Tag: nevin manimala

Age Ageing. 2025 May 31;54(6):afaf154. doi: 10.1093/ageing/afaf154.

ABSTRACT

BACKGROUND: Comorbidities and polypharmacy are common in people with dementia, leading to a higher risk of adverse outcomes. While the impact of anticholinergic properties has been extensively investigated, less is known about other cross-category properties of medications.

OBJECTIVE: To investigate whether medications with dizziness or hypotension as a side effect are associated with adverse outcomes in older adults with dementia.

DESIGN: Retrospective cohort study.

SETTING AND PARTICIPANTS: From a South London catchment, 15 210 patients diagnosed with dementia between 2008 and 2017.

METHODS: Medications with dizziness and/or hypotension listed as a side effect were compiled and quantified in the cohort. Multivariable Cox regression models were run to determine the risk of mortality, all-cause emergency hospitalisation and hospitalisation due to falls. Generalised estimating equations were applied to investigate cognitive decline. The final model adjusted for 19 potential confounders, including physical and mental health measures.

RESULTS: Of the patients, 82.2% were receiving at least one dizziness-associated medication and 71.2% at least one hypotension-associated medication. For each additional medication associated with dizziness or hypotension, there was a 4% increased risk of all-cause emergency hospitalisation. No associations were found with hospitalised falls specifically or with mortality or cognitive decline.

CONCLUSION: Medications that potentially cause dizziness or hypotension were associated with an increased risk of hospitalisation, although not specifically hospitalisation caused by falls. More systematic attention should be paid to coprescribing around the time of dementia diagnosis and the potential for rationalising this to minimise adverse drug events.

PMID:40483728 | DOI:10.1093/ageing/afaf154

Age Ageing. 2025 May 31;54(6):afaf148. doi: 10.1093/ageing/afaf148.

ABSTRACT

BACKGROUND AND OBJECTIVE: Research on the impact of spousal caregiving on caregivers’ frailty remains limited. This study aimed to examine this association between spousal caregiving and frailty, explore how this association varies with care intensity, and investigate potential gender differences.

METHODS: This study utilized data from four waves of the China Health and Retirement Longitudinal Study, including 3,987 participants aged 50 and above. Frailty was assessed using a composite mean score based on 41 indicators aligned with Rockwood’s frailty criteria. These indicators included self-reported health, medically diagnosed conditions, medical symptoms, functional activities assessment, activities of daily living and instrumental activities of daily living. Samples were stratified by gender, and a growth curve model with random intercepts was employed to examine the associations between spousal caregiving status, care intensity and frailty trajectories over time.

RESULTS: Among females, compared to non-caregivers, spousal caregiving was significantly associated with the increased frailty index when adjusted by all covariates, and frailty accelerated at a higher rate for caregivers. Providing care at all three intensity levels was associated with higher frailty, although depression attenuated these associations. Additionally, caregiving at lower intensity showed an accelerating rate of frailty progression over time. Among males, only providing higher-care intensity was associated with higher frailty.

CONCLUSIONS: This study highlights the importance of care intensity as well as the gendered effects of spousal caregiving on frailty-caregiving exacerbates frailty, particularly among females and among higher-intensity male caregivers. Our findings suggest the need for targeted supportive measures to alleviate psychological stress.

PMID:40483727 | DOI:10.1093/ageing/afaf148

Multivariate Behav Res. 2025 Jun 8:1-18. doi: 10.1080/00273171.2025.2512345. Online ahead of print.

ABSTRACT

The assumption of a normal distribution for latent traits is a common practice in item response theory (IRT) models. Numerous studies have demonstrated that this assumption is often inadequate, impacting the accuracy of statistical inferences in IRT models. To mitigate this issue, Gaussian mixture modeling (GMM) for latent traits, known as GMM-IRT, has been proposed. Moreover, the GMM-IRT models can also serve as powerful tools for exploring the heterogeneity of latent traits. However, the computation of GMM-IRT model estimation encounters several challenges, impeding its widespread application. The purpose of this paper is to propose a reliable and robust computing method for GMM-IRT model estimation. Specifically, we develop a mixed stochastic approximation EM (MSAEM) algorithm for estimating the three-parameter normal ogive model with GMM for latent traits (GMM-3PNO). Crucially, the GMM-3PNO is augmented to be a complete data model within the exponential family, thereby substantially streamlining the computation of the MSAEM algorithm. Furthermore, the MSAEM algorithm adeptly avoid the label-switching issue, ensuring its convergence. Finally, simulation and empirical studies are conducted to validate the performance of the MSAEM algorithm and demonstrate the superiority of the GMM-IRT models.

PMID:40483708 | DOI:10.1080/00273171.2025.2512345

Clin Transplant. 2025 Jun;39(6):e70186. doi: 10.1111/ctr.70186.

ABSTRACT

BACKGROUND: Transplantation of hepatitis C virus (HCV) nucleic acid (NAT) positive organs is associated with shorter time to transplant and decreased risk of death on the waiting list. Treatment for HCV post-transplant is well-tolerated, successful, and leads to similar transplant outcomes to patients transplanted with HCV NAT- organs. Despite these outcomes, not all patients consent to receive HCV NAT+ organs, and factors associated with consent are not well-known.

METHODS: This retrospective single-center study of adult patients listed for heart, liver, lung, and kidney transplant aimed to determine whether sociodemographic and organ-specific disparities exist in consent for HCV NAT+ donor organs.

RESULTS: Of 2788 transplant candidates, 44% (N = 1229) consented to receive an HCV NAT+ organ. Patients who designated English as their preferred language were more likely to consent compared to a non-English preference (45% vs. 19%, p < 0.001). Consent rates were highest amongst patients listed for liver transplantation compared to kidney, heart, and lung transplants (67%, N = 319 vs. 42%, N = 602 vs. 38%, N = 159 vs. 32%, N = 149; p < 0.001).

CONCLUSIONS: Overall, more efforts are needed to ensure that all patients who may benefit from consenting for HCV NAT+ organs are appropriately educated in their language of choice on the risks and benefits.

PMID:40483705 | DOI:10.1111/ctr.70186

Aging Ment Health. 2025 Jun 8:1-10. doi: 10.1080/13607863.2025.2515181. Online ahead of print.

ABSTRACT

Older adults receiving home and community based services have been found more vulnerable to mental health distress and suicidal ideation due to loneliness and social isolation. This study evaluated the effectiveness of an eight-week standardized, manualized warm calling phone intervention intended to combat loneliness and social isolation by fostering reciprocally caring relationships. Natural helpers from the Aging Services Network, home-delivered meals (HDM) volunteers who had ongoing interactions with individuals at risk for suicide, were trained to provide supportive phone outreach. Using descriptive statistics and consensual qualitative research (CQR) methodology, results from 78 older adult experiences were explored based on data collected at one-month follow-up to assess what they may have liked, what could be improved, and any takeaways from the program. Five domains and nineteen categories emerged revealing older adults had lasting positive impacts from program participation. Particularly trained helper qualities contributed to these improvements; further, older adults reported key takeaways from the program, increased help-seeking behavior, as well as potential program improvements. Implications for practice and future research are provided.

PMID:40483699 | DOI:10.1080/13607863.2025.2515181

Spine Deform. 2025 Jun 8. doi: 10.1007/s43390-025-01123-x. Online ahead of print.

ABSTRACT

PURPOSE: Vertebral body tethering (VBT) for lumbar curves may have wider application than for thoracic curves due to greater growth potential than thoracic spine and benefits of preserved flexibility. Predicting long-term correction remains challenging, with high revision rates and complications (14-32%) including under-/over-correction, tether breakage, adding-on. This study aimed to validate a planning tool for lumbar VBT using a patient-specific finite element model (FEM) integrating mechanobiological growth modulation as a function of preoperative skeletal maturity.

METHODS: Thirty-five retrospective idiopathic scoliosis patients who underwent lumbar VBT, with or without concomitant thoracic VBT, were included. A personalized FEM calibrated to preoperative spine deformity, flexibility and weight was created using 3D radiographic reconstructions. The FEM was linked to an algorithm integrating spine growth and mechanobiological growth modulation, calibrated using preoperative Sanders score. VBT surgery was simulated to replicate immediate postoperative correction and predict two-year correction. Simulated Cobb angles, sagittal curves, and apical axial rotation were compared to actual two-year radiographic measurements.

RESULTS: Preoperative Cobb angles averaged 37 ± 12° (thoracic) and 48 ± 9° (thoraco-lumbar/lumbar). Immediate postoperative correction was 38 ± 15% and 59 ± 16%, with two-year corrections of 44 ± 24% and 73 ± 21%, respectively. Simulated postoperative correction was accurate within 3° (Cobb angles), while simulated 2-year outcomes were accurate within 3° (Cobb), 2° (kyphosis), 4° (lordosis), and 3° (axial rotation), showing no significant differences from reference results (p < 0.05; statistical power 90%).

CONCLUSION: The patient-specific FEM and growth modulation algorithm accurately predicted two-year correction. This tool can support preoperative planning, reduce surgeon variability, and potentially improve VBT outcomes by providing a predictive tool to help surgical planning.

PMID:40483668 | DOI:10.1007/s43390-025-01123-x

Int J Comput Assist Radiol Surg. 2025 Jun 8. doi: 10.1007/s11548-025-03417-x. Online ahead of print.

ABSTRACT

PURPOSE: Reliable and accurate 2D/3D registration is essential for image-guided navigation and surgical robotics, enabling precise spatial alignment. This work investigates uncertainty quantification and characterization, addressing challenges specific to 2D/3D registration. Despite a few degrees of freedom (DoF), uncertainty in 2D/3D registration is difficult to estimate and interpret since it lacks the dimensional consistency in 2D/2D or 3D/3D registration.

METHODS: We model 2D/3D registration as a Maximum A Posteriori (MAP) estimation over the posterior distribution of 3D object poses given 2D fluoroscopic images. Uncertainty is quantified by sampling from an approximate posterior distribution, derived from a similarity function-based likelihood and a prior over the 6DoF pose space, and computing summary statistics and entropy measures from these samples. To characterize this approach, we generate plausible 2D/3D pelvis registrations and conduct experiments to investigate the relationship between uncertainty metrics and registration error.

RESULTS: Ordinary least squares (OLS) regression, a linear model, failed to capture the relationship between uncertainty metrics and registration error (R-squared = 0.023), while XGBoost provided a significantly better fit (R-squared = 0.85). A paired t-test revealed significant differences in prediction accuracy across registration error groups. XGBoost, fit on registrations closer to the correct solution, showed stronger predictive accuracy than the “global” model, which included the full range of errors, and the importance of uncertainty metrics differed between the two models.

CONCLUSION: This work presents a novel method for uncertainty quantification and characterization in single-view 2D/3D registration. Our results reveal a nonlinear relationship between uncertainty and registration accuracy, with stronger correlations observed in low-error regimes. These insights offer a foundation for better understanding and improving registration reliability in image-guided interventions.

PMID:40483666 | DOI:10.1007/s11548-025-03417-x

Eur J Orthop Surg Traumatol. 2025 Jun 8;35(1):239. doi: 10.1007/s00590-025-04362-w.

ABSTRACT

PURPOSE: To determine the risk factors for reoperation to promote union for periprosthetic distal femur fractures (PDFF).

METHODS: This was a retrospective, multi-centered comparative study of patients with PDFF (AO 33A-C[VB1, C1, D1]) managed operatively with open reduction and internal fixation (ORIF) with a lateral locked plate (LLP). Exclusion criteria were acute management with a distal femur replacement, fixation other than LLP, less than 6 months of follow-up, and lack of injury or follow-up radiographs. The primary outcome measure was reoperation to achieve bony union. Univariate and multivariate analyses were made between cases that did and did not require a reoperation to achieve union.

RESULTS: A total of 52 patients met inclusion criteria, of which 7 (13.5%) required a reoperation for union. There were no differences between the groups for age, sex, body mass index, comorbidities, Su classification, or open injury. Multivariate analysis identified risks for reoperation to promote union including notching preoperatively (OR 1.26, CI 1.04-1.53, p = 0.007), increased number of screws through a fracture line (OR 1.27, CI 1.15-1.41, p < 0.001), plate length < 12 holes (OR 1.15, CI 1.00-1.33, p = 0.020), and lower number of proximal screws that were locking (OR 0.95, CI 0.9-1.0, p = 0.043). Conclusions The reoperation rate to promote union was 13.5%. While limited by total case number, this study identified notching preoperatively, presence of screws through the fracture line, plate length < 12 holes, and lower number of proximal screws that were locking to be independent risk factors for reoperation to promote union.

PMID:40483658 | DOI:10.1007/s00590-025-04362-w

Pediatr Surg Int. 2025 Jun 8;41(1):160. doi: 10.1007/s00383-025-06061-3.

ABSTRACT

PURPOSE: Cloacal exstrophy represents a significant challenge for pediatric surgeons. A critical component of treatment involves bladder closure and reconstruction of the urethra, genitalia and pubic symphysis. The objective of this study is to describe and compare outcomes of patients with cloacal exstrophy based on the type of closure employed and to propose a multidisciplinary management protocol.

METHODS: A retrospective descriptive study was conducted on patients with cloacal exstrophy treated between 2008 and 2024. Demographic, clinical, surgical, and immediate post-operative (< 30 days) variables were recorded. The analysis was stratified into two groups based on the surgical approach: staged closure (SC) versus direct closure (DC).

RESULTS: Twelve patients were evaluated. In the DC group (n = 5), three (60%) were male, with a mean birth weight of 2401 (± 488) g. The median age at the time of surgery was 9 days [interquartile range (IQR): 5526 days]. Cecal plate rescue was successfully achieved in 80% of cases, and the mean pubic diastasis was 4.65 (± 2.84) cm. The most frequent complication observed was surgical wound infection. In the SC group (n = 7), five (71.4%) were female, with a mean birth weight of 2046.67 (± 489.8) g. The median age at surgery was 62.5 days (IQR: 1116 days). Cecal plate rescue was successful in six (85.7%) patients, and the mean pubic diastasis was 5.16 (± 2.74) cm. The most common complication was surgical wound infection associated with external fixation. No statistically significant differences were observed.

CONCLUSION: The outcomes of both techniques were comparable. In the DC group, males predominated, as this technique achieves greater phalloplasty length and was performed at an earlier age. The staged group included patients with higher risks of bladder closure dehiscence: lower birth weight, larger pubic diastasis, and associated cardiac comorbidities. This approach necessitates a specialized team of orthopedic surgeons for modern closure techniques, involving osteotomies and external fixators, which entail higher costs. Individualizing the surgical technique for bladder closure is critical. We recommend single stage closure for male neonates. A staged approach is advised for patients referred later in life with low birth weight, pubic diastasis > 5 cm, or hemodynamically significant cardiac comorbidities.

PMID:40483640 | DOI:10.1007/s00383-025-06061-3

Clin Rheumatol. 2025 Jun 8. doi: 10.1007/s10067-025-07512-x. Online ahead of print.

ABSTRACT

PURPOSE: The pan-immune-inflammation value (PIV) is a promising biomarker that reflects systemic inflammation and aids in disease prognosis. We sought to explore the potential association between PIV and hyperuricemia in the adult population of the USA.

METHODS: The data were collected from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. PIV was calculated as follows: (neutrophil × platelet × monocyte)/lymphocyte (10⁹/L). Hyperuricemia is defined as uric acid levels ≥ 420 mmol/L in males and ≥ 360 mmol/Ls in females. The association between PIV and the prevalence of hyperuricemia, as well as its impact on all-cause and cardiovascular mortality, was investigated.

RESULTS: A total of 31,151 adult participants were included in this study. The prevalence of hyperuricemia increased progressively with higher PIV levels (13.41% vs. 14.87% vs. 15.75% vs. 20.02%, P < 0.001). Participants in the fourth quartile of PIV had a greater risk of hyperuricemia compared to those in the first quartile (OR = 1.19, 95% CI: 1.07-1.32, P = 0.001). Smooth curve fitting also indicated a dose-response relationship between PIV levels and hyperuricemia risk. Additionally, elevated PIV levels were linked to an increased risk of all-cause and cardiovascular mortality in patients with hyperuricemia (P < 0.001).

CONCLUSIONS: PIV is an emerging biomarker reflecting systemic inflammation, with the potential for assessing hyperuricemia and its prognostic risk. Key Points • Pan-immune-inflammation value (PIV) holds potential as an epidemiological tool for analyzing immune-inflammatory responses tied to hyperuricemia and its long-term mortality risk.

PMID:40483638 | DOI:10.1007/s10067-025-07512-x