Tag: nevin manimala

R I Med J (2013). 2026 Aug 1;109(8):49-53.

ABSTRACT

BACKGROUND/PURPOSE: Dietary factors greatly influence kidney stone disease (KSD). We aimed to examine the dietary pattern changes of adult stone formers (SF) in the United States from 1988 to 2018.

METHODS: We used weighted, multiple linear regression analyses to examine dietary data from prevalent SF in the National Health and Nutrition Examination Survey (NHANES) III and 2007-2018.

RESULTS: The study was divided into four periods: 1988-1994, 2007-2010, 2011-2014, and 2015-2018. The KSD prevalence rate increased from 5.5% in 1988-1994 to 10.8% in 2015-2018. No significant changes occurred in the intake of total calories, total protein, saturated fat, or sodium. Total daily fat intake increased significantly (78.9 g in 1988-1994 to 88.7 g in 2015-2018, p=0.03). Daily potassium intake decreased significantly (2,947 mg in 1988-1994 to 2,628 mg in 2015-2018, p<0.001). Daily calcium intake (795 mg in 1988-1994 to 950 mg in 2015-2018, p<0.001) and daily fluid intake (2,120 ml in 1988-1994 to 3,124 ml in 2015-2018, p<0.001) increased significantly. No effect modification by gender or age group was detected.

CONCLUSION: There were significant increases in polyunsaturated fat, calcium, and fluid intakes. However, dietary potassium intake was reduced. Overall, there were no statistically significant changes in dietary intakes of calories, protein, carbohydrates, fiber, saturated fat, and sodium.

PMID:42520235

R I Med J (2013). 2026 Aug 1;109(8):43-48.

ABSTRACT

PURPOSE: We evaluate the Clínica Esperanza Ophthalmology Service, a free service for uninsured patients in southern New England.

METHODS: The service operates monthly under a novel clinic-within-a-clinic model, existing as a subsidiary of a local free clinic. A mixed-methods program evaluation and a retrospective chart review from December 2021 to January 2025 were analyzed using descriptive statistics.

RESULTS: One hundred and forty-three (143) patients were scheduled during the study period, of whom 106 (74%) were seen. Median age was 51 years and 52/106 (49%) were female. Most patients (97%) identified Spanish as their primary language. There were no significant demographic differences between those seen and no-shows. Diabetic retinopathy was the most common diagnosis (37/106, 35%), followed by dry eye (35/106, 33%), and cataracts (29/106, 27%). Half of the patients (51/106, 48%) received a referral, most commonly for refraction (23/51, 45%). Ophthalmic medication was prescribed for 53/106 (50%) patients, most commonly for artificial tears (43/53, 81%). Qualitative strengths included education and low operational overhead. Qualitative challenges included long length of encounters and consequently, low patient volumes.

CONCLUSIONS: Our novel ophthalmology service supplements existing operations and helps meet an unmet public health need among its region’s most vulnerable patients. Opportunities for improvement include improving clinic volumes and mitigating no-show rates.

PMID:42520234

JMIR Res Protoc. 2026 Jul 28;15:e91675. doi: 10.2196/91675.

ABSTRACT

BACKGROUND: Continuing medical education (CME) is a legal and ethical obligation for physicians in Germany. The rapid rise of large language models (LLMs) such as ChatGPT, Gemini, Claude, and Grok raises concerns about the integrity of CME assessments, as LLMs can already pass German CME tests.

OBJECTIVE: This study aims to determine whether the choice of document format (searchable PDF, protected PDF, raster PDF, or vector PDF) and LLM influences the ability of LLMs to solve CME test questions at rates exceeding the passing threshold specified for each CME module (typically 70%).

METHODS: In a fully crossed within-subjects repeated-measures design, 18 expired CME articles from 3 major German publishers across 6 specialties will be converted into 3 cheating-impeding PDF formats and processed alongside the original PDF files by 4 current LLMs (GPT-5, Claude Sonnet 4, Grok-4, and Gemini 3). This results in 16 model-format combinations. Each model will answer every article 3 times per file-format condition, with outcomes derived from aggregated run-level results. The primary outcome is the proportion of correctly answered questions; the secondary outcome is the pass/fail rate.

RESULTS: The study has been approved by the Witten/Herdecke University Ethics Committee (S-260/2025; dated August 10, 2025) and is preregistered at the Open Science Framework. The study is supported by internal departmental resources only, and no external funding was received. Because this protocol evaluates LLMs using expired CME materials, no human participants are being recruited. Data collection is planned to begin in June 2026 and is expected to last approximately 4 weeks. At the time of manuscript submission, no data have been collected or analyzed. Results are expected to be available after the completion of data collection and statistical analysis in 2026. The analyses will quantify performance differences across document formats; these findings may inform the feasibility of nonsearchable document formats as a temporary measure to reduce LLM-enabled cheating risks in CME contexts.

CONCLUSIONS: By quantifying how document format constrains LLM performance, this study aims to evaluate simple technical safeguards that may reduce artificial intelligence-assisted manipulation of CME tests and inform regulators and CME providers about how to balance assessment validity, accessibility, and responsible LLM integration into postgraduate medical education.

PMID:42520225 | DOI:10.2196/91675

J Bone Miner Res. 2026 Jul 28:zjag117. doi: 10.1093/jbmr/zjag117. Online ahead of print.

ABSTRACT

Time in moderate-to-vigorous intensity activity (MVPA), light intensity activity (LPA), and sleep are critical for bone health in older adults but are often considered separately despite being inherently co-dependent. We examined cross-sectional associations between compositions of accelerometry-derived MVPA, LPA, inactivity, and sleep with bone microarchitecture and strength (High-Resolution Peripheral Quantitative Computed Tomography; HR-pQCT) in community-dwelling older men (n=119) and women (n=177), mean age 76.3±4.6 yrs. Participants wore an ActiGraph GT9X on their non-dominant wrist for 7 consecutive 24hr periods during the Study of Muscle, Mobility and Aging (SOMMA) baseline visit. The primary outcomes were distal radius (DR) and tibia (DT) estimated failure load, and secondarily, total volumetric bone mineral density (vBMD), and cortical (Ct) and trabecular (Tb) vBMD, area (Ar), and thickness (Th) from HR-pQCT. Compositional data analysis methods evaluated proportions of time in one behavior relative to the remaining behaviors. Sex-stratified multiple linear regression estimated associations between 24hr composition with sex-specific standardized HR-pQCT parameters. Compositional isotemporal substitution methods estimated hypothetical changes in continuous HR-pQCT measures if 10-60 min in one behavior was displaced by another. On average, women spent 90.2 min/day (6.3%) in MVPA, 346.1 min/day (24.0%) in LPA, 556.4 min/day (38.6%) in inactivity, and 447.4 min/day (31.1%) in sleep; men spent 93.6 min/day (6.5%) in MVPA, 309.5 min/day (21.5%) in LPA, 596.7 min/day (41.4%) in inactivity, and 440.2 min/day (30.6%) in sleep. Compared to the average sex-specific 24hr composition, higher proportions of MVPA were associated with higher DR and DT failure load in women; higher DR Tb.vBMD and Tb.Th in men; and higher DR Tt.vBMD, Ct.Ar, and Ct.Th, and DT Ct.vBMD, Ct.Ar, and Ct.Th in women. Hypothetically displacing 10-60 min in inactivity for MVPA resulted in more favorable HR-pQCT parameters. These data support the importance of MVPA for a healthy skeleton in older men and women.

PMID:42520223 | DOI:10.1093/jbmr/zjag117

Int J Clin Exp Hypn. 2026 Jul 28:1-31. doi: 10.1080/00207144.2026.2700719. Online ahead of print.

ABSTRACT

Hypnosis has a long history of use in anesthesia, but it has not yet achieved the level of widespread clinical usage, despite favorable results in some individual studies. This systematic review aimed to quantify hypnosis in the different anesthetic domains. A comprehensive search of the literature was undertaken using Medline, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials. In addition, the studies needed to be randomized controlled trials studying hypnosis and anesthesia. The search yielded 19 studies with a total of 3,699 patients over obstetrics, pediatrics, and dentistry. The results are encouraging, especially in the pediatric and dental areas where hypnosis was correlated with a statistically significant decline in both preoperative and intraoperative anxiety and a partial reduction in postoperative pain. In obstetrics, there was no beneficial impact from hypnosis on the pain. In conclusion, even though the number of high-quality studies is small, the studies indicate that hypnosis could serve as a helpful adjunct in defined anesthetic domains.

PMID:42520209 | DOI:10.1080/00207144.2026.2700719

J Occup Environ Med. 2026 Jul 28. doi: 10.1097/JOM.0000000000003838. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the association between perceived physical and psychosocial work environment in early adulthood (ages 21 and 28) and self-rated health at age 32.

METHODS: This study was based on data from the Vestliv cohort, a longitudinal study following individuals born in 1989 who were residents of Ringkøbing County in 2004. The study included questionnaire data from 556 working participants from 2010 and 794 from 2017.

RESULTS: Low trust at work, measured at age 21, was associated with poor self-rated health at age 32 in both adjusted and unadjusted analyses. Several work environment variables showed strong associations with poor self-rated health at age 32 in crude and partially adjusted models.

CONCLUSION: The study found that low trust at age 21 was statistically significantly associated with poor self-rated health at age 32.

PMID:42520192 | DOI:10.1097/JOM.0000000000003838

Brief Bioinform. 2026 Jul 3;27(4):bbag414. doi: 10.1093/bib/bbag414.

ABSTRACT

Mendelian randomization (MR) leverages genetic variants as instrumental variables to infer causal relationships between molecular traits and diseases, however, identifying the specific causal genes underlying disease risk remains challenging. Here, we present MULTI (Multi-tissue Unified Likelihood-based Transcriptomic Integration), a Bayesian MR framework that integrates genetic information across tissues to improve the accuracy of causal inference. MULTI yields reliable estimates even when the number of instruments in a single tissue is limited, and further increases statistical power by adaptively integrating information from similar tissues without inflating type I error rates. Extensive simulations confirm its robustness under diverse genetic architectures, and applications to real datasets demonstrate its capacity to reveal tissue-specific causal mechanisms and coordinated cross-tissue regulation. MULTI offers a practical and extensible framework for elucidating the molecular architecture of complex human diseases.

PMID:42520158 | DOI:10.1093/bib/bbag414

Logoped Phoniatr Vocol. 2026 Jul 28:1-22. doi: 10.1080/14015439.2026.2705822. Online ahead of print.

ABSTRACT

Introduction: Singing-voice therapy by Speech and Language Therapists (SLTs) is the main treatment for singing-voice disorders. Who are the SLTs who treat singing-voice disorders? Who are their patients? What clinical tools do they use? This study answers these three questions through a survey conducted in the French-speaking clinical community.

Method: 112 French-speaking SLTs responded to an open-ended survey. Descriptive and inferential statistical analyses were carried out, together with a comparison with existing voice therapy taxonomies.

Results: Most of the SLTs who work with singers are musicians. They have received cross-disciplinary training from health professionals, singing teachers and voice pedagogues, and teachers of mind-body techniques. Most of them use the term “dysodia” to refer to singing-voice disorders. Semi-occluded vocal tract exercises constitute their primary clinical tool. Indirect therapy is significantly less common than direct therapy. SLTs work significantly less on the musculoskeletal system than on the other systems (respiratory, auditory, somatosensory and vocal function). Their patients are mainly amateur singers of all styles.

Conclusions: This study provides a first structured overview of singing-voice therapy practices among French-speaking SLTs. It highlights clinical practices and tools consistent with recommendations in the literature. It lays the groundwork for future research on these specific therapeutic practices, as well as for the development of clinical guidelines, strengthened interprofessional collaboration, and international standardisation. The issue of therapeutic dosage has yet to be addressed. The predominance of amateur singers among singer-patients confirms the need for prevention.

PMID:42520146 | DOI:10.1080/14015439.2026.2705822

JBJS Rev. 2026 Jul 28;14(7). doi: 10.2106/JBJS.RVW.26.00060. eCollection 2026 Jul 1.

ABSTRACT

BACKGROUND: Aseptic loosening is a leading indication for revision total knee arthroplasty (rTKA). When one component remains well-fixed, surgeons may choose between isolated component revision (ICR) and full component revision (FCR), but the outcomes of these strategies remain uncertain. This systematic review and meta-analysis compared ICR with FCR in aseptic rTKA.

METHODS: Comparative studies of adult patients undergoing aseptic rTKA with ICR vs. FCR were identified. Outcomes included all-cause and cause-specific revision failure, patient-reported outcome measures (PROMs), and range of motion (ROM). The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach for statistically significant meta-analyses. Individual participant data (IPD) were reconstructed from Kaplan-Meier curves and pooled for time-to-event analyses to estimate hazard ratios (HRs). Aggregate data (AD) meta-analyses used random-effects models to calculate pooled odds ratios (ORs) and mean differences (MDs).

RESULTS: Fifteen cohort studies (4,429 patients; 2,893 FCR, 1,536 ICR) were included. Reconstructed IPD from 5 studies (3,187 patients) showed a higher hazard of all cause revision failure after ICR compared with FCR (HR 1.51; 95% CI 1.28-1.78; p < 0.001). The AD meta-analysis of 13 studies showed a similar association (OR 1.58; 95% CI 1.21-2.07; p < 0.001; I2 = 33%). Cause-specific analyses were imprecise and crossed the null for aseptic loosening (OR 1.50; 95% CI 0.75-2.99), infection related failure (OR 0.90; 95% CI 0.41-1.96), and instability-related failure (OR 1.03; 95% CI 0.43-2.46). PROMs did not clearly differ between strategies. ICR was associated with greater postoperative ROM (MD 7.03°; 95% CI 0.21-13.85; p = 0.043).

CONCLUSION: ICR in aseptic rTKA was associated with an increased overall all-cause revision failure rate compared with FCR. While ICR is associated with a higher all-cause revision failure rate, the choice between techniques remains subject to surgeon discretion and patient-specific factors.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:42520142 | DOI:10.2106/JBJS.RVW.26.00060

Gut Microbes. 2026 Dec 31;18(1):2699456. doi: 10.1080/19490976.2026.2699456. Epub 2026 Jul 28.

ABSTRACT

BACKGROUND: Although COVID-19 vaccination has reduced morbidity and mortality, adults aged 65 y old and older are at high risk of complications from COVID-19. The evidence suggests that probiotics may enhance immune responses when co-administered with influenza vaccination. However, few studies have evaluated the potential benefit of probiotic supplementation in this context in this high-risk population.

MATERIAL: This study was a randomized controlled trial recruiting adults between 65 and 89 y of age living in Quebec, Canada, who received an mRNA booster (Pfizer-BioNTech or Moderna). Probiotic supplementation (Lacticaseibacillus rhamnosus Rosell^®-11 and Lacticaseibacillus paracasei Rosell^®-215, 1x 6 x 10⁹CFU per capsule) versus placebo was administered from 15 d pre- to 15 d post-vaccination. Participants provided dried blood spot samples at baseline, at 3- and 6-month post-vaccination. The primary outcome was the proportion of participants without detectable anti-S1-receptor binding domain (anti-S1-RBD) antibodies at 6 months post-vaccination. Secondary outcomes included longitudinal anti-S1-RBD and anti-nucleocapsid (anti-N) antibody responses across the three timepoints.

RESULTS: 592 adults were enrolled. At 6 months post-vaccination, anti-S1-RBD antibodies were comparable between groups, and the percentage of participants with undetectable antibody response in the placebo and probiotic groups (1.2% vs 1.6%) was comparable. Anti-N seropositivity was lower in the probiotic group at 6 months (OR 0.6, 95% CI 0.4-0.9; p = 0.02) and marginally lower at 3 months after adjustment. Self-reported COVID-19 infection incidence was 16.5% overall (19.1% placebo vs 13.9% probiotic; p = 0.134).

CONCLUSION: Probiotic supplementation administered around COVID-19 vaccination did not change the proportion of seronegative participants for anti-S1-RBD antibodies at 6 months. However, in the probiotic group, anti-N antibody levels were lower, while self-reported COVID-19 infections also tended to be reduced, although this difference was not statistically significant. They may be consistent with earlier control of infection and reduced exposure to the nucleocapsid antigen, but this interpretation remains speculative.

TRIAL REGISTRATION NUMBER: #NCT05195151.

PMID:42520140 | DOI:10.1080/19490976.2026.2699456