Nevin Manimala

Age Ageing. 2025 Jul 1;54(7):afaf180. doi: 10.1093/ageing/afaf180.

ABSTRACT

BACKGROUND: Despite the well-documented health benefits of Physical Activity (PA), older adults often struggle to engage in PA. The present review examines the relationship between PA, motivation and basic psychological needs among older adults aged 65 and over, through the lens of Self-Determination Theory (SDT).

METHODS: Relevant studies that used qualitative methodologies and applied SDT framework were systematically searched in five electronic databases (i.e. Scopus, Web of Science, PubMed, PsycINFO and CINAHL). Methodological rigour was assessed using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research).

RESULTS: 21 studies met inclusion criteria (N = 412; ages 65-97). Four themes and nine subthemes were identified. Peer relationships emerged as a pivotal element in supporting most autonomous forms of motivation and satisfying psychological needs (i.e. autonomy, competence and relatedness). A peer coach was preferred during several health programs, enhancing competence and relatedness. Outdoor activities in natural settings promoted intrinsic motivation, while indoor activities were driven more by extrinsic motivation. Barriers included ageist stereotypes and perceptions of inevitable physical decline, which negatively impacted competence and autonomy, ultimately reducing motivation for PA.

CONCLUSIONS: This qualitative synthesis highlights a complex interplay of SDT components and social factors in influencing PA behaviours among older adults. Tailored interventions that integrate social interaction, provide feedback from coaches and offer choices among several exercises with graduate intensity levels are likely to enhance adherence in PA. Future interventions should address both psychological and social barriers to create inclusive PA strategies that meet older adults’ needs and motivation.

PMID:40601367 | DOI:10.1093/ageing/afaf180

J Vet Med Educ. 2025 Jun 30:e20240165. doi: 10.3138/jvme-2024-0165. Online ahead of print.

ABSTRACT

Lameness in horses resulting from foot pathology is very common. When investigating the cause of a lameness localised to the foot, the first step is most frequently radiographic imaging. Therefore, being able to identify normal anatomy and recognise pathology on radiographs is important for a veterinary medicine student to learn. Computer-aided learning (CAL) is becoming increasingly utilised in the teaching of students on medicine-related courses, especially post-COVID where online learning has been continued in hybridisation with in-person teaching.In this study, a low-cost CAL module was created focusing on anatomy and pathology of the equine foot on radiographic images and testing was carried out to evaluate how beneficial students found this resource for their learning. There were two research questions: 1. Can a useful CAL module be produced at low cost? 2. Will this CAL module function to increase student confidence? The CAL module was produced at no cost; similar CAL modules could be easily re-created using a similar module at a low-to-no cost. Three skills were reviewed: recognition of normal anatomy, identification of pathology, and selection of appropriate radiographic views for investigation of specific pathologies. A statistically significant increase in confidence of students’ ability to recognise pathology and to select radiographic views for investigating specific pathologies when comparing pre- and post-resource confidence. Anecdotally there was a positive response to the resource: users found it useful for the intended purpose. Therefore, a useful CAL module was produced at low cost, and did indeed increase students’ confidence in some areas investigated.

PMID:40601339 | DOI:10.3138/jvme-2024-0165

Am Surg. 2025 Jul 2:31348251358439. doi: 10.1177/00031348251358439. Online ahead of print.

ABSTRACT

IntroductionTransanal minimally invasive surgery (TAMIS) is a technique used for the management of low rectal neoplasms in properly selected patients. Transanal minimally invasive surgery may be performed using either laparoscopic or robotic platforms. Little data exists in the literature comparing the two. We hypothesize that the use of the robotic platform will facilitate superior outcomes due the advantages of the robotic platform in terms of its superior maneuverability, ease of suturing, and 3-dimensional visualization.MethodsThis retrospective study included adults who underwent a TAMIS via a robotic or laparoscopic approach in a rural tertiary care hospital between January 2016 and December 2023. Following IRB approval, patients who underwent TAMIS were identified using CPT codes 45171, 45172, 0184T, and S2900. Chart review was performed comparing approaches. Variables included patient demographics, operative time, blood loss, need for reoperation, presence of positive margins, and cost. Outcomes were compared using Fisher’s Exact and Mann-Whitney U-tests (SPSS version 22.0, IBM, Armonk NY).ResultsTwenty-seven patients met inclusion criteria (19 laparoscopic and 8 robotic). Both groups did not differ significantly in age (65.47 ± 12.16 vs 54.75 ± 19.09, P = 0.26) and sex (male, 73.7% vs 75.0%, P = 1.00). Outcomes did not differ statistically across the two groups with respect to operative time (1.54 ± 0.58 vs 1.35 ± 0.22 hours, P = 0.33), blood loss (89.5% minimal vs 100.0% minimal, P = 1.00), and incidence of positive margins (10.5% vs 12.5%, P = 1.00). The cost of the laparoscopic TAMIS was significantly lower ($2271/case vs $15,948/case, P < 0.001) compared to the robotic TAMIS approach.ConclusionsLaparoscopic and robotic TAMIS yield comparable results, but the laparoscopic approach is much less costly. Prospective studies comparing surgical outcomes and procedural costs are therefore warranted.

PMID:40601337 | DOI:10.1177/00031348251358439

JAMA Dermatol. 2025 Jul 2. doi: 10.1001/jamadermatol.2025.1976. Online ahead of print.

ABSTRACT

IMPORTANCE: There is limited comparative information on regulatory approved and pipeline treatments in hidradenitis suppurativa (HS).

OBJECTIVE: To compare efficacy, safety, and tolerability of treatments for moderate to severe HS.

DATA SOURCES: MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from inception to June 28, 2024.

STUDY SELECTION: Phase 2 and 3 randomized clinical trials of medical interventions (cytokine inhibitors, small molecule inhibitors, cell inhibitors, and other novel immune or inflammatory modifiers) for adults with moderate to severe HS having primary efficacy assessments between 12 and 16 weeks.

DATA EXTRACTION AND SYNTHESIS: Data extraction and risk of bias assessments were performed independently by 2 reviewers. Efficacy outcomes were analyzed using random-effects network meta-analysis. Safety and tolerability outcomes were analyzed using pairwise fixed-effect meta-analyses vs placebo. Data analysis was performed between August 22, 2024, and April 7, 2025.

MAIN OUTCOMES AND MEASURES: Primary efficacy, safety, and tolerability outcomes were Hidradenitis Suppurativa Clinical Response (HiSCR)-50, occurrence of serious adverse events (SAEs), and treatment discontinuation due to adverse events, respectively. HiSCR-75 was a secondary efficacy outcome.

RESULTS: Of 26 eligible trials, 25 had available HiSCR-50 data, including 5767 total patients and 39 unique treatments. Compared with placebo, the following treatments were associated with significantly higher HiSCR-50 response rates: sonelokimab, 120 mg, every 4 weeks; lutikizumab, 300 mg, every 2 weeks; adalimumab, 40 mg, once per week; sonelokimab, 240 mg, every 2 weeks; bimekizumab, 320 mg, every 2 weeks; povorcitinib, 15 mg, once per day; bimekizumab, 320 mg, every 4 weeks; secukinumab, 300 mg, every 4 weeks; and secukinumab, 300 mg, every 2 weeks. Most differences between adalimumab, 40 mg, once per week, and other targeted treatments were not statistically significant. The percentage of patients experiencing SAEs ranged from 0% to 10% in the placebo groups, 0% to 8% in the adalimumab (40 mg, once per week) groups, and 0% to 6% in the other active treatment groups. The percentage of patients discontinuing treatment due to adverse events ranged from 0% to 10% in the placebo groups, 0% to 4% in the adalimumab (40 mg, once per week) groups, and 0% to 15% (ropsacitinib) in the other active treatment groups.

CONCLUSIONS AND RELEVANCE: This network meta-analysis provides evidence for the comparative efficacy and safety of currently approved and pipeline medications for moderate to severe HS in the absence of head-to-head trials.

PMID:40601333 | DOI:10.1001/jamadermatol.2025.1976

JAMA Netw Open. 2025 Jul 1;8(7):e2517834. doi: 10.1001/jamanetworkopen.2025.17834.

ABSTRACT

IMPORTANCE: Systemic antibiotic use for patients with a non-Clostridioides difficile infection (CDI) is a major risk factor for recurrent CDI. Increasing use of oral vancomycin for secondary prophylaxis against recurrent CDI in this context has uncertain efficacy.

OBJECTIVE: To evaluate whether oral vancomycin prophylaxis compared with placebo is effective against recurrent CDI during and 8 weeks after the end of study treatment.

DESIGN, SETTING, AND PARTICIPANTS: This phase 2, placebo-controlled, double-blind randomized clinical trial was conducted in 4 large health systems across the upper Midwest US. Adults who had completed treatment for CDI within the past 180 days and were taking a systemic antibiotic for a non-CDI indication were enrolled between May 21, 2018, and March 30, 2023, and followed up for 8 weeks after the end of study treatment.

INTERVENTION: Participants were randomized 1:1 to 125 mg of oral vancomycin or placebo once daily during antibiotic use for a non-CDI plus 5 days following cessation of those antibiotics.

MAIN OUTCOMES AND MEASURES: The primary outcome was recurrent CDI incidence during treatment and the 8-week follow-up period. The secondary outcome was vancomycin-resistant Enterococcus carriage in stool.

RESULTS: Among 81 randomized participants (median age, 59 years [IQR, 50-67 years]), all were included in the primary as-randomized analysis (39 in the vancomycin group; 42 in the placebo group). Sixty patients (74.1%) completed 8-week follow-up and were included in the secondary as-completed treatment analysis (31 in the vancomycin group; 29 in the placebo group). Recurrent CDI occurred in 17 of 39 participants in the oral vancomycin group (43.6%) and 24 of 42 in the placebo group (57.1%; absolute difference in percentage, -13.5% [95% CI, -35.1% to 8.0%]). Adverse events occurred in 27 of 39 participants in the oral vancomycin group (69.2%) and 27 of 42 in the placebo group (64.3%). Vancomycin-resistant Enterococcus carriage was found in 15 of 30 patients in the oral vancomycin group (50.0%) and 6 of 25 in the placebo group (24.0%) (P = .048) 8 weeks after treatment.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the incidence of recurrent CDI was lower (though did not reach significance) in participants taking oral vancomycin compared with those taking placebo. Because the study was underpowered, it was unable to reveal firm conclusions about the efficacy (or lack thereof) of vancomycin prophylaxis with respect to recurrent CDI.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03462459.

PMID:40601321 | DOI:10.1001/jamanetworkopen.2025.17834

JAMA Netw Open. 2025 Jul 1;8(7):e2518513. doi: 10.1001/jamanetworkopen.2025.18513.

ABSTRACT

IMPORTANCE: Over 90% of the US population relies on community water supplies (CWS), which generally use chlorine for disinfection. Trihalomethanes are regulated disinfection byproducts associated with bladder cancer and adverse birth outcomes. Animal studies report trihalomethanes, especially brominated compounds, may damage kidney function, but epidemiologic research is limited.

OBJECTIVE: To evaluate long-term exposure to trihalomethanes in residential CWS and its association with chronic kidney disease (CKD) risk.

DESIGN, SETTING, AND PARTICIPANTS: The California Teachers Study (CTS) is an ongoing prospective cohort of female teachers and administrators enrolled between 1995 and 1996 with data linked to mortality and health care records. This cohort study analyzed CTS data from January 1, 2005, once CKD diagnostic coding was adopted, through December 31, 2018. Statistical analysis was conducted from July 2023 to December 2024.

EXPOSURES: Residence time-weighted mean concentrations of 4 trihalomethanes, including 3 brominated trihalomethanes and chloroform, were calculated using annual measurements from CWS serving participants’ homes from 1995 to 2005. Uranium and arsenic (potentially nephrotoxic metals, previously evaluated in the cohort) from CWS were included as part of a g-computation mixture analysis.

MAIN OUTCOMES AND MEASURES: Cases of moderate (stage 3) to end-stage CKD were identified with diagnostic codes or dialysis-related procedures. Mixed-effects multivariable-adjusted Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for CKD by exposure to trihalomethane levels (US maximum contaminant level of 80 μg/L).

RESULTS: The study sample included 89 320 female participants (median age, 50 years [IQR, 43-61 years]) with 6242 CKD cases. Median concentrations were 5.5 μg/L (IQR, 0.5-24.1 μg/L; 95th percentile, 57.8 μg/L) for total trihalomethanes and 2.7 μg/L (IQR, 0.7-11.3 μg/L; 95th percentile, 30.0 μg/L) for brominated trihalomethanes. In flexible spline-based models, a clear exposure-response association was observed between trihalomethanes and CKD risk, with the highest risk for brominated trihalomethanes. The HRs for CKD risk associated with brominated trihalomethanes at the highest 2 exposure categories (75th percentile and at or above the 95th percentile) were 1.23 (95% CI, 1.13-1.33) and 1.43 (95% CI, 1.23-1.66), respectively (P < .001 for trend). Brominated trihalomethanes were the largest contributor (52.9%) to the association of the overall mixture with CKD risk, followed by uranium (35.4%), arsenic (6.2%), and chloroform (5.5%).

CONCLUSIONS AND RELEVANCE: In this prospective cohort study of California female teachers, exposure to trihalomethane concentrations less than 80 μg/L (US current standard) increased CKD risk, particularly brominated trihalomethanes, which are not separately regulated in community water. The findings may have public health implications given the widespread use of water chlorination and growing burden of CKD.

PMID:40601319 | DOI:10.1001/jamanetworkopen.2025.18513

JAMA Netw Open. 2025 Jul 1;8(7):e2518525. doi: 10.1001/jamanetworkopen.2025.18525.

ABSTRACT

IMPORTANCE: Mobility, defined as the ability to move freely, decreases with increasing age. The increasing frequency and intensity of extreme weather and climate events (EWCEs), such as hurricanes, pose a considerable risk for older adults (aged ≥65 years) to maintain their mobility (ie, mobility resilience).

OBJECTIVE: To examine whether an association exists between older-aged neighborhoods and mobility resilience following an EWCE.

DESIGN, SETTING, AND PARTICIPANTS: This case series study used 2022 demographics with prospectively observed social infrastructure point-of-interest visitations before and after Hurricane Ian (September 23-30, 2022) to characterize neighborhood mobility resilience. Analyses were conducted for all residents (age categories, <36 years, 36-42 years, 43-53 years, >53 years) of central and southern Florida neighborhoods.

MAIN OUTCOMES AND MEASURES: Using a resilience triangle framework, daily point-of-interest visitation data before, during, and after the event were used to measure the duration of recovery, ratio of recovery, ratio of impact, and area of resilience triangles.

RESULTS: Among 1819 neighborhoods including 8 084 335 residents (median [range] of neighborhood ages, 46 [19-82] years; 51% female), a total of 225 218 social infrastructure points of interest with 75.4 million visitation records were included. Compared with younger-aged neighborhoods, neighborhoods in the oldest age quartile had a longer duration of mobility recovery after Hurricane Ian (1.137 days; 95% CI, 0.844-1.431 days), lower mobility recovery ratio (-2.1%; 95% CI, -4.0% to -0.2%), higher ratio of impact (1.2%; 95% CI, 0.3%-2.1%), and higher cumulative losses of daily mobility (17.0 percentage-days; 95% CI, 8.4-26.3 percentage-days). These associations were substantially attenuated by hurricane wind exposure (ie, the strength of the storm) (Lindemann, Merenda, and Gold relative importance, 0.919-0.960 vs 0.031-0.065 for age quartiles).

CONCLUSIONS AND RELEVANCE: In this case series study, neighborhoods with an older population showed compromised mobility resilience associated with the aftermath of Hurricane Ian. These findings may inform neighborhood-targeted mobility interventions for climate resilience.

PMID:40601318 | DOI:10.1001/jamanetworkopen.2025.18525

JAMA Netw Open. 2025 Jul 1;8(7):e2518569. doi: 10.1001/jamanetworkopen.2025.18569.

ABSTRACT

IMPORTANCE: There is a disproportionately high rate of overdose deaths immediately following an emergency department (ED) visit for opioid overdose. Thus, an improved understanding of disparities in ED treatment and referral is vital. Racial and ethnic disparities in access to naloxone and buprenorphine have been described in the outpatient setting but prevalence in the ED setting remains understudied.

OBJECTIVE: To examine racial and ethnic disparities in treatment referral rates in ED patients with opioid overdose.

DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis of a prospective consecutive cohort from the Toxicology Investigators Consortium (TOXIC) Fentalog Study from September 21, 2020, to November 11, 2023. Ten hospital sites were a part of the TOXIC network and participants included ED patients in aged 18 years or older with opioid overdose. Data were analyzed from December 2022 to March 2025.

EXPOSURES: Patient race, ethnicity, sex, and other demographic and clinical factors of interest.

MAIN OUTCOMES AND MEASURES: Study outcomes included the proportion of patients receiving a referral to outpatient addiction care and the proportion receiving a naloxone kit or prescription or buprenorphine prescription at discharge. Descriptive statistics were tabulated, and χ2 and multivariable logistic regression analyses were used to evaluate for differences by race, ethnicity, sex, and other demographic and clinical variables.

RESULTS: In this study, 1683 patients met all inclusion criteria (mean [SD] age, 42.5 [14.5] years; 1221 males [72.6%]; 461 females [27.4%]; 447 Black patients [26.6%]; 63 Hispanic patients [4.3%]; 867 White patients [51.5%]). Of the 1683 included patients, 299 (17.8%) received a referral for outpatient treatment, 713 (42.4%) received a naloxone kit or prescription, and 141 (8.4%) received a buprenorphine prescription. Compared with White patients, Black patients had a decreased adjusted odds ratio (aOR) of outpatient treatment referral (aOR, 0.67; 95% CI, 0.47-0.97). Hospital admission was also associated with increased adjusted odds of outpatient treatment referral (aOR, 3.13; 95% CI, 2.34-4.20). Geographic variation was associated with all primary and secondary outcomes.

CONCLUSIONS AND RELEVANCE: In this study, Black patients were less likely to receive outpatient referrals for OUD. These findings underscore the need for targeted interventions to address racial disparities in ED care for OUD, particularly in enhancing referral processes.

PMID:40601317 | DOI:10.1001/jamanetworkopen.2025.18569

JAMA Netw Open. 2025 Jul 1;8(7):e2518826. doi: 10.1001/jamanetworkopen.2025.18826.

ABSTRACT

IMPORTANCE: Neighborhood characteristics may be independently associated with survival after acute myocardial infarction (AMI).

OBJECTIVE: To examine the association of living in a marginalized neighborhood with mortality and care for younger AMI survivors (aged <65 years) in a universal health care system.

DESIGN, SETTING, AND PARTICIPANTS: Population-based retrospective cohort using clinical and administrative databases in Ontario, Canada. Participants were younger patients hospitalized for their first AMI who received invasive evaluation and survived to 7 days after discharge between April 1, 2010, and March 1, 2019. Statistical analysis was performed between May 27, 2022, and March 31, 2025.

EXPOSURES: Neighborhood marginalization, a metric comprising material deprivation, residential instability, and dependency.

MAIN OUTCOMES AND MEASURES: All-cause death, all-cause hospitalizations, and subsequent AMIs. Proportional hazards regression models were used to quantify the association of marginalization with outcomes over 3 years.

RESULTS: Among 65 464 AMI patients (median age, 56 [IQR, 50-61] years; 22.9% female), increasing neighborhood marginalization was associated with higher rates of mortality beginning 30 days after discharge and persisting over time. At 3 years, mortality rates ranged from 2.2% in the least marginalized neighborhood quintile (Q1) to 5.2% in the most marginalized (Q5). Adjusted hazard ratios for mortality over 3 years of follow-up were significantly higher in patients from marginalized neighborhoods and ranged from 1.13 (95% CI, 0.95-1.35) in Q2 to 1.52 (95% CI, 1.29-1.80) in Q5. Over 1 year, differences were observed between Q1 and Q5 in visits to primary care physicians (Q1, 96.1%; Q5, 91.6%) and cardiologists (Q1, 88.0%; Q5, 75.7%), as well as diagnostic testing.

CONCLUSIONS AND RELEVANCE: In this cohort study of younger AMI survivors with universal health care, living in marginalized neighborhoods was associated with adverse outcomes. The observed differences in health service utilization among marginalized patients warrant further investigation to better understand the underlying structural and systemic factors.

PMID:40601315 | DOI:10.1001/jamanetworkopen.2025.18826

J Comput Assist Tomogr. 2025 Jul 2. doi: 10.1097/RCT.0000000000001769. Online ahead of print.

ABSTRACT

OBJECTIVE: To construct and validate the optimal model for preoperative prediction of proliferative HCC based on habitat-derived radiomics features of Gd-EOB-DTPA-Enhanced MRI.

METHODS: A total of 187 patients who underwent Gd-EOB-DTPA-enhanced MRI before curative partial hepatectomy were divided into training (n=130, 50 proliferative and 80 nonproliferative HCC) and validation cohort (n=57, 25 proliferative and 32 nonproliferative HCC). Habitat subregion generation was performed using the Gaussian Mixture Model (GMM) clustering method to cluster all pixels to identify similar subregions within the tumor. Radiomic features were extracted from each tumor subregion in the arterial phase (AP) and hepatobiliary phase (HBP). Independent sample t tests, Pearson correlation coefficient, and Least Absolute Shrinkage and Selection Operator (LASSO) algorithm were performed to select the optimal features of subregions. After feature integration and selection, machine-learning classification models using the sci-kit-learn library were constructed. Receiver Operating Characteristic (ROC) curves and the DeLong test were performed to compare the identified performance for predicting proliferative HCC among these models.

RESULTS: The optimal number of clusters was determined to be 3 based on the Silhouette coefficient. 20, 12, and 23 features were retained from the AP, HBP, and the combined AP and HBP habitat (subregions 1, 2, 3) radiomics features. Three models were constructed with these selected features in AP, HBP, and the combined AP and HBP habitat radiomics features. The ROC analysis and DeLong test show that the Naive Bayes model of AP and HBP habitat radiomics (AP-HBP-Hab-Rad) archived the best performance. Finally, the combined model using the Light Gradient Boosting Machine (LightGBM) algorithm, incorporating the AP-HBP-Hab-Rad, age, and AFP (Alpha-Fetoprotein), was identified as the optimal model for predicting proliferative HCC. For the training and validation cohort, the accuracy, sensitivity, specificity, and AUC were 0.923, 0.880, 0.950, 0.966 (95% CI: 0.937-0.994) and 0.825, 0.680, 0.937, 0.877 (95% CI: 0.786-0.969), respectively. In its validation cohort of the combined model, the AUC value was statistically higher than the other models (P<0.01).

CONCLUSIONS: A combined model, including AP-HBP-Hab-Rad, serum AFP, and age using the LightGBM algorithm, can satisfactorily predict proliferative HCC preoperatively.

PMID:40601290 | DOI:10.1097/RCT.0000000000001769