Nevin Manimala

J Sports Sci. 2025 May 19:1-15. doi: 10.1080/02640414.2025.2502894. Online ahead of print.

ABSTRACT

The study compares three methods of evaluating semi-tethered performance in front crawl swimming using different velocity extraction techniques. Thirty Level 4 swimmers (17 males, 13 females) completed three protocols: Absolute (5 × 25 m, 1-9 kg for males; 1-5 kg for females), Modified (3 × 10 m, 1, 5, 9 kg for males; 1, 3, 5 kg for females) and Velocity-Restricted (device limited to 1 m/s), across three testing sessions, 7 days apart. Absolute and Modified protocols generated load-velocity (LV) and force-velocity (FV) profiles, while Velocity-Restricted produced an FV profile to determine maximal velocity (LV-V₀, FV-V₀), absolute and relative load/force (L₀, F₀, rL₀, rF₀) and slope (S_LV, S_FV). Reliability estimates for the Absolute method: ICC 0.74-0.83, CV% 2.4-9.0% for males; ICC 0.57-0.87, CV% 2.4-11.6% for females. Modified: ICC 0.51-0.85, CV% 2.8-13.7% for males; ICC 0.16-0.80, CV% 2.9-17.1% for females. Velocity-Restricted: ICC 0.50-0.84, CV% 2.6-8.5% for males; ICC 0.10-0.55, CV% 4.2-21.7% for females. FV-V₀ was significantly higher than LV-V₀ (p < 0.001), showing LV and FV outputs are not interchangeable. No statistical differences between Absolute and Modified protocols suggest that the latter (5 m analysis) is a more time-efficient method. Differences in reliability highlight the need for sex-specific considerations when interpreting results.

PMID:40384530 | DOI:10.1080/02640414.2025.2502894

Stat Med. 2025 May;44(10-12):e70126. doi: 10.1002/sim.70126.

ABSTRACT

In clinical trials, principal stratification analysis is commonly employed to address the issue of truncation by death, where a subject dies before the outcome can be measured. However, in practice, many survivor outcomes may remain uncollected or be missing not at random, posing a challenge to standard principal stratification analysis. In this article, we explore the identification, estimation, and bounds of the average treatment effect within a subpopulation of individuals who would potentially survive under both treatment and control conditions. We show that the causal parameter of interest can be identified by introducing a proxy variable that affects the outcome only through the principal strata, while requiring that the treatment variable does not directly affect the missingness mechanism. Subsequently, we propose an approach for estimating causal parameters and derive nonparametric bounds in cases where identification assumptions are violated. We illustrate the performance of the proposed method through simulation studies and a real dataset obtained from a human immunodeficiency virus study.

PMID:40384521 | DOI:10.1002/sim.70126

Pharmacol Res Perspect. 2025 Jun;13(3):e70122. doi: 10.1002/prp2.70122.

ABSTRACT

Cardiovascular diseases are the leading cause of mortality worldwide, with dyslipidemia as a major modifiable risk factor. This study aimed to assess 25-year trends in lipid-lowering agent consumption in Croatia from 2000 to 2023. We conducted a population-based analysis using IMS and IQVIA databases, calculating drug utilization in defined daily doses per 1000 inhabitants per day (DDD/1000) and evaluating financial expenditures and prescribing patterns. Over the study period, total lipid-lowering drug consumption increased more than 30-fold, from 4.91 DDD/1000 in 2000 to 152.56 DDD/1000 in 2023. Statins, particularly atorvastatin and rosuvastatin, drove this trend, while the uptake of PCSK9 inhibitors and ezetimibe reflected an evolving therapeutic landscape. Financial expenditures peaked in 2010, declined until 2015, and rose again by 2023, with average drug prices per DDD decreasing significantly. The observed increase in lipid-lowering therapy correlated with enhanced adherence to international guidelines and expanded patient access. However, administrative barriers and restrictive reimbursement policies continue to limit optimal utilization of newer agents. These findings underscore the importance of evidence-based policy development to address clinical inertia and improve cardiovascular outcomes in Croatia.

PMID:40384513 | DOI:10.1002/prp2.70122

Obesity (Silver Spring). 2025 May 19. doi: 10.1002/oby.24300. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study is to identify whether the glucagon-like peptide-1 receptor (GLP1R) gene variant rs6923761G→A has an influence on semaglutide response in individuals with severe obesity.

METHODS: From March 2023 to July 2024, we prospectively genotyped 112 patients treated with semaglutide 2.4 mg weekly. All patients had been treated over 4 months for grade 3 obesity (BMI ≥ 40 kg/m²).

RESULTS: The frequency of the rs6923761 AA variant was 9 out of 112 patients (8%), GA was 42 out of 112 (37.5%), and GG was 61 out of 112 (54.5%). The mean weight loss kinetics was 1.64% (SD 0.78%) per month in homozygotes of variant A in comparison with a mean weight loss of 1.04% (SD 0.79%) per month in carriers of at least one G variant (p = 0.03). Multivariate analysis demonstrated that rs6923761G→A and sex were independent predictors of weight loss. The rate of weight loss in women homozygous for the A allele was more than double that observed in men carrying the G allele: mean (SD) 1.89% (0.75%) per month versus 0.7% (0.7%) per month (p = 0.0009). No woman homozygous for the A allele was a nonresponder, compared with 56% (21 out of 37) of the men carrying the G allele.

CONCLUSIONS: The rs6923761G→A gene variant and sex profoundly affect weight loss in response to semaglutide in patients with severe obesity.

PMID:40384505 | DOI:10.1002/oby.24300

J Dent Educ. 2025 May 19:e13940. doi: 10.1002/jdd.13940. Online ahead of print.

ABSTRACT

PURPOSES: This study compared a chatbot with an expository interactive lecture as a tool for teaching pulpal and periapical diagnosis in undergraduate dental education.

METHODS: A chatbot and an expository interactive lecture were used to deliver the topic of pulpal and periapical diagnosis based on the American Association of Endodontics guidelines. A total of 24 second-year students in a 4-year undergraduate program were enrolled. An initial test (Test A) with 10 multiple-choice questions was applied to all students. Then, the students were randomly assigned to two different groups: Lecture (control) and Chatbot (experimental). The Lecture group attended an expository interactive lecture delivered by an endodontist. Simultaneously, in the Chatbot group, the chatbot was delivered to the students through the Telegram Messenger application. After 50 min, both groups were submitted to the same test (Test B). Subsequently, the Control group used the chatbot, while the Experimental group attended a lecture by the same faculty. After the split activity, all the students replied to a questionnaire with their perceptions regarding both activities. Statistical analysis was performed with the significance level set at 5%.

RESULTS: Twenty-two students replied to the questions. Both Lecture and Chatbot groups showed significant grade improvement (Lecture: from 6.18 ± 2.08 to 8.45 ± 1.28; Chatbot: from 5.55 ± 1.63 to 7.91 ± 1.58). No difference in the initial and final average grades was detected between the groups. Overall, the chatbot was considered more fun and simpler while the lecture was preferred for understanding (p < 0.05). Chatbot was rated 4.95/5 for ease of use.

CONCLUSIONS: The chatbot was as effective as an interactive lecture in delivering the basic content of pulpal and periapical diagnosis. The students’ perception was that the chatbot was simpler and more fun than the lecture; however, the interactive lecture is a better tool to fully understand the topic. The professor is irreplaceable when discussing the content.

PMID:40384501 | DOI:10.1002/jdd.13940

JPEN J Parenter Enteral Nutr. 2025 May 19. doi: 10.1002/jpen.2771. Online ahead of print.

ABSTRACT

BACKGROUND: In response to coronavirus disease 19, healthcare organizations made dramatic and immediate shifts from in-person office to telehealth visits to provide care to patients while adhering to social distancing restrictions. The objective of this study was to test the efficacy of virtual visits compared with “brick and mortar” (in-person visits) for patients receiving home parenteral nutrition for clinical outcomes of the incidence of catheter complications and 30-day readmissions.

METHODS: A retrospective cohort study was conducted between January 2020 and December 2020 on eligible patients managed by the Cleveland Clinic Home Nutrition Support and the Center Gut Rehabilitation and Transplant teams. Those receiving home parenteral nutrition who were seen in a follow-up clinic appointment were included.

RESULTS: Of 189 patients studied, 103 had in-person visits and 86 had virtual visits. A total of 7.9% (n = 15) of patients had catheter complications. Virtual visits demonstrated statistical noninferiority of the incidence of catheter-related complications when compared with in-person visits (90% CI, -0.051 to 0.106; margin <0.1). Readmission incidence for in-person visits was 8.5% (n = 16) and 6.3% (n = 12) for virtual visits. Virtual visits demonstrated statistical noninferiority to in-person visits for incidence of readmissions after the visit (90% CI, -0.094 to 0.106; margin <0.1).

CONCLUSION: Virtual visits demonstrate noninferiority to in-person visits based on the incidence of catheter complications and readmission rates. New evaluation techniques need to be developed for this high-risk populations in virtual visits to establish effective and safe patient management.

PMID:40384499 | DOI:10.1002/jpen.2771

Emerg Med Australas. 2025 Jun;37(3):e70057. doi: 10.1111/1742-6723.70057.

ABSTRACT

OBJECTIVE: We evaluated guideline adherence and healthcare utilisation in an emergency department (ED) pre- and post-implementation of a physiotherapy-led low back pain (LBP) guideline and rapid outpatient follow-up service (collectively termed PLEDGE model).

METHODS: The PLEDGE model was implemented in a metropolitan tertiary hospital. Data from LBP ED presentations were extracted from electronic medical records for 1 year pre- and post-PLEDGE model implementation. To evaluate guideline-adherent care, the primary outcome was the incidence of any opioid analgesia use. Requests for imaging and pathology were secondary outcomes. To evaluate healthcare utilisation, the primary outcome was the ED National Emergency Access Target (NEAT). Secondary outcomes included ED re-presentations within 28 days, short stay unit (SSU) admissions and ED length of stay (LOS).

RESULTS: Overall, 2732 patients were included (1384 post-implementation). For guideline-adherent care, opioid analgesia (χ² (1, N = 2732) = 17.406, p < 0.001) and pathology ordering (χ² (1, N = 2732) = 6.363, p = 0.012) significantly reduced post-implementation; however, there was no reduction in imaging requests (χ² (1, N = 2732) = 1.859, p = 0.173). With respect to healthcare utilisation, measures of ED NEAT and ED LOS worsened. Patients were significantly less likely to be admitted to SSU (χ² (1, N = 2732) = 6.356, p = 0.012) or re-present to ED (χ² (1, N = 2732) = 4.098, p = 0.043).

CONCLUSION: Implementation of the PLEDGE model reduced opioid analgesia use, pathology ordering, SSU admissions and ED re-presentations and provided a valuable safety net. ED NEAT worsened, ED LOS increased and imaging requests remained unchanged.

PMID:40384488 | DOI:10.1111/1742-6723.70057

J Esthet Restor Dent. 2025 May 19. doi: 10.1111/jerd.13489. Online ahead of print.

ABSTRACT

OBJECTIVE: Lithia-based glass ceramics lead the indirect single-unit restoration market, but the underlying evidence is dominated by a single material. New materials have been introduced. The purpose was to investigate the elemental composition, elemental oxide composition, as-fabricated surface morphology, as-fabricated flexural strength, color, contrast ratio, and absolute light transmission for a variety of lithia-based glass ceramics.

MATERIALS AND METHODS: Test and control materials included: Amber Direct, Amber Mill, Cerec Tessera, IPS Emax CAD, Enamic, IPS Empress CAD, Initial Lisi, Supriniy PC, and TriLuxe Forte. Inductively coupled plasma-optical emission spectrometry, X-ray fluorescence, scanning electron microscopy, mechanical testing (n = 10), visible light spectroscopy (n = 4), and transmission testing (n = 4) were used to evaluate the above parameters. Where appropriate, ANOVA and multiple comparisons testing were used to determine which of the materials differed from one another (α = 0.05).

RESULTS: A range of lithia-based glass ceramics exhibited substantial differences in the above parameters. Differences were of sufficient magnitude to have statistical significance (p < 0.05) and clinical importance. Milling partly crystallized blocks, followed by additional crystallization, almost doubled flexural strength values in comparison to milling fully sintered blocks. Differences in a wide range of color parameters, more than sufficient to be obvious to the eye, were measured even though the materials were all the same nominal shade.

CONCLUSIONS: A variety of lithia-based glass-ceramic materials differed substantially across a range of chemical and physical properties.

CLINICAL SIGNIFICANCE: A range of dental lithia-based glass-ceramic materials exhibited substantial differences in chemical composition, strength, and optical properties of a magnitude expected to influence their clinical performance. The milling of partly crystallized blocks, followed by additional crystallization, almost doubled flexural strength values in comparison to the milling of fully sintered blocks or control materials. At high magnification, machining damage was evident for all materials except for one partially crystallized lithia-based material, which had also exhibited the highest strength.

PMID:40384480 | DOI:10.1111/jerd.13489

Cancer Control. 2025 Jan-Dec;32:10732748251344469. doi: 10.1177/10732748251344469. Epub 2025 May 19.

ABSTRACT

IntroductionCancer-related financial hardship is pervasive, impacting both patients and caregivers, making it crucial to address financial hardship at the household level. The CREDIT (S1912CD) study was designed to enroll and randomize cancer patients and spousal caregivers as dyads to proactive financial navigation compared to usual care. The study faced several challenges to recruitment. This paper discusses the changes made to successfully complete the study.MethodsThe study took place among NCI Community Oncology Research Program (NCORP) sites and allowed several venues for protocol feedback, including SWOG group meetings, NCORP administrator meetings, and individual calls with recruiting sites. A patient advocate worked with the study team to review and update documents to ensure the study was relevant and accessible to potential participants.ResultsSeveral barriers were identified including sites facing challenges in enrolling patient-spouse dyads, multiple financial navigation partners causing confusion and delays in delivery of the intervention, eligibility criteria concerns, and participant discomfort with providing social security numbers. Several modifications were made to address these obstacles during a study restructure, including making caregiver participation optional, streamlining intervention delivery, and modifying eligibility criteria to allow more time between diagnosis and enrollment. Changes from the restructure resulted, on average, in a 9.5 patient per month increase in accrual (4.1 to 13.6) and has enabled the study to reach overall accrual within the study timeline. Importantly, the study maintained diverse accrual and continued to accrue willing caregivers to enable exploratory analysis of caregiver outcomes.ConclusionInterventions examining how to mitigate financial hardship for cancer patients and those affected by cancer, must be pragmatic in order to be translated into sustainable programs in real world settings. Providing recruiting sites an avenue for feedback ensured that the study team could adjust the protocol to meet site needs and successfully complete this financial navigation study.

PMID:40384469 | DOI:10.1177/10732748251344469

Emerg Med Australas. 2025 Jun;37(3):e70060. doi: 10.1111/1742-6723.70060.

ABSTRACT

OBJECTIVES: To explore and describe patients’ expectations, perceptions and experiences of having a pelvic examination (PV) in the emergency department (ED) and to describe ED clinicians’ attitudes and perceptions regarding PVs.

METHODS: A mixed methods study using questionnaires and semi-structured interviews with patients and clinicians at two EDs in the same health service (tertiary ED and urban district ED) between May 2023 and February 2024. Quantitative data are reported descriptively using means and proportions. A qualitative descriptive approach and thematic analysis were used to develop themes from interviews and gather granular insights from participants’ first-hand experiences.

RESULTS: Clinicians completed 84 questionnaires and nine interviews. Patients completed 63 questionnaires and eight interviews. Quantitative and qualitative data were merged to form four themes: (1) the variable clinical utility of the PV in ED, (2) lack of ED clinician confidence and training, (3) bedside manner as primary influence on patient experience, and (4) the inadequate ED setting for performing intimate exams.

CONCLUSIONS: The utility of PVs in ED remains ambiguous and it is vital to avoid unnecessary invasive exams. However, urgent PVs will sometimes be needed and participants have made actionable suggestions to improve the clinical care delivered when performing PVs in ED. The four themes can inform future strategies to advance clinicians’ training, confidence and skill level when performing PVs. This will lead to overall enhanced patient experience and satisfaction and reduce downstream negative consequences of having an inadequate PV experience in ED.

PMID:40384467 | DOI:10.1111/1742-6723.70060