Nevin Manimala

Med Decis Making. 2025 Nov 14:272989X251388915. doi: 10.1177/0272989X251388915. Online ahead of print.

ABSTRACT

BackgroundCervical cancer, driven predominantly by persistent high-risk human papillomavirus (HPV) infection, ranks as the fourth most common malignancy in women worldwide. China faces barriers to achieving the World Health Organization (WHO) 2030 elimination targets due to low vaccination rates and complex demographics. Strategic intervention optimization is critical for accelerating elimination.MethodsWe developed an age-stratified deterministic compartmental model integrating demographic data and HPV transmission dynamics, capturing heterogeneity in age, sex, sexual activity, and intervention efficacy. The model simulated cervical cancer natural history, including HPV infection, progression to precancerous lesions, and invasive cancer and was calibrated using epidemiological data from the Global Burden of Disease. We evaluated multiple vaccination scenarios (varying coverage rates, age groups, and durations) to project incidence trajectories, estimate elimination timelines, and calculate the reproduction number. Sensitivity analyses were conducted to assess parameter effects.ResultsWithout vaccination, HPV infection becomes endemic (R₀ = 1.38), causing 2.92 million cervical cancer cases in China during 2021 to 2070. Maintaining the 2020 vaccination rate would prevent 1.01 million cases in this period. While prioritizing females aged 15 to 26 y maximizes the per-dose impact, expanding vaccination to all females aged ≥15 y is essential for achieving elimination before 2040. Even single-year vaccination would confer >50-y protection. A higher vaccination rate accelerates elimination: annual rates of 0.09, 0.15, and 0.21 among females aged ≥15 y achieve elimination by 2037, 2035, and 2034, respectively, accelerating timelines by 15 to 20 y compared with strategies targeting only 15- to 26-y-olds.ConclusionsHPV vaccination is pivotal for reducing cervical cancer burden in China, with prioritizing women aged 15 to 26 y as the optimal strategy. Expanding vaccination to all women aged ≥15 y can accelerate the achievement of WHO elimination targets.HighlightsAn age-stratified model simulates HPV transmission patterns and assesses cervical cancer interventions.Without intervention, HPV remains endemic (R₀ = 1.38), causing 2.92 million cervical cancer cases in China (2021-2070).Prioritizing 15- to 26-y-olds maximizes the per-dose impact, but expanding to 15+ y cohorts is essential for elimination.Even a single year of vaccination offers >50 y of protection.Females ≥15 y vaccinated annually at rates of 0.09, 0.15, and 0.21 achieve elimination by 2037, 2035, and 2034, respectively.

PMID:41237272 | DOI:10.1177/0272989X251388915

Sci Adv. 2025 Nov 14;11(46):eadz2616. doi: 10.1126/sciadv.adz2616. Epub 2025 Nov 14.

ABSTRACT

Photosynthesis in vivo is driven by sunlight, an ultraweak incoherent thermal source. However, most experiments and theories have studied photosynthetic light harvesting driven by strong coherent laser sources. The quantum states of light are characterized by their photon statistics, in addition to classical properties such as intensity and frequency spectrum. Here, we report experiments that investigate how photon statistics affect a natural photosynthetic system and vice versa. We directly compare how single photons and pseudothermal light from spontaneous parametric down-conversion drive light harvesting in the light-harvesting 2 complex from a purple bacterium. We find that the fluorescence lifetime and quantum efficiency are unchanged while the fluorescence photon statistics are markedly different, resembling that of the incident light, implying that the dynamics do not fundamentally modify the photon statistics. This represents a step toward clarification of the similarities and differences between photosynthetic light harvesting in laboratory and in natural sunlight conditions.

PMID:41237251 | DOI:10.1126/sciadv.adz2616

Sci Adv. 2025 Nov 14;11(46):eady1674. doi: 10.1126/sciadv.ady1674. Epub 2025 Nov 14.

ABSTRACT

Sicily, situated at the heart of the Mediterranean Sea, has been a crossroads of people of different origins since the Paleolithic. To gain further insight into the genetic history of this island from a matrilineal viewpoint, we investigated 15 millennia of human mitogenome evolution. A unique Sicilian mitochondrial DNA (mtDNA) dataset, represented by 116 ancient mitogenomes (including two newly sequenced) collected from 16 archeological sites dating from 14,700 to 545 years ago, was compared with a collection of 236 modern mitogenomes covering all districts of the island. By integrating demographic modeling with phylogeographic analyses, we identified a statistically supported genetic discontinuity between the Paleolithic/Late Mesolithic and Early Neolithic periods and two mtDNA lineages (U5b and U8b/K) that specifically mark this transition. The extensive variation and lack of genetic structure among modern mitogenomes suggest the presence of a continuous, maternally inherited gene flow from different regions of Western Eurasia (since the Paleolithic) and Africa (since the Bronze Age).

PMID:41237225 | DOI:10.1126/sciadv.ady1674

JMIR Serious Games. 2025 Nov 14;13:e71823. doi: 10.2196/71823.

ABSTRACT

BACKGROUND: Individuals with mild intellectual disabilities (ID) often face cognitive and functional challenges, which can lead to low physical activity (PA) and a higher risk of obesity. While virtual reality (VR) exergames show promise for promoting PA in typically developing children, a key barrier for individuals with ID is the lack of a structured teaching methodology. This study argues that a tailored approach is essential to help children with mild ID gain independence in gameplay. By learning specific patterns, they can achieve greater autonomy, which not only facilitates increased PA but also improves motor competence, physical fitness, functional abilities, and overall well-being.

OBJECTIVE: This study aims to evaluate the effectiveness of the WISH (Warm-up, Imitation, Settings, Half-hour exergame session) and WON (Warm-up, Objective evaluation, No problem!) training protocols in improving participant independence, exergame performance, and overall gameplay experience in VR.

METHODS: We used a multisession, single-group research design involving 16 training sessions in this pilot study. The 16 sessions were conducted during scheduled physical education classes at a special school in Poland from October 2023 to May 2024. The intervention comprised two main protocols: the WISH protocol (sessions 1-4), an introductory phase focused on familiarization with VR technology and gameplay mechanics, and the WON protocol (sessions 5-16), designed for gradual reduction of trainer assistance to promote gameplay independence.

RESULTS: The statistical analysis confirmed the effectiveness of both the WISH and WON protocols. A Wilcoxon signed-rank test on the WISH protocol revealed a statistically significant improvement in understanding instructions for the warm-up (r=0.87; P=.009), the projector imitation (r=0.91; P=.007), and participant exergame performance (r=0.90; P=.03). Within the WON protocol, the Wilcoxon test also showed a significant increase in participant exergame performance (r=0.89; P=.008). Further analysis using Spearman rank-order correlation indicated a very strong association between increased independence and better exergame performance (ρ=0.91; P=.002) and overall gameplay experience (ρ=0.63; P<.05).

CONCLUSIONS: This pilot study suggests that the structured WISH and WON training protocols may have the potential to enhance functional autonomy, exergame performance, and overall gameplay experience in individuals with mild ID. The observed improvements indicate that such structured pedagogical approaches could be beneficial for this population. These preliminary findings warrant further investigation through larger-scale, controlled studies to confirm efficacy and explore the transferability of these benefits to broader contexts and other VR exergames.

PMID:41236816 | DOI:10.2196/71823

Technol Cancer Res Treat. 2025 Jan-Dec;24:15330338251394573. doi: 10.1177/15330338251394573. Epub 2025 Nov 14.

ABSTRACT

IntroductionBody mass index (BMI) is a common clinical parameter associated with cancer prognosis, but its association with survival outcomes in lung cancer patients receiving immune checkpoint inhibitors (ICIs) remains unclear. This study aimed to clarify the prognostic value of BMI in ICI-treated lung cancer patients.MethodsA systematic review and meta-analysis were conducted based on online databases including PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov up to December 1, 2024. Eligible studies included lung cancer patients treated with ICIs and reported hazard ratios (HRs) for overall survival (OS) and/or progression-free survival (PFS) stratified by BMI. Random-effects models were used to determine HRs with 95% confidence intervals (CIs).ResultsA total of 30 studies involving 5987 patients were included. High BMI was significantly associated with better OS (HR = 0.69, 95%CI = 0.60-0.80) and PFS (HR = 0.82, 95%CI = 0.72-0.93). The subgroup analysis showed improved survival outcomes particularly in patients with BMI ≥ 30 kg/m² as compared with others. However, this association was not statistically significant in small-cell lung cancer.ConclusionHigh BMI was associated with a better prognosis than low BMI in ICI-treated patients with lung cancer. Due to study limitations, the prognostic impact of BMI still requires further clarification with additional evidence.

PMID:41236792 | DOI:10.1177/15330338251394573

Hum Vaccin Immunother. 2025 Dec;21(1):2583804. doi: 10.1080/21645515.2025.2583804. Epub 2025 Nov 14.

ABSTRACT

While international and domestic recommendations advocating for influenza vaccination during pregnancy, the vaccination rate among this demographic in China remains low, mainly due to concerns about fetal safety. This retrospective cohort enrolled mothers who registered and delivered between August 2020 and July 2023. The relationship between maternal influenza vaccination and adverse neonatal outcomes was assessed using Poisson regression models and logistic regression analyses. The adverse neonatal outcomes under evaluation included small for gestational age (SGA), large for gestational age (LGA), preterm birth (PTB), low birth weight (LBW), low Apgar score, congenital anomalies, neonatal intensive care unit (NICU) admission or referral, as well as stillbirth or neonatal death. Of the 2,517 women, 203 (8.1%) had received influenza vaccination during their pregnancies. The incidence rate of gestational complications in the vaccinated group being significantly higher than that in the unvaccinated group. In comparison with no vaccination, there was no statistically connection between vaccination and an increased risk of any adverse neonatal outcomes. The adjusted risk ratios (95% CIs) were: SGA 1.354 (0.842-2.177), LGA 1.504 (0.808-2.798), PTB 0.639 (0.257-1.590), LBW 0.294 (0.072-1.211), low Apgar score 0.918 (0.213-3.958), congenital anomaly 0.676 (0.087-5.247), and NICU admission or referral 0.151 (0.021-1.089). In this study, there was only 1 stillbirth and 1 neonatal death in the unvaccinated group, resulting in a cumulative incidence of 0.1%. No stillbirths or neonatal deaths occurred in the vaccinated group. These findings endorse public health initiatives aimed at enhancing vaccination rates among pregnant women.

PMID:41236786 | DOI:10.1080/21645515.2025.2583804

J Manag Care Spec Pharm. 2025 Nov 14:1-10. doi: 10.18553/jmcp.2025.25148. Online ahead of print.

ABSTRACT

BACKGROUND: In the United States, rIX-FP, rFIXFc, and rFIX are approved as treatment options for people with hemophilia B (PwHB). Although clinical trials have demonstrated the efficacy and safety of each product, real-world data can help to understand their use and treatment outcomes in the absence of direct head-to-head trials.

OBJECTIVE: To assess real-world factor IX (FIX) consumption and bleeding outcomes for PwHB receiving rIX-FP, rFIXFc, or rFIX prophylaxis.

METHODS: Retrospective, deidentified medical record information for PwHB with moderate or severe hemophilia B (FIX activity ≤5%) treated with rIX-FP, rFIXFc, or rFIX prophylaxis for at least 12 months was obtained from Hemophilia Treatment Centers in the United States between 2020 and 2023. FIX consumption was calculated using the most recently prescribed dosing frequency and dosage. Annualized bleeding rate (ABR), annualized spontaneous bleeding rate, and annualized joint bleeding rate were calculated based on the number of bleeding events over the observation period. Generalized linear models adjusting for covariates were used to test the statistical significance of the differences of consumption and ABR among the products.

RESULTS: Overall, 213 PwHB (53% with severe disease) aged 12 years and older were included for main analysis, with a mean age (range) of 32.7 (12-84) years. PwHB treated with rIX-FP prophylaxis had significantly lower mean FIX consumption compared with those receiving rFIXFc (45.8 vs 65.4 IU/kg/week; P = 0.0003) and rFIX (95.7 IU/kg/week; P < 0.0001). The mean dosing interval was 10.2, 7.3, and 5.2 days for rIX-FP, rFIXFc, and rFIX, respectively. Mean ABR was significantly lower in PwHB receiving rIX-FP compared with the other 2 products (rIX-FP vs rFIXFc: 1.2 vs 2.1; P = 0.0119; rIX-FP vs rFIX: 1.2 vs 2.3; P = 0.004). Mean annualized spontaneous bleeding rate was 0.4, 1.0, and 0.7 for rIX-FP, rFIXFc, and rFIX, respectively. Mean annualized joint bleeding rate was 0.7, 1.1, and 1.2 for rIX-FP, rFIXFc, and rFIX, respectively. The pattern of results for PwHB of all ages (including those aged <12 years, N = 50) were similar to those reported for PwHB aged 12 years and older. In a subgroup of 16 PwHB who switched to rIX-FP from a previous FIX product, mean FIX consumption was significantly reduced after switching to rIX-FP (49.0 vs 94.2 IU/kg/week; P = 0.0004). Mean ABR was also significantly reduced after switching to rIX-FP (3.2 vs 1.7; P = 0.0009).

CONCLUSIONS: In this retrospective study, rIX-FP prophylaxis was associated with lower FIX consumption and potentially improved protection against bleeds compared with prophylactic treatment with rFIXFc and rFIX.

PMID:41236778 | DOI:10.18553/jmcp.2025.25148

J Asthma. 2025 Nov 14:1-11. doi: 10.1080/02770903.2025.2589785. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to examine the effectiveness of motivational interviewing (MI) in enhancing asthma self-efficacy among adults in a primary care setting in Northern Jordan.

METHODS: A quality improvement project employing a quasi-experimental pre-post design was conducted using a convenience sample of adults diagnosed with asthma. The Asthma Self-Efficacy Scale (ASES) was administered at baseline and again eight weeks after implementation of the MI intervention. The sessions were guided by Bandura’s self-efficacy framework, focusing on mastery experiences, social persuasion, and emotional regulation. Data were analyzed using paired t-tests at a significance level of 0.05.

RESULTS: Participants demonstrated a significant improvement in asthma self-efficacy scores and symptom control following the intervention. The paired t-test indicated a statistically significant increase in self-efficacy (p < 0.001), confirming the intervention’s effectiveness. Additionally, participants reported lower perceived stress and a 56% reduction in asthma symptom flare-ups.

CONCLUSIONS: Motivational interviewing proved effective in strengthening asthma self-management by enhancing patients’ confidence and promoting behavioral change. The integration of MI into routine primary care is recommended to foster patient empowerment and improve clinical outcomes.

PMID:41236776 | DOI:10.1080/02770903.2025.2589785

JAMA Health Forum. 2025 Nov 7;6(11):e254235. doi: 10.1001/jamahealthforum.2025.4235.

ABSTRACT

IMPORTANCE: Evidence is limited regarding whether end-of-life care for individuals with dementia varies by race and ethnicity, and whether observed variations can be explained by differences in the physicians providing their care.

OBJECTIVE: To evaluate end-of-life care among individuals with dementia across racial and ethnic groups, and to investigate whether care variations are explained by differences in treating physicians.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used national, population-based claims data from a 20% random sample of Medicare fee-for-service beneficiaries aged 66 years or older with a diagnosis of dementia who died between 2016 and 2019. Data were analyzed from January 2024 to June 2025.

MAIN OUTCOMES AND MEASURES: Emergency department, hospital, and intensive care unit use, mechanical ventilation or cardiopulmonary resuscitation, and feeding tube placement in last 30 days of life; death in acute care hospital; hospice use and palliative care counseling in last 180 days of life; and any billed advance care planning before death.

RESULTS: Among 259 945 decedents with dementia (mean [SD] age, 85.8 [8.0] years; 60.4% female), 8.3% were non-Hispanic Black, 4.4% were Hispanic, and 87.3% were non-Hispanic White. Compared with non-Hispanic White decedents, non-Hispanic Black decedents were more likely to receive emergency department (difference, 5.7 percentage points [pp]; 95% CI, 5.0-6.4 pp), hospital (difference, 4.0 pp; 95% CI, 3.3-4.7 pp), intensive care unit (difference, 4.3 pp; 95% CI, 3.7-4.9 pp), mechanical ventilation or cardiopulmonary resuscitation (difference, 3.8 pp; 95% CI, 3.3-4.3 pp), and feeding tube placement (difference, 1.8 pp; 95% CI, 1.5-2.1 pp) care, as well as die in a hospital (difference, 3.5 pp; 95% CI, 2.9-4.1 pp). Non-Hispanic Black decedents were less likely to use hospice (difference, -6.1 pp; 95% CI, -6.8 to -5.4 pp) and more likely to receive palliative care counseling (difference, 3.2 pp; 95% CI, 2.6-3.9 pp) and billed advance care planning (difference, 1.8 pp; 95% CI, 1.2-2.3 pp) than non-Hispanic White decedents. Similar patterns were observed among Hispanic decedents. Variations in end-of-life care remained qualitatively unchanged when comparing decedents treated by the same physician.

CONCLUSIONS AND RELEVANCE: Findings from this cohort study suggest that non-Hispanic Black and Hispanic decedents with dementia received more intensive end-of-life care despite higher rates of billed advance care planning and palliative care counseling than non-Hispanic White decedents. Observed racial and ethnic variations were not explained by differences in the physicians treating them.

PMID:41236764 | DOI:10.1001/jamahealthforum.2025.4235

Hum Vaccin Immunother. 2025 Dec;21(1):2583577. doi: 10.1080/21645515.2025.2583577. Epub 2025 Nov 14.

ABSTRACT

Human Papillomavirus (HPV) vaccination has been implemented for more than 15 years to prevent HPV infection and associated precancerous lesions. However, limited data are available regarding the long-term impacts of HPV vaccination, particularly concerning cross-protection and type replacement. Using data from the 2007-2016 National Health and Nutrition Examination Survey (NHANES), we employed the survey-weighted Student’s t-tests, chi-square tests, and logistic regression models to examine the association between vaccine effectiveness and timing of vaccination. Among 9040 females aged 18 years and over, vaccination showed great effectiveness against both vaccine-targeted and non-vaccine-targeted high-risk HPV (hrHPV) among those vaccinated before sexual debut. After full adjustment, participants vaccinated after sex had a 48% increased risk of hrHPV infection (OR (95% CI) = 1.48 (1.16, 1.88)) compared to unvaccinated participants, and their sexual behaviors were more active as well. The most prevalent HPV subtypes were HPV 16/51/52/66, and the prevalence of subtypes 18/35/52/66/68 differed significantly across racial groups. Despite the prevalence of most hrHPV subtypes declined continuously or fluctuated over time, it is noteworthy that the infection rate of HPV 66 increased by 59% compared to the unvaccinated (95% CI: 0.18-0.92). Continuous surveillance is warranted for hrHPV types antigenically distant from vaccine strains, as early type replacement may be emerging. Given the notable difference in effectiveness based on vaccination timing, public-health education should emphasize both the benefits and limitations of HPV vaccination in the context of sexual health.

PMID:41236750 | DOI:10.1080/21645515.2025.2583577