J Hazard Mater. 2026 Aug 14:143292. doi: 10.1016/j.jhazmat.2026.143292. Online ahead of print.
NO ABSTRACT
PMID:42601240 | DOI:10.1016/j.jhazmat.2026.143292
Tag: nevin manimala
Arch Dis Child. 2026 Aug 14:archdischild-2026-330279. doi: 10.1136/archdischild-2026-330279. Online ahead of print.
ABSTRACT
Directed acyclic graphs (DAGs) are increasingly recommended or required by journals for observational studies making causal claims yet few paediatric observational studies present DAGs to support their analytical approach. This practical guide addresses the implementation gap between methodological guidance and research practice by clarifying when DAGs are needed (causal questions only, not descriptive or predictive research), demonstrating how to construct them for paediatric studies, and explaining how to use them to identify appropriate statistical adjustment strategies. We illustrate common pitfalls, including adjusting for colliders and mediators, address practical challenges such as temporal ordering ambiguity, and provide a worked example from recent paediatric literature. Proper use of DAGs makes causal assumptions explicit, prevents common analytical errors and strengthens causal inference in observational paediatric research.
PMID:42601214 | DOI:10.1136/archdischild-2026-330279
Br J Ophthalmol. 2026 Aug 14:bjo-2026-329939. doi: 10.1136/bjo-2026-329939. Online ahead of print.
ABSTRACT
BACKGROUND/AIMS: To investigate glaucoma prevalence and diagnostic discrepancies-undiagnosed glaucoma, missed diagnostic opportunities and false-positive diagnoses-in South Korea and to identify factors contributing to these errors.
METHODS: This nationwide cross-sectional study used data from the Korea National Health and Nutrition Examination Survey 2019-2021. Participants aged ≥20 years who had gradable ophthalmic examinations were included. Glaucoma was adjudicated by specialists using International Society of Geographical and Epidemiological Ophthalmology criteria. Survey-weighted logistic regression analyses were performed to identify factors associated with undiagnosed glaucoma and missed diagnostic opportunities.
RESULTS: The final analytical cohort comprised 18 710 participants. The weighted prevalence of glaucoma was 3.9% (95% CI 3.6% to 4.2%). The awareness rate was only 17.1%, leaving 82.9% (95% CI 80.4% to 85.4%) of cases undiagnosed. Notably, 44.7% (95% CI 41.0% to 48.3%) of undiagnosed cases represented a missed diagnostic opportunity. Multivariable analysis identified high myopia as the strongest predictor of a missed diagnostic opportunity (OR 23.53, 95% CI 5.65 to 98.09, p<0.001), alongside younger age (OR 0.98, p=0.039), rural residence (OR 1.97, p=0.047) and thicker retinal nerve fibre layer (OR 1.09, p<0.001). The lowest household income quartile was associated with undiagnosed glaucoma (OR 1.87, p=0.019).
CONCLUSION: Diagnostic discrepancies present a dual burden: profound underdiagnosis coexists with frequent false-positive diagnosis. High myopia, milder disease phenotype and rural residence are central drivers of missed diagnostic opportunities. Reducing discrepancies will therefore require efforts at both the clinical-professional and health system levels.
PMID:42601192 | DOI:10.1136/bjo-2026-329939
Stat Med. 2026 Aug;45(18-19):e70700. doi: 10.1002/sim.70700.
ABSTRACT
The FDA initiated Project Optimus and issued guidance for dose optimization, recommending randomized parallel dose-response cohorts to generate additional data at promising dose levels and implying that different dosages may be needed for different indications. In addition to dose optimization, with recent advancements in precision medicine and cancer biology, the development of cancer treatments has shifted toward the search for agents targeted to specific molecular profiles that may appear in more than one type of cancer. The basket trials are clinical trial designs that enable the simultaneous assessment of a new treatment in multiple indications. Concerning the FDA’s dose optimization perspective and the recent trend of basket trials in early-phase clinical trials, this paper proposes a dose-ranging basket trial design based on a Bayesian model-averaging approach considering efficacy and toxicity outcomes, where indications and dose levels define baskets. A key benefit of the proposed approach is that it explicitly accounts for the possible heterogeneity of response rates among baskets. Our simulation study shows that the proposed approach outperforms other methods, offering higher statistical power, better control of Type I error rates, precise optimal dose selection, and sample size savings in various scenarios with heterogeneous treatment effects between baskets.
PMID:42601178 | DOI:10.1002/sim.70700
BMJ Open Gastroenterol. 2026 Aug 14;13(1):e002278. doi: 10.1136/bmjgast-2026-002278.
ABSTRACT
OBJECTIVE: Patients with inflammatory bowel disease (IBD) have an increased risk of cardiovascular and cerebrovascular events, but the underlying mechanisms remain unclear. We aimed to assess subclinical carotid atherosclerosis in IBD in a large population-based cohort.
METHODS: We performed a cross-sectional analysis of the Paracelsus 10 000 cohort in Salzburg, Austria. Adults aged 40-77 years underwent standardised clinical evaluation, laboratory testing and bilateral carotid ultrasonography. The primary endpoint was carotid plaque burden; secondary endpoints included plaque presence, intima-media thickness, carotid stenosis, coronary artery calcium and polygenic risk scores. Multivariable ordered logistic regression models were adjusted for age, sex and comprehensive cardiovascular risk measures including Systematic Coronary Risk Evaluation 2 and Life’s Essential 8.
RESULTS: Among 9723 participants, 70 had IBD and 9653 served as controls. Patients with IBD had higher levels of high-sensitivity C reactive protein (median 0.15 vs 0.12 mg/dL; p=0.039) and lower ferritin levels (86 vs 117 ng/mL; p=0.018). Carotid plaque prevalence (40% vs 38%; p=0.79) and plaque burden distribution (p=0.82) were similar between groups. Intima-media thickness, carotid stenosis, coronary artery calcium score categories and polygenic risk scores were also comparable. In multivariable analysis, IBD was not associated with higher plaque burden (adjusted OR 1.49; 95% CI 0.88 to 2.55; p=0.139).
CONCLUSIONS: In this population-based cohort, IBD was not associated with increased subclinical carotid atherosclerosis. These findings suggest that cardiovascular risk in IBD may not be fully explained by atherosclerotic burden alone and may involve inflammation-related and prothrombotic mechanisms beyond atherosclerosis.
PMID:42601172 | DOI:10.1136/bmjgast-2026-002278
BMJ Open Qual. 2026 Aug 14;15(3):e003713. doi: 10.1136/bmjoq-2025-003713.
ABSTRACT
BACKGROUND: Perioperative anaphylaxis is a rare but complex clinical crisis, with outcomes heavily dependent on prompt and effective management by anaesthesiologists. However, evidence supporting the efficacy of scenario-based simulation (SBS) training in perioperative anaphylaxis management remains limited. This study aimed to evaluate the impact of SBS versus video-based training (VBT) on learning outcomes and satisfaction among undergraduate anaesthesia students.
METHODS: In this prospective randomised study, 84 fourth-year anaesthesia undergraduate students from Anhui Medical University were assigned to either SBS or VBT for perioperative anaphylaxis education. Knowledge assessments were conducted before (pretest) and after (post-test) training. Outcomes included post-test scores, student satisfaction (assessed via a 5-point Likert scale) and performance in a simulated clinical scenario 1 week later. Scenario performance was evaluated using a technical checklist and the Anesthesiologists’ Non-Technical Skills scoring system.
RESULTS: Baseline characteristics (age, sex and pretest scores) were comparable between groups. The post-test scores were higher in the SBS group than those of the VBT group (80.0 (73.7–85.0) vs 70.0 (65.0–75.0), respectively, p<0.001). Both groups improved in post-test scores after training. The SBS group’s post-test score increased significantly more than that of the VBT group (39.2% (30.7%–44.6%) vs 16.6% (8.3%–20.0%), respectively, p<0.001). In the simulation scenario test, the SBS group outperformed the VBT group in both technical (33.5 (31.0-36.0) vs 28.0 (26.0-30.0), p<0.001) and non-technical skills (47.5 (44.0-51.0) vs 43.0 (42.0-48.0), p=0.002).
CONCLUSIONS: SBS demonstrates greater efficacy than VBT in improving anaesthesia students’ learning outcomes, including technical and non-technical skills in managing perioperative anaphylaxis, with higher student satisfaction.
PMID:42601170 | DOI:10.1136/bmjoq-2025-003713
BMJ Open Respir Res. 2026 Aug 14;13(1):e004013. doi: 10.1136/bmjresp-2025-004013.
ABSTRACT
BACKGROUND: Timely diagnosis is critical for improving lung cancer outcomes, yet diagnostic pathways in England remain complex and variable. Real-world evidence examining imaging use, delays and emergency care during the diagnostic interval is limited.
METHODS: We conducted a national retrospective cohort study using linked Hospital Episode Statistics and Diagnostic Imaging Dataset for adults newly diagnosed with lung cancer between April 2018 and March 2019. Diagnostic intervals were defined from first chest imaging to diagnosis. We assessed imaging utilisation, diagnostic pathways and A&E attendance, with subgroup analyses by ethnicity, deprivation and diagnostic interval.
RESULTS: Among 21 052 patients, the median diagnostic interval was 56 days: 25% experienced intervals ≥113 days. Patients underwent a median of three chest scans, and 25% received four or more. Multimodality imaging was strongly associated with prolonged intervals. One-third of patients attended A&E during the diagnostic pathway, rising to 45% among those with the longest intervals. Asian patients experienced the longest diagnostic intervals (median: 67 days). Patterns were consistent across deprivation quintiles, with diagnostic intervals and high A&E attendance observed across all strata, indicating systemic gaps in coordinated diagnostic pathways.
CONCLUSION: A substantial proportion of patients with lung cancer in England experience prolonged diagnostic intervals, often accompanied by high emergency care utilisation. Prolonged diagnostic intervals may reflect underlying differences in patient pathways. Multimodality imaging was associated with longer diagnostic timelines, which could represent clinical complexity, diagnostic challenges or possibly fragmentation of diagnostic pathways. These findings highlight the need for streamlined imaging processes, timely follow-up after initial chest imaging and stronger primary care engagement to support earlier diagnosis and alignment with the National Optimal Lung Cancer Pathway.
PMID:42601167 | DOI:10.1136/bmjresp-2025-004013
JMIR Med Educ. 2026 Aug 14;12:e94122. doi: 10.2196/94122.
ABSTRACT
BACKGROUND: Virtual reality (VR) offers immersive learning opportunities in health professions education, yet its effects on learner experience and short-term learning outcomes in education on execution of musculoskeletal special tests remain underexplored.
OBJECTIVE: This randomized controlled trial evaluated the effects of an immersive 180° video-based VR instruction, compared with conventional 2D video-based instruction, on undergraduate physical therapy students’ learning satisfaction, technology acceptance, learning motivation, and quiz-based learning achievement, reflecting short-term procedural knowledge.
METHODS: Undergraduate physical therapy students were randomly assigned to either the immersive 180° video-based VR instruction group (VR group) or the conventional 2D video-based instruction group (control group). Both groups received identical instructional content on 4 musculoskeletal special tests (pronator teres, Hawkins-Kennedy, Yergason, and Neer tests). The VR group participated in an immersive 180° video-based instructional module delivered via a head-mounted display, whereas the control group viewed the same content on a standard monitor. Participants completed 4 instructional sessions within a single day, each lasting approximately 3 to 4 minutes. The primary outcome was learning satisfaction. Secondary outcomes were technology acceptance, learning motivation, and quiz-based learning achievement. These outcomes were assessed before and after the intervention using validated questionnaires and a 12-item quiz. Between-group posttest differences were primarily analyzed using analysis of covariance (ANCOVA) with pretest scores as covariates. Supplementary within-group and unadjusted between-group analyses were also performed.
RESULTS: Fifty-two students were randomly assigned to receive either immersive 180° video-based VR instruction (VR group; n=28) or conventional 2D video-based instruction (control group; n=24) on 4 musculoskeletal special tests, with all 4 instructional sessions completed within a single day. After adjustment for baseline scores, the VR group showed significantly higher learning satisfaction (adjusted mean 107.04 vs 93.28; F1,49=13.710; P=.001; ηp2=0.219) and technology acceptance (adjusted mean 74.44 vs 68.03; F1,49=4.402; P=.04; ηp2=0.082) than the control group. Adjusted between-group differences were not significant for quiz-based learning achievement (F1,49=1.175; P=.28). For learning motivation, the homogeneity of regression slopes assumption was violated; therefore, the adjusted estimate was interpreted descriptively and did not indicate a clear between-group advantage (F1,48=1.729; P=.20).
CONCLUSIONS: Compared with conventional 2D video-based instruction, immersive 180° video-based VR instruction showed a clear advantage in learning satisfaction, while technology acceptance also favored the VR group in exploratory secondary analysis, among undergraduate physical therapy students. Findings for learning motivation and quiz-based learning achievement were less conclusive. These results support immersive video as a supplementary educational approach rather than as evidence of superior psychomotor skills training.
PMID:42600147 | DOI:10.2196/94122
JMIR Nurs. 2026 Aug 14;9:e98624. doi: 10.2196/98624.
ABSTRACT
BACKGROUND: Health care professionals are exposed to high levels of occupational stress, emotional exhaustion, and anxiety-depressive symptoms. Digital interventions using mindfulness- and acceptance-based approaches have shown promising results in improving psychological well-being in this population. The MINDxYOU program is a self-guided digital intervention designed to reduce perceived stress and enhance emotional regulation, resilience, and psychological flexibility. Although its effectiveness has been demonstrated, treatment response may vary substantially between individuals.
OBJECTIVE: The aims of this study are to explore the sociodemographic, occupational, and psychological moderators of the effectiveness of the digital MINDxYOU program on perceived stress among health care professionals and to identify differential response profiles.
METHODS: This study is a secondary analysis of a stepped-wedge cluster randomized trial including 347 health care professionals from 6 clusters allocated to 3 intervention start sequences. The intervention (MINDxYOU) is a self-guided, web-based program designed to be completed over 8 weeks, grounded in third-wave psychological approaches and incorporating mindfulness-, compassion-, and acceptance-based components. Weekly support was provided via WhatsApp Messenger (Meta Platforms Inc), phone calls, or email to promote adherence. Assessments were conducted every 8 weeks across 5 measurement waves. Linear mixed-effects models were used to evaluate moderation effects by testing condition × moderator interactions, accounting for repeated measures within participants and clustering effects.
RESULTS: Moderation analyses showed greater reductions in perceived stress among participants with higher baseline depressive symptom scores (9-item Patient Health Questionnaire [PHQ-9]; B=-0.22, SE 0.08; P=.004) and those with higher scores in the observing facet of mindfulness (15-item Five Facet Mindfulness Questionnaire [FFMQ-15]; B=-0.86, SE 0.41; P=.04). In addition, nursing staff exhibited greater reductions in perceived stress compared with physicians (B=1.92, SE 0.81; P=.02) and other health care professionals (B=1.80, SE 0.90; P=.04).
CONCLUSIONS: The results suggest that baseline psychological and occupational characteristics may contribute to differences in the effectiveness of the MINDxYOU program in reducing perceived stress. These findings provide preliminary evidence regarding potential response profiles in digital mental health interventions and support the development of more personalized and targeted approaches to stress management in health care settings.
PMID:42600138 | DOI:10.2196/98624
Artif Life. 2026 Aug 12:1-14. doi: 10.1162/ARTL.a.474. Online ahead of print.
ABSTRACT
Living systems must preserve organization while their components relax, diffuse, or fluctuate. Most origin-of-life accounts place this problem in space, emphasizing membranes and compartments, but persistence also has a temporal dimension. Here we ask whether a dissipative system with delayed feedback can retain statistically meaningful dependence on its own past without an explicit clock or dedicated memory variable. We studied a minimal stochastic delay equation with inhibitory delayed feedback and quantified temporal self-retention by comparing autocorrelation decay time with the intrinsic dissipative timescale. The index crossed unity at τ ≈ 1.918 and remained above unity up to τ = 30.0 under the default parameters. The transition occurred across feedback strengths β = 1.0-3.5, collapsed under nondimensional γτ scaling when β/γ and σ/√γ were fixed, and was distinct from the analytical Hopf boundary. Delay dispersion did not abolish the near-threshold regime, whereas high noise shifted it slightly below unity. Mutual information confirmed persistent dependence between present and delayed states in the long-delay regime. These results identify a minimal delay-dissipative regime in which temporal organization persists beyond dissipation alone, providing a proof of concept for temporal self-retention in artificial-life systems.
PMID:42600121 | DOI:10.1162/ARTL.a.474