Category: Statistics

BMC Health Serv Res. 2025 Aug 5;25(1):1027. doi: 10.1186/s12913-025-13048-2.

ABSTRACT

BACKGROUND: Monitoring a patient’s functional status in the rehabilitation process is essential for the ongoing improvement of the quality of the rehabilitation services offered. This possibility is provided by the use of the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets developed on its basis. The purpose of this study was to validate and evaluate the use of the ICF Rehabilitation Set in rehabilitation patients in clinical practice in southeastern Poland.

METHODS: This study included patients who required comprehensive rehabilitation in a tertiary care rehabilitation centre. The study used the Polish version of a rating reference guide for the ICF Rehabilitation Set and the Barthel Index. The assessment was carried out by an interdisciplinary team, which established the ICF qualifier values by consensus. Interrater reliability was assessed using intraclass correlation coefficients (ICCs). Convergent validity was assessed using Spearman correlation coefficients between the Disability Index (DI) and the Barthel Index (BI). To assess the effectiveness of rehabilitation in the study group, a paired Wilcoxon test was used to compare the measurements of the two ICF codes.

RESULTS: This study demonstrated the consistency and reliability of the reference guide for the ICF Rehabilitation Set. The ICC values were very high (for B620; D450; D640, the ICC was 1.000) and high (for E155, the ICC was 0.793). The individual entries from the ICF Rehabilitation Set were found to have very high concordance for assessing individual qualifiers between researchers (the ICC for the DI was 0.995). The ICF Rehabilitation Set scores and the calculated DI were correlated with the BI scores. The ICF Rehabilitation Set is sensitive to changes in the functional status of patients undergoing rehabilitation and is consistent with the results obtained by the BI measure. There was also a statistically significant improvement in patients’ functional status after rehabilitation.

CONCLUSIONS: The ICF Rehabilitation Set and the developed rating reference guide are reproducible, consistent and relevant and can be used in clinical settings to collect health information from people undergoing rehabilitation. Further research is needed to strengthen the evidence to validate the ICF in Poland.

TRIAL REGISTRATION: The study was registered in the clinical trial registry at ClinicalTrials.gov (NCT06718036, date of registration 2024-11-30, retrospectively registered).

PMID:40764554 | DOI:10.1186/s12913-025-13048-2

BMC Public Health. 2025 Aug 5;25(1):2655. doi: 10.1186/s12889-025-23853-3.

ABSTRACT

BACKGROUND: Self-directed violence encompasses both suicide and self-injury. United States correctional settings face high self-directed violence rates. Training correctional behavioral health clinicians (BHCs) in evidence-based self-directed violence prevention practices represents one solution. The Core Competency Model for Corrections (CCM-C) is a self-directed violence prevention training program addressing clinician self-management (e.g., managing personal reactions to self-directed violence) and clinical care (e.g., eliciting evidence-based risk and protective factors) skills. The present study held aims to: (1) assess CCM-C feasibility, appropriateness, acceptability, and usability; (2) evaluate short-term impacts on BHC self-directed violence knowledge, attitudes, and skill usage; and (3) explore short-term impacts on BHC compassion fatigue.

METHODS: The present study was a statewide hybrid feasibility-effectiveness trial evaluating the CCM-C taking place between January and December 2024. Pre-training feedback was gathered from a corrections advisory panel (N = 7). For the trial implementation, we conducted a waitlist control sequential cross-over design. BHCs (N = 60) were randomly assigned to two training groups: Baseline training versus waitlist control. BHCs provided quantitative and qualitative survey input on CCM-C feasibility outcomes (aim 1), and completed self-report inventories of self-directed violence-related outcomes (aims 2 and 3). Descriptive statistics and thematic analysis assessed feasibility outcomes. Repeated-measures analysis of variance (ANOVA) tests examined CCM-C outcomes.

RESULTS: CCM-C was highly acceptable, appropriate, feasible, and usable. Recommended improvements included removing non-corrections content, enhancing opportunities for BHC participation and interaction, and creating participant handout packages. CCM-C increased BHC self-directed violence prevention knowledge, perceived skill mastery, intent/actual use of training content, and lowered compassion fatigue levels. Attitudes toward intervening with a suicidal person only improved for the waitlist control group. Attitudes towards incarcerated individuals who self-harm remained unchanged.

DISCUSSION: Early results show CCM-C to be a feasible, effective self-directed violence prevention training program for correctional BHCs. Results support broader CCM training literature and a social-cognitive training model. Statewide partners will generate the CCM-C Toolkit, a package comprising training materials, implementation guidance, and train-the-trainer materials. The Toolkit will provide accessible resources for further CCM-C implementation, adaptation, and evaluation.

TRIAL REGISTRATION: This study was registered at clinicaltrials.gov (NCT06359574).

PMID:40764547 | DOI:10.1186/s12889-025-23853-3

BMC Infect Dis. 2025 Aug 5;25(1):986. doi: 10.1186/s12879-025-11382-8.

ABSTRACT

INTRODUCTION: Hepatitis E virus (HEV) infection poses a significant public health challenge, particularly in immunocompromised populations such as those living with HIV. Limited data exist on HEV seroprevalence and its correlates among HIV-positive individuals in urban low-resource settings, especially in the aftermath of disasters. This study investigates HEV seroprevalence and risk factors among HIV positive individuals in 2016, a post-earthquake period in Kathmandu, Nepal, with relevance to ongoing challenges in 2025.

METHODS: We conducted a cross-sectional serological study among 200 HIV-positive individuals from Sukraraj Tropical and Infectious Disease Hospital’s (STIDH) Antiretroviral Therapy (ART) center in Kathmandu. Serological testing determined anti-HEV IgG and IgM status using Wantai Hepatitis E (HEV-IgG/M) ELISA kits. Sociodemographic, behavioral, and clinical data were collected via structured interviews and medical records. Multivariable logistic regression identified independent predictors of anti-HEV IgG seropositivity. Statistical analyses used Chi-square, Mann-Whitney U, and Cochran’s Q tests, with p < 0.05 considered significant. A comparative general population sample (n = 100) from earthquake-affected districts was also analyzed.

RESULTS: Overall, 43.5% (87/200) of HIV-positive participants tested positive for anti-HEV IgG. Key demographic predictors included increasing age, which showed a significant non-linear association (adjusted OR = 3.95 for age, 0.60 for age²; p < 0.001), and a marginal association with male gender (aOR = 2.03; p = 0.059). In contrast, no significant associations were observed between HEV seropositivity and specific drinking water sources, water processing methods, eating habits, smoking status, CD4 count, HIV viral load suppression, common comorbidities, or routine liver and hematological markers. anti-HEV IgG seroprevalence was considerably higher than that of Hepatitis B virus (4.5%) and Hepatitis C virus (5.0%) in the cohort and notably absent in a comparative general population sample. The predictive model showed good performance (AUC = 0.80), supporting its exploratory utility.

CONCLUSION: Our findings reveal a high burden of past HEV exposure among HIV-positive individuals in post-earthquake Kathmandu, with age being a key correlate. The absence of HEV IgG positivity in the general population sample suggests that HEV exposure during this period may have been localized to vulnerable clinical groups. The lack of association with traditional behavioral or clinical markers highlights the complexity of transmission in this setting. These results underscore the need to integrate HEV awareness and targeted screening into HIV care in endemic regions. Future studies should prioritize longitudinal follow-up, genotype surveillance, and environmental sampling to inform public health preparedness and response.

PMID:40764531 | DOI:10.1186/s12879-025-11382-8

BMC Gastroenterol. 2025 Aug 5;25(1):554. doi: 10.1186/s12876-025-04150-0.

ABSTRACT

BACKGROUND: Delirium frequently occurs as a severe complication among patients with acute pancreatitis (AP), contributing to extended hospital stays, higher mortality rates, and lasting cognitive deficits. The pathogenesis of delirium in this setting is strongly influenced by metabolic abnormalities, including disturbances in electrolyte balance and widespread inflammation. Although the albumin-corrected anion gap (ACAG) is a recognized indicator of metabolic dysfunction, its relevance to delirium in AP patients has not been adequately investigated.

METHODS: This study utilized patient records from the MIMIC-IV database to investigate how ACAG relates to the onset of delirium in individuals with acute pancreatitis. Analytical approaches included the use of summary statistics, Kaplan-Meier survival analyses, receiver operating characteristic (ROC) curve evaluation, and both univariable and multivariable Cox proportional hazards models. To capture potential nonlinear effects, restricted cubic spline (RCS) modeling was implemented. Subgroup analyses were conducted to examine possible demographic and clinical effect modifiers. Additionally, several machine learning algorithms-such as the Random Forest-were employed to further evaluate the predictive power of ACAG.

RESULTS: Elevated levels of ACAG were independently linked to an increased likelihood of developing delirium during both the 28-day hospitalization period and throughout the ICU stay. Results from the multivariable Cox proportional hazards analysis indicated that each incremental rise in ACAG was associated with a greater risk of delirium (hazard ratio: 1.06, 95% confidence interval: 1.02-1.10, p < 0.001). The application of restricted cubic spline modeling verified the linear nature of this association. Among the machine learning models, the Random Forest achieved superior predictive accuracy (AUC = 0.81), and SHAP analysis highlighted ACAG as a primary determinant in model prediction.

CONCLUSIONS: The ACAG emerged as an independent predictor of delirium among individuals with acute pancreatitis, displaying a linear association with the risk of delirium onset. When compared to other commonly used biomarkers, ACAG exhibited enhanced predictive capacity for identifying patients at risk. These findings suggest that ACAG could serve as a practical clinical marker for the early detection and prompt management of delirium in this patient population.

PMID:40764528 | DOI:10.1186/s12876-025-04150-0

Sci Rep. 2025 Aug 5;15(1):28522. doi: 10.1038/s41598-025-10542-9.

ABSTRACT

To assess the 1-month outcomes of visual performance and positional stability of capsule-fixated intraocular lenses (IOLs) in patients with IOL-Bag complex dislocation. We enrolled 36 eyes (34 patients) with IOL-Bag complex dislocation due to pseudoexfoliation syndrome. Patients with intraoperative complications or prior posterior capsule Nd-YAG laser were excluded. Surgical intervention involved creating a superior service keratotomy and using introflective sutures for IOL fixation. Best Corrected Visual acuity (BCVA), endothelial cell counts, and tonometry were assessed at multiple postoperative time points. We also evaluated the mean spherical equivalent (SE), and the residual cylinder and sphere at each follow-up. This study has been successfully registered on ClinicalTrials.gov public (Identifier NCT06423079). The study included 36 eyes, with 22 having a one-piece IOL, 2 with a one-piece IOL plus capsular tension ring, and 12 with a three-piece IOL. Our technique demonstrates a statistically significant improvement in BCVA 1 year after surgery compared to BCVA at the time of IOL dislocation (preoperative BCVA 1.45 ± 0.81 vs 1 year 0.06 ± 0.09 logMAR; p < 0.001). There were no statistically significant differences when comparing the BCVA before the IOL dislocation with the 1-year post-operative BCVA (p > 0.13). No intraocular pressure fluctuations (preoperative IOP 15.0 ± 2.43 vs 1 year IOP 14.69 ± 2.27 p > 0.3), changes in endothelial cell counts (CC) (Preoperative CC: 1812 ± 461 cell/mm² vs 1 year 1760 ± 329 cell/mm²; p > 0.3), or significant complications were observed. This novel surgical technique may represent a viable, economic, and durable solution to restore dislocations of IOLs accessible from the anterior chamber that respect the cornea and restores visual function without damaging ocular structures.

PMID:40764517 | DOI:10.1038/s41598-025-10542-9

Sci Rep. 2025 Aug 5;15(1):28625. doi: 10.1038/s41598-025-09012-z.

ABSTRACT

The etiology of moyamoya disease (MMD) remains unknown. The main pathological finding is fibrocellular thickening of the intima, irregular undulation of the internal elastic lamina affecting the distal portions of the internal carotid artery and A1 and M1 segments. Our aim is to describe the histological and electron microscope ultrastructural characteristics of cortical MMD vessels (middle cerebral artery) in hemorrhagic and ischemic presentation along different Suzuki stages. From January 2022 to December 2022, we collected clinical and radiological data of 310 patients with MMD, among them we identified 52 patients that underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass. We collected arterial walls (excisional arteriotomy) of the recipient arteries specifically, M3 or M4 segments of the MCA. Observations and micrographs were captured utilizing an HT7700 transmission electron microscope. MMD patients exhibit severe internal elastic lamina (IEL) changes as compared to patients with intracranial atherosclerosis. Hemorrhagic MMD presentation showed a higher score of IEL ruptured when comparing to ischemic presentation. Endothelial cells in hemorrhagic MMD showed more significant contraction compared to those in ischemic moyamoya disease. Hemorrhagic and ischemic MMD patients showed no statistically significant differences when correlated to Suzuki stages and cerebral perfusion. MMD patients exhibit IEL changes and endothelial cells contraction extending into the distal segments of the middle cerebral artery. Hemorrhagic MMD presentation has higher IEL rupture score making these patients probably more susceptible for hemorrhage. This study provides an inside of the extension of MMD into the brain surface.

PMID:40764498 | DOI:10.1038/s41598-025-09012-z

Sci Rep. 2025 Aug 5;15(1):28510. doi: 10.1038/s41598-025-09224-3.

ABSTRACT

To evaluate the improvement effect of graded exercise rehabilitation on diaphragm function, exercise function, and respiratory performance in AECOPD patients. 68 AECOPD patients admitted to the Respiratory and Critical Care Department of a tertiary hospital in Zunyi City. Patients were randomly divided into a study group and a control group (each group 34 patients), and then according to the grading criteria, patients in each group were divided into 3 levels, for a total of 6 groups. The control group used conventional rehabilitation, while the study group used graded exercise rehabilitation. Bedside ultrasound was used to monitor the changes in diaphragm function (DE, DTei, DTee, DTF), 6MWT, CAT score, mMRC questionnaire, non-invasive mechanical ventilation time, and hospital stay between two groups of patients before and after rehabilitation. Compared with before the rehabilitation intervention, the study group showed significant improvement in diaphragm movement compared to the control group (P < 0.05). The end-inspiratory, end-expiratory, and diaphragm thickening scores all improved compared to before, and the differences were statistically significant (P < 0.05); The 6MWT and CAT scores of the study group were significantly higher than those of the control group after the intervention, and the difference was statistically significant (P < 0.05); Compared with the control group, the study group had significantly less mechanical ventilation time and hospitalization time, and the difference was statistically significant (both P < 0.05); The total incidence of MV related complications in the study group was lower than that in the control group, and the difference was statistically significant (P < 0.05). There were no actual compression injuries, aspiration, deep vein thrombosis, atelectasis, etc. in either group; The mMRC questionnaire did not show statistical significance (P > 0.05), but there was improvement before the intervention. Graded exercise rehabilitation can effectively improve the overall diaphragm function of patients, and has a positive effect on enhancing exercise quality and endurance; Bedside ultrasound can dynamically and real-time observe the diaphragm movement status of AECOPD patients, objectively and directly evaluate the recovery of respiratory muscle function, and has important clinical value.

PMID:40764492 | DOI:10.1038/s41598-025-09224-3

Sci Data. 2025 Aug 5;12(1):1355. doi: 10.1038/s41597-025-05715-0.

ABSTRACT

As the cornerstone of China’s food security, Northeastern China contributes nearly 20% of national rice production. However, we are still lacking of high-resolution rice maps with detailed and long time-series in this region, impeding crop management decisions for food security. Here we generated an annual 30 m resolution rice distribution dataset for Northeastern China since the 21st century (NECAR) using the Google Earth Engine platform and random forest classification. The workflow involved (1) hierarchical screening principle to select ground samples, (2) the linear interpolation and Whittaker smoothing Landsat5/7/8 time series data and (3) enhanced spectral-feature sets. The resultant annual maps have high overall accuracy (OA) ranging from 0.93 to 0.99, and the satellite estimates corresponded well with statistics for most cities (R² ≥ 0.7, p < 0.01), with higher accuracy than that of similar crops mapping datasets. This is the first attempt in Northeastern China to reconstruct paddy rice patterns at a 30-m resolution over a detailed and extended time series, enabling in-depth analysis of potential environmental and economic impacts.

PMID:40764483 | DOI:10.1038/s41597-025-05715-0

Cardiovasc Intervent Radiol. 2025 Aug 5. doi: 10.1007/s00270-025-04142-3. Online ahead of print.

ABSTRACT

PURPOSE: To report safety and efficacy (on terms of long-term pain reduction results) after percutaneous splanchnic nerve cryoneurolysis for the treatment of refractory pancreatic cancer-related pain.

MATERIALS AND METHODS: This single-center, institutional review board-approved, retrospective observational study recruited consecutive patients with pancreatic cancer-related pain refractory to conservative treatment who underwent CT-guided cryoneurolysis of the splanchnic nerves. Outcomes included overall pain reduction rate (> 4 pain score units in the VAS pain scores), technical success (successful cryoprobe placement at the level of interest), and opioid usage reduction.

RESULTS: Fifty patients were included (mean age 65 ± 7 years). Overall, clinically relevant pain reduction was achieved in 76% of the patients (38/50). Baseline mean self-reported pain score was 9.52 ± 0.6 (range 8-10) reduced to a mean value of 4.36 ± 2.9, 4.23 ± 3, and 4.43 ± 3.1 after 1, 6, and 12 months, respectively. Technical success was achieved in 100% (50/50) of the patients. Reduction in opioid analgesia usage was observed in 76% (38/50) of the patients. Median overall survival after treatment was 21 months (interquartile range: 6, 36). A statistically significant difference was observed in the self-reported pain scores at 1, 6, and 12 months in patients with and without infiltration of the celiac plexus. No grade > 1b complications, according to the modified CIRSE classification system, were reported.

CONCLUSION: This retrospective study highlights that percutaneous cryoneurolysis of the splanchnic nerves is effective and offers long-lasting pain palliation in patients with refractory pancreatic cancer-related pain. This effect is more pronounced when the celiac plexus is not infiltrated by the tumor.

PMID:40764465 | DOI:10.1007/s00270-025-04142-3

Aquat Toxicol. 2025 Aug 4;287:107524. doi: 10.1016/j.aquatox.2025.107524. Online ahead of print.

ABSTRACT

The Veneto Region (Italy) experienced one of the heaviest contaminations by per- and polyfluoroalkyl substances (PFAS), pollutants of emerging concern due to their environmental persistence and bioaccumulation potential in animal tissues. Hence, there is a need to study their impact on freshwater fish inhabiting contaminated rivers, particularly at the level of the antioxidant system, since PFAS are known to cause an imbalance in reactive oxygen species (ROS) production, thereby increasing the risk of oxidative stress. This study examines the physiological responses triggered by chronic exposure to three distinct environmental concentrations of PFAS in the European chub (Squalius cephalus). The sites were classified as “control” (with a PFAS concentration < 5 ng/L), “low polluted” (5.64 ng/L) and “highly polluted” (582.6 ng/L). Biochemical and molecular analyses were performed on the kidney, one of the main organs for xenobiotic bioaccumulation. The catalase (CAT) and selenium-dependent glutathione peroxidases (Se-GPXs) expression was quantified at both active protein and mRNA transcript levels. Results confirm the activation of antioxidant defences against the risk of PFAS-induced oxidative stress. There is a differential induction in the biosynthesis of enzymes inside specific intracellular compartments: CAT in peroxisomes in the “low polluted” site and Se-GPXs in the cytoplasm in the “highly polluted” one. The gene gpx1 was the only isoform whose mRNA level corresponded to that of the active protein, suggesting the highest contribution to the biosynthesis of Se-GPXs at high PFAS concentrations. Conversely, gpx4 increased its transcription level in the “low polluted” site, which didn’t match with an increase in protein content, leading us to hypothesise an involvement of specific cytoplasmic mRNA-protein complexes, called stress granules, acting in the temporary silencing of gpx4.

PMID:40763376 | DOI:10.1016/j.aquatox.2025.107524