Nevin Manimala

Neurodiagn J. 2026 Jun 2:1-13. doi: 10.1080/21646821.2026.2671520. Online ahead of print.

ABSTRACT

INTRODUCTION: Linked Quadripolar Stimulation (LQP) is a recent adaptation of transcranial electric motor evoked potential stimulation, with proposed advantages over traditional Bipolar (BP) stimulation. This study aims to comprehensively compare BP and LQP stimulation to validate the efficacy of LQP.

METHODS: BP and LQP stimulation were performed on 30 patients undergoing anterior cervical discectomy and fusion. A comprehensive assessment involved conducting four trials for each technique on each patient. An Accelerometer placed over the right masseter region recorded movement. A Mann-Whitney U test and Pearson Correlation Coefficient were used to quantitatively compare patient movement, compound muscle action potential (CMAP) response amplitude, and area under the curve (AUC) values.

RESULTS: TCMEP recordings were successfully obtained from the entire sample. No statistical significance was found between patient movement, amplitude, or area under the curve (AUC) between BP and LQP stimulation. A weak correlation was found between patient movement and stimulation intensity for both techniques. A strong correlation was found between amplitude and AUC values.

CONCLUSION: Patient movement and stimulation parameters showed similar outcomes between BP and LQP. LQP did not demonstrate reduced movement compared to BP stimulation. This study contributes valuable insights into the effectiveness of BP and LQP stimulation in anterior cervical discectomy and fusion surgery.

PMID:42228986 | DOI:10.1080/21646821.2026.2671520

Neurodiagn J. 2026 Jun 2:1-14. doi: 10.1080/21646821.2026.2659990. Online ahead of print.

ABSTRACT

The National Association of Epilepsy Centers mandates that epilepsy monitoring unit (EMU) patient observers must always be present to minimize risk of patient injury during admissions. To comply with this requirement, our staffing model and workflow were adjusted accordingly. Upon activation of the event button, rather than attending to EMU patients in person, the patient observer responded verbally through the room’s speaker system and subsequently contacted nursing staff via a Vocera™ device. This study evaluates the efficiency of this model by measuring the time between event button (PB) activation, observer response, and subsequent evaluation by either nursing staff or physicians. We retrospectively reviewed video EEG files for all available PBs on EMU patients admitted between January 1 and December 31, 2023, and calculated the intervals between PB activation, patient observer’s response, and in-person attendance by the health care provider. Patient demographics and event details were examined for statistical differences. Of 129 admissions (402 PBs), the median observer response time was 15 seconds, which increased with age (14 s, 16 s, and 20 s for <45, 45-64, and ≥65 yo, respectively; p = .027). The average time for a nurse or a physician to physically attend to the patient was 94 s (range, 4 to 1808 s). The average observer’s response to psychogenic non-epileptic seizures (PNES) was faster (10 s) than responses to epileptic seizures (14 s), accidents (15 s), and other events (17 s) (p < .001). There was no difference in response time between sexes (p = .870) or races (p = .197). Although patient observer response time was short, only 15% of PBs were seizure-related, while > 50% were accidental. These findings highlight the need to critically evaluate EMU staffing models to maintain compliance with the safety requirements, improve the accuracy of seizure detection, and to meet overall goals of EMU evaluation.

PMID:42228984 | DOI:10.1080/21646821.2026.2659990

Surg Laparosc Endosc Percutan Tech. 2026 Jun 1;36(3):e1448. doi: 10.1097/SLE.0000000000001448.

ABSTRACT

BACKGROUND AND AIMS: Esophageal foreign body (FB) impaction demands timely gastroscopic extraction, yet the need for preoperative radiographic imaging (PORI) varies by patient. To date, no validated risk-stratification tools exist to guide clinicians in determining the necessity of PORI before gastroscopic FB extraction. This study aims to fill this gap by developing a novel esophageal FB symptom score (EFBSS) to stratify patients at risk of severe complications, thereby providing a personalized approach to PORI decision-making.

METHODS: Patients with suspected FBs were retrospectively categorized into PORI or non-PORI groups. Gastroscopic success rate, complications, and survival prognosis were compared and analyzed between the 2 groups. Logistic regression was used to identify risk factors for FB-related perforation or surgical complications. A risk stratification system (low-risk: 0 to 3; moderate-risk: 4 to 6; high-risk: 7 to 9 points) was then built based on the likelihood of such complications to guide PORI decision-making.

RESULTS: There was no statistically significant difference between the PORI group (n=749) and the non-PORI group (n=1751) in the main outcome indicators, such as disease characteristics, FB types, incidence of complications, gastroscopic success rate, and survival prognosis (P>0.05). However, the PORI group had a longer duration of FB impaction and higher outpatient costs than the non-PORI group (P<0.05). The EFBSS includes swallowing FBs with pain, intentional ingestion of FBs, and cervical/chest/abdominal pain, with good discriminative power. The total score had an area under the receiver operating characteristic curve (AUC) of 0.822 (95% CI: 0.736-0.908), while the AUCs for the 3 components were 0.716, 0.699, and 0.894, respectively. The EFBSS system stratified the risk of FB-related perforation or surgical complications into 3 tiers: low (0.41%), moderate (2.95%), and high (39.29%). A significantly increasing risk trend was observed across tiers (P<0.001).

CONCLUSIONS: We developed a risk scoring system incorporating swallowing FBs with pain, intentional ingestion of FBs, and cervical/chest/abdominal pain. This system preoperatively stratifies patients by the risk of FB-related perforation or surgical complications to facilitate PORI decision-making and maximize benefits.

PMID:42228962 | DOI:10.1097/SLE.0000000000001448

Integr Comp Biol. 2026 Jun 2:icag061. doi: 10.1093/icb/icag061. Online ahead of print.

ABSTRACT

Geometric morphometrics is a common tool that quantifies shape variation and has been used to explore morphological changes over ontogeny and investigate evolutionary relationships. Lionfishes are suction feeders that have cycloid scales. Cycloid scales in bony fishes are smooth, overlapping structures that have been hypothesized to serve multiple functions such as protection and streamlining the fish for efficient locomotion. Lionfish undulate their soft dorsal, anal, and caudal fins to move slowly through the water column, near the substrate. In this study we examined invasive lionfish, Pterois volitans, collected from public fishing derbies on the eastern coast of Florida. We used 2D geometric morphometrics to investigate lionfish scale variation along the length of the body from three regions (anterior, middle, caudal), and between sexes. We placed eight landmarks using anatomical loci on sixty scales from twenty specimens similar in size (TL = 170mm- 230mm). We hypothesized to observe significant scale shape variation among body regions and we expected to see shape variation between sexes, as males exhibit more aggressive behavior during mating. Lionfish showed significant shape differences among all regions (anterior, middle, and caudal), with scales being more elongated near the caudal fin. We also observed statistically significant shape differences between male and female scales. Specifically, females have wider scales in the middle body region and males have wider scales near the caudal fin. Overall, this study reveals more information about the morphology and sexual dimorphic traits of lionfish using unconventional specimen collection methods (public lionfish derbies). When conducting research on invasive species we emphasize the importance of utilizing public events sponsored by state and local organizations, which are already engaging the public to significantly reduce population sizes.

PMID:42228949 | DOI:10.1093/icb/icag061

Anesth Analg. 2026 Jun 2. doi: 10.1213/ANE.0000000000008107. Online ahead of print.

ABSTRACT

BACKGROUND: Oxytocin is the most widely used uterotonic for postpartum hemorrhage prevention, yet high-quality data comparing bolus versus infusion administration are limited. Given the very high uterine blood flow at term, rapid achievement of uterine tone is critical to minimize blood loss. We hypothesized that bolus administration leads to a greater likelihood of attaining adequate uterine tone at 2 minutes.

METHODS: In this randomized, double-blinded clinical trial, 121 patients undergoing elective cesarean delivery under spinal anesthesia were randomized 1:1 to receive oxytocin by bolus or infusion after cord clamping. Masked study drugs were prepared by the investigational pharmacy to maintain blinding of the anesthesiologist, obstetrician, and study personnel. The primary end point was adequate uterine tone at 2 minutes. Secondary end points included patient satisfaction, time to adequate uterine tone, quantitative blood loss, postpartum hemorrhage (blood loss greater than 1000 mL), and safety measures (heart rate, blood pressure, phenylephrine dose, chest pain, nausea/vomiting, additional uterotonic use, and intensive care unit admission).

RESULTS: Of 121 patients enrolled, 115 were analyzable (6 screen failures received no study drug); 114/115 received oxytocin per protocol. Baseline characteristics were similar between groups. Adequate uterine tone at 2 minutes (primary end point) was similar in bolus (50/60, 83.3%) vs infusion (43/55, 78.2%), P = .483. Patient satisfaction scores were also not significantly different (P = .495) between the two arms, with both the bolus and infusion arms having medians and interquartile range (IQRs) of (10 [IQR 10-10]). Median blood loss was slightly lower with bolus (558 mL [IQR 429-733]) vs infusion (687 mL [IQR 480-826], P = .0438; Hodges-Lehmann estimate of 82 mL [95% confidence interval {CI}, 2-168 mL]). Phenylephrine dosage and rates of postpartum hemorrhage, nausea, and additional uterotonic use were similar between groups (all P > .28). Rates of postpartum hemorrhage, hypotension, phenylephrine use, nausea, and additional uterotonic use were similar.

CONCLUSIONS: There was no statistically significant difference in the frequency of achieving adequate uterine tone at 2 minutes between oxytocin given by infusion or bolus. Although the bolus group demonstrated statistically lower blood loss, the magnitude of this difference was small (upper confidence limit of 168 mL) and is unlikely to be clinically significant. Both methods showed comparable safety profiles.

PMID:42228946 | DOI:10.1213/ANE.0000000000008107

Anesth Analg. 2026 Jun 2. doi: 10.1213/ANE.0000000000007978. Online ahead of print.

ABSTRACT

BACKGROUND: Anesthetic adjuvants used in multimodal analgesia-including intravenous lidocaine, dexmedetomidine, or intrathecal morphine (ITM)-may differentially affect immune responses and metastasis-related pathways in colorectal cancer surgery. Their comparative effects on these pathways remain poorly understood.

METHODS: In this prospective, randomized, patient- and assessor-blinded trial, adults undergoing elective laparoscopic or robotic colorectal cancer resection were allocated to receive intravenous lidocaine, dexmedetomidine, or ITM. The primary outcome was plasma matrix metalloproteinase-9 (MMP-9) concentration at 1 hour postoperatively. Secondary outcomes included other metastasis-promoting biomarkers (MMP-2, VEGF, IL-6), immune cell subsets (T and NK cells), and CD39/CD73 expression on T lymphocytes at 1 hour postoperatively and postoperative day 1. Clinical outcomes-including pain scores, opioid consumption, and complications-were also assessed.

RESULTS: Of the 114 enrolled patients, 109 completed the study and were analyzed (ITM group = 37, DEX group = 34, LIDO group = 38). Overall group × time interaction was significant for MMP-9 (P = .028). At 1 hour, MMP-9 was higher in LIDO group than in the DEX group (difference on the log scale, 0.333; 95% confidence interval [CI], 0.0642-0.601; P = .009) and in the ITM group (0.424; 95% CI, 0.0248-0.823; P = .033). The DEX group was associated with increased CD73+CD8+ T cells compared with the LIDO group (difference on the logit scale: 0.669; 95% CI, 0.000987-1.34; P = .050), and with decreased CD39-CD73-CD8+ T cells compared with the ITM group (-0.695; 95% CI, -1.3 to -0.0908, P = .018) and the LIDO group (-0.645; 95% CI, -1.24 to -0.05, P = .029). The ITM group was associated with lower dynamic pain scores than the other groups. Rescue antiemetic use was less frequent with the DEX group, whereas other adverse events were mild and comparable across groups.

CONCLUSIONS: Anesthetic adjuvants exerted differential effects on perioperative biomarkers and immune profiles relevant to tumor progression. Compared with the other groups, lidocaine was associated with higher MMP-9 levels, dexmedetomidine with relative shifts toward an immunosuppressive T-cell phenotype, and intrathecal morphine with superior analgesia with minimal immune impact. Further studies are warranted to determine whether multimodal analgesia strategies influence long-term oncologic outcomes.

PMID:42228944 | DOI:10.1213/ANE.0000000000007978

J Med Internet Res. 2026 Jun 2;28:e86498. doi: 10.2196/86498.

ABSTRACT

BACKGROUND: Large language models (LLMs) require specialized methodologies to quantify model confidence for safe deployment in health care systems; however, there is a lack of established methods for confidence assessment.

OBJECTIVE: This study aimed to evaluate confidence metrics for multimodal LLMs interpreting ultrasound-based radiology cases and to compare self-reported, consistency-based, and hybrid methods.

METHODS: From a total of 330 quizzes on the Korean Society of Ultrasound in Medicine digital platform, we selected 94 multiple-choice cases. Four multimodal LLMs were evaluated: 3 reasoning models (GPT-5, Claude-4.5-Sonnet, and Gemini-3-Pro) and 1 general model (GPT-4o). Temperature was fixed at 1.0. Multiple confidence metrics were assessed: (1) self-reported metrics generated by LLMs using prompts that elicited direct confidence percentages with answers, including first self-reported confidence and mean self-reported confidence; (2) consistency-based metrics derived from 20 repeated outputs per case, including relative entropy calculated as 1 – H/log2 k (H=Shannon entropy, k=number of answer choices) and majority-vote percentage; and (3) a Top Weighted Score combining response frequency with self-reported confidence. Receiver operating characteristic analysis for discrimination and Spearman correlation between accuracy and each confidence metric was conducted. Additionally, model calibration was assessed using expected calibration error and Brier score. Processing time and token consumption (input, output, and total) were recorded for each application programming interface call to evaluate resource use across models.

RESULTS: Diagnostic accuracy varied across models, with Gemini-3-Pro achieving the highest accuracy (70/94, 74.47%), surpassing the median human accuracy (59%, IQR 40.3%-75%). Top Weighted Score, a hybrid metric combining response frequency and self-reported confidence, was the only metric achieving statistically significant correlations across all 4 models: Gemini-3-Pro (ρ=0.52), GPT-5 (ρ=0.43), Claude-4.5-Sonnet (ρ=0.30), and GPT-4o (ρ=0.22). Receiver operating characteristic analysis revealed that Top Weighted Score demonstrated the highest discriminative ability, with area under the curve values of 0.826 (95% CI 0.731-0.920) for Gemini-3-Pro and 0.767 (95% CI 0.668-0.866) for GPT-5. Top Weighted Score was the only metric achieving statistical significance in GPT-4o. Calibration analysis showed that Top Weighted Score achieved the lowest expected calibration error in GPT-5 (0.098) and Claude-4.5-Sonnet (0.192), while Gemini-3-Pro showed comparable calibration between relative entropy (0.119) and Top Weighted Score (0.122). Resource use analysis demonstrated that reasoning models required substantially longer processing times and higher token consumption compared to general models.

CONCLUSIONS: In multimodal LLMs applied to ultrasound-based radiology cases, hybrid methods (Top Weighted Score) demonstrated significant associations across all evaluated models and appear to serve as more reliable indicators of diagnostic confidence compared to self-reported or consistency-based metrics alone, although the strength of these associations varied across models, and external validation is warranted before broader clinical application. These findings support integrative confidence estimation approaches that incorporate response consistency while highlighting the need for resource-efficient sampling strategies to enable practical clinical deployment.

PMID:42228942 | DOI:10.2196/86498

JMIR Res Protoc. 2026 Jun 2;15:e60583. doi: 10.2196/60583.

ABSTRACT

BACKGROUND: Hispanic adults with type 1 diabetes (T1D) have suboptimal access to continuous glucose monitoring (CGM). Widening access to and increasing uptake of CGM for Hispanic adults with T1D are warranted.

OBJECTIVE: This randomized controlled trial (RCT) will evaluate the feasibility of a federally qualified health center (FQHC) CGM intervention and assess for an intervention signal in patient outcomes.

METHODS: A mixed methods, pragmatic pilot RCT will be used. A total of 30 adult Hispanic patients with T1D will be recruited from 4 FQHC sites allocated to provide the intervention (n=2) or control (n=2) conditions. At intervention sites, participants must be willing to use CGM for 3 months and have a willing adult family member participate in the study. Guided by the socioecological model, our intervention has three levels: (1) individual (culturally sensitive CGM information, motivation, and skills acquisition), (2) family or social networks (integration of the core Hispanic values of familismo and collectivismo to leverage family and peer support for CGM uptake), and (3) health care provider levels with CGM training using Project ECHO (Extension for Community Healthcare Outcomes). Intervention participants (n=15) will receive a culturally sensitive CGM intervention with 4 weekly intervention sessions (coattended by a family member), followed by 7 peer support group sessions over 6 months. Control participants will receive a self-monitoring of blood glucose control condition over a 6-month period. Study feasibility will be assessed in terms of recruitment, enrollment, retention, adherence, study procedures and implementation, and acceptability with mixed methods. We will collect physiological (eg, glycated hemoglobin and CGM metrics) and psychosocial (eg, depression, quality of life, social support, and interpersonal processes of care) outcome data. Feasibility data will be analyzed using content analysis and univariate or bivariate statistics. Linear and generalized linear mixed modeling will assess intervention signals and clinically meaningful differences from baseline to 3 and 6 months.

RESULTS: Funding for this project was secured in September 2022. As of May 2024, recruitment commenced following formative qualitative data collection on the social determinants of health and CGM uptake in Hispanic adults with T1D (N=32). Our community advisory board informed protocol modifications by reviewing qualitative findings, collaborating on related intervention refinement, and advising on cultural sensitivity methods.

CONCLUSIONS: Guided by the socioecological model, our novel FQHC CGM intervention will provide feasibility and outcome data to guide a full-scale RCT. Our intervention model has unique potential to widen CGM access and increase CGM uptake in low-income Hispanic adults with T1D while improving outcomes for this vulnerable population.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06487962; https://clinicaltrials.gov/study/NCT06487962.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/60583.

PMID:42228938 | DOI:10.2196/60583

JMIR Hum Factors. 2026 Jun 2;13:e92145. doi: 10.2196/92145.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) detection tools for intracranial hemorrhage (ICH) are increasingly integrated into radiology workflows. In real-world practice, perceived utility depends not only on diagnostic performance but also on workflow fit, false positive burden, and how clinicians interpret and act on AI outputs.

OBJECTIVE: This study aimed to characterize radiologists’ perceptions of a Food and Drug Administration (FDA)-cleared ICH AI detection tool in a national teleradiology network, including perceived reliability, false positive burden, workflow impact, medicolegal concerns, and self-reported behaviors during routine use.

METHODS: We conducted an anonymous cross-sectional survey of radiologists in a national teleradiology practice who had access to an FDA-cleared ICH AI overlay during noncontrast head computed tomography interpretation. Survey items used a 5-point Likert scale. Results are summarized as agreement proportions (“agree” or “strongly agree”) with 95% CIs. We compared neuroradiologists with non-neuroradiologists using Fisher exact tests. One primary end point was prespecified: agreement that time spent reviewing examinations with false positive AI alerts outweighed the benefits. Remaining subgroup comparisons were treated as exploratory, with false discovery rate control using the Benjamini-Hochberg procedure.

RESULTS: A total of 65 radiologists responded, including 23 (35.4%) neuroradiologists and 42 (64.6%) non-neuroradiologists. Only 18.5% (12/65; 95% CI 10.9%-29.6%) agreed that false-positive alerts were infrequent enough to be acceptable. Agreement that the AI correctly identified most ICH cases was 32.3% (21/65; 95% CI 22.2%-44.4%), and agreement that the AI rarely missed clinically important hemorrhages was 43.1% (28/65; 95% CI 31.8%-55.2%). Trust in AI output was conditional: 50.8% (33/65; 95% CI 38.9%-62.5%) reported trusting the AI when it agreed with their interpretation, whereas 3.1% (2/65; 95% CI 0.8%-10.5%) reported trusting it when it conflicted with their interpretation. Only 10.8% (7/65; 95% CI 5.3%-20.6%) reported reduced overall interpretation time, whereas 33.8% (22/65; 95% CI 23.5%-46.0%) agreed that time spent reviewing false-positive alerts outweighed the benefits. Self-reported reduced scrutiny after an AI-negative result was uncommon (4/65, 6.2%; 95% CI 2.4%-14.8%). In subgroup analysis, neuroradiologists more often endorsed the primary end point than non-neuroradiologists (12/23, 52.2% vs 10/42, 23.8%; unadjusted P=.03), but no exploratory subgroup differences remained statistically significant after false discovery rate correction. Free-text responses emphasized artifact- and calcification-driven false positives, delayed or inconsistent AI availability, consultation burden, and medicolegal concerns.

CONCLUSIONS: In this national teleradiology setting, radiologists reported substantial false positive burden, limited perceived time savings, and strongly conditional trust in an FDA-cleared ICH AI detection tool. Self-reported reduced scrutiny after negative AI outputs was uncommon but present in a minority of cases. These findings support the importance of specificity, interpretability, latency, and workflow-aware implementation when deploying radiology AI tools in practice.

PMID:42228936 | DOI:10.2196/92145

Annu Rev Vis Sci. 2026 Jun 2. doi: 10.1146/annurev-vision-121225-090634. Online ahead of print.

ABSTRACT

Inferring 3D surface structure is one of the most fundamental functions of vision. There are many well-known depth cues, such as shading, texture, and highlights. However, how these cues are extracted from images-and what exactly they tell the brain about 3D shape-is not fully understood. Here, we describe how these seemingly distinct 3D shape cues could share a common currency for the first stages of shape estimation. The key insight is that when patterns such as shading or texture are projected from a 3D object into the 2D retinal image, they are spatially distorted, with profound consequences for local image statistics. The distortions create highly organized patterns of local image orientation (orientation fields) that are systematically related to specific 3D shape properties. Orientation fields can be reliably measured by filter populations and predict both successes and failures of human shape perception across diverse conditions.

PMID:42228868 | DOI:10.1146/annurev-vision-121225-090634