Tag: nevin manimala

Trends Cogn Sci. 2026 Aug 13:S1364-6613(26)00161-0. doi: 10.1016/j.tics.2026.07.003. Online ahead of print.

ABSTRACT

Understanding human decision-making processes in everyday life is a central, yet rarely addressed, challenge in psychology. Either real-life complexity is reduced by isolating specific aspects of decision-making in highly constrained experimental settings, yielding insights into specific cognitive mechanisms under idealized conditions, or decision-making is studied in real-life contexts, using high-level descriptions of behavior that do not afford fine-grained, process-level insights. Bridging this gap poses a challenge of both measurement and inference. Recent advances in high-resolution tracking technologies provide novel solutions to many measurement challenges but are rarely integrated with formal psychological theory. In this article, we review tracking technologies and statistical tools, proposing a cognitive-computational framework that uses high-resolution spatiotemporal data to investigate the mechanisms of real-life decision-making in a theory-driven manner.

PMID:42586903 | DOI:10.1016/j.tics.2026.07.003

Clin Lymphoma Myeloma Leuk. 2026 Jul 18:S2152-2650(26)00214-4. doi: 10.1016/j.clml.2026.07.009. Online ahead of print.

ABSTRACT

BACKGROUND: Chimeric antigen receptor (CAR) T-cell therapies offer substantial survival benefits for relapsed and/or refractory multiple myeloma (RRMM). However, access remains limited across the US. We examined geographic variation in MM burden and key drivers of CAR T access disparities to inform targeted strategies to close these gaps.

PATIENTS AND METHODS: Patients with MM and CAR T recipients from January 2021-August 2024 were identified from the Komodo Patient-Level Analytics and Insights Derivative claims database. MM prevalence at the ZIP-3 level came from the US Cancer Statistics database. Drive-times to the nearest authorized treatment center (ATC) for patients with MM and to ATCs for CAR T recipients were calculated and compared nationally and by region.

RESULTS: There were 106,593 prevalent patients over the study period. The South had the second highest MM burden (66.1/100,000 people) but the lowest proportion of patients within 1 hour of an ATC (55.7%). CAR T recipients in the South also traveled the longest to their ATC (median, 1.5 hours). Multivariable analysis with socio-economic and demographic covariates indicated that ≥ 2 hour potential drive-time to nearest ATC versus < 1 hour (adjusted odds ratio [or] = 0.43; 95% confidence interval (CI), 0.27-0.69), household income < $50k versus ≥ $100k (or = 0.19; 95% CI, 0.05-0.69), and residence in nonmetropolitan areas versus metropolitan (or = 0.41; 95% CI, 0.28-0.60) were significantly associated with reduced odds of CAR T use.

CONCLUSIONS: There were substantial geographic and socioeconomic disparities in CAR T access, with long drive‑times, lower household income, and non‑metro residence limiting uptake and underscoring the need for targeted ATC expansion.

PMID:42586901 | DOI:10.1016/j.clml.2026.07.009

Appl Nurs Res. 2026 Jul 30:152133. doi: 10.1016/j.apnr.2026.152133. Online ahead of print.

ABSTRACT

BACKGROUND: AI-driven virtual standardized patients (VSPs) integrated within virtual reality (VR) environments offer structured opportunities for safe communication practice in nursing education; however, empirical evidence regarding their preliminary feasibility and educational effects remains limited, particularly in domain-specific clinical contexts such as preoperative nursing care.

METHODS: This mixed-methods pilot study pursued two objectives: (1) to develop a VR simulation integrating an AI-driven VSP (AI-VSP) for preoperative nursing communication, and (2) to pilot-test its preliminary feasibility and exploratory pre-post effects. Ten third-year nursing students completed a single 50-minute preoperative care simulation using the VIRTI platform (Meta Quest 3). Quantitative data on satisfaction, self-confidence, simulation design perceptions, and immersion were collected using four validated instruments and analysed using paired-samples t-tests with effect sizes and 95% confidence intervals. Qualitative data were collected via semi-structured interviews and analysed using inductive thematic analysis.

RESULTS: All four outcome variables showed statistically significant pre-post differences (all p ≤ .004), with large effect sizes (Cohen’s d = 1.10-1.75). Qualitative themes indicated realistic conversational learning experiences and perceived clinical relevance, while identifying technical limitations in nonverbal feedback and scenario-level construct alignment as areas for refinement.

CONCLUSION: These preliminary findings suggest that AI-VSP-based VR simulation may offer a feasible and structured pre-clinical learning environment for preoperative nursing communication competency development. Future work should prioritise multimodal feedback enhancement and controlled comparative designs to evaluate educational effectiveness more rigorously.

PMID:42586890 | DOI:10.1016/j.apnr.2026.152133

Clin Ther. 2026 Aug 12:S0149-2918(26)00265-1. doi: 10.1016/j.clinthera.2026.07.004. Online ahead of print.

ABSTRACT

PURPOSE: Clopidogrel is a cornerstone of antiplatelet therapy after lower-limb endovascular intervention in patients with peripheral arterial disease (PAD), yet interindividual variability in treatment response may influence clinical outcomes. To our knowledge, this is the first systematic review and meta-analysis to combine an updated quantitative synthesis of functional clopidogrel resistance with a dedicated qualitative appraisal of CYP2C19 genetic determinants, while explicitly separating analyses based on raw event data from exploratory analyses using published effect estimates and applying conservative small-sample sensitivity methods. We evaluated the association between functional clopidogrel resistance and clinically relevant limb outcomes-target lesion/target vessel revascularization (TLR/TVR) and major adverse limb events (MALE)-with all-cause mortality as a secondary exploratory outcome.

METHODS: The review was conducted according to PRISMA 2020 and registered in PROSPERO (CRD42026129845). MEDLINE (PubMed), EMBASE, Web of Science, and Google Scholar were searched from inception to May 17, 2026. Functional resistance was defined as high on-treatment platelet reactivity (HTPR) assessed by platelet function testing, and genetic determinants as CYP2C19 loss-of-function alleles or metabolizer status associated with impaired clopidogrel response. Random-effects meta-analyses using restricted maximum likelihood (REML) were performed, with Hartung-Knapp-Sidik-Jonkman (HKSJ) sensitivity analyses and prediction intervals to quantify statistical uncertainty in sparse data. Genetic studies were synthesized qualitatively.

FINDINGS: Ten studies met the inclusion criteria; 6 functional studies contributed to the quantitative analyses. In the primary analysis based on 3 studies with raw event data, HTPR was associated with an approximately 3.7-fold increase in TLR/TVR risk (odd ratios [OR] 3.68; 95% confidence interval [CI] 1.56-8.68; P = 0.003; I² = 59%). An exploratory analysis of 5 studies with published effect estimates was directionally consistent (OR 4.46; 95% CI 1.09-18.31; I² = 87%). HKSJ sensitivity analyses preserved the direction of effect but produced substantially wider confidence intervals crossing the null, indicating increased statistical uncertainty. HTPR was not significantly associated with all-cause mortality (OR 1.49; 95% CI 0.92-2.42).

IMPLICATIONS: Functional clopidogrel resistance may be associated with an approximately 3- to 4-fold higher risk of repeat revascularization after lower-limb endovascular intervention; however, the small number of studies, substantial heterogeneity, and conservative sensitivity analyses warrant cautious interpretation. Larger prospective studies and randomized trials are needed before platelet-function-guided or genotype-guided antiplatelet strategies can be recommended.

PROSPERO REGISTRATION: CRD42026129845.

PMID:42586868 | DOI:10.1016/j.clinthera.2026.07.004

Nurs Crit Care. 2026 Sep;31(5):e70637. doi: 10.1111/nicc.70637.

ABSTRACT

BACKGROUND: Continuous renal replacement therapy (CRRT) is the preferred renal replacement therapy for critically ill patients with acute kidney injury; however, unplanned treatment discontinuation remains a major challenge that compromises treatment efficacy and patient outcomes.

AIMS: To investigate the risk factors and temporal trends associated with unplanned CRRT discontinuation using descriptive time-series analysis and to identify evidence-based nursing interventions.

STUDY DESIGN: This retrospective cohort study was conducted at a tertiary hospital in China between January and December 2025. Univariate analysis and binary logistic regression were used to identify factors independently associated with unplanned discontinuation. Descriptive time-series analysis with 7-day moving average smoothing was applied to evaluate temporal patterns throughout the study period.

RESULTS: Unplanned discontinuation occurred in 77 of 3128 CRRT sessions (2.46%). After adjustment, anticoagulation regimen, treatment duration (p < 0.001) and net ultrafiltration rate (p = 0.032) were identified as independent predictors of unplanned discontinuation. Compared with no anticoagulation, nafamostat mesylate was associated with lower odds of unplanned CRRT discontinuation (p = 0.013), whereas sodium citrate was associated with higher odds (p = 0.004), likely reflecting centre-specific implementation factors related to low citrate utilization. Descriptive time-series analysis showed temporal fluctuations in unplanned discontinuation rates, with an apparent peak in November. Elevated circuit pressure was the leading cause of unplanned discontinuation.

CONCLUSIONS: Unplanned CRRT discontinuation was associated with anticoagulation regimen, treatment duration and ultrafiltration rate. Standardized anticoagulation protocols, staff training, safe ultrafiltration practices and enhanced circuit pressure surveillance may reduce unplanned discontinuation and improve patient outcomes.

RELEVANCE TO CLINICAL PRACTICE: These findings provide nurses with evidence-based strategies, including locally informed monitoring protocols, standardized anticoagulation checklists and circuit pressure early warning indicators, to reduce unplanned CRRT discontinuation.

PMID:42586802 | DOI:10.1111/nicc.70637

Vet Comp Oncol. 2026 Aug 12. doi: 10.1111/vco.70101. Online ahead of print.

ABSTRACT

With the development and increased accessibility of diagnostic methods in veterinary medicine, the possibilities for early detection of proliferative lesions in the canine large intestine have expanded over the past decade. Since in human medicine, topoisomerase II alpha (Topo IIα) is considered a prognostic and predictive marker in various tumours, including colorectal carcinoma, we aimed to verify the role of this enzyme in proliferative epithelial lesions of the canine large intestine. In this study, we examined and compared the expression of Topo IIα in normal rectal mucosa, hyperplastic polyps, adenomas, and adenocarcinomas of the large intestine in dogs. Each type of lesion included 20 cases, in which the expression of Topo IIα was evaluated using immunohistochemistry. The median percentage of Topo IIα positive cells was 29.4% (IQR 24.9-37.1) in polyps, 30.3% (IQR 24.6-34.1) in adenomas, 36% (IQR 26.2-42.0) in adenocarcinomas, and 7.8% (IQR 5.9-10.6) in normal intestinal mucosa. Statistical analysis using the Kruskal-Wallis test followed by Dunn’s post hoc tests with Bonferroni correction revealed significantly higher Topo IIα expression in hyperplastic polyps (p = 0.013, r = 0.62), adenomas (p = 0.033, r = 0.57) and adenocarcinomas (p = 0.002, r = 0.73) compared with normal rectal mucosa, with large effect sizes. Our results may serve as a preliminary basis for the potential use of anthracyclines in the treatment of canine colorectal adenocarcinomas, as well as in multiple adenomas or polyps when surgical options are limited. This study presents new insights of Topo IIα expression in canine large intestine carcinogenesis and could provide a valuable foundation for further clinical research.

PMID:42586801 | DOI:10.1111/vco.70101

Nurs Crit Care. 2026 Sep;31(5):e70635. doi: 10.1111/nicc.70635.

ABSTRACT

BACKGROUND: Critical illness threatens the Quality of Life (QoL) of both ICU survivors and their family members through Post-Intensive Care Syndrome (PICS) and its family counterpart (PICS-F). These syndromes unfold within the ICU survivor-family member dyad, yet their dyadic interdependence and joint trajectories remain insufficiently explored.

AIM: To develop a conceptual framework and study protocol for a longitudinal investigation of dyadic QoL in ICU survivor-family member dyads, with explicit attention to reciprocal interdependence over time.

DESIGN AND METHODS: A longitudinal study will enrol ICU survivor-family member dyads assessed at 1, 3, 6 and 12 months post-ICU discharge in two Italian ICUs. The 1-month timepoint captures early PICS and PICS-F manifestations while minimising post-discharge confounding. A qualitative phenomenological component will explore how survivorship is experienced within the dyad. Dyadic QoL trajectories will be examined using descriptive statistics, χ² tests, Student’s t-tests and Mann-Whitney U-tests. Longitudinal analyses will apply hierarchical linear models to capture trajectories over time. Qualitative data will be analysed manually following Cohen’s hermeneutic phenomenological approach.

CONCLUSION: This protocol advances the conceptualisation of post-ICU outcomes as dyadic and interdependent, integrating quantitative and qualitative evidence within a relational framework.

RELEVANCE TO CLINICAL PRACTICE: Findings will inform nurse-led follow-up interventions targeting ICU survivors and family members as an interdependent unit, supporting person- and family-centred care across the post-ICU trajectory.

PMID:42586790 | DOI:10.1111/nicc.70635

Nurs Crit Care. 2026 Sep;31(5):e70636. doi: 10.1111/nicc.70636.

ABSTRACT

BACKGROUND: Clinical competence is central to safe and high-quality nursing care in intensive care units (ICUs). Although professional experience has long been regarded as a primary pathway to competence, this assumption requires empirical testing in contemporary ICU nursing, where care is increasingly shaped by advanced technologies, evidence-based protocols and structured professional development. However, it remains unclear whether clinical competence among ICU nurses is shaped primarily by accumulated experience or by structured ICU training and certification.

AIM: The primary aim of this study was to determine the clinical competence levels of ICU nurses. The secondary aim was to examine the relative contributions of sociodemographic characteristics, professional experience, ICU experience, certification and ICU training to clinical competence using hierarchical regression analysis.

STUDY DESIGN: A descriptive cross-sectional study. Data were collected using a self-administered online questionnaire prepared with Google Forms. The questionnaire included the Nurse Information Form, which assessed selected socio-demographic and professional characteristics and the Intensive and Critical Care Nursing Competence Scale (ICCNCS), which assessed competence across knowledge, skills, attitudes and values. Total ICCNCS scores range from 108 to 540 and are categorised as poor (108-216), fair (217-324), good (325-432) or excellent (433-540), with higher scores indicating greater clinical competence. Hierarchical multiple regression analysis was performed to determine the determinants of clinical competence.

RESULTS: The study was conducted over a six-month period, between October 2022 and March 2023 and included 253 ICU nurses from 36 hospitals in Türkiye. The mean ICCNCS total score was 441.58 ± 51.66 out of 540, corresponding to the excellent competence category; 130 nurses (51.4%) were classified as having excellent competence. The model, including age, gender and total nursing experience, explained 29.3% of the variance in competence. The inclusion of ICU experience increased the explained variance from 29.3% to 29.4% (p > 0.05). In contrast, when education and certification variables were added to the model, the explanatory power increased from 29.4% to 33.7%, and the final model was found to be statistically significant (p < 0.001).

CONCLUSIONS: These results suggest that clinical competence among ICU nurses cannot be explained solely by experience. They also question the experience-competence assumption underlying Benner’s Novice-to-Expert model and support education-driven competence development approaches in contemporary ICU nursing.

RELEVANCE TO CLINICAL PRACTICE: By challenging Benner’s experience-based assumption, this study supports education-driven competence development through structured ICU training, certification and continuing professional development.

PMID:42586787 | DOI:10.1111/nicc.70636

Int J Spine Surg. 2026 Aug 12:8930. doi: 10.14444/8930. Online ahead of print.

ABSTRACT

BACKGROUND: Image-guided pedicle screw placement improves accuracy over fluoroscopy, but level-specific performance and independent predictors in routine care remain incompletely defined. This study aims to compare intraoperative computed tomography (iCT)-navigated vs fluoroscopy-assisted (FA) lumbar screw placement, while quantifying level-specific performance and exploring independent predictors of optimal (grade A) placement.

METHODS: We performed a single-center retrospective, noncontemporaneous cohort study of 229 adults who underwent primary lumbar pedicle screw fixation, including 131 iCT navigated and 98 FA. In total, 1304 lumbar screws were graded on postoperative computed tomography (CT) using the Gertzbein-Robbins scale. Mixed-effects logistic regression estimated odds of Grade A placement with fixed effects for technique, pathology, level, side, and age.

RESULTS: iCT was associated with higher accuracy than FA (grade A 97% vs 86%), with no grade C breaches under iCT (vs 2% with FA). The advantage was level dependent and most pronounced at L5 (grade A 97.3%-98.2% with iCT vs 79.3%-85.7% with FA); additional statistically significant differences favored iCT at L2 left, L3 left, and L4 left, while L3 right showed a nonsignificant trend. In adjusted analyses, FA was associated with markedly lower odds of grade A placement. Trauma was independently associated with a reduced likelihood of grade A placement, whereas revision surgery served as the reference category and was not an independent predictor; age, level, and side were not independent predictors.

CONCLUSIONS: In this retrospective cohort, iCT navigation was associated with superior radiographic accuracy compared with fluoroscopy and higher rates of optimal screw placement. Traumatic pathology was associated with lower odds of optimal placement.

CLINICAL RELEVANCE: iCT-based navigation was associated with an increased likelihood of achieving optimal (Gertzbein-Robbins grade A) lumbar pedicle screw placement compared with fluoroscopy in routine clinical practice. The advantage appears particularly pronounced at L5 and in anatomically challenging scenarios. However, these findings are based on radiographic accuracy only and should be interpreted cautiously, as no direct conclusions on clinical outcomes or complication reduction can be drawn.

PMID:42586781 | DOI:10.14444/8930

J Appl Toxicol. 2026 Aug 12. doi: 10.1002/jat.70386. Online ahead of print.

ABSTRACT

Carbon nanoparticles (CNPs) have been reported to disrupt cellular integrity and induce oxidative stress and genotoxicity. Potential health risks thus make it imperative to look into tissue specific toxic impact and thereby focus on the safety measures. Given the wide-range applications of CNPs across biomedical and industrial domains, the present study was designed to investigate the dose-dependent effects of CNPs in male Sprague-Dawley rats. Characterization of synthesized CNPs was carried out using standard analytical techniques to determine their structure and composition through x-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). The rats were randomly divided into the following five groups: control group, saline group, and three treatment groups, which received intraperitoneal doses of CNPs over a 28-day period. Renal toxicity was determined through biochemical assay and the histological examination of kidney tissues. The data were statistically analyzed using Minitab 17. Both biochemical and microscopic findings revealed that CNPs exposure induced an increase in blood urea nitrogen, creatinine, and uric acid levels, indicating renal dysfunction. Similarly, kidney to body weight ratio showed a dose-dependent increase, which is consistent with the kidney injury. However, body weight was found decreased with respect to increased CNPs dose. Additionally, certain behavioral and physiological changes were also observed, that is, systemic distress, including weight loss, dry skin, and tight body condition. Autopsy revealed visibly compromised organ health, particularly in the kidneys, which appeared pale and shrunken. Histopathological assessment and serum biochemical analysis demonstrated renal damage at high dose. Overall, these findings revealed possible health hazards associated with CNP exposure, which induces significant renal toxicity in male Sprague-Dawley rats in a dose-dependent manner. Further research work is needed to develop smart strategies for risk assessment and the cautious use of CNPs in future.

PMID:42586780 | DOI:10.1002/jat.70386