Nevin Manimala

Gait Posture. 2025 May 10;121:135-138. doi: 10.1016/j.gaitpost.2025.04.034. Online ahead of print.

ABSTRACT

INTRODUCTION: Falls in older adults frequently occur during obstacle crossing. Recent investigations have focused on age-related differences in foot trajectory patterns throughout the swing phase of obstacle crossing. However, a standardized method for comparing these differences has not been established. Statistical parametric mapping (SPM) is advantageous for comparing time-series data and may be applicable to foot trajectory data.

OBJECTIVE: This study aimed to elucidate age-related differences in foot trajectory patterns using SPM.

METHODS: We conducted a secondary analysis of data from Sakurai et al. (2021), involving 72 older (78.04 ± 5.74 years) and 76 younger (28.36 ± 7.84 years) adults. Participants were required to walk and cross a 15 cm-high obstacle four times. The foot trajectory pattern was calculated using the toe height throughout one step (i.e., the swing phase from toe-off to heel contact) when the leading limb crossed the obstacle. The patterns were normalized based on the time required for each step. Differences in foot trajectory patterns were compared between age groups using a non-paired t-test SPM.

RESULTS: Older adults exhibited higher toe heights preceding obstacle crossing and lower toe heights before landing compared to younger adults. This indicates that age-related differences in the foot trajectory patterns occurred both before obstacle crossing and landing.

CONCLUSION: Our novel approach demonstrates the utility of SPM in capturing foot trajectory patterns during obstacle crossing and provides evidence that age-related characteristics may be overlooked by confining analysis solely to the moment of obstacle crossing.

PMID:40373352 | DOI:10.1016/j.gaitpost.2025.04.034

Arch Cardiol Mex. 2025 May 15. doi: 10.24875/ACM.24000260. Online ahead of print.

ABSTRACT

In this article we aim to evaluate the impact of the microaxial flow pump on mortality in patients with cardiogenic shock associated with acute myocardial infarction through a systematic review and meta-analysis of clinical trials and cohort studies. Patients with acute myocardial infarction, both with and without ST-segment elevation, associated with cardiogenic shock and treated with a microaxial flow pump, were included. Mortality data and implantation time of the device were reported. Patients with more than 24 hours of shock progression, those with other shock etiologies, patients with mechanical complications from acute myocardial infarction, and other comorbidity, were excluded. The search was conducted in PubMed and Web of Science databases for articles published from 2019 until November 10, 2024. Risk of bias was evaluated using the RoB 2 tool and the ROBINS-E, while statistical analysis was performed using Review Manager 5.4.1 software. A total of 1000 patients from five studies were included. The use of the microaxial flow pump was associated with a reduction in mortality compared to placebo (OR: 0.6; 95%CI: 0.42-0.85; p = 0.005). However, there were no significant differences in mortality related to the timing of the microaxial flow pump implantation (before, during, or after percutaneous coronary intervention) (OR: 0.85; 95%CI: 0.59-1.22; p = 0.37). Patients with cardiogenic shock have gained access to various treatment opportunities that were not available until recently. The results suggest that the microaxial flow pump is a therapeutic option in these patients with significant effects on mortality.

PMID:40373343 | DOI:10.24875/ACM.24000260

J Speech Lang Hear Res. 2025 May 15:1-14. doi: 10.1044/2025_JSLHR-24-00306. Online ahead of print.

ABSTRACT

PURPOSE: Listening difficulty (LiD), often classified as auditory processing disorder (APD), has been studied in both research and clinic settings. The aim of this study was to examine the predictive relation between these two settings. In our SICLiD (Sensitive Indicators of Childhood Listening Difficulties) research study, children with normal audiometry, but caregiver-reported LiD, performed poorly on both listening and cognitive tests. Here, we examined results of clinical assessments and interventions for these children in relation to research performance.

METHOD: Study setting was a tertiary pediatric hospital. Electronic medical records were reviewed for 64 children aged 6-13 years recruited into a SICLiD LiD group based on a caregiver report (Evaluation of Children’s Listening and Processing Skill [ECLiPS]). The review focused on clinical assessments and interventions provided by audiology, occupational therapy, psychology (developmental and behavioral pediatrics), and speech-language pathology services, prior to study participation. Descriptive statistics on clinical encounters, identified conditions, and interventions were compared with quantitative, standardized performance on research tests. z scores were compared for participants with and without each clinical condition using univariate and logistic prediction analyses.

RESULTS: Overall, 24 clinical categories related to LiD, including APD, were identified. Common conditions were Attention (32%), Language (28%), Hearing (18%), Anxiety (16%), and Autism Spectrum Disorder (6%). Performance on research tests varied significantly between providers, conditions, and interventions. Quantitative research data combined with caregiver reports provided reliable predictions of all clinical conditions except APD. Significant correlations in individual tests were scarce but included the SCAN Composite score, which predicted clinical language and attention difficulties, but not APD diagnoses.

CONCLUSIONS: The variety of disciplines, assessments, conditions, and interventions revealed here supports previous studies showing that LiD is a multifaceted problem of neurodevelopment. Comparisons between clinical- and research-based assessments suggest a path that prioritizes caregiver reports and selected psychometric tests for screening and diagnostic purposes.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.28907780.

PMID:40373331 | DOI:10.1044/2025_JSLHR-24-00306

Obstet Gynecol. 2025 Jun 1;145(6):721-731. doi: 10.1097/AOG.0000000000005922. Epub 2025 May 1.

ABSTRACT

OBJECTIVE: To perform metabolomic and lipidomic profiling with plasma samples from patients with placenta accreta spectrum (PAS) to identify possible biomarkers for PAS and to predict PAS with machine learning methods that incorporated clinical characteristics with metabolomic and lipidomic profiles.

METHODS: This was a multicenter case-control study of patients with placenta previa with PAS (case group n=33) and previa alone (control group n=21). Maternal third-trimester plasma samples were collected and stored at -80°C. Untargeted metabolomic and targeted lipidomic assays were measured with flow-injection mass spectrometry. Univariate analysis provided an association of each lipid or metabolite with the outcome. The Benjamini-Hochberg procedure was used to control for the false discovery rate. Elastic net machine learning models were trained on patient characteristics to predict risk, and an integrated elastic net model of lipidome or metabolome with nine clinical features was trained. Performance using the area under the receiver operating characteristic curve (AUC) was determined with Monte Carlo cross-validation. Statistical significance was defined at P<.05.

RESULTS: The mean gestational age at sample collection was 33 3/7 weeks (case group) and 35 5/7 weeks (control group) (P<.01). In total, 786 lipid species and 2,605 metabolite features were evaluated. Univariate analysis revealed 31 lipids and 214 metabolites associated with the outcome (P<.05). After false discovery rate adjustment, these associations no longer remained statistically significant. When the machine learning model was applied, prediction of PAS with only clinical characteristics (AUC 0.685, 95% CI, 0.65-0.72) performed similarly to prediction with the lipidome model (AUC 0.699, 95% CI, 0.60-0.80) and the metabolome model (AUC 0.71, 95% CI, 0.66-0.76). However, integration of metabolome and lipidome with clinical features did not improve the model.

CONCLUSION: Metabolomic and lipidomic profiling performed similarly to, and not better than, clinical risk factors using machine learning to predict PAS among patients with PAS with previa and previa alone.

PMID:40373320 | DOI:10.1097/AOG.0000000000005922

Obstet Gynecol. 2025 May 15. doi: 10.1097/AOG.0000000000005912. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate demographic, pregnancy, and labor characteristics and perinatal outcomes related to intrapartum cesarean delivery in twin gestations.

METHODS: We conducted a population-based retrospective cohort study of twin pregnancies using natality data from the National Center for Health Statistics in the United States from 2018 to 2023. Women who attempted vaginal delivery for twin pregnancy after 35 weeks of gestation were included. The primary outcome was intrapartum cesarean delivery for one or both twins. Multinomial and binary logistic regression models were used to explore factors related to intrapartum cesarean delivery. In secondary analyses, we compared perinatal outcomes between twin pregnancies with intrapartum cesarean delivery and those with successful vaginal delivery.

RESULTS: A total of 69,172 participants with twin gestations were included. The rate of intrapartum cesarean delivery for one or both twins was 25.0% (95% CI, 24.6-25.3%), with 16.6% of participants undergoing intrapartum cesarean delivery for both twins and 8.4% for the second twin (combined delivery). The factors most strongly associated with intrapartum cesarean delivery for both twins and combined delivery included previous cesarean delivery (adjusted odds ratio [aOR] 3.27, 95% CI, 3.00-3.55) and nulliparity (aOR 2.55, 95% CI, 2.44-2.66) compared with vaginal delivery of both twins. In secondary analyses, compared with vaginal delivery of both twins, intrapartum cesarean delivery was most strongly associated with maternal transfusion (1.2% vs 2.9%, aOR 1.98, 95% CI, 1.71-2.30 with cesarean delivery of both twins; 1.2% vs 3.0%, aOR 2.53, 95% CI, 2.13-3.01 with combined delivery), maternal intensive care unit admission (0.1% vs 0.5%, aOR 2.96, 95% CI, 2.02-4.33 with cesarean delivery of both twins; 0.1% vs 0.5%, aOR 3.51, 95% CI, 2.28-5.41 with combined delivery), and Apgar score lower than 7 at 5 minutes (1.9% vs 5.1%, aOR 2.44, 95% CI, 2.20-2.71 with combined delivery).

CONCLUSION: Intrapartum cesarean delivery in twin gestations was more prevalent than previously reported and was associated with adverse perinatal outcomes. The factors associated with intrapartum cesarean delivery in twin pregnancies may assist in decision making regarding attempted vaginal delivery.

PMID:40373309 | DOI:10.1097/AOG.0000000000005912

JCO Precis Oncol. 2025 May;9:e2400821. doi: 10.1200/PO-24-00821. Epub 2025 May 15.

ABSTRACT

PURPOSE: Genomic testing for prostate cancer (PCa) clinical management and hereditary cancer assessment has grown in clinical impact; however, challenges remain regarding optimal implementation and end-user confidence. The Decision-making, Experience, and Confidence In Determining Genomic Evaluation (DECIDE) survey was designed to collect information regarding utility and understanding of genomic testing from PCa health care providers, researchers, and stakeholders.

METHODS: The DECIDE survey was administered online from October 2022 to January 2023 with 18 multiple-response questions. Survey domains included self-confidence with ordering and interpreting germline and somatic genomic tests, process of testing and use of results, decision-making factors, and barriers to testing. Data were summarized by evaluating counts and percentages of responses, and the results were presented by descriptive statistics.

RESULTS: One hundred twenty-two participants completed the survey. The majority were medical oncologists (70%) and at academic medical centers (89%). Self-confidence was high in knowing indications for genomic testing (82% respondents) but lower in interpretation of results, especially from circulating tumor DNA (52%). Confidence varied in interpreting pathogenic variants (65% high confidence), variants of unknown significance (47%), and incidental findings from genomic tests (35%). Common barriers to testing were difficulty obtaining tissue (71%) and cost (35%). Testing utility was sometimes limited by inability to obtain the recommended treatment (33%). Most of the respondents (55%) agreed that lack of education and training of health care professionals regarding genomic testing is impeding clinical translation.

CONCLUSION: The DECIDE survey provided critical insights into challenges with genomic testing, from provider confidence in interpretating results to testing and practice barriers. The results inform next steps to further educate PCa providers and to collectively improve testing and result reporting for enhanced implementation of PCa genomic testing.

PMID:40373262 | DOI:10.1200/PO-24-00821

JCO Precis Oncol. 2025 May;9:e2400449. doi: 10.1200/PO-24-00449. Epub 2025 May 15.

ABSTRACT

PURPOSE: Guidelines recommend biomarker testing and biomarker-informed therapies in patients with metastatic non-small cell cancer (mNSCLC); however, the use remains suboptimal.

METHODS: To understand contemporary testing and treatment patterns, retrospective data from 42,037 patients with mNSCLC in a nationwide electronic health record-derived deidentified database from January 2011 to April 2023 were used to quantify testing rates, test positivity, and use of biomarker-informed therapies, stratified by key demographics to identify potential disparities. Multivariable logistic regression was conducted to include patient characteristics associated with the receipt of biomarker testing and subsequent biomarker-informed therapies.

RESULTS: A total of 34,510 patients (82.1%) received ≥one biomarker test(s). Biomarker testing and use of biomarker-informed therapies increased for all studied biomarkers (EGFR, ALK, ROS1, PD-L1, BRAF, RET, MET) over time, with highest rates observed in 2023: EGFR (88.7% and 79.5%, respectively) and ALK (87.7% and 84.3%, respectively). In multivariate logistic regression, patient sex, race, Eastern Cooperative Oncology Group at baseline, insurance type, smoking status at baseline, and histology were all significantly associated with odds of receiving biomarker testing. Covariates statistically associated with receipt of biomarker-informed therapy varied by biomarker without a clear pattern of association. Although the use of biomarker testing and biomarker-informed therapies has increased in recent years, gaps and potential disparities remain.

CONCLUSION: Analysis of contemporary trends in biomarker testing and use of targeted therapies in mNSCLC in the United States highlight improvements in recent years. However, these rates remain suboptimal in specific strata of the patient population, including differences in racial groups and insurance groups, indicating further work is needed to bridge remaining gaps.

PMID:40373260 | DOI:10.1200/PO-24-00449

Neurology. 2025 Jun 10;104(11):e213706. doi: 10.1212/WNL.0000000000213706. Epub 2025 May 15.

ABSTRACT

BACKGROUND AND OBJECTIVES: Investigation of olfactory impairment, an early manifestation of Alzheimer disease (AD), in relation to plasma biomarkers of AD and neurodegeneration could provide insights into the disease’s pathophysiology. Because few such studies based on large, diverse, community-based populations exist, we investigated associations of odor identification ability with plasma biomarkers of AD and other neurodegenerative pathologies in community-dwelling Black and White older adults.

METHODS: This cross-sectional investigation included participants from the Atherosclerosis Risk in Communities study who attended visit 5 (2011-2013) and who completed olfactory testing and brain MRI examinations and had plasma biomarkers measured (namely, amyloid-beta [Aβ]₄₂/Aβ₄₀ ratio, phosphorylated-tau at threonine-181 [p-tau₁₈₁], p-tau₁₈₁/Aβ₄₂ ratio, glial fibrillary acidic protein [GFAP], and neurofilament light chain [NfL]). Odor identification ability was measured by the 12-item Sniffin’ Sticks test. Separate linear regression models were used to examine the association of continuous olfaction score and olfaction categories (anosmia: score 6; hyposmia: 7-8; moderate-normal: 9-10; good-normal: 11-12) with each biomarker (all were log-transformed), adjusting for sociodemographic and cardiovascular factors, head injury, APOE-ε4 status, and estimated glomerular filtration rate. We further examined whether any observed associations are explained by total and regional brain volumes.

RESULTS: Among 1,545 participants (age: 76 ± 5 years, 60% women, 27% self-reported Black participants), the mean olfaction score was 9.2 ± 2.3; 14% had anosmia. Consistent with our hypotheses, poorer olfactory scores were associated with higher plasma p-tau₁₈₁ (β per 1-unit lower score: 0.026 [95% CI 0.012-0.040]), p-tau₁₈₁/Aβ₄₂ (β: 0.027 [95% CI 0.011- 0.044]), GFAP (β: 0.024 [95% CI 0.009-0.040]), and NfL (β: 0.034 [95% CI 0.019-0.050] and lower Aβ₄₂/Aβ₄₀ ratio (β: -0.007 [95% CI -0.015 to 0.000]). Likewise, compared with good-normal olfaction, anosmia showed associations with all biomarker levels indicative of greater neuropathology (e.g., β for plasma p-tau₁₈₁/Aβ₄₂: 0.235 [95% CI 0.113-0.358] and β for plasma NfL: 0.210 [95% CI 0.102-0.317]), although the association with Aβ₄₂/Aβ₄₀ ratio was not statistically significant (β: -0.054 [95% CI -0.108 to 0.001]). These biomarkers were not significantly associated with hyposmia or moderate-normal olfaction. Smaller medial-temporal lobe volumes partly explained olfaction’s link with plasma p-tau₁₈₁, p-tau₁₈₁/Aβ₄₂, GFAP, and NfL.

DISCUSSION: Our findings suggest that poor olfaction is associated with multiple AD-related and other neurodegenerative processes. Future studies should investigate how longitudinal changes in both olfaction and biomarkers relate to each other.

PMID:40373252 | DOI:10.1212/WNL.0000000000213706

JMIR Hum Factors. 2025 May 15;12:e68581. doi: 10.2196/68581.

ABSTRACT

BACKGROUND: Clinical decision support systems are known to improve adherence to clinical practice guidelines and patient outcomes by providing clinicians with timely, accurate, and appropriate knowledge.

OBJECTIVE: This study investigates the perceived usefulness and practical implementation of UpHill Route v3, a personalized digital care pathway (PDCP) system, in enhancing clinical decision-making and patient management across various clinical settings.

METHODS: A mixed-methods retrospective study was conducted among medical doctors and nurses from four National Health System-Local Health Units in Portugal. Data were collected from May 2023 to April 2024. The primary data source was an anonymous questionnaire assessing health care professionals’ perceptions of UpHill Route v3’s usefulness using the Likert scale ranging from 0 (do not agree) to 10 (totally agree). Secondary analysis involved quantifying decisions across heart failure, multimorbidity, diabetes, and colorectal and breast cancer clinical pathways. These data were collected from user interactions with UpHill Route v3 as well as from its internal database. Descriptive and bivariate statistics were used to analyze the data.

RESULTS: A total of 22 health care professionals with mean age 44.7 (SD 10.6) years, including 15 (68%) female participants and 9 (41%) physicians were included in the study. High ratings for adherence to clinical protocols, mean score 8.06 (SD 1.73); clinical decision support, mean score 8.05 (SD 1.73); patient care improvement, mean score 7.63 (SD 2.22); and confidence in patient management, mean score 8.26 (SD 1.56) were reported. Secondary analysis showed that across 3574 patients, 25,741 clinical decisions were informed, and 9254 actions were performed with the assistance of the PDCP tool.

CONCLUSIONS: The UpHill Route v3 PDCP tool is highly valued by health care professionals for its ability to support clinical decision-making and improve operational efficiency across various clinical settings. Our findings suggest that this tool can effectively bridge the gap between clinical guidelines and real-world practice.

PMID:40373224 | DOI:10.2196/68581

JMIR Aging. 2025 May 15;8:e67982. doi: 10.2196/67982.

ABSTRACT

BACKGROUND: Frailty syndrome in older adults represents a significant public health concern, characterized by a reduction in physiological reserves and an increased susceptibility to stressors. This can result in adverse health outcomes, including falls, hospitalization, disability, and mortality. The early identification and management of frailty are essential for improving quality of life and reducing health care costs. Conventional assessment techniques, including dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and muscle ultrasound (US), are efficacious but frequently constrained in primary care settings by financial and accessibility limitations.

OBJECTIVE: The aim of this study is to analyze the differences in anthropometric characteristics, physical function, nutritional status, cognitive status, and body composition among older adults identified as frail, prefrail, or robust in primary care services using the PowerFrail mobile app. Furthermore, the study assesses the predictive capacity of body composition variables (whole-body phase angle [WBPhA] via BIA, US-measured rectus femoris muscle thickness, and DXA-derived lean mass) in identifying frailty and evaluates their feasibility for implementation in primary care.

METHODS: A descriptive cross-sectional study was conducted with 94 older adult participants aged between 70 and 80 years, recruited through the Andalusian Health Service in Spain. Frailty status was classified using the PowerFrail App, which integrates muscle power assessment and provides personalized physical activity recommendations. Body composition was measured using WBPhA (BIA), muscle US, and DXA. Statistical analyses included 1-way ANOVA for group comparisons, logistic regression to investigate associations, and receiver operating characteristic curve analysis to evaluate the predictive accuracy of the body composition measures.

RESULTS: Participants were categorized into frail (n=28), prefrail (n=33), and robust (n=33) groups. All body composition measures exhibited high specificity in detecting frailty, with varying sensitivity. Unadjusted US showed the highest specificity but low sensitivity (10.7%). WBPhA and right leg lean mass (LeanM RL) demonstrated significant predictive capabilities, especially when adjusted for age and sex, with area under the curve values ranging from 0.678 to 0.762. The adjusted LeanM RL model showed a good balance between sensitivity (35.7%) and specificity (93.9%; P=.045), indicating its potential as a reliable frailty predictor. These findings are consistent with previous research emphasizing the importance of muscle mass and cellular health in frailty assessment.

CONCLUSIONS: Body composition variables, particularly WBPhA, LeanM RL, and US, are effective predictors of frailty in older adults. The PowerFrail mobile app, combined with advanced body composition analysis, offers a practical and noninvasive method for early frailty detection in primary care settings. Integrating such technological tools can enhance the early identification and management of frailty, thereby improving health outcomes in the aging population.

PMID:40373218 | DOI:10.2196/67982