Category: Statistics

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

Clin Oral Investig. 2025 May 27;29(6):315. doi: 10.1007/s00784-025-06390-6.

ABSTRACT

BACKGROUND: Molar-incisor hypomineralization (MIH) results in teeth that are highly prone to dental caries, sensitive to temperature changes and challenging to restore due to the atypical cavities or coronal deformation.

OBJECTIVES: This study aimed to assess the prevalence of MIH, the characteristics of affected first permanent molars (FPMs), and the relationship between MIH and hypomineralized second primary molars (HSPM) among primary school children in Jeddah, Saudi Arabia.

METHODS: Jeddah City was divided into three regions, and 12-schools were randomly selected through stratified sampling. The inclusion criteria involved 7 to 9 years old children who had at least one erupted FPM. The caries status was assessed using the World Health Organization (WHO) indices dmft/DMFT. The assessment of MIH was conducted based on the criteria established by the European Academy of Pediatric Dentistry at their meeting in Athens in 2003.

RESULTS: A total of 2,019 children participated with an MIH prevalence of MIH 18.3% (369 patients), and an HSPM prevalence of 1.8% (36 patients). The mean DMFT/dmft index was 5.99 ± 4.08. White creamy opacities were the most common presentation of FPMs and HSPM (about 80% of MIH-affected FPMs). A statistically significant association was found between MIH and HSPM and increased odds ratio of MIH with HSPM (P < 0.001, OR = 5.96, and 95% CI: 5.3-6.57).

CONCLUSION: The prevalence of MIH was higher than compared to the reported Middle East studies. The white creamy opacities were the most common presentations of MIH. A strong association existed between MIH and HSPM and an increased risk of having MIH when the child was found to have HSPM.

PMID:40423935 | DOI:10.1007/s00784-025-06390-6

Cardiovasc Toxicol. 2025 May 27. doi: 10.1007/s12012-025-10009-3. Online ahead of print.

ABSTRACT

Previous studies have inconclusively examined the associations of metals or polycyclic aromatic hydrocarbons (PAHs) with cardiovascular disease (CVD) separately, highlighting the need to explore their combined association with CVD. Based on the 2011-2016 National Health and Nutrition Examination Survey, the association of 12 metals and six PAHs in urine with CVD was analyzed using weighted logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). Crucial metals and PAHs were screened, and dose-response, subgroup, interactions, and mediation analyses were conducted. 4306 participants were included, of whom 406 had CVD. Weighted logistic regression showed that cadmium (OR = 1.41, 95% CI 1.11-1.78), tin (OR = 1.63, 95% CI 1.03-2.60), and 1-hydroxypyrene (1-PYR) (OR = 1.40, 95% CI 1.15-1.69) were positively correlated with CVD. These factors also showed a linear relation with CVD. The WQS and BKMR models indicated that the combined association of 12 metals and six PAHs was positively associated with CVD. Cadmium, cesium, tin, uranium, and 1-PYR played critical roles (all weights > 0.050). Subgroup analysis revealed that these substances were mostly positively associated with CVD in young and middle-aged people, smokers, drinkers, and those who were overweight. There was an interaction between tin and smoking status (P for interaction < 0.05). Cadmium and tin mediated 18.40% and 6.90% of the association of 1-PYR with CVD, respectively, whereas the proportions of the mediating effects of 1-PYR in the association of cadmium and tin with CVD were 8.10% and 7.90%, respectively. Overall, higher levels of urinary metals and PAHs mixtures may be associated with higher CVD prevalence. Cadmium, cesium, tin, uranium, and 1-PYR played crucial roles in this association. Cadmium and tin played mediating roles in the association between 1-PYR and CVD. Meanwhile, 1-PYR also played a mediating role in the association between cadmium and tin and CVD.

PMID:40423918 | DOI:10.1007/s12012-025-10009-3

Ambio. 2025 May 27. doi: 10.1007/s13280-025-02188-8. Online ahead of print.

ABSTRACT

Loss of soil organic carbon (SOC) from farmland is a key threat to the capacity of soils to provide ecosystem services and exacerbates climate change. In alignment with a published protocol, we conducted a review and meta-analysis of time series of SOC measurements in long-term agricultural experiments to study absolute SOC changes under different agricultural management regimes. Our results show that SOC in the upper 30 cm layer generally declined across long-term experiments (214 time data series in arable land across 23 sites in temperate to cold regions), but reducing tillage, adding organic amendments, diversifying crop rotations and avoiding bare fallows reduced losses. Furthermore, a net increase in SOC content is achieved when combining all four interventions. Applying multiple strategies for SOC preservation can unleash the potential for agricultural land to become a carbon sink while safeguarding agricultural yields for future generations.

PMID:40423915 | DOI:10.1007/s13280-025-02188-8

Environ Monit Assess. 2025 May 27;197(6):682. doi: 10.1007/s10661-025-14119-x.

ABSTRACT

Transboundary air pollution (TAP) imposes high health and economic burdens on neighboring regions, further causing the issue of environmental injustice. In this study, changes in PM_2.5 concentrations resulting from TAP across various provinces in China were quantitatively analyzed, and the quadratic assignment procedure (QAP) method was employed to explore influencing factors from a regional heterogeneity perspective, with the aim of reducing the impact of transboundary pollution. The results reveal the following: (1) The impact of TAP continued to decrease in all provinces. Compared with those in other regions, inland central cities were more significantly affected. (2) Hebei and Jiangsu were identified as the primary pollution sources, and they exported significant amounts of pollutants to neighboring provinces. In contrast, Shaanxi and Chongqing were the main recipients. The reason for this finding is that TAP is influenced by both geographical proximity and regional development differences. (3) Disparities in the total factor energy efficiency played a crucial role in determining pollution spillover in the short term. In the long term, reducing the gaps in environmental regulations between regions constituted the core element for mitigating TAP. Additionally, the subregional regression analysis results indicated that differences in the industrial structure positively affected the broker and net spillover sectors. On the basis of these findings, targeted policy recommendations for regional collaboration, balanced spatial development, and differentiated governance were formulated.

PMID:40423902 | DOI:10.1007/s10661-025-14119-x

Lasers Med Sci. 2025 May 27;40(1):245. doi: 10.1007/s10103-025-04497-6.

ABSTRACT

This study aimed to evaluate quantitatively the effects of low-level laser therapy (LLLT) on bone healing performed after rapid maxillary expansion (RME) in rats, using micro-computed tomography (micro-CT). Ninety rats were used, randomly distributed into three groups: control (n = 10) (young and adult rats – intact suture), experimental I (n = 40) (young and adult rats with RME without LLLT), and experimental II (n = 40) (young and adult rats with RME + LLLT). Five rats from the groups were euthanized on days 0, 7, 14, and 21 of the experiment and evaluated by microCT analysis. The laser increased the bone formation volume at 7 and 14 days (young rats) and 14 days (adult rats) were statistically significant (p < 0.05), but at the end of the healing (21 days), no statistically significant difference was observed between the laser and no-laser groups (p > 0.05). These findings suggest that LLLT improves bone mineralization during the early healing phases after RME, accelerating the process of bone mineralization during the initial experimental phase, which may have clinical implications in reducing orthodontic treatment duration and improving bone stability.

PMID:40423898 | DOI:10.1007/s10103-025-04497-6