Nevin Manimala

Proc Natl Acad Sci U S A. 2025 Jul 15;122(28):e2500874122. doi: 10.1073/pnas.2500874122. Epub 2025 Jul 8.

ABSTRACT

This study examines the theoretical and methodological limitations of migration research in understanding gender-specific trends of migration. In particular, theory-driven methods suffer from the gender blindness of migration theories, while data-driven methods suffer from the scarcity of gender disaggregated migration data. This research aims to evaluate how these dual limitations affect the accuracy of commonly used migration prediction models. By analyzing migration flows disaggregated by gender, the study compares the performance of deterministic methods and probabilistic gravity-type models in predicting migrant flows with varying gender compositions. The findings reveal significant differences in the predictive performance of gravity-type models based on the gender composition of migration flows. Drawing on migration theories and case studies, the study contextualizes these findings, concluding that the lack of robust theoretical frameworks and the limited availability of gender-specific migration data have critically undermined the accuracy of current prediction and forecasting methods. The implications of this research highlight the urgent need for a critical reassessment of migration theories and methodologies through the lens of gender biases, paving the way for more inclusive and accurate migration predictions.

PMID:40627387 | DOI:10.1073/pnas.2500874122

Dentomaxillofac Radiol. 2025 Jul 8:twaf054. doi: 10.1093/dmfr/twaf054. Online ahead of print.

ABSTRACT

OBJECTIVES: To reduce the problems arising from the inability to identify dental implant brands, this study aims to classify various dental implant brands using deep learning algorithms on panoramic radiographs.

METHODS: Images of four different dental implant systems (NucleOSS, Medentika, Nobel, and Implance) were used from a total of 5,375 cropped panoramic radiographs. To enhance image clarity and reduce blurriness, the Contrast Limited Adaptive Histogram Equalization (CLAHE) filter was applied. GoogleNet, ResNet-18, VGG16, and ShuffleNet deep learning algorithms were utilized to classify the four different dental implant systems. To evaluate the classification performance of the algorithms, ROC curves and confusion matrices were generated. Based on these confusion matrices, accuracy, precision, sensitivity, and F1 score were calculated. The Z-test was used to compare the performance metrics across different algorithms.

RESULTS: The accuracy rates of the deep learning algorithms were obtained as 96.00% for GoogleNet, 84.40% for ResNet-18, 98.90% for VGG16, and 84.80% for ShuffleNet. A statistically significant difference was found between the accuracy rate of the VGG16 algorithm and those of GoogleNet, ShuffleNet, and ResNet-18 (p < 0.001, p < 0.001, and p < 0.001, respectively).

CONCLUSIONS: With the achievement of high accuracy rates, deep learning algorithms are considered a valuable and powerful method for identifying dental implant brands.

PMID:40627380 | DOI:10.1093/dmfr/twaf054

JAMA Netw Open. 2025 Jul 1;8(7):e2519410. doi: 10.1001/jamanetworkopen.2025.19410.

ABSTRACT

IMPORTANCE: National Immunization Technical Advisory Groups recommend long-acting monoclonal antibody prophylaxis for the prevention of respiratory syncytial virus (RSV) disease for children at high risk in the first season, regardless of RSV vaccination during pregnancy, and for those who remain at increased risk in the second season.

OBJECTIVE: This study assessed which groups of children with chronic medical conditions (CMCs) are at higher risk of RSV hospitalization during their first and second RSV seasons.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based, season-stratified cohort analysis was conducted among children who were born between April 1, 2013, and March 31, 2023, in British Columbia, Canada (population of 5.7 million in 2024), and were enrolled in the provincial medical service plan and followed up until the day before their third RSV season or April 1, 2024, whichever occurred first.

EXPOSURE: Any CMC diagnosed in the first 2 years of life.

MAIN OUTCOMES AND MEASURES: Respiratory syncytial virus-related hospitalizations.

RESULTS: The final cohort consisted of 431 937 children (32 959 [7.6%] born at <37 weeks’ gestation; 222 207 boys [51.4%]) followed up for a median of 728 days (IQR, 642-729 days), including 25 452 children (5.9%) diagnosed with at least 1 of 1116 distinct CMCs. In total, 4567 children (1.1%) experienced a combined total of 4592 RSV hospitalizations, combining data from the first and second RSV seasons. In the first RSV season, the RSV hospitalization rate per 1000 person-years for children with CMCs was 15.9 (95% CI, 14.2-17.6) and for children without CMCs was 8.0 (95% CI, 7.7-8.3). In the second RSV season, the RSV hospitalization rate per 1000 person-years for children with CMCs was 7.8 (95% CI, 6.7-8.8) and for children without CMCs was 2.2 (95% CI, 2.1-2.3). Children with multisystem CMCs, particularly those affecting the respiratory, cardiovascular, or gastrointestinal systems, had second-season RSV hospitalization rates that were at least 2-fold higher than the rate among all children in the first season. Second-season rates among children with Down syndrome or those who were born prematurely (<28 weeks of gestation) were 5-fold higher than for all children in the first season.

CONCLUSIONS AND RELEVANCE: This population-based retrospective cohort study identified specific groups of higher-risk children with CMCs who could most benefit from prophylaxis with long-acting monoclonal antibodies in their first and second RSV seasons. This study supports expanded eligibility criteria for long-acting monoclonal antibody prophylaxis.

PMID:40627354 | DOI:10.1001/jamanetworkopen.2025.19410

JAMA Netw Open. 2025 Jul 1;8(7):e2519467. doi: 10.1001/jamanetworkopen.2025.19467.

ABSTRACT

IMPORTANCE: Understanding the association of postoperative delirium with adverse outcomes and the hospital-level variation of postoperative delirium is important for efforts to improve perioperative brain health.

OBJECTIVE: To examine (1) the association of postoperative delirium with 30-day mortality and complications and (2) hospital-level variation in postoperative delirium.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study examined hospitalizations among patients aged 65 years and older who underwent noncardiac surgery in US hospitals between January 1, 2017, and December 31, 2020. Data were analyzed between August 28, 2024, and April 10, 2025.

EXPOSURE: Postoperative delirium.

MAIN OUTCOMES AND MEASURES: The association of the composite of death and major complications with postoperative delirium was examined using multivariable logistic regression. Variability in the hospital incidence of postoperative delirium was evaluated using multilevel logistic regression analysis.

RESULTS: Among 5 530 054 inpatient admissions for major noncardiac surgery in 3169 hospitals, the mean (SD) patient age was 74.7 (7.0) years, and 3 161 054 admissions (57.2%) were of female patients. The incidence of postoperative delirium was 3.6% (197 921 admissions). Compared with patients without postoperative delirium, patients with postoperative delirium were more likely to experience death or major complications (adjusted OR [aOR], 3.47; 95% CI, 3.41-3.53; P < .001), 30-day mortality (aOR, 2.77; 95% CI, 2.71-2.83; P < .001), and nonhome discharges (aOR, 3.96; 95% CI, 3.88-4.04; P < .001). Controlling for patient characteristics, the odds of postoperative delirium were higher for patients undergoing surgery in hospitals with a higher rate of postoperative delirium compared with hospitals with lower rates of postoperative delirium (median OR, 1.53; 95% CI, 1.50-1.56).

CONCLUSIONS AND RELEVANCE: In this national retrospective cohort study of more than 5.5 million hospitalizations, older individuals undergoing major noncardiac surgery who experienced postoperative delirium had 3.5-fold higher odds of death or major complications, 2.8-fold higher odds of death, and 4.0-fold higher odds of nonhome discharge. There was substantial variation in the hospital rate of postoperative delirium after accounting for patient risk, which suggests that this complication may be an appropriate target for hospital efforts to improve perioperative brain health, provided that delirium screening and coding accuracy are improved.

PMID:40627352 | DOI:10.1001/jamanetworkopen.2025.19467

JAMA Netw Open. 2025 Jul 1;8(7):e2519507. doi: 10.1001/jamanetworkopen.2025.19507.

ABSTRACT

IMPORTANCE: Massachusetts implemented a Flexible Services program (FSP) under a Medicaid Section 1115 waiver to address food and housing insecurity for accountable care organization (ACO) beneficiaries. Little is known about the social, behavioral, and clinical outcomes associated with Medicaid social needs interventions.

OBJECTIVE: To compare 1-year changes in food and housing insecurity, diet, stress, and acute health care use between individuals who participated in the Massachusetts FSP and those who did not.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study enrolled adult Medicaid beneficiaries from 5 community health centers in 1 eastern Massachusetts ACO from December 2019 through December 2020. Participants who were enrolled in FSP were compared with propensity score-weighted FSP-eligible study participants who were not enrolled in FSP (hereafter non-FSP participants). All FSP participants completed surveys and dietary recalls at enrollment and then annually for 3 years. In-depth interviews were conducted with 27 FSP participants. All data analyses were conducted from August 2024 to April 2025.

EXPOSURE: Enrollment in FSP.

MAIN OUTCOMES AND MEASURES: Primary outcomes were 1-year changes in food and housing insecurity, stress, dietary quality, and acute health care use. Secondary outcomes were changes in depression and anxiety symptoms. Annual surveys measured food insecurity (10-item US Department of Agriculture Food Security Scale Module; score range: 0-10, with ≥3 indicating food insecurity), housing insecurity (questions regarding current housing, moving ≥2 times in past year, and worrying about losing housing), and stress (the 10-item Perceived Stress Scale [PSS]; score range: 0-40, with ≥14 indicating moderate to severe stress). Diet quality was measured with the Healthy Eating Index-2020 (HEI-2020; score range: 0-100, with higher scores indicating healthier diet quality). Acute health care use included annual emergency department (ED) visits and acute hospitalizations.

RESULTS: There were 153 FSP participant episodes (representing 153 study participants; mean [SD] age, 43.6 [10.8] years; 129 females [84.3%]) and 1495 non-FSP participant episodes (representing 610 unique study participants; mean (SD) age 43.2 (11.2) years; 464 females [76.1%]) in the sample. Before FSP enrollment, 111 (72.5%) had food insecurity, 68 (44.4%) had housing insecurity, and 55 (35.9%) had both. There were no differences between the FSP and non-FSP groups in changes in proportion of individuals with food insecurity (difference in change, 4.96%; 95% CI, -3.13% to 13.05%) or housing insecurity (difference in change, 2.75%; 95% CI: -5.39% to 10.88%). There were no differences between groups in HEI-2020 scores, PSS scores, or acute health care use. Participant interviews reflected a range of experiences associated with FSP, from favorable changes in social needs and health to persistent challenges related to cost of food and limited housing availability.

CONCLUSIONS AND RELEVANCE: This study of adult Medicaid beneficiaries found that FSP was not associated with short-term favorable changes in food or housing insecurity, diet, stress, or acute health care use. In interviews, FSP participants highlighted both the benefits and challenges of addressing social needs through such health system interventions.

PMID:40627351 | DOI:10.1001/jamanetworkopen.2025.19507

Obes Surg. 2025 Jul 8. doi: 10.1007/s11695-025-08046-6. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to investigate changes in food neophobia (fear of trying new foods), eating psychopathology and depression in patients with sleeve gastrectomy (SG) at preoperative (T0), 3-month (T1) and 6-month (T2) follow-up.

METHODS: This study was conducted with 87 adults (43 males, 44 females) undergoing SG. Participants were assessed using the characteristic form, the Food Neophobia Scale (FNS), the Eating Disorder Examination Questionnaire (EDE-Q) and the Beck Depression Inventory (BDI) at baseline. These assessments were repeated at T1 and T2. Higher scores on the FNS, EDE-Q, and BDI indicate greater levels of food neophobia, disordered eating behaviors and depressive symptoms, respectively.

RESULTS: There was a significant increase in the total FNS score and the number of neophobic patients from T0 to T1 and then a slight decrease (from T1 to T2), but it was still significantly higher at T2 than at T0. A statistically significant and progressive reduction was observed in the total and subscale scores of the EDE-Q and total BDI score at both T1 and T2. The BDI total score, the EDE-Q total score and all EDE-Q subscale scores (except for the Restraint) were significantly higher in females than in males at T1 and T2. FNS total score and the number of neophobic patients were higher in males at T0, T1 and T2.

CONCLUSION: Eating psychopathology and depressive symptoms may tend to improve after SG. Although it is possible to state that food neophobia has changed over time compared to before SG, it needs to be supported by studies.

PMID:40627325 | DOI:10.1007/s11695-025-08046-6

Cardiovasc Interv Ther. 2025 Jul 8. doi: 10.1007/s12928-025-01155-0. Online ahead of print.

ABSTRACT

The efficacy and durability of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) has been demonstrated in randomized studies, but these findings were not confirmed in several observational studies. This is an analysis of 5706 AS patients who underwent SAVR from 2010 and 2012, and 2989 AS patients who underwent TAVR from 2017 and 2018 from the prospective OBSERVANT I and II studies. TAVR procedures were performed with new-generation devices. Five-year all-cause mortality was the primary outcome of this analysis. Propensity score matching yielded 1008 pairs of TAVR and SAVR patients. The mean EuroSCORE II was comparable between the study cohorts (TAVR 4.7 ± 4.0% and SAVR 4.5 ± 5.7%, p = 0.419). At 5 years, TAVR was associated with higher mortality (44.4% vs. 33.2%, HR 1.36, 95%CI 1.18-1.57, Log-rank test p < 0.001), major adverse cardiac and cerebrovascular events (MACCEs) (49.3% vs. 37.9%, HR 1.32, 95%CI 1.15-1.51, Log-rank test p < 0.001), permanent pacemaker implantation (23.1% vs. 9.3%, HR 2.72, 95%CI 2.14-3.45, Log-rank test p < 0.001) and percutaneous coronary intervention rates (3.7% vs. 1.2%, HR 3.44, 95%CI 1.76-6.71, Log-rank test p < 0.001) compared to SAVR. Age ≤ 80 years, male gender, EuroSCORE II ≤ 4.0%, absence of coronary artery disease and absence of diabetes were associated with higher 5-year mortality after TAVR compared to SAVR. TAVR had a significantly higher 5-year mortality than SAVR both in patients with left ventricular ejection fraction ≤ 50% and > 50%. This observational study from prospective data showed that TAVR using new-generation devices was associated with increased rates of all-cause mortality compared to SAVR at 5 years. These findings should be viewed considering the non-randomized nature of this study and may be attributable to the characteristics of patients selected for TAVR, rather than the procedure itself.

PMID:40627314 | DOI:10.1007/s12928-025-01155-0

Ophthalmol Ther. 2025 Jul 8. doi: 10.1007/s40123-025-01164-5. Online ahead of print.

ABSTRACT

INTRODUCTION: High patient burdens from diabetic retinopathy (DR)-associated vision loss and intravitreal therapy (IVT) support patient experience inclusion in DR trial designs. This trial simulation characterized patient and site staff opinions to improve future nonproliferative DR (NPDR) trial designs.

METHODS: Between March 27 and May 31, 2023, survey data were collected from trial simulation participants. After a preread and trial design animation, study features were simulated followed by a 75-90-min web-assisted telephone interview. Patients with NPDR and trial site staff from the United States, United Kingdom, and Germany were included. The likelihood of patient participation and the challenges faced by site staff in conducting the simulated clinical trial at their study site were assessed using a 1-7 scale. Outcomes were evaluated via thematic analysis and descriptive statistics.

RESULTS: Twenty-two patients aged 36-55 years and mostly female (59.1%), and 16 site staff were interviewed. Mean NPDR duration was 9.3 years; most patients (81.8%) had never participated in a clinical trial. Although eligibility criteria resembled other trials, site staff indicated that restrictive exclusion criteria of the trial simulation could limit recruitment and that endpoints did not match patients’ goals, which mainly focused on saving vision. The proposed 4-5-h on-site visits and 72-week trial length were considered “too long” by 45.5% and 50.0% of patients, respectively. For the 1:2 sham or active treatment allocation ratio, responses were 40.9% neutral, 36.4% positive, and 22.7% negative. Some patients misunderstood that sham injections imitate actual injections, expressing concerns about adverse events. Patients reported IVT-related anxieties, particularly IVT-inexperienced patients. Mean patient trial participation interest score was 4.9/7; 62.5% of site staff were interested in conducting the trial. Some proposed adaptations were implemented in the trial protocol (e.g., offering patient/caregiver transportation).

CONCLUSIONS: Insights gained from respondent feedback in this simulation may inform future DR clinical trial design, potentially enhancing recruitment rates and patient experience.

PMID:40627309 | DOI:10.1007/s40123-025-01164-5

Infection. 2025 Jul 8. doi: 10.1007/s15010-025-02589-7. Online ahead of print.

ABSTRACT

PURPOSE: Sepsis survivorship is associated with significant long-term morbidity, mortality and health care utilization. Transitional care between inpatient and follow-up care is crucial, but insufficiently understood. We investigated health care utilization in sepsis survivors 90 days post-discharge, comparing translational care during 2016-2019 vs. 2020 in the first year of the pandemic.

METHODS: This retrospective cohort study used nationwide health claims data of the “AOK- die Gesundheitskasse”. Sepsis patients with inpatient treatment in 2016-2019 were identified using explicit ICD-10 codes for sepsis and codes for organ dysfunction. A second sepsis patient cohort was identified in 2020, which included also explicitly defined sepsis patients as well as patients with COVID-19 and Influenza with evidence of organ dysfunction. Among survivors, health care utilization in the 90 days post-discharge was assessed and first health service provider contacts were visualized using Sankey diagrams.

RESULTS: Among 234,874 sepsis survivors in 2016-2019, 94.4% were treated by a general practitioner, 47.7% had ≥ 1 hospital readmission and 42.8% of patients had ≥ 1 emergency treatment 90 days post-sepsis. Nearly all patients had prompt health service provider contacts in that time frame, with physicians in the outpatient sector being the most common first and second health service provider contacts. In the 2020 cohort (n = 69,432 survivors), more patients died without follow-up contact. Additionally, the latency to the first and second health service provider contacts were elevated compared to 2016-2019.

DISCUSSION: Sepsis survivors receive early, high-frequency follow-up care in the inpatient and outpatient sector. This may be an opportunity to implement early screening for sequelae and targeted therapies.

PMID:40627302 | DOI:10.1007/s15010-025-02589-7

J Imaging Inform Med. 2025 Jul 8. doi: 10.1007/s10278-025-01602-7. Online ahead of print.

ABSTRACT

Hydatid cysts, caused by Echinococcus granulosus, form progressively enlarging fluid-filled cysts in organs like the liver and lungs, posing significant public health risks through severe complications or death. This study presents a novel deep feature generation framework utilizing vision transformer models (ViT-DFG) to enhance the classification accuracy of hydatid cyst types. The proposed framework consists of four phases: image preprocessing, feature extraction using vision transformer models, feature selection through iterative neighborhood component analysis, and classification, where the performance of the ViT-DFG model was evaluated and compared across different classifiers such as k-nearest neighbor and multi-layer perceptron (MLP). Both methods were evaluated independently to assess classification performance from different approaches. The dataset, comprising five cyst types, was analyzed for both five-class and three-class classification by grouping the cyst types into active, transition, and inactive categories. Experimental results showed that the proposed VIT-DFG method achieves higher accuracy than existing methods. Specifically, the ViT-DFG framework attained an overall classification accuracy of 98.10% for the three-class and 95.12% for the five-class classifications using 5-fold cross-validation. Statistical analysis through one-way analysis of variance (ANOVA), conducted to evaluate significant differences between models, confirmed significant differences between the proposed framework and individual vision transformer models ( $p<0.05$ ). These results highlight the effectiveness of combining multiple vision transformer architectures with advanced feature selection techniques in improving classification performance. The findings underscore the ViT-DFG framework’s potential to advance medical image analysis, particularly in hydatid cyst classification, while offering clinical promise through automated diagnostics and improved decision-making.

PMID:40627295 | DOI:10.1007/s10278-025-01602-7