Tag: nevin manimala

JMIR Form Res. 2025 Apr 18;9:e69113. doi: 10.2196/69113.

ABSTRACT

BACKGROUND: Acute respiratory infections (ARI) are a significant challenge in military settings due to close communal living, which facilitates the rapid transmission of pathogens. A variety of respiratory pathogens contribute to ARI, each varying in prevalence, severity, and impact on organizational productivity. Understanding and mitigating the impact of ARI is critical for optimizing the health of military personnel and maintaining organizational productivity.

OBJECTIVE: This retrospective study of surveillance data aims to identify pathogens causing ARI among servicemen and determine which pathogens contribute most to medical absenteeism, defined as the combined duration of the issued medical certificate and light duty.

METHODS: From September 2023 to August 2024, anonymous nasopharyngeal swabs (BioFire FilmArray Respiratory Panel) were collected from Singapore Armed Forces servicemen presenting with ARI symptoms after a doctor’s consultation at a local military camp’s medical centre. The presence of fever and duration of medical certificate and light duty were self-reported by Singapore Armed Forces servicemen.

RESULTS: A total of 1095 nasopharyngeal swabs were collected, of which 608 (55.5%) tested positive. The most common respiratory pathogen was human rhinovirus/enterovirus (HRV/HEV) in 303 (27.7%) individuals. The highest proportions of fever were observed in servicemen with influenza (62.8%, 27/43), SARS-CoV-2 (34.3%, 12/35), and parainfluenza (31.6%, 12/38). The odds of patients with influenza that have fever was 5.8 times higher than those of patients infected with HRV/HEV (95% CI 2.95-11.40, P<.001). The median duration of medical certificate, light duty, and medical absenteeism were 0 (IQR 0), 2 (IQR 2) and 2 (IQR 0) days, respectively. The odds of patients with influenza having a medical certificate with duration ≥1 day was 5.34 times higher than those in patients with HRV/HEV (95% CI 2.63-10.88, P<.001). No significant differences in the duration of medical absenteeism were found between HRV/HEV and other pathogens.

CONCLUSIONS: Compared to HRV/HEV, influenza infections were significantly associated with longer medical certificate duration. Nonetheless, there were no significant differences in the overall duration of medical absenteeism across pathogens, as servicemen infected with other pathogens were given light duty instead. These findings emphasize the need for pathogen-agnostic ARI measures. While influenza vaccinations are already mandatory for servicemen in local military camps, encouraging additional public health measures (eg, mask-wearing among symptomatic servicemen, COVID-19 vaccinations, therapeutics) can further reduce ARI incidence, minimize the duration of medical absenteeism, and mitigate the impact on organizational productivity.

PMID:40249956 | DOI:10.2196/69113

J Am Acad Orthop Surg. 2025 Apr 15. doi: 10.5435/JAAOS-D-25-00011. Online ahead of print.

ABSTRACT

INTRODUCTION: Tibiotalocalcaneal (TTC) arthrodesis is a critical surgical intervention for advanced hindfoot and ankle pathologies, offering pain relief, stabilization, and functional alignment restoration. Intramedullary nail fixation, particularly with dynamic compression (DC) nails, has emerged as a promising solution for addressing high nonunion rates associated with standard static compression (SC) nails. This study compares union and complication rates between DC and SC nails in TTC arthrodesis using the Nationwide Readmissions Database.

METHODS: This retrospective cohort study used the Nationwide Readmissions Database to identify cases of TTC fusion with DC and SC nails based on ICD-10-PCS codes. Propensity score matching (1:1) controlled for confounders, including age, sex, and comorbidities. Primary outcomes included complications such as thromboembolism, wound dehiscence, cellulitis, implant-related complications, nonunion, malunion, and infections. Secondary outcomes included 30-day and 31-90-day readmission rates. Statistical significance was set at P < 0.05.

RESULTS: The study analyzed 311 cases (149 with DC, 162 with SC). Demographic and comorbidity distributions were balanced after matching. Nonunion rates were significantly lower in the DC group (6.0%) compared with the SC group (17.3%; P = 0.002). Overall complication rates were comparable (DC: 30.2% vs. SC: 35.2%, P = 0.350).

DISCUSSION: DC devices demonstrated markedly reduced nonunion rates compared with SC nails, likely because of the continuous compression provided by the nitinol-based design. This novel finding validates the biomechanical advantages of devices using DC in TTC fusion and aligns with previous research advocating for such devices.

CONCLUSION: DC nails offer an advancement in TTC arthrodesis by markedly reducing nonunion rates. Future studies should focus on cost-effectiveness, long-term outcomes, and patient-specific optimization to further refine treatment protocols.

PMID:40249946 | DOI:10.5435/JAAOS-D-25-00011

J Med Internet Res. 2025 Apr 18;27:e71057. doi: 10.2196/71057.

ABSTRACT

BACKGROUND: Knee osteoarthritis (OA) presents a significant burden in China due to its high prevalence, aging population, and rising obesity rates. Despite clinical guidelines recommending evidence-based care, limited practitioner training and inadequate telehealth integration hinder effective OA management.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of an e-learning program in improving the confidence and knowledge of Chinese physical therapists in managing knee OA and to explore their perceptions of the program.

METHODS: This was a randomized controlled trial with 2 parallel arms involving 81 rehabilitation practitioners from 18 Chinese provinces. The intervention group completed a 4-week web-based training program (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis [PEAK]-Chinese), while the control group received no training. The primary outcome was self-reported confidence in OA management (11-point scale). Secondary outcomes included knowledge (Chinese Knee Osteoarthritis Knowledge Scale [KOAKS]) and likelihood of clinical application of core OA treatments. Process measures and semistructured interviews captured participants’ training perceptions. Quantitative data were analyzed using regression models, 2-sided t tests, and descriptive statistics, while thematic analysis was performed on the interview data of 10 participants.

RESULTS: A total of 80 participants completed the outcome measures at 4 weeks. The intervention group demonstrated significant improvements in confidence compared to the control group, including managing OA with exercise-based programs (adjusted mean difference=3.27, 95% CI 2.72-3.81), prescribing exercise (adjusted mean difference=3.13, 95% CI 2.55-3.72), and delivering telehealth (adjusted mean difference=4.41, 95% CI 3.77-5.05). KOAKS scores also improved significantly (mean change=9.46); however, certain belief bias related to OA concepts and the use of scans remained unchanged (25/41, 61% and 27/41, 66%, respectively). Approximately 73% (30/41) of the intervention participants rated the course as extremely useful. Interviews emphasized the need for cultural adaptation and practical telehealth training with real-life scenarios to enhance program applicability.

CONCLUSIONS: The PEAK program improved Chinese practitioners’ confidence and knowledge in managing knee OA, underscoring e-learning’s potential to support evidence-based OA care in China. To optimize future implementations, further research strategies could include enhancing cultural relevance, addressing misconceptions, and incorporating practical, real-world training.

TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR2400091007; https://www.chictr.org.cn/showproj.html?proj=239680.

PMID:40249943 | DOI:10.2196/71057

JMIR Form Res. 2025 Apr 18;9:e66791. doi: 10.2196/66791.

ABSTRACT

BACKGROUND: Smartphone apps are a growing field supporting the prevention of chronic diseases. The user experience (UX) is an important predictor of app use and should be considered in mobile health research. Long-term skin protection behavior is important for those with work-related skin diseases. However, altering health behavior is complex and requires a high level of self-management. We developed a maintenance program consisting of the Mein Hautschutz im Alltag (MiA; “My skin protection in everyday life”) app combined with an individual face-to-face goal-setting interview to support patients in the implementation of skin protection behavior after inpatient rehabilitation.

OBJECTIVE: The objectives of this paper are to (1) describe the intervention in a standardized manner; (2) evaluate the UX, subjective quality, and perceived impact of the MiA app; and (3) evaluate the adherence to the MiA app.

METHODS: We followed a user-centered and multistage iterative process in 2 steps that combined qualitative and quantitative data. The maintenance program was tested over 12 weeks after discharge from rehabilitation. The UX, subjective quality, and perceived impact were evaluated formatively based on the user version of the Mobile Application Rating Scale after 12 weeks (T2). Adherence was measured using the frequency of interactions with the app.

RESULTS: In total, 42 patients took part (with a dropout rate of n=18, 43% at T2). The average age was 49.5 (SD 13.1) years, and 57% (24/42) were male. We found high ratings for the UX, with an average score of 80.18 (SD 8.94) out of a theoretical maximum of 100, but there were a few exceptions in the usability and interaction with the app. The app was most frequently rated with 4 out of 5 stars (15/24, 65%), which indicates a high subjective quality. Furthermore, the app seemed to influence important determinants to implement skin protection behavior. Adherence to skin protection tracking was higher over the study period than adherence to skin documentation and goal assessment. The number of adherent participants to skin protection tracking was higher in the skin care and skin cleansing categories (28/42, 67% each) compared to the skin protection category (13/42, 31%) on day 1 and decreased until day 84 in all dimensions (12/42, 29% each for skin care and skin cleansing; 9/42, 21% for skin protection).

CONCLUSIONS: The results in terms of adherence met the expectations and were consistent with those of other studies evaluating the use of apps for chronic diseases. Interaction with the app could be increased using artificial intelligence to determine eczema severity via photos. It should be investigated which subgroups have difficulties with usability to individualize the support to a greater degree during onboarding. There is a need for further research regarding the effectiveness of the MiA app on skin protection behavior, quality of life, and eczema severity.

PMID:40249942 | DOI:10.2196/66791

Blood Adv. 2025 Apr 18:bloodadvances.2024015734. doi: 10.1182/bloodadvances.2024015734. Online ahead of print.

ABSTRACT

The prognostic impact of monocytic differentiation in AML patients receiving Venetoclax (Ven) and azacitidine (Aza) remains unclear. In a prospective cohort of 86 newly diagnosed AML patients treated with Ven-Aza, we used multiparametric flow cytometry (MFC) to define mono-blasts as AML blasts co-expressing ≥2 monocytic markers (CD4, CD36, CD64) per ELN guidelines. Patients with higher mono-blasts/CD45+ proportions had lower complete response rates (OR=0.24, p=0.005) and significantly shorter overall survival (OS, 4.0 versus 14.9 months, p=0.003). A ≥10% mono-blasts/CD45+ threshold, identified via maximally selected rank statistics, stratified patients into mono-blasthigh (≥10%) and mono-blastlow (<10%) groups. MFC reclassified 20% of FAB non-M4/5 and 15% of FAB M4/5 cases into mono-blasthigh and mono-blastlow groups, respectively. Multivariable analysis confirmed mono-blasthigh status as an independent adverse prognostic factor for OS (HR=1.95, p=0.023), with a particularly strong impact in ELN 2024 favorable-risk patients (HR=2.81, p=0.024). Our findings highlight monocytic differentiation, assessed via MFC, as a key predictor of Ven-Aza resistance and poor survival, independent of genetic classification. Given its availability in routine diagnostics, MFC-based monocytic assessment could improve AML risk stratification and treatment decisions in patients eligible for less intensive therapies.

PMID:40249917 | DOI:10.1182/bloodadvances.2024015734

Rhinology. 2025 Apr 18. doi: 10.4193/Rhin24.420. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the efficacy of mepolizumab as add-on therapy to intranasal corticosteroids for the treatment of severe, uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in a real-life setting in the Triveneto region of northeast Italy.

METHODS: Patients with severe CRSwNP receiving mepolizumab were followed up at 1, 3, 6, 9 and 12 months from the first administration. At baseline and at each follow-up, patients underwent nasal endoscopy, completed the Sinonasal Outcome Test 22, Visual Analogue Scales for smell, nasal obstruction, rhinorrhoea and facial pain, the Nasal Congestion Score and the Asthma Control Test. Peak nasal inspiratory flow, Sniffin’ Sticks Identification Test and blood eosinophil count were also evaluated.

RESULTS: Ninety patients from twelve different rhinological units were enrolled in the study. Both patient- and physician- derived outcome measures significantly improved within the first month after biological treatment initiation, maintaining the benefit at subsequent follow-ups. Nine percent of patients discontinued the treatment due to lack of benefit within the first year. No major adverse events were reported.

CONCLUSIONS: Mepolizumab is effective in improving nasal obstruction and the sense of smell in patients with severe uncontrolled CRSwNP, based on both patient- and physician derived outcome measures.

PMID:40249916 | DOI:10.4193/Rhin24.420

Med Sci Sports Exerc. 2025 Apr 18. doi: 10.1249/MSS.0000000000003728. Online ahead of print.

ABSTRACT

METHODS: Forty-two young, resistance-trained men and women were randomly assigned to 1 of 2 parallel groups: A group that trained to failure on all exercises (FAIL) or a submaximal effort group (2-RIR) that trained with two repetitions in reserve for the same exercises. Participants performed a single set of 9 exercises targeting all major muscle groups per session, twice weekly for 8 weeks. We assessed pre-post study changes in muscle thickness for the biceps brachii, triceps brachii, and quadriceps femoris, along with measures of muscular strength, power, endurance, and ability to estimate RIR in the bench press and squat.

RESULTS: Results indicated that both FAIL and 2-RIR elicited appreciable gains in most of the assessed outcomes. Several measures of hypertrophy tended to favor FAIL, although absolute differences between conditions were generally modest. Increases in countermovement jump height favored FAIL, but with no clear statistical support for either the null or alternative hypothesis. Increases in strength and local muscular endurance were similar between conditions. Participants demonstrated greater accuracy in estimating RIR for the bench press compared to the squat and improved their accuracy over the intervention, particularly for the bench press.

CONCLUSIONS: These findings suggest that single-set routines can be a time-efficient strategy for promoting muscular adaptations in resistance-trained individuals, even when transitioning from higher-volume programs. Training to failure in single-set routines may modestly enhance some measures of muscle hypertrophy and power, but not strength or local muscle endurance.

PMID:40249908 | DOI:10.1249/MSS.0000000000003728

Med Sci Sports Exerc. 2025 Apr 18. doi: 10.1249/MSS.0000000000003730. Online ahead of print.

ABSTRACT

PURPOSE: It is recognized that disruptions in circadian behavior, such as with shift work or jet lag, are associated with diminished health. This known relationship implies that people with stronger indices of circadian behavior will exhibit improved physiology. To address the association between rhythmic activity behavior and physiology we proposed that metrics indicative of ‘more rhythmic’ rest-activity patterns would be associated with better cardiorespiratory fitness and walking energetics in a cohort of older adults.

METHODS: Using baseline data from the Study of Muscle, Mobility and Aging (N = 799, Age: 76 ± 5 yrs, 58% female), we quantified metrics describing rhythmic aspects of rest-activity behavior (amplitude, robustness, time of peak activity, others) from continuous wrist-worn accelerometry. We used linear models to examine cross-sectional associations between rhythmic metrics with VO2peak and walking energetics (cost-capacity ratio at slow and preferred walking speeds) adjusted for age, sex, race, height, health conditions, and other factors.

RESULTS: Metrics that reflect more rhythmic behavior were associated with VO2peak (higher amplitude: Q1: 18.4 vs. Q4: 22.0 mL·kg-1·min-1; p-trend <0.001, higher pseudo F-statistic/robustness Q1: 19.2 vs. Q4: 21.3 mL·kg-1·min-1; p-trend <0.001, and earlier time of peak activity (Q1 (earliest): 20.9 vs. Q4 (latest): 19.2 mL·kg-1·min-1; p-trend <0.001). Similar trends were observed with lower cost-capacity ratio at preferred and slow walking speeds (amplitude, pseudo F-statistic, acrophase: p-trend <0.001 for all).

CONCLUSIONS: More rhythmic activity behavior and earlier time of peak activity were associated with better cardiorespiratory fitness and walking energetics. These findings support the framework that rhythmic activity supports healthy physiology. Further investigations are warranted to determine if declines in rhythmicity of human behavior are predictive of disease.

PMID:40249906 | DOI:10.1249/MSS.0000000000003730

Med Sci Sports Exerc. 2025 Apr 18. doi: 10.1249/MSS.0000000000003726. Online ahead of print.

ABSTRACT

PURPOSE: Studies on heat acclimation (HA) involving high-intensity exercise report impairments in time trial (TT) performance in the heat immediately after HA. This study aimed to determine whether a high-carbohydrate (HC) diet can enhance 3.22 km run TT performance in the heat following exercise-intensive short-term HA.

METHODS: Fourteen healthy military-age males were assigned to either a HC diet (70 %kcal carbohydrate (CHO), n = 7) or lower CHO comparison (COMP, 35 %kcal CHO, n = 7) to be consumed during and for one week after a 6-day HA protocol.

RESULTS: Baseline descriptive statistics, heat tolerance, and run performance were similar between groups (p > 0.05). Both groups acclimated, showing reduced heart rate, rectal and skin temperature, and increased sweat rate (each p ≤ 0.03) during heat stress testing one day and five days after HA. The HC group demonstrated a faster TT (959 ± 103 sec vs. 1067 ± 172, p = 0.02, g = 0.71) than COMP one day post-HA. HC showed improved TT performance from baseline at one day (p = 0.01, g = 0.59) and five days post-HA (p = 0.04, g = 0.59). The HC group showed greater TT improvement at one day (-7.0 ± 4.9 % vs. -0.7 ± 4.7 %, p = 0.03, g = 1.23) and five days post-HA (-8.4 ± 4.9 % vs. -2.8 ± 3.9 %, p = 0.01, g = 1.18), with no group differences in HA outcomes or relative strain during TT.

CONCLUSIONS: Insufficient CHO intake during heavy daily exertion in unacclimated heat stress, such as in short-term HA, may affect post-HA performance outcomes unless addressed with additional CHO consumption.

PMID:40249903 | DOI:10.1249/MSS.0000000000003726

Clin Chem Lab Med. 2025 Apr 21. doi: 10.1515/cclm-2025-0089. Online ahead of print.

ABSTRACT

OBJECTIVES: Accurate medical laboratory reports are essential for delivering high-quality healthcare. Recently, advanced artificial intelligence models, such as those in the ChatGPT series, have shown considerable promise in this domain. This study assessed the performance of specific GPT models-namely, 4o, o1, and o1 mini-in identifying errors within medical laboratory reports and in providing treatment recommendations.

METHODS: In this retrospective study, 86 medical laboratory reports of Nucleic acid test report for the seven upper respiratory tract pathogens were compiled. There were 285 errors from four common error categories intentionally and randomly introduced into reports and generated 86 incorrected reports. GPT models were tasked with detecting these errors, using three senior medical laboratory scientists (SMLS) and three medical laboratory interns (MLI) as control groups. Additionally, GPT models were tasked with generating accurate and reliable treatment recommendations following positive test outcomes based on 86 corrected reports. χ2 tests, Kruskal-Wallis tests, and Wilcoxon tests were used for statistical analysis where appropriate.

RESULTS: In comparison with SMLS or MLI, GPT models accurately detected three error types, and the average detection rates of the three GPT models were 88.9 %(omission), 91.6 % (time sequence), and 91.7 % (the same individual acted both as the inspector and the reviewer). However, the average detection rate for errors in the result input format by the three GPT models was only 51.9 %, indicating a relatively poor performance in this aspect. GPT models exhibited substantial to almost perfect agreement with SMLS in detecting total errors (kappa [min, max]: 0.778, 0.837). However, the agreement between GPT models and MLI was moderately lower (kappa [min, max]: 0.632, 0.696). When it comes to reading all 86 reports, GPT models showed obviously reduced reading time compared with SMLS or MLI (all p<0.001). Notably, our study also found the GPT-o1 mini model had better consistency of error identification than the GPT-o1 model, which was better than that of the GPT-4o model. The pairwise comparisons of the same GPT model’s outputs across three repeated runs showed almost perfect agreement (kappa [min, max]: 0.912, 0.996). GPT-o1 mini showed obviously reduced reading time compared with GPT-4o or GPT-o1(all p<0.001). Additionally, GPT-o1 significantly outperformed GPT-4o or o1 mini in providing accurate and reliable treatment recommendations (all p<0.0001).

CONCLUSIONS: The detection capability of some of medical laboratory report errors and the accuracy and reliability of treatment recommendations of GPT models was competent, especially, potentially reducing work hours and enhancing clinical decision-making.

PMID:40249886 | DOI:10.1515/cclm-2025-0089