Tag: nevin manimala

Proc Natl Acad Sci U S A. 2026 Sep 8;123(36):e2600906123. doi: 10.1073/pnas.2600906123. Epub 2026 Aug 31.

ABSTRACT

Cousin marriage, practiced by over 10% of the world’s population, restructures kinship networks by overlapping blood and affinal ties. Theory makes competing predictions about how such kin density shapes intrahousehold conflict. “Protection” accounts posit that consanguinity aligns spouses’ interests and increases kin oversight, reducing men’s incentives and opportunities to use coercion. “Constraint” accounts, by contrast, emphasize that dense kin networks can prioritize family cohesion over women’s autonomy, potentially suppressing help-seeking and facilitating control. Here, I adjudicate between these hypotheses using data on ~36 to 46,000 women from Egypt, Jordan, Pakistan, and Türkiye. Using cluster-fixed-effects models that compare women within the same Demographic and Health Survey primary sampling units and survey waves, I find that marriage to a first cousin is associated with a 2.5 percentage-point lower probability of physical intimate partner violence relative to nonconsanguineous unions (≈11% lower relative risk). Parallel reductions are observed for coercive controlling behaviors and estimates are robust to matching on observed confounders. The protective association for physical violence is stronger for patrilateral than matrilateral cousins, consistent with protection depending on kin with recognized authority over men in patrilineal systems rather than generic relatedness. In Türkiye, the association persists after adjusting for both spouses’ parental consanguinity, suggesting that it is not explained solely by family-level characteristics associated with the intergenerational practice of cousin marriage. These findings indicate that, in these settings, consanguinity is associated with lower reported violence and control.

PMID:42673449 | DOI:10.1073/pnas.2600906123

J Craniofac Surg. 2026 Aug 31. doi: 10.1097/SCS.0000000000013332. Online ahead of print.

ABSTRACT

BACKGROUND: Frontofacial monobloc advancement (FFMBA) carries a well-recognized risk of postoperative infection owing to the communication created between the nasal cavity and the anterior cranial base. Risk factors specific to this procedure have not been systematically characterized. This exploratory study aimed to examine preoperative factors associated with infection following FFMBA.

METHODS: We retrospectively reviewed 26 consecutive patients who underwent FFMBA at a single craniofacial center between 2015 and 2025. Six prespecified candidate variables were examined in univariable analyses: sex, operative time, intraoperative blood loss, tracheotomy, ventriculoperitoneal (VP) shunt, and institution of first cranial vault surgery. Categorical variables were compared using Fisher’s exact test and continuous variables using the Mann-Whitney U test.

RESULTS: Postoperative infection occurred in 6 of 26 patients (23.1%). Time to infection ranged from 1 day to 4 years, with 5 cases within 1 month and 1 late case at 4 years in a VP-shunted patient, consistent with shunt-associated peritonitis. VP shunt status was the only variable showing a statistically significant association with postoperative infection (OR 45.00, 95% CI 3.35-604.02; P = 0.002): 5 of 7 VP-shunted patients (71.4%) developed infection compared with one of 19 non-shunted patients (5.3%). All 7 VP-shunted patients had received their VP shunt at another institution before referral. No other candidate variable reached nominal statistical significance.

CONCLUSIONS: In this exploratory series, VP shunt status was the only variable showing a statistically significant association with postoperative infection following FFMBA. The estimate was highly imprecise, and the finding should be regarded as hypothesis-generating. The proposed mechanism-persistent extradural dead space related to impaired brain expansion after advancement-remains speculative and requires prospective evaluation. Because all shunts had been placed elsewhere before referral, residual confounding related to referral patterns and treatment sequencing cannot be excluded. These findings support multidisciplinary planning and long-term surveillance in VP-shunted patients undergoing FFMBA.

PMID:42673442 | DOI:10.1097/SCS.0000000000013332

J Physiol. 2026 Aug 31. doi: 10.1113/JP291647. Online ahead of print.

ABSTRACT

Ventilatory long-term facilitation (LTF) is a persistent increase in minute ventilation ( V ̇ I ) elicited by acute intermittent hypoxia (AIH) that outlasts the stimulus duration. In humans, AIH-induced ventilatory LTF is dependent upon a sustained background of mild hypercapnia. It is not known whether changes in CO₂ chemoreflex sensitivity contribute to ventilatory LTF. We hypothesised that hypercapnic AIH increases the sensitivity of peripheral, but not central, chemoreflex responses to CO₂. Twenty healthy adults (age = 25 ± 4 years) completed the study. On days 1 and 2, pulmonary function testing and three hyperoxic modified CO₂ rebreathing tests were performed to determine baseline central CO₂ chemoreflex sensitivity. On days 3 and 4, participants were randomly assigned to hypercapnic AIH or mild hypercapnia alone. On day 5, 16 participants returned to the laboratory to complete a time-matched control (CTRL). Two CO₂ rebreathing tests were performed approximately 45 and 75 min post-trial. Transient CO₂ tests were used to quantify peripheral CO₂ chemoreflex sensitivity pre- and post-trial. Twenty minutes after hypercapnic AIH, V ̇ I was increased 32 ± 22% versus baseline, which was significantly greater than CTRL (P < 0.001), demonstrating the presence of ventilatory LTF. Central CO₂ chemoreflex sensitivity (P = 0.880) and the ventilatory recruitment threshold (P = 0.425) were unchanged after all trials. Peripheral CO₂ chemoreflex sensitivity was increased 41 ± 46% after hypercapnic AIH, which was significantly greater than CTRL (P < 0.001). We conclude that enhanced peripheral CO₂ chemoreflex sensitivity contributes to ventilatory LTF induced by hypercapnic AIH in awake humans. KEY POINTS: In awake humans, induction of ventilatory long-term facilitation (LTF) by acute intermittent hypoxia (AIH) requires a continuous background of mild hypercapnia; thus, ventilatory LTF may arise from increases in central and/or peripheral CO₂ chemoreflex sensitivities. Central and peripheral CO₂ chemoreflex sensitivity were assessed by modified hyperoxic CO₂ rebreathing and transient CO₂ tests, respectively, before and after hypercapnic AIH, sustained hypercapnia, and a time-matched control on separate days in 20 healthy young adults. Peripheral CO₂ chemoreflex sensitivity was increased 41 ± 46% after hypercapnic AIH but no statistically significant changes were found in central CO₂ chemoreflex sensitivity. These data indicate plasticity in the peripheral CO₂ chemoreflex after exposure to hypercapnic AIH that contributes to ventilatory LTF in a background of mild hypercapnia.

PMID:42673352 | DOI:10.1113/JP291647

Eur Stroke J. 2026 Aug 5;11(8):aakag102. doi: 10.1093/esj/aakag102.

ABSTRACT

INTRODUCTION: Procedural sedation during EVT for acute ischaemic stroke is widely used, but factors associated with analgosedative drug requirements remain poorly characterised. We aimed to identify patient and procedural factors associated with analgosedative drug requirements during EVT and explore their association with clinical outcomes.

PATIENTS AND METHODS: We performed a post hoc analysis of the randomised INDIVIDUATE trial, including patients with anterior circulation ischaemic stroke undergoing EVT under procedural sedation. Sedation exposure was quantified using mean propofol, remifentanil and esketamine dose rates derived from protocolised 5-min medication records. Multivariable linear regression analyses were used to identify factors associated with sedation requirements. Sensitivity analyses were performed using body weight-normalised dose rates in patients with available body weight data. Exploratory analyses assessed associations between sedation requirements and procedural and clinical outcomes.

RESULTS: Of 250 patients enrolled in the INDIVIDUATE trial, 239 were included. In multivariable analyses, male sex was associated with higher propofol and esketamine dose rates; however, after body weight-normalisation, the association with propofol was no longer statistically significant. In weight-normalised sensitivity analyses including 198 patients (82.8%), male sex, ICA + M2 occlusion compared with M1 occlusion and pre-stroke disability remained associated with higher weight-normalised esketamine dose rates (β = 2.39 μg/kg/min, P = .021; β = 13.56 μg/kg/min, P < .001; and β = 2.82 μg/kg/min, P = .028, respectively). Additionally, the number of thrombectomy attempts was associated with higher remifentanil dose rates (β = 0.56 ng/kg/min, P = .010). Higher body weight-normalised esketamine dose rates were associated with less favourable NIHSS change at 24 h (β = 0.17, P = .022). Sedation requirements were not associated with 3-month functional outcome or mortality.

CONCLUSION: Sedation requirements during EVT appeared to vary according to patient- and procedure-related factors, including sex, occlusion pattern, pre-stroke disability and procedural complexity. Sedation intensity was not associated with long-term clinical outcomes, supporting the use of adequate procedural sedation when clinically indicated.

CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov; NCT04578288.

PMID:42673143 | DOI:10.1093/esj/aakag102

Nutr Rev. 2026 Aug 31:nuag124. doi: 10.1093/nutrit/nuag124. Online ahead of print.

ABSTRACT

CONTEXT: The global increase in diabetes incidence has been linked to dietary transitions away from traditional coarse grains. Millets-sorghum, finger millet, and pearl millet-are nutrient-dense, climate-resilient crops with fiber, minerals, and phytochemicals that may improve glycemic control. Their sustainability and nutritional profile make them promising candidates for diabetes management.

OBJECTIVE: To systematically review and meta-analyze the effect of sorghum, finger millet, and pearl millet on diabetes management using outcome indicators such as fasting blood glucose, postprandial glucose, HbA1c, and insulin index.

DATA SOURCES: A comprehensive search was conducted of the PubMed, Scopus, Embase, ScienceDirect, and ClinicalTrials.gov databases from inception to April 2025.

DATA EXTRACTION: Two reviewers independently extracted study details, including design, participant characteristics, intervention type, control foods, and outcomes. Mean and SD values for fasting, postprandial glucose, HbA1c, and incremental area under the curve (iAUC) were recorded. Where unavailable, values were calculated using standard formulas. Study quality was assessed using the Cochrane Risk-of-Bias 2 tool.

DATA ANALYSIS: Of 36 283 records identified, 20 studies met the inclusion criteria for the review and 11 for meta-analysis. Effect sizes (Cohen’s d) were pooled using a random-effects model with millet-type subgroup analysis in SPSS Statistics; publication bias was assessed with funnel plots and Egger’s test. Millet intake significantly reduced postprandial glucose iAUC (d = -2.10, P < .001), with the greatest effect being found for finger millet (d = -4.77); pearl millet also showed a significant reduction, but sorghum did not. Long-term millet intake improved fasting blood glucose levels (d = 1.05, P = .02), and 1 study reported reduced HbA1c in 75% of participants after 3 months.

CONCLUSIONS: Millet intake improved short-term indicators of blood sugar, such as postprandial glucose, and long-term indicators, namely, fasting and HbA1c. More studies are needed to confirm long-term effects. Policies supporting millet cultivation and accessibility, alongside community education on simple millet preparations, may help translate benefits into practice.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. CRD42024557062.

PMID:42672549 | DOI:10.1093/nutrit/nuag124

Ultrasound Obstet Gynecol. 2026 Sep;68 Suppl 1:35. doi: 10.1002/uog.70305_84.

NO ABSTRACT

PMID:42672434 | DOI:10.1002/uog.70305_84

Ultrasound Obstet Gynecol. 2026 Sep;68 Suppl 1:346. doi: 10.1002/uog.70305_998.

NO ABSTRACT

PMID:42672233 | DOI:10.1002/uog.70305_998

Med Educ Online. 2026 Dec 31;31(1):2724652. doi: 10.1080/10872981.2026.2724652. Epub 2026 Aug 31.

ABSTRACT

INTRODUCTION: Disability inclusion in residency is essential to building a diverse and equitable physician workforce. Recent Accreditation Council for Graduate Medical Education requirements mandate that programs maintain formal disability policies and provide reasonable accommodations. However, residents with disabilities continue to face barriers, including stigma, complex documentation processes, and limited institutional infrastructure, challenges that differ from medical school settings. Specialty-specific data are necessary to identify gaps in inclusion, especially given that national data show higher rates of disability among trainees entering pediatrics. This pilot study reports the prevalence and accommodation practices of four pediatric residency programs.

METHODS: In collaboration with the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network, we conducted the first pilot survey examining disability prevalence, disclosure patterns, and accommodation use among pediatric residents. The survey was distributed to four programs between April and October 2024. Data were analyzed descriptively, with Fisher’s exact tests used to examine group differences.

RESULTS: Of the sixty-nine respondents, 36% self-identified as having a disability, more than triple the national average for residents with disabilities. ADHD, chronic health conditions, and psychological disabilities were the most reported. Fear of stigma and lack of documentation issues emerged as barriers to requesting accommodations. First-generation college graduates were significantly more likely to be unsure of their disability status.

DISCUSSION: This pilot study provides preliminary and important insights into disability prevalence, disclosure, disability uncertainty, and accommodation use in pediatric residency programs. While these findings suggest encouraging rates of accommodation receipt among disabled residents, they also highlight stigma and uncertainty around disability identity and disclosure. Findings should be interpreted in the context of the small sample size, the self-selected participation of programs, and potential response bias.

PMID:42672136 | DOI:10.1080/10872981.2026.2724652

PLoS Biol. 2026 Aug 31;24(8):e3003991. doi: 10.1371/journal.pbio.3003991. Online ahead of print.

ABSTRACT

Renewed interest in phage therapy has highlighted a need to understand how bacteria subvert phage infection through antiphage defense systems. Traditionally, strategies to identify antiphage defense systems lack throughput or have limitations for bacterial species where antiphage defense systems are understudied. Herein, we developed a bioinformatic pipeline that uses a small serine recombinase to identify known and unknown antiphage defense systems. Using this approach to query reference genomes and metagenomes, we show that small serine recombinase genes are genetically linked to antiphage defense systems and serve as bait for finding these systems across diverse bacterial phyla. Using co-transcription predictions and statistical analysis of protein domain abundances, we experimentally validated our bioinformatic approach by discovering that KAP P-loop NTPases are fused to putative antiphage domains and reinforce prokaryotic Schlafen proteins as a new class of antiphage defense. Our work shows that small serine recombinases are a reliable genetic marker for the discovery of antiphage defenses across diverse bacterial phyla.

PMID:42672116 | DOI:10.1371/journal.pbio.3003991

PLOS Glob Public Health. 2026 Aug 31;6(8):e0006341. doi: 10.1371/journal.pgph.0006341. eCollection 2026.

ABSTRACT

Family planning (FP) self-care is a strategic pillar for advancing Universal Health Coverage (UHC) and mitigating health workforce shortages. However, a significant disconnect persists between global normative frameworks and local implementation realities. This study examines the local meanings, perceptions, and experiences of FP self-care in Niger to inform contextualized scale-up of self-care interventions. We employed a sequential mixed-methods design in the Niamey (urban) and Zinder (rural) regions of Niger. A quantitative household survey was conducted with 510 women and 357 men to assess fertility awareness, method preferences, and information-seeking behaviors. This was complemented by qualitative in-depth interviews with 36 women, 18 men, 12 healthcare providers, and 15 community leaders. Quantitative data were analyzed using descriptive statistics, while qualitative transcripts underwent iterative thematic analysis mapped to global self-care frameworks. “Self-care” was locally reconstructed not as autonomy. While defined by all participants as hygiene, it was uniquely reconstructed by men and community leaders as economic provision. A distinct “medicalization paradox” emerged: women defined self-care as the agency to seek clinical dependence, prioritizing facility-based providers over community sources (e.g., 58.1% vs. 12.1% for oral contraceptives) to mitigate fears regarding product quality and side effects. Conversely, men favored Community Health Workers (34.3%) driven by logistical efficiency and economic motivations. Physiological knowledge was low; only 11.8% of women correctly identified the fertile window, with misconceptions reinforced by fatalistic narratives propagated by community gatekeepers. Furthermore, providers expressed strong skepticism regarding user competence, fearing “chaos” without medical supervision. Implementing FP self-care in Niger requires shifting from a “product-first” to a “values-first” approach. Strategies must be gender-stratified: leveraging “medicalized validation” to address women’s safety concerns while utilizing community-based channels to meet men’s efficiency needs. Ultimately, self-care should be framed not as independence from the health system, but as an empowered partnership with it.

PMID:42672113 | DOI:10.1371/journal.pgph.0006341