Tag: nevin manimala

JMIR Res Protoc. 2025 Jul 10;14:e67511. doi: 10.2196/67511.

ABSTRACT

BACKGROUND: Detained adolescents exhibit high rates of behavioral health needs, yet few receive treatment during detention or community re-entry. Once adolescents are released into the community, caregivers must mobilize significant resources and overcome barriers to facilitate their treatment engagement. Parenting stress is often heightened during this forced separation and the re-entry transition. Parenting stress is associated with greater perceived barriers to treatment and, for adolescents who begin treatment, less therapeutic change and premature treatment dropout. Interventions designed to support caregivers of detained adolescents in managing their stress while navigating the juvenile legal system are urgently needed, and mobile health (mHealth) interventions offer promising, scalable approaches. RAISE (Reducing pArentIng StrEss) is a web-based application co-designed with caregivers of detained adolescents to reduce caregiver stress and promote postrelease adolescent behavioral health services use.

OBJECTIVE: This study will evaluate the effectiveness of RAISE in reducing caregiver stress and promoting adolescent behavioral health services use following release from detention.

METHODS: A randomized controlled trial with 60 caregivers of detained adolescents (ages 12-17 years) across the United States will be conducted. Caregivers will be recruited through passive and active techniques and randomized to receive RAISE (intervention) or an informational brochure (comparison). Self-assessment questionnaires will be completed at baseline and 3- and 6-month follow-up timepoints. The fully automated RAISE intervention includes an 8-week stress reduction intervention, self-monitoring and affirmational SMS text messaging, and resources related to navigating the juvenile legal system. Assessments include empirically validated measures of parenting stress, mindful parenting, parenting self-efficacy, adolescent services use, motivation for youth treatment, caregiver behavioral health, sociodemographics, and RAISE usability (intervention only). Caregivers will also participate in a semistructured qualitative exit interview at the 3-month (postintervention) timepoint. Descriptive statistics will examine recruitment, randomization, assessment, retention, and application usability. Independent samples t tests and chi-square analyses will determine whether randomization was successful based on multiple background variables; group differences will be accounted for in outcome analyses. Regression analyses will be used for outcome analyses, with an intent-to-treat design; analyses will include intervention group as a predictor and control for the baseline level of the outcome, application usage, and demographic characteristics. Potential moderators and mediators of intervention effects will be explored.

RESULTS: We propose the enrollment of 60 caregivers by April 2025, final data collection by September 2025, and submission of main findings for publication in December 2025.

CONCLUSIONS: This study will provide empirical evidence regarding the impact of an mHealth stress reduction intervention co-designed with caregivers of detained adolescents. Findings will be informative for legal systems regarding how best to support caregivers of detained adolescents and the impact of reducing caregiver stress on adolescents’ linkage to behavioral health services following their release into the community.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05032742; https://clinicaltrials.gov/study/NCT05032742.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/67511.

PMID:40638918 | DOI:10.2196/67511

Am J Ther. 2025 Jul 11. doi: 10.1097/MJT.0000000000001950. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertension is a serious health problem, and resistant hypertension occurs when blood pressure (BP) is uncontrolled despite at least 3 optimal-dosed agents of different pharmacologic classes. Aprocitentan is a novel pharmacological agent approved in early 2024 for treatment of hypertension, in patients whom BP is not adequately controlled while on other antihypertensive medications.

MECHANISM OF ACTION, PHARMACODYNAMICS AND PHARMACOKINETICS: Aprocitentan acts as a dual endothelin receptor antagonist, inhibiting both ETa and ETb. It is postulated that low-renin models and salt-sensitive models of hypertension, consistent with resistant hypertension, exhibit increased levels of plasma ET-1. Thus, inhibition of ET-1 at ETa receptors inhibits vasoconstriction effects. The oral bioavailability of aprocitentan is currently unknown. Maximum plasma concentrations reaching a Cmax is within 4-5 hours with an effective half-life of 41 hours. Plasma concentrations increase in a dose-proportional manner and reach steady state within 8 days. The volume of distribution is 20 L, highly protein bound, primarily to albumin, and undergoes both renal and hepatic metabolism via UGT1A1- and UGT2B7-mediated N-glycosylation and nonenzymatic hydrolysis.

CLINICAL TRIALS: In a phase 3, multicenter-study in adult patients (N = 730) with systolic blood pressure ≥140 mm Hg with a run-in placebo and standard background BP therapy continued throughout the study, placebo or aprocitentan (12.5, 25 mg) were randomized at various stages. Aprocitentan 12.5 mg was superior to placebo in reducing sitting (sitting systolic blood pressure) at week 4, and a persistence of the BP-lowering effect was demonstrated (sitting systolic blood pressure was maintained and was statistically superior at week 40) when aprocitentan 25 mg were rerandomized to placebo.

THERAPEUTIC ADVANCE: Aprocitentan is a novel endothelin receptor antagonist approved for the treatment of resistant hypertension. It is a welcome development in the arsenal to fight against resistant hypertension for those with difficulty to manage with conventionally available antihypertensive medications.

PMID:40638911 | DOI:10.1097/MJT.0000000000001950

J Med Internet Res. 2025 Jul 10;27:e70674. doi: 10.2196/70674.

ABSTRACT

BACKGROUND: One of the main challenges with COVID-19 has been that although there are known factors associated with a worse prognosis, clinicians have been unable to predict which patients, with similar risk factors, will die or require intensive care unit (ICU) care.

OBJECTIVE: This study aimed to develop a personalized artificial intelligence model to predict the patient risk of mortality and ICU admission related to SARS-CoV-2 infection during the initial medical evaluation before any kind of treatment.

METHODS: It is a population-based, observational, retrospective study covering from February 1, 2020, to January 24, 2023, with different circulating SARS-CoV-2 viruses, vaccinated status, and reinfections. It includes patients attended by the reference hospital in Fuenlabrada (Madrid, Spain). The models used the random forest technique, Shapley Additive Explanations method, and processing with Python (version 3.10.0; Python Software Foundation) and scikit-learn (version 1.3.0). The models were applied to different epidemic SARS-CoV-2 infection waves. Data were collected from 11,975 patients (4998 hospitalized and 6737 discharged). Predictive models were built with records from 4758 patients and validated with 6977 patients after evaluation in the emergency department. Variables recorded were age, sex, place of birth, clinical data, laboratory results, vaccination status, and radiologic data at admission.

RESULTS: The best mortality predictor achieved an area under the receiver operating characteristic curve (AUC) of 0.92, sensitivity of 0.89, specificity of 0.82, positive predictive value (PPV) of 0.35, and mean negative predictive value (NPV) of 0.98. The ICU admission predictor had an AUC of 0.89, sensitivity of 0.75, specificity of 0.88, PPV of 0.37, and NPV of 0.98. During validation, the mortality model exhibited good performance for the nonhospitalized group, achieving an AUC of 0.95, sensitivity of 0.88, specificity of 0.98, PPV of 0.21, and NPV of 0.99, predicting the death of 30 of 34 patients who were not hospitalized. For the hospitalized patients, the mortality model achieved an AUC of 0.85, sensitivity of 0.86, specificity of 0.74, PPV of 0.24, and NPV of 0.98. The model for predicting ICU admission had an AUC of 0.82, sensitivity of 1.00, specificity of 0.59, PPV of 0.05, and NPV of 1.00. The models’ metrics presented stability along all pandemic waves. Key mortality predictors included age, Charlson value, and tachypnea. The worse prognosis was linked to high values in urea, erythrocyte distribution width, oxygen demand, creatinine, procalcitonin, lactate dehydrogenase, heart failure, D-dimer, oncological and hematological diseases, neutrophil, and heart rate. A better prognosis was linked to higher values of lymphocytes and systolic and diastolic blood pressures. Partial or no vaccination provided less protection than full vaccination.

CONCLUSIONS: The artificial intelligence models demonstrated stability across pandemic waves, indicating their potential to assist in personal health services during the 3-year pandemic, particularly in early preventive and predictive clinical situations.

PMID:40638909 | DOI:10.2196/70674

Online J Public Health Inform. 2025 Jul 10;17:e68977. doi: 10.2196/68977.

ABSTRACT

BACKGROUND: In 2023, Cayuga County, a rural county in New York State, developed and published a publicly available, interactive overdose dashboard highlighting demographic, geographic, and time trends in suspected overdoses as well as substance use-related resources in the community. Despite the widespread use of data dashboards in the overdose crisis, there is little evidence to suggest that these dashboards can effectively disseminate data and enable public health data-driven decision-making, especially in a rural county. We conducted an evaluation of the Cayuga County Overdose Data Dashboard to fill this knowledge gap.

OBJECTIVE: Our study aimed to evaluate the Cayuga County Overdose Data Dashboard’s acceptability, use, and perceived effectiveness in disseminating overdose data and resources.

METHODS: Following the launch of the dashboard, an online Qualtrics survey collected feedback from individuals older than 18 years of age living or working in Cayuga County, asking respondents to reflect upon their experience using the dashboard. The 10-minute survey assessed usage patterns and motivations to access the dashboard as well as the dashboard’s ease of use, most valued design features, and overall perceived effectiveness in communicating information on overdoses and local resources. Data were analyzed using descriptive statistics.

RESULTS: From May to December 2023, a total of 61 individuals from Cayuga County completed the survey, including those with lived substance use experience (n=8, 13%) as well as their close contacts (n=28, 46%), health care providers (n=12, 20%), law enforcement (n=11, 18%), and local public health and mental health care professionals (n=27, 44%). The user-friendly design and frequent updates facilitate engagement, as 54% (n=33) of respondents reported accessing the dashboard at least monthly and 75% (n=46) using it to inform decision-making. Most thought that the dashboard was easy to use (n=59, 97%) and very effective in disseminating information (n=46, 76%). From the 8 different types of overdose-related information portrayed on the dashboard, the most valued were the locations of treatment and recovery services, scoring an average of 4.75 (SD 0.65) on a 5-point scale (1=”Not important” to 5=”Most important”), followed by the locations of free, publicly accessible Naloxone (mean 4.58, SD 0.89) and trends in fatal and nonfatal overdoses (mean 4.48, SD 0.81).

CONCLUSIONS: Overall, this study suggests that the Cayuga County Overdose Data Dashboard effectively disseminates information and enables data-driven decision-making in the region. When developing a community-level dashboard, our findings underscore the necessity of a user-friendly design, frequent data updates, and inclusion of key information and visuals on local overdose trends and resources.

PMID:40638856 | DOI:10.2196/68977

J Med Internet Res. 2025 Jul 10;27:e69953. doi: 10.2196/69953.

ABSTRACT

BACKGROUND: The United States is facing an opioid overdose epidemic resulting in an unprecedented number of preventable deaths. The use of medications including buprenorphine and methadone has proven effective for opioid use disorder (OUD), but many patients struggle to stay in treatment. Novel solutions, such as digital health tools, offer one option to help improve clinic management and improve treatment engagement.

OBJECTIVE: Using a mixed methods approach, we investigated facilitators and barriers to the use of a third-party digital health platform called Opioid Addiction Recovery Support (OARS) to aid OUD treatment engagement and adherence in a primary care setting.

METHODS: Patient and provider use of OARS was observed for 10 months and summarized using descriptive statistics. Differences in use were assessed using Wilcoxon signed rank tests. Additionally, key informant interviews were conducted with providers who prescribe medication for opioid use disorder (MOUD) and their case managers to understand the facilitators and barriers to implementation. Qualitative data were analyzed using a coding reliability thematic analysis approach.

RESULTS: Among 205 patients invited to use OARS, the median age was 37 (IQR 31-44) years, 130 (63.4%) identified as men, and 193 (94.1%) identified as non-Hispanic White. Of these 205 patients, 158 (77.1%) used the app at least 1 time. The median number of days the 158 patients viewed test results was 1 (IQR 1-3), progress was 1 (IQR 0-2), and educational content was 0 (IQR 0-1). The 55 patients whose providers had manually entered their results into OARS when the electronic health record (EHR) integration failed viewed test results (P=.002), progress (P<.001), and educational content (P<.001) more days than the 103 patients who could not view their results in OARS. Providers and the lead case manager reported that OARS increased patient-provider communication, allowed patients to better track their overall MOUD treatment, and enhanced providers’ ability to identify patients at risk for relapse. They also acknowledged that the lack of integration between OARS with the EHR resulted in administrative burdens, which impacted provider use of the system.

CONCLUSIONS: Findings from this study highlight the challenges of successfully implementing OARS with patients who receive MOUD in primary care settings. Our results show a lack of OARS uptake among providers, case managers, and patients, despite positive assessments made by participants. We also show several barriers that impacted provider use, including the lack of integration between OARS and EHR. Future research is needed (1) to determine whether digital health tools like OARS are efficacious in improving OUD outcomes and, if proved efficacious, (2) to identify ways to routinize the use of digital health tools in MOUD treatment, primarily by solving technical and organizational challenges associated with EHR integration and patient engagement.

PMID:40638840 | DOI:10.2196/69953

Nucleosides Nucleotides Nucleic Acids. 2025 Jul 10:1-14. doi: 10.1080/15257770.2025.2532089. Online ahead of print.

ABSTRACT

Type 2 diabetes (T2D) is a complex multifactorial metabolic disorder characterized by progressive disease progression, involving varying degrees of insulin resistance and pancreatic islet dysfunction. Methylenetetrahydrofolate reductase (MTHFR) is a crucial enzyme regulating folate metabolism, and its polymorphisms have been associated with T2D. However, the methylation pattern of the MTHFR gene has not been previously studied. This study aimed to assess the association between T2D and the methylation profile of the MTHFR gene promotor in a Moroccan population. A total of 107 patients with T2D and 100 healthy controls were included in the study. The methylation status of CpG sites in the MTHFR gene promoter was conducted by methylation-specific PCR (MS-PCR). Statistical analyses were performed using SPSS software (version 20). The promoter region of the MTHFR gene was predominantly hyper-methylated in patients with T2D compared to healthy controls (OR: 2.924; 95% CI: 1.285-6.650; p = 0.008). The hypermethylated profile was not influenced by environmental or metabolic factors examined in this study. These findings suggest that hypermethylation of CpG sites in the MTHFR gene promoter is associated with T2D in the Moroccan population, highlighting a potential epigenetic mechanism contributing to the disease.

PMID:40638835 | DOI:10.1080/15257770.2025.2532089

Environ Technol. 2025 Jul 10:1-25. doi: 10.1080/09593330.2025.2525558. Online ahead of print.

ABSTRACT

Recycling waste plastic as a binding material and substitution of sand with quarry offers a promising alternative. This study investigates the potential of recycled waste linear low-density polyethylene (LLDPE) plastic as a sustainable alternative binder to cement in construction block production. An extrusion technique was adopted to melt the plastic and disperse and distribute quarry dust within the molten plastic to produce a composite. Waste LLDPE plastic-quarry dust composite samples were produced at varying mix ratios of 1:0, 1:1, 1:2, and 1:3. Similar ratios were used to produce cement-quarry dust composite samples. The density, morphology, compressive strength, split tensile strength, water absorption, flexural strength, ultrasonic pulse velocity, and skid resistance of the composites were evaluated. Comparative analysis was conducted, evaluating the performance of waste LLDPE plastic-quarry dust composites against cement-quarry dust composites at various mix ratios. Results revealed that the density of the waste LLDPE plastic-quarry dust composites were in the range of 1288-1571 kg/m³, and its compressive strength increased with increasing quarry dust content, reaching 18.22 MPa at a 1:3 ratio. Conversely, cement-quarry dust composites exhibited a decreasing compressive strength trend with increasing quarry dust, and the lowest strength of 17.57 MPa was obtained at a 1:3 ratio. A statistical analysis approach using post hoc analysis with Bonferroni adjustments validates the significant difference for the mix compressive strengths. Notably, the waste LLDPE plastic-quarry dust composites demonstrated promising performance characteristics, particularly at higher quarry dust ratios, suggesting a viable eco-friendly composite block.

PMID:40638813 | DOI:10.1080/09593330.2025.2525558

JMIR Med Inform. 2025 Jul 10;13:e66544. doi: 10.2196/66544.

ABSTRACT

BACKGROUND: Communication among health care professionals is essential for effective clinical care. Asynchronous text-based clinician communication-secure messaging-is rapidly becoming the preferred mode of communication. The use of secure messaging platforms across health care institutions creates large-scale communication networks that can be used to characterize how interaction structures affect the behaviors and outcomes of network members. However, the understanding of the structure and interactions within these networks is relatively limited.

OBJECTIVE: This study investigates the characteristics of a large-scale secure messaging network and its association with health care professional messaging behaviors.

METHODS: Data on electronic health record-integrated secure messaging use from 14 inpatient and 282 outpatient practice locations within a large Midwestern health system over a 6-month period (June 1, 2023, through November 30, 2023) were collected. Social network analysis techniques were used to quantify the global (network)- and node (health care professional)-level properties of the network. Hierarchical clustering techniques were used to identify clusters of health care professionals based on network characteristics; associations between the clusters and the following messaging behaviors were assessed: message read time, message response time, total volume of messages, character length of messages sent, and character length of messages received.

RESULTS: The dataset included 31,800 health care professionals and 7,672,832 messages; the resultant messaging network consisted of 31,800 nodes and 1,228,041 edges. Network characteristics differed based on practice location and professional roles (P<.001). Specifically, pharmacists and advanced practice providers, as well as those working in inpatient settings, had the highest values for all network metrics considered. Four clusters were identified, representing differences in connectivity within the network. Statistically significant differences across clusters were identified between all considered secure messaging behaviors (P<.001). One of the clusters with 1109 nodes, consisting mostly of physicians and other inpatient health care professionals, had the highest values for all node-level metrics compared to the other clusters found. This cluster also had the quickest message read and response times and handled the largest volume of messages per day.

CONCLUSIONS: Secure messaging use within a large health care system manifested as an expansive communication network where connectivity varied based on a health care professional’s role and their practice setting. Furthermore, our findings highlighted a relationship between health care professionals’ connectivity in the network and their daily secure messaging behaviors. These findings provide insights into the complexities of communication and coordination structures among health care providers and downstream secure messaging use. Understanding how secure messaging is used among health care professionals can offer insights into interventions aimed at streamlining communication, which may, in turn, potentially enhance clinician work behaviors and patient outcomes.

PMID:40638810 | DOI:10.2196/66544

Med Sci Sports Exerc. 2025 Jul 10. doi: 10.1249/MSS.0000000000003816. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate how genotype and caffeine habituation influence the acute effects of caffeine ingestion on exercise-induced hemostatic responses in individuals with obesity.

METHODS: Using a randomized, double-blind, placebo-controlled crossover design, 40 physically inactive young men with obesity (age, 22.2 ± 2.3 years; BMI, 34.1 ± 2.7 kg/m2) completed two moderate-to-high-intensity concurrent exercise sessions following ingestion of caffeine (3 mg/kg) or placebo. Blood samples were collected at baseline, after exercise, and after 60 minutes of recovery. Statistical analysis was performed by repeated measures MANOVA.

RESULTS: Acute exercise increased platelet count and aggregation, fibrinogen, F1 + 2, tPA antigen, D-dimer, and clot lysis time, regardless of genotype or caffeine habituation status (P < 0.05). PAI-1 antigen remained unchanged after exercise (P > 0.05) but decreased following recovery (P < 0.01). Caffeine resulted in a greater increase in platelet aggregation, fibrinogen, F1 + 2, and clot lysis time, alongside a blunted increase in tPA antigen levels post-exercise in naïve consumers (P < 0.05). In contrast, habitual caffeine consumers exhibited a mitigated increase in clot lysis time and a greater post-recovery reduction in PAI-1 antigen following caffeine ingestion (P < 0.001). Caffeine’s impact on hemostatic responses to exercise was unaffected by genotype (P > 0.05).

CONCLUSIONS: Moderate-to-high-intensity concurrent exercise induces a transient prothrombotic state in physically inactive individuals with obesity. Acute caffeine supplementation at a moderate dose modulates the hemostatic responses depending on caffeine habituation status rather than CYP1A2 genotype: it exacerbates the prothrombotic response in naïve consumers but attenuates it in habitual consumers.

PMID:40638809 | DOI:10.1249/MSS.0000000000003816

Med Sci Sports Exerc. 2025 Jul 10. doi: 10.1249/MSS.0000000000003815. Online ahead of print.

ABSTRACT

BACKGROUND: Physical inactivity contributes to systemic disease burden and premature mortality worldwide. Leisure-time physical activity (LTPA) improves health outcomes; however, its genetic determinants, particularly in Asian populations, remain unclear. This study aimed to identify genetic loci associated with LTPA in the Taiwanese population.

METHODS: We conducted genome-wide association studies (GWASs) in 122,258 Taiwan Biobank participants. LTPA was assessed both as a binary trait (regular exerciser vs. non-exerciser) and an ordinal trait (categorized by MET-hours/week into low, moderate, and high PA levels). Logistic and ordinal logistic regression models were used under an additive genetic model, adjusting for age, age2, sex, BMI, smoking, and the first 10 genetic principal components. Candidate nonsynonymous mutations were further examined in 1,494 whole-genome sequenced participants.

RESULTS: Binary trait GWAS identified genome-wide significant (GWS) loci at ATXN2 (12q24.12), FTO (16q12.2), and NOTCH4 (6p21.32), with associations for FTO and NOTCH4 only observed in BMI-adjusted models. Ordinal trait analysis (MET-hours/week <10, 10-<20, ≥20) identified a single GWS locus at BRAP (12q24.12). Fine-mapping of 12q24.12 revealed multiple GWS single nucleotide polymorphisms (SNPs) in strong linkage disequilibrium (LD) with lead variants; these signals largely disappeared after conditional analysis, consistent with a single underlying association. Whole-genome sequencing and LD analysis identified three GWS nonsynonymous mutations, with ALDH2 rs671 emerging as the most likely causal variant.

CONCLUSIONS: ATXN2-ALDH2 region on chromosome 12q24.12 was identified as a key locus for LTPA in Taiwanese individuals. These findings enhance our understanding of the genetic basis of physical activity and may inform future precision medicine and public health strategies.

PMID:40638807 | DOI:10.1249/MSS.0000000000003815