Tag: pubmed

J Obstet Gynaecol. 2026 Dec;46(1):2697258. doi: 10.1080/01443615.2026.2697258. Epub 2026 Jul 21.

ABSTRACT

BACKGROUND: Ineffective uterine contractions contribute to labour dystocia and are a leading indication for primary caesarean delivery. Although oxytocin is the standard therapy for augmentation, prolonged exposure may result in receptor desensitisation and reduced effectiveness. Calcium is essential for myometrial contraction; however, systemic calcium homeostasis is tightly regulated, and it is unclear whether oral calcium supplementation can meaningfully influence uterine activity. This study aimed to evaluate the effect of oral calcium carbonate on uterine contractility.

METHODS: We conducted a single-centre randomised controlled pilot trial at a tertiary care teaching hospital (ClinicalTrials.gov: NCT07056062). Term patients with singleton foetus in cephalic presentation and an intrauterine pressure catheter in place were randomised 1:1 to receive a single 2,000 mg oral dose of calcium carbonate or no intervention. Uterine activity was measured using Montevideo units (MVUs) at baseline and at 30-minute intervals for two hours. Secondary outcomes included contraction frequency, peak contraction pressure, labour duration, mode of delivery, oxytocin dose, and postpartum haemorrhage. Oxytocin infusion rates were held constant during the observation period.

RESULTS: Eighty-nine patients were analysed (45 control; 44 intervention) with similar baseline characteristics. No statistically significant difference in baseline MVUs was observed between groups (p = 0.1825). Although absolute MVUs were higher in the intervention group at 30 minutes (p = 0.0500), this difference was not sustained at subsequent time points and was absent in change-from-baseline analyses, suggesting no clinically meaningful treatment effect. No statistically significant differences were identified in secondary outcomes.

CONCLUSIONS: Oral calcium carbonate did not result in a statistically significant improvement in uterine contractility or clinical outcomes. These findings likely reflect the limited physiologic effect of oral calcium on serum calcium levels. Oral calcium carbonate appears unlikely to be an effective intervention for labour augmentation; future research should focus on strategies with more controllable mechanisms.

PMID:42480078 | DOI:10.1080/01443615.2026.2697258

Nat Prod Res. 2026 Jul 21:1-16. doi: 10.1080/14786419.2026.2705308. Online ahead of print.

ABSTRACT

This pioneering study reports the phytoconstituents of aerial organs of the vulnerable Stereospermum colais. These parts have been historically overlooked compared to root and bark exploitation in Ayurveda. This approach eliminates destructive root harvesting while staying within WHO elemental limits for multi-herb Ayurvedic formulations. The study proved leaves as the richest source of antioxidant phenolics and flavonoids, particularly rutin. The abscised petals stand out, containing a high level of the biomarker lignan cycloolivil (15.3 mg/g-DW), thus ideal for zero-impact, sustainable harvesting. Meanwhile, green stems are the best source of lapachol (1558 μg/g-DW in acetone). These highly significant profiles expand our understanding of the S. colais beyond previously identified compounds from roots and bark. This minimises expenses while maintaining tree health and bioactive yields for Ayurvedic applications. This study unlocks sustainable, eco-friendly sourcing for Ayurvedic and modern medicines, easing pressure on wild populations with non-destructive harvesting that can readily scale for commercial use.

PMID:42480068 | DOI:10.1080/14786419.2026.2705308

JMIR Res Protoc. 2026 Jul 21;15:e89405. doi: 10.2196/89405.

ABSTRACT

BACKGROUND: Outdoor play supports children’s physical, social, and cognitive development; yet, opportunities are declining as indoor, screen-based childhoods become the norm. Early Learning and Child Care (ELCC) centers are key settings for promoting outdoor play, but limited evidence exists on the health and developmental outcomes of licensed nature-based ELCC programs, particularly for children with and those without disabilities.

OBJECTIVE: The Sending Preschoolers Outside (SPROUT) and SPROUT-able studies aim to examine the impact of one of Canada’s first purposely designed and built licensed outdoor-focused ELCC programs. The primary objective is to examine the health and developmental outcomes of children aged 10-59 months, with and those without disabilities, attending an outdoor-focused, full-day licensed ELCC program compared to those in conventional (eg, not outdoor-focused) ELCC settings. Secondary objectives are to (1) examine educator job satisfaction, health, well-being, and attitudes toward teaching outdoors for children with and those without disabilities; (2) examine caregiver beliefs and attitudes toward children’s participation in outdoor play and learning; and (3) identify barriers and facilitators to outdoor play and learning for children with and those without disabilities (ie, the SPROUT-able substudy) in an outdoor-focused ELCC program.

METHODS: This prospective longitudinal open cohort study follows children, caregivers, and educators over 3 years. Participants are recruited from 1 outdoor-focused (experimental) and 3 conventional (usual care) ELCC centers in Ontario, Canada; all sites are licensed. Assessments occur every 6 months and include direct measures of children (eg, anthropometry, motor skills, and accelerometry) and caregiver and educator questionnaires. Mixed-effects modeling will examine changes over time and between groups (experimental vs usual care).

RESULTS: As of August 2025, 86 caregiver-child dyads are enrolled in the study (67 experimental and 43 control). Of these, 70 children who enrolled at study initiation have completed baseline and T1 and T2 assessments (43 experimental and 27 usual care), while 18 children enrolled at the 6-month time point (T1; 13 experimental and 5 usual care) have completed T1 and T2 (with a missing baseline assessment). A total of 19 children from the experimental group were identified as having a disability meeting criteria for the SPROUT-able substudy: 4 with a formal diagnosis, 3 with caregiver-reported functional difficulties, and 12 receiving additional support from an inclusion support worker.

CONCLUSIONS: By combining a holistic and comparative approach with a focus on children with and those without disabilities, the SPROUT and SPROUT-able studies will generate comprehensive evidence to inform ELCC practice and policy in Canada and internationally. This model within Canada provides timely evidence on outdoor-focused ELCC delivery, integrating disability inclusive outdoor play into ELCC settings, and has the potential to guide meaningful improvements in child development, educator well-being, and community health.

PMID:42480064 | DOI:10.2196/89405

JMIR Mhealth Uhealth. 2026 Jul 21;14:e90422. doi: 10.2196/90422.

ABSTRACT

BACKGROUND: Structured exercise is a key component of cardiac rehabilitation (CR) for patients with heart failure (HF), but access to center-based cardiac rehabilitation (CBCR) is often limited. Mobile health (mHealth) platforms enable remote, virtual, or hybrid cardiac rehabilitation (RVH-CR) delivery.

OBJECTIVE: This study aimed to evaluate the effectiveness and safety of structured, exercise-focused RVH-CR supported by mHealth compared with usual care or CBCR in patients with heart failure with reduced ejection fraction (HFrEF) or in HF populations predominantly comprising patients with HFrEF.

METHODS: We searched PubMed, Web of Science, MEDLINE via Ovid, Cochrane CENTRAL, and CINAHL Complete from inception to April 27, 2026. Randomized controlled trials comparing mHealth-supported RVH-CR with usual care or CBCR were included. The primary outcome was exercise capacity, assessed by peak oxygen uptake (VO2 peak) and 6-minute walk distance (6MWD). Secondary outcomes included health-related quality of life and safety. Data were pooled using random-effects meta-analysis stratified by comparator. Risk of bias was assessed with the Cochrane Risk of Bias Tool version 2, and evidence certainty was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).

RESULTS: Eight randomized controlled trials with 1368 patients were included. In the CBCR comparison, mHealth-supported RVH-CR showed a statistically significant greater improvement in VO2 peak than CBCR (mean difference [MD] 0.82, 95% CI 0.06-1.57; P=.03), although this finding was based on a limited number of trials. Compared with usual care, mHealth-supported RVH-CR was associated with improved 6MWD (MD 22.99, 95% CI 1.15-44.82; P=.04). Single-trial estimates suggested improvements in VO2 peak (MD 2.50, 95% CI 0.88-4.12) and Minnesota Living with Heart Failure Questionnaire scores (standardized MD -0.57, 95% CI -0.98 to -0.17; P<.01) versus usual care. The certainty of evidence ranged from low to moderate. No intervention-related deaths or serious adverse events were reported, but sparse events and short follow-up limited conclusions regarding safety.

CONCLUSIONS: The effects of structured RVH-CR supported by mHealth differed according to comparator type, but the certainty of evidence ranged from low to moderate. Compared with usual care, mHealth-supported RVH-CR was associated with improved 6MWD. Compared with CBCR, mHealth-supported RVH-CR showed a significantly greater improvement in VO2 peak in a limited number of trials, but superiority, equivalence, or noninferiority to CBCR cannot be concluded. Because usual care and CBCR are clinically distinct comparators, no single overall effect across comparator types should be inferred. Future studies should assess long-term outcomes and standardize structured exercise protocols across RVH-CR models.

PMID:42480049 | DOI:10.2196/90422

Brief Bioinform. 2026 Jul 3;27(4):bbag390. doi: 10.1093/bib/bbag390.

ABSTRACT

Variant-set association analysis is a powerful strategy for genetic studies of whole-genome sequence (WGS) data, especially for rare variants. By aggregating variant signals, variant-set analysis can improve statistical power, result interpretability, and study replicability. Motivated by the evidence that 3D genome architecture plays a critical role in regulating gene transcription, several works have incorporated 3D genome architecture into gene-based association tests and demonstrated great promise. In this work, we extend the idea of 3D-genome guided test from gene-centric to gene-agnostic, whole-genome testing by introducing an Hi-C informed kernel association test (i.e. HiC-KAT). We present a principled procedure that converts Hi-C contact confidence into borrowing weights and integrates these weights into genetic similarity kernels so that higher-confidence interacting loci contribute more to the association test of the target variant set. We use a controlling parameter to adaptively determine the appropriate degree of information borrowing from its interacting loci during association testing. We assess the performance of HiC-KAT using simulations and illustrate its advantage in detecting rare-variant sets using WGS data from the ARIC study in the Trans-Omics for Precision Medicine program.

PMID:42480046 | DOI:10.1093/bib/bbag390

Brief Bioinform. 2026 Jul 3;27(4):bbag384. doi: 10.1093/bib/bbag384.

ABSTRACT

Alternative splicing (AS) is a fundamental posttranscriptional mechanism that amplifies proteomic diversity and enables adaptive responses across eukaryotes. Current AS detection methods rely heavily on reference genomes, limiting their applicability to non-model organisms. Existing reference-free approaches suffer from inaccurate splice site prediction and treat detection and classification as separate processes, resulting in cascading errors. We present IRCAS, an integrated end-to-end framework for reference-free AS analysis, comprising three modules: identification, rectification, and classification. IRCAS employs colored de Bruijn graphs for AS detection, an attention-based convolutional neural network for splice site rectification, and a hybrid graph neural network combining graph attention network and Transformer layers for classification. Evaluation across four species demonstrates substantial improvements: splice site accuracy increased to 92%-96% versus 50%-55% for existing methods, and end-to-end inference accuracy reached 83.4% on rice (fine-tuned) compared to 44.7% for the previous best method. IRCAS establishes a new benchmark for reference-free AS detection in non-model organisms.

PMID:42480045 | DOI:10.1093/bib/bbag384

J Am Nutr Assoc. 2026 Jul 21:1-6. doi: 10.1080/27697061.2026.2705957. Online ahead of print.

ABSTRACT

OBJECTIVE: Available evidence indicates that fat-free mass and muscle mass positively associate with baseline urine specific gravity, particularly in physically active individuals and athletes. Relatively little, however, is known about the relationships between skeletal muscle mass and other hydration biomarkers in more diverse samples. This investigation sought to evaluate the associations between skeletal muscle mass and hydration status measured via urine specific gravity, urine osmolality, and saliva osmolality.

METHODS: Eighty-three adults (37 men, 46 women; 36.1 ± 13.2 yr, 170.6 ± 9.4 cm, 90.0 ± 17.9 kg; 27.9 ± 11.8% body fat) visited the laboratory once to complete body composition testing and provide spot urine and saliva samples. Urine and saliva were analyzed using a digital pocket refractometer, benchtop osmometer, and portable handheld saliva osmometer.

RESULTS: Urine osmolality and specific gravity were highly associated with one another (ρ = 0.98, p < 0.001; n = 81). In contrast, saliva osmolality showed no significant associations with urine specific gravity (ρ = 0.04, p = 0.726; n = 82) or urine osmolality (ρ = 0.03, p = 0.795; n = 81). Furthermore, urine specific gravity, urine osmolality, and saliva osmolality all showcased no statistically significant relationships with skeletal muscle mass, in either unadjusted or adjusted (age, past 4h fluid intake, and time of day) analyses.

CONCLUSIONS: The insignificant associations between muscle mass and hydration measures are possibly due to the diverse physical activity of participants, variations in sampling time of day, and limited control over pre-visit nutritional intake. In comparison to homogenous athlete samples, there may be less of a relationship between muscle mass and hydration measures in diverse populations, particularly when relatively unrestricted pre-testing controls are imposed.

PMID:42480042 | DOI:10.1080/27697061.2026.2705957

JMIR Form Res. 2026 Jul 21;10:e86899. doi: 10.2196/86899.

ABSTRACT

BACKGROUND: Depression carries the highest burden of mental health-related disability in the United States. Approximately 13% of military veterans report elevated rates of depression. Despite the availability of evidence-based treatments for depression, nearly 50% of veterans in need of mental health care remain untreated. Internet-based interventions show promise in reducing this gap; however, there are currently no standard self-guided internet-based interventions for depressive symptoms in veterans. Deprexis is one such intervention that leverages cognitive behavioral therapy to target depressive symptoms.

OBJECTIVE: This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of Deprexis, a fully self-guided internet-based intervention for depression, in US military veterans with mild to severe depressive symptoms.

METHODS: This open-label pilot trial recruited 19 veterans with mild to severe depression (mean age 55.5, SD 8.2 y; baseline Quick Inventory of Depressive Symptomatology-Self-Report [QIDS-SR]: mean 16.2, SD 4.1) for an 8-week course of Deprexis, with self-report assessments at baseline, posttreatment (8 wk), and follow-up (16 wk). Primary outcomes included depressive symptoms (QIDS-SR), functional disability (World Health Organization Disability Assessment Schedule 2.0), and symptom-related disability (Sheehan Disability Scale). Feasibility was assessed through recruitment and retention rates, and acceptability was measured using validated questionnaires (Credibility and Expectancy Questionnaire and Client Satisfaction Questionnaire). Multilevel models examined change over time, with effect sizes calculated using pooled SDs from unconditional models.

RESULTS: Recruitment and retention targets were met, with 15 out of 19 (79%) participants meeting the adherence criteria (ie, ≥60 min of active program use). Of these, 14 participants completed posttreatment questionnaires and were included in the completer analyses. The program received a positive acceptability rating: of the 18 participants who completed follow-up assessments, 78% (n=14) rated services as good or excellent and 72% (n=13) were satisfied with the amount of help received. No safety concerns were reported. Among completers (n=14), QIDS-SR scores decreased from baseline to posttreatment (estimate -2.22, SE 1.44; P=.14; d=-0.54, 95% CI -1.07 to 0.13) and follow-up (estimate -2.85, SE 1.19; P=.02; d=-0.70, 95% CI -1.21 to -0.08) with moderate-to-large effect sizes. Effect sizes were similar in the total sample. Functioning (World Health Organization Disability Assessment Schedule 2.0) improved among completers at follow-up (estimate -8.09, SE 3.80; P=.045; d=-0.41, 95% CI -0.96 to -0.05). Disability (Sheehan Disability Scale) did not significantly improve from baseline to posttreatment or follow-up.

CONCLUSIONS: This pilot trial demonstrates that Deprexis is feasible and acceptable for veterans with mild to severe depression, with preliminary evidence of effectiveness for depressive symptoms. The delayed emergence of functional improvements and sustained gains at follow-up support the potential of this scalable intervention. The results provide a strong foundation for the ongoing randomized controlled trial.

PMID:42480022 | DOI:10.2196/86899

JCO Oncol Pract. 2026 Jul 21:OP2501346. doi: 10.1200/OP-25-01346. Online ahead of print.

ABSTRACT

PURPOSE: Systematic integration of tobacco cessation treatment within cancer centers is needed to improve smoking cessation outcomes among cancer patients and survivors. The current study characterizes baseline rates of tobacco use, use of cessation support, and changes in tobacco use over time among 756 participants diagnosed with cancer and enrolled in 9 ECOG-ACRIN Cancer Research Group trials.

MATERIALS AND METHODS: Participants completed surveys at trial enrollment and at 3- and 6-month follow-ups. Descriptive statistics were used to characterize patient characteristics and selected items from the Cancer Patient Tobacco Use Questionnaire (C-TUQ). Generalized estimating equations were used to examine the time point effect on tobacco product use.

RESULTS: At baseline, 11% of participants (n = 740) currently smoked cigarettes. Among participants with data available at all time points (n = 443), prevalence of current smoking was stable over time, with 7.2% of participants (n = 32) reporting current smoking at baseline, 7.0% (n = 31) at the 3-month follow-up assessment, and 6.8% (n = 30) at the 6-month follow-up assessment. Most participants (n = 77/104) who smoked cigarettes within the year prior to their cancer diagnosis continued smoking after their diagnosis, and during (n = 44/72) and following completion (n = 30/46) of their treatment. Sixty-two percent of participants (n = 81) who were currently smoking at baseline reported using smoking cessation medication and 32.1% reported use of nonpharmacologic smoking cessation support since their cancer diagnosis. In longitudinal analyses, the odds of using cigarettes since their cancer diagnosis, 3-month follow-up, and 6-month follow-up was higher than the odds of using cigarettes for the past 30 days at baseline (odds ratio [OR] = 1.97, OR = 1.62, and OR = 1.50, respectively; all ps < .01).

CONCLUSION: Smoking persists over time among patients with cancer enrolled in therapeutic cancer trials. Findings highlight the importance of increasing access to integrated and longitudinal smoking cessation support.

PMID:42480004 | DOI:10.1200/OP-25-01346

Proc (Bayl Univ Med Cent). 2026 Jul 21:1-4. doi: 10.1080/08998280.2026.2699604. Online ahead of print.

ABSTRACT

BACKGROUND: The application of artificial intelligence (AI) in simulating detailed patient-doctor interactions for objective structured clinical examinations (OSCEs) remains emerging. This study aimed to evaluate an AI virtual patient (AIVP) innovation designed to support medical education through interactive patient simulations and feedback.

METHOD: This prospective mixed-methods pilot recruited final-year medical students during their critical care term. Two cohorts were examined: a volunteer AIVP group (n = 43) and an educational-support medical education enhancement training (MEET) group (n = 8). Participants completed pre- and postintervention OSCEs scored across communication, history and examination, management, and overall outcome domains. Students accessed nine emergency medicine scenarios featuring AI-driven dialogue, speech recognition, avatar interaction, and immediate feedback. Quantitative outcomes were analyzed using the Wilcoxon signed-rank test. Postintervention surveys (Likert scale) and focus groups provided qualitative data, which were analyzed thematically.

RESULTS: In the AIVP cohort, descriptive improvements were observed across domains; however, Wilcoxon testing identified no statistically significant changes. MEET students demonstrated significant improvement in overall OSCE outcomes (median 37 [IQR: 30-67] vs 67 [IQR: 47-75]; P = 0.03), with positive trends in all domains. Survey responses (n = 25) showed high agreement that AIVP enhanced confidence in history-taking (83%), differential diagnosis (78%), and management planning (78%). Thematic analysis from 10 students demonstrated that AIVP was experienced as a structured, exam-focused, and confidence-building learning tool that addresses gaps in workplace-based learning.

CONCLUSION: AIVP was feasible and well received, providing practice aligned with university OSCE standards. While the volunteer cohort showed modest gains, the MEET group demonstrated significant improvement, suggesting benefit for students needing structured support. Tailored feedback and alignment with OSCE standards highlight AIVP as a promising adjunct for training.

PMID:42480003 | DOI:10.1080/08998280.2026.2699604