Category: Statistics

New Phytol. 2026 Apr 11. doi: 10.1111/nph.71148. Online ahead of print.

ABSTRACT

Leaf deciduousness is a key drought-avoidance strategy in tropical flora, reducing water loss during seasonal dry periods. While winter-deciduousness in temperate regions is well-understood, the evolutionary and environmental drivers of dry-season deciduousness remain poorly explored. Using the genus Mimosa, a species-rich and morphologically diverse lineage, we applied an eco-evolutionary framework to investigate the role of dry-season deciduousness across time and space. We combined a time-sliced trait-dependent diversification model, analyses of joint evolution of environmental niches in relation to leaf habit (deciduous vs evergreen), and phylogenetic multilevel models to test whether deciduousness influenced diversification and to identify its environmental drivers. Lineages switch from evergreen to deciduous habit more frequently before c. 7 Ma, whereas deciduous to evergreen transitions and increased speciation rates of evergreen lineages became dominant after this time. Deciduous lineages exhibited faster evolutionary rates along gradients of vapor pressure deficit, which also emerged as the strongest environmental predictor of deciduousness. However, most variation in leaf habit was explained by species-level (nonphylogenetic) variation and phylogeny. Although deciduous lineages respond rapidly to atmospheric dryness, dry-season deciduousness appears to be primarily shaped by the interplay between species identity and shared ancestry rather than by environmental conditions alone.

PMID:41964351 | DOI:10.1111/nph.71148

Anat Histol Embryol. 2026 May;55(3):e70108. doi: 10.1111/ahe.70108.

ABSTRACT

The radial artery is a vital access point for various cardiovascular and neurological interventions yet detailed morphometric studies in African populations are limited. This study aimed to investigate the radial artery dimensions in thirty adult body donors housed in the Department of Clinical Anatomy, University of KwaZulu-Natal, Durban, South Africa. The external and internal diameters, along with wall thickness of the radial artery, were measured at three anatomical sites viz. the point of origin, at the wrist joint and in the anatomical snuffbox bilaterally using a digital vernier calliper in sixty upper limb specimens (BREC/00006978/2024). There was a progressive distal tapering pattern, with the external diameters of the radial artery decreasing from its point of origin to the anatomical snuffbox. The internal diameter of the radial artery was 2.98 ± 0.76 mm at the origin, 2.20 ± 0.75 mm at the wrist joint and 1.75 ± 0.69 mm in the anatomical snuffbox. The wall thickness of the radial artery also decreased distally, from its point of origin to the anatomical snuffbox. There were no statistically significant differences between biological sex or laterality. The internal radial artery diameters suggest that a 5 French (5Fr) sheath may be suitable in 32% of upper limbs at the wrist and in 38% of upper limbs in the anatomical snuffbox. The findings of this study can contribute to the existing knowledge in this field and may help clinicians during cardiovascular and neurological interventional procedures within this select sample.

PMID:41964349 | DOI:10.1111/ahe.70108

J Dent Educ. 2026 Apr 11. doi: 10.1002/jdd.70223. Online ahead of print.

ABSTRACT

OBJECTIVE: This study assessed the validity of panoramic anatomical virtual reality (VR) software among senior dental students.

MATERIALS AND METHODS: A total of 79 fourth-year dental students were randomly divided into two groups in this crossover study. Students’ knowledge of panoramic anatomical landmarks was tested. The study group (VR-lecture) first received VR-based instruction and then lecture-based instruction, while the control group (lecture-VR) first received lecture-based instruction and then VR-based instruction. Both groups were tested before and after each learning method via an online 20-question quiz. In each group, there was a 1-week interval between primary and secondary learning methods. Student feedback was collected via an online survey.

RESULTS: The control group scored significantly higher in the VR posttest (independent samples t-test, p = 0.020), but no difference was found in posttest scores after the lecture (p = 0.681). Within-group comparisons showed a statistically significant increase in scores in both groups, but the study group demonstrated a significant increase from the VR pretest (13.58 ± 3.3) to the lecture posttest (16.61 ± 2.3) with a higher mean gain of 3.03 points (paired samples t-test, p < 0.001) than the control group. All students expressed strong positive attitudes in regard to VR’s effectiveness, ease of use, and motivational benefits.

CONCLUSION: Both groups showed statistically significant improvement in test scores. However, the study group demonstrated higher overall gain, suggesting that VR is a supplementary educational tool that may enhance initial conceptual understanding, which can then be reinforced through traditional didactic teaching.

PMID:41964332 | DOI:10.1002/jdd.70223

J Rural Health. 2026 Mar;42(2):e70151. doi: 10.1111/jrh.70151.

ABSTRACT

PURPOSE: Veteran use of Veteran Health Administration (VHA)-purchased community care (CC) for mental health has accelerated at a faster pace compared to both primary care and emergency services. Few studies have conducted an in-depth exploration of rural Veteran experience using community mental health. This paper focuses on the voices of rural Veterans, with the aim of exploring advantages and disadvantages for Veterans receiving mental health services through CC.

METHODS: We conducted interviews with rural Veterans, using purposive sampling to identify Veterans through the Integrated Veteran Care Consolidated Data Sets who were enrolled in VHA medical centers in the southcentral United States, had received CC for mental health, and were living in a rural area. Interviews asked Veterans about their experience with receiving community mental health care. We used thematic analysis to organize quotes and present salient themes from interviews.

FINDINGS: We interviewed 30 Veterans. We highlight four findings: (1) Most Veterans were pleased with the mental health care they received through the community. (2) Some Veterans reported instances of unprofessionalism and recognized a lack of military expertise among community providers. (3) Rural Veterans continue to face access barriers and noted limited availability of community mental health providers. (4) Difficulty with navigating multiple health systems impacted some rural Veterans’ continuity of care.

CONCLUSIONS: While CC has improved access to mental health care for Veterans, there are concerns related to the quality of care and continuity gaps for rural Veterans.

PMID:41964331 | DOI:10.1111/jrh.70151

Nurs Open. 2026 Apr;13(4):e70545. doi: 10.1002/nop2.70545.

ABSTRACT

AIM: To examine knowledge, attitude and practice of research utilization among clinical nurses and midwives using the Rogers theory of Diffusion of innovation.

DESIGN: Cross-sectional design.

METHODS: Quantitative with multistage sampling of 400 clinical nurses and midwives in six hospitals in Kumasi, Ghana. A self-administered questionnaire was used for data collection. Exploratory and inferential statistical analysis was carried out using Stata 16.

RESULTS: The findings indicated that the majority of respondents had moderate knowledge (71%), a negative attitude (56.2%), and did not practice (76.5%) research utilization. Hierarchical log-linear analysis revealed a significant positive relationship between research utilization knowledge and practice. Thus, nurses and midwives with more knowledge were more likely to use it. However, knowledge did not significantly affect their attitude towards research utilization. Similarly, attitude did not significantly affect practice. Binary logistic regression analysis revealed gender (male), practising for less than 10 years and profession (nursing) had higher odds of implementing research findings in their practice, with none being statistically significant.

CONCLUSION: Despite moderate research utilization knowledge, participants had a negative attitude and poor practice aligning with Rogers’ theory that attitude influences the decision to adopt an innovation. While research utilization knowledge was significantly associated with improved practice, it did not influence attitude, nor did attitude impact practice. This shows a significant disparity between respondents’ knowledge and practice highlighting a gap between knowledge and practice. Therefore, targeted interventions, including continuous professional development and institutional support, are essential to enhance research utilization knowledge, foster positive attitudes, and improve practice. Further research is needed to explore the underlying factors influencing research utilization in nursing and midwifery.

PMID:41964329 | DOI:10.1002/nop2.70545

J Dent Educ. 2026 Apr 11. doi: 10.1002/jdd.70228. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVES: Dental education is undergoing a digital transformation, yet the adoption of immersive technologies such as haptic virtual reality (HVR) remains limited. This study aimed to map global adoption trends, barriers, and opportunities for equitable integration of HVR in dental curricula.

METHODS: A 73-item global survey (July-August 2025) was distributed to dental educators across 57 countries via professional networks and social media. The mixed-methods instrument, validated by experts, assessed simulation methods, usage, barriers, and perceptions. Descriptive and exploratory inferential statistics (e.g., one-way ANOVA, Kruskal-Wallis, and chi-square tests) were used to analyze quantitative data, while thematic analysis was used to analyze qualitative responses. Ethical approval was granted by a university ethics review board (No. 13/2023).

RESULTS: Responses from 130 educators (115 institutions, 57 countries) showed traditional methods (phantom heads, n = 118; benchtop exercises, n = 84) dominating (∼80% clinical training time), while HVR (n = 42, primarily in undergraduate programs) and mixed reality (n = 14, primarily in undergraduate programs) were less prevalent, especially in postgraduate programs (10% HVR use). Barriers in implementing HVR simulators were mainly external, with a lack of resources (66.3%) and resistance from staff and students (21.3%), while personal barriers such as technological limits (9.0%), lack of training (2.2%), and lack of evidence (1.1%) were less common (total n = 89). Countries with higher socioeconomic status were found to use HVR more in undergraduate education than the less well-off countries (p = 0.002).

CONCLUSION(S): Immersive technologies remain underutilized in dental education, particularly at the postgraduate level, creating potential gaps in clinical preparedness. Strategic integration, collaboration, and sustainability-focused adoption may enhance equity and clinical readiness, informing accreditation and policy reforms.

PMID:41964327 | DOI:10.1002/jdd.70228

J Dent Educ. 2026 Apr 11. doi: 10.1002/jdd.70230. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to compare dental students’ subjective user experience of digital versus conventional axiography following structured teaching interventions, using the User Experience Questionnaire (UEQ).

METHODS: A total of 47 dental students (26.37 ± 3.81 years; 33 female) participated in a standardized seminar consisting of theoretical instruction and hands-on training in digital axiography using the ZEBRIS system. After completion of the course, the students evaluated both methods using the validated German version of the UEQ, covering six user experience scales. Internal consistency was assessed using Cronbach’s alpha, as well as Guttman’s lambda-2. Differences between digital and conventional axiography were analyzed using Wilcoxon matched-pairs signed-rank tests.

RESULTS: Digital axiography received higher mean UEQ scores across all scales, with particularly positive ratings in the hedonic dimensions of Stimulation and Novelty. These differences were statistically significant (p < 0.001). Pragmatic dimensions (Perspicuity, Efficiency, and Dependability) showed no significant differences between the two methods.

CONCLUSION: Digital axiography was perceived more positively by dental students than conventional axiography regarding the hedonic user experience. While both methods demonstrated comparable pragmatic qualities, the digital workflow offered added motivational value. These findings support the integration of digital axiography as an additional component alongside conventional techniques in dental education to enhance not only the learning experience but also preparedness for contemporary clinical practice.

PMID:41964326 | DOI:10.1002/jdd.70230

J Rural Health. 2026 Mar;42(2):e70145. doi: 10.1111/jrh.70145.

ABSTRACT

PURPOSE: Rural Veterans face persistent barriers to care, often exacerbated by health care workforce shortages. Although recruitment initiatives are important, retaining providers in rural areas is equally critical to sustaining access and continuity of care. This rapid scoping review examined how “rural workforce retention” is defined and measured in the peer-reviewed literature and synthesized recommended reporting elements to improve clarity and comparability.

METHODS: Six bibliographic databases were searched (2014-2025) for English-language studies of rural health care in the United States, Canada, the United Kingdom, and Australia using terms related to rural workforce retention. Data were extracted on definitions of retention, time frames, and measurement approaches.

FINDINGS: Of 2392 abstracts screened, 268 met inclusion criteria. Among these, 172 (64%) lacked a retention definition. Of the remaining 96, nearly half (45%) measured retention using providers’ intentions to stay or leave; others relied on turnover or continued rural practice. More than half (61%) specified a retention timeframe, most often retrospectively (41/59; 69%). Substantial heterogeneity across definitions, time horizons, and data sources led to the development of a reporting checklist outlining key conceptual, temporal, and methodological elements for retention research.

CONCLUSIONS: Inconsistent and incompletely reported measures of rural workforce retention limit evaluation and scalability of effective strategies. Research should explicitly define retention, specify a measurable time frame, and clearly report key conceptual and methodological elements to enable comparison across settings. For the Veterans Health Administration (VHA) and other rural systems, clear retention metrics are essential to ensure workforce stability and sustain access to high-quality care for rural Veterans.

PMID:41964317 | DOI:10.1111/jrh.70145

J Rural Health. 2026 Mar;42(2):e70140. doi: 10.1111/jrh.70140.

ABSTRACT

PURPOSE: To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics.

METHODS: Data from Waves 4-7 (2016-2023) of the Population Assessment of Tobacco and Health (PATH) study (N = 18,590 adults) were analyzed using survey-weighted logistic regression to evaluate location and time differences in likelihoods of current, daily, and established use of combustible tobacco, electronic nicotine delivery systems (ENDS), smokeless products, and poly use (≥2 products).

FINDINGS: Compared to those residing in urban locations, suburban residents were less likely to report current (adjusted odds ratio (aOR) = 0.88), daily (aOR = 0.73), and established combustible products use (aOR = 0.77); town residents were more likely to use these products currently (aOR = 1.20) and daily (aOR = 1.42), and rural residents were more likely to use daily (aOR = 1.25) and report established use (aOR = 1.33). Rural residents had a lower likelihood of current ENDS use (aOR = 0.90), compared with those in urban locations. Compared with urban residents, current smokeless products use was more likely among rural residents (aOR = 1.63) and less likely among those in suburban locations (aOR = 0.74). Participants living in suburban (vs. urban) locations were less likely to use ≥2 products currently (aOR = 0.89) or daily (aOR = 0.79), while rural residents were more likely to engage in daily poly use (aOR = 1.39). Time was a significant factor in all models, with fluctuating patterns across waves.

CONCLUSIONS: These findings highlight nuanced geographic differences in tobacco/nicotine product use patterns beyond simple urban-rural comparisons, informing efforts to eliminate tobacco/nicotine use disparities.

PMID:41964313 | DOI:10.1111/jrh.70140

Nurs Open. 2026 Apr;13(4):e70541. doi: 10.1002/nop2.70541.

ABSTRACT

BACKGROUND: Internationally qualified nurses (IQNs) form a critical part of the global health workforce, yet persistent structural inequities continue to limit their recognition and career mobility. Health systems in developed countries rely on IQNs to address shortages, but structural bias, credential hierarchies, and historically embedded knowledge valuation systems impede the full utilisation of their specialty skills. While regulatory standards are designed to protect patient safety, misalignment between global education systems and local recognition frameworks can inadvertently produce inequitable outcomes.

AIM: To explore how IQNs transfer and apply their specialty skills within the Australian health system and to identify the equity-oriented facilitators and barriers that shape this process.

DESIGN: A meta-synthesis of a sequential explanatory mixed-methods research program, underpinned by a pragmatic and explicit equity framework informed by principles of fairness, transparency, and recognition of global competence.

METHODS: Four interconnected studies (online surveys, interviews, and focus groups) were conducted with IQNs and recruiting managers across Australia. Phase 3 involved a meta-synthesis of findings from Phases 1 and 2, which were previously published, using joint display analysis and meta-inference generation to examine structural, organisational, and individual determinants of specialty skill utilisation.

RESULTS: Findings across four primary empirical studies reported in six peer-reviewed publications reveal that IQNs bring advanced specialty expertise that can enhance care quality and equity. However, system-level constraints, including recruitment bias, fragmented transition pathways, and inconsistent recognition of international qualifications, restrict their impact. Equity-focused transition programs and inclusive leadership development for both IQNs and recruiting managers emerged as critical mechanisms for change.

CONCLUSION: Harnessing IQNs’ specialised skills is not only a workforce imperative but a matter of justice. Balancing regulatory standards for patient safety with equitable recognition practices will enable nurses to act as agents of transformative change.

PATIENT OR PUBLIC CONTRIBUTION: The study involved 115 participants (n = 71 IQNs; n = 44 recruiting managers) whose lived experiences illuminate the urgent need for inclusive policy reform and equity-driven workforce transformation.

PMID:41964306 | DOI:10.1002/nop2.70541