Nevin Manimala

PLoS Negl Trop Dis. 2025 May 27;19(5):e0013134. doi: 10.1371/journal.pntd.0013134. Online ahead of print.

ABSTRACT

BACKGROUND: Advanced schistosomiasis imposed a heavy economic burden on society and had a high rate of mortality and disability. However, methods for assessing its long-term prognosis were currently insufficient, and there was a lack of predictive tools to aid clinical decision-making and personalized follow-up plans for patients. We sought to determine risk factors associated with six-year all-cause mortality in advanced schistosomiasis, deriving and validating a six-year all-cause mortality prediction model through a retrospective cohort study based on a large population-based cohort.

METHODOLOGY: We collected information from 4,136 patients with advanced schistosomiasis who were discharged between December 2014 and January 2015. After excluding 17 patients with the less common subtypes of colonic tumoroid proliferation and dwarfism, as well as 92 patients who were lost to follow-up or had incomplete information, data from 4,027 patients were included in the study. These patients were randomly assigned to the derivation cohort and the external validation cohort in a 7:3 ratio, with 1,400 patients randomly selected from the derivation cohort for internal validation. Sixteen candidate variables were collected: age, gender, nutritional status, splenectomy history, presence of other conditions (such as cardiovascular and digestive diseases), clinical classification, disease duration, ascites occurrence frequency, levels of serum total bilirubin (TBil), direct bilirubin (DBil), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), alkaline phosphatase (ALP), Hepatitis B surface antigen (HBsAg), and alpha-fetoprotein (AFP). High-risk factors associated with the 6-year mortality outcome were identified through univariate and multivariate Cox proportional hazards regression analyses. The predictive value of different models was evaluated and compared using the receiver operating characteristic (ROC) curves, Akaike information criterion (AIC), net reclassification improvement (NRI), C statistic, and integrated discrimination improvement (IDI).

FINDINGS: The derivation cohort comprised 2819 patients and we randomly selected 1400 cases from this cohort for internal validation. The external cohort consisted of 1208 patients. The mortality rate for three groups was around 27%-28%. We identified ten variables associated with increased risk of death, including age, course of disease, frequence of ascites, hepatitis B co-infection, and levels of DBil, ALT, AST, ALP, ALB, and AFP at baseline. Using these variables, we developed a ten-variable model and three simpler models. In the derivation cohort, the ten-variable model showed the highest C statistic (0.759; 95% CI, 0.739-0.778) and the lowest AIC (2834.2). ROC curves indicated an AUC of 0.759 for the ten-variable model, outperforming the simpler models. External validation also demonstrated superior performance of the ten-variable model with a higher C statistic (0.774; 95% CI, 0.749-0.797). This model consistently showed better results in ROC curves, IDI, continuous NRI, and categorical NRI analyses compared to the reduced models in external validation cohort.

CONCLUSIONS: This study developed a multivariate model to predict the 6-year all-cause mortality rate in patients with advanced schistosomiasis, which demonstrated good performance. This convenient tool may potentially assist clinicians in formulating patient follow-up plans.

PMID:40424464 | DOI:10.1371/journal.pntd.0013134

PLoS One. 2025 May 27;20(5):e0322132. doi: 10.1371/journal.pone.0322132. eCollection 2025.

ABSTRACT

BACKGROUND: Measuring person-centered maternity care outcomes typically consists of two types of measures: experiences of care and satisfaction with care. There are limited validated measurement tools for these measures, particularly in low- and middle-income countries (LMICs). The QUALI-DEC study aims to improve decision-making around caesarean section. We describe development of the QUALI-DEC Study Birth Experience and Satisfaction (QD-BES) scale, and scale validation in Argentina, Burkina Faso, Thailand, and Viet Nam.

METHODS: We used a three-phase scale development and validation approach: 1) item development, 2) scale development, and 3) scale evaluation. We systematically identified existing tools, and assessed them using the QUALI-DEC theory of change, study context, and psychometric qualities. We proposed the 10-item QD-BES scale to balance feasibility, theoretical coverage, and comprehensiveness. We conducted a baseline exit survey with post-partum women in 32 hospitals in 4 countries. We conducted exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

RESULTS: 3127 women participated, most were multiparous (61.0%), without previous caesarean section (77.2%), and preferred vaginal birth (72.8%) despite high rates of caesarean section (39.4%). EFA identified three dimensions: emotional satisfaction (3-items), support and respect by providers (4-items), and communication with providers (3-items), with high loading coefficients (0.5-0.97). CFA confirmed the three-dimension scale, with good model fit (CFI and IFI: 0.95, Cronbach’s alpha: 0.70-0.90). Criterion validity was assessed by exploring characteristics of women, obstetric histories, and birth experiences.

CONCLUSIONS: We present psychometric validation of a scale measuring women’s satisfaction with care and experiences of childbirth care, using a systematic approach to development and validation in four LMICs. The 10-item QD-BES-scale is short, easily-administered, valid, and reliable. The QD-BES-scale is useful to contribute to the generation of new knowledge about quality of maternity care in LMICs, as well as help to meet the major challenge of implementing and measuring respectful care at scale.

PMID:40424400 | DOI:10.1371/journal.pone.0322132

PLoS One. 2025 May 27;20(5):e0323166. doi: 10.1371/journal.pone.0323166. eCollection 2025.

ABSTRACT

With the growing digitization of society, there is a need to enhance computational thinking as an indispensable skill for modern daily life. Consequently, computer science education for children at early ages has become increasingly important. This study conducts a randomized controlled trial to examine the impact of the interventions using educational robotics as well as computer-aided mathematics drills (via a “math app”) on students’ performance in primary schools in Basra, Iraq. We provide several new empirical findings. First, the short-run impact of robotics-based learning on computational thinking is positive and statistically significant for girls, particularly poor performing girls, but not for boys. Second, the impact on computational thinking is augmented by introducing a math app, further improving computational thinking. Together, these two interventions also enhance general intelligence. Third, the positive impact was still evident more than three months after the interventions for girls who received both computer science and math education, suggesting their complementarity. Our results show that computer science education using educational robots in primary schools is effective in enhancing computational thinking and relevant skills.

PMID:40424386 | DOI:10.1371/journal.pone.0323166

Endocr Relat Cancer. 2025 May 1:ERC-25-0018. doi: 10.1530/ERC-25-0018. Online ahead of print.

ABSTRACT

Management of malignant insulinoma (MI) presents dual management challenges of hypoglycaemia and tumour control. This study aims to analyse long-term outcomes of PRRT for treatment of MI. We retrospectively reviewed consecutive patients with MI treated with [177Lu]Lu-DOTATATE (LuTATE) at two Australian NET centres between 2004-2022. Follow-up for hypoglycaemia, molecular imaging, radiologic and biochemical responses, treatment-related side-effects, progression free- and overall-survival were assessed. Of 15 patients (7 female; median age 60, range 26-82) treated for intractable hypoglycaemia WHO Grade (G) was known in 12 patients (3 G1, 6 G2 and 3 G3). PRRT was administered median 7 cycles (range 1-15) with median cumulative activity 42GBq (range 4-117GBq) and radiosensitizing chemotherapy in 9/15 (60%). Resolution of hypoglycaemia was observed in 14/15 (93%) patients after median 2.5 months (range 0.2-23.5) but recurred in 7/14 cases after median 17.7 months (range 7.6-48.3). Patients with recurrent hypoglycaemia had longer time to hypoglycaemia resolution (median 3.0 vs 0.5 months), were more likely G3 (57% vs 0%) and experienced higher mortality (86% vs 29%). In all 7 cases, PRRT re-treatment was successful. Duration of hypoglycaemia remission was median 23.8 months (range 9.2-101). Median progression free- and overall-survival was 17.9 months (95% CI, 8.5-43.2) and 50.1 months (95% CI, 23.0-ND) respectively. Side-effects included G3/4 myelosupression in 4/15 patients, and hypoglycaemia flare (hospitalisation >48 hours) in 7/15 patients. PRRT provides durable hypoglycaemic and oncologic disease control of MI with manageable toxicity including hypoglycaemia flare requiring multidisciplinary care.

PMID:40424062 | DOI:10.1530/ERC-25-0018

Small. 2025 May 27:e2502976. doi: 10.1002/smll.202502976. Online ahead of print.

ABSTRACT

Controlling metal properties is essential for achieving functional applications, as metals show extreme tunability on surface energies, structural surface areas, and sterilization ability. Existing materials for respiratory droplet detection, critical for controlling infectious disease spread, often lack combined extreme wettability and intrinsic antimicrobial activity. Inspired by the photonic crystals of peacock feathers, a highly sensitive and self-sterilizing optical grating sensor is developed based on a core-shell nanostructured copper/copper-zinc and zinc oxide (Cu/CuZn-ZnO) composite (interconnected Cu or CuZn nanoparticles encapsulated by ZnO). A two-step laser-induced process controls the composite’s properties, creating hierarchical, core-shell nanostructures and simultaneously tailoring surface energy and morphology for superhydrophilicity. This laser-engineered superwetting surface, combining increased surface area and low surface energy, amplifies aqueous droplet footprint diameter over fivefold, enabling picoliter-range electrical detection. The amounts and distribution of droplets can be analyzed using point-to-point optical Fourier translation analysis and classical statistics. The laser-generated ZnO and residual copper species provide inherent antimicrobial properties, achieving effective self-disinfection. This integrated superhydrophilicity and self-disinfection platform offers significant potential for advanced respiratory droplet analysis and public health monitoring.

PMID:40424060 | DOI:10.1002/smll.202502976

J Vet Med Educ. 2025 May 27:e20240095. doi: 10.3138/jvme-2024-0095. Online ahead of print.

ABSTRACT

The acquisition of clinical skills is a fundamental component of veterinary education, necessitating effective instructional methods that balance theoretical knowledge and practical application. Although this study primarily aimed to assess the effectiveness of clinical skills laboratory (CSL) training in skill development of first-year veterinary students, an emerging observation was the gender-based differences in skills acquisition and improvement. Given the limited existing research on this aspect, these findings contribute to the understanding of potential gender-related learning variations in surgical training. In this prospective, blinded, randomized clinical trial, 140 first-year veterinary students were tasked with basic suturing exercises. Performance scores demonstrated improvement across all assessed skills, with notable gains in suturing proficiency following CSL training. Students who participated in hands-on practice achieved significantly higher posttest scores compared with those who relied solely on online instruction, reinforcing the effectiveness of practical training. Notably, female students in both groups exhibited a statistically higher increase in performance scores than their male counterparts. These findings underscore the importance of practical, model-based training in CSL for fostering skills acquisition and revealed the impact of gender on skill development. This study contributes to the growing body of evidence supporting the integration of experiential learning into veterinary education and offers insights into optimizing training methods to enhance student outcomes.

PMID:40424030 | DOI:10.3138/jvme-2024-0095

JAMA Netw Open. 2025 May 1;8(5):e2512133. doi: 10.1001/jamanetworkopen.2025.12133.

ABSTRACT

IMPORTANCE: Research biobanks of human cells and tissues, particularly tissues accessible only after death, are crucial for advancing the understanding of human pathophysiological function. Research biobanks are bereft of tissues from individuals of diverse races and ethnicities, thus limiting the generalizability of biobank findings.

OBJECTIVE: To evaluate the barriers and facilitators to participation in postmortem brain donation for research among individuals from historically marginalized races and ethnicities.

EVIDENCE REVIEW: The published literature in PubMed, Embase, Web of Science, and PsycINFO databases was searched from 1973 to January 1, 2024. Studies that were written in English that involved adult participants (aged ≥18 years) and explored attitudes, perceptions, and beliefs on solid organ donation were included. Studies in which organ donation was for transplant and not for research, studies examining pediatric organ donation, narratives or perspectives, and studies that did not examine attitudes or beliefs toward organ donation were excluded. Two authors independently coded and performed a thematic analysis of eligible studies.

FINDINGS: Eighteen studies met the inclusion criteria, which involved 12 124 participants across multiple self-reported races and ethnicities (eg, Black or African American, Chinese, Hispanic or Latiné, and White). Most studies (16 [89%]) evaluated perceptions, attitudes, and beliefs among Black or African American and Hispanic or Latiné individuals toward postmortem brain donation. Five themes that informed the decision to donate were identified: information and misconceptions about the organ donation process (16 studies [89%]), mistrust of the research and medical communities (9 studies [50%]), family involvement (9 studies [50%]), religious and cultural beliefs (9 studies [50%]), and altruism (7 studies [39%]). Mistrust and religious and cultural beliefs were largely barriers to considering postmortem organ donation for research. Misconceptions were common, particularly regarding the donation process and purpose of biospecimens for research. Family involvement was both a barrier and a facilitator. Altruism, particularly understanding that organ donation would benefit the participants’ family, future generations, and community, was a facilitator.

CONCLUSIONS AND RELEVANCE: This systematic review suggests that sharing culturally sensitive information about the organ donation process, engagement of participants and family members in shared decision-making, and addressing barriers and facilitators to donor recruitment practices may increase participation in research biobanks of individuals from underrepresented racial and ethnic groups.

PMID:40423972 | DOI:10.1001/jamanetworkopen.2025.12133

JAMA Netw Open. 2025 May 1;8(5):e2512271. doi: 10.1001/jamanetworkopen.2025.12271.

ABSTRACT

IMPORTANCE: When their proportion of faculty positions are accounted for, Asian American women are the most underrepresented group among academic medicine leadership. Despite the importance of diversity and representation in academic medicine leadership, no study to date has explored the specific factors that hinder or support Asian American women’s advancement to leadership roles in academic medicine.

OBJECTIVE: To characterize perceptions of facilitators and barriers to academic medicine leadership for Asian American women.

DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, Asian American female residents were interviewed between December 1, 2023, and April 30, 2024, using an online video platform. Data were analyzed using thematic content analysis. Eligible participants were recruited through word of mouth, social media groups, cold emailing, and snowball sampling. A purposive sampling strategy ensured diversity in ethnicity, geographic locations of past and current institutions, postgraduate years, and specialties.

MAIN OUTCOMES AND MEASURES: Key themes related to the perceptions of Asian American female residents on facilitators and barriers to leadership in academic medicine.

RESULTS: Fifteen participants (age range, 25-32 years) who self-identified as female and Asian American (3 [20%] Asian Indian, 6 [40%] Chinese, 2 [13%] Korean, 1 [7%] Punjabi, 1 [7%] Taiwanese, and 2 [13%] Vietnamese) were interviewed. Participants were enrolled in residency programs geographically distributed across the US. Training levels ranged from postgraduate year 1 to postgraduate year 6, spanning 9 residency program specialties. This analysis revealed 4 key themes: (1) role models of leadership, especially the representation of Asian American women in leadership positions; (2) multifactorial development of professional identity, specifically through peers, mentors, and formalized institutional programming; (3) the othering nature of workplaces and institutional cultures, including the exclusionary “boys’ club,” discrimination from patients and colleagues, and burden of familial responsibilities imposed on women; and (4) leadership discordance, including differing ideas of leadership and sociocultural perceptions of Asian American women influencing perceptions of leadership potential.

CONCLUSIONS AND RELEVANCE: This qualitative study of Asian American female resident physicians’ perceptions of facilitators and barriers to academic medicine leadership found 4 key themes and identified opportunities for intervention, paving the way for enhanced representation of Asian American women in academic medicine leadership.

PMID:40423971 | DOI:10.1001/jamanetworkopen.2025.12271

JAMA Netw Open. 2025 May 1;8(5):e2512279. doi: 10.1001/jamanetworkopen.2025.12279.

ABSTRACT

IMPORTANCE: Sepsis-associated acute kidney injury (SA-AKI) is a common and clinically important condition in patients who are critically ill. Dysregulated inflammation may contribute to it. Intravenous hydrocortisone may decrease the risk of SA-AKI progression.

OBJECTIVE: To describe the associations of hydrocortisone use with the incidence and outcomes of requirement for kidney replacement therapy (KRT), as well as source of sepsis, mean arterial pressure (MAP), and MAP indexed to required vasopressor (norepinephrine equivalent [NEE]).

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted as a post hoc analysis of the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) randomized clinical trial (RCT), a multicenter placebo-controlled RCT of hydrocortisone in patients with septic shock in 69 intensive care units in Australia, the United Kingdom, New Zealand, Saudi Arabia, and Denmark that recruited between 2013 and 2017. Participants were patients enrolled in the ADRENAL study with septic shock who did not require KRT in the 24 hours prior to randomization and who did not have a prior longstanding dialysis requirement. Data were analyzed between July and September 2024.

EXPOSURES: Receipt of hydrocortisone (vs placebo), MAP at enrollment, vasopressor dose (NEE) and MAP:NEE ratio, source of sepsis, causative organism, bacteremia, and the use of nephrotoxic antimicrobials, vasopressin, or specific inotropes.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were KRT requirement and liberation from KRT, measured as days alive and free of KRT.

RESULTS: A cohort of 3161 patients (median [IQR] age, 65 [53-74] years, 1921 [61%] male) was identified, including 1589 patients randomized to receive hydrocortisone and 1572 patients who received the placebo. Allocation to treatment with hydrocortisone was associated with a significantly reduced incidence of KRT requirement compared with placebo (329 patients [21%] vs 372 patients [24%]; odds ratio [OR], 0.84 [95% CI, 0.70 to 0.99]; P = .04). When controlled for factors associated with KRT requirement, randomization to hydrocortisone remained significantly associated with a reduced odds of new KRT requirement (OR, 0.79 [95% CI, 0.66 to 0.95]; P = .01). Among patients who started KRT following randomization, hydrocortisone was not associated with reduced days alive and free of KRT (mean difference, 1.28 [95% CI, -4.31 to 6.87] days; P = .65).

CONCLUSIONS AND RELEVANCE: In this post hoc cohort study of patients with septic shock enrolled in a large RCT, intravenous hydrocortisone was associated with a reduced risk of new KRT requirement following randomization.

PMID:40423970 | DOI:10.1001/jamanetworkopen.2025.12279

JAMA Netw Open. 2025 May 1;8(5):e2512465. doi: 10.1001/jamanetworkopen.2025.12465.

ABSTRACT

IMPORTANCE: Intensive home treatment (IHT) is regarded as a safe and effective alternative to psychiatric inpatient care during acute crises.

OBJECTIVE: To estimate the cost-effectiveness of implementing IHT in comparison with inpatient treatment for persons with severe mental illness in acute crisis in the German health care system.

DESIGN, SETTING, AND PARTICIPANTS: This health economic evaluation was performed as part of a quasiexperimental nonrandomized trial conducted at 10 sites in Germany from January 2021 to December 2022. It included 200 patients with severe mental illness treated by IHT for acute crisis matched by means of propensity scores with 200 patients with severe mental illness receiving inpatient treatment. Participants were observed for 12 months. All analyses were conducted from January 15 to October 30, 2024.

MAIN OUTCOMES AND MEASURES: Incremental cost utility ratios (ICURs) were calculated for 12 months from the societal perspective and from the payer perspective of German statutory health insurance. ICUR uncertainty was estimated by nonparametric bootstrapping and estimated cost-effectiveness acceptability curves for maximum willingness to pay (MWTP) thresholds of €25 000 and €50 000.

RESULTS: The mean (SD) age of all 400 eligible study participants was 45 (16) years, and 264 (66%) were female. Overall, 374 were considered in the analysis. The ICUR point estimates were €48 786.43 from the perspective of statutory health insurance and €38 433.81 from the societal perspective. Acceptability rates for IHT being a cost-effective alternative compared with inpatient treatment from the societal perspective were 67% at an MWTP threshold of €25 000 and 50% at an MWTP of €50 000 and were 60% at an MWTP of €25 000 and 44% at an MWTP of €50 000 from the perspective of the statutory health insurance.

CONCLUSIONS AND RELEVANCE: This economic analysis found that IHT for persons with severe mental illness in acute crisis is expected to be cost-effective compared with inpatient treatment, with a slightly higher acceptability probability for statutory health insurance than for the economy as a whole. Due to the high stochastic uncertainty, the study results suggest that more research is needed to assess the economic efficiency of IHT more clearly.

PMID:40423967 | DOI:10.1001/jamanetworkopen.2025.12465