi: 10.1093/mam/ozag046.

ABSTRACT

In-situ, large-area, and high-quality surface preparation is essential for statistically representative microstructure characterization. Focused ion beam (FIB) systems are typically confined to scales below a hundred microns, while standalone broad ion beam (BIB) polishing systems often suffer from surface contamination and repositioning errors during sample transfer. Herein, we report an integrated argon broad ion beam scanning electron microscope (BIB-SEM) system achieved by mounting an electron cyclotron resonance (ECR) ion source directly into the SEM chamber. Three key engineering challenges were addressed through dual-layer magnetic shielding to suppress stray fields from the ECR ion source, a sputter-shielding assembly to mitigate debris contamination, and a wide-range tilt stage enabling flexible polishing angles and EBSD analysis. The integration establishes an iterative polishing-and-characterization workflow, allowing for in-situ assessment and parameter optimization without breaking vacuum. This capability enabled feedback-driven optimization on aluminum alloy to reach 99.98% EBSD indexing rates, uniform surfaces on molybdenum with >98% EBSD indexing rates across multiple regions on a ∼21 mm2 area, statistical analysis of estimated over 8 × 105 NCM811 particle cross-sections, and rapid cleaning of contaminated surface within 5 min. This integrated BIB-SEM system enables in-situ, millimeter-scale surface preparation with SEM/EBSD validation, advancing representative microstructural characterization in materials science.

PMID:42390897 | DOI:10.1093/mam/ozag046

Cancer. 2026 Jul 15;132(14):e70504. doi: 10.1002/cncr.70504.

ABSTRACT

BACKGROUND: Survivors of Ewing sarcoma (EWS) are at significant long-term risk of treatment- and disease-related complications. The purpose of this study was to characterize long-term outcomes in EWS survivors according to treatment regimen.

METHODS: Five-year survivors of EWS diagnosed between 1970 and 1999 from the Childhood Cancer Survivor Study were included. Late mortality (>5 years from diagnosis), subsequent malignant neoplasms (SMNs), and severe to fatal chronic health conditions (CHCs) by chemotherapy regimen were compared. Patients were compared to siblings via cumulative incidence and proportional hazards models. Standardized mortality ratios (SMRs) compared late mortality between survivors and the general population.

RESULTS: Survivors (N = 739) had higher all-cause (SMR, 6.16; 95% CI, 5.36-7.05), SMN-related (SMR, 9.24; 95% CI, 6.92-12.08), cardiac-related (SMR, 4.53; 95% CI, 2.81-6.93), and noncardiopulmonary health-related (SMR, 2.04; 95% CI, 1.25-3.15) mortality compared with the general population. Compared with siblings (N = 5040), survivors had an increased risk of developing CHCs (any: hazard ratio [HR], 5.49; 95% CI, 4.58-6.59; cardiovascular: HR, 4.59; 95% CI, 3.67-5.74; neurological: HR, 2.82; 95% CI, 1.72-4.63; respiratory: HR, 5.37; 95% CI, 2.76-10.5; renal: HR, 4.61; 95% CI, 2.26-9.40). Between chemotherapy groups within EWS, there were no statistically significant differences in all-cause, SMN-caused, or health-related late mortality and the risk of developing SMNs or CHCs (any, cardiovascular, neurological, or respiratory), except that the vincristine, doxorubicin, and cyclophosphamide (VDC) plus ifosfamide and etoposide (IE) group had a higher risk of renal complications (HR, 2.55; 95% CI, 1.07-11.7; 30-year incidence was 0.56% for VDC and 3.2% for VDC/IE).

CONCLUSIONS: No differences in late mortality, SMNs, and most CHCs were observed between patients who received VDC versus VDC/IE. Aging EWS survivors’ elevated risk of morbidity and mortality underscores the need for lifelong survivorship care and therapies that reduce the risk for late effects.

PMID:42390889 | DOI:10.1002/cncr.70504