Nevin Manimala

J Pediatr Hematol Oncol. 2026 Mar 30. doi: 10.1097/MPH.0000000000003195. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare postoperative visual outcomes in pediatric patients undergoing resection of craniopharyngioma via endoscopic endonasal versus transcranial craniotomy approaches.

METHODS: We retrospectively reviewed 37 pediatric patients (74 eyes) who underwent resection of histologically confirmed craniopharyngioma at a tertiary center between 1995 and 2023. Ophthalmologic evaluations included best-corrected visual acuity (VA), optic nerve findings, and visual fields. Outcomes were assessed at early, intermediate, and long-term follow-up and compared by surgical approach.

RESULTS: Twenty-five patients (68%) underwent craniotomy and 12 (32%) endoscopic resection. Preoperatively, 51% had normal vision in both eyes, while 6 were legally blind. Postoperatively, no significant differences in VA or visual fields were observed between approaches at any interval. Optic nerve pallor was somewhat more frequent in the endoscopic group, though not statistically significant. Gross total resection was achieved in 66% of endoscopic versus 34% of craniotomy cases. Most craniotomies (88%) occurred before 2015, compared with 16% of endoscopic cases.

CONCLUSIONS: Both endoscopic and transcranial approaches yielded comparable visual outcomes in pediatric craniopharyngioma surgery. Rates of gross total resection were higher in the endoscopic cohort, suggesting that surgical approach should remain anatomy-driven, with either technique capable of preserving visual function in appropriately selected patients.

PMID:41921232 | DOI:10.1097/MPH.0000000000003195

J Med Internet Res. 2026 Apr 1;28:e75458. doi: 10.2196/75458.

ABSTRACT

BACKGROUND: Research on the effectiveness of digital health campaign strategies is lacking. Understanding performance outcomes is essential for the successful implementation of campaigns. Two studies examined platforms, tactics, and content of digital health campaigns using paid media performance data.

OBJECTIVE: This analysis compared 2 digital advertising methods (social media and banner or display) using click-through rate (CTR) and cost-per-click (CPC) as performance measures. Performance differences by state, community type, message approach, format, and image type were assessed. CTR and CPC served as measures in determining performance differences between social media and banner or display.

METHODS: This cross-sectional secondary analysis examined campaign performance for the HEALing (Helping to End Addiction Long-Term) Communities Study, which served 85,875,105 impressions. Data were collected from media buy reports, entered into templates that included method (display or banner and social media) and key performance indicators (impressions, clicks, and media spend), and CTR and CPC were calculated. Study 1 assessed differences in CTR and CPC for social media and banner or display by state (KY, NY, MA, and OH) and community type (urban and rural). Study 2 assessed differences in CTR for social media and banner or display by state (KY, NY, MA, and OH), community type (urban and rural), message approach (testimonial and information-based), format (motion graphic or graphics interchange format, video, and static image), and image type (local and stock). Separate analyses were conducted for each advertising method.

RESULTS: Study 1 found significant differences between advertising methods, where social media had higher CTR compared to banner or display. Social media had a significant main effect for state, where OH had the highest CTR. There was a statistically significant difference in CPC based on advertising method, where social media had a lower CPC compared to banner or display. Social media had a significant main effect for state, where OH had the lowest CPC. Banner or display had a significant main effect for state and community type, where OH and urban communities had the highest CPC. Study 2 found significant differences between advertising methods, where social media had higher CTR than banner or display. For social media, urban communities, static format, and local spokespersons had the highest CTR. There were significant differences between all pairs of states, where OH had the highest CTR. For display or banner, static format and local spokespersons had the highest CTR.

CONCLUSIONS: This analysis provides guidance for digital health campaigns. It examined the performance of opioid use disorder campaigns using CTR and CPC measures, demonstrating utility in future campaign evaluations. Social media was more related to stimulating responses to campaign messages compared to banner or display. State-to-state variations emphasized the importance of message pilot testing. Using local spokespersons versus stock spokespersons is recommended.

PMID:41921212 | DOI:10.2196/75458

JMIR Hum Factors. 2026 Apr 1;13:e83857. doi: 10.2196/83857.

ABSTRACT

BACKGROUND: Over-the-counter (OTC) hearing aids were introduced to improve the affordability and accessibility of hearing health care for adults with perceived mild-to-moderate hearing loss. While these devices have demonstrated effectiveness in cognitively healthy older adults-particularly in the domains of audibility, self-reported hearing ability, and speech recognition in quiet-their use and outcomes in people with dementia remain underexplored. This issue warrants further attention, as people with dementia often experience co-occurring hearing loss and may rely on OTC hearing aids to overcome cost and access barriers to prescription amplification. However, given the cognitive and functional challenges of dementia, it is unclear whether and how OTC hearing aids can support the hearing care needs of these individuals.

OBJECTIVE: To explore interest-holder perspectives on the feasibility and acceptability of OTC hearing aids for community-dwelling older adults with dementia, identifying key facilitators and barriers that influence their use in this population.

METHODS: Semistructured interviews were conducted with 45 participants across three interest-holder groups (15 per group): (1) community-dwelling older adults with dementia and hearing loss, (2) family caregivers of community-dwelling older adults with dementia and hearing loss, and (3) geriatric direct care professionals. Interviews were conducted and recorded via secure Zoom (Zoom Communications) videoconferencing, then transcribed and analyzed using thematic analysis.

RESULTS: Participants endorsed several facilitators and barriers to OTC hearing aid use in people with dementia. Facilitators included increased accessibility, perceived affordability and value, and enhanced autonomy and control. Barriers included mistrust of OTC hearing aids, difficulty assessing candidacy due to unreliable self- and proxy reports of hearing status, caregiver uncertainty regarding device programming and adjustment, challenges evaluating device effectiveness, and concerns about caregiver burden and burnout from long-term device management.

CONCLUSIONS: OTC hearing aids offer meaningful advantages for people with dementia and their family caregivers. However, significant barriers must be addressed to ensure their feasibility and acceptability for this population. Future research should further examine and quantify these barriers to inform the development of tailored devices, services, and delivery models that promote successful OTC hearing aid use in people with dementia and their family caregivers.

PMID:41921210 | DOI:10.2196/83857

Hepatol Commun. 2026 Mar 31;10(4):e0936. doi: 10.1097/HC9.0000000000000936. eCollection 2026 Apr 1.

ABSTRACT

BACKGROUND: Individuals with cirrhosis frequently require Emergency Department (ED) care, with some experiencing repeated ED use, yet little is known about the patient and caregiver perspectives driving decisions to visit the ED. We aimed to explore perspectives of including high ED utilizers with cirrhosis and their caregivers to identify drivers of ED use and opportunities to optimize care.

METHODS: Using human-centered design methods, we conducted an in-person group engagement session with 7 adults with cirrhosis and their caregivers, recruited from recent ED encounters. A custom board-game activity facilitated the discussion. Data were analyzed using snippet extraction, affinity mapping, and affinity concept modeling.

RESULTS: Seven major themes emerged: (1) Mindset around symptoms, which includes fear, uncertainty, and caregiver burden. (2) Informational needs, including reliance on variable-quality online resources and lack of trusted education. (3) Day-to-day cirrhosis management, particularly challenges related to medications and symptom monitoring. (4) Symptom-driven ED triggers, with some prompting, urgent visits. (5) Decision-making factors, including limited alternatives to ED care and prior experiences, and mismatched patient-caregiver thresholds for seeking care. (6) Expectations of ED care, focused on pain relief and return to baseline health. (7) Challenges during ED care, including long wait times, misdiagnosis concerns, and stigma related to pain treatment. Concept modeling revealed that ED decision-making is a dynamic journey shaped by symptom severity, emotional states, logistical considerations, and evolving patient-caregiver-provider roles.

CONCLUSIONS: Pain, uncertainty about symptom severity, and lack of accessible real-time clinical support were major drivers of ED utilization in cirrhosis. Interventions addressing these specific needs may reduce avoidable ED use. These findings provide a patient-informed foundation for care delivery redesign in cirrhosis.

PMID:41921201 | DOI:10.1097/HC9.0000000000000936

Brief Bioinform. 2026 Mar 1;27(2):bbag132. doi: 10.1093/bib/bbag132.

ABSTRACT

N6-methyladenosine (m6A) is the most prevalent internal modification in mRNA and plays a critical role in post-transcriptional regulation. Despite the development of various detection methods, accurate and quantitative detection of m6A modifications at single-molecule and single-nucleotide resolution remains challenging. Many existing approaches struggle with limited resolution, inaccurate quantification, or dependence on sequence motifs. Here, we present m6Astorm, a novel computational framework for stoichiometry-preserving and stochasticity-aware identification of m6A. m6Astorm encodes the signal features (signal intensity and maximum instantaneous amplitudes derived from raw signal) and sequence context via a hybrid architecture built from convolutional neural networks and bidirectional long short-term memory networks. Trained with quantitative labels from GLORI, m6Astorm could achieve motif-independent detection of m6A modifications at single-molecule resolution by a dual-objective optimization: (i) minimizing binary cross-entropy loss for methylation state classification at molecule level, regularized by a confidence-aware penalty term suppressing low-certainty predictions; (ii) minimizing the stoichiometry bias for accurate quantitative at the nucleotide level. m6Astorm resolves co-methylation events at single-molecule, revealing coordination in m6A regulatory patterning across transcriptomes. Systematic evaluation across Hela and mouse embryonic stem cell datasets demonstrates robust cross-sample generalizability, evidenced by high prediction power (Recall), low false positive rate, accurate stoichiometric, and high area under the receiver operating characteristic curve/area under the precision-recall curve in transcriptome-wide modification profiling.

PMID:41921196 | DOI:10.1093/bib/bbag132

Brief Bioinform. 2026 Mar 1;27(2):bbag141. doi: 10.1093/bib/bbag141.

ABSTRACT

Understanding the complex nature of multifunctional interactions among genes is crucial for interpreting omics data. We developed NetCrafter, an ontology-driven platform for constructing de novo gene networks that are specific to each input gene list and quantitatively defined by ontology-weighted similarity. By incorporating the probabilistic association of ontology or curated gene sets into a weighted Tanimoto similarity metric, NetCrafter transforms enrichment results into quantitative semantic similarity scores between genes, enabling the creation of context-specific statistical networks. These networks can be further decomposed into optimal sub-networks, facilitating multifunctional interpretation and the identification of gene interaction hotspots. NetCrafter also supports the integration of heterogeneous omics-derived gene lists through consensus ontology scoring. Importantly, this list-specific, quantitative framework reveals functional hotspots and target-biomarker relationships-even in cases where ontology terms alone are not predictive of node-level attributes such as clustered regularly interspaced short palindromic repeats (CRISPR) efficacy. NetCrafter provides an interactive platform for constructing and interpreting dynamic, context-specific gene networks, leveraging ontology-based functional associations to uncover underlying mechanisms and identify key nodes. It is freely available at https://netcrafter.sookmyung.ac.kr and integrated into Q-omics platform (https://qomics.ai) to enhance the utility of cancer omics data.

PMID:41921194 | DOI:10.1093/bib/bbag141

Hepatol Commun. 2026 Mar 31;10(4):e0905. doi: 10.1097/HC9.0000000000000905. eCollection 2026 Apr 1.

ABSTRACT

BACKGROUND: Hepatorenal syndrome-acute kidney injury (HRS-AKI) is associated with high mortality in cirrhosis. Recent FDA approval of terlipressin and updated clinical guidance have expanded management options, but real-world practice patterns remain unknown.

METHODS: We conducted a nationwide survey of U.S. hepatology providers regarding HRS-AKI management practices. The 33-question survey assessed provider demographics, vasoconstrictor selection, treatment timing, and adherence to guideline recommendations.

RESULTS: Among 162 respondents, most were hepatologists (94%) at academic centers (83%). Only 11% obtained a nephrology consultation at AKI detection, with 44% waiting until worsening renal function. Terlipressin was available at 80% of institutions but more commonly at academic centers (84% vs. 53%, p=0.003). Consistent with guideline recommendations, 77% of providers initiate vasoconstrictors only after completing a trial of volume expansion (if no renal improvement), particularly in academic centers (80% vs. 60% non-academic, p=0.03). Terlipressin (49%) and midodrine/octreotide (44%) were preferred first-line treatments, with providers at academic centers more likely to use midodrine/octreotide (46% vs. 30%, p=0.008). Mean arterial pressure was used by 62% of providers to guide vasoconstrictor dosing. Most providers (73%) discontinued vasoconstrictor treatment after 4 days if no improvement.

CONCLUSIONS: Significant variations exist between guideline recommendations and real-world HRS-AKI management, especially first-line treatment choice, treatment monitoring, and nephrology consultation. These findings highlight opportunities to improve guideline implementation and identify areas where practice patterns might inform provider education and future guidance updates.

PMID:41921139 | DOI:10.1097/HC9.0000000000000905

JMIR Res Protoc. 2026 Apr 1;15:e83377. doi: 10.2196/83377.

ABSTRACT

BACKGROUND: Retention of specialists is critical for sustaining health system performance. In Malaysia, the Ministry of Health (MOH) has implemented multiple workforce retention strategies (WRSs) to enhance job satisfaction and reduce turnover among specialists. However, evidence on specialists’ awareness, participation, and perceived effectiveness of these strategies remains limited. To address this gap, we plan to administer a standardized survey among specialists in MOH health care facilities to guide evidence-based strategic planning toward specialist retention.

OBJECTIVE: This protocol describes a national-level online survey to assess MOH specialists’ perceptions of WRS and examine their associations with job satisfaction and turnover intention, using REDCap (Research Electronic Data Capture) to ensure real-time data collection within a robust and secure digital platform.

METHODS: A cross-sectional mixed methods study will be conducted among 1325 MOH specialists selected through systematic random sampling from the Human Resource Management Information System. Data collection will be implemented using a REDCap-based workflow to support secure and efficient survey administration. REDCap functionalities will be used, including automated survey invitations with nontransferable links to prevent duplicate responses, branching logic to tailor item relevance, auto-reminder scheduling, and real-time data validation to minimize entry errors. The self-administered questionnaire comprises measures of specialists’ awareness, participation, and perceived effectiveness of 12 MOH-implemented WRSs, job satisfaction assessed using the Job Satisfaction Survey, and turnover intention measured with the Turnover Intention Scale-6, as well as 2 optional open-ended questions for qualitative input to strengthen the quantitative results. A pilot study will be conducted to assess instrument reliability and REDCap platform usability. Quantitative data will be exported from REDCap for descriptive and inferential analyses, while qualitative responses will undergo thematic analysis using NVivo and be integrated with quantitative findings during interpretation.

RESULTS: This study will generate vital evidence of MOH specialists’ engagement with WRSs and how perceptions of these strategies related to their job satisfaction and turnover intention. Participant recruitment and data collection have been completed, and the study is in the data analysis phase. It is expected that the data analysis will be completed in March 2026 and that the results will be published in June 2026.

CONCLUSIONS: This protocol establishes a REDCap-based survey for conducting large-scale research focused on MOH specialists. Findings are expected to guide data-driven improvements to WRS implementation within the MOH Malaysia and may serve as a useful methodological model for similar research in public sector workforce studies.

PMID:41921120 | DOI:10.2196/83377

JCO Oncol Pract. 2026 Apr 1:OP2501270. doi: 10.1200/OP-25-01270. Online ahead of print.

ABSTRACT

PURPOSE: The objective of priority review is to expedite the review duration for drugs that provide significant improvements. We analyzed the duration of regulatory review of cancer drugs granted priority versus nonpriority review and differences in the proportion of cancer drugs with high therapeutic value granted priority versus nonpriority review in the United States, European Union, and Switzerland.

METHODS: In this cross-sectional study, we used US Food and Drug Administration’s (FDA), European Medicines Agency’s (EMA), and Swissmedic’s databases to identify all new cancer drugs approved in 2010-2024, their submission and approval dates, and approval pathways. European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) and ESMO-Magnitude of Clinical Benefit Scale for Haematological Malignancies scores were calculated to assess their therapeutic value. We applied summary statistics (medians and IQR) to describe differences in review duration for priority versus nonpriority review. Review duration was calculated from submission to approval date. For estimated differences in proportions of high therapeutic value scores for drugs granted priority versus nonpriority review, we calculated classical normal 95% CIs.

RESULTS: In all, 144 (86%) of 168 cancer drugs were granted priority review by the FDA, 37 (25%) of 147 by EMA, and 37 (28%) of 132 by Swissmedic. Of those, the FDA reviewed 30%, EMA 5%, and Swissmedic 49% within the required time period; review duration was similar for drugs with high and low therapeutic value. The difference in the proportion of high value scores between priority and nonpriority review was -4% (95% CI, -20 to 13) for the FDA, 22% (95% CI, 6 to 38) for EMA, and 17% (95% CI, <1 to 33]) for Swissmedic.

CONCLUSION: It could be beneficial for patients if agencies applied more scrutiny in the selection of which cancer drugs to grant priority review. Such drugs should have a high therapeutic value, and their review should be completed in a timely manner to enable quicker access to important cancer drugs for patients. Although the FDA would need to take the most substantial steps, EMA and Swissmedic could also improve their systems.

PMID:41921119 | DOI:10.1200/OP-25-01270

JCO Oncol Pract. 2026 Apr 1:OP2501182. doi: 10.1200/OP-25-01182. Online ahead of print.

ABSTRACT

PURPOSE: Contact days exceeding trial protocol-mandated care may represent adverse clinical events and portend worse outcomes. Identifying patients at risk of poor outcomes could enable clinical teams to intervene early and support patients’ needs.

MATERIALS AND METHODS: We linked data from 6 SWOG trials to Medicare claims. We calculated contact days (days with ambulatory, emergency department, inpatient, or facility-based care) and their composition using protocol calendars. Total contact days were delineated as protocol-mandated (planned) ambulatory or unplanned (including unplanned ambulatory v unplanned inpatient). Cox frailty landmark regression analysis was used in a random 60% training set to identify the optimal threshold (percentile) and landmark (months) for contact-day measures as the predictor based on the chi-square statistic. Candidate predictors were tested in the remaining 40% sample.

RESULTS: We included 1,429 patients (median age, 71 years, 7.6% Black, 21.4% female). In the first 3 months, among 15,301 contact days in the training set (6.4 contact days per person per month; 21.2% of total days), 4,102 (26.8%) were protocol-mandated ambulatory, and 11,199 (73.2%) were unplanned (including 7,328 [47.9%] ambulatory and 3,871 [25.3%] inpatient). The 2-month follow-up time at the 75th percentile threshold was the optimal model in the training set. In the test set, unplanned contact days, especially unplanned inpatient contact days, were associated with subsequent survival (≥1 unplanned inpatient contact days, adjusted hazard ratio, 1.25 [1.02-1.52], P = .014).

CONCLUSION: One in five trial follow-up days was a health care contact day, of which the majority were unplanned ambulatory contact days. Meaningfully decreasing contact-day burdens will require addressing uncoordinated unplanned ambulatory contact days. The low threshold (≥1 in the first 2 months) of unplanned inpatient days in predicting mortality highlights the adverse impact of any acute care use on survival.

PMID:41921118 | DOI:10.1200/OP-25-01182