Category: Nevin Manimala

J Clin Neurosci. 2026 Mar 30;149:111994. doi: 10.1016/j.jocn.2026.111994. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brain injury (TBI) represents a significant global health burden and often results in functional impairment. Blood pressure variability (BPV), a surrogate marker of autonomic dysfunction, has been shown to influence outcomes in patients with cerebrovascular disease. Increased BPV has been strongly linked to deviation from optimal cerebral perfusion pressure, which may elevate the risk of secondary brain injury and poor outcomes after TBI. This study aimed to investigate the association of early BPV with clinical and functional outcomes, as well as brain injury biomarkers, in patients with TBI.

METHOD: We conducted a retrospective cohort study using data from the Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study (TRACK-TBI), which prospectively enrolled acute TBI patients across 18 United States Level 1 trauma centers between 2014-2018. The study population included adults with moderate-to-severe TBI who required intracranial pressure monitoring. The primary exposure was early BPV, calculated from hourly blood pressure measurements during the first 24 h after ICU admission; 72-hour BPV was examined in sensitivity analyses. Two BPV metrics were evaluated: systolic standard deviation (SSD) and average real variability (ARV). The primary outcome was the 6-month Glasgow Outcome Scale-Extended score specific to TBI (GOSE-TBI). Secondary outcomes included in-hospital mortality, GOSE-TBI at 3 and 12 months, Disability Rating Scale (DRS) at 3 months, 6 months, and 12 months, and blood-based brain injury biomarkers [glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), neuron-specific enolase (NSE), S100 calcium-binding protein B (S100B), and the inflammatory biomarker C-reactive protein (CRP)]. Multivariable regression models were used to assess associations between BPV, clinical outcomes, and biomarker levels.

RESULTS: A total of 108 patients were included. The mean age (SD) was 41.3 years (17.3), 81% were male, and 81% identified as White. There were no statistically significant associations between 24-hour BPV and 6-month GOSE for either ARV (OR 0.84, 95% CI 0.68-1.05; p = 0.133) or SSD (OR 0.86, 95% CI 0.69-1.08; p = 0.194). Among secondary outcomes, higher 24-hour SSD was associated with increased odds of in-hospital mortality (OR 1.13, 95% CI 1.00-1.27; p = 0.048). Higher average 72-hour SSD was also associated with higher hs-CRP levels (Ratio 1.04, 95% CI 1.00-1.07; p = 0.036).

CONCLUSION: Early BPV was not associated with GOSE-TBI at 6 months or most blood-based brain injury biomarkers. However, higher 24-hour SSD may be associated with increased in-hospital mortality. The prognostic value of BPV warrants confirmation in future prospective studies.

PMID:41915974 | DOI:10.1016/j.jocn.2026.111994

Sci Total Environ. 2026 Mar 30;1029:181672. doi: 10.1016/j.scitotenv.2026.181672. Online ahead of print.

ABSTRACT

As a keystone species in tropical freshwater ecosystems, Caiman crocodilus (Linnaeus, 1758) serves as a valuable bioindicator for assessing genetic damage in polluted environments. This study examined mercury (Hg) and arsenic (As) bioaccumulation in caudal scutes and blood across various age groups, alongside the evaluation of genotoxic effects using the micronucleus (MN) assay. Among adults, subadults and juveniles (n = 16), Hg concentrations in the scutes ranged from 41.8 to 535 μg/kg with a median of 145.0 μg/kg, while in blood they ranged from 32.5 to 472.9 μg/L and a median of 131.7 μg/L. The median concentrations of As in blood were 1.0 μg/L, whereas in scutes they were below the limit of quantification (LOQ) established in the analytical methods. Females exhibited slightly higher Hg levels in both scutes (162.0 μg/kg) and blood (131.7 μg/L) compared to males (scutes: 145.0 μg/kg; blood: 118.4 μg/L), although these differences were not statistically significant (p > 0.05). Subadult individuals had significantly higher blood Hg concentrations than juveniles (U = 9; p = 0.03; n = 9). Neonates (n = 6), the median Hg concentrations were 303.1 μg/kg and 109.6 μg/L in scutes and blood, respectively. The MN assay revealed evidence of genotoxic damage. Although the mean MN frequency in large individuals (excluding neonates) was low (0.3), nuclear buds (NB, 9.8) and binucleated cells (BC, 1.4) were more prominent. A negative trend was observed between Hg concentrations and the frequency of MN, NB, and BC, whereas As showed a positive correlation with BC (r = 0.38, p = 0.28). Additionally, 37.5% of the individuals exhibited poor body condition (Elsey condition factor < 1). These findings support the potential of C. crocodilus as an effective sentinel species for assessing genotoxic effects linked to environmental pollution. Moreover, this study contributes valuable data to pollution monitoring efforts in the Colombian Pacific region, which have largely focused on toxic metal(loid) analysis in fish to date.

PMID:41915960 | DOI:10.1016/j.scitotenv.2026.181672

Mar Pollut Bull. 2026 Mar 30;228:119654. doi: 10.1016/j.marpolbul.2026.119654. Online ahead of print.

ABSTRACT

Understanding how vegetation and sediment regimes jointly shape trace metal risks in deltaic tidal wetlands is pivotal for targeted monitoring and restoration. Here we propose a vegetation-sediment indicator framework to diagnose the distribution and ecological risk of six trace metals (Cu, Zn, Cr, As, Cd, Pb) in the tidal flat wetlands of the Yellow River Estuary (YRE). A total of 18 sampling sites were established, covering five vegetation types (mudflat, Suaeda salsa, Phragmites australis, Suaeda salsa & Tamarix chinensis, Suaeda salsa & Phragmites australis) and three soil depth layers (0-10 cm, 10-20 cm, 20-30 cm). Multi-dimensional evidence was obtained through analyses of spatial distribution, pollution assessment, and statistical modeling. Redundancy analysis (RDA), linear fitting, and partial least squares regression (PLS) confirmed that hydrodynamic-driven grain size differentiation laid the foundation framework for metal distribution. Grain-size differentiation driven by local hydrodynamics emerged as the first-order control, setting a “risk template” in which fine-sediment zones show higher metal accumulation and risk than coarse-grained areas. Vegetation further amplified the spatial heterogeneity of metal distribution through “grain size regulation” and “rhizosphere chemistry” effects: Phragmites australis zones emerged as metal enrichment hotspots, while Suaeda salsa zones exhibited a distinct “buffering” capacity. Vertical differentiation across 0-30 cm soil profile was weak, which favored the formation of horizontally structured metal hotspots. This study advances a generalizable, management-oriented indicator set-vegetation type plus sediment grain-size characteristics-to support targeted surveillance, early warning, and restoration prioritization in deltaic tidal wetlands.

PMID:41915933 | DOI:10.1016/j.marpolbul.2026.119654

Neuro Endocrinol Lett. 2026 Mar 24;47(1). Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate first-trimester FBG category, pre-pregnancy BMI, and serial FBG trajectory as stratified predictors of GDM in a routine-care antenatal cohort.

METHODS: Retrospective cohort of 771 women delivering at a single Chinese tertiary hospital (January-June 2013), with first-trimester FBG (<12 weeks) and 75-g OGTT at 24-28 weeks (Chinese IADPSG thresholds). GDM was diagnosed in 158 women (20.5%). Associations were analyzed by chi-square and Fisher’s Exact Test (SPSS v19.0); all estimates are unadjusted.

RESULTS: First-trimester FBG supported a two-tier, not three-tier, risk classification: GDM incidence in the ≤4.7 and 4.7-5.1 mmol/L strata was statistically indistinguishable (14.2% vs. 18.0%; Bonferroni-corrected p=0.188), while both were significantly lower than the ≥5.1 mmol/L stratum (45.9%; both P<0.001; overall χ²=58.835, p<0.01). The sole statistically supported triage cut-point is FBG ≥5.1 mmol/L. Non-decreasing FBG trajectory was the strongest predictor: 100% GDM incidence in the FBG ≥5.1 non-decreased subgroup (n=29; 95% CI: 88-100%; p<0.01) and 54.9% (95% CI: 43-67%) versus 4.2% in the FBG 4.7-5.1 stratum (n=71 vs. 190; p<0.01), yielding NPV 95.8% for a decreasing trajectory in this intermediate-risk group. BMI ≥24 kg/m² independently elevated GDM risk in women with FBG <5.1 mmol/L (p<0.01) but not in the FBG ≥5.1 stratum (p=0.075, n=34).

CONCLUSION: Non-decreasing FBG trajectory identifies high-risk subgroups missed by a single threshold, using measurements already collected in routine prenatal care. FBG ≥5.1 mmol/L alone carries a 54.1% false-positive rate; the trajectory rule substantially refines this triage. RCTs are needed to assess early intervention benefit.

PMID:41915924

J Nurs Educ. 2026 Apr 1:1-6. doi: 10.3928/01484834-20260216-01. Online ahead of print.

ABSTRACT

BACKGROUND: As artificial intelligence (AI) becomes increasingly integrated into education, understanding student perceptions of AI-generated support is critical. This pilot study examined how Doctor of Nursing Practice (DNP) students evaluate statistical help from different sources.

METHOD: Seven DNP students submitted statistical questions related to their capstone projects and received blind responses from a custom-trained, large language model (LLM) chatbot; a graduate assistant; and a professor. Students rated each response on helpfulness, satisfaction, and likelihood of use (i.e., 1 = worst, 5 = best), and guessed which response came from the chatbot.

RESULTS: The LLM chatbot received the highest average ratings for helpfulness and satisfaction. However, students consistently rated responses lower when they believed they were AI-generated.

CONCLUSION: Students preferred the LLM chatbot’s responses when blinded yet demonstrated a bias against AI when the source was suspected. This bias may influence AI adoption in academic support and warrants further study.

PMID:41915914 | DOI:10.3928/01484834-20260216-01

JMIR Cancer. 2026 Mar 31;12:e79215. doi: 10.2196/79215.

ABSTRACT

BACKGROUND: Cancer survivors frequently face persistent nutrition-related challenges after treatment. Mobile health tools may extend access to dietary self-management support beyond clinic settings, but feasibility and preliminary effects remain insufficiently characterized in this population.

OBJECTIVE: This study aims to evaluate the feasibility, user engagement, and preliminary effects of a 4-week mobile nutrition app on dietary behavior and quality of life (QoL) among cancer survivors, and to explore whether higher engagement is associated with greater improvements.

METHODS: A single-arm, prospective pilot feasibility study was conducted at a tertiary cancer center in Korea. Participants used a mobile nutrition app that provided dietary feedback and self-monitoring features. In-app log data were analyzed to determine engagement metrics (session frequency, duration, and gap regularity) using an elbow-based 10-minute session threshold. Primary outcomes included the Nutrition Quotient for Adults (NQ-2021) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) scores, measured before and after 4 weeks. Nonparametric paired analyses assessed changes, and exploratory correlations examined relationships between engagement and outcomes.

RESULTS: Among 27 enrolled participants, 24 cancer survivors (88.9%) completed the intervention and postassessment; the majority were female (17/24, 70.8%), with a mean age of 58.5 (SD 8.7) years. Breast cancer was the most common diagnosis (11/24, 45.8%), and most participants reported no diet-related adverse effects (20/24, 83.3%) and stable body weight during the study period. Participants averaged 2.3 app sessions per day and a median cumulative use of 177.5 minutes. Retention was 88.9%, and median adherence to daily self-monitoring exceeded 85%. The NQ Moderation domain improved significantly (mean 76.6, SD 17.5 → mean 81.0, SD 13.7; P=.02), while Balance and Dietary Behavior showed positive trends (mean 63.7, SD 16.1 → mean 65.5, SD 13.3, P=.14; mean 64.9, SD 17.3 → mean 67.1, SD 15.9, P=.10). In QoL outcomes, appetite loss decreased (mean 17.9, SD 22.0 → mean 7.7, SD 14.6; P=.03) and global health status increased modestly (mean 68.5, SD 21.4 → mean 72.9, SD 20.1; P=.08). Higher engagement correlated with improved moderation (r=0.46; P=.02) and reduced appetite loss (r=-0.42; P=.04). Exploratory subgroup analyses suggested stronger effects among participants aged 60 years and older (ΔNQ Moderation +7.9; P=.04) and those with longer cancer survivorship (>3 years; P=.047). No adverse events were reported.

CONCLUSIONS: This pilot feasibility study demonstrates high user engagement, satisfactory retention, and preliminary improvements in nutritional behavior and QoL among cancer survivors using a mobile nutrition app. These findings indicate the feasibility of a larger controlled trial to confirm the app’s effectiveness and explore long-term adherence strategies.

PMID:41915906 | DOI:10.2196/79215

JMIR Public Health Surveill. 2026 Mar 31;12:e84805. doi: 10.2196/84805.

ABSTRACT

BACKGROUND: Contact tracing (CT), the process of identifying and managing contacts of infected cases, is one public health and social measure that may reduce the spread of infectious diseases. While previous systematic reviews of CT exist, a comprehensive review of both the effectiveness and potential unintended consequences has not been undertaken to our knowledge. Understanding effective CT strategies could help governments and health authorities prepare effectively for emergency epidemic or pandemic situations.

OBJECTIVE: This study aims to systematically review the evidence on the effectiveness of CT across infectious diseases with epidemic or pandemic potential. Effectiveness is measured in terms of impacts on disease transmission, health care use, mortality, or unintended consequences.

METHODS: We searched 6 bibliographic databases (MEDLINE, Embase, Global Health, CINAHL Ultimate, Cochrane, and Scopus) between November 29 and December 3, 2024, with supplementary citation searching. We sought human studies comparing CT with interventions with no CT or other forms of CT, delivered in the community, in prespecified diseases of epidemic or pandemic potential. We included studies with any measure of disease transmission, related health care use, or unintended consequences of CT and prioritized studies with concurrent comparators. Screening, data extraction, and critical appraisal were performed in duplicate. Due to substantial heterogeneity, a narrative synthesis was performed. This review was informed by meetings with a patient and public involvement and engagement group.

RESULTS: After deduplication, a total of 12,816 titles and abstracts were screened, with 198 records assessed for eligibility at full text. Five additional studies were found through supplementary searching. Finally, 88 reports (of 86 studies) were included, of which 57 reports (of 55 studies) were prioritized. Two main routes of transmission were represented: respiratory (tuberculosis [TB], 15 studies; COVID-19, 5 studies) and blood-borne or sexually transmitted infections (STIs; 35 studies, of which 13 were in HIV, and 22 were bacterial or parasitic infections). No evidence was found on vector-borne, direct contact, or food- or water-borne routes of transmission. Evidence was highly heterogeneous, and more than half of the studies had notable methodological limitations. While there was no difference between CT and comparator interventions for most outcomes, there was some evidence of reductions in disease prevalence in TB and for provider-initiated CT to be superior to patient-led approaches in STIs. Only 2 studies reported measures of unintended consequences.

CONCLUSIONS: We found inconsistent evidence for the effectiveness of CT, focused primarily on TB and on contrasts between provider-initiated CT and patient-led referral in STIs and HIV. High heterogeneity in study design precluded clear assertions regarding optimal strategies for CT, including with respect to relevant subgroups. Future work should consider generalizability of CT mechanisms across contexts, including by route of transmission and from the Global South, and a more thorough account of unintended consequences.

PMID:41915901 | DOI:10.2196/84805

JMIR Mhealth Uhealth. 2026 Mar 31;14:e57046. doi: 10.2196/57046.

ABSTRACT

BACKGROUND: Technology-based solutions to support the mental health needs of workers are on the rise, as evidenced by the growing body of research related to e-mental health apps implemented with workers or within the context of workplaces. This expanding landscape of evidence related to mental health apps underscores the necessity of summarizing and consolidating the different ways in which studies are evaluating real-world technology-based interventions in a complex setting such as a workplace.

OBJECTIVE: The aim of this scoping review is to summarize the growing body of evidence evaluating mental health apps with workers. Specific research questions include “What types of mental health apps are studied?” “With whom are they being evaluated?” and “What outcomes are being tracked with what tools?”

METHODS: The scoping review followed 5 stages: specifying the research question, identifying relevant literature, selecting studies, extracting data, and synthesizing the findings. The search strategy was applied across 6 databases (PsycINFO, Embase, MEDLINE, Cochrane Database, OVID Healthstar, and OVID Emcare) to identify relevant studies from January 2000 to August 2023.

RESULTS: From the 288 abstracts screened, 54 studies met the inclusion criteria for this review. Over two-thirds of the studies were randomized controlled trials. The studies included 44 different apps, comprising 23 structured self-guided apps, 15 unstructured self-guided apps, and 6 apps designed as adjuncts to other interventions. Evaluation approaches included examining user engagement and utilization, investigating the impact on users, and evaluating the implementation process. Most studies evaluated the impact on individual mental health-related outcomes as well as workplace-related outcomes.

CONCLUSIONS: This scoping review provides a comprehensive overview of the ways in which studies are currently evaluating workplace mental health apps. The review highlights key trends and gaps in the existing research, noting that most studies focus on the effects of mental health apps on individual users, while only a limited number of studies explore how implementing such dynamic interventions within complex real-world settings (eg, workplaces) may influence their overall effectiveness. Future research should explore the implementation process to identify factors that promote and/or hinder the optimal use and impact of mental health apps for workers.

PMID:41915896 | DOI:10.2196/57046

J Med Internet Res. 2026 Mar 31;28:e82285. doi: 10.2196/82285.

ABSTRACT

BACKGROUND: Telemedicine has expanded rapidly in recent years, with particularly pronounced growth following the COVID-19 pandemic. By improving access to care and offering greater flexibility in service delivery, it has become an important component of health care. Although the benefits of telemedicine for patients are well documented, its effects on physician job satisfaction remain insufficiently understood. Given the importance of job satisfaction for workforce stability, physician well-being, and quality of care, further examination of how telemedicine affects physician job satisfaction is warranted.

OBJECTIVE: This study aims to examine the association between telemedicine adoption and physician job satisfaction and to assess whether the physician-patient relationship mediates this association.

METHODS: A cross-sectional survey was conducted among health care professionals in Xi’an, China. Data were collected between November 7 and December 8, 2023, via an online questionnaire administered using the REDCap (Research Electronic Data Capture; Vanderbilt University) platform. A total of 12,052 physicians were included in the analysis. Physician job satisfaction was measured using a validated 6-point Likert scale. Telemedicine adoption was assessed through self-report. A partial proportional odds model was used to examine the association between telemedicine adoption and job satisfaction, adjusting for a comprehensive set of potential confounders. Additionally, the Karlson-Holm-Breen (KHB) decomposition method was used to explore the mediating role of physician-patient relationship quality in this association.

RESULTS: Among 12,052 surveyed physicians, 1642 (13.62%) reported adopting telemedicine, whereas 10,410 (86.38%) did not. After adjusting for demographic characteristics, work-related factors, psychological factors, and physician-patient relationship, telemedicine adoption was significantly associated with higher job satisfaction (odds ratio [OR] 1.17, 95% CI 1.05-1.30). Findings were robust across multiple sensitivity analyses. Subgroup analyses indicated that the association did not vary across physician subgroups, and no significant interaction effects were observed. Mediation analysis revealed a total effect of telemedicine on job satisfaction of 0.33 (95% CI 0.17-0.50), with an indirect effect of 0.10 (95% CI 0.07-0.13) through improved physician-patient relationships, accounting for 30.30% of the total effect.

CONCLUSIONS: These findings suggest that telemedicine adoption is positively associated with physician job satisfaction, partially mediated by the physician-patient relationship. Policies should promote telemedicine adoption while prioritizing platform designs that support effective physician-patient interactions to enhance provider well-being and care outcomes.

PMID:41915895 | DOI:10.2196/82285

Rev Esc Enferm USP. 2026 Mar 23;60:e20250335. doi: 10.1590/1980-220X-REEUSP-2025-0335en. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the sociocognitive determinants of adherence to standard precautions by the nursing staff in a Brazilian regional hospital.

METHOD: Mixed methodology study, explanatory sequential design, conducted between January 2023 and March 2024, with 230 professionals. The Brazilian version of Standard Precautions Questionnaire and semi-structured interviews were used. The quantitative analysis employed the Mann-Whitney test, and the qualitative analysis, content analysis.

RESULTS: The overall mean sociocognitive adherence score was 3.90 (SD = 0.48), with the highest score in the “Attitude” factor (4.60; SD = 0.48) and the lowest in “Organizational Constraints” (2.95; SD = 1.17). Significant differences were identified between professional categories in “Social Influence” (nurses: 4.72; technicians: 4.79; p = 0.001) and “Organization” (nurses: 4.60; technicians: 4.49; p = 0.033). The integration of the findings demonstrated convergence between quantitative and qualitative data, showing that adherence, although satisfactory, is influenced by work-related factors.

CONCLUSIONS: Technicians demonstrated greater social influence, while nurses identified more organizational barriers. Peer example encourages adherence, despite the persistent fear of reprimands for non-compliance with best practices.

PMID:41915861 | DOI:10.1590/1980-220X-REEUSP-2025-0335en