Category: Statistics

J Nurs Res. 2025 Apr 22. doi: 10.1097/jnr.0000000000000672. Online ahead of print.

ABSTRACT

BACKGROUND: Children experience fear and anxiety not only during painful procedural interventions but also during painless procedural interventions such as electrocardiography (ECG). Pediatric nurses should be aware of the emotional changes experienced by children during ECG procedures.

PURPOSE: The aim of this single-center, single-blinded, randomized controlled intervention study was to investigate the impact of the undersea-themed examination table cover (UTETC) on the levels of fear and anxiety experienced by children during ECG procedures.

METHODS: This study was conducted between April 1 and July 31, 2022, in the pediatric emergency department of a training and research hospital in Turkey. The participants included 80 children (experimental group = 40, control group = 40) aged 3-12 years. The experimental group underwent the procedure in the ECG room using the UTETC, while the control group underwent the routine procedure in the examination room. The entire process was video-recorded. Video recordings were watched by two nurses who were not otherwise involved in this study, and the data were collected using the Descriptive Data Form, the Children’s Fear Scale, and the Children Emotional Manifestation Scale.

RESULTS: No statistically significant difference was found in the descriptive characteristics of the two groups (p > .05). The experimental group completed the procedure more successfully than the control group with significantly lower levels of procedure-related fear and anxiety (p < .05).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The UTETC was found to be effective in reducing fear and anxiety in children aged 3-12 years during ECG procedures in a pediatric emergency department.

PMID:40257748 | DOI:10.1097/jnr.0000000000000672

Eur J Health Econ. 2025 Apr 21. doi: 10.1007/s10198-025-01781-8. Online ahead of print.

ABSTRACT

OBJECTIVE: As European healthcare systems struggle with increasing workload and sustainability issues, it is estimated that 20% of their production is ineffective. One potential strategy to reduce this excess is by minimizing the use of unnecessary laboratory tests. The aim of this review was to investigate the effect of presenting physicians in Europe with the cost of laboratory tests at the time of ordering on the quantities and expense of laboratory tests as well as to identify knowledge gaps on this matter.

METHODS: Following PRISMA guidelines, a systematic search in PubMed and EMBASE was conducted in February 2025. Studies were included if written in English and conducted in Europe. There were no restrictions on year of publication. Study quality was evaluated using a modified Downs and Black checklist.

RESULTS: Of the 2185 publications identified, five met the inclusion criteria. All included studies were published 2002-2021 and found a reduction in order cost and/or volume of laboratory test, following price display (four with statistically significant results). The reduction in order costs were greater than the reduction in order volume. Additionally, the impact of price display diminished over time as the intervention period continued. None of the studies included patient safety measures.

CONCLUSIONS: Price display is a simple yet potentially impactful intervention as it is likely to reduce both the cost and volume of tests, thereby decreasing the workload and enhancing the sustainability of the healthcare systems. Further high-quality studies are needed to determine if price display is a patient-safe intervention.

PMID:40257741 | DOI:10.1007/s10198-025-01781-8

Sports Med. 2025 Apr 21. doi: 10.1007/s40279-025-02217-2. Online ahead of print.

ABSTRACT

BACKGROUND: In response to exercise, protein kinases and signaling networks are engaged to blunt homeostatic threats generated by acute contraction-induced increases in skeletal muscle energy and oxygen demand, as well as serving roles in the adaptive response to chronic exercise training to blunt future disruptions to homeostasis. High-intensity interval training (HIIT) is a time-efficient exercise modality that induces superior or similar health-promoting skeletal muscle and whole-body adaptations compared with prolonged, moderate-intensity continuous training (MICT). However, the skeletal muscle signaling pathways underlying HIIT’s exercise intensity-specific adaptive responses are unknown.

OBJECTIVE: We mapped human muscle kinases, substrates, and signaling pathways activated/deactivated by an acute bout of HIIT versus work-matched MICT.

METHODS: In a randomized crossover trial design (Australian New Zealand Clinical Trials Registry number ACTRN12619000819123; prospectively registered 6 June 2019), ten healthy male participants (age 25.4 ± 3.2 years; BMI 23.5 ± 1.6 kg/m²; V ˙ O 2 max 37.9 ± 5.2 ml/kg/min, mean values ± SD) completed a single bout of HIIT and MICT cycling separated by ≥ 10 days and matched for total work (67.9 ± 10.2 kJ) and duration (10 min). Mass spectrometry-based phosphoproteomic analysis of muscle biopsy samples collected before, during (5 min), and immediately following (10 min) each exercise bout, to map acute temporal signaling responses to HIIT and MICT, identified and quantified 14,931 total phosphopeptides, corresponding to 8509 phosphorylation sites.

RESULTS: Bioinformatic analyses uncovered exercise intensity-specific signaling networks, including > 1000 differentially phosphorylated sites (± 1.5-fold change; adjusted P < 0.05; ≥ 3 participants) after 5 min and 10 min HIIT and/or MICT relative to rest. After 5 and 10 min, 92 and 348 sites were differentially phosphorylated by HIIT, respectively, versus MICT. Plasma lactate concentrations throughout HIIT were higher than MICT (P < 0.05), and correlation analyses identified > 3000 phosphosites significantly correlated with lactate (q < 0.05) including top functional phosphosites underlying metabolic regulation.

CONCLUSIONS: Collectively, this first global map of the work-matched HIIT versus MICT signaling networks has revealed rapid exercise intensity-specific regulation of kinases, substrates, and pathways in human skeletal muscle that may contribute to HIIT’s skeletal muscle adaptations and health-promoting effects. Preprint: The preprint version of this work is available on medRxiv, https://doi.org/10:1101/2024.07.11.24310302 .

PMID:40257739 | DOI:10.1007/s40279-025-02217-2

J Magn Reson Imaging. 2025 Apr 21. doi: 10.1002/jmri.29796. Online ahead of print.

ABSTRACT

BACKGROUND: Axillary lymph node burden(ALNB) is a critical factor in determining treatment strategies for clinical T₁-T₂ (cT₁-T₂) stage breast cancer. However, as ALNB assessment relies on invasive procedures, exploring non-invasive methods is essential.

PURPOSE: To develop and validate a habitat radiomics model for assessing ALNB in cT₁-T₂ breast cancer, incorporating radiogenomic data to improve interpretability.

STUDY TYPE: Retrospective.

POPULATION: 468 patients with cT₁-T₂ stage breast cancer from two institutions and The Cancer Imaging Archive (TCIA) and The Cancer Genome Atlas (TCGA)-Breast Invasive Carcinoma (BRCA) were included. The cohort was divided into training (n = 173), internal validation (n = 58), external validation (n = 130), and TCGA-BRCA sets (n = 107). Patients were categorized into high nodal burden (HNB; > 3 positive lymph nodes) and non-HNB (≤ 3 positive lymph nodes) groups.

FIELD STRENGTH/SEQUENCE: 1.5-T MRI and 3.0-T MRI, and three-dimensional dynamic contrast-enhanced T1-weighted gradient-echo sequences.

ASSESSMENT: Two logistic regression models were developed using habitat-based and clinical features. Model performance was evaluated using the AUC. SHapley Additive exPlanations (SHAP) analysis was employed to identify key features. Radiogenomic analysis, including gene set enrichment and drug sensitivity assessments, was conducted using transcriptomic data from the TCGA-BRCA set.

STATISTICAL TESTS: Pearson correlation, Mann-Whitney U, genetic algorithm, logistic regression, AUC analysis, delong test, and SHAP analysis. A p-value < 0.05 was considered statistically significant.

RESULTS: The Habitat model outperformed the Clinical model (AUCs: 0.840-0.932 vs. 0.558-0.673). The SHAP analysis was used to rank feature importance, with subregion 3 showing the highest average SHAP value. Radiogenomic analysis indicated upregulation of the KEGG ribosome pathway in the HNB group and identified differential drug sensitivity profiles among risk groups.

DATA CONCLUSION: The Habitat model has the potential to assess ALNB in cT₁-T₂ breast cancer and assist radiologists in axillary diagnosis, which may help reduce the need for unnecessary ALN dissection.

EVIDENCE LEVEL: 3. Technical Efficacy: Stage 2.

PMID:40256826 | DOI:10.1002/jmri.29796

Diabetes Technol Ther. 2025 Apr 21. doi: 10.1089/dia.2025.0064. Online ahead of print.

ABSTRACT

Background: Potatoes are a staple food, especially in pediatric populations, but they pose distinct challenges for individuals with type 1 diabetes (T1D). This study evaluated glycemic responses in youth with T1D using a second-generation automated insulin delivery system after consuming potatoes prepared by two methods: fried and boiled. Methods: The study was conducted during a 5-day school camp for unaccompanied youth with T1D, aged 11-17 years, who had been using the Tandem t:slim X2™ Control-IQ insulin pump for at least 6 months. On two separate days, participants consumed a standardized meal containing 240 g of either fried or boiled potatoes, considered as 38 g of carbohydrates. Continuous glucose monitoring (CGM) data were collected and analyzed for all participants. Results: Our study population consisted of 31 children and adolescents (mean age 14.2 ± 1.7 years). Time in range was slightly higher after consuming boiled potatoes compared with fried potatoes, though the difference was not statistically significant (73.7% vs. 67.8%; P = 0.225). Mean glucose changes from pre-meal to 3-h post-meal were comparable between groups (-34.3 vs. -25.4 mg/dL; P = 0.517). Similarly, no significant differences were observed in the area under the curve of glucose levels. However, the percentage of bolus insulin within the 3-h post-meal period tended to be higher after fried potato consumption (20.7% vs. 11.9%; P = 0.075). Conclusions: Despite differences in glycemic index and fat content, the Tandem t:slim X2 Control-IQ system effectively maintained satisfactory glucose control within the 3-h post-meal period for both fried and boiled potatoes.

PMID:40256802 | DOI:10.1089/dia.2025.0064

Dent Traumatol. 2025 Apr 21. doi: 10.1111/edt.13067. Online ahead of print.

ABSTRACT

This in vitro study aimed to evaluate the effect of isotonic sports drinks (Gatorade) on color variation and thickness of ethylene-vinyl acetate (EVA). White thermoformed EVA blocks (n = 60) were prepared and randomly allocated into five groups (n = 12): reverse osmosis water (G1-control, transparent/colorless), isotonic passion fruit flavor (G2-yellow drink), isotonic citrus flavor (G3-orange drink), isotonic strawberry with passion fruit flavor (G4-red drink), and isotonic grape flavor (G5-purple drink). The specimens were submerged in their respective liquids/drinks for each group and incubated at 37°C for 28 consecutive days. The liquids/drinks were replaced every 24 h. Color variation (ΔE_ab) and thickness (mm) were evaluated using a digital spectrophotometer and a digital micrometer, respectively, at baseline and after 7, 14, 21, and 28 days. ΔE_ab was calculated using the CIEL*a*b* system. Statistical analysis for both independent and dependent data was performed (α = 5%). Regarding color variation, G2 and G5 showed significant changes in ΔE_ab values after 21 and 28 days (p < 0.05), respectively. After 21 days, G2 became less clear and more pigmented towards the blue and red coordinates, with a reduction in L* (p < 0.001) and b* (p < 0.001), and an increase in a* (p < 0.001). After 28 days, G5 became pigmented towards the red and blue coordinates, with no significant change in L* (p > 0.05), but a reduction in b* (p = 0.021) and an increase in a* (p < 0.001). The thickness did not vary in relation to time or isotonic flavor/drink (p > 0.05). Isotonic drinks may cause changes in the color of EVA depending on the exposure time and the color of the isotonic drink consumed.

PMID:40256793 | DOI:10.1111/edt.13067

Breastfeed Med. 2025 Apr 21. doi: 10.1089/bfm.2024.0368. Online ahead of print.

ABSTRACT

Introduction: Breastfeeding provides substantial health benefits for both children and mothers; yet the U.S. rates remain suboptimal, with disparities shaped by structural, social, and policy factors. This study examines how the U.S. hospital maternity care practices influence breastfeeding initiation, with particular attention to their impact across different population groups. Methods: We analyzed cross-sectional county-level variations in hospital maternity care quality and breastfeeding initiation from 2017 to 2022 using data from the National Vital Statistics System and the Maternity Practices in Infant Nutrition and Care (mPINC) surveys. We employed a linear probability model to assess these relationships. Results: Higher county mPINC scores are significantly associated with increased breastfeeding initiation, with each additional point linked to a 0.10 percentage point (pp) increase (p < 0.001). This association varies by race/ethnicity. Each additional mPINC point corresponds to a 0.25 pp increase for non-Hispanic Black mothers (p < 0.001) and a 0.14 pp increase for non-Hispanic American Indian/Alaska Native mothers (p < 0.001), approximately three and two times higher, respectively, than the increase for non-Hispanic White mothers. The effect of better maternity practices also differs by county type, with a 0.08 pp increase in metro areas (p < 0.001) and a 0.17 pp increase in nonmetro areas (p < 0.001). Conclusions: Higher quality hospital maternity care practices are associated with increased breastfeeding initiation, particularly among population groups with historically lower breastfeeding rates. Enhancing maternity care policies and practices may help reduce long-standing breastfeeding disparities.

PMID:40256784 | DOI:10.1089/bfm.2024.0368

Front Bioeng Biotechnol. 2025 Apr 4;13:1491775. doi: 10.3389/fbioe.2025.1491775. eCollection 2025.

ABSTRACT

OBJECTIVE: To compare the clinical efficacy and screw placement accuracy of robot artificial intelligence (AI)-assisted percutaneous screw fixation and conventional C-arm-assisted percutaneous screw fixation (manual placement) in the treatment of thoracolumbar single-segment fractures without neurological symptoms.

METHODS: This study is a single-center retrospective analysis involving patients with thoracolumbar single-segment fractures without neurological symptoms. Patients were divided into Group A (robotic AI-assisted placement) and Group B (manual placement). Clinical outcomes such as operative time, intraoperative fluoroscopy frequency, screw placement accuracy, postoperative complications, length of hospital stay, and postoperative pain were compared between the two groups.

RESULTS: Group A showed significantly better screw placement accuracy, fewer intraoperative fluoroscopy attempts, shorter fluoroscopy time, and fewer guidewire adjustments compared to Group B (P < 0.05). Additionally, Group A had shorter hospital stays, a lower incidence of postoperative complications, and short-term greater improvement in Visual Analog Scale (VAS) scores (P < 0.05). However, after 1 year of follow-up, there was no statistically significant difference between the two groups in the improvement of VAS scores.

CONCLUSION: Robotic AI-assisted placement improves pedicle screw placement accuracy, reduces intraoperative fluoroscopy frequency and time, alleviates postoperative pain, and accelerates patient recovery. This approach aligns with the principles of enhanced recovery in orthopedic surgery and holds promise for wider clinical application in the treatment of thoracolumbar fractures.

PMID:40256780 | PMC:PMC12006081 | DOI:10.3389/fbioe.2025.1491775

Front Bioeng Biotechnol. 2025 Apr 4;13:1510642. doi: 10.3389/fbioe.2025.1510642. eCollection 2025.

ABSTRACT

BACKGROUND: Clinically relevant postoperative pancreatic fistula (CR-POPF) represents a significant complication after pancreaticoduodenectomy (PD). Therefore, the early prediction of CR-POPF is of paramount importance. Based on above, this study sought to develop a CR-POPF prediction model that amalgamates radiomics and clinical features to predict CR-POPF, utilizing Shapley Additive explanations (SHAP) for visualization.

METHODS: Extensive radiomics features were extracted from preoperative enhanced Computed Tomography (CT) images of patients scheduled for PD. Subsequently, feature selection was performed using Least Absolute Shrinkage and Selection Operator (Lasso) regression and random forest (RF) algorithm to select pertinent radiomics and clinical features. Last, 15 CR-POPF prediction models were developed using five distinct machine learning (ML) predictors, based on selected radiomics features, selected clinical features, and a combination of both. Model performance was compared using DeLong’s test for the area under the receiver operating characteristic curve (AUC) differences.

RESULTS: The CR-POPF prediction model based on the XGBoost predictor with the combination of the radiomics and clinical features selected by Lasso regression and RF exhibited superior performance among these 15 CR-POPF prediction models, achieving an accuracy of 0.85, an AUC of 0.93. DeLong’s test showed statistically significant differences (P < 0.05) when compared to the radiomics-only and clinical-only models, with recall of 0.63, precision of 0.65, and F1 score of 0.64.

CONCLUSION: The proposed CR-POPF prediction model based on the XGBoost predictor with the combination of the radiomics and clinical features selected by Lasso regression and RF can effectively predicting the CR-POPF and may provide strong support for early clinical management of CR-POPF.

PMID:40256777 | PMC:PMC12006764 | DOI:10.3389/fbioe.2025.1510642

EClinicalMedicine. 2025 Apr 10;83:103195. doi: 10.1016/j.eclinm.2025.103195. eCollection 2025 May.

ABSTRACT

BACKGROUND: The BALANCE trial demonstrated non-inferiority of 7 (vs 14) day antibiotic durations in patients with uncomplicated non-S. aureus/lugdunensis bacterial bloodstream infections (BSI). However, there may be patient subgroups who benefit from longer durations. We aimed to evaluate if bedside clinical decision rules could identify these subgroups.

METHODS: In this post-hoc analysis of the multicentre, randomised BALANCE trial (October 17, 2014-May 5, 2023), we applied three clinical decision rules to investigate heterogeneity of treatment effect in 7-day vs 14-day antibiotic durations on 90-day all-cause mortality. We used the rules to categorize patients in BALANCE into different risk groups and calculated the unadjusted absolute risk difference (RD) for 90-day mortality in patients receiving 7- vs 14-day antibiotics within each risk group. Statistical significance was tested using an interaction test. The BALANCE trial is registered with ClinicalTrials.gov (NCT03005145).

FINDINGS: 3581 patients were included. All three rules predicted mortality risk, but none identified statistically significant effect modification: (a) static rule (low-risk: RD -0.58, 95% CI -8.91 to 7.73; moderate-risk: RD -.01, 95% CI -3.86 to 1.83; high-risk: RD -2.65, 95% CI -7.12 to 1.81; p = 0.74); (b) dynamic rule (met rule on day 7: RD -2.18, 95% CI -4.81 to 0.45; did not meet rule: RD 1.75, 95% CI -3.89 to 7.40; p = 0.16); and (c) early clinical failure criteria (score<2: RD -2.38, 95% CI -5.0 to 0.23; score ≥2: RD -0.65, 95% CI -5.06 to 3.77; p = 0.24). Results were consistent across sensitivity analyses including imputation for missing data and restricting analyses to gram-negative BSI.

INTERPRETATION: The decision rules included in our analyses did not identify a subgroup of patients within BALANCE that would benefit from 14 (vs 7) days of treatment. 7-day treatment duration is sufficient for most patients with uncomplicated non-S. aureus/lugdunensis BSI. Future research could explore data-driven machine-learning approaches to identify comprehensive combinations of patient characteristics that may guide individualised duration of antibiotic therapy.

FUNDING: The BALANCE trial was funded by the Canadian Institutes of Health Research, Health Research Council of New Zealand, Australian National Medical Research Council, Physicians Services Incorporated Ontario and Ontario Ministry of Health and Long-term Care Innovation Fund. SWXO conducted this study as part of his PhD studies, with funding from: the Emerging & Pandemic Infections Consortium (University of Toronto, Canada); Connaught International Scholarship (University of Toronto, Canada); the Queen Elizabeth II Graduate Scholarship in Science and Technology (QEII-GSST; Government of Ontario, Canada); and the Melbourne Research Scholarship (University of Melbourne, Australia). VML is supported by Clinical Research Scholar-Junior 2 program (FRQ-S).

PMID:40256773 | PMC:PMC12008128 | DOI:10.1016/j.eclinm.2025.103195