Category: Statistics

Front Hum Neurosci. 2026 Jul 16;20:1832178. doi: 10.3389/fnhum.2026.1832178. eCollection 2026.

ABSTRACT

BACKGROUND: Insomnia is a prevalent and burdensome condition in primary care, associated with impaired functioning, increased health risks, and suffering. Infra-slow neurofeedback (ISF-NF) has been proposed as an intervention for stress-related sleep dysregulation, yet empirical evidence from primary care remains scarce.

OBJECTIVE: To examine the feasibility, acceptability, and preliminary effects of ISF-NF for insomnia in primary care using a single-case experimental design.

METHODS: A single-case experimental design with repeated measures was applied. Ten patients with insomnia and related comorbidities (e.g., stress-related exhaustion, migraine, anxiety) were enrolled. Nine completed the intervention, and eight had sufficient data for analysis following a 2-week baseline and 12 weekly ISF-NF sessions with individualized adjustment of the temporal integration (frequency) parameter. Subjective sleep quality was assessed daily using the Brief Self-Reported Sleep Quality Assessment (BSRSQA). Standardized questionnaires including the Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) were collected at baseline, post-intervention, and 3-month follow-up. Treatment effects were evaluated using visual analysis and non-parametric Tau-U statistics. Wearable sleep data (Fitbit Inspire 3) were analyzed descriptively to contextualize subjective outcomes.

RESULTS: Visual single-case analyses revealed heterogeneous but interpretable trajectories, with several participants showing improved perceived sleep quality. Five of eight participants demonstrated statistically significant Tau-U effects (p < 0.05). Group-level analyses showed reductions in sleep problems (PSQI) and depressive symptoms (PHQ-9) from pre to post-intervention, with partial return toward baseline at three-month follow-up. Wearable sleep metrics indicated variability and limited convergence with total sleep time but suggested improvements in sleep consolidation and timing in some cases. Feasibility and acceptability were supported by high treatment adherence, therapeutic alliance, and few reported adverse effects.

CONCLUSION: These findings suggest that ISF-NF may be a feasible and well-tolerated intervention in a primary care context, with preliminary indications of benefit in a subset of individuals. Effects were heterogeneous and should be interpreted cautiously. Individualized parameter adjustment and visual single-case analysis may provide a useful framework for capturing treatment dynamics in adaptive interventions. Wearable sleep data may offer contextual information but should be interpreted alongside subjective outcomes. Controlled studies are needed to evaluate efficacy and underlying mechanisms.

PMID:42534695 | PMC:PMC13422157 | DOI:10.3389/fnhum.2026.1832178

J Trop Med. 2026 Jul 30;2026:6520515. doi: 10.1155/jotm/6520515. eCollection 2026.

ABSTRACT

BACKGROUND AND AIMS: This study evaluated in vitro antigiardial activity in 16 Indonesian plants extracted in methanol, methanol-tetrahydrofuran (1:1), and water. These plants exhibiting promising antiparasitic activity were selected on the basis of collected behavioral data and the ability of these plants to decrease parasite load in Sumatran orangutans.

METHODS: Plant extracts of different concentrations (0.15625-10 mg/mL) and metronidazole (100 μg/mL), a standard antigiardial drug, were incubated with 10⁵ trophozoites per milliliter of growth medium in 96-well tissue culture plates under anaerobic conditions for 24 h. Cultures were counted in a hemocytometer using a light microscope and then statistically evaluated.

RESULTS: All tested plants were found to be effective to some extent against Giardia intestinalis trophozoites, with eight of them having never been previously tested for any biological activity nor probably used in ethnomedicine (as far as we know).

CONCLUSION: Our results show that these extracts have potential as an alternative treatment of enteric diseases caused by G. intestinalis and confirm the assumption that orangutans use these plants for self-medication.

PMID:42534676 | PMC:PMC13421921 | DOI:10.1155/jotm/6520515

Qatar Med J. 2026 Jun 10;2026(2):30. doi: 10.5339/qmj.2026.30. eCollection 2026.

ABSTRACT

BACKGROUND: Safe perioperative transfer of patients with potential spinal cord injury (SCI) is essential to prevent secondary neurological damage. Targeted training of operating room nurses (ORNs) is critical for ensuring adherence to best-practice transfer techniques.

OBJECTIVES: To determine the effect of a scenario-based training intervention on knowledge and self-reported practices of ORNs regarding safe perioperative transfer of patients with potential SCI.

METHODS: This survey-based pre- and post-intervention study was conducted at Hamad General Hospital, Doha, Qatar, between January and March 2024. A structured self-administered questionnaire was administered to ORNs before and after a targeted training intervention. Variables included preferred transfer device, number of staff required, leadership during transfer, hand positioning, and command sequence. Descriptive statistics and McNemar’s test were used for analysis.

RESULTS: A total of 138 ORNs participated (mean age, 37.6 ± 6.2 years; 68% female). Use of plastic boards increased from 88% (n = 122) to 93% (n = 128) post-intervention (P < 0.05). Compliance with the recommended four-person log-roll team improved from 67% (n = 92) to 79% (n = 109). Reliance on anesthetists for transfer leadership increased from 41% to 58%, while inappropriate reliance on other staff decreased from 33% to 28%.

CONCLUSION: A targeted scenario-based training intervention significantly improved ORNs’ knowledge and self-reported adherence to safe perioperative transfer practices for patients with potential SCI.

PMID:42534675 | PMC:PMC13421393 | DOI:10.5339/qmj.2026.30

Front Neurosci. 2026 Jul 16;20:1871045. doi: 10.3389/fnins.2026.1871045. eCollection 2026.

ABSTRACT

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is associated with neurodevelopmental impairments, including listening difficulties not always explained by peripheral hearing loss, suggesting alterations at the level of neural auditory processing. The frequency-following response (FFR) provides an objective measure of neural speech encoding and may offer insight into auditory function in this population.

METHODS: Twenty-five normal-hearing participants were included: 11 individuals with FASD and 14 controls. Speech-evoked FFRs were recorded using a 160 ms /da/ stimulus at 80 dB SPL with a stimulation rate of 4.35/s. Pitch tracking, stimulus-response correlation, response latency, and signal quality were analyzed using non-parametric statistics. Given the exploratory nature of the study and uncontrolled demographic variables – including a significant age difference between groups – findings should be interpreted as preliminary and hypothesis-generating.

RESULTS: Compared to controls, individuals with FASD showed reduced pitch-tracking consistency and lower stimulus-response correlation, with the most robust finding being a large-effect reduction in F0-range correlation (R[70-120 Hz]: p < 0.001, rank-biserial r = 0.823). Prolonged latencies were observed across multiple response components, and signal-to-noise ratio tended to be lower in the FASD group.

CONCLUSION: This exploratory proof-of-concept study provides preliminary evidence of altered neural speech encoding in individuals with FASD despite normal peripheral hearing. Given uncontrolled confounds, observed differences cannot be specifically attributed to FASD. These findings establish the feasibility of FFR in this population and provide the empirical foundation for future controlled research on auditory biomarkers and intervention monitoring in FASD.

PMID:42534674 | PMC:PMC13422169 | DOI:10.3389/fnins.2026.1871045

J Exp Orthop. 2026 Jul 30;13(3):e70861. doi: 10.1002/jeo2.70861. eCollection 2026 Jul.

ABSTRACT

PURPOSE: Whether medially congruent (MC) total knee arthroplasty (TKA) provides clinically meaningful advantages over posterior-stabilized (PS) designs remains controversial. In this randomized trial, early recovery profiles and 2-year outcomes were compared between Persona® MC and PS TKA.

METHODS: In this triple-blinded randomized controlled trial, 82 patients undergoing primary TKA for Kellgren-Lawrence Grade IV osteoarthritis were allocated to receive a Persona® MC or PS system. The primary endpoint was Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living (KOOS-ADL). Secondary outcomes included range of motion, visual analogue scale (VAS) pain, Forgotten Joint Score-12 (FJS-12), satisfaction and complications. Follow-up was 2 years. Group, time and group × time interaction were assessed using repeated-measures models.

RESULTS: Both groups improved over time. Significant group × time interactions were observed for ROM, VAS pain, KOOS-ADL and FJS-12, indicating different recovery profiles. MC knees had greater flexion at 2 weeks (95.3° vs. 83.9°, p < 0.001), and flexion contracture at 2 weeks was observed only in the PS group (0/41 vs. 4/41). Conversely, PS patients reported lower pain scores at 2 weeks (4.75 vs. 6.17, p < 0.001) and 6 weeks (1.92 vs. 2.97, p < 0.001). Later flexion favoured PS, including at 2 years (118.8° vs. 113.9°, p < 0.001). MC patients reported statistically higher KOOS-ADL and FJS-12 scores at 1 and 2 years; however, between-group differences did not exceed established minimum clinically important difference thresholds. Satisfaction was high in both groups and complications were infrequent.

CONCLUSION: Persona® MC and PS TKA showed different recovery profiles rather than clear superiority of either design. MC-TKA was associated with better early flexion and fewer observed early flexion contractures, whereas PS TKA was associated with lower early postoperative pain and greater flexion at later follow-up. MC showed statistically higher KOOS-ADL and FJS-12 scores, but these differences remained below minimum clinically important difference thresholds. Both designs provided substantial 2-year improvement without clinically meaningful between-group differences in patient-reported outcomes.

LEVEL OF EVIDENCE: Level I.

PMID:42534647 | PMC:PMC13420843 | DOI:10.1002/jeo2.70861

Cureus. 2026 Jun 30;18(6):e111801. doi: 10.7759/cureus.111801. eCollection 2026 Jun.

ABSTRACT

Periprosthetic distal femur fractures (PDFFs) are challenging injuries that commonly affect elderly patients following total knee arthroplasty (TKA). The commonly used surgical interventions are distal femoral replacement (DFR) and open reduction and internal fixation (ORIF), although the best approach remains debatable. This study aimed to evaluate the different ORIF subtypes and compare DFR versus ORIF for the management of PDFFs. This study was conducted in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with International Prospective Register of Systematic Reviews (PROSPERO). A comprehensive search was conducted across various databases up to October 2025. This study included only cohort studies comparing various surgical management approaches. Primary outcomes included functional scores (Knee Society Score (KSS)/Knee Society Function Score (KSFS)/Oxford Knee Score (OKS)), reoperation, and range of motion (ROM). Risk of bias and methodological quality were assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool. Fifteen retrospective comparative studies involving 1,417 patients were included. Pooled analysis demonstrated a statistically significant reduction in reoperation rates favoring DFR (OR = 0.64; 95% CI: 0.42-0.97). One-year mortality showed a non-significant trend favoring DFR (OR = 0.70; 95% CI: 0.45-1.09). Infection rates were slightly higher in the DFR group without statistical significance (OR = 1.39; 95% CI: 0.61-3.18). No significant differences were observed in perioperative and functional outcomes between the two interventions. DFR allowed earlier full weight-bearing and mobilization, whereas ORIF required protected weight-bearing protocols. Compared with ORIF in PDFFs, DFR was associated with a reduced risk of reoperation and earlier postoperative mobilization. Mortality and functional outcomes remained comparable between the two interventions. Treatment selection should be individualized, with ORIF appropriate for reconstructible fractures with stable implants and DFR reserved for patients in whom fixation is unlikely to succeed or protected weight-bearing is unrealistic; all findings should be interpreted cautiously given the retrospective evidence base.

PMID:42534630 | PMC:PMC13420835 | DOI:10.7759/cureus.111801

Front Endocrinol (Lausanne). 2026 Jul 16;17:1893897. doi: 10.3389/fendo.2026.1893897. eCollection 2026.

ABSTRACT

INTRODUCTION: The influence of physical activity on outcomes of assisted reproductive technology (ART) remains incompletely understood, with conflicting evidence regarding the impact of exercise intensity and frequency. This study aimed to evaluate the association between self-reported physical activity and reproductive outcomes in patients undergoing ART.

METHODS: This retrospective single-center cohort study included 2,576 patients undergoing 6,850 ART cycles with embryo transfer between 2000 and 2021. Patients were categorized according to self-reported weekly physical activity as no regular exercise (Group A), exercise 1-2 times per week (Group B), and exercise ≥3 times per week, including competitive athletes (Group C). The primary outcome was cumulative live birth rate per oocyte pick-up (OPU), including fresh and frozen embryo transfers within one year following OPU. Secondary outcomes included cumulative pregnancy rate, pregnancy rate per embryo transfer, live birth rate per transfer, miscarriage rate, and number of oocytes retrieved.

RESULTS: Patients exercising 1-2 times weekly demonstrated the most favorable reproductive outcomes. Pregnancy rate per embryo transfer was highest in Group B (34.8%) compared with Group A (32.5%) and Group C (29.7%, p<0.005). Similarly, live birth rate per transfer was higher in Group B (25.6%) than in Groups A (23.0%) and C (22.4%, p<0.05). Cumulative pregnancy rate per OPU was highest in Group B (58.7%) compared with Group A (52.5%) and Group C (49.5%, p<0.001). Cumulative live birth rate per OPU was also higher in Group B (43.1%) compared with Group A (37.2%) and Group C (37.1%, p<0.01).

DISCUSSION: Moderate physical activity was associated with more favorable ART outcomes, including higher cumulative pregnancy and live birth rates, compared with both no regular exercise and high levels of physical activity. These findings suggest that moderate exercise may represent a beneficial lifestyle factor for patients undergoing ART and may support individualized patient counseling.

PMID:42534628 | PMC:PMC13421417 | DOI:10.3389/fendo.2026.1893897

Qatar Med J. 2026 Jun 10;2026(2):29. doi: 10.5339/qmj.2026.29. eCollection 2026.

ABSTRACT

BACKGROUND: Abdominoplasty, although classified as a clean elective procedure, carries a meaningful risk of surgical site infection (SSI), with reported SSI rates varying depending on patient factors and procedural complexity.

OBJECTIVE: To describe SSI incidence and associated risk factors after abdominoplasty at a Qatari tertiary facility, and to assess compliance with prophylaxis practices, antibiotic consumption, and costs.

METHODS: Retrospective cohort of all abdominoplasties at The Cuban Hospital, from January 1, 2022, to July 31, 2025 (N = 323). Data included demographics, comorbidities, perioperative glucose monitoring, procedure characteristics, and antibiotic use (prophylactic and therapeutic). The cohort comprised both simple abdominoplasties and combined procedures performed with additional interventions such as liposuction or hernia repair. SSI rates were analyzed using relative risk, 95% confidence intervals, and statistical tests with significance at P < 0.05.

RESULTS: A total of 323 patients underwent abdominoplasty with a mean age of 40.5 years (SD, 9.8; range, 19-63 years). The majority were female (276 patients, 85.4%), and 13.9% (45 patients) had a history of diabetes mellitus. Overall SSI incidence was 5.3% (17/323), highest in 2025 (8/112; 7.1%). Combined abdominoplasty had a higher SSI rate than simple procedures (10.4% [5/48] vs. 4.4% [12/275]; RR, 2.36 [95% CI, 0.88-6.35]). SSI was more frequent with diabetes (11.1% [5/45] vs. 4.3% [12/278]), overweight/obesity (7.3% [12/151]/4.3% [5/112] vs. 0% [0/42]), and higher postoperative glucose (mean: 7.97, standard deviation: 1.99; P = 0.04). Adherence to antibiotic prophylaxis was high for timing/selection/dose, but discontinuation beyond 24 hours and 7-day discharge prescriptions were common. Antibiotic consumption and costs were higher in SSI cases (355.9 vs. 280.5 DDD/100; 2807.6 vs. 2180 QR/100; P = 0.45; P = 0.72).

CONCLUSION: SSI incidence after abdominoplasty was modest but increased with combined procedures and poorer postoperative glycemic control. Strengthening perioperative glucose protocols and enforcing 24-hour prophylaxis limits may reduce SSI and unnecessary antimicrobial use and costs.

PMID:42534619 | PMC:PMC13421423 | DOI:10.5339/qmj.2026.29

Front Sociol. 2026 Jul 16;11:1842865. doi: 10.3389/fsoc.2026.1842865. eCollection 2026.

ABSTRACT

PURPOSE: Youth unemployment remains one of the most pressing socioeconomic challenges in fragile and conflict-affected contexts such as Somalia, where prolonged instability, weak institutions, and limited labor market opportunities continue to constrain young adults’ access to sustainable employment. In response to these challenges, innovation hubs have emerged as important platforms for skills development, entrepreneurship support, and freelancing opportunities. However, empirical evidence on the relationship between innovation hub initiatives and employment outcomes remains limited. This study examines the association between innovation hub services, specifically skills development and training, entrepreneurship support, and freelancing programs, and young adults’ employment outcomes in Mogadishu, Somalia.

METHODOLOGY: A quantitative cross-sectional research design was employed using primary data collected through a structured online questionnaire. The study focused on young adults who had participated in innovation hub programs, with a sample of 360 respondents selected through purposive sampling. Data were analyzed using SPSS through descriptive statistics, reliability analysis, Pearson correlation, and multiple linear regression to examine the relationships among the study variables.

FINDINGS: The findings reveal that all three innovation hub services are positively and significantly associated with young adults’ employment outcomes. Skills development and training emerged as the strongest predictor, followed by freelancing programs and entrepreneurship support. The results further suggest that participants reported improved employment experiences after engaging in innovation hub programs. The regression model demonstrated a moderate level of explanatory power, indicating that the three predictors jointly account for a meaningful proportion of variation in employment outcomes.

IMPLICATIONS: The study provides important insights for policymakers, educators, and practitioners by highlighting the potential role of innovation hubs in addressing youth unemployment in fragile and conflict-affected settings. Strengthening practical skills training, expanding freelancing opportunities, and supporting entrepreneurship development may enhance employment opportunities for young adults. The findings further support the integration of innovation hubs into broader employment and workforce development strategies in Somalia.

PMID:42534614 | PMC:PMC13422156 | DOI:10.3389/fsoc.2026.1842865

Front Nutr. 2026 Jul 16;13:1831634. doi: 10.3389/fnut.2026.1831634. eCollection 2026.

ABSTRACT

INTRODUCTION: The role of sarcopenia in cancer treatment remains to be fully documented. This umbrella meta-analysis aimed to investigate the impact of sarcopenia on therapeutic outcomes across common malignancies with high incidence or mortality.

METHODS: We conducted an umbrella review of existing meta-analyses based on cohort studies. PubMed, Web of Science, and Embase were systematically searched from inception to October 2025. The primary endpoints were survival outcomes after surgical or first-line treatments. Supplementary meta-analyses were performed for outcomes with insufficient existing evidence. The systematic review protocol was registered in PROSPERO (CRD42022383726).

RESULTS: A total of 59 meta-analyses were included, comprising 49 from the literature search and 10 newly conducted in this study, covering 12 cancer types. In patients undergoing surgery, sarcopenia was significantly associated with shorter overall survival (HR = 1.59, 95% CI: 1.37-1.88) and disease-free survival (HR = 1.64, 95% CI: 1.39-1.93), as well as increased risks of any postoperative complications (OR = 1.48, 95% CI: 1.21-1.81) and major complications (OR = 1.51, 95% CI: 1.30-1.76). In patients receiving first-line non-surgical therapy, sarcopenia remained an independent risk factor for poorer overall survival (HR = 1.49, 95% CI: 1.39-1.61) and progression-free survival (HR = 1.39, 95% CI: 1.17-1.66). The methodological quality of included meta-analyses was generally high, while the GRADE certainty of evidence for most outcomes was rated as low or very low. Sarcopenia was also associated with inferior survival after cancer immunotherapy.

DISCUSSION: Sarcopenia is consistently associated with adverse therapeutic outcomes across multiple cancers and treatment modalities. It warrants attention in clinical management and represents a promising target for improving cancer therapeutic outcomes.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42022383726.

PMID:42534612 | PMC:PMC13421404 | DOI:10.3389/fnut.2026.1831634