Category: Nevin Manimala

S D Med. 2026 May;79(suppl 5):s48-s49.

ABSTRACT

INTRODUCTION: Central retinal artery occlusion (CRAO) is an ophthalmic emergency analogous to acute ischemic stroke, presenting with sudden painless vision loss and carrying a poor visual prognosis. The use of thrombolysis in managing CRAO remains controversial; recent randomized trials have not demonstrated statistically significant improvement in visual outcomes, though authors acknowledge potential underpowering to detect a clinically meaningful effect, with larger trials ongoing. Observational data suggest time-dependent treatment effects within a 4.5-hour window. Regardless of treatment efficacy, rapid recognition and evaluation within this narrow therapeutic window are essential for time-sensitive intervention. This study evaluated CRAO incidence and barriers to timely diagnosis within a regional healthcare system.

METHODS: Retrospective chart review of patients diagnosed with CRAO across Avera Health facilities (June 2018-September 2025). Cases were identified using ICD-10 codes and confirmed through medical record review. Thrombolysis rates were used as a process measure to identify workflow inefficiencies. Data included presentation site, referral pathways, time from symptom onset to presentation, and thrombolysis eligibility and administration.

RESULTS: Of 107 patients identified, 67 had complete documentation. Initial presentation occurred across multiple settings: 36 (53.7%) to the emergency department, 31 (46.3%) to ophthalmology/optometry/outpatient settings. Forty-three patients (64.2%) presented >4.5 hours after symptom onset. Among 24 presenting within the window, 7 (29%) received thrombolysis, 4 (16.7%) had contraindications to thrombolysis, and 13 (54.2%) either presented to or were referred to ophthalmology for evaluation, all of whom were diagnosed outside the treatment window.

CONCLUSION: Timely CRAO evaluation remains uncommon due to delayed presentation and diagnostic delays awaiting ophthalmologic consultation. Among patients presenting within the treatment window, just 45.8% received time-sensitive treatment options. Referral for ophthalmologic evaluation prior to emergency department diagnosis was the most common barrier (54.2%). Streamlined triage pathways, emergency department education, and remote retinal imaging may facilitate earlier diagnosis and preserve treatment opportunities.

PMID:42526019

S D Med. 2026 May;79(suppl 5):s37.

ABSTRACT

BACKGROUND: Chronic pain affects nearly one quarter of U.S. adults and remains difficult to treat with existing pharmacologic therapies. High-definition transcranial direct current stimulation (HD-tDCS) has emerged as a potential non-invasive neuromodulation approach. The insular cortex plays a central role in pain perception and represents a promising stimulation target. Capsaicin-induced hyperalgesia provides a validated experimental pain model for studying analgesic interventions.

OBJECTIVE: To determine whether HD-tDCS targeting the insular cortex modulates thermal sensitivity and subjective pain perception in a capsaicin-induced pain model.

METHODS: Fifteen healthy participants underwent both active and sham HD-tDCS conditions. Capsaicin was applied to induce localized thermal hyperalgesia. Thermal sensory testing was performed before and after stimulation, including heat pain threshold (HPT), thermal sensory limen (TSL), and numeric rating scale (NRS) pain ratings. Repeated-measures ANOVA evaluated the effects of time and stimulation condition.

RESULTS: Capsaicin application increased thermal sensitivity and pain ratings across participants. However, no significant stimulation × time interaction was observed for HPT, TSL, or NRS scores, indicating no detectable difference between active and sham HD-tDCS conditions.

CONCLUSIONS: In this pilot study, insular HD-tDCS did not significantly alter thermal sensitivity or pain perception in a capsaicin-induced pain model. These findings may reflect limited statistical power given the small sample size. Larger studies are needed to determine whether targeted neuromodulation of the insula can modulate acute pain processing.

PMID:42526006

S D Med. 2026 May;79(suppl 5):s36.

ABSTRACT

BACKGROUND: The healthcare industry is the largest private employer in the United States, yet workforce shortages persist. The Health Resources and Services Administration (HRSA) estimates that 92 million people live in primary care health professional shortage areas (HPSAs), 64 million in dental HPSAs, and 137 million in mental health HPSAs. An aging population and rising chronic illness rates place a growing burden on the healthcare system, with projected shortages exceeding 140,000 physicians and 100,000 registered nurses by 2038. Recruiting younger learners into healthcare careers is therefore critical. This study evaluated whether a traditional informational presentation or a presentation combined with hands-on activities was more effective at increasing high school students’ interest in healthcare careers.

METHODS: Two medical students visited eight high school chemistry classes, providing either a 30-minute informational presentation with time for questions, or a 10-minute presentation followed by 30 minutes of hands-on healthcare activities, including practicing vital signs and learning intubation techniques. Both presentations discussed motivations for working in healthcare and potential career paths. Students completed anonymous pre- and post-surveys assessing healthcare career interest. Surveys were paired using anonymous identifiers. Parental consent and student assent were obtained per institutional review board requirements.

RESULTS: The study included 129 consented participants, primarily 10th-grade students (n=124). Prior healthcare exposure was reported by 54%, and 62% had previously considered a healthcare career. On a scale of 1-10, baseline interest averaged 4.29. Interest increased by 0.64 (±1.16) in the presentation-only group and by 0.68 (±1.27) in the presentation plus hands-on group. These changes were statistically significant (p<0.001), with no significant difference between groups. Overall, 44% of students reported increased interest, 43% no change, and 12% decreased interest.

CONCLUSION: Both approaches were influential in reaffirming students’ interest or disinterest in a healthcare career. However, they did not differ significantly in their effect on interest. Future studies including broader student populations and expanded hands-on activities may better clarify effective strategies for engaging undecided students.

PMID:42526004

S D Med. 2026 May;79(suppl 5):s34-s35.

ABSTRACT

INTRODUCTION: More than 100,000 patients are on the U.S. transplant waitlist, with proportionally fewer organ donations coming from rural areas. Optimization of donation services in rural and frontier communities could address this discrepancy. We sought to better understand attitudes, knowledge, and concerns regarding organ donation and transplantation among frontier populations by surveying patients in the United States Great Plains region.

METHODS: A 15-item survey was distributed for voluntary completion to patients ≥18 years at three rural clinics in the Great Plains from July 2025 to January 2026. The survey included questions on demographics, exposure to and knowledge of organ donation, and attitudes regarding organ donation and transplantation. A total knowledge score was created by scoring participants’ accuracy in selecting which organs/tissues can be donated. Statistical analyses included Fisher exact and Mann Whitney U testing, as well as a multiple logistic regression. A p-value of ≤0.05 was considered significant.

RESULTS: Among 101 respondents (74.3% female, 77.2% registered donors), 90.1% were White and 7.9% were Native American/Alaska Native (NA/AN). Registered donors had significantly higher knowledge scores than non-donors (p=0.0012). Men were more likely to limit transplant acceptance to donations from friends/relatives (p=0.024), while NA/AN respondents showed higher willingness for unconditional living donation (p=0.039). Multivariable regression identified knowledge score as the sole independent predictor of donor status amongst variables surveyed (OR 1.48; 95% CI 1.13-1.99). The primary concern with donation reported was fear of health complications (37.5%) and the most requested intervention was more information on the donation process (18.1%).

CONCLUSION: Medical literacy appears to be positively associated with organ donor status in this population. Sex-, race-, and education-specific differences in donation attitudes exist and may inform targeted interventions. Addressing knowledge gaps and specific concerns through education and outreach could provide a strategy to increase donation rates in rural populations.

PMID:42526002

S D Med. 2026 May;79(suppl 5):s22-s23.

ABSTRACT

INTRODUCTION: Traditional Objective Structured Clinical Examinations (OSCEs) primarily assess students in the physician role. The OSCE 360 model expands this framework by incorporating student-authored cases and role rotation (student-doctor, student-patient, and evaluator), promoting experimental learning and exposure to multiple perspectives in patient care. Case writing may enhance clinical reasoning and diagnosis generation, while participation as standardized patients and peer evaluators reinforces understanding of clinical encounters. This study evaluates student perceptions of the educational impact of OSCE 360.

METHODS: A cross-sectional anonymous Qualtrics survey was administered to pre-clerkship medical students (Class of 2028) following participation in the OSCE 360 sessions. The survey assessed perceived case complexity, number of differential diagnoses considered, learning across roles, and confidence in case-writing. Descriptive statistics were used to summarize responses.

RESULTS: Twenty-seven students responded, with 16 completing all items. Most respondents, 87.5%, rated their cases as average to somewhat complex. When writing cases, 81.3% considered three or more differential diagnoses, compared to 56.3% when acting as student-doctor. Most agreed or strongly agreed that writing cases improved medical knowledge and patient management skills by 75.0%. Similarly, 68.8% agreed or strongly agreed that portraying the patient enhanced understanding of symptom presentation and clinical reasoning. Self-assessed case-writing proficiency was most commonly rated as average (75.0%).

CONCLUSIONS: OSCE 360 is perceived as a valuable educational approach for enhancing clinical reasoning, diagnostic thinking, and understanding of patient presentations through experiential learning. Role rotation and case construction provide meaningful learning beyond traditional OSCE formats. These findings support continued implementation of OSCE 360 and further investigation into its impact on objective performance and longitudinal clinical skill development.

PMID:42525984

S D Med. 2026 May;79(suppl 5):s20-s22.

ABSTRACT

BACKGROUND: Prolonged ambulatory ECG monitoring is hypothesized to improve detection of paroxysmal arrhythmias compared with standard 24-hour Holter monitoring. This systematic review and meta-analysis evaluated whether 14-day single-lead adhesive ECG patch monitoring enhances detection of clinically significant arrhythmias versus conventional Holter monitoring.

METHODS: Following PRISMA guidelines, PubMed, Scopus, and Embase were searched. Studies comparing 14-day ECG patch with Holter monitoring (primarily 24-72 hours) in ambulatory adults with suspected paroxysmal arrhythmia were included. Primary outcomes were detection rates of atrial fibrillation/flutter (AF), major arrhythmias, atrioventricular block, sinus pause, ventricular tachycardia, and supraventricular tachycardia. Risk of bias was assessed using ROBINS-I and RoB 2. Risk ratios (RR) with 95% confidence intervals were pooled using random-effects models in Review Manager (RevMan). Heterogeneity was evaluated with I² statistics, and sensitivity/subgroup analyses performed. The protocol was registered on PROSPERO (CRD420251248305).

RESULTS: Six studies met inclusion criteria. Primary analyses showed substantial heterogeneity for most outcomes. No significant differences were observed for AF (RR 0.43, 95% CI 0.05-3.51), major arrhythmias (RR 0.41, 95% CI 0.16-1.01), atrioventricular block (RR 1.10, 95% CI 0.42-2.90), sinus pause (RR 1.09, 95% CI 0.47-2.49), ventricular tachycardia (RR 0.62, 95% CI 0.03-11.98), or supraventricular tachycardia (RR 0.39, 95% CI 0.11-1.44). Sensitivity analyses excluding one influential study often resolved heterogeneity and shifted results, favoring Holter monitoring for AF, major arrhythmias, and ventricular tachycardia, or the 14-day patch for supraventricular tachycardia. Subgroup analysis by patient type showed no significant interaction.

CONCLUSION: Fourteen-day ECG patch monitoring showed no overall statistically significant superiority over 24-hour Holter monitoring for detecting clinically actionable arrhythmias. High heterogeneity and strong sensitivity to individual studies reflecting variability in devices, populations, and designs shows key limitations in current evidence. Larger, high-quality, standardized randomized trials are essential to clarify if extended patch monitoring offers true diagnostic advantages.

PMID:42525983

JMIR Rehabil Assist Technol. 2026 Jul 29;13:e84735. doi: 10.2196/84735.

ABSTRACT

BACKGROUND: Access to physical rehabilitation services, including orthotics and wheelchairs, is recognized as a fundamental human right but remains limited in many low- and middle-income countries due to resource constraints, fragmented care, and a shortage of trained rehabilitation professionals. In Cambodia, where the health system still faces challenges from past conflict, these services are delivered through a mix of government, international, and nongovernmental organizations.

OBJECTIVE: This study investigated the pathways to obtaining orthoses and wheelchairs in Cambodia and their impact on individuals with physical impairments.

METHODS: Semistructured interviews were conducted to explore experiences and the impact of accessing physical rehabilitation and assistive products for orthosis and wheelchair users. Interviews were conducted face-to-face with translation support, audio recorded, transcribed, and analyzed using thematic analysis. Interviews were conducted with participants in Phnom Penh and the Kandal province in Cambodia. In total, 17 participants aged 18 to 65 years who were current or previous patients of the Exceed Worldwide physical rehabilitation center located in Phnom Penh took part in the study.

RESULTS: Three themes emerged (early experiences of illness and health care seeking, pathways to assistive products, and the impact of these assistive products). Access to orthoses and wheelchairs often involved lengthy delays and inconsistent experiences with medical care and physiotherapy. Despite these challenges, assistive products played a vital role in improving mobility, independence, and social participation, contributing to greater confidence and emotional well-being. However, issues such as poor environmental accessibility and delays in repair or replacement limited their effectiveness.

CONCLUSIONS: The findings demonstrate that, while assistive products offer significant benefits, they do not fully address the systemic barriers faced by people with physical disabilities in Cambodia. Persistent challenges such as stigma, environmental constraints, and emotional strain demonstrate the need for integrated policy reforms and a robust continuum of care that ensures coordinated, ongoing support across all stages of rehabilitation.

PMID:42525972 | DOI:10.2196/84735

Traffic Inj Prev. 2026 Jul 29:1-9. doi: 10.1080/15389588.2026.2698873. Online ahead of print.

ABSTRACT

OBJECTIVES: This comprehensive register-based study examines fatal at-fault crashes of motor vehicle drivers with alcohol and other substance findings. We categorized substances with possible impact on driving into three categories: alcohol, medicines without addiction potential, and other substances, including illegal substances and medications with addiction potential. We analyzed the differences in crash circumstances and risk factors using odds ratios (ORs), comparing at-fault drivers with different substance combinations to those who were non-impaired.

METHODS: Our material comprises crash data from the Finnish Road Accident (FRA) database in 2019-2022. Multidisciplinary Road Traffic Accident Investigation Teams (RAITs) investigate all fatal crashes in depth, and the Finnish Crash Data Institute (OTI) maintains the FRA database. RAITs have access to all police records, including medico-legal autopsy findings and toxicological data from virtually all deceased drivers.During the study period, there were 750 at-fault motor vehicle drivers of fatal crashes. Our final study material consisted of all data with information on alcohol and other substance findings, including 234 drivers with substance findings, and 446 non-impaired drivers.

RESULTS: Alcohol was clearly the most prevalent substance, used by 75% of the drivers with substance findings. The mean alcohol concentration in alcohol-only cases was 1.64‰, and in cases with alcohol and other substances, 1.45‰. Drivers with substance findings were much more likely to have prior DUI offenses (OR = 21.9 [10.6-45.0]). Moreover, drivers using substances other than alcohol had even higher odds of previous DUIs (OR = 31.9 [13.5-75.3]). Drivers with alcohol findings were more likely <25 years old compared to non-impaired drivers (OR = 2.10 [1.31-3.37]). Drivers with substance findings had higher odds of causing a crash while speeding compared to non-impaired drivers (for example, speeding at least 30 km/h: OR = 5.88 [4.00-8.62]). We found no statistically significant differences between drivers who had used alcohol alone and those who had used alcohol and other substances.

CONCLUSIONS: Alcohol with high concentrations dominated among at-fault drivers with substance findings in fatal road traffic crashes. Substance use co-occurred with other forms of risk taking such as speeding. Young drivers were overrepresented among drivers with alcohol findings. Despite new illegal substances and increasing drug use, alcohol still has a major impact on fatal crashes. This means that traditional measures for tackling DUI problems still apply but we must be open for new innovations, too.

PMID:42525969 | DOI:10.1080/15389588.2026.2698873

IEEE Trans Pattern Anal Mach Intell. 2026 Jul 29;PP. doi: 10.1109/TPAMI.2026.3718490. Online ahead of print.

ABSTRACT

Graph convolutional networks (GCNs) have been widely used and have achieved remarkable results in skeleton-based action recognition. In this paper, we propose a channel-wise topology refinement-graph convolution (GC) to dynamically learn different topologies and effectively aggregate joint features in different channels for skeleton-based action recognition. Channel-wise topologies are modeled by learning a shared topology as a generic prior for all the channels and refining the topology using channel-specific correlations between joints. Our refinement method introduces very few extra parameters and significantly reduces the difficulty in modeling channel-wise topologies. Furthermore, we reformulate graph convolutions (GCs) into a unified form, and theoretically show that the channel-wise topology refinement-GC relaxes strict constraints of GCs and then has stronger representation capability. In order to model long-range joint dependencies and dynamically adjust channel-wise feature weights, we propose a channel-wise topology refinement squeeze-excitation transformer. Global information is aggregated in the temporal and spatial dimensions to capture correlations between distant joints. The channel-attention mechanism extracts channel-level statistics using global average pooling. The channel weights are generated using a fully connected layer to reinforce action-adaptive feature channels. Experimental results show the effectiveness of the proposed channel-wise topology refinement-GC and channel-wise topology refinement squeeze-excitation transformer on the NTU RGB+D, NTU RGB+D120, and NW-UCLA datasets.

PMID:42525939 | DOI:10.1109/TPAMI.2026.3718490

IEEE Trans Cybern. 2026 Jul 29;PP. doi: 10.1109/TCYB.2026.3715550. Online ahead of print.

ABSTRACT

Information granularity provides a framework for machine intelligence to simulate human cognitive processes in problem-solving, enabling machines to make more flexible and adaptive decisions in complex data environments. However, most existing information granularities are based on fuzzy c-mean (FCM) or K-means clustering for granularity construction. This kind of convex data structure clustering has difficulty in recognizing some irregular nonconvex data types, and can only be filled irregularly by increasing the cluster classes, which is easy to lose the wholeness and accuracy of the data. The density-based spatial clustering of applications with noise (DBSCAN), a classical density-based spatial clustering method, is well-suited for both convex and nonconvex datasets. Building on the versatility of DBSCAN, a new density-based clustering method called stacked density granulation (SDG) is proposed, which constructs information granularities capable of effectively describing both convex and nonconvex data. This approach addresses the limitations of traditional information granularity. By applying the newly constructed information granularities to the feature space, the importance of features can be measured. To enhance this process, a heuristic feature selection method called density granular feature selection (DGFS) is introduced. DGFS constructs a low-dimensional feature space by aggregating and discretizing the information granularities, retaining only the most relevant features. To demonstrate the superiority and effectiveness of the DGFS algorithm, 12 publicly available datasets are utilized, and its performance is compared with other feature selection methods across four different classifiers. The experimental results and the statistical significance test indicate that DGFS consistently outperforms the competing methods.

PMID:42525932 | DOI:10.1109/TCYB.2026.3715550