Tag: nevin manimala

JMIR Mhealth Uhealth. 2025 Jun 2;13:e56678. doi: 10.2196/56678.

ABSTRACT

BACKGROUND: Older adults were disproportionately affected by the COVID-19 pandemic, with a high number of deaths occurring in this age group. The impact of social isolation and home confinement continues to impact the mental and emotional health of older adults, despite the end of the COVID-19 pandemic. Unhealthy lifestyle behaviors, including physical and social inactivity, and poor sleep quality, have been reported. Recommendations for healthy lifestyle changes have primarily targeted the general population, highlighting the need for personalized recommendations for vulnerable older adults. Remote sensing technologies may offer an opportunity to understand behavior changes among older adults and provide personalized recommendations.

OBJECTIVE: This study aims to describe the effects of home confinement and social isolation on community-dwelling older adults during the COVID-19 outbreak and investigate how integrated computing technologies, such as remote sensors installed in homes, can help inform recommendations for safe and healthy lifestyles.

METHODS: As part of a larger study and ongoing research with community-dwelling older adults, remote sensors including bed transducers, 3D depth cameras, and passive infrared (PIR) motion sensors were installed in the homes of the study sample. We compared features derived from sensors for approximately one month before the COVID-19 outbreak (January 14, 2020-February 13, 2020) and one month after the onset of the pandemic (March 14, 2020-April 13, 2020). We used descriptive statistics and paired-sample t tests to compare the 2 time periods, pre-COVID-19 and early-COVID-19.

RESULTS: Sensor data from 64 older adults were analyzed, the majority identifying as female (n=51, 80%), aged >76 years (n=58, 92%), and living alone (n=50, 78%). Results from paired-sample t tests demonstrated significant differences in sensor features between the pre-COVID-19 and early-COVID-19 time periods. We found statistically significant differences in bed restlessness (pre-COVID: mean 14.98, SD 5.10; early-COVID: mean 15.56, SD 5.25; t554=-4.10; P<.001), time spent in bed (pre-COVID: mean 32,547.41, SD 9269.96; early-COVID: mean 33,494.73, SD 10,887.33; t554=-2.81; P=.005), pulse (pre-COVID: mean 68.45, SD 3.30; early-COVID: mean 68.10, SD 3.36; t554=3.66; P<.001), respiration (pre-COVID: mean 14.54, SD 1.32; early-COVID: mean 14.41, SD 1.31; t553=3.72; P<.001), and stride length (pre-COVID: mean 29.10, SD 4.813; early-COVID: mean 28.76, SD 5.016; t595=2.17; P=.03). Among the study sample, bed restlessness and time spent in bed increased between the 2 time periods, while pulse, respiration, and stride length decreased.

CONCLUSIONS: This study highlights that home confinement during the pandemic significantly impacted the behavior and health of older adults, leading to more sedentary lifestyles and poorer sleep quality. These changes may contribute to a decline in physical and mental health, increasing the risk of depression, lack of social contact, and diminished functional capacity. The findings underscore the need for older adults in future infectious disease outbreaks and suggest in-home sensor technology as a potential tool for monitoring their health and guiding decisions during periods of confinement.

PMID:40456114 | DOI:10.2196/56678

JMIR Aging. 2025 Jun 2;8:e66372. doi: 10.2196/66372.

ABSTRACT

BACKGROUND: With changes in lifestyle, the issue of sleep disorders is becoming increasingly common. Diabetes and sarcopenia have been found to be independently associated with sleep disorders. However, fewer studies have explored the interaction between the combination of diabetes and sarcopenia at different stages and sleep disorders.

OBJECTIVE: This study aimed to explore the relationship between the combination of diabetes and sarcopenia and the incidence of sleep disorders in adults aged 45 years and older.

METHODS: Based on data from the CHARLS (China Health and Retirement Longitudinal Study), we selected participants with comprehensive diagnostic information on diabetes and sarcopenia from 2011 who had normal sleep duration at baseline and checked their follow-up information of sleep duration from 2013, 2015, 2018, and 2020. Diabetes was classified into diabetes (D), prediabetes (PD), and nondiabetes (ND), and sarcopenia was divided into sarcopenia (S), possible sarcopenia (PS), and nonsarcopenia (NS). The participants were divided into DS, DPS, DNS, PDS, PDPS, PDNS, NDS, NDPS, and NDNS groups. Kaplan-Meier survival curves, the log-rank test, Cox proportional hazards regression, and restricted cubic spline models were used for statistical analysis.

RESULTS: A total of 4936 participants were included in this study. The DS group had the highest incidence of sleep disorders: 49.32%, 28.57%, 36.36%, and 80.00% in 2013, 2015, 2018, and 2020 respectively. In the crude model, compared with the NDNS group, the risk of sleep disorders was increased in the DS group (hazard ratio [HR] 1.707, 95% CI 1.196-2.437), PDS (HR 1.599, 95% CI 1.235-2.071), NDS (HR 1.465, 95% CI 1.282-1.674), and DPS group (HR 1.318, 95% CI 1.097-1.583). The risk was increased but not statistically significant in the PDPS group (HR 1.160, 95% CI 0.987-1.365). After adjusting for covariates, the risk of sleep disorders remained statistically significant in the DS group (HR 1.515, 95% CI 1.059-2.167) and was significantly higher in the PDS (HR 1.423, 95% CI 1.096-1.847) and NDS (HR 1.279, 95% CI 1.113-1.468) groups than that in the NDNS group. The nonlinear associations between appendicular skeletal muscle mass, grip strength, 5-time chair test, fasting plasma glucose, and sleep disorders were observed and described.

CONCLUSIONS: The combination of diabetes and sarcopenia significantly increases the risk of sleep disorders in adults aged 45 years and older. and the implementation of progression control of both diabetes and sarcopenia may be helpful to prevent sleep disorders in this population.

PMID:40456103 | DOI:10.2196/66372

J Am Acad Orthop Surg Glob Res Rev. 2025 May 22;9(6). doi: 10.5435/JAAOSGlobal-D-25-00118. eCollection 2025 Jun 1.

ABSTRACT

BACKGROUND: The time required to form new bone is a critical aspect of bone lengthening but is not constant depending on the osteotomy location. The objective of this study was to establish the bone healing index (BHI) after femur and tibia bone lengthening procedures. Additional objectives included identifying procedure-related complications and implant reliability.

METHODS: A retrospective analysis was conducted on all consecutive internal lengthening nails (Precice; Nuvasive) implanted in the femur or tibia at a single institution from September 2012 to November 2019. Groups were delineated by surgical approach (antegrade femur [AF], retrograde femur [RF], or antegrade tibia [AT]). The primary outcome was the BHI (days to consolidate regenerate per centimeter bone lengthened). Additional outcomes included iatrogenic bone deformity, implant complications, and nail reliability. Comparative analysis of demographic characteristics and complications was conducted using chi-square tests, and BHI was compared using independent t-tests. Multivariate analysis was used to evaluate independent outcomes among the groups. Statistical significance was set at P < 0.05.

RESULTS: Of 286 bone lengthening events (164 AF, 67 RF, 55 AT), BHI was significantly lower for AF at 24.5 ± 9.5 d/cm than for RF at 33.5 ± 14.5 d/cm and AT at 41.0 ± 17.4 d/cm (P = 0.001) and lower for RF than for AT (P = 0.012). After multivariate analysis, nail approach (AF), younger age (≤16), and lengthening for stature (versus deformity) were significantly associated with a lower BHI. Lengthening > 3 cm was also associated with better BHI. Iatrogenic deformity was induced in 8/164 = 4.9% AF, 2/67 = 3.0% RF, and 5/55 = 9.1% AT. Implant reliability was 92.7% for AF, 93.1% for RF, and 94.8% for AT. Complications requiring another surgery were observed in 39 of 286 (13.6%), and failure to achieve the lengthening goal was observed in 1 of 286 (0.3%).

CONCLUSION: AF lengthening, younger age, stature lengthening, and lengthening > 3 cm lead to better bone healing indices using the Precice internal lengthening nail. Complications and iatrogenic deformity can be partially mitigated with surgeon-controlled decisions (surgical approach, blocking screws, distraction rate, weight-bearing restrictions) and rarely lead to a failure in achieving the lengthening goal if treated promptly.

LEVEL OF EVIDENCE: III.

PMID:40456100 | DOI:10.5435/JAAOSGlobal-D-25-00118

IEEE Trans Neural Syst Rehabil Eng. 2025 Jun 2;PP. doi: 10.1109/TNSRE.2025.3575695. Online ahead of print.

ABSTRACT

The aim of this study is to characterize the acquisition delay in wireless EEG instruments and evaluate its impact on the detection of time-locked neural phenomena, such as P300 and movement-related cortical potentials (MRCP). Accurate timing is critical for both research and clinical applications, especially for real-time brain-computer interfaces (BCI). A measurement setup was thus developed to assess acquisition delays and their uncertainty. Delays were measured at both the start and stop of a reference signal generation to investigate the consistency and reliability of the devices. BCI experiments were also performed to evaluate the impact of the measured delay on the detection of the time-locked phenomena. Statistical tests confirmed significant differences in delays across devices and configurations (e.g., from few tens to a hundred ms). These delays directly impacted P300 and MRCP detection, raising concerns about potential misclassification. Nonetheless, the correction of the measured acquisition delay proved beneficial, especially with regard to the P300 latency measured through low-cost instrumentation.

PMID:40456094 | DOI:10.1109/TNSRE.2025.3575695

PLoS One. 2025 Jun 2;20(6):e0321601. doi: 10.1371/journal.pone.0321601. eCollection 2025.

ABSTRACT

Variable selection methods are widely used in observational studies. While many penalty-based statistical methods introduced in recent decades have primarily focused on prediction, classical statistical methods remain the standard approach in applied research and education. In this study, we evaluated the variable selection performance of several widely used classical and modern methods for descriptive modeling, using both simulated and real data. A novel aspect of our research is the incorporation of a statistical approach inspired by the supersaturated design-based factor screening method in an observational setting. The methods were evaluated based on Type I and Type II error rates, the average number of predictors selected, variable inclusion frequency, absolute bias, and root mean square error. The detailed results of these evaluations are presented, and the methods’ performance is discussed across various simulation scenarios and in application to real data.

PMID:40456058 | DOI:10.1371/journal.pone.0321601

J Am Assoc Nurse Pract. 2025 Jun 1;37(6):327-333. doi: 10.1097/JXX.0000000000001091.

ABSTRACT

BACKGROUND: The transition to practice (TTP) hour requirement presents a barrier to full practice authority (FPA) for nurse practitioners (NPs). Since 2015, the predominant method of granting FPA entails a TTP hour requirement.

PURPOSE: Adverse action reports (AARs) and medical malpractice payment reports (MMPRs) of NPs were compared in states with FPA on initial licensure and states with FPA requiring a TTP hour period using data from the National Practitioner Data Bank (NPDB). The relationship of TTP hours to AARs and MMPRs was also evaluated.

METHODOLOGY: A secondary analysis was obtained from a review of retrospective data in the NPDB. States examined were those that grant FPA on initial advanced practice registered nurse licensure and states that require a TTP hour requirement as part of their criteria for granting FPA.

RESULTS: In a 5-year period, postimplementation of FPA or 5-year postexpiration of the TTP requirement in 23 states, plus the District of Columbia, revealed that states with FPA granted on initial licensure demonstrated a lower incidence of AARs and MMPRs at the 5-year period compared with states that require a TTP hour period. No relationship existed between the amount of TTP hours and the incidence of AARs and MMPRs.

CONCLUSION: Transition to practice hours remains a barrier to NPs achieving FPA. It is important for nursing to continue to build the body of evidence that refutes or supports the need for TTP hours.

IMPLICATIONS: These data can be used when lobbying at the state level in the remaining states seeking FPA.

PMID:40456052 | DOI:10.1097/JXX.0000000000001091

J Am Assoc Nurse Pract. 2025 Jun 1;37(6):323-326. doi: 10.1097/JXX.0000000000001119.

ABSTRACT

Candello, the national medical professional liability (MPL) data collaborative of CRICO, the medical malpractice insurer for all Harvard medical institutions and their affiliates undertook a comprehensive retrospective analysis to evaluate malpractice risk associated with the increasing number of nurse practitioners (NPs) and physician associates (PAs) in the health care workforce. The report analyzed 65,754 asserted MPL cases and 69,782 closed MPL cases between 2012 and 2021 to compare those involving NPs and PAs to those involving medical doctors (MDs). Despite increasing use of NPs and PAs, there was no observed increase in the proportion of MPL claims involving these practitioners. The analysis also includes the differences in case characteristics by provider type, including contributing factors, clinical severity, and location. The data showed no significant differences in medical malpractice risk between NPs, PAs, and MDs based on the analysis of these characteristics. However, these data show the likelihood of indemnity, and the average paid is higher in cases involving multiple providers.

PMID:40456051 | DOI:10.1097/JXX.0000000000001119

Health Aff (Millwood). 2025 Jun;44(6):707-715. doi: 10.1377/hlthaff.2024.01277.

ABSTRACT

Insurance claim denials are a common source of administrative burden, especially for patients with private health insurance. Contesting denied claims requires considerable investment from physicians and patients or caregivers, including both institutional knowledge of health policies and billing practices and the means to engage in reconciliation. We used a novel national data set comprising remittance data and patient demographics to describe disparities in the rates of seeking and receiving claim denial corrections across demographic and socioeconomic dimensions. We found that patients from historically disadvantaged racial and ethnic groups or with low household incomes experienced the largest burdens from claim denials. Patients with household incomes less than $50,000 annually were least likely to have denied claims contested and, conditionally, have cost-sharing obligations reduced. Racial minority patients were more likely than non-Hispanic White patients to have cost-sharing obligations reduced but achieved lower mean savings per successfully contested denial. Policy makers working to promote equitable health care access should make available more resources for contesting and rectifying administrative errors and enact policies to prevent billing errors and consequent claim denials.

PMID:40456042 | DOI:10.1377/hlthaff.2024.01277

Health Aff (Millwood). 2025 Jun;44(6):731-738. doi: 10.1377/hlthaff.2024.01287.

ABSTRACT

Since 2013, Medicare has reimbursed clinicians for delivering transitional care management (TCM) services after patients’ discharge from eligible medical facilities. Concurrently, Medicare has implemented population-based Alternative Payment Models (APMs) to encourage patient-centered care, care coordination, and clinician accountability. In this analysis, we used 2017-20 Medicare data to evaluate the effect of TCM on four quality and cost outcomes and the effect of population-based APM participation on the association between TCM and the four outcomes. TCM was associated with more healthy days at home and lower total spending after hospital discharge, with more pronounced differences among patients aligned with population-based APMs compared to nonaligned patients. TCM was also associated with lower readmissions but not differences in mortality; neither finding varied between patients who were versus were not aligned with population-based APMs. These findings suggest that the benefits of TCM may be even greater when patients are aligned with population-based APMs, highlighting potentially complementary effects.

PMID:40456041 | DOI:10.1377/hlthaff.2024.01287

Health Aff (Millwood). 2025 Jun;44(6):702-706. doi: 10.1377/hlthaff.2024.01485.

ABSTRACT

This article quantifies the prevalence of claim denials in Medicare Advantage (MA), along with their direct impact on provider revenue. Employing medical claims data from multiple MA plans, covering 30 percent of the entire MA market in 2019, our study found claim denial rates of 17 percent as a share of initial claim submissions. We also found that 57 percent of all claim denials were ultimately overturned. We calculated that denials resulted in a 7 percent net reduction in provider MA revenue, based on the dollar-weighted share of claim denials that were not overturned. However, the indirect impact of denials could be even greater than this direct effect that we measured. This article points to the important role that claim denials play in reducing MA spending and in driving outcome differences between MA and traditional Medicare. However, our analysis did not weigh the cost-saving benefits of claim denials against potential downsides.

PMID:40456040 | DOI:10.1377/hlthaff.2024.01485