Category: Nevin Manimala

Proc Natl Acad Sci U S A. 2025 Dec 23;122(51):e2526690122. doi: 10.1073/pnas.2526690122. Epub 2025 Dec 16.

ABSTRACT

Strong coupling photonics, in which coupling strengths significantly exceed decay factors, holds great promise for applications in energy conversion and information processing. However, the effective and scalable design of strongly coupled polaritonic structures requires precise determination of the transition boundaries between strong and weak coupling regions. Traditional trial-and-error methods and classical machine learning (ML) algorithms struggle to achieve this due to the inherent difficulty in measuring decay factors during coupling. To address these challenges, we propose a hybrid ML framework that integrates physics-informed modeling with uncertainty quantification. This approach enables accurate determination of strong-weak coupling transition boundaries-even with inaccessible decay factors. By leveraging this capability, our method facilitates efficient and large-scale design of strongly coupled polaritonic structures with sparse data, achieving a computational speedup of ~10⁴ times compared to conventional simulations. Guided by this framework, we experimentally constructed a hexagonal boron nitride (hBN) polariton coupling structure and observed strong coupling via near-field spectroscopy. This work establishes a generalizable optimization methodology for strongly coupled photonic devices, opening a broad avenue for polariton-enhanced energy conversion and optical information modulation.

PMID:41400999 | DOI:10.1073/pnas.2526690122

Work. 2025 Dec 16:10519815251401871. doi: 10.1177/10519815251401871. Online ahead of print.

ABSTRACT

BackgroundShift work is a major occupational health issue, disrupting circadian rhythms and increasing risks for physical, psychological, and social problems. Its impact on sexual function and sexual quality of life among female healthcare workers remains underexplored.ObjectiveThis study examined the impact of shift work on sexual function and sexual quality of life among female healthcare workers and highlighted its occupational health implications within a prevention, assessment, and rehabilitation framework.MethodsA descriptive cross-sectional study was conducted with 390 female healthcare workers in Turkey employed in rotating shifts. Data were collected using a Participant Information Form, the Female Sexual Function Index (FSFI), and the Sexual Quality of Life Questionnaire-Female (SQOL-F). Analyses included descriptive statistics, independent t-tests, one-way ANOVA and Multivariable linear regression.ResultsLonger professional experience, working in high-stress units (intensive care/emergency), ≥ 4 monthly night shifts, and >45 weekly working hours were significantly associated with poorer FSFI and SQOL-F scores (p < 0.05). Conversely, ≥ 32 h of rest after shifts was linked to higher scores. In multivariable analysis, FSFI and FGSIS scores were lower among participants who reported that shift/on-call work affects sexual desire (p < 0.001).ConclusionsShift work negatively affects sexual function and sexual quality of life among female healthcare workers. These outcomes should be recognized as critical occupational health issues. Adequate rest periods, reduced night-shift frequency, and psychosocial support programs are essential preventive and rehabilitative strategies. Worker-centered institutional policies that balance service continuity with employee health may enhance both well-being and healthcare system sustainability.

PMID:41400989 | DOI:10.1177/10519815251401871

J Glaucoma. 2025 Dec 8. doi: 10.1097/IJG.0000000000002671. Online ahead of print.

ABSTRACT

PRECIS: An implantable IOP sensor study in glaucoma patients found that five evenly spaced daily measurements over 18 waking hours effectively reflect the 24-hour IOP rhythm, with peaks and troughs often occurring outside clinic hours.

PURPOSE: The availability of an implantable IOP sensor enables patients to obtain IOP measurements over 24 hours and on demand. The current study assesses the optimal frequency of daily IOP measurements required to reflect the 24-hour IOP rhythm in glaucoma patients.

METHODS: Twenty-two patients with primary open-angle glaucoma (POAG) who had previously been implanted with a sulcus-based IOP sensor (eyemate-IO, Implandata, Germany) as part of the prospective multicentric ARGOS-02 study were enrolled. The following parameters were used to characterize the 24-hour IOP rhythm: distribution of IOP measurements and timing of IOP peaks and troughs. To assess the optimal number of IOP values to predict the 24-hour rhythm, the daily count of IOP measurements and the time interval between the first and last daily measurements were used. The correlation with the detection of daily IOP variability was assessed via student T-test and a kernel-density estimate using Gaussian kernels and Earth Movers Distance.

RESULTS: Twenty-two patients (8 female and 14 male) with a mean age of 67.8±6.8 years were followed up over 6.6±1.7 years with a total of 80,495 IOP measurements. The percentage of peak IOP values was highest (50.6%) during the early morning hours (4 to 5 am), while trough measurements occurred predominantly (42.3%) during the late-night hours (between 11 pm and 12 pm). Five IOP measurements equally distributed over an 18-hour period were sufficient to characterize the 24-hour rhythm. Additional measurements did not yield any statistically significant value in the characterization of 24-hour IOP patterns.

CONCLUSIONS: Using an implanted telemetric sensor, the results of this study show that 5 daily IOP measurements evenly spread over 18 hours, provide sufficient information for assessment of the diurnal IOP rhythm. However, patients in practice recorded on average four measurements over 14 hours, highlighting the gap between the ideal recommendation and real-life adherence.

PMID:41400987 | DOI:10.1097/IJG.0000000000002671

Nutr Cancer. 2025 Dec 16:1-13. doi: 10.1080/01635581.2025.2598922. Online ahead of print.

ABSTRACT

Obesity is a significant lifestyle factor that affects the development and outcomes of endometrial tumors. Excess body weight can disrupt hormonal balance and promote cellular mutations, increasing the risk of endometrial cancer. We developed a three-step stochastic model that incorporates clonal proliferation at each stage to investigate how obesity affects cancer progression. The model was tested on two datasets: non-obesity-related cases from the SEER registry (2010-2020) and obesity-related cases in women from the CDC (2017-2021). Our results show that obesity mainly impacts the development of endometrial tumors by causing genetic mutations in women. The stochastic model indicates that fat increases the rates of both initial and later mutations. Body weight can affect the rate at which early intermediate cells multiply, especially in women who are still premenopausal. Understanding how these cellular changes happen is important for estimating an individual’s risk of developing endometrial cancer.

PMID:41400983 | DOI:10.1080/01635581.2025.2598922

Blood Press. 2025 Dec 16:1-19. doi: 10.1080/08037051.2025.2605798. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effect of acupuncture on 24-hour ambulatory blood pressure (BP) and its circadian rhythm in patients with essential hypertension (EH).

METHODS: A systematic search was conducted across five English databases (PubMed, the Cochrane Library, Embase, Web of Science and The National Library of Medicine) and four Chinese databases (China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and VIP Chinese Science and Technology Journal Full-Text Database). The search period for each database was from inception to 31 May 2025. A meta-analysis was performed using RevMan 5.4.1 software.

RESULTS: A total of 13 randomised controlled trials, involving 1,080 patients with EH, were included. The meta-analysis results showed that compared with the control group, the experimental (acupuncture) group demonstrated significantly lower values in the following parameters: 24-hour average systolic BP (SBP) (MD = -3.57, 95% confidence interval [CI]: -5.04 to -2.10, p < 0.001), 24-hour average diastolic BP (DBP) (MD = -3.61, 95% CI: -5.12 to -2.10, p < 0.001), 24-hour SBP variability (MD = -1.15, 95% CI: -1.57 to -0.73, p < 0.001), 24-hour DBP variability (MD = -0.96, 95% CI: -1.27 to -0.65, p < 0.001), 24-hour SBP load (MD = -3.47, 95% CI: -5.76 to -1.17, p = 0.003) and 24-hour DBP load (MD = -2.20, 95% CI: -4.08 to -0.31, p = 0.02).

CONCLUSION: Compared with Western medication alone, acupuncture combined with Western medication shows significant advantages in improving ambulatory BP parameters, including 24-hour average BP, 24-hour BP variability, 24-hour BP load and the BP circadian rhythm.

PMID:41400971 | DOI:10.1080/08037051.2025.2605798

JAMA Netw Open. 2025 Dec 1;8(12):e2548028. doi: 10.1001/jamanetworkopen.2025.48028.

ABSTRACT

IMPORTANCE: As Medicare Advantage (MA) continues to expand, an increasing number of MA plans are marketed to specific affinity groups, including Asian Medicare beneficiaries in the US. Little is known about the potential trade-offs of these emerging Asian-oriented affinity plans.

OBJECTIVES: To evaluate the prevalence of MA Asian-oriented affinity plans and the characteristics of their Asian beneficiaries, to understand the differences in plan-benefit design between these affinity plans and other MA plans, and to compare the breadth of MA physician networks of Asian-oriented affinity plans vs other MA plans.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2023 national Medicare data to identify Asian-oriented affinity plans. MA plans were identified as Asian-oriented affinity plans if the difference in Asian enrollment between the plan and its service area exceeded the 99th percentile of the Box-Cox-transformed normal distribution. When comparing Asian-oriented affinity plans with other MA plans, the sample was restricted to states where Asian-oriented affinity plans were offered. Data analyses were performed from June 2024 to June 2025.

EXPOSURE: Asian-oriented affinity plan classification.

MAIN OUTCOMES AND MEASURES: Cost-sharing, supplemental benefits, Medicare Star Ratings, and network breadth. Enrollee-weighted, adjusted regression models were used to assess differences in plan-benefit design, Medicare Star Ratings, and network breadth between Asian-oriented affinity plans and other MA plans.

RESULTS: The sample included 4224 MA plans in 2023, of which 27 were identified as Asian-oriented affinity plans. These 27 plans were offered in California, New York, Texas, and Massachusetts and enrolled 16.1% (109 906 of 684 764) of Asian beneficiaries in these states. Asian enrollees in these plans (mean [SD] age, 73.0 [7.19] years; 57 729 females [52.5%]) were more likely to be older, male, without disability, and dually eligible for Medicaid-Medicare benefits. Compared with other MA plans, Asian-oriented affinity plans had a higher likelihood of $0 Part C premiums (adjusted difference, 10.8 [95% CI, 10.8-10.9] percentage points), Part B premium reductions (adjusted difference, 6.7 [95% CI, 6.5-6.9] percentage points), and lower monthly Part D premiums (adjusted difference, -$7.18 [95% CI, -$14.24 to -$0.12]). Asian-oriented affinity plans were more likely than other MA plans to provide culturally relevant benefits, including acupuncture (adjusted difference, 23.2 [95% CI, 23.0-23.4] percentage points) and alternative therapies (adjusted difference, 4.8 [95% CI, 4.7-5.0] percentage points). However, Asian-oriented affinity plans were less likely to cover annual physical examinations (adjusted difference, -41.7 [95% CI, -41.9 to -41.5] percentage points), had lower Medicare Star Ratings, and had narrower physician networks compared with other MA plans.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, while MA Asian-oriented affinity plans offered more culturally relevant benefits and favorable premiums, they came with important trade-offs, including narrower physician networks, lower Medicare Star Ratings, and reduced coverage of certain traditional benefits. Enrollment growth and performance of Asian-oriented affinity plans should be closely monitored to ensure that they address the health care needs of Asian beneficiaries.

PMID:41400953 | DOI:10.1001/jamanetworkopen.2025.48028

JAMA Netw Open. 2025 Dec 1;8(12):e2548380. doi: 10.1001/jamanetworkopen.2025.48380.

ABSTRACT

IMPORTANCE: HIV viral load (VL) testing is essential for monitoring responses to antiretroviral therapy (ART) among people with HIV (PWH) and prior to the initiation of HIV preexposure prophylaxis (PrEP). In the US, the potential benefit of implementing HIV VL testing in these scenarios on linkage to care (LTC) has not been evaluated.

OBJECTIVES: To investigate whether providing laboratory-based HIV VL test results changed LTC rates or time to linkage for ART or PrEP across 12 weeks.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from August 18, 2021, to February 2, 2023, with 12 weeks of follow-up. Participants were a convenience sample of adults with risk factors for HIV acquisition or PWH not taking daily ART, all of whom were recruited from an academic center emergency department in Baltimore, Maryland, and via social media advertising.

INTERVENTIONS: Participants were randomized 1:1 to receive a laboratory-based plasma HIV VL test with next-day results in addition to the standard of care HIV antigen/antibody test result (intervention) or to receive the standard of care HIV antigen/antibody assay alone (control).

MAIN OUTCOMES AND MEASURES: The primary outcome was LTC for ART or PrEP within 12 weeks of enrollment. Secondary outcomes included time to LTC and differences in LTC by HIV status. Analyses were conducted using the intention-to-treat population.

RESULTS: Of 1105 potential participants screened, 195 (17.6%) were enrolled (median [IQR] age 36, [27-47] years; 119 [61.0%) male; 112 [57.4%] Black or African American, 51 (26.2%) White, and 32 (16.4%) other race and ethnicity; and 34 [17.4%] PWH). By week 12, 93 participants (47.7%) completed follow-up, and 69 (35.4%) were linked to care (38 of 69 [55.1%] in the intervention group vs 31 of 69 [44.9%] in the control group). Overall, there was no statistically significant difference in LTC between the intervention and control group (hazard ratio, 1.28 [95% CI, 0.80-2.05]; P = .31]). In a modified intention-to-treat analysis, time to LTC was significantly less for PWH in the intervention group (log-rank P = .03).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial assessing the effects of HIV VL test results on LTC, providing a next-day HIV VL test result did not change LTC overall. More data are required to ascertain whether a rapid point-of-care HIV VL test would improve LTC.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04793750https://clinicaltrials.gov/study/NCT04793750.

PMID:41400951 | DOI:10.1001/jamanetworkopen.2025.48380

JAMA Netw Open. 2025 Dec 1;8(12):e2549815. doi: 10.1001/jamanetworkopen.2025.49815.

ABSTRACT

IMPORTANCE: It is unclear why areas of medicine overrepresented by female physicians receive lower pay. One theory is devaluation-that work done by women is systematically devalued over time.

OBJECTIVE: To assess whether an increase in the proportion of female physicians in a specialty is associated with a decrease in the median annual payments for that specialty.

DESIGN, SETTING, AND PARTICIPANTS: In 2022, a population-based, repeated cross-sectional analysis was conducted using routinely collected data of all active physicians in Ontario, Canada, from 1992-1993 (1993) to 2019-2020 (2020). For each year, the percentage of female physicians and total annual median payments for each specialty were calculated.

MAIN OUTCOME AND MEASURE: Random-effects linear regression models were constructed to evaluate the association between the percentage of female physicians and median payments overall. Additionally, we conducted a sensitivity analysis of the subgroup of physicians with 1.0 or more full-time equivalency (FTE).

RESULTS: The physician workforce increased from 18 572 in 1993 to 31 374 in 2020 with the number of female physicians increasing from 4151 (22.3%) to 13 205 (42.1%). The mean (SD) age for all physicians in 2020 was 49.6 (12.8) years, and for female physicians in 2020 was 46.2 (11.5) years. Median annual payments increased from $183 033 to $316 570. Regression results found that an absolute 1 percentage point increase in the percentage of female physicians in a specialty over 1 year was associated with a $2183 lower increase in median payments than expected overall (95% CI, -$3932 to -$434; P = .02) and a $3235 lower increase for female physicians (95% CI, -$4888 to -$1583; P < .001), but not for male physicians (-$554; 95% CI, -$2373 to $1264).

CONCLUSION AND RELEVANCE: This repeated cross-sectional study did not find evidence to directly support the theory of devaluation, yet the results underscore that occupational segregation, both across and within specialties, is associated with the gender pay gap. These findings should prompt medical leaders and policymakers to reconsider what activities are monetarily valued in medicine and whether these align with what patients and the public consider most valuable from a care perspective.

PMID:41400950 | DOI:10.1001/jamanetworkopen.2025.49815

JAMA Netw Open. 2025 Dec 1;8(12):e2549822. doi: 10.1001/jamanetworkopen.2025.49822.

ABSTRACT

IMPORTANCE: Low-dose vaginal estrogen (VE) is a safe and effective treatment for genitourinary syndrome of menopause (GSM). The frequency of VE prescribing for GSM is unknown.

OBJECTIVE: To evaluate VE prescriptions among women with GSM and to identify clinical phenotypes associated with VE claims.

DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective, population-based cohort study of a 20% random sample of Medicare fee-for-service beneficiaries enrolled in Parts A, B, and D from 2006 to 2018. Women aged 66 years and older with a diagnosis indicative of GSM were included. Exclusion criteria included diagnoses of breast and/or endometrial cancer within 6 months of GSM diagnosis. Data analysis was performed from October 2023 to June 2024.

EXPOSURE: Diagnosis indicative of GSM.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of women with a VE prescription claim (cream, ring, or tablet) during the follow-up period, from first GSM diagnosis to the end of Medicare enrollment or the study period. To quantify associations between patient characteristics and the likelihood of VE claims, univariable and multivariable logistic regression analyses were conducted.

RESULTS: A total of 1 838 732 women with at least 1 GSM-related diagnosis were identified (median [IQR] age, 74 [69-81] years; median [IQR] follow-up, 8 [4-10] years). VE prescriptions were filled by 165 530 women (9.0%) at a median (IQR) of 15 (2-46) months after diagnosis. Older women (adjusted odds ratio [aOR] for >86 years vs 66-70 years, 0.59; 95% CI, 0.58-0.60) and those with higher Charlson Comorbidity Index scores (aOR for score ≥5 vs 0, 0.67; 95% CI, 0.66-0.69) were less likely to have a VE claim. When comparing GSM symptom groups, women with recurrent urinary tract infections were least likely to have a VE claim (aOR vs local sexual symptoms, 0.54; 95% CI, 0.46-0.64). Women with vulvovaginal symptoms (aOR, 2.70; 95% CI, 2.45-2.97) and GSM multimorbidity (aOR, 15.91; 95% CI, 14.41-17.57) were most likely to have a VE claim.

CONCLUSIONS AND RELEVANCE: In this large cohort study, 9.0% of female Medicare beneficiaries with a diagnosis indicative of GSM filled a VE prescription. Younger and healthier beneficiaries and those with GSM multimorbidity were more likely to fill a VE prescription. The majority of patients with GSM symptoms, including dyspareunia, vulvovaginal atrophy, and recurrent urinary tract infections, did not fill a VE prescription. Improving patient and practitioner education, revising the diagnostic code schema to capture the full breadth of symptoms, and validating GSM clinical phenotypes will help facilitate care and enhance our understanding of symptoms in research studies.

PMID:41400949 | DOI:10.1001/jamanetworkopen.2025.49822

Interdiscip Cardiovasc Thorac Surg. 2025 Dec 16:ivaf300. doi: 10.1093/icvts/ivaf300. Online ahead of print.

ABSTRACT

OBJECTIVES: This study develops a visual scoring system based on Chest Computed Tomography(CT) findings to assess donor lung function and explores its use for brain-dead donors.

METHODS: We conducted a retrospective cohort study of 151 donors after brain death managed by our local Organ Procurement Organization from January 1 to June 30 2024. A multidisciplinary team developed a chest CT evaluation protocol based on Fleischner Society guidelines. Lung lesions were scored lobe-by-lobe for statistical analysis.

RESULTS: Of 151 potential donors, 56 (37.09%) underwent lung transplantation. Transplanted lungs had a higher proportion of blood type O, better oxygenation index, lower C-reactive protein and procalcitonin level, and lower CT scores compared to non-transplanted lungs. A higher total lung score (TLS) was strongly and negatively associated with lung utilization (OR 0.643, p < 0.001). ROC curve analysis indicated good discriminative ability for the TLS alone (AUC = 0.803). Our findings establish that chest CT visual scoring is a valuable univariable tool for assessing lungs from brain-dead donors. Based on the CT scoring results, the overall utilization rate of potential lung lobes reached 79.22%.

CONCLUSIONS: In the evaluation of donor lungs, a high TLS demonstrates a significant negative univariable association with lung utilization rates and exhibits good univariable diagnostic accuracy. The TLS has the potential to serve as a powerful and practical screening tool for donor lung assessment. Our findings suggest that chest CT visual scoring holds potential importance in assessing lungs from brain-dead donors and provides meaningful insights into the evaluation of donor lung lobes. However, further studies with larger sample sizes are required to explore these findings in greater depth.

PMID:41400936 | DOI:10.1093/icvts/ivaf300