Nevin Manimala

Malar J. 2025 Apr 15;24(1):121. doi: 10.1186/s12936-025-05346-1.

ABSTRACT

BACKGROUND: Long-Lasting Insecticidal Nets (LLINs) are effective malaria prevention tools. However, information is limited about their durability and wash resistance in field circumstances, especially in seasonal transmission areas in South Asia. This study comprised a systematic examination of usage, physical integrity and insecticidal activity of LLINs in households in Afghanistan, three years after distribution.

METHODS: In 2014, 500 households in 5 malaria endemic Afghan provinces (Balkh, Herat, Khost, Kunduz and Nangarhar) that had received LLINs (PermaNet 2.0) three years earlier were randomly selected through cluster sampling. All household heads were interviewed about LLIN survivorship, usage and maintenance. One randomly selected LLIN from each household was rigorously inspected to calculate the proportionate Hole Index (pHI). Four location-specific pieces from 200 randomly selected LLINs (40 per province) underwent cone bioassay testing in the Jalalabad entomology laboratory, to measure mosquito knock-down after 60 min and 24-h mortality. The number and percentage of nets with ≥ 80% mosquito mortality was assessed. Five location-specific pieces from 34 randomly selected LLINs (5-8 per province) were tested for insecticidal content by High-Performance Liquid Chromatography (HPLC).

RESULTS: Of the 1190 distributed LLINs, 1045 were still in the household at the time of the survey (survivorship 87.8%) and 1006 of those (96.3%) had been used every night in the past week. 9.1% of the LLINs were used by more than three people.. Physical integrity measurements indicated that 97.0% of the LLINs were in a serviceable condition (pHI 0-642), while 3.0% were ‘too torn’ (pHI > 642). Functional Net survival was 93.4% (95%CI 91.7-94.8%). However, only 28% of the LLINs met the WHOPES ≥ 80% mortality criterion. Washing of LLINs was associated with a significant reduction in mosquito mortality. Median deltamethrin concentration was 0.12 g/kg netting material (6.7% of the original concentration at production).

CONCLUSIONS: LLIN survivorship and functional net survival in this setting was excellent, while only a minority of LLINs retained sufficient insecticidal activity after three years of usage. This study underlines the need for evaluation of real-life LLIN durability in field circumstances. LLIN washing should be avoided, as it lowers insecticide content and LLIN efficacy.

PMID:40234878 | DOI:10.1186/s12936-025-05346-1

BMC Oral Health. 2025 Apr 15;25(1):575. doi: 10.1186/s12903-025-05947-x.

ABSTRACT

BACKGROUND: The quality of marginal and internal adaptation plays a crucial role in the clinical longevity of pediatric crowns. This study aimed to evaluate the effect of restoration type (3D-printed, milled, and prefabricated) on the marginal and internal adaptation and absolute marginal discrepancy (AMD) values of crowns for primary molar teeth.

METHODS: Three restoration groups were created: 3D-printed resin, milled resin-matrix ceramic, and prefabricated zirconia crowns (n = 10 per group). A typodont tooth was prepared according to the guidelines for prefabricated zirconia crowns and scanned to design restorations. 3D-printed and milled crowns were fabricated from the same design. All crowns were cemented on standardized 3D-printed resin dies with self-adhesive resin cement. Marginal and internal adaptation and AMD values were evaluated using micro-computed tomography (micro-CT) at multiple measurement points. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey HSD tests, with statistical significance set at P < 0.05.

RESULTS: The restoration type significantly influenced the marginal and internal gap and AMD values (P < 0.05). The prefabricated crown group exhibited the highest marginal gap (233.5 ± 33.4 μm) and internal gap (538.6 ± 47.4 μm). The 3D-printed group showed the highest AMD value (299.5 ± 70.2 μm). The milled group demonstrated the lowest gap values, which remained within clinically acceptable limits.

CONCLUSIONS: Prefabricated zirconia crowns displayed the highest marginal and internal gaps, whereas milled crowns exhibited the most favorable adaptation values within clinically acceptable limits. Given their superior adaptation, CAD-CAM-produced restorations may be a recommendable alternative for pediatric patients.

PMID:40234877 | DOI:10.1186/s12903-025-05947-x

Radiat Oncol. 2025 Apr 15;20(1):53. doi: 10.1186/s13014-025-02630-x.

ABSTRACT

PURPOSE: Although partial breast irradiation (PBI) is accepted as an effective and cosmesis-preserving technique for low-risk early-stage breast cancer following standard lumpectomy, data supporting PBI following oncoplastic surgery are sparse. We report prospective data in efforts to determine whether PBI can be safely utilized after oncoplastic surgery.

METHODS: Patients with low-risk stage 0-1 breast cancer following successful lumpectomy with optional oncoplastic reconstruction were enrolled on a phase II trial. Patients were treated with a modified Florence regimen to 30 Gy in 5 fractions on the Varian Edge radiosurgery system using IMRT or VMAT. Presurgical MRI, post-operative seroma and surgical clips were used to assist target delineation. The effect of oncoplastic surgery on radiation dosimetry and Breast Cancer Treatment Outcome Scale scores were assessed using student’s t-test for continuous variables and chi-square for categorical variables.

RESULTS: From 2018 to 2022, 50 patients with 52 tumors were enrolled with 48% undergoing oncoplastic reconstruction. Although median PTV volumes were numerically larger in the oncoplastic group (266 cc vs. 223 cc), there were no statistically significant differences in PTV volumes, ratio of PTV to whole breast or mean heart or lung doses (p > 0.05). Mean baseline BCTOS aesthetic scores were 1.35 for standard lumpectomy vs. 2.52 for oncoplastic (p = 0.003). At long-term follow-up > 2 years, mean BCTOS aesthetic scores were 1.29 for standard lumpectomy vs. 1.35 for oncoplastic (p = 0.71). At a median follow-up of 46 months, there were no local recurrences.

CONCLUSIONS: When utilizing pre-treatment MRI, surgical clips and a relatively large PTV, PBI after oncoplastic surgery was safe and effective for appropriately selected patients. In combination with oncoplastic surgery, partial breast irradiation achieves excellent long-term cosmesis that improves over time.

PMID:40234874 | DOI:10.1186/s13014-025-02630-x

Chaos. 2025 Apr 1;35(4):043132. doi: 10.1063/5.0252938.

ABSTRACT

We use the minimum description length (MDL) principle, which is an information-theoretic criterion for model selection, to determine echo-state network readout subsets. We find that this method of MDL subset selection improves accuracy when forecasting the Lorenz, Rössler, and Thomas attractors. It also improves the performance benefit that occurs when higher-order terms are included in the readout layer. We provide an explanation for these improvements in terms of decreased linear dependence and improved consistency.

PMID:40233402 | DOI:10.1063/5.0252938

Chaos. 2025 Apr 1;35(4):043134. doi: 10.1063/5.0244816.

ABSTRACT

In this paper, we illustrate the innovative techniques to explore the dynamical properties of the hybrid complex systems by various parameters and demonstrate the clusters under the chaotic-condensation peculiarities to accentuate the different technological challenges in the modern world. The complex dynamic characteristics of the contemplated systems are explored with interferometry techniques, which play key roles in examining the consequences of intricate features to interpreting the dynamics of an assemblage that possesses the ability to traverse along dependable tracks of particles, and thus, the solutions within the framework of quantum perturbation for partially chaotic structures are explored with substantial peculiar outcomes in the expanding active matter systems. Correlation graphs with chaotic parameters illustrate the significance of coherent stochastic generation for quasi-granular systems at finite momenta that possess sufficient fractions of instability fluxes. The distribution of temperature profiles is demonstrated by employing specific techniques to account for the different asymmetries and distinct formulas that characterize the structure of the dynamical system using realistic interference methods. The analytical solution contained distinctive information about the response of chaotic and probabilistic droplets within the multiplicities throughout hot and cold particulates, which are triggered by an influenced time crossover phase that occurs continually under the emissions of various sources that proliferate. Our results indicate that the newly developed phase encompasses the partially coherent collection of active matter with the temperature, which probes the rapidity of its transformation, and such phases exhibit significant mutual relationships. The findings accentuate the significance of contemplating correlations and bestowing extraordinary farsightedness about the meticulous manifestation of complex systems. The current methods are unique in obtaining new forms of solutions that appear beneficial for researchers to further understand nonlinear dynamical problems. The acquired techniques are also applicable to examine the solutions of other types of chaotic systems with mathematical analysis through machine learning.

PMID:40233401 | DOI:10.1063/5.0244816

Chaos. 2025 Apr 1;35(4):043128. doi: 10.1063/5.0250492.

ABSTRACT

Two dynamical indicators, the local dimension and the extremal index, used to quantify persistence in phase space have been developed and applied to different data across various disciplines. These are computed using the asymptotic limit of exceedances over a threshold, which turns to be a generalized Pareto distribution in many cases. However, the derivation of the asymptotic distribution requires mathematical properties, which are not present even in highly idealized dynamical systems and unlikely to be present in the real data. Here, we examine in detail the issues that arise when estimating these quantities for some known dynamical systems. We focus on how the geometry of an invariant set can affect the regularly varying properties of the invariant measure. We demonstrate that singular measures supported on sets of the non-integer dimension are typically not regularly varying and that the absence of regular variation makes the estimates resolution dependent. We show as well that the most common extremal index estimation method is not well defined for continuous time processes sampled at fixed time steps, which is an underlying assumption in its application to data.

PMID:40233400 | DOI:10.1063/5.0250492

Chaos. 2025 Apr 1;35(4):043131. doi: 10.1063/5.0249549.

ABSTRACT

This work explores the relationship between state space methods and Koopman operator-based methods for predicting the time evolution of nonlinear dynamical systems. We demonstrate that extended dynamic mode decomposition with dictionary learning (EDMD-DL), when combined with a state space projection, is equivalent to a neural network representation of the nonlinear discrete-time flow map on the state space. We highlight how this projection step introduces nonlinearity into the evolution equations, enabling significantly improved EDMD-DL predictions. With this projection, EDMD-DL leads to a nonlinear dynamical system on the state space, which can be represented in either discrete or continuous time. This system has a natural structure for neural networks, where the state is first expanded into a high-dimensional feature space followed by linear mapping that represents the discrete-time map or the vector field as a linear combination of these features. Inspired by these observations, we implement several variations of neural ordinary differential equations (ODEs) and EDMD-DL, developed by combining different aspects of their respective model structures and training procedures. We evaluate these methods using numerical experiments on chaotic dynamics in the Lorenz system and a nine-mode model of turbulent shear flow, showing comparable performance across methods in terms of short-time trajectory prediction, reconstruction of long-time statistics, and prediction of rare events. These results highlight the equivalence of the EDMD-DL implementation with a state space projection to a neural ODE representation of the dynamics. We also show that these methods provide comparable performance to a non-Markovian approach in terms of the prediction of extreme events.

PMID:40233399 | DOI:10.1063/5.0249549

J Am Acad Orthop Surg. 2025 Apr 10. doi: 10.5435/JAAOS-D-24-01041. Online ahead of print.

ABSTRACT

Workplace violence (WPV) is a pervasive issue in health care that has shown rising incidence in recent years. There are several risk factors related to the worker, occupational environment, and patient that predispose to WPV events and should be considered in risk mitigation strategies. WPV has been associated with negative effects on worker health and professional efficacy. Past work has shown that multifactorial intervention models are more effective at improving WPV prevention and response in health care. This review summarizes the statistical trends, risk factors, and negative effects of WPV in health care, as well as interventions to improve prevention and response.

PMID:40233398 | DOI:10.5435/JAAOS-D-24-01041

J Am Acad Orthop Surg. 2025 Apr 10. doi: 10.5435/JAAOS-D-24-01049. Online ahead of print.

ABSTRACT

INTRODUCTION: The steep rise in utilization of large language model chatbots, such as ChatGPT, has spilled into medicine in recent years. The newest version of ChatGPT, ChatGPT-4, has passed medical licensure examinations and, specifically in orthopaedics, has performed at the level of a postgraduate level three orthopaedic surgery resident on the Orthopaedic In-Service Training Examination question bank sets. The purpose of this study was to evaluate ChatGPT-4’s diagnostic and decision-making capacity in the clinical management of bone-related injuries of the foot and ankle.

METHODS: Eight bone-related foot and ankle orthopaedic cases were presented to ChatGPT-4 and subsequently evaluated by three fellowship-trained foot and ankle orthopaedic surgeons. Cases were scored using criteria on a Likert scale, graded from a total score of 5 (lowest) to 25 (highest) across five criteria. ChatGPT-4 was referred to as “Dr. GPT,” establishing a peer dynamic so that the role of an orthopaedic surgeon was emulated by the chatbot.

RESULTS: The average score across all criteria for each case was 4.53 of 5, noting an overall average sum score of 22.7 of 25 for all cases. The pathology with the highest score was the second metatarsal stress fracture (24.3), whereas the case with the lowest score was hallux rigidus (21.3). Kendall correlation analysis of interrater reliability showed variable correlation among surgeons, without statistical significance.

CONCLUSION: ChatGPT-4 effectively diagnosed and provided appropriate treatment options for simple bone-related foot and ankle cases. Importantly, ChatGPT did not fabricate treatment options (ie, hallucination phenomenon), which has been previously well-documented in the literature, notably receiving its second-highest overall average score in this criterion. ChatGPT struggled to provide comprehensive information beyond standard treatment options. Overall, ChatGPT has the potential to serve as a widely accessible resource for patients and nonorthopaedic clinicians, although limitations may exist in the delivery of comprehensive information.

PMID:40233367 | DOI:10.5435/JAAOS-D-24-01049

JMIR Res Protoc. 2025 Apr 15;14:e63269. doi: 10.2196/63269.

ABSTRACT

BACKGROUND: Cognitive impairments are a key aspect of schizophrenia spectrum disorders (SSDs), significantly affecting clinical and functional outcomes. The COVID-19 pandemic has heightened concerns about mental health services and cognitive stimulation opportunities. Despite evidence-based interventions like action-based cognitive remediation (ABCR) and metacognitive training (MCT), a research-to-practice gap exists in their application across mental health settings.

OBJECTIVE: The iCogCA study aims to address this gap by implementing digital ABCR and MCT through a national Canadian collaborative effort using digital psychological interventions to enhance cognitive health in SSDs.

METHODS: The study involves 5 Canadian sites, with mental health care practitioners trained digitally through the E-Cog platform, which was developed by our research group. Over 2.5 years, participants with SSDs will undergo pre- and postintervention assessments for clinical symptoms, cognition, and functioning. Each site will run groups annually for both ABCR and MCT, totaling ~390 participants. A nonrandomized concurrent controlled design will assess effectiveness design, in which one intervention (eg, ABCR) acts as the active control for the other (eg, MCT) and vice versa, comparing cognitive and clinical outcomes between the interventions using generalized linear mixed effect modeling. Implementation strategy evaluation will consider the digital platform’s efficacy for mental health care practitioners’ training, contextual factors influencing implementation, and sustainability, using descriptive statistics for quantitative data and thematic analysis for qualitative data.

RESULTS: A pilot pragmatic trial has been conducted previously at the Montreal site, evaluating 3 early implementation outcomes: acceptability, feasibility, and engagement. Patient and therapist acceptability was deemed as high and feasible (21/28, 75% of recruited service users completed therapy, rated feasible by therapists). Technology did not appear to significantly impede program participation. Therapist-rated levels of engagement were also satisfactory. In the ongoing study, recruitment is underway (114 participants recruited as of winter 2024), and intervention groups have been conducted at all sites, with therapists receiving training via the E-Cog learning platform (32 enrolled as of winter 2024).

CONCLUSIONS: At least 3 significant innovations will stem from this project. First, this national effort represents a catalyst for the use of digital technologies to increase the adoption of evidence-based interventions and will provide important results on the effectiveness of digitally delivered ABCR and MCT. Second, the results of the implementation component of this study will generate the expertise needed to inform the implementation of similar initiatives. Third, the proposed study will introduce and validate our platform to train and supervise mental health care practitioners to deliver these interventions, which will then be made accessible to the broader mental health community.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05661448; https://clinicaltrials.gov/study/NCT05661448.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63269.

PMID:40233365 | DOI:10.2196/63269