Nevin Manimala

J Contin Educ Nurs. 2026 Aug 18:1-6. doi: 10.3928/00220124-20260528-01. Online ahead of print.

ABSTRACT

BACKGROUND: Transgender and gender-diverse (TGD) individuals experience stigma and discrimination that contribute to health inequities. Many health care providers receive limited education on TGD-specific care. This study evaluated the impact of a trauma-informed digital storytelling (DST) continuing education (CE) module on health care professionals’ attitudes, beliefs, and comfort regarding the care of TGD individuals.

METHOD: A single-group pre-post study design was conducted with clinicians and allied health staff in a regional health system (n = 154). Participants completed the Transgender Attitudes and Beliefs Scale (TABS) before and after a 1-hour asynchronous module featuring digital stories from TGD individuals and a parent of a TGD child, plus open-ended reflections.

RESULTS: Statistically significant improvements were observed in Interpersonal Conflict (median increase = 2.5), Sex/Gender Beliefs (median increase = 2.0), and total TABS scores (median increase = 4.5; all p < .001).

CONCLUSION: Trauma-informed DST-based CE is feasible and may promote reflective learning and more inclusive attitudes toward TGD patient care.

PMID:42600080 | DOI:10.3928/00220124-20260528-01

JMIR Mhealth Uhealth. 2026 Aug 14;14:e80321. doi: 10.2196/80321.

ABSTRACT

BACKGROUND: The increasing prevalence of chronic illness presents a significant global health challenge due to growing end-of-life suffering. Palliative care is now an essential health service under Universal Health Coverage. Its integration into primary health care and use of mobile health (mHealth) have been recommended to improve access.

OBJECTIVE: This study aimed to synthesize evidence on how mHealth interventions in home-based palliative care work, for whom, and in what context.

METHODS: This realist review identified global evidence relevant to mHealth interventions for home-based palliative care through searches of 9 electronic databases (ie, MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, Scopus, and Global Index Medicus), and forward citation tracking of included articles conducted in March 2026. The review followed the 5 key stages of a realist review: scoping the literature to assess what is important about the context of mHealth intervention in home-based palliative care and what mechanisms might be important in how such interventions result in their intended outcomes; articulating the underlying program theory and refining the review scope through consultation with international palliative care experts; conducting iterative searches for and appraisal of relevant evidence; extracting data; and narratively synthesizing the data, prioritized by relevance and rigor to generate conclusions and recommendations. The Framework of Complexity in Palliative Care Context, adapted from Bronfenbrenner’s Ecological Systems Theory, was applied to examine the contextual influences and interactions among factors within the multilayered system. Context-mechanism-outcome configurations were developed and iteratively tested to refine the program theory for mHealth in home-based palliative care.

RESULTS: A total of 4134 records were identified, of which 422 (10.21%) articles were retained for full-text screening, and 126 (3.05%) studies were included in the final synthesis. The contextual factors and mechanisms that positively influence the intended outcomes include (1) alleviating concerns and mitigating perceived threats about mHealth’s suitability in palliative care through proper orientation for patients and carers, along with clear guidelines for health care professionals; (2) minimizing infrastructural and technological barriers through user-friendly designs and investment in sustainable models of mHealth for home-based palliative care; (3) engaging diverse stakeholders to ensure mHealth aligns with priority health care needs, user preferences, and the operations of implementing organizations and the wider health care system; (4) streamlining health management information systems through interoperable mHealth systems implemented at different levels of care; (5) enabling access to and regular communication with relevant health care teams; and (6) facilitating access to adequate information to empower users in palliative care services.

CONCLUSIONS: mHealth interventions can enhance home-based palliative care but must align with local contexts. It is recommended that mHealth interventions ensure safety and comfort, technology competence, tailored communication, empowerment of end users, family involvement, health care worker motivation, and system integration.

PMID:42600073 | DOI:10.2196/80321

JMIR Serious Games. 2026 Aug 14;14:e95572. doi: 10.2196/95572.

ABSTRACT

BACKGROUND: Adolescents with mild intellectual disabilities often exhibit deficits in motor proficiency and neurocognitive processing, which can limit their functional independence. Although virtual reality (VR) exergames provide a motivating platform for physical activity, objective data quantifying their impact on standardized motor scales remain scarce, particularly when implemented through structured pedagogical frameworks. Earlier research established the WISH (warm-up, imitation, settings, half-hour) and WON (warm-up, objective evaluation, no problem!) protocols to facilitate gameplay independence in this population. However, the extent to which this systematic approach translates into measurable clinical motor and reaction time gains requires further investigation.

OBJECTIVE: This study evaluated the effectiveness of a 16-session structured VR exergame intervention, using the WISH and WON protocols, in enhancing motor proficiency and shortening simple reaction time among adolescents with mild intellectual disability.

METHODS: A multisession, single-group pretest and posttest pilot design was used. A convenience sample of 8 adolescents (3 males, 5 females; mean age 17.63, SD 1.77, range 15-20 years) was recruited from a special school complex in Poland. The intervention was conducted over an 8-month period (October 2023 to May 2024), consisting of 16 sessions conducted once every 2 weeks. The rhythmic fitness game “OhShape!” (Odders Lab) was played on the Meta Quest 2 system. Motor proficiency was assessed with the Bruininks-Oseretsky Test of Motor Proficiency short form, and simple reaction time to visual and auditory stimuli was measured using a standardized Alfa-Electronics meter. Statistical analysis was performed using the Wilcoxon signed-rank test (α=.05).

RESULTS: Total Bruininks-Oseretsky Test of Motor Proficiency scores significantly improved from a baseline mean of 69.25 (SD 6.80; 95% CI 63.56-74.94) to 80.50 (SD 5.50; 95% CI 75.90-85.10) at the posttest (P=.01; r=0.74). Based on the standardized 5-point proficiency scale, the group mean rose from 1.88 (SD .64; 95% CI 1.34-2.42) at baseline to 2.88 (SD .35; 95% CI 2.59-3.17) postintervention (P=.008; r=0.89). Furthermore, the mean simple reaction time decreased from 426.50 (SD 52.3; 95% CI 382.78-470.22) ms to 392.10 (SD 38.4; 95% CI 359.98-424.22) ms at the final assessment (P=.02; r=0.72).

CONCLUSIONS: This pilot study suggests structured VR exergaming may address motor deficits in adolescents with mild intellectual disability. Promoting autonomy via protocols was associated with measurable motor gains within this cohort. Although the absence of a control group limits causal claims, immersive VR may offer a supportive tool for neuro-motor adaptations in special education, warranting validation in larger controlled trials.

PMID:42600070 | DOI:10.2196/95572

Asian Pac Isl Nurs J. 2026 Aug 14;10:e83091. doi: 10.2196/83091.

ABSTRACT

BACKGROUND: Digital health technologies (DHTs), including mobile health (mHealth) apps and online medical records, are increasingly being used to support self-management and communication with health care professionals among the general population across the United States. However, few studies have explored whether cultural, privacy, and sociodemographic factors may influence DHT adoption among Vietnamese Americans specifically.

OBJECTIVE: This cross-sectional study aimed to explore DHT use, barriers to adoption, and their associations with social determinants, such as age, sex, social support, and mental health concerns, among Vietnamese Americans.

METHODS: Data were collected from a sample of Vietnamese American adults (n=304) through surveys assessing DHT engagement, confidence in medical record security, and social and psychological factors. Descriptive statistics and inferential analyses, including 2-tailed t tests and chi-square tests, were used to examine differences across demographic groups.

RESULTS: Many participants had engaged with mHealth tools (253/304, 83.2%), including using mobile devices for health tracking (185/302, 60.9%), and health care professional discussions (194/301, 64.5%). Online medical records were reported to be widely available (230/304, 75.7%), with a large proportion of the participants (182/227, 80.2%) accessing them at least once in the past year. Privacy concerns were a key barrier to using online medical records, with 40.5% (17/42) of nonusers citing security fears, and 26.6% (81/304) reporting withholding health information from health care professionals. The main reasons participants did not access online medical records (45/304, 14.8%) were that they preferred to speak to health care professionals directly (31/44, 70.5%) or did not perceive a need to access their online medical records (30/43, 69.8%). There were no statistically significant differences in sociodemographic characteristics between DHT users and nonusers. There were statistically significant differences in the levels of social support of participants who had varying levels of confidence in the security of their medical records (F2,301=10.19; P<.001; η²=0.063). A greater proportion of male participants reported distrust (ie, being “not confident” in the security of their medical records) than female participants (χ22=20.8; P<.001), indicating a significant association between sex and confidence level.

CONCLUSIONS: While DHT adoption is high among Vietnamese Americans, privacy concerns remain a major barrier to full use of online medical records. Health care professionals and public health initiatives should focus on improving trust in medical record security, incorporating culturally tailored education on the benefits of digital health, and leveraging social media and mHealth tools to optimize patient engagement. Developing stronger family and community support may facilitate the adoption of DHTs.

PMID:42600066 | DOI:10.2196/83091

FASEB J. 2026 Aug 31;40(16):e72200. doi: 10.1096/fj.202601567R.

ABSTRACT

The genetic architecture of polycystic ovary syndrome (PCOS) has not been fully elucidated. Translating genome-wide association study (GWAS) loci into functional effector genes represents a key challenge for elucidating disease mechanisms and advancing targeted therapeutic strategies. In this study, the FinnGen R12 dataset was utilized in conjunction with the Genotype-Tissue Expression Project (GTEx) v8 eQTL dataset to conduct cross-tissue transcriptome-wide association studies (TWAS). External validation was performed in two independent datasets, comprising a PCOS meta-analysis of Rotterdam- and NIH-criteria cohorts and UK Biobank summary statistics. To prioritize high-confidence candidate genes, we integrated a cross-tissue (UTMOST) TWAS and tissue-specific (FUSION) TWAS with a gene-based association test (MAGMA). Furthermore, causal inference analyses including Mendelian randomization (MR), colocalization analysis, summary data-based MR, and the heterogeneity in dependent instrument (HEIDI) test were carried out on candidate genes. GeneMANIA, gene-chemical-disease analysis, and phenome-wide association study (PheWAS) were further performed on candidate genes. Finally, we explored expression profiles of core candidate genes using transcriptomic datasets from the Gene Expression Omnibus (GEO) database. We prioritized 15 candidate genes potentially associated with PCOS. External analyses across independent datasets showed limited consistency, which may reflect differences in statistical power and cohort heterogeneity. MCM6 was prioritized by all three approaches, whereas the remaining 14 genes were supported by two approaches. Among the 15 candidate genes, six genes were demonstrated to have causal associations with PCOS risk. GeneMANIA network analysis further revealed that these candidate genes were involved in key biological functions, including DNA replication and regulation, DNA repair and recombination, protein-DNA complex, cell cycle regulation, nucleic acid-enzyme activities, DNA structure and chromosomal regions, reproductive system development, and sex differentiation. Gene-chemical-disease analysis suggested that the prioritized genes may mediate crosstalk between PCOS genetic risk and environmental/metabolic factors. PheWAS analysis highlighted the pleiotropic roles of PCOS candidate genes, which contributed to both PCOS susceptibility and a spectrum of PCOS-related traits including metabolic and cardiovascular phenotypes. Finally, transcriptomic data showed downregulated MCM6 expression in granulosa cells of PCOS patients. Our study established a multipronged pipeline for PCOS gene prioritization and provided novel insights into the genetic architecture of PCOS.

PMID:42600058 | DOI:10.1096/fj.202601567R

Womens Health (Lond). 2026 Jan-Dec;22:17455057261478351. doi: 10.1177/17455057261478351. Epub 2026 Aug 14.

ABSTRACT

BackgroundApproximately 13,000 women in the United States are diagnosed with cervical cancer and approximately 4000 women die from it annually. Although there has been an overall decline in mortality rates for cervical cancer, the mortality rates for women in rural areas are 42% higher than for urban areas. Given rural cervical cancer disparities, it is important to identify how to improve this population’s cancer care.ObjectivesBy applying intersectionality theory, we explored the unique healthcare experiences of rural women diagnosed with cervical cancer. The goal of this study was to examine (1) how rural cervical cancer survivors describe their cancer care needs and barriers and (2) rural cervical cancer survivors’ perspectives on optimal cancer care.DesignUtilizing an exploratory qualitative study design, we conducted approximately 60-minute semi-structured individual interviews with ten cisgender women diagnosed with cervical cancer residing in five different rural areas of the United States.MethodsData were analyzed utilizing reflective thematic analysis.ResultsData revealed six themes: (1) “No treatment options around here”; (2) “Don’t dismiss us”; (3) “Certain things aren’t talked about”; (4) “Being more trauma-informed”; (5) “You really need to stick up for yourself”; and (6) “They cared about my well-being outside of just being a patient.” Taken as a whole, these themes demonstrate the ways that rurality, gender, and cancer type intersected to impact the type and quality of care received by rural cervical cancer survivors.ConclusionsAs with many cancer survivors, rural cervical cancer survivors value care that respects their bodily autonomy and treats survivors holistically. Trauma-informed survivor-provider interactions are critical for improving outcomes for rural cervical cancer survivors whose location may limit their choices in providers and how they access care. Providers can address intersectional barriers to enhance shared decision-making, survivor self-advocacy, and affirming cancer care.

PMID:42600052 | DOI:10.1177/17455057261478351

J Econ Entomol. 2026 Aug 14:toag252. doi: 10.1093/jee/toag252. Online ahead of print.

ABSTRACT

The Old World date mite, Oligonychus afrasiaticus (McGregor) (Acari: Tetranychidae), is one of the most economically important pests of date palm (Phoenix dactylifera L.) throughout the Middle East and North Africa. Reliable estimation of mite density is essential for integrated pest management (IPM), but the aggregated spatial distribution of this species reduces the efficiency of conventional fixed-sample-size sampling. This study developed and validated cultivar-specific fixed-precision sequential sampling plans for O. afrasiaticus on the commercially important date palm cultivars Sayer and Barhi using field data collected from commercial orchards in southwestern Iran during 2020 and 2021. Taylor’s power law adequately described the variance-mean relationship for both cultivars (R² > 0.93), with aggregation parameters significantly greater than unity (b = 1.380 for Sayer and 1.460 for Barhi), confirming aggregated distributions. Green’s fixed-precision sequential sampling model was used to construct stop lines at precision levels of D = 0.25, 0.15, and 0.10. Required sample size decreased with increasing mite density and increased as higher precision was required. Validation using the Resampling for Validation of Sampling Plans (RVSP) procedure with 1,000 iterations and 10 independent datasets showed excellent agreement between target and achieved precision. Mean achieved precision ranged from 0.101 to 0.251 for Sayer and from 0.099 to 0.249 for Barhi, with deviations from target precision below 0.01 for all sampling plans. The proposed sequential sampling plans provide statistically robust and operationally efficient tools for estimating O. afrasiaticus populations and improving pest monitoring and decision-making in date palm IPM programs.

PMID:42600049 | DOI:10.1093/jee/toag252

PLoS One. 2026 Aug 14;21(8):e0355354. doi: 10.1371/journal.pone.0355354. eCollection 2026.

ABSTRACT

OBJECTIVES: To assess the association between geographic region and availability of ICU resources in Brazil, as well as the relationship between resource availability and KAP for protective ventilation.

METHODS: We conducted a cross-sectional study of ICU directors using a validated online survey that included 29 items about ICU characteristics and the availability of 38 resources, and 27 KAP items. We used a Likert scale to score KAP items and calculated a KAP score as the sum of the points, standardized on a scale of 0-100. We used multiple linear regression to assess associations between geographic regions, resources, and KAP.

RESULTS: We included 255 ICUs, 12% of the country’s ICUs, in a geographically representative distribution of all regions in Brazil. The median of resources available was 34 (interquartile range [IQR] 33-36) out of 38, with statistically significant inequalities among regions, p < 0.001 and 178 (70%) of participants reported an increase in resources available after the COVID-19 pandemic. The median KAP score was 83 (IQR 77-90) and there was a significant association between a greater number of resources and higher KAP (p = 0.031).

CONCLUSION: In this study including a representative sample of ICUs in Brazil, we identified regional inequalities in the availability of ICU resources. KAP scores regarding protective ventilation were generally high but varied across regions. Although greater resource availability was associated with higher KAP scores, the magnitude of this association was modest, suggesting that factors beyond resource availability may also contribute to differences in knowledge, attitudes, and practices related to protective ventilation.

PMID:42600045 | DOI:10.1371/journal.pone.0355354

PLoS One. 2026 Aug 14;21(8):e0354966. doi: 10.1371/journal.pone.0354966. eCollection 2026.

ABSTRACT

In this study, we propose and examine two procedures for constructing intervals that capture the uncertainty associated with determining the effective number of components in model selection problems or the shrinkage parameters in a regularization problem. The output of these methods is an interval (defined by two integer bounds) representing plausible values for the number of components and/or shrinkage parameters. Notably, these methods do not rely on the availability of a likelihood function, making them broadly applicable across various domains, such as regression, classification, feature and/or order selection, clustering, and dimensionality reduction. These techniques leverage the geometric properties of the error curve to construct intervals. Extensive experiments on both synthetic and real-world datasets demonstrated the effectiveness and practical utility of the proposed procedures. In addition, a MATLAB code is provided to facilitate adoption by practitioners and researchers.

PMID:42600041 | DOI:10.1371/journal.pone.0354966

Sci Adv. 2026 Aug 14;12(33):eaee2671. doi: 10.1126/sciadv.aee2671. Epub 2026 Aug 14.

ABSTRACT

Structured light offers a promising solution for the increasing data demands of modern optical networks, opening up degrees of freedom that can be leveraged for greater channel capacity and more bits per photon. However, its implementation is hindered by real-world distortions, for example, atmospheric turbulence in free space, with severe and rapidly evolving phase perturbations that alter the amplitude, phase, and vectorial polarization structure of the beam. Here, we demonstrate that optical topologies in the form of skyrmions are highly resilient to the effects of real-world atmospheric turbulence. We create and transmit these particle-like topologies of light through a 270-meter free-space optical link, revealing their robustness across a wide variety of conditions and turbulence strengths. While we observe severe distortion in the states’ underlying degrees of freedom, we show that the topological numbers are preserved in all cases. We account for fast changes to the medium, where the channel produces statistically averaged outcomes, by probing the state’s decoherence, showing that while the degree of polarization consequently decays, the topology remains intact. Using topology, we show that information can be transmitted through the channel with almost perfect fidelity (>98%) in most cases, only decreasing to 86% in the most severe conditions tested. This work idemonstrates the potential for optical topologies as reliable and robust information carriers in a real-world environment and points to the potential for other complex channels too, offering attractive features for classical and quantum communication alike.

PMID:42600027 | DOI:10.1126/sciadv.aee2671