Nevin Manimala

JMIR Nurs. 2025 Jun 16;8:e72230. doi: 10.2196/72230.

ABSTRACT

BACKGROUND: Diabetes has become a significant global health issue, particularly imposing a deep economic burden on low-income countries. Innovative and integrated digital solutions can reduce the impact of diabetes and enhance the quality of care. However, digital solutions have not been utilized before in Myanmar.

OBJECTIVE: This study aimed to demonstrate the novel integrated effect of diabetes knowledge and registry tools on the performance of front-line health workers in primary health care settings.

METHODS: A quasi-experimental study with an intervention and a control group was conducted in two townships from October 2022 to April 2023. For the first time, researchers trained the intervention group to use digital tools for diabetes control and performed monthly follow-ups. The study employed multiple linear regression models to explore the novel impact of digital tools on knowledge and performance scores, their correlations, and their association with covariates. Additionally, it assessed the cost-effectiveness of the intervention by using self-administered questionnaires as measurement tools formulated based on the National Diabetes Guidelines.

RESULTS: A total of 96 participants were enrolled in the study, divided evenly into the two groups. The intervention group exhibited a significant increase in the mean knowledge scores from 85.81 to 99.25 (P<.001) and performance scores from 71.22 to 107.16 (P<.001). The intervention accounted for 43.2% of the variance in knowledge scores and 62.5% in performance scores (P<.001). A positive correlation was found between knowledge and performance scores (r=0.45, P<.001). The intervention was also cost-effective, with a cost-effectiveness analysis value of 0.711 and an incremental cost-effectiveness ratio of 10127.04 Kyats (US$ 4.83).

CONCLUSIONS: As the new integrated intervention yields significant economic gains and positive effects, researchers suggest policy makers replicate this intervention as a nationwide program and recommend scaling up the use of digital tools to improve knowledge and performance for diabetes control in frontline health workers.

PMID:40523215 | DOI:10.2196/72230

JCO Oncol Pract. 2025 Jun 16:OP2401075. doi: 10.1200/OP-24-01075. Online ahead of print.

ABSTRACT

PURPOSE: To explore long-term young adult (YA) cancer survivors’ experience with health insurance in a post-Affordable Care Act (ACA) era.

METHODS: This was a mixed-methods analysis of insurance-related data collected from a cohort of English-speaking YA (currently age 18-39 years) blood cancer survivors, ≥3 years from diagnosis, recruited from six US hospitals as part of a financial navigation interventional study (ClinicalTrials.gov identifier: NCT05620979). Participants completed baseline questionnaires, with a subset participating in semistructured interviews after the 6-month study period. Summary statistics were reported for survey responses. Qualitative interviews were coded using directed content analysis.

RESULTS: A total of 130 long-term (median, 10 [IQR, 6-16] years from diagnosis) YA survivors were enrolled, and 45 participated in interviews. Among the total cohort, most (63%) had employer-based private insurance; 22% had public insurance through Medicaid. Eighteen percent reported seeking a new health insurance plan in the past year to afford survivorship care. Over a fifth (23%) reported not knowing how to seek help navigating insurance, while 30% reported delaying or forgoing survivorship care because of not understanding their insurance plan. Four themes emerged from the interviews: (1) Many YA survivors experience insurance churn (ie, moving between plans or between insured and uninsured status); (2) learning to navigate the insurance system is confusing and not straightforward; (3) interactions related to insurance coverage are time-consuming and stressful; and (4) insurance churn and/or out-of-pocket costs affect YAs’ ability to receive optimal medical care.

CONCLUSION: Ongoing insurance-related challenges persist for YA cancer survivors in a contemporary post-ACA era. Although the ACA has provided essential coverage for many patients, ongoing issues include excessive insurance churn, lack of navigation resources, and the continued financial burden of out-of-pocket costs.

PMID:40523211 | DOI:10.1200/OP-24-01075

Clin Neuropharmacol. 2025 Jun 13. doi: 10.1097/WNF.0000000000000642. Online ahead of print.

ABSTRACT

OBJECTIVES: Currently, there is a paucity of optimal treatment method for ischemic stroke. This study conducted a meta-analysis of the application value of indobufen combined with clopidogrel in the field of ischemic stroke.

METHODS: The randomized controlled trials of indobufen combined with/without clopidogrel for the treatment of ischemic stroke were retrieved in Cochrane Library, PubMed, and CNKI from the establishment time of database to November 28, 2023. Cochrane risk-of-bias tool and Review Manager software were used for study quality evaluation and meta-analysis, respectively.

RESULTS: A total of 5 studies were ultimately included, published from 2021 to 2023, with a total of 408 patients. The meta-analysis results showed that the intervention group had a higher effective rate in treating stroke than the control group, with statistically significant difference (94.25% vs 75.29%, relative risk = 1.25, 95% confidence interval [CI] [1.14, 1.37], P < 0.00001), and there was no significant heterogeneity among the studies (P = 0.64, I2 = 0%). In addition, the meta-analysis results indicated that indobufen combined with clopidogrel decreased National Institutes of Health Stroke Scale score (mean difference [MD] = -3.52, 95% CI [-5.7, -1.35], P = 0.001), fibrinogen (MD = -0.65, 95% CI [-1.1, -0.2], P = 0.004), platelet aggregation (MD = -5.84, 95% CI [-6.96, -4.73], P < 0.00001), whole blood low shear viscosity (MD = -4.38, 95% CI [-4.81, -3.94], P < 0.00001), and whole blood high shear viscosity (MD = -0.96, 95% CI [-1.19, -0.73], P < 0.00001) and elevated thrombin time (MD = 0.42, 95% CI [0.09, 0.74], P = 0.01), but had no statistical effects on activated partial thromboplastin time and adverse reactions.

CONCLUSION: The dual antiplatelet therapy regimen using indobufen and clopidogrel is suitable for the treatment of ischemic stroke, which can effectively alleviate neurological damage and inhibit cerebral thrombogenesis.

PMID:40523207 | DOI:10.1097/WNF.0000000000000642

Proc Natl Acad Sci U S A. 2025 Jun 24;122(25):e2319933121. doi: 10.1073/pnas.2319933121. Epub 2025 Jun 16.

ABSTRACT

Choosing social partners is a potentially demanding task which involves paying attention to the right information while disregarding salient but possibly irrelevant features. The resultant trade-off between cost of evaluation and quality of decisions can lead to undesired bias. Information-processing abilities mediate this trade-off, where individuals with higher ability choose better partners leading to higher performance. By altering the salience of features, technology can modulate the effect of information-processing limits, potentially increasing or decreasing undesired biases. Here, we use game theory and multiagent reinforcement learning to investigate how undesired biases emerge, and how a technological layer (in the form of a perceptual intervention) between individuals and their environment can ameliorate such biases. Our results show that a perceptual intervention designed to increase the salience of outcome-relevant features can reduce bias in agents making partner choice decisions. Individuals learning with a perceptual intervention showed less bias due to decreased reliance on features that only spuriously correlate with behavior. Mechanistically, the perceptual intervention effectively increased the information-processing abilities of the individuals. Our results highlight the benefit of using multiagent reinforcement learning to model theoretically grounded social behaviors, particularly when real-world complexity prohibits fully analytical approaches.

PMID:40523185 | DOI:10.1073/pnas.2319933121

Langmuir. 2025 Jun 16. doi: 10.1021/acs.langmuir.5c01673. Online ahead of print.

ABSTRACT

Plasma Electrolytic Oxidation (PEO) coatings enhance the physical and chemical properties of metallic substrates, including corrosion resistance, wear resistance, and thermal stability. These enhancements are strongly influenced by the porous surface morphology of the coatings, which affects the ion transport, stress distribution, and permeability. Accurate quantification of pore structures is essential for understanding interfacial structure-property relationships, yet traditional image segmentation methods often fail to capture the complexity of PEO surfaces in SEM images. This study presents a deep learning-based segmentation framework using U-Net architectures integrated with Atrous Spatial Pyramid Pooling (ASPP) to improve multiscale feature extraction. The performance impact of ASPP placement within different parts of U-Net was systematically evaluated. Results show that modifications to the bridge and decoder paths have the greatest impact on segmentation performance, with a combined modification applying ASPP in both achieving the highest F1 score (0.9360) and the highest IoU (0.8798). Statistical analysis using 5-fold cross-validation, bootstrap confidence intervals, and paired t-tests confirmed that only the bridge-modified model (B_1×1) significantly outperformed the baseline (p < 0.05). The proposed approach enables high-fidelity pore segmentation and supports advanced microstructural analysis of PEO coatings. By facilitating accurate morphological quantification, it contributes to the understanding of structure-property relationships in interfacial materials and offers a robust tool for future materials characterization workflows.

PMID:40523154 | DOI:10.1021/acs.langmuir.5c01673

J Extra Corpor Technol. 2025 Jun;57(2):89-95. doi: 10.1051/ject/2025013. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: The use of cell salvage reduces homologous blood transfusions during operations and avoids associated complications. Therefore, autotransfusion is an integral part of Patient Blood Management (PBM). The quality control of cell salvage in Germany is performed by checking the target values of a hematocrit in the autotransfusion blood (target: over 50%) and a total protein elimination (target: over 90%). The aim of this study was to identify intraoperative circumstances leading to deviations from the target values.

METHODS: This retrospective data analysis includes the use of the cell saver at the Charité – Universitätsmedizin Berlin, Campus Charité Mitte and Campus Benjamin Franklin from 01.01.2019 to 29.03.2022, in which autotransfusion occurred. In addition to the hematocrit and total protein elimination, the age and gender of the patients, as well as the surgical diagnosis, were included to investigate possible factors influencing compliance with the target values. The data were statistically analyzed using SPSS.

RESULTS: A total patient collective of 238 cell salvage applications (154 men, 84 women) was examined. The target values for quality control were achieved on average. The target value for hematocrit was not achieved in about 22% and for total protein elimination in about 8% of cell salvage applications. The age and gender of the patient, as well as the surgical diagnosis, had very little to no influence on compliance with the target values. The target values were not met primarily when the emergency option of the cell saver was used, when the collection volume was too low or when the collection volume was heavily diluted with rinsing fluid.

CONCLUSION: The target values for quality control were achieved in most of the cell salvage applications examined and are suitable for ensuring the quality of autotransfusion. Special clinical circumstances may lead to the treating anesthetist having to accept deviating collection volumes or washing processes.

PMID:40523136 | DOI:10.1051/ject/2025013

J Periodontol. 2025 Jun 16. doi: 10.1002/jper.11362. Online ahead of print.

ABSTRACT

BACKGROUND: This prospective cohort trial examines the effects of heavy smoking on peri-implant marginal bone loss (MBL) and implant survival rates over 15 months.

METHODS: Thirty subjects, categorized as either smokers (more than 20 cigarettes daily for over 5 years) or non-smokers, were initially recruited with pocket depths ≤ 5 mm and at least one missing tooth. Urine cotinine assay was used to confirm smoking status. Implants were placed and restored after 4 months. Clinical, radiographic and stability variables were assessed at placement, 15, 24, and 67 weeks. Measurements included marginal bone height, peri-implant pocket depth, implant stability, bleeding on probing, and plaque index. Statistical analyses included Mann-Whitney tests for continuous variables, Fisher exact tests for categorical variables, and generalized estimating equations for longitudinal changes.

RESULTS: Thirteen implants were installed in the smoker group (11 subjects) and 18 in the non-smoker group (18 subjects). Survival rates were lower in smokers (84.6%) compared with non-smokers (94.4%). Smokers experienced significantly greater marginal bone loss 12 months after final reconstruction (1.5 ± 0.3 mm versus 0.7 ± 0.6 mm; p = 0.008). Pocket depth was slightly greater in smokers but this did not reach statistical significance.

CONCLUSIONS: Heavy smoking significantly increases marginal bone loss and decreases implant survival. Further research is needed to corroborate these findings and develop intervention programs.

PLAIN LANGUAGE SUMMARY: Heavy smoking is a well-known risk factor for poor dental health, yet its effects on dental implants are less frequently examined. This study investigated how heavy smoking (more than 20 cigarettes daily for at least 5 years) impacts the success of dental implants. We monitored 29 patients, including both heavy smokers and non-smokers, over 15 months after implant placement and restoration. We evaluated bone loss, implant stability, and success rates. Our results showed that heavy smokers experienced significantly more bone loss-twice as much as non-smokers-along with slightly reduced implant stability and survival. These adverse outcomes likely relate to smoking’s negative effects on bone healing and immune function. Our findings underscore the importance of addressing smoking before implant procedures and suggest that quitting smoking could greatly improve long-term outcomes. Further research is needed to develop strategies for mitigating the risks of smoking in implant dentistry.

PMID:40522719 | DOI:10.1002/jper.11362

JAMA Intern Med. 2025 Jun 16. doi: 10.1001/jamainternmed.2025.1853. Online ahead of print.

ABSTRACT

IMPORTANCE: Cystic fibrosis is one of the most commonly diagnosed autosomal recessive disorders in the US. It is estimated that more than 10 million individuals are heterozygous for a pathogenic CFTR gene variant in the US (heterozygotes). The phenotypic risk of these heterozygotes is not well defined, particularly among populations of predominantly non-European genetic ancestry. Understanding disease risk across each population can improve management strategies for all.

OBJECTIVE: To examine associations of diseases across the phenome with CFTR heterozygotes.

DESIGN, SETTING, AND PARTICIPANTS: The All of Us Research Program is a US-based ongoing longitudinal cohort study whose enrollment started nationally in 2018. In this genetic association study, whole-genome sequencing data were linked to electronic health records (EHRs) and surveys. Participants were 18 years and older. Similarity to genetic ancestral groups was genetically inferred using All of Us data and 2 large reference datasets, the 1000 Genomes Project and Human Genome Diversity Project. This analysis was conducted between February and April 2025.

EXPOSURES: A single pathogenic CFTR variant.

MAIN OUTCOMES AND MEASURES: The main variables included clinical diagnoses documented in EHRs. Multivariable-adjusted phenome-wide association studies were performed. The main measures were odds ratios (ORs), indicating risk for a particular disease or condition.

RESULTS: Overall, 363 pathogenic variants were identified in the cohort. Among 317 964 adult participants (55.7% female; mean [SD] last age in EHR, 56.1 [16.9] years), 7957 heterozygotes and 280 995 noncarriers were identified. Participants were followed up through EHRs with a mean (SD) follow-up of 12.4 (9.0) years. The genetically inferred ancestral distribution of the cohort was 18.0% African, 16.2% American or Admixed American, 2.1% East Asian, 53.4% European, 0.3% South Asian, and 0.4% West Asian. Frequencies of heterozygotes varied by groups of genetic similarity to reference populations: 3.62% in participants most genetically similar to a European reference population (n = 169 812), 1.35% in participants most genetically similar to an African reference population (n = 57 297), and 1.86% in participants most genetically similar to an Admixed American reference population (n = 51 483). A total of 2909 phenotypes were analyzed. No statistically significant associations were identified in heterozygotes of all populations combined or within each genetic ancestral group. Among 52 cystic fibrosis-associated diseases, although an elevated risk of respiratory diseases and infections was observed in some heterozygotes (allergic bronchopulmonary aspergillosis [OR, 2.50; 95% CI, 1.27-4.95]; bronchiectasis [OR, 1.21; 95% CI, 1.00-1.47]; pneumonia due to Streptococcus pneumoniae [OR, 1.54; 95% CI, 1.05-2.26]; chronic obstructive pulmonary disease [OR, 1.14; 95% CI, 1.05-1.24]; asthma [OR, 1.08; 95% CI, 1.01-1.15]; and Pseudomonas infection [OR, 1.34; 95% CI, 1.03-1.74]), effect sizes of these associations were several orders of magnitude lower than those found in homozygotes or predicted compound heterozygotes.

CONCLUSIONS AND RELEVANCE: In this genetic association study, most heterozygotes did not appear to have a substantially higher risk of cystic fibrosis-associated diseases during their adulthood compared to noncarriers. Additional studies are needed to investigate the underlying factors for the elevated risk of respiratory and infectious diseases in some heterozygotes.

PMID:40522671 | DOI:10.1001/jamainternmed.2025.1853

JAMA Netw Open. 2025 Jun 2;8(6):e2515980. doi: 10.1001/jamanetworkopen.2025.15980.

ABSTRACT

IMPORTANCE: The onset of the COVID-19 pandemic created urgency for advance care planning, including documenting goals-of-care conversations (GoCCs), while seismically disrupting usual health care delivery. Characterizing trends in GoCC rates during the pandemic can provide insight into the extent to which health care systems prioritized advance care planning in the face of competing clinical demands, shifts to telemedicine, and staffing shortages.

OBJECTIVE: To determine how the COVID-19 pandemic was associated with changes in outpatient first-ever GoCCs.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of patients eligible for their first-ever documented GoCC in outpatient clinics at 123 US Veterans Health Administration facilities nationwide from March 2019 to February 2023.

EXPOSURE: COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES: National- and facility-level weekly GoCC rates, defined as number of first-ever documented GoCCs per 100 000 outpatient appointments. Secondary analyses examined associations between facility-level characteristics and facility GoCC rates.

RESULTS: Of 5 027 956 patients nationally, 124 216 (2.5%) had a first-ever outpatient GoCC during the study period (facility-level range: 0.01%-26.3%). The mean (SD) weekly national first-ever outpatient GoCC rate was 99.6 (12.1) in the year preceding the pandemic. At pandemic onset, mean weekly outpatient GoCC rates dropped to a nadir of 74.1 (week of March 21, 2020), then sharply increased, peaking at 177.4 (week of April 18, 2020), before steadily declining to pre-COVID-19 rates and ending with a COVID year 3 mean (SD) of 96.6 (11.5). At the facility level, 29 of 123 facilities (23.6%) significantly increased outpatient GoCC rates in the early pandemic and maintained or further improved through COVID year 3, with significant rate increases pre-COVID to COVID year 3.

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study of outpatient GoCC rates, the early COVID-19 pandemic was associated with initial disruption and then with increased first-ever outpatient GoCC rates nationally. Despite unprecedented challenges to health care delivery, several facilities increased GoCC rates during the first COVID-19 surge and maintained increased rates through 2023. These facilities could serve as models for best practices to improve advance care planning.

PMID:40522660 | DOI:10.1001/jamanetworkopen.2025.15980

JAMA Netw Open. 2025 Jun 2;8(6):e2515986. doi: 10.1001/jamanetworkopen.2025.15986.

ABSTRACT

IMPORTANCE: Sudden unexpected infant death (SUID) is the leading cause of postneonatal mortality, with disparities attributed to social determinants of health (SDOH). SUID in the Hispanic population has received limited attention, despite the fact that one-fourth of US children are Hispanic.

OBJECTIVE: To compare SUID rates and risk factors among Hispanic and non-Hispanic infants, and associated interactions among SUID, SDOH, and acculturation.

DESIGN, SETTING, AND PARTICIPANTS: This US nationwide retrospective cohort study used US National Center for Health Statistics (NCHS) linked birth and infant death data, and Pregnancy Risk Assessment Monitoring System (PRAMS) data from 1996 to 2017. All live births (NCHS) or participants (PRAMS) with documented maternal ethnicity were included. Data were analyzed from February to October 2024.

EXPOSURE: Maternal Hispanic ethnicity.

MAIN OUTCOMES AND MEASURES: The primary outcome was postneonatal SUID occurring at age 28 to 364 days, as designated by International Classification of Diseases, Ninth Revision codes 798, 799, and 913 (1996-1999), and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes R95, R99, and W75 (2000-2017). Odds ratios (ORs) were calculated by exposure, and adjusted ORs controlled for risk factors in a multivariable model. Maternal nativity variables associated with race, poverty, local SUID rates, and region of origin were investigated. Subgroup analysis explored the relative association of Hispanic ethnicity with SUID risk factors. Maternally reported risk factors were compared according to Hispanic ethnicity.

RESULTS: Among 88 067 608 live births (median [IQR] maternal age, 27 [22-32] years; median [IQR] gestational age, 39 [38-40] weeks) and 54 828 SUID deaths, there were 7173 SUID deaths among 19 887 156 Hispanic infants. The SUID rate was lower for Hispanic infants (0.36 deaths per 1000 live births) than for non-Hispanic infants (0.70 deaths per 1000 live births), across essentially all factors analyzed. Overall, Hispanic infants had 33% lower odds of SUID than non-Hispanic infants (adjusted OR, 0.67; 95% CI, 0.65-0.69). Infants of non-US-born Hispanic mothers had lower SUID rates, regardless of race, county-level poverty, local SUID rates, or Hispanic region of origin, except Puerto Rican infants. Altered associations with detrimental and protective factors were found, despite a mixed picture of risk.

CONCLUSIONS AND RELEVANCE: In this cohort study of SUID in infants born from 1996 to 2017, Hispanic infants had lower SUID rates than non-Hispanic infants, despite adverse SDOH. Risk factors operated differently in Hispanic infants, challenging current conceptualizations of risk. Understanding how risk operates in Hispanic populations can help to better address the mortality burden of SUID.

PMID:40522659 | DOI:10.1001/jamanetworkopen.2025.15986