Tag: nevin manimala

J Ultrasound Med. 2025 Dec 27. doi: 10.1002/jum.70157. Online ahead of print.

ABSTRACT

OBJECTIVES: To analyze obstetric ultrasound utilization and expenditures per live birth delivery among the commercially insured from 2016 to 2022 and present updated trends and variation in use by type of ultrasound and across subgroups.

METHODS: In this retrospective United States-based cohort study, obstetric ultrasound utilization and expenditures during pregnancy were measured for a cohort of all deliveries with at least 28-week gestation that resulted in a live birth between January 1, 2017 and December 31, 2022, using the Health Care Cost Institute commercial claims database. We report utilization trends and the clinical and sociodemographic factors correlated with utilization using descriptive statistics and negative binomial regression.

RESULTS: In our sample of 1,731,823 pregnancies, there were an average of 5.3 (SD ± 3.9) claims for obstetric ultrasounds per live birth delivery. After adjusting for covariates, the number of ultrasounds per live birth increased by 8.3% and inflation-adjusted spending for these ultrasounds increased 5.6% over the 7-year study period (p < .001); though utilization decreased during the COVID-19 pandemic in 2020. Follow-up ultrasound (CPT 76816) was the fastest growing procedure.

CONCLUSION: Obstetric ultrasound utilization and expenditures increased from 2016 to 2022. Information on the variation in patterns and trends related to obstetric ultrasound use may assist policy makers in their assessment of resource utilization and approach to reimbursement design, such as obstetric bundled payments.

PMID:41454739 | DOI:10.1002/jum.70157

Comput Assist Surg (Abingdon). 2026 Dec;31(1):2604610. doi: 10.1080/24699322.2025.2604610. Epub 2025 Dec 27.

ABSTRACT

Colorectal cancer represents a major global health concern and obesity adds complicates its surgical management. This meta-analysis aimed to evaluate the comparative effectiveness and safety of robotic-assisted surgery and standard laparoscopic surgery in obese colorectal cancer patients. A comprehensive literature search performed across databases from inception to April 2024. Pooled estimates included hospital stay duration, drainage tube removal time, first ventilation time, complication rates, re-admission rates and re-operative rates. Six studies involving 4215 patients were included. Robotic-assisted surgery was associated with a statistically significant but modest reduction in hospital stay time compared to laparoscopic surgery (p = 0.02). No significant differences were found for drainage tube removal time (p = 0.42) and first ventilation time (p = 0.27). Complication rates (OR [odds ratio] = 0.92, 95% confidence interval [CI]: 0.74 to 1.13, p = 0.41), re-admission rates (OR = 0.81, 95% CI: 0.31 to 2.13, p = 0.67) and re-operative rates (OR = 1.20, 95% CI: 0.77 to 1.86, p = 0.41) did not significantly differ between surgical approaches. Robotic-assisted surgery significantly provides a modest reduction in hospital stay duration without compromising patient safety for obese colorectal cancer patients. These findings should be interpreted with caution. Future randomized controlled trials are required to confirm these results.

PMID:41454717 | DOI:10.1080/24699322.2025.2604610

Urologia. 2025 Dec 27:3915603251406813. doi: 10.1177/03915603251406813. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to develop and validate an AI-assisted framework for the automated evaluation of uroflowmetry data in patients presenting with lower urinary tract symptoms. The primary goal was to overcome the limitations of traditional manual interpretations by leveraging advanced machine learning techniques to achieve higher diagnostic accuracy, objectivity, and clinical applicability in urological assessments.

MATERIALS AND METHODS: A retrospective analysis was conducted using a large, de-identified dataset comprising uroflowmetry recordings, patient-reported symptom scores, and comprehensive demographic data. The data underwent rigorous preprocessing-including noise reduction, baseline correction, normalization, and feature extraction-with key parameters such as peak flow rate, voided volume, average flow rate, and voiding time being analyzed. Multiple machine learning models-including a deep neural network, support vector machine, and random forest classifier-were developed and validated through cross-validation and extensive statistical testing. Performance metrics such as accuracy, sensitivity, specificity, and area under the ROC curve (AUC-ROC) were calculated, while multivariate regression analyses were performed to explore the relationships between uroflowmetry parameters and symptom severity.

RESULTS: The AI framework, particularly the deep neural network model, exhibited outstanding diagnostic performance with an accuracy of 92.5%, sensitivity of 90.0%, specificity of 94.0%, and an AUC-ROC of 0.96. Statistical analyses demonstrated significant correlations between key uroflowmetry parameters and clinical symptoms, with lower peak flow rates showing a strong association with increased symptom severity (p < 0.001). These findings confirm that the integration of multi-dimensional data through AI significantly enhances the objectivity and precision of urinary function evaluation compared to conventional methods.

CONCLUSION: The study successfully established an AI-assisted diagnostic framework that markedly improves the automated evaluation of uroflowmetry data and lower urinary tract symptoms. This innovative approach offers a robust alternative to traditional diagnostic practices by reducing subjectivity and enhancing diagnostic accuracy, thereby paving the way for more personalized and effective management of urinary disorders.

PMID:41454715 | DOI:10.1177/03915603251406813

Subst Use Misuse. 2025 Dec 27:1-8. doi: 10.1080/10826084.2025.2604637. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on the association between urban regeneration and alcohol use remains limited. This study examines the impact of urban environmental factors, specifically air pollution (measured by PM2.5, a common indicator of fine particulate matter), traffic congestion, and limited green space, on problematic alcohol use, and explores potential social and behavioral mechanisms underlying these relationships.

METHODS: A cross-sectional survey was conducted among 11,954 students from 50 universities across 43 Chinese cities. Individual-level data were collected via self-report questionnaires, while regional environmental data were obtained from the National Bureau of Statistics. Structural equation modeling (SEM) was applied to analyze the mediating pathways.

RESULTS: The prevalence of problematic alcohol use was 7.3%. Multilevel logistic regression showed that higher PM2.5 levels were positively associated with alcohol use (ORs = 2.98, 3.48), while more green space (ORs = 0.55, 0.23) and a higher proportion of paved roads (OR = 0.37) were protective factors. SEM results indicated that PM2.5 exerted both a direct effect on alcohol use (β = 0.358, p < 0.01) and an indirect effect mediated by uncertainty stress (indirect β = 0.011). Paved road area had a direct effect (β = -0.009, p < 0.01) and indirect effects through uncertainty stress (indirect β = -0.007) and life stress (indirect β = -0.001). Green space directly reduced alcohol use (β = -0.188, p < 0.01) and also indirectly via lower uncertainty stress (indirect β = -0.011).

CONCLUSION: Improving urban environmental quality, especially reducing air pollution and expanding green infrastructure, may help mitigate problematic alcohol use and promote mental health.

PMID:41454707 | DOI:10.1080/10826084.2025.2604637

OTJR (Thorofare N J). 2025 Dec 27:15394492251403433. doi: 10.1177/15394492251403433. Online ahead of print.

ABSTRACT

Occupational disruption (OD) is common during the perinatal period. Occupational therapy (OT) intervention may improve knowledge of perinatal occupational balance (OB) strategies. The aim of this exploratory study was to evaluate the effectiveness of an OT intervention in increasing knowledge of perinatal OB strategies among working first-time mothers (WFTMs). A total of 30 perinatal WFTMs attended a virtual OT educational workshop that addressed the OB constructs of stress management, energy conservation, sleep hygiene, and routine management. Pre- and post-intervention surveys measured OD and self-reported knowledge of OB strategies. Data were analyzed using descriptive statistics and paired samples t-tests. Participants reported moderate OD across all OB constructs. Statistically significant improvements were noted in knowledge of OB strategies to improve energy conservation (p = .003) and overall OB (p = .001). OT intervention can improve knowledge of OB strategies in perinatal WFTMs. Including OB education in routine perinatal care shows promise.

PMID:41454704 | DOI:10.1177/15394492251403433

Liver Int. 2026 Feb;46(2):e70490. doi: 10.1111/liv.70490.

ABSTRACT

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) represent a spectrum of liver conditions that can gradually progress to cirrhosis. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have shown benefits in reducing hepatic steatosis and liver-related events in MASLD. This study aims to assess whether SGLT-2 inhibitors are associated with a reduced risk of all-cause mortality and disease-specific outcomes in patients with MASH cirrhosis and type 2 diabetes (T2D).

METHODS: A retrospective cohort study was performed using TriNetX. Patients with T2D and MASH cirrhosis on SGLT-2 inhibitors were matched 1:1 with other glucose-lowering drugs (oGLDs) based on demographics, comorbidities and medications. Primary outcomes included all-cause mortality, hepatic decompensation and major adverse liver outcomes (MALO). Cox-proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence interval (CI).

RESULTS: A total of 51 427 patients with MASH cirrhosis and T2D were identified, of which 6833 (13.28%) were on SGLT-2 inhibitors. Patients on SGLT-2 inhibitors (n = 6449, mean age 63.7 years, 52.9% female) were matched with 6449 individuals (mean age 63.9 years, 53.5% female) on oGLDs. The SGLT-2 inhibitors cohort had statistically significantly lower risk of all-cause mortality (HR: 0.58, 95% CI: 0.53-0.63), hepatic decompensation (HR: 0.85, 95% CI: 0.81-0.90) and MALO (HR: 0.88, 95% CI: 0.83-0.93).

CONCLUSION: SGLT-2 inhibitors are associated with a reduced risk of all-cause mortality in patients with MASH cirrhosis and T2DM, which may be partly attributable to a lower risk of hepatic decompensation and subsequent events. Further studies are warranted as SGLT-2 inhibitors may serve as an adjunctive therapy for patients with MASH cirrhosis.

PMID:41454700 | DOI:10.1111/liv.70490

Br J Math Stat Psychol. 2025 Dec 27. doi: 10.1111/bmsp.70027. Online ahead of print.

ABSTRACT

The growing popularity of the ecological momentary assessment method in psychological research requires adequate statistical models for intensive longitudinal data (ILD), with multilevel latent state-trait (ML-LST) models based on the latent state-trait theory revised (LST-R theory) as one possible alternative. Besides the traditional LST-R coefficients reliability, consistency and occasion-specificity, ML-LST models are also suitable for estimating reliability at Level 1 (“within-subject reliability”) and Level 2 (“between-subject reliability”). However, these level-specific coefficients have not yet been defined in LST-R theory and, therefore, their interpretation has been unclear from the perspective of LST-R theory. In the current study, we discuss the interpretation and identification of these coefficients based on the (multilevel) versions of the Multistate-Singletrait (MSST), the Multistate-Indicator-specific trait (MSIT) and the Multistate-Singletrait model with M-1 correlated method factors (MSST-M-1). We show that, in the MSST-M-1 model, the between-subject coefficient is a measure of the indicator-unspecificity of an item (i.e. the portion of between-level variance that a specific item shares with a common trait) or the unidimensionality of a scale. Moreover, we highlight differences between occasion-specificity and within-subject reliability. The performance of the ML-MSST-M-1 model and the corresponding theoretical findings are illustrated using data from an experience sampling study on the within-person fluctuations of narcissistic admiration (Heyde et al., 2023).

PMID:41454688 | DOI:10.1111/bmsp.70027

Eur J Neurosci. 2025 Dec;62(12):e70370. doi: 10.1111/ejn.70370.

ABSTRACT

The autonomic nervous system (ANS) plays a crucial role in maintaining homeostasis, and its dysfunction is linked to numerous clinical conditions, including chronic pain. Neuromodulatory interventions such as transcutaneous auricular vagus nerve stimulation (taVNS), transcutaneous cervical magnetic stimulation (tCMS), and intermittent theta burst stimulation (iTBS) have been investigated for their potential to modulate autonomic responses and pain perception. However, the efficacy and safety of these techniques remain unclear. This study aimed to evaluate the feasibility and safety of a single session of neuromodulatory stimulation in modulating autonomic function and pain processing in healthy individuals. A double-blind, randomized, crossover clinical trial was conducted with 22 healthy participants, each undergoing four intervention sessions (taVNS, tCMS, iTBS, and Sham-taVNS) in randomized order, with a washout period of at least 36 h between sessions. Heart rate variability (HRV) and conditioned pain modulation (CPM) were assessed pre- and post-intervention using a Polar H10 cardiac sensor and a digital pressure algometer. Adverse effects were recorded immediately after each session. No statistically significant differences were observed in HRV or CPM outcomes across active stimulation conditions when compared to Sham. Among the techniques evaluated, tCMS presented the most favorable safety profile, with fewer reported adverse effects relative to iTBS and taVNS. The absence of significant modulation effects suggests that a single session may be insufficient to induce detectable changes in autonomic or pain processing. However, the tolerability and safety of tCMS indicate its potential for future research involving repeated sessions and clinical populations.

PMID:41454683 | DOI:10.1111/ejn.70370

Pediatr Int. 2026 Jan-Dec;68(1):e70300. doi: 10.1111/ped.70300.

ABSTRACT

BACKGROUND: Patients discharged from the intensive care unit (ICU) often experience high morbidity rates. The aim of the present study was to estimate the incidence of functional capacity impairment in pediatric patients who were discharged from the ICU in a middle-income country and to identify associated factors, considering the socioeconomic context.

METHODS: This was a multicenter cohort study of 357 patients aged <18 years admitted to three ICUs in the interior cities of São Paulo State. The Functional Status Scale was used to assess the patients at admission, ICU discharge, and hospital discharge. New morbidity was defined as a change in any domain of the scale equal to or greater than two, or a change in the total score equal to or greater than three. A multiple logistic regression model was used to identify independent associations with new morbidity.

RESULTS: New morbidity occurred in 14.6% and 12.3% of patients at ICU and hospital discharge, respectively, compared with those at admission. The feeding (p < 0.001) and respiratory (p = 0.036) functional domains were the most affected at ICU discharge. The risk factors associated with new morbidity at hospital discharge were heart disease, older age, longer ICU stay, and higher PELOD2 severity score.

CONCLUSIONS: To reduce the risk of new functional morbidity, healthcare teams should be attentive to the critically ill pediatric population, particularly those who are older and have chronic clinical conditions, especially heart disease.

PMID:41454658 | DOI:10.1111/ped.70300

Aliment Pharmacol Ther. 2025 Dec 27. doi: 10.1111/apt.70511. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-reported barriers to care can delay treatment and increase mortality. Addressing these barriers can improve clinical outcomes and reduce disparities, underscoring the importance to understand their prevalence in patients with cirrhosis.

METHODS: We invited adults with cirrhosis at four US health systems (two tertiary care referral centres, one safety-net health system, and one Veterans Affairs medical center) to complete a survey assessing barriers to care. Questions for barriers to care were adapted from prior surveys as available. Responses were summarised using descriptive statistics, and Chi-square analysis was used to examine differences by study site and race/ethnicity.

RESULTS: Of 5197 patients contacted by telephone, 1332 (25.6%) completed the survey and were eligible for analyses. The most frequent barriers to care included time to travel to clinic (22.7%), long wait times for appointments (21.6%), and difficulty scheduling visits (19.2%). Conversely, few patients reported competing demands or difficulty finding time for liver appointments, difficulty discussing concerns with their physicians, or lack of physician engagement with concerns. Several barriers to care significantly differed by study site but were generally consistent across racial and ethnic subgroups.

CONCLUSION: Patients with cirrhosis report frequent barriers to medical care including limited access to clinic appointments, although barriers vary by healthcare system. Barriers to care serve as intervention targets to improve outcomes for patients with cirrhosis.

PMID:41454644 | DOI:10.1111/apt.70511