Category: Statistics

JMIR Hum Factors. 2026 Mar 9;13:e86443. doi: 10.2196/86443.

ABSTRACT

BACKGROUND: Suboptimal design of infusion pumps may lead to usage errors, thereby compromising patient safety. Usability evaluation enables medical device design teams to identify and rectify design-related usability issues in a timely manner. Nevertheless, existing research on infusion pump usability continues to exhibit limitations in aspects such as task design.

OBJECTIVE: The study aimed to evaluate the usability of an infusion pump (SLGO SP-200 [SLGO Medical Technology Co, Ltd]) through simulation-based testing with nurses in a usability laboratory designed to simulate an intensive care unit.

METHODS: A total of 12 registered nurses with experience in using infusion pumps participated in this study. Nurses were asked to perform 12 operational tasks using the infusion pump. The participants were also asked to perform 7 knowledge tasks, where they were required to find relevant information in the user manual. Participants’ behavioral measures (task completion time, frequency of manual query, frequency of asking for assistance from researchers, frequencies of operation difficulties, near-misses, and failures), perceptions (perceived ease of use, perceived concentration level required, perceived likelihood of making programming errors, perceived mental workload, satisfaction, and use intention) were collected to evaluate the usability and identify interface design deficiencies of the pump.

RESULTS: The study found that the participants were generally able to complete the tasks. All operational tasks were completed within 3 minutes, and all knowledge tasks were completed within 2 minutes. Our study identified 79 difficult operations, 9 near-miss operations, and 36 operation failures. The causes of the above problems were analyzed. Participants generally found the infusion pump to be user-friendly, requiring a medium level of attention resources, and reported low levels of mental workload and likelihood of making programming errors.

CONCLUSIONS: The study results can provide a basis for the design of infusion pumps, help practitioners define the risks of use and the key content of training, and provide an important reference for the design of usability evaluation schemes for medical devices.

PMID:41802226 | DOI:10.2196/86443

Int J Epidemiol. 2026 Feb 18;55(2):dyag022. doi: 10.1093/ije/dyag022.

ABSTRACT

BACKGROUND: The burden of non-communicable diseases (NCDs) in adolescent and young adult females in sub-Saharan Africa (SSA) has not been comprehensively studied. To address this gap, we analysed data from the Global Burden of Diseases (GBD) 2021, focusing on death due to NCDs in females aged 10-24 years in SSA.

METHODS: We extracted data from GBD 2021 on NCD deaths in females aged 10-24 years in SSA from 2000 to 2021. We presented the numbers and death rates of NCDs, and the proportion of NCDs in all-cause deaths was calculated. Pearson’s correlation was applied to explore the NCD burden on the socioeconomic development and health system. Additionally, we projected the NCD burden until 2050 by applying mixed-effects models.

RESULTS: In 2021, 52 083.13 (42 018.18∼61 630.88) NCD deaths, at a mortality rate of 27.59 (22.26∼32.64) per 100 000 population, emerged, accounting for 21.13% (17.57%∼24.22%) of the total deaths. Neoplasms, cardiovascular diseases, digestive diseases, neurological disorders, and diabetes and kidney diseases were the top five leading causes of deaths. Inverse associations were observed between the NCD death rates and indicators of the socioeconomic and health system (P < .001). An increasing trend was observed of the NCD death numbers and the contributing proportions since 2000, and it was predicted to continue increasing through to 2050, with the highest increasing trend in neoplasms.

CONCLUSION: The rising disease burden of NCDs for adolescent and young adult females in SSA has attracted attention. Targeted interventions and strengthened health systems should be prioritized to address the concerning NCD burden in adolescent girls in SSA.

PMID:41802219 | DOI:10.1093/ije/dyag022

Int J Epidemiol. 2026 Feb 18;55(2):dyag030. doi: 10.1093/ije/dyag030.

ABSTRACT

BACKGROUND: During the perinatal period, the fetus can exert profound effects on processes that alter pre- and postnatal maternal physiology. It is possible to investigate the causal effect of offspring perinatal exposures on their mother’s health using Mendelian randomization (MR). However, analyses need to be adjusted for maternal genotype to avoid confounding. Such analyses are difficult to perform at scale because of the paucity of cohorts across the world with large numbers of genotyped maternal-offspring dyads and parent-offspring trios.

METHODS: We introduce the “offspring genotype-by-proxy” MR framework which can be employed in the absence of offspring genetic information to complement existing approaches in the triangulation of causal inference. The basic idea is to use paternal genotypes to proxy the direct effect of their offspring’s genotype on their offspring’s own exposures.

RESULTS: We compare our framework to other MR designs and investigate the consequences of model misspecification and spousal misclassification on statistical power, consistency, and bias. In addition, we discuss the key MR assumptions that prevent these approaches from being appropriate for investigating the effect of many offspring postnatal and later life exposures on maternal health.

CONCLUSION: Given the increasing availability of datasets such as the UK Biobank that (incidentally) include tens of thousands of genome-wide genotyped spousal pairs and large population biobanks with linked health record data for first-degree relatives, the offspring genotype-by-proxy MR approach could augment causal analyses of offspring perinatal exposures on their mother’s outcomes as implementation is not restricted to datasets with mother-offspring genotype information.

PMID:41802218 | DOI:10.1093/ije/dyag030

Int J Epidemiol. 2026 Feb 18;55(2):dyag015. doi: 10.1093/ije/dyag015.

ABSTRACT

BACKGROUND: Healthy worker survivor bias (HWSB) skews health outcome studies by favouring healthier employed individuals. While advanced statistical methods exist, their application in Korea has been limited due to insufficient occupational and mortality data. This study quantifies HWSB due to employment status changes (HWSB-ES) using Korea’s National Health Insurance Service (NHIS) database.

METHODS: This retrospective cohort study analysed NHIS data to assess HWSB-ES in individuals aged 30-59 years who maintained consistent insurance types from 2008 to 2010. The primary outcome, all-cause mortality, was tracked until December 2022. Insurance type determined employment status, with industry details collected for employees. Landmark analysis (origin: 2011; current: 2012-21) estimated HWSB-ES by assessing mortality risk attenuation in fixed and dynamic cohorts, stratified by age, sex, and landmark periods (1-10 years for short-term; 1-7 years for long-term).

RESULTS: After exclusions, 18 192 989 participants were included (median age: 44 years; 49.05% male). HWSB-ES was more pronounced in female, dynamic cohorts, and longer landmark periods. Importantly, the effect of HWSB-ES intensified with age but showed a smaller long-term attenuation compared to the short-term effect. Short-term HWSB-ES attenuated mortality risk by 25%-30% in male and 36%-39% in female. Long-term attenuation was lower, at 7%-15% in male and 12%-18% in female.

CONCLUSIONS: The quantified HWSB-ES results provide critical national-level estimates for adjustment, especially in female and older cohorts, to prevent the underestimation of adverse health effects in occupational research.

PMID:41802217 | DOI:10.1093/ije/dyag015

J Am Acad Orthop Surg. 2026 Mar 10. doi: 10.5435/JAAOS-D-25-00824. Online ahead of print.

ABSTRACT

BACKGROUND: Tandem spinal stenosis (TSS) is characterized by stenosis in two or more noncontiguous spinal regions. Surgical management may involve simultaneous decompression or staged procedures; however, no universally accepted decision-making algorithm exists.

METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, and EMBASE databases were searched for studies reporting outcomes of simultaneous and/or staged surgery for TSS. Fifteen studies were included in the qualitative review, and 12 were eligible for meta-analysis. Surgical strategies were compared based on postoperative functional outcomes.

RESULTS: A total of 1,006 interventions (604 staged and 402 simultaneous) were analyzed. Overall, significant postoperative improvement in Japanese Orthopaedic Association scores was observed (pooled SMD, 2.87; 95% CI, 1.88 to 3.86). Subgroup analysis demonstrated the greatest improvement with staged surgery using a cervical-first approach (SMD, 4.31; 95% CI, 3.87 to 4.76; I2 = 0%), followed by simultaneous surgery (SMD, 2.65; 95% CI, 1.76 to 3.53). Lumbar-first staged surgery showed smaller and statistically negligible improvement (SMD, 1.94; 95% CI, -1.69 to 5.56). Complication rates were higher in older patients and in those with longer operative times and greater estimated blood loss.

CONCLUSIONS: Surgical strategy for TSS should be individualized. In the presence of myelopathy, staged surgery prioritizing cervical decompression is recommended. In the absence of myelopathy, simultaneous decompression may be considered in patients who can tolerate longer operative times. We propose a treatment algorithm to guide surgical decision-making based on symptom predominance, presence of myelopathy, and patient comorbidities.

PMID:41802210 | DOI:10.5435/JAAOS-D-25-00824

Ocul Immunol Inflamm. 2026 Mar 9:1-7. doi: 10.1080/09273948.2026.2633445. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate retinal and choroidal microvascular alterations in sarcoidosis using optical coherence tomography angiography (OCTA) and assess their association with different clinical phenotypes and disease duration.

METHODS: This cross-sectional study included 76 patients with sarcoidosis divided into three subgroups: pulmonary (n = 33), pulmonary + ocular (n = 25), and pulmonary + extrapulmonary involvement (n = 18), along with 31 healthy controls. OCTA was used to quantify vessel density (VD) in the superficial (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ) area, choriocapillaris flow, and radial peripapillary capillary (RPC) network. Statistical analyses included ANOVA, Tukey post hoc, and correlation tests.

RESULTS: No significant differences were observed between groups for SCP-VD, RPC-VD, FAZ area, or choriocapillaris flow. However, DCP-VD showed significant intergroup differences, particularly in foveal and perifoveal regions (p = 0.005 and p = 0.012). Post hoc analyses revealed that DCP-VD was significantly lower in sarcoidosis subgroups than in controls, even among patients without clinical ocular involvement. No significant correlation was found between disease duration and OCTA metrics, though weak negative trends were observed for perifoveal DCP-VD and foveal SCP-VD.

CONCLUSIONS: DCP-VD is selectively reduced in sarcoidosis, suggesting early subclinical microvascular compromise, particularly in extrapulmonary and ocular phenotypes. OCTA may serve as a valuable non-invasive tool for detecting subtle retinal microvascular changes before clinical signs appear. Further longitudinal studies are warranted to assess the prognostic implications of these findings.

PMID:41802207 | DOI:10.1080/09273948.2026.2633445

Prostate. 2026 Mar 9. doi: 10.1002/pros.70156. Online ahead of print.

ABSTRACT

BACKGROUND: Active surveillance (AS) is the preferred management approach for patients with low-risk prostate cancer (PC); yet whether younger patients with favorable-intermediate-risk (FIR) PC experience increased mortality-risk when electing AS remains unknown. We evaluated all-cause, PC-specific, and non-PC-specific mortality (ACM, PCSM, and non-PCSM) in younger patients with FIR PC managed with either AS/watchful-waiting (WW) or immediate definitive treatment, stratified by race.

METHODS: We conducted a retrospective cohort study using SEER data (2010-2020). Patients included were < 60 years-old with FIR PC. The primary outcome was ACM, secondary outcomes PCSM and non-PCSM. Multivariable Cox and Fine-Gray competing-risk regressions were used, adjusting for known prognostic factors. Interaction by race (White vs underrepresented minority [URM]) was explored. Statistical significance was set at p < 0.025 (Bonferroni-adjusted).

RESULTS: Among 3,832 patients, 127 died (3.31%), including 18 of the 127 deaths from PC (14.17%). Initial treatment with RP/RT did not significantly reduce ACM or non-PCSM compared to AS/WW in White (ACM AHR, 0.92; 95% CI, 0.44-1.94; non-PCSM AHR, 1.36; 95% CI, 0.53-3.46) or URM patients (ACM AHR, 0.68; 95% CI, 0.33-1.43; non-PCSM AHR, 1.04; 95% CI, 0.44-2.44). However, after adjustment for multiplicity RP/RT significantly reduced PCSM-risk compared to AS/WW in URM (AHR, 0.03; 95% CI, 0.00-0.48; p = 0.01), but not in White patients (AHR, 0.21; 95% CI, 0.05-0.88; p = 0.03) although the median follow-up was 6.5-months longer in URM patients undergoing AS/WW compared to RP/RT.

CONCLUSIONS: Early mortality-risks were similar and low in patients age < 60 years with FIR PC managed with AS/WW compared to RP/RT, irrespective of race.

PMID:41802205 | DOI:10.1002/pros.70156

Evolution. 2026 Mar 9:qpag037. doi: 10.1093/evolut/qpag037. Online ahead of print.

ABSTRACT

One of the most fundamental calculations needed in an examination of the effect of natural selection in a Mendelian population is to find the rate of change in continuous-time of the frequency of any allele under natural selection, and from this to find the number of generations needed for the frequency of an allele to change from one given value to another. In this paper we analyze the presently accepted self-contained continuous-time theory of allele frequency change for large populations caused only by natural selection, which assumes no mutation and no gene frequency changes due to random genetic drift in a monoecious diploid population. We claim that the present theory is incomplete, with severe restrictions on how the population size varies over time, and with no natural generations concept built in. In order to remedy this we propose a new self-contained theory, making throughout the same assumptions described above concerning mutation and random genetic drift, and also assuming a monoecious diploid population.

PMID:41802202 | DOI:10.1093/evolut/qpag037

J Am Acad Orthop Surg. 2026 Mar 10. doi: 10.5435/JAAOS-D-25-00569. Online ahead of print.

ABSTRACT

BACKGROUND: Periacetabular metastatic disease can cause notable morbidity, prompting potential surgical intervention. Open approaches, including the Harrington type reconstructive with a total hip replacement and cemented gap cup, have been the standard approach; however, these surgeries are invasive. Minimally invasive techniques, including screw fixation with cementation and potential ablation, aim to reduce morbidity. This study compares surgical and short-term postoperative outcomes between open reconstructive techniques and minimally invasive treatments in patients with periacetabular metastatic disease.

METHODS: Prospectively maintained institutional medical records were used to retrospectively identify patients who had undergone an open approach, who would be minimally invasive candidates, and patients who have undergone the minimally invasive procedure. Demographic, surgical data, and postoperative outcomes of patients with minimum 3-month follow-up were collected. Wilcoxon rank-sum test, chi-squared, and minimal clinically important difference (MCID) tests were used to determine statistical and clinical differences.

RESULTS: Seventeen open and 48 minimally invasive patients were identified. Minimally invasive patients had statistically significant lower rate of surgical blood loss, transfusion rates, surgical time, and length of stay (P < 0.05). Fourteen open and 32 minimally invasive patients had minimum 3-month follow-up. No notable difference was found in the need for secondary procedures, complications, death within 90 days, or Pain and Ambulatory Function Scores (P > 0.05). 57.1% of the open cohort and 43.8% of the minimally invasive cohort met the MCID threshold. Minimally invasive patients had statistically significant quicker return to adjuvant therapies (P < 0.05).

DISCUSSION: Our cohort study demonstrated that minimally invasive techniques reduced surgical morbidity while achieving similar short-term (3 month) postoperative outcomes and a faster return to potentially life-prolonging therapies. Larger patient sample will help determine patients at risk for failure of both approaches and the need for secondary procedures to further define patients who might benefit from the different techniques.

PMID:41802193 | DOI:10.5435/JAAOS-D-25-00569

Mol Carcinog. 2026 Mar 9. doi: 10.1002/mc.70106. Online ahead of print.

ABSTRACT

Oral administration of broccoli constituent sulforaphane (SFN) prevents prostate cancer development in preclinical mouse models. However, the mechanism(s) underlying prostate cancer prevention by SFN are not fully understood. In this study, we used a human relevant mouse model (Hi-Myc mice) to demonstrate restoration of immune surveillance by oral SFN administration. Treatment of Hi-Myc mice with SFN for 16 weeks resulted in about 1.33-fold increase in the number of prostate tumor-infiltrating CD8α + T cells (p = 0.02 by Student’s t-test). The number of CD4+ helper T cells was not affected by SFN treatment. The number of CD11c/MHCII+ dendritic cells was increased by about 57% upon SFN administration. On the other hand, the number of NKp46+ natural killer cells was not significantly affected by SFN treatment. Oral administration of SFN resulted in about 30% decrease in the number of Gr1/CD11b+ myeloid-derived suppressor cells in the prostate tumor when compared to control mice. Plasma levels of interleukin (IL)-1α, IL-1β, IL-4, IL-5, IL-10, and C-X-C motif chemokine ligand 2 (CXCL2 or MIP-2) were statistically significantly lower in SFN-treated mice when compared to control mice. Treatment of recurrent prostate cancer patients with 200 μmol/day of SFN-rich broccoli sprout extract for 20 weeks also caused a statistically significant decrease in plasma levels of IL-1β, IL-4, and IL-13. Cell proliferation inhibition by SFN in vitro was partially but significantly attenuated by IL-4 and IL-13 supplementation in 22Rv1 cells. These results indicate restoration of immune surveillance by oral SFN treatment in Hi-Myc mouse model.

PMID:41802185 | DOI:10.1002/mc.70106