Tag: statistics

J Back Musculoskelet Rehabil. 2025 Oct 7:10538127251384096. doi: 10.1177/10538127251384096. Online ahead of print.

ABSTRACT

BackgroundExtracorporeal shock wave therapy (ESWT) and Kinesio taping (KT) are used for musculoskeletal disorders (MSKDs). Despite limited supporting evidence and misalignment with contemporary rehabilitation approaches, they endure in practice to relieve pain and enhance function; however, their comparative effectiveness remains uncertain.ObjectivesThis systematic review aimed to compare the effects of ESWT versus KT on pain, functionality, strength, and quality of life (Qol) in individuals with MSKDs.MethodsSystematic searches of randomized clinical trials (RCTs) were performed across six databases from inception to June 2025. Two researchers independently screened titles, abstracts, and full-text articles. Risk of bias was assessed using the revised Cochrane Collaboration tool (RoB 2.0). Meta-analysis was conducted using RevMan 5.4 software, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.ResultsFifteen RCTs (n = 907) were included. Comparative analysis revealed no statistically significant difference between ESWT and KT in improving pain 0.12 (95% CI: -0.17, 0. 41, p = 0.41), function 0.04 (95% CI: -0.43, 0.51; P = 0.86), strength 0.68 (95% CI: -7.46, 8.81; P = 0.87), or Qol (P >> 0.05) in the short-term. However, medium-term favored ESWT in pain -1.15 (95% CI: -1.52, -0.78, p < 0.00001) and function -0.89 (95% CI: -1.35, -0.42; P = 0.0002) over KT. The certainty of evidence for all outcomes was very low.ConclusionsVery low-quality evidence indicates no difference between ESWT and KT in improving pain, function, strength, and Qol in patients with MSKDs in the short-term, with a possible medium-term advantage for ESWT in improving pain and function. Our findings should be placed within the context of limited and geographically narrow evidence. High-quality, long-term RCTs are warranted.Other: No funding was received for this review. PROSPERO registration number (CRD42024559635).

PMID:41055921 | DOI:10.1177/10538127251384096

JAMA Netw Open. 2025 Oct 1;8(10):e2534549. doi: 10.1001/jamanetworkopen.2025.34549.

ABSTRACT

IMPORTANCE: Asynchronous patient-portal messaging has emerged as a central component of patient-physician communication, yet disparities in response patterns remain underexplored.

OBJECTIVE: To examine variations in asynchronous messaging responses in primary care by race and ethnicity, insurance type, and primary language.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of messaging data included 795 170 adult patients receiving primary care at Mass General Brigham in 2021, 341 836 of whom sent an asynchronous patient portal message. Data were analyzed from April 17, 2023, to July 29, 2025.

EXPOSURES: Race and ethnicity, insurance status, and preferred language.

MAIN OUTCOMES AND MEASURES: Receipt of a response within 1 or 3 business days and time to first response from care team. Multivariable regression models adjusted for patient demographics, clinic, and time fixed effects.

RESULTS: The analytic sample consisted of 341 836 patients, who sent a total of 3 525 905 messages comprising 1 270 662 message threads to 1113 physicians. Among these patients (mean [SD] age, 52.2 [17.3] years), 18 442 were Asian (5.4%), 14 089 were Black or African American (4.1%), 9979 were Hispanic or Latino (2.9%), 285 919 were White (83.6%), 232 661 had commercial insurance (68.1%), and 332 004 primarily spoke English (97.1%). Characteristics of patient-threads that received a response from any care team member within 1 business day were as follows: 65.7% of threads from Black participants (32 165 of 48 983), 63.9% of threads from Hispanic or Latino (21 732 of 34 014), 68.5% of threads from White participants (743 161 of 1 085 517), 70.0% of threads from patients with commercial insurance (529 803 of 756 923), 60.9% of threads from patients with dual-eligibility (40 846 of 67 045), 68.4% of threads from patients preferring English (847 489 of 1 239 768), and 58.0% of threads from patients preferring Spanish (6898 of 11 903). Similar disparities were found in the response rate from primary care physicians. After adjustment, compared with White patients, the rate of response from any care team member within 1 day was lower for Black patients (1.1 [95% CI, 0.2-2.0] percentage points; P = .01) and Hispanic patients (1.1 [95% CI, 0.3-1.9] percentage points; P = .01). Compared with patients with commerical insurance, the response rate within 1 day was lower for dual-eligible patients (4.9 [95% CI, 4.2-5.5] percentage points; P < .001), and compared with patients who preferred English, the response rate within 1 day was lower for patients who preferred Spanish (4.1 [95% CI, 2.5-5.7] percentage points; P < .001). Adjustment for clinic and time fixed effects accounted for most of the observed disparities in response rates and timing.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of primary care patients in a single health system, there were significant disparities in the responsiveness of primary care teams to asynchronous patient-portal messages by race and ethnicity, insurance type, and language. These were partially attributable to slower response times at practices that treat underserved patients.

PMID:41055905 | DOI:10.1001/jamanetworkopen.2025.34549

JAMA Netw Open. 2025 Oct 1;8(10):e2534985. doi: 10.1001/jamanetworkopen.2025.34985.

ABSTRACT

IMPORTANCE: Kidney biopsy pathology via transmission electron microscopy (TEM) is essential for diagnosing glomerular diseases, offering critical information on glomerular basement membrane (GBM) thickness, foot process (FP) number, and electron-dense deposits (EDDs). These tasks are laborious and time-consuming.

OBJECTIVE: To develop and validate an artificial intelligence (AI) diagnostic system, TEM image-based AI-assisted device (TEM-AID), that accurately segments and measures glomerular ultrastructures (including the GBM, FPs, and EDDs) and determines glomerular disease subtypes using TEM images.

DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study used a large, multicenter cohort including 160 727 TEM images from 31 670 patients with chronic kidney disease across 6 medical centers from January 2021 to December 2023. TEM-AID was trained and validated on 26 650 patients from 1 center and tested externally on 5020 patients (5 test sets) plus a human-AI test set (454 patients representing 7 glomerular disease subtypes). Data were analyzed from January to December 2024.

EXPOSURES: TEM-AID integrates 4 modules. Segmentation combined YOLO-v8 detection, segment anything model, and human-in-the-loop refinement to segment GBMs, podocyte FPs, and EDDs. Measurement quantified GBM thickness, FP fusion degree, and EDD deposition sites. Classification used least absolute shrinkage and selection operator-selected deep learning and statistical features with a stacking classifier to diagnose 7 glomerular disease subtypes: immunoglobin A nephropathy, membranous nephropathy, lupus nephritis, diabetic nephropathy, minimal change disease, mesangial proliferative glomerulonephritis, and thin basement membrane nephropathy.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were segmentation performance (mean intersection-over-union [IOU], Dice coefficient), subtype classification accuracy, area under the receiver operating characteristic curve (AUC), and human-AI diagnostic concordance.

RESULTS: A total of 31 670 patients (mean [SD] age, 43.2 [16.5] years; 17 372 [54.9%] male) contributed 160 727 TEM images for analysis. Segmentation achieved a mean (SD) IOU of 0.835 (0.062) and Dice of 0.874 (0.023). Subtype classification accuracy was 0.911 (95% CI, 0.904-0.918) in internal validation and 0.895 to 0.914 in external tests. Macro-AUC ranged from 0.972 to 0.989 across cohorts. In human-AI testing (454 patients), TEM-AID accuracy (0.886 (95% CI, 0.859-0.912]; AUC, 0.963 [95% CI, 0.937-0.989]) exceeded clinicians’ unaided performance. Clinicians’ accuracy improved by a mean (SD) of 11.7% (5.2%) when they used TEM-AID.

CONCLUSIONS AND RELEVANCE: In this multicenter diagnostic study, TEM-AID precisely quantified glomerular ultrastructures and determined glomerular disease subtypes from TEM images, significantly enhancing diagnostic efficiency and accuracy. This system provides quantitative evaluation tools to support clinical pathologists in diagnostic workflows, demonstrating robust multicenter performance.

PMID:41055904 | DOI:10.1001/jamanetworkopen.2025.34985

JAMA Netw Open. 2025 Oct 1;8(10):e2536236. doi: 10.1001/jamanetworkopen.2025.36236.

ABSTRACT

IMPORTANCE: For many US children, the nearest hospital may be out of state. Medicaid coverage differs by state, affecting access across state lines.

OBJECTIVE: To evaluate the frequency of out-of-state acute care use for pediatric patients.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed acute care hospital data for emergent and inpatient encounters among children younger than 16 years enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in the 2021-2022 Transformed Medicaid Statistical Information System Analytic File database. Analyses were conducted January to July 2025.

EXPOSURE: Distance from a state border.

MAIN OUTCOMES AND MEASURES: The primary outcome was out-of-state care. The percentages of encounters occurring out of state were measured by state, city, and zip code. Logistic regression was used to evaluate the association of out-of-state care use with the log distance from a patient’s zip code to the border between states.

RESULTS: This analysis included 28 952 692 acute care patient encounters (median [IQR] age, 5.3 [2.0-10.8] years, 52.3% male). Out-of-state care occurred among 820 972 encounters (2.8% [95% CI, 2.8%-2.8%]). Maryland (61 468 of 389 539 [15.8% (95% CI, 15.7%-15.9%)]), Vermont (3625 of 31 101 [11.7% (95% CI, 11.3%-12.0%)]), and West Virginia (18 455 of 168 151 [11.0% (95% CI, 10.8%-11.1%)]) had the highest percentages of out-of-state care. The city from which the highest number of children accessed care out of state was Kansas City, Missouri (13 327 of 84 181 encounters [15.8% (95% CI, 15.6%-16.1%)]). Out-of-state care use was more common in rural areas (4.4% [95% CI, 4.3%-4.4%]) compared with urban areas (2.7% [95% CI, 2.7,%-2.7%]). For every 2-fold increase in distance from a state border, crossing a border for care was 34.2% (95% CI, 34.2%-34.3%) less likely. Among children within 1 mile of a state border, 10.0% (95% CI, 9.9%-10.0%) received care out of state.

CONCLUSIONS AND RELEVANCE: Findings from this cross-sectional study of Medicaid and CHIP enrollees indicated that out-of-state acute care use was uncommon overall but more common near state borders. Certain states and cities had high rates of out-of-state acute care use. Changes to Medicaid reimbursement could affect patients’ ability to access cross-border care.

PMID:41055903 | DOI:10.1001/jamanetworkopen.2025.36236

JAMA Netw Open. 2025 Oct 1;8(10):e2536870. doi: 10.1001/jamanetworkopen.2025.36870.

ABSTRACT

IMPORTANCE: Despite the rise in exposure to both positive and negative race-related experiences online, research on how these experiences are associated with mental health outcomes is limited.

OBJECTIVE: To examine the associations between negative online race-related experiences (online racial discrimination, traumatic events online, and algorithmic and filter bias), positive racial socialization messages, and mental health outcomes (depressive and anxiety symptoms).

DESIGN, SETTING, AND PARTICIPANTS: This survey study examined data from a nationally representative, intensive longitudinal 7-day daily dairy, collected as part of the National Survey of Critical Digital Literacy. Surveys were administered daily, with a 24-hour response window, in December 2020. Participants included Black or Black biracial or multiracial (parent-identified) adolescents. Participants were part of a larger nationally representative sample of 1138 adolescents, aged 11 to 19 years of various racial and ethnic backgrounds, recruited through Ipsos’ KnowledgePanel. One eligible adolescent per household was randomly selected to participate. Analyses were conducted in August 2021 and revised in July 2025.

MAIN OUTCOMES AND MEASURES: To examine the daily associations between online race-related experiences and mental health outcomes, dynamic structural equation models were estimated for the longitudinal data.

RESULTS: Results were drawn from survey responses of 141 Black and Black biracial or multiracial adolescents (mean [SD] age, 14.74 [2.51] years; 80 [56.7%] female). Adolescents reported a total of 6 online race-related experiences per day, including 3.2 that are considered online racism and 2.8 that are positive. The study found experiences of online racial discrimination (γ = 0.12; 95% credible interval [CrI], 0.01-0.21), algorithmic bias (γ = 0.11; 95% CrI, 0.02-0.19), and traumatic events online (γ = 0.10; 95% CrI, 0.01-0.19) were positively associated with next day anxiety symptoms. Online racial discrimination (γ = 0.20; 95% CrI, 0.01-0.33]), traumatic events online (γ = 0.10; 95% CI, 0.04-0.15), and algorithmic bias (γ = 0.13; 95% CrI, 0.03-0.22) were positively associated with next-day depressive symptoms. Positive racial socialization experiences were not associated with mental health outcomes.

CONCLUSIONS AND RELEVANCE: In this survey study of online race-related experiences, Black adolescents, on average, reported experiencing 6 per day. Negative experiences were associated with poor mental health. Because young people can experience algorithms almost constantly, this study suggests more research is needed on related daily mental health outcomes.

PMID:41055902 | DOI:10.1001/jamanetworkopen.2025.36870

Health Care Manag Sci. 2025 Oct 7. doi: 10.1007/s10729-025-09731-9. Online ahead of print.

ABSTRACT

Contagious diseases severely impact health systems and economies, with close contact leading to further spread and fatalities. This paper examines the effects of government interventions on controlling such diseases. Key interventions include media isolation of susceptible individuals, effective quarantining of infected persons, and vaccination. A system dynamics approach models the complexities of government interventions in coronary conditions. We used the SEIR (Susceptible, Exposed, Infected, and Recovered) model and developed a new model to address its shortcomings for a new virus. Resilience actions were defined and plotted based on the emergency management cycle phases: Prevention, Preparedness, Response, and Recovery. The model can be applied to any contagious disease worldwide. We calibrated the model using data from sources like the World Health Organization (WHO) and Centers for Disease Control (CDC), and validated it against official and historical data. A sensitivity analysis was conducted based on various resilience strategies: Isolation Rate Slope, Isolation Efficiency, Minimum Isolation Rate, Quarantine Portion, Quarantine Transmission, Vaccination Rate, and Media Rate Slope. The study identifies key conditions for controlling outbreaks: achieving rapid isolation with a minimum rate above 50% and efficiency above 95%, rapid detection and quarantine above 90% with efficiency over 92%, and an optimal contact rate below 0.2, achieved with a media rate slope of 0.005 and vaccination rate above 90%. These measures can control the disease within 455 days or less.

PMID:41055886 | DOI:10.1007/s10729-025-09731-9

J Assist Reprod Genet. 2025 Oct 7. doi: 10.1007/s10815-025-03670-8. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to determine the feasibility of implementing non-invasive PGT-A (niPGT-A) in clinical practice. Informativity and concordance rates between three sample types (embryonic cell-free DNA [cfDNA] present in spent blastocyst medium [SBM], trophectoderm [TE] biopsy, and whole blastocyst [WB]) from the same embryo were evaluated.

METHODS: This was a prospective, multicenter study conducted between February 2022 and November 2022 at seven Japanese IVF centres. 212 blastocysts were donated for research. The cfDNA released into the SBM was analysed, and the results were compared against the corresponding TE biopsy and WB sample.

RESULTS: Overall informativity rates for SBM, TE, and WB were 81.6% (173/212), 98.6% (209/212), and 98.6% (209/212), respectively. There was no difference between TE and WB; however, SBM was significantly different to both (p < 0.001). The informativity rate in SBM samples significantly varied among the seven centres, ranging between 72.7 and 97.1% (p = 0.041). Ploidy concordance (SBM-TE) also varied across the centres, ranging between 68.2 and 90.9%; however, this did not reach statistical significance (p = 0.63). Ploidy concordance rates in SBM-TE, SBM-WB, and TE-WB were 77.4% (130/168), 77.4% (130/168), and 90.5% (152/168), respectively. There was no statistical difference for SBM-TE and SBM-WB, but both were statistically different to TE-WB (p = 0.0054).

CONCLUSION: We have shown results that are consistent with the existing literature, indicating the feasibility of applying the niPGT-A protocol described here, and thus using the SBM result to establish a priority for embryo transfer.

TRIAL REGISTRATION INFORMATION: The study was approved by Tokushima University Hospital Life Science and Medical Research Ethics Review Committee (Permission number: 4057).

PMID:41055878 | DOI:10.1007/s10815-025-03670-8

Med Biol Eng Comput. 2025 Oct 7. doi: 10.1007/s11517-025-03459-y. Online ahead of print.

ABSTRACT

Over the past few years, there has been an increase of clinical interest aimed at looking for correlations between morphology, extracted through statistical shape models (SSMs), and hemodynamics, extracted through computational fluid dynamics (CFD) simulations, in cardiovascular diseases. This study explores correlations between aortic morphology and hemodynamics in the thoracic aorta (TA). Existing research often simplifies geometries by excluding supra-aortic vessels due to software limitations in non-rigid registration. To overcome this, a novel algorithm was used to include these vessels in TA analysis. Principal component analysis reduced dimensionality, followed by automatic CFD simulations and correlation analysis between geometric and hemodynamic parameters. The first ( $M_0$ ) and second ( $M_1$ ) SSM modes explained 46.9 $\%$ and 22.4 $\%$ of dataset variance, respectively. Significant correlations were identified between $M_0$ and ascending TA aneurysm volume (Pr = 0.69), and $M_1$ and TA tortuosity (Pr = 0.60). Ten TA shapes were generated by varying standard deviations of $M_0$ and $M_1$ from -2 to +2, and CFD simulations revealed links between wall shear stress (WSS) indicators and TA morphology. This study presents a novel pipeline to analyze geometric and hemodynamic correlations using realistic TA geometries generated via SSM.

PMID:41055863 | DOI:10.1007/s11517-025-03459-y

Odontology. 2025 Oct 7. doi: 10.1007/s10266-025-01226-x. Online ahead of print.

ABSTRACT

The aim of this study is to evaluate the effects of thermocycling and material thickness on the radiopacity values of various universal composite resins. A total of 18 different composite resin materials were tested, including 7 single-shade, 6 polyshade, and 5 simply-shade composites. Disk-shaped specimens with a diameter of 5 mm and thicknesses of 1 mm and 2 mm were prepared from each material. Radiographic images of all specimens were taken alongside an aluminium step-wedge and tooth sections (enamel and dentin) of corresponding thickness. Using the ImageJ software, the mean gray values (MGV) of each specimen, the 15 steps of the aluminium wedge, and the enamel and dentin sections were measured. These values were converted into aluminium equivalents (mm Al). Differences among materials were analyzed using one-way ANOVA and Tukey’s multiple comparison test, while differences related to thickness and aging were evaluated with two-way ANOVA and Tukey’s test. The level of statistical significance was set at p < 0.05. All composite resin samples exhibited significantly higher radiopacity values than dentin (p < 0.05). The 2 mm thick samples showed greater radiopacity than those with 1 mm thickness (p = 0.000). The material with the highest radiopacity was Charisma Diamond. Among the 1 mm thick specimens before thermocycling, the lowest radiopacity was observed in Omnichroma. In other parameters, Clearfil Majesty ES-2 exhibited the lowest radiopacity values. All tested composite resins demonstrated higher radiopacity values compared to dentin and met the criteria set by the International Organization for Standardization (ISO). Material thickness significantly affected radiopacity. However, radiopacity values varied among materials after thermocycling through thermocycling.

PMID:41055856 | DOI:10.1007/s10266-025-01226-x

Ir J Med Sci. 2025 Oct 7. doi: 10.1007/s11845-025-04111-2. Online ahead of print.

ABSTRACT

BACKGROUND: Young-onset type 2 diabetes mellitus (T2DM) is an increasingly prevalent condition characterized by rapid progression. Apart from adipose tissue, there has been growing attention to the relationship between T2DM and total body skeletal muscle mass (SMM).

AIM: This study investigated the relationships between body composition indicators and glycemic parameters in young-onset T2DM patients versus young, healthy adults, aiming to identify predictive markers with optimal cutoff values for the early identification of young-onset T2DM.

METHODS: A cross-sectional study was conducted among 252 participants aged 18-40 years, including 96 young-onset T2DM patients and 156 non-T2DM individuals. Glycemic parameters and body composition variables were assessed via bioelectrical impedance analysis. Statistical analysis included correlation, multiple logistic regression, and receiver operating characteristic curve analysis to determine optimal SMM% cutoff values for young-onset T2DM prediction.

RESULTS: The SMM% displayed a significant negative correlation with HbA1c (p = – 0.624) and FBG (p = – 0.656). VF demonstrated a positive correlation with both HbA1c (p = 0.636) and FBG (p = 0.580). Logistic regression analysis identified SMM, VF, and subcutaneous fat as significant predictors of HbA1c levels. Receiver operating characteristic analysis revealed gender-specific SMM% cutoff values of 23.14% for females and 28.6% for males, with high sensitivity and specificity.

CONCLUSION: Reduced SMM% and increased VF are significant predictors of young-onset T2DM. The study established the optimal gender-specific cutoff value of SMM% for identifying individuals at risk of young-onset T2DM in the Indian population. Incorporating body composition assessments into clinical practice may facilitate early detection and targeted interventions.

PMID:41055852 | DOI:10.1007/s11845-025-04111-2