Tag: nevin manimala

Chronic Obstr Pulm Dis. 2026 Jun 1. doi: 10.15326/jcopdf.2025.0746. Online ahead of print.

ABSTRACT

BACKGROUND: Lung sound analysis may capture chronic obstructive pulmonary disease (COPD) related physiology, but many methods are hard to interpret clinically. We developed a multidimensional acoustic physiology map using four indices from digital lung sounds: median respiratory frequency (MRF), long-term energy index (LTEI), subharmonic index (SubH), and harmonicity deviation index (HDI).

METHODS: In this single-center retrospective study, 235 adults were classified as Healthy (n=62), Stable COPD (n=85), or COPD exacerbation (n=88). We analyzed 1,403 posterior thoracic 15-s recordings. Between-group differences in the four indices were tested with the Kruskal-Wallis test; when significant, Dunn post-hoc pairwise comparisons were performed with Holm adjustment. Multidimensional separation was evaluated in the z-scored four-index space using principal component analysis (PCA) and permutational multivariate analysis of variance. All tests were two-sided with P-value < 0.05 considered significant.

RESULTS: Overall group differences were significant for MRF (P-value =1.36×10⁻⁵), SubH (P-value =3.29×10⁻⁶), and HDI (P-value =4.74×10⁻⁸), whereas LTEI did not show a statistically significant overall effect (P-value =0.086). Post-hoc analyses indicated that MRF and SubH primarily separated Stable COPD from both Healthy and COPD exacerbation, while HDI primarily separated COPD exacerbation from Healthy and Stable COPD. Group distributions were visualized with triangular heatmaps and summarized in a three-axis model.

CONCLUSION: Complementary acoustic indices reflect distinct domains of COPD-related sound generation and transmission. Although standalone classification performance was limited, the proposed map provides an interpretable framework for digital auscultation phenotyping and future composite scoring.

PMID:42224716 | DOI:10.15326/jcopdf.2025.0746

Anesth Analg. 2026 Jun 1. doi: 10.1213/ANE.0000000000008131. Online ahead of print.

ABSTRACT

BACKGROUND: The Non-Operating Room Anesthesia (NORA) Safety Project is an exploratory prospective cohort study examining the incidence of near-miss events in NORA settings. While adverse events are typically well captured because of quality improvement programs that exist in most major health settings, near-miss events are often not documented, and safety standards are not well established. We present the results of a dedicated forum for near-miss reporting, including the incidence and type of near-miss events, as a first step toward understanding NORA near misses. By providing granular data from a highly engaged audience, we aimed to highlight evidence-backed opportunities for improving safety culture in the procedural landscape.

METHODS: We surveyed all in-hospital NORA cases excluding pediatrics, those performed in the intensive care unit, or the peri-partum areas. The day of data collection was rotated weekly. Providers surveyed included anesthesiologists, nurse anesthetists, and anesthesiology residents. REDCap survey was sent via secure e-mail. If a near-miss event occurred, respondents were asked to classify their events in the following categories: patient, provider, and/or environment.

RESULTS: Over a 42-week period, 1383 completed surveys were received in which 90 near-miss events were reported. Filtering for near misses reported on study data collection days and removing voluntary near misses from our total survey responses, our incidence rate was 3.22% (43/1336). The top near-miss locations were the magnetic resonance imaging suite (21/90 [23.3%]) and both neuro and body interventional radiology suites (15/90 [16.7%] and 11/90 [12.2%], respectively). The top near-miss category was environmental concerns (75/90 [83.3%]), and top subcategory was poor group dynamics (31/90 [34.4%]). Significant characteristics in the near-miss patients included older age (mean [±standard deviation {SD}] 60.8 [±16.9] vs 56.8 [±17.3] years [P = .03]), male (52/90, 57.8% vs 586/1293, 45.3% [P = .03]), higher American Society of Anesthesiologists (ASA) physical status (III and IV 65/90, 72.2% [P < .001]), longer procedure (119.8 ± 108.9 minutes vs 63.1 ± 72.2 minutes [P < .001]), emergent procedures (28/90, 31.1% vs 159/1293, 12.3% [P < .001]), and involvement of resident providers (36/90, 40.0% vs 234/1293, 18.1% [P < .001]). A Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression model confirmed a statistically significant relationship between the presence of a resident provider and near-miss events (odds ratio: 2.38 [P = .02]).

CONCLUSIONS: The NORA landscape is often remote in location, not as well-staffed or well-resourced, and with variable setups. With a systematic survey, we were able to capture near-miss events which would otherwise have been lost. These near-miss events cannot be evaluated in isolation. Future direction should focus on a systems-wide approach in safety surveillance that facilitates multidisciplinary collaboration and reporting. Our findings demonstrate near misses as an opportunity-to improve in-hospital access to care, promote quality assurance, and ultimately, make NORA a safer place.

PMID:42224707 | DOI:10.1213/ANE.0000000000008131

JMIR Diabetes. 2026 Jun 1;11:e87364. doi: 10.2196/87364.

ABSTRACT

BACKGROUND: The prevalence of diabetes in the United States necessitates investigations into how to better enable adults with type 2 diabetes mellitus (T2DM) to manage their health using easy-to-access and personally adaptable technologies. The ubiquity of digital content further justifies the need to consider the impact of different digital intervention modalities in diabetes self-care activities.

OBJECTIVE: This study aimed to compare the impact of 2 digital diabetes self-care education programs delivered separately and in combination to adults with T2DM across various settings in Texas.

METHODS: We conducted a randomized controlled trial in Texas with 188 adults with T2DM to assess whether 2 different interventions alone (Virtual Making Moves with Diabetes or Technology-Based Education and Support) or in combination (Virtual Making Moves with Diabetes followed by Technology-Based Education and Support) improved multiple outcomes associated with diabetes self-management. We used several estimation techniques, including generalized estimating equations, to account for multiple factors simultaneously.

RESULTS: All 3 digital intervention modalities led to statistically significant improvements in diabetes-related confidence, distress, and self-care behaviors, with significance from baseline through 6 months and supported by moderate to strong effect sizes (Cohen d) ranging from 0.446 to 0.827 at 3-month follow-up versus baseline and from 0.538 to 0.888 at 6-month follow-up versus baseline. No statistically significant superiority was observed among the intervention modalities. Higher self-care behaviors were significantly associated with higher baseline confidence and lower distress. Those in the most disadvantaged positions (less education, less financial stability, and no health insurance) showed significantly larger improvement in self-care behaviors.

CONCLUSIONS: Given the benefits associated with this study’s interventions, we suggest future work to further develop digital content that can be tailored to individuals with T2DM to help them manage their chronic conditions in a cost-effective manner.

PMID:42224653 | DOI:10.2196/87364

J Med Internet Res. 2026 Jun 1;28:e68051. doi: 10.2196/68051.

ABSTRACT

BACKGROUND: Phishing remains a dominant initial attack vector in health care, exploiting psychological factors such as urgency and authority. Despite extensive investment in technical controls and awareness training, health care staff remain highly susceptible in real operational conditions. Cognitive dissonance (CD), the discomfort arising from inconsistencies between beliefs and actions, has been proposed as a mechanism to disrupt unsafe rationalization at the moment of exposure, but has rarely been evaluated in live organizational settings using objective behavioral outcomes.

OBJECTIVE: This study examined whether a brief CD-based priming intervention, delivered immediately prior to a real-world phishing simulation, was associated with differences in phishing susceptibility among health care staff. Secondary objectives explored whether CD exposure was associated with directional differences in security-related perceptions and self-reported practices.

METHODS: A 2-stage hybrid randomized-encouragement experiment was conducted at a large Norwegian hospital. In Stage 1, staff were randomly assigned to a control or CD-primed condition and completed a survey assessing security perceptions and self-reported practices (n=62). In Stage 2, an in-the-wild phishing simulation was sent to all staff, enabling objective measurement of phishing susceptibility via observed link-click behavior. Behavioral outcomes were analyzed across 3 groups-control (n=34), CD-primed (n=32), and neutral nonresponders (n=753)-using a prespecified omnibus chi-square test as the sole confirmatory analysis. Survey-based multivariate and univariate analyses were treated as exploratory due to limited sample size and variable construct reliability.

RESULTS: Due to voluntary uptake, only a subset of randomized participants received the intervention. Observed phishing click rates were 65% (22/34) in the control group, 44% (14/32) in the CD-primed group, and 53% (396/753) in the neutral group. The omnibus chi-square test did not detect a statistically significant association between group membership and click behavior (χ²2=3.00; n=819; P=.22; Cramér V=0.06). Descriptive comparisons within the randomized subset suggested lower click rates in the CD-primed group, but effect estimates were imprecise and associated with wide CIs. Survey-based analyses indicated group differences across combined psychological constructs; however, several constructs exhibited low internal consistency, and follow-up analyses were underpowered.

CONCLUSIONS: In a real-world hospital phishing simulation, pre-exposure CD priming was associated with a directional but statistically nonsignificant pattern of reduced phishing click behavior. This evidence does not establish a reliable behavioral effect, and construct-level findings are exploratory. CD-based prompts may serve as a lightweight behavioral signal in real-world conditions, but larger, fully randomized, and longitudinal studies with improved psychometric validation are needed before such interventions can be considered reliable complements to established cybersecurity controls.

PMID:42224651 | DOI:10.2196/68051

JCO Oncol Pract. 2026 Jun 1:OP2501315. doi: 10.1200/OP-25-01315. Online ahead of print.

ABSTRACT

PURPOSE: Sotorasib represents an early example in which the US Food and Drug Administration (FDA) requested formal dose optimization under Project Optimus. Although 960 mg remains the labeled dose, tolerability is often challenging. After the FDA Oncologic Drugs Advisory Committee discussion of CodeBreak100 part B, Ratain and Popat argued there was no clear basis for doses above 240 mg. We conducted a systematic review and meta-analysis comparing the efficacy and tolerability of standard versus reduced starting doses of sotorasib in KRAS G12C-mutated non-small cell lung cancer.

METHODS: We conducted a systematic search of PubMed, EMBASE, SCOPUS, CINAHL, and Web of Science through October 28, 2025. Eligible studies included randomized trials, prospective studies, and retrospective studies reporting objective response rate (ORR), progression-free survival (PFS), and treatment-related adverse events (TRAEs). Pooled estimates were calculated using a random-effects model.

RESULTS: Among 5,133 studies screened, 145 studies were reviewed, with 10 studies meeting inclusion criteria. The pooled ORR was 33% (95% CI, 29% to 36%) for patients starting at 960 mg (n = 1,347) versus 26% (95% CI, 19% to 34%) for those starting at reduced dose (n = 130), similar to the dose-optimization study (32.7% v 24.8%). There was no statistically significant improvement in ORR with the higher dose (risk ratio, 1.26 [95% CI, 0.87 to 1.83]). Similarly, pooled PFS did not favor 960 mg dosing (hazard ratio, 0.77 [95% CI, 0.56 to 1.05]). At 960 mg dose, TRAEs were common, with any-grade and grade ≥3 TRAE in 83% and 22%, respectively, with dose reductions in 17% and discontinuation in 10% of patients.

CONCLUSION: The labeled 960 mg dose did not demonstrate meaningful improvement in efficacy, while toxicity remained substantial. These findings support efforts under Project Optimus to identify the lowest effective dose. Lower doses, including 240 mg, may provide comparable outcomes while reducing toxicity, pill burden, and treatment costs.

PMID:42224643 | DOI:10.1200/OP-25-01315

JCO Clin Cancer Inform. 2026 Apr;10(2):e2500139. doi: 10.1200/CCI-25-00139. Epub 2026 Jun 1.

ABSTRACT

PURPOSE: Cancer registries are often asked to present cancer data for small geographic areas to inform and facilitate targeted interventions and prevention programs. However, it is challenging to compute and visualize reliable cancer estimates for areas with small case counts and populations to support cancer control planning.

METHODS: Leveraging a user-centered design process, we developed a visual analytics platform and interactive graphics to display modeled cancer risk estimates for small areas. Development of our visual analytics platform was informed by cancer registry and public health professionals through focus groups and surveys. The reliable cancer risk estimates for small areas that we displayed on this platform were created using a Bayesian hierarchical model that borrows strength from neighboring areas and over time to produce cancer estimates for small areas.

RESULTS: The Cancer Analytics and Maps for Small Areas tool (CAMSA) provided age-adjusted cancer incidence and mortality rates and risk probabilities for eight cancers at the county and ZIP-code tabulation area levels. It allowed the user to identify areas of high cancer incidence, including among subgroups defined by sex and race/ethnicity. Potential end users were enthusiastic about the opportunity to implement CAMSA within their practice, emphasizing the tool’s potential for increased collaborative opportunities at local and state levels. Suggestions for improvement included adding map overlays such as additional cancer risk variables and incorporating functionalities such as exportable data tables.

CONCLUSION: CAMSA presented cancer rate and risk estimates for small geographic areas where they may have previously been suppressed. Through our user-centered design process, we developed statistical models and data visualizations to support the needs of an array of potential end users.

PMID:42224633 | DOI:10.1200/CCI-25-00139

Chron Respir Dis. 2026 Jan-Dec;23:14799731261453571. doi: 10.1177/14799731261453571. Epub 2026 Jun 1.

ABSTRACT

ObjectivesTo determine whether a remote behaviour change service (Active Steps), delivered by a UK charity, can increase physical activity over a 12-month period in adults with lung disease.MethodsActive Steps (n=166) consisted of 1:1 telephone health coaching for 12 months alongside printed (e.g. activity diary and chart, information and goal setting booklet) and digital behaviour change strategies (e.g. exercise videos, motivational newsletters, pedometer). A concurrent control group was recruited (n=80) for comparison. Self-reported physical activity (Short Active Lives Survey) and self-reported health (EQ-VAS) were collected at baseline, 3, 6, and 12 months. Logistic regression models (adjusted for confounders) were used to analyse the odds of becoming physically active or average changes in physical activity time and EQ-VAS.ResultsPrimary outcome: The number of participants defined as physically active at 12 months was greater with Active Steps (46%) compared to controls (23%) which was statistically significant in an unadjusted (odds ratio (OR) [95% confidence intervals (CI)]:2.8 [1.3-6.1], p=0.011) but not adjusted model (OR: 2.2 [0.9-5.4], p=0.097). Secondary outcomes: Compared to controls, Active Steps increased the number of participants physically active at 3 and 6 months, increased the weekly minutes of moderate-vigorous physical activity and improved self-reported health (EQ-VAS) across all timepoints.DiscussionOur findings suggest that charity-led remote behaviour change support is effective in the short-to-medium-term in adults with lung disease, but high participant attrition necessitates caution in interpreting sustained effect estimates at 12 months. Further long-term evaluations are needed to address adherence and sustainability of such services.

PMID:42224628 | DOI:10.1177/14799731261453571

Proc Natl Acad Sci U S A. 2026 Jun 9;123(23):e2518179123. doi: 10.1073/pnas.2518179123. Epub 2026 Jun 1.

ABSTRACT

Childhood stunting is associated with increased mortality, higher risk of chronic disease, impaired cognitive development, lower educational attainment, reduced economic opportunities, and intergenerational transmission of stunting. These risks are likely to intensify as climate change exacerbates key drivers of undernutrition, making it important to understand how rising temperatures affect stunting and the role of socioeconomic inequality in this relationship. We analyze data from 34 African countries from 2004 to 2020 using Demographic and Health Surveys (DHS), combining observed temperature variability from ERA5 reanalysis with anthropogenic temperature anomalies derived from Detection and Attribution Model Intercomparison Project (DAMIP) simulations. Using a mediation framework, we examine pathways linking temperature anomalies, inequality, and child stunting. Results based on observed temperature anomalies show no direct climate effect on stunting or inequality, but a positive and statistically significant association between inequality and stunting. In contrast, anthropogenic temperature anomalies are positively associated with inequality and stunting, with a 1 °C increase linked to a 3.45% rise in child stunting (SE = 1.52, P = 0.023), with no evidence of mediation through inequality. Notably, we find a consistent positive association between inequality and stunting across specifications. These findings suggest that reducing inequality, together with investments in education, sanitation, and household resilience, could substantially lower stunting rates and protect child health in a warming world.

PMID:42224608 | DOI:10.1073/pnas.2518179123

Opt Lett. 2026 Jun 1;51(11):3253-3256. doi: 10.1364/OL.592295.

ABSTRACT

This work investigates the enhancement of channel capacity in photon-starved deep-space optical links by leveraging inter-photon correlations. We analyze an M-ary pulse-position modulation (PPM) photon-counting channel in the presence of Poisson background noise and compare conventional signal sources with recently proposed correlated photonic-dimer sources. In the low-photon-rate regime, the dimer sources in both the Bose-Einstein condensate (BEC) and Bardeen-Cooper-Schrieffer (BCS) limits yield substantial capacity improvements over conventional sources. Specifically, at the operationally relevant PPM order of M = 128, the increase relative to lasers reaches up to ∼37% (BEC) and ∼94% (BCS), respectively. These results underscore photon-statistics and correlation engineering as a promising degree of freedom for maximizing photon information efficiency under stringent power and transceiver constraints.

PMID:42224570 | DOI:10.1364/OL.592295

Toxicol Ind Health. 2026 Jun 1:7482337261453776. doi: 10.1177/07482337261453776. Online ahead of print.

ABSTRACT

The potential of the neonicotinoid insecticide dinotefuran to induce oxidative DNA damage was evaluated in human peripheral blood lymphocyte cultures at three concentrations (0.05, 0.15, and 0.30 µg/mL) using the single-cell gel electrophoresis assay (COMET). Its ability to interact with DNA was further examined through molecular docking analysis. The comet assay results revealed statistically significant increases (p < 0.001) in both the genetic damage index (GDI) and the percentage of heavily damaged cells (DCP) at all tested concentrations compared with the negative control. DNA damage within individual cells caused by genotoxic agents can thus be effectively detected using the comet assay, as demonstrated in our study. Additionally, the optimized molecular structure, total energy, molecular orbital energies, molecular electrostatic potential (MEP) maps, and global reactivity parameters of dinotefuran were obtained using the DFT/B3LYP/6-311G(d,p) method. The fully optimized energy was predicted, and geometric parameters were compared with available single-crystal structure data. Computational studies employing density functional theory (DFT) and MEP analyses provided detailed insights into the geometric and electronic characteristics of dinotefuran, suggesting that the compound possesses significant chemical reactivity and potential for biological activity upon interaction with DNA. Molecular docking studies with the B-DNA dodecamer (PDB ID: 1BNA) yielded a minimum binding energy of -6.24 kcal/mol. Dinotefuran was found to form four conventional hydrogen bonds, two carbon-hydrogen bonds, and one π-donor hydrogen bond with DNA, primarily involving guanosine, cytosine, and thymidine bases. These interactions are consistent with the experimental evidence of genetic-oxidative DNA damage, indicating that dinotefuran can establish strong molecular interactions with DNA.

PMID:42224505 | DOI:10.1177/07482337261453776