Tag: nevin manimala

J Dtsch Dermatol Ges. 2026 Apr 8. doi: 10.1111/ddg.70067. Online ahead of print.

ABSTRACT

BACKGROUND: Realistic and accessible models are essential for training physicians in clinical procedures. This study investigated whether a cost-effective 3D-printed skin model is superior to fruit and foam models for teaching skin biopsies.

PATIENTS AND METHODS: The study (10/2023-02/2025) involved 148 medical students who compared the 3D skin model, made of soft silicone, shore hardness 10-A, with fruit and foam for punch biopsy training. Previous cohorts used only fruit and foam. 28 physicians assessed realism of the 3D model versus real skin. Practical skills were evaluated in Objective Structured Clinical Examinations (OSCEs), and feedback from students and physicians was collected via standardized questionnaires. Economic and ecological impacts were analyzed.

RESULTS: Students rated the 3D skin model significantly higher for realism and training suitability than fruit and foam (p < 0.001). OSCE scores indicated comparable skill acquisition (p = 0.2005). Physicians found the 3D model more anatomically and haptically realistic than foam and fruit (each p < 0.001).

CONCLUSIONS: The 3D-printed skin model is a superior, cost-effective training tool that overcomes limitations of traditional models, improves confidence, and enhances skill acquisition. Although production is resource-intensive, its reusability and low-cost materials make it sustainable. Anatomical realism fosters interest in dermatology, making it a promising innovation in medical education.

PMID:41948892 | DOI:10.1111/ddg.70067

Am J Hum Biol. 2026 Apr;38(4):e70255. doi: 10.1002/ajhb.70255.

ABSTRACT

OBJECTIVES: Adverse childhood experiences (ACEs) have long been associated with poor health in adulthood, with many researchers interpreting these findings as evidence of a “fast” life history. In this study we utilize data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS) to test the expectations of this framework among inhabitants of the Cebu metropolitan area in the Philippines.

METHODS: Data on development, behavior, and reproduction were collected from study participants (N = 1288, 54% male) over the course of multiple survey rounds, beginning before their birth in 1983-84. In 2018, participants completed a retrospective ACEs questionnaire. We built discrete hazard models and generalized linear models to test whether recalled ACEs predict characteristics of a “faster” life history in CLHNS.

RESULTS: There was no significant relationship between ACEs and maturational timing, but individuals who recalled more ACEs engaged in health-risk behaviors earlier and exhibited younger ages at sexual debut. Among women specifically, ACEs also predicted a younger age at first reproduction and higher gravidity. After splitting ACEs into two dimensions, the same results were observed in response to deprivation but not threat.

CONCLUSIONS: As in other low resource settings, physical maturation in Cebu was accelerated in households with greater access to resources but not in response to early psychosocial stressors as indicated by recalled ACEs. However, individuals who experienced ACEs did exhibit behavioral profiles consistent with faster life history scheduling and greater investment in reproduction.

PMID:41948874 | DOI:10.1002/ajhb.70255

Phys Chem Chem Phys. 2026 Apr 8. doi: 10.1039/d5cp04712a. Online ahead of print.

ABSTRACT

Advances in single-molecule measurements, active-matter control, and nonequilibrium statistical mechanics are transforming our understanding of thermodynamics in small, strongly fluctuating systems. Biological molecular motors, driven chemical-reaction networks (e.g., gene regulation), artificial active matter, autonomous engines, and synthetic nanomachines all operate via inherently irreversible, dissipative processes in noisy environments, while producing entropy. Quantifying this entropy production (EP) has therefore become central to understanding both the physical limits and design principles of nanoscale systems. This review surveys principled routes to characterize and quantify EP from time-series and trajectory data. Because experimental observables are often coarse-grained and only partially resolve the underlying dynamics, we discuss how dissipation can be inferred from incomplete information, and how coarse-graining systematically biases EP estimates. This overview maps the current toolkit for estimating EP and outlines open challenges in unifying inference approaches to obtain reliable and tight bounds on EP in living and engineered nanoscale systems.

PMID:41948859 | DOI:10.1039/d5cp04712a

Adv Mater. 2026 Apr 8:e22059. doi: 10.1002/adma.202522059. Online ahead of print.

ABSTRACT

Vanadium oxides have emerged as attractive cathode materials for zinc-based batteries owing to their high theoretical capacity and versatile redox chemistry. Nevertheless, their persistent dissolution in aqueous electrolytes remains a long-standing challenge, hindering real-world implementation. Here, we develop a cation-engineered electrolyte strategy enabled by a data-driven framework that integrates density functional theory (DFT) calculations, discrete wavelet transform (DWT)-based multi-scale analysis, and differential feature extraction, to efficiently screen potential hetero-cations and their combinations with objective statistic quantification, while minimizing trial-and-error experimentation and selection bias. As a proof of concept, the Zn/VOx batteries with the predicted Na⁺-Mg²⁺-Zn²⁺ tri-cation electrolyte (NMZ) achieved exceptional reversibility and record-long cycling stability, sustaining 500 cycles at 0.2 A g^-1 (1400 h) and 10,000 cycles at 5 A g^-1. The tri-cation electrolyte successfully triggers a potential-driven sequential ion insertion pathway involving Na⁺, Mg²⁺, and Zn²⁺, thereby fundamentally suppressing proton intercalation above 1.3 V and hydrated Zn²⁺ insertion near 1.0 V (vs Zn²⁺/Zn). This work not only provides valuable data-driven insights into ion-engineering electrochemistry for regulating insertion stability but also uncovers critical ion-related factors that are frequently overlooked. This approach establishes a reusable and statistically robust framework for guiding research across diverse battery chemistries.

PMID:41948846 | DOI:10.1002/adma.202522059

Epileptic Disord. 2026 Apr 8. doi: 10.1002/epd2.70232. Online ahead of print.

ABSTRACT

OBJECTIVES: Antiseizure medications (ASMs) can induce the activity of drug-metabolizing enzymes and drug transporters, including cytochrome P450 (CYP)2C9 and P-glycoprotein (P-gp). Our objective was to comparatively assess the effects of ASMs on exposure to clinical CYP2C9 and P-gp substrates.

METHODS: This systematic review and network meta-analysis (NMA) was registered in PROSPERO (CRD42023473609) and performed following PRISMA 2020 guidelines. MEDLINE, EMBASE, and Cochrane Library were searched until October 22, 2025, with additional searches conducted in the FDA and EMA databases and ClinicalTrial.gov. Studies were included if they were prospective and the ASM was used as monotherapy for ≥5 days. The primary endpoint was the substrate area under the curve ratio (AUCR) with/without the ASM. Treatments were ranked by P-scores (range 0-1, higher values reflect stronger induction). The point estimate for indirect pairwise comparisons was the standardized mean difference (SMD). Bias risk was assessed using the PKclin tool.

RESULTS: Twelve and six interventional pharmacokinetic studies with 227 and 97 participants were included in the CYP2C9 and P-gp NMAs, respectively. The ASM with the greatest CYP2C9 induction potential was carbamazepine (600 mg/day, P-score .78). The only statistically significant effect size estimate for CYP2C9 was obtained in the comparison between carbamazepine 600 mg/day and cenobamate 200 mg/day (SMD -.42; CI -.76, -.09). Carbamazepine (300 or 600 mg/day) was also the strongest P-gp inducer (P-scores, .79 and .55, respectively). The effects of its two doses did not differ, and 300 mg/day had a stronger effect on P-gp compared with the other ASMs.

SIGNIFICANCE: Despite variability in populations, substrate drugs, and doses, our findings demonstrate that carbamazepine is an inducer at 300 mg/day, and that ASMs can rank differently as CYP2C9 versus P-gp inducers. Therefore, the safety of ASM polytherapy cannot be extrapolated from one pathway to another for treatment selection, for example, for post-stroke epilepsy.

PMID:41948839 | DOI:10.1002/epd2.70232

Am J Clin Pathol. 2026 Apr 3;165(4):aqag024. doi: 10.1093/ajcp/aqag024.

ABSTRACT

OBJECTIVES: Cancer is a leading cause of mortality worldwide, yet access to specialized pathology services remains limited in many low- and middle-income countries, including Tanzania. Telepathology offers a practical means to expand diagnostic capacity and improve timely cancer care. Through a partnership with the American Society for Clinical Pathology (ASCP) and Duke University, Kilimanjaro Christian Medical Centre (KCMC) implemented a telepathology consultation platform to provide expert review for diagnostically challenging cases.

METHODS: This cross-sectional observational study analyzed challenging pathology cases submitted for teleconsultation between September 2018 and March 2025. Whole-slide images were reviewed by pathologists from Duke University, Radboud University Medical Centre, Princess Máxima Center, ASCP-Tanzania, and the Medical College of Wisconsin. Diagnostic concordance between local and expert interpretations was measured. Turnaround time (TAT) and subspecialty variation were analyzed using descriptive statistics and χ2 testing.

RESULTS: A total of 1266 cases were reviewed, representing 16 different subspecialties. Hematopathology (28.4%), head and neck pathology (17.1%), and soft tissue pathology (9.9%) were the most frequently consulted. The overall concordance rate was 44.79% (567/1266), with a partial concordance rate of 19.75% (250/1266) and a discordance rate of 32.78% (415/1266). Concordance varied significantly across subspecialties (χ2(15) = 31.90, P = .0066). The mean TAT was 18.3 days, with a downward trend from 2018 to 2025.

CONCLUSIONS: Implementation of telepathology at KCMC is feasible and provides a sustainable model for expanding access to expert pathology consultation in resource-limited settings. Despite modest concordance rates, telepathology enhanced diagnostic accuracy, education, and quality assurance, while TATs improved over the study period. Continued investment is needed in digital infrastructure.

PMID:41948834 | DOI:10.1093/ajcp/aqag024

Stroke. 2026 Apr 8. doi: 10.1161/STROKEAHA.125.054863. Online ahead of print.

ABSTRACT

Management of unruptured intracranial aneurysms requires balancing the risk of aneurysm rupture against the risk of procedural complications. Estimates of rupture risk stem from a few landmark natural history studies whose findings differ substantially, creating uncertainty for clinical decision-making. This review appraises these studies, highlighting areas of agreement and contradiction to inform future directions. Across studies, short-term rupture risk is low and increases with aneurysm size. The magnitude of risk varies (0.20%-1.85% at 1 year). These discrepancies likely arise from methodological challenges inherent to natural history research, including selection, crossover, incomplete follow-up, and regional variation. The effects of these factors are difficult to disentangle due to confounding. Rupture risk is highest in Finnish studies, followed by Japanese, then other international cohorts. This geographic pattern is reversed for the treatment rate. Rupture risk also shows a strong inverse relationship with treatment rate (P=0.008, R²=0.79). This makes it impossible to know whether rupture risk reflects treatment or geography, and which estimates apply clinically. Studies have short follow-up (mean 2.8 years) and require substantial extrapolation to estimate lifetime risk (mean age at diagnosis 42-66 years). Small differences in short-term estimates produce large variations in long-term projections. Moreover, the underlying assumption that risk remains constant with time has not been formally evaluated. Half of the data sets are consistent with this, but half suggest it declines with time. The effects of key aneurysm rupture predictors vary between studies. This includes age, sex, hypertension, smoking, prior subarachnoid hemorrhage, family history of intracranial aneurysms, and aneurysm location, multiplicity, and size thresholds. It is unclear whether this reflects regional variation, overfitting, or other factors. Meta-analyses are most representative, but remain constrained by limitations of contributing data sets. Larger multicenter studies with longer follow-up, fewer losses, and deeper phenotyping are still needed, despite their practical challenges.

PMID:41948814 | DOI:10.1161/STROKEAHA.125.054863

Disaster Med Public Health Prep. 2026 Apr 8;20:e82. doi: 10.1017/dmp.2026.10353.

ABSTRACT

OBJECTIVES: Hazardous materials (HazMat) incidents pose significant risks to public health, safety, and the environment. This study aimed to characterize the temporal trends, geographic distribution, operational settings, and incident types of HazMat events reported in Oman.

METHODS: This retrospective descriptive study analyzed data from the national HazMat incident records maintained by the Civil Defence and Ambulance Authority (CDAA). All reported chemical, biological, or radiological incidents between June 1, 2019, and November 30, 2024, were included.

RESULTS: A total of 55 HazMat incidents were recorded during the study period. Reported incidents increased over time, with the highest annual counts observed in 2023 (14 incidents) and 2024 (17 incidents). Muscat Governorate accounted for 39 incidents (71%). Residential neighborhoods were the most common operational setting (26/55, 47%), followed by other public areas (9/55, 16%), while airports, educational institutions, industrial areas, and transportation corridors each accounted for 5 incidents (9%). Gas leaks were the most frequently reported incident type, involved in 28 incidents (51%).

CONCLUSIONS: HazMat incidents in Oman increased over the study period and were concentrated in Muscat Governorate. Incidents occurred across diverse operational settings, particularly residential and public environments, while gas leaks represented the most frequently reported incident type.

PMID:41948793 | DOI:10.1017/dmp.2026.10353

JPRAS Open. 2026 Mar 7;49:358-365. doi: 10.1016/j.jpra.2026.03.014. eCollection 2026 May.

ABSTRACT

BACKGROUND: Necrotizing fasciitis (NF) is a rapidly progressing, life-threatening soft tissue infection. Procalcitonin (PCT) has emerged as a promising biomarker for early diagnosis and prognosis in severe infections.

METHODS: We performed a retrospective analysis of 62 patients with confirmed NF treated at a high-volume Department of Plastic Surgery between January 2005 and May 2024. Clinical parameters, laboratory values, and surgical outcomes were evaluated. Patients were stratified into survivors and non-survivors.

RESULTS: Elevated PCT levels at admission were significantly associated with in-hospital mortality (p = 0.0329), whereas other parameters showed no statistical significance. Skin grafting was the most common reconstructive procedure. No significant association was found between the type of reconstructive surgery and survival.

CONCLUSION: Serum PCT levels at admission may serve as a valuable prognostic marker in NF. Once infection control is achieved, reconstructive surgical interventions appear to be safe and do not influence survival.

PMID:41948778 | PMC:PMC13051722 | DOI:10.1016/j.jpra.2026.03.014

Pediatr Qual Saf. 2026 Apr 6;11(2):e876. doi: 10.1097/pq9.0000000000000876. eCollection 2026 Mar-Apr.

ABSTRACT

INTRODUCTION: Emergency department evaluations for acute child sexual assault include anogenital photodocumentation as a standard of care, which has implications for accurate clinical care and forensic significance. If photodocumentation quality is suboptimal from a diagnostic standpoint, this may lead to wasted care and resources and place needless burdens on patients and families. Our project aimed to improve the diagnostic quality of anogenital photodocumentation at 2 sites in a pediatric emergency department, increasing it from a baseline of 24% to 50% during a 9-month intervention period.

METHODS: We surveyed multiple clinical teams to determine drivers of diagnostic quality. Using the Model for Improvement, we implemented multiple interventions (clinical pathway revisions, visual guidance, direct provider feedback, and an improved light source option) in the care process for these patients and measured diagnostic quality using a definition adapted from a validated photograph-scoring system. We used statistical process control charts to track diagnostic quality.

RESULTS: We detected no special-cause variation in the outcome measure of improved diagnostic quality. We detected special-cause variation for the process measure of whether care teams obtained photodocumentation, which increased from 77% to 89%.

CONCLUSIONS: Interventions to improve the diagnostic quality of anogenital photodocumentation did not result in improvement; however, there was improvement in the likelihood of care teams obtaining photodocumentation in acute sexual assault evaluations.

PMID:41948737 | PMC:PMC13052962 | DOI:10.1097/pq9.0000000000000876