Category: Statistics

J Surg Oncol. 2025 Nov 16. doi: 10.1002/jso.70134. Online ahead of print.

ABSTRACT

INTRODUCTION: Procedural volume thresholds (VTs) for hospital quality reporting rely on expert consensus or analytic methods that may produce inconsistent VTs (e.g. restricted cubic splines (RCS), optimal cutpoints, classification and regression trees (CART), stratum specific likelihood ratios (SSLR)). The objective of this study was to compare variation in hospital-level VTs for pancreatectomy across multiple methodologies.

METHODS: Patients undergoing pancreatectomy from 2004 to 2021 were identified using the National Cancer Database. RCS, optimal cutpoints, CART, and SSLR were used to compute VTs based on 90-day mortality. From a single clinical data set, VTs were derived multiple times for each method by varying statistical parameters within each model.

RESULTS: Overall, 61,920 patients underwent pancreatectomy at 982 hospitals. VTs associated with reductions in 90-day mortality ranged from 9.2 to 26.1 cases/year (RCS), 15.7-33.8 cases/year (optimal cutpoints), and 11-18 cases/year (CART), all based on modifiable statistical parameters. SSLR analysis yielded a singular VT of 21 cases/year without variability due to lack of statistical input.

CONCLUSION: Among 4 common strategies for identifying VT that we studied, SSLR required the fewest assumptions. This may make it ideal for enhancing transparency and standardization in outcomes reporting.

PMID:41241876 | DOI:10.1002/jso.70134

J Manipulative Physiol Ther. 2025 Nov 15:S0161-4754(25)00055-7. doi: 10.1016/j.jmpt.2025.10.025. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to examine the effect of adding cervical stability training (CST) to a battery of treatment modalities on somatosensory evoked potential (SSEP) in patients with forward head (FHP) and chronic mechanical neck pain (CMNP).

METHODS: Sixty patients with FHP and CMNP were randomized into 2 groups: Group A (study group) was subjected to CST and a battery of treatment modalities, whereas Group B (traditional group) underwent a battery of treatment modalities alone. Treatment was applied 3 sessions per week for 8 successive weeks. The primary outcomes were SSEP and craniovertebral angle (CVA). The secondary outcomes were visual analog scale for pain intensity, Neck Disability Index Arabic version for functional disability, an endurance test for neck flexor and extensor muscles, craniocervical flexion test for deep cervical flexor muscles activation, lateral radiographs using the posterior tangent method for cervical lordotic curvatures, and a phone application clinometer for cervical range of motion.

RESULTS: The findings demonstrated short-term statistically significant differences (P < .05) at posttreatment between the study and traditional treatment groups in favor of the study group. The mean difference and 95% CI between both groups in SSEP and CVA = 1.83 (1.63, 2.03) and 7.37 (6.49, 8.25), respectively.

CONCLUSION: For patients with chronic neck pain, CST exercises plus a battery of treatment modalities exhibited a greater effect on primary and secondary outcomes than the battery of treatment modalities alone.

PMID:41241867 | DOI:10.1016/j.jmpt.2025.10.025

J Med Econ. 2025 Dec;28(1):1979-1988. doi: 10.1080/13696998.2025.2584888. Epub 2025 Nov 16.

ABSTRACT

AIMS: Obstructive hypertrophic cardiomyopathy (oHCM) is associated with substantial disease burden, healthcare resource utilization (HCRU), and healthcare costs. This study assessed HCRU and healthcare costs among patients with oHCM treated in real-world settings over 5 years of follow-up.

METHODS: This retrospective cohort study used the Optum database (January 2013-December 2021) and included patients aged ≥18 years with ≥2 claims for oHCM and continuous health plan enrollment for ≥6 months pre-initial and post-initial oHCM claim (index date). Patients with ≥5 years of follow-up data were analyzed. All-cause and HCM-related HCRU (ambulatory visits [physician office visits and outpatient visits], emergency room [ER] visits, hospital admissions, length of stay [LOS], and pharmacy use) and healthcare costs were assessed in US dollars.

RESULTS: In total, 5,129 patients with oHCM were identified: 5,056 (98.6%) had an all-cause ambulatory visit and 4,669 (91.0%) had an HCM-related visit. 4,079 (79.5%) had an all-cause ER visit, and 1,499 (29.2%) an HCM-related ER visit. 2,949 (57.5%) reported an all-cause admission, and 2,232 (43.5%) an HCM-related admission. The mean (SD) per-person count of all-cause ambulatory visits was 101.0 (90.7) and 15.3 (18.7) for HCM-related ambulatory visits. Mean (SD) all-cause admissions per patient were 1.8 (3.8), and 0.9 (1.6) were HCM related. Mean (SD) all-cause LOS was 18.0 (54.7) days, and HCM-related LOS was 10.0 (39.6) days. Mean (SD) all-cause healthcare cost per patient was $181,968 (241,608), of which $67,531 (114,705) was HCM related. Hospital admissions were the largest proportion of medical costs: all-cause admissions cost $71,001 (149,533) during follow-up, of which $44,781 (99,431) was HCM-related.

LIMITATIONS: Analyses were unadjusted for covariates or confounding factors.

CONCLUSION: Patients with oHCM experience substantial HCRU and costs over 5 years of follow-up. These results indicate a need for new treatment options which could decrease HCRU and improve patient outcomes.

PMID:41241831 | DOI:10.1080/13696998.2025.2584888

Pak J Pharm Sci. 2025 Nov-Dec;38(6):2292-2302. doi: 10.36721/PJPS.2025.38.6.REG.14034.1.

ABSTRACT

To compare synthetic and natural-source pulmonary surfactants (PS) for treating neonatal respiratory distress syndrome (NRDS) in very low-birth-weight neonates. A total of 113 neonates with NRDS were retrospectively divided into the natural-source PS group (NSPS, 63 cases) and the synthetic PS group (SPS, 50 cases). Oxygenation, ventilation, complications, efficacy and mortality were compared. Binary logistic regression analysis was performed using Statistical Package for the Social Sciences (SPSS) 23.0 to analyze the impact of PS type on the treatment of NRDS in very low birth weight neonates (VLBWIs). Additionally, the receiver operating characteristic curve (ROC) and the area under the curve (AUC) were calculated and evaluated to assess the association and closeness between PS type and the treatment of NRDS in VLBWIs. After treatment, NSPS group had higher arterial partial pressure of oxygen (PaO₂), lower arterial partial pressure of carbon dioxide (PaCO₂) and oxygenation index (OI). It also had shorter ventilation and hospital stay, lower pneumothorax, total-complication and mortality rates and higher effective rate. PS type correlated with complications and efficacy; the closeness (AUC) order was: clinical efficacy > complications. Natural-source PS in treating NRDS in very low-birth-weight neonates improves efficacy, optimizes blood gas, shortens treatment and reduces complications and mortality.

PMID:41241798 | DOI:10.36721/PJPS.2025.38.6.REG.14034.1

Pak J Pharm Sci. 2025 Nov-Dec;38(6):2271-2278. doi: 10.36721/PJPS.2025.38.6.REG.14594.1.

ABSTRACT

Tuberculosis, being an infectious disease, is unchecked and still hard to wipe out in the underdeveloped countries. Despite ongoing efforts, no new TB vaccine has been successfully developed in the past century beyond BCG, although DNA-based vaccines have shown promise over the last two decades. In this study, five Mycobacterium tuberculosis-specific genes- Rv1908c/KatG, Rv3418c/GroES, Rv0934/PhoS1/PstS, Rv0440/GroEL2 and Rv0350/DnaK-were cloned into the pVAX1 expression vector to construct DNA vaccines. These constructs were evaluated in rats using naked DNA and BCG prime-boost strategies. Forty-five Wistar albino rats were divided into three major groups: DNA vaccine group, BCG prime-boost group and no vaccine control. Post-immunization responses were evaluated through cytokine ELISA for TNF-α, IFN-γ and IL-6. Among DNA vaccines, DnaK-pVAX1 and GroES-pVAX1 elicited the strongest cytokine responses, followed by GroEL2-pVAX1 and PstS-pVAX1. The prime-boost groups (especially BCG + DnaK-pVAX1, BCG + GroES-pVAX1 and BCG + cocktail) showed further enhanced responses. Statistical analysis confirmed significant cytokine elevation in vaccinated groups compared to controls (p < 0.05). DNA vaccines, whether used alone or in combination with BCG, show strong potential as immunogenic and therapeutic tools for TB and may help reduce treatment duration in the future.

PMID:41241795 | DOI:10.36721/PJPS.2025.38.6.REG.14594.1

Pak J Pharm Sci. 2025 Nov-Dec;38(6):2264-2270. doi: 10.36721/PJPS.2025.38.6.REG.14009.1.

ABSTRACT

The therapeutic approach of combining doxycycline (DOX) with azithromycin (AZM) has emerged as an effective strategy for managing pediatric Mycoplasmal pneumonia (MP), with its clinical efficacy well-established. It is worth noting that both DOX and AZM are antibiotics and require an interval of 24-72 hours when used in combination, but there are few studies on the optimal interval between the two drugs. This study aimed to elucidate the differential outcomes of two treatment regimens. The short-term group received DOX in combination with AZM within 24-72 hours after AZM administration for MP treatment, while the long-term group initiated DOX therapy more than 72 hours after AZM treatment. Our findings indicated that there were no statistically significant differences in clinical efficacy and the impact on pediatric pulmonary function between the two groups (P>0.05). However, the time for symptom improvement in the short-term group was significantly shortened (P<0.05), while the long-term group exhibited lower inflammatory responses, stress responses and a reduced incidence of complications (P<0.05). In conclusion, initiating DOX within 72 hours after AZM treatment can expedite the treatment course of MP, while using DOX more than 72 hours after AZM treatment confers enhanced safety.

PMID:41241794 | DOI:10.36721/PJPS.2025.38.6.REG.14009.1

Cancer. 2025 Nov 15;131(22):e70174. doi: 10.1002/cncr.70174.

ABSTRACT

IMPORTANCE: Although Black women have higher absolute quantitative breast density, they are often assigned lower subjectively determined Breast Imaging and Reporting Data System (BI-RADS) density scores than White women. Background parenchymal enhancement (BPE) on breast magnetic resonance imaging is independently linked to breast cancer risk and may improve risk stratification for Black and White women.

OBJECTIVE: To evaluate differences in quantitative BPE between Black and White women and determine whether breast cancer risk factors mediate these differences.

DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of 1202 women (200 Black, 1002 White; aged 40-74 years) with negative mammograms and no breast cancer history who underwent breast magnetic resonance imaging between 2016 and 2023 at an academic medical center.

EXPOSURES: Self-reported race (Black vs. White).

MAIN OUTCOMES AND MEASURES: The primary outcome was automated, quantitative BPE (median BPE and BPE ratio). Covariates included BI-RADS density, fibroglandular tissue volume, qualitative BPE, age, body mass index, and menopausal status.

RESULTS: Fewer Black women were classified as having extremely dense breasts (10% vs. 21%; p < .01), yet similar proportions had high qualitative BPE (35% vs. 29%; p = .29). Quantitative BPE was significantly higher in Black women (median difference, 1.51; standard deviation, 9; 95% CI, 0.13-2.90), independent of covariates. No risk factors mediated this difference.

CONCLUSIONS AND RELEVANCE: Despite lower BI-RADS density in Black women, as suggested by prior literature, higher quantitative BPE was found, suggesting that BPE captures aspects of breast tissue composition not reflected by density. Future studies can incorporate BPE into risk models, which can improve performance and reduce disparities in risk prediction.

PMID:41241787 | DOI:10.1002/cncr.70174

J Econ Entomol. 2025 Nov 16:toaf312. doi: 10.1093/jee/toaf312. Online ahead of print.

ABSTRACT

Helicoverpa zea (Bodie) is a widespread damaging pest in the US that has evolved varying levels of resistance to Cry toxins in corn and cotton. To delay resistance evolution to this pest and others targeted by Bt corn, growers in the southern United States are required to plant at least 20% of their corn area with non-Bt corn. However, growers are reluctant to do this. Multiple small-plot research studies show timely planted non-Bt and Bt corn hybrids yield equally; however, growers often think non-Bt hybrids yield less than Bt hybrids. In response, we compared non-Bt and Bt hybrids using grower-owned planting and harvesting equipment. Growers planted 5 corn hybrids as strip plots (Bt-P1197YHR, DKC65-99, non-Bt-P1197LR, DKC67-70, and DKC65-93) in 2022 at 27 locations and 4 hybrids (excluding DKC65-93) in 2023 at 28 locations throughout North Carolina. When corn reached dent (R5), we measured the area of H. zea injury from each hybrid at each location. We calculated yield and economic net returns at harvest. We separated analyses for Bt trait pyramid and hybrid for both feeding and yield. H. zea feeding was at moderate levels, following predictable patterns. There were no significant differences between Bt and non-Bt hybrids within the 2 companies we compared (Pioneer [P] and Bayer [DKC]) across both years. In general, farm profitability is not statistically different when planting a 20% non-Bt refuge compared to planting 100% Bt corn. Factors other than typical H. zea feeding are more impactful on yield in North Carolina.

PMID:41241782 | DOI:10.1093/jee/toaf312

J Econ Entomol. 2025 Nov 16:toaf278. doi: 10.1093/jee/toaf278. Online ahead of print.

ABSTRACT

The biological control for fruit flies in Brazil has been extended with the introduction of the parasitoid Diachasmimorpha longicaudata (Ashmead, 1905) (Hymenoptera: Braconidae) and native parasitoids, such as Doryctobracon brasiliensis (Szepligeti, 1911) (Hymenoptera: Braconidae), which show great potential for control. Among the main pest species of fruit flies, Anastrepha fraterculus (Wiedemann, 1830) (Diptera: Tephritidae) and Ceratitis capitata (Wiedemann, 1830) (Diptera: Tephritidae) have a wide geographic distribution in the South American continent. The objectives of this study were to evaluate the functional response of D. brasiliensis to the density of A. fraterculus larvae and to model the parasitism rates of D. longicaudata and D. brasiliensis on A. fraterculus and that of D. longicaudata when exposed to C. capitata. The experiments were conducted to evaluate the parasitism rate, and the data were subjected to statistical analysis, verifying the probability distribution. The parasitism rate of D. brasiliensis ranged from 82.2% to 35% when 5 and 30 larvae were offered to each female, respectively. The results revealed a type II functional response, indicating that the parasitism rate reached a saturation point as the larval density increased. In A. fraterculus, the average number of larvae parasitized by D. longicaudata females was higher than that of C. capitata at nearly all host densities. The highest percentage of parasitism (55%) was observed at the density of 3 larvae per parasitoid, similar to what was recorded for C. capitata. The results obtained support the biological control program for fruit flies in Brazil, optimizing laboratory rearing and field release.

PMID:41241778 | DOI:10.1093/jee/toaf278

Med Educ Online. 2025 Dec 31;30(1):2585634. doi: 10.1080/10872981.2025.2585634. Epub 2025 Nov 15.

ABSTRACT

The overturning of Roe v. Wade in Dobbs v. Jackson Women’s Health Organization (2022) has led to varying abortion laws across states in the U.S., potentially influencing medical education choices. While some research has examined abortion policy changes and medical residencies and fellowship decisions, none has investigated abortion policy and medical school decisions. This study aims to determine whether pre-medical students’ personal views on abortion influence their willingness to attend medical schools in states where abortion is illegal at all stages EXCEPT to save the life of the mother. A cross-sectional survey was distributed to pre-medical organizations at the two largest four-year institutions in each U.S. state and the District of Columbia, except Wyoming, which has only one four-year institution. The survey collected demographic data, political affiliation, intended medical specialty, and personal stance on abortion. Participants indicated their willingness to attend medical school in states with different types of abortion policies. There were 182 completed surveys from participants in 20 different states. Analysis showed that students who believed abortion is acceptable and should be legal at all stages were significantly less willing to attend medical school in states where abortion is illegal EXCEPT to save the life of the mother. Abortion policy may influence medical school decisions among pre-medical students, which may have long-term implications for physician distribution, particularly in states with restrictive abortion laws. Future research should explore how these trends impact healthcare workforce shortages and access to reproductive care.

PMID:41241769 | DOI:10.1080/10872981.2025.2585634