Nevin Manimala

Sci Rep. 2026 Jul 5. doi: 10.1038/s41598-026-59887-9. Online ahead of print.

ABSTRACT

Craniomaxillofacial (CMF) reconstruction is interdisciplinary, requiring precise coordination between neurosurgeons, oral and maxillofacial surgeons, and nursing teams. Despite its importance, standardized interdisciplinary nursing protocols for neurosurgical patients undergoing CMF reconstruction are lacking, leading to variable care quality and increased complications. This study aimed to evaluate the association between standardized interdisciplinary nursing protocols and clinical outcomes in this patient population. This study aimed to evaluate adherence to interdisciplinary nursing procedures, identify nursing-related risk factors, and explore the association between standardized protocols and clinical outcomes. This multicenter retrospective pre-test/post-test study included 152 patients from five tertiary hospitals treated between 2018 and 2023. Patients were divided into a pre-optimization group (n = 76) and a post-optimization group (n = 76). We applied propensity score matching (1:1 nearest-neighbor, caliper 0.2 SD) to balance baseline characteristics and multilevel mixed-effects models to account for center-level clustering. Data on neurosurgical nursing records such as postoperative infection prevention, position management, swallowing function assessment via Kubota Drinking Test, oral and maxillofacial prosthodontic nursing records, and clinical outcomes were extracted and analyzed. The overall compliance rate for interdisciplinary nursing was associated with significant improvement in the post-optimization group compared to the pre-optimization group (81.6% vs. 42.1%, p < 0.001; Cohen’s h = 0.80, 95% CI: 0.52-1.08). In propensity score-matched analyses (n = 128), standardized protocols remained associated with reduced implant-related infections (OR = 0.38, 95% CI: 0.16-0.91, p = 0.031) and shorter swallowing recovery (mean difference = -4.6 days, 95% CI: -7.8 to -1.4, p = 0.006; Cohen’s d = 1.69). In the full cohort, standardized protocols were associated with direction-consistent reductions in implant-related infections (18.4% vs. 7.9%, p = 0.029; Bonferroni-adjusted p = 0.232) and swallowing function recovery (14.2 ± 3.1 days vs. 9.1 ± 2.5 days, p = 0.012; Bonferroni-adjusted p = 0.096). In continuous compliance analysis, each 10% increase in protocol adherence was associated with a 24% reduction in infection risk (OR = 0.76, 95% CI: 0.65-0.89, p < 0.001) and a 0.58-day reduction in swallowing recovery time (p < 0.001). Patient satisfaction scores were significantly higher in the post-optimization group (4.2 ± 0.5 vs. 3.5 ± 0.7, p = 0.001), which survived Bonferroni correction (adjusted alpha = 0.00625). Multivariate analysis identified non-compliance with oral care (OR = 3.26), delayed rehabilitation training (OR = 2.89), and lack of specialized nurse training (OR = 2.54) as independent factors associated with infections. Six Sigma optimization further improved prosthetic cleaning stability and reduced process defects by 72.3%. Standardized interdisciplinary nursing protocols were associated with improved procedure compliance and enhanced patient satisfaction, which survived correction for multiple comparisons. Direction-consistent but statistically exploratory associations were observed for reduced implant-related infections and accelerated swallowing recovery. While the retrospective design limits causal inference, these findings provide a foundation for developing interdisciplinary nursing guidelines and inform future prospective research in this complex patient population.

PMID:42402655 | DOI:10.1038/s41598-026-59887-9

Sci Rep. 2026 Jul 5;16(1):20571. doi: 10.1038/s41598-026-60367-3.

ABSTRACT

A validated HPTLC densitometric approach was employed for the simultaneous determination of Cefazolin (CFZ), Sulfadimidine (SDD), and Marbofloxacin (MFC) residues in milk. The method utilizes a mobile phase composed of ethyl acetate, methanol, and triethylamine in a 50:30:1 v/v/v ratio, with detection carried out at 270 nm. The chromatographic conditions were carefully optimized, and the retardation factor (R_f) values for CFZ, MFC, and SDD were 0.29, 0.58, and 0.73, respectively. Sample preparation included protein precipitation with acetonitrile, followed by dispersive solid-phase extraction (dSPE) using Enhanced Matrix Removal-Lipid (EMR-L) tubes to remove interfering lipids. Validation in accordance with ICH Q2(R2) guidelines demonstrated excellent linearity for all analytes over the concentration range of 0.001-0.09 µg/band. Accuracy was confirmed by recovery values between 98.19% and 99.15%. The proposed method was successfully applied to the determination of the investigated drug residues in real cattle milk samples following the withdrawal period, showing no statistically significant differences in accuracy and precision compared to previously reported HPLC method. Furthermore, sustainability evaluation using multiple greenness assessment tools (Eco-scale score of 77, AGSA score of 75%, BAGI score of 77.5, and RGB12 score of 85.2) demonstrated that the method is excellent green.

PMID:42402651 | DOI:10.1038/s41598-026-60367-3

Sci Rep. 2026 Jul 5. doi: 10.1038/s41598-026-59439-1. Online ahead of print.

ABSTRACT

Reliable estimation of the confined compressive strength of fiber-reinforced polymer (FRP)-wrapped concrete is essential for the safe design and assessment of strengthened structural members. This study proposes an adaptive neuro-fuzzy inference system (ANFIS) model to predict the confined compressive strength of FRP-confined circular concrete cylinders. The model is trained using the Levenberg-Marquardt backpropagation algorithm, combined with an early-stopping strategy, to enhance generalization and prevent overfitting. Four physically meaningful parameters-unconfined compressive strength, cylinder diameter, FRP thickness, and FRP elastic modulus-are employed as input variables, while the confined compressive strength is taken as the output. A comprehensive database of 812 experimental results from the literature was compiled and used for model training, validation, and testing. The predictive capability of the proposed ANFIS framework was evaluated against five widely used analytical confinement models using statistical performance indicators. The developed model demonstrated superior predictive consistency and reduced scatter relative to existing confinement equations, indicating improved reliability across a broad range of strengths. The results confirm that the proposed ANFIS approach provides a stable and practical tool for estimating the confined compressive strength of FRP-wrapped concrete, supporting preliminary structural assessment and strengthening design applications.

PMID:42402639 | DOI:10.1038/s41598-026-59439-1

BMC Nutr. 2026 Jul 6. doi: 10.1186/s40795-026-01420-2. Online ahead of print.

ABSTRACT

BACKGROUND: Porphyromonas gingivalis (P. gingivalis) is a vital pathogen that can increase mortality. However, whether serum carotenoids, commonly known antioxidants, modify the association of serum P. gingivalis immunoglobulin G (IgG) antibody levels with mortality remains uncertain. We aimed to explore the modification of this association by serum carotenoids.

METHODS: The associations of serum P. gingivalis IgG levels with mortality among 7,043 participants from the Third U.S. National Health and Nutrition Examination Survey were assessed. The modifications of serum carotenoids on the associations were also examined. We used the recommended sampling weights to account for the complex survey design. Surveycox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and specific-cause mortality.

RESULTS: We identified 2,646 deaths during a median follow-up period of 25.8 years. Compared with participants with low serum P. gingivalis IgG levels (< 69 EU), those with high levels (≥ 69 EU) were associated with an HR (95% CI) of 1.10 (1.04-1.16) for all-cause mortality. Similar results were found in mortality analyses for cardiovascular disease, cerebrovascular disease, and diabetes mellitus (all P < 0.05). Notably, significant interactions were detected between the serum α-carotene, β-carotene, or lutein/zeaxanthin concentrations and the serum P. gingivalis IgG levles on all-cause mortality (all P_int < 0.05). Compared with high P. gingivalis IgG participants with low carotenoids, low P. gingivalis IgG participants with high carotenoids had the lowest risk of all-cause mortality, with HR of 0.74 (0.68-0.80) for α-carotene, 0.78 (0.72-0.86) for β-carotene, 0.70 (0.64-0.76) for β-cryptoxanthin, 0.79 (0.73-0.85) for lutein/zeaxanthin and 0.64 (0.59-0.69) for lycopene, respectively.

CONCLUSION: Serum carotenoids mitigate the associations between serum P. gingivalis IgG levels and mortality.

PMID:42402631 | DOI:10.1186/s40795-026-01420-2

BMC Psychol. 2026 Jul 6. doi: 10.1186/s40359-026-05123-y. Online ahead of print.

ABSTRACT

BACKGROUND: Psychological distress and subjective well-being are increasingly recognized as related but distinct dimensions of mental health that may influence academic outcomes in higher education. Consistent with the dual-continuum perspective of mental health, few studies have simultaneously examined how these dimensions relate to academic experiences and university dropout intention within a single analytical framework. This study aimed to analyze the relationships among psychological distress, subjective well-being, and university dropout intention, while examining indirect statistical associations involving academic burnout and satisfaction with education within the proposed model.

METHODS: A cross-sectional study was conducted with 614 undergraduate students from a private university in Cali, Colombia, selected through proportional stratified sampling. Data were collected using the Depression, Anxiety, and Stress Scale (DASS-21), the WHO-5 Well-Being Index, and the Screening Instrument for Students At-Risk of Dropping Out. Structural equation modeling (SEM) with a weighted least squares mean and variance adjusted (WLSMV) estimator was used to test direct and indirect relationships. Model fit was assessed using CFI, TLI, RMSEA, and SRMR.

RESULTS: The final model showed good fit (CFI = 0.998; TLI = 0.998; RMSEA = 0.044; SRMR = 0.051) and explained a substantial proportion of variance in university dropout intention (R² = 0.764). Academic burnout was strongly associated with university dropout intention (β = 0.900, p < .001), while satisfaction with education showed a negative association (β = -0.175, p < .001). Psychological distress was positively associated with academic burnout (β = 0.322, p < .001), and subjective well-being was negatively associated (β = -0.117, p = .011). No significant direct associations were found between mental health variables and university dropout intention; however, academic burnout emerged as the principal academic-experience correlate associated with dropout intention and was involved in the indirect statistical associations observed between mental health indicators and university dropout intention. Indirect associations involving satisfaction with education were not statistically significant.

CONCLUSION: Academic burnout emerged as the primary academic correlate associated with university dropout intention within the proposed model. By simultaneously considering psychological distress and subjective well-being, this study extends the application of the dual-continuum perspective of mental health to the context of university dropout intention. These findings highlight the relevance of considering both dimensions of mental health alongside academic experiences when examining university dropout intention. Because of the cross-sectional design, the observed relationships should be interpreted as statistical associations rather than causal effects and warrant further investigation in longitudinal studies.

PMID:42402620 | DOI:10.1186/s40359-026-05123-y

Matern Health Neonatol Perinatol. 2026 Jul 6;12(1):30. doi: 10.1186/s40748-026-00275-6.

ABSTRACT

BACKGROUND: Mistreatment during childbirth remains a barrier to maternal health in low-resource settings.

OBJECTIVE: To assess the prevalence of mistreatment during childbirth and its associated factors among women in public health facilities of Ilubabor Zone, Southwest Ethiopia, 2025.

METHODS: A facility-based cross-sectional study was conducted from August to October 2025 among 470 women using multistage sampling and interviewer-administered questionnaires. Data were analyzed with descriptive statistics and multivariable logistic regression.

RESULTS: Mistreatment during childbirth was reported by 68.1% (95% CI: 63.9-72.3%) of women. Verbal insults, denial of mobility during labor, refusal of pain relief, and lack of consent for procedures were the most common forms. Significant factors included low maternal education (AOR = 7.10, 95% CI: 3.71-13.58), observed provider burnout (AOR = 3.30, 95% CI: 2.14-5.10), and high provider workload (AOR = 2.70, 95% CI: 1.80-4.06).

CONCLUSION: High prevalence of mistreatment was observed, driven by low maternal education and multiple provider- and system-level factors. Enhanced training, staffing, and community education are urgently needed.

PMID:42402616 | DOI:10.1186/s40748-026-00275-6

Trop Med Health. 2026 Jul 5. doi: 10.1186/s41182-026-01016-3. Online ahead of print.

ABSTRACT

BACKGROUND: Diphtheria remains a life-threatening disease in low-resource settings where immunization coverage is poor and access to a laboratory is limited. Somalia is currently experiencing a resurgence of clinically suspected diphtheria among children, yet detailed case-level clinical data remain scarce. The purpose of this study was to illustrate clinical features, vaccination status, complications, and early outcomes of pediatric diphtheria in a resource-limited Somali hospital. Furthermore, it identified the factors associated with severity and mortality for enhanced early recognition and management.

METHODS: A prospective observational study was conducted, including 51 pediatric patients aged < 18 years admitted with clinically diagnosed diphtheria to a tertiary referral hospital in Somalia between January 2025 and December 2025. Diagnosis was based on WHO clinical criteria due to the absence of local laboratory capacity. Demographic, clinical, treatment, and outcome data were collected prospectively. The requirement for pediatric intensive care unit admission defined disease severity. Statistical comparisons between severe and non-severe cases used appropriate parametric or non-parametric tests, and univariable logistic regression explored predictors of severity and mortality. Statistical significance was set at p < 0.05. This study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to guarantee transparent, thorough, and consistent demonstration of the observational methods and results.

RESULTS: Fifty-one children met the clinical case definition (median age 6.0 years; 52.9% male). Classical airway manifestations were frequent: pseudomembrane (88.2%), bull neck (88.2%), stridor (58.8%), and airway obstruction (52.9%). Vaccination coverage was extremely low, with only 9.8% having received any diphtheria-containing vaccine. Systemic complications included neuritis in 47.1% and myocarditis in 19.6%. Eleven patients (21.6%) required PICU admission and were classified as severe. Toxin-mediated complications strongly predicted severity: myocarditis (72.7% in severe vs 5.0% non-severe) and neuritis (100% vs 32.5%). Eight children died (overall case-fatality rate: 15.7%), all in the PICU cohort. Mortality was highest among children with myocarditis (50.0%) and neuritis (33.3%), and all deaths occurred in unvaccinated children. Univariable logistic regression revealed that toxin-mediated problems such as myocarditis and neuritis were robust predictors of severe disease and mortality (p < 0.05), whereas the classical airway features and vaccination status were not substantial.

CONCLUSION: Clinically diagnosed pediatric diphtheria in Somalia is characterized by profound under-immunization, high rates of classical airway features, significant toxin-mediated complications, and substantial mortality. Early identification of severe illness is essential, particularly recognition of cardiac and neurological involvement. Strengthening immunization programs, ensuring timely diphtheria antitoxin availability, and expanding critical care capacity are urgent priorities to improve outcomes.

PMID:42402610 | DOI:10.1186/s41182-026-01016-3

Clin Epigenetics. 2026 Jul 5. doi: 10.1186/s13148-026-02197-8. Online ahead of print.

ABSTRACT

BACKGROUND: Mitochondrial metabolism-driven epigenetic modifications have emerged as crucial regulators for acute myeloid leukemia (AML) progression, linking metabolic activity in leukemic stem cells to epigenetically controlled transcriptional programs that drive oncogenic gene expression.

RESULTS: Here, by integrating proteomic and transcriptomic data, we identified six genes whose expression were able to predict outcome in AML. Among these, IDH3B was highly expressed in leukemic stem cells and associated with poor prognosis. Functional studies revealed that IDH3B deletion in KMT2A-rearranged AML increased global protein succinylation, reduced acetylation, and sensitized cells to the menin-KMT2A inhibitor, both in vitro and in vivo. Mechanistically, loss of IDH3B, by increasing histone succinylation and reducing H3K79 methylation at the MYC promoter, amplified Revumenib-induced transcriptional repression of MYC.

CONCLUSIONS: These findings establish IDH3B as a key metabolic-epigenetic regulator in AML and highlight it as a potential synergistic target to enhance menin inhibition therapy.

PMID:42402603 | DOI:10.1186/s13148-026-02197-8

BMC Med Educ. 2026 Jul 6. doi: 10.1186/s12909-026-09841-0. Online ahead of print.

ABSTRACT

This study examines whether undergraduate students in an introductory statistics course report different learning outcomes and experiences based on whether they use code-based or non-code-based statistical software. The sample included 2,241 students enrolled in courses using the Passion-Driven Statistics curriculum across 61 post-secondary institutions. Seventy-two percent of participants learned a code-based platform (R, SAS, Stata, Python), while 27.6% learned a non-code-based platform (SPSS, Excel, JMP, StatCrunch). Mixed-effects cumulative logit and logistic regression models were used to compare outcomes between groups while accounting for clustering of students within courses and adjusting for student demographics and academic background. Students in code-based courses had higher odds of reporting that they worked harder and found the course more challenging than those in non-code-based courses. At the same time, learning a code-based platform was positively associated with perceived gains in analyzing data for patterns, greater excitement about learning new concepts, and increased interest in conducting research. However, students learning code-based software reported feeling less prepared for advanced disciplinary coursework or thesis work. Overall, the results suggest that learning to work with code is associated with greater engagement and interest in data-driven work, even as it introduces greater challenges. These findings highlight the potential value of incorporating code-based statistical tools into undergraduate curricula while also underscoring the importance of supporting students through the initial learning curve.

PMID:42402579 | DOI:10.1186/s12909-026-09841-0

BMC Public Health. 2026 Jul 6. doi: 10.1186/s12889-026-28394-x. Online ahead of print.

ABSTRACT

BACKGROUND: Health perception mismatch is common in older adults, yet its longitudinal patterns and prognostic value remain unclear. This study aimed to identify distinct mismatch trajectories and their associations with depression, cognitive decline, and mortality.

METHODS: Data from three longitudinal ageing cohorts-the China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS)-were used to identify health perception mismatch trajectories and evaluate their associations with depression, cognitive impairment, and mortality. Baseline SRH-ADL/IADL interplay was examined within these longitudinal cohorts, while the National Health and Nutrition Examination Survey (NHANES) was retained as an independent external cross-sectional comparison. Associations were evaluated using multivariable regression, structural equation modeling, inverse probability of treatment weighting, causal forests, random-effects meta-analysis, and counterfactual prediction.

FINDINGS: Baseline analyses in CHARLS, ELSA, and HRS showed heterogeneous and generally modest SRH-ADL/IADL additive interaction estimates, while NHANES provided an independent external cross-sectional comparison. Three stable perception mismatch trajectories, Mildly pessimistic, Mildly optimistic, and Highly optimistic, were consistently identified across CHARLS, ELSA, and HRS. Despite reporting better SRH, individuals in the Highly optimistic group had poorer baseline health and higher subsequent risks of depression, cognitive decline, and mortality. Counterfactual prediction analyses indicated 13-18% differences in mortality and depression risk between hypothetical trajectory contrasts, with the largest differences observed between the mildly pessimistic and highly optimistic classes, suggesting that discordantly favorable SRH may mark elevated risk.

INTERPRETATION: Health perception mismatch trajectories may help identify older adults at elevated health risk. Discordantly optimistic perceptions may mark underlying vulnerability, suggesting that combining subjective and objective assessments could complement existing approaches to risk stratification. However, these observational findings do not establish that modifying health perceptions or trajectory membership would alter subsequent outcomes.

PMID:42402575 | DOI:10.1186/s12889-026-28394-x