Tag: nevin manimala

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

Neurology. 2026 Sep 22;107(6):e218449. doi: 10.1212/WNL.0000000000218449. Epub 2026 Aug 14.

ABSTRACT

BACKGROUND AND OBJECTIVES: Diffusion-weighted imaging (DWI)-positive lesions are increasingly recognized as markers of cerebral small vessel disease (cSVD) in acute intracerebral hemorrhage (ICH), but their underlying mechanisms, clinical-radiologic associations, and prognostic significance remain uncertain. We therefore aimed to determine their prevalence, anatomical distribution, and associations with baseline clinical-radiologic features and 6-month functional outcome assessed by the modified Rankin Scale (mRS).

METHODS: In this prospective cohort study, we analyzed consecutive patients with ICH included in the Stroke Investigation Group in North and Central London registry. We assessed the presence and anatomical distribution of DWI-positive lesions on acute MRI, as well as other cSVD markers rated according to the STandards for ReportIng Vascular changes on nEuroimaging criteria. The primary outcome was disability at 6 months assessed using the mRS. We investigated associations between DWI-positive lesions, clinical-radiologic features, and poor 6-month functional outcome (mRS ≥3) using adjusted multivariable logistic regression.

RESULTS: We included 342 patients (median age 67 years [interquartile range (IQR) 55-78]; 142 (41.5%) women; 138 (40.3%) lobar ICH; median cSVD burden 2 [IQR 1-3]). Overall, 74 patients (21.6%) had DWI-positive lesions, most commonly in lobar regions (33 [44.6%]). Patients with cerebral amyloid angiopathy (CAA) more frequently had strictly lobar DWI-positive lesions compared with those without (78.6% vs 36.7%); strictly deep DWI-positive lesions were exclusively observed in the non-CAA group (25.0% vs 0%). Compared with patients without DWI-positive lesions, those with DWI-positive lesions more frequently had severe white matter hyperintensities (WMH; Fazekas ≥2: 81.1% vs 64.2%, p < 0.001), higher cerebral microbleed (CMB) burden (median = 3 vs 1, p = 0.034), and larger ICH volume (median = 14 mL vs 7 mL, p = 0.0006). In adjusted analyses, DWI-positive lesions were independently associated with severe WMH (odds ratio [OR] 3.37, 95% CI 2.72-6.89), ICH volume ≥30 mL (OR 2.29, 95% CI 1.76-3.42), CMBs (OR 1.61, 95% CI 1.21-2.93), and poor functional outcome at 6 months (OR 2.16, 95% CI 1.67-3.48).

DISCUSSION: DWI-positive lesions are common after acute ICH and are independently associated with cSVD and poor functional outcome, supporting their role as a prognostic biomarker. Their anatomical distribution differs according to the underlying cSVD subtype.

PMID:42600114 | DOI:10.1212/WNL.0000000000218449

Ann Work Expo Health. 2026 Jul 17;70(6):wxag062. doi: 10.1093/annweh/wxag062.

ABSTRACT

INTRODUCTION: It has been estimated that 2% to 8% of cancers in high-income countries are linked to carcinogenic exposures in workplaces. In Finland, employers are obliged by law to provide data annually on selected carcinogens and carcinogenic working processes to the Finnish Register of Employees Exposed to Carcinogens (ASA). In this study, we expand the follow-up period of a previous study on cancer incidence in exposed employees by 16 years and add estimates of cancer mortality.

METHODS: The study population included all 142,204 workers registered in ASA from 1979 to 2018. For the cancer follow-up, the data were linked to the Finnish Cancer Registry. To compare the incidence and mortality with those of the Finnish general population, we estimated standardized incidence ratios (SIRs) and standardized mortality ratios.

RESULTS: A total of 12,687 cancer cases and 3,640 cancer deaths were reported among ASA workers over time by the end of 2019. In the entire ASA cohort, the all-site cancer incidence was similar to the general population (SIR 0.98, 95% confidence interval [CI] 0.96 to 0.99). Persons exposed to asbestos showed an excess incidence of mesothelioma (SIR 1.80, CI 1.17 to 2.66) and small cell carcinoma of the lungs (SIR 1.32, CI 1.02 to 1.67). Exposure to hardwood dust (oak and beech) was associated with an increased incidence of nasal cancer (8.69, 1.05 to 31.4), specifically nasal adenocarcinoma (SIR 58.3, CI 7.06 to 211). Increased mortality was observed for exposure-cancer combinations that also showed increased cancer incidence.

CONCLUSIONS: This study demonstrated the strongest confirmed associations between occupational exposures and cancer. The absence of many known exposure-cancer associations may point to low levels of exposure among workers registered in ASA or to small effect sizes of the agents investigated.

PMID:42600110 | DOI:10.1093/annweh/wxag062

JCO Clin Cancer Inform. 2026 Jul-Sep;10(3):e2600123. doi: 10.1200/CCI-26-00123. Epub 2026 Aug 14.

ABSTRACT

Despite vast investments in data collection, generation, and sharing from childhood cancer studies, for example, Gabriella Miller Kids First Research Program, Childhood Cancer Data Initiative, and other efforts, secondary use of data remains a challenge especially for rare diseases. The National Cancer Institute (NCI) Office of Data Sharing (ODS) aimed to promote FAIR (Findable, Accessible, Interoperable, Reusable) data sharing practices to enhance data utility, accelerate discovery, and foster interdisciplinary collaboration. NCI ODS launched its inaugural Data Jamboree focusing on childhood cancer alongside its third Annual Symposium in September 2025. Over 120 participants with diverse backgrounds coalesced into 23 multidisciplinary teams to solve real-world problems in a collaborative setting. The Jamboree built a diverse pool of data users and catalyzed pediatric cancer research, with several project findings being prepared for publication. Moreover, key feedback and recommendations for areas of improvement were provided to NCI in real time. The event highlighted the power of team science, data sharing, use, and reuse to accelerate childhood cancer research and improve diagnostic and therapeutic outcomes.

PMID:42600109 | DOI:10.1200/CCI-26-00123

JMIR Cancer. 2026 Aug 14;12:e69886. doi: 10.2196/69886.

ABSTRACT

BACKGROUND: Social media is a common source of cancer information for patients, caregivers, and survivors. Factors influencing engagement with oncology nutrition content on social media are not well-defined, despite the high prevalence of social media use for health information. The impact of bilingual content strategies on that engagement is also poorly understood.

OBJECTIVE: This study aims to describe changes in postlevel engagement on a Facebook page used to disseminate evidence-based cancer nutrition information during the period before and after the implementation of a bilingual, multiformat content strategy and to identify creative and linguistic features associated with audience engagement at the post level.

METHODS: This cross-sectional study analyzed 306 Facebook posts from Cook for Your Life over 12 months, comprising 9 months before the strategy change (T1) and 3 months after (T2). Postlevel engagement metrics (likes, comments, shares, and link clicks) and aggregated user demographics were obtained from Meta Business Suite. Trained coders annotated visual and creative features, including branding, post shape, and infographics, as well as topical categories. Linguistic Inquiry and Word Count characterized language features. Group differences across time periods were tested using t tests and chi-square tests. Generalized linear models estimated associations between post characteristics and engagement, adjusting for the time period.

RESULTS: Users who engaged with oncology nutrition Facebook content (N=10,196) were mostly female (n=9500, 93.2%) participants, over 35 years of age (n=9311, 91.4%), based in the United States (n=6708, 71.4%), and English-language users (n=9419, 93.4%). Engagement tripled from T1 (mean 5.3, SD 4.2) to T2 (mean 17.7, SD 37.9; P<.001). Creative features such as branding and format were positively associated with engagement. Linguistically, there was a shift toward longer sentence structures, simplified vocabulary, increased analytical language, and a decline in emotionally charged and cognitive language in posts during T2. In models controlling for time period, posts that used bilingual content had 1.72-fold higher odds of audience engagement than English-only posts (95% CI 1.05-2.80).

CONCLUSIONS: Implementing a bilingual, multiformat content strategy may promote engagement with oncology nutrition information on Facebook and enhance the equitable dissemination of health information. The use of creative visual design elements in combination with language that is more analytical and emotionally neutral was associated with higher engagement with educational public health content. Future research should test bilingual language presentation more directly and examine whether exposure to such content influences health beliefs and downstream behaviors across additional platforms.

PMID:42600092 | DOI:10.2196/69886

JMIR Res Protoc. 2026 Aug 14;15:e89917. doi: 10.2196/89917.

ABSTRACT

BACKGROUND: Access to health care remains a critical issue in protracted forced displacement contexts globally. In Cox’s Bazar, Bangladesh, the co-existence of Rohingya refugees and the host community for many years has generated complex health care dynamics. While humanitarian interventions have increased service availability for refugees, barriers still persist, and disparities in health care access between refugees and host populations exist.

OBJECTIVE: This study aims to understand the experiences and coping strategies of refugees, host community members, and health care providers involved in accessing and delivering health care services, and to explore how these dynamics influence social cohesion between the two communities.

METHODS: The study will use a qualitative design involving focus group discussions (FGDs) with Rohingya refugees and host community members, and in-depth interviews (IDIs) with health care providers in Cox’s Bazar, Bangladesh. Separate FGDs will be conducted with men and women from both refugee and host communities. Participants will be recruited through purposive sampling, complemented with snowball sampling, where required. Each IDI and FGD will be guided by guides developed from prior studies and contextual insights. The anticipated sample includes approximately 3 to 5 FGDs with Rohingya refugees, 3 to 5 FGDs with host community members, and 10 to 12 IDIs with health care providers. Data will be analyzed using Braun and Clarke’s reflexive thematic analysis, and the analysis will be primarily inductive, while also considering the wider social, institutional, and structural conditions that shape participants’ experiences. Since the data will be transferred to Sweden for secure storage, management, and analysis, ethical approval has been obtained from both Sweden and Bangladesh.

RESULTS: Preparatory work began in 2025 following ethical approval, focusing on stakeholder engagement, field coordination, tool refinement, and recruitment planning. Findings are expected to be submitted for publication by 2027.

CONCLUSIONS: Guided by a critical realist paradigm, this study is grounded in the understanding that individuals’ lived experiences of accessing and delivering health care are shaped by deeper social, structural, and institutional mechanisms that may not be immediately visible. By integrating the perspectives of refugees, host community members, and health care providers, the study will generate context-specific evidence to inform more equitable and socially responsive health care delivery in Cox’s Bazar and similar humanitarian settings. Additionally, by exploring how disparities in health care access affect perceptions of inequalities, the study will shed light on the broader implications for social cohesion between these coexisting communities. Findings will help inform future strategies to improve equitable health care delivery and policies in displacement-affected regions.

PMID:42600087 | DOI:10.2196/89917