Tag: pubmed

PLoS One. 2026 Jan 27;21(1):e0341152. doi: 10.1371/journal.pone.0341152. eCollection 2026.

ABSTRACT

Fourier-transform near-Infrared (FT-NIR) technology offers a promising alternative to traditional methods for detecting soil Chromium (Cr) contamination. However, the relationship between soil Cr content and the spectra may involve complex non-linear dynamics and data redundancy. Therefore, selecting spectral feature variables and constructing parametric scaling models for rapid estimation has become a focal point in current research. In this study, the parametric scaling support vector machine (PSSVM) method is proposed for optimizing the modeling parameters, the binary modified differential evolution (BDE) algorithm is designed for selecting the feature variables. In combination, a novel combined optimization system is established by embedding the PSSVM model into the BDE iterative process. The system (BDE-PSSVM) is validated by estimating the soil Cr content based on the FT-NIR spectral data. The soil samples are collected from the area around a centralized waste treatment base, serving as the research subject. The original spectral data underwent preprocessing using Savitzky-Golay smoothing. Subsequently, the samples were divided into the training and testing sets by the SPXY algorithm, where the testing samples are strictly excluded from the model training process. Feature selection and the parametric scaling model optimization are simultaneously performed by applying the BDE-PSSVM model. The most optimal model observes the minimal root mean square error of 8.114, which only carries 56 discrete variables. In comparison to some other counterpart modeling methods, the BDE-PSSVM uses less feature variables and yields the better prediction results. This finding indicates that the proposed BDE-PSSVM modeling system provides an efficient way for rapid estimation of soil Cr content in cooperation with the FT-NIR technology. The proposed system is expected to undergo testing for its application in detecting additional analytes.

PMID:41592072 | DOI:10.1371/journal.pone.0341152

PLoS One. 2026 Jan 27;21(1):e0341570. doi: 10.1371/journal.pone.0341570. eCollection 2026.

ABSTRACT

BACKGROUND: The role of health insurance and its diverse hearing health benefits on hearing aid utilization is currently unknown. The objective of this study is to examine rates of ever and regular hearing aid (HA) use by insurance status in older U.S. adults.

METHODS: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) (2005-2018). Older adults (≥65 years) with complete data on health insurance, audiometry, and hearing aid use (n = 3,172) were included. Eight combinatorial insurance categories were created and compared pairwise to the reference of Medicare only coverage. Outcomes included ever and regular hearing aid use.

RESULTS: Among older U.S. adults, 30.3% [95% CI:27.6%-33.2%] of those with audiometry-measured hearing loss reported ever using HAs while 22.9% [95% CI:20.3%-25.7%] reported regular HA use. Among older adults with hearing loss, those with military-related insurance (Tricare, VA and Champ-VA) had amongst the highest rates of ever and regular HA use (43.3% [95% CI:31.3%-56.2%] and 30.8% [95% CI:21.1%-42.5%], respectively). Ever HA use rates for individuals with Medicare and Medicaid was 30.8% [95% CI:27.8%-33.8%] and 17.7% [95% CI:11.9%-25.5%], respectively. In a multivariable model adjusting for demographics and hearing loss severity, individuals with military-related and military-related+Medicaid insurance were significantly more likely to report ever using HAs compared to those with Medicare only (OR 1.80, 95% CI:1.03-3.16; OR 20.38, 95% CI:1.07-386.84, respectively). Those with military-related insurance were more likely to report regular HA use (OR 2.17, 95% CI:1.16-4.09).

CONCLUSION: In this nationally representative study of older U.S. adults, we found differences in ever and regular HA use rates by insurance status, even when adjusting for hearing loss, demographics, and comorbidities. Future research is warranted to investigate group-specific differences, including access to hearing care, hearing health benefits, and stigma, to better understand the facilitators and barriers to hearing aid use by insurance status.

PMID:41592065 | DOI:10.1371/journal.pone.0341570

PLoS One. 2026 Jan 27;21(1):e0339721. doi: 10.1371/journal.pone.0339721. eCollection 2026.

ABSTRACT

Healthcare transition from pediatrics to adult care is a critical yet challenging process for adolescents with long-term medical conditions. This population-based cohort study aims to present a replicable method to identify and quantify adolescents in need of comprehensive transitional care. Using data from Danish national health registers, disease complexity was categorized by expert clinicians based on diagnoses indicative of a need for comprehensive transitional care and transfer to specialized adult healthcare. The study identified 4,677 adolescents requiring comprehensive transitional care from a background population of 418,994 Danish adolescents aged 16-17 years, corresponding to 1.1%. Analysis of outpatient visit data from tertiary hospitals revealed variability in the proportion of adolescents with comprehensive transitional care needs across Denmark’s four tertiary hospitals. For instance, 11.6% of outpatient visits at Aalborg University Hospital involved a comprehensive transition-requiring diagnosis, compared to 26.7% at Copenhagen University Hospital. While the method is intentionally specific and focused on adolescents with the most complex conditions, it offers a scalable framework that could be applied across broader clinical settings. We illustrate this by also applying the method within a pediatric department-based setting. This study provides al replicable framework to assess transition care needs at a population level, primarily identifying adolescents with the most complex conditions. Broader implementation across clinical settings may refine and inform equitable transitional strategies.

PMID:41592040 | DOI:10.1371/journal.pone.0339721

PLOS Digit Health. 2026 Jan 27;5(1):e0001190. doi: 10.1371/journal.pdig.0001190. eCollection 2026 Jan.

ABSTRACT

The global rise in prescription opioid use has contributed to an opioid epidemic, associated harms, and unintentional deaths in several western countries. Opioids however continue to be regularly prescribed for acute pain and in the chronic pain context due to limited treatment options. Currently there are no accurate tools that help predict which patients prescribed opioids may be at risk of death, which depends on the cultural context and varies across countries. Existing models do not account for statistical considerations such as censoring and competing risks. Using nationally representative data from the United Kingdom from 1,026,139 patients newly prescribed an opioid, we developed three competing risk time-to-event models: a regression model, a random forest, and a deep neural network to predict opioid-related deaths using UK primary care records. The models were externally validated in an external cohort of 337,015 patients. The models exhibited good discrimination and positive predictive value during internal validation (C-statistic for the regression model, random forest, and neural network: 84.3%, 84.4% and 82.1% respectively), and external validation (C-statistic for the regression model, random forest, and neural network: 81.8%, 81.5% and 81.5% respectively). Prior substance abuse, lung and liver comorbidities, morphine, fentanyl, or oxycodone at initiation and co-prescription of gabapentinoids were some of candidate predictors associated with a higher risk of opioid-related mortality within the models. These results demonstrate how routinely collected data from a nationally representative dataset may be used to develop and validate opioids risk algorithms to better help clinicians and patients predict risk to this serious adverse outcome.

PMID:41592035 | DOI:10.1371/journal.pdig.0001190

PLoS One. 2026 Jan 27;21(1):e0338434. doi: 10.1371/journal.pone.0338434. eCollection 2026.

ABSTRACT

BACKGROUND: Accurate sources on environmental nicotine exposure, such as biomarker data, remain insufficient in low- and middle-income countries. This study aimed to i) determine the optimal cut-off point of urinary cotinine that discriminates smokers from non-smokers, ii) estimate misclassification rate between self-reported smoking and urinary cotinine, and III) explore the distribution of tobacco smoke exposure levels using urinary cotinine concentrations among adults in Vietnam in 2024.

METHODS: A cross-sectional study was conducted in 2024 across seven provinces representing Vietnam’s ecological regions. Using multi-level stratified random sampling techniques, 1,077 adults aged 18-60 were recruited. Demographic and behavioural data were obtained through structured interviews. Urinary cotinine to creatinine ratios (CCR) were measured using high-performance liquid chromatography-tandem mass spectrometry. The Youden J method was used to determine the optimal cut-off point of CCR. Statistical analyses were performed using SPSS 20.0.

RESULTS: Self-reported results showed that 18.3% were active smokers, 33.4% were exposed to SHS at home, and 48.3% lived in a non-smoking household. The optimal CCR cut-off value of 20.947 µg/g can distinguish smokers and non-smokers with a sensitivity of 61.5%, specificity of 93.2%, 70.6% positive predictive value and 90% negative predictive value. Regional disparities and urinary cotinine among the non-smoking groups suggest potential environmental exposure to nicotine.

CONCLUSION: The CCR level of 20.947 µg/g indicated the optimal cut-off value to distinguish smokers and non-smokers. Vietnam was among countries with high levels of environmental nicotine exposure, with significant variation by sex, education, occupation, income, and region. Urinary cotinine is a reliable biomarker for nicotine exposure and should be integrated into routine surveillance. These findings support the need for stricter enforcement of smoke-free environments and interventions tailored to reduce involuntary tobacco exposure.

PMID:41592032 | DOI:10.1371/journal.pone.0338434

J Glaucoma. 2026 Jan 26. doi: 10.1097/IJG.0000000000002693. Online ahead of print.

ABSTRACT

PRECIS: Phacoemulsification combined with endoscopic cyclophotocoagulation had a statistically significant reduction in both intraocular pressure and number of medications as compared to Phacoemulsification alone.

PURPOSE: Comparative evaluation of Phacoemulsification combined with Endoscopic Cyclophotocoagulation (Phaco-ECP) Vs Phacoemulsification (Phaco) alone in primary angle closure glaucoma (PACG) with cataract.

DESIGN: Prospective, randomized, parallel group, active controlled trial.

PARTICIPANTS: Patients of PACG with cataract.

METHODS: A total of 100 consecutive patients with PACG and cataract were screened, of whom 66 patients meeting the inclusion criteria were recruited. Patients were randomized into 2 groups and underwent Phaco-ECP or Phaco alone. The patients were examined at baseline and at 1 week, 1 month, 3, 6, 12, 18 and 24 months. The anterior chamber angle parameters on swept-source anterior segment OCT (SS-ASOCT) were noted at baseline, and at 3, 6 and 12-months follow-up. Main Outcome Measures: The primary outcome measure was reduction in intraocular pressure (IOP) and the number of anti-glaucoma medications.

RESULTS: The mean baseline IOP was 19.9±5.8 mmHg and 19.5±7.2 mmHg in Phaco-ECP and Phaco groups, respectively (P=0.59). The mean IOP decreased to 14.0±2.6 mmHg and 15.7±2.2 mmHg at 24 months in Phaco-ECP and Phaco group, respectively (P=0.02). The reduction in number of medications was also significantly higher in Phaco-ECP group (1.8±1.10 mmHg vs. 1.0±0.8 mmHg; P=0.02) as compared to Phaco alone group. Qualified success with IOP ≤12 mmHg was obtained in 46.6% of patients in Phaco-ECP group and 13.7% of patients in Phaco group (P=0.01). No absolute failures (requirement of trabeculectomy) were noted in Phaco-ECP whereas 6.9% of patients had failure in Phaco group (P=0.23). A significant widening of the angle parameters was noted postoperatively at 3, 6, 12 and 18 months as compared to baseline in both the groups. The other secondary outcome parameters like BCVA, visual field changes, endothelial cell count, pupil diameter and complication rate were comparable between the groups.

CONCLUSIONS: Phaco-ECP group demonstrated a significant reduction in IOP and number of medications, along with a notable widening of nasal anterior chamber angle parameters as compared to Phaco alone group.

PMID:41591796 | DOI:10.1097/IJG.0000000000002693

JAMA Netw Open. 2026 Jan 2;9(1):e2554512. doi: 10.1001/jamanetworkopen.2025.54512.

ABSTRACT

IMPORTANCE: Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) was designed to improve access to care and reduce health disparities. Its association with breast cancer mortality and related disparities remains unclear.

OBJECTIVES: To evaluate the association between Medicaid expansion and overall mortality among women with breast cancer and to assess whether survival differs by race and ethnicity, disease stage, income, and treatment modality.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, hospital-based cohort study used a National Cancer Database cohort of 1 595 845 women aged 40 to 64 years with breast cancer who received a diagnosis from January 1, 2006, to December 31, 2021. States were classified as either Medicaid expansion or nonexpansion states. Statistical analyses were performed between January and July 2025.

EXPOSURE: Residence in a state that implemented Medicaid expansion by January 2014.

MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality. Policy effects were derived from difference-in-differences Cox proportional hazards regression models, reported as hazard ratios (HRs) and percentage change in hazard. Effect modification by race and ethnicity, disease stage, zip code-level income, and treatment was tested with 3-way interactions and joint Wald χ2 tests.

RESULTS: Of 1 595 845 women with breast cancer (mean [SD] age, 53.7 [6.8] years), 922 862 (57.8%) lived in early-expansion states, and 672 983 (42.2%) in nonexpansion states. Medicaid expansion was associated with lower overall mortality (HR, 0.95; 95% CI, 0.95-0.96; P < .001), a 4.8% relative hazard reduction vs nonexpansion. Hazard reductions were -3.4% (95% CI, -4.2% to -2.6%) for non-Hispanic White women, -4.3% (95% CI, -6.3% to -2.2%) for non-Hispanic Black women, and -19.0% (95% CI, -20.8% to -17.2%) for Hispanic women; associations for non-Hispanic women of other race or ethnicity were not significant. Lower mortality was most pronounced among patients with metastatic disease (-13.9%; 95% CI, -20.0% to -7.2%), those in the highest-income neighborhoods (-9.7%; 95% CI, -10.7% to -8.7%), and those receiving immunotherapy (-24.1%; 95% CI, -28.6% to -19.3%).

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that Medicaid expansion under the ACA was associated with lower overall mortality among women aged 40 to 64 years with breast cancer. Benefits were uneven, underscoring persistent racial and ethnic and socioeconomic disparities and the need for targeted interventions.

PMID:41591779 | DOI:10.1001/jamanetworkopen.2025.54512

JAMA Netw Open. 2026 Jan 2;9(1):e2554524. doi: 10.1001/jamanetworkopen.2025.54524.

ABSTRACT

IMPORTANCE: Sex differences in Alzheimer disease (AD) neuropathology have not been examined extensively across multiple pathological constructs within broadly representative samples.

OBJECTIVE: To examine sex differences in neuroimaging biomarkers of AD-related pathologies in a racially and ethnically diverse cohort.

DESIGN, SETTING, AND PARTICIPANTS: Data for this cross-sectional study were collected from a community-based sample of adults without cognitive impairment aged 60 to 69 years in New York City from March 1, 2016, to September 31, 2022, and analyzed in March 2025.

EXPOSURE: The primary exposure was self-reported sex (women or men).

MAIN OUTCOMES AND MEASURES: The outcomes were global amyloid burden measured with florbetaben labeled with fludeoxyglucose 18 (18F) positron emission tomography (PET), tau burden in Braak stages I to VI measured with 18F-MK-6240 PET, and magnetic resonance imaging (MRI)-derived AD signature cortical thickness and white matter hyperintensity volumes. Linear regression analyses were performed to examine sex differences in the outcomes. Covariates included demographics, APOE ε4 status, and vascular health-related factors. Sex × age, sex × APOE ε4, and sex × race and ethnicity interactions were additionally examined on the outcomes. False discovery rate (FDR) correction for multiple comparisons were also performed.

RESULTS: A total of 503 participants (mean [SD] age, 64.6 [2.8] years; 321 [63.8%] women; 305 [60.6%] Hispanic, 120 [23.9%] non-Hispanic Black, and 78 [15.5%] non-Hispanic White) with Aβ PET, MRI (n = 501), and tau PET (n = 355) data were studied. Compared with men, women had greater amyloid burden (B = 0.05; 95% CI, 0.02-0.07; P < .001), Braak stages III and IV (B = 0.05; 95% CI, 0.02-0.08; P = .003) and Braak stages V and VI (B = 0.09; 95% CI, 0.06-0.12; P < .001) tau burden, and AD signature thickness (B = 0.04; 95% CI, 0.02-0.05; P < .001). A significant sex × APOE ε4 interaction was observed, with women showing greater Braak stages I and II (B = 0.15; 95% CI, 0.04-0.25; P = .006) and Braak stages III and IV (B = 0.08; 95% CI, 0.02-0.14; P = .01) tau burden than men among APOE ε4 carriers. All findings remained statistically significant after FDR correction. No significant sex × age or sex × race and ethnicity interactions were observed on any outcome.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of community-based adults found greater AD pathology yet better preserved structural brain integrity in women compared with men. Sex differences in tau burden across early to middle Braak stages were more pronounced among APOE ε4 carriers compared with noncarriers. These findings were not modified by age or race and ethnicity. Overall, the results underscore sex-specific distinctions in AD pathology burden and brain structure at the cross-sectional level.

PMID:41591778 | DOI:10.1001/jamanetworkopen.2025.54524

JAMA Netw Open. 2026 Jan 2;9(1):e2555428. doi: 10.1001/jamanetworkopen.2025.55428.

ABSTRACT

IMPORTANCE: Many acceptable-quality deceased donor kidneys go unused every year. Older transplant candidates are more vulnerable to rapid health decline.

OBJECTIVE: To assess the cost-effectiveness of increasing the kidney transplantation rate among older patients with end-stage kidney disease by using acceptable-quality deceased donor kidneys.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation with cost-effectiveness analysis uses a microsimulation model of the kidney transplantation process for a synthetic cohort of adult candidates aged 65 years or older on the transplant waiting list between 2010 and 2019 over their remaining lifetimes. Statistical analysis was performed from January 2023 to December 2025.

INTERVENTION: Increasing the transplantation rate in 5% increments higher than the status quo rate from 5% to 25% using acceptable-quality deceased donor kidneys, with a corresponding shift in the distribution of kidney quality to reflect the use of donor kidneys of lower quality than the status quo.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the number of key waiting list and posttransplant outcomes, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Health state transition probabilities were derived from Scientific Registry of Transplant Recipients data. Costs and quality-of-life weights were derived from published literature and US Renal Data System annual reports, all of which were varied in a probabilistic sensitivity analysis.

RESULTS: In this synthetic cohort of 100 000 individuals, the mean age was 68.8 years (95% CI, 65.0-78.0 years), they had received dialysis for a mean of 1.2 years (95% CI, 0-6.6 years), 61.7% were male, and 56.8% had diabetes. It was estimated there would be 141 (range, 118-161) fewer waiting list deaths per 10 000 candidates if the deceased donor transplantation rate were increased by 25%. Increasing the deceased donor transplantation rate by 25% would cost $8100 (95% credible interval, $700-$14 100) per QALY gained or was cost saving from the health care sector and modified health care sector perspectives. From the health care sector perspective, a 25% increase in the deceased donor transplantation rate was the preferred strategy in all probabilistic sensitivity analysis samples for willingness-to-pay thresholds of $40 000 or more per QALY gained.

CONCLUSIONS AND RELEVANCE: This economic analysis of increasing the kidney transplantation rate in older adults suggests that using acceptable-quality deceased donor kidneys would be cost-effective or cost saving. Decision-makers should consider policies that make better use of recovered kidneys to increase transplantation rates among older patients and any other patients with similar preferences.

PMID:41591776 | DOI:10.1001/jamanetworkopen.2025.55428

Minerva Urol Nephrol. 2026 Jan 27. doi: 10.23736/S2724-6051.25.06301-3. Online ahead of print.

ABSTRACT

BACKGROUND: The role of surgical exploration and frozen sections (FSs) in monorchid patients with testicular nodules is still not well defined. We tested the role of surgical exploration and FSs in monorchid patients and the impact on the chance of testis sparing surgery (TSS).

METHODS: We identified 81 consecutive monorchid patients with testicular nodules between 2008 and 2024 candidates to surgical exploration and FSs. The statistical significance of differences in medians and proportions was tested with the Wilcoxon rank sum and chi-square tests. Multivariable logistic regression models (MLRMs) were used.

RESULTS: Testicular lesions number was available in 61 patients and was one in 35 (57.4%) of those, two in 15 (24.6%), three in 7 (11.5%) and more than three in 4 (6.5%). Median larger lesion size was 12 mm (IQR 9-20 mm). FSs were performed in 59 (73%) patients and showed germ-cell tumor (GCT) in 53 (65.4%). Orchidectomy was performed in 68 patients (84%). In 55 of 56 patients (98.3%) definitive histology confirmed FSs. Thirteen (16%) had TSS including 7 patients with seminomatous GCT, of those none had disease relapse at follow-up. At MLRMs older age was associated with lower probability of GCT (Odds Ratio 0.91, Confidence Interval 0.84-0.99, P value 0.03).

CONCLUSIONS: FSs are feasible and reliable in monorchid patients following a history of GCT. Nonetheless, TSS is rarely performed, as most of these patients actually have GCT. The few ones who had TSS had excellent oncological results.

PMID:41591767 | DOI:10.23736/S2724-6051.25.06301-3