Category: Statistics

Am J Trop Med Hyg. 2025 Nov 18:tpmd250482. doi: 10.4269/ajtmh.25-0482. Online ahead of print.

ABSTRACT

Mass azithromycin distribution has been shown to reduce all-cause child mortality in several settings in the Sahel by 14-18%. A trial in Niger found that mass azithromycin distribution to children ages 1-59 months old reduced cause-specific mortality because of malaria, dysentery, meningitis, and pneumonia. However, this study was done in the absence of seasonal malaria chemoprevention (SMC). Here, we assess the effect of mass azithromycin distribution on cause-specific child mortality in a setting receiving SMC. The Child Health with Azithromycin Treatment trial was a cluster-randomized, placebo-controlled trial of 341 communities in Nouna District, Burkina Faso. Eligible children (ages 1-59 months old) received a single oral 20-mg/kg dose of azithromycin or matching placebo. Six rounds of distribution occurred over a 36-month period. An enumerative census was conducted during each twice-yearly distribution, during which vital status for all children in the community was collected. Verbal autopsy was performed to assess cause of death. Of 1,086 deaths recorded in the trial, verbal autopsy results were available for 992 (91%). The most common causes of death were infectious, including malaria (34%), diarrhea (24%), and pneumonia (9%). Children living in communities receiving azithromycin had significant reduction in malaria mortality (incidence rate ratio, 0.67; 95% CI, 0.50-0.90; P = 0.008). Other infectious causes of mortality, including diarrhea and pneumonia, were lower in communities receiving azithromycin but were not statistically significantly different. Mass azithromycin distribution for child mortality has benefits in the context of SMC for reducing mortality, including for malaria mortality.

PMID:41252743 | DOI:10.4269/ajtmh.25-0482

J Gerontol Nurs. 2025 Nov 19:1-7. doi: 10.3928/00989134-20251112-02. Online ahead of print.

ABSTRACT

PURPOSE: To describe a model of nurse-led age-friendly care in the acute care setting and associated processes and outcomes aligned with the 4Ms Framework.

METHOD: We implemented the Supporting Older Adults at Risk Model-a novel model of care that includes primary care geriatric nurse practitioner co-management and AGS CoCare^®:HELP-and used descriptive statistics to evaluate outcomes aligned with each of the 4Ms: What Matters, Medication, Mentation, and Mobility.

RESULTS: Advance care planning conversations were documented for 81% of the selected sample, resulting in subsequent family meetings and goal-concordant care. Beers Criteria^® and anticholinergic medications were identified and reduced. Mobility goals were identified for 100% of the selected sample and mobility was maintained or improved for 46%. Addressing mentation was done in alignment with What Matters.

CONCLUSION: Nurses are well-positioned to lead age-friendly care and drive optimal outcomes in the acute care setting, especially considering the geriatrician workforce shortage.

PMID:41252722 | DOI:10.3928/00989134-20251112-02

Chem Soc Rev. 2025 Nov 18. doi: 10.1039/d4cs00375f. Online ahead of print.

ABSTRACT

Single-molecule sensors are pivotal tools for elucidating chemical and biological phenomena. Among these, quantum tunnelling sensors occupy a unique position, due to the exceptional sensitivity of tunnelling currents to sub-ångström variations in molecular structure and electronic states. This capability enables simultaneous sub-nanometre spatial resolution and sub-millisecond temporal resolution, allowing direct observation of dynamic processes that remain concealed in ensemble measurements. This review outlines the fundamental principles of electron tunnelling through molecular junctions and highlights the development of key experimental architectures, including mechanically controllable break junctions and scanning tunnelling microscopy-based approaches. Applications in characterising molecular conformation, supramolecular binding, chemical reactivity, and biomolecular function are critically examined. Furthermore, we discuss recent methodological advances in data interpretation, particularly the integration of statistical learning and machine learning techniques to enhance signal classification and improve throughput. This review highlights the transformative potential of quantum-tunnelling-based single-molecule sensors to advance our understanding of molecular-scale mechanisms and to guide the rational design of functional molecular devices and diagnostic platforms.

PMID:41252716 | DOI:10.1039/d4cs00375f

J Cardiovasc Pharmacol. 2025 Nov 18. doi: 10.1097/FJC.0000000000001774. Online ahead of print.

ABSTRACT

Preeclampsia is a hypertensive disorder of pregnancy associated with substantial maternal morbidity and long-term cardiovascular risk, but the consistency of echocardiographic remodeling remains unclear. We conducted a mega-meta-analysis of left ventricular function and geometry, enabled by a large language model based suite of tools. A PROSPERO-registered review (CRD420251109103) searched PubMed, Scopus, and Embase without date limits. Synthesa AI screened more than 18,000 abstracts, extracted data, assessed risk of bias, and generated Bayesian analytic code, with all outputs validated by human reviewers. Seventy-five studies including met eligibility criteria. Preeclampsia was associated with a small but statistically significant reduction in ejection fraction (mean difference -0.87%, 95% CrI -1.58 to -0.16) and a clinically meaningful impairment in global longitudinal strain (-3.08%, 95% CrI -4.13 to -2.06). Left ventricular mass index was substantially higher in the preeclampsia group (+13.10 g/m2, 95% CrI 10.06 to 16.21), as was relative wall thickness (+0.062, 95% CrI 0.042 to 0.081), whereas fractional shortening showed no significant difference (-0.60%, 95% CrI -2.15 to +0.86). Moderator analyses revealed that BMI and parity significantly influenced strain, while gestational age at diagnosis accounted for nearly all variance in ventricular mass. This mega-meta-analysis defines a remodeling phenotype of preserved ejection fraction, impaired strain, and hypertrophic adaptation consistent with subclinical systolic dysfunction. Equally, it demonstrates the transformative role of LLM-based tools, showing that evidence syntheses of this magnitude can be automated, scaled, and standardized in ways previously unattainable.

PMID:41252711 | DOI:10.1097/FJC.0000000000001774

Clin Exp Dent Res. 2025 Dec;11(6):e70167. doi: 10.1002/cre2.70167.

ABSTRACT

OBJECTIVES: This retrospective cohort study aimed to assess the survival rate of implants placed in grafted edentulous maxillary arches following a delayed loading protocol versus a graftless approach with an immediate loading protocol.

MATERIALS AND METHODS: Eighty seven patients with atrophic edentulous maxillae were included in two groups: Group-1 (GG group, n = 155 implants): 26 patients that underwent maxillary bone grafting before treatment with axially placed delayed loading implants and provided with a fixed full-arch prostheses; Group-2 (GL group; n = 244 implants): 61 patients who received axial and tilted implants without bone augmentation followed by an immediately loaded fixed full-arch prostheses. Patients were followed up for up to 10 years. Kaplan-Meier and Mantel-Cox analyses were performed to determine implant survival rates, and a Cox hazards model was run to assess the influence of patient, implant, and prosthesis-based covariates.

RESULTS: There were no significant differences in implant failure rates between the two treatment groups (p = 0.298). Five implant failures were observed in Group-1 (GG group) and four failures were observed in Group-2 (GL group) (N = 9). Survival rate was 96.8% and 98.4% in the GG and GL groups, respectively. No significant association between patient and implant-based covariates and implant failure was observed in both groups; however, a significant association was observed regarding the nature of the opposing arch (p = 0.019).

CONCLUSION: Immediately loaded implants placed in maxillary native bone show statistically similar survival rates compared to implants placed in grafted bone following a delayed loading. The nature of the opposing arch may negatively influence the survival rate of dental implants.

CLINICAL SIGNIFICANCE: For atrophic edentulous maxillae, both grafted and graftless approach may represent a viable treatment modality in the long term.

PMID:41252708 | DOI:10.1002/cre2.70167

Clin Exp Dent Res. 2025 Dec;11(6):e70221. doi: 10.1002/cre2.70221.

ABSTRACT

OBJECTIVE: Evidence on biological, technical, and esthetic outcomes following dental implant treatment in the anterior maxilla after traumatic tooth loss is limited. Therefore, this study aimed to evaluate the survival, esthetic, and patient-reported outcome measures of implant treatment in the anterior maxilla after up to 9 years of functional loading.

MATERIAL AND METHODS: The study was conducted at Copenhagen University Hospital, Denmark. Patients who underwent implant treatment for anterior maxillary tooth loss due to trauma between 2007 and 2019, with at least 1 year of functional loading, were recalled for clinical and radiographic follow-up.

RESULTS: In total, 56 implants in 49 patients were included. The mean follow-up period was 4.2 years (range 1-9.5 years). Implant and superstructure survival rates were 100%. Between baseline and the latest follow-up, there was no statistically significant change in radiographic crestal bone level, but a statistically significant improvement in papilla index. Although not significant, soft tissue texture appeared to improve, while slight soft tissue discoloration was observed in most patients, but remained unchanged from baseline to follow-up. Crown esthetics generally declined from baseline to follow-up, although not significantly. Correlation analysis indicated an association between esthetic outcomes and several variables, such as age, gender, number of lost teeth, type of bone defect, and complications before loading. In total, 14% of implants exhibited crown infraposition at follow-up. No predictive factors for crown infraposition could be identified. Patient-reported outcome measures generally revealed satisfaction with the treatment results.

CONCLUSIONS: The present study found that the biological, technical, and esthetic outcomes of dental implant treatment in the anterior maxilla following traumatic tooth loss are, in general, stable and satisfactory to both clinician and patient. To achieve optimal results in these complex cases, interdisciplinary treatment planning is essential.

PMID:41252690 | DOI:10.1002/cre2.70221

West Afr J Med. 2025 Jun 30;42(6):466-473.

ABSTRACT

BACKGROUND: Serum biomarkers, such as glial fibrillary acidic protein (GFAP), have been proposed to accurately assess stroke severity and prognosis. However, there is limited published data on their potential role in resource-limited settings where the stroke burden is highest.

OBJECTIVE: The study aims to determine the predictive value of the serum level of GFAP in assessing the severity and functional outcome of acute stroke.

METHOD: This prospective cohort study recruited forty consecutively presenting stroke subjects each for both ischaemic stroke and intracerebral haemorrhage at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife with forty apparently healthy controls. Serum concentrations of GFAP were measured using Enzyme-Linked Immunoassays, and the data were analyzed using Statistical Package for the Social Sciences software with significance at p<0.05.

RESULT: The median serum GFAP levels among apparently healthy controls, ischaemic stroke group and the ICH group at admission were 18.04 pg/ml, 24.10 pg/ml, and 33.33 pg/ml respectively. At admission, there was a significant difference in the median serum GFAP level in the ICH and apparently healthy control group as well as in the ischaemic stroke group and apparently healthy control group (p = 0.001). The study found no significant correlation between admission NIHSS and serum GFAP levels in both the ischaemic stroke group and the ICH group. In the ICH group, there was an inverse correlation between median serum GFAP level at day 7 and Barthel index at day 7 (p = 0.021) and day 30 (p = 0.001), but a positive correlation with modified Rankin score at day 30 (p = 0.001).

CONCLUSION: The study found that routine screening for serum GFAP level at admission in ischaemic stroke and ICH does not predict acute stroke severity and does not correlate with functional outcomes. However, Serum GFAP level at day 7 correlated with 30-day functional outcomes for ICH and its usefulness may be explored further in larger studies.

PMID:41252688

West Afr J Med. 2025 Jun 30;42(6):457-465.

ABSTRACT

BACKGROUND: Chronic diseases contribute the highest to disease burden and deaths worldwide and require long-term access to health care. This study identified the payment methods and coping strategies for healthcare costs by patients with chronic diseases using public health facilities in Yenagoa, Bayelsa State, Nigeria.

METHODS: Three hundred and thirty-nine (339) adult patients, being managed for chronic conditions (Hypertension, Diabetes mellitus, Tuberculosis & HIV), were randomly selected from three specialist hospitals that are the major providers of specialized care for patients with chronic diseases in the State. Data on sociodemographic characteristics, morbidity patterns, household financing and coping with health expenditure were collected. Chi-squared test was used to identify significant associations. A p-value 0.05 was considered significant.

RESULTS: Majority were females 211(62%) and about a third were not working 113(33.3%). To pay for their chronic disease healthcare expenses, 268 (79.1%) paid out-of-pocket while 71 (20.9%) used social health insurance. Among the 120 (35.4%) patients who subscribed to a health insurance program, about 2 in 5 still paid out-of-pocket. Missing a clinic visit 145(42.8%) was the common coping strategy followed by patients having to forfeit necessities 113(33.3%) to cope with their healthcare costs. The type of chronic disease was statistically associated with payment methods adopted by patients (p<0.01).

CONCLUSIONS: Most patients with chronic diseases rely on out-of-pocket payments for healthcare expenditures including patients with health insurance coverage. This has necessitated households to adopt coping strategies, found to be economically distressing, to source funds for healthcare needs. Targeted programmes are needed for patients with chronic diseases to enhance financial risk protection.

PMID:41252669

J Anim Physiol Anim Nutr (Berl). 2025 Nov 18. doi: 10.1111/jpn.70031. Online ahead of print.

ABSTRACT

Chronic kidney disease (CKD) is a known risk factor for hypercalcemia in cats. Phosphate-restricted diets have also been implicated in causing hypercalcemia, in part because phosphate restriction increases the Ca:P ratio. The primary objective of this study was to evaluate the impact of two different therapeutic renal foods on ionized (iCa) and total (tCa) calcium concentrations in cats with early-stage CKD. Twenty colony-housed cats with stage 1 or 2 CKD were enrolled, and 18 cats completed the study. Cats were randomly assigned to receive one of two diets formulated for renal disease for 140 days: a moderately phosphate restricted food (M-PR; n = 10 cats; 1.8 g/Mcal calcium; 1.5 g/Mcal phosphorus; Ca:P ratio, 1.2:1) or a more highly phosphate restricted food (H-PR; n = 8 cats; 2.3 g/Mcal calcium; 1.1 g/Mcal phosphorus; Ca:P ratio, 2.0:1). Blood and urine samples were collected on Days 0, 28, 84, and 140. Data were analyzed using a linear mixed model with fixed effects of diet, day, and diet by day interaction. At baseline, all cats had iCa within the normal reference interval (1.10─1.30 mmol/L). On d28 and thereafter, cats fed H-PR food had higher iCa compared with cats fed M-PR food (day 140 means: 1.42 mmol/L vs. 1.24 mmol/L, respectively; p < 0.001). Results were similar for tCa (day 140 means: 11.49 mg/dL vs. 9.51 mg/dL, respectively; p < 0.001; normal reference interval 8.80-10.00 mg/dL). This corresponded to higher fractional excretion of calcium in urine in cats fed H-PR food (Day 140 means 1.18% vs. 0.19%; p < 0.001), and increased calcium oxalate (CaOx) stone formation risk metrics (Day 140 means for CaOx RSS 4.54 vs. 3.13; Day 140 means for CaOx CORI risk index 563 vs. 30/L, respectively; all p < 0.020). Cats fed H-PR food also had higher FGF-23 concentrations compared with cats fed M-PR food (Day 140 means: 2329 vs. 204 pg/mL, respectively; p = 0.003; normal reference interval ≤ 299 pg/mL), and lower calcitriol concentrations (Day 140 means: 94 vs. 186 pmol/L, respectively; p = 0.021; normal reference interval 90-342 pmol/L). PTH concentrations in cats consuming H-PR food were significantly decreased from their baseline means and from cats consuming M-PR food at all timepoints (Day 140 means: < 0.05 vs. 3.1 pmol/L, respectively; p < 0.050; normal reference interval 0.7-3.4 pmol/L). Therapeutic renal diets impact calcium status in cats with early-stage CKD, but the effect is formulation dependent. Cats fed a M-PR food maintained normal iCa and tCa, which suggests this food is a safe and well-accepted option for cats with early-stage renal disease.

PMID:41252663 | DOI:10.1111/jpn.70031

JCO Oncol Pract. 2025 Nov 18:OP2500505. doi: 10.1200/OP-25-00505. Online ahead of print.

ABSTRACT

PURPOSE: This study assesses the accuracy of radiographic clinical staging by computed tomography (CT) of mismatch repair-deficient (dMMR) colon cancer, given emerging data for neoadjuvant immune checkpoint inhibitors (ICIs).

METHODS: Patients with stage I-III colon cancer treated with upfront surgical resection were retrospectively reviewed using the electronic medical record from a single institution from 2012 to 2023. We performed a cohort study of dMMR tumors with a stage-matched control cohort of mismatch repair-proficient (pMMR) tumors. The primary end point was the accuracy of clinical stage using preoperative CT compared with pathologic stage for dMMR colon cancer. Statistical analysis was performed using R.

RESULTS: We identified 78 patients with dMMR colon cancer. For dMMR tumors, T-stage clinical radiologic staging matched pathologic stage in 51% of cases and the nodal stage was accurately matched in 55% of cases. For stage I and IIA (low-risk) tumors, the overstaging rate on CT was 41% and for T4 or N+ (high-risk), the understaging rate was 25%. When comparing the dMMR and pMMR cohorts, pMMR nodal status was more likely to be understaged (P < .001). There was moderate to substantial interrater reliability for overall stage, T stage, and N staging between radiologists (kappa = 0.64, 0.60, and 0.63, respectively).

CONCLUSION: Radiographic tumor and nodal staging for dMMR colon tumors is unreliable with high rates of overstaging low-risk tumors where neoadjuvant treatment may not be indicated. The low accuracy of clinical staging demonstrates clear limitations to make systemic therapy decisions. Additional diagnostic modalities for lymph node status may be necessary to accurately clinically stage patients before neoadjuvant ICIs in patients with locally advanced disease.

PMID:41252662 | DOI:10.1200/OP-25-00505