Category: Statistics

JMIR Public Health Surveill. 2025 Jul 16;11:e68854. doi: 10.2196/68854.

ABSTRACT

BACKGROUND: People with opioid use disorder (OUD) have the highest rates of hepatitis C virus (HCV) infection. Despite the availability of curative HCV medication, people with OUD have limited health care access largely due to stigma. In a recent, pragmatic, randomized controlled trial (RCT), we compared a facilitated telemedicine intervention for HCV treatment integrated into opioid treatment programs (OTPs) with off-site referral. Facilitated telemedicine is bidirectional videoconferencing between a remote provider and a patient, supported by a case manager who facilitates the telemedicine encounter. The case manager schedules telemedicine visits, provides appointment reminders, and operates the digital equipment. Among 602 participants in the RCT, 90% (n=262) were cured through facilitated telemedicine and 39% (n=123) were cured through off-site referral. In this work, a multidisciplinary group of investigators, who directed the RCT, conducted a workshop, “Advancing Viral Hepatitis Screening and Treatment in Opioid Treatment Settings – Models & Resources,” at the American Association for Treatment of Opioid Dependence Conference in May 2024 to disseminate knowledge of facilitated telemedicine, including implementation considerations. We highlighted facilitated telemedicine as a patient-centered, sociotechnical, pragmatic health care delivery model for underserved populations.

OBJECTIVE: This study aimed to identify lessons learned to successfully overcome challenges of facilitated telemedicine implementation for HCV treatment integrated into OTPs.

METHODS: We partnered with the National Alliance of State and Territorial AIDS Directors in planning the workshop. The workshop consisted of 7 presentations on topics related to facilitated telemedicine implementation. The workshop was recorded and transcribed by Zoom (Zoom Communications). The transcripts served as data for the thematic analysis. The transcripts were interpreted to elucidate patterns of meanings and nuances derived from each presentation. In an iterative process, preliminary findings were compared and coalesced into themes. Verbatim quotes from the workshop were highlighted to support the themes.

RESULTS: We developed 3 themes. First, patient-centered care promotes HCV treatment for underserved populations through facilitated telemedicine. Case managers leveraged the destigmatizing environment of the OTP to build trust with patients, promoting an HCV cure through facilitated telemedicine. Second, sociotechnical approaches expand health care access for people with OUD. To be effective, facilitated telemedicine integrates 2 necessary components, a social aspect and a technical aspect. Third, facilitated telemedicine supports pragmatic research emphasizing people with OUD. Pragmatic research of facilitated telemedicine is needed to assess sustainability and scaling considerations beyond OTPs. Overall, we found that facilitated telemedicine overcame the digital divide, promoting access to digital technology, internet provision, and digital literacy.

CONCLUSIONS: Facilitated telemedicine incorporates both a technical and a social component. The technical component largely addresses geographical challenges, while the social component addresses temporal (ie, care coordination) issues, promotes trust, and largely assuages patients’ concerns related to HCV treatment. The patient-centered, sociotechnical intervention can address the digital divide, thereby increasing health care access.

PMID:40669057 | DOI:10.2196/68854

JMIR Med Inform. 2025 Jul 16;13:e69328. doi: 10.2196/69328.

ABSTRACT

BACKGROUND: Wearable devices are increasingly used for monitoring health and detecting digital biomarkers related to chronic diseases such as metabolic syndrome (MetS). Although circadian rhythm disturbances are known to contribute to MetS, few studies have explored wearable-derived circadian biomarkers for MetS identification.

OBJECTIVE: This study aimed to detect and analyze sleep and circadian rhythm biomarkers associated with MetS using step count and heart rate data from wearable devices and to identify the key biomarkers using explainable artificial intelligence (XAI).

METHODS: Data were analyzed from 272 participants in the Korean Medicine Daejeon Citizen Cohort, collected between 2020 and 2023, including 88 participants with MetS and 184 without any MetS diagnostic criteria. Participants wore Fitbit Versa or Inspire 2 devices for at least 5 weekdays, providing minute-level heart rate, step count, and sleep data. A total of 26 indicators were derived, including sleep markers (midsleep time and total sleep time) and circadian rhythm markers (midline estimating statistic of rhythm, amplitude, interdaily stability, and relative amplitude). In addition, a novel circadian rhythm marker, continuous wavelet circadian rhythm energy (CCE), was proposed using continuous wavelet transform of heart rate signals. Statistical tests (t test and the Wilcoxon rank sum test) and machine learning models-Shapley Additive Explanations, explainable boosting machine, and tabular neural network-were applied to evaluate marker significance and importance.

RESULTS: Circadian rhythm markers, especially heart rate-based indicators, showed stronger associations with MetS than sleep markers. The newly proposed CCE demonstrated the highest importance for MetS identification across all XAI models, with significantly lower values observed in the MetS group (P<.001). Other heart rate-based markers, including relative amplitude and low activity period, were also identified as important contributors. Although sleep markers did not reach statistical significance, some were recognized as secondary predictors in XAI-based analyses. The CCE marker maintained a high predictive value even when adjusting for age, sex, and BMI.

CONCLUSIONS: This study identified CCE and relative amplitude of heart rate as key circadian rhythm biomarkers for MetS monitoring, demonstrating their high importance across multiple XAI models. In contrast, traditional sleep markers showed limited significance, suggesting that circadian rhythm analysis may offer additional insights into MetS beyond sleep-related indicators. These findings highlight the potential of wearable-based circadian biomarkers for improving MetS assessment and management.

PMID:40669055 | DOI:10.2196/69328

JMIR Serious Games. 2025 Jul 16;13:e71385. doi: 10.2196/71385.

ABSTRACT

BACKGROUND: Heart failure (HF) is a growing global health concern, and adherence to early cardiac rehabilitation (CR) remains suboptimal. Exergaming is a promising alternative to conventional exercise programs for patients with HF. However, existing research has limitations, and the integration of exergaming into clinical practice remains challenging. Most notably, current studies often rely on commercially available systems that are not tailored to needs specific to patients with HF, lack long-term adherence strategies, and have limited evaluation in the initial phases of cardiac rehabilitation.

OBJECTIVE: This study aimed to design, develop, and assess the usability of a novel exergaming prototype (ie, HEFMOB), integrating immersive virtual reality (VR), real-time biometric monitoring, and autonomous session management to support early-phase, exercise-based CR in patients with HF.

METHODS: A multidisciplinary team developed HEFMOB through iterative prototyping. The final system included a pedal-based VR cycling game and an upper-limb mobilization minigame, with real-time monitoring of heart rate, blood pressure, and peripheral capillary oxygen saturation. Usability was assessed in two phases: (1) an expert evaluation and refinement phase and (2) a single-session usability phase involving 10 patients with HF (4 female). The sessions were recorded and individually evaluated by 2 researchers using the Serious Game Usability Evaluator tool. After each session, the participants completed the System Usability Scale (SUS) and a subscale of Intrinsic Motivation Inventory (IMI) to rate the usability of the exergaming prototype and enjoyment, respectively. Descriptive statistics were reported.

RESULTS: The participants had a mean age of 64.8 (SD 8.4) years, BMI of 26.7 (SD 4.6) kg/m2, and left ventricular ejection fraction of 40.5% (SD 7.4%). All participants completed the session without adverse events. The SUS score averaged 71.5, SD 17.8 (indicating good usability) and IMI scores indicated very high enjoyment (mean 25.1, SD 3.5). A total of 136 gameplay-related events were recorded: negative (n=76, mostly confusion), neutral (n=49), and positive (n=11). Interface-related issues (n=61) were most common, followed by design (n=52) and hardware (n=23).

CONCLUSIONS: HEFMOB appears to be a promising, engaging, and well-tolerated tool for delivering tailored exergaming interventions in patients with HF. High usability and enjoyment ratings support its acceptability, while structured user experience analysis provided valuable insights for system refinement. This study marks a critical step toward integrating personalized, gamified exercise in inpatient settings, especially where early mobilization is lacking. Building on these findings, future research will assess long-term usability and clinical impact through a multicenter randomized controlled trial.

PMID:40669044 | DOI:10.2196/71385

J Nurs Adm. 2025 Jul 15. doi: 10.1097/NNA.0000000000001599. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to describe the 6-month outcomes of a pilot study testing a web-based decision-making tool for nurse managers (NMs) to use in determining RN hiring needs, and to evaluate the effect on workforce stability and NM satisfaction at a large academic hospital.

BACKGROUND: To ensure that day-to-day staffing in inpatient units is adequate, NMs must be proactive in determining hiring needs. However, adequate tools to guide this skill are lacking, leading to administrative burden. Simultaneously, reducing the administrative burden of NMs is a priority to develop healthy work environments, foster staff development, and facilitate patient care.

METHODS: Researchers used a matched cohort comparison (24 clinical units; 1177.57 full-time equivalents) to evaluate the impact of HealthForceRx, a Web-based workforce management tool, on workforce stability and NM satisfaction. Researchers measured workforce stability as the gap between functional RNs and budgeted RNs. Primary and secondary analyses were performed using mixed model analysis of variance.

RESULTS: The intervention group demonstrated a statistically significant improvement in the RN functional gap from baseline to 6 months post (P = .003), in contrast to no significant change in control units. Nurse managers also reported significant improvements in the tools available to manage staffing and determine hiring needs (P = .15), competencies (P = .28), and RN turnover (P = .007).

CONCLUSIONS: The use of this innovative software tool to proactively determine RN hiring needs may improve workforce stability and NM satisfaction.

PMID:40669016 | DOI:10.1097/NNA.0000000000001599

J Indian Prosthodont Soc. 2025 Jul 1;25(3):266-275. doi: 10.4103/jips.jips_64_25. Epub 2025 Jul 16.

ABSTRACT

AIM: Maxillectomy patients frequently have speech impairments resulting from the loss of the oral-nasal partition. Prosthodontic rehabilitation with an obturator helps restore speech intelligibility, with its success largely dependent on accurate impression recording of maxillary defects. This investigation evaluated the effectiveness of conventional versus digital impression techniques in the context of speech analysis, specifically using Hindi vowels, in maxillectomy patients rehabilitated with obturators.

STUDY SETTING AND DESIGN: This research, designed as a quasi-experimental study, was undertaken at a tertiary care hospital.

MATERIAL AND METHODS: The study included 20 patients needing obturators, assigned to two groups: one received prostheses fabricated with conventional impressions, and the other with digital techniques. Speech parameters, including fundamental frequency, formant frequencies (F1, F2, F3), intensity, jitter, shimmer, and maximum phonation duration (MPD), were analyzed using Praat software before and three months after rehabilitation. Hindi vowels aa /a:/, ii /i:/, and uu /u:/ were sustained at a controlled intensity. Swallowing efficiency was assessed via the water swallow test.

STATISTICAL ANALYSIS USED: The Wilcoxon Rank Sum test or exact test was used to compare the data, with a p-value < 0.05 considered significant.

RESULTS: The most common maxillectomy defects were Brown class 2b. After three months, significant improvement in speech parameters and swallowing efficiency was seen in both groups of participants. However, no statistically significant differences (P > 0.05) were found between the conventional and digital impression groups.

CONCLUSIONS: This novel study compared conventional and digital impressions for speech analysis using Hindi vowels in maxillectomy patients after rehabilitation with an obturator. Voice recording and acoustic analysis using Hindi vowels provide valuable insights into speech rehabilitation outcomes in maxillectomy patients. Both conventional and digital impression techniques effectively fabricate obturators, improving speech characteristics and intelligibility. Both methods can be used for maxillectomy patients, allowing flexibility in clinical practice.

PMID:40669000 | DOI:10.4103/jips.jips_64_25

J Indian Prosthodont Soc. 2025 Jul 1;25(3):258-265. doi: 10.4103/jips.jips_97_25. Epub 2025 Jul 16.

ABSTRACT

AIM: To evaluate the effects of hydroxyapatite gypsum puger-cassava starch (HAGP-CS) scaffold on the number of osteoblasts and alkaline phosphatase (ALP) and osteocalcin (OCN) expression in the alveolar bone rat model.

SETTINGS AND DESIGN: In vivo study.

MATERIALS AND METHODS: Thirty-six Wistar rats were randomly divided into three groups: rat sockets were given a 1 mm × 1 mm × 1 mm HAGP scaffold, rat sockets were given a 1 mm × 1 mm × 1 mm HAGP-CS, and a control group (rat sockets were not given scaffold material). Following lower left molar extraction, scaffold materials were applied to the sockets. Assessments were conducted on days 7th, 14th, and 28th, with osteoblast counts determined via hematoxylin-eosin staining, and ALP and OCN expressions were analyzed using immunohistochemistry (IHC) staining.

STATISTICAL ANALYSIS USED: Two-way analysis of variance and Tukey’s test.

RESULTS: A significant increase in osteoblast count was observed on day 28 (P = 0.001). In addition, significant differences were noted in ALP expression on day 7 (P = 0.030) and day 28 (P = 0.001), as well as in OCN expression on days 7 and 28 (P = 0.001) across the groups.

CONCLUSIONS: Administering a HAGP-CS scaffold significantly enhances osteoblast proliferation and increases ALP and OCN expression in the alveolar bone rat model.

PMID:40668999 | DOI:10.4103/jips.jips_97_25

J Indian Prosthodont Soc. 2025 Jul 1;25(3):251-257. doi: 10.4103/jips.jips_130_25. Epub 2025 Jul 16.

ABSTRACT

AIM: Sustainability of dental polymethyl methacrylate (PMMA) in acidic environments is crucial as oral pH fluctuations can degrade the mechanical properties of denture bases. PMMA strengthening with polypropylene (PP) mesh has improved mechanical properties, but its effectiveness in acidic conditions remains underexplored. This investigation aimed to evaluate the mechanical properties of PP mesh reinforced PMMA (PP-PMMA) on exposure to an acidic environment as against unreinforced denture base resin (UN-PMMA).

SETTINGS AND DESIGN: Experimental In-vitro study.

MATERIALS AND METHODS: A total of 120 PMMA samples were prepared as per standardized guidelines and divided into two groups as unreinforced and PP – PMMA. Prepared specimens were immersed in artificial saliva and simulated gastric acid (0.06M HCl, pH 1.2) at 37°C for 96 hours to simulate long-term clinical exposure to an acidic environment. Flexural strength, impact strength, surface roughness and microscopic characteristics were assessed with aid of universal testing machine, Izod’s impact tester, profilometer and high-resolution scanning electron microscope (HR-SEM) in order.

STATISTICAL ANALYSIS USED: The data were statistically analyzed using ANOVA and independent t-test set at a significance level of P-values less than 0.05.

RESULTS: PP-PMMA exhibited significantly higher flexural strength in simulated gastric acid (70.03±1.4MPa) compared to UN-PMMA (68.77±2.2MPa) (P < 0.05). In simulated gastric acid (HCl), PP-PMMA showed no significant difference in surface roughness compared to UN-PMMA (P = 0.29). However, in artificial saliva, PP-PMMA exhibited lower surface roughness (0.47±0.14μm) than UN-PMMA (0.56±0.08μm) (P < 0.05), indicating improved smoothness. Impact strength remained comparable between groups in both immersion conditions (P > 0.05). The presence of mesh between the layers restricted the ingress of saliva and HCl as was perceived with rougher surface in the external area.

CONCLUSION: PP reinforcement improved the flexural strength of PMMA in acidic environments and maintained surface roughness in acidic environments but did not significantly enhance impact strength. Polypropylene mesh reinforcement effectively reduced porosities and maintained structural integrity within the PMMA matrix. These findings suggested that polypropylene mesh reinforcement enhances the durability of denture base materials and benefits patients with gastroesophageal reflux condition.

PMID:40668998 | DOI:10.4103/jips.jips_130_25

J Indian Prosthodont Soc. 2025 Jul 1;25(3):244-250. doi: 10.4103/jips.jips_33_25. Epub 2025 Jul 16.

ABSTRACT

AIM: To validate the CBCT classification for immediate implant placement (IIP) given by Howard Gluckman in the local population of Gujarat, India, and additionally evaluate the available bone beyond the tooth apex for IIP in the direction of proposed osteotomy.

SETTING AND DESIGN: Cross-sectional Observational study.

MATERIALS AND METHODS: A total of 103 cone beam computed tomography (CBCT) scans involving the six maxillary anterior teeth were scrutinized in the radial plane. Each CBCT was divided into six slices (n = 618), which were classified according to Gluckman’s classification, followed by making the osteotomy lines. Six measurements (L, W1, W2, W3, W4, and W5) were made from root to nasal floor. Bone length (L) was measured in the direction of proposed osteotomy, whereas the bone width was measured at five different points along the proposed osteotomy.

STATISTICAL ANALYSIS USED: Chi-square p value, One-way ANOVA and Post hoc Tukey test.

RESULTS: As per Gluckman’s classification, it was found that class I showed the highest bone width with the lowest bone length, whereas Class V showed the lowest bone width. The highest bone length was observed in Class IV. The prevalence of different radial root position (RRP) starting from class I to class V was 1%, 75%, 15%, 16%, and 3%, respectively.

CONCLUSION: A distinct correlation was found between the anterior root position and the available bone between the root tip and the nasal floor as per Gluckman’s classification.

CLINICAL SIGNIFICANCE: This study helps in the radiographic evaluation of available bone around the roots of maxillary anterior teeth, which is a critical determining factor for treatment planning in IIP cases. A deep knowledge of RRP, bone morphology, and available alveolar bone beyond the apex provides useful perception to the clinician to plan surgical and grafting procedures to achieve primary stability. This will also help the clinicians to visualize the final prosthetic outcome with respect to the position of access hole.

PMID:40668997 | DOI:10.4103/jips.jips_33_25

J Indian Prosthodont Soc. 2025 Jul 1;25(3):235-243. doi: 10.4103/jips.jips_270_24. Epub 2025 Jul 16.

ABSTRACT

AIM: The aim of the study is to assess the antimicrobial efficacy at Implant-Abutment Interface (IAI) coated with metal ions (silver and gold) causing peri-implantitis, with the objective of comparing its antimicrobial properties.

STUDY SETTING AND DESIGN: The study conducted is an in vitro experimental study.

MATERIAL AND METHODS: A total of 90 specimens 45 Titanium alloy discs substitute for Implant (Ti-6Al-4V, Grade V) and 45 Stainless Steel (315L SS) disc substitute for Abutment were serially ground, polished and cleaned to be coated with gold (Au) and silver (Ag) ions by sputtering technique which was later tested for antimicrobial efficacy by means of agar disk diffusion method with gram negative microorganisms causing peri-implantitis, the measurement of inhibition zone (ZOI) encircling each sample were taken and noted.

STATISTICAL ANALYSIS USED: The mean zone of inhibition data for all the groups were subjected for statistical analysis by Tukey’s multiple comparison test and one way ANOVA.

RESULTS: The results showed that the antimicrobial efficacy of gold coated Titanium alloy-Stainless steel, (TiAu -SSAu) and Silver coated Titanium- stainless steel (TiAg-SSAg) were significantly higher with a mean ZOI value of 24.6mm (Prevotella intermedia) for gold coated and 17 mm for silver coated groups compared to Uncoated group Titanium alloy- stainless steel (Ti-SS) with a mean zone of inhibition of 10mm, also proved by Tukeys multiple comparison test with statistical significant difference in the antibacterial activity of gold coated group compared to other groups where p <0.0001 against Porphyromonas Gingivalis, Prevotella Intermedia and Aggregatibacter Actinomyces.

CONCLUSIONS: The surface modification of titanium alloy and stainless steel with metal ion coating (Au and Ag) significantly reduces the signs of peri-implantitis and thus leading to lasting success of implants.

PMID:40668996 | DOI:10.4103/jips.jips_270_24

J Indian Prosthodont Soc. 2025 Jul 1;25(3):229-234. doi: 10.4103/jips.jips_49_25. Epub 2025 Jul 16.

ABSTRACT

AIM: Microbial assessment of internal recess of two different internal implant connections in an in vivo study.

STUDY SETTINGS AND DESIGN: This randomized, in vivo study included 40 patients requiring mandibular single-tooth implant-supported prostheses, allocated into two equal groups based on implant connection design.

MATERIALS AND METHODS: Group Internal Hex (IH) and group Conical Connection (CC) received implants with IH and CC, respectively. On the day of prosthetic loading, peri-implant sulcular fluid (PISF) sample was collected and stored. PISF samples were recollected after 3 months. Subsequently, the screw access hole was exposed, and the abutment screw was removed. Implant-abutment recess was washed with saline, lavage was sent for microbiological assay. The abutment screw and crown were restored. PISF was analyzed for interleukin-6 (IL-6).

STATISTICAL ANALYSIS USED: For nonparametric values Chi square test and for parametric values t-test was used to analyse the data.

RESULTS: No implant failure or patient fallout was observed. In Group IH, 17 out of 20 samples were positive for aerobic viz-a-viz 7 samples from Group CC; P = 0.001. For anaerobic bacteria, similar results were obtained with a number of positive samples 19 as compared to 6 in respective groups; P = 0.00002. IL-6 values did not differ significantly from baseline to 3 months in either group.

CONCLUSION: Within the limitations of the study, results show higher bacterial contamination of implant recess in IH than CC. However, the bacterial load had an insignificant contribution to IL-6 levels in PISF of the patients of either group in this time period.

PMID:40668995 | DOI:10.4103/jips.jips_49_25