Nevin Manimala

medRxiv [Preprint]. 2026 Mar 17:2026.03.13.26348337. doi: 10.64898/2026.03.13.26348337.

ABSTRACT

INTRODUCTION: Particulate Matter (PM _2.5 ) exposure contributes to the global disease burden, yet its monitoring remains sparse and uneven and is limited in many limited ground monitoring network settings. Road-traffic proxy indicators can provide indirect estimates of PM _2.5 where measurements are limited but require context-specific validation. We evaluated three PM _2.5 road-traffic related proxies:(I) population-Weighted Road Network Density (WRND), (ii) Euclidean (straight line) distance from highways (EH), and (iii) Euclidean distance from main roads (EM).

METHODS: We validated proxies using high-resolution outdoor filtered PM _2.5 personal exposure measurements collected over 1 year from 343 postpartum participants in The Gambia, Kenya, and Mozambique. Village-level spatial patterns for the PM _2.5 -proxy relationship were mapped using 5 km hexagonal aggregated tessellations. Proxy-PM _2.5 associations were assessed using Spearman correlation, and predictive utility was tested using country-specific and global Random Forest (RF) models (3-fold cross-validation), reporting R ² , RMSE, and feature importance.

RESULTS: Spatial mapping showed heterogeneous proxy-PM _2.5 relationships across and within sites, with elevated PM _2.5 occurring in both low- and high-proxy contests. WRND-PM _2.5 correlations were weak overall and statistically significant only in Mozambique (r = 0.351; p = 0.005 ), with non-significant associations in Kenya (r = -0.041; p = 0.673 ) and The Gambia (r = -0.020; p = 0.909 ). EH-PM _2.5 correlations were positive in The Gambia (r = 0.335; p = 0.053 ) and Mozambique (r = 0.292; p = 0.020 ) but negative and significant in Kenya (r = -0.224; p = 0.018 ).Single-variable RF models performed poorly across all countries (R ² < 0.45) and the Global model (R ² =0.42). Combining proxies improved performance in Kenya (R ² =0.52; RMSE=31.7µg/m ³ ) and Mozambique (R ² =0.60; RMSE=8.9 µg/m ³ ), Global R ² =0.46; RMSE=29.1 µg/m ³ ), although in The Gambia, the combined model (R ² =0.53; RMSE=37.6 µg/m ³ ) did not exceed the best single-proxy model.

CONCLUSION: Road-network proxies provide context-dependent signals of personal PM _2.5 exposure, and predictive performance is strengthened when proxies are combined in a hybrid model.

PMID:41891017 | PMC:PMC13015645 | DOI:10.64898/2026.03.13.26348337

medRxiv [Preprint]. 2026 Mar 20:2026.03.18.26348637. doi: 10.64898/2026.03.18.26348637.

ABSTRACT

BACKGROUND: The clinical safety profile of e-cigarette use for smoking reduction remains poorly characterized. This study compared the relative safety and tolerability of nicotine e-cigarette use with non-nicotine e-cigarettes or a non-aerosol cigarette substitute (CS) among adults interested in reducing their smoking.

METHODS: We conducted a secondary analysis of adverse events (AEs) reported in a 6-month, double-blind RCT involving 520 participants assigned to either e-cigarettes with 0, 8, or 36 mg/mL nicotine or a CS. AEs were coded using CTCAE V4.0 and assessed for frequency, severity, seriousness and relatedness across groups. Cumulative incidence was calculated over 24 weeks. We estimated risk differences (RDs) and 95% confidence intervals (CIs) for frequently reported AEs (≥1% of participants overall) comparing e-cigarette vs. CS and nicotine versus non-nicotine e-cigarette groups. Fisher’s exact test, with adjustment for multiple comparisons, was used to assess statistical significance.

RESULTS: Most study-related AEs (those rated as possibly, probably, or definitely related by medical monitor) were mild in severity and none were classified as serious. At 24 weeks, cumulative incidence of first study-related AE was highest in the 36 mg/mL (37.0%) and 8 mg/mL (35.2%) e-cigarette groups, followed by 0 mg/mL (23.4%), and lowest in CS group (2.5%). E-cigarette users experienced significantly greater risks of cough (RD [95%CI]: 8.5% [5.6 – 11.3]), headache (RD [95%CI]: 5.4% [3.3 – 7.6]) and sore throat (RD [95%CI]: 5.4% [3.2 – 7.6]) as compared with the CS group. Cough was also more common in those randomized to nicotine versus non-nicotine e-cigarettes (RD [95%CI]: 8.1% [3.4 – 12.8]).

CONCLUSION: All study products were generally well-tolerated; however, AEs were more common in e-cigarette groups, especially with nicotine. Findings highlight the need to monitor common symptoms such as cough, headache, and sore throat in clinical and regulatory evaluations of e-cigarette safety.

WHAT IS ALREADY KNOWN ON THIS TOPIC: Nicotine e-cigarettes can help people who smoke to quit combustible cigarette use and reduce some cigarette-related toxicant exposures. However, the safety of inhaled nicotine and other constituents such as propylene glycol, vegetable glycerin in e-cigarettes remains unclear.

WHAT THIS STUDY ADDS: This study suggests that e-cigarette use is associated with a higher incidence of study-related AEs such as cough, headache, and sore throat, particularly among those using nicotine-containing products. However, overall safety and tolerability profiles were comparable across e-cigarette groups with differing nicotine concentrations.

HOW THIS STUDY MIGHT AFFECT RESEARCH PRACTICE OR POLICY: These findings offer methodological guidance for evaluating e-cigarette safety in clinical trials and may inform regulators, clinicians, and public health professionals regarding the tolerability of e-cigarette products varying in nicotine concentration.

PMID:41891015 | PMC:PMC13015618 | DOI:10.64898/2026.03.18.26348637

Ann Clin Transl Neurol. 2026 Mar 26. doi: 10.1002/acn3.70373. Online ahead of print.

ABSTRACT

OBJECTIVE: Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-RFTC) has emerged as a safe and effective minimally invasive treatment for children with drug-resistant focal epilepsy. Although evidence from real-world studies remains limited, numerous pediatric cases have demonstrated promising outcomes. This retrospective study aimed to evaluate the seizure outcomes of SEEG-RFTC in pediatric patients and identify predictive factors associated with seizure freedom.

METHODS: A retrospective observational study was conducted across two epilepsy centers, including 111 children with drug-resistant epilepsy who underwent SEEG-RFTC. Postoperative outcomes were assessed primarily by the rate of seizure freedom at the last follow-up (minimum 1 year). Potential predictive factors were analyzed through comparisons of clinical, neuroimaging, electrophysiological, and etiological variables.

RESULTS: All patients were followed for at least 1 year post-procedure, with 73 (65.8%) achieving seizure freedom. Among 46 patients with focal cortical dysplasia, the seizure-free rate was 80.4%. In 10 patients with hippocampus sclerosis, 6 (60%) were seizure-free at the final follow-up. Statistical analysis identified the course of illness (p < 0.01) and positron emission tomography (PET) findings (p = 0.01) as significant predictors of seizure freedom.

CONCLUSION: SEEG-RFTC is a safe procedure that yields favorable outcomes in a substantial proportion of pediatric patients with drug-resistant focal epilepsy. The duration of epilepsy and PET characteristics are significantly associated with the likelihood of achieving seizure freedom. These findings highlight the potential of SEEG-RFTC as a valuable therapeutic option in this population.

PMID:41888055 | DOI:10.1002/acn3.70373

Rural Remote Health. 2026 Mar;26(1):9712. doi: 10.22605/RRH9712. Epub 2026 Mar 26.

ABSTRACT

INTRODUCTION: Pathways aimed at increasing the medical workforce in regional and rural areas in Aotearoa New Zealand have been implemented in universities, such as the Regional and Rural Admission Scheme (RRAS) at Waipapa Taumata Rau | The University of Auckland, to address urban-rural variations in health outcomes. A recent review of the university’s scheme suggested the program was not providing equitable opportunities for students from a rural background as originally intended. Therefore, an updated RRAS was required to be developed to address these inequities, creating a more genuine scheme that may more strongly contribute to developing the regional and rural workforce in New Zealand.

METHODS: We developed a methodological framework to identify and evaluate candidate rural definitions for the purposes of developing a new RRAS for the university. Following an extensive literature review, we utilised two sets of criteria to select candidate rural definitions, which were then evaluated using visual evaluation (mapping) and exploratory analysis. Candidate definitions were modified to use a three-group (rural-regional-urban) version to be suitable for use as an updated RRAS. We used a de-identified student dataset of applicants enrolled for the MBChB medical program at the University of Auckland from 2017 to 2023 (inclusive) and population counts from the New Zealand 2018 Census to investigate differences in potential admission numbers under each candidate definition. The New Zealand Index of Multiple Deprivation 2018 was used to assess the distribution of potential admission numbers by area-level socioeconomic status. We also examined the suitability of the candidate definitions by ethnicity, specifically for students of M&#257;ori ethnicity.

RESULTS: We selected two candidate definitions for exploratory analysis: Geographic Classification for Health (GCH) developed by the University of Otago, and the urban accessibility classification 2020 (UA 2020) by Stats NZ. We found that the three-group modified version of the UA 2020 definition consistently classified a higher proportion of students as regional and rural compared to the current RRAS and the alternative candidate definition, the three-group GCH. The modified UA 2020 was found to classify a higher number of M&#257;ori students and those living in less-deprived neighbourhoods as rural when compared to the other definitions. Therefore, our final recommendation is to update the existing RRAS using a three-group modified version of the UA 2020 by Stats NZ. Our proposed version will refocus attention to address the under-representation of rural students admitted to professional health programs at the University of Auckland, while not disadvantaging regional students.

CONCLUSION: The updated RRAS will assist in supplementing the future professional rural medical workforce, and subsequently help to reduce health outcome variations between rural and urban areas in New Zealand. The modified UA 2020 is likely to be updated regularly by Stats NZ, and therefore the RRAS can be kept up to date in the future.

PMID:41888043 | DOI:10.22605/RRH9712

Int J Audiol. 2026 Mar 26:1-10. doi: 10.1080/14992027.2026.2642750. Online ahead of print.

ABSTRACT

OBJECTIVE: Digital hearing aid processing introduces delay. While traditional literature suggests a 10-ms threshold, evidence indicates that even shorter delays may degrade sound quality. This study examined the impact of Ultra-Low Delay (ULD; 0.5 ms) versus Standard Delay (SD; 2.7 ms) on temporal and spectral auditory processing abilities in hearing aid users.

DESIGN AND STUDY SAMPLE: Twenty experienced hearing aid users (aged 41-75 years) with bilateral, symmetrical, mild-to-moderate sensorineural hearing loss participated. Auditory performance was assessed under the ULD and SD conditions using the Frequency Pattern Test, Duration Pattern Test, Random Gap Detection Test, and Spectral-Temporally Modulated Ripple Test.

RESULTS: Statistical analyses revealed significant differences between the two processing delay conditions across all evaluated tests (p < .01). Participants demonstrated statistically superior temporal and spectral processing performance under the ULD condition compared to the SD condition.

CONCLUSIONS: The findings demonstrate that the ULD condition significantly improves central auditory temporal and spectral processing abilities compared to the SD condition. These results challenge the traditional view that delays under 10 ms are negligible and highlight the clinical importance of ultra-low delay technology for preserving auditory resolution in individuals with hearing loss.

PMID:41888031 | DOI:10.1080/14992027.2026.2642750

J Labelled Comp Radiopharm. 2026 Apr;69(4-6):e70027. doi: 10.1002/jlcr.70027.

ABSTRACT

M. H. Abdel-Aal, Y. A. Hasanien, N. A. Younis, G. El Didamony, A. Askora, and G. Abdelaziz, “Enhanced Control of Bacterial Wilt Disease in Tomato Plant via Transport and Penetration Tracking by Aid of ^99mTc-Labeled Ralstonia solanacearum-Specific Bacteriophage,” Journal of Labelled Compounds and Radiopharmaceuticals 68, no. 13 (2025): e4169, https://doi.org/10.1002/jlcr.4169. The above article, published online on 11 November 2025 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, V Derdau; and John Wiley & Sons Ltd. The retraction has been agreed upon following concerns raised by a third party. A subsequent investigation confirmed several deficiencies in the study, including the absence of essential controls, replicates, and appropriate statistical analysis. In addition, in Figure 3, the Ral 10, Ral 9, Ral 8 and Ral 7 bands appear to be duplicated, and there is evidence that Ral 10 has been spliced into the image. Furthermore, the images shown in Figures 12A and 12C are identical, despite representing untreated and treated plants. The authors cooperated with the investigation and explained that Figure 3 combines two images from separate experimental runs, as the gel tank could not hold all samples simultaneously. However, they were unable to provide the original images and did not comment on the duplicated bands. The authors also explained that the duplication in Figure 12 was an error due to figure mismanagement; they provided an alternative image for Figure 12C. However, this was not satisfactory to address all the concerns. As a result, the editors determined that the results cannot be validated and therefore the conclusions of the study are unreliable. The authors disagree with the retraction.

PMID:41888030 | DOI:10.1002/jlcr.70027

Foot Ankle Surg. 2026 Mar 19:S1268-7731(26)00074-3. doi: 10.1016/j.fas.2026.03.006. Online ahead of print.

ABSTRACT

INTRODUCTION: This study evaluated the rate of fracture-related infection (FRI) of open forefoot fractures caused by dropped objects, and examined associations of treatment characteristics, including intravenous and oral antibiotics and operative debridement, with FRI.

METHODS: Patients aged 18-80 years who sustained an open metatarsal or phalanx fracture caused by a dropped object between January 2021 and June 2024 were retrospectively identified from two Level 1 trauma centers. The primary outcome was FRI, determined based on the FRI consensus criteria. FRI rates were compared between those who underwent irrigation and debridement (I&D) at bedside versus in the operating room, and between those who received oral versus intravenous (IV) antibiotics. Patient characteristics were also analyzed to determine host factors associated with FRI.

RESULTS: A total of 86 patients (median age 41 years [IQR: 29-56], 58% male) were included. Eighty-five patients (99%) received antibiotics, 31 (36%) of whom received intravenous antibiotics. Sixty-six patients (77%) received an I&D at presentation, 57 (66%) at bedside and 9 (10%) in the operating room. Thirteen patients (15%, 95% CI: 8.3%-24%) developed FRI. No significant difference in FRI rate was found between patients who underwent I&D at bedside versus in the operating room (12% versus 11%, p > 0.99). Among patients who did not undergo I&D in the operating room, no significant difference in FRI rate was found between patients who received oral versus IV antibiotics (17% versus 13%, p = 0.74). Insulin-dependent diabetes was associated with an increased risk of FRI (60% versus 12%, p = 0.02).

CONCLUSIONS: In this cohort, one in seven patients developed FRI. No statistically significant differences in FRI rates were observed by I&D setting (bedside versus operative) or antibiotic route (oral versus IV), including in a subgroup analysis excluding patients treated with operating room I&D. These findings are limited by sample size and potential treatment selection bias and should not be interpreted as evidence of equivalence. Management should be individualized based on clinical judgement, resource availability, and patient factors. These findings can help guide the management protocols for “dropped objects” open forefoot fractures presenting to urgent care and the emergency department.

LEVEL OF EVIDENCE: Therapeutic Level III.

PMID:41887998 | DOI:10.1016/j.fas.2026.03.006

J Cyst Fibros. 2026 Mar 25:S1569-1993(26)00082-2. doi: 10.1016/j.jcf.2026.03.015. Online ahead of print.

ABSTRACT

BACKGROUND: Coping and Learning to Manage Stress with CF (CALM) is a manualized intervention for adults with cystic fibrosis (AWCF). A unique feature of the CALM multisite randomized controlled trial (RCT) was the inclusion of individuals with severe symptoms of depression and/or anxiety, including those endorsing suicidal ideation. Post-hoc analyses examined the extent to which those with severe symptoms benefited from CALM.

METHODS: Analyses included 121 AWCF who participated in CALM and provided evaluable depression (Patient Health Questionnaire; PHQ-9) and/or anxiety (Generalized Anxiety Disorder-7; GAD-7) data. Established cut-points classified participants into four symptom severity groups (normal, mild, moderate, severe) for both depression and anxiety before participating in CALM. Linear mixed models examined mean depression and anxiety scores across severity groups at 4 time points: pre-CALM, post-CALM, 1-month follow-up, and 3-month follow-up.

RESULTS: Pre-CALM depression severity ranged from normal (n = 24) to severe (n = 11), with most participants reporting mild (n = 57) or moderate (n = 29) symptoms. Anxiety severity followed a similar distribution (normal=18; mild=59; moderate=27; severe=16), and 9% of participants reported suicidal ideation. AWCF reporting severe depression and/or anxiety symptoms before starting CALM showed statistically significant reductions in both depression and anxiety at the post, 1-month follow-up, and 3-month follow-up (p<.0001 for each comparison with the pre-CALM time point).

CONCLUSIONS: AWCF with severe depression and/or anxiety symptoms showed significant symptom improvement following participation in CALM. This RCT is first to provide evidence of the efficacy of a stress management intervention to effectively treat severe depression and anxiety symptoms in AWCF.

PMID:41887978 | DOI:10.1016/j.jcf.2026.03.015

J Gen Psychol. 2026 Mar 26:1-24. doi: 10.1080/00221309.2026.2647742. Online ahead of print.

ABSTRACT

The primary objective of the present article is to identify the socio-demographic factors that increase the risk of developing gambling addiction in Kazakhstan and to analyze the effectiveness of rehabilitation interventions through the application of both quantitative and qualitative approaches. The research included two samples of individuals aged 18 to 65: 782 participants for the assessment of the severity of gambling addiction across different social groups, and 148 participants for the empirical evaluation of a rehabilitation program. The South Oaks Gambling Screen (SOGS) was used as the assessment tool. Research methods included quantitative analysis (descriptive statistics, t-test, ANOVA, multiple regression) and qualitative analysis (thematic analysis of semi-structured interviews in NVivo). The results highlighted the importance of considering social and demographic factors when studying gambling addiction. Men and middle-aged individuals (45-59 years) were found to be most vulnerable to gambling addiction, while women and elderly participants showed lower levels of addiction. Low income and below-average education were associated with higher levels of dependency. The rehabilitation program demonstrated high effectiveness.

PMID:41887939 | DOI:10.1080/00221309.2026.2647742

Head Neck. 2026 Mar 26. doi: 10.1002/hed.70244. Online ahead of print.

ABSTRACT

BACKGROUND: Safety net hospitals (SNHs)-institutions committed to providing care regardless of a patient’s ability to pay-are the primary access point for nearly one-third of the US population. Patients at SNHs consistently present with more advanced-stage head and neck cancer (HNC) and experience significant challenges related to social determinants of health (SDOH), often resulting in delays in diagnosis and treatment initiation. This delay can be associated with decreased overall survival, locoregional control, and an increased risk of recurrence. Thus, we propose utilizing a single-visit multidisciplinary clinic (MDC) to consolidate appointments and create comprehensive treatment plans to help combat systemic issues, reduce time to treatment initiation (TTI), and improve pretreatment speech language pathology (SLP), nutrition, and dental oncology consult completion.

METHODS: This retrospective cohort and quality improvement study was conducted at an urban, publicly funded tertiary care center that functions as the city’s sole SNH. Patients with newly diagnosed squamous cell carcinoma of the head and neck were identified between May 2019 and May 2022. Baseline demographics, ancillary service consultations, and treatment information from our single-institution database were collected. Patients were divided into the pre-MDC cohort and the post-MDC cohort. Primary outcome was TTI while the secondary objective was to improve completion of pretreatment evaluation by SLPs, nutrition oncology, and dental oncology. The MDC was developed using the Plan Do Study Act (PDSA) method for quality improvement and established in June 2021. HNC surgeons, radiation oncologists, medical oncologists, and ancillary services designed a clinic to host a single-day visit to include a needs assessment for treatment optimization, a comprehensive discussion of therapeutic options, and consideration of the SDOH that may present barriers to care.

RESULTS: Sixty-nine patients met the inclusion criteria. Mean age was 59.1 years (range: 34-83), and over 71% of patients were uninsured or Medicaid-insured. The post-MDC cohort was associated with a significant decrease in TTI compared to the pre-MDC cohort (44.1 ± 16.1 vs. 57.4 ± 30.5 days, p = 0.038) and trended toward improvement in those patients undergoing primary chemoradiation therapy (44.9 ± 11.1 vs. 54.9 ± 19.9 days, p = 0.097) and for patients undergoing primary surgical resection (40.0 ± 35.2 vs. 61.0 ± 41.8 days, p = 0.287). In a multivariable analysis, participation in the MDC was the only independent variable associated with a statistically significant shorter TTI in the overall patient population (p = 0.05). We also observed an improvement in pretreatment consult completion including SLP (96.0% vs. 54.5%, p ≤ 0.001), nutrition (96.0% vs. 59.1%, p ≤ 0.001), and pre-radiation therapy dental oncology evaluation (96.0% vs. 59.1%, p ≤ 0.001).

CONCLUSION: Implementation of a single-visit HNC MDC is associated with an improvement in TTI and pretreatment consult referral and completion for patients with HNC in a SNH setting. Our findings underscore the potential of structural care redesign to help facilitate timely care at SNHs. As SNHs continue to absorb a growing share of the HNC care burden, targeted investments in care coordination and infrastructure are critical to help deliver timely, high-quality cancer care.

PMID:41887938 | DOI:10.1002/hed.70244