Category: Nevin Manimala

J Med Internet Res. 2025 Jan 2;27:e53205. doi: 10.2196/53205.

ABSTRACT

BACKGROUND: Requests for public social care support can be made through an online portal. These digital “front doors” can help people navigate complex social care systems and access services. These systems can be set up in different ways, but there is little evidence about the impact of alternative arrangements. Digital front-door systems should help people better access services, particularly low-intensity services (high-intensity care is likely to require a full in-person assessment).

OBJECTIVE: This study aimed to investigate the association between 2 primary digital front door arrangements, easy-read information, and self-assessment tools provided on official websites, and the type of social care support that is offered: ongoing low-level support (OLLS), short-term care (STC) and long-term care (LTC).

METHODS: Information on front door arrangements was collected from the official websites of 152 English local authorities in 2021. We conducted a cross-sectional analysis using aggregated service use data from official government returns at the local authority level. The independent variables were derived from the policy information collected, specifically focusing on the availability of online digital easy-read information and self-assessment tools for adults and caregivers through official websites. The dependent variables were the rates of using social care support, including OLLS, STC, and LTC, across different age groups: the adult population (aged 18 and older), younger population (aged between 18 and 64 years), and older population (aged 65 and older). Multivariate regression analysis was used to examine the association between digital front door arrangements and access to social care support, controlling for population size, dependency level, and financial need factors.

RESULTS: Less than 20% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system with about 25% (37/147) adopting digital self-assessment within their system. We found that local authorities that offered an integrated digital easy-read information format showed higher rates of using OLLS (β coefficient=0.54; P=.03; but no statistically significant association with LTC and STC). The provision of an online self-assessment system was not associated with service use in the 1-year (2021) cross-sectional estimate, but when 2 years (2020 and 2021) of service-use data were analyzed, a significant positive association was found on OLLS rates (β coefficient=0.41; P=.21). Notably, these findings were consistent across different age groups.

CONCLUSIONS: These findings are consistent with our hypothesis that digital systems with built-in easy-read and self-assessment may make access to (low-intensity) services easier for people. Adoption of these arrangements could potentially help increase the uptake of support among those who are eligible, with expected benefits for their care-related well-being. Given the limited adoption of the digital front door by local authorities in England, expanding their use could improve care-related outcomes and save social care costs.

PMID:39746193 | DOI:10.2196/53205

JMIR Med Inform. 2025 Jan 2;13:e58457. doi: 10.2196/58457.

ABSTRACT

BACKGROUND: In this study, we evaluate the accuracy, efficiency, and cost-effectiveness of large language models in extracting and structuring information from free-text clinical reports, particularly in identifying and classifying patient comorbidities within oncology electronic health records. We specifically compare the performance of gpt-3.5-turbo-1106 and gpt-4-1106-preview models against that of specialized human evaluators.

OBJECTIVE: We specifically compare the performance of gpt-3.5-turbo-1106 and gpt-4-1106-preview models against that of specialized human evaluators.

METHODS: We implemented a script using the OpenAI application programming interface to extract structured information in JavaScript object notation format from comorbidities reported in 250 personal history reports. These reports were manually reviewed in batches of 50 by 5 specialists in radiation oncology. We compared the results using metrics such as sensitivity, specificity, precision, accuracy, F-value, κ index, and the McNemar test, in addition to examining the common causes of errors in both humans and generative pretrained transformer (GPT) models.

RESULTS: The GPT-3.5 model exhibited slightly lower performance compared to physicians across all metrics, though the differences were not statistically significant (McNemar test, P=.79). GPT-4 demonstrated clear superiority in several key metrics (McNemar test, P<.001). Notably, it achieved a sensitivity of 96.8%, compared to 88.2% for GPT-3.5 and 88.8% for physicians. However, physicians marginally outperformed GPT-4 in precision (97.7% vs 96.8%). GPT-4 showed greater consistency, replicating the exact same results in 76% of the reports across 10 repeated analyses, compared to 59% for GPT-3.5, indicating more stable and reliable performance. Physicians were more likely to miss explicit comorbidities, while the GPT models more frequently inferred nonexplicit comorbidities, sometimes correctly, though this also resulted in more false positives.

CONCLUSIONS: This study demonstrates that, with well-designed prompts, the large language models examined can match or even surpass medical specialists in extracting information from complex clinical reports. Their superior efficiency in time and costs, along with easy integration with databases, makes them a valuable tool for large-scale data mining and real-world evidence generation.

PMID:39746191 | DOI:10.2196/58457

CBE Life Sci Educ. 2025 Mar 1;24(1):ar9. doi: 10.1187/cbe.24-02-0078.

ABSTRACT

The aim of inclusive education is to provide a supportive space for students from every background. The theory of intersectionality suggests that multiple identities intersect within social spaces to construct specific positionalities. To support the heterogeneity of all students, there is a need to understand who is in our Science, Technology, Engineering and Mathematics (STEM) courses and how we would go about assessing this. This article problematizes the traditional approach to demographic data collection and presents the beginnings of an alternative approach. The study utilized qualitative and quantitative data in order to examine the way students self-describe within a large multi-institutional program. There were 2,082 students presented with 12 identity categories and asked to specify which of these identities were important to them for their own self-definition and then write an open self-description. The data was analyzed using descriptive statistics, comparative proportional usage analyses of identity categories by traditional demographic groupings, and hierarchical cluster analysis of identity variables. The results showed that the majority of students use multiple categories of identity in combination, that these identity preferences differ in relation to traditional demographic categories, and that there were four underpinning identity orientations consisting of a focus on heritage, health, self-expression, and career.

PMID:39746189 | DOI:10.1187/cbe.24-02-0078

Comput Inform Nurs. 2025 Jan 1;43(1):e01217. doi: 10.1097/CIN.0000000000001217.

ABSTRACT

This descriptive study aims to investigate the content, quality, and reliability of YouTube videos containing content related to endotracheal tube aspiration. The study was scanned using the keywords “endotracheal aspiration” and “endotracheal tube aspiration,” and 22 videos were included in the study. The contents of the selected videos were measured using the Endotracheal Tube Aspiration Skill Form, their reliability was measured using the DISCERN Survey, and their quality was measured using the Global Quality Scale. Of the 22 videos that met the inclusion criteria, 18 (81.8%) were educational, and four (18.2%) were product promotional videos. When pairwise comparisons were made, the coverage score of open aspiration videos was higher for educational videos than for product promotion videos (P < .005). Useful videos had higher reliability and quality scores than misleading videos (P < .05). In addition, the reliability and quality scores of videos uploaded by official institutions were significantly higher than those of videos uploaded by individual users (P < .05). This study found that the majority of endotracheal tube aspiration training videos reviewed in the study were published by individual users, and a significant proportion of these videos had low levels of reliability and quality.

PMID:39746187 | DOI:10.1097/CIN.0000000000001217

Int J Radiat Biol. 2025 Jan 2:1-10. doi: 10.1080/09553002.2024.2445582. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to investigate the radiobiological effects underlying the inhibition of breast cancer (BCa) following radiotherapy in nude mice models, and to evaluate the impact of changes in immunohistochemical parameters induced by FF and FFF beams.

MATERIALS AND METHODS: The study included thirty-six adult nude mouse models, which were randomly assigned to five groups: control (G1), breast cancer (BCa) (G2), FF-400 MU/min (G3), FFF-1100 MU/min (G4), and FFF-1800 MU/min (G5). The control group received neither radiation nor treatment, while the BCa group had a cancer model without radiation. The BCa models were subjected to a single dose of 20 Gy of radiotherapy at varying dose rates. Twenty days after the implantation of the MCF-7 cancer cell line, the nude mice were irradiated and sacrificed 48 h later for ER, PR, HER-2, Ki-67, CD-133, Caspase-3, APAF-1, NOS-2 and NOS-3 IHC analysis.

RESULTS: A statistically significant decrease in IHC staining values for ER, Ki-67 and NOS-2 was observed in the FF-400 MU/min, FFF-1100 MU/min and FFF-1800 MU/min groups due to radiotherapy compared to the BCa group. The FFF beams demonstrated superior efficacy in the treatment of BCa. The significant differences in Caspase-3 and APAF-1 levels were found between BCa and control groups, while CD-133, NOS-3, HER-2, and PR staining showed no differences between groups.

CONCLUSIONS: It was concluded that FFF beam was more effective than FF beam for BCa, especially on ER, Ki-67 and NOS-2 IHC parameters.

PMID:39746183 | DOI:10.1080/09553002.2024.2445582

JCO Glob Oncol. 2025 Jan;11:e2300407. doi: 10.1200/GO.23.00407. Epub 2025 Jan 2.

ABSTRACT

PURPOSE: Management of locally advanced rectal cancer (LARC) includes neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision. Recently, total neoadjuvant treatment (TNT) has gained attention. In developing countries, patients with rectal cancer often present at advanced stages. This study assesses treatment patterns and outcomes in LARC at a largest referral center in Ethiopia.

MATERIALS AND METHODS: A cross-sectional study was conducted on 100 patients with LARC treated at Tikur Anbessa Specialized Hospital from January 2020 to September 2022.

RESULTS: The median age at diagnosis was 45.5 years (range, 20-86), with 51% male. Of the patients, 81% had no previous oncologic treatment and 75.3% was discussed in a multidisciplinary tumor board. Up-front surgery was planned for 44.4% of patients, whereas 22.2% and 8.6% were assigned to TNT and NACRT, respectively. Among 81 treatment-naïve patients, 79 were triaged for surgery, but only 47 (59.5%) underwent surgery, achieving an 89.9% R0 resection rate. Of 36 up-front planned surgeries, 35 proceeded as planned, whereas only 12 of 43 (28%) planned after neoadjuvant treatment underwent surgery. Neoadjuvant chemotherapy (NACT) was given to 37% of patients, with 16.7% (5 of 30) undergoing subsequent surgery. Radiotherapy was given to 24.2% of participants, with 56.25% undergoing surgery. Short-course radiotherapy (SCRT) was given to two patients. Only 14.8% completed all planned treatments, with radiation waiting time (median, 10 months) being the main impediment.

CONCLUSION: Timely administration of neoadjuvant treatment is not possible in most resource-limited settings. Because of better treatment completion, up-front surgery looks a more viable option than NACT in these situations. Extended waiting time for radiotherapy can be mitigated by opting for alternatives like SCRT in selected patients.

PMID:39746169 | DOI:10.1200/GO.23.00407

JCO Glob Oncol. 2025 Jan;11:e2400431. doi: 10.1200/GO-24-00431. Epub 2025 Jan 2.

ABSTRACT

PURPOSE: Metastatic urothelial carcinoma (mUC) poses a challenge to health care systems, given its treatment complexity and mortality. We aimed to describe the characteristics, treatment patterns, and survival outcomes of Mexican patients with mUC.

METHODS: A retrospective study was conducted across eight centers for adults with mUC from January /2001 to December 2021. We recorded medical history, eligibility for first-line platinum therapy, treatment lines received, and access to novel drugs. Descriptive statistics were used and survival analysis, including Kaplan-Meier curves and Cox proportional hazards model, was performed.

RESULTS: We identified 379 patients with mUC; 37 were excluded, and 76% was male, with a median age of 67 years. The median follow-up was 8.4 months. Among those who received a first-line treatment (65%), cisplatin-based chemotherapy (45%) was the most common followed by carboplatin (39%). Causes of cisplatin ineligibility were Eastern Cooperative Oncology Group ≥2 (41%) and glomerular filtration rate <60 mL/min (33%). The overall response rate to up-front platinum therapy was 33%, with a median progression-free survival of 6.1 months (95% CI, 4.9 to 6.9). Second-, third-, and fourth-line treatment was given to 24.6%, 8.8%, and 3.5%, respectively. Chemotherapy was the most common regimen prescribed. Access to novel drugs was limited, 14 patients received avelumab, and 25% received immunotherapy as second-line treatment. The median overall survival was 11.8 months (95% CI, 10.2 to 15.2). Multivariate analysis showed that first-line treatment was independently associated with better survival, whereas poor performance status and visceral disease were associated with worse survival.

CONCLUSION: To our knowledge, these data represent the first effort to delineate treatment trends of mUC in Mexico. First-line treatment prescription and rates of progression to platinum therapy were higher than those described worldwide. Factors affecting survival included performance status, first-line treatment, and visceral disease. Our study highlights unequal access to novel treatments, underscoring the need for equitable care.

PMID:39746168 | DOI:10.1200/GO-24-00431

J Clin Oncol. 2025 Jan 2:JCO2401875. doi: 10.1200/JCO-24-01875. Online ahead of print.

ABSTRACT

PURPOSE: In light of evolving evidence that some patients with node-positive estrogen receptor-positive (ER+) disease may receive less benefit from chemotherapy, this study reports 12-year outcomes of the C9741 trial overall, and by the sensitivity to endocrine therapy (SET2,3) test index, a biomarker measuring endocrine transcriptional activity, to identify patients most likely to benefit from dose-dense chemotherapy.

METHODS: In all, 1,973 patients were randomly assigned to dose-dense versus conventional chemotherapy. Hazard ratios (HRs) for prognosis and for predictive interaction with chemotherapy schedule were estimated from Cox models of long-term disease-free survival (DFS) and overall survival (OS). SET2,3 was tested on the 682 banked RNA samples from ER+ cancers.

RESULTS: Dose-dense chemotherapy improved DFS in the overall study population by 23% (HR, 0.77 [95% CI, 0.66 to 0.90]) and OS by 20% (HR, 0.80 [95% CI, 0.67 to 0.95]); the benefits of dose-dense therapy were seen for ER+ and ER-negative subsets, without significant interaction between treatment arm and ER status. Low SET2,3 status was highly prognostic, but also predicted improved outcomes from dose-dense chemotherapy (interaction P = .0998 for DFS; 0.027 for OS), independent of menopausal status. Specifically, low endocrine transcriptional activity predicted benefit from dose-dense chemotherapy, whereas tumor burden and proliferation-driven signatures for molecular subtype classification did not.

CONCLUSION: At 12-year follow-up, C9741 confirmed the sustained long-term benefit of adjuvant dose-dense chemotherapy for node-positive breast cancer. SET2,3 identified patients with ER+ breast cancer who benefited from dose-dense chemotherapy, and specifically, this benefit was predicted by low endocrine activity in the cancer, rather than tumor burden, molecular subtype, or menopausal status.

PMID:39746162 | DOI:10.1200/JCO-24-01875

J Am Chem Soc. 2025 Jan 2. doi: 10.1021/jacs.4c13999. Online ahead of print.

ABSTRACT

We recently reported a chiral phosphoric acid (CPA) catalyzed enantioselective photomediated ring contraction of piperidines and other saturated heterocycles. By extruding a single heteroatom from a ring, this transformation builds desirable C(sp³)-C(sp³) bonds in the ring contracted products; however, the origins of enantioselectivity remain poorly understood. In this work, enantioselectivity of the ring contraction has been explored across an expanded structurally diverse substrate scope, revealing a wide range of enantioselectivities (0-99%) using two distinct CPA catalysts. Mechanistic investigations support rate-determining excitation that generates short-lived achiral intermediates that are intercepted by the CPA in an enantiodetermining ring closure. The effects of competitive uncatalyzed reactivity and light-driven reversibility of the enantiodetermining ring closure on enantioselectivity have been elucidated. Statistical models were built by regressing the range of enantioselectivities from the substrate scope against key structural features of the products for both CPA catalysts. The resultant models suggested distinct factors that influence the enantioselectivity response for each catalyst and enabled rational modification of a pharmaceutically relevant target molecule to improve enantioselectivity. Finally, density functional theory (DFT)-based transition state analysis identified distinct noncovalent interactions with each catalyst that correlated with the unique selectivity-relevant features uncovered through statistical modeling. Our findings not only offer comprehensive insight into the origins of enantioselectivity in this system but should also aid future development of related photomediated CPA-catalyzed reactions.

PMID:39746148 | DOI:10.1021/jacs.4c13999

J Pediatr Ophthalmol Strabismus. 2024 Dec 30:1-8. doi: 10.3928/01913913-20241121-01. Online ahead of print.

ABSTRACT

PURPOSE: To compare changes of vertical palpebral fissure height after bilateral lateral rectus (BLR) recessions versus unilateral lateral rectus (LR) recession and medial rectus (MR) muscle scleral plication, for treatment of intermittent exotropia.

METHODS: This prospective, comparative, randomized study included 40 patients with intermittent exotropia who were divided into two groups: 20 patients who underwent BLR recessions (BLR recession group) and 20 patients who underwent unilateral LR recession and MR muscle scleral plication (recession-plication group). Eyelid evaluation included measurement of margin reflex distance 1 (MRD1) and margin reflex distance 2 (MRD2) at 1 week, 6 weeks, and 3 months postoperatively. Angle of deviation and any incomitance were also recorded at each visit.

RESULTS: There was no significant statistical difference in eyelid measurements after the surgery between both groups (P = 1.00). There was no significant statistical difference in ocular alignment after the surgery between both groups (P = 1.00). Also, there was no significant statistical difference in lateral incomitance after the surgery between both groups (P = 1.00).

CONCLUSIONS: Both the unilateral recession and plication of horizontal rectus muscles technique and bilateral recession provide comparable surgical results for correction of exotropia without significant palpebral fissures changes or lateral incomitance. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

PMID:39746118 | DOI:10.3928/01913913-20241121-01