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Nevin Manimala Statistics

Comparative Diagnostic Accuracy of the Braden and Cubbin/Jackson Scales for Predicting Pressure Injury Development in an Adult Intensive Care Unit: A Prospective Cohort Study

Int Wound J. 2026 Jun;23(6):e70984. doi: 10.1111/iwj.70984.

ABSTRACT

This study evaluated and compared the diagnostic accuracy of the Braden and Cubbin/Jackson Pressure Injury Risk Scales for predicting pressure injury development in adult ICU patients. In this prospective cohort study, 153 patients admitted to an adult ICU between September and November 2025 were assessed within 24 h using both scales and followed during their ICU stay. Diagnostic accuracy indices were calculated across cut-off points and optimal cut-offs were selected using the Youden J index. ROC curves were compared using the DeLong test. Precision-recall analysis and adjusted logistic regression analyses were also performed. Pressure injury developed in 37 patients (24.2%). The optimal Braden cut-off was ≤ 12, with sensitivity 43.2%, specificity 67.2%, PPV 29.6%, NPV 78.8%, LR+ 1.32, LR- 0.84 and Youden J 0.105. The optimal Cubbin/Jackson cut-off was ≤ 35, with sensitivity 73.0%, specificity 50.9%, PPV 32.1%, NPV 85.5%, LR+ 1.49, LR- 0.53 and Youden J 0.238. AUCs were 0.546 (95% CI: 0.439-0.653) and 0.605 (95% CI: 0.503-0.707), respectively; the difference was not statistically significant (p = 0.187). Precision-recall analysis showed limited predictive performance and adjusted logistic regression analyses indicated that neither cut-off was a statistically significant independent predictor of pressure injury development (p > 0.05). Both scales showed limited discriminatory accuracy. Cubbin/Jackson performed numerically better, but not significantly so; therefore, both scales should support, rather than replace, comprehensive clinical judgement in intensive care nursing.

PMID:42324497 | DOI:10.1111/iwj.70984

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Nevin Manimala Statistics

Elucidation of Brain Morphogenesis Using Quantitative Brain Magnetic Resonance Imaging in Children

Pediatr Int. 2026 Jan-Dec;68(1):e70450. doi: 10.1111/ped.70450.

ABSTRACT

Quantitative brain magnetic resonance imaging has revolutionized pediatric neurodevelopment research by enabling noninvasive, reproducible, and high-resolution assessments of brain morphology across the entire brain. Advances in anatomical structure analysis and diffusion-weighted tractography now permit detailed characterization of gray and white matter, cortical thickness, surface area, gyrification, and fiber integrity throughout development. Automated processing pipelines, including FreeSurfer, FSL, and CIVET, have supported large-scale analyses, while harmonization frameworks and normative growth curves have facilitated clinical translation. Diffusion tensor imaging (DTI) provides complementary insights into white matter microstructure, revealing neurodevelopmental trajectories and disorder-specific connectivity alterations. These approaches have identified structural biomarkers in multiple conditions, including reduced nucleus accumbens volume and ventricular enlargement in autism spectrum disorder (ASD), as well as early amygdala overgrowth and glymphatic dysfunction that may predict ASD onset. Despite these advances, several challenges remain, such as inter-scanner variability, age-dependent processing limitations, and the lack of validated individual-level biomarkers. Standardization of imaging protocols and robust statistical harmonization will be essential to overcome these obstacles and enable longitudinal, patient-specific assessments. The incorporation of quantitative magnetic resonance imaging into clinical workflows holds promise for early diagnosis, individualized monitoring, and therapeutic stratification of neurodevelopmental and genetic disorders. Ultimately, comprehensive morphometric and diffusion-based profiling will advance understanding of brain morphogenesis and drive precision medicine in pediatric neurology.

PMID:42324486 | DOI:10.1111/ped.70450

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Nevin Manimala Statistics

Refocusing the study of human-plant relations to the genus scale: Indigenous selection pressures in Xanthosoma

J Ethnobiol Ethnomed. 2026 Jun 21. doi: 10.1186/s13002-026-00919-z. Online ahead of print.

ABSTRACT

BACKGROUND: Domestication and conservation research often relies on single-species frameworks, which can obscure how Indigenous management practices applied to multiple related taxa may interact to shape shared gene pools. Studies of crops such as manioc/cassava (Manihot esculenta), yam (Dioscorea spp.), sorghum (Sorghum spp.), and Amazonian treegourd (Crescentia spp.) demonstrate that domestication frequently involves interactions among multiple cultivated and wild or semi-managed relatives. However, little is known about how these dynamics operate within the genus Xanthosoma, particularly in the Ecuadorian upper Amazon, a key center of diversity and domestication history for the genus. This gap limits understanding of how Indigenous management practices may influence the maintenance, erosion, or redirection of genetic diversity, with implications for crop improvement, resilience under changing environmental conditions, and the identification of underutilized plant resources.

METHODS: We combined ethnobotanical fieldwork in the Runa community of Mondayacu-including structured and unstructured interviews, participant observation, and genus-focused walks-with a national-level syntheses of herbarium records and ethnobotanical literature to contextualize Xanthosoma diversity and use across Ecuador. Interview responses were topically coded and summarized as aggregated frequencies, with patterns visualized using bar graphs. Descriptive statistics summarized reported management, while qualitative quotations and participant observation grounded interpretation.

RESULTS: Participants reported no current cultivation of Xanthosoma sagittifolium, despite its historical importance in Mondayacu and broader global use. In contrast, participants described a spectrum of management practices for lalu (Xanthosoma purpureomaculatum), ranging from eradication to selective retention for medicinal, zootechnical, and ritual uses. Lalu was the most commonly observed Xanthosoma species during fieldwork and was perceived as highly persistent, rapidly regrowing and spreading across forests and semi-managed areas. Decisions to remove or retain plants were trait- and context-dependent, with individuals exhibiting desirable characteristics (e.g., large, deep green leaves, minimal pest damage) preferentially spared or relocated near houses or gardens. National-level herbarium and ethnobotanical synthesis documented broader Xanthosoma species diversity, multifunctional uses, and possible selection pressures across Ecuadorian Amazonian Indigenous groups.

CONCLUSIONS: Building on evidence from other crop systems, our findings suggest that domestication dynamics in Xanthosoma are not fully captured by a single-species framework. In a key center of Xanthosoma diversity and domestication history, differential management of multiple related species may contribute to shaping patterns of persistence and diversity within the genus. While this study does not directly measure genetic change, it identifies ethnobotanical processes that may influence the distribution and maintenance of diversity across related taxa, including those in secondary and less-studied gene pools. Approaches that account for genus-level diversity and Indigenous management practices may therefore improve understanding of domestication processes and support conservation of genetic diversity, crop improvement, and the identification of underutilized plant resources. These findings also contribute to decolonizing domestication research by highlighting how Indigenous knowledge systems and management practices shape the structure and future of crop diversity.

PMID:42324484 | DOI:10.1186/s13002-026-00919-z

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Nevin Manimala Statistics

Integrating epidemiological and transcriptomic data reveals novel lipid metabolic drivers of obstructive sleep apnea

Nutr Metab (Lond). 2026 Jun 21. doi: 10.1186/s12986-026-01160-x. Online ahead of print.

ABSTRACT

BACKGROUND: Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction during sleep and is frequently accompanied by dyslipidemia. However, the molecular mechanisms linking lipid metabolism to OSA remain incompletely understood. This study aimed to investigate the association between blood lipid levels and OSA and explore potential underlying molecular pathways.

METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 and 2015-2018 were analyzed to evaluate the associations between OSA and blood lipid parameters using multivariable regression and sensitivity analyses. Additionally, OSA-related transcriptomic data (GSE135917) were obtained from the Gene Expression Omnibus (GEO), and lipid metabolism-related genes were retrieved from the Molecular Signatures Database (MSigDB). Differentially expressed lipid metabolism-related genes (DELMRGs) were identified through data integration. Machine learning approaches, protein-protein interaction network analysis, and receiver operating characteristic analysis were applied to identify key genes. Gene set enrichment analysis (GSEA) was performed to elucidate associated biological pathways, and transcription factor-gene and gene-microRNA regulatory networks were constructed using NetworkAnalyst and Cytoscape.

RESULTS: Analysis of NHANES data showed that triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) levels were positively associated with OSA, whereas high-density lipoprotein cholesterol (HDL-C) levels was inversely associated (all p < 0.001). A nonlinear, inverted U-shaped association between TG levels and OSA risk was also observed (p for nonlinearity < 0.05). Transcriptomic analysis identified 34 DELMRGs, among which CYP3A4, CYP4A22, and MED18 emerged as key genes. GSEA revealed pathways potentially involved in lipid metabolism and OSA pathophysiology, while regulatory network analyses further supported the biological relevance of these genes.

CONCLUSIONS: This study demonstrates that dyslipidemia characterized by elevated TG and LDL-C levels and reduced HDL-C levels is associated with an increased likelihood of OSA, and identifies three DELMRGs that may be involved in OSA pathophysiology. These findings provide exploratory mechanistic insights and offer a basis for future studies to further investigate the role of lipid metabolism in OSA.

PMID:42324483 | DOI:10.1186/s12986-026-01160-x

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Nevin Manimala Statistics

Prevention of inadvertent perioperative hypothermia as a quality indicator in anesthesia: an eight-year experience from 2014 to 2022

BMC Anesthesiol. 2026 Jun 22. doi: 10.1186/s12871-026-04022-4. Online ahead of print.

ABSTRACT

BACKGROUND: Inadvertent perioperative hypothermia remains one of the most common yet undertreated complications in anesthesia practice. Although evidence-based guidelines for its prevention have long been available, a significant gap persists between existing knowledge and clinical implementation. This study reports an eight-year institutional experience in which perioperative hypothermia was adopted as a quality indicator and managed through a collaborative framework between the anesthesiology department and the hospital quality management unit.

METHODS: A single-center, retrospective quality improvement study was conducted between May 2014 and September 2022. Adult patients who underwent surgery lasting more than four hours under general anesthesia were included. Postoperative body temperature was measured by tympanic infrared thermometry upon admission to the recovery unit; values below 36 °C were recorded as hypothermia. A Plan, Do, Check, Act (PDCA) cycle was employed in four phases: problem identification and baseline data collection (2014), awareness and education interventions (2014-2015), structural and technical improvements including provision of tympanic thermometers to all operating rooms and standardization of forced-air warming protocols (2015-2016), and continuous monitoring with periodic reinforcement (2016-2022). Data were collected monthly during 2014-2016 and through a sampled audit of one representative month per quarter from 2017 onward. Trends were analyzed using a Cochran, Armitage test and grouped binomial logistic regression, and process stability with a statistical process control chart.

RESULTS: A total of 1,902 patients were evaluated over the study period, of whom 348 (18.3%) were found to be hypothermic postoperatively. The annual hypothermia rate was 32.5% in 2014, falling to 25.9% in 2015 and 15.2% in 2016 following the educational and structural interventions. From 2017 to 2022, rates stabilized between 9.7% and 15.1%, representing an approximate 3.2-fold reduction from baseline. The decreasing trend was statistically significant (Cochran, Armitage p < 0.001; odds ratio 0.806 per year, 95% CI 0.762, 0.852). Intermittent spikes were observed in isolated quarters (e.g., 32.4% in the third quarter of 2019), but targeted re-education sessions led to prompt correction. The lowest annual rate recorded was 9.7% in 2021.

CONCLUSION: Systematic identification and monitoring of perioperative hypothermia as a quality indicator, coupled with relatively straightforward interventions (education, equipment provision, and ongoing surveillance), was associated with a substantial and sustained reduction in hypothermia rates over eight years. Active collaboration between the quality management unit and the anesthesiology department, with a designated physician serving as quality representative, appeared central to sustaining these gains. These findings suggest that a structured, PDCA-based quality improvement approach may help bridge the gap between established guidelines and day-to-day clinical practice, even without large-scale resource investment; as a single-center experience, this should be regarded as a working hypothesis requiring multi-site confirmation.

PMID:42324460 | DOI:10.1186/s12871-026-04022-4

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Nevin Manimala Statistics

Determinants of out-of-home food consumption: development and validation of a multidimensional scale in a Brazilian sample

BMC Public Health. 2026 Jun 22. doi: 10.1186/s12889-026-28251-x. Online ahead of print.

ABSTRACT

BACKGROUND: Out-of-home food consumption has become an integral component of contemporary dietary patterns, particularly in urban contexts. Evidence suggests that eating outside the home is associated with diet quality, nutritional intake, and broader public health outcomes. However, Brazil lacks validated multidimensional instruments capable of comprehensively assessing the economic, behavioral, and experiential determinants underlying this behavior. This study aimed to develop and validate the Scale of Determinant Factors in Out-of-Home Food Consumption (SDF-OHFC) and to examine the structural relationships among its dimensions.

METHODS: A cross-sectional study was conducted with 426 Brazilian adults who reported consuming food outside the home at least once per week. Data were collected through an online survey and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The measurement model was assessed for reliability, convergent and discriminant validity. Structural relationships were tested using bootstrapping procedures (5,000 resamples), and predictive performance was evaluated through R², Q², RMSE, and MAE. Measurement invariance was examined across sex, marital status, and geographic regions.

RESULTS: The SDF-OHFC comprises five dimensions: economic aspects, convenience, habits and personal preferences, social and experiential aspects, and perceived food quality. The scale demonstrated satisfactory internal consistency (Cronbach’s α = 0.705-0.762), composite reliability (> 0.70), and convergent validity (AVE > 0.50). All hypothesized structural relationships were statistically significant (p < 0.05). Economic aspects played a central antecedent role, positively influencing convenience and habits, and negatively influencing social and experiential aspects. Convenience and social and experiential dimensions were positively associated with perceived food quality. Structural invariance was confirmed across all tested demographic groups.

CONCLUSIONS: The SDF-OHFC is a valid and reliable multidimensional instrument for assessing determinants of out-of-home food consumption in Brazil. By integrating economic, behavioral, and experiential factors within a single framework, the scale supports public health research and policy development aimed at improving urban food environments, promoting healthier eating practices, and addressing structural determinants of dietary behavior.

PMID:42324459 | DOI:10.1186/s12889-026-28251-x

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Nevin Manimala Statistics

Expanding the clinical spectrum of RNU4ATAC-opathies: more frequent and diverse than assumed

Genet Med. 2026 Jun 19:102632. doi: 10.1016/j.gim.2026.102632. Online ahead of print.

ABSTRACT

PURPOSE: Biallelic variants in the minor spliceosomal gene RNU4ATAC were successively identified in Taybi-Linder/MOPD1 (Microcephalic osteodysplastic primordial dwarfism type I), Roifman, and Lowry-Wood syndromes, characterized by variable microcephaly, short stature, neurodevelopmental impairment, skeletal dysplasia, and immunodeficiency. Two-thirds of the reported individuals present with Taybi-Linder syndrome, the first described and most severe form.

METHODS: We collected clinical and molecular data from individuals with biallelic RNU4ATAC variants through various French and European networks and clinics, to refine the phenotypic spectrum of RNU4ATAC-opathies.

RESULTS: We enrolled 69 participants and identified 18 new pathogenic variants. We report a significant proportion of attenuated/atypical presentations, novel rare symptoms, and, unexpectedly, a broad spectrum of autoimmune/inflammatory manifestations, affecting nearly half of the participants. Integrating our data with the 109 published cases, we propose a novel classification based on the main manifestations, immunodeficiency and microcephalic primordial dwarfism. Using computer-assisted facial analysis, we also demonstrated the existence of a specific dysmorphic pattern in RNU4ATAC-opathies, distinct between some sub-syndromes.

CONCLUSION: We present a large cohort of individuals with RNU4ATAC-opathies and expand the phenotypic spectrum to pauci-symptomatic forms, indicating that these diseases are likely to remain underdiagnosed.

PMID:42322192 | DOI:10.1016/j.gim.2026.102632

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Nevin Manimala Statistics

Delineating the clinical and molecular spectrum of the neurodevelopmental disorder associated with SET

Genet Med. 2026 Jun 19:102637. doi: 10.1016/j.gim.2026.102637. Online ahead of print.

ABSTRACT

PURPOSE: SET is a member of the inhibitor of histone acetyltransferases (INHAT) complex, involved in transcriptional silencing and gene regulation. Pathogenic variants in SET are postulated to cause neurodevelopmental disorder (NDD) phenotypes, but as only few individuals are described, detailed clinical information is scarce. Hence, currently counseling on phenotype and prognosis of this condition remains challenging.

METHODS: Here we describe the clinical phenotype and mutational spectrum of 23 unreported individuals harboring (likely) pathogenic variants in SET.

RESULTS: Phenotypes include global developmental delay with often pronounced hypotonia, delayed motor development and speech and language delay, ultimately evolving into (mild) intellectual disability. Comorbidities include behavioral concerns, sleeping disturbance and variable unspecific ocular problems. Next generation computer-assisted phenotyping using GestaltMatcher showed limited overlapping facial features between affected individuals and differences compared to disorders caused by related chromatin modifying genes. In addition, we generated a DNA methylation signature, able to distinguish individuals carrying pathogenic variants in SET from individuals with other NDDs and healthy controls. We used this DNA methylation signature to assess pathogenicity of two variants of uncertain significance in SET found in two additional individuals.

CONCLUSION: Together, this expands the knowledge on the SET-related disorder and provides novel approaches for its diagnosis.

PMID:42322191 | DOI:10.1016/j.gim.2026.102637

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Nevin Manimala Statistics

A Survey on Knowledge, Attitude, and Current Practice in Diabetic Foot Care Among Indian Physiotherapists

ScientificWorldJournal. 2026;2026(1):e3077222. doi: 10.1155/tswj/3077222.

ABSTRACT

BACKGROUND: Diabetic foot ulcers are a major complication of diabetes and contribute significantly to morbidity and healthcare burden in India. Physiotherapists play a vital role in prevention and management; however, their knowledge, attitude, and clinical practices in the Indian context remain unexplored.

OBJECTIVE: The study is aimed at assessing the knowledge, attitudes, and practices (KAP) of physiotherapists practicing across India regarding diabetic foot care through a national online cross-sectional survey.

METHOD: A cross-sectional national online survey was conducted from January 2024 to March 2025 among physiotherapists practicing across India. A total of 249 participants were included using a convenience sampling technique. Data were collected using a self-developed, content-validated questionnaire consisting of 20 questions across knowledge, attitude, and clinical practice domains. Descriptive statistical analysis was performed using Jamovi (2.6.23).

RESULTS: A total of 249 respondents from 28 Indian states were included. While 94.8% acknowledged their role in diabetic care, only 41% had received formal training in diabetic foot management. Although most participants identified clinical signs of complications, inconsistencies were observed in interpreting ABI and HbA1c values. Although 98.8% reported providing patient education practices, only 47.4% performed routine foot assessments. Greater clinical experience was associated with better application of knowledge in practice.

CONCLUSION: Indian physiotherapists demonstrate positive attitudes toward diabetic foot care; however, gaps remain in formal training and consistent clinical practice persist. Strengthening structured education and developing standardized clinical guidelines are essential to improve practice.

PMID:42322180 | DOI:10.1155/tswj/3077222

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Nevin Manimala Statistics

High interobserver variability exists in grading appendiceal goblet cell adenocarcinoma using World Health Organization 5th edition criteria

Histopathology. 2026 Jun 20. doi: 10.1111/his.70205. Online ahead of print.

ABSTRACT

AIMS: Appendiceal goblet cell adenocarcinoma (GCA) is an uncommon malignancy that has been described under various names and grading schemes. The 5th Edition of the World Health Organization (WHO) Classification of Digestive System Tumours provides a three-tiered system for grading these neoplasms, but the reproducibility of this classification scheme has not been studied.

METHODS AND RESULTS: We scanned 58 H&E-stained slides from 20 GCA and circulated the whole-slide images among seven pathologists with interest in appendiceal pathology. They evaluated each slide for the presence of 15 histological patterns defined by the WHO as criteria for low-grade (n = 5) and high-grade (n = 10) GCA. Cases were also evaluated for the presence of extracellular mucin. Participants also reported the percentage of high-grade features in each whole slide image and each case. Interobserver variability was assessed statistically. All seven observers agreed on the WHO grade for four of the 20 cases (20%; one grade 1, three grade 3). Using Fleiss’s kappa statistic, overall agreement for cases was fair at 0.29 (95% confidence interval [CI]: 0.14-0.44), and pairwise agreement between observers ranged from 0.00 to 0.82 (median = 0.13). Gwet’s agreement coefficient ranged from 0.10 to 0.87 (median = 0.28), while overall agreement was 0.36 (95% CI: 0.17-0.54). There was significant variability with respect to assessing the presence of individual features. The best agreement was seen for extracellular mucin (neutral feature, κ = 0.43) and tumour sheets (high-grade feature, κ = 0.41), whereas the worst agreement was seen for mild architectural disarray/tubular fusion (low-grade feature, κ = 0.05) and necrosis (high-grade feature, κ = 0.07).

CONCLUSIONS: We conclude that interobserver agreement for grading GCA using the three-tiered WHO 5th Edition classification system is fair at best. A validated two-tiered system (i.e. low- versus high-grade) may be more reproducible.

PMID:42322148 | DOI:10.1111/his.70205