Tag: nevin manimala

J Med Microbiol. 2026 Aug;75(8). doi: 10.1099/jmm.0.002183.

ABSTRACT

Introduction. Bacterial vaginosis (BV) is a common gynaecological disorder characterized by an imbalance in the vaginal microbiota, leading to increased risk of infection and recurrence.Hypothesis/Gap statement. Although the role of microbiota dysbiosis in BV is established, the dynamic changes in microbial communities and inflammatory factors during BV formation and recurrence, as well as reliable biomarkers for predicting recurrence, remain inadequately explored.Aim. This study aimed to systematically analyse the changes in vaginal microbiota and inflammatory factors during different stages of BV formation and recurrence, and to identify potential biomarkers for predicting BV recurrence.Methodology. Vaginal swab samples were collected from 135 women, including 55 BV patients, 50 intermediate BV (IBV) patients and 30 healthy controls. Twenty-six recurrent BV (Re-BV) samples were obtained within 1 year after treatment. 16S rRNA gene sequencing was performed to profile the vaginal microbiota, and ELISA was used to measure IL-6, IL-10 and IL-1β levels. Statistical analyses included diversity metrics, correlation analysis and predictive modelling using LASSO regression and receiver operating characteristic curves.Results. Microbial richness was significantly higher in BV, Re-BV and IBV groups compared to controls. Lactobacillus abundance decreased progressively from IBV to BV, while Gardnerella, Prevotella, Sneathia, Fannyhessea and Dialister increased. These genera were positively correlated with vaginal pH, human papillomavirus (HPV) status and enzymatic activity. IL-6, IL-10 and IL-1β levels were elevated in BV, IBV and Re-BV groups. IL-10 and IL-1β were further increased in recurrent cases. A combined predictive model integrating microbial and cytokine markers achieved an area under the curve of 0.928 for BV recurrence.Conclusion. Distinct shifts in vaginal microbiota composition and inflammatory factor levels occur during BV formation and recurrence. The integration of microbial and cytokine profiles offers a robust approach for predicting BV recurrence, with important implications for clinical management and prevention strategies.

PMID:42566243 | DOI:10.1099/jmm.0.002183

Traffic Inj Prev. 2026 Aug 7:1-9. doi: 10.1080/15389588.2026.2704704. Online ahead of print.

ABSTRACT

OBJECTIVE: Professional delivery riders in China have experienced a sharp increase in traffic crashes, injuries, and fatality rates over recent years. This observational study sought to identify and analyze risk factors influencing riding behavior among electric bicycle delivery riders compared to other electric bicycle riders during potential conflicts at unsignalized intersections.

METHODS: Two typical unsignalized intersections in Nantong City with mixed traffic (pedestrians, motorized and non-motorized vehicles) were selected for observation. Through systematic video coding and analysis of 637 min of continuous video observations, we extracted a total of 1,558 potential conflict events, including interactions between electric bicycle riders and pedestrians, motorized vehicles, or non-motorized vehicles. Among these events, 394 occurred under congested traffic and 1,164 under free-flowing traffic. Data were analyzed via descriptive statistics, non-parametric chi-square tests and logistic regression.

RESULTS: (1) Under congested traffic conditions, delivery riders generally exhibited more pronounced hazardous riding behaviors than other riders, and such differences were more obvious among male and young delivery riders; (2) Regardless of road user type, delivery riders exhibited a high proportion (about 20%) of hazardous riding behaviors under both traffic conditions; (3) During potential conflicts with motor vehicles in congested traffic, delivery riders engaged in more hazardous riding than other riders; (4) Professional delivery riders engaged in risky behavior at a rate 1.88 times that of other riders.

CONCLUSIONS: For delivery riders at unsignalized intersections, hazardous riding behaviors are influenced by the combined effects of traffic conditions, rider demographic characteristics, and potential conflict objects. Professional delivery riders exhibit the highest risk levels under congested traffic conditions, particularly during potential conflicts with motor vehicles. Findings reflect the influence of occupational demands, such as tight delivery schedules, on delivery riders’ riding strategies in various contexts.

PMID:42566229 | DOI:10.1080/15389588.2026.2704704

Int J Radiat Biol. 2026 Aug 7:1-12. doi: 10.1080/09553002.2026.2705996. Online ahead of print.

ABSTRACT

PURPOSE: Early prediction of hematological acute radiation syndrome (H-ARS) saves lives. For H-ARS severity prediction, we established a four-gene panel (FDXR, DDB2, POU2AF1, WNT3) using leukemia patients and non-human primates. Further confirmation in 12 minipigs failed, due to a weak response of these genes after irradiation.

MATERIALS AND METHODS: Here, we intended to confirm previous findings using a larger cohort (n = 19) and assess the impact of Myelo001 on clinical progression and gene expression. All minipigs received 2.1 Gy total-body irradiation (LD ≈ 40/30). The study included an irradiated control group and two irradiated groups treated with Myelo001 (11 or 15 days). Peripheral blood was collected six days before and on days 1-, 3-, and 10 after irradiation. RNA was isolated, reverse-transcribed, and analyzed by qRT-PCR using TaqMan assays. Differential gene expression (DGE) was calculated relative to pre-irradiation samples.

RESULTS: WNT3 was undetectable in most animals. No significant difference in gene expression, survival, or clinical progression were found between Myelo001-treated and untreated animals, so treatment groups were pooled for DGE analyses. Across all time points, no significant changes in DGE were observed, except for slight DDB2 upregulation on day 3 (DGE = 2.3). The expected pattern of upregulated (DGE >2) FDXR/DDB2 with simultaneous downregulation (DGE <0.5) of POU2AF1, was absent (except on day one in one minipig). This missing pattern contrasted with an on average 5.5-fold reduction in lymphocyte counts, indicative of severe H-ARS. Also, no age or sex related changes were observed.

CONCLUSION: This independent minipig study confirms previous work showing that these genes do not exhibit statistically significant radiation-responsiveness in this animal model. Under the experimental conditions applied, no significant age or sex related changes nor treatment-related effects of Myelo001 were observed, which may reflect model-specific limitations or a lack of efficacy in this setting, or a combination of both.

PMID:42566227 | DOI:10.1080/09553002.2026.2705996

JAMA Netw Open. 2026 Aug 3;9(8):e2627643. doi: 10.1001/jamanetworkopen.2026.27643.

ABSTRACT

IMPORTANCE: Brain maturation varies between individuals, particularly during dynamic developmental periods such as adolescence. Directly assessing the differences in longitudinal trajectories can reveal deviations from normative patterns.

OBJECTIVE: To ascertain the association of longitudinal change in brain volumes with birth weight, gestational age, and longitudinal changes in psychopathology.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, cross-sectional and longitudinal normative models were developed for brain volumes from the first 2 neuroimaging data collection time points (baseline: 2016-2018; follow-up: 2019-2021) of the Adolescent Brain Cognitive Development (ABCD) Study, an ongoing community-based longitudinal cohort study at 21 US sites. Longitudinal models indexed an individual’s expected brain volume at follow-up, conditioned on their baseline measurement, and thus were conditional-longitudinal models. Split-half subsets on demographically matched samples were used to fit the models. ABCD Study participants were recruited through the US school systems. Exclusion criteria included severe medical conditions that interfered with the study protocols. The present analysis further excluded the sample based on imaging quality flags and missing data. Data analysis was performed between May 2024 and August 2025.

EXPOSURES: Birth weight and gestational age derived from parent-reported questionnaires. General psychopathology and subfactor scores were calculated using a bifactor model.

MAIN OUTCOMES AND MEASURES: Brain volumes and change in volume between time points 1 (baseline) and 2 (follow-up). Cross-sectional and longitudinal centiles were used to quantify deviations in volumes.

RESULTS: The sample included 10 830 ABCD Study participants with neuroimaging data collected at baseline (mean [SD] age, 9.9 [0.62] years; 5609 males [51.8%]) and 7262 with data collected at follow-up (mean [SD] age, 12.0 [0.65] years; 3875 males [53.4%]). Longitudinal centiles were sensitive to individual-specific changes in brain volumes. Lower birth weight was associated with lower longitudinal centiles, suggesting larger decreases in brain volumes over time (n = 27 regions, β range = 0.030-0.083). Lower longitudinal centiles were associated with greater increases in psychopathology, suggesting decreasing brain volumes with increasing psychopathology scores (n = 37 regions, β range = -0.061 to -0.031). Changes in psychopathology were not associated with brain volumes at either time point when indexed by cross-sectional centiles.

CONCLUSIONS AND RELEVANCE: In this cohort study, conditional-longitudinal models captured individual-level deviations from expected growth trajectories, providing information beyond static positions on a growth curve to assess differences in maturation. Robust associations were observed between individual trajectory deviations, birth weight, and longitudinally assessed mental health symptoms. Conditional-longitudinal models hold promise for applications across psychiatric neuroscience, from development to aging.

PMID:42566216 | DOI:10.1001/jamanetworkopen.2026.27643

JAMA Netw Open. 2026 Aug 3;9(8):e2627655. doi: 10.1001/jamanetworkopen.2026.27655.

ABSTRACT

IMPORTANCE: Primary health care (PHC) is recognized as pivotal for achieving universal health coverage and reducing mortality rates among children younger than 5 years.

OBJECTIVES: To estimate the association of effective PHC coverage with child mortality in 3 diverse sub-Saharan countries over the past 2 decades and to estimate the number of child deaths that could occur by 2035 if PHC services are dismantled due to the current decrease in development assistance for health funding.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study assessed children younger than 5 years from January 1, 2007, to December 31, 2022, in Mozambique, Gabon, and Ethiopia. The study drew on 5 national and subregional representative US Agency for International Development Demographic and Health surveys with longitudinal information from the 3 countries. Statistical analysis was performed from October 2024 to May 2026.

EXPOSURE: An effective PHC coverage index (PHC index) was developed for this study, integrating core dimensions of child PHC service provision and access and structured into progressively ordered coverage categories.

MAIN OUTCOMES AND MEASURES: The outcome was child mortality, assessed with 2-way fixed-effects multivariable Poisson regression models with child-clustered standard errors, adjusted for relevant confounding factors at the individual, regional, and national levels. This evaluation was also integrated into validated microsimulation forecasting analysis.

RESULTS: Of the 118 911 child-year observations of 37 583 children (mean [SD] age, 1.4 [1.3] years; 60 252 boys [50.7%]), Gabon had the greatest coverage of service provision, followed by Mozambique and Ethiopia, though Mozambique showed a marginally higher proportion in the highest category (Gabon, 796 of 33 269 [2.4%]); Mozambique, 554 of 20 728 [2.7%]; and Ethiopia, 317 of 64 914 [0.5%]); the inverse pattern was observed for the lowest coverage categories (Gabon, 2143 of 33 269 [6.4%]; Mozambique, 1976 of 20 728 [9.5%]; and Ethiopia, 32 189 of 64 914 [49.6%]). Across all child-year observations, there were 2166 deaths (1.8%). Ethiopia accounted for 2.1% of deaths (1338 of 64 914 child-years), Mozambique for 1.8% (364 of 20 728), and Gabon for 1.4% (464 of 33 269). Increasing PHC coverage was associated with decreases in child mortality in a dose-response manner, reaching a 58% reduction (rate ratio, 0.42 [95% CI, 0.19-0.91]) for consolidated high coverage. The dismantling of PHC coverage, triggered by the defunding of development assistance for health , may lead to an increase in preventable child deaths, amounting to an estimated 373 108 deaths (95% uncertainty interval, 313 152-444 244 deaths) across the 2025 to 2035 period.

CONCLUSIONS AND RELEVANCE: This cohort study found evidence indicating that PHC was associated with substantially reduced mortality rates among children younger than 5 years in sub-Saharan Africa over the past 2 decades. These findings suggest that PHC should be expanded rather than dismantled, particularly amid the ongoing defunding of development assistance for health.

PMID:42566215 | DOI:10.1001/jamanetworkopen.2026.27655

JAMA Netw Open. 2026 Aug 3;9(8):e2627714. doi: 10.1001/jamanetworkopen.2026.27714.

ABSTRACT

IMPORTANCE: Health care-associated bloodstream infections (BSIs), particularly central line-associated BSIs (CLABSIs), remain an important cause of morbidity among neonates admitted to neonatal intensive care units (NICUs). Long-term Korean national data describing the trends and interhospital variability in NICU-associated infections remain limited.

OBJECTIVE: To evaluate national trends, interhospital variability, and microbiological characteristics of NICU-associated BSIs in Korea using nationwide surveillance data.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study analyzed data from the NICU module of the Korean National Healthcare-Associated Infections Surveillance System, including NICUs that participated between July 2019 and June 2024. Surveillance definitions were based on modified Centers for Disease Control and Prevention criteria. Data were analyzed from October 2025 to June 2026.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were annual BSI and CLABSI rates per 1000 patient-days and 1000 central line-days, respectively, and device utilization ratios (DURs). Temporal trends were assessed using mixed-effects negative binomial regression models with hospital-level random intercepts, adjusting for birth weight category, NICU bed capacity, and nurse staffing grade.

RESULTS: Between July 2019 and June 2024, 74 to 82 NICUs were included annually, contributing a total of 2 178 107 patient-days and 585 582 central line-days of surveillance, with annual NICU admissions ranging from 24 607 to 30 260 neonates. Overall, 948 BSIs were identified, including 836 CLABSIs (88.2%). The pooled mean BSI rate declined from 0.56 (95% CI, 0.49-0.63) to 0.35 (95% CI, 0.29-0.41) per 1000 patient-days, and the CLABSI rate declined from 1.78 (95% CI, 1.56-2.03) to 1.16 (95% CI, 0.98-1.38) per 1000 central line-days. After adjustment, the adjusted rate ratio per surveillance year was 0.91 (95% CI, 0.86-0.96) for BSI, 0.92 (95% CI, 0.87-0.97) for CLABSI, and 0.95 (95% CI, 0.93-0.98) for DUR. Despite overall improvement, substantial interhospital variability in both BSI and CLABSI rates persisted. Gram-positive cocci predominated, followed by gram-negative bacilli and fungi.

CONCLUSIONS AND RELEVANCE: In this nationwide surveillance cohort study of NICUs, BSIs and CLABSIs rates declined significantly over 5 years, while substantial interhospital variability persisted. Although institutional-level risk adjustment was applied, the absence of patient-level clinical variables limits individual hospital comparisons, underscoring the need for refined risk adjustment and targeted quality improvement strategies.

PMID:42566214 | DOI:10.1001/jamanetworkopen.2026.27714

JAMA Netw Open. 2026 Aug 3;9(8):e2627727. doi: 10.1001/jamanetworkopen.2026.27727.

ABSTRACT

IMPORTANCE: Afghans are one of the world’s largest refugee populations. Afghan women face compounded health risks due to sociocultural restrictions, low literacy, forced displacement, and limited health care access, yet little is known about their experiences with health care after resettlement in the US.

OBJECTIVE: To explore health and health care access issues of Afghan refugee women in the US.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study was part of an ongoing community-based participatory research project started in July 2020. Bilingual investigators conducted semistructured interviews with Afghan refugee women in Dari or English. Dari interviews were interpreted to English by a fluent bilingual investigator, validated by a separate bilingual investigator, and then reviewed with an Afghan immigrant community member for accuracy. Transcribed interviews were analyzed using grounded theory from July 2023 to July 2024. Participants who self-identified as Afghan, were born outside of the US, and were 18 years or older were recruited with convenience and purposive sampling from the San Francisco Bay Area of California through refugee-serving community organizations and word of mouth until data saturation was met.

MAIN OUTCOMES AND MEASURES: Themes and subthemes about health and health care access.

RESULTS: Of 23 Afghan women interviewed (median age, 30 years [range, 19-55 years]), most were married (22 [96%]) and had health insurance (16 [70%]). Their median time of residence in the US was 4 years (range, 1-17 years). Five key themes of health and health care access were identified: (1) health system barriers, such as inadequate interpretation causing miscommunication and mistrust, and insensitive health care including lack of informed consent; (2) sociocultural norms and women’s autonomy, with patriarchal gender norms persisting after resettlement and limiting women’s decision-making; (3) structural barriers resulting in the use of home remedies, driven by long wait times and negative prior experiences; (4) sociocultural barriers to sexual and reproductive health, with knowledge gaps shaped by intergenerational shame; and (5) mental health challenges, including widespread distress expressed through culturally specific idioms and somatic symptoms.

CONCLUSIONS AND RELEVANCE: In this qualitative study, Afghan women described multilayered health care barriers, including displacement-related trauma, sociocultural norms, and structural deficiencies. Study findings suggest that culturally sensitive and linguistically appropriate public health interventions and structural changes are needed to improve health care access for Afghan women in the US.

PMID:42566213 | DOI:10.1001/jamanetworkopen.2026.27727

JAMA Health Forum. 2026 Aug 7;7(8):e262503. doi: 10.1001/jamahealthforum.2026.2503.

ABSTRACT

IMPORTANCE: Administrative costs account for nearly one-quarter of US hospital expenditures and are substantially higher than those in other high-income countries. Although mandatory value-based payment programs implemented by the Centers for Medicare & Medicaid Services (CMS) aim to improve quality and efficiency, they may be associated with increased administrative burden.

OBJECTIVE: To evaluate the association between participation in CMS mandatory value-based payment programs and hospital administrative costs.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a synthetic difference-in-differences design to compare hospital administrative costs obtained from the Medicare cost report data from fiscal years 2006 to 2020. The sample included Medicare-certified general acute care hospitals, critical access hospitals, and long-term acute care hospitals. Administrative costs at hospitals participating in mandatory value-based payment programs, including the Hospital Value-Based Purchasing (HVBP) program, Hospital Readmissions Reduction Program (HRRP), and Hospital-Acquired Condition Reduction Program (HACRP), were compared with hospitals not participating in these programs. In addition, hospitals participating in the Comprehensive Care for Joint Replacement (CJR) model were compared with hospitals not participating in this model. Data were analyzed between July 5 and December 25, 2025.

EXPOSURE: Hospital participation in CMS mandatory value-based payment programs initiated under the Affordable Care Act (HVBP, HRRP, and HACRP) or the CJR model.

MAIN OUTCOMES AND MEASURES: The primary outcome was hospital administrative costs, defined as the sum of administrative and general, nursing administration, and medical records costs reported in Medicare cost report data.

RESULTS: A total of 4332 hospitals were included in the sample. Of these hospitals, 2820 (65.1%) participated in the mandatory value-based payment programs (HVBP, HRRP, and HACRP). Nonparticipating hospitals included 42 general acute care hospitals in Maryland (0.9%), 1159 critical access hospitals (26.8%), and 311 long-term acute care hospitals (7.2%). In addition, 357 hospitals participated in the CJR model compared with 2029 that did not participate in the model. Participation in the 3 mandatory value-based programs was associated with annual increases in administrative costs of $1.23 (95% CI, $0.11-$2.36) million per hospital compared with general acute care hospitals in Maryland, $0.93 (95% CI, $0.27-$1.59) million compared with critical access hospitals, and $0.65 (95% CI, $0.01-$1.29) million compared with long-term acute care hospitals. Participation in the CJR model was associated with an annual increase in administrative costs of $1.40 (95% CI, $0.30-$2.49) million per hospital. Aggregated nationally, these increases corresponded to more than $3 billion in additional annual administrative costs.

CONCLUSIONS AND RELEVANCE: In this cohort study, participation in mandatory value-based payment programs was associated with increased hospital administrative costs. These findings suggest that policymakers should consider administrative burden when designing and evaluating payment reforms to ensure that anticipated improvements in cost, quality, and access are not offset by increased complexity.

PMID:42566204 | DOI:10.1001/jamahealthforum.2026.2503

Int J Radiat Biol. 2026 Aug 7:1-12. doi: 10.1080/09553002.2026.2705994. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the dosimetric feasibility of combining stereotactic body radiotherapy (SBRT) for peripheral tumors with conventionally fractionated mediastinal lymph node (MLN) radiotherapy in small cell lung cancer (SCLC), with a focus on tumor-nodal spatial separation and geometry-dependent dose redistribution.

MATERIALS AND METHODS: A retrospective virtual planning study was conducted in 21 patients with peripheral SCLC. Three treatment strategies were generated: (1) SBRT 40 Gy in 5 fractions plus MLN radiotherapy 60 Gy in 30 fractions, (2) SBRT 50 Gy in 5 fractions plus MLN radiotherapy, and (3) conventional thoracic radiotherapy (60 Gy in 30 fractions). Target coverage and dose-volume parameters for organs at risk (OARs) were compared. Biological dose normalization using equivalent dose in 2 Gy fractions (EQD2), based on the linear-quadratic model, and prescription-matched sensitivity analyses were performed.

RESULTS: All strategies achieved adequate target coverage. SBRT-based approaches significantly reduced low-dose lung exposure compared with conventional radiotherapy, particularly in the 40 Gy regimen (lung V5 – 7.34%, V10 – 3.34%, V20 – 2.20%; all p ≤ 0.003), along with a reduction in mean lung dose (-125.74 cGy, p < .001). In exploratory EQD2-normalized analysis, the reduction in mean lung dose remained statistically significant (-0.95 Gy EQD2, p < .001). In prescription-matched analyses, lung V5 remained significantly lower, indicating that differences were not solely attributable to prescription dose. Patients with tumor-nodal spatial separation ≥2 cm exhibited lower doses to multiple OARs, supporting a geometry-dependent reduction in normal tissue exposure.

CONCLUSIONS: Combining SBRT with MLN radiotherapy is dosimetrically feasible in selected patients with SCLC, with feasibility strongly influenced by tumor-nodal spatial separation. Reduced low-dose lung exposure appears to be associated with geometry-dependent dose redistribution. These findings provide a rationale for further investigation of geometry-informed treatment strategies in prospective clinical studies.

PMID:42566199 | DOI:10.1080/09553002.2026.2705994

Carbon Balance Manag. 2026 Jul 27;21(1):104. doi: 10.1186/s13021-026-00488-4.

ABSTRACT

BACKGROUND: Forest carbon mapping is crucial for sustainable forest management, climate mitigation, biodiversity conservation, ecosystem service provision and land-use planning. Carbon stocks have been studied at regional to global scales and across various biomes. However, island-wide studies of carbon stocks and carbon mapping remain limited. Here, we present the first high-resolution (50 m) spatial mapping of forest carbon for the Canary Archipelago. Combining structural field data from the Spanish National Forest Inventory plots with airborne laser scanning, Sentinel-2 multispectral satellite data and fine-scale interpolated climatic variables, we modeled total, aboveground and belowground carbon density of 18 forest types, using machine learning approaches, including Boosted Regression Tree and Random Forest models.

RESULTS: Forests across the Canary Islands store an estimated 10.26 Tg of carbon. Canarian pine forests contain the largest carbon pool (57%) due to their extensive distribution area, whereas mature laurel forests exhibit exceptional carbon densities. In humid laurel forests, average carbon densities reached 413.2 ± 149.5 Mg C ha⁻¹, exceeding previous regional estimates and approaching levels of primary tropical forests. The high spatial heterogeneity of carbon densities across forest types and islands was best explained by structural stand attributes, such as tree canopy cover and volume, and climatic factors with carbon stocks being more strongly associated with moisture than with temperature. Both statistical modelling approaches performed similarly in terms of efficiency, accuracy and error statistics, and the selection of the best model depended on the specific island.

CONCLUSIONS: Our approach integrates field data with advanced remote sensing tools and machine learning algorithms to produce a high-resolution and accurate carbon map of topographically complex oceanic islands. We show that the Canary Islands contain exceptionally high total carbon densities, particularly within the mature, humid laurel forests of La Gomera, and identify structural attributes and water availability as the main drivers of spatial variation in carbon stocks. This assessment provides a baseline for biodiversity conservation, nature-based forest management, ecological restoration and regional climate policy towards carbon neutrality in island ecosystems.

PMID:42566171 | DOI:10.1186/s13021-026-00488-4