Category: Statistics

Implement Sci. 2026 May 7. doi: 10.1186/s13012-026-01500-8. Online ahead of print.

ABSTRACT

BACKGROUND: “Nudges” embedded in the electronic health record (EHR) facilitate desired decisions while preserving autonomy and may provide a scalable strategy to overcome the common implementation barrier of lack of knowledge about a best practice. We sought to test whether EHR-based nudges targeting two intensive care unit (ICU) clinician groups would safely increase evidence-based use of low tidal volume ventilation.

METHODS: We performed a stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial in 12 ICUs from February 2021 to May 2023 to test three nudges targeting clinicians responsible for order entry and respiratory therapists responsible for operationalizing orders and documentation. A default ventilation order auto-populated a low tidal volume setting; an accountable justification order required a free-text justification to order high tidal volume; and an accountable justification flowsheet required a free-text justification to document delivery of high tidal volume. ICUs were randomly assigned to launch one of the two order nudges on a pre-specified date, followed by the flowsheet nudge six months thereafter. The primary outcome was fidelity to low tidal volume ventilation, defined as percentage of time during the first 72 h of ventilation with low tidal volumes. For additional contextual inquiry, we conducted qualitative interviews with ICU clinicians regarding their perspectives on low tidal volume ventilation and study nudges.

RESULTS: The primary analysis included 4412 patients. Unadjusted median fidelity to low tidal volume ventilation was 45.7%. Using multivariable mixed effects regression, marginal estimates of fidelity to low tidal volume ventilation ranged from 47.1% to 57.8% across study groups, with no significant differences after Holm adjustment for multiple comparisons. ICUs experienced variable changes with nudges in fidelity to low tidal volume ventilation. Clinician interviews revealed potential explanations for this variability, including the possibility of differential effects by experience level of clinicians and culture of interprofessional collaboration, and influence of the COVID-19 pandemic on familiarity with and use of low tidal volume ventilation.

CONCLUSIONS: EHR-based default and accountable justification nudges did not increase utilization of low tidal volume ventilation in a broad population of mechanically ventilated patients; however, nudge effectiveness varied by ICU.

TRIAL REGISTRATION: Clinicaltrials.gov, NCT04663802. Registered 10 December 2020, https://clinicaltrials.gov/study/NCT04663802.

PMID:42098760 | DOI:10.1186/s13012-026-01500-8

BMC Med Educ. 2026 May 7. doi: 10.1186/s12909-026-09365-7. Online ahead of print.

ABSTRACT

BACKGROUND: Periodontal diseases are closely related to various systemic conditions including diabetes mellitus (DM), cardiovascular diseases, adverse pregnancy outcomes, and rheumatoid arthritis (RA). Internal medicine physicians frequently encounter patients with these systemic conditions and are in a strategic position to facilitate early diagnosis and referral for periodontal problems. Despite international evidence suggesting significant knowledge gaps among medical practitioners regarding periodontal health, limited data are available from Turkey. The aim of this study was to evaluate the knowledge levels and attitudes of internal medicine specialists and residents regarding periodontal health and periodontal disease, and their relationship with systemic conditions, in comparison with dentists.

METHODS: This cross-sectional descriptive survey study was conducted between April 2021 and December 2021 in Turkey. A content-validated, self-administered online questionnaire consisting of 7 sociodemographic questions and 29 questions related to periodontal health and periodontal disease knowledge and attitudes was distributed to internal medicine specialists/residents (IMS group, n = 107) and dentists (control group, n = 133) via social media platforms. Internal consistency was assessed using Cronbach’s alpha (α = 0.829). Normality of continuous variables was assessed using the Shapiro-Wilk test. Data were analyzed using chi-square tests, Kruskal-Wallis tests, and Mann-Whitney U tests, with statistical significance set at p < 0.05. Bonferroni correction was applied for multiple comparisons. Multiple linear and logistic regression models were used to adjust for potential confounders.

RESULTS: A total of 240 participants met the inclusion criteria. Internal medicine specialists/residents demonstrated significantly lower knowledge levels compared to dentists across most periodontal knowledge domains (p < 0.05). Only 65.4% of the IMS group correctly defined periodontitis compared to 98.5% of dentists (p < 0.001). Knowledge gaps were particularly prominent regarding the relationship between periodontal disease and pregnancy complications (46.7% vs. 91%, p < 0.001), the effect of smoking on periodontal tissues (59.8% vs. 97.7%, p < 0.001), and the role of radiographic examination in periodontal diagnosis (37.4% vs. 88.8%, p < 0.001). After Bonferroni correction, 14 of 22 comparisons remained statistically significant. Notably, both groups showed high and comparable knowledge regarding the recognition of diabetes as a risk factor for periodontitis (IMS: 93.5% vs. dentists: 92.5%). Subgroup analysis revealed that specialists scored significantly higher than residents across all knowledge domains (total score: 16.94 ± 2.90 vs. 14.38 ± 3.73, p < 0.001). Multivariate analysis confirmed that group differences remained significant after adjusting for age, sex, marital status, and years since graduation (adjusted B = 4.65, p < 0.001). Self-assessment scores for periodontal knowledge significantly increased after completing the survey in the IMS group (4.02 to 5.34, p < 0.001).

CONCLUSIONS: The findings of this study suggest that internal medicine specialists and residents in Turkey may have lower knowledge levels regarding periodontal health and periodontal disease, and the periodontal-systemic health relationship compared to dentists. Specialists demonstrated significantly higher knowledge than residents across all domains. While these results should be interpreted within the context of the study’s methodological limitations, they point to a potential need for integration of oral health education into medical curricula and enhanced interprofessional collaboration between medicine and dentistry. Further research using representative sampling strategies and longitudinal designs is warranted to confirm these findings.

PMID:42098754 | DOI:10.1186/s12909-026-09365-7

BMC Public Health. 2026 May 7. doi: 10.1186/s12889-026-27664-y. Online ahead of print.

ABSTRACT

BACKGROUND: It is still unclear how the risk of cardiovascular disease (CVD) changes across life course and the specific influence of body mass index (BMI) on risk trajectory.

METHODS: We included 106,962 participants aged 35-74 from a Chinese longitudinal cohort during 1992 to 2021 with 4 repeated measurements. China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) equation was applied to calculate 10-year CVD risk. General additional mixed model and Joinpoint model were used to elaborate CVD risk trajectory and the potential benefits of normal BMI.

RESULTS: The 10-year CVD risk for Chinese adults increased from 1.11% [95% confidence interval (CI): 1.00%, 1.22%] to 14.87% (95%CI: 14.76%, 14.99%) dramatically between ages 35-74, with average CVD risk reaching moderate- and high-risk level at 53 and 65 years, respectively. Compared to overweight/obesity (BMI ≥ 25 kg/m²), normal BMI (< 25 kg/m²) could effectively slow the increase of CVD risk during lifespan (average slope: 0.42% vs. 0.33%), and postpone the moderate- and high-risk age window by 4 years and 5 years, respectively. Risk difference between overweight/obesity and normal BMI groups gradually climbed from -0.10% (95%CI: -0.47%, 0.28%) to 3.02% (95%CI: 2.69%, 3.35%) between ages 35-74. Women displayed a similar uptrend, while men experienced peak benefits at 53 years (2.09%, 95%CI: 1.86%, 2.31%) followed by a slight decrease.

CONCLUSIONS: This study delineated cardiovascular risk trajectory, identifying critical intervention windows and demonstrating potential cardiovascular benefits of normal BMI, particularly in women.

PMID:42098752 | DOI:10.1186/s12889-026-27664-y

BMC Womens Health. 2026 May 7. doi: 10.1186/s12905-026-04520-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine temporal trends in routine leucorrhea test results and associated pathogen findings among women participating in sustained cervical and breast cancer screening programs in a county-level city of western China.

METHODS: In this repeated cross-sectional screening study, routine leucorrhea test data were collected from women aged 35-64 years who participated in cervical and breast cancer screenings in Jianyang City, Sichuan Province, between January 2022 and December 2024 (12,156 cases in 2022, 13,824 cases in 2023, and 11,382 cases in 2024). Participants were stratified by age and region. Vaginal cleanliness and pathogens were assessed using the normal saline wet mount method. Statistical analyses were performed using SPSS 26.0, including trend analysis, linear regression, and stratified analyses to examine age-region interaction effects.

RESULTS: Over the three-year period, the abnormal rate of routine leucorrhea tests (Grade III-IV) decreased from 34.21% to 30.00%, corresponding to an annual reduction of 6.5% (P < 0.001). Infection rates of Candida albicans, Trichomonas vaginalis, and clue cell positivity declined concurrently. The 51-55 age group had the highest baseline abnormal rate but showed the most pronounced decrease (5.40% points). Stratified analysis indicated that township perimenopausal women (51-55 years) experienced the steepest improvement (7.2% points) compared with urban counterparts (3.8% points, P < 0.01). The urban-rural gap narrowed by 3.90% points (P < 0.001). Following the 2023 township healthcare initiative, township abnormal rates declined more steeply than the pre-intervention trend would have predicted (difference of 3.10% points); given the cross-sectional design, this difference should be interpreted as a temporal association rather than causal attribution.

CONCLUSION: Participation in a sustained, population-based screening program was temporally associated with a declining trend in abnormal leucorrhea findings among women aged 35-64 years in this county-level city of western China. Based on a preliminary linear trend estimate derived from three annual data points, the abnormal rate may decrease to approximately 26% by 2026 if current intervention intensity is maintained; this projection should be interpreted with caution given the limited time series. Because this is a repeated cross-sectional analysis, causal inference is not warranted. Targeted interventions for perimenopausal women and residents of township areas should be reinforced to optimize gynecological health services in western China.

PMID:42098750 | DOI:10.1186/s12905-026-04520-0

Forensic Sci Int. 2026 Apr 29;386:112980. doi: 10.1016/j.forsciint.2026.112980. Online ahead of print.

ABSTRACT

A high-level data fusion approach for classifying spray paint samples from five major U.S. manufacturers, each represented by five color groups (black, blue, red, silver/gray, and white), was investigated. Spectral data were collected using four analytical techniques: Fourier transform infrared (FTIR) spectroscopy, Raman spectroscopy with laser excitation at 532 nm and 785 nm, scanning electron microscopy coupled with energy-dispersive spectroscopy (SEM-EDS), and UV-Vis microspectrophotometry (MSP). Their combined use and discriminating ability were evaluated. Each dataset was independently modeled using five supervised machine learning classifiers: Naïve Bayes, k-nearest neighbors (KNN), support vector machine (SVM), random forests, and extreme gradient boosting (XGBoost). The intermediate predictions from each classifier were integrated using the majority voting mechanism to yield a final class assignment, forming a high-level data fusion scheme. The proposed approach consistently outperformed individual instruments, achieving near-perfect classification accuracy across several color blocks, particularly for red and blue paints. Among classifiers, generally, Random Forest and Naïve Bayes provided the most stable performance, while SVM with a linear kernel and XGBoost showed lower accuracy. The findings confirm that fusing complementary spectral information improves discriminative ability, reduces redundancy, and creates a computationally efficient, reproducible framework for objective evaluation of source-level questions arising from forensic paint examinations. Overall, the developed model mirrored the process followed by forensic paint examiners in recognizing relevant spectral features from the various techniques. This approach offers a promising pathway toward integrating multimodal spectral data within probabilistic or likelihood ratio-based frameworks following comparative examinations of paint.

PMID:42096743 | DOI:10.1016/j.forsciint.2026.112980

Comput Biol Chem. 2026 May 5;124(Pt 1):109097. doi: 10.1016/j.compbiolchem.2026.109097. Online ahead of print.

ABSTRACT

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) enables rapid species identification in clinical microbiology and shows promise for predicting antimicrobial resistance (AMR) from mass spectra. However, models trained at one hospital site suffer substantial performance degradation at another site due to differences in instruments, sample preparation, and patient populations. Despite numerous domain adaptation (DA) methods in the machine learning literature, none has been systematically benchmarked for cross-site MALDI-TOF AMR prediction. This study presents the first comprehensive benchmark evaluating 13 methods (spanning baselines, supervised transfer learning, and unsupervised DA) across five transfer scenarios involving three public datasets (DRIAMS, MS-UMG, and MARISMa) covering up to 20 species-antibiotic pairs. In total, the benchmark comprises over 15,000 experiments with five random seeds per configuration. A label-efficiency analysis across all five scenarios further examines how model performance scales with 10%, 25%, 50%, and 75% of available target-site labels. The results demonstrate that simple fine-tuning with target-site labels closes 92%-97% of the domain gap and dominates all unsupervised DA methods, which yield only 0%-6% improvement over source-only baselines. The label-efficiency analysis reveals that for competitive transfer methods, as few as 25% of target labels suffice to recover 81%-94% of full supervised performance on cross-site scenarios. These findings provide practical guidelines for clinical deployment: collecting a modest number of labeled samples at the target site is far more effective than applying sophisticated unsupervised adaptation techniques.

PMID:42096742 | DOI:10.1016/j.compbiolchem.2026.109097

Biomed Pharmacother. 2026 May 6;199:119472. doi: 10.1016/j.biopha.2026.119472. Online ahead of print.

ABSTRACT

Statistics indicate that brain metastases occur in nearly 30% of patients with solid tumors, with lung cancer, breast cancer, and melanoma being the three most common primary sources. Brain metastasis is characterized by the co-evolution of tumor cells co-evolve with the brain microenvironment, inducing changes in the phenotype of brain stromal cells that facilitate the colonization, survival, and growth of tumors. The prognosis for brain metastases remains poor, with 2-year and 5-year survival rates for patients diagnosed with brain metastases of 8.1% and 2.4%, respectively. Notably, more than half of brain metastases patients die from neurological diseases. Current treatment options for brain metastases include radiotherapy, neurosurgery, systemic chemotherapy, targeted therapy, and immunotherapy, which are often used in combination to improve therapeutic outcomes. In recent years, the use of nanomaterials for brain metastases treatments has been progressively developed to enhance the efficiency and precision of drug delivery. In the future, with a deeper understanding of the mechanisms underlying brain metastases and further development of treatment strategies, patient outcomes are expected to improve. This review, summarizes the current understanding of brain metastasis mechanisms and therapeutic approaches, and outlines an outlook on future research directions in the field.

PMID:42096737 | DOI:10.1016/j.biopha.2026.119472

Obstet Gynecol. 2026 May 7. doi: 10.1097/AOG.0000000000006292. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the driving distance from U.S. prisons housing women to hospitals providing obstetric care and advanced neonatal intensive care.

METHODS: Using the Google Distance Matrix API, we conducted a cross-sectional analysis to calculate driving distances from state and federal prisons housing women to the closest in-state obstetric hospitals and level III or IV neonatal intensive care units (NICUs). The primary outcome was obstetric hospital distance (driving distance from each prison to the closest hospital providing obstetric care). The secondary outcome was NICU hospital distance (driving distance from each prison to the closest level III or IV NICU). We calculated state-level descriptive statistics and assessed regional differences using the Kruskal-Wallis test.

RESULTS: Of 136 prisons, 134 (98.5%) had an in-state driving route to an obstetric hospital. There were 1,920 obstetric hospitals and 836 level III or IV NICUs. The median (IQR) obstetric hospital distance was 11.4 miles (4.5-22.8) (range 0.6-139.8). The farthest obstetric hospital distances were in Wyoming (139.8 miles), North Dakota (122.4 miles), and Georgia (69.6 miles). Twelve prisons (9.0%) were located more than 37.2 miles from the closest obstetric hospital, including two in both Wyoming and Georgia. Of the 130 prisons with driving routes to an in-state level III or IV NICU, the median (IQR) NICU hospital distance was 19.5 miles (7.7-39.6) (range 0.4-357.9). The farthest NICU hospital distances were in Alaska (357.9 miles), New Mexico (187.0 miles), and South Dakota (175.8 miles). Distances to the closets NICU were significantly longer in the South and Midwest than in the Northeast (P=.025).

CONCLUSION: Although most prisons housing women were located near hospitals providing obstetric and neonatal intensive care, there were state and regional disparities. For some prisons, distance could pose a substantial barrier to timely perinatal care and may exacerbate existing inequities in maternal and neonatal morbidity and mortality.

PMID:42096711 | DOI:10.1097/AOG.0000000000006292

N Z Med J. 2026 May 8;139(1634):51-64. doi: 10.26635/6965.7460.

ABSTRACT

BACKGROUND: Gastric cancer (stomach cancer) is an important contributor to morbidity and mortality in Aotearoa New Zealand, with marked ethnic inequities. Although national incidence rates are declining, Māori and Pacific peoples continue to experience higher rates than other groups. Demographic change and regional population growth are expected to influence future burden, yet no published projections provide estimates disaggregated by ethnicity and region.

METHODS: Gastric cancer registrations from 2001 to 2022 from the New Zealand Cancer Registry were linked to population estimates and projections stratified by age, sex, prioritised ethnicity and Health New Zealand – Te Whatu Ora region. Incidence was modelled using an age-period-cohort approach with time-based weighting to emphasise recent trends. Projections to 2045 were generated, and uncertainty was quantified using 1,000 non-parametric bootstrap iterations incorporating perturbation of population denominators.

RESULTS: Gastric cancer cases are projected to increase by 47.7% to approximately 725 per year by 2045, despite a decline in the age-standardised rate from 5.9 to 5.3 per 100,000. All regions show increasing absolute numbers, with the Northern Region experiencing the largest rise. Māori and Pacific peoples have the highest current incidence and a large proportional increase in projected cases, although incidence rates decline modestly for all ethnic groups. Future case growth is driven mainly by demographic expansion and an ageing population.

CONCLUSION: Absolute gastric cancer cases are projected to increase, particularly among Māori and Pacific populations and in regions experiencing rapid population growth. This has implications for early diagnosis and specialist service delivery. These projections support equity-focussed prevention and service planning, including Helicobacter pylori control, timely diagnostic pathways, and regional planning for specialist cancer services.

PMID:42096700 | DOI:10.26635/6965.7460

N Z Med J. 2026 May 8;139(1634):32-37. doi: 10.26635/6965.7068.

ABSTRACT

AIM: This study aims to describe the epidemiology, clinical features, microbiology and management of paediatric patients (<18 years) admitted to Christchurch Hospital with periorbital or orbital infections over a 10-year period.

METHODS: A retrospective review was conducted of all patients under 18 years admitted with periorbital and orbital infections between 2013 and 2023. Cases were identified using surgical theatre records and discharge coding, with data extracted from electronic medical records. Clinical, demographic, microbiological and management data were analysed descriptively.

RESULTS: A total of 495 paediatric cases were identified, with 93% presenting with periorbital cellulitis and 7% with orbital cellulitis. Sinusitis was the predominant predisposing factor for postseptal disease, present in 83% of those cases. Orbital signs such as proptosis, pain with eye movement, reduced visual acuity and ophthalmoplegia were more frequent in orbital cellulitis. Orbital cases had longer hospital stays with a median of 4.5 days (range 2-33 days) compared to periorbital disease with a median of 1 day (range 0-8 days). Orbital cases also had a higher rate of surgical intervention (47%), most commonly functional endoscopic sinus surgery. Staphylococcus aureus was the most frequently isolated organism in both groups (45% periorbital, 42% orbital). Māori and Pacific children were disproportionately affected (comprising 20% and 10% respectively of periorbital cases and 17% and 19% of orbital cases).

CONCLUSIONS: The presence of orbital signs should prompt urgent imaging to exclude orbital disease. Sinusitis remains a key risk factor for orbital cellulitis, and Māori and Pacific children are disproportionately affected.

PMID:42096698 | DOI:10.26635/6965.7068