Category: Statistics

Syst Rev. 2026 May 8. doi: 10.1186/s13643-026-03156-3. Online ahead of print.

ABSTRACT

BACKGROUND: Indigenous populations in high-income countries (HICs) experience disproportionately high rates of food insecurity, particularly in remote regions where high costs, poor quality, and limited variety limit access to perishable foods. Fragile perishable food supply chains (PFSCs) further compound these vulnerabilities. Although existing reviews have examined nutrition policies, socioeconomic interventions, and retail food environments, they have largely overlooked the operational and logistical challenges associated with perishable food supply chain management (PFSCM). Moreover, no review has systematically mapped the reported practices in the literature to address these challenges across interconnected supply chain levels, including procurement, transportation, distribution, and retail. To address these gaps, this systematic scoping literature review (SSLR) will employ a food access framework to synthesize the challenges and practices of PFSCM in remote Indigenous communities across 17 HICs.

METHODS: This SSLR will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols (PRISMA-P). A three-step JBI search strategy will be used to identify relevant published and unpublished evidence, including grey literature. Databases will include IEEE, MEDLINE (Ovid), ABI/Inform Global (ProQuest), CAB Abstracts, and Web of Science (Core Collection). Grey literature will be sourced from the Grey Source Index, Web of Conferences, government publications, OpenDOAR, OpenAIRE, and SSRN. Sources will be included if published in English between 1996 and 2024 and if they address PFSCM (phenomenon), perishable food access (concept), and remote Indigenous communities in HICs (context). Data will be extracted using a structured framework. Descriptive statistics will summarize study characteristics, and thematic analysis will be conducted to identify patterns in PFSCM challenges and reported practices. NVivo will support data management, and results will be reported in accordance with PRISMA-ScR guidelines.

DISCUSSION: This review will provide the first systematic scoping synthesis of PFSCM challenges and reported practices in remote Indigenous communities across HICs. By integrating a food access framework with a systems-oriented supply chain perspective, the review will extend prior work that has primarily focused on retail or policy interventions and limited geographic settings. The resulting evidence map and conceptual framework will support future research, policy dialogue, and context-sensitive planning to strengthen perishable food systems and food access in remote Indigenous settings.

SYSTEMATIC REVIEW REGISTRATION: Open science framework registration: https://osf.io/kqpvn.

PMID:42098800 | DOI:10.1186/s13643-026-03156-3

BMC Oral Health. 2026 May 7. doi: 10.1186/s12903-026-08525-x. Online ahead of print.

ABSTRACT

BACKGROUND: This randomized clinical trial aimed to compare postoperative pain (PP) and analgesic consumption following single-visit root canal treatment using two calcium silicate-based sealers (BioMTA + and Well-Root PT) and one epoxy resin-based sealer (Endoplus) in mature permanent mandibular molars diagnosed with asymptomatic irreversible pulpitis.

METHODS: Fifty-four patients were randomly allocated into three groups (n = 18) according to the obturation material used: Endoplus, BioMTA+, or Well-Root PT. All treatments were performed in a single visit under standardized clinical conditions. Root canals were prepared using FKG Race Evo rotary files and irrigated with NaOCl and EDTA, followed by passive ultrasonic activation. Postoperative pain was assessed using a visual analog scale (VAS) at 6, 12, 24, 48, and 72 h and at 1 week postoperatively. Analgesic intake was recorded. Data were analyzed using repeated measures ANOVA and chi-square tests, with the significance level set at p < 0.05.

RESULT: All groups exhibited a statistically significant reduction in postoperative pain over time (p < 0.001 for Endoplus and BioMTA+; p = 0.004 for Well-Root MTA). However, intergroup comparisons revealed no statistically significant differences in pain scores at any evaluation time point (p > 0.05). The highest pain levels were observed within the first 24 h, followed by a rapid decline thereafter. None of the patients required analgesic intake during the postoperative period. Demographic variables were comparable among the groups.

CONCLUSION: Within the limitations of this randomized clinical trial, no statistically significant differences were detected among BioMTA+, Well-Root PT, and Endoplus regarding early postoperative pain following single-visit root canal treatment in mandibular molars with asymptomatic irreversible pulpitis. The type of root canal sealer did not significantly influence postoperative pain outcomes.

TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (ID: NCT06795282, Record Dates: 22/12/2024).

PMID:42098797 | DOI:10.1186/s12903-026-08525-x

Implement Sci. 2026 May 7. doi: 10.1186/s13012-026-01500-8. Online ahead of print.

ABSTRACT

BACKGROUND: “Nudges” embedded in the electronic health record (EHR) facilitate desired decisions while preserving autonomy and may provide a scalable strategy to overcome the common implementation barrier of lack of knowledge about a best practice. We sought to test whether EHR-based nudges targeting two intensive care unit (ICU) clinician groups would safely increase evidence-based use of low tidal volume ventilation.

METHODS: We performed a stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial in 12 ICUs from February 2021 to May 2023 to test three nudges targeting clinicians responsible for order entry and respiratory therapists responsible for operationalizing orders and documentation. A default ventilation order auto-populated a low tidal volume setting; an accountable justification order required a free-text justification to order high tidal volume; and an accountable justification flowsheet required a free-text justification to document delivery of high tidal volume. ICUs were randomly assigned to launch one of the two order nudges on a pre-specified date, followed by the flowsheet nudge six months thereafter. The primary outcome was fidelity to low tidal volume ventilation, defined as percentage of time during the first 72 h of ventilation with low tidal volumes. For additional contextual inquiry, we conducted qualitative interviews with ICU clinicians regarding their perspectives on low tidal volume ventilation and study nudges.

RESULTS: The primary analysis included 4412 patients. Unadjusted median fidelity to low tidal volume ventilation was 45.7%. Using multivariable mixed effects regression, marginal estimates of fidelity to low tidal volume ventilation ranged from 47.1% to 57.8% across study groups, with no significant differences after Holm adjustment for multiple comparisons. ICUs experienced variable changes with nudges in fidelity to low tidal volume ventilation. Clinician interviews revealed potential explanations for this variability, including the possibility of differential effects by experience level of clinicians and culture of interprofessional collaboration, and influence of the COVID-19 pandemic on familiarity with and use of low tidal volume ventilation.

CONCLUSIONS: EHR-based default and accountable justification nudges did not increase utilization of low tidal volume ventilation in a broad population of mechanically ventilated patients; however, nudge effectiveness varied by ICU.

TRIAL REGISTRATION: Clinicaltrials.gov, NCT04663802. Registered 10 December 2020, https://clinicaltrials.gov/study/NCT04663802.

PMID:42098760 | DOI:10.1186/s13012-026-01500-8

BMC Med Educ. 2026 May 7. doi: 10.1186/s12909-026-09365-7. Online ahead of print.

ABSTRACT

BACKGROUND: Periodontal diseases are closely related to various systemic conditions including diabetes mellitus (DM), cardiovascular diseases, adverse pregnancy outcomes, and rheumatoid arthritis (RA). Internal medicine physicians frequently encounter patients with these systemic conditions and are in a strategic position to facilitate early diagnosis and referral for periodontal problems. Despite international evidence suggesting significant knowledge gaps among medical practitioners regarding periodontal health, limited data are available from Turkey. The aim of this study was to evaluate the knowledge levels and attitudes of internal medicine specialists and residents regarding periodontal health and periodontal disease, and their relationship with systemic conditions, in comparison with dentists.

METHODS: This cross-sectional descriptive survey study was conducted between April 2021 and December 2021 in Turkey. A content-validated, self-administered online questionnaire consisting of 7 sociodemographic questions and 29 questions related to periodontal health and periodontal disease knowledge and attitudes was distributed to internal medicine specialists/residents (IMS group, n = 107) and dentists (control group, n = 133) via social media platforms. Internal consistency was assessed using Cronbach’s alpha (α = 0.829). Normality of continuous variables was assessed using the Shapiro-Wilk test. Data were analyzed using chi-square tests, Kruskal-Wallis tests, and Mann-Whitney U tests, with statistical significance set at p < 0.05. Bonferroni correction was applied for multiple comparisons. Multiple linear and logistic regression models were used to adjust for potential confounders.

RESULTS: A total of 240 participants met the inclusion criteria. Internal medicine specialists/residents demonstrated significantly lower knowledge levels compared to dentists across most periodontal knowledge domains (p < 0.05). Only 65.4% of the IMS group correctly defined periodontitis compared to 98.5% of dentists (p < 0.001). Knowledge gaps were particularly prominent regarding the relationship between periodontal disease and pregnancy complications (46.7% vs. 91%, p < 0.001), the effect of smoking on periodontal tissues (59.8% vs. 97.7%, p < 0.001), and the role of radiographic examination in periodontal diagnosis (37.4% vs. 88.8%, p < 0.001). After Bonferroni correction, 14 of 22 comparisons remained statistically significant. Notably, both groups showed high and comparable knowledge regarding the recognition of diabetes as a risk factor for periodontitis (IMS: 93.5% vs. dentists: 92.5%). Subgroup analysis revealed that specialists scored significantly higher than residents across all knowledge domains (total score: 16.94 ± 2.90 vs. 14.38 ± 3.73, p < 0.001). Multivariate analysis confirmed that group differences remained significant after adjusting for age, sex, marital status, and years since graduation (adjusted B = 4.65, p < 0.001). Self-assessment scores for periodontal knowledge significantly increased after completing the survey in the IMS group (4.02 to 5.34, p < 0.001).

CONCLUSIONS: The findings of this study suggest that internal medicine specialists and residents in Turkey may have lower knowledge levels regarding periodontal health and periodontal disease, and the periodontal-systemic health relationship compared to dentists. Specialists demonstrated significantly higher knowledge than residents across all domains. While these results should be interpreted within the context of the study’s methodological limitations, they point to a potential need for integration of oral health education into medical curricula and enhanced interprofessional collaboration between medicine and dentistry. Further research using representative sampling strategies and longitudinal designs is warranted to confirm these findings.

PMID:42098754 | DOI:10.1186/s12909-026-09365-7

BMC Public Health. 2026 May 7. doi: 10.1186/s12889-026-27664-y. Online ahead of print.

ABSTRACT

BACKGROUND: It is still unclear how the risk of cardiovascular disease (CVD) changes across life course and the specific influence of body mass index (BMI) on risk trajectory.

METHODS: We included 106,962 participants aged 35-74 from a Chinese longitudinal cohort during 1992 to 2021 with 4 repeated measurements. China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) equation was applied to calculate 10-year CVD risk. General additional mixed model and Joinpoint model were used to elaborate CVD risk trajectory and the potential benefits of normal BMI.

RESULTS: The 10-year CVD risk for Chinese adults increased from 1.11% [95% confidence interval (CI): 1.00%, 1.22%] to 14.87% (95%CI: 14.76%, 14.99%) dramatically between ages 35-74, with average CVD risk reaching moderate- and high-risk level at 53 and 65 years, respectively. Compared to overweight/obesity (BMI ≥ 25 kg/m²), normal BMI (< 25 kg/m²) could effectively slow the increase of CVD risk during lifespan (average slope: 0.42% vs. 0.33%), and postpone the moderate- and high-risk age window by 4 years and 5 years, respectively. Risk difference between overweight/obesity and normal BMI groups gradually climbed from -0.10% (95%CI: -0.47%, 0.28%) to 3.02% (95%CI: 2.69%, 3.35%) between ages 35-74. Women displayed a similar uptrend, while men experienced peak benefits at 53 years (2.09%, 95%CI: 1.86%, 2.31%) followed by a slight decrease.

CONCLUSIONS: This study delineated cardiovascular risk trajectory, identifying critical intervention windows and demonstrating potential cardiovascular benefits of normal BMI, particularly in women.

PMID:42098752 | DOI:10.1186/s12889-026-27664-y

BMC Womens Health. 2026 May 7. doi: 10.1186/s12905-026-04520-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine temporal trends in routine leucorrhea test results and associated pathogen findings among women participating in sustained cervical and breast cancer screening programs in a county-level city of western China.

METHODS: In this repeated cross-sectional screening study, routine leucorrhea test data were collected from women aged 35-64 years who participated in cervical and breast cancer screenings in Jianyang City, Sichuan Province, between January 2022 and December 2024 (12,156 cases in 2022, 13,824 cases in 2023, and 11,382 cases in 2024). Participants were stratified by age and region. Vaginal cleanliness and pathogens were assessed using the normal saline wet mount method. Statistical analyses were performed using SPSS 26.0, including trend analysis, linear regression, and stratified analyses to examine age-region interaction effects.

RESULTS: Over the three-year period, the abnormal rate of routine leucorrhea tests (Grade III-IV) decreased from 34.21% to 30.00%, corresponding to an annual reduction of 6.5% (P < 0.001). Infection rates of Candida albicans, Trichomonas vaginalis, and clue cell positivity declined concurrently. The 51-55 age group had the highest baseline abnormal rate but showed the most pronounced decrease (5.40% points). Stratified analysis indicated that township perimenopausal women (51-55 years) experienced the steepest improvement (7.2% points) compared with urban counterparts (3.8% points, P < 0.01). The urban-rural gap narrowed by 3.90% points (P < 0.001). Following the 2023 township healthcare initiative, township abnormal rates declined more steeply than the pre-intervention trend would have predicted (difference of 3.10% points); given the cross-sectional design, this difference should be interpreted as a temporal association rather than causal attribution.

CONCLUSION: Participation in a sustained, population-based screening program was temporally associated with a declining trend in abnormal leucorrhea findings among women aged 35-64 years in this county-level city of western China. Based on a preliminary linear trend estimate derived from three annual data points, the abnormal rate may decrease to approximately 26% by 2026 if current intervention intensity is maintained; this projection should be interpreted with caution given the limited time series. Because this is a repeated cross-sectional analysis, causal inference is not warranted. Targeted interventions for perimenopausal women and residents of township areas should be reinforced to optimize gynecological health services in western China.

PMID:42098750 | DOI:10.1186/s12905-026-04520-0

Forensic Sci Int. 2026 Apr 29;386:112980. doi: 10.1016/j.forsciint.2026.112980. Online ahead of print.

ABSTRACT

A high-level data fusion approach for classifying spray paint samples from five major U.S. manufacturers, each represented by five color groups (black, blue, red, silver/gray, and white), was investigated. Spectral data were collected using four analytical techniques: Fourier transform infrared (FTIR) spectroscopy, Raman spectroscopy with laser excitation at 532 nm and 785 nm, scanning electron microscopy coupled with energy-dispersive spectroscopy (SEM-EDS), and UV-Vis microspectrophotometry (MSP). Their combined use and discriminating ability were evaluated. Each dataset was independently modeled using five supervised machine learning classifiers: Naïve Bayes, k-nearest neighbors (KNN), support vector machine (SVM), random forests, and extreme gradient boosting (XGBoost). The intermediate predictions from each classifier were integrated using the majority voting mechanism to yield a final class assignment, forming a high-level data fusion scheme. The proposed approach consistently outperformed individual instruments, achieving near-perfect classification accuracy across several color blocks, particularly for red and blue paints. Among classifiers, generally, Random Forest and Naïve Bayes provided the most stable performance, while SVM with a linear kernel and XGBoost showed lower accuracy. The findings confirm that fusing complementary spectral information improves discriminative ability, reduces redundancy, and creates a computationally efficient, reproducible framework for objective evaluation of source-level questions arising from forensic paint examinations. Overall, the developed model mirrored the process followed by forensic paint examiners in recognizing relevant spectral features from the various techniques. This approach offers a promising pathway toward integrating multimodal spectral data within probabilistic or likelihood ratio-based frameworks following comparative examinations of paint.

PMID:42096743 | DOI:10.1016/j.forsciint.2026.112980

Comput Biol Chem. 2026 May 5;124(Pt 1):109097. doi: 10.1016/j.compbiolchem.2026.109097. Online ahead of print.

ABSTRACT

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) enables rapid species identification in clinical microbiology and shows promise for predicting antimicrobial resistance (AMR) from mass spectra. However, models trained at one hospital site suffer substantial performance degradation at another site due to differences in instruments, sample preparation, and patient populations. Despite numerous domain adaptation (DA) methods in the machine learning literature, none has been systematically benchmarked for cross-site MALDI-TOF AMR prediction. This study presents the first comprehensive benchmark evaluating 13 methods (spanning baselines, supervised transfer learning, and unsupervised DA) across five transfer scenarios involving three public datasets (DRIAMS, MS-UMG, and MARISMa) covering up to 20 species-antibiotic pairs. In total, the benchmark comprises over 15,000 experiments with five random seeds per configuration. A label-efficiency analysis across all five scenarios further examines how model performance scales with 10%, 25%, 50%, and 75% of available target-site labels. The results demonstrate that simple fine-tuning with target-site labels closes 92%-97% of the domain gap and dominates all unsupervised DA methods, which yield only 0%-6% improvement over source-only baselines. The label-efficiency analysis reveals that for competitive transfer methods, as few as 25% of target labels suffice to recover 81%-94% of full supervised performance on cross-site scenarios. These findings provide practical guidelines for clinical deployment: collecting a modest number of labeled samples at the target site is far more effective than applying sophisticated unsupervised adaptation techniques.

PMID:42096742 | DOI:10.1016/j.compbiolchem.2026.109097

Biomed Pharmacother. 2026 May 6;199:119472. doi: 10.1016/j.biopha.2026.119472. Online ahead of print.

ABSTRACT

Statistics indicate that brain metastases occur in nearly 30% of patients with solid tumors, with lung cancer, breast cancer, and melanoma being the three most common primary sources. Brain metastasis is characterized by the co-evolution of tumor cells co-evolve with the brain microenvironment, inducing changes in the phenotype of brain stromal cells that facilitate the colonization, survival, and growth of tumors. The prognosis for brain metastases remains poor, with 2-year and 5-year survival rates for patients diagnosed with brain metastases of 8.1% and 2.4%, respectively. Notably, more than half of brain metastases patients die from neurological diseases. Current treatment options for brain metastases include radiotherapy, neurosurgery, systemic chemotherapy, targeted therapy, and immunotherapy, which are often used in combination to improve therapeutic outcomes. In recent years, the use of nanomaterials for brain metastases treatments has been progressively developed to enhance the efficiency and precision of drug delivery. In the future, with a deeper understanding of the mechanisms underlying brain metastases and further development of treatment strategies, patient outcomes are expected to improve. This review, summarizes the current understanding of brain metastasis mechanisms and therapeutic approaches, and outlines an outlook on future research directions in the field.

PMID:42096737 | DOI:10.1016/j.biopha.2026.119472

Obstet Gynecol. 2026 May 7. doi: 10.1097/AOG.0000000000006292. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the driving distance from U.S. prisons housing women to hospitals providing obstetric care and advanced neonatal intensive care.

METHODS: Using the Google Distance Matrix API, we conducted a cross-sectional analysis to calculate driving distances from state and federal prisons housing women to the closest in-state obstetric hospitals and level III or IV neonatal intensive care units (NICUs). The primary outcome was obstetric hospital distance (driving distance from each prison to the closest hospital providing obstetric care). The secondary outcome was NICU hospital distance (driving distance from each prison to the closest level III or IV NICU). We calculated state-level descriptive statistics and assessed regional differences using the Kruskal-Wallis test.

RESULTS: Of 136 prisons, 134 (98.5%) had an in-state driving route to an obstetric hospital. There were 1,920 obstetric hospitals and 836 level III or IV NICUs. The median (IQR) obstetric hospital distance was 11.4 miles (4.5-22.8) (range 0.6-139.8). The farthest obstetric hospital distances were in Wyoming (139.8 miles), North Dakota (122.4 miles), and Georgia (69.6 miles). Twelve prisons (9.0%) were located more than 37.2 miles from the closest obstetric hospital, including two in both Wyoming and Georgia. Of the 130 prisons with driving routes to an in-state level III or IV NICU, the median (IQR) NICU hospital distance was 19.5 miles (7.7-39.6) (range 0.4-357.9). The farthest NICU hospital distances were in Alaska (357.9 miles), New Mexico (187.0 miles), and South Dakota (175.8 miles). Distances to the closets NICU were significantly longer in the South and Midwest than in the Northeast (P=.025).

CONCLUSION: Although most prisons housing women were located near hospitals providing obstetric and neonatal intensive care, there were state and regional disparities. For some prisons, distance could pose a substantial barrier to timely perinatal care and may exacerbate existing inequities in maternal and neonatal morbidity and mortality.

PMID:42096711 | DOI:10.1097/AOG.0000000000006292