Category: Statistics

J Neurosurg Spine. 2026 May 29:1-6. doi: 10.3171/2025.8.SPINE25389. Online ahead of print.

ABSTRACT

OBJECTIVE: With the advent of artificial intelligence (AI), scientific research and writing has benefitted from large language models to generate hypotheses, evaluate data, and draft manuscripts. However, this brings into question the prevalence, impact, and ethics of AI writing assistance on published literature. The purpose of this study was to quantify the extent of AI involvement in published spine articles and establish a statistical threshold for scientific integrity.

METHODS: Spine-focused clinical journals were selected for their impact factor and comprehensive representation of the specialty. All full-length research articles published in 2005 and 2023-2024 in these journals were extracted. ZeroGPT was used to assess AI content in each article. Baseline AI utilization was evaluated on the 2005 data, with 2 standard deviations above the mean serving as the threshold for significant AI usage. Based on pre-AI era articles, a threshold ZeroGPT score of 48.8% was established. Articles exceeding this threshold in the 2023-2024 data were assessed across spine journals and years of publication.

RESULTS: In total, 2790 post-AI articles published across 6 spine journals in 2023-2024 were examined. Among these spine journal articles, 25.7% were considered to have significant AI involvement. AI involvement varied significantly across spine journals, ranging from 20.2% for Spine (Phila Pa 1976) to 31.1% for Journal of Neurosurgery: Spine (p < 0.01). Likewise, AI involvement varied significantly across the years, with peak utilization at 32.0% at the start of 2023 and plateau in utilization at 20.7% by the second quarter of 2024 (p < 0.01).

CONCLUSIONS: AI involvement in drafting manuscripts was observed in 25% of articles in recent spine literature. Although the use of AI has plateaued since mid-2024, likely due to the implementation of clear ethical guidelines and utilization of improved detection tools, continued efforts should be made with the evolving AI landscape to the ensure quality, authenticity, and integrity of spine research.

PMID:42214108 | DOI:10.3171/2025.8.SPINE25389

J Neurosurg Pediatr. 2026 May 29:1-7. doi: 10.3171/2026.1.PEDS25230. Online ahead of print.

ABSTRACT

OBJECTIVE: In shunted pediatric hydrocephalus patients, the potential for shunt failure is a frequent cause of emergency department (ED) presentation. The assessment of papilledema through ophthalmological fundoscopic examination (OFE) is an often-utilized adjunct evaluation in clinical workup to rule out shunt failure in patients. However, its utility in this setting has not been established in the literature. The objective of the present study was to investigate the association of papilledema with eventual shunt revision in ED encounters to rule out shunt failure.

METHODS: The authors conducted a retrospective, single-institution, cohort study of ED encounters with concern for shunt failure prompting neurosurgical evaluation in patients who underwent OFE from January 1, 2014, to December 31, 2021. Chart encounters were reviewed for baseline demographic characteristics, clinical characteristics, presence of papilledema, and interventions. The primary endpoint was need for shunt revision and intraoperative evidence of shunt failure.

RESULTS: A total of 594 ED encounters with concern for shunt failure were identified, and 98 encounters were included. Overall, 6 cases of papilledema were identified (6.1%), of whom only 3 were new or worsened (3.1%) compared to prior examinations. Twenty-six (26.5%) encounters resulted in shunt revision, while 72 (73.4%) encounters resulted in no revision. There was no statistically significant difference in baseline patient demographic characteristics, etiology of hydrocephalus, or clinical symptoms between encounters resulting in shunt revision or no revision. No significant difference was identified in the comparison of patients who underwent shunt revision versus those without revision with regard to the presence of papilledema (3 [12%] patients with papilledema vs 3 [4%] without, p = 0.19), performance of shunt tap (6 [23%] vs 9 [12.5%], p = 0.21), or prior shunt revisions (3.2 ± 3.9 vs 2.9 ± 3.3, p = 0.77).

CONCLUSIONS: Among pediatric ED encounters with concern for shunt failure, ophthalmological consultation for fundoscopic examination and the presence of papilledema did not demonstrate a significant association with shunt revision. Additional prospective studies are warranted to assess the clinical utility of using OFE as part of the armamentarium of triage in acute shunt failure evaluation.

PMID:42214105 | DOI:10.3171/2026.1.PEDS25230

J Neurosurg. 2026 May 29:1-11. doi: 10.3171/2025.12.JNS251651. Online ahead of print.

ABSTRACT

OBJECTIVE: The rates of thromboembolic events are highest within the first few days of intracranial stent placement and before complete endothelialization has occurred. Accelerating the rate of neointima formation may be a strategy to reduce thromboembolic events. This study was performed to evaluate the efficacy of vascular endothelial growth factor (VEGF) embedded in a poly(lactic-co-glycolic acid) (PLGA) coating in conjunction with mesenchymal stem cells (MSCs) to improve neointima formation after stent placement.

METHODS: Endovascular stents were coated with VEGF/PLGA or PLGA alone (control 1) or left uncoated (control 2), and protein quantification was performed both before and after a mock endovascular deployment process. A total of 23 New Zealand White rabbits then underwent endovascular implantation of stents coated with VEGF/PLGA, followed by an intra-arterial microcatheter injection of MSCs; stents coated with VEGF/PLGA without MSC injection (vehicle alone); stents coated with PLGA alone without MSC injection (vehicle alone); or uncoated stents without MSC injection (vehicle alone). After stent deployment on day 0 and prior to euthanasia on day 3, animals underwent optical coherence tomography (OCT), so that the degree of neointima formation over the stent struts as well as thrombus formation could be evaluated. Scanning electron microscopy (SEM) was also performed after euthanasia. OCT and SEM images were both scored by observers blinded to treatment group.

RESULTS: Stents coated with VEGF/PLGA contained a significantly larger amount of protein than the stents coated with PLGA alone or uncoated stents, and there was no significant loss of protein after the mock delivery process. In vivo, VEGF/PLGA-coated stents with MSC injection demonstrated superior measurements of the neointimal area, neointimal ratio, stent-strut neointimal coverage ratio, and maximum neointimal thickness on OCT compared to those for the uncoated stent at 3 days. VEGF/PLGA-coated stents with MSCs also showed significantly improved scores on SEM and a large, though not statistically significant, reduction in the variability of thrombus formation compared to that with uncoated stents at 3 days (p = 0.06).

CONCLUSIONS: This short-term study demonstrates that coating stents with VEGF embedded in PLGA, along with an intra-arterial injection of MSCs, improves neointimal coverage and may reduce thrombus formation. Follow-up studies are required to assess the long-term consequences of VEGF and MSC administration, as well as to elucidate the potential mechanism of their effect.

PMID:42214099 | DOI:10.3171/2025.12.JNS251651

J Neurosurg. 2026 May 29:1-12. doi: 10.3171/2025.11.JNS251462. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the respiratory consequences of phrenic nerve transfer (PNT) by analyzing clinical and paraclinical data across published studies.

METHODS: The authors conducted a systematic review and meta-analysis of studies reporting respiratory outcomes after PNT. Only cases with documented postoperative follow-up and perioperative respiratory outcome were included. Data on patient demographics, diaphragm imaging, and pulmonary function test (PFT) values were extracted. Paired analyses were conducted in cases in which pre- and postoperative PFT data were available.

RESULTS: Among 617 patients with postoperative follow-up, 4.9% reported respiratory symptoms, and 67.4% of those assessed showed unilateral diaphragm paralysis. A meta-analysis of paired PFT data demonstrated a significant reduction in forced expiratory volume in 1 second and a nonsignificant reduction in forced vital capacity postoperatively. Fifteen (2.4%) of 617 patients reported mild but persistent respiratory symptoms.

CONCLUSIONS: Although PNT is effective for motor restoration, postoperative respiratory impairment, although typically mild, was observed in a subset of patients with follow-up data. These findings emphasize the need for long-term monitoring and careful patient selection in PNT, particularly in individuals with reduced pulmonary reserve.

PMID:42214098 | DOI:10.3171/2025.11.JNS251462

Prim Care Companion CNS Disord. 2026 May 26;28(3):25m04143. doi: 10.4088/PCC.25m04143.

ABSTRACT

Objective: To compare the efficacy of lorazepam and diazepam in managing alcohol withdrawal and associated anxiety and depressive symptoms in alcohol dependence syndrome.

Methods: Sixty male patients diagnosed with alcohol dependence syndrome (International Classification of Diseases, Eleventh Revision) were randomly assigned to receive lorazepam or diazepam using a symptom-triggered oral detoxification protocol. Baseline assessments included the Severity of Alcohol Dependence Questionnaire (mean score = 22.6 ± 4.81) and the Clinical Institute Withdrawal Assessment for Alcohol-Revised (mean CIWA-Ar score= 10.98±2.45). Anxiety and depression were measured using the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) at baseline, postdetoxification, and 12 weeks. Benzodiazepines were gradually tapered and stopped after detoxification.

Results: Participants (mean age of 40.85 ± 8.30 years) showed comparable baseline withdrawal severity (CIWA-Ar P = .795) and similar reductions after detoxification (P = .999) and at 12 weeks (P = .321). Time to >50% symptom reduction was slightly shorter with diazepam (4.6 vs. 4.97 days; P = .241). Both groups demonstrated improvement in anxiety and depression, with slightly greater reductions in the lorazepam group, though differences were not statistically significant (HAM-A: P = .146; HAMD-D: P = .103).

Conclusions: Lorazepam and diazepam are equally effective in managing alcohol withdrawal.

Trial Registration: Clinical Trial Registry-India identifier: CTRI/2023/09/057998.

Prim Care Companion CNS Disord 2026;28(3):25m04143.

PMID:42214083 | DOI:10.4088/PCC.25m04143

JMIR Biomed Eng. 2026 May 29;11:e91138. doi: 10.2196/91138.

ABSTRACT

BACKGROUND: Family caregivers experience significant stress due to intensive caregiving activities, making them highly susceptible to adverse psychosocial health conditions. Early detection of this stress is crucial for timely interventions to prevent disease progression and long-term disability.

OBJECTIVE: This study aimed to develop and validate the Linguistic and Acoustic Speech Analytics Program, a novel machine learning approach capable of providing a fusion analysis of linguistic and acoustic speech features to enhance the effectiveness of psychosocial stress assessment.

METHODS: This quantitative study analyzed speech data collected from 100 Chinese family caregivers. Participants responded to 12 open-ended questions, and their voices were recorded for linguistic and acoustic feature extraction. Various machine learning classifiers, including support vector machine, were developed to process speech data. A key methodological step was the application of an orthogonalization procedure to decorrelate acoustic features from linguistic features before fusion analysis. The classifiers were then trained to evaluate psychosocial stress levels based on the processed and fused linguistic and acoustic speech features. Model performance was measured using receiver operating characteristic-area under the curve, F1-score, and accuracy.

RESULTS: The linear support vector machine model emerged as the top performer, achieving a receiver operating characteristic-area under the curve of 78.28%, an F1-score of 75.27%, and an accuracy of 73%. These results demonstrate the model’s strong capability in identifying stressed participants based on their speech. Critically, the fusion of linguistic and acoustic features significantly outperformed models using either feature type alone. Furthermore, the orthogonalization procedure proved essential, as decorrelating features before fusion markedly enhanced classification accuracy compared to using non-orthogonalized features.

CONCLUSIONS: This study demonstrates that fusion analysis of linguistic and acoustic features effectively identifies psychosocial stress among family caregivers. It also emphasizes the importance of proper feature processing when combining multiple features extracted from the same audio sample. These findings provide valuable insights for developing machine learning models for psychosocial stress assessment and addressing various psychosocial conditions in different contexts, supporting population mental health management.

PMID:42214077 | DOI:10.2196/91138

J Med Internet Res. 2026 May 29;28:e91338. doi: 10.2196/91338.

ABSTRACT

BACKGROUND: The comprehensive effects of multicomponent digital health interventions (DHIs) on multidimensional physical activity indicators and sedentary behavior (SB) remain controversial.

OBJECTIVE: This systematic review aimed to evaluate the impact of multicomponent DHIs on daily steps, moderate-to-vigorous physical activity (MVPA), light physical activity, total physical activity, and SB in older adults.

METHODS: PubMed, Web of Science, Embase, The Cochrane Library, and CINAHL were searched up to February 20, 2026. Randomized controlled trials concerning multicomponent DHIs for promoting exercise behavior in older adults were included. RoB 2.0 was used to evaluate study quality. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman random-effects model, and 95% prediction intervals (PIs) were calculated via Nagashima adjustment to evaluate effect dispersion. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system was used to evaluate evidence certainty.

RESULTS: A total of 26 randomized controlled trials (n=4129) were included. The results showed that multicomponent DHIs significantly improved daily steps (mean difference [MD] 822.8, 95% CI 198.3 to 1447.3 steps/d; 95% PI -1452.4 to 3098.0) and MVPA (MD 45.9, 95% CI 23.9 to 67.9 min/wk; 95% PI -9.4 to 101.2). However, the improvements in SB (MD -283.7, 95% CI -610.8 to 43.5 min/wk; 95% PI -984.5 to 417.1), total physical activity (MD 104.4; 95% CI -109.2 to 318.0 min/wk; 95% PI -444.4 to 653.2), and light physical activity (MD 39.3, 95% CI -96.2 to 174.7 min/wk; 95% PI -227.6 to 306.2) did not reach statistical significance. As some included studies combined digital tools with human support, the independent contribution of digital technology remains uncertain. PIs indicated a certain degree of dispersion across different clinical contexts. Subgroup analysis showed higher effect sizes for standalone wearables, human-assisted interventions, and populations with chronic disease risks. Meta-regression showed that effect sizes remained stable across different ages and durations. The trim-and-fill method confirmed the robustness of MVPA results. GRADE assessment indicated “moderate” certainty for MVPA and “low” for daily steps and other indicators.

CONCLUSIONS: This systematic review suggests that multicomponent DHIs may serve as an effective means for enhancing daily steps and MVPA in older adults. The innovation lies in evaluating the true effect distribution of multicomponent DHIs through Hartung-Knapp-Sidik-Jonkman random-effects models and Nagashima PIs. Compared with previous studies, this review identified the impact of population characteristics and control group differences on effect estimates using PI and subgroup models, confirming that advanced age did not significantly diminish the good adaptability of older adults to DHIs. Evidence limitations include high heterogeneity, lack of long-term follow-up, and differences between objective and subjective measurement tools. In practice, priority should be given to hardware carriers with simplified interaction and integrated human support, with tailored strategies developed for different risk subgroups.

PMID:42214075 | DOI:10.2196/91338

J Med Internet Res. 2026 May 29;28:e89067. doi: 10.2196/89067.

ABSTRACT

BACKGROUND: Reducing 30-day hospital readmissions has been a long-standing goal across health systems in the United States. While nurse-led phone outreach has been widely adopted to support transitional care, its reach is constrained by staffing and time limitations. Mobile health (mHealth) interventions, such as automated SMS text messaging and patient portals, offer scalable alternatives but have shown mixed effectiveness in reducing readmissions. Understanding how patients engage with mHealth after discharge may help optimize these tools for postdischarge care.

OBJECTIVE: This study aimed to characterize patients in an mHealth transitional care program who experienced hospital revisits within 30 days of discharge, comparing demographic and clinical characteristics, intervisit interactions, and revisit features between those who engaged with mHealth and those who did not.

METHODS: We conducted a secondary analysis of patients in the intervention arm of the Mobile Outreach to Reduce Emergencies-Primary Care randomized clinical trial. Participants received automated SMS text messages for 30 days after discharge alongside usual transitional care. We identified patients with a 30-day hospital revisit and conducted manual chart reviews to assess mHealth engagement and other forms of health care contact. We compared patient characteristics, intervisit interactions, and revisit features (time to revisit, relatedness to index hospitalization, and predictability of revisit) between mHealth users and nonusers.

RESULTS: Among 496 patients with a 30-day revisit, 185 (37%) engaged with mHealth before their return. mHealth users were younger (n=47, 26% aged <50 years vs n=41, 14% among nonusers; P=.004) and more likely to have commercial insurance (n=43, 23% mHealth users vs n=35, 11% mHealth nonusers; P=.005). Revisits were more likely to be rated highly or somewhat predictable among mHealth users compared to nonusers (n=105, 56% vs n=152, 49%; P=.04), while relatedness to the index hospitalization was similar (n=98, 53% vs n=173, 55%; P=.09). mHealth users had a longer mean time to revisit than nonusers (15.2, SD 8.1 vs 11.3, SD 8.4 days; P<.001) and were more likely to contact their practices via telephone (n=100, 54% vs n=136, 44%; P=.03) or attend a clinic visit (n=112, 61% vs n=131, 42%; P<.001).

CONCLUSIONS: Among patients enrolled in an mHealth postdischarge program who experienced hospital revisits, fewer than half engaged with mHealth prior to their return. Revisits among mHealth users occurred later and were more predictable, suggesting that engagement may enhance situational awareness but not necessarily prevent revisits. Future work should focus on strategies to increase engagement across groups and integrate mHealth with existing transitional care infrastructure.

PMID:42214074 | DOI:10.2196/89067

JMIR Infodemiology. 2026 May 29;6:e82221. doi: 10.2196/82221.

ABSTRACT

BACKGROUND: The COVID-19 pandemic highlighted the importance of effective health communication and reliable information for crisis management, particularly following the introduction of vaccinations. Varied attitudes toward COVID-19 vaccination and an overwhelming amount of online information complicated communication and pandemic management. Previous studies have often focused on general vaccination behavior and its correlation with vaccination attitudes, establishing a link between information-seeking and vaccination decisions. However, there is insufficient analysis distinguishing specific user groups based on their actual online information behavior regarding COVID-19 vaccination and examining its correlation with vaccination behavior.

OBJECTIVE: This study aims to fill this research gap by identifying user groups based on their information behavior and investigating its influence on vaccination uptake.

METHODS: As part of the “Internetnutzung zur COVID-19-Impfung” (INCOVI) study, 1000 individuals in Germany were surveyed online (November 26 to December 8, 2021) regarding their internet usage related to COVID-19 vaccination. A hierarchical cluster analysis was conducted to identify user groups. Logistic regression analyses were then used to explore correlations among the user groups and their demographic characteristics, readiness to vaccinate, knowledge of vaccination, and health literacy. Additionally, a logistic regression analysis was performed to identify the influence of user groups and other factors on vaccination behavior.

RESULTS: A total of 3 user groups were identified: frequent and critical information evaluators (454/778, 58.4%), who primarily relied on official information sources, exhibited a higher level of health literacy, and were older than the other groups; infrequent and passive recipients (222/778, 28.5%), who rarely sought information actively and were younger than the other groups; and frequent and multichannel, interaction-focused users (102/778, 13.1%), who actively searched across multiple channels and engaged in information exchange. Notably, the user groups did not significantly differ in knowledge or willingness to vaccinate. User group affiliation, knowledge, and health literacy did not significantly influence vaccination behavior. The strongest predictor of vaccination was preexisting willingness to vaccinate. Additionally, women were more likely to be vaccinated than men, and individuals with medium or higher education levels were 6-11 times more likely to be vaccinated compared to those with only a basic level of education.

CONCLUSIONS: Segmenting the population into different user groups allows for more targeted communication tailored to the specific needs and beliefs of each group. Because these groups stem from observable usage patterns, they constitute a transferable framework for other health topics. For frequent and critical information evaluators, providing well-founded and detailed information on public channels is important. Infrequent and passive recipients benefit from straightforward formats, such as short explanatory videos, while frequent and multichannel, interaction-focused users are better reached through interactive offerings on social media. By specifically targeting these groups, informed decision-making about vaccinations can be supported.

PMID:42214069 | DOI:10.2196/82221

JMIR Res Protoc. 2026 May 29;15:e92574. doi: 10.2196/92574.

ABSTRACT

BACKGROUND: Physical activity (PA) is safe and beneficial for children and adolescents diagnosed with cancer, yet most engage in low levels of PA. We developed IMPACT (IMplementation of Physical Activity for Children and adolescents on Treatment), a PA intervention delivered by videoconference to enhance PA among young people during treatment for cancer and blood disorder diagnoses. IMPACT is being evaluated in a type II hybrid effectiveness-implementation trial in Alberta, Canada. While referral rates are high and early visual analyses suggest IMPACT may enhance PA and aspects of quality of life and physical function, participation, retention, and adherence rates are low. Findings signal the positive effect of IMPACT for those who participate and underscore the necessity of implementation adaptations. On the basis of these early findings, a demonstrated desire, and funding for PA at sites across Canada, we must first reimagine IMPACT through active collaboration with research users-those who will refer to and/or use or benefit from the intervention.

OBJECTIVE: Over the next 5 years, our larger research program will (1) co-adapt IMPACT and prepare for scaling (phase 1) and (2) implement and evaluate co-adapted IMPACT across additional provinces in Canada (phase 2). Specific aims for phase 1 are detailed herein and include (1) identifying necessary IMPACT modifications, (2) examining site-specific factors influencing IMPACT implementation, and (3) developing an implementation research logic model to guide continued scaling.

METHODS: An integrated knowledge translation and patient-oriented research approach and pragmatic orientation have been adopted. A multiple-perspective mixed methods study is underway. Descriptive surveys and interviews, guided by the Consolidated Framework for Implementation Research 2.0, are being conducted with key research user groups, including children and adolescents diagnosed with cancer and blood disorders (on- and off-treatment), carers, health care providers, and support organization personnel. Data will be analyzed using descriptive statistics and framework analysis. An implementation research logic model will be developed with participants and IMPACT co-adaptation advisory board members and program partners and collaborators.

RESULTS: Funding was secured, and initial ethics approval was granted on June 10, 2025. Additional administrative and full approvals were secured subsequently. Recruitment started in July 2025 in British Columbia and is commencing across sites in a staggered manner. Full results (ie, all site-specific modifications and implementation strategies and the final version of the implementation research logic model) are expected to be submitted for publication late 2026.

CONCLUSIONS: Co-adaptation of IMPACT with research users will enhance the likelihood of relevance, acceptability, and uptake nationally. The resulting data will inform a model to guide continued scaling and a larger trial evaluating the co-adapted IMPACT intervention across British Columbia, Ontario, and the Maritime provinces. This work reimagines IMPACT for broader applicability across varied Canadian contexts..

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/92574.

PMID:42214066 | DOI:10.2196/92574