Nevin Manimala

Proc Natl Acad Sci U S A. 2026 Aug 11;123(32):e2534106123. doi: 10.1073/pnas.2534106123. Epub 2026 Jul 27.

ABSTRACT

Islands are at the forefront of global environmental change. Biological invasions, land-use change, and climate change are driving population declines and causing irreversible losses in island ecosystems. Although global threat exposure maps have been developed in recent years, they are mostly designed for coarse-grained, continental-extent analyses, often overlooking islands. Here, we assessed the cumulative exposure to biological invasion, land-use change, and climate change by 2050, for more than 16,000 islands worldwide using multiple threat markers. Climate change emerged as a ubiquitous threat, being the dominant threat for 65% of all islands, followed by land-use change (22%) and biological invasions (13%). Islands with the highest cumulative exposure were more likely to be isolated, without historical connection with the mainland. Small and low-elevation islands at low latitudes exhibited greater exposure to climate change, whereas larger, high-elevation islands tended to be more exposed to land-use change. Certain countries and subdivisions, such as Seychelles, Bangladesh, China, French Polynesia, and Micronesia, harbored statistically disproportionate numbers of highly exposed islands, highlighting geographic hotspots of cumulative exposure where conservation efforts might be particularly urgent. Our study indicates that by 2050, most islands will be simultaneously exposed to a triple threat arising from the combined impacts of land-use change, climate change, and biological invasions. This study provides robust quantification of island cumulative exposure to three key drivers of biodiversity loss, making a crucial step toward assessing global biodiversity vulnerability.

PMID:42507912 | DOI:10.1073/pnas.2534106123

Rheumatology (Oxford). 2026 Jul 27:keag309. doi: 10.1093/rheumatology/keag309. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the psychometric properties (inter-rater reliability, agreement, responsiveness, and measurement error) of the Psoriatic Arthritis Ratingen Score (PARS) and modified Sharp-van der Heijde (SVDH) methods using the Belgian Psoriatic Arthritis (BePas) cohort.

METHODS: Radiographs of hands and feet (baseline T0, follow-ups T1, T2) were independently scored by two blinded readers using SVDH (max 528) and PARS (max 360). Statistical analyses included Intraclass Correlation Coefficient (ICC), Bland-Altman analysis, Standardized Response Mean (SRM), and Smallest Detectable Change (SDC).

RESULTS: Both methods detected positive mean change, primarily between T0 and T1. Inter-rater reliability for absolute scores was high for both (ICC >0.865; baseline ICC: PARS 0.906, SVDH 0.888). For cumulative change scores (ΔT2-T0), inter-rater reliability was low and very similar for both methods (ICC=0.483 for SVDH and 0.485 for PARS). Both methods showed moderate responsiveness over the cumulative interval (two-reader average SRM: PARS 0.571, SVDH 0.531). For both methods and both readers, mean cumulative change scores were smaller than the corresponding SDC values (PARS: 2.8-3.7% of maximum score; SVDH: 2.8-4.1%), indicating that average progression fell below the threshold of reliable individual-level detection. Bland-Altman analysis showed slightly narrower absolute limits of agreement for PARS in selected comparisons, whereas SVDH showed narrower relative limits after normalization to the maximum possible score.

CONCLUSIONS: SVDH and PARS showed broadly comparable psychometric performance for PsA damage assessment. Both methods were robust for cross-sectional scoring but showed important limitations in reliably detecting cumulative change in this low-progression cohort. Neither method demonstrated clear superiority.

PMID:42507901 | DOI:10.1093/rheumatology/keag309

Int J Circumpolar Health. 2026 Dec 31;85(1):2710003. doi: 10.1080/22423982.2026.2710003. Epub 2026 Jul 27.

ABSTRACT

Sauna bathing is a culturally significant practice in Nordic countries and is increasingly recogniced as a multidimensional health-promoting behavior. Although its physiological benefits are well-documented, less is known why people engage in sauna bathing and how they perceive its contribution to health and well-being. To investigate why Swedish women and men engage in sauna bathing and to describe their perceptions of sauna bathing as a health-promoting practice. A descriptive cross-sectional study was conducted using an online questionnaire completed by 588 regular sauna bathers (384 women and 204 men). The questionnaire included closed-ended items on health and sauna habits and open-ended questions exploring motivations for sauna bathing. Qualitative data were analysed using inductive thematic analysis, and quantitative data were analysed using descriptive and analytic statistics. Thematic analysis generated a conceptual model of sauna bathing as a health-promoting practice comprising four interconnected themes: mental recovery, social togetherness, purification and physical health. Mental recovery was the prominent motivation among women, whereas social togetherness ranked highest among men. Participants described sauna bathing as promoting relaxation, reflection, social connection, physical recovery, and a sense of cleanliness and renewal. Women reported significantly better perceived sleep quality and reduced perceived bodily pain following sauna bathing, whereas no corresponding significant changes were observed by men. Sauna bathing was perceived as a multidimensional health-promoting practice integrating psychological, social, cultural, and physical dimensions of health. The findings provide a conceptual understanding of why people engage in sauna bathing and support its potential role as a person-centered health promotion strategy. Prospective studies are needed to confirm these self-reported findings.

PMID:42507891 | DOI:10.1080/22423982.2026.2710003

Am J Clin Oncol. 2026 Jul 23. doi: 10.1097/COC.0000000000001355. Online ahead of print.

ABSTRACT

OBJECTIVES: Anaplastic thyroid carcinoma (ATC) is a rare and aggressive malignancy. The purpose of this study was to update the outcomes of ATC in a large provincial database in a modern cohort.

METHODS: All patients diagnosed with ATC in British Columbia between 2000 and 2022 were included in this retrospective analysis. Charts were reviewed for demographic, staging, treatment, and outcomes data. Statistical analysis was performed using the Kaplan-Meier method for overall survival. The Fine and Gray method was used to determine factors associated with progression.

RESULTS: A total of 127 patients were included, with a median age of 73 years. At diagnosis, 22% had stage IVA, 42% stage IVB, and 36% stage IVC disease. Surgery was performed in 43% of patients, and 66% received radiotherapy. Molecular testing was conducted in 13%, with 5 patients testing positive for BRAF mutations. Chemotherapy was used in 15 patients, either concurrently with radiotherapy or palliatively. Median OS was 5.7 months (stage IVA), 4.3 months (IVB), and 2.5 months (IVC). Improved OS was associated with better ECOG performance status, surgery, radiotherapy, and higher radiation doses (P<0.05). Improved progression-free survival was linked to better ECOG status, absence of metastases, and higher radiation dose (P<0.05). Only 3% of patients survived longer than 3 years.

CONCLUSIONS: In this large population-based cohort, ATC remains associated with poor survival, with outcomes strongly influenced by stage and performance status at diagnosis. Surgery and radiotherapy, particularly higher radiation doses, were associated with improved survival outcomes in selected patients.

PMID:42507837 | DOI:10.1097/COC.0000000000001355

JMIR Hum Factors. 2026 Jul 27;13:e98864. doi: 10.2196/98864.

ABSTRACT

BACKGROUND: Overdose fatality reviews (OFRs) are an important public health tool for developing local overdose prevention strategies by reviewing individual overdose cases. While this approach offers a rich, contextual understanding of drug overdose factors in communities, it examines a small number of cases, providing limited insight into broader population-level risk patterns. To complement OFRs, we developed a real-time dashboard that visualizes trends about 5 key “touchpoints” (ie, interactions with medical and justice services preceding overdose). We then trained local OFR teams to use this dashboard to identify prevention opportunities.

OBJECTIVE: This study examines the integration of population-level data into OFR practices, as well as the tensions that emerge between OFRs’ traditional case-driven review processes and the statistical, population-level analysis typical in public health. We analyze how and when the dashboard was used in meetings, determine the extent to which the data informed recommendations, and identify barriers that prevented the broad uptake of this intervention.

METHODS: We observed 26 OFR meetings across 11 counties in Indiana over 10 months, from November 2024 to September 2025, during which teams conducted case reviews and developed recommendations. We documented instances of dashboard use as well as “missed opportunities,” in which relevant population-level data were available but not incorporated into the discussion. We also conducted semistructured interviews with OFR team members (n=7) to understand their perceptions of the dashboard, including its usefulness, usability, and adoption barriers.

RESULTS: Despite its intended role, the dashboard was rarely integrated into OFR meetings; it was used only 10 times, compared to 114 missed opportunities in which relevant data could have informed discussions. Interviews revealed that this limited uptake was not solely due to usability barriers but reflected a deeper tension between 2 distinct analytic approaches. OFR teams prioritized narrative-driven case reviews that were grounded in empathy, local knowledge, and lived experience. This approach seemed at odds with the population-level visualizations shown in the dashboard, which required statistical abstraction and interpretation. Other barriers identified included limited time and resources, staff turnover, and varying levels of data fluency, which made it difficult for teams to confidently interpret the dashboard despite training.

CONCLUSIONS: The results highlight a tension between case-based and data-driven approaches to overdose prevention. These approaches are grounded in different workflows, values, and motivations, making it challenging for OFR teams to maintain their traditional, empathetic review practices while incorporating population-level trends. Our findings indicate the need for data tools that bridge these approaches, such as visualizations that connect aggregate patterns to individual cases. The results also underscore the need for additional support and training for teams, such as dedicated data specialists who interpret population-level trends and provide insights to augment team discussions and inform prevention strategies.

PMID:42507832 | DOI:10.2196/98864

JMIR Res Protoc. 2026 Jul 27;15:e64658. doi: 10.2196/64658.

ABSTRACT

BACKGROUND: Simulation-based training has demonstrated effectiveness in enhancing proficiency in interventional procedures. The endovascular treatment of peripheral arterial lesions has become a prominent minimally invasive therapeutic option. However, operators from various specialties, including Interventional Cardiology, Interventional Radiology, and Vascular Surgery, often follow diverging guideline recommendations and training pathways. Despite growing use of simulation in this field, the influence of an operator’s specialty on learning outcomes remains poorly understood.

OBJECTIVE: This study aimed to evaluate the impact of simulation training on peripheral angioplasty performance scores across different interventional specialties and assess how specialty-specific factors influence skill acquisition.

METHODS: This quasi-experimental observational study will be conducted at the Simulation Center of the Faculty of Medicine of Sfax, Tunisia (trial registration: PACTR Trial ID 30697). Participants consist of 60 novice fellows from three specialties: Cardiology (n=20), Interventional Radiology (n=20), and Vascular Surgery (n=20). All participants will undergo identical simulation training using a high-fidelity Mentice simulator, comprising five standardized clinical scenarios addressing peripheral angioplasty of complex iliac and femoral lesions (TASC B-D). Each participant will receive a 4-hour hands-on training session with pre- and posttest assessments using a 25-item Global Score (10 knowledge items, 15 competence items). Primary outcomes consist of percentage change in performance scores from baseline to posttraining (threshold for clinical significance:≥25% improvement) and comparison across specialty groups using nonparametric statistics. Secondary outcomes consist of radiation protection parameters, including fluoroscopy duration, cumulative radiation dose, air kerma, and dose area product (KAP), measured by a simulator with real-time ALARA (As Low As Reasonably Achievable) feedback.

RESULTS: Study enrollment started on September 15, 2024. As of December 2025, 42 fellows were screened, and 21 have been enrolled (15 Cardiology, 3 Radiology, 3 Vascular Surgery), representing 35% of the target sample (21/60). All 21 enrolled participants completed the full simulation training protocol, with radiation protection parameters recorded for all sessions. Enrollment and data collection are expected to be completed by June 2026, with full results anticipated for publication thereafter.

CONCLUSIONS: This protocol describes the first comparative study evaluating the impact of high-fidelity simulation on peripheral angioplasty performance across three distinct specialties. Findings are anticipated to provide novel evidence regarding specialty-specific learning trajectories and may inform the development of standardized, specialty-tailored training pathways for complex peripheral interventions.

PMID:42507471 | DOI:10.2196/64658

Natl Vital Stat Rep. 2026 Jun;volnum. doi: 10.15620/cdc/252441.

ABSTRACT

OBJECTIVES: This report presents final 2024 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined.

METHODS: Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2024 period linked birth/infant death file. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia.

RESULTS: A total of 20,048 infant deaths were reported in the United States in 2024, which was not significantly different from 2023 (20,162). The U.S. infant mortality rate was 5.52 infant deaths per 1,000 live births, which was not significantly different from the rate in 2023 (5.61). The change in the neonatal mortality rate from 3.65 in 2023 to 3.66 in 2024 was not significant. The postneonatal mortality rate declined 4.6% from 1.96 in 2023 to 1.87 in 2024. Changes in mortality rates for infants by maternal race and Hispanic origin and among Hispanic-origin subgroups were not significant. Infants of Black non-Hispanic women had the highest mortality rate (10.98) in 2024, followed by infants of American Indian and Alaska Native non-Hispanic (9.20) and Native Hawaiian or Other Pacific Islander non-Hispanic (7.90), Hispanic (4.88), White non-Hispanic (4.41), and Asian non-Hispanic (3.72) women. The mortality rate decreased from 2023 to 2024 for infants born at 39-40 weeks of gestation (1.64 to 1.55), but the rate change was not significantly different for other gestational age categories. Among the five leading causes of infant death in 2024, mortality rates for sudden infant death syndrome declined compared with 2023. Infant mortality rates by state for 2024 ranged from a low of 2.97 in New Hampshire to a high of 9.65 in Mississippi.

PMID:42507465 | DOI:10.15620/cdc/252441

JAMA Netw Open. 2026 Jul 1;9(7):e2620981. doi: 10.1001/jamanetworkopen.2026.20981.

ABSTRACT

IMPORTANCE: Financial strain is associated with suicide risk; however, no research has examined financial stressors in the year preceding suicide using national credit data.

OBJECTIVE: To assess financial stressors in the 12 months preceding suicide in a national sample of veterans by linking financial, mortality, and health care records.

DESIGN, SETTING, AND PARTICIPANTS: This case-control study of 5000 veterans who died by suicide (January 1, 2015 to December 31, 2017) used mortality data from the US Department of Veterans Affairs (VA) and the US Department of Defense. Cases were matched to 12 500 living controls on age, sex, VA health care use, and suicide index date. Analyses were conducted in December 2025.

EXPOSURES: Financial stressors in the prior 12 months were identified in TransUnion credit records provided by FinThrive.

MAIN OUTCOMES AND MEASURES: The primary outcome was death by suicide. Differences between cases and controls were analyzed using multivariable conditional logistic regression, adjusting for demographics and, among VA users, marital status and diagnoses of depression, posttraumatic stress disorder, and substance use disorder.

RESULTS: Among 17 439 veterans included in this study, the mean (SD) age was 52.9 (15.7) years, and 94.6% were male. Suicide was associated with having (vs not having) delinquent mortgage payments (odds ratio [OR], 1.4; 95% CI, 1.2-1.7), repossessions (OR, 1.9; 95% CI, 1.3-2.7), and credit card payments 30 or more days past due (OR, 1.7; 95% CI, 1.6-1.9). Lower credit score categories were associated with increasing odds of suicide. Veterans with 3 or more financial stressors had higher odds of suicide (OR, 2.4; 95% CI, 1.9-3.0) compared with those who had none. Among individuals with available data, credit score declines of 51 to 100 points (OR, 1.3; 95% CI, 1.1-1.5) and greater than 100 points (OR, 2.8; 95% CI, 2.3-3.5) over 1 year, relative to no change in score, were associated with increased odds of suicide. Cumulative financial stressors and declining credit scores had the highest ORs for suicide when adjusting for demographics and, among VA users, marital status and prior psychiatric diagnoses. ORs were lower among VA users than among non-VA users.

CONCLUSIONS AND RELEVANCE: In this case-control study, suicide was associated with financial stressors in the prior 12 months. Incorporating financial stressors into clinical evaluations and safety planning may aid in identifying patients at risk for suicide. Policymakers and researchers could consider strategies to detect and mitigate financial stressors as part of comprehensive suicide prevention efforts.

PMID:42507447 | DOI:10.1001/jamanetworkopen.2026.20981

JAMA Netw Open. 2026 Jul 1;9(7):e2624991. doi: 10.1001/jamanetworkopen.2026.24991.

ABSTRACT

IMPORTANCE: The decision to transfuse a patient with myocardial infarction (MI) and anemia at a higher vs lower hemoglobin threshold must consider the potential benefit of reduced risk of 30-day death or MI and the potential risk of heart failure.

OBJECTIVES: To estimate bayesian posterior risk differences and posterior probabilities that a liberal vs restrictive transfusion strategy is associated with reduced risk of 30-day death or MI and whether the probabilities exceed predefined thresholds.

DESIGN, SETTING, AND PARTICIPANTS: The Myocardial Ischemia and Transfusion (MINT) trial recruited adults from April 26, 2017, to April 14, 2023, who were hospitalized with MI and anemia at 144 sites in 6 countries. Statistical analysis was performed from July 31, 2024, to February 18, 2026.

INTERVENTION: The MINT trial randomized participants to a restrictive (transfuse if hemoglobin is <7 to 8 g/dL) or liberal (maintain hemoglobin at >10 g/dL) transfusion strategy.

MAIN OUTCOMES AND MEASURES: Bayesian posterior risk differences were estimated for 30-day death or MI and for heart failure using 3 prior beliefs regarding the treatment strategies: noninformative, liberal strategy superiority, or restrictive strategy superiority.

RESULTS: The mean (SD) age of the 3504 participants was 72.1 (11.6) years and 1911 (54.5%) were men. Compared with the restrictive strategy, the risk of 30-day death or MI with the liberal strategy was 1.4% (95% credible interval, -0.8% to 3.5%) to 2.4% (95% credible interval, 0.3%-4.6%) lower, depending on prior beliefs. The probability that the liberal strategy was associated with a lower risk of 30-day death or MI ranged from 89.1% to 98.8%, and the probability that a liberal strategy was associated with at least 1 less death or MI per 100 treated was between 62.7% and 90.4%. Conversely, the risk of heart failure with the liberal strategy was 0.2% (95% credible interval, -1.6% to 1.2%) to 0.6% (95% credible interval, -2.0% to 0.8%) higher compared with the restrictive strategy, depending on prior beliefs. The probability that the liberal strategy was associated with a higher risk of heart failure ranged from 60.6% to 80.0%, and the probability that a liberal strategy was associated with at least 1 more heart failure event per 100 treated was between 13.3% and 29.3%.

CONCLUSIONS AND RELEVANCE: This post hoc analysis of a randomized clinical trial of patients with MI and anemia suggests that a liberal transfusion strategy was associated with a lower risk of 30-day death or MI, outweighing the increased risk of heart failure. Consistent with guideline recommendations and according to patients’ values and clinician risk assessment, a liberal transfusion strategy may be reasonable.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02981407.

PMID:42507445 | DOI:10.1001/jamanetworkopen.2026.24991

JAMA Netw Open. 2026 Jul 1;9(7):e2625250. doi: 10.1001/jamanetworkopen.2026.25250.

ABSTRACT

IMPORTANCE: Evidence on hand hygiene promotion in resource-limited settings remains sparse, and its generalizability and long-term sustainability are poorly understood. Previous studies have predominantly relied on single-center, short-duration, before-and-after interventional designs.

OBJECTIVE: To assess the long-term impact of the World Health Organization (WHO) multimodal improvement strategy (MMIS) supported by locally manufactured alcohol-based handrub (ABHR) on hand hygiene performance across multiple health care facilities in Uganda.

DESIGN, SETTING, AND PARTICIPANTS: This stepped-wedge cluster randomized trial was conducted at 8 health care facilities across 4 districts in eastern Uganda from November 1, 2020, to July 31, 2024 (45 months). Participants included all health care workers at the participating sites.

INTERVENTION: Following a baseline phase of 12 to 21 months, the WHO MMIS combined with locally manufactured ABHR was sequentially introduced in each district at 3-month intervals and implemented for 12 to 21 months (ie, the intervention phase), followed by a 12-month follow-up period without additional intervention.

MAIN OUTCOMES AND MEASURES: The primary outcome was hand hygiene adherence among health care workers. Secondary outcomes included scores on the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and the Infection Prevention and Control Assessment Framework (IPCAF).

RESULTS: A total of 27 895 hand hygiene opportunities were observed. Hand hygiene adherence increased from 22.1% (95% CI, 11.4%-32.8%) at baseline to 79.2% (95% CI, 67.2%-91.2%; P < .001) during the intervention phase and remained high at 72.7% (95% CI, 57.8%-87.6%; P < .001) during follow-up. Median HHSAF scores improved significantly from 145.00 (IQR, 52.50-202.50) at baseline to 383.75 (IQR, 367.50-417.50 [P = .008]) during the intervention phase and 366.25 (IQR, 316.25-380.00 [P = .008]) during follow-up. Median IPCAF scores followed a similar pattern, from 335.00 (IQR, 235.00-520.25) at baseline to 657.50 (IQR, 648.75-705.00) (P = .008) during the intervention phase and 676.25 (IQR, 656.25-705.00) (P = .008) during follow-up. ABHR accounted for more than 99% of observed hand hygiene actions during the intervention and follow-up phases.

CONCLUSIONS AND RELEVANCE: In this study of hand hygiene promotion in eastern Uganda, the WHO MMIS supported by locally produced ABHR led to substantial and sustained improvements in hand hygiene adherence. This stepped-wedge cluster randomized trial provides robust evidence supporting the scalability of this approach at regional and national levels in resource-limited settings.

TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Identifier: UMIN000039483.

PMID:42507443 | DOI:10.1001/jamanetworkopen.2026.25250