Nevin Manimala

Biostatistics. 2024 Dec 31;26(1):kxaf043. doi: 10.1093/biostatistics/kxaf043.

ABSTRACT

Nonlinear causal effects are prevalent in many research scenarios involving continuous exposures, and instrumental variables (IVs) can be employed to investigate such effects, particularly in the presence of unmeasured confounders. However, common IV methods for nonlinear effect analysis, such as IV regression or the control-function method, have inherent limitations, leading to either low statistical power or potentially misleading conclusions. In this work, we propose an alternative IV framework for nonlinear effect analysis, which has recently emerged in genetic epidemiology and addresses many of the drawbacks of existing IV methods. The proposed IV framework consists of up to three key “S” elements: (i) the Stratification approach, which constructs multiple strata that are sub-samples of the population in which the IV core assumptions remain valid, (ii) the Scalar-on-function model and Scalar-on-scalar model, which connect local stratum-specific information to global effect estimation, and (iii) the Sum-of-single-effects method for effect estimation. This framework enables study of the effect function while avoiding unnecessary model assumptions. In particular, it facilitates the identification of change points or threshold values in causal effects. Through a wide variety of simulations, we demonstrate that our framework outperforms other representative nonlinear IV methods in predicting the effect shape when the instrument is weak and can accurately estimate the effect function as well as identify the change point and predict its value under various structural model and effect shape scenarios. We further apply our framework to assess the nonlinear effect of alcohol consumption on systolic blood pressure using a genetic instrument (ie Mendelian randomization) with UK Biobank data. Our analysis detects a threshold beyond which alcohol intake exhibits a clear causal effect on the outcome. Our results are consistent with published medical guidelines.

PMID:41319223 | DOI:10.1093/biostatistics/kxaf043

Cancer Med. 2025 Dec;14(23):e71392. doi: 10.1002/cam4.71392.

ABSTRACT

BACKGROUND: The method of lymph node (LN) irradiation for locally advanced esophageal squamous cell carcinoma (LA-ESCC) is still a topic of debate. We investigated the efficacy, toxicity, and rate of out-of-field LNs in irradiation across different target areas in patients with LA-ESCC undergoing neoadjuvant chemoradiotherapy (nCRT).

METHODS: We retrospectively reviewed patient records from June 2017 to August 2022 and divided patients into elective nodal irradiation (ENI) and involved-field irradiation (IFI) groups. The differences in hematological and non-hematological toxicities of the out-of-field LNs were analyzed between the two groups. The log-rank test was used to evaluate the Kaplan-Meier curves for overall and progression-free survival.

RESULTS: Among the 306 included patients, 202 (66.0%) received ENI and 104 (34.0%) received IFI. At the 3-year follow-up, the survival rate did not differ significantly between the groups (p > 0.05). Although the occurrence of radiation-induced pneumonia did not differ (p > 0.05), the incidence of radiation-induced esophagitis and the degree of leukopenia differed significantly (p < 0.05). While the average heart irradiation dose or heart V₂₀, V₃₀, and V₄₀ did not differ significantly (p > 0.05), we observed significant differences in the clinical target volume, average lung irradiation dose, and lung V₂₀, V₃₀, and V₄₀ (p < 0.05). Among all patients, 29 cases (9.5%) experienced out-of-field LNs with 26 (93.1%) in abdominal LNs, whereas only 3 cases (6.9%) with out-of-field LNs were in the upper esophagus. There was no statistical significance between out-of-field LNs and LN irradiation methods (p = 0.724).

CONCLUSIONS: Under similar prognostic conditions, IFI resulted in mild toxicity compared to ENI. Therefore, for patients with ESCC undergoing nCRT, IFI is the preferred irradiation approach for the lymphatic drainage area.

PMID:41319202 | DOI:10.1002/cam4.71392

Brain Behav. 2025 Dec;15(12):e70873. doi: 10.1002/brb3.70873.

ABSTRACT

AIM: This study was conducted to investigate the effects of positive psychotherapy-based education on pain, psychological resilience, and mental well-being after lumbar canal stenosis surgery.

MATERIALS AND METHODS: A randomized controlled experimental study was conducted with 66 participants (33 control, 33 experimental) at the Brain and Neurosurgery Department of Medical Center X between March 2025 and July 2025. The control group received no intervention, while the experimental group received 8 weeks of psychoeducation based on positive psychotherapy. Pretests were administered to the control and experimental groups in March 2025. The training of the experimental group was administered between April 2025 and May 2025. Data collection tools included the Descriptive Characteristics Form, Pain Scale, Brief Resilience Scale, and Mental Well-Being Scale. It was determined that the data showed normal distribution, and parametric tests were used in the analyses. Chi-square and Fisher’s exact tests were used to compare the descriptive characteristics of the patients in the experimental and control groups. A t-test was applied to the dependent and independent groups to determine the effect of the training.

FINDINGS: In the study, no statistically significant difference was found in the comparison of the pretest pain, psychological resilience, and mental well-being scales of the control and experimental groups (p = 0.259, p = 0.177, p = 0.428). In the study, a statistically significant difference was found in the comparison of the posttest pain, psychological resilience, and mental well-being scales of the control and experimental groups (p = 0.001). In the study, a statistically significant difference was found in the pretest-posttest pain, psychological resilience and mental well-being scale total score averages of the experimental group (p = 0.001).

CONCLUSION AND RECOMMENDATIONS: Positive psychotherapy-based education was effective in reducing pain and increasing psychological resilience, and mental well-being in patients after lumbar spinal stenosis surgery. Based on these findings, positive psychotherapy-based education can be recommended as an adjunct to pharmacological treatment for not only physical but also psychological recovery.

PMID:41319196 | DOI:10.1002/brb3.70873

Med Educ Online. 2025 Dec 31;30(1):2592434. doi: 10.1080/10872981.2025.2592434. Epub 2025 Nov 30.

ABSTRACT

Medical career preferences are in focus because the future medical workforce should align with society’s needs. The study investigated how medical students’ perceptions of the attractiveness of various clinical and non-clinical career options evolved as they approached the end of medical school, and which factors might influence their career choices. This was a cross-sectional online survey of medical students who completed the master’s program in spring 2025 in different medical education tracks at different Swiss universities. The survey included both Likert-scaled and open-ended questions. Flow diagrams were used to depict changes in attractiveness throughout medical school. Network visualization mapped the connections between the most important career determinants. Regression analysis assessed the factors associated with career preferences. Among 364 medical students included, the most attractive careers at the end of medical school were the specialized disciplines of inpatient care (37%) and outpatient care (20%). These specialties were preferred due to interest in surgery or specialization. During the master’s program, attractiveness of general practice, specialized outpatient care, and specialized inpatient care increased while the attractiveness of outpatient gynecology/pediatrics and inpatient general internal medicine decreased. Career characteristics perceived to be the most important determinants of career choice were primarily performing medical activities, part-time work, and relationships with patients. The most prevalent factors favoring career decisions were experience during the elective year (91%) and clinical courses with patient contact during the studies (70%). Students who found a career more attractive during their studies were more likely to prefer that career at the end of medical school. Career preferences at the end of medical school were associated with specific factors. Among these factors, the most significant was the perceived attractiveness of the career during medical education. This emphasizes the importance of medical education in shaping students’ dynamic and multifaceted career decisions.

PMID:41319195 | DOI:10.1080/10872981.2025.2592434

Int J Cosmet Sci. 2025 Nov 30. doi: 10.1111/ics.70052. Online ahead of print.

ABSTRACT

OBJECTIVE: To address the current lack of standardized tools for evaluating hair appearance in the beauty industry, this study presents a robust and accessible method for objectively quantifying hair fibre orientation using two-dimensional discrete Fourier transform (2D-DFT).

METHODS: We analysed hair images of 120 Japanese women using 2D-DFT and extracted the principal orientation angle and anisotropy index by fitting an ellipse to the directional Fourier spectrum. The robustness of the method at the image scale was tested by evaluating its performance across various image resolutions.

RESULTS: The proposed method accurately quantified hair orientation and showed consistent performance across differing image scales provided that individual hair fibres were visually distinguishable. As the method requires only standard digital images and basic computational processing, it is well suited for practical applications.

CONCLUSION: Our 2D-DFT-based approach offers a simple yet robust framework for analysing overall hair orientation. Although further validation is required for different hair types and local orientation analyses, this method provides a foundation for objective evaluation of hair appearance in cosmetic diagnostics and hair science research.

PMID:41319176 | DOI:10.1111/ics.70052

Aust N Z J Psychiatry. 2025 Nov 30:48674251393162. doi: 10.1177/00048674251393162. Online ahead of print.

ABSTRACT

OBJECTIVE: The onset of youth suicidal ideation and behaviour is a critical predictor of future mental health. This study examines generational differences in the prevalence and age of onset for suicidal ideation, plans, self-harm, and suicide attempts by age 25 in a nationally representative Australian cohort.

METHOD: A retrospective analysis using data from the Australian Bureau of Statistics National Study of Mental Health and Wellbeing, 2020-22. Respondents were grouped into Generation Z (16-25 years), Millennials (26-41 years), Generation X (42-57 years), and Baby Boomers (58-76 years). Cox proportional hazards models assessed the impact of demographic, childhood adversities, and mental health factors across generations.

RESULTS: Of the 14,753 respondents, 16.1% were Generation Z, 31.3% Millennials, and around one-quarter were from either Generation X or the Baby Boomer generation. Generation Z had the highest hazards for youth suicidal ideation, planning, self-harm, and suicide attempts, with the youngest age of onset. Adverse childhood experiences and lifetime mental health diagnoses were consistent risk factors across generations, but generational differences in their impact were evident. Sexual abuse before 19 was less strongly associated with earlier onset in Generation Z, while witnessing parental violence and exposure to suicide in others had stronger associations with younger onset in Generation Z. Mental disorders were linked to earlier onset, particularly in Baby Boomers.

CONCLUSIONS: Generational differences in the prevalence and age of onset of suicidal ideation and behaviours in Australia are evident, emphasising the need for a tailored, multi-sectorial suicide prevention strategy to address these evolving risks.

PMID:41319174 | DOI:10.1177/00048674251393162

Pharmacol Res Perspect. 2025 Dec;13(6):e70204. doi: 10.1002/prp2.70204.

ABSTRACT

Medication errors, often linked to inadequate numeracy skills, pose significant risks to patient safety. To address this, Kent and Medway Medical School (KMMS) became the first UK medical school to integrate safeMedicate, a validated e-learning platform, into its Year 1 undergraduate medical curriculum. This study aimed to evaluate its impact on student engagement, numeracy competence, and confidence. The entire cohort of 111 first-year medical students (2024 intake) was introduced to the safeMedicate Essential Skills module within the Year 1 module titled Professional Development and Person-Centred Practice. Engagement was assessed via platform analytics (logins, time, completion), numeracy competence through a formative online test, and perceptions via an anonymous survey. Engagement was high, with students averaging 9.1 logins and 124.2 min on the platform. Completion rates were near universal (95%). The average test score was 85.4%, with 75% of students achieving ≥ 85%. Competency analysis showed strong performance in conceptual, calculation, and technical measurement skills. Survey responses indicated that 89% found safeMedicate helpful for test preparation and 83% reported increased confidence in numeracy. Students valued the clarity, usability, and practice-based learning approach. Early integration of safeMedicate demonstrated improved engagement, numeracy performance, and student confidence. Although limited to one institution and formative assessment, findings support continued use of structured digital tools to strengthen medication safety education. Embedding safeMedicate into undergraduate curricula may reduce prescribing errors and better prepare future doctors for safe clinical practice.

PMID:41319170 | DOI:10.1002/prp2.70204

Alzheimers Dement. 2025 Dec;21(12):e70971. doi: 10.1002/alz.70971.

ABSTRACT

Longitudinal data on risk factors at different ages across the lifecourse are essential for gaining important insights into how the timing and accumulation of exposure to risk factors influence the risk of Alzheimer’s disease and related dementias (dementia). With increased interest in the exposome and lifecourse research questions, there have been commensurate increases in data sources and methodological approaches for answering these questions using empirical data. Methodological approaches developed within specific disciplines have largely remained within disciplinary silos, despite their potential for broader applications. By enumerating these approaches in a single place, we aim to expand discovery in lifecourse dementia research and help investigators align their research questions with appropriate analytic methods. In doing so, we seek to guide methodological decision-making and ensure that researchers use appropriate statistical tools to answer important questions about the exposome and lifecourse risk factors for dementia. HIGHLIGHTS: Longitudinal exposure data are valuable for exposome and lifecourse research on dementia. Multiple methodological approaches exist to analyze such data, with different assumptions, advantages, and disadvantages. Some methodological approaches have been used predominantly in specific disciplines but may have wider utility. Additional research is needed to integrate added complexity from the co-occurrence of multiple exposures into existing methods. Comparisons between methods help researchers make informed decisions on the appropriate method for a specific research question.

PMID:41319155 | DOI:10.1002/alz.70971

Microbiologyopen. 2025 Dec;14(6):e70190. doi: 10.1002/mbo3.70190.

ABSTRACT

Salmonella is recognized as one of the foodborne bacterial infections. The bacterium spreads through contact with animals and ingestion of contaminated foods. This study aimed to determine the prevalence, risk factors, and antimicrobial susceptibility patterns of Salmonella from bulk milk at dairy farm level in Mekelle and Southeast Zones of Tigrai, Ethiopia. A cross-sectional study was carried out from January to June 2025. After taking the consent, sociodemographic, risk factors, and 203 bulk milk samples were collected from the dairy farms. Salmonella was isolated and identified through pre-enrichment, selective enrichment, selective media, and a series of biochemical tests. Antimicrobial susceptibility testing was conducted using the disk diffusion method. Stata v-16 was employed to determine the strength of the factors that associates with Salmonella. The prevalence of Salmonella was six (2.96%). Salmonella positivity showed statistically significant association with farms that don’t practice regular udder washing before milking, lack of knowledge about bacterial infections, and do not know that consumption of raw milk cause foodborne illness. Five (83.3%) isolates of Salmonella showed resistance to ampicillin and tetracycline, and four (66.7%) to streptomycin. All Salmonella isolates were susceptible to ceftazidime and cefotaxime. Three isolates of Salmonella showed multidrug resistance. The prevalence of Salmonella was low, but its presence in milk may be considered a potential risk to milk safety. Three Salmonella isolates showed resistance to four and six antimicrobial classes. The finding highlights the need for appropriate hygiene practices and the correct use of antibiotics in the farms.

PMID:41319139 | DOI:10.1002/mbo3.70190

J Hum Nutr Diet. 2025 Dec;38(6):e70175. doi: 10.1111/jhn.70175.

ABSTRACT

AIM: Given the limited literature internationally, this cross-sectional study explored associations between inpatient plate waste, food experience and meal quality.

METHODS: Eligible participants were adult inpatients ( $\ge$ 18 years) ordering the same meal as the scheduled test meal. The Meal Quality Audit Tool (MQAT) assessed the temperature and sensory quality of the test meal, the Hospital Food Experience Questionnaire (HFEQ) assessed patient meal experience and plate waste was visually estimated. Binary logistic regression analysis was used to identify factors associated with plate waste. Chi-squared or nonparametric t-tests were used to compare MQAT data with patient, audit and HFEQ data.

RESULTS: Eligible participants (n = 187) were (mean ± SD) 59 ± 21 years, 51% female, 73% hospital stay of < 1 week and 57% had data collected at lunch. Across 41 test meals audited, temperature was the only MQAT element not meeting targets. Most patients (68%, n = 120/176) had 0% or 25% plate waste and a median (IQR) HFEQ score of 91 (82-98). For every 1-point increase in patient food experience score, the odds of achieving lower plate waste (≤ 25% plate waste) increased by 5% (OR 0.953, p < 0.05). When temperatures of matched test meals met temperature targets, the odds of lower plate waste (≤ 25% plate waste) increased by 82% (OR 0.183, p < 0.01). Sensory meal quality was not associated with plate waste or food experience (p > 0.05).

CONCLUSION: Lower plate waste (≤ 25% plate waste) was associated with higher patient food experience and meal temperatures meeting temperature targets. However larger, multicentre studies involving diverse patient groups are required to confirm these relationships.

PMID:41319134 | DOI:10.1111/jhn.70175