Nevin Manimala

Waste Manag Res. 2026 May 31:734242X261451606. doi: 10.1177/0734242X261451606. Online ahead of print.

ABSTRACT

Biogas desulfurization is essential to prevent equipment corrosion and ensure its suitability for energy applications. Although several technically established desulfurization technologies are commercially available, their implementation may still be constrained by acquisition costs, operational expenses, and environmental impacts associated with the use of conventional materials such as activated carbon. In this context, this study investigates the potential of two abundant agro-industrial residues – Luffa cylindrica and Carya illinoinensis – as low-cost and environmentally favorable filter media for biofilters applied to biogas desulfurization. A pilot-scale system operated for 62 days treating biogas with H₂S concentrations above 5000 ppm, and their performance was compared with that of a conventional activated carbon filter. Both biofilters demonstrated high initial removal efficiencies, reducing H₂S concentrations in the treated gas to below 20 ppm. Over time, the loofah-based filter showed a decline in performance due to sulfur accumulation, whereas the pecan shell medium exhibited greater operational stability and indications of self-regeneration, achieving performance statistically comparable to that of activated carbon. These results highlight the technical feasibility of using abundant agro-industrial biomass as alternative biofilter media, contributing to reduced operational costs and lower environmental impacts in biogas purification systems. The findings also reveal opportunities for integrating biomass waste valorization with biogas purification technologies, indicating promising pathways for more sustainable and economically accessible desulfurization strategies in decentralized and industrial biogas applications.

PMID:42218620 | DOI:10.1177/0734242X261451606

Mult Scler. 2026 May 31:13524585261449988. doi: 10.1177/13524585261449988. Online ahead of print.

ABSTRACT

BACKGROUND: There is growing support for high-efficacy disease-modifying therapy (DMT) in multiple sclerosis (MS), but escalation (ESC) approaches remain common.

OBJECTIVE: To describe decision-making in a pragmatic trial of early high-efficacy treatment (EHT) versus ESC.

METHODS: DELIVER-MS is a multi-center, pragmatic, randomized controlled trial (RCT) with a parallel observational study (OBS), which enrolled treatment-naïve people with RRMS in 31 UK/US sites. Primary outcome was as follows: 36-month brain volume loss according to initial treatment approach (EHT vs. ESC). Stepwise multivariable logistic regression was used to predict participation in RCT versus OBS and choice of EHT versus ESC within the OBS cohort.

RESULTS: In total, 816 people with MS were enrolled. Participants declined randomization due to preference for a particular DMT (85%), efficacy concerns (20%), and safety concerns (9%). RCT versus OBS participation was associated with lower relapse rate (p = 0.043) and greater brain parenchymal fraction (p = 0.002). Among 374 in the OBS cohort, 125 (33%) chose ESC and 249 (67%) chose EHT. People commencing EHT had higher education attainment (p < 0.001) and relapse rate (p = 0.025).

CONCLUSION: Baseline DELIVER-MS data demonstrate that participants with milder disease are more likely to participate in RCT. The choice of EHT versus ESC was associated with demographic factors and disease activity.

CLINICAL TRIAL REGISTRATION: NCT03535298.

PMID:42218617 | DOI:10.1177/13524585261449988

J Diabetes Sci Technol. 2026 May 30:19322968261450632. doi: 10.1177/19322968261450632. Online ahead of print.

ABSTRACT

INTRODUCTION: Driving requires complex cognitive, motor, and sensory coordination, all of which may be adversely affected by diabetes. For individuals treated with insulin, hypoglycemia represents the principal safety concern. Although many jurisdictions provide guidance for insulin-treated drivers, adherence to these recommendations remains unclear.

METHODS: An online survey was conducted among 500 licensed drivers with insulin-requiring type 2 diabetes (T2D) from the United States and the United Kingdom, not using continuous glucose monitoring (CGM). The survey included discrete and open-ended questions relating to diabetes management and driving behaviors. Descriptive and inferential statistical analyses were performed.

RESULTS: Participants were predominantly male (59%, n = 293) with a mean T2D duration of eight years. Insulin regimens included basal-only therapy (54%, n = 257), multiple daily injections (39%, n = 197), and continuous subcutaneous insulin infusion (9%, n = 46). Severe hypoglycemic event(s) in the preceding 12 months were reported by 34%, and 54% had evidence of impaired awareness of hypoglycemia (Clarke score >4). Furthermore, 37% (n = 185) limited their driving due to insulin-related concerns, and 72% (n = 359) worried particularly about hypoglycemia. Only 34% (n = 168) reported checking glucose levels before driving >75% of the time. If feeling hypo before driving, 59% (n = 295) would take a snack but drive immediately. If feeling hypoglycemic while driving, 10% (n = 48) would attempt to ‘get to their destination fast’. Only 27% (n = 138) carried fast-acting carbohydrates, and 42% (n = 210) felt safe to drive ‘as soon as I feel better’ while 32% (n = 163) would ‘wait 45 minutes and recheck their glucose levels’.

CONCLUSIONS: Potentially unsafe driving behaviors are common among adults with insulin-treated T2D. There appears to be a need to improve the understanding of safe driving guidance.

PMID:42218605 | DOI:10.1177/19322968261450632

Mil Med. 2026 May 31:usag253. doi: 10.1093/milmed/usag253. Online ahead of print.

ABSTRACT

INTRODUCTION: Military-civilian partnerships are increasingly recognized as necessary to sustain surgical readiness for expeditionary combat casualty care. Because military installations are geographically fixed and may have limited high-acuity case volume, medical readiness depends in part on access to civilian clinical environments. Under a training affiliate agreement, Keesler Medical Center (KMC) general surgeons were integrated into the trauma service at Memorial Hospital at Gulfport (MH), a civilian Level 2 trauma center.

MATERIALS AND METHODS: Non-elective general surgery cases at MH and KMC were compared during calendar year 2025. In addition, trauma activation data from MH were analyzed to characterize day-of-week patterns and the temporal distribution of high-acuity trauma, using blood product administration as a proxy for severity. Weekly clustering was evaluated using chi-square goodness-of-fit testing, and late-week comparisons were assessed using Fisher’s exact testing.

RESULTS: MH generated significantly greater non-elective surgical exposure per weekend call period than KMC (P < .001 using both parametric and non-parametric comparisons). Trauma activations were not evenly distributed across the week (P = .030), with higher volumes observed during mid- to late-week periods. High-acuity trauma demonstrated a similar directional late-week pattern but did not reach statistical significance.

CONCLUSIONS: Integration of military surgeons into a civilian trauma center substantially increased exposure to non-elective and high-acuity surgical care while simultaneously supporting community trauma coverage. These findings suggest that surgical readiness is influenced not only by site-level volume but by exposure density and temporal structure, supporting military-civilian partnership models that deliberately align personnel with high-yield clinical windows.

PMID:42218599 | DOI:10.1093/milmed/usag253

J Clin Exp Neuropsychol. 2026 May 30:1-24. doi: 10.1080/13803395.2026.2678869. Online ahead of print.

ABSTRACT

BACKGROUND: Reproductive factors have been associated with cognition in older women, yet findings have been inconsistent. Moreover, recent studies have also found similar associations in men.

OBJECTIVE: Examine the relationship between reproductive and cognitive factors in both sexes, controlling for multiple covariates.

METHODS: We analyzed data from 914 women with natural menopause (M^AGE = 72.65±5.57) and 811 men (M^AGE = 74.43±5.37) from the HELIAD study. Participants provided reproductive, medical, and social histories and had a comprehensive neuropsychological assessment, including Mild Cognitive Impairment and dementia diagnosis. Covariates included age, education, medical, genetic, lifestyle, and socioeconomic factors.

RESULTS: Controlling for age and education, in women, later menarche, earlier menopause, fewer menstrual years, shorter interpregnancy intervals, and menstrual regularity were associated with poorer cognitive outcomes. Earlier first childbirth (<25y), greater parity (especially, before 20y), and older age at fourth childbirth were linked to better cognition (ORs:.95-2.20). In men, older age at third and fourth child birth, having more children at ages 20-29 or 40+, the last child at >35y, and childlessness were associated with poorer cognition, while having the first child at >35y (language tasks) and having more children overall were associated with better cognition (ORs:1.37-2.20). After full-adjustment and Bonferroni correction, no associations remained.

CONCLUSIONS: Reproductive patterns may affect cognition differentially based on sex. Moderate reproductive activity may be protective, whereas extreme patterns (e.g. very early/late childbirth, childlessness) may be linked to cognitive decline. These associations attenuate after statistical adjustment and correction, necessitating further controlled and longitudinal studies to clarify these relationships.

PMID:42218593 | DOI:10.1080/13803395.2026.2678869

Disabil Rehabil. 2026 May 30:1-9. doi: 10.1080/09638288.2026.2669996. Online ahead of print.

ABSTRACT

BACKGROUND: People with multiple sclerosis (PwMS) experience impaired balance and elevated fall risk, yet research on reactive stepping responses to lateral perturbations remains limited. This study examined spatiotemporal characteristics and step choices following lateral perturbations in PwMS compared to healthy controls (HC).

METHODS: Seventeen individuals with relapsing-remitting MS and fourteen age- and gender-matched HCs completed lateral perturbation trials. Step latency, length, velocity, and step type were analyzed. A total of 60 valid perturbations in PwMS and 56 in HC were evaluated.

RESULTS: PwMS exhibited a higher frequency of steps or falls following perturbations compared to HC (38.2% vs. 12.5%, p = 0.0013). No statistically significant differences in step latency, length, or velocity were found between groups. However, step choice differed as PwMS more frequently employed crossover and medial steps, while HC primarily used lateral steps. PwMS also showed greater reliance on multiple steps for recovery.

CONCLUSIONS: While spatiotemporal stepping measures were similar between groups, PwMS demonstrated distinct compensatory stepping strategies compared to healthy controls. These findings highlight the need for targeted interventions aimed at improving lateral balance reactions and reducing fall risk in PwMS.

PMID:42218585 | DOI:10.1080/09638288.2026.2669996

Am J Mens Health. 2026 May-Jun;20(3):15579883261453962. doi: 10.1177/15579883261453962. Epub 2026 May 30.

ABSTRACT

Cigarette smoking is a recognized risk factor for multiple sclerosis (MS) development and progression; however, the association between smoking and features of MS in male patients remains insufficiently explored. A cross-sectional exploratory study was conducted involving 31 male patients with approved relapsing-remitting MS (RRMS), divided into smokers (n = 9) and non-smokers (n = 22). The Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT) were used to assess cognitive performance. Hand dexterity was evaluated using the 9-Hole Peg Test (9HPT). Depressive symptoms and disability were assessed via the Beck Depression Inventory (BDI) and the Expanded Disability Status Scale (EDSS), respectively. Fatigue and related factors were assessed using the Comprehensive Fatigue Assessment Battery for Multiple Sclerosis (CFAB-MS). Serum markers of oxidative stress and antioxidant status, including superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), total antioxidant capacity (TAC), malondialdehyde (MDA), and glutathione (GSH), were also measured. Smokers demonstrated significantly lower SDMT scores compared with non-smokers (36.86 ± 11.16 vs. 52.47 ± 18.54; p = .04), which was no longer significant after adjusting for EDSS and age. No significant differences were observed between groups in PASAT, 9HPT, EDSS, or BDI. Smokers reported higher anxiety and worry scores on the CFAB-MS (p < .05), while other fatigue-related domains were comparable between groups. Regarding the oxidative stress markers, a statistically significant difference was only detected in SOD activity. Regular cigarette smoking may be associated with decreased cognitive processing speed and increased anxiety in male patients with RRMS, which warrants further investigation.

PMID:42218574 | DOI:10.1177/15579883261453962

J Clin Nurs. 2026 May 30. doi: 10.1111/jocn.70383. Online ahead of print.

ABSTRACT

AIMS: To evaluate the health-related quality of life (HRQOL) of adults with Long COVID 2 years and beyond after COVID-19 illness.

DESIGN: Cross-sectional study.

METHODS: Health status was assessed using the EQ-5D-5L instrument among 226 adults diagnosed in primary care with mild-to-moderate COVID-19 during the 2021 pandemic. Data were collected through a cross-sectional survey using a standardized questionnaire with a set of validated clinical outcomes for Long COVID. The sample consisted of adults aged ≥ 18 years who attended the specified ambulatory settings, tested positive for SARS-CoV-2, and agreed to be interviewed; the response rate was 70%. Health utility scores were compared between adults with and without Long COVID. Multivariate logistic regressions were applied to investigate the relationship between Long COVID and health-related quality of life outcomes.

DATA SOURCES: Primary data were collected from six public Family Health Care Units in João Pessoa, Brazil, between May 2023 and July 2024.

RESULTS: Adults with Long COVID had statistically significantly lower median utility scores (0.784, IQR: 0.633-0.902) than those without persistent symptoms (1.0, IQR: 0.877-1.0). Poorer HRQOL was more evident among women, older adults, non-White individuals, participants with pre-existing chronic diseases, and those with lower educational attainment. Long COVID was associated with impairments in anxiety/depression, pain/discomfort and usual activities.

CONCLUSION: Adults with Long COVID experienced poorer HRQOL 2 years or longer after mild-to-moderate infection compared with those without persistent symptoms, regardless of sex, age, ethnicity, education level or comorbidities. These findings support the implementation of targeted interventions and rehabilitation services in primary care for individuals experiencing long-term health problems following COVID-19 illness.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Identifying adults at greater risk of persistent health impairments following COVID-19 may help health professionals, caregivers and policymakers better address the aspects of patients’ lives that lack quality and develop a multidisciplinary approach in primary care to managing this condition.

IMPACT: What problem did the study address? ○ This study examined the association between persistent symptoms 2 years or longer after non-severe COVID-19 illness and health-related quality of life. What were the main findings? ○ Long COVID was associated with poorer health-related quality of life, particularly in the domains of anxiety/depression, pain/discomfort and usual activities. Where and on whom will the research have an impact? ○ The findings highlight the need for multidisciplinary management of long-term health problems among adult COVID-19 survivors in primary care.

REPORTING METHODS: The STROBE checklist was followed.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:42218573 | DOI:10.1111/jocn.70383

J Clin Nurs. 2026 May 30. doi: 10.1111/jocn.70377. Online ahead of print.

ABSTRACT

AIM: This study aimed to (1) implement a Safety Protocol of Thirst Management (SPTM) as an evidence-based practice for quenching postoperative thirst and (2) evaluate its effectiveness using a comparative pre-and-post induction design.

DESIGN: A quasi-experimental study using propensity scored matching.

METHOD: Guided by the Iowa Model, the SPTM was implemented at a tertiary medical centre in Taiwan in 2023. Outcomes were compared between adult surgical patients admitted in 2023 (post-induction) and those admitted prior (pre-induction). Data on thirst and pain intensity, body temperature, and PACU length of stay (LOS) were analyzed for 15,168 patients.

RESULTS: A standardized SPTM flow diagram was established. Following SPTM induction, mean thirst scores significantly decreased from 5.76 to 1.30 (p < 0.001). Although pain intensity and PACU LOS (63.63 vs. 62.23 min) showed statistically significant increases, these changes were clinically marginal. Body temperature remained stable with no incidence of perioperative hypothermia.

CONCLUSIONS: The Iowa Model effectively guides nursing organizations in translating evidence into practice. The SPTM provides a safe, consistent framework for nurses to alleviate postoperative thirst, significantly enhancing the quality of surgical care.

IMPACT: This study addresses the lack of standardized thirst management. Results demonstrate that an evidence-based SPTM protocol effectively quenches thirst without increasing adverse clinical risks.

PATIENT AND PUBLIC CONTRIBUTION: The SPTM was triggered by patient reports of thirst-related distress. During the design phase, patient feedback on the acceptability of cold oral stimuli was used to refine the protocol. While patients did not participate in the data analysis, the primary outcome (thirst intensity) was selected based on its significance to patient-cantered care.

REPORTING METHOD: This study was reported according to TIDieR guideline.

PMID:42218571 | DOI:10.1111/jocn.70377

BMC Psychol. 2026 May 30. doi: 10.1186/s40359-026-04673-5. Online ahead of print.

ABSTRACT

BACKGROUND: The growing popularity of cosmetic surgery over the past two decades reflects increasing concern with physical appearance. However, many individuals do not experience the expected psychological benefits following cosmetic procedures. body image victimization experiences, particularly those involving peers or caregivers, may play a critical role in shaping body-related shame and appearance anxiety later in life.

OBJECTIVES: This study aimed to investigate the relationship between body image victimization experiences and appearance anxiety among individuals seeking cosmetic surgery, with a focus on the serial mediating roles of body image shame and body compassion.

METHODS: A total of 409 patients attending cosmetic surgery clinics in Tehran were recruited through convenience sampling. Participants completed standardized self-report measures assessing appearance anxiety, body image victimization experiences, body image shame, and body compassion. Data were analyzed using IBM SPSS Statistics version 24. Simple and serial mediation models were tested using bootstrapping procedures, with age and gender entered simultaneously as covariates in all analyses.

RESULTS: Body image victimization experiences were positively associated with appearance anxiety. Body image shame was positively associated with appearance anxiety, whereas body compassion was negatively associated with appearance anxiety. Mediation analyses indicated that body image shame and body compassion were statistically associated with the relationship between body image victimization experiences and appearance anxiety within the tested models. These associations remained significant after controlling for age and gender.

CONCLUSIONS: The findings are consistent with theoretical models suggesting that body image shame and body compassion may be relevant psychological correlates of appearance anxiety among individuals seeking cosmetic procedures. However, given the cross-sectional design, causal inferences cannot be drawn. Longitudinal and experimental studies are needed to clarify the temporal ordering of these variables and to determine their potential relevance for future interventions.

PMID:42218568 | DOI:10.1186/s40359-026-04673-5