Category: Nevin Manimala

JACC Adv. 2026 Jun 29;5(8):102965. doi: 10.1016/j.jacadv.2026.102965. Online ahead of print.

ABSTRACT

BACKGROUND: Sudden cardiac arrest (SCA) during marathons is a rare but life-threatening event. Although underlying cardiovascular conditions have been implicated in race-related SCA, the contribution of environmental factors, including meteorological conditions and ambient air pollution, remains incompletely understood.

OBJECTIVES: The objective of the study was to examine the associations of meteorological conditions and ambient air pollutants with SCA during marathon races.

METHODS: We conducted a nationwide race-level study in Japan using data from 4.53 million runners participating in Japan Association of Athletics Federations-certified full marathons between April 2011 and March 2020. Race-level SCA counts were linked to meteorological variables at race start, including ambient temperature, humidity, solar radiation, wind speed, precipitation, and air pressure, and to ambient air pollutants including fine particulate matter, suspended particulate matter, photochemical oxidants, sulfur dioxide, nitrogen dioxide, and carbon monoxide. Associations were examined using Poisson regression models with adjustment for race characteristics and participant composition.

RESULTS: Among 4.53 million runners, 75 cases of SCA were identified. Ambient temperature at race start was inversely associated with SCA risk (adjusted incidence rate ratio per 1 °C increase: 0.94; 95% CI: 0.90-0.99), corresponding to a higher risk at lower temperatures. No statistically significant associations were observed between ambient air pollutants and SCA risk.

CONCLUSIONS: In Japanese marathon races held predominantly in autumn and winter, lower ambient temperature at race start was associated with a higher risk of SCA, whereas no significant association was observed for ambient air pollutants.

PMID:42372349 | DOI:10.1016/j.jacadv.2026.102965

Lang Speech Hear Serv Sch. 2026 Jun 29:1-10. doi: 10.1044/2026_LSHSS-25-00225. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to examine the relationship between temporal processing and literacy performance in children with hearing aids.

METHOD: The study included a total of 45 children, comprising 21 with typical hearing and 24 who used hearing aids, all of whom were attending the second, third, or fourth grades of primary school. Temporal processing skills were evaluated using the Frequency Pattern Test and the Duration Pattern Test (DPT), whereas reading and writing abilities were assessed through the Literacy Assessment Battery.

RESULTS: Children using hearing aids demonstrated statistically significantly lower performance in the DPT and in the test assessing writing skills compared to their typically hearing peers. A positive, significant correlation was found between temporal processing skills and literacy skills. Moreover, temporal processing and literacy performance were observed to be negatively correlated with the age at which the child’s first amplification was provided and positively correlated with the duration of auditory rehabilitation.

CONCLUSIONS: This study found that in children using hearing aids, performance on temporal pattern tests was significantly correlated with reading and writing skills. Furthermore, these findings suggest that early amplification and consistent auditory rehabilitation may be correlated with better temporal processing and literacy skills.

PMID:42372307 | DOI:10.1044/2026_LSHSS-25-00225

Dis Esophagus. 2026 May 12;39(3):doag062. doi: 10.1093/dote/doag062.

ABSTRACT

Water-soluble esophagram and endoscopy are commonly used to detect anastomotic leak after esophagectomy. However, the comparative performance of these two modalities in detecting leaks has not been well established. We retrospectively reviewed all patients who underwent esophagectomy for cancer between January 2021 and December 2022 from a prospectively maintained database. Occurrence, management and consequences of leaks were examined. The primary outcome was to compare the diagnostic performance of esophagram and endoscopy in detecting anastomotic leak. Therefore, a total of 846 patients were identified. The overall incidence of anastomotic leak was 10.4%. Patients with leaks had older age and more retrosternal routes for reconstruction. Of them, 466 patients underwent endoscopy and 217 underwent esophagram. After matching, 434 patients, 217 per group were analyzed. The sensitivity and negative predictive value of endoscopy were 79.2% and 97.5%, whereas those of esophagram were only 37.9% and 91.3%, respectively (P = 0.003; P = 0.007). In the subset of patients with cervical anastomosis, endoscopy also demonstrated superior sensitivity (78.3% vs 36.0%, P = 0.004) and negative predictive value (97.4% vs 90.8%, P = 0.007). Esophagram showed false-negative results in 18 patients, while only 5 leaks were missed by initial endoscopy. Regarding the management of false negatives, esophagram group showed non-significant trends toward longer hospital stay and more interventions, including stenting (11.1% vs 0%) and clipping (5.6% vs 0%) (both P > 0.05). In conclusion, endoscopy showed higher sensitivity and negative predictive value than esophagram in detecting anastomotic leak after esophagectomy in this study. However, a large-scale, randomized study is warranted to validate these results.

PMID:42372290 | DOI:10.1093/dote/doag062

Subst Use Misuse. 2026 Jun 29:1-7. doi: 10.1080/10826084.2026.2685620. Online ahead of print.

ABSTRACT

Naswar, a form of smokeless tobacco, has become an important public health concern in southern Iran due to its increasing use and associated health risks. Despite its growing social acceptance, limited evidence is available regarding the combined influence of individual, cognitive, and social factors on Naswar consumption. This study aimed to investigate the individual and social determinants of Naswar use among residents of Bandar Abbas, southern Iran. This cross-sectional study was conducted from June to September 2024 among 399 individuals aged 15 years and older recruited from urban healthcare centers in Bandar Abbas. Data were collected through face-to-face interviews using a validated questionnaire assessing demographic characteristics, knowledge, attitudes, social norms, behavioral intention, and Naswar use. Descriptive statistics, univariate analyses, and multivariable logistic regression were performed to identify factors associated with current Naswar consumption. The prevalence of Naswar use was 6% in the study population. Univariate analyses indicated that male gender, lower educational level, and lower socioeconomic status were associated with higher odds of use. Greater knowledge of Naswar harms, more negative attitudes toward use, and stronger anti-use social norms were associated with lower odds of consumption. In the multivariable model, higher knowledge and stronger anti-use social norms remained significant protective factors, whereas stronger behavioral intention toward Naswar use was identified as a significant risk factor. Naswar use in Bandar Abbas is influenced more by psychosocial factors than demographic characteristics alone. Prevention strategies should strengthen health knowledge, reinforce anti-use social norms, and target behavioral intentions through culturally appropriate interventions.

PMID:42372287 | DOI:10.1080/10826084.2026.2685620

Sci Prog. 2026 Apr-Jun;109(2):368504261456900. doi: 10.1177/00368504261456900. Epub 2026 Jun 29.

ABSTRACT

This study aims to develop a spatio-temporal predictive model for the luminous intensity distribution of the laser welding molten pool-a key visual indicator of process stability and quality-to overcome the limitations of conventional analytical models in handling complex multi-physical interactions. A data-driven framework based on a nonparametric artificial neural network architecture is proposed. Gaussian functions are employed as radial basis functions to capture localized spatio-temporal variations in the light field. The root mean square error is adopted as the evaluation metric and integrated into a systematic hyperparameter optimization procedure to enhance model fidelity and robustness. The optimized model successfully predicts two distinct molten pool luminous patterns under different welding conditions. Predictions show strong agreement with synchronized high-speed experimental images, confirming the model’s accuracy and generalization capability. This method effectively reconstructs the molten pool’s luminous signature, demonstrating significant potential for real-time process monitoring, online anomaly detection, and non-destructive quality assessment in advanced laser welding operations.

PMID:42372284 | DOI:10.1177/00368504261456900

Ann Intern Med. 2026 Jun 30. doi: 10.7326/ANNALS-26-00217. Online ahead of print.

ABSTRACT

BACKGROUND: Safety studies of the COVID-19 vaccine have identified some adverse events. Yet newer variant-updated formulations, along with increased hybrid immunity, may change these risks. Early-era safety data may not reflect experience with updated formulations in more immune-experienced populations.

OBJECTIVE: To evaluate 90-day risks for adverse events after coadministration of COVID-19 and influenza vaccines compared with influenza vaccination alone, across bivalent, XBB-adapted, and KP-adapted COVID-19 vaccine periods.

DESIGN: Target trial emulation using electronic health care data.

SETTING: U.S. Department of Veterans Affairs.

PARTICIPANTS: Participants receiving both COVID-19 and seasonal influenza vaccines (n = 705 124) and those receiving only an influenza vaccine (n = 1 813 205) between 1 September 2022 and 26 August 2025.

INTERVENTION: Receipt of both COVID-19 and seasonal influenza vaccines versus receipt of only an influenza vaccine.

MEASUREMENTS: 90-day risks for 46 prespecified individual adverse events grouped into 3 composite outcomes (tier 1, serious or life-threatening; tier 2, clinically significant; tier 3, less severe or self-limiting), using weighted discrete-time survival models.

RESULTS: For all 3 composite outcomes, risks were similar between groups: tier 1 (risk ratio [RR], 1.03 [95% CI, 0.99 to 1.09]), tier 2 (RR, 0.99 [CI, 0.96 to 1.03]), and tier 3 (RR, 0.99 [CI, 0.96 to 1.02]). Of the 46 individual adverse events, 2 tier-3 risks had nominal statistical significance: syncope (RR, 1.09 [CI, 1.02 to 1.17]) and tinnitus (RR, 0.95 [CI, 0.92 to 0.99]); no risks were statistically significant after correcting for multiple comparisons. For all risks in tier 1 or tier 2, confidence bounds included 1.0 (no effect). In period-stratified analyses, neither composite (tier) nor individual event estimates supported differences in risks between groups.

LIMITATION: Generalizability and potential unmeasured confounding.

CONCLUSION: Same-day coadministration of COVID-19 and influenza vaccines was not associated with an increased risk for adverse events in 3 updated-formulation periods. These findings support the short-term safety of coadministration.

PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.

PMID:42372279 | DOI:10.7326/ANNALS-26-00217

JMIR Res Protoc. 2026 Jun 29;15:e93700. doi: 10.2196/93700.

ABSTRACT

BACKGROUND: Proficiency in interpersonal communication and social skills is fundamental for health sciences students, but public speaking anxiety and communication apprehension frequently compromise academic performance, emotional well-being, and the acquisition of essential competencies. The postpandemic educational environment has exacerbated student stress, highlighting the urgent need for reliable assessment tools for social anxiety in this population.

OBJECTIVE: This scoping review protocol aims to map instruments used to assess public speaking anxiety and communication apprehension among health sciences students, analyzing their psychometric properties, cultural adaptations, and application contexts.

METHODS: Following the Joanna Briggs Institute framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, a systematic search will be conducted across PubMed, Scopus, Embase, LILACS, Web of Science, the Cochrane Library, and the Biblioteca Virtual em Saúde Portal. Eligible studies will include those evaluating social or performance anxiety in undergraduate or postgraduate health sciences students, using validated or culturally adapted instruments. Two independent reviewers will screen studies, with discrepancies resolved by a third reviewer. Data extraction will be conducted systematically, focusing on structural and content variables. Analysis will use a mixed methods approach, combining descriptive statistics with thematic synthesis and incorporating psychometric expertise.

RESULTS: As of May 2026, protocol registration has been completed via the Open Science Framework. Systematic database searches and study selection are scheduled to commence in June 2026, with anticipated completion by December 2026, aligned with a 2-year implementation road map designed to generate comprehensive instrument mapping and secondary analyses for evidence-based health professional training.

CONCLUSIONS: This protocol establishes a transparent and reproducible methodological plan, ensuring scientific rigor through adherence to Joanna Briggs Institute and PRISMA-ScR standards. It will deepen understanding of social anxiety assessment in oral communication among health sciences students and support the development of more effective interventions.

TRIAL REGISTRATION: Open Science Framework 10.17605/OSF.IO/YQ4KM; https://osf.io/yq4km.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/93700.

PMID:42372261 | DOI:10.2196/93700

JMIR Hum Factors. 2026 Jun 29;13:e85816. doi: 10.2196/85816.

ABSTRACT

BACKGROUND: Blended therapy (BT) combines digital applications with face-to-face treatment and has become an increasingly important component of psychiatric care. Evidence indicates that BT can achieve outcomes comparable to or even superior to those of traditional face-to-face therapy. Despite certain advantages, routine implementation of BT remains challenging, and clinical practice suggests that while some inpatients engage with BT, many either discontinue early or do not initiate its use at all. To better understand these patterns, this multicentric, retrospective observational study investigates factors associated with noninitiation and dropout among inpatients who are offered BT.

OBJECTIVE: In this study, data from 278 inpatients were analyzed to examine the influence of sociodemographic variables, comorbidities, and symptom severity on the uptake and continued use of BT. The objective was to identify predictors of noninitiation and dropout.

METHODS: Multivariable logistic regression models were conducted to identify significant predictors of noninitiation and dropout among inpatients using the transdiagnostic, cognitive behavioral therapy-based electronic mental health platform Minddistrict, which offers modules targeting psychoeducation, cognitive restructuring, and behavioral activation. Data were collected from 2 psychiatric hospitals between January 2020 and May 2024. The sample consisted predominantly of patients diagnosed with depression (182/278, 65.7%) and posttraumatic stress disorder (61/278, 21.9%), alongside various comorbid conditions.

RESULTS: The findings indicate distinct patterns of association for noninitiation and dropout. Of the 278 patients, only 5 (1.8%) completed all the assigned modules, and one-third of the patients never initiated the platform at all. Specifically, increasing age was linked to a lower risk of noninitiation (odds ratio [per year age difference] 0.98, 95% CI 0.96-1.00; P=.01), while the presence of a comorbid anxiety disorder was associated with a reduced risk of dropout (odds ratio 0.23, 95% CI 0.08-0.66; P=.007). Several variables showed no association with either noninitiation or dropout across all analyses, including sex, overall symptom severity, and certain comorbidities such as personality disorders and depression.

CONCLUSIONS: In this preselected inpatient sample, uptake of BT was very limited. Older age was associated with lower noninitiation, and comorbid anxiety disorders were associated with a lower likelihood of dropout. These findings may help inform future prospective studies on how BT can be introduced and supported more effectively in inpatient psychiatric care. As access to BT was granted selectively by therapists, the results should be interpreted as predictors of engagement within a selected sample rather than general predictors of BT uptake among all psychiatric inpatients.

PMID:42372259 | DOI:10.2196/85816

JMIR Res Protoc. 2026 Jun 29;15:e77241. doi: 10.2196/77241.

ABSTRACT

BACKGROUND: Parkinson disease (PD) is characterized by motor symptoms as well as progressive cognitive decline leading to long-term functional impairment and diminished quality of life. Mild cognitive impairment in PD (PD-MCI) is a risk factor for developing PD-related dementia. PD-MCI provides a window to assess interventions that can improve cognition. Repetitive transcranial magnetic stimulation (rTMS) shows promise as an effective treatment to improve cognitive performance.

OBJECTIVE: This study aims to test the safety and feasibility of a 10-session, high-frequency rTMS protocol applied to the left dorsolateral prefrontal cortex and the rTMS efficacy in improving cognitive test performance among veterans with PD-MCI.

METHODS: This is a double-blind randomized controlled trial. We will enroll US military veterans with PD-MCI. Participants will be randomized to either active or sham rTMS treatment groups, each with 10 treatment sessions (2 sessions/day). Treatment need not be consecutive; rather, they can be spread across approximately 10 days (eg, Monday, Wednesday, Thursday, Monday, Tuesday, and Wednesday). Participants randomized to active rTMS will receive stimulation applied to the left dorsolateral prefrontal cortex at 110% the resting motor threshold, a 15-Hz rate, 5 seconds per train of pulses, a 10-second intertrial interval, and 40 trains of pulses per session. Each patient will receive approximately 3000 pulses per session. Sham stimulation will be administered at the same parameters as real rTMS; however, no magnetic field will be produced on the placebo side of the active or placebo coil. This protocol was approved by the Edward Hines Jr Veterans Administration Hospital and Jesse Brown Department of Veterans Affairs Medical Center institutional review boards. This study includes a Food and Drug Administration investigational device exemption (G190076).

RESULTS: Safety will be assessed using the number of research-related adverse events experienced by the active rTMS group compared to the sham rTMS group. Feasibility will be assessed using protocol completion rates. To examine preliminary effects of rTMS, participants will complete a standardized neurocognitive battery assessment at baseline, end point, and 1-month follow-up. The primary study outcome is the change in score from baseline to end point on the National Institutes of Health-sponsored Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research Executive Composite score. This project was funded in June 2019, with additional funding secured in April 2024. As of April 2025, a total of 18 veterans with PD-MCI have completed the randomized controlled trial phase. Data collection is ongoing and will be completed by March 2027. We expect the results of this study to be available by March 2028.

CONCLUSIONS: The knowledge gained on the safety, feasibility, and efficacy of rTMS will set the stage for future research optimizing therapeutic gains for existing cognitive rehabilitation treatments or developing new and adjunct treatments for PD-MCI.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03836950; https://clinicaltrials.gov/study/NCT03836950.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/77241.

PMID:42372258 | DOI:10.2196/77241