Category: Nevin Manimala

BMC Pregnancy Childbirth. 2025 Oct 1;25(1):994. doi: 10.1186/s12884-025-08026-9.

ABSTRACT

BACKGROUND: Sleep disorders are common among pregnant women and can adversely affect maternal and infant health. Traditional statistical methods have limitations in predicting these disorders, highlighting the need for advanced machine learning (ML) approaches. This study aimed to develop a reliable ML model for early prediction of pregnancy-related sleep disorders.

METHODS: Data from 1,681 pregnant women in western China were analyzed. Logistic regression and LASSO regression identified key predictors, with 10 variables selected for Model training. Eight ML algorithms were evaluated using 5-fold cross-validation. SHAP analysis interpreted the model’s decisions.

RESULTS: Ten predictors were identified: age, standardized gestational weight gain, gestational weeks, severity of morning sickness, pregnancy intention, pre-pregnancy health, underlying diseases, anxiety, depression, and the combined effect of anxiety and depression. LightGBM achieved the highest AUC (0.718) in the test set, with accuracy of 0.670 and specificity of 0.764. SHAP analysis revealed depression as the strongest predictor (mean |SHAP|=0.26), followed by gestational weeks and Std. GWG.

CONCLUSION: The interpretable and accurate LightGBM model, using clinically feasible variables, is a practical tool for early identification of pregnant women at high risk of sleep disorders. It enables targeted interventions to mitigate sleep – related adverse outcomes, thus improving maternal and infant health.

PMID:41034737 | DOI:10.1186/s12884-025-08026-9

J Hazard Mater. 2025 Sep 27;498:139981. doi: 10.1016/j.jhazmat.2025.139981. Online ahead of print.

ABSTRACT

Microplastics (MPs) are emerging environmental contaminants that pose potential health risks through inhalation, ingestion, and dermal contact. However, data on MP exposure and its impact on the pediatric respiratory system remain limited. This study aimed to assess MP levels in bronchoalveolar lavage fluid (BALF) and evaluate their associations with macrolide resistance in children with Mycoplasma pneumoniae pneumonia (MPP). BALF samples from 195 children aged 1-16 years were analyzed using Laser Direct Infrared (LDIR) spectroscopy and Pyrolysis-Gas Chromatography/Mass Spectrometry (Py-GC/MS). Six types of MPs were identified: Polyamide 66 (PA66) (92.31 %), Polyvinyl Chloride (PVC) (81.54 %), Polystyrene (PS) (78.97 %), Polyethylene (PE) (51.28 %), Polymethyl Methacrylate (PMMA) (21.02 %), and Polypropylene (PP) (11.28 %). MPs were detected in 194 out of 195 samples, with an overall detection rate of 99.48 %. Logistic regression showed that moderate exposure to PE (0.32-1.05 µg/mL) significantly increased the odds of macrolide-resistant MPP compared to low exposure (OR = 1.39; 95 % CI: 1.01-1.92; P < 0.05). Among children aged ≤ 6 years, high PE exposure was strongly associated with odds of macrolide-resistant MPP (OR = 2.62; 95 % CI: 1.37-5.02; P < 0.05), with a significant dose-response trend (P trend = 0.004). These findings provide the first evidence linking lower respiratory tract MP exposure with antibiotic resistance in pediatric MPP, particularly among younger children, and underscore the importance of minimizing environmental MP exposure in vulnerable populations.

PMID:41032928 | DOI:10.1016/j.jhazmat.2025.139981

Neurosurg Focus. 2025 Oct 1;59(4):E12. doi: 10.3171/2025.7.FOCUS25500.

ABSTRACT

OBJECTIVE: To date, there is no consensus on treatment indications for chronic subdural hematoma (CSDH) in patients in their 10th decade of life. The present investigation aims to focus on and carefully evaluate the clinical course of this particularly fragile subgroup of patients.

METHODS: The authors retrospectively analyzed the clinical, radiological, and surgical records from a multicentric prospectively maintained database of patients with CSDH surgically treated between June 2005 and August 2021. Patients included in the study were divided into two subgroups: group A, those whose age was < 90 years; and group B, those whose age was ≥ 90 years. The following variables were recorded for each patient: age, sex, clinical disease onset, history of traumatic brain injury, antiplatelet or anticoagulant use, and pre- and/or postoperative corticosteroid medication intake. The surgical approach and whether a surgical drain had been left in the subdural space were recorded, as was the anesthesia protocol. Clinical results were measured using the Markwalder Grading Scale. Recurrence and mortality were analyzed separately.

RESULTS: The final cohort comprised 1312 patients who had undergone surgery for CSDH, 1240 patients whose age was < 90 years and 72 patients whose age was ≥ 90. Patients in their 10th decade of life experienced similar or even better clinical outcomes than their younger counterparts. In particular, the pre-postoperative variation in Markwalder grades was favorable in elderly patients (p = 0.006). Multivariate analyses confirmed that local anesthesia (p = 0.013), single-sided CSDH (p = 0.010), and no antiplatelet or anticoagulant intake (p = 0.004 and p = 0.037, respectively) are independent predictors of favorable outcomes.

CONCLUSIONS: Patients in their 10th decade can experience clinical and radiological outcomes similar to those in their younger counterparts. Such patients could be eligible for standard minimally invasive treatments.

PMID:41032907 | DOI:10.3171/2025.7.FOCUS25500

Neurosurg Focus. 2025 Oct 1;59(4):E10. doi: 10.3171/2025.7.FOCUS25528.

ABSTRACT

OBJECTIVE: Chronic subdural hematoma (cSDH) is one of the most common diseases treated by neurosurgeons. While surgical evacuation has been the traditional way to address symptomatic lesions, there is expanding evidence of the beneficial use of middle meningeal artery (MMA) embolization as a treatment or as an adjunct for cSDH. With the current strain on healthcare resources, physicians must balance providing the best care for patients and making cost-conscious decisions. Therefore, the aim of this study was to compare the cost of surgery alone versus surgery plus MMA embolization for treatment of cSDH, and to calculate an institutional tipping point for cost benefit.

METHODS: This is a retrospective study of patients with symptomatic cSDH requiring surgical intervention at a single institution from May 2019 to December 2022. The patients were concurrently enrolled in a prospective randomized controlled trial. To compare the cost of surgical treatment alone versus surgical treatment plus MMA embolization, all charges related to cSDH treatment from admission to the last follow-up were categorized (procedure, radiology, pharmacy, intensive care unit bed, laboratory, floor bed, and other) and assessed. The institutional tipping point (point at which it becomes financially beneficial to add MMA embolization to surgical evacuation during the same admission) was calculated to help guide decision-making.

RESULTS: Forty-one patients (28 male, mean age 67.9 years) were included in the analysis, and were previously randomized to surgical intervention only (n = 21) or surgical intervention plus MMA embolization (n = 20). The groups were comparable in terms of demographic and cSDH characteristics. The overall mean cost for the index admission was lower in the surgery only group (US$158,320 vs $235,263; p = 0.037). This was also true for all categories of charges. Throughout the duration of the study there were 27 admissions in the surgery only group and 20 admissions in the surgery plus MMA embolization group (p = 0.0052). When analyzing costs per patient instead of per admission, no differences were observed between treatment groups for any of the categories. Likewise, the overall mean costs related to the care of patients in either treatment group showed no statistical difference ($203,554 vs $235,263; p = 0.25). Consequently, the institutional tipping point for the addition of MMA embolization was 20.8%.

CONCLUSIONS: MMA embolization can be considered as an adjunct to surgery in the treatment of symptomatic cSDH, decreasing the overall cost by lowering rates of readmission and repeat intervention. The tipping point formula used in this study is versatile and adaptable. It can be a useful guide to determine appropriate treatment options for patients with symptomatic cSDH according to institutional or national standards.

PMID:41032896 | DOI:10.3171/2025.7.FOCUS25528

Neurosurg Focus. 2025 Oct 1;59(4):E6. doi: 10.3171/2025.7.FOCUS25531.

ABSTRACT

OBJECTIVE: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical pathologies. Despite the optimization of surgical approaches, outcomes such as recurrence and complication rates remain unacceptably high. Consolidated evidence-based pathways have demonstrated a clear impact on surgical outcomes. Herein, the authors aggregated literature evidence and institutional experience to design and implement an enhanced recovery pathway for cSDH.

METHODS: A multicenter cohort study was conducted over two periods: prior to (July 2021 to June 2022) and after (July 2022 to June 2023) pathway implementation. All adult patients with surgically evacuated cSDH or subacute subdural hematoma (SDH) were included in the study. Patients with SDHs that were managed conservatively, acute SDH treated with craniotomy or craniectomy, or subdural empyemas were excluded. Demographic details as well as preoperative clinical and radiological data were collected. Outcome measures included hospital length of stay (LOS), complication rate, discharge location, 30-day mortality, and 3-month recurrence. An excellent outcome was defined as discharge within a week of burr hole evacuation to a location similar to or better than premorbidly and no 3-month recurrence.

RESULTS: One hundred seventy prepathway and 169 postpathway patients were included in the final analysis and were comparable both demographically and clinically. After multivariable logistic regression analysis, the postpathway group had a shorter median LOS (9 vs 7 days, p = 0.003) and were more likely to be discharged to home or a rehabilitation facility (OR 2.77, 95% CI 1.45-5.56, p = 0.002). The 3-month recurrence rate reduced from 11.8% prepathway to 7.7% postpathway, although the difference between the two was not statistically significant (p = 0.13). Excellent outcomes were more likely postpathway, increasing from 34.7% to 49.7% (OR 1.92, 95% CI 1.19-3.13, p = 0.008).

CONCLUSIONS: The treatment of cSDH is ever evolving with newer adjuncts and treatment modalities described in the literature. However, with the simple standardization of care in patients with cSDH, a reduced LOS, an optimized patient discharge location, and an increase in the proportion of patients with excellent outcomes were noted.

PMID:41032893 | DOI:10.3171/2025.7.FOCUS25531

Transplantation. 2025 Sep 24. doi: 10.1097/TP.0000000000005515. Online ahead of print.

ABSTRACT

BACKGROUND: The spirometric response to standard-of-care (SOC) immunosuppressive therapy for the management of bronchiolitis obliterans syndrome (BOS) has been sparsely reported in the literature. Data from a Medicare-approved Registry were analyzed to characterize the effectiveness/durability of a wide range of SOC interventions to manage the decline of lung function and to validate the study spirometric criteria for initiation of rescue therapy.

METHODS: Lung transplant recipients with refractory BOS at 21 US collaborating centers were enrolled in the Registry. Data included both nonspirometric (eg, demographic, Immunosuppressive Regimens for management of BOS) and spirometric parameters (ie, FEV1 measurements and derived indices). The utility of study forced expiratory volume in 1 s (FEV1) criteria for treatment (ie, statistically significant rate of FEV1 decline >30 mL/mo) was evaluated by comparing the spirometric course between participants who met or did not meet this criterion.

RESULTS: Only 21% of participants treated with SOC therapy had >50% decrease (76 ± 25% decrease) in the rate of FEV1 decline. Although 51% of participants had a partial response (rate of FEV1 decline decreased on average 71%), 49% of participants had a substantial increase (mean increase 224%). The FEV1 criterion for treatment was able to identify 19% of participants (48/258) who achieved durable stabilization (ie, nonsignificant rate of FEV1 <30 mL/mo) with SOC therapy.

CONCLUSIONS: Patients with BOS have a widely variable response to SOC therapy. Our findings support the use of FEV1 rate of decline to assess response to SOC therapy and to assure appropriate assignment of participants with refractory BOS to rescue therapy treatment cohorts.

PMID:41032890 | DOI:10.1097/TP.0000000000005515

JMIR Res Protoc. 2025 Oct 1;14:e73040. doi: 10.2196/73040.

ABSTRACT

BACKGROUND: Photoplethysmography (PPG) is an optical method for measuring blood volume changes in microcirculation through noninvasive photodetection. It has become a widespread and essential clinical tool, used in pulse oximeters and wearable devices. However, technical aspects of PPG make it susceptible to intrinsic bias, with the potential to adversely affect particular patient and consumer populations. Developments in PPG technology, increasingly driven by openly accessible datasets as opposed to de novo experimentation, have the potential to help monitor an array of physiological variables. However, some populations may be underrepresented in PPG datasets. We describe a protocol for a systematic review to assess the biases within open access PPG datasets.

OBJECTIVE: This review aims to evaluate the underlying reporting patterns and structure of openly accessible PPG datasets. We will provide insight into the measured biosignals and demographic variables included in the datasets in the hope of shedding light on what PPG data parameters are being used to develop medical devices. Therefore, we can elucidate current gaps and areas for improvement to reduce bias in medical device development.

METHODS: This review will be reported in accordance with the standard PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We will include primary studies that mention PPG and specifically reference openly accessible datasets since 2000. The datasets must contain physiological parameters such as heart rate, blood pressure, or respiratory rate, as well as the PPG waveform data, collected from humans. Searches will be conducted in literature databases and data repositories, including MedLine OVID, IEEE Xplore, Scopus, and PhysioNet. Studies will be evaluated in accordance with the Standing Together Initiative recommendations, which are urging for health care technologies supported by representative data. Biosignal and demographic variables will be extracted from the PPG datasets, with steps taken to harmonize and store this information. Statistical analysis will be performed, including descriptive statistics and the chi-square test for comparisons. Additional statistical analyses will be performed after data extraction is completed and the level of heterogeneity is characterized.

RESULTS: We will analyze the dataset diversity and the structural basis of PPG datasets. This includes statistically analyzing the demographic and biosignal variables in the datasets. By using statistical test fit for nominal variable comparisons, we will evaluate the frequencies of characteristics like the devices used, biosignals collected, clinical parameters, demographic characteristics, and geographic information. This systematic review is expected to be completed by September 2025. The screening and review of the articles is currently being conducted.

CONCLUSIONS: This review will provide insight into the potential gaps of existing open access PPG datasets. It will inform future data collection and design of openly available PPG datasets for training medical devices, including wearables, to avoid perpetuating biases, allowing for application in diverse clinical settings.

PMID:41032881 | DOI:10.2196/73040

JMIR Form Res. 2025 Oct 1;9:e68052. doi: 10.2196/68052.

ABSTRACT

BACKGROUND: Depression in women results in elevated morbidity rates, functional impairment, diminished quality of life, and an increased risk of suicide. Numerous obstacles impede access to mental health treatment for women in India. Digital mental health solutions can bridge the treatment gap, but it is important to tailor these solutions to the context and to end-users.

OBJECTIVE: We conducted a pilot randomized controlled trial to test the feasibility, acceptability, and preliminary effectiveness of a mental health app deployed in community-based organizations in improving depression outcomes.

METHODS: The Multiuser Interactive Health Response Application (MITHRA) is a multiple-user mobile app used in community-based organizations for screening, tracking, and supporting stepped-care treatment for depression. MITHRA is based on the healthy activity program, a brief psychological intervention based on behavioral activation. It includes audio, video, and enhanced touchscreen capabilities to overcome the barrier of illiteracy and lack of access. It was developed in collaboration with a participatory design group consisting of primary and secondary end-users and is available on tablets installed in self-help groups (SHGs), which are community-based organizations in India. The SHGs were randomized to MITHRA (n=3) or enhanced usual care (EUC; n=3). During SHG meetings, women completed the Patient Health Questionnaire-9 (PHQ-9). Based on their PHQ-9 scores, they were assigned different modules. In the EUC SHGs, women viewed one module of education on symptoms of depression. Primary outcomes include feasibility and acceptability, and secondary outcomes include depressive symptoms and functioning. Repeated-measures ANOVA was performed to compare the change in the outcome scores over time between study groups. A P value of<.05 was considered statistically significant.

RESULTS: MITHRA was found to be feasible and acceptable. A total of 96% of intervention arm participants completed at least half of their assigned modules. Although not powered for effectiveness outcomes, in this trial, we found that the change at 6 months from baseline in depressive symptoms (PHQ-9) were significantly different between MITHRA and EUC (P=.037), with greater improvement in the intervention group. Similarly, significant improvement in the World Health Organization Disability Assessment Scale score was noted in the MITHRA group (P=.005).

CONCLUSIONS: MITHRA is feasible and acceptable for use in women’s SHGs. Larger studies should examine the effectiveness of this approach in identifying and treating depression.

PMID:41032879 | DOI:10.2196/68052

JMIR Nurs. 2025 Oct 1;8:e72846. doi: 10.2196/72846.

ABSTRACT

BACKGROUND: “Internet Plus Nursing Service” (IPNS) offers innovative solutions for China’s growing home health care demands. Understanding primary care nurses’ participation intentions is crucial for service optimization.

OBJECTIVE: This study evaluates primary health nurses’ intention to participate in IPNS-a technology-mediated home care model combining mobile health platforms with in-person visits-and examines how digital readiness, safety perceptions, and organizational factors influence participation decisions, to guide policy optimization for scalable digital home health care delivery.

METHODS: A cross-sectional survey was conducted in Jiangsu Province, China (December 2023-December 2024) using the validated Participation Intention of Nurses on IPNS Scale. Convenience sampling enrolled 3952 nurses from 13 prefecture-level cities in Jiangsu-the second-tier administrative divisions in China that typically encompass both urban and rural areas, each with independent health care systems governed by municipal health authorities. Statistical analyses included t tests and ANOVA with SPSS 22.

RESULTS: A total of 3952 surveys were completed. The participation intention scale yielded a mean (SD) total score of 66.13 (7.89) across respondents. Subscale analysis revealed mean (SD) scores of 18.57 (2.68) for participation attitude, 18.87 (2.49) for subjective norms, and 25.67 (3.48) for perceived behavioral control. Significant demographic predictors of participation intention were identified through statistical analysis. Male nurses demonstrated stronger intention (t72.974=-23.139, P<.0001), as did those over 30 years old (F39,51=27.215, P<.0001) and bachelor’s degree holders (t2185.018=-4.994, P<.0001). Workplace characteristics also showed significant associations, with nursing management department staff (F39,51=45.877, P<.0001) and those with less organizational workloads (F39,51=9.829, P<.0001) displaying greater intention. Professional factors including higher positional rank (F39,51=37.32, P<.0001), more advanced titles (F39,51=30.176, P<.0001), and over 11 years of experience (F39,51=5.242, P=.001) predicted stronger participation intent. Finally, nurses earning 5000-10,000 RMB (a currency exchange rate of RMB 1=US $0.71 is applicable) monthly showed significantly higher intention scores (F39,51=16.141, P<.0001).

CONCLUSIONS: Policymakers should prioritize 3 interventions: (1) develop IPNS-specific safety protocols and legal safeguards, (2) optimize workload allocation through intelligent scheduling systems, and (3) establish tiered incentive mechanisms targeting middle-income nurses and experienced practitioners.

PMID:41032878 | DOI:10.2196/72846

JMIR Form Res. 2025 Sep 30. doi: 10.2196/80917. Online ahead of print.

ABSTRACT

BACKGROUND: Discharge instructions are essential for patient post-hospital care, but are time-consuming to write. With the rise of large language models (LLMs), there is strong potential to automate this process. This study explores the use of open-source LLMs for generating discharge instructions.

OBJECTIVE: We investigated whether a Mistral model can reliably generate patient-oriented discharge instructions. Two distinct instruction-tuning paradigms were compared, each using a different mechanism for embedding guidance during fine-tuning.

METHODS: In our experiment, we applied Mistral-NeMo-Instruct, a large language model, in combination with two distinct instruction strategies for fine-tuning. The first were detailed instructions tailored to the task of discharge instruction generation. The second was a basic instruction with minimal guidance and no task-specific detail. The independent variable in this study is the instruction strategy (detailed vs. generic), while the dependent variables are the evaluation scores of the generated discharge instructions. The generated discharge instructions were evaluated against 3,621 ground-truth references. We used BLEU-1 to BLEU-4, ROUGE (ROUGE-1, ROUGE-2, ROUGE-L), SentenceTransformer similarity, and BERTScore as evaluation metrics to assess the quality of the generated outputs in comparison to the corresponding ground-truth instructions for the same discharge summaries.

RESULTS: The detailed instruction model demonstrated superior performance across all automated evaluation metrics compared with the generic instruction model. BERTScore increased from 78.92% to 87.05%, while structural alignment measured by ROUGE-L improved from 8.59% to 26.52%. N-gram precision (BLEU-4) increased from 0.81% to 21.24%, and METEOR scores rose from 15.33% to 18.47%. Additional metrics showed consistent gains: ROUGE-1 improved from 16.59% to 42.72%, and ROUGE-2 increased from 1.97% to 45.84%. All improvements were statistically significant (P < .001), indicating that detailed, task-specific instruction design substantially enhances model performance.

CONCLUSIONS: The use of detailed, task-specific instruction strategies significantly enhances the effectiveness of open-source large language models in generating discharge instructions. These findings indicate that carefully designed instructions during fine-tuning substantially improve model performance.

PMID:41032874 | DOI:10.2196/80917