Nevin Manimala

Swiss Med Wkly. 2025 Nov 18;155:4546. doi: 10.57187/s.4546.

ABSTRACT

INTRODUCTION: Human childbirth remains a complex and risky process for both mothers and infants, even with modern advancements in medical care. This study investigated the prevalence of obstetric interventions, namely caesarean sections, episiotomies, and forceps deliveries, along with the role of maternal-foetal body size mismatch in influencing delivery outcomes.

METHODS: Utilising two datasets from similar archival sources in two Swiss cities (Basel and Lausanne) from the 1920s, we explored the relevance of a mismatch between the body size of the mother and the foetus as a risk factor for obstetrical interventions and the duration of the expulsion phase during delivery.

RESULTS: Over 91% of births (1290/1407 in Basel and 1062/1145 in Lausanne) featured the foetal head in a normal position (either the right or left occiput anterior position). Episiotomies were performed in 8-17% of cases (233/1407 in Basel and 98/1145 in Lausanne) and forceps deliveries in 1-5% (17/1407 in Basel and 54/1145 in Lausanne). Caesarean sections were rare (<1%, 19/1407 in Basel and 6/1145 in Lausanne). Key findings indicated that larger foetal head diameters and narrower pelvic measurements were linked to prolonged expulsion phases and an increased likelihood of intervention. Abnormal head positions and first-time births were also associated with obstetrical interventions. Additionally, rickets was documented in 2% of mothers (23/1145) in Lausanne, correlating with increased forceps use and caesarean section rates.

CONCLUSION: This research provides insights into obstetric practices and maternal health conditions over a century ago, emphasising the significant impact of maternal-foetal body size mismatches on childbirth complications in a historical context.

PMID:41364818 | DOI:10.57187/s.4546

J Med Internet Res. 2025 Dec 9;27:e80981. doi: 10.2196/80981.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) techniques, particularly those using machine learning and deep learning to analyze multimodal imaging data, have shown considerable promise in enhancing preoperative prediction of extraprostatic extension (EPE) in prostate cancer.

OBJECTIVE: This meta-analysis compares the diagnostic performance of AI-enabled imaging techniques with that of radiologists for predicting preoperative EPE in prostate cancer.

METHODS: We conducted a systematic literature search in PubMed, Embase, and Web of Science up to September 2025, following PRISMA-DTA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis of Diagnostic Test Accuracy) guidelines. Studies applying AI techniques to predict EPE using multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging were included. Sensitivity, specificity, and area under the curve (AUC) for both internal and external validation sets were extracted and pooled using a bivariate random effects model. Study quality was assessed using the modified Quality Assessment of Diagnostic Performance Studies (QUADAS-2) tool.

RESULTS: A total of 21 studies were included in the analysis. For internal validation sets in patient-based analyses, mpMRI-based AI demonstrated a pooled sensitivity of 0.77 (95% CI 0.71-0.82), specificity of 0.71 (95% CI 0.64-0.78), and AUC of 0.81 (95% CI 0.77-0.84). In external validation, mpMRI-based AI achieved a sensitivity of 0.66 (95% CI 0.43-0.84), specificity of 0.80 (95% CI 0.64-0.90), and AUC of 0.80 (95% CI 0.77-0.84). In comparison, radiologists achieved a pooled sensitivity of 0.69 (95% CI 0.60-0.76), specificity of 0.73 (95% CI 0.66-0.78), and AUC of 0.77 (95% CI 0.73-0.80). Statistical comparisons between mpMRI-based AI and radiologists showed no significant difference in sensitivity (Z=1.61; P=.10), specificity (Z=0.43; P=.67). Conversely, the AUC of mpMRI-based AI was significantly higher than that of PSMA PET-based (Z=2.77; P=.01). PSMA PET-based AI showed moderate performance with sensitivity of 0.73 (95% CI 0.65-0.80), specificity of 0.61 (95% CI 0.30-0.85), and AUC of 0.74 (95% CI 0.70-0.77) in internal validation, and in external validation, it demonstrated sensitivity of 0.77 (95% CI 0.57-0.89) and specificity of 0.50 (95% CI 0.22-0.78), demonstrating no significant advantage over radiologists.

CONCLUSIONS: mpMRI-based AI demonstrated improved diagnostic performance for preoperative prediction of EPE in prostate cancer compared to conventional radiological assessment, achieving higher AUC. However, PSMA PET-based AI models currently offer no significant advantage over either mpMRI-based AI or radiologists. Limitations include the retrospective design and high heterogeneity, which may introduce bias and affect generalizability. Larger, more diverse cohorts are essential for confirming these findings and optimizing the integration of AI in clinical practice.

PMID:41364797 | DOI:10.2196/80981

Medwave. 2025 Dec 9;25(11):e3154. doi: 10.5867/medwave.2025.11.3154.

ABSTRACT

INTRODUCTION: Bariatric and metabolic surgery is a safe and effective method for treating clinically severe obesity. In Argentina, Law 26 396 and its amendments establish the regulatory framework for its coverage. However, administrative, regulatory, and financial barriers limit effective access to it, with gaps remaining in its scope and understanding. This study aimed to explore surgeons’ and health insurance providers’ perceptions of the implementation of bariatric and metabolic surgery in Argentina, within the framework of Law 26 396, and to identify the barriers that impede effective, timely access.

METHODS: We conducted an exploratory qualitative study comprising 16 in-depth virtual interviews with eight surgeons specializing in bariatric and metabolic surgery and eight health insurance officers of the Argentine healthcare system, conducted between November and December 2024. The sampling was intentional. The interviews were recorded, transcribed, and coded. A thematic and recursive analysis was conducted, enabling us to identify emerging categories.

RESULTS: We identified multiple barriers and challenges to the effective implementation of bariatric and metabolic surgery in Argentina, including geographic inequalities, heterogeneity in surgical module agreements, administrative and bureaucratic restrictions related to variability in the interpretation of the law and its requirements, high costs, and the imposition of quotas that delay timely access, among others.

CONCLUSIONS: The implementation of bariatric and metabolic surgery presents structural and functional challenges that affect equitable and timely access. Although Law 26 396 and its subsequent regulations established a regulatory framework for its coverage, tensions among healthcare system actors and regional disparities have resulted in heterogeneous implementation. Administrative and financial barriers persist, affecting its effective and timely practice. We highlight the need to strengthen coordination between physicians and health insurance providers, promoting opportunities for dialogue that optimize authorization and funding processes.

PMID:41364794 | DOI:10.5867/medwave.2025.11.3154

J Med Internet Res. 2025 Dec 9;27:e76126. doi: 10.2196/76126.

ABSTRACT

BACKGROUND: While machine learning (ML) technologies have shifted from development to real-world deployment over the past decade, US health care providers and hospital administrators have increasingly embraced ML, particularly through its integration with electronic health record (EHR) systems. This evolving landscape underscores the need for empirical evidence on ML adoption and its determinants; however, the relationship between hospital characteristics and ML integration within EHR systems remains insufficiently explored.

OBJECTIVE: This study aimed to examine the current state of ML adoption within EHR systems across US general acute care hospitals and to identify hospital characteristics associated with ML implementation.

METHODS: We used linked data between the 2022-2023 American Hospital Association Annual Survey and the 2023-2024 American Hospital Association Information Technology Supplement Survey. The sample includes 2562 general and acute care hospitals in the United States with a total of 4055 observations over 2 years. Applying inverse probability weighting to address nonresponse bias, we used descriptive statistics to assess ML adoption patterns and multivariate logistic regression models to identify hospital characteristics associated with ML adoption.

RESULTS: Overall, about 75% of the hospitals had adopted ML functions within their EHR systems in 2023-2024, and the majority tended to adopt both clinical and operational ML functions simultaneously. The most commonly adopted individual functions were predicting inpatient risks and outpatient follow-ups. ML model evaluation practices, while still limited overall, showed notable improvement. Multivariate regression estimates indicate that hospitals were more likely to adopt any ML if they were not-for-profit (4.4 percentage points, 95% CI 0.6-8.2; P=.02), large hospitals (15 percentage points, 95% CI 9.4-21; P<.001), operated in metropolitan areas (4.3 percentage points, 95% CI 0.8-7.8; P=.02), contracted with leading EHR vendors (20.6 percentage points, 95% CI 17.1-24; P<.001), and affiliated with a health system (26.8 percentage points, 95% CI 22.4-31.3; P<.001). Similar patterns were observed for predicting the adoption of both clinical and operative ML. We also identified specific hospital characteristics associated with the adoption of individual ML functions.

CONCLUSIONS: ML adoption in hospitals is influenced by organizational resources and strategic priorities, raising concerns about potential digital inequities. Limited quality control and evaluation practices highlight the need for stronger regulatory oversight and targeted support for underresourced hospitals. As the integration of ML into EHR systems expands, disparities in both adoption and oversight become increasingly critical. To ensure the equitable, safe, and effective implementation of ML technologies in health care, well-designed policies must address these gaps and promote inclusive innovation across all hospital settings.

PMID:41364792 | DOI:10.2196/76126

Proc Natl Acad Sci U S A. 2025 Dec 16;122(50):e2519691122. doi: 10.1073/pnas.2519691122. Epub 2025 Dec 9.

ABSTRACT

In the presence of a laminar shear flow, the diffusion of passive colloidal particles is enhanced in the direction parallel to the flow. This classical phenomenon is known as Taylor-Aris dispersion. Besides, microorganisms, such as active microswimmers, exhibit an effective diffusive behavior at long times. Combining the two ingredients above, a natural question then emerges on how the effective diffusion of active microswimmers is altered in shear flows-a widespread situation in natural environments with practical implications, e.g., regarding biofilm formation. In this Letter, we investigate the motility and dispersion of Chlamydomonas reinhardtii microalgae, within a rectangular microfluidic channel subjected to a sinusoidal Poiseuille flow. Using high-resolution optical microscopy and a particle-tracking algorithm, we reconstruct individual trajectories in various flow conditions and statistically analyze them through moment theory and sliding windowed demodulation. We find that the velocity fluctuations and the dispersion coefficient increase as the flow amplitude is increased, with only weak dependencies on the flow periodicity. Importantly, our results demonstrate that the generalization of Taylor-Aris law to active particles is valid.

PMID:41364755 | DOI:10.1073/pnas.2519691122

Vet Ital. 2025 Dec 9;61(4). doi: 10.12834/VetIt.3739.35888.2.

ABSTRACT

Urban pigeon populations pose significant challenges in cities worldwide, contributing to structural damage, health concerns, and environmental imbalances. Since 2005, the Municipality of Genoa has implemented a targeted pigeon control programme utilising Nicarbazin, a sterilising agent that inhibits egg fertilisation. This study assesses the effectiveness of the sterilisation strategy in the Circonvallazione a Monte district from 2010 to 2017, analysing population trends and behavioural responses across various feeding points. Using a combination of statistical methods, including Duncan’s test, ANOVA, and time series analysis, we identify significant declines in pigeon numbers and the emergence of distinct population dynamic patterns. Results indicate that while pharmacological sterilisation effectively reduces populations, its success varies depending on local environmental factors, nesting availability, and unauthorised feeding. The study suggests that an integrated approach, combining reproductive control with habitat modification and public awareness initiatives, is essential for long-term pigeon population management. Our findings contribute to the growing body of research on humane and sustainable urban wildlife control.

PMID:41364501 | DOI:10.12834/VetIt.3739.35888.2

Stat Methods Med Res. 2025 Dec 9:9622802251399913. doi: 10.1177/09622802251399913. Online ahead of print.

ABSTRACT

The expectation-maximization (EM) algorithm is a popular tool for maximum likelihood estimation, but its use in high-dimensional regularization problems in linear mixed-effects models has been limited. In this article, we introduce the EMLMLasso algorithm, which combines the EM algorithm with the popular and efficient R package glmnet for Lasso variable selection of fixed effects in linear mixed-effects models and allows for automatic selection of the tuning parameter. A comprehensive performance evaluation is conducted, comparing the proposed EMLMLasso algorithm against two existing algorithms implemented in the R packages glmmLasso and splmm. In both simulated and real-world applications analyzed, our algorithm showed robustness and effectiveness in variable selection, including cases where the number of predictors $\left(p\right)$ is greater than the number of independent observations $\left(n\right)$. In most evaluated scenarios, the EMLMLasso algorithm consistently outperformed both glmmLasso and splmm. The proposed method is quite general and simple to implement, allowing for extensions based on ridge and elastic net penalties in linear mixed-effects models.

PMID:41364493 | DOI:10.1177/09622802251399913

JAMA Netw Open. 2025 Dec 1;8(12):e2547111. doi: 10.1001/jamanetworkopen.2025.47111.

ABSTRACT

IMPORTANCE: Aortic stenosis (AS) and obstructive coronary artery disease (CAD) often coexist, yet the impact of obstructive CAD on clinical and patient-reported outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) remains a subject of ongoing debate.

OBJECTIVES: To investigate the association of obstructive CAD with clinical outcomes and health status among patients with symptomatic severe AS undergoing TAVR.

DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis of the investigator-initiated, multicenter SCOPE I (Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis for Transcatheter Aortic Valve Implantation by Transfemoral Approach) randomized clinical trial was conducted at 20 tertiary heart centers in Europe from February 8, 2017, to February 2, 2019, with follow-up through 3 years. Data were analyzed from February 17 through August 13, 2025.

EXPOSURE: Presence vs absence of obstructive CAD, defined as greater than 50% stenosis in at least 1 major epicardial coronary vessel.

MAIN OUTCOMES AND MEASURES: Parameters of interest included vital and patient-reported disease-specific health status (Kansas City Cardiomyopathy Questionnaire [KCCQ] scores, ranging from 0 to 100, with higher numbers indicating better health status), and clinical efficacy according to Valve Academic Research Consortium (VARC)-3 definitions. Analyses were conducted using the as treated population.

RESULTS: Of 732 patients with symptomatic severe AS undergoing TAVR (mean [SD] age, 82 [4] years; 416 [56.8%] female), obstructive CAD was identified in 373 (51.0%), 144 (38.6%) of whom underwent elective percutaneous coronary intervention (PCI) during the periprocedural period. At 3 years after TAVR, there were no statistically significant differences in patient-reported health status (eg, median [IQR] baseline overall KCCQ scores with CAD, 54.2 [40.3-69.8] vs without CAD, 55.2 [38.5-72.9] and at 3-year follow-up with CAD, 79.7 [64.4-90.6] vs without CAD, 82.3 [68.2-91.7]), mortality (all-cause death: 88 of 373 [24.7%] vs 76 of 359 [22.3%], adjusted hazard ratio, [HR], 0.97 [95% CI, 0.66-1.43]; cardiovascular death: 59 of 373 [17.6%] vs 51 of 359 [15.5%], adjusted HR, 0.87 [95% CI, 0.54-1.42]), and clinical efficacy of TAVR (163 of 313 [52.1%] vs 159 of 298 [53.4%]; adjusted risk ratio, 1.10 [95% CI, 0.92-1.32]) between patients with vs without obstructive CAD. Having (vs not having) obstructive CAD was associated with a numerically albeit not statistically significantly higher risk of myocardial infarction (18 of 372 [5.5%] vs 3 of 359 [1.1%]; adjusted HR, 3.83 [95% CI, 0.96-15.31]). Periprocedural PCI among patients with obstructive CAD did not improve clinical outcomes, patient-reported health status, nor the integrated end points of clinical outcomes and quality of life measures.

CONCLUSIONS AND RELEVANCE: In this post hoc analysis of SCOPE I, patients with obstructive CAD who underwent TAVR had no statistically significant differences in survival, patient-reported health status, or VARC-3 clinical efficacy compared with patients without CAD through 3 years of follow-up. Findings suggest that a tailored approach may be essential in the treatment of TAVR candidates with severe AS and CAD.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03011346.

PMID:41364435 | DOI:10.1001/jamanetworkopen.2025.47111

JAMA Netw Open. 2025 Dec 1;8(12):e2547831. doi: 10.1001/jamanetworkopen.2025.47831.

ABSTRACT

IMPORTANCE: Second primary cancers are an important cause of morbidity, mortality, and resource use among lung cancer survivors, yet their risk relative to recurrence and their determinants have been incompletely defined.

OBJECTIVES: To quantify the competing risks of recurrence, intrathoracic new cancer (locoregional or distant recurrences confined to the thorax and/or second primary lung cancers), and non-lung secondary cancers (NLSCs) after curative-intent local therapy for non-small cell lung cancer (NSCLC) and to identify clinical factors associated with NLSC.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included consecutive stage I to III NSCLC survivors treated with definitive local therapy and evaluated in a dedicated survivorship clinic at a single high-volume academic cancer center from January to May 2019. Follow-up was measured from completion of local therapy; eligible participants were disease-free 12 months or longer following curative-intent surgery or radiotherapy. Data were analyzed in October 2025.

EXPOSURES: Definitive local therapy (surgery or radiotherapy) for NSCLC followed by survivorship care.

MAIN OUTCOMES AND MEASURES: The outcomes were incidence and timing of recurrence, NLSC, intrathoracic new cancer, extrathoracic cancer, or death measured using nonparametric cumulative incidence functions (CIFs), with death as a competing event, and multivariable Fine-Gray and cause-specific Cox models for NLSC. Overall survival (OS) was estimated using the Kaplan-Meier method.

RESULTS: Among 496 survivors (58.5% female [290]; median [IQR] age, 69.1 [62.8-74.3] years), the median (IQR) follow-up was 71.6 (57.7-84.8) months. Of these patients, 367 (74.0%) were former smokers; the index cancer was adenocarcinoma in 372 (75.0%); 337 (67.9%) had stage I disease, 72 (14.5%) had stage II, and 87 (17.5%) had stage III. Recurrence occurred in 67 of 496 patients (13.5%). Secondary cancers developed in 116 of 496 patients (23.4%), including a new primary lung cancer in 77 of 496 patients (15.5%) and NLSC in 39 of 496 patients (7.9%). Median (IQR) time to diagnosis of an NLSC was 52.3 (35.9-65.6) months, and CIFs (competing risks) at 5 years (death and other first events treated as competing risks) were 11.5% for recurrence, 5.6% for NLSC, 16.8% for intrathoracic new cancer, and 10.4% for extrathoracic cancer. In Fine-Gray models, a hereditary syndrome and/or pathogenic germline variant was associated with higher risk for NLSC (subdistribution hazard ratio [SHR], 10.76; 95% CI, 4.62-25.06; P < .001), whereas pack-years (per 10) were not associated with higher risk (SHR, 1.00; 95% CI, 0.97-1.03; P = .85). Cause-specific Cox results were concordant (HR, 8.32; 95% CI, 3.14-22.02; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study of NSCLC survivors, the risk of NLSC was clinically meaningful and distinct from intrathoracic new cancers. Genetic predisposition correlated with NLSC risk and should inform survivorship care pathways.

PMID:41364434 | DOI:10.1001/jamanetworkopen.2025.47831

JAMA Netw Open. 2025 Dec 1;8(12):e2547924. doi: 10.1001/jamanetworkopen.2025.47924.

ABSTRACT

IMPORTANCE: Older adults with metastatic solid cancers experience substantial treatment burdens. Advances in cancer therapeutics and evolutions in care over the years have changed the experience of cancer diagnosis and treatment, but it is unknown how health care contact days have evolved over time.

OBJECTIVE: To assess the burden of and trends in health care contact days among older adults diagnosed with 4 common metastatic cancers.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the Surveillance, Epidemiology, and End Results-Medicare linked database to identify traditional Medicare beneficiaries 66 years and older who were diagnosed with metastatic breast, colorectal, lung, and prostate cancers from January 2008 to February 2019. Analyses were conducted from February 2024 to January 2025.

EXPOSURES: Cancer type and year of diagnosis.

MAIN OUTCOMES AND MEASURES: Health care contact days (sum of ambulatory [days with a clinician visit, test, imaging, procedure, or treatment] and institutional [days in a hospital, emergency department, skilled nursing facility, or inpatient hospice] days) in the year after diagnosis were assessed. Changes in contact days over time were examined using multivariable negative binomial regression models.

RESULTS: A total of 55 806 beneficiaries (14 827 [26.6%] diagnosed at 71-75 years of age; 29 347 [52.6%] male) with metastatic cancer (6495 breast, 10 232 colorectal, 27 340 lung, and 11 739 prostate) who survived 1 year or more after diagnosis were studied. In the year after diagnosis, beneficiaries with colorectal cancer had the highest mean (SD) contact days (62.9 [48.1]), followed by those with lung (60.2 [47.0]), breast (48.7 [47.9]), and prostate (40.1 [42.4]) cancers. Across all cancer types, mean contact days increased from 2008 to 2019 with a prominent increase in ambulatory days from 2016 onward; the largest increase in contact days was observed for breast cancer (44.9 [95% CI, 38.7-52.2] to 57.6 [95% CI, 46.9-70.8]).

CONCLUSIONS AND RELEVANCE: This cohort study of older traditional Medicare beneficiaries who were diagnosed with common metastatic cancers found a mean of 40.1 to 62.9 health care contact days in the year after diagnosis. Health care contact days increased from 2008 to 2019, suggesting that treatment advancements and/or care inefficiencies may have imposed additional burdens on beneficiaries.

PMID:41364432 | DOI:10.1001/jamanetworkopen.2025.47924