Nevin Manimala

Ambio. 2025 Nov 27. doi: 10.1007/s13280-025-02278-7. Online ahead of print.

ABSTRACT

Community-based forest management (CBFM) is widely promoted as a strategy that links forest management with local livelihoods through participatory governance. This global review used novel systematic review methods to evaluate predictors of people’s participation in CBFM. Based on 66 cases from 47 studies across 18 countries, we identified 248 predictors that have been used to explain people’s participation in CBFM and categorized them into seven broad categories. While demographics, household size, and landholding size are the most frequently tested, factors such as off-farm household income, leadership style, and forest condition are less commonly tested yet more often statistically significantly related to participation in CBFM. The meta-regression revealed that the specific type of CBFM (the institutional model) moderates the effects of certain predictors. These results highlight the multifaceted and context-specific drivers of participation in CBFM, underscoring the need for both household- and community-level strategies to foster effective forest governance.

PMID:41310143 | DOI:10.1007/s13280-025-02278-7

Eur Radiol. 2025 Nov 28. doi: 10.1007/s00330-025-12186-9. Online ahead of print.

ABSTRACT

OBJECTIVES: Atherosclerotic carotid artery disease (CarAD) is a significant contributor to the global burden of cerebrovascular diseases. Several positron emission tomography computed tomography (PET/CT) radiotracers showed promising results in identifying and assessing vulnerable carotid atherosclerotic plaque. This review aims to assess the current evidence surrounding the use and potential of multiple PET radiotracers in identifying vulnerable carotid atherosclerotic plaque.

MATERIALS AND METHODS: A scoping review of the literature was conducted for original peer-reviewed articles of PET studies published between 2010 and 2024 that used ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG), ¹⁸F-sodium fluoride (¹⁸F-NaF), ¹⁸F-fluoromisonidazole (¹⁸F-FMISO), ⁶⁸Ga-DOTATATE, ⁶⁸Ga-Pentixafor, and ¹¹C-Acetate for the evaluation of vulnerable carotid atherosclerotic plaque. The Covidence platform facilitated the screening of articles and data extraction.

RESULTS: 37 studies matched the inclusion criteria. Seven (19%) included serial dual-tracer PET/CT with ¹⁸F-FDG/¹⁸F-NaF, ¹⁸F-FDG/¹⁸F-FMISO, ¹⁸F-FDG/⁶⁸Ga-DOTATATE, and ¹⁸F-FDG/⁶⁸Ga-Pentixafor. The remaining studies used PET/CT ¹⁸F-FDG (N = 26, 70%), ¹⁸F-NaF (N = 2, 5%), 11C-Acetate (N = 1, 3%) and ⁶⁸Ga-DOTATATE (N = 1, 3%). Substantial variation in PET/CT acquisition parameters such as uptake time (min) [¹⁸F-FDG: 50-180, ¹⁸F-NaF: 60-180, and ⁶⁸Ga-DOTATATE: 60-120], radiotracer dose (MBq) [¹⁸F-FDG: 185-555, ¹⁸F-NaF: 125-370] and analysis methods [target-to-background ratio and/or standardised uptake values] were observed with no clear consensus on what constitutes a standard approach for carotid plaque evaluation using PET/CT.

CONCLUSION: The use of multiple PET radiotracers may provide novel diagnostic insights into the diagnosis of CarAD and improve the identification of vulnerable carotid atherosclerotic plaque. However, protocol heterogeneity affects reproducibility, necessitating standardised imaging parameters and histological validation to enable future clinical use of PET for CarAD assessment.

KEY POINTS: Question Conventional atherosclerotic plaque assessments, focusing on vessel occlusion, lack predictive power for vulnerable carotid atherosclerotic plaque. Can multi-radiotracer PET/CT, targeting plaque metabolic processes, address this? Findings Multi-radiotracer PET/CT demonstrates promising potential in detecting vulnerable carotid atherosclerotic plaque, but variability in data acquisition and analysis methods persists. Clinical relevance This review shows that multi-radiotracer PET/CT may provide novel diagnostic insights for detecting vulnerable carotid atherosclerotic plaque, potentially enhancing risk assessment and identifying patients at higher risk of cerebrovascular events.

PMID:41310133 | DOI:10.1007/s00330-025-12186-9

Gait Posture. 2025 Nov 22;124:110062. doi: 10.1016/j.gaitpost.2025.110062. Online ahead of print.

ABSTRACT

INTRODUCTION: Knee osteoarthritis (KOA) can alter gait biomechanics and neuromuscular activity. Valgus brace (VB) treatment aims to reduce medial compartment loading. While the mechanical efficacy of VBs is well-documented, their effect on neuromuscular deviations in KOA patients remains unclear. This study assesses the potential of VB to modulate altered muscle synergy activation patterns in KOA patients.

METHODOLOGY: Forty participants (twenty KOA, twenty age-matched controls) performed five locomotion tasks: overground walking, ramp and stair ascent / descent. Trials with and without VB were conducted at baseline and after six weeks of regular brace use. Muscle synergies were calculated based on electromyographic data of eight lower limb muscles per side. Inverse dynamics were calculated using marker-based motion capture data. A statistical parametric mapping three-way ANOVA with the factors group affiliation, brace condition, and measurement time point was conducted for each task.

RESULTS: Four synergies were identified across groups, tasks, brace conditions, and time points. The KOA cohort exhibited increased knee flexor synergy activity during early- to mid-stance, increased sagittal trunk flexion, increased hip flexion angles and moments, and decreased knee flexion angles and moments. Brace condition and time point had no effect on synergy activity or sagittal joint moments.

DISCUSSION AND CONCLUSION: Persistently increased hip flexion moments in the KOA group, possibly caused by increased sagittal trunk flexion, appeared to drive elevated activity of the biarticular knee flexor synergy. Increased knee flexor synergy activity can result in elevated knee joint contact forces, potentially aggravating KOA progression. Rather than being caused solely by the need for local stability, increased knee flexor synergy activity may be driven by altered trunk dynamics, which remained unaffected throughout the brace intervention.

PMID:41308271 | DOI:10.1016/j.gaitpost.2025.110062

Physiotherapy. 2025 Sep 9;130:101841. doi: 10.1016/j.physio.2025.101841. Online ahead of print.

ABSTRACT

OBJECTIVES: Behaviour change interventions may support physical activity behaviour in people with chronic respiratory disease. The most effective interventions for long-term physical activity behaviour change in this cohort remains unclear. This aim of this study was to explore the use and perceptions of behaviour change interventions by both providers of physical activity programmes for people with chronic respiratory disease and by people living with chronic obstructive pulmonary disease (COPD) in The Republic of Ireland.

DESIGN: Two anonymous online and paper-copy cross-sectional surveys, piloted and mapped to the COM-B model of behaviour change, were distributed via social media and relevant gate-keepers (e.g Irish Society of Chartered Physiotherapists, COPD Support Ireland) between November 2023 and April 2024. Findings were summarised using descriptive statistics including frequencies, percentages, means and medians. Relationships between variables were investigated using Chi² (p = 0.05).

RESULTS: The response rate to the provider survey was 71% (107/150), and 112 participants responded to the COPD cohort survey. Providers perceived encouragement, pertaining to theoretical constructs such as self-confidence, optimism and reinforcement to be the most effective techniques influencing physical activity behaviour. People with COPD perceived social support, pertaining to theoretical constructs such as interpersonal skills and social identity, to be the most effective interventions influencing their physical activity behaviour. Motivation was frequently identified as a common COM-B component, suggesting important links to this mechanism of action in influencing behaviour.

CONCLUSIONS: Interventions with motivational components are perceived as effective influencers of physical activity behaviour by providers of physical activity programmes and by those living with chronic respiratory disease. CONTRIBUTION OF THE PAPER.

PMID:41308270 | DOI:10.1016/j.physio.2025.101841

Patient Educ Couns. 2025 Nov 23;143:109431. doi: 10.1016/j.pec.2025.109431. Online ahead of print.

ABSTRACT

PURPOSE: The growing prevalence of cancer and of the responsibilities of primary informal caregivers calls for exploring the burden of caregivers. Communication with providers has become a major responsibility of caregivers increasing their burden. Despite the harmful consequences of caregiver burden (CB), little is known regarding mitigators of CB. The perceived high quality of communication with providers may be a mitigator of CB which is yet to be tested. Therefore, this study tests the association of episodic listening behaviors of providers and CB among caregivers of cancer patients. We hypothesize that constructive listening behaviors of nurses will shape the extent of CB.

METHODS: In this cross-sectional study, hospitalized oncology patients gave their consent to approach their informal primary caregivers and requested their consent to participate by completing anonymous questionnaires. Study variables included the Zarit Burden Interview and the abbreviated Constructive and Destructive Listening questionnaires. Statistical analyses used Pearson correlations and multivariable linear regression.

RESULTS: The sample comprised 80 primary caregivers of cancer patients. 65 % were women, 65 % were religious, and the average age was 51 years. Mean CB was 27.21 (SD-16.39). CB was positively associated with destructive listening (r = 0.400, p = 0.000) and negatively associated with constructive listening (r = -0.223, p = 0.000). Multivariable linear regression identified destructive listening as a significant antecedent (β = 0.265; t = 2.007; p = 0.049), explaining 14.7 % of the variance in CB (R² = 0.0192; MS = 568.147; df = 6; F = 2.7; p = < 0.002).

CONCLUSIONS: Although episodic listening is a key component of nursing ethics and fundamental to relationships with patients, caregivers of cancer patients may be ignored. To reduce CB, nurses should eradicate destructive listening and promote constructive listening forging higher quality communication with patients. Insights may guide future research and paths to reduce CB.

PMID:41308256 | DOI:10.1016/j.pec.2025.109431

Biomed Phys Eng Express. 2025 Nov 27. doi: 10.1088/2057-1976/ae250e. Online ahead of print.

ABSTRACT

The study of inter-beat intervals (IBI) and systolic blood pressure (SBP) fluctuations is of public health importance. Here we obtain insights about their underlying dynamics by means of an innovative study of the distribution of their rank-ordered registers, provided by fits to the Discrete Generalized Beta Distribution (DGBD), for healthy subjects and patients with end-stage renal disease (ESRD), under an active standing maneuver. SBP and IBI non-invasive time series were recorded during supine position followed by active standing for nine ESRD patients and eighteen age-matched healthy subjects. Once the data were rank ordered, the three parameter DGBD function was fitted through the Levenberg-Marquardt non-linear algorithm. Taking into consideration the statistical interpretations of the parameters, the quantitative exploration of their dependence with regard to the cases examined and changes in body position provided new insights: i) Evidence for the presence of regulatory mechanisms that preserve the tail symmetry of the IBI distributions in healthy subjects, which are not evident in ESRD patients; ii) The identification of a more pronounced weight of low-magnitude fluctuations at active standing in the SBP time series, manifested as a broader statistical dispersion of blood pressure values; iii) A quantitative determination of a more undermined SBP regulation in ESRD. Overall, a better understanding of the statistical behavior of IBI and SBP time series is achieved by means of the DGBD function. Through the variation of its parameters, the DGBD approach has the potential to become a marker for assessing or even predicting the impairment of cardiovascular control mechanisms.&#xD.

PMID:41308208 | DOI:10.1088/2057-1976/ae250e

Biomed Phys Eng Express. 2025 Nov 27. doi: 10.1088/2057-1976/ae250f. Online ahead of print.

ABSTRACT

Photoplethysmography (PPG) is widely used in wearable health monitors for tracking fundamental physiological parameters (e.g., heart rate and blood oxygen saturation) and advancing applications requiring high-quality signals-such as blood pressure assessment and cardiac arrhythmia detection. However, motion artifacts and environmental noise significantly degrade the accuracy of PPG-derived physiological measurements, potentially causing false alarms or delayed diagnoses in longitudinal monitoring cohorts. While signal quality assessment (SQA) provides an effective solution, existing methods show insufficient robustness in ambulatory scenarios. This study concentrates on PPG signal quality detection and proposes a robust SQA algorithm for wearable devices under unrestricted daily activities. PPG and acceleration signals were acquired from 54 participants using a self-made physiological monitoring headband during daily activities, segmented into 35712 non-overlapping 5-second epochs. Each epoch was annotated with: (1) PPG signal quality levels (good: 10817; moderate: 14788; poor: 10107), and (2) activity states classified as stationary, light, moderate, or vigorous-intensity. The dataset was stratified into training (80%) and testing (20%) subsets to maintain proportional representation. Fourteen discriminative features were extracted from four domains: morphological characteristics, time-frequency distributions, physiological parameter estimation accuracy, and statistical properties of signal dynamics. Four machine learning algorithms were employed to train models for SQA. The random forest (95.6%) achieved the highest accuracy on the test set, but no significant differences (p=0.471) compared to support vector machine (95.4%), naive Bayes (94.1%), and BP neural network (95.1%). Additionally, the classification accuracy showed no statistically significant variations (p=0.648) across light (95.3%), moderate (97.6%), and vigorous activity (100%) when compared to sedentary (95.8%). All features exhibited significant differences (p<0.05) across high/moderate/poor quality segments in all pairwise comparisons.The results indicate that the proposed feature set achieves robust SQA, maintaining consistently high classification accuracy across all activity intensities. This performance stability enables real-time implementation in wearable devices.

PMID:41308204 | DOI:10.1088/2057-1976/ae250f

JMIR Serious Games. 2025 Nov 27;13:e71593. doi: 10.2196/71593.

ABSTRACT

BACKGROUND: Staff working in residential care homes (RCHs) have played a significant role in preventing the spread of infection among residents, visitors, and staff. Providing continuous professional training to the staff is essential. Current infection control training mostly rests on short educational talks or one-to-one reminders in the RCHs. A blended mode of online interactive games and face-to-face consultations was now proposed as a new way to conduct infection control training in the RCHs.

OBJECTIVE: This study aims to assess the efficacy of the Blended Gaming COVID-19 Training System (BGCTS) on infection control practices and self-reported knowledge, attitude, and practices of standard precautions among health care workers in RCHs.

METHODS: A 2-arm, single-blinded, parallel cluster randomized controlled trial was designed, and 30 RCHs were recruited and randomized into an intervention group to receive the BGCTS and a control group to receive usual care on infection control training. Due to the COVID-19 pandemic and infected cases in the homes, 17 RCHs refused or delayed the on-site observations. The BGCTS intervention, developed based on “The COVID-19 Risk Communication Package for Healthcare Facilities” of the World Health Organization, consists of two parts: (1) an eHealth mode of a 120-minute web-based training system covering 8 topics, delivered in short-clip videos and games, and (2) two 30-minute face-to-face interactive sessions for concept clarification. The 2 infection control practices, “use of gloves and personal protective equipment (PPE) and performing respiratory hygiene” and “hand rub,” were assessed by on-site unobtrusive observations, and self-reported infection control practices and knowledge and attitude toward infection control were measured via online survey post intervention.

RESULTS: A total of 212 staff from 13 RCHs were involved in the analysis, with 7 RCHs from the intervention group (n=114) and 6 RCHs from the control group (n=98). A significantly greater increase in the proportions of proper use of gloves and PPE and respiratory hygiene performance (β=.195, 95% CI 0.046-0.344; P=.02) and properly performed hand rub (β=.068, 95% CI 0.005-0.132; P=.04) was observed in the intervention group. The changes in the self-reported outcomes were not statistically significant.

CONCLUSIONS: BGCTS improved RCH staff’s performance in 2 infection control practices by objective measurement, “gloves and PPE use and performance in respiratory hygiene” and “hand rub.” BGCTS was shown to be an effective training, although it was a 2-week intervention. The BGCTS did not perform better than infection control briefing sessions in self-reported infection control knowledge, attitude, and practices. This electronic-based infection control training with 2 intensive interactive sessions has good potential to be adopted as regular training in RCHs.

TRIAL REGISTRATION: Clinicaltrials.gov NCT04783025; http://clinicaltrials.gov/ct2/show/NCT04783025.

PMID:41308187 | DOI:10.2196/71593

Percept Mot Skills. 2025 Nov 27:315125251395108. doi: 10.1177/00315125251395108. Online ahead of print.

ABSTRACT

Visual perception is crucial for successfully executing motor skills in interceptive sports like baseball. Understanding the contribution of visual skills (VS) to baseball performance is essential for talent selection and development. Some evidence suggests that performance on visual tests is predictive of batting performance, though these findings are not consistently replicated across studies. Therefore, the aim of this study is to associate a broad spectrum of visual performance indicators with a set of batting performance variables in highly trained baseball players by combining different methodological approaches used in previous studies. Forty-five highly trained male baseball players from the same club, aged between 15 and 19 years old (mean = 17.25), underwent a thorough battery of visual tests under standardized conditions. Twenty-one variables of VS were collected and associated with ten performance indicators, including game statistics, players’ ranking, age, years of practice, and position. Frequentist correlations and t-tests revealed that 17 out of the 210 associations (8.09%) reached our unadjusted threshold level and thus indicated a positive and statistically significant association. Bayesian analyses identified 34 associations (16.19%) that supported a positive association between VS and performance indicators, but only two of them (0.95%) revealed a moderate level of evidence in favor of the positive association. Therefore, this study provides limited support to the hypothesis that performance on visual tests predicts batting performance. The homogeneity of the sample and potential non-linear relations between visual and batting performance may account for these findings.

PMID:41308178 | DOI:10.1177/00315125251395108

Interdiscip Cardiovasc Thorac Surg. 2025 Nov 27:ivaf281. doi: 10.1093/icvts/ivaf281. Online ahead of print.

ABSTRACT

OBJECTIVES: Increased aortic angulation (AA) is anatomically challenging during transcatheter aortic valve implantation (TAVI) and may affect procedural outcomes. This study evaluates the clinical and procedural impact of aortic angulation in contemporary TAVI procedures.

METHODS: This retrospective single-center observational study included 509 consecutive patients undergoing transfemoral TAVI between January 2021 and December 2024. Primary end-point was device success according to VARC-3 criteria. Secondary end-points included technical success, early safety at 30 days, procedural time, fluoroscopy time, contrast volume, paravalvular regurgitation (PVR) and permanent pacemaker implantation (PPI). Multivariable logistic and linear regression models were used to assess the association between aortic angulation (in degrees) and clinical outcomes. ROC and spline regression analyses were used to evaluate potential threshold effects.

RESULTS: Device success at discharge was achieved in 89.4% (455/509) of patients, technical success in 96.3% (490/509), and early safety at 30 days in 75.6% (385/509). Aortic angulation did not significantly influence device success (aOR: 0.974, 95% CI: 0.938-1.012, p = 0.175), technical success (aOR 1.034; 95% CI 0.980-1.091; P = 0.22), or early safety (aOR: 0.994, 95% CI: 0.968-1.020, p = 0.633). Similarly, no association was observed between aortic angulation and PPI (aOR 1.016; 95% CI 0.984-1.050; P = 0.34) and PVR. However, aortic angulation significantly correlated with increased fluoroscopy times (coefficient: 0.073, SE: 0.026; P = 0.006) and greater contrast usage (coefficient: 0.406, SE: 0.194; P = 0.037).

CONCLUSIONS: While higher aortic angulation increased procedural imaging demand, it did not adversely affect device performance or clinical safety outcomes after TAVI. Importantly, outcomes remained consistent across prosthesis types.

PMID:41308164 | DOI:10.1093/icvts/ivaf281