Category: Statistics

J Magn Reson Imaging. 2025 Oct 4. doi: 10.1002/jmri.70143. Online ahead of print.

ABSTRACT

BACKGROUND: Disruption of the blood-brain barrier (BBB) is an important mechanism in the pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE), potentially influencing disease progression and cognitive function.

PURPOSE: To investigate voxel-wise BBB permeability differences among NPSLE, non-NPSLE, and healthy controls (HC) using dynamic contrast-enhanced MRI (DCE-MRI), and explore associations with disease activity and cognitive function.

STUDY TYPE: Multicenter, cross-sectional study.

SUBJECTS: 22 NPSLE patients, 24 non-NPSLE patients, and 27 age- and sex-matched HC.

FIELD STRENGTH/SEQUENCE: 3.0 Tesla, GE: 3D T1-FSPGR, DCE-LAVA-Flex sequences; Philips: 3D T1-FFE, eTHRIVE sequences.

ASSESSMENT: Post-processing of DCE-MRI images was conducted to calculate the volume transfer constant (K^trans) and plasma volume fraction (V_p) maps, which were transformed to Montreal Neurological Institute space. Brain regions were defined using the Anatomical Automatic Labeling (AAL) atlas. Group differences among NPSLE, non-NPSLE, and HC were assessed. Mean K^trans/V_p values from suprathreshold clusters were evaluated for associations with the Disease Activity Index (SLEDAI) and Montreal Cognitive Assessment (MoCA) scores. Mean K^trans/V_p from corresponding AAL regions was extracted for further validation of the observed correlations.

STATISTICAL TESTS: Voxel-wise ANOVA with Tukey’s HSD test; Spearman correlation and linear regression. Threshold: Voxel-wise p < 0.001, cluster size > 20; group comparisons p < 0.05.

RESULTS: A significantly elevated K^trans was observed in the right caudate of NPSLE patients compared to non-NPSLE patients, and hippocampal K^trans was significantly higher in NPSLE than both non-NPSLE and HC. Both NPSLE and non-NPSLE patients exhibited widespread significant increases in V_p compared to HC. In the entire SLE cohort, right caudate K^trans was positively associated with SLEDAI (ρ = 0.43, R² = 0.18) and negatively associated with MoCA scores (ρ = -0.35, R² = 0.12) after adjusting for confounding factors.

DATA CONCLUSION: This study provided voxel-level evidence linking regional BBB leakage to both disease activity and cognitive impairment in SLE.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 2.

PMID:41045050 | DOI:10.1002/jmri.70143

Early Interv Psychiatry. 2025 Oct;19(10):e70087. doi: 10.1111/eip.70087.

ABSTRACT

AIM: In 2016, the Access and Waiting Time Standard (AWTS) was introduced in England, UK, outlining that people with first-episode psychosis should receive treatment from an early intervention for psychosis (EIP) service within 2 weeks. We examined sociodemographic, pathways to care (PtC), and clinical factors associated with EIP service wait time.

METHOD: We collected de-identified data from a large mental health provider in South London, UK. We included patients referred and accepted to EIP services as inpatient or community contacts between 1 May 2016 and 30 April 2019, providing 3 years of data from the introduction of AWTS. Descriptive statistics and multivariable linear regression were performed.

RESULTS: A total of 1806 patients were identified with a mean age of 30 (SD: 10.7) years, of whom 86.3% (n = 1559) accessed community EIP and 13.7% (n = 247) accessed inpatient EIP; of these, 26.7% were not seen within 2 weeks. Community EIP patients waited longer adj.β = 2.21 days (95% CI: 2.05-2.37) compared with inpatient EIP patients, and being older was associated with longer wait time. Conversely, a shorter wait time was associated with A&E [adj.β = -0.22 days (95% CI: -0.36, -0.10)] and ‘other’ [adj.β = -0.21 days (95% CI: -0.36, -0.03)] PtC characteristics. White non-British and South Asian patients had shorter wait times compared with White British patients; however, this difference diminished after adjusting for PtC and clinical factors.

CONCLUSIONS: Our findings indicate that individual factors, PtC, and mode of contact influence wait time for EIP services. More than a quarter of patients were not seen within 2 weeks, indicating that targeted support in community EIP services is needed to meet clinical guidelines.

PMID:41045048 | DOI:10.1111/eip.70087

Psychiatry Clin Neurosci. 2025 Oct 4. doi: 10.1111/pcn.13906. Online ahead of print.

NO ABSTRACT

PMID:41045043 | DOI:10.1111/pcn.13906

Early Interv Psychiatry. 2025 Oct;19(10):e70095. doi: 10.1111/eip.70095.

ABSTRACT

BACKGROUND: Trauma exposure is pervasive in people with an At Risk Mental State (ARMS) and is associated with adverse clinical and functional outcomes. While promising developments have been made in treating trauma in psychosis, evidence regarding the efficacy of trauma therapies in ARMS individuals is limited. This trial aims to evaluate the feasibility of conducting a future randomised controlled trial (RCT) to determine the efficacy of Eye Movement Desensitisation and Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (TF-CBT) in people with ARMS.

METHOD: Seventy ARMS individuals with a history of trauma will be randomised to receive 24 sessions of EMDR plus treatment as usual (TAU), 24 sessions of TF-CBT+TAU, or TAU alone. Feasibility will be determined against pre-specified thresholds for recruitment, retention, treatment engagement, and fidelity. To examine the promise of efficacy of EMDR and TF-CBT, participants will complete a battery of clinical and mechanistic measures at baseline and 9-month post-randomisation, including assessments of attenuated psychotic symptoms and post-traumatic symptoms. Clinical notes will be reviewed to identify transitions to first episode psychosis up to 12 months post-randomisation. Qualitative interviews with trial participants, therapists, and professional stakeholders will explore the acceptability of EMDR and TF-CBT and factors to facilitate future implementation of trauma therapies in routine practice.

CONCLUSIONS: If a large-scale RCT is deemed feasible, it will be possible to establish whether EMDR and/or TF-CBT represent beneficial treatments to augment existing evidence-based care for individuals at ultra-high risk for future psychosis, potentially reducing transition rates and improving clinical outcomes for ARMS individuals.

PMID:41045040 | DOI:10.1111/eip.70095

Int J Gynaecol Obstet. 2025 Oct 4. doi: 10.1002/ijgo.70571. Online ahead of print.

ABSTRACT

OBJECTIVE: Domestic violence (DV) is a major public health concern with profound emotional, psychological, and medical consequences for women and their families. This study assessed the prevalence, associated factors, and proffered solutions to domestic violence in pregnancy (DVP) among married women in Enugu, southeastern Nigeria.

METHODS: A cross-sectional study was conducted among 447 pregnant married women attending antenatal care at the University of Nigeria Teaching Hospital, Enugu. Data were collected using an interviewer-administered, pretested questionnaire (with supplementary validated tools) and analyzed with IBM SPSS Statistics (version 22.0). Descriptive and inferential statistics were applied, with significance set at P < 0.05.

RESULTS: The prevalence of DVP was 27.1%. Husbands or intimate partners were the main perpetrators (66.2%). Emotional/psychological abuse was the most common form of violence (60.3%), while sexual abuse was least reported. On multivariable logistic regression, factors independently associated with DVP included rural residence, maternal age ≥ 30 years, lower maternal educational status, and partners with tertiary education or social habits such as alcohol use, infidelity, and keeping late nights (P < 0.05). Most respondents (40.2%) believed prayer was the solution, while 31.1% felt no solution existed.

CONCLUSION: Domestic violence in pregnancy remains prevalent in Enugu, Nigeria with emotional abuse being most frequent. The reliance on prayer or resignation as “solutions” reflects deep-rooted cultural and religious influences. Routine screening during antenatal care, coupled with culturally sensitive counseling, referral pathways, and community-based interventions, is urgently needed to address the burden and prevent associated complications.

PMID:41045037 | DOI:10.1002/ijgo.70571

Health Serv Res. 2025 Oct 4:e70048. doi: 10.1111/1475-6773.70048. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the impact of private equity (PE) hospital acquisitions on maternal health for Medicaid patients.

STUDY SETTING AND DESIGN: This quasi-experimental study focuses on 66 PE acquisitions of hospitals between 2014 and 2018, analyzing national Medicaid claims data from 2011 to 2020. Using a difference-in-differences (DiD) framework, the study compares labor and delivery (L&D) outcomes at PE-acquired hospitals with matched control hospitals to evaluate the effects on patient volume, process of care, and quality outcomes for Medicaid patients.

DATA SOURCES AND ANALYTIC SAMPLE: The analysis uses data from the Transformed Medicaid Statistical Information System (T-MSIS) and Medicaid Analytic eXtract (MAX), including over 1 million L&D hospitalizations. The analytic sample comprises 66 PE hospitals and 290 matched control hospitals.

PRINCIPAL FINDINGS: PE acquisition was associated with a significant 12% decrease in Medicaid L&D market share (p < 0.05). The reduction was more pronounced in states with larger Medicaid-to-commercial payment gaps (-15.8% vs. -7.2%). However, no significant changes were observed in low-risk cesarean rates, number of procedures, length of stay, or severe maternal morbidity.

CONCLUSIONS: PE acquisitions of hospitals are associated with reduced Medicaid market share, particularly in states with lower Medicaid reimbursement relative to commercial insurance. Policymakers should consider addressing these issues by adjusting Medicaid payment rates to support vulnerable populations in PE-acquired hospitals.

PMID:41045029 | DOI:10.1111/1475-6773.70048

J Magn Reson Imaging. 2025 Oct 4. doi: 10.1002/jmri.70140. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate tumor staging and treatment response evaluation (TRE) are critical for nasopharyngeal carcinoma (NPC) clinical decisions. Conventional methods relying on manual imaging analysis are expertise-dependent, time-consuming, and prone to inter-observer variability and errors.

PURPOSE: To assess the performance of two large language models (LLMs): ChatGPT-4o-latest and DeepSeek-V3-0324 in automating T, N staging and TRE for NPC patients.

STUDY TYPE: Retrospective.

POPULATION: Three hundred seven NPC patients from three centers (mean age: 45.5 ± 11.3 years; 216 men, 91 women).

FIELD STRENGTH/SEQUENCE: All imaging was conducted using 3.0T or 1.5T scanners. The imaging sequence included axial T1-weighted fast spin-echo, T2-weighted fast spin-echo, T2-weighted fat-suppressed spin-echo, and Contrast-Enhanced T1-weighted fast spin-echo.

ASSESSMENT: Two radiologists established the reference standards for TN staging at baseline and for TRE at two time points: post-induction chemotherapy (TRE-1) and post-concurrent chemoradiotherapy (TRE-2), based on the 9th version of AJCC/UICC guidelines and the RECIST1.1 criteria. LLMs were via few-shot chain-of-thought prompting and tested on 277 patients with 831 reports. Additionally, four radiologists independently assessed 68 cases both with and without the assistance of LLMs and compared the performance and efficiency in both conditions.

STATISTICAL TESTS: McNemar-Bowker test, Wilcoxon signed-rank test. p < 0.05 was considered statistically significant.

RESULTS: DeepSeek-V3-0324 significantly outperformed GPT-4o-latest in TRE-1 staging (96.5% vs. 82.9%, p < 0.001). For T staging (95.3% vs. 93.5%, p = 0.24), N staging (93.8% vs. 89.6%, p = 0.265), and TRE-2 (94.9% vs. 93.2%, p = 0.556), the accuracy between DeepSeek-V3-0324 and ChatGPT-4o-latest showed no significant difference. DeepSeek-V3-0324 also showed stronger agreement with expert annotation (κ = 0.85-0.90), compared to ChatGPT-4o-latest (κ = 0.49-0.86). Significant improvements in time efficiency were observed across all radiologists with LLM assistance (p < 0.001).

DATA CONCLUSION: LLMs, particularly DeepSeek-V3-0324, can automate NPC TN staging and TRE with high accuracy, enhancing clinical efficiency. LLMs integration may improve diagnostic consistency, especially for junior clinicians.

TECHNICAL EFFICACY: Stage 4.

PMID:41045017 | DOI:10.1002/jmri.70140

Pediatr Int. 2025 Jan-Dec;67(1):e70224. doi: 10.1111/ped.70224.

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to significant epidemiological shifts in various diseases due to reduced interpersonal contact. This study examined changes in pediatric intestinal intussusception incidence, a disease with unclear etiology, during the pandemic.

METHODS: Weekly intussusception cases in children ≤10 years old in Seoul (2009-2022) were collected from the Health Insurance Review and Assessment Service (HIRA). Trends were analyzed using spline functions, and breakpoints were identified via student methods. Bayesian Structural Time Series (BSTS) models assessed incidence changes relative to predicted values. Cases were stratified by surgical intervention, and the complicated-to-uncomplicated case ratio was evaluated.

RESULTS: A sharp decline in intussusception incidence was observed around 2020, with breakpoints aligning with the first reported COVID-19 case. Post-breakpoint, total cases decreased by 58.8% (95% CrI: -79.0%, 7.8%), with reductions of 62.4% (95% CrI: -78.9%, -20.2%) for uncomplicated cases and 51.1% (95% CrI: -62.6%, -33.8%) for complicated cases. The complicated-to-uncomplicated ratio increased by 43.3% (95% CrI: 13.0%, 87.1%). When analyzing only the post-COVID-19 period, total and uncomplicated cases increased by 23.1% (95% CrI: 5.7%, 45.5%) from May 2022, but the change in ratio was not statistically significant.

CONCLUSION: Pediatric intussusception incidence significantly declined following COVID-19 onset, supporting a link between disease occurrence and contact or infectious exposure.

PMID:41045014 | DOI:10.1111/ped.70224

Pediatr Int. 2025 Jan-Dec;67(1):e70214. doi: 10.1111/ped.70214.

ABSTRACT

BACKGROUND: Postural stability is a prerequisite for the performance of daily gross motor functions. It is usually impaired in children with cerebral palsy. The aim of this study was to compare the effect of robotic-assisted gait training and body weight supported treadmill training on postural stability in ambulatory children with cerebral palsy.

METHODS: A randomized clinical trial involved 40 ambulatory children with cerebral palsy (5-14 years old). They were randomly allocated to one of two locomotor treadmill-training groups: (1) robotic-assisted gait training (RAGT) and (2) body weight supported treadmill training (BWSTT). All participants completed 24 training sessions within 8 weeks. Postural stability was measured by a computer dynamic posturography (NeuroCom EquiTest®) before and after the intervention.

RESULTS: A two-way repeated measures ANOVA revealed that there was a statistically significant interaction between group and time [F(15, 24) = 3.02, p = 0.008]. The study found that RAGT is more effective than BWSTT on some variables of static and dynamic postural stability. RAGT showed more improvement in weight symmetry at 60° knee flexion, limit of stability, velocity composite (front/back), and directional control composite for both left/right and front/back (p < 0.05).

CLINICALTRIALS: gov (identifier: NCT06719271).

CONCLUSION: Ambulatory children with CP can improve their postural stability after intensive RAGT.

PMID:41045011 | DOI:10.1111/ped.70214

Glob Chang Biol. 2025 Oct;31(10):e70533. doi: 10.1111/gcb.70533.

ABSTRACT

In large river basins, migratory fish populations are threatened by the combination of hydropower and climate change. With river temperatures rising and hydropower development increasing globally, the longstanding monitoring programs for threatened Pacific salmon populations in the Columbia River Basin present an opportunity to study these impacts over extended time scales. We fit a statistical model to 20 years of PIT-tagging data to jointly model the effects of temperature and dam operations (spill management) on the movement of Steelhead (anadromous Oncorhynchus mykiss) during their adult pre-spawn migration. We modeled the relationship between these factors and behaviors that pose mortality risks, including natal tributary overshoot (ascending a dam upstream of a natal tributary) and non-natal tributary use. We then used the posterior distributions of model-estimated parameters to predict the homing success of fish to natal tributaries under different climate and hydropower scenarios. Across the populations in our study, movement decisions were consistently thermally influenced, with temperature having a negative relationship with natal homing and a positive relationship with both natal tributary overshoot and non-natal tributary use. Another consistent finding across the populations in our study was that higher overshoot rates were associated with lower homing rates. Despite data limitations associated with the PIT-tag array network, we found evidence for population-specific benefits of winter spill on natal homing success, which is currently being implemented to assist the downstream migration of overshooting Steelhead. We demonstrate how integrating the effects of climate and hydropower management actions with movement ecology provides powerful insights into how species may respond to future scenarios. In our case study, we found that pre-spawn mortality of Steelhead is likely to increase with future climate change due to temperature-driven interactions with the hydrosystem, but there is potential for hydropower managers to partially offset these impacts.

PMID:41045009 | DOI:10.1111/gcb.70533