Nevin Manimala

Nurs Open. 2026 Apr;13(4):e70501. doi: 10.1002/nop2.70501.

ABSTRACT

AIM: Shared decision-making (SDM) involves the incorporation of patient preferences, values, and beliefs which yield patient-centered care. This study aims to explore patient engagement in the healthcare decision-making process and its association with the patients’ satisfaction.

DESIGN: A cross-sectional, descriptive correlational design was used.

METHOD: OPTION tool-Arabic version was used to measure the patients’ decision-making level. The Patients’ Satisfaction Questionnaire was used to measure patients’ satisfaction level. Data was analysed using SPSS.

RESULTS: The results showed that patients generally agreed with statements about their engagement in healthcare decision-making, with an overall mean score of 2.03 (SD = 0.08). In contrast, their satisfaction with medical care was neutral, with an overall mean of 2.90 (SD = 0.17), indicating mixed experiences. There was no significant relationship between patient engagement and satisfaction, as correlation and regression analyses showed a very weak, non-significant association (R² = 0.001, p > 0.05). Additionally, demographic variables such as gender, age, marital status, employment, years of infection, and caregiver support showed no statistically significant impact on satisfaction levels.

CONCLUSION: Patient engagement in decision-making was generally agreed upon; however, it did not significantly influence satisfaction with medical care, suggesting that other unmeasured factors may play a more important role in shaping patient satisfaction, and decision-making alone is not sufficient.

PATIENT CONTRIBUTION: Involving patients and the public (PPI) was a key component of this study. From the beginning, patients helped shape the research questions and contributed to designing the study protocol. They also took part in the recruitment process, offering important perspectives on how to engage participants effectively. Additionally, patient representatives reviewed the study materials, providing feedback to improve their clarity and relevance. Lastly, patients were involved in sharing the research outcomes to help make the findings more accessible and understandable to a broader audience.

PMID:41928053 | DOI:10.1002/nop2.70501

Environ Monit Assess. 2026 Apr 3;198(4):403. doi: 10.1007/s10661-026-15245-w.

ABSTRACT

Rapid urbanization puts additional strain on traditional livestock systems, but the spatial dynamics of urban/peri-urban grazing in South Asia remain largely unknown. This study examines practices, socioeconomic effects, and stakeholder acceptance via surveys conducted with 100 graziers and 50 non-graziers in the semiarid region of Multan, Pakistan. The results indicate clear spatial divergence. Urban areas face significantly elevated public health hazards, deterioration of green belts, and spatial limitations that concentrate livestock among middle-income groups, whereas peri-urban systems exhibit inequities in land access that benefit small ruminants and exhibit bimodal income distributions. Urban graziers like young cattle for rapid turnover and exhibit heightened confidence for expansion, in contrast to peri-urban stakeholders who foresee a reduction due to urban sprawl. Perceptions of non-graziers markedly differ, highlighting zoonotic and environmental concerns in contrast to cultural advantages and waste recycling. Findings necessitate cohesive policies that safeguard grazing lanes, create peripheral market centers, and improve veterinary services to maintain livelihoods during urban transitions.

PMID:41928044 | DOI:10.1007/s10661-026-15245-w

J Math Biol. 2026 Apr 3;92(4):62. doi: 10.1007/s00285-026-02387-1.

ABSTRACT

The widely used incompatible insect technique based on Wolbachia for the control of mosquito-borne diseases might be limited in field since high temperature has an adverse effect on some Wolbachia, which reduces its density in mosquitoes and induces incomplete cytoplasmic incompatibility (CI) when the larval habitats experience large temperature fluctuations. By analyzing a model of delay differential equations, we identify a threshold CI intensity, below which the infected male release would not reduce but instead increase the stable adult population level, a phenomenon called suppression paradox, which caused by the overcompensation effect of adult mosquitoes increasing when larval density decreases. For Aedes albopictus mosquitoes in Guangzhou, our simulations predict that paradox would occur if CI intensity is no more than 0.6094. Besides, to reduce at least $80\%$ of the wild adult mosquitoes in the peak season within 8 weeks, we find that the CI intensity should be no less than 0.96, and the least release ratio is sensitive to the CI intensity.

PMID:41928035 | DOI:10.1007/s00285-026-02387-1

Environ Geochem Health. 2026 Apr 2;48(6):277. doi: 10.1007/s10653-026-03176-x.

ABSTRACT

Extensive soil contamination with polycyclic aromatic hydrocarbons (PAHs), particularly naphthalene and benzo(a)pyrene, poses serious threats to agricultural productivity and ecological health. This study aimed to evaluate the synergistic effects of foliar-applied selenium nanoparticles (SeNP) and aged cellulose-derived biochar (CBC) on PAH immobilization and spinach growth in contaminated soils. A controlled pot experiment was conducted, and comparative analysis among treatments was performed using adsorption isotherm modelling, physicochemical characterization of biochar (FTIR and mineral phase analysis), PAH quantification by GC-MS, elemental analysis by ICP-OES, and statistical evaluation of plant physiological and biochemical parameters. Results revealed that aging of CBC enhanced surface functional group formation and transformed mineral phases from Mg₂SiO₄ and MgO to more stable forms such as MgCO₃, Ca, and SiO₂. During PAH adsorption, the relative contribution of mineral components decreased while non-mineral functional groups played a dominant role, reflected by a shift from Freundlich to Langmuir isotherm behavior. The combined application of foliar SeNP and aged CBC significantly improved antioxidant enzyme activities, photosynthetic performance, and PAH sequestration in root cell walls and vacuoles, thereby reducing naphthalene and benzo(a)pyrene uptake and toxicity. Overall, the integrated strategy of SeNP and aged CBC demonstrated enhanced PAH immobilization and improved plant resilience, providing a sustainable approach for remediation of contaminated agricultural soils and protection of food security.

PMID:41928033 | DOI:10.1007/s10653-026-03176-x

Aesthetic Plast Surg. 2026 Apr 2. doi: 10.1007/s00266-026-05802-6. Online ahead of print.

ABSTRACT

BACKGROUND: Trapezius hypertrophy is a significant aesthetic concern among women. Botulinum toxin has emerged as a potential treatment option for this condition. In this study, we conducted a prospective, randomized, double-blind trial to evaluate the effectiveness and safety of letibotulinumtoxinA specifically for women.

METHODS: We conducted a prospective study between July 2022 and June 2023, recruiting 20 patients seeking treatment for trapezius hypertrophy. LetibotulinumtoxinA (Botulax®) was used as the neurotoxin. The patients were randomized into group A (n = 10, 40 units) and group B (n = 10, 80 units). Each group received different doses of toxin at 10 injection points along the trapezius muscle.

RESULTS: We analyzed the contour changes in two groups and calculated the average area before and after treatment. After 12 weeks post-treatment, both groups demonstrated a decrease in the trapezius area with statistically significant differences (p = 0.011, p = 0.005). The median satisfactory score was 4, indicating a moderate level of satisfaction in both groups. No statistically significant differences or complications were observed between the groups.

CONCLUSION: LetibotulinumtoxinA for trapezius hypertrophy demonstrated efficacy with no differences between two experimental groups. Aesthetic concerns were addressed, enhancing shoulder and neck appearance with a high degree of satisfaction.

LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:41927997 | DOI:10.1007/s00266-026-05802-6

Eur Radiol. 2026 Apr 2. doi: 10.1007/s00330-026-12520-9. Online ahead of print.

NO ABSTRACT

PMID:41927981 | DOI:10.1007/s00330-026-12520-9

Eur Radiol. 2026 Apr 2. doi: 10.1007/s00330-026-12494-8. Online ahead of print.

ABSTRACT

OBJECTIVES: Sentinel lymph node (SLN) biopsy remains the standard for axillary staging in early-stage breast cancer, though ongoing clinical investigations are exploring the omission of axillary procedures in specific subgroups. This study assessed whether axillary ultrasonography (US) and MRI can predict SLN involvement and developed a predictive tool to identify patients who may safely forgo axillary surgery.

MATERIALS AND METHODS: We retrospectively analyzed 8114 patients with cT1-T2N0 invasive breast cancer across three cancer centers in China. All patients underwent preoperative axillary US and/or MRI. Multivariate logistic regression identified independent predictors of SLN metastases, which were used to construct a predictive model. The model was validated using a 70:30 training-validation split and visualized through a nomogram. Subgroup analyses evaluated the risk of SLN involvement among patients with negative imaging findings.

RESULTS: SLN metastases were observed in 2545 patients (31.37%), with clinical T2 stage, lymphovascular invasion, Ki-67 ≥ 20%, ER + /HER2- subtype, and positive findings on US or MRI independently associated with SLN involvement (p < 0.001). Among 2282 patients with negative US and MRI findings, the SLN metastasis rate was 16.39%. The multivariable predictive model integrating imaging findings with clinicopathologic variables demonstrated good performance, with an AUC of 0.775 (95% CI: 0.750-0.801) in the training set and 0.759 (95% CI: 0.740-0.778) in the validation set. Notably, omission of axillary surgery would miss nodal metastases in 17.4% of patients eligible for CDK4/6 inhibitors.

CONCLUSION: Preoperative US and MRI are valuable for identifying low-risk patients. The prediction model may help select early-stage breast cancer patients for whom axillary surgery can be safely omitted while minimizing undertreatment risks for adjuvant therapies.

KEY POINTS: Question Can preoperative axillary ultrasound and MRI reliably stratify lymph node metastasis risk in patients with early-stage breast cancer? Findings A multivariate nomogram developed from 8,114 patients showed consistent predictive accuracy for axillary metastasis (AUC: 0.775 in training; 0.759 in validation cohort). Clinical relevance This model supports individualized axillary management by identifying patients who may safely avoid axillary surgery while preserving accurate nodal risk stratification for adjuvant systemic therapy and radiotherapy decision-making.

PMID:41927980 | DOI:10.1007/s00330-026-12494-8

Eur Radiol. 2026 Apr 2. doi: 10.1007/s00330-026-12493-9. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the association between the cancer detectability by artificial intelligence (AI) and long-term survival outcomes in invasive breast cancer.

MATERIALS AND METHODS: This retrospective study analyzed consecutive women diagnosed with invasive breast cancer who underwent preoperative mammography between January and December 2013. Mammograms were analyzed using FDA-cleared AI software (Lunit INSIGHT MMG v1.1.8.2). Cancers were classified as AI-detected if correctly localized by AI, and AI-undetected if AI missed or mislocalized. Propensity score matching was performed using 29 clinical, pathological, and treatment-related covariates. Recurrence-free survival (RFS) and overall survival (OS) were compared using Kaplan-Meier estimates and Cox proportional hazards models.

RESULTS: Among 879 women (mean age ± standard deviation, 50.3 ± 10.2 years), AI correctly identified cancers in 83%. Before matching, the AI-detected group had higher recurrence (11% vs 5%; p = 0.02) and mortality rates (7% vs 1%; p = 0.003). Distant recurrence was also more prevalent in AI-detected cases (p = 0.04). After matching, no differences were observed in RFS (HR, 1.7 [95% CI: 0.8, 3.9]; p = 0.20) or OS (HR, 4.1 [95% CI: 0.5, 38.1]; p = 0.21). AI detectability was not associated with RFS (HR, 1.9 [95% CI: 0.9, 3.8]; p = 0.07) or OS (HR, 5.5 [95% CI: 0.8, 40.7]; p = 0.09) in multivariable analysis.

CONCLUSION: AI-detected breast cancers showed higher recurrence and mortality rates in the unadjusted analysis. However, after adjusting for confounders, AI detectability was not associated with RFS or OS, suggesting that AI may preferentially detect tumors with aggressive characteristics.

KEY POINTS: Question AI-based software for mammography interpretation is increasingly being integrated into practice, but the long-term prognostic implications of breast cancers detected or undetected by AI remain unclear. Findings In this retrospective study, AI detectability was not associated with recurrence-free (HR, 1.7; p = 0.20) or overall survival (HR, 4.1; p = 0.21) after propensity score matching. Clinical relevance AI may be more likely to detect biologically aggressive tumors, rather than directly influencing survival.

PMID:41927979 | DOI:10.1007/s00330-026-12493-9

Int J Obes (Lond). 2026 Apr 2. doi: 10.1038/s41366-026-02072-9. Online ahead of print.

ABSTRACT

PATHWEIGH is the first intervention scaled to 274,182 patients to mitigate population weight gain. In a stepped-wedge cluster-randomized pragmatic trial in Colorado, USA, 56 primary care clinics were randomly assigned to three clusters with staggered start dates for a one-way crossover from usual care to the intervention phase. The intervention (PATHWEIGH) included: health system primary care leadership endorsement, an electronic health record (EHR)-driven care process designed to prioritize, facilitate and expedite weight management, and implementation strategies to support use of the care process and educate clinicians on obesity treatment. The objective of the current analysis was to identify mediators and moderators associated with successful population-level weight management in primary care. The majority of subgroups (moderators) benefited from the intervention because they either lost more weight, gained less weight or switched from weight gain to weight loss compared to usual care. Patient and/or provider use of an EHR component of the intervention mediated 37% of additional patient weight loss and use of an anti-obesity medication mediated 4% over 18 months (p < 0.001 for all comparisons). Altogether, the intervention had favorable effects on patient weight across the subgroups, particularly when a patient or provider used ≥1 EHR component of PATHWEIGH.

PMID:41927969 | DOI:10.1038/s41366-026-02072-9

Commun Med (Lond). 2026 Apr 2. doi: 10.1038/s43856-026-01528-3. Online ahead of print.

ABSTRACT

BACKGROUND: Growing evidence implicates early metabolic dysfunctions in retinal ganglion cells (RGCs) as a contributor to both high- and normal-tension glaucoma, yet no approved therapy directly protects RGCs to preserve vision. We aimed at identifying a safe, druggable neuroprotective strategy that restores RGC metabolic homeostasis for glaucoma therapy.

METHODS: Using a live-cell mitochondrial screen in human embryonic stem cell-derived retinal ganglion cells (H7; female donor), we identified the clinically tested 5-HT1A antagonist WAY-100635 (WAY) as a neuroprotective agent. Mechanisms are probed by pharmacologic competition with agonist 8-OH-DPAT, cAMP assays, and PGC-1α dependent mitochondrial-biogenesis tests. RGC metabolism and survival are assessed by Seahorse and apoptosis assays. In vivo efficacy is evaluated in acute optic-nerve crush (ONC) and microbead-induced ocular-hypertension glaucoma models using histology, brain MRI, visual-acuity, contrast sensitivity testing, and flash VEPs to quantify cortical responses in wild-type C57BL/6 J male mice. Statistics used two-tailed Student’s t-tests or ANOVA, as appropriate.

RESULTS: Here we show that WAY elicits a reversible cAMP surge that drives PGC-1α dependent mitochondrial biogenesis and reduces apoptosis in hRGCs. In glaucoma-associated OPTN^E50K hRGCs, it restores mitochondrial fitness, attenuates excitotoxicity, and shifts metabolism toward aerobic glycolysis, while in progenitors, WAY enhances cristae maturation, oxidative phosphorylation, accelerating RGC specification. Systemic dosing in ONC mice preserves RGC somata, retinal function (PhNR), and optic-pathway integrity. WAY-treated glaucoma mice show preserved visual acuity and fVEP propagation to cortex, halting glaucoma progression.

CONCLUSIONS: A clinically tested 5-HT1A antagonist WAY restores RGC metabolic homeostasis and preserves visual-pathway function across acute and chronic injury models, without detected systemic toxicity, supporting development of a neuroprotective candidate for glaucoma and potentially for other mitochondrial optic neuropathies.

PMID:41927968 | DOI:10.1038/s43856-026-01528-3