Category: Statistics

N Z Med J. 2026 Jun 12;139(1636):36-43. doi: 10.26635/6965.7377.

ABSTRACT

AIM: The aim of this article was to examine clinical and demographic factors associated with receipt of rhythm control procedures (electrical cardioversion [ECV] or ablation) in patients with atrial fibrillation or flutter (AF/AFL) in Auckland, Aotearoa New Zealand.

METHOD: We conducted a retrospective cross-sectional study of patients with AF/AFL, collecting data up to 31 August 2021. Descriptive statistics were used to characterise procedural use, and associations between patient factors and rhythm control procedures were assessed using multivariable logistic regression.

RESULTS: We identified 1,908 patients with AF/AFL (46.8% female), of whom 292 (15.3%) underwent rhythm control procedures (ablation in 109, ECV only 183). In adjusted analysis, increasing age (adjusted odds ratio [aOR] per year 0.96 [95% confidence interval (CI) 0.95-0.97]) and female sex (aOR 0.46 [95% CI 0.34-0.63]) were associated with lower odds of receiving rhythm control procedures. Compared with European patients (New Zealand/other European), Māori (aOR 0.52 [95% CI 0.36-0.77]), Pacific peoples (aOR 0.41 [95% CI 0.28-0.60]) and other ethnicities (aOR 0.47 95% CI 0.28-0.79]) were less likely to undergo rhythm control procedures. The most common indication for rhythm control procedures was symptomatic relief (76.7%) followed by heart failure optimisation (13.7%).

CONCLUSION: Rhythm control procedures are selectively applied and vary by demographic and clinical factors. Female sex and ethnicity-based differences highlight the need to understand decision-making and access to rhythm control pathways.

PMID:42275654 | DOI:10.26635/6965.7377

J Speech Lang Hear Res. 2026 Jun 11:1-13. doi: 10.1044/2026_JSLHR-25-00593. Online ahead of print.

ABSTRACT

PURPOSE: Oral narrative abilities are essential for social participation, academic success, and the development of literacy. While children with Down syndrome (DS) often show relative strengths in narrative macrostructure, little is known about how these skills develop over time and how they respond to targeted intervention, particularly in Spanish-speaking contexts.

METHOD: This cross-case study explored macrostructural narrative development in four Chilean children with DS aged 8-12 years over a 6-month period and evaluated the effects of a brief one-on-one narrative intervention. Participants’ narrative competence was assessed, using the Frog Goes to Dinner story in retelling modality, at three points: 6 months earlier, 1 week before the intervention, and 1 week after. Macrostructural elements were scored using the Narrative Scoring Scheme (NSS), complemented by special coding for targeted elements.

RESULTS: Children showed modest improvement over the 6-month period without intervention but greater and more consistent gains following the 3-week intervention. Statistically significant increases were observed in overall macrostructure (NSS total score), character development, conflict-resolution, mental states, and use of emotional vocabulary and temporal markers. Microstructural measures remained stable, suggesting that macrostructural changes were not confounded by general linguistic development.

CONCLUSIONS: These findings underscore the value of brief structured narrative interventions for children with DS and highlight the importance of addressing specific macrostructural components, such as character detail and event sequencing. This is the first known study to explore narrative macrostructure development and intervention in Chilean children with DS, contributing culturally relevant insights to a growing field.

PMID:42275646 | DOI:10.1044/2026_JSLHR-25-00593

JMIR Serious Games. 2026 Jun 11;14:e86092. doi: 10.2196/86092.

ABSTRACT

BACKGROUND: Serious games (SGs) have emerged as a promising tool in nursing education, providing interactive learning environments for clinical simulation, skill development, and feedback. These games enhance knowledge, clinical reasoning, and psychomotor skills. However, evidence on their effectiveness is dispersed across various platforms and outcome measures, making it difficult to derive clear guidelines for their integration into nursing curricula.

OBJECTIVE: This scoping review aimed to systematically identify and map existing evidence on the use of SGs in nursing education, analyze game characteristics, and identify critical gaps to inform future research and practice development.

METHODS: This scoping review followed the JBI framework and the PRISMA-ScR checklist. Nine databases (PubMed, Web of Science, Embase, CINAHL, the Cochrane Library, CBM, Wanfang Data, CNKI, and VIP) were searched from inception to January 15, 2026. Eligible studies were those reporting on original research on SGs in nursing education. Two reviewers screened titles, abstracts, and full texts. Risk of bias was assessed using a standardized checklist. The extracted data encompassed study characteristics, study design, participant information, sample sizes, application context, teaching content, and SG characteristics. Data were extracted and synthesized with descriptive statistics and content analysis. An evidence gap map was created to show the study distribution across course categories and outcome domains.

RESULTS: We screened 6078 records and included 24 studies. Publications were from 2021 to 2025 (n=13, 54%), with the majority conducted in Europe (n=13, 54%). Quasi-experimental designs (n=10, 42%) and randomized controlled trials (n=8, 33%) were predominant. SGs were mainly used in fundamental or skills training and adult nursing courses. Scenario-based decision points (n=20, 83%) and points, badges, or leaderboards (n=20, 83%) were the most common game mechanics, while progression or unlocking and collaborative elements were less frequent. Outcomes most often assessed were knowledge (n=16, 67%), skills (n=10, 42%), and engagement or usability (n=13, 54%). Objective use metrics were rarely reported (n=1, 4%), indicating limited data on in-platform learning behaviors. Most SGs were delivered as digital non-virtual reality applications or computer-based simulation games. Follow-up assessment beyond immediate postintervention outcomes was infrequent. An evidence gap map showed studies concentrated in skills-based training and adult nursing, with fewer studies in maternity or neonatal nursing, critical care, and foundational sciences.

CONCLUSIONS: This review extends earlier work on SGs in nursing education by mapping evidence across curricular areas, intervention reporting, and outcome assessment, rather than focusing mainly on effectiveness or specific formats. It shows where evidence is concentrated and where important gaps remain, particularly in underrepresented course areas, intervention descriptions, follow-up assessments, and objective use data. These findings provide a clearer picture of the evidence base and can inform curriculum planning; the use of SGs in skills-based and clinical training; and future decisions about their design, implementation, and evaluation.

PMID:42275629 | DOI:10.2196/86092

Am J Public Health. 2026 Jun 11:e1-e5. doi: 10.2105/AJPH.2026.308558. Online ahead of print.

ABSTRACT

Objectives. To examine how men’s characteristics and traditional masculine attitudes are associated with vasectomy utilization in the United States. Methods. Using 2022-2023 National Survey of Family Growth data on men aged 30 to 49 years (n = 2278), we conducted descriptive statistics and multivariable logistic regression to assess how sociodemographic characteristics and traditional masculine attitudes are associated with undergoing vasectomy. Results. Approximately 1 in 9 men (11.9%) reported undergoing vasectomy. Men who agreed that men have greater sexual needs than women were more likely to report having ever had a vasectomy (adjusted odds ratio = 1.86; 95% confidence interval = 1.24, 2.80). Other masculine attitudes were not significantly associated with vasectomy utilization. Conclusions. Gender beliefs are an important and overlooked component of male contraceptive behavior. Men may view vasectomies as a means to maintain sexual continuity by reducing reliance on female-controlled contraception, suggesting opportunities to reframe vasectomy utilization within public health messaging. (Am J Public Health. Published online ahead of print June 11, 2026:e1-e5. https://doi.org/10.2105/AJPH.2026.308558).

PMID:42275620 | DOI:10.2105/AJPH.2026.308558

J Chem Inf Model. 2026 Jun 11. doi: 10.1021/acs.jcim.6c00831. Online ahead of print.

ABSTRACT

A unified atlas of 11073 noncovalent complexes spanning quantum-chemical benchmark dimers, deep eutectic solvent formulations, and large supramolecular host-guest assemblies is constructed using the Kulkarni Universal Interaction Descriptor (K-UID), a hierarchically structured hexadecimal addressing system derived from the nine-dimensional Kulkarni-NCI Fingerprint. Discretization of the globally normalized KNF feature space yields 1119 distinct topological families, of which 754 contain two or more members with a median within-family coefficient of variation of 6.93% for the Noncovalent Interaction Score (S_NCI), establishing that topological address membership exhibits statistically consistent interaction descriptor behavior across all four source datasets. A controlled row-shuffling ablation confirms that the KNF feature vector encodes genuine, molecule-specific physical information: random permutation of feature vectors across complexes increases mean absolute error by a factor of 2.8 and drives the coefficient of determination to R² = -1.251, establishing that predictive performance derives from the physical correspondence between features and molecular interaction fields rather than from exploitable distributional properties of the descriptor. Principal component analysis of the KNF feature space reveals a striking asymmetry in topological coverage: the 27-complex S30L supramolecular dataset occupies 39.3% of the accessible PC1-PC2 interaction manifold, a per-compound coverage 652 times greater than NENCI-2021 dimers, with 91.3% of S30L topological families having no analog in the reference benchmarks. Nearest-neighbor matching of deep eutectic solvent and supramolecular complexes to reference-dataset physics twins in the scale-invariant intensive feature space yields a Spearman rank correlation of ρ = 0.283 (p = 1.16 × 10^-52, n = 2789), confirming transferable rank information across molecular scales governed by interaction topology without structural similarity constraints. Family occupancy analysis further reveals that 66.9% of reference topological families (401 of 599) have no experimentally realized DES analog in the current atlas, while 499 DES-exclusive families lie outside the reference benchmark space, establishing that current DES design practice explores a confined, nonrepresentative region of the accessible interaction manifold. Together, these findings establish interaction topology as a transferable classification property and provide a concrete, atlas-defined route to identifying underexplored design space in functional noncovalent materials.

PMID:42275604 | DOI:10.1021/acs.jcim.6c00831

Mol Biol Evol. 2026 Jun 11:msag141. doi: 10.1093/molbev/msag141. Online ahead of print.

ABSTRACT

Credible intervals and credible sets, such as highest posterior density (HPD) intervals, form an integral statistical tool in Bayesian phylogenetics, both for phylogenetic analyses and for development. Readily available for continuous parameters such as base frequencies and clock rates, the vast and complex space of tree topologies poses significant challenges for defining analogous credible sets. Traditional frequency-based approaches are inadequate for diffuse posteriors where sampled trees are often unique. To address this, we introduce novel and efficient methods for estimating the credible level of individual tree topologies using tractable tree distributions, specifically Conditional Clade Distribution (CCD). Furthermore, we propose a new concept called α credible CCD, which encapsulates a CCD whose trees collectively make up α probability. We present algorithms to compute these credible CCDs efficiently and to determine credible levels of tree topologies as well as of subtrees. We evaluate the accuracy of these credible set methods leveraging simulated and real datasets. Furthermore, to demonstrate the utility of our methods, we use well-calibrated simulation studies to evaluate the performance of different CCD models. In particular, we show how the credible set methods can be used to conduct rank-uniformity validation and produce Empirical Cumulative Distribution Function (ECDF) plots, supplementing standard coverage analyses for continuous parameters.

PMID:42275602 | DOI:10.1093/molbev/msag141

Arch Endocrinol Metab. 2026 Jun 10;70(4). doi: 10.20945/2359-4292-2026-0057.

ABSTRACT

OBJECTIVE: To investigate the impact of smoking on serum selenium levels, autoimmune activity, and macular microvascular density in patients with clinically inactive thyroid-associated orbitopathy (TAO), using optical coherence tomography angiography (OCTA).

SUBJECTS AND METHODS: This retrospective cross-sectional study included 44 patients with inactive TAO (24 smokers, 20 non-smokers) and 32 ageand sex-matched healthy controls. All participants underwent ophthalmologic evaluation and laboratory testing for thyroid hormones, selenium, and thyroid-stimulating immunoglobulin (TSI). Macular vessel density was measured using spectral-domain OCTA at the superficial capillary plexus, deep capillary plexus, outer retinal layer, and choriocapillaris. Clinical activity score (CAS) was used to assess disease activity. The collected data were analyzed statistically.

RESULTS: Smokers with TAO exhibited significantly higher CAS (p = 0.016) and TSI levels (p = 0.027), and lower serum selenium concentrations (p = 0.042) compared to non-smokers. Central superficial and deep capillary plexus densities were significantly reduced in smokers versus healthy controls (p = 0.029 and p = 0.017, respectively). No significant differences were observed between smokers and non-smokers within the TAO group, or in the outer retinal layer and choriocapillaris layers among all groups.

CONCLUSION: Smoking status was associated with lower selenium levels, higher TSI levels, and increased CAS. Furthermore, retinal microvascular attenuation detected by OCTA, even in the absence of clinical activity in TAO, may serve as a significant indicator of persistent vascular deterioration.

PMID:42275591 | DOI:10.20945/2359-4292-2026-0057

Psychol Health Med. 2026 Jun 11:1-16. doi: 10.1080/13548506.2026.2686302. Online ahead of print.

ABSTRACT

This study aimed to investigate the level of self-regulatory fatigue and its associated factors among young and middle-aged adults with type 2 diabetes mellitus (T2DM), examining the mediating role of psychological resilience in the relationship between perceived social support and self-regulatory fatigue. A cross-sectional study was conducted from August to December 2025 in Shandong Province, China. A total of 261 patients aged 18-59 years with T2DM were recruited via convenience sampling from a tertiary hospital. Participants completed a series of structured questionnaires, including the Self-Regulatory Fatigue Scale, the Connor-Davidson Resilience Scale, and the Scale of Perceived Social Support. The data were analyzed using descriptive statistics, Pearson’s correlation, multiple linear regression, and mediation analysis with the SPSS PROCESS macro. The mean score for self-regulatory fatigue was 42.22 ± 5.72, which was higher than the general population norm. Multivariate linear regression analysis identified longer diabetes duration (β = 0.106, p = 0.01), greater number of complications (β = 0.102, p = 0.008), lower psychological resilience (β = -0.142, p = 0.013), lower perceived social support (β = -0.508, p < 0.001) and lower self-management behaviors (β = -0.144, p < 0.001) as significant independent predictors of higher self-regulatory fatigue. Mediation analysis revealed that psychological resilience partially mediated the relationship between social support and self-regulatory fatigue accounting for 22.4% of the total effect. The present study identifies elevated levels of self-regulatory fatigue in young and middle-aged patients with T2DM, particularly in the cognitive dimension. The study emphasizes the significance of social support and psychological resilience as modifiable protective factors, with resilience mediating the effect of support to a certain extent. These findings support the integration of psychosocial strategies into diabetes care with a view to alleviating self-regulatory burden.

PMID:42275582 | DOI:10.1080/13548506.2026.2686302

JMIR Res Protoc. 2026 Jun 11;15:e90704. doi: 10.2196/90704.

ABSTRACT

BACKGROUND: Specifically in primary musculoskeletal care settings, the employment of advanced physiotherapy practice (APP) roles seems to be safe, as well as clinically and financially effective. In tertiary care settings, the implementation of APP roles is still in its infancy. A structured identification of relevant APP roles and a definition of practice areas, needed skills, and core competencies is widely pending.

OBJECTIVE: This study aims to identify and prioritize the most relevant areas of tertiary care for the implementation of APP roles within the German health care system. Additionally, it is aimed to achieve expert consensus on practice areas, needed skills, and core competencies relevant to execute identified roles.

METHODS: A total of 100 national experts will be invited to participate in a 3-round Delphi survey. Participants will purposively be sampled among physiotherapists with extensive clinical and/or academic experiences in German tertiary care. Data will be pseudonymized and collected via online questionnaires. In Delphi round 1, close-ended questions on relevant APP roles and open-ended input on practice areas, skills, and core competencies will be queried. Open-ended questions will be structured according to key domains of the National Health Service multiprofessional framework for advanced clinical practice. In round 2, participants will rate close-ended items on practice areas, skills, and core competencies that emerged from open-ended questions of round 1. Each item will be rated on a 7-point Likert scale ranging from “not relevant at all” to “extremely relevant.” Consensus will be set on ≥70% agreement per item (including “5=fairly relevant,” “6=very relevant,” and “7=extremely relevant”). Items with agreements of ≤30% will be excluded. Items of 31% to 69% agreement will be reevaluated in round 3. Descriptive statistics (median, IQR, and absolute and relative frequencies) will be used to visualize response patterns, and McNemar and Wilcoxon signed-rank tests will be applied to explore changes between rounds.

RESULTS: Data collection took place between January and May 2026. For the first Delphi round, 98 experts were invited, of which 37 fully completed round 1. In round 2, these 37 experts were invited, of which 34 fully completed Delphi round 2. Following these response rates, we were confident to receive the targeted study sample of 20 experts after data collection of Delphi round 3 was completed. Data collection for the third and final round was completed in May 2026 and included 32 final respondents.

CONCLUSIONS: Findings will support evidence-based APP role development and contribute to optimizing tertiary care areas relevant to physiotherapy care in Germany.

PMID:42275572 | DOI:10.2196/90704

J Occup Environ Hyg. 2026 Jun 11:1-13. doi: 10.1080/15459624.2026.2668076. Online ahead of print.

ABSTRACT

Noise in the clinical dental setting has been shown to exceed safe levels, and the risk to dental professionals, including occupational noise-induced hearing loss, is well-established. This pilot study investigated dentists’ perceptions and experiences of the use of custom-made earplugs as a means of attending to the risk in the clinical dental setting. Dentists were recruited using convenience and purposive sampling and provided with custom-made attenuated earplugs, which were worn for a period of 12 weeks of usual clinical dental practice. Questionnaires were completed periodically. Data were analyzed statistically and thematically. There was a total of eight participants. Participants recognized the risk of hearing loss and supported the promotion and inclusion of hearing protection as a part of personal protective equipment. Participants noted an improved focus due to a reduction in noise perception. Disadvantages included discomfort and communication challenges. This pilot study assessed the process for, and feasibility of, conducting a larger-scale study and will contribute to the reliability and validity of such, which is recommended.

PMID:42275558 | DOI:10.1080/15459624.2026.2668076