Tag: nevin manimala

JMIR Form Res. 2025 Dec 29. doi: 10.2196/81499. Online ahead of print.

ABSTRACT

BACKGROUND: Suicide is the second leading cause of death for children and adolescents aged 6 to 18 years old. Pediatric suicidality is underreported, which poses significant challenges for effective intervention and prevention strategies. Identifying populations at risk for suicidality can provide critical benefits in terms of study cohort selection, prevalence estimation, and clinical resource allocation.

OBJECTIVE: This study sought to (1) measure the prevalence of mental health comorbidities in pediatric suicidality, and (2) identify undiagnosed high-risk suicidality cases by matching patients with similar mental health comorbidity burden.

METHODS: Electronic health record data from a large academic pediatric hospital in Boston, Massachusetts, were analyzed for patients aged 6-18 years old presenting to the emergency department between June 1, 2016, and June 1, 2022. Suicidality cases were defined using ICD-10 codes for three suicidality subtypes: suicidal ideation, self-harm, and suicide attempt. Comorbidities of suicidality were calculated as the conditional probability of ICD-10 code pairs. After multiple hypothesis corrections, statistically significant comorbidities and patient encounter demographics were input as covariates into a propensity score matching (PSM) model. Accuracy of the PSM model was validated against chart review by two independent subject matter experts.

RESULTS: In total, 2,638 ED encounters met an ICD-10-based case definition of suicidality during the study period. The prevalence of suicidality (2.9%) by subtype was ideation (2.5%), self-harm (1.1%), and attempt (0.2%). Suicidality prevalence was more common for female sex (4.2%) than male sex (1.7%). Comorbidities of suicidality were statistically significant for 55 frequently co-occurring ICD-10 codes. Nearly half of these comorbidities (26/55) were not present in DSM-5, and nearly a quarter (12/55) consisted of ICD-10 codes for accidental rather than intentional self-harm. Increased probability of suicidality was observed for patients with personality disorder (44%), gender dysphoria (43%), bipolar disorder (36%), depression (33%), and schizophrenia spectrum disorders (32%). Based on gold standard chart review, 53.4% of propensity matched non-cases were unrecognized suicidality cases.

CONCLUSIONS: Propensity score matching using comorbidity profiles is an effective approach for identifying suicidality cases that lack ICD-10 codes for suicidality.

PMID:41525105 | DOI:10.2196/81499

J Refract Surg. 2026 Jan;42(1):e31-e40. doi: 10.3928/1081597X-20251124-03. Epub 2026 Jan 1.

ABSTRACT

PURPOSE: To compare the visual quality and stereopsis after bilateral implantation of the zonal refractive multifocal intraocular lens (IOL) LS-313 MF15 (Oculentis) and enhanced monofocal IOL TECNIS Eyhance ICB00 (AMO).

METHODS: In this retrospective case series at The Second Hospital of Jilin University, patients underwent bilateral phacoemulsification with implantation of either enhanced monofocal (Tecnis Eyhance ICB00) or zonal refractive (LS-313 MF15) IOLs. Postoperative evaluations at 3 months included visual quality and stereopsis parameters: uncorrected distance, intermediate, and near visual acuity; corrected distance visual acuity; defocus curves; higher order aberrations; Strehl ratio; modulation transfer function; stereoacuity with correlation analysis; Visual Function Index-14 (VF-14) score; and spectacle independence rate.

RESULTS: Sixty patients (120 eyes) were included, with 30 patients (60 eyes) per group completing follow-up assessments. At the 3-month follow-up visit, the LS-313 MF15 group showed superior near visual acuity and stereopsis versus the Eyhance ICB00, with stereopsis positively correlating with binocular near visual acuity. The LS-313 MF15 demonstrated smoother defocus curves, broader landing zones, and superior near vision performance versus the Eyhance ICB00. The LS-313 MF15 group demonstrated lower spherical aberration but higher coma, trefoil, and total higher order aberrations compared to the Eyhance ICB00 group. No statistically significant differences were observed between the two groups in SR, MTF curve area, VF-14 questionnaire scores, or spectacle independence rates.

CONCLUSIONS: For patients with intermediate-vision requirements, both IOLs represent viable options, whereas the LS-313 MF15 may be preferable for those requiring enhanced near vision and stereopsis. The Eyhance ICB00 appears more suitable for patients with suboptimal ocular conditions.

PMID:41525097 | DOI:10.3928/1081597X-20251124-03

J Refract Surg. 2026 Jan;42(1):e64-e70. doi: 10.3928/1081597X-20251202-03. Epub 2026 Jan 1.

ABSTRACT

PURPOSE: To evaluate the biomechanical properties of the cornea after refractive surgery using an inflation test combined with optical coherence tomography (OCT).

METHODS: Nine human donor corneas were divided into two groups: healthy (control) and treated (divided into three subgroups: photorefractive keratectomy [PRK], laser in situ keratomileusis [LASIK], and small incision lenticule extraction). Refractive treatments were applied to simulate -4.00 diopters of myopia correction. The corneas were mounted on an artificial anterior chamber, and an inflation test was performed using a custom set-up. Intraocular pressure was increased from 15 to 120 mm Hg in steps of 15 mm Hg, and corneal deformation was monitored via OCT imaging. The apex displacement versus IOP relationship was analyzed to calculate corneal stiffness, expressed as Young’s modulus. Corneal thickness and curvature were also measured. Statistical comparisons were performed between healthy and treated corneas.

RESULTS: All treated corneas exhibited significant reductions in thickness and Young’s modulus compared to the healthy group. The mean corneal thickness was 552.0 ± 5.9 µm in the healthy group and 486.9 ± 14.0 µm in the treated group (P < .05). Young’s modulus was significantly lower in treated corneas (14.2 ± 4.9 MPa) compared to healthy corneas (22.9 ± 0.5 MPa, P = .02). Among surgical techniques, LASIK resulted in the greatest reduction in corneal stiffness, whereas PRK showed the least impact.

CONCLUSIONS: Inflation testing combined with OCT imaging allows for precise assessment of biomechanical alterations following refractive surgery. These findings highlight the importance of considering biomechanical consequences when selecting refractive procedures.

PMID:41525093 | DOI:10.3928/1081597X-20251202-03

J Refract Surg. 2026 Jan;42(1):e12-e17. doi: 10.3928/1081597X-20251113-02. Epub 2026 Jan 1.

ABSTRACT

PURPOSE: To evaluate safety and clinical outcomes of the sutureless intrascleral one-piece intraocular lens (SSF IOL) fixation in patients with Marfan syndrome (MFS) presenting with ectopia lentis.

METHODS: This retrospective, longitudinal, non-comparative case series was a multicenter study involving Ophthalmology Departments at three tertiary care centers in Italy. Fifteen eyes from 10 patients (4 males, 6 females; mean age 29.13 ± 16.96 years) diagnosed as having Marfan syndrome underwent lensectomy and implantation of the SSF one-piece IOL (FIL SSF; Soleko). Patients were followed up for 12 months postoperatively. Primary outcomes included corrected distance visual acuity (CDVA), IOL tilt (35-MHz ultrasound biomicroscopy), and endothelial cell density (ECD). Intraoperative and postoperative complications were recorded.

RESULTS: All surgeries were performed uneventfully, and no intraoperative complications occurred. CDVA improved significantly from 0.50 to 0.09 logarithm of the minimum angle of resolution (logMAR) (P = .0001). At 12 months postoperatively, the mean IOL tilt was 2.89 ± 0.91 degrees, indicating good centration and stability. No cases of IOL dislocation were reported. ECD showed a statistically significant mean reduction of 257.4 ± 138.2 cells/mm² (P < .0001), although no corneal decompensation was observed. The postoperative complications included one case of macular edema with subsequent development of an epiretinal membrane and one case of haptic exposure.

CONCLUSIONS: The SSF implantation of a single-piece IOL appears to be a viable and reproducible option for the successful surgical management of ectopia lentis in patients with MFS.

PMID:41525090 | DOI:10.3928/1081597X-20251113-02

JAMA Netw Open. 2026 Jan 2;9(1):e2546800. doi: 10.1001/jamanetworkopen.2025.46800.

ABSTRACT

IMPORTANCE: The Neighborhood Atlas Area Deprivation Index (NA-ADI) has been widely used in health policy research and incorporated into Medicare payment models such as the Accountable Care Organization Realizing Equity, Access, and Community Health model. However, calculation errors have been independently identified by multiple groups, showing that the NA-ADI contains distorted deprivation estimates that pose risks to equitable funding allocation and outcome adjustment.

OBJECTIVE: To develop the Reproducible ADI (ReADI) as a corrected, transparent replacement aligned with the original ADI methodology and to compare its agreement with established deprivation indices, including the Social Vulnerability Index (SVI), Social Deprivation Index, French Deprivation Index, and Neighborhood Stress Score, and its performance for estimating mortality.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2011-2015 and 2018-2022 data from the American Community Survey (ACS), a population-based US sample across census block groups, tracts, and counties. US geographic levels with sufficient data included 235 952 block groups, 83 722 census tracts, and 3214 counties. Census tract-level 2011-2015 mortality data were obtained from the US Small-Area Life Expectancy Estimates Project. Data from the 2015 NA-ADI were accessed March 7, 2024, and data from the 2022 NA-ADI, December 1, 2024.

EXPOSURES: The ReADI was constructed using corrected methods described in the original work developing the ADI. The NA-ADI was downloaded and aggregated to tract and county levels. The SVI was from the Centers for Disease Control and Prevention. Other indices were independently constructed from the ACS.

MAIN OUTCOMES AND MEASURES: The primary outcomes were ReADI and NA-ADI comparisons against each other, other deprivation indices, and mortality.

RESULTS: The ReADI more closely aligned with other deprivation indices (R2 range, 0.609 [95% CI, 0.586-0.630] to 0.932 [95% CI, 0.931-0.933]) compared with the NA-ADI (R2 range, 0.331 [95% CI, 0.300-0.362] to 0.710 [95% CI, 0.692-0.727]). ReADI scores also better reflected component weights (R2 ≥ 0.999 [95% CI, 0.996-1.000]; RMSE ≤ 0.042 [95% CI, 0.029-0.053]) compared with the NA-ADI (R2 range, 0.832 [95% CI, 0.574-0.932] to 0.844 [95% CI, 0.601-0.937]; RMSE range, 0.346 [95% CI, 0.279-0.414] to 0.405 [95% CI, 0.334-0.470]), consistent with correct computation. In 3332 high-discrepancy census tracts representing approximately 13 million individuals, the ReADI explained more variance in life expectancy (R2 difference, 0.064; 95% CI, 0.039-0.090), particularly in underresourced urban areas.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the ReADI was correctly calculated and should replace the flawed NA-ADI for future health policy applications. Its open-source methods support transparency, adaptability, and further development.

PMID:41525076 | DOI:10.1001/jamanetworkopen.2025.46800

JAMA Netw Open. 2026 Jan 2;9(1):e2551553. doi: 10.1001/jamanetworkopen.2025.51553.

ABSTRACT

IMPORTANCE: Increasing germline genetic testing rates may impact contralateral prophylactic mastectomy (CPM) rates in patients with newly diagnosed breast cancer.

OBJECTIVE: To quantify the impact of a personalized contralateral breast cancer (CBC) risk counseling tool that incorporates genetic testing results.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial recruited participants from a single tertiary referral center between June 8, 2020, and December 31, 2022. Patients aged 18 to 80 years with unilateral breast cancer who underwent genetic counseling and surgery were eligible. Exclusion criteria were prior or metastatic breast cancer or prior multigene panel testing. Follow-up was completed June 30, 2023.

INTERVENTION: Personalized age-specific CBC risks were estimated based on the presence or absence of pathogenic variants associated with breast cancer and were incorporated into a visual decision support tool. Patients were randomized 1:1 to quantitative counseling via the tool vs standard counseling without personalized CBC risk estimates.

MAIN OUTCOMES AND MEASURES: Co-primary end points included patients’ personal CBC risk knowledge and propensity to undergo CPM, before and after counseling, by randomization arm. The secondary end point was CPM rate. Sample size calculations assumed postcounseling CBC risk self-assessments would be 5% different from baseline (SD, 20%). A total of 199 patients in each arm would achieve 80% power and 5% type I error (based on a 2-sample t test). Univariate and multivariate analyses were performed for each end point.

RESULTS: A total of 400 patients were randomized (mean [SD] age, 54 [11] years), and 54 were excluded after randomization, leaving 346 patients. Among 341 patients with data available, 21 (6.2%) were Asian or Pacific Islander, 18 (5.3%) were Black, 295 (86.5%) were White, and 7 (2.1%) were of other race; 33 of 330 patients with available data (10.0%) were of Ashkenazi Jewish ancestry. Seventy-five of 346 patients (21.7%) had a first-degree relative with breast cancer. Patients who received quantitative counseling more accurately reported their CBC risk estimates than those who received standard counseling by univariate (coefficient, -9.39; 95% CI, -14.86 to -3.93; P < .001) and multivariate (coefficient, -9.52; 95% CI, -16.50 to -2.51; P = .008) analyses. The type of counseling did not significantly impact perception of risk, self-reported propensity to undergo CPM, or CPM rates.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, patients more accurately described their calculated CBC risk after quantitative counseling. This improved knowledge did not impact decisions to undergo CPM. The CBC risk assessment tool is publicly available and can be used for preoperative discussions.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04245176.

PMID:41525075 | DOI:10.1001/jamanetworkopen.2025.51553

JAMA Netw Open. 2026 Jan 2;9(1):e2551563. doi: 10.1001/jamanetworkopen.2025.51563.

ABSTRACT

IMPORTANCE: Alcohol use disorder (AUD) is a major public health concern; medications for AUD (MAUD) are an effective form of treatment but remain underused. Identifying MAUD access trends and the characteristics of counties with limited availability can inform targeted efforts to expand treatment capacity.

OBJECTIVE: To examine trends in geographic availability of MAUD at US substance use disorder treatment facilities (SUDTFs) from 2017 to 2023 and assess county characteristics associated with SUDTFs offering MAUD.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cross-sectional study used data from the Mental Health and Addiction Treatment Tracking Repository, which includes longitudinal data on licensed SUDTFs and whether they offer MAUD (acamprosate, disulfiram, or naltrexone), to quantify trends in MAUD availability at SUDTFs from January 2017 to December 2023.

MAIN OUTCOMES AND MEASURES: The primary outcome was a county-year indicator for whether at least 1 SUDTF in the county offered MAUD. Explanatory county variables included rurality, percentage of traffic fatalities involving alcohol, percentage of the population that drank excessively, percentage of uninsured individuals, poverty rate, percentage of individuals over age 65 years, and percentage of non-Hispanic White individuals. Univariate logistic regressions with state and year fixed effects were used to explore associations between county characteristics and the probability that a county had any SUDTFs offering MAUD.

RESULTS: Across 22 000 county-years in a total of 3153 counties, the mean (SD) percentage of counties with at least 1 SUDTF offering MAUD increased from 34.12% (47.42%) in 2017 to 43.88% (49.63%) in 2021, but growth plateaued after 2021. Lower MAUD presence in a county was associated with rural-adjacent (difference, -22.40 percentage points [pp]; 95% CI, -24.43 to -20.38 pp) and rural-remote (-23.64 pp; 95% CI, -25.72 to -21.56 pp) relative to metropolitan county status as well as with a higher poverty rate (-0.66 pp; 95% CI, -0.93 to -0.38 pp), greater percentage of individuals aged 65 years or older (-2.33 pp; 95% CI, -3.02 to -1.65 pp), and higher proportion of non-Hispanic White individuals (-0.58 pp; 95% CI, -0.71 to -0.46 pp), whereas greater prevalence of binge drinking (difference, 1.90 pp; 95% CI, 1.26-2.54 pp) and a higher percentage of college-educated individuals (1.28 pp; 95% CI, 1.13-1.43) were associated with higher MAUD presence.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the proportion of SUDTFs offering MAUD increased from 2017 to 2021, but growth then plateaued. Policies supporting the expansion of MAUD-providing facilities, particularly in underserved counties, may be needed to address persistent gaps in access.

PMID:41525074 | DOI:10.1001/jamanetworkopen.2025.51563

JAMA Netw Open. 2026 Jan 2;9(1):e2553228. doi: 10.1001/jamanetworkopen.2025.53228.

ABSTRACT

IMPORTANCE: Prior research conducted in private for-profit health care systems has suggested that social determinants of health (SDOH) play a role in adverse postoperative outcomes. Whether these findings translate to universal health care systems is unknown.

OBJECTIVE: To quantify the association of SDOH with risk of 30-day mortality after scheduled inpatient surgery.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted in Ontario, Canada’s most populous province. The cohort included consecutive adult patients (aged ≥18 years) who were eligible for Ontario’s universal health insurance and underwent a scheduled inpatient surgical procedure between January 1, 2017, and December 31, 2023. Diagnostic and procedural, demographic, vital statistics, and other data were obtained from linked health administrative databases.

EXPOSURES: SDOH including neighborhood income, immigration status, and migration recency.

MAIN OUTCOME AND MEASURE: Death within 30 days of index surgery. Logistic regression models were used to estimate the adjusted and unadjusted odds ratios (AORs and ORs) of the association of each SDOH with 30-day mortality.

RESULTS: Overall, 1 036 759 patients (median [IQR] age, 66 [56-74] years; 526 158 females [50.8%]) who underwent a range of scheduled inpatient surgical procedures were included. Of these patients, 1780 (0.9%) from the lowest-income areas died, as did 1307 (0.6%) from the highest-income areas. Patients from the lowest-income areas were at 52.0% increased odds of death (OR, 1.52; 95% CI, 1.42-1.64) compared with those from the highest-income areas. This association persisted with models partially adjusted for demographic and procedural factors (AOR, 1.54; 95% CI, 1.44-1.66) and fully adjusted for comorbidities (AOR, 1.43; 95% CI, 1.33-1.54). A dose-response association was demonstrated between neighborhood income and mortality, with odds of death increasing with diminishing income (eg, quintile 3 vs quintile 5: AOR, 1.18 [95% CI, 1.10-1.27]; quintile 2 vs quintile 5: AOR, 1.32 [95% CI, 1.22-1.42]). There was evidence of effect modification of the association between neighborhood income and mortality by procedure complexity (eg, effect estimate for quintile 4 and high complexity: -0.0776 [95% CI, -0.2722 to 0.1169]; P = .002). Immigrant and refugee status and recent migration (<5 years) demonstrated reduced odds of mortality in unadjusted analyses, but these associations diminished with risk adjustment.

CONCLUSIONS AND RELEVANCE: In this cohort study, residency in lowest-income neighborhood was associated with increased risk of postoperative mortality despite adjustment for patient, procedure, and hospital factors. Improving postoperative outcomes likely requires addressing underlying SDOH disparities.

PMID:41525072 | DOI:10.1001/jamanetworkopen.2025.53228

JAMA Netw Open. 2026 Jan 2;9(1):e2553244. doi: 10.1001/jamanetworkopen.2025.53244.

ABSTRACT

IMPORTANCE: Public reporting of outcomes increases transparency. Research on the association between public reporting programs and quality of care and outcomes is needed.

OBJECTIVE: To evaluate whether hospital voluntary participation in the Get With The Guidelines (GWTG)-Stroke public reporting program is associated with quality of care and clinical outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used GWTG-Stroke registry data from January 1 to December 31, 2021. Clinical characteristics associated with hospital participation in public reporting were identified, and differences in patient quality of care and outcomes were compared between hospitals that participated in public reporting of outcomes and those that did not. The primary data analysis was completed on December 27, 2024, and revised November 15, 2025.

EXPOSURE: Hospital participation in public reporting.

MAIN OUTCOMES AND MEASURES: The primary quality metric was defect-free care, a composite of 7 ischemic stroke quality measures (intravenous thrombolysis for patients arriving by 3.5 hours and treated by 4.5 hours, early antithrombotic use within 48 hours of admission, venous thromboembolism prophylaxis, antithrombotics at hospital discharge, anticoagulation for atrial fibrillation or flutter, smoking cessation counseling, and intensive statin therapy at discharge). Component measures were evaluated as secondary outcomes. The primary clinical outcome was independent ambulation at discharge. Secondary clinical outcomes included discharge to home, in-hospital mortality, and a composite of in-hospital mortality or discharge to hospice. Associations were measured using multivariable models adjusted for patient- and hospital-level variables.

RESULTS: There were 501 763 patients admitted for acute ischemic stroke (mean [SD] age, 69.8 [3.8] years; mean [SD] male, 51.5% [10.3%]) at 2423 hospitals; 1582 hospitals (65.3%) participated in public reporting. High-volume hospitals (quartile 4 [highest] vs 1 [lowest]: adjusted odds ratio [OR], 2.07 [95% CI, 1.43-2.99]) and high-performing hospitals measured by 2018 GWTG-Stroke quality awards (silver or gold: OR, 3.32 [95% CI, 2.63-4.20]) were more likely to participate in public reporting. In fully adjusted models, patients treated at participating hospitals were more likely to receive defect-free care (OR, 1.31 [95% CI, 1.27-1.35]) and more likely to receive all 7 of the individual components of defect-free care, although absolute differences between groups were small. There were minor differences in independent ambulation at discharge (OR, 1.02 [95% CI, 1.01-1.04]) and the composite of in-hospital mortality or discharge to hospice (OR, 1.05 [95% CI, 1.02-1.08]). There were no differences in discharge to home or in-hospital mortality.

CONCLUSIONS AND RELEVANCE: In this cohort study of hospitals in the GWTG-Stroke program in 2021, patients at hospitals participating in voluntary public reporting were more likely to receive guideline-based care but had similar clinical outcomes compared with patients at nonreporting hospitals. More research is needed to evaluate whether public reporting could improve clinical outcomes.

PMID:41525071 | DOI:10.1001/jamanetworkopen.2025.53244

JAMA Netw Open. 2026 Jan 2;9(1):e2553413. doi: 10.1001/jamanetworkopen.2025.53413.

ABSTRACT

IMPORTANCE: During out-of-hospital cardiac arrest (OHCA), initial airway device choice as well as final device choice in the event of failure may both influence overall procedural success and patient outcomes. Understanding national practice patterns in airway device placement may inform resuscitation strategies and system-level quality improvement.

OBJECTIVE: To assess patterns in the order of advanced airway device use for adults in the United States receiving OHCA treatment during emergency medical service (EMS) activations.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used data from the National EMS Information System (NEMSIS) database from January 2018 to December 2023. During this period, NEMSIS included more than 256 million EMS activations from nearly 14 000 agencies across 54 states and territories. Activations for 911 responses during adult OHCA with advanced airway device attempts after EMS arrival, with documented success (yes or no) and number of attempts, were included.

EXPOSURES: Advanced airway devices documented by EMS clinicians.

MAIN OUTCOME AND MEASURES: Order of advanced airway device use, measured by EMS clinician documentation.

RESULTS: From 2018 to 2023, EMS reported 2 365 224 activations involving adults having an OHCA, with 650 440 patients (0.3%) receiving either endotracheal intubation (ETI) and/or supraglottic airway (SGA). Most patients received a successful initial airway device attempt (503 774 [77.4%]). Although ETI was the most common initial airway device (458 546 [70.5%]), SGA had a higher first-pass success rate (93.0% vs 71.0%). Among patients whose first ETI attempt failed (133 177 of 458 546 [29.0%]), the final documented device remained ETI in 72 167 cases (72.3%) and changed to SGA in 27 651 (27.7%). Among patients whose first SGA attempt failed, 13 480 (61.9%) remained with SGA and 3388 (38.1%) were switched to ETI.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, most patients with OHCA received ETI as the first advanced airway procedure, despite higher SGA first-pass success. Among patients whose initial attempt failed, most continued with the same device. However, switching from ETI to SGA had a higher final success rates. These findings highlight the importance of airway device sequence in prehospital care and may inform training and protocols for airway management.

PMID:41525070 | DOI:10.1001/jamanetworkopen.2025.53413