Nevin Manimala

Stroke. 2026 May 8. doi: 10.1161/STROKEAHA.126.055315. Online ahead of print.

ABSTRACT

BACKGROUND: Preservation of treatment allocation randomness, achievement of treatment group size balance, and balance on prognostic baseline covariates are desirable properties of optimal randomization schemes. Previous studies have demonstrated the accuracy of covariate-adaptive randomizations, such as minimal sufficient balance (MSB) randomization, for achieving covariate balance in acute stroke trials at the end of the trial. This study evaluates the performance of covariate-adaptive randomization techniques against simple and block randomization in minimizing site-specific treatment group imbalance in multicenter acute stroke trials.

METHODS: Monte Carlo simulations were used to evaluate the performance of stratified and unstratified versions of MSB, common scale MSB, and common scale group-size MSB (CSSize-MSB), against permuted block and simple randomization designs, for achieving balance across baseline covariates and sites. Simulation conditions investigated include the number of sites (3, 6, or 20 sites), enrollment per site (equal or unequal enrollment across sites), number and distribution of baseline covariates (sex, age, National Institutes of Health Stroke Scale score, large vessel occlusion status), and sample size (n=250, 600, 1000, 3000). The probability of observing statistically significant imbalance on any baseline covariate, proportion of biased allocations, and overall and site-specific group allocation ratio at interims and end of enrollment were used to evaluate the performance of the randomization schemes.

RESULTS: The average probability of observing imbalance on any of the baseline covariates for the simple randomization, permuted block, common scale MSB, common scale group-size MSB, and MSB were 21%, 21%, 0%, 2%, and 2%, respectively, at n=600 with 20 study sites. Although site-specific treatment allocation imbalance was improved under MSB algorithms, imbalance at low-enrolling sites persisted, regardless of the randomization scheme. Treatment allocation randomness and treatment-control group balance were preserved in high-volume sites under MSB.

CONCLUSIONS: Although site-specific treatment group imbalance persisted in low-enrolling sites, regardless of the randomization technique adopted, the overall randomness of treatment allocation and balance of covariates were preserved with MSB algorithms. Logistical considerations and oversight to minimize low enrollment across sites are recommended before onboarding sites in multicenter acute stroke trials.

PMID:42100801 | DOI:10.1161/STROKEAHA.126.055315

Hum Reprod. 2026 May 8:deag029. doi: 10.1093/humrep/deag029. Online ahead of print.

ABSTRACT

STUDY QUESTION: What updates of the International Glossary on Infertility and Fertility Care are required, to reflect contemporary scientific knowledge, social needs, and inclusive definitions, while harmonizing international communication across clinical, research, policy, and public domains?

SUMMARY ANSWER: This 4th edition presents 348 consensus-based terms and definitions, including numerous revisions from the previous edition and 79 newly introduced definitions reflecting advances in reproductive science, technology, and evolving social contexts.

WHAT IS KNOWN ALREADY: Previous glossary editions (2006, 2009, 2017) established internationally recognized definitions related to clinical practice, research, and policy. The 2017 edition comprised 283 terms and, among many others, expanded the concept of infertility to include not only its recognition as a disease, but also as an impairment of function generating disability. The glossary has been extensively used worldwide and has contributed to international standardization of data collection, appropriate comparison of outcome measures, and provided a reference for all stakeholders including policy makers.

STUDY DESIGN, SIZE, DURATION: Under guidance of the organizing committee, 21 professionals from across the world, and representing expertise in different sub-specialties, formed five working groups: clinical definitions; outcome measures; embryology laboratory; clinical and laboratory andrology; and epidemiology, public health and gender related definitions. The definitions from the previous glossary were evaluated and new terms identified. All definitions were then reviewed by an international advisory panel of nine experts that evaluated the glossary from scientific, ethical, cultural, and policy perspectives.

PARTICIPANTS/MATERIALS, SETTING, METHODS: Between November 2024 and October 2025, periodical virtual meetings were held within and between working groups and the organizing committee. Following circulation of the first consensually agreed draft, a one-day in-person meeting with representatives of all working groups and members of the international advisory panel was held at ESHRE, June 2025. Most terms and definitions were discussed and agreed. In the absence of agreement, further discussions were held between the organizing committee, working group chairs and members of the advisory panel. It had been determined at the outset that final disagreement would be resolved via a two-third majority vote. All terms and definitions were, however, reached by consensus and adopted following a final round of review and approval by all authors.

MAIN RESULTS AND THE ROLE OF CHANCE: The glossary now includes 348 terms. Compared to the previous edition, 14 terms were deleted, numerous terms modified and 79 new terms were added. Modifications reflect current scientific knowledge, technological advancements, and inclusivity related to gender and family structures. Chance does not play a role, as all definitions are consensus-based.

LIMITATIONS, REASONS FOR CAUTION: Some terms may require future refinement as scientific knowledge evolves and societal contexts change. The glossary reflects consensus rather than empirical testing of all definitions.

WIDER IMPLICATIONS OF THE FINDINGS: This glossary provides a global reference for standardized terminology, supporting clinical care, research, international comparisons, policy making, patient communication, and reproductive health literacy.

STUDY FUNDING/COMPETING INTEREST(S): Neither ICMART, responsible for conducting this project, nor any of the participants received specific financial support for their activities in this project. Ferring provided ICMART with a fixed amount to cover venue costs and a one-day hotel accommodation for participants attending the in-person meeting held prior to the ESHRE Congress in June 2025. Disclosures were provided by all authors, and none reported any conflict of interest related to this manuscript.

TRIAL REGISTRATION NUMBER: N/A.

PMID:42100799 | DOI:10.1093/humrep/deag029

Front Psychiatry. 2026 Apr 22;17:1799213. doi: 10.3389/fpsyt.2026.1799213. eCollection 2026.

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the physical and mental health of older adults worldwide. This study aimed to identify the factors associated with depression among older adults during the pandemic and to develop strategies to enhance their psychological well-being.

METHODS: Data from The Irish Longitudinal Study on Ageing (TILDA) collected during the COVID-19 pandemic were compared with pre-pandemic data (Wave 5). We examined the impact of the pandemic on depressive symptoms in older adults and investigated potential influencing factors related to depression, including lifestyle changes, COVID-19 concern and protective behaviors, and psychological assessments.

RESULTS: The prevalence of clinically significant depressive symptoms in older adults was significantly higher after the onset of the COVID-19 pandemic than in the pre-pandemic Wave 5 (p < 0.001). The rates of difficulty falling asleep and early awakening increased significantly, whereas the time spent on anaerobic exercise, aerobic exercise, and slow walking decreased markedly (all p < 0.001). Hierarchical multiple linear regression analysis revealed that the model including predictors such as age, gender, Perceived Stress Scale score, UCLA Loneliness Scale score, difficulty falling asleep, early awakening, sleep duration, days of anaerobic exercise, days of aerobic exercise, and days of slow walking was statistically significant (F = 165.241, p < 0.001, R = 0.734, R² = 0.539, adjusted R² = 0.536), explaining 53.9% of the variance in depressive symptoms.

CONCLUSION: The COVID-19 pandemic might be associated with an increase in depressive symptoms among older adults. This exacerbation is closely linked to lifestyle changes (sleep disturbances and reduced physical activity), psychological factors (heightened stress and loneliness), and certain information-seeking behaviors. These findings underscore the need for integrated interventions that target these modifiable risk factors.

PMID:42100780 | PMC:PMC13143985 | DOI:10.3389/fpsyt.2026.1799213

Front Psychiatry. 2026 Apr 22;17:1811824. doi: 10.3389/fpsyt.2026.1811824. eCollection 2026.

ABSTRACT

INTRODUCTION: The neurobiological mechanisms underlying Attention-Deficit/Hyperactivity Disorder (ADHD) remain incompletely understood. Existing research has identified abnormalities in alpha rhythm among individuals with ADHD; however, its association with core symptoms lacks consistency, suggesting that enhanced alpha activity may represent a state-dependent compensatory manifestation. The family environment, particularly caregiver stress, is recognized as an important external factor influencing the development of children with ADHD, yet its potential role as a mediator between clinical symptoms and neural brain activity has yet to be systematically explored.

METHODS: The study included 59 children with ADHD. Correlations among attention deficit scores (ADS), hyperactivity/impulsivity scores (HIS), various dimensions of caregiver strain, and posterior alpha power were analyzed, with Bonferroni correction applied to control for multiple comparisons. Subsequently, hierarchical regression and mediation modeling were employed to examine the mediating effect of caregiver strain.

RESULTS: No direct correlation was found between ADS and alpha power. A triangular pattern among symptoms, stress, and brain activity emerged: ADS showed strong positive correlations with all dimensions of caregiver strain, and subjective internalized strain (SIS) remained significantly positively correlated with alpha power even after correction. The mediation model indicated a suppression pattern, wherein the statistical association between ADS and alpha power was consistent with a positive indirect pathway via SIS, alongside a masked direct association, resulting in a non-significant total effect.

DISCUSSION: The findings suggest a model in which SIS is a key statistical mediator in the relationship between ADHD symptoms and specific neural oscillatory patterns, and highlight the plasticity of brain function in response to the family emotional environment.

PMID:42100769 | PMC:PMC13143875 | DOI:10.3389/fpsyt.2026.1811824

Dialogues Health. 2026 Apr 21;8:100305. doi: 10.1016/j.dialog.2026.100305. eCollection 2026 Jun.

ABSTRACT

PURPOSE: This study aimed to evaluate oral and dental health status, hygiene practices, and access to dental care among adults living in Gaza, Khan Younis, and the central governorates of Palestine.

METHODS: A descriptive cross-sectional survey was conducted in 2025 among 39 adults aged ≥18 years residing in the study regions. Data were collected using a structured questionnaire (14 closed-ended and 4 open-ended questions) addressing oral hygiene habits, healthcare access, living conditions, and perceptions of dental services. The survey was administered via Google Forms. Descriptive statistics were used, and categorical variables were presented as frequencies and percentages.

RESULTS: The study included 39 participants (48.7% women, 51.3% men). None reported adequate access to nutritious food. A high proportion (89.7%) experienced toothache within the last two years. The most common response was self-management with analgesics (71.6%), while other strategies included visiting a health facility (28.6%), tooth extraction (28.6%), and use of traditional remedies (28.6%). A small proportion (5.7%) reported taking no action. Only 46.2% had visited a dentist in the last two years. Open-ended responses highlighted key challenges, including lack of hygiene supplies (25.6%), limited access to dental services (20.5%), financial constraints (5.1%), poor nutrition (5.1%), and ongoing oral health problems (5.1%).

CONCLUSION: Findings indicate a substantial burden of untreated oral conditions and limited access to dental care in a conflict-affected population. Oral health needs should be integrated into humanitarian health responses to ensure access to preventive and essential dental services.

PMID:42100760 | PMC:PMC13146592 | DOI:10.1016/j.dialog.2026.100305

Health Sci Rep. 2026 May 5;9:e72487. doi: 10.1002/hsr2.72487. eCollection 2026 May.

ABSTRACT

BACKGROUND AND AIMS: The first 28 days of life, the neonatal period, represent a phase of heightened vulnerability for infant survival globally. Despite advancements in medical interventions and increased healthcare access, a substantial number of newborns continue to succumb to preventable causes annually. This study aimed to ascertain the time to death and its associated factors among neonates admitted to the Neonatal Intensive Care Unit (NICU) at Tibebe Ghion Specialized Hospital, Ethiopia.

METHODS: A retrospective follow-up design was employed, encompassing 385 neonates admitted to the NICU of Tibebe Ghion Specialized Hospital between September 11, 2022 and September 5, 2023. Data were extracted from patient records using a standardized checklist. The outcome was time to death, with surviving neonates considered censored. Data were analyzed using STATA version 17. Kaplan-Meier survival curves analyses were used to estimate the probability of death over time. A Cox proportional hazards model was utilized to identify independent predictors of neonatal mortality. Variables with a p value < 0.05 in the multivariable Cox regression were deemed statistically significant at a 95% confidence interval.

RESULTS: Among the 385 neonates, 12.73% experienced mortality, yielding an incidence rate of 43.80 deaths per 1000 neonatal days (95% CI: 0.03-0.06). The median time to death for neonates was 7 days (95% CI: 6.00, 8.00). After multivariable adjustment, respiratory distress syndrome (Adjusted Hazard Ratio [AHR]: 3.00; 95% CI: 1.27-7.75), congenital anomalies (AHR: 2.90; 95% CI: 1.42-5.91), very low birth weight (AHR: 2.50; 95% CI: 1.18-5.28), and gestational diabetes mellitus (AHR: 4.00; 95% CI: 1.76-9.67) were identified as significant independent predictors of neonatal death.

CONCLUSION: The incidence of neonatal mortality observed in this setting was notable. Respiratory distress syndrome, congenital anomalies, very low birth weight, and gestational diabetes mellitus were found to be independently associated with an increased risk of neonatal death.

PMID:42100758 | PMC:PMC13144749 | DOI:10.1002/hsr2.72487

Health Sci Rep. 2026 May 5;9:e72493. doi: 10.1002/hsr2.72493. eCollection 2026 May.

ABSTRACT

INTRODUCTION: Traditional fish smoking in Abuesi, Ghana, exposes workers, primarily women, to significant health risks due to prolonged smoke inhalation. This study evaluates the knowledge, attitudes, and practices (KAP) concerning safe smoking methods. It examines the prevalence of eye conditions among these fish smokers to assess their awareness of health risks and document the impact of extended exposure to smoke.

METHODS: A cross-sectional design was employed involving 320 fish smokers from Abuesi. Data collection was conducted through structured interviews and detailed eye examinations. Statistical analysis included chi-square tests and logistic regression models, were used to explore relationships between exposure duration and health outcomes.

RESULTS: Most participants were women, mostly between the ages of 30 and 65. While nearly 90% were aware of the health risks linked to smoke exposure, fewer than 30% followed recommended safety practices, which shows a significant gap between what they knew and what they did. Many self-reported health concerns, including mild vision problems (about 22%), moderate impairments (just under 2%), and even cases of blindness (around 3%) were reported. Other frequently mentioned symptoms included breathing difficulties (66%), persistent headaches (58%), and eye irritation (49%). Importantly, the analysis showed that participants with greater awareness were 21% more likely to take safety precautions and 13% less likely to suffer from eye conditions, suggesting that knowledge does have a protective effect when it is acted upon.

CONCLUSION: The study highlights a critical disparity between knowledge and the implementation of safety measures among fish smokers in Abuesi. The results underscore the need for targeted educational programs and intervention strategies to reduce health risks among traditional fish smokers.

PMID:42100753 | PMC:PMC13144757 | DOI:10.1002/hsr2.72493

iScience. 2026 Apr 15;29(5):115753. doi: 10.1016/j.isci.2026.115753. eCollection 2026 May 15.

ABSTRACT

Ayahuasca refers to an entheogenic brew and its main vine, Banisteriopsis caapi, whose high morphological diversity underlies traditional folk classifications. This study evaluated whether machine learning algorithms can recover folk classifications using images of dried leaves. We analyzed 47 vine plants, mainly B. caapi folk types and Diplopterys cabrerana as an outgroup, using adaxial and abaxial leaf image features related to color, shape, texture, and filters. All evaluated algorithms showed statistically similar performance; however, support vector machine (SVM) achieved the highest accuracy, reaching 70% overall and over 90% for the folk types Hybrid and Arara, and the related outgroup species D. cabrerana. Lower accuracy in Cabi and Quebrador reflects morphological overlap. Confusion matrix and similarity network analyses showed only partial agreement with previous ethnobotanical classifications. Focusing on subtle variation within a single species, this study demonstrates that integrating traditional knowledge with machine learning enables automated validation of folk taxonomies.

PMID:42100741 | PMC:PMC13145879 | DOI:10.1016/j.isci.2026.115753

Geohealth. 2026 May 6;10:e2025GH001501. doi: 10.1029/2025GH001501. eCollection 2026 May.

ABSTRACT

Extreme heat has been associated with adverse health outcomes, yet its impact on asthma exacerbations remains understudied. This is, in part, due to data limitations: research that relies on weather station records and aggregated health statistics cannot resolve fine-scale differences in heat impacts. This study investigates the association between heat wave definitions and summertime asthma-related emergency department visits in Baltimore, Maryland from 2016 to 2022, including 819 adult and 695 pediatric exacerbations. Using geocoded electronic health records and air temperature measurements at several spatial resolutions, we applied a case-crossover design with conditional logistic regressions at the census block group and tract levels. We found strong associations between asthma exacerbations and nighttime heat wave definitions based on relative thresholds of minimum temperatures when census block group or tract level temperature estimates were used. These relationships were significant for both age groups and showed elevated risks in socially vulnerable areas. In contrast, heat wave definitions derived from the city’s primary National Weather Service synoptic weather station show associations between asthma and daytime heat extremes, suggesting that the character of the heat hazard depends on the scale at which it is defined. The extreme heat event definition used by Baltimore City’s Code Red system showed no significant association with exacerbations. These findings highlight the importance of data resolution in shaping health inferences related to extreme heat in urban environments. Further, this study demonstrates that, regardless of spatial scale, extreme heat is associated with asthma exacerbations in both age groups.

PMID:42100719 | PMC:PMC13147955 | DOI:10.1029/2025GH001501

Front Microbiol. 2026 Apr 22;17:1815688. doi: 10.3389/fmicb.2026.1815688. eCollection 2026.

ABSTRACT

INTRODUCTION: Staphylococcus species, particularly Staphylococcus aureus, are leading opportunistic pathogens responsible for a wide range of infections, with antimicrobial resistance-including high rates of macrolide resistance-severely limiting treatment options. The msrA gene encodes the ABC-F protein MsrA, which mediates inducible resistance to 14-membered macrolides and type B streptogramins. Despite its clinical and epidemiological relevance, the evolutionary forces, selective pressures, and transmission routes shaping msrA in staphylococci remain insufficiently understood.

METHODS: Six hundred and one complete staphylococcal msrA coding sequences (CDSs) were retrieved from GenBank. Evolutionary analyses of msrA included nucleotide diversity (π), selection metrics (d_N-d_S , π_a/π_s, Tajima’s D, Fu’s Fs, FUBAR, MEME, and aBSREL), and conservation mapping using DnaSP in relation to MsrA functional domains (UniProt P23212). Linkage disequilibrium (LD) was assessed using ZnS, Za, ZZ, and Wall’s statistics. Recombination and transmission pathways were inferred using GARD, RDP4-embedded algorithms, SplitsTree network analysis, and the PHI test.

RESULTS: Forty-one msrA allelic variants were determined, with five predominant alleles accounting for approximately 90% of CDSs; allele 19 was almost exclusive to S. aureus. Nucleotide diversity was moderate (π ≈ 0.039-0.042), and strong purifying selection predominated (π_a/π_s ≈ 0.169; d_N-d_S = -0.138 ± 0.016; strongly negative Fu’s Fs), with only four codons showing evidence of episodic positive selection. Three highly conserved regions were identified, mainly overlapping the inter-domain linker and the second nucleotide-binding domain across MsrA. Moderate-to-high LD with minimal decay indicated the persistence of only a limited number of successful allelic variants. Predominant msrA alleles were largely plasmid-associated. Recombination analyses revealed frequent interspecies transfer within Staphylococcus, with S. aureus acting as a central donor to Staphylococcus chromogenes and Staphylococcus saprophyticus, as well as rare intergeneric transfers involving Citrobacter, Enterococcus, Corynebacterium, and Pseudomonas.

CONCLUSION: These findings support a dual evolutionary strategy for msrA: strong purifying selection preserves its essential ribosomal-protection function, while plasmid-mediated dissemination promotes the spread of fit alleles. S. aureus appears to be a key reservoir and vector, facilitating both interspecies and intergeneric transmission. Clinically, this underscores the need for surveillance of plasmid-borne msrA and targeted control of S. aureus reservoirs to limit resistance to macrolides and type B streptogramins.

PMID:42100691 | PMC:PMC13144154 | DOI:10.3389/fmicb.2026.1815688