Category: Statistics

Int Orthop. 2026 May 17. doi: 10.1007/s00264-026-06854-8. Online ahead of print.

ABSTRACT

BACKGROUND: Operating rooms contribute disproportionately to healthcare-related greenhouse gas emissions and waste generation. Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are high-volume procedures with increasing global incidence, yet pooled data on their environmental impact are lacking.

METHODS: A systematic review and pooled analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261297449). PubMed, Embase, and Scopus were searched through October 31, 2025, for studies reporting total waste, recyclable waste, and carbon dioxide equivalent (CO₂e) emissions associated with primary THA and TKA. Seventeen studies, including 394 procedures, were included. Data extraction covered waste quantity, recyclable proportion, and carbon footprint. Random-effects models with inverse variance weighting were used to calculate pooled mean estimates. Standard deviations were estimated from reported ranges when not provided. Heterogeneity was assessed using I² statistics.

RESULTS: Pooled mean total waste per arthroplasty was 12.27 kg (95% CI, 10.88-13.66). Recyclable waste averaged 1.97 kg per procedure (95% CI, 1.64-2.31), representing 14.5% of total waste (95% CI, 11.99-17.02), and indicating substantial unrealized recycling potential. Carbon footprint estimates varied substantially by accounting methodology. Studies measuring waste-disposal emissions alone reported a pooled mean of 13.7 kg CO₂e per case (95% CI, 11.32-16.08), whereas comprehensive life-cycle assessment (LCA) studies reported a pooled mean of 135.37 kg CO₂e per case (95% CI, 74.91-195.83). Considerable inter-study heterogeneity reflected differences in waste segregation, recycling infrastructure, and carbon accounting methodologies.

CONCLUSIONS: Primary THA and TKA generate substantial waste and carbon emissions, with low recycling rates across institutions. These findings provide benchmark data to inform sustainability initiatives, optimize resource use, and guide standardized environmental assessment frameworks in arthroplasty.

PMID:42143633 | DOI:10.1007/s00264-026-06854-8

Environ Monit Assess. 2026 May 17;198(6):598. doi: 10.1007/s10661-026-15421-y.

ABSTRACT

This study presents a novel application of source-specific particle size distribution (PSD) and moisture content-derived from laser gradation analysis of mining wastes-as explicit inputs to the AERMOD dispersion model, significantly improving its predictive realism for PM₁₀ from complex mining operations at the Jajarm Alumina Plant in Iran. Sampling targeted key waste types, including bauxite crusher slime, red mud, and lime tailings, with laser diffraction (HORIBA LA-950) used to quantify PSD and ASTM D2216 for moisture determination. Emission rates were calculated using AP-42 methodologies and integrated into AERMOD with seasonal surface parameters and high-resolution meteorological data. Model validation against field measurements on 21 June 2018 showed excellent agreement (R² = 0.88, RMSE = 127 µg/m³), confirming that incorporation of gradation-specific data enhances prediction accuracy compared to generic assumptions. The highest 24-h PM₁₀ concentration reached 2087 µg/m³ near crushers, with an annual average of 542 µg/m³, far exceeding the air standards for particulate matter set by the EPA and the air quality standard in Iran (150 μg/m³). Results identify bauxite crusher slime (60% PM₁₀) and red mud (50% PM₁₀, 15.4% clay) as high-dispersion-potential wastes, and lime loading/unloading as the largest emission source (104 t/a). We recommend prioritizing dust suppression at lime/bauxite handling operations and surface stabilization of fine-grained tailings to mitigate air quality and public health impacts.

PMID:42143632 | DOI:10.1007/s10661-026-15421-y

J Perianesth Nurs. 2026 May 16:S1089-9472(26)00080-8. doi: 10.1016/j.jopan.2026.03.018. Online ahead of print.

ABSTRACT

PURPOSE: Postoperative nausea and vomiting (PONV) is a common occurrence that leads to patient discomfort and prolonged length of stay. The average rate of PONV is approximately 30% in the general population and can be as high as 70% to 80% in those at high risk. Enhanced recovery after surgery (ERAS) protocols have been created from analysis of current evidence-based research aimed to decrease postoperative complications and improve patient outcomes following surgical interventions.

DESIGN: This retrospective pre-experimental cohort study used convenience sampling of 1,200 past surgical patients to determine the trend of PONV rates in females who underwent laparoscopic gynecological surgery from 2018 to 2024, and to examine whether there was a difference in PONV rates between those who received general anesthesia utilizing ERAS protocols and those who did not during the designated time period.

METHODS: Compliance with antiemetic ERAS protocols was recorded and defined by the administration of three or more antiemetics, and noncompliance was defined as fewer than three. The primary outcome, the presence of PONV, was assessed by the administration of rescue antiemetics in the postanesthesia care unit (PACU). Additional outcomes included PACU length of stay and provider compliance with the ERAS protocols.

FINDINGS: The findings reflect those who received a general anesthetic before the introduction of the ERAS protocol through its early and most current use. During this time period, 1,200 patients underwent laparoscopic gynecologic surgery with general anesthesia. The study divided participants into pre-ERAS (2018 to 2019), early-ERAS (2020 to 2022), and current-ERAS (2023 to 2024) groups. The result of this study found a statistically significant decrease in ERAS compliance (P = .004), with a concurrent increase in PONV rates (P < .001). In patients who reported PONV, PACU length of stay increased from a mean of 92.75 (44.8) minutes in 2018 to 2019 to 130.7 (47.8) minutes in 2023 to 2024 (P = .001). Our study discovered that there was an overall decrease in compliance rates with antiemetic prophylactic administration throughout all phases of the perioperative period.

CONCLUSIONS: PONV is a key postoperative issue affecting patient comfort, recovery, and health care resources. Our findings emphasize the importance of comprehensive ERAS adherence beyond pharmacologic prophylaxis and call for further research to refine protocols based on patient outcomes, risk factors, and evolving pharmacology.

PMID:42143626 | DOI:10.1016/j.jopan.2026.03.018

Neuro Oncol. 2026 May 15:noag081. doi: 10.1093/neuonc/noag081. Online ahead of print.

ABSTRACT

BACKGROUND: Meningiomas exhibit clinical heterogeneity. Radiotherapy (RT) remains the only adjuvant therapy, but tumor-control is variable, and biomarkers are limited. NRG/RTOG-0539 is the first prospective phase 2 trial to stratify meningioma patients for adjuvant RT based on clinical risk. Here, we apply modern molecular tools to this cohort and identify correlates of RT response.

METHODS: Tumor tissue from 100 RTOG-0539 patients was profiled using DNA methylation arrays, RNA sequencing, and whole-exome sequencing. Recurrence scores, Molecular Groups, gene expression, and copy number alterations were compared across clinical groups and between RT responders and non-responders; non-response was defined as progression or death within 3 years.

RESULTS: Modern grading criteria, including brain invasion, TERT mutation, CDKN2A/B deletion, and 1p/1q status, would reclassify 10% of tumors and alter treatment group assignment in 7%. Non-responders to RT exhibited more frequent 1p and 14q loss, and more copy number alterations. Transcriptomic and epigenetic profiling revealed immune-related signatures in responders and cell cycle-related pathways in non-responders, several of which overlapped with targets of vorinostat, a histone deacetylase inhibitor previously validated in aggressive meningioma models. The Proliferative Molecular Group was an independent predictor of post-RT recurrence in multivariable analysis, outperforming WHO grade.

CONCLUSION: Multi-omic analysis of the NRG/RTOG-0539 cohort shows that updated WHO grading criteria, incorporating molecular and cytogenetic features, improve risk stratification. However, molecular classification, particularly the Proliferative group, remains an independent and stronger predictor of RT response. These findings support integrating molecular biomarkers alongside modern grading frameworks to guide treatment and trial design in meningioma.

PMID:42143623 | DOI:10.1093/neuonc/noag081

Age Ageing. 2026 May 4;55(5):afag129. doi: 10.1093/ageing/afag129.

ABSTRACT

BACKGROUND: Hospital-based education in geriatric medicine is often limited in availability and accessibility. Microlearning is defined as short, on-the-go, focused educational interventions (<15 minutes) and offers a practical way to deliver key geriatrics concepts in time-constrained environments. This systematic review investigated the effectiveness of microlearning to learn geriatric medicine principles for hospital-based clinicians.

METHODS: This systematic review with meta-analysis (PROSPERO: CRD42023422522) involved a comprehensive search across five databases. Studies evaluating microlearning interventions for hospital-based clinicians (medical, nursing and allied health) were included. Two independent reviewers conducted title/abstract screening and full-text review. Effectiveness was assessed using Kirkpatrick model, which evaluates educational outcomes across four levels: participant reaction, learning, behaviour and clinical practice. Data were synthesised narratively, and meta-analysis conducted using random-effects model. Study quality and risk of bias were assessed using Medical Education Research Quality Instrument and Newcastle-Ottawa scale-education.

RESULTS: Of 15 232 articles retrieved, 15 met inclusion criteria, mostly pre-post implementation studies (11/15, 73%). Common interventions included bedside teaching (6/15, 40.0%), pocket cards (5/15, 33.3%) and e-modules (4/15, 27%), focusing on delirium (9/15, 60%) and dementia (3/15, 20%). Of 40 educational outcomes measured, 90% showed positive results, and 30% were statistically significant. Meta-analysis indicated significant improvements in delirium knowledge (SMD 0.80, 95% CI 0.49-1.10, P < .00001) and recognition (SMD 0.91, 95% CI 0.10-1.72, P = .03).

CONCLUSION: Microlearning shows promise as an effective educational intervention for learning geriatric medicine principles, particularly recognising delirium. Further research is needed to assess impact on patient outcomes and guide implementation in current training programs.

PMID:42143602 | DOI:10.1093/ageing/afag129

JPEN J Parenter Enteral Nutr. 2026 May 17. doi: 10.1002/jpen.70103. Online ahead of print.

ABSTRACT

BACKGROUND: Malnutrition, frailty, and sarcopenia are common and interrelated in patients with cancer, yet their associations with nutrition impact symptom clusters remain unclear. This study examined the overlap of these conditions, and their relationships with symptom clusters in adults with cancer.

METHODS: Malnutrition was assessed using the Patient-Generated Subjective Global Assessment and Global Leadership Initiative on Malnutrition criteria, frailty using the FRAIL scale, and sarcopenia using the 2019 Asian Working Group for Sarcopenia consensus. Latent class analysis identified nutrition impact symptom clusters. Logistic regression models evaluated associations between symptom clusters and the three conditions.

RESULTS: This cross-sectional latent class analysis included 28,377 hospitalized adults with cancer (median age 58 years; 55.3% male). Gastrointestinal (41.0%) and lung (23.1%) cancers were the most common diagnoses. The prevalence of malnutrition, frailty and sarcopenia was 56.4%, 37.7%, and 16.9%, respectively. Weight loss and low muscle mass represent key shared features of their coexistence. Five nutrition impact symptom clusters were identified and ranked by severity. Patients with severe multi-symptom cluster had 3.87-fold higher odds of malnutrition and 6.03-fold higher odds of frailty. Patients with the gastrointestinal-dominant symptom cluster were most likely to experience malnutrition, whereas those with the sensory-alteration symptom cluster were most likely to exhibit frailty.

CONCLUSION: Maintaining stable body weight, particularly muscle mass, is crucial for cancer patients to reduce the risk of comorbidity among these conditions. Identifying nutrition impact symptom clusters and providing targeted interventions may help reduce the burden of these conditions and improve the efficiency of nutritional care.

PMID:42143564 | DOI:10.1002/jpen.70103

Clin Genitourin Cancer. 2026 Apr 14;24(5):102564. doi: 10.1016/j.clgc.2026.102564. Online ahead of print.

ABSTRACT

PURPOSE: To characterize financial toxicity (FT) of non-muscle invasive bladder cancer (NMIBC) among our uniquely diverse and urban population.

MATERIALS AND METHODS: We surveyed a cohort of patients at our institution with NMIBC using the validated COST tool (COmprehensive Score for financial Toxicity). Scores are inversely correlated to the degree of FT. Scores of 25-14 indicated “Mild FT” and < 14 indicated “Moderate FT”. Demographic and disease specific information were collected. Statistical analysis was performed using SPSS.

RESULTS: Hundred patients with NMIBC were surveyed. The median age was 74 years (IQR, 66-79). A total of 39% were female; 35% identified as Caucasian, 26% as Black, and 37% as Hispanic. The median COST score was 23 (IQR,15-33). 61% of patients reported at least mild FT (COST score 25-14). A total of 21% reported moderate FT (COST score < 14). Black patients were more likely to experience FT than Caucasians (73% vs 37%, P < .05). Caucasian patients had a mean COST score 8 points higher than all other races combined (P < .01). Overall median household income was $30,000 (IQR, $18,250-$60,750), and increasing income had a significant positive correlation with COST score (Spearman ρ = 0.502, P < .001). Risk factors for FT included non-Caucasian race and lower education level.

CONCLUSION: In a diverse, urban population, rates of FT among NMIBC patients were higher than previously reported. FT may disproportionately affect non-Caucasian patients and may be related to decreased access to care. These results highlight the need to further assess and address FT in NMIBC patients.

PMID:42143549 | DOI:10.1016/j.clgc.2026.102564

Clin Neurol Neurosurg. 2026 May 14;268:109473. doi: 10.1016/j.clineuro.2026.109473. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the association between antidepressant use and survival outcomes in patients with glioblastoma multiforme (GBM).

METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. MEDLINE, Embase, and LILACS were searched for observational studies evaluating the association between antidepressant use and survival in patients with GBM. Hazard ratios (HRs) for overall survival were pooled using a random-effects model. Subgroup analyses were performed by antidepressant class, timing of initiation, and patient age. Between-study heterogeneity was assessed using the I² statistic, and meta-regression was conducted to explore potential sources of variability.

RESULTS: Eight studies comprising 8915 patients were included. Antidepressant use was not significantly associated with overall survival (HR 1.09, 95% CI 0.76-1.55; p = 0.64), with substantial between-study heterogeneity (I² = 95%). Subgroup analyses revealed no significant survival association when stratified by antidepressant class (SSRIs alone: HR 0.95, 95% CI 0.73-1.25; SSRIs and TCAs combined: HR 1.18, 95% CI 0.62-2.26), timing of initiation (pre-diagnosis: HR 0.91, 95% CI 0.63-1.32; post-diagnosis: HR 1.28, 95% CI 0.64-2.54), or age. Leave-one-out sensitivity analysis confirmed the robustness of the null finding. Meta-regression did not identify antidepressant exposure as a significant source of heterogeneity. Gross total resection was consistently associated with improved survival across studies.

CONCLUSIONS: Current evidence does not support a survival benefit associated with antidepressant use in patients with GBM. Antidepressants should be prescribed based on psychiatric indications rather than with the expectation of oncological benefit. Prospective studies with standardized exposure definitions and molecular subtyping are needed to further clarify any potential therapeutic role.

PMID:42143537 | DOI:10.1016/j.clineuro.2026.109473

Clin Neurol Neurosurg. 2026 May 10;268:109471. doi: 10.1016/j.clineuro.2026.109471. Online ahead of print.

ABSTRACT

SIGNIFICANCE: Levetiracetam (LTM), a second generation anti-epileptic drug, is routinely prescribed to patients for seizure prophylaxis following traumatic brain injury (TBI). Limited research exists on the safety and efficacy of levetiracetam in patients aged 80 + . This study investigates the association between levetiracetam administration and outcomes in patients 80 + with severe TBI.

METHODS: Our institutional trauma registry was queried for patients aged 80 + who did not have an active anti-epileptic drug prescription and were admitted for severe TBI between January 2021 – May 2023. Statistical tests were performed to determine any significant difference in demographics or outcomes between those who received LTM and those who did not.

RESULTS: 91 patients were included in the final analysis, 32 not given LTM and 59 given LTM. Age was significantly higher in the no-levetiracetam group (87.07 vs. 85.91; p = 0.04). ISS (25 vs. 17 p = 0.04), Max AIS Head (5 vs. 4; p < 0.01), and three-month mortality rates (28.8% vs. 9.4%; p = 0.03) were significantly higher in the levetiracetam group. Three levetiracetam patients (5.08%) had their prescriptions discontinued due to adverse effects. Three levetiracetam patients experienced seizures within seven days of TBI but did not experience seizures at 3 months follow-up.

CONCLUSION: Levetiracetam is well-tolerated for seizure prophylaxis in patients 80 + following TBI based on low rates of adverse effects. Levetiracetam is generally prescribed to patients with more severe TBIs. Further studies are needed to determine long-term outcomes of levetiracetam in octogenarians with TBI.

PMID:42143536 | DOI:10.1016/j.clineuro.2026.109471

Food Chem. 2026 May 3;518:149492. doi: 10.1016/j.foodchem.2026.149492. Online ahead of print.

ABSTRACT

This study aims to characterise the milk metabolome from a seasonal pasture-based dairy system using ¹H-NMR spectroscopy. Over 41 weeks, ten dairy farms were visited weekly for the collection of raw bulk tank milk samples (n = 410) and three commercial pasteurised skimmed milks were also purchased weekly (n = 123). In total, 38 milk metabolites were quantified, 30 of which exhibited significant seasonal variation. Multivariate analysis identified several key compounds associated with seasonal metabolic changes. Winter-Feb milk, corresponding to early-lactation period, was enriched in ketone bodies, O-phosphocholine, creatinine, and glucose-1-phosphate, reflecting increased metabolic stress and negative energy balance following parturition. In contrast, autumn milk, corresponding to late-lactation, contained higher concentrations of choline and urea, indicative of improved energy status but reduced nitrogen use efficiency. These findings highlight the potential of milk metabolomics as a valuable tool for monitoring physiological status and guiding interventions to enhance sustainability in dairy systems.

PMID:42143509 | DOI:10.1016/j.foodchem.2026.149492