Nevin Manimala

Sci Rep. 2026 Aug 3;16(1):24004. doi: 10.1038/s41598-026-63542-8.

ABSTRACT

Understanding dengue dynamics from a spatiotemporal perspective has become increasingly relevant in recent years, as it allows the identification of factors influencing disease transmission, including climatic conditions, human behavior, and the distribution of Aedes aegypti, the primary vector responsible for dengue virus transmission in tropical and subtropical regions. This knowledge is essential for supporting public health decision-making and reducing the impact of dengue on vulnerable populations. This study proposes a spatio-temporal deep learning framework based on the U-Net++ architecture to generate high-resolution dengue risk maps in Colombia. The model integrates climatic, environmental, demographic, and socioeconomic information derived from satellite and census sources. Two spatial approaches were evaluated: a high-dimensional geography (HDG) approach at the national scale and a low-dimensional geography (LDG) approach applied to five departments with high dengue incidence. The model integrating climatic, social, and environmental information achieved the best performance in both approaches. In the HDG configuration, the best model (M9) reached a test mIoU of 0.6646 (validation mIoU = 0.7361). In the LDG configuration, the corresponding model achieved an average test mIoU of approximately 0.73 across departments. These results highlight the potential of integrating heterogeneous climatic, environmental, and socioeconomic data within a spatiotemporal deep learning framework to characterize dengue risk patterns and support high-resolution surveillance.

PMID:42552340 | DOI:10.1038/s41598-026-63542-8

Nat Commun. 2026 Aug 4;17(1):7559. doi: 10.1038/s41467-026-75655-9.

ABSTRACT

Linking abiotic forcing to coherent biotic responses over Phanerozoic time remains difficult to quantify because both environmental drivers and biological dynamics are heterogeneous, irregularly sampled, and affected by proxy and geochronological uncertainty. Here we introduce a regime-based description of the climate-carbon system in which Phanerozoic evolution is organized into a small number of recurring, long-lived mega-climate states separated by relatively sharp transitions. Using recurrence diagnostics on paired carbon and oxygen stable isotope records, together with complementary early-warning indicators, we identify five persistent regimes and their boundaries. We interpret the resulting structure with a conceptual climate-carbon cycle model that admits multiple coexisting equilibria, providing a mechanistic basis for state changes that switch between stable attractors under changing environmental forcings and perturbations. We connect these results to a biosphere vulnerability metric that incorporates biotic turnover with sample-standardized global diversity to show that vulnerability is systematically elevated near major regime transitions. These results suggest that transitions between persistent climate-carbon attractors provide a dynamical context for why some perturbation intervals coincide with heightened biospheric stress, beyond what is expected from more gradual background environmental changes alone.

PMID:42552311 | DOI:10.1038/s41467-026-75655-9

Environ Monit Assess. 2026 Aug 5;198(9):913. doi: 10.1007/s10661-026-15754-8.

ABSTRACT

Harmful algal blooms (HABs) are increasingly prevalent in freshwater ecosystems due to human activities and global warming. These blooms present severe environmental and public health risks, including the contamination of drinking water and the production of toxins harmful to humans and animals. Effective management requires a deep understanding of HAB formation mechanisms to transition from reactive treatment to proactive prevention. While nutrients, light, and temperature are recognized drivers, hydrodynamic conditions such as turbulence, flow velocity, and shear stress have gained significant research attention for their role in bloom dynamics. This study explores how these physical factors influence algal proliferation and highlights the utility of the CE-QUAL-W2 (a two-dimensional hydrodynamic and water quality model) for predictive management. Furthermore, it evaluates sustainable operational strategies, such as horizontal flushing and selective withdrawal, to control blooms in reservoirs. By integrating hydrodynamic modeling with innovative management practices, this research aims to provide a roadmap for advancing HAB control and guiding future ecological studies.

PMID:42552288 | DOI:10.1007/s10661-026-15754-8

Am J Physiol Heart Circ Physiol. 2026 Aug 4. doi: 10.1152/ajpheart.00517.2026. Online ahead of print.

ABSTRACT

Patients with chronic inflammatory disorders, including inflammatory bowel disease (IBD), carry an increased risk of cardiovascular disease. The 2022 ORAL Surveillance study reported that the pan-selective Janus kinase inhibitor (JAKi) tofacitinib was associated with increased risk of major adverse cardiovascular events (MACE) among patients with rheumatoid arthritis compared to anti-tumor necrosis factor (anti-TNF) therapy. This prompted guideline changes regarding the use of all JAKis, including upadacitinib, a JAK1-selective drug approved for use in chronic inflammatory conditions, including IBD. However, the mechanism underlying JAKi-related MACE outcomes and the significance of JAK selectivity relative to TNF inhibition remain unclear. Microvascular dysfunction (MVD) is a predictor of MACE. Flow-mediated dilation (FMD) is a measure of MVD. Using an established ex vivo model of resistance arterioles isolated from adipose tissue, we performed the first mechanistic comparison of anti-tumor necrosis factor (anti-TNF; infliximab), pan-JAK inhibitor (tofacitinib), and JAK1-selective (upadacitinib) therapies on human microvascular endothelial function. Arterioles were obtained from low-cardiovascular-risk subjects of both sexes. Isolated microvessels were incubated with drugs of interest. Flow-mediated dilation (FMD), an assessment of MVD, was measured before and after nitric oxide (NO) synthase inhibition or hydrogen peroxide (H₂O₂) scavenging. No therapy statistically altered FMD magnitude, yet underlying mechanisms differed. Control and infliximab-treated vessels maintained physiologic NO-mediated dilation. Tofacitinib induced a shift toward pathologic H₂O₂-mediated dilation. Upadacitinib impaired NO-dependent dilation without evidence of compensatory H₂O₂ signaling. In summary, anti-TNF therapy and selective versus non-selective JAKi differentially modulate endothelial mechanisms of vasodilation, suggesting unique microvascular phenotypes with potential implications for cardiovascular risk.

PMID:42552281 | DOI:10.1152/ajpheart.00517.2026

Support Care Cancer. 2026 Aug 4;34(8):828. doi: 10.1007/s00520-026-11064-4.

ABSTRACT

PURPOSE: Lymphedema is a chronic and progressive condition that significantly affects functional outcomes and quality of life. Social determinants of health (SDOH) contribute substantially to health disparities; however, their association with lymphedema severity and treatment adherence remains underexplored. This study aimed to evaluate the association between SDOH and both lymphedema severity and adherence to therapy.

METHODS: A retrospective chart review was conducted on 300 patients diagnosed with lymphedema (ICD-10: I89.0) who received care at the Georgia Cancer Center between March 2019 and December 2023. SDOH variables were categorized across five domains: economic stability, education, healthcare access, neighborhood environment, and social/community context. Lymphedema severity was assessed using the International Society of Lymphology staging system and dichotomized as moderate or less versus severe. Treatment adherence was measured as a composite score (0-100%) based on four components of complete decongestive therapy and categorized as low (< 50%) or high (≥ 50%). Multivariable logistic regression was used to examine associations.

RESULTS: Among 295 eligible patients included in the final analysis, transportation access, ethnicity, and gender were significantly associated with both lymphedema severity and treatment adherence (p < 0.05). Limited transportation access and lower socioeconomic indicators were associated with higher odds of severe lymphedema and lower adherence. African American ethnicity and male gender were also associated with worse outcomes.

CONCLUSIONS: SDOH significantly influences lymphedema severity and treatment adherence. Addressing barriers such as transportation and socioeconomic disparities is critical to improving outcomes and reducing inequities in lymphedema care.

PMID:42552279 | DOI:10.1007/s00520-026-11064-4

J Diabetes. 2026 Aug;18(8):e70260. doi: 10.1111/1753-0407.70260.

ABSTRACT

BACKGROUND: The combined prognostic value of continuous glucose monitoring (CGM) metrics and circulating glucose biomarkers for predicting mortality in type 2 diabetes has not been fully established, particularly regarding residual risk in patients achieving glycemic targets.

METHODS: This cohort study included 3677 patients with type 2 diabetes for a median of 7.4 years follow-up. Cox proportional hazards models evaluated the associations of baseline CGM-derived time in range (TIR) (target 70%) and serum 1,5-anhydroglucitol (1,5-AG) (threshold 6.0 μg/mL) with all-cause and cardiovascular mortality in the overall population. We further examined the relationship between 1,5-AG and mortality within TIR subgroups and compared its performance with metrics of glycemic variability derived from CGM.

RESULTS: During follow-up, 522 all-cause deaths and 181 cardiovascular deaths occurred. TIR and 1,5-AG were moderately correlated and independently predicted mortality, with concurrent low TIR (≤ 70%) and low 1,5-AG (< 6.0 μg/mL) yielding the highest risk (hazard ratio [HR] 1.82, 95% CI 1.40-2.37). In stratified analyses, reduced 1,5-AG was significantly associated with increased mortality risk in patients with TIR > 70% (HR 1.69, 95% CI 1.25-2.28), whereas no significant association was observed in those with TIR ≤ 70%. Adding 1,5-AG improved traditional risk prediction in the former subgroup. Compared with 1,5-AG, CGM-derived glycemic variability indices such as mean amplitude of glycemic excursions, coefficient of variation, and standard deviation of glucose showed no significant association with mortality.

CONCLUSIONS: TIR and serum 1,5-AG offer independent and complementary value, with low 1,5-AG identifying residual mortality risk despite achieving TIR targets.

PMID:42552233 | DOI:10.1111/1753-0407.70260

J Peripher Nerv Syst. 2026 Sep;31(3):e70154. doi: 10.1111/jns.70154.

ABSTRACT

BACKGROUND AND AIM: Neuropathic pain (NeuP) is widely underdiagnosed, and treatment-related adverse events often drive nonadherence. We investigated the probable NeuP prevalence, symptoms recognition, and treatment preferences among the general population in Malaysia.

METHODS: We utilized a digital ID-Pain questionnaire across nine tertiary hospitals to screen for probable NeuP. We also designed a discrete choice experiment (DCE) to assess participants’ ability to differentiate NeuP from nociceptive symptoms and to evaluate treatment preferences across five attributes (perceived pain reduction, time to effect, proven effectiveness, risk of common side effects, and cost) among the general population.

RESULTS: The screening cohort included 13 592 adults (17.1% with diabetes). The overall prevalence of screen-positive for probable NeuP was 18.3% in the general population, increasing to 40.1% among people with diabetes. In the DCE cohort (n = 3999), 82.1% of participants demonstrated poor-to-moderate NeuP symptom recognition. Regarding treatment preferences, avoiding a high risk of common side effects was the primary driver of choice (coefficient -1.744, 95% CI -1.820, -1.669), followed by the desire for strong scientific evidence (coefficient 1.237, 95% CI 1.182, 1.291). Apart from clinical attributes, participants showed significant cost sensitivity (coefficient -5.565, 95% CI -6.909, -4.221).

INTERPRETATION: Despite a high prevalence of probable NeuP, poor symptom recognition creates a significant diagnostic challenge. Given that aversion to side effects is prioritized over other attributes, clinicians need to focus on tolerable anti-neuropathic agents and employ proactive side-effect management to optimize NeuP treatment adherence.

PMID:42552228 | DOI:10.1111/jns.70154

Eur J Intern Med. 2026 Aug 4:107116. doi: 10.1016/j.ejim.2026.107116. Online ahead of print.

ABSTRACT

BACKGROUND: Orthostatic hypotension (OH), defined as a reduction in systolic/diastolic blood pressure ≥20/10 mmHg upon standing, is common in older adults and may interfere with the optimization of guideline-directed medical therapy (GDMT) for Heart Failure (HF). However, the prevalence of OH in patients with HF has not been systematically quantified.

AIMS: To estimate the prevalence of orthostatic hypotension among patients with heart failure through a systematic review and meta-analysis.

METHODS: This study was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42023420255). MEDLINE and EMBASE databases were systematically searched from inception to 31 December 2025. Studies reporting the prevalence of OH in HF populations with a sample size ≥100 patients were included. Pooled prevalence estimates with 95% confidence intervals (CI) were calculated, and heterogeneity was assessed using the I² statistic. Subgroup analyses were performed according to geographical location, study design, and clinical setting.

RESULTS: Nine studies (10 cohorts) including 2036 patients with HF were analyzed. The pooled prevalence of OH was 26.7% (95% CI 20.4-34.2%), indicating that approximately one in four HF patients presents this condition. Between-study heterogeneity was high (I²=90.2%). Subgroup analyses revealed higher prevalence in Europe and Asia and the Middle East compared with other countries.

CONCLUSIONS: HF is often burdened by OH which is common and found in 1 out 4 patients with HF and may complicate its management. Its impact on GDMT and clinical outcomes needs to be further investigated.

PMID:42552200 | DOI:10.1016/j.ejim.2026.107116

J Prosthet Dent. 2026 Aug 5:S0022-3913(26)00514-7. doi: 10.1016/j.prosdent.2026.07.010. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Although digital prosthodontic workflows have improved anatomic data acquisition for articulator mounting and jaw simulation, virtual articulator systems still commonly rely on average intercondylar distance values and standardized mounting procedures, limiting the simulation of patient-specific mandibular movement.

PURPOSE: The purpose of this in vitro study was to evaluate the feasibility of estimating sagittal condylar inclination (SCI) from facial scan-derived eccentric mandibular positional data in a temporomandibular joint (TMJ) simulation model and to investigate whether intercondylar distance influences measurement behavior.

MATERIAL AND METHODS: This study used a TMJ simulation model with intercondylar distance set at 5 levels (90, 100, 110, 120, and 130 mm) and SCI set at 4 levels (0, 15, 30, and 45 degrees). For each condition, facial scans at maximum intercuspation position (MIP), protrusive, right lateral, and left lateral positions were acquired as a single acquisition cycle, with 15 repeated cycles per condition. Eccentric scans were aligned to the MIP scan, and mandibular anterior transformation matrices were derived and mapped to the hinge axis to calculate SCI and the Bennett angle. Agreement between measured and actual SCI was evaluated using a mixed-effects Bland-Altman approach. Supportive analyses included linear regression, signed and absolute error, root mean square error (RMSE), mixed-effects modeling of SCI absolute error, and intraclass correlation coefficient (ICC) for repeatability.

RESULTS: The mixed-effects Bland-Altman analysis showed a negative overall bias (-1.07 degrees; 95% confidence interval (CI), -1.78 to -0.36), with broad individual-measurement variability. Supportive regression analyses showed slopes not significantly different from 1 and intercept confidence intervals including 0. Pooled mean ±standard deviation absolute error was 4.56 ±4.34 degrees, and RMSE was 6.29 degrees. For SCI absolute error, actual SCI was significant, whereas the side, intercondylar distance, and intercondylar distance×actual SCI interaction were not. Overall ICC was 0.886 (95% CI, 0.819 to 0.919). Descriptively, the Bennett angle showed significant negative correlations with intercondylar distance and positive correlations with actual SCI in most, but not all, distance conditions.

CONCLUSIONS: Based on the findings of this in vitro TMJ simulation study, facial scan- and eccentric position-based SCI estimation showed generally stable measurement performance across the evaluated conditions, with no statistically detectable systematic effect of intercondylar distance on SCI error under the evaluated simulator-based conditions.

PMID:42552176 | DOI:10.1016/j.prosdent.2026.07.010

Womens Health Issues. 2026 Aug 4:S1049-3867(26)00103-9. doi: 10.1016/j.whi.2026.06.008. Online ahead of print.

ABSTRACT

BACKGROUND: Comorbidity is common with migraine. To inform services to support maternal well-being, we identified comorbidity patterns among pregnant individuals with a history of seeking health care for migraine before pregnancy.

METHODS: In a population-based cohort of pregnancies in 2007-2022 in Ontario, Canada, to individuals with migraine-related health care encounters in the 5 years before conception, we used latent class analysis to identify subgroups using 33 comorbidities. Classes were chosen using statistical fit indices, parsimony, and clinical interpretability. We compared the sociodemographic and reproductive health-related characteristics of the classes using standardized differences.

RESULTS: Of 174,164 pregnant individuals with migraine, 67.2% had one or more comorbidities. The most prevalent comorbidities were mood/anxiety disorders (41.4%), low back pain (16.9%), obesity (12.1%), and asthma (10.6%). Three distinct subgroups characterized comorbidity patterns: class 1, the “mood/anxiety disorder comorbidity,” included 81.2% of the cohort; class 2, the “mood/anxiety disorder and low back pain comorbidity” cohort included 8.3%’ and class 3, the “multiple mental health comorbidity” cohort included 10.6%. Compared with class 1, at conception individuals in the “multiple mental health comorbidity” group were more likely to be aged 13 to 24 years (37.9% vs. 18.9%; standardized difference, 0.43), reside in neighborhoods in the lowest income quintile (29.7% vs. 22.1%, 0.17), be Canadian born or a long-term resident (87.0% vs. 74.4%, 0.32), and be nulliparous (53.2% vs. 47.5%, 0.11). Those in the “mood/anxiety disorder and low back pain comorbidity” group were more likely to be 35 to 44 years of age (31.9% vs. 20.6%, 0.26) or 45 to 54 years of age (2.1% vs. 0.6%, 0.14), more likely to reside in neighborhoods in the lowest income quintile (26.6% vs. 22.1%, 0.11), and less likely to be nulliparous (38.6% vs. 47.5%, 0.18). Findings were similar in a sensitivity analysis including only comorbidities with a prevalence of 1% or greater. Using physical conditions as indicators only, we also identified three latent classes: “low back pain comorbidity” (4.3%), “obesity comorbidity” (2.8%), and “no physical comorbidity” (92.9%).

CONCLUSION: Comorbidity affects two-thirds of pregnant individuals with a history of seeking health care for migraine. Identified patterns of comorbidity suggest subgroups who may benefit from tailored perinatal support related to mental health and chronic pain.

PMID:42552172 | DOI:10.1016/j.whi.2026.06.008