Nevin Manimala

JMIR Serious Games. 2025 Jun 16;13:e63424. doi: 10.2196/63424.

ABSTRACT

BACKGROUND: Nature engagement, including affective and physical interactions with nature, is linked to a multitude of health and well-being benefits. Unfortunately, opportunities for engaging with nature are decreasing worldwide. University students, especially, are a demographic group that tends to engage little with nature. Immersive virtual nature (IVN; ie, digital nature content delivered through immersive devices, such as head-mounted displays) has been proposed as a medium to facilitate nature experiences and engagement. In recent years, 360° nature videos have emerged as an accessible way to create IVN content, although it is still unclear whether they can elicit presence and increase nature engagement to a greater extent than nature videos delivered through nonimmersive media.

OBJECTIVE: We aimed to investigate the effectiveness of nature videos as a medium to promote nature engagement among university students, comparing devices with different levels of immersion. Specifically, 2 experimental conditions were tested: a 360° nature video delivered through a head-mounted display (IVN) and a matching video displayed on a tablet screen (nonimmersive virtual nature).

METHODS: In total, 38 students were recruited at the library of a university campus and invited to participate in an organized hiking tour at the location displayed during the virtual nature experience. They were then randomized, using a random number generator, to either the IVN (n=20, 53%) or the nonimmersive virtual nature condition (n=18, 47%). Pre- and postexposure assessments of nature connectedness, intention to perform green exercise, intention to visit the hiking location, and intention to participate in the organized hiking tour were collected. Presence, cybersickness, and actual attendance on the tour were also assessed.

RESULTS: A mixed ANOVA showed statistically significant pre- to postexposure assessment increases in nature connectedness (F_1,36=33.49; P<.001; η_p²=0.48); intention to perform green exercise (F_1,36=5.55; P=.02); intention to visit the hiking location (F_1,36=15.34; P<.001; η_p²=0.26); and intention to participate in the hiking tour (F_1,36=12.45; P=.001; η_p²=0.30). Both conditions were associated with medium to high ratings of “being there” and “sense of reality” but low ratings of “realism.” The cybersickness levels were generally low. Of the 38 students, 6 (16%) participated in the organized tour. The mixed ANOVA found no statistical differences between the two conditions for any of the outcomes. The participants’ changes in nature connectedness (ρ=0.35; P=.03) and attendance on the hiking tour (ρ=.37; P=.02) correlated with the presence item “being there.”

CONCLUSIONS: This study provides novel evidence on the potential of virtual nature as a medium to improve nature engagement among university students, adding to the current debate on the effectiveness of 360° videos. These findings can inform future research as well as initiatives seeking to promote nature engagement.

PMID:40523269 | DOI:10.2196/63424

Ann Am Thorac Soc. 2025 Jun 16. doi: 10.1513/AnnalsATS.202501-129OC. Online ahead of print.

ABSTRACT

RATIONALE: The effects of long-term ambient air pollution exposure on survival in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) remain unclear.

OBJECTIVES: Evaluate the association between exposure to PM2.5, NO2, and O3, and mortality or lung transplantation in the Pulmonary Hypertension Association Registry (PHAR).

METHODS: 2,196 adult patients enrolled in the PHAR provided data between 2015 and 2024. Annual average concentrations of air pollutants, including PM2.5, NO2, and O3, estimated from validated spatiotemporal models in 2015 were linked to each participant’s residential address. Cox proportional hazards models evaluated the associations between air pollutant exposures and risk of death or lung transplantation, adjusting for baseline demographics, individual and neighborhood socioeconomic factors (SES), disease severity, and spatial confounders. Additional analyses were adjusted for and stratified by nine U.S. census divisions.

RESULTS: Study participants were broadly distributed across U.S. regions, with 72.0% female and a mean age of 55.7. 35.6% had idiopathic PAH, 26.5% had connective tissue disease-associated PAH, and 14.5% had CTEPH. In models adjusted for demographics, individual and neighborhood SES, each IQR increase of PM2.5 was associated with a mortality or lung transplant hazard ratio (HR) of 1.16 (95% confidence interval [CI]: 1.01-1.33). This association was marginally attenuated and not statistically significant after adjusting for spatial covariates, with an HR of 1.12 (95% CI: 0.95-1.31) per IQR increase in PM2.5. We noted regional variation in the observed associations. No significant associations were found with NO2 or O3.

CONCLUSIONS: Long-term ambient air pollution exposure was not significantly associated with survival in PHAR patients with PAH or CTEPH. Future research should investigate potential modifying effects of regional social determinants and healthcare-related factors on the relationship between air pollution exposure and mortality in these conditions.

PMID:40523262 | DOI:10.1513/AnnalsATS.202501-129OC

J Cataract Refract Surg. 2025 Jun 10. doi: 10.1097/j.jcrs.0000000000001709. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the morphologic characteristics of lens in cataract patients with zonule dialysis (ZD) before and after cycloplegia by anterior segment optical coherence tomography (AS-OCT).

SETTING: Peking University Third Hospital, Beijing, China.

DESIGN: Cross-sectional observational study.

METHODS: 56 eyes from 56 participants who would undergo cataract operations were included, with 29 eyes of normal controls and 27 eyes of zonule dialysis patients. Lens morphologic parameters were then evaluated by AS-OCT, including anterior chamber depth (ACD), lens thickness (LT), lens diameter, lens vault, anterior curvature radius, posterior curvature radius, decentration and tilt of lens. After participants were treated with three-time tropicamide solution, AS-OCT was repeated to acquire the post-cycloplegia results. SPSS Software 22.0 was used for statistical analysis.

RESULTS: The comparison of basic lens morphologic parameters without cycloplegia found only anterior curvature (P=0.039) showed significant differences between normal and ZD groups. AS-OCT measured after 30-min cycloplegia treatment showed significantly increased ACD, lens diameter, posterior curvature and decreased vault in both groups, decreased lens thickness in normal group, increased anterior curvature and decreased lens decentration in ZD group (all P<0.05). The logistic regression model showed ZD group had greater alterations of ACD (P=0.014), anterior curvature (P=0.009) and decentration (P=0.031) after cycloplegia treatment when compared with the normal group.

CONCLUSIONS: Lens in ZD patients was characterized by steeper anterior curvature, and grater alterations of ACD, anterior curvature and decentration after cycloplegia. The comparison of lens morphologic parameters before and after cycloplegia might be the potential method to evaluate the stability of zonule.

PMID:40523260 | DOI:10.1097/j.jcrs.0000000000001709

Biopsychosoc Sci Med. 2025 Jun 17. doi: 10.1097/PSY.0000000000001414. Online ahead of print.

ABSTRACT

OBJECTIVE: Genetics contribute to elevated body mass index (BMI) in youth. Adolescents experiencing interpersonal stressors (e.g., peer victimization or parental criticism) may additionally be at a heightened risk for developing high BMI. However, few studies have examined additive contributions of genetic factors and interpersonal stressors to BMI. The current study aimed to address this gap by analyzing associations of BMI with polygenic risk scores (PRS) for BMI and an inflammatory C-reactive protein (CRP), and a range of interpersonal stressors, in a community-based adolescent sample.

METHODS: 827 adolescents (Mage=13.63, SD=1.01, 76% girls of European ancestry) completed self-report measures of peer victimization and parental criticism at baseline. BMI was assessed on average 2 years after baseline. PRS were calculated using summary statistics from the largest genome-wide association studies of BMI and CRP. Analyses consisted of linear regressions, adjusting for population stratification and demographic characteristics.

RESULTS: BMI-PRS and CRP-PRS were independently and significantly associated with BMI (β=0.20 and β=0.10, P<0.05, respectively). Additionally, greater father criticism at baseline was independently associated with higher phenotypic BMI at follow-up (β=0.12, P<0.05). Peer victimization and maternal criticism were not associated with BMI.

CONCLUSIONS: Genetic vulnerabilities to high BMI and inflammation, as well as father criticism, were significantly and uniquely associated with BMI in adolescents. The results are consistent with models of additive contributions of genetics and interpersonal stress to health outcomes.

PMID:40523250 | DOI:10.1097/PSY.0000000000001414

J Med Internet Res. 2025 Jun 16;27:e71091. doi: 10.2196/71091.

ABSTRACT

BACKGROUND: The role of artificial intelligence (AI) in enhancing the accuracy of lymphovascular space invasion (LVSI) detection in cervical cancer remains debated.

OBJECTIVE: This meta-analysis aimed to evaluate the diagnostic accuracy of imaging-based AI for predicting LVSI in cervical cancer.

METHODS: We conducted a comprehensive literature search across multiple databases, including PubMed, Embase, and Web of Science, identifying studies published up to November 9, 2024. Studies were included if they evaluated the diagnostic performance of imaging-based AI models in detecting LVSI in cervical cancer. We used a bivariate random-effects model to calculate pooled sensitivity and specificity with corresponding 95% confidence intervals. Study heterogeneity was assessed using the I2 statistic.

RESULTS: Of 403 studies identified, 16 studies (2514 patients) were included. For the interval validation set, the pooled sensitivity, specificity, and area under the curve (AUC) for detecting LVSI were 0.84 (95% CI 0.79-0.87), 0.78 (95% CI 0.75-0.81), and 0.87 (95% CI 0.84-0.90). For the external validation set, the pooled sensitivity, specificity, and AUC for detecting LVSI were 0.79 (95% CI 0.70-0.86), 0.76 (95% CI 0.67-0.83), and 0.84 (95% CI 0.81-0.87). Using the likelihood ratio test for subgroup analysis, deep learning demonstrated significantly higher sensitivity compared to machine learning (P=.01). Moreover, AI models based on positron emission tomography/computed tomography exhibited superior sensitivity relative to those based on magnetic resonance imaging (P=.01).

CONCLUSIONS: Imaging-based AI, particularly deep learning algorithms, demonstrates promising diagnostic performance in predicting LVSI in cervical cancer. However, the limited external validation datasets and the retrospective nature of the research may introduce potential biases. These findings underscore AI’s potential as an auxiliary diagnostic tool, necessitating further large-scale prospective validation.

PMID:40523236 | DOI:10.2196/71091

JMIR Infodemiology. 2025 Jun 16;5:e69321. doi: 10.2196/69321.

ABSTRACT

BACKGROUND: As the global population ages, concerns about older drivers are intensifying. Although older drivers are not inherently more dangerous than other age groups, traditional surveys in Japan reveal persistent negative sentiments toward them. This discrepancy suggests the importance of analyzing discourse on social media, where public perceptions and societal attitudes toward older drivers are actively shaped.

OBJECTIVE: This study aimed to quantify long-term public discourse on older drivers in Japan through Twitter (subsequently rebranded X), a leading social media platform. The specific objectives were to (1) examine the sentiments toward older drivers in tweets, (2) identify the textual contents and topics discussed in the tweets, and (3) analyze how sentiments correlate with various variables.

METHODS: We collected Japanese tweets related to older drivers from 2010 to 2022. Each quarter, we (1) applied to the Japanese version of the Linguistic Inquiry and Word Count dictionary for sentiment analysis, (2) employed 2-layer nonnegative matrix factorization for dynamic topic modeling, and (3) applied correlation analyses to explore the relationships of sentiments with crash rates, data counts, and topics.

RESULTS: We obtained 2,625,807 tweets from 1,052,976 unique users discussing older drivers. The number of tweets has steadily increased, with significant peaks in 2016, 2019, and 2021, coinciding with high-profile traffic crashes. Sentiment analysis revealed a predominance of negative emotions (n=383,520, 62.42%), anger (n=106,767, 17.38%), anxiety (n=114,234, 18.59%), and risk (n=357,311, 58.15%). Topic modeling identified 29 dynamic topics, including those related to driving licenses, crash events, self-driving technology, and traffic safety. The crash events topic, which increased by 0.28% per year, showed a strong correlation with negative emotion (r=0.76, P<.001) and risk (r=0.72, P<.001).

CONCLUSIONS: This 13-year study quantified public discourse on older drivers using Twitter data, revealing a paradoxical increase in negative sentiment and perceived risk, despite a decline in the actual crash rate among older drivers. These findings underscore the importance of reconsidering licensing policies, promoting self-driving systems, and fostering a more balanced understanding to mitigate undue prejudice and support continued safe mobility for older adults.

PMID:40523233 | DOI:10.2196/69321

Interact J Med Res. 2025 Jun 16;14:e65311. doi: 10.2196/65311.

ABSTRACT

BACKGROUND: Virtual reality (VR) has become a powerful tool for enhancing the experiences of patients with critical illnesses, particularly hospitalized children with leukemia. Since traveling is nearly impossible for them, St Jude has teamed up with the travel company Expedia to launch “Dream Adventures,” a pilot program that offers immersive VR experiences, allowing children to explore new destinations from the comfort of the hospital.

OBJECTIVE: The aim of this study was to evaluate the pleasurable experience of VR and its impact on healthy and hospitalized children’s travel expectations and hope by using electrocardiography (ECG) and questionnaires to enhance research objectivity.

METHODS: Participants were children aged 7-18 years, divided into 2 distinct groups: 30 healthy children and 18 hospitalized children with leukemia. Both groups received the same VR intervention and were assessed using a 1-group pretest-posttest design. The questionnaires were designed to assess differences in the children’s sense of hope and travel expectations, and their physiological data were collected through ECG.

RESULTS: The results indicated a statistically significant increase in hope levels from pre-VR to post-VR intervention in both healthy children (preintervention: mean 5.83, SD 0.87; postintervention: mean 6.36, SD 0.76; P=.002) and hospitalized children (preintervention: mean 5.51, SD 1.17; postintervention: mean 5.73, SD 1.15; P=.03), as determined by paired samples 2-tailed t tests. Furthermore, an independent samples 2-tailed t test revealed a significant difference in postintervention hope levels between the hospitalized children (mean 5.73, SD 1.15) and healthy children (mean 6.36, SD 0.76; P=.05). Then, we further compared the mean differences in hope scores from preintervention to postintervention. Healthy children demonstrated a greater increase (an increase of 0.53, from 5.83 to 6.36) than the hospitalized children (an increase of 0.22, from 5.51 to 5.73). In terms of physiological responses, ECG indicators such as SD of all normal-to-normal intervals and low-frequency power revealed significant differences in autonomic nervous system activity between the 2 groups. Healthy children exhibited higher sympathetic activation, suggesting greater emotional engagement during the VR experience, whereas hospitalized children demonstrated more attenuated responses. The consistency between physiological data and self-reported measures strengthens the construct validity of the instruments used and enhances the overall reliability of the study findings.

CONCLUSIONS: The VR intervention significantly increased hope levels in both healthy children and hospitalized children with leukemia, with a greater improvement observed among healthy participants. Therefore, this study suggests that when designing interventions for hospitalized children, more targeted emotional support strategies should be considered. Future studies are recommended to explore different types of VR content and the medical conditions of hospitalized children.

PMID:40523232 | DOI:10.2196/65311

Photobiomodul Photomed Laser Surg. 2025 Jun 16. doi: 10.1089/photob.2024.0150. Online ahead of print.

ABSTRACT

Objective: To evaluate the efficacy and safety of neoadjuvant radiotherapy combined with transurethral photoselective vaporization of bladder tumors (PVBT), followed by postoperative adjuvant radiotherapy and chemotherapy, in the treatment of T3 muscle-invasive bladder cancer (MIBC). Background: Transurethral resection of bladder tumors combined with radiotherapy and chemotherapy, also known as trimodal therapy (TMT), is the recommended bladder-preserving approach for MIBC and has demonstrated favorable outcomes in T2 MIBC. However, T3 MIBC remains a challenging candidate for TMT due to its relatively poor prognosis. Therefore, optimizing the “triple therapy” strategy for T3 MIBC is essential. Methods: This was a retrospective case series. Patients with T3 MIBC who underwent preoperative neoadjuvant radiotherapy combined with PVBT, followed by postoperative adjuvant radiotherapy and chemotherapy, between January 2018 and December 2020 were included. Tumor response after neoadjuvant radiotherapy, the incidence of PVBT-related complications, and adverse effects of radiotherapy and chemotherapy were assessed. Tumor recurrence and survival outcomes were monitored through outpatient follow-ups and telephone consultations. Risk factors for recurrence were analyzed using statistical methods. Results: A total of 48 patients were included. Four weeks after neoadjuvant radiotherapy, complete response, partial response, stable disease, and disease progression were observed in 3 (6.3%), 23 (47.9%), 20 (41.7%), and 2 (4.2%) patients, respectively. The objective response rate and disease control rate were 54.2% and 95.8%, respectively. Radiation- or chemotherapy-related toxicity occurred in 23 patients (47.9%), all of whom experienced only grade I-II adverse effects, with no grade III-IV toxicity reported. During a follow-up period of 14-58 months, 22 patients (45.83%) experienced recurrence, and 3 patients died due to distant organ metastases. Multi-variate Cox regression analysis identified tumor diameter (≤3.0 cm vs. >3.0 cm) and tumor multiplicity (single vs. multiple) as significant risk factors for recurrence. Conclusions: Preoperative neoadjuvant radiotherapy combined with PVBT, followed by postoperative adjuvant radiotherapy and chemotherapy, is an effective and well-tolerated treatment for T3 MIBC.

PMID:40523218 | DOI:10.1089/photob.2024.0150

JMIR Nurs. 2025 Jun 16;8:e72230. doi: 10.2196/72230.

ABSTRACT

BACKGROUND: Diabetes has become a significant global health issue, particularly imposing a deep economic burden on low-income countries. Innovative and integrated digital solutions can reduce the impact of diabetes and enhance the quality of care. However, digital solutions have not been utilized before in Myanmar.

OBJECTIVE: This study aimed to demonstrate the novel integrated effect of diabetes knowledge and registry tools on the performance of front-line health workers in primary health care settings.

METHODS: A quasi-experimental study with an intervention and a control group was conducted in two townships from October 2022 to April 2023. For the first time, researchers trained the intervention group to use digital tools for diabetes control and performed monthly follow-ups. The study employed multiple linear regression models to explore the novel impact of digital tools on knowledge and performance scores, their correlations, and their association with covariates. Additionally, it assessed the cost-effectiveness of the intervention by using self-administered questionnaires as measurement tools formulated based on the National Diabetes Guidelines.

RESULTS: A total of 96 participants were enrolled in the study, divided evenly into the two groups. The intervention group exhibited a significant increase in the mean knowledge scores from 85.81 to 99.25 (P<.001) and performance scores from 71.22 to 107.16 (P<.001). The intervention accounted for 43.2% of the variance in knowledge scores and 62.5% in performance scores (P<.001). A positive correlation was found between knowledge and performance scores (r=0.45, P<.001). The intervention was also cost-effective, with a cost-effectiveness analysis value of 0.711 and an incremental cost-effectiveness ratio of 10127.04 Kyats (US$ 4.83).

CONCLUSIONS: As the new integrated intervention yields significant economic gains and positive effects, researchers suggest policy makers replicate this intervention as a nationwide program and recommend scaling up the use of digital tools to improve knowledge and performance for diabetes control in frontline health workers.

PMID:40523215 | DOI:10.2196/72230

JCO Oncol Pract. 2025 Jun 16:OP2401075. doi: 10.1200/OP-24-01075. Online ahead of print.

ABSTRACT

PURPOSE: To explore long-term young adult (YA) cancer survivors’ experience with health insurance in a post-Affordable Care Act (ACA) era.

METHODS: This was a mixed-methods analysis of insurance-related data collected from a cohort of English-speaking YA (currently age 18-39 years) blood cancer survivors, ≥3 years from diagnosis, recruited from six US hospitals as part of a financial navigation interventional study (ClinicalTrials.gov identifier: NCT05620979). Participants completed baseline questionnaires, with a subset participating in semistructured interviews after the 6-month study period. Summary statistics were reported for survey responses. Qualitative interviews were coded using directed content analysis.

RESULTS: A total of 130 long-term (median, 10 [IQR, 6-16] years from diagnosis) YA survivors were enrolled, and 45 participated in interviews. Among the total cohort, most (63%) had employer-based private insurance; 22% had public insurance through Medicaid. Eighteen percent reported seeking a new health insurance plan in the past year to afford survivorship care. Over a fifth (23%) reported not knowing how to seek help navigating insurance, while 30% reported delaying or forgoing survivorship care because of not understanding their insurance plan. Four themes emerged from the interviews: (1) Many YA survivors experience insurance churn (ie, moving between plans or between insured and uninsured status); (2) learning to navigate the insurance system is confusing and not straightforward; (3) interactions related to insurance coverage are time-consuming and stressful; and (4) insurance churn and/or out-of-pocket costs affect YAs’ ability to receive optimal medical care.

CONCLUSION: Ongoing insurance-related challenges persist for YA cancer survivors in a contemporary post-ACA era. Although the ACA has provided essential coverage for many patients, ongoing issues include excessive insurance churn, lack of navigation resources, and the continued financial burden of out-of-pocket costs.

PMID:40523211 | DOI:10.1200/OP-24-01075