Tag: nevin manimala

JAMA Netw Open. 2025 Apr 1;8(4):e257295. doi: 10.1001/jamanetworkopen.2025.7295.

ABSTRACT

IMPORTANCE: Alcohol use disorder (AUD) may negatively affect preexposure prophylaxis (PrEP) adherence and continuation, reducing PrEP effectiveness.

OBJECTIVE: To estimate the prevalence of and and factors associated with AUD diagnoses among commercially insured individuals who take PrEP.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used US health care claims data to identify individuals aged 16 to 64 years who received at least 1 new PrEP prescription between January 1, 2014, to December 31, 2021. Data were analyzed from June 2024 to February 2025.

EXPOSURE: Sociodemographic characteristics included patient age, sex, geographic location, employment status, and type of health insurance. Clinical characteristics included sexually transmitted infection (STI) diagnosis and testing, use of psychotherapy services, and diagnosis of other mental health conditions.

MAIN OUTCOMES AND MEASURES: The main outcome was an AUD diagnosis within 6 months before or after the date of PrEP initiation. Among individuals with an AUD diagnosis, receipt of medications for AUD (MAUDs), including Food and Drug Administration (FDA)-approved MAUDs (acamprosate, disulfiram, and oral and injectable naltrexone) and non-FDA-approved MAUDs (baclofen, gabapentin, and topiramate) was determined.

RESULTS: The study cohort included 43 913 individuals receiving PrEP (mean [SD] age, 35.8 [10.94] years; 35 027 [90.1%] male assigned at birth). There were 6274 individuals (14.29%) who had an AUD diagnosis, with 1245 (2.84%) and 5029 (11.45%) receiving their diagnosis before and after PrEP initiation, respectively. The sociodemographic and clinical factors that were associated with an AUD diagnosis were similar whether AUD was diagnosed before or after PrEP initiation, including male sex assigned at birth (before: adjusted odds ratio [aOR], aOR, 0.62; 95% CI, 0.52-0.73; after: aOR, 0.81; 95% CI, 0.73-0.90) and the presence of other mental health diagnoses such as depression (before: aOR, 3.26; 95% CI, 2.78-3.84; after: aOR, 3.17; 95% CI, 2.88-3.49), anxiety (before: aOR, 2.16; 95% CI, 1.83-2.55; after: aOR, 2.24; 95% CI, 2.04-2.46), and any substance use disorder (before: aOR, 14.54; 95% CI, 12.46-16.96; after: aOR, 13.09; 95% CI, 11.82-14.49). There were 531 individuals with AUD diagnosis (8.46%) who received an FDA-approved MAUD and 883 (14.07%) who had a claim for a non-FDA-approved MAUD.

CONCLUSIONS AND RELEVANCE: This population-based cohort study found that nearly 15% of individuals who took PrEP had an AUD diagnosis within 6 months of PrEP initiation; individuals with an AUD diagnosis were more likely to have co-occurring mental health conditions, and less than 9% received any FDA-approved MAUD. These findings suggest that interventions are needed to improve AUD services among individuals who take PrEP.

PMID:40279125 | DOI:10.1001/jamanetworkopen.2025.7295

Biometrics. 2025 Apr 2;81(2):ujaf042. doi: 10.1093/biomtc/ujaf042.

ABSTRACT

The coexistences of high dimensionality and strong correlation in both responses and predictors pose unprecedented challenges in identifying important predictors. In this paper, we propose a model-free conditional feature screening method with false discovery rate (FDR) control for ultrahigh-dimensional multi-response setting. The proposed method is built upon partial distance correlation, which measures the dependence between two random vectors while controlling effect for a multivariate random vector. This screening approach is robust against heavy-tailed data and can select predictors in instances of high correlation among predictors. Additionally, it can identify predictors that are marginally unrelated but conditionally related with the response. Leveraging the advantageous properties of partial distance correlation, our method allows for high-dimensional variables to be conditioned upon, distinguishing it from current research in this field. To further achieve FDR control, we apply derandomized knockoff-e-values to establish the threshold for feature screening more stably. The proposed FDR control method is shown to enjoy sure screening property while maintaining FDR control as well as achieving higher power under mild conditions. The superior performance of these methods is demonstrated through simulation examples and a real data application.

PMID:40279121 | DOI:10.1093/biomtc/ujaf042

Biometrics. 2025 Apr 2;81(2):ujaf040. doi: 10.1093/biomtc/ujaf040.

ABSTRACT

Many studies employ the analysis of time-to-event data that incorporates competing risks and right censoring. Most methods and software packages are geared towards analyzing data that comes from a continuous failure time distribution. However, failure-time data may sometimes be discrete either because time is inherently discrete or due to imprecise measurement. This paper introduces a new estimation procedure for discrete-time survival analysis with competing events. The proposed approach offers a major key advantage over existing procedures and allows for straightforward integration and application of widely used regularized regression and screening-features methods. We illustrate the benefits of our proposed approach by a comprehensive simulation study. Additionally, we showcase the utility of the proposed procedure by estimating a survival model for the length of stay of patients hospitalized in the intensive care unit, considering 3 competing events: discharge to home, transfer to another medical facility, and in-hospital death. A Python package, PyDTS, is available for applying the proposed method with additional features.

PMID:40279120 | DOI:10.1093/biomtc/ujaf040

Biometrics. 2025 Apr 2;81(2):ujaf044. doi: 10.1093/biomtc/ujaf044.

ABSTRACT

Valid statistical inference is notoriously challenging when the sample is subject to nonresponse bias. We approach this difficult problem by employing multiple candidate models for the propensity score (PS) function combined with empirical likelihood. By incorporating multiple working PS models into the internal bias calibration constraint in the empirical likelihood, the selection bias can be safely eliminated as long as the working PS models contain the true model and their expectations are equal to the true missing rate. The bias calibration constraint for the multiple PS models is called the multiple bias calibration. The study delves into the asymptotic properties of the proposed method and provides a comparative analysis through limited simulation studies against existing methods. To illustrate practical implementation, we present a real data analysis on body fat percentage using the National Health and Nutrition Examination Survey dataset.

PMID:40279119 | DOI:10.1093/biomtc/ujaf044

Biometrics. 2025 Apr 2;81(2):ujaf041. doi: 10.1093/biomtc/ujaf041.

ABSTRACT

Dynamic treatment regimes (DTRs) are sequences of functions that formalize the process of precision medicine. DTRs take as input patient information and output treatment recommendations. A major focus of the DTR literature has been on the estimation of optimal DTRs, the sequences of decision rules that result in the best outcome in expectation, across the complete population if they were to be applied. While there is a rich literature on optimal DTR estimation, to date, there has been minimal consideration of the impacts of nonadherence on these estimation procedures. Nonadherence refers to any process through which an individual’s prescribed treatment does not match their true treatment. We explore the impacts of nonadherence and demonstrate that, generally, when nonadherence is ignored, suboptimal regimes will be estimated. In light of these findings, we propose a method for estimating optimal DTRs in the presence of nonadherence. The resulting estimators are consistent and asymptotically normal, with a double robustness property. Using simulations, we demonstrate the reliability of these results, and illustrate comparable performance between the proposed estimation procedure adjusting for the impacts of nonadherence and estimators that are computed on data without nonadherence.

PMID:40279118 | DOI:10.1093/biomtc/ujaf041

JAMA Health Forum. 2025 Apr 4;6(4):e250724. doi: 10.1001/jamahealthforum.2025.0724.

ABSTRACT

IMPORTANCE: The US Centers for Medicare & Medicaid Services launched the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) payment model in January 2023. In contrast to prior ACO initiatives, such as the Medicare Shared Savings Program (MSSP), ACO REACH includes equity-focused measures and payment adjustments, including an equity plan and financial risk adjustment for ACOs with higher proportions of underserved beneficiaries. However, it is unknown whether these changes have incented participation from organizations that serve beneficiaries from marginalized communities.

OBJECTIVE: To compare characteristics between participants in ACO REACH with those in MSSP and the broader pool of Medicare beneficiaries, organizations, and clinicians.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included all Medicare beneficiaries clinicians, and ACOs enrolled in fee-for-service Medicare, MSSP, and ACO REACH from January 2022 to January 2023.

EXPOSURE: Enrollment in fee-for-service Medicare, MSSP, or ACO REACH.

MAIN OUTCOMES AND MEASURES: Beneficiary, clinician, and ACO characteristics.

RESULTS: In 2023, among 35 801 118 beneficiaries in the overall fee-for-service Medicare program, 18 911 213 (52.8%) were female, and 163 706 (0.5%) were American Indian or Alaska Native, 1 251 553 (3.5%) were Asian or Pacific Islander, 2 952 244 (8.2%) were Black, 2 396 771 (6.7%) were Hispanic, 27 642 765 (77.2%) were White, and 1 394 079 (3.9%) were another race (includes individuals who did not identify with a listed race, including those who self-identified as multiracial) or unknown race. A total of 1 958 881 beneficiaries were attributed to ACO REACH, and 11 340 987 were attributed to MSSP. A total of 132 ACOs participated in ACO REACH, while 456 ACOs participated in the MSSP. Compared with Medicare beneficiaries overall, REACH beneficiaries were older (85 years or older: 14.2% vs 10.3%; standardized mean difference [SMD], 0.44) and more often White (80.2% vs 77.2%) and less often Black (5.9% vs 8.2%) or Hispanic (5.8% vs 6.7%) (SMD, 0.24). REACH beneficiaries were slightly less likely to have Medicare entitlement due to disability (15.2% vs 17.6%) or be dually enrolled (15.1% vs 15.8%) (SMD, 0.07). REACH beneficiaries were less likely to be rural (3.9% vs 8.4%; SMD, 0.19) and less likely to reside in highly vulnerable geographic areas based on the Social Vulnerability Index (27.7% vs 29.4%; SMD, 0.08) compared with beneficiaries overall.

CONCLUSIONS AND RELEVANCE: These findings suggest that, in its first year, ACO REACH did not achieve its goal of enrolling organizations that serve beneficiaries with high levels of social risk. Without broader participation, ACO REACH is unlikely to achieve its goal of reducing health inequities.

PMID:40279112 | DOI:10.1001/jamahealthforum.2025.0724

Eur J Heart Fail. 2025 Apr 25. doi: 10.1002/ejhf.3664. Online ahead of print.

ABSTRACT

AIMS: Adult patients with transposition of the great arteries (TGA) and an systemic right ventricle (sRV) are at risk for heart failure (HF). In this study, we investigated risk factors for HF hospitalization and developed a novel risk stratification tool to optimize risk prediction for clinical practice.

METHODS AND RESULTS: In this international multicentre study, 522 patients with TGA and an sRV, without history of HF hospitalization, were followed retrospectively for a median of 17.9 years (interquartile range [IQR] 12.9-22.1). HF hospitalization was defined as a hospital admission for HF signs and symptoms with initiation or increase of HF medication. Predictors for HF hospitalization were established using a Cox regression analysis and were used to build a 10-year risk score. Of the 522 patients, 70% had an atrial switch operation and 30% had a congenitally corrected TGA. The median age at time of enrolment was 23.7 years (IQR 19.9-32.1) and 64% were male. During follow-up, 127 patients (24.3%) had at least one HF hospitalization. A risk stratification tool was built using the following independent predictors associated with a 10-year risk of HF hospitalization: age, New York Heart Association functional class ≥II, QRS duration >120 ms, atrial fibrillation, moderate/severe right ventricular dysfunction, with a C-statistic of 0.868 (95% confidence interval 0.823-0.913).

CONCLUSION: During follow-up, 24.3% of sRV patients had at least one HF hospitalization. Five simple, clinically-accessible variables can be used as a risk score tool to identify patients at higher risk of HF hospitalization.

PMID:40279105 | DOI:10.1002/ejhf.3664

Insect Mol Biol. 2025 Apr 25. doi: 10.1111/imb.12992. Online ahead of print.

ABSTRACT

The western flower thrips, Frankliniella occidentalis, is the principal thrips vector of Orthotospovirus tomatomaculae (order Bunyavirales, family Tospoviridae), a devastating plant-pathogenic virus commonly referred to as tomato spotted wilt virus (TSWV). The larval gut is the gateway for virus transmission by F. occidentalis adults to plants. In a previous report, gut expression at the transcriptome level was subtle but significant in response to TSWV in L1s. Since it has been well documented that the relationship between the expression of mRNA and associated protein products in eukaryotic cells is often discordant, we performed identical, replicated experiments to identify and quantify virus-responsive larval gut proteins to expand our understanding of insect host response to TSWV. While we documented statistically significant, positive correlations between the abundance of proteins (4189 identified) and their cognate mRNAs expressed in first and second instar guts, there was virtually no alignment of individual genes identified to be differentially modulated by virus infection at the transcriptome and proteome levels. Predicted protein-protein interaction networks associated with clusters of co-expressed proteins revealed wide variation in correlation strength between protein and cognate transcript abundance, which appeared to be associated with the type of cellular processes, cellular compartments and network connectivity represented by the proteins. In total, our findings indicate distinct and dynamic regulatory mechanisms of transcript and protein abundance (expression, modifications and/or turnover) in virus-infected gut tissues. This study provides molecular candidates for future functional analysis of thrips vector competence and underscores the necessity of examining complex virus-vector interactions at a systems level.

PMID:40279100 | DOI:10.1111/imb.12992

Anat Sci Int. 2025 Apr 25. doi: 10.1007/s12565-025-00843-4. Online ahead of print.

ABSTRACT

The suprascapular notch is one of the anatomical sites most commonly exposed to compressive and traction injuries of the suprascapular nerve. In this preliminary study, we aimed to evaluate the morphological and morphometric features of the notch to enhance the diagnostic accuracy and therapeutic outcomes of nerve compression. This retrospective study was conducted using computed tomography images of the scapula obtained between January 1, 2022, and August 30, 2024. A total of 852 scapulae were evaluated, of which 448 belonged to males and 404 to females. Morphometric measurements included superior transverse diameter, middle transverse diameter, and maximal depth of the notch. In addition, the notch was classified using both the Polguj and Rengachary classification systems. When the measurement parameters were compared between genders, the values were higher in males; however, only the maximal depth showed a statistically significant difference (p < 0.05). According to the Polguj classification, Type 3 was the most common (63.38%). Based on the Rengachary classification, the U-shaped form was the most frequently observed (65.02%), while the J-shaped form was the rarest (3.41%). The foramen shape was detected in 5.75% of cases. The J-shaped variant was found to be approximately four times more common in males than in females. Knowledge of the anatomical variations of the notch is likely to be beneficial for both endoscopic and open surgical interventions in the suprascapular region. In particular, three-dimensional computed tomography imaging may be useful in preoperative planning for arthroscopic resection of ossified ligament.

PMID:40279073 | DOI:10.1007/s12565-025-00843-4

Head Neck Pathol. 2025 Apr 25;19(1):50. doi: 10.1007/s12105-025-01790-2.

ABSTRACT

INTRODUCTION: Oral squamous cell carcinoma is the most prevalent of all the oral cancers. There is no definitive marker available for its early diagnosis and its effective prognosis. YAP serves as a transcriptional regulator in hippo tumor suppressor pathway thereby activating the transcription of genes taking part in cellular proliferation, alteration, migration, and invasion. On the contrary, PARK2 acts as a tumor suppressor and has been widely explored in various malignancies. However, its role in OSCC carcinogenesis is untrodden.

AIM: To evaluate the Immunohistochemical expression of YAP and PARK2 in oral epithelial dysplasia and Oral Squamous Cell Carcinoma and establish them as prognostic markers.

MATERIAL AND METHOD: The study sample consisted of 70 formalin fixed paraffin embedded tissue sections of normal oral mucosa (10), oral epithelial dysplasia (30) and oral squamous cell carcinoma (30). Immunohistochemical analysis of YAP and PARK2 was done and final scores were calculated. Further, the markers were graded as low and high expression groups. Statistical analysis was done using chi-square test, cox regression analysis and Spearman’s correlation. Kaplan Meier plot for survival analysis was also plotted.

RESULT: Immunohistochemical expression of YAP depicted a gradual incline from normal oral mucosa to oral squamous cell carcinoma while PARK2 showed a reverse trend. Significant difference of YAP and PARK2 expression between three groups was noted. Inverse moderate degree of correlation was observed between both the markers in OSCC group.

CONCLUSION: Concomitant immunoexpression of YAP and PARK2 with a moderate degree of inverse correlation from normal oral mucosa to oral squamous cell carcinoma could probably serve as diagnostic and prognostic markers as they might act through a common mechanism, probably hippo/YAP signaling, which could be further confirmed by larger sample size, including longer follow up in future studies.

PMID:40279065 | DOI:10.1007/s12105-025-01790-2