Category: Statistics

Brain Behav. 2026 Jul;16(7):e71598. doi: 10.1002/brb3.71598.

ABSTRACT

BACKGROUND: Smartphone-based Ecological Momentary Assessment (EMA) enables the real-time measurement of emotional states in daily life, reducing recall bias and capturing clinically meaningful fluctuations. However, evidence regarding the reliability and validity of EMA measures remains limited, and validated instruments are scarce, highlighting the need for EMA-specific psychometric evaluation.

OBJECTIVE: To assess the reliability, validity, and structural characteristics of a brief 11-item smartphone-based EMA of mood in a non-clinical sample.

METHODS: We used data from a randomized controlled trial evaluating a 1-week digital self-efficacy training in a stress-enriched non-clinical sample of 93 Swiss university students. Baseline psychometric assessments included the Beck Depression Inventory II (BDI II), the Positive and Negative Affect Schedule (PANAS), the General Self-Efficacy Scale (GSE), the State and Trait Anxiety Inventory (STAI), and the Perceived Stress Scale (PSS). The EMA assessment included moods such as cheerful, irritated, anxious, happy, insecure, lonely, relaxed, sad, overthinking, focused, and stressed. Analyses included descriptive statistics, internal consistency (Cronbach’s alpha), and external validity (correlations between baseline questionnaires and participant-level aggregated EMA ratings from the first 24 h). Exploratory and confirmatory factor analyses and network analyses assessed the structure.

RESULTS: We considered the data of all 93 participants for the analysis. Participants (78.5% female) were on average 23.27 years of age (SD = 3.49). EMA items showed normal distribution, good internal consistency (α = 0.88), and low correlations (0.19-0.39) with the BDI II, the PANAS positive affect subscale, and the GSE. Moderate correlations (0.40-0.48) were found with the PANAS negative affect subscale, the STAI, and the PSS. An exploratory factor analysis indicated two or three factors, while network analysis revealed positive and negative affect communities. Confirmatory analysis suggested that the network model showed the most favorable fit indices among the models examined (CFI = 0.99; TLI = 0.99; RMSEA = 0.01).

CONCLUSION: The smartphone-based EMA mood item set provided preliminary evidence of reliability and validity in this stress-enriched non-clinical student sample. Findings suggest differentiation between positive and negative affective states, as well as between depressive and anxiety-related features. These results support the potential utility of the item set for monitoring transient mood states in non-clinical populations.

PMID:42444535 | DOI:10.1002/brb3.71598

Ann N Y Acad Sci. 2026 Jul;1561(1):e70325. doi: 10.1111/nyas.70325.

ABSTRACT

The preferential engagement of the right hemisphere in vertebrates biases visuospatial attention to the left. This attentional bias has been proposed as the basis for the organization of numbers along a left-to-right mental number line, with small numbers associated with the left and large ones with the right. In humans, this predisposition is modulated by culture, education, and even short exposure to spatial positions of numbers; yet data on animals are lacking. Here, in day-old chicks, we explore whether experience with increasing and decreasing numerical sequences influences the left-to-right visual exploration of numerosities. We conducted two experiments with day-old chicks (n = 70), training them to circumnavigate a sagittal sequence of three number sequences. In Experiment 1, chicks saw stimuli with either 2-5-8 (increasing-group) or 8-5-2 (decreasing-group) elements and then evaluated for searching behavior from left to right; in Experiment 2, we used larger numerosities, 8-20-32 or 32-20-8, and controlled for non-numerical cues. At test, chicks faced the stimuli arranged horizontally. We found that the increasing-group consistently approached the number stimuli from the left, regardless of the number arrangement. In contrast, the decreasing-group showed no directional preference. These results demonstrate that early exposure to numerical sequences can modulate the spontaneous left-to-right bias in newborn chicks, shedding light on the flexibility of cognitive biases in visuospatial and numerical cognition early in life.

PMID:42444529 | DOI:10.1111/nyas.70325

J Int Assoc Provid AIDS Care. 2026 Jan-Dec;25:23259582261467826. doi: 10.1177/23259582261467826. Epub 2026 Jul 14.

ABSTRACT

BackgroundDespite global advances in HIV care, pediatric populations in Africa continue to experience suboptimal treatment outcomes. Dolutegravir (DTG)-based antiretroviral therapy (ART) offers improved efficacy and tolerability, however, its real-world impact on viral load suppression (VLS) and the uptake of DTG-based regimens from older ART to newly recommended DTG-based ART among children and adolescents in Africa has not been systematically quantified.ObjectiveThis systematic review and meta-analysis aimed to estimate the pooled viral load suppression after initiation of dolutegravir-based ART and the uptake of DTG-based regimens from older regimens to dolutegravir-based ART among children and adolescents living with HIV in Africa.MethodsA systematic review and meta-analysis conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches of PubMed, Google Scholar, ScienceDirect, Hinari, CORE, and DOAJ were performed from January 01-10, 2026. Studies reporting VLS after initiation of DTG-based ART and the uptake of DTG-based regimens among pediatric patients with HIV in Africa were included. Pooled estimates were computed using random-effect models. Heterogeneity was assessed using I² statistics, and subgroup, sensitivity, and publication bias analyses were performed.Resultsout of 7,789 records screened, twenty-four studies comprising 119,292 participants were included. The overall pooled viral load suppression at six months after initiation of DTG-based ART was 82% (95% CI: 79-85%) and 70 (95% CI: 62-77%) among participants who were unsuppressed at baseline. The pooled uptake of DTG-based regimens was 77% (95% CI: 68-86%) based on 23 studies. Substantial heterogeneity was observed across outcomes (I²≥98%). Subgroup analysis indicated regional and study-design variation in the uptake of DTG-based regimens but not in viral suppression. No substantial publication bias was detected among the included studies.ConclusionDTG-based ART effectively suppressed viral load among pediatric patients in Africa, though adoption remains incomplete and below UNAIDS 95-95-95 targets. Significant heterogeneity highlights the influence of contextual and health system factors. Accelerated rollout, strengthened adherence support, and harmonized monitoring are needed to optimize pediatric HIV outcomes.

PMID:42444527 | DOI:10.1177/23259582261467826

J Appl Gerontol. 2026 Jul 14:7334648261464234. doi: 10.1177/07334648261464234. Online ahead of print.

ABSTRACT

BackgroundOlder women in India experience high levels of chronic illness, psychosocial distress, and social vulnerability. With the growing interest in predictive healthcare approaches, identifying psychosocial risk patterns among ageing women is critical for early intervention.ObjectiveThis study examined the prevalence of physical and mental health problems, coping strategies across age groups, and the relationship between coping styles and quality of life (QOL), along with implications for geriatric care.MethodsA descriptive analytical design was employed among 420 older women in Aligarh city using stratified random sampling. Data were collected through structured interviews, the WHO Quality of Life Scale (WHO-QOL), and a coping strategies inventory. Data were analysed using descriptive statistics, chi-square tests, ANOVA, correlation, and regression techniques.ResultsArthritis (44%) and hypertension (39%) were the most prevalent conditions, with 49% of respondents reporting multimorbidity. Problem-focused coping was associated with higher QOL, whereas avoidant coping showed a significant negative association. Social protection factors, including pension access and healthcare support, were positively associated with QOL.ConclusionThe findings highlight the importance of psychosocial and structural determinants in shaping quality of life among older women. These results provide empirically grounded indicators that may inform the future development of predictive and preventive geriatric healthcare approaches.

PMID:42444505 | DOI:10.1177/07334648261464234

Nurs Ethics. 2026 Jul 14:9697330261463755. doi: 10.1177/09697330261463755. Online ahead of print.

ABSTRACT

BackgroundWhen patients refuse basic nursing care in the hospital setting, ethical tension arises between promoting patient dignity by providing hygiene and honoring bodily autonomy by respecting patient refusal of interventions.Research AimTo describe patient factors, clinical context, and the role of ethics consultation when basic care is refused to identify implications for future practice and/or policy.Research DesignWe conducted a retrospective qualitative content analysis of adult and pediatric ethics consultation documentation between January 2015 and December 2025 at a quaternary academic medical center, screening 2,381 consultations to identify cases involving refusal of basic nursing care. We collected patient demographics, admission and clinical information, reasons for ethics consultation, and actions taken by the ethics consultation service. Data were summarized via descriptive statistics, and categories were abstracted to develop a framework.Participants and Research ContextPatients receiving inpatient care at an academic medical center in the Midwestern United States.Ethical ConsiderationsUniversity of Michigan IRBMED deemed the study exempt (HUM00256591).Findings34 ethics consultations for 29 unique patients involved refusal of basic nursing care. Patients were adults (100%), with an average LACE score of 12.8; 15 (44%) had decision-making capacity. Care over objection was provided in 16 (47%) of cases, and physical restraints were used in 2 (6%) cases. Refusals involved hygiene (18, 53%), wound care (15, 44%), and repositioning (9, 26%), and occurred across nursing units and clinical services. Refusals were addressed through persuasion (9, 26%), soft paternalism (13, 38%), hard paternalism (3, 9%), or permitted refusal (9, 26%).DiscussionEthics consultation involvement resulted in four approaches to refusal of basic nursing care based on patient agency, decision-making capacity, and clinical context.ConclusionsWhen refusal results in dignitary or physical harm, healthcare teams should address barriers and encourage participation. In rare circumstances, care over objection is ethically permissible with multidisciplinary input.

PMID:42444500 | DOI:10.1177/09697330261463755

Biom J. 2026 Aug;68(4):e70153. doi: 10.1002/bimj.70153.

ABSTRACT

Beyersmann et al. propose a functional interpretation of hazards, viewing them as evolving quantities describing the entire event process rather than as pointwise causal contrasts. In this commentary, we elaborate on the implications of this view for causal inference in modern clinical trials with survival outcomes. We emphasize how censoring, competing events, and multistate structures shape not only identifiability but also the definition and transportability of hazard-based estimands. We highlight that, even within a functional framework, censoring mechanisms may implicitly determine the statistical estimand through time-dependent weighting, with direct implications for generalizability across studies and populations. We further discuss how these issues are amplified in competing-risks and multistate settings, where causal interpretation requires careful consideration of intercurrent events and selection induced by post-randomization state occupancy.

PMID:42444496 | DOI:10.1002/bimj.70153

Int Health. 2026 Jul 14:ihag070. doi: 10.1093/inthealth/ihag070. Online ahead of print.

ABSTRACT

Corporate social responsibility has received substantial attention from researchers in the business and organizational literature. However, this concept is equally desirable in nursing care, as nurses must realize their responsibility towards society in the effective delivery of healthcare services. Employing the concept analysis method of Walker and Avant, 128 journal articles published in the PubMed journal during 2000 to 2025 were selected based on the inclusion criteria. Based on this model, the study proposes a framework for nurses’ social responsibility (NSR), especially in the context of developing countries. This framework coins three important dimensions of social responsibility that include NSR towards their profession, community, and patients. Based on the three dimensions of the NSR, this study proposes six major principles that govern this framework. It also presents four strategies for successful implementation of this framework. This framework also outlines certain challenges and mitigation strategies to effectively counter these challenges. Potential outcomes of the proposed framework are discussed, followed by a call for action to nurses, nursing organizations, governments, and the community at large.

PMID:42444477 | DOI:10.1093/inthealth/ihag070

Circ Heart Fail. 2026 Jul 14:e013935. doi: 10.1161/CIRCHEARTFAILURE.125.013935. Online ahead of print.

ABSTRACT

BACKGROUND: There is a growing consensus that screening for subclinical preheart failure (HF) may reduce the burden of symptomatic HF by allowing for timely preventive interventions. However, validated screening algorithms are currently lacking. The aim of this study was to evaluate a fully mobile telemedically supervised cardiac magnetic resonance, as a simple standardized, and ubiquitously applicable screening algorithm for subclinical pre-HF in rural and underresourced regions.

METHODS: HERZCHECK was a cross-sectional cohort study conducted at 12 sites across rural and underresourced regions of Germany. Asymptomatic participants (40-69 years) with ≥1 cardiovascular risk factor-obesity, smoking, arterial hypertension, diabetes, hypercholesterolemia, or chronic kidney disease-were enrolled and underwent telemedically supervised contrast-free short cardiac magnetic resonance in mobile screening units. Subclinical pre-HF was diagnosed using a predefined cutoff of global longitudinal strain ≥-15%. A matched and entropy-balanced control cohort constructed from claims data was used to determine the time difference between detection of subclinical pre-HF in HERZCHECK and the first symptom-based diagnosis of HF within the standard of care.

RESULTS: Between June 2021 and April 2023, 4666 participants were enrolled in the study, of which 4509 participants were included in the final analysis. The prevalence of subclinical pre-HF in the studied at-risk population was 22.7% (95% CI, 21.5%-23.9%). Global longitudinal strain-based screening identified subclinical pre-HF 6.7 years before the average onset of symptomatic HF within the standard of care (n=8420).

CONCLUSIONS: Subclinical pre-HF affects approximately one-fourth of the at-risk population in rural and underresourced regions. The HERZCHECK approach identifies patients suitable for targeted preventive interventions ≈7 years earlier than the standard of care.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05122793.

PMID:42444474 | DOI:10.1161/CIRCHEARTFAILURE.125.013935

Circ Cardiovasc Imaging. 2026 Jul 14:e019755. doi: 10.1161/CIRCIMAGING.126.019755. Online ahead of print.

ABSTRACT

Fetal ultrasound is the primary screening modality for routine prenatal examinations, but its effectiveness can be influenced by factors such as maternal body habitus, polyhydramnios, or fetal position. Although magnetic resonance imaging (MRI) is well established for fetal brain and body imaging, cardiac assessment has been restricted by the absence of reliable cardiac gating and motion compensation strategies. Only recently have advances in fetal cardiac rhythm monitoring within the MRI scanner enabled retrospective gating, paving the way for clinical use of fetal cardiac MRI. However, a reproducible and standardized imaging protocol for systematic cardiac assessment on cine sequences has not yet been universally adopted. This article proposes a practical framework for fetal cardiac cine MRI acquisition and interpretation based on a segmental approach consistent with standard fetal echocardiographic orientations, while also incorporating ungated T2-weighted imaging with slice-to-volume reconstruction for the assessment of extracardiac vascular anatomy. Representative cases with annotated anatomic landmarks illustrate how MRI can be integrated into a multimodality prenatal imaging strategy. The development of a standardized protocol may facilitate reproducibility across centers and support the incorporation of fetal cardiac MRI as a complementary tool within comprehensive prenatal cardiac evaluation.

PMID:42444472 | DOI:10.1161/CIRCIMAGING.126.019755

Circ Heart Fail. 2026 Jul 14:e014449. doi: 10.1161/CIRCHEARTFAILURE.126.014449. Online ahead of print.

ABSTRACT

BACKGROUND: Skilled nursing facilities (SNFs) play a critical role in postacute recovery for older adults with heart failure (HF), yet the transition from SNF to home remains a vulnerable and understudied phase of care. Although discharge guidelines emphasize clear communication, HF-specific self-care education, medication management, and follow-up coordination, little is known about how these practices are implemented during SNF-to-home transitions.

METHODS: We conducted a convergent mixed-methods study across 4 nonprofit SNFs, integrating data from postdischarge patient and caregiver surveys, structured medical record abstraction of discharge instructions, and semi-structured staff interviews. Eligible patients were Medicare beneficiaries aged ≥65 years discharged from SNF to home following HF hospitalization, with SNF stays ≤60 days. Quantitative data were analyzed using descriptive statistics, while qualitative data underwent thematic and directed content analysis. Findings were triangulated across data sources to identify key challenges and actionable strategies.

RESULTS: Among 150 respondents, 59% reported receiving written discharge instructions; however, HF-specific self-care elements (eg, daily weight monitoring, low salt diet) were documented in only 15% to 41% of instructions. Although 87% reported receiving a medication list, only 53% had it reflected in the discharge instructions, and adherence support was infrequently addressed (24%). Follow-up coordination was similarly discordant: 37% of respondents reported a scheduled primary care appointment, compared with 13% documented in discharge instructions. Staff interviews revealed nonstandardized discharge workflows, workforce constraints, and reliance on verbal education, contributing to variability in patient preparation and communication across care settings.

CONCLUSIONS: SNF-to-home transitions after HF hospitalization are marked by discordance between patient-reported education and written documentation, as well as inconsistent medication and follow-up coordination. These gaps represent modifiable vulnerabilities during a high-risk recovery period. Standardized HF-focused discharge workflows and strengthened cross-setting communication may improve transitional care, while long-term solutions must address structural and workforce constraints.

PMID:42444467 | DOI:10.1161/CIRCHEARTFAILURE.126.014449