Category: Statistics

J Craniofac Surg. 2026 Aug 25. doi: 10.1097/SCS.0000000000013246. Online ahead of print.

ABSTRACT

Cartilage grafts are widely used in rhinoplasty; however, concerns remain regarding bacterial contamination during graft handling and storage. The authors aimed to evaluate bacterial growth in septal cartilage grafts stored in gentamicin-diluted saline solution and to investigate the relationship between storage duration, the localization of bacterial growth, and microbiological characteristics. This ambispective observational study included 94 septal cartilage grafts harvested during rhinoplasty procedures and stored under controlled conditions. Microbiological analyses were performed prospectively using standard aerobic and anaerobic culture techniques. Storage duration was defined as the interval between harvesting and culture. Culture results, bacterial species, and localization of growth (cartilage versus storage solution sediment) were recorded. Statistical analysis was performed using the Mann-Whitney U test and the Fisher exact test. Bacterial growth was detected in 18 of 94 samples (19.1%), while 76 samples (80.9%) showed no growth. Growth was more frequently observed in the storage solution sediment (n=11) than within the cartilage graft itself (n=8). Mean storage duration did not differ significantly between culture-positive and culture-negative samples (452.1 versus 418.3 d, P=0.882). Stratified analysis (<365 versus ≥365 d) also showed no significant difference in culture positivity (P=0.613; OR=0.73). No association was observed between storage duration and the type of microorganisms. The majority of septal cartilage grafts remained culture-negative despite prolonged storage. Bacterial growth was more commonly confined to the surrounding storage solution rather than the graft itself. These findings suggest that storage in gentamicin-containing solutions may provide a microbiologically stable environment, although complete sterility cannot be guaranteed.

PMID:42636444 | DOI:10.1097/SCS.0000000000013246

Endocr Relat Cancer. 2026 Aug 24:ERC-26-0116. doi: 10.1530/ERC-26-0116. Online ahead of print.

ABSTRACT

MammaPrint® refines risk stratification in early oestrogen receptor-positive, HER2-negative breast cancer, evolving from a binary to a four-tier classification (UltraLow, Low, High-Risk1, High-Risk2). The relationship between routine histopathological features, immune infiltration and genomic risk within this framework remains incompletely characterised in luminal disease. We retrospectively analysed 492 luminal breast carcinomas with available MammaPrint® results. Clinicopathological variables (including histological subtype, grade, Ki-67, hormone receptor expression, lymphovascular invasion (LVI) and HER2-low status) were recorded. Stromal tumor-infiltrating lymphocytes (TILs) were quantified according to Salgado et al. criteria and spatially categorised as immune-deserted, stromal-restricted, immune-excluded or inflamed patterns. CD4 and CD8 infiltration was assessed by immunohistochemistry on tissue microarrays. Associations with binary and four-tier MammaPrint® categories were examined using multivariable models. High-Risk tumours (41%) were enriched for increased grade, Ki-67 and LVI; and lower PR expression. In High-Risk inflamed spatial patterns were more frequent and median TILs levels were significantly higher compared with Low-Risk (15% vs. 5%, p<0.001). CD4 and CD8 infiltration increased with genomic risk; and CD4 retained a modest but statistically significant association after adjustment for conventional pathological variables. In the four-tier model, UltraLow/Low tumours showed minimal TILs and were enriched for invasive lobular carcinoma, whereas High-Risk1/High-Risk2 displayed progressively higher proliferative and immune features. No association was observed between HER2-low status and genomic risk. Immune infiltration parallels proliferative and genomic risk gradients in luminal breast cancer. These findings indicate that immune descriptors align with the genomic risk continuum, although their independent prognostic contribution beyond established genomic assays requires further evaluation.

PMID:42636438 | DOI:10.1530/ERC-26-0116

JMIR AI. 2026 Aug 24;5:e85822. doi: 10.2196/85822.

ABSTRACT

BACKGROUND: Fairness evaluation is essential for trustworthy clinical risk prediction. However, existing fairness-oriented discrimination metrics either ignore cross-group comparisons or rely on exhaustive pairwise evaluations, making them difficult to interpret and impractical for model selection.

OBJECTIVE: This study aimed to develop and evaluate novel fairness-oriented discrimination metrics for clinical risk prediction that address limitations of within-group and pairwise cross-group approaches.

METHODS: We examined theoretical properties of existing U-statistic-based metrics, including concordance index (CI) and area under the receiver operating characteristic curve (AUC), when applied to subgroups. We highlighted the distinction between within-group discrimination (ranking within a subgroup) and group-level discrimination (ranking relative to the broader population). Building on this framework, we proposed group-level extensions of the CI and AUC that summarize subgroup-specific performance in a single interpretable measure. We then applied these metrics to the PREVENT (Predicting Risk of Cardiovascular Disease Events) equation, a recently developed model for atherosclerotic cardiovascular disease.

RESULTS: The traditional subgroup-specific CI and AUC captured within-group but not group-level discrimination, obscuring inequities in clinical decision-making. Existing cross-group approaches (eg, the xCI and xAUC metrics) addressed this limitation but became computationally and interpretively burdensome with multiple subgroups due to pairwise comparisons. Our proposed metrics provided a streamlined alternative, yielding 1 summary statistic per subgroup while retaining sensitivity to cross-group ranking disparities. Applied to PREVENT, these metrics revealed differences in subgroup performance not apparent from within-group evaluations.

CONCLUSIONS: By distinguishing between within-group and group-level discrimination, our framework clarifies a common source of misinterpretation in fairness evaluation. The proposed group-level extensions of the CI and AUC provide practical, interpretable tools for evaluating fairness in clinical prediction models, enabling more transparent and equitable risk assessment.

PMID:42636434 | DOI:10.2196/85822

JMIR Rehabil Assist Technol. 2026 Aug 24;13:e79358. doi: 10.2196/79358.

ABSTRACT

BACKGROUND: Improving exercise self-efficacy (ESE) is a key strategy for promoting sustained physical activity among older adults with frailty. The lumbar-type Hybrid Assistive Limb (HAL), a wearable device that supports voluntary movement through bioelectric signals, may facilitate mastery experiences in individuals with low baseline self-efficacy via adjustable assistance. However, its effects on ESE remain unclear.

OBJECTIVE: This study evaluated the effects of lumbar-type HAL exercise on ESE in older adults with frailty and examined whether responsiveness differed according to baseline readiness for exercise.

METHODS: A retrospective pooled analysis was conducted using data from 2 prospective studies of a lumbar-type HAL-based frailty prevention program: a feasibility study (n=20) and a randomized controlled trial (RCT; n=76; lumbar-type HAL group: n=38; waitlist control: n=38). Participants aged 50 to 84 years performed sit-to-stand and squat exercises using the lumbar-type HAL twice weekly. ESE was assessed using a validated 4-item questionnaire (range 4-20). The prespecified primary analysis examined within-person changes in ESE in the lumbar-type HAL group (2-tailed paired t test; n=96). A secondary analysis compared changes in ESE between the lumbar-type HAL and waitlist control groups in the RCT using the Welch t test and baseline-adjusted analysis of covariance. A prespecified subgroup analysis compared participants in stages 1 to 4 of the transtheoretical model of behavior change (exercise habit not established) with those in stage 5 (maintenance). All statistical tests were 2 sided, with significance at P<.05.

RESULTS: The primary pooled paired analysis demonstrated a significant increase in ESE of 1.05 points (95% CI 0.41-1.69; P=.002). The subgroup analysis was also significant: those in stages 1 to 4 (n=56) improved by 1.73 points vs 0.05 points for those in stage 5 (n=38), a difference of 1.68 points (95% CI 0.41-2.95; P=.01). The largest within-group improvement was observed in stage 1 (precontemplation: +3.50 points, 95% CI 0.27-6.73; P=.04; Cohen d=1.14); 4 of 6 participants improved and none deteriorated. In the secondary RCT between-group comparison, the lumbar-type HAL group showed a directionally favorable improvement (between-group difference=1.21 points, 95% CI -0.33 to 2.75; P=.12; Cohen d=0.36). The subgroup differences were 2.10 points in stages 1 to 4 (P=.07; Cohen d=0.58) and 0.02 points in stage 5 (P=.99). Sensitivity analyses confirmed robustness to source-related heterogeneity (heterogeneity test: P=.74; source-adjusted regression: P=.76).

CONCLUSIONS: The pooled analysis demonstrated significant within-person improvement in ESE among older adults with frailty following lumbar-type HAL training, with the greatest improvement in individuals without established exercise habits. The RCT indicated a favorable but inconclusive between-group effect, and adequately powered confirmatory RCTs remain necessary. The exploratory response among precontemplators-typically difficult to engage in interventions-suggests that HAL-supported mastery experiences may support disengaged older adults at high risk of frailty in starting physical exercise.

PMID:42636433 | DOI:10.2196/79358

Health Care Women Int. 2026 Aug 24:1-27. doi: 10.1080/07399332.2026.2715599. Online ahead of print.

ABSTRACT

Maternal mortality remains a major public health challenge in low- and middle-income countries (LMICs). Utilizing maternal healthcare services (MHS)-such as antenatal care (ANC), skilled birth attendance (SBA), institutional delivery (ID), and postnatal care (PNC) is vital for reducing maternal mortality. Using data from 33 LMICs, the authors found that the average MHS utilization rates were 58.9% for ANC, 70.0% for SBA, 66.9% for ID, and 53.8% for PNC, with considerable variation across countries. Using logistic regression analysis, we found that factors like rural residence, lower education, and higher parity were associated with reduced MHS access. Tailored interventions may help achieve Sustainable Development Goals (SDGs) for maternal health by 2030.

PMID:42636430 | DOI:10.1080/07399332.2026.2715599

J Orthop Surg (Hong Kong). 2026 May-Aug;34(2):10225536261483752. doi: 10.1177/10225536261483752. Epub 2026 Aug 24.

ABSTRACT

BackgroundPhysical therapy and exercise form the cornerstone of plantar fasciitis management, and clinicians rely heavily on systematic reviews to navigate a crowded and heterogeneous evidence base. Exercise interventions are inherently difficult to blind, outcome measures vary widely across trials, and protocols differ in dosage, supervision, and adherence, creating ample opportunity for selective framing. Whether spin, reporting behavior that inflates perceived benefit without falsification, has shaped this literature remains unknown.MethodsPubMed, Embase, Web of Science, and the Cochrane Library were searched. Spin was classified using the Yavchitz et al. taxonomy across misleading interpretation, misleading reporting, and inappropriate extrapolation domains. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews, Version 2 (AMSTAR-2).ResultsSeven systematic reviews were included. Selective overemphasis on efficacy outcomes and selective focus on statistically significant results each affected 4 of 7 reviews (57%), and conclusions claiming benefit despite high risk of bias were present in 3 of 7 (43%). On AMSTAR-2, no review reported primary study funding sources (0/7), no review provided a list of excluded studies (0/7), and duplicate data extraction was performed in only 2 of 7 (29%).ConclusionsSpin in the physical therapy plantar fasciitis literature operates subtly, not through overreaching extrapolation but through selective framing of results already within the data. This form is harder to detect and correct than outright misrepresentation. Strengthened protocol pre-registration, funding disclosure, and peer review processes that explicitly assess data-conclusion alignment are necessary to produce a trustworthy evidence base for this foundational treatment category.

PMID:42636417 | DOI:10.1177/10225536261483752

Prehosp Emerg Care. 2026 Aug 24:1-15. doi: 10.1080/10903127.2026.2719957. Online ahead of print.

ABSTRACT

OBJECTIVES: Determining a child’s weight is a critical first step in administering the appropriate dose of a medication in an emergency. The National Emergency Medical Services Quality Alliance (NEMSQA) patient safety process measure, “Pediatrics-03b,” calls for weight documentation in kilograms or length-based weight estimate for pediatric patients who receive weight-based medications in the prehospital setting. To date, no publication has identified compliance with this measure at a national level. The goal of this study was to describe weight documentation in pediatric 9-1-1 responses and factors associated with this quality measure.

METHODS: Using the ImageTrend Collaborate 2024 national dataset, we analyzed 9-1-1 responses for pediatric patients (<18 years of age) who received medication by EMS clinicians consistent with the Pediatrics-03b definition denominator. Weight documentation was obtained from eExam01 and eExam02 National EMS Information System fields. Differences in weight documentation were assessed by patient demographics, unit, and scene characteristics. Furthermore, medication type and administration routes were examined. Statistical analyses included chi-square tests for comparison of proportions and population averaged univariable logit regression models for the binary outcome of weight documentation with clustering for state.

RESULTS: Overall, 57,378 responses met inclusion criteria, and 41,963 (73.1%) had a documented weight. Weights were less likely to be documented in cases involving adolescent (age 13-17) patients (Odds Ratio [OR]: 0.87, 95% Confidence Interval [95% CI]: 0.75-0.99), patients described as Black (OR: 0.72, 95% CI: 0.61-0.85), or those with lower acuity (OR: 0.59, 95% CI: 0.50-0.71). Weights were more likely to be documented in cases managed by advanced life support units (OR: 2.02, 95% CI: 1.31-3.11) and in patients described as male (OR: 1.08, 95%: 1.03-1.14).

CONCLUSIONS: Three quarters of 9-1-1 responses meeting the Pediatrics-03b case definition were compliant with the measure. Future studies should be focused on evaluating the case definition for the measure to determine how to best evaluate and improve care in this domain.Establishing a benchmark, evaluating that benchmark, and understanding barriers to optimal implementation are critical to improving prehospital care and documentation of pediatric patients by EMS clinicians.

PMID:42636409 | DOI:10.1080/10903127.2026.2719957

JMIR Med Inform. 2026 Aug 24;14:e84820. doi: 10.2196/84820.

ABSTRACT

BACKGROUND: Public reporting systems (PRSs) in health care are defined as digital platforms that make comparative health care performance data available to the public (eg, Hospital Compare in the United States, NHS Choices in the United Kingdom, national quality registries in Europe, and MyHospital in Australia). These systems aim to improve transparency, accountability, and patient choice. While these systems have been widely studied from policy and clinical perspectives, the information system (IS) foundations that enable their operation, including architecture, interoperability, data governance, APIs, usability, and technical performance, remain underexplored.

OBJECTIVE: This study aims to map the extent and nature of the published literature addressing the technological foundations of PRSs in health care and to identify persistent gaps in IS scholarship.

METHODS: This scoping review followed the Joanna Briggs Institute guidelines and was reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Seven databases were searched: PubMed, Web of Science, Scopus, IEEE (Institute of Electrical and Electronics Engineers), ACM (Association for Computing Machinery), AIS (Association for Information Systems) eLibrary, and Cochrane. The search covered articles published between 2000 and 2026. Eligible articles included peer-reviewed journal articles and conference papers on PRSs in health care. Data were charted according to study characteristics, including 6 IS-specific coding dimensions: architecture, interoperability, data governance, APIs, usability, and technical performance. Descriptive statistics were used to summarize the findings, and a narrative synthesis was conducted to identify thematic trends and research gaps.

RESULTS: A total of 1882 records were identified across 7 databases. After deduplication, 1127 records were screened, and 233 studies were included in the review. Most of the included studies originated from the United States (n=157, 67.4%), followed by Europe (n=43, 18.4%). Of the 233 included studies analyzed, 60.5% (n=141) used quantitative methods, whereas 24.0% (n=56) used qualitative methods and 15.5% (n=36) used mixed methods. Applying a structured IS coding framework to all 233 studies revealed that the technical substrate of PRSs remains underexplored.

CONCLUSIONS: Despite the centrality of IS infrastructure to public reporting, existing scholarship predominantly frames these systems as policy or social tools while neglecting their technical underpinnings. This oversight has practical implications, including poor system usability, weak interoperability, and noncompliance with data regulations, which can undermine patient trust and system effectiveness. Addressing this gap requires interdisciplinary approaches that integrate IS frameworks, sociotechnical analysis, and usability evaluation to ensure that PRSs are effective, equitable, and technically robust.

PMID:42636404 | DOI:10.2196/84820

Eur J Dent Educ. 2026 Aug 24. doi: 10.1111/eje.70286. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the present study was to compare the reliability and outcomes of traditional and digital assessment methods for preclinical dental students’ tooth preparations at the beginning and end of the semester.

MATERIALS AND METHODS: Forty-two second-year preclinical dental students were included in the present study (n = 42). Tooth preparations were assessed both at the beginning and end of the semester using a CAD/CAM-based digital system and traditional assessment method. Evaluation criteria included the presence of undercuts, finishing line quality, axial walls’ smoothness and taper. Intragroup comparisons were conducted using paired-sample t-tests. The level of agreement between the two methods was determined using the intraclass correlation coefficient (ICC). Significance was assessed at the p < 0.05 level.

RESULTS: No statistically significant differences were identified between traditional and digital assessment methods at either evaluation time (p > 0.05). Although the digital method showed no statistically significant changes over time, scores of the traditional assessment method were significantly higher at the beginning of the semester than at the end (p < 0.05). The agreement between the two methods was moderate, with ICC values of 0.602 (95% CI: 0.259-0.786) at the beginning of the semester and 0.531 (95% CI: 0.127-0.748) at the end of the semester.

CONCLUSION: The agreement between traditional and digital assessment methods was moderate. Although digital systems provide objective and standardized evaluations of geometric parameters, they should serve as complementary tools rather than complete replacements for individualized faculty feedback.

PMID:42636390 | DOI:10.1111/eje.70286

Proc Natl Acad Sci U S A. 2026 Sep;123(35):e2609143123. doi: 10.1073/pnas.2609143123. Epub 2026 Aug 24.

ABSTRACT

Coarse-grained models of chaotic systems neglect unresolved degrees of freedom, inducing structured model error that limits predictability and distorts long-term statistics. Typical data-driven closures are trained to minimize prediction error over a single time step, implicitly assuming Markovian dynamics and often failing to capture long-term behavior. Recent approaches instead optimize losses over finite trajectories. However, when such trajectory-based training is carried out with deterministic pointwise losses, it introduces a fundamental mathematical degeneracy. We prove that optimizing pointwise deterministic losses, including but not limited to mean squared error, over chaotic trajectories suppresses predictive variance, with a corresponding loss of physical variability in long integrations. In contrast, strictly proper scoring rules avoid this degeneracy. By targeting forecast distributions rather than realized trajectories, they remove the penalty against predictive spread and align the long-lead optimum with the invariant measure. Using quasi-geostrophic turbulence as a canonical chaotic system, we validate this theory: Closures trained with one-step losses fail to capture stable coarse-grained dynamics, while deterministic closures optimized over trajectories exhibit the variance-loss tendency predicted by our analysis. Stochastic closures calibrated over trajectories using the energy score, however, overcome both structural limitations, yielding skillful ensemble forecasts and realistic long-term statistics. Our results establish that both stochastic modeling and trajectory-based calibration are essential for faithfully representing the dynamics of coarse-grained systems.

PMID:42636379 | DOI:10.1073/pnas.2609143123