Nevin Manimala

J Health Care Poor Underserved. 2025;36(4):1209-1224. doi: 10.1353/hpu.2025.a975583.

ABSTRACT

This study examined the association of rental assistance receipt with cost-related medication nonadherence (CRN) engagement in low-income adults with diabetes. Using National Health Interview Survey (NHIS) data from 2016 through 2019 and 2020 through 2022, we included low-income adults who were 1) diagnosed with diabetes, 2) prescribed medications, and 3) renters. Propensity score weighting approach created a sample in which receipt of rental assistance was independent of observed sociodemographic characteristics. Logistic regression examined the association of rental assistance receipt with CRN, respectively. Lack of receipt of rental assistance was significantly associated with higher odds of CRN engagement in NHIS 2016-2019 (Odds ratio=2.32; 95% confidence interval=(1.59, 3.37); p<.0001) and NHIS 2020-2022 (Odds ratio=1.74; 95% confidence interval=(1.04, 2.91); p=.03). Given the shortage of affordable housing in the United States, findings suggest that expansion of affordable housing could be critical for improving health outcomes in low-income adults with diabetes.

PMID:41355639 | DOI:10.1353/hpu.2025.a975583

J Health Care Poor Underserved. 2025;36(4):1193-1208. doi: 10.1353/hpu.2025.a975582.

ABSTRACT

Dental care remains an optional benefit for adults with Medicaid, with coverage varying across states. Recent expansions increased periodontal service coverage, but the scope of coverage and the policies that govern that scope remain unknown. This study analyzed coverage policies and fees for four periodontal services across 43 Medicaid programs between January and March 2024. Frequency limitations were the most common coverage policies identified, followed by prior authorization requirements, clinical requirements, and quadrant limitations. Veteran Health Administration fees were roughly three times higher than Medicaid fees across the four dental services. Current coverage policies may not consider the multidimensional and nuanced pathogenesis of periodontitis and the need for individualized treatment plans based on patient risk factors and disease progression. Furthermore, low reimbursement rates and administrative challenges may discourage dentists from participating.

PMID:41355638 | DOI:10.1353/hpu.2025.a975582

J Health Care Poor Underserved. 2025;36(4):1179-1192. doi: 10.1353/hpu.2025.a975581.

ABSTRACT

OBJECTIVE: Black birthing people are three times more likely to die from pregnancy-related causes than White birthing people. This disparity is related to racism and implicit bias. The project’s goal was to evaluate the effect of a novel anti-racism curriculum on the ability of health care providers to address implicit biases.

METHODS: Attendees of grand rounds education for the Department of Obstetrics and Gynecology at one academic institution were eligible. Pre- and post-intervention surveys were conducted annually. Results were analyzed through paired t-tests.

RESULTS: Anti-racism curriculum participants had a statistically significant difference in their understanding of disparities and comfort speaking about instances of bias after participation. There was no significant difference in knowledge of historical context.

CONCLUSION: Although most participants had previous anti-racism training, participants lacked comfort discussing disparities with peers and those in positions of leadership prior to this curriculum, which empowered participants to address racism in actionable ways.

PMID:41355637 | DOI:10.1353/hpu.2025.a975581

J Health Care Poor Underserved. 2025;36(4):1159-1172. doi: 10.1353/hpu.2025.a975579.

ABSTRACT

OBJECTIVES: To investigate racism in the health care setting experienced by American Indian and Alaska Native people and its influence on health care engagement.

METHODS: Data were collected via self-report surveys administered in person at two community powwows in Denver, Colorado in 2021 and 2022.

RESULTS: Approximately one-third (29.8%) of American Indian and/or Alaska Native respondents reported having a health care visit where they felt uncomfortable due to their race. Of those, 51% were less likely to see a doctor in the future because of these experiences. Experiences were categorized as racial microaggressions and overt racism.

CONCLUSIONS: American Indian and Alaska Native people experience racial microaggressions and overt racism during health care visits, leading to decreased likelihood of engaging with health care in the future.

PMID:41355635 | DOI:10.1353/hpu.2025.a975579

J Health Care Poor Underserved. 2025;36(4):1151-1158. doi: 10.1353/hpu.2025.a975578.

ABSTRACT

BACKGROUND: In the United States, uninsured patients with kidney failure often rely on emergency (compassionate) hemodialysis in acute care settings to manage life-threatening complications, as scheduled hemodialysis is often unattainable due to cost. This reactive approach has higher mortality rates, health care utilization, and cost than scheduled hemodialysis. Quality of life (QoL) outcomes are underexplored. This study evaluates changes in QoL after transitioning uninsured patients from emergency to scheduled hemodialysis.

METHODS: Kidney Dialysis Quality of Life (KDQOL) surveys were administered pre- and three-months post- transition at a federally qualified health center in Texas. A Wilcoxon signed-rank test analyzed score differences.

RESULTS: Among 39 patients significant improvements were observed across all KDQOL domains, with the greatest improvements in the “burden of kidney disease” (54.7%), “physical composite (33.13%), and “symptoms” (22.32%).

CONCLUSION: Expanding access to scheduled hemodialysis may improve QoL, reduce symptom burden, and lower cost in underserved populations.

PMID:41355634 | DOI:10.1353/hpu.2025.a975578

J Clin Oncol. 2025 Dec 7:JCO2502477. doi: 10.1200/JCO-25-02477. Online ahead of print.

ABSTRACT

PURPOSE: Pirtobrutinib, a highly selective, noncovalent Bruton tyrosine kinase inhibitor (BTKi), has shown efficacy and safety in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) who received prior covalent BTKi. We report results, to our knowledge, from the first randomized head-to-head comparison of pirtobrutinib versus ibrutinib in BTKi-naïve CLL/SLL in both treatment-naïve (TN) patients and patients with relapsed/refractory (R/R) disease.

PATIENTS AND METHODS: Patients (N = 662) were randomly assigned 1:1 to receive pirtobrutinib or ibrutinib. All patients were BTKi-naïve. Primary end points were overall response rate (ORR) by independent review committee (IRC) among all randomly assigned patients (intention to treat [ITT]) and in patients with R/R disease.

RESULTS: The study met its primary end points, demonstrating statistically significant noninferiority (NI) of IRC-ORR for pirtobrutinib versus ibrutinib in both the ITT (87.0% [95% CI, 82.9 to 90.4] v 78.5% [95% CI, 73.7 to 82.9]; ORR ratio = 1.11 [95% CI, 1.03 to 1.19]; two-sided P < .0001) and R/R populations (n = 437; 84.0% [95% CI, 78.5 to 88.6] v 74.8% [95% CI, 68.5 to 80.4]; ORR ratio = 1.12 [95% CI, 1.02 to 1.24]; two-sided P < .0001). In TN patients (n = 225), IRC-ORR was 92.9% (95% CI, 86.4 to 96.9) with pirtobrutinib versus 85.8% (95% CI, 78.0 to 91.7) with ibrutinib. Investigator assessed ORR results were consistent. Investigator-assessed progression-free survival (PFS) favored pirtobrutinib in the ITT (hazard ratio [HR], 0.57 [95% CI, 0.39 to 0.83]), R/R (HR, 0.73 [95% CI, 0.47 to 1.13]), and TN (HR, 0.24 [95% CI, 0.10 to 0.59]) populations. Cardiac adverse event rates of atrial fibrillation/flutter and hypertension were lower with pirtobrutinib.

CONCLUSION: Pirtobrutinib demonstrated NI of ORR versus ibrutinib, with a favorable early PFS trend, particularly in TN patients, and a favorable safety profile including low rates of atrial fibrillation and hypertension.

PMID:41353787 | DOI:10.1200/JCO-25-02477

J Chem Inf Model. 2025 Dec 7. doi: 10.1021/acs.jcim.5c01597. Online ahead of print.

ABSTRACT

Uncertainty quantification (UQ) has been recognized as a prerequisite for reliable and trustworthy computational modeling in drug discovery. Two widely considered paradigms, Bayesian methods (deep ensemble and MC dropout) and evidential learning, differ in their computational demands and expressivity of uncertainties, excelling in complementary settings. Here, we propose hybrid approaches that combine both paradigms and benchmark them on the Papyrus++ data set across two end points (xC₅₀, K_x) and multiple split strategies. Our ensemble of evidential models (EOE) consistently achieves the best overall performance, yielding the lowest RMSE and leading CRPS and interval scores, including under the most challenging distributional shifts. While large ensembles often excel in rejection-based utility, EOE matches or surpasses them at a fraction of the computational cost. Statistical tests confirm its advantage, and a hardware-agnostic compute analysis highlights favorable performance-efficiency trade-offs. These results demonstrate that combining evidential and Bayesian principles yields more accurate and informative uncertainties for bioactivity modeling, with EOE offering a robust─and computationally practical─default for uncertainty-aware decision-making in drug discovery.

PMID:41353755 | DOI:10.1021/acs.jcim.5c01597

Knee Surg Sports Traumatol Arthrosc. 2025 Dec 7. doi: 10.1002/ksa.70218. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effect of medial patellofemoral ligament (MPFL) reconstruction with or without lateral retinacular release (LRR) on patellar height in patients with recurrent patellar dislocation (RPD). It was hypothesised that the addition of LRR would not significantly modify patellar height compared with isolated MPFL reconstruction.

METHODS: This prospective, single-blinded randomised controlled trial was conducted between 2011 and 2022. Patients aged 18-45 years with RPD were randomised into two groups: isolated MPFL reconstruction and MPFL reconstruction with associated LRR. Exclusion criteria included previous surgery on the same knee, concomitant bony procedures, or prior contralateral MPFL reconstruction. All patients were evaluated by blinded investigators. The primary outcome was patellar height measured by the Caton-Deschamps Index (CDI) on standardised lateral radiographs obtained at a minimum of 1 year after surgery.

RESULTS: Out of 140 enrolled patients, 107 completed the study, with 59 in the LRR group and 48 in the isolated MPFL group. The preoperative CDI was similar in both groups (1.32 [±0.168] in the LRR group and 1.29 [±0.163] in the isolated MPFL group), and postoperative CDI showed a significant decrease in patellar height in both groups (1.1 [±0.133] in the LRR group and 1.1 [±0.166] in the isolated MPFL group), with a mean follow-up of 12.5 ± 0.3 months, with no significant difference between them. A statistically significant reduction in CDI of 0.2 was observed in both groups.

CONCLUSION: Adding LRR to MPFL reconstruction has no effect on patellar height. Caton Deschamps Index demonstrated a mean decrease of 0.2 after MPFL reconstruction, with or without LRR.

LEVEL OF EVIDENCE: Level II, low-powered randomised clinical trial.

PMID:41353731 | DOI:10.1002/ksa.70218

Knee Surg Sports Traumatol Arthrosc. 2025 Dec 7. doi: 10.1002/ksa.70210. Online ahead of print.

ABSTRACT

PURPOSE: To compare short-term patient-reported outcomes (PROMs) and revision rates between autologous hand-minced cartilage implantation (MCI) and autologous chondrocyte implantation (ACI) for knee cartilage lesions.

METHODS: All patients undergoing MCI or ACI at a single centre were retrospectively analysed from a prospectively maintained database. Propensity score matching was performed based on age, defect localisation, defect size, general health status (ASA class), and prior surgery. PROMs, including the COMI, IKDC score and VAS for pain, were obtained preoperatively and at 6, 12, and 24 months postoperatively. Statistical comparisons were performed for PROM absolute values, improvement from baseline, Patient Acceptable Symptom State (PASS) and Maximum Outcome Improvement (MOI). Postoperative complications and revision surgeries were also compared.

RESULTS: After matching, 25 patients per group were compared. Both groups demonstrated statistically significant improvements in all PROMs when compared against baseline: COMI scores improved from 5.0 ± 1.5 to 2.6 ± 2.0 for ACI and from 5.3 ± 1.7 to 2.0 ± 2.0 for MCI. IKDC scores improved for ACI (49.8 ± 14.0 to 71.3 ± 18.7, p < .001) and MCI (49.4 ± 15.8 to 74.3 ± 15.9, p < 0.001). The VAS score for pain decreased significantly for both ACI (5.0 ± 2.2 to 2.2 ± 2.1, p < 0.001) and MCI (4.2 ± 2.5 to 2.2 ± 2.0, p < 0.001). ACI and MCI differed neither statistically nor clinically in PROMs. Gender, defect localisation, defect size, and concomitant interventions had no substantial influence on outcomes. Overall, 60% and 68% of ACI patients and 68% and 80% of MCI patients achieved PASS for IKDC and COMI scores at 24 months (p = n.s.). Re-operation rates were comparable between both groups.

CONCLUSION: Patients undergoing single-stage MCI or two-stage ACI for medium to large knee chondral defects achieve comparable and favourable short-term outcomes with low rates for adverse event. MCI is an efficient and effective alternative treatment option for patients seeking a single-stage solution or in areas where ACI is inaccessible.

LEVEL OF EVIDENCE: Level III.

PMID:41353730 | DOI:10.1002/ksa.70210

Knee Surg Sports Traumatol Arthrosc. 2025 Dec 7. doi: 10.1002/ksa.70213. Online ahead of print.

ABSTRACT

PURPOSE: To compare the patellar tendon-lateral trochlear ridge (PT-LTR) distance and patellar tendon-trochlear groove angle (PT-TGA) between patients with lateral patellar instability (LPI) and those with malalignment-induced patellofemoral pain (PFP), and to evaluate their differential diagnostic validity.

METHODS: Sixty patients with LPI (mean age: 24.2 ± 7.1 years) and 60 patients with malalignment-induced PFP (mean age: 25.3 ± 6.2 years) were included. PT-LTR, PT-TGA, as defined by Dai et al. (PT-TGA1) and Hinckel et al. (PT-TGA2), and additional patellofemoral alignment parameters-including the tibial tubercle-trochlear groove (TT-TG) distance, tibial tubercle-posterior cruciate ligament (TT-PCL) distance, lateral trochlear inclination (LTI) angle, patellar height, valgus deviation, femoral and tibial torsion, knee rotation and leg axis-were measured. The unpaired t tests with Welch’s correction, receiver operating characteristic (ROC) curve analysis via the Youden index, and parametric power analysis were utilized.

RESULTS: PT-LTR, PT-TGA1 and PT-TGA2 values were significantly greater in LPI patients compared to those with PFP (PT-LTR: 8.8 ± 6.7 mm vs. 3.9 ± 5.3 mm; PT-TGA1: 29.1 ± 11.3° vs. 17.3 ± 8.9°; PT-TGA2: 35 ± 9.6° vs. 24.9 ± 8.5°; all p < 0.0001). ROC analysis revealed AUCs of 0.73 (PT-LTR), 0.79 (PT-TGA1) and 0.78 (PT-TGA2). PT-TGA1 demonstrated the highest sensitivity (85%), whereas PT-TGA2 showed the highest specificity (83%). Significant differences were also found for LTI (p < 0.0001), patellar height (p < 0.0001), TT-PCL (p < 0.0001) and valgus deviation (p = 0.004), but not for TT-TG, femur/tibia torsion, or knee rotation. Power analysis confirmed robust statistical validity (Z ≈ 5.60; power = 99.987%).

CONCLUSIONS: While PT-LTR and PT-TGA measurements were significantly greater in patients with LPIs than in those with malalignment-induced PFP, only PT-TGA measurements demonstrated sufficient diagnostic accuracy to identify LPI. The results reinforce the conceptual advantage of angular over linear measurements of the extensor apparatus.

LEVEL OF EVIDENCE: Level III, diagnostic cohort study.

PMID:41353728 | DOI:10.1002/ksa.70213