Nevin Manimala

S D Med. 2026 May;79(suppl 5):s20-s22.

ABSTRACT

BACKGROUND: Prolonged ambulatory ECG monitoring is hypothesized to improve detection of paroxysmal arrhythmias compared with standard 24-hour Holter monitoring. This systematic review and meta-analysis evaluated whether 14-day single-lead adhesive ECG patch monitoring enhances detection of clinically significant arrhythmias versus conventional Holter monitoring.

METHODS: Following PRISMA guidelines, PubMed, Scopus, and Embase were searched. Studies comparing 14-day ECG patch with Holter monitoring (primarily 24-72 hours) in ambulatory adults with suspected paroxysmal arrhythmia were included. Primary outcomes were detection rates of atrial fibrillation/flutter (AF), major arrhythmias, atrioventricular block, sinus pause, ventricular tachycardia, and supraventricular tachycardia. Risk of bias was assessed using ROBINS-I and RoB 2. Risk ratios (RR) with 95% confidence intervals were pooled using random-effects models in Review Manager (RevMan). Heterogeneity was evaluated with I² statistics, and sensitivity/subgroup analyses performed. The protocol was registered on PROSPERO (CRD420251248305).

RESULTS: Six studies met inclusion criteria. Primary analyses showed substantial heterogeneity for most outcomes. No significant differences were observed for AF (RR 0.43, 95% CI 0.05-3.51), major arrhythmias (RR 0.41, 95% CI 0.16-1.01), atrioventricular block (RR 1.10, 95% CI 0.42-2.90), sinus pause (RR 1.09, 95% CI 0.47-2.49), ventricular tachycardia (RR 0.62, 95% CI 0.03-11.98), or supraventricular tachycardia (RR 0.39, 95% CI 0.11-1.44). Sensitivity analyses excluding one influential study often resolved heterogeneity and shifted results, favoring Holter monitoring for AF, major arrhythmias, and ventricular tachycardia, or the 14-day patch for supraventricular tachycardia. Subgroup analysis by patient type showed no significant interaction.

CONCLUSION: Fourteen-day ECG patch monitoring showed no overall statistically significant superiority over 24-hour Holter monitoring for detecting clinically actionable arrhythmias. High heterogeneity and strong sensitivity to individual studies reflecting variability in devices, populations, and designs shows key limitations in current evidence. Larger, high-quality, standardized randomized trials are essential to clarify if extended patch monitoring offers true diagnostic advantages.

PMID:42525983

JMIR Rehabil Assist Technol. 2026 Jul 29;13:e84735. doi: 10.2196/84735.

ABSTRACT

BACKGROUND: Access to physical rehabilitation services, including orthotics and wheelchairs, is recognized as a fundamental human right but remains limited in many low- and middle-income countries due to resource constraints, fragmented care, and a shortage of trained rehabilitation professionals. In Cambodia, where the health system still faces challenges from past conflict, these services are delivered through a mix of government, international, and nongovernmental organizations.

OBJECTIVE: This study investigated the pathways to obtaining orthoses and wheelchairs in Cambodia and their impact on individuals with physical impairments.

METHODS: Semistructured interviews were conducted to explore experiences and the impact of accessing physical rehabilitation and assistive products for orthosis and wheelchair users. Interviews were conducted face-to-face with translation support, audio recorded, transcribed, and analyzed using thematic analysis. Interviews were conducted with participants in Phnom Penh and the Kandal province in Cambodia. In total, 17 participants aged 18 to 65 years who were current or previous patients of the Exceed Worldwide physical rehabilitation center located in Phnom Penh took part in the study.

RESULTS: Three themes emerged (early experiences of illness and health care seeking, pathways to assistive products, and the impact of these assistive products). Access to orthoses and wheelchairs often involved lengthy delays and inconsistent experiences with medical care and physiotherapy. Despite these challenges, assistive products played a vital role in improving mobility, independence, and social participation, contributing to greater confidence and emotional well-being. However, issues such as poor environmental accessibility and delays in repair or replacement limited their effectiveness.

CONCLUSIONS: The findings demonstrate that, while assistive products offer significant benefits, they do not fully address the systemic barriers faced by people with physical disabilities in Cambodia. Persistent challenges such as stigma, environmental constraints, and emotional strain demonstrate the need for integrated policy reforms and a robust continuum of care that ensures coordinated, ongoing support across all stages of rehabilitation.

PMID:42525972 | DOI:10.2196/84735

Traffic Inj Prev. 2026 Jul 29:1-9. doi: 10.1080/15389588.2026.2698873. Online ahead of print.

ABSTRACT

OBJECTIVES: This comprehensive register-based study examines fatal at-fault crashes of motor vehicle drivers with alcohol and other substance findings. We categorized substances with possible impact on driving into three categories: alcohol, medicines without addiction potential, and other substances, including illegal substances and medications with addiction potential. We analyzed the differences in crash circumstances and risk factors using odds ratios (ORs), comparing at-fault drivers with different substance combinations to those who were non-impaired.

METHODS: Our material comprises crash data from the Finnish Road Accident (FRA) database in 2019-2022. Multidisciplinary Road Traffic Accident Investigation Teams (RAITs) investigate all fatal crashes in depth, and the Finnish Crash Data Institute (OTI) maintains the FRA database. RAITs have access to all police records, including medico-legal autopsy findings and toxicological data from virtually all deceased drivers.During the study period, there were 750 at-fault motor vehicle drivers of fatal crashes. Our final study material consisted of all data with information on alcohol and other substance findings, including 234 drivers with substance findings, and 446 non-impaired drivers.

RESULTS: Alcohol was clearly the most prevalent substance, used by 75% of the drivers with substance findings. The mean alcohol concentration in alcohol-only cases was 1.64‰, and in cases with alcohol and other substances, 1.45‰. Drivers with substance findings were much more likely to have prior DUI offenses (OR = 21.9 [10.6-45.0]). Moreover, drivers using substances other than alcohol had even higher odds of previous DUIs (OR = 31.9 [13.5-75.3]). Drivers with alcohol findings were more likely <25 years old compared to non-impaired drivers (OR = 2.10 [1.31-3.37]). Drivers with substance findings had higher odds of causing a crash while speeding compared to non-impaired drivers (for example, speeding at least 30 km/h: OR = 5.88 [4.00-8.62]). We found no statistically significant differences between drivers who had used alcohol alone and those who had used alcohol and other substances.

CONCLUSIONS: Alcohol with high concentrations dominated among at-fault drivers with substance findings in fatal road traffic crashes. Substance use co-occurred with other forms of risk taking such as speeding. Young drivers were overrepresented among drivers with alcohol findings. Despite new illegal substances and increasing drug use, alcohol still has a major impact on fatal crashes. This means that traditional measures for tackling DUI problems still apply but we must be open for new innovations, too.

PMID:42525969 | DOI:10.1080/15389588.2026.2698873

IEEE Trans Pattern Anal Mach Intell. 2026 Jul 29;PP. doi: 10.1109/TPAMI.2026.3718490. Online ahead of print.

ABSTRACT

Graph convolutional networks (GCNs) have been widely used and have achieved remarkable results in skeleton-based action recognition. In this paper, we propose a channel-wise topology refinement-graph convolution (GC) to dynamically learn different topologies and effectively aggregate joint features in different channels for skeleton-based action recognition. Channel-wise topologies are modeled by learning a shared topology as a generic prior for all the channels and refining the topology using channel-specific correlations between joints. Our refinement method introduces very few extra parameters and significantly reduces the difficulty in modeling channel-wise topologies. Furthermore, we reformulate graph convolutions (GCs) into a unified form, and theoretically show that the channel-wise topology refinement-GC relaxes strict constraints of GCs and then has stronger representation capability. In order to model long-range joint dependencies and dynamically adjust channel-wise feature weights, we propose a channel-wise topology refinement squeeze-excitation transformer. Global information is aggregated in the temporal and spatial dimensions to capture correlations between distant joints. The channel-attention mechanism extracts channel-level statistics using global average pooling. The channel weights are generated using a fully connected layer to reinforce action-adaptive feature channels. Experimental results show the effectiveness of the proposed channel-wise topology refinement-GC and channel-wise topology refinement squeeze-excitation transformer on the NTU RGB+D, NTU RGB+D120, and NW-UCLA datasets.

PMID:42525939 | DOI:10.1109/TPAMI.2026.3718490

IEEE Trans Cybern. 2026 Jul 29;PP. doi: 10.1109/TCYB.2026.3715550. Online ahead of print.

ABSTRACT

Information granularity provides a framework for machine intelligence to simulate human cognitive processes in problem-solving, enabling machines to make more flexible and adaptive decisions in complex data environments. However, most existing information granularities are based on fuzzy c-mean (FCM) or K-means clustering for granularity construction. This kind of convex data structure clustering has difficulty in recognizing some irregular nonconvex data types, and can only be filled irregularly by increasing the cluster classes, which is easy to lose the wholeness and accuracy of the data. The density-based spatial clustering of applications with noise (DBSCAN), a classical density-based spatial clustering method, is well-suited for both convex and nonconvex datasets. Building on the versatility of DBSCAN, a new density-based clustering method called stacked density granulation (SDG) is proposed, which constructs information granularities capable of effectively describing both convex and nonconvex data. This approach addresses the limitations of traditional information granularity. By applying the newly constructed information granularities to the feature space, the importance of features can be measured. To enhance this process, a heuristic feature selection method called density granular feature selection (DGFS) is introduced. DGFS constructs a low-dimensional feature space by aggregating and discretizing the information granularities, retaining only the most relevant features. To demonstrate the superiority and effectiveness of the DGFS algorithm, 12 publicly available datasets are utilized, and its performance is compared with other feature selection methods across four different classifiers. The experimental results and the statistical significance test indicate that DGFS consistently outperforms the competing methods.

PMID:42525932 | DOI:10.1109/TCYB.2026.3715550

J Clin Oncol. 2026 Jul 29:JCO2503052. doi: 10.1200/JCO-25-03052. Online ahead of print.

ABSTRACT

PURPOSE: Immunotherapy for frontline mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) metastatic colorectal cancer (mCRC) is effective; however, nearly half of the patients treated with single-agent PD-1 therapy will progress within 12 months. Preclinical studies in CRC and clinical data from other cancers suggest that vascular endothelial growth factor inhibition and chemotherapy can synergize with PD-L1 inhibition.

METHODS: The NRG-GI004/SWOG-S1610 (COMMIT) three-arm prospective phase III open-label trial randomly assigned first-line dMMR/MSI-H mCRC patients (1:1:1) to either: mFOLFOX6 (oxaliplatin 85 mg/m², leucovorin 400 mg/m², 5-FU bolus 400 mg/m², and 46-hour infusional 5-FU 2,400 mg/m²)/bevacizumab (FFX/bev), or atezolizumab (atezo) monotherapy (840 mg IV once every 2 weeks), or the combination of FFX/bev/atezo. The primary end point was progression-free survival (PFS) in the intent-to-treat population. Because of KEYNOTE 177 results, the FFX/bev arm was closed after 20 patients were enrolled. The study continued with atezo alone versus FFX/bev/atezo, with a revised sample size of 100 patients in the two remaining arms (120 patients across all three arms).

RESULTS: From November 2017 to March 2025, a total of 102 patients were enrolled in the three arms: FFX/bev: n = 20, atezo: n = 41, and FFX/bev/atezo: n = 41. At a median follow-up of 46 months for the two arms (median age: 63.3 years; 47.6% female; 23.2% BRAF V600E mutated), PFS of FFX/bev/atezo was superior to that of atezo (hazard ratio [HR], 0.439 [95% CI, 0.23 to 0.84]; P = .0103) and below the critical value of 0.0152. The objective response rate was 86.1% versus 46%, and the disease control rate at 12 months was 64.7% versus 32.4% in the FFX/bev/atezo arm compared with the atezo-only arm, respectively. Grade 3 or higher adverse events of any attribution occurred in 52 patients (atezo: 18; combination arm: 34).

CONCLUSION: The combination of FFX/bev plus atezo led to significantly longer PFS compared with atezo monotherapy in the first-line treatment of dMMR/MSI-H mCRC.

PMID:42525921 | DOI:10.1200/JCO-25-03052

JCO Glob Oncol. 2026 Jul;12(7):e2600157. doi: 10.1200/GO-26-00157. Epub 2026 Jul 29.

ABSTRACT

PURPOSE: The global need for training in clinical research is substantial, particularly in resource-limited settings. We describe an international collaboration to build capacity in clinical research skills through a semi-personalized curriculum.

METHODS: Five sequential workshops (2020-2025) combined online modules with on-site, project-based learning. The curriculum across workshops included research project planning, proposal writing, and manuscript publishing. Topics included fundamentals of clinical study design, data registries, statistical considerations, research ethics, and scientific writing. At registration, applicants submitted an abstract for further development. An average of 35 applicants per workshop were selected. Participants’ experiences were evaluated through postworkshop surveys.

RESULTS: Participants across the workshops presented from 17 countries and seven disciplines, with the majority being physicians (66%) and nurses (16%). During each 2.5-day workshop, participants refined their abstracts with structured guidance and shared their work in a 10-minute presentation. Workshop 1 used a group-based model where each group developed one common abstract. Workshop 2 focused on quality improvement research; each group worked on preselected mock concepts through a structured learning exercise. Workshops 3 and 4 involved individualized learning, with each participant developing their own abstract into a study proposal. Workshop 5 focused on scientific writing, guiding participants to develop their abstracts into a manuscript outline. Surveys after each workshop consistently demonstrated a high level of satisfaction and perceived gain in knowledge and skill.

CONCLUSION: These workshops effectively engaged trainees with various levels of clinical research training and imparted skills for research planning and manuscript writing. Future iterations will include thematic workshops including advanced statistical methods. Combining asynchronous learning modules with on-site, project-based training can be implemented across other regions and specialties in context-relevant settings.

PMID:42525911 | DOI:10.1200/GO-26-00157

JCO Glob Oncol. 2026 Jul;12(7):e2500688. doi: 10.1200/GO-25-00688. Epub 2026 Jul 29.

ABSTRACT

PURPOSE: Lebanon’s ongoing economic collapse has severely disrupted access to cancer care and increased out-of-pocket financial burden for patients. Financial toxicity and psychological distress are recognized barriers to treatment experience and adherence, yet little is known about how these factors interact within collapsing health systems. This study assessed whether psychological distress is indirectly associated between financial toxicity and treatment satisfaction among Lebanese adults with cancer.

METHODS: A cross-sectional survey was conducted among 308 adult patients with cancer receiving or recently completing treatment across Lebanon. Participants completed validated Arabic versions of the Comprehensive Score of Financial Toxicity Functional Assessment of Chronic Illness Therapy (COST-FACIT; financial toxicity; lower scores indicate greater toxicity), PHQ-4 (anxiety/depression), FACIT-TS-G (treatment satisfaction), and Multidimensional Scale of Perceived Social Support (social support). Descriptive statistics, bivariate analyses, and multivariable linear regression were performed. Indirect associations were tested using Hayes’ PROCESS Model 4 with 5,000 bias-corrected bootstrap samples, adjusting for relevant sociodemographic and clinical covariates including age, insurance status, and treatment variables.

RESULTS: Participants had a mean age of 47.9 years; 58.4% was female. Lower COST scores (greater financial toxicity) were significantly associated with higher psychological distress (P < .001). Higher distress was significantly associated with lower treatment satisfaction (P < .001). In multivariable models, financial toxicity, psychological distress, social support, and insurance coverage were independent predictors of treatment satisfaction. Indirect analysis indicated a significant indirect association between financial toxicity and treatment satisfaction through psychological distress. The direct association remained significant, indicating mediation.

CONCLUSION: Among patients with cancer living through Lebanon’s economic crisis, greater financial toxicity was associated with higher psychological distress and lower treatment satisfaction. Psychological distress accounted for this relationship. These findings underscore the need for integrated psychosocial support and financial navigation within resource-constrained oncology settings.

PMID:42525910 | DOI:10.1200/GO-25-00688

J Med Internet Res. 2026 Jul 29;28:e93633. doi: 10.2196/93633.

ABSTRACT

BACKGROUND: Frailty is prevalent and dynamic in older people living with HIV and is associated with adverse outcomes. Lifestyle support is recommended but difficult to deliver at scale. Digital self-access education may help, although evidence in older, multimorbid populations is limited.

OBJECTIVE: This study aims to evaluate 6-month changes in frailty phenotype and related outcomes after a QR code-enabled self-access lifestyle education program on Mediterranean diet and exercise routines for people living with HIV aged ≥60 years.

METHODS: We conducted a pragmatic, single-arm, quasi-experimental exploratory pretest-posttest evaluation in the HIV outpatient clinic of University Hospital Costa del Sol (Marbella, Spain). Participants received a trifold leaflet with QR codes linking to curated YouTube videos on Mediterranean diet and aerobic or resistance exercise, as an adjunct to usual care. Frailty was assessed using the Fried frailty phenotype. Secondary outcomes included frailty criteria, patient-reported measures (Insomnia Severity Index [ISI], 10-item Connor-Davidson Resilience Scale [CD-RISC-10], University of California, Los Angeles, Loneliness Scale [ULS], and Hospital Anxiety and Depression Scale categories), physical activity (International Physical Activity Questionnaire), Mediterranean diet adherence (MEDAS), and inflammatory and immunologic markers. Frailty transitions were summarized descriptively; paired dichotomous variables were analyzed with McNemar test, and continuous variables with a paired t test or Wilcoxon signed-rank test. All tests were 2-tailed.

RESULTS: Of 52 enrolled participants, 50 (96.2%) were included at 6 months. Frailty transitions were frequent and bidirectional and occurred only between adjacent states. Of 4 frail participants at baseline, 2 transitioned to prefrail; of 25 prefrail participants, 5 improved to robust and 6 progressed to frail; and of 21 robust participants, 10 transitioned to prefrail. No statistically significant changes were observed in inflammatory and immunologic markers, physical activity, or MEDAS scores. Insomnia improved (from a median ISI score of 6.5, IQR 4-9 to a median of 4.0, IQR 2-7; P=.001; r=0.49), resilience increased (median CD-RISC-10 32.0, IQR 28-36 to 37.0, IQR 33-40; P<.001; r=0.65), and loneliness worsened (median ULS 34.5, IQR 30-39 to 38.0, IQR 34-42; P=.001; r=0.49). Grip strength did not improve among participants with impaired baseline strength.

CONCLUSIONS: In this uncontrolled exploratory study, selected psychosocial outcomes changed over 6 months after delivery of a QR code-enabled lifestyle education strategy, whereas no clear short-term changes were observed in lifestyle, strength, or biomarker outcomes. Findings should be interpreted as exploratory and hypothesis-generating rather than causal.

PMID:42525444 | DOI:10.2196/93633

JAMA Netw Open. 2026 Jul 1;9(7):e2626021. doi: 10.1001/jamanetworkopen.2026.26021.

ABSTRACT

IMPORTANCE: Understanding how Ukrainian refugee children accessed the health care system after fleeing the war is essential to inform future preparedness and resource allocation in host countries.

OBJECTIVE: To use latent class analysis of registry data to identify distinct health care utilization profiles among young Ukrainian refugee children who accessed the health care system in southern Poland in 2022.

DESIGN, SETTING, AND PARTICIPANTS: This registry-based retrospective cohort study used electronic health record data from 2022 and included Ukrainian refugee children, aged 0 to 5 years, who received health care services in facilities in Małopolska Voivodeship, Poland. Participants were followed up from February 24 through December 31, 2022. The data were analyzed from April to October 2025.

EXPOSURE: Healthcare utilization indicators among postwar displaced Ukrainian refugee children used as inputs to the latent profile analysis.

MAIN OUTCOMES AND MEASURES: Latent profile membership of health care utilization based on health care visit types, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coded diagnoses, and intensity of health care use, with temporal patterns of system entry and service trajectories examined after profile identification.

RESULTS: The analytic sample included 9845 Ukrainian refugee children aged 0 to 5 years (4849 [49.3%] female) who received 35 199 health care services in Małopolska Voivodeship in 2022. Age at first health care contact was evenly distributed across categories (mean [SD] of 2.7 [1.6] years), 3802 children (38.6%) had a single recorded service, 1845 (18.7%) had more than 5 services, and nearly half (4505 [45.8%]) received care in the regional capital (Krakow). Based on latent class analysis, 5 pediatric patient profiles were identified: mostly primary care (5216 [53.0%]), hospitalized with infectious diseases (1539 [15.6%]), highest health care use (1329 [13.5%]), emergency care for injuries (900 [9.1%]), and dental and preventive care (861 [8.7%]), differing in visit type, diagnostic patterns, and health care utilization intensity. Temporal patterns varied across profiles with earlier system entry among children requiring hospitalization for infectious diseases or emergency care for injuries, and later entry among those using primary care or dental and preventive care.

CONCLUSIONS AND RELEVANCE: In this cohort study of pediatric Ukrainian refugees in southern Poland, distinct health care utilization patterns were observed with early reliance on hospital and emergency care followed by greater use of primary services. These findings underscore the need for refugee-hosting countries to rapidly adapt health care resources, prioritizing inpatient and emergency care in the initial months following a crisis.

PMID:42525412 | DOI:10.1001/jamanetworkopen.2026.26021