Nevin Manimala

JMIR Form Res. 2026 Aug 6;10:e86944. doi: 10.2196/86944.

ABSTRACT

BACKGROUND: Telemedicine offers promising solutions for improving access to care among older adults with chronic conditions, but there is limited evidence on how older patients navigate and engage with video telehealth in their home environments.

OBJECTIVE: This study aimed to assess older adults’ acceptability, usability, comfort, and engagement with pharmacist-led telemedicine visits conducted at home using behavioral observation separate from the telehealth platform.

METHODS: This descriptive mixed methods pilot study included a convenience sample of 20 older adult veterans (aged ≥65 years, ≥2 chronic conditions, and ≥5 medications) recruited from a Veterans Affairs (VA) health care system. A project manager observed and video-recorded participant preparation for and conduct during in-home telemedicine visits with a clinical pharmacist. Recordings were coded using structured protocols to assess verbal and nonverbal behavior, technological challenges, and environmental factors. Trained and reliable coders rated verbal and nonverbal comfort, frustration, and engagement during technology setup and the telemedicine appointment using Likert-type impression scales (intercoder reliability was good, Cohen κ=0.81). Video data were also transcribed and coded for behavioral events (eg, troubleshooting, verbal expressions of age or technology ability, and nonverbal adaptation) and analyzed using rapid qualitative analysis.

RESULTS: Participants expressed moderate engagement and comfort with technology overall. Verbal and nonverbal engagement significantly increased from setup to appointment (Z=2.03, P=.002). Technology-related challenges (eg, audio lag and troubleshooting) occurred in over half the visits but were often resolved through participant adaptation or support from the research staff. Participants displayed both frustration (eg, sighing and leaning away) and adaptability (eg, propping up tablets and retrieving medications). Verbal expressions reflected a mix of technology confidence and age-related limitations. Environmental distractions were present in some visits (eg, dogs barking or phones ringing), but also allowed for rich clinical engagement (eg, home tours and direct observation of medications).

CONCLUSIONS: In this small pilot sample of older veterans, participants generally remained engaged during in-home telemedicine visits despite technological and contextual barriers, suggesting that home-based telemedicine may be acceptable for some older adults when support is available. Addressing technical support, home environment considerations, and age-related perceptions of technology may increase telehealth usability and satisfaction among aging populations.

PMID:42561385 | DOI:10.2196/86944

JMIR Res Protoc. 2026 Aug 6;15:e97653. doi: 10.2196/97653.

ABSTRACT

BACKGROUND: Young adults aged 18 to 25 years in rural communities face barriers to sexual and reproductive health (SRH) information, including clinician shortages, clinic closures, and privacy concerns in close-knit communities. Many rely on online sources of varying quality; one analysis found that 40% of birth control video content is inaccurate or misleading. AI-enabled conversational health tools (chatbots) may provide scalable SRH information, but implementation may be constrained by low institutional trust, privacy concerns, and rural users’ underrepresentation in AI development. SARHAchat is an AI-enabled SRH conversational health tool developed through prior work. This protocol describes a study to co-design and evaluate SARHAchat with rural young adults, treating trust as a design input rather than a postdeployment outcome.

OBJECTIVE: This study aims to (1) identify multilevel determinants of trust and acceptability for AI-enabled conversational health tools among rural pregnancy-capable individuals aged 18 to 25 years in North and South Carolina; (2) co-design a SARHAchat prototype with rural stakeholders using human-centered design; and (3) evaluate its feasibility, acceptability, usability, trust, and implementation outcomes in a pilot. The goal is to develop methods that support responsible implementation of conversational AI health tools in rural and underserved communities.

METHODS: This protocol uses a 3-phase mixed methods design with exploratory sequential logic. In phase 1, we will conduct semistructured interviews (target n=24) with pregnancy-capable individuals aged 18 to 25 years living in Health Resources and Services Administration (HRSA)-designated rural counties in North and South Carolina to identify determinants of trust and acceptability and develop a conceptual framework. In phase 2, we will convene 5 to 8 stakeholders per session across 2 community feedback sessions to co-design and refine SARHAchat. In phase 3, we will conduct a nonrandomized mixed methods feasibility pilot with 75 pregnancy-capable individuals aged 18 to 25 years from rural counties, recruited through community-identified social media platforms.

RESULTS: This proposal was funded in February 2026. All 3 phases have been approved by the University of North Carolina at Chapel Hill Institutional Review Board (26-0669). A total of 14 participants have enrolled in phase 1. Phase 2 co-design activities are planned for August to October 2026, and phase 3 pilot recruitment is expected to begin in January 2027, with data collection concluding in October 2027. Findings are anticipated to be submitted for publication in April 2028.

CONCLUSIONS: This protocol describes a feasibility study of a community-informed AI-enabled conversational SRH tool for rural young adults. By identifying trust-related design needs, refining a prototype through co-design, and generating preliminary feasibility, acceptability, usability, and implementation data, the study aims to establish trust-by-design methods that guide future effectiveness testing and may transfer to other sensitive health domains and underserved communities.

PMID:42561383 | DOI:10.2196/97653

Ophthalmic Plast Reconstr Surg. 2026 Aug 6. doi: 10.1097/IOP.0000000000003246. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study is to investigate whether checkpoint inhibitor proteins, including programed death protein-1, programmed death-1-pathway ligand, cytotoxic T-lymphocyte associated protein-4, lymphocyte activation gene-3, and CD73, are implicated in orbitally invasive sinonasal undifferentiated carcinomas (SNUCs).

METHODS: Patients with orbitally invasive SNUC presenting to a single institution between 2020 and 2024 were identified. Age and gender match controls were identified. Immunohistochemical staining was performed for each of the checkpoint inhibitors. Using light microscopy, the number of positively staining cells per 40× field was recorded across 5 consecutive fields and averaged. The differences in expression between the 2 were compared via a Mann-Whitney analysis.

RESULTS: Six patients with orbitally invasive SNUC and 11 sinus mucosal controls were identified. Immunohistochemical analysis of these tumors demonstrated positivity in both SNUC specimen and normal sinus mucosa for all biomarkers tested (CD73, lymphocyte activation gene-3, cytotoxic T-lymphocyte associated protein-4, programmed death-1-pathway ligand, programed death protein-1). Expression of CD73 and programmed death-1-pathway ligand was statistically significantly higher in SNUC specimens compared with normal sinus controls (p = 0.0003 and p = 0.0111, respectively).

CONCLUSION: Specimens from patients with sinonasal undifferentiated carcinoma express increased levels of programmed death-1-pathway ligand and CD73 compared with sinus controls. The results discovered in this investigation represent a significant proof of principle that immunotherapy may be a promising approach to address a potentially devastating disease.

PMID:42561378 | DOI:10.1097/IOP.0000000000003246

Diabetes Care. 2026 Aug 6:dc261042. doi: 10.2337/dc26-1042. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the link between continuous glucose monitoring (CGM) metrics and risk of severe hypoglycemia and diabetic ketoacidosis (DKA) in individuals of type 1 diabetes.

RESEARCH DESIGN AND METHODS: We pooled individual-level data from 10 studies of type 1 diabetes. From a 14-day baseline period, we derived CGM metrics (time in range [TIR] 70-180 mg/dL, time above range [TAR], time below range [TBR], sensor mean glucose, SD, and percent coefficient of variation [%CV]) and CGM-defined hypo- and hyperglycemic episodes. We used Cox regression to evaluate associations with severe hypoglycemia and diabetic ketoacidosis, with and without adjustment for HbA1c.

RESULTS: Among 1,550 participants, 65 severe hypoglycemia and 163 DKA events occurred over a median follow-up of 16 weeks. Higher TBR <70 and <54 mg/dL, SD, %CV, and CGM-defined hypoglycemic episodes were associated with greater risk of severe hypoglycemia independent of HbA1c (e.g., hazard ratio [HR] 1.52 [1.29-1.79] per 1-SD higher TBR <70). Lower TIR and higher mean glucose, SD, %CV, TAR, and hyperglycemic episodes were associated with higher DKA risk; these associations were attenuated after HbA1c adjustment, but TIR, sensor mean glucose, and SD remained statistically and clinically significant (e.g., HR 0.76, 95% CI 0.60-0.97 per 1-SD higher TIR).

CONCLUSIONS: CGM hypoglycemic and glycemic variability metrics were associated with severe hypoglycemia risk independent of HbA1c, whereas TIR, mean glucose, and SD provided information for DKA risk beyond HbA1c. This supports the complementary value of CGM and HbA1c in risk assessment for severe hypoglycemia and DKA.

PMID:42561376 | DOI:10.2337/dc26-1042

Crit Care Sci. 2026 Aug 3;38:e20260480. doi: 10.62675/2965-2774.20260480. eCollection 2026.

ABSTRACT

OBJECTIVE: We aimed to assess the effect of a short period of invasive mechanical ventilation after a successful spontaneous breathing trial, compared with immediate extubation, on the risk of reintubation within 48 hours.

METHODS: We conducted a systematic review and meta-analysis of randomized clinical trials comparing a short period of invasive mechanical ventilation following a successful spontaneous breathing trial versus immediate extubation. We searched PubMed®, Cochrane Central, Embase, Scopus, and Web of Science. Pairs of reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane Risk of Bias tool 2.0. The primary outcome was reintubation within 48 hours after randomization. Data were pooled using a Hartung-Knapp-Sidik-Jonkman random-effects model. Trial sequential analysis was performed to determine whether the accumulated evidence was sufficient for definitive conclusions. Certainty of evidence was assessed using the GRADE approach. Secondary outcomes were reintubation or death within 7 days after extubation, intensive care unit and hospital length of stay, in-hospital mortality, and ventilator-free days up to day 28.

RESULTS: Our search identified 1,473 unique records, of which 4 randomized clinical trials (n = 1,071 patients) were eligible. The pooled risk ratio for reintubation within 48 hours in patients receiving a short period of invasive mechanical ventilation after a successful spontaneous breathing trial, compared with immediate extubation, was 0.48 (95% confidence interval 0.22 – 1.07; p = 0.06; I2 = 41.6%). Trial sequential analysis confirmed that the current evidence base is underpowered for definitive conclusions. The evidence was rated as low due to serious inconsistency and imprecision. No significant differences were observed for any of the secondary outcomes.

CONCLUSIONS: Among critically ill adults, a short period of invasive mechanical ventilation after a successful spontaneous breathing trial did not significantly reduce the risk of extubation failure within 48 hours compared with immediate extubation (low-certainty evidence). Further adequately powered trials are needed to clarify the clinical efficacy of this intervention.

PMID:42561371 | DOI:10.62675/2965-2774.20260480

An Acad Bras Cienc. 2026 Aug 3;98(3):e20251036. doi: 10.1590/0001-3765202420251036. eCollection 2026.

ABSTRACT

The Atlantic Forest Biome, historically marked by intense human occupation, hosts the majority of Brazil’s population despite covering only a fraction of the national territory. However, available population estimates lack methodological transparency, undermining their application in public policies and conservation strategies. This study aims to rigorously estimate the number of inhabitants living within the limits of the Atlantic Forest Biome, considering two official territorial boundaries: the area defined by the Atlantic Forest Law, 2006 and the domain defined by Brazilian Institute of Geography and Statistics, 2019. Using data from the 2022 Demographic Census and a standardized criterion for municipal inclusion, results indicate that approximately 57% of the Brazilian population resides within the Atlantic Forest Biome. This figure is lower than those reported in the literature but still represents a significant number, considering the biome covers approximately 15% of Brazil’s continental territory. These findings underscore the need for demographic studies based on replicable methods to support planning of policies aimed at conservation, restoration, and sustainable use of the Atlantic Forest.

PMID:42561357 | DOI:10.1590/0001-3765202420251036

Codas. 2026 Aug 3;38(5):e20250244. doi: 10.1590/2317-1782/e20250244pt. eCollection 2026.

ABSTRACT

PURPOSE: To analyze the neural response of the subcortical pathway through click and speech stimuli in infants and young children with congenital cytomegalovirus (CMVc).

METHODS: Cross-sectional and prospective study. The sample consisted of infants and young children with a median age of 6.43 months (Q1-Q3: 2.62-11.25) in the CMV group (G1; n=10) and 6.23 months (Q1-Q3: 1.60-12.06) in the control group (G2; n=10). All participants underwent Transient Evoked Otoacoustic Emissions (TEOAE) and bilateral peak positive pressure tympanometry. The procedures included anamnesis, Auditory Brainstem Response with click stimulus (ABR-click), and Frequency Following Response (FFR). Click ABR was performed at intensities of 80 and 30 dB nHL in both ears. FFR was recorded in the right ear with a speech stimulus /da/ of 170 ms. FFR responses were analyzed in the temporal and spectral domains, regarding neural synchrony, spectral representation, and stability of the speech response. The Mann-Whitney test or Student’s t-test was applied for intergroup analysis. The Wilcoxon test was applied for intragroup analysis.

RESULTS: In the analysis of click ABR latencies and amplitudes, as well as in FFR measurements related to subcortical neural coding of speech, no statistically significant differences were observed between groups or between ears in the intergroup analysis.

CONCLUSION: Preliminary results indicate a similar pattern of subcortical neural coding of speech and neural synchrony in infants and young children with and without CMVc.

PMID:42561348 | DOI:10.1590/2317-1782/e20250244pt

Codas. 2026 Aug 3;38(5):e20250202. doi: 10.1590/2317-1782/e20250202pt. eCollection 2026.

ABSTRACT

PURPOSE: To evaluate the clinical impact of the DHACA® method on the development of social skills in children with Autism Spectrum Disorder (ASD).

METHODS: This longitudinal quantitative intervention study conducted with 23 children with ASD, aged 3 to 6 years, who were nonverbal or minimally verbal. Individual intervention sessions using the DHACA® method were held weekly for 20 weeks. Social skills were assessed before and after the intervention using the ACOTEA-R protocol. Data were statistically analyzed using the Wilcoxon test.

RESULTS: There was a significant improvement (p < 0.05) in ten of the sixteen skills assessed, including “responds to name,” “eye contact,” “shared attention,” and “symbolic play.” Other skills, such as “responds to ‘no'” and “takes turns,” showed a tendency toward clinical improvement, although not statistically significant. Only three skills did not show relevant progress.

CONCLUSION: The DHACA® method proved effective in promoting social skills in children with ASD, contributing to greater autonomy and social participation. The results reinforce its clinical potential as a therapeutic resource in both educational and healthcare settings.

PMID:42561347 | DOI:10.1590/2317-1782/e20250202pt

Codas. 2026 Aug 3;38(5):e20250194. doi: 10.1590/2317-1782/e20250194pt. eCollection 2026.

ABSTRACT

PURPOSE: To evaluate the performance of the PETIT application (automated tablet-based screening) compared with conventional sweep screening in identifying the risk of hearing impairment in school-aged children, using headphones with passive noise cancellation.

METHODS: Cross-sectional observational study including 122 children (aged 5 to 8 years) from the public school of Santana de Parnaíba. The following procedures were performed: otoscopy; automated hearing screening via tablet (with Sennheiser HD-280 headphones); and conventional sweep screening. Part of the sample also underwent pure-tone audiometry. Statistical analysis used binomial and binary logistic regression tests, along with the calculation of sensitivity, specificity, and accuracy.

RESULTS: There was significant association between the results of the sweep screening and PETIT, as well as the coefficient of the predictor variable (conventional audiometry) was significant to the performance in the sweep screening. For PETIT, a sensitivity of 85.7%, specificity of 100%, and accuracy of 99.18% were observed.

CONCLUSION: The results suggest that this tool has promising applicability in schools for identifying children at risk of hearing impairments.

PMID:42561346 | DOI:10.1590/2317-1782/e20250194pt

Arq Bras Cardiol. 2026 Aug 3;123(6):e20250862. doi: 10.36660/abc.20250862. eCollection 2026.

ABSTRACT

BACKGROUND: Cardiovascular magnetic resonance (CMR) is the reference standard for morphofunctional cardiac assessment. In Brazil, the application of international normal reference values faces challenges related to population admixture, technical heterogeneity among centers, and the absence of national standardization, all of which may affect diagnostic accuracy.

OBJECTIVES: To compare normal reference values for morphofunctional parameters obtained by CMR between a multicenter international review and a Brazilian publication, discussing concordance, methodological differences, and implications for Brazilian clinical practice.

METHODS: An analytical-comparative review was performed using summarized data from an international reference-value review and a Brazilian study. Means and standard deviations of key ventricular variables were compared, with assessment of 95% CI overlap, Welch’s t-test, and effect size (Hedges’ g). Standard-deviation-based cut-off points were proposed for grading abnormality.

RESULTS: Overall concordance between means was observed for most variables. Statistically significant differences occurred in a few parameters, mainly ventricular diameters and left ventricular mass, with small to moderate effect sizes. Discrepancies were largely attributed to methodological differences in measurement and indexation.

CONCLUSIONS: International normal reference values may be used in Brazilian clinical practice, provided they are adjusted for body surface area and interpreted in light of local particularities. Standardization of protocols and national multicenter studies are needed to strengthen regional validation. Keywords: Normal Values, Cardiac Magnetic Resonance, Reference Interval.

PMID:42561341 | DOI:10.36660/abc.20250862