Category: Nevin Manimala

JMIR Form Res. 2026 May 22;10:e79141. doi: 10.2196/79141.

ABSTRACT

BACKGROUND: Population aging is driving a rapid rise in dementia cases worldwide, posing a major challenge for health care systems around the globe, including in the Netherlands. Digital multidomain lifestyle interventions, which target multiple lifestyle domains simultaneously, can protect against cognitive decline in at-risk older adults but struggle to sustain engagement. Addressing stress in these interventions is crucial, as it can directly increase dementia risk and may promote unhealthy behaviors in other domains targeted in these interventions, including physical activity, diet, and sleep.

OBJECTIVE: This study explores the motivators and barriers for Dutch adults aged 60 years and older to use mindfulness apps for stress management within digital multidomain lifestyle interventions. Despite their potential, it remains unclear which stress-related needs would motivate older adults to use mindfulness apps in these interventions and whether these apps effectively address those needs. Moreover, little is known about how older adults practice mindfulness independently in everyday settings alongside other lifestyle priorities.

METHODS: We conducted 15 semistructured interviews with former participants of a 26-week multidomain lifestyle intervention study (the “HELI” [Hersenfuncties na Leefstijlinterventie] study) that included a mindfulness app for stress management. Participants (8 females; age range 61-73 years) were first invited to describe their practices to improve brain health to see whether stress and mindfulness emerged spontaneously. Follow-up questions and scenarios explored experiences with stress and mindfulness before these concepts were explicitly introduced midway through the interview, providing insight into their roles in participants’ lives free from associations with the terms. Data were analyzed using template analysis.

RESULTS: Older adults reported experiencing fewer minor daily stressors than earlier in life and having developed effective coping strategies with age. These strategies often included elements associated with mindfulness, such as acceptance and deliberate attention to the present moment. However, many frequently worried at night about major concerns, including personal health, the well-being of loved ones, and global issues. These findings suggest that older adults may be more motivated to use mindfulness apps to cope with nighttime worry than with minor daily stressors. At the same time, older adults reported barriers to using mindfulness apps, including negative associations with the term “mindfulness” (eg, perceived as too spiritual) and challenges in maintaining focus during exercises.

CONCLUSIONS: We discuss how older adults develop mindfulness skills with age and how these skills help older adults cope with daily stressors but not with nighttime rumination. Specifically, we argue that diminished cognitive resources at night, fewer distractions, and metacognitive patterns may sustain worry before sleep. This study highlights the importance of tailoring multidomain lifestyle interventions to the unique challenges of older adults. We also offer recommendations to present mindfulness in ways that help older adults stay focused during practice.

PMID:42172617 | DOI:10.2196/79141

JMIR Hum Factors. 2026 May 22;13:e77808. doi: 10.2196/77808.

ABSTRACT

BACKGROUND: Support, Monitoring, and Reminder Technology for Mild Dementia (SMART4MD), a customized tablet app, was developed to improve or maintain the quality of life of people with mild cognitive impairment (MCI) and their informal caregivers.

OBJECTIVE: This study conducts an 18-month economic evaluation of the SMART4MD app, in addition to standard care, compared with standard care alone in Sweden and Spain, from a health care provider perspective.

METHODS: In a pragmatic randomized controlled trial, people with MCI and their informal caregivers were randomized to the intervention and control groups. Health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured in 345 Swedish people with MCI and their informal caregivers, and in 347 Spanish people with MCI.

RESULTS: The analysis showed higher incremental costs and lower QALYs for Swedish people with MCI than for controls, whereas higher incremental costs and higher QALYs were observed for Spanish people with MCI. The intervention was not found to be cost-effective for Swedish informal caregivers, with an ICER of €78,000/QALY (€1=US $1.16).

CONCLUSIONS: The differing findings regarding cost-effectiveness for people with MCI in Sweden and Spain highlight the need for further research with extended follow-up, ideally involving a larger sample size and conducted across different national contexts.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699.

PMID:42172614 | DOI:10.2196/77808

Interact J Med Res. 2026 May 22;15:e86448. doi: 10.2196/86448.

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) and treatment-resistant depression (TRD) are heterogeneous conditions in which key clinical details are split across structured fields and free-text notes in electronic health records (EHRs), constraining population-level insight and timely audit of care quality.

OBJECTIVE: This study aims to present a clinician-oriented, artificial intelligence-supported real-world evidence (RWE) methodology integrating structured and unstructured EHR data to profile MDD and TRD, and report comorbidity patterns from a 2-site pilot. This analysis reports the first objective of the MOOD project, which is to characterize the real‑world clinical and disease severity profile of patients with MDD and treatment‑resistant depression, providing a necessary foundation for subsequent evaluations of treatment patterns and outcomes.

METHODS: We conducted a retrospective study in 2 Belgian hospitals (September 2021-June 2023). Adults (aged ≥18 years) with MDD were identified via DSM-IV (Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition]) and ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes or natural language processing-detected note mentions; bipolar depression was excluded. TRD was defined as initiation of a third distinct antidepressant, supplemented by explicit mentions of TRD in notes. Structured data (demographics, diagnoses, medications, and hospitalizations) were harmonized in an Observational Medical Outcomes Partnership warehouse. Free-text notes were processed with a natural language processing pipeline to capture symptoms, psychiatric comorbidities, and contextual events.

RESULTS: We identified 1147 adults with MDD, of which 46% (524/1147) met TRD criteria. Females comprised 62.9% (722/1147) and mean (SD) age was 57.8 (18.4) years. Mortality was 13.3% (152/1147) overall (57/1147, 10.9% TRD vs 95/1147, 15.2% non-TRD). Common medical comorbidities were central nervous system diseases (477/1147, 41.6%) and heart diseases (349/1147, 30.4%). Dementia was more frequent in TRD (42/1147, 8% vs 32/1147, 5.1%), whereas obesity was higher in non-TRD (70/1147, 11.2% vs 46/1147, 8.8%). Anxiety disorder occurred in 35.4% (406/1147) overall and was more prevalent in TRD (229/1147, 43.7% vs 177/1147, 28.4%); personality and panic disorders also trended higher. Severity was sparsely documented (severe MDD 170/1147, 14.8%) and standardized scales were rarely recorded.

CONCLUSIONS: We present a step-by-step artificial intelligence-supported methodology tailored for clinicians, discussing challenges in integrating RWE into psychiatry, and identifying opportunities to enhance data collection with minimal workflow changes, which emphasizes the transformative potential of RWE systems in mental health research.

PMID:42172608 | DOI:10.2196/86448

Interact J Med Res. 2026 May 22;15:e55866. doi: 10.2196/55866.

ABSTRACT

BACKGROUND: Children’s eating habits are formed at an early age, making childhood a crucial period for introducing novel foods, such as pulse-based food products. Pulse Discovery Toolkit (PDTK) intervention was designed to increase familiarity with pulses and to eventually contribute to the consumption of pulse-based foods among preschool children in childcare centers (CCs).

OBJECTIVE: To determine PDTK’s impact on knowledge, acceptability, and consumption of pulse-based foods among preschool children attending CCs, and to assess its feasibility and acceptability by early childhood educators (ECE) and cooks. The nutrient contents and food group servings of pulse-based intervention recipes in the PDTK were also compared with regular CC recipes.

METHODS: The PDTK intervention was delivered over a 3-month period in 2 CCs in Saskatoon (50 children, 8 staff). The intervention, which integrated taste exposure and nutrition education, consisted of 12 child-friendly weekly lessons, a food service guide for cooks, 15 recipes for pulse-based foods, 4 intervention recipes incorporated in the CC menu, and 4 parent newsletters. Mixed methods were used with pre- and postintervention knowledge tests, plate waste measurement, sensory evaluation, ECE and cook’s perspective, and nutrient content comparison of the intervention and control foods from the regular childcare menu to evaluate the intervention’s impact.

Improvements in correct identification of chickpeas (2/21 [10%] at preintervention to 7/21 [33%] at postintervention, P=.074), beans (8/21 [38%] to 11/21 [52%], P=.68), and peas (6/21 [27%] to 8/21 [38%], P=.61) were not statistically significant. Children consumed higher amounts of the regular recipes (293.54, SD 27.65; 178.46, SD 24.33) than the intervention recipes (211.56, SD 25.61; 108.83, SD 21.97) at both times, respectively. However, at the end of the intervention, significant differences were only observed in the amount of total food consumption (P=.049) and the protein content (P=.04) when consumption proportion was examined, with both being higher for the control recipes in comparison to the intervention recipes. The majority (92% and 72%) of the children rated the refried bean wrap and lentil smoothie, “yummy,” respectively. Most of the intervention recipes have lower energy, fat, and sodium content compared with the regular CC recipes. Findings from ECE semistructured interviews and the lesson plan evaluations revealed that the ECEs reacted favorably to the curriculum. The cooks from the participating CCs did not report any barriers to cooking pulses in their facility. However, the need for modification to make the recipes easier to cook in CCs was noted in our study.

CONCLUSIONS: With a few modifications to make some of the lessons more age-appropriate and some of the recipes easier to cook, it is feasible to implement the PDTK in CCs in order to promote regular consumption of pulses.

PMID:42172607 | DOI:10.2196/55866

Integr Environ Assess Manag. 2026 May 22:vjag086. doi: 10.1093/inteam/vjag086. Online ahead of print.

ABSTRACT

This study illustrates results of an ecological survey performed on a former quarry area, morphologically reshaped from late ’90 s, through the use of red gypsum obtained as a by-product from the production cycle of a facility in Italy. After emplacement of the red gypsum in the former quarry, the area underwent spontaneous revegetation. To evaluate the ongoing restoration process and to document existing ecological values, a geopedological survey, a preliminary vegetation survey and preparation of a wildlife checklist were conducted in autumn 2023; additionally, desktop studies were carried out to identify the expected vegetation series and habitats for the area. A preliminary assessment was also carried out to identify the main Ecosystem Services currently provided by the subject area. The investigations showed that, although of its recent origin and the modest rate of pedological evolution, the area currently presents elements of high ecological value: the observed vegetation is consistent with the successional series expected for the area and the observed ecological features (in terms of vegetational structures, outcropping soils and more arid microclimatic conditions) introduce elements of habitat diversity with respect to the surrounding area (a dense wood), favoring therefore the presence of animal species adapted to habitats that are limiting for many. Specifically, the southern portion of the area displays a complex assemblage of different native plant species, while the northern part of the area is characterized by the presence of a dense bramble bush, species is of ecological value for wildlife since offering food/ refuge/ habitat/ pollination. Overall results thus indicate that the approach adopted in the restoration of the former quarry allowed a functional restoration of the area; on the basis of this work, key suggestions were provided to optimize the management of the restored area, meanwhile monitoring its temporal evolution.

PMID:42172597 | DOI:10.1093/inteam/vjag086

J Gerontol A Biol Sci Med Sci. 2026 May 22:glag135. doi: 10.1093/gerona/glag135. Online ahead of print.

ABSTRACT

Mild cognitive impairment (MCI) is a key stage for early intervention in dementia, and its inflammatory mechanisms remain unclear. Myeloperoxidase (MPO), a key enzyme involved in inflammation and immune regulation, has not been fully studied in MCI. This multicenter longitudinal cohort study prospectively followed 133 patients with MCI for 12 months. Plasma MPO, Alzheimer’s disease (AD)-related biomarkers (p-Tau181, p-Tau217, GFAP, NFL, and Aβ42/40), inflammatory cytokines (IL-1β, IL-6, and TNF-α), neuropsychological performance, and APOE genotype were assessed at baseline and follow-up. During follow-up, 58 patients showed cognitive deterioration and 75 remained non-deteriorated. At both baseline and the 12-month follow-up, the cognitive deterioration group showed higher MPO, IL-1β, and IL-6 levels than the non-deterioration group. Within-group longitudinal changes from baseline to follow-up were modest and were not statistically significant. Cross-sectional analyses showed that MPO was associated with IL-1β, IL-6, Aβ42/40, MMSE, and ADAS-Cog at different assessment time points. Longitudinal delta analyses showed that changes in MPO were significantly correlated with changes in MMSE, IL-1β, and IL-6, but not with changes in ADAS-Cog or Aβ42/40. After adjustment for potential confounders, MPO remained an independent predictor of cognitive deterioration in MCI (OR = 1.018, 95% CI: 1.00-1.03, p = 0.015). Nomogram analysis showed that MPO was the most prominent predictor in the model. These findings suggest that elevated plasma MPO may serve as a clinically accessible prognostic biomarker for risk stratification in patients with MCI.

PMID:42172591 | DOI:10.1093/gerona/glag135

J Pediatr Orthop. 2026 May 22. doi: 10.1097/BPO.0000000000003330. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the clinical efficacy of ultrasound-assisted closed reduction and percutaneous pinning (CRPP) compared with traditional open reduction and internal fixation (ORIF) in the treatment of Song type V lateral condylar humerus fractures (LCHFs) in children.

METHODS: A multicenter retrospective study was conducted on 187 pediatric patients with Song type V LCHFs between August 2019 and August 2023. Among them, 96 patients underwent ultrasound-assisted CRPP, and 91 patients received ORIF. Operative time, number of intraoperative fluoroscopy exposures, fracture healing duration, and postoperative complications were compared between the 2 groups. Radiographic parameters-including the Baumann angle (BA) and shaft-condylar angle (SCA)-and functional outcomes assessed by the Flynn criteria were evaluated at 12 months postoperatively.

RESULTS: The mean operative time was significantly shorter in the CRPP group (37.07±8.95 min) compared with the ORIF group (53.09±18.36 min; P<0.05). Lateral humeral condylar overgrowth was noted in 37 patients in the CRPP group and 40 in the ORIF group, with no statistical difference. At 12 months, radiographic parameters (BA and SCA) and Flynn functional scores showed no significant differences between groups. The excellent and good rate was 98.96% in the CRPP group and 97.80% in the ORIF group (P>0.05).

CONCLUSION: Compared with traditional ORIF, ultrasound-assisted CRPP for Song type V LCHFs in children yields comparable clinical outcomes while significantly reducing operative time and avoiding surgical exposure. This technique facilitates minimally invasive treatment and warrants broader clinical adoption.

LEVEL OF EVIDENCE: Level III.

PMID:42172589 | DOI:10.1097/BPO.0000000000003330

Mil Med. 2026 May 22:usag223. doi: 10.1093/milmed/usag223. Online ahead of print.

ABSTRACT

INTRODUCTION: The use of Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for life-threatening trauma has increased and its association with improved survival outcomes compared to resuscitative thoracotomy (RT) has been reported in civilian literature, however data from military settings has been limited. Achieving rapid hemorrhage control is essential to preventing battlefield fatalities. During modern combat casualty care, REBOA offers a solution to non-compressible torso hemorrhage (NCTH) and may reduce complications associated with RT. The purpose of this study is to examine survival rates between Zone 1 REBOA and RT with aortic cross clamping in deployed environments over a 6-year study period.

MATERIALS AND METHODS: This study received IRB approval at Brooke Army Medical Center (BAMC), San Antonio, TX. A retrospective analysis was performed to compare outcomes in deployed military personnel following the use of RT and REBOA with NCTH using data from the Department of Defense Trauma Registry January 2017-May 2022. Comparative, descriptive, and summary statistical analyses were utilized to evaluate relative risk and hazards ratio of death after REBOA placement or thoracotomy (P < .05). Univariate propensity matching was used to control for differences in injury severity score between the 2 cohorts.

RESULTS: A total of 9 REBOA and 23 RT patients were identified, with 88.9% of REBOA patients and 44% of RT patients surviving to evacuation to the next role of care and to hospital discharge (P = .039). No difference in hospital length of stay, ICU stay, or ventilator days was seen between the cohorts. In surviving patients, complications following aortic occlusion with REBOA and RT are reported with no appreciable complication rates following extended aortic occlusion time beyond 30 minutes (max 60 minutes). The small sample and low number of events limit the robustness of these findings and call for cautious interpretation.

CONCLUSIONS: This retrospective analysis comparing Zone 1 REBOA and RT for NCTH in a U.S. military deployed setting demonstrates association of REBOA with improved survival compared to RT. However, these findings are limited by a small sample size and potential selection bias inherent to retrospective design and clinician-driven procedural choice, particularly in cases perceived as survivable. As such, the results should be interpreted with caution and considered hypothesis-generating, warranting further investigation in larger, more robust studies in order to define optimal REBOA use in an austere environment. Despite the limitations, these results highlight REBOA’s potential use in resource limited environments and can improve the ability to triage multiple casualties.

PMID:42172583 | DOI:10.1093/milmed/usag223

J Chem Inf Model. 2026 May 22. doi: 10.1021/acs.jcim.6c00479. Online ahead of print.

ABSTRACT

For complex multicomponent condensed-phase systems, coarse-grained (CG) molecular dynamics often struggles to simultaneously achieve structural fidelity and thermodynamic consistency. Using base asphalt as a representative system, this study proposes and validates a hierarchical hybrid, closed-loop parametrization strategy. Bonded interactions are derived via iterative Boltzmann inversion (IBI) and further stabilized through robust statistical treatment and reduced representations, improving the parameter identifiability and numerical stability. Non-bonded interactions are built on the Martini 3 framework and are calibrated in a low-dimensional manner using only two global scaling factors, followed by geometric fine-tuning for the overall correction. The resulting model reproduces the density-temperature response within the experimentally relevant window and remains consistent with all-atom (AA) references in key structural statistics. Dynamically, it preserves the relative diffusion ranking among components and enables consistent time rescaling to the AA reference. Arrhenius-like diffusion behavior and the temperature dependence of the viscosity are also captured. At the mesoscale, the model reproduces the evolution of asphaltene self-aggregation, representative stacking-like local arrangements of aromatic-core regions, and bee-like morphological features consistent with experimental observations. Overall, this work provides a reproducible and parsimonious paradigm for CG force field construction in complex mixtures, enabling coupled convergence of structure and thermodynamics.

PMID:42172574 | DOI:10.1021/acs.jcim.6c00479

Cir Cir. 2026 May 22. doi: 10.24875/CIRU.25000450. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to investigate the relationship between liver enzymes and lipid profiles in cholecystectomy cases with cholecystitis, cholesterolosis, and cholesterol polyps.

METHODS: The cholecystectomy cases were divided into 3 groups according to their pathological diagnosis; cholesterolosis and cholelithiasis (Group 1), cholesterolosis (Group 2), and cholesterolosis and cholesterol polyp (Group 3). The groups were subjected to statistical analysis based on age, gender, cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein (HDL), alkaline phosphatase, gamma-glutamyl transferase (GGT), and C-reactive protein values.

RESULTS: Of the 227 cases included, 39 (17.2%) were male, and 188 (82.8%) were female. HDL value was significantly lower in men than in women (p = 0.00), while GGT (p = 0.00), aspartate aminotransferase (p = 0.01), and alanine aminotransferase (p = 0.00) values were significantly higher in men. No significant differences were detected in comparisons between pathological diagnostic groups (all p > 0.05).

CONCLUSIONS: No statistically significant findings were found regarding lipid profile and liver enzyme levels in cases of cholesterolosis, cholelithiasis, and cholesterol polyps. Although it is predicted that the HDL level being significantly lower in men than in women will increase the risk of polyp, no significant difference was detected between the pathological diagnosis groups in terms of gender. Studies containing larger case series are needed to reveal this relationship more clearly.

PMID:42172546 | DOI:10.24875/CIRU.25000450