Tag: pubmed

JMIR Form Res. 2026 Apr 16. doi: 10.2196/89306. Online ahead of print.

ABSTRACT

BACKGROUND: There are a large number of pediatric emergency patients. Due to the fact that the children cannot describe their own conditions, there is a shortage of nursing staff, it is extremely important to identify the early warning signs of the children’s conditions as early as possible. The current targeted care needs to be improved.

OBJECTIVE: This study aimed to investigate the application of an artificial intelligence-based pediatric early warning score (PEWS) in the pediatric emergency observation unit, analyze the relationship between PEWS and disease severity , and assess its impact on length of hospital stay and hospitalization costs after admission, so as to provide references for targeted nursing care.

METHODS: We performed a retrospective study. A total of 1,233 pediatric patients admitted via the pediatric emergency department of a tertiary specialty hospital in Guangzhou from September 2023 to March 2024 were included. The patients were divided according to the status of the activation of the early-warning group (PEWS score ≥ 1) vs. not triggered [score 0]) during emergency observation. Length of stay and hospitalization costs were compared between the early warning group and the non-early warning group.The differences between groups were performed with the Mann-Whitney U test. We did the multivariable logistic regression to discuss the association of resource utilization metrics and the status of AI-PEWS, adjusted by age, sex and disease category (respiratory, neurological, hematologic).

RESULTS: In 1,233 patients, 597 (48.4%) triggered the AI-PEWS (mean score 2.44 ± 1.41), and 636 (51.6%) did not. In the early warning group, 68 children were transferred to the intensive care unit, with a mean PEWS of 3.32 ± 1.73. Compared with the non-early warning group, the early warning group had a longer hospital stay (z = -5.180, P < 0.001) and higher hospitalization costs (z = -6.500, P < 0.001), and the differences between groups were statistically significant (P < 0.001). Among the top three admission categories-respiratory, neurological, and hematologic diseases-children in the PEWS early warning group had significantly longer hospital stays and higher hospitalization costs, with statistically significant differences between groups (P < 0.01). The β coefficient for length of hospital stay was 0.053 (SE=0.010), Waldχ²=5.533, OR=1.055 (95% CI: 1.035-1.075); while the β coefficient for hospitalization costs was 0.001 (SE=0.000), Waldχ²=6.075, OR=1.001 (95% CI: 1.001-1.001).

CONCLUSIONS: Compared with the non-early-warning group, the early-warning group had significantly longer hospital stays and higher hospitalization costs; similar patterns were observed within respiratory, neurological, and hematologic disease categories. It shows differences between children who triggered the warning and children who did not, providing a reference for identifying critically ill children and for targeted care.

PMID:41995245 | DOI:10.2196/89306

Echocardiography. 2026 Apr;43(4):e70461. doi: 10.1111/echo.70461.

ABSTRACT

BACKGROUND: Right ventricular (RV) dysfunction in chronic kidney disease (CKD) remains underrecognized. The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE/sPAP) reflects RV-pulmonary arterial coupling, but its relationship with CKD severity is unknown. To evaluate the association between TAPSE/sPAP ratio and CKD stage severity and assess age-related effect modification.

METHODS: This cross-sectional study enrolled 120 participants: 40 patients with stage I-II CKD, 40 with stage III-IV CKD, and 40 healthy controls. All underwent echocardiography and nephrologist evaluation. Proportional odds regression models adjusted for cardiovascular risk factors evaluated the TAPSE/sPAP-CKD association. ROC analysis assessed discriminatory performance. Age-stratified analyses (<65 vs. ≥65 years) evaluated effect modification.

RESULTS: TAPSE/sPAP ratio declined progressively across CKD stages (controls: 0.67 ± 0.11, stage I-II: 0.61 ± 0.13, stage III-IV: 0.53 ± 0.13 mm/mmHg; p < 0.01). Each 0.10-unit decrease was independently associated with advanced CKD (adjusted OR 2.08, 95% CI 1.49-2.89, p < 0.001). TAPSE/sPAP ratio achieved the highest AUC (0.734, 95% CI 0.625-0.833), outperforming TAPSE alone (AUC 0.615; DeLong p = 0.049), while statistically comparable to sPAP (AUC 0.715; DeLong p = 0.400). Age-stratified analysis revealed excellent performance in patients <65 years (AUC 0.819, sensitivity 78.6%, specificity 86.8%) but limited utility in those ≥65 years (AUC 0.579; p = 0.015). Random forest analysis identified age (35.8%) and TAPSE/sPAP (22.0%) as dominant predictors.

CONCLUSIONS: TAPSE/sPAP ratio is an independent marker of CKD severity enabling non-invasive detection of RV-PA uncoupling, with excellent discriminatory performance in younger but limited utility in older patients, suggesting that age-specific interpretation and integration with renal biomarkers are recommended.

PMID:41995221 | DOI:10.1111/echo.70461

Clin Transplant. 2026 Apr;40(4):e70543. doi: 10.1111/ctr.70543.

ABSTRACT

BACKGROUND: Before KAS250 (circles-based allocation), donor service area (DSA) of listing was the largest contributor to deceased donor kidney transplantation (DDKT) rate disparities. Both before and after KAS250, it is unclear to what extent DSA-level disparities are attributable to center-level practice variation. We aimed to disentangle contributions to DDKT rate variation from: (1) center practices, (2) kidney distribution within sharp policy boundaries (DSAs, OPTN Regions), and (3) other geographic variation in kidney scarcity.

METHODS: With national transplant registry data, we studied transplant rate variation in the pre-KAS250 era, which prioritized patients based on DSAs and Regions, and under KAS250, which prioritizes patients within 250 nautical mile circles. We modeled candidate DDKT rates with multilevel Poisson regression, adjusting for candidate factors, and calculated median incidence rate ratios (MIRR) to summarize variation attributable to DSAs, OPTN regions, states, census divisions, and to centers within those units.

RESULTS: DSA-level MIRR declined sharply from _1.311.35_1.39 to _1.131.17_1.21 after KAS250 implementation. Under KAS250, 93.4% of geographic variability in transplant rates was attributable to center-level (within-DSA) variation (MIRR: centers _1.761.82_1.86, DSAs _1.131.17_1.21), while before KAS250, only 81.7% of geographic variability in transplant rates was attributable to center-level (within-DSA) variation (MIRR: centers _1.831.89_1.95, DSAs _1.311.35_1.39). Adjusted center-level DDKT rates under KAS250 were highly associated with offer acceptance rates (ρ = 0.60, p < 0.001).

CONCLUSIONS: Though geographic disparities are driven primarily by center-level practice differences including offer acceptance, KAS250 did reduce DSA-level disparities. Further allocation policy changes are unlikely to substantially reduce geographic variation in DDKT rates.

PMID:41995213 | DOI:10.1111/ctr.70543

Arthroscopy. 2026 Apr 17. doi: 10.1002/arj.70140. Online ahead of print.

ABSTRACT

PURPOSE: To leverage a large national database to assess the association of type 1 diabetes mellitus (T1DM) with hip arthroscopy outcomes in patients with labral tears and/or femoroacetabular impingement syndrome.

METHODS: Patients who underwent hip arthroscopy for labral tears and/or femoroacetabular impingement syndrome were abstracted from the 2010 to 2023 PearlDiver M170 database. Patients with T1DM were matched 1:4 with those without T1DM based on age, sex, and Elixhauser comorbidity index. Multivariable logistic regression was used to assess the relationship between T1DM and 90-day postoperative adverse events as well as emergency department visits. Five-year conversion rates to total hip arthroplasty were assessed and compared with a log-rank test.

RESULTS: Of 69,679 patients undergoing hip arthroscopy, T1DM was identified in 951 patients (1.4%). After matching, 760 patients undergoing hip arthroscopy with T1DM were matched with 2968 patients without T1DM. Those with T1DM had significantly higher 90-day odds of any adverse events (odds ratio [OR] = 5.81), severe adverse events (OR = 2.65), minor adverse events (OR = 5.63), and emergency department visits (OR = 4.03) (P < .0001 for all). Five-year conversion to total hip arthroplasty was statistically significantly higher in the T1DM group (9.4% vs 6.4%, P = .05).

CONCLUSIONS: Patients with T1DM undergoing hip arthroscopy for labral tears and/or femoroacetabular impingement syndrome showed significantly higher rates of postoperative adverse events and emergency department visits, as well as greater rates of 5-year conversion to total hip arthroplasty compared with a matched control group without T1DM.

LEVEL OF EVIDENCE: Level III, retrospective comparative case-control study.

PMID:41995211 | DOI:10.1002/arj.70140

J Nurs Manag. 2026;2026(1):e7770229. doi: 10.1155/jonm/7770229.

ABSTRACT

BACKGROUND: The rapid digital transformation of healthcare systems requires nurses to continuously update their competencies to remain effective, adaptable, and resilient. Although digital competence, technological self-efficacy, and learning agility are recognized as key factors influencing career adaptability, the mechanisms connecting these constructs within nursing contexts remain underexplored.

AIM: This study investigated the relationship between digital competence and career adaptability among clinical nurses, with a focus on the mediating roles of technological self-efficacy and learning agility.

METHODS: A cross-sectional, correlational design was employed, involving 307 nurses recruited from two specialized university hospitals using stratified sampling. Data were collected using validated instruments measuring digital competence, technological self-efficacy, learning agility, and career adaptability. Partial Least Squares Structural Equation modeling was utilized to test the hypothesized parallel mediation model, following STROBE reporting guidelines.

RESULTS: Nurses reported a moderate level of digital competence (M = 3.46, SD = 0.42) and technological self-efficacy (M = 3.64, SD = 0.46), while learning agility and career adaptability were rated high (M = 3.85, SD = 0.47; M = 4.50, SD = 0.43, respectively). Digital competence had significant positive direct effects on career adaptability (β = 0.185, p < 0.01), learning agility (β = 0.184, p < 0.01), and technological self-efficacy (β = 0.254, p < 0.001). Both learning agility (β = 0.167, p < 0.01) and technological self-efficacy (β = 0.236, p < 0.001) were also significant predictors of career adaptability. Moreover, digital competence exerted significant indirect effects on career adaptability through technological self-efficacy (β = 0.060, p < 0.05) and learning agility (β = 0.031, p < 0.05).

CONCLUSION: Digital competence emerged as a fundamental determinant of nurses’ career adaptability, operating directly and indirectly through technological self-efficacy and learning agility. These findings highlight the importance of fostering digital readiness and adaptive learning among nurses. Nursing leaders should prioritize professional development initiatives to enhance workforce adaptability and sustain effective practice in technology-driven healthcare environments.

PMID:41995209 | DOI:10.1155/jonm/7770229

Phys Chem Chem Phys. 2026 Apr 17. doi: 10.1039/d6cp00142d. Online ahead of print.

ABSTRACT

Organic-inorganic lead-free halide double perovskites of the general formula A₂B⁺B³⁺X₆ have emerged as compelling candidates to replace toxic lead-based perovskite absorbers in optoelectronic applications. Taking MA₂AgBiBr₆ as the host lattice, we employ first-principles calculations combined with statistical thermodynamic modeling to systematically investigate the phase stability, electronic properties, and optical absorption characteristics of four B-site alloyed systems: MA₂AgSb_xBi_1-xBr₆, MA₂AgIn_xBi_1-xBr₆, MA₂K_xAg_1-xBiBr₆ and MA₂Tl_xAg_1-xBiBr₆. Thermodynamic phase diagram analysis identifies critical temperatures of 395 K (Sb), 281 K (In), 391 K (K), and 417 K (Tl), respectively. Notably, MA₂AgIn_xBi_1-xBr₆ is thermodynamically stable across the entire composition range at 300 K. B-site cation alloying affords precise bidirectional bandgap engineering: substitution with In³⁺ or K⁺ induces systematic bandgap widening, whereas Sb³⁺ or Tl⁺ incorporation results in progressive bandgap narrowing, thereby achieving a tunable optical bandgap spanning 2.07-2.52 eV. Importantly, this bandgap reduction is quantitatively correlated with enhanced absorption across the visible spectrum, thereby establishing a direct structure-property relationship rooted in electronic band alignment. Furthermore, In-doping drives an indirect-to-direct bandgap transition, demonstrating that B-site compositional control simultaneously governs both the magnitude and the nature (direct vs. indirect) of the fundamental bandgap. These combined attributes position the investigated lead-free double perovskites as highly promising materials for wide-bandgap top-cell absorbers in tandem solar cells and for efficient blue-green light-emitting diodes.

PMID:41995206 | DOI:10.1039/d6cp00142d

Physiother Theory Pract. 2026 Apr 17:1-18. doi: 10.1080/09593985.2026.2654806. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic Obstructive Pulmonary Disease(COPD) leads to reduced exercise capacity, lung function, and muscle dysfunction, highlighting the need for effective rehabilitation. Exercise is a key component of COPD management.

PURPOSE: This study aims to compare the effectiveness of high-intensity interval training (HIIT) and Moderate-Intensity Continuous Training (MICT) on functional capacity, pulmonary function, and muscle performance in individuals with COPD.

METHODS: Eight electronic databases were systematically searched from inception to August 2025. Data extraction and quality assessment were independently performed by two reviewers. Methodological quality was assessed using the PEDro scale and the JBI Critical Appraisal Checklist. The risk of bias was evaluated using the Cochrane Collaboration’s Tool and the ROBINS-I tool.

RESULTS: Twelve studies with 401 participants were included. Seven of the included studies involved patients with GOLD stage III (severe COPD), and five involved patients with GOLD stage II (moderate COPD). HIIT did not demonstrate a statistically significant superiority over MICT in improving lung function parameters (p > .05). The combined mean difference for FEV₁ was 6.84 (95% CI: -1.59 to 15.28; p = .11) and the mean difference for FEV₁/FVC was 1.15 (95% CI: -8.98 to 11.28; p = .82). In terms of functional capacity, MICT showed superiority for VO₂peak (MD = -41.79 mL/min, 95% CI [-74.77, -8.81], p = .01; I² = 39%, p = .12), while HIIT significantly improved 6MWT performance (MD = 14.63 m, 95% CI [1.00, 28.25], p = .04; I² = 33%, p = .22); no significant difference was observed for 12MWT (MD = -55.00 m, 95% CI [-147.40, 37.40], p = .24). In terms of muscle function, HIIT provided greater benefits than MICT, including improvements in respiratory pressure, quadriceps endurance, handgrip strength, and muscle fiber composition.

CONCLUSION: HIIT is superior to MICT in improving selected functional capacity outcomes and muscle function in COPD patients, and shows comparable effects to MICT in other functional measures. HIIT is a viable alternative training method; further research is needed to determine optimal protocols to maximize its benefits.

PMID:41995152 | DOI:10.1080/09593985.2026.2654806

Adv Sci (Weinh). 2026 Apr 17:e20612. doi: 10.1002/advs.202520612. Online ahead of print.

ABSTRACT

Coral reef ecosystems are among the most biodiverse and ecologically significant marine habitats; however, the carbon storage potential of these ecosystems and how corals and reef-dwelling fish participate in carbon cycling remain largely unexplored. In this study, stereo-video surveys, elemental analysis, and statistical modeling were used to quantify the carbon reservoirs of coral reef ecosystems in the South China Sea (SCS) in terms of carbon reservoirs in reef fish, coral communities, and sediment, and assess the factors influencing carbon storage. The results revealed that the average carbon stock of the SCS coral reef ecosystems is 3.22 kgC m^-2, with an estimated carbon storage of 25.73-121.99 TgC. Sediments are the dominant carbon reservoir and store 90.6%-95.7% of the total estimated carbon stock; however, coral and fish biomass also contribute to carbon stocks. The impact of corals and reef-dwelling fish on the carbon cycle of coral reefs far exceeds their direct carbon storage function, and reef fish communities transport an average of 235.63 gC m^-2 yr^-1 into the sediment carbon reservoir. These findings, reported for the first time, demonstrate the significant carbon sequestration potential of coral reef ecosystems, in which SCS reefs were used as an example, and provide critical insights into the role of corals and reef-dwelling fish in coral reef carbon cycling. These findings further highlight the necessity of biodiversity conservation amid increasingly severe global changes, specifically to maintain the carbon sequestration function and stability of coral reef ecosystems.

PMID:41995145 | DOI:10.1002/advs.202520612

Biomed Res Int. 2026;2026(1):e2741454. doi: 10.1155/bmri/2741454.

ABSTRACT

BACKGROUND AND AIMS: Sickle cell disease (SCD) is a genetic disorder characterized by intrinsic clinical manifestations, frequently exacerbated by vaso-occlusive episodes (VOEs), which significantly affect hematological parameters. This systematic review and meta-analysis is aimed at synthesizing evidence from studies published over the past 25 years on complete blood count profiles in SCD patients, both in the steady state and during VOEs. The objective was to clarify hypotheses and highlight the need for prospective studies to establish specific reference values for steady-state SCD patients, thereby improving patient management.

MATERIALS AND METHODS: In accordance with the PRISMA guidelines and the Cochrane Handbook, a systematic search of major databases (including PubMed, Web of Science, and Google Scholar) was conducted to identify analytical studies published between 2000 and 2025. Eligible studies compared complete blood count profiles in SCD patients during VOEs and in the steady state. Study selection and data extraction were performed independently by two reviewers, with disagreements resolved by consensus. Extracted data were entered into Microsoft Excel 2013 and analyzed using R statistical software (Version 4.3.2). Between-study heterogeneity was evaluated using Higgins’ inconsistency (Q) statistics, with results expressed as I² values and corresponding p values. The risk of bias in the included studies was assessed using the ROBINS-E tool.

RESULTS: Eight studies met the inclusion criteria. Pooled analyses demonstrated a significant impact of VOEs on hemogram parameters. This impact was characterized by anemia and erythrocytopenia (standardized mean difference [SMD], random-effects model: -0.97 [-1.45; -0.50]), accompanied by microcytosis (SMD, random-effects model: 0.18 [-0.21; 0.58]) and hypochromia (SMD, random-effects model: -0.90 [-2.96; 1.15]). These changes were also associated with reduced fetal hemoglobin levels, increased red cell distribution width (RDW), and reticulocytosis. Regarding the white blood cell lineage, VOEs were associated with leukocytosis (SMD, random-effects model: 0.73 [0.23; 1.24]) and a moderate increase across leukocyte subpopulations. Concerning the platelet lineage, VOEs exerted variable effects on platelet production, ranging from negative to positive influences, with an overall increase in platelet count (SMDs, random-effects model: -0.17 [-1.13; 0.78] and 0.78 [0.53; 1.03], respectively), accompanied by reductions in mean platelet volume and platelet distribution width (PDW).

CONCLUSION: This meta-analysis confirms the substantial influence of VOEs on red blood cell, white blood cell, and platelet parameters, as well as their associated indices. Importantly, although hematological parameters in the steady state are less severely altered than during VOEs, they often remain outside conventional reference ranges, reflecting a distinct physiological baseline in SCD patients. These findings underscore the urgent need for prospective studies to define specific hematological reference values for steady-state SCD patients, which is essential for optimizing their clinical management.

PMID:41995143 | DOI:10.1155/bmri/2741454

J Nurs Manag. 2026;2026(1):e4278999. doi: 10.1155/jonm/4278999.

ABSTRACT

AIM: To assess the psychological status and the prevalence of presenteeism among Spanish nurses working in emergency departments (EDs) and intensive care units (ICUs) and to explore the association between these variables.

BACKGROUND: Nurses working in ED and ICU settings experience higher levels of psychological stress, including burnout and lower job satisfaction. Anxiety and depression are common in this group and may contribute to nursing presenteeism. Presenteeism is defined as continuing to work despite feeling ill or unwell. There are gaps in research addressing the psychological status and presenteeism of ED and ICU nurses in Spain.

METHODS: A cross-sectional study using the Kessler Psychological Distress Scale (K-10) and the Stanford Presenteeism Scale (SPS-6) was conducted between April and December 2022. In total, 182 participants were included. The study followed the STROBE guidelines.

FINDINGS: Psychological distress was identified in 35.7% of participants, and a presenteeism prevalence of 43.8% was observed among nurses. A statistically significant association between psychological distress and presenteeism was found (p < 0.001). Age, educational background, and perceived work-related stress (p = 0.05) were identified as factors associated with psychological distress. Perceived work-related stress was also significantly associated with presenteeism (p < 0.05).

CONCLUSIONS: More than one-third of nurses working in ED and ICU settings experienced psychological distress, and a high prevalence of presenteeism was identified. Presenteeism was associated with higher levels of psychological distress.

IMPLICATIONS FOR NURSING: Early detection of psychological distress and the implementation of workplace interventions may help reduce presenteeism among nurses.

PMID:41995116 | DOI:10.1155/jonm/4278999