Tag: nevin manimala

JAMA Netw Open. 2025 May 1;8(5):e258199. doi: 10.1001/jamanetworkopen.2025.8199.

ABSTRACT

IMPORTANCE: Post-cancer therapy kidney outcomes, including chronic kidney disease (CKD) and hypertension, are common in childhood cancer survivors (CCS). The incidence and timing of CKD and hypertension in CCS compared with other at-risk or general populations are unclear.

OBJECTIVE: To determine the association of childhood cancer treatment with post-cancer therapy CKD or hypertension.

DESIGN, SETTING, AND PARTICIPANTS: Population-based matched cohort study of children treated for cancer between April 1993 and March 2020 in Ontario, Canada, with follow-up until March 2021. The CCS (exposed) cohort included children (≤18 years) surviving cancer. Comparator cohorts were a hospitalization cohort (children who were hospitalized) and a general pediatric population (GP) cohort (all other Ontario children). Exclusion criteria were history of previous cancer, organ transplant, CKD, dialysis, or hypertension. Matching with each of the 2 comparator cohorts was performed separately and in a 1:4 ratio by age, sex, rural vs urban status, income quintile, index year, and presence of previous hospitalization. Data were analyzed from March 2021 to August 2024.

EXPOSURE: Treatment for cancer.

MAIN OUTCOMES AND MEASURES: The primary outcome was the composite of CKD or hypertension, defined by administrative health care diagnosis and procedure codes. Fine and Gray subdistribution hazard modeling, accounting for competing risks (death and new cancer diagnosis or relapse) and adjusting for cardiac disease, liver disease, and diabetes, was used to determine the association of cancer treatment with outcomes.

RESULTS: There were 10 182 CCS (median [IQR] age at diagnosis, 7 [3-13] years; 5529 male [54.3%]; median [IQR] follow-up time, 8 [2-15] years) matched to 40 728 hospitalization cohort patients (median [IQR] age at diagnosis, 7 [2-12] years; 5529 male [weighted percentage, 54.3%]; median [IQR] follow-up time, 11 [6-18] years) and 8849 CCS (median [IQR] age at diagnosis, 5 [2-11] years; 4825 male [54.5%]; median [IQR] follow-up time, 7 [2-14] years) matched to 35 307 GP cohort individuals (median [IQR] age at diagnosis, 6 [2-11] years; 4825 male [weighted percentage, 54.5%]; median [IQR] follow-up time, 10 [5-16] years). Most frequent cancer types were leukemia (2948 patients [29.0%]), central nervous system neoplasms (2123 patients [20.9%]), and lymphoma (1583 patients [15.5%]). During observation, cumulative incidence of CKD or hypertension was 20.85% (95% CI, 18.75%-23.02%) in the CCS cohort vs 16.47% (95% CI, 15.21%-17.77%) in the hospitalization cohort and 19.24% (95% CI, 15.99%-22.73%) in the CCS cohort vs 8.05% (95% CI, 6.76%-9.49%) in the GP cohort. CCS were at increased risk of CKD or hypertension compared with the hospitalization cohort (adjusted hazard ratio, 2.00; 95% CI, 1.86-2.14; P < .001) and the GP cohort (adjusted hazard ratio, 4.71; 95% CI, 4.27-5.19; P < .001).

CONCLUSIONS AND RELEVANCE: In this population-based study, CCS were at increased risk for CKD and hypertension, which are associated with mortality, suggesting that early detection and treatment of these conditions in CCS may decrease late complications and mortality.

PMID:40388170 | DOI:10.1001/jamanetworkopen.2025.8199

JAMA Netw Open. 2025 May 1;8(5):e2510894. doi: 10.1001/jamanetworkopen.2025.10894.

ABSTRACT

IMPORTANCE: Evidence from everyday dining situations regarding the effects of traffic light labels (TLLs) on dietary improvement remains inconsistent.

OBJECTIVE: To evaluate the effects of TLLs on dietary consumption and choices in cafeteria settings.

DESIGN, SETTING, AND PARTICIPANTS: This 2-arm, parallel randomized clinical trial was conducted at a company staff cafeteria in Shanghai, China, from September to December 2022. Of 153 adult participants, 76 were randomly assigned to the intervention group and 77 to the control group. Data analysis was conducted from July to October 2024.

INTERVENTION: The intervention group gained access to TLLs offering a comprehensive rating of added sugar, fat, and sodium for each dish on the lunch menu, while the control group did not.

MAIN OUTCOMES AND MEASURES: Primary outcomes were lunch intake of added sugar, fat, and sodium. Secondary outcomes included the mean traffic light score (calculated based on the number of dishes consumed, with higher scores indicating worse overall dietary choices) and number of green-coded (reaching dietary recommendations), yellow-coded (between the recommendation and mean intake of the Chinese population), and red-coded (above the upper limit of intake) dishes. The primary and secondary outcomes were automatically calculated based on the precollected recipe dataset of the cafeteria and the Chinese food composition database when participants ordered meals using an applet during weekday lunchtime. Weekly median values of these outcomes were used for analyses, which were conducted for the intention-to-treat population.

RESULTS: Among 153 participants, the mean (SD) age was 32.7 (7.5) years, and 97 (63.4%) were female. At week 12, compared with the control group, the intervention group demonstrated no statistically significant decrease in dietary consumption of added sugar (mean difference, -0.15 [95% CI, -0.75 to 0.46] g), fat (mean difference, -1.54 [95% CI, -6.13 to 3.05] g), or sodium (mean difference, -116.12 [95% CI, -454.78 to 222.54] mg). Similarly, no statistically significant differences were observed in dietary choices based on the mean traffic light score (mean difference, -0.05 [95% CI, -0.12 to 0.03]) or the number of green-coded (odds ratio [OR], 1.15 [95% CI, 0.99-1.32]), yellow-coded (OR, 1.04 [95% CI, 0.90-1.20]), and red-coded (OR, 0.84 [95% CI, 0.57-1.23]) dishes.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, TLLs indicating added sugar, fat, and sodium ratings on menus failed to improve dietary consumption and choices in a company cafeteria setting. This finding suggests that TLLs on menus may not effectively promote dietary improvement in this setting.

TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2100051771.

PMID:40388169 | DOI:10.1001/jamanetworkopen.2025.10894

JAMA Netw Open. 2025 May 1;8(5):e2511430. doi: 10.1001/jamanetworkopen.2025.11430.

ABSTRACT

IMPORTANCE: There are more than 2.1 million adult survivors of cancer diagnosed in adolescence and young adulthood (AYA) in the US. Although the mental health burden during treatment has been well documented, the long-term mental health trajectories of survivors of AYA cancer into later adulthood have not been explored.

OBJECTIVE: To understand the prevalence and trajectories of mental health challenges among middle-aged or older survivors of AYA cancer compared with those who received a diagnosis as adults or individuals without cancer.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used cross-sectional data from the Health and Retirement Study (HRS) to characterize mental health outcomes for US adults older than 50 years and longitudinal data to examine trajectories of mental health outcomes. The study started on September 1, 2023. HRS is a longitudinal, population-based national sample that interviews approximately 20 000 participants every 2 years since 1992 on topics related to health, employment, income, and others.

EXPOSURE: A diagnosis of cancer during AYA, defined as ages 15 to 39 years.

MAIN OUTCOMES AND MEASURES: The primary outcomes were lifetime prevalence of psychiatric issues, prescription medication for anxiety and/or depression, meeting criteria for Major Depressive Disorder using Composite International Diagnostic Interview-Short Form scoring, depression symptoms using the Center for Epidemiological Studies-Depression measure, and anxiety symptoms using items from the Beck Anxiety Inventory.

RESULTS: A total of 39 668 respondents (22 166 female [55.88%]; mean [SE] age at HRS entry, 59 [0.05] years; age range, 18-103 years; 7699 Black or African American [19.41%]; 28 459 White [71.74%]; 3402 other race [8.58%], which includes American Indian and Asian; and 108 [0.27%] missing) were identified who reported having cancer as an AYA (374 respondents), receiving a first-time cancer diagnosis after study onset as adults (5045 respondents), or never having cancer (34 249 respondents). Cross-sectional estimates revealed survivors of AYA cancer had the highest prevalence of lifetime psychiatric issues (16.36% [95% CI, 7.17%-25.55%] to 37.80% [95% CI, 26.55%-49.06%]), prescription anxiety and/or depression medication (25.10% [95% CI, 17.09%-33.10%] to 33.78% [95% CI, 23.93%-43.64%]), and meeting major depression criteria (13.13% [95% CI, 6.08%-20.18%] to 20.96% [12.91%-29.01%]) versus other cohorts. Compared with adult cancer survivors and even after adjusting for demographic covariates, AYA cancer survivors had higher odds of lifetime psychiatric issues (in 4 of 14 waves), similar odds of taking anxiety or depression medications, and higher odds of meeting major depression criteria (in 3 of 7 waves). Linear mixed-effects growth models revealed age-dependent U-shaped trajectories for depression and anxiety symptoms but significantly higher mean levels of symptoms among AYA cancer survivors. A flattening of anxiety symptoms later in life was only observed for AYA cancer survivors.

CONCLUSIONS AND RELEVANCE: In this cohort study, survivors of AYA cancer reported significantly worse mental health trajectories into middle or older adulthood, compared with individuals who experienced cancer as adults or never had it. Cancer clinicians should recognize the mental health burden for this population into middle age and older adulthood.

PMID:40388164 | DOI:10.1001/jamanetworkopen.2025.11430

JAMA Netw Open. 2025 May 1;8(5):e2511499. doi: 10.1001/jamanetworkopen.2025.11499.

ABSTRACT

IMPORTANCE: Patients hospitalized with nonsevere COVID-19 continue to receive community-acquired pneumonia (CAP) antibiotic treatment despite a low risk of bacterial coinfection. Unnecessary antibiotic prescribing contributes to global antibiotic resistance and also poses a threat to individual patients.

OBJECTIVE: To examine the association of CAP antibiotic treatment started on admission with clinical outcomes among a large sample of patients hospitalized for nonsevere COVID-19 in hospitals across the US.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used a target trial emulation design. Participants were adult, immunocompetent patients admitted to general care for COVID-19 from April 2020 to December 2023 at 1053 US-based acute-care hospitals that contribute data to the Premier Healthcare Database. Patients with nonpneumonia bacterial infections present on admission were excluded. Data were analyzed from April to October 2024.

EXPOSURE: Receipt of a CAP antibiotic regimen on the day of admission.

MAIN OUTCOMES AND MEASURES: The primary outcome was a composite measure of deterioration (vasopressor, high-flow oxygen, noninvasive ventilation, invasive mechanical ventilation, intermediate care, intensive care unit admission) and in-hospital mortality occurring on day 2 or later. The association between receipt of antibiotic therapy and the primary outcome was assessed using propensity methods while adjusting for a broad set of potential confounders, including cotreatments.

RESULTS: The cohort included 520 405 patients with COVID-19 (median [IQR] age, 66 [53-78] years; 266 186 [51.2%] male), including 92 708 Black patients (17.8%), 63 619 Hispanic patients (12.2%), and 304 649 White patients (58.5%); 279 656 patients (53.7%) had Medicare insurance. A total of 160 482 patients (30.8%) were treated with a CAP antibiotic regimen on day 1 of admission. The primary composite outcome was higher in the CAP group (20.8%) compared with the unexposed (no antibiotic) group (18.4%), but the difference did not meet the predefined criteria for clinical significance (ASD, 4.1%). Patients who received CAP antibiotics had higher odds of poor clinical outcomes (propensity matched-odds ratio [OR], 1.03 [95% CI, 1.01-1.05]; P = .003; inverse probability treatment weighted-OR, 1.03 [95% CI, 1.02-1.05]; P < .001; standardized mortality ratio weighted-OR, 1.10 [95% CI, 1.08-1.12]; P < .001).

CONCLUSIONS AND RELEVANCE: In this large cohort study of patients hospitalized with nonsevere COVID-19, there was no clinically meaningful difference in outcomes with early antibiotic treatment. Given the risks associated with unnecessary antibiotic treatment, these results argue against routine antibiotic use in this population.

PMID:40388163 | DOI:10.1001/jamanetworkopen.2025.11499

Psychol Rev. 2025 May 19. doi: 10.1037/rev0000549. Online ahead of print.

ABSTRACT

A fundamental question in the psychological sciences is the degree to which culture shapes core cognitive processes-perhaps none more foundational than how we perceive the world around us. A dramatic and oft-cited “case study” of culture’s power in this regard is the Müller-Lyer illusion, which depicts two lines of equal length but with arrowheads pointing either inward or outward, creating the illusion that one line is longer than the other. According to a line of research stretching back over a century, depending on the society you were raised in (and how much carpentry you were exposed to), you may not see the illusion at all-an ambitious and influential research program motivating claims that seemingly basic aspects of visual processing may actually be “culturally evolved byproducts.” This cultural byproduct hypothesis bears on foundational issues in the science, philosophy, and sociology of psychology, and remains popular today. Yet, here we argue that it is almost certainly false. We synthesize evidence from diverse fields which demonstrate that (a) the illusion is not limited to humans, appearing in nonhuman animals from diverse ecologies; (b) the statistics of natural scenes are sufficient to capture the illusion; (c) the illusion does not require straight lines typical of carpentry (nor even any lines at all); (d) the illusion arises in sense modalities other than vision; and (e) the illusion arises even in congenitally blind subjects. Moreover, by reexamining historical data and ethnographic descriptions from the original case studies, we show that the evidence for cultural variation and its correlation with key cultural variables is in fact highly inconsistent, beset by questionable research practices, and misreported by later discussions. Together, these considerations undermine the most popular and dramatic example of cultural influence on perception. We further extend our case beyond this phenomenon, showing that many of these considerations apply to other visual illusions as well, including similarly implicated visual phenomena such as the Ebbinghaus, Ponzo, Poggendorf, and horizontal-vertical illusions. We conclude by outlining future approaches to cross-cultural research on perception, and we also point to other potential sources of cultural variation in visual processing. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40388159 | DOI:10.1037/rev0000549

Interdiscip Cardiovasc Thorac Surg. 2025 May 19:ivaf101. doi: 10.1093/icvts/ivaf101. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to develop an automated method for pulmonary artery and vein segmentation in both left and right lungs from computed tomography (CT) images using artificial intelligence (AI). The segmentations were evaluated using PulmoSR software, which provides 3D visualizations of patient-specific anatomy, potentially enhancing a surgeon’s understanding of the lung structure.

METHODS: A dataset of 125 CT scans from lung segmentectomy patients at Erasmus MC was used. Manual annotations for pulmonary arteries and veins were created with 3D Slicer. nnU-Net models were trained for both lungs, assessed using Dice score, sensitivity, and specificity. Intraoperative recordings demonstrated clinical applicability. A paired t-test evaluated statistical significance of the differences between automatic and manual segmentations.

RESULTS: The nnU-Net model, trained at full 3D resolution, achieved a mean Dice score between 0.91 and 0.92. The mean sensitivity and specificity were: left artery: 0.86 and 0.99, right artery: 0.84 and 0.99, left vein: 0.85 and 0.99, right vein: 0.85 and 0.99. The automatic method reduced segmentation time from ∼1.5 hours to under 5 min. Five cases were evaluated to demonstrate how the segmentations support lung segmentectomy procedures. P-values for Dice scores were all below 0.01, indicating statistical significance.

CONCLUSIONS: The nnU-Net models successfully performed automatic segmentation of pulmonary arteries and veins in both lungs. When integrated with visualization tools, these automatic segmentations can enhance preoperative and intraoperative planning by providing detailed 3D views of patients anatomy.

PMID:40388152 | DOI:10.1093/icvts/ivaf101

Psychol Methods. 2025 May 19. doi: 10.1037/met0000756. Online ahead of print.

ABSTRACT

Daily diary data of emotional experiences are typically modeled with a first-order autoregressive model to account for possible day-to-day dynamics. However, our emotional experiences are likely influenced by the weekly rhythm of our activities, which may be reflected by (a) day-of-the-week effects (DOWEs), where different weekdays are characterized by different means; and (b) week-to-week dynamics, where weekday-specific activities and experiences have a delayed effect on the emotions that we experience on the same weekday a week later. While DOWEs have been studied occasionally, week-to-week dynamics have been largely ignored in psychological research. We present a set of complementary visualization techniques for detecting weekly rhythms and day-to-day dynamics in time series data. Subsequently, we introduce the family of seasonal autoregressive-moving average models from the econometrics literature, extend them with DOWEs models, and show how their components appear in visualizations. We then provide a tutorial on fitting these models in R, discuss model fit and model selection, and apply them to a daily diary dataset of 56-101 daily measures from 98 individuals. The results suggest that most individuals in the sample may be characterized by patterns and dynamics that the current practices in psychological research cannot capture adequately, and we discuss their implications for current psychological research practices. Reflecting critically on the limitations of our approach, we regard our findings as an initial step to encourage researchers to move beyond the ubiquitous paradigm of lag-1 autoregressive modeling and consider other types of dynamics at different timescales, and put forth ways forward. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40388125 | DOI:10.1037/met0000756

Sports Health. 2025 May 19:19417381251338283. doi: 10.1177/19417381251338283. Online ahead of print.

ABSTRACT

BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), chronic changes in knee joint biomechanics during higher level tasks, such as running, may negatively impact long-term knee joint health. Among the factors that contribute to these chronic changes, the influence of quadriceps strength on knee joint biomechanics during running is not well understood.

HYPOTHESIS: Higher involved limb quadriceps strength (peak torque and rate of torque development [RTD]) and limb symmetry index (LSI) will be positively associated with greater peak knee flexion angle and peak knee extensor moment during running.

STUDY DESIGN: Cross-sectional study.

LEVEL OF EVIDENCE: Level 3.

METHODS: Peak knee extensor moment and peak knee flexion angle were analyzed during the stance phase of running, 6 months following ACLR (n = 26; 18 female participants; age, 19 ± 5.0 years). Involved limb quadriceps strength and LSI were calculated for peak torque and RTD. Linear regression models were used to analyze the relationship between involved limb and LSI values of quadriceps peak torque and RTD to peak knee flexion angle and peak knee extensor moment.

RESULTS: Quadriceps peak torque (R² = 0.37; P < .01) and RTD (R² = 0.31, P < .01) each had a positive relationship to peak knee extensor moment, but not peak knee flexion angle. Quadriceps peak torque and RTD LSI were not associated with peak knee flexion angle or peak knee extensor moment (P > .20).

CONCLUSIONS: Quadriceps peak torque and RTD are positively associated with running kinetics 6 months after ACLR. Peak torque and RTD LSI were not associated with running mechanics after ACLR.

CLINICAL RELEVANCE: Quadriceps peak torque and rate of torque development are positively associated with running mechanics after ACLR. Clinicians should consider objective assessments of quadriceps strength before initiating running after ACLR.

PMID:40388121 | DOI:10.1177/19417381251338283

Arch Pharm Res. 2025 May 19. doi: 10.1007/s12272-025-01549-x. Online ahead of print.

ABSTRACT

The use of tacrolimus (TAC), a critical immunosuppressant post transplantation, is complicated by its high pharmacokinetic variability. While the gut microbiota has gained attention as a potential contributor, few studies have assessed its role in TAC metabolism variability. This study investigated the associations between the gut microbiota and TAC metabolism rates in kidney transplant recipients during the first month post transplantation-a crucial period for adjusting TAC to achieve therapeutic levels. We recruited 20 kidney transplant recipients and profiled their gut microbiota diversity and composition from stool samples collected before transplantation and at weeks 1 and 4 post transplantation via 16S rRNA sequencing. The TAC pharmacokinetic parameters were also collected. Associations between TAC metabolism status or pharmacokinetic parameters and gut microbiota diversity and composition were evaluated. Recipients with a fast TAC metabolism rate (C₀/D ratio < 1.05 ng/mL × 1/mg) presented significantly greater changes in both bacterial alpha and beta diversity metrics at 1 week post transplantation than did those with a slow metabolism rate (C₀/D ratio ≥ 1.05 ng/mL × 1/mg). Compared with slow metabolizers, fast metabolizers were associated with a significant increase in the abundance of three bacterial genera (Faecalibacterium, Clostridia vadinBB60, and Ruminococcus) and a significant decrease in the abundance of two bacterial species (Bacteroides plebeius and Parabacteroides goldsteinii). This study revealed links between gut microbiota diversity and composition and TAC metabolism rates in kidney transplant recipients during the early posttransplant period, underscoring the importance of investigating the gut microbiota as a contributor to TAC pharmacokinetic variability. Clarifying this causal relationship could better predict inter- and intraindividual TAC pharmacokinetic variability.

PMID:40388103 | DOI:10.1007/s12272-025-01549-x

J Epidemiol Glob Health. 2025 May 19;15(1):72. doi: 10.1007/s44197-025-00415-9.

ABSTRACT

OBJECTIVE: The COVID-19 lockdown impacted interactions with the health care system and societal stress levels. Previous US-based studies suggest that pandemic lockdowns may have lowered preterm birth rates although there are mixed findings from different settings. We evaluated the impact of COVID-19 on preterm birth and low birthweight rates at two San Francisco hospitals.

METHODS: We compared rates of preterm birth (< 37 weeks) and low birthweight (< 2500 g) in San Francisco at a safety net hospital and an academic medical center during two time periods early in the COVID-19 pandemic compared with the same months from the prior year: from March to May 2019 and 2020 and August to December 2019 and 2020. We calculated crude rates for preterm birth and low birth weight as well as compared maternal and infant birth demographics and health characteristics during these same time periods using descriptive statistics. Secondly using a cross-sectional study design, we used logistic and linear regression models to evaluate risk for preterm birth, gestational age at birth, and low birthweight adjusting for confounders comparing the lockdown period with the pre-COVID year. All analyses were conducted using Stata 15.0.

RESULTS: From August to December 2019 to 2020, the preterm birth rate decreased from 13.20 to 7.96% in the combined hospital data (p < 0.01), and the low birthweight rate decreased from 11.33 to 9.70% during the same time period (p = 0.13). We did not find a comparable reduction from March to May 2019 to 2020. Maternal age at delivery was significantly younger during the lockdown period, August to December, than in the prior year (36.29 ± 5.69 versus 37.15 ± 5.68 years p < 0.01) and parity was greater (0.83 ± 1.15 versus 0.74 ± 1.04, p = 0.03) but there were no other significant differences in race or ethnicity, infant sex or type of delivery (vaginal versus Cesarean section) from 2019 to 2020. In a logistic and linear regression model adjusting for maternal age and infant sex and other confounders, the lockdown period from August to December was protective against preterm birth (OR 0.65, 95%CI 0.51-0.82) and associated with overall longer gestational duration (Coeff 0.23, 95%CI 0.07-0.39). The August to December lockdown period was also associated with greater birthweight (Coeff 43.76, 95%CI 2.19-85.34).

CONCLUSIONS: In San Francisco, COVID-19 lockdowns lowered the preterm birth and increased gestational duration in infants comparing 2019 with 2020 for August to December. The reduced in preterm birth rates may be related to the overall strict lockdown measures that San Francisco implemented compared with other US cities. WHAT THIS STUDY ADDS TO THE CLINICAL WORK?: This study suggests that COVID-19 lockdowns lowered the preterm birth rate in August -December 2020 compared with the same months in 2019 in two hospitals in San Francisco. San Francisco had strict lockdowns compared with other areas of the country and fewer deaths. The stay-at-home measures could possibly have reduced stress for pregnant women or had other positive benefits that reduced the preterm birth rate.

PMID:40388095 | DOI:10.1007/s44197-025-00415-9