Category: Statistics

JMIR Form Res. 2025 Jul 8;9:e75215. doi: 10.2196/75215.

ABSTRACT

BACKGROUND: The synthesis of evidence in health care is essential for informed decision-making and policy development. This study aims to validate The Umbrella Collaboration (TU), an innovative, semiautomated tertiary evidence synthesis methodology, by comparing it with traditional umbrella reviews (TURs), which are currently the gold standard.

OBJECTIVE: The primary objective of this study is to evaluate whether TU, an artificial intelligence-assisted, software-driven system for tertiary evidence synthesis, can achieve effectiveness comparable to that of TURs, while offering a more timely, efficient, and comprehensive approach.

METHODS: This comparative study evaluated TU against TURs across 8 matched projects in geriatrics. For each selected TUR, a parallel TU project was conducted using the same research question. Outcomes of interest (OoIs), effect sizes, certainty ratings, and execution times were systematically compared. Effect sizes were assessed both quantitatively, by transforming TUR metrics to Cohen d and correlating them with TU’s RTU metric, and qualitatively, through categorical classifications (trivial, small, moderate, and large). Certainty levels were compared by mapping Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ratings and TU’s sentiment analysis scores onto a common 0-1 scale. Execution time was measured precisely in TU, while TUR durations were estimated from literature benchmarks. Statistical analyses included chi-square tests and Spearman correlations.

RESULTS: Eight TURs in geriatrics were matched with parallel projects using TU. TU replicated 73 of the 86 (85%) OoIs identified by TURs and reported an additional 337 OoIs, representing a 4.77-fold increase in outcome identification. In the comparison of effect size classifications, full concordance was observed in 24 of the 48 (50%) cases, and consistent concordance (full plus 1-level deviation) in 45 of the 48 (94%) cases, with a moderate strength of association (Cramér V=0.339). The correlation of transformed certainty values between TU and GRADE yielded a statistically significant Spearman coefficient (ρ=0.446; P=.02). The average execution time per TU project was 4 hours and 46 minutes, compared with estimated durations of 6-12 months for TURs.

CONCLUSIONS: The TU demonstrated high concordance with TURs, replicating 73 of the 86 (85%) outcomes identified by TURs and identifying nearly 5 times as many additional outcomes. The experimental effect size metric (RTU) showed moderate agreement with conventional measures, and the certainty ratings derived from sentiment analysis correlated acceptably with GRADE-based assessments. While further validation is needed, TU appears to be a valid and efficient approach for tertiary evidence synthesis, offering a scalable and time-efficient alternative when rapid results are required.

PMID:40627806 | DOI:10.2196/75215

J Am Acad Orthop Surg. 2025 Jul 1. doi: 10.5435/JAAOS-D-24-01183. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this study is to determine the incidence and risk factors of yoga-related injuries to generate guidelines for safely practicing yoga.

METHODS: The National Electronic Injury Surveillance System was searched from 2004 to 2023 for injury codes including yoga. Narrative descriptions were reviewed by two authors to select entries specifically addressing yoga practice. Descriptive statistics were done, and the Stata svyset function (SE 17.0; StataCorp) was used to calculate national estimates. Athletes were also categorized based on age into <45 years and ≥45 years, and significance between age groups was determined using adjusted Wald tests to compare proportions in the setting of complex weighted survey data.

RESULTS: The initial data search yielded 160,521 entries. The narrative review process (Cohen kappa = 0.76) resulted in 1,615 entries for analysis, corresponding to a national estimate of 63,280 yoga-related injuries. Patients were disproportionately female and White (mean age = 46.5 years, SD = 18.0). Most injuries occurred in places of recreation (42.4%) and the home (10.0%). The most common type of injury was strains/sprains (32.5%). The trunk was the most injured body region (lower trunk = 24.2%, shoulder = 9.0%). In the lower limb region, the knee was most often affected (9.4%). Wald tests revealed that for body region injured, in the <45 category, head injuries contributed to a markedly larger proportion of total injuries (P < 0.005). In the ≥45 category, hip injuries (subset of trunk) contributed to a markedly larger proportion of total injuries (P < 0.001).

CONCLUSION: Yoga can involve strenuous physical activity resulting in injury, especially strains/sprains. Given that hip injuries contributed to a markedly larger proportion of injuries in patients ≥45 years, athletes in this age range should be counseled about these risks to maximize the safety of all participants.

PMID:40627803 | DOI:10.5435/JAAOS-D-24-01183

Plast Aesthet Nurs (Phila). 2025 Jul-Sep 01;45(3):163-172. doi: 10.1097/PSN.0000000000000609. Epub 2025 Jul 9.

ABSTRACT

This real-world data evaluation assesses the effectiveness of a hyaluronic acid-based product (Profhilo®, IBSA Farmaceutici Italia, Lodi, Italy) for improving neck skin laxity, firmness, tone, and texture in a satisfaction survey involving 26 patients from Malaysia (n = 9), Singapore (n = 9), and Indonesia (n = 8). Each patient received two treatments: the first at baseline, and the second on Day 30. Using the IBSA Neck Skin Laxity Scale (IBSA NSLS), physicians evaluated photographs of the patients’ necks at baseline, Day 30, and Day 90. Before treatment on Day 30 and at the follow-up visit on Day 90, physicians and patients assessed clinical improvement and satisfaction related to skin laxity, firmness, and texture. After each treatment, the patients recorded their pain level using a visual analogue scale. The mean IBSA NSLS grades for all patients significantly decreased from 3.08 at baseline to 2.12 at follow-up (p < .0001). At Day 90, the most frequent response from all participants was that their neck laxity and skin firmness and tone was either improved or much improved and their skin texture was very much improved. Following the injections, the patients reported low to moderate pain levels. In this real-world satisfaction survey involving patients from Malaysia, Singapore, and Indonesia, the physicians concluded that Profhilo® was an effective and well tolerated treatment for improving neck skin laxity, firmness, tone, and texture in patients of varying ages, genders, and baseline skin laxity and wrinkle severity.

PMID:40627798 | DOI:10.1097/PSN.0000000000000609

PLoS One. 2025 Jul 8;20(7):e0327121. doi: 10.1371/journal.pone.0327121. eCollection 2025.

ABSTRACT

In this study, we introduce a novel Field-Agnostic Riemannian-Kernel Alignment (FARKA) method to advance the classification of motion imagination in Brain-Computer Interface (BCI) systems. BCI systems enable direct control of external devices through brain activity, bypassing peripheral nerves and muscles. Among various BCI technologies, electroencephalography (EEG) based on non-intrusive cortical potential signals stands out due to its high temporal resolution and non-invasive nature. EEG-based BCI technology encodes human brain intentions into cortical potentials, which are recorded and decoded into control commands. This technology is crucial for applications in motion rehabilitation, training optimization, and motion control. The proposed FARKA method combines Riemannian Alignment for sample alignment, Riemannian Tangent Space for spatial representation extraction, and Knowledge Kernel Adaptation to learn field-agnostic kernel matrices. Our approach addresses the limitations of current methods by enhancing classification performance and efficiency in inter-individual MI tasks. Experimental results on three public EEG datasets demonstrate the superior performance of FARKA compared to existing methods.

PMID:40627787 | DOI:10.1371/journal.pone.0327121

PLoS Comput Biol. 2025 Jul 8;21(7):e1013229. doi: 10.1371/journal.pcbi.1013229. Online ahead of print.

ABSTRACT

The COVID-19 pandemic and related non-pharmaceutical interventions (NPIs) significantly alter the transmission dynamics of non-SARS-CoV-2 infectious diseases, with respiratory infections such as influenza being disproportionately affected. We aim to compare influenza’s epidemiological characteristics between pre-pandemic and post-pandemic periods to inform public health responses. We develop two influenza transmission models incorporating age structure and multi-strain dynamics, featuring time-varying transmission and mortality rates. Using publicly available U.S. data, we calibrate these models to evaluate age- and strain-specific transmission patterns and mortality rates across different pandemic eras. Our analysis reveals that during the final pandemic year, influenza transmission among adults ([Formula: see text] years) initially declined but rebounded to pre-pandemic levels within the first post-pandemic year following NPI relaxation and behavioral normalization, while transmission stability persists in the <18 cohort. All-age influenza mortality rates exhibit a transient elevation during the pandemic’s final year before returning to baseline levels pre-pandemic. Furthermore, after the COVID-19 pandemic, the transmission rate of influenza A decreases alongside peaks in new cases, while the transmission of influenza B fluctuates without a decline. Our findings indicate that while the COVID-19 pandemic has induced significant transient modifications in influenza’s epidemiological profile, key transmission and mortality characteristics regain pre-pandemic equilibrium within one year following pandemic resolution.

PMID:40627783 | DOI:10.1371/journal.pcbi.1013229

Int J Lang Commun Disord. 2025 Jul-Aug;60(4):e70083. doi: 10.1111/1460-6984.70083.

ABSTRACT

BACKGROUND: Stuttering, as a visible and audible deviation from the norm, often provokes negative reactions and leads to social stigmatisation. Studies have shown that there is a negative stuttering stereotype, the origins of which can be traced back to early life. As environmental reactions have a significant impact on the success of therapeutic interventions, understanding public knowledge and attitudes towards stuttering is essential to mitigate these prejudices at an early stage.

AIMS: The present study collects the first specific data on the knowledge of German non-stuttering primary school children about stuttering and their attitudes towards children who stutter, and relates them to the results of previous international studies. Since no data have been collected from German-speaking children to date, there was a need to replicate international studies, to include data from German-speaking children in international databases, and to discuss German results with international data in order to identify educational needs and to be able to meet them in the future.

METHODS AND PROCEDURES: A total of 78 German-speaking primary school children aged 6 to 11 were interviewed using a newly translated and adapted German version of the Public Opinion Survey of Human Attributes-Stuttering/Child. Participants were recruited via stakeholders (e.g., principals, teachers). Influencing factors like socio-demographic variables and previous experience with persons who stutter were included in the analysis. The data were analysed descriptively and statistically in comparison with international data and group comparisons.

OUTCOMES AND RESULTS: The sample (M = 8.7 yr; N_female = 47, N_male = 28, N_other = 3) showed uncertain knowledge and rather neutral, partly negative attitudes towards stuttering. Three key knowledge gaps were evident in the domains of character traits and personality of individuals who stutter, the causes of stuttering and supportive behaviour. Stuttering as an abstract behavioural attribute was overall rated more negatively than the actual person who stutters him- or herself. Personal experience was identified as a factor potentially influencing non-stuttering children’s reactions to people who stutter in a positive way. Results of German-speaking children are basically in line with data from international studies. Comparisons will be discussed in this article.

CONCLUSIONS AND IMPLICATIONS: The identified gaps in knowledge and the partly negative attitudes underline the continuing need for psychoeducational interventions in childhood, in particular, providing options for non-stuttering children to gain direct personal experience with stuttering children. In practice, educational interventions should provide information, particularly in relation to the three identified key knowledge gaps.

WHAT THIS PAPER ADDS: What is already known on this subject To date, data on the knowledge and attitudes of non-stuttering children have been collected in the United States of America, Portugal, Bosnia and Herzegovina, Poland, and Turkey. The studies have identified a negative stuttering stereotype that can be present from a young age and have a negative impact on the quality of life of children who stutter. Prior to the study, no data were available for German-speaking countries, and there were also no German survey instruments that could measure the variables of interest in the target group. What this paper adds to existing knowledge The study provides data on the knowledge and personal attitudes of German non-stuttering primary school children collected with the newly translated and adapted German version of the Public Opinion Survey of Human Attributes-Stuttering/Child (POSHA-S/Child). The results of the German sample are essentially consistent with previous international studies. The variable personal experience has been identified as a key predictor variable for the improvement of reactions to a person’s stuttering. What are the potential or actual clinical implications of this work? The study supports, clarifies and underlines the international need for educational interventions. In the German sample, three key areas were identified: Character traits and personality of people who stutter, causes of stuttering, and supportive behaviour. Educational interventions should provide appropriate knowledge and provide a platform for exchange in order to gain personal experience with people who stutter.

PMID:40627781 | DOI:10.1111/1460-6984.70083

PLoS One. 2025 Jul 8;20(7):e0327565. doi: 10.1371/journal.pone.0327565. eCollection 2025.

ABSTRACT

INTRODUCTION: Skilled birth attendants play an important role in reducing maternal mortality. Although Ethiopia has shown a remarkable reduction in maternal mortality, maternal health service utilization, such as skilled birth attendance, remains low. Thus, this study aims to assess the urban-rural disparity in skilled birth attendance in Ethiopia using the 2019 Ethiopian mini demographic health survey.

METHODS AND MATERIALS: The study was based on data obtained from demographic and health surveys in Ethiopia. A total weighted sample of 5,527 women who gave birth within 5 years preceding the survey was included. The result of descriptive statistics was reported using the frequency, percentages, graphs, and tables. A multivariate decomposition analysis was used to identify factors contributing to the disparity of skilled birth attendance across residence. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05.

RESULT: Skilled birth attendance utilization among women in Ethiopia was 49.8% (95% CI: 48.5-51.1). The disparity in skilled birth attendance coverage between urban and rural areas was significantly high (Urban coverage was 72.1% and rural coverage was 42.5%). Endowment coefficients (women’s characteristics) explained 88% of the urban-rural disparity in the magnitude of skilled birth attendance. Women with secondary and above educational status, four or more antenatal care visits, households with televisions and radio, women in the richest wealth index and women with five or more parity were the determinants that explained the urban-rural disparity in skilled birth attendance.

CONCLUSION AND RECOMMENDATIONS: There was a significant disparity in skilled birth attendance utilization between urban and rural areas. Factors like maternal education, wealth status, antenatal care visits, and media access explained the disparity. To attain equitable progress towards universal coverage of SBA, special efforts and resources should be targeted towards rural women. Initiatives aimed at enhancing access to health services and health care consultations for the rural community are also recommended.

PMID:40627778 | DOI:10.1371/journal.pone.0327565

IEEE Trans Biomed Eng. 2025 Jul 8;PP. doi: 10.1109/TBME.2025.3587003. Online ahead of print.

ABSTRACT

Knee Osteoarthritis (KOA) is a prevalent musculoskeletal disorder that severely impacts mobility and quality of life, particularly among older adults. Its diagnosis often relies on subjective assessments using the Kellgren-Lawrence (KL) grading system, leading to variability in clinical evaluations. To address these challenges, we propose a confidence-driven deep learning framework for early KOA detection, focusing on distinguishing KL-0 and KL-2 stages. The Siamese-based framework integrates a novel multi-level feature extraction architecture with a hybrid loss strategy. Specifically, multi-level Global Average Pooling (GAP) layers are employed to extract features from varying network depths, ensuring comprehensive feature representation, while the hybrid loss strategy partitions training samples into high-, medium-, and low-confidence subsets. Tailored loss functions are applied to improve model robustness and effectively handle uncertainty in annotations. Experimental results on the Osteoarthritis Initiative (OAI) dataset demonstrate that the proposed framework achieves competitive accuracy, sensitivity, and specificity, comparable to those of expert radiologists. Cohen’s kappa values ($kappa$ $>$ 0.85)) confirm substantial agreement, while McNemar’s test ($p$ $>$ 0.05) indicates no statistically significant differences between the model and radiologists. Additionally, Confidence distribution analysis reveals that the model emulates radiologists’ decision-making patterns. These findings highlight the potential of the proposed approach to serve as an auxiliary diagnostic tool, enhancing early KOA detection and reducing clinical workload. Our code is available at https://github.com/ZWang78/Confidence.

PMID:40627470 | DOI:10.1109/TBME.2025.3587003

Future Oncol. 2025 Jul 8:1-12. doi: 10.1080/14796694.2025.2526319. Online ahead of print.

ABSTRACT

BACKGROUND: Early-onset colorectal cancer, diagnosed before 50 years (EOCRC), is rising. Previous studies suggest younger patients experience longer diagnostic intervals potentially contributing to poorer outcomes.

RESEARCH DESIGN AND METHODS: A prospective cohort study comparing EOCRC patients in Canterbury, Aotearoa New Zealand, with a control group of late-onset patients (65+ years, LOCRC). Pathways to diagnosis and diagnostic intervals were compared.

RESULTS: Sixty-three consecutive EOCRC patients were compared 64 LOCRC patients. The younger cohort was more likely to have advanced disease (stage four in 32% v 17%). Pathways to diagnosis were comparable between the groups (p > 0.05). EOCRC patients, however, visited their GP more frequently before diagnosis (p = 0.04), and 40% had an appraisal interval (time from symptoms to seeking medical advice) exceeding 3 months compared to 26% of LOCRC patients, though this was not significant (p = 0.146). Stage four EOCRCs were less likely to have appraisal intervals >3 months (OR 0.28, p = 0.046).

CONCLUSION: Pathways to diagnosis were similar between EOCRC and LOCRC patients. Shorter diagnostic intervals were associated with advanced disease, indicating that shortening diagnostic intervals alone may not improve outcomes. Diagnosing CRC prior to symptoms develop (screening) is likely the best way to improve outcomes.

PMID:40627443 | DOI:10.1080/14796694.2025.2526319

Kardiologiia. 2025 Jul 7;65(6):34-43. doi: 10.18087/cardio.2025.6.n2933.

ABSTRACT

Aim To monitor the dynamics of biomarkers during chemotherapy, targeted chemotherapy and targeted monotherapy in patients with HER2-positive breast cancer (BC); to analyze the emergence timing of these changes; to compare early biochemical and echocardiographic criteria; and to determine the best time for assessing latent subclinical cardiac dysfunction.Material and methods Patients with BC (229 women aged 57±11 years) treated sequentially with anthracyclines, a combination of docetaxel and trastuzumab, and trastuzumab monotherapy were examined during three blocks of BC therapy until the development of clinical cardiotoxicity. Time-related changes in high-sensitivity cardiac troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular (LV) global longitudinal strain (GLS) and LV ejection fraction (EF) (up to 12 speckle-tracking echocardiograms/up to 12 laboratory tests) were analyzed. Clinical cardiotoxicity was defined as a symptomatic decrease in LV EF ≥10% from the baseline value of 54% or more.Results Clinically significant cardiotoxicity developed in 6.3-10.9% of cases depending on the treatment option for BC. Early manifestations of cardiotoxicity were detected already at 3 weeks after the start of the first course of chemotherapy. For the BC treatment with anthracyclines and targeted chemotherapy with docetaxel and trastuzumab, the markers of clinical cardiotoxicity were high-sensitivity cardiac troponin I, NT-proBNP and GLS LV. For the trastuzumab monotherapy, only GLS LV had a prognostic value. No statistically significant changes in the concentrations of high-sensitivity troponin I and NT-proBNP were found.Conclusion For timely detection of clinical cardiotoxicity, laboratory tests (high-sensitivity troponin I, NT-proBNP) and echocardiography (GLS LV) are recommended to be performed every 3 weeks before the next course of BC therapy. While doing so, their sensitivity will depend on the treatment option for BC.

PMID:40627425 | DOI:10.18087/cardio.2025.6.n2933