Category: Nevin Manimala

JMIR Hum Factors. 2026 Feb 19;13:e79883. doi: 10.2196/79883.

ABSTRACT

BACKGROUND: Patients with insomnia have difficulty in both falling asleep and maintaining sleep. Individuals with long-term sleep deprivation are prone to poor concentration and impaired memory; however, these problems can be alleviated following brief behavioral treatment for insomnia (BBT-I). This study involved the design of an app called “Sleep Well” that enables individuals with insomnia to easily record their sleep behavior. The app guides users to recall and record sleep-related information, acquire sleep hygiene knowledge, and communicate with therapists online.

OBJECTIVE: This study examined how specific sleep diary interface design features in a brief cognitive behavioral therapy for insomnia (BBT-I) app influence users’ attention and short-term memory. Using a combination of objective eye-tracking measures and subjective attention assessments, the study compared 3 interface designs to determine how visual layout, input modality, and interaction style interact with insomnia symptoms to affect attentional performance, memory accuracy, and user preference.

METHODS: Three sleep diary interfaces were designed, varying background mode (day vs night), color scheme (blue vs green), box shape (circular, rounded rectangular, or rectangular), and input method (slide-in, tap, or type-in). A total of 33 participants completed standardized diary-entry tasks while eye movements were recorded using an eye tracker to capture gaze trajectories and visual attention patterns during app interaction. User experience, subjective attention, and interface preferences were assessed using structured questionnaires. Data were analyzed using descriptive statistics, nonparametric tests, Pearson correlation analysis, cross-tabulation analysis, and exploratory factor analysis to examine associations among interface design, attentional performance, memory accuracy, and user characteristics.

RESULTS: A total of 33 participants (n=13, 39.4% male and n=20, 60.6% female) aged 20 to 64 years completed this study. Based on the Insomnia Severity Index, 6 of 33 (18.2%) participants had clinical insomnia and 13 of 33 (39.4%) reported insomnia symptoms. Most participants reported staying up late (22/33, 66.7%), and more than half of participants reported drinking tea (17/33, 51.5%). Interface design significantly influenced objective attentional performance, as measured by eye-tracking indicators of task efficiency and visual allocation. Sleep quality and insomnia symptoms were consistently associated with attentional and short-term memory outcomes, with memory accuracy varying across interfaces and showing particular sensitivity to sleep maintenance difficulties. Subjective attentional control was strongly associated with both eye-tracking metrics and memory performance, and interface preferences differed by insomnia status.

CONCLUSIONS: Interface design significantly modulates attention and short-term memory performance in users with insomnia. Eye-tracking revealed that insomnia symptoms and sleep quality influence visual attention and task efficiency, whereas subjective attentional control showed stronger and more consistent associations with memory accuracy than physiological eye-movement indicators. These findings suggest that cognitive processing during sleep diary completion relies more on internal attentional states than on observable gaze behavior. Designing low-load, attention-supportive interfaces may therefore improve usability and data accuracy in digital BBT-I interventions.

PMID:41712956 | DOI:10.2196/79883

JMIR Res Protoc. 2026 Feb 19;15:e80214. doi: 10.2196/80214.

ABSTRACT

BACKGROUND: Urinary calculi (UC), affecting 1%-13% globally, pose a significant health burden due to high recurrence rates (up to 50% within 10 years) and substantial health care costs. Adequate fluid intake is a cornerstone of prevention; yet, its adherence remains poor due to forgetfulness, lifestyle barriers, and limited patient education. Existing mobile health interventions for UC prevention often lack medical oversight and clinical validation. WeChat-based digital therapeutic intervention may have a positive effect on fluid adherence in this patient group.

OBJECTIVE: Our objective is to develop a WeChat applet to improve hydration behavior and reduce stone recurrence among postoperative patients with UC.

METHODS: This is an open-label, 2-arm, parallel-group randomized controlled trial. We will recruit 148 participants from China’s tertiary hospital and randomly allocate them in a ratio of 1:1 to the intervention or control group. The intervention group received standard postoperative care supplemented by the WeChat-Based Applet Fluid Intake Reminder (WAFIR), which delivers personalized fluid intake reminders, urine color monitoring, 24-hour fluid intake and urine output tracking, and evidence-based educational content on hydration and urolithiasis management. The control group receives standard care of general discharge instructions from nurses. The primary outcome is the fluid adherence, measured by 24-hour fluid intake and urine volume; secondary outcome measures are the Wisconsin Stone Quality of Life Questionnaire, Patient Health Questionnaire-9, Electronic Health Literacy Scale, physical activity (International Physical Activity Questionnaire-Short Form), and recurrence rate of UC. Outcomes are measured before intervention (T0) and after a 1-month (T1) and 3-month (T2) follow-up period. Intention-to-treat analysis, 2-tailed t tests, and repeated measures ANOVA will be used to compare outcomes; statistical significance is set at a P<.05 significance threshold. The study was approved by the ethics review board in December 2024.

RESULTS: The development of WAFIR, conducted in collaboration with stakeholders, was finalized in February 2025. Recruitment commenced on March 1, 2025; data collection was completed in September 2025, and data analysis was analyzed in December 2025. Dissemination of findings is planned through conferences and publications in 2026.

CONCLUSIONS: This research evaluates the effectiveness of a nurse-led, evidence-based digital therapeutic intervention, WAFIR, in overcoming fluid adherence barriers among postoperative patients following urolithiasis surgery, aiming to increase daily fluid intake and urine output, reduce recurrence rates, enhance quality of life, and generate empirical evidence for its application in urology care, thereby optimizing postoperative management within clinical settings.

PMID:41712953 | DOI:10.2196/80214

Obstet Gynecol. 2026 Feb 19. doi: 10.1097/AOG.0000000000006195. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the association between intrauterine manipulator use and survival outcomes in patients undergoing minimally invasive hysterectomy for endometrial cancer because the oncologic effects of intrauterine manipulator use remain controversial.

DATA SOURCES: A comprehensive systematic review of the literature published up to December 31, 2024, was conducted with the PubMed, Scopus, Web of Science, and Cochrane Library databases.

METHODS OF STUDY SELECTION: Two independent investigators screened comparative studies, including prospective or retrospective studies and randomized controlled trials, examining oncologic outcomes in patients with endometrial cancer who underwent minimally invasive hysterectomy with or without an intrauterine manipulator. Studies with insufficient outcome data, including those involving patients who underwent open abdominal hysterectomy and those published in languages other than English, were excluded.

TABULATION, INTEGRATION, AND RESULTS: Data extraction and synthesis were performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Random-effects analysis was used for data pooling. The primary outcomes were disease-free survival and overall survival. Confounding factors affecting prognosis and risk of bias were also evaluated. Between 2013 and 2024, 12 eligible studies, including 10 retrospective studies and two randomized controlled trials, enrolled 6,029 patients who underwent minimally invasive hysterectomy with an intrauterine manipulator and 4,776 patients without one. In the unadjusted pooled analysis, disease-free survival was lower in patients who underwent surgery with an intrauterine manipulator than in those without (nine studies, hazard ratio 1.18, 95% CI, 1.01-1.38, P=.04). Albeit statistically nonsignificant, the hazard ratio for all-cause mortality comparing intrauterine manipulator use with nonuse was 1.27 (six studies, 95% CI, 0.99-1.62, P=.06). Only a limited number of studies (4 of 12 studies, 33.3%) examined survival outcomes after adjustment for factors such as adjuvant treatment and tumor histology. Most studies (7 of 12, 58.3%) had a moderate risk of bias, and five (41.6%) had a serious risk of bias.

CONCLUSION: This meta-analysis suggests that intrauterine manipulator use during minimally invasive hysterectomy may be associated with decreased disease-free survival in patients with endometrial cancer; however, the association with overall survival is marginal and did not reach statistical significance. Considering that most studies included in this meta-analysis were retrospective, did not adjust for prognostic factors such as postoperative treatment, and were of low to moderate quality, the associations found in this study warrant further investigation in future prospective trials.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023428140.

PMID:41712940 | DOI:10.1097/AOG.0000000000006195

Am J Clin Oncol. 2026 Feb 19. doi: 10.1097/COC.0000000000001308. Online ahead of print.

ABSTRACT

OBJECTIVES: Given the favorable prognosis of HPV-mediated (HPV+) oropharyngeal (OPX) cancers, studies have attempted to de-escalate therapy. We surveyed expert head and neck (H&N) radiation oncologists to better understand practice patterns to inform future clinical trial design.

METHODS: Participants were identified using publicly available radiation committees. Treatment of ≥12 cases of noncutaneous H&N cancer within the last year was required. A 25-question survey was sent through email using an anonymous RedCap link. Results were compared using RedCap statistics and χ2 tests.

RESULTS: Fifty-five H&N radiation oncologists participated in the survey (36%), representing 41 institutions. Three participants were excluded. Most physicians treat definitively to 69.96 or 70 Gy in 33 to 35 fractions (96% HPV+, 98% HPV-). The average CTV expansion is 3.6 mm. Yet, CTV expansions for HPV+ OPX vary considerably, with 48% of responders expanding 0 to 3 mm. In addition, 13 physicians use a smaller CTV expansion for HPV+ OPX lymph nodes, while 39 use the same expansion. In the HPV- postoperative setting, 96% of responders treat to 60 Gy, whereas in HPV+ disease, 52% treat to 60 Gy, and 35% prescribe only 50 Gy (P<0.05). In HPV+ OPX, the most common indications for postoperative radiation include positive surgical margins (SM) and extranodal extension (ENE) (100%), pT3-4 (98%), and ≥2 involved nodes (92%), with chemotherapy indicated for positive SM and ENE (98% HPV+, 100% HPV-).

CONCLUSIONS: There is significant variation and a lack of consensus in radiation planning for OPX cancers among institutions, which may impact resident training and patient outcomes.

PMID:41712935 | DOI:10.1097/COC.0000000000001308

Obstet Gynecol. 2026 Feb 19. doi: 10.1097/AOG.0000000000006225. Online ahead of print.

ABSTRACT

OBJECTIVE: Activity restriction is commonly recommended in pregnancy despite lacking evidence of benefit. We sought to evaluate the amount of physical activity in patients at high risk for preterm birth and pregnancy latency and preterm birth.

METHODS: This is an ancillary study of two randomized trials of preterm birth prevention in people with a short cervical length. People were enrolled from 16 0/7 to 23 6/7 weeks of gestation and instructed to wear a wrist accelerometer, which calculated physical activity data (steps per day) until delivery. The number of steps per day was calculated for each participant. The primary outcome was latency from time of enrollment to delivery. Sedentary activity was defined as a median of fewer than 3,500 steps per day. We compared outcomes between those with fewer than 3,500 median steps per day and those with 3,500 or more median steps per day. Secondary outcomes included preterm birth before 32, 34, and 37 weeks of gestation.

RESULTS: Of the 120 participants enrolled in the ancillary study, 117 (97.5%) had complete accelerometer data. At enrollment, the median gestational age was 22.8 weeks (interquartile range 21.3, 23.7), and a quarter of participants (25.8%) had been placed on activity restriction by their practitioner. The primary outcome, latency from time of enrollment to delivery, was not different between the groups (hazard ratio 0.95, 95% CI, 0.88-1.03). Steps per day did not differ by median cervical length at baseline between the groups. However, participants with fewer than 3,500 median steps per day delivered at an earlier gestational age (34.9 weeks vs 37.7 weeks, P=.04) and were more likely to deliver before 34 weeks (47.3% vs 17.7%, P=.03).

CONCLUSION: There was no statistically significant difference in latency from time of enrollment to delivery between those with and those without activity restriction. However, among individuals with a short cervix in the second trimester, sedentary activity (fewer than 3,500 steps per day) was associated with an increased risk of preterm birth before 34 weeks of gestation and delivery at an earlier gestational age.

PMID:41712929 | DOI:10.1097/AOG.0000000000006225

Interact J Med Res. 2026 Feb 19;15:e76930. doi: 10.2196/76930.

ABSTRACT

BACKGROUND: Self-rated health (SRH) is a robust predictor of morbidity, functional decline, and mortality in later life. As internet use becomes increasingly embedded in older adults’ daily routines, clarifying its association with SRH and the pathways through which it may operate is important for research, practice, and policy.

OBJECTIVE: This scoping review aimed to map and characterize the international evidence on the association between internet use and SRH among older adults, synthesize how potential mediators and moderators have been examined, and identify key methodological, theoretical, and population gaps in the literature.

METHODS: Guided by the Joanna Briggs Institute methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting standards, we conducted a scoping review and searched 5 databases: PubMed, CINAHL, AgeLine, PsycINFO, and Web of Science. The final search was performed on February 5, 2024. Reference lists were screened, and Google Scholar searches were conducted as supplementary search methods.

RESULTS: Database searches identified 4294 records; after removing 615 duplicates, 3679 records were screened, and 77 full texts were assessed, resulting in 27 included studies. All included studies were quantitative, and the evidence base was predominantly cross-sectional (25/27). Explicit theoretical frameworks were used in 6 out of 27 studies. Most studies were published between 2019 and 2024 (22/27) and were conducted most frequently in China (11/27) and the United States (7/27). All studies were conducted in high-income countries. SRH was typically assessed using a single-item measure, while internet use was operationalized as access/use (yes/no), frequency, and/or purpose/domain-specific measures. Most studies reported a statistically significant positive association between internet use and better SRH (24/27), with socially oriented uses (eg, communication and social participation) showing the most consistent associations. Mediating pathways were examined in 6 out of 27 studies, and most often suggested social mechanisms such as greater social support, higher social engagement, and lower loneliness. Subgroup heterogeneity was reported in 10 out of 27 studies, including differences by age, gender, residence, and marital status.

CONCLUSIONS: Overall, internet use, particularly socially oriented use, was most consistently associated with better SRH among older adults. Policy efforts should support digital inclusion by improving access, skills, and ongoing assistance that enable meaningful use for social connection and service access. At the same time, nondigital options are essential to avoid excluding older adults who do not use the internet. In addition, evidence gaps, including limited use of theoretical frameworks and scarce data from low- and middle-income countries, underscore the need for theory-informed longitudinal and intervention studies to strengthen causal inference, expand knowledge on mediating and moderating factors, and assess generalizability across diverse contexts.

PMID:41712917 | DOI:10.2196/76930

JMIR Res Protoc. 2026 Feb 19;15:e82716. doi: 10.2196/82716.

ABSTRACT

BACKGROUND: Diabetic dyslipidemia (DD), characterized by a classical triad of abnormal lipid profiles among the diabetic population, presents a major public health concern in South Africa, particularly among Black South Africans. The increasing prevalence of DD significantly contributes to the development of atherosclerotic cardiovascular disease. With the incidence of diabetes rising from 4.5% in 2010 to 12.7% in 2021, urgent preventive measures and effective treatments are crucial to tackle the risk of premature mortality.

OBJECTIVE: This systematic review and meta-analysis protocol aims to examine the existing literature on DD, providing an understanding of its prevalence and associated predictors among the diabetic population in South Africa, with the intention of informing more effective clinical and public health interventions.

METHODS: The protocol is registered in PROSPERO (International Prospective Register of Systematic Reviews) and will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The available literature on DD will be systematically searched in common scholarly databases and reviewed accordingly. All published and unpublished studies conducted in South Africa prior to 2024 and written in English will be included. Two members (MN and FA) of the review team will independently screen the studies identified through the database search and assess risk of bias using the revised JBI critical appraisal tools. The review will integrate both quantitative and qualitative data synthesis. Results from both qualitative and quantitative data synthesis will be presented through forest plots, subgroup forest plots, and summary tables, which will present findings on pooled prevalence, odds ratios for predictors, heterogeneity statistics, and sensitivity analyses.

RESULTS: The protocol was finalized in January 2025. The literature search was conducted between October 2024 and March 2025. Title and abstract screening began in April 2025, and full-text review was completed by July 2025, with data extraction scheduled for completion by September 2025. The completion of statistical analyses is expected by October 2025. We anticipate submission of the completed systematic review and meta-analysis for publication in December 2025.

CONCLUSIONS: The findings of the study protocol will inform the design of targeted interventions and policies aimed at advancing the management of DD and subsequently reducing the increased risk of atherosclerotic cardiovascular disease among the diabetic population.

PMID:41712906 | DOI:10.2196/82716

J Phys Chem A. 2026 Feb 19. doi: 10.1021/acs.jpca.5c06742. Online ahead of print.

ABSTRACT

The source of atmospheric nitrous acid (HONO) has not yet been fully identified, as observed concentrations remain significantly higher than predicted levels. The hydrolysis reaction of t-ONONO₂, as a feasible source of HONO, has attracted much attention in the field of atmospheric chemistry. In this study, the roles of sulfuric acid (SA), methanesulfonic acid (MSA), and methyl hydrogen sulfate (MHS) in the hydrolysis reaction of t-ONONO₂ to produce HONO and HNO₃ were explored by DFT and statistical dynamics methods. Thermodynamic and kinetic data indicate that SA, MHS, and MSA enhance the hydrolysis reaction of t-ONONO₂ through two mechanisms: single hydrogen atom transfer (S-HAT) and double hydrogen atom transfer (DHAT). Among these, SA exhibits the strongest catalytic effect. This study will contribute to a better understanding of the mechanistic characterization of t-ONONO₂ hydrolysis reactions, which is of great significance for the control of atmospheric particulate matter in polluted areas.

PMID:41712904 | DOI:10.1021/acs.jpca.5c06742

JACC Asia. 2025 Dec 30:S2772-3747(25)00690-8. doi: 10.1016/j.jacasi.2025.10.031. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on the association between family history and atherosclerotic cardiovascular disease (ASCVD) across age groups remains limited.

OBJECTIVES: This study aimed to evaluate the relations of family history of ASCVD (FHA) with incident ASCVD and its predictive value across age groups in China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) and UK Biobank.

METHODS: A total of 117,640 Chinese and 457,781 UK adults were included from 2 population-based cohorts, with family history assured by face-to-face interviews with standardized questionnaires.

RESULTS: During median follow-ups of 6.0 (Q1-Q3: 5.7-11.4) years (China-PAR) and 11.8 (Q1-Q3: 11.0-12.5) years (UK Biobank), 4,681 and 26,913 ASCVD cases occurred. Generally, FHA was consistently associated with higher ASCVD risk, but the association weakened with age (P_interaction < 0.001). The strongest effect was in adults <45 years, with HRs of 1.48 (95% CI: 1.11-1.96) in China-PAR and 1.47 (95% CI: 1.23-1.76) in UK Biobank, which was transformed to 6.75 and 5.33 years ASCVD-free years lost at the index of 20 years, and this gap decreased to 3.40 and 1.42 years at the index of 80 years, respectively. Notably, sibling history conferred greater risk than parental history (P_{heterogeneity} < 0.001).

CONCLUSIONS: In both populations, FHA is a key indicator for identifying high ASCVD risk, especially in younger individuals, with a stronger impact driven by sibling history. These findings highlight the importance of tailoring recommendations for identifying high-risk individuals based on family history, with consideration of different age groups.

PMID:41712897 | DOI:10.1016/j.jacasi.2025.10.031

Neurology. 2026 Mar 24;106(6):e214655. doi: 10.1212/WNL.0000000000214655. Epub 2026 Feb 19.

ABSTRACT

BACKGROUND AND OBJECTIVES: Contrast-associated acute kidney injury (CA-AKI) is a potentially preventable complication after exposure to iodinated contrast media. In patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the incidence and clinical impact are poorly characterized, and no validated prediction tool is currently available. The aim of this study was to assess the incidence and prognostic significance of CA-AKI in EVT-treated patients with AIS and to develop and validate a predictive score.

METHODS: A retrospective, multicenter cohort study was conducted involving EVT-treated patients across 73 centers in 16 countries (January-December 2023). Inclusion criteria were age ≥18 years, absence of dialysis, availability of preprocedural and 48-hour postprocedural creatinine levels, and available 90-day follow-up (modified Rankin Scale [mRS] score). The primary outcome was CA-AKI, defined by KDIGO (Kidney Disease: Improving Global Outcomes criteria;creatinine increase ≥0.3 mg/dL or ≥1.5 times baseline, within 48 hours). Secondary outcomes were (1) in-hospital mortality, (2) 90-day mRS score, and (3) 90-day severe disability or death (mRS score >3). Logistic models assessing associations with outcomes accounted for within-center clustering by applying robust standard errors. CA-AKI prediction models were developed across imputed data sets using univariable selection (p < 0.20), backward elimination (p < 0.05), and coefficient-based scoring after categorization of continuous predictors, with internal validation by bootstrap to obtain optimism-adjusted estimates.

RESULTS: Among 6,638 patients (median age 74 years; 48.7% male), CA-AKI occurred in 326 (4.9%) and was independently associated with in-hospital mortality (adjusted odds ratio [aOR] 2.269; 95% CI 1.615-3.190), higher 90-day mRS scores (adjusted common odds ratio 1.584; 95% CI 1.110-2.258), and 90-day severe disability or death (aOR 1.530; 95% CI 1.057-2.216). A preprocedural risk model including 12 routine clinical variables-sex, ethnicity, arterial hypertension, dyslipidemia, chronic kidney disease, antiplatelet therapy, NIH Stroke Scale score at admission, serum glucose, estimated glomerular filtration rate, hemoglobin, mean arterial pressure, and IV thrombolysis-demonstrated acceptable discrimination (area under the receiver operating characteristic curve 0.710 [95% CI 0.682-0.738]; precision-recall area under the curve 0.13 [95% CI 0.10-0.16]), good calibration (slope 0.870 [95% CI 0.759-0.928]), good overall performance (Brier score 0.045 [95% CI 0.042-0.049]). A second model that included EVT-related variables (e.g., contrast volume) showed similar performances.

DISCUSSION: In this large, international cohort, CA-AKI occurred in approximately 1 in 20 EVT-treated patients with AIS and was independently associated with poor outcomes. A simple preprocedural risk score enables early identification of high-risk individuals and may support preventive strategies.

PMID:41712884 | DOI:10.1212/WNL.0000000000214655