Category: Statistics

Caspian J Intern Med. 2026 Mar 10;17(2):403-411. doi: 10.22088/cjim.17.2.403. eCollection 2026.

ABSTRACT

BACKGROUND: Renal diseases strongly influence global health burden and healthcare costs, especially for countries with low and middle socio-demographic indices. This study aimed to provide data on kidney disorder patterns and compare results with our previous analysis of biopsy-proven renal diseases to determine how the pattern is changing in our region.

METHODS: This cross-sectional analysis of 2,392 native renal biopsies was performed from 2019 to 2024 at the Namazi Hospital, a tertiary referral healthcare center in Shiraz, Iran.

RESULTS: Of 2,392 native kidney biopsies, primary glomerulonephritis was the most common finding, with the leading diagnosis of membranous glomerulonephritis (MGN), followed by focal segmental glomerulosclerosis (FSGS), and mesangioproliferative GN (MesGN). For secondary GN, lupus nephritis (LN), diabetic nephropathy, and amyloidosis were prominent. Lupus nephritis was the only female-predominant subtype (p < 0.001). Significant male predominance was observed in MGN (p < 0.001), IgA nephropathy (p< 0.001), Amyloidosis (p< 0.05), and hypertensive nephropathy (p < 0.05), whereas most other renal biopsy subtypes showed no statistically significant gender differences (p > 0.05). Age-related analysis showed that LN was the predominant finding in patients <45 years, whereas MGN was the most common among older patients (P < 0.001).

CONCLUSION: Comparing the proportions of biopsy results with our previous analysis revealed that FSGS and LN decreased dramatically, while MGN, Diabetic nephropathy, IgA nephropathy, and tubulointerstitial diseases showed increasing trends. These data provided essential clues for further studies on organizing renal health goals.

PMID:42668987 | PMC:PMC13525818 | DOI:10.22088/cjim.17.2.403

PeerJ. 2026 Aug 24;14:e21631. doi: 10.7717/peerj.21631. eCollection 2026.

ABSTRACT

INTRODUCTION: Intensive Care Unit (ICU) patients are at high risk of acute clinical deterioration and in-hospital mortality. Accurate prediction of in-hospital mortality is essential for optimizing clinical decision-making and resource allocation. However, most existing models rely primarily on short-term physiological data from a single hospitalization and lack adequate external validation. This study develops a deep learning-based model that integrates long-term temporal clinical sequences derived from patients’ historical ICU records with diagnostic information from the current ICU admission to predict in-hospital all-cause mortality during the current hospitalization. The proposed framework is applicable to both patients with a single ICU admission and those with multiple ICU admissions.

METHODS: We used current and historical International Classification of Diseases (ICD) codes, temporal features, and basic demographics to construct the prediction models. Single-admission patients were represented as one-event sequences, while repeated-admission patients were represented as longitudinal diagnostic trajectories. Model training and internal validation were conducted based on the MIMIC-IV database, while the eICU and MIMIC-III databases were used for external independent testing. Five deep learning (DL) models, including Informer and Transformer, were constructed for comparative analysis. On this basis, a stacked model integrating these five base models was further developed. The Area Under the Receiver Operating Characteristic Curve (AUROC), calibration curves, and clinical epidemiological analyses involving meta-analyses across different datasets were used to comprehensively evaluate the model’s predictive performance, generalizability, and specific clinical application value.

RESULTS: A total of 22,176 patients from Medical Information Mart for Intensive Care IV (MIMIC-IV), MIMIC-III, and eICU were included, and five deep learning models as well as one stacked ensemble model were constructed. In the internal validation set, the AUROC of most deep learning models exceeded 0.89, with the exception of the RNN. Among them, the Informer model achieved the best internal performance, with an AUROC of 0.95 (95% CI [0.928-0.967]). In the dual external validation across different databases, model performance exhibited apparent heterogeneity across cohorts. Although no single model consistently outperformed others, the stacked ensemble model showed relatively competitive overall predictive accuracy and stable generalizability.

CONCLUSIONS: Compared with traditional models based on short-term biochemical indicators, the proposed deep learning models and the stacked ensemble model demonstrated competitive predictive performance for in-hospital mortality. This study demonstrates the potential of deep learning for ICU mortality prediction and proposes a novel framework for integrating longitudinal diagnostic trajectories into predictive modeling.

PMID:42668985 | PMC:PMC13525758 | DOI:10.7717/peerj.21631

PeerJ. 2026 Aug 24;14:e21549. doi: 10.7717/peerj.21549. eCollection 2026.

ABSTRACT

BACKGROUND: The purpose of this study was to compare the influence of three enamel finishing and polishing systems (Sof-Lex discs, lithium disilicate Eve burs and lithium disilicate polishing burs) on the shear bond strength and distribution of failure modes of nanohybrid composite resin bonded to enamel.

MATERIALS AND METHODS: A sample of 240 healthy human premolars were randomized into four treatment groups (n = 60 per group): (1) untreated control, (2) Sof-Lex disc polishing, (3) lithium disilicate EVE burs (Li-EVE) burs, and (4) lithium disilicate polishing burs (Li-Polish) burs. Specimens were prepared with standardized protocols and restored with a nanohybrid composite and universal adhesive system. The enamel surfaces were etched with 35% phosphoric acid. Shear bond strength (SBS) was measured using a universal testing machine and fracture modes were assessed with a dissecting microscope. Descriptive statistics, one-way analysis of variance (ANOVA), Games-Howell post hoc test, and chi-square analysis of the mode of failure were conducted at α = 0.05.

RESULTS: There were significant differences in SBS between the groups (F(3,236) = 10.54, p = 1.6 ± 10^-6). Both Sof-Lex (31.39 ± 7.81 MPa) and Li-Polish (30.94 ± 5.70 MPa) had significantly higher bond strength values than control (23.18 ± 14.04 MPa) and Li-EVE (26.00 ± 8.26 MPa) (p ≤ 0.024). There was no significant difference between Sof-Lex and Li-Polish (p = 0.82). The failure modes were predominantly cohesive in all the groups and the distribution of failure modes was not significantly different (χ ² (3) = 6.31, p = 0.098, Cramér’s V = 0.162).

CONCLUSION: The enamel polishing system significantly influenced composite bond strength. Multi-step polishing systems, e.g., Sof-Lex discs or Li-Polish burs, increased adhesive performance markedly over the control groups or one-step polished systems to untreated enamel. The failure mode was not significantly influenced by polishing systems. These findings demonstrated the importance of finishing systems for successful restorative performance.

PMID:42668980 | PMC:PMC13525744 | DOI:10.7717/peerj.21549

J Multidiscip Healthc. 2026 Aug 25;19:624664. doi: 10.2147/JMDH.S624664. eCollection 2026.

ABSTRACT

BACKGROUND: As newly employed nurses transition into clinical practice, understanding and implementing Entrustable Professional Activities (EPAs) is crucial for ensuring quality patient care and professional development. This study aims to assess the knowledge, attitudes, and practices (KAP) of newly employed nurses regarding EPAs.

METHODS: A cross-sectional, multicenter study was conducted between September 2024 and November 2024 in six general hospitals. The study included newly employed nurses who voluntarily consented to participate. A self-designed questionnaire was used to collect demographic characteristics and KAP scores.

RESULTS: A total of 240 valid questionnaires were collected. Among the participants, 193 (80.42%) were female, and 219 (91.25%) held an associate or bachelor’s degree. Additionally, 142 respondents (59.17%) reported working 40 to 49 hours per week, while 172 (71.67%) had received training related to EPAs. The median (interquartile range) scores for knowledge, attitude, and self-reported practice were 16 (13-18.5), 46 (40-50), and 40 (38-49), respectively. Exploratory path analysis showed that knowledge was negatively associated with self-reported practice after accounting for attitude (β = -0.121, P = 0.012), whereas attitude was positively associated with self-reported practice (β = 0.514, P = 0.012). The path from knowledge to attitude (β = 0.111, P = 0.115) and the indirect association between knowledge and self-reported practice through attitude (β = 0.057, P = 0.127) were not statistically significant.

CONCLUSION: Newly employed nurses demonstrated insufficient knowledge but positive attitudes and proactive self-reported practices regarding EPAs. Positive attitudes were associated with higher self-reported practice scores, whereas the association between knowledge and self-reported practice was more complex. Targeted education combining EPA-related knowledge, practical training, and mentorship may support self-reported practice, although its effects on actual clinical performance and patient outcomes require evaluation in future longitudinal or interventional studies.

PMID:42668973 | PMC:PMC13525766 | DOI:10.2147/JMDH.S624664

PeerJ. 2026 Aug 24;14:e21643. doi: 10.7717/peerj.21643. eCollection 2026.

ABSTRACT

BACKGROUND: Among low- and middle-income countries, noncommunicable diseases (NCDs) are a significant health burden among the elderly. Mobile health interventions provide resource-constrained health education that is scalable.

AIMS: Determine the viability, acceptability, and preliminary effects of culturally adapted Short Message Service (SMS)-based nutrition and lifestyle change on the knowledge, attitudes, and practices (KAP) of older adults in Jordan towards prevention of noncommunicable diseases (NCDs).

METHOD AND MATERIALS: A total of 79 older adults (mean age 57.33 ± 9.37 years) with NCDs received 30 culturally tailored SMS messages daily for one month. Messages were based on Social Cognitive Theory and addressed dietary habits, physical activity, and NCD risk reduction. A validated Arabic-adapted KAP questionnaire was administered pre- and post-intervention.

STATISTICAL ANALYSIS: Paired-samples t-tests were used to compare pre- and post-KAPs. Effect sizes were calculated using Cohen’s d. Sociodemographic factors associated with KAP improvement were examined through multiple linear regression (p ≤ 0.05).

RESULTS: Significant improvements occurred in knowledge (mean difference = 40.62, p ≤ 0.001; Cohen’s d = 3.29) and attitudes (mean difference = 24.43, p ≤ 0.001; Cohen’s d = 1.77). There was no significant change in practice scores (p = 0.175). Overall KAP improved significantly (p ≤ 0.001; Cohen’s d = 2.15), driven primarily by gains in knowledge and attitudes; practice scores did not change significantly. Greater improvement in KAP was associated with higher education (β = 0.379, p ≤ 0.001), younger age (β = – 0.646, p ≤ 0.001), female sex (β = – 0.067, p = 0.007), and living alone (β = 0.150, p = 0.031).

CONCLUSIONS: The pilot study indicates that culturally adapted SMS messaging among older adults with NCDs is feasible and acceptable in Jordan, and its early impacts on knowledge and attitudes are promising. These results provide preliminary evidence and effect size estimates needed to design a fully powered randomized controlled trial to determine effectiveness.

PMID:42668969 | PMC:PMC13525760 | DOI:10.7717/peerj.21643

Patient Prefer Adherence. 2026 Aug 25;20:615467. doi: 10.2147/PPA.S615467. eCollection 2026.

ABSTRACT

BACKGROUND: Thalassemia is a chronic blood disorder requiring lifelong blood transfusions and iron chelation therapy (ICT) to reduce iron overload.

PURPOSE: In Pakistan, limited evidence exists on how medication adherence, clinical outcomes, and health-related quality of life (HRQoL) interact simultaneously in β-thalassemia major (β-TM) children. This study therefore aimed to evaluate these variables and examine their interrelationships in pediatric β-TM patients receiving ICT.

METHODS: A cross-sectional observational study was conducted among 622 patients aged 5-12 years across six thalassemia centers in Punjab, Pakistan (September 2024-February 2025). For data collection, Treatment Adherence Scale (TAS) and Paediatric Quality of Life Inventory™ (PedsQL™) 4.0 Generic Core Scales were used. Clinical outcomes were assessed via hematological and iron overload parameters. Statistical analyses, including non-parametric tests, Friedman test, multiple regression analysis, and Spearman’s rank correlation, with p < 0.05 considered significant.

RESULTS: The total adherence score was 6 IQR (3-8). Clinical outcomes showed significant improvement in hemoglobin levels, while serum ferritin remained elevated. Younger age, urban residency, and deferasirox monotherapy were significantly associated with higher adherence and HRQoL. The total QoL score was 67.3 IQR (50-84.4). Family history, deferoxamine use, and serum ferritin were identified as negative predictors of adherence and HRQoL, whereas urban residency, splenectomy, and higher adherence to ICT were positive predictors of HRQoL. A significant positive correlation was found between adherence and HRQoL (ρ = 0.420, p < 0.001), while serum ferritin was negatively correlated with adherence (ρ = -0.476, p < 0.001) and HRQoL (ρ = -0.329, p < 0.001).

CONCLUSION: Pediatric β-TM patients reported moderate overall adherence to ICT. Clinical outcomes showed improvement in anemia and increased iron overload. HRQoL was moderately affected, especially in school functioning. Patients with low adherence had lower HRQoL and increased serum ferritin levels, reflecting suboptimal clinical outcomes.

PMID:42668965 | PMC:PMC13525769 | DOI:10.2147/PPA.S615467

Iowa Orthop J. 2026;46(1):293-301.

ABSTRACT

BACKGROUND: This study aimed to comprehensively assess the most recent data on the prognostic effects of hematologic markers, including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII), on deep vein thrombosis (DVT) following lower limb fractures.

METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study was registered in PROSPERO (CRD420251006336). We performed a comprehensive search in the PubMed, EMBASE, Web of Science, and Scopus electronic databases. Date of publication and language were not restricted. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated and all statistical analyses were performed using Stata 18 software.

RESULTS: Ten studies, involving a total of 6183 patients with lower extremity fractures, of whom 896 developed DVT, were included in the final analysis. The results indicated that, compared to the non-DVT group, patients with DVT had higher levels of NLR (SMD = 0.48, 95% CI = 0.02-0.94, p = 0.04) and SII (SMD = 1.01, 95% CI = 0.121.89, p = 0.02). However, PLR and MLR level was not different between the two groups. Among the evaluated biomarkers, SII demonstrated the highest specificity (80%, PLR = 74%), while NLR had the highest sensitivity (68%).

CONCLUSION: The literature supported that, compared to the non-DVT group, patients with DVT had higher levels of NLR and SII. Among these biomarkers, SII demonstrated the highest specificity, while NLR had the highest sensitivity. Composite inflammatory markers, particularly SII, may hold value in DVT risk stratification during post-fracture period.Level of Evidence: II.

PMID:42668964 | PMC:PMC13525540

Pak J Med Sci. 2026 Aug;42(8):1934-1942. doi: 10.12669/pjms.42.8.16082.

ABSTRACT

OBJECTIVES: To evaluate the effects of different anesthesia procedures and surgical approaches on maternal and neonatal outcomes in cases of abnormal placental invasion (API), and to determine the factors that predict the transition from spinal anesthesia to general anesthesia.

METHODOLOGY: This retrospective cohort study included 115 patients who underwent API surgery at University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey; between 2015 to 2023. Demographic, obstetric, anesthetic, surgical, and neonatal data were analyzed. Comparisons were made based on the anesthesia type (spinal, general, and spinal-to-general conversion) and depth of invasion.

RESULTS: Placenta percreta was detected in 67% of the cases. As the severity of invasion increased, the operative time, blood and fluid replacement, and hospital stay were significantly prolonged (p<0.05). The American Society of Anesthesiologists (ASA) score, blood product consumption, and intraoperative complication rates were significantly higher in patients undergoing general anesthesia (p<0.001). Spinal anesthesia was the first choice (91.3%), and 47.6% of the cases required intraoperative conversion to general anesthesia. ROC analysis revealed that colloid use, ASA score, and fibrinogen requirement were significant predictors. There were no statistically significant differences in neonatal outcomes between the groups.

CONCLUSION: In API cases, initiating neuraxial anesthesia, which allows for transition to general anesthesia when necessary, may improve maternal safety. Parameters such as colloid use and ASA score may guide early identification of high-risk cases. Prospective multicenter studies are required to establish standard management protocols for this high-risk group.

PMID:42668945 | PMC:PMC13525536 | DOI:10.12669/pjms.42.8.16082

Pak J Med Sci. 2026 Aug;42(8):1980-1986. doi: 10.12669/pjms.42.8.7502.

ABSTRACT

OBJECTIVE: To determine the sensitivity, specificity, and diagnostic accuracy of caesarean scar tenderness in predicting uterine dehiscence or rupture during per-operative findings.

METHODOLOGY: This cross-sectional study was conducted in the Department of Obstetrics & Gynaecology, JPMC, Karachi, from November 2021 to July 2024. Women with singleton pregnancies having previous caesarean were given Trial of Labor After Caesarean (TOLAC) after informed consent using consecutive sampling. Exclusion criteria included uterine abnormalities, hypertension, diabetes mellitus, multiple pregnancies, and pre-eclampsia. Data were collected on demographic details, clinical findings, and operative outcomes. Statistical analysis was performed using SPSS Version 27.

RESULTS: A total of 385 women were included in the study. Scar tenderness was present in 67.8% of women. Uterine rupture was found in 22.3% of cases, while scar dehiscence was present in 49.9%. The sensitivity of scar tenderness in predicting uterine rupture and dehiscence was 85.6%, and the specificity was 78.5%. The positive predictive value (PPV) was 91.2%, and the negative predictive value (NPV) was 67.7%. The overall diagnostic accuracy was 83.6%.

CONCLUSIONS: Scar tenderness is a useful clinical predictor of uterine scar complications during TOLAC, particularly in low-resource settings.

PMID:42668942 | PMC:PMC13525533 | DOI:10.12669/pjms.42.8.7502

Int J Microbiol. 2026 Aug 29;2026:3336189. doi: 10.1155/ijm/3336189. eCollection 2026.

ABSTRACT

Tropical peatlands are among the largest global carbon sinks and face increasing impacts from drainage, fire, and land-use change. These disturbances modify soil physicochemical characteristics and influence bacterial community structure. However, the response of bacterial communities to these changes is incompletely understood. This study examined bacterial community composition at six peatland sites in the Giam Siak Kecil-Bukit Batu Biosphere Reserve, Riau, Indonesia. The sites represent various land-use types: secondary forest, restored peat, burned peat, oil palm, rubber, and acacia plantations. The analysis employed 16S rRNA gene sequencing combined with measurements of soil physicochemical properties. Results showed that key bacterial phyla, such as Acidobacteriota, Pseudomonadota, and Actinomycetota, were consistently found across sites, though their relative abundances varied. Burned sites had increased abundances of Bacillota and other copiotrophic groups and decreased abundances of several oligotrophic taxa. Beta diversity analysis showed differences in community patterns among sites, but multivariate analysis did not show significant differences between land-use types. Variation in bacterial community composition is associated with soil pH and nutrient availability, including available phosphorus, exchangeable potassium, and exchangeable magnesium, although these relationships are not always statistically supported. A small number of ASVs were detected across all sites, suggesting overlapping community members amid high spatial heterogeneity. Overall, tropical peatland bacterial communities form within a narrow environmental framework in which distinctive physicochemical properties constrain which microbes can survive. Land-use changes are primarily associated with shifts in the relative abundance of bacterial taxa rather than complete community turnover. Given the limited number of samples and single time-point observations, these findings are exploratory and provide a basis for further research.

PMID:42668938 | PMC:PMC13525552 | DOI:10.1155/ijm/3336189