Tag: nevin manimala

Elife. 2025 Oct 1;14:RP106614. doi: 10.7554/eLife.106614.

ABSTRACT

Past sensory experiences influence perception of the present. Multiple research subfields have emerged to study this phenomenon at different temporal scales. These phenomena fall into three categories: the influence of immediately preceding sensory events (micro), expectations established by short sequences of events (meso), and regularities over long sequences of events (macro). In a single paradigm, we examined the influence of temporal context on human perception at each scale. By integrating behavioral and pupillometry recordings with electroencephalographical recordings from a previous study, we identify two distinct mechanisms that operate across all scales. The first is moderated by attention and supports rapid motor responses to expected events. The second operates independently of task demands and dampens the feedforward neural responses produced by expected events, leading to unexpected events eliciting earlier and more precise neural representations.

PMID:41032362 | DOI:10.7554/eLife.106614

J Med Internet Res. 2025 Oct 1;27:e79289. doi: 10.2196/79289.

ABSTRACT

BACKGROUND: Peer online forums offer people experiencing mental health challenges easily accessible and anonymous support. However, little is known about the impacts of using forums, how these impacts are generated, or who might benefit from which type of forum.

OBJECTIVE: We aimed to develop a program theory to understand how peer online mental health forums work to help potential users, health professionals, service providers, and commissioners to decide whether to use forums and which to choose.

METHODS: A realist evaluation using a mixed methods, case series design in collaboration with 7 peer online mental health forums was conducted. We triangulated analysis of a large web-based survey (n=791) with in-depth realist interviews (n=52) to test and refine previously developed program theories about the impacts of using online forums. We then analyzed forum posts to identify in situ evidence for our revised theories. We only used forum posts from individuals who had freely consented to posts being shared for research. Data collection and analysis involved extensive input from our patient and public involvement group, including forum users, moderators, and senior forum staff (n=22), which met monthly for 22 two-hour-long workshops throughout the study.

RESULTS: Impacts of using peer online mental health forums were largely positive. Forums that are easy to navigate, make users feel safe to post, and are supported by well-trained moderators offering timely and sensitive responses can help people find new ways to make sense of their mental health challenges, feel understood, and accepted in the forum. This can lead to an increase in self-efficacy, a reduction in self-stigma, and increased mental well-being. Writing about experiences in a forum can itself be cathartic, but when posts have evidently been helpful to other members, posters also benefit from a sense of greater purpose and value. Negative impacts can occur if forums are difficult to navigate or if moderation is unresponsive, insensitive, or inadequate, as users can be left feeling unheard, misunderstood, or overly responsible for the welfare of others.

CONCLUSIONS: Forums offer accessible and inclusive ways to effectively support mental health for many people, some of whom may have limited access to other forms of help. The impacts on users are largely positive, but care is needed to ensure forums are well designed and moderators are well trained and supported. These findings are being used to inform the co-design of a web-based moderator toolkit and design guidelines, which will be made freely available.

TRIAL REGISTRATION: ISRCTN 62469166; https://www.isrctn.com/ISRCTN62469166.

PMID:41032361 | DOI:10.2196/79289

Minerva Obstet Gynecol. 2025 Oct 1. doi: 10.23736/S2724-606X.25.05702-1. Online ahead of print.

ABSTRACT

BACKGROUND: Congenital anomalies of the kidney and urinary tract (CAKUT) represent 15-20% of prenatally diagnosed congenital anomalies, often presenting unilaterally. This study aimed to describe sonographic features of fetuses with unilateral renal anomalies and evaluate their postnatal outcomes. Additionally, we assessed whether specific prenatal ultrasound findings predicted postnatal complications.

METHODS: This was a retrospective, observational study including singleton pregnancies referred to our center from 2008 to 2023 for unilateral renal anomalies identified in second or third trimester ultrasounds. Sequential prenatal ultrasound evaluations were conducted to monitor disease progression and associated anomalies. Postnatal outcomes were retrieved from delivery records and pediatric follow-ups. Statistical analyses included Chi-square tests, t-tests, and ROC curve analysis to assess the predictive value of the antero-posterior diameter (DAP) of the renal pelvis for postnatal complications.

RESULTS: A total of 226 cases were included: 116 (51.3%) pyelectases, 51 (22.6%) hydroureteronephroses, 48 (21.2%) multicystic kidneys, and 11 (4.9%) renal dysplasias. Diagnosis occurred at an average gestational age of 25 weeks, with 19.3% showing progression during pregnancy and 23% having associated anomalies detected during ultrasound examinations. Of 135 children with follow-up data, 47.4% required surgery, 1.5% developed hypertension, and 1.5% developed chronic kidney disease (CKD). Associated anomalies significantly correlated with unfavorable outcomes, such as need for intervention (P=0.001), risk of developing postnatal recurrent urinary infections (P=0.025), vesicoureteral reflux (P=0.001) and CKD (P=0.010). Progression during pregnancy correlated with vesicoureteral reflux (P=0.002) and development of anomalies in the contralateral kidney (P=0.012). DAP measurement did not reliably predict postnatal complications (AUC=0.590, P=0.191).

CONCLUSIONS: Unilateral renal anomalies are often associated with other congenital anomalies, influencing postnatal outcomes. DAP measurement was not a significant predictor of postnatal complications. Comprehensive prenatal ultrasound assessments are critical for guiding parental counseling, pregnancy management, and postnatal care.

PMID:41032351 | DOI:10.23736/S2724-606X.25.05702-1

JAMA Psychiatry. 2025 Oct 1. doi: 10.1001/jamapsychiatry.2025.2689. Online ahead of print.

ABSTRACT

IMPORTANCE: Associations among general intelligence (IQ), educational attainment (EA), and alcohol use disorder (AUD) are not well understood.

OBJECTIVE: To examine the relationship between IQ, EA, and AUD risk.

DESIGN, SETTING, AND PARTICIPANTS: The association between IQ and AUD risk was examined in a Swedish national conscription cohort. Potential causality was explored using mendelian randomization (MR) analyses, and the association of polygenic scores (PGS) for cognitive performance with AUD diagnosis was assessed. Participant data were obtained from cross-linked Swedish national registers, genome-wide association study (GWAS) summary statistics, and the US Yale-Penn cohort.

EXPOSURES: IQ and genetic variants associated with cognitive performance.

MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs; time-to-event analyses) or odds ratios (ORs) for AUD.

RESULTS: Included in this study was a national cohort of 645 488 males, born between 1950 and 1962, from the Swedish Military Conscription Register, of whom 573 855 individuals were included in this analysis. All individuals were aged 18 years at IQ assessment with no substance use disorder diagnosis at conscription, and mean (SD) follow-up time (SD) was 60.5 (7.9) years. Summary statistics from GWAS of cognitive performance (n = 257 481) and AUD (total = 753 248; cases = 113 325) in individuals of European-like genetic ancestry (EUR), with FinnGen AUD GWAS as a replication sample (total = 500 348; cases = 20 597), were used for MR analyses. PGS analyses were conducted using the data of EUR individuals from the Yale-Penn cohort (n = 5424). IQ at age 18 years was inversely associated with AUD risk in Swedish males (adjusted HR, 1.43; 95% CI, 1.40-1.47; P < .001), adjusting for parental substance use disorder, probands’ psychiatric disorders, socioeconomic factors, and birth year strata. MR analyses suggested a causal relationship between lower cognitive performance and AUD risk (β [SE], 0.11 [0.02]; P = 2.6 × 10-12). The mediating role of EA differed between national contexts. Higher cognitive performance PGS were associated with reduced odds of AUD in Yale-Penn participants (OR, 0.83; 95% CI, 0.78-0.89).

CONCLUSIONS AND RELEVANCE: IQ and cognitive performance have a significant but context-dependent association with AUD risk, highlighting the need for a better understanding of the interplay among genetic factors, cognitive traits, and sociocultural influences on AUD susceptibility.

PMID:41032335 | DOI:10.1001/jamapsychiatry.2025.2689

JAMA Surg. 2025 Oct 1. doi: 10.1001/jamasurg.2025.3611. Online ahead of print.

ABSTRACT

IMPORTANCE: Bariatric surgery is widely recognized for its health benefits; however, its association with work productivity and employment participation, though frequently reported, has not been systematically synthesized. This evidence is crucial to inform the economic evaluation of bariatric surgery.

OBJECTIVE: To systematically analyze the evidence on occupational outcomes of bariatric surgery.

EVIDENCE REVIEW: A systematic literature search was conducted in 5 online databases to identify empirical studies on bariatric surgery-related employment and productivity outcomes published up to April 2024. Two coauthors independently screened the literature, and all coauthors contributed to data extraction and validation. Differences in occupational outcomes were compared before vs after surgery and between surgery vs nonsurgery groups. Comparisons were categorized into 3 groups: improvement, no difference, and worse. Where possible, summary values of occupational outcomes (eg, the average employment rate) were synthesized for each observational time point. Reported barriers and enablers to employment return or productivity were also identified.

FINDINGS: A total of 42 studies from 15 countries were included. Studies were published between 1977 and 2023, with most conducted in high-income countries. Roux-en-Y gastric bypass was the most frequently studied procedure. The most commonly evaluated metrics were employment and unemployment rates and absenteeism and sick leave. Bariatric surgery was associated with improvements in presenteeism and work hours and ability and short-term absenteeism and employment rates. However, the long-term employment rate followed a reversed U-shape trajectory, with employment rates initially increasing postsurgery but returning to baseline levels after about 5 years. Key barriers to improved occupational outcomes included insufficient weight loss, female sex, older age, preoperative comorbidities, lower quality of life, and a lack of prior work experience.

CONCLUSIONS AND RELEVANCE: Bariatric surgery demonstrates positive short-term impact on productivity and employment, but its long-term occupational benefits remain uncertain. Certain subgroups, such as females and older adults, may require tailored postsurgery support to sustain employment and productivity gains. These findings highlight the critical need for long-term strategies to sustain the occupational benefits postsurgery and to develop targeted interventions for at-risk populations.

PMID:41032316 | DOI:10.1001/jamasurg.2025.3611

JAMA Dermatol. 2025 Oct 1. doi: 10.1001/jamadermatol.2025.3512. Online ahead of print.

NO ABSTRACT

PMID:41032310 | DOI:10.1001/jamadermatol.2025.3512

J Natl Cancer Inst. 2025 Oct 1:djaf272. doi: 10.1093/jnci/djaf272. Online ahead of print.

ABSTRACT

BACKGROUND: Lung adenocarcinoma (LUAD) in never-smokers is a major public health burden, especially among East Asian women. Polygenic risk scores (PRSs) are promising for risk stratification but are primarily developed in European-ancestry populations. We aimed to develop and validate single- and multi-ancestry PRSs for East Asian never-smokers to improve LUAD risk prediction.

METHODS: PRSs were developed using genome-wide association study summary statistics from East Asian (8,002 cases; 20,782 controls) and European (2,058 cases; 5,575 controls) populations. Single-ancestry models included PRS-25, PRS-CT, and LDpred2; multi-ancestry models included LDpred2+PRS-EUR128, PRS-CSx, and CT-SLEB. Performance was evaluated in independent East Asian data from the Female Lung Cancer Consortium (FLCCA) and externally validated in the Nanjing Lung Cancer Cohort (NJLCC). We assessed predictive accuracy via AUC, with 10-year and (age 30-80) absolute risks estimates.

RESULTS: The best multi-ancestry PRS, using East Asian and European data via CT-SLEB (clumping and thresholding, super learning, empirical Bayes), outperformed the best East Asian-only PRS (LDpred2; AUC = 0.629, 95% CI:0.618,0.641), achieving an AUC of 0.640 (95% CI : 0.629,0.653) and odds ratio of 1.71 (95% CI : 1.61,1.82) per SD increase. NJLCC Validation confirmed robust performance (AUC =0.649, 95% CI: 0.623, 0.676). The top 20% PRS group had a 3.92-fold higher LUAD risk than the bottom 20%. Further, the top 5% PRS group reached a 6.69% lifetime absolute risk. Notably, this group reached the average population 10-year LUAD risk at age 50 (0.42%) by age 41, nine years earlier.

CONCLUSIONS: Multi-ancestry PRS approaches enhance LUAD risk stratification in East Asian never-smokers, with consistent external validation, suggesting future clinical utility.

PMID:41032288 | DOI:10.1093/jnci/djaf272

South Med J. 2025 Sep;118(9):634-638. doi: 10.14423/SMJ.0000000000001866.

ABSTRACT

OBJECTIVES: The purpose of this study was to evaluate the financial literacy of medical trainees and assess knowledge gaps in loan repayment, credit management, investment strategies, and financial planning.

METHODS: A cross-sectional survey study was conducted at a single institution between July 25, 2023 and January 10, 2024. A 52-question financial literacy survey was distributed to 97 residents and 101 first- and second-year medical students. The survey assessed knowledge across financial domains, including student loans, credit cards, mortgages, investing, and business ownership. Statistical analysis included independent samples t tests and analysis of variance to compare financial literacy scores across trainee levels.

RESULTS: Residents demonstrated significantly higher financial literacy scores than medical students (mean 18.80 vs 9.40 out of 35; P < 0.05). Despite this, substantial knowledge gaps persisted across multiple financial concepts. Of all respondents, 84.5% reported student loan debt exceeding $50,000, yet 64.6% were not enrolled in income-driven repayment plans, and 57.3% could not differentiate between Pay As You Earn and Revised Pay As You Earn. In addition, although 74.2% contributed to retirement accounts, 60.8% lacked knowledge about investment strategies. Despite limited financial literacy, 82.5% expressed interest in receiving structured financial education.

CONCLUSIONS: Medical trainees, including both medical students and residents, exhibit significant financial literacy deficits despite their progression through medical education. These findings underscore the need for structured financial education early in training to improve financial decision making, debt management, and long-term financial stability among future healthcare professionals.

PMID:41032276 | DOI:10.14423/SMJ.0000000000001866

South Med J. 2025 Sep;118(9):628-633. doi: 10.14423/SMJ.0000000000001877.

ABSTRACT

OBJECTIVES: The residency application process has become increasingly complex, with factors like holistic review, specialty signaling, and multiple application services posing new challenges for medical schools seeking to offer personalized support to students. In addition, fourth-year students often quickly dive into demanding externships, which make it challenging to access residency support services from their home institution and dedicate adequate time to the application process. To address these challenges, the Offices of Student Affairs and Medical Education at Florida International University Herbert Wertheim College of Medicine launched the mandatory Career Advising and Professional Development (CAPD) course, which aimed to standardize residency application support and reduce student stress while increasing preparedness.

METHODS: The 2-week CAPD course, piloted during the 2024-2025 academic year, occurred immediately after students’ dedicated Step 2 study period. Students with scheduling conflicts participated in a longitudinal, asynchronous version of the course with specified due dates for each assignment. Both course formats used a mixture of lectures, small-group activities, and written assignments to cover topics such as crafting a curriculum vitae, writing personal statements, completing residency applications, developing a match strategy, and preparing for interviews. To assess student satisfaction with the course, students were e-mailed three anonymous, optional surveys: one before the course, one just after it, and one after submitting their residency applications. Surveys consisted of a mixture of Likert-type and short-answer questions. Likert-type responses were analyzed using descriptive statistics; thematic review was employed for short-answer questions.

RESULTS: Of the 69 students who participated in the in-person course, 51 (74%) completed the precourse survey, and 48 (70%) completed the postcourse survey. Before the course, 27% of respondents felt confident about their application preparation; after the course, 92% felt confident. After the course, all students reported having completed drafts of key documents like the curriculum vitae, personal statement, and residency application. Free-text responses describing student emotions regarding the application process shifted from anxiety to excitement. In the longitudinal asynchronous version of the course, similar trends existed, but to a lesser extent when compared with the in-person course. In a subsequent survey sent after applications were submitted, 86 (61%) students from both course formats responded. Results showed that 95% felt the course, regardless of format, helped them prepare for the Match, and 90% considered it a valuable use of their time. In addition, 83% agreed that the course should be a curricular requirement.

CONCLUSIONS: The CAPD course successfully offered a framework for personalized support in the rapidly evolving residency application process. As a mandatory part of the curriculum, it allowed faculty to ensure that all students were engaged in the support services offered by our institution, which ultimately increased student confidence and decreased anxiety about the application process. Successful implementation requires significant logistical support (course coordinators, faculty, and career specialists) and the identification and participation of key stakeholders (academic advisors, department chairs, and content experts) to guide students through critical application components.

PMID:41032275 | DOI:10.14423/SMJ.0000000000001877

South Med J. 2025 Sep;118(9):614-617. doi: 10.14423/SMJ.0000000000001873.

ABSTRACT

OBJECTIVE: Extreme temperatures negatively impact pulmonary function. This study explored whether the variability in ambient temperatures across disparate geographic regions in the United States was associated with differences in hospital outcomes for patients admitted with chronic obstructive pulmonary disease (COPD).

METHODS: Using the 2016-2019 National Inpatient Sample database, we compared adults hospitalized with COPD in the US Northeast with those in the US South. We conducted multivariable regression analyses to study outcomes, including mortality, resource utilization, and posthospital discharge disposition.

RESULTS: From 2016 to 2019, 463,830 (30.1%) patients were admitted with COPD in the Northeast and 1,078,930 (69.9%) in the South. The lowest hospitalization rates for COPD were observed in both regions during the hottest months (July and August). Those in the Northeast had higher adjusted odds of in-hospital mortality (adjusted odds ratio: 1.1 [95% confidence interval {CI} 1.0-1.2]; P = 0.03) and a lower likelihood of being discharged to home after the hospitalizations (adjusted odds ratio: 0.63 [95% CI 0.61-0.65]; P < 0.01]) compared with patients hospitalized in the South. Patients in the Northeast had longer hospital stays (adjusted mean difference: +0.19 days; 95% CI 0.13-0.25; P < 0.01) and incurred greater hospital charges compared with patients in the South (adjusted mean difference: $3728; 95% CI 1840-5616; P < 0.01).

CONCLUSIONS: Patients hospitalized with COPD in the Northeast had worse clinical outcomes and greater resource utilization than in the South. These findings, coupled with the higher admission rates during colder months, raise questions about the influence of colder ambient temperatures on COPD exacerbations.

PMID:41032272 | DOI:10.14423/SMJ.0000000000001873