Nevin Manimala

JMIR Mhealth Uhealth. 2026 Mar 17;14:e66074. doi: 10.2196/66074.

ABSTRACT

BACKGROUND: Accessibility barriers contribute to low participation in center-based cardiac rehabilitation. We developed an innovative, comprehensive, dual-phase telerehabilitation program to address this gap (Smartphone Cardiac Rehabilitation, Assisted Self-Management; SCRAM).

OBJECTIVE: The study aimed to determine the effectiveness of SCRAM for increasing maximal aerobic exercise capacity (VO2max).

METHODS: A multicenter, parallel 2-arm randomized controlled trial recruited clinically stable adults (aged ≥18 y) with diagnosed coronary heart disease at 3 hospitals in Victoria, Australia (Melbourne, Geelong, and Bendigo) from 2018 to 2021. Participants were randomized (1:1), stratified by sex and study site, to receive SCRAM plus usual cardiovascular care (intervention) or usual cardiovascular care alone (control). SCRAM provided 24 weeks of remote exercise supervision, coaching, and behavior change support via smartphone. Usual cardiovascular care included standard medical care and advice to seek a referral to center-based cardiac rehabilitation, which was heavily impacted during the COVID-19 pandemic. Due to the nature of the treatments, participants were not blinded to allocation; primary outcome assessors and biostatisticians were blinded. The primary outcome was VO2max at 24 weeks, analyzed on the principle of intention-to-treat, using linear regression adjusted for baseline and stratification factors on multiple imputed data.

RESULTS: Recruitment and data collection were heavily impacted by COVID-19, although SCRAM delivery was sustained throughout. Of 220 required participants, only 123 (56%) were recruited and randomized (intervention n=63, control n=60); 45% (55/123) had missing VO2max at 24 weeks-largely due to enforced COVID-19 restrictions. Mean VO2max at 24 weeks favored SCRAM (26.10, SD 10.72 mL/kg/min) over control (24.65, SD 7.87 mL/kg/min), but the difference was not statistically significant (mean difference=1.61 mL/kg/min, 95% CI -1.38 to 4.61, P=.28). Among secondary outcomes, patients receiving SCRAM had lower diastolic blood pressure at 24 weeks (mean difference=-5.54 mm Hg, 95% CI -10.01 to -1.06). All reported adverse events (control n=6, intervention n=16) were deemed mild or moderate, with only one deemed as possibly related to treatment. There were no deaths or hospitalizations.

CONCLUSIONS: This was an underpowered trial, but SCRAM did not lead to a clinically important difference in VO2max compared to usual cardiac care. SCRAM was resilient to COVID-19-related disruptions that significantly impacted the delivery of cardiac rehabilitation and supervised exercise training in particular. Further research is needed to conclusively assess treatment effects and understand how virtual cardiac rehabilitation can be translated into routine practice to augment center-based delivery and enhance equity of access.

PMID:41843837 | DOI:10.2196/66074

JCO Glob Oncol. 2026 Mar;12(3):e2500373. doi: 10.1200/GO-25-00373. Epub 2026 Mar 17.

ABSTRACT

PURPOSE: Leadership is essential for addressing global challenges in cancer care. Equipped with leadership skills, health care providers can respond effectively to complex oncology issues in diverse settings, including resource-constrained environments. The Princess Margaret Global Oncology Leadership Development (GOLD) program provides accessible, interdisciplinary leadership training to support this. Each year, roughly 165 clinical fellows train at the Princess Margaret Cancer Centre, most of whom are internationally trained. GOLD offers leadership training to any fellow interested in global oncology, supporting their ability to tackle complex challenges worldwide. This study describes the development, implementation, and outcomes of the first 5 years of the GOLD program.

METHODS: GOLD is a hybrid, multiformat leadership training program integrating experiential learning, mentorship, and systems-level thinking. It is offered free of charge and is open to all fellows in oncology to eliminate common barriers such as selection/promotion bias, travel, and cost. McNemar’s test and T-tests were used to compare rankings with pre- and postprogram survey and session evaluations. Inductive thematic analysis was conducted to analyze semistructured interviews.

RESULTS: Participants (53% female, 47 countries represented) showed statistically significant improvements in confidence across 24 leadership competencies. No associations were found between confidence gains and participants’ geographic or economic backgrounds. Thematic analysis identified four key themes: improved preparedness for leadership roles, sustained global networking and mentorship, enhanced understanding of leadership across diverse contexts, and growth in intrapersonal skills.

CONCLUSION: The GOLD program demonstrates the effectiveness of inclusive, experiential leadership training in oncology. By removing barriers to access and prioritizing diversity, it supports a new generation of global cancer leaders. Ongoing evaluation and adaptation will ensure that the program remains relevant across diverse sociocultural and economic contexts, contributing to more equitable and effective leadership in cancer care worldwide.

PMID:41843835 | DOI:10.1200/GO-25-00373

Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2026 Mar 17:1-14. doi: 10.1080/19440049.2026.2636065. Online ahead of print.

ABSTRACT

Commission Regulation 2021/808 sets performance criteria for methods for analysing pharmacologically active substances in food-producing animals. Due to the vast numbers of veterinary drugs and sample matrices, conventional re-validation of existing methods to this regulation is costly and disruptive to the delivery of routine analyses. This paper presents an alternative approach to method validation based on adding fortified samples to routine screening batches that is cost-effective and fits seamlessly within routine analytical workflows. The relationships between added concentration and each of three quantities: (1) mean measurement result, (2) the uncertainty of the mean result, and (3) the within laboratory reproducibility standard deviation are directly estimated by a maximum likelihood fit of a statistical model to measurement results. Hence, the model provides estimates of trueness, relative standard deviation and measurement uncertainty at concentrations of interest that are within the range of concentrations used in the model fit. The CCα (decision limit for confirmation) and CCβ (detection capability for screening) are calculated from estimates of measurement uncertainty. Because this approach uses data collected during routine analyses across a large number of analytical batches, rather than relying on specifically constructed validation studies, the resulting estimates of trueness and within-laboratory reproducibility better reflect real-world method performance. Estimates of performance do not rely on patterns of replication at specific concentrations or the availability of a particular number of results. Instead, the sufficiency of validation data is judged by the relative standard errors of estimates of within lab-reproducibility at concentrations of interest gained by a parametric bootstrap of the fitted statistical model. R script (a programming language used for statistical analysis) which demonstrates model fitting, performance parameter estimation and assessment of validation quality via a parametric bootstrap is provided here along with further scripts that demonstrate the method in two examples.

PMID:41843822 | DOI:10.1080/19440049.2026.2636065

J Chem Theory Comput. 2026 Mar 17. doi: 10.1021/acs.jctc.5c01970. Online ahead of print.

ABSTRACT

Stochastic formulations of electronic-structure theory often reduce computational cost by replacing exact contractions with statistical estimates obtained from random samples, a procedure that inherently introduces random fluctuations and systematic bias. The fluctuations decay as M^-1/2 with the number of samples M, whereas the bias generated in nonlinear or self-consistent settings decays as M^-1 and can remain significant for moderate M. To control this bias we employ the jackknife-2 estimator, which reduces its leading term to $O\left(M^{–2}\right)$ with only modest extra cost. We examine bias formation and removal in three settings: (i) stochastic treatments of the Markovian master equation using bundled dissipators, (ii) stochastic Kohn-Sham density functional theory for warm dense hydrogen, and (iii) stochastic evaluation of the Hubbard-model partition function. The first two settings have been presented in earlier works; accordingly, we review them only briefly and focus primarily on the issue of bias control. The Hubbard-model application is entirely new. For this case, we present two approaches: a direct estimator, which has large variance but no bias, and a “midway transition probability” (ΣMTP) estimator, which has smaller variance but introduces bias. Applying the jackknife-2 procedure to the ΣMTP estimator controls this bias and yields a substantially lower total error than the direct estimator. Across all cases, jackknife bias removal markedly improves the accuracy and reliability of stochastic electronic-structure calculations without increasing the computational cost.

PMID:41843818 | DOI:10.1021/acs.jctc.5c01970

J Cardiopulm Rehabil Prev. 2026 Mar 17. doi: 10.1097/HCR.0000000000001030. Online ahead of print.

ABSTRACT

PURPOSE: Evaluate the effectiveness of a hybrid cardiac rehabilitation (CR) program compared with a traditional CR program and to assess the long-term effectiveness of the hybrid program in terms of promoting improvements in physical activity, functional capacity, health-related quality of life (HRQoL), and symptoms of anxiety and depression.

METHODS: A pragmatic randomized clinical trial was conducted across nine centers. The traditional program involved in-center exercise sessions twice a week for 12 weeks. The hybrid program included in-center sessions twice a week for 6 weeks, followed by a gradual replacement of in-center sessions by home-based sessions over the next 6 weeks. Physical activity levels, functional capacity, HRQoL, and symptoms of anxiety and depression were assessed at baseline, at the end of the program, and at a 6-month follow-up. A generalized linear mixed model was used to assess between-group differences.

RESULTS: Of the 295 participants recruited, 224 completed the end-of-program assessment (76%), and 169 were followed up at 6 months (57%). There were no statistically significant differences between the groups for all variables except for HRQoL. Between baseline and discharge, both groups showed significant improvements in all variables. At 6 months, no significant changes or differences between groups were found, indicating that the benefits were maintained over time.

CONCLUSIONS: No statistically significant differences were observed between groups for most outcomes. Both hybrid and traditional CR programs led to significant improvements in all outcomes. These benefits were sustained 6 months after completing either type of program.

PMID:41843817 | DOI:10.1097/HCR.0000000000001030

J Am Acad Orthop Surg Glob Res Rev. 2026 Mar 17;10(3). doi: 10.5435/JAAOSGlobal-D-26-00001. eCollection 2026 Mar 1.

ABSTRACT

INTRODUCTION: MRI is commonly used to evaluate pelvic musculoskeletal infections. Limited “quick” MRI protocols enable timely imaging without intravenous contrast or sedation. This study examines the consistency of interpretation among pediatric orthopaedic surgeons when using quick versus full, contrast-enhanced MRI scans in cases of peripelvic musculoskeletal infection and explores these findings to inform future development and design of machine learning algorithms.

METHODS: Twenty-nine pediatric patients with full pelvis MRI with and without contrast and culture-positive peripelvic infection were retrospectively identified. Two deidentified files were created for each patient: one including all sequences and the other containing only the limited sequences included in our institution’s quick MRI protocol. Three pediatric orthopaedic surgeons independently and sequentially evaluated the images, followed by group discussion to reach consensus on the primary diagnosis and management. Fleiss’ Kappa (FK) statistic was calculated for each outcome.

RESULTS: Moderate agreement in primary diagnosis was observed among reviewers using quick MRI sequences (Kappa = 0.488), and substantial agreement was seen with full sequences (0.684; P = 0.003). Inter-rater agreement on treatment recommendations was poor with both quick (0.09) and full (0.233) MRI (P = 0.046). No difference was found in team consensus diagnosis and final diagnosis between quick (0.523) and full (0.569) MRI (P = 0.662). Poor agreement was found between team treatment recommendations and actual treatment for both quick (0.182) and full (0.07) MRI (P = 0.254).

CONCLUSION: Independent evaluation of limited, quick MRI sequences by pediatric orthopaedic surgeons showed more variability in diagnosis and treatment compared with full MRI review. When reviewed collaboratively, the diagnostic accuracy of quick MRI approached that of full MRI. Future artificial intelligence-based imaging interpretation platforms will benefit from multi-institutional collaboration to improve training data quality; use of ensemble learning techniques to reflect the diversity of multispecialist approaches; and incorporation of relevant clinical data to properly identify, triage, and direct treatment of complex pediatric musculoskeletal conditions.

PMID:41843807 | DOI:10.5435/JAAOSGlobal-D-26-00001

JMIR Form Res. 2026 Mar 17;10:e59700. doi: 10.2196/59700.

ABSTRACT

BACKGROUND: The prevalence of various mental health conditions is higher among physicians and medical learners. One common barrier to receiving adequate care includes a lack of time to see a provider and follow treatment plans. As such, virtual forms of cognitive behaviour therapy with mindfulness (CBTm) were introduced to mitigate these barriers and provide care in an efficient and effective manner.

OBJECTIVE: The objective of this study was to determine the acceptability and feasibility of a 5-session CBTm program, delivered in 2 virtual formats within a population of medical learners and physicians.

METHODS: Participants signed up to the program using an online link and were able to choose a preferred format to participate in the CBTm program. One option was a virtual, facilitator-led class that was held once a week for 5 weeks, in a group setting (CBTm facilitator-led). Another option included a self-directed course that had identical content to the live classes but was independently completed by the participant using an online platform (CBTm self-directed). Feedback forms were collected from participants after every class and analyzed using quantitative and qualitative methods. Thematic analysis was used to qualitatively analyze open-ended questions from participant feedback forms. In addition, the mean values of questionnaire items were used to determine participant satisfaction with the program.

RESULTS: The results indicated a good level of interest in both CBTm facilitator-led (n=15) and CBTm self-directed (n=94) groups. Of those who registered for the program, 13.8% (15/109) registered for CBTm facilitator-led and 86.2% (94/109) chose the self-directed version. The percentage of participants who participated in the majority of classes was 80% (12/15) for the CBTm facilitator-led group and 45.7% (43/94) for the CBTm self-directed group. The mean age of participants was 44.86 (SD 12.15 years), and the highest rate of uptake was among female physicians. Quantitative mean scores of participant feedback forms also showed a high level of satisfaction. For example, the Client Satisfaction Questionnaire 8 (CSQ-8) was analyzed, and the results indicated mean total scores of 28.00 (SD 3.24) and 26.46 (SD 3.55) for CBTm facilitator-led and CBTm self-directed, respectively. In addition, many themes emerged from thematic analysis and were subsequently categorized into 3 major categories. This included perceived strengths, perceived weaknesses, and suggested revisions to improve the program. Perceived strengths included improved mental health, helpful course content, and improved patient care. Perceived weaknesses included individual barriers to participation, content downfalls, and format-specific barriers. Suggested revisions included improving adherence to homework and virtual delivery of the program.

CONCLUSIONS: In conclusion, the results indicate that the self-directed and facilitator-led versions of CBTm were acceptable and feasible in this population of physicians and medical learners.

PMID:41843800 | DOI:10.2196/59700

Cutan Ocul Toxicol. 2026 Mar 17:1-8. doi: 10.1080/15569527.2026.2642191. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Cadmium causes systemic inflammation and retinal damage, posing a serious threat to visual and public health.

BACKGROUND: Cadmium is a harmful heavy metal that builds up in body tissues and cause systemic inflammation and organ damage. This research sought to explore the impact of subacute cadmium exposure on retinal morphology and inflammatory cytokine levels.

METHOD: A total of fourteen male Wistar albino rats were randomized into control and cadmium-exposed groups within the scope of the experiment. 3 mg/kg cadmium (CdCl₂) was administered intraperitoneally to the subjects in the cadmium group for 15 days. At the end of study, serum IL-6 and TNF-α levels were determined by ELISA method. In addition, retinal tissues were examined histopathologically after Hematoxylin and Eosin staining. Retinal apoptotic changes were assessed by semi-quantitative immunohistochemical analysis of Bax and Bcl-2 expression in the inner and outer nuclear layers.

RESULTS: According to the findings, cadmium exposure caused a statistically significant increase in serum IL-6 and TNF-α levels. Histopathological examination revealed a marked decrease in the thickness of the inner plexiform layer (IPL), inner nuclear layer (INL), and outer nuclear layer (ONL), as well as focal vacuolization and cellular disorganization. Cadmium exposure significantly increased Bax immunoreactivity and the Bax/Bcl-2 ratio in both the INL and ONL, while significantly decreasing Bcl-2 expression.

CONCLUSION: In conclusion, cadmium exposure increased the systemic inflammatory response, leading to significant histopathological damage in the retinal layers and a dominant proapoptotic Bax/Bcl-2 balance, thereby triggering cellular apoptosis.

PMID:41843795 | DOI:10.1080/15569527.2026.2642191

JMIR Form Res. 2026 Mar 17;10:e63135. doi: 10.2196/63135.

ABSTRACT

BACKGROUND: Electronic medical records (EMRs) are increasingly adopted globally to improve health care delivery, yet challenges remain in their acceptance, defined here as favorable attitudes toward their use among health professionals. Understanding factors influencing acceptance is critical for successful implementation.

OBJECTIVE: This study aimed to identify predictors (or factors) associated with favorable attitudes toward EMRs among health professionals in 3 Ethiopian hospitals.

METHODS: A cross-sectional study was conducted from January to March 2025 in 3 Ethiopian hospitals implementing EMRs. A systematic random sampling method was used to initially select 397 health professionals, and data were collected using a structured questionnaire. Multivariate logistic regression was employed to identify predictors of favorable attitudes toward EMRs.

RESULTS: Of the final 382 professionals, 198 (51.8%, 95% CI 0.43-0.53) showed favorable attitudes. Predictors of positive attitude included computer literacy (adjusted odds ratio [AOR] 2.66, 95% CI 1.16-6.09; P=.02), EMR training (AOR 2.87, 95% CI 1.80-4.56; P<.001), and age of 29 years or younger (AOR 3.05, 95% CI 1.58-5.9; P=.001).

CONCLUSIONS: Improving computer literacy, providing refresher training, and strengthening management support are key strategies for enhancing health professionals’ attitudes toward EMRs. Future research should explore qualitative insights into barriers and facilitators of EMR adoption.

PMID:41843793 | DOI:10.2196/63135

JMIR Mhealth Uhealth. 2026 Mar 17;14:e75662. doi: 10.2196/75662.

ABSTRACT

BACKGROUND: Regular physical activity is a crucial and an important modifiable lifestyle factor reducing the risk of recurrent incidents after stroke or transient ischemic attack (TIA). Mobile health (mHealth) has emerged as a promising approach for providing long-term support for physical activity. However, little is known about how individuals poststroke or TIA adhere to and engage with mHealth interventions.

OBJECTIVE: This study aimed to (1) describe adherence to supervised sessions in an mHealth intervention targeting physical activity, (2) describe engagement with self-managed mHealth support for physical activity during and after the intervention, (3) compare characteristics of participants with high and low adherence and app engagement, and (4) examine whether high adherence and app engagement were associated with maintained physical activity after having completed the intervention and at a 12-month follow-up.

METHODS: In this study, a secondary analysis of data from the experimental arm of a feasibility randomized controlled trial was conducted. The experimental group received a 6-month mHealth version of the i-REBOUND intervention, which included supervised mHealth support for physical activity and behavior change, followed by a 6-month postintervention period with access to self-managed mHealth support. The control group received mHealth consultations via video conferencing. Adherence measures included attendance at supervised exercise and counseling sessions, while app engagement was measured by weekly interactions with self-managed mHealth support during and after the intervention. Participants’ level of physical activity (steps per day) was measured using accelerometers at baseline, and at 6- and 12-month postbaseline. Logistic regression analysis examined the associations between high adherence and app engagement during the intervention and postintervention period and maintained physical activity (ie, >7000 steps/day) across the 12-month study period.

RESULTS: Of the 57 participants enrolled, 51 (89%) completed the intervention; the average age was 71 years, 34/51 (67%) were female, and 47/51 (92%) had mild stroke symptoms. Adherence to supervised mHealth support was high (supervised exercise sessions: 79%, counseling sessions: 98%), while engagement with self-managed mHealth support was high during the intervention (83%) but declined postintervention (38%). A larger proportion of females (24/31, 77%) demonstrated high adherence to the intervention compared to males (7/31, 23%, χ²1=4.1; P=.04). High adherence (≥80%) during the intervention was associated with maintained physical activity between baseline and the 6-month follow-up (OR 12.07, 95% CI 2-72.76; P=.01), while high app engagement (≥80%) during postintervention was associated with maintained physical activity between the 6- and 12-month follow-up (OR 5.10, 95% CI 1.02-25.52; P=.05).

CONCLUSIONS: Supervised mHealth support was well received with high adherence, while modules for self-management of physical activity faced challenges in engaging the participants. Future studies could benefit from qualitative and cocreative approaches to better understand and refine self-managed mHealth support for individuals poststroke or TIA.

PMID:41843778 | DOI:10.2196/75662