Category: Statistics

Anal Chim Acta. 2025 Dec 15;1379:344732. doi: 10.1016/j.aca.2025.344732. Epub 2025 Oct 2.

ABSTRACT

Silver is a precious metal, and high-purity silver is widely used in electronic, optical, and reference material applications, where even trace amounts of impurities can critically impact performance and accuracy. Quantifying trace elements such as Cu, Pb, Fe, and others in high-purity silver poses analytical challenges due to the potential matrix effects and the need for accurate calibration strategies. The trace impurities, Cu, Fe, and Pb in high-purity silver samples were quantified using the standard addition (SAM) and the matrix-matched external standard method (MMESM) using inductively coupled plasma optical emission spectrometry (ICP-OES), and their results are compared. The research also includes a comprehensive uncertainty evaluation associated with each method. Validating parameters like LOD (Limit of Detection), LOQ (Limit of Quantification), working range, accuracy, and precision are also discussed in detail in the manuscript. The results obtained from both the calibration approaches were found to be comparable. Both methods were found to have the ability to account for the matrix effect. The recovery found for the results indicates that both methods provide reliable quantification. The two-way ANOVA results demonstrate that both emission lines and matrix concentrations yield statistically comparable results for copper, iron, and lead determination by SAM & MMESM. Two extra emission lines for copper and one for iron estimation were observed and are reported here. Also, the results for both SAM and MMESM with and without internal standard correction were quantified, and the results were almost the same. Thus, this work provides a comprehensive understanding of trace element analysis in silver, which can also be extended to other metals for trace element analysis.

PMID:41167894 | DOI:10.1016/j.aca.2025.344732

Anal Chim Acta. 2025 Dec 15;1379:344751. doi: 10.1016/j.aca.2025.344751. Epub 2025 Oct 6.

ABSTRACT

BACKGROUND: Exposome research has expanded rapidly in recent years, driven by advances in analytical techniques such as liquid chromatography-high-resolution mass spectrometry (LC-HRMS), which enable broad and sensitive chemical coverage. Targeted methods focus on known compounds, while untargeted metabolomic approaches provide a more holistic view and may reveal exposure biomarkers, but they are not specifically designed to detect exogenous chemicals. Identifying relevant exposure markers within the vast and complex datasets generated by untargeted LC-HRMS data remains a significant analytical and computational challenge, requiring innovative data mining strategies.

RESULTS: We developed a novel untargeted data mining strategy to extract exogenous chemical signatures from complex LC-HRMS datasets. The approach integrates isotopic signature enrichment (ISE), biotransformation-informed feature selection and an “exposure rate” metric. When applied to meconium data from the EDEN cohort, the strategy led to a six-fold reduction in the number of features by retaining only those exhibiting valid carbon isotope patterns. Mass defect plots revealed signatures of suspect monohalogenated species and putative conjugated and non-conjugated metabolites in a specific region. Incorporating ISE results into the chemical formula prediction significantly reduced the number of candidates, improving annotation efficiency. In utero exposure to xenobiotics was supported by the detection of known exposure markers such as acetaminophen, caffeine and nicotine. These results demonstrate the method’s potential to uncover exposomic signals in complex biological matrices.

SIGNIFICANCE: This study presents a novel data mining strategy that reduces the complexity of untargeted LC-HRMS data by retaining chemically reliable features based on isotopic signatures. As a proof of concept, this strategy enables the detection of specific chemical signatures and exogenous compounds without prior knowledge. Its adaptability to various biological matrices and its compatibility with different high-resolution mass spectrometry platforms make this strategy a valuable tool for exposome research and early-life exposure assessment.

PMID:41167878 | DOI:10.1016/j.aca.2025.344751

Anal Chem. 2025 Oct 30. doi: 10.1021/acs.analchem.5c03399. Online ahead of print.

ABSTRACT

Effective monitoring of microcystin (MC)-LR toxin produced by blue-green algae is of great importance for water pollution and human health. Herein, a field-deployable (FiDe) photoelectrochemical (PEC) biosensor based on nitrogen vacancy-engineered Fe₂O₃@g-C₃N₄-6N_v was proposed for the sensitive and reliable detection of MC-LR. A critical insight was elucidated on atomic-level altered Fe-O/N coordination for an oriented built-in electric field in the composite, which thereby established a Z-scheme charge transfer for enhanced PEC responses. A thiolated aptamer, stably immobilized via Fe-S bonding, enabled specific MC-LR recognition with exceptional resilience. Synergistic integration of a defect-tailored Fe-N heterojunction and Fe-S aptamer immobilization precisely controlled interfacial charge dynamics through concentration-dependent target recognition, where MC-LR binding inhibited Fe-S/Fe-N electron transport to weaken PEC signals. Coupled with an in-house developed FiDe PEC device, the platform exhibited a log-linear detection range from 0.1 to 10000 ng·L^-1 with a detection limit of 0.034 ng·L^-1, significantly below the WHO safety threshold (1 μg·L^-1). It demonstrated exceptional robustness, pH tolerance, storage stability, and selectivity against MC-YR/RR/LA. Field validation across six representative sites along a small watershed of the Yangtze River Basin was conducted in complex matrices, with Bland-Altman analysis confirming statistical equivalence to HPLC. This work not only pioneers a defect-aptamer coengineering strategy to reconfigure Z-scheme charge dynamics but also develops a FiDe PEC device enabling on-site accurate quantification of MC-LR, ultimately empowering proactive water quality management and public health protection.

PMID:41167817 | DOI:10.1021/acs.analchem.5c03399

Inj Prev. 2025 Oct 30:ip-2025-045766. doi: 10.1136/ip-2025-045766. Online ahead of print.

ABSTRACT

BACKGROUND: Motorcycle injuries are a major cause of death in Cameroon and the burden is on the rise. Low personal protective equipment (PPE) use, especially helmets, exacerbates the burden.

OBJECTIVES: This study investigated PPE uptake and determinants among motorcyclists in the crisis-affected Limbe and Tiko Health Districts.

MATERIALS AND METHODS: A community-based cross-sectional study was conducted among 499 commercial motorcyclists aged 18 years and above in all 16 health areas of the Limbe and Tiko Health Districts, Cameroon. Participants were recruited through consecutive sampling at motorcycle pick-up points after obtaining ethical clearance from the University of Buea. Trained research assistants used structured questionnaires to collect data on sociodemographics, riding habits and determinants of PPE uptake. An observational checklist was used to collect data on helmet use. The data were analysed using descriptive statistics and logistic regression to identify factors influencing helmet use among the riders.

RESULTS: The mean age of the motorcyclists was 32.2 (and the SD was 7.6) years. A total of 242 (48.5%) were within the age range 21-30 years and all the riders were males.The majority of riders were single, 261 (52.3%) and 291 (58.3%) had attended secondary school. The proportion of riders who reported not having a valid motorcycle licence was 339 (67.9%).Among the 499 riders studied, 81.8% used long trousers, 30.1% used boots and 28.6% used helmets. Only 22.7% used gloves and 14.8% used eye glasses. Factors independently associated with helmet use were being married (adjusted OR (aOR) 1.81, 95% CI 0.34 to 7.42, p<0.005), owning a valid license (aOR 1.97, 95% CI 1.22 to 3.19, p=0.006) and being an internally displaced person (aOR 0.83, 95% CI 1.18 to 2.84, p=0.007). Also, having good knowledge of PPE (aOR 3.01, 95% CI 1.60 to 5.65, p=0.001) and being trained on PPE (aOR 2.48, 95% CI 1.61 to 3.84, p=0.000) were significant factors.

CONCLUSIONS: The uptake of PPE is low, highlighting the need for targeted interventions to improve PPE uptake among commercial motorcyclists. The identified determinants of helmet use can inform evidence-based strategies to enhance road safety and reduce the burden of motorcycle-related injuries in this at-risk population.

PMID:41167805 | DOI:10.1136/ip-2025-045766

JMIR Cancer. 2025 Oct 30;11:e79956. doi: 10.2196/79956.

ABSTRACT

BACKGROUND: Although the use of telehealth has declined since the pandemic, it remains a popular mode of care delivery across the cancer care continuum. Understanding telehealth in the context of cancer care is essential, as its benefits and challenges may differ among diverse population groups and geographic areas.

OBJECTIVE: This study aimed to examine patterns of telehealth utilization across the cancer care continuum and to identify factors associated with the receipt of telehealth in a large patient population. This study also aimed to assess the telehealth’s impact on key health care delivery outcomes.

METHODS: We used an annualized retrospective cohort design using patient data from the Johns Hopkins Health System (JHHS), a large regional academic health center in Maryland. The study analyzed electronic health record (EHR) data covering the period from January 1, 2019, to December 31, 2023. Chronic conditions were defined through the Johns Hopkins Adjusted Clinical Groups (ACG) System, which identifies comorbidities based on the International Classification of Diseases, Tenth Revision, Clinical Modification, codes in the electronic health record. In addition, we used publicly available geospatial data (eg, internet connectivity, rural-urban commuting area) to assess telehealth receipt associations. Statistical modeling, including generalized estimating equations, was used to evaluate variations in telehealth utilization and outcomes.

RESULTS: A total of 124,974 adult patients receiving cancer-related care at Johns Hopkins Health System were identified during the study period. Telehealth users were significantly older (52.2% aged ≥65 years, 19,942 patients) compared to nonusers (48.7%, 42,209 patients). In addition, these users were more likely to be male (45.4%, 17,365 patients vs 40.2%, 34,839 patients) and to identify as White (70.8%, 27,071 patients vs 64.7%, 56,122 patients). Telehealth users also had a higher prevalence of comorbidities, with 61.5% (23,503 patients) reporting 3 or more chronic conditions compared to 38.0% (33,000 patients) among nonusers. A positive correlation was noted between rural-urban commuting area codes and telehealth service utilization (ρ=0.36; P<0.05), indicating higher usage in more rural areas. Conversely, average maximum download and upload speeds showed an inverse relationship with telehealth utilization (ρ=-0.22; P<0.05; and ρ=-0.34; P<0.05, respectively). Adjusted analyses indicated that concurrent telehealth use was associated with reduced odds of emergency department visits (0.916, 95% CI 0.884-0.948) and hospitalizations (0.830, 95% CI 0.799-0.863), acknowledging the potential influence of residual confounding.

CONCLUSIONS: Telehealth has emerged as a crucial mode of care delivery for patients with complex conditions such as cancer. Understanding usage patterns and factors influencing telehealth across the cancer care continuum, including geographic barriers, is vital to optimizing its implementation and ensuring health care systems meet the diverse needs of patients with cancer in a value-based care environment.

PMID:41166738 | DOI:10.2196/79956

Hepatol Res. 2025 Oct 30. doi: 10.1111/hepr.70066. Online ahead of print.

ABSTRACT

AIM: Liver stiffness measurement is a noninvasive liver disease assessment (NILDA) for hepatic fibrosis and is covered by health insurance in Japan. This study aimed to examine nationwide trends in liver stiffness measurement in Japan by analyzing data from the National Database of Health Insurance Claims (NDB).

METHODS: We analyzed NDB open data from 2016 to 2020. In the NDB, liver stiffness measurement (Medical Fee Schedule Code: D215-2) includes both imaging techniques (transient elastography) and biochemical examinations (mac-2 binding protein glycosylation isomer). The claim number was counted across all 47 Prefectures in Japan.

RESULTS: The annual number of liver stiffness measurements all over Japan was 76,183 in 2016. The number increased to 124,584 in 2020, representing a 1.64-fold increase during this period. The annual number of liver stiffness measurements adjusted by population size (1000 population) was 0.60 in 2016. The numbers were 0.64, 0.53, 0.89, and 0.99 in 2017, 2018, 2019, and 2020, respectively. There was a 1.67-fold increase during the period. We carried out statistical analysis using Poisson regression, which confirmed that the observed increases in liver stiffness measurement uptake were statistically significant (p < 0.0001). In almost all Prefectures, the population-adjusted number of liver stiffness measurements showed an increasing trend. Notably, Saga Prefecture had the highest prevalence of liver stiffness measurements (4.10) during the period. This was followed by Kagawa (3.19), Miyazaki (2.70), and Wakayama (2.44) Prefectures.

CONCLUSIONS: The number of liver stiffness measurements has increased from 2016 to 2020 throughout Japan. Liver stiffness has been increasingly measured nationwide and is expected to become a valuable NILDA for identifying at-risk patients and evaluating treatment efficacy in steatotic liver disease.

PMID:41165742 | DOI:10.1111/hepr.70066

Gigascience. 2025 Oct 30:giaf139. doi: 10.1093/gigascience/giaf139. Online ahead of print.

ABSTRACT

BACKGROUND: While cell-free DNA (cfDNA) is a promising biomarker for cancer diagnosis and monitoring, there is limited agreement on optimal cfDNA collection and extraction protocols as well as analysis pipelines of the corresponding cfDNA sequencing data. In this paper, we address the latter by studying the effect of various bioinformatics preprocessing choices on derived genetic and epigenetic cfDNA features and study how observed feature differences influence the downstream task of separating between healthy and cancer cfDNA samples.

RESULTS: Using low-pass whole-genome cfDNA sequencing data from 20 lung cancer and 20 healthy samples, we assessed the influence of various preprocessing settings such a read trimming, filtering of secondary alignments and choice of genome build as well as practices such as downsampling or selecting for short fragment on derived cfDNA features including cfDNA fragment size, fragment end motifs, copy number alterations, and nucleosome footprints. Our results demonstrate that the analyzed features are robust to common preprocessing choices, but exhibit variable sensitivity to sequencing coverage. Fragment length statistics and end motifs are the least affected by low coverages, whereas nucleosome footprint analysis is very sensitive to it. Our findings confirm that selecting for shorter fragments, enhances cancer-specific signals, however, by removing data, also reduces signals in general. Interestingly, we find that fragment end motif analysis benefits the most from in silico size selection. We also observe that the filtering of low-quality and secondary alignments and choice of genome build result in slight improvements in cancer classification performance based on nucleosome coverage and copy number features.

CONCLUSIONS: Altogether, we conclude that cfDNA analysis is minimally affected by different bioinformatics preprocessing settings, however we describe some synergistic effects between analytical approaches, which can be leveraged to improve cancer detection.

PMID:41165721 | DOI:10.1093/gigascience/giaf139

JAMA. 2025 Oct 30. doi: 10.1001/jama.2025.18109. Online ahead of print.

NO ABSTRACT

PMID:41165718 | DOI:10.1001/jama.2025.18109

JAMA Netw Open. 2025 Oct 1;8(10):e2540065. doi: 10.1001/jamanetworkopen.2025.40065.

ABSTRACT

IMPORTANCE: There is a need to determine the relative effect of message-based psychotherapy (MBP), an asynchronous approach that uses emails, texts, or voice or video messages to permit therapeutic exchanges, compared with video-based psychotherapy (VBP) and whether a combination of modalities would result in better outcomes for those who do not respond to either treatment alone.

OBJECTIVES: To compare MBP with VBP on a commercial digital mental health platform and test combinations of modalities for participants who did not respond to single-modality treatment.

DESIGN, SETTING, AND PARTICIPANTS: In this sequential multiple assignment randomized clinical trial, psychotherapy was delivered by therapists on a commercial digital mental health platform from January 10, 2022, to January 14, 2024, among 850 participants who were 18 years of age or older, English or Spanish speaking, living in the US in a state where the digital mental health platform had available therapists, scored 10 or more on the 9-item Patient Health Questionnaire (PHQ-9), and received a diagnosis of depression during intake assessment.

INTERVENTIONS: At baseline, participants were randomized to MBP or weekly VBP. At week 6, nonresponders were rerandomized to MBP with weekly or monthly VBP. Participants received treatment for 12 weeks.

MAIN OUTCOMES AND MEASURES: Primary outcomes included depression severity (measured by the PHQ-9), social functioning, response to treatment, and remission. Secondary outcomes included treatment engagement, therapeutic alliance, and indicators of treatment quality and satisfaction. Analysis was performed on an intention-to-treat basis.

RESULTS: The analytic sample included 850 participants (mean [SD] age, 33.8 [10.5] years; 562 women [66.1%]; mean [SD] PHQ-9 score, 15.0 [4.8]), with 423 randomized to MBP and 427 to VBP. Treatment disengagement by week 5 was more likely for VBP than MBP (VBP, 91 [21.3%]; MBP, 56 [13.2%]; Cramér V = 0.10; 95% CI, 0.03-0.13; P = .003). There were no significant differences on depression or social functioning score changes between MBP and VBP or on depression score changes for nonresponders randomized to MBP with weekly vs monthly VBP. At week 12, MBP and VBP did not differ in the proportion of participants who responded to treatment (MBP, 144 of 303 [47.5%]; VBP, 134 of 284 [47.2%]; Cramér V < .001; 95% CI, -0.08 to 0.09; P = .99) or who experienced remission (MBP, 95 of 303 [31.4%]; VBP, 86 of 284 [30.3%]; Cramér V = 0.01; 95% CI, -0.07 to 0.09; P = .85). Among nonresponders, VBP had a stronger initial therapeutic alliance than MBP at week 4 (P < .001; d = 0.48-0.57). Among participants assessed for rerandomization, there were no statistically significant differences among those who responded to treatment by week 5 (MBP, 105 of 363 [28.9%]; VBP, 93 of 336 [27.7%]; Cramér V = 0.01; 95% CI, -0.06 to 0.08; P = .78). Therapeutic alliance ratings increased across all conditions by week 10; however, these changes were not statistically significant. Video-based psychotherapy was more frequently recommended than MBP (VBP, 69 of 71 [97.2%]; MBP, 70 of 80 [87.5%]; odds ratio, 0.18; 95% CI, 0.04-0.88; P = .03). There were no significant differences in clinical outcomes between nonresponders randomized to weekly vs monthly VBP.

CONCLUSIONS AND RELEVANCE: In this sequential multiple assignment randomized clinical trial comparing MBP with VBP, there were no differences between groups on improvement in depression or social functioning. More participants in the VBP group disengaged from treatment, while VBP also had greater therapeutic alliance early in treatment among nonresponders. There were no differential effects from rerandomizing nonresponders. Findings reinforced MBP as a viable alternative to VBP. Broader insurance reimbursement for MBP could improve access to evidence-based care. Future research should explore optimizing early alliance-building in MBP.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04513080.

PMID:41165707 | DOI:10.1001/jamanetworkopen.2025.40065

JAMA Netw Open. 2025 Oct 1;8(10):e2540453. doi: 10.1001/jamanetworkopen.2025.40453.

ABSTRACT

IMPORTANCE: Replantation and revascularization are among the most technically challenging surgical procedures and have varying success rates. Methods to assess surgeon skill for this complex undertaking are lacking.

OBJECTIVE: To examine whether a surgeon proficiency score is associated with clinical outcomes across multiple institutions.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter retrospective cohort study analyzed all digit replantation and revascularization after traumatic amputations for adult patients from January 1, 2000, to August 31, 2022, at 8 medical institutions in the United States, India, and Singapore. Data were collected and analyzed from February to October 2024.

EXPOSURE: Surgeon proficiency (range, 1.0 to 7.5; higher score indicates greater proficiency) and procedure difficulty (range, -1.0 to 7.5; higher score indicates greater difficulty) scores. Each surgeon’s procedures were sorted chronologically, then divided in half. Proficiency scores were calculated for each surgeon based on the difficulty and outcomes of their early procedures and validated using outcomes from their later procedures. Difficulty scores were calculated based on patient and injury characteristics.

MAIN OUTCOMES AND MEASURES: The outcome of interest was procedure success, defined as digit survival at 1 month after the operation.

RESULTS: Of 653 digits that were replanted or revascularized by 65 surgeons, 458 (70.1%) were successful. Mean (SD) patient age was 41.0 (15.7) years, and 571 patients (87%) were male. Difficulty scores ranged from 1.0 to 7.5, with a mean of 2.7, and were significantly higher in failed procedures than in successful procedures (mean [SD], 3.2 [1.4] vs 2.5 [1.2]; P < .001). Proficiency scores ranged from -0.37 to 4.14, with a mean of 1.40. For each 1-point increase in proficiency score, a surgeon’s future success rate increased by 7.5% (95% CI, 5.5%-8.1%; P < .001). After adjusting for surgeon experience, difficulty score, and additional patient- and injury-level characteristics using mixed-effects logistic regression, greater surgeon proficiency score and lower difficulty score were associated with greater likelihood of individual procedure success (surgeon proficiency: odds ratio [OR], 1.46; 95% CI, 1.02 to 2.10; P = .04; difficulty: OR, 0.70; 95% CI, 0.57 to 0.86; P = .001).

CONCLUSIONS AND RELEVANCE: This multi-institutional cohort study of patients who underwent digit replantation or revascularization found that surgeon proficiency score was associated with 1-month success. These findings suggest that national trauma referral networks should incorporate difficulty and proficiency scoring tools when coordinating patient transfers after traumatic digit amputation. Centers with high replant volume or those who are geographically well-positioned to become replant centers should aim to recruit and improve reimbursement for surgeons with high proficiency scores. Meanwhile, surgeons with low proficiency scores should seek out additional training to improve their skills.

PMID:41165706 | DOI:10.1001/jamanetworkopen.2025.40453