Category: Statistics

J Environ Qual. 2026 Jan-Feb;55(1):e70147. doi: 10.1002/jeq2.70147.

ABSTRACT

In Germany during several decades, emissions and thus the chemical climate affecting forests have changed significantly. The effects of these changes on the element balance of forests can be documented only by long-term observations, as has been done at the Höglwald site (Southern Bavaria) since 1985. Since then, structural changes in agriculture have led to a reduction in emissions of reduced nitrogen (NH₃). There was also a slight decrease in emissions of oxidized nitrogen (NO_x). Air pollution control measures, especially in the 1980s, led to a particularly drastic reduction of sulfur emissions (SO₂). Consequently, inputs to the ecosystem decreased by almost 95% between 1985 and 2020. Dry deposition nowadays plays practically no role for this element. High nitrogen inputs, dominated by reduced nitrogen, have led to a high proton production through N transformations. This has gradually reduced the buffering capacity of the topsoil. Comparing measured fluxes shows that with decreasing sulfur inputs, the sulfur stored in the topsoil from times of high deposition was remobilized. At the Höglwald, this process occurred rather clearly over a period of about 28 years and has resulted in only about 11% of the initial amount of sulfur being still present in the topsoil (humus layer + mineral soil down to 40 cm) in 2020. Forestry should take the changed chemical conditions into account in its nutrient management.

PMID:41612122 | DOI:10.1002/jeq2.70147

J Gen Intern Med. 2026 Jan 29. doi: 10.1007/s11606-026-10210-2. Online ahead of print.

ABSTRACT

BACKGROUND: Entrustable professional activities (EPAs) have been proposed as a holistic approach to competency-based assessment. The 13 Core EPAs for Entering Residency (CEPAER) are essential tasks that a medical student should be trusted to perform with indirect supervision upon entering residency, based on demonstrated competence.

OBJECTIVE: To study the validity and reliability of workplace-based assessments of the 13 core EPAs as measurements of medical student performance and growth over the Internal Medicine (IM) clerkship.

DESIGN: Correlational-based population study.

PARTICIPANTS: A total of 398 third-year medical students at the University of Minnesota Medical School participated. Students were enrolled in a required 8-week IM clerkship during the 2023-2024 and 2024-2025 academic years. A total of 825 assessors provided EPA ratings with a mean number of 12 per assessor; SD = 15.08.

MAIN MEASURES: There were 10,034 EPA-based assessments collected (mean per student = 25; SD = 6.1). The most frequently assessed EPAs were EPA 6 (Provide an oral presentation of a clinical encounter; n = 1866; mean per student = 4.69), EPA 5 (Document a clinical encounter in the patient record; n = 1662; mean per student = 4.18), and EPA 2 (Recommend and interpret common diagnostic and screening tests; n = 1421; mean per student = 3.57).

KEY RESULTS: Regression analyses indicated statistically significant growth in entrustment scores for EPAs 1, 2, 3, 5, 6, 8, 10, and 12. Generalizability analysis showed that to achieve adequate reliability (Ep2 ≥ 0.80), at least 5 assessments were required to be conducted by 5 raters.

CONCLUSION: EPAs represent a valid and reliable measure for medical student growth during the IM clerkship, particularly for EPAs 1, 2, 3, 5, 6, 8, and 10.

PMID:41612117 | DOI:10.1007/s11606-026-10210-2

Environ Geochem Health. 2026 Jan 29;48(3):122. doi: 10.1007/s10653-026-02989-0.

ABSTRACT

This study investigated the hydrogeochemical characteristics of surface waters in the Congonhas Mineral District (CMD), located in the southern portion of Quadrilátero Ferrífero, Brazil. A total of 38 sites were monitored between 2021 and 2024 to understand seasonal and spatial variability across distinct lithologies and land uses. Hydrogeochemical patterns revealed dominant mixed bicarbonate facies associated with metavolcano-sedimentary terrains, while domains of granitoids exhibited alkali enrichment. Waters under the influence of larger Urban settlements were enriched in Na, Cl, sulfate, and nutrients. By integrating geospatial classification, seasonal sampling, and robust statistical techniques, we investigated the behavior of Fe and Mn, key elements influenced by both natural geological sources and mining activities. Reference values for geochemical background and baseline thresholds, based on samples from preserved and mixed land use areas, respectively, were estimated using three distinct statistical approaches. Among these, the upper tolerance limit (UTL) method was considered the most consistent and suitable. Spatial and seasonal patterns revealed elevated Fe and Mn levels during the rainy season, particularly in areas influenced by mining and urbanization. The proposed reference values provide a realistic basis for identifying contamination, and can give support for more realistic regulatory frameworks, and definition of strategies for water quality management. The obtained results highlight the relevance of tailored guidelines in mining contexts, where reference values adopted by regulatory agencies may not reflect local geochemical conditions.

PMID:41612109 | DOI:10.1007/s10653-026-02989-0

Neurosurg Rev. 2026 Jan 30;49(1):173. doi: 10.1007/s10143-025-04128-2.

ABSTRACT

BACKGROUND: Stent-assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for intracranial bifurcation aneurysms. However, studies comparing FDs and SAC were scarce. Thus, we performed a two-center, propensity score matched (PSM) cohort study to compare the FDs and SAC devices for intracranial bifurcation aneurysms.

METHODS: Consecutive patients with intracranial bifurcation aneurysms were treated with FDs or SAC at two advanced stroke centers were enrolled in the study. Propensity score matching (PSM) was employed to adjust for demographic and aneurysm characteristics. The perioperative and midterm follow-up outcomes were compared between the two devices.

RESULTS: A total of 131 patients with 131 intracranial bifurcation aneurysms were included. After PSM, 66 aneurysms treated with the FDs and SAC were matched (n = 33 in each group). At a median follow-up of 6-7 months, significant differences were observed in procedure time (105.00 min vs. 155.00 min, p < 0.001), rate of complete aneurysm occlusion (60.6% vs. 93.9%, p = 0.001) between the FDs and SAC group. There were no statistical differences in total perioperative complications (3.0% vs. 9.1%, p = 0.302), in-stent stenosis (9.1% vs. 9.1%, p = 1.000), device-related challenges (3.0% vs. 6.1%, p = 0.555) and follow-up mRS score of 3-5 (3.0% vs. 3.0%, p = 1.000) between the FDs and SAC group.

CONCLUSION: Compared with SAC, FDs provide a comparable rate of perioperative and clinical outcomes in unruptured intracranial bifurcation aneurysms. Nevertheless, a better occlusion status in the SAC group needs to be further verified over a longer follow-up period.

PMID:41612108 | DOI:10.1007/s10143-025-04128-2

Clin Rheumatol. 2026 Jan 29. doi: 10.1007/s10067-026-07936-z. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the value of combining chest muscle measurements, spleen density, and immunological serum indicators for predicting the occurrence of interstitial lung disease (ILD) in Sjögren’s syndrome (SS).

METHODS: A retrospective study was performed by SS patients admitted to the First Affiliated Hospital of Henan Medical University from January 2018 to June 2025 and 196 cases were included. Propensity score matching (PSM) was used to balance baseline characteristics, resulting in the Sjögren’s syndrome without interstitial lung disease (SS-NILD, n = 59) and Sjögren’s syndrome-associated interstitial lung disease (SS-ILD, n = 32) groups. Spearman correlation analysis was performed to assess variable relationships, and variance inflation factor (VIF) and tolerance (TOL) to quantify multicollinearity severity. Binary logistic regression was used to build models. The area under the receiver operating characteristic curve (AUC) was used to determine discriminatory ability and DeLong’s test to compare different models. Finally, model performance was assessed through calibration curves, decision curve analysis (DCA), and Bootstrap internal validation, and the contribution of imaging indicators was analyzed.

RESULTS: The occurrence of SS-ILD was associated with reduced spleen density (SD), decreased total pectoral muscle area (T-PMA), decreased right pectoral muscle area (R-PMA), lower CD4⁺T lymphocyte percentage (CD4⁺T%), lower CD4⁺/CD8⁺ ratio, and decreased complement C4 levels. There was significant collinearity between T-PMA and R-PMA, and potential collinearity between CD4⁺T% and CD4⁺/CD8⁺ ratio. Four models were constructed. Validation via calibration and decision curves confirmed that model 1 (T-PMA, SD, CD4⁺T%, and C4) had high predictive accuracy and clinical net benefit (AUC = 0.872, sensitivity = 0.813, specificity = 0.797, 95% CI: 0.800-0.945). Bootstrap internal validation indicated high stability for model 1 and analysis of model 1’s components showed enhanced predictive performance with imaging indicators.

CONCLUSION: Model 1 (T-PMA, SD, CD4⁺T%, and C4) demonstrates potential for the early prediction of SS-ILD and carries substantial clinical translational value. Key Points • Developed a SS-ILD predictive model using pectoral muscle area, spleen density, CD4⁺T cell percentage, and complement C4. • Built via correlation heatmap, collinearity diagnosis, and propensity score matching for bias control, the model includes more indicators than prior studies and has reliable internal validation. • Identified the association of pectoralis muscle cross-sectional area with SS-ILD, and potential links of systemic immune dysregulation, muscle atrophy, splenic involvement to SS-ILD pathogenesis. • Selected indicators are easily accessible, facilitating clinical application and validation.

PMID:41612106 | DOI:10.1007/s10067-026-07936-z

JACC Cardiovasc Interv. 2026 Jan 21:S1936-8798(25)03198-X. doi: 10.1016/j.jcin.2025.12.003. Online ahead of print.

ABSTRACT

BACKGROUND: Right ventricular (RV)-pulmonary arterial (PA) coupling, a measure of RV function in relation to pulmonary afterload, has emerged as a promising prognostic marker in critically ill patients and can be readily assessed using echocardiography.

OBJECTIVES: The aim of this study was to evaluate the prognostic significance of RV-PA coupling in patients presenting with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.

METHODS: This post hoc analysis of a retrospective study analyzed 973 STEMI patients (derivation and validation cohorts) undergoing primary percutaneous coronary intervention between 2014 and 2023 (median follow-up duration 4.2 years; Q1-Q3: 2.1-6.7 years). RV-PA uncoupling was assessed using echocardiography via the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP). Using maximally selected log-rank statistics, a cutoff of 0.405 mm/mm Hg for TAPSE/sPAP ratio was identified, effectively stratifying patients into high- and low-risk groups.

RESULTS: As confirmed in an external validation cohort, patients with RV-PA uncoupling showed significantly higher 1-year all-cause mortality compared with those with preserved RV-PA coupling (33.30% [95% CI: 4.65%-53.40%] vs 3.04% [95% CI: 1.40%-4.65%]; HR for 1-year mortality: 12.60; 95% CI: 4.49-35.40; P < 0.001). TAPSE/sPAP ratio outperformed TAPSE alone in predicting 1-year mortality, as demonstrated by receiver-operating characteristic curve analysis (area under the curve: 0.732 [95% CI: 0.643-0.821] vs 0.643 [95% CI: 0.537-0.732]; P = 0.018). Multivariate analysis confirmed that RV-PA uncoupling independently predicted 1-year mortality.

CONCLUSIONS: This study highlights the importance of hemodynamic equilibrium between the RV and pulmonary circulation in STEMI patients. RV-PA uncoupling (TAPSE/sPAP ratio < 0.405 mm/mm Hg) is an independent predictor of 1-year all-cause mortality in these patients, aiding in early risk stratification.

PMID:41609536 | DOI:10.1016/j.jcin.2025.12.003

JACC Clin Electrophysiol. 2026 Jan 24:S2405-500X(25)01105-3. doi: 10.1016/j.jacep.2025.12.028. Online ahead of print.

ABSTRACT

BACKGROUND: The diagnosis of carotid sinus syndrome requires the reproduction of spontaneous symptoms during carotid sinus massage (CSM) alongside clinical features indicative of a reflex mechanism. In contrast, the significance of asymptomatic asystolic carotid sinus hypersensitivity (CSH) remains uncertain, as it is frequently observed in older adults without syncope.

OBJECTIVES: This study aimed to evaluate the correlation between asymptomatic asystolic CSH and spontaneous events documented via implantable loop recorder (ILR).

METHODS: In this study, 92 reflex syncope patients with an asymptomatic pause >3 seconds during CSM (average 4.9 ± 1.7 seconds) received an ILR and were followed for a median of 23.1 months. The control group consisted of reflex syncope patients with negative CSM drawn from a historical ILR population and matched with the propensity score method to the CSH group based on clinical variables.

RESULTS: During the observation period, 38 (41.3%) CSH patients had recurrence of syncope, which was associated with asystole of 8.0 seconds (95% CI: 5.3-13.5 seconds) in 29 (76.3%) cases. Although the actuarial rate of total syncope recurrence in CSH group was similar to that in the control group (HR: 1.22; P = 0.40), CSH patients showed a higher rate of asystolic syncope (HR: 2.13; P = 0.011) and asystolic pauses (HR: 2.06; P = 0.009).

CONCLUSIONS: Patients with asymptomatic asystolic CSH were more likely to experience spontaneous asystolic syncope than those without CSH. Among CSH patients who experienced a recurrence of syncope documented by an ILR, the positive predictive value of an asystolic pause detected during CSM was 76.3%.

PMID:41609532 | DOI:10.1016/j.jacep.2025.12.028

Int J Dermatol. 2026 Jan 29. doi: 10.1111/ijd.70306. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis is a chronic immune-mediated disease associated with multiple systemic comorbidities. Biologic therapies have transformed the management of moderate-to-severe psoriasis; however, their high cost remains a major barrier for uninsured and socioeconomically disadvantaged individuals. The Psoriasis Biologics Center for Indigent Patients at Jackson Memorial Hospital provides a structured dermatology access model for underserved populations.

METHODS: We conducted a descriptive retrospective cohort study of patients with moderate-to-severe psoriasis receiving biologic therapy through a dedicated safety-net access program between 2005 and 2025. Patient demographics, comorbidities, and management strategies were obtained from electronic medical records and standardized intake questionnaires. Only descriptive statistics were performed; standardized disease severity and quality-of-life measures such as the Psoriasis Area and Severity Index (PASI) or the Dermatology Life Quality Index (DLQI) were not available.

RESULTS: A total of 450 patients (mean age 52.6 years; 54% female) were included. Nearly half (49.8%) presented with at least one systemic comorbidity. The most common were psoriatic arthritis (35.1%), hypertension (31.3%), diabetes mellitus (20%), cardiovascular disease (19.1%), obesity (13.8%), and dyslipidemia (12.2%). Psychiatric comorbidities included depression (9.6%) and anxiety (3.8%). Infectious conditions occurred at higher-than-expected frequencies, including hepatitis B/C (3.8%), latent tuberculosis (3.6%), and human immunodeficiency virus (HIV) (2.7%). Care delivery was organized within a structured safety-net model that incorporated standardized screening protocols, referral pathways, and multidisciplinary coordination to support biological access for uninsured patients.

CONCLUSIONS: This 20-year descriptive cohort characterizes comorbidity burden and biologic access within an indigent psoriasis population. This study does not assess clinical outcomes or treatment effectiveness. These findings describe a care delivery framework that may inform future health system and health equity-focused initiatives.

PMID:41609515 | DOI:10.1111/ijd.70306

Clin Cancer Res. 2026 Jan 29. doi: 10.1158/1078-0432.CCR-25-2916. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the efficacy and safety of poly(ADP-ribose) polymerase inhibitor (PARPi) rechallenge combined with bevacizumab as maintenance therapy in patients with platinum-sensitive recurrent ovarian cancer previously treated with a PARPi.

EXPERIMENTAL DESIGN: KGOG 3056/NIRVANA-R is a multicenter, single-arm, phase II trial that enrolled 44 patients with platinum-sensitive recurrent ovarian cancer who had received ≥2 prior lines of platinum-based chemotherapy and prior PARPi maintenance. Eligible patients achieving a response to the most recent platinum therapy received daily niraparib and triweekly bevacizumab until disease progression or unacceptable toxicity. The primary endpoint was the 6-month progression-free survival (PFS) rate, analyzed using Simon’s two-stage design with adaptive statistical inference.

RESULTS: The primary endpoint was met, with 26 of 44 patients (59.1%) remaining progression-free at 6 months. The estimated 6-month PFS rate was 68% [95% confidence interval (CI), 55%-85%], and the median PFS was 11.5 months [95% CI, 7.9-not reached]. Subgroup analyses suggested greater benefit in patients with a longer treatment-free interval after the penultimate chemotherapy and in those who achieved a complete response to the most recent chemotherapy. Grade ≥3 treatment-related adverse events occurred in 27.3% of patients, with no treatment-related deaths or new safety signals observed.

CONCLUSIONS: This is the first report of PARPi rechallenge with bevacizumab as maintenance therapy in this setting. The combination demonstrated promising efficacy, particularly in patients with favorable platinum responsiveness, and warrants further investigation in biomarker-driven studies.

PMID:41609513 | DOI:10.1158/1078-0432.CCR-25-2916

J Trauma Acute Care Surg. 2026 Jan 29. doi: 10.1097/TA.0000000000004930. Online ahead of print.

ABSTRACT

BACKGROUND: Teaching hospitals serve as referral centers for pediatric trauma care. However, the impact of interhospital transfer on outcomes in pediatric traumatic brain injury (TBI) within urban teaching hospitals remains unclear. Hence, we examined whether transferred pediatric TBI patients to urban teaching hospitals experienced different outcomes from directly admitted patients, hypothesizing that results would be comparable.

METHODS: We conducted a cross-sectional study of pediatric TBI hospitalizations from 2016 to 2021 using the National Inpatient Sample database. Patients were categorized as direct admissions or transfers. Propensity score matching (1:2 with replacement) was performed using demographic, clinical, and hospital-level variables. Outcomes included in-hospital mortality, medical complications, length of stay (LOS), and postdischarge rehabilitation referral.

RESULTS: Out of 28,548 total patients, 15,324 were successfully matched with 7,239 (47.2%) interhospital transfers. Baseline demographics, clinical, and hospital characteristics were well balanced between the two groups (all standardized mean differences <10%). Unadjusted in-hospital mortality was similar between transferred and directly admitted patients (3.6% vs. 3.4%, p = 0.49). However, transferred patients experienced longer LOS (median, 2 days; interquartile range, 1-6; p < 0.001), fewer discharges to rehabilitation (5.7% vs. 6.7%, p < 0.001), and higher complications (deep vein thrombosis, 1.2 vs. 0.9; p = 0.04; urinary tract infection, 1.6 vs. 1.1; p = 0.005). After multivariable adjustment, transfer status was not associated with mortality (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.89-1.28) and rehabilitation discharge (OR, 0.92; 95% CI, 0.80-1.06). However, transfer remained independently associated with longer LOS (OR, 1.31; 95% CI, 1.24-1.39) and higher complications (OR, 1.25; 95% CI, 1.09-1.44).

CONCLUSION: Interhospital transfer was not associated with mortality or rehabilitation discharge among pediatric TBI patients treated at urban teaching hospitals. However, longer LOS and higher complications among transferred patients raise equity and system efficiency concerns. While statistically significant, these differences were modest and may not be clinically meaningful, warranting further research with more granular data.

LEVEL OF EVIDENCE: Original article, cross-sectional study; Level III.

PMID:41609509 | DOI:10.1097/TA.0000000000004930