Category: Statistics

Hum Brain Mapp. 2026 Jul;47(10):e70593. doi: 10.1002/hbm.70593.

ABSTRACT

Establishing the reliability of spinal cord functional magnetic resonance imaging (fMRI) is critical before employing it to assess experimental or clinical interventions. Previous studies have mapped human motor activity primarily to the ipsilateral ventral horn, aligning with myotomal and dermatomal projections. Despite these insights, the test-retest reliability of spinal fMRI remains under-investigated. Here we assessed spinal cord activation during a sensorimotor paradigm involving right-hand grasping and grip force estimation in 30 healthy volunteers. Participants completed two identical scanning visits, each time performing the same task twice, enabling the investigation of test-retest reliability both within a single experimental visit and between visits performed on different days. Aggregating all task runs, motor-evoked activation was observed in ipsilateral ventro-dorsal regions of spinal segmental levels C5-T1, as well as in medial regions of levels C2-C3. Despite highly reliable task performance (grip force) and fMRI signal quality (temporal signal-to-noise ratio), the reliability of motor activation was predominantly poor-to-fair both within and between visits, with notable variability in spatial distribution observed across task runs. Increasing the number of task runs per individual improved the robustness of group-level activation, as indexed by higher activated voxel count, larger cluster spatial extent, and attenuated t-statistic distribution. Although we demonstrated that motor-evoked activation corresponds to the known neuroanatomical organisation of motor circuits, its low test-retest reliability presents a challenge for wider applications of spinal fMRI. Understanding the drivers of low reliability in functional imaging is warranted, but we suggest that looking beyond measurement error is required, including careful consideration of inherent within-individual variability underpinned by neurophysiological and psychological factors.

PMID:42367071 | DOI:10.1002/hbm.70593

J Adolesc. 2026 Jun 29. doi: 10.1002/jad.70211. Online ahead of print.

ABSTRACT

INTRODUCTION: Rooted in Buddhist thought, nonattachment refers to the ability to let go of rigid desires and fixed self-concepts, fostering a balanced and flexible engagement with one’s experiences. The present study examined whether interpersonal harmony moderated the association between nonattachment and general well-being among Chinese junior high school students. Interpersonal harmony was conceptualized as comprising two facets: harmony enhancement (a proactive motivation to cultivate warm and supportive relationships) and disintegration avoidance (a defensive motivation to suppress conflict to maintain surface harmony).

METHODS: A sample of 652 Chinese junior high school students completed the nonattachment scale (NAS), harmony scale, and general well-being scale (GWB). Hierarchical regression analyses were conducted with grade and family structure controlled.

RESULTS: The results indicated that nonattachment was positively related to general well-being. Both harmony enhancement and disintegration avoidance showed statistically significant but small moderating effects (ΔR² = 0.01). Specifically, the positive relationship between nonattachment and well-being was stronger at lower levels of harmony enhancement and disintegration avoidance and weaker at higher levels.

CONCLUSIONS: These findings suggest that nonattachment serves as a particularly important intrapersonal resource for adolescents experiencing limited relational harmony. Consistent with a person × context interaction framework, the psychological benefits of nonattachment appear to vary as a function of adolescents’ culturally rooted relational tendencies.

PMID:42367043 | DOI:10.1002/jad.70211

Prog Community Health Partnersh. 2026;20(2):183-194. doi: 10.1353/cpr.2026.a993186.

ABSTRACT

BACKGROUND: Workforce roles that address social determinants of health, such as regional health connectors (RHCs), can reduce health inequities that disproportionately affect people of lower socioeconomic status and marginalized communities.

OBJECTIVES: The aim of this evaluation was to describe, from the perspective of RHCs’ community partners, 1) strategies that RHCs employ, 2) social needs that RHCs address, and 3) outcomes associated with RHCs’ community efforts.

METHODS: This convergent mixed-methods evaluation included a cross-sectional statewide survey of Colorado RHC partners followed by interviews with a subset of participants. Descriptive statistics (frequency distributions, proportions, means, standard deviations) were used to summarize survey results. We used a thematic summary approach to qualitatively analyze interviews.

RESULTS: Survey participants (n = 182) were community partners working with RHCs, representing public health (36%), health care (30%) and social services sectors (25%). RHCs most commonly addressed access to care, food security, and housing support. Community partners reported that RHCs impact their organizations by connecting them to new resources, assisting in connecting the people they serve to resources to address social needs, and identifying and/or addressing resource gaps in the community. Survey comments and interviews (n = 11) illuminated RHCs’ involvement in connecting community members and organizations to tailored resources and services. Partners appreciated RHCs’ high-level perspective and broad knowledge base. Areas for improvement included organizational change affecting relationship development and processes to connect partners with resources.

CONCLUSIONS: The Colorado RHC model could help other regions build collaborations and leverage resources and support for health-related social needs to improve community health outcomes.

PMID:42366979 | DOI:10.1353/cpr.2026.a993186

Hypertension. 2026 Jun 29. doi: 10.1161/HYPERTENSIONAHA.125.26521. Online ahead of print.

ABSTRACT

BACKGROUND: Adaptive optics retinal imaging (rtx1e, Imagine Eyes, Orsay, France) enables high-resolution visualization of the retinal microvasculature, providing insights into systemic vascular health. Currently, no studies exist describing changes in wall-to-lumen ratio (WLR) during pregnancy, neither during the physiological course of pregnancy nor in pregnancy-associated complications.

METHODS: This single-center, prospective study at the Leipzig University Hospital, Germany, examines changes in retinal microvasculature by employing adaptive optics to calculate the WLR of an arteriole within a few seconds. The study examined a well-phenotyped cohort of 460 primarily White healthy singleton pregnancies, with 543 measurements taken from the first to the third trimester. The WLR was automatically determined using the nnUNet deep learning model.

RESULTS: Step-down selection mixed-effects modeling identified gestational week, maternal age, mean arterial pressure, and parity as significant contributors to WLR, whereas body mass index did not improve model fit. In the final model, advancing gestational week (P<0.001), higher maternal age (0.012), and higher mean arterial pressure (<0.001) were independently associated with increased WLR, whereas multiparous women showed significantly lower WLR values compared with nulliparous women, with negligible multicollinearity (variance inflation factor ≈1).

CONCLUSIONS: We identify WLR as a sensitive marker for imaging microvascular remodeling, serving as an indicator of adaptation to physiological pregnancy. Normal pregnancy is associated with an instant change of the retinal microvasculature indicated by an increase of WLR. Further studies are required to investigate the postpartum course of WLR and establish whether these changes are reversible.

REGISTRATION: URL: https://www.drks.de; Unique identifier: DRKS00032530.

PMID:42366971 | DOI:10.1161/HYPERTENSIONAHA.125.26521

Infect Control Hosp Epidemiol. 2026 Jun 29:1-8. doi: 10.1017/ice.2026.10485. Online ahead of print.

ABSTRACT

OBJECTIVES: Timely detection of pathogen-related outbreaks in hospitals is important for preventing onward transmission and can be supported by automated outbreak detection systems (AODS). Many methods overlook in-hospital patient transfers and focus only on patient locations at the time of sampling. This study compares three approaches for incorporating patient transfers into AODS.

DESIGN: Two existing AODS frameworks, a local percentile-based system and a statistical modeling-based system were extended to include patient transfers: 1) grouping wards into communities based on frequent patient exchange, 2) including prior ward visits in the past 14 days, and 3) including both prior ward visits and time spent on wards. Alerts generated were reviewed for clinical relevance.

SETTING: Data from January 2014 to December 2021 from a University Medical Center in the Netherlands.

RESULTS: Using the percentile-based approach, the baseline scenario detected 99 possible outbreaks. Extension with ward community groupings, prior ward visits, and prior ward visits accounting for time spent in each ward increased this number with 16 (+15%), 42 (+42%), and 106 (+110%) possible outbreaks, respectively. Of the alerts generated by including individual patient transfer history, 35% were judged as requiring investigation. The trade-off between increased detection and relevance was less favorable for the other approaches. Similar findings were found for statistical modeling-based methods.

CONCLUSIONS: Inclusion of patient transfer data in AODS improved sensitivity, at the cost of increasing the alert burden. Therefore, ongoing refinement should further optimize the balance between accurate outbreak detection and a manageable alert burden.

PMID:42366951 | DOI:10.1017/ice.2026.10485

J Magn Reson Imaging. 2026 Jun 29. doi: 10.1002/jmri.70390. Online ahead of print.

ABSTRACT

BACKGROUND: In cardiac MRI, poor breath-holding may lead to suboptimal image quality. However, the effect of different breath-hold methods on image quality remains unknown.

PURPOSE: To explore the effect of respiratory training with different breath-holding methods and identify the optimal technique for reducing respiratory motion artifacts in cardiac MRI.

STUDY TYPE: Prospective.

POPULATION: A total of 93 patients undergoing cardiac MRI (64 men and 29 women; mean age of 48.9 ± 13.7 years).

FIELD STRENGTH/SEQUENCES: 3T, single-shot fast spin-echo sequence, fast imaging employing steady-state acquisition sequence, first-pass perfusion sequence (fast gradient echo), and late gadolinium enhancement sequence (phase-sensitive myocardial delayed enhancement).

ASSESSMENT: All patients undergoing cardiac MRI were divided into three groups: mouth-breathing, nasal-breathing, and nose-clip. Respiratory-gated monitoring diagrams, examination duration, and subjective and objective image quality assessments were compared.

STATISTICAL TESTS: One-way ANOVA, Chi-square test, Kruskal-Wallis H test, Kappa test. Statistical significance was set at p < 0.05.

RESULTS: Evaluation of the cardiac MRI respiratory-gated monitoring diagrams showed that the probability of good breath-holding in the nose-clip group was 96.7%, significantly higher than in the mouth-breathing (64.5%) and nasal-breathing groups (75.0%). There was no significant difference in examination duration among groups. Myocardial noise in the mouth-breathing group was significantly higher than those in the other two groups (24.2 [18.3, 32.5] vs. 15.8 [12.5, 23.9]/19.2 [13.7, 24.4]); blood pool noise was significantly higher than in the nasal-breathing group (34.6 [22.6, 42.9] vs. 24.9 [18.4, 33.8]). However, CNR did not significantly differ among the three groups (p = 0.07). Subjective image quality scores were higher in the nose-clip group than those in the other two groups (26 [86.7%] versus 16 [51.6%]/18 [56.3%]).

DATA CONCLUSION: Optimized respiratory training can enhance breath-holding performance and image quality in patients undergoing cardiac MRI. The use of a nose clip for assisted breath-holding was found to be the most effective method.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 2.

PMID:42366921 | DOI:10.1002/jmri.70390

Pain Pract. 2026 Jul;26(6):e70182. doi: 10.1111/papr.70182.

ABSTRACT

INTRODUCTION: Percutaneous vertebral augmentation is widely used to provide symptom relief for patients with painful vertebral compression fractures (VCFs), but adjacent fractures remain a known complication. This retrospective study evaluated the risk of adjacent vertebral fractures following different percutaneous vertebral augmentation techniques.

METHODS: A total of 985 encounters from 878 patients who underwent vertebroplasty, kyphoplasty, or bone tumor radiofrequency ablation (BT-RFA) with cement augmentation were included. The primary outcome was incidence of postprocedural adjacent fractures. Associations with demographic and clinical factors including age, sex, BMI, pathologic fractures, bone density, imaging guidance, and number of treated levels were assessed. Statistical analyses included a generalized linear mixed model and Cox proportional hazards models clustered by patient.

RESULTS: Adjacent fracture occurred in 17.8% of encounters. BT-RFA was associated with a significantly lower risk of adjacent fractures compared with kyphoplasty (HR: 0.54, 95% CI:0.36-0.81; p = 0.003) and vertebroplasty (HR: 0.40, 95% CI: 0.27-0.60; p < 0.0001). Multilevel vertebral augmentations increased fracture risk by 1.42-fold, while pathologic fractures lowered the odds of adjacent fracture. No significant associations were found for age, BMI, sex, cement extravasation, or bone density.

CONCLUSION: BT-RFA combined with cement augmentation significantly reduced the risk of adjacent fractures compared to kyphoplasty or vertebroplasty.

PMID:42366910 | DOI:10.1111/papr.70182

Pediatr Pulmonol. 2026 Jul;61(7):e71717. doi: 10.1002/ppul.71717.

ABSTRACT

BACKGROUND: Cystic fibrosis (CF) is a rare, multisystem genetic disease requiring early diagnosis and lifelong multidisciplinary follow-up. In many middle-income countries, including Colombia, national CF registries are absent, and epidemiological information largely relies on administrative health data. Although such data do not reflect true clinical prevalence, they enable systematic monitoring of service-based prevalence and diagnostic practice patterns, offering critical insights for health system planning.

METHODS: We conducted a nationwide, observational study using the Colombian Individual Registry of Provision of Health Services (RIPS) from 2015 to 2024. Children and adolescents aged 0-19 years with CF diagnoses (ICD-10 E84.0-E84.9) were identified. Annual crude and age-standardized administrative prevalence rates were estimated using national population projections. Diagnostic test utilization (spirometry, chest CT, pancreatic elastase, genetic testing) was quantified per 100 encounters. Temporal trends were analyzed using LOESS smoothing with 95% confidence intervals.

RESULTS: The age-standardized national administrative prevalence of CF-related healthcare encounters was 5.64 per 100,000. Administrative prevalence was highest in children aged 0-4 years and declined progressively with age. The contributory insurance regime showed the highest service-based prevalence, suggesting disparities in diagnostic access. Temporal patterns revealed a peak in 2018-2019 followed by a decline after 2020, coinciding with COVID-19-related disruptions in pediatric care. Diagnostic utilization was markedly low: spirometry was performed in fewer than 6 tests per 100 encounters annually, chest CT use was sporadic, and genetic testing was minimal before 2018, increasing slightly thereafter.

CONCLUSIONS: Administrative prevalence of CF in Colombia has remained stable over a decade but is accompanied by underutilization of essential diagnostic procedures and inequities across insurance groups. Strengthening diagnostic capacity, standardizing monitoring practices, and improving early detection are urgent priorities. This study provides a scalable framework for CF surveillance in countries lacking national registries.

PMID:42366899 | DOI:10.1002/ppul.71717

J Appl Behav Anal. 2026 Aug;59(3):e70071. doi: 10.1002/jaba.70071.

ABSTRACT

Treatment durability can be compromised when challenging behavior recurs following context changes (i.e., renewal), yet the temporal features of lapses have not been well described in large clinical samples. We examined latency to onset and persistence of renewal to inform clinical monitoring and planning following context changes. Using a retrospective consecutive case series of 98 patients receiving intensive outpatient treatment for challenging behavior, we analyzed 749 context changes involving person, setting, and task variables. Renewal emerged quickly (M = 1-2 sessions), with half beginning in the first postchange session. Persistence was often brief (49.74% resolved within one session), whereas 32.28% persisted for three or more sessions and 12.17% for five or more. Latency and persistence did not differ meaningfully across context-change types. Latency was not systematically associated with magnitude or persistence, whereas greater renewal magnitude predicted prolonged persistence. Results support extended monitoring and high-fidelity implementation following context changes.

PMID:42366898 | DOI:10.1002/jaba.70071

Nurs Crit Care. 2026 Jul;31(4):e70542. doi: 10.1111/nicc.70542.

ABSTRACT

BACKGROUND: Fatigue is highly prevalent among ICU survivors and is associated with adverse outcomes. However, its longitudinal trajectories and prognostic significance remain unclear.

AIM: To identify fatigue trajectories after critical illness, determine baseline predictors and examine their associations with long-term mortality and health-related quality of life (HRQoL).

STUDY DESIGN: This prospective multicentre cohort study was conducted in 10 ICUs across five tertiary hospitals in Fujian Province, China, from February 2022 to August 2023. Fatigue was assessed using the 14-item Fatigue Scale (FS-14) at ICU admission, ICU discharge, hospital discharge and 1 week, 2 weeks, 1 month and 6 months after discharge. The primary outcome was the 6-month fatigue trajectory group, identified using group-based trajectory modelling. Secondary outcomes were 6- and 12-month mortality and 6-month HRQoL. Multinomial logistic regression was used to examine baseline predictors of fatigue trajectory group. Inverse probability treatment weighting-adjusted Cox models were used for mortality, and weighted linear regression models were used for HRQoL.

RESULTS: Among 348 critically ill adults, three fatigue trajectories were identified: persistent fatigue (38.8%), recovered fatigue (43.1%) and no fatigue (18.1%). Recovered fatigue was associated with older age, prolonged mechanical ventilation, lower skeletal muscle index and higher Hospital Anxiety and Depression Scale scores. Compared with no fatigue, persistent fatigue was associated with lower physical HRQoL at 6 months (estimate -13.17, 95% CI: -19.85 to -6.495, p < 0.001), and higher 12-month mortality (hazard ratio, 6.75; 95% CI, 1.37-33.35; p = 0.019).

CONCLUSIONS: Fatigue trajectories after critical illness are heterogeneous. Persistent fatigue is linked to modifiable clinical factors and is associated with impaired HRQoL and increased long-term mortality.

RELEVANCE TO CLINICAL PRACTICE: Routine fatigue assessment should be embedded in ICU care to identify patients at risk for persistent fatigue, enabling personalised rehabilitation and self-management strategies that reduce symptom burden and promote long-term recovery.

PMID:42366878 | DOI:10.1111/nicc.70542