Tag: nevin manimala

Am J Public Health. 2026 Jul 2:e1-e8. doi: 10.2105/AJPH.2026.308488. Online ahead of print.

ABSTRACT

Objectives. To evaluate site-specific testing and isolation procedures for preventing on-site SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infections among unaccompanied migrant children in federal congregate care settings. Methods. From August 2021 to May 2023, the Increasing Community Access to Testing, Treatment, and Response (ICATT) program administered 385 234 rapid antigen and nucleic acid amplification tests to 68 674 children at 2 emergency intake sites in Texas. We used logistic regression, the χ² test, and Kaplan-Meier survival analysis to estimate the number of infections acquired on-site and the number of cases prevented via implementation of ICATT comprehensive testing and isolation protocols. Results. ICATT protocols identified 83% of cases at intake, and our analyses projected that 92% of cases were isolated before on-site transmission could occur. Testing and isolation measures prevented an estimated 1335 to 2377 on-site infections, reducing caseloads by 15% to 23% and transmission by 68% to 79%. Conclusions. Site-specific, algorithmic testing and isolation protocols substantially reduced SARS-CoV-2 transmission among children in federal congregate care settings. Public Health Implications. Enhanced testing and isolation strategies should be considered to mitigate within-facility transmission among temporary residents in congregate care settings. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308488).

PMID:42391588 | DOI:10.2105/AJPH.2026.308488

J Gerontol Nurs. 2026 Jul;52(7):7-11. doi: 10.3928/00989134-20260608-03. Epub 2026 Jul 1.

ABSTRACT

PURPOSE: To examine the readability and linguistic characteristics of Alzheimer’s disease and related dementias (ADRD) prevention, symptom, and treatment information from generative artificial intelligence (GenAI) chatbots.

METHOD: We analyzed 66 outputs from free-to-use GenAI chatbots. We extracted readability (word count, Fleisch Reading Ease, and Fleisch-Kincaid Grade Level) and linguistic scores (analytical thinking, clout, authenticity, and emotional tone) using Microsoft Word and the Linguistic Inquiry and Word Count software. Data were analyzed using descriptive statistics, t tests, analysis of variance, and multivariate analysis of variance.

RESULTS: ADRD information from GenAI chatbots, especially treatment information, had college-level readability. Linguistic analyses indicate a high analytical thinking score and low scores for clout, authenticity, and emotional tone.

CONCLUSION: Our sample of ADRD GenAI information exceeded recommended reading levels for patient education materials. Although the outputs exhibited logical thinking, they also included uncertain, inauthentic, and negative tones. ADRD caregivers should be aware of these characteristics when using GenAI chatbots for ADRD information-seeking.

PMID:42391577 | DOI:10.3928/00989134-20260608-03

Age Ageing. 2026 Jul 2;55(7):afag198. doi: 10.1093/ageing/afag198.

ABSTRACT

AIM: This study aimed to explore the prevalence of these overlapping premorbid geriatric conditions and examine the association between the number of these conditions and the risk of mortality and major cardiovascular events within 1 year after acute stroke.

METHODS: In this single-centre prospective cohort study, consecutive stroke patients admitted between November 2020 and September 2024 were enrolled. Premorbid frailty was assessed using the 33-item Rockwood Frailty Index. Multimorbidity was defined as the presence of two or more chronic comorbidities other than stroke. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria. Patients were categorised according to the number of overlapping conditions (NOCs), ranging from 0 to 3. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events within 1 year after admission. Cox proportional hazards regression models adjusted for potential confounders were used to estimate adjusted hazard ratios.

RESULTS: Among 781 patients (mean age 77.9 ± 12.6 years; 390 [49.9%] female), 226 patients (28.9%) were NOC 0, 289 (37.0%) were NOC 1, 161 (20.6%) were NOC 2 and 105 (13.4%) were NOC 3. Compared with NOC 0, the adjusted hazard ratios for the composite outcome were 1.52 (95% CI 0.86-2.68) for NOC 1, 2.64 (95% CI 1.44-4.85) for NOC 2 and 5.20 (95% CI 2.77-9.73) for NOC 3.

CONCLUSIONS: One-third of patients with acute stroke had overlapping premorbid geriatric conditions. The NOCs was significantly associated with a composite event in a dose-response manner.

PMID:42391556 | DOI:10.1093/ageing/afag198

Traffic Inj Prev. 2026 Jul 2:1-11. doi: 10.1080/15389588.2026.2688905. Online ahead of print.

ABSTRACT

OBJECTIVES: Motorcyclists face high risk of severe and long-term injuries, yet the use of personal protective equipment (PPE) beyond helmets remains inconsistent across European cities. This study examined determinants of motorcycle PPE use to understand barriers and enablers influencing protective behavior.

METHODS: A cross-sectional survey was conducted in five European cities (Athens, Barcelona, Copenhagen, London, and Rome). Data were collected through an online questionnaire designed using the COM-B model of behavior (Capability, Opportunity, Motivation). The survey examined ownership and use of multiple motorcycle PPE types beyond helmets (protective jackets and leg protection). Additional measures captured riding context (e.g., urban/non-urban riding, trip purpose, and riding frequency), perceived barriers to PPE, and social norms. Statistical analyses examined associations between PPE use and behavioral determinants across the COM-B domains. Awareness and interest in innovative PPE were also analyzed.

RESULTS: Among the 905 respondents, helmet ownership and use were high, whereas ownership and use of non-mandatory PPE such as jackets and leg protection were lower. A gap emerged between access to PPE and consistent use, particularly for jackets and leg protection. Multivariable analyses showed that physical opportunity factors played a central role in PPE use: riders reporting greater comfort when wearing protective equipment and greater convenience in carrying it had significantly higher odds of consistent use. Among riders who did not always wear PPE, the most frequently reported barriers were heat, discomfort, and inconvenience when not riding. Reflective motivation also influenced behavior. Although most riders recognized the protective value of jackets and leg protection, many reported that such equipment is less necessary for short journeys or urban riding, indicating context-dependent risk perceptions. Social opportunity factors were also present: perceptions that other riders commonly use non-mandatory PPE were relatively low. Respondents also showed interest in innovative PPE, particularly upper-body protection, although affordability, comfort, and usability were identified as key considerations for adoption.

CONCLUSIONS: Among riders participating in the study, PPE use is shaped by interacting opportunity-, and motivation-related factors, with practical barriers such as heat, discomfort, and inconvenience playing a central role in limiting consistent use of non-mandatory equipment. The findings also highlight the importance of context-specific risk perceptions, as many riders consider PPE less necessary for short or urban trips, and of social influences linked to the perceived behavior of other riders. Improving PPE adoption requires behaviorally informed strategies addressing usability and comfort of protective equipment, strengthening risk communication in everyday riding contexts, and promoting social normalization of PPE use. Interest in innovative PPE concepts suggests opportunities for further uptake, prioritizing affordability, comfort, and ease of use alongside protection.

PMID:42391532 | DOI:10.1080/15389588.2026.2688905

Traffic Inj Prev. 2026 Jul 2:1-11. doi: 10.1080/15389588.2026.2688459. Online ahead of print.

ABSTRACT

OBJECTIVE: Crest vertical curves are frequently employed in long mountainous freeway tunnels to facilitate drainage and ventilation, yet the mechanisms by which specific grades and grade changes within these curves influence driving behavior and traffic safety at tunnel portals remain insufficiently understood. This study aims to explore the effects of crest vertical grade designs, specifically entrance grades, exit grades, and grade changes, on driving behavior at the portals of long mountainous freeway tunnels.

METHODS: Based on a survey of alignment design indicators of over 100 tunnels in Guangdong Province, this study identified that most long tunnels adopt a crest vertical grade design and their typical alignment indicators. Based on the investigation, a 26-km-long freeway model comprising 10 tunnels with distinct vertical profile was constructed. Subsequently, a driving simulation experiment was conducted with 32 recruited participants. Driving behavior data were collected within 100-meter zones inside and outside each portal. Eight key behavioral indicators, including mean and standard deviation of speed, time headway, lane departure, and acceleration, were extracted. Repeated-measures one-way analysis of variance (ANOVA) was then used to identify significant differences across various design conditions. Subsequently, indicators exhibiting statistical significance were integrated into a Fuzzy Comprehensive Evaluation (FCE) model, combining with entropy weight methods to objectively quantify the overall safety performance of each design scheme.

RESULTS: ANOVA results indicated that five specific indicators showed significant variations under different grade designs: mean and standard deviation of speed, mean and standard deviation of time headway, and mean acceleration. Lane departure and standard deviation of acceleration were not significantly affected by grade designs. The Fuzzy Comprehensive Evaluation revealed distinct optimal conditions for portal safety. At tunnel entrances, uphill grades yielded significantly higher safety scores compared to flat or downhill sections, with the 1.5% uphill grade achieving the highest comprehensive score. Conversely, flat (0%) entrances resulted in the lowest safety ratings. At tunnel exits, safety scores generally decreased as the exit grade became less steep; the 1.5% exit grade produced the optimal safety outcome. Regarding internal grade changes, a moderate change of 3% resulted in the highest safety scores, whereas larger changes led to increased speed dispersion and reduced time headways, lowering the overall safety evaluation.

CONCLUSIONS: This study confirms that vertical alignment design critically influences driver performance and safety at portals of long tunnels. These findings provide quantitative guidance for updating freeway tunnel design specifications, recommending that designers prioritize uphill approaches and moderate grade transitions. Furthermore, the results offer a scientific basis for traffic authorities to implement targeted safety management measures, thereby mitigating crash risks in critical tunnel portal zones.

PMID:42391531 | DOI:10.1080/15389588.2026.2688459

Mol Biol Evol. 2026 Jul 2:msag157. doi: 10.1093/molbev/msag157. Online ahead of print.

ABSTRACT

Reconstructing ancient population size history is essential for understanding the evolutionary origin of Homo sapiens. We recently developed the fast infinitesimal time coalescent process (FitCoal) and detected a severe population bottleneck occurring approximately 930 thousand years ago. However, two recent studies compared FitCoal and mushi and concluded that the severe bottleneck is a statistical artifact. In this study, we compared the two methods against a benchmark of ten billion msprime coalescent simulations. We demonstrate that FitCoal achieves both superior speed and accuracy in expected site frequency spectrum (SFS) estimation. Analyses of simulated datasets confirmed that FitCoal reliably recovers the bottleneck, whereas mushi fails under identical conditions. Independent fossil and paleoclimate evidence is consistent with the timing and evolutionary impact of this bottleneck, including associations with hominin dispersals, speciation events, and a subsequent increase in brain size. These findings refine the demographic history of Homo during the Pleistocene and highlight the importance of high-precision SFS computation for revealing critical evolutionary transitions that shaped modern human ancestry.

PMID:42391510 | DOI:10.1093/molbev/msag157

Jpn J Clin Oncol. 2026 Jul 2:hyag102. doi: 10.1093/jjco/hyag102. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with schizophrenia spectrum disorders (SSD) experience higher cancer mortality, partly because of later-stage diagnosis and lower rates of recommended treatments. While treatment disparities have been reported across several cancer types, no study has specifically examined stage-appropriate treatment for gastric cancer among patients with SSD.

METHODS: We conducted a retrospective cohort study using a nationwide Hospital-Based Cancer Registry linked to administrative data in Japan. Patients who received initial treatment for gastric cancer between 2018 and 2021 were included. Multivariable logistic regression models examined the association between SSD and the receipt of stage-appropriate cancer treatments, adjusting for age, sex, clinical stage, Charlson Comorbidity Index, and Barthel Index.

RESULTS: Among 189 447 patients from 709 hospitals, 1312 had SSD. Patients with SSD were more likely to be diagnosed at advanced stages. In crude analysis, SSD was associated with lower rates of surgical or endoscopic treatment; however, this association was not statistically significant after adjustment (adjusted odds ratio [aOR], 0.90; 95% confidence interval [CI], 0.75-1.08). In contrast, SSD was independently associated with lower rates of postoperative adjuvant chemotherapy for pathological stage II/III disease (aOR, 0.64; 95% CI, 0.45-0.91) and systemic therapy for stage IV disease (aOR, 0.36; 95% CI, 0.28-0.47).

CONCLUSIONS: Among patients with gastric cancer, SSD was associated with reduced receipt of systemic therapy but not surgical or endoscopic treatment. Efforts to improve early detection among patients with SSD may be important for reducing treatment disparities, alongside strengthened support for systemic therapy to ensure equitable access to guideline-recommended gastric cancer care.

PMID:42391504 | DOI:10.1093/jjco/hyag102

JMIR Nurs. 2026 Jul 2;9:e94450. doi: 10.2196/94450.

ABSTRACT

BACKGROUND: Inequitable and time-consuming shift scheduling contributes to nurse burnout, dissatisfaction, and turnover. In Taiwan, annual nurse turnover reaches 11.6%, with rigid 3-shift systems and unfair workload distribution frequently cited as key drivers. Although artificial intelligence (AI) scheduling tools exist, most lack transparency and do not formally address algorithmic bias, limiting clinical adoption.

OBJECTIVE: This study aimed to design, deploy, and evaluate a transparent, fairness-audited, explainable AI-enabled nurse scheduling decision support system (XAI-NSDSS) to reduce administrative burden, eliminate experience-based algorithmic bias, and enhance staff acceptance in a real-world hospital setting.

METHODS: A pragmatic before-after implementation study was conducted at a 671-bed teaching hospital in Taiwan (January-December 2023), involving 8 departments and 156 nurses (42 novice, 78 midlevel, and 36 experienced). A 6-month manual scheduling baseline (January-June 2023) was compared with a 6-month AI-assisted period (July-December 2023). The XAI-NSDSS integrates a random forest workload prediction model (R²=0.887), Shapley Additive Explanations-based explainability, a hybrid integer programming and binary differential evolution (IP+ BDE) optimizer, and a multidimensional fairness monitoring dashboard. A formal weight sensitivity analysis (WSA) was conducted across 7 prespecified weight configurations using full-factorial repeated-measures ANOVA to assess outcome robustness. Primary outcomes were scheduling time, error rate, and user satisfaction. Statistical analyses used linear mixed effects models (LMMs) and generalized estimating equations (GEE) with department as a random effect.

RESULTS: Monthly scheduling time decreased by 81.2% (mean 32.0, SD 8.0-mean 6.0, SD 2.0) hours; P<.001; Cohen d=4.33) and error rate decreased by 73.8% (mean 18.3, SD 4.3%-mean 4.8, SD 1.2%; P<.001; Cohen d=4.12). Nurse satisfaction improved from a mean of 3.2 (SD 0.8) to a mean of 4.4 (SD 0.6; P<.001), with 148 out of 156 nurses (94.9%) adopting the system by Month 3. Preexisting experience-based bias was fully eliminated: workload coefficient of variation (CV) decreased 50% (0.18-0.09; P<.001), disparate impact ratios normalized from 1.35-1.56 to 1.01-1.04, and preference satisfaction equity was achieved across experience tiers (ANOVA P=.38). Among 156 nurses, 82 (52.6%) regularly engaged with Shapley Additive Explanations; this engagement was positively associated with satisfaction (Pearson r=0.456; P<.001). The WSA across 7 configurations confirmed that the consensus-derived default weights achieved the highest composite quality score (mean 82.1, SD 3.2) and that disparate impact ratios remained within the 0.80-1.25 fairness threshold across all configurations (P=.12), demonstrating structural robustness of the fairness-auditing module.

CONCLUSIONS: This study presents the first longitudinally validated explainable AI implementation framework for nurse scheduling with formal algorithmic fairness auditing and WSA. The XAI-NSDSS framework is replicable, scalable, and provides a practical blueprint for responsible AI adoption in health care workforce governance, with fairness guarantees that are robust to institutional customization of optimization priorities.

PMID:42391503 | DOI:10.2196/94450

Int Braz J Urol. 2026 Sep-Oct;52(5):e20260166. doi: 10.1590/S1677-5538.IBJU.2026.0166.

ABSTRACT

PURPOSE: To critically evaluate the clinical presentation, imaging performance and surgical findings of malleable penile prosthesis (MPP) fractures in a high-volume tertiary center.

MATERIALS AND METHODS: Medical reports of men who underwent revision surgery with intraoperative confirmation of MPP fracture between January 2008 and January 2025 were reviewed. MPP from a single manufacturer (Promedon®, Cordoba, Argentina) were inserted, and no comparisons were possible. Demographic data, presenting symptoms, imaging findings, and fracture location were analyzed. Diagnostic performance of physical examination and imaging modalities was descriptively compared.

RESULTS: Among 741 penile prosthetic procedures, 98 were revisions and 52 (53.1%) were due to MPP fracture. Median time from implantation to fracture was 59 months (IQR 24.8-84.0). Penile instability was the most common symptom (96.1%), while pain was reported in 21.1%. Physical examination correctly identified fractures in 88.5% of cases, outperforming radiography and magnetic resonance imaging. Bilateral fractures occurred in 51.9% of revisions, most commonly in the proximal segment. Recurrent fractures occurred in 28.2% of patients.

CONCLUSIONS: MPP fractures are more prevalent than expected and a clinically relevant complication in high-volume centers. Diagnosis relies primarily on clinical assessment, with physical examination outperforming imaging modalities. Increased awareness of typical presentation patterns may support earlier recognition and more efficient management. Prospective studies are needed to identify modifiable risk factors, improve device design and quality, and advise patients on use to potentially improve prosthesis lifetime.

PMID:42391489 | DOI:10.1590/S1677-5538.IBJU.2026.0166

Prostate. 2026 Jul 2. doi: 10.1002/pros.70209. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to investigate the effects of holmium laser enucleation of the prostate (HoLEP) with proactive preservation of one lateral lobe (PLL-HoLEP) on urinary function and sexual function in patients with benign prostatic hyperplasia (BPH).

METHODS: From April 2024 to April 2025, 71 patients who underwent PLL-HoLEP (Group A) were studied based on inclusion and exclusion criteria. Meanwhile, 140 patients who underwent traditional HoLEP from September 2022 to March 2024 were selected as the control group (Group B). After propensity score matching (PSM) was performed, the baseline characteristics of the two groups were balanced. Subsequently, differences in clinical outcomes between the groups were compared. We compared preoperative and postoperative complications, international prostate symptom score (IPSS), quality of life (QoL), maximum urine flow rate (Q_max), postvoid residual urine (PVR), International Index of Erectile Function (IIEF-5), QMSHQ EjF, and QMSHQ EjS between the two groups, and conducted follow-up evaluations of surgical outcomes and sexual function.

RESULTS: Fifty-four pairs of patients were successfully matched by PSM. Operative time, resected prostate weight, hemoglobin decrease, and incidence of transient incontinence and retrograde ejaculation in Group A were lower than those in Group B. There were significant differences in IPSS, QoL, Q_max, and PVR between preoperative and 1 month postoperative periods in two groups (p < 0.05). However, there were no statistically significant differences in IPSS, QoL, Q_max, and PVR between the two groups at one and 6 months postoperatively (p > 0.05). Significant differences in IIEF-5, QMSHQ EjF, and QMSHQ EjS scores were observed between the two groups during the 6-month postoperative follow-up of sexual function (p < 0.05), with Group A showing better outcomes.

CONCLUSION: For patients who satisfy the inclusion and exclusion criteria, PLL-HoLEP can reduce the incidence of transient urinary incontinence and retrograde ejaculation and more effectively preserve the sexual function of patients with BPH.

PMID:42391476 | DOI:10.1002/pros.70209