Nevin Manimala

Environ Monit Assess. 2026 May 27;198(6):657. doi: 10.1007/s10661-026-15505-9.

ABSTRACT

Continuous and uninterrupted air quality monitoring is essential for environmental management and public policy formulation, which requires the absence of missing data and good quality measurements. However, due to a variety of factors (local power outages, data transmission, instrument calibration, preventive maintenance, weather conditions, etc.), measurement gaps with different time windows frequently occur in historical air quality data. This work addresses the problem of missing data in air quality monitoring time series, which compromises the quality of information and hinders decision-making related to air pollution. Carbon monoxide (CO) data were imputed in artificially generated gaps (from 24 to 72 h) for a monitoring station located in Salvador, Bahia (Brazil). Three dynamic modeling strategies with different architectures and learning algorithms were applied: XGboost and two recurrent neural networks (LSTM and RNN). The results showed that, although XGboost presented the lowest medians associated with RMSE and MAE distributions (0.1028 and 0.1266 ppm, respectively), the difference compared to the neural networks was not statistically significant. The statistical analysis of the predictions showed that the mean of the residuals does not differ significantly from zero, indicating an absence of systematic bias and suggesting that the imputed values preserve the dominant dynamics and seasonal patterns of the original series. The percentages of gaps consistently described by the models were 82.0% (XGboost) and 91.3% (LSTM and RNN recurrent neural networks). The results demonstrate that the adopted model structures (decision tree and recurrent neural networks), along with a systematic approach involving the analysis and preparation of the training sample (identification of input variables, mapping of existing gaps in the historical data of the measurement station, and generation of artificial gaps, among others), enabled the imputation of dynamic CO data, preserving the dominant behavior of the time series and ensuring the validity of environmental monitoring.

PMID:42192051 | DOI:10.1007/s10661-026-15505-9

Support Care Cancer. 2026 May 27;34(6):582. doi: 10.1007/s00520-026-10816-6.

ABSTRACT

PURPOSE: As the number of cancer survivors increases, psychological distress has become an important issue. Using nationally representative data, we evaluated mental health outcomes among Korean cancer survivors compared with cancer-free controls and developed models to identify individuals at risk of psychological distress.

METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2021. Psychological outcomes were assessed using standardized questionnaires, and a composite distress outcome was constructed. Risk stratification models were developed among cancer survivors using logistic regression and machine learning algorithms, including random forest, XGBoost, LightGBM, support vector machines, k-nearest neighbors, and naïve Bayes.

RESULTS: A total of 88,061 participants were included, comprising 3733 cancer survivors and 84,328 cancer-free controls. Compared with cancer-free controls, cancer survivors had higher odds of depressed mood (OR 1.33; 95% CI 1.18-1.51), suicidal ideation (OR 1.14; 95% CI 1.00-1.31), suicide planning (OR 1.91; 95% CI 1.37-2.65), and mental health counseling (OR 1.36; 95% CI 1.08-1.71). Among cancer survivors, multiple models were evaluated, with logistic regression showing the highest performance (AUROC 0.689), followed by XGBoost (0.686). In logistic regression, longer working hours, depression history, activity limitation, female sex, smoking, employment, low income, and distorted body image were independently associated with distress. SHAP analysis identified activity limitation, sex, and depression history as key factors.

CONCLUSIONS: Cancer survivors experience increased psychological distress across multiple outcomes. Machine learning-based models may help identify individuals at higher risk of psychological distress, supporting risk-based assessment in survivorship care.

PMID:42192026 | DOI:10.1007/s00520-026-10816-6

Eur J Nutr. 2026 May 26;65(4):140. doi: 10.1007/s00394-026-04002-x.

ABSTRACT

PURPOSE: To examine the associations of planetary health diet (PHD) with all-cause and cause specific mortality, alongside heart age based on the Guangzhou Biobank Cohort Study (GBCS) and conduct mediation analysis.

METHODS: Participants were recruited from the GBCS and were aged ≥ 50 years. Dietary information was collected using a validated Food Frequency Questionnaire. Participants were assigned PHD scores between 0 (no adherence to PHD) and 140 (complete adherence to PHD). Primary outcomes were all-cause, cardiovascular disease (CVD) and cancer mortality. Causes of death were identified through death registry. Secondary outcome, heart age, was calculated using sex-specific 10-year CVD risk prediction models previously developed and validated in the GBCS. Cox proportional hazards regression and linear regression were used to analyze the associations of PHD scores with mortality and heart age. Mediation analyses were conducted using the difference method implemented by the “mediate” SAS macro.

RESULTS: Of 25,550 participants aged 50+ years, during 417,590 person-years of follow-up, higher PHD scores was linearly associated with lower all-cause and CVD but not cancer mortality (hazard ratio (HR) (95% confidence interval (CI)) per 10-point increment: 0.94 (0.92-0.97), 0.92 (0.89-0.95) and 0.97 (0.93-1.01)). The association with all-cause mortality was mediated by white blood cell count (WBC), waist-to-hip ratio and waist-to-hip-to-height ratio (mediation proportion (95% CI): 6.2% (3.2-11.7%), 2.6% (0.9-7.2%) and 5.4% (2.8-9.9%)), whereas the association with CVD mortality was mediated by WBC and waist-to-hip-to-height ratio (7.9% (4.1-14.9%) and 7.4% (3.0-17.0%)). A negative association between PHD scores and heart age was observed in women but not in men (β (95% CI) per 10-point increment: – 0.13 (- 0.24, -0.01) and 0.05 (- 0.15, 0.25) years, P_interaction < 0.001).

CONCLUSION: Higher adherence to PHD was linearly associated with lower all-cause and CVD but not cancer mortality in Chinese aged 50+ years, and with lower heart age in women only. Our findings advocate for PHD in middle-aged to older Chinese, particularly women to improve cardiovascular health.

PMID:42192022 | DOI:10.1007/s00394-026-04002-x

Transpl Infect Dis. 2026 May 26:e70245. doi: 10.1111/tid.70245. Online ahead of print.

ABSTRACT

BACKGROUND: Despite increasing interest in sex and gender in transplant medicine, the impact of recipient-donor sex combinations (RDSCs) on posttransplant infections, graft survival, and rejection remains unclear. To assess if RDSC is independently associated with infectious events in solid organ transplantion (SOT) recipients.

METHODS: This retrospective cohort study assessed a national prospectively maintained registry including six transplant centers. All adult patients, undergoing primary transplant of either heart, kidney, liver, or lung, between May 1, 2008, and December 31, 2021, were included. Endpoints were clinically significant infectious events (primary endpoint), graft survival, rejection, and overall survival within the first year. Patients were grouped as per RDSC. The primary statistical outcome of the organ-specific, a priori known risk factor-adjusted analyses are reported as incidence rate ratios (IRRs).

RESULTS: The cohort included 5033 recipients: 2886 (57.3%) kidney, 1224 (24.3%) liver, 515 (10.2%) lung, and 408 (8.1%) heart transplants, documenting 6067 infections. Recipient-donor sex mismatch was not associated with weighted posttransplant infection risk in heart (IRR: 1.06; 95% CI: 0.75, 1.48; p = 0.75), kidney (IRR: 1.03; 95% CI: 0.90, 1.17; p = 0.69), liver (IRR: 1.10; 95% CI: 0.81, 1.50; p = 0.52), or lung (IRR: 1.02; 95% CI: 0.82, 1.26; p = 0.89) recipients. Female kidney recipients had significantly higher infection rates than males (IRR: 1.50; 95% CI: 1.32, 1.71; p < 0.001), largely explained by urinary tract infections. One-year graft survival, rejection, and overall survival were unaffected by RDSC across all organs.

CONCLUSION: RDSC does not influence 1-year SOT infectious outcome, as well as rejection or graft survival as exploratory outcomes.

PMID:42189585 | DOI:10.1111/tid.70245

Arch Argent Pediatr. 2026 May 28:e202510997. doi: 10.5546/aap.2025-10997.eng. Online ahead of print.

ABSTRACT

Introduction. Multiple pregnancies are more frequently associated with adverse maternal and neonatal outcomes. The incidence of multiple pregnancies has increased with the use of assisted reproductive technologies (ART): they account for between 15% and 25% of twin births. ART has also been associated with adverse outcomes in both singleton and multiple pregnancies, although the available evidence is limited and heterogeneous. Objective. To evaluate maternal and perinatal outcomes in spontaneously conceived twin pregnancies and compare them with those conceived through ART. Population and methods. Patients aged 18 years or older with twin pregnancies who reached a gestational age of 24.0 weeks and who underwent first-trimester screening, follow-up, and delivery at the Hospital Italiano de Buenos Aires between January 2014 and December 2022. A composite outcome of maternal and neonatal adverse events was analyzed. Neurological development was monitored until age 2. Results. A total of 243 twin pregnancies were included (148 ART; 95 spontaneous). The ART group had a higher prevalence of advanced maternal age, nulliparity, obesity, and chronic diseases, with statistically significant differences (p <0.001). There were no significant differences in primary maternal outcomes (29% vs. 23%; p = 0.347) or neonatal outcomes (16% vs. 19%; p = 0.371). We found an increased frequency of autism spectrum disorders in pregnancies conceived through ART. Conclusion. Twin pregnancies resulting from ART showed similar maternal and neonatal outcomes to those resulting from spontaneous conception, despite significant differences in baseline maternal characteristics. Long-term follow-up studies are needed.

PMID:42189568 | DOI:10.5546/aap.2025-10997.eng

JAMA Neurol. 2026 May 26. doi: 10.1001/jamaneurol.2026.1443. Online ahead of print.

ABSTRACT

IMPORTANCE: Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition with limited therapeutic options. Although electroacupuncture has demonstrated potential analgesic effects, high-quality evidence from rigorous randomized clinical trials remains limited.

OBJECTIVE: To determine whether electroacupuncture reduces pain severity compared with sham electroacupuncture and evaluate its safety in patients with PHN.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized, sham-controlled clinical trial took place at 7 tertiary hospitals in China and enrolled participants from October 2020 to July 2022, with the last follow-up in September 2022. Data analyses were performed from August to December 2025. Participants with PHN aged 45 to 75 years and moderate to severe pain (11-point Numeric Rating Scale [NRS-11] score ≥4) were recruited. Of 1072 patients screened, 624 were excluded. The remaining 448 participants were randomized to electroacupuncture (n = 225) or sham electroacupuncture (n = 223); 383 participants (85.49%) completed the trial.

INTERVENTION: Twenty sessions of electroacupuncture or sham electroacupuncture over 4 weeks, followed by a 4-week posttreatment follow-up.

MAIN OUTCOMES AND MEASURES: The primary outcome was the change in the NRS-11 scores from baseline to week 4, with responders defined as participants achieving a 30% or more reduction in NRS-11 scores.

RESULTS: Of 448 participants, the mean (SD) age was 63.19 (9.26) years, 233 (52.01%) were male, and 215 were female (47.99%). At week 4, the electroacupuncture group had a greater decrease in the NRS-11 scores (-1.52) than the sham electroacupuncture group (-0.99) with an adjusted mean difference of -0.53 (95% CI, -0.61 to -0.43; P < .001), and the responder rate was significantly higher in the electroacupuncture group (46.68%) than in the sham electroacupuncture group (24.28%) (adjusted risk difference, 22.40%; 95% CI, 13.02%-31.79%; P < .001). These treatment benefits persisted through a 1-month follow-up; no clinically significant adverse events were observed.

CONCLUSIONS AND RELEVANCE: Among patients with PHN in this study, electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes. These benefits suggest that electroacupuncture may be a useful nonpharmacological option for integrated management of PHN.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04560361.

PMID:42189557 | DOI:10.1001/jamaneurol.2026.1443

JAMA Netw Open. 2026 May 1;9(5):e2615000. doi: 10.1001/jamanetworkopen.2026.15000.

ABSTRACT

IMPORTANCE: The abrupt withdrawal of humanitarian aid in early 2025 has destabilized health systems across sub-Saharan Africa, yet little is known about the frontline realities of these cuts in refugee-hosting settings.

OBJECTIVE: To explore health care practitioners’ perspectives and experiences of how reductions in global health funding have affected services and refugee health and to identify practitioner recommendations for sustaining care.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used semistructured, in-depth interviews conducted in July 2025 at 6 health facilities within Nakivale Refugee Settlement, Uganda. Participants were health care practitioners representing diverse cadres and facility sizes.

EXPOSURE: Reduction of humanitarian aid.

MAIN OUTCOMES AND MEASURES: The primary outcomes were health care practitioners’ perspectives on the impacts of funding reductions, including changes in service delivery, supply availability, staff conditions, and anticipated future health trends, as well as their recommendations to mitigate harms. Rapid qualitative techniques and thematic analysis were used to analyze responses to obtain actionable implications systematically and efficiently.

RESULTS: The 26 participants (mean [SD] age, 30.92 [3.52] years; 16 men [61.5%]) had a mean (SD) duration in practice of 6.80 (2.65) years, with a mean (SD) of 3.09 (1.92) years in Nakivale. Interviews yielded 4 overarching themes and 18 subthemes: (1) reductions in health care services (HIV and tuberculosis services, nutritional support, maternal health, immunization adherence, inpatient and outpatient care, and perceptions of service availability), (2) supply shortages (medical supplies, transportation fuel, and household support), (3) deteriorating staff conditions (staff reduction, workload and burnout, and resilience), and (4) future predictions and recommendations (disease patterns, migration patterns, bridging the funding gap, and general settlement conditions).

CONCLUSIONS AND RELEVANCE: This qualitative study examined the cascading outcomes of humanitarian aid withdrawal on refugee health care through the voices of frontline practitioners. Their testimonies underscored urgent priorities for restoring and retargeting aid-investing in high-impact levers, strengthening local leadership, and advancing policy reforms-to safeguard refugee health and system resilience, while reminding us of the shared human stakes of humanitarian policy and the global responsibility to act.

PMID:42189537 | DOI:10.1001/jamanetworkopen.2026.15000

JAMA Pediatr. 2026 May 26. doi: 10.1001/jamapediatrics.2026.1815. Online ahead of print.

ABSTRACT

IMPORTANCE: The prevalence of invasive bacterial infections (IBIs), specifically bacteremia and bacterial meningitis, is not well established among febrile infants in the third month of life. International guidelines exclude or vary in management recommendations for this age group.

OBJECTIVE: To assess the prevalence of IBIs among febrile infants aged 60 to 90 days.

DATA SOURCES: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Scopus were searched with deliberate limitation to studies between January 1, 2000, to October 2, 2025, and analyzed in December 2025.

STUDY SELECTION: Studies were included that reported on previously healthy, well-appearing febrile infants 60 to 90 days old evaluated in emergency department or outpatient settings and for whom patient-level IBI status could be ascertained.

DATA EXTRACTION AND SYNTHESIS: Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, and risk of bias was assessed using the Joanna Briggs Institute critical appraisal Checklist for Prevalence Studies. Pooled prevalences were calculated using random-effects generalized linear mixed models of logit-transformed single proportions of cases.

MAIN OUTCOMES AND MEASURES: The primary outcome was the prevalence of IBI. Secondary outcomes included the prevalence of bacteremia and bacterial meningitis separately.

RESULTS: The search yielded 13 130 records; 59 studies were included (20 distinct datasets of 34 835 infants). The pooled prevalence of IBI was 1.11% (95% CI, 0.84%-1.47%), bacteremia was 1.01% (95% CI, 0.76%-1.34%), and bacterial meningitis was 0.11% (95% CI, 0.08%-0.16%). Results were consistent across multiple sensitivity analyses excluding (1) retrospective cohorts; (2) cohorts of only infants with fever without source; (3) cohorts with shorter clinical follow-up of less than 7 days; and (4) the largest study (66% of all included patients).

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, the pooled prevalence of IBI among well-appearing febrile infants in the third month of life was 1.11%; bacteremia accounted for most cases, whereas bacterial meningitis was rare. These contemporary prevalence estimates should inform guideline development and shared parent and clinician decision-making for the management of these infants.

PMID:42189531 | DOI:10.1001/jamapediatrics.2026.1815

Hum Vaccin Immunother. 2026 Dec;22(1):2670827. doi: 10.1080/21645515.2026.2670827. Epub 2026 May 26.

ABSTRACT

We aimed to evaluate 12-y (2012-2024) burden, clinical and microbiological characteristics of Invasive Pneumococcal Disease (IPD) at one large research hospital – IRCCS Fondazione Policlinico San Matteo – in northern Italy, with focus on serotypes’ distribution, resistance trends, and vaccination impact on outcomes and costs. The study included 234 IPD cases. Data were obtained from medical records, microbiological reports, and vaccination registries. Statistical analyses included descriptive measures, multivariate regression models for risk factors (adjusted for sex, age group, comorbidities), and comparison of length of stay and costs between vaccinated and unvaccinated patients. Most cases occurred in males aged ≥65. Bacteremia with pneumonia was the most frequent presentation (55.6%). Obesity and splenectomy were associated with higher risk of severe outcome. The most common serotypes overall were 3 and 8. Among vaccinated patients serotypes 15A, 14, 19A, and 15C were more frequent. Macrolide resistance was detected in 26.9% of isolates and beta-lactam resistance in 14.9%. Collectively, 34.5% of cases were caused by serotypes preventable with Pneumococcal Conjugate Vaccine 13 (PCV13), an additional 5.1% by PCV15, 21% by PCV20 and 14.4% by V116 preventable serotypes. Vaccine-preventable serotypes accounted for 64% of cases, mostly (56%) in patients aged ≥65. Vaccinated patients reported shorter hospital stay (median 8 vs 16 d) and lower associated costs (€3313 vs €5101). IPD surveillance is critical to inform prevention strategies. Our findings quantify how much vaccination reduces disease severity and healthcare costs but highlight gaps in vaccine coverage against emerging serotypes due to replacement mechanisms.

PMID:42189530 | DOI:10.1080/21645515.2026.2670827

Pathog Glob Health. 2026 May 26:1-7. doi: 10.1080/20477724.2026.2679956. Online ahead of print.

ABSTRACT

SARS-CoV-2 XFG (nicknamed Stratus), a recombinant lineage arising from LP.8.1.2 and LF.7, is currently the most prevalent circulating lineage. Although most recombinant lineages do not pose a significant public health concern, some have shown the capacity to emerge and spread, highlighting the importance of their investigation. In this context, we performed a genome-based analysis to assess the genetic variability of XFG and to identify its recombination breakpoint. The breakpoint was mapped to approximately position 1507 within the spike (S) gene, in the distal region of the receptor-binding domain. This configuration suggests that LP.8.1.2 contributed the genomic backbone as the acceptor, whereas LF.7 acted as the donor. Phylodynamic survey suggests that XFG originated in early 2024, approximately 10 months before its first genomic detection. Bayesian Skyline Plot revealed a transient expansion phase beginning in August 2024, followed by a plateau, indicating limited and non-sustained growth. The estimated evolutionary rate of XFG (2.90 × 10^-4 subs/site/year) was comparable to those of its parental lineages, supporting a relatively low level of genetic variability. Overall, these findings suggest that the widespread prevalence of XFG is more likely driven by lineage turnover rather than increased transmissibility, highlighting the importance of continuous genomic surveillance for monitoring emerging SARS-CoV-2 lineages.

PMID:42189509 | DOI:10.1080/20477724.2026.2679956