Nevin Manimala

Med Health Care Philos. 2026 Apr 1. doi: 10.1007/s11019-026-10346-2. Online ahead of print.

ABSTRACT

Artificial intelligence is increasingly integrated into medical decision-making, often framed as a supportive tool that enhances accuracy while leaving final judgment to clinicians. This paper argues that such framing obscures a deeper structural shift: medical action may proceed without any judgment ever occurring. AI systems do not judge; they generate outputs through statistical transduction. Clinicians, under institutional and legal pressures, may relay these outputs without regenerating them as their own reasons. When neither AI nor clinician generates judgment, decisions are enacted without a judging subject. While judgment without a judging subject may be sustainable elsewhere, medicine renders this absence unsustainable. Medical practice is characterized by irreversibility, case-specificity, meaning-demand, and relational accountability-features that presuppose judgment as a human act. Even clinically correct outcomes do not guarantee that patients will recognize a decision as right for them. When judgment disappears, informed consent persists only as a procedural ritual, simulating understanding without grounding it. To make this absence explicit, the paper introduces Metaqualia Theory (MTQ), distinguishing patient experience (Q), technical transduction (T), and judgment as meaning-generating endorsement (M). This leads to a prior ethical question: Is there an M here? This question precedes concerns about explainability and helps clarify the conditions under which consent and responsibility remain meaningful. The analysis suggests that when AI outputs are not regenerated as human judgment, their role in medical practice raises structural limits that cannot be addressed by transparency alone.

PMID:41920434 | DOI:10.1007/s11019-026-10346-2

Ther Innov Regul Sci. 2026 Apr 1. doi: 10.1007/s43441-026-00962-8. Online ahead of print.

NO ABSTRACT

PMID:41920433 | DOI:10.1007/s43441-026-00962-8

Qual Life Res. 2026 Apr 1;35(5):126. doi: 10.1007/s11136-026-04234-8.

NO ABSTRACT

PMID:41920430 | DOI:10.1007/s11136-026-04234-8

Clin J Pain. 2026 Apr 1. doi: 10.1097/AJP.0000000000001383. Online ahead of print.

ABSTRACT

OBJECTIVE: Given that liposomal bupivacaine (LB) is not currently approved for thoracic surgery, this study evaluated postoperative analgesia after thoracic procedures.

METHODS: This retrospective cohort study with propensity score matching yielded 99 matched pairs. Patients were grouped by receipt of a postoperative ultrasound-guided serratus anterior plane block with LB plus standard care versus standard care alone. The primary outcome was the area under the curve (AUC) for pain scores over the first 0-72 postoperative hours. Secondary endpoints included verbal response scale pain scores, opioid consumption, quality of recovery, and hospital length of stay. Statistical significance was defined as P < 0.05.

RESULTS: Baseline characteristics were well balanced after matching. The LB group had a lower 0-72 hour pain AUC (110 ± 48 vs. 185 ± 67; P < 0.01), exceeding the prespecified threshold for clinical relevance (at least a 10% reduction), and lower early postoperative pain scores. Opioid consumption was reduced at 24 and 48 hours (both P < 0.01). Quality of recovery scores were higher at 24, 48, and 72 hours, with the 24-hour difference meeting the minimal clinically important difference. Postoperative nausea and vomiting was less frequent from 6 to 24 hours; length of stay did not differ.

CONCLUSIONS: Perioperative regional block with LB was associated with reduced pain burden and opioid use after thoracic surgery. Prospective, multicenter randomized trials with longer follow-up and health economic evaluations are needed.

PMID:41919481 | DOI:10.1097/AJP.0000000000001383

J Chem Inf Model. 2026 Apr 1. doi: 10.1021/acs.jcim.6c00453. Online ahead of print.

ABSTRACT

Metal ions play a crucial role in the function, regulation, and stability of proteins. Therefore, accurate prediction of metal ions’ binding sites is valuable to reveal the molecular mechanism of related biological processes. Here, we propose MetalKB, a novel knowledge-based framework for predicting the binding sites of metal ions on proteins by using atomic-level statistical potentials and graph-theoretical strategies. Specifically, possible donor atom clusters are first identified using a clique detection algorithm, from which initial metal ion coordinates are generated. These candidate coordinates are then evaluated and locally refined using knowledge-based statistical potentials derived from a protein-metal ion binding database. Redundant predictions are subsequently removed by applying spatial distance thresholds. Evaluations on diverse benchmark data sets provided by Metal3D and TEMSP show that MetalKB demonstrates competitive performance compared with seven representative methods in terms of precision, recall, and F1 score, while exhibiting strong robustness and parameter stability. MetalKB is capable of identifying complex coordination environments, including multinuclear and bridging metal-binding sites, as illustrated in representative structural examples. In addition, it also provides prediction of both metal ion 3D coordinates and residue-level coordinating ligands.

PMID:41919470 | DOI:10.1021/acs.jcim.6c00453

Neurol Neurochir Pol. 2026 Apr 1. doi: 10.5603/pjnns.109338. Online ahead of print.

ABSTRACT

AIM OF THE STUDY: Evaluate and compare F‑wave and cutaneous silent period (CSP) parameters in caput‑pattern idiopathic cervical dystonia (CD) in the waning phase of botulinum toxin therapy vs. healthy controls to identify alterations in segmental excitability and spinal inhibition.

CLINICAL RATIONALE FOR THE STUDY: Cervical dystonia likely reflects sensorimotor network dysfunction. Objective neurophysiological markers of spinal and supraspinal inhibition could clarify pathophysiology, improve diagnostic accuracy versus pseudodystonia and offer candidate biomarkers for monitoring and therapeutic studies.

MATERIAL AND METHODS: A control study enrolled 21 patients with focal caput‑pattern CD (18 female, 3 male, mean age 53.5 ± ± 7.9 years) and 21 matched healthy volunteers (18 female, 3 male, mean age 51.6 ± 9.2 years). The standard F‑wave protocol, including F‑wave minimal latency (Fmin), chronodispersion (Fchronosp), persistence (Fpersistence), amplitude (Fampl), F/M amplitude ratio (F/Mampl), F‑wave maximal latency (Fmax), mean latency (Fmean), F/M latency ratio (F/Mlat ratio) and conduction velocities (CV1, CV2). Similarly, the CSP measurement protocol, which typically includes CSP onset latency (CSPo), CSP end latency (CSPe), CSP duration (CSPd), was expanded with CSP onset minimal latency (CSPom) and velocities CV3, CV4 and CV5. Because conduction velocity depends on anatomical distance and CSP latencies, incorporating precise distances enables a more reliable and accurate evaluation of both afferent and efferent overall neural pathway efficiency than latency measures alone.

RESULTS: Compared with controls, patients with caput‑pattern CD demonstrated prolonged Fmax and Fmean (p = 0.012 and p = = 0.019 respectively), increased Fchronosp (p = 0.004) and Fampl (p = 0.043), increased F/Mlat ratio (p = 0.037), shortened CSPd and CSPe (p < 0.0001 and p = 0.0001), and altered (generally increased) CSP‑related conduction velocities: CV4 (p < 0.0001) and CV5 (p = 0.007). The most sensitive measures were CSPd, CSPe and CV4.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Cervical dystonia is associated with impaired inhibition and altered conduction velocities (CV4, CV5). CSPd, CSPe and CV4 are candidate markers to aid diagnosis, differentiate pseudodystonia, and monitor disease or treatment effects. These measures may also inform studies of other motor‑control disorders.

PMID:41919456 | DOI:10.5603/pjnns.109338

Disaster Med Public Health Prep. 2026 Apr 1;20:e75. doi: 10.1017/dmp.2026.10339.

ABSTRACT

OBJECTIVE: Attacks on health care are war crimes. This study aims to investigate the types, scales, and patterns.

METHODS: The secondary analysis explores public data from WHO’s “Surveillance System for Attacks on Health Care (SSA)” from January 2018 to December 2024.

RESULTS: The analysis shows that the attacks on health care and number of affected countries increased strongly. A total of 8,012 attacks on health care were recorded across 22 countries. Just over half of the attacks impacted health care personnel, and almost a quarter affected patients. Attacks can vary widely in type, complexity, and impact, which have regional specificities. The occupied Palestinian territory and Ukraine have suffered the most attacks on health care worldwide. Country-specific attack strategies are identified. Furthermore, the combination of violence with individual and heavy weapons in an attack accumulated the probability of injuries or deaths. Improvements were observed in a few countries. A 2-step cluster analysis reveals that the heterogeneous attacks can be well clustered into approximately 2 halves. It identifies patterns across countries. The most important predictor for clustering of the attacks on health care is violence with heavy weapons, which is frequently observed, for example, in Ukraine.

CONCLUSION: The global trend has worsened dramatically. Prevention and protection are needed.

PMID:41919438 | DOI:10.1017/dmp.2026.10339

Disaster Med Public Health Prep. 2026 Apr 1;20:e66. doi: 10.1017/dmp.2026.10344.

ABSTRACT

OBJECTIVES: Researchers have revealed that the incidence of aspiration pneumonia (AP) increases following a disaster, not only due to the disaster itself but also due to environmental factors, which will propose dysphagia rehabilitation targets. We aimed to delineate the current status of dysphagia rehabilitation in disasters.

METHODS: English literature was searched via scientific databases, representative journal homepages, trial registries, and gray literature.

RESULTS: A total of 242 articles were reviewed in full text, and 31 were included in this review. Most hazards were earthquakes (19/31), and most reports originated from Japan (19/31). The reported issues were summarized according to the International Classification of Functioning, Disability, and Health (ICF) codes. Twenty-seven codes related to areas such as Swallowing, Caring for teeth, and Food were the most frequently reported. In addition, three additional items not formally listed in the ICF were considered: nutrition, oral hygiene, and denture.

CONCLUSIONS: The mechanisms of emergency lifestyle-related aspiration pneumonia were identified, and approaches to prevent AP were proposed. We further discuss how to promote dysphagia rehabilitation in disasters. Nevertheless, multidisciplinary coordination is important, and more involvement of rehabilitation specialists is required.

PMID:41919436 | DOI:10.1017/dmp.2026.10344

Disaster Med Public Health Prep. 2026 Apr 1;20:e76. doi: 10.1017/dmp.2026.10337.

ABSTRACT

OBJECTIVE: This study qualitatively examines community experiences related to housing following natural disasters, focusing on damage to home infrastructure, barriers to completing repairs, and the resources needed for recovery and rebuilding.

METHODS: Participants included members from 3 historically underserved Houston communities (Kashmere Gardens, Fifth Ward, and Third Ward) with Social Vulnerability Index (SVI) rankings in the 80th percentile. Town hall-style conversations were held within each community; small focus groups were completed within the town halls. Reflexive thematic analysis was used to identify themes, supported by researcher triangulation, reflexivity, and member checking to establish trustworthiness.

RESULTS: Analysis identified 7 key themes :1) Successive Disasters Exacerbate Problems Driven by Gentrification, 2)Insufficient and Unequal Post-Disaster Resources Drive Dependence on Community Support Networks, 3) Systemic Delays in Relief Services to Underserved Communities Underscore The Need for Government Accountability, 4) Growing Distrust in Local Government to Address Evolving Post-Disaster Needs, 5) Navigating Complex Insurance Policies While Being Drained by a Disaster, 6) Trickle-Down Unpreparedness Starts at a City Level, and 7) Steps to Prepare for Future Disasters.

CONCLUSIONS: Systemic inequities in disaster preparedness and response affecting low-income Black and Hispanic communities are evident. Addressing these disparities requires prioritizing resource distribution, infrastructure investments, and community-driven planning and resilience building.

PMID:41919435 | DOI:10.1017/dmp.2026.10337

Disaster Med Public Health Prep. 2026 Apr 1;20:e68. doi: 10.1017/dmp.2026.10335.

ABSTRACT

On April 14 and October 1, 2024, and then for 10 days from June 13, 2025, Israel was under ballistic missile attacks, causing casualties and destruction. This report describes the response of an emergency department (ED) in Jerusalem to maintain quality care and safety during these attacks. It was vital to minimize the number of ED patients in unprotected zones. Patients in the unprotected area of the ED were relocated to protected zones, and a mechanism was implemented to close blast doors that had been blocked by a technical issue. Lessons learned included: adapting protected areas in the ED for continued patient care, properly closing blast doors, and maintaining flexible emergency protocols to address evolving hazards.

PMID:41919411 | DOI:10.1017/dmp.2026.10335