Tag: nevin manimala

Chaos. 2025 May 1;35(5):053101. doi: 10.1063/5.0244221.

ABSTRACT

A transformer-based Koopman autoencoder is proposed for linearizing Fisher’s reaction-diffusion equation. The primary focus of this study is on using deep learning techniques to find complex spatiotemporal patterns in the reaction-diffusion system. The emphasis is on not just solving the equation but also transforming the system’s dynamics into a more comprehensible, linear form. Global coordinate transformations are achieved through the autoencoder, which learns to capture the underlying dynamics by training on a data set with 60,000 initial conditions. Extensive testing on multiple data sets was used to assess the efficacy of the proposed model, demonstrating its ability to accurately predict the system’s evolution as well as to generalize. We provide a thorough comparison study, comparing our suggested design to a few other comparable methods using experiments on various PDEs, such as the Kuramoto-Sivashinsky equation and Burger’s equation. Results show improved accuracy, highlighting the capabilities of the transformer-based Koopman autoencoder. The proposed architecture is significantly ahead of other architectures, in terms of solving different types of PDEs using a single architecture. Our method relies entirely on the data, without requiring any knowledge of the underlying equations. This makes it applicable to even the data sets where the governing equations are not known.

PMID:40310706 | DOI:10.1063/5.0244221

J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251333359. doi: 10.1177/19160216251333359. Epub 2025 May 1.

ABSTRACT

ImportanceUnlike other head and neck cancers, head and neck soft tissue sarcoma (HN-STS) is staged similarly to sarcomas in the trunk and extremities. The current American Joint Committee on Cancer (AJCC) staging system has limitations that hinder accurate prognosis prediction for HN-STS.ObjectiveWe aimed to develop a novel location-grading-node-metastasis (LGNM) staging system based on the primary tumor location to more accurately stratify prognosis for HN-STS.DesignA retrospective case series from 1990 to 2021.Setting/ParticipantsThis study included 471 patients diagnosed with HN-STS at Sun Yat-sen University Cancer Center between 1990 and 2021.Main outcome measuresIn the primary analysis, we obtained the overall survival (OS) rate. Secondary measures included area under the receiver operating characteristic curve, Harrell’s C, Somers’ D, Gönen and Heller’s K, O’Quigley’s ρ2k, Royston’s R², the Bayesian information criterion for concordance, and variation in patient outcomes.ResultsThe eighth edition of AJCC T classification for tumor size inadequately conveys prognosis information. In contrast, the primary tumor location and local invasion are prognostic factors for HN-STS and categorized into 4 stages: L1 (low risk: scalp, face, supraclavicular, ear), L2 (intermediate risk: neck, paravertebral, pharynx, tonsil, eye, orbit), L3 (high risk: cavity, lip, palate, buccal mucosa, salivary gland, maxilla, mandible), and L4 (any location with local invasion). The new LGNM staging system effectively distributed patients into stages I to IV, with statistically-significant survival differences among these stages. Five-year OS rates were 96.9% for stage I, 78.4% for stage II, 37.1% for stage III, and 7.1% for stage IV (P < .001). Additionally, the LGNM staging system demonstrated superior predictive ability and concordance compared with the seventh and eighth editions of AJCC staging systems.Conclusions/RelevanceThe LGNM staging system shows better homogeneity and discriminatory power than the AJCC system, improving risk stratification and prognosis prediction in HN-STS.

PMID:40310697 | DOI:10.1177/19160216251333359

JMIR Res Protoc. 2025 May 1;14:e66982. doi: 10.2196/66982.

ABSTRACT

BACKGROUND: Malaria is a major health issue that is distributed across 85 countries globally including Indonesia. Indonesia is in the process of achieving malaria elimination. Currently, a high burden of malaria exists in the rural eastern part of the nation, including East Nusa Tenggara Province where the number of malaria cases increased significantly during COVID-19. To achieve malaria elimination, malaria awareness must be measurable and integrated into malaria policy. Currently, malaria awareness among rural communities in the region is low, and interventional studies aiming at improving malaria awareness in rural areas in Indonesia are poorly documented.

OBJECTIVE: This study aims to investigate the impact of a local wisdom-based health education campaign combining local music, the voice of subdistrict leaders, and loudspeaker announcements on malaria-related behaviors in rural communities. Specifically, we aim to assess the effect of this intervention on (1) improvement in the malaria awareness index among rural communities and their associated factors, (2) changes in appropriate malaria treatment-seeking behavior (AMTSB) and its associated factors, (3) enhancements in knowledge and practice of malaria prevention measures and their associated factors, and (4) increased use of long-lasting insecticide-treated nets and their associated factors.

METHODS: This study used a cluster-assigned quasi-experimental design with pretest and posttest assessments in control and intervention groups. The control group, consisting of 12 villages, received malaria education integrated into routine health services provided by local health centers. The intervention group, comprising 13 villages, received the same education as the control group, in addition to a malaria campaign conducted once a week for 20 weeks. Before and after the campaign, a household survey was conducted to assess behavioral aspects of malaria, including general knowledge of malaria, AMTSB, and malaria prevention measures knowledge and practice. Improvement in the malaria awareness index, AMTSB, good level of malaria prevention measure knowledge, and good level of malaria prevention measure practice will be determined based on the difference scores for each index before and after the intervention in both groups. The chi-square test will be used to assess score differences. Binary logistic regression analysis will be conducted to identify key risk factors associated with changes in each index.

RESULTS: The intervention was conducted from the last week of August 2024 to the second week of January 2025. A total of 894 respondents participated before and after the intervention. The project is currently in progress, with multiple papers being drafted for publication in peer-reviewed journals.

CONCLUSIONS: This study is expected to provide significant findings to comprehensively investigate the change in behavioral aspects of malaria due to a local wisdom-based malaria education campaign. The findings could assist stakeholders in Indonesia with developing malaria health policies that are contextually relevant, thereby supporting global efforts to achieve malaria-free status by 2030.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/66982.

PMID:40310678 | DOI:10.2196/66982

Interact J Med Res. 2025 May 1;14:e65213. doi: 10.2196/65213.

ABSTRACT

BACKGROUND: Physical activity and appropriate nutrition are essential for older adults. Improving physical health and quality of life can lead to healthy aging.

OBJECTIVE: This study aims to investigate the long-term effects of multihealth promotion programs on the physical and mental health of older adults in communities.

METHODS: A quasi-experimental method was used to recruit 112 older adults voluntarily from a pharmacy in central Taiwan between April 2021 and February 2023. Participants were divided into an experimental group receiving a multihealth promotion program and a control group with no specific intervention. The study measured frailty, nutritional status, well-being, and quality of life using standardized tools such as the Clinical Frailty Scale (CFS), Mini-Nutritional Assessment-Short Form (MNA-SF), Well-being Scale for Elders, and the EQ-5D-3L. Data were analyzed using descriptive statistics, independent t tests, Pearson correlation, and generalized estimating equations.

RESULTS: A total of 112 participants were recruited. There were 64 (57.1%) in the experimental group and 48 (42.9%) in the control group. The experimental group exhibited significantly better quality of life (EQ-5D index) at weeks 12 (β=-.59; P=.01) and 24 (β=-.44; P=.04) compared to the control group. The experimental group muscle mass significantly increased at weeks 24 (β=4.29; P<.01) and 36 (β=3.03; P=.01). Upper limb strength improved significantly at weeks 12 (β=3.4; P=.04) and 36 (β=5; P=.01), while core strength showed significant gains at weeks 12 (β=4.43; P=.01) and 36 (β=6.99; P<.01). Lower limb strength increased significantly only at week 12 (β=4.15; P=.01). Overall physical performance improved significantly at weeks 12 (β=5.47; P<.01), 24 (β=5.17; P<.01), and 36 (β=8.79; P<.01).

CONCLUSIONS: The study’s findings highlight the practical benefits of interventions, including physical and social activities and nutritional support, in enhancing the quality of life and general physical health of older adults. This study’s findings have significant implications for clinical practice. These findings can aid in the establishment of effective interventions for older adults.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05412251; https://clinicaltrials.gov/study/NCT05412251.

PMID:40310677 | DOI:10.2196/65213

JMIR Mhealth Uhealth. 2025 May 1;13:e67151. doi: 10.2196/67151.

ABSTRACT

BACKGROUND: The digital education platform Doctorvice (iKooB Inc.) offers face-to-face physician-patient education during outpatient clinic visits, remote glucose monitoring, and the delivery of educational messages, and is expected to be effective for personalized diabetes care.

OBJECTIVE: This study aims to evaluate the effectiveness of the digital education platform for diabetes care by comparing cases that included both face-to-face education and remote monitoring with those that included only face-to-face education.

METHODS: This was a randomized clinical study conducted at the Diabetes Center of Seoul St. Mary’s Hospital. Participants were aged ≥19 years and had glycated hemoglobin (HbA_1c) levels between 7.5% and 9.5%. In the intervention group, physicians used the digital education platform to provide face-to-face education at enrollment and at the 3- and 6-month visits, along with remote monitoring during the first 3 months of the 6-month study period. The control group received conventional outpatient education. Both groups completed questionnaires-assessing satisfaction with diabetes treatment, diabetes-related stress, and adherence to diabetes medication-at the beginning and end of the study. The primary endpoint was the change in HbA_1c levels.

RESULTS: A total of 66 participants were enrolled between August 1, 2022, and August 31, 2023. Of these, 26 in the intervention group and 30 in the control group were analyzed, excluding 10 participants who dropped out of the study. The mean baseline HbA_1c levels were 8.3% (SD 0.6%) in the intervention group and 8.0% (SD 0.5%) in the control group. At the 3-month follow-up, mean HbA_1c decreased by 0.5%-7.8% (SD 0.9%; P=.01) in the intervention group and by 0.2%-7.8% (SD 0.7%) in the control group. HbA_1c levels substantially improved during the first 3 months with both face-to-face education and remote glucose monitoring. However, HbA_1c tended to increase during the 3- to 6-month follow-up in the intervention group without the remote monitoring service. Satisfaction with diabetes treatment significantly improved at the end of the study compared with baseline in the intervention group (mean change +3.6 points; P=.006). Medication adherence improved in both groups, with no significant difference at 6 months (P=.59), although the intervention group showed a greater increase from baseline. Subgroup analysis indicated that the reduction in HbA_1c was greater for patients with baseline HbA_1c levels ≥8.0%, those aged ≥65 years, smokers, drinkers, and those with obesity in the intervention group.

CONCLUSIONS: The digital education platform for personalized diabetes management may be beneficial for glycemic control in type 2 diabetes mellitus. Its effectiveness appears to be enhanced when physicians provide personalized face-to-face education combined with remote feedback.

TRIAL REGISTRATION: Clinical Research Information Service (CRiS) of Republic of Korea KCT0007953; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23507&search_page=L.

PMID:40310669 | DOI:10.2196/67151

JAMA Netw Open. 2025 May 1;8(5):e258072. doi: 10.1001/jamanetworkopen.2025.8072.

ABSTRACT

IMPORTANCE: Medicare covers gender-affirming surgical procedures on a case-by-case basis. The proportion of Medicare beneficiaries who receive gender-affirming surgical procedures is unknown.

OBJECTIVE: To examine the frequency and trends of gender-affirming surgical procedures for Medicare beneficiaries.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used national Medicare data to analyze transgender and gender diverse beneficiaries’ use of gender-affirming surgical procedures from January 1, 2016, to February 29, 2020, as well as use of the same surgical procedures by beneficiaries not identified as transgender. Transgender Medicare beneficiaries were identified using a claims-based algorithm; nontransgender individuals were selected using propensity score matching. Analyses were conducted from November 2022 through October 2024.

EXPOSURES: Race and ethnicity, Medicare-Medicaid dual status, age, original reason for Medicare entitlement, geographic area, and chronic conditions.

MAIN OUTCOMES AND MEASURES: Descriptive analyses and generalized estimating equations were used to assess gender-affirming surgical procedures and beneficiary characteristics associated with surgical procedures.

RESULTS: This study included transgender individuals (mean [SD] age, 60.0 [18.6] years; 43.2% transfeminine individuals, 33.0% transmasculine individuals, and 23.9% individuals with unclassified gender) and individuals (mean [SD] age, 62.7 [21.0] years; 55.5% women and 44.5% men) not identified as transgender. Of 142 703 total person-years, there were 2156 instances of transgender individuals having at least 1 gender-affirming surgical procedure in the calendar year. The rate of individuals receiving at least 1 surgical procedure decreased from between 2.1% and 2.2% in 2016 and 2017 to 1.4% in 2018 and 2019. There was substantial variability in surgical procedures across beneficiary characteristics. Transgender beneficiaries who underwent surgery were younger (31-40 years vs 61-65 years: adjusted odds ratio [AOR], 1.91 [95% CI, 1.55-2.34]) and had higher enrollment in Medicaid (AOR, 1.14 [95% CI, 1.02-1.26]), higher rates of chronic conditions (≥10 conditions vs 0: AOR, 2.10 [95% CI, 1.79-2.46]), and higher proportions of residents on the West Coast (Alaska, Idaho, Oregon, and Washington) vs the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) (AOR, 1.30 [95% CI, 1.05-1.61]) compared with those who did not undergo surgery. Geographically, the largest difference was observed when comparing the Northeast with the Southeast (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) (AOR, 0.70 [95% CI, 0.58-0.86]; P < .001) and other parts of the South (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) (AOR, 0.56 [95% CI, 0.44-0.71]; P < .001). There was no significant difference in receipt of surgical procedures across regions for those not identified as transgender.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of the Medicare program found that gender-affirming surgical procedures were very rare, particularly for those who were older, were not dually enrolled in Medicare and Medicaid, and who resided in the South. Although there were substantive regional differences in receipt of gender-affirming surgical procedures among transgender Medicare beneficiaries, beneficiaries not identified as transgender did not experience regional differences. Further study is warranted to examine barriers to accessing gender-affirming surgery for transgender and gender diverse beneficiaries.

PMID:40310645 | DOI:10.1001/jamanetworkopen.2025.8072

JAMA Netw Open. 2025 May 1;8(5):e258086. doi: 10.1001/jamanetworkopen.2025.8086.

ABSTRACT

IMPORTANCE: Among older women (aged ≥50 years) with ERBB2 (formerly HER2 or HER2/neu)-positive breast cancer, research has shown racial and ethnic disparities in access to ERBB2-targeted therapies, with Black women receiving treatment at lower rates than their White counterparts.

OBJECTIVE: To examine racial and ethnic disparities in receipt of ERBB2-targeted therapies and changes in receipt over time.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used Surveillance, Epidemiology, and End Results-Medicare linked data from January 1, 2010, to December 31, 2020. Beneficiaries who were diagnosed with ERBB2-positive breast cancer between 2010 and 2019, were aged 66 years or older at diagnosis, were continuously enrolled in Medicare Parts A and B in the 12 months before and after diagnosis, and had localized or regional stage disease at diagnosis were included. Data were analyzed from February through September 2024.

EXPOSURE: Race and ethnicity defined as non-Hispanic Black or African American, Hispanic, or non-Hispanic White.

MAIN OUTCOME AND MEASURES: The primary outcome was receipt of ERBB2-targeted therapies in the 12 months after diagnosis of ERBB2-positive breast cancer. Modified Poisson regression was used to evaluate the probability of receiving ERBB2-targeted therapy by race and ethnicity.

RESULTS: Among 12 765 beneficiaries with ERBB2-positive breast cancer (median [IQR] age, 74 [69-80] years; 99.2% female), 8.1% were of Black, 6.9% Hispanic, and 85.0% White race and ethnicity, and 54.2% received ERBB2-targeted therapy. The overall proportion who received ERBB2-targeted therapies increased from 41.3% in 2010-2011 to 64.3% in 2018-2019. Compared with White patients, Black patients had a lower likelihood of receiving ERBB2-targeted therapies in 2010-2011 (adjusted risk ratio [ARR], 0.81; 95% confidence limit [CL], 0.68-0.97), as did Hispanic patients (ARR, 0.75; 95% CL, 0.62-0.92). Racial and ethnic disparities in receipt of ERBB2-targeted therapies narrowed over time, with no significant differences observed across racial and ethnic groups in 2018-2019 for Black patients (ARR, 0.97; 95% CL, 0.87-1.08) and Hispanic patients (ARR, 1.05; 95% CL, 0.95-1.16).

CONCLUSIONS AND RELEVANCE: These findings suggest a narrowing of racial and ethnic disparities in receipt of ERBB2-targeted therapies over time among older Medicare beneficiaries with ERBB2-positive breast cancer. Future research is needed to understand the practices that contributed to the narrowing of racial and ethnic disparities and to develop implementation strategies to effectively improve the quality and equity of breast cancer care.

PMID:40310643 | DOI:10.1001/jamanetworkopen.2025.8086

Transl Vis Sci Technol. 2025 May 1;14(5):2. doi: 10.1167/tvst.14.5.2.

ABSTRACT

PURPOSE: To investigate whether cataract surgical skill performance metrics automatically generated by artificial intelligence (AI) models can differentiate between trainee and faculty surgeons and the correlation between AI metrics and expert-rated skills.

METHODS: Routine cataract surgical videos from residents (N = 28) and attendings (N = 29) were collected. Three video-level metrics were generated by deep learning models: phacoemulsification probe decentration, eye decentration, and zoom level change. Three types of instrument- and landmark- specific metrics were generated for the limbus, pupil, and various surgical instruments: total path length, maximum velocity, and area. Expert human judges assessed the surgical videos using the Objective Structured Assessment of Cataract Surgical Skill (OSACSS). Statistical differences between AI and human-rated scores between attending surgeons and trainees were assessed using t-tests, and the correlations between them were examined by Pearson correlation coefficients.

RESULTS: The phacoemulsification probe had significantly lower total path lengths, maximum velocities, and area metrics in attending videos. Attending surgeons demonstrated better phacoemulsification centration and eye centration. Most AI metrics negatively correlated with OSACSS scores, including phacoemulsification decentration (r = -0.369) and eye decentration (r = -0.394). OSACSS subitems related to eye centration and different steps of surgery also exhibited significant negative correlations with corresponding AI metrics (r ranging from -0.77 to -0.49).

CONCLUSIONS: Automatically generated AI metrics can be used to differentiate between attending and trainee surgeries and correlate with the human expert evaluation on surgical performance.

TRANSLATIONAL RELEVANCE: AI-generated useful metrics that correlate with surgeon skill may be useful for improving cataract surgical education.

PMID:40310637 | DOI:10.1167/tvst.14.5.2

Clin Auton Res. 2025 May 1. doi: 10.1007/s10286-025-01130-y. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this work is to determine the relationship between the cross-sectional area (CSA) of the vagus nerve and cardiovagal function in people with multiple sclerosis (pwMS) and healthy controls (HC).

METHODS: We enrolled 50 pwMS and 50 HC. All participants underwent an ultrasound of the vagus nerve and autonomic nervous system testing. The Croatian version of the COMPASS-31 questionnaire was used as a measure of autonomic symptom burden. Cardiovagal function was evaluated with the respiratory sinus arrhythmia (RSA), Valsalva ratio (VR), and heart rate variability.

RESULTS: The mean vagus CSA in pwMS was 2.03 ± 0.49 mm² on the right side and 1.72 ± 0.38 mm² on the left side. The mean vagus CSA in HC was 2.08 ± 0.50 mm² on the right side and 1.74 ± 0.37 mm² on the left side. There was no statistically significant difference between the two groups in right (p = 0.615) or left (p = 0.866) vagus CSA. In the HC, there was a statistically significant positive correlation between the mean right CSA and both RSA (r_p = 0.331, p = 0.019) and VR (r_p = 0.327, p = 0.020). On univariable linear regression analysis in the HC group, the mean right CSA was a predictor of both RSA (B = 5.599, 95% CI 0.974-10.224, p = 0.019) and VR (B = 0.253, 95% CI 0.041-0.466, p = 0.020). These findings were not present in pwMS.

CONCLUSIONS: The loss of correlation between vagus nerve CSA and parameters of parasympathetic nervous system function in pwMS corroborates the presence of cardiovagal dysfunction in multiple sclerosis.

PMID:40310594 | DOI:10.1007/s10286-025-01130-y

Genet Med. 2025 Apr 25:101449. doi: 10.1016/j.gim.2025.101449. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive disorder caused by pathogenic variants in CYP27A1 resulting in sterol 27-hydroxylase deficiency and accumulation of cholestanol and bile alcohols. Clinical features include cholestasis, diarrhea, cataracts, tendon xanthomas, and neurological deterioration. Chenodeoxycholic acid (CDCA) is the standard treatment for CTX. The effects of CDCA withdrawal on CTX biomarkers and safety in adult patients were evaluated.

MATERIALS AND METHODS: Patients (≥16 years) received CDCA 750 mg/day for two 8-week open-label periods followed by double-blinded (DB) CDCA or placebo for two 4-week periods. Key endpoints included changes from baseline in CTX biomarkers (23S-pentol, cholestanol, 7αC4, 7α12αC4) and the proportion of patients requiring CDCA rescue during DB periods.

RESULTS: CDCA withdrawal resulted in a 20-fold increase in 23S-pentol, and increases in cholestanol (2.8-fold), 7αC4 (50-fold) and 7α12αC4 (14-fold). During the DB withdrawal periods, 61% of participants on placebo required rescue medication. CDCA treatment was well tolerated; the most common treatment-emergent adverse events were diarrhea and headache, most mild/moderate in severity and not considered treatment-related.

CONCLUSIONS: CDCA withdrawal caused statistically significant increases in CTX biomarkers and necessitated rescue therapy in most participants. CDCA treatment is critical for control of biochemical abnormalities and helps avoid disease progression.

PMID:40297984 | DOI:10.1016/j.gim.2025.101449