Nevin Manimala

J Toxicol Environ Health A. 2025 Aug 16:1-15. doi: 10.1080/15287394.2025.2542348. Online ahead of print.

ABSTRACT

Under the United States Environmental Protection Agency’s (U.S. EPA) CERCLA program, soils suspected of lead (Pb) contamination are evaluated to assess the impact of soil Pb exposure on blood Pb levels. The decision to remediate relies, in part, on whether the measured soil exposure point concentration (EPC) excee ds an action level. The U.S. EPA established data quality objectives (DQOs) to support data collection used to estimate the EPC and assess confidence in remediation decisions. To support DQO processes at sites where site-specific soil Pb relative bioavailability (RBA) is assessed, a statistical simulation model was developed that estimates false compliance/exceedance decision error probabilities based upon uncertainty in the RBA-adjusted EPC, employing model inputs defining (1) the sampling protocol being evaluated, (2) variability in total and bioavailable soil Pb across the assessed area, and (3) analytical measurement uncertainty. A framework for utilizing the simulation model is presented using a hypothetical site informed by concentration and soil Pb bioavailability distributions from an actual Pb-contaminated site. Pre-sampling, false compliance/exceedance decision error probabilities were predicted for various sampling protocols. A DQO-compliant sampling protocol was then selected, and accuracy and precision in the measured EPC were assessed relative to a specified risk-based action level.

PMID:40817761 | DOI:10.1080/15287394.2025.2542348

J Dent Res. 2025 Aug 16:220345251356437. doi: 10.1177/00220345251356437. Online ahead of print.

ABSTRACT

Oral frailty is a key factor in maintaining nutritional status, yet its impact on weight loss remains unclear. This study aimed to (1) evaluate the longitudinal association between oral frailty and the onset of weight loss among independent older adults and (2) explore how oral frailty components contribute to this association. Data were sourced from 2016 to 2022 of the Japan Gerontological Evaluation Study (JAGES). As a 6-y follow-up cohort study, the onset of >10% weight loss was used as the dependent variable, reflecting the significant threshold for older adults at ≥6-mo follow-up. Oral frailty was assessed as independent variables in 4 ways: (a) count score (sum of 5 components: fewer teeth, chewing difficulty, swallowing difficulty, dry mouth, and pronunciation difficulty), (b) individual 5 components, (c) a latent variable structured from 5 components, and (d) a refined latent variable incorporating additional paths from fewer teeth to chewing difficulty and pronunciation difficulty. Structural equation models (SEMs) were applied to examine the effect of oral frailty on weight loss, estimating standardized coefficients (SCs) and 95% confidence intervals (CIs). The construct validity of oral frailty was assessed using confirmatory factor analysis within the SEM framework. Model fit was evaluated using the standardized root mean squared residual (SRMR) and coefficient of determination (CD). Among 3,305 participants (47.4% women; mean age at baseline: 72.0 ± 4.9 y), 8.9% experienced >10% weight loss. Model d, which incorporated a refined latent structure of oral frailty, demonstrated the strongest association with weight loss (SC = 0.09; 95% confidence interval [CI] = 0.01; 0.16) among all models, with chewing difficulty showing the highest standardized factor loading (0.45; 95% CI = 0.35; 0.55). Model d also showed the best model fit (SRMR = 0.013; CD = 0.217), providing the high explanatory power and appropriateness of this model. Oral frailty significantly increases the risk of weight loss among independent older adults and its components have interrelationships.

PMID:40817757 | DOI:10.1177/00220345251356437

J Dent Res. 2025 Aug 16:220345251357588. doi: 10.1177/00220345251357588. Online ahead of print.

ABSTRACT

Canonical and noncanonical WNT signaling pathways are tissue specific and play roles in mineralized tissue development and repair. Here we characterize the activity of noncanonical WNT5B and canonical WNT10B in dental pulp stem cells (DPSCs) in osteo-/odontogenesis and target dentin-pulp complex regeneration using rWNT-loaded hydrogels. DPSCs in monolayers were treated with recombinant WNT10B (rWNT10B, 50 ng/mL), rWNT5B (50 ng/mL), or the canonical WNT pan-activator CHIR 99021 (10 nM). Gene expression of osteo-/odontogenic markers and Alizarin Red assay were performed. Collagen-based hydrogels were prepared from bovine type I collagen and loaded with rWNT10B, rWNT5B, or CHIR. A control group with no treatment was included. WNT release from hydrogels in phosphate-buffered saline was performed up to 14 d. The DPSC response to hydrogels was characterized by viability, morphology, gene expression, and alkaline phosphatase (ALP) activity. In vivo investigation was conducted using an ectopic model of pulp exposure in human tooth fragments implanted in mice for 4 wk. Hematoxylin and eosin, trichrome staining, and immunohistochemistry were performed. Statistical analysis was performed using analysis of variance and Tukey post hoc (α = 0.05). Our in vitro studies showed that rWNT5B significantly upregulated ALP, RUNX2, and DMP1 after 7 d. rWNTs and CHIR significantly enhanced mineralization. rWNTs were almost completely released from the hydrogels in 14 d, with 2 release peaks at 6 h and 4 d. rWNT-loaded hydrogels did not affect cell viability and morphology. rWNT10B-loaded hydrogels significantly increased the expression of ALP and RUNX2. The rWNT-loaded hydrogels significantly increased ALP activity. Our in vivo histological data indicate the presence of gel in the exposure area, the formation of pulp-like tissue in contact with the hydrogels, new blood vessels, and polarized cells adjacent to dentin tubules. Canonical WNT10B and noncanonical WNT5B appear to play specific roles in DPSC differentiation. WNT-loaded hydrogels are cytocompatible, increase the expression of osteo-/odontogenic markers and ALP activity, and induce pulp-like tissue formation.

PMID:40817756 | DOI:10.1177/00220345251357588

Int J Gynaecol Obstet. 2025 Aug 16. doi: 10.1002/ijgo.70466. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the potential reciprocal influences between in vitro fertilization (IVF) and the psychological states of patients.

MATERIALS AND METHODS: A prospective cohort study involved 180 couples who sought consultation for IVF. To monitor the fluctuations in the emotional states of the couples throughout the IVF process, questionnaires were administered on two separate occasions: the first was conducted immediately before the initiation of medication, and the second was administered promptly following the completion of embryo transfer. The BECK inventories for anxiety and depression were employed for evaluation. Pregnancy outcomes were exclusively analyzed for women who received high-quality blastocysts, with cleavage-stage embryo transfers being excluded from consideration.

RESULTS: Pregnancy rates did not significantly differ based on the presence of heightened anxiety and/or depression among couples. Notably, a correlation was identified between severe anxiety in women before IVF and diminished rates of fertilization, as well as lower blastocyst/oocyte and blastocyst/metaphase II (M2) ratios (8.7 ± 5.0 vs. 7.5 ± 6.1, P = 0.029; 0.284 ± 0.199 vs. 0.218 ± 0.209, P = 0.001; and 0.333 ± 0.209 vs. 0.272 ± 0.232, P = 0.016, respectively). In the male cohort, elevated anxiety scores, either pre- or post-IVF treatment, were found to be linked with a reduced mean oocyte count, as well as lower rates of M2, fertilization, blastocyst, and total embryo counts (P < 0.05).

CONCLUSIONS: Pregnancy rates were not affected by the presence of anxiety and depression, as they do not exert a significant impact on the implantation success of blastocysts. However, given that fertilization rates are statistically diminished in instances of severe anxiety, which consequently results in a reduced number of blastocysts and total embryos, a decline in cumulative pregnancy rates may be anticipated.

PMID:40817721 | DOI:10.1002/ijgo.70466

Int J Soc Psychiatry. 2025 Aug 16:207640251358085. doi: 10.1177/00207640251358085. Online ahead of print.

ABSTRACT

BACKGROUND: Mental health issues, including depression, anxiety, and insomnia, are increasingly prevalent among university students and graduates, especially those involved in academic research. The impact of research-related characteristics on mental health remains underexplored.

AIM: We examined this relationship using machine learning alongside traditional statistical analyses and GIS mapping.

METHODS: Data from 508 university students and graduates were collected, and encompassed socio-demographics, academic information, research related information, and mental health outcomes. Statistical analyses were performed using SPSS, while spatial analysis was conducted using QGIS and machine learning models were developed with Python with Google Colab.

RESULTS: High prevalence rates of depression (39.8%), anxiety (29.3%), and insomnia (12.2%) emerged. Feature selection highlighted research experience (excluding thesis), research courses during the bachelor’s program, and interest in a research-related career as significant predictors of mental health outcomes. CatBoost modeling performed best in accuracy and precision of risk prediction of mental health conditions. Support Vector Machine model performed well in predicting depression, while Random Forest showed consistent low log loss, indicating better calibration across mental health issues. GIS mapping revealed no significant regional heterogeneity in mental health outcomes. Research-related factors, such as research experience and academic pressures, significantly impact the mental health of university students and graduates.

CONCLUSIONS: Machine learning models may enable institutions to more effectively identify at-risk students and provide personalized support to foster a supportive research environment, ultimately improving both mental health outcomes and academic success.

PMID:40817703 | DOI:10.1177/00207640251358085

J Adv Nurs. 2025 Aug 16. doi: 10.1111/jan.70144. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the increasing number of doctorally prepared midwives in Europe, particularly after the Bologna Declaration 1999, little is known about the context and experiences of their doctoral education.

AIM: To explore European initially qualified midwives’ experiences with doctoral education; and the context of their education through their professional associations.

DESIGN: An exploratory descriptive observational survey.

METHODS: An ethically approved web-based survey was used to collect data from midwifery associations and midwives in 33 European countries between October and December 2024. Descriptive statistics and inductive thematic analysis were used to analyse the responses.

RESULTS: Twenty-two midwifery associations from 19 European countries and 207 midwives from 23 European countries participated. Over the last two decades, there has been an increase in the number of doctorally prepared midwives. Common reasons to gain doctoral qualifications included an interest in research, career progression, in particular in education, and improving healthcare. Midwives reported growing availability of European-wide opportunities for doctoral programmes, alongside an increase in the number of doctoral midwifery programmes and supervisors with midwifery expertise. Although many barriers were reported, effectively combining study with their personal life and support from family, friends and colleagues was highlighted as crucial factors in completing their doctoral studies.

CONCLUSION: This is the first study exploring the experiences of European midwives pursuing a doctoral degree. The findings highlight a need for universities to improve the collaboration with midwives’ supportive networks as well as for the profession to reduce intraprofessional hostilities to enhance doctoral midwifery students’ well-being. Implications for the profession: Acknowledging challenges faced by these midwives is necessary to improve professional and institutional support in academia and midwifery.

IMPACT: Findings of this study inform strategies to improve doctoral education for midwives and, in this way, strengthen the contributions of midwives to maternal evidenced-based care development and healthcare innovations.

REPORTING METHOD: The Consensus-Based Checklist for Reporting of Survey Studies (CROSS) was used to guide reporting.

PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting.

PMID:40817697 | DOI:10.1111/jan.70144

Ann Clin Transl Neurol. 2025 Aug 15. doi: 10.1002/acn3.70162. Online ahead of print.

ABSTRACT

BACKGROUND: Stroke is a leading cause of long-term disability in adults, with upper limb hemiparesis being a common impairment. Traditional training is mostly aimed at paralyzed limbs, but the effect of bilateral training is still unclear.

OBJECTIVE: This study explores the influence and mechanism of unilateral and bilateral rhythmic task training on the rehabilitation of stroke patients.

STUDY DESIGN: This was a double-blind randomized controlled trial.

METHODS: Thirty-six patients were randomly assigned to the bilateral group or to the unilateral group. The bilateral group engaged in repetitive training involving both arms and distal hand movements, while the unilateral group focused on the affected arm. Evaluations were performed before treatment and immediately after treatment. The outcome measures included Fugl-Meyer Upper Extremity (FMA-UE), the average electromyographic values of a total of 16 muscle groups on both the unaffected and affected sides (with 8 muscle groups on each side) during maximum voluntary isometric contraction, as well as the active range of motion (ROM). Changes in interhemispheric inhibition (IHI) were assessed using transcranial magnetic stimulation.

RESULTS: Post-treatment assessments indicated that the FMA-UE scores significantly increased in both groups, with the bilateral group exhibiting more pronounced improvements (p = 0.031; ηp² = 0.130). Specifically, compared to their pre-treatment states, the bilateral group showed statistically significant differences in the maximum EMG amplitudes of the anterior deltoid (p = 0.006; ηp² = 0.204) and wrist flexor muscles (p < 0.001; ηp² = 0.308) on the affected side, with greater gains than the unilateral group. Additionally, the maximum EMG amplitudes of the biceps brachii (p = 0.035; ηp² = 0.124) and wrist extensors (p = 0.018; ηp² = 0.153) on the unaffected side were significantly enhanced in the bilateral group. In terms of active ROM, the bilateral group demonstrated significant improvements in shoulder flexion (p = 0.024; ηp² = 0.142) and wrist flexion (p = 0.020; ηp² = 0.149), which surpassed those observed in the unilateral group. Furthermore, a significant reduction in IHI (p = 0.023; ηp² = 0.196) was observed, which was positively correlated with FMA-UE scores following bilateral training (r = 0.85, p < 0.001).

CONCLUSION: Bilateral training is more effective than unilateral training in enhancing upper limb function and may contribute to balancing IHI in stroke recovery patients.

PMID:40817662 | DOI:10.1002/acn3.70162

BJOG. 2025 Aug 15. doi: 10.1111/1471-0528.18324. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine differences in the location of service and management for patients receiving early pregnancy loss (EPL) care based on racial/ethnic identity.

DESIGN: Retrospective cohort study.

SETTING: A single university-affiliated urban tertiary care centre in the United States.

POPULATION: A cohort of 796 received care for EPL at a single university-affiliated urban tertiary care centre from July 1, 2021, through June 30, 2023.

METHODS: Descriptive statistics for demographic factors were generated, reporting frequencies and percentages; continuous variables were expressed as a mean with standard deviation; and chi-squared tests were performed. Descriptive statistics were used to describe the demographics of this patient population and the frequency of location of service and management type. Multivariate logistic regression models assessed the relationship between the location of services (ED and GYN triage vs. other), management type (expectant vs. active management) and patient race and ethnicity. Statistics are reported as adjusted odds ratio (aOR) and 95% confidence interval (CI).

MAIN OUTCOME MEASURES: Location of service, management type.

RESULTS: There were differences in care location and management based on race/ethnicity. Black and Hispanic/Latinx patients were more likely to receive care in the emergency department or gynaecology triage compared to their White counterparts. Black patients were also more likely to receive expectant management and office procedural management compared to their White counterparts. Receiving treatment in the emergency department or gynaecology triage was associated with expectant management.

CONCLUSIONS: Racial disparities exist in both location of service and management type for EPL.

PMID:40817641 | DOI:10.1111/1471-0528.18324

Environ Toxicol. 2025 Aug 15. doi: 10.1002/tox.24557. Online ahead of print.

ABSTRACT

The potential adverse effects of 17-alpha-ethynylestradiol (50, 100, and 500 μg EE₂/kg b.w., for 30 days) on tench (Tinca tinca) were evaluated by integrating biomarkers including physiological (hepato-somatic index, spleen-somatic index, and hematocrit), oxidative stress (catalase, glutathione peroxidase, and glutathione reductase activities; total glutathione level, and lipid peroxidation), metabolic (glutathione S-transferase activity), as well as histopathological (descriptive and analytical studies) responses. The general health status of the EE₂-exposed tench was disturbed based on the increase of somatic indices at high tested doses, and the development of anemia in all exposed individuals. Effective control of reactive oxygen species by the antioxidant defense system of the tench exposed to EE₂ should have occurred because the lipid peroxidation process was irrelevant. Histopathological study revealed the presence of regressive changes in the liver (vacuolar degeneration, and deposits of eosinophilic material), regressive (deposits of eosinophilic material), and progressive (hyperplasia of reticuloendothelial cells) changes in the spleens of exposed fish. The severity of some lesions was dose dependent. The identified injuries did not compromise the functions of these organs. Finally, a common pattern of correlation between parameters of oxidative stress and morphological changes was not detected in the current study.

PMID:40817632 | DOI:10.1002/tox.24557

J Rural Health. 2025 Jun;41(3):e70073. doi: 10.1111/jrh.70073.

ABSTRACT

PURPOSE: Research has demonstrated many types of disparities in tobacco retailer density (TRD), but these analyses often fail to explore rural disparities. Given the substantial burden of rural tobacco use in the USA, this is a critical gap. The purpose of the present study was to estimate rural disparities in TRD across four US states.

METHODS: For the states of California, Connecticut, North Carolina, and Ohio, we used spatial statistical methods to model per capita TRD at the census tract level. Rurality was defined by the US Department of Agriculture Rural-Uran Commuting Area (RUCA) codes and categorized into Metropolitan, Micropolitan, Small Town, and Rural.

FINDINGS: Tobacco retailer count was highest in California (22,533), but TRD was highest in Connecticut (1.23 retailers per 1000 residents). In models for California, North Carolina, and Ohio (but not Connecticut), there was an association between rurality and TRD, such that rural census tracts had greater TRD than metropolitan census tracts. Micropolitan and small town (vs. metropolitan) census tracts also had greater TRD, although the association was not as strong. Models further showed associations between TRD and census tract poverty, racial and ethnic composition, and Appalachian designation.

CONCLUSIONS: Although there are notable state-level differences, TRD is clearly associated with rurality. Given the literature on the impacts of living in tobacco-retailer-dense areas, rural disparities in TRD likely contribute to rural disparities in tobacco use. There is a need for further policies in rural areas of the USA that address the tobacco retailer environment.

PMID:40817627 | DOI:10.1111/jrh.70073