Category: Nevin Manimala

J Med Internet Res. 2025 Apr 2;27:e64028. doi: 10.2196/64028.

ABSTRACT

BACKGROUND: Symptom checker apps (SCAs) are layperson-facing tools that advise on whether and where to seek care, or possible diagnoses. Previous research has primarily focused on evaluating the accuracy, safety, and usability of their recommendations. However, studies examining SCAs’ impact on clinical care, including the patient-physician interaction and satisfaction with care, remain scarce.

OBJECTIVE: This study aims to evaluate the effects of an SCA on satisfaction with the patient-physician interaction in acute care settings. Additionally, we examined its influence on patients’ anxiety and trust in the treating physician.

METHODS: This parallel-group, randomized controlled trial was conducted at 2 emergency departments of an academic medical center and an emergency practice in Berlin, Germany. Low-acuity patients seeking care at these sites were randomly assigned to either self-assess their health complaints using a widely available commercial SCA (Ada Health) before their first encounter with the treating physician or receive usual care. The primary endpoint was patients’ satisfaction with the patient-physician interaction, measured by the Patient Satisfaction Questionnaire (PSQ). The secondary outcomes were patients’ satisfaction with care, their anxiety levels, and physicians’ satisfaction with the patient-physician interaction. We used linear mixed models to assess the statistical significance of primary and secondary outcomes. Exploratory descriptive analyses examined patients’ and physicians’ perceptions of the SCA’s utility and the frequency of patients questioning their physician’s authority.

RESULTS: Between April 11, 2022, and January 25, 2023, we approached 665 patients. A total of 363 patients were included in the intention-to-treat analysis of the primary outcome (intervention: n=173, control: n=190). PSQ scores in the intervention group were similar to those in the control group (mean 78.5, SD 20.0 vs mean 80.8, SD 19.6; estimated difference -2.4, 95% CI -6.3 to 1.1, P=.24). Secondary outcomes, including patients’ and physicians’ satisfaction with care and patient anxiety, showed no significant group differences (all P>.05). Patients in the intervention group were more likely to report that the SCA had a beneficial (66/164, 40.2%) rather than a detrimental (3/164, 1.8%) impact on the patient-physician interaction, with most reporting no effect (95/164, 57.9%). Similar patterns were observed regarding the SCA’s perceived effect on care. In both groups, physicians rarely reported that their authority had been questioned by a patient (intervention: 2/188, 1.1%; control: 4/184, 2.2%). While physicians more often found the SCA helpful rather than unhelpful, the majority indicated it was neither helpful nor unhelpful for the encounter.

CONCLUSIONS: We found no evidence that the SCA improved satisfaction with the patient-physician interaction or care in an acute care setting. By contrast, both patients and their treating physicians predominantly described the SCA’s impact as beneficial. Our study did not identify negative effects of SCA use commonly reported in the literature, such as increased anxiety or diminished trust in health care professionals.

TRIAL REGISTRATION: German Clinical Trial Register DRKS00028598; https://drks.de/search/en/trial/DRKS00028598/entails.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-022-06688-w.

PMID:40173434 | DOI:10.2196/64028

PLoS One. 2025 Apr 2;20(4):e0311459. doi: 10.1371/journal.pone.0311459. eCollection 2025.

ABSTRACT

BACKGROUND/OBJECTIVE: Relative proportion of cases in a multi-strain pandemic like the COVID-19 pandemic provides insight on how fast a newly emergent variant dominates the infected population. However, the behavior of relative proportion of emerging variants is an understudied field. We investigated the emerging behavior of dominant COVID-19 variants using nonlinear statistical methods and calculated the time to dominance of each variant.

METHOD: We used a phenomenological approach to model national- and regional-level variant share data from the national genomic surveillance system provided by the Centers for Disease Control and Prevention to determine the best model to describe the emergence of two recent dominant variants of the SARS-CoV-2 virus: XBB.1.5 and JN.1. The proportions were modeled using logistic, Weibull, and generalized additive models. Model performance was evaluated using the Akaike Information Criteria (AIC) and the root mean square error (RMSE).

FINDINGS: The Weibull model performed the worst out of all three approaches. The generalized additive model approach slightly outperformed the logistic model based on fit statistics, but lacked in interpretability compared to the logistic model. These models were then used to estimate the time elapsed from emergence to dominance in the infected population, denoted by the time to dominance (TTD). All three models yielded similar TTD estimates. The XBB.1.5 variant was found to dominate the population faster compared to the JN.1 variant, especially in HHS Region 2 (New York) where the XBB.1.5 was believed to emerge. This research expounds on how emerging viral strains transition to dominance, informing public health interventions against future emergent COVID-19 variants and other infectious diseases.

PMID:40173404 | DOI:10.1371/journal.pone.0311459

PLoS One. 2025 Apr 2;20(4):e0318825. doi: 10.1371/journal.pone.0318825. eCollection 2025.

ABSTRACT

Understanding past climate is essential to our knowledge of how our current climate system operates, and how it might respond to future change. Techniques to reconstruct climate history are challenging, and both accuracy and certainty are hampered by the quality of the datasets used. Here we both develop a new reconstruction tool and apply it to four ice core proxy based multi-millennial Holocene climate reconstructions, chosen because of their potential influence on East Antarctic climate. The new multi-proxy reconstruction method is called Segmented Linear Integral Correlation Kernel Ensemble Reconstruction (SLICKER). This method employs a segmented linear rather than Gaussian correlation approach and builds an ensemble of reconstructions with a best fit and spread related to the best estimate of uncertainty. This method is robust for non-linear, uneven or differently sampled data and produces high-fidelity reconstructions and associated uncertainty estimates. This new method has the potential to produce more realistic reconstructions, with associated uncertainty estimates based on robust statistical measures that are insensitive to outliers. The main findings from these new reconstructions are: Antarctica temperature shows multi-decadal variability over the last twelve thousand years with increased frequency over the last two thousand years; Zonal Wave 3 index and the Southern Annular Mode both show limited trends over the last two thousand years, but an increase since the 1970s CE; and the Indian Ocean Dipole Moment index has a twentieth century CE upward trend, and a thirteenth to sixteenth century CE below average period which may be related to volcanic activity.

PMID:40173401 | DOI:10.1371/journal.pone.0318825

JMIR Pediatr Parent. 2025 Apr 2;8:e62841. doi: 10.2196/62841.

ABSTRACT

BACKGROUND: Essential Coaching for Every Mother is an SMS text messaging program that positively improved parenting self-efficacy and reduced postpartum anxiety when measured immediately after intervention at 6 weeks postpartum. However, the impact of a short-term postpartum intervention over time is unknown.

OBJECTIVE: This study aims to compare parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and perceived social support at 6 months postpartum for mothers in the Essential Coaching for Every Mother trial.

METHODS: Participants (n=150) were randomized to Essential Coaching for Every Mother or control (usual care). Data were collected on parenting self-efficacy (primary outcome, Karitane Parenting Confidence Scale), postpartum anxiety symptoms (Postpartum Specific Anxiety Scale), postpartum depressive symptoms (Edinburgh Postnatal Depression Scale), and perceived social support (Multidimensional Scale of Perceived Social Support) at enrollment and 6-months postpartum. Data were analyzed using analyses of covariance and chi-square analysis.

RESULTS: A total of 139 women completed the primary outcome at 6 months and 136 completed secondary outcomes. At 6 months, there were no statistically significant differences between mothers in the intervention group and mothers in the control group on any of the outcomes. More mothers in the intervention group had higher postpartum anxiety scores (31/68, 45.6%) than mothers in the control group (16/68, 23.5%; P=.007).

CONCLUSIONS: At 6 months postpartum, all mothers had similar scores on parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and social support. Thus, Essential Coaching for Every Mother improved parenting self-efficacy and reduced postpartum anxiety at 6 weeks, with all mothers having similar scores at 6 months postpartum.

PMID:40173396 | DOI:10.2196/62841

Asian Pac Isl Nurs J. 2025 Apr 2;9:e63769. doi: 10.2196/63769.

ABSTRACT

BACKGROUND: Racism against Asian Americans escalated during the COVID-19 pandemic. About 31%-91% of Asian American adults and children reported experiencing various types of racism during the pandemic. According to the Federal Bureau of Investigation hate crime statistics, anti-Asian hate crime incidents increased from 158 in 2019 to 279 in 2020 and 746 in 2021. In 2022, the incidents decreased to 499, corresponding to the downward trend of the pandemic. The degree of impact racism has on mental health and wellness among Asian Americans requires investigation, specifically during the COVID-19 pandemic.

OBJECTIVE: We aim to describe racism-related mental health problems experienced by Asian Americans living in the United States and propose implementation strategies for mitigating their consequences.

METHODS: We conducted an integrative review of peer-reviewed publications in English reporting anti-Asian sentiments and racism’s impacts on mental health among Asian Americans in the United States.

RESULTS: The 29 eligible articles report on studies that utilized cross-sectional survey designs with various sample sizes. Racism is directly correlated with the prevalence of depression and anxiety experienced by victims of racist acts. The prevalence of in-person direct racism (racist expression aimed directly at the victim) is lower than in-person indirect racism (racist expression aimed at the ethnic group the victim belongs to). During the COVID-19 pandemic, the incidence of explicit online racism was lower than online indirect racism.

CONCLUSIONS: COVID-19-related racism exacerbated preexisting racism, contributing to worse depression and anxiety among Asian Americans. To address this issue, we propose 2 main approaches: increase public awareness and education about recognizable racist sentiments/acts and systematized reporting of racially motivated crimes to guide political action. At an individual level, culturally responsive, trauma-informed interventions promoting cultural support and cohesion for various Asian American groups will foster this empowerment. These proposed actions will help alleviate racism by reducing stereotypes, empowering victims, and chipping away at the systemic racism structure.

PMID:40173392 | DOI:10.2196/63769

JMIR Med Inform. 2025 Apr 2;13:e66466. doi: 10.2196/66466.

ABSTRACT

BACKGROUND: The use of patient-reported outcome measures (PROMs) is an expected component of high-quality, measurement-based chiropractic care. The largest health care system offering integrated chiropractic care is the Veterans Health Administration (VHA). Challenges limit monitoring PROM use as a care quality metric at a national scale in the VHA. Structured data are unavailable, with PROMs often embedded within clinic text notes as unstructured data requiring time-intensive, peer-conducted chart review for evaluation. Natural language processing (NLP) of clinic text notes is one promising solution to extracting care quality data from unstructured text.

OBJECTIVE: This study aims to test NLP approaches to identify PROMs documented in VHA chiropractic text notes.

METHODS: VHA chiropractic notes from October 1, 2017, to September 30, 2020, were obtained from the VHA Musculoskeletal Diagnosis/Complementary and Integrative Health Cohort. A rule-based NLP model built using medspaCy and spaCy was evaluated on text matching and note categorization tasks. SpaCy was used to build bag-of-words, convoluted neural networks, and ensemble models for note categorization. Performance metrics for each model and task included precision, recall, and F-measure. Cross-validation was used to validate performance metric estimates for the statistical and machine-learning models.

RESULTS: Our sample included 377,213 visit notes from 56,628 patients. The rule-based model performance was good for soft-boundary text-matching (precision=81.1%, recall=96.7%, and F-measure=88.2%) and excellent for note categorization (precision=90.3%, recall=99.5%, and F-measure=94.7%). Cross-validation performance of the statistical and machine learning models for the note categorization task was very good overall, but lower than rule-based model performance. The overall prevalence of PROM documentation was low (17.0%).

CONCLUSIONS: We evaluated multiple NLP methods across a series of tasks, with optimal performance achieved using a rule-based method. By leveraging NLP approaches, we can overcome the challenges posed by unstructured clinical text notes to track documented PROM use. Overall documented use of PROMs in chiropractic notes was low and highlights a potential for quality improvement. This work represents a methodological advancement in the identification and monitoring of documented use of PROMs to ensure consistent, high-quality chiropractic care for veterans.

PMID:40173367 | DOI:10.2196/66466

J Am Chem Soc. 2025 Apr 2. doi: 10.1021/jacs.5c00968. Online ahead of print.

ABSTRACT

Visualizing the sliding dynamics of a topological network can provide critical insight into determining the design and properties of mechanically interlocked materials. Although several auxiliary techniques have been proposed to infer the microscopic motion of rotaxanes, employing intuitive and convenient methods to explore the microscopic dynamics of a mechanically interlocked polymer remains a significant challenge. Herein, this work introduces a mechanically interlocked network (MIN) into the patterned surfaces for visualizing and regulating the sliding process of [2]rotaxane units through the evolution of surface wrinkles. Upon the photodimerization of the anthracene-functionalized polymer chain, the surface wrinkle can be formed after thermal treatment and subsequent cooling to room temperature. Specifically, the cross-linked films exhibit visible changes in wrinkle topography through the disruption of host-guest recognition by alkaline stimuli. Moreover, by leveraging the unique mechanical properties of surface wrinkles, we prolonged and amplified the originally extremely transient and difficult-to-detect sliding motion of rotaxane units in terms of time scale. Through statistical analysis of the changes in wrinkle morphology, we were able to correspondingly deconstruct the three processes of the rotaxane sliding motion: (I) unrestricted rapid sliding following host-guest dissociation; (II) restricted sliding; and (III) termination of sliding. The novel approach we propose opens a new avenue for studying the microscopic molecular motion of mechanically interlocked materials, facilitating the advancement and application of mechanically interlocked structures. In addition to using macroscopic surface patterns to visualize and explore microscopic molecular motion, the motion of microscopic molecules can also be used to regulate macroscopic surface patterns.

PMID:40173364 | DOI:10.1021/jacs.5c00968

Oral Dis. 2025 Apr 2. doi: 10.1111/odi.15336. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the necessity of adjuvant radiotherapy for oral squamous cell carcinoma patients with a pN1 stage and no adverse pathological features.

PATIENTS AND METHODS: This was a multicenter cohort study including 231 patients.

RESULTS: Among the enrolled patients, 171 received adjuvant radiotherapy, and 60 did not. According to the Kaplan-Meier survival analysis, there were no significant differences between the two groups in terms of disease-free survival (59.5% vs. 58.3%, p = 0.938), overall survival (73.1% vs. 75.0%, p = 0.936), and disease-specific survival (74.9% vs. 76.7%, p = 0.914). In patients with local/regional recurrence after surgery, after-recurrence survival (34.8% vs. 44.0%, p = 0.197) was not significantly different. Analysis by T stage revealed no significant differences in disease-free survival (60.9% vs. 75.0%, p = 0.084), overall survival (73.6% vs. 90.6%, p = 0.053) and disease-specific survival (75.8% vs. 90.6%, p = 0.072) for T1-2 patients between the radiotherapy and non-radiotherapy groups. The results revealed statistically significant differences in disease-free survival (57.9% vs. 39.3%, p = 0.030), overall survival (72.4% vs. 57.1%, p = 0.034) and disease-specific survival (73.7% vs. 60.7%, p = 0.049) between the two groups.

CONCLUSIONS: Adjuvant radiotherapy does not improve the prognosis of T1-2N1M0 patients without adverse pathological features; however, adjuvant radiotherapy should be recommended for T3-4aN1M0 patients.

PMID:40173300 | DOI:10.1111/odi.15336

Ultrasound Q. 2025 Mar 24;41(2):e00712. doi: 10.1097/RUQ.0000000000000712. eCollection 2025 Jun 1.

ABSTRACT

Noninvasive assessment of liver fat content is crucial due to the high global prevalence of nonalcoholic fatty liver disease. Algorithms based on ultrasound (US) attenuation coefficient (AC) for estimating liver fat content are commercially available, but a lack of consensus exists regarding the best estimation protocol. The aim of our study was to evaluate the influence of the size of the region of interest (ROI) on the US AC.A prospective study was conducted. An abdominal US was done for 86 outpatients. A sampling box was positioned within the liver parenchyma, approximately 2 cm beneath the liver capsule with a ROI, measuring about 2 × 4 cm and then 4 × 5 cm, precisely placed at the center of this sampling box. Five readings of the AC were captured, and the average of these measurements was employed to assess the severity of hepatic steatosisA statistically significant difference between AC with 2 different ROI sizes was shown (P < 0.001) with AC values with 2 × 4 cm ROI were higher than those obtained with 4 × 5 cm ROI (AC mean 0.668 VS 0.653). However, the agreement between AC values obtained with 2 different ROI sizes was excellent (correlation coefficient 0.941)An ROI size dependence is observed in the measurement of AC in the liver. A standardized acquisition protocol with a fixed size of the ROI needs to be developed to minimize differences in AC measurements and to assess changes in serial measurements reliably.

PMID:40173292 | DOI:10.1097/RUQ.0000000000000712

Diabet Med. 2025 Apr 2:e70036. doi: 10.1111/dme.70036. Online ahead of print.

ABSTRACT

AIMS: To investigate the cost-effectiveness of early initiation of metformin and usual care for gestational diabetes mellitus (GDM).

METHODS: Economic evaluation from a healthcare perspective, based on the EMERGE randomised controlled trial. In total, 535 women with GDM were randomised to placebo in addition to usual care or metformin in addition to usual care. Economic outcomes included incremental healthcare costs and quality adjusted life years (QALYs) and expected cost-effectiveness at cost-effectiveness threshold values of €20,000, €45,000 and €100,000 per QALY gained. Uncertainty was explored using parametric, non-parametric, deterministic and probabilistic methods and heterogeneity using subgroup analysis.

RESULTS: On average, relative to the placebo arm, the early metformin arm was associated with non-statistically significant mean increases of €193.07 (95% CI: -€789.88, €1176.01; p = 0.700) and 0.002 QALYs (95% CI: -0.009, 0.013; p = 0.771). In terms of expected cost-effectiveness at threshold values of €20,000, €45,000 and €100,000 per QALY gained, the probability of the early metformin arm being more cost-effective was estimated at 0.423, 0.452 and 0.524. Exploratory subgroup analyses provided more favourable but not definitive evidence in favour of the early metformin arm for cohorts with previous GDM and previous caesarean section.

CONCLUSIONS: We do not find definitive evidence that early initiation of metformin in addition to usual care for GDM was more cost-effective than usual care alone. The clinical and economic evidence may be considered equivocal, but worthy of further examination.

PMID:40173275 | DOI:10.1111/dme.70036