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Complex Patient Scores Meaningfully Affect 2022 Medicare Merit-Based Incentive Payment System Bonus Payments for Orthopedic Surgeons
Full text linkIntroduction: The Merit-Based Incentive Payment System (MIPS) affects Medicare reimbursements for over 600,000 clinicians, including ~ 15,000 orthopedic surgeons in the United States. MIPS policies are rapidly evolving, yet limited research exists to guide orthopedic surgeons in optimizing performance. This study evaluates whether recent MIPS policy changes have led to increased payment adjustments for orthopedic surgeons and examines the role of MIPS in enhancing care quality.
Methods: A retrospective analysis of 2021-2022 MIPS performance data from nearly 9000 orthopedic surgeons assessed the impact of policy changes on payment adjustments using McNemar's test and mixed effects logistic regression.
Results: Raising the MIPS performance threshold to 75 points significantly reduced the likelihood of receiving bonus payments (χ 2 = 803.21, degrees of freedom = 1; P < .01). Surgeons in smaller practices had 60% lower odds of earning bonus payments (odds ratio, 0.40; 95% confidence interval, 0.33-0.48; P < .008), though this disparity was smaller than previously reported. The updated complex patient bonus scoring policy showed the strongest positive effect on the likelihood of receiving bonus payments (odds ratio, 6.49; 95% confidence interval, 3.31-12.76; P < .017). Nonetheless, MIPS continues to fall short in encouraging the reporting of specialty-specific, outcome-based, and patient-experience measures.
Discussion: Raising the MIPS performance threshold further may lead to greater dissatisfaction. Despite some improvements, equity gaps remain for small and rural practitioners. However, the revised complex patient bonus policy effectively rewards clinicians caring for high-risk populations
Recommendations for Studying In Situ Extracellular Vesicles From Solid Tissue
No full textSolid tissue-derived extracellular vesicles (ST-EVs) are extracellular vesicles (EVs) separated directly from solid tissues of both vertebrates and invertebrates. ST-EVs provide a physiologically relevant snapshot of tissue-specific molecular dynamics and can be enriched directly in situ, from tissues in their natural state, preserving the native characteristics of ST-EVs. However, their enrichment presents unique technical challenges compared to EVs derived from biofluids or cell culture media. The need for transparent reporting in ST-EV research is crucial to enhance the reproducibility, comparability, and reliability of research findings. The Solid Tissue Task Force, part of the Scientific Reproducibility Subcommittee of International Society for Extracellular Vesicles, aims to recommend reporting parameters and identify outstanding questions related to the pre-analytical and analytical handling of solid tissues, as well as ST-EV separation and characterization. These steps are essential for advancing the understanding of the biological roles of ST-EVs and their potential clinical applications
Kidney Complications in Children with Bronchopulmonary Dysplasia
Full text linkBackground: To describe kidney outcomes in a cohort of children with bronchopulmonary dysplasia (BPD).
Methods: We assessed short-term (acute kidney injury defined using neonatal KDIGO criteria) and long-term kidney outcomes, including chronic kidney disease (defined as a GFR < 90 ml/min/1.73 m2), albuminuria, and hypertension in a single-center retrospective cohort of children with BPD born between 2010 and 2020.
Results: 309 (38.8%) of 797 children included in the cohort had acute kidney injury (AKI) during their NICU admission. Kidney specific follow-up evaluation was infrequent in this cohort; 52.4% of patients had serum creatinine testing and 31.5% had a urinalysis performed after discharge. 163 (32.0%) of 510 patients with long-term data had CKD, which occurred at a median age of 2.2 years. An abnormal eGFR occurred in 31.7%, proteinuria in 12.5% and hypertension in 15.2%.
Conclusions: Children with BPD had high frequencies of AKI and CKD. While the retrospective nature and single-center convenience cohort design limit generalizability, our findings suggest that children with BPD should be carefully monitored for short- and long-term kidney outcomes, including CKD.
Impact: Children with bronchopulmonary dysplasia (BPD) may have a higher likelihood of both acute and chronic kidney complications than currently recognized. Kidney outcomes in children with BPD is an area that remains underexplored. To our knowledge, this is the first study exploring the prevalence of CKD in a cohort of children with BPD. Our findings suggest children with BPD have high rates of kidney complications in early childhood. Increased attention should be placed on monitoring children with BPD for both short- and long-term kidney outcomes
Polygenic risk score predicts pathologically confirmed cerebral amyloid angiopathy
No full textIntroduction: Cerebral amyloid angiopathy (CAA) and Alzheimer's disease (AD) both involve amyloid beta (Aβ) accumulation in vessels and brain parenchyma, respectively. As Aβ-targeting therapies emerge, CAA draws attention due to its link with amyloid-related imaging abnormalities (ARIA), underscoring the need for biomarkers beyond magnetic resonance imaging (MRI).
Methods: CAA polygenic risk scores (CAA-PRS) were generated in 105 ADNI participants, and their predictive ability for pathological CAA was evaluated, including in subgroups with high amyloid burden or without MRI-visible CAA markers.
Results: CAA-PRS was significantly associated with pathological CAA (OR = 1.766, p < 0.001), with an AUC of 0.783 overall and 0.766 (OR = 1.780, p = 0.002) in those with high amyloid burden. A marginal association was observed in MRI-negative individuals.
Discussion: CAA-PRS may serve as a complementary biomarker to imaging for identifying high-risk individuals with CAA, particularly in the context of Aβ-targeting therapies and ARIA risk.
Highlights: CAA-PRS is generated. CAA-PRS is associated with pathologically confirmed CAA. CAA-PRS is associated with CAA in individuals with high amyloid burden
Voiceprints of cognitive impairment: analyzing digital voice for early detection of Alzheimer's and related dementias
Full text linkEarly detection of Alzheimer's disease (AD) is critical yet challenging, particularly in younger individuals. This study leverages artificial intelligence to analyze digital voice recordings from the Craft Story Recall task within the Longitudinal Early-onset AD Study (LEADS) to (1) detect cognitive impairment and (2) differentiate early-onset AD (EOAD) from early onset non-AD cognitive impairment (EOnonAD). Using speech samples from 120 patients and 68 cognitively unimpaired controls, we employed two classification approaches: feature-engineered machine learning and end-to-end deep learning incorporating a Large Language Model. To detect mild cognitive impairment, the feature-engineered model, using acoustic and linguistic features, achieved an AUC of 0.945 on the holdout test set, while the end-to-end model yielded an AUC of 0.988. For differentiating EOAD from EOnonAD, the feature-engineered model achieved an AUC of 0.804, and the end-to-end model yielded an AUC of 0.904 on the holdout set. Explainability analyses revealed reduced linguistic informativeness as a key AD indicator
Rethinking psychological treatment targets for pediatric rumination syndrome: Clinical implications from a case series analysis
Full text linkRumination syndrome (RS) is a common pediatric disorder of gut-brain interaction. However, a dearth of research on efficacious treatment to help guide clinical decision-making remains. Thus, relying on well-established treatment recommendations for other conditions with similar mechanisms or symptom profiles may be helpful; for example, conceptualizing RS treatment targets to address it as a "tic disorder of the gut" could be beneficial. To demonstrate the clinical utility of this conceptualization, we presented two cases that provide broad implications for treating pediatric RS. In both cases, akin to pediatric tic and related disorders, cognitive distress and physical discomfort were alleviated temporarily by rumination episodes. Thus, we recommend a targeted diagnostic assessment, including a functional analysis incorporating a transdiagnostic evaluation of symptoms. Close comanagement with specialty physicians and psychologists is also highly recommended. The patients represent complex yet standard cases seen in pediatric psychology outpatient clinics, suggesting the clinical utility of implications for psychologists and allied health professionals
HOTFOOT: Acute Effects of Combined Foot Heating and Pneumatic Compression in Type 2 Diabetes: a Preliminary Report
Full text linkBackground and Hypothesis: Despite over 1.2 million annual U.S. Type 2 Diabetic (T2D) diagnoses, effective therapies for diabetic foot complications remain limited. We hypothesized that a device combining pneumatic compression and localized heating could increase leg blood flow and foot oxygenation in individuals with T2D.
Design and Methods: Six healthy individuals (age: 67±3 years, A1c: 5.7 ± 0.38%) and five with T2D (age: 68±5 years, A1c: 7.06 ± 0.57%) were fitted with dorsal and plantar surface thermocouples and near-infrared spectroscopy sensors (OxiplexTS, ISS) over the metatarsal heads to assess foot temperature and oxygenation. Both legs were fitted with boot-like garments with a water-circulating pad and inflatable bladders (Aquilo Sports). After 30 minutes supine, heat (40°C) and intermittent compression (20 mmHg) were applied to one leg for 60 minutes, while the opposite leg served as control. Popliteal artery velocity and diameter were measured via Doppler ultrasound (GE Medical Systems) at baseline and after 60 minutes. A two-tailed paired t-test assessed differences between legs.
Results: Foot temperature increased by 6.5 ± 1.2°C in healthy controls and by 6.6 ± 1.8°C in participants with T2D (p<0.01). NIRS-derived tissue oxygen saturation (StO₂) increased in the treated foot by 5.3 ± 4.6% in healthy participants (p = 0.01) and by 4.9 ± 10.3% in T2D participants (p = 0.325). Popliteal blood flow increased by 23.0 ± 15.8 mL/min in the treated leg vs. 3.6 ± 18.6 mL/min in the control leg (p = 0.167) in healthy participants. In T2D participants, blood flow increased by 75.8 ± 112.9 mL/min in the treated leg and 8.0 ± 10.7 mL/min in the control leg (p = 0.153).
Conclusion and Potential Impact: Combined foot heating and compression increases foot oxygenation and leg blood flow in older adults with/without T2D. This accessible therapy may aid in managing diabetic foot complications
The Impact of Polygenic Risk, Parental Separation, and Parental Relationship Discord on Heavy Episodic Drinking Across Adolescence and Young Adulthood in a High-Risk Sample
Full text linkObjective: Parental separation and relationship discord are linked to alcohol use behaviors, but their influence on the longitudinal course of alcohol misuse and interactions with genetic predisposition remain unclear. This study examined how the longitudinal course of heavy episodic drinking (HED) from adolescence to young adulthood varies with polygenic risk, parental separation, and relationship discord.
Method: Participants were from the Collaborative Study on the Genetics of Alcoholism (COGA) Prospective Sample, and included individuals from 2 genetically inferred continental groups: European-like (EA; n = 1761) and African-like (AA; n = 894) who were reassessed biennially (mean age = 16.39 at first assessment; mean assessments = 4.65). Alcohol misuse was indexed by past-year HED frequency. Predictors included parental separation, parental relationship discord, and problematic alcohol use polygenic scores (PGSPAU). Data were analyzed using linear mixed-effects growth models.
Results: HED increased through young adulthood before declining. In European Americans (EA), parental separation was associated with HED intercepts, but not with linear slope or quadratic curvature. Higher PGSPAU was associated with a faster initial growth and slower decline. In African American (AA), parental relationship discord was not associated with HED intercepts but was associated with a faster initial growth and slower decline. PGSPAU were not associated the intercept or the course of HED. No interaction was found between PGSPAU and parental separation or discord to predict the longitudinal course of HED in either EA or AA samples.
Conclusion: Genetic risk and exposure to parental separation and discord are associated with the course of HED, with some differences across continental groups
Validation of a Dermatology-Focused Multimodal Large Language Model in Classification of Pigmented Skin Lesions
No full textBackground: Artificial intelligence (AI) has shown significant promise in augmenting diagnostic capabilities across medical specialties. Recent advancements in generative AI allow for synthesis and interpretation of complex clinical data including imaging and patient history to assess disease risk. Objective: To evaluate the diagnostic performance of a dermatology-trained multimodal large language model (DermFlow, Delaware, USA) in assessing malignancy risk of pigmented skin lesions. Methods: This retrospective study utilized data from 59 patients with 68 biopsy-proven pigmented skin lesions seen at Indiana University clinics from February 2023 to May 2025. De-identified patient histories and clinical images were input into DermFlow, and clinical images only were input into Claude Sonnet 4 (Claude) to generate differential diagnoses. Clinician pre-operative diagnoses were extracted from the clinical note. Assessments were compared to histopathologic diagnoses (gold standard). Results: Among 68 clinically concerning pigmented lesions, DermFlow achieved 47.1% top diagnosis accuracy and 92.6% any-diagnosis accuracy, with F1 = 0.948, sensitivity 93.9%, and specificity 89.5% (balanced accuracy 91.7%). Claude had 8.8% top diagnosis and 73.5% any-diagnosis accuracy, F1 = 0.816, sensitivity 81.6%, specificity 52.6% (balanced accuracy 67.1%). Clinicians achieved 38.2% top diagnosis and 72.1% any-diagnosis accuracy, F1 = 0.776, sensitivity 67.3%, specificity 84.2% (balanced accuracy 75.8%). DermFlow recommended biopsy in 95.6% of cases vs. 82.4% for Claude, with multiple pairwise differences favoring DermFlow (p < 0.05). Conclusions: DermFlow demonstrated comparable or superior diagnostic performance to clinicians and superior performance to Claude in evaluating pigmented skin lesions. Although additional data must be gathered to further validate the model in real clinical settings, these initial findings suggest potential utility for dermatology-trained AI models in clinical practice, particularly in settings with limited dermatologist availability
The role for artificial intelligence in identifying combination therapies for Alzheimer’s disease
No full textDespite substantial investment in biomedical and pharmaceutical research over the past two decades, the global prevalence of Alzheimer's disease (AD) and AD-related dementias (AD/ADRD) is still rising. This underscores the significant unmet need for identifying effective disease-modifying therapies. Here, we provide a critical perspective on the application of data science and artificial intelligence (AI) to the rational design of drug combinations in AD and ADRD, addressing their potential to transform therapeutic development. We examine AI's current and prospective capabilities in therapeutic discovery, identify areas where AI-driven strategies can enhance drug combination development, and outline how multidisciplinary professionals in the field, including clinical trialists, neuropsychiatrists, pharmacologists, medicinal chemists, and computational scientists, can leverage these tools to address therapeutic gaps. We also highlight AI's role in synthesizing the rapidly growing amount of biomedical data in the field of AD/ADRD, especially clinical trials, biomarkers, multi-omics data (genomics, transcriptomics, proteomics, metabolomics, interactomics, and radiomics), and real-world patient data. We further explore AI's utility in prioritizing potential drug combination regimens and estimating clinical effect size in combination therapy trials for AD/ADRD. Lastly, we emphasize AI-powered network medicine methodologies for prioritizing drug combinations targeting AD/ADRD co-pathologies and summarize the challenges of their translation to clinical practice