Nevin Manimala

BMC Nurs. 2025 Dec 16. doi: 10.1186/s12912-025-04221-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Radiotherapy for nasopharyngeal cancer (NPC) frequently induces malnutrition, which is a serious complication that adversely affects patients’ quality of life and prognosis. Although there are currently nutritional assessment procedures for such patients, their clinical effectiveness requires further investigation.

OBJECTIVE: This study aims to evaluate the impact of implementing an optimal nutritional assessment strategy on the nutritional management skills of nurses and patients and on the nutritional status of NPC patients undergoing radiotherapy.

METHODS: The project followed a three-phase approach. In the first phase, a systematic search and critical appraisal of evidence on nutritional management for NPC radiotherapy patients was conducted, yielding 17 best-practice items and 18 audit indicators. A baseline assessment of these indicators was subsequently performed in a radiotherapy ward between November 2024 and January 2025. The findings from this audit informed the second phase, where barriers and facilitators were analyzed using the Consolidated Framework for Implementation Research. This analysis led to the development of the 4 C Nutrition pathway as the core intervention strategy, which was implemented in the third phase from March to May 2025. The effectiveness was evaluated by comparing pre- and post-implementation data on audit compliance, knowledge levels of nurses, patients’ treatment adherence, and nutritional status indicators. Comparative analyses used paired or independent-sample t-tests for continuous variables and chi-square tests for categorical variables, with significance set at P < 0.05 (SPSS software, version 25.0).

RESULTS: A total of 51 patients were included pre-implementation, compared to 52 post-implementation. Following evidence translation, the implementation rates of nurse review indicator increased overall from a range of 0% to 90.2% pre-implementation to 50.00% to 100.00% post-implementation. Nurse nutrition management knowledge questionnaire scores increased from (68.22 ± 5.90) to (85.11 ± 7.10). Patients’ nutritional management adherence scores increased from (103.43 ± 12.92) to (117.00 ± 5.97). Moreover, at the 4-week follow-up, the hemoglobin level in the post-implementation group (126.38 ± 6.19) g/L was significantly higher than the pre-implementation level (109.58 ± 17.15) g/L. All these differences were statistically significant (P < 0.05).

CONCLUSIONS: The implementation effectively enhanced the standardization of clinical nutritional assessment for nurses, significantly narrowed the gap between clinical practice and best evidence, and improved the knowledge of nutritional management among nurses and patients.

TRIAL REGISTRATION: This study has been retrospectively registered with the China Clinical Trial Registry.

CLINICAL TRIAL NUMBER: ChiCTR2500107011. Registration date: 1 August 2025.

PMID:41402847 | DOI:10.1186/s12912-025-04221-3

Respir Res. 2025 Dec 16. doi: 10.1186/s12931-025-03447-8. Online ahead of print.

ABSTRACT

BACKGROUND: Flexible bronchoscopy (FB) is recommended for pediatric Mycoplasma pneumoniae pneumonia (MPP) with persistent consolidation or atelectasis, though substantial heterogeneity in treatment effects exists. This study aimed to develop a causal forest-based predictive model to identify pediatric MPP patients most likely to benefit from FB.

METHODS: This retrospective two-center study enrolled pediatric MPP patients in derivation (n = 753) and validation (n = 139) cohorts. Clinical, laboratory, and AI-quantified computed tomography (CT) data were analyzed. Individual treatment effects (ITEs) were estimated using causal forest algorithms. FB-beneficial subgroups were defined using receiver operating characteristic (ROC) analysis of ITEs, with the varying treatment effect across the subgroups validated via multivariable linear regression. Subgroup characteristics, feature importance, and heatmap-based feature interactions were also analyzed.

RESULTS: FB treatment significantly reduced total fever duration in identified FB-beneficial subgroups in both derivation (β = – 1.16, p < 0.001) and validation (β = – 0.68, p = 0.04) cohorts. These beneficial subgroups exhibited significantly higher consolidation/atelectasis volume (CAV), pneumonia attenuation (PA), and consolidation-to-pneumonia ratio (CAR) compared to non-beneficial groups (all p < 0.001). Heatmap analyses confirmed that increased CAV combined with elevated PA or lymphocyte counts could improve FB efficacy.

CONCLUSIONS: This study developed and validated an individualized prediction model to identify pediatric MPP patients most likely to benefit from FB treatment. Our model may serve as a tool to support clinicians in optimizing FB utilization, potentially reducing unnecessary interventions and associated risks. An accessible online tool of this model facilitates practical clinical implementation.

PMID:41402819 | DOI:10.1186/s12931-025-03447-8

BMC Oral Health. 2025 Dec 16;25(1):1912. doi: 10.1186/s12903-025-07225-2.

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the effects of sintering speed and surface finishing on the optical, mechanical, microstructural, and surface properties of monolithic zirconia ceramics with different yttria content.

MATERIALS AND METHODS: Three different zirconia materials (Katana UTML, Katana STML, DD Cube Bio ZX²) were subjected to either speed or conventionally sintering, followed by the application of various surface treatments. Translucency parameters were measured before and after aging. The biaxial flexural strength was measured after aging. The microstructure of the specimens was examined using scanning electron microscopy (SEM) and X-Ray diffraction (XRD) analyses, while the surface roughness was analyzed using atomic force microscopy (AFM). Statistical analysis of the data was performed using three-way ANOVA, one-way ANOVA, the Kruskal-Wallis test, and Bonferroni post hoc comparisons.

RESULTS: The applied sintering speed, clinical adjustment, and aging processes did not produce a statistically significant effect on flexural strength (p = 0.245) or translucency (p = 0.478). The phase content of Katana UTML was not influenced by sintering speed or clinical adjustment either before or after aging. For the Katana STML material, phase content was unaffected by sintering speed and clinical adjustment prior to aging, but the monoclinic phase was detected in the structure after aging. In the DD Cube Bio ZX² material, the monoclinic phase was observed both before and after aging, and the proportion of the monoclinic phase increased after aging. SEM analysis revealed that speed sintering reduced the average grain size of monolithic zirconia. AFM analysis indicated that, after aging, the glazed samples of Katana UTML and Katana STML exhibited smoother surfaces compared to the grinding and polishing groups of the same materials. Furthermore, the speed sintering of DD Cube Bio ZX² material resulted in the formation of a more homogeneous surface. The increase in yttria content in the material decreased flexural strength and the amount of monoclinic phase formed after aging while increasing translucency, grain size, and the proportion of the cubic phase (p = 0.000).

CONCLUSION: Speed sintering, surface finishing, and aging did not significantly affect the translucency or flexural strength of monolithic zirconia. Polishing kits designed for zirconia can be used after speed sintering. Higher yttria content improved translucency, grain size, cubic phase, and aging resistance, but reduced flexural strength and monoclinic phase after aging.

PMID:41402817 | DOI:10.1186/s12903-025-07225-2

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