Tag: pubmed

BMC Med Res Methodol. 2025 Nov 13;25(1):255. doi: 10.1186/s12874-025-02712-0.

ABSTRACT

BACKGROUND: Continuous biomedical data is often dichotomized into two or more groups for analysis, despite long-standing warnings from statisticians that this constitutes bad practice. This dichotomisation is typically discouraged because it reduces statistical power and may obscure important trends. This paper considers another reason to discourage this practice: that dichotomisation is a powerful tool to manipulate data, as dichotomising at an arbitrary yet flexible threshold (which we term ‘promiscuous dichotomisation’) represents a powerful researcher degree of freedom.

METHODS: The motivating question is how probable is it that given a set of uniformly distributed data a threshold can be engineered to produce the illusion of a true effect when none exists? To estimate this, we employed both analytical approaches and Monte-Carlo simulation approaches to quantify the expected number of spurious findings that could arise from manipulating a dichotomous threshold for an arbitrary data set. We also illustrate an example of this with NHANES data, showing how a spurious relationship between blood glucose and herpes status could be engineered.

RESULTS: For even a relatively small sample of [Formula: see text], a false positive rate of [Formula: see text] can be observed, rising to over [Formula: see text] if low counts scenarios are not excluded. With larger samples even with low-count exclusion, false positive rates in excess of [Formula: see text] for [Formula: see text] and [Formula: see text] for [Formula: see text] are possible, climbing to in excess of [Formula: see text] and [Formula: see text] respectively if low-count scenarios were not excluded. For most configurations, manipulation of thresholds was a highly viable methods of crafting a false positive result.

CONCLUSIONS: It is likely that manipulating cut-off points in measured variables represents a significant source of data manipulation in published science, and the ease of access of larger health databases means this is an issue that is likely to grow in severity. We discuss implications of this, and means of identifying potential promiscuous dichotomisation.

PMID:41233729 | DOI:10.1186/s12874-025-02712-0

BMC Plant Biol. 2025 Nov 13;25(1):1560. doi: 10.1186/s12870-025-07545-z.

ABSTRACT

BACKGROUND: Macrotyloma geocarpum is a socio-economically important and nutrient-rich opportunity legume crop in which a broader genetic basis is required for an accelerated higher-yielding cultivar development.

MATERIALS AND METHODS: Here, we reported for the first time the performance of a set of 300 mutants developed along with five local checks for their agronomic features spanning vegetative, physiological, developmental, seed and yield traits in an augmented design scheme. Descriptive statistics, correlation and multivariate analyses were combined to analyze the data.

RESULTS: Broader genotypic variability was observed in grain yield. Mutants were top outperformers for all traits. For instance, we observed a four-fold variation for grain yield between the best check (Check 3: 643.7 kg.ha^-1) and the most productive mutant (ML645: 2,942.42 kg.ha^-1) genotypes. Higher positive correlation (r = 0.98, p < 0.001) was recorded between the time to 50% flowering and time to maturity while higher negative one (r = -0.92, p < 0.001) was recorded between plant height and time to maturity. Heritability estimates ranged from 1.85 to 96.4% and two traits including seed length and grain yield exhibited high heritability estimates. The 305 genotypes were categorized in three clusters, with Cluster 3 encompassing individuals with the best characteristics.

CONCLUSION: Genotypes of this Cluster 3 including for instance mutants ML645, ML619, ML10126 and ML1000 offer a good opportunity for market development and can be leveraged to advance elite individuals’ selection for M. geocarpum improvement.

PMID:41233726 | DOI:10.1186/s12870-025-07545-z

BMC Geriatr. 2025 Nov 13;25(1):897. doi: 10.1186/s12877-025-06472-w.

NO ABSTRACT

PMID:41233725 | DOI:10.1186/s12877-025-06472-w

JMIR Hum Factors. 2025 Nov 13;12:e64471. doi: 10.2196/64471.

ABSTRACT

BACKGROUND: Mobile health (mHealth), defined as health care facilitated by mobile devices, offers a promising strategy for enhancing disease management and treatment for patients with chronic conditions. However, there is limited information about how patients with inflammatory bowel disease (IBD) use mHealth and their digital preferences.

OBJECTIVE: The aim of the study was to investigate the use of mHealth as well as the preferences, obstacles, and eHealth literacy reported by patients with IBD in Germany.

METHODS: In April and May 2023, we sequentially enrolled patients diagnosed with IBD, including Crohn disease and ulcerative colitis, to participate in a paper-based survey. The survey included questions on sociodemographic details, health characteristics, mHealth use, internet use, eHealth literacy (measured with the eHealth Literacy Scale), and preferences regarding communication and information.

RESULTS: Of the 200 surveyed participants, almost all (197/200, 98.5%) reported regular smartphone use, and more than two-thirds (139/200, 69.5%) indicated regular engagement with social media. Most of the respondents (168/200, 84%) expressed the belief that incorporating medical apps into their routine could positively impact their health. However, only 25 (12.5%) of the 200 patients acknowledged using medical apps, of which just 2 apps were IBD specific, used by only a few (n=3, 12%). Furthermore, awareness of useful websites or mobile apps tailored for IBD was limited (45/200, 22.5%). Nearly all participants (196/200, 98%) expressed willingness to share app data for research purposes, and most (171/200, 85.5%) consented to transmit app data to their treating physicians. A large majority (175/200, 87.5%) indicated readiness to regularly input data into an app, with a preferred duration of up to 5 minutes (109/200, 54.5%) and weekly input frequency (76/200, 38%). For an IBD-specific app, the most frequently requested functions were electronic prescriptions (110/200, 55%) and a newsletter about new scientific work and clinical studies (94/200, 47%). Usability and security were identified as key app attributes. The internet was the predominant source of health-related information (180/200, 90%). The average eHealth literacy score, measured with the eHealth Literacy Scale, was high (mean 28.9, SD 5.4; range 8-40), with a positive correlation observed between higher eHealth literacy and factors such as younger age and more frequent internet use for health information.

CONCLUSIONS: Patients with IBD are well prepared and motivated to use mHealth technologies to better understand their chronic condition and optimize treatment. However, their enthusiasm is tempered by the currently low adoption of mHealth. To fully harness the potential of mHealth in IBD treatment, effective and tailored mHealth solutions, guidance for their implementation, and patient education are needed.

PMID:41232095 | DOI:10.2196/64471

JCO Clin Cancer Inform. 2025 Nov;9:e2500186. doi: 10.1200/CCI-25-00186. Epub 2025 Nov 13.

ABSTRACT

PURPOSE: Acute care use (ACU) is more costly and prolonged for oncology patients and often leads to treatment disruptions and worsened outcomes. Reducing ACU requires understanding risk factors and proactively identifying at-risk patients. This study addresses research gaps by developing predictive models to assess all-cause acute care use (A-ACU) versus preventable acute care use (P-ACU) and rural-specific barriers.

PATIENTS AND METHODS: We conducted a retrospective cohort study of adult oncology patients who received intravenous cancer treatment between October 2021 and April 2024 within a rural midwestern regional cancer network. We used predictor and outcome data from electronic medical records and insurance claims. We defined P-ACU using the Centers for Medicare & Medicaid Services’ OP-35 criteria and classified A-ACU as any emergency department visit or hospitalization, regardless of reason. We trained LASSO and Random Forest models on 80% of the cohort to predict 30-, 90-, and 180-day risk of P-ACU and A-ACU after regimen initiation.

RESULTS: Among 2,922 patients, 45.3% experienced A-ACU and 10.3% had P-ACU within 180 days of chemotherapy regimen initiation. Key predictors included number of previous inpatient stays and comorbidities. Insurance type and age were more influential in predicting P-ACU, whereas laboratory values (albumin, sodium, and neutrophil-to-lymphocyte ratio) were more important in A-ACU models. Nearly all LASSO and Random Forest models showed strong performance (mean area under the receiver operating characteristic curve = 0.73, mean F1 score = 0.79).

CONCLUSION: Our models effectively identify patients at high risk for ACU using routinely collected data and validate known risk factors in a large rural oncology population. Future work should integrate these tools into practice and address rural-specific challenges to reduce ACU during chemotherapy.

PMID:41232065 | DOI:10.1200/CCI-25-00186

Neurology. 2025 Dec 9;105(11):e214385. doi: 10.1212/WNL.0000000000214385. Epub 2025 Nov 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: Temporal lobe epilepsy (TLE) is a highly prevalent neurologic disorder, with 30%-50% of patients developing drug-resistant epilepsy. Pharmacoresistant seizures remodel critical arousal and respiratory networks, impairing autonomic function and chemoreception and putting patients at increased risk of adverse respiratory events and sudden unexpected death (SUDEP). Given that the bed nucleus of stria terminalis (BNST) serves as a key relay between brainstem respiratory nuclei and cortical arousal networks, we characterized interictal BNST connectivity alterations in patients with TLE.

METHODS: We conducted a case-control study of patients with drug-resistant TLE evaluated for epilepsy surgery at Vanderbilt University Medical Center, compared with healthy controls with no history of neurologic disease. Inclusion criteria for patients included clinical TLE diagnosis and age 18-65 years. Using resting-state fMRI (multiband factor = 3, repetition time [TR] = 1.3 seconds), we measured functional connectivity (FC) and effective connectivity through Granger causality (GC) between BNST and whole-brain cortical networks, and brainstem nuclei. Graph theoretical network metrics assessed BNST hub properties. Statistical analyses used multiple comparison corrections and age-corrected z-scores.

RESULTS: Thirty-seven patients with TLE (mean age 42.5 ± 12.1 years, 43.2% female) and 33 healthy controls (mean age 36.2 ± 12.0 years, 54.5% female) were studied. Patients demonstrated bilateral reductions in BNST connectivity and causal influence with the whole brain (FC: -2.31 ± 2.87, p = 0.0032; GC: -0.18 ± 0.08, p = 0.0025). While FC showed preserved BNST-brainstem connectivity, GC revealed ipsilateral disruptions in BNST influence over ventral tegmental area (0.023 ± 0.026, p = 0.0067), median raphe (-0.009 ± 0.029, p = 0.0038), and cuneiform nuclei (0.012 ± 0.062, p = 0.0153). Critical respiratory circuits showed divergent reorganization: dorsal raphe-parabrachial complex pathways exhibited 57.2% efferent reduction (p = 0.0028), with 204.6% compensatory afferent increase (p = 0.0020), while dorsal raphe-locus coeruleus circuits showed bilateral deterioration (66.2% reduction in dorsal raphe-locus coeruleus [DR→LC], p = 0.0015; 56.4% reduction in LC→DR, p = 0.0189). Graph analyses confirmed compromised BNST network integration bilaterally (p < 0.05).

DISCUSSION: Our findings reveal network reorganization in TLE that compromises autonomic and arousal circuit integrity, leading to failed respiratory-autonomic integration that may underlie respiratory vulnerability and increased SUDEP risk; however, we did not directly study SUDEP cases.

PMID:41232063 | DOI:10.1212/WNL.0000000000214385

Neurology. 2025 Dec 9;105(11):e214316. doi: 10.1212/WNL.0000000000214316. Epub 2025 Nov 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by 3 core symptom complexes: parkinsonism, cerebellar syndrome, and dysautonomia. Recent Movement Disorder Society (MDS) criteria allow for the clinical diagnosis of MSA based solely on motor symptoms, without requiring dysautonomia. This study aimed to evaluate the frequency and disease trajectory of MSA patients without dysautonomia compared with those with autonomic involvement.

METHODS: A multicenter cohort of autopsy-confirmed patients with MSA was analyzed for demographic characteristics, symptom onset, and progression of parkinsonism, cerebellar syndrome, and dysautonomia. Clinical data were collected through standardized chart reviews across participating centers and categorized using the MDS-MSA criteria. Patients were grouped according to their initial symptom complex and tracked for the evolution of additional symptoms. Analyses included time to development of further symptom complexes, age at symptom onset, disease duration, and phenotype at the last recorded visit. Patients with motor symptoms only were matched to patients with similar demographics but with dysautonomia. Statistical methods included ANOVA, t tests, Welch t tests, and χ² tests, with significance set at p < 0.05.

RESULTS: Among 140 patients (mean age at onset 62.3 ± 8.9 years; 44% female), 81 (58%) initially presented without dysautonomia (57 with parkinsonism only, 17 with cerebellar syndrome only, 7 with both). At final follow-up, 12 patients (9%) had not developed dysautonomia. These patients showed significantly longer disease duration (mean 8.1 ± 2.1 years) than matched patients with dysautonomia (mean 6.3 ± 2.6 years; p = 0.035). Overall, 51% of patients developed all 3 symptom complexes. Patients with cerebellar onset progressed more rapidly to multisystem involvement than those with parkinsonian onset (mean interval to second symptom: 2.0 vs 3.4 years; p < 0.05).

DISCUSSION: The MDS-MSA criteria expand the diagnostic scope by identifying a motor-only subgroup with a distinct and potentially slower disease course. These findings underscore the importance of including motor-only patients in natural history and interventional studies. Limitations include retrospective data collection and potential variability in symptom documentation.

PMID:41232058 | DOI:10.1212/WNL.0000000000214316

Am J Public Health. 2025 Nov 13:e1-e4. doi: 10.2105/AJPH.2025.308289. Online ahead of print.

ABSTRACT

Objectives. To compare changes in the number of facility-based abortions among Texas residents in different age groups following the state’s 2021 law prohibiting abortion after detection of embryonic cardiac activity. Methods. We obtained data from Texas and 6 surrounding states on Texas residents’ age at abortion from state vital statistics and data provided directly by out-of-state abortion facilities. Using negative binomial regression, we estimated the percentage change in abortions before (September 2020-May 2021) and after (September 2021-May 2022) the law went into effect. Results. After the law’s implementation, total (in-state and out-of-state) facility-based abortions decreased by 26.1% (95% confidence interval [CI] = -32.7%, -18.8%) among Texans younger than 18 years, by 19.6% (95% CI = -21.4%, -17.7%) among young adult Texans aged 18 to 24 years, and by 17.0% (95% CI = -19.1%, -14.8%) among Texans aged 25 to 29 years. Conclusions. Texas’s law disproportionately affected access to facility-based abortion care among Texans aged 24 years and younger. Public Health Implications. State laws prohibiting abortions in early pregnancy disproportionately affect young people’s reproductive autonomy, likely by compounding long-standing financial and logistical barriers to facility-based care. (Am J Public Health. Published online ahead of print November 13, 2025:e1-e4. https://doi.org/10.2105/AJPH.2025.308289).

PMID:41232053 | DOI:10.2105/AJPH.2025.308289

Am J Public Health. 2025 Nov 13:e1-e8. doi: 10.2105/AJPH.2025.308284. Online ahead of print.

ABSTRACT

Objectives. To examine how gerrymandering affects federally qualified health center (FQHC) availability in North Carolina. Methods. We used data from 2004 to 2022 and spatial regression models to correlate gerrymandering metrics with FQHC availability and utilization at the zip code level. Results. Gerrymandering severity is inversely associated with FQHC availability and utilization. For example, individuals in communities split evenly between 2 state senate districts in this 18-year period (from the end of 2004 through 2022) traveled about 30% farther to their nearest FQHC in 2022 than individuals in communities entirely within a district, and they were up to 20% less likely to visit an FQHC. Increased electoral competitiveness also reduced FQHC availability and utilization. Residential segregation was not linked to FQHC availability or gerrymandering severity. Conclusions. Gerrymandering weakens local political representation and may lead to reduced access to vital health care services-a structural issue with far-reaching implications for health equity and national policy reform. (Am J Public Health. Published online ahead of print November 13, 2025:e1-e8. https://doi.org/10.2105/AJPH.2025.308284).

PMID:41232048 | DOI:10.2105/AJPH.2025.308284

JCO Oncol Pract. 2025 Nov 13:OP2500306. doi: 10.1200/OP-25-00306. Online ahead of print.

ABSTRACT

PURPOSE: The multicenter Symptom Management Implementation of Patient Reported Outcomes in Oncology Consortium developed electronic Symptom Management (eSyM), an electronic health record-based symptom management program, to reduce acute care utilization. We hypothesized that implementing eSyM would also improve self-reported symptom burden and self-efficacy.

METHODS: eSyM was deployed via a pragmatic stepped-wedge cluster randomized trial for adults who started chemotherapy or had surgery for confirmed or suspected GI, gynecologic, or thoracic malignancies across six cancer centers from 2019 to 2023. In parallel, we administered a survey to two distinct cohorts: patients treated before and after eSyM deployment (ie, pre-live and post-live). A REDCap-based survey collected demographic and clinical characteristics and assessed six Patient-Reported Outcomes Measurement Information System measures: self-efficacy for symptom management, pain interference, anxiety, fatigue, depression, and physical function. Differences in mean T-scores were derived for the post-live versus pre-live cohorts among chemotherapy and surgery recipients. Multivariable regression models controlled for relevant patient and clinical characteristics.

RESULTS: The pre-live cohort included 1,043 respondents (490 chemotherapy and 553 surgery); the post-live cohort included 1,046 respondents (535 chemotherapy and 511 surgery). After controlling for other clinical and demographic factors, the post-live chemotherapy cohort reported statistically significantly lower fatigue and anxiety, but the reductions did not meet the clinically meaningful threshold (adjusted mean T-score difference: -1.3 and -1.8, respectively; P < .05). The post-live surgery cohort reported statistically significantly lower fatigue and anxiety; the differences met the clinically meaningful threshold (-2.0 and -2.2, respectively; P < .01).

CONCLUSION: eSyM deployment was associated with reduced symptom burden, but clinically meaningful differences were only observed in fatigue and anxiety scores among surgical patients. Future studies should investigate the mechanisms by which symptom reporting affects patient outcomes, such as improving patient-clinician communication, enhancing clinician attention to symptom management, or increasing patient self-efficacy.

PMID:41232046 | DOI:10.1200/OP-25-00306