Category: Statistics

Int J Spine Surg. 2026 Aug 12:8930. doi: 10.14444/8930. Online ahead of print.

ABSTRACT

BACKGROUND: Image-guided pedicle screw placement improves accuracy over fluoroscopy, but level-specific performance and independent predictors in routine care remain incompletely defined. This study aims to compare intraoperative computed tomography (iCT)-navigated vs fluoroscopy-assisted (FA) lumbar screw placement, while quantifying level-specific performance and exploring independent predictors of optimal (grade A) placement.

METHODS: We performed a single-center retrospective, noncontemporaneous cohort study of 229 adults who underwent primary lumbar pedicle screw fixation, including 131 iCT navigated and 98 FA. In total, 1304 lumbar screws were graded on postoperative computed tomography (CT) using the Gertzbein-Robbins scale. Mixed-effects logistic regression estimated odds of Grade A placement with fixed effects for technique, pathology, level, side, and age.

RESULTS: iCT was associated with higher accuracy than FA (grade A 97% vs 86%), with no grade C breaches under iCT (vs 2% with FA). The advantage was level dependent and most pronounced at L5 (grade A 97.3%-98.2% with iCT vs 79.3%-85.7% with FA); additional statistically significant differences favored iCT at L2 left, L3 left, and L4 left, while L3 right showed a nonsignificant trend. In adjusted analyses, FA was associated with markedly lower odds of grade A placement. Trauma was independently associated with a reduced likelihood of grade A placement, whereas revision surgery served as the reference category and was not an independent predictor; age, level, and side were not independent predictors.

CONCLUSIONS: In this retrospective cohort, iCT navigation was associated with superior radiographic accuracy compared with fluoroscopy and higher rates of optimal screw placement. Traumatic pathology was associated with lower odds of optimal placement.

CLINICAL RELEVANCE: iCT-based navigation was associated with an increased likelihood of achieving optimal (Gertzbein-Robbins grade A) lumbar pedicle screw placement compared with fluoroscopy in routine clinical practice. The advantage appears particularly pronounced at L5 and in anatomically challenging scenarios. However, these findings are based on radiographic accuracy only and should be interpreted cautiously, as no direct conclusions on clinical outcomes or complication reduction can be drawn.

PMID:42586781 | DOI:10.14444/8930

J Appl Toxicol. 2026 Aug 12. doi: 10.1002/jat.70386. Online ahead of print.

ABSTRACT

Carbon nanoparticles (CNPs) have been reported to disrupt cellular integrity and induce oxidative stress and genotoxicity. Potential health risks thus make it imperative to look into tissue specific toxic impact and thereby focus on the safety measures. Given the wide-range applications of CNPs across biomedical and industrial domains, the present study was designed to investigate the dose-dependent effects of CNPs in male Sprague-Dawley rats. Characterization of synthesized CNPs was carried out using standard analytical techniques to determine their structure and composition through x-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). The rats were randomly divided into the following five groups: control group, saline group, and three treatment groups, which received intraperitoneal doses of CNPs over a 28-day period. Renal toxicity was determined through biochemical assay and the histological examination of kidney tissues. The data were statistically analyzed using Minitab 17. Both biochemical and microscopic findings revealed that CNPs exposure induced an increase in blood urea nitrogen, creatinine, and uric acid levels, indicating renal dysfunction. Similarly, kidney to body weight ratio showed a dose-dependent increase, which is consistent with the kidney injury. However, body weight was found decreased with respect to increased CNPs dose. Additionally, certain behavioral and physiological changes were also observed, that is, systemic distress, including weight loss, dry skin, and tight body condition. Autopsy revealed visibly compromised organ health, particularly in the kidneys, which appeared pale and shrunken. Histopathological assessment and serum biochemical analysis demonstrated renal damage at high dose. Overall, these findings revealed possible health hazards associated with CNP exposure, which induces significant renal toxicity in male Sprague-Dawley rats in a dose-dependent manner. Further research work is needed to develop smart strategies for risk assessment and the cautious use of CNPs in future.

PMID:42586780 | DOI:10.1002/jat.70386

Inj Prev. 2026 Aug 12:ip-2025-045936. doi: 10.1136/ip-2025-045936. Online ahead of print.

ABSTRACT

BACKGROUND: Cycling-related injuries are a growing public health concern. Although bicycle helmets are intended to reduce head injury severity, evidence regarding traumatic brain injury and mortality remains limited in large emergency department (ED)-based datasets.

METHODS: This matched case-control study used South Korean ED-based Injury In-depth Surveillance data from 2011 to 2021. Cases were injured cyclists who died in the ED; controls were injured cyclists whose ED disposition was not coded as death. Controls were matched to cases at a 1:4 ratio by age, sex and year of visit. Conditional logistic regression assessed associations of recorded helmet use with traumatic brain injury, the primary outcome and ED mortality, the secondary outcome.

RESULTS: Among 1394 injured cyclists, 282 were cases and 1112 were controls; 155 patients (11.1%) were recorded as wearing helmets. Recorded helmet use was associated with lower odds of traumatic brain injury, but the association was not statistically significant after adjustment (adjusted OR: 0.76, 95% CI 0.40 to 1.44). It was also associated with lower odds of ED mortality (adjusted OR: 0.30, 95% CI 0.14 to 0.65); however, only 11 helmeted patients died in the Evening crashes:ED arrival during evening hours (18:00-24:00) was associated with higher odds of ED mortality compared with daytime hours (06:00-18:00), and motor vehicle collisions were associated with higher odds of ED mortality.

CONCLUSIONS: Recorded helmet use was not significantly associated with traumatic brain injury after adjustment. Its association with lower ED mortality was based on only 11 helmeted deaths and may reflect limited precision, residual confounding and unmeasured crash severity. This finding should be interpreted cautiously and confirmed in larger studies with detailed crash data.

PMID:42586776 | DOI:10.1136/ip-2025-045936

J Epidemiol Community Health. 2026 Aug 12:jech-2025-225014. doi: 10.1136/jech-2025-225014. Online ahead of print.

ABSTRACT

INTRODUCTION: Falls among middle-aged and older-aged adults are a significant public health concern. However, a holistic understanding of how different indicators of socioeconomic position (SEP) are associated with falls is lacking, particularly for SEP across the life course.

METHODS: We systematically searched for observational studies analysing the association between at least one indicator of SEP and one fall outcome. Due to heterogeneity between included studies, results were narratively synthesised.

RESULTS: After de-duplication, 5880 search results were screened and 125 studies were included. Only 14 included studies explicitly aimed to study the relationship between SEP and falls, which generally found that higher SEP was associated with lower risks/rates of falls. An additional nine studies also had relevant adjusted models that largely showed a negative relationship. However, adjusted results were mixed and often lacked statistical significance. The remaining 102 studies only contained unadjusted results of interest, with 50-100% of results for each SEP indicator showing that low SEP groups experience disproportionately high risks/rates of fall outcomes compared with high SEP groups. Notably, only four studies measured any SEP indicators from a stage of the life course prior to the study period.

DISCUSSION: Our findings suggest that falls disproportionately impact low SEP groups and that knowledge gaps exist regarding the relationship between different SEP indicators and falls, particularly for SEP exposures across the life course. Future research on this topic should use causal diagrams for appropriate model building and include a wide range of SEP indicators across the life course.

PMID:42586773 | DOI:10.1136/jech-2025-225014

Mol Ecol. 2026 Aug;35(15):e70492. doi: 10.1111/mec.70492.

ABSTRACT

Early-life environmental and genetic factors play key roles in shaping the fitness of individuals by influencing life-history traits. The impact of early life conditions is hypothesized to be reflected at the cellular level on telomere length. In many animal species, telomeres shorten with age and their length early in life is often related to individual life expectancy. It is therefore essential to understand the relative importance of environmental and genetic factors influencing telomere length during this early developmental period. In this study we determine the relative influence of environmental and genetic components on telomere length in Tree swallows (Tachycineta bicolor) across various environments. To do so, we used data from 518 nestlings across 176 broods, collected over 2 years in a population breeding in southern Québec (Canada). We found no effect of environmental conditions on telomere length but found that nestlings from larger broods tended to have slightly longer telomeres. Parent-offspring regressions revealed a significant and positive association between nestling rTL and that of their mothers. While the association was also positive for fathers-offspring, it was slightly weaker and not statistically significant. Heritability of telomere length estimated using an animal model ranged between 0.34 and 0.55. Our results suggest that telomere length of Tree swallow nestlings is influenced by the proximal environment (i.e., within a brood) and by a genetic component. These findings suggest that broader-scale environmental conditions might not directly affect nestlings at this stage.

PMID:42586771 | DOI:10.1111/mec.70492

Genome Res. 2026 Aug 12. doi: 10.1101/gr.281262.125. Online ahead of print.

ABSTRACT

Advances in technology have decreased the cost of generating genetic data from ancient people, resulting in exponentially increasing numbers of individuals with whole-genome data. However, these technologies come with platform-specific biases, limiting coanalyzability of individuals sequenced with different technologies as well as joint analysis of modern and ancient individuals. Here, we present a method to identify single-nucleotide polymorphisms (SNPs) with minimal technology-specific bias. Leveraging data from more than 18,000 individuals, we apply this method to identify a set of around 1 million SNPs that we call the “compatibility” panel, which has been effectively assayed in a large fraction of ancient human DNA experiments published to date. We also identify a subset of these SNPs, the “compatibility-HO” panel, which are restricted to positions that have been assayed in more than 10,000 modern people from more than 1000 diverse populations using the Affymetrix Human Origins (HO) genotyping array. The compatibility panel reduces spurious Z-scores owing to differing sequencing platforms by nearly an order of magnitude, while retaining ∼60%-85% of statistical power for f-statistic analysis. We also provide a tool for users to select different tradeoffs between bias and power as well as sequencing platforms for their specific analyses.

PMID:42586760 | DOI:10.1101/gr.281262.125

Nurs Crit Care. 2026 Sep;31(5):e70627. doi: 10.1111/nicc.70627.

ABSTRACT

BACKGROUND: Intensive care units (ICUs) are among the most resource-intensive areas within health care and generate more waste and greenhouse gas emissions. Critical care nurses (CCNs) are well positioned to influence environmentally sustainable practices.

AIMS: To assess CCNs’ attitudes and climate-health engagement related to healthcare sustainability, to explore perceived challenges and identify other factors affecting sustainable practice in critical care settings.

STUDY DESIGN: A quantitative descriptive cross-sectional study was conducted using convenience sampling of CCNs working in adult ICUs, emergency departments and cardiac care units in the Eastern Region of Saudi Arabia. Data were collected using the Sustainability Attitudes in Nursing Survey (SANS-2), Climate, Health and Nursing Tool (CHANT) and a self-developed checklist to assess perceived challenges to practising healthcare sustainability, which were distributed electronically. Descriptive and inferential statistics, correlation analysis and multivariate linear regression were performed.

RESULTS: A total of 216 CCNs participated, yielding a response rate of 90%; the respondents demonstrated generally positive attitudes towards sustainability and climate change (mean SANS-2 score = 23.87 ± 8.69). Concern about the health impacts of climate change ranked highest among CHANT domains (76.0%), while sustainability-related behaviours at work were lowest (49.1%). Awareness, concern and motivation were positively associated with sustainability behaviours, whereas attitudes showed weak associations with behaviour. Key challenges included lack of organisational support (45.8%), staff shortages and workload (41.2%) and inadequate policies or infrastructure (36.1%). Leadership role and lack of previous training independently predicted higher attitude scores, whereas prior education predicted greater climate-health engagement.

CONCLUSIONS: Although CCNs express strong concern and positive attitudes towards sustainability, organisational and workload constraints limit translation into practice. Strengthening leadership engagement, targeted education and institutional support is essential to embed sustainable practices in critical care.

RELEVANCE TO CLINICAL PRACTICE: The study highlights sustainability attitudes, climate-health engagement, perceived challenges and persistent behavioural gaps, while identifying the central roles of education, leadership, and organisational support.

PMID:42586755 | DOI:10.1111/nicc.70627

Int J Health Plann Manage. 2026 Aug 12. doi: 10.1002/hpm.70104. Online ahead of print.

ABSTRACT

Sub-Saharan Africa (SSA) continues to experience a high and uneven disease burden, mainly from HIV/AIDS, tuberculosis, and malaria. As external funding declines, the strategic allocation of domestic public health spending (DPHS) becomes crucial. This study assesses whether directing DPHS towards major diseases and high-burden areas improves health outcomes across 43 SSA countries between 2003 and 2022, using DALYs as the outcome measure. Results show a statistically significant positive relationship between DPHS and DALYs: HIV-specific models yield coefficients of 0.105-0.288 (p < 0.01), and all-cause models yield coefficients of 0.071-0.085 (p < 0.05), while other models are insignificant. The paradoxical positive association-stronger in high-burden settings-suggests that DPHS is reactive, mainly used to address existing disease burdens rather than prevent them. The significant persistence of DALYs, especially in low-burden and high-burden contexts, further indicates that spending is directed towards treatment and case management rather than preventive measures. The DPHS effect on tuberculosis or malaria outcomes in DALYs is slightly greater in low-burden areas. Beyond health spending, factors such as economic growth, inequality, population ageing, and governance substantially influence health outcomes. Overall, the findings highlight that while DPHS remains essential, its current reactive deployment limits effectiveness. A systemic shift is needed towards proactive, preventive approaches with targeted health interventions to reduce the region’s disease burden.

PMID:42585620 | DOI:10.1002/hpm.70104

JCO Clin Cancer Inform. 2026 Jul-Sep;10(3):e2600018. doi: 10.1200/CCI-26-00018. Epub 2026 Aug 12.

ABSTRACT

PURPOSE: AML is a highly aggressive hematologic cancer. During induction chemotherapy, up to 40% of patients experience complications resulting in unplanned readmissions or early death. This study aimed to identify the reasons for postinduction unplanned readmissions and to develop predictive models for unplanned readmissions or early death using structured and unstructured electronic health record (EHR) data to identify patients at highest risk.

METHODS: We retrospectively analyzed 1,111 inpatient encounters from 305 adult patients with AML treated at a Midwestern university hospital between 2006 and 2021. Inclusion criterion was adults with AML undergoing induction chemotherapy; exclusion criteria included acute promyelocytic leukemia, stem cell transplant recipients, and confirmed chronic myeloid leukemia. Adverse events-unplanned readmissions or mortality within 30 days of discharge from the initial induction hospitalization-were identified through chart review using predefined rules. Multiple logistic regression was used to identify risk factors. Variable selection was performed using the least absolute shrinkage and selection operator.

RESULTS: Within 30 days postdischarge, 22% of patients experienced an unplanned readmission. The most frequent reasons were fever/infection (53.5%), metabolic/GI/renal complications (16.2%), and pain/discomfort (14.1%). Mortality within 30 days was 22%. Predictive performance improved when comorbidities and symptom frequency from clinical notes were added (AUC increased from 0.67 to 0.74). Statistically significant predictors of increased adverse event risk included solid neoplasm (odds ratio [OR], 2.34), higher cardiopulmonary symptom burden per day (OR, 1.16), and a chemotherapy intensity moderated by age (OR, 0.90).

CONCLUSION: Unplanned readmissions or early mortality occurred in 39.7% of patients with AML within 30 days postdischarge. Integrated risk stratification tools leveraging structured and unstructured EHR data may inform timely interventions to improve survival and reduce avoidable hospitalizations.

PMID:42585617 | DOI:10.1200/CCI-26-00018

J Clin Oncol. 2026 Aug 12:JCO2501846. doi: 10.1200/JCO-25-01846. Online ahead of print.

ABSTRACT

PURPOSE: Age ≥40 years is regarded as a high-risk feature and an indication for adjuvant chemoradiotherapy for patients with lower-grade glioma in clinical practice guidelines. It is unclear whether age remains a relevant prognostic factor for contemporary definitions of lower-grade gliomas in the molecular era.

METHODS: The Prospective Gliomas Research (PROGRES) database contains individual patient-level data from 11 prospective clinical trials or observational registries of histologically defined lower-grade 2-3 oligodendroglioma or astrocytoma. We determined the association of age (18-39 years v ≥40 years) with progression-free survival (PFS) stratified by isocitrate dehydrogenase 1 or 2 (IDH1/2) status, using log-rank tests and Cox regression models. We validated our findings in a separate multi-institutional retrospective cohort (Retrospective Glioma Research [REGRES] database).

RESULTS: We identified 1,619 and 1,292 eligible patients in the PROGRES and REGRES cohorts, respectively. IDH-wildtype tumors were more common in patients 40 years and older (38% v 5%, odds ratio: 11.3 [95% CI, 6.5 to 19.7]). Age was associated with PFS in IDH-wildtype (5-year PFS for ≥40 v 18-39 years: 6% v 24%, hazard ratio [HR], 1.74 [95% CI, 1.21 to 2.50]) but not in IDH-mutant glioma (60% v 59%, HR, 0.89 [95% CI, 0.76 to 1.05], P_interaction < .001). In IDH-wildtype tumors, older age predicted aggressive molecular features, including TERT promoter mutation (65% v 28%), EGFR amplification (41% v 15%), and chromosome +7/-10 alteration (57% v 25%). In a pooled analysis of four clinical trials, age was not predictive of a benefit from chemoradiotherapy versus radiotherapy alone for IDH-mutant glioma.

CONCLUSION: In the absence of additional clinical or molecular risk factors, age alone should not be considered an indication for administration or deferral of adjuvant treatment. Practice guidelines should be revised to reflect contemporary prognostic factors in the molecular era.

PMID:42585601 | DOI:10.1200/JCO-25-01846