Nevin Manimala

J Strength Cond Res. 2026 Apr 22. doi: 10.1519/JSC.0000000000005469. Online ahead of print.

ABSTRACT

Zheng, S, Wang, S, Cao, Q, and Li, H. The impact of aquatic training on athletic performance and physical recovery in competitive athletes: A meta-analysis. J Strength Cond Res XX(X): 000-000, 2026-To evaluate the effects of aquatic training on performance and physical recovery in competitive athletes, particularly its impact on explosive power, speed, agility, strength, aerobic capacity, and balance. This study used a meta-analysis approach to search relevant literature in the Web of Science and Scopus databases since their inception. The selected studies were limited to English-language articles that met predefined inclusion criteria. All included studies were randomized controlled trials or controlled experiments, with subjects being competitive athletes with a systematic training background. Standardized mean differences (SMDs) were used for data analysis, and statistical analysis was conducted using R (version 4.3.0). A total of 13 studies were included in the analysis, with 392 subjects. Aquatic training significantly improved athletes’ explosive power (SMD = 0.79, 95% confidence interval [CI] = 0.0.50 to 1.07, p < 0.001), speed (SMD = 1.14, 95% CI = 0.89 to 1.38, p < 0.001), and agility (SMD = 0.47, 95% CI = 0.0.15 to 0.78, p = 0.004). However, the improvement in strength (SMD = 0.32, 95% CI = -0.32 to 0.96, p = 0.321) and balance (SMD = 0.42, 95% CI = -0.35 to 1.19, p = 0.282) was not statistically significant, and there was high heterogeneity in the studies on aerobic capacity (SMD = 1.92, 95% CI = -1.47 to 5.32, p = 0.267). In addition, aquatic training showed a modest yet positive effect on physical recovery, including improvements related to injury rehabilitation and fatigue relief (SMD = 0.38, 95% CI = 0.12 to 0.63, p = 0.004). As an effective supplementary training method, aquatic training significantly enhances athletic performance, especially in explosive power, speed, and agility. It has beneficial effects on injury recovery and post-training fatigue reduction. Although the effects on strength and aerobic capacity require further validation, aquatic training has proven to be an important tool in sports training and rehabilitation with promising application potential.

PMID:42013467 | DOI:10.1519/JSC.0000000000005469

JMIR Med Inform. 2026 Apr 21;14:e94813. doi: 10.2196/94813.

ABSTRACT

The rapid integration of large language models into electronic medical record systems introduces a critical theoretical vulnerability. Drawing on foundational computer science proofs of “model collapse,” this viewpoint introduces the concept of “Clinical Model Autophagy”-a systemic degradation of diagnostic integrity that occurs when clinical artificial intelligence (AI) models are recursively trained on unverified, AI-generated synthetic data. As these recursive models may progressively regress toward statistical means, they undergo “Interpretative Drift,” a clinically concerning phenomenon where rare pathological variances are systematically erased and complex diseases are homogenized into benign averages. To prevent the irreversible contamination of health care data ecosystems, the author urgently proposes the Data Purity Standard (DPS). The DPS mandates the cryptographic watermarking of all AI-assisted clinical entries for provenance tracking, alongside the establishment of “Human Vaults.” These physically segregated repositories of physician-verified heritage data will serve as immutable biological anchors to safely guide future AI training, ensuring the long-term reliability of digital health infrastructure.

PMID:42013455 | DOI:10.2196/94813

J Particip Med. 2026 Apr 21;18:e84705. doi: 10.2196/84705.

ABSTRACT

BACKGROUND: Maternal health during the perinatal period is a global public health priority. While antenatal education is widely implemented, conventional lecture-based models often fail to achieve sustained behavior change. Innovative approaches that integrate experiential learning with digital support may enhance maternal knowledge, self-management, and pregnancy outcomes.

OBJECTIVE: The aim of this study is to evaluate the feasibility and preliminary effectiveness of a combined experiential class and online logging intervention for pregnant women in China and to explore the mechanisms underpinning its impact on health practices and service experiences.

METHODS: A mixed methods design was used in a district-level maternal and child health hospital in Beijing. In the quantitative arm, 40 women (intervention group, n=20; control group, n=20) were enrolled in a quasi-experimental comparison. Outcomes included knowledge-attitude-practice indicators, service satisfaction, and clinical birth outcomes. Given the limited sample size, a qualitative arm was conducted to complement statistical findings: semistructured interviews with 20 women (10 per group) were analyzed thematically. Quantitative and qualitative results were integrated during interpretation to provide a comprehensive evaluation.

RESULTS: Compared with the experiential class alone, the combined intervention was associated with higher knowledge scores (mean difference 1.6 points, 95% CI 0.8-2.4), stronger adherence to recommended health practices (composite adherence score difference 1.0, 95% CI 0.4-1.6), and higher overall service satisfaction (mean difference 0.6, 95% CI 0.2-1.0). Across multiple domains, a higher proportion of participants in the intervention group met dietary, exercise, and supplementation recommendations. Clinical outcome differences were exploratory, as the study was not powered for these end points. Qualitative analysis revealed 3 mechanisms, such as empowerment and self-efficacy, practice and persistence, and systemic/environmental support, through which the intervention influenced experiences and practices.

CONCLUSIONS: The experiential class plus online logging model is feasible and acceptable in a real-world antenatal setting. Although limited by a small sample size, findings suggest that the intervention improves maternal knowledge, health practices, and service experiences and may inform future adequately powered trials to evaluate pregnancy outcomes. Qualitative insights highlight mechanisms of health practice change and provide contextual depth, underscoring the value of mixed methods designs in maternal health research.

PMID:42013442 | DOI:10.2196/84705

Am J Dent. 2026 Apr;39(2):85-94.

ABSTRACT

PURPOSE: To investigate comparatively the changes in surface roughness and surface microhardness of resin composites applied with traditional incremental layering technique and bulk-fill resin composites after erosive/abrasive applications.

METHODS: In this laboratory study, three conventional resin composites with different contents: Filtek Z250 (FZ), Filtek Ultimate (FU), Clearfil Majesty Esthetic (CME), and four bulk-fill resin composites: X-tra fil (VXF), Filtek One Bulk Fill (FOB), QuiXfil (QXF), and Tetric N-Ceram Bulk Fill (TNC) were used. While preparing the test specimens, resin composites were applied to 8 mm diameter and 2 mm height round plexiglass molds (n= 15) and polymerized. Each specimen was polished. Then, the baseline surface roughness (R0) and surface microhardness (H0) values of the specimens were measured. Each group had been exposed to erosive/abrasive cycle for 10 days. After the cycle, by measuring the roughness (R1) and microhardness (H1) values of the specimen, the alterations of the surface properties were investigated. After the baseline and erosive/abrasive cycles of the specimens, the surface analyses were performed with scanning electron microscopy. One-way ANOVA test, Tukey’s post hoc test, and t-test were used for statistical analysis. Differences at the P< 0.05 level were considered statistically significant.

RESULTS: There was no statistically significant difference between the H0 values of the FU, VXF, QXF, and FZ groups, and the H0 values of these groups were higher than the other groups (P< 0.05). After the erosive/abrasive cycle, there was no significant difference in the H1 values of only the FZ and VXF groups (P> 0.05). When the R0 values were examined, there was no significant difference between the FOB, FU, FZ, and TNC groups (P> 0.05), and the R0 values of these groups were statistically lower than the other groups (P< 0.05). A statistically significant increase was observed in the R1 values of all composite materials examined after erosive/abrasive applications (P< 0.05). In the SEM findings, erosive/abrasive applications caused degradation of both the organic matrix and surface properties of inorganic fillers.

CLINICAL SIGNIFICANCE: According to the results of this laboratory study, erosive and abrasive cycles negatively affected the surface microhardness and roughness of conventional and bulk-fill composites at different rates and varied depending on the structural properties. However, the surface roughness of Filtek Ultimate and Filtek One Bulk Fill, both with nanofill structure, was less affected by combined erosive and abrasive cycles.

PMID:42013430

Am J Dent. 2026 Apr;39(2):73-76.

ABSTRACT

PURPOSE: To evaluate the comparative clinical efficacy of a test toothpaste containing 0.454% stannous fluoride stabilized with zinc phosphate as compared to a regular fluoride toothpaste containing 0.76% sodium monofluorophosphate in controlling supragingival calculus formation over a 12-week period.

METHODS: A randomized, single-center, double-blind, parallel-group study was conducted in Bangkok, Thailand. Healthy adults (n= 100) with a baseline Volpe-Manhold Calculus Index score ≥7.0 were randomized to either the stannous fluoride (Test) or sodium monofluorophosphate (Control) group. After a dental prophylaxis, subjects brushed twice daily for 12 weeks. Supragingival calculus was assessed using the Volpe-Manhold Calculus Index. The primary efficacy endpoint was the comparison of baseline-adjusted mean calculus scores at 12 weeks, analyzed using ANCOVA.

RESULTS: 97 subjects completed the study. At 12 weeks, the Test Group had baseline adjusted mean Volpe-Manhold score of 11.47, while the Control Group had a score of 17.48. The Test Group demonstrated a statistically significant 34.4% (P< 0.001) less supragingival calculus formation compared to the Control Group.

CLINICAL SIGNIFICANCE: A toothpaste containing 0.454% stannous fluoride provided a statistically significant and clinically relevant reduction in supragingival calculus formation compared to a standard sodium monofluorophosphate fluoride toothpaste after 12 weeks of use.

PMID:42013428

AIDS. 2026 Apr 21. doi: 10.1097/QAD.0000000000004524. Online ahead of print.

ABSTRACT

OBJECTIVES: We examined the characteristics and time trends of late diagnosis among people living with HIV (PLWH) aged ≥50 years in southwest China from 2010 to 2023, and assessed the impact of the expanded HIV testing strategy and associated factors.

METHODS: We retrospectively analyzed cross-sectional data from 26,233 newly diagnosed older PLWH in southwest China between 2010 and 2023, from the Chinese Comprehensive Response Information Management System for HIV/AIDS (CRIMS). A multilevel logistic regression model was used to identify factors associated with late diagnosis, with latent class analysis as a sensitivity analysis to test the robustness of the results.

RESULTS: The late diagnosis rate declined from 2010 to 2023 (p for trend <0.05). Compared with the pre-strategy period (2010-2017), the post-strategy period (2018-2023) was associated with lower odds of late diagnosis (adjusted odds ratio [aOR] = 0.900, 95% CI: 0.854-0.950). Across all age groups (50-59, 60-74, and ≥75 years), primary education or below was associated with lower odds of late diagnosis (aOR range: 0.804-0.892). Late diagnosis rates were higher than the overall average for HIV testing approaches (i.e., the specific route or setting through which HIV was diagnosed) including testing of other patients (i.e., provider-initiated testing in general medical settings), testing at sexually transmitted infection clinics, and pre-testing of receiving blood/products.

CONCLUSIONS: Targeted health education should focus on high-risk subgroups including males and married individuals, and community-based testing should be promoted. The higher odds with facility-based testing underscore the need to integrate routine HIV testing into healthcare services.

PMID:42013424 | DOI:10.1097/QAD.0000000000004524

JMIR Res Protoc. 2026 Apr 21;15:e86384. doi: 10.2196/86384.

ABSTRACT

BACKGROUND: As a prevalent side effect, chemotherapy-induced nausea and vomiting (CINV) imposes a burden on the daily lives of patients with breast cancer. Multiple clinical trials have suggested the validity of acupuncture in alleviating CINV; however, the optimal acupuncture modality remains unclear.

OBJECTIVE: This protocol describes a systematic review and network meta-analysis to investigate the efficacy and safety of distinct acupuncture interventions for treating CINV in patients with breast cancer.

METHODS: Eight databases (PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, VIP Database, Wanfang Database, and the Chinese Biomedical Literature Database) will be searched for eligible studies from their respective inception to July 31, 2025. The language of published studies is limited to English and Chinese. Primary outcomes are CINV intensity and clinical effectiveness rates. Secondary outcomes include recurrence rates, safety outcomes, and quality of life. Risk of bias will be assessed using the Cochrane risk of bias tool. Pairwise meta-analysis will be conducted in Stata using random-effects models with Hartung-Knapp-Sidik-Jonkman CIs. Network meta-analysis will be conducted using Bayesian Markov chain Monte Carlo methods in R software. Convergence will be assessed using Gelman-Rubin statistics and trace plots. Heterogeneity will be summarized using τ2 and τ, along with prediction intervals, when applicable. Consistency between direct and indirect evidence will be evaluated using the node-splitting method and design-by-treatment interaction test. Small-study effects will be assessed via comparison-adjusted funnel plots and the Egger test in Stata. Where feasible, subgroup analyses and meta-regression analyses will be performed. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework.

RESULTS: A preliminary scoping search was completed in August 2025, and this protocol was finalized in October 2025. The comprehensive literature search and study selection are expected to be completed by June 2026, followed by data extraction by August 2026. Data synthesis and final manuscript preparation are scheduled to be completed by December 2026.

CONCLUSIONS: This analysis will expand the range of evidence-based acupuncture options available to clinicians for treating CINV in patients with breast cancer.

PMID:42013419 | DOI:10.2196/86384

JMIR Hum Factors. 2026 Apr 21;13:e83427. doi: 10.2196/83427.

ABSTRACT

BACKGROUND: High-quality professional development can help teachers build the skills and confidence needed to implement evidence-based practices, such as classroom physical activity breaks. While in-person training is often preferred, virtual asynchronous training offers a flexible alternative for teachers. However, its effectiveness may be limited by design and usability challenges.

OBJECTIVE: The aim of this study was to conduct a usability assessment of the Interrupting Prolonged Sitting with Activity (InPACT) virtual teacher training modules, using a human-centered design (HCD) approach to align the training with end-user preferences and needs.

METHODS: The InPACT professional development program includes nine modules delivered through an online platform (Qualtrics XM). A usability assessment was conducted using (1) structured online surveys with elementary school teachers who had completed the modules, (2) a heuristic evaluation based on the Jakob Nielsen 10 usability heuristics, and (3) a competitive analysis of three learning management systems (Moodle, Teachable, and Thinkific) to identify platform strengths, limitations, and insights. Findings and recommendations were compiled to inform module improvements.

RESULTS: Eleven teachers completed the survey. They reported that the modules were easy to use, the content was informative and relevant, and they valued the interactive and practical components. Areas for improvement included enhancing content engagement and increasing technical flexibility. The heuristic evaluation identified 14 usability issues across nine of the Nielsen heuristics (eg, navigation difficulties and text-heavy pages). The competitive analysis highlighted features that enhance user experience, such as progress tracking, estimated completion times, interactive elements, and feedback on quiz answers.

CONCLUSIONS: Usability assessments grounded in an HCD approach can enhance virtual training for educators, improving the uptake and implementation of evidence-based practices, such as classroom physical activity breaks. Five overarching recommendations emerged as follows: (1) removing video time constraints, (2) implementing accurate progress bars, (3) incorporating active learning or retention activities, (4) creating consistent and actionable end pages, and (5) ensuring consistency in titles and references to physical materials. Building on preliminary positive data from revised modules, future research should evaluate the impact of HCD revisions on teacher self-efficacy, training completion, and fidelity of program implementation.

PMID:42013411 | DOI:10.2196/83427

Neurology. 2026 May 12;106(9):e214937. doi: 10.1212/WNL.0000000000214937. Epub 2026 Apr 21.

ABSTRACT

BACKGROUND AND OBJECTIVES: Disability rating scales play a pivotal role in clinical trials, but there is a notable lack of guidance on how to analyze these scales. Using amyotrophic lateral sclerosis as a case study, our aim was to explore how disability rating scales have been analyzed in completed clinical trials and to assess how these different approaches influence both the risk of false-positive findings and the statistical power to detect true treatment effects.

METHODS: We searched PubMed and Embase to systematically identify randomized, placebo-controlled clinical trials using the revised ALS functional rating scale (ALSFRS-R) as primary end point, with ≥20 randomly assigned patients and ≥12-weeks of follow-up. Data were extracted on the statistical analysis approaches and strategies for handling missing data. Variability in statistical methods was mapped to the various research questions that the trials aimed to address. A simulation study assessed how each statistical method influenced validity (false-positive rate) and precision (statistical power), using the Ceftriaxone trial data set to model a realistic trial scenario.

RESULTS: Our analysis included 45 randomized clinical trials, comprising a total sample size of 7,338 patients, and identified 39 distinct statistical methods using a mixture of longitudinal and cross-sectional techniques. Most trials (55.6%) did not use all available (longitudinal) ALSFRS-R measurements, resulting in suboptimal utilization of patient data and reduced statistical precision. Applying the different statistical methods to the same trial data set resulted in large differences in the estimated treatment effect size, ranging from a negative 1.33 to a positive 2.33 SD difference. Among the methods used, 38.9% (95% CI 24.8%-55.1%) were at risk of increasing false-positive rates, potentially contributing to the erroneous advancement of ineffective treatments. Statistical power of valid strategies varied widely, ranging from 17.9% to 78.2%.

DISCUSSION: Our results demonstrate considerable variability in statistical methods, with the choice of method able to influence the estimated treatment effects, potentially resulting in misleading conclusions and uncertainty about treatment effects. This limits the interpretability and comparability of clinical trials and influences clinical decision-making and drug development. Establishing statistical consensus recommendations could improve the utility of disability scales in clinical trials and accelerate progress toward effective therapies for neurodegenerative diseases.

PMID:42013406 | DOI:10.1212/WNL.0000000000214937

JMIR Aging. 2026 Apr 21;9:e85626. doi: 10.2196/85626.

ABSTRACT

BACKGROUND: With the growing aging population, technology that supports independent living is increasingly important. Web search systems are well established, whereas generative artificial intelligence (Gen-AI; eg, ChatGPT) represents a newer, adaptive tool that could offer personalized information access. However, little is known about how older adults, particularly those with mild cognitive impairment (MCI) or mild dementia, perceive and engage with these systems.

OBJECTIVE: This study explored the use of and perspectives on web search and Gen-AI in older adults with and without cognitive impairment (including MCI and early-stage dementia).

METHODS: A UK-wide mixed methods study was conducted with older adults, including those with MCI or mild dementia. An online survey captured technology use, Likert-scale ratings of web search and Gen-AI, and reasons for nonuse. Follow-up focus groups provided in-depth qualitative perspectives. Quantitative data were analyzed using descriptive and comparative statistics, while qualitative data were thematically analyzed.

RESULTS: Survey findings showed higher use of web search (275/280, 98.2%) compared to Gen-AI (40/286, 14%) within these groups. Web search was rated positively across participants, although challenges were raised regarding the phrasing of queries and commercialization. Gen-AI use was less common, but more than half of nonusers expressed willingness to adopt it in the future. Combined with focus group responses, themes exploring keyword searching, mistrust, lack of knowledge, and willingness to learn were established. Participants also suggested potential applications of Gen-AI, such as supporting independent living through monitoring and simplifying complex searches.

CONCLUSIONS: Web search remains the primary method, and participants highlighted both advantages and frustrations with current systems. Gen-AI was underused but seen as promising, with its adoption mainly limited by mistrust and knowledge gaps. Our findings indicate that structured training, early introduction, and user-centered design could encourage adoption, enhance accessibility, and support independent living among older adults with and without MCI.

PMID:42013397 | DOI:10.2196/85626