Nevin Manimala

Acad Med. 2024 Dec 24. doi: 10.1097/ACM.0000000000005962. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates mental health-related content to delineate potentially deficient topics for improvement in future obstetrics and gynecology (OBGYN) resident educational curriculum initiatives.

METHOD: In this quantitative content analysis, educational resources commonly used by OBGYN residents were selected based on a 2020 multi-institutional survey of OBGYN residents and informal group discussion with 32 OBGYN residents from a New York academic institution in April 2020. After independent screening, the authors iteratively developed, tested, and implemented a coding scheme for relevant keywords. The primary outcome was total depression and anxiety content in the educational resource materials. Information about other mental health conditions was additionally collected, and content ratings were assigned. Descriptive statistics were used and interrater reliability calculated. Data were accessed and archived on July 30, 2020, for all future analyses.

RESULTS: From 7 materials reviewed, 36 items were analyzed. The cumulative percentage of resources with mental health-related content was 1.1%. Professional society publications contained the most content at 5.0% (95% CI, 1.4%-12.3%), and a podcast series contained the least at 0.6% (95% CI, 0.02%-3.3%). Depressive (30 [83.3%]), anxiety (12 [33.3%]), and bipolar (9 [25.0%]) disorders were the most common content, whereas posttraumatic stress disorder (5 [13.9%]), postpartum psychosis (4 [11.1%]), obsessive compulsive disorder (3 [8.3%]), and schizophrenia (2 [5.6%]) were the least. The content ratings for schizophrenia, postpartum psychosis, posttraumatic stress disorder, obsessive compulsive disorder, pathophysiology of mental health conditions, lactation safety, and fetal and maternal adverse effects of psychiatric medications and psychiatric disease were low. No educational resource reviewed in this study contained all recommended Council on Resident Education in Obstetrics and Gynecology residency curriculum topics related to mental health.

CONCLUSIONS: Mental health disorders are underrepresented in commonly used OBGYN educational resources, reinforcing the need for more comprehensive inclusion of these topics in OBGYN curriculum initiatives.

PMID:39752589 | DOI:10.1097/ACM.0000000000005962

Inorg Chem. 2025 Jan 3. doi: 10.1021/acs.inorgchem.4c04603. Online ahead of print.

ABSTRACT

The pentafluoroorthotellurate group (-OTeF₅, teflate) exhibits high electron-withdrawing properties. Indeed, it is often used as a bulky substitute for fluoride due to its high chemical stability and larger size, which reduces its tendency to act as a bridging ligand. These characteristics make it a valuable ligand in synthetic chemistry, facilitating the preparation of molecular structures analogous to polymeric fluoride-based compounds. In this study, we explore the electronic structure of the teflate group by using advanced Quantum Chemical Topology (QCT) methods to better understand its bonding nature and compare its group electronegativity with that of the halogens. For that, we examine XOTeF₅ systems (X = F, Cl, Br, I) and decompose X-OTeF₅ interactions into classical (ionic) and exchange-correlation (covalent) contributions by using interacting quantum atoms (IQA) energy decomposition scheme. We also conduct a detailed analysis of electron distribution by utilizing the statistical framework of electron distribution functions (EDFs) and examine the electron localization function (ELF), electron density, and reduced density gradient scalar functions, as well as delocalization indices and QTAIM charges. The results show that the electron-withdrawing properties of the teflate group are comparable to those of fluorine, albeit slightly lower. Moreover, its internal bonding is primarily ionic. Additionally, we compare -OTeF₅ with other O-donor groups, demonstrating that the electron-withdrawing properties within OEF₅ (E = S, Se, Te) systems are nearly identical, and these groups show a higher group electronegativity than OCF₃, OC(CF₃)₃, and OC₆F₅.

PMID:39752584 | DOI:10.1021/acs.inorgchem.4c04603

J Occup Environ Hyg. 2025 Jan 3:1-7. doi: 10.1080/15459624.2024.2421004. Online ahead of print.

ABSTRACT

Farmers may be at a higher risk of developing hip osteoarthritis (OA) due to the high demands of their occupation. To the authors’ knowledge, the gait patterns of farmers that may be associated with hip joint degeneration have yet to be analyzed. Therefore, this study compares gait mechanics between farmers and non-farmers (controls). It is hypothesized that farmers would exhibit altered lower extremity joint mechanics during walking when compared to matched controls. This exploratory study included five farmers and five sex-, age-, and body mass index (BMI)-matched controls. A 3D gait analysis was performed while study participants walked at a self-selected speed on an instrumented treadmill. Sagittal plane hip, knee, and ankle kinetics and kinematics were assessed. Effect sizes and between-group differences in demographics and gait mechanics were assessed. There were no group differences in walking speed, total stance time as well as hip and knee joint kinematics (p > 0.05). Farmers exhibited statistical trends (p = 0.07-0.08) of lower peak ankle plantarflexion angles, higher plantarflexor moments, higher knee flexion moment impulse, and higher peak vertical ground reaction force during the first and second halves of stance. Additionally, farmers ambulated with a significantly higher knee extensor moment (p = 0.04) and moment impulse (p = 0.05) during the first half of stance and a higher ankle plantarflexion moment impulse (p = 0.04). The results demonstrate a multi-joint gait alteration in farmers compared to non-farmers and may suggest a compensatory gait pattern to optimize hip joint mechanics and mitigate hip joint degeneration. These results provide a preliminary understanding of the impact that agricultural occupations have on joint mechanics that may be associated with the increased prevalence of hip OA in the farming population.

PMID:39752577 | DOI:10.1080/15459624.2024.2421004

Liver Int. 2025 Feb;45(2):e16224. doi: 10.1111/liv.16224.

ABSTRACT

BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) and its more severe subtype, metabolic dysfunction-associated steatohepatitis (MASH), are highly prevalent and strongly associated with obesity and type 2 diabetes (T2D). This study sought to identify challenges to the diagnosis, treatment and management of people living with MASLD and MASH and understand the key barriers to adopting relevant clinical guidelines.

METHODS: A real-world, cross-sectional study (BARRIERS-MASLD) consisting of a quantitative survey and qualitative interviews of physicians in France, Germany, Italy, Spain and the United Kingdom was conducted from March to September 2023. Descriptive statistics were used for data analysis.

RESULTS: A total of 626 physicians completed the survey; n = 10 from each country participated in the qualitative interviews. Physicians considered the presence of MASH to be highly impactful on how they treated people living with obesity (66%) and T2D (69%). Over one-third (35%) of the respondents could not identify any MASH-specific clinical guidelines issued by medical societies or associations top-of-mind, but overall awareness rose when prompted about country-specific guidelines. Physicians said they would need evidence of success (48%) and clinical guidelines that address common MASLD comorbidities (38%) to increase their adoption.

CONCLUSIONS: This study found that lack of awareness around MASLD and MASH clinical guidelines and clearly established care pathways, particularly for addressing common comorbidities, was a key factor preventing physicians from optimising care for people living with MASH in Europe. This research highlights opportunities to improve education and training about clinical guidelines and care coordination.

PMID:39752213 | DOI:10.1111/liv.16224

J Vis. 2025 Jan 2;25(1):2. doi: 10.1167/jov.25.1.2.

ABSTRACT

Sensory-motor systems can extract statistical regularities in dynamic uncertain environments, enabling quicker responses and anticipatory behavior for expected events. Anticipatory smooth pursuit eye movements (aSP) have been observed in primates when the temporal and kinematic properties of a forthcoming visual moving target are fully or partially predictable. To investigate the nature of the internal model of target kinematics underlying aSP, we tested the effect of varying the target kinematics and its predictability. Participants tracked a small visual target in a constant direction with either constant, accelerating, or decelerating speed. Across experimental blocks, we manipulated the probability of each kinematic condition varying either speed or acceleration across trials; with either one kinematic condition (providing certainty) or with a mixture of conditions with a fixed probability within a block. We show that aSP is robustly modulated by target kinematics. With constant-velocity targets, aSP velocity scales linearly with target velocity in blocked sessions, and matches the probability-weighted average in the mixture sessions. Predictable target acceleration does also have an influence on aSP, suggesting that the internal model of motion that drives anticipation contains some information about the changing target kinematics, beyond the initial target speed. However, there is a large variability across participants in the precision and consistency with which this information is taken into account to control anticipatory behavior.

PMID:39752177 | DOI:10.1167/jov.25.1.2

JAMA Netw Open. 2025 Jan 2;8(1):e2449556. doi: 10.1001/jamanetworkopen.2024.49556.

ABSTRACT

IMPORTANCE: Research indicates that social drivers of health are associated with cancer screening adherence, although the exact magnitude of these associations remains unclear.

OBJECTIVE: To investigate the associations between individual-level social risks and nonadherence to guideline-recommended cancer screenings.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2022 Behavioral Risk Factor Surveillance System data from 39 US states and Washington, DC. Analyses for each specific cancer screening subsample were limited to screening-eligible participants according to the latest US Preventive Services Task Force (USPSTF) guidelines. Data were analyzed from February 22 to June 5, 2024.

EXPOSURES: Ten social risk items, including life satisfaction, social and emotional support, social isolation, employment stability, food security (2 questions), housing security, utility security, transportation access, and mental well-being.

MAIN OUTCOMES AND MEASURES: Up-to-date status (adherence) was assessed using USPSTF definitions. Adjusted risk ratios (ARRs) and 95% CIs were estimated using modified Poisson regression with robust variance estimator.

RESULTS: A total of 147 922 individuals, representing a weighted sample of 78 784 149 US adults, were included in the analysis (65.8% women; mean [SD] age, 56.1 [13.3] years). The subsamples included 119 113 individuals eligible for colorectal cancer screening (CRCS), 7398 eligible for lung cancer screening (LCS), 56 585 eligible for cervical cancer screening (CCS), and 54 506 eligible for breast cancer screening (BCS). Findings revealed slight differences in effect size magnitude and in some cases direction; therefore results were stratified by sex, although precision was reduced for LCS. For the social contextual variables, life dissatisfaction was associated with nonadherence for CCS (ARR, 1.08; 95% CI, 1.01-1.16) and BCS (ARR, 1.22; 95% CI, 1.15-1.29). Lack of support was associated with nonadherence in CRCS in men and women and BCS, as was feeling isolated in CRCS in women and BCS. An association with feeling mentally distressed was seen in BCS. Under economic stability, food insecurity was associated with increased risk of nonadherence in CRCS in both men and women, CCS, and BCS; the direction of effect sizes for LCS were the same, but were not statistically significant. Under built environment, transportation insecurity was associated with nonadherence in CRCS in women and BCS, and cost barriers to health care access were associated with increased risk of nonadherence in CRCS for both men and women, LCS in women, and BCS, with the greatest risk and with reduced precision seen in LCS in women (ARR, 1.54; 95% CI, 1.01-2.33).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of adults eligible for cancer screening, findings revealed notable variations in screening patterns by both screening type and sex. Given that these risks may not always align with patient-centered social needs, further research focusing on specific target populations is essential before effective interventions can be implemented.

PMID:39752162 | DOI:10.1001/jamanetworkopen.2024.49556

JAMA Netw Open. 2025 Jan 2;8(1):e2452371. doi: 10.1001/jamanetworkopen.2024.52371.

ABSTRACT

IMPORTANCE: Suicide prevention requires risk identification, intervention, and follow-up. Traditional risk identification relies on patient self-reporting, support network reporting, or face-to-face screening. Statistical risk models have been studied and some have been deployed to augment clinical judgment. Few have been tested in clinical practice via clinical decision support (CDS). Barriers to effective CDS include potential alert burden for a stigmatized clinical problem and lack of data on how best to integrate scalable risk models into clinical workflows.

OBJECTIVE: To evaluate the effectiveness of risk model-driven CDS on suicide risk assessment.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness randomized clinical trial was performed from August 17, 2022, to February 16, 2023, in the Department of Neurology across the divisions of Neuro-Movement Disorders, Neuromuscular Disorders, and Behavioral and Cognitive Neurology at Vanderbilt University Medical Center, an academic medical center in the US Mid-South. Patients scheduled for routine care in those settings were randomized at visit check-in. Follow-up was completed March 16, 2023, and data were analyzed from April 11 to July 24, 2023. Analyses were based on intention to treat.

INTERVENTIONS: Interruptive vs noninterruptive CDS to prompt further suicide risk assessment using a real-time, validated statistical suicide attempt risk model. In the interruptive CDS, an alert window via on-screen pop-up and a patient panel icon were visible simultaneously. Dismissing the alert hid it with no effect on the patient panel icon. The noninterruptive CDS showed the patient panel icon without the pop-up alert. When present, the noninterruptive CDS displayed “elevated suicide risk score” in the patient summarization panel. Hovering over this icon resulted in a pop-up identical to the interruptive CDS.

MAIN OUTCOMES AND MEASURES: The main outcome was the decision to assess risk in person. Secondary outcomes included rates of suicidal ideation and attempts in both treatment arms and baseline rates of documented screening during the prior year. Manual medical record review of every trial encounter was used to determine whether suicide risk assessment was subsequently documented.

RESULTS: A total of 561 patients with 596 encounters were randomized to interruptive or noninterruptive CDS in a 1:1 ratio (mean [SD] age, 59.3 [16.5] years; 292 [52%] women). Adjusting for clinician cluster effects, interruptive CDS led to significantly higher numbers of decisions to screen (121 of 289 encounters [42%]) compared with noninterruptive CDS (12 of 307 encounters [4%]) (odds ratio, 17.70; 95% CI, 6.42-48.79; P < .001) and compared with the baseline rate the prior year (64 of 832 encounters [8%]). No documented episodes of suicidal ideation or attempts occurred in either arm.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of interruptive and noninterruptive CDS to prompt face-to-face suicide risk assessment, interruptive CDS led to higher numbers of decisions to screen with documented suicide risk assessments. Well-powered large-scale trials randomizing this type of CDS compared with standard of care are indicated to measure effectiveness in reducing suicidal self-harm.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05312437.

PMID:39752160 | DOI:10.1001/jamanetworkopen.2024.52371

Pharmacoeconomics. 2025 Jan 3. doi: 10.1007/s40273-024-01462-z. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Approximately half of lung adenocarcinomas in East Asia harbor epidermal growth factor receptor (EGFR) mutations. EGFR testing followed by tissue-based next-generation sequencing (NGS), upfront tissue-based NGS, and complementary NGS approaches have emerged on the front line to guide personalized therapy. We study the cost effectiveness of exclusionary EGFR testing for Taiwanese patients newly diagnosed with advanced lung adenocarcinoma.

METHODS: This economic evaluation was conducted from the perspective of the healthcare sector with a lifetime horizon. Simulated patients were entered into a joint model combining decision trees and partitioned survival models upon diagnosis of advanced lung adenocarcinoma. We compared exclusionary EGFR testing with upfront tissue-based NGS and complementary NGS approaches. The model inputs were derived from regional estimates (prevalence of targetable gene alterations), trials (testing accuracy, survival outcomes, and adverse events), ACT Genomics (testing costs), National Health Insurance payments, retail prices (drug costs), and hospital cohorts (utility values). All costs were made equivalent to 2023 US dollars. An annual discount rate of 3% was applied. We adopted a willingness-to-pay threshold of US$70,000 per quality-adjusted life-year. One-way deterministic and probabilistic analyses were performed.

RESULTS: The incremental cost-effectiveness ratio of exclusionary EGFR testing versus upfront tissue-based NGS was US$15,521 per quality-adjusted life-year, whereas the incremental net monetary benefit was US$2530. The costs of osimertinib and pembrolizumab were the major determinants. The incremental net monetary benefit of exclusionary EGFR testing versus complementary NGS approach was US$2174, and its major determinants included the true-negative rate of EGFR testing and the prevalence rate of an EGFR mutation. Given the willingness-to-pay thresholds of US$35,000, US$70,000, and US$105,000 (1, 2, and 3 per capita gross domestic product) per quality-adjusted life-year, the probabilities that exclusionary EGFR testing would be cost effective were 79.1%, 95.6%, and 91.2%, respectively.

CONCLUSIONS: Our analysis suggests that exclusionary EGFR testing is a cost-effective strategy for Taiwanese patients newly diagnosed with advanced lung adenocarcinoma.

PMID:39752129 | DOI:10.1007/s40273-024-01462-z

Bull Math Biol. 2025 Jan 3;87(2):26. doi: 10.1007/s11538-024-01402-0.

ABSTRACT

Immune events such as infection, vaccination, and a combination of the two result in distinct time-dependent antibody responses in affected individuals. These responses and event prevalence combine non-trivially to govern antibody levels sampled from a population. Time-dependence and disease prevalence pose considerable modeling challenges that need to be addressed to provide a rigorous mathematical underpinning of the underlying biology. We propose a time-inhomogeneous Markov chain model for event-to-event transitions coupled with a probabilistic framework for antibody kinetics and demonstrate its use in a setting in which individuals can be infected or vaccinated but not both. We conduct prevalence estimation via transition probability matrices using synthetic data. This approach is ideal to model sequences of infections and vaccinations, or personal trajectories in a population, making it an important first step towards a mathematical characterization of reinfection, vaccination boosting, and cross-events of infection after vaccination or vice versa.

PMID:39752117 | DOI:10.1007/s11538-024-01402-0

CJEM. 2025 Jan 3. doi: 10.1007/s43678-024-00839-5. Online ahead of print.

ABSTRACT

OBJECTIVES: POCUS is a core emergency medicine skill and mainstay of early pregnancy assessment. The ultrasound competency assessment tool was developed as an entrustment-based assessment tool for use by content experts evaluating trainees performing multiple POCUS study types. The objective of this study was to evaluate the scoring and extrapolation inferences of the tool within Kane’s validity framework when used to assess trainees performing an early pregnancy POCUS.

METHODS: This was a multicentered study of emergency medicine residents participating in a POCUS assessment. After a background questionnaire, participants were read a case stem requesting a POCUS evaluation of an early pregnancy patient. Trainees were independently assessed by two fellowship-trained faculty. Descriptive statistics and two-way random, intraclass correlation coefficients, Cronbach’s alpha were calculated on the merged data and used to assess all domains. Domain scores and an entrustment score for each participant were used to create a composite score. A one-way analysis of variance was performed.

RESULTS: 36 trainees and 5 assessors completed the study. When used to assess trainee POCUS performance in early pregnancy, the tool demonstrated good to excellent interrater reliability for image acquisition, image generation, clinical integration, and entrustment (intraclass correlation coefficients 80-91 p < .001). The preparation domain had poor, but statistically significant interrater reliability (intraclass correlation coefficient 0.46 p = .04). An analysis of variance suggested the POCUS performance scores differed based on prior experience [F(2,32) = 3.74, p = .021).

CONCLUSION: This study adds further validity evidence relating to scoring and extrapolation of the ultrasound competency assessment tool when used to assess trainees performing a POCUS study in early pregnancy.

PMID:39752091 | DOI:10.1007/s43678-024-00839-5