Nevin Manimala

Eur J Public Health. 2025 Jul 15:ckaf120. doi: 10.1093/eurpub/ckaf120. Online ahead of print.

ABSTRACT

We explored the association between education and academic ability in childhood and both outpatient appointments and hospital admissions in adulthood, accounting for adult factors, including long-term conditions. The analytical sample consisted of 7183 participants in the Aberdeen Children of the 1950s. Three outcomes were measured using routine Scottish medical records over a five-year period (2004-2008): (1) ≥5 outpatient appointments, (2) ≥2 hospital admissions, or (3) ≥3 outpatient appointments plus ≥1 hospital admission. We constructed a childhood (age 6-11) education and academic ability domain and calculated predicted risk scores of the three outcomes for each cohort member. Nested logistic regression models investigate the association between domain predicted risk scores and odds of each of the three outcomes accounting for childhood confounders and self-reported adult mediators. Adjusting for childhood confounders, lower childhood education and academic ability were positively associated with ≥5 outpatient appointments (OR 1.03, 95% CI 1.01-1.05), ≥2 hospital admissions (OR 1.04, 95% CI 1.03-1.6), and ≥3 outpatient appointments plus ≥1 hospital admissions (OR 1.04, 95% CI 1.02-1.06). Accounting for adult mediators, associations remained statistically significant, but their effect sizes were reduced. When school leaving age was included in the model, the association between the exposure and all three outcomes were attenuated. Education and academic ability in early life may be related to the burden of multiple hospital admissions and outpatient appointments later in life. However, the age at which the participant left school seems to substantially mediate this relationship underscoring the positive impact of time spent in education.

PMID:40663774 | DOI:10.1093/eurpub/ckaf120

JMIR Res Protoc. 2025 Jul 15;14:e63596. doi: 10.2196/63596.

ABSTRACT

BACKGROUND: The rapid proliferation of health care apps has transformed health care delivery, providing patients with unprecedented access to medical information and services. These apps facilitate remote consultations, appointment scheduling, medication reminders, and health monitoring, thereby enhancing patient engagement and improving health outcomes. Despite the widespread benefits, disparities in the adoption and usage of health care apps persist, influenced by demographic and socioeconomic factors. Understanding these disparities is crucial for designing interventions that promote equitable access to digital health tools.

OBJECTIVE: This systematic review aims to identify and synthesize empirical studies on health care app usage disparities, focusing on demographic and socioeconomic factors. This review seeks to inform stakeholders about the key factors influencing app usage and provide insights to improve accessibility and effectiveness. Specifically, this review addresses the following research questions: (1) what are the key demographic and socioeconomic factors associated with health care app usage disparities? (2) how do these factors influence the adoption and utilization of health care apps? and (3) what are the barriers to and facilitators of effective use of health care apps?

METHODS: This review will adhere to PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Eight databases-ACM Digital Library, CINAHL, IEEE Xplore, ProQuest Nursing and Allied Health Journals, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science-were searched for studies published in English between January 1, 2014, and June 17, 2024. Eligibility criteria include journal papers focusing on health care app usage across different demographic and socioeconomic groups. Data management will involve using Zotero for reference management and Excel for screening and eligibility assessment. Two reviewers will independently extract the data and assess the study quality and risk of bias. Descriptive statistics will be used to summarize the study characteristics.

RESULTS: As of June 2025, the review is in the screening stage. The completion of data collection is anticipated by November 2025. The final results are expected to be published by late 2025. This review aims to provide comprehensive insights into the disparities in health care app usage.

CONCLUSIONS: The findings of this systematic review will offer valuable insights into demographic and socioeconomic disparities in health care app usage, informing stakeholders on how to address these disparities. By identifying the factors influencing app adoption and usage, this review will contribute to the development of targeted interventions and policies to enhance digital health equity.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63596.

PMID:40663773 | DOI:10.2196/63596

Blood. 2025 Jul 15:blood.2025028964. doi: 10.1182/blood.2025028964. Online ahead of print.

ABSTRACT

Tumor inflammation-associated neurotoxicity (TIAN) was recently proposed as a unique complication of immunotherapy in brain tumor patients. Here, we report a first comprehensive characterization of TIAN in CNS lymphoma (CNSL) patients treated with CD19-directed chimeric antigen receptor T-cells (CD19-CAR). TIAN occurred in 10/56 (17.9%) CNSL with clinical onset at a median 3.5 days (range: 1-9) after CD19-CAR infusion. It was less frequently associated with cytokine release syndrome (60% vs 100%, p = 0.009) than immune effector cell-associated neurotoxicity syndrome (ICANS). Although symptoms were usually transient and fully reversible, TIAN was associated with a fatal outcome in one patient. Larger CNS tumor volume at baseline allowed the identification of patients at risk for TIAN (AUC: 0.847, p = 0.002). Maximizing Youden J statistics, a discriminatory tumor volume threshold >3.4cm3 was determined, which carried 87.5% sensitivity and 80.5% specificity. TIAN correlated with higher overall response rates to CD19-CAR (90% vs 52%, p = 0.036) and improved progression-free survival (Hazard ratio: 0.22; 95%-Confidence interval: 0.07-0.61, p = 0.006) on multivariate Cox proportional hazard regression. Post-mortem histopathological evaluation of a TIAN lesion revealed a dense macrophage population with central necrosis and peripheral reactive gliosis, accompanied by loss of white matter and intracytoplasmic myelin in foamy macrophages. Collectively, our work supports TIAN as a localized on-tumor, on-target neurotoxicity syndrome, closely related to pre-existing CNSL lesions and distinct from ICANS. CNS tumor volume at baseline may allow to identify patients at risk and may guide management.

PMID:40663771 | DOI:10.1182/blood.2025028964

Plast Reconstr Surg. 2025 Jul 1. doi: 10.1097/PRS.0000000000012283. Online ahead of print.

ABSTRACT

INTRODUCTION: Lower Extremity Free Flap Reconstruction (LE-FFR) is essential for significant soft tissue defects, but prolonged hospital stays can negatively impact patients and healthcare systems. This study aimed to identify factors associated with post-flap surgery length of stay (pfsLOS) in LE-FFR patients to optimize healthcare delivery and outcomes.

METHODS: This retrospective cohort study included 405 patients who underwent 415 microvascular LE-FFR at two Level I Trauma Centers. The primary outcome was pfsLOS, which was then described in the context of total LOS (tLOS). Statistical analyses involved multivariable linear and Cox regression models, analyzing outcomes as relative percentage changes in pfsLOS.

RESULTS: Across all defect etiologies, median pfsLOS (IQR) was 10 days (8-14), with prolonged pfsLOS (>14 days) in 81 patients (20%). Combined initial plastic and orthopaedic surgery treatment (primary multidisciplinary orthoplastic treatment) was associated with a significant decrease in pfsLOS (-13.58%, p=0.047) in multivariable regression analysis, with the greatest benefit observed in high-severity cases. Other factors significantly affecting pfsLOS included the number of plastic surgery operations (14.47% increase per operation, p<0.001), blood transfusion (13.03% increase, p=0.023), and flap surgery duration (0.06% increase per minute, p=0.041). The time between the first surgery and flap surgery was associated with a significant decrease in pfsLOS (-0.90% per day, p=0.046). Sub-analysis showed that discharge to destinations other than home significantly increased pfsLOS (16.45%, p=0.001), particularly in socially deprived areas.

CONCLUSION: Initial combined orthoplastic intervention reduced pfsLOS by 9.10%-13.58% and overall tLOS by 50.00% for LE-FFR patients. Early coordination between services reduces LOS, optimizes resource utilization, and likely improves cost-effectiveness and patient outcomes in LE-FFR.

LEVEL OF EVIDENCE: III – therapeutic.

PMID:40663765 | DOI:10.1097/PRS.0000000000012283

Chaos. 2025 Jul 1;35(7):073128. doi: 10.1063/5.0273965.

ABSTRACT

In this paper, based on the traditional prisoner’s dilemma model, we introduce time-varying peer pressure and verify the enhancing effect of this time-varying peer pressure model on cooperation in different types of networks. We decompose peer pressure into two aspects: pressure intensity, reflecting the degree of punishment an individual receives due to strategy inconsistency with neighbors, and pressure sensitivity, indicating the likelihood of an individual being influenced by peer pressure, which can be regarded as an individual characteristic. Considering individuals’ continuous development over time, it is possible for individual characteristics to change over time. Thus, we treat pressure sensitivity as a time-varying function in this paper and construct it based on the widely used Sigmoid function, taking into account the differences in sensitivity among different individual types. We apply the time-varying peer pressure model to Watts-Strogatz (WS) and Barabási-Albert (BA) networks and evaluate its effect from two aspects: the increase in the proportion of cooperators compared to the traditional prisoner’s dilemma model, and the range of b within which there are still cooperators that can survive in the system. Overall, we find that the introduction of the time-varying peer pressure can more significantly enhance the evolution of cooperation in WS networks. Specifically, under the time-varying peer pressure model, the range of b that the system can withstand can be expanded to b≤1.95 in WS networks, and the range expands to b≤2.7 in BA networks, while the network scale is 100.

PMID:40663761 | DOI:10.1063/5.0273965

JMIR Cancer. 2025 Jul 15;11:e52627. doi: 10.2196/52627.

ABSTRACT

BACKGROUND: In the modern era, the use of technology can substantially impact care access. Despite the extent of its influence on several chronic medical conditions related to the heart, lungs, and others, the relationship between one’s access to digital resources and oncologic conditions has been seldom investigated in select pathologies among gastrointestinal and head-neck regions. However, studies on the influence of this “digital inequity” on other cancers pertaining to nasal and paranasal sinus cancer (NPSC) have yet to be performed. This remains in stark contrast to the extent of large data approaches assessing the impact of traditional social determinants/drivers of health (SDoH), such as factors related to one’s socioeconomic status, minoritized race or ethnicity, and housing-transportation status, on prognostic and treatment outcomes.

OBJECTIVE: This study aims to use the Digital Inequity Index (DII), a novel, comprehensive tool that quantifies digital resource access on an area- or community-based level, to assess the relationship between inequities in digital accessibility with NPSC disparities in prognosis and care in the United States.

METHODS: Patients with NPSC from 2008 to 2017 in the Surveillance, Epidemiology, and End Results Program were assessed for significant regression trends in the long-term follow-up period and treatment receipt across NPSCs with increasing overall digital inequity, as measured by DII. DII was based on 17 census-tract level variables derived from the summarized values overlapping that same time period from the US Census/American Community Survey and Federal Communications Commission Annual Broadband Report. Variables were categorized as infrastructure-access (ie, electronic device ownership, internet provider availability, and income-broadband subscription ratio) or sociodemographic (education, income, age, and disability), ranked, and then averaged into a composite score to encompass direct and indirect factors related to digital inequity.

RESULTS: Across 8012 adult patients with NPSC, males (n=5416, 67.6%) and White race (n=4293, 53.6%) were the most represented demographics. With increasing digital inequity, as measured by increasing total DII scores, significant decreases in the length of long-term follow-up were observed with nasopharyngeal (P<.01) and maxillary sinus cancers (P=.02), with decreases as high as 19% (35.2 to 28.5 months, nasopharynx). Electronic device and service availability inequities showcased higher-magnitude contributions to observed associated regression trends, while the income-broadband ratio contributed less. Significantly decreased odds of receiving indicated surgery (lowest odds ratio 0.87, 95% CI 0.80-0.95, maxillary) and radiation (lowest odds ratio 0.78, 95% CI 0.63-0.95, ethmoid) for several NPSCs were also observed.

CONCLUSIONS: Digital inequities are associated with detrimental NPSC care and surveillance trends in the United States, even when accounting for traditional SDoH factors. These results prompt the need to include digital factors into the discussion of contextualizing SDoH-based analyses of cancer care disparities, as well as the specific factors from which prospective implementations and initiatives can invest limited public health resources to alleviate the most pertinent drivers of disparities.

PMID:40663723 | DOI:10.2196/52627

IEEE Trans Pattern Anal Mach Intell. 2025 Jul 15;PP. doi: 10.1109/TPAMI.2025.3588186. Online ahead of print.

ABSTRACT

Self-attention and transformers have been widely used in deep learning. Recent efforts have been devoted to incorporating transformer blocks into different neural architectures, including those with convolutions, leading to various visual transformers for computer vision tasks. In this paper, we propose a novel and compact transformer block, Transformer with Learnable Token Merging (LTM), or LTM-Transformer. LTM-Transformer performs token merging in a learnable scheme. LTM-Transformer is compatible with many popular and compact transformer networks, and it reduces the FLOPs and the inference time of the visual transformers while maintaining or even improving the prediction accuracy. In the experiments, we replace all the transformer blocks in popular visual transformers, including MobileViT, EfficientViT, ViT, and Swin, with LTM-Transformer blocks, leading to LTM-Transformer networks with different backbones. The LTM-Transformer is motivated by reduction of Information Bottleneck, and a novel and separable variational upper bound for the IB loss is derived. The architecture of mask module in our LTM blocks which generate the token merging mask is designed to reduce the derived upper bound for the IB loss. Extensive results on computer vision tasks evidence that LTM-Transformer renders compact and efficient visual transformers with comparable or much better prediction accuracy than the original visual transformers. The code of the LTM-Transformer is available at https://github.com/Statistical-Deep-Learning/LTM.

PMID:40663671 | DOI:10.1109/TPAMI.2025.3588186

J Clin Endocrinol Metab. 2025 Jul 15:dgaf391. doi: 10.1210/clinem/dgaf391. Online ahead of print.

ABSTRACT

CONTEXT: Longer-term survival is possible for some patients with Anaplastic Thyroid Cancer (ATC). However, genomic factors associated with improved survival are poorly characterized.

OBJECTIVE: To develop a mathematical model to predict mutation-based survival risk in ATC.

DESIGN: Retrospective cohort study of 204 ATC samples from the cBioPortal database, divided into 80% training and 20% validation cohorts. Multivariate analysis identified prognostic genes, used to construct a point-based risk model. KEGG pathway enrichment and BRAF subanalyses were performed.

SETTING: Multi-institutional, international genomic database.

PATIENTS OR OTHER PARTICIPANTS: Samples were included if sequencing and survival data were available (N=204).

INTERVENTION(S): Not applicable.

MAIN OUTCOME MEASURE(S): The prespecified primary outcome was overall survival.

RESULTS: Fourteen genes were associated with increased risk – TET1, MAPK12, ATP10A, PIK3CA, MUC4, PNPLA2, PLD4, EGLN2, BSN, FLNC, RADIL, ZMYND8, FRAS1, RECQL4. More aggressive (n=37) and less aggressive cohorts (n=128) were determined using the maximally selected rank statistic, yielding a point threshold of 0.27. The predictive performance of the risk model demonstrated a C-index of 0.74. On Kaplan Meier analysis, 1-year survival differed for more aggressive patients (0%) compared to less aggressive patients (32%). For the validation cohort, survival remained significantly different between risk cohorts and on BRAF subanalysis. Each risk cohort subsequently underwent KEGG pathway enrichment analysis which showed significantly increased enrichment across several pathways for more aggressive tumors.

CONCLUSIONS: This model identifies mutated genes that are associated with the most aggressive ATCs and thus may aid in preoperative risk assessment when evaluating patients for surgery for curative intent.

PMID:40663630 | DOI:10.1210/clinem/dgaf391

Menopause. 2025 Jul 15. doi: 10.1097/GME.0000000000002574. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore potential differences in physical activity and sedentary behavior volumes and patterns among postmenopausal women with and without premenopausal bilateral oophorectomy (PBO).

METHODS: Women with a history of PBO (n = 50) and age-matched postmenopausal referent women (n = 50) were recruited. Participants wore accelerometers on both ankles for 7 days. Volume metrics of sedentary behavior and physical activity, such as step counts, active time, and sedentary time, as well as the sedentary behavior and habitual physical activity distribution, and accumulation patterns, were quantified from the accelerometer data and compared between groups.

RESULTS: Metrics indicating volume of sedentary behavior and physical activity were not statistically different between groups. PBO was significantly associated with higher variability in stepping bout time (P = 0.022), indicating a potentially more complex walking pattern. In addition, PBO was significantly associated with lower variability in sedentary break time (P = 0.012), and lower activity time Gini index (Z = -2.428, P = 0.015). This suggests that women with PBO may have broken up their sedentary time with shorter and less variable activity bouts, and because they had relatively shorter average daily active time, they might be at a higher risk of subsequent adverse health outcomes such as low bone mineral density.

CONCLUSIONS: Although there were no differences in overall activity volume, some differences in activity patterns emerged between women with PBO and referent women. The study highlights the need for longitudinal research to understand how physical activity and sedentary behavior patterns evolve in postmenopausal women with a history of PBO.

PMID:40663581 | DOI:10.1097/GME.0000000000002574

PLoS One. 2025 Jul 15;20(7):e0327214. doi: 10.1371/journal.pone.0327214. eCollection 2025.

ABSTRACT

Despite global efforts, gender-based violence (GBV) remains a problem that affects millions of people, particularly women. The prevalence of GBV in Nigeria has not improved over time; women who experienced physical violence since age 15 increased from 28% in 2008 to 31% in 2018. Intimate partner violence (IPV) constitutes a large proportion of the GBV in Nigeria. Although perceptions of IPV have been studied, differentials in perceptions among the different generations of Nigerians are unknown. People’s perceptions of IPV are influenced by societal shifts and other factors that differ among people of various ages. This research examined inter-generational differentials in the perception of IPV in Nigeria. Data were obtained from the 2021 Nigeria Multiple Indicator Cluster Survey. A sample of 53,706 men and women was analyzed using descriptive statistics, and logistic regression models. The older generations of men and women in Nigeria have significantly better perceptions of IPV than the younger generation, but there is a significant variation at the sub-national level. The observed pattern is worrisome and calls for urgent action by the government to advance more positive perceptions of GBV in Nigeria if the country will make progress in reducing the prevalence of GBV and achieve a violence-free society.

PMID:40663580 | DOI:10.1371/journal.pone.0327214