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Recent Submissions
How active is ‘active’? Overcoming Misconceptions and Optimizing Pedagogical Practices of Active Learning in EFL Classrooms
(2025-05-01) Lu B.D.; Watanapokakul S.; Lu B.D.; Mahidol University
Active Learning (AL) has emerged as a promising pedagogical alternative to traditional passive learning across various educational fields, including English as a Foreign Language (EFL) instruction. Despite its increasing adoption, discrepancies and misconceptions persist in its implementation within EFL contexts. This review article first delineates the core principles of AL as recognised in contemporary educational literature. It then addresses prevalent misunderstandings that hinder effective practice. In response, the paper proposes an updated, comprehensive framework tailored to EFL classrooms, with practical recommendations for instructional design, activity integration, and the strategic use of educational technologies, including generative artificial intelligence (GenAI). Finally, it outlines key criteria for evaluating the effectiveness of AL, focusing on student achievement, attitudes, and engagement.
Safety and Efficacy of High-Dosage Infliximab in Recalcitrant Retinal Vasculitis
(2025-01-01) Li Y.; Thongborisuth T.; Lee R.; Stolberg N.; Sweiss N.; Lobo-Chan A.M.; Bhat P.; Li Y.; Mahidol University
Purpose: We evaluated the long-term safety and efficacy of high-dosage infliximab and biosimilars (IFX+) in recalcitrant, non-infectious inflammatory retinal vasculitis (RV) after antimetabolite and adalimumab failure. Methods: This retrospective study included patients from the University of Illinois at Chicago Uveitis Service (2014–2024) who transitioned to IFX+ after prior treatment failure. Patients were categorized into low-dosage (LD, ≤5 mg/kg/Q4W, n = 14), medium-dosage (MD, 5.5–9.5 mg/kg/Q4W, n = 8), and high-dosage (HD, ≥10 mg/kg/Q4W, n = 9) groups. Efficacy was defined as ≥ 1 zone fluorescein angiographic (FA) improvement, prednisone reduction to < 10 mg/day with no flares, or both, at 6, 12, and 24 months, and last follow-up. Secondary outcomes included visual acuity (VA) and central macular thickness changes. Results: At 12 months, efficacy was achieved by 57.1%, 87.5%, and 88.9% of LD, MD, and HD IFX+ patients, increasing to 83.3%, 75.0%, and 100% by last visits. FA improvement rate was 60.0% (LD), 50.0% (MD), and 87.5% (HD) at 12 months, increasing to 71.4%, 60.0%, and 100% at last visits. VA significantly improved in HD by 12 months (p = 0.03) and MD by 24 months (p = 0.02). LD and MD groups required dosage increases to sustain inflammation control. By 24 months, no significant dosage differences between groups existed. No adverse events were reported in the HD group. Conclusion: In this retrospective study, medium- and high-dosage IFX+ achieved better inflammation control and visual outcomes versus low-dosage IFX+, with no additional safety concerns, in treating recalcitrant non-infectious inflammatory RV. Early initiation at greater dosages may optimize IFX response, reduce treatment duration, and improve health-related quality of life.
Mitapivat in adults with non-transfusion-dependent α-thalassaemia or β-thalassaemia (ENERGIZE): a phase 3, international, randomised, double-blind, placebo-controlled trial
(2025-01-01) Taher A.T.; Al-Samkari H.; Aydinok Y.; Besser M.; Boscoe A.N.; Dahlin J.L.; De Luna G.; Estepp J.H.; Gheuens S.; Gilroy K.S.; Glenthøj A.; Sim Goh A.; Iyer V.; Kattamis A.; Loggetto S.R.; Morris S.; Musallam K.M.; Osman K.; Ricchi P.; Salido-Fiérrez E.; Sheth S.; Tai F.; Tevich H.; Uhlig K.; Urbstonaitis R.; Viprakasit V.; Cappellini M.D.; Kuo K.H.M.; Taher A.T.; Mahidol University
Background: Non-transfusion-dependent (NTD) thalassaemia is characterised by ineffective erythropoiesis and haemolytic anaemia, leading to long-term complications, poor quality of life, and early mortality. No oral disease-modifying therapies are approved for β-thalassaemia and no agents are approved for α-thalassaemia. The objective of this study was to evaluate the efficacy and safety of mitapivat, an oral activator of pyruvate kinase, in adults with NTD α-thalassaemia or NTD β-thalassaemia. Methods: ENERGIZE is a phase 3, double-blind, randomised, placebo-controlled trial followed by an open-label extension conducted at 70 hospitals in 18 countries globally. Participants had to be aged 18 years or older with NTD α-thalassaemia or NTD β-thalassaemia and haemoglobin concentrations of 10 g/dL or lower. Participants were randomly assigned 2:1 to mitapivat or placebo (100 mg orally twice a day for 24 weeks) via a central interactive response technology system using block randomisation, stratified by baseline haemoglobin concentration and thalassaemia genotype. Everyone was masked to the patients' treatment assignment until the study was unblinded for the analysis of the primary endpoint. The primary endpoint was haemoglobin response (≥1·0 g/dL increase from baseline in mean haemoglobin concentration from week 12 through week 24), analysed in all patients who were randomly assigned. Safety was analysed in all patients who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, number NCT04770753, and is active but not recruiting. Findings: Between Nov 8, 2021, and March 31, 2023, 235 patients were screened, of whom 194 were enrolled (123 [63%] were female and 71 [37%] were male). 130 patients were randomly assigned to mitapivat and 64 patients to placebo and formed the full analysis set. One patient in each group was randomly assigned but not given treatment and was therefore excluded from the safety analysis set (mitapivat 129 patients and placebo 63 patients). Seven patients in the mitapivat group and one patient in the placebo group discontinued treatment before the end of the 24-week double-blind period. 55 (42%) of 130 patients in the mitapivat group had a haemoglobin response versus one (2%) of 64 in the placebo group (least-squares mean difference 41% [95% CI 32–50], two-sided p<0·0001). Adverse events were reported in 107 (83%) of 129 patients who received mitapivat and 50 (79%) of 63 patients who received placebo. The most commonly reported adverse events with mitapivat were headache (29 [22%] of 129 patients in the mitapivat group vs six [10%] of 63 in the placebo group), initial insomnia (18 [14%] vs three [5%]), nausea (15 [12%] vs five [8%]), and upper respiratory tract infection (14 [11%] vs four [6%]). No deaths were reported. Interpretation: Mitapivat could be a new oral treatment for adults with NTD α-thalassaemia or NTD β-thalassaemia by increasing haemoglobin concentration and improving fatigue. Funding: Agios Pharmaceuticals.
Multipoint Observations and Modeling of the 2021 November 4 Forbush Decrease Using Solar Orbiter, CSES-01, and Ground-based Neutron Monitor Data
(2025-06-20) Benella S.; Laurenza M.; Martucci M.; Ruffolo D.; Hu Q.; Nicolaou G.; Owen C.J.; Stumpo M.; Plainaki C.; Palma F.; Piersanti M.; Sorbara M.; Sotgiu A.; Sparvoli R.; Benella S.; Mahidol University
During their propagation in the heliosphere, interplanetary coronal mass ejections (ICMEs) interact with galactic cosmic ray (GCR) particles, modifying their spectrum and driving anisotropies. We analyze the first large Forbush decrease (FD) of Solar Cycle 25 on 2021 November 3-5 by using multipoint in situ observations and neutron monitors to study the association between FD characteristics and ICME. We use the Grad-Shafranov reconstruction to infer the magnetic field configuration of the ICME. We model the neutron monitor response through primary spectrum and anisotropy. The primary spectrum is parameterized with the force-field approximation and the anisotropy is modeled through a spherical harmonic expansion. We optimize the model parameters during the FD by using ground-based observations provided by the worldwide neutron-monitor network. The model’s results are compared with space-based measurements of the differential proton flux measured by the HEPD-01 detector on board the CSES-01 satellite and of the integral counts of both the High-Energy Particle Detector (HEPD-01) and the High Energy Telescope on board the Solar Orbiter. Anisotropy develops during the ICME passage, within the magnetic flux rope (MFR) and is found to be bidirectional. The force-field parameterization of the primary GCR fluxes based on ground-based measurements is found to be in very good agreement with spacecraft observations in the sub-GeV range. The GCR anisotropy obtained by fitting the model to ground-based observations is consistent with interplanetary magnetic field observations. The results suggest that the local magnetic field has a substantial axial component that is aligned to the MFR axis, and determines the GCR anisotropy at the typical neutron monitor energies.
Epidemiology and excess mortality of antimicrobial resistance in bacteraemias among cancer patients: A cohort study using routinely collected health data from regional hospital trusts in Oxford and Oslo, 2008-2018
(2025-06-13) Danielsen A.S.; Lim C.; Yoon C.H.; Gran J.M.; Kacelnik O.; Eyre D.W.; Bjørnholt J.V.; Danielsen A.S.; Mahidol University
Objectives We investigated the epidemiology and impact on mortality of antimicrobial resistance (AMR) in cancer patients with bacteraemia at Oxford University Hospitals (OxUH), UK, and Oslo University Hospital (OsUH), Norway, during 2008-2018. Design Historical cohort study. Setting Regional hospital trusts with multiple sites in OxUH and OsUH. Methods Patients with cancer and blood cultures positive for one of six pathogen groups during a hospital stay within 3 years following their first cancer diagnosis were followed for 30 days after their first bacteraemia episode. We determined the number of cases and the proportion of infections with an AMR phenotype. Excess mortality and the population-attributable fraction (PAF) due to AMR were estimated by contrasting observed mortality at the end of follow-up with an estimated counterfactual scenario where AMR was absent from all bacteraemias, using inverse probability weighting. Main outcome measure 30-day all-cause mortality following the first bacteraemia episode. Main exposure measure A resistant phenotype of the causative pathogen. Results The study included 1929 patients at OxUH and 1640 patients at OsUH. The highest resistance proportions were found for vancomycin resistance in enterococci (85/314, 27.1%) and carbapenem-resistance in Pseudomonas aeruginosa (63/260, 24.2%) at OxUH, and third-generation cephalosporin resistance in Escherichia coli (62/743, 8.3%) and Klebsiella pneumoniae (14/223, 6.3%) at OsUH. Observed mortality for all infections was 26.4% at OxUH, with an estimated counterfactual mortality without AMR of 24.7%, yielding an excess mortality of 1.7% (95% CI: 0.8 to 2.5%). The PAF was 6.3% (95% CI: 2.9 to 9.6%), meaning an estimated 32 of 509 deaths could be attributed to AMR. Limited events at OsUH precluded a similar estimate. Conclusions Despite estimating modest excess mortality, the mortality attributable to resistance in these two high-income, low-prevalence settings highlights the potential for escalation if global resistance trends continue to worsen.