Category: Statistics

J Pediatr Urol. 2026 Jul 30:106190. doi: 10.1016/j.jpurol.2026.106190. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate outcomes of conservative versus endoscopic initial management in pediatric ureterocele through a systematic review and exploratory meta-analysis, with emphasis on secondary surgical intervention and clinically relevant postoperative outcomes.

METHODS: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, and reference lists were searched for studies published from 1990 onward evaluating pediatric ureterocele managed initially with conservative observation and/or endoscopic puncture or incision. Comparative studies, retrospective cohorts, and case series with extractable data were eligible. Studies including single-system, duplex-system, intravesical, and ectopic ureteroceles were included. The primary outcome was secondary surgical intervention after initial management. Secondary outcomes included de novo vesicoureteral reflux (VUR), febrile urinary tract infection (UTI), and treatment success. Risk of bias was assessed using established tools for observational studies.

RESULTS: Twenty-five studies met inclusion criteria. Most were retrospective cohorts or case series with heterogeneous anatomical subtypes, patient populations, and outcome definitions. Sample sizes ranged from 9 to 287 patients. Four studies provided direct comparative data suitable for quantitative synthesis of the primary outcome. In a random-effects exploratory meta-analysis, no statistically significant difference was identified between initial observation and endoscopic treatment regarding the risk of secondary intervention (RR 0.40, 95% CI 0.13-1.24; I² = 36.5%). Across observational cohorts, selected low-risk patients managed conservatively frequently avoided surgical intervention during follow-up, whereas endoscopic decompression remained effective in symptomatic or higher-risk patients, although repeat procedures or delayed reconstruction were required in a subset. Secondary outcomes, including de novo VUR and febrile UTI, could not be quantitatively synthesized because of inconsistent definitions and reporting across studies.

CONCLUSIONS: Current evidence remains limited by retrospective study design, substantial anatomical heterogeneity, and confounding by indication. Although definitive comparative conclusions cannot be drawn, available data suggest that individualized management strategies may be appropriate in selected patients. Management decisions should be individualized according to anatomy, clinical presentation, obstruction, infection risk, and renal functional characteristics. Further prospective multicenter studies are needed to better define optimal patient selection criteria.

PMID:42580998 | DOI:10.1016/j.jpurol.2026.106190

Jt Comm J Qual Patient Saf. 2026 Jul 14:S1553-7250(26)00168-6. doi: 10.1016/j.jcjq.2026.07.004. Online ahead of print.

ABSTRACT

BACKGROUND: Accreditation is widely used to improve healthcare quality and patient safety; however, staff experiences during accreditation preparation and survey activities remain inadequately understood, particularly in Middle Eastern healthcare settings. The objective of this study was to examine healthcare staff experiences during Joint Commission International (JCI) accreditation and identify organizational factors associated with positive accreditation experiences and perceived outcomes.

METHODS: A cross-sectional survey was conducted among clinical and nonclinical staff at a tertiary academic medical center in Dubai, United Arab Emirates, following a JCI accreditation survey. Descriptive statistics, bivariate analyses, and multivariable logistic regression were used to evaluate associations between organizational factors and staff-reported experiences.

RESULTS: A total of 304 staff responses were analyzed. Overall perceptions of accreditation were highly favorable, with more than 90% of respondents reporting positive perceptions of patient safety, quality of care, teamwork, and leadership engagement. Leadership engagement (adjusted odds ratio [AOR] 2.45), perceived improvements in patient safety (AOR 2.89), and quality of care (AOR 2.63) were independently associated with positive accreditation experiences. Workload manageability (AOR 0.61) and psychological safety (AOR 0.68) were negatively associated with positive experience. Nurses and allied health professionals reported more favorable perceptions than physicians, although differences were small. Qualitative findings highlighted the need for continuous readiness, protected time for accreditation activities, improved coordination, and ongoing training.

CONCLUSION: Healthcare staff generally perceived JCI accreditation positively and associated it with improvements in patient safety and quality of care. Leadership engagement emerged as a key facilitator of positive accreditation experiences, whereas workload burden and psychological safety represented important challenges. Organizations implementing accreditation programs should prioritize continuous readiness, workforce support, psychological safety, and targeted physician engagement strategies to sustain accreditation benefits.

PMID:42580990 | DOI:10.1016/j.jcjq.2026.07.004

J Prosthet Dent. 2026 Aug 11:S0022-3913(26)00520-2. doi: 10.1016/j.prosdent.2026.07.016. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Personalized presintering pigmentation (PPSP) has been proposed to enhance the esthetics of monolithic zirconia. However, concerns remain regarding its impact on mechanical and optical properties.

PURPOSE: The purpose of this study was to systematically review and meta-analyze the effects of PPSP on the physicochemical and optical properties of monolithic zirconia.

MATERIAL AND METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided search of the PubMed, Scopus, and LILACS databases was conducted through December 2024. The protocol had been registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (2024120027). Studies evaluating PPSP effects on zirconia physicochemical and optical properties were included. Random-effects meta-analyses were performed in RevMan 5.4 when at least 2 studies reported comparable outcomes. Risk of bias was assessed with the Risk of Bias tool for DEntal MATerials (RobDEMAT). Standardized mean differences were used to estimate pooled effects and the I² statistic to assess heterogeneity.

RESULTS: Thirty-four studies were included. The descriptive review revealed that prolonged shading durations and acid colorants adversely affected most of the studied outcomes. The meta-analysis showed that when all techniques were combined, PPSP decreased zirconia’s biaxial and flexural strength, except when the zirconia specimens had been industrially colored before PPSP (P<.001); the surface roughness (Ra and Rz) and the Vickers hardness translucency of industrially colored zirconia were also reduced after PPSP (P<.001). Although statistically significant reductions were observed, pooled flexural strength values remained above the International Organization for Standardization (ISO) 6872 standard minimum requirement for 3-unit fixed dental prostheses (800 MPa). Translucency parameters were within established acceptability thresholds.

CONCLUSIONS: PPSP affects zirconia properties, but within limits that remain above the minimum flexural strength requirement for 3-unit fixed partial dentures and within established perceptibility and acceptability thresholds for translucency when manufacturer instructions are strictly followed.

PMID:42580978 | DOI:10.1016/j.prosdent.2026.07.016

Clin Ther. 2026 Aug 11:S0149-2918(26)00271-7. doi: 10.1016/j.clinthera.2026.07.010. Online ahead of print.

ABSTRACT

PURPOSE: Middle-aged adults with hypertension and no prior cardiovascular disease are commonly seen in clinical practice, yet limited research exists on optimal antihypertensive therapy for this group. This study evaluated whether cardiovascular outcomes vary by antihypertensive drug classes in this population.

METHODS: Using the Korean National Health Insurance Service database, we analyzed individuals aged <60 years without cardiovascular disease who were prescribed antihypertensive drugs between 2013 and 2014. Patients on monotherapy were grouped by drug class; those on ≥2 drug classes or uncommon agents (eg, alpha-blockers, hydralazine, or mineralocorticoid receptor antagonists) were categorized as “Others.” A subgroup analysis compared outcomes between different angiotensin receptor blockers (ARBs). The primary outcome was a composite of cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, and hospitalization for heart failure.

FINDINGS: A total of 217,617 participants were included; ARBs were the most common monotherapy (n = 59,906, 27.5%). During follow-up, 3.3% (n = 7080) experienced the primary outcome. The highest incidence of the primary outcome, all-cause death, and cardiovascular death occurred in the diuretic group, and the lowest observed rates were in the ARB group (P < 0.001). In multivariable analysis, beta-blockers (hazard ratio [HR] = 1.81, 95% confidence interval [CI] = 1.48-2.22, P < 0.001) and diuretics (HR = 2.09, 95% CI = 1.70-2.57, P < 0.001) were associated with higher event rates compared with the angiotensin-converting enzyme inhibitor reference group. No statistically significant differences were detected among the individual ARBs evaluated.

IMPLICATIONS: Among middle-aged adults with hypertension and no prior cardiovascular disease, ARB users had the lowest observed cardiovascular event rates in this cohort. The higher event rates observed with beta-blockers and diuretics likely reflect confounding by indication. These hypothesis-generating findings require confirmation in prospective studies.

PMID:42580976 | DOI:10.1016/j.clinthera.2026.07.010

Ultrasound Med Biol. 2026 Aug 11:S0301-5629(26)00269-3. doi: 10.1016/j.ultrasmedbio.2026.07.008. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study aims to assess the clinical utility of super resolution contrast-enhanced ultrasound (SR CEUS) in differentiating benign and malignant thyroid nodules for which fine-needle aspiration (FNA) is recommended according to the ACR guidelines, thereby providing incremental value beyond conventional ultrasound.

METHODS: A total of 51 patients with thyroid nodules were recruited in this prospective research. All the conventional ultrasound, CEUS and SR CEUS images were acquired and all of the CEUS parameters were analyzed. SR CEUS analysis included qualitative and quantitative parameters. The independent sample t-test, the Mann-Whitney U test, a chi-square test and the Fisher’s exact probability method were used to compare the difference between benign and malignant groups.

RESULTS: A total of 23 malignant nodules, 27 benign nodules and 1 borderline follicular tumor were included. With respect to CEUS characteristic, malignant lesions were associated with hypoenhancement, centripetal enhancement, later arrival time, heterogeneity enhancement, and earlier wash out time. With respect to microvascular morphology, malignant lesions were associated with convergence pattern and radial pattern. Benign lesions were associated with ring pattern, regular line-like and branch-like patterns and puncture vessel or avascular. The min interval, mean interval and med interval of local lesion were statistically different between benign and malignant nodules (p < 0.05).

CONCLUSION: The qualitative microvascular morphology based on SR CEUS showed high diagnostic value in the evaluation of thyroid nodules. For thyroid nodules recommended for FNA according to ACR guidelines, SR CEUS can provide additional diagnostic information and enhance the diagnostic performance of ultrasound.

CRITICAL RELEVANCE STATEMENT: This study verified for the first time the diagnostic value of super-resolution contrast-enhanced ultrasound for thyroid nodules.

PMID:42580954 | DOI:10.1016/j.ultrasmedbio.2026.07.008

Sleep Health. 2026 Aug 11:S2352-7218(26)00152-X. doi: 10.1016/j.sleh.2026.07.001. Online ahead of print.

ABSTRACT

PURPOSE: Healthy sleep habits are important when children transition from variable preschool environments to a more structured elementary school setting. However, few studies have harnessed the unique partnership between teachers and parents in preventing suboptimal child sleep. This study aimed to engage key community partners (i.e., 4K & 5K teachers and parents) in developing a combined school- and home-based sleep promotion program for young children (4-6 years old).

METHODS: Teachers (n=34, 100% female, 12.4±9.0 years’ experience) from 2 school districts participated in semistructured focus groups or phone interviews (n=26 teachers in 3 focus groups; n=8 interviews), while parents (n=61, 97% female, age=33.1 ± 5.1 years) completed an online semistructured survey to inform the development of a sleep promotion program. Transcripts were independently coded using an inductive approach and consensus coding. Themes were generated using constant-comparison methods. Survey results were summarized using descriptive statistics.

RESULTS: Four key themes emerged from teachers’ perspectives: 1) suboptimal sleep impacts children during the school day across multiple domains, (2) several barriers to adequate sleep exist, 3) parent-teacher interactions about sleep are complex and require unique approaches, and 4) a sleep program must fit within parent and teacher needs. Teachers noted leveraging the parent-teacher relationship may increase parent buy-in. Parents reported challenges with their child’s sleep and conveyed interest in a tailored sleep promotion program during 4K.

CONCLUSIONS: Teachers are concerned about suboptimal child sleep and are invested in working with parents to support healthy sleep habits. A sleep promotion program that encompasses collaboration between the school and home environment would be well-received by families of young children. Findings will inform future content, engagement strategies, and delivery mode.

PMID:42580950 | DOI:10.1016/j.sleh.2026.07.001

Lancet Digit Health. 2026 Aug 11:101035. doi: 10.1016/j.landig.2026.101035. Online ahead of print.

ABSTRACT

Artificial intelligence (AI)-based prediction models, including risk scoring systems and decision support systems, are being increasingly adopted in health care. Addressing AI fairness is essential to fighting health disparities and ensuring equitable model performance and patient outcomes. However, numerous and conflicting definitions of fairness complicate this effort. In this Viewpoint, we aim to support the transition of AI fairness from theory to practice using appropriate fairness metrics. We assess the relation of 27 fairness definitions identified in the literature to the model’s intended use, type of decision influenced, and ethical principles of distributive justice. Because of limitations in some notions of fairness, we argue that clinical utility, performance-based metrics (such as area under the receiver operating characteristic curve), calibration, and statistical parity are the most relevant group-based metrics for medical applications. Through two use cases, we show that different metrics might be applicable depending on the intended use and ethical framework. Our approach provides practical guidance for fair AI development, helping AI developers and assessors to evaluate model fairness and understand the effects of bias mitigation strategies, thereby supporting equitable AI-based implementations.

PMID:42580934 | DOI:10.1016/j.landig.2026.101035

Diagn Interv Imaging. 2026 Aug 11:S2211-5684(26)00139-7. doi: 10.1016/j.diii.2026.08.001. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to compare the image quality and lesion detection between ultra-low dose (ULD) chest-abdomen-pelvis computed tomography (CAP-CT) reconstructed with a deep-learning image reconstruction (DLR) algorithm, and standard-dose CT (STD-CT) in cancer follow-up.

MATERIALS AND METHODS: A total of 106 patients undergoing CAP-CT for the follow-up of cancer were prospectively included. Each patient underwent both STD-CT and ULD-CT acquisitions. ULD-CT images were reconstructed using two DLR levels (Smooth/Smoother). Dosimetric indicators, objective image quality, subjective image quality, and lesion detection were compared. Agreement between protocols and readers was assessed using Gwet’s AC1 or AC2 coefficients.

RESULTS: ULD-CT significantly reduced radiation exposure, with a mean CTDI_vol reduction of -71.5% and dose-length product reduction of -71.5% (P < 0.05). Minor but statistically significant differences in HU values were observed between STD-CT and ULD-CT across most tissues. For all organs or tissues, image noise was significantly higher with ULD-CT-Smooth than with STD-CT (P < 0.001), and with ULD-CT-Smoother than with STD-CT, except for dorsal vertebra (P = 0.39) and trachea (P = 0.26). For all organs or tissues, image noise was significantly lower with the Smoother DLR level than with Smooth DLR level (P < 0.001). Agreement between STD-CT and ULD-CT regarding lesion detection was almost perfect for thoracic, abdominal, and bone lesions. Detection of infracentimetric hepatic was lower with ULD-CT, whereas detection of larger lesions (≥ 10 mm) remained similar. Subjective image quality was lower with ULD-CT, with moderate inter-reader agreement, and lower diagnostic confidence than with STD-CT. One of the two readers considered that 19%-24% of ULD-CT examinations were uninterpretable.

CONCLUSION: ULD-CT with DLR offers substantial radiation dose reduction but resulted in poorer image quality and lower detection of small low-contrast abdominal lesions compared with STD-CT. Although lesion detection remained equivalent for thoracic and skeletal lesions, the high proportion of suboptimal or uninterpretable examinations may limit routine use of ULD protocols in cancer follow-up.

PMID:42580928 | DOI:10.1016/j.diii.2026.08.001

Med Dosim. 2026 Aug 11:S0958-3947(26)00056-7. doi: 10.1016/j.meddos.2026.07.003. Online ahead of print.

ABSTRACT

To develop and rigorously validate a deep learning framework for CT-free positron emission tomography (PET) attenuation correction in non-small cell lung cancer (NSCLC), with a comprehensive assessment of both quantitative and physical integrity to establish a proof-of-concept for its technical feasibility. A U-Net was trained on a multi-center dataset of 100 NSCLC patients to synthesize attenuation-corrected (AC) from nonattenuation-corrected (NAC) PET data. The framework’s performance was evaluated on an independent 30-patient test set. The multi-faceted validation protocol included global image fidelity (peak signal-to-noise ratio [PSNR], structural similarity index measure [SSIM]), quantitative lesion integrity (SUV_max/SUV_mean bias, dice similarity coefficient [DSC]), and fundamental physical characteristics (contrast recovery, spatial resolution). Bland-Altman analysis and paired statistical tests were used. The framework generated images with state-of-the-art global fidelity (PSNR: 36.2 dB; SSIM: 0.967). For lesion-specific analysis, the model introduced a negligible and statistically insignificant mean bias in both SUV_max (+0.72%;p=0.067). While SUV_mean showed a statistically significant difference due to per-patient aggregation, the absolute bias remained clinically negligible (-1.23%;p=0.005). Spatial accuracy was excellent (mean DSC: 0.89). Critically, physical performance was preserved, with 99.2% contrast recovery and no significant degradation in spatial resolution. Deep learning-based attenuation correction synthesis is a highly promising proof-of-concept for CT-less thoracic PET. By demonstrating quantitative fidelity and preserved image-derived physical characteristics, this work establishes a foundational step toward a prospective emission-only workflow, which has the future potential to enhance patient safety by eliminating CT-associated radiation dose.

PMID:42580920 | DOI:10.1016/j.meddos.2026.07.003

ISA Trans. 2026 Aug 4:S0019-0578(26)00399-X. doi: 10.1016/j.isatra.2026.08.005. Online ahead of print.

ABSTRACT

This paper constructs a safety-critical and resource-efficient synchronization control framework for multi-weighted directed networks with an adaptive intermittent event-triggered mechanism. First, the adaptive control gains are rigorously proven to remain bounded for practical feasibility. Second, a unified event-triggering condition with an internal dynamic variable is designed to integrate synchronization errors and safety margins, so that synchronization and safety requirements are handled within a single triggering logic. Third, safety is enforced as a hard constraint via an input-to-state safe barrier function and quadratic programming, providing a unified method to manage both safety and synchronization objectives. This framework guarantees asymptotic synchronization, state invariance within a safe set, and exclusion of Zeno behavior. A numerical example of a collaborative sensor network is provided to illustrate the theoretical findings.

PMID:42580904 | DOI:10.1016/j.isatra.2026.08.005