Nevin Manimala

Scand J Trauma Resusc Emerg Med. 2025 Jun 17;33(1):107. doi: 10.1186/s13049-025-01418-y.

ABSTRACT

BACKGROUND: Healthcare systems are increasingly shifting toward specialization and centralization. As a result, distances are growing between emergency patients and suitable emergency hospitals, as well as in between hospitals for interhospital transfers. Helicopter Emergency Medical Services (HEMS) are essential in maintaining equitable access to emergency care, particularly in rural regions. However, the availability and quality of HEMS landing infrastructure at hospitals remains largely unexamined. This study provides the first nationwide integrated mapping and analysis of emergency care hospital and HEMS landing facility distribution.

METHODS: We conducted a nationwide cross-sectional analysis of all German hospitals classified under the Emergency Care Level system (ECL I-III). Using data from hospital quality reports, government registries, and satellite imagery, we assessed the availability and type of HEMS landing facilities, categorized as certified helipads or Public Interest Sites (PIS). The study aimed to map and characterize the emergency care hospital and HEMS infrastructure, identify associated hospital and regional factors, and assess spatial access and data completeness through targeted analyses.

RESULTS: Of 1,037 emergency care hospitals, 69.6% have a designated landing facility, with 44.0% of these featuring a certified helipad and 56.0% relying on PIS. A substantial proportion of hospitals (30.4%) lack any HEMS landing facility, especially in urban areas. Certified helipads are more prevalent at higher-tier emergency hospitals (ECL II and III) but no landing facility is available at 18.3% of these facilities, particularly in metropolitan regions. Hospitals in rural areas are more likely to have a HEMS landing facility.

CONCLUSIONS: Despite the crucial role of HEMS in emergency medical care, nearly one-third of Germany’s emergency care hospitals lack designated landing facilities, with PIS still outnumbering certified helipads. This reflects structural and regulatory shortcomings that may compromise timely access to specialized care. Enhancing national oversight, modernizing infrastructure, and adopting harmonized European standards are key measures to ensure reliable aeromedical access – and to improve patient outcomes across borders.

PMID:40528175 | DOI:10.1186/s13049-025-01418-y

Crit Care. 2025 Jun 17;29(1):247. doi: 10.1186/s13054-025-05461-0.

ABSTRACT

BACKGROUND: The routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening.

METHODS: This was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were functional outcome (modified Rankin Scale) and survival status at 6 months, occurrence of clinical seizures during the intensive care stay, and late awakening (Full outline of unresponsiveness motor score of four 96 h after randomization). Cumulative propofol doses were divided into quartiles (Q1-Q4). Logistic regression models were used to assess associations between sedative doses and functional outcome and survival, clinical seizures, and late awakening, adjusting for the severity of illness and other clinical factors influencing sedation.

RESULTS: A total of 1861 patients were analyzed. In a multivariable logistic regression model, higher propofol doses (Q3, 100.7-153.6 mg/kg) were associated with good functional outcome (OR 1.62, 95%CI 1.12-2.34) and (Q2 and Q3, 43.9-153.6 mg/kg) with survival (OR 1.49, 95%CI 1.05-2.12 and OR 1.84, 95%CI 1.27-2.65, respectively). Receiving fentanyl and remifentanil were associated with good functional outcome (OR 1.69, 95%CI 1.27-2.26 and OR 1.50, 95%CI 1.11-2.02) and survival (OR 1.80, 95%CI 1.35-2.40 and OR 1.56, 95%CI 1.16-2.10). Receiving fentanyl (OR 0.64, 95%CI 0.48-0.86) and higher propofol doses (Q2-4 (43.9-669.4 mg/kg) were associated with the occurrence of clinical seizures. The highest quartile of propofol dose (153.7-669.4 mg/kg, OR 3.19, 95%CI 1.91-5.42) was associated with late awakening.

CONCLUSIONS: In this study, higher doses of propofol and the use of remifentanil and fentanyl were associated with good functional outcome and survival, occurrence of clinical seizures, and late awakening.

PMID:40528173 | DOI:10.1186/s13054-025-05461-0

Forensic Sci Int Genet. 2025 Jun 11;79:103316. doi: 10.1016/j.fsigen.2025.103316. Online ahead of print.

ABSTRACT

Over the past decade, numerous assays for forensic age estimation based on the analysis of DNA methylation markers have been developed, demonstrating significant potential for use in criminal investigations. Despite these advancements, only few comprehensive evaluation studies were published. In this study, we present findings of an extensive inter-laboratory evaluation of the VISAGE Enhanced Tool and its associated statistical models for epigenetic age estimation in blood and buccal swabs. Six laboratories conducted reproducibility, concordance, and sensitivity assessments using DNA methylation controls alongside blood and saliva samples to evaluate the tool’s technical performance. Results demonstrated consistent and reliable DNA methylation quantification across all participating laboratories, with the tool maintaining sensitivity even with a DNA input of 5 ng for bisulfite conversion. To evaluate the age estimation models, 160 blood and 100 buccal swab samples were analysed in three laboratories. The models achieved mean absolute errors (MAEs) of 3.95 years for blood and 4.41 years buccal swabs, which represents an increase of ∼0.7 years for both tissues to the results from the original VISAGE testing set. When comparing results of each laboratory with the original VISAGE testing set, significant differences were found only for age estimation results from blood of one laboratory with an underestimation of chronological age observed within the entire range tested at that laboratory. When excluding this laboratory, the MAE decreased to 3.1 years (N = 89). No significant differences among laboratories were found for buccal swabs. Overall, this study confirms that the VISAGE Enhanced Tool performs robust DNA methylation quantification and reliable age prediction, however protocol and model validation within each laboratory is required upon implementation.

PMID:40526988 | DOI:10.1016/j.fsigen.2025.103316

Appl Ergon. 2025 Jun 16;129:104579. doi: 10.1016/j.apergo.2025.104579. Online ahead of print.

ABSTRACT

This study investigated the effects of different magnifications of the Galilean system on the posture of dental students during pre-clinical procedures. Thirty-seven second-year undergraduate dental students participated in this study. Dependent variables included angular deviation from the neutral position of the neck, neck muscle activity, and working distance from the operator’s eyes to the mannequin’s mouth. The independent variable was the magnification of the Galilean system loupes at four levels (naked eye, 2.5×, 3.0 × , and 3.5× magnification). Students performed Class I teeth preparations on the maxillary first molar using a dental mannequin, and postures were recorded on photographs during the procedure. The “Software for Postural Assessment” (version 0.69) analyzed the angular deviation and working distance. Muscle activity was assessed bilaterally using surface electromyography of the descending trapezius and sternocleidomastoid muscles. Descriptive statistical analysis and one-way repeated-measures analysis of variance (rANOVA) was conducted (α = 0.050). As a result, a greater angular deviation of the neck was observed with the naked eye during tooth preparation (p < 0.001). However, different magnifications did not affect the muscle activity (p = 0.050-0.911) or working distance (p = 0.136). It was possible to conclude that, regardless of the magnification, using Galilean loupes reduced angular deviation; however, it did not influence muscle activity or working distance.

PMID:40526987 | DOI:10.1016/j.apergo.2025.104579

Appl Ergon. 2025 Jun 16;129:104580. doi: 10.1016/j.apergo.2025.104580. Online ahead of print.

ABSTRACT

The wide adoption of autonomous vehicles (AVs) or robot taxis relies on technological advancements and public acceptance, which can be influenced by users’ trust in AVs and comfort during rides. Among the influential factors of riding comfort, motion sickness (MS) has attracted lots of attention in previous research, and both trust and MS have been found to be associated with human-machine interface (HMI) designs in AVs. However, previous research on trust and MS in AVs predominantly utilized driving simulations or “Wizard of Oz” methods, which failed to introduce risk and realistic vehicle motions, potentially introducing bias to conclusions. For the first time, our study investigated the impact of displaying the dynamic path trajectories of AVs on passengers’ perceptions of system transparency, trust, and MS in a commercially running AV. The results from 16 participants and 32 rides revealed limited effects of the dynamic path trajectory on trust, and a discernible but statistically non-significant trend in MS alleviation. Further, we found that the initial riding experience was more important in trust enhancement than subsequent rides. These results provide insights into future HMI design in robot taxis and suggest directions for future research in trust enhancement and MS alleviation in AVs.

PMID:40526986 | DOI:10.1016/j.apergo.2025.104580

J Med Internet Res. 2025 Jun 17;27:e68054. doi: 10.2196/68054.

ABSTRACT

BACKGROUND: As digital interventions gain prominence in mental health care, they present opportunities to improve access and scalability. Despite their potential, the overall impact of digital behavioral activation (BA) interventions across different formats and populations is not yet fully understood.

OBJECTIVE: This systematic review examines the characteristics and functions of digital BA interventions and evaluates their effectiveness for mental health and other patient-related outcomes.

METHODS: A comprehensive search of databases (PubMed, Embase, Web of Science, APA PsycInfo, and ClinicalTrials.gov) was performed in November 2023 to identify randomized controlled trials (RCTs) assessing the effectiveness of digital BA interventions for depression and anxiety. A total of 2 reviewers screened the studies for inclusion. Meta-analysis using a random-effects model assessed intervention impact on outcomes including depression, anxiety, quality of life (QoL), BA scores, functioning and disability, and stress. Statistical heterogeneity was evaluated with the I² statistic and statistical significance was evaluated with P values. Studies that did not meet the meta-analysis criteria underwent narrative synthesis.

RESULTS: A total of 18 articles reporting 17 RCTs were included across three intervention types: (1) internet-based BA (n=12, 71%), delivering digital therapies to foster new behavioral activities for depression management; (2) electronic messaging-based BA (n=2, 12%), involving prompts to support behavior change; and (3) telehealth-based BA (n=3, 17%), providing remote health care services. We identified single-component and multicomponent interventions that combined BA with elements such as problem-solving therapy or cognitive behavioral therapy. A total of 12 RCTs were included in the meta-analysis, while the remaining studies were narratively synthesized. Risk of bias (RoB) was assessed in all included studies. Digital BA interventions significantly reduced depressive symptoms at 2 months (P<.001, I²=0%), 3 months (P=.001, I²=51%), and 6 months (P=.009, I²=29%) post treatment, but not at 12 months (P=.82, I²=89%). Significant improvements in BA scores at 6 months were observed (P<.001, I²=0%). QoL improved significantly at 3 months (P=.002, I²=22%) and 6 months (P=.009, I²=0%). Stress levels were also significantly reduced at 3 months (P<.001, I²=25%). However, no significant changes were identified in anxiety and functioning and disability outcomes at either 3 months (anxiety: P=.08, I²=68%) or 6 months (anxiety: P=.24, I²=44%; functioning and disability: P=.88, I²=90%). Across included studies, RoB was generally low, particularly for random sequence generation and allocation concealment.

CONCLUSIONS: Digital BA interventions are effective in reducing depressive symptoms and improving QoL in the short- to midterm. However, these effects tend to diminish over time with no sustained benefits observed at 12 months. Future research should focus on developing and testing interventions with greater long-term efficacy, clarifying the role of BA within multicomponent digital approaches, and identifying the optimal intervention “dose” needed to maintain lasting effects.

PMID:40526910 | DOI:10.2196/68054

J Am Acad Orthop Surg. 2025 Jun 17. doi: 10.5435/JAAOS-D-24-01171. Online ahead of print.

ABSTRACT

INTRODUCTION: Durability of surgical treatment is important to patients, providers, and payers. In addition to the obvious effect on clinical outcomes and satisfaction, durability is an important variable when evaluating cost-effectiveness. The purpose of this study was to analyze the prevalence and indications for revision surgery after anterior cervical discectomy and fusion (ACDF).

METHODS: A multisurgeon, single-institution database was queried for revision surgery after ACDF from 2014 to 2018 with a minimum follow-up of 4 years (N = 1,652). Demographic data, surgical data, and primary indication for revision surgery were collected by medical record analysis. All statistical analyses were performed using IBM SPSS v28.0 (IBM).

RESULTS: A total of 147 of 1,652 patients (9%) underwent unplanned revision surgery during the study period. The mean patient age was 53.6 years; the mean number of surgical levels was 1.8. The most common indication for revision surgery was nonunion (N = 94, 6%), which occurred at a mean of 33 months postoperatively. The second most common indication was adjacent segment disease (N = 37, 2%), which occurred at a mean of 24 months postoperatively. Patients who had a revision surgery for nonunion had more levels fused (2.06) compared with patients who had no revision surgery (1.65) or had surgery for adjacent segment disease (1.76) (P < 0.001). Likewise, patients with nonunion had longer surgical time (P < 0.001) and length of stay (P = 0.036). Patients who underwent a revision surgery for adjacent segment disease had a higher body mass index (BMI = 33.6) compared with patients without revision surgery (BMI = 30.4) or patients who underwent revision surgery for nonunion (BMI = 31.2) (P = 0.012). Comorbidities as measured by ASA grade did not differ between groups (P = 0.633). Smoking status, use of anterior plate, and use of structural allograft did not differ between groups (P > 0.05). No other differences were found among these groups. Other indications for revision surgery were much less common (<1%) and included evacuation of hematoma (N = 5), repeat decompression (N = 5), infection (N = 2), extension into the thoracic spine (N = 2), and implant reposition (N = 2).

DISCUSSION: ACDF is a relatively durable procedure (91%) as currently indicated and performed in a large multisurgeon spine center. Early revision surgery (<90 days) for hematoma or infection is rare. Late revision surgery (>90 days) for nonunion is more than twice as common as adjacent segment disease and occurred earlier and more commonly when a greater number of levels were fused. These data can help guide clinicians and researchers in future quality improvement initiatives.

PMID:40526909 | DOI:10.5435/JAAOS-D-24-01171

Retina. 2025 Jun 13. doi: 10.1097/IAE.0000000000004558. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the long-term natural history of avascular serous pigment epithelial detachment (PED) in age-related macular degeneration (AMD) and identify risk factors for choroidal neovascularization (CNV) development.

METHODS: This retrospective study analyzed 71 eyes from 50 patients with pure avascular serous PED due to AMD, diagnosed via fluorescein angiography and indocyanine-green angiography. Patients were followed for at least 12 months (mean follow-up: 54.9 months). Baseline and follow-up assessments included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) measurements of PED height and diameter. Disease progression was categorized as stable, atrophic, or CNV development, and statistical analyses identified CNV risk factors.

RESULTS: Among studied eyes, 15.5% developed CNV, 21.1% progressed to atrophy, and 63.4% remained stable. Larger baseline PED height and diameter significantly correlated with CNV risk (p=0.004 and p=0.003, respectively). Every 100μm increase in PED height and diameter raised CNV risk by 50% and 10%, respectively. BCVA declined in all groups, with greater deterioration in CNV and atrophic cases.

CONCLUSIONS: Larger PED height and diameter are significant CNV risk factors in avascular serous PED. OCT-based monitoring is crucial for early detection of high-risk cases, optimizing clinical management, and preventing vision loss in AMD patients.

PMID:40526904 | DOI:10.1097/IAE.0000000000004558

JMIR Mhealth Uhealth. 2025 Jun 17;13:e58204. doi: 10.2196/58204.

ABSTRACT

Background: Perimenopausal and menopausal symptoms affect many women’s well-being and quality of life. Digital technologies, especially smartphones, allow self-management interventions for menopausal symptoms, but they are understudied., Objective: We evaluated whether a novel digital care app, Caria, effectively reduced vasomotor and behavioral health symptoms of menopause., Methods: We enrolled 149 women for a 6-week randomized controlled trial (app treatment: n=112; web-based educational control: n=37). Enrolled participants had problematic vasomotor symptoms and at least one elevated behavioral health symptom (depression, anxiety, or sleep issues). Web-based self-reported assessments (Hot Flush Rating Scale [HFRS], Patient Health Questionnaire Depression Scale-8 [PHQ-8], Generalized Anxiety Disorder-7, and Pittsburgh Sleep Quality Index [PSQI]) were conducted at baseline, 3 weeks, and 6 weeks., Results: For hot flash severity (HFRS; treatment baseline mean 16.4, SD 6.7 to 6-wk mean 13.6, SD 6.6; control: baseline mean 19.1, SD 7.3 to 6-wk mean 17.8, SD 7.2), a repeated-measures ANOVA revealed main effects for time (F2,262=9.82; P<.001) and treatment arm (F1,131=6.08; P=.01) and a significant time × treatment arm interaction (F2,262=3.23; P=.04); the treatment arm showed lower hot flash severity than the control arm (t147=2.72; P=.007). For depression scores (PHQ-8; treatment baseline mean 14.0, SD 3.8 to 6-wk mean 11.2, SD 5.3; control baseline mean 15.0, SD 3.7 to 6-wk mean 13.4, SD 4.1), a repeated-measures ANOVA showed a main effect of time in the treatment arm (F2,96=15.2; P<.001) but not the control arm (F2,40=2.0; P=.15). Follow-up 2-tailed paired t tests in the treatment arm showed depression decreased from baseline to week 3 (t49=3.3; P=.002) and from weeks 3 to 6 (t48=2.3; P=.02). For sleep quality scores (PSQI; treatment baseline mean 10.7, SD 3.1 to 6-wk mean 10.0, SD 3.5; control baseline mean 11.5, SD 3.7 to 6-wk mean 11.0, SD 3.7), the repeated-measures ANOVA showed a main effect of time in the treatment arm (F2,186=7.8; P=.001) but not the control arm (F2,62=1.3; P=.28). Follow-up 2-tailed paired t tests in the treatment arm showed a significant decrease in sleep issues from baseline to week 3 (t95=3.9; P<.001) but no change from weeks 3 to 6 (t93=0.2; P=.81). Participants with elevated anxiety symptoms showed decreased symptoms in both the treatment and control groups. App engagement was high (average logins over 6 weeks: 53.2)., Conclusions: The findings highlight the potential of digital interventions for mitigating menopausal vasomotor and behavioral health symptoms. Significant improvements in the intervention group underscore the app’s effectiveness in providing relief from some of the most challenging aspects of menopause. This study contributes to the evidence supporting digital health interventions in managing menopausal symptoms, presenting a promising avenue for accessible and scalable solutions for women in midlife.

PMID:40526898 | DOI:10.2196/58204

Rev Med Chil. 2025 May;153(5):362-372. doi: 10.4067/s0034-98872025000500362.

ABSTRACT

Suicidal behavior is a global public health issue, particularly among adolescents, where it stands as one of the leading causes of death in this age group. In Chile, adolescent suicide rates have alarmingly increased over recent decades, with psychological, clinical, and socio-familial factors emerging as key contributors. However, existing theoretical models face limitations when applied to specific sociocultural contexts.

AIM: To explain suicidal behavior in a clinical sample of Chilean adolescents, integrating psychological, clinical and socio-familial factors.

METHODS: A non-experimental cross-sectional study was carried out in 388 adolescents (59.3% female; mean age: 15.63 years) admitted to the healthcare system in the Maule Region. Validated instruments were applied, including the BIS-11, DASS-21, DERS, ISI, GHSQ-V, and C-SSRS, to assess impulsivity, emotional regulation, anxious-depressive symptoms, and suicide risk. Multiple logistic regression models were fitted to identify significant predictors of suicidal ideation and attempts. Model quality was assessed through ROC analysis.

RESULTS: For the suicidal ideation model, significant predictors included maternal responsiveness, depressive symptoms, family history of mental illness, prior hospitalization due to suicide attempts, and victimization through bullying and sexual abuse. In the suicidal attempt model, relevant factors were the absence of siblings, unplanned impulsivity, emotional interference, previous hospitalizations for mental health, suicidal ideation, and serious intent to attempt suicide. The models demonstrated adequate predictive performance with areas under the curve (AUC) of 0.89 and 0.94, respectively.

CONCLUSIONS: The findings highlight the multidimensional nature of adolescent suicidal behavior, revealing the interplay between individual and contextual factors. These models contribute to understanding the phenomenon and could guide targeted preventive interventions and public policies aimed at this vulnerable group. Expanding the analysis to different regions and populations is suggested to validate and enrich the results.

PMID:40526864 | DOI:10.4067/s0034-98872025000500362