Category: Statistics

Math Program. 2026;217(1-2):43-78. doi: 10.1007/s10107-026-02368-8. Epub 2026 Jun 5.

ABSTRACT

We study a class of multi-stage stochastic programs, which incorporate modeling features from Markov decision processes (MDPs). This class includes structured MDPs with continuous action and state spaces. We extend policy graphs to include decision-dependent uncertainty for one-step transition probabilities as well as a limited form of statistical learning. We focus on the expressiveness of our modeling approach, illustrating ideas with a series of examples of increasing complexity. As a solution method, we develop new variants of stochastic dual dynamic programming, including approximations to handle non-convexities.

PMID:42602018 | PMC:PMC13473183 | DOI:10.1007/s10107-026-02368-8

Front Public Health. 2026 Jul 31;14:1876665. doi: 10.3389/fpubh.2026.1876665. eCollection 2026.

ABSTRACT

BACKGROUND: Antimicrobial resistance (AMR) is a major global public health threat driven by the overuse and misuse of antimicrobials across sectors. Medical students, as future prescribers, play a crucial role in combating AMR. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding antimicrobial use and AMR among medical students and house surgeons in India.

METHODS: A cross-sectional survey was conducted among medical students and house surgeons in Maharashtra, India, using a previously validated questionnaire administered via Google Forms. Data were analyzed using R statistical software. Descriptive statistics were used, and inferential analyses included chi-square tests, Kruskal-Wallis tests, Dunn’s post hoc tests, and Spearman correlation.

RESULTS: A total of 414 participants were included. The overall knowledge score was 69%, indicating moderate knowledge. While 90.1% recognized that AMR affects all age groups, only 52.7% were aware that resistant bacteria can spread between individuals, and 33.6% correctly understood that AMR results from microorganisms becoming resistant rather than the human body. Knowledge varied significantly across academic years (p < 0.001). More than 75% of participants demonstrated a positive attitude toward AMR as a major health threat; however, only 20.8% had received formal training on AMR. Regarding practices, 80.7% reported completing antibiotic courses, while 60.4% reported that they would avoid self-medication. Spearman correlation showed a positive association between knowledge and attitude (r = 0.39, p < 0.001) and weak negative correlations between knowledge and practice (r = -0.11, p = 0.03) and between attitude and practice (r = -0.10, p = 0.03).

CONCLUSIONS: The study highlights moderate knowledge, positive attitudes, and suboptimal practices regarding AMR among medical students. Significant gaps in formal training and understanding persist. Early integration of AMR education into medical curricula, along with training in rational prescribing, patient assessment, and antimicrobial stewardship, is essential to curb the development and spread of AMR.

PMID:42602016 | PMC:PMC13473186 | DOI:10.3389/fpubh.2026.1876665

Front Bioeng Biotechnol. 2026 Jul 31;14:1854164. doi: 10.3389/fbioe.2026.1854164. eCollection 2026.

ABSTRACT

INTRODUCTION: This pilot study presents a 3D markerless motion capture system for table tennis using binocular cameras, based on the OpenPose framework and linear triangulation to obtain 3D joint motion data. The system’s accuracy was compared to a marker-based system, and the impact of different camera.

METHODS: A comparative experiment was conducted between the proposed markerless system and a marker-based reference system. Three camera configurations were tested: RR-100 (right-right placement, 100 cm baseline), RR-145 (right-right placement, 145 cm baseline), and RF-100 (right-front placement, 100 cm baseline). Dynamic Time Warping (DTW) similarity of elbow joint angle curves was used as the primary accuracy metric, and statistical comparisons (p-values) were performed to identify significant differences in system errors across configurations.

RESULTS: (1) At a camera position of RR-100, the DTW similarity of the elbow joint angle curves between the markerless and marker-based systems was 0.941, 0.719, and 0.854, respectively, similar to the marker-based system. The DTW similarity reached 0.948, 0.730, and 0.887 for RR-145 and 0.949, 0.729, and 0.860 for RF-100. (2) Significant differences in system errors were found at varying baseline distances with L = RR, showing better accuracy at 145 cm (p < 0.01). (3) Significant differences in errors were found with L = RF and a 100 cm baseline, with better accuracy at RF (p < 0.01).

CONCLUSION: (1) The markerless system, though slightly less accurate, can also capture joint motion data. (2) Increasing baseline distance improves accuracy when the camera position is fixed. (3) With a fixed baseline distance, the system with the RF camera position outperforms the RR position in accuracy.

PMID:42602004 | PMC:PMC13473170 | DOI:10.3389/fbioe.2026.1854164

Front Physiol. 2026 Jul 31;17:1908148. doi: 10.3389/fphys.2026.1908148. eCollection 2026.

ABSTRACT

OBJECTIVE: To evaluate whether post-exercise compression garments improve subsequent endurance performance and delayed-onset or perceived muscle soreness in adult endurance athletes.

METHODS: This systematic review and meta-analysis searched PubMed, Scopus, and Web of Science through 19 May 2026 for controlled intervention studies comparing post-exercise compression garments with no compression, usual clothing, sham/placebo, passive recovery, or lower-pressure controls. RoB 2 and GRADE assessed risk of bias and certainty. Soreness was synthesized as Hedges g using random-effects models with Hartung-Knapp-Sidik-Jonkman inference; performance was synthesized narratively. The protocol was registered in Open Science Framework (osf.io/46ck9).

RESULTS: Of 503 records screened, nine studies were included (158 participants; six crossover, three parallel-group). All studies included in the final evidence base were randomized parallel-group or crossover trials. Ten of 11 assessments were high risk. At approximately 24 hours, soreness favored compression but was uncertain (four studies; Hedges g = 0.62, 95% CI -0.57 to 1.82; I² = 74.0%). Immediate-to-2-hour acute post-exercise perceived soreness/discomfort was also uncertain (three studies; g = 0.38, 95% CI -0.67 to 1.42; I² = 51.0%). Performance findings were not pooled because of heterogeneity or non-isolatable recovery effects. Certainty was very low.

CONCLUSIONS: Soreness estimates were directionally favorable to compression, but the evidence was very uncertain, statistically imprecise, and vulnerable to expectation effects because blinding was limited or poorly credible. Effects on subsequent endurance performance remain unresolved. Registration: OSF osf.io/46ck9 on 14/05/2026.

SYSTEMATIC REVIEW REGISTRATION: https://osf.io/b3c78/overview, identifier osf.io/46ck9.

PMID:42602003 | PMC:PMC13472931 | DOI:10.3389/fphys.2026.1908148

Cureus. 2026 Jul 14;18(7):e112679. doi: 10.7759/cureus.112679. eCollection 2026 Jul.

ABSTRACT

INTRODUCTION: Undergraduate research training improves critical thinking, although barriers related to mentorship and time persist. This study evaluated changes in self-perceived research competencies after a free extracurricular student-led research methodology course combining lectures, practical workshops, and mentorship.

METHODOLOGY: A single-group quasi-experimental study with a retrospective pretest-posttest design was conducted among medical students after completion of this 13-session, 30-hour extracurricular course. Descriptive statistics were used to summarize outcomes; pre- and post-course self-perceived competencies were compared using the Wilcoxon signed-rank test; grades were modeled according to attendance using linear regression; and perceived barriers were explored.

RESULTS: Among 59 participants (mean age 23.7 ± 1.58 years; 36, 61.0%, women), those feeling well or very well prepared increased from 8 (13.6%) to 37 (62.7%). Attendance was positively associated with grade (r = 0.4716; β = +2.39 points per session attended; R² = 22.2%; P = 0.00016). The Wilcoxon test showed a significant difference (statistic = 0.0; P < 0.000001).

CONCLUSIONS: A structured student-led course was associated with higher self-perceived research competencies and better academic performance. Incorporating mentorship and practical sessions is recommended to strengthen outcomes and support implementation in other faculties.

PMID:42602002 | PMC:PMC13473197 | DOI:10.7759/cureus.112679

Front Public Health. 2026 Jul 31;14:1846531. doi: 10.3389/fpubh.2026.1846531. eCollection 2026.

ABSTRACT

BACKGROUND: Loneliness is increasingly recognized as an important psychosocial health issue among older adults. Older adults with chronic diseases and multimorbidity may be particularly vulnerable because long-term disease burden, coexisting chronic conditions, functional limitations, and reduced social participation often interact. This scoping review aimed to map the available evidence on assessment tools, prevalence estimates, and factors associated with loneliness among older adults with chronic diseases and multimorbidity.

METHODS: A systematic search was conducted in CNKI, Wanfang, VIP, China Biomedical Literature Database, Embase, The Cochrane Library, PubMed, Web of Science, and CINAHL from database inception to November 2025. Eligible studies were screened and extracted according to predefined criteria. Descriptive statistics, narrative synthesis, and thematic analysis were used to summarize the findings.

RESULTS: Twenty-one studies involving 26,140 participants were included. Five loneliness assessment approaches were identified, including the UCLA Loneliness Scale, the 3-item UCLA Loneliness Scale, the ULS-8 Scale, the De Jong Gierveld Loneliness Scale, and a single-item loneliness question. Thirteen studies reported prevalence estimates, ranging from 25.0 to 97%. When stratified by assessment instrument, estimates were generally higher in studies using the full UCLA Loneliness Scale and lower in studies using single-item loneliness questions. Factors associated with loneliness were grouped into four categories: sociodemographic factors, health status and disease-related factors, lifestyle and social support factors, and psychological and cognitive factors. Insufficient social support, chronic disease burden, multimorbidity, functional impairment, depression, anxiety, living alone, and widowhood were repeatedly reported.

CONCLUSION: Loneliness among older adults with chronic diseases and multimorbidity is common but heterogeneous across studies. Future research should standardize measurement approaches and conduct longitudinal and intervention studies to inform integrated and personalized management strategies.

SYSTEMATIC REVIEW REGISTRATION: Identifier md2je. The review was registered with the Open Science Framework. The publicly accessible registration URL is: https://osf.io/md2je/.

PMID:42601983 | PMC:PMC13472916 | DOI:10.3389/fpubh.2026.1846531

Front Public Health. 2026 Jul 31;14:1917410. doi: 10.3389/fpubh.2026.1917410. eCollection 2026.

ABSTRACT

BACKGROUND: Chronic low-dose exposure to organophosphorus pesticides (OPPs) is widespread in the general population and has been linked to heart disease mortality, yet the biological pathways connecting such exposure to fatal outcomes remain poorly defined. We examined whether urinary OPP metabolites are associated with heart disease mortality and whether DNA methylation biomarkers might contribute to this association.

METHODS: We studied 502 adults aged ≥50 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 cycles with urinary OPP metabolite measurements, DNA methylation profiles, and linked mortality follow-up. Survey-weighted Cox models were used to relate baseline metabolites [per 1-standard-deviation (SD) increase] to heart disease mortality, with sensitivity analyses for exposure definition and confounding. DNA methylation biomarkers that were significant after false discovery rate (FDR) correction were examined in exploratory single-mediator models, with Benjamini-Hochberg correction applied across the five indirect-effect tests, and in a secondary survival random forest. THP-1 monocytes were exposed to chlorpyrifos as a mechanistic probe of pathways suggested by the epidemiological findings.

RESULTS: Among four OPP metabolites, only diethylthiophosphate (DETP) was associated with heart disease mortality after multivariable adjustment [hazard ratio 1.33, 95% confidence interval (CI) 1.11-1.61 per 1-SD increase, FDR = 0.010], with a positive association across quartiles. After Benjamini-Hochberg correction, DETP showed FDR-significant linear associations with five DNA methylation biomarkers. In separate single-mediator models, MonoPP and ZhangAge showed nominal indirect effects at raw p < 0.05, with estimated proportions mediated of approximately 9.2 and 8.4%, respectively; however, neither remained statistically significant after Benjamini-Hochberg correction across the five mediation models. A survival random forest combining DETP with the five markers achieved a 5-fold cross-validated 20-year area under the curve (AUC) of 0.71 (95% CI 0.66-0.76). In vitro, sub-cytotoxic chlorpyrifos raised pro-inflammatory cytokines, increased DNMT1, suppressed TET2, and induced global DNA hypermethylation.

CONCLUSION: In this exploratory analysis, higher urinary DETP was associated with greater heart disease mortality in middle-aged and older adults. MonoPP and ZhangAge showed suggestive indirect effects in separate exploratory models, each accounting for an estimated 8-9% of the association, but neither effect remained significant after FDR correction. Most of the DETP-related risk, therefore, remained unexplained by the measured methylation markers. The in vitro experiments provided hypothesis-generating support-most directly for inflammatory signaling-rather than confirmation of the epidemiological pathway.

PMID:42601976 | PMC:PMC13473126 | DOI:10.3389/fpubh.2026.1917410

Front Public Health. 2026 Jul 31;14:1915867. doi: 10.3389/fpubh.2026.1915867. eCollection 2026.

ABSTRACT

BACKGROUND: After diagnosis of high-risk human papillomavirus (HPV) infection, patients often seek guidance on cancer risk, colposcopy, follow-up, treatment, partner management, pregnancy, and anxiety. Large language models (LLMs) are increasingly used for medical consultation, but their response quality and safety in this setting require evaluation.

METHODS: In this single-center, expert-rated methodological study, 15 patient-style questions based on common outpatient consultations were submitted to ChatGPT-5.5 Instant and DeepSeek-V3. Each model generated three independent responses per question, yielding 90 artificial intelligence (AI)-generated responses. Five blinded gynecology experts independently evaluated all responses, producing 450 expert-rating records. Accuracy, safety, guideline concordance, completeness, and understandability were rated on a 1-5 Likert scale. Experts also assessed major error and potential harm. The primary outcome was the proportion of responses without major error or potential harm.

RESULTS: ChatGPT-5.5 Instant had higher response-level scores than DeepSeek-V3 for accuracy (mean difference, 0.25; 95% CI, 0.11-0.39; FDR-adjusted p = 0.010), safety (0.27; 0.07-0.47; p = 0.010), completeness (0.22; 0.07-0.37; p = 0.020), and composite score (0.18; 0.04-0.31; p = 0.027). The difference in guideline concordance did not remain significant after multiplicity correction (0.16; -0.01 to 0.33; FDR-adjusted p = 0.057), and understandability was similar. Responses without major error or potential harm occurred in 42/45 (93.3%; 95% CI, 81.7-98.6%) ChatGPT responses and 38/45 (84.4%; 70.5-93.5%) DeepSeek-V3 responses (risk difference, 8.9 percentage points; 95% CI, -13.3 to 31.1; p = 0.344). Exploratory question-level risks were observed in HPV16/18 positivity, normal cytology, partner management, and pregnancy scenarios.

CONCLUSION: Both two models demonstrated generally strong performance across the evaluated quality domains. ChatGPT achieved higher ratings in several quality domains, but response-level binary safety differences were imprecise and not statistically significant. Both models require guideline-based clinical oversight.

PMID:42601968 | PMC:PMC13473150 | DOI:10.3389/fpubh.2026.1915867

Front Surg. 2026 Jul 31;13:1882855. doi: 10.3389/fsurg.2026.1882855. eCollection 2026.

ABSTRACT

BACKGROUND: The accessory maxillary ostium (AMO) is a common anatomical variant of the lateral nasal wall and has been implicated in impaired maxillary sinus drainage, mucus recirculation, and chronic sinus pathology. Although AMO can be identified using both radiologic and endoscopic techniques, the endoscopic visualization rate of CT-documented AMO has not been well characterized. This study aimed to evaluate the endoscopic visualization rate of AMO using FFE in patients with CT-documented AMO.

METHOD: This retrospective cohort study was conducted at a tertiary referral center between January 2023 and December 2024. Patients with CT-confirmed AMO who subsequently underwent FFE were included. Patients with a history of prior sinus surgery were excluded. Demographic data, CT findings, and endoscopic visualization of AMO were collected from electronic medical records. Descriptive statistics were used to summarize the data, and categorical variables were analyzed using Chi-square or Fisher’s exact tests as appropriate.

RESULTS: A total of 274 patients were included, with a mean age of 34.4 ± 14.1 years; 51.8% were male. While AMO was confirmed on CT imaging in all participants by inclusion criteria, FFE visualized AMO in only 26% of cases (71/274), indicating a low endoscopic visualization rate among patients with CT-confirmed AMO. Maxillary sinus opacification was detected on CT in 49.6% of patients, while nasal polyps were present in 34.3%. No significant gender differences were observed in the prevalence of maxillary opacification or nasal polyps.

CONCLUSION: Flexible fiberoptic endoscopy demonstrated limited ability to visualize accessory maxillary ostium in patients with CT-documented AMO. While FFE remains useful for functional and mucosal assessment, CT imaging appeared to useful for anatomical identification of AMO and may be considered for comprehensive evaluation and surgical planning.

PMID:42601967 | PMC:PMC13472984 | DOI:10.3389/fsurg.2026.1882855

Front Nutr. 2026 Jul 31;13:1893988. doi: 10.3389/fnut.2026.1893988. eCollection 2026.

ABSTRACT

BACKGROUND: Optimal protein provision in critically ill patients remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of higher versus lower or standard protein provision in critically ill adults.

METHODS: Randomized controlled trials comparing higher versus lower/standard protein provision in critically ill adults were included. The primary analysis focused on trials with a between-group protein difference of at least 0.3 g/kg/day. Mortality was analyzed separately by time point, including 28/30-day, 60-day, 90-day, in-hospital, and ICU mortality. Secondary outcomes included mechanical ventilation duration, ICU and hospital length of stay, nutrition/metabolic markers, muscle-related outcomes, and safety. Risk ratios (RRs) and mean differences (MDs) were pooled using random-effects models. Certainty of evidence was assessed using GRADE.

RESULTS: Twenty-six studies were included. Higher protein provision did not significantly reduce mortality at any time point. For 28/30-day mortality, no statistically significant difference was observed, although the point estimate was lower with higher protein provision (RR = 0.82, 95% CI 0.58-1.17; I ² = 0%). No significant differences were observed for 60-day mortality (RR = 0.85, 95% CI 0.52-1.39; I ² = 51.1%), 90-day mortality (RR = 1.03, 95% CI 0.93-1.14; I ² = 0%), in-hospital mortality (RR = 1.04, 95% CI 0.78-1.39; I ² = 0%), or ICU mortality (RR = 0.84, 95% CI 0.57-1.26; I ² = 0%). Higher protein provision did not significantly shorten mechanical ventilation duration (MD = -0.74 days, 95% CI-1.92-0.43; I ² = 79.0%), ICU stay, or hospital stay. Higher protein provision was associated with a more favorable Day 3 nitrogen balance (MD = 6.39 g/day, 95% CI 2.77-10.01; I ² = 51.7%), but was not associated with a significant increase in gastrointestinal intolerance.

CONCLUSIONS: Higher protein provision did not significantly reduce mortality or consistently improve clinical recovery outcomes in critically ill adults. It was associated with more favorable early nitrogen balance, but evidence for patient-centered benefit and safety remains limited.

PMID:42601943 | PMC:PMC13472815 | DOI:10.3389/fnut.2026.1893988