Tag: pubmed

JMIR AI. 2026 Jun 5;5:e77351. doi: 10.2196/77351.

ABSTRACT

BACKGROUND: Medical documentation imposes a significant administrative burden on physicians and reduces time for direct patient care. Artificial intelligence (AI)-assisted tools such as automatic speech recognition and large language models (LLMs) promise to reduce this burden, but their performance in multilingual environments has not been explored. Switzerland is highly multilingual, and non-native German-speaking physicians may find documentation particularly challenging.

OBJECTIVE: This study aimed to compare the efficiency and documentation quality of four clinical documentation workflows-including both AI-assisted and traditional methods-in a Swiss tertiary hospital setting characterized by linguistic diversity.

METHODS: In this proof-of-concept study at a Swiss tertiary hospital (Department of Plastic and Hand Surgery, Cantonal Hospital Aarau), two physicians-a native Swiss German speaker and a non-native German speaker-documented encounters with simulated patients having common hand disorders. Four documentation workflows were tested: (1) traditional dictation with transcription by a secretary; (2) real-time dictation using speech recognition software for voice to text transcription; (3) postencounter dictation transcribed by an AI (Whisper) and processed by a GPT-based agent; and (4) AI-assisted ambient dictation of entire appointments using audio recording and automatic transcription. Documentation efficiency was measured by recorded physician time, and note quality was assessed using a modified Physician Documentation Quality Instrument (PDQI-9) scored by three different LLMs. To protect patient privacy, only synthetic (simulated) patient data were used.

RESULTS: AI-assisted workflows-particularly workflow 4 (AI-assisted ambient dictation)-produced the shortest physician documentation times per report. In post-hoc comparisons, workflow 4 was significantly faster than solely the speech recognition software workflow (workflow 2) for both physicians (adjusted P<.001). For the non-native speaker, workflow 4 was not significantly faster than traditional dictation (workflow 1) after adjustment (P=.08). LLM evaluators assigned high absolute scores (median PDQI-9 >47/50); however, inter-rater reliability was poor (Krippendorff’s alpha=-.433, 95% CI: -0.444 to -0.416), indicating systematic disagreement that precludes definitive conclusions about documentation quality from these scores alone.

CONCLUSIONS: AI-assisted documentation demonstrated significant time savings for the native speaker, though the reduction for the non-native speaker did not reach statistical significance in this pilot (P=.08). Such tools show potential to alleviate the linguistic challenges faced by non-native speakers, reduce administrative burdens, and enable physicians to spend more time with patients. However, the inconsistency of AI-based quality scoring suggests that LLMs cannot yet reliably replace human evaluation. Future studies should evaluate these workflows in real-world clinical implementation, address data privacy and security issues, and include human evaluators to validate the benefits observed in this study.

PMID:42247573 | DOI:10.2196/77351

Proc Natl Acad Sci U S A. 2026 Jun 9;123(23):e2528457123. doi: 10.1073/pnas.2528457123. Epub 2026 Jun 5.

ABSTRACT

Dynamical heterogeneity, in which transitory local fluctuations occur in the conformation and dynamics of constituent particles, is widely hypothesized to be essential to the evolution of supercooled liquids into the structural glass state. Yet its microscopic spatiotemporal phenomenology is challenging to detect directly in molecular glass forming liquids. Because recent theoretical advances predict that corresponding dynamical heterogeneity could occur in supercooled magnetic monopole fluids (Proc. Nat. Acad. Sci. 112, 8549 (2015)), we searched for such phenomena in Dy₂Ti₂O₇. By measuring its microsecond-resolved spontaneous magnetization fluctuations [Formula: see text] we detected a sharp bifurcation in monopole noise characteristics below [Formula: see text], with the appearance of powerful spontaneous monopole current bursts. This intense dynamics emerges upon entering the supercooled monopole fluid regime, reaches maximum strength near [Formula: see text] and then collapses along with coincident loss of ergodicity approaching [Formula: see text]. Moreover, when the four-point dynamical susceptibility [Formula: see text] is determined directly from temperature dependence of correlations in [Formula: see text], it evolves as predicted when dynamical heterogeneity is present, revealing its simultaneously and rapidly escalating length and time scales, [Formula: see text] and [Formula: see text]. This overall phenomenology greatly expands our empirical knowledge of supercooled monopole fluids and, more generally, demonstrates techniques for detection of the time sequence, magnitude, statistics, and correlations of dynamical heterogeneity, access to which may greatly accelerate fundamental vitrification studies.

PMID:42247567 | DOI:10.1073/pnas.2528457123

Proc Natl Acad Sci U S A. 2026 Jun 9;123(23):e2522504123. doi: 10.1073/pnas.2522504123. Epub 2026 Jun 5.

ABSTRACT

We prove that kernel covariance embeddings lead to information-theoretically perfect separation of distinct continuous probability distributions. In statistical terms, we establish that testing for the equality of two nonatomic (Borel) probability measures on a locally compact uncountable Polish space is equivalent to testing for the singularity between two centered Gaussian measures on a reproducing kernel Hilbert space. The corresponding Gaussians are defined via the notion of kernel covariance embedding of a probability measure, and the Hilbert space is that generated by the embedding kernel. Distinguishing singular Gaussians is structurally simpler from an information-theoretic perspective than nonparametric two-sample testing, particularly in complex or high-dimensional domains. This is because singular Gaussians are supported on essentially separate and affine subspaces. Our proof leverages the classical Feldman-Hájek dichotomy, and shows that even a small perturbation of a continuous distribution will be maximally magnified through its Gaussian embedding. This “separation of measure phenomenon” appears to be a blessing of infinite dimensionality, by means of embedding, with the potential to inform the design of efficient inference tools in considerable generality. The elicitation of this phenomenon also appears to crystallize, in a precise and simple mathematical statement, a core mechanism underpinning the empirical effectiveness of kernel methods.

PMID:42247566 | DOI:10.1073/pnas.2522504123

IEEE Trans Neural Syst Rehabil Eng. 2026 Jun 5;PP. doi: 10.1109/TNSRE.2026.3700284. Online ahead of print.

ABSTRACT

Cochlear implants (CIs) restore hearing in individuals with severe sensorineural hearing loss. In recent years, electrically evoked auditory steady-state responses (EASSRs) to amplitude modulated (AM) signals have been studied as an objective measure. EASSRs can be objectively detected in electroencephalography (EEG) recordings at the modulation frequency using statistical tests. However, the presence of electrical stimulation artifacts from the CI itself hinders the EASSR detection. Whereas previous research has focused on an experimental characterization of these artifacts, this study presents a theoretical analysis of the stimulation signal together with an experimental analysis of the resulting artifacts to characterize their properties, origins and the effects of system nonlinearities.

METHODS: A stimulation signal model is presented and analyzed. The effects of pulse asymmetry and nonlinearity are examined. The theoretical statements are experimentally validated using an experimental setup containing a head phantom.

RESULTS: The analysis shows that the stimulation artifact at the modulation frequency is inherent to the stimulation signal, even in the absence of system nonlinearities. Moreover, when the pulse asymmetry is taken into account, second and higher order polynomial nonlinearities are found to contribute negligibly to the spectral component at the modulation frequency.

SIGNIFICANCE: The experimental analyses indicate the proposed signal model is a more accurate model for the stimulation signal and the resulting stimulation artifact at the modulation frequency. The model may form an important step in determining artifact contamination in EEG recordings of EASSRs and other envelope-following responses in CI recipients, enabling improved response detection.

PMID:42247548 | DOI:10.1109/TNSRE.2026.3700284

IEEE Trans Biomed Eng. 2026 Jun 5;PP. doi: 10.1109/TBME.2026.3700464. Online ahead of print.

ABSTRACT

OBJECTIVE: Patient-specific instrumentation (PSI) and robotic systems are being developed to improve Total Knee Arthroplasty outcomes in severe knee osteoarthritis. In image-based solutions, preoperative CT scans provide accurate bone geometry for planning, but not cartilage, which can affect intraoperative registration, thus surgical accuracy, if not addressed properly. Solutions exist, such as bone probing through cartilage, but they require additional surgical steps. As an alternative, Statistical Shape Models (SSMs) can automatically predict cartilage from bone shape. The present study evaluates whether SSMs can capture pathological variability, which features complex patterns of cartilage loss and bone deformation.

METHODS: Segmentations from the OAI-ZIB database were classified into healthy and pathological groups based on joint space narrowing. Coupled bone-cartilage SSMs were trained separately on these groups, for femur and tibia. The performance of the SSM was assessed by comparing bone fitting and cartilage prediction accuracy.

RESULTS: Bone fitting errors (median 0.27-0.32 mm) and cartilage prediction errors (median 0.41-0.49 mm, RMSE 0.66-0.79 mm) were comparable to the literature, with cartilage errors close to the inter-observer MRI manual segmentation variability reported for similar datasets. Predictive performance was similar for healthy and pathological cases, suggesting that SSMs can capture pathological variability. However, osteophytes were not fully captured, locally affecting prediction accuracy.

CONCLUSION: The four coupled SSMs accurately reconstructed bone and predicted cartilage in both healthy and arthritic knees, suggesting robustness to pathological variability and suitability for clinical integration.

SIGNIFICANCE: The proposed method could be integrated into CT-based PSI or robotic workflows without requiring MRI or additional steps.

PMID:42247542 | DOI:10.1109/TBME.2026.3700464

PLoS One. 2026 Jun 5;21(6):e0333572. doi: 10.1371/journal.pone.0333572. eCollection 2026.

ABSTRACT

Microplastics (MPs) in soils are becoming increasingly recognised as important terrestrial contaminants, yet their vertical distribution below the plough layer remains poorly understood. Here, we examined 76 genetic soil horizons from 27 profiles along four transects spanning managed and unmanaged land uses in Fars Province, southwest Iran, to depths of up to 140 cm. A total of 392 MPs were recovered from 71 of 76 samples, comprising 342 fibres (87.2%), 48 fragments or films and two spherules, with concentrations reaching about 320 particles kg-1 of dry soil. Raman analysis of 98 representative particles showed a dominance of polyamides, polyesters and polyolefins. MP abundance, size and polymer type were heterogeneous among sites and horizons, and only a few statistically significant relationships with soil properties were observed (notably inverse relationships with sand at Darab and silt at Sarvestan). MPs occurred throughout the profiles, including the deepest horizons, with no consistent size- or polymer-related fractionation with depth. These observations indicate sustained MP accumulation in soils and suggest that downward transport can occur under arid to semi-humid conditions through percolation, drying-cracking of the substrate and bioturbation. Because strong local point sources were not evident at most sites and fibres dominated the assemblage, atmospheric deposition is considered a major contributor at the soil surface, although additional source-specific data are needed to confirm this inference. The persistence and vertical mobility of MPs in Fars soils indicate potential risks to subterranean ecosystems and groundwater quality.

PMID:42247464 | DOI:10.1371/journal.pone.0333572

PLoS One. 2026 Jun 5;21(6):e0342982. doi: 10.1371/journal.pone.0342982. eCollection 2026.

ABSTRACT

BACKGROUND: During emergencies and crises, comprehending the influence of various factors on the health-related quality of life (HRQoL) of older adults is crucial for enhancing it. This study aimed to investigate the mediating role of resilience in the relationship between social support and health related quality of life.

METHODS: In this descriptive-analytical cross-sectional study, 341 older adults over 60 years participated, in 2023. Vaux’s social support questionnaire, SF-36 health-related quality of life questionnaire, and Conner and Davidson’s resilience questionnaire were used. Structural equation modeling (SEM) was used to determine the role of resilience as a mediator between social support and HRQoL. Statistical analysis of data was performed using STATA 14.2 software.

RESULTS: Based on the results, a one-unit increase in social support is associated with a 0.44-unit increase in resilience (β = 0.44) and a 0.24- unit increase in HRQoL (β = 0.24) on average. Furthermore, considering the mediating role of resilience, a one-unit increase in social support contributes 0.097- units directly (β = 0.097) and 0.12- units indirectly (β = 0.12) to HRQoL on average. The total effect of social support on HRQoL was also significant (β = 0.22).

CONCLUSION: Considering the mediating role of resilience in the relationship between social support and HRQoL among older people during the Covid-19 pandemic and the possibility of emergencies and pandemics in the future, it is necessary to carry out interventions focusing on improving resilience skills to make social support more effective in the elderly and to improve the quality of life related to health.

PMID:42247444 | DOI:10.1371/journal.pone.0342982

PLoS One. 2026 Jun 5;21(6):e0340749. doi: 10.1371/journal.pone.0340749. eCollection 2026.

ABSTRACT

BACKGROUND: Cutaneous melanoma incidence is rising globally, yet clinicopathological data from the high ultraviolet (UV) environment in the United Arab Emirates (UAE), with its diverse expatriate population, remain scarce. This study aims to characterize the histopathological features of cutaneous melanoma in a large, multi-ethnic cohort in the UAE.

METHODS: This retrospective cross-sectional study analyzed histopathologically confirmed cases of cutaneous melanoma diagnosed at a specialized dermatopathology laboratory in the UAE from 01/01/2017-01/01/2025. Patient demographics, tumor location, histologic subtype, Clark level, Breslow thickness, mitosis, lymphovascular, and perineural invasion were extracted and analyzed. Descriptive statistics, group comparisons, and multivariable logistic regression were performed using IBM SPSS version 29.0 to identify predictors of thick melanoma (Breslow thickness >1.0 mm).

RESULTS: A total of 597 patients met the inclusion criteria (50.8% male; mean age 47.4 ± 12.3 years). Individuals of European ancestry constituted 73.4% of cases. Superficial spreading melanoma was the predominant subtype (58.5%), and 46.9% of melanomas were thin (≤1.0 mm). Males presented with significantly thicker tumors than females (Breslow thickness of 0.72 ± 1.32 vs. 0.50 ± 0.58 mm; p < 0.01) and exhibited distinct anatomical distributions predominant to the trunk as compared to females with leg predominance. Multivariable analysis confirmed nodular melanoma (OR 18.40; 95% CI [7.08, 47.86]; p < 0.001) as the single strongest independent predictor of thick melanoma.

CONCLUSION: Melanoma in the UAE disproportionately affects fair-skinned expatriates and frequently presents with sex-specific clinical patterns. These findings highlight the need for targeted public awareness initiatives to reduce melanoma morbidity and mortality in the region.

PMID:42247436 | DOI:10.1371/journal.pone.0340749

PLOS Glob Public Health. 2026 Jun 5;6(6):e0006553. doi: 10.1371/journal.pgph.0006553. eCollection 2026.

ABSTRACT

Postpartum depression (PPD) harms maternal and child health. Evidence showed elevated PPD during the COVID-19 pandemic, but post-pandemic data from low-resource urban settings are limited. We measured PPD prevalence and its correlates among mothers attending postnatal clinics in Bole sub-city, Addis Ababa, Ethiopia, during the post-COVID-19 period (data collection: 1 March-30 April 2024). An institution-based cross-sectional study enrolled 410 mothers who delivered 2 weeks-1 year prior, attending five primary health centres. Participants were selected using systematic random sampling, with proportional allocation based on client flow across five primary health centers. Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale (EPDS); a cutoff ≥11 defined probable PPD. Data were entered in EpiData and analysed in SPSS. Bivariate analyses (p < 0.25) identified candidates for multivariable logistic regression; adjusted odds ratios (AOR) with 95% confidence intervals (CI) and p < 0.05 indicated statistical significance. A total of 410 mothers participated (mean age 28.8 ± 4.7 years). The prevalence of postpartum depression (PPD) was 20.0% (82/410; 95% CI: 16.4-24.1%). In multivariable logistic regression analysis, primiparity (AOR = 7.83; 95% CI: 1.29-47.71), unplanned pregnancy (AOR = 2.49; 95% CI: 1.25-4.95), poor partner support (AOR = 13.23; 95% CI: 3.08-56.94), low social support (AOR = 3.31; 95% CI: 1.13-9.74), and induction of labor (AOR = 2.73; 95% CI: 1.13-6.60) were independently associated with higher odds of postpartum depression. One in five mothers screened positive for PPD in this post-COVID-19 urban primary-care sample. First-time mothers and those with limited partner or social support, unplanned pregnancies, or induction of labour are at elevated risk. Integrating routine PPD screening into postnatal care, strengthening partner- and community-based support, and expanding family-planning and counselling services are priority measures to reduce PPD burden in Addis Ababa and similar settings.

PMID:42247429 | DOI:10.1371/journal.pgph.0006553

PLoS One. 2026 Jun 5;21(6):e0351214. doi: 10.1371/journal.pone.0351214. eCollection 2026.

ABSTRACT

Airway foreign-body aspiration in adults is uncommon but can be life-threatening.Flexible bronchoscopy is the standard first-line therapy,but critically ill patients may need extracorporeal life support.This study aims to characterize the diagnosis,management,and outcomes of adult airway foreign-body cases treated at a single center over nearly 12 years to inform a standardized clinical pathway.A single-center retrospective observational study of consecutive patients aged ≥14 years with confirmed airway foreign body who were treated at a tertiary hospital in China were conducted.Medical records of consecutive adolescent and adult patients diagnosed with airway foreign-body aspiration and admitted to the hospital from 01/01/ 2014-30/11/2025 were reviewed.Data included demographics,imaging,extraction method, respiratory support and so on.Descriptive statistics were reported as medians with interquartile ranges or counts and percentages.A total of 41 patients were included,with a median age of 59.5 years(interquartile ranges 51-72) and 65.85% male.Flexible bronchoscopy was attempted as the primary intervention in 38 patients(92.68%) and succeeded in 81.58%(31/38) to remove airway foreign body.Most patients(78.05%) required only nasal cannula oxygen,while nine patients(21.95%) needed advanced support including mechanical ventilation (14.63%),high-flow oxygen(4.88%),and extracorporeal life support (2.44%).At discharge,most survivors had a good neurological outcome,with 36 patients(87.80%) having a Cerebral Performance Categories score of 1.The 28-day survival rate was 92.68%.These findings show that flexible bronchoscopy is an effective first-line therapy,and rigid bronchoscopy or surgery is useful when flexible bronchoscopy fails.In unstable cases,timely extracorporeal life support can bridge to definitive removal.These results support a tiered,multidisciplinary approach incorporating early chest computed tomography,flexible bronchoscopy,and escalation to advanced airway or extracorporeal support.

PMID:42247425 | DOI:10.1371/journal.pone.0351214