Tag: nevin manimala

WMJ. 2025;124(2):106-110.

ABSTRACT

INTRODUCTION: Climate change, a global crisis, affects health through changes such as more intense and longer lasting heatwaves. Some populations are more vulnerable to such events, including those with certain medical conditions, like heart failure. This study aimed to improve understanding of heat-related vulnerabilities and opportunities to enhance adaptive capacity of patients within an ambulatory heart failure clinic.

METHODS: Heart failure clinic patients at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin, voluntarily completed a 25-question multiple-choice survey. We present descriptive statistics of the survey responses with count and percentage for categorical responses.

RESULTS: We found that out of 60 survey respondents, 46.55% agreed or strongly agreed they would benefit from discussing heat illness risks with their physician, and 31.58% were not aware their heat illness risk is higher on days hotter than 90 °F (32.2 °C). Several vulnerability factors were common: 70.69% follow a prescribed fluid restriction, 33.33% live alone, 20.34% lack a car with air conditioning, and 20.00% worry about their ability to pay electric bills. Notable knowledge gaps included 65% do not check forecasted temperatures, 60% do not plan activities for the coolest times of day, 43.10% lacked awareness of cooling centers, 33.33% were unsure of heat illness symptoms, and 27.12% lacked awareness of Wisconsin’s Focus on Energy program.

CONCLUSIONS: A sizable portion of survey respondents indicated they would benefit from discussing their heat illness risk with their clinicians, and many underestimated their personal risk of heat illness. Additionally, multiple vulnerability factors were highly prevalent and knowledge gaps were demonstrated in this population. Our findings support adaptive capacity opportunities through heat illness education, anticipatory guidance, and increased resource awareness for patients with heart failure in an ambulatory setting.

PMID:40690627

WMJ. 2025;124(2):102-105.

ABSTRACT

INTRODUCTION: Community paramedicine (CP) is an expanding area of interest within the field of emergency medical services. Few studies have established operational metrics and outcome measures for CP programs. We aimed to evaluate change in 911 use and operational metrics among patients enrolled in a pilot, fire department-based, CP program.

OBJECTIVE: The purpose of this study was to determine if the ongoing CP program decreased unscheduled emergency health care utilization among high utilizers. It was hypothesized that the implementation of community paramedicine visits would reduce 911 calls among this cohort.

METHODS: A retrospective cohort study of adults enrolled in a CP program during 2016 to 2020 was performed. Patients were enrolled in the CP program if they frequently used a community emergency department or 911 services. This was defined as greater than 4 uses in the past 12 months. A select group of experienced paramedics received targeted training in relevant concepts. Paramedics frequently contacted patients via both in-home visits and phone calls based on perceived clinical need. Through a review of electronic medical records, we collected patient demographic and clinical information and program operational metrics. The primary outcome of interest was the change in 911 use after enrollment. These 2 groups were compared using a paired t test.

RESULTS: Of 33 patients who met inclusion criteria, 29 were successfully enrolled. Pre-enrollment 911 calls averaged 31.8 calls per month. Post-enrollment 911 calls averaged 14.2 calls per month. Average calls per month decreased by 54.2% (P = .003) post-enrollment, a reduction of 207 calls per year across the cohort. Length of program enrollment also was found to have a greater impact on 911 call reduction.

CONCLUSIONS: A fire-department based CP program effectively reduced 911 calls for high utilizer emergency medical services and emergency department patients by 54.2%. Program participation for 6 months or longer was associated with greater reductions in 911 calls, regardless of the number of existing comorbidities.

PMID:40690626

WMJ. 2025;124(2):91-95.

ABSTRACT

INTRODUCTION: To improve inferior vena cava (IVC) filter retrieval rates, an electronic health record prompt for scheduling retrieval before patient discharge was implemented.

METHODS: This retrospective comparative cohort study was conducted in a single Midwestern tertiary care medical center. Adult patients with IVC filters placed for a medical (Medical subgroup) or trauma (Trauma subgroup) indication before and after protocol implementation and who had follow-up documented in the electronic health record were included. IVC filter retrieval attempt rates both overall and by indication for placement before and after protocol implementation were compared.

RESULTS: Three hundred eighty-five patients met eligibility criteria: 223 before implementation (Before group) and 162 after implementation (After group). The attempted retrieval rate for the After group was 11.4% higher than the Before group (P = .012). Attempted retrieval rates in the Medical Before and After subgroups were 56.2% and 76.0%, respectively (P = .001). The Trauma subgroups’ rates were similar to each other (P = .594). Time to retrieval attempt was significantly shorter in the Medical After subgroup than in the Medical Before subgroup (P = .018) but similar in the Trauma subgroups.

CONCLUSIONS: Attempted retrieval rates were significantly higher in the After group and Medical After subgroup. Trauma subgroup rates were similar, likely because a previous intervention to increase retrieval in trauma patients was in place during the pre-implementation period of our study. Findings suggest that using an automated electronic health record-based prompt to facilitate IVC filter retrieval scheduling could greatly improve retrieval rates and patient safety.

PMID:40690624

Acc Chem Res. 2025 Jul 21. doi: 10.1021/acs.accounts.5c00219. Online ahead of print.

ABSTRACT

ConspectusMetal heterogeneous catalysis is the workhorse of the chemical industry, driving the conversion of reactants to desirable products. Traditional design approaches for metal catalysts rely on trial-and-error tests and take a lot of time to identify promising catalytic active species from the large candidate space. Over the decades, much focus has been placed on identifying the factors affecting the active sites, which, in turn, guides the design and preparation of more active, selective, and stable catalysts. In the context of theoretical design method for catalysts, the concept of the energy descriptor strategy provides correlations between the adsorption energy of key intermediates and catalytic reactivity. Such energy descriptors for catalytic reactivity can be used to predict the activity of candidate catalysts and understand trends among different catalysts.However, a more efficient descriptor strategy is still attractive and needed that avoids density functional theory calculation on the adsorption energy of each candidate and possesses the guidance power for the rational design of microstructural characteristics of catalytic active species. In this regard, bridging the gap between the electronic/atomic-level descriptions of the microscopic properties of the catalytic active species and the macroscopic catalytic performance of the desirable reaction, that is, the microscopic-to-macroscopic relationship, remains intriguing yet challenging, toward which progress leads to revolutionizing catalyst design.In this Account, we propose a structural descriptor strategy that for the first time maps the quantitative relationship between microstructural features and catalytic performances for metal catalysts, as well as its application in the high-throughput screening and rational design of catalytic active species. We begin with the analysis of the microstructural characteristics of the reaction center and its coordination environment and extract key feature parameters to build a mathematical expression of the structural descriptor. Next, through regression fitting, a mathematical correlation is built between the structural descriptor and the energetics involved with the reaction pathway. Finally, substituting the above statistical correlations into the rate equation derived from microkinetic model offers the structural descriptor-based prediction model for metal catalysts. The use of easily accessible structural descriptors has proven to be a powerful method to advance and accelerate the discovery and design of metal catalysts, including atomically dispersed metal catalysts, metal alloy catalysts, and metal cluster catalysts. Overall, the structural descriptor strategy not only demonstrates much potential to elucidate the quantitative interplay between microstructural features of catalytic active species and intrinsic catalytic reactivity but also provides a new approach in kinetics analysis to rationalize metal catalyst design. We conclude with an outlook for further constructing a universal structural descriptor and accelerating predictions on catalytic performance of metal catalysts by leveraging material databases and machine learning.

PMID:40690617 | DOI:10.1021/acs.accounts.5c00219

Med Mycol. 2025 Jul 21:myaf058. doi: 10.1093/mmy/myaf058. Online ahead of print.

ABSTRACT

Following the complete relaxation of COVID-19 epidemic control measures in China by the end of 2022, the number of patients with pulmonary mycosis admitted to hospitals across the country has exhibited a more pronounced upward trend. However, statistical data is lacking to determine whether there is a significant correlation between COVID-19 and pulmonary mycosis. This study collected baseline information, the first laboratory indicators after admission, the types of pathogens, and the prognosis data of patients with pulmonary fungal infections from a tertiary hospital in northern Anhui Province from January 1, 2017, to December 31, 2023, to reveal any association between COVID-19 infection and pulmonary fungal infections. The research results indicated that the G and GM test levels of patients who recovered from COVID-19 and those currently experiencing active infection with COVID-19 were significantly higher than those of patients with pulmonary fungal infections who had never been infected with COVID-19. Infection with COVID-19 and other viruses (excluding COVID-19), mechanical ventilation, and concurrent solid tumors were identified as independent risk factors for poor prognosis in patients with pulmonary fungal diseases. Among patients with viral infections, COVID-19 infection was the most common, with 25 cases (41.67%), followed by herpes simplex virus infection, with 15 cases (25.00%).

PMID:40690278 | DOI:10.1093/mmy/myaf058

JMIR Form Res. 2025 Jul 21;9:e65224. doi: 10.2196/65224.

ABSTRACT

BACKGROUND: Age-related differences in motor skills have been extensively studied, with growing interest in using behavioral data for cognitive assessment. Compared to traditional tools like the Mini-Mental State Examination or Cognitive Impairment Screening Test, behavior-based methods offer the advantage of shorter testing durations, less learning effects, and continuous data tracking. Hand movements, in particular, provide a practical way to gather motor performance data with fewer spatial constraints. This study aims to explore whether hand rotation movement can effectively distinguish age-related motor skill differences, with future applications potentially extending to cognitive assessments, including early detection of mild cognitive impairment.

OBJECTIVE: This study investigates whether hand rotation movements can be used to distinguish 2 age groups, young adults (aged 20-29 years) and older adults (aged 65-80 years). We hypothesize that differences in hand motion control ability will exist between the 2 groups. In total, 7 hand motion measurement indicators related to single hand test indicators, time comparison indicators between rotations, and angle comparison indicators between rotations were defined to test this hypothesis, aiming to identify meaningful indicators for older adults experiencing normal aging before conducting experiments on patients with mild cognitive impairment or dementia.

METHODS: A total of 68 participants, 39 older adults (aged 65-80 years) and 29 young adults (aged 20-29 years), all capable of normal arm, hand, and finger movements, participated in the experiment. Participants sat facing a webcam and were asked to perform hand rotation movements as quickly and accurately as possible with both hands for 10 seconds. They performed 3 trials with a 30-second break in between. For statistical verification, we set the significance level at .05 and analyzed the data using the generalized estimation equations model to assess the effects of the between-subject factor (age group: younger vs older) and the within-subject factors (hand: left vs right, and trials 1, 2, and 3).

RESULTS: Among the 7 measured indicators, 3 (total rotation count, angle, and time) showed statistically significant differences between age groups. Younger participants performed more rotations (B=5.29, P=.002), demonstrated a greater range of motion (B=1334.37, P=.007), and completed the task in less time (B=0.99, P=.003), indicating age-related differences in upper limb motor function. Trial order also had a significant main effect on rotation count and angle. Trial 1 differed significantly from trials 2 and 3, while no difference was observed between trials 2 and 3, suggesting that trial 1 may reflect a practice effect.

CONCLUSIONS: The findings revealed that the older adult group demonstrated statistically significant differences compared to the young adult group in their ability to control hand rotation movements. A learning effect was observed across the 3 trials, suggesting that the first trial should be discarded for use as a stable measurement.

PMID:40690275 | DOI:10.2196/65224

JAMA Netw Open. 2025 Jul 1;8(7):e2521575. doi: 10.1001/jamanetworkopen.2025.21575.

ABSTRACT

IMPORTANCE: Cancer imposes a substantial economic burden on patients that may be worse in patients with higher-stage disease due to the need for more therapy.

OBJECTIVE: To investigate the out-of-pocket costs (OOPCs) attributable to the initial treatment of common cancers among privately insured individuals diagnosed at different stages.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used administrative claims data of a large national insurer in the US linked to the Surveillance, Epidemiology, and End Results (SEER) cancer registry to compare OOPCs of individuals diagnosed with breast, colorectal, and lung cancer at different stages with OOPCs of similar individuals without cancer using difference-in-differences methods. Individuals living in the US between 2008 and 2022, aged younger than 65 years, insured through a large national private health insurer, and with 6 or more months of continuous enrollment were included. Data were analyzed from June 2024 through February 2025.

EXPOSURE: The presence or absence of an incident cancer diagnosis and disease stage from the SEER registry diagnosed from 2008 to 2019.

MAIN OUTCOMES AND MEASURES: The primary outcome was OOPCs among individuals with breast, colorectal, and lung cancer diagnosed at different disease stages compared with those with no cancer diagnosis.

RESULTS: The cohort consisted of 46 158 patients (mean [SD] age at diagnosis, 46 [12] years; 30 733 female [66.6%]; 2543 Asian [5.5%], 4114 Black [8.9%], 3590 Hispanic [7.8%], and 31 099 White [67.4%]), including 19 656 patients with cancer and 26 502 patients without cancer in the control group. Among patients with cancer, 14 581 patients had breast cancer, 2842 patients had colorectal cancer, and 2233 patients had lung cancer. An incident cancer diagnosis was associated with a mean increase in OOPCs of $592.53 per month (95% CI, $528.01-$627.04 per month) for the 6 months after the diagnosis. Cost monotonically increased with stage at diagnosis (mean OOPC increase range, $462.01 per month [95% CI, $417.92-$506.11 per month] for stage 0 to $719.97 per month [95% CI, $626.11-$813.83 per month] for stage 4).

CONCLUSIONS AND RELEVANCE: In this study of individuals with private insurance, patients faced high OOPCs after an incident diagnosis of cancer, with patients with more advanced cancer having the highest OOPCs. Further research is needed to determine the clinical and financial effects of increased OOPCs for patients with cancer.

PMID:40690219 | DOI:10.1001/jamanetworkopen.2025.21575

JAMA Netw Open. 2025 Jul 1;8(7):e2522036. doi: 10.1001/jamanetworkopen.2025.22036.

ABSTRACT

IMPORTANCE: Screening measures of depressive symptoms (eg, 9-item Patient Health Questionnaire [PHQ-9]) are increasingly used in surveys and remote applications, where shorter versions would be valuable.

OBJECTIVE: To derive shorter versions of the PHQ-9 that maximize the variability in total depressive symptom severity captured.

DESIGN, SETTING, AND PARTICIPANTS: This survey study used data from 4 waves of a 50-state nonprobability web-based survey conducted between November 2, 2023, and July 21, 2024. Survey respondents were aged 18 years or older. The first survey wave data were used to identify shortened question subsets capturing variance in the PHQ-9 and estimating a PHQ-9 score of 10 or higher. Resulting models (eg, 3-item version of the PHQ [PHQ-3]) were validated in subsequent survey waves.

MAIN OUTCOME AND MEASURE: Performance of PHQ-3 in the full sample and across subgroups of age, gender, race and ethnicity, and educational levels. Depressive symptom severity was measured with the PHQ-9 (total score range: 0-27, with a score ≥10 indicating moderate or greater depressive symptoms).

RESULTS: In the 4 survey waves, there were 96 234 total participants (mean [SD] age, 47.3 [17.1] years; 55 245 [57.4%] identifying as women). In the full sample, 4401 participants (4.6%) identified as Asian American, 12 699 (13.2%) as Black or African American, 9776 (10.2%) as Hispanic or Latino, and 65 309 (67.9%) as White individuals, with 4049 (4.2%) who identified as having other race or ethnicity. Among these participants, the mean (SD) PHQ-9 score was 6.5 (6.6), and 25 411 (26.4%) met the criteria for moderate or greater depressive symptoms (PHQ-9 score ≥10). The optimal 3-item version, PHQ-3, used items 2 (subject: depressed mood), 6 (self-esteem or failure), and 1 (interest), yielding a Cronbach α of 0.88 (95% CI, 0.88-0.88) and Pearson correlation with the PHQ-9 total score of 0.93 (95% CI, 0.93-0.94). At a threshold of 3 or greater, the PHQ-3 sensitivity was 0.98 (95% CI, 0.97-0.98) and specificity was 0.76 (95% CI, 0.75-0.76) for moderate or greater depressive symptoms. Performance was consistent across sociodemographic subgroups and survey waves.

CONCLUSIONS AND RELEVANCE: This survey study of US adults identified a 3-item scale that remained highly correlated with the full PHQ-9 instrument. The reduced set of questions could enable more widespread and efficient incorporation of depressive symptom measurement in general population samples.

PMID:40690217 | DOI:10.1001/jamanetworkopen.2025.22036

JAMA Netw Open. 2025 Jul 1;8(7):e2522080. doi: 10.1001/jamanetworkopen.2025.22080.

ABSTRACT

IMPORTANCE: Deployment to Afghanistan and Southwest Asia has been associated with adverse respiratory health outcomes. However, the impact of inhalational exposures (eg, vapor, dust, gas, fumes), which are known correlates of reduced lung function and future chronic lung disease, during military service time outside this deployment period has not been assessed.

OBJECTIVE: To assess military inhalational exposures during nonwartime routine activities and their associations with chronic respiratory symptoms.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the US Department of Veterans Affairs Service and Health Among Deployed Veterans study. US veterans who served between October 7, 2001, and February 28, 2017; deployed to Afghanistan or Southwest Asia; and living near 6 Veterans Affairs sites were randomly selected from Defense Manpower Data Center records. Participants completed interviewer-administered multi-item questionnaires about 29 exposures related to active duty military service time when not deployed. Onsite visits occurred between April 27, 2018, and March 13, 2020, and analyses were performed between April 1, 2023, and February 10, 2025.

EXPOSURE: Inhalation exposures during active duty military service time.

MAIN OUTCOMES AND MEASURES: The main outcomes were chronic respiratory symptoms of dyspnea, wheeze in the previous 12 months, and chronic bronchitis. Using factor analysis, the 29 exposures were reduced to 20 items and categorized into 5 factors. Responses were scored ordinally (0, 1, 2) according to exposure prevalence and duration. Generalized linear modeling was used to explore associations between exposures and chronic respiratory symptoms.

RESULTS: The sample included 1712 veterans (median [IQR] age, 37 [33-45] years; 1522 male [88.9%]) who had military service other than during their deployment to Afghanistan or Southwest Asia. The median (IQR) total active duty military service duration was 77 (57-128) months, with 82.8% of their service time spent outside the theater of conflict. The prevalence of dyspnea, chronic bronchitis, and wheeze was 7.0% (117 participants), 7.1% (121 participants), and 15.2% (260 participants), respectively. The most commonly reported exposure categories were combustion and ground dust (1014 participants [59.2%]), aircraft maintenance (812 participants [47.4%]), and heavy equipment maintenance (783 participants [45.7%]). Adjusted multivariable analyses identified significant associations between heavy equipment maintenance exposures and dyspnea (odds ratio [OR], 1.33; 95% CI, 1.06-1.68) and wheeze (OR, 1.29; 95% CI, 1.10-1.52). Aircraft maintenance exposures were significantly associated with wheeze (OR, 1.22; 95% CI, 1.01-1.47). No statistically significant associations were found between these exposures and chronic bronchitis.

CONCLUSIONS AND RELEVANCE: This cross-sectional study shows significant associations between heavy equipment maintenance and aircraft maintenance inhalation exposures outside of deployment with chronic respiratory symptoms among US veterans. These findings suggest that certain military inhalational exposures may contribute to the development of chronic lung disease and that policy interventions to reduce such exposures may protect the long-term respiratory health of military personnel.

PMID:40690216 | DOI:10.1001/jamanetworkopen.2025.22080

JAMA Netw Open. 2025 Jul 1;8(7):e2522154. doi: 10.1001/jamanetworkopen.2025.22154.

ABSTRACT

IMPORTANCE: Historically Black Colleges and Universities (HBCUs) play a pivotal role in higher education and the physician career path in the US. Studies have highlighted the importance of HBCU medical schools in the training of Black physicians. However, little is known about the contributions of HBCU undergraduate institutions to the medical school pathway over the past 30 years.

OBJECTIVE: To describe trends in Black HBCU undergraduate students’ medical school application and acceptance rates from 1980 to 2022.

DESIGN, SETTING, AND PARTICIPANTS: This descriptive cross-sectional study analyzed data from the Association of American Medical Colleges from 1980 to 2022 on medical school applicantions and acceptances, as well as National Center for Education Statistics data on Black bachelor’s degree recipients (1990-2020). Data were analyzed from August to December 2023.

MAIN OUTCOMES AND MEASURES: The number and proportion of medical school applicants and accepted students were compared over time for Black students who completed their undergraduate training at HBCUs vs non-HBCUs.

RESULTS: The study population included 1 666 145 total applicants (754 580 female [45.3%]; 146 852 Black [8.8%]). Between 1990 and 2020, Black bachelor’s degree recipients from HBCUs increased by 50% (from 17 930 to 26 944 recipients), while those from non-HBCUs rose 271% (from 48 445 to 179 583 recipients). Black representation among medical school applicants grew from 7.2% in 1980 (2490 of 34 369 applicants) to 11.5% (5895 of 51 385 applicants) in 2022. From 1990 to 2017, Black HBCU graduates made up a higher proportion of Black medical school applicants, but from 2018 to 2020, non-HBCU graduates contributed more to the applicant pool. Throughout the study period, Black HBCU applicants had consistently lower medical school acceptance rates than their non-HBCU counterparts.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that while HBCUs consistently produced a significant portion of Black medical school applicants, Black HBCU graduates faced lower medical school acceptance rates compared with their non-HBCU peers. Underinvestment in HBCUs and potential biases within medical school admissions may contribute to these challenges, limiting the full potential of HBCU students in diversifying the physician workforce; addressing these disparities through HBCU support, partnerships, and funding could enhance pathways to medical careers for Black students and contribute to achieving greater health equity.

PMID:40690215 | DOI:10.1001/jamanetworkopen.2025.22154