Tag: nevin manimala

Intensive Crit Care Nurs. 2026 Jul 12;96:104499. doi: 10.1016/j.iccn.2026.104499. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-ventilator asynchrony is common in critically ill patients receiving mechanical ventilation, and timely recognition is essential for safe ventilatory management. However, factors associated with intensive care professionals’ ability to identify these events have not been systematically synthesized.

OBJECTIVE: To identify and synthesize factors associated with intensive care professionals’ ability to identify patient-ventilator asynchronies through a systematic review and meta-analysis.

METHODS: Two reviewers independently conducted systematic literature searches in PubMed, LILACS, Cochrane Library, ScienceDirect, and EMBASE from database inception to January 2026. Study selection, data extraction, and methodological appraisal were performed independently. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Pooled odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated using random-effects models. Statistical heterogeneity was assessed using the I² statistic, and leave-one-out sensitivity analyses were performed to evaluate the influence of individual studies. Publication bias was explored using funnel plots. Statistical significance was set at p < 0.05. Certainty of evidence was assessed using the GRADE approach.

RESULTS: Twelve studies including 4823 healthcare professionals were included, of which seven contributed data to the meta-analysis. Previous training in mechanical ventilation was significantly associated with a higher likelihood of correctly identifying patient-ventilator asynchronies (OR = 3.49; 95% CI: 1.95-6.25; I² = 83%). Similarly, advanced academic training was also significantly associated with correct identification (OR = 1.83; 95% CI: 1.07-3.16; I² = 28%). In contrast, specific training in asynchronies or waveform interpretation was not significantly associated (OR = 1.75; 95% CI: 0.67-4.56; I² = 68%). No significant association was observed according to profession. Overall, most studies were at low risk of bias, although some methodological limitations were identified, and the certainty of the evidence was low.

CONCLUSION: Previous training in mechanical ventilation and advanced academic training were associated with improved identification of patient-ventilator asynchronies among intensive care professionals. However, the available evidence remains limited and heterogeneous.

IMPLICATIONS FOR CLINICAL PRACTICE: General training in mechanical ventilation is associated with improved recognition of patient-ventilator asynchrony in clinical practice. Specific training in waveform interpretation alone may be insufficient. Standardized and clinically integrated training approaches may support improved detection of asynchrony in intensive care settings.

PMID:42437551 | DOI:10.1016/j.iccn.2026.104499

Musculoskelet Sci Pract. 2026 Jul 12;85:103616. doi: 10.1016/j.msksp.2026.103616. Online ahead of print.

ABSTRACT

Psychological distress, particularly anxiety and depression, is prevalent among KOA patients and may exacerbate functional disability through maladaptive cognitive processes such as pain catastrophizing. This study examined whether pain catastrophizing mediates the relationship between psychological distress and functional disability in KOA patients. We enrolled 90 KOA patients between January 2024 and January 2025. Anxiety (GAD-7), depression (PHQ-9), pain catastrophizing (Pain Catastrophizing Scale, PCS), functional disability (WOMAC), and pain intensity (visual analog scale, VAS) were assessed. Pearson correlation, hierarchical regression, and bootstrap-based mediation analyses were performed. The mean age was 61.77 ± 7.63 years, and 58.9% were female. Anxiety (GAD-7: 8.58 ± 4.68), depression (PHQ-9: 8.92 ± 5.31), and pain catastrophizing (PCS: 23.59 ± 10.43) were moderately elevated. All psychological variables were significantly correlated with WOMAC scores (r = 0.464-0.637, P < 0.001). Hierarchical regression showed psychological variables significantly increased explained variance in functional disability (ΔR² = 0.095, P < 0.001). Mediation analysis revealed pain catastrophizing partially mediated the anxiety-disability relationship (indirect effect = 0.816, 95% CI [0.425, 1.256], proportion mediated = 48.5%) and fully mediated the depression-disability relationship (indirect effect = 1.028, 95% CI [0.557, 1.636], proportion mediated = 65.0%). Within these cross-sectional data, pain catastrophizing statistically mediated the associations of anxiety and depression with functional disability; because temporal precedence cannot be established, these relationships should be interpreted as associational rather than causal. The findings nonetheless identify pain catastrophizing as a potentially modifiable cognitive correlate of disability and support evaluating cognitive-behavioral interventions targeting catastrophizing within comprehensive KOA management.

PMID:42437550 | DOI:10.1016/j.msksp.2026.103616

Water Res. 2026 Jul 5;305:126429. doi: 10.1016/j.watres.2026.126429. Online ahead of print.

ABSTRACT

Per- and polyfluoroalkyl substances (PFAS) pose persistent and widespread risks to aquatic ecosystems, yet their long-term risk dynamics remain poorly quantified. Here, we reconstruct the spatiotemporal evolution of PFAS ecological risk in China’s river networks from 2011 to 2024 by integrating a national historical monitoring database (n = 1,110 sites) with interpretable machine learning and statistical modeling. Ecological risk was quantified using a mixture-based risk index and predicted at 2 km resolution using an XGBoost classifier trained on 19 dynamic environmental and socioeconomic covariates. Model transferability was evaluated using an independent out-of-time field survey conducted in 2024. The model achieved stable predictive performance (AUC = 0.84 for internal testing; AUC = 0.86 for independent external validation), indicating its out-of-time generalization potential in a typical mixed-use watershed. High-risk regions were persistently concentrated in eastern China. Temporal analysis revealed a transient reduction in national high-risk area temporally coincident with the 2019 PFOS ban (-18.5% relative to the 2019 peak), followed by an observed rebound trajectory in 2023-2024, temporally associated with the increasing prevalence of short-chain alternatives. SHAP-SEM analysis suggests that natural hydrogeological conditions are associated with lower baseline vulnerability, whereas anthropogenic pressures are associated with elevated risk, potentially through the attenuation of soil retention capacity. These results provide a decadal-scale, policy-resolved assessment of PFAS ecological risk and provide data-driven insights into the limitations of substance-by-substance regulation.

PMID:42437549 | DOI:10.1016/j.watres.2026.126429

Eur J Radiol. 2026 Jul 9;204:113056. doi: 10.1016/j.ejrad.2026.113056. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate whether quantitative craniospinal MRI assessment of baseline tumor burden provides prognostic value in patients with recurrent, previously irradiated medulloblastoma undergoing MEMMAT (Metronomic Antiangiogenic) therapy.

METHODS: We analyzed craniospinal MRI of 40 patients with recurrent, previously irradiated medulloblastoma enrolled in the MEMMAT trial (April 1, 2014, and March 31, 2021). Ependymal, leptomeningeal, and local relapse lesions were retrospectively manually segmented on T1-contrast-enhanced (T1CE) and diffusion-weighted imaging (DWI) at baseline and follow-up (best response). Lesion count and volume were quantified. Bland-Altman analyses and intraclass correlation coefficients (ICC) assessed inter-sequence agreement., logistic regression evaluated associations between baseline tumor burden and progressive disease.

RESULTS: Patients achieving Complete Response (n = 6/40) showed mean monthly decreases of – 12.7% in T1CE lesion count and – 12.9% in volume. Partial Response patients (n = 9/40) showed similar declines (-10.3% and – 13.0%). Stable Disease patients (n = 5/40) demonstrated minimal decreases (-0.8% and – 2.3%). Progressive Disease patients (n = 16/40) showed increases of 33.7% in lesion count and 56.2% in volume. Logistic regression indicated trends toward higher baseline tumor burden predicting PD (volume OR 1.18, p = 0.08; lesion count OR 1.05, p = 0.075). Agreement between T1CE and DWI was limited (ICC 0.35 for lesion count, 0.47 for volume), with 23% of patients misclassified using either modality alone. Survival analyses demonstrated significantly shorter overall survival in patients with baseline lesion volumes ≥ 5.5 ml (log-rank p = 0.003), while a similar association for progression-free survival did not reach statistical significance (p = 0.053).

CONCLUSIONS: Combined intracranial and intraspinal T1CE and intracranial DWI assessment improves response evaluation. Exploratory analyses suggested that higher baseline tumor burden may be associated with progression, although the observed associations were of borderline statistical significance and require validation in larger cohorts.

PMID:42437539 | DOI:10.1016/j.ejrad.2026.113056

Biotechnol Bioeng. 2026 Jul 12. doi: 10.1002/bit.70306. Online ahead of print.

ABSTRACT

Microbial inulinases are increasingly recognized as valuable biocatalysts for the sustainable production of high-value products, including fructooligosaccharides, fructose, bioethanol, and organic acids in industries, such as food, pharmaceuticals, and bioenergy. In the last few decades, microbial inulinase research has advanced significantly, from strain selection and fermentation optimization to advanced enzyme engineering and immobilization, improving yields, stability, and reusability. There are still some final bottlenecks, such as low yields, poor thermostability, and high purification costs. This review examines strategies to innovate and overcome these bottlenecks, including novel immobilization strategies that utilize nanomaterials, system-scale bioprocess optimization using artificial intelligence (AI), and bioprospecting extremophiles using metagenomics. The present review discusses how statistical and computational modeling (RSM, ANN, and AI) significantly increases yield and process efficiency, with comments on their relevance to contemporary biorefinery applications. The advanced immobilization approaches significantly enhance operational stability and reusability, allowing for continuous processing. This review situates the development of inulinase as not just an enzymological effort but a multidisciplinary effort involving process engineering and sustainability science. Overall, emphasize is given toward the thought that advancements leaning toward the future will require a synthesis of AI-designed enzyme systems; economical immobilization supports; and incorporation of circular bioeconomy principles through the valorization of agro-wastes. These barriers to knowledge transfer must be resolved if we are to unlock the full bioeconomic potential of microbial inulinase systems.

PMID:42437513 | DOI:10.1002/bit.70306

Orv Hetil. 2026 Jul 12;167(28):1105-1112. doi: 10.1556/650.2026.33598. Print 2026 Jul 12.

ABSTRACT

INTRODUCTION: Animal-assisted therapies are increasingly applied in rehabilitation and complementary care, particularly in supporting mental and neurocognitive conditions. The targeted therapeutic use of songbirds and their vocalizations (ornithotherapy) represents a relatively novel approach that remains underrepresented in the international literature, especially regarding objectively measurable physiological outcomes.

OBJECTIVE: The aim of our study was to evaluate the effects of an ornithotherapy intervention on blood pressure and pulse rate in a residential institution caring for individuals with intellectual disabilities, compared to corresponding periods before and after the intervention.

METHOD: A retrospective analysis was conducted covering the period between 2022 and 2025. Documented blood pressure and pulse data of residents were analyzed. The intervention took place between October 17, 2023, and March 15, 2024, during which birdsong was played on weekdays for 10 minutes daily in communal areas. Data from the intervention period were compared with corresponding control periods.

RESULTS: Generalized Estimating Equation analyses showed consistent cardiovascular patterns across the three years. A statistically significant change was observed only in systolic blood pressure during the intervention year. Mean systolic blood pressure values in 2023 were significantly lower compared to 2022, with an estimated reduction of approximately 2-3 mmHg. No significant changes were found in diastolic blood pressure or pulse rate.

DISCUSSION: These findings suggest that auditory intervention may exert a modest but measurable effect on systolic blood pressure, while diastolic blood pressure and pulse remain unaffected.

CONCLUSION: Birdsong-based auditory stimulation appears to have a moderate and selective effect on systolic blood pressure. Ornithotherapy may represent a low-cost, easily applicable complementary approach in institutional care. Further prospective studies are warranted to better define its therapeutic potential. Orv Hetil. 2026; 167(28): 1105-1112.

PMID:42437466 | DOI:10.1556/650.2026.33598

J Clin Nurs. 2026 Jul 12. doi: 10.1111/jocn.70445. Online ahead of print.

ABSTRACT

AIM: To observe and describe the surgical wound care practices of nurses in a Sri Lankan tertiary care hospital.

DESIGN: A cross-sectional observational study.

METHODS: We observed surgical wound care practices of registered nurses (RNs) working in 13 general surgical wards of a 3000-bed tertiary care hospital in Sri Lanka. An observation tool developed based on clinical practice guidelines (CPGs) and a chart audit tool were used for data collection. Field notes were taken to describe contextual details. A convenience sample of RNs and a consecutive sample of adult, postoperative patients were recruited. Patients were included once, while nurses were observed on multiple occasions. Descriptive statistics were used, and field notes were added to contextualise the data.

RESULTS: We observed wound care episodes across 250 postoperative patients with 63 RNs. Nurses’ hand hygiene (HH) adherence was 58.4% (n = 146) before dressing changes and 43.2% (n = 108) after dressing changes. Wound care education was observed in only 22% (n = 55) of episodes. Documentation of wound care was noted only on 53 (21.2%) occasions. Field notes highlighted the lack of standard wound assessment and management protocols and resource constraints influencing the nurses’ adherence to CPGs on many occasions.

CONCLUSION: Our findings suggest that nurses’ adherence to CPGs was limited, and there are unwarranted variations in nurses’ surgical wound care practices. Unavailability of standard wound care protocols and resource constraints were also identified. These variations appear multifactorial, reflecting limitations in training, staffing, resources and the absence of standardised wound care protocols.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Targeted training programs should be conducted for nurses, and context-sensitive wound management protocols should be introduced.

IMPACT: As one of the first studies to describe nurses’ surgical wound care practices in a resource-limited country, these findings offer valuable insights into both practice and the contextual influences.

REPORTING METHOD: The Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:42437459 | DOI:10.1111/jocn.70445

Acta Ophthalmol. 2026 Jul 12. doi: 10.1111/aos.70188. Online ahead of print.

ABSTRACT

To identify, describe and critically appraise studies developing and/or validating models for predicting sight-threatening retinopathy of prematurity (ROP) in preterm infants undergoing screening in neonatal intensive care units. PubMed, Embase via Ovid, trial registers, and grey literature were searched from inception to 21 October 2025. Eligible studies included those that developed and/or validated prognostic models for sight-threatening ROP in screened preterm infants. Data extraction followed the CHARMS checklist. Reporting adhered to TRIPOD-SRMA and PRISMA guidelines. Model quality, risk of bias, and applicability were assessed using PROBAST+AI. The protocol is available on Open Science Framework (https://osf.io/dgc4y). Thirty-five unique prognostic models for sight-threatening ROP were identified from 30 development studies. Gestational age, birth weight, and postnatal weight gain were the most frequently reported predictors, followed by sex. Twenty-three models underwent at least one external validation (155 validations in total). Most development studies showed substantial methodological concerns related to study design, handling of missing data, lack of external validation, and inadequate reporting of performance measures. Studies assessing model performance (apparent, internal, or external) were also at high overall risk of bias due to design, analytical, and reporting shortcomings. Collectively, these limitations may reduce the generalizability and clinical applicability of existing models. Despite numerous ROP prediction models, methodological limitations and limited robust validation preclude widespread clinical adoption. Future research should prioritize development and prospective, multicentre validation across large, diverse cohorts, with emphasis on readily available and objectively measured predictors, alongside strict adherence to established methodological and reporting standards (TRIPOD-AI, PROBAST+AI) to ensure reliable, generalizable tools for optimizing ROP screening.

PMID:42437452 | DOI:10.1111/aos.70188

Soft Matter. 2026 Jul 12. doi: 10.1039/d6sm00280c. Online ahead of print.

ABSTRACT

Colloidal suspensions exhibit diverse phases from fluid-like to solid-like, which are critical for numerous industrial applications. However, accurately identifying their phases remains a challenge, as they depend on a complex interplay of solid volume fraction, particle size distribution, and interparticle interactions. Near phase boundaries, subtle microstructural changes can induce drastic macroscopic property variations, yet these differences are often indistinguishable through conventional observation. To overcome these limitations and the high computational costs of long-time simulations, we propose a transformer-driven framework based on reference-based data embedding. Unlike standard point cloud models that directly embed positions, our approach utilizes particle stress information as the primary feature while using spatial coordinates solely as a reference to map interparticle relationships. This allows the transformer-driven model to effectively capture structural characteristics at both local and global scales. By training the model exclusively on unambiguous regions far from phase boundaries to prevent mislabeling, we successfully predicted the complete phase diagram, which was further validated through theoretical and statistical analysis. Notably, our methodology significantly alleviates the need to monitor long-term structural convergence, which is typically challenging due to the inherently slow phase evolution in attractive colloidal systems. This framework provides a robust and cost-effective tool for the systematic discovery and reverse engineering of complex soft condensed matter.

PMID:42437443 | DOI:10.1039/d6sm00280c

Environ Geochem Health. 2026 Jul 12;48(10):448. doi: 10.1007/s10653-026-03326-1.

ABSTRACT

Samples were taken from 16 surface sediments (0-10 cm) and 12 core sediments from the drinking-water reservoir, the Wan’an Reservoir, which is located near small-scale and historical tungsten occurrences. The total concentrations and chemical speciation of As, Cd, Cr, Cu, Pb, Zn and W were analyzed by inductively coupled plasma optical emission spectrometry (ICP-OES) and the BCR sequential extraction procedure. Spatial distribution analysis indicated that toxic metal pollution exhibited significant downstream enrichment characteristics, among which Cd, W, and Cu were particularly prominent. The geo-accumulation and ecological risk analyses indicated that Cd was the dominant risk contributor. As a result, 87.5% of the surface sampling points were classified as having extremely high potential ecological risk. The Risk Assessment Code further indicated that the proportion of the acid-soluble/exchangeable fraction of Cd was relatively high, indicating strong mobility risk. Core sediment analysis indicated abrupt historical Cd enrichment peaks in the midstream area, while Zn and Cu exhibited surface enrichment over the past decade. Multivariate statistical analysis, along with geographical data on mining areas, revealed that mining activities were the primary anthropogenic source of complex pollution from Cu, Pb, Zn, W, and Cd in the downstream regions. In contrast, the middle and upper reaches are primarily influenced by natural geology and agricultural non-point sources. Comprehensive assessment suggests prioritizing the control of Cd migration in the downstream areas. In the middle and upstream regions, efforts should focus on preventing agricultural non-point source pollution to safeguard the reservoir’s water quality.

PMID:42437432 | DOI:10.1007/s10653-026-03326-1