Nevin Manimala

Sci Rep. 2026 Jun 12. doi: 10.1038/s41598-026-56436-2. Online ahead of print.

ABSTRACT

The management of medical insurance funds is pivotal to the development of medical consortia. These funds serve as the operational lifeline of medical consortia and constitute critical public resources essential for public welfare. Medical expense settlement involves multiple stakeholders, including patients, tiered healthcare institutions, and insurance administrative agencies. However, disputes frequently arise between medical insurance authorities and hospitals regarding expense legitimacy due to information asymmetry and interpretative discrepancies. Such conflicts impede smoothness of payment mechanism, thereby undermining consortium operations and inter-institutional collaboration. To address these challenges, this study proposes a blockchain-based framework integrating medical expense investigation with insurance settlement. The system employs two core components: Anomaly detection via the Isolation Forest (IF) algorithm to identify potentially irregular expenses. Consensus-driven adjudication using Fleiss Kappa-based smart contracts facilitated by an anonymous panel of medical experts. This design enhances coordination between expense oversight and settlement processes, thus streamlining dispute resolution for medical expense anomalies and improving the scientific governance of insurance funds. Experimentally, the statistical validity demonstrated for unsupervised anomaly detection of IF and potential engineering applicability indicated in the analysis of healthcare cost. The healthcare consortium blockchain based on a Delegated Proof-of-Stake (DPoS) consensus mechanism and smart contract batch processing achieved a peak throughput of 229.64 transactions per second (TPS) and reduced transaction costs by up to 3,095 gwei. This demonstrates scalability for real-world medical insurance collaborative settlement systems.

PMID:42286116 | DOI:10.1038/s41598-026-56436-2

Int J Obes (Lond). 2026 Jun 12. doi: 10.1038/s41366-026-02112-4. Online ahead of print.

ABSTRACT

BACKGROUND: Investigating early life growth dynamics is important for understanding the developmental origins of obesity. Basis splines (B-splines) provide excellent flexibility for modelling complex growth patterns, but they are prone to overfitting. Penalised B-splines (P-splines) extend B-splines by using a penalty to control their flexibility and avoid overfitting. Despite their advantages, P-splines remain underused in epidemiology, partly due to lack of guidance and accessible software. Our aim was to provide a guide on applying P-spline linear mixed effects models to analyse early life growth trajectories and extract key growth features.

METHODS: We outline the theoretical foundation and fitting procedures for P-splines and illustrate their use on repeated height, weight, and body mass index (BMI) measures up to age 10 years from a Southeast Asian birth cohort (n = 1014). P-splines linear mixed effects models were fitted by reformulating P-splines as mixed models with sparse matrices for efficient estimation. From the fitted trajectories, we estimated infant peak growth velocity, magnitude and timing of infant peak BMI and childhood rebound BMI, and examined their sex differences, intercorrelations, and associations with prenatal factors.

RESULTS: Infant peak height velocity (means:.4.4 vs. 3.9 cm/month) and peak weight velocity (1121 vs. 890 grams/month) was higher in boys than girls. Infancy peak BMI (17.4 vs. 16.8 kg/m²), childhood rebound BMI (15.1 vs. 14.9 kg/m²), age at peak BMI (5.8 vs. 6.4 months), and age at rebound BMI (5.4 years) were comparable between sexes. Ages of peak and rebound BMI had a negligible correlation, higher maternal height was associated with higher peak growth velocity, higher maternal early-pregnancy weight was associated with higher and earlier rebound BMI, and higher birth weight was associated with higher and earlier peak BMI.

CONCLUSIONS: P-splines simplify knot selection, making them a valuable approach for growth modelling. Software, code and datasets are provided to promote uptake of this method.

PMID:42286114 | DOI:10.1038/s41366-026-02112-4

Mar Environ Res. 2026 Jun 9;220:108190. doi: 10.1016/j.marenvres.2026.108190. Online ahead of print.

ABSTRACT

Abyssal and hadal macroinfaunal communities (>300 μm) were studied across a longitudinal geographic transect in the Southeast Pacific region (71°- 109°W). Composition, structure, and distribution were analyzed in relation to the seafloor organic content associated with surface productivity. Sediment samples were collected at each study site with a multicore containing eight cores of 7.5 cm internal diameter, covering associated seamounts, oceanic islands, and trench environments. Faunal composition was dominated by Crustacea, Mollusca, and Annelida, with Crustacea as the most diverse. Polychaeta and Copepoda were always the most common and abundant in all sites recording a relative abundance of 38% and 33%, respectively. Vertical distribution showed that 73% of fauna inhabit the first centimeter of sediment. The number of individuals was low and mean density per site was 710 ind. m^-2, however the high number of species recorded only once would indicate a high diversity of species in the study zone. Ecological indices showed higher values in eutrophic and mesotrophic areas coinciding with the record of the highest concentrations of parameters related to sediment organic content. Differences between habitats were observed, recording higher abundance and diversity on Trench and Seamount sites from eutrophic and mesotrophic zones, while lower values of these descriptors on Seamount and Oceanic Island sites associated with less productive zones. Statistical analysis and correlations showed that Chloroplast Pigment Equivalent and Chlorophyll-a may explain the observed patterns for the benthic community. The macroinfaunal communities described are typical of abyssal and hadal sediment environments and they appear to respond to organic inputs according to recorded spatial distribution patterns.

PMID:42284669 | DOI:10.1016/j.marenvres.2026.108190

Soc Sci Med. 2026 Jun 8;404:119483. doi: 10.1016/j.socscimed.2026.119483. Online ahead of print.

ABSTRACT

RATIONALE: Publicly financed health insurance expansions in India have often increased inpatient utilisation without commensurate reductions in out-of-pocket (OOP) spending. Whether integrating benefits to cover chronic-disease medicines improves financial protection has received little empirical attention.

OBJECTIVE: This study examines whether the Karunya Arogya Suraksha Padhathi (KASP), Kerala’s implementation of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), which consolidated multiple state and national schemes under a unified purchaser and expanded package-based cashless coverage for secondary, tertiary, and eligible day-care services from April 2019, reduced household OOP health expenditure.

METHODS: We use household panel data from the Consumer Pyramids Household Survey (CPHS) covering April 2017 to February 2020, comprising 58,171 household interview observations across Kerala, Tamil Nadu, and Karnataka, and apply a difference-in-differences (DiD) design. Outcomes include net OOP health spending and its components.

RESULTS: KASP reduced net OOP health spending by approximately 31.7% in specifications allowing Kerala-specific trends. The decline was concentrated in medicine spending, while hospitalisation rates were statistically unchanged. Total health spending declined in baseline two-way fixed-effects (TWFE) models but was statistically indistinguishable from zero in trend-adjusted specifications; the net OOP reduction remained robust. Effects were larger among poorer households and those with chronic conditions, and smaller in rural areas, consistent with limited access to empanelled hospitals. Results are robust to event-study diagnostics, alternative comparator pools, and a timing placebo based on Tamil Nadu’s December 2018 inpatient-cap expansion.

CONCLUSIONS: Benefit expansion covering medicine costs can improve financial protection by reducing point-of-care payments, even without reducing total costs in the short run. The findings suggest that aligning public insurance benefit packages with households’ pharmaceutical spending patterns, particularly among those managing chronic conditions, may offer a more direct route to financial protection than hospitalisation-focused expansion alone.

PMID:42284657 | DOI:10.1016/j.socscimed.2026.119483

Clin Breast Cancer. 2026 May 14;26(7):24-29. doi: 10.1016/j.clbc.2026.05.005. Online ahead of print.

ABSTRACT

BACKGROUND: Circulating tumor cells (CTCs) are frequently detected in patients with breast cancer, but key studies investigating their clinical significance in early-stage disease rely on less-sensitive methods for CTC detection.

OBJECTIVE: To evaluate the prevalence and prognostic implications of CTCs in patients undergoing NAC for early-stage breast cancer.

DESIGN: This was a single-center prospective cohort study. Patients with early-stage breast cancer who were planned to receive NAC were enrolled.

METHODS: CTCs were measured before NAC and again at least 4 weeks following definitive surgery using the Epic Sciences platform. Clinical, pathological, and treatment data were abstracted from electronic medical records and summarized.

RESULTS: A total of 40 patients comprised the analyzable study population. The median age at diagnosis was 53 years. Breast cancer subtypes included HER2+ (38%), hormone receptor-positive/HER2-negative (HR+/HER2-, 32%), and triple-negative breast cancer (TNBC, 25%). After a median follow-up of 39.8 months, only 5 patients (12%) had experienced disease recurrence. CTCs were detected in 82% of patients before treatment and 45% of patients after treatment (P = .001). All subgroups of patients had numerically lower rates of CTC prevalence post-treatment compared to pretreatment; subgroups in whom this difference was statistically significant included patients with TNBC (90% vs. 30%, P = .006), premenopausal patients (79% vs. 29%, P = .008), and patients who did not experience disease recurrence (80% vs. 43%, P = .001).

CONCLUSION: CTCs are more prevalent both before and after NAC than had previously been reported. The clinical significance of their persistence warrants further investigation.

PMID:42284652 | DOI:10.1016/j.clbc.2026.05.005

Am J Emerg Med. 2026 Jun 6;108:72-79. doi: 10.1016/j.ajem.2026.06.007. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigates the effectiveness of Endovascular Therapy (EVT) in very late windows (beyond 24 h) for patients with ischemic stroke, focusing on 90-day mortality, functional outcomes, and procedural success.

METHODS: This systematic review and meta-analysis followed Cochrane and PRISMA guidelines to evaluate the effectiveness of endovascular therapy (EVT) in acute ischemic stroke patients. Literature from PubMed, Embase, Web of Science, and Scopus was reviewed using specific keywords. Studies included those after 2000 with outcomes such as functional independence (mRS 0-2), mortality, TICI scores, and neurological improvements.

RESULTS: The data findings reveal mixed outcomes across studies on EVT beyond 24 h. Sarraj et al. (2023) found a significant improvement in functional independence with EVT (38% vs. 10%, p < 0.05), despite an increased risk of sICH. The forest plots for mRS and procedural outcomes show some significant results, such as Sarraj (2023) for mortality (p < 0.05), but most other studies indicated no statistically significant differences (p > 0.05).

CONCLUSION: The study has concluded that Endovascular Therapy (EVT) beyond 24 h can improve functional outcomes and reduce mortality in selected ischemic stroke patients, though patient selection remains crucial.

PMID:42284631 | DOI:10.1016/j.ajem.2026.06.007

Gen Hosp Psychiatry. 2026 Jun 8;101:132-138. doi: 10.1016/j.genhosppsych.2026.06.001. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency department (ED) boarding places substantial demand on healthcare systems. Digital interventions have expanded in the last decade, but their role and integration in emergency psychiatric settings remain limited. The Digital Clinic represents an evidence-based, hybrid digital intervention model that combines brief clinical sessions, a smartphone application, and a non-clinical team member (digital health navigator). Building on this model, a collaboration was established across multiple Beth Israel Lahey Health (BILH) health care departments to provide short-term mental health digital care for patients discharged from the ED at BILH-Needham.

OBJECTIVE: This program evaluation examined changes in healthcare utilization among patients enrolled through the collaboration to inform feasibility and guide the design of future controlled clinical studies.

METHODS: This evaluation uses a retrospective pre-post design to evaluate changes in healthcare visits of patients who were referred through the collaboration.

RESULTS: Across 79 patients enrolled, there was a significant decrease in healthcare visits (t = 3.87, p < .001). Notably, there was a significant reduction in high-cost visits (i.e., Hospital Admissions, ED Care, Urgent Care; t = 7.16, p < .001), and among those who had higher healthcare utilization before enrolling in the treatment (t = 3.91, p < .001). The comparison between patients who completed the treatment and those who discontinued treatment early did not reach statistical significance.

DISCUSSION: These preliminary findings offer a promising signal for further evaluation of the Digital Clinic model integrated into the ED. The digital health navigator role may offer a practical solution for future implementations of psychiatric ED interventions and customizing the program for local needs.

PMID:42284630 | DOI:10.1016/j.genhosppsych.2026.06.001

Radiography (Lond). 2026 Jun 12;32(5):103471. doi: 10.1016/j.radi.2026.103471. Online ahead of print.

ABSTRACT

INTRODUCTION: This study presents a radiographic repeat analysis conducted in public hospitals in the Souss-Massa region of Morocco. It aimed to assess repeat rates, identify the most frequent causes of image repetition and the most affected anatomical regions, and examine variations in recurrence rates.

METHODS: A cross-sectional study was conducted during March and April 2025 in four public hospitals in the Souss-Massa region of Morocco. The number of acquired and repeated images was recorded using a standardized observation grid, supplemented by repeated image extraction for retrospective analysis. Descriptive statistics and chi-square tests were used to assess repeat rates, associated causes, anatomical regions involved, and variations by hospital and day of the week.

RESULTS: Of the 15,493 radiographic images analyzed, 1063 were repeated, resulting in an overall repeat rate of 6.86%, which falls within the acceptable range recommended by the American Association of Physicists in Medicine (AAPM). The highest specific repeat rate was observed at Hospital 2 (11.94%), followed by Hospital 1 (4.63%), Hospital 4 (4.33%), and Hospital 3 (3.92%). The most frequently repeated examinations were chest, pelvis, abdomen, lumbar spine, and shoulder. Across all examination types, the main causes included positioning errors, metallic artifacts, collimation errors, and under- or over-exposure. Daily variability in repeat rates was also observed.

CONCLUSION: Although the repeat rate was within acceptable limits, indicating reasonably adequate radiographic image production, variations between hospitals and the predominance of preventable professional errors highlight the need for improved technical consistency.

IMPLICATIONS FOR PRACTICE: Implementing standardized protocols, extending repeat-rate assessment and regular monitoring, establishing a reference threshold, improving understanding of human and organizational factors, and harmonizing image acceptance criteria would help reduce repetition and strengthen consistency in assessments across professionals.

PMID:42284629 | DOI:10.1016/j.radi.2026.103471

Nutrition. 2026 May 19;150:113294. doi: 10.1016/j.nut.2026.113294. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients hospitalized with respiratory diseases are at high risk of nutritional deterioration due to increased metabolic demands and systemic inflammation. When enteral nutrition is not feasible, parenteral nutrition (PN) becomes necessary; however, evidence in respiratory referral centers remains limited. This study aimed to characterize the indications, timing, and clinical outcomes of PN, with emphasis on metabolic complications.

METHODS: A retrospective analysis of prospectively collected data was conducted in a tertiary respiratory referral hospital between September 2023 and December 2024. Adults (≥18 y) receiving PN for >2 d were included. Clinical characteristics, indications, timing of PN initiation, nutritional delivery, and metabolic complications were evaluated. PN-associated liver dysfunction and electrolyte disturbances were defined using standardized criteria. Descriptive statistics were applied.

RESULTS: Eighty-two patients were included (54.9% male; mean age 55.6 ± 15.8 y); 79.3% were at nutritional risk on admission. PN was initiated at a median of 4 (1-13) d, mainly due to gastrointestinal dysfunction and hemodynamic instability (31.7% each). Total PN predominated (82.9%), and 57.3% received combined enteral and parenteral nutrition. Nutritional delivery increased stepwise, reaching 31.9 kcal/kg/d and 1.5 g/kg/d of protein by day 7. Glycemic control remained stable, and triglycerides did not exceed critical thresholds. Hypokalemia was the most frequent electrolyte disturbance (36.1% at day 7), while phosphorus and magnesium remained stable. Liver enzyme elevations appeared more related to disease severity than PN.

CONCLUSION: PN was frequently initiated in the context of gastrointestinal dysfunction and hemodynamic instability, often with delayed timing. A structured approach based on gradual nutrient delivery and close monitoring was associated with a low incidence of severe metabolic complications, underscoring the importance of individualized nutritional management.

PMID:42284623 | DOI:10.1016/j.nut.2026.113294

Hum Immunol. 2026 Jun 12;87(8):111783. doi: 10.1016/j.humimm.2026.111783. Online ahead of print.

ABSTRACT

BACKGROUND: In addition to well-established immune checkpoints (ICs), such as CTLA-4, PD-1, PD-L1, increasing attention is being directed toward next-generation ICs, including TIM-3, Gal-9, LAG-3, BTLA, HVEM, and CD160. Single nucleotide polymorphisms (SNPs) within IC-related genes may contribute to dysregulation of inhibitory pathways and impair anti-tumor immune responses. This study aimed to evaluate the association between selected IC gene variants and susceptibility to bladder cancer (BC).

PATIENTS AND METHODS: A total of twelve SNPs located in TIM-3, LGALS9, BTLA, HVEM, and CD160 genes were genotyped using TaqMan assays in 314 BC patients and over 520 healthy controls (HC). Genotype distributions were analyzed under multiple genetic models, and associations with clinicopathological parameters were assessed using multivariate logistic regression.

RESULTS: Genotype distributions of BTLA polymorphisms (rs2705511, rs1982809, rs9288953) differed between BC patients and HC, suggesting potential associations with BC risk. Stratified analyses revealed sex-specific effects, with variants in BTLA (rs1982809), HVEM (rs1886730, rs2234167, rs8725), and CD160 (rs231375) showing potential associations with susceptibility among women. Additionally, SNPs in BTLA and HVEM were nominally associated with recurrence and high-grade tumors, while CD160 and LGALS9 variants were potentially linked to primary tumor occurrence. However, these associations lost statistical significance after correction for multiple comparisons.

CONCLUSIONS: Although the observed associations did not remain significant after multiple testing correction, the results suggest that genetic variation within BTLA, HVEM, and CD160 genes may still play a biologically relevant role in BC susceptibility and disease progression. These findings underscore the potential importance of IC pathways in BC pathogenesis and warrant further investigation in larger, well-powered studies.

PMID:42284619 | DOI:10.1016/j.humimm.2026.111783