Tag: nevin manimala

JCO Precis Oncol. 2025 May;9:e2400821. doi: 10.1200/PO-24-00821. Epub 2025 May 15.

ABSTRACT

PURPOSE: Genomic testing for prostate cancer (PCa) clinical management and hereditary cancer assessment has grown in clinical impact; however, challenges remain regarding optimal implementation and end-user confidence. The Decision-making, Experience, and Confidence In Determining Genomic Evaluation (DECIDE) survey was designed to collect information regarding utility and understanding of genomic testing from PCa health care providers, researchers, and stakeholders.

METHODS: The DECIDE survey was administered online from October 2022 to January 2023 with 18 multiple-response questions. Survey domains included self-confidence with ordering and interpreting germline and somatic genomic tests, process of testing and use of results, decision-making factors, and barriers to testing. Data were summarized by evaluating counts and percentages of responses, and the results were presented by descriptive statistics.

RESULTS: One hundred twenty-two participants completed the survey. The majority were medical oncologists (70%) and at academic medical centers (89%). Self-confidence was high in knowing indications for genomic testing (82% respondents) but lower in interpretation of results, especially from circulating tumor DNA (52%). Confidence varied in interpreting pathogenic variants (65% high confidence), variants of unknown significance (47%), and incidental findings from genomic tests (35%). Common barriers to testing were difficulty obtaining tissue (71%) and cost (35%). Testing utility was sometimes limited by inability to obtain the recommended treatment (33%). Most of the respondents (55%) agreed that lack of education and training of health care professionals regarding genomic testing is impeding clinical translation.

CONCLUSION: The DECIDE survey provided critical insights into challenges with genomic testing, from provider confidence in interpretating results to testing and practice barriers. The results inform next steps to further educate PCa providers and to collectively improve testing and result reporting for enhanced implementation of PCa genomic testing.

PMID:40373262 | DOI:10.1200/PO-24-00821

JCO Precis Oncol. 2025 May;9:e2400449. doi: 10.1200/PO-24-00449. Epub 2025 May 15.

ABSTRACT

PURPOSE: Guidelines recommend biomarker testing and biomarker-informed therapies in patients with metastatic non-small cell cancer (mNSCLC); however, the use remains suboptimal.

METHODS: To understand contemporary testing and treatment patterns, retrospective data from 42,037 patients with mNSCLC in a nationwide electronic health record-derived deidentified database from January 2011 to April 2023 were used to quantify testing rates, test positivity, and use of biomarker-informed therapies, stratified by key demographics to identify potential disparities. Multivariable logistic regression was conducted to include patient characteristics associated with the receipt of biomarker testing and subsequent biomarker-informed therapies.

RESULTS: A total of 34,510 patients (82.1%) received ≥one biomarker test(s). Biomarker testing and use of biomarker-informed therapies increased for all studied biomarkers (EGFR, ALK, ROS1, PD-L1, BRAF, RET, MET) over time, with highest rates observed in 2023: EGFR (88.7% and 79.5%, respectively) and ALK (87.7% and 84.3%, respectively). In multivariate logistic regression, patient sex, race, Eastern Cooperative Oncology Group at baseline, insurance type, smoking status at baseline, and histology were all significantly associated with odds of receiving biomarker testing. Covariates statistically associated with receipt of biomarker-informed therapy varied by biomarker without a clear pattern of association. Although the use of biomarker testing and biomarker-informed therapies has increased in recent years, gaps and potential disparities remain.

CONCLUSION: Analysis of contemporary trends in biomarker testing and use of targeted therapies in mNSCLC in the United States highlight improvements in recent years. However, these rates remain suboptimal in specific strata of the patient population, including differences in racial groups and insurance groups, indicating further work is needed to bridge remaining gaps.

PMID:40373260 | DOI:10.1200/PO-24-00449

Neurology. 2025 Jun 10;104(11):e213706. doi: 10.1212/WNL.0000000000213706. Epub 2025 May 15.

ABSTRACT

BACKGROUND AND OBJECTIVES: Investigation of olfactory impairment, an early manifestation of Alzheimer disease (AD), in relation to plasma biomarkers of AD and neurodegeneration could provide insights into the disease’s pathophysiology. Because few such studies based on large, diverse, community-based populations exist, we investigated associations of odor identification ability with plasma biomarkers of AD and other neurodegenerative pathologies in community-dwelling Black and White older adults.

METHODS: This cross-sectional investigation included participants from the Atherosclerosis Risk in Communities study who attended visit 5 (2011-2013) and who completed olfactory testing and brain MRI examinations and had plasma biomarkers measured (namely, amyloid-beta [Aβ]₄₂/Aβ₄₀ ratio, phosphorylated-tau at threonine-181 [p-tau₁₈₁], p-tau₁₈₁/Aβ₄₂ ratio, glial fibrillary acidic protein [GFAP], and neurofilament light chain [NfL]). Odor identification ability was measured by the 12-item Sniffin’ Sticks test. Separate linear regression models were used to examine the association of continuous olfaction score and olfaction categories (anosmia: score 6; hyposmia: 7-8; moderate-normal: 9-10; good-normal: 11-12) with each biomarker (all were log-transformed), adjusting for sociodemographic and cardiovascular factors, head injury, APOE-ε4 status, and estimated glomerular filtration rate. We further examined whether any observed associations are explained by total and regional brain volumes.

RESULTS: Among 1,545 participants (age: 76 ± 5 years, 60% women, 27% self-reported Black participants), the mean olfaction score was 9.2 ± 2.3; 14% had anosmia. Consistent with our hypotheses, poorer olfactory scores were associated with higher plasma p-tau₁₈₁ (β per 1-unit lower score: 0.026 [95% CI 0.012-0.040]), p-tau₁₈₁/Aβ₄₂ (β: 0.027 [95% CI 0.011- 0.044]), GFAP (β: 0.024 [95% CI 0.009-0.040]), and NfL (β: 0.034 [95% CI 0.019-0.050] and lower Aβ₄₂/Aβ₄₀ ratio (β: -0.007 [95% CI -0.015 to 0.000]). Likewise, compared with good-normal olfaction, anosmia showed associations with all biomarker levels indicative of greater neuropathology (e.g., β for plasma p-tau₁₈₁/Aβ₄₂: 0.235 [95% CI 0.113-0.358] and β for plasma NfL: 0.210 [95% CI 0.102-0.317]), although the association with Aβ₄₂/Aβ₄₀ ratio was not statistically significant (β: -0.054 [95% CI -0.108 to 0.001]). These biomarkers were not significantly associated with hyposmia or moderate-normal olfaction. Smaller medial-temporal lobe volumes partly explained olfaction’s link with plasma p-tau₁₈₁, p-tau₁₈₁/Aβ₄₂, GFAP, and NfL.

DISCUSSION: Our findings suggest that poor olfaction is associated with multiple AD-related and other neurodegenerative processes. Future studies should investigate how longitudinal changes in both olfaction and biomarkers relate to each other.

PMID:40373252 | DOI:10.1212/WNL.0000000000213706

JMIR Hum Factors. 2025 May 15;12:e68581. doi: 10.2196/68581.

ABSTRACT

BACKGROUND: Clinical decision support systems are known to improve adherence to clinical practice guidelines and patient outcomes by providing clinicians with timely, accurate, and appropriate knowledge.

OBJECTIVE: This study investigates the perceived usefulness and practical implementation of UpHill Route v3, a personalized digital care pathway (PDCP) system, in enhancing clinical decision-making and patient management across various clinical settings.

METHODS: A mixed-methods retrospective study was conducted among medical doctors and nurses from four National Health System-Local Health Units in Portugal. Data were collected from May 2023 to April 2024. The primary data source was an anonymous questionnaire assessing health care professionals’ perceptions of UpHill Route v3’s usefulness using the Likert scale ranging from 0 (do not agree) to 10 (totally agree). Secondary analysis involved quantifying decisions across heart failure, multimorbidity, diabetes, and colorectal and breast cancer clinical pathways. These data were collected from user interactions with UpHill Route v3 as well as from its internal database. Descriptive and bivariate statistics were used to analyze the data.

RESULTS: A total of 22 health care professionals with mean age 44.7 (SD 10.6) years, including 15 (68%) female participants and 9 (41%) physicians were included in the study. High ratings for adherence to clinical protocols, mean score 8.06 (SD 1.73); clinical decision support, mean score 8.05 (SD 1.73); patient care improvement, mean score 7.63 (SD 2.22); and confidence in patient management, mean score 8.26 (SD 1.56) were reported. Secondary analysis showed that across 3574 patients, 25,741 clinical decisions were informed, and 9254 actions were performed with the assistance of the PDCP tool.

CONCLUSIONS: The UpHill Route v3 PDCP tool is highly valued by health care professionals for its ability to support clinical decision-making and improve operational efficiency across various clinical settings. Our findings suggest that this tool can effectively bridge the gap between clinical guidelines and real-world practice.

PMID:40373224 | DOI:10.2196/68581

JMIR Aging. 2025 May 15;8:e67982. doi: 10.2196/67982.

ABSTRACT

BACKGROUND: Frailty syndrome in older adults represents a significant public health concern, characterized by a reduction in physiological reserves and an increased susceptibility to stressors. This can result in adverse health outcomes, including falls, hospitalization, disability, and mortality. The early identification and management of frailty are essential for improving quality of life and reducing health care costs. Conventional assessment techniques, including dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and muscle ultrasound (US), are efficacious but frequently constrained in primary care settings by financial and accessibility limitations.

OBJECTIVE: The aim of this study is to analyze the differences in anthropometric characteristics, physical function, nutritional status, cognitive status, and body composition among older adults identified as frail, prefrail, or robust in primary care services using the PowerFrail mobile app. Furthermore, the study assesses the predictive capacity of body composition variables (whole-body phase angle [WBPhA] via BIA, US-measured rectus femoris muscle thickness, and DXA-derived lean mass) in identifying frailty and evaluates their feasibility for implementation in primary care.

METHODS: A descriptive cross-sectional study was conducted with 94 older adult participants aged between 70 and 80 years, recruited through the Andalusian Health Service in Spain. Frailty status was classified using the PowerFrail App, which integrates muscle power assessment and provides personalized physical activity recommendations. Body composition was measured using WBPhA (BIA), muscle US, and DXA. Statistical analyses included 1-way ANOVA for group comparisons, logistic regression to investigate associations, and receiver operating characteristic curve analysis to evaluate the predictive accuracy of the body composition measures.

RESULTS: Participants were categorized into frail (n=28), prefrail (n=33), and robust (n=33) groups. All body composition measures exhibited high specificity in detecting frailty, with varying sensitivity. Unadjusted US showed the highest specificity but low sensitivity (10.7%). WBPhA and right leg lean mass (LeanM RL) demonstrated significant predictive capabilities, especially when adjusted for age and sex, with area under the curve values ranging from 0.678 to 0.762. The adjusted LeanM RL model showed a good balance between sensitivity (35.7%) and specificity (93.9%; P=.045), indicating its potential as a reliable frailty predictor. These findings are consistent with previous research emphasizing the importance of muscle mass and cellular health in frailty assessment.

CONCLUSIONS: Body composition variables, particularly WBPhA, LeanM RL, and US, are effective predictors of frailty in older adults. The PowerFrail mobile app, combined with advanced body composition analysis, offers a practical and noninvasive method for early frailty detection in primary care settings. Integrating such technological tools can enhance the early identification and management of frailty, thereby improving health outcomes in the aging population.

PMID:40373218 | DOI:10.2196/67982

JMIR Form Res. 2025 May 15;9:e70129. doi: 10.2196/70129.

ABSTRACT

BACKGROUND: Natural killer/T-cell lymphoma (NKTL) is a rare malignancy of mature natural killer/T-cells, predominantly found in Asian and South/Central American populations, with limited studies conducted in Europe and the United States.

OBJECTIVE: The aim of this study is to present an overview of the incidence rate, demographic and clinical characteristics, treatment options, overall survival (OS), and factors influencing OS of NKTL in the United States.

METHODS: We used data from the Surveillance, Epidemiology, and End Results 17 database to analyze NKTL cases recorded between 2000 and 2020. In a cohort of 1162 patients with NKTL, we calculated the incidence rates and performed statistical analyses to evaluate OS, the effect of radiotherapy and chemotherapy on survival, and lymphoma-specific survival.

RESULTS: The mean annual incidence rate of NKTL in the United States was 0.067 per 100,000, with higher rates observed in men compared to women, and an increase noted with age. However, there has been no significant rise in incidence over recent years. Significant racial disparities were observed, with higher incidence rates in non-Hispanic Asian or Pacific Islanders and Hispanic people. The median survival time for patients with NKTL was 21 months, with a 5-year OS rate of 39.5%, which has shown improvement in recent years. Key independent prognostic factors impacting patient survival included age at diagnosis, clinical stage, nasal type presentation, presence of systemic symptoms, and treatment modality. Patients receiving combined radiotherapy and chemotherapy exhibited the best outcomes, with a median OS of 138 months and a 5-year OS rate of 58%. This survival benefit remained consistent even in patients with stage I/localized nasal type lymphoma, achieving a 5-year OS rate of 73.3%.

CONCLUSIONS: The incidence of NKTL has remained stable in recent years. Patients with the nasal type generally experience better survival outcomes. The use of combined radiotherapy and chemotherapy appears to enhance survival, though further validation through prospective multicenter clinical trials is necessary.

PMID:40373215 | DOI:10.2196/70129

Natl Vital Stat Rep. 2025 Apr 8;(2).

ABSTRACT

OBJECTIVES: This report presents complete period life tables for the United States by Hispanic origin and race and sex, based on age-specific death rates in 2022.

METHODS: Data used to prepare the 2022 life tables are 2022 final mortality statistics; July 1, 2022, population estimates based on the Blended Base population estimates produced by the U.S. Census Bureau; and 2022 Medicare data for people ages 66-99. The methodology used to estimate the life tables for the Hispanic population remains unchanged from that developed for the publication of life tables by Hispanic origin for data year 2006. The same methodology is used to estimate the life tables for the American Indian and Alaska Native non-Hispanic and Asian non-Hispanic populations. The methodology used to estimate the 2022 life tables for all other groups was first implemented with data year 2008.

RESULTS: In 2022, the overall expectation of life at birth was 77.5 years, increasing 1.1 years from 76.4 in 2021. Between 2021 and 2022, life expectancy at birth increased by 1.3 year for males (from 73.5 to 74.8) and by 0.9 year for females (79.3 to 80.2). Between 2021 and 2022, life expectancy increased 2.2 years for the Hispanic (77.8 to 80.0) and the American Indian and Alaska Native non-Hispanic (65.6 to 67.8) populations. Life expectancy increased by 1.6 years for the Black non-Hispanic population (71.2 to 72.8), by 0.9 year for the Asian non-Hispanic population (83.5 to 84.4), and by 0.8 year for the White non-Hispanic population (76.7 to 77.5).

PMID:40373208

G3 (Bethesda). 2025 May 15:jkaf108. doi: 10.1093/g3journal/jkaf108. Online ahead of print.

ABSTRACT

Fruit quality represent the major constraints to consumer acceptance of new blueberry cultivars. However, breeding for fruit quality is challenging due to its complex inheritance and genotype × environment interaction. Despite previous efforts to detect quantitative trait loci (QTL) associated with fruit quality traits, most of the identified QTL explain only a fraction of the total variability or lack stability across multiple environments. In this study, we investigated multiple fruit quality traits and phenology-related traits of 187 diverse southern highbush blueberry germplasm over two to four years. Significant phenotypic variation across observation years was detected for most traits. Genome-wide association study (GWAS) failed to identify stable peaks supported by multiple observation years, indicating complex control of fruit-related traits. To elucidate factors contributing to phenotypic variation, the relationship between observed phenotypic values and the stability measure of these values was examined. Significant correlations were found between the variation of phenology-related traits and the stability of fruit-related traits; it was found that early blooming and ripening accessions tended to exhibit variable firmness over the years. Additionally, size variability was influenced by the fruit size itself: accessions producing smaller fruit tended to show more variation in size over the years. Furthermore, GWAS conducted on the stability indices identified novel marker-trait associations that were not detected using normalized phenotypic values only, and their effects on fruit-related traits were similarly dependent on environment (observation year). Collectively, these findings deepen our understanding of variability in fruit-related traits and provide insights into their genetic control, thereby advancing breeding for superior cultivars with stable phenotypic performance.

PMID:40373202 | DOI:10.1093/g3journal/jkaf108

Optom Vis Sci. 2025 May 16. doi: 10.1097/OPX.0000000000002261. Online ahead of print.

ABSTRACT

SIGNIFICANCE: Identifying potential modifiable risk factors for keratoconus progression is crucial for better outcomes. This study suggests that sleeping position may contribute to interocular asymmetry in keratoconus, providing an actionable target for patient education and clinical management and underscoring the importance of sleep posture in slowing disease progression.

PURPOSE: This study aimed to investigate whether the preferred sleeping position can contribute to interocular asymmetry of keratoconus.

METHODS: A clinical cross-sectional study was conducted on 50 patients (100 eyes) with grade I and II keratoconus (Amsler-Krumeich) and 40 individuals (80 eyes) without keratoconus. Corneal tomographic parameters from the Galilei G6 (keratometry plus curve [Steep K], mean keratometry [Sim K], thinner corneal thickness, central corneal thickness, Cone Location and Magnitude Index, dioptric asymmetry between the inferior and superior corneal hemispheres, and vertical coma) were obtained to assess interocular asymmetry. All participants answered a questionnaire about their preferred sleeping position. The eye positioned lower during sleep has been referred to as the dependent eye, and the eye positioned higher was classified as the nondependent eye, regardless of the sleeping position (lateral or ventral).

RESULTS: There were no significant differences between dependent and nondependent eyes regarding the evaluated tomographic variables among individuals without keratoconus. However, in individuals with keratoconus, statistically significant differences were observed between dependent and nondependent eyes for the following parameters: Steep K (47.89 vs. 45.78 D, p=0.0047), Sim K (46.54 vs. 44.42 D, p=0.0016); thinnest corneal thickness (445.84 vs. 460.34 μm, p=0.0057), central corneal thickness (463.03 vs. 477.6 μm, p=0.0125), vertical coma (-1.98 vs. -1.41 μm, p=0.0448), and total coma (1.60 vs. 1.22 μm, p=0.0495).

CONCLUSIONS: This study suggests that in individuals with keratoconus, the preferred sleeping position may contribute to keratoconus asymmetry in the dependent eye, regardless of whether the sleeping position is lateral or ventral.

PMID:40373201 | DOI:10.1097/OPX.0000000000002261

CBE Life Sci Educ. 2025 Jun 1;24(2):ar27. doi: 10.1187/cbe.24-05-0157.

ABSTRACT

Conflict-reducing practices during evolution instruction have been recommended to increase students’ perceived compatibility between evolution and religion, increase evolution acceptance, and decrease stereotypes about religious students in science. However, the efficacy of these practices has not been demonstrated in a randomized controlled design making it uncertain whether they are causing the effects reported in less controlled studies. Further, we do not know the extent to which the religious identities of instructors may impact their effectiveness. In this study, we randomly assigned 2623 undergraduate students in 19 biology courses across different states to receive an evolution video with 1) no conflict-reducing practices, 2) conflict-reducing practices implemented by a non-religious instructor, or 3) conflict-reducing practices implemented by a Christian instructor. We found that the evolution videos with conflict-reducing practices led to decreased conflict, increased compatibility, and increased acceptance of human evolution compared with the video without conflict-reducing practices. Further, the Christian and non-religious instructor conditions were equally effective at improving all student outcomes, except the non-religious instructor was more effective for increasing perceived compatibility between religion and evolution among atheist students. These results illustrate that conflict-reducing practices, implemented by either Christian or non-religious instructors, can be effective in a controlled study.

PMID:40373175 | DOI:10.1187/cbe.24-05-0157