Nevin Manimala

Psychol Med. 2025 Nov 25;55:e358. doi: 10.1017/S003329172510264X.

ABSTRACT

BACKGROUND: Ecological momentary assessment (EMA) is increasingly recognized as a vital tool for tracking the fluctuating nature of mental states and symptoms in psychiatric research. However, determining the optimal sampling rate – that is, deciding how often participants should be queried to report their symptoms – remains a significant challenge. To address this issue, our study utilizes the Nyquist-Shannon theorem from signal processing, which establishes that any sampling rate more than twice the highest frequency component of a signal is adequate.

METHODS: We applied the Nyquist-Shannon theorem to analyze two EMA datasets on depressive symptoms, encompassing a combined total of 35,452 data points collected over periods ranging from 30 to 90 days per individual.

RESULTS: Our analysis of both datasets suggests that the most effective sampling strategy involves measurements at least every other week. We find that measurements at higher frequencies provide valuable and consistent information across both datasets, with significant peaks at weekly and daily intervals.

CONCLUSIONS: Ideal frequency for measurements remains largely consistent, regardless of the specific symptoms used to estimate depression severity. For conditions in which abrupt or transient symptom dynamics are expected, such as during treatment, more frequent data collection is recommended. However, for regular monitoring, weekly assessments of depressive symptoms may be sufficient. We discuss the implications of our findings for EMA study optimization, address our study’s limitations, and outline directions for future research.

PMID:41287919 | DOI:10.1017/S003329172510264X

Int J Surg. 2025 Nov 24. doi: 10.1097/JS9.0000000000004104. Online ahead of print.

ABSTRACT

BACKGROUNDAIMS: Current binary definition of early allograft dysfunction (EAD) was not sufficiently accurate for discriminating clinical outcomes after liver transplantation (LT). We investigated the clinical heterogeneity among EAD sub-criteria and explored the necessity of dividing EAD into different stages to grade the severity of graft dysfunction.

METHODS: 1242 LT patients from 5 centers were included. EAD patients were divided as i) EAD-type-A: only AST/ALT criteria; ii) EAD-type-B: bilirubin or INR criteria; iii) EAD-type-C: meeting two or three EAD sub-criteria. Peri-operative clinical complications and survival outcomes were compared.

RESULTS: Three-month early graft failure (EAF) from non-EAD to EAD-type-C were 1.6%, 3.5%, 12.8% and 29.6%. EAD-type-B and EAD-type-C were significantly associated with higher rates of AKI, RRT, in-hospital death, longer hospital stay, ICU stay, ventilator support time, and inferior one-year survival outcomes(P<0.001); However, there were no statistical differences between EAD-type-A and non-EAD (P>0.05). New EAD classification with three stages was proposed to grade EAD severity: a)EAD-stage-I: only ALT/AST≥2000 U/L within POD7; b)EAD-stage-II: only bilirubin 10-30 mg/dL or INR≥1.6 on POD7; c)EAD-stage-III: bilirubin≥30 mg/dL; both bilirubin≥10 mg/dL and INR≥1.6 on POD7. Clinical outcomes and survival rates deteriorated following EAD stages. New EAD classification had an excellent discrimination (AUROC = 0.84, CI 0.81-0.86) in determining EAF, superior to binary EAD definition (AUROC = 0.73, CI 0.70-0.77) and MEAF (AUROC = 0.76, CI 0.73-0.79) (P<0.001), while similar to L-GrAFT-7(AUROC = 0.87, CI = 0.84-0.90 P>0.05). Consistent with findings in derivation cohort, external validation confirmed its excellent discrimination of graft dysfunction and 3-month EAF.

CONCLUSIONS: Different EAD sub-criteria had significantly different clinical outcomes. EAD definition should be further reclassified with different severities. New EAD classification with 3 stages could be serve as an effective tool to accurately grade the severity of EAD and identify patients in high risk of early graft failure.

PMID:41287877 | DOI:10.1097/JS9.0000000000004104

Int J Surg. 2025 Nov 25. doi: 10.1097/JS9.0000000000003891. Online ahead of print.

ABSTRACT

BACKGROUND: While the relationship between adult obesity and dysfunction-associated steatotic liver disease (MASLD) is well-established, the impact of childhood obesity remains unclear. We aimed to comprehensively characterize the causal effect and genetic relationships of child obesity-related exposures at different ages and MASLD.

METHODS: Using summary statistics from large-scale genome-wide association studies (GWAS) of child obesity-related traits and MASLD in European-ancestry populations, we performed LDSC and SUPERGNOVA to quantify overall and local genetic correlations, respectively. Univariable Mendelian randomization (UVMR) analysis infers causal relationships. Genomic structural equation modeling (GenomicSEM) and multivariable Mendelian randomization (MVMR) estimated independent genetic correlations and causal effects of each obesity-related trait on MASLD. A two-step MR analysis investigated the mediating pathway from childhood obesity to MASLD through adult obesity.

RESULT: We observed a positive genetic correlation between BMI at age 5 and MASLD ( = 0.45, P-value = 0.01), and a similar correlation for BMI at age 7 ( = 0.44, P-value = 0.044). A significant negative genetic correlation was identified between birth weight and MASLD ( = – 0.23, P-value = 4.4 × 10-8). UVMR indicated increased MASLD risk was associated with overall obesity (OR ivw = 1.40, 95% CI = 1.22, 1.62) and obesity at age 8 (OR ivw = 1.34, 95% CI = 1.01, 1.78). Birth weight had a protective effect (OR ivw = 0.69, 95% CI = 0.61, 0.78). The birth weight effect estimate attenuated to null after collectively adjusting for lifestyle factors in MVMR (OR = 1.05, 95%CI = 0.98-1.12). Mediation analysis showed that this masking effect was mediated by adult obesity.

CONCLUSION: These findings suggest that the association between childhood obesity at different ages and MASLD may differ, indicating a contribution of childhood obesity to MASLD risk and confirmed that sustained obesity into adulthood is the mediating pathway.

PMID:41287864 | DOI:10.1097/JS9.0000000000003891

Int J Nurs Educ Scholarsh. 2025 Nov 26;22(1). doi: 10.1515/ijnes-2025-0047. eCollection 2025 Jan 1.

ABSTRACT

OBJECTIVES: Nurse educators play a vital role in supporting disadvantaged nursing students, especially in rural areas. This project implemented innovative strategies including full scholarships, academic support, and mentorship panels featuring rural nurse leaders role models to improve student success at a rural public university in the Midwest U.S.

METHODS: Disadvantaged students-including those from low-income households, first-generation college backgrounds, and rural underserved communities-encounter substantial barriers to successfully completing nursing programs. To address these challenges, targeted interventions are essential to support their admission, retention, graduation, and transition into employment, particularly in rural and medically underserved communities (MUCs). This study analyzed admission, retention and graduation outcomes of 73 scholarship recipients. An online survey evaluated the effectiveness of various support strategies.

RESULTS: Admission and retention outcomes for disadvantaged nursing students improved substantially over the course of the project. Admission rates increased more than fourfold, rising from a baseline of 5 % in 2019 to 24.3 % by 2025. Among the 73 disadvantaged scholarship recipients, the retention rate reached 88 %, and all graduates achieved a 100 % pass rate on the RN licensure examination. Student feedback also reflected that 95.2 % of participants rating the mentorship panels as “very effective”.

CONCLUSION: Scholarships and structured academic and social support programs improved disadvantaged students’ success, contributing to a more diverse and competent nursing workforce. Holistic support, equity-focused access, and alignment with underserved community needs offer a practical framework for international nursing education to strengthen workforce diversity and reduce health disparities.

PMID:41287863 | DOI:10.1515/ijnes-2025-0047

Hum Vaccin Immunother. 2025 Dec;21(1):2591463. doi: 10.1080/21645515.2025.2591463. Epub 2025 Nov 25.

ABSTRACT

New treatment strategies are needed for patients who relapse during or following first-line immune checkpoint inhibitor-based treatment for esophageal squamous cell carcinoma (ESCC). Second-line immune checkpoint inhibitors (ICI) rechallenge aims to reactivate the immune system’s response to tumor cells and may improve the prognosis of patients who progressed during or after completing previous treatment. The purpose of this study is to explore the effectiveness and safety of second-line ICI rechallenge therapy in the treatment of advanced ESCC. We retrospectively reviewed the records of patients with advanced ESCC at the Department of Oncology of Jiangsu Cancer Hospital (January 2021 to June 2023) who had at least one measurable lesion at progression after first-line immunotherapy, received at least two cycles of second-line treatment, and who had subsequently undergone radiographic response assessment. The primary outcomes of interest were the progression-free survival (PFS)and overall survival (OS). Treatment-related adverse events were also recorded. In the ICI rechallenge and non-ICI rechallenge groups, the objective response rate (ORR) was 15.4% and 11.8%, the disease control rate (DCR) was 67.6% and 44.1% (P = .011). Compared with the non-ICI rechallenge group, median PFS2 in the ICI rechallenge group was significantly prolonged (5.63 vs. 3.03 months, hazard ratio [HR] = 0.45, 95% confidence interval [CI]: 0.28, 0.73; P = .001), while there was no statistically significant difference in median OS (12.33 vs. 7.10 months, HR: 0.80, 95% CI: 0.51, 1.27; P = .344). ICI rechallenge therapy and radiotherapy administered during second-line treatment were recognized as independent predictive factors influencing PFS2. These findings suggest that second-line ICI rechallenge is tolerable and could benefit a subset of patients with advanced ESCC.

PMID:41287859 | DOI:10.1080/21645515.2025.2591463

PeerJ. 2025 Nov 20;13:e20146. doi: 10.7717/peerj.20146. eCollection 2025.

ABSTRACT

OBJECTIVE: This meta-analysis aimed to explore the effects of multi-component exercise interventions on glycemic and lipid metabolism, physical fitness, and cognitive function in individuals with type 2 diabetes mellitus (T2DM).

METHODS: From inception to December 28, 2024, PubMed, Web of Science, Cochrane, and Elsevier databases were systematically searched for randomized controlled trials (RCTs) investigating multi-component exercise interventions for T2DM. A total of 37 articles, comprising 3,201 participants, were included. Primary and secondary outcome measures were categorized, summarized, and analyzed using RevMan 5.4 software.

RESULTS: Compared to control groups, multi-component exercise interventions produced statistically significant improvements across all measured outcomes in individuals with T2DM: (1) Glycemic control: HbA1c (standard mean difference (SMD) = -0.52, 95% confidence interval (CI) [-0.76 to -0.28]); fasting blood glucose (SMD = -0.53, 95% CI [-0.93 to -0.12]). (2) Lipid metabolism: high density lipoprotein (HDL) (SMD = 0.32, 95% CI [0.21-0.44]); low density lipoprotein (LDL) (SMD = -0.21, 95% CI [-0.33 to -0.09]); triglycerides (SMD = -0.18, 95% CI [-0.30 to -0.06]). (3) Physical fitness: upper limb strength (SMD = 0.67, 95% CI [0.51-0.83]); lower limb strength (SMD = 0.56, 95% CI [0.10-1.02]); peak oxygen consumption (SMD = 0.62, 95% CI [0.31-0.93]); body mass index (BMI) (SMD = -0.38, 95% CI [-0.67 to -0.09]). (4) Cognitive function: overall cognitive performance (SMD = 0.34, 95% CI [0.18-0.50]). (5) Quality of life: vitality (SMD = 0.37, 95% CI [0.09-0.64]); physical functioning (SMD = 0.48, 95% CI [0.20-0.75]); mental health (SMD = 0.35, 95% CI [0.07-0.63]); general health (SMD = 0.34, 95% CI [0.06-0.61]). Quality assessment indicated that the included studies were of high overall quality. Egger’s regression analysis did not reveal significant publication bias.

CONCLUSIONS: Multi-component exercise interventions significantly improved glycemic and lipid metabolism, physical fitness, and cognitive function in individuals with T2DM. These findings support the clinical value of incorporating multi-component exercise programs-particularly those performed at least three times per week and lasting 6 months or longer-into diabetes management strategies.

PMID:41287857 | PMC:PMC12640639 | DOI:10.7717/peerj.20146

PeerJ. 2025 Nov 20;13:e20414. doi: 10.7717/peerj.20414. eCollection 2025.

ABSTRACT

BACKGROUND: Virtual care can increase access to healthcare and improve provider efficiency; however, many healthcare providers lack formal education in virtual care delivery, including skills in virtual communication, physical examination adaptations, confidentiality, and billing procedures. This training gap can result in reduced confidence and suboptimal patient care. To address this, an asynchronous continuing professional development (CPD) module was developed. The objective of this study was to evaluate the module’s efficacy regarding satisfaction and changes in knowledge and confidence.

METHODS: The module covered key topics such as virtual visit etiquette, technology troubleshooting, adapted physical examinations, documentation, and remuneration processes. Interactive features included embedded videos, knowledge-check quizzes, and reflective questions. A single-group pre-post quasi-experimental design was used to evaluate its impact. Data were collected via electronic surveys administered at three time points (before, during, and post-module). Surveys included multiple choice questions assessing objective knowledge, and Likert-scale questions assessing confidence levels in virtual care delivery. Open-ended short answer questions captured qualitative feedback. Quantitative data were analyzed using descriptive statistics and paired t-tests or Wilcoxon signed-rank tests where appropriate. Qualitative data were analyzed thematically to identify learner-reported strengths and areas for improvement.

RESULTS: A total of nine to 22 learners responded at each time point. Respondents were heterogeneous, with most identifying as male (66.7%), general practitioners (55.6%), practicing in hospital settings (55.6%), and in communities of 2,000 to 10,000 people (55.6%). Learners reported high satisfaction with the module’s content relevance, navigation, and interactive components, but requested more interactive components (e.g., case-based learning). Statistically significant improvements were observed in confidence levels (n = 20-21; p < 0.001 to 0.009) and objective knowledge scores (n = 20-22; p = 0.046).

CONCLUSION: This evaluation study demonstrated that the asynchronous virtual care module had a statistically significant impact on objective knowledge and confidence, in addition to having positive satisfaction ratings. Limitations include the small sample size and lack of long-term follow-up to assess sustained practice change. However, these findings support the incorporation of asynchronous, virtual modules into CPD curricula to enhance provider competencies in virtual care delivery. Future directions include integrating additional case-based and specialty-specific content, as well as exploring the module’s scalability for other health professions to promote interprofessional virtual care training.

PMID:41287853 | PMC:PMC12640642 | DOI:10.7717/peerj.20414

PeerJ. 2025 Nov 20;13:e20088. doi: 10.7717/peerj.20088. eCollection 2025.

ABSTRACT

BACKGROUND: The 2023-24 El Niño event caused extreme marine heat stress and widespread coral bleaching. Coral reefs at the Reserva Biológica Isla del Caño and the northern coast of the Osa Peninsula, Costa Rica, underpin critical ecosystem services, including biodiversity conservation and marine tourism, and have previously withstood similar events with minimal coral loss. Evaluating the ecological impacts of the 2023-24 El Niño is essential to assess coral reef resilience and guide future management.

METHODS: Coral Reef Watch sea surface temperature (SST) data (1985-2025; CoralTemp V3.1) were used to calculate long-term SST trends and degree heating weeks (DHW). Reef surveys were conducted at nine sites between 2019 and 2025, with primary benthic composition and coral health data collected in 2024-25. Benthic cover was assessed using point-intercept, line-intercept, and quadrat methods, while coral diversity, abundance, and health were measured via belt transects. Beta regression was used to assess the effect of temperature on coral cover, and multivariate analyses, including principal component analysis (PCA) and similarity percentage analysis (SIMPER), evaluated benthic community changes and bleaching patterns. An Ecological Recovery Feasibility Index (ERFI) was developed using PCA loadings and benthic indicators to rank sites by recovery potential.

RESULTS: SST increased significantly over the past 40 years (∼0.23 °C/decade), with the 2023-24 El Niño recording peak SST (31.2 °C). Bleaching threshold exceedance days increased, while cool days declined. Twelve coral taxa were recorded; Pocillopora spp. and Porites lobata were present at all sites. Coral diversity varied, with Cueva and Ancla highest, and San Josecito lowest. Estimated baseline bleaching prevalence was ∼23%, highest in Pocillopora spp. (33.9%). SIMPER and PCA revealed a shift from coral to algal dominance: turf algae increased by 70.62%, dead coral declined 80.71%, and coral cover fell 40.44%. Major coral declines were statistically significant at Ancla, Esquina, and Tina. Bayesian regression confirmed coral decline at Chorro, Cueva, Tina, and Ancla, alongside turf algae increases. Coral cover was higher at warmer sites, though non-temperature site-specific factors were also influential. Chorro and Esquina had the highest recovery potential; Ancla, San Josecito, and Barco Profundo the lowest.

CONCLUSION: There is an urgent need to develop and implement a coral reef restoration strategy for Isla del Caño that addresses site-specific conditions, integrates tourism management, and promotes long-term resilience. Under continued climate change, localized, targeted restoration will be essential to maintain the ecological function of these historically resilient but increasingly vulnerable reefs in Costa Rica’s Eastern Tropical Pacific.

PMID:41287849 | PMC:PMC12640635 | DOI:10.7717/peerj.20088

PeerJ. 2025 Nov 20;13:e20361. doi: 10.7717/peerj.20361. eCollection 2025.

ABSTRACT

BACKGROUND: Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycaemia, affecting various metabolic processes and leading to multiple complications, particularly in wound healing. This study aims to evaluate the impact of diabetes on the healing of extraction sockets in non-diabetic, prediabetic, and type 2 diabetic patients in Saudi Arabia.

METHODOLOGY: A prospective observational study was conducted with 72 participants who were divided equally (n = 24 for each group) into three groups, viz. non-diabetic, prediabetic, and diabetic groups based on glycated hemoglobin (HbA1c) and random blood glucose levels. Tooth extractions were performed by an experienced maxillofacial surgeon. Healing outcomes were assessed by measuring extraction socket size, post-operative pain, discharge, swelling, infection, erythema, dry socket occurrence, and analgesic consumption over one week. Initially descriptive statistics were calculated and one way Analysis of Variance (ANOVA) test was done to compare the reduction in socket size between groups. The level of statistical significance was set at P ≤ 0.05.

RESULTS: Out of 275 screened participants, 104 provided informed consent, and 72 completed the study. Significant differences were found in socket size reduction, with non-diabetic patients showing a 62.5% reduction, prediabetic 56.4%, and diabetic 48.6% (p < 0.001). Diabetic patients experienced more post-operative pain (p = 0.039) and a higher incidence of complications such as swelling, infection, and discharge, although not statistically significant (p = 0.141).

CONCLUSION: Diabetes significantly affects post-operative healing in dental extractions, leading to less socket size reduction, higher pain levels, and increased complications. These findings underscore the necessity for specialized post-operative care for diabetic patients, including stringent infection control and pain management strategies. Further research with larger sample sizes and extended follow-up periods is recommended to better understand the long-term impacts of diabetes on oral health.

PMID:41287847 | PMC:PMC12640633 | DOI:10.7717/peerj.20361

F1000Res. 2025 Sep 9;14:805. doi: 10.12688/f1000research.167786.2. eCollection 2025.

ABSTRACT

BACKGROUND: Effective performance monitoring is essential for improving academic productivity, especially in private higher education institutions. This study aimed to establish the perception of academic staff toward performance monitoring and how these perceptions influence academic staff performance in private chartered universities in Western Uganda. Guided by Expectancy Theory and Self-Determination Theory, the study explored how monitoring practices affect motivation and performance outcomes.

METHODS: A convergent parallel mixed-methods design was employed. The quantitative strand involved 386 academic staff selected from five private chartered universities using stratified random sampling. Data were collected using structured questionnaires. In the qualitative strand, semi-structured interviews were conducted with 10 purposively selected Deans of Faculties. Quantitative data were analyzed using descriptive statistics, Pearson correlation, and regression analysis, while qualitative data were analyzed thematically.

RESULTS: Findings revealed that 58.2% of academic staff had a moderately positive perception of existing performance monitoring practices. Pearson correlation analysis showed a moderate positive relationship between perception of performance monitoring and academic staff performance (r = .476, p < 0.01). Regression analysis further indicated that perception of performance monitoring significantly predicted academic staff performance (β = 0.394, p = 0.000), explaining 18.7% of the variance (R ² = 0.187). Qualitative data revealed challenges such as irregular feedback, lack of transparency, and limited involvement of academic staff in developing performance indicators.

CONCLUSIONS: The study concludes that academic staff performance can be enhanced when performance monitoring systems are perceived as fair, transparent, and participatory. It recommends the standardization of performance evaluation procedures, improved feedback mechanisms, and the active involvement of academic staff in setting performance targets. Strengthening these areas could improve motivation, engagement, and overall academic performance in private universities across the region.

PMID:41287836 | PMC:PMC12640481 | DOI:10.12688/f1000research.167786.2