Category: Statistics

J Clin Endocrinol Metab. 2025 Jul 15:dgaf391. doi: 10.1210/clinem/dgaf391. Online ahead of print.

ABSTRACT

CONTEXT: Longer-term survival is possible for some patients with Anaplastic Thyroid Cancer (ATC). However, genomic factors associated with improved survival are poorly characterized.

OBJECTIVE: To develop a mathematical model to predict mutation-based survival risk in ATC.

DESIGN: Retrospective cohort study of 204 ATC samples from the cBioPortal database, divided into 80% training and 20% validation cohorts. Multivariate analysis identified prognostic genes, used to construct a point-based risk model. KEGG pathway enrichment and BRAF subanalyses were performed.

SETTING: Multi-institutional, international genomic database.

PATIENTS OR OTHER PARTICIPANTS: Samples were included if sequencing and survival data were available (N=204).

INTERVENTION(S): Not applicable.

MAIN OUTCOME MEASURE(S): The prespecified primary outcome was overall survival.

RESULTS: Fourteen genes were associated with increased risk – TET1, MAPK12, ATP10A, PIK3CA, MUC4, PNPLA2, PLD4, EGLN2, BSN, FLNC, RADIL, ZMYND8, FRAS1, RECQL4. More aggressive (n=37) and less aggressive cohorts (n=128) were determined using the maximally selected rank statistic, yielding a point threshold of 0.27. The predictive performance of the risk model demonstrated a C-index of 0.74. On Kaplan Meier analysis, 1-year survival differed for more aggressive patients (0%) compared to less aggressive patients (32%). For the validation cohort, survival remained significantly different between risk cohorts and on BRAF subanalysis. Each risk cohort subsequently underwent KEGG pathway enrichment analysis which showed significantly increased enrichment across several pathways for more aggressive tumors.

CONCLUSIONS: This model identifies mutated genes that are associated with the most aggressive ATCs and thus may aid in preoperative risk assessment when evaluating patients for surgery for curative intent.

PMID:40663630 | DOI:10.1210/clinem/dgaf391

Menopause. 2025 Jul 15. doi: 10.1097/GME.0000000000002574. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore potential differences in physical activity and sedentary behavior volumes and patterns among postmenopausal women with and without premenopausal bilateral oophorectomy (PBO).

METHODS: Women with a history of PBO (n = 50) and age-matched postmenopausal referent women (n = 50) were recruited. Participants wore accelerometers on both ankles for 7 days. Volume metrics of sedentary behavior and physical activity, such as step counts, active time, and sedentary time, as well as the sedentary behavior and habitual physical activity distribution, and accumulation patterns, were quantified from the accelerometer data and compared between groups.

RESULTS: Metrics indicating volume of sedentary behavior and physical activity were not statistically different between groups. PBO was significantly associated with higher variability in stepping bout time (P = 0.022), indicating a potentially more complex walking pattern. In addition, PBO was significantly associated with lower variability in sedentary break time (P = 0.012), and lower activity time Gini index (Z = -2.428, P = 0.015). This suggests that women with PBO may have broken up their sedentary time with shorter and less variable activity bouts, and because they had relatively shorter average daily active time, they might be at a higher risk of subsequent adverse health outcomes such as low bone mineral density.

CONCLUSIONS: Although there were no differences in overall activity volume, some differences in activity patterns emerged between women with PBO and referent women. The study highlights the need for longitudinal research to understand how physical activity and sedentary behavior patterns evolve in postmenopausal women with a history of PBO.

PMID:40663581 | DOI:10.1097/GME.0000000000002574

PLoS One. 2025 Jul 15;20(7):e0327214. doi: 10.1371/journal.pone.0327214. eCollection 2025.

ABSTRACT

Despite global efforts, gender-based violence (GBV) remains a problem that affects millions of people, particularly women. The prevalence of GBV in Nigeria has not improved over time; women who experienced physical violence since age 15 increased from 28% in 2008 to 31% in 2018. Intimate partner violence (IPV) constitutes a large proportion of the GBV in Nigeria. Although perceptions of IPV have been studied, differentials in perceptions among the different generations of Nigerians are unknown. People’s perceptions of IPV are influenced by societal shifts and other factors that differ among people of various ages. This research examined inter-generational differentials in the perception of IPV in Nigeria. Data were obtained from the 2021 Nigeria Multiple Indicator Cluster Survey. A sample of 53,706 men and women was analyzed using descriptive statistics, and logistic regression models. The older generations of men and women in Nigeria have significantly better perceptions of IPV than the younger generation, but there is a significant variation at the sub-national level. The observed pattern is worrisome and calls for urgent action by the government to advance more positive perceptions of GBV in Nigeria if the country will make progress in reducing the prevalence of GBV and achieve a violence-free society.

PMID:40663580 | DOI:10.1371/journal.pone.0327214

PLoS One. 2025 Jul 15;20(7):e0326922. doi: 10.1371/journal.pone.0326922. eCollection 2025.

ABSTRACT

This study aimed to develop the Italian version of the Compassionate Engagement and Action Scales (CEAS) and examine its validity and reliability among Italian-speaking adults. A total of 374 (mean age = 23.11) Italian speaking participants took part in the study. All of them completed a questionnaire comprising the CEAS, together with measures of self-compassion, self-criticism, social support, empathy, well-being and general distress, used to estimate the scale’s convergent and criterion-related validity. Confirmatory Factor Analysis (CFA) revealed a satisfactory fit for a model in which three second-order factors (Self-compassion, Compassion for others and Compassion from others) were further articulated in two first-order factors (Engagement and Action). All the scales presented good reliability in terms of internal consistency. Correlations with measures of social support, empathy, self-compassion, self-criticism, well-being, and general distress indicated good convergent and criterion-related validity of the Italian version of the CEAS. Taken together, these results suggest that the CEAS can be properly used with Italian-speaking individuals in order to assess the three compassion flows in terms of both engagement and action.

PMID:40663573 | DOI:10.1371/journal.pone.0326922

PLOS Glob Public Health. 2025 Jul 15;5(7):e0004890. doi: 10.1371/journal.pgph.0004890. eCollection 2025.

ABSTRACT

Although the prevalence of childhood stunting has reduced in Bangladesh over time, it is still considered a major public health issue. While research has determined the risk factors for childhood stunting in Bangladesh, the factors that lead to reductions in stunting have received very little attention. Hence, we examined the factors contributing to the changes in childhood stunting over time in Bangladesh using a decomposition approach. In this study, data on childhood stunting of 41,013 under-5 children (U5C) were utilized from the Multiple Indicator Cluster Survey (MICS) 2012 and 2019, which are nation-wide cross-sectional surveys. Mixed-effect logistic regression analysis was adopted to identify the predictors of childhood stunting, and multivariate decomposition analysis was used to examine the factors contributing to the changes in childhood stunting over time. The prevalence of stunting declined from 41.9% in 2012 to 28.0% in 2019. Regression analysis showed that lower education of household head and mothers, older children, lower wealth status of households, unimproved sanitation facilities, and being urban residents were significant predictors of childhood stunting. The decomposition analysis revealed that around 86% of the overall decline in stunting resulted from the differences in the effect of independent variables. Furthermore, children’s age, maternal education, place of residence, and regions were significant factors contributing to the decline in childhood stunting prevalence over time based on both compositional and behavioral changes in these factors. Although childhood stunting has decreased in Bangladesh over time, the current prevalence remains high. Over 86% of the overall decline in stunting was due to the differences in the effect of independent variables. Interventions targeting children of mothers with lower education, infants, rural children, and children from households with lower wealth status and unimproved sanitation facilities may help to reduce the stunting prevalence in Bangladesh.

PMID:40663564 | DOI:10.1371/journal.pgph.0004890

PLoS One. 2025 Jul 15;20(7):e0328452. doi: 10.1371/journal.pone.0328452. eCollection 2025.

ABSTRACT

The seamless integration of shared bikes and metro systems promotes green and eco-friendly travel, yet the supply-demand imbalance of shared bikes around metro stations remains a critical challenge, making accurate demand prediction particularly crucial. Targeting metro-adjacent areas, this study proposes a method to identify shared bike trips connecting to metro usage, effectively filtering out approximately 24% of non-connecting travel records within the buffer zones. A predictive model integrating a Spatiotemporal Attention Graph Convolutional Network (STAGCN), Long Short-Term Memory (LSTM) network, and Informer is developed to forecast shared bike demand for metro connectivity. Specifically, the Informer model incorporates STAGCN to capture spatial correlations in bike demand and introduces an LSTM module to learn long- and short-term temporal dependencies. The final demand prediction is generated through a multilayer perceptron. Experiments conducted on shared bike and metro datasets in Shenzhen demonstrate that the proposed model achieves a coefficient of determination (R2) of 0.893, outperforming baseline models by 6.7% in prediction accuracy. Additionally, it exhibits lower Root Mean Square Error (RMSE) and Mean Absolute Error (MAE) compared to traditional time-series forecasting methods. The proposed demand prediction model can assist operators in optimizing the allocation of shared bike resources, which is of great significance for improving user experience.

PMID:40663546 | DOI:10.1371/journal.pone.0328452

J Med Internet Res. 2025 Jul 15;27:e74299. doi: 10.2196/74299.

ABSTRACT

BACKGROUND: Perioperative education is crucial for optimizing outcomes in neuroendovascular procedures, where inadequate understanding can heighten patient anxiety and hinder care plan adherence. Current education models, reliant on traditional consultations and printed materials, often lack scalability and personalization. Artificial intelligence (AI)-powered chatbots have demonstrated efficacy in various health care contexts; however, their role in neuroendovascular perioperative support remains underexplored. Given the complexity of neuroendovascular procedures and the need for continuous, tailored patient education, AI chatbots have the potential to offer tailored perioperative guidance to improve patient education in this specialty.

OBJECTIVE: We aimed to develop, validate, and assess NeuroBot, an AI-driven system that uses large language models (LLMs) with retrieval-augmented generation to deliver timely, accurate, and evidence-based responses to patient inquiries in neurosurgery, ultimately improving the effectiveness of patient education.

METHODS: A mixed methods approach was used, consisting of 3 phases. In the first phase, internal validation, we compared the performance of Assistants API, ChatGPT, and Qwen by evaluating their responses to 306 bilingual neuroendovascular-related questions. The accuracy, relevance, and completeness of the responses were evaluated using a Likert scale; statistical analyses included ANOVA and paired t tests. In the second phase, external validation, 10 neurosurgical experts rated the responses generated by NeuroBot using the same evaluation metrics applied in the internal validation phase. The consistency of their ratings was measured using the intraclass correlation coefficient. Finally, in the third phase, a qualitative study was conducted through interviews with 18 health care providers, which helped identify key themes related to the NeuroBot’s usability and perceived benefits. Thematic analysis was performed using NVivo and interrater reliability was confirmed through Cohen κ.

RESULTS: The Assistants API outperformed both ChatGPT and Qwen, achieving a mean accuracy score of 5.28 out of 6 (95% CI 5.21-5.35), with a statistically significant result (P<.001). External expert ratings for NeuroBot demonstrated significant improvements, with scores of 5.70 out of 6 (95% CI 5.46-5.94) for accuracy, 5.58 out of 6 (95% CI 5.45-5.94) for relevance, and 2.70 out of 3 (95% CI 2.73-2.97) for completeness. Qualitative insights highlighted NeuroBot’s potential to reduce staff workload, enhance patient education, and deliver evidence-based responses.

CONCLUSIONS: NeuroBot, leveraging LLMs with the retrieval-augmented generation technique, demonstrates the potential of LLM-based chatbots in perioperative neuroendovascular care, offering scalable and continuous support. By integrating domain-specific knowledge, NeuroBot simplifies communication between professionals and patients while ensuring patients have 24-7 access to reliable, evidence-based information. Further refinement and research will enhance NeuroBot’s ability to foster patient-centered communication, optimize clinical outcomes, and advance AI-driven innovations in health care delivery.

PMID:40663377 | DOI:10.2196/74299

Br J Radiol. 2025 Jul 15:tqaf161. doi: 10.1093/bjr/tqaf161. Online ahead of print.

ABSTRACT

The TNM classification system is fundamental for describing the anatomical extent of lung cancer, encompassing the primary tumor (T), lymph node involvement (N), and distant metastases (M). It is crucial for patient stratification, treatment planning, and survival prognosis. Clinical staging (cTNM) relies on imaging and physical exams, while pathological staging (pTNM) uses surgical specimens. Advances in tumor biology, imaging, surgery, and treatments necessitate periodic updates to ensure the system reflects current knowledge and practices effectively. The International Association for the Study of Lung Cancer (IASLC), alongside the American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC), updates the system through a global, multidisciplinary approach supported by international data and statistical analysis. The ninth edition of the TNM classification, effective January 1, 2025, introduces revisions to the N and M categories while the T categories remain identical. N2 (ipsilateral mediastinal nodal disease) is now divided into N2a (single lymph node station involvement) and N2b (multiple N2 stations involvement). Similarly, M1c category is split into M1c1 (metastases confined to one organ system) and M1c2 (metastases involving multiple organ systems). These updates aim to improve the accuracy and utility of lung cancer staging in clinical practice and research.

PMID:40663374 | DOI:10.1093/bjr/tqaf161

JAMA Netw Open. 2025 Jul 1;8(7):e2518440. doi: 10.1001/jamanetworkopen.2025.18440.

ABSTRACT

IMPORTANCE: The PACIFIC trial established durvalumab as the standard-of-care therapy for unresectable, stage III non-small cell lung cancer (NSCLC) without progression following concurrent chemoradiotherapy (cCRT). Novel immunotherapy combinations involving the anti-CD73 monoclonal antibody oleclumab or the anti-NKG2A monoclonal antibody monalizumab have the potential to build on the durvalumab standard of care.

OBJECTIVE: To report updated results from the phase 2 COAST trial of consolidation durvalumab alone or combined with oleclumab or monalizumab in patients with unresectable, stage III NSCLC and no progression following cCRT.

DESIGN, SETTING, AND PARTICIPANTS: COAST was an open-label, phase 2, multidrug platform randomized clinical trial conducted across 73 sites globally. Patients with an Eastern Cooperative Oncology Group Performance Status of 0 or 1 and no progression following definitive platinum-based cCRT were enrolled between January 2019 and July 2020. The data cutoff for this final analysis was July 18, 2023. Data were analyzed from September 2023 to March 2024.

INTERVENTION: Patients were randomized 1:1:1, stratified by histologic type within 42 days after cCRT, to durvalumab alone or durvalumab combined with oleclumab or monalizumab for up to 12 months.

MAIN OUTCOMES AND MEASURES: The primary end point was investigator-assessed confirmed objective response rate (ORR). Key secondary end points included investigator-assessed progression-free survival (PFS), overall survival (OS), and safety. Efficacy end points were assessed in the intention-to-treat population. Safety was assessed in the as-treated population.

RESULTS: Of 189 randomized patients (median [range] age, 65 [37-87] years; 129 males [68.3%]; 176 [93.1%] current or former smokers), 186 received treatment consisting of durvalumab plus oleclumab (n = 59), durvalumab plus monalizumab (n = 61), or durvalumab alone (n = 66). Of these patients, 1 (0.5%) self-reported as American Indian or Alaska Native, 14 (7.5%) as Asian, 8 (4.3%) as Black or African American, 1 (0.5%) as Native Hawaiian or Other Pacific Islander, 159 (85.5%) as White, and 3 (1.6%) as other race. After a median (range) follow-up in all patients of 30.1 (0.4-48.9) months, confirmed ORR was numerically higher with durvalumab plus oleclumab (35.0%; 95% CI, 23.1%-48.4%) or monalizumab (40.3%; 95% CI, 28.1%-53.6%) than with durvalumab alone (23.9%; 95% CI, 14.3%-35.9%). However, the difference in ORR for durvalumab plus oleclumab (11.1 [-6.4 to 28.1] percentage points) and durvalumab plus monalizumab (16.9 [-0.8 to 33.4] percentage points) was not statistically significant compared with durvalumab alone. Both combinations prolonged PFS vs durvalumab alone (plus oleclumab: hazard ratio [HR], 0.59 [95% CI, 0.37-0.93]; plus monalizumab: HR, 0.63 [95% CI, 0.40-0.99]) but did not demonstrate nominal associations with longer OS (plus oleclumab: HR, 0.69 [95% CI, 0.40-1.20]; plus monalizumab: HR, 0.77 [95% CI, 0.44-1.33]). Safety was comparable across arms, without new or notable safety signals.

CONCLUSIONS AND RELEVANCE: In the COAST trial, combining consolidation durvalumab with oleclumab or monalizumab provided additional clinical benefit over durvalumab alone. This finding supports further investigation of these novel combinations in the phase 3 PACIFIC-9 trial.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03822351.

PMID:40663352 | DOI:10.1001/jamanetworkopen.2025.18440

JAMA Netw Open. 2025 Jul 1;8(7):e2521009. doi: 10.1001/jamanetworkopen.2025.21009.

ABSTRACT

IMPORTANCE: Examining racial and ethnic disparities in pediatric COVID-19 hospitalizations is critical to inform public health efforts to reduce those disparities.

OBJECTIVE: To characterize trends in pediatric COVID-19 hospitalizations by race and ethnicity from March 2020 to September 2023, focusing on recent epidemiologic findings (October 2022 to September 2023).

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the COVID-19 Hospitalization Surveillance Network (COVID-NET) including 13 555 hospitalizations among patients aged 17 years or younger with a laboratory-confirmed SARS-CoV-2 infection who are residents of the COVID-NET catchment area in 12 states, covering approximately 10% of the US population.

EXPOSURE: Laboratory-confirmed SARS-CoV-2 infection within 14 days prior to or during hospitalization.

MAIN OUTCOMES AND MEASURES: Pediatric COVID-19-associated hospitalization rates by race and ethnicity and characteristics associated with COVID-19-associated hospitalizations.

RESULTS: Between March 2020 and September 2023, COVID-NET identified 13 555 pediatric hospitalizations (median patient age, 3.3 years [IQR, 0.6-12.5 years]; 7110 boys [52.5%]; 780 non-Hispanic Asian or Pacific Islander children [5.8%], 3837 non-Hispanic Black children [28.3%], 4131 Hispanic children [30.5%], and 4807 non-Hispanic White children [35.5%]). Hospitalization rates were 2.15 (95% CI, 2.01-2.34) times higher for Black children and 2.06 (95% CI, 1.91-2.23) times higher for Hispanic children compared with Asian or Pacific Islander children, who had the lowest rates. Despite overall decreased pediatric hospitalization rates between October 2022 and September 2023, higher rates of intensive care unit admissions among Black and Hispanic children persisted, at 1.88 (95% CI, 1.28-2.74) times higher for Black children and 2.13 (95% CI, 1.47-3.10) times higher for Hispanic children compared with Asian or Pacific Islander children. Among hospitalized children, 61.4% (95% CI, 57.0%-65.8%) of Black patients and 45.5% (95% CI, 41.9%-49.3%) of Hispanic patients had 1 or more underlying medical condition compared with 45.6% (95% CI, 42.1%-49.1%) of White children and 45.0% (95% CI, 41.9%-49.3%) of Asian or Pacific Islander children. Obesity (17.8%; 95% CI, 15.3%-20.5%) and neurologic disorders (15.2%; 95% CI, 13.7%-16.8%) were the most common conditions overall; 11.9% (95% CI, 9.1%-15.1%) of Black children had sickle cell disease, the fourth most common condition in this group.

CONCLUSIONS AND RELEVANCE: This study found that among pediatric patients hospitalized with COVID-19, Black and Hispanic children were disproportionately more likely to be hospitalized for COVID-19 and experience severe disease compared with White and Asian or Pacific Islander children. A higher proportion of hospitalized Black children had underlying medical conditions. This study underlines the need for targeted interventions, particularly for children with underlying medical conditions, and the need for equitable access and use of vaccines and therapeutics for disproportionately affected populations.

PMID:40663351 | DOI:10.1001/jamanetworkopen.2025.21009