Nevin Manimala

JAMA Netw Open. 2025 Aug 1;8(8):e2525644. doi: 10.1001/jamanetworkopen.2025.25644.

ABSTRACT

IMPORTANCE: While remission from clinical high risk (CHR) for psychosis is a favorable outcome, it is not well characterized over time.

OBJECTIVE: To examine remission incidence, prevalence, and stability, and their association with demographic, clinical, medication, and cognitive variables, comparing 2 commonly used definitions.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined data from individuals aged 12 to 30 years at CHR in the North American Prodromal Longitudinal Study 3, collected from 9 sites across the US from February 2015 to November 2018. Statistical analyses were conducted between January 2023 and May 2025.

EXPOSURE: CHR status using 2 definitions: (1) a symptoms-only definition based on the positive symptoms from the Scale of Prodromal Symptoms and (2) a symptoms-and-function definition based on positive symptoms and the modified Global Assessment of Functioning.

MAIN OUTCOMES AND MEASURES: The primary outcomes were remission incidence, prevalence, and stability for 7 follow-up visits over 2 years. Associations of remission with age, sex at birth, race, antipsychotic and antidepressant medication, history of trauma, and cognitive performance were determined using mixed-effects logistic regression.

RESULTS: The sample included 692 individuals (mean [SD] age, 18.7 [4.1] years; 319 female [46%]) at baseline, with 614 completing at least 1 follow-up. For the symptoms-only definition, 7% (95% CI, 5%-10%) met remission criteria after 2 months, 34% (95% CI, 31%-38%) met remission criteria at least once during the study, and 26% (95% CI, 22%-29%) met criteria at their last visit. The symptoms-and-function definition was associated with a lower remission incidence and prevalence, with 4% (95%CI, 2%-5%) meeting remission criteria after 2 months, 21% (95% CI, 18%-24%) meeting criteria at least once, and 15% (95% CI, 13%-18%) meeting criteria at their last visit. Under the symptoms-only definition, 83 of 153 individuals at CHR with at least 1 follow-up after remission (54%; 95% CI, 46%-62%) were stable remitters. Under the symptoms-and-function definition, 43 of 91 individuals (47%; 95% CI, 37%-58%) were stable remitters. The chance of staying in remission rose drastically once a person had more than 1 previous recorded remission visit. Higher functioning was associated with higher likelihood of remission (current score for symptoms only: OR, 1.04; 95% CI, 1.01-1.08; current score for symptoms and function: OR, 1.08; 95% CI, 1.02-1.14). More symptoms at baseline was associated with a lower likelihood of remission (general symptoms for symptoms only: OR, 0.77; 95% CI, 0.70-0.84; general symptoms for symptoms and function: OR, 0.80; 95% CI, 0.69-0.92).

CONCLUSIONS AND RELEVANCE: These findings suggest that CHR status is a dynamic state and that vulnerability can persist even after functional remission. Hence, continued follow-up and facilitated reengagement with clinical services after remission are essential.

PMID:40762913 | DOI:10.1001/jamanetworkopen.2025.25644

JAMA Netw Open. 2025 Aug 1;8(8):e2525681. doi: 10.1001/jamanetworkopen.2025.25681.

ABSTRACT

IMPORTANCE: Inequities in rapid access to emergency medical services (EMS) represent a critical gap in prehospital care and the first system-level milestone for critically injured patients. As delays in EMS response are associated with increased mortality and known disparities within historically redlined areas are prevalent, this study sought to examine disparities in rapid access to EMS across the United States.

OBJECTIVE: To assess the association between historically redlined areas and rapid EMS access (defined as ≤5-minute response time) across the United States.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional study analyzed the geographic distribution of EMS centers in relation to 2020 US Census block groups and Home Owners’ Loan Corporation (HOLC) residential security maps, classified by grades (A-D). Populations of 236 US cities with publicly available redlining data were included. Travel distance radius (5-minute drive times) was centered on population-weighted block group centroids. Redlining grades include A (“most desirable,” green), B (“still desirable,” blue), C (“declining,” yellow), and D (“hazardous,” red).

EXPOSURE: HOLC grade classification (A-D).

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of the population with rapid EMS access. Secondary outcomes included the socioeconomic and demographic profiles of populations without rapid access.

RESULTS: Of the total US population (N = 333 036 755), 41 367 025 (12.42%) lived in cities with redlining data. Among these, 2 208 269 (5.34%) lacked rapid access to 42 472 EMS stations. Grade D areas had a higher proportion of residents without rapid EMS access compared with grade A areas (7.06% vs 4.36%; P < .001). The odds of having no rapid access to EMS in grade D areas were 1.67 (95% CI, 1.66-1.68) times higher than in grade A areas. Compared with grade A, grade D areas had a lower percentage of non-Hispanic White residents (65.21% [95% CI, 59.43%-70.99%] vs 39.36% [95% CI, 36.99%-41.73%]; P < .001), a higher percentage of non-Hispanic Black residents (10.38% [95% CI, 7.14%-13.62%] vs 27.85% [95% CI, 25.4%-30.3%]; P < .001), and greater population density (7500.72 [95% CI, 4341.26-10 660.18] persons/km2 vs 15 277.87 [95% CI, 13 281.7-17 274.04] persons/km2; P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, structural disparities in rapid EMS access were associated with historically redlined areas. Strategic resource allocation and system redesign are warranted to address these inequities in prehospital emergency care.

PMID:40762912 | DOI:10.1001/jamanetworkopen.2025.25681

JAMA Netw Open. 2025 Aug 1;8(8):e2526643. doi: 10.1001/jamanetworkopen.2025.26643.

ABSTRACT

IMPORTANCE: Both commitment to patient welfare and conflict of interest management are important components of physician professionalism. However, the interplay between them has not been well explored.

OBJECTIVE: To examine the association between unsolicited patient complaints, measured by Patient Advocacy Reporting System (PARS) Index, and acceptance of general (nonresearch) payments from industry, including significant payments, defined as exceeding $5000 annually.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study included physicians at health care sites participating in the PARS program. General payments accepted by physicians from industry were identified from the Open Payments Program database. Data were collected from July 1, 2015, through June 30, 2020, and linked using National Provider Identifier numbers. Data were analyzed from April 5, 2024, to May 12, 2025.

EXPOSURE: The physician’s highest PARS Index score, categorized as 0, 1 to 20, 21 to 50, and 51 or greater.

MAIN OUTCOMES AND MEASURES: The outcome of interest was acceptance of general payments, any or exceeding $5000 annually. Ordinal regression was used to assess the association between PARS Index scores and general payments.

RESULTS: This analysis included 71 944 physicians (27 065 [37.6%] female; mean [SD] age in 2015, 45 [12.5] years), with 44 296 (61.6%) practicing in academic settings. The most common specialties were internal medicine (30 043 physicians [41.8%]), general surgery (6819 physicians [9.5%]), and anesthesiology (4461 physicians [6.2%]). Of the included physicians, 49 169 (68.3%) received at least 1 general payment, and 8067 (11.2%) received more than $5000 in a year; 30 979 physicians (43.1%) received unsolicited patient complaints. Median (IQR) PARS Index score was 2 (0-17). A higher PARS Index score was significantly associated with higher general payments accepted per year (eg, PARS Index score ≥51: odds ratio [OR], 1.69; 95% CI, 1.56-1.82; P < .001). This association remained significant after adjusting for physician gender, age, region, practice setting, and specialty. Male physicians (OR, 1.90; 95% CI, 1.84-1.97) and physicians practicing at nonacademic settings (OR, 1.15; 95% CI, 1.10-1.19) were also more likely to receive higher general payments per year.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of nearly 72 000 physicians across the US, physicians with higher PARS Index scores, indicative of a higher risk of medical malpractice claims, worse patient outcomes, and well-being concerns, were more likely to accept industry payments, particularly in higher amounts. These findings underscore the importance of conflict of interest review and management to support medical professionalism and patient trust.

PMID:40762911 | DOI:10.1001/jamanetworkopen.2025.26643

Mil Psychol. 2025 Aug 5:1-10. doi: 10.1080/08995605.2025.2525657. Online ahead of print.

ABSTRACT

The prevention of suicide mortality and suicidality (ideation, self-harm, and attempted suicide) is a key concern for the Australian Army. Currently, there are limitations to the scope of surveillance of these events, resulting in a restricted evidence base from which to design prevention and intervention strategies. This study aimed to examine opportunities to improve surveillance through analysis of the existing data landscape. A 10-year, mixed-methods, retrospective review of all events involving suicide or suicidality over the period Jan 2012 – Dec 2021 was conducted utilizing Army administrative records. Variables of interest related to demographics, event characteristics, and outcomes were summarized, and bivariate associations between variables were explored. Misclassification errors were common due to the inconsistent application of event definitions and the reliance on free-text narratives rather than structured data fields led to missing data and inconsistent data quality. Demographic data was the most reliable, while contextual and outcome data was scarce which limited statistical analysis. High-quality surveillance data contributes to many aspects of suicide and suicidality prevention. Our findings suggest the need for improved standardization and structured data fields, in addition to the expansion of data collection, particularly for event context and outcomes.

PMID:40762908 | DOI:10.1080/08995605.2025.2525657

Indian Pediatr. 2025 Aug 5. doi: 10.1007/s13312-025-00156-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and validate the Assamese version of the Rashtriya Bal Swasthya Karyakram (RBSK) screening tool for developmental delay (1-72 months) and autism (15-24 months) and to assess its diagnostic accuracy in comparison with the Developmental Profile-3 (DP-3) and the All India Institute of Medical Sciences (AIIMS)-Modified INCLEN Diagnostic Tool for autism spectrum disorder (INDT-ASD).

METHODS: A cross-sectional study was conducted from January to December 2024 at a tertiary care hospital in India. The RBSK screening tool for developmental delay and autism was translated into Assamese through a standardized process involving forward translation, back-translation, expert review, and pilot testing (n = 10). Children aged 1-72 months were recruited from the outpatient department. Developmental delay was assessed using the Developmental Profile-3 (DP-3) and ASD in children aged 15-24 months using the AIIMS-Modified INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) tool. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values, Cohen’s kappa statistic, and area under receiver operating characteristic (AUROC) curves.

RESULTS: A total of 139 children with mean (SD) age 30.5 (12.2 months) were enrolled. The Assamese version of the RBSK screening tool demonstrated a sensitivity and specificity of 94.1% and 84.9%, respectively, for developmental delay, and 89.5% and 93.8%, respectively, for ASD. Agreement with reference tools was high (Cohen’s kappa = 0.85 for DP-3, 0.83 for AIIMS-Modified INDT-ASD). The tool showed excellent discriminative performance with AUROC (95%CI) of 0.94 (0.89, 0.98) for developmental delay and 0.92 (0.85, 0.98) for ASD.

CONCLUSION: The validated Assamese version of the RBSK screening tool for developmental delay and autism is an accurate screening tool in Assamese-speaking population.

PMID:40762879 | DOI:10.1007/s13312-025-00156-9

Obes Surg. 2025 Aug 5. doi: 10.1007/s11695-025-08088-w. Online ahead of print.

ABSTRACT

BACKGROUND: To describe patterns and predictors of leisure-time physical activity (LTPA) in patients awaiting (PRE) and after (POST) metabolic and bariatric surgery (MBS).

METHODS: A cross-sectional study was conducted with 180 participants (PRE: n = 63, POST: n = 117). Data were collected through a structured questionnaire on demographic and clinical variables, LTPA patterns, and professional guidance. Descriptive statistics, chi-square and Fisher’s exact tests, and binomial logistic regression were used.

RESULTS: The sample was predominantly female (83.3%), with a mean age of 43.16 ± 11.13 years and BMI of 40.85 ± 10.79 kg/m². In the PRE group, 70% were classified as inactive, with 44.3% reporting no physical activity (PA). Walking or running outdoors was the most common activity. Most active participants (88.2%) exercised under professional supervision versus 27.8% of inactive ones [X²(1) = 13.05; p < 0.001]. In the POST group, 57% were inactive, although 43.1% engaged in at least one type of LTPA. Walking or running was most common overall (40.2%), while resistance training predominated among active individuals (60%). Indoor settings were preferred for LTPA (63.4%). Being accompanied by an exercise professional significantly increased the odds of being active (OR = 4.57, 95% CI: 1.31-15.88, p = 0.017).

CONCLUSIONS: LTPA participation and characteristics differ considerably between PRE and POST MBS groups. Receiving guidance from an exercise professional was significantly associated with higher PA levels. These findings highlight the importance of developing tailored LTPA programs that include professional support to encourage PA among MBS patients.

PMID:40762865 | DOI:10.1007/s11695-025-08088-w

Radiology. 2025 Aug;316(2):e243788. doi: 10.1148/radiol.243788.

ABSTRACT

Background The optimal treatment of patients with oligometastatic breast cancer and the methods for selecting individuals who may benefit from metastasis-directed therapies are controversial. Purpose To determine the prevalence of oligometastatic disease (OMD; defined as five or fewer distant metastases) in patients with locally advanced breast cancer initially staged at fluorine 18 (¹⁸F) fluorodeoxyglucose (FDG) PET/CT or at CT and bone scintigraphy (CTBS), and to compare patterns of local-regional and distant metastatic disease. Materials and Methods This is a post hoc analysis of data from a prospective, multicenter randomized trial including participants with stage IIb (T3N0) or III invasive ductal carcinoma in the breast between December 2016 and April 2022. Participants were randomized for staging at ¹⁸F-FDG PET/CT or at conventional chest, abdomen, and pelvis CTBS. The prevalence of OMD, sites of distant metastases, and extent of local-regional disease were compared using the χ² test or Fisher exact test. Logistic regression was used to assess the association between imaging and disease extent, with P < .05 indicating a statistically significant difference. Results The study included 369 participants (mean age, 53 years ± 13 [SD]). OMD was more common on ¹⁸F-FDG PET/CT scans (19 of 180; 11%; 95% CI: 6.9, 15.9) than on CTBS scans (eight of 185; 4%; 95% CI: 2.2, 8.3; P = .03). Polymetastatic disease (more than five distant metastases) was also more common on ¹⁸F-FDG PET/CT scans (24 of 180; 13%) than on CTBS scans (13 of 185; 7%; P = .04). Patients with OMD that was depicted on ¹⁸F-FDG PET/CT and CTBS scans had axillary lymph node metastases, but ¹⁸F-FDG PET/CT helped to detect extra-axillary regional lymphadenopathy, extra-regional lymph node metastases, and liver metastases more frequently than did CTBS (six of 19 [32%] vs one of eight [13%], three of 19 [16%] vs 0 of eight [0%], and six of 19 [32%] vs one of eight [13%], respectively; P = .63, .53, and .63, respectively). Conclusion At patient presentation, ¹⁸F-FDG PET/CT helped to detect OMD in more than one in 10 participants with locally advanced breast cancer, which was more than 2.5 times more often than CTBS, and ¹⁸F-FDG PET/CT helped to detect more extensive local-regional metastatic disease. ClinicalTrials.gov Identifier: NCT02751710 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Ulaner in this issue.

PMID:40762843 | DOI:10.1148/radiol.243788

Dev Neurorehabil. 2025 Aug 5:1-7. doi: 10.1080/17518423.2025.2541823. Online ahead of print.

ABSTRACT

This study aimed to investigate the effect of Sensory Integration Therapy (SIT) in children with cerebral palsy (CP). Twenty children with CP were randomly assigned to intervention and control groups. Quality of Upper Extremity Skills Test (QUEST), Trunk Control Measurement Scale (TCMS), and Pediatric Balance Scale (PBS) were used in pre-and post-treatment. There was a statistically significant increase in the dissociated movements sub-scale of the QUEST, dynamic reaching sub-scale of the TCMS, and PBS scores in the intervention group. There was a statistically significant increase in both dissociated movements and grasps sub-scale of the QUEST and PBS scores in the control group. In conclusion, SIT applications can be integrated into rehabilitation programs to improve dissociated upper extremity movements, dynamic trunk control, and balance control in children with CP.

PMID:40762832 | DOI:10.1080/17518423.2025.2541823

Psychol Rep. 2025 Aug 5:332941251363891. doi: 10.1177/00332941251363891. Online ahead of print.

ABSTRACT

Grit is important to experiencing success and is shaped through several childhood experiences. However, the association of adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) to grit is underexplored, especially through emotional regulation. Hence, this study examined the association between ACEs, BCEs, emotional regulation, and grit. Further, we investigated the mediating role of emotional regulation between (a) ACEs and grit and (b) BCEs and grit. Self-report measures of ACEs, BCEs, emotional regulation, and grit were used to collect data from 548 Gen Z young adults born in 1997 or later (Female = 344, Male = 202, Mean age = 20.39) in India. We applied descriptive statistics, linear regression, and structural equation modelling (SEM) to analyze the data. The analyses revealed a significant negative association of ACEs with emotional regulation and grit, whereas BCEs were associated positively. Emotional regulation fully mediated the relationships between (a) ACEs and grit (β = -.08; CI = -.13 to -.04) and (b) BCEs and grit (β = .16; CI = .10 to .23). The study findings confirm the negative relationship of ACEs on an important life outcome, grit. However, BCEs showed beneficial effects. Furthermore, emotional regulation explains the association between negative and positive childhood experiences and grit. These findings have implications for fostering emotional regulation and mitigating the negative outcomes of ACEs among emerging adults.

PMID:40762830 | DOI:10.1177/00332941251363891

J Math Biol. 2025 Aug 5;91(3):24. doi: 10.1007/s00285-025-02255-4.

ABSTRACT

In order to be useful in assessing the effects of climate change on biological populations, mathematical models have to adequately represent the life cycle of the species in question, the dynamics of and interactions with its resource(s), and the effect of changing environmental conditions on their vital rates. Due to this complexity, such models are often analytically intractable. We present here a consumer-resource model that captures seasonality (summer and winter), with synchronously reproducing consumers (birth pulse), structured into non-reproductive juveniles and reproductive adults, and that remains analytically tractable. Our model is motivated by hibernating mammals, such as marmots, ground squirrels, or bats, some of which live in high altitude regions where the effects of climate change are stronger than elsewhere. One stage-specific impact of climate change in those species is that juveniles may benefit from warmer winters while adults may suffer. We explore various aspects of how this differential response to climate change shapes population dynamics from stable populations to cycles and chaos. We show that the qualitative relationship between winter temperature and winter mortality has a significant effect on the model dynamics, hence informing empiricists of required data to assess the effect of climate change on these species. Our results question the long-standing expectation that species with slower life histories are necessarily more strongly affected by climate change than species with faster life histories.

PMID:40762823 | DOI:10.1007/s00285-025-02255-4