Nevin Manimala

Acta Orthop Belg. 2024 Dec;90(4):575-579. doi: 10.52628/90.4.12752.

ABSTRACT

Dislocation is the second most common indication for revision total hip arthroplasty (THA). In revision cases the dislocation rate can be as high as 5-30%. The aim of this study was to assess the outcome, specifically the dislocation rate in revision THA where a dual mobility cup was used. We retrospectively reviewed all the revision THAs where a dual mobility cup (G7) was used. The pre-operative and post-operative oxford hip scores were recorded. Patients’ electronic records and radiographs were studied for the indications, approaches used, post-operative complications, re-operation rates, and re-revision surgery. Between 2016 and 2020, we performed 59 revision total hip replacements where a dual mobility cup (G7) was used. There were 23 males and 36 females. The average age was 74 years (range, 64-89). Acetabular components were revised in 47 (80%) cases and both the femoral and the acetabular components were revised in 12 (20%) cases. The average follow-up time was 4 years (range, 2-6 years). Average pre-operative and post-operative oxford hip scores were 17 and 36 respectively. The improvement was significant with P value of <.001. Complications were noted in 5 (8%) patients. One patient had dislocation. This patient required re-revision with constrained liner. One patient had intraoperative fracture of the femur and was treated with plate and cables. We conclude that the dual mobility cup can significantly reduce the risk of dislocation when used in revision THA.

PMID:39869859 | DOI:10.52628/90.4.12752

JMIR Public Health Surveill. 2025 Jan 27;11:e59845. doi: 10.2196/59845.

ABSTRACT

BACKGROUND: Numerous studies have assessed the risk of SARS-CoV-2 exposure and infection among health care workers during the pandemic. However, far fewer studies have investigated the impact of SARS-CoV-2 on essential workers in other sectors. Moreover, guidance for maintaining a safely operating workplace in sectors outside of health care remains limited. Workplace surveillance has been recommended by the Centers for Disease Control and Prevention, but few studies have examined the feasibility or effectiveness of this approach.

OBJECTIVE: The objective of this study was to investigate the feasibility and effectiveness of using frequent point-of-care molecular workplace surveillance as an intervention strategy to prevent the spread of SARS-CoV-2 at essential rural workplaces (mining sites) where physical distancing, remote work, and flexible schedules are not possible.

METHODS: In this nonrandomized controlled clinical trial conducted from February 2021, to March 2022, 169 miners in New Mexico (intervention cohort) and 61 miners in Wyoming (control cohort) were enrolled. Investigators performed point-of-care rapid antigen testing on midnasal swabs (NSs) self-collected by intervention miners. Our first outcome was the intervention acceptance rate in the intervention cohort. Our second outcome was the rate of cumulative postbaseline seropositivity to SARS-CoV-2 nucleocapsid protein, which was analyzed in the intervention cohort and compared to the control cohort between baseline and 12 months. The diagnostic accuracy of detecting SARS-CoV-2 using rapid antigen testing on NSs was compared to laboratory-based reverse transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs (NPSs) in a subset of 68 samples.

RESULTS: Our intervention had a mean acceptance rate of 96.4% (11,413/11,842). The intervention miners exhibited a lower cumulative postbaseline incident seropositivity at 12 months compared to control miners (14/97, 14% vs 17/45, 38%; P=.002). Analysis of SARS-CoV-2 antigen detection in self-administered NSs revealed 100% sensitivity and specificity compared to laboratory-based RT-PCR testing on NPSs.

CONCLUSIONS: Our findings establish frequent point-of-care molecular workplace COVID-19 surveillance as a feasible option for keeping essential rural workplaces open and preventing SARS-CoV-2 spread. These findings extend beyond this study, providing valuable insights for designing interventions to maintain employees’ safety at other essential workplaces during an infectious disease outbreak.

PMID:39869851 | DOI:10.2196/59845

J Urol. 2025 Jan 27:101097JU0000000000004455. doi: 10.1097/JU.0000000000004455. Online ahead of print.

ABSTRACT

PURPOSE: Urinary incontinence (UI) is common in nulliparous female elite athletes, but underlying pathophysiology is inadequately understood. We examined urinary symptoms and associated pelvic floor anatomy and function in this population, hypothesizing that athletes with UI would exhibit pelvic floor findings seen in older incontinent women (e.g., pelvic floor descent and urethral hypermobility) and findings attributable to elite sporting such as muscle hypertrophy.

MATERIALS AND METHODS: We performed a cross-sectional study of NCAA Division 1 nulliparous female athletes comparing symptomatic (i.e. currently or previously experienced urinary leakage during exercise) and asymptomatic athletes. We assessed demographics, sport characteristics, relevant medical history (including Brief Eating Disorder in Athletes Questionnaire) and validated genitourinary symptom questionnaires (Lower Urinary Tract Dysfunction Network Symptom Index-29; Female Genitourinary Pain Index). Pelvic exam and dynamic MRI were used to assess the pelvic floor at rest and at maximal strain. Pelvic floor anatomic structures were evaluated and segmented by MRI.

RESULTS: Of 29 athletes (11 asymptomatic, 18 symptomatic), demographics, sport characteristics, and pelvic exam findings were not statistically different between groups. Symptomatic athletes had significantly worse urinary symptoms (median LURN SI-29 8.5 vs. 8.0, P=0.022) and genitourinary pain (median GUPI 7 vs. 3, P=0.036), greater anterior thickness of the striated urethral sphincter muscle (median 2.5 vs. 1.8 mm, P=0.016) and puborectalis and levator ani muscles (median 10.3 vs. 8.6 mm, P=0.028), and worse disordered eating (median BEDA-Q 7.5 vs. 4.5, P=0.022).

CONCLUSIONS: In nulliparous female elite athletes with UI, dynamic pelvic MRI identified differences in pelvic floor anatomy, which may be part of a multifactorial etiology of UI.

PMID:39869821 | DOI:10.1097/JU.0000000000004455

Proc Natl Acad Sci U S A. 2025 Feb 4;122(5):e2401237121. doi: 10.1073/pnas.2401237121. Epub 2025 Jan 27.

ABSTRACT

Funding of curiosity-driven science is the lifeblood of scientific and technological innovation. Various models of funding allocation became institutionalized in the 20th century, shaping the present landscape of research funding. There are numerous reasons for scientists to be dissatisfied with current funding schemes, including the imbalance between funding for curiosity-driven and mission-directed research, regional and country disparities, path-dependency of who gets funded, gender and race disparities, low inter-reviewer reliability, and the trade-off between the effort and time spent on writing or reviewing proposals and doing research. We discuss possible alternative models for dealing with these issues. These alternatives include incremental changes such as placing more weight on the proposals or on the investigators and representative composition of panel members, along with deeper reforms such as distributed or concentrated funding and partial lotteries in response to low inter-reviewer reliability. We also consider radical alternatives to current funding schemes: the removal of political governance and the introduction of international competitive applications to a World Research Council alongside national funding sources. There is likely no single best way to fund curiosity-driven research; we examine arguments for and against the possibility of systematically evaluating alternative models empirically.

PMID:39869812 | DOI:10.1073/pnas.2401237121

Int J Surg. 2025 Jan 24. doi: 10.1097/JS9.0000000000002240. Online ahead of print.

ABSTRACT

BACKGROUND: Liver malignancies present substantial challenges to surgeons due to the extensive hepatic resections required, frequently resulting in posthepatectomy liver failure. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was designed to increase the resectable liver volume, yet it is associated with significant mortality and morbidity rates. Recently, minimally invasive techniques have been incorporated into ALPPS, with the potential to improve the procedure’s safety profile whilst maintaining efficacy.

MATERIALS AND METHODS: This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase and Cochrane for all interventional studies that evaluated the operative outcomes of minimally invasive ALPPS compared to open ALPPS. Two independent reviewers appraised and extracted the summary data from published studies. Random effects meta-analyses were used for primary analysis.

RESULTS: Nine studies with 637 patients undergoing ALPPS were included. Meta-analyses indicated a statistically significant decreased risk of 90-day mortality (RR = 0.48, 95%CI: 0.29;0.80) and decreased overall length of hospital stay (MD = -8, 95%CI: -11.25;-4.74) in patients undergoing minimally invasive ALPPS compared to patients undergoing open ALPPS. No significant differences in terms of the rate of future liver remnant growth (MD = 11.37, 95%CI: -4.02;26.77) and risk of posthepatectomy liver failure (RR = 0.52, 95%CI: 0.09;2.97) were identified. Subgroup analyses identified a trend in lowering the risk of posthepatectomy liver failure in patients undergoing laparoscopic ALPPS compared to robotic ALPPS. In terms of oncologic surgical outcomes, 92% of patients undergoing minimally invasive ALPPS achieved negative margin resections, while 86% of patients undergoing open ALPPS achieved negative margin resections.

CONCLUSION: This systematic review and meta-analysis provide evidence that minimally invasive ALPPS offers a safer alternative with reduced mortality and shorter hospital stays, while maintaining comparable efficacy in liver remnant growth and R0 resections. These findings highlight the potential of minimally invasive techniques to combat the criticism that ALPPS has been placed under.

PMID:39869398 | DOI:10.1097/JS9.0000000000002240

Int J Surg. 2025 Jan 24. doi: 10.1097/JS9.0000000000002232. Online ahead of print.

ABSTRACT

BACKGROUND: The impact of aortic arch (AA) morphology on the management of the procedural details and the clinical outcomes of the transfemoral artery (TF)-transcatheter aortic valve replacement (TAVR) has not been evaluated. The goal of this study was to evaluate the AA morphology of patients who had TF-TAVR using an artificial intelligence algorithm and then to evaluate its predictive value for clinical outcomes.

MATERIALS AND METHODS: A total of 1480 consecutive patients undergoing TF-TAVR using a new-generation transcatheter heart valve at 12 institutes were included in this retrospective study. The AA measurements were evaluated by deep learning, and then the approach index (IA) was determined. The machine learning algorithm was used to construct the predictive model and was validated externally.

RESULTS: The area under the curve of the IA model using random forest and logistic regression was 0.675 [95% confidence interval (CI): 0.586-0.764] and 0.757 (95% CI: 0.665-0.849), respectively. The IA model was validated externally, and consistent distinctions were obtained. After we used a generalized propensity score matching method for continuous exposure, the IA was the strongest correlation factor for major procedural events (odds ratio: 3.87; 95% CI: 2.13-7.59, P < 0.001). When leaflet morphology or transcatheter heart valve type was an interactive item with IA, neither of them was statistically significant in terms of clinical outcomes.

CONCLUSION: IA may be used to identify the impact of AA morphology on procedural and clinical outcomes in patients having TF-TAVR and to help to predict the procedural complications.

PMID:39869394 | DOI:10.1097/JS9.0000000000002232

Q J Nucl Med Mol Imaging. 2025 Jan 27. doi: 10.23736/S1824-4785.24.03567-2. Online ahead of print.

ABSTRACT

BACKGROUND: One can assess cortical defects on the early images of [99mTc]Tc-MAG3 renography. We aimed to assess interobserver and intraobserver reproducibility for detecting renal cortical defects using [99mTc]Tc-MAG3 for adults and children; identify causes for poor inter- and intraobserver reproducibility and to assess the effect of the kidney to background ratio (KTBR) on reproducibility.

METHODS: One hundred adult and 200 pediatric renograms were included. The observers reviewed the summed 1-minute posterior images for the first four minutes to detect cortical defects. Interobserver reproducibility between three observers and intra-observer reproducibility for two observers were determined. Agreement was tested using percentage agreement, Krippendorff’s reliability coefficient alpha and Cohen’s kappa statistic. The association between KTBR and agreement was evaluated.

RESULTS: Interobserver agreement on the 1-2 minutes images was 78 (95% CI: 74.8-82.7%) and 79.7 (95% CI: 75.9-83.5%) for left and right kidneys respectively. Intraobserver percentage was 89.7% (95% CI: 86.2-93.1%) for the senior and 80.7% (95% CI: 76.2-85.2%) for the junior observer. In 13.5% (27) of the adult and 4.5% (19) of the pediatric kidneys the difference in image interpretation between the observers would have had a clinical impact. If the KTBR is ≤2, the percentage agreement was between 61.5% and 64.8%. In cases with a KTBR >2, the percentage agreement was between 83.6% and 87.1%.

CONCLUSIONS: The percentage interobserver agreement was moderate. Disagreement between normal and abnormal cases were infrequent. The interobserver reproducibility was decreased when the KTBR was ≤2.

PMID:39869360 | DOI:10.23736/S1824-4785.24.03567-2

JAMA Netw Open. 2025 Jan 2;8(1):e2456392. doi: 10.1001/jamanetworkopen.2024.56392.

ABSTRACT

IMPORTANCE: Medication nonadherence imposes high morbidity, mortality, and costs but is challenging to address given its multiple causes. Subscription models are increasingly used in health care to encourage healthy behaviors; in January 2023, Amazon Pharmacy launched RxPass, a subscription program offering Amazon Prime members (hereafter, company members) in 45 states access to 60 common generic medications for a flat $5 monthly fee.

OBJECTIVE: To evaluate the associations of program enrollment with medication refills, days’ supply, and out-of-pocket costs.

DESIGN, SETTING, AND PARTICIPANTS: In this retrospective, population-based cohort study, a difference-in-differences approach with doubly robust estimation was used to assess outcomes 6 months before and after program enrollment, compared with a contemporaneous control group (study period included July 24, 2022, to January 24, 2024). Participants were younger than 65 years, company members, and not enrolled in Medicare or Medicaid. Exposure individuals were enrolled in the program in the first 6 months of program launch. Control individuals resided in the 5 states where the program was not available but who clicked on the enrollment webpage in the first 6 months of program launch.

EXPOSURE: Subscription program enrollment.

MAIN OUTCOMES AND MEASURES: The primary outcome was the number of days’ supply of medications on the subscription program list per person per month (PPPM). Secondary outcomes were the number of prescription refills and out-of-pocket costs of medications on the program list, including program subscription costs, PPPM.

RESULTS: After propensity score weighting, there were 5003 enrollees (mean [SD] age, 45.9 [11.1] years; 2076 female [41.5%]) and 5137 controls (mean [SD] age, 45.8 [11.1] years; 2116 female [41.2%]). The program was associated with an increase in days’ supply of 10.39 days PPPM (95% CI, 10.29-10.48 days PPPM), a 27% increase, an increase in prescription refills of 0.19 PPPM (95% CI, 0.19-0.19 refills PPPM), a 29% increase, and a decrease in out-of-pocket spending by $2.35 PPPM (95% CI, $2.37-$2.33 PPPM), a 30% decrease.

CONCLUSIONS AND RELEVANCE: In this cohort study, program enrollment was associated with increased medication refills and total days’ supply and reduced out-of-pocket costs. Future research should investigate the potential cognitive and/or behavioral mechanisms by which subscription programs encourage healthy behaviors and whether the results could be replicated among other pharmacies or cohorts.

PMID:39869337 | DOI:10.1001/jamanetworkopen.2024.56392

JAMA Netw Open. 2025 Jan 2;8(1):e2456429. doi: 10.1001/jamanetworkopen.2024.56429.

ABSTRACT

IMPORTANCE: Suicide rates among adolescents continue to rise, but there are a lack of clinical tools to predict when youths may be at risk for suicidal behaviors.

OBJECTIVE: To identify whether geolocation metrics, assessed through an app installed on adolescents’ personal smartphones, could detect the risk of next-week suicidal events and clinically meaningful suicidal ideation.

DESIGN, SETTING, AND PARTICIPANTS: This case series study included high-risk adolescents aged 13 to 18 years reporting a current affective and/or substance use disorder, oversampled for suicidal thoughts and behaviors (STB). Participants were recruited from the greater New York City and Pittsburgh communities through psychiatric outpatient programs, emergency departments, medical center research registries, and social media. Participants installed the Effortless Assessment Research System (EARS) software application onto their personal smartphones, which obtained passive sensor data, including geolocation metrics (via the global positioning system [GPS]), as well as weekly experience sampling data probing STB for the duration of the 6-month study. Adolescents also completed clinical assessments at baseline as well as during the 1-, 3-, and 6-month follow-up assessments. Statistical analysis was performed from March 2023 to November 2024.

MAIN OUTCOMES AND MEASURES: Repeated measures mixed-effects logistic models estimated whether weekly aggregates of geolocation features (ie, entropy, homestay, distance traveled) were associated with next-week suicidal events (ie, suicide attempts, psychiatric hospitalizations, emergency department visits for suicide concerns) and clinically meaningful ideation (via weekly experience sampling).

RESULTS: Overall, 186 participants were included in this study (148 [79.6%] female; 19 [10.2%] Asian, 23 [12.4%] Black, and 106 [57.0%] White), with a mean (SD) age of 16.4 (1.7) years. Greater homestay (amount of time spent at home) on a given week, relative to one’s own mean, was associated with 2-fold greater odds of suicidal events during the subsequent week (odds ratio, 1.99 [95% CI, 1.15-3.45]). Results were not significant for entropy and distance traveled metrics. However, using leave-future-out validation, the accuracy of the homestay model was modest (area under the receiver operating characteristic curve, 0.64 [95% CI, 0.50-0.78]).

CONCLUSIONS AND RELEVANCE: Advancements in smartphone technology afford unique opportunities to capture affective and behavioral dynamics that presage suicide risk. This case series study found that greater homestay obtained through smartphone GPS data over the course of a week, relative to one’s own mean, was associated with greater odds of a suicidal event in the subsequent week. Although accuracy was modest, these findings offer a novel starting point for suicide prevention research, particularly as smartphone sensor data may have the capacity to identify who is at risk while also providing an opportunity to deliver clinical tools when that risk is greatest.

PMID:39869336 | DOI:10.1001/jamanetworkopen.2024.56429

JAMA Netw Open. 2025 Jan 2;8(1):e2456787. doi: 10.1001/jamanetworkopen.2024.56787.

ABSTRACT

IMPORTANCE: An increasing number of older adults are undergoing surgery. Older adults face significant challenges throughout the spectrum of perioperative care. No frameworks exist to support primary care clinicians in helping older adults navigate perioperative care beyond preoperative medical clearance.

OBJECTIVE: We aimed to develop a framework to assist primary care clinicians in surgical care navigation for older patients.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used semistructured interviews with a sample of geriatricians from across the US between January and June 2022. Interviews were conducted one on one via an online video conferencing platform without observers present. Demographics of participants were analyzed using descriptive statistics.

MAIN OUTCOME AND MEASURES: Directed content analysis of interview data was used to examine how primary care clinicians can optimally support older patients throughout the perioperative process.

RESULTS: This qualitative study included 24 geriatricians, 16 (67%) women, with median time in practice of 12.4 years (IQR, 5.0-24.5 years). Of those, 11 (46%) worked at an academic or tertiary referral center. Qualitative analysis identified 7 actions that geriatricians perform when caring for patients through the surgical continuum: conduct risk-benefit analysis of surgical referral, elicit and communicate patient goals, prepare patient and family for surgical consultation, set realistic expectations, assist with decision about surgery, advocate for patient and family, and coordinate postoperative care.

CONCLUSIONS AND RELEVANCE: In this qualitative study of geriatricians, 7 key domains of perioperative care for older adults were identified. The resulting framework can be used by primary care clinicians as they help their older patients navigate surgical care.

PMID:39869335 | DOI:10.1001/jamanetworkopen.2024.56787