Category: Statistics

Eur J Prev Cardiol. 2025 Apr 28:zwaf270. doi: 10.1093/eurjpc/zwaf270. Online ahead of print.

ABSTRACT

BACKGROUND: The elucidation of the contributory role of multimorbidity to heart failure (HF) including the gut-heart axis has added a new dimension to our understanding of HF pathophysiology which is not reflected in currently available risk scores. The present investigation aimed to develop and validate a novel risk score model of multimorbidity for HF risk stratification.

METHODS: A risk model was developed based on the contribution of markers associated with HF multimorbidities on outcomes of mortality and/or rehospitalization due to HF (death/HF) at one year. Two independent HF cohorts were combined and randomly split 70:30 using a split-sample validation approach for training and validation cohorts which were not significantly different for investigated variables. Backward logistic regression was used to develop the risk model with a further scoring system to create a simple risk calculator.

RESULTS: A final 11-variable risk model (age, previous HF hospitalization, NYHA group III/IV, NT-proBNP, diastolic blood pressure, loop diuretic use, beta-blocker non-use, creatinine, COPD, diabetes, and combined gut metabolites) showed a diagnostic performance of 0.71 in the training cohort (C-statistic validation cohort, 0.70, p<0.001). A risk score/calculator was further developed based on this model with categorization into three (low-, mid- and high-) and two (low- and high-) risk groups, with both approaches demonstrating increased incidence of death/HF in patients at the highest risk (p<0.001).

CONCLUSION: A novel risk model and score were derived which showed the contribution of comorbidities including the added value of the gut-heart axis on risk stratification of HF patients on rehospitalization and death.

PMID:40294213 | DOI:10.1093/eurjpc/zwaf270

Eur J Prev Cardiol. 2025 Apr 28:zwaf269. doi: 10.1093/eurjpc/zwaf269. Online ahead of print.

ABSTRACT

AIMS: Chronotropic incompetence (ChI) in heart failure with preserved ejection fraction (HFpEF) is associated with a reduced exercise capacity. The role of exercise training in improving chronotropic response (ChR) and functional capacity in these patients remains uncertain. This study assessed the effects of four different exercise programs on peak oxygen consumption (peakVO₂), Kansas City Cardiomyopathy Questionnaire (KCCQ) score and ChR in patients with the ChI HFpEF phenotype.

METHODS: In this randomized clinical trial, 80 symptomatic (NYHA class II-III/IV) patients with the ChI HFpEF phenotype were randomized (1:1:1:1) to one of four interventions: (a) a 12-week supervised aerobic training (AT) program, (b) AT with low-intensity strength training (AT/LRT), (c) AT with moderate- to high-intensity strength training (AT/HRT), or (d) non-supervised exercise recommendations (ER). The primary endpoint was the change in peakVO2 at 12 weeks. Secondary endpoints included changes in ChR and KCCQ. A linear regression model was used.

RESULTS: The mean age of 80 participants was 75.1±7.2 years, and 59.6% were women. Baseline values for peakVO2, chronotropic index, and KCCQ were 11.8±2.6 mL/kg/min, 0.4±0.2, and 63.5±17.9, respectively, with no significant differences across arms. All supervised training programs led to significant improvements in peakVO2 compared to ER: AT/HRT: Δ+4.0, (95% CI: 2.9 to 5.1, p< 0.001), AT/LRT: Δ+3.6, (95% CI: 2.5-4.6, p<0.001), and AT: Δ+2.9, (95% CI: 1.9-4.0, p<0.001). AT/HRT was superior over AT alone: Δ+1.1, (95% CI, 0.1 to 2.2, p=0.046). Likewise, supervised exercise improved ChR and KCCQ without statistical differences between groups.

CONCLUSIONS: Different supervised exercise training improved peakVO2, ChR and KCCQ in patients with ChI HFpEF phenotype.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT05649787).

PMID:40294211 | DOI:10.1093/eurjpc/zwaf269

Eur J Prev Cardiol. 2025 Apr 28:zwaf257. doi: 10.1093/eurjpc/zwaf257. Online ahead of print.

ABSTRACT

AIM: This meta-analysis aims to evaluate the effect of semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RAs), on new-onset atrial fibrillation (AF) in randomized clinical trials (RCTs).

METHODS AND RESULTS: Twenty-six RCTs involving 48,583 participants (of whom 25,879 on semaglutide) with 541 new onset AF were analyzed. Semaglutide treatment resulted in a 17% reduction in AF incidence compared to controls (OR 0.83, 95% CI 0.70-0.98, p = 0.03) with no heterogeneity (I² = 0%). The effect was more pronounced with the oral formulation, which reduced AF incidence by 52% (OR 0.48, 95% CI 0.24-0.95, p = 0.04), while studies with active comparators showed a 59% reduction in AF risk (OR 0.41, 95% CI 0.20-0.83, p = 0.01). In trials without Sodium-Glucose Co-Transporter 2 inhibitors (SGLT2i) concomitant therapy, there was a significant reduction of 21% in new-onset AF (OR 0.79, 95% CI, 0.63-0.99; p=0.04). Meta-regression revealed no influence of baseline covariates, including BMI and HbA1c. An additional meta-regression analysis evaluating the percentage of patients on SGLT2 inhibitors as a potential moderator revealed no statistically significant association (p= 0.336).

CONCLUSIONS: Treatment with semaglutide significantly reduces the incidence of new-onset AF. This effect appears more evident with the oral formulation and independent of baseline characteristics.

PMID:40294206 | DOI:10.1093/eurjpc/zwaf257

ACS Nano. 2025 Apr 28. doi: 10.1021/acsnano.5c01257. Online ahead of print.

ABSTRACT

Development of functional nanocrystals requires precise control over their composition and structure. Particularly, surface composition, defects, and doping play a central role in our ability to develop functional nanomaterials. As such, there is great interest in capturing these properties. Solid-state NMR spectroscopy is a powerful tool for probing structural and compositional features at the atomic scale, in particular, when it is coupled with the high sensitivity gained by dynamic nuclear polarization (DNP). DNP enhances NMR sensitivity by transferring high electron spin polarization to the surrounding nuclear spins. This dramatically improves the signal intensity, making it a valuable tool for detecting subtle structural features. Utilizing metal ion dopants as polarization agents for DNP has been shown to be an excellent approach to increasing ssNMR sensitivity in the bulk of inorganic solids. Here, we demonstrate the implementation of this approach to nanocrystals, focusing on Mn(II)-doped CdS, where homogeneous doping is known to be challenging while being critical for the DNP process. The intricate nature of the doping was elucidated by quantitative electron microscopy and electron paramagnetic resonance spectroscopy. We confirmed that Mn(II) doping is confined to the core of the nanocrystals and that statistically dopants are homogeneously distributed within each nanocrystal. DNP from Mn(II) dopants is then shown to increase ¹¹³Cd NMR sensitivity by an order of magnitude, enabling distinction between core and surface environments as well as the detection of defects in the bulk of the nanocrystals. We expect that the approach can be extended to other nanocrystals, providing an efficient route for characterizing their bulk and surface properties.

PMID:40294147 | DOI:10.1021/acsnano.5c01257

Vet Med Sci. 2025 May;11(3):e70357. doi: 10.1002/vms3.70357.

ABSTRACT

Fascioliasis is a common hepatic parasitic disease that is caused by Fasciola, resulting in significant economic losses by reducing production and consigning viscera in animals. Currently, there is little research regarding the impact of chemical compounds on the ultrastructure and motility of adult F. hepatica. The present study aims to assess the effect of Vanadate erbium/silver oxide (ErVO₄/AgO) and Vanadate iron/silver oxide (FeVO₄/AgO) nanoparticles against liver fluke F. hepatica, in vitro assay. Fasciola hepatica adult worms were collected from the livers and gallbladders of sheep and goats centrality of Iran. One hundred fresh worms were incubated with each nanoparticle concentration of 4.5-6 mg/mL FeVO₄/AgO and ErVO₄/AgO (test, groups) in comparison to triclabendazole 5-20 µg/mL (positive control) and RPMI media culture (negative control) after 12 and 24 hours of treatment. To ensure the reliability of the data, the tests on the sample were performed twice. The effectiveness of these compounds was evaluated by examining parasite movement, reaction to vital stain and changes in the tegument through scanning electron microscopy (SEM) using Fisher statistical tests and logistic regression. Analysis of variance was performed to compare Kaplan-Meier and Cox groups and models to analyse parasite survival. In addition, the anthelmintic efficacy was measured as the mortality rate based on the number of live and dead worms. The mortality ratios show that the anthelmintic activities of the compounds highly relied on time and concentration, as time and concentration increased, increasing the mortality rate. Lethal concentration 50 (LC₅₀) of FeVO₄/AgO and ErVO₄/AgO are 4, 4.7 and 5 mg/mL at 24 h, respectively. FeVO₄/AgO showed more lethal effects on F. hepatica than on ErVO₄/AgO and triclabendazole. SEM analysis of treated F. hepatica by both nanoparticles at a concentration of 6 mg/mL showed that the tegument surface of fasciola is swollen in some parts, the pores on the tegument surface are completely visible, the sensory papillae are lost, the tegument is severely damaged and the prominent network structure and its vesicles have completely disappeared. F. hepatica is more susceptible to the lethal effects of FeVO₄/AgO and ErVO₄/AgO nanoparticles. The effectiveness of these compounds depends on the concentration and time of the drug’s effect, in such a way that the effectiveness increases with the increase in concentration and time.

PMID:40294130 | DOI:10.1002/vms3.70357

Med Teach. 2025 Apr 28:1-9. doi: 10.1080/0142159X.2025.2496382. Online ahead of print.

ABSTRACT

PURPOSE: Assessment design significantly influences evaluation of student learning. Multiple choice questions (MCQ) and very short answer questions (VSAQ) are commonly used assessment formats, especially in high-stakes settings like medical education. MCQs are favoured for efficiency, coverage, and reliability but may lack depth in assessing critical thinking. VSAQs require students to generate responses, potentially enhancing depth, but posing challenges in consistency and subjective interpretation.

METHODS: Data from parallel MCQ/VSAQ exams over three years was collected. Summary statistics for each exam (marks, time, and discrimination index; DI) and the effect of year and question characteristics were analysed.

RESULTS: VSAQs were associated with lower marks (p < 0.001), longer time (p < 0.001), and higher DI (p < 0.001). Question characteristics (e.g. basic science or clinical stems) significantly affected the mark, time, and DI, changing across years, but not interacting with question format.

CONCLUSION: While MCQs resulted in higher marks, VSAQs provided higher discrimination of student performance. Response options in MCQs likely enhance recall, however real-world settings also offer contextual cues. Question characteristics affect student performance independently of format, likely due to differences in cohort career progression. Future research should investigate predictive validity and standard setting of VSAQs in a basic science context.

PMID:40293799 | DOI:10.1080/0142159X.2025.2496382

Crit Care Explor. 2025 Apr 28;7(5):e1255. doi: 10.1097/CCE.0000000000001255. eCollection 2025 May 1.

ABSTRACT

IMPORTANCE: Benzodiazepines are the most frequently used sedatives in PICUs, but they are increasingly associated with negative outcomes. Understanding their impact on patient outcomes is critical to provide better sedative management for patients.

OBJECTIVE: Our objective was to determine the impact of midazolam and lorazepam on clinical outcomes among subjects requiring mechanical ventilation in the PICU. We hypothesized that subjects receiving benzodiazepines for tolerance of mechanical ventilation will demonstrate worse clinical outcomes when compared with those not receiving benzodiazepines.

DESIGN: Single-center, retrospective cohort study.

SETTING AND PARTICIPANTS: PICU of a tertiary-care medical center. One thousand fifty-four pediatric participants requiring invasive mechanical ventilation between June 2018 and December 2022. Participants were categorized into those who received benzodiazepine-inclusive sedation regimens (n = 747) and those who received nonbenzodiazepine regimens (n = 307).

INTERVENTIONS: None.

MAIN OUTCOMES AND MEASURES: Subjects were sorted into groups of benzodiazepine-sedative regimens (midazolam and lorazepam, only lorazepam) or nonbenzodiazepine-sedation regimens. The primary outcome was ventilator-free days (VFDs). Statistical analysis was performed using multivariable linear regression and propensity-score matching.

RESULTS: Subjects receiving continuous and/or intermittent benzodiazepines had fewer VFDs compared with the nonbenzodiazepine group (median 21.0 vs. 26.7; p < 0.001). The benzodiazepine group had fewer ICU-free and hospital-free days, higher delirium scores, and a greater need for withdrawal-tapering medications. This was redemonstrated in subjects only receiving intermittent benzodiazepines as well. Younger subjects were more likely to receive benzodiazepines.

CONCLUSIONS AND RELEVANCE: Our study demonstrates an association between children receiving both continuous and intermittent benzodiazepine sedation and worse clinical outcomes. These patients have fewer VFDs and longer length of stay, higher doses of nonbenzodiazepine sedatives, and increased need for withdrawal tapering medications and antipsychotics. It is unclear in this retrospective study if the outcomes were worse because the subjects received benzodiazepines or because subjects receiving benzodiazepines were sicker and thus required benzodiazepines in their analgosedative regimen. Further investigation is warranted into the impact of benzodiazepines on patient outcomes, nonpharmacologic management of sedation, improvement in bedside assessment of analgosedation, and optimal balance between over- and under-sedation.

PMID:40293788 | DOI:10.1097/CCE.0000000000001255

J Med Internet Res. 2025 Apr 28;27:e59037. doi: 10.2196/59037.

ABSTRACT

BACKGROUND: As populations age, the demand for long-term care services steadily increases. The effectiveness of government-promoted long-term care policies and the public’s access to relevant service information are demonstrably influenced by media representation. In addition, prior research has suggested that news framing can mitigate the negative influence (the Werther effect) with a more hopeful framing (the Papageno effect), thereby reducing the public’s susceptibility to negative news.

OBJECTIVE: This study investigates the phenomenon of suicides and homicides in long-term care reported in the news, in which family caregivers or care receivers died by suicide or homicide. We examined changes in the media’s reporting framework before and after the implementation of Taiwan’s Long-Term Care Plan 2.0 in 2017. We further examined the consistency between the content of news reports and the information provided by the media on long-term care services and suicide prevention (eg, hotlines).

METHODS: Content analysis and text-mining techniques were used to analyze 433 news reports covering 95 cases of suicides and homicides in long-term care in Taiwan from 2009 to 2021. A random-effects model was applied to examine term frequency transition post implementation.

RESULTS: The majority (>60%) of the cases involved family caregivers’ homicide-suicide. The term “family moral tragedy” has been replaced by “long-term care tragedy” in recent discourse. This shift is evident in a decline in the frequency of “family moral tragedy” since 2017, with usage decreasing by 32.4% in headlines and by 24% in news content. The term frequency of “care burden” has significantly increased from 0.0006 (SD 0.0008) to 0.017 (SD 0.0461; t₃₃₇=3.006; P=.003). While linguistic characteristics of the content have remained consistent, there were statistically significant differences in medical and ethics-related terms. The media tends to provide more suicide prevention information (eg, hotlines; >50%), offering relatively limited coverage on long-term care services (<25%).

CONCLUSIONS: The news media have the potential to change the public’s response to specific issues. Our findings suggest that government efforts to encourage media coverage of positive experiences with long-term care services can be a preventative measure against caregiving suicides and homicides. Moreover, government initiatives should focus on strengthening media publicity and enhancing media literacy within the long-term care sector. By empowering the media to provide readers with clear channels for seeking help, such as hotlines, the media will contribute positively to the mental health of family caregivers. Finally, an annual database on family caregiver homicide-suicide should be established. In that case, the government could identify potential risk factors and inform the formulation and revision of relevant policies and services via this database, ultimately contributing to preventing suicides and homicides in long-term care and achieving public health goals.

PMID:40293785 | DOI:10.2196/59037

J Med Internet Res. 2025 Apr 28;27:e66231. doi: 10.2196/66231.

ABSTRACT

BACKGROUND: A substantially lower proportion of female individuals participate in sufficient daily activity compared to male individuals despite the known health benefits of exercise. Investment in female sports and exercise medicine research may help close this gap; however, female individuals are underrepresented in this research. Hesitancy to include female participants is partly due to assumptions that biological rhythms driven by menstrual cycles and occurring on the timescale of approximately 28 days increase intraindividual biological variability and weaken statistical power. An analysis of continuous skin temperature data measured using a commercial wearable device found that temperature cycles indicative of menstrual cycles did not substantially increase variability in female individuals’ skin temperature. In this study, we explore physical activity (PA) data as a variable more related to behavior, whereas temperature is more reflective of physiological changes.

OBJECTIVE: We aimed to determine whether intraindividual variability of PA is affected by biological sex, and if so, whether having menstrual cycles (as indicated by temperature rhythms) contributes to increased female intraindividual PA variability. We then sought to compare the effect of sex and menstrual cycles on PA variability to the effect of PA rhythms on the timescales of days and weeks and to the effect of nonrhythmic temporal structure in PA on the timescale of decades of life (age).

METHODS: We used minute-level metabolic equivalent of task data collected using a wearable device across a 206-day study period for each of 596 individuals as an index of PA to assess the magnitudes of variability in PA accounted for by biological sex and temporal structure on different timescales. Intraindividual variability in PA was represented by the consecutive disparity index.

RESULTS: Female individuals (regardless of whether they had menstrual cycles) demonstrated lower intraindividual variability in PA than male individuals (Kruskal-Wallis H=29.51; P<.001). Furthermore, individuals with menstrual cycles did not have greater intraindividual variability than those without menstrual cycles (Kruskal-Wallis H=0.54; P=.46). PA rhythms differed at the weekly timescale: individuals with increased or decreased PA on weekends had larger intraindividual variability (Kruskal-Wallis H=10.13; P=.001). In addition, intraindividual variability differed by decade of life, with older age groups tending to have less variability in PA (Kruskal-Wallis H=40.55; P<.001; Bonferroni-corrected significance threshold for 15 comparisons: P=.003). A generalized additive model predicting the consecutive disparity index of 24-hour metabolic equivalent of task sums (intraindividual variability of PA) showed that sex, age, and weekly rhythm accounted for only 11% of the population variability in intraindividual PA variability.

CONCLUSIONS: The exclusion of people from PA research based on their biological sex, age, the presence of menstrual cycles, or the presence of weekly rhythms in PA is not supported by our analysis.

PMID:40293784 | DOI:10.2196/66231

Pain Med. 2025 Apr 28:pnaf051. doi: 10.1093/pm/pnaf051. Online ahead of print.

ABSTRACT

OBJECTIVES: There are no updated systematic reviews examining the prevalence of persistent pain among head and neck cancer survivors. This systematic review aims to identify the prevalence and characteristics of persistent pain across locations among head and neck cancer survivors.

METHODS: A systematic review was conducted according to PRISMA guidelines on December 14th, 2023 (PROSPERO reference CRD42024494926). The MEDLINE via PubMed, Scopus, Web of Science, CINAHL, Ovid and Cochrane Library databases were searched. Studies had to report prevalence data on persistent pain in head and neck cancer survivors who completed cancer treatment at least 3 months ago. Quality of the included studies was assessed using the critical appraisal tool developed by the Joanna Briggs Institute. Statistical heterogeneity was assessed prior to performing the meta-analysis using τ2, I2, and Q. Univariate meta-regression analyses were used to examine sources of heterogeneity.

RESULTS: 1713 records were retrieved. After removing duplicates 1385 articles were screened.Ultimately, 182 articles were assessed for full-text screening, of which 17 manuscripts were included for review. The prevalence of the studies was 31% (95% CI: 20-42). The meta-regression explained approximately 40% of the observed heterogeneity (R2 = 40.57).

CONCLUSION: This systematic review highlights that almost third of head and neck cancer survivors are under persistent pain after finishing cancer treatment. No final conclusions can be drawn as to which extent cancer location, cancer treatment, pain measurement method and timing of pain assessments could modify this prevalence. Results should be interpreted with caution since there is considerable variability in the methods.

PMID:40293769 | DOI:10.1093/pm/pnaf051