Nevin Manimala

Front Med (Lausanne). 2026 May 14;13:1829842. doi: 10.3389/fmed.2026.1829842. eCollection 2026.

ABSTRACT

INTRODUCTION: The comparative impact of Minimally Invasive Cardiac Surgery versus median sternotomy on the interplay between peripheral muscle strength, kinesiophobia, and functional capacity remains unclear. This study compared these parameters in the early postoperative period.

METHODS: Forty-six patients (30 Sternotomy, 16 Minimally Invasive Cardiac Surgery) were included in this prospective study. Peripheral muscle strength (handgrip and knee extension), functional capacity (30-Second Sit-to-Stand test), and kinesiophobia (Tampa Kinesiophobia Scale) were assessed preoperatively and on the postoperative 5th day.

RESULTS: Both groups experienced a significant decline in postoperative muscle strength from baseline; however, there was no statistically significant difference between the groups regarding the magnitude of this decline (e.g., right handgrip p = 0.366, right knee extension p = 0.294). However, the Minimally Invasive Cardiac Surgery group demonstrated superior functional performance in the 30-Second Sit-to-Stand test (p = 0.008) and significantly lower increases in kinesiophobia scores compared to the sternotomy group (p = 0.008). A significant negative correlation was found between kinesiophobia and functional capacity (r = -0.311, p = 0.035).

CONCLUSION: Although Minimally Invasive Cardiac Surgery does not mitigate surgery-associated muscle strength decline, it offers a distinct advantage in preserving functional capacity by minimizing kinesiophobia. Functional limitations after sternotomy appear driven more by movement-related fear than muscle weakness. Consequently, rehabilitation strategies should integrate kinesiophobia management to optimize early mobilization and functional independence.

CLINICAL TRAIL REGISTRATION: ClinicalTrials.gov, identifier (NCT07172529).

PMID:42221065 | PMC:PMC13216003 | DOI:10.3389/fmed.2026.1829842

Front Big Data. 2026 May 15;9:1799073. doi: 10.3389/fdata.2026.1799073. eCollection 2026.

ABSTRACT

Inventory management is a critical business process that affects the operational efficiency and competitiveness of manufacturing companies. Inaccurate inventory decisions can result in significant financial losses for companies. Demand variability poses a challenge in determining inventory levels, requiring more sophisticated, flexible forecasting methods. This study was conducted to examine the roles of statistical methods and Artificial Intelligence (AI) in inventory decision-making in the manufacturing industry, analyze the conditions under which each method is suitable, and evaluate the potential of a hybrid approach integrating statistical methods and AI. This study uses the Systematic Literature Review method with the PRISMA 2020 framework to ensure research transparency and accuracy. This study identifies articles from reputable databases indexed in Scopus. The findings show a significant shift in inventory management research. In the last decade, AI technology has dominated the literature at 62.5%, while statistical methods account for 25%, and hybrid methods have begun to emerge but remain limited to 12.5%. Based on the review of selected papers, statistical methods have proven to remain effective for consistent historical data and stable demand patterns. Conversely, in dynamic operational environments with large-scale data and complex nonlinear patterns, AI technology is superior. This study also found that the hybrid approach has great potential to balance accuracy, interpretability, and decision support, although the relevant literature remains limited. The implementation of technology in the manufacturing industry faces several obstacles, including limited data quality, a skills gap in technology, and the black-box nature of complex AI. This review provides a systematic and critical synthesis of methodological patterns and operational fit in the use of statistical, AI, and hybrid methods for manufacturing inventory management. Future research is recommended to focus on the development of interpretable AI, modular hybrid frameworks, and the use of real industry data to ensure that academic innovations can be applied in the manufacturing industry.

PMID:42221062 | PMC:PMC13218985 | DOI:10.3389/fdata.2026.1799073

J Med Educ Curric Dev. 2026 May 29;13:23821205261450082. doi: 10.1177/23821205261450082. eCollection 2026 Jan-Dec.

ABSTRACT

BACKGROUND: Clear communication and cohesive teamwork are critical for ensuring safe, high-quality patient care, especially within the demanding environment of the labor ward. Pakistan faces some of the worst pregnancy outcomes globally. The TeamSTEPPS® is a validated curriculum for teaching interprofessional communication to healthcare professionals. Given the unique contexts of maternity care in Pakistan, there is a need to test the effectiveness of the TeamSTEPPS® program in interprofessional team involved in provision of care.

METHODS: This quasi experimental study was conducted at Services Institute Medical Sciences/Services hospital Lahore, Pakistan. All the nursing students, pharmacist, obstetric, anesthesia and pediatric residents posted in labour room for two months were included. A core team of faculty taught the participants using TeamSTEPPS® framework. Participants knowledge, perceptions and attitudes were checked pre-training, one week and one month post-training using TeamSTEPPS® questionnaire of Teamwork Attitudes Questionnaire, Teamwork Perceptions Questionnaire and learning benchmarks. Team performance using Team Performance Observation Tool was also assessed after a month by simulation scenarios. Data were entered and analyzed using SPSS version 25. Descriptive statistics were used to summarize demographic characteristics and Chi-square test was applied to evaluate the association between pre- and post-intervention scores related to attitude, perception, benchmark and team performance. P-value of less than 0.05 was considered statistically significant.

RESULTS: Total of 25 participants were imparted training. Significant improvements in team knowledge were seen in understanding the role of a team leader, shared mental model identifying the best method for conflict resolution at one week and one month post training (P<0.05). Changes in attitudes was observed in Team Structure, leadership and communication after one month (p<0.05). The intervention was effective in enhancing perceptions of team structure, situation monitoring, mutual support, and communication (p<0.05). The team performance assessment showed that all teams scored from acceptable to excellent implying that training had positive impact on their ability to work as interprofessional team.

CONCLUSION: The study demonstrated improvements in knowledge, attitudes, perceptions, and observed behaviors of healthcare professionals, affirming the relevance and effectiveness of structured teamwork training in a maternity care setting. This advocates for integration of TeamSTEPPS® into medical curricula, institutional policy, and national health programs.

PMID:42221058 | PMC:PMC13221585 | DOI:10.1177/23821205261450082

Tob Induc Dis. 2026 May 28;24. doi: 10.18332/tid/219364. eCollection 2026.

ABSTRACT

INTRODUCTION: Previous studies have established a link between marital relationship quality and smoking cessation behavior, but the mediating role of nicotine dependence has not been fully explored. The purpose of this study was to explore the association between marital satisfaction and willingness to quit smoking, and to test the mediating role of nicotine dependence in this association.

METHODS: This study was conducted among students in grades 1 to 5 at 17 pilot elementary schools in Qingdao, China. It is a cross-sectional analysis study that collected data in July 2022. The sample consisted of families in which the father smoked and the mother did not. Researchers underwent standardized training before data collection. Parents were screened, and both spouses completed corresponding questionnaires, ultimately yielding 950 valid matched questionnaires. Structural equation modeling using AMOS was employed to test the mediating effect of nicotine dependence.

RESULTS: Path analysis revealed that marital satisfaction was negatively associated with nicotine dependence (β= -0.091; 95% CI: -0.172 – -0.014). Willingness to quit smoking was positively related to marital satisfaction (β=0.063; 95% CI: 0.001-0.129) and negatively associated with nicotine dependence (β= -0.394; 95% CI: -0.469 – -0.314). Moreover, the indirect effect of willingness to quit smoking on marital satisfaction via nicotine dependence was positive and statistically significant (β=0.036; 95% CI: 0.006-0.072). Bootstrap mediation tests revealed statistically significant direct and mediating effects, with the mediating effect accounting for 36.36% of the variance.

CONCLUSIONS: The results supported that nicotine dependence had a mediating effect between marital satisfaction and willingness to quit smoking.

PMID:42221057 | PMC:PMC13218405 | DOI:10.18332/tid/219364

Tob Induc Dis. 2026 May 28;24. doi: 10.18332/tid/220358. eCollection 2026.

ABSTRACT

INTRODUCTION: Although smoking is not an effective coping mechanism, it is a common behavior among university students experiencing psychological distress, but limited research has examined its psychological determinants in multicultural university settings. This mixed-methods study investigated the relationship between smoking behavior and the mental toughness scale.

METHODS: A convergent mixed-methods cross-sectional study design was conducted between March and June 2025 among 280 immigrant students at the University of Bologna. Eligible participants were students aged 18-30 years, currently enrolled in a study program, able to communicate in English or Italian, and without chronic conditions affecting smoking behavior. Quantitative data assessed demographic characteristics, smoking patterns, and mental toughness, assessed using the Mental Toughness Questionnaire (MTQ-18), which evaluates control, commitment, challenge, self-confidence, and underlying psychological and migration-related stressors. Qualitative data were obtained through semi-structured interviews exploring emotional coping, cultural adaptation, and smoking motivations. Data were analyzed separately and integrated during interpretation.

RESULTS: Among the 280 participants, 42.86% were smokers and 57.14% were nonsmokers. No statistically significant associations were found between smoking status and demographic variables, including gender (χ²=0.66, p=0.417), age (χ²=6.70, p=0.152), parental smoking (χ²=0.00, p=1.000), and sibling smoking (χ²=0.07, p=0.789). Most smokers reported low to moderate cigarette consumption (1-10 cigarettes per day). Across all mental toughness dimensions, smokers demonstrated lower mean scores compared to non-smokers. For instance, overall mental toughness scores were lower among smokers (males: 2.57; females: 2.31) compared to non-smokers (males: 3.84; females: 3.74). Qualitative findings highlighted key psychological stressors, including identity disruption, anxiety, academic pressure, and social isolation, which contributed to smoking behavior as a perceived means of emotional regulation.

CONCLUSIONS: Smoking behavior among immigrant students is shaped primarily by psychological vulnerability and migration-related stress rather than demographic characteristics. Integrating mental health support, stress-management resources, and culturally responsive interventions into smoking prevention programs may be essential for reducing smoking in immigrant student populations.

PMID:42221056 | PMC:PMC13218404 | DOI:10.18332/tid/220358

Intractable Rare Dis Res. 2026 May 31;15(2):194-199. doi: 10.5582/irdr.2026.01011.

ABSTRACT

There is controversial evidence that some selected congenital anomalies (CA) are associated with sex, maternal age, urban-rural residence, or socioeconomic status among the Hispanic population. This study aimed to assess the prevalence and maternal-child clinical and socioeconomic factors across a wide range of CA in a hospital-based setting from northwest Mexico. From January to December 2023, a cross-sectional study for CA and live births at Durango General Hospital was performed. Hospital-based prevalence was calculated for all CA subtypes and grouped anatomical system defects. Associations with CA and subgroup analysis were conducted to assess newborn sex, maternal age, residence, and socioeconomic factors on CA prevalence, using Pearson’s chi-squared test and Fisher’s exact test. Probability of CA was estimated based on logistic regression analysis along with odds ratio (OR) and its 95% confidence interval. All tests were two-sided with p values < 0.05 considered statistically significant. A total of 6,784 newborns and 306 CA were assessed (hospital-based prevalence 4.5%). Males, maternal age < 20 and ≥ 35 years, urban residence, and lowest socioeconomic status were associated with CA (all OR > 1.0 and p < 0.05). Subgroup analysis indicated associations between males and cardiovascular and genitourinary defects; maternal age < 20 years and craniofacial and abdominal defects; maternal age ≥ 35 years and digestive and chromosomal abnormalities; mother’s urban residence and craniofacial, cardiovascular, genitourinary, and abdominal defects; socioeconomic levels D-E and craniofacial and cardiovascular defects (all OR > 1.0 and p < 0.05). These findings reflect noticeable components associated with several CA and might be relevant for prevention and maternal-child health.

PMID:42221043 | PMC:PMC13220133 | DOI:10.5582/irdr.2026.01011

Clin Ophthalmol. 2026 May 25;20:593122. doi: 10.2147/OPTH.S593122. eCollection 2026.

ABSTRACT

PURPOSE: To compare the effect of surgical sequence during combined excisional KDB goniotomy using the Kahook Dual Blade (KDB) and phacoemulsification.

METHODS: In this prospective comparative randomized cohort we included patients that underwent combined phacoemulsification and excisional KDB goniotomy with KDB. Eye were randomized into 2 groups: group PG underwent phacoemulsification followed by KDB goniotomy and GP KDB followed by phacoemulsification.

RESULTS: A total of 47 patients (59 eyes) were included: 27 eyes (46%) in group PG and 32 eyes (54%) in GP. Post-operative efficacy outcomes were comparable for IOP, number of medications, decrease in IOP at all the follow-up periods regardless of surgical sequence. Post-operative IOP and number of medications significantly decreased in both groups. Surgical success was achieved in 82% and 73% of eyes at 6- and 12-month follow-up respectively. Postoperative hyphema at day 1 was more frequent in group PG (52% vs. 19%, p=0.008). This difference did not reach statistical significance at day 7 (26% vs. 13%, p=0.16).

CONCLUSION: Combined Phacoemulsification-KDB KDB goniotomy has a good safety and efficacy profile. If KDB goniotomy is performed before phacoemulsification, the occurrence of early postoperative hyphema is significantly lower without affecting surgical success in terms of IOP decrease and reduction in glaucoma medication.

PMID:42221037 | PMC:PMC13220826 | DOI:10.2147/OPTH.S593122

Clin Ophthalmol. 2026 May 23;20:561121. doi: 10.2147/OPTH.S561121. eCollection 2026.

ABSTRACT

PURPOSE: To investigate the possible influence of repeated anti-VEGF injections on vascular metrics measured by optical coherence tomography angiography (OCTA) in patients with age-related macular degeneration (AMD).

METHODS: This retrospective longitudinal study included AMD patients with a follow-up time of at least 18 months from 2019 to 2024. Swept-source OCTA was performed on all eyes. Based on whether an eye received injections or not during follow-up, all eyes were divided into two groups (non-injection group only included non-exudative AMD). Vessel density, Vessel skeleton density in the superficial, deep, and retina slab, as well as foveal avascular zone (FAZ) size, circularity and perimetry of Angio 6mm×6mm were calculated. Change in vascular metrics between baseline and last follow-up were compared between the two groups using t-test or Mann-Whitney U-test. Correlation between change in vascular metrics and visual acuity was investigated by Spearman’s Rank Correlation test.

RESULTS: A total of 164 eyes from 107 patients were included. The average follow-up time was 34 months. No statistically significant difference in baseline vascular metrics was detected between the injection group (57 eyes) and non-injection (107 eyes) group. The injection group received 12.56 injections during follow-up. Among all the parameters, only change in FAZ size during follow-up showed a statistically significant difference between the two groups (0.03 vs. 0.02 mm², P=0.043). No correlation was found between change in vascular metrics and change in visual acuity (P>0.05).

CONCLUSION: In this retrospective longitudinal study of 164 eyes, repeated intravitreal anti-VEGF injections were associated with no relevant significant changes in OCTA vascular metrics over time.

PMID:42221036 | PMC:PMC13217431 | DOI:10.2147/OPTH.S561121

Front Pediatr. 2026 May 14;14:1819033. doi: 10.3389/fped.2026.1819033. eCollection 2026.

ABSTRACT

BACKGROUND: In pediatric oncology, randomized clinical trials are an integral part of standard treatment. Because enrollment typically must occur before therapy begins, families receive trial information shortly after diagnosis and must provide consent within a brief time frame. The informed consent process therefore often takes place while parents are experiencing emotional stress, have limited medical knowledge, and have little opportunity to reflect on or discuss the available treatment options, as stipulated by good clinical practice.

OBJECTIVE: To gain insight into parents’ experiences of the informed consent process and their motivations for participating in a randomized clinical trial.

METHODS: A Nordic survey using a study-specific questionnaire was conducted. Parents of children enrolled in the NOPHO-DBH AML 2012 and B-NHL 2013 protocols responded. A multimethod approach was applied. Quantitative data were analyzed using descriptive statistics and factor analysis, while qualitative data were analyzed thematically.

RESULTS: In total, parents of 72 children (60 single mothers, 32 single fathers, and 8 couples) participated, yielding 100 complete questionnaires. The two protocol groups were similar in sample size, with 49 participants from AML 2012 and 51 from B NHL 2013. Factor analysis identified three factors and one single-item indicator. No statistically significant differences were found between the protocols for any of the variables examined: Influence of information provided (Factor 1; p = .570), Emotional influences (Factor 2; p = .308), Influence on decision-making (Factor 3; p = .017), and Perceived impact on care in the event of non-participation (Indicator; p = .174). The qualitative results illuminate the parents’ motivation for enrollment which comprise three themes: Opportunities and risks associated with new treatment, Contributing to research and helping others, Information and strain in the situation.

CONCLUSION: This study contributes to a broader understanding of parents’ experiences of the informed consent process within the context of standard treatment practice in pediatric oncology. Despite making decisions under considerable emotional pressure, most parents reported satisfaction with the information provided and did not express regret regarding their enrollment decision. The findings underscore the importance of communication practices that support parents’ comprehension and decision-making during the consent process.

PMID:42221007 | PMC:PMC13216218 | DOI:10.3389/fped.2026.1819033

Front Pediatr. 2026 May 14;14:1814290. doi: 10.3389/fped.2026.1814290. eCollection 2026.

ABSTRACT

BACKGROUND: Acquired external auditory canal stenosis (EACS) is a major cause of conductive hearing loss in children and adults, with multiple etiologies including otological surgical procedures, blunt trauma, and chronic inflammatory diseases, which can lead to persistent hearing loss and other adverse outcomes. Due to children’s unique anatomical fragility and strong tissue proliferative capacity, the clinical management of EACS remains challenging.This study aims to explore the clinical characteristics, optimal surgical approaches and prognostic factors of traumatic EACS in children, so as to provide evidence-based references for clinical practice.

METHODS: A retrospective medical record review was conducted for patients diagnosed with EACS who received treatment at The Second Xiangya Hospital between November 2020 and November 2025. Data were collected regarding age, gender, etiology, clinical symptoms, surgical methods, and postoperative outcomes. Descriptive statistics and Fisher’s exact test were used for data analysis.

RESULTS: The findings indicated that the characteristics of EACS in children were unilateral involvement (100%), with the primary etiologies being associated with prior ear surgeries (86%) and isolated hearing loss (100%). The postoperative recurrence rate was 57%, and all recurrent cases were accompanied by restenosis. In pediatric surgeries, the temporoparietal fascial flap was the most frequently utilized graft (43%), 43% of patients underwent conchal cartilage resection, and 86% received absorbable drug-eluting stent (DES) implantation. All patients adhered to a unified DES implantation and postoperative care protocol. Type I tympanoplasty (Wullstein classification) was carried out in one pediatric case and one adult case for tympanic membrane repair. The adult cohort exhibited multiple etiologies (50% related to prior ear surgeries, 17% post-trauma, 25% post-inflammation), frequent accompanying symptoms (25% with tinnitus, 50% with otorrhea, 17% with earache), a recurrence rate of 25%, and no postoperative restenosis. Statistical analysis verified that the restenosis rate in pediatric patients was significantly higher than that in adults (P = 0.012), and there was no significant correlation between recurrence and flap selection, cartilage resection, or DES implantation (all P > 0.05).

CONCLUSION: This study tentatively indicates that there exist disparities in the clinical characteristics of acquired external auditory canal stenosis between children and adults. The risk of postoperative restenosis in children is notably elevated, and this tendency might be associated with the inherent anatomical fragility and robust tissue proliferation capacity in children. Comprehensive preoperative imaging assessment, individualized surgical plan development, standardized drug-eluting stent implantation, structured long-term postoperative follow-up, and postoperative care may be conducive to enhancing the prognosis of acquired external auditory canal stenosis in children. Multicenter prospective studies with a larger sample size are required to further validate the optimal treatment strategy for acquired external auditory canal stenosis in children.

PMID:42220998 | PMC:PMC13216209 | DOI:10.3389/fped.2026.1814290