Category: Statistics

Handb Clin Neurol. 2025;213:17-29. doi: 10.1016/B978-0-443-29884-4.00004-2.

ABSTRACT

Placebo effects are a family of diverse effects that tap into the brain and body’s latent endogenous therapeutic potential. Unlike placebo responses, which can reflect statistical artifacts and natural history, placebo effects are driven by multiple types of psychological and brain responses to the treatment context. These include memories and learned associations from past experiences, expectations about future outcomes, cognitive appraisals of the self and context, and emotional states arising from these. Likewise, these psychological and brain responses to placebo arise from multiple aspects of the therapeutic encounter, including the relationship with the care provider, specific treatment cues like procedures and setting, and suggestions. Thus, many forms of placebo effect depend on the thoughts and imagination of the patient, and their interaction with the social and physical elements of the treatment context. In this way, placebo effects may overlap with cognitive self-regulation, a family of techniques that involve using attention, appraisal, and imagination to influence one’s emotions, pain, and motivation based on regulatory goals. In this chapter, we focus on the relationship between placebo effects and self-regulation of emotion. We review research on placebo effects, focusing on the idea that changes in brain processes related to affect and motivation are central and consistently identified across disorders. We then describe studies of the cognitive regulation of emotion and pain, highlighting several commonalities shared by self-regulation and placebo. The picture that is emerging is one in which appraisals of the treatment context – influenced by both placebo treatments and self-regulatory goals – shape brain systems involved in the construction of value, feelings, and motivation. These systems are central to clinical outcomes that depend on feelings and function, and interact with learning processes to alter therapeutic trajectories across disorders.

PMID:41161956 | DOI:10.1016/B978-0-443-29884-4.00004-2

Air Med J. 2025 Nov-Dec;44(6):548-552. doi: 10.1016/j.amj.2025.08.006. Epub 2025 Sep 13.

ABSTRACT

Obstetric transport to higher levels of maternal care for critically ill pregnant individuals is recommended to reduce maternal and neonatal morbidity, yet data on these transports are lacking. We aimed to describe the characteristics of obstetric transports of 1 integrated health system’s perinatal transport service from January 2020 to December 2023, with a specific focus on assessing factors associated with transport directly to an intensive care unit (ICU) rather than an emergency room or labor and delivery unit. During the study period, 1,087 obstetric transports occurred, most frequently for preterm labor (28.8%), preeclampsia (28.7%), and preterm prelabor rupture of membranes (18.7%). Transport most often occurred via rotor wing (48.0%). Transport to the ICU occurred in 3.2% of cases. Transport to the ICU was associated with longer physician consultation time (17.0 minutes [interquartile range 9.75-31.0] vs. 11.0 minutes [7.0-18.0], P = .006), shorter flight team dispatch time (13 minutes [8.0-33.0] vs. 20.0 minutes [13.5-29.0], P = .03), longer stabilization time before departure (19.0 minutes [15.0-33.0] vs. 15.0 minutes [12.0-20.0], P < .001), and longer time to load the patient to the aircraft (10.0 minutes [7.0-14.0] vs. 7.0 minutes [5.0-10.0], P = .002). Factors associated with transport to the ICU included a diagnosis of coronavirus disease 2019 (adjusted odds ratio [aOR], 11.85, 95% confidence interval [CI] 3.14-36.79), being postpartum (aOR 54.93, 95% CI 21.52-144.81), and further distance traveled (aOR 1.01 per mile traveled, 95% CI 1.00-1.01). Obstetric transports to the ICU are uncommon but require specialized patient care.

PMID:41161888 | DOI:10.1016/j.amj.2025.08.006

Air Med J. 2025 Nov-Dec;44(6):521-524. doi: 10.1016/j.amj.2025.08.005. Epub 2025 Sep 17.

ABSTRACT

OBJECTIVE: Although numerous studies have evaluated transport modes for pediatric trauma, few have addressed strategies for sepsis. This study evaluates whether ground versus rotor wing transport affects transport time, hospital length of stay (LOS), or mortality in pediatric patients with suspected sepsis.

METHODS: We performed a retrospective chart review at a 255-bed tertiary children’s hospital and level 1 trauma center (∼81,000 annual emergency department visits). Patients aged 0 to 18 years with a referring diagnosis of possible sepsis and transported by Pedi-Flite, a specialized neonatal/pediatric critical care team, between January 1, 2010, and January 1, 2020, were included; neonatal intensive care unit admissions were excluded. Data included demographics, transport time, fluid/antibiotic administration, vasopressor use, blood culture results, LOS, discharge disposition, and insurance status.

RESULTS: Of 87 patients, 63 were transported by ground and 24 by rotor wing. Baseline characteristics and outcomes did not differ significantly. Mean transfer time was 150 ± 80 minutes for ground and 210 ± 297 minutes for rotor (P = .40). Team arrival to the referring hospital was 72 ± 51 minutes for ground and 125 ± 296 minutes for rotor (P = .40). LOS was 10.78 days (ground) versus 9.22 days (rotor; P = .6), and survival was 97% (rotor) versus 90% (ground; P = .40). Most patients received intravenous fluids (97%) and antibiotics (95%), with no group differences in administration rates or mean volume (33.4 vs. 33.3 mL/kg; P = .77). Vasopressors were started during transport in 10% and by the receiving hospital in 63%. In addition, 12 patients (14%) were intubated. Blood cultures were obtained in 40%, with 17% positive; no differences were observed between the groups (all P > .30).

CONCLUSION: Transport mode was not associated with differences in care or outcomes for suspected pediatric sepsis. In regions with similar geography and dispatch logistics, ground transport by a specialized critical care team may provide equivalent outcomes to rotor wing.

PMID:41161884 | DOI:10.1016/j.amj.2025.08.005

Air Med J. 2025 Nov-Dec;44(6):497-504. doi: 10.1016/j.amj.2025.07.008.

ABSTRACT

OBJECTIVE: Helicopter emergency medical services (HEMS) provide time-sensitive transport and advanced prehospital care. Although traditional bibliometrics (eg, citation counts) have measured academic impact, the role of alternative metrics (altmetrics), such as social media and news mentions, in capturing real-time scholarly influence remains underexplored in HEMS research. To evaluate the relationship between traditional citation metrics and altmetric indicators in HEMS-related publications and to identify trends in online engagement and academic dissemination.

METHODS: This cross-sectional analysis included 817 HEMS-related articles published between 1984 and 2025, identified using Altmetric Explorer. Data were extracted from Altmetric Explorer, PlumX Metrics, and Springer Nature Citations, covering various traditional and alternative impact indicators. Descriptive statistics summarized citation and altmetric indicators. Spearman’s correlation analysis assessed relationships between Altmetric Attention Score (AAS), Mendeley readership, and citation counts from multiple sources (Dimensions, CrossRef, Scopus, PubMed). Geographic and temporal engagement patterns were also evaluated.

RESULTS: The mean AAS was 11.18 ± 28.80, and the mean citation count (Dimensions) was 17.04 ± 24.48. A strong positive correlation was found between AAS and X (formerly Twitter) mentions (ρ = 0.723, P < .001). Mendeley readers had strong positive correlations with citation counts. However, overall correlations between AAS and citation counts were weak. Social media engagement was highest in the United Kingdom and the United States. Nordic countries dominated policy and guideline citations.

CONCLUSION: This is the first comprehensive altmetric analysis of HEMS-related publications. Although AAS reflects online attention, it correlates only modestly with traditional academic impact. Altmetrics offer complementary insight into research dissemination, especially in the digital age, and may inform more holistic evaluation strategies in prehospital and emergency medicine scholarship.

PMID:41161880 | DOI:10.1016/j.amj.2025.07.008

Air Med J. 2025 Nov-Dec;44(6):478-484. doi: 10.1016/j.amj.2025.06.023. Epub 2025 Jul 23.

ABSTRACT

OBJECTIVE: Air medical evacuation (AE) plays a vital role in emergency medical services by facilitating swift transfer of critically ill or injured patients to advance health care facilities. Despite its increasing importance, standardized protocols and comprehensive research on AE outcomes remain scarce, particularly in Nepal. This study evaluates clinical characteristics, interventions, and prognostic determinants of AE cases managed by anesthesiologists at a military tertiary care hospital.

METHODS: This retrospective observational study analyzed AE cases handled by anesthesiologists in an 11-year period (July 2013-July 2024). Data were retrieved from hospital records, encompassing patient demographics, clinical characteristics, air medical factors, and outcomes. The primary outcomes assessed were in-hospital mortality and recovery. Chi-square tests and logistic regression analyses were used to evaluate associations between key clinical variables and patient outcomes.

RESULTS: The study included 83 patients, with a median age of 30 years (interquartile range: 23-36) and a male-to-female ratio of 16:1. Road traffic accidents were leading cause of AE (39.8%), followed by high-altitude illness and heat-related conditions (9.6% each). Mortality was significantly associated with hemodynamic instability (odds ratio: 96.67, 95% confidence interval: 11.34-823.77, P < .001) and intubation status (odds ratio: 12.75, 95% confidence interval: 3.236-50.191, P < .001), whereas no significant correlation was observed between the reason for AE and mortality.

CONCLUSIONS: Our study represents first in-depth analysis of AEs involving anesthesiologists in Nepal, identifying illness severity, hemodynamic instability, and intubation status as significant predictors of mortality. The findings underscore urgent need for improved AE infrastructure, implementation of standardized protocols, and specialized training to enhance patient outcomes.

PMID:41161876 | DOI:10.1016/j.amj.2025.06.023

Air Med J. 2025 Nov-Dec;44(6):473-477. doi: 10.1016/j.amj.2025.06.022. Epub 2025 Jul 21.

ABSTRACT

OBJECTIVE: This study aimed to determine the impact of having 2 physicians versus 1 physician in a helicopter emergency medical team on OST.

METHODS: This retrospective observational study analyzed 828 patients who underwent helicopter emergency medical services in 2 years (2020-2021). We used chi-square and t tests to analyze the difference in OST between patients attended by 1 versus 2 physicians. We then used general linear model analysis to evaluate the impact of the number of physicians on OST.

RESULTS: Of the 828 patients, we observed 1 physician group (n = 356) and 2 physician groups (n = 472). Analysis revealed significant main effects of diagnosis type (F = 10.78, P < .001) and the number of physicians (F = 18.60, P < .001) on OST, whereas the interaction was not significant (F = 0.30, P = .911). In another analysis, the interaction between the transport facility and the number of physicians was significant (F = 7.00, P = .008), including their main effects.

CONCLUSIONS: Having 2 physicians on board the helicopter emergency medical services seems to reduce OST compared with having 1, particularly in trauma and neurology cases.

PMID:41161875 | DOI:10.1016/j.amj.2025.06.022

Liver Transpl. 2025 Oct 29. doi: 10.1097/LVT.0000000000000765. Online ahead of print.

ABSTRACT

Geographic variation in liver transplant access in the United States have spurred interest in spatial accessibility to care. There is currently no consensus about which measure should be used for spatial accessibility. We used 2015-2022 data from the Scientific Registry of Transplant Recipients and the National Center for Health Statistics to calculate county listing-to-death ratios (LDR) for liver transplant. We used a two-step floating catchment area approach to define a novel measure of spatial accessibility (Spatial Accessibility Ratio, SPAR). We compared this measure to other accessibility measures using generalized linear models and Vuong’s non-nested hypothesis test. Across 3,108 included counties, SPAR ranged from 0.56 to 9.98; 29% of counties and 65% of the population had a SPAR≥1 (mean or better accessibility to liver transplant). SPAR outperformed distance (p<0.001), rurality (p<0.001), and health care resource-based measures (p<0.001) in predicting population-based transplant access; SPAR remained significantly associated with LDR after adjustment for other county-level factors. Sensitivity analyses revealed that the association between SPAR and LDR was modified by socioeconomic characteristics and geographic region. This measure may be used in future research on spatial accessibility, including developing interventions to improve access to liver transplant for patients in low-accessibility areas.

PMID:41160883 | DOI:10.1097/LVT.0000000000000765

Traffic Inj Prev. 2025 Oct 29:1-11. doi: 10.1080/15389588.2025.2570829. Online ahead of print.

ABSTRACT

OBJECTIVE: As of 2022, motorcyclist fatalities in the United States had risen 38% since 2010, representing 15% of all U.S. traffic fatalities. Recently developed injury risk models have sought to better predict injury potential for certain collision configurations involving motorcycles using relative speed as a primary predictor variable. Advancing the state-of-the-art, this study developed injury risk models for motorcyclist collisions with passenger vehicles across all planar configurations and incorporated biomechanically-relevant predictor variables including a novel speed parameter.

METHODS: We analyzed real-world crash data from the German In-Depth Accident Study (GIDAS) (1999-2023) to examine motorcyclist injury patterns and create injury risk functions at the MAIS2 + F, 3 + F, 4 + F, and 5 + F levels. Biomechanically relevant variables, including age (via a spline function), sex, and a geometric-based assessment of motorcyclist post-impact response (i.e., potential for a normal projection), were considered. Effective Collision Speed, combining passenger vehicle and motorcycle speeds while accounting for reduced engagement associated with frictional effects in side impacts, was employed as an important predictor. We analyzed the impact of reweighting the dataset to German national statistics, addressing GIDAS’ bias toward severe and fatal collisions.

RESULTS: The dataset comprised 2,499 passenger-vehicle to motorcycle collisions, of which 59% involved contact with the front of the passenger vehicle, 25% the side, and 16% the rear. 37% of motorcyclists sustained AIS2 + F injuries and 11% sustained AIS3 + F injuries. At the MAIS3 + F level, the lower extremities were the most commonly injured body region, followed by the thorax and head. Age significantly influenced injury risk at MAIS2 + F and MAIS3 + F levels. A potential normal projection was associated with higher injury risk, significant only for MAIS2 + F. Effective Collision Speed emerged as the sole significant predictor for higher severity levels.

CONCLUSIONS: These findings highlight the importance of incorporating biomechanical factors and refined speed metrics into motorcyclist injury risk models. The proposed Effective Collision Speed demonstrated strong predictive capability, offering a more comprehensive approach for assessing injury potential across varied crash configurations.

PMID:41160882 | DOI:10.1080/15389588.2025.2570829

Nucleic Acids Res. 2025 Oct 29:gkaf1058. doi: 10.1093/nar/gkaf1058. Online ahead of print.

ABSTRACT

Proteins are biological effectors that mediate the effects of exposures on diseases and serve as predictors for constructing high-performance disease prediction models. However, an integrative, sex-specific proteomic resource using a biobank-scale dataset remains unavailable. Here, we introduce ProteoNexus, a database featuring a standardized best-practice pipeline integrating protein pQTLs mapping, mediation analysis, and risk prediction. Following stringent quality control, ProteoNexus comprises three categories of exposures: 129 measurement-based variables, 54 environmental variables, 1 251 123 single-nucleotide polymorphisms (SNPs), and 57 incident diseases among 33 325 European participants. ProteoNexus identifies 16 998 putative causal pQTLs, of which 5 979 are cis-pQTLs and 11 019 are trans-pQTLs in the combined-sex dataset, while 9 464 and 7 832 pQTLs were identified in the female and male datasets, respectively. Using a two-step screening strategy, ProteoNexus identifies 308 325, 144 975, and 1 336 significant pathways caused by measurement-based variables, environmental variables, and SNPs, respectively, followed by enrichment analysis of proteins associated with these exposures. With 21 optimized parameters for four machine learning algorithms, ProteoNexus provides an online analysis module that enables users to analyze their own proteomic data. Users can search for results by protein, reported disease, ICD-10 code, or exposure, with accompanying summary statistics for each query. ProteoNexus is freely accessible at https://www.proteonexus.com/.

PMID:41160873 | DOI:10.1093/nar/gkaf1058

Wiad Lek. 2025;78(9):1899-1908. doi: 10.36740/WLek/212533.

ABSTRACT

OBJECTIVE: Aim: The objective of the study is to analyze the economic determinants that contribute to enhancing the quality of medical care in the context of metropolitan zoning.

PATIENTS AND METHODS: Materials and Methods: The study draws on statistical data from the Center for Medical Statistics of the Ministry of Health of Ukraine, the State Statistics Service of Ukraine, and the Health Departments of the metropolitan cities of Dnipro and Kharkiv for the years 2010, 2013-2014, and 2018-2020. The research employed methods of statistical analysis and synthesis, logical analysis, generalization, and systems approaches.

CONCLUSION: Conclusions: An analysis was conducted of morbidity trends in the Dnipro metropolis during 2010, 2013-2014, and 2018-2020 with respect to socially significant diseases – hypertension, myocardial infarction, stroke, HIV/AIDS, as well as AIDS-related mortality, all of which pose risks of premature death (18 years and older). Consideration was also given to the human resources available in primary health care and prevailing demographic trends. A comparative analysis of the effectiveness of health care systems in the metropolises of Dnipro and Kharkiv was undertaken by assessing the number of emergency medical service calls per 100,000 average annual population. The study proposes approaches to assessing the influence of metropolitan health care infrastructure on medical institutions within the metropolitan region and substantiates the prospects for establishing a unified metropolitan health care system. In the context of the ongoing war in Ukraine, there is an urgent need to create a competitive health care environment in metropolitan areas, prioritizing economic determinants of quality optimization. This will require the joint efforts of government, business, academia, and the media in developing modern competitivestrategies for metropolitan development, supported by the adoption and implementation of legislation on the status and functions of metropolises. Such measures are expected to reduce irrational and unjustified financial expenditures in the health care sector.

PMID:41160871 | DOI:10.36740/WLek/212533