Category: Nevin Manimala

BMC Oral Health. 2026 May 19. doi: 10.1186/s12903-026-08622-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Transitioning from a treatment-oriented model to a prevention-focused approach is essential for improving oral health outcomes. This study aimed to assess the feasibility and implementation outcomes of Integrated Oral Health Care Pathways (IOHCPs) for pediatric and adult patients referred to a dental school setting.

METHODS: A four-month mixed-methods feasibility study was conducted at the School of Dentistry, Tehran University of Medical Sciences. IOHCPs were implemented for pediatric and adult patients using risk-based preventive care, oral health education, and structured follow-up. Participants were allocated into three groups (control, routine care, and IOHCP intervention). The study followed the Donabedian framework (structure, process, and outcomes). Clinical outcomes (OHI-S, DMFT, and bleeding on probing [BOP]) and behavioral indicators were assessed. Process indicators were evaluated between routine care and IOHCP groups. Semi-structured interviews were conducted to assess structural feasibility. Statistical analyses included trend tests, chi-square tests, and independent t-tests, with a significance level of 0.05.

RESULTS: A total of 780 patients (420 adults and 360 children) were included. OHI-S showed a significant improvement across groups in both adults (2.75 to 1.88) and children (2.29 to 1.25; p < 0.001). Behavioral indicators demonstrated favorable trends in the IOHCP group, including increased tooth brushing frequency and higher preventive care uptake (p < 0.001). Process indicators showed marked improvement in the delivery of preventive services in the IOHCP group compared to routine care (p < 0.001). DMFT increased in adults over time, reflecting cumulative disease experience, while no significant change was observed in children. Differences in BOP between routine care and IOHCP groups were not statistically significant.

CONCLUSION: The implementation of Integrated Oral Health Care Pathways in a dental educational setting was feasible and acceptable. The pathways improved preventive care delivery processes and were associated with favorable oral hygiene behaviors. However, changes in clinical disease indicators were limited within the short study period. Further long-term studies are needed to evaluate sustainability and clinical impact.

PMID:42157031 | DOI:10.1186/s12903-026-08622-x

Australas Psychiatry. 2026 May 19:10398562261447698. doi: 10.1177/10398562261447698. Online ahead of print.

ABSTRACT

BackgroundThe Dynamic Appraisal of Situational Aggression – Inpatient Version (DASA-IV) is a brief violence risk assessment tool to evaluate imminent risk of aggression. There have been no previous studies to investigate its utility in an acute adult non-forensic psychiatric setting in Australia.ObjectiveTo examine the feasibility of DASA-IV implementation in an acute adult inpatient non-forensic psychiatric setting.MethodsThis study utilised a quasi-experimental design with pre- and post-testing. Subjective data from questionnaires administered to psychiatric staff on utility of DASA-IV and objective data on frequency of aggression incidents were collected.ResultsStaff reported higher confidence in deciding when medications, seclusion, and security and medical staff were required to manage aggression. DASA-IV was reported as valuable and easy to use. Lack of time and lack of DASA-IV training for non-regular nurses were barriers to implementation. Only the control unit had a statistically higher number of aggression incidents post-intervention.Conclusions DASA-IV is a feasible tool that improves staff confidence in managing aggression and reduces aggression incidents in an acute adult non-forensic inpatient psychiatric setting in a metropolitan tertiary public hospital. Its implementation may assist in aggression management in the acute adult non-forensic inpatient psychiatric setting.

PMID:42157028 | DOI:10.1177/10398562261447698

Pharm Stat. 2026 Jul-Aug;25(4):e70074. doi: 10.1002/pst.70074.

ABSTRACT

Adaptive clinical dose-finding trials aim to identify an optimal drug dose for use in subsequent phase II and III trials. In adaptive dose-finding trials, dose levels for newly included patients are informed by outcomes of patients that received the drug earlier in the trial. The body of methodological research on adaptive dose-finding trials is extensive, but a clear overview is lacking. The goal of this paper is to provide a knowledge base of designs and statistical methods for adaptive clinical dose-finding trials by means of a literature review. We identified 315 adaptive dose-finding trial methodology articles of which the majority was inspired by oncology. Recent methods focused on identification of an optimal dose considering both toxicity and efficacy endpoints, and addressing challenges related to subgroup-specific dose-finding, dose-finding for combination therapies, and incorporation of delayed outcomes in dose-finding. These developments are driven by the emergence of newer classes of cancer drugs, such as targeted therapies and immunotherapies, and by initiatives like Project Optimus. Most articles focused on model-based designs, like the Continual Reassessment Method (CRM), but recent years have seen a strong increase in model-assisted or interval-based designs, including Toxicity Probability Interval (TPI) and Bayesian Optimal Interval (BOIN) designs and expansions thereof. Considering the increasing availability and large variety of adaptive dose-finding trial designs, it is challenging for researchers to find relevant designs tailored to their needs. Therefore, we provide an interactive map summarizing the classification of our results to facilitate the identification of relevant designs/methods, which we will update regularly.

PMID:42157027 | DOI:10.1002/pst.70074

Clin Neuropsychol. 2026 May 19:1-22. doi: 10.1080/13854046.2026.2670535. Online ahead of print.

ABSTRACT

Objective: To reevaluate the psychometric properties and contemporary relevance of the 1969 Lawton and Brody Instrumental Activities of Daily Living (iADL) Scale in older adults. Methods: Data from 3552 participants and co-participants in the Texas Alzheimer’s Research and Care Consortium cohort were analyzed. Lawton and Brody iADL Scale items were analyzed in a sample with no cognitive disorder, mild cognitive impairment, and dementia. Graded response models assessed item discrimination and difficulty, with differential item functioning (DIF) analyses examining demographic effects. Expert reviewers evaluated item content for cultural and technological relevance. Results: Items assessing shopping, food preparation, and transportation were most sensitive to mild functional impairment, while the total scale had limited detection of subtle functional decline. Statistical DIF emerged on 75% of items, whereas clinically meaningful DIF for several demographic groupings emerged on the transportation item. Expert reviewers identified outdated content, particularly for telephone and financial items, reflecting technological shifts. Broader changes in normative behaviors and sample demographics may further challenge scale applicability. Conclusions: The Lawton and Brody iADL Scale remains foundational but shows limited sensitivity for early functional decline. Outdated items and evolving socioeconomic and technological contexts underscore the need for refinement to enhance unbiased early detection and maintain longitudinal comparability. Updating the instrument to reflect modern demands could strengthen functional assessment in Alzheimer’s disease and related disorders research and clinical trials.

PMID:42157020 | DOI:10.1080/13854046.2026.2670535

Commun Med (Lond). 2026 May 19;6(1):290. doi: 10.1038/s43856-026-01658-8.

ABSTRACT

BACKGROUND: Primary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri carries historical case fatality rates (CFR) exceeding 97%. The 2025 Kerala outbreak, the largest documented globally, provided an unprecedented opportunity to identify host factors and inflammatory correlates influencing survival under standardised management.

METHODS: We conducted a prospective observational study of 200 laboratory-confirmed PAM cases across six districts of Kerala, India (January-November 2025). All patients received protocolised amphotericin B ± miltefosine. Demographic, clinical, and laboratory data were collected, including inflammatory biomarkers (IL-6, TNF-α, IL-1β, neutrophil-to-lymphocyte ratio), pathogen burden (qPCR), and treatment timing. Multivariable logistic regression identified mortality predictors; bootstrap resampling and E-value sensitivity analyses assessed robustness.

RESULTS: Here we show that among 200 patients (median age 41 years; 50% male), 134 with resolved outcomes yield a CFR of 45·5% (95% CI 37·3-54·5%; 61 deaths, 73 recoveries). Diabetes mellitus is the only statistically significant predictor of mortality in the adjusted model (adjusted OR 2·59; 95% CI 1·01-6·66; p = 0·048), though the proximity of the lower confidence bound to unity warrants cautious interpretation. This association remains consistent across sensitivity analyses (bootstrap 95% CI 1·06-8·74; E-value 4·62). Asthma demonstrates a protective association in univariable analysis (OR 0·37; p = 0·021), though this finding remains hypothesis-generating. Early treatment (≤2 days) shows a trend toward improved survival (p = 0·084). Inflammatory biomarkers show no association with outcome, though CSF pathogen burden correlates significantly with admission neurological severity.

CONCLUSIONS: Under standardised treatment, diabetes mellitus emerges as a key host determinant of PAM mortality. The dissociation between inflammatory markers and outcomes suggests neurological fate may be determined early in infection, with immediate clinical implications as climate change expands the geographic range of N. fowleri.

PMID:42156999 | DOI:10.1038/s43856-026-01658-8

Sci Rep. 2026 May 20. doi: 10.1038/s41598-026-54067-1. Online ahead of print.

ABSTRACT

To investigate changes in the pupil size and accommodation following prophylactic peripheral laser retinopexy (PPLR). This prospective self-controlled study enrolled patients who underwent unilateral PPLR. The photopic and mesopic pupil diameters (PPD and MPD), accommodative amplitude (AA), and central corneal sensation (CCS) were measured at baseline and 1 week, 1 month, and 3 months post-PPLR in both the treated eye and the untreated fellow eye. Standard ophthalmic examinations were also performed at each follow-up visit. Longitudinal changes were analysed by using baseline-adjusted linear mixed-effects models comparing the treated and fellow eye over time. Associations between pupillary or accommodative changes and baseline characteristics were evaluated with multivariable regression. A total of 98 patients (98 treated and 98 fellow eyes) were analysis. Both the PPD and MPD increased significantly at 1 week post-PPLR compared with those at baseline. By 1 month, the dilation of the PPD and MPD had decreased but remained significant. At 3 months, neither the PPD nor the MPD significantly differed from baseline at the group level. A higher laser dose was strongly associated with the development of pupil dilation. Compared with that at baseline, the AA in the treated eyes significantly decreased at 1 week and 1 month after PPLR, with the difference no longer reaching statistical significance at 3 months. No significant differences in CCS were detected at any follow-up visit. PPLR resulted in significant but transient increases in the PPD and MPD, along with a temporary reduction in accommodation. A higher number of laser spots was significantly associated with postoperative pupil dilation. These potential effects should be discussed with patients prior to treatment, particularly with those scheduled for refractive surgery.

PMID:42156994 | DOI:10.1038/s41598-026-54067-1

Muscle Nerve. 2026 May 19. doi: 10.1002/mus.70281. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: High quality reference limits for nerve conduction studies (NCS) are essential for diagnosis of neuromuscular disorders. Examining healthy controls to calculate reference limits directly is expensive and time consuming. Indirect methods, including extrapolated norms (E-norms), extrapolated reference values (E-Ref), and multivariate extrapolated reference values (MeRef), use historical hospital data instead. These methods sort the historical measurements in increasing order, creating so-called S-curves, and select normal measurements based on the shape of these S-curves. Current versions of these methods have several limitations, and we aimed to improve them by modifying how they select normal measurements.

METHODS: E-norms, E-Ref, and MeRef were modified with new S-curve selection algorithms. The modified versions of the methods were used to calculate reference limits for common NCS measurements from a large historical database. The results were compared to reference limits calculated from 680 healthy subjects using Youden’s J statistic and z-score deviation.

RESULTS: The modified methods provided reference limits with Youden’s J > 0.8 and z-score deviation < 0.9 for most types of NCS measurements and similar or higher Youden’s J than the unmodified methods. In most cases, the methods required at least 500 measurements and fewer than 20% abnormal measurements for good performance.

DISCUSSION: Changing the S-curve selection algorithms improves E-norms, E-Ref, and MeRef. The modifications require a sufficient number and proportion of normal measurements in the historical database. When these prerequisites are met, a combination of indirect methods can be used when developing reference limits from historical patient data.

PMID:42156990 | DOI:10.1002/mus.70281

Br J Cancer. 2026 May 19. doi: 10.1038/s41416-026-03428-8. Online ahead of print.

ABSTRACT

BACKGROUND: We explored the association of immune-related adverse events (irAE), along with prior and concomitant antibiotic and steroid use, on oncological outcomes following immune checkpoint inhibitor (ICI) treatment in various solid tumours.

METHODS: Pooled data from seven trials on ICI therapy across multiple cancer types (head and neck, non-small cell lung cancer, gastroesophageal junctional adenocarcinoma, oesophageal, renal cell, and urothelial carcinoma) was analysed, focusing on overall survival (OS) and progression-free survival (PFS) and antibiotic or steroid use before and during the study.

RESULTS: Of 693 patients, 80 used steroids and 52 used antibiotics prior to the study, while 360 and 331, respectively, used them concomitantly. Lack of prior antibiotic use was associated with longer OS (No vs. Yes: HR 0.552, 95%-CI 0.370-0.822, p = 0.0035) and PFS (No vs. Yes: HR 0.703, 95%-CI 0.485-1.019, p = 0.0625), whereas concomitant antibiotic use had no such effect. Patients with concomitant steroid use demonstrated longer PFS (No vs. Yes: HR 1.359, 95%-CI 1.091-1.693, p = 0.0061).

DISCUSSION: Our study confirmed associations between antibiotic and steroid use and ICI efficacy in cancer. Prior, but not concomitant, antibiotic use was linked to reduced OS, supporting the role of microbiome diversity in tumour response. Concomitant steroid use was associated with improved PFS, potentially reflecting its link to irAE occurrence.

PMID:42156980 | DOI:10.1038/s41416-026-03428-8

NPJ Digit Med. 2026 May 19. doi: 10.1038/s41746-026-02753-9. Online ahead of print.

ABSTRACT

iPad-based eye tracking could support Parkinson’s disease (PD) screening and longitudinal monitoring by enabling objective, low-cost, portable assessment of oculomotor function. We previously validated an iPad-based eye-tracking system against the EyeLink 1000 Plus for temporal and spatial saccade metrics. Here, in a convenience sample of 19 healthy controls (HC) and 12 patients with PD, we recorded eye movements simultaneously with both devices during pro-saccade, anti-saccade (AS), memory-guided saccade (MGS), and self-generated saccade tasks. Across all pre-specified metrics, statistically significant PD-HC differences and null results were concordant between devices. In addition, saccade-level mixed-effects models showed small group × device interaction effects that remained below literature-based benchmarks for clinically meaningful PD-HC differences, indicating that iPad-based measurements preserved benchmark clinical-grade group-level effects. A compact three-metric iPad-based classifier comprising AS directional error rate, AS gain, and MGS gain supported strong subject-level PD-HC discrimination, with an area under the receiver operating characteristic curve of 0.98, sensitivity of 0.91, specificity of 1.00, and accuracy of 0.96. These findings support scalable tablet-based oculomotor assessment for PD-related screening and longitudinal monitoring.

PMID:42156978 | DOI:10.1038/s41746-026-02753-9

Sci Rep. 2026 May 19. doi: 10.1038/s41598-026-53333-6. Online ahead of print.

ABSTRACT

Heart rate variability biofeedback (HRVB) is increasingly examined as an adjunctive method for reducing psychological symptoms. Standard protocols involve identifying each participant’s resonance frequency (RF); however, it remains unclear whether this individualized calibration offers advantages over training at a fixed breathing rate of 0.1 Hz. We conducted a randomized trial with three groups (RF, 0.1 Hz, Control) to compare the effectiveness of a four-week HRVB intervention using an individually determined RF versus a fixed breathing frequency of 0.1 Hz. Participants (N = 88) completed pre- and post-intervention assessments of perceived stress, anxiety, depressive symptoms (DASS-21), and resting HRV. Both HRVB groups showed significant reductions in stress, anxiety, and depressive symptoms relative to the control group, with no meaningful differences between them. Bayesian analysis provided anecdotal evidence favoring the null hypothesis of no difference between groups. The intervention did not produce significant changes in resting HRV. The present study does not permit firm conclusions regarding whether breathing at the RF confers additional benefits over breathing at a fixed rate of 0.1 Hz or whether the two approaches differ in effectiveness. Future studies aimed at detecting small differences between these approaches should include larger samples.Trial registration: The study was retrospectively registered at isrctn.com (Identifier ISRCTN17808563 date of first registration 20/01/2026, https//doi.org/10.1186/ISRCTN17808563). The full trial protocol and statistical analysis plan can be accessed via the registry.

PMID:42156977 | DOI:10.1038/s41598-026-53333-6