Tag: nevin manimala

Proc Natl Acad Sci U S A. 2025 May 6;122(18):e2501394122. doi: 10.1073/pnas.2501394122. Epub 2025 May 2.

ABSTRACT

Many organisms employ reversible dormancy, or seedbank, in response to environmental fluctuations. This life-history strategy alters fundamental ecoevolutionary forces, leading to distinct patterns of genetic diversity. Two models of dormancy have been proposed based on the average duration of dormancy relative to coalescent timescales: weak seedbank, induced by scheduled seasonality (e.g., plants, invertebrates), and strong seedbank, where individuals stochastically switch between active and dormant states (e.g., bacteria, fungi). The weak seedbank coalescent is statistically equivalent to the Kingman coalescent with a scaled mutation rate, allowing the use of existing inference methods. In contrast, the strong seedbank coalescent differs fundamentally, as only active lineages can coalesce, while dormant lineages cannot. Additionally, dormant individuals typically mutate at a slower rate than active ones. Consequently, despite the significant role of dormancy in the ecoevolutionary dynamics of many organisms, no methods currently exist for inferring population dynamics involving dormancy and associated parameters. We present a Bayesian framework for jointly inferring a latent genealogy, seedbank parameters, and evolutionary parameters from molecular sequence data under the strong seedbank coalescent. We derive the exact probability density of genealogies sampled under the strong seedbank coalescent, characterize the corresponding likelihood function, and present efficient computational algorithms for its evaluation based on our theoretical framework. We develop a tailored Markov chain Monte Carlo sampler and implement our inference framework as a package SeedbankTree within BEAST2. Our work provides both a theoretical foundation and practical inference framework for studying the population genetic and genealogical impacts of dormancy.

PMID:40314983 | DOI:10.1073/pnas.2501394122

Proc Natl Acad Sci U S A. 2025 May 6;122(18):e2414578122. doi: 10.1073/pnas.2414578122. Epub 2025 May 2.

ABSTRACT

Through a field study (N = 1,519) that uses a technology to record real-time data on waste sorting, we find that offering the opportunity to sign a pledge increases the effectiveness of an environmental campaign. With a timespan of over four years, the pledge increased waste sorting participation by 4.55 to 5.10 percentage points (SD = 0.1997). The effect is greater immediately after the campaign (around 9 to 10 pp during the first 15 wk), but it remains sizable and statistically significant 150 to 210 wk after signing (3.11 to 4.45 pp).

PMID:40314980 | DOI:10.1073/pnas.2414578122

Proc Natl Acad Sci U S A. 2025 May 13;122(19):e2423266122. doi: 10.1073/pnas.2423266122. Epub 2025 May 2.

ABSTRACT

This paper examines the relationship between democratization and the development of AI and information and communication technology (ICT). Our empirical evidence shows that in the past 10 y, the advancement of AI/ICT has hindered the development of democracy in many countries around the world. Given that both the state rulers and civil society groups can use AI/ICT, the key that determines which side would benefit more from the advancement of these technologies hinges upon “technology complementarity.” In general, AI/ICT would be more complementary to the government rulers because they are more likely than civil society groups to access various administrative big data. Empirically, we propose three hypotheses and use statistical tests to verify our argument. Theoretically, we prove a proposition, showing that when the above-mentioned complementarity assumption is true, the AI/ICT advancements would enable rulers in authoritarian and fragile democratic countries to achieve better control over civil society forces, which leads to the erosion of democracy. Our analysis explains the recent ominous development in some fragile-democracy countries.

PMID:40314966 | DOI:10.1073/pnas.2423266122

JAMA Netw Open. 2025 May 1;8(5):e258342. doi: 10.1001/jamanetworkopen.2025.8342.

ABSTRACT

IMPORTANCE: Approximately 30% of US patients develop acute kidney injury (AKI) after cardiac surgery, which is associated with increased morbidity, mortality, and health care costs. The variation in potentially modifiable hospital- and clinician-level operating room practices and their implications for AKI have not been rigorously evaluated.

OBJECTIVE: To quantify variation in clinician- and hospital-level hemodynamic and resuscitative practices during cardiac surgery and identify their associations with AKI.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed integrated hospital, clinician, and patient data extracted from the Multicenter Perioperative Outcomes Group dataset and the Society of Thoracic Surgeons Adult Cardiac Surgical Database. Participants were adult patients (aged ≥18 years) who underwent cardiac surgical procedures between January 1, 2014, and February 1, 2022, at 8 geographically diverse US hospitals. Patients were followed up through March 2, 2022. Statistical analyses were performed from October 2024 to February 2025.

EXPOSURES: Hospital- and clinician-level variations in operating room hemodynamic practices (inotrope infusion >60 minutes and vasopressor infusion >60 minutes) and resuscitative practices (homologous red blood cell [RBC] transfusion and total fluid volume administration).

MAIN OUTCOMES AND MEASURES: The primary outcome was consensus guideline-defined AKI (any stage) within 7 days after cardiac surgery. Hospital- and clinician-level variations were quantified using intraclass correlation coefficients (ICCs). Associations of hospital- and clinician-level practices with AKI were analyzed using multilevel mixed-effects models, adjusting for patient-level characteristics.

RESULTS: Among 23 389 patients (mean [SD] age, 63 [13] years; 16 122 males [68.9%]), 4779 (20.4%) developed AKI after cardiac surgery. AKI rates varied across hospitals (median [IQR], 21.7% [15.5%-27.2%]) and clinicians (18.1% [10.1%-23.7%]). Significant clinician- and hospital-level variation existed for inotrope infusion (ICC, 6.2% [95% CI, 4.2%-8.0%] vs 17.9% [95% CI, 3.3%-31.9%]), vasopressor infusion (ICC, 11.7% [95% CI, 8.3%-14.9%] vs 44.5% [95% CI, 11.7%-63.5%]), RBC transfusion (ICC, 1.7% [95% CI, 0.9%-2.6%] vs 4.5% [95% CI, 1.2%-9.4%]), and fluid volume administration (ICC, 2.1% [95% CI, 1.3%-2.7%] vs 23.8% [95% CI, 2.7%-39.9%]). In multilevel risk-adjusted models, the AKI rate was higher for patients at hospitals with higher inotrope infusion rates (adjusted odds ratio [AOR], 1.98; 95% CI, 1.18-3.33; P = .01) and lower among clinicians with higher RBC transfusion rates (AOR, 0.89; 95% CI, 0.79-0.99; P = .03). Other practice variations were not associated with AKI.

CONCLUSIONS AND RELEVANCE: This cohort study of adult patients found that hospital- and clinician-level variation in operating room practices was associated with AKI after cardiac surgery, suggesting possible targets for intervention.

PMID:40314957 | DOI:10.1001/jamanetworkopen.2025.8342

JAMA Netw Open. 2025 May 1;8(5):e258455. doi: 10.1001/jamanetworkopen.2025.8455.

ABSTRACT

IMPORTANCE: The Healthy People 2030 initiative has set national cancer screening targets for breast, colon, and cervical cancers, as well as aims for reducing cancer mortality. State-level tax policy is an underappreciated social determinant of health that may improve cancer screening and mortality rates.

OBJECTIVE: To define the association of tax revenue and tax progressivity with state-level cancer screening and mortality.

DESIGN, SETTING, AND PARTICIPANTS: This ecologic, population-based, cross-sectional study assessed cancer screening (2020 and 2022) and mortality rates (1999-2021) in the US relative to state-level tax revenue (1997-2019) and tax progressivity (2002, 2009, 2012, 2014, and 2018) with a 2-year lag. The study included 50 states through 23 years with state-years used as the unit of analysis. Cancer screening rates were derived from the Centers for Disease Control and Prevention (CDC) Population Level Analysis and Community Estimates database. State-level cancer-related death and population counts were derived from the CDC Wide-Ranging Online Data for Epidemiologic Research database. Data analysis occurred from September to January 2024.

EXPOSURE: State-level tax policy was proxied by tax revenue per capita and the Suits index of tax progressivity, with progressive taxation equaling lower tax burden for more disadvantaged populations.

MAIN OUTCOMES AND MEASURES: Outcomes included screening rates for colon, breast, and cervical cancer, as well as mortality rates for all malignant neoplasms and malignant neoplasms with guideline-recommended screening. Multivariable models were adjusted for tax-related, socioeconomic, and demographic variables.

RESULTS: In total, 1150 state-years were included in the analysis. Median (IQR) tax revenue per capita was $4432 ($3862-$5210), and the median (IQR) number of cancer-related deaths was 8341 (3150-13 585) across all state-years. Of note, each $1000 increase in tax revenue per capita was associated with a 1.61% (95% CI, 0.50%-2.73%) increase in colorectal cancer screening, 2.17% (95% CI, 1.39%-2.96%) increase in breast cancer screening, and 0.72% (95% CI, 0.34%-1.10%) increase in cervical cancer screening rate. For malignant neoplasms with guideline-recommended screening, each $1000 increase in tax revenue per capita was associated with a decreased cancer mortality rate among White (adjusted incidence rate ratio, 0.95, 95% CI, 0.93-0.98), but not racial and ethnic minority (adjusted incidence rate ratio, 0.99, 95% CI, 0.97-1.02) populations.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, tax policy was associated with increased state-level cancer screening rates, as well as decreased cancer mortality rates, which mostly benefited White populations, suggesting that state-level policies may contribute to bridging ongoing cancer care gaps.

PMID:40314956 | DOI:10.1001/jamanetworkopen.2025.8455

JAMA Netw Open. 2025 May 1;8(5):e258461. doi: 10.1001/jamanetworkopen.2025.8461.

ABSTRACT

IMPORTANCE: The role of anticoagulation for stroke prevention in patients with device-detected atrial high-rate episodes, also known as subclinical atrial fibrillation (AF), is a subject of equipoise.

OBJECTIVE: To assess the net benefit of nonvitamin K antagonist oral anticoagulants (NOACs) in patients with device-detected subclinical AF.

DESIGN, SETTING, AND PARTICIPANTS: Decision analytical model run with 10 000 patients with anticoagulation and 10 000 patients without anticoagulation in a clinical scenario of deciding whether to start NOACs for stroke prevention in patients with subclinical AF. A Markov decision model was conducted on October 1, 2024, to estimate net outcomes of NOACs. The patients had stroke risk and bleeding risks similar to those of patients in randomized trials of anticoagulation in subclinical AF.

EXPOSURE: Anticoagulation was modeled to decrease the risk of ischemic stroke by 32% and increase the risk of major bleeding by 62%. In probabilistic sensitivity analyses, the 95% CIs for treatment effect sizes were also considered.

MAIN OUTCOMES AND MEASURES: The main outcome measure for overall net benefit was the cumulative quality-adjusted life-years (QALYs) during the simulation. The model considered the number and severity of ischemic strokes, hemorrhagic strokes, other intracranial bleeds, and extracranial bleeds, as well as the number of deaths during a 10-year simulation.

RESULTS: When comparing the 2 cohorts of 10 000 patients (mean age, 77 years; 3700 [37%] women), those receiving NOAC therapy had 233 fewer ischemic strokes (21.7%), 55 fewer deaths (1.1%), and 453 more major bleeding events (37.3%) over a 10-year simulation period. Per patient, these differences translated to approximately 1 additional quality-adjusted week of life (0.024 QALYs) with NOAC treatment during the 10-year simulation. When the 95% CIs of treatment effect sizes were considered in probabilistic sensitivity analysis, there was a 65.8% probability that NOAC treatment leads to more QALYs than withholding treatment.

CONCLUSIONS AND RELEVANCE: In this analytical model study, initiating NOACs in patients with device-detected subclinical AF was associated with a minimal increase in QALYs. However, the benefits were uncertain, and the effect size of the overall net benefit does not appear to be clinically meaningful.

PMID:40314955 | DOI:10.1001/jamanetworkopen.2025.8461

JAMA Netw Open. 2025 May 1;8(5):e258469. doi: 10.1001/jamanetworkopen.2025.8469.

ABSTRACT

IMPORTANCE: After the Medicaid continuous enrollment provision ended on March 31, 2023, millions of Medicaid patients were disenrolled, a process called “Medicaid unwinding.” Whether this process was associated with changes in dispensing of buprenorphine, a medication for opioid use disorder preventing opioid overdose deaths, is unknown.

OBJECTIVE: To evaluate changes in buprenorphine dispensing during Medicaid unwinding.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used difference-in-differences analysis to assess data from the IQVIA Longitudinal Prescription Database, capturing 92% of US retail prescriptions. Treatment and comparison states were those in the top vs bottom quartile of the percentage change in adult Medicaid enrollment between the month before the state resumed Medicaid eligibility determinations and December 31, 2023. Analyses included Medicaid-insured adults with active buprenorphine prescriptions in quarter 1 from 2017 to 2023.

EXPOSURE: State-level change in adult Medicaid enrollment. The preexposure period was from July 1, 2017, to December 31, 2022, and the postexposure period was from July 1 to December 31, 2023 (quarters 3 and 4).

MAIN OUTCOMES AND MEASURES: Four outcomes assessed buprenorphine dispensing in quarters 3 and 4 from 2017 to 2023: the number of days with active buprenorphine prescriptions, no active prescriptions, 1 or more active prescriptions paid with private insurance, and 1 or more active cash-pay prescriptions. Linear and logistic regression models compared changes in outcomes over time among treatment and comparison states.

RESULTS: Analyses included 754 675 person-years from 569 069 patients (mean [SD] age, 39.2 [9.6] years; 386 719 men [51.2%]). Among adults in treatment states, the number of days with active buprenorphine prescriptions in quarters 3 and 4 decreased by 3.9 days (95% CI, -6.7 to -1.1 days) more compared with adults in comparison states. Adults in treatment states also had an increase of 1.8 percentage points (95% CI, 0.6-3.0 percentage points) in the probability of having no days with active prescriptions, an increase of 1.9 percentage points (95% CI, 0.4-3.4 percentage points) in the probability of having 1 or more active prescriptions paid with private insurance, and an increase of 0.9 percentage points (95% CI, 0.1-1.7 percentage points) in the probability of having 1 or more active cash-pay prescriptions.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study using difference-in-differences analysis, Medicaid patients in states with the highest vs lowest magnitude of Medicaid disenrollment through December 2023 were more likely to decrease or discontinue buprenorphine use and more likely to transition to private insurance or cash to pay for prescriptions. Findings suggest that Medicaid unwinding was associated with disruptions in buprenorphine therapy, raising concerns about the potential for increased opioid-related morbidity and mortality among patients in this population.

PMID:40314954 | DOI:10.1001/jamanetworkopen.2025.8469

JAMA Netw Open. 2025 May 1;8(5):e258491. doi: 10.1001/jamanetworkopen.2025.8491.

ABSTRACT

IMPORTANCE: Less than half of the US population with any mental health condition receives services. Cost is the most commonly cited barrier to treatment.

OBJECTIVE: To examine whether service use and out-of-pocket expenditures among Medicare beneficiaries with depression changed after Medicare implemented equal cost-sharing for outpatient mental health and medical services (Medicare parity).

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used a single-group, interrupted time series design and examined data from the Medical Expenditure Panel Survey Household Component from 2008 to 2019. The sample included Medicare beneficiaries aged 65 years or older with depression. Data were analyzed from June 2, 2023, to June 17, 2024.

EXPOSURE: Under the Medicare Improvements for Patients and Providers Act of 2008, beneficiary cost-sharing for outpatient mental health services decreased from 50% prior to 2010 to 20% in 2014, creating parity with equivalent medical care.

MAIN OUTCOMES AND MEASURES: The primary outcomes were outpatient mental health service use, as assessed by mean use, proportion of beneficiaries with any use, and intensity of use (ie, mean use among users), and out-of-pocket expenditures.

RESULTS: The analysis included 5831 Medicare beneficiaries. Using the Medical Expenditure Panel Survey person-level survey weights, this number corresponded to a nationally representative sample of 72 436 656 beneficiaries (median [IQR] age, 72 [68-79] years; 64.2%-72.2% female per study year). After Medicare parity, mean use of outpatient mental health services among beneficiaries with depression increased by 0.54 visits per year (95% CI, 0.31-0.76 visits per year), and proportion of use increased by 6.61% per year (95% CI, 2.23%-10.99% per year). Intensity of use decreased at parity by a factor of 0.90 (95% CI, 0.82-1.00) and increased after parity by a multiple of 1.07 per year (95% CI, 1.04-1.10 per year). Mean out-of-pocket expenditures for these services increased after parity by $12.25 per year (95% CI, $2.42-$22.08 per year). Sensitivity analysis using the 2016 US Preventive Services Task Force recommendation for routine adult depression screening indicated that the proportion of use increased 28.26% (95% CI, 24.33%-32.19%) once the recommendation was issued.

CONCLUSIONS AND RELEVANCE: In this economic evaluation of Medicare parity, implementation of Medicare parity coupled with routine adult depression screening was associated with significant increases in outpatient mental health service use among Medicare beneficiaries with depression. These findings suggest that parity policies alone may not be sufficient to effectively address multiple barriers to mental health care but in tandem with physician screening, diagnosis, and referral practices, may increase the accessibility of mental health services.

PMID:40314953 | DOI:10.1001/jamanetworkopen.2025.8491

JAMA Netw Open. 2025 May 1;8(5):e258498. doi: 10.1001/jamanetworkopen.2025.8498.

ABSTRACT

IMPORTANCE: Emergency department (ED) triage may impact timeliness of care for high-risk conditions.

OBJECTIVE: To determine the association of ED undertriage with delays in care for patients with subarachnoid hemorrhage (SAH), aortic dissection (AD), and ST-elevation myocardial infarction (STEMI).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adult ED patients diagnosed with SAH, AD, or STEMI from January 1, 2016, to December 31, 2020, from a multicenter, community-based health care delivery system. Data analysis were completed in March 2023 to October 2024.

EXPOSURE: Undertriage vs correct triage, defined by operational measures of mistriage.

MAIN OUTCOMES AND MEASURES: Using a lognormal distribution, the outcomes of interest for patients with SAH and AD were adjusted median time to noncontrast computed tomography (CT) (head CT for patients with SAH, chest CT for patients with AD), antihypertensive medication orders (SAH), and β-blocker orders (AD), and ED length of stay (LOS). For patients with STEMI, outcomes of interest were adjusted median time to electrocardiogram (ECG) and troponin orders.

RESULTS: A total of 5929 patients (median [IQR] age, 63.0 [54.0 to 73.0] years; 3876 [65.4%] male) were identified, including 915 with SAH, 480 with AD, and 4534 with STEMI. There were 1129 Asian patients (19.0%), 553 Black patients (9.3%), 889 Hispanic patients (15.0%), and 2906 non-Hispanic White patients (49.0%). Overall, 2175 patients (36.7%) were undertriaged. For patients with SAH, the lognormal estimate for delay in time to head CT was 0.2 (95% CI, 0.0-0.3), or a delay of 2.4 minutes, and for antihypertensive orders, the lognormal estimate was 4.8 (95% CI, 3.6-5.9), or a delay of 33.3 minutes; the lognormal estimate for ED LOS was 0.1 (95% CI, 0.0-0.1), or 7.7 minutes longer. For patients with AD, the lognormal estimate for delays were 0.2 (95% CI, 0.0-0.4), or 8.9 minutes, for chest CT and 0.5 (95% CI, 0.2-0.7), or 17.6 minutes, for β-blocker orders, and ED LOS was 0.2 (95% CI, 0.1-0.3), or 64 minutes longer. For patients with STEMI, differences in time to ECG and troponin orders were not statistically significant, at less than 1 minute, comparing correctly and undertriaged patients.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients diagnosed with SAH, AD, or STEMI, ED undertriage was associated with small but significant delays in key diagnostic and therapeutic orders for patients with SAH and AD but not for patients with STEMI.

PMID:40314952 | DOI:10.1001/jamanetworkopen.2025.8498

Eval Rev. 2025 May 2:193841X251339686. doi: 10.1177/0193841X251339686. Online ahead of print.

ABSTRACT

This study demonstrates how to evaluate a university-wide online course designed to support student transition into university by using Propensity Score Matching (PSM) and Doubly Robust Estimation (DRE). Using data from seven academic years, from 2016/17 to 2022/23, with more than 28,000 students, we examine whether enrolment in this optional pre-arrival course affects first-year pass rates. We also conducted additional analyses to compare outcomes from the year before and after the course’s implementation, as well as to examine these patterns across recent cohorts to potentially account for contextual changes over time. Results indicate that enrolled students show a 6.2 percentage point increase in the likelihood of passing Year 1, controlling for factors including sex, domicile, age, ethnicity, disability and socioeconomic status. We demonstrate how utilising existing institutional data can potentially strengthen evidence of impact for centralised initiatives and conclude with reflections on the use of such institutional data and matching techniques and their viability for future evaluations.

PMID:40314949 | DOI:10.1177/0193841X251339686