Nevin Manimala

Int J Emerg Med. 2025 Nov 26. doi: 10.1186/s12245-025-01068-y. Online ahead of print.

ABSTRACT

BACKGROUND: Ambulance offload delay (AOD) indicates the persistent and increasingly visible problem of Emergency Department (ED) crowding. AOD is defined as the extended time from ambulance arrival at the ED until patient care is transferred to ED staff. Despite its negative consequences and international attention, AOD is currently not monitored within the Dutch Emergency Care. It is also unknown whether or not AOD is associated with the ambulance diversion (AD) status. In the Dutch ED the AD status is monitored by means of the traffic light system. This study aims to monitor AOD at the EDs of Franciscus Gasthuis & Vlietland (FGV).

METHODS: A 10-week observational study was conducted at both the EDs of FGV. Ambulance personnel was queried regarding AOD duration and traffic light statuses by means of paper questionnaires. Descriptive statistics are reported as frequencies, medians and interquartile ranges (IQR). Associations between the traffic light status and categorical AOD data were analyzed using Chi-square tests.

RESULTS: During the study period, 2967 ambulances arrived at the EDs. In 229 cases (7.7%), the definition of AOD was met. The median AOD was 16 min (IQR: 10-25 min). In 95.6% (n = 2830) of the cases the handover time was less than 15 min. No statistically significant association was found between the traffic light status (green, orange, red) and offload delay categories (p = 0.109). A non-significant difference remained (p = 0.075) when comparing median AOD in the absence of an AD with the median AOD during an (impending) AD.

CONCLUSION: This is the first observational study conducted in the Netherlands collecting data regarding the AOD. The limited observation period, the reliance of self-reported data and the single-center design restricts the generalizability of the data. Consequently, the authors conclude hypothesis-generating findings which warrant validation through planned multicenter research. Nevertheless, besides the existing traffic light system, this unique study provides policy makers with a candidate complementary quality indicator for ED-crowding in the Dutch context.

PMID:41299224 | DOI:10.1186/s12245-025-01068-y

Foot Ankle Int. 2025 Nov 26:10711007251388432. doi: 10.1177/10711007251388432. Online ahead of print.

ABSTRACT

BACKGROUND: The Infinity with Adaptis Total Ankle System (Stryker, Mahwah, NJ) is a low-profile, fixed-bearing implant that became available for use in October 2019. The aim of this study was to describe the early clinical and radiographic outcomes of the Infinity with Adaptis implant at minimum 2-year follow-up.

METHODS: A retrospective review of 71 ankles that underwent primary total ankle arthroplasty (TAA) with Infinity with Adaptis implants between November 2019 and November 2021 at a single institution was completed. Chart review was performed to identify complications, reoperations, and revision procedures. Preoperative and postoperative radiographs were measured to assess tibiotalar alignment and identify periprosthetic lucencies, cysts, or subsidence. Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected preoperatively and at 1 and 2 years postoperatively to assess clinical outcomes.

RESULTS: At final follow-up (average 2.7 ± 0.6 years), 68 of the 71 ankles remained implanted (95.8%). Three ankles were revised within 1.5 years of the index procedure (1 for talar component loosening and 2 for infection). There were an additional 5 (7.0%) reoperations at an average of 16.0 (range: 1.1-37.1) months postoperatively. Patients demonstrated both clinically and statistically significant improvements in preoperative to 1-year postoperative PROMIS scores (P < .0001). There was no statistically significant improvement in scores from 1 to 2 years postoperatively. There was improvement in radiographic alignment from the preoperative to postoperative radiographs (P < .001), and tibial component lucency was observed in 20 of 71 without progressive global lucency during the study window.

CONCLUSION: Patients who underwent total ankle arthroplasty with the Infinity with Adaptis Total Ankle Replacement demonstrated significant improvements in radiographic and clinical outcomes at a minimum of 2-year follow-up with 95.8% (68/71) implant retention and a tibial lucency rate of 28.2% in this cohort. These observational findings warrant mid- to long-term surveillance to determine the clinical significance of early lucencies and the durability of this design’s porous-surface osseointegration.

PMID:41299218 | DOI:10.1177/10711007251388432

Environ Mol Mutagen. 2025 Nov 26. doi: 10.1002/em.70037. Online ahead of print.

ABSTRACT

This interlaboratory evaluation of HepaRG CometChip was conducted to assess transferability and reproducibility of this new approach methodology (NAM) across four laboratories. Concentrations inducing up to ~70% relative cytotoxicity were determined by the organizing laboratory, and frozen chemical formulation blocks were sent to each participant. When noncytotoxic, 10 mM was the maximum dose. Cultures were exposed once daily for three consecutive days, and both cytotoxicity assessment, via ATP quantification, and comet analysis, commenced 3-4 h after initiation of the final exposure. Positive response was statistical pairwise significance (p < 0.05) with concentration-related increases in %Tail DNA across ≥ 2 consecutive exposures. For 8 of 11 compounds, all four labs generated unanimous test results, with four negative compounds (2-acetylaminofluorene [2-AAF], 2,4-dichlorophenol, eugenol and hydroquinone) and four positive compounds (azidothymidine, benzo(a)pyrene [BP], cyclophosphamide [CP], ethyl methanesulfonate).For the remaining chemicals, three of four labs generated negative calls for amitrole, cadmium chloride, and DMBA. In cases where bulky lesions were anticipated, the magnitude of %Tail DNA was low, due to the inherent insensitivity of the alkaline comet assay (not the CometChip per se) to detect bulky adducts repaired by nucleotide excision repair. This is supported by the small magnitude in %Tail DNA induced by BP and CP. Taken together, for all compounds there was majority agreement in CometChip results across participating laboratories supporting that the endpoint is readily transferable to new labs. Overall, this platform is a promising human-relevant NAM, with a physiologically relevant detoxification process that could be incorporated into rodent replacement strategies.

PMID:41299203 | DOI:10.1002/em.70037

J Int Med Res. 2025 Nov;53(11):3000605251395573. doi: 10.1177/03000605251395573. Epub 2025 Nov 26.

ABSTRACT

ObjectiveMammography and ultrasound are commonly used for early detection of breast cancer; however, they have several limitations and are outperformed by magnetic resonance imaging for screening and diagnosis because of its higher sensitivity. This study aimed to evaluate female awareness of magnetic resonance imaging as a tool for early breast cancer detection and to enhance early-stage diagnosis.MethodsA cross-sectional study was conducted using an online questionnaire. Data were analysed using Statistical Package for the Social Sciences software. Awareness was categorised as poor or good.ResultsA total of 498 women participated in this study. Although 98% of the participants recognised the importance of early breast cancer detection, only 42.6% were aware of the role of breast magnetic resonance imaging. Awareness of the ability of magnetic resonance imaging to detect intraductal carcinoma and small invasive tumours, particularly in dense breast tissue, was moderate, with a mean awareness score of 2.5 ± 1.1 out of 4. Awareness was significantly higher among older women, those with family history of breast cancer and those who practised self-examinations or had prior magnetic resonance experience (p ≤ 0.002).ConclusionsThis study highlights a deficiency in awareness regarding the value of magnetic resonance imaging in breast cancer screening, particularly among young women with dense breast tissue and those without prior exposure to magnetic resonance imaging.

PMID:41299197 | DOI:10.1177/03000605251395573

Pharm Stat. 2026 Jan-Feb;25(1):e70055. doi: 10.1002/pst.70055.

ABSTRACT

The International Conference on Harmonisation (ICH) adopted revision 2 (R2) of its Quality Guidance Q2 Validation of Analytical Procedures in 2023. The revision includes a new statement that confidence interval limits for validation performance characteristics (i.e., accuracy and precision) should be compatible with acceptance criteria, unless otherwise justified. It also allows for sponsors to use prior knowledge (e.g., from development or previous studies) to support the validation study conclusion. These two new aspects of ICH Q2(R2) present both opportunities and challenges for the validation of analytical procedures. In this paper, we provide comprehensive examples of how to compute confidence intervals for key validation performance characteristics under different modeling approaches. We also describe methodologies for combining prior knowledge with the validation study results, both from frequentist and Bayesian perspectives. The paper is written in tutorial style and is aimed at statisticians and analytical scientists responsible for validating analytical procedures in compliance with ICH Q2(R2).

PMID:41299187 | DOI:10.1002/pst.70055

Discov Oncol. 2025 Nov 26. doi: 10.1007/s12672-025-01773-3. Online ahead of print.

ABSTRACT

BACKGROUND: Chlormethine gel is a promising treatment for early-stage mycosis fungoides (MF) with strong efficacy and manageable side effects. This study evaluates its effectiveness as a second-line treatment in patients unresponsive to prior skin-directed therapies (SDTs) or combined systemic treatments, hypothesising significant therapeutic benefits with manageable adverse reactions.

METHODS: A retrospective observational study was conducted from April 2021 to December 2022, including adult patients with histologically confirmed MF who had not responded to at least one prior SDT. Patients received daily chlormethine gel applications, and responses were evaluated at 3, 6, and 12 months using the Modified Severity-Weighted Assessment Tool (mSWAT). Statistical analyses were performed using SPSS ver 26 (IBM), including one-way ANOVA and univariate regression.

RESULTS: The study included 21 patients (12 males, 9 females; mean age 61 years). 81% had early-stage MF, and 19% had advanced-stage disease. Chlormethine gel showed a 90% response rate, with 33.3% achieving complete response (CR) and 57.1% partial response (PR). Adverse reactions were primarily contact or irritative dermatitis, which were manageable and did not significantly affect outcomes. Median mSWAT scores significantly reduced from baseline at 3, 6, and 12 months (P = 0.002).

CONCLUSIONS: Chlormethine gel appeared to be efficacious and safe as a second-line treatment for MF, including in advanced stages. Despite limitations like small sample size and retrospective design, these findings highlight its potential in combination therapies and the importance of continued treatment for optimal outcomes. Future research should confirm these results in larger, prospective studies.

PMID:41299164 | DOI:10.1007/s12672-025-01773-3

Atten Percept Psychophys. 2025 Nov 26;88(1):12. doi: 10.3758/s13414-025-03187-3.

ABSTRACT

This report targets the claim that gist representations of visual stimuli, called “ensemble averages”, are perceptual representations of statistics pertaining to stimuli. We report predictions of a mathematical model based on classical memory architectures which assumes ensemble averages are statistical approximations to stimuli, and that those approximations are constructed within short-term memory. We report results of three new experiments that test those predictions. The results support the memory model and contradict the view that representations of ensemble averages are computed early in perceptual processing via parallel processing or neural pooling, suggesting instead that they are computed via control processes acting on item representations held in visual short-term memory. We conclude that the flight toward new mechanisms that has occurred within the ensemble representation literature is ill-advised, and suggest that one first carefully consider what well-established memory models can accomplish in the ensemble “perception” domain.

PMID:41299152 | DOI:10.3758/s13414-025-03187-3

Discov Ment Health. 2025 Nov 27. doi: 10.1007/s44192-025-00338-8. Online ahead of print.

ABSTRACT

BACKGROUND: Previous findings have established a negative association between financial strain and mental health, although this kind of investigation among Nigerian university students is relatively scarce. However, the mechanism as well as the conditions among the associations have not received sufficient research attention in the literature. Therefore, this study investigated the link between financial strain and mental health as well as the mediating effect of subjective happiness in the association between financial strain and mental health among university students. The study also explored the moderated mediated role of gender in the relationship.

METHODS: This cross-sectional study used self-report measures of the Mental Health Scale, Financial Strain Scale, and Subjective Happiness Scale for data collection. A total of 196 university students aged 18-29 (female = 51.5%; mean age = 21.11 ± 1.64 years) participated in the study. Data were analysed with the Pearson Product Moment Correlation (PPMC) and Hayes PROCESS macro statistical tools.

RESULTS: A negative predictive association was linked with financial strain and mental health among university students. Further, subjective happiness was found to statistically mediate the link between financial strain and mental health. Also, gender did not have conditional indirect effect on subjective happiness on mental health through subjective happiness.

CONCLUSION: The study concluded that financial strain negatively linked with mental health and subjective happiness was associated with a mediation pattern between financial strain and mental health with no moderating effect in the association. Intervention policies aimed at reducing financial strain as well as student’s wellbeing programs aimed at improving positive affect among university students should be tailored toward enhancing students’ mental health.

PMID:41299146 | DOI:10.1007/s44192-025-00338-8

Environ Geochem Health. 2025 Nov 27;48(1):18. doi: 10.1007/s10653-025-02877-z.

ABSTRACT

The dissolution of fugitive gases in saline to hypersaline groundwater in arid regions is largely unclear. Groundwater samples from three major oil field aquifers in northern (NK), southeastern (SEK), and western Kuwait (WK) were investigated to determine the concentration, sources, evolution, and distribution of dissolved CH₄. Saline NK wells demonstrated the highest concentration of CH₄ at 688 µg/L, followed by WK at 419 µg/L and SEK at 102 µg/L. Elevated CH₄ concentrations were detected in Na-Cl-SO₄ and Na-Cl type groundwater. CH₄ hotspots were located in regions with increased lineament intersections and proximity to older wells near the hydrocarbon reservoirs, exhibiting an inverse correlation with conductivity and H₂S levels. Microbes in the SEK region utilize carbon substrates, leading to reduced CH₄ levels in comparison to NK and WK. δ¹³C_CH₄ values showed relatively depleted signatures for WK (- 51.2‰), while NK displayed enriched values alongside decreasing CH₄ levels, indicating thermogenic sources. Enriched δ¹³C_CH₄ values in SEK (+ 9.5‰) are associated with elevated CH₄ concentrations. The δ²H_CH₄ values range from – 479‰ to – 140‰, while δ²H_H₂O values range from + 4 to – 36‰, indicating the presence of mixed methanogenic sources across the regions. In NK, the thermogenic methane was observed with variation in isotope signatures due to complex processes. In SEK, although reducing environments prevailed, the carbon isotope fractionation is exceeded by the hydrogen isotope due to the significant impact of microbial oxidation during the diffusive migration process. In the west of Kuwait, the isotopic signatures of methane are depleted, mainly due to the oxidation of organic matter or through Sulfate-Driven Anaerobic Oxidation of Methane (SD-AOM) and carbonate dissolution. Four primary sources of CH₄ are microbial, methyl-substrates, carbonate substrates, and mixed sources, which are identified alongside two main processes: biogenic and thermogenic.

PMID:41299129 | DOI:10.1007/s10653-025-02877-z

Obes Surg. 2025 Nov 26. doi: 10.1007/s11695-025-08410-6. Online ahead of print.

ABSTRACT

INTRODUCTION: The 2022 updates from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) have revised the indications for metabolic and bariatric surgery (MBS). This study investigated the association between a history of MBS and micronutrient status in a nationally representative U.S. adult population.

METHODS: The study included 2,970 adults aged ≥ 18 years from the National Health and Nutrition Examination Survey (2015-2018). Participants were categorized into three groups: (1) individuals with a BMI within the normal weight range (18.5-24.9 kg/m²); (2) individuals with a history of MBS; and (3) individuals who met the eligibility criteria for MBS but had not undergone the procedure. Weighted logistic regression models were used to compare between-group differences in the prevalence of micronutrient abnormalities.

RESULTS: Compared to the individuals with normal weight group, individuals eligible for MBS but without a history of surgery exhibited an increased likelihood of hyperferritinemia (OR, 1.779; 95% CI: 1.168-2.709), high transferrin receptor levels (OR, 2.145; 95% CI: 1.175-3.917), hypocalcemia (OR, 3.415; 95% CI: 1.306-8.929), and vitamin D deficiency (OR, 2.126; 95% CI: 1.522-2.969). In contrast, no statistically significant differences in the prevalence of these conditions were observed between the group with a history of MBS and the individuals with normal weight group.

CONCLUSION: In this cross-sectional analysis, individuals eligible for MBS who had not undergone surgery showed a higher prevalence of several micronutrient abnormalities compared to individuals with normal weight. This pattern was not observed in individuals with a history of MBS, suggesting that postoperative management, including micronutrient supplementation, may mitigate these deficiencies. However, these findings should be interpreted with caution due to the study’s limitations.

PMID:41299128 | DOI:10.1007/s11695-025-08410-6