Nevin Manimala

JAMA Netw Open. 2025 Aug 1;8(8):e2526067. doi: 10.1001/jamanetworkopen.2025.26067.

ABSTRACT

IMPORTANCE: Donation physicians (DPs) are usually critical care specialists whose responsibilities may include assessment of donation eligibility, care of potential donors, death determination, education, and advocacy. While DP programs have been implemented in some countries with the aim of optimizing the organ donation process, there are few studies evaluating their effectiveness.

OBJECTIVE: To assess the association of a DP program with key performance metrics.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used interrupted time series analysis to compare baseline data from intensive care units and emergency departments in a Canadian province (December 2019 to February 2020 and March 2021 to May 2021) with data following the initial 3 years of a DP program (July 2021 to June 2024). Donation data included consecutive deceased critically ill patients with various forms of brain injury who received mechanical ventilation in the last 12 hours of life.

EXPOSURE: Implementation of a province-wide DP program coupled with regular audit and feedback aimed at identifying and minimizing missed donation opportunities.

MAIN OUTCOMES AND MEASURES: Missed organ donation opportunities, defined as occurring when families of eligible potential donors were not given the option of donation. Secondary outcomes included appropriate notification of the provincial donation organization, donors per million population, and median number of organs transplanted per donor.

RESULTS: Over 42 months, there were 1072 eligible potential donors, including 635 (59%) following death by neurologic criteria and 437 (41%) following death by circulatory criteria. The median (IQR) age was 44.6 (30.8-58.3) years, 662 (62%) were male, and the most common cause of death was hypoxic-ischemic brain injury. During the initial 36 months of the DP program, 129 of 942 (14%) eligible potential donors were missed, compared with 43 of 123 (33%) during 6 months of baseline data (P < .001). The monthly proportion of missed cases decreased by 10.9% (95% CI, -22.0% to 0.3%; P = .06) immediately following the start of the program and then declined -0.7% (95% CI, -0.9% to -0.5%; P < .001) per month. Appropriate notification of the provincial organ donation organization increased 0.9% (95% CI, 0.6% to 1.3%, P < .001) per month. The annual donation rate increased from 14.0 to 23.7 donors per million. The median (IQR) number of organs transplanted per donor did not change (4 [3-5]; P = .69). Missed opportunities occurred in 3% of eligible potential donors when the most responsible physician was a DP and 17% when it was not (P < .001).

CONCLUSIONS: In this cohort study of consecutive eligible potential organ donors, implementation of a novel DP program was associated with a sustained reduction in missed organ donation opportunities, increased referrals, and a higher deceased donation rate.

PMID:40773195 | DOI:10.1001/jamanetworkopen.2025.26067

JAMA Netw Open. 2025 Aug 1;8(8):e2526077. doi: 10.1001/jamanetworkopen.2025.26077.

ABSTRACT

IMPORTANCE: The emergence of fentanyl and other high-potency synthetic opioids (HPSOs) has not only been underlying overdose deaths, but has complicated initiation of methadone and buprenorphine for opioid use disorder (OUD) treatment, including in the hospital. In response, clinicians with addiction expertise have developed novel initiation practices, yet no studies have characterized initiation practices nationally.

OBJECTIVE: To assess the use of novel hospital-based practices for initiating methadone and buprenorphine.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study of directors of hospital-based addiction consult services (ACS) associated with addiction medicine and addiction psychiatry fellowships in hospitals in the US was conducted using a REDcap anonymous survey from October 2023 to April 2024.

EXPOSURE: Predefined methadone and buprenorphine initiation practices. Standard methadone initiation was defined as 40 mg oral maximum on day 1 with up-titration of 5 to 10 mg every 3 days. Rapid methadone initiation was defined as any initiation regimen more rapid than standard. Buprenorphine initiation practices included low dose, high dose, traditional, and rescue.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of ACS directors using predefined methadone and buprenorphine initiation practices. Perceived impact of the drug supply on methadone and buprenorphine initiation was assessed through a 5-point Likert scale ranging from strongly disagree to strongly agree. Typical selection of buprenorphine initiation practices was assessed using 7 case-based scenarios intended to represent common hospital scenarios.

RESULTS: Among 80 consult services, 58 directors (72.5%; median [IQR] age, 41 [38-50] years; 27 of 57 [47.3%] women) completed surveys, one of which was partially completed. Of 57 ACS directors, specialties included addiction medicine (41 respondents [71.9%]), addiction psychiatry (11 respondents [19.3%]), general or consult liaison psychiatry (11 respondents [19.3%]), and toxicology (2 respondents [3.5%]). Among those who reported initiating methadone (47 of 58 respondents [81.0%]), 33 (70.2%) agreed that HPSOs changed their methadone initiation practices. Of 46 respondents, 40 (87.0%) reported rapid initiation of methadone, and of those, 26 (65.0%) reported using rapid initiation for more than 50% of initiations. Full-agonist opioids were used by 31 of 46 ACS directors (67.4%) to treat withdrawal during methadone initiation. Of 58 respondents, 54 (93.1%) agreed that HPSOs changed their buprenorphine initiation practices. All 58 ACS directors reported that their initiation practices offered buprenorphine initiation, including 53 of 57 (92.9%) offering low dose, 50 of 57 (87.7%) offering traditional, 43 of 57 (75.4%) offering high dose , and 20 of 57 (35.1%) offering rescue. For 7 clinical cases provided, low-dose initiation was the most commonly endorsed method of buprenorphine initiation, except in the case of a person presenting in significant withdrawal 2 days after last fentanyl use.

CONCLUSIONS AND RELEVANCE: The findings of this survey study of hospital-based academic ACS directors suggest that methadone and buprenorphine initiation has adapted to a shifting opioid supply, often outpacing research and changes in clinical guidelines.

PMID:40773194 | DOI:10.1001/jamanetworkopen.2025.26077

JAMA Netw Open. 2025 Aug 1;8(8):e2526089. doi: 10.1001/jamanetworkopen.2025.26089.

ABSTRACT

IMPORTANCE: Hippocampal sclerosis (HS), defined as severe neuronal loss and astrogliosis in coronal sections of the midhippocampus cornu ammonis 1 or subiculum, is an important pathology associated with limbic-predominant age-related transactive response DNA-binding protein 43 encephalopathy neuropathological change (LATE-NC), Alzheimer disease, and dementia. The association of diet with HS or HS with LATE-NC in humans remains underexplored.

OBJECTIVE: To investigate the association of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet with HS and HS with LATE-NC.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included autopsied participants from the ongoing Rush Memory and Aging Project cohort study. Participants with dietary and neuropathological data from 2004 to 2024 were included. Data were analyzed from April 3, 2024, to May, 13, 2025.

EXPOSURES: Mean MIND diet scores (range, 0-15; higher score indicates better diet), computed from all validated food frequency questionnaires administered annually for up to 18 years before death.

MAIN OUTCOMES AND MEASURES: The outcomes of interest were presence of HS, assessed using hematoxylin and eosin staining, and presence of LATE-NC, detected by TDP-43 immunohistochemistry in 8 brain regions. For a subset of 300 participants, hippocampal neuronal loss severity was scored using a semiquantitative scale from 0, indicating none, to 5, severe, and categorized as none to mild, moderate, and severe neuronal loss.

RESULTS: Among 809 participants (mean [SD] age at death, 91.3 [6.1] years; 538 [72%] female; mean [SD] follow-up, 7.2 [4.4] years), HS was present in 82 (10.1%) participants; 71 participants (9%) had both HS and LATE-NC, and in the scored subset, 43 participants (14%) had moderate and 35 participants (12%) had severe hippocampal neuronal loss. Higher MIND diet scores were associated with lower odds of HS (odds ratio [OR], 0.78; 95% CI, 0.65 to 0.95) and HS with LATE-NC (OR, 0.79; 95% CI, 0.64 to 0.97) after controlling for age at death, sex, education, total calories, APOE-ε4 status, AD, and vascular pathologies. In mediation analyses, the MIND diet was associated with less dementia at the time of death (β = -0.26; 95% CI, -0.36 to -0.15; P < .001), with an indirect association of 21% through HS (β = -0.05; 95% CI, -0.10 to -0.01; P = .02). A higher MIND diet score was associated with less hippocampal neuronal loss (P for trend = .01).

CONCLUSIONS AND RELEVANCE: This cohort study of autopsied participants found that MIND diet adherence during follow-up was associated with a lower likelihood of HS, HS with LATE-NC, and hippocampal neuronal loss. The association of diet with dementia was partially mediated by its association with HS. These findings suggest that the MIND diet may reduce adverse brain health outcomes.

PMID:40773193 | DOI:10.1001/jamanetworkopen.2025.26089

Radiol Technol. 2025 Jan-Feb;96(3):192-196.

ABSTRACT

PURPOSE: To assess the awareness of medical imaging students about cardiopulmonary resuscitation (CPR) and how to perform it correctly.

METHODS: This cross-sectional study assessed CPR knowledge among third- and fourth-year students enrolled in the bachelor of medical imaging program at Fatima College of Health Sciences (FCHS). A survey was adopted from Saquib et al and modified and validated by 2 experts, then piloted with 5 potential participants. The survey included questions about demographics as well as knowledge of and perceptions regarding CPR performance. The awareness and student perception questions were designed in a multiple-choice question format.

RESULTS: Fifty-seven students completed the survey. Among these, 50% did not know CPR or basic life support (BLS) sequences. However, 84.2% of participants had heard of CPR and BLS, and 89.5% wanted to learn them. Furthermore, 91.2% of respondents agreed with adding a mandatory formal CPR or BLS course to the current medical imaging undergraduate program at FCHS. Students’ knowledge of CPR and BLS differed between the Abu Dhabi campus and the Al Ain campus.

DISCUSSION: These findings agree with previous studies that found medical imaging students and students in other health care education programs have more general knowledge about CPR and BLS but less specific knowledge about performing them. Also aligned with other studies, the findings showed that trained individuals are more likely to perform CPR or BLS and are more confident in their abilities.

CONCLUSION: Students in the FCHS bachelor of medical imaging program showed a lack of awareness of how to perform CPR. A formal CPR and patient safety course is recommended as part of the medical imaging curriculum.

PMID:40773157

Eur Arch Paediatr Dent. 2025 Aug 7. doi: 10.1007/s40368-025-01089-4. Online ahead of print.

ABSTRACT

PURPOSE: The study aimed to use eye tracking technology to assess children’s visual attention and preferences towards paediatric dentists and dental operatory. The secondary objective was to determine the stress levels associated with it.

METHODS: A pilot study included 40 children aged 4-12 years. Eye movements were tracked using the View-Point eye tracker, measuring mean dwell time, total fixations, time to first fixation (TTFF), and total fixation time (TFT). Respiratory and heart rates were recorded. Statistical analysis was performed using the Wilcoxon rank-sum test and paired t-test (p < 0.05).

RESULTS: While no significant differences were observed in overall dwell times, TTFF, or TFT among image pairs, male children showed significantly higher dwell times and fixations for male dentist images (p = 0.02; 0.002), with similar results for female children viewing female dentist images (p = 0.007). TFT was longer for images of dentists in white coats (p = 0.008) and yellow dental chairs (p = 0.04). Stress levels did not significantly differ by gender or age.

CONCLUSION: Eye tracking proves to be a valuable tool in pediatric dentistry for assessing children’s preferences. Children of a certain gender preferred dentists of the same gender, while most favoured dentists in white coats and yellow dental chairs. Further research with advanced technology can better explore children’s dental preferences in paediatric dental settings.

PMID:40773154 | DOI:10.1007/s40368-025-01089-4

Discov Ment Health. 2025 Aug 7;5(1):116. doi: 10.1007/s44192-025-00253-y.

ABSTRACT

BACKGROUND: Mental health workers in post-conflict settings such as Timor Leste face distinct stressors stemming from limited human resources, underdeveloped systems, and ongoing socio-political instability, all of which increase the risk of psychological distress among these professionals. Consequently, constructs such as mindfulness, cognitive fusion, and coping strategies are essential not only theoretically significant, but also serve as practical targets for strengthening mental resilience of these professionals in these high-burden environments. This study aims to investigate the relationships between mindfulness, cognitive fusion, coping strategies, and psychological distress (depression, anxiety, and stress) among mental health workers in Timor Leste.

METHODS: A cross-sectional study design was employed, involving a convenience sample of 37 mental health workers from PRADET and the national referral hospital in Dili. Mindfulness was assessed using the Toronto Mindfulness Questionnaire (TMQ), psychological flexibility using the Acceptance and Action Questionnaire (AAQ-II), cognitive fusion was measured using the Cognitive Fusion Questionnaire (CFQ), and coping strategies were evaluated using the DBT-Ways of Coping Checklist (DBT-WCCL). Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scales (DASS-21). All scales were using English validated versions. Descriptive statistics, Pearson correlation coefficients, and multiple regression analyses were used to analyze the data.

RESULTS: Significant positive correlations were found between Depression and Anxiety (Spearman’s rho = 0.649, p < 0.001), and between Depression and Stress (Spearman’s rho = 0.753, p < 0.001). Depression was also significantly correlated with Cognitive Fusion (Spearman’s rho = 0.445, p = 0.006) and Blaming Others (Spearman’s rho = 0.422, p = 0.009), and negatively correlated with Coping Strategies (Skills Use) (Spearman’s rho =- 0.341, p = 0.039). Anxiety and Stress were highly correlated (Spearman’s rho = 0.855, p < 0.001), and both were significantly associated with Cognitive Fusion, General Dysfunctional Coping, and Blaming Others. Mindfulness (De-Centering) showed a strong positive correlation with Mindfulness (Curiosity) (Spearman’s rho = 0.770, p < 0.001), and was also weakly associated with General Dysfunctional Coping (Spearman’s rho = 0.343, p = 0.038). Overall, the results suggest that higher levels of depression, anxiety, and stress are linked to greater cognitive fusion and dysfunctional coping, while effective coping skills are negatively associated with depression.

CONCLUSION: The findings highlight the critical roles of cognitive fusion and coping strategies in predicting psychological distress among mental health workers in Timor Leste. Cognitive fusion and dysfunctional coping strategies were associated with higher levels of depression, anxiety, and stress. Adaptive coping strategies, such as skills use, were linked to lower levels of depression. Given the high risk of vicarious trauma, compassion fatigue, and secondary traumatic stress disorder in this population, targeted interventions promoting mindfulness and adaptive coping skills are essential. Addressing these factors can enhance resilience and well-being among mental health professionals, ultimately improving the quality of care provided to their clients.

PMID:40773146 | DOI:10.1007/s44192-025-00253-y

Blood Res. 2025 Aug 7;60(1):42. doi: 10.1007/s44313-025-00091-5.

ABSTRACT

PURPOSE: Allogeneic hematopoietic stem cell transplantation remains a curative option for acute leukemia. While an adequate CD34⁺ cell dose is essential for engraftment, the optimal upper threshold in haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) remains unclear.

METHODS: We retrospectively analyzed 81 patients with acute leukemia who underwent haplo-PBSCT with reduced-intensity conditioning between 2010 and 2020. Patients were stratified by CD34⁺ cell dose (< 8 × 10⁶/kg vs. ≥ 8 × 10⁶/kg). Clinical outcomes, including overall survival (OS), non-relapse mortality (NRM), graft failure, and graft-versus-host disease (GVHD) incidence, were compared.

RESULTS: A higher CD34⁺ cell dose was associated with inferior OS (P = 0.022) and increased NRM (P = 0.002), despite similar rates of graft failure and acute GVHD. Chronic GVHD was more frequent in the higher dose group, though the difference was not statistically significant. Multivariate Cox analysis confirmed a high CD34⁺ cell dose as an independent predictor of poor OS (HR 2.054, P = 0.031).

CONCLUSION: These findings suggest that excessively high doses may adversely affect survival by increasing transplant-related toxicity. Graft cell dose should be carefully balanced to optimize outcomes in haplo-PBSCT.

PMID:40773143 | DOI:10.1007/s44313-025-00091-5

Environ Monit Assess. 2025 Aug 7;197(9):990. doi: 10.1007/s10661-025-14434-3.

ABSTRACT

Ocean acidification (OA), caused by the uptake of anthropogenic carbon dioxide, is a concern for ocean resource users in coastal regions where the phenomenon is compounded by variable processes. Sustained OA monitoring systems are critical for characterization of baseline ocean conditions and identification of changes and impacts to coastal ecosystems and communities. Establishing an OA monitoring network is best accomplished through iterative planning, sustained funding, and comprehensive understanding of the coastal system. This paper offers decision-making considerations for entities interested in establishing a local to regional scale OA observing system. Such considerations include which carbon system parameters can be measured in each system, which sensors and platforms will provide applicable information for interested partners, and best practices for observing data management. Because every region faces unique circumstances, we present context-specific examples of effective decision-making processes from established U.S. OA observing networks. These regional case studies offer information on specific scientific questions, observing techniques, and methodology employed to establish and manage OA observations in the coastal zone.

PMID:40773125 | DOI:10.1007/s10661-025-14434-3

Discov Oncol. 2025 Aug 7;16(1):1490. doi: 10.1007/s12672-025-03370-w.

ABSTRACT

BACKGROUND: Breast cancer (BC) represents a significant public health challenge characterized by complex pathogenic mechanisms. While inflammatory proteins are known to play crucial roles in cancer development, their causal relationships with breast cancer risk remain inadequately understood. This study employed Mendelian randomization (MR) analysis to investigate potential causal associations between inflammatory proteins and breast cancer susceptibility.

METHODS: We utilized genome-wide association study (GWAS) data for inflammatory protein levels from 14,824 European individuals as exposure data. The primary outcome data were obtained from BC GWAS summary statistics, with an additional independent BC cohort serving as validation(FinnGen_R12). The primary analysis was conducted using inverse-variance weighted (IVW) method, supplemented by MR-Egger and weighted median approaches. Comprehensive sensitivity analyses included Cochran’s Q test, MR-Egger intercept test, MR-PRESSO, and leave-one-out analysis. The causal direction was verified through Steiger test and reverse MR. We further performed multivariable MR (MVMR), linkage disequilibrium score regression (LDSC), and colocalization analysis to strengthen our findings.

RESULTS: After Bonferroni correction, we identified a significant inverse genetic association between Leukemia inhibitory factor receptor (LIFR) levels and BC risk. While C-X-C motif chemokine 5 (CXCL5) did not survive Bonferroni correction, it showed significant negative association with BC in MVMR analysis. Reverse MR analyses found no evidence of causal effects of BC on these inflammatory proteins, supporting the direction of our primary findings. Colocalization analysis revealed strong evidence of shared genetic variants between LIFR and BC, suggesting common genetic determinants underlying their relationship.

CONCLUSION: This study provides genetic evidence for causal relationships between inflammatory proteins and BC risk, particularly highlighting the protective role of LIFR. These findings enhance our understanding of BC pathogenesis and may inform future therapeutic strategies.

PMID:40773112 | DOI:10.1007/s12672-025-03370-w

Quintessence Int. 2025 Aug 7;0(0):0. doi: 10.3290/j.qi.b6444204. Online ahead of print.

ABSTRACT

OBJECTIVES: To comprehensively characterize dental unit waterline (DUWL) biofilms through integrated analysis combining scanning electron microscopy and high-throughput sequencing, examining structural features and microbial community composition across different tubing sections.

METHOD AND MATERIALS: For each of the eight dental units with high-speed handpiece waterlines in continuous clinical service for ≥6 months at a university dental hospital, three 2-cm segments were collected from proximal, middle, and distal sections (total n=24). Scanning electron microscopy evaluated biofilm coverage percentage and morphology across 10 fields per specimen using a 9-grid quantification method. Microbial communities were analyzed using 16S rRNA gene V3-V4 region sequencing with subsequent bioinformatic processing through QIIME2. Statistical analyses included ANOVA, Kruskal-Wallis tests, and PERMANOVA to assess sectional differences.

RESULTS: Scanning electron microscopy revealed a gradient of biofilm coverage increasing from proximal (31%) to middle (87%) and distal sections (nearly 100%). Structural features included partially detached biofilm fragments and distinctive bulging bacterial aggregates. Molecular analysis identified Proteobacteria as the predominant phylum, followed by Bacteroidetes and Firmicutes, with significant variations in community composition between sections. The distal section showed the highest microbial diversity, with significant differences observed in Chao1 richness (P =.025), observed species (P =.025), and ODS coverage (P =.024) between study groups. Principal coordinate analysis confirmed distinct clustering patterns among biofilm communities from different tubing sections.

CONCLUSION: This multidimensional analysis achieved its aim of comprehensively characterizing DUWL biofilms, establishing that heterogeneous distribution patterns warrant section-specific monitoring approaches for effective contamination control.

PMID:40773105 | DOI:10.3290/j.qi.b6444204