Category: Statistics

Can J Physiol Pharmacol. 2026 Feb 13. doi: 10.1139/cjpp-2025-0274. Online ahead of print.

ABSTRACT

This study evaluated the presence of bacterial species in the placenta of women with pre-eclampsia and compared with that of normotensive women. One hundred and twenty participants, comprising 60 pre-eclamptic (30 early- and late-onset, respectively) and 60 age-matched normotensive women (30 early and late-gestation normotensive, respectively) were recruited. After informed consent was obtained, the placenta were obtained through caesarean section with sterile and standardized clinical procedures. DNA was extracted from each tissue, and the samples were pooled into six libraries and sequenced on Illumina NextSeq500 using a shotgun metagenomic approach. Bioinformatics was used to analyse the reads with the implementation of Kraken2/MetaPhlAn classification methods and complemented by multi-layered contamination assessment strategy that included frequency-based decontam filtering. Most reads were classified as belonging to the phyla Cutibacterium acnes, Staphylococcus epidermidis, and various Bradyrhizobium species. PE samples showed notable Corynebacterium tuberculostearicum and Pseudomonas species, while Bradyrhizobium and Cutibacterium acnes dominated normotensive samples. Further analysis showed no significant difference between bacterial species of pre-eclamptic and normotensive placental samples. The results show very low levels of bacteria in the placental samples. In addition, a little difference was observed between the bacterial compositions of pre-eclamptic and age-matched normotensive placental tissues, but not statistically significant.

PMID:41687083 | DOI:10.1139/cjpp-2025-0274

Ophthalmic Plast Reconstr Surg. 2026 Feb 13. doi: 10.1097/IOP.0000000000003188. Online ahead of print.

ABSTRACT

PURPOSE: To determine current dacryocystorhinostomy (DCR) practice patterns of American Society of Ophthalmic Plastic and Reconstructive Surgery members and identify surgeon and case-related factors impacting preference for endoscopic versus external DCR and the use of preoperative imaging.

METHODS: A cross-sectional web-based anonymous 16-question survey was distributed to 277 American Society of Ophthalmic Plastic and Reconstructive Surgery members enrolled in survey-based research. The survey assessed surgeons’ demographics, practice settings, surgical preferences, and imaging practices. Responses were summarized and compared using statistical tests for frequency distribution.

RESULTS: A total of 111 surgeons (40.0%) responded to the survey. Utilization of endoscopic DCR (endoDCR) was highly variable, with 57% of junior surgeons (<5 years in practice) using it for >66% of their cases, compared with only 18.3% of surgeons with >15 years postfellowship experience. High utilization of endoDCR (>66% of cases) was more common in academic surgeons compared with private practice (48.4% vs. 19.6%, p < 0.01). The most cited reasons for endoDCR were scar avoidance and revision surgery. For external DCR, anatomical barriers and concern for mass/need for biopsy were common indications. Most surgeons only order imaging for certain indications, such as prior sinonasal surgery, facial trauma, suspected tumor, or atypical presentation.

CONCLUSION: Utilization of endoDCR was correlated with years in practice, with younger surgeons preferring the endoscopic technique. A large majority felt that the relevance of imaging is low in most patients. Future research is needed to standardize case-based indications for endoscopic versus external approaches and preoperative imaging.

PMID:41687079 | DOI:10.1097/IOP.0000000000003188

MSMR. 2026 Feb 4;32(12):36-43.

ABSTRACT

Although mental health conditions are the leading underlying cause of maternal mortality, there is limited research on the prevalence of perinatal mental health conditions among active duty service women (ADSW). In this study of live-born deliveries among U.S. ADSW (n=62,729) with pregnancy start and end dates (i.e., dates of last menstrual period and infant delivery, respectively) from October 1, 2016 through December 31, 2021, International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes were used to identify mental health conditions: trauma and stressor-related disorders, anxiety and panic disorders, depressive disorders, suicidal ideation or attempt, and eating disorders. Data were collected through 1 year postpartum, until December 31, 2022. The prevalence of diagnosed mental health conditions from 1 year prior to pregnancy through 1 year postpartum was 33.8%. Trauma and stressor-related disorders were most prevalent (23.1%), followed by anxiety and panic disorders (16.9%), depressive disorders (14.6%), suicidal ideation or attempt (1.6%), and eating disorders (0.4%). The prevalence of mental health conditions was higher in the postpartum period (22.0%) compared to pregnancy (18.4%) and prior to pregnancy (15.0%). Overall, higher prevalence of these conditions was found among non-Hispanic Black ADSW (37.4%), and those who were unmarried (38.4%), never deployed (34.9%), or in the Army (37.4%) and Navy (36.4%). One in 3 active duty service women were diagnosed with a mental health condition in the year preceding pregnancy through 1 year postpartum. Overall, non-Hispanic Black and junior enlisted active duty service women demonstrated higher prevalences of mental health conditions compared to all other racial and ethnic groups and military ranks.

PMID:41687061

MSMR. 2026 Feb 4;32(12):25-35.

ABSTRACT

Mental health disorders have long been recognized as a problem in a wide range of domains, including the military, resulting in significant impacts on general morbidity, health care provision, disability, and military discharges. From 2020 through 2024, a total of 560,035 U.S. active component service members were diagnosed with at least 1 mental health disorder. Annual incidence rates of mental health disorder increased steadily from 2020 until 2022, but adjustment disorder decreased since then, anxiety gradually increased, and the remaining conditions remained relatively unchanged. Most mental health disorder diagnoses were attributable to adjustment disorders, anxiety disorders, depressive disorders, post-traumatic stress disorder, alcohol-related disorder, and other mental health disorders. Historically, mental health disorders have often been misunderstood and stigmatized, leading to under-reporting, delayed treatment, and poor prognoses. Reflecting the unique stressors and cultural stigmas of military life, ongoing efforts to raise awareness, encourage help-seeking, and improve treatment options are essential to supporting the mental and emotional well-being of service members. While the incidence of U.S. service members who were diagnosed with at least 1 mental health disorder remained stable from 2023 to 2024, the annual incidence rate of anxiety disorders demonstrated a continual increase from 2020 to 2024.

PMID:41687060

JMIR Mhealth Uhealth. 2026 Feb 13;14:e71412. doi: 10.2196/71412.

ABSTRACT

BACKGROUND: eHealth is an increasingly used method of health care in the field of psycho-oncology. While many reports highlight the positive impact of psychological eHealth tools, some patients refuse to use them.

OBJECTIVE: This study aimed to expand knowledge of the motivation and psychoemotional functioning of patients who consciously refuse to use eHealth technology in the form of a mobile psycho-oncology app offered as part of a clinical trial. To our knowledge, this is the first study to address this topic.

METHODS: A retrospective cross-sectional study was conducted between December 2022 and February 2023 to investigate the reasons why 56 patients with breast cancer refused to use the psycho-oncology mobile app offered as part of a clinical trial by the Breast Cancer Unit. The primary aim of the study was to analyze patients’ self-reported reasons for not engaging with the app, while also exploring their psychoemotional functioning, including stress levels (measured using the distress thermometer), personality traits (measured using the Ten-Item Personality Inventory), coping strategies (measured using the Coping Orientation to Problems Experienced Questionnaire), and Self-efficacy (measured using the General Self-Efficacy Scale). Participants in this study declined the app intervention but agreed to participate in this separate observational study, indicating that their refusal was related to the app itself rather than to participation in clinical research in general.

RESULTS: The patients experienced a clinically meaningful elevation in stress levels (mean 5, SD 2.1 points) and Self-efficacy (mean 32.1, SD 5.1 points). Among 5 dimensions of personality traits, patients scored highest in Agreeableness (mean 6.5, SD 0.8 stens) and Conscientiousness (mean 6.4, SD 0.9) and lowest in Neuroticism (mean 3.4, SD 1.8) (other dimensions: Extraversion [mean 5.8, SD 1.6 stens] and Openness to Experiences [mean 4.4, SD 1.5 stens]). In terms of coping with stress, patients most frequently used the strategies of Active Coping (mean 2.6, SD 0.5 points), Acceptance (mean 2.6, SD 0.6 points), and Seeking Emotional Support (mean 2.6, SD 0.6 points), and least frequently used the strategies of Psychoactive Substance Use (mean 0.2, SD 0.6 points) and Restraint (mean 0.5, SD 0.7 points). Patient responses regarding refusal to participate in app testing were divided into four categories: (1) Focus on Life Outside the Disease, (2) Focus on Disease and Treatment, (3) Denial Mechanism, and (4) Technical Issues. Statistically significant differences were found between the groups. The Focus on Life Outside the Disease group of patients had higher levels of Self-efficacy, lower Neuroticism, and more frequent use of the Positive reevaluation strategy compared to the other groups.

CONCLUSIONS: Our patients’ decision not to use the eHealth psycho-oncology app was mainly influenced by characteristics suggesting better emotional coping with the disease and treatment. These factors were significantly more influential than other factors studied, particularly those related to technology. Assessing reasons for opting out of eHealth and associated psychomotional functioning may be important for improving patients’ adoption of eHealth solutions.

PMID:41687056 | DOI:10.2196/71412

Proc Natl Acad Sci U S A. 2026 Feb 24;123(8):e2531783123. doi: 10.1073/pnas.2531783123. Epub 2026 Feb 13.

ABSTRACT

Chen Ning Yang made important contributions to the theory of solvable models in statistical mechanics, including generalizations of the Bethe Ansatz, magnetization in the Ising model, the Lee-Yang circle theorem, and the Yang-Baxter equation. Most famously, Yang made transformative contributions to the current Standard Model of elementary particle interactions. The proposal of Yang and T. D. Lee, that left-right symmetry (parity) is violated in weak particle decays, established that the primary currents involved in weak interactions are left handed. The work of Yang and R. L. Mills gave a framework for force carriers coupling to these currents that are non-Abelian generalizations of the electromagnetic photon, which unlike the electrically neutral photon, carry “charges” to which they self-couple. Two decades of work by others on quantization and mass generation mechanisms then culminated in the Standard Model.

PMID:41686479 | DOI:10.1073/pnas.2531783123

JAMA Health Forum. 2026 Feb 6;7(2):e256800. doi: 10.1001/jamahealthforum.2025.6800.

ABSTRACT

IMPORTANCE: Pediatric hospital care is rapidly consolidating in the US, with some states now depending on neighboring states to supply pediatric inpatient services. The extent and nature of this interstate dependence have not been characterized.

OBJECTIVE: To describe cross-state pediatric hospital utilization patterns and quantify the degree of interstate dependence in the New England region.

DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cross-sectional study of inpatient admissions at all hospitals admitting children (age <15 years) in the New England region and the enclosing border state of New York in 2019. Admissions for mental health, routine newborn care, and pregnancy-related diagnoses were excluded. Data analysis was conducted from July to December 2024.

EXPOSURE: Hospitalization location in state or out of state.

MAIN OUTCOMES AND MEASURES: The source, number, and proportion of out-of-state admissions, bed-days, primary diagnoses, and insurance types in each state in the New England region.

RESULTS: Among 28 631 pediatric admissions, 71.1% occurred in Massachusetts, corresponding to 86.8% of bed-days in the region. Of the total admissions, 16 211 (56.7%) were of male children and slightly more than half (16 336 encounters [57.1%]) were of children older than 4 years. The fraction of residents receiving out-of-state care varied from 2.0% in Massachusetts to 65.8% in New Hampshire (median [IQR], 21.5% [11.3%-28.9%]). Massachusetts hospitals served 578 of the 599 primary diagnoses reported in the region and provided 43.5% (36 731) of all hospital days required by residents of other New England states. In all states, privately insured children were more likely than Medicaid enrollees to be admitted to out-of-state hospitals (median [IQR], 30.5% [17.0%-37.2%] vs 15.6% [6.4%-24.7%]; adjusted odds ratio, 2.21 [95% CI, 2.01-2.44]), often for common conditions.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, pediatric care in New England constituted a de facto regionalized system, with substantial interstate movement of patients and heavy reliance on Massachusetts. These findings highlight an unplanned interdependence that may leave the system vulnerable to disruption. Regional planning and formal coordination among states may be necessary to ensure sustainable access to care. These findings may hold relevance for other regions.

PMID:41686465 | DOI:10.1001/jamahealthforum.2025.6800

JAMA Netw Open. 2026 Feb 2;9(2):e2556937. doi: 10.1001/jamanetworkopen.2025.56937.

ABSTRACT

IMPORTANCE: Experts recommend a shared decision-making (SDM) process before percutaneous left atrial appendage occlusion (pLAAO) in patients with atrial fibrillation, and the Centers for Medicare & Medicaid Services (CMS) require SDM with the use of a patient decision aid (DA) as a condition for reimbursement. However, little is known about how these guidelines and policies have influenced practice.

OBJECTIVE: To describe overall trends in reported SDM and use of DAs for pLAAO and to identify key patient, operator, and institutional factors associated with their use.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from October 1, 2022, to June 30, 2024, from the American College of Cardiology’s National Cardiovascular Data Registry (NCDR) LAAO Registry. Participants included patients who underwent first-time pLAAO.

EXPOSURE: pLAAO implantation.

MAIN OUTCOMES AND MEASURES: The proportion of encounters reporting SDM and DA use (SDM plus DA) overall and each month. Hierarchical logistic regression was used to estimate the odds of reported SDM plus DA, the probability of SDM plus DA, and the variance in SDM plus DA associated with operator and institutional levels.

RESULTS: A total of 147 296 unique patient encounters (86 593 [58.8%] male; mean [SD] age, 76.6 [7.7] years) were included. Of 830 institutions participating in the NCDR LAAO Registry during the study period, 829 (99.9%) reported on SDM and 817 (98.4%) reported on DA use. In the unadjusted analysis, 95 305 encounters (64.7%) reported SDM plus DA had occurred. Unadjusted rates of SDM plus DA rose steadily during the study period from 62.5% in October 2022 to 75.0% in June 2024. The adjusted analysis suggests that the observed variance in SDM plus DA reporting was large and attributable primarily to the institutional level (median odds ratio, 115.64; 95% CI, 79.71-151.56). The range of estimated probability of SDM plus DA by institution was 0.1% to 76.4%, with a mean (SD) of 52.0% (28.6%). There was no statistically significant difference in odds of SDM plus DA for patients with Medicare vs those without (odds ratio, 1.03; 95% CI, 0.98-1.09).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients who underwent pLAAO, SDM plus DA reporting was high, but there was large variation between institutions. Patients with Medicare did not have greater odds of reported SDM plus DA, despite the CMS requirement. These findings exhibit the need for further exploration of institutional barriers and facilitators to SDM and DA use for pLAAO.

PMID:41686441 | DOI:10.1001/jamanetworkopen.2025.56937

JAMA Netw Open. 2026 Feb 2;9(2):e2556945. doi: 10.1001/jamanetworkopen.2025.56945.

ABSTRACT

IMPORTANCE: Prompt antimicrobial therapy is essential in sepsis, but accelerating antimicrobial administration may increase overtreatment.

OBJECTIVES: To examine the extent of and factors associated with physician variation in time from emergency department (ED) presentation to antimicrobial administration (hereinafter termed door-to-antimicrobial time) for sepsis and to assess whether faster practice patterns are associated with overtreatment.

DESIGN, SETTING, AND PARTICIPANTS: This explanatory mixed-methods study linked a quantitative retrospective cohort (July 1, 2013, to January 31, 2017) involving 30-day patient follow-up with prospective qualitative physician interview data (May 17, 2022, to June 28, 2023) at 4 Utah EDs. Participants included ED attending physicians and their patients meeting sepsis criteria (including intravenous antimicrobial administration) before ED departure. Data analysis occurred from 2021 to 2025.

MAIN OUTCOMES AND MEASURES: Assessment for physician door-to-antimicrobial time variation used a likelihood ratio test comparing a linear mixed-effects model incorporating physician-level random intercepts and patient-level covariates with a model without physician random effects. Empirical best linear unbiased predictions of the physician random intercepts (termed physician-predicted mean door-to-antimicrobial times) quantified variation. The primary analysis used a joint mixed-effects shared parameter model to evaluate the association of physicians’ door-to-antimicrobial practice patterns with their overtreatment rate (infection ruled out on final retrospective adjudication). Qualitative analysis of semistructured cognitive task analysis interviews compared ED physicians in the fastest and slowest door-to-antimicrobial time quartiles.

RESULTS: Quantitative analyses included 88 ED physicians (71 [80.7%] male; median age, 39 [IQR, 35-49] years) and 9810 patients with sepsis (median age, 63 [IQR, 48-75] years), of whom 4635 (50.5%) were female and 3540 (38.6%) received antimicrobials more than 3 hours after ED arrival. The median number of patient encounters per physician was 105 (IQR, 75-129). Physicians’ door-to-antimicrobial time varied significantly (likehood ratio test P < .001), with average physician-level estimated mean door-to-antimicrobial time of 184 (95% estimation interval, 146-222) minutes for a typical patient, but was not associated with overtreatment (adjusted odds ratio, 0.98 [95% CI 0.94-1.02] per 10-minute increase in physician estimated mean door-to-antimicrobial time; P = .37). Among 18 physicians interviewed, physicians with faster door-to-antimicrobial times emphasized proactive, parallel task execution and care team coordination, while physicians with slower times described a more reactive and stepwise sepsis evaluation and treatment process.

CONCLUSIONS AND RELEVANCE: In this mixed-methods study, ED physicians’ antimicrobial administration time for sepsis varied significantly, but faster antimicrobial initiation practice patterns were not associated with overtreatment. Physicians with shorter door-to-antimicrobial times described a proactive, parallel processing approach to sepsis care.

PMID:41686440 | DOI:10.1001/jamanetworkopen.2025.56945