Nevin Manimala

JCO Oncol Pract. 2026 Apr 24:OP2501161. doi: 10.1200/OP-25-01161. Online ahead of print.

ABSTRACT

PURPOSE: 177Lu-PSMA-617 (LuPSMA) is an approved prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical therapy for men with metastatic castration-resistant prostate cancer (mCRPC). Older patients, particularly octogenarians, represent a substantial proportion of men with mCRPC but have been traditionally underrepresented in key registrational trials of LuPSMA.

METHODS: This retrospective multi-institutional study evaluated patients age 80 years and older with mCRPC after chemotherapy treated with ≥1 cycle of LuPSMA from August 2022 to December 2024. Clinical and demographic data were abstracted from electronic medical records. Outcomes included prostate specific antigen (PSA) response (PSA50 and PSA90), progression-free survival (PFS), overall survival (OS), and toxicities. Kaplan-Meier methods estimated PFS/OS; descriptive statistics summarized baseline and safety data.

RESULTS: Ninety-five patients (median age, 83 years) were included, of whom 36 (38%) and 21 (22%) had a history of cardiac disease or chronic kidney disease, respectively. Median follow-up was 24.1 months (IQR, 6.7-28.1). Patients received a median of five cycles of LuPSMA. Fifty-two (57%) and 21 (23%) patients achieved a PSA50 and PSA90, respectively. Median PFS and OS were 7.3 months (95% CI, 6.4 to 8.7) and 13.5 months (95% CI, 9.7 to 18.8), respectively. Grade ≥3 hematologic toxicities included anemia (n = 19; 20%) and thrombocytopenia (n = 4, 4%); grade ≥3 acute kidney injury occurred in one patient. Fourteen (15%) patients had dose delays, seven (7%) required reductions, and 10 (11%) discontinued therapy due to toxicity. Thirty-seven patients (39%) were hospitalized during therapy, with intensive care unit-level care required in two patients (2%), and there was one treatment-related death.

CONCLUSION: LuPSMA had comparable outcomes in octogenarians with mCRPC to patients on registrational trials, although 2/5 of patients required hospitalization during therapy. These findings support the feasibility and efficacy of LuPSMA in well-selected older men with mCRPC and suggest a role for closer monitoring of older patients.

PMID:42030508 | DOI:10.1200/OP-25-01161

JMIR Med Inform. 2026 Apr 24;14:e83127. doi: 10.2196/83127.

ABSTRACT

BACKGROUND: Artificial intelligence-augmented electrocardiogram (AI-ECG) models for detecting left ventricular systolic dysfunction (LVSD) often exhibit degraded performance in patients with comorbidities.

OBJECTIVE: This study aimed to introduce and validate a recalibration method using longitudinal patient data to enhance prediction accuracy and simulate its clinical utility for ongoing monitoring.

METHODS: We conducted a multicenter, retrospective cohort study using data from 2 hospitals in Korea. A dataset of paired transthoracic echocardiograms (TTEs) and electrocardiograms (ECGs) matched within a 2-week interval was constructed, separating pairs into baseline (first for each patient) and follow-up assessments. In addition to conventional supervised learning, we developed a patient-wise recalibration strategy that incorporated historical left ventricular ejection fraction measurements and prior AI-ECG outputs to adjust for future predictions, thus empirically mitigating confounding effects. Pretraining was also implemented to enhance the model’s performance.

RESULTS: The recalibrated 12-lead DeepECG LVSD model achieved an area under the receiver operating curve of 0.956 (95% CI 0.946-0.965) for internal validation and 0.940 (95% CI 0.936-0.945) for external validation of follow-up TTE-ECG pairs. The uncalibrated 12-lead DeepECG LVSD model also showed modest performance, with an area under the receiver operating curve of 0.953 (95% CI 0.941-0.965) in the internal validation and 0.947 (95% CI 0.943-0.951) in the external validation when tested on baseline TTE-ECG pairs. Recalibration yielded statistically significant improvements in the 12-lead DeepECG LVSD models (P<.001), with enhanced and more balanced performance across all clinical subgroups.

CONCLUSIONS: Patient-wise recalibration improved accuracy and consistency across various comorbidities by mitigating performance degradation and bias. This broadens the application of AI-ECG for LVSD detection from low-risk screening to high-risk longitudinal monitoring.

PMID:42030497 | DOI:10.2196/83127

Int J Methods Psychiatr Res. 2026 Jun;35(2):e70074. doi: 10.1002/mpr.70074.

ABSTRACT

OBJECTIVES: To develop a statistical method that uncovers clinically meaningful differences between active psychiatric treatments, even when traditional rating scales fail to do so.

METHODS: We introduce Supervised Varimax (SV), a novel algorithm that transforms individual items from clinical rating scales into a small set of optimized outcomes that maximally differentiate treatments. SV was applied to data from two large, multi-center, randomized controlled trials: CATIE (schizophrenia) and STAR*D (treatment-resistant depression).

RESULTS: SV identified significant differential treatment effects that were not evident in the original analyses. In CATIE Phase I, olanzapine was more effective than quetiapine and ziprasidone for hostility, and perphenazine outperformed ziprasidone for emotional dysregulation. In Level 2 of STAR*D, bupropion augmentation was more effective than buspirone augmentation for patients with increased appetite. These findings were validated using post-hoc permutation testing and matched to clinical subgroups using simple, symptom-based rules.

CONCLUSIONS: SV enables precision psychiatry by optimizing outcome definitions to enhance treatment differentiation in RCTs. This approach provides interpretable, clinically actionable insights using existing trial data, without requiring complex predictive modeling or additional biomarkers.

TRIAL REGISTRATION: CATIE (NCT00014001), STAR*D (NCT00021528).

PMID:42030496 | DOI:10.1002/mpr.70074

Trends Psychiatry Psychother. 2026 Apr 24. doi: 10.47626/2237-6089-2025-1228. Online ahead of print.

ABSTRACT

OBJECTIVE: The constant access to online content has raised concerns worldwide. Excessive engagement with digital platforms can contribute to significant mental health challenges, including increased levels of depression, anxiety, and stress. This phenomenon is related to impairments in neuroanatomical areas leading to adverse outcomes. The study aimed to analyze the associations between internet addiction (IA), depression, anxiety, stress, and a diversity of sociodemographic variables, including gender, social media use, employment status, sleep, and physical activity patterns.

METHODS: A sample of 618 adolescents and young adults in southern Brazil was analyzed (mean age: 23.34). Participants filled an online form and statistical analysis was conducted.

RESULTS: The results show that depression, anxiety, and stress levels were higher in women (p < 0.001), whereas IAT scores did not reach statistical significance, despite being higher in women (p = .06). Those who are employed may have lower levels of IA; poor sleep habits are associated with higher internet addiction and social media use is associated with poorer mental health and IA (p < 0.001).

CONCLUSION: Mental health support and internet use limits should be offered to the general population in terms of prevention and treatment of these conditions.

PMID:42030494 | DOI:10.47626/2237-6089-2025-1228

JMIR Res Protoc. 2026 Apr 24;15:e87902. doi: 10.2196/87902.

ABSTRACT

BACKGROUND: School health policies and practices are key components of health promotion for children and adolescents and play a central role in shaping healthy school environments, reducing health inequities, and fostering intersectoral collaboration between education and health systems. Despite their relevance, systematic and comparable assessments of how these policies and practices are implemented across different national contexts remain limited, particularly in low- and middle-income countries. Internationally comparable data are essential to identify strengths, gaps, and priorities for investment in school health.

OBJECTIVE: The aim of this study is to describe the protocol of a mixed methods study evaluating and comparing school health policies and practices in Brazil and Portugal.

METHODS: An explanatory sequential mixed methods design (QUAN → qual → [qual] → [qual]) will be adopted. The quantitative phase (phase I) consists of a cross-sectional survey conducted with school administrators using the Global School Health Policies and Practices Survey, which assesses multiple domains of school health policies, coordination, services, and practices. Quantitative findings will inform the subsequent qualitative phases. Phase II involves semistructured interviews with school principals or head teachers to explore institutional decision-making and policy implementation. Phase III includes interviews with school nurses to examine health service organization, intersectoral collaboration, and professional practices. Phase IV comprises participatory research with adolescents using the photovoice technique to capture youths’ perspectives on school health environments and practices. The study will be conducted in elementary and secondary schools and related health services in selected cities in Brazil and Portugal. Data integration will occur sequentially through connected analyses and joint displays, enabling the development of meta-inferences that link quantitative patterns with qualitative explanations.

RESULTS: The study has secured funding from 2 funding agencies, with project activities initiated in 2025. Quantitative data collection and analysis began in October 2025 in the city of Cuiabá, Brazil. The expansion of data collection to additional Brazilian and Portuguese cities is planned for the first half of 2026. The qualitative phases, including interviews and photovoice activities, are scheduled to take place throughout 2026. The final integrated mixed methods analysis and manuscript preparation are planned for 2027, with dissemination of findings through peer-reviewed journals and national and international scientific conferences by the end of the project cycle.

CONCLUSIONS: This study is expected to generate context-sensitive and comparative evidence to support intersectoral actions and inform the development and strengthening of school health promotion policies and practices in different national settings.

PMID:42030489 | DOI:10.2196/87902

J Psychosoc Nurs Ment Health Serv. 2026 Apr 28:1-13. doi: 10.3928/02793695-20260420-02. Online ahead of print.

ABSTRACT

PURPOSE: To examine the effect of metacognitive beliefs and cognitive insight on subjective perception of recovery in individuals with schizophrenia.

METHOD: Participants in the current descriptive cross-sectional and correlational study comprised 133 individuals with schizophrenia being treated in the psychiatry clinic of a training and research hospital in Türkiye. Data were collected using a Personal Information Form, Metacognition Questionnaire-30 (MCQ-30), Beck Cognitive Insight Scale (BCIS), and Subjective Recovery Assessment Scale (SubRAS). Descriptive statistics, bivariate analysis, and hierarchical regression analysis were used to analyze the data.

RESULTS: Participants’ MCQ-30, BCIS, and SubRAS scores were 84.45 (SD = 9.90), -0.15 (SD = 5.12), and 57.78 (SD = 15.26), respectively. Metacognitive beliefs were a predictor of subjective perception of recovery (β = -0.179, p = .034). The meta-cognition score explained 10.1% of the total variance associated with subjective perception of recovery (adjusted R² = 0.101).

CONCLUSION: Results of the current study can guide psychiatric-mental health nurses to develop specific interventions and programs to support subjective recovery in individuals with schizophrenia and improve their mental health outcomes.

PMID:42030479 | DOI:10.3928/02793695-20260420-02

J Psychosoc Nurs Ment Health Serv. 2026 Apr 28:1-13. doi: 10.3928/02793695-20260414-01. Online ahead of print.

ABSTRACT

PURPOSE: To compare relational authenticity and empathy among rural and urban psychiatric-mental health nurses and examine their correlation with recovery capital in individuals with substance use disorder (SUD) using Peplau’s Theory of Interpersonal Relations as a conceptual framework.

METHOD: Using a descriptive comparative study design, 278 participants were recruited from rural and urban psychiatric settings. Nurses (n = 152) completed the Kernis-Goldman Authenticity Inventory, Interpersonal Reactivity Index, and Working Alliance Inventory-Short Version. Patients (n = 126) with SUD were evaluated using the Brief Assessment of Recovery Capital.

RESULTS: A statistically significant difference was observed in responses regarding the relational orientation domain of authenticity, as well as the fantasy and empathic concern dimensions of empathy (p = .013, p = .042, and p = .022, respectively). Empathy and therapeutic alliance were identified as significant independent predictors of authenticity among nurses. Higher levels of empathy and authentic engagement were positively associated with increased recovery capital in patients with SUD.

CONCLUSION: Empathetic and authentic nurse-patient relationships, as framed by Peplau’s theory, are critical to supporting recovery in individuals with SUD. Enhancing these relational competencies, especially in under-resourced rural settings, may improve mental health outcomes and reduce disparities in recovery support.

PMID:42030478 | DOI:10.3928/02793695-20260414-01

Vet Med Sci. 2026 May;12(3):e70962. doi: 10.1002/vms3.70962.

ABSTRACT

OBJECTIVE: This study aimed to investigate the potential systemic gastrointestinal (GI) effects of short-term topical administration of ocular steroids and non-steroidal anti-inflammatory drugs (NSAIDs) in rats.

ANIMALS: A total of 56 adult male Wistar rats were assigned to seven treatment groups (n = 8 for each group), receiving topical applications of saline, prednisolone acetate, dexamethasone phosphate, loteprednol etabonate, ketorolac tromethamine, nepafenac or diclofenac sodium for 1 week.

METHODS: GI bleeding was assessed using faecal occult blood tests, gastric and duodenal tissues were analysed histopathologically, and endoscopic evaluations were performed.

RESULTS: Positive faecal occult blood results were observed in the prednisolone acetate group (3/8; 37.5%), dexamethasone phosphate (2/8; 25%), diclofenac sodium (1/8; 12.5%) and loteprednol etabonate (1/8; 12.5%). No positive results were recorded in the ketorolac tromethamine, nepafenac, or saline groups (0%). Differences between groups were not statistically significant (p > 0.05). No significant within-group differences between baseline and post-treatment results were detected (p > 0.05). Endoscopic scores ranged from 0 to 1 across all groups, and histopathology revealed no abnormalities.

CONCLUSIONS AND CLINICAL RELEVANCE: Short-term topical ocular steroid and NSAID treatments were not associated with statistically significant systemic gastrointestinal alterations under the conditions of this study.

PMID:42030432 | DOI:10.1002/vms3.70962

J Chem Theory Comput. 2026 Apr 24. doi: 10.1021/acs.jctc.6c00293. Online ahead of print.

ABSTRACT

Nuclear quantum effects (e.g., zero-point motion and tunneling) can control hydrogen transfer and diffusion, but fully quantum dynamics is rarely feasible for realistic systems. Ring-polymer molecular dynamics (RPMD) samples quantum statistics with a classical ring polymer, yet ab initio RPMD is costly because electronic-structure energies and forces are required for every bead at every time step. Here, we introduce a Feynman path tube-guided surrogate RPMD framework that propagates all beads on an on-the-fly surrogate ring-polymer Hamiltonian with an uncertainty estimate: ab initio data are acquired only when the uncertainty exceeds a threshold and are shared across beads and trajectories. Combined with well-tempered metadynamics, the method targets quantum free-energy surfaces and activation barriers. On gas-phase OH + H₂O and CH₄ + Cl benchmarks with full-dimensional reference potentials, surrogate ab initio RPMD reproduces brute-force RPMD profiles within 0.1-0.2 kcal/mol, preserves the symmetry of the OH + H₂O identity exchange, and resolves subkcal barriers. We then compute ab initio RPMD free-energy surfaces for proton transfer on TiO₂(011), H migration on graphene, and H₂ dissociative chemisorption on Cu(111), including a two-dimensional surface and minimum free-energy path on the metal. Across all five systems, the number of ab initio calls grows sublinearly with bead number, delivering speedups of 10³-10⁵ ring-polymer bead-steps per QM evaluation and reducing the expensive force workload by three to more than 4 orders of magnitude. Tube-aware surrogate sharing therefore makes quantum-statistical free-energy sampling with ab initio RPMD practical for both molecular and interfacial reactions.

PMID:42030428 | DOI:10.1021/acs.jctc.6c00293

PLoS Med. 2026 Apr 24;23(4):e1005081. doi: 10.1371/journal.pmed.1005081. Online ahead of print.

ABSTRACT

Why obesity increases cancer risk has long remained a biological mystery. Rapid advances in statistical and analytical methods are now opening the door to mechanistic discoveries that may finally help resolve this question.

PMID:42030412 | DOI:10.1371/journal.pmed.1005081