Nevin Manimala

Med J Aust. 2025 Feb 17;222(3):135-143. doi: 10.5694/mja2.52594.

ABSTRACT

OBJECTIVES: To assess differences in eligibility rates and use of the National Disability Insurance Scheme (NDIS).

STUDY DESIGN: Analysis of NDIS unit-record administrative data.

SETTING, PARTICIPANTS: Applicants for NDIS support aged 7 years or older, 1 July 2016 – 31 August 2022 (eligibility analysis); active NDIS participants aged 7 years or older on 31 August 2022 (plan size and spending analyses).

MAIN OUTCOME MEASURES: Differences in NDIS eligibility rates by broad age group (under 55 years v 55 years or older), gender (girls and women v other applicants), and residential socio-economic status (three lowest deciles of the Index of Relative Socioeconomic Disadvantage v other areas); differences in NDIS personal plan size (allocation) and spending (use) by gender and residential socio-economic status.

RESULTS: During 2016-22, 705 594 people aged 7 years or older had applied for NDIS support; 485 676 applicants with recorded decisions were included in our analysis (393 152 eligible, 92 524 ineligible). Eligibility rates were highest for applicants with brain injury or stroke, intellectual disability, or autism (900 or more per 1000 applicants), and only minor inequalities by socio-demographic group were evident. Eligibility rates were lower for applicants with physical disability, psychosocial disability, or unclassified (other) disability (60-75%). Eligibility inequalities were most marked for people with physical disability, with fewer approvals for women and girls than men and boys (145 [95% confidence interval {CI}, 138 – 152] fewer approvals per 1000 applicants), for people aged 55 years or older than for younger applicants (235 [95% CI, 227-242] fewer approvals per 1000 applicants), and for people from lower socio-economic status areas than for those from other areas (86 [95% CI, 78-93] fewer approvals per 1000 applicants). The eligibility rate for applicants with psychosocial disability was lower for women and girls than men and boys (83 [95% CI, 77-89] fewer approvals per 1000 applicants). Inequalities in plan sizes and spending by socio-economic group and gender for the 312 268 active participants at 31 August 2022 were smaller.

CONCLUSIONS: Women and girls and applicants over 55 years of age or living in socio-economically disadvantaged areas with certain disability types are less likely to be deemed eligible for NDIS support than other applicants. Inequalities in plan allocation and use of personal NDIS budgets are less marked. Changes to NDIS eligibility processes could reduce these inequalities.

PMID:39955631 | DOI:10.5694/mja2.52594

ALTEX. 2025 Feb 14. doi: 10.14573/altex.2403272. Online ahead of print.

ABSTRACT

Prediction of hepatotoxicity in humans remains an unresolved challenge. Recently, an in-vitro/in-silico-method was established to predict blood concentrations of test compounds with an increased risk of causing human hepatotoxicity. In the present study, we addressed the question whether gene expression data can improve the quality of hepatotoxicity prediction compared to cytotoxicity analysis alone. A particular challenge is that high-dimensional gene expression data must be summarized into variables that allow for the determination of the lowest test compound concentration that causes altered gene expression. To address this challenge, we analyzed 60 hepatotoxic and non-hepatotoxic substances in a concentration dependent manner for cytotoxicity and expression of 3,524 probes, whose expression were previously reported to be influenced by hepatotoxicants. The toxicity separation index (TSI) was applied to quantify how well specific summary variables of gene expression are able to differentiate between the set of hepatotoxic and non-hepatotoxic substances. The best TSI was obtained when the lowest concentration of a test compound was considered positive that led to differential expression of two genes when compared to vehicle controls. Furthermore, the best gene expression-based summary variable was superior to cytotoxicity-based variables alone, and the combination of the best summary variables of gene expression and cytotoxicity data further improved the TSI compared to each category alone. In conclusion, the method used to derive summary variables of gene expression is critical and the best summary variables improve the prediction of hepatotoxic substances in relation to oral doses and blood concentrations in humans.

PMID:39955620 | DOI:10.14573/altex.2403272

J Cardiothorac Surg. 2025 Feb 15;20(1):128. doi: 10.1186/s13019-025-03368-z.

ABSTRACT

OBJECTIVE: Unnecessary blood preparation by surgeons adversely affects blood bank stocks and the healthcare system in many ways. In this study, it is aimed to evaluate the patient blood management strategy in patients in whom we performed lobectomy and pneumonectomy with thoracotomy.

METHODS: A total of 87 patients have been included in this study. Patient specific data, such as demographic information, laboratory information, preoperative blood ordering, and blood transfusion information have been recorded.

RESULTS: All patients were cross-matched, but only 32 (36.7%) of the patients received blood transfusions. Although a total of 264 units of blood had been reserved, the amount of blood used for transfusion was 68 (25.7%) units. The cross-match / transfusion rate was 3.88, the transfusion index was 0.78, and the transfusion probability was 36.7%. There is a positive and statistically significant correlation between the amount of blood allocated (r = 0.591, p = 0.00) and the duration of intensive care and hospital stay (r = 0.266, p = 0.013). There was also a positive and statistically significant correlation between the amount of blood used and the duration of intensive care and hospital stay (r = 0.422, p = 0.00) (r = 0.474, p = 0.00).

CONCLUSION: In elective lung resection performed by thoracotomy, the amount of blood wasted during the patient’s blood preparation process is high. During the patient blood preparation process, institution-controlled programs should be implemented instead of subjective evaluation at the discretion of the surgeon Planning a patient-specific blood preparation process to alleviate the burden on the healthcare system may prove to be more efficient.

PMID:39955605 | DOI:10.1186/s13019-025-03368-z

J Orthop Surg Res. 2025 Feb 15;20(1):169. doi: 10.1186/s13018-025-05572-y.

ABSTRACT

BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disease that impairs proprioception and postural control, increasing fall risk and reducing quality of life. This study evaluated cervical proprioception and postural control in RA patients versus asymptomatic individuals, examined their relationship within the RA group, and investigated pain’s mediating effects on this association.

METHODS: In this cross-sectional study, 82 RA patients and 82 age- and gender-matched controls were recruited. Cervical proprioception was assessed using the Cervical Joint Position Error Test (CJPET), while postural control was evaluated via a stabilometric force platform measuring center-of-pressure length (L CoP), 95% confidence ellipse sway area (ESA 95%), and center-of-pressure velocity (V CoP). Statistical analyses included t-tests, correlation, regression, and mediation analysis to evaluate relationships and the role of pain in cervical proprioception and postural control.

RESULTS: RA patients demonstrated significantly impaired cervical proprioception and postural control compared to controls (p < 0.001). Significant differences were observed in cervical flexion, extension, rotation, and postural control measures (L CoP, ESA 95%, and V CoP; p < 0.001 for all parameters). Pearson’s correlations revealed significant relationships between cervical proprioception and postural control parameters. Regression analysis indicated that cervical proprioception, particularly when combined with age and disease duration, significantly predicted postural control. Mediation analysis revealed that pain significantly mediated the relationship between cervical proprioception and postural control.

CONCLUSIONS: Cervical proprioception is significantly reduced in RA patients and strongly influences postural control. Pain serves as a key mediator in this relationship, emphasizing the need for effective pain management to enhance proprioceptive and postural functions in RA patients. These findings suggest that the insights from this cross-sectional study could inform future interventions aimed at enhancing proprioception and managing pain, which may significantly benefit RA patients’ postural stability and overall quality of life.

PMID:39955601 | DOI:10.1186/s13018-025-05572-y

J Cardiothorac Surg. 2025 Feb 15;20(1):130. doi: 10.1186/s13019-025-03373-2.

ABSTRACT

BACKGROUND: Studies show conflicting results regarding the impact of the COVID-19 pandemic on the treatment of patients with coronary artery disease requiring cardiac surgery and data from Germany are lacking. In this study, two patient cohorts who underwent coronary artery bypass graft surgery before and after the start of the COVID-19 pandemic were compared.

METHODS: Patients who presented for coronary artery bypass graft surgery before (01.05.18-30.04.19; group “B”) or during the COVID-19 pandemic (01.05.20-30.04.21; group “P”) at the University Hospital Münster in Germany were retrospectively identified and compared regarding demographics, preoperative status, surgical data, and postoperative outcome.

RESULTS: 513 (group “B”) and 501 patients (group “P”) were included, demographics were comparable. In group “P”, preoperative myocardial infarction and emergency indications were more frequent, heart-lung machine and aortic clamping times were longer. Postoperative ICU-days and inpatient stay did not differ. Postoperative need of an extracorporeal life support system and intrahospital mortality tended to be higher in group “P”, without reaching statistical significance.

CONCLUSION: The COVID-19 pandemic had a significant impact on cardiac surgical care with the prioritization of emergency procedures. Patients treated during the pandemic were in a more critical preoperative condition, duration of surgery was longer, but post-operative mortality was comparable.

PMID:39955596 | DOI:10.1186/s13019-025-03373-2

BMC Vet Res. 2025 Feb 15;21(1):68. doi: 10.1186/s12917-025-04528-y.

ABSTRACT

BACKGROUND: Canine chronic enteropathies (CE) are a group of disorders defined by persistent or recurrent clinical signs of gastrointestinal disease without a primary neoplastic, metabolic, parasitic, or other infectious cause. In this prospective, multicentre, uncontrolled, open-label study, a commercial dry diet with a protein source of extensively hydrolysed poultry feather was assessed in the management of dogs with CE that had not responded to previous dietary and antibacterial therapies. Dogs with moderate or marked protein-losing enteropathy were excluded. After screening, dogs entered stage 1 and started the test diet. Gastrointestinal endoscopy was performed, and only dogs with histopathological evidence of small intestinal inflammation confirming CE could continue to stage 2 of the trial. The test diet was fed for 10 weeks throughout stages 1 and 2, and the primary outcome measure was clinical success defined as a reduction in canine inflammatory bowel disease activity index (CIBDAI) of ≥ 75%. Secondary outcomes included body condition score (BCS, scale 1-9) and faecal consistency score (scale 1-5). Results (median [range]) for dogs with confirmed CE that participated in both study stages are reported.

RESULTS: A total of 15 dogs commenced stage 1, and 13 of these progressed to stage 2 (age 4.2 [1.1-7.1] years; BCS 3 (2-4); previous diet therapies 2 [1-3]) of which two were withdrawn at week 5 for protocol deviations. CIBDAI scores decreased from 9 (7-16; n = 13) at baseline to 2 (1-11; n = 13) at week 2 (P < 0.001), 2 (0-6; n = 13) at week 5 (P < 0.001), and 1 (0-3; n = 11) at week 10 (P < 0.001). Treatment success was achieved by 8/13 dogs at week 5 and 10/11 dogs at week 10. Faecal score (n = 11) and BCS (n = 11) improved between baseline (1 [1-3] and 3 [3-4], respectively; P < 0.001) and week 10 (4 [3-5] and 4 [3-5], respectively; P < 0.001).

CONCLUSIONS: Dogs with CE that had failed to respond to previous dietary and antibacterial therapy showed clinical improvement within 10 weeks when fed a dry extruded diet with a single protein source hydrolysed to amino acids and oligopeptides, without concurrent immunosuppressant treatment.

PMID:39955592 | DOI:10.1186/s12917-025-04528-y

BioData Min. 2025 Feb 15;18(1):15. doi: 10.1186/s13040-025-00430-3.

ABSTRACT

Explainable and interpretable machine learning has emerged as essential in leveraging artificial intelligence within high-stakes domains such as healthcare to ensure transparency and trustworthiness. Feature importance analysis plays a crucial role in improving model interpretability by pinpointing the most relevant input features, particularly in disease subtyping applications, aimed at stratifying patients based on a small set of signature genes and biomarkers. While clustering methods, including unsupervised random forests, have demonstrated good performance, approaches for evaluating feature contributions in an unsupervised regime are notably scarce. To address this gap, we introduce a novel methodology to enhance the interpretability of unsupervised random forests by elucidating feature contributions through the construction of feature graphs, both over the entire dataset and individual clusters, that leverage parent-child node splits within the trees. Feature selection strategies to derive effective feature combinations from these graphs are presented and extensively evaluated on synthetic and benchmark datasets against state-of-the-art methods, standing out for performance, computational efficiency, reliability, versatility and ability to provide cluster-specific insights. In a disease subtyping application, clustering kidney cancer gene expression data over a feature subset selected with our approach reveals three patient groups with different survival outcomes. Cluster-specific analysis identifies distinctive feature contributions and interactions, essential for devising targeted interventions, conducting personalised risk assessments, and enhancing our understanding of the underlying molecular complexities.

PMID:39955586 | DOI:10.1186/s13040-025-00430-3

BMC Health Serv Res. 2025 Feb 15;25(1):258. doi: 10.1186/s12913-025-12402-8.

ABSTRACT

BACKGROUND: Ensuring universal access to delivery healthcare services is a core Sustainable Development Goals target to be achieved by 2030. However, in pursuing this target, Bangladesh, like other low- and middle-income countries (LMICs), is now facing an escalation in cesarean section (CS) deliveries, with almost all facility-based deliveries ending in CS. This places an additional burden on the healthcare system as well as maternal and child health. This study aims to explore the association between access to facility-based normal delivery services and health facility-level factors in Bangladesh.

METHODS: We analyzed data from 3,171 mothers and 1,524 healthcare facilities extracted from the 2017-18 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. These datasets were linked via GPS coordinates of clusters where mothers resided and healthcare facilities were located. The outcome variable was facility-based normal delivery (yes/no). Explanatory variables included health facility readiness (management and infrastructure), availability of normal delivery services at the nearest facility, readiness for normal delivery care, and average distance from mothers’ homes to the nearest facility offering such care. A multilevel logistic regression model assessed associations between facility-based normal delivery and health facility factors, adjusting for individual, household, and community-level characteristics.

RESULTS: We found 26% access of facility based normal delivery. The likelihood of facility-based normal delivery was found to be increased with higher scores for management (adjusted odds ratio (aOR) 1.24; 95% CI, 1.01-1.62) and infrastructure (aOR, 1.20; 95% CI, 1.01-1.60) of the nearest healthcare facility to mothers’ homes. Furthermore, a one-unit increase in the availability and readiness of the nearest healthcare facility to provide normal delivery care was associated with 2.10 (95% CI, 1.14- 3.12) and 3.15 (95% CI, 1.16-5.11) times higher likelihoods of facility-based normal delivery, respectively. The likelihood of facility-based normal delivery decreased by 20% for every kilometer increase in the distance from mothers’ homes to the nearest healthcare facility.

CONCLUSION: This study’s findings suggest that healthcare facilities’ availability and readiness are important in ensuring facility-based normal deliveries in Bangladesh. It calls for policies and programs to enhance the capacity of facilities to provide normal delivery care.

PMID:39955580 | DOI:10.1186/s12913-025-12402-8

Trials. 2025 Feb 15;26(1):54. doi: 10.1186/s13063-024-08642-4.

ABSTRACT

BACKGROUND: Multimodal rehabilitation has shown good results in adults with temporomandibular disorder (TMD), but there is still doubt regarding the protocol’s ideal format (face-to-face or online), and its effectiveness among adolescents. The purpose of this study is to describe a randomized clinical trial protocol of face-to-face and online multimodal rehabilitation, in adolescents with TMD, and to determine its effects on pain, peripheral oxygenation of the masseter muscle, and mandibular range of motion, kinesiophobia and parafunction.

METHODS: A randomized, controlled clinical trial, blinded to statistical analyses, will be carried out, involving 26 adolescents, diagnosed with TMD. After randomization, the participants will be allocated into two groups: (1) telerehabilitation and (2) face-to-face treatment groups. Each group will undergo an initial assessment, followed by three treatment sessions, reassessment, and follow-up. Appointments and reassessments will be face-to-face, with instruments validated and adapted for adolescent age groups. The intervention protocol also aims at practicality, ease of execution, and strategies for the patient to easily self-manage and perform independently, adapted for face-to-face or online formats. The Diagnostic Criteria for Temporomandibular Disorders, physical and psychosocial aspects, algometry, near-infrared spectroscopy, and the Tampa scale for kinesiophobia will be used to assess the outcomes.

DISCUSSION: It is expected that this study will contribute to online and face-to-face assessments and demonstrate the differences in the practice of rehabilitation of adolescents with TMD. Data will be published after the study is completed, and if the benefits are proven, care modalities may be implemented.

TRIAL REGISTRATION: REBEC-RBR-5scd5tm, UTN code: U1111-1288-4495 . Registered on 19 May 2023.

PMID:39955572 | DOI:10.1186/s13063-024-08642-4

Diabetol Metab Syndr. 2025 Feb 15;17(1):59. doi: 10.1186/s13098-025-01616-9.

ABSTRACT

BACKGROUND: The significant burden of cardiovascular diseases underscores the necessity for identifying novel predictive markers that can forecast both cardiovascular diseases and mortality. In recent years, TyG-obesity-related parameters have gained special attention in this regard. This study aimed to assess the association between TyG-waist circumference (TyG-WC) and cardiovascular diseases and mortality.

METHODS: A comprehensive search was performed in databases including PubMed, Scopus, and Web of Science from their inception until October 6, 2024. The key outcomes of interest included all-cause mortality, cardiovascular mortality, cardiovascular diseases, myocardial infarction, stroke, coronary artery diseases, peripheral artery diseases, and heart failure. The pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) was calculated. Meta-analysis was carried out using StataMP 14.0.

RESULTS: A total of 17 studies were included in the analysis. The number of participants ranged between 2,224 and 95,342. The meta-analysis revealed that TyG-WC is significantly associated with an increased risk of all-cause mortality, cardiovascular mortality, cardiovascular diseases, myocardial infarction, stroke, coronary artery diseases, and peripheral artery diseases. However, only one study addressed the relationship between TyG-WC and heart failure with a positive correlation.

CONCLUSION: This study indicates that TyG-WC could serve as a promising predictor of cardiovascular diseases, along with cardiovascular and all-cause mortality. Given its accessibility, TyG-WC may be a practical tool for screening purposes.

PMID:39955571 | DOI:10.1186/s13098-025-01616-9