Nevin Manimala

Pediatr Res. 2025 Sep 10. doi: 10.1038/s41390-025-04363-9. Online ahead of print.

ABSTRACT

BACKGROUND: Body fat distribution patterns impact adolescent health, yet research on dietary lignans’ influence remains limited. This study investigated their association among U.S. adolescents.

METHODS: Data from 1579 adolescents (NHANES 2003-2006) were analyzed. Urinary enterolactone and enterodiol concentrations measured dietary lignan intake. Dual-energy X-ray absorptiometry assessed body fat distribution. Survey-weighted linear regression models with progressive adjustment were employed, and restricted cubic spline analyses evaluated potential non-linear relationships.

RESULTS: Urinary enterolactone levels were significantly inversely associated with android-to-gynoid fat ratio (fully adjusted model: β = -0.007, 95% CI: -0.012, -0.002, P = 0.008), indicating a significant negative relationship between enterolactone and android-to-gynoid fat ratio, with restricted cubic spline analysis confirming significant overall association (P for overall = 0.001, demonstrating the statistical significance of the entire relationship) and linear relationship (P for nonlinear = 0.064, indicating the relationship does not significantly deviate from linearity). Further analysis showed that enterodiol was positively associated with gynoid fat ratio (β = 0.360, 95% CI: 0.043, 0.677, P = 0.028), suggesting enterodiol exposure may favor gynoid fat distribution.

CONCLUSION: Dietary lignan intake significantly associates with more favorable body fat distribution patterns among U.S. adolescents, suggesting that increasing dietary lignan intake may be a potential strategy for improving adolescent body composition.

IMPACT: Dietary lignan intake, measured by urinary biomarkers, is significantly associated with favorable body fat distribution patterns in U.S. adolescents. This study highlights the role of dietary lignans, an underexplored dietary component, in influencing body fat distribution during adolescence, expanding on prior research focused on adults. These findings suggest dietary lignans as a potential nutritional strategy to improve body fat distribution in adolescents, offering insights for public health interventions targeting metabolic health in youth.

PMID:40931118 | DOI:10.1038/s41390-025-04363-9

Surg Endosc. 2025 Sep 10. doi: 10.1007/s00464-025-12138-w. Online ahead of print.

ABSTRACT

OBJECTIVE: Rigid suction-coagulation probes constrain the wrist-like articulation that is central to robotic surgery. We therefore designed a 5-mm single-use flexible suction ball coagulator (flex-SBC) with a modified core design to restore dexterity and assessed its mechanical performance and early clinical feasibility, including the effect of the common robotic gripping strategies on suction flow.

METHODS: Preclinical. The new 7 × 7 core embedded in silicone was compared with the conventional 1 × 7 core design. Shaft pliability was quantified by sagging displacement and rebound force testing. Suction flow at – 20, – 30, and – 40 kPa was measured, and the impact of grip location (electrode base vs silicone shaft) and forceps type (fenestrated or Maryland bipolar) was analyzed statistically.

CLINICAL: The flex-SBC was used in 12 consecutive robotic gastrectomies with prospective collection of device performance, adverse events, and surgeon rating on seven-domain via three-point Likert scale.

RESULTS: Preclinical. Adopting the 7 × 7 increased mean sagging displacement from 15.6 ± 1.8 to 39.3 ± 3.2 mm (p < 0.001) and reduced rebound force from 0.288 ± 0.014 to 0.059 ± 0.004 N (p < 0.001). Mean flow rates were 6.76 ± 0.88, 8.87 ± 0.43, and 10.58 ± 0.40 mL/sec at – 20, – 30, and – 40 kPa, respectively-approximately half those of a rigid probe (all p < 0.001) but still exceeding published thresholds for effective evacuation. Gripping the silicone shaft, especially with Maryland forceps, sharply reduced flow (60% reduction; p < 0.0011).

CLINICAL: All operations were completed without device-related malfunctions, injuries, or conversions. Of 84 survey ratings, connection setup, suction efficiency, tissue safety, and overall satisfaction were “satisfactory” in 100%; maneuverability was “satisfactory” in 65% and “average” in 35%. No “unsatisfactory” scores were recorded.

CONCLUSIONS: The flex-SBC bends where the robot bends, enabling safe, practical use across robot-assisted upper-GI surgery. Grip technique influences device performance, providing important implications training. Larger comparative trials should clarify whether these ergonomic gains translate into shorter operating times and improved oncologic precision.

PMID:40931103 | DOI:10.1007/s00464-025-12138-w

Appl Radiat Isot. 2025 Sep 4;226:112161. doi: 10.1016/j.apradiso.2025.112161. Online ahead of print.

ABSTRACT

Accurate determination of the parameters of each high purity germanium, HPGe detectors ensure the precision of quantitative results obtained from spectrum analysis. This study presents a comprehensive performance evaluation and long-term quality control assessment of a high-purity germanium (HPGe) gamma spectrometry system that has been operational for over 15 years. Key spectrometric measures were recorded, including energy resolution, peak shape ratios, asymmetry, peak-to-Compton ratio, relative efficiency, electronic noise, minimum detectable activity (MDA), and repeatability and reproducibility of the system. With the assistance of a calibrated source Co-60, the detector exhibited a commendable energy resolution of 2.01 keV (FWHM), along with good peak shape ratios (FWTM/FWHM = 1.73, FWFM/FWHM = 2.48) and a peak-to-Compton ratio of 52.2, indicating high resolution and zero spectral distortion. Relative detector efficiency was 33.88 % at 1332.5 keV, and electronic noise was negligible at 0.178 %. MDA for certain radionuclides was found to be in the range 0.048-0.605 Bq/kg, which showed good sensitivity even for low-activity peaks. Repeatability tests gave a coefficient of variation (%CV) less than 1 % for all peaks measured, while reproducibility was confirmed with t-test and F-test statistical tests. A Shewhart X‾-control chart revealed that at all times in all cases, measurements were within control limits, though a slight downward trend in the last few years suggests potential need for recalibration or maintenance. The findings corroborate the sustained conformity of the system to ISO/IEC 17025 quality standards and its sufficiency for precise and trustworthy gamma-ray analysis in radionuclide quantification and environmental monitoring.

PMID:40929755 | DOI:10.1016/j.apradiso.2025.112161

Int J Epidemiol. 2025 Aug 18;54(5):dyaf150. doi: 10.1093/ije/dyaf150.

ABSTRACT

BACKGROUND: Existing longitudinal cohort study data and associated biospecimen libraries provide abundant opportunities to efficiently examine new hypotheses through retrospective specimen testing. Outcome-dependent sampling (ODS) methods offer a powerful alternative to random sampling when testing all available specimens is not feasible or biospecimen preservation is desired. For repeated binary outcomes, a common ODS approach is to extend the case-control framework to the longitudinal setting.For ODS designs, we consider the impact of incomplete follow-up when missingness is completely at random (MCAR), missing at random (MAR), and missing not at random (MNAR). We further consider sampling from (i) complete cases, in which, in an attempt to maximize power, participants who dropped out before study completion were excluded; and (ii) all individuals, including those with incomplete follow-up.

METHODS: Simulation studies based on the Advancing Clinical Therapeutics Globally HIV Infection, Aging, and Immune Function Long-Term Observational Study cohort were used to examine the impact of MCAR, MAR, and MNAR missingness, assuming specimens were sampled from either (i) complete cases; or (ii) all individuals. Three ODS analytical methods were considered.

RESULTS: When longitudinal data are MNAR, ODS methods exhibit bias similar to that seen in random sampling. MNAR and MAR bias is exacerbated when sampling only participants with complete follow-up. Simulations indicate that ODS analyses that include participants with incomplete follow-up are robust to MCAR and less biased by MAR missingness.

CONCLUSION: Dropout is common in longitudinal cohort studies. Investigators utilizing ODS methods must consider the effect of dropout in both the retrospective sampling design and analysis.

PMID:40929733 | DOI:10.1093/ije/dyaf150

JMIR Res Protoc. 2025 Sep 10;14:e83537. doi: 10.2196/83537.

ABSTRACT

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PMID:40929725 | DOI:10.2196/83537

JMIR Cancer. 2025 Sep 10;11:e58657. doi: 10.2196/58657.

ABSTRACT

BACKGROUND: Electronic health records (EHRs) are a cornerstone of modern health care delivery, but their current configuration often fragments information across systems, impeding timely and effective clinical decision-making. In gynecological oncology, where care involves complex, multidisciplinary coordination, these limitations can significantly impact the quality and efficiency of patient management. Few studies have examined how EHR systems support clinical decision-making from the perspective of end users. This study aimed to explore multiprofessional experiences of EHR use in gynecological oncology and to develop a co-designed informatics platform to improve decision-making for ovarian cancer care.

OBJECTIVE: This study aims to evaluate the perspectives of health care professionals on retrieving routine clinical data from EHRs in the management of ovarian cancer and to design an integrated informatics platform that supports clinical decision-making.

METHODS: We conducted a national cross-sectional survey of 92 UK-based professionals working in gynecological oncology, including oncologists, nurses, radiologists, and other specialists in ovarian cancer. The web-based questionnaire, combining quantitative and free-text responses, assessed their experiences with EHR use, focusing on information retrieval, usability challenges, perceived risks, and benefits. In parallel, a human-centered design approach involving health care professionals, data engineers, and informatics experts codeveloped a digital informatics platform that integrates structured and unstructured data from multiple clinical systems into a unified patient summary view for clinical decision-making. Natural language processing was applied to extract genomic and surgical information from free-text records, with data pipelines validated by clinicians against original clinical system sources.

RESULTS: Among 92 respondents, 84 out of 91 (92%) routinely accessed multiple EHR systems, with 26 out of 91 (29%) using 5 or more. Notably, 16 out of 92 respondents (17%) reported spending more than 50% of their clinical time searching for patient information. Key challenges included lack of interoperability (35/141 reported challenges, 24.8%), difficulty locating critical data such as genetic results (57/85 respondents, 67%), and poor organization of information. Only 10 out of 92 professionals (11%) strongly agreed that their systems provided well-organized data for clinical use. While ease of access to patient data was a key benefit, 54 out of 90 respondents (60%) reported lacking access to comprehensive patient summaries. To address these issues, our co-designed informatics platform consolidates disparate patients’ data from different EHR systems into a single visual display to support clinical decision-making and audit.

CONCLUSIONS: Current EHR systems are suboptimal for supporting complex gynecological oncology care. Our findings highlight the urgent need for integrated, user-centered clinical decision tools. Fragmentation and lack of interoperability hinder information retrieval and may compromise patient care. Our co-designed ovarian cancer informatics platform is a potential real-world solution to improve data visibility, clinical efficiency, and ultimately the quality of ovarian cancer care.

PMID:40929723 | DOI:10.2196/58657

J Med Internet Res. 2025 Sep 10;27:e64989. doi: 10.2196/64989.

ABSTRACT

BACKGROUND: Every year in France, 40% of people aged ≥80 years are hospitalized, with an average length of hospital stay of 25 days and a readmission rate of 14% to 30% within the month following discharge. This situation is putting pressure on the health care system, encouraging the reinforcement of home care to reduce avoidable hospitalization. The EPOCA remote patient monitoring (RPM) system is a medical and social telehealth solution specialized in RPM, teleconsultation, tele-expertise, and care coordination in emergency medicine and geriatrics. The platform provides long-term medical support at home (MSAH) with 24-7 telemonitoring of older adults with polypathology. We hypothesized that receiving long-term MSAH via the EPOCA RPM system would be associated with a reduction in the rates and durations of hospitalizations or emergency department (ED) visits in older adults with polypathology.

OBJECTIVE: We aimed to compare the hospitalization and ED visit rates, as well as the cumulative hospital stay duration, before and after enrollment in the EPOCA RPM system for older adults with polypathology.

METHODS: This retrospective observational study included older adults (aged ≥70 years) with polypathology (>2 affected systems) followed throughout 2 different types of long-term MSAH between February 2022 and October 2023. We compared the number of hospital admissions, including ED visits; the cumulative duration of hospital stays during the follow-up; and the average length of hospital stays during the period corresponding to the MSAH program (Y) compared to the year before entering the program (Y – 1). Subgroup analyses were conducted according to the severity of the participants’ disability.

RESULTS: A total of 120 participants were included in the MSAH program, with a mean age of 86.8 (SD 7.9) years. Hospitalization and ED visit rates decreased (-48%) between the Y – 1 and Y periods, as did the total duration of hospital stays (-63%). A significant reduction in number of hospitalizations (median decreased from 1.0 to 0.0 per patient per year; P<.001) and ED visits (median decreased from 1.0 to 0.0 per patient per year; P<.001) was observed between the Y – 1 and Y periods. This corresponded to a significant median reduction of 14 days spent at the hospital per patient per year (P<.001). The decrease in hospitalization and ED visit rates and numbers was greater in participants with severe disabilities than in those with no or moderate disabilities.

CONCLUSIONS: Among older adults with polypathology, the EPOCA RPM system is associated with reduction in number of hospitalizations, ED visits, and duration of hospital stays. Facing the challenge of population aging, home telemonitoring embedded in the health care system offers potential benefits.

PMID:40929722 | DOI:10.2196/64989

JMIR Form Res. 2025 Sep 10;9:e75697. doi: 10.2196/75697.

ABSTRACT

BACKGROUND: Hospital falls represent a persistent and significant threat to safety within health care systems worldwide, impacting both patient well-being and the occupational health of health care staff. While patient falls are a primary concern, addressing fall risks for all individuals within the health care environment remains a key objective. Caregiver visibility and spatial monitoring are recognized as crucial considerations in mitigating fall-related incidents.

OBJECTIVE: This study aimed to investigate the association between the percentage of spatial shadow zone, defined as areas within an acute care unit unvisited by mobile workstations for prolonged periods, and the incidence of hospital falls and intensive care unit (ICU) transfers.

METHODS: This retrospective observational study was conducted in a 400-square-meter acute care unit of a tertiary hospital for over 210 days. An ultrawideband real-time location system was deployed to continuously track mobile workstations’ spatial coverage. Spatial shadow zones were defined as areas unvisited by mobile workstations for 60 continuous minutes. The primary outcome was hospital falls; the secondary outcome was ICU transfers. Multivariable logistic regression analysis, adjusted for patient-to-nurse ratio and day of week, was used to examine the association between the percentage of spatial shadow zone and these outcomes. Sensitivity analyses were performed by varying the spatial dilation distance (1-4 meters) and temporal shadow zone thresholds (15-90 minutes).

RESULTS: During this study’s period, 8 hospital falls and 89 ICU transfers occurred. Real-time location system validation indicated a mean positional error of 0.346 (SD 0.282) meters. In multivariable regression, a higher percentage of spatial shadow zone was significantly associated with an increased odds of hospital falls (odds ratio 1.02, 95% CI 1.01 to 1.03, P<.001). Conversely, a higher percentage of spatial shadow zone was associated with decreased odds of ICU transfer (odds ratio 0.99, 95% CI 0.99 to 0.99, P<.001). Sensitivity analyses demonstrated consistency of the association between spatial shadow zones and falls across varying parameter settings.

CONCLUSIONS: This study provides novel evidence for a significant positive association between the percentage of spatial shadow zones and hospital falls, underscoring the critical role of caregiver visibility in fall prevention. The findings suggest that proactively minimizing spatial shadow zones through optimized hospital design, workflow strategies, and technology-enabled monitoring may be a valuable approach to enhance patient safety and reduce hospital falls in acute care settings.

PMID:40929719 | DOI:10.2196/75697

JMIR Public Health Surveill. 2025 Sep 10;11:e73318. doi: 10.2196/73318.

ABSTRACT

BACKGROUND: In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research. This article seeks to bridge this gap by consolidating field notes and practical considerations derived from 3 ongoing NIH-supported studies focused on Ending the HIV Epidemic in the United States.

OBJECTIVE: This article aims to inform the design, planning, and implementation of operationally effective community-partnered social media strategies in HIV research, ultimately contributing to enhancements in HIV practice and improved outcomes across the HIV prevention and care continua.

METHODS: Supported by the University of California, Los Angeles Rapid, Rigorous, Relevant (3R) Implementation Science Hub, the 3 Ending the HIV Epidemic projects convened to form the community-partnered social media campaigns working group. The working group used the Consolidated Framework for Implementation Research to help identify and organize key barriers and facilitators of relevance to implementation of the projects’ social media strategies. Given the high degree of interrelatedness across reported factors, the working group thematically synthesized the content into 5 practical considerations to inform use of community-partnered social media strategies in HIV research.

RESULTS: The practical considerations identified by the community-partnered social media campaigns working group include the following: (1) the power and pitfalls of social media platforms (ie, opportunities and challenges inherent to social media platforms that may affect use of social media strategies in HIV research), (2) messengers and messages matter (ie, ensuring the appropriateness, acceptability, and quality of social media messengers and content), (3) the significance of the sociopolitical environment (ie, characterizing the sociopolitical environment surrounding HIV and its potential impact on implementing social media strategies to reach priority populations), (4) investing in academic-community partnerships (ie, cultivating positive and productive academic-community partnerships to support implementation of social media strategies in HIV research), and (5) the alignment of the institutional environment and research approach (ie, assessing and working to address features of institutional environments that may impact implementation of social media strategies in community-partnered HIV research).

CONCLUSIONS: As use of social media in HIV research and practice continues to grow, the practical considerations presented in this paper can help research teams anticipate factors that may impact implementation of community-partnered social media strategies and take early action to mitigate potential challenges. By understanding and addressing the unique challenges and opportunities of social media in community-partnered HIV research, we can leverage these platforms to accelerate progress toward ending the HIV epidemic.

PMID:40929715 | DOI:10.2196/73318

JMIR Public Health Surveill. 2025 Sep 10;11:e68437. doi: 10.2196/68437.

ABSTRACT

BACKGROUND: Scrub typhus (ST), also known as tsutsugamushi disease, is a common febrile vector-borne illness in South Korea, transmitted by trombiculid mites infected with Orientia tsutsugamushi, with rodents serving as the main hosts. Although vector-borne diseases like ST require both a One Health approach and a spatiotemporal perspective to fully understand their complex dynamics, previous studies have often lacked integrated analyses that simultaneously address disease dynamics, vectors, and environmental shifts.

OBJECTIVE: We aimed to explore spatiotemporal trends, high-risk areas, and risk factors of ST by simultaneously incorporating host and environmental information.

METHODS: ST cases were extracted from the 2013-2019 Korea National Health Insurance Service data at 250 municipal levels and by epidemiological weeks (International Classification of Diseases, Tenth Revision, Clinical Modification code: A75.3). Data on potential risk factors, including the maximum probability of rodent presence, area of dry field farming, forest coverage, woman farmer population, and financial independence, were obtained from publicly available sources. In particular, the maximum rodent presence probability was estimated using a maximum entropy model incorporating ecological and climate variables. Spatial autocorrelation was assessed using Global Moran I statistics with 999 Monte Carlo permutations. Spatial and temporal clusters were identified using Getis-Ord Gi* and hot and cold spot trend analyses. Bayesian hurdle models with a spatiotemporal interaction term, accounting for zero-inflated Poisson distribution, were used to identify associations between ST incidence and regional factors. Stratification analyses by gender and age group (0-39, 40-59, 60-79, and ≥80 years) were performed.

RESULTS: Between 2013 and 2019, 95,601 ST patients were reported. ST incidence had positive spatial autocorrelation (I=0.600; P=.01), with spatial expansion from southwestern to northeastern regions. Spatiotemporal models demonstrated better fit compared with spatial and temporal models, as indicated by lower Watanabe-Akaike information criterion (WAIC) values. Municipalities with higher rodent suitability (β coefficient=0.618; 95% credible interval [CrI] 0.425-0.812) and lower financial independence from central government (β coefficient=-0.304; 95% CrI -0.445 to -0.163) had higher likelihoods of increased ST incidence, even after adjusting for spatiotemporal autocorrelation. However, risk factors varied by age group: among individuals aged 40 years or older, ST incidence was positively associated with rodent suitability, while patients in the 0-39 years age group showed no association with rodent suitability (β coefficient=0.028; 95% CrI -0.072 to 0.126), and ST incidence was negatively associated with the women farmer population (β coefficient=-0.115; 95% Crl=-0.223 to -0.006).

CONCLUSIONS: This is the first study to investigate ST in South Korea using a spatiotemporal framework grounded in a holistic One Health perspective. We elucidated the critical role of spatiotemporal dynamics in ST distribution, highlighting rodent suitability and economic independence as key drivers of disease distribution. Our findings lay the groundwork for evidence-based, region-specific intervention strategies and may inform targeted public health strategies in South Korea and other settings with similar ecological conditions.

PMID:40929714 | DOI:10.2196/68437