Tag: nevin manimala

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

JAMA Netw Open. 2025 May 1;8(5):e2514278. doi: 10.1001/jamanetworkopen.2025.14278.

ABSTRACT

IMPORTANCE: Available antidepressants provide inadequate therapeutic responses in many patients with major depressive disorder (MDD), highlighting a substantial unmet need.

OBJECTIVE: To evaluate the efficacy and safety of azetukalner, a novel, potent KV7 potassium channel opener, in participants with MDD.

DESIGN, SETTING, AND PARTICIPANTS: X-NOVA was a multicenter, proof-of-concept, phase 2, randomized, double-blind, parallel-group, placebo-controlled clinical trial that evaluated azetukalner in participants (adults aged ≥18 to ≤65 years) with moderate to severe MDD in a current depressive episode. Participants were enrolled between April 2022 and October 2023, and data analysis occurred from January 2023 to January 2024.

INTERVENTION: Participants were randomized (1:1:1) to 10 mg of azetukalner, 20 mg of azetukalner, or placebo orally once daily with food for 6 weeks, with a 4-week follow-up. Concomitant antidepressant medications were not permitted.

MAIN OUTCOMES AND MEASURES: The primary efficacy end point was change in Montgomery-Åsberg Depression Rating Scale (MADRS) score at week 6. Secondary end points included change from baseline at week 6 in the Snaith-Hamilton Pleasure Scale (SHAPS) and Beck Anxiety Inventory. Exploratory end points included change in the Hamilton Depression Rating Scale, 17-Item (HAM-D17) score and change in MADRS at week 1. Frequency and severity of treatment-emergent adverse events (TEAEs) were recorded.

RESULTS: Altogether, 168 participants were randomized (56 to placebo, 56 to 10 mg of azetukalner, and 56 to 20 mg of azetukalner); mean (SD) age was 47.2 (13.6) years, and 111 participants (66.5%) were female. The modified intent-to-treat and safety populations consisted of 164 and 167 participants, respectively. The mean (SE) reduction in MADRS scores from baseline to week 6 was -13.90 (1.41) points with placebo, -15.61 (1.34) points with 10 mg of azetukalner, and -16.94 (1.45) points with 20 mg of azetukalner; the mean (SE) reduction with 20 mg of azetukalner vs placebo was clinically meaningful but not statistically significant (-3.04 points; 95% CI, -7.04 to 0.96 points; P = .14) at week 6, while significant at week 1 (-2.66 points; 95% CI, -5.30 to -0.03 points; P = .047). The mean (SE) reduction in HAM-D17 from baseline to week 6 was significantly greater with 20 mg of azetukalner vs placebo (-13.3 [1.1] vs -10.2 [1.0] points; P = .04). The mean (SE) reduction in SHAPS scores from baseline to week 6 was significantly greater with 20 mg of azetukalner vs placebo (-7.77 [0.87] vs -5.30 [0.85] points; P = .046). Similar rates of discontinuation due to TEAEs were reported across groups.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of azetukalner, preliminary findings supported its further clinical development for the treatment of MDD and anhedonia.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05376150.

PMID:40423966 | DOI:10.1001/jamanetworkopen.2025.14278

JAMA Intern Med. 2025 May 27. doi: 10.1001/jamainternmed.2025.1345. Online ahead of print.

ABSTRACT

IMPORTANCE: Weight loss maintenance (WLM) is one of the most difficult challenges in obesity treatment. Continuous care, which involves frequent behavioral weight management sessions delivered by professional staff, shows promise; however, this care is costly and unsustainable. Thus, new, efficacious treatment models are needed for WLM.

OBJECTIVE: To examine the efficacy of an entirely patient-delivered treatment for WLM compared with professionally delivered standard-of-care treatment (SOC).

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial used a 2-phase WLM design. During phase 1, participants received an online weight loss program. Those who achieved 5% or greater weight loss in phase 1 were eligible for phase 2, the actual 18-month WLM trial. Participants in the maintenance trial were randomized to either an entirely patient-delivered lifestyle intervention for WLM or SOC delivered by professional staff. Participants aged 18 to 75 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 to 50 were recruited from a single academic research center. Data were collected from February 2018 to March 2023, and data were analyzed from September 2024 to February 2025.

INTERVENTIONS: Patient-to-patient treatment involved no professional staff; instead, mentors (successful weight losers) delivered intervention sessions and peers (fellow participants) provided ongoing, remotely delivered evidence-based social support. SOC was current best practice for WLM-group lifestyle intervention led by professionals. Both WLM interventions were 18 months in duration.

MAIN OUTCOMES AND MEASURES: Primary outcome was weight change during the 18-month trial. Secondary outcomes included blood pressure, heart rate, physical activity, and sedentary behavior.

RESULTS: Among the 287 randomized participants (240 [83.6%] female; mean [SD] age, 53.6 [0.9] years), 268 (93.4%) completed the trial. There was a statistically significant difference in weight change by arm; patient-to-patient treatment yielded significantly less weight regain than SOC (month 6: -1.44 kg [95% CI, -2.35 to 0.54] vs -0.16 [95% CI, -1.13 to 0.82]; month 12: 0.04 kg [95% CI, -0.86 to 0.95] vs 0.77 [95% CI, -0.21 to 1.47]; month 18: 0.77 kg [95% CI, -0.14 to 1.68] vs 2.37 [95% CI, 1.40 to 3.34]; P = .002). Parallel findings were observed for diastolic blood pressure, heart rate, physical activity, and sedentary behavior.

CONCLUSIONS AND RELEVANCE: In this trial, patient-delivered lifestyle intervention (mentor interventionists plus peer support) yielded significantly better WLM and cardiovascular risk outcomes compared with SOC delivered by professionals. Future research may examine the effectiveness of this novel treatment approach in community and clinical settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03396653.

PMID:40423949 | DOI:10.1001/jamainternmed.2025.1345