Category: Nevin Manimala

JAMA Netw Open. 2025 Apr 1;8(4):e258565. doi: 10.1001/jamanetworkopen.2025.8565.

ABSTRACT

IMPORTANCE: The economic value of cleaning and disinfection of shared medical equipment is currently unknown.

OBJECTIVE: To evaluate whether or not better environmental cleaning and disinfection of shared medical equipment would be cost-effective compared with usual care.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation study was a within-trial cost-effectiveness analysis of a stepped-wedge cluster randomized clinical trial: the Cleaning and Enhanced Disinfection (CLEEN) study. The trial included 5002 inpatients and was conducted in 10 adult acute-care wards at a tertiary hospital in Australia between March 20, 2023, and November 24, 2023. The evaluation takes a hospital costing perspective. A decision-tree model was developed to evaluate the intervention; costs are presented in Australian dollars. Statistical analysis was performed from May to October 2024.

INTERVENTIONS: A multimodal cleaning intervention was introduced during the intervention, focusing on additional cleaning hours, education, audit, and feedback. The control group received usual care, including routine cleaning by clinical staff.

MAIN OUTCOMES AND MEASURES: Incremental cost-effectiveness ratio, where the mean change to costs associated with the intervention is divided by the mean change in outcomes.

RESULTS: This study assessed 5002 patients (2478 [49.5%] male, 2524 [50.5%] female [50.5%]; mean [SD] age, 71.6 [16.1] years). For a cohort of 1000 patients at risk of health care-associated infection (HAI), the estimated total costs associated with the intervention were $1 513 300, compared with $2 155 310 for usual care. The estimated number of HAIs was 100 in the intervention group, compared with 130 for the usual care group. Compared with usual care, the intervention was associated with reduced HAIs and costs, with a 90.5% chance that intervention adoption was cost-saving. This probability increased to 99.9% if a decision-maker was willing to pay $20 000 to avoid an infection.

CONCLUSIONS AND RELEVANCE: In this economic evaluation study of enhanced cleaning and disinfection of shared medical equipment, the intervention resulted in reduced HAIs and a $642 010 reduction in costs per 1000 patients, compared with the control group. These results suggest that the CLEEN intervention is a cost-saving initiative.

PMID:40208588 | DOI:10.1001/jamanetworkopen.2025.8565

Ann Am Thorac Soc. 2025 Apr 10. doi: 10.1513/AnnalsATS.202501-087OC. Online ahead of print.

ABSTRACT

BACKGROUND: Long-term exposure to air pollution has been linked with acute lower respiratory infections (ALRIs) in children, but the evidence in adults is still mixed and sparse. We aimed to examine the association between long-term exposure to air pollution and incident ALRIs in adults.

METHOD: We followed all Danish residents aged 30 or older (N=3,083,227) for the first-ever hospital contact (in-, outpatient, or emergency) for ALRIs (and pneumonia or influenza separately) from 2000 to 2018. Long-term exposure to air pollution was defined as annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC), which were modeled using hybrid land-use regression models and assigned to baseline residential addresses. Cox regression models were used to assess the association between air pollution and incidence of ALRIs in total, pneumonia, and influenza.

RESULTS: During 16 years’ mean follow-up, there were 322,035, 309,092 and 11,977 incident cases of ALRIs, pneumonia, and influenza, respectively. We detected positive associations of air pollution and incident ALRIs, with hazard ratios (95% confidence interval) of 1.08 (1.07, 1.09) per 10 μg/m3 for NO2, 1.07 (1.06, 1.08) per 0.5 10-5 m-1 for BC, and 1.04 (1.03, 1.04) per 2 μg/m3 for PM2.5. We detected similar associations with pneumonia, but no detected association with influenza.

CONCLUSION: Long-term exposure to air pollution may contribute to an increased risk of contracting ALRIs, particularly pneumonia, that require hospital care. Associations persisted for all major pollutants (PM2.5, NO2 and BC) even at exposure lower than the current EU limits and WHO guideline.

PMID:40208575 | DOI:10.1513/AnnalsATS.202501-087OC

Omega (Westport). 2025 Apr 10:302228251333838. doi: 10.1177/00302228251333838. Online ahead of print.

ABSTRACT

This study assessed the relationship between grief and posttraumatic growth (PTG) in 2415 individuals from six Latin American countries, and how the relationship between these variables is moderated by gender and age. The Posttraumatic Growth Inventory-Short Form and Pandemic Grief Scale were used. Moderation analysis utilized Model 2, proposed by Hayes. The findings from the analysis indicate that the proposed regression model is statistically significant in most countries. Gender moderated the relationship between grief and PTG in El Salvador and Peru; meanwhile, age moderated this relationship in Uruguay. The findings support the importance of incorporating gender and age differences into both the theory of grief and PTG and empirical studies investigating these variables in Latin America. Furthermore, mental health professionals should consider gender and age differences when planning interventions aimed at fostering PTG in individuals who have experienced the loss of a loved one in the evaluated countries.

PMID:40208570 | DOI:10.1177/00302228251333838

Multivariate Behav Res. 2025 Apr 10:1-33. doi: 10.1080/00273171.2025.2480437. Online ahead of print.

ABSTRACT

In this work, we introduce a multiple-group longitudinal IRT model that accounts for skewed latent trait distributions. Our approach extends the model proposed by Santos et al. in 2022, which introduced a general class of longitudinal IRT models. The latent traits follow a multivariate skew-normal distribution, induced by an antedependence structure with centered skew-normal errors. Additionally, latent mean trajectories are modeled using quadratic curves, while structured covariance matrices capture within-participant dependencies. A three-parameter probit model is employed for dichotomous items. Bayesian parameter estimation and model fit assessment are conducted through a hybrid MCMC algorithm, combining the FFBS sampler with Metropolis-Hastings steps. The model’s effectiveness is demonstrated through an application to real data from the Longitudinal Study of the 2005 School Generation in Brazil (GERES project), where it outperforms the normal model by better capturing asymmetry in latent traits. A simulation study further supports its robustness across various test conditions.

PMID:40208567 | DOI:10.1080/00273171.2025.2480437

CNS Drugs. 2025 Apr 10. doi: 10.1007/s40263-025-01175-7. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Residual sleepiness can occur in adult patients with obstructive sleep apnea (OSA) despite adequate treatment with continuous positive airway pressure (CPAP). Various wake-promoting agents (WPAs) have been shown to reduce residual sleepiness in CPAP-treated patients with OSA. This systematic review and network meta-analysis aimed to compare the efficacy and safety of WPAs in this setting.

METHODS: We searched MEDLINE, Scopus, and ClinicalTrials.gov up to 9 January 2025 for randomized controlled trials (RCTs) examining WPAs for treating sleepiness in patients with OSA. Included were all RCTs that explored the efficacy and/or safety of any approved WPAs (i.e., modafinil, armodafinil, solriamfetol, or pitolisant) in patients with OSA (aged $\ge$ 18 years) treated with CPAP but who are still sleepy [Epworth sleepiness scale (ESS) score ≥10]. Studies that were conducted in patients whose comorbidities cause daytime somnolence [i.e., psychiatric conditions (other than depression), other sleep disorders, medical or surgical conditions], open label extension studies, and studies published in a language other than English were excluded. The primary outcomes included ESS, maintenance of wakefulness test (MWT), and adverse events. Two authors independently assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials 2.0.

RESULTS: In total, 14 RCTs studying four WPAs (total N = 2969) including modafinil (six RCTs; 200-400 mg/day), armodafinil (four RCTs; 150-250mg/day), solriamfetol (two RCTs; 37.5-300 mg/day), and pitolisant (two RCTs; 5-40 mg/day) were included. Solriamfetol, modafinil, and armodafinil were efficacious in reducing subjective sleepiness as measured by ESS [mean difference (95% confidence interval) at $\le$ 4 weeks: -3.84 (-5.60, -2.07), -2.44 (-3.38, -1.49), and -2.41 (-3.60, -1.21) for solriamfetol, modafinil, and armodafinil, respectively; at > 4 weeks: -4.11 (-6.14, -2.08), -2.88 (-3.85, -1.91), -2.46 (-3.68, -1.24) for solriamfetol, armodafinil, and modafinil, respectively] and clinical global impression of change, as well as the objective MWT [at $\le$ 4 weeks: 11.66 min (9.70, 13.61), 3.61 min (2.48, 4.73), and 2.52 min (1.27, 3.76) for solriamfetol, modafinil, and armodafinil, respectively; at > 4 weeks: 10.34 min (4.16, 16.52) for solriamfetol]. Pitolisant showed later improvements in ESS [at > 4 weeks: -2.70 (-3.66, -1.73)], with limited data on MWT. Sensitivity analyses restricted to U.S. Food and Drug Administration-approved solriamfetol dosages (37.5-150 mg/day) still showed higher efficacy, but lower anxiety risk.

CONCLUSIONS: Among all WPAs, solriamfetol demonstrated the highest efficacy on ESS and MWT, with the latter being significant. Modafinil demonstrated the best clinician impression, albeit not statistically significant. All four WPAs were associated with a low risk of serious or adverse events.

REGISTRATION: PROSPERO registration number, CRD42022359237.

PMID:40208562 | DOI:10.1007/s40263-025-01175-7

Methods Mol Biol. 2025;2922:335-354. doi: 10.1007/978-1-0716-4510-9_26.

ABSTRACT

The clinical application of tissue engineered products aims to regenerate skin and enhance the appearance, texture, sensation, and functionality of affected skin or scars. To evaluate the efficacy and effectiveness of novel products, level 1 randomized controlled trials are required. However, currently a significant challenge in this field is the clinical and statistical heterogeneity of trial designs and outcome measures for tissue engineered products. To address this challenge and improve clinical outcomes, it is essential to standardize high-quality outcome measures. These measures are clinimetrically developed tools designed to reliably and validly assess specific health outcomes across diverse patient populations, clinical settings, and studies. This chapter proposes a core set of outcome measurements designed to evaluate the most relevant, feasible, reliable, and valid parameters in the clinical application of tissue engineered products. For routine clinical practice, we recommend the inclusion of photography, graft take, re-epithelialization, and scar quality assessment using the Patient and Observer Scar Assessment Scale. For clinical trials, additional measures such as colorimetry and elasticity assessment are advised. Detailed protocols for these methods are provided, resulting in a standardized core outcome set. High-quality outcome assessment also necessitates specialized training and the presence of trained personal at all assessment points. The chapter further addresses specific considerations for outcome assessment in pediatric patients, remote assessment strategies, and additional recommendations for optimizing clinical and research practices in this field. The implementation of standardized outcome measurement is essential for improving the outcomes of patients treated with tissue engineered products.

PMID:40208548 | DOI:10.1007/978-1-0716-4510-9_26

J Neurooncol. 2025 Apr 10. doi: 10.1007/s11060-025-04996-0. Online ahead of print.

ABSTRACT

PURPOSE: Glioma patients often suffer from psychiatric and neurological conditions. However, little is known about the patterns of use of psychotropic drugs pre- and post-glioma diagnosis. Therefore, we assessed temporal patterns of psychotropic prescriptions among glioma patients, compared to an age and sex matched comparison cohort in four European countries.

METHODS: Incident gliomas were identified in Wales from the Secured Anonymized Information Linkage Databank (2005-2016) and population-based registries in Denmark (2001-2016), Norway (2006-2019), and Sweden (2008-2018). From each data source, a cancer-free comparison cohort was matched to the glioma cases by age and sex. We calculated rates of new psychotropic prescriptions and any psychotropic prescriptions during the 2 years prior to and post glioma diagnosis. Analyses were stratified by histological subtypes and subclasses of psychotropic medications.

RESULTS: We identified 16,007 glioma patients. The rate of new psychotropic drug use increased from 7 months before diagnosis, peaking around the month of glioma diagnosis (with peak rates ranging from 227 to 753 new psychotropic drugs per 1000 person-months). New use remained substantially higher among glioma patients than comparators throughout the 2-year follow-up period after glioma diagnosis, though rates of new use continued to decline throughout. New use was largely driven by antiepileptics, anxiolytics, hypnotics, and sedatives. Patterns were similar when analyses were stratified by histological subtype.

CONCLUSION: Psychotropic drug use among glioma patients was high, and elevations observed around the time of cancer diagnosis, largely driven by antiepileptics, anxiolytics, hypnotics, and sedatives, are likely associated with the consequences of the disease.

PMID:40208515 | DOI:10.1007/s11060-025-04996-0

Br J Nutr. 2025 Apr 10:1-13. doi: 10.1017/S0007114525000522. Online ahead of print.

ABSTRACT

One of the most significant challenges in research related to nutritional epidemiology is the achievement of high accuracy and validity of dietary data to establish an adequate link between dietary exposure and health outcomes. Recently, the emergence of artificial intelligence (AI) in various fields has filled this gap with advanced statistical models and techniques for nutrient and food analysis. We aimed to systematically review available evidence regarding the validity and accuracy of AI-based dietary intake assessment methods (AI-DIA). In accordance with PRISMA guidelines, an exhaustive search of the EMBASE, PubMed, Scopus and Web of Science databases was conducted to identify relevant publications from their inception to 1 December 2024. Thirteen studies that met the inclusion criteria were included in this analysis. Of the studies identified, 61·5 % were conducted in preclinical settings. Likewise, 46·2 % used AI techniques based on deep learning and 15·3 % on machine learning. Correlation coefficients of over 0·7 were reported in six articles concerning the estimation of calories between the AI and traditional assessment methods. Similarly, six studies obtained a correlation above 0·7 for macronutrients. In the case of micronutrients, four studies achieved the correlation mentioned above. A moderate risk of bias was observed in 61·5 % (n 8) of the articles analysed, with confounding bias being the most frequently observed. AI-DIA methods are promising, reliable and valid alternatives for nutrient and food estimations. However, more research comparing different populations is needed, as well as larger sample sizes, to ensure the validity of the experimental designs.

PMID:40207441 | DOI:10.1017/S0007114525000522

Epilepsia Open. 2025 Apr 10. doi: 10.1002/epi4.70036. Online ahead of print.

ABSTRACT

OBJECTIVE: Temporal encephaloceles (TEs) are increasingly recognized as a cause of MRI-negative temporal lobe epilepsy (TLE). The optimal surgical approach for TE-related refractory epilepsy remains unclear, particularly regarding the necessity of excluding mesiotemporal structures such as the hippocampus, which may lead to worse neuropsychological outcomes. This study evaluates the impact of hippocampectomy on achieving seizure freedom in patients with TE-related epilepsy through a systematic review and individual participant data (IPD) meta-analysis.

METHODS: A systematic literature review was conducted across Medline, Google Scholar, Embase, and Web of Science, identifying studies reporting surgical outcomes in TE-related epilepsy. Studies were included if they provided at least 12 months of follow-up and reported seizure outcomes using Engel or ILAE classification. The primary outcome was postsurgical seizure freedom (Engel Class IA or ILAE Class 1). A mixed-effects logistic regression model was used to compare outcomes between patients who underwent hippocampectomy and those who did not. Heterogeneity was assessed using τ² and I² statistics.

RESULTS: The meta-analysis included 23 studies with a total of 155 surgically treated patients. The primary analysis did not identify a statistically significant difference in seizure freedom between patients who underwent hippocampectomy and those who did not (Risk Ratio [RR] = 0.66, 95% Confidence Interval [CI]: 0.29-1.52, p = 0.329). Other covariates, including sex, duration of epilepsy, presence of additional epileptogenic lesions, and the use of invasive presurgical evaluation, were not significant predictors of seizure freedom. The I² statistic indicated moderate heterogeneity (54.68%).

SIGNIFICANCE: This IPD meta-analysis suggests that hippocompectomy does not significantly impact seizure freedom in patients with TE-related epilepsy and should not be part of a universal approach when determining the optimal surgical strategy. These results reinforce the need for an individualized approach, considering patient-specific factors to optimize surgical decision-making in TE-related epilepsy.

PLAIN LANGUAGE SUMMARY: Temporal encephaloceles (TEs) can cause drug-resistant epilepsy, often requiring surgical management for seizure control. Given the variety of surgical techniques available, the optimal approach remains uncertain, particularly regarding the necessity of hippocampectomy, which may impact neuropsychological outcomes. This one-stage individual participant data meta-analysis found no significant difference in seizure freedom between patients who underwent hippocampectomy and those who did not. These findings suggest that hippocampectomy should not be routinely performed and highlight the importance of individualized surgical decision-making for patients with TEs.

PMID:40207440 | DOI:10.1002/epi4.70036

Alzheimers Dement. 2025 Apr;21(4):e70144. doi: 10.1002/alz.70144.

ABSTRACT

INTRODUCTION: Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities are among the fastest growing segments of older adults in the United States yet remain underrepresented in aging, dementia, and caregiving research.

METHODS: The Collaborative Approach for AANHPI Research & Education (CARE), a recruitment registry, aims to improve the representation of AANHPI older adults in research. We describe activity to date, as well as planned expansions in cultural groups, language capacity, and data collection in the registry.

RESULTS: Between October 15, 2020, and November 4, 2024, 10,367 total AANHPI adults enrolled in the CARE registry, including 50.0% with limited English proficiency, 35.1% age ≥ 65, and 80.2% with no prior participation in research. CARE has made more than 13,954 referrals of 6868 unique registrants to at least one study.

DISCUSSION: Through collaborative partnerships with AANHPI communities and researchers, the CARE Registry is achieving its goal of increasing AANHPI representation in research.

HIGHLIGHTS: The CARE registry has enrolled 10,367 AANHPI adults. More than 80% of those enrolled had no prior research experience. As of November 4, 2024, CARE had referred 6868 unique participants to at least one study. In total, CARE has made 13,954 referrals to requesting studies.

PMID:40207420 | DOI:10.1002/alz.70144