Nevin Manimala

JAMA Netw Open. 2025 Jan 2;8(1):e2456246. doi: 10.1001/jamanetworkopen.2024.56246.

ABSTRACT

IMPORTANCE: Multiple organ dysfunction (MOD) is a leading cause of in-hospital child mortality. For survivors, posthospitalization health care resource use and costs are unknown.

OBJECTIVE: To evaluate longitudinal health care resource use and costs after hospitalization with MOD in infants (aged <1 year) and children (aged 1-18 years).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used nationwide data from 2004 to 2019 from Optum’s deidentified Clinformatics Data Mart Database, an insurance claims database. Infants and children from birth to age 18 years with an index hospitalization between January 1, 2005, and December 31, 2018, were included. Infants (age <1 year) and children (age 1-18 years) with MOD (MOD cohort) or without MOD (non-MOD cohort) were separately identified, and cohorts were propensity score weighted to balance demographics and pre-index hospitalization characteristics, including health care use and comorbidities. The data were analyzed between January 7, 2022, and September 8, 2023.

MAIN OUTCOMES AND MEASURES: Weighted generalized estimating equations were used to evaluate differences between cohorts in rehospitalizations, emergency department visits, and health care costs up to 5 years after the index hospitalization.

RESULTS: During the study period, 9671 children in the MOD cohort were compared with 1 691 793 children in the non-MOD cohort in the weighted sample. Infants comprised 67.4% of the MOD cohort (mean [SD] age at index hospitalization, 0.1 [0.8] years; 51.2% male) and 87% of the non-MOD cohort (mean [SD] age at index hospitalization, 0.1 [0.8] years; 50.8% male), and children comprised 32.5% of the MOD cohort (mean [SD] age at index hospitalization, 11.6 [5.7] years; 50.7% female) and 13.0% of the non-MOD cohort (mean [SD] age at index hospitalization, 11.5 [5.5] years; 51.3% female). The infant MOD cohort had more emergency department visits, with an adjusted incidence rate ratio of 1.76 (95% CI, 1.56-1.97) at 30 days; this difference persisted for years 1 through 5. Children had a similar pattern except at 30 days among those who acquired new organ-supportive technology during the index hospitalization. Among infants, the MOD cohort had more rehospitalizations, with an adjusted incidence rate ratio of 12.45 (95% CI, 11.40-13.59) at 30 days; this difference persisted for years 1 through 5. A similar pattern was observed among children. Annual health care costs were higher for the MOD cohort in year 1 (infants: mean [SD], $80 133 [$6543] vs $5183 [$19] [P < .001]; children: mean [SD], $54 113 [$17 544] vs $10 935 [$95] [P < .001]) and in all years through year 5.

CONCLUSIONS AND RELEVANCE: In this cohort study of nearly 1.7 million children, survivors of MOD accrued substantial ongoing health care resource use and cost burden after the index hospitalization. These findings suggest that follow-up care of survivors of MOD should include economic well-being alongside measures of clinical health.

PMID:39878981 | DOI:10.1001/jamanetworkopen.2024.56246

JAMA Netw Open. 2025 Jan 2;8(1):e2456264. doi: 10.1001/jamanetworkopen.2024.56264.

ABSTRACT

IMPORTANCE: Limited research explores mental health disparities between individuals in sexual and gender minority (SGM) populations and cisgender heterosexual (non-SGM) populations using national-level data.

OBJECTIVE: To explore mental health disparities between SGM and non-SGM populations across sexual orientation, sex assigned at birth, and gender identity within the All of Us Research Program.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used survey data and linked electronic health records of eligible All of Us Research Program participants from May 31, 2017, to June 30, 2022.

EXPOSURE: Self-identified SGM status.

MAIN OUTCOMES AND MEASURES: Prevalence of common mental health conditions identified from linked electronic health records. Logistic regression adjusted for age, race and ethnicity, educational level, income, employment status, and geographic region was used to assess the association between SGM status and mental health conditions.

RESULTS: Among 413 457 participants, 269 947 (65.3%) were included in the analysis (median age, 59 [IQR, 43-70] years), with 22 189 (8.2%) self-identified as SGM. Men with cisgender sexual minority identity had higher odds of bipolar disorder (adjusted odds ratio [AOR], 1.87; 95% CI, 1.70-2.56) compared with cisgender heterosexual men. Women with cisgender sexual minority identity had higher odds of bipolar disorder (AOR, 2.09; 95% CI, 1.95-2.25) compared with cisgender heterosexual women. Gender diverse people assigned female sex at birth had higher odds of posttraumatic stress disorder (PTSD) compared with both cisgender heterosexual men (AOR, 3.67; 95% CI, 2.99-4.50) and cisgender heterosexual women (AOR, 2.77; 95% CI, 2.26-3.40). Gender diverse individuals assigned male sex at birth had higher odds of bipolar disorder (AOR, 2.35; 95% CI, 1.66-3.33) compared with cisgender heterosexual men and higher odds of attention-deficit/hyperactivity disorder (AOR, 2.19; 95% CI, 1.48-3.23) compared with cisgender heterosexual women. Transgender men had higher odds of depression (AOR, 2.11; 95% CI, 1.80-2.49) compared with cisgender heterosexual men, while transgender women had higher odds of any personality disorder (AOR, 2.71; 95% CI, 1.84-3.99) compared with cisgender heterosexual women.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of participants in the All of Us Research Program, there were significant mental health disparities between participants in SGM and non-SGM groups. These findings underscore the need for tailored mental health interventions to improve the well-being of SGM populations, while noting that the associations do not imply causality but reflect the stigma and minority stress experienced by these individuals.

PMID:39878980 | DOI:10.1001/jamanetworkopen.2024.56264

JAMA Netw Open. 2025 Jan 2;8(1):e2456528. doi: 10.1001/jamanetworkopen.2024.56528.

ABSTRACT

IMPORTANCE: There is a clear benefit to body armor against firearms; however, it remains unclear how these vests may influence day-to-day patient encounters when worn by emergency medical services (EMS).

OBJECTIVE: To determine the association of ballistic vests worn by EMS clinicians with workplace violence (WPV) and disparities in care among racial and/or ethnic minority patients.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of a volunteer-based sample of EMS clinicians at a large, multistate EMS agency encompassing 15 ground sites across the Midwest from April 1, 2023, to March 31, 2024. Data were analyzed from May to June 2024.

EXPOSURE: External ballistic armor being used by a group of self-selected clinicians on every run.

MAIN OUTCOMES AND MEASURES: Prevalence and characteristics associated with WPV and with declines of treatment and/or transport compared between crews with 1 or more vested vs no vested members.

RESULTS: A total of 156 of 415 staff (37.6%) opted in to wear the vests, including 77 male participants (49.4%). Prevalence of WPV was higher for vested crews (1.11 vs 0.85 cases per 100 runs; adjusted risk ratio [aRR], 1.28; 95% CI, 1.10 to 1.50; P = .001) and was due to higher rates of verbal abuse. The presence of 1 or more vested crew members increased the likelihood of all patients declining EMS treatment and/or transport; however, effect size was highest among patients with an unknown race and/or ethnicity (2234 [21.1%] vs 2134 [16.5%] patients; aRR, 1.19; 95% CI, 1.10 to 1.27; P < .001), followed by racial and/or ethnic minority patients (708 [16.7%] vs 399 [13.8%] patients; aRR, 1.18; 95% CI, 1.05 to 1.33; P = .01). Analyses of individual minority groups revealed a significant increase only in Black or African American patients declining treatment and/or transport by vested crews (461 [17.6%] vs 223 [13.7%] patients; RR, 1.28; 95% CI, 1.10 to 1.49; P = .002).

CONCLUSIONS AND RELEVANCE: In this cohort study, vested crews experienced increased prevalence of WPV compared with nonvested crews. Use of vests increased the frequency of all patients declining EMS treatment and/or transport. Among minority groups, there was a significant increase in Black or African American patients declining treatment and/or transport. Agencies should consider benefits and unintended consequences of EMS clinicians wearing body armor.

PMID:39878979 | DOI:10.1001/jamanetworkopen.2024.56528

J Vis Exp. 2025 Jan 10;(215). doi: 10.3791/67475.

ABSTRACT

Chronic wounds, due to their high prevalence, are a serious global health concern. Effective therapeutic strategies can significantly accelerate healing, thereby reducing the risk of complications and alleviating the economic burden on healthcare systems. Although numerous experimental studies have investigated wound healing, most rely on qualitative observations or quantitative direct measurements. The objective of this study was to standardize an indirect wound measurement method using digital planimetry, incorporating digital scaling and segmentation. This approach addresses the lack of detailed, step-by-step methodologies for accurate wound assessment. A photodocumentation booth was designed and constructed, and computer-assisted digital planimetry tools were employed to minimize variability in measurements of the wound area, perimeter, and the distance from the wound center to its edges. A circular traumatic wound (5 mm in diameter) was created on the dorsal midline at the shoulder blade level of male CD1 mice (n = 4, 10 weeks old, 30-35 g). Wound evolution was photodocumented for 14 days using the custom-designed photo booth, which controlled lighting conditions, focal distance, and subject positioning. Scaling and wound measurements were performed using segmentation in ImageJ software, and statistical analysis was conducted using statistical analysis software. The kinetics of wound closure showed a slight increase in wound size and perimeter between day 0 and day 2, followed by a gradual decrease until complete closure by day 14. The photodocumentation booth and computer-assisted digital planimetry enabled quantitative measurements with minimal variability. In conclusion, these tools provide a reliable and reproducible method for evaluating wound closure kinetics in pre-clinical models.

PMID:39878954 | DOI:10.3791/67475

JMIR Aging. 2025 Jan 29;8:e69493. doi: 10.2196/69493.

NO ABSTRACT

PMID:39878948 | DOI:10.2196/69493

Sports Med. 2025 Jan 29. doi: 10.1007/s40279-025-02179-5. Online ahead of print.

ABSTRACT

BACKGROUND: Diastasis recti abdominis (DRA), commonly occurring in postpartum women, is not only an aesthetic issue but is also highly associated with functional impairments. Various conservative treatment modalities have been employed in clinical practice to alleviate DRA. However, the comparative efficacy of these non-surgical treatments for improving the inter-recti distance (IRD) remains to be determined.

AIM: This current network meta-analysis (NMA) aims to compare the efficacy and acceptability of different non-surgical treatments with or without exercise for improving DRA in postpartum women.

METHODS: This NMA adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ClinicalKey, Cochrane Library, CINAHL, Embase, PubMed, Web of Science, and ClinicalTrials.gov were systematically searched for randomized controlled trial (RCT) studies up to April 2024. The analysis included studies that met the following criteria: (1) postpartum women diagnosed with DRA defined as an IRD greater than 2 cm; (2) intervention: any non-surgical treatments for at least 2 weeks; (3) comparator: no-treatment control; and (4) outcome: changes in IRD and acceptability. The relative efficacy between the non-surgical treatments tested and the probability of treatments were evaluated.

RESULTS: Twenty-one RCTs comprising 1195 participants aged from 18 to 45 years old were included. The forest plot revealed that exercise coupling with neuromuscular electrical stimulation systems (NMES) [mean difference (MD) – 1.12 cm, 95% confidence interval (CI) – 1.66 to – 0.58], acupuncture (MD – 0.81 cm, 95% CI – 1.54 to – 0.08), corset (MD – 0.65 cm, 95% CI – 1.24 to – 0.06), and exercise alone (MD – 0.48 cm, 95% CI – 0.80 to – 0.16) led to significant reductions in IRD compared with control. Further, the treatment ranking indicated that the combination of NMES with exercise has the highest probability (91.0%) of being the best treatment for reducing IRD, followed by acupuncture with exercise (71.1%). Treatments combined with exercise demonstrated better rankings for reducing IRD than individual treatments without exercise. Acceptability did not significantly differ between the groups.

LIMITATIONS AND IMPLICATIONS: This NMA encountered limitations due to participant variability, differing measurement methods, and sparse data, necessitating careful interpretation of findings regarding postpartum DRA interventions.

CONCLUSIONS: This NMA suggests NMES combined with exercise as the best treatment tested for DRA in postpartum women.

PROSPERO REGISTRATION: CRD42024541345.

PMID:39878918 | DOI:10.1007/s40279-025-02179-5

J Patient Rep Outcomes. 2025 Jan 29;9(1):13. doi: 10.1186/s41687-025-00842-z.

ABSTRACT

BACKGROUND: Multiple diseases, such as Adolescent Idiopathic Scoliosis (AIS), present at adolescent age and the impact on quality of life (QoL) prolongs into adulthood. For the EQ-5D, a commonly used instrument to measure QoL, the current guideline is ambiguous whether the youth or adult version is to be preferred at adolescent age. To assess which is most suitable, this study tested for equivalence along predefined criteria of the youth (EQ-5D-5L) and adult (EQ-5D-Y-5L) version in an adolescent population receiving bracing therapy for AIS.

METHODOLOGY: 107 adolescents were recruited from 4 scoliosis centers in the Netherlands between March 2022 and January 2023; they completed both EQ-5D’s and the SRS-22r (scoliosis-specific questionnaire). The following criteria were evaluated using the individual and sum of domains (level-sum-score (LSS)). Our primary criterion for non-equivalence of the EQ-5D’s was less than excellent (≤ 0.9) intra-individual agreement using Intraclass Correlation Coefficient (ICC) analysis for LSS and weighted (quadratic) kappa for domains. Secondary criteria were differences in ceiling using McNemar test; a different number of quantified hypotheses for construct validity achieved using the SRS-22r as comparator; differences in test-retest reliability by comparing ICC/kappa values using a Z-test.

RESULTS: Adolescents had a mean age of 14 years (range 12-18), and 78% were female. Ceiling was mostly comparable between EQ-5D’s, ranging from 78 to 81% for mobility and self-care, 52-54% for usual activities, and 31-36% for pain/discomfort. The EQ-5D-5L showed more ceiling (57%) compared to the EQ-5D-Y-5L (41%) on anxiety/depression (p = 0.006). Agreement between the EQ-5D’s did not meet our criterion for the LSS (ICC 0.79 (95% confidence interval 0.70-0.85)), and decreased further at the domain-level. Both EQ-5D’s achieved 5/7 validity hypotheses. Test-retest reliability was slightly better for EQ-5D-5L LSS (ICC 0.76 (0.64-0.84)) compared to EQ-5D-Y-5L LSS (ICC 0.69 (0.55-0.79)), although this was statistically insignificant (p = 0.284). This pattern was similar for most domains.

CONCLUSIONS: The EQ-5D versions showed insufficient agreement, and cannot be considered fully equivalent. While they were similar in terms of validity and test-retest reliability, differences in score distribution were present. Taken together, we advise using the EQ-5D-5L to monitor the QoL in adolescent patients with AIS, as it avoids switching instruments and thus data discontinuities. Future studies should verify these findings in different patient groups and the general population.

PMID:39878911 | DOI:10.1186/s41687-025-00842-z

Bioinformatics. 2025 Jan 29:btaf034. doi: 10.1093/bioinformatics/btaf034. Online ahead of print.

ABSTRACT

MOTIVATION: The accurate prediction of O-GlcNAcylation sites is crucial for understanding disease mechanisms and developing effective treatments. Previous machine learning models primarily relied on primary or secondary protein structural and related properties, which have limitations in capturing the spatial interactions of neighboring amino acids. This study introduces local environmental features as a novel approach that incorporates three-dimensional spatial information, significantly improving model performance by considering the spatial context around the target site. Additionally, we utilize sparse recurrent neural networks to effectively capture sequential nature of the proteins and to identify key factors influencing O-GlcNAcylation as an explainable machine learning model.

RESULTS: Our findings demonstrate the effectiveness of our proposed features with the model achieving an F1 score of 28.3%, as well as feature selection capability with the model using only the top 20% of features achieving the highest F1 score of 32.02%, a 1.4-fold improvement over existing PTM models. Statistical analysis of the top 20 features confirmed their consistency with literature. This method not only boosts prediction accuracy but also paves the way for further research in understanding and targeting O-GlcNAcylation.

AVAILABILITY: The entire code, data, features used in this study are available in the GitHub repository: https://github.com/pseokyoung/o-glcnac-prediction.

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:39878910 | DOI:10.1093/bioinformatics/btaf034

Eur Radiol. 2025 Jan 29. doi: 10.1007/s00330-025-11387-6. Online ahead of print.

ABSTRACT

OBJECTIVE: To conduct a meta-analysis assessing the diagnostic performance of the node reporting and data system (Node-RADS) for detecting lymph node (LN) invasion.

METHOD: We performed a systematic literature search of online scientific publication databases from inception up to July 31, 2024. We used the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) to assess the study quality, and heterogeneity was determined by the Q-test and measured with I² statistics. We employed the hierarchic summary ROC (HSROC) model to estimate the summary sensitivity and specificity. Subgroup analyses were conducted according to the imaging modality and cutoff values.

RESULTS: A total of 13 studies involving 1341 participants met the inclusion criteria. Pooled summary estimates of sensitivity, specificity, and area under the curve of HSROC were 0.79 (95% CI: 0.66-0.88), 0.86 (95% CI: 0.80-0.90), and 0.90 (95% CI: 0.87-0.92). Subgroup analysis showed that the pooled sensitivity and specificity for CT were 0.74 (95% CI: 0.63-0.83) and 0.84 (95% CI: 0.74-0.91), whereas for MRI were 0.84 (95% CI: 0.59-0.95) and 0.88 (95% CI: 0.81-0.93), respectively.

CONCLUSION: Node-RADS demonstrates the promising potential for the prediction of LN invasion, with high specificity but moderate sensitivity, particularly with optimal cutoff value ≥ 3. Indirect comparisons showed no significant difference between CT and MRI regarding overall diagnostic accuracy.

KEY POINTS: Question Since the Node-RADS has been proposed, a number of studies have assessed its diagnostic performance for evaluating LN invasion. Findings Node-RADS demonstrated high specificity but moderate sensitivity, and cutoff ≥ 3 is the optimal threshold; indirect comparison suggested no significant difference between CT and MRI. Clinical relevance This study synthesized currently available evidence on studies of utilizing Node-RADS for assessing LNI in patients with various cancers, providing valuable insights for radiologists for utilizing this new risk scoring system in clinical practice.

PMID:39878903 | DOI:10.1007/s00330-025-11387-6

Eur Radiol. 2025 Jan 29. doi: 10.1007/s00330-025-11369-8. Online ahead of print.

ABSTRACT

OBJECTIVES: To analyze the CT imaging features of extranodal natural killer/T (NK/T)-cell lymphoma, nasal type (ENKTCL-NT) involving the gastrointestinal tract (GI), and to compare them with those of Crohn’s disease (CD) and diffuse large B-cell lymphoma (DLBCL).

MATERIALS AND METHODS: Data were retrospectively collected from 17 patients diagnosed with GI ENKTCL-NT, 68 patients with CD, and 47 patients with DLBCL. The CT findings of ENKTCL-NT were analyzed and compared with those of CD and DLBCL. Data were analyzed using SPSS (version 25.0) and MedCalc (version 18.2.1). p < 0.05 was considered statistically significant.

RESULTS: The 17 patients with ENKTCL-NT included 11 males (64.7%) and 6 females (35.3%) (mean age, 46.41 ± 4.12 years). The CT features of ENKTCL-NT included: circumferential symmetric thickening (100%), moderate thickening (70.6%), skip lesions (52.9%), contiguous lesion (47.1%), mucosal or layered enhancement (70.6%), moderate mural enhancement (64.7%) with non-enhanced regions (47.1%), absence of lymphadenopathy (76.5%), bowel perforation or fistula (17.6%), and peri-enteric blurred fat space (70.6%). The presence of circumferential symmetric thickening, moderate mural enhancement, and non-enhanced regions were more indicative of ENKTCL-NT than CD (17/17 vs. 17/68, 11/17 vs. 22/68, 8/17 vs. 0/68, p < 0.05). The presence of skip lesions, mucosal or layered enhancement, and absence of peri-enteric lymphadenopathy were more indicative of ENKTCL-NT than DLBCL (9/17 vs. 2/47, 12/17 vs. 1/37, 13/17 vs. 19/47, p < 0.05).

CONCLUSION: CT imaging features can provide useful information for the early diagnosis of ENKTCL-NT and effectively differentiate it from CD and DLBCL.

KEY POINTS: Question Extranodal natural killer/T-cell lymphoma, nasal type (ENKTCL-NT) involving the gastrointestinal tract (GI) is highly malignant but easily misdiagnosed by clinicians and endoscopic examination. Findings CT could provide useful information in the diagnosis of ENKTCL-NT involving GI and in differentiating it from Crohn’s disease and diffuse large B-cell lymphoma. Clinical relevance This study will help improve the ability of radiologists to diagnose ENKTCL-NT involving GI, and a more predictive diagnosis will also alert clinicians to perform multiple deep endoscopic biopsies, which will contribute to the early diagnosis and treatment of ENKTCL-NT.

PMID:39878902 | DOI:10.1007/s00330-025-11369-8