Nevin Manimala

JAMA Netw Open. 2025 Jan 2;8(1):e2456528. doi: 10.1001/jamanetworkopen.2024.56528.

ABSTRACT

IMPORTANCE: There is a clear benefit to body armor against firearms; however, it remains unclear how these vests may influence day-to-day patient encounters when worn by emergency medical services (EMS).

OBJECTIVE: To determine the association of ballistic vests worn by EMS clinicians with workplace violence (WPV) and disparities in care among racial and/or ethnic minority patients.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of a volunteer-based sample of EMS clinicians at a large, multistate EMS agency encompassing 15 ground sites across the Midwest from April 1, 2023, to March 31, 2024. Data were analyzed from May to June 2024.

EXPOSURE: External ballistic armor being used by a group of self-selected clinicians on every run.

MAIN OUTCOMES AND MEASURES: Prevalence and characteristics associated with WPV and with declines of treatment and/or transport compared between crews with 1 or more vested vs no vested members.

RESULTS: A total of 156 of 415 staff (37.6%) opted in to wear the vests, including 77 male participants (49.4%). Prevalence of WPV was higher for vested crews (1.11 vs 0.85 cases per 100 runs; adjusted risk ratio [aRR], 1.28; 95% CI, 1.10 to 1.50; P = .001) and was due to higher rates of verbal abuse. The presence of 1 or more vested crew members increased the likelihood of all patients declining EMS treatment and/or transport; however, effect size was highest among patients with an unknown race and/or ethnicity (2234 [21.1%] vs 2134 [16.5%] patients; aRR, 1.19; 95% CI, 1.10 to 1.27; P < .001), followed by racial and/or ethnic minority patients (708 [16.7%] vs 399 [13.8%] patients; aRR, 1.18; 95% CI, 1.05 to 1.33; P = .01). Analyses of individual minority groups revealed a significant increase only in Black or African American patients declining treatment and/or transport by vested crews (461 [17.6%] vs 223 [13.7%] patients; RR, 1.28; 95% CI, 1.10 to 1.49; P = .002).

CONCLUSIONS AND RELEVANCE: In this cohort study, vested crews experienced increased prevalence of WPV compared with nonvested crews. Use of vests increased the frequency of all patients declining EMS treatment and/or transport. Among minority groups, there was a significant increase in Black or African American patients declining treatment and/or transport. Agencies should consider benefits and unintended consequences of EMS clinicians wearing body armor.

PMID:39878979 | DOI:10.1001/jamanetworkopen.2024.56528

J Vis Exp. 2025 Jan 10;(215). doi: 10.3791/67475.

ABSTRACT

Chronic wounds, due to their high prevalence, are a serious global health concern. Effective therapeutic strategies can significantly accelerate healing, thereby reducing the risk of complications and alleviating the economic burden on healthcare systems. Although numerous experimental studies have investigated wound healing, most rely on qualitative observations or quantitative direct measurements. The objective of this study was to standardize an indirect wound measurement method using digital planimetry, incorporating digital scaling and segmentation. This approach addresses the lack of detailed, step-by-step methodologies for accurate wound assessment. A photodocumentation booth was designed and constructed, and computer-assisted digital planimetry tools were employed to minimize variability in measurements of the wound area, perimeter, and the distance from the wound center to its edges. A circular traumatic wound (5 mm in diameter) was created on the dorsal midline at the shoulder blade level of male CD1 mice (n = 4, 10 weeks old, 30-35 g). Wound evolution was photodocumented for 14 days using the custom-designed photo booth, which controlled lighting conditions, focal distance, and subject positioning. Scaling and wound measurements were performed using segmentation in ImageJ software, and statistical analysis was conducted using statistical analysis software. The kinetics of wound closure showed a slight increase in wound size and perimeter between day 0 and day 2, followed by a gradual decrease until complete closure by day 14. The photodocumentation booth and computer-assisted digital planimetry enabled quantitative measurements with minimal variability. In conclusion, these tools provide a reliable and reproducible method for evaluating wound closure kinetics in pre-clinical models.

PMID:39878954 | DOI:10.3791/67475

JMIR Aging. 2025 Jan 29;8:e69493. doi: 10.2196/69493.

NO ABSTRACT

PMID:39878948 | DOI:10.2196/69493

Sports Med. 2025 Jan 29. doi: 10.1007/s40279-025-02179-5. Online ahead of print.

ABSTRACT

BACKGROUND: Diastasis recti abdominis (DRA), commonly occurring in postpartum women, is not only an aesthetic issue but is also highly associated with functional impairments. Various conservative treatment modalities have been employed in clinical practice to alleviate DRA. However, the comparative efficacy of these non-surgical treatments for improving the inter-recti distance (IRD) remains to be determined.

AIM: This current network meta-analysis (NMA) aims to compare the efficacy and acceptability of different non-surgical treatments with or without exercise for improving DRA in postpartum women.

METHODS: This NMA adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ClinicalKey, Cochrane Library, CINAHL, Embase, PubMed, Web of Science, and ClinicalTrials.gov were systematically searched for randomized controlled trial (RCT) studies up to April 2024. The analysis included studies that met the following criteria: (1) postpartum women diagnosed with DRA defined as an IRD greater than 2 cm; (2) intervention: any non-surgical treatments for at least 2 weeks; (3) comparator: no-treatment control; and (4) outcome: changes in IRD and acceptability. The relative efficacy between the non-surgical treatments tested and the probability of treatments were evaluated.

RESULTS: Twenty-one RCTs comprising 1195 participants aged from 18 to 45 years old were included. The forest plot revealed that exercise coupling with neuromuscular electrical stimulation systems (NMES) [mean difference (MD) – 1.12 cm, 95% confidence interval (CI) – 1.66 to – 0.58], acupuncture (MD – 0.81 cm, 95% CI – 1.54 to – 0.08), corset (MD – 0.65 cm, 95% CI – 1.24 to – 0.06), and exercise alone (MD – 0.48 cm, 95% CI – 0.80 to – 0.16) led to significant reductions in IRD compared with control. Further, the treatment ranking indicated that the combination of NMES with exercise has the highest probability (91.0%) of being the best treatment for reducing IRD, followed by acupuncture with exercise (71.1%). Treatments combined with exercise demonstrated better rankings for reducing IRD than individual treatments without exercise. Acceptability did not significantly differ between the groups.

LIMITATIONS AND IMPLICATIONS: This NMA encountered limitations due to participant variability, differing measurement methods, and sparse data, necessitating careful interpretation of findings regarding postpartum DRA interventions.

CONCLUSIONS: This NMA suggests NMES combined with exercise as the best treatment tested for DRA in postpartum women.

PROSPERO REGISTRATION: CRD42024541345.

PMID:39878918 | DOI:10.1007/s40279-025-02179-5

J Patient Rep Outcomes. 2025 Jan 29;9(1):13. doi: 10.1186/s41687-025-00842-z.

ABSTRACT

BACKGROUND: Multiple diseases, such as Adolescent Idiopathic Scoliosis (AIS), present at adolescent age and the impact on quality of life (QoL) prolongs into adulthood. For the EQ-5D, a commonly used instrument to measure QoL, the current guideline is ambiguous whether the youth or adult version is to be preferred at adolescent age. To assess which is most suitable, this study tested for equivalence along predefined criteria of the youth (EQ-5D-5L) and adult (EQ-5D-Y-5L) version in an adolescent population receiving bracing therapy for AIS.

METHODOLOGY: 107 adolescents were recruited from 4 scoliosis centers in the Netherlands between March 2022 and January 2023; they completed both EQ-5D’s and the SRS-22r (scoliosis-specific questionnaire). The following criteria were evaluated using the individual and sum of domains (level-sum-score (LSS)). Our primary criterion for non-equivalence of the EQ-5D’s was less than excellent (≤ 0.9) intra-individual agreement using Intraclass Correlation Coefficient (ICC) analysis for LSS and weighted (quadratic) kappa for domains. Secondary criteria were differences in ceiling using McNemar test; a different number of quantified hypotheses for construct validity achieved using the SRS-22r as comparator; differences in test-retest reliability by comparing ICC/kappa values using a Z-test.

RESULTS: Adolescents had a mean age of 14 years (range 12-18), and 78% were female. Ceiling was mostly comparable between EQ-5D’s, ranging from 78 to 81% for mobility and self-care, 52-54% for usual activities, and 31-36% for pain/discomfort. The EQ-5D-5L showed more ceiling (57%) compared to the EQ-5D-Y-5L (41%) on anxiety/depression (p = 0.006). Agreement between the EQ-5D’s did not meet our criterion for the LSS (ICC 0.79 (95% confidence interval 0.70-0.85)), and decreased further at the domain-level. Both EQ-5D’s achieved 5/7 validity hypotheses. Test-retest reliability was slightly better for EQ-5D-5L LSS (ICC 0.76 (0.64-0.84)) compared to EQ-5D-Y-5L LSS (ICC 0.69 (0.55-0.79)), although this was statistically insignificant (p = 0.284). This pattern was similar for most domains.

CONCLUSIONS: The EQ-5D versions showed insufficient agreement, and cannot be considered fully equivalent. While they were similar in terms of validity and test-retest reliability, differences in score distribution were present. Taken together, we advise using the EQ-5D-5L to monitor the QoL in adolescent patients with AIS, as it avoids switching instruments and thus data discontinuities. Future studies should verify these findings in different patient groups and the general population.

PMID:39878911 | DOI:10.1186/s41687-025-00842-z

Bioinformatics. 2025 Jan 29:btaf034. doi: 10.1093/bioinformatics/btaf034. Online ahead of print.

ABSTRACT

MOTIVATION: The accurate prediction of O-GlcNAcylation sites is crucial for understanding disease mechanisms and developing effective treatments. Previous machine learning models primarily relied on primary or secondary protein structural and related properties, which have limitations in capturing the spatial interactions of neighboring amino acids. This study introduces local environmental features as a novel approach that incorporates three-dimensional spatial information, significantly improving model performance by considering the spatial context around the target site. Additionally, we utilize sparse recurrent neural networks to effectively capture sequential nature of the proteins and to identify key factors influencing O-GlcNAcylation as an explainable machine learning model.

RESULTS: Our findings demonstrate the effectiveness of our proposed features with the model achieving an F1 score of 28.3%, as well as feature selection capability with the model using only the top 20% of features achieving the highest F1 score of 32.02%, a 1.4-fold improvement over existing PTM models. Statistical analysis of the top 20 features confirmed their consistency with literature. This method not only boosts prediction accuracy but also paves the way for further research in understanding and targeting O-GlcNAcylation.

AVAILABILITY: The entire code, data, features used in this study are available in the GitHub repository: https://github.com/pseokyoung/o-glcnac-prediction.

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:39878910 | DOI:10.1093/bioinformatics/btaf034

Eur Radiol. 2025 Jan 29. doi: 10.1007/s00330-025-11387-6. Online ahead of print.

ABSTRACT

OBJECTIVE: To conduct a meta-analysis assessing the diagnostic performance of the node reporting and data system (Node-RADS) for detecting lymph node (LN) invasion.

METHOD: We performed a systematic literature search of online scientific publication databases from inception up to July 31, 2024. We used the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) to assess the study quality, and heterogeneity was determined by the Q-test and measured with I² statistics. We employed the hierarchic summary ROC (HSROC) model to estimate the summary sensitivity and specificity. Subgroup analyses were conducted according to the imaging modality and cutoff values.

RESULTS: A total of 13 studies involving 1341 participants met the inclusion criteria. Pooled summary estimates of sensitivity, specificity, and area under the curve of HSROC were 0.79 (95% CI: 0.66-0.88), 0.86 (95% CI: 0.80-0.90), and 0.90 (95% CI: 0.87-0.92). Subgroup analysis showed that the pooled sensitivity and specificity for CT were 0.74 (95% CI: 0.63-0.83) and 0.84 (95% CI: 0.74-0.91), whereas for MRI were 0.84 (95% CI: 0.59-0.95) and 0.88 (95% CI: 0.81-0.93), respectively.

CONCLUSION: Node-RADS demonstrates the promising potential for the prediction of LN invasion, with high specificity but moderate sensitivity, particularly with optimal cutoff value ≥ 3. Indirect comparisons showed no significant difference between CT and MRI regarding overall diagnostic accuracy.

KEY POINTS: Question Since the Node-RADS has been proposed, a number of studies have assessed its diagnostic performance for evaluating LN invasion. Findings Node-RADS demonstrated high specificity but moderate sensitivity, and cutoff ≥ 3 is the optimal threshold; indirect comparison suggested no significant difference between CT and MRI. Clinical relevance This study synthesized currently available evidence on studies of utilizing Node-RADS for assessing LNI in patients with various cancers, providing valuable insights for radiologists for utilizing this new risk scoring system in clinical practice.

PMID:39878903 | DOI:10.1007/s00330-025-11387-6

Eur Radiol. 2025 Jan 29. doi: 10.1007/s00330-025-11369-8. Online ahead of print.

ABSTRACT

OBJECTIVES: To analyze the CT imaging features of extranodal natural killer/T (NK/T)-cell lymphoma, nasal type (ENKTCL-NT) involving the gastrointestinal tract (GI), and to compare them with those of Crohn’s disease (CD) and diffuse large B-cell lymphoma (DLBCL).

MATERIALS AND METHODS: Data were retrospectively collected from 17 patients diagnosed with GI ENKTCL-NT, 68 patients with CD, and 47 patients with DLBCL. The CT findings of ENKTCL-NT were analyzed and compared with those of CD and DLBCL. Data were analyzed using SPSS (version 25.0) and MedCalc (version 18.2.1). p < 0.05 was considered statistically significant.

RESULTS: The 17 patients with ENKTCL-NT included 11 males (64.7%) and 6 females (35.3%) (mean age, 46.41 ± 4.12 years). The CT features of ENKTCL-NT included: circumferential symmetric thickening (100%), moderate thickening (70.6%), skip lesions (52.9%), contiguous lesion (47.1%), mucosal or layered enhancement (70.6%), moderate mural enhancement (64.7%) with non-enhanced regions (47.1%), absence of lymphadenopathy (76.5%), bowel perforation or fistula (17.6%), and peri-enteric blurred fat space (70.6%). The presence of circumferential symmetric thickening, moderate mural enhancement, and non-enhanced regions were more indicative of ENKTCL-NT than CD (17/17 vs. 17/68, 11/17 vs. 22/68, 8/17 vs. 0/68, p < 0.05). The presence of skip lesions, mucosal or layered enhancement, and absence of peri-enteric lymphadenopathy were more indicative of ENKTCL-NT than DLBCL (9/17 vs. 2/47, 12/17 vs. 1/37, 13/17 vs. 19/47, p < 0.05).

CONCLUSION: CT imaging features can provide useful information for the early diagnosis of ENKTCL-NT and effectively differentiate it from CD and DLBCL.

KEY POINTS: Question Extranodal natural killer/T-cell lymphoma, nasal type (ENKTCL-NT) involving the gastrointestinal tract (GI) is highly malignant but easily misdiagnosed by clinicians and endoscopic examination. Findings CT could provide useful information in the diagnosis of ENKTCL-NT involving GI and in differentiating it from Crohn’s disease and diffuse large B-cell lymphoma. Clinical relevance This study will help improve the ability of radiologists to diagnose ENKTCL-NT involving GI, and a more predictive diagnosis will also alert clinicians to perform multiple deep endoscopic biopsies, which will contribute to the early diagnosis and treatment of ENKTCL-NT.

PMID:39878902 | DOI:10.1007/s00330-025-11369-8

Eur J Nucl Med Mol Imaging. 2025 Jan 29. doi: 10.1007/s00259-024-07061-6. Online ahead of print.

ABSTRACT

PURPOSE: The positron range effect can impair PET image quality of Gallium-68 (⁶⁸Ga). A positron range correction (PRC) can be applied to reduce this effect. In this study, the effect of a tissue-independent PRC for ⁶⁸Ga was investigated on patient data.

METHODS: PET/CT data (40 patients: [⁶⁸Ga]Ga-DOTATOC or [⁶⁸Ga]Ga-PSMA) were reconstructed using Q.Clear reconstruction algorithm. Two reconstructions were performed per patient, Q.Clear with and without PRC. SUV_max and contrast-to-noise ratio (CNR) values per lesion were compared between PRC and non-PRC images. Five experienced nuclear medicine physicians reviewed the images and chose the preferred reconstruction based on the image quality, lesion detectability, and diagnostic confidence.

RESULTS: A total of 155 lesions were identified. The PRC resulted in statistically significant increase of the SUV_max and CNR for soft tissue lesions (6.4%, p < 0.001; 8.6%, p < 0.001), bone lesions (14.6%, p < 0.001; 12.5%, p < 0.001), and lung lesions (3.6%, p = 0.010; 6.3%, p = 0.001). This effect was most prominent in small lesions (SUV_max: 12.0%, p < 0.001, and CNR: 13.0%, p < 0.001). Similar or better image quality, lesion detectability, and diagnostic confidence was achieved in PRC images compared to the non-PRC images as those assessed by the expert readers.

CONCLUSIONS: A tissue-independent PRC increased the SUV_max and CNR in soft tissue, bone, and lung lesions with a larger effect for the small lesions. Visual assessment demonstrated similar or better image quality, lesion detectability, and diagnostic confidence in PRC images compared to the non-PRC images.

PMID:39878896 | DOI:10.1007/s00259-024-07061-6

Asian Pac Isl Nurs J. 2025 Jan 28;9:e56667. doi: 10.2196/56667.

ABSTRACT

BACKGROUND: Neuromuscular disorders (NMDs) constitute a heterogeneous group of disorders that affect motor neurons, neuromuscular junctions, and muscle fibers, resulting in symptoms such as muscle weakness, fatigue, and reduced mobility. These conditions significantly affect patients’ quality of life and impose a substantial burden on caregivers. Spinal muscular atrophy (SMA) is a relatively common NMD in children that presents in various types with varying degrees of severity.

OBJECTIVE: This study aimed to evaluate the sleep quality of children with NMDs, particularly SMA types 1, 2, and 3 and assess the stress levels experienced by their parents.

METHODS: A descriptive analytical study was conducted from February to October 2023, in selected hospitals and dystrophy associations in Tehran and Isfahan, Iran. A total of 207 children aged 1-14 years with various NMDs were included in the study. Data were collected using a web-based questionnaire with 3 parts: demographic information, the Children’s Sleep Habits Questionnaire to assess children’s sleep, and the Stress Response Inventory to measure parental stress. Statistical analyses were performed using SPSS version 22, with an α level of .05.

RESULTS: Significant differences in sleep quality were found among SMA types, with mean scores of 74.76 (SD 7.48) for SMA type 1, 76.4 (SD 7.29) for SMA type 2, 72.88 (SD 6.73) for SMA type 3, and 75.87 (SD 5.74) for other NMDs (P=.02). A correlation was found between sleep and length of hospital stay (r=0.234, P<.001)and between sleep and the child’s sex (r=-0.140, P=.04). Parental stress scores averaged 95.73 (SD 32.12). There was not a statistically significant difference in parental stress scores among the 4 groups (P=.78). This suggests that parental stress levels were similar across different NMD groups.

CONCLUSIONS: Sleep disorders are prevalent among children with NMDs, especially SMA. Parents experience high levels of stress that can affect the care they provide. Therefore, interventions to improve children’s sleep and address parental stress are crucial. Regular screening, counseling, and tailored support are recommended to enhance the well-being of children with NMDs and their families.

PMID:39878075 | DOI:10.2196/56667