Nevin Manimala

JAMA Netw Open. 2025 Nov 3;8(11):e2543385. doi: 10.1001/jamanetworkopen.2025.43385.

ABSTRACT

IMPORTANCE: Obstructive sleep apnea (OSA) is common among patients with ischemic stroke and transient ischemic attack (TIA) and is associated with poor outcomes. Guidelines favor considering sleep testing among patients with cerebrovascular events.

OBJECTIVE: To evaluate the effectiveness of a quality improvement intervention to increase OSA diagnostic testing after stroke or TIA.

DESIGN, SETTING, AND PARTICIPANTS: This stepped-wedge cluster randomized trial of patients with ischemic stroke or TIA admitted to Department of Veterans Affairs facilities assessed outcomes during 8 data periods of 7-month duration (May 15, 2019, to January 24, 2024).

INTERVENTION: The quality improvement intervention was implemented with a virtual kickoff; site teams reviewed their facility’s baseline data, identified improvement opportunities, considered barriers and potential solutions to diagnosing OSA among patients with cerebrovascular disease, and developed a site-specific action plan. Team members attended monthly collaborative conferences. A web-based platform provided quality data, action plans, and a resource library. The research team provided external facilitation.

MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day OSA diagnostic testing rate. Secondary outcomes were 30-day positive airway pressure treatment rate, 90-day recurrent vascular event rate, and 90-day readmission rate. Implementation effects were assessed using generalized linear mixed-effects models with binomial distributions and log link fit to patient-level data with site-level random effects.

RESULTS: The study included 1747 patients at 6 intervention sites (mean [SD] age, 68.7 [11.1] years; 1634 [93.5%] male) and 7454 patients at 30 usual care sites (mean [SD] age, 71.8 [10.8] years; 7114 [95.4%] male). The index event was stroke (vs TIA) in 1429 (81.8%) at the intervention sites and 5931 (79.6%) at the usual care sites. The 30-day diagnostic testing rate increased from 2.1% (20 of 952) during baseline to 29.1% (189 of 650) during implementation (odds ratio [OR], 16.13; 95% CI, 8.25-31.53); the 30-day diagnostic testing rate varied from 0.7% to 2.2% among usual care sites across data periods. Thirty-day positive airway pressure treatment increased from 0.3% (3 of 952) during baseline to 2.8% (18 of 650) during implementation (OR, 14.22; 95% CI, 2.40-84.40) at the intervention sites, while varying from 0.0% (0 of 876) to 0.4% (4 of 1158) at the usual care sites. No statistically significant changes were observed in 90-day readmission or recurrent vascular event rates.

CONCLUSIONS AND RELEVANCE: In this cluster randomized trial of patients with acute cerebrovascular events, quality improvement approaches increased OSA testing. These results suggest that health care systems can improve the delivery of guideline-concordant care for patients with acute ischemic stroke and TIA by delivering inpatient sleep medicine services.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04322162.

PMID:41236739 | DOI:10.1001/jamanetworkopen.2025.43385

JAMA Netw Open. 2025 Nov 3;8(11):e2543637. doi: 10.1001/jamanetworkopen.2025.43637.

ABSTRACT

IMPORTANCE: The long-term impacts of the COVID-19 pandemic on after-school activity patterns among youths remain poorly understood, hindering the development of policies to promote beneficial engagement.

OBJECTIVE: To examine longitudinal changes in after-school activity participation before (2019), during (2020 to 2021), and after (2022) the COVID-19 pandemic and assess whether these changes differed by sex.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study used linked yearly census survey data from the Well-Being and Engagement Collection (WEC) survey in South Australia. Participants were youths starting year 6 of school on January 29, 2019, who progressed to starting year 9 by January 31, 2022. Data analyzed were collected in weeks 2 to 5 of term 2 (May 2019 to May 2022).

EXPOSURE: COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES: Weekly frequency of engagement in 11 after-school activities was measured in the WEC survey. Ordinal logistic regression models examined the trajectory of after-school activity participation. The results were visualized as estimated proportions over time.

RESULTS: A total of 14 350 participants (mean [SD] age in 2019, 11.7 [0.5] years; 7232 [50.4%] male) contributing 36 572 observations were included in the analysis. Participation in music, art, reading for fun, hanging out with friends, tutoring, and sports declined during and after the pandemic. Among these participants, youths who never participated in art (2019, 25.7% [95% CI, 24.5%-27.0%]; 2022, 70.4% [95% CI, 68.8%-72.0%]) and reading for fun (2019, 10.8% [95% CI, 10.1%-11.6%]; 2022, 52.6% [95% CI, 50.5%-54.8%]) showed the largest changes. Conversely, time spent watching television, doing chores, and playing electronic games showed meaningful increases but returned to prepandemic levels in 2022. Social media was the only activity that showed consistent increases during the 4 years, demonstrating the greatest growth. Everyday use increased from 26.0% (95% CI, 24.6%-27.3%) in 2019 to 85.4% (95% CI, 84.1%-86.7%) in 2022. Females spent more time on social media than males, while males experienced a more pronounced decline in reading.

CONCLUSIONS AND RELEVANCE: This cohort study found associations between the COVID-19 pandemic and after-school activity participation patterns among youths, with rapid increases in social media use compared with all other activities. These associations largely persisted 3 years after the onset of the pandemic. These findings provide a timely benchmark for evaluating forthcoming policies aimed at restricting youth access to social media platforms. Interventions to support activities such as sports, art, and music are warranted.

PMID:41236738 | DOI:10.1001/jamanetworkopen.2025.43637

JAMA Netw Open. 2025 Nov 3;8(11):e2543701. doi: 10.1001/jamanetworkopen.2025.43701.

ABSTRACT

IMPORTANCE: Although hepatitis C virus (HCV) is an oncovirus, its association with the risk of pancreatic ductal adenocarcinoma (PDAC) is unclear. In addition, it is unknown whether there is differential risk for PDAC across HCV genotypes.

OBJECTIVE: To assess the association between chronic HCV and PDAC.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, national, population-based cohort study was conducted across Veterans Health Administration (VA) sites. The study included veterans with HCV testing documented in the VA or VA-linked Medicare with at least 1 inpatient or outpatient visit between October 1, 2001, and September 30, 2020. Patients were followed-up for at least 18 months after this visit. Data were analyzed from October 2023 to September 2025.

EXPOSURE: HCV status was categorized as chronic HCV, exposure to HCV, or no chronic HCV infection.

MAIN OUTCOMES AND MEASURES: The association of HCV status with PDAC was evaluated using Cox proportional hazards regression, adjusting for demographic and clinical confounders. Analysis was substratified by HCV genotype.

RESULTS: Of 6 330 856 people tested for HCV (5 841 571 men [92.3%]; median [IQR] age, 61.6 years [49.9-70.1]), 246 218 (3.9%) had chronic HCV and 209 492 (3.3%) were exposed. Of the 33 451 individuals (0.5%) who developed PDAC, age at diagnosis was younger among those with vs those without HCV (median [IQR] age, 65.0 [59.9-69.6] years vs 72.4 [66.7-79.0] years). Compared with no HCV infection, chronic HCV infection (adjusted hazard ratio [aHR], 1.76; 95% CI, 1.67-1.86) and HCV exposure (aHR, 1.18; 95% CI; 1.11-1.25) were associated with increased risk of incident PDAC. Hazards for PDAC were greater for HCV genotype 3 (aHR, 2.02; 95% CI, 1.67-2.45) and genotype 1 (aHR, 1.75; 95% CI, 1.64-1.87) than for genotype 2 (aHR, 1.35; 95% CI, 1.14-1.60) compared with no HCV infection.

CONCLUSIONS AND RELEVANCE: In this cohort study of veterans, chronic HCV infection was associated with a 1.8-fold higher risk of PDAC diagnosis, and HCV genotypes 3 and 1 had greater PDAC risk than genotype 2. These findings prompt future research on the mechanisms underlying this association and the impact of HCV treatment on PDAC risk.

PMID:41236736 | DOI:10.1001/jamanetworkopen.2025.43701

Cancer Epidemiol Biomarkers Prev. 2025 Nov 14. doi: 10.1158/1055-9965.EPI-25-1230. Online ahead of print.

ABSTRACT

BACKGROUND: C-reactive protein (CRP) is a widely used inflammatory biomarker that has been related to colorectal cancer (CRC) risk. However, observational studies are prone to confounding and reverse causality.

METHODS: We conducted a two-sample Mendelian randomization using CRP GWAS data from 59,605 Korean individuals and CRC GWAS data from 23,572 cases and 48,700 controls from an East Asia population. The analysis had 80% power to detect an odds ratio (OR) of 1.12 for CRC risk per two-fold increase in CRP levels.

RESULTS: Genetically predicted serum CRP levels (per two-fold increase) were not significantly associated with CRC risk (inverse-variance weighted OR: 0.995, 95% confidence interval: 0.893-1.109, P-value: 0.929). Null findings remained consistent in sensitivity analyses excluding the horizontally pleiotropic effect.

CONCLUSIONS: Despite sufficient statistical power, little evidence supported a causal association between CRP and CRC risk in East Asians.

IMPACT: Our findings suggest that CRP is unlikely to be a key determinant of colorectal carcinogenesis, aligning with prior studies in European populations.

PMID:41236733 | DOI:10.1158/1055-9965.EPI-25-1230

Int J Neurosci. 2025 Nov 14:1-11. doi: 10.1080/00207454.2025.2589395. Online ahead of print.

ABSTRACT

BackgroundWe aimed to evaluate the association between elevated cardiac troponin I (cTnI) and clinical outcomes in AIS patients receiving reperfusion therapy.MethodsWe conducted a multicenter retrospective cohort study of AIS patients treated with thrombolytics at Southern Illinois Healthcare and the University of Oklahoma (2017-2024). Demographic, clinical, laboratory, and radiographic data were collected. Elevation of cTnI was defined as levels above 0.028 ng/mL. For high sensitivity troponins, the cutoff was 15 ng/L for women and 20 ng/L for men.Outcomes included symptomatic intracranial hemorrhage (sICH), in-hospital mortality, and functional status at 30 days (good outcome defined as mRS ≤2). Overlap-weighted multivariable logistic regression was performed, adjusting for demographics, comorbidities, and stroke severity. Statistical significance was set at p < 0.05.ResultsAmong 496 patients, 143 (29%) had elevated cTnI. Compared with patients with normal cTnI, those with elevated levels were older, had more vascular risk factors, and higher baseline NIHSS. Elevated cTnI was not significantly associated with sICH (OR:3.75, 95%CI 0.52-27.21, p = 0.19), but was independently associated with increased in-hospital mortality (OR:1.96, 95%CI 1.62-6.20, p = 0.025) and decreased odds of good functional outcome at 30 days (OR:0.40, 95%CI 0.19-0.84, p = 0.016). Subgroup analyses showed these associations were most pronounced in older patients and in those with moderate (NIHSS 6-15) to severe (NIHSS 16-20 and > 20) strokes, whereas no significant relationships were observed in younger patients or mild strokes. Normalization of cTnI during hospitalization did not improve survival (p > 0.05).ConclusionsIn our study, elevated cTnI on admission is an independent predictor of poor short-term outcomes in AIS patients treated with reperfusion therapy. Troponin measurement may provide important prognostic information, particularly in older patients and those with more severe strokes.

PMID:41236729 | DOI:10.1080/00207454.2025.2589395

Account Res. 2025 Nov 14:1-11. doi: 10.1080/08989621.2025.2575442. Online ahead of print.

ABSTRACT

BACKGROUND: This article reports on the prevalence of registration of empirical studies presented at three editions of the World Conference on Research Integrity at the time of abstract submission.

METHODS: During registration and abstract submission, applicants were invited to answer questions on registration of the study they presented and their academic background.

RESULTS: Descriptive analyses of the responses regarding a total of 452 abstracts describing empirical studies showed that the prevalence of registration among presenters of empirical research did not increase across the three WCRIs, and was on average 28%. The verifiability of claims of registration did increase over time, however, from 44% to 88% of the abstracts of empirical studies claimed to be registered. Reasons given for not registering varied substantially, but little faith in its usefulness and unfamiliarity were frequently mentioned. Younger researchers tended to register more often than others, and researchers with a biomedical background registered more frequently.

CONCLUSION: We suggest simplifying the registration process and propose that funding agencies, research institutes, and scholarly journals should demand registration of empirical studies.

PMID:41236715 | DOI:10.1080/08989621.2025.2575442

Appl Biochem Biotechnol. 2025 Nov 14. doi: 10.1007/s12010-025-05473-0. Online ahead of print.

ABSTRACT

This study aims to evaluate the potential of green-synthesized titanium dioxide (TiO₂) nanoparticles (NPs) derived from herbal extracts-namely Camellia sinensis (Green Tea), Eclipta prostrata (Bhringraj), Glycyrrhiza glabra (Licorice), and Cinnamomum zeylanicum (Cinnamon)-for enhancing the Sun Protection Factor (SPF) in sunscreen formulations. Addressing the environmental and toxicity concerns associated with conventionally synthesized TiO₂ NPs, this eco-friendly approach offers a sustainable and effective alternative for cosmetic applications without compromising efficacy. The synthesized nanoparticles were characterized using UV-Vis spectroscopy, X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR), and then incorporated into oil-in-water emulsions containing 5% homosalate. In vitro SPF was measured using the Labsphere UV-2000S system, while formulation stability was assessed via pH monitoring, rheological behavior, and accelerated centrifugation using the LUMiSizer. Statistical analysis, including one-way ANOVA and effect size metrics (η², Cohen’s d), confirmed significant SPF enhancement, particularly in formulations using Green Tea and Cinnamon-derived TiO₂ NPs, which showed 3.12-fold and 3.11-fold improvements, respectively. Notably, smaller crystallite size (30.2 nm in Green Tea-derived TiO₂) correlated with higher SPF (14.97 ± 0.31). All formulations exhibited excellent physical and thermal stability. These findings underscore the promise of plant-mediated TiO₂ NPs as a viable, sustainable solution for next-generation sunscreen products, with further investigation warranted for scale-up and in vivo validation.

PMID:41236699 | DOI:10.1007/s12010-025-05473-0

Aging Clin Exp Res. 2025 Nov 14;37(1):326. doi: 10.1007/s40520-025-03224-z.

ABSTRACT

BACKGROUND: Ageism and stigma toward individuals with dementia contribute to their social exclusion and negatively impact their well-being. Intergenerational interventions, particularly those based on shared enjoyable experiences, have shown potential in reducing negative stereotypes. This study explored whether a Silent Disco event could challenge ageism and dementia-related stigma by fostering positive intergroup contact.

AIMS: The study assessed the effectiveness of an intergenerational Silent Disco event in reducing ageism and stigma among young adults (21-40 years, M = 32.76 ± 4.70), middle-aged adults (41-60, years M = 51.21 ± 5.88), and young-old adults (61-80 years, M = 66.67 ± 6.10).

METHODS: A 6-item questionnaire with two subscales-“Non-inclusion” and “Unpleasantness of company”-was administered to 115 participants before and after the event to measure negative stereotypes about aging and dementia. Changes in attitudes were analyzed across age groups.

RESULTS: The event reduced stigma-related unpleasantness in the total sample (p = .020) and ageism-related unpleasantness among middle-aged participants (p = .011). However, no statistically significant changes were observed in non-inclusion perceptions for either ageism or stigma.

DISCUSSION: These findings indicate that intergenerational Silent Disco events help reduce specific negative stereotypes-particularly unpleasant perceptions of older adults and people with dementia-with the strongest reduction in ageism-related unpleasantness seen in middle-aged participants. However, the persistence of non-inclusion attitudes highlights the need for broader interventions to address social exclusion.

CONCLUSIONS: Silent Disco events show potential in challenging stereotypes and fostering inclusivity, but additional strategies are needed to promote deeper intergenerational engagement and social inclusion.

PMID:41236675 | DOI:10.1007/s40520-025-03224-z

Geroscience. 2025 Nov 14. doi: 10.1007/s11357-025-02009-6. Online ahead of print.

ABSTRACT

Postoperative delirium is a potentially devastating complication of surgery that commonly affects older adults. Neurofilament light chain (NfL) is a biomarker of neuronal injury with reported associations with the development of postoperative delirium. Previous studies suggest that nighttime dexmedetomidine may help prevent delirium following cardiac surgery. However, the mechanisms involved in the delirium-sparing properties of dexmedetomidine treatment remain unclear. This study investigated circulating NfL levels as an objective molecular biomarker associated with postoperative delirium and investigated whether nighttime dexmedetomidine moderates the association between NfL and delirium severity. Serum collected from participants aged 60 years and older who underwent cardiac surgery in the Minimizing ICU Neurological Dysfunction with Dexmedetomidine Induced Sleep (MINDDS) trial were analyzed for NfL concentrations using single-molecule immunoassays (n = 355 patients with preoperative NfL and delirium severity scores). Delirium assessments were performed using the Confusion Assessment Method (CAM). The primary outcome was the peak CAM-Severity score observed within 3 days after surgery. The analysis investigated the associations between preoperative and postoperative NfL levels and delirium severity, and whether nighttime dexmedetomidine modified these associations. Elevated preoperative NfL was associated with increased delirium incidence (odds ratio = 1.62, 95% confidence interval [1.22-2.14], p = 0.001). A one-standard-deviation increase in preoperative NfL was associated with a 0.32-point increase in CAM-S (95% confidence interval [0.14-0.50], p = 0.001). Dexmedetomidine significantly attenuated the association between preoperative NfL levels and delirium severity suggesting that dexmedetomidine may intervene early in the disease process to mitigate neuronal damage in older adults following surgery. This study provides insight into the use of preoperative NfL levels to predict delirium risk and reveals a novel interaction between dexmedetomidine treatment and delirium severity.

PMID:41236671 | DOI:10.1007/s11357-025-02009-6

Langenbecks Arch Surg. 2025 Nov 14;411(1):12. doi: 10.1007/s00423-025-03890-7.

ABSTRACT

BACKGROUND: Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes among patients undergoing elective gastric cancer surgery, as in the GASTRODATA Registry, and to identify associated risk factors.

METHODS: We conducted an international prospective study on patients aged ≥ 18 years undergoing elective surgery for gastric cancer with curative intent from January 4 to September 30, 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression were used to identify variables associated with the 90-day outcome.

RESULTS: 380 collaborators from 47 countries submitted data on 1538 patients. Median age was 65 years (IQR: 19-94), and 58.5% were males. 90-day morbidity and mortality rates were 38.2% (n = 587) and 2.9% (n = 45), respectively. Pre-operative higher Charlson Comorbidity Index, higher ASA score, pre-operative weight loss > 10%, positive specimen margin, and post-operative pathological IV staging (p value < 0.05) were significantly associated with clinically relevant complications and mortality.

CONCLUSION: Elective gastric cancer surgery has a 90-day morbidity of 38.2% and a 90-day mortality of 2.9% globally. This study provided the most comprehensive international 90-day prospective data to date regarding gastric cancer surgery. Several factors associated with higher morbidity were identified, highlighting the importance of a unified language on surgical morbidity, prehabilitation, and ongoing audits to enhance patient outcomes.

PMID:41236666 | DOI:10.1007/s00423-025-03890-7