Tag: nevin manimala

Diagn Microbiol Infect Dis. 2025 Oct 22;114(2):117165. doi: 10.1016/j.diagmicrobio.2025.117165. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the comparative diagnostic efficacy of metagenomic next-generation sequencing (mNGS) versus conventional microbiological culture in spinal infections.

METHODS: A retrospective analysis was conducted in a cohort of 80 patients with suspected spinal infections who underwent concurrent testing via metagenomic next-generation sequencing (mNGS), microbial culture, and histopathological examination. Diagnostic performance of mNGS and microbial culture was compared using a composite clinical reference standard (definitive diagnosis integrating histopathology, clinical history, and laboratory findings) as the diagnostic gold standard.

RESULTS: Pathogens were detected in 64 cases (80 %) by mNGS, compared to 34 cases (42.5 %) via conventional microbial culture, demonstrating a statistically significant difference in detection rates (P < 0.001). Using clinical diagnosis (histopathology combined with medical history and laboratory findings) as the gold standard, mNGS exhibited superior sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in tissue specimens. Conversely, microbial culture showed higher specificity. In pus specimens, mNGS maintained advantages in sensitivity, accuracy, and PPV, while culture demonstrated higher specificity and NPV.

CONCLUSION: Compared to conventional microbial culture, mNGS demonstrates superior diagnostic performance in spinal infections, with significantly higher pathogen detection rates and enhanced sensitivity, accuracy PPV and NPV. mNGS exhibits significant advantages over culture in identifying both common pathogens and fastidious organisms, while also demonstrating robust fungal detection capabilities. Additionally, in tissue specimens, mNGS demonstrates relatively pronounced advantages compared to conventional microbial culture. For purulent specimen testing, comprehensive sensitivity and specificity in diagnosis can be achieved through a combined strategy of mNGS and microbial culture.

PMID:41183417 | DOI:10.1016/j.diagmicrobio.2025.117165

Injury. 2025 Oct 29;56(12):112850. doi: 10.1016/j.injury.2025.112850. Online ahead of print.

ABSTRACT

INTRODUCTION: Sacral fractures are an increasingly recognized clinical entity, particularly among older adults with osteoporosis. However, national-level data on long-term trends in incidence, diagnostic imaging, treatment strategies, and the recognition of underlying bone fragility remain limited. This study aimed to evaluate nationwide trends in sacral fracture care in Germany over a 19-year period.

METHODS: We conducted a retrospective analysis of all inpatient cases with a primary diagnosis of sacral fracture (ICD-10-GM: S32.1) recorded in the German Federal Statistical Office database from 2005 to 2023. Fragility fractures were defined as cases in patients aged ≥65 years. Outcomes included use of CT and MRI (OPS codes), surgical versus conservative treatment, and coded diagnoses of osteoporosis (ICD-10: M80-M82). Time trends were analyzed using linear regression; group comparisons were conducted with t-tests and chi-square tests (p < 0.05).

RESULTS: A total of 162,116 sacral fractures were identified. Annual cases increased from 1,861 in 2005 to 7,695 in 2023. Fragility fractures in women aged ≥65 years rose significantly, from 985 to 12,901 cases (p < 0.0001). CT use increased by 241% and MRI by 175%, with a significant shift toward CT as the preferred modality (p < 0.0001). Despite increased access to minimally invasive options, surgical treatment rates remained stable at approximately 20% (p = 0.15). Osteoporosis was documented in only 1.5% of cases.

CONCLUSIONS: The incidence of sacral fractures in Germany has risen markedly, driven by an aging population and under-recognized bone fragility. While cross-sectional imaging use has expanded, surgical treatment remains underutilized, and osteoporosis continues to be grossly underdiagnosed. These findings underscore a systemic gap in secondary prevention and highlight the need for integrated, bone-focused trauma care models.

PMID:41183411 | DOI:10.1016/j.injury.2025.112850

J Glaucoma. 2025 Nov 1;34(11):888-894. doi: 10.1097/IJG.0000000000002617. Epub 2025 Aug 19.

ABSTRACT

PRCIS: Evaluation of aqueous humor outflow (AHO) pathways shows a segmental pattern with the nasal quadrant having the maximum and the temporal quadrant having the least AHO pathways in nonglaucomatous subjects.

AIM: To evaluate circumferential aqueous humor outflow (AHO) pathways in nonglaucomatous subjects using aqueous angiography (AA).

METHODS: A cross-sectional, observational, single-center study recruited 30 subjects with visually significant age-related cataract planned for phacoemulsification. AA was performed using indocyanine green (ICG) dye 0.1% just before phacoemulsification. Images were analyzed at 60 seconds from the injection of ICG dye for angiographic signal intensity in 4 quadrants and 8 sectors, circumferentially (360 degrees) along the limbus. Signal intensities were evaluated and compared between quadrants and sectors as the primary outcome measure. Signal intensities between males and females, right and left eyes were assessed as secondary outcome measures, using appropriate statistical tests.

RESULTS: The mean age of the patients was 61.53±5.5 years (range: 49-68 y) with 16 males and 14 females; 16 right eyes and 14 left eyes. Segmental AHO was noted in all patients. The median signal intensity was highest in the nasal quadrant [45.95(35.59-54.34)] followed by the inferior [31.56 (24.82-41.71)], superior [30.16 (28.2-37.43)], and temporal [26.66 (22.92-34.33)] quadrants, and their difference was statistically significant (P<0.0001). Median signal intensity among 8 sectors was highest in the nasosuperior sector [23.05 (17.14-29.20)] and least in the temporoinferior sector [12.98 (10.82-17.51)] (P<0.0001). No significant difference was observed in median signal intensities between males [132.83 (115.82-174.18)] and females [143.74 (122.43-166.00)] (P=0.771) and right eyes [143.74 (118.53-170.6)] and left eyes [133.51 (122.43-153.86)] (P=0.967). Anterior capsule rupture and vitreous staining were noted in one patient each.

CONCLUSION: Nonuniform, segmental AHO pathways were seen in nonglaucomatous subjects using AA. The nasal quadrant had the maximum AHO functional channels, followed by the inferior, superior, and least in the temporal quadrant. Within the sectors, the nasosuperior sector had the highest signal intensity.

PMID:41183392 | DOI:10.1097/IJG.0000000000002617

JMIR Public Health Surveill. 2025 Nov 3;11:e78068. doi: 10.2196/78068.

ABSTRACT

BACKGROUND: The triglyceride-glucose (TyG) index and blood pressure (BP) status are key indicators associated with coronary heart disease (CHD). However, limited research has focused on individuals with disabilities.

OBJECTIVE: This study explores the potential combined effects of the TyG index and BP status on CHD risk in groups with varying disability characteristics.

METHODS: This study analyzed data from the Shanghai Disability Health Survey, conducted between January 2012 and December 2022. Participants were then categorized into 3 BP status groups: nonelevated BP, elevated BP, and hypertension. Cox proportional hazards regression models were used to assess the associations between BP status, the TyG index, and CHD incidence. Additionally, the mediating, interaction, and combined effects of these factors on CHD risk were examined. A stratified analysis was performed based on participants’ disability characteristics, including disability type and severity, to explore potential variations in the associations.

RESULTS: Among the 21,628 participants, the mean age was 53.30 (SD 10.57) years, and 50.89% (11007/21628) were male. In a follow-up of 77.45 months, CHD events occurred in 2312 participants (10.69%). The TyG index and BP status were independently associated with an increased risk of CHD. Mediation analysis showed that TyG explained 20.5% (95% CI 13.6%-22.0%) of the BP and CHD association. Significant multiplicative interactions were identified (hazard ratio [HR] 1.41, 95% CI 1.02-1.94), and joint analysis indicated the highest CHD risk in those with both hypertension and elevated TyG (HR 1.92, 95% CI 1.52-2.42). Stratified analyses revealed stronger mediation in participants with physical disabilities (22.6%, 95% CI 9.0%-60%) or visual disabilities (16.6%, 95% CI 4.8%-51%), while this was not significant in those with hearing or speech (P=.07) or intellectual or mental disabilities (P=.13). By disability grading, the mediated proportion was 22.3% (95% CI 9.2%-59.4%) in mild or moderate and 18.8% (95% CI 15.7%-29%) in severe or very severe groups. Joint associations showed consistently higher CHD risk across most disability classifications, with particularly elevated risk in people with intellectual or mental disabilities (HR 3.51, 95% CI 1.89-6.50).

CONCLUSIONS: BP and the TyG index were significantly associated with CHD risk in individuals with disabilities, with TyG mediating a part of this association and showing stronger effects in physical and mild to moderate disabilities. Significant interactions between BP and TyG further highlight their combined impact, underscoring the need for integrated interventions targeting both factors.

PMID:41183379 | DOI:10.2196/78068

J Med Internet Res. 2025 Nov 3;27:e79718. doi: 10.2196/79718.

ABSTRACT

BACKGROUND: Consistent wear is essential for valid and reliable actigraphy data. Adherence to actigraphy may be challenging in primary school children due to developmental and design considerations, yet no quantitative synthesis of adherence in this age group exists.

OBJECTIVE: The aim of this study was to provide the first pooled estimate of actigraphy adherence in primary school-aged children and examine the impact of individual, device, and study-specific factors on adherence.

METHODS: We searched seven electronic databases for studies reporting adherence to actigraphy in primary school-aged children. Searches were conducted in Embase, MEDLINE, PsycINFO, Social Policy and Practice via OVID, Education Resources Information Center, British Education Index, and CINAHL via EBSCO using database-specific search strategies conducted between January 2018 and January 24, 2023. Forward and backward citation searches were completed on the Web of Science Core Collection and Google Scholar. Gray literature searches were undertaken in PsycEXTRA and Healthcare Management Information Consortium. Empirical studies reporting quantitative data on adherence to community-based actigraphy in children aged 5-11 years (or if ≥50% of the average age fell within this range) were included. Eligible studies were written in English and could be published or unpublished. Risk of bias was assessed using an 8-item checklist adapted from Berger et al’s actigraphy reporting standards. All included studies were narratively synthesized, and adherence data were pooled in a proportional meta-analysis. Adherence was calculated as the proportion of children meeting wear-time criteria to be included in the analysis compared to the number of children invited to use the device at baseline. Meta-regression was used to examine the impact of individual, device, and study-specific factors on adherence. Prediction intervals were calculated to estimate the range of adherence expected across future studies.

RESULTS: Data were extracted from 235 studies (N=148,161); of these, 135 studies (n=64,541) provided adherence data for proportional meta-analysis. Pooled adherence, measured across 1-140 days, was 81.6% (95% CI 78.7%-84.4%; I2=98.8%). The prediction intervals (42.8%-100%) indicated substantial variability in adherence estimates across studies. Meta-regression suggested that individual characteristics contributed to observed heterogeneity as children with a physical health diagnosis (b=0.236, 95% CI 0.009-0.464; P=.04) and those with neurodevelopmental or mental health diagnosis (b=0.395, 95% CI 0.125-0.665; P=.004) demonstrated higher adherence than undiagnosed children, though these effects were of modest magnitude. No significant effects were found for age, placement, protocol length, protocol deviation, or incentivization. Reporting quality was poor, with only 3.4% of studies satisfying all criteria.

CONCLUSIONS: This review demonstrates generally high actigraphy adherence in primary school-aged children, particularly those with health conditions. However, observed variability indicates that adherence was much lower in some contexts, underscoring that the reported pooled adherence cannot be assumed across future actigraphy applications within this age group. Future research should use standardized adherence reporting and should plan for adherence variability.

PMID:41183377 | DOI:10.2196/79718

Soft Matter. 2025 Nov 3. doi: 10.1039/d5sm00947b. Online ahead of print.

ABSTRACT

Drawing inspiration from the concept of the “primitive path” of a linear chain in melt conditions, we introduce here a numerical protocol which allows us to detect, in an unambiguous manner, the “primitive shapes” of ring polymers in two-dimensional melts. Then, by analysing the conformational properties of these primitive shapes, we demonstrate that they conform to the statistics of two-dimensional branched polymers (or, trees) in the same melt conditions, in agreement with seminal theoretical work by Khokhlov, Nechaev and Rubinstein. Results for polymer dynamics in light of the branched nature of the rings are also presented and discussed.

PMID:41183354 | DOI:10.1039/d5sm00947b

Nanoscale. 2025 Nov 3. doi: 10.1039/d5nr02899j. Online ahead of print.

ABSTRACT

Multiphoton 3D laser printing (MPLP) offers a unique combination of sub-micron resolution, geometrical freedom, and property variability. While this technique opens an extensive parameter space to develop new materials, it poses a significant challenge to disentangle and optimize the interrelated effects of chemical composition, process parameters, and resulting material properties. In this context, data analysis through full factorial analysis (FFA) can serve as a crucial tool for the systematic examination of how multiple factors interact and influence the final material properties of 3D printed microstructures, resulting in the identification of key parameters. In this work we propose a three-step approach, called ‘nano-FFA’, that involves: (1) evaluation of the printability of selected inks via scanning electron microscopy (SEM); (2) characterization of 3D printed structures using nanoindentation and vibrational spectroscopy; and (3) identification of interactions between ink formulation and printing parameters via FFA. Three scenarios have been investigated using the three-step nano-FFA approach: scenario I focuses on the effect of the photoinitiator concentration. Scenario II examines the influence of different photoinitiator species and scenario III evaluates the effect of the crosslinker. Across all scenarios, a significant interaction is observed between ink composition-i.e. photoinitiator concentration, photoinitiator type, and crosslinker-and the laser power (LP) printing parameter. This finding demonstrates that the properties of the final structures can be tailored by precisely selecting these two factors. The results of this study highlight the value of integrating statistical data analysis methods, such as FFA, into 3D printing material optimization toolboxes. Implementation of this new nano-FFA approach can provide a practical method for streamlining ink formulation and process optimization in MPLP, allowing rational ink development over a wide range of applications.

PMID:41183352 | DOI:10.1039/d5nr02899j

Ann Intern Med. 2025 Nov 4. doi: 10.7326/ANNALS-25-00739. Online ahead of print.

ABSTRACT

BACKGROUND: Data extraction is a critical but error-prone and labor-intensive task in evidence synthesis. Unlike other artificial intelligence (AI) technologies, large language models (LLMs) do not require labeled training data for data extraction.

OBJECTIVE: To compare an AI-assisted versus a traditional, human-only data extraction process.

DESIGN: Study within reviews (SWAR) using a prospective, parallel-group comparison with blinded data adjudicators.

SETTING: Workflow validation within 6 ongoing systematic reviews of interventions under real-world conditions.

INTERVENTION: Initial data extraction using an LLM (Claude, versions 2.1, 3.0 Opus, and 3.5 Sonnet) verified by a human reviewer.

MEASUREMENTS: Concordance, time on task, accuracy, sensitivity, positive predictive value, and error analysis.

RESULTS: The 6 systematic reviews in the SWAR yielded 9341 data elements from 63 studies. Concordance between the 2 methods was 77.2% (95% CI, 76.3% to 78.0%). Compared with the reference standard, the AI-assisted approach had an accuracy of 91.0% (CI, 90.4% to 91.6%) and the human-only approach an accuracy of 89.0% (CI, 88.3% to 89.6%). Sensitivities were 89.4% (CI, 88.6% to 90.1%) and 86.5% (CI, 85.7% to 87.3%), respectively, with positive predictive values of 99.2% (CI, 99.0% to 99.4%) and 98.9% (CI, 98.6% to 99.1%). Incorrect data were extracted in 9.0% (CI, 8.4% to 9.6%) of AI-assisted cases and 11.0% (CI, 10.4% to 11.7%) of human-only cases, with corresponding proportions of major errors of 2.5% (CI, 2.2% to 2.8%) versus 2.7% (CI, 2.4% to 3.1%). Missed data items were the most frequent error type in both approaches. The AI-assisted method reduced data extraction time by a median of 41 minutes per study.

LIMITATIONS: Assessing concordance and classifying errors required subjective judgment. Consistently tracking time on task was challenging.

CONCLUSION: Data extraction assisted by AI may offer a viable, more efficient alternative to human-only methods.

PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality and RTI International.

PMID:41183336 | DOI:10.7326/ANNALS-25-00739

JMIR Aging. 2025 Nov 3;8:e80034. doi: 10.2196/80034.

ABSTRACT

BACKGROUND: Measuring and promoting healthy aging at an individual level remains challenging as promoting healthy longevity requires real-time, personalized tools to assess risk and guide interventions in clinical practice.

OBJECTIVE: This study aimed to develop and validate a novel Healthy Longevity Index (HLI) for use in primary care settings in older adults.

METHODS: Using data from the Taiwan Longitudinal Study on Aging (TLSA; n=4470), we developed a nomogram-based HLI incorporating demographics, lifestyle factors, intrinsic capacity (IC) measures, and chronic conditions to predict 4-, 8-, and 12-year disability- and dementia-free survival (absence of physical disability, dementia, or mortality). The HLI was internally validated in a TLSA subset and externally validated in the Japanese National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA) cohort (n=1090).

RESULTS: The 12-year HLI nomogram demonstrated robust performance, with C-statistics of 0.79 (bootstrapped 95% CI 0.78-0.80) in the TLSA training cohort and 0.77 (bootstrapped 95% CI 0.75-0.79) in the TLSA validation cohort. External validation in the NILS-LSA yielded a C-statistic of 0.71 (bootstrapped 95% CI 0.66-0.76). The HLI effectively stratified participants into risk tertiles, with the highest-risk group showing only 27.8% probability of 12-year disability- and dementia-free survival compared to 87.8% in the lowest-risk group. Key predictors included age, sex, education, and, particularly, IC impairments in locomotion, visual acuity, and cognition-all assessable during routine primary care consultations.

CONCLUSIONS: The HLI provides a practical tool for real-time, personalized assessment of healthy longevity risk in primary care settings. Its design enables providers to deliver person-centered care through targeted interventions and individualized prevention strategies that promote healthy aging across populations, especially in older adults.

PMID:41183329 | DOI:10.2196/80034

JMIR Res Protoc. 2025 Nov 3;14:e76405. doi: 10.2196/76405.

ABSTRACT

BACKGROUND: Heterogeneity in outcome selection and measurement methods has been noted in studies examining the minimization of physical restraint use in adult intensive care units (ICUs). This variability undermines evidence synthesis, limiting the development of evidence-based approaches to minimize restraint use and improve patient outcomes.

OBJECTIVE: This protocol outlines the methods for developing international consensus on core outcomes and standardized measurement approaches for studies focused on physical restraint minimization in adult ICUs.

METHODS: We will follow the Core Outcome Measures in Effectiveness Trials Handbook. Drawing on our previous work, including a scoping review of studies on physical restraint minimization and interviews with family members, we will compile a list of potential outcomes for a 2-round Delphi survey. In round 1, stakeholders will rank outcomes using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) scale. In round 2, they will review the aggregated results for rescoring and refinement. A consensus meeting using the modified nominal group technique will finalize the core outcome set, followed by another meeting to agree on standardized measurement methods.

RESULTS: Research ethics board approval is in progress. Recruitment has not yet begun. Project initiation is anticipated in January 2026, with completion planned for April 2027 and publication of findings is expected by June 2027.

CONCLUSIONS: This study will be the first to establish a core outcome set and a core outcome measurement set for minimizing restraint use in adult ICUs. Standardization will enhance comparability across future studies and support evidence synthesis. The resulting outcome and measurement sets will provide a foundation for high-quality research and guide evidence-based strategies to improve patient safety and care in ICU settings.

TRIAL REGISTRATION: COMET Initiative 3368; https://tinyurl.com/yubfzre9.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/76405.

PMID:41183322 | DOI:10.2196/76405