Category: Statistics

ANZ J Surg. 2026 Jun 4. doi: 10.1111/ans.70728. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite established ethical principles, a critical synthesis of how informed consent deficiencies, leading to costly malpractice lawsuits in elective orthopedic surgery, relate to medico-legal outcomes, documentation pitfalls, and team roles is lacking. This scoping review aimed to investigate the status of obtaining informed consent by the treatment team in elective orthopedic surgeries and the related legal consequences.

METHODS: Following the Arksey & O’Malley framework update by Levac et al., we conducted a comprehensive search across PubMed, Scopus, Web of Science databases, and the Google Scholar search engine. Studies focusing on informed consent, legal factors, and the treatment team in elective orthopedic procedures were included in this review. Data were charted and analyzed using thematic analysis for qualitative synthesis, supplemented by quantitative summary statistics.

RESULTS: Qualitative analysis identified four themes: documentation patterns, legal factors, cultural considerations, and risk mitigation strategies. Findings showed frequent documentation gaps (13%-32% of forms lacked specific complications). Nerve injury was the most common cause of lawsuits (46%-56%). In lumbar fusion, 24% of claims cited failure to obtain consent. US compensation averaged $871 093, vastly exceeding European figures. Patient recall of complications was poor (22.5%) but improved to 48% with written aids.

CONCLUSION: The informed consent process in elective orthopedics faces systematic challenges, including inconsistent documentation, high litigation risk, and inadequate patient understanding. To reduce legal exposure and promote safety, implementing evidence-based, procedure-specific consent forms, interdisciplinary team training, and culturally competent communication is recommended. Addressing these requires coordinated policy reform at institutional and educational levels.

PMID:42241726 | DOI:10.1111/ans.70728

Intern Med J. 2026 Jun 4. doi: 10.1111/imj.70457. Online ahead of print.

ABSTRACT

BACKGROUND: Polymyalgia rheumatica is the commonest inflammatory condition affecting adults over 50 years of age, however it has been under-researched and management varies in everyday clinical practice.

AIM: This national survey of rheumatologists and trainees managing polymyalgia rheumatica (PMR) in Australia sought to determine current diagnostic and management approaches and establish a baseline for future development of a disease-specific clinical care standard.

METHODS: Following ethics approval, an online survey was circulated to the membership of the Australian Rheumatology Association. Relevant demographic information about respondents was collected, along with answers to multiple-choice questions on the clinical presentation, diagnosis, management and prognosis of PMR. Free-text responses were also permitted at the end of each section. The survey remained open between 25 March 2022 and 11 November 2022. Data analysis involved descriptive statistics for multiple-choice questions and thematic analysis for free-text responses.

RESULTS: Seventy-nine clinicians completed the survey, of whom the majority were qualified rheumatologists who regularly managed patients with PMR. Most respondents relied upon clinical diagnosis, but some did not recognise peripheral joint involvement or normal inflammatory markers as possible features of PMR. Access to imaging investigations like ¹⁸F-fluorodeoxyglucose positron emission tomography combined with computed tomography was limited but desirable in circumstances of diagnostic uncertainty. Management predominantly involved glucocorticoid monotherapy; however, long-term outcomes were diverse and almost every clinician had prescribed a conventional synthetic DMARD for steroid-sparing purposes. The use of adjunctive physical therapy was inconsistent.

CONCLUSION: Variability remains in the diagnosis and management of PMR among Australian clinicians, with gaps in recognition of atypical presentations, imaging access and incorporation of physical therapy, ultimately supporting the need for standardised, evidence-based clinical care guidelines.

PMID:42241712 | DOI:10.1111/imj.70457

Obstet Gynecol. 2026 Jun 4. doi: 10.1097/AOG.0000000000006344. Online ahead of print.

ABSTRACT

OBJECTIVE: To synthesize evidence on the benefit-risk profile of antenatal corticosteroid (ACS) exposure in twin pregnancies and to explore effect modification by gestational age at birth and study design.

DATA SOURCES: PubMed, Embase, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (from inception to October 2025) were searched using terms for twin pregnancy or multiple gestation and antenatal corticosteroids (eg, betamethasone, dexamethasone).

METHODS OF STUDY SELECTION: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis (PROSPERO CRD420251275650), we included randomized controlled trials (RCTs) and observational studies comparing ACS exposure with no ACS in twin pregnancies and reporting neonatal outcomes. Observational studies were eligible only if they reported adjusted effect estimates accounting for relevant confounders. Primary outcomes were neonatal mortality and neonatal hypoglycemia; key secondary outcomes included neonatal intensive care unit (NICU) or special care unit admission and major respiratory outcomes. Risk of bias was assessed with version 2 of the Cochrane Risk of Bias tool and Risk of Bias in Non-randomized Studies of Interventions.

TABULATION, INTEGRATION, AND RESULTS: Random-effects meta-analyses were conducted to estimate risk ratios (RRs) with 95% CIs. Heterogeneity was assessed with the I2 statistic, and small-study effects were evaluated when feasible. Prespecified subgroup analyses examined gestational age (less than 34 weeks vs 34 or more weeks) and study design. Sixteen studies (18,367 neonates, 8,723 ACS exposed) were included. Overall, the certainty of evidence was moderate to low. Exposure to ACS was not significantly associated with a reduction in neonatal mortality (RR 0.77, 95% CI, 0.59-1.01). Antenatal corticosteroid was not associated with a reduction in respiratory distress syndrome (RDS) overall (RR 1.11, 95% CI, 0.81-1.52), and gestational age-stratified analyses were nonsignificant; however, analyses restricted to RCTs suggested a higher risk of RDS among ACS-exposed neonates (P<.001). Exposure to ACS was associated with increased supplemental oxygen requirement (RR 1.72, 95% CI, 1.07-2.74), neonatal hypoglycemia (RR 1.80, 95% CI, 1.30-2.51), and NICU or special care unit admission (RR 1.33, 95% CI, 1.07-1.64), with consistent hypoglycemia effects across gestational ages.

CONCLUSION: In twin pregnancies, ACS exposure was not consistently associated with improved neonatal outcomes, with no overall reduction in RDS and neonatal mortality. Associations with increased risks of hypoglycemia, oxygen requirement, and NICU or special care unit admission were observed. Given the moderate-to-low certainty of the available evidence, these findings should be interpreted cautiously.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD420251275650.

PMID:42241699 | DOI:10.1097/AOG.0000000000006344

Cancer Res Commun. 2026 Jun 4. doi: 10.1158/2767-9764.CRC-25-0756. Online ahead of print.

ABSTRACT

Assessments of chimeric antigen receptor (CAR) T-cell pharmacokinetics by flow cytometry (FC) and a droplet digital PCR (ddPCR) assay were compared in adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia following treatment with obecabtagene autoleucel (obe-cel) in the Phase Ib/II FELIX study (NCT04404660). CAR T-cell persistence and B-cell aplasia (BCA) were then correlated with event-free survival (EFS). Peripheral blood (PB) samples collected from 127 obe-cel-infused patients were tested by FC and ddPCR. The Spearman correlation coefficient was used to measure the correlation between the number of CAR T-positive cells by FC and ddPCR. The impact of CAR T-cell persistence and BCA (B-cells <20 cells/µL by FC in PB) on EFS was assessed using Cox proportional hazards regression. ddPCR was observed to statistically correlate with both the surface (0.60, P < 0.0001) and intracellular FC assays (0.74, P < 0.0001). A higher sensitivity for detecting CAR T-cell positive samples was observed with ddPCR, with 58.8% and 41.3% of samples negative by surface and intracellular FC, respectively, being positive by ddPCR. Loss of CAR T-cell persistence (HR: 2.7; 95% CI: 1.4-5.4), and to a lesser degree B-cell recovery (HR: 1.7; 95% CI: 0.7-3.8), as time-dependent variables and at Month 3, were associated with poorer EFS. ddPCR demonstrated enhanced sensitivity over FC methods for detection of obe-cel persistence. Additionally, ongoing persistence and BCA were associated with longer EFS and may be taken into consideration, together with clinical parameters, in informing decision making.

PMID:42241689 | DOI:10.1158/2767-9764.CRC-25-0756

JMIR Med Educ. 2026 Jun 4;12:e81052. doi: 10.2196/81052.

ABSTRACT

BACKGROUND: Applicants participating in the Residency Match generally submit a photograph through the Electronic Residency Application Service (ERAS). Studies demonstrate that subjectively more attractive applicants are more likely to succeed during job recruitment, including a paper related to the Residency Match.

OBJECTIVE: This study further investigates the relationship between an applicant’s attractiveness and the likelihood that they are invited to interview with a residency program to explore if more attractive applicants are more likely to be invited to interview when controlled for demographic and academic variables. If there are enough data suggesting that an ERAS photograph being visible prior to the interview gives an unfair advantage to more attractive applicants, this practice might be reconsidered by some residency programs or by ERAS itself.

METHODS: Residency directors were surveyed on application review practices. Programs that viewed ERAS photographs prior to deciding whether to invite an applicant to interview were asked to share ERAS files of all reviewed applicants of the 2022 Match. A machine learning model was used to determine attractiveness scores for ERAS photographs. The scores ranged from 1 to 10, where 1 represents the least attractive and 10 represents the most attractive. Multivariable logistic regression analysis was performed considering attractiveness scores, demographics, and professional characteristics. The primary outcome of interest was an invitation to an interview with a residency program.

RESULTS: The residency program response rate was 47.5% (29/61). Among 2681 unique applications to 10 specialties in a single academic health system, the median attractiveness score for all applicants was 6.02 (IQR 5.54-6.55). The univariable analysis indicated a 19% higher invitation likelihood with a 1-point increase in attractiveness. After adjusting for demographics and professional experiences, the association lost statistical significance. Additional adjustment for United States Medical Licensing Examination scores further attenuated the association.

CONCLUSIONS: While higher attractiveness scores correlated with an increased likelihood of securing an interview, this correlation was not statistically significant after adjusting for other variables.

PMID:42241682 | DOI:10.2196/81052

J Appl Physiol (1985). 2026 Jun 4. doi: 10.1152/japplphysiol.00192.2026. Online ahead of print.

ABSTRACT

While estrogen is known to confer cardioprotective benefits in cisgender women, transgender women on gender-affirming hormone therapy may experience unique cardiovascular risks. Emerging evidence suggests that feminizing hormone therapy may confer both beneficial and adverse effects on cardiovascular, renal, and hepatic systems. In this cross-sectional study, transgender women receiving gender-affirming hormone therapy with orchiectomy (n=15) or without orchiectomy (n=15) were compared with age-matched cisgender men (n=15) and cisgender women (n=15). Transgender women had received hormone therapy for 11±3 years. Serum estradiol concentrations were significantly lower in cisgender men (33±10 pg/mL) than in transgender women with orchiectomy (141±47 pg/mL), transgender women without orchiectomy (116±41 pg/mL), and cisgender women (131±38 pg/mL), whereas serum testosterone concentrations were significantly higher in cisgender men (22.0±6.1 nmol/l) compared with the other groups (1.2±1.1, 0.6±0.3, 1.0±0.3 nmol/l) (all p<0.001). No statistically significant group differences were observed in brachial-ankle pulse wave velocity, brachial artery flow-mediated dilation, post-occlusive skin reactive hyperemia, or blood nitric oxide concentrations (all p>0.05). Blood urea nitrogen, creatinine, and liver enzyme concentrations were significantly higher in cisgender men than in the other groups (all p<0.05). Collectively, these results indicate that no statistically significant differences were observed in macro- and microvascular function, as well as liver and renal function, between transgender women (with or without orchiectomy) and cisgender women.

PMID:42241669 | DOI:10.1152/japplphysiol.00192.2026

Plant Physiol. 2026 Jun 4:kiag342. doi: 10.1093/plphys/kiag342. Online ahead of print.

ABSTRACT

Understanding how leaf water relations integrate with carbon economy is central to plant physiological ecology and to predictions of vegetation responses to environmental change, yet the degree of their coordination remains debated. We investigated relationships between leaf pressure-volume (PV) traits (leaf-specific capacitance at full turgor per dry mass (C*ft,mass), osmotic potential at the turgor loss point (πtlp), and other PV traits) and leaf economics spectrum (LES) traits (leaf nitrogen content, specific leaf area, and photosynthetic capacity) across temperate, subtropical, and tropical forests. These two suites of traits exhibited statistically partial coordination: C*ft,mass was tightly coupled with LES traits, whereas πtlp was independent of the LES framework, and this partial coupling was primarily driven by leaf saturated water content. Notably, coordination was strongest at the subtropical site, where conservative strategies strengthened the integration between PV and LES traits, thereby improving resource-use efficiency. This partial coupling provides insights into the multidimensional nature of plant functional strategies and the mechanisms underpinning species coexistence across forest types.

PMID:42241664 | DOI:10.1093/plphys/kiag342

Am J Public Health. 2026 Jun 4:e1-e10. doi: 10.2105/AJPH.2026.308439. Online ahead of print.

ABSTRACT

Objectives. To estimate associations of fatherhood with cardiovascular health (CVH), incident cardiovascular disease (CVD), and all-cause mortality. Methods. The Coronary Artery Risk Development in Young Adults (CARDIA) study is a US-based cohort that enrolled Black and White individuals aged 18 to 30 years at baseline (1985-1986). CVH was defined by Life’s Essential 8 scores. Models included multivariable linear regression and Cox proportional hazards. Results. Among 1648 men with fatherhood data, there was a statistical interaction between age at fatherhood onset and race on CVH (P < .05) in adjusted models. Among Black men, fathers had lower death rates than nonfathers (hazard ratio [HR] = 0.5; 95% confidence interval [CI] = 0.3, 0.9). Black fathers who were younger than 25 years (HR = 4.2; 95% CI = 1.2, 14.6) and those aged 25 to 29 years (HR = 4.2; 95% CI = 1.2, 14.8) at fatherhood onset had higher death rates compared with Black fathers who were aged 30 years or older. White fathers who were younger than 25 years and those aged 25 to 29 years at fatherhood onset had worse total CVH compared with White fathers who were aged 30 years or older (69.2 and 69.9 vs 73.3 points; P < .05). Conclusions. Fatherhood may be a protective health factor for Black men and adverse influence for young fathers, offering insight for public health programming. (Am J Public Health. Published online ahead of print June 4, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308439).

PMID:42241661 | DOI:10.2105/AJPH.2026.308439

Am J Public Health. 2026 Jun 4:e1-e12. doi: 10.2105/AJPH.2025.308416. Online ahead of print.

ABSTRACT

Objectives. To describe trends in US community health worker (CHW) place of employment and wages and the impact of state certification programs and Medicaid reimbursement. Methods. Using 2012 to 2023 Bureau of Labor Statistics data, we performed tests of proportions to describe CHWs’ changes in employment in different industries, linear regression to compare their wages between industries, and staggered difference-in-differences to evaluate the impact of certification and Medicaid reimbursement on the proportion of CHWs in each industry and wages. Results. CHW employment in health care and government has increased (P < .001), and CHWs are paid the least in social assistance agencies (P < .001). Certification was associated with a decreased proportion of government and public health CHWs (-9.4%; P = .003) but was not associated with wages. Medicaid reimbursement was not associated with place of employment or wages. Conclusions. Substantial wage differences exist across industries employing CHWs, and neither Medicaid reimbursement nor certification was associated with higher wages. Certification may influence workforce distribution, particularly in government settings. Public Health Implications. Improved Medicaid reimbursement rates and billing procedures and optimized payment models could grow and sustain the CHW workforce. Decreases in government employment after certification warrant further research. (Am J Public Health. Published online ahead of print June 4, 2026:e1-e12. https://doi.org/10.2105/AJPH.2025.308416).

PMID:42241658 | DOI:10.2105/AJPH.2025.308416

JCO Glob Oncol. 2026 Jun;12(6):e2600117. doi: 10.1200/GO-26-00117. Epub 2026 Jun 4.

ABSTRACT

PURPOSE: In Brazil, diagnosing and treating non-small cell lung cancer (NSCLC) with actionable molecular alterations pose substantial challenges because of health care disparities. Anaplastic lymphoma kinase (ALK) rearrangements represent a clinically relevant subset with highly effective targeted therapies. However, real-world access to ALK diagnostics and treatments across different Brazilian health care sectors remains inadequately characterized.

METHODS: We conducted a cross-sectional survey of Brazilian oncologists between October 2024 and March 2025 to assess the availability of ALK testing and targeted therapies, alongside perceived implementation barriers. Of 197 responses collected, 156 were included in the final analytic cohort. Data were analyzed using descriptive statistics, and categorical variables were reported as proportions with 95% CIs.

RESULTS: Within the final analytic cohort (N = 156), 93.9% of the respondents practicing in the private sector (n = 147) reported access to ALK testing, whereas only 43.9% of those practicing in the public health care system (n = 107) had access. Access to ALK-targeted therapies was limited for the public health care population: 7.1% received crizotinib and <2% received newer-generation ALK-targeted therapies available in the first-line setting. By contrast, in the private sector, 75.6% and 60.9% reported access to alectinib and lorlatinib, respectively. Chemotherapy remained predominant in the public health care system. Main barriers included lack of reimbursement (58.3%), insufficient tissue (40.4%), and urgency to initiate treatment (36.5%).

CONCLUSION: Despite robust evidence supporting ALK-targeted therapies, this study highlights substantial disparities in access to diagnostics and treatment for ALK-rearranged NSCLC in Brazil, particularly among patients reliant on the public health care system. Findings underscore the need for policies to strengthen testing infrastructure, ensure equitable access to guideline-recommended therapies, and enhance provider education. Addressing these gaps is essential for equitable precision oncology and improved outcomes.

PMID:42241650 | DOI:10.1200/GO-26-00117