Category: Statistics

Insights Imaging. 2026 Feb 3;17(1):33. doi: 10.1186/s13244-026-02215-6.

ABSTRACT

OBJECTIVES: In the context of a global appraisal of the environmental impact of radiology, this survey among members of the European Society of Breast Imaging (EUSOBI) investigated procedural aspects of ultrasound-guided core-needle breast biopsy that may impact its environmental sustainability.

MATERIALS AND METHODS: A 25-item online questionnaire, developed by a panel of nine breast imaging experts, was distributed from September 25th to December 25th, 2024, within the EUSOBI mailing list and social media platforms. The survey investigated materials routinely used for ultrasound-guided core-needle biopsies, waste disposal practices, the relationship between perceived procedural hygiene levels and self-reported frequency of post-procedural infectious complications, and results’ communication methods. Replies were analysed with descriptive and non-parametric statistics.

RESULTS: Among the 787/823 respondents (95.6%) who routinely perform ultrasound-guided core-needle biopsy, most (460/787, 58.4%) perceived to attain aseptic conditions, without significant associations (p = 0.334) of hygiene levels with post-procedural infectious complications (never seen by 549/776 respondents, 70.7%). For most disposable materials, the majority of respondents used no more than one unit per procedure, including sterile gloves (551/787, 70.0%), sterile drapes (651/787, 82.7%), and sterile gel packets (729/787, 92.6%), also avoiding to use prepackaged biopsy kits (424/787, 53.9%). However, most respondents did not use recycling bins (404/787, 51.3%) and employed at least one resource-intensive modality to communicate benign results (in-person or by letter, 584/787, 74.2%).

CONCLUSION: Procedural aspects of ultrasound-guided core-needle biopsy carrying an environmental impact vary widely. In the absence of significant associations between perceived hygiene levels and post-procedural infectious complications, resource-intensive habits could be safely streamlined to improve sustainability.

CRITICAL RELEVANCE STATEMENT: This EUSOBI survey demonstrates that, despite widely varying procedural aspects in ultrasound-guided core-needle breast biopsy, higher perceived sterility levels are not associated with fewer infections, highlighting opportunities to safely reduce resource use and environmental impact.

KEY POINTS: This EUSOBI survey investigated how procedural habits and the use and amount of material in ultrasound-guided core-needle breast biopsy impact its environmental sustainability. Procedural aspects varied widely among the 787/823 respondents who routinely perform ultrasound-guided core-needle breast biopsy. While some economically driven sustainable behaviours are already in place, there are several opportunities to reduce materials use and waste. As no association was found between perceived hygiene levels and post-procedural infections, resource-intensive hygiene-related practices could be streamlined to improve sustainability.

PMID:41632394 | DOI:10.1186/s13244-026-02215-6

CJEM. 2026 Feb 3. doi: 10.1007/s43678-026-01091-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Management of febrile neutropenia in previously healthy, presumed immunocompetent children varies. Unnecessary treatment impacts the patients, families, and the healthcare system. With guidance from a Canadian Paediatric Society Practice Point, most well-appearing children with a first episode of febrile neutropenia can be managed with reduced exposure to antibiotics and close outpatient follow-up. The aim of this initiative was to safely reduce antibiotic use in this low-risk population presenting to the emergency department (ED).

METHODS: A multidisciplinary team designed a quality improvement (QI) initiative. From July 2022 to July 2024, treatment with antibiotics was classified as indicated or non-indicated according to guidance from the Practice Point. Interventions involved guideline dissemination, provider education, and point-of-care tools to facilitate clinical decision-making and follow-up. Outcome measures included the proportion of children receiving antibiotics, hospital admission, and appropriate laboratory follow-up. Re-presentation to ED and missed serious bacterial infections were monitored as balancing measures. Analysis of the primary outcome was by statistical process control.

RESULTS: Three hundred and ninety-eight (398) children with febrile neutropenia were included. The proportion of non-indicated antibiotics was 6.7% at baseline. Statistical process control analysis of the G-chart demonstrated special cause variation with 97 consecutive cases occurring without error (non-indicated antibiotics). Following the occurrence of special cause variation until the end of the study, only 1.6% of children received non-indicated antibiotics. There was no increase in re-presentations to ED (9% vs 8%; p = 0.65) nor missed serious bacterial infections (0% vs 0%).

CONCLUSIONS: Quality improvement methodology can facilitate the timely adoption of best practices to align local clinical care with new national guidelines. Implementation of the national guideline allowed low-risk children with febrile neutropenia to avoid overtreatment.

PMID:41632376 | DOI:10.1007/s43678-026-01091-9

Eur J Nutr. 2026 Feb 3;65(2):38. doi: 10.1007/s00394-026-03893-0.

ABSTRACT

PURPOSE: Cocoa is a significant source of theobromine, a bioactive compound proposed to provide cardiovascular protection. However, relatively few studies have provided conclusive evidence of the potential beneficial health effects. The aim of this study was to determine the relationship between the consumption of cocoa products containing theobromine and cardiovascular risk factors in the U.S. population sample using 2015-2020 National Health and Nutrition Examination Survey (NHANES) data.

METHOD: This cross-sectional study included 8531 individuals aged 20-70 years and 3808 people in a fasting sub-sample. Theobromine and cocoa product intake levels were obtained from 24-h dietary recalls and linked to the Food and Nutrient Database for Dietary Studies database. Primary outcomes included systolic and diastolic blood pressure, hypertension, serum total, HDL and LDL cholesterol, triglyceride, glycohemoglobin, insulin, plasma glucose, and high-sensitivity C-reactive protein (hs-CRP). Linear regression models were applied to analyze the associations between theobromine or cocoa product consumption and cardiovascular risk factors.

RESULTS: The consumption of cocoa was not associated with cardiovascular disease risk factors compared to non-consumption. The amounts of cocoa consumed were inversely associated with glycohemoglobin levels (mean ± SE, – 0.04 ± 0.02% per 100 g, P = 0.04). Theobromine intake (vs. no intake) was positively associated with serum insulin (1.85 ± 0.85 μU/mL; P = 0.03). Theobromine levels consumed were inversely associated with glycohemoglobin (- 0.05 ± 0.03% per 100 mg, P = 0.04), serum triglycerides (- 5.4 ± 2.73 mg/dL, P = 0.05), and hs-CRP levels (- 0.26 ± 0.12 mg/L, P = 0.04). These associations were also mostly observed in people with healthier profiles.

CONCLUSION: Increased cocoa consumption is associated with reduced glycohemoglobin levels, while higher theobromine intake is associated with reduced triglyceride, glycohemoglobin, and hs-CRP levels compared to a lower intake. The positive link between theobromine intake, as opposed to no intake, and serum insulin required further investigation. Overall findings support the inclusion of cocoa-derived compounds in healthy diets.

PMID:41632311 | DOI:10.1007/s00394-026-03893-0

Support Care Cancer. 2026 Feb 3;34(2):159. doi: 10.1007/s00520-026-10331-8.

ABSTRACT

PURPOSE: To assess the effect of patient education on quality of life, fatigue, and anxiety in patients diagnosed with lung cancer.

METHODS: An electronic search was conducted across four databases (PubMed, Web of Science, CINAHL, and Scopus) using a combination of terms including lung neoplasms, health education, educat (truncated), quality of life, fatigue, and anxiety. The Cochrane RoB 2 tool and the TIDieR checklist were used to assess risk of bias and intervention replicability, respectively. The GRADE approach was applied to evaluate the certainty of the evidence. Study selection, data extraction, and all assessments were carried out independently by two reviewers. Where appropriate, data were pooled using meta-analysis (95% confidence interval [CI]).

RESULTS: Seventeen studies were included in the qualitative synthesis, and thirteen in the quantitative analysis, comprising a total sample of 1799 participants. The meta-analysis demonstrated that, compared with controls, patient education interventions had a statistically significant and large effect on improving quality of life (SMD = 0.98; 95% CI [0.26, 1.69], p = 0.007, I² = 96%), anxiety (SMD = -1.75; 95% CI [-2.74, -0.77], p = 0.0005, I2 = 98%) and fatigue (SMD = -0.091; 95% CI [-1.61, -0.22], p = 0.01, I2 = 88%). In all cases, heterogeneity remained high. However, the educational content of the interventions was generally consistent, with most being delivered in a face-to-face format.

CONCLUSIONS: Patient education appears to be an effective approach for improving quality of life, fatigue, and anxiety in individuals with lung cancer. Nevertheless, these findings should be interpreted with caution, as the certainty of the evidence was rated as very low.

PMID:41632307 | DOI:10.1007/s00520-026-10331-8

Cancer Immunol Immunother. 2026 Feb 3;75(3):66. doi: 10.1007/s00262-026-04318-x.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitor doublet (ICI-ICI) and ICI plus tyrosine kinase inhibitor (ICI-TKI) regimens are the cornerstone of treatment for metastatic renal cell carcinoma (mRCC), although no head-to-head comparisons are currently available. This study aimed to compare the real-world effectiveness of ICI-ICI versus ICI-TKI combinations in patients with intermediate- and poor-risk mRCC according to International Metastatic RCC Database Consortium (IMDC).

METHODS: The Meet-URO 33 study is a multicentre retrospective-prospective registry collecting real-world data on patients with mRCC. Multivariable logistic and Cox models were built for objective response rate (ORR), PFS and OS, with a propensity score (PS) adjustment for baseline imbalances.

RESULTS: Among 1497 patients, 755 were intermediate-risk (199 ICI-ICI, 556 ICI-TKI) and 312 poor-risk (77 ICI-ICI, 212 ICI-TKI). Median follow-up was 14.2 months (8.0 months and 14.5 months in poor- and intermediate-risk subgroups, respectively). In poor-risk patients, median OS was 20.3 versus 12.9 months (HR 0.87, 95% CI 0.59-1.28, p = 0.49), and median PFS was 6.7 versus 8.7 months (HR 1.10, 95% CI 0.79-1.54, p = 0.53), for ICI-ICI versus ICI-TKI, respectively. In the intermediate-risk patients treated with ICI-ICI versus ICI-TKI, median OS was 37.8 versus 35.5 months (HR 1.08; 95% CI 0.77-1.50; p = 0.65), and median PFS was 17.8 versus 18.6 months (HR 1.29, 95% CI 1.00-1.66, p = 0.050). ORR was 42.9% versus 45.8% in poor-risk patients (OR 0.72, 95% CI 0.39-1.34, p = 0.303) and 48.1% versus 54.3% in intermediate-risk patients (OR 0.71, 95% CI 0.48-1.04, p = 0.075).

CONCLUSIONS: No statistically significant differences in survival or response were observed between ICI-ICI and ICI-TKI combinations in patients with IMDC intermediate- and poor-risk mRCC.

PMID:41632305 | DOI:10.1007/s00262-026-04318-x

Quintessence Int. 2026 Feb 3;0(0):0. doi: 10.3290/j.qi.b6881272. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical margin relocation (CMR) is a non-invasive technique using composite resin to elevate the interproximal floor beneath indirect restoration, improving margin integrity and tooth vitality.

OBJECTIVES: This study evaluated periodontal outcomes of CMR, like pocket depth (PD) and bleeding on probing (BOP), as well as restorative outcomes.

METHODS: A systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Scopus, Google Scholar, and Web of Science with keywords like ‘Cervical Margin Relocation,” “Deep Margin Elevation,” and ” Proximal Box Elevation,”. Meta-analyses assessed PD and BOP, analyzing heterogeneity with I² statistic.

RESULTS: After sensitivity analysis, CMR does not appear to worsen periodontal PD or BOP in periodontally healthy or stabilized patients when proper isolation and restorative protocols are followed. The standardized mean difference for PD is -0.60 (95% CI [-0.94, -0.27], p = 0.001), with heterogeneity reduced to I² = 0%; and BOP also showed (OR: 0.06, 95% CI [0.01, 0.44]), with I² = 0%. These findings reflect the periodontal tolerance to properly executed CMR. Material selection affected marginal adaptation, with glass-ceramic bonding yielding the best outcomes. Composite margin elevation was effective for deep cavities, surpassing ceramic onlays, and subgingival resin composites enhance periodontal health.

CONCLUSION: CMR is effective for managing subgingival margins and compatible with periodontal health when appropriate materials are used. Material selection impacts marginal adaptation, and long-term follow-up is essential for measuring durability, offering valuable insights for clinical practice.

PMID:41631460 | DOI:10.3290/j.qi.b6881272

Biometrics. 2026 Jan 6;82(1):ujaf176. doi: 10.1093/biomtc/ujaf176.

ABSTRACT

In the present study, we examine long-term population-level effects on episodic memory of an intervention over 15 years that reduces systolic blood pressure in individuals with hypertension. A limitation with previous research on the potential risk reduction of such interventions is that they do not properly account for the reduction of mortality rates. Hence, one can only speculate whether the effect is due to changes in memory or changes in mortality. Therefore, we extend previous research by providing both an etiological and a prognostic effect estimate. To do this, we propose a Bayesian semi-parametric estimation approach for an incremental threshold intervention, using the extended G-formula. Additionally, we introduce a novel sparsity-inducing Dirichlet prior for longitudinal data, that exploits the longitudinal structure of the data. We demonstrate the usefulness of our approach in simulations, and compare its performance to other Bayesian decision tree ensemble approaches. In our analysis of the data from the Betula cohort, we found no significant prognostic or etiological effects across all ages. This suggests that systolic blood pressure interventions likely do not strongly affect memory, either at the overall population level or among individuals who would remain alive under both the natural course and the intervention (the always survivor stratum).

PMID:41631433 | DOI:10.1093/biomtc/ujaf176

Biometrics. 2026 Jan 6;82(1):ujag002. doi: 10.1093/biomtc/ujag002.

ABSTRACT

Motivated by the need for flexible and interpretable models to handle circular data, this paper introduces a semiparametric regression model for a circular response that can include both linear and circular covariates in its parametric and nonparametric components. Rather than imposing a particular parametric distribution on the error term, we adopt a circular quasi-likelihood function, which is useful when the underlying distribution is unknown. We discuss the asymptotic properties of the resulting estimators and a backfitting algorithm for model fitting. We evaluate the finite-sample performance of our proposal through simulations and illustrate its advantages for assessing the genetic effect on the migratory patterns of willow warblers. This offers new insights into how specific genomic elements can influence migratory behaviour.

PMID:41631432 | DOI:10.1093/biomtc/ujag002

Biometrics. 2026 Jan 6;82(1):ujag004. doi: 10.1093/biomtc/ujag004.

ABSTRACT

The Cox proportional hazards model (Cox model) is a popular model for survival data analysis. When the sample size is small relative to the dimension of the model, the standard maximum partial likelihood inference is often problematic. In this work, we propose the Cox catalytic prior distribution for Bayesian inference on Cox models, which extends a general class of prior distributions originally designed to stabilize complex parametric models. The Cox catalytic prior is formulated as a weighted likelihood of the regression coefficients derived from synthetic data and a surrogate baseline hazard constant. This surrogate hazard can be either provided by the user or estimated from the data, and the synthetic data are generated from the predictive distribution of a fitted simpler model. For point estimation, we derive an approximation of the marginal posterior mode, which can be computed conveniently as a regularized log partial likelihood estimator. We prove that our prior distribution is proper and the resulting estimator is consistent under mild conditions. In simulation studies, our proposed method outperforms standard maximum partial likelihood inference and is on par with existing shrinkage methods. We further illustrate the application of our method to a real dataset.

PMID:41631431 | DOI:10.1093/biomtc/ujag004

Respir Care. 2026 Feb 3:19433654251405270. doi: 10.1177/19433654251405270. Online ahead of print.

ABSTRACT

BACKGROUND: Prone positioning is a recommended therapy for patients with moderate-to-severe ARDS; however, the optimal duration of this maneuver is still unknown.

METHODS: We performed a systematic review and meta-analysis comparing clinical outcomes of extended (≥24 h) versus traditional prone positioning (16-24 h) of adults with moderate-to-severe ARDS receiving invasive mechanical ventilation.

RESULTS: Ten studies involving 2,412 subjects met the inclusion criteria, including one randomized controlled trial and 9 observational studies, all with COVID-19-related ARDS. Extended prone positioning was associated with reduced mortality compared with the traditional approach (risk ratio [RR]: 0.76, 95% CI 0.66-0.86, I² = 12.8%). Sensitivity and subgroup analyses confirmed consistency across risk of bias, baseline P_aO2/F_iO2, and PEEP levels. No differences were found in duration of mechanical ventilation (mean difference [MD]: 2.43 days, 95% CI -1.06 to 5.92, I² = 70%) or ICU stay (MD: 1.31 days, 95% CI -1.07 to 3.68, I² = 55%). The extended strategy was associated with a higher incidence of pressure injuries (RR: 1.30, 95% CI 1.02-1.65, I² = 56%) but no differences in device displacement or hemodynamic instability. Certainty of evidence was rated as low to very low.

CONCLUSIONS: Extended prone positioning was associated with reduced mortality in ARDS but increased risk of pressure injuries, without impact on ventilator duration or ICU stay. While this strategy appears feasible and potentially beneficial, further randomized trials are warranted to confirm its role in routine practice.

TRIAL REGISTRATION: PROSPERO no. CRD42024529311.

PMID:41631378 | DOI:10.1177/19433654251405270