Category: Nevin Manimala

Phys Med. 2026 Jun 23;148:105863. doi: 10.1016/j.ejmp.2026.105863. Online ahead of print.

ABSTRACT

PURPOSE: Patient-specific quality assurance (PSQA) for VMAT treatments represents a significant workload. This study presents an integrated approach combining plan complexity metrics with statistical process control (SPC) to safely reduce PSQA burden while maintaining robust process monitoring.

MATERIAL AND METHODS: We analyzed 557 consecutive patients (695 VMAT plans, 1650 arcs). MCSv and SAS were combined into a composite modulation index (CMI). Spearman correlation analysis identified the optimal gamma criterion among 22 configurations, with Bonferroni correction across 220 pairwise tests. Statistical distribution analysis determined tolerance limits using the percentile-equivalent method. ROC analysis established a complexity threshold for PSQA exemption, validated on an independent cohort of 267 patients.

RESULTS: High correlation was observed between (1 – MCSv) × SAS(7.5 mm) and 3%/1.5 mm local gamma criterion (r_S = -0.74, p < 10^-11). The beta distribution provided superior fit to PSQA data across all standard goodness-of-fit metrics (KS = 0.155 vs 0.229-0.235; AD = 34.3 vs 147-160) compared to normal, lognormal, and gamma distributions. Control and action limits were established at 78.1% and 66.5%, and ROC analysis demonstrated excellent discriminative performance (AUC = 0.90, 95% CI: 0.87-0.92). A complexity threshold of 0.131 achieved 100% sensitivity (95% CI: 93.4%-100.0%). Independent validation confirmed perfect sensitivity with zero false negatives. Eight months of clinical implementation achieved 26% workload reduction with no safety incidents.

CONCLUSIONS: This methodology demonstrates that integrating complexity metrics with appropriate statistical modeling and SPC enables safe, clinically validated PSQA workload reduction while maintaining rigorous quality standards and continuous process monitoring.

PMID:42335518 | DOI:10.1016/j.ejmp.2026.105863

Musculoskelet Sci Pract. 2026 Jun 17;85:103604. doi: 10.1016/j.msksp.2026.103604. Online ahead of print.

ABSTRACT

BACKGROUND: Femoroacetabular Impingement Syndrome (FAIS) is a prominent source of non-arthritic hip pain and is highly prevalent in young active populations. Decisions to undergo surgery are significant in nature and require proper understanding of potential benefits and risks.

OBJECTIVE: To develop and user-test a patient decision aid comparing non-surgical management and hip arthroscopy for FAIS with an additional military-related section.

DESIGN: Mixed-methods.

METHOD: The initial draft of the decision aid was developed by a multidisciplinary steering group. An iterative process of semi-structured interviews, re-drafting and further interviews provided feedback on the decision aid. The interviews were analysed reflexively using thematic analysis for qualitative findings. Acceptability questionnaires were analysed using descriptive statistics for quantitative findings.

RESULTS: We interviewed 27-participants; 13 clinicians (6 physiotherapists, 3 orthopaedic surgeons, 2 general practitioners, 1 sports medicine doctor, 1 anaesthesia pain physician) and 14 patients. Most participants rated the decision aid’s acceptability as good-to-excellent. Participants agreed on most aspects of the decision aid including the introduction, treatment options, comparison of outcomes and questions to consider asking a health professional. Participants agreed on including more information on the treatment options and provide more long-term outcomes comparing the options. Our decision aid met all 6 of the International Patient Decision Aid Standards qualifying criteria.

CONCLUSION: Our decision aid was considered a useful tool that may help patients choose an appropriate treatment option for the management of FAIS. A clinical trial evaluating the impact of the decision aid on decision making for patients considering surgery for FAIS is needed.

PMID:42335507 | DOI:10.1016/j.msksp.2026.103604

Pregnancy Hypertens. 2026 Jun 23;45:101492. doi: 10.1016/j.preghy.2026.101492. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare echocardiographic hemodynamic parameters between pregnant women with and without preeclampsia evaluated at high altitude.

STUDY DESIGN: We conducted an observational cross-sectional study including pregnant women evaluated at a tertiary referral center located at 2640 m above sea level. Participants were classified according to the presence or absence of preeclampsia, diagnosed using International Society for the Study of Hypertension in Pregnancy criteria. All participants underwent standardized transthoracic echocardiography following international guidelines. Conditions known to significantly affect maternal hemodynamics were excluded.

RESULTS: A total of 105 pregnant women were included (35 with preeclampsia and 70 controls). Women with preeclampsia had higher cardiac output (median 5.18 L/min (IQR 3.90-6.04) vs. 4.52 L/min (IQR 3.67-5.15); p = 0.045) and higher left ventricular stroke volume (median 62.80 mL (IQR 53.04-71.41) vs. 55.65 mL (IQR 50.24-62.80); p = 0.019) compared with controls. Systemic vascular resistance was lower in the preeclampsia group, although the difference was not statistically significant (median 1243.36 dyn·s·cm^-5 (IQR 1057.32-1594.65) vs. 1418.58 dyn·s·cm^-5 (IQR 1234.44-1717.41); p = 0.06). Left ventricular systolic function and indexed chamber volumes were similar between groups.

CONCLUSIONS: Among pregnant women evaluated at high altitude, preeclampsia was associated with higher cardiac output and stroke volume, accompanied by mild alterations in diastolic filling, without significant differences in ventricular structure or systolic function. These findings underscore the heterogeneity of maternal hemodynamic presentation in preeclampsia and support further investigation of maternal cardiovascular adaptation in high-altitude settings.

PMID:42335505 | DOI:10.1016/j.preghy.2026.101492

Gait Posture. 2026 Jun 18;130:110264. doi: 10.1016/j.gaitpost.2026.110264. Online ahead of print.

ABSTRACT

BACKGROUND: Independent outdoor ambulation is a key rehabilitation goal after stroke, but it is unclear whether instrumented gait analysis adds prognostic information beyond conventional clinical measures.

RESEARCH QUESTION: Do spatiotemporal gait parameters provide incremental predictive value beyond clinical assessments-independent of admission Functional Ambulation Category (FAC)-for outdoor ambulation in subacute stroke patients?

METHODS: We retrospectively analysed 137 subacute stroke inpatients with admission FAC 2-3 (89 outdoor, 48 indoor-only ambulators at discharge); one patient was excluded for an implausible step time. Admission FAC was excluded from candidate predictors to avoid overlap with the outcome. Hierarchical logistic regression compared a clinical model (Motricity Index [MI], time since onset) with one adding GAITRite-derived spatiotemporal parameters, using likelihood-ratio and DeLong tests with Firth-penalised sensitivity analysis.

RESULTS: Model 1 achieved near-perfect discrimination (AUC = 0.995, 95% CI 0.984-0.999). Adding affected-side single- and double-support percentages (Model 2) significantly improved fit (likelihood-ratio χ² = 9.39, p = 0.009; AUC = 0.998); the AUC difference was not significant by DeLong’s test (p = 0.262). Firth-penalised analyses produced concordant, stable coefficients. MI and gait velocity were the strongest single predictors (both AUC = 0.981); bootstrap optimism was ≤ 0.002.

SIGNIFICANCE: Beyond a near-perfect clinical model, affected-side support-phase parameters add statistically detectable model information (improved fit and calibration) rather than a clinically decisive gain in discrimination, which is constrained by a ceiling effect. Their value is best understood as quantifying paretic-limb weight-bearing and balance-related gait quality not captured by bedside scales, in subacute stroke inpatients with admission FAC 2-3. The Youden cut-offs (MI ≥ 40, velocity ≥ 32.1 cm/s, single support ≥ 29.7%) are hypothesis-generating and require external validation before clinical use.

PMID:42335499 | DOI:10.1016/j.gaitpost.2026.110264

J Psychiatr Res. 2026 Jun 22;201:225-230. doi: 10.1016/j.jpsychires.2026.06.025. Online ahead of print.

ABSTRACT

INTRODUCTION: Major depressive disorder (MDD) is strongly associated with suicidal ideation, a major predictor of suicide attempts and completed suicide. Transcranial magnetic stimulation (TMS) has shown promise in improving suicidal ideation, though the generalizability of these findings to routine clinical practice remains uncertain. This study evaluated whether TMS exposure was associated with recurrent suicidal ideation among adults with moderate-to-severe MDD using real-world electronic health record data.

METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Adults with moderate-to-severe MDD and documented suicidal ideation who received TMS were compared with matched patients not exposed to TMS. Propensity score matching and Kaplan-Meier and Cox proportional hazards analyses were performed. A landmark sensitivity analysis excluding outcomes within the first 30 days after index was conducted to address potential immortal time bias.

RESULTS: After matching, 1193 patients per cohort were included. Recurrent suicidal ideation occurred in 22.5% of TMS-exposed patients versus 33.9% of controls (HR 0.584, 95% CI 0.500-0.681; p < 0.001). In the landmark sensitivity analysis, recurrent suicidal ideation occurred in 17.5% of the TMS cohort and 14.5% of controls, and the association was no longer statistically significant (HR 1.203, 95% CI 0.954-1.516; p = 0.118).

CONCLUSION: The initially observed association between TMS exposure and lower recurrent suicidal ideation attenuated substantially after landmark sensitivity analysis addressing potential immortal time bias. These findings do not provide robust evidence that TMS independently reduces recurrent suicidal ideation in adults with moderate-to-severe MDD.

PMID:42335495 | DOI:10.1016/j.jpsychires.2026.06.025

J Psychiatr Res. 2026 Jun 6;201:198-206. doi: 10.1016/j.jpsychires.2026.05.037. Online ahead of print.

ABSTRACT

BACKGROUND: Late-life depression (LLD) is a growing public health concern in aging populations. Although digital mindfulness interventions show promise for depression, anxiety, and insomnia, their efficacy and electroencephalogram (EEG) correlates in older adults with LLD remain unclear. This study evaluated the FocusZen Mindfulness Stress Reduction System, a digital mindfulness intervention with EEG feedback, in mild-to-moderate LLD.

METHODS: Fifty-four participants with mild-to-moderate LLD were randomly assigned to a 6-week intervention group (n = 27; daily FocusZen sessions) or a control group (n = 27; general health education). The primary outcome was the change in HAMD-17 score. Secondary outcomes included anxiety, sleep quality, cognition, and frontal EEG spectral activity. Data were analyzed using mixed-effects models and intention-to-treat principles.

RESULTS: The intervention group demonstrated significant reductions in depressive symptoms [HAMD-17: F(3, 132.69) = 8.83, P < 0.001], anxiety [HAMA: F(3, 129.95) = 8.34, P < 0.001], and sleep disturbances [PSQI: F(3, 128.91) = 5.55, P = 0.01], alongside improved cognition [MOCA: F(3, 133.19) = 5.14, P = 0.01]. Response and remission rates were higher in the intervention group. Exploratory EEG analysis showed increased frontal theta [F(1.96, 43.12) = 25.28, P < 0.001] and alpha activity [F(1.44, 31.73) = 22.92, P < 0.001].

CONCLUSIONS: FocusZen-based digital mindfulness reduced depressive, anxiety, and sleep symptoms and improved cognition in mild-to-moderate LLD, potentially accompanied by enhanced frontal theta and alpha activity.

TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2400086063; https://www.chictr.org.cn/.

PMID:42335492 | DOI:10.1016/j.jpsychires.2026.05.037

J Psychiatr Res. 2026 Jun 17;201:190-197. doi: 10.1016/j.jpsychires.2026.06.021. Online ahead of print.

ABSTRACT

Previous studies have linked opioid use to altered metabolic profiles, but findings have been inconsistent and mechanisms remain unclear. One potential mechanism involves increased adiposity, leading to chronic low-grade inflammation that elevates metabolic risk. Here, we examined metabolic profiles in individuals with opioid use disorder (OUD) and matched non-OUD controls, focusing on the sequential mediating roles of BMI and inflammation. Data from individuals with OUD (n = 281) and non-OUD (n = 246) were drawn from a natural history screening protocol from the National Institute on Alcohol Abuse and Alcoholism intramural program. Groups were matched on age, sex, race, ethnicity, socioeconomic status, and education via propensity score matching. Metabolic measures included body mass index (BMI), hemoglobin A1c (HbA1c), and lipid profiles, with lipid imbalance indexed by the atherogenic index of plasma (AIP). Inflammatory markers included C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Individuals with OUD had significantly higher BMI (F_1,481 = 12.9, p < 0.001), higher HbA1c (F_1,481 = 10.5, p = 0.001), lower high-density lipoprotein cholesterol (HDL-C; F_1,481 = 46.2, p < 0.001), higher low-density lipoprotein cholesterol (LDL-C; F_{1, 481} = 11.9, p < 0.001), and higher AIP (F_1,481 = 20.7, p < 0.001) compared to non-OUD. Inflammatory markers were also elevated in individuals with OUD, including CRP (F_1,481 = 9.4, p = 0.002) and ESR (F_1,481 = 7.4, p = 0.007),and statistically mediated group differences in AIP and HbA1c, respectively. Our results are consistent with prior evidence of metabolic dysfunctions in individuals with OUD and suggest inflammation as a contributing mechanism. Targeting metabolic health and inflammation may offer new avenues for improving long-term health outcomes in OUD.

PMID:42335491 | DOI:10.1016/j.jpsychires.2026.06.021

Ticks Tick Borne Dis. 2026 Jun 23;17(4):102675. doi: 10.1016/j.ttbdis.2026.102675. Online ahead of print.

ABSTRACT

Illinois is known to have established populations of four vector tick species of human health concern: Ixodes scapularis, Dermacentor variabilis, Amblyomma americanum, and Amblyomma maculatum. These ticks can transmit pathogens causing eight reportable tick-borne diseases (TBDs): anaplasmosis, babesiosis, ehrlichiosis, Lyme disease, spotted fever group rickettsioses (SFG rickettsioses), Powassan virus disease, Heartland virus disease, and Bourbon virus disease. The incidence of these diseases is spatially varied and has been changing over time. The purpose of this research is to describe factors associated with human incidence of the various tick-borne diseases in Illinois and to compare this to factors associated with canine seroprevalence to similar tick-borne diseases. All cases of tick-borne diseases in humans reported to the Illinois Department of Public Health (IDPH) between 2004 (when reporting began) and 2022 were reviewed (n = 6423), with all county-level seropositivity and canine test data reported by the Companion Animal Parasite Council between 2009 (when reporting began) and 2022. Descriptive statistics were performed to identify spatial and temporal variation. Comparison with known risk factors was conducted using zero-inflated spatiotemporal modeling for anaplasmosis, ehrlichiosis, Lyme disease, and SFG rickettsioses in humans and anaplasmosis, ehrlichiosis, and Lyme disease in dogs. Every county in Illinois reported at least one case of a human TBD from 2004 to 2022. Most reported cases were in males (61%), white (71%), and non-Hispanic (64%) residents over 40 years of age (56%). On average, the annual number of human cases increased by 23 cases every year (95% CI: 15, 31), despite large year-to-year fluctuations, with 343 in 2022 and 645 in 2021. The spatial hotspots were noted in southern Illinois for human TBDs associated with A. americanum, and D. variabilis, and for dog exposure associated with A. americanum. Hotspots were also noted in northern Illinois for diseases and exposure associated with I. scapularis for both humans and dogs and across the 2004-2022 study period. Case incidence was higher in rural counties, counties with higher deer harvests, and counties with lower median household income. These findings can be used to guide public health efforts that target self-prevention strategies to decrease the risk of a tick bite and tick-borne diseases in Illinois and are applicable in similar midwestern states with expanding TBD risk.

PMID:42335481 | DOI:10.1016/j.ttbdis.2026.102675

J Med Internet Res. 2026 Jun 23;28:e90152. doi: 10.2196/90152.

ABSTRACT

BACKGROUND: Public health crises often reshape online discourse by amplifying uncertainty, frustration, stigma, and misinformation, with important implications for risk communication.

OBJECTIVE: This study examines these dynamics on Reddit (Reddit Inc) during a recent outbreak, using Mpox as a case study.

METHODS: We analyzed sentiment, topical themes, and audience engagement in posts and comments drawn from 4 Mpox-related subreddits. Using natural language processing methods, we applied sentiment analysis and latent Dirichlet allocation to classify 1169 posts and 6571 comments (from July 21, 2021, to July 16, 2025) into sentiment categories and 9 distinct topics. Of the 1169 posts, 611 (52.3%) were neutral, 370 (31.6%) were negative, and 188 (16.1%) were positive. Among comments, 2825 of 6571 (43%) were neutral, 1962 (29.9%) were negative, and 1784 (27.1%) were positive. We then used Kruskal-Wallis tests, Dunn post hoc comparisons, and Vargha-Delaney A to assess relationships among sentiment, topic, and engagement metrics.

RESULTS: Engagement differed significantly by sentiment (P<.001) and topic (P<.001). Negative posts had higher median scores (median 7, IQR 2-27) than positive ones (median 5, IQR 2-16; z score=6.02; adjusted P<.001; Vargha-Delaney A=0.55). Posts about systemic public health failures (Topic 4) received lower median scores (median 4, IQR 1.75-14.25) than other topics. Topic 9 accounted for 980 of 6571 (14.9%) comments, dominating discussions regardless of original post topic. Positive posts generated 284 of 922 (30.8%) positive comments, whereas negative posts received 526 of 1615 (32.6%) negative comments. Comments on positive posts had higher sentiment scores (Vargha-Delaney A=0.550), whereas comments on negative posts had lower sentiment scores (Vargha-Delaney A=0.463). Topic-level differences in comment sentiment were also observed: comments responding to posts on scientific- and policy-related debates (Topic 8) were more positive (Vargha-Delaney A=0.531), whereas those on systemic failures (Topic 4) were more negative (Vargha-Delaney A=0.478).

CONCLUSIONS: Overall, the findings highlight how audience reactions can amplify emotionally charged narratives and reframe technical information into socially and politically charged debates. These insights can inform public health communication strategies by anticipating likely audience responses, mitigating stigma and misinformation, and fostering constructive dialogue during health crises.

PMID:42335474 | DOI:10.2196/90152

JMIR Serious Games. 2026 Jun 23;14:e78169. doi: 10.2196/78169.

ABSTRACT

BACKGROUND: Exposure and response prevention is a first-line intervention for obsessive-compulsive disorder (OCD), yet many individuals with contamination concerns do not access care. Virtual reality exposure-based therapy (VRET) may improve scalability and acceptability.

OBJECTIVE: This pilot study evaluated the feasibility and acceptability of a standardized single-session VRET protocol targeting contamination concerns and whether it elicited within-session anxiety and exploratory contamination symptom change at 1-month follow-up.

METHODS: We conducted a single-arm pilot study in adults with elevated contamination concerns and no formal OCD diagnosis, recruited via convenience sampling. Participants completed a baseline survey, an in-laboratory VRET session using a standardized virtual public toilet environment, and a follow-up survey. Outcomes included momentary anxiety (Subjective Units of Distress Scale) during exposure, affect (positive and negative affect schedule) across time points, and contamination symptoms (Obsessive-Compulsive Inventory-Revised contamination subscale) at baseline and follow-up. Usability (System Usability Scale) and VR sickness were also assessed. Within-session outcomes used repeated-measures ANOVA or Friedman tests; symptom change used paired t tests (α=.05); point estimates include 95% CIs. Missing data were addressed using multiple imputation (random forest; m=5); 37.5% of participants did not complete the follow-up survey (overall missingness: 5.47%).

RESULTS: Sixteen participants were included (aged 18-32 years). Anxiety increased during exposure tasks and decreased after virtual hand washing in both trials (Exposure 1 Friedman Test: χ²3=28.56; P<.001; W=0.6); Exposure 2 repeated measures ANOVA: F1.85, 27.81=5.35; P=.01; Greenhouse-Geisser corrected=0.058. Negative and positive affect both changed significantly across time points (negative affect: Friedman Test: χ²3=13.76; P=.003; W=0.29 and positive affect: repeated measure ANOVA: F3, 45=4.60-4.71; P=.006-.007; Greenhouse-Geisser corrected=0.07-0.073). Contamination symptoms did not significantly change from baseline to follow-up (mean change 1.30, SD 3.39; 95% CI -0.36 to 2.96; P=.12). Usability was adequate (System Usability Scale mean 69.5, 95% CI 62.79-76.21).

CONCLUSIONS: This study is among the first to systematically evaluate a standardized single-session contamination-focused VRET protocol in adults with elevated contamination concerns who did not meet diagnostic criteria for OCD, a subthreshold population underrepresented in prior VRET research, which has focused on clinically diagnosed samples and multisession protocols. The protocol proved feasible and acceptable, eliciting within-session anxiety and providing benchmarks in existing clinical literature. Contamination symptom change at 1-month follow-up was not statistically significant, and the effect size estimate was sensitive to the missingness assumption, underscoring the need for adequately powered multisession designs in future trials. The usability profile and VR sickness levels that did not prevent session completion suggest self-administered or minimally supervised delivery warrants evaluation, with implications for scalable early intervention in individuals with elevated contamination concerns who have not accessed formal treatment.

PMID:42335471 | DOI:10.2196/78169