Nevin Manimala

J Am Geriatr Soc. 2025 Aug 27. doi: 10.1111/jgs.70063. Online ahead of print.

ABSTRACT

BACKGROUND: Perioperative neurocognitive disorders (PNDs) are among the most common complications in older adults after surgery. Awareness of PNDs is important as they often can be prevented, and early recognition can improve recovery. We sought to understand what older adults know about PNDs, the information provided, and the counseling provided to guide recovery when PND symptoms occur. We hypothesized that older adults rarely receive information regarding PND before surgery or counseling after experiencing symptoms.

METHODS: We conducted a mixed methods study by (1) employing a survey to better understand the information patients received before surgery and (2) conducting semi-structured interviews in patients who subjectively experienced PNDs to better understand what counseling they received after experiencing symptoms. Surveys were distributed preoperatively to older adults undergoing elective surgery. Semi-structured interviews were conducted with older adults who had undergone surgery and experienced symptoms of PND. The quantitative data were summarized using descriptive statistics, and qualitative data were analyzed using a hybrid inductive and deductive approach.

RESULTS: The response rate for survey participants was approximately 19%. Among survey participants (n = 312), 58% of participants were between 65 and 69 years of age, 24% were between 70 and 79 years of age, and 18% were ≥ 80 years of age. Before their scheduled elective surgery, 7% (n = 22) indicated a healthcare provider discussed the risk of PNDs during their preoperative visit. None of the patients received educational material regarding PNDs. Ten older adults participated in the semi-structured interviews, which revealed that 9 (90%) participants attempted to discuss symptoms after they occurred with a healthcare provider, but none received counseling or information on what to do next, and all were instructed to wait to see if symptoms persisted.

CONCLUSION: Our findings underscore that discussions about PND risk and symptom management do not occur as part of routine perioperative care, leaving patients without important information and guidance.

PMID:40864409 | DOI:10.1111/jgs.70063

Forensic Toxicol. 2025 Aug 27. doi: 10.1007/s11419-025-00737-0. Online ahead of print.

ABSTRACT

PURPOSE: Etomidate, which is a psychoactive drug with an anesthetic effect, is used as a substitute for expensive mainstream drugs. There has been a trend toward abuse of etomidate and its emerging structural analogues now. Faced with a large number of samples, a rapid and effective detection method is needed.

METHODS: In this study, ambient flame ionization (AFI) coupled with LTQ-Orbitrap mass spectrometry was used to analyze etomidate and its structural analogues in urine. It can realize detection in less than 0.2 min without sample preparation.

RESULTS: Ideal analysis conditions were obtained by optimizing various parameters and analytical performance was validated. The isomers (isopropoxate and propoxate) can be distinguished by ion abundance ratios. Positive samples (n = 75) were analyzed very efficiently and successfully from plenty of authentic specimens (n = 116). Statistical analysis was conducted on drug types, age, and gender of drug users. A new structural analogue was discovered in one of the samples, which was a very crucial discovery. That meant the market may face with the emergence of new structural analogues.

CONCLUSIONS: This study can satisfy both targeted and non-targeted screening, which provides support for timely monitoring and detection of novel drugs and offers a wider range of method choices for forensic laboratories. It can also better cope with the current situation of drug control and combat crimes related to new types of drugs.

PMID:40864408 | DOI:10.1007/s11419-025-00737-0

Forensic Sci Med Pathol. 2025 Aug 27. doi: 10.1007/s12024-025-01071-y. Online ahead of print.

ABSTRACT

This study presents an investigation of the potential of radiomic features extracted from postmortem computed tomography (PMCT) scans of the lungs to provide valuable insights into the postmortem interval (PMI), a crucial parameter in forensic medicine. Sequential PMCT scans were performed on 17 bodies with known times of death, ranging from 4 to 108 h postmortem. Radiomic features were extracted from the lungs, and a mixed-effects model, tailored for sequential data, was employed to assess the relationship between feature values and the PMI. Four model variants were tested to identify the most suitable functional form for describing this association. Several statistically significant trends between the PMI and radiomic features were observed, with twelve distinct features demonstrating selective relevance to postmortem changes in the lungs. Notably, cluster shade, a grey-level co-occurrence matrix (GLCM) feature, significantly decreased with the PMI, the median intensity increased over time, and the root mean squared feature values tended to decrease. The retained features included first-order statistical metrics, shape-based characteristics, and second-order texture attributes, which may reflect alterations such as gas formation and structural modifications within the lungs. This study highlights the potential of PMCT scan-based radiomics as a complementary tool to enhance existing postmortem interval estimation methods. These findings reinforce the role of quantitative imaging techniques in forensic investigations.

PMID:40864404 | DOI:10.1007/s12024-025-01071-y

J Racial Ethn Health Disparities. 2025 Aug 27. doi: 10.1007/s40615-025-02608-1. Online ahead of print.

ABSTRACT

INTRODUCTION: The rising Hispanic population in the U.S. is at significant end-stage kidney disease (ESKD) risk. However, Hispanic communities face notable challenges in kidney transplantation access. We aimed to identify U.S. regions that might lack kidney transplant centers (KTCs) actively engaging Hispanic individuals living with ESKD.

METHODS: We identified location of U.S. KTCs using the UNOS database from 2018 to 2022. We examined county-level prevalence and mortality of adult Hispanic individuals living with ESKD from the 2021 public USRDS dataset. We performed geospatial analysis to characterize the Hispanic population within a two-hour drive from each KTC, and identified statistically significant spatial hot and cold spot clustering for our variables of interest. Additionally, we identified KTCs with dedicated Hispanic kidney clinics (H-KTC) and analyzed pre- and post-implementation transplantation rates.

RESULTS: We included 196 KTCs and 11 H-KTCs. Geospatial analysis showed that there was a higher proportion of Hispanic individuals living with ESKD outside the two-hour driving zone than within the two-hour driving zone (0.23% vs. 0.21. Death count among Hispanic individuals living with ESKD was 11.4% outside vs. 10.2% within 2-h driving zone, with mortality rate > 10Std-Dev in some south-west regions of US out of the 2 h-driving zones. After H-KTC implementation, the median transplants per center among Hispanic recipients increased from 81 [IQR 58-146.5] to 109 [IQR 66-178.5] (p = 0.006).

CONCLUSION: Although the existing KTCs serving Hispanic populations are located within strategic geographic locations, there are still areas with a high prevalence of Hispanic individuals living with ESKD with limited access to KTCs. These populations might benefit from extensive outreach from new or existing KTCs.

PMID:40864380 | DOI:10.1007/s40615-025-02608-1

Pilot Feasibility Stud. 2025 Aug 26;11(1):114. doi: 10.1186/s40814-025-01696-4.

ABSTRACT

BACKGROUND: University students with ADHD and executive functioning challenges are at a higher risk of experiencing academic and functional challenges. Group cognitive-behavioral therapy (CBT) targeting organization, time management, and planning skills have shown promise in improving attention and academic functioning. However, attendance and logistic barriers may limit participation in traditional programs. This feasibility study aims to adapt and evaluate the feasibility of delivering ultra-brief, group CBT skills workshops (both in-person and online) to university students.

METHODS: A non-randomized pilot design with a convergent mixed-method approach will be used. From January 2024 to April 2025, 40-60 French-speaking students from Canadian postsecondary institutions that are experiencing attentional or executive challenges (with or without a formal ADHD diagnosis) will be recruited. The intervention consists of three weekly 90-min workshops, with strategies focusing on organization, time management, planning and prioritizing tasks, and managing procrastination. Data will be collected at pre- and post-workshop interventions including recruitment and retention rates, as well as standardized questionnaires assessing treatment perception, acceptability, and satisfaction (primary outcomes), along with ADHD symptoms, executive functioning, and functional impairment (secondary outcomes). Individual interviews (baseline evaluation) and focus groups (post-workshop evaluation) will further explore participants’ functioning as well as expectations and experiences related to the intervention. Quantitative data will be analyzed using descriptive and inferential statistics, whereas qualitative data will undergo qualitative descriptive analysis using rapid assessment procedure (RAP) sheets.

DISCUSSION: This study will assess the “feasibility of ultra-brief CBT skills workshops for university students with ADHD and executive functioning difficulties. If effective, it could inform scalable strategies to support academic success and daily functioning. Findings will also inform the feasibility and acceptability of this intervention for future large-scale studies.

PMID:40859338 | DOI:10.1186/s40814-025-01696-4

BMC Public Health. 2025 Aug 26;25(1):2922. doi: 10.1186/s12889-025-24230-w.

ABSTRACT

INTRODUCTION: Childhood obesity and sedentary lifestyles are growing public health concerns, with familial practices playing a critical role in shaping children’s physical activity attitudes. The influence of family attitudes and behaviours regarding nutrition and exercise has been highlighted as a pivotal determinant in promoting healthier choices among children. This study aims to explore the relationship between family nutrition and physical activity practices and children’s attitudes toward physical activity.

METHODS: A descriptive cross-sectional study was conducted with 633 children and their parents from a tertiary hospital in eastern Turkey. Data were collected using three tools: (1) a sociodemographic form, (2) the Family Nutrition and Physical Activity Screening Scale (FNPASS), and (3) the Youth Physical Activity Attitude Scale in Children and Young People. Data were analysed using SPSS software and statistical analyses included Pearson correlation, linear regression, and ANOVA to explore associations and group differences.

RESULTS: Family nutrition and physical activity practices significantly predicted children’s physical activity attitudes. Physical activity positive attitudes (mean score: 3.74 ± 0.88) correlated strongly with healthier family practices (FNPASS mean: 52.44 ± 7.65; r = 0.648, p < 0.01), while physical activity negative attitudes (mean: 2.46 ± 0.92) showed inverse relationships (r = -0.596, p < 0.01). Higher parental education, urban residency, and income levels were associated with more physical activity positive attitudes (p < 0.001). Underweight children had higher positive attitude scores than overweight/obese peers (p < 0.001).

CONCLUSION: Family environments significantly influence children’s physical activity attitudes, with socioeconomic factors acting as key modifiers. This study demonstrates that family nutrition and physical activity practices significantly influence children’s attitudes toward physical activity. Healthier family habits correlated with more positive attitudes in children, particularly among families with higher parental education and urban residency. Public health initiatives should focus on educating parents about healthy practices while ensuring equitable access to physical activity opportunities for children.

PMID:40859306 | DOI:10.1186/s12889-025-24230-w

Neurol Res Pract. 2025 Aug 26;7(1):60. doi: 10.1186/s42466-025-00420-0.

ABSTRACT

BACKGROUND: Endovascular thrombectomy (EVT)-often combined with intravenous thrombolysis-is the standard of care for acute ischemic stroke (AIS) secondary to large vessel occlusions (LVO). While indications keep expanding, the feasibility and utility of intra-procedural neuromonitoring of the sedated patient has neither been clarified nor characterized.

OBJECTIVE: To evaluate the feasibility of near-infrared spectroscopy (NIRS) for cortical oxygenation and bispectral index (BIS) for electroencephalographic function as non-invasive neuromonitoring tools for AIS patients undergoing EVT, and assess their utility in predicting successful recanalization.

METHODS: We extracted data on all patients receiving continuous NIRS and/or BIS monitoring in the Sedation versus Intubation for Endovascular Stroke TreAtment (SIESTA) clinical trial. SIESTA randomized AIS patients undergoing EVT for anterior proximal LVO to general anesthesia versus conscious sedation. For this analysis, the primary outcomes included changes in NIRS and BIS values pre- and post-recanalization and associations of parameter changes with successful or unsuccessful recanalization outcomes. Statistical analysis was performed using a Wilcoxon signed rank tests.

RESULTS: Of the 150 patients, 66 were monitored continuously with NIRS, and 50 with BIS. An increased NIRS-derived cerebral tissue oxygenation (stated as tissue saturation index – TSI) was observed in affected hemisphere following successful recanalization, as well as a significant reduction in the difference between affected and unaffected hemispheres. In contrast, no significant changes were observed with BIS monitoring between pre- and post-recanalization status.

CONCLUSION: In this post-hoc analysis, changes in NIRS monitoring were associated with successful reperfusion. Non-invasive oximetry by NIRS may serve as a valuable tool during and after mechanical thrombectomy to detect and respond to an insufficient perfusion or re-occlusion.

PMID:40859303 | DOI:10.1186/s42466-025-00420-0

Lipids Health Dis. 2025 Aug 26;24(1):267. doi: 10.1186/s12944-025-02682-8.

ABSTRACT

BACKGROUND/AIMS: High triglyceride (TG) levels, low high-density lipoprotein cholesterol (HDL-C), and an elevated TG/HDL-C ratio are linked to increased systemic inflammation and impaired immune function. However, the clinical significance of the TG/HDL-C ratio in pyogenic liver abscess (PLA) remains poorly defined.

METHODS: In this multicenter, cross-sectional study of 2,201 cases of PLA, logistic regression, smoothed curve fitting, and comprehensive sensitivity analyses were employed to assess the relationship between the baseline TG/HDL-C ratio and positive blood or pus cultures. Subgroup analyses and interaction tests were performed to evaluate the robustness of the findings.

RESULTS: Logistic regression showed that the TG/HDL-C ratio was positively associated with blood or pus culture positivity in PLA [odds ratio (OR) = 1.04, 95% confidence interval (CI): 1.02-1.06, P < 0.001. Smoothed curve fitting revealed a nonlinear dose-response relationship, with an inflection point at 9.2. Below this threshold, the TG/HDL-C ratio remained significantly associated with culture positivity (OR = 1.1, 95% CI: 1.1-1.2, P < 0.001). Sensitivity analyses and interaction tests confirmed these results.

CONCLUSIONS: The TG/HDL-C ratio demonstrates a nonlinear relationship with the risk of positive blood or pus cultures in patients with PLA, with a pivotal threshold value identified at 9.2. This readily obtainable ratio may help clinicians individualize management strategies and facilitate timely interventions for PLA patients in this at-risk group, leading to improved health outcomes for this vulnerable population.

PMID:40859300 | DOI:10.1186/s12944-025-02682-8

Diabetol Metab Syndr. 2025 Aug 27;17(1):355. doi: 10.1186/s13098-025-01923-1.

ABSTRACT

OBJECTIVE: The weight-adjusted waist index (WWI), an innovative indicator of central obesity, is still inadequately researched in relation to diabetic complications. This study sought to elucidate the relationship between WWI and all-cause as well as cardiovascular disease (CVD) mortality in US patients with diabetic retinopathy (DR).

METHODS: We performed a retrospective cohort research with 1247 people in the United States diagnosed with diabetic retinopathy (DR). Qualified technicians collected anthropometric data using defined techniques. Mortality data was collected from participant recruitment until December 31, 2019. Cox proportional hazards models limited cubic spline curves, and Kaplan-Meier survival analysis were employed to investigate the research aims.

RESULTS: During a median follow-up of 6.75 years, there were 446 documented deaths from all causes and 163 fatalities attributed to cardiovascular events. Multivariable-adjusted Cox regression indicated a positive association between WWI and all-cause mortality (HR = 1.35, 95%CI:1.16-1.56, P < 0.001) as well as CVD mortality (HR = 1.36, 95%CI:1.07-1.73, P = 0.011). Subgroup analyses corroborated these findings, demonstrating similar relationships across various age, sex, race, and comorbidity strata.RCS analysis revealed a linear positive connection between WWI and both all-cause and cardiovascular disease mortality (P for non-linearity > 0.05).

CONCLUSIONS: Higher WWI was significantly associated with increased risk of all-cause and CVD mortality in patients with DR, suggesting a positive correlation between WWI and mortality risk in this population.

PMID:40859292 | DOI:10.1186/s13098-025-01923-1

BMC Med Educ. 2025 Aug 26;25(1):1202. doi: 10.1186/s12909-025-07803-6.

ABSTRACT

BACKGROUND: Operational Research (OR), as part of a quality assurance program, has become a standard feature of most health institutions in most high-income countries. In contrast, in low-income settings, operational research is less common, and almost no one has asssed operational research capacity building (ORCB) as a tool to improve efficacy, efficiency and quality in these settings. This study evaluated the impact of an ORCB program on participants’ research competencies and the extent to which research findings were implemented in practice.

MATERIALS AND METHODS: This study combined quantitative and qualitative data to evaluate an ORCB intervention in eye hospitals in Nepal (3 sites) and northern India (1 site) from 2019 to 2022. A self-reported questionnaire was administered at the end of the study period, and formal interviews were conducted. The questionnaire covered knowledge improvement, practice implementation, and motivating and challenging factors. Statistical analysis included paired t-tests to compare pre- and post-training scores. Qualitative data were gathered through interviews and observations and analysed thematically.

RESULTS: The program demonstrated significant improvements in participants’ research knowledge gain. Quantitative analysis revealed substantial gains in knowledge (p-values < 0.05 for all domains). Post-training, 66.7% developed study protocols, and 60% trained other staff or students. Qualitative feedback indicated overall positive impacts, including enhanced research and operational activities. However, reported challenges such as inconsistent mentorship quality, poor internet connectivity during online sessions, and difficulty in balancing clinical work with research. Despite these challenges, there was notable improvement in research practice and internal training within hospitals, and the program’s approach was appreciated for its effectiveness.

CONCLUSION: The study highlights the need for standardized training modules, consistent mentorship, and stronger institutional support. Building operational research capacity in resource-poor settings with limited administrative staff and weak data infrastructure improves individual staff knowledge and skills. Participants learned about scientific principles of reliability and validity and their importance to efforts to improve service equity, efficiency, and effectiveness.

PMID:40859281 | DOI:10.1186/s12909-025-07803-6