Nevin Manimala

Eur J Psychotraumatol. 2025 Dec;16(1):2547549. doi: 10.1080/20008066.2025.2547549. Epub 2025 Sep 5.

ABSTRACT

Aims: To determine if neighbourhood socioeconomic deprivation is associated with post-traumatic stress disorder (PTSD) severity and psychological treatment response.Methods: This was a retrospective cohort study based on the analysis of electronic health records for N = 2064 patients treated for PTSD across 16 psychological therapy services in England. The Revised Impact of Events Scale (IES-R) scale was used to measure PTSD severity and associations were examined with the neighbourhood-level index of multiple deprivation (IMD) using non-parametric correlations and multilevel modelling.Results: Three times more PTSD cases (33.6% vs. 9.7%) were clustered within the most deprived IMD quintile compared to the least deprived quintile. A small and statistically significant correlation between IMD and IES-R baseline severity (r = -0.16, p < .001), indicated that patients living in the most deprived neighbourhoods had more severe symptoms. Post-treatment IES-R severity was also significantly associated with IMD (B = -0.74, p < .001), after controlling for baseline severity of PTSD and comorbid depression symptoms, adjusting for between-service variability in treatment outcomes (ICC = 0.023). Treatment duration was a moderator of the association between IMD and treatment outcomes.Conclusions: Neighbourhood deprivation is associated with a higher prevalence of PTSD, higher symptom severity at the start of treatment and poorer treatment response. A longer course of therapy mitigated the adverse impact of deprivation on treatment outcomes.

PMID:40910182 | DOI:10.1080/20008066.2025.2547549

Circ Heart Fail. 2025 Sep 5:e013074. doi: 10.1161/CIRCHEARTFAILURE.125.013074. Online ahead of print.

ABSTRACT

BACKGROUND: Although the effects of various combinations of treatments on mortality and morbidity outcomes in heart failure with reduced ejection fraction (HFrEF) have been evaluated, the impact on quality of life is unknown. This study evaluated and compared the composite impact of pharmacological therapies on quality of life in HFrEF using a frequentist network meta-analysis and systematic review methodology.

METHODS: We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for randomized controlled trials published between January 1, 2021 and August 10, 2024. We included all contemporary and efficacious HFrEF therapies used in adults. The primary outcome was change in quality of life measured through the Kansas City Cardiomyopathy Questionnaire and the Minnesota Living with Heart Failure Questionnaire, expressed as mean difference (MD).

RESULTS: We identified 41 randomized controlled trials representing 41 145 patients (76.5% male). The trials had a median of 276 participants (105-464), a mean left ventricular ejection fraction of 28%, and a median follow-up time of 5 months (3-8). A combination of angiotensin receptor blocker/neprilysin inhibitors (ARNi)+β-blockers (BB)+sodium-glucose cotransporter 2 inhibitors (SGLT2i; MD, +5.3 [+0.4, +10.3]) was the most effective at improving quality of life followed by ARNi+BB+mineralocorticoid receptor antagonists (MRA)+SGLT2i (MD, +7.1 [-1.0 to +15.2]), ACE inhibitor+BB+MRA+SGLT2i (MD, +5.3 [-2.6, to +13.3]), and ACE inhibitor+BB+MRA+ivabradine (MD, +5.2 [-3.1 to +13.6]), which were not statistically significant. Individually, the most effective treatments for improving quality of life were SGLT2i (MD, +3.4 [+1.4 to +5.30]), ivabradine (MD, +3.3 [+0.1 to +6.4]), ARNi (MD, +2.6 [-3.2 to +8.5]), and MRA (MD, +1.8 [-4.8 to +8.4]).

CONCLUSIONS: A composite of ARNi+BB+SGLT2i or ARNi+BB+MRA+SGLT2i was the most effective at improving quality of life in patients with HFrEF.

PMID:40910162 | DOI:10.1161/CIRCHEARTFAILURE.125.013074

J Clin Ultrasound. 2025 Sep 5. doi: 10.1002/jcu.70071. Online ahead of print.

ABSTRACT

BACKGROUND: Predicting tumor regression grade (TRG) after neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC) preoperatively accurately is crucial for providing individualized treatment plans. This study aims to develop transrectal contrast-enhanced ultrasound-based (TR-CEUS) radiomics models for predicting TRG.

METHODS: A total of 190 LARC patients undergoing NCRT and subsequent total mesorectal excision were categorized into good and poor response groups based on pathological TRG. TR-CEUS examinations were conducted before and after NCRT. Machine learning (ML) models for predicting TRG were developed by employing pre- and post-NCRT TR-CEUS image series, based on seven classifiers, including random forest (RF), multi-layer perceptron (MLP) and so on. The predictive performance of models was evaluated using receiver operating characteristic curve analysis and Delong test.

RESULTS: A total of 1525 TR-CEUS images were included for analysis, and 3360 ML models were constructed using image series before and after NCRT, respectively. The optimal pre-NCRT ML model, constructed from imaging series before NCRT, was RF; whereas the optimal post-NCRT model, derived from imaging series after NCRT, was MLP. The areas under the curve for the optimal RF and MLP models demonstrated values of 0.609 and 0.857, respectively, in the cross-validation cohort, with corresponding values of 0.659 and 0.841 observed in the independent test cohort. Delong tests showed that the predictive efficacy of the post-NCRT model was statistically higher than that of the pre-NCRT model (p < 0.05).

CONCLUSIONS: Radiomics model developed by TR-CEUS images after NCRT demonstrated high predictive performance for TRG, thereby facilitating precise evaluation of therapeutic response to NCRT in LARC patients.

PMID:40910157 | DOI:10.1002/jcu.70071

Front Artif Intell. 2025 Aug 20;8:1623573. doi: 10.3389/frai.2025.1623573. eCollection 2025.

ABSTRACT

Autonomous systems operating in high-dimensional environments increasingly rely on prioritization heuristics to allocate attention and assess risk, yet these mechanisms can introduce cognitive biases such as salience, spatial framing, and temporal familiarity that influence decision-making without altering the input or accessing internal states. This study presents Priority Inversion via Operational Reasoning (PRIOR), a black-box, non-perturbative diagnostic framework that employs structurally biased but semantically neutral scenario cues to probe inference-level vulnerabilities without modifying pixel-level, statistical, or surface semantic properties. Given the limited accessibility of embodied vision-based systems, we evaluate PRIOR using large language models (LLMs) as abstract reasoning proxies to simulate cognitive prioritization in constrained textual surveillance scenarios inspired by Unmanned Aerial Vehicle (UAV) operations. Controlled experiments demonstrate that minimal structural cues can consistently induce priority inversions across multiple models, and joint analysis of model justifications and confidence estimates reveals systematic distortions in inferred threat relevance even when inputs are symmetrical. These findings expose the fragility of inference-level reasoning in black-box systems and motivate the development of evaluation strategies that extend beyond output correctness to interrogate internal prioritization logic, with implications for dynamic, embodied, and visually grounded agents in real-world deployments.

PMID:40910117 | PMC:PMC12405252 | DOI:10.3389/frai.2025.1623573

Front Cell Neurosci. 2025 Aug 20;19:1606451. doi: 10.3389/fncel.2025.1606451. eCollection 2025.

ABSTRACT

BACKGROUND: Cognitive reserve (CR) refers to the discrepancy between brain pathology and observed cognitive decline. While education is a key indicator of CR, its role as a potential moderator in the relationships between brain morphology and cognitive impairments in Parkinson’s disease (PD) remains unclear. This study examined whether education affects the relationship between brain age and cognitive impairments in patients with PD.

METHODS: Data from 58 patients with PD were analyzed using a secondary dataset from the OpenNeuro database. Participants aged ≥55 years were on stable medications and underwent standardized neuropsychological assessments. Brain age predictions were generated from T1-weighted magnetic resonance imaging (MRI) using the brainageR package, and the brain age difference (BAD) was calculated after correction for regression dilution. The moderation effect of education on the relationship between BAD and cognition was assessed using Hayes’ PROCESS macro. The primary outcome was cognitive performance across six domains: attention, executive function, language, learning and memory, visuospatial ability, and global cognition.

RESULTS: Among the six domains, a significant moderation effect of education was found only for language ability (β = 0.01, p = 0.013, R ² = 0.20). The relationship between BAD and language was steeper at lower education levels. No statistically significant moderation was found in the remaining five domains.

CONCLUSION: Having more years of education is associated with buffering the effects of accelerated brain aging on language ability in PD.

PMID:40910106 | PMC:PMC12405238 | DOI:10.3389/fncel.2025.1606451

Med Phys. 2025 Sep;52(9):e17960. doi: 10.1002/mp.17960.

ABSTRACT

BACKGROUND: Advanced diffusion models have been introduced to improve characterization of tissue microstructure in breast cancer assessment.

PURPOSE: This study aimed to evaluate the diagnostic utility of monoexponential apparent diffusion coefficient (ADC), time-dependent diffusion magnetic resonance imaging (td-dMRI), and the Continuous-Time Random-Walk (CTRW) diffusion model for differentiating breast lesions and predicting Ki-67 expression levels.

METHODS: Fifty-three consecutive patients with suspected breast lesions undergoing preoperative MRI were enrolled in this prospective investigation. Each participant underwent conventional diffusion-weighted imaging (DWI), CTRW, and td-dMRI acquisition. From conventional DWI, ADC_mean, ADC_min, and ADC_max were extracted from two-dimensional lesion regions of interest, and the intralesional ADC difference (ADC_max – ADC_min) was computed. CTRW analysis involved whole-lesion histograms to quantify temporal heterogeneity (α), spatial heterogeneity (β), and the anomalous diffusion coefficient (D). td-dMRI data were fitted using the JOINT model to derive five microstructural parameters, with PGSE_50ms also obtained. Group comparisons of diffusion parameters between benign and malignant lesions were performed using Mann-Whitney U tests, followed by correlation analyses with Ki-67. Bonferroni correction was applied to account for multiple testing, with p < 0.05 indicating statistical significance. Logistic regression was employed to combine significant parameters, and diagnostic performance was assessed via receiver operating characteristic (ROC) analysis.

RESULTS: The td-dMRI-derived f_in and cellularity, alongside various CTRW-based histogram parameters, demonstrated statistically significant distinctions between benign and malignant breast lesions (all adjusted p < 0.05, Bonferroni correction). Among all evaluated models, the combined CTRW metrics yielded the highest area under the ROC curve (AUC) (0.975), indicating markedly improved diagnostic efficacy compared to conventional DWI (all p < 0.05). Diffusion metrics generated from ADC, α, and td-dMRI maps were significantly associated with Ki-67 expression (ρ = 0.39-0.62, all p < 0.05).

CONCLUSIONS: Diffusion parameters derived from conventional DWI, td-dMRI, and CTRW mapping demonstrate potential in characterizing breast lesion microstructure. Nevertheless, validation in larger cohorts remains necessary to substantiate their clinical utility.

PMID:40908518 | DOI:10.1002/mp.17960

Photodermatol Photoimmunol Photomed. 2025 Sep;41(5):e70051. doi: 10.1111/phpp.70051.

ABSTRACT

BACKGROUND: Narrowband-ultraviolet B (NB-UVB) phototherapy is an effective treatment for psoriasis in patients who have failed topical regimens or those who desire to avoid systemic treatment. Despite its regular use in non-white individuals, NB-UVB treatment response for psoriasis in skin of color (SOC) has not been systematically reviewed.

METHODS: We conducted a systematic review on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) on all available studies to date assessing NB-UVB for psoriasis treatment in skin of color (SOC) (up to 15 November 2024). The primary outcome was qualitative data on clinical outcomes of UVB (PASI 75). Random-effects meta-analysis was performed to assess treatment responses. Secondary outcomes of biochemical and immunologic mechanisms of NB-UVB, NB-UVB in combination with other treatments, and NB-UVB compared to other forms of phototherapy were assessed.

RESULTS: Of 1283 articles initially identified, 54 were ultimately included for formal review. We identified 43 articles assessing clinical outcomes of NB-UVB phototherapy in patients with Fitzpatrick skin type III-IV for a total of 1322 patients with chronic plaque psoriasis and 12 patients with palmoplantar psoriasis. Nine studies were included for meta-analysis of PASI75 response; 70.5% of patients achieved PASI75, and all studies demonstrated statistically significant PASI improvement after treatment. NB-UVB demonstrated a higher rate of complete clearance when compared to BB-UVB but did not result in a statistically significant difference in the proportion of the patient population achieving PASI75 when compared to PUVA.

CONCLUSIONS: Phototherapy is effective for the treatment of psoriasis in SOC patients and remains a valuable treatment option despite the advent of various topical, systemic, and biologic treatments for psoriasis.

PMID:40908513 | DOI:10.1111/phpp.70051

Health Serv Res. 2025 Sep 4:e70033. doi: 10.1111/1475-6773.70033. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the relationship between the changing Accountable Care Organizations-ACO workforce and ACOs’ shared savings earnings and quality performance.

DATA SOURCES: Medicare Shared Savings Program-MSSP provider-level research identifiable files, performance year financial and quality report public use files, and National Physician Compare data (2013-2021).

STUDY SETTING AND DESIGN: We characterized 865 MSSPs, separately pre- (2013-2019) and post-pandemic (2020-2021) according to the percentage of primary care physicians (PCPs), non-physicians, specialists, and other specialty, financial risk model, assigned Medicare beneficiary demographics, clinical risk factors, and provider supply by specialty within the MSSP’s primary service state, (total and per-capita) shared savings earnings/losses owed and quality score. Longitudinal ordinary least-squares regressions with random effects were estimated to assess the association between MSSP provider specialty mix and annual (1) per-capita shared savings/losses and (2) quality score, controlling for risk model, beneficiary characteristics, provider supply, and year factors. We also compared outcomes across MSSPs, 32 Pioneers and 62 Next Generation-NGACOs.

PRINCIPAL FINDINGS: PCPs represented 33.9% of MSSP’s workforce, on average. Higher percentages of PCPs and non-physicians were associated with higher per-capita earned shared savings and quality scores among MSSPs. A 1-percentage-point (ppt) increase in PCPs and non-physicians was associated with higher per-capita shared savings of $2.25 (p < 0.01) and $1.82 (p = 0.03), respectively, pre-COVID, and $2.73 (p < 0.01) and $1.81 (p = 0.14) post-COVID. We estimated increases in quality scores among MSSPs of ~0.1 ppt with a 1 ppt increase in PCPs, non-physicians, and specialists only pre-pandemic. No statistically significant relationships were estimated between provider specialty mix and performance measures in Pioneers and NGACOs.

CONCLUSIONS: Higher percentages of PCPs and non-physicians were associated with higher per-capita shared savings earnings and quality scores among MSSPs. As new federal initiatives continue to unfold, value-based payment models increasing incentives for primary care should be monitored to determine their ability to further improve care efficiency.

PMID:40908503 | DOI:10.1111/1475-6773.70033

BMC Public Health. 2025 Sep 4;25(1):3038. doi: 10.1186/s12889-025-24231-9.

ABSTRACT

BACKGROUND: Questionnaires that assess psychological functioning are 21 limited by their subjective nature, while HRV can serve as a more objective 22 (but also complex) index of such functioning. This study aims to validate sex 23 differences in college students’ mental well-being using psychological scales 24 and HRV, and to investigate the correlation between psychological scales 25 and HRV for each sex.

METHOD: 240 college students (120 males and 120 females, aged 18-22 27 years) were recruited via cluster sampling from 1st Sept. to 1st Nov. 2023 at 28 Zhejiang University in China. Mental well-being was assessed using the 29 Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the 21-item 30 version of the Depression, Anxiety, and Stress Scale (DASS-21), while HRV 31 was measured at rest using a Polar H7 heart rate monitor.

RESULTS: Comparative analyses showed that female students had higher 33 anxiety scores (DASS-21) (p = 0.033, Partial η² = 0.019) and lower mental 34 well-being scores (WEMWBS) (p = 0.047, Partial η² = 0.016) compared to 35 male students. Additionally, female students exhibited lower HRV across 36 multiple indices, including SDNN (p < 0.001, Partial η² = 0.158), RMSSD (p 37 < 0.001, Partial η² = 0.064), pNN50 (p < 0.001, Partial η² = 0.045), and 38 absolute high-frequency (HF) power (p = 0.003, Partial η² = 0.038). 39 Correlational analyses further revealed that only female students’ anxiety 40 scores were negatively associated with RMSSD (r = -0.245, p = 0.008), 41 absolute HF power (r = -0.261, p = 0.005), and normalized HF power (r = – 42 0.262, p = 0.005).

CONCLUSIONS: Female university students exhibited poorer mental well-being 44 than male students, as indicated by both subjective and objective measures, with anxiety being particularly prominent. Combining psychological scales 46 with measures of HRV (RMSSD and HF power) may improve anxiety 47 assessment in female university students.

PMID:40908489 | DOI:10.1186/s12889-025-24231-9

Genome Biol. 2025 Sep 4;26(1):266. doi: 10.1186/s13059-025-03702-7.

ABSTRACT

We present a new and considerably improved version of RoAM (Reconstruction of Ancient Methylation), a flexible tool for reconstructing ancient methylomes and identifying differentially methylated regions (DMRs) between populations. Through a series of filtering and quality control steps, RoAM produces highly reliable DNA methylation maps, making it a valuable tool for paleoepigenomics studies. We apply RoAM to pre-and post-Neolithic transition Balkan samples, and uncover DMRs in genes related to sugar metabolism. Notably, we observe post-Neolithic hypermethylation of PTPRN2, a regulator of insulin secretion. These results are compatible with hypoinsulinism in pre-Neolithic hunter-gatherers.

PMID:40908480 | DOI:10.1186/s13059-025-03702-7