Category: Statistics

Alzheimers Dement. 2026 Apr;22(4):e71372. doi: 10.1002/alz.71372.

ABSTRACT

INTRODUCTION: We investigated the association between retirement, age at retirement, and domain-specific cognitive decline.

METHODS: Three hundred twenty-one participants aged 65+ from the Study of Healthy Aging in African Americans completed verbal episodic memory (VEM) and executive function (EF) assessments across three waves (every 16 months). Linear mixed-effects models with random intercepts and slopes examined associations of retirement status (retired, not retired) and timing (retired before age 65, retired at 65+, and not retired) with cognitive decline adjusting for demographics and parental education.

RESULTS: Participants’ mean age was 74.6 ± 6.9, 65% were women, and 87% were retired (33% at age 65+). Retirement status and timing were not associated with baseline cognition. Over 2.11 ± 0.66 years, non-retirees had slower EF decline than retirees (b = 0.11 [0.03, 0.19]). Participants who retired at 65+ had slower VEM decline than those who retired before 65 (b = 0.11 [0.02, 0.21]).

DISCUSSION: Retirement and early retirement were associated with faster cognitive decline among Black/African American adults.

PMID:42043792 | DOI:10.1002/alz.71372

Nurs Educ Perspect. 2026 Apr 27. doi: 10.1097/01.NEP.0000000000001537. Online ahead of print.

ABSTRACT

In this pilot study, which utilized a pretest/posttest design, baccalaureate nursing students used artificial intelligence to generate a case scenario and nursing care plan and analyzed the content for accuracy, bias, and holistic nursing practices. The authors found that students had statistically significant improvements in their perceived ability to identify accurate nursing content, bias, and holistic nursing concepts. This article provides recommendations for nurse educators to improve students’ ability to analyze artificial intelligence-generated content.

PMID:42043776 | DOI:10.1097/01.NEP.0000000000001537

Indian Pediatr. 2026 Apr 27. doi: 10.1007/s13312-026-00340-5. Online ahead of print.

ABSTRACT

OBJECTIVE: This survey was conducted to explore the current status of empyema thoracis management practices of pediatricians in India, as a prelude to developing evidence-based guidelines for managing empyema.

METHODS: A questionnaire examining various aspects of empyema management (diagnosis, investigations, treatment, monitoring and follow-up) was prepared, refined, and pilot-tested. It was disseminated to pediatricians across the country, through a Google form link, using email and a social media platform. Responses were collated, analyzed, and presented with descriptive statistics.

RESULTS: Ninety-four complete responses were received, mostly from pediatricians in teaching/ tertiary-care hospitals. There were significant variations in all aspects of empyema management. There was overuse of computed tomography (CT) scan (27%) and pleural fluid Cartridge Based Nucleic Acid Amplification Test (CBNAAT) (61%) in children with pleural effusion. Whilst > 80% pediatricians used ceftriaxone empirically for pneumonia and empyema, co-amoxiclav (18%), vancomycin (56%), and teicoplanin or linezolid (16%) were also used for empyema. Less than three quarters of respondents used intercostal drainage appropriately. 25% pediatricians routinely used intrapleural fibrinolytic therapy (most often streptokinase); 37% did not use it at all. The common indications were septations/loculations on ultrasonography (57%), thick pus (38%), and persisting clinical features (33%). The duration of antibiotics ranged from < 4 weeks (18%), 4-6 weeks (59%), and > 6 weeks (15%). The indications for surgical referral also varied widely, as did monitoring during therapy, and post-treatment follow-up protocols.

CONCLUSION: There are significant variations in all facets of empyema management amongst pediatricians working in diverse Indian healthcare settings, underscoring the need for evidence-based guideline recommendations.

PMID:42043772 | DOI:10.1007/s13312-026-00340-5

Ophthalmol Ther. 2026 Apr 27. doi: 10.1007/s40123-026-01381-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Keratoconus (KC) is a progressive corneal disorder caused by impaired biomechanical integrity, leading to geometric deformation. Although corneal changes are well characterized, iris structural alterations across KC stages remain poorly studied. Accordingly, this study aims to compare quantitative iris characteristics among healthy controls and patients with different stages of KC.

METHODS: This retrospective cross-sectional study included 547 eyes: 497 from 264 keratoconus subjects classified according to the Topographic Keratoconus Classification (TKC) system as subclinical (n = 102), early stage (n = 219, TKC 1-2), and late-stage (n = 176, TKC 3-4), and single eyes from 50 healthy emmetropic controls. Anterior segment imaging was performed using Pentacam Scheimpflug tomography. Iris segmentation was achieved using a semi-automated Python-based pipeline incorporating the Segment Anything Model, followed by extraction of the anterior iris boundary. The iris was subdivided into basal, mid-iris, and pupil-edge regions. Region-specific geometric parameters, including curvature, arc length, and area under the curve (AUC), were computed using spline-based fitting and numerical integration. Group comparisons were conducted using one-way analysis of variance with false discovery rate correction, followed by age-adjusted analysis of covariance.

RESULTS: Mean basal and mid-iris curvature showed significant overall differences across TKC stages, with a progressive reduction from healthy controls to late-stage KC (p = 0.01 and p < 0.001, respectively). In contrast, pupil-edge curvature showed an opposite trend, with the highest values in late-stage KC (p = 0.02). Iris arc length did not differ significantly between groups, whereas AUC exhibited a region-specific difference limited to the pupil-edge iris (p = 0.02). These findings remained statistically significant after age adjustment.

CONCLUSIONS: Increased pupil-edge curvature in KC represents a geometric alteration that may be clinically relevant in eyes undergoing intraocular surgery, particularly in relation to anterior chamber dynamics and potential susceptibility to postoperative pupillary block. Conversely, mid-iris straightening may reflect structural variation within the iris in late-stage disease. Together, these findings suggest that corneal geometric changes in KC may be associated with subtle alterations in anterior chamber mechanical environment, potentially contributing to secondary changes in iris configuration.

PMID:42043741 | DOI:10.1007/s40123-026-01381-6

Environ Monit Assess. 2026 Apr 27;198(5):508. doi: 10.1007/s10661-026-15390-2.

ABSTRACT

This study analyzes the spatial dominance and regional differentiation of forest, agricultural, and water surface areas across Türkiye’s NUTS-2 regions for the period 2000-2024. Land use data were compiled from nationally authoritative sources and standardized in hectares to ensure interregional comparability. Spatial concentration patterns were evaluated using the location quotient (LQ) method, while principal component analysis (PCA), and cluster analysis were employed to identify structural dimensions and regional typologies. Results indicate a pronounced decline in agricultural dominance, contrasted with a relatively stable yet regionally differentiated structure of forest areas. Water surfaces exhibit localized but significant shifts, particularly in eastern and southeastern regions. PCA findings show that 84.6% of total variance is explained by two components representing the agriculture-forest balance and water surface distribution. Cluster analysis reveals two main regional groupings, with TRB2 displaying a distinct dominance pattern driven by water surfaces. The TR61 region emerges as a balanced land use structure where both agricultural and forest dominance remain comparatively strong. These findings demonstrate that land use dynamics in Türkiye are shaped by region-specific ecological and structural factors rather than uniform national trends. The study provides a quantitative, multidimensional framework for interpreting regional land use transformations and offers policy-relevant insights for sustainable resource management and regional planning.

PMID:42043641 | DOI:10.1007/s10661-026-15390-2

J Mol Neurosci. 2026 Apr 27;76(2):71. doi: 10.1007/s12031-026-02515-y.

NO ABSTRACT

PMID:42043620 | DOI:10.1007/s12031-026-02515-y

Childs Nerv Syst. 2026 Apr 27;42(1):183. doi: 10.1007/s00381-026-07277-x.

ABSTRACT

BACKGROUND: Pediatric neuroradiology faces significant workforce shortages, with teleradiology emerging as a vital solution. However, studies investigating findings and their operational impact from teleradiology centers remain limited.

OBJECTIVES: To develop and validate structural equation models for identifying predictors of turnaround time and formulate recommendations for workflow optimization in pediatric tele-neuroradiology services.

DESIGN: A retrospective cohort study following STROBE guidelines.

SETTINGS: 107 hospitals across 17 states in the United States (US) via a teleradiology platform providing interpretation services through US board-certified radiologists.

PATIENTS AND METHODS: We analyzed 9985 pediatric neuroradiology scans from 7958 patients (January 2023-December 2024). We utilized confirmatory factor analysis to validate findings structures, followed by structural equation modeling to predict turnaround times. Binary logistic regression models were developed with area-under-the-curve (AUC) estimation for performance assessment. Bootstrap validation with 5000 samples ensured model stability.

MAIN OUTCOME MEASURES: Primary outcome was turnaround time. Secondary outcomes included requirements for multiple imaging studies, follow-up recommendations, and consultations.

SAMPLE SIZE: A total of 9985 studies providing over 99% statistical power for detecting significant relationships.

RESULTS: Factor analysis demonstrated a two-factor structure (trauma: α = 0.742, structural: α = 0.685). The structural model explained 7.8% of turnaround time variance, with computed tomography (CT) modality (β = -0.164), trauma score (β = 0.125), and structural score (β = 0.142) as significant predictors. Among immediate neurosurgical emergencies (n = 180, 1.8%), 89.4% achieved turnaround time within the 60-min benchmark for time-sensitive consultations. Prediction models demonstrated excellent discrimination: traumatic findings (AUC = 0.91), structural findings (AUC = 0.92), critical findings (AUC = 0.95), and a dedicated neurosurgical emergency model (AUC = 0.94, NPV = 0.996). A severity classification system showed strong validation against imaging needs (AUC = 0.76) and consultations (AUC = 0.89).

CONCLUSIONS: Our study establishes a validated SEM framework for pediatric tele-neuroradiology with excellent predictive performance (AUC = 0.91-0.95). Among immediate neurosurgical emergencies (n = 180, 1.8%), 89.4% met the 60-min benchmark, and a dedicated emergency prediction model achieved AUC = 0.94. However, translation to improved neurosurgical care delivery and patient outcomes remains unvalidated, representing the next investigational priorities.

LIMITATIONS: Retrospective design limits causal inference; a single platform may limit generalizability; the CT majority (96.8%) limits magnetic resonance imaging conclusions. Critically, post-diagnostic clinical outcomes, including neurosurgical consultations, interventions performed, and patient outcomes, were not tracked, precluding conclusions about whether documented operational efficiency translated to improved neurosurgical care delivery.

PMID:42043602 | DOI:10.1007/s00381-026-07277-x

J Mol Model. 2026 Apr 27;32(5):147. doi: 10.1007/s00894-026-06729-0.

ABSTRACT

CONTEXT: BRAF kinases are involved in cancer cell survival and metastasis. Mutations in BRAF are frequent in several types of cancer, occurring in more than 50% of melanomas, 50-70% of thyroid cancers, 15% of colorectal cancers, and 5-8% of non-small-cell lung cancers. The most prevalent mutation is V600E. Vemurafenib and dabrafenib are two selective BRAF inhibitors approved by the FDA for clinical use. However, due to the increasing resistance to current kinase inhibitors, there is an urgent need to identify new molecular scaffolds with potential BRAF inhibitory activity. In this work, molecular docking, molecular dynamics, and metadynamics simulations were performed on twelve triterpenes to identify the best ligands with potential binding to BRAFWT and BRAFV600E. The interaction profiles of the selected triterpenes revealed key contacts with residues ILE463, THR529, GLN530, TRP531, CYS532, and PHE583, which contribute to stabilizing the conformation of both inhibitors and triterpenes within the catalytic binding site of the proteins. The ΔG of betulinic acid (-57.46 kcal/mol) in complex with BRAFWT is comparable to the BRAF inhibitors vemurafenib-OMe and dabrafenib reported in previous work, the ΔG of β-amyrin (-51.83 kcal/mol) showed a ΔG comparable to the inhibitors with BRAFV600E; moreover, the ΔG of lupeol (-62.43 kcal/mol) and moronic acid (-61.05 kcal/mol) are more favorable with BRAFV600E than vemurafenib-OMe and dabrafenib. These computational calculations allow us to consider these triterpenes as potential candidates for drug design cycles and to optimize the binding profile for the development of new selective inhibitors for BRAFV600E to cancer treatments.

METHODS: Molecular docking calculations using AutoGrid 4.2.6, AutoDockGPU 1.5.3, and AutoDockTools 1.5.6 were performed. Molecular dynamics and metadynamics simulations were performed in the Desmond module of the academic version of the Schrödinger-Maestro 2021-4 program, utilizing the OPLS-2005 force field. Finally, all the protein figures presented in this article were made in the PyMOL program and the RMSD graphics were made in the statistical package R and RStudio 2025.05.1.

PMID:42043592 | DOI:10.1007/s00894-026-06729-0

Eur J Pediatr. 2026 Apr 27;185(5):305. doi: 10.1007/s00431-026-06977-5.

ABSTRACT

Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract infections in early infancy, and the recent introduction of two novel immunoprophylaxis tools-maternal vaccination with the RSVpreF vaccine and infant protection with the long-acting monoclonal antibody nirsevimab-represents a major advancement in RSV prevention. The successful implementation of these strategies depends heavily on pediatricians’ awareness, confidence, and readiness to integrate them into routine clinical practice. Evidence from Southern Europe remains limited. This cross-sectional study assessed the knowledge, attitudes, and practices of pediatricians in Crete, Greece, regarding RSV infection and emerging prevention tools. A structured electronic questionnaire was distributed between April and July 2025 to all board-certified pediatricians and pediatric residents registered with the regional medical associations. Among 169 respondents (mean age 46 ± 12.5 years; 83.4% women), overall knowledge was high, with a mean score of 89.6 ± 10.0. Knowledge gaps were concentrated in areas related to newly introduced immunoprophylaxis tools, including awareness of RSV monoclonal antibody availability for infants, updated recommendations covering infants up to 6 months, and distinctions between palivizumab and nirsevimab. Attitudes toward vaccination were overwhelmingly positive: nearly all participants expressed strong vaccine confidence and adherence to national immunization guidelines. Most pediatricians (78.6%) felt adequately informed about RSV. These findings suggest that pediatricians in Crete possess a strong foundation for integrating new RSV prevention strategies, although targeted educational initiatives-particularly regarding nirsevimab-will be essential to ensure consistent and equitable implementation. The results provide timely insights to support national planning and optimize the rollout of RSV immunoprophylaxis in Greece and comparable settings. What is Known: • RSV is a leading cause of severe respiratory disease in early infancy. • New prevention tools (RSVpreF, nirsevimab) are being introduced into national programs. • Pediatricians’ knowledge and confidence strongly influence vaccine uptake. What is New: • Greek pediatricians show high overall RSV knowledge and strong vaccine confidence. • Specific gaps exist regarding nirsevimab and distinctions between immunoprophylaxis tools. • Findings highlight targeted education needs during early implementation of RSV prevention.

PMID:42043589 | DOI:10.1007/s00431-026-06977-5

Support Care Cancer. 2026 Apr 27;34(5):468. doi: 10.1007/s00520-026-10564-7.

ABSTRACT

PURPOSE: Patients with glioblastoma represent a highly vulnerable cohort as they often experience rapid health deterioration with severe symptom burden including neurological, (neuro)psychological, and psychiatric symptoms. The aim of this sub-analysis of the “Early Palliative Care for Patients with Glioblastoma” (EPCOG) trial was to investigate the specific challenges of conducting a multicenter, randomized, controlled, clinical trial in glioblastoma patients testing a specialized palliative care (PC) intervention.

METHODS: We analyzed screening protocols and protocol deviations with respect to number and reasons for non-participation, skipped/delayed visits and attrition using descriptive statistics and content analysis of free-text comments.

RESULTS: In total, 41.5% of 556 screened patients were enrolled. Main reasons for non-participation were lack of interest (25.7%) and low functional status (11.5%). Attrition due to death (57.6%) was higher than due to illness (5.2%) or other reasons (21.2%). Main reasons for visit deviations were structural issues (in > 50% of neurosurgical visits), health status, and patient request. Protocol deviations showed that specialized PC intervention visits were least frequently skipped (4.5%) compared to study-specific outcome assessment (10.1%) and neurosurgical (43.3%) visits. Further, only 11.0% of the specialized PC intervention visits were delayed compared to 22.3% of the outcome assessment and 56.4% of the neurosurgical visits.

CONCLUSION: In this clinical trial involving glioblastoma patients, a high level of motivation among the study participants could be reached, as reflected by low protocol deviations during the specialized PC intervention and study-specific outcome assessment visits. Reasons for this might be a close guidance as well as a patient and caregiver-oriented communication, e.g., by a personal contact of the PC team in the intervention group, personal outcome assessment visits at patients’ whereabouts, or the inclusion of a study nurse at each site. Considering the high vulnerability of glioblastoma patients is crucial when designing and conducting clinical trials.

PMID:42043583 | DOI:10.1007/s00520-026-10564-7