Tag: pubmed

Radiography (Lond). 2026 Aug 7;32(6):103532. doi: 10.1016/j.radi.2026.103532. Online ahead of print.

ABSTRACT

INTRODUCTION: Iodinated contrast dosing in pediatric computed tomography (CT) traditionally relies on total body weight (TBW), which may result in excessive contrast administration, particularly in patients with higher adiposity. Lean body weight (LBW)-based protocols have shown promise in adults but remain underexplored in children. Therefore, the aim of this study was to compare contrast volume requirements and hepatic enhancement quality among three dosing protocols: LBW-based, TBW-based, and the Control Group (CG), based on the institutional standard for pediatric abdominal CT.

METHODS: This prospective study enrolled 66 patients (age 0-16 years) undergoing contrast-enhanced abdominal CT between September 2023 and August 2024. Patients were randomly assigned to receive iodinated contrast (iobitridol 350mg I/mL) dosed by: (1) LBW (0.63 g iodine/kg x LBW, calculated using Peters formula; n = 23), (2) TBW (0.46 g iodine/kg x TBW; n = 20), or (3) institutional control protocol (2 mL/kg x TBW, equivalent to 0.7 g iodine/kg; n = 23). Kruskal-Wallis, ANOVA, Two-way ANOVA, ANCOVA, Scheirer-Ray-Hare, and Cohen’s Kappa tests with Likert scale were used.

RESULTS: The LBW group received lower median contrast volumes (27 mL; IQR, 10-80 mL) compared to the TBW group (34.5 mL; IQR, 18-78 mL) and the CG group (40 mL; IQR, 13-80 mL), although the differences did not reach statistical significance (P > 0.05). Notably, this reduction did not compromise hepatic enhancement, which remained comparable to the CG (552 ± 139 HU; P = 0.107).

CONCLUSION: Lean body weight may be a useful parameter for estimating contrast dose in pediatric abdominal CT, potentially reducing administered volumes without compromising diagnostic image quality.

IMPLICATIONS FOR PRACTICE: These results provide early evidence that LBW-based dosing may support more individualized contrast administration in pediatric CT, potentially reducing exposure-related risks.

PMID:42566807 | DOI:10.1016/j.radi.2026.103532

J Neurosurg Pediatr. 2026 Aug 7:1-9. doi: 10.3171/2026.4.PEDS2659. Online ahead of print.

ABSTRACT

OBJECTIVE: Although myelomeningocele (MMC) remains a leading cause of infant disability and death in many low- and middle-income countries, data regarding access to timely neurosurgical care remain limited. The goal of this study was to characterize sociodemographic and clinical factors associated with delayed presentation for neurosurgical repair of MMC in Zambian infants.

METHODS: Infants with MMC presenting to a major tertiary academic hospital in Lusaka, Zambia, for MMC repair between May 1, 2024, and October 21, 2025, were enrolled in a prospective cohort study. The primary outcome was delayed patient presentation for postnatal neurosurgical care, defined as > 72 hours from birth. Univariate and multivariate logistic regression models were fit to assess the impact of demographic and clinical factors on late presentation to this tertiary care center.

RESULTS: One hundred eighteen infants (53% male, n = 62) were enrolled, with 22% (n = 25) born prematurely. Seventy-one percent (n = 84) had a delayed presentation to the tertiary hospital. The median age at first neurosurgical evaluation was 8.0 (IQR 3.0-22.0) days. The median maternal age was 25.0 (IQR 20.0-30.0) years, with a median parity of 2 (IQR 1-4). Most mothers (67%, n = 79) had either no formal education or completed primary school only, and of those who answered the question, the majority were married (72%, 47/65). The self-reported median monthly household income was 16.56 (IQR 4.42-26.50) US dollars. The median distance from the primary referring center to the tertiary hospital was 414.9 (IQR 206.5-577.0) km. Preterm infants (OR 3.997, p = 0.027) and those who traveled ≥ 500 km to receive care (OR 5.085, p = 0.001) were more likely to present late, while those who received ≥ 1 antenatal ultrasound after 20 weeks’ gestation tended to have earlier presentation (OR 0.363, p = 0.032). No statistically significant association was found between late presentation and any of the following: maternal age at delivery, education level, marital status, parity, multiplicative increases in monthly household income, infant sex, and presence of any congenital anomalies or comorbidities (p > 0.05).

CONCLUSIONS: Longer distances to care and preterm birth were associated with delayed patient presentation, while receipt of antenatal ultrasound was associated with earlier presentation. Further investigations aimed at enhancing antenatal and postnatal care, as well as improving transportation access to neurosurgical tertiary care services, are warranted.

PMID:42566797 | DOI:10.3171/2026.4.PEDS2659

JMIR Form Res. 2026 Aug 7;10:e87320. doi: 10.2196/87320.

ABSTRACT

BACKGROUND: Digital phenotyping-the use of continuous data streams from digital devices such as smartphones to assess behavioral, psychological, and physiological states-holds transformative potential for health monitoring and personalized care. However, real-time analysis of large multimodal data often exceeds mobile devices’ computational resources, leading most platforms to rely on sequential processing and cloud-based computation.

OBJECTIVE: We propose the Stanford Screenomics platform as a software reference architecture that uses a modular design to integrate parallel processing and edge computing, enabling scalable, real-time digital phenotyping on smartphones.

METHODS: Two prototype apps were developed: one following the parallel, on-device architecture (Stanford Screenomics platform) and another based on a traditional sequential, cloud-based design (traditional). Both processed identical multimodal data streams at the same intensity; only the location and sequence of computation differed. In two 48-hour experiments, performances were compared across four load profiles: low (≈10 MB/min), medium (≈30 MB/min), heavy (≈40 MB/min), and very heavy (≈60 MB/min). In the first experiment, offline resource performance was assessed under continuous simulated smartphone use. Virtual users completed six tasks in a fixed five-minute sequence: watching YouTube (Google LLC), reading eBooks, browsing TikTok (ByteDance Ltd), web surfing, listening to Spotify, and scrolling Instagram Reels (Meta). Minute-by-minute measurements of CPU usage (%), RAM usage (MB), battery drain (%/h), and data loss (%) were collected. Descriptive statistics (mean±SD) summarized performance, and independent t tests compared architectures. Data loss trajectories were analyzed to determine whether growth was linear or exponential under increasing load. In the second experiment, end-to-end phenotyping latency was evaluated over stable Wi-Fi. Five key-stage timestamps per trial tracked local writes, preprocessing, memory parsing, phenotype analysis, and intervention delivery. Total phenotype update time per trial was the primary outcome, and latency differences between architectures were analyzed using linear mixed-effects models, with IQRs reported to capture variability across load conditions.

RESULTS: The Stanford Screenomics platform consistently demonstrated lower CPU usage (3.9%-14.6% vs 10.5%-26.9%) and RAM usage (97-132 MB vs 101-155 MB) than the traditional, with reduced battery drain (0.9%-2.1%/h vs 1.4%-3.2%/h). Data fidelity was higher in the Stanford Screenomics, with shallow linear data loss (0.4%-1.5%/h) compared to exponential growth in the traditional (2%-7.1%/h), achieving up to 9.4× greater data retention under very heavy load. The Stanford Screenomics completed phenotype updates in 0.90 seconds under low load and 9.32 seconds under very heavy load, compared to 30.1-398.1 seconds for traditional, representing 34-43×faster processing with substantially narrower variability (IQR 0.3-6 s vs 11 s-5 min).

CONCLUSIONS: These results demonstrate that the Stanford Screenomics platform architecture enables real-time, on-device digital phenotyping with high fidelity and low latency. This validated prototype architecture establishes a resilient foundation for the next generation of scalable, reliable, and context-aware deployment of real-world mobile health interventions on mobile devices.

PMID:42566795 | DOI:10.2196/87320

J Neurosurg. 2026 Aug 7:1-10. doi: 10.3171/2026.3.JNS252582. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to investigate the impact of 3D 1H-MR spectroscopy (MRS)-guided metabolic boundary resection (MBR) on the extent of resection (EOR), surgical safety, and prognosis in glioblastoma.

METHODS: A retrospective analysis was performed on clinical data from patients with IDH-wildtype glioblastoma who underwent resection at the authors’ hospital. Patients were divided into two groups based on surgical methods: the traditional boundary resection (TBR) group (neuronavigation + contrast-enhancing [CE] boundary resection) and the MBR group (3D 1H-MRS combined with neuronavigation + MBR). Demographic, perioperative, and follow-up data were collected and compared between the two groups. Cox proportional hazards regression and Kaplan-Meier survival analysis were used to evaluate the effects of various clinical and treatment-related factors on patient survival.

RESULTS: The MBR group included 41 patients (mean age 54.17 ± 12.04 years, 65.85% male) with a mean tumor volume of 58.07 ± 20.63 cm3. The TBR group included 30 patients (mean age 56.86 ± 9.78 years, 63.33% male) with a mean tumor volume of 52.51 ± 24.06 cm3. There were no statistically significant differences between the two groups in tumor laterality, location, volume, and length of hospital stay. In the TBR group, 10 patients achieved supra-total resection (SpTR), 13 achieved gross-total resection (GTR), and 7 achieved subtotal resection (STR). In the MBR group, 25 patients achieved SpTR, 10 achieved GTR, and 6 achieved STR. The rate of SpTR was significantly higher in the MBR group compared to the TBR group (p = 0.021). Postoperative neurological deficits occurred in 1 patient (2.4%) in the MBR group (transient) and 2 patients (6.7%) in the TBR group (1 permanent). No significant difference in complication rates was observed (p = 0.369). Kaplan-Meier survival analysis and log-rank tests demonstrated that the MBR group had significantly longer progression-free survival (PFS) and overall survival (OS) compared to the TBR group (p < 0.001). Multivariable Cox proportional hazards regression analysis identified EOR and surgical methods as independent prognostic factors.

CONCLUSIONS: Three-dimensional 1H-MRS combined with a neuronavigation system is used to guide glioblastoma resection along the metabolic boundary during surgery, which can lead to a more complete resection of the glioblastoma and improve the PFS and OS of patients. Compared to CE boundary resection, MBR appears to be a stronger prognostic factor for survival.

PMID:42566787 | DOI:10.3171/2026.3.JNS252582

J Neurosurg Pediatr. 2026 Aug 7:1-7. doi: 10.3171/2026.4.PEDS2682. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the prognostic value of intraoperative EEG during corpus callosotomy (CC) in pediatric patients with drug-resistant epilepsy (DRE), with a particular focus on bisynchronization blockade and its correlation with long-term seizure outcomes.

METHODS: A retrospective review was performed of pediatric patients with DRE and injurious drop attacks who underwent CC between 2005 and 2024. Patients were stratified into three groups based on intraoperative scalp EEG findings: 1) > 50% bisynchronization blockade, 2) < 50% blockade, and 3) absent bisynchronization. Baseline clinical characteristics, surgical approach, and extent of CC were recorded. Seizure outcomes were assessed using Engel and International League Against Epilepsy (ILAE) classifications with a minimum follow-up of 1 year. Whether atonic seizures resolved postoperatively was also evaluated. Group comparisons were performed using Fisher’s exact test and Kruskal-Wallis rank-sum testing.

RESULTS: Forty-six patients met the inclusion criteria. The majority underwent complete CC (65%), most via an open approach (67%). At 1 year, freedom from atonic seizures (ILAE class 1Engel class I) was highest in the > 50% blockade group (70.0%) compared with the < 50% blockade (40.0%) and absent bisynchronization (25%) groups (p = 0.042). At last follow-up (mean 5.3 years), the > 50% blockade group similarly achieved significantly higher rates of atonic seizure freedom (ILAE class 1/Engel class I, 76%) compared with 0% in the < 50% blockade and 25% in the absent bisynchronization groups (p < 0.001). Outcomes for total seizure freedom varied and did not reach statistical significance between groups.

CONCLUSIONS: Achieving > 50% intraoperative bisynchronization blockade during CC was strongly associated with improved long-term atonic seizure freedom. These findings support the role of intraoperative EEG as a prognostic marker of effective seizure control.

PMID:42566786 | DOI:10.3171/2026.4.PEDS2682

JMIR Diabetes. 2026 Aug 7;11:e99345. doi: 10.2196/99345.

ABSTRACT

BACKGROUND: Serious digital games have been proposed as a novel approach to support diabetes education and self-management, but evidence regarding their effectiveness remains limited.

OBJECTIVE: This study aimed to evaluate the effects of SugarVita, a serious game for people with type 2 diabetes, on diabetes-related knowledge, self-confidence, and self-management. Secondary outcomes included hemoglobin A1c (HbA1c), engagement, and user evaluation.

METHODS: In this pilot randomized controlled trial, 30 adults with type 2 diabetes were randomized to SugarVita plus standard care or standard care alone for 8 weeks. Outcomes were assessed before and after the intervention using validated questionnaires and laboratory HbA1c values. Within-group changes were analyzed using Wilcoxon signed-rank tests and between-group differences using Mann-Whitney U tests. Bonferroni correction was applied for multiple primary outcomes.

RESULTS: No statistically significant between-group differences were observed for diabetes-related knowledge, self-confidence, or self-management after correction for multiple testing. Both groups showed numerical improvements over time. HbA1c decreased significantly within the intervention group (median 73.0, IQR 70.8-81.5 to median 64.5, IQR 60.8-72.0 mmol/mol; P=.007), whereas no significant change was observed in the control group. Greater total playtime was moderately associated with HbA1c reduction. User evaluations indicated high perceived educational value.

CONCLUSIONS: Participants reported positive experiences with SugarVita and perceived the game as educational and user-friendly. No statistically significant between-group differences were observed for the primary outcomes. These findings support the feasibility and acceptability of SugarVita as a digital educational intervention and warrant further evaluation in larger studies.

PMID:42566777 | DOI:10.2196/99345

J Med Internet Res. 2026 Aug 7;28:e96800. doi: 10.2196/96800.

ABSTRACT

BACKGROUND: Pain remains a critical issue among hospitalized children and may negatively affect postoperative recovery. In addition to pharmacological pain management, nonpharmacological approaches have been used to support pediatric care. Among these emerging approaches, socially assistive robots (SARs) may offer an opportunity to support children during hospitalization. However, limited evidence exists regarding the use of SARs in pediatric postoperative recovery and their influence on children’s emotional responses during child-robot interaction (CRI).

OBJECTIVE: This study aimed to examine changes in postoperative pain levels following a SAR intervention among hospitalized children. In addition, it aimed to explore emotional responses during CRI using automated facial expression analysis.

METHODS: A single-arm pre-post study was conducted in a pediatric surgical ward. Children recovering from surgery participated in a structured SAR intervention consisting of 3 phases: warm-up, educational video, and interactive engagement. Pain outcomes were assessed using the self-reported Wong-Baker FACES pain rating scale and the observer-rated FLACC (face, legs, activity, cry, and consolability) scale. Emotional responses were evaluated using automated facial expression analysis, which generated continuous emotional valence scores ranging from -1 (negative) to +1 (positive). Wilcoxon signed-rank tests were used to analyze pain outcomes, and Friedman tests were used to examine differences in emotional valence across intervention phases.

RESULTS: A total of 37 children were included in the pain outcome analysis, and 35 (95%) children were included in the emotional valence analysis after excluding participants with insufficient facial expression data. Significant reductions were observed in both self-reported and observed behavioral pain following the intervention. Self-reported pain scores decreased from a median of 6 (IQR 4-6) to 4 (IQR 2-4; P<.001), and FLACC scores decreased from a median of 3 (IQR 2-4) to 1 (IQR 1-2; P<.001). Emotional valence remained negative across all intervention phases. The Friedman test did not reach statistical significance across the 3 phases and showed a small effect size (P=.05).

CONCLUSIONS: The SAR interventions may be associated with lower postoperative pain scores among hospitalized children. Although emotional valence did not significantly change during CRI, automated facial expression analysis was implemented and demonstrated the feasibility of continuous affective assessment in a real-world pediatric clinical setting. These findings support the potential use of the SAR interventions as a complementary strategy in pediatric postoperative care and provide preliminary evidence supporting the integration of real-time affective assessment into pediatric health care.

PMID:42566770 | DOI:10.2196/96800

JMIR Perioper Med. 2026 Aug 7;9:e84457. doi: 10.2196/84457.

ABSTRACT

BACKGROUND: Patient satisfaction is a key indicator of health care quality, and it guides improvement efforts. Although many local studies have examined perioperative patient satisfaction in Ethiopia, there is no comprehensive national synthesis. This gap limits the development of targeted strategies to enhance patient care.

OBJECTIVE: The aim of this systematic review and meta-analysis is to determine the pooled prevalence of patient satisfaction with perioperative services in Ethiopia and identify associated factors.

METHODS: This study included all observational research articles on patient satisfaction with perioperative services in Ethiopia. A multidatabase search strategy, incorporating PubMed/MEDLINE, HINARI, Web of Science, Cochrane Library, African Journals Online, and Scopus, was used alongside a gray literature search to identify all Ethiopian studies on perioperative satisfaction available before January 1, 2024. The Newcastle-Ottawa Scale was used to assess the quality of the studies. To assess heterogeneity, subgroup analyses were conducted, and I² statistics were calculated. This study used funnel plots, the Egger test, and a nonparametric trim-and-fill analysis to assess publication bias. A sensitivity analysis was also used to identify any influential studies. Univariate meta-regression examined the association between study-level covariates and perioperative satisfaction.

RESULTS: This review included 21 studies comprising 6858 participants. Overall satisfaction with perioperative services was expressed by 5072 participants (73.96%, 95% CI 68.84%-79.08%; I²=96.56%). Factors significantly associated with higher satisfaction included effective postoperative pain management (adjusted odds ratio [AOR] 2.23, 95% CI 1.56-2.90), illiteracy (AOR 3.18, 95% CI 1.23-5.13), primary school education (AOR 6.55, 95% CI 3.61-9.49), local anesthesia use (AOR 2.80, 95% CI 2.03-3.57), and history of prior surgery or anesthesia (AOR 2.76, 95% CI 1.51-4.01).

CONCLUSIONS: This study found that the pooled prevalence of patient satisfaction with perioperative services in Ethiopia was 73.96% (5072/6858 participants). Postoperative pain management, illiteracy, primary school, local anesthesia, and a history of surgery or anesthesia were significantly associated with patient satisfaction with perioperative services. Health care facilities should focus on providing effective postoperative pain management, clear information about perioperative services, and training for surgical and anesthesia teams to boost patient satisfaction with perioperative services in Ethiopia.

PMID:42566769 | DOI:10.2196/84457

Online J Public Health Inform. 2026 Aug 7;18:e97291. doi: 10.2196/97291.

ABSTRACT

BACKGROUND: Financial toxicity can contribute to adverse health and care-access outcomes among US veterans, yet scalable methods to identify individuals at elevated risk remain limited. Public health informatics frameworks may enable the translation of patient-reported financial risk signals into streamlined screening, risk stratification, and care-navigation workflows.

OBJECTIVE: This study aimed to examine concept-level indicators of financial literacy and financial toxicity among US veterans and explore how these findings could inform future informatics-enabled screening strategies for identifying subgroups at increased risk of health-related financial strain.

METHODS: We conducted an exploratory cross-sectional survey of 88 US veterans from 2024 to 2025. Financial literacy was assessed using 3 benchmark items from the National Financial Capability Study. Financial toxicity was assessed using items aligned with domains reflected in the Comprehensive Score for Financial Toxicity framework, including difficulty affording care, reduced or quit work, borrowing money or using savings for care, and treatment-adherence impact. Analyses included descriptive statistics, Fisher exact tests, unadjusted logistic regression, and a minimally adjusted sensitivity model for work disruption, controlling for age and education.

RESULTS: Female veterans had lower rates of high financial literacy than male veterans (15/29, 52% vs 48/59, 81%; P=.006) and lower correct-response rates on compound interest (10/29, 35% vs 36/59, 61%; P=.02) and inflation (14/29, 48% vs 43/59, 73%; P=.03). Black veterans had lower correct-response rates than non-Black veterans on inflation (11/24, 46% vs 46/64, 72%; P=.03) and retirement strategy (15/24, 63% vs 56/64, 88%; P=.014), although composite high-literacy rates did not differ significantly by race. In unadjusted models among participants with complete outcome data (n=75), lower financial literacy was directionally associated with higher odds of all 4 financial toxicity outcomes, with the clearest association observed for work disruption (odds ratio 0.56 per 1-point increase in financial literacy score, 95% CI 0.33-0.95; P=.03). Black female veterans reported elevated financial toxicity across multiple domains. Financial support program use was low overall (29%).

CONCLUSIONS: These findings suggest that financial literacy may be a marker of vulnerability to financial toxicity among veterans, but observed associations should be regarded as preliminary and hypothesis-generating. The results identify concept-level financial literacy domains and work disruption as candidate signals for future screening evaluation. Future research should evaluate whether brief screening, financial literacy assessment, and benefit-navigation strategies improve identification, referral, adherence, and downstream financial and health-related outcomes in larger and more representative veteran populations.

PMID:42566768 | DOI:10.2196/97291

Traffic Inj Prev. 2026 Aug 7:1-7. doi: 10.1080/15389588.2026.2694621. Online ahead of print.

ABSTRACT

OBJECTIVE: Driver drowsiness is a critical factor in road accidents. This study aimed to model behavioral indicators of drowsiness using a driving simulator to support noninvasive detection systems.

METHODS: Twenty-four participants completed simulated driving tasks under varying alertness levels. Behavioral metrics including eye-blinking frequency, head movement acceleration, and eye movement variability were recorded. Drowsiness classification was performed using supervised Partial Least Squares Discriminant Analysis (PLS-DA), with the Karolinska Sleepiness Scale as the reference standard. Preprocessing steps included general mean-centering, pairwise mean-centering, and unit variance scaling.

RESULTS: Blink frequency significantly increased with drowsiness, while fluctuations in head movement acceleration and eye movements also rose, indicating reduced alertness. Derived variables such as Corrected Turning Ratio (CTR) showed predictive relevance, whereas angular velocity of head movement was not statistically significant. Model evaluation demonstrated strong performance (ROC AUC = 0.935), with low misclassification rates and acceptable residual normality.

CONCLUSIONS: Behavioral metrics provide practical predictive value for noninvasive drowsiness detection. Although limited by sample size, the model achieved meaningful separation between alertness and drowsiness. Future studies should expand sample size, incorporate additional behavioral indicators, and validate findings externally to strengthen predictive performance.

PMID:42566753 | DOI:10.1080/15389588.2026.2694621