Tag: nevin manimala

Cogn Neuropsychol. 2025 May 5:1-22. doi: 10.1080/02643294.2025.2498154. Online ahead of print.

ABSTRACT

We investigated visual working memory (VWM) for faces and two novel non-face pattern types (Blobs and Mondrians) in individuals with developmental prosopagnosia (DP) and age-matched controls. Participants completed both simultaneous and sequential encoding tasks, judging whether a probe item matched one shown at encoding. DPs showed a consistent face disadvantage across both encoding types, while controls showed a face advantage, but only during simultaneous encoding. Compared to controls, DPs had impaired face VWM in both tasks but performed equivalently for abstract shapes and patterns. Face VWM impairments in DP were not exacerbated by increased memory load or updating demands, suggesting these deficits stem from face perception difficulties that affect encoding rather than general VWM mechanisms. Our group-based analyses were supplemented by individual case statistics. Overall, our findings indicate that DPs do not exhibit general VWM deficits, but rather specific difficulties with face processing across formats.

PMID:40324216 | DOI:10.1080/02643294.2025.2498154

J Med Internet Res. 2025 May 5;27:e69284. doi: 10.2196/69284.

ABSTRACT

BACKGROUND: Mental health is emerging as an increasingly prevalent public issue globally. There is an urgent need in mental health for efficient detection methods, effective treatments, affordable privacy-focused health care solutions, and increased access to specialized psychiatrists. The emergence and rapid development of large language models (LLMs) have shown the potential to address these mental health demands. However, a comprehensive review summarizing the application areas, processes, and performance comparisons of LLMs in mental health has been lacking until now.

OBJECTIVE: This review aimed to summarize the applications of LLMs in mental health, including trends, application areas, performance comparisons, challenges, and prospective future directions.

METHODS: A scoping review was conducted to map the landscape of LLMs’ applications in mental health, including trends, application areas, comparative performance, and future trajectories. We searched 7 electronic databases, including Web of Science, PubMed, Cochrane Library, IEEE Xplore, Weipu, CNKI, and Wanfang, from January 1, 2019, to August 31, 2024. Studies eligible for inclusion were peer-reviewed articles focused on LLMs’ applications in mental health. Studies were excluded if they (1) were not peer-reviewed or did not focus on mental health or mental disorders or (2) did not use LLMs; studies that used only natural language processing or long short-term memory models were also excluded. Relevant information on application details and performance metrics was extracted during the data charting of eligible articles.

RESULTS: A total of 95 articles were drawn from 4859 studies using LLMs for mental health tasks. The applications were categorized into 3 key areas: screening or detection of mental disorders (67/95, 71%), supporting clinical treatments and interventions (31/95, 33%), and assisting in mental health counseling and education (11/95, 12%). Most studies used LLMs for depression detection and classification (33/95, 35%), clinical treatment support and intervention (14/95, 15%), and suicide risk prediction (12/95, 13%). Compared with nontransformer models and humans, LLMs demonstrate higher capabilities in information acquisition and analysis and efficiently generating natural language responses. Various series of LLMs also have different advantages and disadvantages in addressing mental health tasks.

CONCLUSIONS: This scoping review synthesizes the applications, processes, performance, and challenges of LLMs in the mental health field. These findings highlight the substantial potential of LLMs to augment mental health research, diagnostics, and intervention strategies, underscoring the imperative for ongoing development and ethical deliberation in clinical settings.

PMID:40324177 | DOI:10.2196/69284

JMIR Res Protoc. 2025 May 5;14:e72091. doi: 10.2196/72091.

ABSTRACT

BACKGROUND: Veterans are more likely to experience chronic pain than civilians, with significant negative impacts on long-term health outcomes. Evidence for the effectiveness of prescription opioids for chronic pain management is limited, and chronic use of opioids is associated with an increased risk of sleep-disordered breathing, cardiovascular complications, and bowel dysfunction, as well as opioid misuse and overdose. Veterans Affairs (VA) and Department of Defense guidelines are prioritizing low-risk, evidence-based interdisciplinary pain management strategies while optimizing pain-related outcomes (PRO) for veterans. Commission on Accreditation of Rehabilitation Facilities (CARF)-Accredited VA Interdisciplinary Pain Rehabilitation Programs (IPRPs) have shared characteristics, while maintaining their unique characteristics as individual pain management programs. Though little is known about the characteristics of VA’s IPRPs (eg, staffing, services, and patients served), implementation, and sustainability of these mandated programs.

OBJECTIVE: The goals of our operational partner-driven evaluation are to (1) characterize IPRPs across multiple program factors, including but not limited to, service delivery methods, team composition, program characteristics, services and modalities offered, and patients served; (2) triangulate data to inform data visualization that characterizes and illustrates the IPRPs individually and collectively as a system of care; and (3) identify patient-reported outcomes (PROs) and metrics to measure program effectiveness and determine overlap across IPRPs.

METHODS: This partnered-driven program evaluation will use a sequential mixed methods prospective design, including interviews and surveys. The Consolidated Framework for Implementation Research (CFIR), Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, and Expert Recommendations for Implementing Change (ERIC) strategies will be used to contextualize qualitative data. Rapid content analysis will be used to iteratively analyze qualitative data, while descriptive statistics will be used to analyze quantitative data. Datasets will be triangulated to support data visualization for partners to inform clinical and operational decision support.

RESULTS: As of April 2025, All IPRP sites are engaged, and survey and interview data have been collected and prepared for analysis. The results and deliverables will inform VA CARF-accredited IPRP characterization, evaluation, and implementation as a learning health system.

CONCLUSIONS: The results of this evaluation will characterize CARF-accredited IPRPs and identify determinants affecting the implementation of this complex intervention, made up of multiple evidence-based practices. Partner-driven data will inform the state of implementation at each site, and quantitative measures will provide options for collecting standardized outcome measures for continued program evaluation. This operational partner-driven evaluation will inform future efforts for quality improvement to improve veterans’ pain management outcomes. This protocol informs the use of a mixed methods approach to evaluate a multimodal intervention (ie, IPRP), made up of multiple evidence-based practices to treat a complex comorbid condition. Future work may include data management infrastructure development and cost evaluations to inform clinical and operational decision-making.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/72091.

PMID:40324171 | DOI:10.2196/72091

Health Soc Care Deliv Res. 2025 Apr 30:1-47. doi: 10.3310/MWKJ5102. Online ahead of print.

ABSTRACT

BACKGROUND: Type 2 diabetes is considered a critical challenge to modern healthcare systems. The National Health Service Diabetes Prevention Programme delivered an evidence-based behaviour change programme at a national scale to reduce the incidence of type 2 diabetes in England.

OBJECTIVE(S): The Diabetes Prevention – Long-term Multimethod Assessment research programme provided a comprehensive assessment of the delivery of the National Health Service Diabetes Prevention Programme and its effectiveness and cost-effectiveness.

DESIGN: Mixed-methods research including qualitative methods, observations, patient surveys and secondary analysis of administrative and survey data using statistical and econometric methods.

SETTING: Community settings in England delivering the commissioned intervention, supported by general practices responsible for recruitment and referral.

PARTICIPANTS: Patients in community settings identified as being at high risk of type 2 diabetes offered and participating in the National Health Service Diabetes Prevention Programme, and staff involved in the organisation and delivery of the service.

INTERVENTIONS: The National Health Service Diabetes Prevention Programme, including its evidence-based behaviour change intervention (using both face-to-face and digital platforms) and the associated services for patient recruitment.

MAIN OUTCOME MEASURES: Incidence of type 2 diabetes, cost-effectiveness, access to the programme and fidelity of intervention delivery.

DATA SOURCES: Interviews with patients and staff, document analysis and observations of the National Health Service Diabetes Prevention Programme delivery, patient surveys, secondary data (including National Health Service Diabetes Prevention Programme data, national surveys and audits).

RESULTS: The National Health Service Diabetes Prevention Programme was associated with significant reductions in incidence of type 2 diabetes and was highly likely to be cost-effective. Analyses of the delivery of the programme highlighted several aspects which impacted access to the programme and the fidelity with which the behaviour change intervention was delivered. For example, uptake and adherence were influenced by participants’ psychosocial beliefs (e.g. chance of getting type 2 diabetes and whether taking part would reduce this). There were large differences between general practices in how many people they referred to the programme, with practices that offered higher-quality care for people with diabetes referring more. Variation in retention and outcomes was associated with differences in providers.

LIMITATIONS: Analysis of administrative data to explore effectiveness and cost-effectiveness may be influenced by confounding. Recruitment of diverse and representative samples for surveys, interviews and observations was likely impacted by selection.

CONCLUSIONS: The National Health Service Diabetes Prevention Programme is highly likely to be cost-effective. Data from Diabetes Prevention – Long-term Multimethod Assessment have been used to improve aspects of programme delivery and could suggest further enhancements to improve recruitment, retention and fidelity.

FUTURE WORK: Future research should address the question of whether the National Health Service Diabetes Prevention Programme prevents or delays type 2 diabetes when longer-term follow-up data are available. We identified factors that could be targeted to impact on recruitment, retention and inequalities, and recommend a robust assessment of the link between fidelity and outcomes.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 16/48/07.

PMID:40323644 | DOI:10.3310/MWKJ5102

J Med Internet Res. 2025 May 5;27:e66463. doi: 10.2196/66463.

ABSTRACT

BACKGROUND: Disorders of the patella are among the most prevalent knee injuries. While exercise therapy is widely accepted as an effective treatment strategy, the positive effects of conventional exercise therapy under the guidance of a physiotherapist may be offset by inherent limitations, such as difficulties in scheduling appointments or statutory policies restricting the number of training sessions. Home-based exercise interventions using digital health applications (DHAs) may help address some of these limitations.

OBJECTIVE: This study aimed to assess the efficacy of a 12-week exercise intervention using a web-based DHA for improving knee function and reducing pain in patients with disorders of the patella (International Classification of Diseases code M22).

METHODS: The outcomes of the DHA intervention group (IG) were compared to a control group (CG) that received conventional physiotherapy covered by statutory health insurance in Germany (SHI-PT). A total of 259 patients with diagnosed disorders of the patella were included in the trial and randomly allocated to IG DHA (n=136, 52.5%) and CG SHI-PT (n=123, 47.5%). Two primary end points were examined: “knee function” (Knee Injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOS_ADL] subscale, range 0-100 points) and “knee pain” (visual analog scale [VAS], range 0-100 points). Participants were asked to complete 2 surveys: one before the first therapy session (PRE) and one after completing the treatment period of 12 weeks (POST).

RESULTS: Training with the DHA resulted in a 4.5-fold greater improvement in “knee function” (PRE-POST differences in KOOS_ADL score; IG DHA: 15.7 points, 95% CI 13.7-17.6 vs CG SHI-PT: 3.5 points, 95% CI 1.5-5.5) and a 3.5-fold greater reduction in “knee pain” (PRE-POST differences in VAS pain score; IG DHA: -22.5 points, 95% CI -25.2 to -19.9 vs CG SHI-PT: -6.5 points, 95% CI -8.7 to -4.4) compared to SHI-PT. The improvements in IG DHA exceeded the limits of clinical relevance. The differences between the treatment groups (KOOS_ADL score -10.1 points, 95% CI -infinity to -8.0; VAS pain score 14.3 points 95% CI 11.7-infinity) were statistically significant (P<.001) for both end points in favor of IG DHA. No effect was found for age or sex. The reported use of pain medication decreased substantially in IG DHA, and showed almost no change in CG SHI-PT.

CONCLUSIONS: Our findings indicated that the investigated DHA is superior to SHI-PT for treating disorders of the patella. Therefore, DHA has been approved by the German Federal Institute for Drugs and Medical Devices for treating disorders of the patella in persons of all sexes aged ≥12 years.

TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00023454; https://drks.de/search/en/trial/DRKS00023454.

PMID:40323642 | DOI:10.2196/66463

J Craniofac Surg. 2025 May 5. doi: 10.1097/SCS.0000000000011364. Online ahead of print.

ABSTRACT

Reverse engineering techniques, including computed tomography (CT) equipment and 3-dimensional (3D) scanners, enable the acquisition of digital data for computational modeling and biomodel plotting. The objective of this study was to evaluate the dimensional fidelity of rapid prototyping (RP) biomodels obtained from different CT and 3D scanner equipment. Five dry mandibles were scanted by multidetector and cone beam CT equipment and 3D scanner. The data were processed in a standardized way to construct RP biomodels by the technique of deposition of molten material. Linear measurements were performed on dry mandibles and biomodels. The results revealed that there was no statistically significant difference between the measurements of dry mandibles and biomodels, but there was a difference between the measurements of the biomodels obtained by multidetector CT in relation to the other equipment (P=0.02). There was no significant difference in the measurements of the posterior region of the mandible (P=0.09), but in the anterior region the biomodels obtained by CBCT showed a significant difference in relation to the dry mandible (P=0.0002). Dimensional error was irrelevant to clinical practice. The biomodels produced were accurate for use in the biomedical area, although the anterior region of the mandible presents dimensional discrepancy when cone beam CT is used.

PMID:40323638 | DOI:10.1097/SCS.0000000000011364

Expert Opin Drug Metab Toxicol. 2025 May 5. doi: 10.1080/17425255.2025.2501128. Online ahead of print.

ABSTRACT

INTRODUCTION: Model Informed Precision Dosing (MIPD) allows determining the optimal dosage regimen and its correction based on the target plasma/serum concentrations of the drug. MIPD software must go through a validation and clinical study of its effectiveness and safety before being used in clinical practice.

AREAS COVERED: This narrative literature review provides insight into what is known to date about efficacy and safety trials of MIPD concept. Relevant publications were searched for in the PubMed database, without time or language constraints.

EXPERT OPINION: The application of MIPD in clinical practice logically and theoretically has great potential to improve the treatment of patients by leading to optimal exposure of target tissues to drugs, while achieving full effect and minimizing toxicity. Greater implementation of MIPD in clinical practice is hindered by the fact that the beneficial effects of MIPD on treatment outcomes and reduction of drug toxicity have been proven through clinical studies only for a small number of drugs. It is necessary to conduct well-designed clinical studies of the effects of MIPD, with sufficient statistical power, to prove the benefits of MIPD administration and to justify the costs of implementation in clinical practice.

PMID:40323636 | DOI:10.1080/17425255.2025.2501128

JAMA Neurol. 2025 May 5. doi: 10.1001/jamaneurol.2025.0716. Online ahead of print.

ABSTRACT

IMPORTANCE: MR CLEAN-LATE (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands for Late Arrivals) showed efficacy of endovascular treatment (EVT) in the late window (6-24 hours after stroke symptom onset or time last seen well) among patients with ischemic stroke selected based on collateral flow. Therefore, the future role of computed tomography perfusion (CTP) imaging in patient selection for late-window EVT may change.

OBJECTIVE: To investigate the interaction among CTP parameters (core volumes, penumbra volumes, and mismatch ratio) and the association of EVT with functional outcomes among patients in the late window after ischemic stroke selected based on collateral flow.

DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc secondary analysis of MR CLEAN-LATE, a multicenter randomized clinical trial, with open-label treatment and blinded end point, conducted from February 2, 2018, to January 27, 2022, in 18 Dutch stroke intervention centers. Participants included 502 patients with anterior circulation large vessel occlusion and present collateral flow on results of computed tomographic angiography in the late window after stroke, who gave deferred consent and were included in MR CLEAN-LATE. All patients had completed follow-up at 90 days. This secondary analysis included 313 patients (62%) with available CTP results. Statistical analysis was performed in September 2023.

INTERVENTION: Patients were randomized to receive EVT (EVT group) and best medical management vs best medical management alone (no EVT group).

MAIN OUTCOMES AND MEASURES: The primary outcome was functional outcome at 90 days measured by the modified Rankin Scale score. The treatment effect was analyzed in subgroups of core volumes, penumbra volume, and mismatch ratios using ordinal regression analysis. An interaction analysis was performed to assess whether CTP parameters modified the EVT effect on the modified Rankin Scale score at 90 days. All analyses were adjusted for relevant prognostic factors.

RESULTS: Among the 313 patients (158 women [50%]) in the study, the median age was 73 years (IQR, 63-80 years), and the EVT group had fewer male participants than the no EVT group (73 of 168 [43%] vs 82 of 145 [57%]). Penumbra volumes significantly modified the association of EVT with outcomes (P < .001 for interaction), with the largest effect size among patients with penumbras of 120 mL or more (adjusted common odds ratio [ACOR], 6.89 [95% CI, 2.96-16.04]) and the smallest effect size among patients with penumbras of 72 mL or less (ACOR, 0.49 [95% CI, 0.22-1.08]). Core volume and mismatch ratio did not modify the EVT effect.

CONCLUSIONS AND RELEVANCE: Based on results from this secondary analysis of the MR CLEAN-LATE randomized clinical trial, there was a direct interaction between penumbra volume and treatment effect, and a trend toward potential harm of EVT was seen among patients with the smallest penumbras, which warrants further research. However, core volume and mismatch ratio did not seem to have additional value in patient selection.

TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN19922220.

PMID:40323620 | DOI:10.1001/jamaneurol.2025.0716

JAMA Neurol. 2025 May 5. doi: 10.1001/jamaneurol.2025.0806. Online ahead of print.

ABSTRACT

IMPORTANCE: Migraine and major depressive disorder are frequently comorbid; however, evidence evaluating the efficacy of preventive migraine therapy in patients with both diseases is limited.

OBJECTIVE: To evaluate the efficacy and safety of fremanezumab in adults with migraine and comorbid major depressive disorder.

DESIGN, SETTING, AND PARTICIPANTS: The UNITE study was a double-blind, placebo-controlled, parallel-group, randomized clinical trial consisting of a 4-week screening period, 12-week double-blind period, and 12-week open-label extension (OLE), conducted between July 9, 2020, and August 31, 2022. The trial was conducted at 55 centers across 12 countries. Eligible patients were adults with episodic migraine (EM) or chronic migraine (CM), history of major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for 12 or more months before screening, and active symptoms of depression (9-item Patient Health Questionnaire score of 10 or more) at screening.

INTERVENTIONS: Patients were randomized 1:1 to receive monthly fremanezumab (225 mg) or matched placebo. All patients in the OLE received quarterly fremanezumab (675 mg).

MAIN OUTCOMES AND MEASURES: The primary end point was the mean change from baseline in monthly migraine days during the 12-week double-blind period.

RESULTS: Of the 540 patients screened for the study, 353 patients (mean [SD] age, 42.9 [12.3] years; 310 female [88%]; EM, 48%; CM, 52%) were eligible and randomized to receive fremanezumab (n = 175) or placebo (n = 178). Mean (SE) change from baseline in monthly migraine days during the 12-week double-blind period was -5.1 (0.50; 95% CI, -6.09 to -4.13) for fremanezumab and -2.9 (0.49; 95% CI, -3.89 to -1.96) for placebo (P <.001). Mean (SE) change from baseline in the Hamilton Depression Rating Scale-17 Items score at week 8 was -6.0 (0.55; 95% CI, -7.10 to -4.95) for fremanezumab and -4.6 (0.54; 95% CI, -5.66 to -3.55) for placebo (least squares mean [SE] difference: -1.4 [0.61]; 95% CI, -2.61 to -0.22; P = .02). Adverse events were consistent with other fremanezumab trials. Results were maintained throughout the OLE.

CONCLUSIONS AND RELEVANCE: Treatment with fremanezumab compared with placebo resulted in significant reductions in monthly migraine days and depressive symptoms. No new safety concerns were observed. To the authors’ knowledge, this was the first placebo-controlled, randomized clinical trial, specifically designed to assess patients with migraine and comorbid depressive disorder, to demonstrate significant improvements in migraine and depressive symptoms with a single pharmacological intervention.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04041284.

PMID:40323613 | DOI:10.1001/jamaneurol.2025.0806

JAMA Netw Open. 2025 May 1;8(5):e258283. doi: 10.1001/jamanetworkopen.2025.8283.

ABSTRACT

IMPORTANCE: The oral microbiome likely plays key roles in human health. Yet, population-representative characterizations are lacking.

OBJECTIVE: To characterize the composition, diversity, and correlates of the oral microbiome in US adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data from the population-representative National Health and Nutrition Examination Survey (NHANES) from 2009 to 2012. Microbiome data were made publicly available in 2024. NHANES participants were aged 18 to 69 years and provided oral rinse samples in 1 of 2 consecutive NHANES cycles (2009-2010 and 2011-2012).

EXPOSURES: Demographic, socioeconomic, behavioral, anthropometric, metabolic, and clinical characteristics.

MAIN OUTCOMES AND MEASURES: Oral microbiome measures, characterized through 16S ribosomal RNA gene sequencing, included α diversity (observed amplicon sequence variants [ASVs], Faith phylogenetic diversity, Shannon-Weiner Index, and Simpson Index); β diversity (unweighted UniFrac, weighted UniFrac, and Bray-Curtis dissimilarity); and prevalence and relative abundance at phylum level through genus level. Analyses accounted for the NHANES complex sample design.

RESULTS: This study included 8237 US adults aged 18 to 69 years, representing 202 314 000 individuals (102 813 000 men [50.8%]; mean [SD] age, 42.3 [14.4] years; 9.3% self-reported as Mexican American, 12.1% as non-Hispanic Black, 64.7% as non-Hispanic White, 5.9% as other Hispanic, and 8.1% as other non-Hispanic individuals). The oral microbiome encompassed 37 bacterial phyla, 99 classes, 212 orders, 446 families, and 1219 genera. Five phyla (Firmicutes, Actinobacteria, Bacteroidetes, Proteobacteria, and Fusobacteria) and 6 genera (Veillonella, Streptococcus, Prevotella 7, Rothia, Actinomyces, and Gemella) were present in nearly all US adults (weighted prevalence, >99%). These genera were the most abundant, accounting for 65.7% of total abundance. Observed ASVs showed a quadratic pattern with age (peak at 30 years), were similar by sex, significantly lower among non-Hispanic White individuals, and increased with greater body mass index (BMI), alcohol use, and periodontal disease severity. All covariates together accounted for a modest proportion of oral microbiome variability as measured by β diversity: R2 = 8.7% (95% CI, 8.4%-9.1%) for unweighted UniFrac, R2 = 7.2% (95% CI, 6.6%-7.7%) for weighted UniFrac, and R2 = 6.3% (95% CI, 3.1%-6.7%) for Bray-Curtis matrices. By contrast, relative abundance of a few genera explained a high percentage of variability in β diversity for weighted UniFrac: Aggregatibacter (R2 = 22.4%; 95% CI, 22.1%-22.8%), Lactococcus (R2 = 21.6%; 95% CI, 20.9%-22.3%), and Haemophilus (R2 = 18.4%; 95% CI, 18.1%-18.8%). Prevalence and relative abundance of numerous genera were associated with age, race and ethnicity, smoking, BMI categories, alcohol use, and periodontal disease severity.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of the oral microbiome in US adults showed that a few genera were universally present and a different set of genera explained a high percentage of oral microbiome diversity across the population. This comprehensive characterization provides a contemporary reference standard for future studies.

PMID:40323603 | DOI:10.1001/jamanetworkopen.2025.8283