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Nevin Manimala Statistics

Effects of Statistical Learning on Stimulus Detection Speed Reflect Attention Rather Than Representational Changes

Cogn Sci. 2026 May;50(5):e70226. doi: 10.1111/cogs.70226.

ABSTRACT

Statistical learning (SL) is believed to enable humans to assimilate a range of statistical structures, and thus plays a role in many cognitive functions. There is also a growing interest in how SL interacts with basic cognitive processes, including perception and attention. Here, we ask how the extent to which stimuli predict, and are predicted by, other elements in a continuous stream affects their perception (i.e., encoding and representation) and the attention they attract. In two experiments, participants were first exposed to a stream of structured pairs of visual shapes (e.g., AB and CD). Then, they completed a target detection task to test if stimulus detection speed is influenced by a target’s predictability during exposure (indexing representation) or by whether the shape preceding the target reliably predicted elements in the input (indexing attention). In Experiment 1 (N = 86), Reaction Times (RTs) were faster for second elements from structured pairs (i.e., cued elements) than first elements (i.e., cue elements), even when they appeared in new configurations (e.g., AD and CB). However, in Experiment 2 (N = 89), which orthogonally manipulated the target and the preceding shape properties, RTs were influenced solely by whether the preceding element was a cue for other elements, but not by the target’s predictability. Thus, in contrast to previous studies using the same paradigm, our results do not provide evidence for an effect of SL on representation. Instead, our findings highlight how attention is guided by knowledge of statistical regularities, pointing to SL as a system that helps minimize uncertainty in structured environments.

PMID:42143743 | DOI:10.1111/cogs.70226

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Nevin Manimala Statistics

The Immediate Effects of a 3D Intraoral Scanner as an Adjunctive Oral Hygiene Educational Tool: A Randomised Controlled Trial

Int J Dent Hyg. 2026 May 17. doi: 10.1111/idh.70091. Online ahead of print.

ABSTRACT

OBJECTIVES: This single-visit randomised controlled clinical trial (RCT) aimed to evaluate the immediate effects of a three-dimensional (3D) intraoral scanner as an adjunctive oral hygiene education tool compared to standard personalised oral hygiene instruction (OHI) in healthy adults.

METHODS: Fifty-two subjects were randomised into the IOS (test) or the hand mirror (control) group. Full mouth plaque score (FMPS) was measured at baseline and immediately after the intervention. Subjects also completed a questionnaire assessing their perception of plaque visualisation and the effectiveness of the intervention.

RESULTS: Both groups achieved a statistically significant reduction in FMPS post-intervention compared to baseline (p < 0.05). The test group demonstrated a statistically significant change in FMPS (p < 0.05) and a reduction in plaque on the posterior teeth compared to the control group (p < 0.05), but not on the anterior teeth (p > 0.05). The treatment effect increased towards the posterior teeth, reaching statistical significance from the third molars to the second premolars (p < 0.05). Survey results also revealed that 96.2% of the test group favoured the IOS, particularly for visualising and cleaning posterior and lingual/palatal surfaces.

CONCLUSION: The 3D intraoral scanner showed short-term benefits in plaque visualisation and removal, especially in areas with poor visibility. IOS is well-accepted by subjects and may serve as a promising adjunctive tool in OHE.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT06349330 (available at https://clinicaltrials.gov/study/NCT06349330).

PMID:42143740 | DOI:10.1111/idh.70091

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Harnessing institutional knowledge: mixed methods evaluation of peer coaching in a multi-site EHR transition

J Am Med Inform Assoc. 2026 May 17:ocag071. doi: 10.1093/jamia/ocag071. Online ahead of print.

ABSTRACT

OBJECTIVE: Health systems undertaking electronic health record (EHR) transitions often struggle to prepare and support clinicians in learning and using the new system. We evaluated a national peer coaching program-the National EHRM Supplemental Staffing Unit (NESSU)-designed to support clinicians during the U.S. Department of Veterans Affairs’ (VA’s) transition to a new EHR. Our goal was to assess NESSU’s reach, perceived usefulness, and association with key EHR user outcomes, and to characterize how NESSU achieved its observed impacts.

MATERIALS AND METHODS: Using a convergent mixed-methods design, we surveyed EHR users at the most recent VA facility to implement the new EHR. Descriptive statistics summarized program reach and perceived helpfulness. Regression models assessed associations between NESSU participation and 3 outcomes: burnout, EHR-related stress, and EHR confidence. Qualitative data included 62 interviews with users and open-ended survey responses. We used structured coding and thematic analysis to identify themes.

RESULTS: Among 385 respondents, 58.4% reported receiving NESSU support and 83.6% of those rated it as helpful. NESSU participation was associated with lower rates of burnout (29% vs 41%, P = 0.016) but not with differences in EHR confidence or EHR-related stress. Qualitative analysis yielded 4 themes describing how NESSU functioned (filling education gaps, providing responsive support, offering expert guidance, and drawing upon notable interpersonal skills) and one theme describing its overall impact.

DISCUSSION: Findings demonstrate that peer coaching can address important support needs during EHR transitions.

CONCLUSION: Scalable, clinician-led peer coaching may represent an essential component of large-scale EHR transitions, supporting both implementation and clinician well-being.

PMID:42143681 | DOI:10.1093/jamia/ocag071

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A SEER Registry-Based Analysis of the Management Strategies and Survival Outcomes of Colorectal Cancer With Isolated Synchronous Lung Metastases

World J Surg. 2026 May 17. doi: 10.1002/wjs.70415. Online ahead of print.

ABSTRACT

BACKGROUND: Current treatment guidelines for stage IV colorectal cancer (CRC) with isolated synchronous lung metastases are limited. This study aimed to assess the association between management strategies and cancer-specific survival (CSS).

METHODS: This study was a retrospective cohort analysis of patients with stage IV colorectal adenocarcinoma and isolated synchronous lung metastases from the SEER registry (2010-2022). Patients were grouped by treatment strategy: surgery-only, chemotherapy-only, or combined surgery and chemotherapy. The main outcome measure was 3-year CSS, assessed by Kaplan-Meier statistics and multivariable Cox regression to adjust for survival confounders.

RESULTS: 5666 (6.9%) of 82,502 patients with stage IV CRC had isolated lung metastases. 736 (13%) were treated with surgery-only, 1870 (33%) chemotherapy-only, and 1908 (33.6%) surgery and chemotherapy; no treatment was recorded in 20.3% of patients. Chemotherapy alone was increasingly used over time (from 33.8% to 51.1%), whereas combined treatment decreased. Combined surgery and chemotherapys was associated with the highest 3-year CSS (55.1%) compared with chemotherapy-only (26.1%) and surgery-only (21.7%) (p < 0.001). Resection of both primary CRC and lung metastases combined with chemotherapy conferred the best 3-year CSS (66.2%). Combined surgery for primary and metastatic tumors and chemotherapy was associated with significant mortality risk reduction (HR 0.31, p < 0.001) compared with chemotherapy-only. Older age, signet-ring cell histology, poor differentiation, N2 primary disease, elevated CEA, and perineural invasion were associated with reduced CSS.

CONCLUSIONS: Combined resection of primary CRC and synchronous lung metastases with chemotherapy was associated with the best survival outcomes. However, use of this combined strategy is employed in select patients and has decreased over time.

PMID:42143670 | DOI:10.1002/wjs.70415

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Triphala Modulates the Membrane Vesicle Transcriptome of Enterococcus durans VIT3 to Influence Antibiotic Response and Probiotic Functions

Mol Biotechnol. 2026 May 17. doi: 10.1007/s12033-026-01578-x. Online ahead of print.

ABSTRACT

Membrane vesicles (MVs) are critical mediators of bacterial communication, physiology, and host interactions. This study explores how triphala, a polyherbal formulation, modulates the RNA cargo of MVs in Enterococcus durans VIT3 isolate under varied stress conditions. The isolated MVs from all treatment conditions (triphala, antibiotics, or sequential combinations) were spherical, intact, with negative zeta potential and sizes ranging from 56.4 to 462.3 nm. Cytotoxicity assays indicated no toxicity toward CaCo2 cells under the tested conditions. Transcriptomic profiling suggested that triphala pretreatment enhanced relative expression of genes linked to oxidative stress defense (ohrB, sodA), envelope integrity (dlt operon, pbp, mprF), and CRISPR-Cas-associated genes (cas1). In contrast, antibiotic first regimens suppressed stress and defense-associated genes, underscoring treatment order effects. Notably, triphala antibiotic sequence condition showed coordinated expression patterns within ATP synthase, arginine deiminase, and CRISPR loci, suggesting operon-level transcriptional organization of metabolic and stress-response pathways. STRING network analysis further supported clustering of genes showing relatively higher expression into functionally related molecules. Collectively, these findings suggest a potential role for triphala in shaping MV RNA cargo, offering a conceptual framework for synbiotic strategies aimed at supporting microbial stress resilience. All transcriptomic observations are based on pooled MV samples, which represent exploratory expression trends rather than statistically inferred differential expression or functional outcomes.

PMID:42143634 | DOI:10.1007/s12033-026-01578-x

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Quantifying the environmental footprint of primary hip and knee arthroplasty: a systematic review and pooled-analysis of waste generation and carbon emissions

Int Orthop. 2026 May 17. doi: 10.1007/s00264-026-06854-8. Online ahead of print.

ABSTRACT

BACKGROUND: Operating rooms contribute disproportionately to healthcare-related greenhouse gas emissions and waste generation. Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are high-volume procedures with increasing global incidence, yet pooled data on their environmental impact are lacking.

METHODS: A systematic review and pooled analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261297449). PubMed, Embase, and Scopus were searched through October 31, 2025, for studies reporting total waste, recyclable waste, and carbon dioxide equivalent (CO₂e) emissions associated with primary THA and TKA. Seventeen studies, including 394 procedures, were included. Data extraction covered waste quantity, recyclable proportion, and carbon footprint. Random-effects models with inverse variance weighting were used to calculate pooled mean estimates. Standard deviations were estimated from reported ranges when not provided. Heterogeneity was assessed using I2 statistics.

RESULTS: Pooled mean total waste per arthroplasty was 12.27 kg (95% CI, 10.88-13.66). Recyclable waste averaged 1.97 kg per procedure (95% CI, 1.64-2.31), representing 14.5% of total waste (95% CI, 11.99-17.02), and indicating substantial unrealized recycling potential. Carbon footprint estimates varied substantially by accounting methodology. Studies measuring waste-disposal emissions alone reported a pooled mean of 13.7 kg CO₂e per case (95% CI, 11.32-16.08), whereas comprehensive life-cycle assessment (LCA) studies reported a pooled mean of 135.37 kg CO₂e per case (95% CI, 74.91-195.83). Considerable inter-study heterogeneity reflected differences in waste segregation, recycling infrastructure, and carbon accounting methodologies.

CONCLUSIONS: Primary THA and TKA generate substantial waste and carbon emissions, with low recycling rates across institutions. These findings provide benchmark data to inform sustainability initiatives, optimize resource use, and guide standardized environmental assessment frameworks in arthroplasty.

PMID:42143633 | DOI:10.1007/s00264-026-06854-8

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Modeling dispersion of dust caused by tailings and mining activities at Jajarm based on gradation analysis

Environ Monit Assess. 2026 May 17;198(6):598. doi: 10.1007/s10661-026-15421-y.

ABSTRACT

This study presents a novel application of source-specific particle size distribution (PSD) and moisture content-derived from laser gradation analysis of mining wastes-as explicit inputs to the AERMOD dispersion model, significantly improving its predictive realism for PM10 from complex mining operations at the Jajarm Alumina Plant in Iran. Sampling targeted key waste types, including bauxite crusher slime, red mud, and lime tailings, with laser diffraction (HORIBA LA-950) used to quantify PSD and ASTM D2216 for moisture determination. Emission rates were calculated using AP-42 methodologies and integrated into AERMOD with seasonal surface parameters and high-resolution meteorological data. Model validation against field measurements on 21 June 2018 showed excellent agreement (R2 = 0.88, RMSE = 127 µg/m3), confirming that incorporation of gradation-specific data enhances prediction accuracy compared to generic assumptions. The highest 24-h PM10 concentration reached 2087 µg/m3 near crushers, with an annual average of 542 µg/m3, far exceeding the air standards for particulate matter set by the EPA and the air quality standard in Iran (150 μg/m3). Results identify bauxite crusher slime (60% PM10) and red mud (50% PM10, 15.4% clay) as high-dispersion-potential wastes, and lime loading/unloading as the largest emission source (104 t/a). We recommend prioritizing dust suppression at lime/bauxite handling operations and surface stabilization of fine-grained tailings to mitigate air quality and public health impacts.

PMID:42143632 | DOI:10.1007/s10661-026-15421-y

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Anesthetic Outcomes: Postoperative Nausea and Vomiting in Laparoscopic Gynecological Surgery Patients Who Had General Anesthesia With an Enhanced Recovery After Surgery (ERAS) Technique

J Perianesth Nurs. 2026 May 16:S1089-9472(26)00080-8. doi: 10.1016/j.jopan.2026.03.018. Online ahead of print.

ABSTRACT

PURPOSE: Postoperative nausea and vomiting (PONV) is a common occurrence that leads to patient discomfort and prolonged length of stay. The average rate of PONV is approximately 30% in the general population and can be as high as 70% to 80% in those at high risk. Enhanced recovery after surgery (ERAS) protocols have been created from analysis of current evidence-based research aimed to decrease postoperative complications and improve patient outcomes following surgical interventions.

DESIGN: This retrospective pre-experimental cohort study used convenience sampling of 1,200 past surgical patients to determine the trend of PONV rates in females who underwent laparoscopic gynecological surgery from 2018 to 2024, and to examine whether there was a difference in PONV rates between those who received general anesthesia utilizing ERAS protocols and those who did not during the designated time period.

METHODS: Compliance with antiemetic ERAS protocols was recorded and defined by the administration of three or more antiemetics, and noncompliance was defined as fewer than three. The primary outcome, the presence of PONV, was assessed by the administration of rescue antiemetics in the postanesthesia care unit (PACU). Additional outcomes included PACU length of stay and provider compliance with the ERAS protocols.

FINDINGS: The findings reflect those who received a general anesthetic before the introduction of the ERAS protocol through its early and most current use. During this time period, 1,200 patients underwent laparoscopic gynecologic surgery with general anesthesia. The study divided participants into pre-ERAS (2018 to 2019), early-ERAS (2020 to 2022), and current-ERAS (2023 to 2024) groups. The result of this study found a statistically significant decrease in ERAS compliance (P = .004), with a concurrent increase in PONV rates (P < .001). In patients who reported PONV, PACU length of stay increased from a mean of 92.75 (44.8) minutes in 2018 to 2019 to 130.7 (47.8) minutes in 2023 to 2024 (P = .001). Our study discovered that there was an overall decrease in compliance rates with antiemetic prophylactic administration throughout all phases of the perioperative period.

CONCLUSIONS: PONV is a key postoperative issue affecting patient comfort, recovery, and health care resources. Our findings emphasize the importance of comprehensive ERAS adherence beyond pharmacologic prophylaxis and call for further research to refine protocols based on patient outcomes, risk factors, and evolving pharmacology.

PMID:42143626 | DOI:10.1016/j.jopan.2026.03.018

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Modern Molecular Profiling Recontextualizes the NRG/RTOG 0539 Trial and Reveals Hidden High-Risk and Radiotherapy Resistant Meningiomas

Neuro Oncol. 2026 May 15:noag081. doi: 10.1093/neuonc/noag081. Online ahead of print.

ABSTRACT

BACKGROUND: Meningiomas exhibit clinical heterogeneity. Radiotherapy (RT) remains the only adjuvant therapy, but tumor-control is variable, and biomarkers are limited. NRG/RTOG-0539 is the first prospective phase 2 trial to stratify meningioma patients for adjuvant RT based on clinical risk. Here, we apply modern molecular tools to this cohort and identify correlates of RT response.

METHODS: Tumor tissue from 100 RTOG-0539 patients was profiled using DNA methylation arrays, RNA sequencing, and whole-exome sequencing. Recurrence scores, Molecular Groups, gene expression, and copy number alterations were compared across clinical groups and between RT responders and non-responders; non-response was defined as progression or death within 3 years.

RESULTS: Modern grading criteria, including brain invasion, TERT mutation, CDKN2A/B deletion, and 1p/1q status, would reclassify 10% of tumors and alter treatment group assignment in 7%. Non-responders to RT exhibited more frequent 1p and 14q loss, and more copy number alterations. Transcriptomic and epigenetic profiling revealed immune-related signatures in responders and cell cycle-related pathways in non-responders, several of which overlapped with targets of vorinostat, a histone deacetylase inhibitor previously validated in aggressive meningioma models. The Proliferative Molecular Group was an independent predictor of post-RT recurrence in multivariable analysis, outperforming WHO grade.

CONCLUSION: Multi-omic analysis of the NRG/RTOG-0539 cohort shows that updated WHO grading criteria, incorporating molecular and cytogenetic features, improve risk stratification. However, molecular classification, particularly the Proliferative group, remains an independent and stronger predictor of RT response. These findings support integrating molecular biomarkers alongside modern grading frameworks to guide treatment and trial design in meningioma.

PMID:42143623 | DOI:10.1093/neuonc/noag081

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Microlearning to teach geriatric principles in hospitals: a systematic review and meta-analysis

Age Ageing. 2026 May 4;55(5):afag129. doi: 10.1093/ageing/afag129.

ABSTRACT

BACKGROUND: Hospital-based education in geriatric medicine is often limited in availability and accessibility. Microlearning is defined as short, on-the-go, focused educational interventions (<15 minutes) and offers a practical way to deliver key geriatrics concepts in time-constrained environments. This systematic review investigated the effectiveness of microlearning to learn geriatric medicine principles for hospital-based clinicians.

METHODS: This systematic review with meta-analysis (PROSPERO: CRD42023422522) involved a comprehensive search across five databases. Studies evaluating microlearning interventions for hospital-based clinicians (medical, nursing and allied health) were included. Two independent reviewers conducted title/abstract screening and full-text review. Effectiveness was assessed using Kirkpatrick model, which evaluates educational outcomes across four levels: participant reaction, learning, behaviour and clinical practice. Data were synthesised narratively, and meta-analysis conducted using random-effects model. Study quality and risk of bias were assessed using Medical Education Research Quality Instrument and Newcastle-Ottawa scale-education.

RESULTS: Of 15 232 articles retrieved, 15 met inclusion criteria, mostly pre-post implementation studies (11/15, 73%). Common interventions included bedside teaching (6/15, 40.0%), pocket cards (5/15, 33.3%) and e-modules (4/15, 27%), focusing on delirium (9/15, 60%) and dementia (3/15, 20%). Of 40 educational outcomes measured, 90% showed positive results, and 30% were statistically significant. Meta-analysis indicated significant improvements in delirium knowledge (SMD 0.80, 95% CI 0.49-1.10, P < .00001) and recognition (SMD 0.91, 95% CI 0.10-1.72, P = .03).

CONCLUSION: Microlearning shows promise as an effective educational intervention for learning geriatric medicine principles, particularly recognising delirium. Further research is needed to assess impact on patient outcomes and guide implementation in current training programs.

PMID:42143602 | DOI:10.1093/ageing/afag129