Nevin Manimala

J Med Internet Res. 2025 Apr 17;27:e67484. doi: 10.2196/67484.

ABSTRACT

BACKGROUND: The need for health care underpins health care service provision and serves as the foundation for enhancing service capacity and allocating resources. Health care needs are influenced by health, social, and economic conditions and may exhibit different characteristics over time. However, previous studies have primarily focused on specific populations or types of needs, overlooking the diversity and complexity of residents’ health care requirements. Furthermore, as informatization becomes a defining aspect of modern social development, the impact of internet utilization on the co-occurrence of health care needs remains unclear.

OBJECTIVE: This study aims to determine the co-occurrence of health care needs among residents in China, explore the relationship between internet use frequency and co-occurring health care needs, and analyze the potential pathways of influence.

METHODS: Data were obtained from the “Survey on Chinese Residents’ Health Services Needs in the New Era,” conducted from July to August 2018, yielding a sample of 12,513 individuals. An association rule learning algorithm was used to analyze the characteristics of co-occurring health care needs among Chinese residents, while a generalized linear model was used to examine the relationship between internet use frequency and co-occurring health care needs. Additionally, physical exercise and health status were selected as mediating variables, and their mediating effects were assessed using a path analysis model.

RESULTS: A substantial proportion of the surveyed population (8601/12,513, 68.74%) had 2 or more co-occurring health care needs, with a lower percentage among rural residents (4045/6053, 66.83%) compared with urban residents (4556/6460, 70.53%). Frequent internet users tended to have more co-occurring health care needs (β=.895, SE 0.019, P<.001). The results indicated a positive relationship between internet use frequency and both improved physical exercise (β=.121, P<.001) and health status (β=.026, P<.001). Notably, a high level of physical exercise was associated with an increase in co-occurring health care needs (β=.087, P<.001). By contrast, a significant negative correlation was observed between health status and co-occurring health care needs (β=-.787, P<.001), indicating that these needs decreased as health status improved.

CONCLUSIONS: The findings highlight the need for health policy makers and health care providers to address evolving health care needs and the impact of information technology on these needs. Furthermore, health care providers must adapt their services and delivery methods to meet residents’ co-occurring health care needs. Meanwhile, policy makers and service managers should ensure that service delivery keeps pace with residents’ changing needs through resource allocation, health insurance payment reforms, and performance incentives.

PMID:40245390 | DOI:10.2196/67484

J Med Internet Res. 2025 Apr 17;27:e72321. doi: 10.2196/72321.

ABSTRACT

BACKGROUND: Canadian public safety personnel (PSP) report high rates of mental health concerns and barriers to treatment. PSPNET is a clinical research unit that offers internet-delivered cognitive behavioral therapy (ICBT) that is free, confidential, and developed with and for PSP. Treatment outcomes are promising with clinically significant symptom improvement (eg, anxiety, depression, and posttraumatic stress) and favorable treatment satisfaction. While these results are promising, research has yet to explore ways to optimize therapist-guided ICBT for leaders within public safety. Optimizing ICBT for leaders is particularly important given their widespread organizational impact.

OBJECTIVE: This study aims to investigate (1) the perceived mental health stressors of Canadian leaders within public safety, (2) the degree to which leaders perceived existing therapist-guided ICBT courses tailored for PSP (ie, PSP Wellbeing Course and PSP PTSD Course) as suitable for their needs, and (3) ways to further optimize therapist-guided ICBT for public safety leaders.

METHODS: This study included 10 clients who self-identified as being in a supervisory or leadership position within their public safety organization and completed either the therapist-guided PSP Wellbeing Course or PSP PTSD Course. We used descriptive statistics to analyze demographics, mental health symptoms, treatment engagement, and treatment satisfaction. We also used a reflexive thematic analysis of semistructured interview transcripts to assess leaders’ course perceptions and feedback.

RESULTS: Canadian leaders within public safety reported occupational and nonoccupational stressors and enrolled in ICBT to support their own or colleagues’ mental health. Most clients enrolled in the PSP Wellbeing Course, accessed 4 of 5 lessons (n=7, 70%), engaged with therapist support (n=7, 70%), and identified as employed (n=8, 80%), White (n=8, 80%), and men (n=7, 70%) with an average age of 45 years. At pretreatment, 80% of clients endorsed clinically significant symptoms of one or more disorders; most often depression (n=7, 70%) and anger (n=6, 60%). Clients reported favorable attitudes toward the ICBT courses with most reporting that they were satisfied with the course (n=9, 90%). Feedback to further optimize ICBT content for leaders included the development of a leader case story (n=6, 60%) and new resources to help leaders apply skills learned in ICBT within the context of their leadership roles (n=4, 40%). Leaders also recommended optimizing ICBT delivery by improving the platform technology and incorporating more multimedia.

CONCLUSIONS: Canadian leaders within public safety perceived therapist-guided ICBT developed with and for PSP as a suitable treatment option for their needs and identified ways to further optimize its content and delivery. Future research should investigate the impacts of these efforts and explore optimizing ICBT for other groups of clients.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04127032, https://www.clinicaltrials.gov/study/NCT04127032; ClinicalTrials.gov NCT04335487, https://clinicaltrials.gov/study/NCT04335487.

PMID:40245389 | DOI:10.2196/72321

Expert Rev Hematol. 2025 Apr 17. doi: 10.1080/17474086.2025.2492886. Online ahead of print.

ABSTRACT

BACKGROUND: Glasdegib (GLAS) and venetoclax (VEN) are approved in the US for treating AML in patients aged 75+ or with comorbidities precluding intensive induction chemotherapy. Community oncology outcomes for these therapies are limited.

RESEARCH DESIGN AND METHODS: This retrospective chart review summarized characteristics, treatment patterns, and outcomes of US patients treated with first-line (1 L) GLAS or VEN for AML using descriptive statistics. The study was not designed or powered to compare GLAS and VEN cohorts.

RESULTS: Among 50 patients receiving 1 L GLAS (82.0% with low-dose cytarabine), 50.0% achieved complete remission (CR), morphological leukemia-free state (MLFS), or partial response (PR). Median overall survival (OS) was 6.9 months (95% CI: 5.4-8.9). A trial-matched GLAS cohort represented 80.0% of all GLAS-treated patients in the study. Among 83 patients receiving 1 L VEN (94.0% with a hypomethylating agent), 51.8% achieved CR, MLFS, or PR, median OS was 8.4 months (95% CI: 5.7-16.2), and 31.3% met pivotal trial eligibility criteria.

CONCLUSIONS: This observational study supports the clinical benefit of GLAS and VEN in treating AML patients in the real-world setting.

PMID:40245377 | DOI:10.1080/17474086.2025.2492886

PLoS One. 2025 Apr 17;20(4):e0321988. doi: 10.1371/journal.pone.0321988. eCollection 2025.

ABSTRACT

BACKGROUND: Among acute stroke patients (ASPs), diabetes mellitus (DM) is associated with a higher risk of death, functional dependency, and recurrence. This study aimed to determine the impact of DM on the 30-day mortality among admitted ASPs in northern Tanzania.

MATERIALS AND METHODS: This was a hospital-based prospective cohort study performed among ASPs with and without DM who were admitted to Kilimanjaro Christian Medical Centre from November 2022 to May2023. ASPs were followed for 30 days after the onset of an acute stroke to identify the primary outcome, which was all-cause mortality. Descriptive statistics, logistic regression, and survival analysis were conducted.

RESULTS: Out of 213 ASP, 82 (38.5%) had DM. The overall crude mortality rate was 46.9%. ASPs with DM had a higher mortality rate of 53.7% compared with those without DM (42.7%). A higher proportion of acute stroke patients with DM (84.1%) had a poor outcome (mRS 3-6) (p = 0.038). DM was statistically non-significant for 30-day mortality (aHR 1.56; 95% CI: 0.73-3.32; p = 0.252). However, fever (p = 0.005), severe admission Glasgow coma scale (p = 0.005), severe stroke (p = 0.008), elevated serum creatinine (p = 0.008), and an abnormal respiratory pattern (p = 0.042), were predictors of 30-day mortality.

CONCLUSION: This study demonstrated a high mortality in ASPs. Although DM did not have a significant impact on 30-day mortality, other factors, such as altered mental state, stroke severity, fever, elevated creatinine, and abnormal respiration, need to be accounted for that may have a significant impact on the mortality in ASPs. These findings highlight the significant burden of DM in stroke patients and underscore the importance of early diagnosis and treatment of ASPs, in the hopes of improving clinical practice and guidelines and reducing morbidity and mortality in Tanzania.

PMID:40245372 | DOI:10.1371/journal.pone.0321988

ACS Nano. 2025 Apr 17. doi: 10.1021/acsnano.4c18022. Online ahead of print.

ABSTRACT

Polymer chain stretching enables the plastic and elastic properties that make polymers unique and valuable engineering materials. Despite its importance, polymer chain orientation in amorphous regions remains very challenging to measure by conventional techniques because it is an intrinsically molecule-scale phenomenon lacking long-range order that is frequently heterogeneous across length scales of ≈ (1 to 100) nm. Polarized resonant soft X-ray scattering (P-RSoXS) is an emerging technique that has recently achieved the measurement of amorphous chain orientation with ≈2 nm spatial resolution. The advent of this measurement capability invites comparisons with computational results for which spatial variations in chain orientation are readily accessible, providing a powerful approach to computation validation. Here we forward simulate P-RSoXS patterns for polystyrene grafted gold nanoparticles from real-space representations incorporating spatial polymer backbone orientation heterogeneity directly extracted from coarse-grained modeling results. Agreement between the computation and P-RSoXS experiment is found to depend greatly on assumptions of phenyl ring conformation relative to the polymer chain backbone, because the orientation sensitivity of P-RSoXS relies on a bond-level transition dipole moment of the phenyl ring of polystyrene to report backbone orientation. By incorporating a statistical description of phenyl ring orientation based on atomistic calculations, we report excellent agreement between P-RSoXS data and forward-simulated patterns with no fitting variables.

PMID:40245355 | DOI:10.1021/acsnano.4c18022

Neurology. 2025 May 13;104(9):e213498. doi: 10.1212/WNL.0000000000213498. Epub 2025 Apr 17.

ABSTRACT

BACKGROUND AND OBJECTIVES: Radioimmunoprecipitation assay (RIPA) is the gold standard for acetylcholine receptor (AChR)-immunoglobulin G (IgG) detection in patients with myasthenia gravis (MG), with a reported specificity of ≈99%. The risk of “false” AChR-IgG positivity in clinical practice is often considered negligible, although data on large, real-life populations are scarce. The objective of this study was to determine the positive predictive value (PPV) and risk of false AChR-IgG positivity with RIPA in a large cohort of patients with suspected MG.

METHODS: We retrospectively identified patients consecutively tested for AChR-IgG by RIPA at the University-Hospital of Sassari over 20 years (2003-2022) (n = 4,795). Medical records of AChR-IgG-positive patients (titer ≥0.5 nmol/L) were reviewed by 2 investigators to identify nonmyasthenic cases with false antibody positivity, defined as follows: (1) clinical phenotypes not consistent with MG and/or (2) symptoms better explained by alternative diagnoses. The characteristics of myasthenic and nonmyasthenic patients with AChR-IgG positivity were compared. A sample of nonmyasthenic patients was retested by fixed cell-based assay (CBA).

RESULTS: Among 445 of 4,795 patients testing positive for AChR-IgG during the study period, 83 were excluded (insufficient information). Of 362 AChR-IgG-positive patients included, 50 (13.8%) were designated as nonmyasthenic. The PPV and specificity were 86.2% (95% CI 82.2-89.6) and 98.9% (95% CI 98.5-99.2), respectively. Alternative diagnoses in nonmyasthenic patients included ophthalmologic diseases (n = 8), rheumatic diseases (n = 7), pseudoptosis (n = 5), myopathy (n = 4), functional disorders (n = 3), cranial nerve palsy (n = 2), parkinsonism (n = 2), demyelinating diseases (n = 2), and others (n = 17). Compared with patients with MG, nonmyasthenic patients were younger (median age 65 [range 7-91] vs 38 [range 5-80] years), more frequently female (155/312 [49.8%] vs 37/50 [74%]), had lower AChR-IgG titers (median 6 [range 0.5-28] vs 0.7 [range 0.5-5.5] nmol/L), and were more likely to become seronegative on subsequent tests (9/120 [8%] vs 6/11 [55%]). After stratification by titer ≥1 nmol/L, the PPV increased to 96.6% (95% CI 94-98.3). Serum of 7 nonmyasthenic patients was retested by CBA, giving negative results (n = 6) or selective positivity against the fetal AChR isoform (n = 1).

DISCUSSION: False AChR-IgG positivity may occur in clinical practice with RIPA and associates with low antibody titer. Caution is needed when titers between 0.5 and 0.9 nmol/L are detected in low-probability situations because failure to recognize false antibody positivity may lead to misdiagnosis and inappropriate treatments.

PMID:40245350 | DOI:10.1212/WNL.0000000000213498

J Esthet Restor Dent. 2025 Apr 17. doi: 10.1111/jerd.13467. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the long-term microtensile bond strength (μTBS) to coronal dentin using pre-endodontic dentin sealing (PEDS) and post-endodontic adhesion (PEA) techniques under various endodontic irrigation protocols.

MATERIALS AND METHODS: Ten study groups (n = 10) were established based on the timing of adhesive application (PEDS versus PEA) and irrigation protocol: distilled water (control), 3% sodium hypochlorite (NaOCl), 3% NaOCl followed by 17% ethylenediaminetetraacetic acid (EDTA), 3% NaOCl followed by 17% EDTA and 2% chlorhexidine, and a mixture of 3% NaOCl and 9% etidronic acid (HEDP). Specimens underwent μTBS testing after a six-month microspecimen aging period. Fracture patterns were analyzed, and adhesive interfaces were assessed using scanning electron microscopy (SEM). Statistical analysis employed a mixed linear regression model with a 5% significance level.

RESULTS: PEDS consistently preserved high bond strength across all irrigation protocols (57.4-59.5 MPa), while PEA groups treated with endodontic irrigants resulted in significantly lower values (33.3-40.8 MPa; p < 0.001). No significant differences were observed within the PEDS groups (p > 0.05). SEM analysis revealed consistent hybrid layers in PEDS and PEA/Control groups, while PEA groups treated with endodontic irrigation solutions showed significant resin-dentin interface variations and interfacial gaps.

CONCLUSIONS: The PEDS technique preserved high and consistent μTBS regardless of the irrigation protocol, whereas endodontically irrigated PEA groups exhibited significantly reduced bond strength. PEDS offers a predictable approach to optimizing adhesive performance in endodontic-restorative treatments.

CLINICAL SIGNIFICANCE: Integrating PEDS into routine endodontic-restorative workflow is recommended to enhance long-term bond strength to coronal dentin. The PEDS technique ensures consistent adhesive performance regardless of the endodontic irrigation protocol, enhancing restorative predictability and treatment success while preserving tooth structure.

PMID:40245338 | DOI:10.1111/jerd.13467

J Craniofac Surg. 2025 Apr 17. doi: 10.1097/SCS.0000000000011399. Online ahead of print.

ABSTRACT

Advancements in natural language processing (NLP) have led to the emergence of large language models (LLMs) as potential tools for patient consultations. This study investigates the ability of reasoning-capable models to provide diagnostic and treatment recommendations for orofacial clefts. A cross-sectional comparative study was conducted using 20 questions based on Google Trends and expert experience, with both models providing responses to these queries. Readability was assessed using the Flesch-Kincaid Reading Ease (FRES), Flesch-Kincaid Grade Level (FKGL), sentence count, number of sentences, and percentage of complex words. No statistically significant differences were found in the readability metrics for FKGL (P = 0.064) and FRES (P = 0.56) between the responses of the 2 models. Physician evaluation using a 4-point Likert scale assessed accuracy, clarity, relevance, and trustworthiness, with Deepseek-R1 achieving significantly higher ratings overall (P = 0.041). However, GPT o1-preview exhibited notable empathy in certain clinical scenarios. Both models displayed complementary strengths, indicating potential for clinical consultation applications. Future research should focus on integrating these strengths within medical-specific LLMs to generate more reliable, empathetic, and personalized treatment recommendations.

PMID:40245329 | DOI:10.1097/SCS.0000000000011399

Proc Natl Acad Sci U S A. 2025 Apr 22;122(16):e2407626122. doi: 10.1073/pnas.2407626122. Epub 2025 Apr 17.

ABSTRACT

In order to forage for food, many animals regulate not only specific limb movements but the statistics of locomotor behavior, switching between long-range dispersal and local search depending on resource availability. How premotor circuits regulate locomotor statistics is not clear. Here, we analyze and model locomotor statistics and their modulation by attractive food odor in walking Drosophila. Food odor evokes three motor regimes in flies: baseline walking, upwind running during odor, and search behavior following odor loss. During search, we find that flies adopt higher angular velocities and slower ground speeds and turn for longer periods in the same direction. We further find that flies adopt periods of different mean ground speed and that these state changes influence the length of odor-evoked runs. We next developed a simple model of neural locomotor control that suggests that contralateral inhibition plays a key role in regulating the statistical features of locomotion. As the fly connectome predicts decussating inhibitory neurons in the premotor lateral accessory lobe (LAL), we gained genetic access to a subset of these neurons and tested their effects on behavior. We identified one population whose activation induces all three signature of local search and that regulates angular velocity at odor offset. We identified a second population, including a single LAL neuron pair, that bidirectionally regulates ground speed. Together, our work develops a biologically plausible computational architecture that captures the statistical features of fly locomotion across behavioral states and identifies neural substrates of these computations.

PMID:40244663 | DOI:10.1073/pnas.2407626122

JMIR Infodemiology. 2025 Apr 17;5:e59076. doi: 10.2196/59076.

ABSTRACT

BACKGROUND: The COVID-19 pandemic intensified the challenges associated with mental health and substance use (SU), with societal and economic upheavals leading to heightened stress and increased reliance on drugs as a coping mechanism. Centers for Disease Control and Prevention data from June 2020 showed that 13% of Americans used substances more frequently due to pandemic-related stress, accompanied by an 18% rise in drug overdoses early in the year. Simultaneously, a significant increase in social media engagement provided unique insights into these trends. Our study analyzed social media data from January 2019 to December 2021 to identify changes in SU patterns across the pandemic timeline, aiming to inform effective public health interventions.

OBJECTIVE: This study aims to analyze SU from large-scale social media data during the COVID-19 pandemic, including the prepandemic and postpandemic periods as baseline and consequence periods. The objective was to examine the patterns related to a broader spectrum of drug types with underlying themes, aiming to provide a more comprehensive understanding of SU trends during the COVID-19 pandemic.

METHODS: We leveraged a deep learning model, Robustly Optimized Bidirectional Encoder Representations from Transformers Pretraining Approach (RoBERTa), to analyze 1.13 billion Twitter (subsequently rebranded X) posts from January 2019 to December 2021, aiming to identify SU posts. The model’s performance was enhanced by a human-in-the-loop strategy that subsequently enriched the annotated data used during the fine-tuning phase. To gain insights into SU trends over the study period, we applied a range of statistical techniques, including trend analysis, k-means clustering, topic modeling, and thematic analysis. In addition, we integrated the system into a real-time application designed for monitoring and preventing SU within specific geographic locations.

RESULTS: Our research identified 9 million SU posts in the studied period. Compared to 2019 and 2021, the most substantial display of SU-related posts occurred in 2020, with a sharp 21% increase within 3 days of the global COVID-19 pandemic declaration. Alcohol and cannabinoids remained the most discussed substances throughout the research period. The pandemic particularly influenced the rise in nonillicit substances, such as alcohol, prescription medication, and cannabinoids. In addition, thematic analysis highlighted COVID-19, mental health, and economic stress as the leading issues that contributed to the influx of substance-related posts during the study period.

CONCLUSIONS: This study demonstrates the potential of leveraging social media data for real-time detection of SU trends during global crises. By uncovering how factors such as mental health and economic stress drive SU spikes, particularly in alcohol and prescription medication, we offer crucial insights for public health strategies. Our approach paves the way for proactive, data-driven interventions that will help mitigate the impact of future crises on vulnerable populations.

PMID:40244656 | DOI:10.2196/59076