Category: Statistics

Ann Surg Oncol. 2025 Sep 8. doi: 10.1245/s10434-025-18261-1. Online ahead of print.

ABSTRACT

BACKGROUND: Right-sided hepatectomy (RH) is the standard surgical approach for perihilar cholangiocarcinoma (PHC) due to anatomical considerations but is associated with a high risk of post-hepatectomy liver failure (PHLF). Left-sided hepatectomy (LH) and central hepatectomy (CH) have been proposed as alternative strategies to preserve liver function, but the feasibility and outcomes of CH have not been sufficiently investigated. CH allows for greater preservation of liver parenchyma, potentially reducing the risk of PHLF.

METHODS: This retrospective study analyzed 63 patients with PHC who underwent major hepatectomy at the Juntendo University Hospital between January 2019 and March 2024. Patients were categorized into the LH (n = 18), RH (n = 28), and CH (n = 17) groups. Preoperative future liver remnant volume, perioperative outcomes, pathological findings, and long-term outcomes were compared. Statistical significance was set at p < 0.05.

RESULTS: The CH group had a significantly higher future liver remnant volume compared with the RH group (62.7% vs. 45.5%; p < 0.001). The incidence of PHLF was lower in CH (11.8%) than RH (39.3%), although not statistically significant. CH was associated with a longer median operative time (691 min) and a higher incidence of bile leakage (47.1%). R0 resection rates and long-term outcomes were comparable among the three groups.

CONCLUSIONS: CH is a feasible alternative in selected PHC, offering comparable oncological outcomes while preserving functional liver volume despite its technical complexity.

PMID:40921895 | DOI:10.1245/s10434-025-18261-1

Environ Monit Assess. 2025 Sep 8;197(10):1090. doi: 10.1007/s10661-025-14554-w.

ABSTRACT

To a large extent, the food security and ecological balance of a region, particularly in agriculturally dominated areas, largely depend on the sustainable use and management of groundwater resources. However, in recent times, both natural and human-driven factors have heavily impacted the lowering of groundwater resources. Therefore, the present study has been carried out in a drought-prone region of Birbhum district, part of the red-lateritic agro-climatic zone of West Bengal, Eastern India, to delineate groundwater potential zones (GWPZs). In this regard, 12 hydrological and environmental factors were selected after a multicollinearity test, i.e., elevation, slope, curvature, geomorphology, geology, lineament density, distance from river, topographic wetness index (TWI), groundwater level, rainfall, land use land cover, and soil types for modeling groundwater potentiality. To fulfill the objective, standard machine learning (ML) algorithms like “random forest (RF),” “support vector regression (SVR),” “maximum-entropy (Max-Ent),” and the ensemble approach of RF-Max-Ent have been applied. To validate the obtained result, five statistical techniques, i.e., area under curve (AUC), sensitivity, specificity, F-score, and Kappa coefficient, have been selected. The ranking and relative importance of all factors revealed that elevation, rainfall, TWI, and soil type are the most influential factors for groundwater potentiality in this study. The result of the evaluation metric indicates that the ensemble of RF-Max-Ent is the most suitable model to delineate GWPZ in this study site, as AUC is 0.893 in validation, followed by RF, Max-Ent, and SVR. Additionally, the rank value in the Friedman rank test and chi-squared test for RF-Max-Ent is 3.824 and 32.121, respectively. Overall, the findings revealed that a sizeable section of the study area has moderate to very good groundwater potential. The findings of this study can significantly support achieving sustainable development goals and help to improve groundwater levels in this region through appropriate groundwater policy planning.

PMID:40921891 | DOI:10.1007/s10661-025-14554-w

Environ Monit Assess. 2025 Sep 8;197(10):1093. doi: 10.1007/s10661-025-14534-0.

ABSTRACT

Understanding seagrass dynamics is crucial for the effective management and conservation of seagrass meadows. However, such information remains limited for many regions worldwide, including Kuta Mandalika on Lombok Island, Indonesia. This rapidly developing coastal area, which is home to both tourism infrastructure and an international race circuit, hosts extensive seagrass meadows whose condition and dynamics require careful assessment. Establishing a baseline is essential for long-term monitoring, especially in light of ongoing coastal development. In this study, we integrated time-series Sentinel-2 imagery with a robust seagrass aboveground carbon stock (AGC) mapping model to monitor changes in seagrass AGC from 2019 to 2023. Our analysis shows that seagrass AGC exhibits a clear seasonal pattern, with peak biomass typically occurring in May and June each year. Additionally, results from Seasonal-Trend Decomposition using Loess (STL) and a Generalized Additive Mixed Model (GAMM) with an AR(1) error structure indicate a statistically significant decline in seagrass AGC associated with the construction of the Kuta Mandalika Circuit. These findings provide a critical baseline for distinguishing between natural seasonal variability and long-term anthropogenic impacts, offering valuable insights to inform future monitoring, management, and conservation strategies for these vital coastal ecosystems.

PMID:40921888 | DOI:10.1007/s10661-025-14534-0

Crit Rev Immunol. 2025;45(5):67-78. doi: 10.1615/CritRevImmunol.2025060503.

ABSTRACT

Galectin-10(Gal-10)/CLC(Charcot-Leyden crystal) has been discovered to be related to ECRSwNP characterized by high eosinophilic infiltration. We aimed to investigate the effects of Gal-10 on ECRSwNP. A total of 36 tissue samples were collected, including 11 ECRSwNP samples, 15 non-ECRSwNP samples, and 10 Control samples. Human eosinophils were divided into 3 groups: Control, siRNA-NC, and Gal-10 interference groups. Immunohistochemistry (IHC), Western blotting and quantitative real-time PCR (qRT-PCR) detected the expression of Gal-10 in the tissues samples and expression of p-p38 and p-p65 in human eosinophils. Enzyme-Linked Immunosorbent Assay (ELISA) was adopted to measure the expression levels of IL-4, IL-5, IL-8, MBP, ECP, and TNF-α in the human eosinophils. We found the expression of Gal-10 was significantly higher in ECRSwNP group (P < 0.05). The expression levels of IL-4, IL-5, IL-8, MBP and TNF-α in the Gal-10 interference group were lower (P < 0.05), but ECP had no statistical difference in human eosinophils. There showed the expression levels of p-p38 and p-p65 proteins in the Gal-10 interference group were lower (P < 0.05). The deletion of Gal-10 in eosinophils down-regulates the expression of cytokines and granule cationic proteins in ECRSwNP which may be caused by the p38MAPK/ NF-κB pathway.

PMID:40921147 | DOI:10.1615/CritRevImmunol.2025060503

Eur J Oncol Nurs. 2025 Aug 26;78:102969. doi: 10.1016/j.ejon.2025.102969. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the effectiveness of a mobile chemotherapy drug guide application, ChemoNurse, developed for cancer nurses, in improving their knowledge and attitudes toward chemotherapy practices.

METHODS: A randomized controlled trial with a repeated-measures design was conducted with 59 nurses (29 intervention, 30 control) who participated. Nurses in the intervention group used the ChemoNurse mobile application for six months, while the control group received no additional intervention. Data was collected using the Chemotherapy Practice Knowledge Scale and the Attitude Scale for Chemotherapy Practices at baseline, 3rd month, and 6th month. Statistical analyses included repeated measures ANOVA to examine group, time, and interaction effects.

RESULTS: Significant improvements were observed in the intervention group compared to the control group in total knowledge scores (p < 0.001). Subscale analyses revealed significant time effects in domains such as Creating a Safe Environment (p < 0.001), and Procurement and Administration of Chemotherapy Drugs (p < 0.001). The Treatment Planning and Patient Education subscale showed significant group (p < 0.001) and interaction effects (p < 0.001). In terms of attitudes, the intervention group demonstrated a significant decrease in negative attitudes (p < 0.001) and a significant increase in positive attitudes (p < 0.001).

CONCLUSION: The ChemoNurse mobile application significantly improved cancer nurses’ knowledge and professional attitudes regarding chemotherapy administration. These findings highlight the potential of mobile technologies as effective, scalable tools for enhancing clinical competence and supporting safe, evidence-based cancer nursing practice.

PMID:40921109 | DOI:10.1016/j.ejon.2025.102969

JMIR Cancer. 2025 Sep 8;11:e73843. doi: 10.2196/73843.

ABSTRACT

BACKGROUND: Disparities in cancer burden between transgender and cisgender individuals remain an underexplored area of research.

OBJECTIVE: This study aimed to examine the cumulative incidence and associated risk factors for cancer and precancerous conditions among transgender individuals compared with matched cisgender individuals.

METHODS: We conducted a retrospective cohort study using patient-level electronic health record (EHR) data from the University of Florida Health Integrated Data Repository between 2012 and 2023. Transgender individuals were identified using a validated, computable phenotype algorithm that used structured data and clinical notes. They matched 1:10:10 by age and calendar year of index date with cisgender women and cisgender men. The index date was the first transgender-related record for transgender individuals and a matched diagnosis date for cisgender controls. Primary outcomes included new-onset cancers associated with human papillomavirus, human immunodeficiency virus, tobacco, alcohol, lung, breast, and colorectal sites. Secondary outcomes were precancerous conditions related to the same cancer types. We calculated cumulative incidence rates and conducted time-to-event analyses using the Fine-Gray method, treating all-cause death as a competing risk, to assess associations between gender identity and the presence of cancer or precancer, adjusting for demographic and clinical covariates. Interaction analyses evaluated if associations between cancer risk factors and precancer differed by gender identity.

RESULTS: We identified 2745 transgender individuals (mean age at index date 25.1, SD 14.0 years) and matched them with 27,450 cisgender women and 27,450 cisgender men from the same health care system. The cumulative incidence of cancer did not differ significantly between transgender and cisgender cohorts (transgender n=28, 1.0% vs cisgender women, n=358, 1.3%; P=.13 and cisgender men, n=314, 1.1%; P=.64). However, transgender individuals exhibited significantly higher risks for precancerous conditions compared to cisgender women (subdistribution hazard ratios [sHRs] 1.1, 95% CI 1.0-1.3) and cisgender men (sHR 1.3; 95% CI 1.2-1.5). Specifically, transgender individuals were more likely to develop colorectal precancer (sHR 1.2; 95% CI 1.1-1.4) compared to cisgender women, as well as human papillomavirus-related precancer (sHR 1.8; 95% CI 1.4-2.3) and colorectal precancer (sHR 1.4; 95% CI 1.2-1.6) compared to cisgender men. Subgroup analyses showed similar patterns in both female-to-male and male-to-female individuals compared with their matched cisgender counterparts. Interaction analyses revealed stronger protective effects of private insurance or Medicare against precancers in transgender individuals than in cisgender peers, while being non-Hispanic Black or having substantial comorbidities were stronger risk factors among transgender individuals.

CONCLUSIONS: Transgender individuals showed a similar cancer incidence yet significantly higher precancer incidence compared with cisgender individuals, suggesting underdiagnosis or delayed detection. These findings highlight the need for tailored preventive care strategies, including targeted screenings and risk reduction interventions, to address cancer disparities in the transgender population.

PMID:40921087 | DOI:10.2196/73843

JMIR Res Protoc. 2025 Sep 8;14:e72370. doi: 10.2196/72370.

ABSTRACT

BACKGROUND: Approximately 69% of Americans with spinal cord injury (SCI) have neuropathic pain. Research suggests that impairments in mental body representations (MBRs; ie, representations of the body in the brain) likely contribute to neuropathic pain. Clinical trials in adults with SCI, focused on restoring MBR, led to improvements in sensation and movement as well as neuropathic pain relief. Scales measuring aspects of MBR exist, but none of them assess SCI-related MBR impairments.

OBJECTIVE: As our first aim, we will generate items for a new MBR scale for adults with SCI (the SCI-BodyMap). As our second aim, we will assess the interrater reliability, test-retest reliability, concurrent validity, face validity, and utility of the SCI-BodyMap.

METHODS: Our preliminary work will encompass initial item generation by SB, an Italian physical therapist (PT) specialized in cognitive multisensory rehabilitation, which is a therapeutic approach that focuses on restoring MBR in adults with neurological disorders and chronic pain. Further item refinements will be carried out by Italian PTs (n=7) and Brazilian PTs (n=3) specialized in cognitive multisensory rehabilitation. In aim 1, American PTs or occupational therapists (n=8) and adults with SCI (n=8) will provide feedback on the SCI-BodyMap. Next, American PTs or occupational therapists (n=3) will administer the SCI-BodyMap to adults with SCI (n=3) and provide more feedback during an in-person visit. In aim 2, four assessors will administer the SCI-BodyMap to adults with SCI (n=30) for interrater reliability. The self-report items will be administered at 2 separate time points to assess test-retest reliability. We will also administer the SCI-BodyMap to uninjured adults (n=30) to identify whether healthy adults score statistically different on the scale than adults with SCI. We will assess concurrent validity through correlations between the MBR scale, the Revised Body Awareness Rating Questionnaire, and the Multidimensional Assessment of Interoceptive Awareness-2.

RESULTS: As of August 2025, we have enrolled 8 PTs or occupational therapists and 8 adults with SCI for aim 1 as well as 29 adults with SCI and 13 uninjured adults for aim 2.

CONCLUSIONS: A reliable and valid MBR scale is needed to identify MBR deficits and evaluate intervention effects on MBR outcomes in adults with SCI. Improving MBR can lead to safer, more efficient day-to-day activities (eg, transfers); promote functional independence and quality of life; reduce neuropathic pain and spasms; and improve sensorimotor function.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/72370.

PMID:40921071 | DOI:10.2196/72370

JMIR Public Health Surveill. 2025 Sep 8;11:e70045. doi: 10.2196/70045.

ABSTRACT

BACKGROUND: Neighborhoods resulting from rapid urbanization processes are often saturated with eateries for local communities, potentially increasing exposure to unhealthy foods and creating diabetogenic residential habitats.

OBJECTIVE: We examined the association between proximity of commercial food outlets to local neighborhood residences and type 2 diabetes (T2D) cases to explore how local T2D rates vary by location and provide policy-driven metrics to monitor food outlet density as a potential control for high local T2D rates.

METHODS: This cross-sectional ecological study included 11,354 patients with active T2D aged ≥20 years geocoded using approximate neighborhood residence aggregated to area-level rates and counts by subdistricts (mukims) in Penang, northern Malaysia. We used the National Diabetes Registry complemented with data from medical records across 29 primary care clinics throughout the state. Food establishment data were retrieved from the Open Data Portal sourced through the Penang GeoHub, and urbanization indicators were retrieved from MyCensus 2020. We executed point-level proximity- and density-based area-level analysis through multimodel aspatial and spatial regression methods.

RESULTS: Our final hierarchical linear regression revealed that the distance to food complexes, hawker markets, kopitiams (a type of coffee shop), 24-7 convenience stores, fast food outlets, and public markets showed statistically significant associations (P<.05) with the age and BMI of patients with T2D. In the multiscale geographically weighted regression model, the adjusted R² values ranged from 0.15 to 0.62, with lower values observed across the mainland. The multiscale geographically weighted regression model yielded average β coefficients for densities of kopitiams (β=0.256), fast food outlets (β=-0.061), 24-7 convenience stores (β=0.028), supermarkets (β=0.122), public markets (β=0.067), and nasi kandar (a type of rice dish) restaurants (β=-0.064), urban growth rate (β=0.189), and population density (β=-0.080; t_65.835≥1.96 in all cases). We established population-attributable fractions suggesting that, if local neighborhoods underwent township restructuring to remove food complexes, hawker markets, or kopitiams, an estimated reduction of 0.21%, 0.27%, and 0.09%, respectively, in the risk of T2D cases in Penang would be anticipated. However, if local neighborhoods underwent township restructuring to add hawker complexes, nasi kandar restaurants, fast food outlets, 24-7 convenience stores, public markets, or supermarkets, an estimated reduction of between 0.07% and 0.64% in the number of residents with risk of T2D was estimated.

CONCLUSIONS: The reported variations provide insights into the associations between high neighborhood T2D rates and the density of a range of food outlets. We observed that these associations varied by place, providing insight into potential monitoring and policy considerations. This work provides evidence for interpretation at the individual and aggregate levels, shifting public health interventions from a generic to a targeted approach and prompting township planners to restructure food outlet accessibility or availability in local neighborhoods and to develop health behavior interventions for local communities for healthy food purchase and consumption.

PMID:40921070 | DOI:10.2196/70045

J Med Internet Res. 2025 Sep 8;27:e79080. doi: 10.2196/79080.

ABSTRACT

BACKGROUND: Lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual (LGBTQIA+) researchers and participants frequently encounter hostility in virtual environments, particularly on social media platforms where public commentary on research advertisements can foster stigmatization. Despite a growing body of work on researcher virtual hostility, little empirical research has examined the actual content and emotional tone of public responses to LGBTQIA+-focused research recruitment.

OBJECTIVE: This study aimed to analyze the thematic patterns and sentiment of social media comments directed at LGBTQIA+ research recruitment advertisements, in order to better understand how virtual stigma is communicated and how it may impact both researchers and potential participants.

METHODS: A total of 994 publicly visible Facebook comments posted in response to LGBTQIA+ recruitment advertisements (January to April 2024) were collected and analyzed. Text preprocessing included tokenization, stop-word removal, and lemmatization. Latent Dirichlet allocation was used to identify latent themes across the dataset. Sentiment analysis was conducted using the Bing Liu and National Research Council lexicons, with scores ranging from -1 (most negative) to 1 (most positive). Linguistic Inquiry and Word Count was used to quantify psychological and moral language features. Comments were also manually coded into four audience target groups (researchers, LGBTQIA+ community, general public, and other commenters), and language category differences were analyzed using 1-way ANOVAs with Bonferroni corrections.

RESULTS: Topic modeling identified three key themes: (1) “Transitions, Health, and Gender Dysphoria,” (2) “Polarized Debate and Response,” and (3) “Religious and Ideological Debates.” Topic 2 had the highest average prevalence (average γ=0.486, SD 0.21). Sentiment analysis revealed negative mean sentiment scores for all three topics: Topic 1 (-0.41, SD 0.48), Topic 2 (-0.21, SD 0.44), and Topic 3 (-0.35, SD 0.46). No topic exhibited a statistically significant predominance of positive sentiment. A 1-way ANOVA showed significant differences in linguistic tone across target groups: negative tone (F_3,990=12.84; P<.001), swearing (F_3,990=16.07; P<.001), and anger-related language (F_3,990=9.45; P<.001), with the highest levels found in comments directed at researchers. Comments targeting LGBTQIA+ individuals showed higher references to mental illness, morality, and threats to children. While affirming responses were less frequent and typically appeared within confrontational contexts, their presence highlights significant moments of solidarity and resistance.

CONCLUSIONS: This study documents a persistently hostile virtual environment for LGBTQIA+ research, where researchers are frequently dehumanized and LGBTQIA+ identities are pathologized. These findings reinforce stigma communication models and suggest a need for institutional responses that include mental health support, enhanced moderation tools, and policy advocacy. Future research should investigate how hostile discourse affects researchers’ well-being and recruitment outcomes, and evaluate interventions to foster more respectful engagement with LGBTQIA+ studies.

PMID:40921069 | DOI:10.2196/79080

J Med Internet Res. 2025 Sep 8;27:e76849. doi: 10.2196/76849.

ABSTRACT

BACKGROUND: Older adults are more vulnerable to severe consequences caused by seasonal influenza. Although seasonal influenza vaccination (SIV) is effective and free vaccines are available, the SIV uptake rate remained inadequate among people aged 65 years or older in Hong Kong, China. There was a lack of studies evaluating ChatGPT in promoting vaccination uptake among older adults.

OBJECTIVE: This study aimed to evaluate the effectiveness of ChatGPT with retrieval-augmented generation in increasing SIV uptake among older adults over a 3-month study period in Hong Kong, China. Participants in an ongoing observational cohort study conducted in the same period served as the comparison group.

METHODS: A quasi-experimental study was conducted between November 2024 and April 2025. Participants were (1) aged ≥65 years, (2) possessed a Hong Kong ID, (3) able to speak and comprehend Cantonese, (4) smartphone users, and (5) had no SIV uptake for the approaching flu season. Those with a diagnosis of cognitive impairment or dementia, blindness or deafness, or known contraindications to the SIV were excluded. Participants were recruited through random telephone calls. There were 45 and 55 participants in the SIV-ChatGPT group and the comparison group, respectively. All participants completed follow-up surveys at T1 (1 month after the baseline survey, for the SIV-ChatGPT group only) and T2 (3 months after the baseline survey, for both groups). Participants in the SIV-ChatGPT group gained access to SIV-ChatGPT in the format of a web-based app after completion of the baseline survey. They could use SIV-ChatGPT repeatedly throughout a 1-month intervention period and were free to spend as much time as they wanted with SIV-ChatGPT. Intention-to-treat analysis was used for outcome analyses.

RESULTS: At T2, the SIV uptake rate was higher in the SIV-ChatGPT group than the comparison group (15/45, 33% vs 8/55, 14.3%; adjusted odds ratio 2.72, 95% CI 1.01-7.35, P=.048). All participants were able to provide receipts to validate their SIV uptake. In the SIV-ChatGPT group, 40.5% (15/37) of participants who used SIV-ChatGPT at least once reported a SIV uptake at T2, which was significantly higher than nonusers (0/8, 0%; P=.04). Among the 37 SIV-ChatGPT users, the mean score of the System Usability Scale was 67.1 (SD 14.9). Levels of subjective behavioral and cognitive engagement with SIV-ChatGPT were relatively high, while the affective engagement was moderate.

CONCLUSIONS: SIV-ChatGPT was feasible and acceptable and demonstrated preliminary effectiveness in increasing SIV uptake among people aged 65 years or older. This study also provided implications to improve the performance of SIV-ChatGPT. A full-powered randomized controlled trial should be considered to evaluate its efficacy.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06679647; https://clinicaltrials.gov/study/NCT06679647.

PMID:40921067 | DOI:10.2196/76849