Tag: nevin manimala

Clin J Am Soc Nephrol. 2026 Jul 10. doi: 10.2215/CJN.0000001133. Online ahead of print.

ABSTRACT

BACKGROUND: Frailty and sarcopenia are increasingly common among patients undergoing maintenance hemodialysis. Globally, some countries including Japan have recently introduced insurance reimbursement for intradialytic renal rehabilitation, a supervised intradialytic exercise instruction plus nutritional and lifestyle guidance. However, the survival benefit has not been fully evaluated.

METHODS: We evaluated 708 adult dialysis outpatients (age, 69.8±11.2; men, 59%; and Clinical Frailty Scale≥6, 13%) at 10 institutions across Japan in January 2021 who were retrospectively assessed over a three-year period, including 228 patients who received intradialytic renal rehabilitation, defined as supervised intradialytic exercise instruction plus nutritional and lifestyle guidance (≥1 session/week for ≥1 month), and 480 who did not receive this intervention. Cox regression models and propensity score (PS) matching were used to compare three-year mortality after adjustment for the Clinical Frailty Scale, comorbidities, laboratory data and other baseline characteristics.

RESULTS: During the follow-up, deaths were observed in 14.9% of the rehabilitation group and 23.1% of the non-rehabilitation group (P=0.01). Three-year survival was higher with rehabilitation (84.6% vs 75.6%, P = 0.007), particularly among men and those with severe frailty. In Cox models, renal rehabilitation was consistently associated with lower mortality (crude HR 0.59 [95% CI, 0.40-0.87]; adjusted HR 0.66 [0.44-1.00]). After propensity score matching, the association remained directionally similar (HR 0.65 [0.40-1.05]). Sex-stratified analyses suggested a stronger association among men (adjusted HR 0.49 [0.27-0.89]) than among women (adjusted HR 0.98 [0.54-1.77]), although the formal test for interaction was not statistically significant (P for interaction = 0.13). Patients meeting exercise-habit criteria (≥2 sessions/week, ≥30 min for ≥1 year) also showed better survival relative to the non-exercise-habit group (adjusted HR 0.60 [0.37-0.96], P = 0.03). No adverse events related to rehabilitation were reported.

CONCLUSIONS: Intradialytic renal rehabilitation may be associated with better survival in maintenance hemodialysis patients, particularly in men and in those with severe frailty.

PMID:42455635 | DOI:10.2215/CJN.0000001133

Intern Med J. 2026 Jul 15. doi: 10.1111/imj.70502. Online ahead of print.

ABSTRACT

BACKGROUND: Frailty is a dynamic condition in older adults, and transitions between frailty states may occur over time. However, predictors and clinical implications of changes in frailty status, particularly frailty improvement, remain insufficiently understood.

AIMS: Predictors and clinical implications of changes in frailty status over time have not been studied in detail. This study aimed to evaluate these aspects.

METHODS: In this retrospective cohort study, 2573 patients were screened. After applying exclusion criteria and including only those with longitudinal follow-up, 399 patients were included in the final analysis. Frailty was assessed by the Fried frailty phenotype. Participants were categorised as robust (0), pre-frail (1-2) and frail (3-5). Changes in frailty status from baseline and associations with overall survival were analysed.

RESULTS: We included 399 outpatients from a geriatric clinic. The mean age was 83 ± 7 years, and 291 (73%) were women. At baseline, 9.3% (n = 37) were robust, 34.3% (n = 137) were pre-frail, and 56.4% (n = 225) were frail. Over a median follow-up of 14 months (interquartile range 12-23 months and range 6-71 months), 17.8% of participants improved, 16.0% deteriorated and 66.2% remained stable. Compared to baseline, weight loss and handgrip strength improved while walking speed worsened. Younger age (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.88-0.97, P = 0.003) was independently associated with improvement of frailty status. In the adjusted model, higher glomerular filtration rate was not statistically significant but demonstrated a trend towards association with improvement in overall frailty status (OR 1.02, 95% CI 1.00-1.04, P = 0.057). Overall, frailty transitions were not significantly associated with survival; however, in pre-frail individuals, progression to frailty was associated with shorter survival (41 vs 65 months, P = 0.010). Among pre-frail participants, older age (OR 1.08, 95% CI 1.00-1.16, P = 0.049), higher number of medications (OR 1.25, 95% CI 1.07-1.45, P = 0.005) and higher vitamin D levels (OR 1.06, 95% CI 1.01-1.10, P = 0.011) independently predicted transition to frailty.

CONCLUSIONS: Frailty is potentially reversible, particularly in the pre-frail stage. Improvements in weight loss and muscle strength contribute to enhanced frailty status. Early identification and targeted interventions in pre-frail individuals may prevent progression and reduce adverse outcomes.

PMID:42455628 | DOI:10.1111/imj.70502

Appl Neuropsychol Adult. 2026 Jul 15:1-7. doi: 10.1080/23279095.2026.2702492. Online ahead of print.

ABSTRACT

The present research aimed to validate and standardize classic tasks in neuropsychology for the evaluation of executive functions in young adults from Saudi Arabia: Arabic Wisconsin Card Sorting Test (WCST), Controlled Oral Word Association Test (COWAT) FAS, Stroop Color and Word Test (SCWT) and Trail Making Test Part B (TMT-B). The sample mirrored the demographics of target population (e.g., age, gender, and socioeconomic status) to prevent bias. The population is divided into specific subgroups (strata), and participants were drawn proportionally from each group. Accordingly, 512 healthy young adults were evaluated. The study population ranged in age from 18 to 22 years (20 ± 2.8 years), of which 60% were men. The conditions of sampling adequacy (KMO = .85) and sphericity (p < .001) were satisfactorily met, as the model explains 59.4% of the total variance. For all tests direct and statistically significant correlations (p < .05) were found between measurements taken at different times by the same evaluator. This study analyzes the psychometric properties of the executive function instruments. As the results indicates, all tasks showed adequate internal consistency and inter- and intra-rater reliability, except for the COWAT-FAS, which lacked reliability.

PMID:42455622 | DOI:10.1080/23279095.2026.2702492

JMIR Med Inform. 2026 Jul 15. doi: 10.2196/99639. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical retrieval-augmented generation depends on embedding models. A companion study found that non-retrieval-trained encoders underperformed retrieval-trained general-purpose embeddings and produced near-degenerate embedding geometry, but did not localize the architectural origin, separate training-domain from training-objective effects, or test whether the degradation can be corrected without retraining.

OBJECTIVE: To (a) characterize layer-wise retrieval and geometric trajectories across 13 transformer configurations on clinical documents; (b) separate training-objective from training-domain effects through matched architectural comparisons; (c) re-analyze the panel under a per-query layer-wise linear mixed-effects framework; and (d) evaluate deployment-relevant post-hoc geometric correction.

METHODS: Layer-wise embeddings were extracted from 13 transformer configurations on 3 clinical corpora (n=100 documents each: MTSamples, PMC-Patients, and Mistral-7B-Instruct-generated synthetic notes) under 2 query formats (keyword and natural-language metadata-derived queries via GPT-4o). The panel was extended beyond the companion study by adding BERT-base-uncased and BioMistral-7B as matched controls. Retrieval performance (MRR@10, Recall@10) and geometric properties (participation ratio, average pairwise cosine, anisotropy) were measured at every layer. A per-query layer-wise linear mixed-effects model was fit independently per configuration as the primary inferential analysis. Corpus-only ZCA whitening was evaluated as the primary deployment-relevant intervention, with 5-fold cross-validation, an epsilon sweep, a lexical-overlap audit, and a chunking sensitivity analysis.

RESULTS: Document embeddings clustered into three anisotropy tiers: extreme (avg pairwise cosine>0.92) for non-retrieval-trained encoders and LLMs, moderate (0.65-0.92) for general retrievers and most LLMs, and reduced (<0.65) for BioLORD-2023, instruction-tuned E5-Mistral-7B, and Nomic-embed-text-nopfx. The per-query random-slope LME identified two layer-depth patterns: classical degradation with depth in three non-retrieval-trained encoders (all P<.001), versus net improvement with depth in the remaining 10 models (all P<.001), with the strongest negative coefficients in decoder LLMs. Formal matched-contrast tests confirmed statistically significant training-objective × layer-depth interactions in all three matched pairs (BERT-base-uncased vs BGE-base, P<.001; BioMistral-7B vs E5-Mistral-7B, P<.001; BioBERT vs BioLORD-2023, P<.001). Corpus-only ZCA whitening produced a two-tier pattern under 5-fold cross-validation: Tier 2 non-retrieval-trained models showed positive ΔMRR@10 (+0.066 to +0.304), while Tier 1 retrieval-trained models showed negative ΔMRR@10 (-0.021 to -0.051), confirming held-out generalization. BM25-versus-embedding Spearman rank correlations spanned -0.02-0.37, indicating substantial non-lexical contribution to retrieval. Same-source ranking stability replicated at 4-5× corpus scale (ρ=0.952 for PMC-500, ρ=0.929 for MTSamples-400) for the BERT-scale subset.

CONCLUSIONS: Anisotropy in transformer embeddings is widespread across architectural classes and is lower in configurations with retrieval-specific training. Corpus-only ZCA whitening is a deployment-compatible, retraining-free post-hoc correction candidate that improved retrieval for non-retrieval-trained models on this controlled benchmark but requires target-corpus validation before clinical deployment. The matched-comparison evidence supports training objective rather than training domain as the stronger explanatory axis, though residual confounding is not eliminated. The principal contribution is mechanistic: layer-level localization of embedding degradation and the geometric basis for the two-tier intervention response.

PMID:42455615 | DOI:10.2196/99639

Vet Med Sci. 2026 Jul;12(4):e71091. doi: 10.1002/vms3.71091.

ABSTRACT

OBJECTIVES: The objectives of this study were to evaluate and compare the phenotypic and both production and reproduction performance of two indigenous chicken genotypes-frizzle and deshi dwarf-reared under intensive management system. The aim of this study was to identify the superior genotypes which are suitable for intensive management rearing system.

METHODS: This work was carried out to compare the morphometric characteristics, production and reproductive performance between frizzle and deshi dwarf chickens under intensive management conditions at Sylhet Agricultural University. A total of 62 chickens, 32 frizzle and 30 deshi dwarf chickens, were monitored. Statistical analyses (SAS) were performed to compare the performance between genotypes.

RESULTS: The mean of beak length, chest girth, keel length, wing length, body length and shank length of frizzle and deshi dwarf were 3.5 ± 0.37 and 2.32 ± 0.38, 26.1 ± 2.8 and 28.55 ± 3.8, 8.26 ± 1.12 and 8.66 ± 0.9, 25.25 + 2.5 and 22.5 ± 2.15, 41.12 ± 4.15 and 30.25 ± 2.6, 6.3 ± 1.03 and 4.75 ± 1.04 cm, respectively. The mean live weights of frizzle and deshi dwarf chickens were 965.35 ± 26.45 and 1073.7 ± 20.46 g at 20 weeks of age, respectively. The average mean of the day-old chick weight and egg weight, age of first laying of frizzle and deshi dwarf chickens were 28.47 ± 0.1 and 30.43 ± 0.16, 39.82 ± 0.12 and 40.60 ± 0.13 g, 23.25 ± 0.21 weeks and 20.95 ± 0.20 weeks, respectively. The average mean of frizzle and deshi dwarf chickens’ fertility, and hatchability were 82% and 91%, 78% and 86%. The weight of hens at first egg laying was also positively correlated with their age of both chickens. The study revealed a high positive correlation (p < 0.05) in frizzle chickens between wing length and shank length (0.98) and in deshi dwarf chickens between body length and shank length (0.97). Additionally, strong positive correlations were found between the weights of chickens at 16 and 20 weeks, with correlation values of 0.96 for frizzle and 0.87 for deshi dwarf chickens.

CONCLUSION: These findings are expected to assist in making decision for improving the efficiency and sustainability of both chickens in intensive management systems. Comparatively, deshi dwarf chickens are more promising breed under intensive rearing system.

PMID:42455613 | DOI:10.1002/vms3.71091

J Synchrotron Radiat. 2026 Sep 1. doi: 10.1107/S1600577526005977. Online ahead of print.

ABSTRACT

Grazing-incidence (GI) scattering techniques are widely used to characterize thin films, offering high surface sensitivity and insight into morphology and structure. However, these approaches typically provide statistical averaged information due to elongated footprint or limited spatial resolution due to beam size. Here we introduce a method that combines structured illumination with GI X-ray scattering and leverages our computational imaging approach to resolve local structural details. We demonstrate that our method captures local features of an organic semiconductor thin film without the need for sample rotation as in tomography. The method expands GI techniques from statistical averaging to high-resolution imaging, thereby providing the capability for detailed analysis of local material properties, such as domain shape, orientation and polymorphism, which are critical for advancing material design towards more efficient and tailored materials.

PMID:42455583 | DOI:10.1107/S1600577526005977

J Synchrotron Radiat. 2026 Sep 1. doi: 10.1107/S1600577526005898. Online ahead of print.

ABSTRACT

Wavefront characterization is essential for diagnosing, interpreting and mitigating performance limitations at X-ray free-electron lasers (XFELs). However, the dramatic increase in thermal load and data throughput at high repetition rates makes established wavefront characterization methods difficult to implement effectively. Here, we demonstrate that X-ray speckle arising from beamline optics can enable fast, robust and sensor-free wavefront metrology at next-generation XFEL facilities. Combining this approach with a statistical formulation of X-ray speckle tracking, we quantify local wavefront fluctuations within pulse trains at the European XFEL. We find that shot-to-shot wavefront fluctuations are predominantly planar phase tilts with distinct statistical signatures across intra- and inter-train timescales. The dominant source of wavefront error is periodic at frequencies consistent with known mechanical oscillation modes of the photon transport optics, while intra-train fluctuations correlate with instabilities in the electron bunch trajectory. Our results establish a practical framework for high-repetition-rate wavefront characterization and diagnostics at next-generation XFELs.

PMID:42455581 | DOI:10.1107/S1600577526005898

JAMA Netw Open. 2026 Jul 1;9(7):e2623089. doi: 10.1001/jamanetworkopen.2026.23089.

ABSTRACT

IMPORTANCE: Childhood cancer is a leading cause of disease-related mortality, with increasing incidence in many high-income countries. Socioeconomic disparities in childhood cancer survival are well documented, but less is known about incidence.

OBJECTIVE: To examine associations between area-based deprivation and childhood cancer incidence in a universal health care system.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study linked data from the population-based Pediatric Oncology Group of Ontario Networked Information System cancer registry with Statistics Canada’s postal code and Ontario Marginalization Index (ON-Marg) databases to identify pediatric cancer cases diagnosed in Ontario from January 1, 1999, to December 31, 2023, among approximately 2.3 million children aged 0 to 14 years living in Ontario, Canada. Data analysis was performed from October 2025 to February 2026.

EXPOSURES: ON-Marg dimensions: material resources (income and educational attainment), households and dwellings (residential instability), age and labor force (dependents and adults not in the labor force), and racialized and newcomer populations.

MAIN OUTCOMES AND MEASURES: Crude and age-standardized incidence rates for each ON-Marg dimension; incidence rate ratios were estimated using multivariable Poisson regression models adjusted for age, sex, and diagnosis period for the overall population and stratified by cancer subtype (ie, leukemia and lymphoma, central nervous system tumors, and other non-central nervous system solid tumors).

RESULTS: Of the 9063 pediatric cancer cases (4981 [55.0%] male; median [IQR] age at diagnosis, 5 [2-10] years), the age-standardized incidence rate was 162.7 cases per million (95% CI, 159.3-166.1). Most cancer cases were found in areas with the greatest concentration of racialized and newcomer populations; however, after accounting for population size, there was no difference in cancer incidence across quintiles. A key finding of this study was that the least marginalized quintiles of material resources (incidence rate ratio, 1.15; 95% CI, 1.07-1.22) and households and dwellings (incidence rate ratio, 1.08; 95% CI, 1.01-1.16) had significantly higher incidence rates compared with the most marginalized quintiles. These findings were driven primarily by hematologic and other solid cancer types.

CONCLUSION AND RELEVANCE: This large population-based cross-sectional study with virtually complete ascertainment of pediatric cancer cases in a Canadian province with a universal health care system found higher cancer incidence among children who lived in affluent and residentially stable neighborhoods. These findings underscore the importance of considering sociodemographic factors when examining pediatric cancer epidemiology; more research is needed to understand the mechanisms driving these differences, their impact on outcomes, and how the findings may inform targeted prevention and intervention strategies.

PMID:42455571 | DOI:10.1001/jamanetworkopen.2026.23089

Stat Med. 2026 Jul;45(15-17):e70651. doi: 10.1002/sim.70651.

ABSTRACT

Recent advances in biotechnology and personalized medicine have driven the development of efficient clinical trial methodologies for assessing treatment efficacy across multiple populations defined by treatment effect modifiers. Within-patient comparison of different treatments is a promising approach for improving study efficiency across multiple populations by eliminating between-patient variability in treatment evaluation. This study provides a framework for evaluating treatment efficacy in multiple populations for $2\times 2$ crossover trials and evaluates the efficacy gain in comparison with the standard parallel-group analysis. Simulation experiments confirm that the crossover analysis consistently outperforms the parallel-group analysis in statistical power, especially when carryover effects are small. An application to a clinical trial in Type 2 diabetes demonstrates the efficiency advantages of the crossover analysis. These numerical results emphasize the potential of the crossover analysis for enhancing the efficiency of clinical development of personalized medicine.

PMID:42455565 | DOI:10.1002/sim.70651

Intern Med J. 2026 Jul 15. doi: 10.1111/imj.70554. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine treatment trends and outcomes over time for patients with ST-elevation myocardial infarction-related cardiogenic shock (STEMI-CS) in a regional centre.

METHOD: This retrospective study analysed data from patients with STEMI and Killip class IV cardiogenic shock at a Victorian regional tertiary hospital over 10 years (2014-2024). Patients treated with percutaneous coronary intervention (PCI) or surgical revascularisation (coronary artery bypass grafting) were identified using state-wide registries. The primary outcome was 30-day mortality with secondary outcomes of door-to-balloon time, mechanical circulatory support (MCS) use, ICU/hospital length of stay and revascularisation technique.

RESULTS: One hundred and seventy-two adult patients (74% male) had STEMI-CS. The number of patients presenting with STEMI-CS increased over the 10-year period; however, 30-day mortality remained unchanged at 49%. In addition, 69% achieved a door-to-balloon time <90 min, and the median door-to-balloon time did not differ significantly over time. However, 19% required MCS, with similar numbers for intra-aortic balloon pump and extra (corporeal membrane oxygenation. The median intensive care unit and hospital length of stay was 5 days (IQR = 2-9) and 8 days (IQR = 3-13) respectively and was unchanged over time. There was a strongly positive and statistically significant trend towards increased use of PCI over the 10-year study period.

CONCLUSION: With timely revascularisation and increasing use of PCI, STEMI-CS patients in regional settings with access to a 24-h catheter lab have outcomes consistent with metropolitan and global trends. Despite medical advancements, outcomes for patients with STEMI-CS are largely unchanged over time, with 30-day mortality rates that remain unacceptably high. There is an urgent need for innovative strategies and system-level improvements to address the increasing burden of STEMI-CS.

PMID:42455523 | DOI:10.1111/imj.70554