Category: Statistics

Eur J Oncol Nurs. 2025 Jul 24;78:102944. doi: 10.1016/j.ejon.2025.102944. Online ahead of print.

ABSTRACT

PURPOSE: To statistically characterise both contemporaneous and temporal symptom networks to identify robust, stage-specific intervention targets.

METHODS: We conducted a prospective cohort study of patients with stage I-III breast cancer who completed the MD Anderson Symptom Inventory across each of four chemotherapy cycles (T1-T4, April 2024 to June 2025). Exploratory factor analysis (EFA) first identified co-occurring symptom clusters, which informed the construction of cycle-specific cross-sectional networks via Gaussian graphical models and bridge centrality metrics. We then built cross-lagged panel networks to estimate directed symptom effects across successive cycles and applied non-parametric bootstrapping to derive confidence intervals and assess network stability.

RESULTS: A total of 153 patients completed data collection across four chemotherapy cycles. Parallel analysis showed three relatively stable symptom clusters across the first three chemotherapy cycles (T1-T3), but consolidation into two clusters occurred at the final cycle (T4). Cross-sectional hubs influencing contemporaneous symptom interplay were identified via bridge symptoms in cycle-specific cross-sectional networks: loss of appetite (T1), sadness (T2, T3), and numbness (T4). The core temporal drivers predicting future symptom cascades were identified via cross-lagged panel networks (CLPNs): shortness of breath (T1→T2), sadness (T2→T3), and somnolence (T3→T4). The precision of edge-weight yielded narrow to moderate 95 % confidence intervals (CI) for both cross-sectional and longitudinal networks. Case-drop bootstrapping (1000 iterations) demonstrated moderate to strong stability in the rank order of centrality indices.

CONCLUSIONS: Our integrative network approach reveals a dynamic, dual-mechanistic symptom framework (cross-sectional and temporal key symptom drivers): early intervention should target somatic symptoms, mid-treatment efforts should disrupt psychological amplifiers, and late cycles require attention to neurotoxic perpetuators. This phase-specific roadmap offers precision in symptom management for patients undergoing chemotherapy.

PMID:41004877 | DOI:10.1016/j.ejon.2025.102944

Top Magn Reson Imaging. 2025 Sep 29;34(3):e0319. doi: 10.1097/RMR.0000000000000319. eCollection 2025 Oct 1.

ABSTRACT

BACKGROUND AND AIM: Magnetic resonance imaging (MRI) is essential for diagnosis but often induces anxiety, especially in claustrophobic patients, potentially affecting image quality. This study compared oxygen saturation, heart rate, and anxiety levels between claustrophobic and non-claustrophobic patients undergoing closed and open MRI in Erbil, Iraq.

MATERIAL AND METHODS: The comparative study was conducted from October 2024 to April 2025 in the Radiology Departments of Consultant Medical City and Top Med Medical Complex Centers in Erbil using purposive sampling. The questionnaire contained 3 sections: sociodemographic variables, the Claustrophobia Questionnaire, and the State-Trait Anxiety Inventory-State Subscale. Physiological measures (oxygen saturation and heart rate) were recorded at 3 timepoints: pre-, mid-, and post-MRI. Statistical analyses included one-way ANOVA, repeated measures ANOVA, post hoc tests, and both univariate and multiple linear regression, using SPSS version 26.

RESULTS: A total of 125 participants were involved in the study. The mean anxiety score was moderate, with higher levels in claustrophobic patients. Claustrophobia scores also fell within the moderate range, indicating psychological discomfort during the MRI procedure. Physiological measurements showed that claustrophobic patients, particularly those undergoing closed MRI, experienced elevated heart rates and reduced oxygen saturation compared to non-claustrophobic individuals. Statistical analysis indicated a strong positive association between anxiety and claustrophobia, with scan entry direction, age, and sex also being significant predictors of claustrophobic responses.

CONCLUSIONS: Claustrophobic patients undergoing closed MRI experience increased anxiety and physiological distress. Open MRI systems and pre-scan anxiety screening are recommended to enhance patient comfort and diagnostic outcomes.

PMID:41004856 | DOI:10.1097/RMR.0000000000000319

J Neurosurg Pediatr. 2025 Sep 26:1-9. doi: 10.3171/2025.5.PEDS24631. Online ahead of print.

ABSTRACT

OBJECTIVE: The authors’ objective was to assess the impact of telehealth on pediatric neurosurgical care access for underserved and rural populations in West Virginia. The authors explored how telehealth utilization varied over time, the socioeconomic benefits it provided to families, and its effect on visit completion rates compared with in-person appointments.

METHODS: Clinic visits from January 1, 2017, to May 31, 2023, at the sole pediatric neurosurgery clinic in West Virginia were retrospectively reviewed. The data included three types of outpatient visits: in-person, telemedicine satellite clinic, and MyChart video appointments. Initial statistical analysis focused on visit completion rates, distance traveled, and time and cost savings for families. Additional geospatial analysis used heat density mapping to recognize regional utilization patterns, and community-level socioeconomic variables were analyzed for correlation with visit type utilization.

RESULTS: Telehealth usage (telemedicine and MyChart) increased significantly during and after the COVID-19 pandemic. MyChart visits demonstrated the highest completion rates postpandemic. Telehealth visits saved families substantial travel time and cost, especially for those living more than 100 miles from the clinic. Geospatial analysis revealed that telemedicine usage was clustered in specific Appalachian regions, and in-person visits were more common among patients from economically distressed communities. Correlation analysis showed that higher poverty and unemployment rates were associated with in-person visit reliance, while telehealth adoption was lower in these populations.

CONCLUSIONS: Telehealth significantly enhances access to pediatric neurosurgical care for rural and economically disadvantaged families, reducing travel-related burdens and increasing visit adherence. However, economically distressed communities in Appalachia are less likely to use telehealth, possibly due to digital access issues or skepticism about remote care. Addressing these barriers is crucial to ensure equitable healthcare access. Further research should investigate structural and personal obstacles to telehealth uptake to improve service delivery for at-risk populations, ultimately fostering more inclusive and accessible healthcare options in remote areas.

PMID:41004850 | DOI:10.3171/2025.5.PEDS24631

J Neurosurg. 2025 Sep 26:1-7. doi: 10.3171/2025.5.JNS243160. Online ahead of print.

ABSTRACT

OBJECTIVE: Digital enhancement and visualization technologies, such as augmented reality (AR), are increasingly used in surgery. Rapid and accurate patient registration with minimal device confinements enables AR systems to increase efficiency, safety, and effectiveness, especially in urgent/emergency and/or bedside scenarios. The aim of this study was to quantitatively compare an AR headset-based neuronavigation system with a standard-of-care reference array-based neurosurgical stereotactic navigation system in a real-world setting.

METHODS: This clinical validation trial included adult patients undergoing cranial neurosurgery with stereotactic navigation at a single center from February 2024 to July 2024. Preoperative CT and MR images were acquired and used for construction of a 3D hologram model that included surface-based target fiducial markers for comparison. Preoperative images were stereotactically registered to the patient’s head using standard techniques. The registration coordinates for the fiducial markers (control) and registration time were recorded. The AR system was then deployed to create a separate stereotactic registration to the same preoperative images. A second set of registration coordinates for the fiducial markers (experimental) were acquired using the AR system, and the time for this process was also recorded. The Wilcoxon signed-rank test was used to assess differences in registration time, and a linear mixed-effects model (LMM) was used to conduct equivalence testing of coordinates between the control and experimental data.

RESULTS: Twenty patients (mean age ± SD 50.05 ± 14.38 years) were included in the trial. The mean baseline validation error of the control system was 0.73 ± 0.29 mm (range 0-1.0 mm). Using the control system as ground truth, the mean registration accuracy of the AR system was 2.16 ± 0.12 mm. LMM equivalence testing, conducted with margins of 3 mm and 2.5 mm, demonstrated statistical equivalence between the ground truth and AR system coordinates (p < 0.001 and p < 0.003, respectively). The time required for patient model registration using the AR system was a mean of 45.98 ± 15.00 seconds, which was significantly shorter compared with the control system (228.86 ± 100.06 seconds, p < 0.001).

CONCLUSIONS: The AR navigation system provided statistically similar registration accuracy and significantly faster patient model registration compared with the standard-of-care stereotactic neuronavigation system. AR navigation was accurate, fast, and had a minimal footprint, offering new opportunities to incorporate stereotaxis in low-resource, bedside, and urgent/emergency settings.

PMID:41004845 | DOI:10.3171/2025.5.JNS243160

J Comput Assist Tomogr. 2025 Sep 23. doi: 10.1097/RCT.0000000000001802. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess whether few-shot prompting improves the performance of 2 popular large language models (LLMs) (ChatGPT o1 and DeepSeek-R1) in assigning Coronary Artery Disease Reporting and Data System (CAD-RADS™ 2.0) categories.

METHODS: A detailed few-shot prompt based on CAD-RADS™ 2.0 framework was developed using 20 reports from the MIMIC-IV database. Subsequently, 100 modified reports from the same database were categorized using zero-shot and few-shot prompts through the models’ user interface. Model accuracy was evaluated by comparing assignments to a reference radiologist’s classifications, including stenosis categories and modifiers. To assess reproducibility, 50 reports were reclassified using the same few-shot prompt. McNemar tests and Cohen kappa were used for statistical analysis.

RESULTS: Using zero-shot prompting, accuracy was low for both models (ChatGPT: 14%, DeepSeek: 8%), with correct assignments occurring almost exclusively in CAD-RADS 0 cases. Hallucinations occurred frequently (ChatGPT: 19%, DeepSeek: 54%). Few-shot prompting significantly improved accuracy to 98% for ChatGPT and 93% for DeepSeek (both P<0.001) and eliminated hallucinations. Kappa values for agreement between model-generated and radiologist-assigned classifications were 0.979 (0.950, 1.000) (P<0.001) for ChatGPT and 0.916 (0.859, 0.973) (P<0.001) for DeepSeek, indicating almost perfect agreement for both models without a significant difference between the models (P=0.180). Reproducibility analysis yielded kappa values of 0.957 (0.900, 1.000) (P<0.001) for ChatGPT and 0.873 [0.779, 0.967] (P<0.001) for DeepSeek, indicating almost perfect and strong agreement between repeated assignments, respectively, with no significant difference between the models (P=0.125).

CONCLUSION: Few-shot prompting substantially enhances LLMs’ accuracy in assigning CAD-RADS™ 2.0 categories, suggesting potential for clinical application and facilitating system adoption.

PMID:41004838 | DOI:10.1097/RCT.0000000000001802

J Gastrointestin Liver Dis. 2025 Sep 26;34(3):309-316. doi: 10.15403/jgld-6433.

ABSTRACT

BACKGROUND AND AIMS: Small bowel neuroendocrine neoplasms (SB-NENs) are a rare type of tumor that is clinically challenging and is often diagnosed in advanced stages. This retrospective study aimed to characterize the clinical presentation, diagnostic workup, and therapeutic strategies, as well as to evaluate the prognosis of patients managed in a tertiary care center in Bucharest, Romania, over five years.

METHODS: We conducted an observational, retrospective cohort study on 42 cases of SB-NEN evaluated at our center between January 1, 2020, and March 31, 2025. Data regarding clinicopathological characteristics, treatments, and disease evolution were summarized. Overall survival was estimated at 1, 3, and 5 years.

RESULTS: Computed tomography was the most frequently used imaging method for diagnosis (52.4%). Surgery was the most adopted method for obtaining the pathological specimen, used in 70.7% of cases. The majority of tumors were well-differentiated (85.6%). The overall survival distribution showed a median survival time of 94 months. The cumulative proportion of patients surviving at 1 year was 97.6%, at 3 years was 89.3% and at 5 years was 75.7%. There was a significant difference in overall survival stratified by tumor grading (p=0.006), indicating that this was a significant prognostic factor; the metastatic status and large tumors showed a trend toward statistical significance, but they did not meet the conventional threshold (p=0.068 and 0.103, respectively).

CONCLUSIONS: SB-NEN showed favorable outcomes, with surgery improving survival even in some metastatic cases. Lower tumor grade was associated with a better prognosis, while somatostatin analogues (SSA) therapy showed no survival benefit. Patients with large tumors and metastatic disease also showed a trend towards reduced survival.

PMID:41004806 | DOI:10.15403/jgld-6433

J Glob Health. 2025 Sep 26;15:04122. doi: 10.7189/jogh.15.04122.

ABSTRACT

BACKGROUND: Sleep problems are common among children and mothers. However, little is understood about sleep behaviours in low- and middle-income countries. Here we examine sleep behaviours and predictors among black, low-income, South African mothers and their eight-year-old children over time.

METHODS: We administered standardised measures of sleep behaviours at eight years post-birth to a population cohort of mothers and children in 24 neighbourhoods of Cape Town, South Africa, in 2009-10. We assessed mothers and children six times over eight years with 84% retention since pregnancy. While 71% remained in Cape Town, about 29% of households moved to the profoundly rural Eastern Cape of South Africa. Mothers completed the Pittsburgh Sleep Quality Index and rated their children on the Children’s Sleep Habits Questionnaire.

RESULTS: Among mothers, 29.5% reported sleep difficulties based on their global sleep score, with a mean sleep quality score of 3.72 (standard deviation (SD) = 2.6). Children’s sleep scores were 64.4 (SD = 4.0), with subscale scores on sleep difficulties higher than documented in high-income countries (HICS). There was a relatively low inverse relationship between the quality of maternal and child sleep (r = -0.201; 95% confidence interval (CI) = -0.264, -0.136), which resulted in an R² value of 0.041 in the simple linear regression model. Problematic maternal sleep was associated with living in the rural Eastern Cape (P = 0.034), experiencing intimate partner violence (P = 0.052), and a higher score on the Edinburgh Postnatal Depression Scale (P < 0.001), but not alcohol use. Children’s sleep difficulties decreased by 0.191 points (95% CI = -0.229, -0.152) with a one-unit increase in aggressive behaviour and, similarly, cognitive scores decreased by 0.035 points (95% CI = -0.063, -0.006). Household resources, such as formal vs. informal housing, income, and having water on the premises, were unrelated to sleep difficulties.

CONCLUSIONS: Counter to hypotheses, a small, inverse relationship existed between mothers’ and children’s sleep behaviours. Alcohol use, HIV status, and socioeconomic markers were unrelated to sleep, but intimate partner violence and depressive symptoms affect sleep negatively, similar to HICS.

PMID:41004805 | DOI:10.7189/jogh.15.04122

JMIR Ment Health. 2025 Sep 26;12:e58891. doi: 10.2196/58891.

ABSTRACT

BACKGROUND: There has been an increase in the use of online mental health forums to support mental health. These forums are often moderated by trained moderators to ensure a safe, therapeutic environment. While the moderator role is rewarding, it can also be challenging. There is a need to understand the impact of the role on moderators and how they can best be supported to maintain psychological well-being.

OBJECTIVE: This study aimed to understand how, why, and in what contexts moderator well-being is affected by the moderator role and produce actionable recommendations for how moderators can best be supported to maintain workplace psychological well-being.

METHODS: We conducted realist synthesis of (1) published and gray literature from 2019 to 2023, (2) stakeholder interviews with forum moderators and hosts, and (3) moderator training manuals developed by organizations that host online mental health forums. Self-determination theory was used as the theoretical basis for this synthesis.

RESULTS: We developed 24 context-mechanism-outcome configurations from our realist analysis of 9 published papers, 18 interviews, and 5 training manuals. The findings highlight the specific ways in which moderator well-being can be supported through meeting the psychological needs for autonomy, competence, and relatedness. Forums that allow moderators to work in alignment with their personal motivations can increase moderator well-being. Forum organizations should support moderator competence through initial expectation setting, especially around moderator responsibility for user well-being, and ongoing support, such as meaningful supervision and peer support. Co-designed training, reflective practice, and experiential learning are all key to increasing moderator competence and satisfaction in the workplace. Working within a diverse team with access to innovative forum design can increase moderator psychological well-being. Organizational support for moderators’ well-being through monitoring and encouraging self-care is vital to ensure moderators can effectively carry out their role. Making and supporting meaningful relationships in the forum can boost psychological well-being and the therapeutic value of the moderator role. Key challenges for moderators were dealing with conflicts between supporting open discussion and ensuring a safe community environment, sharing lived experiences in positive ways for both moderator and user, and supporting people within the limitations of an anonymous forum.

CONCLUSIONS: This realist synthesis is the first to examine the impacts on well-being of being a moderator of an online mental health forum. Recommendations to support moderator psychological well-being are proposed, targeted at specific stakeholder groups to aid implementation. Organizational-level endorsement and facilitation of support are particularly important for the realization of recommendations and interventions to support moderator well-being.

PMID:41004804 | DOI:10.2196/58891

JMIR Mhealth Uhealth. 2025 Sep 26;13:e79238. doi: 10.2196/79238.

ABSTRACT

BACKGROUND: The mental health app sector in India is expanding rapidly, driven by increasing smartphone usage, growing internet penetration, the popularity of digital initiatives, and heightened recognition of mental health challenges in public discourse. This growth is also influenced by both supply- and demand-side barriers to seeking professional help and the rise of mental health tech startups. While digital mental health solutions provide scalable ways to address unmet needs, concerns persist regarding app quality, privacy, and safety due to rapid market expansion, regulatory challenges, and limited empirical research. We conducted a comprehensive and systematic review of smartphone-based mental health apps accessible to Indian users through app stores.

OBJECTIVE: This study aims to describe apps in terms of characteristics such as the nature of their functions, involvement of mental health professionals in development, reference to an empirical basis, and inclusion of nudges to seek professional help, as well as to evaluate app quality.

METHODS: This systematic review of mental health apps was conducted using the TECH (Target user, Evaluation focus, Connectedness, and Health domain) approach, along with the PASSR (Protocol for App Store Systematic Reviews) checklist. Fifteen search terms covering mental health conditions and therapies were applied to both Google Play and Apple App Store. Identified apps were screened according to predefined inclusion and exclusion criteria and subsequently downloaded for detailed review. Data were extracted based on prespecified parameters. Additionally, app quality was evaluated using the Mobile Application Rating Scale (MARS).

RESULTS: The initial search identified 5827 apps, of which 350 were reviewed in detail after removing duplicates and applying eligibility criteria. Common search terms such as “depression” and “anxiety” yielded nearly a quarter of relevant apps (128/495, 25.9% to 133/497, 26.8%); 62 (17.7%) of the 350 reviewed apps originated from Asia, and 131 (37.4%) focused on a single mental health condition. Multifunction apps (eg, those combining assessment and intervention) constituted the largest category (230/350, 65.7%). Privacy concerns were notable; for example, 54 (15.4%) apps did not mention a data-sharing policy. Most apps were developed by commercial organizations, and 228 (65.1%) did not report involvement of mental health professionals, while 45 (12.9%) mentioned it only cursorily. Only 38 (10.9%) apps referenced empirical research, and more than half did not indicate an empirical basis for their content. Pointers to seek professional help were present in 139 (39.7%) apps, mostly in the form of disclaimers, whereas nudges or motivational prompts to seek help appeared in slightly less than a quarter. Only 105 (30%) apps attempted to dispel mental health myths. Functionality and aesthetics ratings on the MARS were relatively high, but 50 (14.3%) apps scored 3 or lower on the information subscale.

CONCLUSIONS: This study is among the first systematic evaluations of mental health apps accessible to Indian users on Google Play and Apple App Store. The findings provide insights to guide future research, app development, and policy making in the digital mental health space.

TRIAL REGISTRATION: International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY2024100035; https://inplasy.com/inplasy-2024-10-0035/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/71071.

PMID:41004798 | DOI:10.2196/79238

Phys Rev Lett. 2025 Sep 12;135(11):113401. doi: 10.1103/6jsr-f8q1.

ABSTRACT

Modulational instability (MI) is a fundamental phenomenon in the study of nonlinear dynamics, spanning diverse areas such as shallow water waves, optics, and ultracold atomic gases. In particular, the nonlinear stage of MI has recently been a topic of intense exploration and has been shown to manifest, in many cases, in the generation of dispersive shock waves (DSWs). In this Letter, we experimentally probe the MI dynamics in an immiscible two-component ultracold atomic gas with exclusively repulsive interactions, catalyzed by a hard-wall-like boundary produced by a repulsive optical barrier. We analytically describe the expansion rate of the DSWs in this system, generalized to arbitrary intercomponent interaction strengths and species ratios. We observe excellent agreement among the analytical results, an effective 1D numerical model, full 3D numerical simulations, and experimental data. Additionally, we extend this scenario to the interaction between two counterpropagating DSWs, which leads to the production of Peregrine soliton structures. These results further demonstrate the versatility of atomic platforms toward the controlled realization of DSWs and rogue waves.

PMID:41004759 | DOI:10.1103/6jsr-f8q1