Category: Statistics

J Egypt Public Health Assoc. 2026 Mar 19;101(1):7. doi: 10.1186/s42506-026-00211-8.

ABSTRACT

BACKGROUND: Microbial communities in aquatic ecosystems are integral to water quality and public health, yet their structure and underlying ecological processes in regions like Egypt remain underexplored. To address this gap, this research explores the structure and dynamics of prokaryotic communities in tap water and groundwater in Cairo, Egypt.

METHODS: Using environmental DNA metabarcoding, bioinformatics, and statistical modeling, we investigated microbial composition, pathogen identification, environmental factors, and ecological assembly processes.

RESULTS: The sequence analysis revealed the presence of 6,868 amplicon sequence variants (ASVs), with distinct community structures between groundwater and tap water. Proteobacteria dominated both habitats, with significant habitat-specific variations in Firmicutes, Actinobacteria, Verrucomicrobia, and Bacteroidota. Key genera included Methylobacterium in tap water, and Thauera and Legionella in groundwater, reflecting habitat-specific adaptations. The potential presence of Legionella-detected through 16 S rRNA gene signatures-may indicate conditions that could support organisms associated with diseases such as Legionnaires’ disease; however, 16 S-based detection does not confirm viability or infectivity. Similarly, the surrogate presence of taxa such as Streptococcus salivarius, Stenotrophomonas maltophilia, and Acinetobacter baumannii in tap-water samples suggests possible post-treatment contamination or biofilm-associated persistence, warranting further targeted monitoring using methods capable of confirming viability. Ecological assessments indicated that stochastic mechanisms, particularly ecological drift, were the dominant forces shaping microbial community assembly in both water sources, whereas homogeneous selection exerted a moderate influence specifically within groundwater environments. Environmental parameters such as DO%, NO₂-N, and NO₃-N were critical in shaping tap water communities, while NH₄-N and TDS influenced groundwater communities.

CONCLUSION: This study highlights the distinct microbial dynamics of groundwater and tap water, emphasizing the importance of integrated water quality management strategies to mitigate nutrient pollution, monitor potential pathogen signatures, and protect public health.

PMID:41854783 | DOI:10.1186/s42506-026-00211-8

Cancer Causes Control. 2026 Mar 19;37(4):62. doi: 10.1007/s10552-026-02152-1.

ABSTRACT

PURPOSE: Synthetic census tracts can allow for release of small area cancer data without compromising patient confidentiality. We used synthetic and actual census tract data for California and actual data for New York State (NYS) to examine associations of small area socioeconomic factors with breast cancer prognosis and outcomes and to evaluate results obtained from synthetic versus actual data.

METHODS: We retrieved data on invasive, first primary breast cancers diagnosed between 2006 and 2017 in females ages ≥ 18 in California (n = 237,156) or NYS (n = 149,789). We categorized into quintiles census tract-level exposures and used multivariable-adjusted multilevel logistic and Cox proportional hazards regression analyses to examine associations with stage, grade, subtype, and overall and cancer-specific survival. We conducted separate analyses for California and NYS and compared results from the two states and from synthetic and actual data for California.

RESULTS: Except for income inequality, greater disadvantage for each socioeconomic variable was statistically significantly associated with more advanced stage, higher grade, higher-risk subtypes, and poorer survival in both states. Synthetic and actual results for California were consistent in direction and statistical significance, but the synthetic data tended to overestimate associations with stage and underestimate associations with grade, subtype, and survival.

CONCLUSION: Our results indicate that residence in more disadvantaged census tracts is associated with poorer breast cancer prognosis and outcomes. Associations were similar across two large, diverse states, and synthetic results approximated actual results for California. Additional work is needed to improve early diagnosis, care, and outcomes for individuals with breast cancer in disadvantaged areas.

PMID:41854767 | DOI:10.1007/s10552-026-02152-1

J Egypt Public Health Assoc. 2026 Mar 19;101(1):8. doi: 10.1186/s42506-026-00214-5.

ABSTRACT

BACKGROUND: The Palestinian healthcare system has historically relied on referrals of patients to health facilities across Palestine’s borders. Patients referred typically suffered from chronic conditions or congenital anomalies for which the governmental health facilities in Palestine lacked treatment or diagnostic options. The ongoing Israeli genocide on the Palestinian population has destroyed much of the health system and facilities in Gaza and caused tens of thousands of traumatic injuries that need referral abroad, on top of the cohort of patients with chronic conditions and congenital anomalies.

FINDINGS: Statistics published by the WHO-oPt show that 7,841 patients have been allowed medical evacuation and referral from Gaza between the start of the war in October 2023 and 29 September 2025. About two-thirds of all patients (n = 5,000. 63.8%) were medically evacuated before the Israeli military forces occupied the Rafah border crossing with Egypt on 7 May 2024, and 1,702 (21.7%) patients were evacuated between 19 January 2025 and 17 March 2025 as part of the ceasefire agreement. Egypt has received the majority of patients (n = 3,995, 51%) who have been medically evacuated. Excluding the two periods mentioned, a clear Israeli policy emerged since occupying the Rafah border crossing, which weaponized healthcare by preventing patients from Gaza from being medically evacuated to travel abroad to receive life-saving healthcare.

CONCLUSIONS: The Israeli policy of weaponizing the referrals and medical evacuations has resulted in excess mortality that merits further research and quantification, as patients succumbed to their medical conditions or injuries while waiting to exit Gaza. Action needs to be taken by host countries to step up their efforts to receive more patients from Gaza and put more pressure on Israel to facilitate the safe evacuation process of these patients.

PMID:41854766 | DOI:10.1186/s42506-026-00214-5

Int Ophthalmol. 2026 Mar 19;46(1):166. doi: 10.1007/s10792-026-04037-3.

ABSTRACT

PURPOSE: To leverage a novel Data Integration Centre (DIC) infrastructure and real-world data to analyze pandemic-driven changes in the incidence, demographics, and management of corneal ulceration (H16.0) in a tertiary care setting.

METHODS: We conducted a retrospective single-center analysis of 3029 cases (2016-2024), stratified into pre-pandemic, pandemic, and post-pandemic periods. Data were sourced via the institutional DIC. We employed descriptive statistics and regression models to evaluate temporal trends, age/sex distributions, length of stay (LOS), and surgical interventions.

RESULTS: A significant structural shift from inpatient to outpatient care was observed, with outpatient cases rising by 70% during the pandemic while inpatient numbers declined. A notable demographic shift occurred, with a higher proportion of younger male patients (aged 30-40) affected during and after the pandemic. Mean LOS decreased progressively from 6.27 (pre-pandemic) to 4.13 days (post-pandemic). Despite an overall decline in surgical procedures, the rate of keratoplasties per 1000 patients increased significantly in the post-pandemic phase.

CONCLUSION: The COVID-19 pandemic precipitated a marked restructuring of care for corneal ulcers towards outpatient management and was associated with a distinct demographic shift. The increase in keratoplasty rates for the diagnosis of corneal ulcer after the pandemic could be due to a significantly changed local care structure during the pandemic and the prioritization of follow-up treatment for more difficult cases. This study demonstrates the practical utility of DIC-derived real-world data for health services research, providing robust evidence on evolving care patterns and disease burden.

CLINICAL TRIAL REGISTRATION NUMBER: The study was approved by the Ethics Committee of the Saxony Medical Association under reference number EK-BR-102/23-1 in accordance with the ICH-GCP-Guidelines.

PMID:41854745 | DOI:10.1007/s10792-026-04037-3

Int J Prosthodont. 2026 Mar 19;0(0):1-19. doi: 10.11607/ijp.9690. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate enamel composition in teeth with high wear (HW) and no wear (NW).

MATERIALS AND METHODS: One hundred and eighty-four teeth embedded in polymerized blocks, were assessed using the MolWear system. Specimens were imaged with a Zeiss Gemini 300 field emission SEM and analyzed via energy dispersive X-ray spectrometry. Weight percentages of calcium (Ca), phosphorus (P), sodium (Na), carbon (C), and oxygen (O) were measured. Measurements were taken on lateral enamel to avoid occlusal wear interference.

RESULTS: Eight molars with composite score zero (NW) and 12 molars with composite score >20 (HW) were analyzed. Means and standard deviations for Ca, P, O, C, and Na were calculated for outer, middle, and inner enamel layers. Two-way ANOVA with Tukey-adjusted post hoc tests showed the Ca in the outer region was greater than in the inner region for both the HW and LW cohorts. It also showed that the Na increased from the outer to the inner layer of the enamel in both cohorts. The statistical difference in the Ca and Na cohorts was between the inner and outer range not between the HW and LW. One sample in the NW cohort showed evidence of demineralization.

CONCLUSION: In the teeth evaluated there were no significant differences between the HW cohort and the NW cohort with respect to calcium, phosphorus, carbon, oxygen, and sodium content. Only one sample showed evidence of demineralization, and it was in the no wear cohort.

PMID:41854720 | DOI:10.11607/ijp.9690

Fam Med. 2025 Nov;57(10):732-736. doi: 10.22454/FamMed.2025.195277.

ABSTRACT

BACKGROUND AND OBJECTIVES: This study explored the influence of adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) on coping mechanisms among medical students. It aimed to determine the association between ACE and BCE scores and their impact on coping behaviors, recognizing the potential for interventions to promote healthier coping strategies.

METHODS: We used data collected from the Texas Tech University Health Sciences Center School of Medicine P3-1 Honors Project Omnibus Survey among preclinical medical students. Participants self-reported ACE and BCE scores, along with the frequency and perceived effectiveness of both healthy and unhealthy coping mechanisms.

RESULTS: The analysis showed a significant negative correlation between ACE and BCE scores, indicating that higher ACE scores corresponded to lower BCE scores. Social support emerged as the most common healthy coping mechanism, while self-blame stood out as the predominant unhealthy coping strategy. Additionally, we found statistically significant associations between BCE scores and the use of coping strategies such as spiritual support, self-blame, and isolation.

CONCLUSIONS: Findings imply that high ACE scores correlate with impulsive behaviors. Conversely, high BCE scores are associated with lower tendencies for self-blame, isolation, and impulsive activities, suggesting protective factors. The study underscores the need for interventions to foster healthy coping mechanisms, particularly for individuals with high ACE scores.

PMID:41854707 | DOI:10.22454/FamMed.2025.195277

Fam Med. 2025 Nov;57(10):727-731. doi: 10.22454/FamMed.2025.954255.

ABSTRACT

BACKGROUND AND OBJECTIVES: Artificial intelligence (AI) tools have potential utility in multiple domains, including medical education. However, educators have yet to evaluate AI’s assessment of medical students’ clinical reasoning as evidenced in note-writing. This study compares ChatGPT with a human proctor’s grading of medical students’ notes.

METHODS: A total of 127 subjective, objective, assessment, and plan notes, derived from an objective structured clinical examination, were previously graded by a physician proctor across four categories: history, physical exam, differential diagnosis/thought process, and treatment plan. ChatGPT-4, using the same rubric, was tasked with evaluating these 127 notes. We compared AI-generated scores with proctors’ scores using t tests and χ2 analysis.

RESULTS: The grades assigned by ChatGPT were significantly different than those assigned by proctors in history (P<.001), differential diagnosis/thought process (P<.001), and treatment plan (P<.001). Cohen’s d was the largest for treatment plan at 1.25. The differences led to a significant difference in students’ mean cumulative grade (proctor 23.13 [SD=2.84], ChatGPT 24.11 [SD 1.27], P<.001), affecting final grade distribution (P<.001). With proctor grading, 81 of the 127 (63.8%) notes were honors and 46 of the 127 (36.2%) were pass. ChatGPT gave significantly more honors (118/127 [92.9%]) than pass (9/127 [7.1%]).

CONCLUSIONS: When compared to a human proctor, ChatGPT-4 assigned statistically different grades to students’ SOAP notes, although the practical difference was small. The most substantial grading discrepancy occurred in the treatment plan. Despite the slight numerical difference, ChatGPT assigned significantly more honors grades. Medical educators should therefore investigate a large language model’s performance characteristics in their local grading framework before using AI to augment grading of summative, written assessments.

PMID:41854706 | DOI:10.22454/FamMed.2025.954255

J Exp Psychol Learn Mem Cogn. 2026 Mar 19. doi: 10.1037/xlm0001589. Online ahead of print.

ABSTRACT

Statistical learning is the process of extracting regularities from the environment. Although sequential cross-modal regularities are ubiquitous (e.g., the sight of a falling ball followed by the sound of impact), previous research has failed to demonstrate that such learning occurs between sensory modalities. This has led to the view that sequential statistical learning is modality specific. The present study investigates factors that may determine statistical learning of cross-modal sequences. In the first experiment, participants viewed a stream of meaningless visual fractals and synthetic auditory stimuli. The sequence of stimuli could be grouped into either unimodal or cross-modal pairs based on their transitional probabilities. Using implicit and explicit measures of learning, we found that participants learned only the unimodal pairs. In the second experiment, pairs were presented in separate unimodal and cross-modal blocks. The cross-modal blocks alternated between visual and auditory modalities, allowing participants to anticipate the upcoming modality. This manipulation enabled significant implicit statistical learning for the cross-modal pairs. This suggests that the predictability of modality transitions facilitates appropriate deployment of attention across sensory modalities, which is crucial for learning cross-modal sequential contingencies. In the third experiment, we used audiovisual stimuli with semantic content. Here, participants were able to implicitly learn and explicitly recognize statistical regularities between cross-modal pairs even when the upcoming modality was unpredictable. Together, these findings challenge the view that sequential statistical learning is strictly modality specific, showing that it occurs when sensory-level limitations are bypassed by attentional cues or when learning engages higher level semantic representations shared across modalities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:41854691 | DOI:10.1037/xlm0001589

Res Q Exerc Sport. 2026 Mar 19:1-11. doi: 10.1080/02701367.2026.2619085. Online ahead of print.

ABSTRACT

This cross-sectional study involved secondary data analysis to: (1) examine relationships between psychosocial factors (autonomous motivation for physical activity [PA], PA self-efficacy, social support for PA) and various levels of PA intensity (light PA [LPA], moderate PA [MPA], vigorous PA [VPA]), and moderate-to-vigorous PA [MVPA]) in adolescents aged 10-14 years in the U.S.; and (2) investigate the influence of demographic, physiological, and activity-related characteristics (age, sex, race/ethnicity, body mass index [BMI], annual family income, cardiorespiratory fitness [CRF; estimated maximal oxygen uptake: VO2 max], current sports or cheerleading team participation, and non-sport PA program participation) on various PA intensities. In 2022-2024, adolescents completed demographic and psychosocial surveys and wore accelerometers to assess PA. Of 935 adolescents enrolled, 623 (66.6%) provided valid accelerometer data (≥4 days). Structural equation modeling was used. MPA, VPA, and MVPA were positively associated with male sex, higher CRF, and sports or cheerleading team participation. Age and BMI z-score were negative predictors of MVPA and VPA. MPA was negatively associated with age, and LPA was negatively associated with annual family income. Social support for PA predicted autonomous motivation for PA and PA self-efficacy. Indirect effects of social support on the various levels of PA intensity via autonomous motivation or PA self-efficacy were not significant. Strengthening social support for PA may enhance adolescents’ autonomous motivation for PA and PA self-efficacy to help them increase PA. However, indirect effects on the PA levels were not statistically significant. Findings underscore the promise and limitations of psychosocial pathways.ClinicalTrials.gov Identifier NCT04213014.

PMID:41854685 | DOI:10.1080/02701367.2026.2619085

Clin Psychol Psychother. 2026 Mar-Apr;33(2):e70260. doi: 10.1002/cpp.70260.

ABSTRACT

OBJECTIVE: This study conducted a preliminary naturalistic effectiveness evaluation of Individualised Metacognitive Therapy (MCT+) delivered via videoconferencing for individuals with bipolar I disorder (BD-I) in a real-world clinical setting in Chile. It also explored how therapist characteristics-specifically mentalisation capacity-influence the therapeutic alliance in digital psychotherapy.

METHODS: A longitudinal quantitative case series design was implemented across 14 therapist-patient dyads. Patients received 12 weekly sessions of MCT+ online. Standardised measures assessed anxiety (GAD-7), depression (PHQ-9), metacognitive beliefs (MCQ-30), psychological distress (CORE-10) and quality of life (WHOQOL-BREF). Therapeutic alliance was tracked session-by-session (WAI-S). Therapist mentalisation and attachment were evaluated at baseline (MASC-SP, RFQ-8, ECR-12). Changes in outcome measures were analysed using paired t-tests, effect sizes (Cohen’s d), correlations, reliable change indices (RCI) and hierarchical linear modelling (HLM).

RESULTS: Across the intervention, there were significant decreases in anxiety (d = 0.64) and improvements in metacognitive beliefs (d = 0.37). Depression showed a modest improvement (d = 0.34), while changes in quality of life were negligible (d = -0.21). Hierarchical modelling indicated a significant interaction between automatic and controlled mentalisation (b = -0.45, p = 0.008), suggesting that flexible adjustment supported therapeutic alliance development. Attachment style showed no significant associations with the alliance (largest unadjusted effect: ρ = -0.54, p = 0.073; all adjusted ps > 0.99).

CONCLUSIONS: Digital MCT+ showed preliminary effectiveness in reducing anxiety and maladaptive metacognitive beliefs among individuals with BD-I, with more limited effects on depression and quality of life. Importantly, therapist mentalisation flexibility-the capacity to shift between automatic and controlled modes, or the mentalisation switch-emerged as a central mechanism for alliance building and engagement in digital contexts, highlighting a key target for clinical training and future research.

PMID:41854642 | DOI:10.1002/cpp.70260