Category: Nevin Manimala

Gen Psychiatr. 2025 Sep 14;38(5):e101957. doi: 10.1136/gpsych-2024-101957. eCollection 2025.

ABSTRACT

BACKGROUND: Biomarkers for predicting suicide risk in hospitalised patients with mental disorders have been understudied. Currently, suicide risk assessment tools based on objective indicators are limited in China.

AIMS: To examine the value of various biomarkers in suicide risk prediction and develop a risk assessment model with clinical utility using machine learning.

METHODS: This cohort study analysed patients with major depressive disorder (MDD) who were hospitalised for the first time between January 2016 and March 2023 from four specialised mental health institutions. A total of 139 features, including biomarker measurements, medical orders and psychological scales, were assessed for analysis. Their suicide risk was evaluated by qualified nurses using Nurse’s Global Assessment of Suicide Risk within 1 week after admission. Five machine learning models were trained with 10-fold cross-validation across three hospitals and were externally validated in an independent cohort. The primary performance was assessed using the area under the receiver operating characteristic curve (AUROC). The model was interpreted using the SHapley Additive exPlanations (SHAP) analysis. Biomarker importance was evaluated by comparing model performance with and without these biomarkers.

RESULTS: Of 3143 patients with MDD included in this study, the incidence of high suicide risk within 1 week after first admission was 660 (21.0%). Among all models, the Extreme Gradient Boosting can more effectively predict future risks, with an AUROC higher than 0.8 (p<0.001). The SHAP values identified the 10 most important features, including five biomarkers. After clustering analysis, electroconvulsive therapy, physical restraint, β2-microglobulin and triiodothyronine were found to have heterogeneous effects on suicide risk. Combining biomarkers with other data from electronic health records significantly improved the performance and clinical utility of machine learning models based on demographics, diagnosis, laboratory tests, medical orders and psychological scales.

CONCLUSIONS: This study demonstrates the potential for a biomarker-based suicide risk assessment for patients with MDD, emphasising the interaction between biomarkers and therapeutic interventions.

PMID:40959771 | PMC:PMC12434745 | DOI:10.1136/gpsych-2024-101957

Pregnancy (Hoboken). 2025 Jul;1(4). doi: 10.1002/pmf2.70063. Epub 2025 Jun 30.

ABSTRACT

INTRODUCTION: Operative vaginal delivery (OVD) has experienced a decline, primarily driven by decreasing rates of forceps-assisted vaginal delivery (FAVD). FAVD rates have been suspected to be declining to a point where recovery of this skill may be improbable. While there are numerous reasons for this decline ranging from lack of training to patient preferences, the same period has been suspected to have worsening morbidity with FAVD. Concerns have been raised with respect to obstetric anal sphincter injuries (OASIS). To characterize national trends in OVD and risk factors for associated OASIS between 2016 and 2023, assessing changes in OVD utilization and the associated risk of OASIS.

MATERIALS AND METHODS: This is a cross-sectional study using National Vital Statistics System birth certificate data between 2016 to 2023 to identify temporal trends in OVD and OASIS rates. Liveborn deliveries undergoing trial of labor from 34 weeks and 0 days to 42 weeks and 6 days to patients aged 16-50 years of age were included. Pregnancies with multifetal gestations, fetal anomalies, non-vertex presentations, and unknown mode of delivery were excluded. Temporal trends in OVD and OASIS were assessed using Joinpoint regression. Multivariable logistic regression models were fit to assess the association between OASIS and OVD, adjusting for maternal demographics and comorbidities.

RESULTS: Of the 21,191,398 liveborn deliveries identified, 18,054,141 (85.2%) were spontaneous vaginal births, 2,303,168 (10.9%) were cesarean after trial of labor, 136,927 (0.6%) were forceps-assisted vaginal deliveries (FAVD), and 697,162 (3.3%) were vacuum-assisted vaginal deliveries (VAVD) with a OVD composite of 3.9%. OVD rates decreased significantly from 4.6% to 4.1% (annual average percent change (AAPC): -1.6%, 95% CI: -1.9% to -1.4%). Specifically, FAVD rates declined from 0.8% to 0.6% (AAPC: -3.1%, 95% CI: -3.7% to -2.6%) and VAVD rates declined from 3.8% to 3.4% (AAPC -1.4%, 95%CI: -1.7% to 1.1%). OASIS rates in the overall group did not significantly change (AAPC 1.4%, 95%CI: -2.1% to 4.4%), although among FAVD, there was a significant increase in rates of OASIS from 9.3% in 2016 to 14.0% in 2023 (AAPC 4.8%, 95%CI: 2.3% to 7.0%). Adjusted multivariable logistic regression noted higher likelihood of OASIS in FAVD (aOR 9.50, 95%CI: 9.33 to 9.66), and VAVD (aOR 3.90, 95%CI: 3.85 to 3.94) when compared to spontaneous vaginal birth, adjusting for maternal age, maternal BMI, and maternal comorbidities including diabetes and hypertensive disorders.

CONCLUSION: The primary finding in this study was a national decline in OVD with significantly greater declines in FAVD and an increasing rate of OASIS among FAVD. Whether targeted interventions to enhance training in safe FAVD may increase proficiency in this technique remains to be seen.

PMID:40959760 | PMC:PMC12435513 | DOI:10.1002/pmf2.70063

Front Psychol. 2025 Sep 1;16:1567735. doi: 10.3389/fpsyg.2025.1567735. eCollection 2025.

ABSTRACT

This research primarily investigates whether both reward processing and self-processing are aberrant in individuals with methamphetamine use disorder. It also explores whether initiating self-referential processing modulates reward processing abilities in this population, and how this modulation differs from that observed in healthy controls. Experiment 1 employed a two-factor mixed experimental design to compare the performance of addiction groups with varying withdrawal durations (all participants in the addiction groups were methamphetamine users) against healthy control groups in a probabilistic reward learning task. The results indicated that the healthy control group performed better than the addiction group in learning characters associated with high-probability, high-reward outcomes. While the long-term abstinence group outperformed the short-term abstinence group, these differences were not statistically significant. Therefore, the addiction group subjects in Experiments 2 and 3, the addiction group consisted of methamphetamine users with a uniform withdrawal duration of no more than 12 months. Experiment 2 utilized a two-factor mixed design to explore whether self-processing is abnormal in addicted individuals. The results showed that the addiction group had a significantly lower accuracy rate for self-referential characters compared to the healthy control group, while their accuracy for characters associated with acquaintances was significantly higher than that of the healthy control group. Experiment 3 also employed a two-factor mixed design to examine the moderating effect of self-processing on reward learning. The findings revealed that when high-probability reward characters were linked to self-relevance, learning efficiency was superior to that of characters linked to acquaintances. However, this moderating effect was weaker in the addiction group compared to the healthy control group. These results suggest that substance addiction not only impairs individuals’ reward processing abilities but also reduces their sensitivity to self-referential information. Furthermore, the enhancing effect of self-processing on reward learning is significantly diminished in addicted populations, providing new insights into the cognitive mechanisms underlying addiction.

PMID:40959756 | PMC:PMC12434089 | DOI:10.3389/fpsyg.2025.1567735

Front Rehabil Sci. 2025 Sep 1;6:1626051. doi: 10.3389/fresc.2025.1626051. eCollection 2025.

ABSTRACT

INTRODUCTION: Low balance confidence, i.e., low self-perception in ones’ ability to maintain balance while performing activities, is prevalent among lower limb prostheses users (LLPUs) and can affect community participation and quality of life (QoL). Although low balance confidence can manifest from poor function, it also depends on one’s beliefs in their abilities to engage in activities, which need not reflect actual abilities. Increasing low balance confidence and associated participation limitations requires approaches that address its’ physical and psychological underpinnings.

METHODS: A randomized controlled trial was conducted to evaluate the initial effectiveness of a multicomponent intervention to target balance confidence in LLPU. Nineteen adults with ≥6-months experience using a prosthesis for unilateral, transtibial amputation, and with low balance confidence (Activities-specific Balance Confidence (ABC) scale scores ≤ 80) completed up to eight intervention sessions following an established protocol, which integrated physical therapy exercises (primarily virtual reality active gaming) and cognitive behavioral therapy strategies, or eight weeks of at home-seated exercises. Outcome measures, collected before randomization, and 0- and 16- weeks after completing the intervention/at-home exercises, addressed four domains: (i) balance confidence-the ABC scale, modified Gait Self Efficacy scale and the Fear of Falling Avoidance Behavior Questionnaire; (ii) community participation-sections of the 36-Item Short Form Survey, sections of the Community Reintegration of Injured Servicemembers scale, the Frenchay Activity Index and step counts; (iii) QoL-the wellbeing scale of the Prosthetic Evaluation Questionnaire; and (iv) function-the Berge Balance Sale and the L-Test of walking. Statistical tests compared baseline and post-training assessment scores between groups, and individual responsiveness was evaluated by comparing change scores to minimum detectable change (MDC).

RESULTS: Overall, results support the initial efficacy of the intervention, with at least one outcome in 3-of-4 domains (balance confidence, community participation and functional mobility) showing strong, significant group-level effects, or individual-level effects (>30% of participants having changes > MDC). Moreover, semi-structured exit interviews suggest participants perceived benefit from the intervention.

DISCUSSION: Integrating physical therapy exercises with cognitive behavioral therapy strategies to simultaneously address physical underpinnings and maladaptive cognitions around low balance confidence can meaningfully improve balance and walking confidence, as well as community participation. To the best of our knowledge the current study is the first to evaluate an intervention to specifically target balance confidence in LLPUs.

CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, identifier NCT03411148.

PMID:40959746 | PMC:PMC12434030 | DOI:10.3389/fresc.2025.1626051

Educ Psychol Meas. 2025 Sep 14:00131644251368335. doi: 10.1177/00131644251368335. Online ahead of print.

ABSTRACT

Sequential procedures have been shown to be effective methods for real-time detection of compromised items in computerized adaptive testing. In this study, we propose three item response theory-based sequential procedures that involve the use of item scores and response times (RTs). The first procedure requires that either the score-based statistic or the RT-based statistic be extreme, the second procedure requires that both the score-based statistic and the RT-based statistic be extreme, and the third procedure requires that a combined score and RT-based statistic be extreme. Results suggest that the third procedure is the most promising, providing a reasonable balance between the false-positive rate and the true-positive rate while also producing relatively short lag times across a wide range of simulation conditions.

PMID:40959735 | PMC:PMC12433998 | DOI:10.1177/00131644251368335

Physiother Can. 2025 Feb;77(1):106-112. doi: 10.3138/ptc-2023-0012. Epub 2023 Sep 20.

ABSTRACT

Purpose: This study examined the differential pattern of obesity between men and women with severe OA of the knee or hip joint. The relationship between creatinine, a pro-inflammatory parameter and obesity, sex, and site of joint involvement was examined. Method: This study involved a secondary analysis of prospectively collected data of patients who underwent hip or knee arthroplasty. Results: Data of 5,130 patients (1,989 males, 39%, 3,141 females, 62%), mean age: 66 (11) were used for data analysis. Of these patients, 2,038 patients underwent hip and 3,092 patients underwent knee arthroplasty. Prevalence of obesity (grade I and II) was higher in the TKA group as compared with THA group (55% vs. 38%) with the prevalence of morbid obesity (Grade II) being twice as many in the TKA group (27% vs. 14%), p < 0.001. There was a statistically significant association between obesity and site of joint involvement (p < 0.001) and for the interaction between sex of the patient and site of arthritis (p < 0.001). In the TKA group, the sex factor was the only factor that was related to the pre-op creatinine level (p < 0.001). In THA group, both sex (p < 0.001) and obesity (p = 0.002) showed an association with pre-op creatinine. Conclusions: This study provides further evidence that obesity has a multifaceted interaction with osteoarthritis with a differential pattern in hip and knee joints. Creatinine considered as a pro-inflammatory factor appears to have a differential role in hip and knee OA.

PMID:40959719 | PMC:PMC12392844 | DOI:10.3138/ptc-2023-0012

Trials. 2025 Sep 16;26(1):341. doi: 10.1186/s13063-025-08995-4.

ABSTRACT

BACKGROUND: Morbidity due to anastomotic leakage is a major concern in transthoracic oesophagectomy. The aim of this randomised trial is to evaluate whether a circumferential suture reinforcement of the stapled end-to-side anastomosis in robot-assisted minimally invasive Ivor-Lewis oesophagectomy (RAMIE) leads to a reduced incidence of anastomotic leakages in the postoperative course.

METHODS/DESIGN: This is a multi-centre randomised, double-blind, superiority trial with an adaptive sample size design undergoing RAMIE for malignant tumours. Patients will be randomised 1:1 into two study arms. In study arm A, participants will receive a standard circular-stapled end-to-side oesophagogastric anastomosis, while in study arm B, the anastomosis will have a circumferential suture reinforcement. The primary endpoint is the rate of anastomotic leakage. Secondary endpoints are incision-to-suture time, duration of circumferential suture reinforcement, anastomotic stenosis rate, postoperative morbidity and mortality, and quality of life.

DISCUSSION: This randomised controlled trial will assess the impact of circumferential suture reinforcement of the oesophagogastric anastomosis on short-term outcomes and quality of life of patients undergoing robot-assisted minimally invasive Ivor-Lewis oesophagectomy.

TRIAL REGSITRATION: DRKS00034787. Registered on 7 October 2024.

PMID:40958134 | DOI:10.1186/s13063-025-08995-4

Eur J Sport Sci. 2025 Oct;25(10):e70038. doi: 10.1002/ejsc.70038.

ABSTRACT

This study investigated the associations between ovarian hormones, symptoms, sleep characteristics and nocturnal physiology in female athletes. Twenty-four National Rugby League Indigenous Women’s Academy athletes (naturally cycling: n = 11 and mean age: 21 ± 3 years; hormonal contraception: n = 13 and mean age: 22 ± 3 years) completed a 5-week training camp. During the camp, oestradiol and progesterone concentrations were analysed at three timepoints according to naturally cycling and hormonal contraception groups. Symptoms and subjective sleep were measured daily. Athletes were instructed to wear an Oura ring throughout the camp for sleep and nocturnal heart rate (HR) and HR variability (HRV) measures. Statistical analyses included linear mixed models and Pearson’s correlations. Neither objective (Oura ring) nor subjective (survey) sleep characteristics were associated with oestradiol or progesterone concentrations. In the naturally cycling group, a higher number of total symptoms were associated with a longer sleep onset latency (r = 0.88, 95% CI [0.60, 0.97]) and increased light sleep (r = 0.75, 95% CI [0.28, 0.93]). Higher oestradiol concentrations were significantly associated with fewer symptoms (estimate ± SE: -0.007 ± 0.002 symptoms, p = 0.003). Luteal days were associated with higher average nocturnal HR and lower HRV than follicular menstrual cycle days (estimate ± SE: 4 ± 0.57 bpm, p < 0.001; estimate ± SE: -7 ± 2.13 ms, p < 0.001, respectively). Negligible to moderate correlations were observed between sleep and total symptoms experienced by athletes using hormonal contraception. In conclusion, sleep measures were not significantly associated with ovarian hormone concentrations. A higher number of total symptoms were associated with sleep disturbance in naturally cycling athletes. To optimise sleep, female athletes may benefit from monitoring and managing menstrual cycle symptoms.

PMID:40958133 | DOI:10.1002/ejsc.70038

Knee Surg Relat Res. 2025 Sep 16;37(1):38. doi: 10.1186/s43019-025-00290-5.

ABSTRACT

BACKGROUND: Implant design in total knee arthroplasty (TKA) has evolved considerably, with recent developments focusing on reproducing native knee kinematics. Some implants now feature anatomically and physiologically accurate articular surface geometries. This study aimed to evaluate the impact of different implant designs on knee kinematics using the same cadaveric specimens to ensure consistent comparison. We hypothesized that implant designs incorporating features intended to replicate native joint anatomy, such as the kinematic retaining (KR) design, would more closely reproduce physiological knee kinematics.

METHODS: TKA was performed on nine Thiel-embalmed cadaveric knees with mild medial osteoarthritis, using three implant designs from the Physica system: KR, cruciate retaining (CR), and medial congruent (MC) designs. All procedures were performed using a mechanical alignment technique, with both the posterior tibial slope and femoral rotational angle standardized at 3°. The posterior cruciate ligament was preserved throughout the evaluation of all implant designs. A navigation system was used to collect detailed kinematic data. Evaluations were conducted after trial component placement, focusing on anteroposterior, mediolateral, and compression-distraction positions, as well as rotational angles. From these knee status data, femoral rotational kinematics relative to the tibia and the anteroposterior translation of both femoral condyles during flexion were also calculated.

RESULTS: No significant differences in flexion and extension angles were observed between the groups. The KR group presented the greatest mean femoral external rotation relative to the tibia throughout the range of motion among the groups; however, there were no statistically significant differences. The CR and MC group showed significantly reduced anteroposterior translation of the lateral condyle compared with the native knee (p = 0.021 and 0.003, respectively). Furthermore, the anteroposterior translation of the lateral femoral condyle was significantly greater in the KR group than in MC groups (p = 0.021). In the KR group, six of nine knees exhibited medial pivot motion, compared with three in the CR group and four in the MC group.

CONCLUSIONS: Using identical cadaveric specimens and navigation-based analysis, we identified distinct kinematic profiles associated with each implant design. Notably, the KR implant demonstrated kinematics approximating native knee motion; however, these findings remain preliminary and warrant further clinical validation.

LEVEL OF EVIDENCE: III.

PMID:40958131 | DOI:10.1186/s43019-025-00290-5

BMC Sports Sci Med Rehabil. 2025 Sep 16;17(1):265. doi: 10.1186/s13102-025-01307-y.

ABSTRACT

BACKGROUND: Cardiovascular disease and obesity-related comorbidities are key factors addressed by metabolic-bariatric surgery (MBS). Although High intensity interval training (HIIT) has been proven effective in healthy cohorts, limited evidence exists regarding HIIT and adherence towards HIIT after MBS. This study aims to test feasibility and cardiorespiratory effect of HIIT after MBS.

METHODS: 201 patients undergoing MBS were included in a four-week training protocol with 3 training groups (B-D) including different HIIT protocols on a bicycle designed for patients with obesity and one control group (A) at a university medical center in Germany. Ergometry with estimated VO2max, maximum blood lactate, maximum resistance, time spent on ergometer, and heart rate were performed prior to and after 4 weeks of training.

RESULTS: A significant effect of the four-week training could be shown through reduction of heart rate at 100 W, increase of maximum blood lactate, and maximum resistance when comparing the training groups to the control group (Δ 9,67 BPM; Δ 1.02 mmol/l; Δ 12 W respectively, all p < 0.05) However, adherence of the recruited patient group was very low, shown by a notably high drop-out rate of 78.1% overall (44 patients completed training). The majority of patients dropped out prior to the first training session.

CONCLUSIONS: HIIT bicycle training in post-MBS patients is possibly very effective, however, adherence is extremely low. Although this study shows promising results, an effect on large patient groups cannot be expected if improvement of adherence and a wide range of training methods are not addressed first.

STUDY REGISTRATION: German Registry for Clinical Trials (DRKS) trial registration number DRKS00024939 on 20/09/2021.

PMID:40958128 | DOI:10.1186/s13102-025-01307-y